Niacin
TL;DR
Vitamin B3, used in high doses as a lipid-modifying medication
Moderate evidence for improving the 'cholesterol profile' (raises HDL)
Notable for causing the 'Niacin Flush' — an itchy, red skin reaction
Mixed results in recent large trials (AIM-HIGH, HPS2-THRIVE)
Cheap: ~$5-10/month
Best for: Low HDL cholesterol, high triglycerides
What it is
Niacin is an essential B vitamin involved in over 400 enzyme reactions. However, at 'mega-doses' (1,000mg+), it becomes a powerful drug for cholesterol. It was the primary lipid-lowering tool before statins were invented.
Niacin works by blocking the breakdown of fats in adipose tissue and the liver, which lowers triglycerides and raises 'good' HDL cholesterol. The 'flush' occurs because niacin triggers the release of prostaglandins that dilate the blood vessels in the skin.
What the research says
Niacin's reputation has taken a hit recently. The Profile. It is the single most effective supplement for raising 'good' HDL cholesterol and lowering Lipoprotein(a). The Controversy. Large-scale trials (AIM-HIGH) showed that while Niacin improved cholesterol numbers, it didn't necessarily reduce heart attacks when added to a statin. Practical Use. It is still a valuable tool for those with very high triglycerides or those who cannot take statins.
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Safety
High doses can be taxing on the liver; regular blood tests are recommended. The 'Niacin Flush' is harmless but uncomfortable. Avoid 'No-Flush' Niacin (Inositol Hexanicotinate), as it is generally ineffective for cholesterol. Extended-release (Slo-Niacin) is gentler but carries higher liver risk.
Interactions
- Statins: May increase the risk of muscle pain (myopathy).
- Diabetes Meds: High-dose niacin can raise blood sugar levels.
- Gout: May increase uric acid levels, triggering gout attacks.
Dosing
For Cholesterol: 500-2,000 mg daily. Form: Immediate-release (for least liver risk) or Extended-release (for least flush). Tip: Take with a snack and an aspirin 30 minutes before to minimize flushing.
Cost
Very cheap. $5-10 per month.
The bottom line
Niacin is a powerful, old-school heart tool. It's not for everyone, but if you need to raise your HDL or lower triglycerides, it's the most effective 'vitamin' for the job.
Sources for this page include published meta-analyses, systematic reviews, and NIH dietary supplement fact sheets. All claims reflect the evidence as of early 2026.
This is not medical advice. Consult your healthcare provider before starting any supplement, especially if you take medications.