Should you use niacin to lower your
blood lipids?
Hi. I'm Dr. Chris Masterjohn of
chrismasterjohnphd.com.
And this is Chris Masterjohn Lite, where the name of the
game is "Details? Shmeetails. Just tell me what works!"
And today we're going to talk about the use of
niacin to control blood lipids.
Niacin is not the first line of defense for
controlling blood lipids according to
conventional medical guidelines.
However, many people are using it for this
purpose, and so it deserves some attention.
Recent analyses of the
available science suggests that niacin
does in fact lower the risk of
cardiovascular disease. In fact, for every
18 people who take it for that purpose,
it looks like we're saving one person
from heart disease. That is a pretty good
result at first glance; however, it also
looks to be the case
that when we look at the same science,
for every 43 people who take niacin for
this purpose, one of them is getting
diabetes. It basically works out that for
every 7 people that we save from heart
disease with high-dose niacin, 3 of them
are going to get diabetes. And although
that's doing more harm than good, we
would hope to see safer ways of reducing
the risk of heart disease. Because in
fact, there are some things that we can
do that reduce the risk of heart disease
and reduce the risk of diabetes. Now, in
future episodes I will talk about for
people who are going to use niacin, or
who are already using niacin, how do you
do it safely, and how do you do it without
being one of those people who does
develop diabetes. There is some science
suggesting how we can use niacin more
safely than it's being used currently.
But here I want to talk about just the
general cost-benefit analysis. So, I think
it's important to keep in mind two
things. Number one, using niacin in this
way is using it as a drug. Even though
niacin is natural and even though niacin
is vitamin B3 and is found in food, when
we consume niacin in food, it will not
lower our blood lipids like this. We are
using niacin at doses far higher than
could be consumed in food because it has
an effect when we do so to lower blood lipids that
is not a normal nutritional role of the
vitamin. Therefore, using it like this is
a drug. So, we should not think that
there's anything specially natural about
niacin when used in this way, or that
there's anything more natural about
niacin than about some other drug like
statins to control cholesterol levels.
Number two, niacin appears to have some benefits
towards heart disease but have some
negative effects towards diabetes. So, we
should think about whether there are
natural ways that will reduce the risk
of heart disease and diabetes. So, let's
think about what niacin is doing to
lower blood lipids. The way that it works
is it suppresses your release of fatty
acids from your fat tissue. Those fatty
acids would have gone to your liver, they
would have been converted into
triglycerides that would have left your
liver in what we call VLDL particles, and
those VLDL particles would eventually
have become LDL particles in your blood.
But since the high-dose niacin stopped
you from releasing your fatty acids from
your fat tissue, then it stopped that
process from happening and lowered the
LDL in your blood. Well, why are free
fatty acids elevated in people who have
high blood lipids. The main things that
elevate your fatty acids in your blood
are number one, being overweight or obese,
and number two, being insulin resistant,
which is more complicated than simply
being overweight, but one of the major
drivers of insulin resistance is being
overweight. So, we could achieve what
niacin is doing by optimizing our body weight
to get into a healthy lean body weight,
by maximizing our insulin sensitivity,
and that means achieving that lean body
weight, exercising regularly, and eating a
highly nutritious diet that doesn't have
a lot of junk, and then once we are
insulin sensitive, working healthy
carbohydrates into our diet will further
suppress those free fatty acids. If we
take that approach, we are achieving what
niacin would have done to lower blood
lipids, but instead of increasing the
risk of diabetes,
we're actually squashing the the risk of
diabetes down while we squash the risk
of heart disease down. There are
additional natural ways involving diet
and lifestyle that I believe are
effective for controlling blood lipids
beyond what I just described. And I in
fact did a previous episode called
"The Five Best Ways to Lower Cholesterol
Naturally," and I'll link to that previous
episode in the description of this one.
But with all that said, diet and
lifestyle does not always work for
controlling blood lipids, and this is
especially true for people who have
familial hypercholesterolemia or a
related condition where for genetic
reasons they have poor clearance of LDL
particles from their blood. And I think
particularly in these
genetic cases, it does make sense to
pursue a drug-related way to control
blood lipids. Conventional medical
guidelines put statins and several other
treatments ahead of using niacin to
control blood lipids. I do think that
there's some bias involved because
niacin is not patentable and is not
going to make the degrees of profits
that statins could, and I think that's
part of the preference. I also think
statins are overprescribed, and I think
their potential side effects are
underappreciated. So, I do believe that in
working with a doctor to make sure that
your plan is properly
individualized to you and that you do
recognize that using niacin in this way
is using niacin as a drug, I do believe
that in some cases where because your
genetics are so big of a
factor that if diet and lifestyle is not
a way to get your blood lipids under
control, that niacin should at least be a
tool in the kit for you to potentially
work with. And because of that, I'm going
to do a couple episodes on how to safely
use niacin in this context in the next
couple of videos.
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This has been Chris Masterjohn Lite.
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