Hello this is Dr. Ford Brewer with state-of-the-art heart attack stroke and
cancer prevention. Why depend on a messy and unreliable cure when you can prevent
it in the first place? Today we're going to talk about niacin. It's a big topic.
There's been a lot of debate about niacin over the past decade. We'll cover
a little bit of that. First of all: what is niacin? It's vitamin B3 (NOT D3, B3 ). You put it
together with nicotinamide (which is a related compound) and that's the vitamin
B3 (NOT D3) structure. (I finally catch & correct myself here) The vitamin d3 complex - oops - or B3 complex. What is it for? From a
historical perspective it was found to cure and prevent pellagra. What is
pellagra? Well it's a multi-system problem. One of the key problems that you
have with pellagra is a dermatitis skin rash) - that can become very severe. This is a picture
of an individual with pellagra dermatitis. It also causes a thing
called black tongue. This which is a picture of black tongue. As you can
see this is not a subtle finding. With black tongue - it's obvious.
It's not something that's easy to miss. In fact, some of the first names for
vitamin (did I say D3 again? - It's B3 - Wow! I needed coffee, didn't I? Worse repeated video bloopers yet!) were P P factor - pellagra prevention factor. This was originally
discovered back in the late 1800s and confirmed in the early 1900s when a
researcher withheld niacin in the diet of dogs until they developed black
tongue. Then he gave them this PP factor nicotinamide- or
niacin. I started to say nicotine. Here's why. I started to say that -
here's how that researcher created his niacin. He took this molecule - if if there
are biochemists out there, some of you may recognize that as nicotine. This
is the niacin. This is common to niacin and nicotine. All he did was oxidate (oxidize?)
this - and ended up with not two oxygen molecules on a carbon there. So he
took that ring off right there. This is niacin and again he
made it from nicotine. An interesting thought about ... Some of the reasons why
nicotine may have such an impact that it does ... it messes so many things up. (so many reactions that niacin is involved in). Speaking
of being involved in a lot of processes niacin is involved in over 450 metabolic
processes. You may recognize this is the mitochondria. Again biochemists in
the group may recognize and remember things like the TCA cycle (Krebs
cycle) - and oxidative phosphorylation. - especially all involved NADH NADPH . The N
stands for nicotine. Nicotine is a major component in many
areas of our metabolism well. So what's the big deal about nicotine? I mean not
nicotine - What's the big deal about niacin? It is the only medicine -
prescription or otherwise - that's been shown to have all of these positive
effects. It's the only thing that improves lp(a). Niacin is (currently) the only thing
that will. ( There is a lot of promise for the new anti-sense drugs). There aren't - we have found some other things recently (anti-sense drugs which may help) - but
the only thing that raises HDL. It lowers LDL. It lowers MPO (myeloperoxidase).
Remember we talked about the Joker. It has multiple other
positive impacts in terms. Especially the topics that we talked about -
oxidation, inflammation and cardiovascular disease and lipids. Lipids
(being cholesterol and triglycerides) in our blood our fats in our blood. So there
has been a lot of debate. As I mentioned earlier, over the past ten years about
niacin it revolved around two studies: One of them was AIM HIGH and the other
one was HPS 2 Thriv. HPS2 Thrive came out first. It was set up by Merck, I
think - the maker of of the medication. They put lapropriant with niacin.
Those of us who took niacin back in that time period -
2008/2009 - may remember they came up with a version of niacin. It was "NO Flush".
Remember niacin causes a flush. It causes a flush because of prostaglandins.
You remember that term. If you don't you've got a couple of videos. That
mention - prostaglandins the video on aspirin (and a couple of others).
Prostaglandins - you might recall - were originally named because they were
discovered from the prostate gland. At that point they felt that that was
made by the prostate gland. Since then they found that most tissues
create prostaglandins. Prostaglandins act like like hormones but they don't course
through the entire body. They just are very locally acting. What's the thing
about niacin and prostaglandin? Nicin has a prostaglandin effect. That
prostaglandin effect results in vaso- dilatation. In other words the arteries - small
arteries and capillaries dilate. When they do (and that's in the
skin) . Yyou get that flushing and itching. That's what causes all that. They
discovered a chemical called Lapropriant - which stopped it. It blocked the
prostaglandin receptors that niacin was hitting withthat flush. So you
didn't have the flush anymore. It was very comfortable.
What they found out ( getting back to HPS 2Thrive) was the mechanism
regarding why HBS 2Thrive didn't work. You blocked that prostaglandin (or
prostate receptor). You didn't get the flush> but unfortunately you didn't get the
positive impact of the niacin either. So it does appear that that a lot of the
positive impacts of niacin do have - do depend on that prostaglandin impact. I
give - I recommend (and I take) niacin. What you see today is people do have very few
problems with niacin. The reason is it's - there are extended-release types of
niacin - where you get very very little impact. Pardon me for that spoiler. But it
needed to be there. I'll just make one other comment.
So after HPS - or a couple of other comments about HPS2 Thrive and AIM HIGH. HPS2 Thrive saw that are indicated that - there was NOT an
improvement in cardiovascular events - in patients taking niacin and
the anti flush agent. So guess what. The the press said, "niacin doesn't work.
Niacin has got problems. Doctors say cholesterol drug too risky
to take. " That was in The New York Times, the Daily. The Boston Globe said niacin causes
serious side effects. Of course there are side effects with these medications,
niacin included. However - like my mom said used to say, They threw the baby out
with the bathwater. They threw out the good with the bad."
Niacin - which does work when they threw out the program. Now that would have
been easy enough for the niacin camp to overcome. In fact, they were working
on overcoming that. Then they got hit with AIM HIGH. AIM HIGH - the M in AIM HIGH
stands for metabolic syndrome. This was looking specifically at that huge
portion of the baby boomer population where you have what's called the lipo
dystrophy - usually from diabetes. Now let's don't get confused over terms. Lipid just means fat
and dystrophy means bad. Like muscular dystrophy - a problem. The lipodystrophy
of diabetes is - you have a low HDL( which is not good) and a high triglyceride they
were looking specifically at this group. They gave them niacin I think it might
have been niacin in addition to a statin. What they
expected to see was an improvement. They did not now there was again. The press
came out again saying, "Yep, that proves it! The the niacin doesn't work well." Again
a couple of headlines about that debate, " niacin doesn't work and is
harmful," in the New England Journal that AIM HIGH folks came out and gave their
information regarding it. The bottom line was saying that "niacin didn't work" - was
ignoring tons of other studies - meta analyses that indicates that niacin does
help.
That study - coronary drug project the Oxford study several others so I'm not
going to try to prove to you that niacin works. In fact I can't. I'm not the
arbiter of reality. I can just tell you what's been going on in terms of the
debate. And I can just tell you what I'm doing. I'm taking niacin two grams a day
I occasionally will get a flush. It's not bad at all because I take Rugby brand
extended-release.
Thank you for your interest.