In order to avoid the flushing linked with niacin, the tolerable upper limit is set at 35 milligrams per day, according to the Office of Dietary Supplements (ODS). Higher doses, which are effective for reducing blood lipid levels, may cause flushing in the face and upper extremities.
As an alternative, nicotinamide does not cause flushing, but this also does not have the same cholesterol reduction activity.
New data from Patrick Moriarty, MD, and his co-workers indicated that taking a dose of apple pectin prior to a high dose of niacin can prevent flushing to the same extent as an aspirin.
Writing in the Journal of Clinical Lipidology, the Kansas-based scientists state: “Although larger studies are needed to further support our pilot findings, there are potential applications from our study for clinical practice.
“Because pectin is a common product considered to be extremely safe and possesses no dose limitations according to the Food and Agriculture Organization/World Health Organization, having patients consume dietary pectin (eg, apple), use a quality pectin supplement immediately before the administration of niacin, or encapsulating niacin with pectin, may limit niacin-induced flushing.”
One hundred niacin-naïve subjects were recruited to participate in their study. Participants were randomly assigned to one of four groups to receive either apple pectin, apple pectin plus aspirin, aspirin only, or placebo, followed by a single high-dose of extended-release niacin (1,000 milligrams, ‘Niaspan’, Abbot Laboratories).
Funding for this study was provided by Abbott Labs.
Results showed that both pectin and aspirin significantly lowered the duration of flushing, as well as other flushing parameters, compared with placebo.
Commenting on the potential mechanism, the researchers note that the pectin may be affecting niacin absorption by slowing gastrointestinal transit time, with other studies reporting that pectin can increase the time that it takes for food to pass through the stomach and intestine.
“It is likely the apple pectin prolonged the absorption time of [the extended release niacin] beyond the standard 8–12 hours, thereby resulting in a reduction of flushing symptoms,” they added.
Source: Journal of Clinical Lipidology
Published online ahead of print, doi: 10.1016/j.jacl.2012.11.005
“Apple pectin for the reduction of niacin-induced flushing”
Authors: P.M. Moriarty, J. Backes, J-A. Dutton, J. He, J.F. Ruisinger, K. Schmelzle