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In a past column you recommended replacing Lipitor with either omega-3 fish oil capsules or niacin. I have elected to try the niacin. You said to START with 500 milligrams per day and I have done this for a couple of weeks. Now I want to increase the dosage but don’t know what to increase it to. Should I go to 1000, 1500 or 2000 mg? Maybe more? Also, how long should I stay on the niacin? I would also like to know your opinion on red yeast rice. I have noticed that you don’t mention it.

Niacin is an excellent alternative choice for lowering cholesterol levels. I often recommend patients to start with a relatively low-dose of 250-500 mg daily and then slowly work up to 1000-1500 mg daily, usually in increments of 250 mg. This is primarily to allow the body to become accustomed to the vitamin and reduce the chance of side effects, namely, flushing.

It is important also to have your cholesterol level checked every few months, as well as liver function, to ensure that the medication is working and not causing any damage.

Some individuals are very sensitive to the medication and cannot tolerate it well. For these individuals, I recommend omega-3 oils or flaxseed oil. These do not, to my knowledge, have any side effects but cholesterol testing is still important to determine if the medication is working. If that fails, try combining therapy such as niacin and flaxseed oil daily. This can also reduce the dosage of the niacin leading to a smaller incidence of side effects.

As for red yeast rice, I do not recommend it because it is basically a natural form of the drug Mevacor which is a statin. It is more likely to cause side effects similar to those of other statins, such as muscle/joint pain and liver damage.

To give you related information, I am sending you copies of my Health Reports “Understanding Cholesterol” and “Dr. Gott’s Compelling Home Remedies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure mention the title.

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