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.
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.