Natural products to lower cholesterol levels - Don't forget niacin

[Guest guest]

Natural products to lower cholesterol levels - Don't forget niacin

 

 

Introduction

Niacin does more than lower cholesterol

 

Lovastatin vs. Niacin in a 26-Week Study

 

 

There are a number of specific natural medicines that effectively

lower cholesterol levels. Since new ones come along all the time

(see previous newsletter on Delta-tocotrienol - The 21st Century

Vitamin E?) it is easy to forget just how impressive the results are

with niacin.

 

Before taking a look at the effects of niacin in lowering

cholesterol levels, it is important to have an understanding of

exactly what all the different forms of cholesterol represent. First

of all, cholesterol is a natural substance made by the liver to

serve several important body function including being the backbone

for important hormones like

estrogen, testosterone, and cortisone.

 

Cholesterol travels from the liver and into your circulation by

hitching a ride on protein molecules called low-density lipoprotein

(LDL), often called " bad cholesterol. " It is carried away from

tissues and back to the liver aboard high-density lipoprotein (HDL)

( " good " or " protective cholesterol " ). Some people find it easier to

remember the difference by labeling LDL " lousy " and HDL " healthy or

happy. "

 

The more LDL you have, the more cholesterol is in circulation, and

the greater your risk of heart disease. Currently, experts recommend

that your total blood cholesterol level should be less than 200

mg/dl. The LDL level should be less than 130 mg/dl and the HDL level

should be greater than 35 mg/dl. For every one percent drop in LDL

levels, there's a two percent drop in the risk of heart attack. By

the same token, for every one percent increase in HDL, the risk of

heart attack drops three or four percent.

 

The ratio of your total cholesterol to HDL and the ratio of LDL to

HDL

are clues that indicate whether cholesterol is being deposited into

tissues or is being broken down and excreted. The ratio of total

cholesterol to HDL should be no higher than 4.2, and the LDL-to HDL

ratio should be no higher than 2.5.

 

Another important lipoprotein to be aware of is a form of LDL called

lipoprotein (a), or Lp(a). This form of LDL has an additional

molecule

of an adhesive protein called apolipoprotein. That protein makes the

molecule much more likely to stick to the artery walls and cause

damage.

 

New research suggests that high Lp(a) levels constitute a separate

risk factor for heart attack. For example, it appears that high Lp

(a) levels are ten times more likely to cause heart disease than

high LDL levels. Lp(a) levels lower than 20 mg/dl are associated

with low risk of heart disease; levels between 20 and 40 mg/dl pose

a moderate risk, and levels higher than 40 mg/dl are considered

extremely risky.

 

http://drmurray.libraryonhealth.com/read.php?

id=59bcaf218d04a19b7a9fb8985 & chapter=25

 

 

Niacin does more than lower cholesterol

 

The cholesterol lowering activity of niacin was first described in

the

1950s. It is now known that niacin does much more than lower total

cholesterol. Specifically, niacin has been shown to lower LDL

cholesterol, Lp(a) lipoprotein, triglyceride, and fibrinogen levels

while simultaneously raising HDL cholesterol levels. Despite the

fact

that niacin has demonstrated better overall results in reducing risk

factors for coronary heart disease compared with other

cholesterol-lowering agents, physicians are often reluctant to

prescribe niacin.

 

The reason is a widespread perception that niacin is a difficult

to work with because of the bothersome flushing of the skin. In

addition, since niacin is a widely available " generic " agent, no

pharmaceutical company stands to generate the huge profits that the

other lipid-lowering agents have enjoyed.

 

As a result, niacin does not benefit from the intensive advertising

that focuses upon the " statin " drugs. Despite the advantages of

niacin over other lipid-lowering drugs, it accounts for less than

10% of all cholesterol-lowering prescriptions.

 

Several studies have compared niacin to standard lipid-lowering

drugs including the statin drugs. These studies have shown

significant advantages for niacin. For example, in one 26 week study

patients were randomly assigned to receive treatment with either

lovastatin (Mevacor) or niacin.1 The results are shown below:

 

 

Lovastatin vs. Niacin in a 26-Week Study

 

<

 

These results indicate that while lovastatin produced a greater LDL

cholesterol reduction, niacin provided better overall results

despite

the fact that fewer patients were able to tolerate a full dosage of

niacin because of skin flushing. The percentage increase in HDL

cholesterol, a more significant indicator for coronary heart

disease,

was dramatically in favor of niacin (33 vs. 7%). Equally as

impressive

was the percentage decrease in Lp(a) for niacin. While niacin

produced a

35% reduction in Lp(a) lipoprotein levels, lovastatin did not

produce

any effect. Other studies have shown that niacin can lower Lp(a)

levels

by an average of 38%.2,3

 

The most recent comparative study involved niacin vs. atorvastatin

(Lipitor).4 The average dosage was 3,000 mg with niacin and 80 mg

for

atorvastatin was used at 80 mg/day. The patients selected had

abnormal

particle size of LDL in that the molecules were small and dense -

these

LDL molecules are considerably more atherogenic than larger, less

dense

LDL. The patients selected also had low levels (less than 40%) of a

specific fraction of HDL associated with a greater protective effect

than HDL alone. Although atorvastatin reduced total LDL cholesterol

levels substantially more than niacin, niacin was more effective in

increasing LDL particle size and raising HDL and HDL2 than the

atorvastatin.

 

Back to top

Table 1. The Effect of Atorvastatin (Lipitor) and Niacin on Lipid

Profiles

 

Parameter Atorvastatin Niacin Atorvastatin + Niacin

Before After

Before After Before After

Total LDL (mg/dl) 110 56 111 89 123 55

LDL peak diameter 251 256 253 263 250 263

Lipoprotein (a) (mg/dl) 45 44 37 23 54 35

HDL (mg/dl) 42 43 38 54 38 54

HDL2 (%) 30 42 29 43 32 37

Triglycerides (mg/dl) 186 100 194 108 235 73

 

While statin drugs are also gaining popularity as a prescription

method

to lower C-reactive protein (CRP) - a marker of inflammation and a

risk

factor for heart disease. It appears that the while majority of

physicians appear to be aware of the effect of Lipitor and Pravachol

on

C-reactive protein they do not seem to be aware that natural

products

offer even greater activity. For example, vitamin E (800 IU daily)

lowered C-reactive protein by 49% and niacin (1500 mg at night)

lowered

it by 20%, much more meaningful reductions than those seen with

Pravachol and Lipitor.5,6

 

Because taking niacin at higher dosages (e.g., 3,000 mg or more) can

impair glucose tolerance, many physicians have avoided niacin

therapy in

diabetics, but newer studies with slightly lower dosages (1,000 to

2000

mg) of niacin have not shown it to adversely effect blood sugar

regulation.7 For example, during a 16-week, double-blind,

placebo-controlled trial, 148 type 2 diabetes patients were

randomized

to placebo or 1000 or 1500 mg/d of niacin; in the niacin treated

groups

there was no significant loss in glycemic control and the favorable

effects on blood lipids were still apparent.8 Other studies have

actually shown hemoglobin A1C to drop indicating improvement in

glycemic

control.9

 

If you take a look at the most common blood lipid abnormality in

type 2

diabetic patients it is elevated triglyceride levels, decreased HDL

cholesterol levels, and a preponderance of smaller, denser LDL

particles. Niacin has been shown to address all of these areas much

more

significantly than the statin or other lipid lowering drugs.

However,

one of the reasons that niacin may not be as popular as it should be

is

the bothersome side effect of skin flushing - kind of like a

prickly,

heat rash that typically occurs 20-30 minutes after the niacin is

taken

and disappears in about the same time frame. Other occasional

side-effects of niacin include gastric irritation, nausea, and liver

damage.

 

To reduce the side effect of skin flushing you can use some of the

newer

time-released formulas including the prescription version Niaspan or

take the niacin just before going to bed. Most people sleep right

through the flushing reaction. Taking cholesterol lowering agents at

night is best because most of the cholesterol manufactured by the

liver

happens at night. Another approach to reduce flushing is to use

inositol

hexaniacinate. This form of niacin has long been used in Europe to

lower

cholesterol levels and also to improve blood flow in intermittent

claudication - a peripheral vascular disease that is quite common in

diabetes. It yields slightly better clinical results than standard

niacin, but is much better tolerated, in terms of both flushing and,

more importantly, long-term side-effects.10 If you start out with

trying

inositol hexaniacinate and it does not work, try regular niacin. Our

experience is that some people will only respond to the regular

niacin.

 

If regular niacin or inositol hexaniacinate is being used, start

with a

dose of 500 mg at night before going to bed for one week. Increase

the

dosage to 1,000 mg the next week and 1,500 mg the following week.

Stay

at the 1,500 mg dosage for two months before checking the response -

dosage can be adjusted up or down depending upon the response. If

you

are using a time-release niacin product, like Niaspan, start out at

the

full dosage of 1,500 mg at night.

 

Regardless of the form of niacin being used, I strongly recommend

periodic checking (minimum every 3 months) of cholesterol. A1C, and

liver function tests.

 

 

Back to top

Key References:

 

Illingworth DR et al. Comparative effects of lovastatin and niacin

in

primary hypercholesterolemia. Arch Intern Med 1994; 154: 1586-1595

Carlson LA, Hamsten A, Asplund A. Pronounced lowering of serum

levels of

lipoprotein Lp(a) in hyperlipidaemic subjects treated with nicotinic

acid. J Intern Med 1989; 226: 271-276.

Pan J, Lin M, Kesala RL, Van J, Charles MA. Niacin treatment of the

atherogenic lipid profile and Lp(a) in diabetes. Diabetes Obes Metab

2002;4:255-61.

Van JT, Pan J, Wasty T, et al. Comparison of extended-release niacin

and

atorvastatin monotherapies and combination treatment of the

atherogenic

lipid profile in diabetes mellitus. Am J Cardiol 2002;89:1306-8.

Upritchard JE, Sutherland WH, Mann JI. Effect of supplementation

with

tomato juice, vitamin E, and vitamin C on LDL oxidation and products

of

inflammatory activity in type 2 diabetes. Diabetes Care 2000;23:733-

8.

Grundy SM, Vega GL, McGovern ME, et al. Efficacy, safety, and

tolerability of once-daily niacin for the treatment of dyslipidemia

associated with type 2 diabetes: results of the assessment of

diabetes

control and evaluation of the efficacy of Niaspan trial. Arch Intern

Med

2002;162:1568-76.

Rindone JP, Achacoso S. Effect of low-dose niacin on glucose control

in

patients with non-insulin-dependent diabetes mellitus and

hyperlipidemia. Am J Ther 1996;3:637-639.

Grundy SM, Vega GL, McGovern ME, et al. Efficacy, safety, and

tolerability of once-daily niacin for the treatment of dyslipidemia

associated with type 2 diabetes: results of the assessment of

diabetes

control and evaluation of the efficacy of Niaspan trial. Arch Intern

Med

2002;162:1568-76.

Kane MP, Hamilton RA, Addesse E, Busch RS, Bakst G. Cholesterol and

glycemic effects of Niaspan in patients with type 2 diabetes.

Pharmacotherapy 2001;21:1473-8.

El-Enein AMA. The role of nicotinic acid and inositol hexaniacinate

as

anticholesterolemic and antilipemic agents. Nutr Rep Intl 1983; 28:

899-911.

 

© 2003 www.doctormurray.com

 

 

JoAnn Guest

mrsjo-

www.geocities.com/mrsjoguest/Diets

[Guest guest]

Does it matter which type of niacin is used? The non-flushing vs

flushing? I remember a time when I was introducing niacin into my

system and on one occasion forgot that I had taken it and all of a

sudden started feeling itchy and then hot and notice a rash ... well it

wasn't until after I had to go through the rough parts of the niacin in

my system that I remembered ... DRINK WATER IT'S THE NIACIN!

 

Anyway, does one work better than the other? Thanks

 

, " JoAnn Guest "

<angelprincessjo wrote:

>

> Natural products to lower cholesterol levels - Don't forget niacin

>

>

[Guest guest]

I use the " release assured " and welcome the flush. The flush ( the redness

and uncomfortable heat) lasts about 15 minutes; and I regard it as the

physical sign that it is 1)detoxifying, and 2) opeing up all those tiny

blood vessels. The heat is the blood flow increasing to peripheral areas.

Michael

 

On Behalf Of Kathleen

Thursday, May 04, 2006 11:38 AM

Re: Natural products to lower

cholesterol levels - Don't forget niacin

 

 

Does it matter which type of niacin is used? The non-flushing vs

flushing? I remember a time when I was introducing niacin into my

system and on one occasion forgot that I had taken it and all of a

sudden started feeling itchy and then hot and notice a rash ... well it

wasn't until after I had to go through the rough parts of the niacin in

my system that I remembered ... DRINK WATER IT'S THE NIACIN!

 

Anyway, does one work better than the other? Thanks

 

, " JoAnn Guest "

<angelprincessjo wrote:

>

> Natural products to lower cholesterol levels - Don't forget niacin

>

>