Is Niacin (Nicotinic Acid) Safe?

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by Nils Osmar. Updated November 6, 2022.

Niacin — the nicotinic acid form of vitamin B3– has a number of possible health benefits. It’s been found to increase NAD+ levels, raise HDL, lower LDL and lower triglycerides.

The NAD+ connection

Many people in the anti-aging community are following David Sinclair’s lead and trying to raises their NAD+ levels. Taking precursors (which the body assembles into NAD+) is one approach. But their effects are not identical in the body. Some popular NAD+ boosters include:

  1. NMN (nicotinamide mononucleotide)
  2. NR (nicotinamide riboside)
  3. NAM (niacinamide, also known as nicotinamide) ( Note: David Sinclair considers this form dangerous because some studies have shown that it switches off the sirtuin genes) (It’s actually used medically when doctors want to lower sirtuin activation.) (For this reason, I’m no longer taking it myself.)
  4. NA (niacin, also known as nicotinic acid)

Some of niacin’s benefits

Every supplement has possible benefits and possible side effects. Niacin is no exception.

Its benefits include the fact that it raises NAD levels, lowers lowers LDL and triglycerides, raises HDL, and increases human growth hormone (not to artificially high levels, but closer to those found in young adults). See study: Niacin: an old lipid drug in a new NAD+ dress.

Its side effects are also worth being aware of.

The niacin flush

One side effect is that niacin can cause a sudden and severe flush due to the dilation of blood vessels.

A severe flush will (or may, depending on the dose you take) turn your skin beet-red for as long an hour. You may feel waves of heat radiating from your body due to your blood vessels dilating – and feel chilled afterwards as the flush passes. I actually knew someone once who called 911, who sent an ambulance, when she started flushing — she had not realized it’s a harmless side effect and assumed that she was having a stroke. I don’t personally consider the flush harmful, and I don’t actually mind it most of the time. But some people dislike it intensely and avoid niacin because of it.

According to an article called “The effect of aspirin on niacin-induced cutaneous reactions“, taking a baby aspirin along with niacin will reportedly prevent the flushing – but may also prevent most of niacin’s lipid-lowering benefits. Other drugs (in addition to aspirin) can also blunt the flushing effect – but may also be negating niacin’s benefits according to this article.

Niacin has also been found to increase uric acid levels in the body.

Niacin raises blood glucose — and can trigger diabetes

Niacin’s effect on blood glucose is a bigger and more serious concern (to my mind) than the flush.

According to a study called “Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomised controlled trials” which was published in the British Medical Journal, niacin raises blood glucose enough to move people into pre-diabetes or even diabetes, if large amounts are taken over a long period of time.

According to a study called “Clinical and Research Information on Drug-Induced Liver Injury“, the sustained-release form of niacin can cause liver damage, when taken in a large dose over a prolonged period of time. (This is less likely with the immediate-release (IR) version.)

What I’m currently doing

I used to take niacin to raise NAD+ levels, but switched to taking NMN. I’m currently taking NMN every day (1.5 grams), early in the morning, either with water (if I’m fasting) or along with a fasting mimicking smoothie. (My current source for NMN is DoNotAge. Their bulk NMN powder is about $1 a gram when using the discount code PATHWAYS)

I’m also a fan of niacin (in spite of the flush) and do take it sometimes, not for NAD+ boosting (it’s less effective than NMN), but to keep my cholesterol levels well balanced. But I’m cautious about taking it and keep the dose low. The niacin I’m taking is manufactured by NOW foods.

To prevent blood glucose problems, I take some Ceylon cinnamon or benfotiamine or berberine or metformin or chromium along with it.

To prevent uric acid problems, I eat some parsley, which lowers uric acid levels, along with it. See the study, “Effects of Parsley (Petroselinum crispum) and its Flavonol Constituents, Kaempferol and Quercetin, on Serum Uric Acid Levels

To be proactive against liver damage, I avoid all of the sustained-release forms of niacin, and take milk thistle, which has been found to be liver-protective, with immediate release niacin.

The amount I’m taking is not enough to significantly raise NAD+. So I do the other things known to raise NAD levels which I’ve listed below.

Ways of raising NAD+

NMN and NR both raise NAD levels without causing a flush or increasing blood sugar. So as I mentioned above, I take both. Other ways of maintaining high NAD+ levels include:

  • doing lots of fasting
  • taking hot/cold contrast showers (to trigger heat shock and cold shock)
  • taking ice baths (just for cold shock)
  • doing HIIT exercise and resistance training
  • taking saunas
  • eating parsley or chamomile, or taking apigenin supplements.

Not medical advice

This article is not intended as, and should not be taken as, medical advice. I’m not advising that people eat any particular diet or take any particular supplements, just reporting on what I’m doing. All supplements can have side effects; I would encourage people to research both possible benefits and side effects before starting on any supplementation regimen.  See full Medical Disclaimer

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