The niacin flush was uncomfortable for about an hour the first week or so, but almost never as bad as you describe. To reduce flushing, take the niacin immediately after a meal to slow absorption. The flushing should mostly go away in about a week, but some will remain as you progressively up the dose to 1000 mg twice a day. Niacin flush isn't an issue at all for me anymore, even if taken on an empty stomach.

If the flushing is intolerable even if taken with meals, you might try cutting back to 250 mg. twice a day. Here's a schedule similar to why my cardiologist had me do (I started at 500 mg. twice a day).

- 250 mg. twice a day for two weeks, then
- 250 mg in the AM and 500 in the PM for two weeks
- 500 mg in the AM and 500 in the PM for two weeks
- 500 mg in the AM and 1000 in the PM for two weeks
- 1000 mg in the AM and 1000 in the PM for the duration.

Be sure to get a lipid panel after a month or so at 2 gm. a day to see how the niacin is helping. My cardiologist has added red rice yeast to my regimen, but I haven't tested since starting it.

It goes without saying, but is worth repeating and keeping in mind that if you take niacin or any other cholesterol controlling supplement, but eat a low-fiber, high carb and high fat diet, have a lot of stress in your life, and don't exercise enough, the rest of your life will overwhelm what niacin can do to help your cardiac health.

My cardiac heredity is so bad that it's tough to get the HDL levels up no matter what. I have a lot of motivation to do all I can to prevent my wife from becoming a widow or full-time caretaker anytime soon.