Apple pectin for the reduction of niacin-induced flushing

Background Niacin, or vitamin B3, when used in high doses can significantly improve the levels of all major lipoproteins. Despite these benefits, the use of niacin is greatly limited secondary to benign yet bothersome cutaneous flushing primarily involving the face and upper extremities. Pretreatment with aspirin or other prostaglandin inhibitors has demonstrated significant reductions in niacin-induced flushing (NIF), but other treatment options are needed. Clinical and anecdotal evidence suggests the ingestion of pectin-containing fruits (eg, apple) mitigates NIF; however, clinical trials evaluating this are nonexistent. Objective That pretreatment with encapsulated apple pectin would limit the incidence, severity, time of initiation, and duration of NIF. Methods We enrolled 100 niacin-naive subjects (n = 25 per group) and preteated them in a double-blind manner with apple pectin, apple pectin + aspirin, aspirin, or placebo, followed by a one-time 1000 mg dose of niacin extended-release (niacin ER). Subjects then assessed major flushing parameters hourly for the next 6 hours with a validated visual analog scale. Results Apple pectin and aspirin each significantly lowered the duration of NIF and produced nonsignificant but positive improvements in all other major flushing parameters compared with placebo. Conclusion Apple pectin may potentially be an alternative to aspirin for the prevention of NIF. Larger trials are needed to further evaluate the benefit of pectin on NIF.