Niacin Saturation and the Flush

Niacin Saturation
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HOW TO DETERMINE A SATURATION LEVEL OF NIACIN

by Andrew W. Saul

Niacin is vitamin B-3, one of the water soluble B-complex vitamins. One of niacin's unique properties is its ability to help you naturally relax and get to sleep more rapidly at night. And it is well established that niacin helps reduce harmful cholesterol levels in the bloodstream. Abram Hoffer, M.D., Ph.D. explains: "Niacin is one of the best substances for elevating high density lipoprotein cholesterol (the "good cholesterol) and so decreases the ratio of the total cholesterol over high-density cholesterol." In other words, niacin lowers LDL and raises HDL. It also profoundly lowers tryglycerides.

Another niacin feature is its ability to greatly reduce anxiety and depression. Yet another feature of niacin is that it dilates blood vessels and creates a sensation of warmth, called a "niacin flush." This is often accompanied with a blushing of the skin. It is this "flush" or sensation of heat that indicates a temporary saturation of niacin, and that is our topic here.

When you flush, you can literally see and feel that you've taken enough niacin. The idea is to initially take just enough niacin to have a slight flush. This means a pinkness about the cheeks, ears, neck, forearms and perhaps elsewhere. A slight niacin flush should end in about half an hour or so. If you take too much niacin, the flush may be more pronounced and longer lasting. If you flush beet red for half an hour or two and feel weird, well, you took too much. And a large dose of niacin on an empty stomach is certain to cause profound flushing.

"With larger initial doses, the flush is more pronounced and lasts longer," says Dr. Hoffer. "But with each additional dose, the intensity of the flush decreases and in most patients becomes a minor nuisance rather than an irritant. Niacin should always be taken immediately after finishing ones meal."

I have found that the best way for me to accurately control the flushing sensation is to start with very small amounts of niacin and gradually increase until the first flush is noticed. One method is to start with a mere 25 milligrams (25 mg) three times a day, say with each meal. The next day, try 50 mg at breakfast, 25 mg at lunch and 25 mg at supper. The following day, one might try 50 mg at breakfast, 50 mg at lunch, and 25 mg at supper. And, the next day, 50 mg at each of the three meals. The next day, 75 mg, 50 mg and 50 mg. Then, 75. 75 and 50, and so on. In this way you have increased at the easy rate of only 25 mg per day. One would continue to increase the dosage by 25 mg per day until the flush occurs.

It is difficult to predict a saturation level for niacin because each person is different. As a general rule, the more you hold, the more you need. If you flush early, you don't need much niacin. If flushing doesn't happen until a high level, then your body is obviously using the higher amount of the vitamin. But if you take niacin, you ARE almost certainly going to flush. The question is when.

An important point here is that niacin is a vitamin, not a drug. It is not habit forming. Niacin does not require a prescription because it is that safe. It is a nutrient that everyone needs each day. Different people in different circumstances require different amounts of niacin.

Says Dr. Hoffer: "A person's "upper limit is that amount which causes nausea, and, if not reduced, vomiting. The dose should never be allowed to remain at this upper limit. The usual dose range is 3,000 to 9,000 milligrams daily divided into three doses, but occasionally some patients may need more. The toxic dose for dogs is about 5,000 milligrams per 2.2 pounds (1 kilogram) body weight. We do not know the toxic dose for humans since niacin has never killed anyone."

Inevitable physician skepticism and questions about niacin's proven safety and effectiveness are best answered in Niacin: The Real Story, by Abram Hoffer, MD, Andrew W. Saul, and Harold D. Foster, PhD. This book provides details on all aspects of niacin therapy. Persons with a history of heavy alcohol use, liver disorders, diabetes, or women experiencing pregnancy will especially want to have their physician monitor their use of niacin in quantity. Monitoring long-term use of niacin is a good idea for anyone. It consists of having your doctor periodically check your liver enzymes with a simple blood test.

Proper interpretation of this test requires knowledge of niacin. Elevation of liver enzymes is a sign of liver activity, not liver pathology. Moderate elevation is fairly common among niacin users and not clinically significant. A large elevation is. Full explanation is provided by Mayo Clinic niacin researcher William B. Parsons Jr, MD, in his book Cholesterol Control Without Diet!: The Niacin Solution. If a person is not willing to look at this book and Hoffer's Niacin the Real Story, they have no business promulgating their opinions about niacin. Choosing belief over clinical research means it is time for a reevaluation of your relationship with your doctor.

Plain and simple niacin may be purchased in tablets online or at most pharmacies and health food stores. Tablets typically are available in 50 mg, 100 mg, or 250 mg dosages. The tablets are usually scored down the middle so you can break them in half easily. You can break the halves in half, too, to get the exact amount you want.

If a niacin tablet is taken on an empty stomach, a flush will occur (if it is going to occur at all) within about 10 minutes. If niacin is taken right after a meal, a flush may be delayed for an hour or more. In fact, the flush may occur long enough afterwards that you forgot that you took the niacin! Don't let the flush surprise you. Remember that niacin does that, and you can monitor it easily.

If you want a flush right away, you can powder the niacin tablet. This is easily done by crushing it between two spoons. Powdered niacin on an empty stomach can result in a flush within minutes. Sustained release niacin is often advertised as not causing a flush at all. This claim may not be completely true; sometimes the flush is just postponed. It would probably be difficult to determine your saturation level with a sustained- or time-released product. They are also more costly. But the biggest reason to avoid sustained-release niacin is that most reports of side effects stem from use of that form.

There are two commonly available forms of no-flush niacin, niacinamide and inositol hexaniacinate. These forms of vitamin B-3 are the ones frequently found in multiple vitamins and B-complex preparations. In most persons, inositol hexaniacinate does not cause a flush. Niacinamide almost never does. In my opinion, inositol hexaniacinate is less effective than plain niacin. Niacinamide does not lower serum cholesterol. These are important distinctions to make when purchasing.

It is a good idea to take all the other B-complex vitamins in a separate supplement in addition to the niacin. The B-vitamins, like professional baseball players, work best as a team. Still, the body seems to need proportionally more niacin than the other B vitamins. Even the U.S. Recommended Daily Allowance (RDA) for niacin is much more than for any other B-vitamin. Many physicians consider the current RDA for niacin of only 20 mg to be way too low for optimum health. While the government continues to discuss this, it is possible to decide for yourself based on the success of doctors that use niacin for their patients every day.

TO FLUSH OR NOT TO FLUSH? That is this reader’s question:

”We have learned a great deal from your site and your books and also enjoy them. We have also incorporated some of your suggestions in our lifestyle. My question for you is an attempt to clarify what seems to be a difference of opinion about the niacin flush between you and Dr. Hoffer. He had written ( http://www.doctoryourself.com//hoffer_niacin.html ) that the niacin flush is normal with many people and will diminish or go away as the patient continues to use niacin at his recommended level of 3,000 milligrams per day. You, however, state that the flush is an indication of no niacin deficiency. Who is correct or am I misinterpreting one of you?”

Andrew Saul’s response:

This is how I look at it: Generally speaking, people in fairly good health usually choose to increase their doses gradually in order to minimize flushing. If they do increase the dose slowly, what I describe is pretty accurate. For instance, I've been taking niacin for years, in daily but varying doses depending on my stress level or dietary intake. I know by the flush when I've had enough for the moment. It is like turning off the hot water when the tub is full enough for a nice bath. Dr Hoffer is highly experienced with serious psychiatric cases. Such patients have a niacin dependency, not a mere deficiency. Let’s let him speak for himself:

Abram Hoffer, MD, writes:

“We are both correct. Most people flush at the beginning and gradually get adapted to it unless they stop for a few days and then resume it. A few cannot ever get used to it, and they take the no-flush preparations. But the intensity of the flush is very variable. Generally people who need it the most flush the least. That includes arthritics, schizophrenics, and elderly people with cardiovascular problems. Some schizophrenics do not flush until they get well and then they do. But the presence of the flush or its intensity can not be uniquely used measure the need as there are too many variables such as food in the stomach, whether the drink with it is hot or cold, the kind of food, other medication. Antipsychotics reduce the intensity of the flush as do aspirin and antihistamines.”