A typical, successful amount of niacin to reduce cholesterol is 3,000 mg a day, but there are certain precautions you should take.

Taking more than 1,000 mg of niacin a day can raise homocysteine levels, especially if niacin is not balanced by folic acid (400-1,000 mg a day), vitamin B6 (10-50 mg a day), and vitamin B12 (50-300 micrograms a day). If you take more than 1,000 mg of niacin daily, you need additional B vitamins.

There have been no trials of niacin for lowering cholesterol in persons who have not had a heart attack, but the Coronary Drug Project followed 8,000 men who had had a heart attack for eight years. Taking 3,000 mg of nicotinic acid every day resulted in:

* 10 per cent reduction in total cholesterol,
* 26 per cent reduction in triglycerides,
* 27 per cent reduction in the rates of second heart attacks, and
* 27 per cent reduction in the rates of stroke.

Follow-up over 15 years found that men who took nicotinic acid were 11 per cent more likely to still be alive at the end of the study.

Other studies of both men and women have found that taking niacin raises HDL levels and transforms LDL cholesterol from the sticky apo-A form to the lighter, less harmful apo-B form. Taking beta-carotene, vitamin C, vitamin E, and selenium, however, reduced the benefits of niacin.

If you do choose to use niacin/nicotinic acid to lower cholesterol, you should consult your doctor. That's because a number of things can go wrong when you take nicotinic acid in doses potent enough to have an effect on heart health:

* Like statin drugs, niacin sometimes damages the liver. Hepatitis has been observed from taking dosages as low as 500 mg a day for a period as short as two months, although most cases of liver damage occurred when the dosage was 3,000 to 9,000 mg for several years.
* Diabetics should not take high-dose niacin. The vitamin can reduce insulin sensitivity and raise blood sugars.
* Occasional side effects have included blurred vision, migraine, peptic ulcers, disturbances of heart rhythm, and gout.

And facial flushing with an outbreak around the nose resembling acne is very problem. A slower-release form of niacin, nicotinamide, does not cause flushing, but can aggravate diabetes and cause liver damage. Niacin may lower cholesterol levels for people who cannot or choose not to use statins, but niacin should always be used under professional supervision.


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