Flush-free niacin kills

Here, I re-post a conversation I've posted before, that of the scam product, "no-flush" niacin, also known as "flush-free" niacin.

I find this issue particularly bothersome, since I have a patient or two each and every week who forgets the explicit advice I gave them to avoid these scam products altogether. Despite costing more than conventional niacin, they exert no effect, beneficial or otherwise. Niacin--the real thing--exerts real and substantial beneficial effects. No-flush or flush-free does nothing except drain your wallet. I continue to marvel at the fact that supplement manufacturers persist in selling this product. Ironically, it commands a significant premium over other niacin forms.

They are outright scams that should be avoided altogether.


My former post, No-flush niacin kills:

Gwen was miserable and defeated.

No wonder. After a bypass operation failed just 12 months earlier with closure of 3 out of 4 bypass grafts, she has since undergone 9 heart catheterization procedures and received umpteen stents. She presented to me for an opinion on why she had such aggressive coronary disease (despite Lipitor).

No surprise, several new causes of heart disease were identified, including a very severe small LDL pattern: 100% of LDL particles were small.

Given her stormy procedural history, I urged Gwen to immediately drop all processed carbohydrates from her diet, including any food made from wheat or corn starch. (She and her husband were shocked by this, by the way, since she'd been urged repeatedly to increase her whole grains by the hospital dietitians.) I also urged her to begin to lose the 30 lbs of weight that she'd gained following the hospital dietitians' advice. She also added fish oil at a higher-than-usual dose.

I asked her to add niacin, among our most effective agents for reduction of small LDL particles, not to mention reduction of the likelihood of future cardiovascular events.

Although I instructed Gwen on where and how to obtain niacin, she went to a health food store and bought "no-flush niacin," or inositol hexaniacinate. She was curious why she experienced none of the hot flush I told her about.

When she came back to the office some weeks later to review her treatment program, she told me that chest pains had returned. On questioning her about what she had changed specifically, the problem became clear: She'd been taking no-flush niacin, rather than the Slo-Niacin I had recommended.

What is no-flush niacin? It is inositol hexaniacinate, a molecule that indeed carries six niacin molecules attached to an inositol backbone. Unfortunately, it exerts virtually no effect in humans. It is a scam. Though I love nutritional supplements in general, it pains me to know that supplement distributors and health food stores persist in selling this outright scam product that not only fails to exert any of the benefits of real niacin, it also puts people like Gwen in real danger because of its failure to provide the effects she needed.

So, if niacin saves lives, no-flush niacin in effect could kill you. Avoid this scam like the plague.

No-flush niacin does not work. Period.


Disclosure: I have no financial or other relationship with Upsher Smith, the manufacturer of Slo-Niacin.


Copyright 2008 William Davis, MD

Comments (12) -

  • JPB

    11/29/2008 4:15:00 PM |

    What is your opinion of "Nia-Span"?  My former doctor insisted that this "by prescription only" drug was the only way to take niacin.  The cost per month was virtually the same as for a statin.  (BTW, I declined this product and continued with regular niacin.)

  • Anna

    11/29/2008 4:31:00 PM |

    FYI: the Slo-Niacin link isn't working.

  • Zbig

    11/29/2008 11:02:00 PM |

    RDA for niacin is 18 mg/day - what is your opinion on that, sir?
    BTW, do you guys in the States just go to a pharmacy and buy niacin and D3 without a prescription?

  • Anonymous

    11/30/2008 6:37:00 AM |

    "Slo-Niacin" uses a "polygel" to delay release of the nicotinic acid.  I've been taking Carlson's "Niacin-Time" (also nicotinic acid) which uses brazil wax to delay release.

    The Carlson's product is about a third the price of the Slo-Niacin.

  • IggyDalrymple

    12/1/2008 1:13:00 AM |

    I've been taking regular (not no-flush) niacin for a few months.  Dr Davis recommends "Slo-Niacin" but I got sick from taking timed-release niacin back in the 80s and "Slo-Niacin" sounds suspiciously like "Timed-Release".  I should know in January when I have bloodwork, if the regular niacin helps.

  • Anonymous

    12/3/2008 9:26:00 PM |

    JPB: Niaspan releases over 6-8 hours and yes..it is prescription only. I substituted it for Endur-acin which is MUCH cheaper and non-prescription and also releases over 6-8 hours. No difference in my lipid profiles...just big savings in my pocket book.

    Zbig: 18mg is probably sufficient as a RDA, but in order to achieve the lipid lowering affects from Niacin, one has to take larger doses of 500mg or more from what I understand. And yes, we can buy many supplements like (high dose) niacin, vitamin D3 & even DHEA without a prescription here in the USA.

    Anonymous: I believe Carlson buys their "Niacin-Time" from Endur. I looked at the picture on the Carlson website and the tablets are the exact same shape as Endur-acin. Endur has been around since the late 1980's from what I understand. You can buy direct from Endur.

    IggyDalrmple: Here is a link to an excellent article about (time-release) Niacin written by Doctor Davis himself:

    http://www.lef.org/magazine/mag2007/mar2007_atd_01.htm

  • CindynHouston

    2/3/2009 5:15:00 AM |

    Hi, Id like to know what research supports flush free Niacin has no effect on the human body ?
    I had/have horrible heart palpitations after a heart attack, and after taking Flush Free Niacin 2 to 3 times daily, control them, while time released I tried did not .. and Im afraid to take regular Niacin being so unstable.  I take several other things as well now, but not at the beginning.  I have Late Stage Lyme which has its own set of causal factors as well as the typical ones, but if it has no effect on the human body .. it wouldnt work period.  So, I would guess ..  like all else one thing might work for some, another substance for another depending on what I wish they would narrow down to "Cause".  I still have high Blood pressure, some medications work for a week or two, then stop being effective.  Areas of the brain control heart beat .. I have no clue if this is the whats causing high blood pressure or not .. Lyme can go any where and do anything .. Ive had it since I was a child with mild symptoms until my immune system got a faulty in mid thirties when it became aggressive.  No Doctors know how to treat other than antibiotics, dont treat symptoms like really bad hypercoagulation (thick blood) caused by being exposed to bacteria etc for a long period of time and the immune system becoming over active .. 2002 I had an attack which took me out almost completely .. No heart or other doctor even tried to diagnose and gave me a "hearts fine" .. 3 yrs later I had an almost deadly heart attack.  All these yrs, almost 10 .. spent trying to find help, treating symptoms on my own, having no family and absolutely No life, except for trying to survive. (people with Lyme ramble) Though its good to know info.... Question still remains about Flush Free Niacin...

  • Anonymous

    8/25/2009 9:29:49 PM |

    "IHN is more effective than niacin in its hypocholesterolemic,
    antihypertensive and lipotropic effects"
    Welsh AL, Eade M. Inositol hexanicotinate for improved nicotinic acid therapy.
    Int Record Med 1961;174:9-15.

    "significant lipid-lowering effects of IHN at doses of 400 mg 3-4 times daily"
    Dorner V, Fischer FW. The influence of m-inositol hexanicotinate ester on the serum lipids and lipoproteins. Arzneim-Forsch 1961;11:110-113.

    Sommer H. Nicotinic acid levels in the blood and fibrinolysis under the influence of the hexanicotinic ester of m-inositol. Arzneim Forsch. 1975;15:1337

    "IHN was found to be more effective than niacin in reducing hypercholesterolemia"
    El-Enein AMA, Hafez YS, Salem H, Abdel M. The role of nicotinic acid and inositol hexaniacinate as anticholesterolemic and antilipemic agents.
    Nutr Reports Int 1983;28:899-911.

    "Derivatives of niacin have been examined for their ability to alter lipid levels as well as niacin. It would be advantageous if the niacin vasodilation (flush) were eliminated or removed. The main disadvantage of the niacin derivatives will be cost. Inositol hexanicotinate is an ester of inositol and niacin. In the body it is slowly hydrolyzed releasing both of these important nutrients. The ester is more effective than niacin in lowering cholesterol and triglyceride levels, Abou El-Enein, Hafez, Salem and Abdel (1983). I have used this compound, Linodil, available in Canada but not the U.S.A. (at the time this paper was written) for thirty years for patients who can not or will not tolerate the flush. It is very gentle, effective, and can be tolerated by almost every person who uses it."
    From: Niacin, Coronary Disease and Longevity by Abram Hoffer, M.D., Ph.D.

  • LynP

    11/16/2009 5:25:16 AM |

    Question:  at dinner took 500 mgm Slo-Niacin and within a few hrs had some stomach unpleasant...sensations might be the best description, then my glucose rose.  Fasting rose 25 pts (shock) and yesterday was marked with ravenous hunger and 15-20 pts higher glucose all day; today's fasting was still higher than usual.  Is this expected?  It's almost as if it is undoing the work of my 1500 mg metformin ER in reducing the production of sugar in the liver. This isn't going to wk with higher glucose.  Suggestions? Comments?
    6/25/09 labs: TRI-119, calc LDL-150, HDL-57, D-35, TSH-4.5, AIC-6.4. Taking 12.5 mg Maxzide, 4K IU D3.
    9/22/09 labs: TRI-145, calc LDL-147, HDL-60, D-41, TSH-5.5, AIC-6.5, ApoB-111. Taking 12.5 mg Maxzide, 8K IU D3.
    Doc put me on 25 mcg levothyroxine (don't think this is enough or I need Armour).

    I think my TRI is up from too much carb (eat super low, ate a bit more more berries over summer).  I think my LDL is up from my rising TSH (free T4 & T3 midrange), been rising since Sept08 when it was 2.8 (when I started taking vit D). Wt loss (obese) has been stalled until I started subbing eggs for hi-protein shake with 2-3 ozs coconut milk a month ago.  TSH was high in 2001 (4.7) with high amts of reverse T3 (doc won't test for it)& given 2 mcg Cytomel but my TC was 205 with TRI=100. Now what to do?  Try the 250 mgm SloNiacin & see what happens?  Or just concentrate on improving D levels and improving thyroid function and hoping they help normalize lipids? Just looking for suggestions, not treatment, all ideas will be run by doc. He said statins or niacin...I'm female no familiy hist of heart probs, why statins with no good studies for women? 'Cause he takes a statin *sigh*.

  • Anonymous

    8/16/2010 3:17:08 AM |

    After my heart attack from Late Stage Lyme Disease causing hypercoagulation/thick blood .. after released from the hospital, I had/have severe heart palpatations .. and IM SORRY BUT, FLUSH FREE NIACIN DOES WORK!!  I have to take 2-500mg twice daily and it stops the heart palpatations .. its no gimmick or hype.  IT Works !!  Ive heard about the severe very uncomfortable flush rush with regular Niacin which I think would scare me and make me panick, if not make me ill with the fragile state my system is in.  Purchased at any store online or otherwise .. a lot less than and w/no side effects, I also take Argnine to help open my vessels, but is not needed to stop my heart palpatations. Obviously, something is wrong though if I or anyone is having heart palpatation, so you should keep looking or asking RN/head nurse until you find a heart doctor who will actually address the issue and find out whats going on!!  Once in a while with stressful event I do need to take a beta blocker to stop palpations, but only 3-5 times a yr.  NO SIDE EFFECTS like beta blockers...

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    11/3/2010 3:18:31 PM |

    Given her stormy procedural history, I urged Gwen to immediately drop all processed carbohydrates from her diet, including any food made from wheat or corn starch. (She and her husband were shocked by this, by the way, since she'd been urged repeatedly to increase her whole grains by the hospital dietitians.) I also urged her to begin to lose the 30 lbs of weight that she'd gained following the hospital dietitians' advice. She also added fish oil at a higher-than-usual dose.

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Psssst . . . There's sugar in there

Psssst . . . There's sugar in there

You non-diabetics who check your postprandial blood sugars already know: There are hidden sources of sugar in so many foods.

By now, everybody should know that foods like breakfast cereals, breads, bagels, pretzels, and crackers cause blood sugar to skyrocket after you eat them. But sometimes you eat something you thought was safe only to find you're showing blood sugars of 120, 130, 150+ mg/dl.

Where can you find such "stealth" sources of sugars that can screw up your postprandial blood sugars, small LDL, inflammation, blood pressure, and cause you to grow visceral fat? Here's a few:

Balsamic vinaigrette
Many commercially-prepared balsamic vinaigrettes, especially the "light" varieties, have 3 or more grams carbohydrates per tablespoon. Generous use of a sugar-added vinaigrette can therefore provide 12+ grams carbs. (Some, like Emeril's and Wish Bone, also contain high-fructose corn syrup.)

Hamburgers
I learned this lesson the hard way by taking my blood sugar after having a hamburger, turkey burger, or vegetarian burger (without bun): blood sugar would go way up. The effect is due to bread crumbs added to the meat or soy.

Tomato soup
If it were just tomatoes, it would still be somewhat high in sugars. But commercially-prepared tomato soup often contains added high-fructose corn syrup, sucrose, and wheat flour, bringing sugar totals to 12 to 20+ grams per half-cup. A typical 2-cup bowl of tomato soup can have upwards of 80 grams of sugar.

Granola
Sure, granola contains a lot of fiber. But most granolas come packed with sugars in various forms. One cup of Kellogg's Low-fat Granola with Raisins contains an incredible 72 grams (net) carbohydrates, of which 25 grams are sugar.


Given modern appetites and serving sizes, you can see that it is very easy to get carried away and, before you know it, get exposed to extraordinary amounts of sugar and carbohydrates eating foods you thought were healthy.

And don't be fooled by claims of "natural" sugar. Sugar is sugar--Just check your blood sugar and you'll see. So raw cane sugar, beet sugar, and brown sugar have the same impact as white table sugar. Honey, maple syrup, and agave? They're worse (due to fructose).

Comments (13) -

  • Benpercent

    3/1/2010 10:04:29 PM |

    Regarding the hamburgers: Was the blood sugar increase due to some sort of recipe used or did you purchase the ground beef not knowing bread was added to it? A strange place to find it I'd say! I'll probably switch to grinding my own now.

  • Steve Cooksey

    3/1/2010 10:32:17 PM |

    Doctor Davis... YOU ROCK!!

    I'm a T1.5... who lost 78lbs, I have normal blood sugar ...for non-diabetics.

    NO meds, NO insulin... Keep Spreading the word... to ALL.

    Love your blog ...

    Steve

  • Anna

    3/2/2010 12:10:43 AM |

    I can pretty much count on higher BG readings when I eat at group meal gatherings away from home, unless I bring and eat only my own food.  I don't normally eat much processed convenience food, so I forget that boxed heat & serve breakfast sausage links can be full of sugar.  I also now know to steer clear of table grapes and fruit trays (I used to make sure to have fruit with the bacon or sausage and eggs for breakfast to deflect the comments from others, but now I don't bother with the fruit  because it's always too high-sugar.  

    At restaurants I ask for dressing on the side if I use dressing at all.  I dip my fork in the dressing before spearing a bite - that provides enough flavor without all the dressing.  Most of the time I avoid the dressings because they are made with soybean or canola oil anyway.  I ask for Olive Oil and Vinegar - not vinaigrette, which is often sweetened.  

    At home I always make salad dressing or simply toss with EVOO and a good vinegar, freshly ground SS & BP.  It's been years since I bought salad dressing.  Homemade is a breeze to make (even Ranch style) and economical, too.

    Frozen yogurt is far worse than full fat high quality ice cream.  Frozen yogurt almost always has more sugar and no fat or eggs to slow the absorption of the sugar.  Homemade ice cream is the best because you can control the sweetness level and use more cream and egg yolks (commercial is too sweet-tasting for me anymore, BG notwithstanding).  

    OJ - like a glass of pure sugar - absorbs into the blood stream nearly instantly.  I have a valencia orange tree in my garden but I don't dare drink the juice straight.  I put a tiny splash of freshly squeezed OJ or drop a squeezed orange wedge in a tall glass of Gerolsteiner sparkling mineral water (good source of magnesium).

    BBQ sauce & catsup - loaded with sugars - watch out for honey mustard sauce, too.

  • Anonymous

    3/2/2010 12:48:34 AM |

    Here is a link to a recent study that says vitamin D has no real link to heart health. Perhaps you can comment on this.

    http://www.reuters.com/article/idUSTRE6205AQ20100301

    Michael

  • zach

    3/2/2010 1:23:16 AM |

    I looked at the back of my vinegar and it has 5 grams of carbs per tablespoon, 2 of which are sugars. But the only ingredients listed are red wine vinegar and grape musts.

  • David

    3/2/2010 4:24:59 AM |

    Michael,

    That article isn't talking about a new study per se, but rather a review of several select studies. In other words, it's not really providing any new information. It's a (biased) interpretation of a sampling of the existing data.

    I found this quote from the article to be pretty funny:

    "Now, if there are specific instances of vitamin D or calcium deficiency, then that's a separate issue that should be discussed with a personal physician."

    Uh, except it's hardly a separate issue since nearly everyone is deficient in vitamin D.

    David

  • Anonymous

    3/2/2010 9:03:07 AM |

    grape musts? That should have given you a clue. Grapes are very high in sugar. It always comes down to the same thing: Always read the labels. Carefully. Never trust anything that is processed. Not even if you buy it in Health Food shops.

  • Peter

    3/2/2010 1:17:18 PM |

    You don't need to test your blood sugar.  You can figure whatever your favorite carbs are, those are the ones that are spiking your blood sugar the most.  

    Mostly this is because you ingest those in greater quantities since you like them, but partly because you choose those because the blood sugar rushes feel good.

  • David

    3/2/2010 4:50:50 PM |

    "You don't need to test your blood sugar. You can figure whatever your favorite carbs are, those are the ones that are spiking your blood sugar the most."

    No. This is not a reliable way to go about things, as it isn't always true. It's never good to simply trust your feelings. Being objective with a glucometer isn't difficult or expensive. There's nothing to lose.

  • caphuff

    3/2/2010 5:46:18 PM |

    re hamburgers, also watch out for worcestershire sauce! Just discovered (much to my dismay) that the brand I had been using contains molasses and high fructose corn syrup. Yech!

  • Nigel Kinbrum

    3/3/2010 10:23:18 AM |

    Michael said...
    "Here is a link to a recent study that says vitamin D has no real link to heart health. Perhaps you can comment on this.
    Calcium, vitamin D pills don't help heart: study"
    The RDA for Vitamin D is set for bone health. Therefore, an RDA dose of Vitamin D makes no difference to anything except bone health. It takes a dose about ten times the RDA to be effective elsewhere.

    If you give people one tenth the correct dose of a medication, would you be surprised that the medication is ineffective?

    Nige.

  • Kathy

    3/3/2010 11:13:22 AM |

    so easy to make homemade tomato soup, still a little high in carb's but nowhere near store boguht, handy if you absolutely must have a bowl of tomato soup.  Use tomato paste, water and some heavy cream and salt to taste.  you don't need the cream, but it tastes better.  One of the fastest "homemade' soups.  Keep in mind that tomatoes do have carbs, about 4 per 2 tbsp of paste.  You can add splenda to sweeten a little

  • renegadediabetic

    3/4/2010 2:26:14 PM |

    It's infuriating that sugar and starch show up in places you would least expect them.  You have to read labels very carefully.  I've been burned by failing to read labels.  Even better, eat real food prepared from scratch.

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