The Real Story On Niacin: Niacin associated with significant reductions in cardiovascular disease and mortality

You may have heard some recent reports on Niacin (one of the B-vitamins) that seemed to suggest it wasn’t of benefit for cardiovascular disease. Actually, the recent studies fueling these reports only looked at certain special forms of niacin taken together with a statin drug. These studies proved a disappointment to the statin drug makers, because the research didn’t show any additional benefit in adding the niacin. (By the way, some researchers have pointed out problems with the special forms of niacin used in these studies.)

Given the confusion in some news reports about Niacin, we at NYBC think it’s important to repeat what researchers stated about Niacin in a March 2014 article in the Journal of Cardiovascular Pharmacology and Therapeutics. This article reviewed the recent Niacin studies, and also reiterated the well-known and well-documented benefits of Niacin for cardiovascular health:

1. In a long-term study called the Coronary Drug Project, “niacin treatment was associated with significant reductions in cardiovascular events and long-term mortality, similar to the reductions seen in the statin monotherapy trials.”

2. “In combination trials, niacin plus a statin or bile acid sequestrant produces additive reductions in coronary heart disease morbidity and mortality and promotes regression of coronary atherosclerosis.”

3. Niacin is the “most powerful agent currently available” for RAISING levels of HDL-C (high-density lipoprotein cholesterol, the so-called “good cholesterol”); and it can also REDUCE levels of triglycerides and LDL-C (low-density lipoprotein cholesterol, the so-called “bad cholesterol”).

Here’s the reference for these three important points about Niacin:

Boden, W E, Sidhu M S, & Toth P P. The therapeutic role of niacin in dyslipidemia management. J Cardiovasc Pharmacol Ther. 2014 Mar;19(2):141-58. doi: 10.1177/1074248413514481.

NOTE: NYBC stocks Niacin No-Flush (Source Naturals): http://nybcsecure.org/product_info.php?cPath=50&products_id=439; Niacin TR Niatab 500mg (Douglas): http://nybcsecure.org/product_info.php?cPath=50&products_id=249; and
Niacin TR Niatab 100mg (Douglas) http://nybcsecure.org/product_info.php?cPath=50&products_id=252

As always, we strongly recommend that you consult your healthcare provider when using supplements.

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Study finds link between low Vitamin D and heart disease, cancer, and all-cause mortality

A vast review of studies on Vitamin D has concluded that people with low levels of the vitamin had a 35 percent increased risk of death from heart disease, a 14 percent higher risk of death from cancer, and a greater risk of death from all causes as well.

The authors of this review, who came from a wide range of European and US universities, also looked at the usefulness of supplements, and found that there was no benefit from taking Vitamin D2. However, when they studied middle-aged and older adults who took Vitamin D3, they found an 11% reduction in risk of death from all causes. They also estimated that up to two-thirds of the people in Europe and the US are deficient in Vitamin D, and they calculated that about 13% of all deaths in the US, and about 9% of all deaths in Europe, are linked to low Vitamin D levels.

NYBC’s comment: This review suggests that it is crucial to supplement with Vitamin D3—-which is the type of Vitamin D stocked by NYBC. Older forms of supplementation, such as Vitamin D2-fortified milk, may not have benefit, according to this research. Secondly, though some have argued that low Vitamin D may simply be a side effect of disease processes that can’t be reversed by supplementing, we believe that this study also offers evidence that, especially when people are known to be deficient in Vitamin D (as is often the case in older populations, or among HIV+ people), supplementing with D3 has the potential to reduce disease risks, and indeed may reduce the overall risk of mortality.

See NYBC’s catalog for more detailed recommendations on Vitamin D3 supplementation:

Vitamins and Minerals – NYBC Catalog

Reference:

Chowdhury, R et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ April 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1903

Vitamin C deficiency linked to higher risk of stroke

A preliminary study that will be presented at the American Academy of Neurology meeting in April-May 2014 suggests that being deficient in Vitamin C raises your risk for a stroke. The lead researcher of the study, Dr. Stéphane Vannier, M.D., of Pontchaillou University Hospital in France, said that the research pointed to Vitamin C deficiency as a risk factor for the often deadly hemorrhagic type of stroke, just like high blood pressure or being overweight. He also called for further research to identify exactly how Vitamin C levels affect stroke risk (for instance, as an influence on blood pressure).

This study finds still another negative consequence of Vitamin C deficiency, since low Vitamin C levels have also been linked to anemia, a lower capacity to fight infection, lower wound healing capacity, gingivitis, and joint pain. Vitamin C is found in many fruits and vegetables, including oranges and peppers, and can also be obtained through supplementation.

NYBC stocks several different forms of Vitamin C, including Buffered Vitamin C (Jarrow), which is easier on the stomach than other forms; a Vitamin C with Olea Extract (Jarrow); and C Esterol (Allergy Research), which combines Vitamin C with other plant extracts rutin, quercetin, and grape seed proanthocyanidins.

Reference:
News of this preliminary study was widely reported, but we accessed some information at

http://www.webmd.com/stroke/news/20140214/can-vitamin-c-ward-off-stroke

Taking Vitamin D3 supplements for more than 3 years linked to lower mortality

We’ve heard a lot about Vitamin D in the past few years. There have been studies linking low Vitamin D levels to a host of health issues, from heightened risk of cardiovascular disease, to higher probability of developing the flu, especially during the winter season, when you get less exposure to the sunshine that allows the body to produce its own supply of the vitamin.

Now here’s an interesting meta-analysis (=review of previously published research) that looks at the connection between long-term use of Vitamin D3 supplements (“long-term” defined, in this case, as more than three years). Reviewing data from 42 earlier trials, this investigation found that those who supplemented with Vitamin D for longer than three years had a significant reduction in mortality. Specifically, this research found that the following groups showed a lower risk of death when supplementing with Vitamin D over a period longer than three years: women, people under the age of 80, those taking a daily dose of 800IU or less of Vitamin D, and those participants with vitamin D insufficiency (defined as a baseline 25-hydroxyvitamin D level less than 50 nmol/L).

Here’s the conclusion reached by the researchers:

The data suggest that supplementation of vitamin D is effective in preventing overall mortality in a long-term treatment, whereas it is not significantly effective in a treatment duration shorter than 3 years. Future studies are needed to identify the efficacy of vitamin D on specific mortality, such as cancer and cardiovascular disease mortality in a long-term treatment duration.

Our comment: We’re not surprised that supplementing over a period of years proves, in this review, to be more beneficial than briefer periods of supplementing. Vitamin D, like many supplements, shouldn’t be seen as treatment for an acute condition. It doesn’t act like an antibiotic, which may clear up an infection with a couple weeks of treatment. Instead, think of the body as having a long-term, continual need for Vitamin D; and note as well that seasonal change, or a particular health status (for example, being HIV+), may lead to deficiency and thus increase your need for supplementing. We were somewhat surprised to see that a significantly lowered risk of mortality was found even with a moderate rate of supplementation (800 IU daily dose). On this Blog you can read about other research that links decreased risk of flu, for example, with a daily Vitamin D dose of 2000IU. At any rate, there are no known “adverse events” at either of these doses of the vitamin, so not to worry, whether you’re following the lower or a higher recommendation.

See the NYBC catalog for Vitamin D3 offerings:

http://nybcsecure.org/index.php?cPath=25

Reference:
Zheng Y, et al. Meta-analysis of long-term vitamin D supplementation on overall mortality. PLoS One. 2013 Dec 3;8(12):e82109. doi: 10.1371/journal.pone.0082109.

Pomegranate juice and heart health

In the past decade, there have been a number of studies of the potential of pomegranate juice to support cardiovascular health and provide additional health benefits as well. Recently we reviewed a research report published in 2012 that looked at the cardiovascular and immune system benefits of pomegranate juice for hemodialysis patients. This was a randomized placebo controlled double-blind trial (a kind of research design that is likely to produce reliably objective findings). The patients were followed for one year as they used pomegranate juicee three times a week while continuing their dialysis treatments. The results:

Pomegranate juice intake resulted in a significantly lower incidence rate of the second hospitalization due to infections. Furthermore, 25% of the patients in the pomegranate juice group had improvement and only 5% progression in the atherosclerotic process, while more than 50% of patients in the placebo group showed progression and none showed any improvement.

And the conclusion:

Prolonged pomegranate juice intake improves nontraditional CV [cardiovascular] risk factors, attenuates the progression of the atherosclerotic process, strengthens the innate immunity, and thus reduces morbidity among HD [hemodialysis] patients.

Of course, this research involved a special group of patients, those on hemodialysis. But, as a well-designed study, it does, we think, provide a fairly strong endorsement of the health benefits of pomegranate juice.

For more on pomegranate juice, see the NYBC entry

http://nybcsecure.org/product_info.php?cPath=40&products_id=333

Note that NYBC also carries the Douglas supplement Cardio-Edge, which includes pomegranate:

http://nybcsecure.org/product_info.php?cPath=35&products_id=284

Reference: Shema-Didi, L et al. One year of pomegranate juice intake decreases oxidative stress, inflammation, and incidence of infections in hemodialysis patients: a randomized placebo-controlled trial. Free Radic Biol Med. 2012 Jul 15;53(2):297-304. doi: 10.1016/j.freeradbiomed.2012.05.013. Epub 2012 May 17.

HIV and Aging: Living Long and Living Well

By 2015, more than 50% of the United States HIV population will be over 50. There are approximately 120,750 people now living with HIV/AIDS in NYC; 43% are over age 50, 75% are over age 40. Over 30% are co-infected with hepatitis.

What does the future hold for people with HIV and HIV/HCV as they get older?

These statistics and this question furnished the starting point for the New York Buyers’ Club March 28 event HIV and Aging: Living Long and Living Well, presented by Stephen Karpiak, PhD, of the AIDS Community Research Initiative of America (ACRIA).

Dr. Karpiak’s background uniquely positions him to paint the full picture behind the bare statistics, and to provide expert guidance through the complex healthcare challenges faced by the growing population of older people with HIV. After two decades as a researcher at Columbia University’s Medical School, Dr. Karpiak moved to Arizona, where he directed AIDS service organizations through the 1990s, including AIDS Project Arizona (which offered a supplements buyers’ club similar to NYBC’s). In 2002, back in NYC, he joined ACRIA as Assistant Director of Research, and was the lead investigator for the agency’s landmark 2006 study, Research on Older Adults with HIV. This report, the first in-depth look at the subject, surveyed 1,000 older HIV-positive New Yorkers on a host of issues, including health status, stigma, depression, social networks, spirituality, sexual behavior, and substance abuse.

Why are there more and more older people with HIV? The first and principal answer is very good news: HIV meds (HAART), introduced more than 20 years ago, have increased survival dramatically. Secondly, a smaller but still significant reason: older people are becoming infected with HIV, including through sexual transmission. (Older people do have sex, though sometimes healthcare providers don’t seem to acknowledge this reality.)

As Dr. Karpiak noted, HAART prevents the collapse of the immune system, and so it serves its main purpose, to preserve and extend life. And yet, as he reminded the audience, HIV infection initiates damaging inflammatory responses in the body that continue even when viral load is greatly suppressed. These inflammatory responses, together with side effects of the HIV meds, give rise to many health challenges as the years pass. In people with HIV on HAART, research over longer time periods has found higher than expected rates of cardiovascular disease, liver disease, kidney disease, bone loss (osteoporosis), some cancers, and neurological conditions like neuropathy.

That brings us to “multi-morbidity management”—a term we weren’t enthused about at first, since it sounded more like medical-speak than the plain talk our NYBC event had promised. But Dr. Karpiak gave us a simple definition: dealing with three or more chronic conditions at the same time (and HIV counts as one). He then made the case that this is a critical concept to grasp if older people with HIV are going to get optimal care. Multi-morbidity management, he explained, is a well-accepted healthcare concept in geriatric medicine, which recognizes that older people may have several conditions and will benefit from a holistic approach in order to best manage their health. Treating one condition at a time, without reference to other co-existing conditions, often doesn’t work, and sometimes leads to disastrously conflicting treatments.

And here’s where Dr. Karpiak warned about “polypharmacy”–another medical term worth knowing. “Polypharmacy” can be defined as using more than five drugs at a time. Frequently, it comes about when healthcare provider(s) add more and more pills to treat a number of conditions. But this approach can backfire, because, as a rule of thumb, for every medication added to a regimen, there’s a 10% increase in adverse reactions. That’s why adding more and more drugs to treat evolving conditions may be a poor approach to actually staying well.

In closing, Dr. Karpiak focused especially on a finding from ACRIA’s 2006 study: the most prevalent condition for older people with HIV, aside from HIV itself, was depression. Over two-thirds of those surveyed had moderate to severe depression. Yet while depression can have serious conse-quences–such as threatening adherence to HIV meds–it has remained greatly under-treated. It may seem an obvious truth, but as Dr. Karpiak underlined, psychosocial needs and how they’re met will play a big role in the health of people with HIV as they age. What social and community supports are available becomes a big medical question, and how healthcare providers and service organizations respond to it can make for longer, healthier lives for people with HIV.

And now we come back to NYBC’s contribution to the discussion on HIV and Aging. While NYBC doesn’t keep track of such information in a formal way, we do recognize that quite a few of our members have been using supplements since the days of our predecessor organization DAAIR–going back 20 years now. That’s a lot of accumulated knowledge about managing symptoms and side effects among people with HIV! To accompany the March 28 presentation, our Treatment Director George Carter drew up a pocket guide to complementary and alternative approaches: HIV and Aging – Managing and Navigating. Partly derived from his long experience, and partly drawn from a 2012 Canadian report, the guide ranges over those kinds of “co-morbidities” that Dr. Karpiak spoke of, including cardiovascular, liver, kidney, bone, and mental health conditions. Interventions or management strategies include supplements, but also diet and exercise recommendations, as well as psychosocial supports (counseling, support groups, meditation, and activism).

NYBC has also updated several info sheets from its website and blog, offering these as a way to address some of the most common healthcare issues facing people with HIV as they get older: cardiovascular topics; :digestive health; NYBC’s MAC-Pack (a close equivalent to K-PAX®); key antioxidants NAC and ALA and their potential to counter inflammatory responses; and supplement alternatives to anti-anxiety prescription drugs. These info sheets, together with the HIV and Aging – Managing and Navigating pocket guide, are available on the NYBC website and blog.

We hope that our HIV and Aging: Living Long and Living Well event has been useful to all. Special thanks to our audience on March 28, many of whom brought excellent questions to the session. Now let’s continue the conversation…

To your health,

New York Buyers’ Club

NYBC_March282013

Vitamin D may lower blood pressure in African-Americans

A trial published in the journal Hypertension (Feb 3, 2013) found that Vitamin D supplementation can lower blood pressure in African-Americans, who are at greater risk for high blood pressure than the general population.

In the research study, participants received a placebo, or 1000, or 2000, or 4000 IUs of Vitamin D3 a day for three months. There was no significant change for those taking the placebo. Those who took the highest amount of Vitamin D daily showed the greatest reduction in blood pressure. “This degree of blood pressure reduction, if confirmed in future studies, would be considered clinically significant,” said the lead author, Dr. John P. Forman. (Quoted in NYT online, where we first read of this story.)

NYBC stocks Vitamin D in several different strengths:

http://nybcsecure.org/index.php?cPath=25

Vitamin D is a low-cost supplement, and is reported to have no adverse effects in daily doses as high as 4000IU. Search under Vitamin D for previous posts on this blog about the vitamin’s potential for cardiovascular health benefits, especially for African-Americans and other groups at elevated risk.