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Inositol Hexanicotinate/Hexaniacinate (no-flush niacin)

Note:  I see a lot of orders for no-flush niacin.  I assume the reason people are buying this is to raise HDL cholesterol.  I couldn't find any research that no-flush niacin works to increase HDL.  It's probably a waste of money for the no-flush.  Just do a Medline search of  hexanicotinate HDL, hexaniacinate HDL or no-flush niacin.  Here are the the only studies I could find:

Accumulation of chylomicron remnants and impaired vascular reactivity occur in subjects with isolated low HDL cholesterol: effects of niacin treatment - Atherosclerosis. 2006 Jul;187(1):116-22 - "evaluation of no-flush niacin treatment ... Twenty-two low HDL subjects with reduced FMD were randomized into two groups, one given 1.5 g/day niacin and a placebo group. After 3-month treatment, plasma lipids and chylomicron kinetics were not changed by niacin treatment"

Varying cost and free nicotinic acid content in over-the-counter niacin preparations for dyslipidemia - Ann Intern Med. 2003 Dec 16;139(12):996-1002 - "Commonly used over-the-counter niacin preparations (500-mg tablets or capsules) from the 3 categories of immediate-release, sustained-release, and no-flush were purchased at health food stores and pharmacies and from Internet-based vitamin companies ... The average content of free nicotinic acid was 520.4 mg for immediate-release niacin, 502.6 mg for sustained-release niacin, and 0 for no-flush niacin ... No-flush preparations of over-the-counter niacin contain no free nicotinic acid and should not be used to treat dyslipidemia. Over-the-counter sustained-release niacin contains free nicotinic acid, but some brands are hepatotoxic. Immediate-release niacin contains free nicotinic acid and is the least expensive form of over-the-counter niacin"

I’ve been taking three grams per day of the immediate release niacin (Twinlab).  It raised my HDL from 39 to 57.  Then I switched from Actos to Avandia (both to prevent diabetes) and my HDL went back down to 47. I’m switching back to Actos when I run out of Avandia. I don’t experience any flushing from the IR anymore. I think it took a couple months to get used to it plus I built up to three grams gradually. The IR didn’t have any noticeable effect on my liver enzymes. My ALT is 35. My doctor thinks that’s great. Normal goes up to 60 but I read that you want it below 30 but the 35 was about what it was before the niacin. My father died of liver cancer so I keep an eye on my liver enzymes but my father drank like a fish plus he was 87 when he died.  See:

Elevated ALT Levels Predict Risk of Death From Liver Cancer - Medscape, 11/2/06 - "Upper limits of normal range from 30 IU/L to 60 IU/L, depending on the laboratory. "We want to reset it southward of 30 IU/L," ... ALT levels are a reflection of the general vascular condition ... If the level is above 30, then that person probably has a problem — fatty liver or some vascular disease, including occlusive coronary artery disease"

http://www.lipidsonline.org/slides/slide01.cfm?tk=25&dpg=34 shows that with extended release niacin, HDL peaks out at 2,500 mg.  http://www.lipidsonline.org/slides/slide01.cfm?q=effect+of+niacin&dpg=4 shows immediate release crystalline niacin compared to Niaspan.  There isn't much gain in HDL with the immediate release crystalline niacin after 1,000 mg per day.  After seeing that, I'll probably cut down from 3,000 mg but from the slide it appears that there is a significant advantage to lowering triglycerides by going to 3,000 mg plus there is a linear decrease in LDL-C by going to 3,000 mg immediate release crystalline niacin.  This graph also shows that immediate release crystalline niacin is significantly better at raising HDL and lowering triglycerides compared to Niaspan.  Also see the slide titled CHD Risk According to HDL-C Levels.

I’ve never seen any studies on Niaspan and liver damage but it would seem like it would be similar to the slow release niacin. The only study I’ve seen on that is:

A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients - JAMA. 1994 Mar 2;271(9):672-7 - "None of the patients taking IR niacin developed hepatotoxic effects, while 12 (52%) of the 23 patients taking SR niacin did"

Be sure to see a doctor to have your liver enzymes checked before and after taking any niacin supplement.  See the bottom of http://www.lipidsonline.org/slides/ for some great slide shows on HDL.  The January 2007 Harvard Men's Health Newsletter has a good article on HDL cholesterol but it is a paid subscription.  See niacin at Amazon.com and niacin at Amazon.com.

Related Topics:

• inositol hexaphosphate (IP-6) / cholesterol / HDL cholesterol / homocysteine / inflammation / heart disease / strokes / red yeast rice / policosanol / guggul / pantethine / artichoke / triglycerides / statins / green tea / hesperidin / hypertension / trans fatty acids / omega-3

Specific Recommendations:

• Flush free niacin products at iHerb

News & Research:

• Niacin (Vitamin B-3), Niacinamide - Intelihealth - "Thyroid function may also be impaired while taking niacin. Periodic monitoring of thyroid function is recommended"
• Antioxidants Could Provide All-purpose Radiation Protection - Science Daily, 11/5/07 - "Inositol and inositol hexaphosphate (IP6) protected both human skin cells and a skin cancer-prone mouse from exposure to ultraviolet B (UVB) radiation, the damaging radiation found in sunlight ... Twenty-three percent of treated mice developed tumors, compared to 51 percent of untreated, or control mice, which developed tumors. Moreover, the mice in the treated group that did develop cancer had only half as many tumors as the control mice" - See IP-6 products at Amazon.com.  Note:  IP-6 was one of the supplements I took when they told me I only had a small chance of survival from neck cancer.  Click here for the full story.  I still take it.
• Natural products to lower cholesterol levels - Don't forget niacin - Dr. Murray's Newsletter , 4/23/03 - "The percentage increase in HDL cholesterol, a more significant indicator for coronary heart disease, was dramatically in favor of niacin (33 vs. 7%). Equally as impressive was the percentage decrease in Lp(a) for niacin. While niacin produced a 35% reduction in Lp(a) lipoprotein levels, lovastatin did not produce any effect. Other studies have shown that niacin can lower Lp(a) levels by an average of 38% ... Another approach to reduce flushing is to use inositol hexaniacinate. This form of niacin has long been used in Europe to lower cholesterol levels and also to improve blood flow in intermittent claudication - a peripheral vascular disease that is quite common in diabetes. It yields slightly better clinical results than standard niacin, but is much better tolerated, in terms of both flushing and, more importantly, long-term side-effects"
• Octacosanol Beats Statins - Dr. Janson, 4/02 - "Taking a non-flush form of niacin, inositol hexaniacinate, provides the same cholesterol effects without the liver changes, but it is more expensive. Effective niacin doses are 1500 to 3000 mg daily"
• question regarding your new cholesterol-lowering supplement, Policosanol - Life Extension Magazine, 11/01 - "Studies show that niacin (B3) in doses of 1.5 grams to 3 grams lower triglycerides levels and raise HDL concentrations. Those who tolerated higher doses of niacin (nicotinic acid) showed even more improvement in lipid levels. Some people taking just 1000 mg of flush-free niacin see an elevation in beneficial HDL. Green tea also has been shown to elevate levels of HDL while lowering serum triglyceride levels. In the Journal of Molecular Cell Biochemistry, curcumin has been demonstrated, in vivo, to decrease triglycerides and increase HDL. In a study published in 1989 by the Journal of Associated Physicians-India, 125 patients receiving gugulipid showed a drop of 16.8% in triglycerides, and a 60% increase in HDL cholesterol within three to four weeks. Make sure you are taking at least six Mega EPA fish oil capsules daily, as low dose fish oil may not adequately suppress triglycerides. Finally, there are some lifestyle changes you may wish to consider. If you are overweight, weight loss would be recommended, as it would help to lower triglycerides and raise HDL. Also, try reducing carbohydrates, which can raise triglycerides"
• Integrated Health Care: Applying Best Practices From Two Medical Models - Nutrition Science News, 5/01 - "Many alternative care practitioners utilize a "non-flush" version of niacin, called inositol hexaniacinate, instead of regular niacin. This form of niacin does not have the flushing side effect of regular niacin (which can force patients to discontinue use) and is considered safer than niacin"
• Lower Cholesterol Without The "Flush" - Life Enhancement Magazine, 10/96