Niacin is a B vitamin that can lower cholesterol as part of a doctor-recommended treatment plan. Other supplements may also help, including berberine and fish oil.

Cholesterol is a waxy substance that circulates in the blood. There are two main types of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Sometimes, people call LDL “bad” cholesterol and HDL “good” cholesterol.

LDL takes cholesterol and fats, such as triglycerides, to the cells that need them. HDL takes excess cholesterol and fats to the liver, which removes them from the body. When there is more LDL cholesterol than the HDL cholesterol can remove, it stays in the blood.

When this happens, fatty deposits called plaque can build up in the arteries. Plaque consists of cholesterol, cellular waste products, calcium, fibrin, and fatty substances.

This plaque build-up can increase the risk of cardiovascular diseases (CVDs) such as heart attacks and strokes.

Vitamins are substances, usually present in food, that the body needs to develop and function. Niacin is a vitamin that can help lower LDL cholesterol levels. However, people should not start taking it without speaking with a doctor first.

This article will examine how niacin helps lower a person’s cholesterol. It also looks at other supplements a person may take, safety precautions, and alternatives to cholesterol.

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Niacin, or nicotinic acid, is a B vitamin that can help to lower cholesterol.

Although niacin is naturally present in certain foods, there are two types of dietary niacin supplements. These are nicotinic acid and nicotinamide. A doctor may prescribe prescription-strength nicotinic acid to treat high cholesterol.

The American Heart Association (AHA) states that nicotinic acid limits the production of fats in the liver. This lowers the levels of triglycerides and, as a result, lowers LDL cholesterol.

However, the Office of Dietary Supplements (ODS) notes that although niacin can reduce LDL cholesterol, it does not significantly affect a person’s risk of developing a cardiovascular event.

Prescription-strength nicotinic acid is over 100 times the recommended daily allowance, and as a result, people should only take niacin under the approval and supervision of a doctor.

Dose

People should take the medication at bedtime after eating a low fat snack.

A doctor typically prescribes 500 milligrams (mg) for 1–4 weeks to reduce the chance and severity of the side effects. They may then increase the dose to 1,000–2,000 mg daily, depending on the individual’s needs.

The AHA notes that the Food and Drug Administration (FDA) does not regulate niacin in the form of dietary supplements. These products may contain higher or lower doses of niacin than stated on the label. Always consult a doctor before taking niacin.

A person should never take the dietary supplement version of niacin to replace prescription niacin. This is because it can lead to serious side effects.

The ODS states that if a person takes daily dietary supplements that contain 30 mg or more of nicotinic acid, they can develop the following:

Those who take 1,000 mg or more of nicotinic acid daily as a medication can experience:

As niacin can raise a person’s blood sugar levels, it may not suit those with diabetes. High doses of niacin may also not be suitable for those who take statins.

Other dietary supplements that may help to lower cholesterol include:

Omega-3 polyunsaturated fatty acids (PUFA)

Omega-3 PUFAs, also known as omega-3 fish oils or omega-3 fatty acids, can help reduce the levels of triglycerides fats in the blood.

Omega-3 PUFAs are present in foods such as oily fish, seeds, and nuts. Supplements are also available. The AHA recommends people only use these supplements under their doctor’s care.

Large doses can cause serious side effects, including:

  • bleeding
  • stroke

In people with diabetes, omega-3 PUFA supplements can make it more difficult to control their blood sugar levels. People with fish or shellfish allergies may have an allergic reaction to omega-3 PUFAs.

Berberine

Berberine comes from plants such as goldenseal, barberry, Oregon grape, and tree turmeric.

Some studies have shown that it may be able to reduce levels of LDL and triglycerides in the blood when combined with a healthy lifestyle. However, researchers are not yet sure if this will work for everyone.

The possible side effects of berberine include:

Flaxseed

Flaxseed contains α-linolenic acid, lignans, and phenolic compounds, which can lower LDL and triglycerides in the blood.

The dietary supplement form of flaxseed is usually an oil.

Other ways to lower cholesterol include:

Eating a balanced diet

The best way for a person to help lower their cholesterol level is to limit the amount of total and saturated fat they eat.

Saturated fat raises LDL levels more than any other food. Red meat, dairy, chocolate, deep-fried and processed foods all contain high levels of saturated fat.

Exercising more

Exercise can increase the levels of HDL cholesterol in the blood. The AHA recommends that adults get at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous aerobic activity each week.

Taking prescription medicines

There are lots of prescription medications for people with high cholesterol. They include:

  • statins
  • cholesterol absorption inhibitors
  • bile acid sequestrants
  • PCSK9 inhibitors
  • adenosine triphosphate-citrate lyase (ACL) inhibitors

The right treatment approach will depend on the individual. That is why it is important for people to speak with their doctor if they are concerned about their cholesterol.

The body needs a balance of LDL and HDL cholesterol. However, eating foods high in saturated fats can upset this balance, adding to CVD risks.

Niacin is a vitamin that can help lower LDL cholesterol. However, people should only take niacin under the supervision of a doctor because it can lead to severe side effects.