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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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.

National Institutes of Health: How Resveratrol Works

Resveratrol, a compound found most famously in red wine, is the subject of a Feb. 13, 2012 news release by the National Institutes of Health. The NIH reports on a new study that identified the precise biochemical mechanism in the body that seems to be responsible for resveratrol’s ability to mitigate the harmful health effects of a high-fat diet.

One of the earliest reasons for scientific interest in resveratrol was the perception that people who drank a lot of red wine could also eat a relatively high fat diet, yet still have a rather low risk of cardiovascular disease. (This was the so-called “French paradox,” much discussed in the US media in the early 1990s.) The current NIH-supported study found evidence that resveratrol affects specific biochemical pathways that block the ill effects of a high-fat diet, such as obesity, glucose intolerance, and, potentially, the development of Type 2 diabetes. (Type 2 diabetes, in turn, is a risk factor for coronary heart disease.)

This NIH-supported study follows a pattern we’ve often seen before: the health benefits of a natural product are noted in general population studies, and eventually laboratory science allows us to home in on the exact mechanisms by which the natural substance works. Needless to say, we’re all for this kind of research to confirm and refine our knowledge of supplements!

Read more about the resveratrol study at:
http://www.nih.gov/researchmatters/february2012/02132012resveratrol.htm

You can find resveratrol in two forms at the NYBC. (Resveratrol Synergy adds some of the additional parts of the grape that are thought to have health benefits, and combines those with green tea extract, another food extract that researchers believe may have health benefits.)

Resveratrol
Resveratrol Synergy

The Virtues of Pomegranate

NYBC’s buyers’ co-op stocks Pomegranate Juice Concentrate (Jarrow) Each bottle, 12 oz (355 ml) of 100% pomegranate juice concentrate. This concentrate is really thick, so you are getting a lot of the pomegranate in a bottle!

Pomegranate is one of Nature’s most powerful sources of antioxidants, with an antioxidant power greater than that of blueberries and strawberries. Various studies suggest that pomegranate’s antioxidants may help to improve the level of glutathione in cells. (Glutathione is sometimes called the “master antioxidant” for its role in controlling many damaging inflammatory responses in the body.) Specifically, pomegranate may support blood vessel health and counteract the oxidative processes of atherosclerosis (“hardening of the arteries”)

A related product: Cardio-Edge (Douglas Labs). This combination supplement was devised by Douglas Labs following recent research attention to “plant sterols” and other botanical substances that can support healthy cholesterol levels. Cardio-Edge also includes pomegranate (for support of cardiovascular health, as mentioned above), and Sytrinol (a proprietary extract obtained from citrus and palm fruits).

Reference: Aviram M, Rosenblat M, Gaitini D, et al. Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation. Clinical Nutrition 2004; 23:423-233.

Vitamin D and racial disparity in blood pressure

An article published in 2011 suggested that low Vitamin D levels may contribute to higher rates of hypertension (high blood pressure) among African Americans. Higher rates of hypertension in turn produce higher rates of cardiovascular disease and its related mortality. The article examined existing data on blood pressure and detected a significant link between lower levels of Vitamin D and higher risk of hypertension in African Americans. The authors note that Vitamin D level did not emerge as the sole factor explaining racial disparity in blood pressure (other factors include lack of access to healthcare, diet, and stress). They also call for trials to determine if supplementation can impact high blood pressure risk.

Read the article: Racial disparity in blood pressure: is vitamin D a factor?

See further information about Vitamin D and cardiovascular health on this Blog, or in the NYBC entries under Vitamin D3 at
http://nybcsecure.org/index.php?cPath=25&sort=3a&page=2