Niacin and blood sugar

We've been engaging in a conversation on the Track Your Plaque Forum on whether niacin raises blood sugar.

Yes, it does. In the vast majority of instances, however, the rise is trivial and without consequence. Typically, someone will start with a borderline elevated blood sugar of, say, 108 mg/dl. Niacin, 1000 mg per day, then raises blood sugar to 112 mg/dl. This small increase does not oblige any specific action, nor does it pose any excess risk.

Blood sugars in the normal range of <100 mg/dl tend not to show this effect. Higher blood sugars, e.g., 130 mg/dl, may show a more exagerrated effect but it is also rarely of great consequence. People who take medications for adult type II diabetes, or people with childhood-onset, type I diabetes will also experience rises in blood sugar. This is a somewhat larger issue in these people.

Niacin is best undertaken with a change in diet, specifically a reduction in processed carbohydrate foods, particularly evil and ubiquitous wheat products.This will often compensate for the blood sugar effect.

Niacin also shares many of the benefits of weight loss: rise in HDL, drop in triglycerides and small LDL.

Keep it all in perspective: If HDL is low, e.g., 30 mg/dl, or there is a significant small LDL pattern, or you have Lp(a), using niacin--vitamin B3--is quite safe and the most effective treatment we have. It's also a vitamin. Also recall the famous HATS Trial of simvastatin and niacin: simvastatin (Zocor) reduced heart attack risk 30%; adding niacin reduced heart attack risk an astounding 90%.

Very few strategies can yield the enormous benefits, both as a stand-alone treatment or in combination with others, that niacin can, whether or not blood sugar creeps up a few milligrams.

Comments (14) -

  • Anonymous

    9/19/2007 4:05:00 PM |

    Hi greg here- I 've posted before about diet. Just wondering how that is going at your other site. I think you were going to have something up soon.
    Thanks!

  • Dr. Davis

    9/19/2007 4:19:00 PM |

    Hi, Greg--

    It probably won't happen for 6-8 weeks. It's in the queue of projects.

  • Anonymous

    9/19/2007 4:30:00 PM |

    Is iron monitored as part of the Track Your Plaque program? What is a good level for men?

    Brian

  • Anonymous

    9/19/2007 4:31:00 PM |

    Is iron monitored as part of the Track Your Plaque program? What is a good level for men?

    Brian

  • Anonymous

    9/19/2007 4:40:00 PM |

    Thanks.
    I have a couple questions in the meantime.
    - On a low carb diet should I be concerned about the quality of meat I eat? I know grass-fed beef meat is better for me but expensive. Many people talk about the benefit of low carb and eating meat but WalMart meat is different from grass-fed for sure.
    - Also, organic veggies/fruits/dairy are better for me- or so they say- but expensive- what to do?
    - Also- as I said before I had success on South Beach but have gained all of the  weight back since adding in carbs some "healthy" some refined... they do seem to get addictive.
    Any advice other than avoiding them. Any success stories that you know of.
    Thanks!Greg

  • G, clinical pharmacist

    9/19/2007 5:55:00 PM |

    HI DR. Davis,

    I've really enjoyed your blog and your insights!  What are your thoughts on the negative effects of ACEs, betablockers and drugs like thiazides and sulfonylureas?  One of our prominent rheumatologists believe these meds (which are used at a 'quartet' for preventing CAD at the org that I work at) raises the ANA and other autoimmune titres.
    Thank you and strong work!!

  • G, clinical pharmacist

    9/19/2007 6:42:00 PM |

    btw, my middle name is 'vit D3 oil gelcap only' now!  thank you again for sharing!

  • Anonymous

    9/19/2007 7:36:00 PM |

    Dr. Davis, the same HATS trial that showed the large beneficial effects of statin-niacin combination also showed that a combination of antioxidants significantly blunts these effects. The antioxidant combination they used consisted of 800 IU of vitamin E (as d-alpha-tocopherol), 1000 mg of vitamin C, 25 mg of natural beta carotene, and 100 µg of selenium. Unfortunately none of the antioxidants was tested seperately.

    Is there any data that shows which of these anitoxidants was responsible for the reduced effectiveness of the statin-niacin combination? Do you advocate the use of any of these antioxidants for a person taking a statin-niacin combination, and if so, how much and why?

  • Dr. Davis

    9/19/2007 8:08:00 PM |

    LOL! That's great.

  • Dr. Davis

    9/19/2007 8:11:00 PM |

    I have a problem with thiazides and beta blockers, principally because of the HDL-reducing, small LDL-increasing effects. Also thiazides drop magnesium and potassium. I personally despite the thiazide diuretics and stop them every chance I get.

    Drugs have a place, as you know, but they are often used for the wrong reasons and without full knowledge of their negative potential. Vitamin D is a great anti-hypertensive, as is avoidance of wheat products.

  • Dr. Davis

    9/19/2007 8:19:00 PM |

    Unfortunately, there is very little independent verification of this effect outside of the HATS Trial. A similar effect was seen, for instance, in the ATBC Trial.

    I do not recommend willy-nilly use of antioxidants for their own sake, but for selected applications outside of antioxidation, e.g., coQ10 for statin muscle aches, vit C for Lp(a).

  • Dr. Davis

    9/19/2007 9:14:00 PM |

    No. We do not monitor iron.

  • G

    9/19/2007 9:14:00 PM |

    I was afraid you say that!! (we give a lot of thiazides d/t ALLHAT)  I'm not sure about Vit D as a BP med (but I'll take your word)...  Vit D in the first yr of life 2000 IU/d (don't know what form) significantly prevented Type 1 DM in a large Finnish study (see below).  And I just read in the latest AACE 2007 DM guidelines that early exposure to wheat gluten (yeah, your favorite food) may increase Type 1 Diabetes risks.

    THANK YOU for your response!

    Hypponen E, Laara E, Reunanen A, et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 2001;358:1500-3.

  • buy jeans

    11/3/2010 12:22:10 PM |

    Very few strategies can yield the enormous benefits, both as a stand-alone treatment or in combination with others, that niacin can, whether or not blood sugar creeps up a few milligrams.

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Leave the greatest legacy to your children

Leave the greatest legacy to your children

Phyllis was dumbfounded when she learned of her heart scan score of 995. At age 56, this placed her solidly in the 99th percentile--a score that grouped her with the worst 1% of scores for women her age. Track Your Plaque followers know that scores of 1000 (just days away, given the expected 30% increase in score per year!) pose a risk of heart attack, symptoms leading to stent or bypass, or death of 25% per year.

But after Phyllis gathered her thoughts and thought it over, her first question was "What about my children?"

A natural response for a mother. Phyllis' "children" actually ranged in age from 26 to 37. We talked about how, given her high score, she'd probably been creating plaque in her coronary arteries for 20 years. This triggered her mother's concern for her kids.


This is probably the #1 most useful lesson for all of us. If we learn of our own risk for heart disease, we can pass our concerns on to our children. Imagine how much more well-equipped you could be if you started out with the advice and experience of a parent who'd identified and then conquered their heart disease risk.

Pass your awareness and knowledge on to your children, particularly if they are 30 years old or more.

Interestingly, my own personal experience with my 14-year old son taught me a lesson or two. I had previously assumed that, at age 14, how could he be even remotely interested in these issues? (I have a terrible family history of heart disease and I have a high heart scan score myself.) When my son asked that we check his lipid values (I talk about this more than I'd like to admit!), we did a fingerstick lipid panel in my office. Lo and behold, his HDL (good) cholesterol was a shocking 31 mg--exceptionally low for a teenager. His risk for heart disease over the long-term is very high.

Much to my surprise, this awareness has triggered a genuine interest in healthy eating. It's not uncommon to see him examine food labels and to report to me that "Hey, Dad. Can you believe that this yogurt has 43 grams of carbohydrates?"

Pass on the lessons you've learned to your children and to the important people in your life. This is probably the most crucial lesson you can take from the Track Your Plaque experience.
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