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Is Niacin "Flush Free" the Same As Nicotinic Acid?

By Brandy Williams, R.D. ; Updated August 14, 2017

All niacin is not all the same. Three forms exist, and they do not affect you the same way. One form can improve your overall lipid profile by reducing your triglycerides and bad cholesterol, or LDL, and increasing your HDL, or good cholesterol, while the others have little to no effect. You can decrease your risk for a heart attack or stroke with niacin, but before you reach for any old niacin supplement, especially one that's flush-free, you need to know what you are taking and what it will actually do.

Three Forms of Niacin Have Different Effects

The three forms of niacin are inositol hexaniacinate, or IHN, niacinamide, and nicotinic acid, also referred to as regular niacin. IHN, or the flush free-free niacin supplement, may or may not be effective in improving your cardiovascular system and altering lipoprotein levels. Niacinamiide is not associated with any side effects or health benefits and will do nothing to improve your blood lipids. Nicotinic acid protects the cardiovascular system by decreasing triglycerides and altering lipoprotein levels in the blood. Lipoproteins, specifically LDL and HDL, are two important carriers of fat in the bloodstream, and they vary greatly in how they impact your cardiovascular system. You can only expect healthy changes in lipoprotein levels from doses of nicotinic acid above the dietary reference intakes, or DRIs. Thus, you will need to speak to your doctor before taking a supplement. Your doctor will be able to tell you more about side effects associated with large doses of nicotinic acid.

Flushing Is a Side Effect of High Doses of Nicotinic Acid

One side effect you may experience on a high dose of nicotinic acid is flushing. If you take more than 1000 mg, you are likely to experience warm, red and possibly itchy skin. Nicotinic acid is the only form of niacin associated with health benefits and the only one that will cause significant flushing. Flush-free niacin is IHN and made of six niacin molecules linked together by the chemical inositol. The body breaks down this complex, and niacin enters the blood at an extremely slow rate. A 2006 study in "Preventive Cardiology" writes off flush-free niacin as ineffective at improving lipid profiles. Further, suggests that the benefits of niacin can only be obtained from nicotinic acid.

How Much Nicotinic Acid You Will Need For Health Benefits

Up to 150 times the DRI for nicotinic acid may be prescribed for heart health benefits. Males only need 16 mg, and females need 14 mg daily, which is easily obtained from a healthy diet. These levels are far below the levels needed to have any significant impact on LDL, HDL and triglycerides. According to guidelines for niacin therapy published by the Rush University Medical Center, your physician may prescribe doses of nicotinic acid as high as 2,000 mg per day for you to gain pharmacological effects on blood lipids. You will need to weigh the risk of side effects from such high doses, such as liver damage, indigestion, nausea and flushing, with potential benefits. If flushing becomes bothersome, there are ways you may be able to decrease the severity.

How to Reduce Flushing

To counteract flushing, according to a 1995 study in the "American Journal of Therapeutics," you can take 325 mg aspirin 30 minutes prior to your supplement, take 200 mg of ibuprofen or take your supplements with meals to slow absorption into the bloodstream. Slowly build up to the dose you are trying to reach. Your body will build up a tolerance for nicotinic acid, and the symptoms you experience will lessen. With the help of your physician, you will be able to manage the side effects while gaining invaluable cardiovascular benefits.

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