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Anybody here w/ hi cholestrol and taking Niacin? - JoeM - 10-02-2006
I had an excellent cardiologist years ago who was a teaching doc at Cornell. He had put me on Lipitor and TwinLabs No Flush Niacin (4800 MG per day), along with other things, over 10 yrs ago. I always felt fine and have managed to keep my cholestrol around 200 or under.
Unfortunately, he got injured and since he was older, he retired. I haven't had a cardiologist since then (a good number of years now) but figured I should find someone.
The new doc now says the Twin Lab Niacin is not good for the Liver ( my liver tests have been fine for well over 10 yrs) and the only one that's safe is Niaspan. trouble is this stuff makes me sick as a dog, even taking it exactly as intended - so it is out for me.
He also had me try Zetia which also gives me slight flushing and skin sensitivity. Not sure if I will be able to tolerate it.
New doc now says my only choices are to stay as I have been, taking chances w/ liver problems or go to the stronger Crestor, which I am not crazy about as it is fairly new and may have possible problems.
Anybody have any info about Twin Labs No Flush Niacin not being safe? My old doc always said that it was the only Niacin he trusted due to how it was manufactured and was perfectly fine if you monitored Liver functions.
TIA
Joey, da fat-blooded Italian sausage eatin' goomba
Re: Anybody here w/ hi cholestrol and taking Niacin? - SeattlePhotog - 10-02-2006
I'm hoping the doctor remembers to give you a THIRD choice: lifestyle changes.
More focus on diet and exercise will really help you. And your liver.
Re: Anybody here w/ hi cholestrol and taking Niacin? - bazookaman - 10-02-2006
My Dr. and I had to try several things before we got something that worked. I'm on Vytorin now and its working great btw. But when i tried Niaspan, it was terrible. I would take it at night as instructed and not 15 minutes later i felt like i had a bad sunburn. My skin was red and tingly and very sensitive. I actually passed out once and my wife had to call the ambulance. Needless to say we switched medicines.
Re: Anybody here w/ hi cholestrol and taking Niacin? - NewtonMP2100 - 10-02-2006
. . .using medication can be good but as stated diet and exercise can do wonders. . .to the point where some eventually have no need for the pills. . .but I'm no Doctor Who. . .
Re: Anybody here w/ hi cholestrol and taking Niacin? - bazookaman - 10-02-2006
I don't know about JoeM, but I was lucky enough to get my high colesteral from my mom. Liefstyle and diet changes had almost no impact on it. the only time we saw a dramatic decrease was when i was on medicine. unfortunately.
Re: Anybody here w/ hi cholestrol and taking Niacin? - anonymouse1 - 10-02-2006
Try this:
http://www.aor.ca/related_research/niacin_no-flush.php
Niacin (nicotinic acid, a form of vitamin B3) is an important cellular mediator. Niacin is metabolized primarily in the liver to niacinamide, which is a precursor to the two cellular coenzymes nicotine-adenine dinucleotide (NAD+) (and its high-energy form, NADH), and nicotine-adenine dinucleotide phosphate (NADP). These coenzymes are responsible for carrying out numerous reduction-oxidation (redox) reactions in the body, including their role in energy production in the mitochondria, and play a vital role in protecting and repairing DNA through the enzyme poly-ADP ribose polymerase (PARP).
Different Forms of Niacin
The big problem with high-dose niacin supplementation is the niacin flush. Because it causes blood vessels to expand and release histamines (the immune factors responsible for some of the symptoms of allergies), higher-dose niacin causes warming and itching of the skin. The effect is a harmless – but some people find it absolutely maddening, and stop taking niacin altogether. Early attempts to solve this problem with a simple “sustained-release” niacin formulation eliminated the ‘flush,’ but caused a much more serious one: sustained-release niacin causes liver toxicity in a significant percentage of those taking it. To put this in context: while 39% of patients on regular niacin go off the supplement, mostly because of digestive problems and the “flush,” 78% of those administered regular “sustained-release” niacin quit because of side effects, with 52% of them suffering liver toxicity!
By contrast, less than 1% of people supplementing their diets with high doses of regular niacin experience liver problems – a rate several times lower than that of patients taking statin drugs. Still, the potential of liver toxicity rightly gives many people pause.
While nicotinamide is sometimes mistakenly referred to as “flush-free niacin,” niacinamide is actually not niacin at all, but a niacin metabolite, which lacks the key cholesterol-balancing and blood-vessel widening powers of niacin itself.
Inositol Hexanicotinate (IHN – also sometimes called inositol hexaniacinate) is the true “flushless niacin.” Unlike “sustained-release” niacin, which is just regular niacin in a pill which dissolves more slowly, IHN is a niacin complex, formed with the B-vitamin-like inositol. When you take an IHN supplement, the central inositol ring gradually releases niacin molecules, one at a time – delivering true niacin, but in a controlled fashioned governed by the kinetics of the hydrolysis of the molecule itself. This, like “sustained-release” niacin, allows you to take niacin at clinically-proven doses without going crazy with itch – but there is one big difference. While it’s a good idea to have your liver enzymes tested while you’re taking it, the fact is that no clinical trial has ever reported liver toxicity in persons supplementing with “flush-free” niacin. Regular monitoring of people taking doses as high as 4 000 mg of inositol hexanicotinate daily for four-month stretches has revealed no evidence of liver problems, or even changes in liver enzyme readings.
While only a few milligrams of niacin are needed each day to prevent a frank, life-threatening deficiency, studies clearly show that “megadose” niacin delivers remarkable heart-health benefits.
Cholesterol … And Beyond
Niacin is the classic orthomolecule for supporting healthy cholesterol balance. Its use for this purpose goes back to the early 1950s, when Dr. Abram Hoffer, the “godfather” of the orthomolecular medical movement, happened to observe that the bleeding gums which he’d been experiencing disappeared while taking high-dose niacin. Hoffer realized that this observation might mean that niacin could have implications for atherosclerosis. A successful open trial was soon followed by more rigorous studies which proved Hoffer right beyond the shadow of a doubt.
For nearly 45 years, the improvements in cholesterol profiles in people supplementing their diets with niacin (typically in doses of 2 000 - 4 000 mg per day) have been confirmed again and again. Its greatest strengths are its powerful effects on boosting High-Density Lipoprotein (HDL, or “good” cholesterol) and in lowering triglycerides (TG). The result of this is that the ratio of TG to HDL is more improved by niacin than it is by statin drugs (like pravastatin (Pravachol®) or atorvastatin (Lipitor®) or by fibrates. For people with specific problems in these areas, the National Cholesterol Education Program (NCEP) has repeatedly declared niacin to be the treatment of choice. That’s important, because recent study found that the ratio of TG to HDL ratio is perhaps the most potent predictor of heart attacks we know: men whose ratios were in the highest 20% were a whopping sixteen times more likely to be in the group who had undergone a recent heart attack than those who had the lowest ratios!
Niacin is also the only proven way to reduce levels of lipoprotein(a) (Lp[a] – a little-known, but especially deadly lipoprotein. (One exception: estrogen therapy in menopausal women often restores lower Lp(a) levels).
Recently, for instance, a randomized, controlled comparison with lovastatin (Mevacor®) found that niacin lowers LDL to a similar degree (23% (niacin) vs 32%(statin)), while elevating HDL considerably more (33% vs. 6%). And niacin lowers lipoprotein(a) (Lp[a]) by an astounding 35%, while lovastatin therapy has no effect.
But niacin doesn’t just change the amount of cholesterol floating around in your blood: it also changes the biochemical composition of that cholesterol in heart-healthy directions. It’s well-known that the LDL “bad” cholesterol is much more likely to form atherosclerotic plaques when it’s been oxidized (damaged by free radicals). And the smaller and denser your LDL particles are, the more likely they are to become oxidized. Niacin converts the dense, easily-oxidized LDL particles to larger, more oxidation-proof ones. Likewise, the “good” cholesterol, HDL, is more effective at clearing cholesterol out of your cells when it’s rich in a protein called apolipoprotein A-I. Niacin increases the concentration of apolipoprotein A-I in HDL, boosting its cholesterol-clearing powers.
There’s more. Independently of its effects on cholesterol, niacin also lowers fibrinogen. Fibrinogen, a protein produced in the liver, is a necessary part of the normal blood clotting process. But when fibrinogen levels get too high – as can happen in conditions of inflammation – fibrinogen can increase your odds of forming dangerous blood clots, which can plug off a blood vessel leading into your heart, triggering a heart attack. Fibrinogen also causes smooth muscle cells to proliferate, which can promote atherosclerosis. When scientists pooled the data from several studies which looked at fibrinogen as a marker of heart disease risk, they found that people whose fibrinogen levels are in the highest third have roughly double the risk of coronary heart disease of people whose levels are in the bottom third. So lowering fibrinogen can be a very heart-smart move.
The Real Endpoint
The real proof of niacin’s heart-healthy powers don’t rest with numbers on your blood test charts, but with real-world, life-and death results. Niacin is also the only true dietary supplement clearly proven to reduce heart attacks, strokes, and actual death rates. This proof was provided in a large trial in which 8341 men who had already suffered a heart attack were assigned to receive one of four different cholesterol drugs, or niacin, or a dummy pill. Three drugs were abandoned early due to their side effects.
But niacin proved its heart-protecting powers clearly. Compared to dummy pills, niacin therapy cut the rate of nonfatal heart attacks by 27%, and stroke by 26%, over the course of the trial. And unlike any of the men given the various drugs tested in the study, men taking niacin supplements were 11% less likely to die from any cause compared to the placebo group. The reduction in risk was especially great in people who had the highest cholesterol levels to begin with.
The Stockholm Ischaemic Heart Disease Secondary Prevention Study, the Cholesterol-Lowering Atherosclerosis Study, the Familial Atherosclerosis Treatment Study, and the Harvard Atherosclerosis Reversibility Project further document niacin’s ability, as part of combination therapy, to reduce risk of heart disease, heart attacks, and strokes.
In the last few years, a host of studies have shown that niacin can be combined with statin drugs to improve the safety and overall effects of both. Statins are very effective at lowering total and LDL (“bad”) cholesterol, but have little effect on HDL and triglycerides, and no effect on Lp(a). So the effects of the combination can be very powerful. While we certainly don’t encourage people to rush out and ask their doctor for a statin prescription, people whose physicians want them on a statin may discuss the idea of combining a lower dose of statin with niacin as a way to maximize the benefits of both.
Safe for Diabetics
New research has dispelled an old myth about niacin. For a long time, it was believed that one drawback to the use of this vitamin for cholesterol balance was that it would raise the blood sugar levels of diabetics, thereby worsening their condition. This situation was ironic in the extreme, since diabetics typically have exactly the lipid imbalance combination that most closely match up with niacin’s beneficial properties as a dietary supplement: high LDL, low HDL, and – especially – high triglycerides. But the belief that niacin and diabetes don’t mix was based entirely on a handful of case reports and small-scale, poorly controlled experiments. Recently several large, well-controlled trials have found that niacin does not elevate blood sugar to a clinically significant degree in either diabetics or healthy individuals when administered on a long-term basis (60 weeks).
Guard Against Homocysteine
Some concern has been raised by a recent report, which found that niacin raises homocysteine levels. But in fact, this finding represents yet further proof of niacin’s benefits for heart health, and an opportunity to make them even stronger. That is, since persons taking niacin alone, even with this Hcy-raising effect, still end up with lower rates of both heart attack and death than those not receiving the supplement, it is reasonable to speculate that taking niacin with homocysteine-lowering nutrients may result in even greater reductions in risk. Hcy-lowering nutrients include the vitamins B6, B12, and folic acid, along with trimethylglycine (TMG) – and, to a lesser extent, B2 (riboflavin). Animal studies confirm that B vitamins lower Hcy without inhibiting niacin’s cholesterol-balancing function.
Peripheral Vascular Disease (PVD)
In addition to its ability to keep your arteries clean, IHN has been shown to be a highly effective therapy in the treatment of peripheral vascular diseases, including Raynaud’s syndrome and intermittent claudication. IHN increases blood flow and raised temperature in the hands and feet, while allowing necrotic areas to heal. A typical protocol used in clinical trials would be 4 000 mg per day for 12 weeks.
Of course, niacin – even in the form of IHN – will not help everyone. But given its safety, its orthomolecular status, and its remarkable range of cholesterol-balancing effects, and its proven track record in slashing death rates, it may be the best first choice for most people with concerns about their cholesterol balance.
References
Welsh AL, Ede M. Inositol hexanicotinate for improved nicotinic acid therapy. Int Record Med. 1961 Jan; 174(1): 9-15.
Illingworth DR, Stein EA, Mitchel YB, Dujovne CA, Frost PH, Knopp RH, Tun P, Zupkis RV, Greguski RA. Comparative effects of lovastatin and niacin in primary hypercholesterolemia. A prospective trial. Arch Intern Med. 1994 Jul 25; 154(14): 1586-95.
Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, Friedewald W. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986 Dec;8(6): 1245-55.
Guyton JR. Effect of niacin on atherosclerotic cardiovascular disease. Am J Cardiol 1998 Dec 17; 82(12A): 18U-23U.
Figge HL, Figge J, Souney PF, Mutnick AH, Sacks F.Nicotinic acid: a review of its clinical use in the treatment of lipid disorders. Pharmacotherapy 1988; 8(5): 287-94. Aylward M. Hexopal in Raynaud's disease. J Int Med Res 1979; 7(6): 484-91.
Elam MB, Hunninghake DB, Davis KB, Garg R, Johnson C, Egan D, Kostis JB, Sheps DS, Brinton EA. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease. JAMA 2000 Sep 13; 284(10): 1263-70.
Sunderland GT, Belch JJ, Sturrock RD, Forbes CD, McKay AJ. A double blind randomised placebo controlled trial of hexopal in primary Raynaud's disease. Clin Rheumatol 1988 Mar; 7(1): 46-9.
Guyton JR, Capuzzi DM. Treatment of hyperlipidemia with combined niacin-statin regimens. Am J Cardiol. 1998 Dec 17; 82(12A): 82U-84U.
Re: Anybody here w/ hi cholestrol and taking Niacin? - GGD - 10-02-2006
I've been on Niacin for over 10 years (2500 mg/day). My doctors also specified TwinLab, but not the No Flush, just the regular B-3 Caps (500mg and 1000mg capsules), taken with meals. They also ran several liver tests during the initial use of Niacin and started with low dosages at first before working up to 2500mg/day, and still do periodic liver tests.
My understanding is that the purpose of the Niacin (for me at least) is not really to lower the total cholesterol, but to raise the HDL (good) cholesterol, which in my case is low due to my parents and grandparents. My total cholesterol has always been in the normal range, but my HDL/LDL ratio is a concern.
I get some flushing but it doesn't really bother me much, it's usually associated with a light meal, or liquid meal like soup. My doctors also tried to get me to switch to Niaspan several years ago, to reduce flushing (which wan't really bothering me), and I didn't like the Niaspan because it needed to be taken before sleeping, and I would often forget to take it because I was tired, or take it thinking I was going to go to bed, but then decide to stay up later and get hit with the Niaspan kicking in while I was awake. After trying if for a few months my doctors agreed that straight Niacin was better for me.
One thing that did come up in the conversations about Niaspan was that drug companies can't make big money on Niacin since it can't be patented, but something like Niaspan can. And I seem to recall that the only thing unique about Niaspan was the way it delivers the Niacin over time.
I'd talk with the doctor some more about this. Alot might have to due with the age/experience of the doctor . The doctor that started me on Niacin was also older, and now retired, but he was also the director of the Stanford Preventative Cardiology clinic.
Re: Anybody here w/ hi cholestrol and taking Niacin? - JoeM - 10-02-2006
Thanks everyone and thanks anonymouse1 for all for that info.
I am also in the group known as Familial Hypercholestrolimia(sp?) meaning it is a genetic defect and has nothing to do with diet/exercise. When I eat food with little or no cholestrol/ bad fats my liver will just make more to compensate. My cholestrol was in the high 400s to 500 when I was in my 20's, at 150 lbs and spending 25+ hours a week seriously doing martial arts. My sister is very thin, about 100lbs and her #'s are over 600 without meds.
Years ago, back in the 70's Dr. Robert Hass, the famous sports nutritionist came up with a very hi tech, personalized, computer generated diet that he guaranteed would solve anyones cholestrol problems after blood analysis and weeks of super strict diet/ exercise.
It was quite expensive, and after following the program religiously for the perscribed amount of weeks they found that not only did my number not go down, they actually went up. They refunded all my money and acknowledged my condition was different than the usual lard *ss problem many Americans get themselves into.
Re: Anybody here w/ hi cholestrol and taking Niacin? - spacescape - 10-02-2006
Mine was borderline high for about 4 years but only about 5 points high. This time it was HIGH so I need to get back on my excercise plan and watch my diet. However, he was concerned and put me on Lipitor for 6 weeks. If everything goes good, I'm suppose to stay on it until I get my exercise plan and diet together. I haven't started yet (Got the news last Thursday) because I had a upper respiratory problem and a touch of a cold which made my asthma act up (which NEVER bothers me) and my muscles ache. One of the side effects of Lipitor is "SORE MUSCLES" so I was waiting for my muscles to feel back to normal.
Now that being said, seeing you've been on Lipitor will I have any issues? Should I call my doctor and PLEAD with him that I will watch my diet for 3 months and exercise 3-4 times a week (Cardiovascular) to see if it goes down. If it doesn't, then it's time to medicate? Or is he mainly concerned about getting it under control and lower it quickly?
I would love some guidance.
Thanks!
Bill
Re: Anybody here w/ hi cholestrol and taking Niacin? - JoeM - 10-02-2006
Bill, my advice after being on statins for around 20 yrs and what most docs say to do is to try diet and exercise first before meds, say for 3 months with another test following. That being said, a lot has to do with age, weight, lifestyle and family history.
Your number can vary by 20% +/- from one test to the next, even if you had 2 tests in the same day that's possible. That's why you need to be monitored over time and a history needs to be developed.
Supposedly, the kind of muscle pain you'll feel, if it comes from the drug is VERY pronounced but again, everyone is different. I have had a lot of pain over the years but considering I fought and trained for 10 years, had a pretty nasty car accident and quite a few dings I couldn't say pain is due to the drug. You don't say your number but if you are 230+ you need to really do something. Also you need to check the HDL and LDL levels.
I would speak more with your doc. Lipitor has been pretty ssafe for most.