Posted
Tuesday, April 20, 2010
A study comparing the effects of niacin (B3) with the cholesterol lowering drug ezetimibe show that niacin unblocks arteries while ezetimibe does not. A low GL diet also improves cholesterol status and halves cardiovascular risk in women.
Despite lowering cholesterol ezetimibe was ineffective at improving arterial health. In fact, the more it lowered LDL cholesterol the less effective it appeared to be. The trial, published in the Journal of the American College of Cardiology, involved 363 people, 208 of which completed 14 months of follow up, either given statins plus niacin, or statins plus ezetimibe. Those taking niacin had a significant reduction in artery thickness consistent with improving cardiovascular health, while those on the cholesterol lowering drug did not. Ezetimibe did, however lower LDL cholesterol. In fact, those with the greatest reduction in LDL cholesterol had the greatest increase in arterial thickness. What’s more, the longer a person was on niacin the greater was the reduction in arterial thickness, while the longer a person was on the drug the greater was the increase in arterial thickness.
Apart from showing that high dose niacin is clearly better than ezetimibe this study also implies that lowering LDL cholesterol, the hell bent mission of conventional treatment, has nothing to do with reversal arterial blockage. Niacin is one of the most effective substances for increase HDL cholesterol, sometimes called the ‘good’ cholesterol. Raising HDL and lowering triglycerides (blood fats) is the new, and rightful target of treatment. Niacin needs to be given at a dose of 1000 to 2000mg. At this level it causes blushing and therefore delayed release of non-blushing forms are preferable.
I have long since argued that raised cholesterol is just an indicator of poor diet. A study published this month Journal of the American Medical Association in the shows that a sugar rich diet, or a high GL diet, is associated with low levels of the ‘good’ HDL cholesterol and high levels of triglycerides. The researchers conclude “Although long-term trials to study the effect of reducing added sugars and other carbohydrates on lipid profiles are needed, our data support dietary guidelines that target a reduction in consumption of added sugar.”
Another study, this time from Italy, called the EPICOR trial, which involved more than 47,000 people, compared diet with cardiovascular risk over almost eight years. Those women in the top quarter of glycemic load (GL) diets, eg eating the most carbs in the form of fast-releasing sugar and refined foods, had double the risk of coronary heart disease than those in the lowest quarter. This study didn’t find the same association with men. There is no clear reason for the sex differences however it may be that women are more sensitive to the hormonal changes that accompany high GL diets.
My Low GL Diet Bible contains a section on reversing cardiovascular disease and risk, including what to do regarding supplements such as niacin. If you’d like to find out more about lowering high cholesterol levels without drugs also see the Special Report on this subject.
My eighty year old husband underwent a 4-way coronary bypass operation 5 weeks ago. He has been put on a 40mg dose of Simvastatin. I am anxious to get him on as small a dose as possible - (or preferably off the medication) as we follow 100% lifestyle/eating guidelines and I do not believe that there is any benefit from the drug. Is there a reason that a statin is vital after the surgery or is it just done as a matter of course. I am assembling information to make my case to the surgeon on 4 May and would appreciate any input you can give me.
Posted by Val Wood on 04/24 at 12:40 PM
Is your husband’s total cholesterol level high? What is his HDL/total cholesterol ratio? There is evidence of benefit for statins in those with cardiovascular disease, and especially if cholesterol is high (above 6). Niacin is also beneficial, especially in those with a low HDL/cholesterol ratio. Ideal you want at least 1/3rd of your total cholesterol as HDL.
Statins are so deeply embedded in conventional cardiovascular medicine that I would suggest the first step would be:
a) to enquire about the combination of co-enzyme Q10 (90mg) to mitigate the side-effects of statins. This is well documented, has no side-effects and many benefits beyond reducing the downside of statins. In any event you can buy this over the counter and take it, with or without the doctor’s blessing.
b)ask about the combination of niacin with statin, on the basis of a recent study you heard about (The ARBITER trial - Journal of the American College of Cardiology - [http://www.ncbi.nlm.nih.gov/pubmed/20399059]in which the combination of niacin plus statin reduced arterial thickness, whereas the combination of statin plus ezetimibe (also known as Ezetrol) did not. this is the drug you want to avoid. Niacin also has the advantage of raising HDL, hence raising HDL/cholesterol ratio.Niacin is prescribable as Niaspan.
You also want to check that your husband’s homocysteine level has been checked. Not all cardiologists are going to want to give high dose B vitamins because, however there is no question that raised homocysteine is a significant risk fact and you can give a supplement such as BioCare’s Connect if you choose.
The other no brainer is to have him prescribed omega-3 fish oil. Omacor is the prescribable supplement. Again, this is something you can buy over the counter.
That’s where I would start.
Posted by patrick on 04/25 at 05:24 PM
Hi Patrick
Which is the best form of Niacin to take that is the most effective and easily absorbed? Do you make one in your own range or would Solgar be best?
Thank you
Diane
Posted by A Porritt on 04/28 at 08:14 PM
Good question. Firstly, the dose that works best is 1 to 2grams a day. I find the lower dose is very effective when a person is also on an optimum nutrition strategy.
Pure niacin works, and the prescribable niacin, called Niaspan, is an extended release form. The non-flushing form, which is niacin bound to inositol (inositol hexanicotinate) should also work but there are no double-blind placebo controlled trials on this form yet so we only have case reports to go by. Solgar’s no-flush niacin and BioCare’s NoBlush Niacin uses this form. BioCare’s also contains magnesium ascorbate, the reason being that, together with eg Optimum Nutrition Pack,taking two strips a day, and NoBlush Niacin, taking two strips a day, you’ll be getting:
1,000mg niacin
Magnesium 445mg
Vitamin C 2490mg
Hope that helps.
Posted by patrick on 04/29 at 06:35 AM
My choloesterol level is 7 but the HDL is high about 4.something. Why isn’t that good? I’m in a no-win position as your article says that the risl of heart disease is doubled every time your HDL drops by 0.5 moll/L.
And why, oh why cant the Doctors be informed of their bad practices? I inform mine ND ANYONE I KNOW WHO TAKES STAtins without CQ 10 but a campaign is needed to inform the ignorant politicians and NICE.
Posted by Joanna Molloy on 04/29 at 10:01 PM
Joanna - your cholesterol to HDL ratio is good so something like niacin, which raises HDL, is not likely to be the most helpful. A cholesterol of 7 is quite high and generally a strict low GL diet does help to bring this down. I would try this first.
The situation with doctors is worse than you think. Yesterday a nutritionally informed GP, Dr Sarah Myhill, (see her website http://www.drmyhill.co.uk) who has years of experience as a GP, faced yet another General Medical Council hearing, brought on by a complaint by Ben Goldacre, a nutritionally ignorant doctor who doesn’t practice at all, as far as I know, and certainly not as a GP. She has not lost her licence to practice but has been prohibited from prescribing! Yes, it’s true. A GP who takes time to actually learn about nutritional medicine and prescribes less drugs and more nutrients gets banned from prescribing to patients!
So, you are right that we do need more awareness regarding nutritional medicine, and how it can save lives and money - and we need doctors to be trained in nutritional medicine. It is extraordinary that doctors don’t give CoQ with statins or recommend everyone with cardiovascular concerns to supplement magnesium. These are no brainers. We wrote the book Food Is Better Medicine Than Drugs with GPs in mind. Many I’ve spoken to have had their eyes open by reading this book. That’s one grassroots way to help. counter ignorance.
Posted by patrick on 04/30 at 05:28 AM
Thank you. I have both your low GL diet books (and don’t use them!!) Need more will-power.
I’m now thinking of organising a Conference on nutritional medecine. It seems the best way to persuade those in the medical field and get to the politicians. It’s supposed to be a time for change. Let’s see if the Health Minister can be influenced. If anyone wants to join me, they’re welcome. Joanna.
Posted by Joanna Molloy on 05/04 at 09:04 PM
Hi!
Can’t find an active blog about VitC.
Twice recently a couple of medical doctors have said to me that high doses of VitC causes kidney stones - they are therefore not recommending people take more than 500mgs. Are you aware of the study/s they are referring to…...!? I notice there is a referrence to this in your optimum nutrition bible….What is the best way to respond to this type of comment??
Also heart doctors here seem to be very down on the homocysteine connection…..saying there is not proof….studies do not stack up….!! Comments please.
Posted by Shirlee on 05/12 at 05:29 PM
I posed this question about vitamin C and kidney stones to one of the foremost authorities on kidney stones, Professor Allen Rodgers from the University of Cape Town. This is what he said: “The answer is simply “no”. At the Kidney Stone Research Laboratory of the University of Cape Town, we conducted a controlled trial in which 10 volunteer subjects were required to ingest 4g of Vit C per day for 5 days. Urines (24h) were collected before, during and after the ingestion period. These were rigorously analysed for a host of independent physicochemical risk factors, all of which are regarded as powerful indicators of the risk of kidney stone formation. The
results showed that these risk factors were not significantly altered. We concluded that ingestion of large doses of Vit C does not
increase the risk of forming kidney stones. The results of this study were published internationally.”( Auer B, Auer D, Rodgers A, Clin Chem Lab Med 1998,36(3), 143-148).
So why the scare? Professor Rodgers explains: “The widespread belief that Vit C causes kidney stones is based on the well established metabolic conversion of ascorbic acid (Vit C) to oxalic acid and the observation that oxalic acid levels in urine are elevated after Vit C ingestion. Oxalic acid is a key component of calcium oxalate stones - 70% of all kidney stones
contain this substance. Obviously, an elevated urinary oxalic acid level is undesirable. However, while metabolic conversion does indeed
take place, it is insignificant. The apparently higher levels of oxalic acid in the urine that have been previously reported arise
from the fact that ascorbic acid which is excreted in the urine UNDERGOES A CHEMICAL CONVERSION TO OXALIC ACID WHILE IT IS IN A TEST -TUBE PRIOR TO ANALYSIS. In our study, we simply put a preservative in our urine collection bottles to prevent this conversion. Previous studies failed to take this precaution and hence reported erroneously high oxalic acid levels in their urine specimens.
I presented this evidence to the Food Standards Agency who then revised their own position and now state that there is no risk of kidney stones with high dose vitamin C for the reasons stated above.
Regarding homocysteine, if you select ‘all blogs’ then select the ‘category’ ‘homocysteine’ you’ll see the last entry is about a study finding a that B vitamins, versus placebo,cut risk of death in those with cardiovascular disease and high homocysteine by over 80%. As you’ll see in this blog the reason some docs are down on homocysteine and B vits is that simply giving B vits generally doesn’t reduce cardiovascular disease risk. But it does to people with high homocysteine. it’s a bit like giving statins to people with normal cholesterol - no significant effect. i do not recommend high doses of B vits, designed to lower homocysteine, to those with normal homocysteine levels. The issue become what do you suppolement at what dose? My books give you that formula. Certainly above 15 B vits are proven to be effective. There is an increased risk of heart attack and stroke associated with homocysteine level above 9.
Posted by patrick on 05/13 at 06:01 AM
Thanks Patrick.I will pass on these comments. I realise that doctors particularly in hospitals are under a lot of time stress. Certainly interns are worked to the bone and don’t have time to investigate nutritional issues outside of their day to day work load. I look forward to their response. It does worry me though when I hear that GP clinics in England are actually being rewarded for NOT spending money caring for people though. But that’s another issue altogether.
Will keep you posted.
Regards
Posted by Shirlee on 05/17 at 10:21 AM
