Advice, High dose Niacin

I would like your advice and opinions. I am 44, 5'9", male. My father had heart disease and heart attacks starting in his late 30's, but died of cancer in his mid-50's. I have had high cholesterol, low HDL and high triglycerides for many years; my only brother has a similar condition. Past attempts of trying a low-fat diet worsened my condition. I feel that I may be insulin resistant or sensitive to carbohydrate intake.

I am finally getting serious about my health. I have been on the Atkins diet for over 5 months and reduced about 35 pounds to 165. I had a checkup last week and brought my lipid profile to the best I had ever measured (even when my weight was low (in my 30's)): Total Chol 191, HDL 40, LDL 128,
Triglycerides 116, CRP OK, Homocysteine OK, Lp(a) OK, free testosterone 385.

I am supplementing my diet with Fish oil- 6 gms, Flax oil- 4 gms, B-200, folic acid-1600, DHEA-50, E-800, C-4000, Selenium-400, Co-Q 100, multi-Vit.

My Doctor is OK with my numbers but I would like him to consider high-dose niacin therapy, probably Niaspan. I was on Niaspan in the past but with my standard American diet it did not help much. I want to try again in a hope to bring up my HDL and bring my HDL:Triglycerides to 1:1 while maintaining a low-carb diet for life. I am opposed to Statins unless they were my only option.

I would value your opinions and input even if you can just talk generalities.

Thank you for taking the time to respond to me. I am checking if CIMT screening is available in my hospital or in my healthcare system. Although
I don't know my degree of atherosclerosis I was looking to take measures to at least keep the progression in check. That has been my short term goal.

Trying to get proactive healthcare is difficult in the present state of healthcare financial control - especially in NJ. In the past few years I have been able to get a treadmill EKG and some lab-work steered to look at some important cardiovascular disease markers. Anything beyond that will take inventive solutions.

It would have been wise for me to take action sooner, but before I turned forty my priorities were different. As I say, my risk factors have been a constant which I can't afford to ignore. I will also note that the 20 years of high second hand smoke exposure from my parents has also been on my mind.

It appears that my focus is at least in the right direction and concentrates on atherosclerosis and diabetes. I would have been a good choice for me to follow a low-carb diet plan sooner.

I look forward to seeing a discussion of the complications of atherosclerosis in another thread and any other advice you can give.

Excelllent BP! You may be in better shape than you think - Dr. Roizen ("True age" said that low BP was the best indicator of success in aging. For low carbs, I like "South Beach Diet" much better than
Atkins. For exercise - can you squeeze it into your work schedule (walks, stair climbing)? Please read Harvard's opinion of moderate drinking (healthy): http://www.hsph.harvard.edu/nutritionsource/ alcohol.html

Eating less reduces it more than exercise will.

As does losing weight.

Has anyone ever had a bad reaction from Nician? I got a nasty itchy rash each time I increased the dosage. Mind you I didn't jump from 100 to 300...I went up by 50's. The rash appeared on my upr leg area. I talked to my Cardio about it but all's he said was stop taking it.
Anybody????? Please and thanx, Bogie

Is there any evidence that IHN is as effective as the conventional form of niacin?

Correction: .48 for CRP isn't so great if it's .48 mg/DL (like my lab). It's great if it is .48 mg/L. Alcohol and statins reduce inflammation and CRP.

your CRP is excellent. You could call your lab.

especially dangerous - exercise reduces it - stress and inactivity increases it - see http://www.sciencedaily.com/releases/2003/05/ 030529081315.htm

flushing.

These look to be some promising leads, but you need to dig deeper for substantiated medical literature:
http://www.life-enhancement.com/article_template.asp? ID=7
http://www.thorne.com/altmedrev/.fulltext/3/3/222.html
http://www.thorne.com/altmedrev/fulltext/inositol1- 3.html
http://www.vitaminresearchproducts.com/ LipiControl_Articles.pdf

I became aware of IHN as written about by Dr Atkins. I was hoping to spur some discussion on IHN when I responded to your question.

The topic of Niacin therapy or IHN in particular may have already been discussed in some archived threads. One such thread

Medscape discussion (but only one direct mention of INH):

I also am interested in the independent or combination role of Pantethine in improving a persons lipid profile and I wonder if the combination may be beneficial with little potential side affects.

Also to address Brad Sheppard...

With my family history my goal is to reduce my cardiovascular disease risk.
[Goal 1] My understanding is that if I were to bring my HDL to Tri ratio to
1: 1 my risk of potential problems would be reduced. It may be more difficult to achieve a lower total cholesterol level; this may not be worthwhile goal taking into account the literature I have read and my genealogy. My understanding of my condition and the treatment philosophies are from Dr. Ronald Hoffman and the late Dr Atkins.

I did not get the result of my fasting blood sugar but suspect I may have a propensity for diabetes or a pre-diabetic condition. I have asked my Doctor for a copy of the full lab report. I assume if I were to have a GTT the results would reveal what I suspect. I have realized that simple carbohydrates and even moderate amounts of complex carbohydrates increase my triglyceride levels and contribute to weight gain. The low-carb Atkins approach has had a dramatic affect on my health and weight. In my Atkins eating approach I have leaned toward a Dr Hoffman type "salad and salmon" diet while including chicken and other lean protein sources. I also include eggs and nuts in my diet. I have not added oatmeal or grains back into my diet yet. Bottom line- A low carb diet is probably my best diet and will avoid considering any issues with diabetic tendencies. [Goal 2: Avoid diabetes]

I realize the importance of exercise but my daily work routine leaves little time or energy for that. I am up by 5:30 and not home until 18:30 at the earliest. I will attempt to fit exercise in somewhere. I work at a heart hospital (Newark Beth Israel) but it seems it is the worst environment for maintaining heart health considering the demands of my job and the food choices Somehow I still maintain a BP of 110/70.

Goal 3: Age without "inevitable" health decline.

Why monkey with OTC naicin when the well-tested Niaspan is available?
You might save a few cents but with your health involved is it worth it?

I do not want to make assumptions on what it is that you want (even though this is posted on smc). Can you be more specific as to what you are wanting to achive with your health plan. What are the 3 most important goals you want to achieve?

I understand there is a type of niacin that is not toxic to the liver in high doses.
I would recommend that...unfortunately, I cannot remember the name.

The lab oddly did not specify the unit of measurement but did give a reference range of 0.0-4.99. Considering this I guess the units are mg/dL.

I have lost 35 pounds in 5 months but hope to loose a few more pounds.
Weight loss has been slow since I dropped below 168. I am now bouncing around 163-164. Waistline is down to 36" - not where I want to be yet.
First on, last off! Troublesome where the fat accumulates... another bad factor.

I am still considering niacin therapy. Self prescribing of 1500 mg INH is my thought but then I would need to get follow-up liver tests. Still need to convince GP that Niaspan is worth a consideration.

Funny, statins often seem to be prescribed where diet modification would be affective, and yet, I am following a very strict ketogenic diet but my GP wasn't very supportive of this kind of diet or was concerned about my lab results. I guess from his perspective there were no red flags. The elevated FPG has me concerned and even more so that I have it on paper. The borderline aspects of everything makes me take pause.

Good job with the supplements. Several more ideas 1) moderate drinking (raises HDL) (2 a day for men) 2) more exercise 3) oatmeal to lower chol - 4) you may have prediabetes - is your fasting plasma glucose >100? 5) in your shoes I would consider statins. The benefits may outweight the risks. 6) make sure you're on a heart-friendly diet
- pay special attention to "good fats" see http://www.hsph.harvard.edu/nutritionsource/ pyramids.html 7) take special care to keep your blood pressure under control.

Why not do regular exercise to raise your HDL?

to 3.0 mg/L. High >3.0 mg/ L. Source: AHA/CDC Scientific Statement."
On my diet my CRP is .11

test.

drink 2 ounces of vodka daily. What's wrong drinking to reduce your
CHD risk by 40%? Of course, more than two drinks daily is not good.

How's your weight and waistline? Both your CRP and BP look very good.
You may be (hopefully) one of the "worried well."

My main reason for using niacin is the raise HDL. My total cholesterol is "normal" without it but it increases my HDL about 50%. I wonder why there is so little research on this less problematic form.