About comment responses and moderation

Just a brief word about my responses to reader comments:

I appreciate the many often insightful and interesting reader comments I receive to the Heart Scan Blog. However, managing them and responding to them has simply become impossible, due to time demands.

I'm afraid that I am unable to answer questions seeking medical advice; this is for your doctor, who knows you and can diagnose and prescribe. I cannot.

I'm also unable to engage in lengthy debates; I've had commenters become very angry when I was unable to engage in lengthy conversations on some topic. Nor am I able to do Google or literature searches for commenters, or review studies, papers, or other materials.

I would urge any readers who wish to engage in in-depth discussions about these issues, talk about lipoproteins, heart disease reversal, etc. to do so on the Track Your Plaque Forums. Yes, it is a fee-for-membership website, a model that has become necessary to pay for the services we provide (not pay me).

I wish that I could answer all the concerns and questions that come my way, but it's simply physically impossible doing so while maintaining a full-time very busy cardiology practice, developing the Track Your Plaque website (which is becoming an enormous responsibility), publishing scientific data, maintaining hospital responsibilities, and spending time with my wife and family. We're all busy and I'm no different. I'm afraid that it's my responses to blog comments that I will have to sacrifice.

I invite commenters to continue to comment on these posts, as I've learned many new things by reading them and find them helpful feedback. And I do read them. Should an especially helpful comment be made, I will feature it in a new blog post, rather than respond directly.

Comments (10) -

  • Jenny

    3/2/2008 3:09:00 PM |

    "Necessary to pay for the services we provide."

    This sounds odd to me. Blogger is free. I manage to provide a very high level of service to my bloodsugar101.com visitor base which is huge and growing monthly without charging a penny.

    I earn enough from Google ads to pay overhead. The amount of time it takes to keep the site updated is no more than most people spend watching a favorite TV show or playing golf each week.

    I respond to emails for perhaps half an hour a day, occasionally more, where I help people clarify the issues they need to discuss with their doctors and occasionally direct them to resources relevant to a rare condition my site mentions.

    I can see charging for individual medical consultation, but not for providing a web forum where people discuss topics and where you explain concepts that do not involve personal medical counsel.

    The for-fee nature of your site buys you income at the cost of greatly limiting the number of people who can benefit from the non-specific information you have to share.

    Too many of your posts seem to tantalize with hints of information but conclude with statements making it clear people have to pay to find out the facts.

    That is NOT how the web works and it greatly limits the helpfulness of what you offer.

  • wccaguy / aCipher

    3/2/2008 4:43:00 PM |

    Dr. Davis,

    In a short time, your blog, all by itself, has become the best source of information for dealing with cardiovascular disease on the internet.

    Thank you for having the vision and commitment for sharing your depth and breadth of knowledge of this disease.

  • mike V

    3/2/2008 6:19:00 PM |

    Dear Dr. Davis
    I plead guilty to immoderation in my response to your "Hammers and Nails" piece.

    Here's my bottom line:
    I simply believe that your 'bottom up' approach (to identifying both problems and their solutions) could potentially grow to influence the entire profession for the better. I hope it spreads.
    Thanks for listening.

  • Anonymous

    3/3/2008 2:10:00 PM |

    Hi Dr. Davis

    I read your blog all the time and am surprised to see that you answer blog comments at all.

    I would always think . . . . how does he have time to do that ?

    I for one, understand your situation exactly and I am just thankful that you write your blog at all. I'm sure the course of my health will be forever changed by reading your words, and following them.

    On behalf of all the people who are deeply thankful for what you do, I apologize for the few "who always want more".

    You have my heartfelt appreciation (pun intended).

    Brian - Syracuse, NY

  • Rick

    3/4/2008 4:36:00 AM |

    Dr. Davis,

    Just a note of thanks for all you do on this blog and on the members forum.  My doctor was amazed when I told him that you responded personally to my query on the forum.  I've learned a tremendous amount thanks to you.


  • Anonymous

    3/4/2008 2:26:00 PM |

    Dr. Davis
    I agree with the previous writer - surprised you have time but also thankful.
    In case you wonder if it's worth your time - You have changed my life!
    After reading your column and recognizing myself in many issues, I went out and had my vitamin D tested and it was 23 ng. So now, I also  have my husband and 4 friends on Vitamin D supplements who are also grateful.
    Nice of you to let "Jenny" plug her google ad site

  • Anonymous

    3/4/2008 3:12:00 PM |

    This comment is to Jenny.  Wow, just wow!  You have an overgrown sense of entitlement.  Dr. Davis is providing a lot of great information on his blog as well as in his TYP community.  He also has a full-time cardiology practice.  If you don't like what he is writing and that he would prefer to spend his energy on TYP, which I am fairly certain does not net him a profit, don't read this blog.  Not everyone has to follow your model for blogging and you ought to be respectful of that.


  • moblogs

    3/4/2008 4:13:00 PM |

    It's a fair deal as your posts alone help guide a lot of people.

    As a suggestion, since comments are still flying about about vitamin D, erroneously, being bad for you, and that L-form bacteria being touted as the core cause of heart disease by the same camp, it's worth doing an article about that. Approaching it with undemeaning neutrality, but it would be useful as some people have taken to heart the words of the dubious Marshall Protocol.

  • Anonymous

    3/4/2008 7:10:00 PM |

    I can understand your need for more time but while your postings are excellent I have learned far more from your comments on other peoples comments then from the original postings. What a loss.

  • Anonymous

    3/5/2008 9:25:00 AM |

    Well Dr D, as we say....Dr heal thyself. I have read all the blog and joined TYP. Best fee( and small amt I might add) I ever spent and yes to do all you provide on your forom does cost, I doubt J knows what she is talking about as I don't think she is a member of TYP. You have saved me from an early death and all I can say  since day one of coming here is I wondered how you did it all. You answer all the posts on TYP at least twice a day, you always write new articles, you volunteered your time for our web show, and your attitude is always so supportive and so wise. You know our sacred and healing VIT OSmileSmileSmile
    I have honoured you since the day I met you and I honor you even more now or making good choices to look after yourself thus in the end enable us to look after ourselves.

    I FEEL SOMEWHAT EMBARRASSED BY j's INSENSITIVE COMMENTS.........if only she knew all the work you have done for us in the past 6 months since I have been here. Thank you sooo much and I;ll read you daily on TYP website.



Blame the niacin

Blame the niacin

Despite the fact that niacin is:

1) A vitamin--vitamin B3

2) One of the oldest cholesterol-reducing agents around with a long-standing track record of effectiveness and safety

3) Available as a prescription drug as well as a variety of "nutritional supplements"

most physicians remains shockingly unaware of its benefits, effects, and side-effects. Most, in fact, are either ignorant or frightened of advising their patients on niacin use. As a result, I commonly have to tell my patients to resume the niacin that their primary care physician has (wrongly) stopped because of itchy feet, grumpiness, groin rash, urinary tract infections, nightmares, diarrhea, hair loss, runny nose, etc. All of these are REAL reasons doctors have advised patients to stop niacin (though none were actually due to niacin).

Is niacin really that troublesome? No, it's not. In fact, if used properly, it's among the most effective and safe tools available for correction of low HDL, small LDL and other triglyceride-containing lipoproteins, lipoprotein(a), and dramatic reduction of heart attack risk. If added to a statin agent, the heart attack risk reduction can approach 90%.

Statins are just too easy for doctors to prescribe. Niacin, on the other hand, requires a good 15-20 minutes to describe how to use it. It could generate an occasional phone call from a patient who struggles with the annoying but largely harmless and temporary "hot-flush" feeling, a lot like a hot blush. Given a choice, most doctors would simply choose not to be bothered. For this reason, I'll commonly see many, many people with uncorrected low HDLs and other patterns.

Have a serious discussion and press for confident answers if you find your doctor reflexively telling you that the wart on your thumb should be blamed on niacin.

Here are the steps we advise that really make taking niacin easy and tolerable:

1) Take with dinner.

2) Take with 2 extra glasses of water. If you experience the hot-flush later on, drink an additional 2 8-12 oz glasses of water i.e., a total of 16-24 oz). Extra hydration is extremely effective for blocking the hot-flush.

3) Take a 325 mg, uncoated aspirin. This is only necessary in the beginning or with any increase in dose, rarely chronically for any length of time.

This is not to say that there aren't occasional people who are truly and genuinely intolerant to niacin. It does happen. But those people are a small minority, less than 5% of people in my experience. Niacin is far more effective and safe than most physicians would have you believe.

Comments (7) -

  • madcook

    10/31/2006 6:12:00 AM |

    I've taken prescription Niaspan for over an year and a half.  Several times I've had an unintended "untoward" reaction, more than a blush, more than a flush... more like a niacin storm!  Each time I've learned something new, however.  Yes, hydration is very important.  There are certain foods and drugs which apparently dam up the same metabolic pathway as niacin, and can cause a pretty nasty reaction.  Among these, at least for me, are certain long acting antibiotics (Zithromax), spicy chai tea, pepperoni (not supposed to go there anyway!) and very spicy foods, if taken near the time of Niaspan dosing.  I was advised by my Dr. that Benadryl syrup would help to shorten the duration of the "storm".  Mostly it's a case of dietary management and timing of dosage.  The good done by niacin certainly still outweighs the occasional bad side effects!

  • Jim

    3/14/2008 4:03:00 PM |

    Another comment about niacin from this long-time niacin user, maybe folks will find it useful...
    Dr. Davis's advice to hydrate heavily to prevent/reduce flushing is, alas, not completely effective. One can easily prove this for oneself. The next time you experience a big flush, consume as much water as you are able, and see if the flush quickly resides..does it?  No. Hydration is certainly great advice, I'm not knocking it, but as a flush reduction strategy, it isn't enough. One commentor here mentioned quercetin.  It seems some recent research on certain flavonoids (quercetin, luteolin) have produced good results,better than aspirin, which was mentioned in this thread.  One needs to experiment and see if supplements such as these do help, taken maybe 30-45 minutes before the niacin dose. I have some other comments on niacin strategies I've hardly seen mentioned anywhere, but I'll wait until (1) I see my posts are approved (I'm new here), and (2) that people are interested. Let's see if there is any feedback. Regards, Jim

  • mill

    6/27/2008 5:43:00 PM |

    I've been taking niacin  2 times daily for 6 months and dropped my cholestral from 240 to 162.  Can I go back to once daily?

  • Anonymous

    12/30/2008 10:15:00 PM |

    I have seen some research papers that report that NIACIN, Nicotinamide and/or SAMe ( maybe also other methyl donors such as TMG ) can cause Parkinson's disease. I wonder if niacin can be converted to Nicotinamide in the body. Please see their abstracts and URLs below. Thank you.

    Niacin Metabolism and Parkinson’s Disease

    Tetsuhito FUKUSHIMA1)
    1) Department of Hygiene & Preventive Medicine, Fukushima Medical University School of Medicine
    Epidemiological surveys suggest an important role for niacin in the causes of Parkinson’s disease, in that niacin deficiency, the nutritional condition that causes pellagra, appears to protect against Parkinson’s disease. Absorbed niacin is used in the synthesis of nicotinamide adenine dinucleotide (NAD) in the body, and in the metabolic process NAD releases nicotinamide by poly(ADP-ribosyl)ation, the activation of which has been reported to mediate 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinson’s disease. Recently nicotinamide N-methyltransferase (EC2.1.1.1) activity has been discovered in the human brain, and the released nicotinamide may be methylated to 1-methylnicotinamide (MNA), via this enzyme, in the brain. A deficiency in mitochondrial NADH:ubiquinone oxidoreductase (complex I) activity is believed to be a critical factor in the development of Parkinson’s disease. MNA has been found to destroy several subunits of cerebral complex I, leading to the suggestion that MNA is concerned in the pathogenesis of Parkinson’s disease. Based on these findings, it is hypothesized that niacin is a causal substance in the development of Parkinson’s disease through the following processes: NAD produced from niacin releases nicotinamide via poly(ADP-ribosyl)ation, activated by the hydroxyl radical. Released excess nicotinamide is methylated to MNA in the cytoplasm, and superoxides formed by MNA via complex I destroy complex I subunits directly, or indirectly via mitochondrial DNA damage. Hereditary or environmental factors may cause acceleration of this cycle, resulting in neuronal death.

    Key words:
    nicotinamide N-methyltransferase, 1-methylnicotinamide, poly(ADP-ribosyl)ation, mitochondria, complex I

    Pasted from http://www.jstage.jst.go.jp/article/ehpm/10/1/10_3/_article

    Parkinson's disease: the first common neurological disease due to auto-intoxication?
    A.C. Williams1, L.S. Cartwright2 and D.B. Ramsden2
    From the Divisions of 1Neurosciences and 2Medical Sciences, University of Birmingham, Birmingham, UK
    Parkinson's disease may be a disease of autointoxication. N-methylated pyridines (e.g. MPP+) are well-established dopaminergic toxins, and the xenobiotic enzyme nicotinamide N-methyltransferase (NNMT) can convert pyridines such as 4-phenylpyridine into MPP+, using S-adenosyl methionine (SAM) as the methyl donor. NNMT has recently been shown to be present in the human brain, a necessity for neurotoxicity, because charged compounds cannot cross the blood-brain barrier. Moreover, it is present in increased concentration in parkinsonian brain. This increase may be part genetic predisposition, and part induction, by excessive exposure to its substrates (particularly nicotinamide) or stress. Elevated enzymic activity would increase MPP+-like compounds such as N-methyl nicotinamide at the same time as decreasing intraneuronal nicotinamide, a neuroprotectant at several levels, creating multiple hits, because Complex 1 would be poisoned and be starved of its major substrate NADH. Developing xenobiotic enzyme inhibitors of NNMT for individuals, or dietary modification for the whole population, could be an important change in thinking on primary and secondary prevention.

    Pasted from http://qjmed.oxfordjournals.org/cgi/content/full/98/3/215

    see also

    But,on the contrary,the paper below seems to suggest that niacin protects from Parkinson's.

    Title: Does diet protect against Parkinson's disease? Part 4 – vitamins and minerals
    Author(s): Isabella Brown
    Journal: Nutrition & Food Science
    ISSN: 0034-6659
    Year: 2004 Volume: 34 Issue: 5 Page: 198 - 203
    DOI: 10.1108/00346650410560343
    Publisher: Emerald Group Publishing Limited
    Abstract: This paper is the fourth in a series on Parkinson's disease and diet and investigates the role which antioxidant vitamins A and C, niacin and selenium may have on the incidence of the disease. Oxidative stress is believed to be a key factor in the development of PD and all of these have a role in preventing oxidative stress mediated cell damage. Dietary information was obtained via questionnaires. Vitamin C was found to reduce the risk of PD by 40 per cent in one study, although this was not supported by other studies. Niacin was associated with an at least 70 per cent reduced risk of PD incidence in a number of studies. No evidence was found to support a role for vitamin A or selenium. There is a need for further research to support or disprove the roles of these antioxidant vitamins within the aetiology of PD.
    Keywords: Diet, Diseases, Lifestyles, Vitamins
    Article Type: Research paper
    Article URL: http://www.emeraldinsight.com/10.1108/00346650410560343

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