Niacin deficiency was common in the southern United States in the early 1900’s due to diets being heavy in corn-based products. United States Surgeon General Joseph Goldberger observed the link in pellagra and orphanages and mental hospitals. In 1926 he established a diet that supplemented Brewer’s yeast to correct this deficiency. Pellagra can also occur in populations that are homeless, alcoholic, or psychiatric patients who refuse food.

Dietary sources: meat, fish, legumes, whole grains. Grains are supplemented with micronutrients such as thiamin, riboflavin, niacin, iron and folic acid.

Function: converts carbohydrates into glucose, metabolizing fats and proteins, and keeping the nervous system working properly

Deficiency states are rare, due to the presence in most of the foods we ear. Niacin deficiency causes Pellagra “translation: rough skin”. Primary symptoms involve the 3 D’s of Pellagra: Dermatitis, Diarrhea, Dementia.

Adverse effects: flushing of the top layers of the skin, stomach upset, and may increase blood sugar levels. The “flushing” is like a hot flash, which can be blocked by taking an Aspirin 325mg tablet one hour before the dose of niacin. Acetaminophen (Tylenol) does NOT work.

Supplemental doses: 50mg, 100mg, 250mg & 500 mg (immediate release release)

• No Flush niacin (inositol hexaniacinate) not as effective for hyperlipidemia
• OTC-Niacin: The immediate-release niacin formulations are more likely to cause flushing, especially first dose. Long-acting niacin Slo-Niacin (long-acting niacin) is more likely to cause liver problems.

Patient Education for niacin therapy:

• Cutaneous flushing- may be managed with Aspirin 325mg 1 hour before dose.
• Take with food or light snack to decrease GI upset.
• Swallow whole, with cold water.
• Avoid sudden changes in posture. May cause dizziness.
• Avoid alcohol and hot drinks during administration.
• Increase blood glucose monitoring if diabetic.
• Watch niacin content in multivitamin.

SAFETY: For every 1000 patients treated for about 4 years with a statin plus niacin ( + aspirin), about 18 more will develop diabetes and 37 more diabetics will have worse blood sugar control, compared to patients on a statin alone.

“Urban Legend”: No scientific evidence indicates that taking niacin can alter a urine drug test result. However, readily accessible information on the Internet lists ingestion of niacin as a way to prevent detection of tetrahydracannabinol (THC), the main psychoactive ingredient of marijuana. High dose niacin may cause liver toxicity.