Niacin

[Rob]

Has anyone had any experience using NIACIN to treat high cholesterol ?


My cholesterol has gone up since being on LC . I cannot explain it , I am loosing weight and enjoying it . Look at my previous post to see my numbers .

I dont know what to do , do I eat less animal products such as meat ,cheese, eggs ,cream or do I continue eating as I have done .

Some people believe that the cholesterol story is a myth and that people get heart attacks with low cholesterol .

I am well but there is a history of vascular disease in my family .

So , cholesterol does'nt automatically go down with this WOE !! It may do but no guarantees .

I have posted previously but have had no helpful replies

I would appreciate some advice

Rob

[Lisa N]

Hi Rob!

You may find this link helpful: http://forum.lowcarber.org/showthread.php?s=&threadid=34068.
I'd also suggest another look at Protein Power if you have the book. The Eades' do a very good job of explaining cholesterol and it's funtions in our bodies along with explaining why changes do or don't occur and what measurements we should be concerned about.

[doreen T]

hi Rob ..

For reference, I'll copy your bloodwork from the other post:26/10/01 Fasting
tot chol 5.75
LDL 3.81
HDL 1.65
Tot/HDL = 3.48 (<5)
----------------------

24/07/02 non fasting
tot chol 6.5
HDL 1.34
LDL 4.34
Tot/HDL = 4.85
Trig = 1.8
--------------------

30/07/02 fasting
tot chol 6.42
LDL 4.54
HDL 1.38
tot/HDL 4.65
trig 1.1First off, totally disregard the non-fasting results, as they've been skewed by any food or beverage consumed. Just another quick question .. do you smoke or use nicotine patch or gum?? as those things will cause the levels to appear higher as well.

While your LDL (over 4.1) and consequently the total chol (over 6.2) are high, your HDL is good, over 1.03. Also triglycerides are excellent, below 2.3 :thup:

The total to HDL ratio is high (over 4.6) because of the elevated LDL. You'll find some explanations for this in the link that Lisa N gave in her post.

You have several options :). One is .. do nothing, since triglycerides are now considered a greater indicator of heart risk than total cholesterol, and yours are fine. Also, your HDL is great, which can be protective against heart disease.

Or You can try to manipulate your diet and add some supplements that MAY help to lower LDL. Or, try to raise HDL ... if your LDL remains constant, but your HDL goes up, then the total to HDL ratio would go down, which is desirable.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

In Protein Power Lifeplan (pub. 2000) the Eades devote chapter 4 to "Cholesterol: the Good, the Bad and the Ugly", including a section on using No-Flush niacin (500mg, 3 times a day). You must use specifically No-Flush type.

You might consider using psyllium husk powder (a fiber supplement) which might reduce the LDL. Don't take psyllium or any other fiber at the same time as other medications or supplements as it can prevent their absorption.

To rasie the HDL ("good" cholest), use more olive oil, avocados, raw nuts and unprocessed nut oils. Flax oil or fish oil may also be helpful.

Doreen

[Rob]

Thanks for your replies .


firstly, yes my triglycerides have always been very low . As you can appreciate , I got quite a fright when I saw that my tot chol has gone up since LCing . Yes my tot/HDl ratio is still < 5 which saves the day , but the raised LDL worries me . Doesnt it just mean that I am eating too much saturated fats? I have obviously thought of cutting my saturated fats . I have been eating vast amounts of eggs , regular bacon occasional cream and cheese . I dont eat enough fish !!!

FYI I do use flax oil daily 1 tbl , olive oil in salad dressing , 1 oz nuts eg : macadamia ,walnuts, pecan , avocado . I also take psyllium husk capsules daily .

I was thinking of using Niacin and building up the dose to 1g daily . I read that no flush Niacin is more liable to cause liver problems , so I bought ordinary Niacin . Havent taken any yet though .

Thanks for taking the time and showing interest

Rob

PS:I will have another look at PP

[doreen T]

From the Protein Power website FAQ's:I’ve been on the plan for awhile and feel better than I ever have. I’ve lost weight, my blood pressure is down and my sugar levels are now normal. My most recent lab tests show that my cholesterol and LDL went up. What am I doing wrong?

First of all, be aware that you are not doing anything wrong. The most consistent finding after people go on our program is that triglycerides drop and HDL, the "good" cholesterol increases. This indicates that your insulin levels have dropped and you have stopped converting excess amounts of sugar into fats as trigylcerides. Cholesterol is a number that is composed of both good and bad fractions, therefore we don’t tend to track it nearly as close as more specific levels of HDL, triglycerides and LDL. LDL cholesterol is made up of different particles that vary from person to person. Depending on the type of particles that predominate, one is said to have either pattern A or pattern B. With pattern A, the LDL is light, fluffy, and relatively large. This pattern is actually thought to be beneficial. With pattern B, the molecule is heavy, dense, and relatively small. This pattern is thought to be detrimental. Pattern B is a partial consequence of excessively elevated triglycerides. When triglycerides go down after the Protein Power Plan has been adopted, a phenomenon called the "beta shift" occurs where LDL is transformed into pattern A. So, paradoxically, even though the level of LDL appears to increase, the type of LDL that is being formed is usually much healthier. The difficult part is that the lab testing to determine your levels of LDL "A" and LDL "B" can only be done in a research laboratory with electrophoresis methods. While we cannot be 100% certain that this is what happened in your case, the research strongly supports this view.

The most important thing is to look at the overall picture. With the Protein Power approach we look at the triglyceride/HDL ratio as one of the best measurements of risk for heart disease. An upper limit of 5 is considered desirable, with anything over that indicating an increased risk. Some measures to help bring down your cholesterol and LDL levels are: stay on the plan (some people panic and feel that the plan is causing the opposite effect), take a "no-flush" niacin 500 mg 2-3 capsules per day, increase your fiber intake with perhaps psyllium seed powder-1-2 TBS mixed in water per day, and avoid excessive saturated fats and trans fats (fried foods and margarine.)

http://eatprotein.com/answers11.html#11e

Good idea to review the PP book :thup:

Doreen

[Voyajer]

Conversion of cholesterol numbers:

1 mmol/l = 38.6 mg/dl or 1 mg/dl= 0.026 mmol/l

26/10/01 Fasting
tot chol 5.75 = 222 mg/dL
LDL 3.81 = 147 mg/dL
HDL 1.65 = 64 mg/dL
Tot/HDL = 3.48 (<5)
----------------------

24/07/02 non fasting
tot chol 6.5 = 251 mg/dL
HDL 1.34 = 52 mg/dL
LDL 4.34 = 168 mg/dL
Tot/HDL = 4.85
Trig = 1.8 = 69
--------------------

30/07/02 fasting
tot chol 6.42 = 248 mg/dL
LDL 4.54 = 175 mg/dL
HDL 1.38 = 53 mg/dL
tot/HDL 4.65
trig 1.1

Okay, now I know what I'm looking at. My boyfriend's cholesterol level was 271 mg/dL (7.05 mmol/L) with HDL 35 (0.91) and LDL 171 (4.45). He has been taking no-flush niacin 500 mg at 3 times per day for 3 weeks. He is having another lipid test done this morning. I'll let you know how it turns out.

There are literally hundreds of studies on the efficacy of Niacin reducing total cholesterol and raising HDL. It has been used for over 50 years. All Niacin at high doses above 1000 mg per day has the potential to damage liver (I haven't heard anything about kidneys) because it stresses the liver. No-flush Niacin is better than regular Niacin because you won't be able to take enough to lower your cholesterol of regular Niacin due to the discomfort. The best Niacin is Niaspan a sustained-release niacin (unlike previous sustained-release Niacins) that has been shown in several studies to be safe for 1500 mg a day for 16 weeks and during that time did not cause liver damage because the dose doesn't hit all at once. Niaspan may be prescription only. You should take Folic Acid with the Niacin to prevent a rise in homocysteine levels.

After stating all of that, I'd like to say that your fasting cholesterol is still under 250 which Dr. Eades considers a range not to worry about. I wouldn't try drugs at this point. If you are worried, I would consider taking a homocysteine and C-reactive protein test. These are better determinations of cardiac risk.

In a recent study on the Atkins diet, all 42 patients improved their cholesterol except one. (There's always one.) The human body is very intricate and everyone has different responses to different foods. You could try eating more fish, chicken, and seafood (scallops, clams, lobster and crab too--good sources of omega-3) and less red meat and see if this helps. Dr. Eades says some people have an allergic reaction to red meat.

Also, 2/3 of the population have no reaction whatsoever to the cholesterol in eggs. Of the one-third that do, the reaction is usually small. But there is a very small percentage of people who have a hereditary reaction to the cholesterol in eggs. (Don't get drastic, just cut them out one week before your next test and see if that helps.)

I think Niacin is a good idea. You may find you don't need to take it for very long. Also, some peoples' cholesterol levels adjust after they move on to OWL (stage 2 of Atkins).

Make sure to look at the research forum here for more information. I hope this helps.

[Rob]

Voyager ,

thanks for your really helpful posting .

I have decided to use niacin, at the moment I only have the regular stuff , I have read that you start at 100mg for 4 days and then increase it at 100mg /4 day intervals . I did get a flush this morning ,it wasnt totally an unpleasant feeling .

I will look around for the slow release stuff or the no flush niacin . As I am in the UK I dont know whether it is available without a prescription .

I will also look into having a CRP test . Should I ask the lab for a ?cardiac CRP and a ?fasting homocysteine .

Rob

[Voyajer]

The C-reactive protein test is a simple blood test. You can read about it here on the CNN site:

http://www.cnn.com/2000/HEALTH/03/22/heart.test/

The homocysteine test appears also to be a simple blood test.

http://www.pslgroup.com/dg/d939a.htm

I'm not sure if fasting is necessary for these tests. Fasting is necessary on cholesterol tests because cholesterol naturally goes up after a meal. My boyfriend was fasting today for his homocysteine test but he was also taking the lipid panel, so he needed to fast.

Don't forget to take Folic Acid (Folate) with your Niacin.

[gapgirl420]

ROB,
My Dr had me take 500mg of NIACIN along with METAMUCIL...sounds hokey...but it worked...he said the combo of the two pull the fat from the blood like a magnet!

GAP

[Voyajer]

Thanks GAP on the reassurance that Niacin works even at lower dosages. Rob is already taking fiber like Metamucil in the form of Psyllium Husks. So with his recent addition of Niacin, his cholesterol should start falling.

[Rob]

Voyager

my question was , " is there a cardiac CRP" ? or is CRP a general marker for all inflammation ?

Also , I did read that homocysteine test should be of fasting levels .

I take a multivitamin that has 400mcg / tab is that enough for niacin

Thanks



Rob

[Rob]

Gap

thanks for posting . I am beginning the niacin ( day 2) ,got a flush yesterday and a bit today . It is not that unpleasant , you can feel it working its way around your system .

I take psyllium husks in capsules but I will get the powder stuff
(yuck)


Hope to see the numbers go down



Rob :wave:

[Voyajer]

Rob,

There is no specific test for CRP as it relates to the heart. The CRP blood test is for total body CRP. In a normal healthy individual the CRP would barely be readable. Only with trauma or disease is it readable so if it is high without trauma or disease, then the person is at greater risk for heart disease.

Check out this article for more information:
http://forum.lowcarber.org/showthread.php?s=&threadid=53891

According to the studies I've read, you need to take 1000 mg/day of Niacin. 400 mcg is .4 mg.

1000 mcg = 1 mg. That's why you need No-Flush Niacin.

GAP says you only need one-half the recommended dose to see improvement: 500 mg.

The Psyllium Husk capsules should be fine. They are the same as the liquid.

I hope this is helpful.

[Rob]

Thanks voyager,

you're a star .

I bought no flush niacin today 500mg tabs and folate , 400mcg tabs .

I hope to see a drop in the numbers next month and I will ask for a CRP as well as a homocysteine if thats possible .



Rob :wave:

[jbee]

My recent blood work turned out a lot like Rob's:

Pre Atkins Start Blood Test on May 25, 2002
HBA1C 7.2
Total Cholesterol: 269
HDL: 43
LDL: 93
Triglycerides: 676
BP: 140/92

Here are the meds I was taking at the time of the May 25, 2002 blood panel:
Metformin: 500mg breakfast/500mg dinner
Glyburide: 5mg breakfast/5mg dinner
Prinivil: 10mg bedtime
Pamelor: 80mg bedtime

As a result of the triglycerides, 1200 MG of Lopid (600mg breakfast/600mg dinner), was added to the above drugs. This was a significant change from the blood work I had done 3 months prior in triglycerides. I had been on Weight Watchers during that 3 month period and lost about 12 pounds.

Beginning June 1, the doctor added
Lopid: 600mg breakfast/600mg dinner to help lower the triglycerides.

On July 28, 2002, I had a followup blood panel to check my lipids, liver function and diabetes control. This is 2 months on Atkins plus the Lopid.

Here the results:
Total Cholesterol: 238
HDL: 44
LDL: 196
Triglycerides: 131
HBA1c: 5.8
BP: Home, Drugstore, anywhere but the doc 120/73
BP: Doctor 140/92

With these results, the doctor changed my meds to:
Metformin (my choice 1x 500mg or Breakfast/Dinner 500mg ea - I'm continuing on takin the metformin at breakfast and dinner since I've noticed a trend in my bs going up
Lopid: 600mg breakfast

She's thinking that continuing the Lopid will bring the LDL down and I will have another blood panel at the end of August.

I'm interested in trying the Niacin, but I've read that Niacin can make your bs rise. Anybody have a comment on how Niacin affects bs? I will take 500mg Non flush Niacin but am unsure of how much extra folic acid to take along with the Niacin.

JBee

[Rob]

Hi Jbee,
I would be careful about taking niacin when you are diabetic . I have read that niacin may lower your insulin sensitivity ,meaning that it could cause a rise in your blood glucose and you dont want that .

If you do it ,just be very careful to monitor your sugar closely .

I too am hoping to see a drop in the LDL . I got quite a surprise but I am not really surprised as I have been eating an awful lot of saturated fats , at times I was eating at least 10 eggs per week .

I have cut that right down

Rob :wave:

[Voyajer]

Jbee,

I hope you realize how greatly improved your cholesterol has been since you have been doing Atkins!

You are not like Rob at all! His total cholesterol and HDL ratio went up. Although he is not in any real danger zone.

You on the other hand had both a drop in total cholesterol from 269 to 238 (so you are out of the worry zone) plus your HDL ratio went from 6.25 to 5.4. This is excellent!

As far as your LDL, I really don't think it got worse. You see total cholesterol is made up of HDL, LDL, VLDL, and IDL. The only marker for less risk is high HDL. The VLDL and IDL are not markers for less risk. So when your total cholesterol was 269 and your HDL was 43, all the other lipoproteins added up to 226.
Now they add up to 194. This is good.

Also, saturated fat has been proven in studies to change the type of LDL in your body even if it raises LDL. There are two subtypes of LDL. There is the Pattern A which is light and fluffy and the Pattern B which is small and dense. Pattern B is associated with heart disease. Saturated fats raise pattern A. So the raise in LDL is not increasing your heart disease risk.

400 mcg per day of Folic Acid (Folate) should be fine.

I hope to see that you are soon able to stop the medications.

[Voyajer]

Rob,

I hate for you to be afraid of saturated fat. Eating cholesterol and eating saturated fat are two different things. That is why they are labeled separately on products.

Read this thread. It might change your mind about saturated fat:

http://forum.lowcarber.org/showthread.php?s=&threadid=54255

[Voyajer]

Jbee,

This is a study of Niaspan (an extended release Niacin available by prescription). It shows that it is safe for diabetics.

Arch Intern Med 2002 Jul 22;162(14):1568-76

Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes: results of the assessment of diabetes control and evaluation of the efficacy of niaspan trial.

Grundy SM, Vega GL, McGovern ME, Tulloch BR, Kendall DM, Fitz-Patrick D, Ganda OP, Rosenson RS, Buse JB, Robertson DD, Sheehan JP.

BACKGROUND: Diabetic dyslipidemia is characterized by high triglyceride levels; low high-density lipoprotein cholesterol levels; small, dense low-density lipoprotein particles; and high free fatty acid levels. Niacin reduces concentrations of triglyceride-rich and small low-density lipoprotein particles while increasing high-density lipoprotein cholesterol levels. It also lowers levels of free fatty acids and lipoprotein(a). However, the use of niacin in patients with diabetes has been discouraged because high doses can worsen glycemic control. We evaluated the efficacy and safety of once-daily extended-release (ER) niacin in patients with diabetic dyslipidemia. METHODS: During a 16-week, double-blind, placebo-controlled trial, 148 patients were randomized to placebo (n = 49) or 1000 (n = 45) or 1500 mg/d (n = 52) of ER niacin. Sixty-nine patients (47%) were also receiving concomitant therapy with statins. RESULTS: Dose-dependent increases in high-density lipoprotein cholesterol levels (+19% to +24% [P<.05] vs placebo for both niacin dosages) and reductions in triglyceride levels (-13% to -28% [P<.05] vs placebo for the 1500-mg ER niacin) were observed. Baseline and week 16 values for glycosylated hemoglobin levels were 7.13% and 7.11%, respectively, in the placebo group; 7.28% and 7.35%, respectively, in the 1000-mg ER niacin group (P=.16 vs placebo); and 7.2% and 7.5%, respectively, in the 1500-mg ER niacin group (P=.048 vs placebo). Four patients discontinued participation because of inadequate glucose control. Rates of adverse event rates other than flushing were similar for the niacin and placebo groups. Four patients discontinued participation owing to flushing (including 1 receiving placebo). No hepatotoxic effects or myopathy were observed. CONCLUSION: Low doses of ER niacin (1000 or 1500 mg/d) are a treatment option for dyslipidemia in patients with type 2 diabetes.

[Rob]

Voyager,

I read the article . It is pretty convincing .

Sorry if I mislead you , I don't avoid saturated fats , but I have made a conscious ( maybe unnecessary ) decision to reduce the amount of eggs that I eat and the amount of whipping cream that I use .

What worried me ( sorry to go on ) once again was the rise in total cholesterol ,mirrored by a rise in LDL and a drop in HDL ,although my tot/HDL was ratio still safe and my trigs remain low .

Thanks for your interest once again . It has been a great help talking to you

Rob :wave:

[Debi Warne]

I read this and thought it went well with this discussion.

29-Jul-2002


Extended-Release Niacin Effective in Low Doses for Diabetics


DALLAS – July 2002 – Niacin, a medication once discouraged for the treatment of lipid abnormalities in patients with diabetes, has the potential ability, when given in low doses, to be well-tolerated and effective, according to UT Southwestern Medical Center at Dallas researchers, who led the multicenter trial.

The researchers report in today's issue of Archives of Internal Medicine that in the 148 study participants extended-release niacin (Niaspan) led to significantly improved lipid levels and minimal changes in glycemic control.

"Previous reports have shown that niacin in high doses raises blood glucose, but this trial shows that in doses of 1,000 milligrams per day and 1,500 mg/d, niacin therapy was well-tolerated and changes in glycemic control were minimal," said Dr. Scott Grundy, the study's lead author, director of the Center for Human Nutrition at UT Southwestern and holder of the Distinguished Chair in Human Nutrition. "Low doses of an extended form of niacin also had favorable effects on blood lipids and lipoproteins."

The researchers targeted niacin therapy for a condition in patients with diabetes called dyslipidemia, which is characterized by high levels of triglycerides and other lipid-related abnormalities along with depressed levels of the healthier high-density lipoprotein (HDL) cholesterol.

"Niacin therapy has been discouraged by clinicians because high doses can worsen glycemic control in patients with diabetes," said Dr. Gloria Vega, a professor of clinical nutrition and a study co-author. "In this study we evaluated the tolerance and effectiveness of niacin at low doses. This extended-release form is designed to circumvent the bothersome side effects of regular niacin, such as flushing of the skin."

During the trial, the study participants were divided into three groups. They received either 1,500 mg/d of extended-release niacin, 1,000 mg/d of extended-release niacin, or a placebo. About half of the study participants continued taking their prescribed statin drugs for cholesterol lowering during the trial, and 81 percent continued their medications for diabetes.

In the 1,500 mg/d group, HDL increased as much as 24 percent, triglycerides decreased as much as 36 percent, and the "bad" cholesterol, low-density lipoproteins (LDL), decreased by 7 percent. In the 1,000 mg/d group HDL increased by 19 percent.

Patients with diabetic dyslipipdemia are commonly treated with triglyceride-lowering drugs known as fibrates, but niacin is more effective for raising HDL, or the good cholesterol.

"Niacin clearly increases HDL cholesterol and reduces triglycerides in individuals with type 2 diabetes," Vega said.

Many of the 14 million Americans with non-insulin-dependent (type 2) diabetes are affected by dyslipidemia, which can increase the risk for cardiovascular disease. Last year, the National Institutes of Health's National Cholesterol Education Program deemed diabetes to be a very high-risk condition of cardiovascular disease.

"Most patients with diabetes will require lipid-lowering therapy," Grundy said. "The use of statins to lower LDL cholesterol is becoming routine therapy for the majority of patients; however, this study indicates that the addition of niacin to statin therapy will provide additional benefit for improvement of blood lipids and lipoproteins in patients with diabetes."

Also participating in the multicenter trial were investigators from Kos Pharmaceuticals; the Diagnostic Clinic of Houston; the International Diabetes Center in St. Louis Park, Minn.; the East-West Medical Research Institute in Honolulu; Harvard Medical School; Northwestern University Medical School; University of North Carolina at Chapel Hill School of Medicine; the Atlanta Diabetes Association; and the North Coast Institute of Diabetes and Endocrinology in Westlake, Ohio. The study was supported by Kos Pharmaceuticals.


Source: University of Texas Southwestern

http://gourmetconnection.com/news/bin/dgm.cgi?ID=371

[Voyajer]

Jbee,

I just realized that Lopid was Gemfibrozil. Niacin is much more effective than Gemfibrozil (Lopid). Ask your doctor to put you on Niaspan instead. Have the doctor look at the study below. I hate to see you taking all these drugs. Metformin (glucophage) is important to control blood sugar until lowcarbing gets your blood sugar under control. You may be able to stop this medication then. Glyburide is a glucose-lowering drug, hopefully, you can stop that at some point too. The other drugs: Prinivil is an angiotensin for constricting arteries. And Pamelor is an anti-depressant. A natural alternative to anti-depressants is 5-HTP (tryptophan).

Just keep in mind that your lipid profile seems to be responding well to low-carbing and sometimes the doctors want your cholesterol levels lower than they really need to be. Remember that a lot of these drugs have not been used in long-term studies so the long-term effects of the drugs may be worse than what you are taking the drugs for. The less time on any drug, the better.

Am J Cardiol 2000 Dec 21;86(12A):46L-50L

Raising high-density lipoprotein cholesterol with niacin and fibrates: a comparative review.

Sprecher DL.

Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA.

A growing number of trials that used fibrates and niacin alone or in combination with other lipid-altering agents have shown that both these drugs are effective for reducing total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides, and for increasing high-density lipoprotein cholesterol (HDL-C) levels. These lipid changes are associated with a reduction in events such as fatal and nonfatal myocardial infarction, stroke, and transient ischemic attack. In angiographic trials, they are associated with disease regression, increased minimal luminal diameter, and protection from risk of new lesions. In a head-to-head comparison study, niacin 2,000 mg/day increased HDL-C more than gemfibrozil 1,200 mg/day, and decreased the total cholesterol-to-HDL-C ratio, lipoprotein (a) (Lp[a]), and fibrinogen levels significantly more. Combination therapies of niacin plus a resin or statin are effective, well tolerated, and safe.

[Voyajer]

Rob,

Thanks. I'm glad to help if I can.

And you may be right that eating less eggs will help. It appears that reactions to the cholesterol in eggs is completely hereditary, so in your case it just might help.

Do let everyone know how your next blood test turns out when you take it.

We're all in this together. They should call this website the Low-Carb Brotherhood.

[jbee]

Voyajer:

First of all, let me tell you how much I look forward to the posts you leave on the board in general and specifically, for replying to my post.

I guess I don't really understand the whole cholesterol ratio thing. The blood results I received had the ranges for normal and the LDL by itself scared me! I'll do some more reading to understand.

The pamelor I take is for peripheral neuropathy. At the time they discovered the cause of the excruciating pain, they did many tests to see if I was diabetic and they determined I wasn't at the time this was in the early 90's. But, that's when the numbers for diabetes diagnosis were much higher than today. I did have gestational diabetes (requiring insulin) when I was in my early 30's (now I'm mid 40's). I was diagnosed, by my nerologist with diabetes in 1996/7 at my annual appointment to see where I was with the neuropathy. The pamelor allows me to sleep at night and function during the day, without it, I'm a mess.

With the latest blood panel, the doctor took me off the glyburide and said I could cut down on the metformin to 500 mg at dinner, my choice. I have chosen to continue on 500 mg breakfast/500 mg dinner as my bs fluctuates a lot and I feel less tired. I know when I lose a little more weight, things will be better (although I weighed 175 at the time I was diagnosed with diabetes).

I have an appointment with the doctor in two weeks specifically to discuss the lopid and whether or not to continue. I did tell the doc that I was on atkins and then she immediately ordered a 24 hour urine to check my kidneys, suggested I not do atkins and eat more carbs eventhough the atkins lowered my hba1c from 7.2 to 5.8 in 2 months.

I will print the study and bring it with me to see if I can get her to change from the lopid.

In the meantime, I'm trying to continue on atkins without fear of fat and cholesterol, but sometimes I get a bit worried...I'd like to live a long time.

I know that for me, low carb living is the best health decision I could make...I haven't felt so energetic, am able to face the medical issues and feel confident that I can maintain this for the rest of my life, which I'd like to be very long and healthy. Why did I wait so long? I am also trying to be a role model for my 15 year old daughter. She needs to get a sport or exercise and learn to eat so she doesn't end up like her mom with a number of chronic health problems.


JBee

[Voyajer]

Jbee,

The Lopid increases your LDL levels. See this study below. So it wasn't the lowcarbing that made your LDL go up. It was the Lopid (Gemfibrozil). You should definitely try the Niacin instead.

Arch Intern Med 2000 Apr 24;160(8):1177-84

Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group.

Guyton JR, Blazing MA, Hagar J, Kashyap ML, Knopp RH, McKenney JM, Nash DT, Nash SD.

Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. john.guyton~duke.edu

OBJECTIVE: To provide a direct comparison of agents that raise plasma levels of high-density lipoprotein cholesterol (HDL-C) to help devise strategies for coronary risk reduction. METHODS: In a multicenter, randomized, double-blind trial, we compared the effects of extended-release niacin (Niaspan), at doses increased sequentially from 1000 to 2000 mg at bedtime, with those of gemfibrozil, 600 mg given twice daily, in raising low levels of HDL-C. Enrollment criteria included an HDL-C level of 1.03 mmol/L or less (< or =40 mg/dL), a low-density lipoprotein cholesterol level of 4.14 mmol/L or less (< or =160 mg/dL) or less than 3.36 mmol/L (<130 mg/dL) with atherosclerotic disease, and a triglyceride level of 4.52 mmol/L or less (< or =400 mg/dL). RESULTS: Among 173 patients, 72 (82%) of the 88 assigned to Niaspan treatment and 68 (80%) of the 85 assigned to gemfibrozil treatment completed the study. Niaspan, at 1500 and 2000 mg, vs gemfibrozil raised the HDL-C level more (21% and 26%, respectively, vs 13%), raised the apolipoprotein A-I level more (9% and 11% vs 4%), reduced the total cholesterol-HDL-C ratio more (-17% and -22% vs -12%), reduced the lipoprotein(a) level (-7% and -20% vs no change), and had no adverse effect on the low-density lipoprotein cholesterol level (2% and 0% change vs a 9% increase). Significance levels for comparisons between medications ranged from P<.001 to P<.02. Gemfibrozil reduced the triglyceride level more than Niaspan (P<.001 to P = .06, -40% for gemfibrozil vs -16% to -29% for Niaspan, 1000 to 2000 mg). Effects on plasma fibrinogen levels were significantly favorable for Niaspan compared with gemfibrozil (P<.02), as gemfibrozil increased the fibrinogen level (from 5% to 9%) and Niaspan tended to decrease the fibrinogen level (from -1% to -6%). CONCLUSIONS: In patients with a low baseline HDL-C level, Niaspan at its higher doses provided up to 2-fold greater HDL-C increases, decreases in lipoprotein(a), improvements in lipoprotein cholesterol ratios, and lower fibrinogen levels compared with gemfibrozil. Gemfibrozil gave a greater triglyceride reduction but also increased the low-density lipoprotein cholesterol level, which did not occur with Niaspan.


-------------------------
Also, Lopid (Gemfibrozil) was shown to cause increased death from other causes even though it lowered cholesterol.

See study here:


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7697857&dopt=Abstract

---------------------------
Also, (and I hate to get pushy with doctors), but Lopid is a fibrate (class of drug) and can react poorly with your blood-sugar lowering drugs.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9825949&dopt=Abstract

[Voyajer]

Hey everyone! I'm so ecstatic! My boyfriend just got his results back.

Three weeks ago:

Total cholesterol: 271 mg/dL (7.05 mmol/L)
HDL: 35 mg/dL (0.91)
LDL: 171 mg/dL (4.45)
Triglycerides: 123 (3.2)
Ratio: 7.7%

Today:
Total cholesterol: 214 mg/dL (5.56)
HDL: 41 mg/dL (1.07)
LDL: 159 mg/dL (4.14)
Triglycerides: 70 (1.82)
Ratio: 5.2%
Homocysteine 6 micromol/L
C-reactive protein .7 mg/L (lab says should be .55 or less)

To do this he took No Flush Niacin 3 times per day for 3 weeks along with 500 mcg Folic Acid (Folate).

[Rob]

Great news Voyager,

I am hoping for similar revelations . I am taking 500mg No flush Niacin daily only and 400mcg folate .

I tried normal niacin and wow, I nearly ignited !!!!! it was terrible ,and that was only with 200mg , can you imagine what it must feel like with 500mg !!!! :daze:


I will keep you posted ,will re- test end of August

Rob

[Voyajer]

Rob, uuuuh! You're brave taking 200 mg straight Niacin. I get a bad reaction at 50mg. I'm sure you'll do well with the No Flush Niacin though.

What is unbelievable to me is that even though his cholesterol went down to 214 mg/dL (5.56), the doctor still wants to start him on statin drugs anyway (Lipitor). Statins are the new latest wonderdrug now that a five-year study concluded that they lowered risk of heart disease. I hate drugs! They always find out later that the side-effects are still killing everyone. They don't die of heart disease, they just die from something else that the drug caused. A new report says that doctors should change the guidelines to start people on statin drugs even if they have low cholesterol! Unbelievable! And they try to make it seem like the Pharmaceutical companies have nothing to do with this even though these drugs are mega-expensive.

If these statin class drugs are so safe then why is there a lawsuit against Bayer for their statin drug that killed 30 people?
http://www.baycollawyersource.com/

[ksheffeld]

My husband has a condition in which his liver produces much more cholesterol than is normal or healthful, and for many years he has been controlling it with Niacin (with great success). He uses ONLY the regular Niacin, taking 1500 milligrams three times a day. I know, that's a lot. But the flushing is minimal, since he always takes it with food, and is so accustomed to the dose.

My mother, on the other hand, attempted to control her high cholesterol with the NON-FLUSH variety of Niacin, and now has CIRRHOSIS of the liver, which she and her doctor believe may have been caused by taking the time-release niacin. This woman is (and always has been) a tee-totaller. This condition was not caused by alcohol.

If you follow the prevailing advice on the preference of non-flush niacin over the regular kind, I urge you to have a regular liver enzyme test to monitor the effects.

[chrisews]

Hi, I was so glad to see this discussion. I am taking Niaspan because of a very high lipoprotein level, which is often present in heart disease. I also have a family history of heart disease. I began for several months on 500 mg of Niaspan, the lipoprotein level did not drop enough and the doctor raised me to 1000 mg. I promptly broke out in hives. of course I stopped til the hives cleared up, then tried again, just to ensure that the niaspan was the culpret. sure enough, back came the hives. I am now back on 500 mg with no ill effects. Anyone else have this happen?? thanks. chris :wave:

[Voyajer]

KSheffeld,

There are four kinds of Niacin. There is regular Niacin that causes the flush. There is No-Flush Niacin that is regular Niacin which has Inositol attached to it. Then there are other "sustained released", "slow release", "extended release", and "time released" Niacin that are sold over-the-counter without a prescription. Then there is the prescription kind called "Niaspan" and "Advicor" (when combined with a statin drug) which is a time-released Niacin.

Studies before 1996 showed that the over-the-counter sustained released, etc. types of Niacin as opposed to the over-the-counter regular Niacin, did indeed cause higher rates of liver damage. Then in 1996 the time-released prescription Niacin called "Niaspan" underwent extensive testing until it was found to be better than regular Niacin at NOT causing liver damage.

A couple of the studies on the prescription Niaspan showing even though it is time-release, it didn't cause liver damage are shown here:

http://forum.lowcarber.org/showthread.php?s=&threadid=54396

The kind of time-release Niacin available in health food stores may or may not be the type of Niacin to cause liver damage. No studies need to be done on health food store products.

So I'm interested to know if your mother actually took No-Flush Niacin with Inositol (inositol nicotinate) which although sustained-released has been shown to be safe in four studies OR Slo-Niacin, the sustained-released, time-released kind which also says "no flush" because it releases slowly but without inositol.

[ksheffeld]

Voyajer:
Thanks for the update - I wasn't aware of the various new versions of niacin. I'll definitely check out your suggested sites.

My mother's cirrhosis manifested before 1996, and I'm fairly certain she was taking a time release niacin that did not contain inositol. Unfortunately.

My husband, though, as I said before, has had steady, long-term success with regular niacin in unusually large doses (1500 milligrams three times a day). He believes that the flushing phenomenon is actually beneficial, in that it provides a mental bio-feedback mechanism - a connection between the body and the mind (however ephemeral) that might strengthen the niacin's effectivness. I know, it sounds a bit flakey - but no one can argue with his continued success.

I think for myself, I might be persuaded to try the inositol/niacin combo - or at least to give it some further research.

[chrisews]

KSheffield, Did anyone you knew get hives from the niacin. also, to voyajer, I feel it's really important to go up to the 1000 milagrams of niacin, but not when I get hives. I wonder what in Niaspan could have caused them. do you think regualr Niacin would do the same thing? thanks chris

[Voyajer]

I've read that some people have an allergic reaction to Niacin. Actually, anyone can get an allergic reaction to anything. Hives are usually the first sign of allergic reaction to any chemical, drug or food. If you are allergic to one drug, you are generally allergic to the whole class of drugs. However, if I were you I would try the No Flush Niacin (inositol nicotinate) because it is actually considered a different chemical than Niacin (nicotinate).

There isn't much else you can do if you continue to get hives except take an anti-histamine with the Niaspan.

There is an alternative. Octacosanol works as well as Niacin in lowering cholesterol. You can get it at the health food store.

See this thread:
http://forum.lowcarber.org/showthread.php?s=&threadid=56684

[ksheffeld]

Chrisews:
I've been troubled by hives myself, but not in response to niacin, and no one I know has ever had that response. However, I haven't had hives in years, since I started regularly taking vitamin B (50 milligrams of all the B's) every day, as well as a couple of grams of vitamin C. Maybe if you shore up your body defenses with these nutrients, your hive response will disappear. I agree, the large doses of niacin are necessary to effect the lowering of cholesterol, so good luck!

[Rob]

26/10/01 Fasting
tot chol 5.75
LDL 3.81
HDL 1.65
Tot/HDL = 3.48 (<5)
----------------------

24/07/02 non fasting
tot chol 6.5
HDL 1.34
LDL 4.34
Tot/HDL = 4.85
Trig = 1.8
--------------------

30/07/02 fasting
tot chol 6.42
LDL 4.54
HDL 1.38
tot/HDL 4.65
trig 1.1

Well good news everyone,

here is my blood work from yesterday : 04/09/02

tot chol 6.11
trig 0.8
HDL 1.46
LDL 4.28
tot/HDL 4.18


as you can see there is a significant positive change just after 1 month on No Flush Niacin 500mg daily and Folate 40mcg.

I will take 1000mg No flush Niacin for the next 2 months and then re-measure


Rob

[Voyajer]

Congratulations Rob!

Total cholesterol went from 248 to 236 and your HDL went up and LDL went down. Not bad!!

[Rob]

I should also have said ,

that I have greatly reduced my intake of eggs , I limit them to 2 per week ( instead of 14 !! LOL LOL ) and I have not had bacon for the past month and whipping cream only once and sausage also only once .



I think its just sensible eating less saturated fats and more monounsaturated as well as more omega 3 polyunsaturated . I also have started eating oily fish more frequently .

Rob

[JClifford]

:mad: :thdown:

I had an unpleasant experience after a cardiologist placed me on niaspan and at the same time my family dr. put me on Zocor. Apparently some people react quite severly to niaspan combined with statins (sp?).

The flushing was disturbing in that it was accompanied by what felt like a high feever, but the most disturbing part is that I began to suffer from stiff and sore legs. I have always been able to walk long distances while playing golf or hunting, but after about three months on this combo, I could barely walk 100 yards. I only discovered that this mixture was harmful when I filled both prescriptions at the same time, and my pharmacist cautioned me and directed me back to my family dr., who was surprised that the cardiologist had prescribed niacin, and agreed that this was not a good idea. I ceased taking Zocor, and eventually the niacin as well. My legs have almost reached 100 percent after about 1 and 1/2 years.

I started locarb (perpetual induction) in February, and by mid may I had lost 35lbs. I am off LC now, but plan to start again when my current health crisis passes (angiogram Monday....stents or surgery to follow) or I do.

I hope those of you on niacin check to see if it is a bad combination with anything else you are doing. Good luck.

[Rob]

Plain Niacin is terrible .

In doses over 50g you get an awful flushing with temp . I know it happened to me and I changed to no flush niacin . This preparation has none of the flushing you get with regular niacin .

I am not on any other medication .

I am aware that high dose niacin has been assocaited with liver damage and that it can cause a raise in blood sugar although none of this is reported with INH Niacin

I will recheck my blood sugar and liver function tests when I repeat my lipid profile in 2 or 3 months time .

Rob

[Voyajer]

JClifford,

Rob is right. Try No Flush Niacin with inositol if your cholesterol is still high.

And don't blame the Niacin on the stiff and sore legs. It was the statin drug Zocor (simvastatin) that did that. Statins deteriorate your muscles. One statin drug had to be taken off the market and is being sued for causing 30 deaths from muscle deterioration disease caused by the drug. Scary stuff!

See these threads:

http://forum.lowcarber.org/showthread.php?s=&threadid=56684

http://forum.lowcarber.org/showthread.php?s=&threadid=55457

[freydis]

Originally posted by jbee
BP: Home, Drugstore, anywhere but the doc 120/73
BP: Doctor 140/92[/B]

The whole reason I began LC is because of that specific problem, but I'm almost grateful.

From June 2001-March 2002, my bp kept going higher and higher. Doc kept prescribing meds to get it down and NOTHING was working. Finally, in March, he told me I was doomed - not in so many words - but that I might not last more than a year or two, if I were even that lucky.

On the ride home, discussing the problem with my spouse, I decided to try the Atkins diet that a friend had tried and found successful. It was instantly successful for me and I have been following the Induction level since then - and will until I get my numbers in a better place.

Anyway, on my followup visit the next week, the doc discovered that the nurse had been using the wrong size cuff on me all that time and that my bp was actually being fairly well controlled by the meds he'd given me. Now, I always ask for the largest cuff, just in case she forgets again. This nurse is also overweight and seems actively angry that I'm losing weight - she often misreads my data for the worse, but I truly adore my doctor and will not change because of her.

Also wanted to mention that my pre-Atkins cholesterol levels, controlled by drugs and a 2-yr-old triple bypass, were not terrible - slightly over 200 total. After 2 months on Atkins, my total was down to 185, but the bad cholesterol had raised. Doc is supportive of Atkins, but worried about that aspect and my bp. I was wanting to go off of meds altogether to try the diet "perfectly" but have since resigned myself to taking things much more slowly.

I'm also diabetic, which complicates things somewhat. My mom died of the same problems at age 56. Most people consider that young, but I may be lucky to get that far. :(

[Rob]

Well ,

I've been taking folate 50mcg and no flush niacin 1000mg daily for the past 2 months . I had my bllod work done today so watch this space for the exciting news tomorrow !!!


Rob

[Rob]

Well here they are :


30/07/02 fasting
tot chol 6.42 247.8
LDL 4.54 175.2
HDL 1.38 53.2
tot/HDL 4.65
trig 1.1 42.5
LDL/HDL = 3.3

--------------------

04/09/02 fasting 500mg Niacin and 40mcg Folate daily

tot chol 6.11 235.8 1mmol/l (IU)= 38.6mg/dl USA
LDL 4.28 165
HDL 1.46 56.36
trig 0.8 30.88
chol/HDL 4.18 (<5)
LDL/HDL 2.9

now on 1000g Niacin daily and 40mcg folate . Next check beg November 2001

14/11/02 fasting 1g Niacin and 40mcg folate daily

tot chol 5.7 220
LDL 4.03 155.56
HDL 1.27 49.02
trig 0.88 33.97
chol/HDL 4.49 (<5)
LDL/HDL 3.17


I am really pleased with the results and will continue to take the Niacin and Folate