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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Fish oil (omega-3 fatty acids) and its benefits for Type 2 Diabetes

The Linus Pauling Institute at Oregon State University provides a good review of research on fish oil (omega-3 fatty acids) and Type 2 diabetes (see excerpt below). Although there was some concern that fish oil supplements might interfere with glycemic control (= control of blood sugar levels) in diabetics, that does not seem to be the case. Moreover, fish oil supplementation can significantly lower triglycerides in people with diabetes, and there is good epidemiological evidence that over the long term higher omega-3 fatty acid intakes may also decrease the risk of cardiovascular disease in diabetics.


Cardiovascular diseases are the leading causes of death in individuals with diabetes mellitus (DM). Hypertriglyceridemia […] is a common lipid abnormality in individuals with type 2 DM, and a number of randomized controlled trials have found that fish oil supplementation significantly lowers serum triglyceride levels in diabetic individuals. Although early uncontrolled studies raised concerns that fish oil supplementation adversely affected blood glucose (glycemic) control, randomized controlled trials have not generally found adverse effects of fish oil supplementation on long-term glycemic control. A systematic review that pooled the results of 18 randomized controlled trials including more than 800 diabetic patients found that fish oil supplementation significantly lowered serum triglycerides, especially in those with hypertriglyceridemia. A more recent meta-analysis that combined the results of 18 randomized controlled trials in individuals with type 2 DM or metabolic syndrome found that fish oil supplementation decreased serum triglycerides by 31 mg/dl compared to placebo, but had no effect on serum cholesterol, fasting glucose or hemoglobin A1c concentrations. Although few controlled trials have examined the effect of fish oil supplementation on cardiovascular disease outcomes in diabetics, a prospective study that followed 5103 women diagnosed with type 2 DM, but free of cardiovascular disease or cancer at the start of the study, found that higher fish intakes were associated with significantly decreased risks of CHD over a 16-year follow up period. Thus, increasing EPA and DHA intakes may be beneficial to diabetic individuals, especially those with elevated serum triglycerides. Moreover, there is little evidence that daily EPA + DHA intakes of less than 3 g/day adversely affect long-term glycemic control in diabetics. The American Diabetes Association recommends that diabetic individuals increase omega-3 fatty acid consumption by consuming two to three 3-oz servings of fish weekly.

See also the NYBC entry on DHA Max, a DHA/EPA supplement from Jarrow.

All About Supplements: the FAQ from the New York Buyers’ Club

This FAQ is now posted on the New York Buyers’ Club website in an easy-to-navigate format:

FAQ ON NUTRITIONAL SUPPLEMENTS

Topics covered include supplements used to improve gut function, manage cholesterol/triglycerides, address liver disease, help with mood/memory, maintain lean muscle mass and optimal weight, and address conditions like nausea, diarrhea and neuropathy.

Fish oil lowers triglycerides in people with HIV, according to a 2007 study

Several antiretroviral drugs for people with HIV can cause elevated blood fats, which may increase the risk for cardiovascular disease. One of the therapies that has been tested for managing high cholesterol and triglycerides is fish oil, which has a long history of use to counter cardiovascular disease.

From the March 1, 2007 Journal of Acquired Immune Deficiency Syndromes: French researchers conducted a prospective, double-blind trial to assess the effect of N-3 polyunsaturated fatty acids — better known as omega-3 fatty acids — found in fish oil.The study included 122 HIV positive patients on HAART who still had elevated triglyceride levels (between 2 and 10 g/L) after a 4-week diet. Participants were randomly assigned to receive 2 capsules containing 1 g of fish oil (Maxepa) or else placebo capsules 3 times daily for 8 weeks, followed by an open-label phase during which all participants received fish oil. Ten individuals with baseline triglyceride levels above 10 g/L were not randomized and received open-label fish oil from the outset.

Results

The median triglyceride level decreased by 25.5% in the fish oil group, while rising by 1% in the placebo group.
At week 8, the mean triglyceride levels were 3.4 and 4.8 g/L, respectively.

Triglyceride levels normalized in 22.4% of subjects in the fish oil arm compared with 6.5% in the placebo arm (P = 0.013).

58.6% and 33.9%, respectively, experienced at least a 20% reduction in triglycerides (P = 0.007).

Patients in the fish oil group experienced a slight decline in total cholesterol level, compared with a small increase in the placebo arm. During the open-label phase, the decrease in triglycerides was sustained at week 16 for patients in the fish oil group, while those initially in the placebo group experienced a 21.2% decrease after switching to fish oil.

The patients with baseline triglyceride levels above 10 g/L experienced a 43.6% decrease by week 8.

No significant differences in adverse events were observed between the fish oil and placebo arms.


Conclusion “This study demonstrated the efficacy of [polyunsaturated fatty acids] to lower elevated triglyceride levels in treated HIV-infected hypertriglyceridemic patients. [N-3 polyunsaturated fatty acids] have a good safety profile.”“The place of polyunsaturated fatty acids in the armamentarium of treatment of metabolic disorders in HIV-infected patients needs to be further investigated with future prospective studies…” 

CITATION: P De Truchis, M Kirstetter, A Perier, and others. Reduction in triglyceride level with N-3 polyunsaturated fatty acids in HIV-infected patients taking potent antiretroviral therapy: a randomized prospective study. JAIDS 44(3): 278-285. March 1, 2007.

UCLA Division of Geriatrics/David Geffen Medical School on “Four Supplements Seniors Should Take”

We took a look at the recent issue of the Healthy Years newsletter (Volume 4G) from the UCLA David Geffen Medical School’s Division of Geriatrics, and were pleasantly surprised to find a good balance of advice ranging from exercise, diet, medication regimens when called for…and a number of on-target recommendations for promoting long-term health with the aid of dietary supplements.

The UCLA newsletter, which is directed especially to people 60 and older, offers several general supplement recommendations to promote healthy aging: a multivitamin/mineral supplement (because diet and digestive capability tend to change as you age); Vitamin D plus calcium for bone health; fish oil supplements to keep triglyceride levels down; glucosamine and chondroitin for moderate to severe arthritis knee pain; and CoQ 10 to help keep blood cholesterol down when taking a statin drug.  

A couple of other recommendations emerge for specific conditions: non-smokers with early-stage macular degeneration may want to consider an NIH panel’s advice to supplement with zinc and the antioxidant vitamins C, E, and beta carotene. And niacin and/or a fibrate drug could be beneficial in raising HDL (the so-called “good cholesterol”) levels in a person taking a statin.

Thanks, UCLA Division of Geriatrics! It’s nice to see a general-audience publication from a mainstream medical source include balanced information about supplements, and not just fixate on prescription drugs as the only possible choice for every condition.

Fish Oil, Fenofibrates and Triglycerides

From POZ Magazine, reporting on a study:

December 17, 2007
Fish Oil Plus Fenofibrate Good for High Triglycerides
Fish oil supplements, combined with the lipid-lowering drug fenofibrate (Tricor), reduced triglycerides to normal levels in a significant percentage of HIV-positive people who did not respond to either therapy alone, according to the results of an AIDS Clinical Trials Group (ACTG), made available online in advance of publication in the Journal of Acquired Immune Deficiency Syndromes.
John Gerber, MD, of the Department of Medicine at the University of Colorado Health Sciences Center in Denver, and his colleagues enrolled 100 HIV-positive people whose antiretroviral regimen had caused their triglyceride levels to increase above 200 mg/dL, which is the top limit of the healthy range. Elevated triglycerides can lead to pancreatitis and have been linked to a higher risk of heart disease.
For the first eight weeks of the study, the study volunteers took either 3 grams of fish oil twice daily or 160 mg of fenofibrate once daily. If their triglyceride levels were not below 200 mg/dL after nearly two months, patients in the study were given both treatments to use at the same time.
After the first eight weeks in the study, 8.5 percent of the fish oil-treated patients and 16.7 percent of the fenofibrate-treated patients had triglyceride levels within the normal range. Of the 75 people who went on to take both drugs, 22.7 percent saw their triglyceride levels drop below 200 mg/dL. This was statistically significant, meaning that it was too large of a difference to have happened by chance. The researchers state that these results are sufficiently promising to warrant further study of this combination.

 

 

Fish oil, inflammation and metabolic complications in HIV: a clinical trial and related research

We noticed with interest that Dr. Todd T Brown, a Johns Hopkins researcher who has studied body fat changes in people with HIV, has recently started a wide-ranging investigation of fish oil / omega-3 fatty acid supplementation as a way of preventing/treating metabolic complications associated with highly active antiretroviral therapy (HAART). Metabolic complications, including fat wasting, central body fat build-up, insulin resistance, high cholesterol and triglycerides, and bone loss, have been some of the major side effects experienced by people with HIV on medication, so it’s quite interesting to see research that may “connect the dots” and find links between these various problems. 

Furthermore, this is a study that focuses on fish oil / omega-3 fatty acids, which have quite recently gained more respect in US medical circles, especially as a means of preventing/treating cardiovascular disease, but also for a surprising effect on depression. (You can read more about this aspect of fish oil supplementation in the “depression” category on this blog.)

 Here’s the description of Dr. Brown’s research, as provided on the website of NCCAM/NIH, one of the major sponsors of the study:

Abstract: DESCRIPTION (provided by applicant): The overall goal of this proposal is to understand the role of inflammatory cytokines in the metabolic and skeletal abnormalities in HIV disease and to determine whether omega-3 fatty acid supplementation, in the form of fish oil, will alter the pathophysiology of these clinical disorders. Complementary and alternative medicines (CAM) are used widely among HIV-infected patients, often with the hope of preventing or treating complications associated with highly active antiretroviral therapy (HAART). Metabolic abnormalities, including peripheral fat wasting, central adiposity, insulin resistance, and dyslipidemia, and skeletal abnormalities (reduced bone mineral density and high bone turnover), are common in HIV-infected patients on HAART, yet their relationship is unclear. We hypothesize that these metabolic and skeletal abnormalities are related by abnormal inflammatory cytokine expression and that these conditions can be improved with fish oil, a widely-used CAM agent with anti-inflammatory properties. We have the following specific aims: 1) To understand the association between the metabolic and skeletal abnormalities in HIV-infected subjects and their relationship to inflammation, 2) To determine whether treatment with omega-3 fatty acids will have hypotriglyeridemic, anti-inflammatory, and anti-bone resorptive effects in a randomized trial of HIV-infected patients, and 3) To clarify the mechanisms of action of omega-3 fatty acids, namely the effect on lipolysis and bone turnover using stable isotope infusion techniques. To accomplish our specific aims, I intend to do a secondary analysis of data from two cohorts of HIV-infected subjects, and to then perform a randomized trial using a standardized fish oil product. These results will help to define the pathophysiology of the metabolic and skeletal abnormalities in HIV and evaluate the efficacy and potential mechanisms of action of an important complementary treatment […]

(According to the published information, the clinical trial of fish oil is scheduled to run from 2006-2010.)

Note: An interview with Dr. Brown on body fat changes in people with HIV can be found on the website of our friends at www.thebody.com.