From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative,sci.med.nutrition
Subject: Re: Niacin causing a skin rash
Date: 28 Dec 1997 01:48:34 GMT

In <34A59B97.2C4C@ix.netcom.com> bbeyer1@ix.netcom.com writes:

>My girlfriend took 500mg of timed release Niacin about 5 hrs ago.  She
>broke out in a rash all over her body.  She used to take it 4 1/2 years
>ago without this body rash.  She is currently taking magnesium,
>L-Lysine, Vitamin C, Calcium, Vitamin B-Complex, and a multi vitamin.
>It appears to be a reaction with one of the above.  Has anyone heard of
>niacin reacting with any of elements listed above?


   It's the niacin itself, not a reaction with anything else (if you
doubt this, try a dose yourself).  Perhaps she took some other form of
the vitamin, such as niacinamide, years ago.

   The rash itself is harmless, but unpleasant.  It will go away on its
own, and needs no treatment.  If you absolutely have to do something,
take an antihistamine.

   And tell her to stop taking megadose time-released niacin without
being followed by a physician.  The stuff is too toxic and dangerous
for people to mess with it on their own.   It's not the rash and
unpleasant skin stuff that is the problem, but the liver damage that
can happen after a few weeks of use.

                                         Steve Harris, M.D.

From: ((Steven B. Harris))
Subject: Re: Niacin goodies and baddies
Date: 18 Apr 1995
Newsgroups: sci.life-extension

In <3mvf3m$fug@charnel.ecst.CSUChico.EDU> mcelroy@ecst.csuchico.edu
(James Robert McElroy) writes:

>I have been trying to increase my niacin intake for a few reasons --
>increased serotonin levels (possibly), improved mood, and lowering
>blood chloresterol.  I've run into the  following problems:
>
>1.  Straight niacin is so acidic that it can really upset my stomach.
>2.  Taking as little as 200 mg of niacin makes me turn beet-red, get
>    very irritable, itch all over, and during allergy season, increases
>    my allergies.  I  understand that this is due to  the histamine
>    releasing properties of niacin.  I have been told that this effect
>    diminishes relatively quickly, but not so with me!  It seems to
>    stay relatively constant.  (In terms of building up a tolerance to
>    the effect.)
>3. Time-release niacin sits like a bomb in my stomach, irritating the
>    heck out of the spot it is next to, so I go with capsules, which then
>    release the full dose at once, and make me look like a stoplight.
>4.  Niacinamide does not have the above  problems,  but I have found that
>    in larger doses, it can actually depress me!  Very strange.  It also
>    does not have the ability to lower blood chloresterol.
>5.  I recently tried the flush-free niacin, and much to my surprise, it
>    really is flush-free!  (This  is the inositol-niacin  combination --
>    not just niacin mixed with inositol, but -- oh, heck, the bottle
>    does not have the chemical name of the combination...).   But its
>    problem is that it is REALLY EXPENSIVE!  50 cents per 500 mg seems
>    to be the going rate!
>
>Any suggestions?
>--
>Jim McElroy
>Calif. State Univ., Chico
>mcelroy@ecst.csuchico.edu


You've just about mentioned all the problems.  Another is that
time-release niacin (nicotinic acid) can be hepatotoxic, so you really
should not be taking it without regular physician liver tox monitoring.
Niacinamide is, if anything, even more likely to be hepatotoxic, and as
you note, doesn't lower cholesterol.  Yes, it is brain-active and I'm
not surprised you noticed cognitive effects (they are variable, but
nicotinamide is known to bind to GABA receptors and have anxiolytic
effects and calming effects).   I'm waiting for ANY report that the
hexa-nicotinate lowers cholesterol; so far I know of none.  Let me know
if it lowers yours.

You can block the flush a bit by taking an aspirin half an hour before a
dose of niacin.  It's a hastle, though, especially doing both 3 times a
day.

What is your cholesterol level, that you want to lower it so badly?

                                             Steve Harris, M.D.

From: ((Steven B. Harris))
Subject: Re: Does niacin reduce cholesterol?
Date: 17 May 1995
Newsgroups: misc.health.alternative

In <3pbroo$lpi@pipe3.nyc.pipeline.com> abesrvdl@nyc.pipeline.com
(Abraham  Schneider) writes:

>I'm interested in getting information on the cholesterol lowering
>effectiveness of niacin. Specifically, I'm interested in how it works and
>how much to take?


Nicotinic acid (niacin), but not niacinamide, lowers cholesterol
effectively (lowers total and LDL, raises HDL, which is just what you
want).  The side effects, however, are hard to take (they involve a
flush and itch mediated by histamine, which feels a lot like anything
from mosquito bites on your legs and chest, to the world's worst
sunburn.)  They are harmless and go away, but almost always care the
Devil out of people, even when they have been warned.  Taking aspirin 30
minutes beforehand helps, but not much.  Many people eventually grow
tolerant to the effect, but not everyone.

The effective dose is 1 to 3 grams a day, but you have to work up to
that starting at doses of 25 milligrams several times a day, or you will
be VERY sorry (see above).  The stuff should be taken in normal release
(NOT slow release) form.  The latter is assocated with more episodes of
liver damage, which is the side effect most worrisome.   This side
effect happens at effective doses (1 to 3 grams a day), so you'll need a
doctor during the "working up to dose phase" at anything over 500 mg a
day, to do regular blood tests on you to check for beginning liver
damage (doing it this way is safe, as you can stop before any permanent
damage is done).  But you need blood tests anyway to see how the drop in
cholesterol is going.  Once you're up to make dose for awhile with no
toxicity, you can stop these tests and only check every 6 months or so
to make sure you're doing okay.

There is supposedly a form of niacin called inositol hexanicitinate
which does not cause the side effects of niacin.  This is correct (I've
tried it).  But I can find no published report at all that it lowers
cholesterol, and I suspect it of being inactive.  You might experiment
with it yourself.

                                           Steve Harris, M.D.

From: ((Steven B. Harris))
Subject: Re: Niacin Levels
Date: 29 Jun 1995

In <3rvul2$rsg@mars.efn.org> Brad <brad@gears.efn.org> writes:

>    I've been taking Niacin as a nutritional suppliment
>for about a year, and I've always believed that it was safe
>(as long as the time release formula was avoided).
>	Has anyone had any experiences with Niacin (good or bad)?
>	What amounts are considered safe, and does it interact with
>other vitamins?


I don't think anything is totally safe for everybody, although you're
right about the time release form, avoidance of it doesn't guarantee no
liver problems.  Supposedly, daily doses below 500 mg are pretty safe,
although as anyone knows who has taken that much as a "niacin virgin",
it can be damned uncomfortable (feels like death from sunburn and stroke
combined-- has scared the hell out of more than one person).  It takes 1
to 4 grams a day to lower cholesterol effectively, and at this dose, you
always should check for liver toxicity.

Niacinamide is probably even more liver toxic, and doesn't lower
cholesterol at all.  The inositol hexanicotinate apparently lowers
cholesterol with few side effects, but has been little studied
(figures-- it's unpatentable).
                                             Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Niacin
Date: 30 Apr 1997
Newsgroups: misc.health.alternative

In <5k3n5g$t6u@nntp.seflin.org> a019060t@bcfreenet.seflin.org (Michael
Juliano) writes:

>Can Niacin help to lower cholesterol? Is it safe? how many millagrams are
>needed to be effective?
>
>Thanks for any info, here or e-mail




    Below about 500 mg a day does little.  The effect gets significant
over about 1000 mg a day, and some people require as much as 3,000 mg a
day.  These doses are not safe, but cause liver damage in some people,
and frequent blood tests are needed to be sure this is not happening.
Timed release niacin is the worst offender, and probably all niacin
should be taken in plain crystalline (NOT slow release) form.
Niacinamide doesn't lower cholesterol; only nicotinic acid (niacin)
does this.  And only niacin causes the temporary flush and harmless
"sunburn feeling".

    Cholesterol can also be lowered by inositol hexanicotinate, though
there are few studies on the toxicity of this compound.  I'd get my
blood tested regularly with this one also, until more is known.  The
flush with this compound is less.

                                         Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Lower Your Cholesterol Risk Factor
Date: 09 May 1997
Newsgroups: sci.med.nutrition,misc.health.alternative,sci.med.cardiology,
	sci.med

In <5kt9eg$avf@no-names.nerdc.ufl.edu> selene@astro.ufl.edu (Gottesman)
writes:

>This is a good question.  I was recently adviced by my
>doctor to take a capsule of 100 mg of  niacin a day.
>Five or ten minutes I took the pill I began to feel uncomfortable.
>And I do not mean that I turn tomato red and began to
>itch terrible all over (but especially at the extremeties)
>but also my heart began to beat irregularly, and I was
>sort of shiverring.  In short I felt not very well.
>A friend came over we phoned the doctor and she said do not
>take another oneof the pills because you appear to be
>allergic to the stuff.


   Your doctor is totally wrong.  Niacin releases histamine but only in
the skin and not the lungs (where it would be dangerous).  It's not an
allergic reaction, and is harmless (though uncomfortable).


>In short the attack lasted about 1 hour.
>
>Recently I got 100 mg of niacin in one of those powder
>forms of vitamins all in one things. Well the 100 mg
>niacin that this powder vitamin mixture contains did
>not bother me.  So I began taking the stuff daily.
>It does not make sense how the pill bothered me while
>this concoction does not.  Anyonecares to hypothesize?
>
>Mariou Gottesman



   You probably had niacinamide in the vitamin.  It's the same vitamin,
but a different vitamer (slightly different chemical, but still with
vitamin activity).  Niacinamide does not release histamine, but doesn't
lower cholesterol either.

                                 Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: niacinimide
Date: Mon, 04 Aug 1997
Newsgroups: misc.health.alternative

In <19970804001601.UAA28931@ladder01.news.aol.com> mchealth97@aol.com
(McHealth97) writes:

>Does anyone have information on niacinamide? I have a 13 yr old,90lb son
>and a doctor recommended 200mg of niacinamide 6 times a day, for a daily
>total of 1200mg. I started him a week ago and have him up to 400mg. But I
>have begun to hear stories of liver toxicity. I do not want to harm my
>child by trying to help him. The Doctor that recommened this therapy is
>away until mid August, so I cannot contact him,but when he recommended
>the niacinamide he said there were no side effects with it the way there
>are with niacin. Any help out there????
>
>
>Thanks
>Lisa



   Niacinamide has slightly more liver toxicity than nicotinic acid
(niacin), although it does not produce the other well-known side
effects (flushing).  The flushing, ironically, is a HARMLESS side
effect, and it's the liver you need to worry about.

   What in the world is your son being given this much niacinamide for?
Is he schizophrenic?  Sounds like you're dealing with a quack.  If his
liver functions aren't been carefully monitored with blood tests for
doses of niacinamide above 1 gram a day (which he is getting,
apparently, according to your note), then you definately are dealing
with a quack.  If you're getting niacinamide for cholesterol problems,
also you're dealing with somebody who doesn't know what they are doing.

   There is, BTW, no good evidence that niacinamide in those does does
anything for any medical problem.  The schizophrenia treatment claims
were looked at in the early 1970's, and nobody could duplicate the
claimed results of the "orthomolecular" people.  Beware.

                                    Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: niacin dosage; re: cholesterol
Date: Sat, 16 Aug 1997
Newsgroups: sci.med.nutrition

In <5t24el$gkv@clarknet.clark.net> psykey@clark.net (psykey) writes:

>I hear that niacin is effective at lowering cholesterol? I also
>understand that too much niacin is bad for the liver......so how much is
>enough/too much? Is the correct individual dosage related in any way to
>the amount which will produce the famous flush? TIA, please copy
>responses in email to me if possible........Mike


   You can get itch and flush with as little as 20 mg of niacin
(nicotinic acid).  In fact, the lower doses are insidious in that they
produce stuff like underarm, or "belt level" itch, which you'll never
figure out unless you know what to look for.  It's a histaminic thing.

   The "itch"/"flush" dose is totally individual, and has nothing to do
with cholesterol effect.  It can be blocked a bit by aspirin, and the
body does adjust to it somewhat (at least in some people).

   Dose of niacin to lower cholesterol is generally above 1 gram (range
1 to 4 grams per day), and the doses that begin to lower cholesterol
are also the doses at which liver toxicity is seen in a few people.
Thus, supplementation for this purpose requires medical supervision.

   There is a "no flush" form of niacin called inositol hexanicotinate,
which is effective at approximately the same doses as niacin, with very
much less histamine response.  I know of no toxicity studies on it,
unfortunately.  Small studies which have been done have not found any
liver toxicity, but are too small to be reliable in this regard.  It's
available in health food stores, but until more is known about the
toxicity, I'd treat it exactly the same way you would nicotinic acid,
and have your liver enzymes followed by a doctor for your first 6
months of using it.

                                           Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition
Subject: Re: Taurine?
Date: 8 Jun 1998 07:49:03 GMT

In <357a9d67.3781343@nntp.uio.no> alf.christophersen@basalmed.uio.no
(Alf Christophersen) writes:

>DamnYankee <Damn@Yankee.com> wrote:
>
>>HMMMM!!!!  Nicotine, ay?  What a way to get repeat customers - nicotine
>>addiction *LOL*
>
>He said nicotineamid, not nicotin. It's something different, a
>B-vitamine


   Nicotinic acid is actually a pyrolosis product of nicotene, hence
the name (in other words, heat nicotene, and nicotinic acid is a
product).  The word niacin was chosen as the generic word for nicotinic
acid, partly because nutritionists didn't want people to get the
mistaken idea that there were vitamins in cigarettes.  And, in fact,
smoking doesn't give you enough niacin to make any nutritional
difference.

                                 Steve Harris, M.D.

From: "Steve Harris" <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: Flush-Free Niacin:  case history
Date: Tue, 1 May 2001 15:45:54 -0700

Baron Blackfang wrote in message ...
>I promised you blokes a 3-month update on my wife's progress with her
>niacin therapy for hypercholestemia.
>
>Three month's ago, my wife had a cholesterol of 290 mg/dl, with abnormal
>triglycerides, abnormal low HDL/LDL, and high alkaline phosphotase.  She
>had a lipoprotein electrophoresis and was diagnoosed as Type 1 familial
>hyperlipidemia.  Her alk phos electrophoreis showed normal liver and bone
>fractions.  Type 1 HL can't be lowered by diet alone.  Due to her high
>alk phos, her MD put her on 1000 mg Solaray Flush-Free Naicin (niacin
>inositolate), 1500 mg lecthin, twice daily, and a 200 mg max cholesterol,
>low saturated fat, daily diet.


If she had a high alk phos with normal fractionation, it was probably a
lab error, and should not have influenced your doctor's decision as to
what drug to put her on.  I don't understand this thinking, as niacin is
liver toxic in its own regard. Niacin is a perfectly fine drug, but the
HMG-CoA reductace inhibitor drugs "-statins" are in general more
powerful, even for type 1.

From: "Steve Harris" <SBHarris123@ix.netcom.com>
Newsgroups: sci.med.nutrition,sci.med,sci.med.cardiology
Subject: Re: high cholesterol
Date: Thu, 10 May 2001 13:48:05 -0600

"Baron Blackfang" <WolfCave@yahoo.com> wrote in message
news:iboK6.4303$Ak7.383879@newsread1.prod.itd.earthlink.net...
> She has reported no side effects from Niacin so far and her liver
> enzymes are normal.  Flush-Free Niacin is inositol hexanicinate and is a
> slow-release form of niacin which eliminates the side effects and liver
> damage seen with the older, regular niacin.  Our family doctor
> prescribes it over Lipitor as he says it's safer but a slower lowerer of
> cholesterol.  I would try this before risking the danger of the statins.


Comment:

I doubt that your family doctor can back this up with any evidence. Inositol
hexanicotinate has been around for several decades but the studies on it
were never large, and never ran long enough to establish safety. I can't
find one on Medline less than a dozen years old.

As for the idea that slow release niacin is "safe", available evidence if
anything says just the opposite. The intermediate release form is associated
with liver toxicity more than the pure quick-release. Not enough is known
about the hexanicotinate to know what kind of toxicity it has. All we know
is that, like slow release niacin, the hexanicotinate does do the night
things to blood lipids with fewer side effects than pure niacin.

I should note that niacin has been undergoing a rehabilitation, and is doing
so as we speak. This is driven by some new patents one an ultra slow release
form. As recently as five years ago niacin was on its way to being a "witch
drug": the intermediate form caused more liver problems, and even the pure
stuff could cause myopathy when it was used with statins. With no
proprietary form of niacin on the market, niacin couldn't defend itself
against these charges.

Now, there is a once-a-day slow release Niacin product (Niaspan). This
company has paid for some large studies showing safety and efficacy, and
gotten themselves FDA approval (for all I know, they paid off the FDA also).
Suddenly, niacin is hunky-dory. No liver problems are seen-- they seem to
have disappeared. It doesn't cause flushing. It can even be used with
statins additively, and the myopathy now looks like a mirage also. Golly--
O.J. Simpson should have done as well.

As for the hexanicotinate form, it languishes in the alternative medicine
doldrums, in limbo. Let us place the blame for this squarely where it
belongs: on the public. People want information, but do not want to pay for
it. Out drug-patent system with FDA approval is really the only way to MAKE
people pay for clinical trials when they buy a drug (or a vitamin, for that
matter). And this system stinks. So here we are.

SBH

From: "Steve Harris" <sbharris123@ix.netcom.com>
Newsgroups: alt.brain,alt.health,alt.human-brain,sci.life-extension,sci.med,
	sci.med.nutrition
Subject: Re: Niacin and blood flow
Date: Thu, 6 Sep 2001 14:36:37 -0600

"Jason Dessel" <Jason@unistudios.com> wrote in message
news:9n5j7j02rff@enews4.newsguy.com...
> I have read that Niacin helps increase blood flow to the brain...
>which in turn, would increase oxygen flow.

This is total BS, and what you read is wrong. Niacin increases blood flow to
your skin, not to your brain. But so will a sunburn. In fact, niacin feels
to many people LIKE a sunburn.

You brain is perfectly capable of regulating its own blood and oxygen flow.
Why would you want to give it more than it wants to use, even if you could?
Oxygen is a two edged sword, you know. If you have some problem with
circulation to your brain, it will be because of blockages in major
arteries, and not be anything you can fix with a vitamin which works on
pre-capillary sphincters.

>I've heard that this effect is not as defined with niacinimide as it is
>with niacin.  Does anyone know if that's true?

Niacinamide does not cause the skin flush effect.


> Also, is the "flush-free" form of niacin as effective in increasing
>blood flow to the brain as the regular form?

Yes, it's just as effective. Which is to say, not.  Neither one work to do
that.

 Flush-free niacin (if you're talking the hexanicotinate) will lower
cholesterol. Don't take it for anything else, and don't take more than 500
mg a day without a doctor following your liver enzymes to make sure you
don't poison yourself with it.

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: Niacin
Date: Fri, 22 Feb 2002 18:22:48 -0700
Message-ID: <a56r7c$vd6$1@nntp9.atl.mindspring.net>

"Martin Banschbach Ph.D." <mbansch314@aol.com> wrote in message
news:20020222172808.20957.00000149@mb-cg.aol.com...
> >anyone make a 'pure' niacin (not niacinamide) product ?
> >
> >Arto
>
> Niacinamide is animal niacin.  It's can't cause the niacin flush because
> it's already been detoxified.
>
> Nicotinic acid is plant niacin.  Plants produce it as an insecticide.


They produce nicotine as the insecticide.  And oxidative destruction of
nicotinine does produce niacin. I know of no evidence that plants make
niacin in any quantity.  It's basically a manufactored substance made by
oxidizing m-methyl aniline.


> If you see the term niacin on a lable, it's all nicotinic acid.


Probably.



> It's pretty common to see a niacin/niacinamide mix.  Nicotinic acid as a
> plant insecticide is toxic.  Niacinamide has much less toxicity.


Not really. They're both about equally hepatotoxic, if you must know. Yes,
only nicotinin acid causes the flush, but you shouldn't mistake the flush as
early toxicty.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Question about Niacin (Vitamin B3)
Date: Thu, 28 Feb 2002 12:55:03 -0800
Message-ID: <a5m5lk$5fo$1@slb4.atl.mindspring.net>

Kiddo wrote in message ...
>Hi, was just curious about this Niacin stuff. I have done quite alot of
>research about this stuff, but I cant seam to find an answer to this one
>last question I have. I know that it causes a "Niacin Flush". I know the
>cause of this (Dialation of the capilaries, histamine release). Now Im
>curious, is supplementation of Niacin effective once the flush no longer
>occurs?
>
>Any information would be greatly apprecaited.
>
>Tom



The flush has nothing at all to do with the therapeutic cholesterol effect,
or the therapeutic medical effect.  It's completely a side effect, and
happens at much smaller doses than you need for cholesterol reduction.  In
fact, in studies where they want a good placebo which doesn't "unblind" the
study, they give just 50 mg of nicacin as "placebo".  This is enough to
cause a terrific flush but not enough to affect cholesterol significantly
(this takes 500 mg to as much as 3 grams a day-- and has to be titrated up
carefully because the cholesterol effect is very close to the liver toxicity
effect, and may even be the leading edge of it!).

No matter how much niacin you give, the body adapts to the flush effect
after a while. Meanwhile it can be like getting used to a  sunburn.  It you
know it's harmless, it's a lot less unpleasant than if you think you're
being damaged by it.

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Question about Niacin (Vitamin B3)
Date: Thu, 28 Feb 2002 17:18:34 -0800
Message-ID: <a5mkrg$mn1$1@slb1.atl.mindspring.net>

Kiddo wrote in message ...
>Well, as helpful as this reply was. Its not what I'm looking for. First of,
>I'm not using Niacin to lower my cholesterol. I'm using it to combat acne,
>and its doing a damn good job, first time since I was 12 that I haven't had
>a single new spot in over a week. This MUST be due to the more efficient
>exchange of nutrients/toxins between the cells of my skin and the blood
>(Dilated capillaries, more blood flow to surface of the skin = takes more
>toxins away, gives more nutrients). So, basically I WANT the flush. Its
>helping my face to wonders. Combined with MSM (MSM causes your cell walls to
>"put out" toxins easier, and "take in" nutrients easier) this is the best
>cure for acne I have ever tried (and believe me, I've tried a lot of them,
>almost everything except Accutane, yuck cant believe that shit is legal).
>
>Regardless, so what I need to know is:
>
>Will my capillaries stay dilated even after (example, guess) 3 grams doesn't
>cause a flush?


Short answer: I don't know. Longer answer: I'm not sure that knowing
matters. Don't assume that even if niacin has an empirically salutary effect
on your acne, that that has *anything* to do with the flush or the histamine
release. In fact that last has to be somebody else's *assumption*; it's not
a fact you can get out of the medical literature. There may be no
association between the two effects. Acne is not just an infection-- it's
also an autoimmune reaction which is damped by immune modulators, and also
it's very responsive to things that change the texture and content of sebum
(oils in the diet, dietary B5 and biotin, etc).  Niacin may be doing
something on its own in that direction.

Beware of quack explanations. They'll fasten onto the one thing they know
about a vitamin (dilates capillaries) and then use that to "explain" every
other use they want to put the stuff to. I've seen niacin recommended for
brain aging on the assumption that perhaps it increases brain blood flow
because of capillary dilation!

I suggest only that you don't go too far over 500 mg a day of niacin without
regular blood checks for liver toxicity, exactly as if you were using the
stuff for cholesterol inhibition.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med.nutrition,sci.med
Subject: Re: Niacin
Date: Fri, 1 Mar 2002 11:14:24 -0800
Message-ID: <a5ojsm$tfl$1@slb7.atl.mindspring.net>

Baron Blackfang wrote in message ...

>I just wanted to add that Flush-Free niacin (inosistol nicotinate) at 1000
>mg per day usually will not cause liver damage.

No, but you don't know for sure, because no large tox studies of this have
been undertaken.  We know almost NOTHING about inositol hexanicotinate in
large populations, because nobody has ever put out enough money to study it
in them.  Meanwhile, I think that any dose of niacin large enough to affect
cholesterol is large enough for you to get your liver checked at least once.
You have to have blood drawn for the cholesterol anyway, so why not include
an AST with it?

> My wife has been taking that
>dose for over a year and her liver enzymes are normal.  She reduced her
>cholesterol from 290 to 220 and her LDL is 110, not too bad, and her
>LDL/HDL is 2.5 which is also not bad.

That's nice, but try not to be giving generalized advice based on your
wife's one-time experience, hey? Niacin in gram quantities is a
pharmaceutical, not a health-supplement. Treat it with respect, or it will
bite you.  Anyone considering going out and willy-nilly taking something
with only a safety margin of 2 or 3 with respect to what can make their
liver cells die, is a damn fool. That is NOT enough safety buffer zone for
use of any ingested substance, without some very strict safety precautions.


> I believe the research is showing that the
>slow-release form of niacin may be less toxic at therapeutic levels.

No, if anything the opposite is the case.  Nobody has yet done a direct
comparison study on inositol hexanicotinate. The "intermediate release"
niacins are more toxic than plain niacin. Just how the modern so-called
"slow release" (one a day) niacins fit into the picture is not yet clear.
They are thought to be fairly innocuous, but that was thought true of the
first intermediate release preparations, too. They only found the problems
epidemiologically, and VERY large numbers of patients. If one in 10 thousand
people has liver tox problems, you many not find it in phase III trial
studies.  And it may not show in yer wife.


>Considering that the statins also cauce liver damage, and may also be be
>even more toxic than niacin over the long run,

That's not clear. We have tested statins in far larger numbers of people,
over far longer times. Their BENEFITS of statins on coronary disease and
life expectancy are FAR better proven than those of niacin. So you're
trading for a bigger piece of pie. Not that I'm not recommending liver tests
for anyone taking a statin, too. Of course, I am.

> I would give Flush-free
>niacin a try before signing up for a statin straightaway.


That would depend on what your cholesterol problem is. Statins are the gold
standard of treatment for most high-LDL problems, with niacin an add-on for
low HDLs.  Don't take fibrates (if your doc wants you to, get second and
third opinions; these things are NOT proven).  Get your blood tested
periodically no matter what you do pharmacologically.  Stay away from milk
fat and hydrogenated fat.  Triglyceride problems need additional attention
from the veiwpoint of sugar and alcohol abstinence, and omega-3
supplementation. Don't forget to fix homocysteine problems while you're at
it. That's a short but workable summary of advice for the chemical part of
atherosclerosis prevention.

SBH