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.

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

Nelson Vergel: “Survivor Wisdom”

A Talk by Nelson Vergel: “Survivor Wisdom: Advances in Managing Side Effects, Living Well, and Aging with HIV” – New York City, November 9, 2010

How could you not be impressed by the schedule HIV treatment activist Nelson Vergel keeps? A few days before he arrived in New York to share his “Survivor Wisdom” with New York Buyers’ Club members and guests, he was an invited participant at the 12th International Workshop on Adverse Drug Reactions and Co-morbidities in HIV in London. The founder and moderator of the “pozhealth” group on Yahoo—the largest online discussion group for HIV issues–Nelson also finds time to answer questions on a forum hosted by thebody.com. In addition, he serves as a community member of the federal government’s Department of Health and Human Services HIV treatment guidelines advisory board. And did we mention that he’s the author of a new book, “Testosterone: A Man’s Guide,” especially useful for people with HIV who are considering testosterone therapy to address fatigue and other problems?

As you might expect, Nelson also covered a lot of territory in his NYBC talk, which was co-hosted by the City University of New York’s Graduate Center. He briefly updated the audience on new treatments and guidelines, then reviewed the exceptional case of the HIV+ “Berlin patient,” whose apparent cure following a bone marrow transplant has opened up, at least tentatively, some new lines of research about curing HIV.

Most of Nelson’s talk, however, dealt with familiar issues in managing HIV symptoms and medication side effects: cardiovascular health challenges, lipoatrophy (facial wasting especially) and body fat accumulation (lipohypertrophy), aging with strong bones, fighting off fatigue, minimizing the risk of anal cancer.

Amid this discussion of symptoms and side effects, Nelson spent time on the topic of supplements. His first point, which NYBC would certainly agree with, is that a lot of good evidence has accumulated about the benefit of multivitamin supplementation, and a multivitamin plus antioxidant combination, for people with HIV. These “micronutrients,” as they’re called in the scientific literature, can enhance survival, delay progression of disease in people not yet on HIV meds, and increase CD4 counts in people taking the meds. We have to admit we were pleased when Nelson also took a moment to praise NYBC (and especially our Treatment Director George Carter) for making available an inexpensive, “close equivalent” of the multivitamin/ antioxidant combination that was the subject of Dr. Jon Kaiser’s well-known research and that led to the development and marketing of K-PAX. New York State residents, as Nelson pointed out, have access to many such supplements through formularies. But for residents of other states, this half-price version of the multivitamin/antioxidant combination (MAC-Pack or Opti-MAC-Pack) can provide welcome relief in the budgetary department.

Our speaker then ran through a list of about a dozen supplements that have reasonably good evidence to support their use by people with HIV. He chose to focus more closely, however, on just a few:

Niacin. Despite “flushing” that makes it difficult for some to use, niacin can be very effective in bringing up levels of HDL (“good”) cholesterol in people with HIV. Since cholesterol control is a major long-term health issue for many people on HIV meds, and since recent research suggests that raising HDL cholesterol levels may be an extremely important factor in reducing cardiovascular risk, niacin may be a top choice for many. (Fish oils/omega-3 fatty acids, plant sterols, pantethine, carnitine, and CoQ10 are other supplements that NYBC and many others put in the category of “supports cardiovascular health.”)

Vitamin D. Seems that, even at the London conference Nelson had just attended, the “sunshine vitamin” was a hot topic. Partly that’s because people with HIV have recently been found to have a high prevalence of Vitamin D deficiency, and then because Vitamin D, calcium and other mineral supplementation is a logical approach to addressing long-term challenges to bone health in people taking HIV meds. (Look on the NYBC blog for a whole host of other recent studies about Vitamin D’s potential benefits, from reducing cardiovascular risk to cancer prevention—even as a way of warding off colds and flu.)

Carnitine. This is a supplement, Nelson told the audience, that he’s taken for many years. Reported/perceived benefits: to improve fatigue, lipids, brain function and neuropathy. (NYBC Treatment Director George Carter put in that “acetyl-carnitine”—a form of the supplement that crosses the blood/brain barrier–has shown the most promise for dealing with neuropathy.)

Probiotics. The vulnerability of the gut in HIV infection, and the well-documented problems people with HIV experience in absorbing nutrients, make probiotics a very helpful class of supplements for long-term health maintenance. (Probiotics, good or “friendly” bacteria residing in the gut, are available in a variety of products, from yogurt to supplements. There’s quite a bit of research about the effectiveness of different varieties, and note as well that there are some newer formats that don’t require refrigeration.)

Above and beyond the treatment issues involving supplements, meds, and other strategies, Nelson referred several times to areas where there’s a need for advocacy. He mentioned the cure project, for one, but also a national watch list to help people follow and respond to the devastation created by recent funding cuts and the resultant waiting lists in the ADAP programs of many states, such as Florida.

All in all, NYBC members and guests would doubtless agree: a very thought-provoking presentation, with much helpful information to take away. For more on these and other issues, be sure to check out the NYBC website at:

http://www.newyorkbuyersclub.org/

[A version of this article also appears in NYBC’s free e-newsletter, THE SUPPLEMENT, along with additional reporting on a new Mayo Clinic guide to supplements, and a look at the current state of regulation and research on supplements in the US.]

Mayo Clinic’s Guide to Alternative Medicine 2011

This is an easy-to-read, magazine-style guide created by the Mayo Clinic, the world-famous healthcare facility which also happens to have a long-standing receptiveness to alternative and complementary therapies for wellness and prevention. (That’s one of the reasons why it has recently been cited as an example of best practices in American healthcare–the kind of practices that need to be more widely imitated.)

The section on dietary supplements provides capsule reviews of the scientific evidence for the safety and effectiveness of several dozen popular products, from botanicals like ginseng, echinacea and St. John’s Wort, to vitamins C, D, E, B-3 (niacin), and B-9 (folate or folic acid), as well as minerals like selenium, calcium and zinc. Also discussed are fairly well-known categories of supplements, including probiotics and omega-3 fatty acids (these often obtained with fish oil supplements).

The guide rates these supplements with a green, yellow or red light symbol, depending on the strength of the evidence for their use and their safety profile. We weren’t too surprised by most of the ratings. For example, green for niacin, folic acid, Vitamin C and Vitamin D, but a yellow caution light for Vitamin E, which has shown no effectiveness in several good studies dealing with cardiovascular health and cancer, leading some researchers to wonder if the standard “alpha-tocopherol” form of the vitamin is a good format for supplementation. Also, a yellow light for St. John’s Wort, not because it isn’t effective for mild/moderate depression, but because it can interact with a lot of other medications.

Other supplements getting the green light from the Mayo Clinic editors: SAMe (for depression); saw palmetto (for enlarged prostate); green tea (for cardiovascular health, possibly for cancer prevention, and apparently–according to a large epidemiological study–for longevity); gamma linolenic acid (for peripheral neuropathy); CoQ10 (for cardiovascular health, for which it’s used by millions in Japan); glucosamine chondroitin (for osteoarthritis).

Also getting the green light, a supplement most have probably never heard of, but which is featured in the Health Concerns formula Cold Away, available from NYBC: the botanical Andrographis (a cold remedy, showing promise where many other products have disappointed).

See the NYBC entries for more details on how best to take supplements:


http://www.newyorkbuyersclub.org/

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.

Lipodystrophy: some comments from Nelson Vergel

Nelson Vergel, long-time AIDS treatment activist and community expert on lipodystrophy, recently posted a good set of guides to understanding this topic:

–D4T and AZT linked to lipoatrophy; some protease inhibitors linked to insulin resistance, which can be related to higher triglycerides and fat cell size in some patients

–exercise helpful for maintaining lean body mass; anabolic steroids for help in regaining normal weight

–supplements like omega-3/fish oil and niacin to help statins and fibrates to lower bad cholesterol (LDL), triglycerides and increasing good cholesterol (HDL)

Also included in the post are reviews of some regimen-switching strategies to counter lipodystrophy.

“Unfortunately,” Nelson concludes, more research is still needed on “lower glycemic index diets, good comparison data of what happens to visceral fat when different protease inhibitors or non-nucleosides are used with Truvada in naives with low and higher CD4 at baseline, diet/exercise combinations, and other supplements like carnitine and others.”

Read the full entry at thebody.com.

Jon Kaiser presentation: a nutritional supplement combination therapy to lower cholesterol

We had the opportunity to hear Dr. Jon Kaiser speak in New York last night, in one of his regular information sessions for people wanting to know about holistic/integrative approaches to treating HIV. (It was a double bill, since he had invited his colleague Dr. Ricky Hsu to open the evening with a review of HIV pharmaceuticals, including those just approved.)

While Dr. Kaiser ranged over several topics, including his long-standing interest in micronutrient support for people with HIV and the benefits it can provide, we took the most notes on his approach to reducing cholesterol with nutritional supplements. The need for cholesterol reduction strategies is widespread among people with HIV, since cardiovascular disease is a major concern, especially among those who have been on treatment for a number of years. Yes, as Dr. Kaiser stressed, there are obvious things to start with in order to reduce cardiovascular disease risk: you’ve got to quit smoking, and if you have high blood pressure, you have to work out the (relatively simple) treatment to control it.

But many people with HIV are prescribed statin drugs like Lipitor to reduce cholesterol, and unfortunately the statins come with a handful of potential side effects. So, Dr. Kaiser has recently been offering some of his patients the alternative of a nutritional supplement combination therapy. It consists of low-dose Niacin (to minimize flushing), fish oil (helpful in lowering triglycerides), plant sterols (available now in spreads, by the way), and pantethine. Although he’s only followed a few cases to date, he’s quite encouraged by results, and believes that many people with HIV could achieve good results (comparable to those offered by statins) with this kind of combination therapy.

Of course all of these components have been widely studied for cholesterol control before (you’ll find more information on them on the NYBC website at http://www.newyorkbuyerslcub.org). But it’s another very valuable contribution from Jon Kaiser the integrative health specialist to refine a combination of supplements to serve the particular purpose of reducing cholesterol and cardiovascular risk for people with HIV. We’ll watch for further updates from him on the clinical experience with this combination therapy.