11 replies to this topic

[ironfistx]

I have encountered posts where people were talking about the niacin flush and they said it is an all or nothing thing, like if you get it at a certain dose, taking more will not give you more of a flush.  They also suggested that it only comes from niacin.  What about niacinimide?  And I think I read that it was suggestive of something, like getting it means that a certain thing is happening.

 

Is there a reason to try to do it other than since you like the feeling or does it have some sort of cause?

[Gerrans]

Quite a few here are fans of the niacin flush, but I do not like the feel of it. I take a little niacin in my multivitamin, and as far as I am concerned that is enough for me. I have experimented with niacin and niacinamide to help with my tendency to feel cold at the peripheries, which has led to some nasty bouts of chilblains on occasion. I have discovered that I can counter this coldness with niacinamide.

 

I have mentioned it on these forums before, because I think it is hardly documented, that niacinamide can produce warmth in the skin, in my experience. Hoffer said a small number of his patients actually had a flush from niacinamide, though I do not get that. I get a sense of wellbeing from niacinamide, which I think may be associated with its subtle warming effect. Gradually I have discovered that the warming and the wellbeing are part of the same feeling, and I suspect it might be that niacinamide opens the blood vessels more, easing the brain.

 

One main difference between niacin and niacinamide is that niacin reduces cholesterol levels. I do not feel I need my cholesterol levels reducing, so I do not require it for that.

 

A criticism of niacinamide that one reads on this forum is that it blocks Sirt1 (I forget the detail), which is said to be a longevity gene. But I feel it is more complex than that and that niacinamide--which has its finger in a lot of pies in the body--probably has more of a homeostatic effect in that regard. It may have a function to help prevent us living forever, but it is associated with benefit against several major diseases.

 

Some people extol niacinamide riboside, but their reports of beneficial feelings from it remind me of the benefits I feel from normal niacinamide. They hope to dodge the Sirt block with this form, but I suspect it turns into normal niacinamide in the body anyway.

Edited by Gerrans, 30 July 2014 - 11:18 AM.

[ironfistx]

Having heard that niacinimide might help with tinnitus, I tried some from Swanson.  It is 250mg.  I think I heard somewhere that niacinimide, but not niacin, benefits the joints and that is why I chose that form.  I don't know if I have felt a flush from it, but I have not tried more than one at a go because I think I heard somewhere that taking greater than 500mg at a time is harmful to the liver.

[Turnbuckle]

I think I heard somewhere that taking greater than 500mg at a time is harmful to the liver.

 

 

This is from the NIH--

 

Hepatotoxicity

Niacin in doses above 500 mg daily causes transient, asymptomatic elevations in serum aminotransferase levels in up to 20% of people.  The elevations are rarely greater than 3 times the upper limit of the normal range and usually resolve spontaneously even with continuation of the drug.  The effect is partially dose related and is more common with doses above 3 g/day.  In some patients, there is an overall decrease in serum proteins synthesized by the liver and, in some instances, coagulopathy with an increase in prothrombin time and decline in serum albumin, coagulation factors and apolipoproteins.  These changes resolve rapidly upon stopping therapy and may not recur with lower doses.

 

Niacin can also cause serious hepatotoxicity, but this is uncommon.  Significant hepatotoxicity is particularly common with high doses of sustained release niacin.  In many cases, the injury becomes apparent after a dose increase or after switching from the regular crystalline to a sustained release form.  The pattern is primarily hepatocellular, although cases with a cholestatic pattern have been described.  The patients present with jaundice, itching, nausea, vomiting and fatigue.  When the injury is the result of switching from the crystalline to the sustained release form, the injury may present acutely within days or a few weeks with a prodromal period of nausea, vomiting and abdominal pain, that is followed by jaundice and pruritus.  Early during the injury serum aminotransferase levels are very high and then usually fall rapidly with discontinuation or dose lowering.  The clinical phenotype resembles acute hepatic necrosis, suggesting a direct toxic effect.  Imaging studies of the liver may reveal areas of hypodensity ("starry sky liver") interpreted as focal fatty infiltration that resolves after stopping the drug.  Liver biopsy typically shows varying degrees of centrolobular necrosis with only mild inflammation.

 

Mechanism of Injury

The mechanism of hepatotoxicity is assumed to be an intrinsic toxic reaction related to high serum levels of niacin that overwhelm the high affinity, low concentration nicotinic acid receptors (that are responsible for the flushing response).  The finding that niacin can be restarted at lower doses after an episode of clinically apparent injury indicates that the hepatic damage is unlikely to be idiosyncratic or due to hypersensitivity.

 

Outcome and Management

Niacin hepatotoxicity appears to be dose dependent and more common with the sustained release form of the drug.  Hepatotoxicity is less common with regular, crystalline niacin or extended release niacin.  Most cases are mild and resolve rapidly upon stopping the medication, although in some instances, the injury is acute and severe and progresses to liver failure that is fatal or requires emergency liver transplantation.  Complete resolution of the clinical symptoms is expected within days of stopping niacin, whereas serum enzyme elevations may require several weeks or months to resolve.  Rechallenge with the same form leads to rapid recurrence and should be avoided.  If the injury occurred after switching to a SR formulation, the crystalline form of niacin may be restarted at a lower dose and with caution.

 

http://livertox.nih.gov/Niacin.htm

 

 

 

[Dolph]

Niacin in doses above 500 mg daily causes transient, asymptomatic elevations in serum aminotransferase levels in up to 20% of people.  The elevations are rarely greater than 3 times the upper limit of the normal range and usually resolve spontaneously even with continuation of the drug.  The effect is partially dose related and is more common with doses above 3 g/day.

I also think that this 20% number is still confounded by the common use of slow release formulations. It's very rare to see someone with elevated LFTs who has only taken immediate release niacin in normal doses.

[Bonee]

Big fan of niacin here,

I started to take now's sustained release niacin (not hexanicotinate), and I've been taking instant release for years...

this sustained release is so far the best it seldom gives me a flush, I take 1,5 grams a day and it totally cleared my acne (because of lowered triglycerides imo)

 

[Phoenicis]

Bonee are you aware of the hepatoxicity risk for sustained release? You must mean extended release? Join the instant release train, its the way to go. After 2 months I stopped flushing as much and sometimes I take as much as 2.5 g/day.

Edited by Phoenicis, 01 August 2014 - 12:53 PM.

[Turnbuckle]

 After 2 months I stopped flushing as much and sometimes I take as much as 2.5 g/day.

 

 

I don't flush at all and I'd like to find a co-supplement to bring it back.

[Bonee]

well unfortunately I never stopped flushing with instant release... just reduced the duration, and I also did not mind it at all, but this sustained release works just as good, sometimes I get a little flushing,

and I don't think 1,5 grams should cause a lot concern,my hepatic readings are fine...

Also the mechanism of hepatotoxicity is mediated via depletion of methyl donating groups, (the liver methylates the nitrogen in the niacin) and can be alleviated by taking tmg or choline

Unfortunately it also means that taking niacin without choline or TMG raises homocysteine levels!

 

citation:

http://ajpendo.physi...81/5/E1095.long

Edited by Bonee, 01 August 2014 - 03:23 PM.

[Phoenicis]

wonder if b12 (2 x daily), b6 8mg (2 x daily) and 5-MTHF400mcg (1 x daily) would be enough for 2g Niacin doses? I don't really want to start choline as well, is that absolutely necessary?

[pamojja]

wonder if b12 (2 x daily), b6 8mg (2 x daily) and 5-MTHF400mcg (1 x daily) would be enough for 2g Niacin doses? I don't really want to start choline as well, is that absolutely necessary?

 

Do know get at least Homocysteine tested. Serum Cobalamin and Holo-TC, serum and/or RBC folate, and serum B6 lab tests would give further indications if there were a bottleneck. At high dose niacin my bottleneck has been folates even at 1800 mcg/d.

 

 

 After 2 months I stopped flushing as much and sometimes I take as much as 2.5 g/day.

 

I don't flush at all and I'd like to find a co-supplement to bring it back.

 

For a beginning I would say try it every other day the double dose

 

Interesting interview about that approach:

 

http://www.prescript...transcript.html

... the real good niacins, not the over-the-counter no-flush stuff. That doesn't work as well. In any event I went and got the crystalline kind and I took it 1000 mg every day and it took my HDL up to 77, then I took it every other day to maximize the flushing and itching. I wanted to see if that would have a special effect. Now I'm on half the dose so I should have a fall in my HDL but it went up to 93.

 

[Turnbuckle]

 

 

wonder if b12 (2 x daily), b6 8mg (2 x daily) and 5-MTHF400mcg (1 x daily) would be enough for 2g Niacin doses? I don't really want to start choline as well, is that absolutely necessary?

 

Do know get at least Homocysteine tested. Serum Cobalamin and Holo-TC, serum and/or RBC folate, and serum B6 lab tests would give further indications if there were a bottleneck. At high dose niacin my bottleneck has been folates even at 1800 mcg/d.

 

 

 After 2 months I stopped flushing as much and sometimes I take as much as 2.5 g/day.

 

I don't flush at all and I'd like to find a co-supplement to bring it back.

 

For a beginning I would say try it every other day the double dose 

 

Interesting interview about that approach:

 

http://www.prescript...transcript.html

... the real good niacins, not the over-the-counter no-flush stuff. That doesn't work as well. In any event I went and got the crystalline kind and I took it 1000 mg every day and it took my HDL up to 77, then I took it every other day to maximize the flushing and itching. I wanted to see if that would have a special effect. Now I'm on half the dose so I should have a fall in my HDL but it went up to 93.

 

 

 

Thank you for that excellent suggestion. I'm taking most things on an intermittent basis these days--ranging from every other day to once a week--but I hadn't thought to do that with niacin.

 

Edited by Turnbuckle, 01 August 2014 - 08:17 PM.