We have been discussing the importance of niacin with Dr. Andrew Saul. So far we have discussed niacin’s important, but lesser known roles including mental health, arthritis, and learning and behavior disorders. As important as these functions of niacin are, there are two more widely known functions of niacin. When you ask nutritionists about the role of niacin, most may mention it is the “anti-pellagra” vitamin. Some will add that it is widely prescribed today for controlling blood cholesterol. Many people worry about their blood cholesterol levels, but few people realize how deadly pellagra was in the U.S. as recently as 1945.

In our October 2014 column, I had the honor and privilege of interviewing Professor Fred A. Kummerow, Ph.D., near his 100th birthday. You may remember the two-part interview entitled “From Pellagra to Trans Fats and Beyond — How a Legendary Nutritional Scientist Is Still Saving Countless Thousands From Premature Deaths.” (1).

Dr. Kummerow’s life-saving nutritional efforts began with helping to wipe out the deadly pellagra epidemic in the United States. Thanks to researchers including Drs. Kummerow, Joseph Goldberger and Conrad Elvehjem, pellagra is essentially non-existent today in the U.S. Pellagra is a disease that was present before 1938 in the southeastern United States. It is a deficiency of niacin. The symptoms of pellagra are swelling of the lips and tongue and swelling of the arms to the point that the skin breaks open. When it reaches this stage, the people usually die.

When Professor Kummerow arrived at Clemson, SC, in 1943, thousands of people were still dying of pellagra. Some 3,000–6,000 people were dying each year (about five per 100,000 population). He figured out how to put niacin in corn grits, a food staple in the south. By 1945, there were only 12 deaths from pellagra and it is rare today. It’s now more than 70 years later and pellagra is extremely rare, so that’s roughly 250,000 lives he saved from premature death.

A more modern problem for many people is their blood cholesterol level. This month, let’s chat with Dr. Andrew Saul about niacin and cardiovascular health. Chapter Ten of Dr. Saul’s book, co-authored with Drs. Abram Hoffer and Harold Foster, titled “Niacin: The Real Story,” discusses Cardiovascular Diseases. You can also find information at Dr. Saul’s websitewww.DoctorYourself.com, the largest peer-reviewed, non-commercial natural healing resource on the Internet.

Dr. Saul has been an orthomolecular medical writer and lecturer for 41 years. Dr. Saul has taught clinical nutrition at New York Chiropractic College and postgraduate continuing education programs. He was also on the faculty of the State University of New York for nine years. Two of those years were spent teaching for the university in both women’s and men’s penitentiaries.

Dr. Saul is editor-in-chief of the Orthomolecular Medicine News Service and has published over 200 peer-reviewed articles. His bestselling book “Doctor Yourself” has been translated into eight languages. He has written a dozen other books, four as co-author with Abram Hoffer, MD.  He is a board member of the Journal of Orthomolecular Medicine and the Japanese College of Intravenous Therapy. Saul was inducted into the Orthomolecular Medicine Hall of Fame in 2013. He is featured in the documentaries “FoodMatters” and “That Vitamin Movie.”

Passwater:Dr. Saul, how effective is niacin for lowering high blood cholesterol levels?

Saul:Very effective. Niacin is so good for lowering cholesterol and preventing heart disease that some years ago The New York Times quoted the president of the American College of Cardiology saying, “Niacin is really it. Nothing else comes close.” Then, and since then, drugs old and new simply do not work as well as niacin.

I would like to add this straight away: people need to realize that for really good health there is no magic bullet. To stop cardiovascular disease they’re going to have to take a good, hard look at everything they are doing. To merely substitute niacin for a statin drug is missing the point entirely. You’re also going to have to make lifestyle changes, which includes a proper diet of whole, unprocessed foods, exercise, stress reduction, possibly medication, and, definitely, learning.

Passwater:How does niacin work to lower elevated cholesterol?

Saul:The short answer is, niacin reduces the body’s production of VLDL and LDL; niacin lowers triglycerides; and niacin greatly raises HDL. Niacin also inhibits oxidative stress and vascular inflammation.

The long answer is complicated and only in recent years has the mechanism been understood in detail. According to Ganji, Kamanna, and Kashyap, “the beneficial effect of niacin to reduce triglycerides and apolipoprotein-B containing lipoproteins (e.g., VLDL and LDL) are mainly through: a) decreasing fatty acid mobilization from adipose tissue triglyceride stores, and b) inhibiting hepatocyte diacylglycerol acyltransferase and triglyceride synthesis leading to increased intracellular apo B degradation and subsequent decreased secretion of VLDL and LDL particles. The mechanism of action of niacin to raise HDL is by decreasing the fractional catabolic rate of HDL-apo AI without affecting the synthetic rates. Additionally, niacin selectively increases the plasma levels of Lp-AI (HDL subfraction without apo AII), a cardioprotective subfraction of HDL in patients with low HDL” (2).

Well, then, you asked for it.

Passwater:What dosages are required to achieve this benefit?

Saul:Several thousand milligrams per day, in divided doses.

Passwater: Will that cause a “flush?”

Saul:You can count on it. If you want to flush in a hurry, chew the tablet and take it with something hot, on an empty stomach. I was giving a lecture once to some post-doctoral students, and at their insistence, demonstrated a niacin flush. I thought, “Well, okay,” since I always have my vitamin bottle in my pocket. (That’s why when I walk down the halls, I would rattle and all the students knew it was me before I turned the corner. ) It was before lunch, so I had an empty stomach. I took about 1,500 milligrams of niacin, and I said, “Watch this.”

Now they’re all watching pretty intently. It was a small class, only about 30 people. There’s one fellow at the back who whipped out a pair of opera glasses. Now this was really funny. It wasn’t that big of a room, and he didn’t do it to be a wise guy. But it was a very funny moment. He wanted to actually see precisely where and how I flushed.

The cheeks, the neck, and the upper arms tend to flush first. Then later on you might have a flush on your abdomen and perhaps your legs. If you’d had a big meal, the flush could be delayed for an hour or two, so long that you might have forgotten you took the niacin at all. Well, they liked the niacin flush so much that one of their evaluations said, “The niacin flush was awesome. Do you do birthday parties?”

We got a big laugh out of that. The niacin flush is not a big deal. People need to understand that it is a distraction. Niacin happens to cause you to have a flush. It’s like a little bit of an embarrassment. Ladies, it’s a little bit like a hot flash, I’m reliably informed. It’s a little bit like feeling embarrassed or like you were maybe out in the sun for that extra hour.

Passwater:Just what is this “flush” and is it dangerous?

Saul:It is a vasodilation. As the small blood vessels open up, more blood flows to the skin’s surface. Dr. Hoffer described it as harmless, and with thousands of patients over 55 years of practice, he was qualified to say so. Most persons will itch and feel hot. In some people, such large doses of niacin may cause a temporary drop in blood pressure and feeling faint. All of those side effects may be avoided by taking readily-available, over-the-counter flush-free forms of niacin.

Passwater:Niacinamide doesn’t cause a flush. Does niacinamide lower blood cholesterol?

Saul:It does not. Niacinamide is useful for all other niacin matters except blood lipids.

Passwater:Are there non-flush forms of niacin that work without causing a flush?

Saul:Inositol hexaniacinate is a virtually no-flush form that works but is not as effective as plain flush niacin. There are proprietary (patented) forms of time- or sustained-release niacin that cause little or no flush. However, these forms seem to have the most side effects, the most common of which is elevated liver enzyme levels.

Passwater:What is the most effective way to take niacin?

Saul:Consistently; in divided doses; with meals.

Passwater:How was it discovered that niacin lowered high cholesterol? What is the history?

Saul:Dr. Hoffer’s psychiatric research up in Saskatchewan, early in the 1950s, showed that niacin also lowered cholesterol, that is, it lowered the bad cholesterol — and actually raised good cholesterol. This work was picked up by Dr. William B. Parsons, Jr. at the Mayo Clinic. Dr. Parsons, America’s number-one niacin researcher, wrote a very fine book on this titled “Cholesterol Control without Diet: The Niacin Solution.”

Passwater:People seem to be interested in LDL and HDL values. Does niacin help normalize both or just one?

Saul:Niacin lowers LDL significantly and raises HDL spectacularly. It also lowers triglycerides.

Passwater:How does niacin compare to cholesterol-lowering pharmaceuticals?

Saul:Niacin is more effective. It is far cheaper. And it is vastly safer.

Passwater:Isn’t niacin the first choice of many physicians?

Saul:The smart ones, yes. I tell my readers, and your readers, that if your doctor is not yet employing vitamins for treatment, then you have an old-fashioned doctor.

Passwater: I bet that annoys Big Pharma.

Saul:Darn straight it does.

Passwater:Hasn’t there been a coordinated effort by the pharmaceutical industry to discourage the use of niacin for cholesterol lowering?

Saul:Let’s just say that there is no money in therapy with a cheap vitamin. Pharmaceutical profits are more important to stockholders than public health is.

Passwater:There are occasionally warnings about “elevated liver enzymes” when using niacin at such high doses. Let’s look more closely at this group of enzymes measured in standard blood tests. What are these enzymes and what do they do in the liver?

Saul:Usually it’s alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT). Dr. Abram Hoffer and Dr. William Parsons, Jr., the two most important niacin researchers, both strongly maintained that the elevation is an indication of liver activity, not liver pathology. A moderate elevation is not cause for alarm. Interestingly, the Mayo Clinic agrees, saying at their website I accessed today that “Most of the time, elevated liver enzymes don't signal a chronic, serious liver problem.”

Passwater:Why would physicians be so concerned if these liver enzymes were above “normal?”

Saul:If they are way above normal, they should be concerned. But, as Dr. Parsons and Dr. Hoffer both asserted, a moderate elevation is not cause for alarm. And these two doctors concur that physicians need to understand niacin in order to use it.

Passwater:What is really happening with these enzymes in the case of high niacin intake?

Saul:They indicate that you are alive and that your liver is working. Those are both desirable outcomes.

Passwater:It has been believed that niacin could cause a methyl deficiency in the body, because it is a methyl acceptor. What about that?

Saul:Methyl deficiency can cause fatty liver. But, said Dr. Hoffer and colleague Rudolf Altschul, MD, it does not happen with niacin. They checked that out over 50 years ago. Supplemental vitamin C is additional protection. Vincent Zannoni at the University of Michigan Medical School has shown that vitamin C protects the liver. Even doses as low as 500 milligrams daily helps prevent fatty buildup and cirrhosis. And in 1986, the Associated Press reported that 5,000 mg of vitamin C per day appears to actually flush fats from the liver (3).

Passwater:So, niacin, unlike pharmaceuticals, gives many health benefits including brain health, and arthritis, as well as helping to control cholesterol. How safe is niacin in the high dosages used for lowering cholesterol?

Saul:Very. Safer than any drug, and I mean any drug at all. And, people on long-term niacin treatment should still monitor their liver enzymes. That is easy to do when blood is drawn at your next physical. Always insist on your personally receiving a complete copy of all your test results, not a summary or dumbed-down interpretation. Look at the numbers for yourself; the test scores will come along with a statement of what the normal range is. If the numbers are very high, the niacin needs to be decreased. And not everyone needs huge doses of niacin! Dr. Hoffer figured that a few hundred milligrams a day is good prevention for most people. The therapeutic dose, 3,000 mg/day or more, is for those who would otherwise be on an inherently more dangerous drug regimen. The standard is not perfection; the standard is the alternative.

Passwater:Does niacin have any other cardiovascular benefit? Can it help after someone has an acute coronary episode?

Saul:Evidently it can. In his memoirs, Dr. Hoffer tells of researchers that, over time, found far fewer deaths among niacin-treated patients. He said, “Niacin, unlike the cholesterol-lowering drugs, has the power to extend lifespan.”

Passwater:Where can readers find more information on this topic?

Saul:Dr. Hoffer’s books are so clear, so good at explaining niacin therapy that I urge people to read them for themselves. “Niacin: The Real Story” is his final book, and perhaps the best to begin with. For those who want to know even more, I’d also recommend “The Orthomolecular Treatment of Chronic Disease” and also “The Vitamin Cure for Heart Disease.” If you need free-access information immediately, a site search for “Hoffer niacin” at www.doctoryourself.com will bring up a lot of detailed material.

Passwater:Dr. Saul, once again we thank you for sharing this important health information with us. Since we began chatting about niacin and Dr. Hoffer in Part 1 of this series, I received several inquiries about Dr. Hoffer’s research and other niacin questions. Please share some more about Dr. Hoffer and niacin in the next installment.WF

References1. Passwater R.A. “From Pellagra to Trans Fats and Beyond, — How a Legendary Nutritional Scientist is Still Saving Countless Thousands From Premature Death.” WholeFoods Magazine. 37 (9). 2014 2. Ganji SH, Kamanna VS, Kashyap ML. J Nutr Biochem. 2003 Jun;14(6):298-305. See also: Kamanna VS and Kashyap ML. Am J Cardiol. 2008 Apr 17;101(8A):20B-26B. 3. Ritter, M. "Study Says Vitamin C Could Cut Liver Damage," Associated Press, October 11, 1986.

Dr. Richard Passwater is the author of more than 45 books and 500 articles on nutrition. Dr. dr. passwaterPasswater has been WholeFoods Magazine’s science editor and author of this column since 1984. More information is available on his website, www.drpasswater.com.






NOTE: The statements presented in this article should not be considered medical advice or a way to diagnose or treat any disease or illness. Dietary supplements do not treat, cure or prevent any disease. Always seek the advice of a medical professional before adding a dietary supplement to (or removing one from) your daily regimen. The opinions expressed in bylined articles are not necessarily those of the publisher.

Published in WholeFoods Magazine September 2017