niacin for cholesterol control



Q: What is your advice concerning niacin for lowering cholesterol? How much is safe to take?
— J. Hall, via e-mail

A: Niacin can lower cholesterol, but in general, high doses are needed — 2,000-2,500 mg daily, in three or four divided doses. I recommend the "flush-free" niacin; otherwise the vasodilation flush (a common side effect of regular niacin) is too intense. High-dose niacin has been associated with liver damage, so please don't use this therapy if you already have liver problems.

Many people are concerned about cholesterol levels because there has been an enormous media and medical push to reduce cholesterol levels in the past two decades. Most people interested in lowering their cholesterol levels have been told high cholesterol is a risk factor for premature death from cardiovascular disease; however, more than 50 percent of people going to emergency departments with their first heart attack have total cholesterol levels under 200. This will be a shock to some readers. Further, new information is emerging correlating low cholesterol with increased risk of various cancers.

In my opinion, having cholesterol under 200 is not the best indicator of cardiovascular risk, and there is far too much emphasis on cholesterol reduction, perhaps because drugs exist that will "improve" the numbers. The more northern your ancestry, the more likely you are to have higher cholesterol because your genes evolved in a climate where food might be scarcer in the winter, so you hang on to fat more aggressively. More important risk factors for cardiovascular disease are high C-reactive protein (CRP), a big waist, and high blood pressure.

CRP is a readily available blood test that is much more strongly correlated with heart disease risk than cholesterol. It measures inflammation (you want your number under 2.5).

Waist measurement is a quick and easy test I use in my office to evaluate whether or not people have fat around their abdominal organs — the heart, the lungs, the liver, and the kidneys. Men's waist size (the tape measure should go around the body just above the belly button) should not exceed 38 inches, and women's should not exceed 34 inches. This deep fat, padding the vital internal organs, will impede optimal blood flow (oxygen delivery) and toxin removal. Crunches won't touch this deep fat. You need to eat less and get regular cardiovascular exercise.

Blood pressure control is more complicated, but you must explore why your blood vessels are constricting, which is why the pressure of the blood flowing through them increases. Sometimes caffeine or stress act as vasoconstrictors — adrenaline is an extremely potent vasoconstrictor.

My point is that cholesterol itself isn't inherently bad. Cholesterol is the "mother" hormone: Estrogens, progesterone, cortisol, aldosterone, and testosterone all derive directly from cholesterol. That's why total cholesterol goes up in menopausal women, the ovaries are no longer secreting high levels of female hormones, so the brain directs the liver to produce more cholesterol — at least until the brain "gets" that the ovaries are on permanent vacation. It is perfectly fine — even normal — for cholesterol to go up to 250 or so around menopause. Often it eventually drifts down to 220 or 230. This is not a problem. What is a problem is obesity and hypertension, and niacin would not be my first choice of therapy for either of those conditions.

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By Emily Kane, ND, LAc

Emily Kane, ND, LAc, (aka Dr. Em) received her naturopathic training at Bastyr University in Seattle. She is the author of Managing Menopause Naturally and Ask Doctor Em (a compilation of short essays). She lives in Juneau, Alaska, with her husband and daughter, and enjoys helping patients achieve optimal wellness. Visit

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