This is how to take niacin for your
cholesterol without getting diabetes.
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 how to take
niacin for your cholesterol levels in a way
that won't give you diabetes.
So, in the last episode I talked about how
I don't believe that niacin should be the first
approach for anyone in controlling their cholesterol.
I think diet and lifestyle should lead
the way, but I do think that there are
some people mostly for genetic reasons where
diet and lifestyle is not going to cut it,
and niacin may make sense. And I believe
that some people are going to be
using niacin whatever my opinion is, and
so if people are going to be using niacin,
I think it's good to discuss how to do
so safely. And what I want to talk about
today specifically is how to modulate
your carbohydrate and fat intake,
and how to modulate when you're fasting, and when
you're snacking in a way that in theory
should completely prevent niacin from
causing diabetes. As I mentioned in the
last episode, it looks like for every seven
people we save from heart disease, we're
going to give three people diabetes when
we're looking at the niacin data.
So, how to prevent diabetes when you're taking
high-dose niacin is a very important
topic. This is something that Alex Leaf
and I discussed on the podcast that we
did together that was split up into two
parts totaling three and a half hours on
niacin. I'll link to that in the
description of this episode, and what I'm
about to present to you is actually
Alex's idea, not mine, but it's a great idea,
so I want to share it on this channel, and
I'll link to Alex's blog post about this in the
description as well. If you're watching
the video version of this, you can now
see on the screen some data from Alex's
blog post about what happens to free
fatty acids and to carbohydrate and fat
oxidation when you take high-dose niacin
If you're just
listening along on the audio, you won't
be able to see the graphs, but I'll try
to explain in a way where it makes sense
to everyone. So, in the first two hours after
you take a dose of niacin, it suppresses
your free fatty acids. That means that
your circulating fat is very low. Your
body is going to use either fat or
carbohydrate for its main fuel. So in
those first two hours after niacin, if
your body is suppressing the release of
fat, it's going to preferentially burn
carbohydrate. On the right here what
we're seeing is carbohydrate oxidation
spiking in the one to two hours after
niacin therapy. On the flip side, after
the two and a half-hour mark starting
around the three-hour mark, we had this
enormous rebound where the free fatty
acids go higher than they would
otherwise be. And so in the three- to
six-hour period after we take niacin, we have
an enormous release of fat where, shown
on the right, carbohydrate oxidation is
brought down even lower than baseline.
In other words, here we have the carbohydrate
oxidation where we had not taken the
niacin yet. It's even lower at the five-
to six-hour mark. So basically you're
really good at using carbohydrates in
the two hours after you take niacin, and
you're really terrible at using
carbohydrates in the three to six hours
after you use the niacin. Now, Alex and I
didn't come to 100% agreement on the
implications of this, but we are both in
agreement that it makes a lot of sense
to eat a high-carbohydrate meal when you
take the niacin. So, you could take the
niacin and eat that high-carbohydrate
meal basically anywhere in the next two
hours, but I would recommend taking the
niacin and the high-carbohydrate meal at
the same time, in part because I think
taking niacin with food is protective
against some of the negative effects
on the liver that I'll talk about in a
future episode. So, we take the niacin, and
we take it with a high-carbohydrate meal.
Then Alex and I were definitely both in
agreement that the last thing that you
would want to do is from the three- to
six-hour mark when you are burning, when
you have this enormous release of fat,
the last thing you want to do is put
more carbohydrate into the system. So we
are in total agreement that you do not
want to eat any carbohydrates in the
three- to six-hour window and we are,
I believe we're both in agreement that
probably the main reason that one out of
43 people who take high-dose niacin will
develop diabetes from it is because
people are habitually snacking on
carbohydrate. And that carbohydrate while
it's great in the two hours post niacin therapy
is just utterly terrible for
you in the three to six hours post, the
three- to six-hour mark post niacin.
The one place where Alex and I didn't come
to total agreement was that Alex thought
that it might be a good time to eat fat
in the three to six hours post niacin
window, and my feeling is that if you eat
fat in that window, you're just going to
aggravate the effects of the free fatty
acid rebound and just get a double dose
fat bomb in that time period that is not
going to be good for your blood lipids
or your metabolic health. So both of us
agree that the ideal thing would be to
fast during that period. In other words,
eat the high carbohydrate meal when you
take the niacin and then don't eat
anything for the next six hours. Whether
it's okay to snack on something fatty in
the three- to six-hour post niacin period
I think is up for debate, but I lean on
the edge of you're probably nullifying the
entire point of taking niacin in the
first place if you're going to snack on
something fatty in the three- to six-hour
period. So, key takeaway is when you take
the niacin, take it with a
high-carbohydrate, low-fat meal. In the three-
to six-hour window after you take the
niacin, my preference would be that you
fast and that you don't snack on anything, but the
absolutely last thing that you should do,
the one thing that you should totally,
totally, totally not ever do when you're
on niacin therapy is snack on carbs in
the three- to six-hour period after you
take the niacin pill. Right now this is
based on theory. It would need testing to
see if this actually works to prevent
the diabetes. My suspicion is that Alex
is right and it would. So for now until
there's further research, I believe this
is how you take niacin without
getting diabetes.
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