Do you therefore prescribe Niaspan since its considered to be the gold standard of niacin? If so, I urge you to look up user views on side effects at http://www.askapatient.com/viewrating.asp?drug=20381.  This was key reason why I chose NOT to take Niaspan and got the HDL, triglycerides level just with Vitamin D and Omega 3s

Ganesh:
Reading through some of the comments it seems to me people are starting on too higher dose.
I've been on niacin for almost a year and started with just 50mg/day. Yes, half a tablet.
Slowly worked up to 500mg standard niacin then switched to SloNiacin and increased to 750mg.
I take 75mg aspirin at the same time.
Any slight tingling I get I know the stuff is working and it makes me feel good.

Only problem, SloNiacin is only available from the US, so I have to import it myself. I'm pretty sure it's not legal to do this as amounts over 100mg are considered a drug in this country (NZ).
I've just had some vitamin D confiscated by Customs for the same reason. Capsules over 1000iu available only on prescription. Tough.

The primer states that niacin blocks the release of fatty acids. So if I am trying to loose fat would taking niacin be counter productive to on trying to burn fat stores to lose weight?

I wish it had worked.

Maybe because it was inositol hexaniacinate, 1000mg niacin "equivalent"

I had gotten my HDL up from 25 to 55 primarily through low carbing and adding more saturated fat, but that was with simvastatin 10mg

As an experiment I dropped the statin and added the niacin and also pantethine (NOT pantothenic acid) 600mg.

Previous results:
HDL 55 trigs 62 LDL 94
which is close enough for jazz to your 60-60-60

Latest results
HDL 47 trigs 115 LDL 156

I have now restatinated myself. Either my funky familial genes or the damage from the years of undiagnosed diabetes have caught up with me. Still it was an interesting experiment in showing that the statin actually does have a benefit over and above the diet.

It would be interesting to see what effect the statin *plus* the niacin and pantethine has but I suspect it will be several years before I am permitted another lipid panel. They prefer saving money to saving lives here.

Is supplementing with niacin the only way to raise HDL and lower LDL without taking Staten's?  Some other doctors are recommending a magnesium supplementation using a topical magnesium oil which can raise the magnesium levels to the top of the reference scale in as little as six weeks.  I quote Dr. Mildred S. Selig MD "most modern heart disease is caused by magnesium deficiency as reported in an article by Chris Jennings "what's all the buzz
about magnesium oil?".  

Magnesium in our food and water is drastically lower than it was 100 years ago.  I also understand that heart disease was practically non existent 100 years ago.  If true, what a coincidenc. Hmmm!  

As you know I respect and honor your medical opinion, so, what say you?

I forgot to mention that I also supplement with high dose vitamin D3 and high dose fish oil.  My triglycerides level is now 66 mg/dl down from 115 mg/dl.  However, there has been no movement in my HDL and LDL level so far. I am waiting for a VAP test to come back.  Bottom line, I would not like to supplement with niacin.  Who wants the discomfort of flushes or itching.  I hope that magnesium supplementation works.

Dr. Davis, always appreciate the great information on your blog. I have been taking 500mg of Slo-Niacin for a year with good results. Recently in a Prevention magazine I saw a quote by Dr. Angaston stating that you should only take niacin with a statin, that niacin by itself doesn't do anything. Your thoughts?

The form of niacin I use in 95% of cases is Upsher Smith's Sloniacin. It has a proven and published track record and is 1/20th the cost of prescription Niaspan.

Niacin works great by itself. There is absolutely no need for taking it with a statin.

I can't imagine why Dr. Agatston would say such a thing. I wonder if it's a misquote.

I recall reading that slow release niacin was the more hepatotoxic form of niacin, and that plain ol' niacin was best... is "sloniacin" the same thing as "slow release niacin?"

Niacin has confusing terminology.

Sloniacin is closest in properties to "extended-release" niacin rather than "slow-relase," meaning niacin is trickled out over a briefer period with extended release, a property associated with reduced hepatic toxicity.

Baylor college has a great resource if you want more medical study info.  The HATS study showed the staggering impact of Niacin/Statin combo but I don't think this should encourage statin use. If anything it points to a reduction in dose for those who must take statins ( http://www.lipidsonline.org/slides/slide01.cfm?q=niacin&dpg=9 )

I take 2grms (Now brand)at night before I go to bed.  Sure occasionally I get a flush but the benefits far outweigh the occasional discomfort:-

"In the group receiving niacin plus simvastatin without antioxidants, LDL-C levels were lowered by 42%; the LDL-C levels in the placebo groups were unaltered. HDL-C was increased by 26% in the niacin plus simvastatin group. The combination of niacin and simvastatin reduced CHD events by 60–90%, with about a 90% reduction seen in those subjects who did not take antioxidants, possibly because the treatment-induced increase in HDL particle size was blunted by antioxidants."

Trevor

The primer states that niacin blocks the release of fatty acids. So if I am trying to loose fat would taking niacin be counter productive to on trying to burn fat stores to lose weight?

I read a 2002 paper by John A. Pieper in VOL. 8, NO. 12, SUP. THE AMERICAN JOURNAL OF MANAGED CARE that said Slo-niacin was hepatoxic where as IR Niacin was not...Are there more recent studies that support your use of slo-niacin over IR niacin?

I have been battling slowly rising cholesterol since going through menopause, despite a great diet, ideal weight, and an active lifestyle. I resisted any suggestion of taking statins, especially after the February 2008 WSJ article and the NYTimes Well blog post "Do Statins Make You Stupid?"

Luckily, I have a very conservative doctor, who is not so quick to prescribe statins. First she recommended fish oil capsules, (which raised HDL but also raised LDL). After that, I tried garlic (which I had to stop after my partner commented on the smell of my skin), plant sterols, (which didn't appear to have much effect), and finally niacin.

In July I asked my doctor for instructions on using niacin. She recommended Slo-Niacin, starting with 500 mg once a day and increasing to 500 mg twice a day.

I went back for my three-month visit this morning. My cholesterol has dropped from 220 to 175; HDL still high at 53, LDL down to 102 from 142, triglycerides down to 85 from 160.

I usually avoid flushing by taking it immediately after a meal and drinking lots of water with the pill. If I eat too late in the evening and go right to bed, the flushing effect is worse - you have to move around for a while.

I am very pleased and hope that this anecdotal evidence will encourage others.

Steve,
I used  550 mg Niaspan for 3 months, It made no change in my Lipid Panel. Then I used 750 mg Slow-Niasin for 3 months . My Cholesterol fell from 182 to 174 . LDL dropped from 130 to 118. Triglycerides rose from 82 to 96, HDL went up 1 point from 35 to 36. Not happy with the results .
I am mow trying 1,000 IU of D-3 and 2,400 mg of Fish oil Supplement along with 1 heaping TBS  each of oat bran and  pure cocoa in my oatmeal every morning along with 1/4 cup of walnuts. Will get checked again in April.
I will post my results.

"A small 208-person trial that used ultrasound to examine arteries found that Zetia was clearly inferior to a version of the old drug niacin in preventing clogged arteries. Moreover, in a surprise finding, patients on niacin appeared to have fewer heart attacks and were less likely to die from heart disease than those who got Zetia. It is unusual for such a small trial to show a difference in heart attack rates."
http://www.forbes.com/2009/11/15/zetia-merck-vytorin-business-health-care-pharmaceuticals.html?partner=alerts

I would like to also follow up on the comment about niacin blocking the release of fatty acids.
I have read elsewhere that nicotinic acid inhibits lipolyis.
I cannot seem to determine how the recommended dosage (750 mg of SLO Niacin) might set me back in my current efforts to shed body fat?

Any further reading available on this issue anywhere? Thanks

While some people, no matter what they do, cannot tolerate niacin (about 10% of people), many others enjoy spectacular benefits.

I've been following most elements of the program and my historically elevated triglycerides have come down from 308 in Nov. '07 to 213 in mid Jan. '08. Also, previous physical in Dec'06 they were 383.
Cut back on the carbs and my daily coca-colas the last couple of weeks and am curious to see how big an effect that will have on them.

Hi,
My HFCS google alert picked up your blog. The problem with HFCS is that it has invaded our food supply. Courtesy of the Corn Refiners Assoc., go to
www.corn.org/NSFC2006.pdf p29-30 list all the food and products that contain HFCS. Some surprises:
bagels, soups, cough syrups.
StopHFCS.com lists foods that are
HFCS-free. They welcome additions
and suggestions. Our home is HFCS-free. My soft drink of choice is
Goose Island Root Beer!
Take care,

Dr Davis,

One huge question I have not seen answered is this. Drs measure FASTING tgs which are low on a lower carb diet. But a friend who had access to a cholesterol meter for a while found that after meals on a wheat free low carb diet tgs were extremely high for many hours a day.

So should cholesterol be measured without the usual 12 hour fast? Few  of us ever fasts that long except for the test.

Since the fasting glucose test is so poor at detecting diabetes, I wonder if the fasting cholesterol test is similarly flawed.

Dear Dr Davis,

My copy of 'Track Your Plaque' arrived this morning ! I had to cancel from the first company I ordered it from and found another who had a copy in stock. Thankgoodness, just in time ! I'm seeing my cardiologist on Monday for my echocardiogram and will feel more prepared to discuss referral for an EBCT scan now.

I'm reading TYP straight away and finding it an easy read full of lots of good advice. I just read the bit about using natural progesterone cream - how interesting. I've been using that for about ten years, using it first for PMS, then for osteoporosis (which it didn't prevent but it might have been worse without it), and now I see it may be helping my heart health

I am finding that I already follow the principles of the diet except I don't eat any dairy, grains or legumes, I follow a low carb Paleo diet and have lots of vegetables, though only low carb ones as I'm diabetic too (type 2 but not typical as I'm thin and not insulin resistant)...I loved that bit on page 130 "Eat vegetables, vegetables, and more vegetables. Occasionally add more vegetables". And I do exercise and take fish oils and eat tons of fish, and vitamin D3. I still hope this will help my valve problem.

bw's
Anne

I've been on a near-zero carb diet for 1.5 years and at my last blood screening my triglycerides were 43, HDL 53 and LDL 124. Would this indicate I have a high level of the good LDL? I eat zero wheat, sugar and HFCS.

I've noticed something interesting at my local "natural" food store (sort of a smaller local clone of Whole Foods) ... and that is the infiltration of agave syrup, both as a product and as an ingredient in processed organic food products.  This store proudly states that it doesn't carry foods with HFCS (nor will it sell lard, but that is another rant) yet agave syrup is far worse in terms of high fructose content and all the health problems that concentrated fructose causes (high triglycerides, AGEs, uncontrolled hunger, insulin resistance, obesity, etc.  

As I will get roller coaster blood glucose levels if I don't carefully watch my sugar and starch intake, I looked into agave syrup, because in the last year it was often recommended to me for its "low glycemic" index.  It is often labeled "safe for diabetics".

Well, raw or not, agave syrup (nectar) is an extremely concentrated source of fructose, because the agave juice is hydrolyzed with enzymes to break apart the sugar molecules, allowing the glucose sugar molecules to be removed (I don't care if heat isn't used or if minerals remain, if that isn't "processing", what is?).  According to Wikipedia, the fructose content can be as high as 92% in some brands of agave syrup.  Compare that to 50% fructose in table sugar and 55% in HFCS.  

No one I have talked to who uses or recommends agave syrup is aware of this (especially at the store level), yet agave syrup is halled as a superior, "healthy" sugar to use (perhaps with abandon?), especially for diabetics and anyone who is health conscious.  Enough to make your toes curl, isn't it?

I have kept my triglycerides low (last lab 52) and that is pretty typical for me) since 2004 by reducing all sugars and starches (especially wheat) to a minimum, except for some non-starchy veggies and some very dark chocolate (70-88% cocoa solids).  I can achieve normal blood glucose levels without medication this way.  Prior to 2004 my triglycerides were well nearly 200 all the time.  With my gestational diabetes history and current impaired glucose intolerance (despite normal weight) the last thing I need is worsen things by using HF agave syrup because it is labeled a "low-glycemic" or "healthy", safer sugar.

Thanks, Anna. I wasn't aware of that.

Are all triglycerides the same?  Or is there a subtype analysis for them, too?

Yes, there are, though the breakdown depends on the laboratory and analysis used.

Jenny--

This is among the reasons that I bash conventional cholesterol testing--among many other reasons.

Postprandial (after-eating) patterns, however, are not well explored. One measure we use that is obtained from fasting blood but serves as a useful surrogate measure of postprandial patterns is intermediate-density lipoprotein.

Small vs. large LDL can be genetically determined, as well as influenced by food and lifestyle. So you cannot tell just by looking at the conventional lipid panel.

I have seen a few postings by you in which you mention that beer often contains high fructose corn syrup.  I brew as a hobby and I am unaware of any brewer that uses HFCS in beer making.  True, commercial brewers use adjuncts like rice, but most beer is made primarily from malted barley.  The typical sugar profile from malted barley is 50% maltose, 18% maltotriose, 10% glucose, 8% sucrose, and 2% fructose.  Most residual sweetness in beer comes from complex carbs like dextrins that yeast can't break down easily.

Just thought you'd want to be accurate on this point.  Not saying that beer is a good thing, or that the types of calories in beer don't contribute to the problems you hve identified, but I think the mechanism is something other than HFCS.

My father suffers from triglycerides and all of your advices have been taken a long time ago, this really helps to control them and keep a healthy happy life.

Good advice, I have heard most of this before but have never actually take them to practice, I am getting concerned about my weight lately so I better follow tis directions.

Reduction of high-glycemic index foods--Most notably wheat. Everybody knows that we shouldn't eat Snickers bars or bags of licorice. But many people eat plenty of wheat-containing breads, pastas, pretzels, crackers, breakfast cereals, etc., all in the name of increasing whole grains and fiber. In reality, they are causing triglycerides to skyrocket, dropping HDL, forming small LDL, increaaing blood sugar and blood pressure, and increasing obesity.

Well ain't this funny. I once had a random blood fat test (20th October) and as I was unaware they would do that test in my blood test. I had just eaten a lunch consisting of red meat and fruit juice (with tons of fructose) about an hour before. My serum triclyceride number was 0.4mmol/l or 35mg/dl. I guess it pays to be naturally skinny.

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