Can Niacin Fight Heart Disease?

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i had a dr tell me ..he himself had low HDL and had taken niacin for years but stopped..he said niacin can cause gout as well as ulcers i think he said. i was taking it and he advised i stop. am trying the bergamot now and just did lipids today
 
Brooksy Chuck said:
i had a dr tell me ..he himself had low HDL and had taken niacin for years but stopped..he said niacin can cause gout as well as ulcers i think he said. i was taking it and he advised i stop. am trying the bergamot now and just did lipids today
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Niacin can raise serum uric acid levels which can eventually cause or worsen gout. I also monitor uric acid which has been normal. I think this is in certain cases, but not across the board. Certainly niacin is a far safer bet than any statin drug on the market. I have been taking the bergamot as well. We'll see.
 
what a good simple solution to monitor uric acid! i need to remember this for next year! will keep ya posted how my levels look.. oh i also started some prescription fish oil.. called lovaza.. since i hit my out of pocket max for the year i figured i might as well give it a shot for free!
 
Brooksy Chuck said:
what a good simple solution to monitor uric acid! i need to remember this for next year! will keep ya posted how my levels look.. oh i also started some prescription fish oil.. called lovaza.. since i hit my out of pocket max for the year i figured i might as well give it a shot for free!
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I think Lovaza is overrated. You don't need prescription FO when you can get better products OTC, but hey, it's FREE, so WTF, right? The biggest debate is whether FO is itself already oxidized prior to encapsulation. It all depends on the mfg. process. To cover yourself, make sure you're taking in adequate gamma tocopherol to prevent oxidation. I use both a very high quality (high EPA) FO called Kirunal http://www.bodybio.com/storecategory109.aspx and even better is Krill Oil. The one I use has extra astaxanthin:
http://www.jonnybowden.com/xanthomega-krill-oil-120-gels
The naturally-occuring phospholipids and astaxanthin automatically protect the oil from rancidity/oxidation.

I am going to import a special product that isn't available in the States called tocopheryl nicotinate - a mix of E and niacin - that is said to yield some amazing results on lipid profiles, specifically, the most dangerous one - Lp(a).
 
keep us posted. i am so focused on prepping for surgery the lipids have taken a back burner.. will try to keep checking in and to see what you have found to work!
 
I think the thought on this has changed a bit over the past 3-4 years. My first cardiologist had me on 1500 3 years ago. A year and a half ago, I switched docs and at first he continued the 1500 but on my second visit, he suggested I discontinue siting a study that called into question the benefits of Niacin. We compromised and I continued with 1000 to this day but I don't think he believes that its beneficial. I am going clarify all of this with him later this summer when I visit. I am on Lipitor although I wish I did not need it. For some, its the only way to get our cholesterol levels into a reasonable range, although, as I have known for years, limiting Coronary Artery Disease is more about limiting sugar and carbohydrates than limiting fats and getting a cholesterol score in the low 100s. I would love to drop both Niacin and Lipitor but I just don't think it would be a good idea. If you do....please weigh in.
 
The studies that showed the biggest benefit of niacin was done with immediate release niacin. A few actually showed atherosclerosis regression. I used to work for Abbott labs and they had the product Niaspan, so I knew this area well 6 years ago.
 
“My doctor told me that niacin is dangerous. But I read that niacin increases good HDL cholesterol, and my HDL is low. Who should I believe?”
Your doctor would be right—if it were 1985.


We’ve learned how to use niacin effectively and safely since then. Unfortunately, many physicians have not yet caught up, or are still trapped by the idea that statin drugs are the one and only answer. I’ve personally given niacin to thousands of patients as part of our coronary disease reversal program. In fact, niacin is the closest we have available to a perfect treatment that corrects most of the causes behind coronary heart disease.


Niacin is vitamin B3, also called “nicotinic acid”. It’s found naturally in red meats, chicken, turkey, beans, and grains. Niacin is a required nutrient and member of the B-vitamin family. Have you ever taken a B-complex vitamin pill that triggered a strange burning skin sensation? If you have, that’s the niacin. Niacin plays a crucial role in body processes including energy generation, gene expression, and hormone synthesis. Humans cannot exist without niacin.
The Recommended Daily Allowance (RDA) of niacin to prevent pellagra is 16 mg per day for males, 14 mg per day for females. Niacin deficiency, pellagra, was widespread in the U.S. during the 19th century, but is now long-forgotten and rarely seen.
However, when niacin is taken at doses greater than the RDA, an array of health benefits develop. Niacin:
· Increases HDL cholesterol—30–40%. No other available treatment, prescription or over-the-counter, is as effective.
· Decreases small LDL particles—A major and underappreciated cause of heart disease. Niacin is the most effective agent known for this abnormal pattern.
· Decreases triglycerides—by 30%; especially effective when taken with fish oil (e.g., 4000 mg per day to provide 1200 mg EPA+DHA)
· Decreases very-low density lipoprotein (VLDL) particles
· Decreases lipoprotein(a)—Among the most serious of heart disease risk factors, no other treatment approaches the power of niacin to reduce this genetically-determined pattern.
· Decreases LDL cholesterol—Usually by 20–40 mg/dl

Niacin blocks release of fatty acids from fat cells. Less fatty acids are therefore passed to the liver, resulting in fewer VLDL particles. Less VLDL leads to less small LDL and higher HDL.[SUP]1[/SUP]

Niacin’s benefits are not just in numbers. Niacin reduces heart attack risk dramatically. The Coronary Drug Project was the first to establish niacin as a powerful agent to slash heart attack risk. 8,000 heart attack survivors were given 3000 mg of niacin (“crystalline”, or immediate-release) over six years. Treatment with niacin reduced heart attacks by 27%, strokes by 26%.[SUP]2[/SUP]

In the famous HDL-Atherosclerosis Treatment Study (HATS), 160 participants were given niacin and simvastatin (Zocor®), or placebo. When the group receiving simvastatin and niacin were compared to the placebo group, there was a 90% reduction in death and myocardial infarction over three years.[SUP]3[/SUP] In other words, coronary events were nearly shut off. Small numbers but persuasive. In comparison, the statin drugs alone reduce heart attack by 25-35%. The 90% achieved in the HATS Trial is therefore truly phenomenal.


Despite its track record, many physicians have never really learned how to use niacin effectively. The statin drugs have caused many physicians to forget how effective niacin can be. That’s a shame, because niacin can be a powerful strategy to combat heart disease, either by itself or in combination in with other treatments (especially fish oil).


Niacin’s record for safety is equally impressive. However, a brief foray into use of very slow-release niacin preparations in the 1980s taught us an important lesson about niacin: Niacin is very safe if the liver is exposed for a few hours at a time. Niacin is, after all, just vitamin B3. However, 24-hour, day-after-day exposure can be toxic to the liver over a long period. Thus, the very slow-release niacin preparations that yielded sustained high blood levels of niacin around-the-clock caused liver toxicity in 10–20% of people when these preparations were used in the 1980s. Unfortunately, this learning experience left some less-than-well-informed physicians fearful of niacin.

For this reason, very slow-release niacin that trickles niacin out over a long period should not be used.


What forms of niacin are safe? They are:

Immediate-release, or “crystalline”, niacin
Extended- or intermediate-release niacin

Immediate-release or crystalline niacin is available as a nutritional supplement. It’s inexpensive and effective. However, the niacin in each table is released immediately and usually provokes an annoying “hot flush” (see below). For this reason, starting at small doses, e.g., 250 mg, helps. The dose can be increased gradually, e.g., 250 mg every four weeks, to achieve the dose you desire. Doses greater than 500 mg should be taken with medical supervision. Some people take their niacin in small doses three or four times per day to spread out the dose. This is unsafe. Never take immediate-release niacin more than twice a day.


Extended- or intermediate-release niacin are time-release preparations, but not as slow as slow-release. This has made them safer than the slow-release preparations that can cause liver side-effects. It also provokes less hot flush than immediate-release. Over-the-counter Slo-Niacin®, is one such preparation and has been proven to be safe (Brown 2001). Niaspan® (Kos Pharmaceuticals) is a prescription extended-release preparation.



Slow-release niacin preparations reduce the hot flush effect by trickling niacin out over an extended period of 12 or more hours. Most preparations are unsafe and I do not recommend them.


“No-flush” niacin, or inositol hexaniacinate, and nicotinamide are two preparations that yield no effect whatsoever. They are widely sold as niacin alternatives that spare you the hot flush, but they simply don’t work. No flush, no effect.

The dose of niacin to achieve depends on what abnormality you and your doctor are trying to correct. To raise HDL and correct small LDL, a dose of 750–1000 mg usually provides full effect. An increase to 1500 mg provides slightly more benefit. For reduction of LDL or Lp(a), higher doses of 1000 mg up to 4000–5000 mg per day can used, with the higher the dose, the greater the effect. However, doses this high should only be taken with the guidance of a physician. Keep in mind that full lipoprotein benefits of niacin often require a year or more to fully develop. Sometimes patience is required.

The one common though generally harmless hurdle with niacin use is the dreaded “hot flush”. It’s bothersome enough that some people to want to flush niacin down the toilet!



The flush feels like blushing when you’re really embarrassed, accompanied by a prickly sensation over the face, neck, and chest. Some women say it feels like hot flashes of menopause. It’s usually transient, lasting no more than 20 minutes. Tolerance to this effect occurs with continued administration, usually after a few weeks or months. You may experience flushing both at the start of your niacin program, or with increases in dose. A rare person has a more marked flush reaction that looks like a rash or hives; if this occurs, discuss continued use of niacin with your doctor.


There are several practical strategies to follow that really help minimize or even eliminate the hot flush. These include:


· Drink plenty of water. This is very important and especially helpful when you experience a hot flush: drink two 8–12 oz. glasses of water immediately and the hot flush is almost always gone within a few minutes. (Discuss water intake with your doctor if you’re on a fluid restriction because of kidney disease, heart disease, or a history of water retention, or if you take a diuretic.) If you find that you need to drink water to block hot flushes but you need to get up several times per night to urinate, you might do better to take your niacin with dinner or breakfast.

· Take niacin with a handful (5–10) of raw almonds, walnuts, or pecans. This slows absorption. You might skip this if you’re in the midst of a weight loss effort (i.e., avoid eating at bedtime). Some people say take with a low-fat snack—this is wrong. Low-fat snacks like crackers cause small LDL.
· Take niacin with an aspirin. When you start niacin and whenever your dose is increased, an adult (325 mg), uncoated aspirin blocks the flush. After a few weeks or months, when flushing dissipates, changing to a “baby” (81 mg), enteric-coated aspirin can minimize stomach upset and the long-term risk of stomach ulcers and bleeding if your doctor advises you to take aspirin long-term. (Of course, always discuss aspirin use with your doctor.)
· Avoid alcohol and spicy foods when you take your niacin. This is not all that important, however. Only some people will be sensitive to this phenomena. It’s okay to have a glass of wine, say, at 7 pm and then take your niacin at 9 pm. Only a rare person will have more flushing due to the combination.
Niacin can raise blood sugar around 4–5 mg/dl at the start. This usually dissipates over a few months and is rarely of any importance. However, rises in blood sugar may be greater if you’ve have borderline high blood sugar or diabetes. For this reason, niacin should be taken with medical supervision, with gradual increases in dose, if you have high blood sugars. However, diabetes or pre-diabetes is not necessarily an absolute contraindication to use niacin. In fact, it’s people with these patterns who are most likely to benefit from niacin, since diabetes and pre-diabetes are strongly associated with small LDL, low HDL, increased triglycerides and other abnormalities that are corrected by niacin.[SUP]4[/SUP] (Type I, or childhood-onset, diabetes, however, is a relative contraindication to niacin use, as blood sugars are significantly raised.)
So, in answer to the reader’s question, niacin is among the most effective agents known for correction of multiple causes of heart and vascular disease, and has been proven to yield huge drops in risk for heart attack and is very safe—if used properly. It’s not that tough once you know the ins and outs. In my experience following the above guidelines, over 95% of people are able to take niacin with minimal hot flushing and almost never are truly dangerous side-effects seen.
People with liver disease, unexplained elevations of liver tests, active peptic ulcer disease and a history of abnormal bleeding should discuss use of niacin with their physician before beginning any treatment with niacin. Those with a past history of liver disease, jaundice, peptic ulcer disease or gastritis should exercise caution in the use of niacin. Gout may flare when niacin is used; discuss with your doctor if you have a history of gout.
Selected References:
1. Carlson LA. Nicotinic acid: the broad-spectrum lipid drug. A 50th anniversary review. J Intern Med 2005 Aug;258(2):94–114.
2. Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986; 8:1245-1255.
3. Brown BG, Zhao XQ, Chait A et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001 Nov 29;345(22):1583–1592.
4. McKenney J. New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med 2004 Apr 12;164(7):697–705.
 
The flushing I had was not a mere 20 minutes. It would go on for hours. It would start at the top of my head and slowly make it way down to the face, to the neck, upper body, arms, and the legs. It was a very intense, itchy, hot flush that drove me bonkers. Nevertheless I stuck with it and my HDL did not budge at all.
 
Beyond Testosterone Book by Nelson Vergel
I think NAC at 1200 mg per day may provide the same HDL increasing effects of Niacin without the flushing.

Citrus Bergamot is another interesting supplement for HDL and LDL.
 
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