News about Niacin

You may have read worried news reports earlier this year about a study of niacin + a statin drug used to lower cholesterol (lipids). The study was stopped prematurely because researchers detected a small increase in strokes among participants taking the niacin +simvastatin (Zocor) combination. This was quite a surprise to scientists, because niacin (a B-vitamin) has a 50-year history of safe and effective use for normalizing lipid levels, and the suggestion that a statin drug/niacin combination might carry even a slight extra cardiovascular risk was disturbing.

We were therefore glad to see the Canadian AIDS Treatment Information Exchange (CATIE) review and clarify the results of this study, while at the same time reporting on an important new piece of research about niacin, lipid control, and HIV. (You can find the full CATIE reporting about niacin at www.catie.ca.) CATIE’s view, in line with other cautionary voices, stresses that the niacin/statin study data do not show any clear connection between niacin and increased strokes. And it’s also true that, through 50 years of research on niacin and lipids, there’s never been any evidence of such a connection. In short: expect more examination of the issue, but don’t jump to any conclusions—there’s just not the evidence to support dropping niacin for lipid control.

Coincidentally, as the niacin/statin study was being suspended, results of another trial involving niacin for lipid control were being published. This research, conducted at Baylor College of Medicine in Texas, looked at a combination of niacin, fenofibrate (a prescription drug used to lower cholesterol), diet and exercise for lipid management among people with HIV. Called the Heart Positive study, this investigation found that a combination of high-dose niacin, together with fenofibrate, diet and exercise was clearly the best strategy for managing lipids in a group of more than 100 people with HIV. And, significantly–there were no signs in this research that niacin was unsafe.

We certainly urge all our members who use or are thinking of using niacin as part of a strategy to control lipids to talk to their doctors about the recent research. (You may even want to share the CATIE info with your physician.) As we’ve said above, we don’t see clear evidence that niacin poses extra, unexpected risks. Meanwhile, its benefits continue to be documented in research like the Heart Positive study. As always, we need to keep up with research news—and also maintain a bit of skepticism in judging how that news gets reported.

For more information on Niacin, see the NYBC entries:

Niatab 100/500mg

or the lower, starter dose:

Niacin 100/100mg

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NYBC’s BrainPower Multi-Pak – low-cost “Ultramind Solution”

NYBC’s Low-Cost Alternative to the Pricey “Ultramind Solution”

The UltraMind Solution by Dr. Mark Hyman is one of many recent books that attempt to translate the piles of research from the last few decades about nutrition and brain function into useful guidelines for improving and maintaining good mental functioning and psychological well-being.

The Ultramind Solution contends that changing your diet–your “nutritional intake”–can often make a huge difference with conditions like depression, memory impairment, or “brain fog.” Dr. Hyman’s recommendations focus both on weeding out elements that harm the system (too much sugar, poorly chosen carbs, alcohol, cigarettes), and sticking to a menu of what’s good, especially what’s good for brain function: 1) omega fatty acids (found in salmon, sardines, flaxseed); 2) amino acid sources (nuts, lean meats); 3) high-quality carbs (for example, beans, peas, and lentils); 4) phyto-nutrients (plant foods containing antioxidants and other helpful substances, like blueberries, cilantro, etc.).

Finally, Dr. Hyman observes that, since more than 90% of Americans don’t get adequate nutrients from food (a finding from an often-cited US government survey), many people realistically will need to supplement in several key categories: 1) a multivitamin; 2) fish oil (omega fatty acids); 3) Calcium/Magnesium; 3) Vitamin D; 4) B complex vitamins; 5) probiotics (for good absorption of nutrients).

And yes, you can even go to the ”Ultramind” online store, where you can purchase a kit containing these supplements. The problem is that, at $121.50 for a month’s supply, this package is way overpriced. But never fear—NYBC, as a nonprofit supplements co-op, can offer an alternative that’s a close equivalent (or slightly better), but at only $90 for a month’s supply ($80 if you sign up for a $5 minimum annual membership in the co-op).

Here’s NYBC’s BrainPower Multi-Pak:

    Multivitamin: Added Protection without Iron (Douglas)
    Fish oil: Max DHA (Jarrow)
    Calcium/magnesium/Vitamin D: Ultra Bone Up (Jarrow)
    B: Methyl B-12 (other B vitamins included in the multi)
    Probiotic: Ultra Jarrodophilus

By the way, you can purchase any of these items individually at NYBC if you like. Again–at lower prices than in the “Ultramind” store.

Supplements for the Brain (and Nerves)

“For Your Peace of Mind…”

Recent research on supplements for memory, cognition and other neurological functions
You may remember (we hope you remember!) the Scarecrow’s petition to the Wizard of Oz for a brain. Be advised–we at NYBC do not stock new brains, so don’t come to us with that request.

However, we do follow the sometimes startling new research on supplements, brain function and related neurological issues. In this department, there’s special cause for concern for people with HIV. According to a Canadian study released in 2010, in a group of 1615 people receiving treatment for HIV during the decade 1998-2008, one fourth had neurological problems, including memory loss, cognitive impairment and peripheral neuropathy. Of course being worried about brain function–and neurological function in general–is not unique to people with HIV. As people age, they are more likely to experience memory loss or forms of dementia such as Alzheimer’s. And the nerve condition called peripheral neuropathy (pain, tingling in the feet and hands) is found not just in people with HIV, but also among the growing population with Type 2 diabetes.

Now, on to what we see as some of the most valuable recent findings about supplements and brain or neurological function:

B vitamins can be considered a foundation because they are needed in so many processes essential to the brain’s operation, from energy supply and healthy blood flow, to the formation of neurotransmitters (=chemical messengers of neurologic information from one cell to another). Furthermore, there is evidence that several groups of people, including those over 60 and those with HIV, have a greater risk for Vitamin B deficiencies. So supplementing with a B complex vitamin is a sensible start to cognitive health. More specifically, there is good research linking deficiency of vitamins B12 and B6 to mood disorders like depression—and depression earlier in life is associated with higher risk of dementia in later life. Last, there is also some evidence that B vitamins may reduce stroke risk in older people.

Omega-3 fatty acids (fish oil) support cognitive health in a variety of ways. In 2008, UCLA researchers reported on a lab study showing that the omega-3 fatty acid DHA, together with exercise, improved cognitive function. This caught our attention, because there is wide agreement that regular exercise strongly supports brain function as we age, and here the suggestion is that omega-3 fatty acids multiply that known benefit. A diet rich in omega-3 fatty acids/fish oil has also been linked to lower risk of depression—another plus. And still more: recent research found that omega-3 fatty acids block the development of retinopathy, a chief cause of blindness as we age. (The retina of the eye is actually part of the brain–it is full of nerve cells essential for vision.) All in all, the neurological benefits of omega-3 fatty acids seem both wide-ranging and quite convincing, so it’s high on our recommended list.

The amino acid acetylcarnitine has shown benefit for brain function in a number of studies with humans. In the last decade, acetylcarnitine has also been investigated for peripheral neuropathy in people with HIV. (Some recommend using it with evening primrose oil and Vitamin C.) A 2008 study found that acetylcarnitine influences a chemical process in the brain that triggers Alzheimer’s, so researchers are continuing to puzzle out how this supplement produces its neurological benefits.

Antioxidants. There’s much suggestive research about how antioxidants counter destructive oxidative processes in the brain, thus blocking memory loss and cognitive decline. For example, a 2003 report found that the antioxidant combination alpha lipoic acid and NAC reversed memory loss in aged laboratory mice. And there’s also been a lot of attention to the combination acetylcarnitine and alpha lipoic acid for memory impairment. Furthermore, other antioxidants such as curcumin are under study for their potential to fight the processes that lead to declining brain function.

Acetylcholine. The first neurotransmitter to be identified, acetylcholine is closely associated with memory, with lower levels linked to memory loss. NYBC currently stocks two combination supplements that support acetylcholine levels in the brain, while also providing other nutrients for neurological function: Neuro Optimizer (Jarrow), which includes acetylcholine enhancers, acetylcarnitine, and alpha lipoic acid; and Think Clearly (SuperNutrition), which includes B vitamins, as well as acetylcholine enhancers and a botanical traditionally used for cognitive support, ginkgo biloba.

Resveratrol. In the past decade, there has been intense scientific interest in this compound, most famously found in red wine. While some research ventures have hoped to find in resveratrol a life-extending supplement (a capacity demonstrated in animal studies), others have focused on its therapeutic value for conditions like diabetes or cognitive decline. For example, Cornell researchers reported in 2009 that resveratrol reduced the kind of plaque formation in animal brains that causes Alzheimer’s. And a year later another lab investigation, this one at Johns Hopkins, found that a moderate dose of the compound protected animal brains from stroke damage.

Ginkgo biloba, a botanical derived from Earth’s most ancient tree species, has been widely used for cognitive function. In the late 1990s, two reviews of dozens of ginkgo studies concluded that it could improve symptoms of dementia. However, a long-term trial of ginkgo published in the Journal of the American Medical Association in 2008 found that the supplement did not prevent development of dementia in a group of more than 3000 older people who had normal cognitive function at the start of the research. One possible conclusion: ginkgo may help symptoms of cognitive decline, but doesn’t address underlying causes.

NYBC’s RECOMMENDATIONS: A B complex supplement (like Jarrow’s B-right) and fish oil (like Jarrow’s Max DHA) are foundations for maintaining cognitive health, especially important for people with HIV or people over 60. There is some evidence for acetylcarnitine, alpha lipoic and acetylcholine supplementation for memory impairment and possibly for cognitive decline. Acetylcarnitine and other supplements can be used to address peripheral neuropathy. And stay tuned for emerging research on preserving brain function with compounds like resveratrol, NAC and curcumin.

Niacin for heart health in diabetics

A news item in the journal Diabetes Forecast reported that taking the B vitamin Niacin in addition to statin drugs was a good way to increase the amount of HDL cholesterol (the so-called “good” cholesterol, as opposed to the “bad” or LDL cholesterol) for diabetics who were being treated for high cardiovascular risk.
Higher levels of HDL cholesterol have been linked in a number of studies to lower risk for heart attack, so Niacin appears to be a good way for diabetics to reduce one of the main health challenges of their condition.

Reference: “Vitamin B for your heart,” in Diabetes Forecast, April 2010.

NYBC stocks Niacin in two strengths:

Niacin 100mg

and

Niacin 500mg

Please read the NYBC entries on these two products for recommendations on how to gradually increase Niacin dosage in order to minimize “flushing” (redness, itchiness) that can be associated with taking Niacin.

Top search terms bringing visitors to this blog

Dear NYBC Blog Reader,

Thought you might be interested to see some of the most popular search terms that brought people to the New York Buyers’ Club Blog in the past year:

1. “Saccharomyces boulardii C difficile”
2. “glutamine ulcerative colitis”
3. “cholesterol lowering supplements”
4. “B vitamins depression”
5. “HIV Vitamin D”
6. “vitamins for neuropathy”
7. “Tylenol antidote”

And here, in very brief form, is the information these searchers found on the NYBC Blog:

Saccharomyces boulardii, which NYBC stocks in the form of Florastor, appears in a recent study to be the best probiotic for the stubborn gastrointestinal infection C. difficile.

Glutamine has shown effectiveness in reducing symptoms of ulcerative colitis and other gastrointestinal conditions in a number of research studies.

Plant sterols, fish oil, niacin, pantethine have been studied for cholesterol control.

B vitamins strongly affect mood and memory, and addressing a B vitamin deficiency can improve depressive symptoms.

Vitamin D deficiency is widely prevalent among people with HIV, and supplementing with 1000IU/day of D3 plus 1000mg/day of calcium may be a good way to support bone health for people taking HIV meds. Other research has noted the link between Vitamin D deficiency and cardiovascular disease, certain cancers, and susceptibility to cold and flus.

Acetylcarnitine, alpha lipoic acid and evening primrose oil are among the supplements studied for diabetic or HIV-related neuropathy (pain, tingling in feet, hands).

NAC (N-acetylcysteine) is used as the antidote to acetaminophen overdose. Acetaminophen is the active ingredient in Tylenol and is added to many other over-the-counter drugs, so overdose leading to liver damage or liver failure has become common in the US.

B vitamins and brain function: the latest studies

The evidence continues to pile up that levels of the B vitamins, in particular B6 (pyridoxine), B9 (folate), and B12 (cyanocobalamin), are closely related to maintaining cognitive function and warding off brain-related disorders like Alzheimer’s as we age. Well-designed studies, including the Veterans Affairs (VA) Normative Aging Study, have pointed particularly to Vitamin B deficits being associated with buildup of homocysteine, which in turn may be responsible for impairment to cognitive function.

B Vitamins are central to the preservation of mental capacities as we age. At the same time, the aging digestive system may not absorb nutrients as effectively as it once did; so an obvious strategy is to consider B complex supplementation as well as good dietary habits as we get older.

Read more on the B vitamins on the NYBC site:

B-right (Jarrow) We selected this as a good comprehensive B vitamin supplement.

B-12 Methylcobalamin (Jarrow) Studies have suggested that this is a very effective way to supplement with B12, which may not always be well-absorbed by the body when taken in other formats.

Some References:

Kim JM, Stewart R, Kim SW Changes in folate, vitamin B12 and homocysteine associated with incident dementia. J Neurol. Neurosurg. Psychiatry 2008;79;864-868.

Tucker KL, Qiao N, Scott T, et al. High homocysteine and low B vitamins predict cognitive decline in aging men: the Veterans Affairs Normative Aging Study. Am J Clin Nutr. 2005 Sep;82(3):627-35.

Wang HX, Wahlin A, Basun H, et al. Vitamin B12 and folate in relation to the development of Alzheimer’s disease. Neurology 2001;56:1188-94.

B vitamins for eye health

A heart disease study sponsored by the NIH has also yielded some interesting information about the relationship between B vitamins and eye health. The research study, from Brigham and Women’s Hospital in Boston, found that taking a mixture of B vitamins, including B-6, folic acid and B-12, lowered the chance of middle-aged women developing macular degeneration (a common form of vision loss in older adults) by one-third. The study, which tracked more than 5000 women age 40 and older, was published in the Archives of Internal Medicine, Feb. 23, 2009.

Note that NYBC stocks this B vitamin supplement:

B-right (Jarrow)

B-right includes folic acid, B-6 and B-12; one of the rationales for its formulation is to prevent buildup of the chemical homocysteine, which in studies has been associated with heart attacks.