Here is a great article by Dr. Michael Jurgelewicz from Designs for Health about the recent niacin news and why the reports are so deceiving.
There has been some recent negative news about niacin based on the HPS2-THRIVE study, and now we see it again, this time in the New England Journal of Medicine.
Let’s take a closer look at all of this. First, in the recent HPS2-THRIVE study, which examined an investigational drug from Merck, the researchers state that niacin does not provide any benefits. The drug they looked at is a combination of extended-release niacin and laropiprant, a drug which partially blocks the flushing effect of niacin. This niacin combination was given to subjects already well controlled on statin therapy; in essence meaning that they tested a drug on individuals with no apparent need to take it. Added to this is the fact that there have been numerous studies over the years that have pointed to niacin’s benefits in heart disease, with these accolades having been supported by the National Lipid Association (NLA).
The HPS2-THRIVE study also reported that niacin caused greater harm than the statin arm. The media picked up on this, and associated any reported adverse events (such as diabetic and GI complications) with the niacin component, which is misleading, given the fact there are documented mechanisms of harm that are actually associated with laropiprant. In fact, this drug was pulled from over 20 countries due to these findings.
Now let’s take a closer look at niacin and liver toxicity. There are no known toxic metabolites of niacin; the stress to the liver comes from the continued metabolizing of nicotinates into useful metabolites. The concern of liver toxicity really has more to do with the dosing than the risk of niacin itself. Work in the 1990s by Pharma companies (most likely trying to discredit niacin) demonstrated that 2 g of sustained or extended-release niacin T.I.D. caused elevated enzymes. This has far more to do with the constant metabolizing of niacin than the dose (2 grams) of the niacin itself. Designs for Health’s controlled release niacin delivers niacin in a controlled rate only over a 6-8 hour period, which reduces the potential increase of liver enzyme production.
Niacin has had a long history (over 50 years) of safe use. The vast majority of research with niacin, either when used as a solo nutrient or in conjunction with other lipid-lowering drugs, shows significant benefits, suggesting that this B vitamin remains a safe and effective nutrient in the prevention and treatment of cardiovascular disease.