What’s the Best Form of Niacin and is it Good For Keto?

Yes, niacin is good for keto, but talk to your doctor before taking niacin supplements.

What are the benefits of Niacin for the keto diet?

• Raises HDL (good cholesterol)
• Lowers LDL (bad cholesterol)
• Improves mood
• Lowers inflammation
• Potential to improve health-span
• Improves vascular health and circulation
• Reduces visceral fat
• Lowers triglyceride levels
• Reduces liver fat accumulation

What does Niacin do to the body?

Niacin is the most potent ”drug” known to raise the levels of protective HDL lipoproteins.

I stumbled upon this interesting science-based article titled, “Nicotinic acid: the broad-spectrum lipid drug. A 50th-anniversary review.” Numerous trials over the last 50 years have shown that treatment with nicotinic acid (niacin) reduces the progression of atherosclerosis and heart disease.

I wrote an article that answers the question, “Can keto reverse fatty liver disease?” However, during the research for this article, I learned of a study on PubMed.gov that shows that niacin benefits the liver. Niacin inhibits fat accumulation, inflammation, and oxidative stress in the liver.

Niacin has been approved for use since 1957.

Atherosclerosis is the build-up of fats, cholesterol, and calcium in your arteries that form plaque. This can restrict blood flow to vital cells and organs, especially the brain and heart.

What are the different forms of niacin?

• Niacin: Nicotinic acid IR (intermediate release)
• ER Niacin (extended release)
• Niacin SR (sustained release)
• Niacinamide/inositol hexanicotinate (no flush)
• Niacinamide riboside (NR)
• Nicotinamide mononucleotide (NMN)

When I explain the keto diet I always tell people that keto can raise total cholesterol. Niacin is especially good for keto because not only can it lower total cholesterol, but more importantly, can help improve the ratio of good (HDL) and bad (LDL) cholesterol.

Studies also show that niacin markedly increases HDL-C, large, cholesterol-enriched HDL. Increasing cholesterol particle size can have cardio-protective properties.

When I developed my keto diet beginners guide I discuss the cholesterol paradox. But to sum it up read the below quote.

This study on PubMed demonstrated that compared to an oatmeal breakfast, two eggs per day do not negatively affect the biomarkers associated with cardiovascular risk, but increase satiety throughout the day in a young healthy population.

When it comes to cholesterol, LDL particle size does matter.

LDL particles come in two primary sizes: Large, fluffy particles, and small, dense particles. To simplify the explanation, the large fluffy particles stay buoyant in the blood and return to the liver. However, smaller particles tend to build up and form plaque.

Niacin is good for keto because it increases LDL particle size.

So, if Niacin is so great why doesn’t everyone take it?

There are some complications and side effects with Niacin.

The “niacin flush” is a genuine issue when supplementing with regular, immediate-release niacin B3 (nicotinic acid). Your skin turns red, hot, itchy, and uncomfortable. The condition is harmless and goes away after about 30 minutes, but nonetheless, it’s not a pleasant feeling.

Don’t let the niacin flush discourage you from the benefits of niacin, there are ways around it.

Over time the body adjusts and the niacin flush diminishes, but this can take 2 or 3 weeks and most people stop taking it before they adapt. However, there are different forms of niacin you can take that don’t cause the niacin flush.

Can niacin damage the liver?

In high doses and as a continuous supply, yes it can.

Niacin SR (sustained-release) and Niacinamide (no flush) provides a steady long term dose of niacin, but this can be hard on your liver (hepatotoxicity).

“Niacin hepatotoxicity appears to be dose-dependent and more common with the sustained-release form of the drug (niacin).”

LiverTox: Clinical and Research Information on Drug-Induced Liver Injury

It looks likes niacin in dosages above 500 mg daily can cause elevations in serum aminotransferase levels in up to 20% of people.

So, to prevent possible liver problems I would stay away from sustained-release (SR) version or niacin labeled as no-flush. The no-flush version is usually in the form of niacinamide.

No matter what form of niacin you take, have a liver function test done regularly and have your doctor look closely at the Aminotransferease (ALT) Test. Additionally, I probably wouldn’t take niacin 7 days a week. It would be beneficial to give your liver a break once in a while.

Furthermore, alcohol and Tylenol are also hard on the liver, so I wouldn’t take those in addition to niacin.

The best niacin supplement is Niacin ER (extended release).

The extended-release form of niacin is cheap, effective, and doesn’t cause liver damage. It also doesn’t cause the niacin flush or negatively affect insulin resistance. Niacin ER is available by prescription and over-the-counter. Niacin ER is also sold under several brand names such as Niaspan and Niobid. 

This study on PubMed shows the new extended release niacin called “Niaspan” (1000 mg) decreases LDL cholesterol by 5.8% and raises HDL by 17%.

The recommended dietary allowance (RDA) of Niacin is 14 to 16 mg daily in adults. However, the Niacin ER dosage to help cholesterol ranges from 500 to 2,000 mg. You can take it anytime but I normally see it taken once daily at bedtime.

The over-the-counter (OTC) Niacin ER is developed in a wax matrix system which slowly releases the niacin into your bloodstream over a 4-6 hour period. If you take it with a hot beverage such as coffee it can dissolve the wax faster and you might get a slight flushing effect, but in my experience, it’s very mild.

“Extended-release niacin effectively lowers plasma (triglyceride) TG levels and raises plasma high-density lipoprotein (HDL) cholesterol levels.”

Extended-release niacin alters the metabolism of plasma apolipoprotein

Niacin is good for keto because elevated HDL also has anti-inflammatory, anti-oxidant, and vasoprotective properties.

This study shows HDL can lower inflammation: High-density lipoprotein: a potent inhibitor of inflammation.

“Nicotinic acid (niacin) induces beneficial changes in serum lipoproteins (cholesterol) and has been associated with beneficial cardiovascular effects.

Niacin reduces low-density lipoprotein (bad cholesterol), increases high-density lipoprotein (good cholesterol), and decreases triglycerides.”

Niacin lipid efficacy

One of the benefits of niacin over statins is it (niacin) raises HDL, lowers triglycerides, and improves LDL particle size.

Statins only lower LDL, but don’t really change the overall lipid profile for the better. They can also be hard on your liver and can cause muscle weakness and myopathy by lowering CoQ₁₀ levels in the body.

Statins have also been shown to increase the risk of developing diabetes and an increased risk of hemorrhagic stroke.

“They (statins) have a limited effect on HDL-C, whereas niacin reduces triglycerides (TG) and all atherogenic apo-B-containing particles as well as increasing HDL-C.”

Effect of Extended-Release Niacin on High-Density Lipoprotein (HDL) Functionality

Why do doctors prescribe statins much more than niacin?

Most doctors are consumed by the total cholesterol numbers on blood tests and statins lower total cholesterol more than niacin. Additionally, some of the studies have shown mixed results on how effective raising HDL is to long-term cardiovascular mortality rates.

Most people that take regular niacin quit taking it because of the uncomfortable flushing affect (non compliance).

I don’t think a lot of doctors know about the extended-release version of niacin. Unfortunately, they typically prescribe regular niacin and most people don’t stay with it. Like we discussed earlier, regular niacin is not well tolerated.

Unfortunately the medical community kind of wrote off niacin after the drug companies started pushing statins.

The best niacin supplement is the one you can stick with.

Marketing can’t be ruled out either. Drug companies invest billions of dollars in statin drugs and pay a lot of money on television advertisements. The drug companies also send out an army of “representatives” to the hospitals to convince doctors to prescribe their statin drugs.

Out of the 2,444 doctors in the Medicare prescribing database, almost 37 percent received industry payments.

The drug companies also fund numerous studies to show the benefits of their products. No one is going to make any money from a generic vitamin such as niacin that can’t be patented.

Statins are the most widely prescribed drugs in the world. The massive pharmaceutical company Pfizer’s total revenue in 2019 was about 51.8 billion U.S. dollars.

Lipitor is the most profitable drug in the history of medicine. 

Before Pfizer’s Lipitor patent ran out in 2006, it exceeded $13 billion in annual profits.

Niacin is good for keto because it’s natural and can also raise NAD levels.

”Insight into the role of niacin and various NAD-related diseases ranging from cancer, aging, and metabolic diseases to cardiovascular problems has shifted our view of niacin as a vitamin to current views that explore its potential as a therapeutic.”

Niacin: National Library of Medicine

Niacin is a nutritional precursor of the bioactive molecules nicotinamide adenine dinucleotide (NAD).

“The hypothesis is that an NAD+ precursor, niacin, will increase intracellular NAD+ levels, improve mitochondrial biogenesis and alleviate the symptoms of mitochondrial myopathy in humans.”

Clinical Trials.gov

A benefit of niacin is it might improve ones health-span.

I wrote an article on how to increase your lifespan and health-span, but didn’t explore increasing NAD levels.

Supplementing with Niacin has potential in raising NAD levels in the body.

NAD exists in all living cells and is a vital link between signaling and metabolism. NAD levels decline during the aging process and this decline plays a direct role in the development of metabolic dysfunction and age-related diseases.

It (NAD) is vital for genetic stability, increasing metabolic efficiency, and slowing the aging process. In this controlled study titled, “Niacin Supplementation”. Niacin, in the form of B3, at between 750 to 1000 mg/day for 4-10 months increased blood NAD levels in all subjects up to 8-fold.

 What about niacinamide riboside (NR) and nicotinamide mononucleotide (NMN)?

The study quoted below shows that niacinamide riboside (NR) does raise NAD levels. However, the study does have a conflict of interest. It’s published by the inventor of patents licensed by ChromaDex and owns stock in ChromaDex. ChromaDex has a patent on niacinamide riboside (NR) in a product called TRU NIAGEN.

I am not insinuating that TRU NIAGEN doesn’t raise NAD or anything, however, I am a little skeptical. Furthermore, it’s expensive, to get the 1 gram dose as in the study would cost you over $100 a month. Each tablet of TRU NIAGEN is only 300 mg so you would have to take at least 3 tablets a day.

“We supplemented 12 aged men with 1 g NR per day for 21 days in a placebo-controlled, randomized, double-blind, crossover trial. Targeted metabolomics showed that NR elevated the muscle NAD⁺ metabolome, evident by increased nicotinic acid adenine dinucleotide and nicotinamide clearance products.”

Nicotinamide Riboside Augments the Aged Human Skeletal Muscle NAD

Putting all that in perspective it looks clear to me that niacin is good for keto and the best niacin supplement is the extended-release niacin.

On a side note, during my research, I learned that smoking cigarette has a detrimental effect on HDL cholesterol levels. It has been shown in one study that HDL-C falls by 20% six hours after smoking and that this effect persists at 24 hours.

What foods are high in Niacin?

Here’s the cool part. Almost all the foods that are high in niacin are also keto-friendly including my favorite keto-friendly peanut butter. Additionally, just out of coincidence, a lot of these foods are also included in my top keto superfoods list.

You can also get a lot of these foods while shopping for keto at Costco.

Here are foods highest in niacin:

• Beef liver
• Chicken
• Mushrooms
• Tuna
• Salmon
• Veal
• Sardines
• Grass-fed beef
• Peanuts
• Avocados
• Sweet potatoes
• Green peas
• Asparagus

To get the real benefits of niacin on keto you’re going to have to take niacin supplements.

One of the foods with the highest amount of niacin is beef liver. But, that only has 14.7 mg of niacin per 3 ounces. So you probably couldn’t or wouldn’t want to eat enough liver to give you cardiovascular benefits.

I can’t recommend a dosage, instead, I would ask you to talk to your doctor about it and be sure to get routine liver enzyme tests done. Also, increase your dosage gradually and take a break from niacin supplementation now and then to give your liver a break.

Niacin and keto: how it helped me.

Real life experience supplementing with Niacin.

My HDL has traditionally been very low. I tried statins to no avail and then tried regular niacin, but couldn’t handle the niacin flush. Looking in the mirror, I looked like Hell Boy I was so red.

After watching a great video by Dr. Brad Stanfield (see above) on Niacin, I learned and about sustained-release niacin. I started out with 500 mg once a day and worked my way up to 1000 mg a day.

I took niacin ER for about 3 months before bed and just Monday through Friday. After taking niacin all week I decide to give my liver a rest on the weekends.

After 90 days on niacin my HDL went from 35 to 42 and my liver enzymes were fine.

I’ve had good success taking niacin ER. I was really surprised my HDL went up so much. Check back often and I’ll try to keep this post updated and let you know how it goes long term.

So far, so good with niacin and the keto diet!

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