From the NY Times:
A. Nicotinic acid, one of the two forms of niacin or vitamin B3 (the other is nicotinamide), not only reduces “bad” lipids when taken in pharmacologic doses, but it also increases “good” kinds. It also has anti-inflammatory and antioxidant properties.
Exactly how it works is unclear, said Dr. Sheldon S. Hendler, co-editor of The Physicians’ Desk Reference for Nutritional Supplements. “It does not inhibit cholesterol synthesis as the statins do,” he said. “A protein receptor for nicotinic acid, called GPR109A, has recently been discovered and is thought to play some role.” Many of the suggested explanations deal with reducing liver triglycerides, Dr. Hendler said. “For example, in fat tissue, it leads to a decrease in the amount of free fatty acids going to the liver, where triglycerides are made,” he said. “This means decreased triglyceride-containing lipid particles, including LDL cholesterol (bad cholesterol) and VLDL cholesterol (also bad cholesterol). This exchange leads to an increase in the proportion of HDL cholesterol and other lipid particles that contain good cholesterol.” Nicotinic acid also has a role in reverse cholesterol transport, he said. In that process, HDL-cholesterol particles remove cholesterol from plaque in arterial linings and are transported to the liver for excretion, helping reverse coronary artery disease.
Steve - this is a pretty good explanation by Dr. Hendler. Niacin is a favorite used by our favorite local cardiologist, Dr. Stephen Devries of Northwestern-Chicago. While niacin has always been around to raise HDL as well as lower LDL, it is not a "sexy" choice because it is a vitamin and cannot be patented. A blockbuster HDL drug was scrapped last year when patients started dying during trials, leaving niacin as still the only game in town for raising HDL.
Tuesday, January 08, 2008
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Despite its effectiveness, niacin in supplement forms are typically not promoted by the medical community for cholesterol management.
Certainly, niacin as a supplement does not have well-financed advocates such as the large pharmaceuticals promoting the use of statins. Part of the challenge also may be that relatively high doses are needed to obtain the consistent LDL cholesterol lowering results of statins. The flushing-side effect, that can be intense and uncomfortable at the high levels, can be a real disincentive.
Yet, in somewhat lower doses--500mg-750mg/day---the research supports the view that niacin from nicotinic acid can consistently raise HDL(good) cholesterol by 10-15%. Individuals might still flush even at these levels, but if a 250mg are taken a few times per day, many people will find that they can tolerate these levels well.
LDL cholesterol can then be addressed by other nutrients including soluble fiber, plant sterols and monounsaturated fats in place of saturated and trans fats.
Finally, added Omega-3's from marine sources and you can very substantially improve your cholesterol and overall blood lipid profile.
For the individuals with boarderline high cholesterol--some 65 million Americans---the natural approach to cholesterol management may well prove adequate.
www.kardeanutrition.com
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