Dr. Gott: Can flush-free niacin lower cholesterol?

Dear Dr. Gott: My husband and I both are taking niacin for our cholesterol. When we first started taking it, we bought regular niacin. The side effect of extreme flushing was very uncomfortable. We then switched to flush-free niacin. When we switched, we both saw our physicians. One said the properties that caused the flushing were necessary to control the cholesterol. The other doctor said he was unaware of that problem. Would you give us your opinion as to whether flush-free is or is not helpful for cholesterol control?

Dear Reader: Flush-free niacin is, in most instances, a suitable option to lower cholesterol. Regular niacin can, as you have discovered, cause uncomfortable flushing. This side effect does not affect cholesterol levels.

To my knowledge, there are a few options for relieving the flushing. The first is to start at a low dose and, over a period of several weeks, increase the amount slowly. This may still cause some mild flushing as your body adjusts to the medication but generally subsides quickly. If you do experience flushing, continue to take the same dose until it stops, then start increasing the dosage again. For cholesterol purposes, 1,000 to 1,500 milligrams of niacin should be taken daily (500 to 750 milligrams twice daily).

The second option would be to take a regular-strength (325 milligram) aspirin a few minutes before the niacin. This is not an appropriate choice for some people, however. If you have a sensitive stomach, ulcer, clotting disorder or are allergic to aspirin, Do not use this option. If you start bruising easily, bleeding a lot from injuries, etc., stop the aspirin immediately and see your doctor.

A third option is to switch to flaxseed oil, omega-3 fish oil or both. Flaxseed oil comes in two forms, oil and oil-filled capsules. One tablespoon per 100 pounds or two to three 1,000-milligram capsules should be taken daily. Follow your doctor’s recommendation on dosage of omega-3 fish oil because it can be different for each person.

While attempting to lower your cholesterol, stick with one method for six to eight weeks and then be tested. If that method does not work for you, try another and be tested in another six to eight weeks. Work closely with your physician to find the best option for you. It is also important to remember that a low-fat, low-cholesterol diet can work wonders, both by itself and in conjunction with medication and exercise.