Niacin, or nicotinic acid, is a B vitamin that the body needs to help turn food into fuel. The recommended dietary allowance (RDA) for niacin for men is 16 mg per day, and for women, 14 mg per day. The Upper Tolerable Limit (UL) for niacin is 35 mg per day if niacin is consumed either in supplement form or in niacin-fortified foods. Key food sources of niacin include dairy foods, lean meat, poultry, fish, nuts, and eggs.
Niacin is also sometimes prescribed in much larger doses — up to 2,000 mg, or 2 grams, taken two to three times a day — to increase HDL cholesterol (by 15% to 35%), with secondary effects of lowering LDL and triglycerides. Prescription niacin can be taken along with a statin or a bile acid resin for further LDL reduction. Some common brand names of prescription niacin are Niacor, Niaspan, and Slo-Niacin.
While consuming the RDA for niacin in foods or vitamin supplements is safe (but will likely have no effect on your HDL cholesterol level), you should never take large doses of niacin on your own without checking first with your doctor. Side effects of prescription-strength niacin can include flushing (redness of the face and neck), stomach upset, itching, high blood glucose, and liver damage.
Red yeast rice
Red yeast rice is a fungus that grows on rice. It’s been used in Asian countries both as a medicine (for various ailments) and as a food coloring (for Peking duck, for example) for hundreds of years.
Interest in red yeast rice in the United States has grown in recent years because of its ability to block the production of cholesterol by the liver. This ability is due, in part, to a substance called monacolin K, which is a “natural” form of lovastatin, a prescription drug used to lower LDL cholesterol. Red yeast rice is essentially a lower-dose type of statin. As a result, many people who either cannot tolerate the side effects of prescription statins or who do not want to take them for other reasons have turned to red yeast rice.
A study published in 2009 in the Annals of Internal Medicine showed that people who were unable to tolerate statins because of muscle pain were able to tolerate 1800 mg of red yeast rice twice daily for 24 weeks, with an average drop in LDL of 35 mg/dl. A study done in China showed that red yeast rice lowered heart disease risk by 30% after study subjects took the supplement for about 4 1/2 years.
The catch is that red yeast rice is sold as a dietary supplement in the United States, not as a drug. That means that the FDA does not regulate it for quality, safety, or effectiveness. An analysis of 10 brands of red yeast rice capsules done by ConsumerLab.com in 2008 found that there was wide variation in red yeast rice content from brand to brand. And given the fact that red yeast rice is essentially a low-dose statin, possible side effects are similar to those of statins, including muscle pain or tenderness that can lead to kidney damage, flulike symptoms, dark-colored urine, difficulty with urination, upset stomach, bloating, and headache.
In 2007, the FDA asked the manufacturers of three red yeast rice supplements — Red Yeast Rice, Red Yeast Rice/Policosanol Complex, and Cholestrix — to withdraw their products from the US market, citing them for containing “unauthorized” lovastatin. However, people are still able to obtain this supplement with smaller amounts of the “natural” lovastatin.
As tempting as it can be to take something that’s natural and effective, it’s wise not to take this supplement without first talking with your doctor. People who decide to take red yeast rice should have their liver enzymes checked about six weeks after starting it and then every six months thereafter. If any of the side effects listed above occur, anyone taking red yeast rice should call his doctor.