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High Cholesterol Message Board

High Cholesterol Board Index

Why is everybody assuming that there is anything NATURAL about 1000 mg. nicotinic acid a day? There's certainly no way that anyone could get it in one's food. On top of that it's chemically compounded into a form to avoid the flush.
Just because something is sold without a prescritiption doesn't in any way render it "natural."
Niacin therapy is a very potent DRUG therapy, one among the choice of several drug therapies.

I found this interesting and perhaps others will too (from the Linus Pauling Institute.):
High cholesterol and cardiovascular diseases

[quote]Pharmacologic doses of nicotinic acid, but not nicotinamide, have been known to reduce serum cholesterol since 1955 (22). Only one randomized placebo-controlled multicenter trial examined the effect of nicotinic acid therapy alone (3 grams daily) on outcomes of cardiovascular disease. The Coronary Drug Project (CDP) followed over 8,000 men with a previous myocardial infarction (heart attack) for 6 years (23). In the group that took 3 grams of nicotinic acid daily, total blood cholesterol decreased by an average of 10%, triglycerides decreased by 26%, recurrent nonfatal myocardial infarction decreased by 27%, and cerebrovascular events (stroke + transient ischemic attacks) decreased by 26% compared to the placebo group. Though nicotinic acid therapy did not decrease total deaths or deaths from cardiovascular disease during the 6-year study period, post-trial follow up 9 years later revealed a 10% reduction in total deaths. Four out of five major cardiovascular outcome trials found nicotinic acid in combination with other therapies to be of statistically significant benefit in men and women (24). Nicotinic acid therapy has been found to result in markedly increased HDL-cholesterol levels, as well as decreased serum Lp(a) lipoprotein concentrations, and a shift from small dense LDL particles to large, buoyant LDL particles, all of which are considered cardioprotective changes in blood lipid profiles. Because of the adverse side effects associated with high doses of nicotinic acid (see Safety), it has most recently been used in combination with other lipid-lowering medications in slightly lower doses (22). A recent randomized controlled trial found that a combination of nicotinic acid (2 to 3 grams/day) and a cholesterol-lowering drug (simvastatin) resulted in greater benefits on serum HDL levels and cardiovascular events, such as heart attack and stroke, than placebo in patients with coronary artery disease and low HDL levels (25, 26). However, an antioxidant combination (vitamin E, vitamin C, selenium, and b-carotene) appeared to blunt the beneficial effects of niacin plus simvastatin.

Although it is a nutrient, at the pharmacologic dose required for cholesterol-lowering effects, the use of nicotinic acid should be approached as if it were a drug. Individuals should only undertake cholesterol-lowering therapy with nicotinic acid under the supervision of a qualified health care provider, so that the potential for adverse effects may be minimized and treatment benefit maximized.[/quote]

I'm doing Lipitor plus small doses (couple/three hundred mg./day) of niacin (for my HDL) and I guess I should discontinue my Vit.C and Vit. E til I find out if there's an adverse interaction.
I cannot BELIEVE they tested 8300 men for 9 YEARS and didn't bother to measure their HDL levels...I guess because there wasn't much thinking about HDL and heart disease in the '60's and '70's? (I VAGUELY recall only total cholesterol being of much interest.)
[QUOTE=Lenin]Why is everybody assuming that there is anything NATURAL about 1000 mg. nicotinic acid a day? [/QUOTE]Well, I guess I'm not part of "everybody." ;) I believe in approaching use of niacin with extreme caution. Here is the approach I took:

When the doctor started getting concerned that my risk ratio was the highest it had ever been (4.0 with LDL 158) and mentioned statins, I said I wanted to try to get it down with diet first. She gave me three months. But we'd been this route a couple of years earlier, and though I got it down some then, after doing a lot of reading on the web, I decided on my own to try niacin in addition to being more careful about diet this time. I wanted to be extremely cautious, so took only 250 mg. for about two months before I went back to her for that 3-month checkup.

She expressed concern about using an OTC product, but I had read the research on the particular one I was taking and was satisfied that it was probably no more dangerous than a statin in terms of liver toxicity. She reluctantly agreed to let me try 500 mg, since my liver enzymes showed zero problems at the 250 mg level. After another three months, I had another lipid panel and liver enzyme test. At this point, my doctor was so excited about my results, that she asked me to get her the address of where I ordered that particular OTC niacin, so she could give it to others. However, the results (TC=202, LDL=115, HDL=60, trigs=83) were still not good enough for her, so she recommended increasing the niacin to 750 mg, which is the level I'm still at.

In my book, even 750 mg, though lower than most therapeutic doses, is still not natural. But it allows me to do some experimenting with diet to see if I can find some combination which will allow me to back off and lower that niacin dosage. The lower I can make it, the lower the risk.

I liked the assertive approach I used, though. By starting the OTC on my own at a low dose and getting back a very favorable liver enzyme test the first time, my doctor, though still concerned, was probably less adamently against continuing on an OTC than she might have been otherwise. I simply cannot see paying ten times the price for Niaspan, when the research on the one I'm using seems to indicate a high level of safety.

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