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.

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    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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I'll supply the tar if you supply the feathers

I'll supply the tar if you supply the feathers

The results of the latest Heart Scan Blog poll are in.


DIRECT-TO-CONSUMER PHARMACEUTICAL ADVERTISING HAS:

Increased public awareness of medical conditions and their treatment
19 (11%)

Has had little overall effect on health and healthcare
29 (18%)

Needlessly increased healthcare costs
81 (50%)

Further empowered the revenue-obsessed pharmaceutical industry
130 (81%)


Clearly, there's a lot of negative sentiment against direct-to-consumer (DTC) drug advertising.

It looks as if a small minority believe that good has come from DTC advertising, judging by the meager 11% who voted for increased awareness. In fact, the poll results are heavily weighed towards the negative: 50% voted for "needlessly increased healthcare costs," while an astounding 81% voted for "empowered the revenue-obsessed pharmaceutical industry."

It is, indeed, an odd situation: Pharmaceutical agents available only by prescription being hyped directly to the consumer.

Personally, I would vote for choices 1,3, and 4. While awareness has increased, it has come with a hefty price, not all of it well spent. I believe the pharmaceutical industry still adheres to the rule that, for every $1 spent on advertising, $4 is made in revenue. They are, in effect, printing money.

Comments (13) -

  • Jim Purdy

    11/30/2009 1:06:16 PM |

    I would add this answer:

    Led to the massive over-prescribing of dangerous and powerful drugs to millions of patients, resulting in very large numbers of deaths and harmful side-effects.

  • Anonymous

    11/30/2009 4:51:34 PM |

    I have a young Cardiologist who told my husband and me on the last visit that drug companies are suffering from the downturn in the economy because of the billions that they are spending on research, and seems to believe it!!

  • Dr. William Davis

    11/30/2009 7:05:47 PM |

    Yes, among the most brainwashed of all are my colleagues.

  • Kathryn

    11/30/2009 11:59:50 PM |

    When this first began (& i was firmly ensconced in the medical system) i strongly believed the DTC ads would be helpful.  I was working for a doctor at the time & believed that folks should educate themselves & be their own advocates, to learn more of the meds they took & be more aware of side effects.  (The doc i worked for was not very impressed with my thoughts, however.)

    Sadly, that is not at all what has occurred with these ads.  

    Instead, ads give folks a false impression of what they do & then the folks insist on the meds to their docs.  No one is better educated or making a better effort at partnering with docs rather than taking their word as gospel.

    I'm long out of the conventional medical field (it has been over 5 years since i was on staff at a hospital).  But we still need to help folks learn to be their own advocates & educate themselves.  I'm so impressed with your website Dr. Davis, as it is a wonderful tool to do so.

  • Anonymous

    12/1/2009 1:24:45 AM |

    Sad that the results of your poll show only the opinion of a small more enlightened minority...

  • Dr. William Davis

    12/1/2009 3:05:45 AM |

    True, but it's a start!

    I can only hope that the "enlightened" further enlighten those around them.

  • renegadediabetic

    12/1/2009 2:19:52 PM |

    Some of that "awareness" may just be the power of suggestion making people think they have a disease and need that drug.  For example, restless leg syndrome is rare, though it is real.  Why advertize drugs to treat a rare condition???  I'm sure individual doctors can diagnose it and know what to prescibe.  Could it be that they want people to think they have restless leg syndrome when they really don't so that drug sales will increase?  Any why is it necessary to advertize antipsychotic drugs?  Do they think the entire population is crazy???  I'm sure that psychiatrists are capable of knowing what to prescibe without direct advertizing.

  • Richard A.

    12/1/2009 8:11:43 PM |

    I do not understand what advantage expensive Plavix has over dirt cheap low dose aspirin.

    From LAtimesblogs --
    Plavix advertising indirectly cost taxpayers an extra $207 million over five years

    http://latimesblogs.latimes.com/booster_shots/2009/11/plavix-advertising-indirectly-cost-taxpayers-an-extra-207-million-over-five-years-1.html

  • Allen

    12/26/2009 7:44:49 AM |

    Hello, you have tried to your best. I agree with you and really liked it. Great effort... Keeps it up!!!!

  • Anonymous

    5/23/2010 3:36:30 AM |

    Hey I just a got a VAP blood test and my results stunned me.

    LDL 173 with 80% Type B. I was stunned, because I have been taking my fish oil, eating low carb, and no grains for 8 months now. She said your HDL is 44 so a statin is a better choice than niacin, but I insisted on niacin. My Doctor isn't happy, but it's my body, so my decision.

    Well yesterday I went brought that glucose meter and been taking my glucose reading and found them to range between 70 and 84.

    That is until today. I went out to dinner and ordered mussels and shrimp cooked in olive oil with cherry tomatoes with a side of spinach. Low carb right?

    Well an hour later I took a reading and found my blood glucose to be 137.

    What the Heck?

    I eat out a lot; maybe these places have been adding sugar to my Low Carb orders and that is the reason for my poor VAP test results? I am hoping the glucose meter helps me understand the weaknesses in my diet and with the niacin help me score better in my next VAP test.

    All I can say is thank you Dr. Davis for sharing your knowledge with us.

    Steve

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