Niacin's Impact on Blood Sugar Levels in Seniors

Issues related to niacin?

Hello Doctor, my mother is 62 years old.
A year ago, she was recommended to take niacin supplements.
Recently, she underwent a health check-up, and her coronary artery calcium score was 3.
Her cholesterol levels are normal, but her fasting blood glucose was 118, and her hemoglobin A1c was 6.2.
For the past year, her hemoglobin A1c has consistently been around 6.2, but her fasting blood glucose has been steadily increasing from 95 to this latest 118.
She is very concerned and recalls that she has been taking niacin (which some say is vitamin B3).
I found online that it might affect blood glucose levels.
I would like to ask if stopping the niacin could help bring her levels back to normal.
My mother is very careful with her diet; for breakfast, she eats steamed buns but discards half of the skin.
For lunch and dinner, she has half a bowl of brown rice with sufficient vegetables and meat, a cup of unsweetened yogurt daily, only drinks water, and eats low-sugar fruits like guava and apples.
Her snacks between meals consist of a piece of soda cracker.
She is 160 cm tall and weighs only 44 kg.
She has always been very disciplined with her eating habits, and if her fasting blood glucose is 118, she feels helpless because she is already eating very little.
How long would you recommend she stop taking niacin before retesting her blood? Thank you.

Xiao Zhen, 30~39 year old female. Ask Date: 2019/05/03

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Xiao Zhen,
1.
Clinically, Niacin can be used as a medication; Niacin is also known as vitamin B3.
Its primary function is to reduce VLDL levels, as LDL is synthesized from VLDL.
Therefore, Niacin also lowers LDL levels in patients, meaning it can reduce bad cholesterol.
Some studies have reported that Niacin can decrease LDL (the "bad" cholesterol carrier) concentrations by 10-20% and is the most effective medication for increasing HDL (the "good" cholesterol carrier).
Thus, Niacin is mainly used to lower cholesterol and triglyceride levels in the blood and to raise HDL levels.
2.
The most common side effects of Niacin treatment are severe skin flushing (accompanied by uncomfortable feelings of warmth) and pruritic rashes.
Some patients may also experience nausea and abdominal pain.
Niacin can inhibit renal tubular secretion of uric acid, potentially leading to hyperuricemia and gout.
Abnormal glucose tolerance and hepatotoxicity have also been reported.
3.
Generally, if the increase in blood sugar or adverse tolerance is caused by Niacin, it should theoretically return to normal after discontinuation of the medication.
Your mother's fasting blood glucose of 118 mg/dL and hemoglobin A1c of 6.2% are actually quite acceptable.
The measurement of hemoglobin A1c typically requires an interval of at least six weeks.
4.
However, your mother's issue may not necessarily be caused by Niacin; there could be other underlying reasons that need clarification.
Therefore, I recommend that you have a thorough discussion with her attending physician, as diabetes management is a very complex matter.

Reply Date: 2019/05/03

More Info

Niacin, also known as vitamin B3, is a water-soluble vitamin that plays a crucial role in energy metabolism and the functioning of the nervous system. It is commonly used to manage cholesterol levels, as it can effectively lower low-density lipoprotein (LDL) cholesterol (often referred to as "bad" cholesterol) and increase high-density lipoprotein (HDL) cholesterol ("good" cholesterol). However, one of the lesser-known side effects of niacin is its potential impact on blood glucose levels.

In your mother's case, her fasting blood glucose level has risen to 118 mg/dL, and her hemoglobin A1c (HbA1c) is at 6.2%, which indicates that she is in the prediabetic range. It is understandable that she is concerned, especially given her careful dietary habits. Research has shown that niacin can impair glucose tolerance and may lead to increased blood sugar levels in some individuals. This effect is particularly relevant for those who may already be predisposed to insulin resistance or have a history of glucose metabolism issues.

Given that your mother has been taking niacin for an extended period, it is plausible that it could be contributing to her elevated blood sugar levels. The good news is that if niacin is indeed the culprit, discontinuing its use may help her blood glucose levels return to baseline. Typically, it can take several weeks for the body to adjust after stopping a medication or supplement, so it would be advisable to wait at least six weeks after discontinuation before retesting her blood glucose levels.

However, it is essential to consider that other factors could also be influencing her blood sugar levels. These may include her overall diet, physical activity levels, stress, and any other medications she may be taking. Even with a careful diet, the body’s response to food can vary significantly from person to person, and factors such as age, hormonal changes, and metabolic health can all play a role.

In terms of dietary management, it seems that your mother is already following a low-sugar and balanced diet, which is commendable. However, it may be beneficial for her to consult with a registered dietitian or a healthcare provider who specializes in diabetes management. They can provide personalized advice and help her make any necessary adjustments to her diet or lifestyle to better manage her blood sugar levels.

In summary, if your mother decides to stop taking niacin, it would be wise to wait at least six weeks before retesting her blood glucose levels to assess any changes. Additionally, it is crucial to have an open discussion with her healthcare provider to explore all potential factors affecting her blood sugar and to ensure that she receives comprehensive care tailored to her specific needs. Regular monitoring and a proactive approach to her health will be key in managing her blood sugar levels effectively.

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