ApoE4.Info

pgf54 wrote:Julie said

[quoteGeorge, fascinating to hear that niacin helps promote ketosis. That's new to me. Did either you or Ski catch that Dr. Dayspring was OPPOSED to niacin for our group? Does anyone understand his reasoning why? I haven't taken the time to look into any of this; other than note the discrepancy between his advice and Gundry's.
]

Due to recent major clinical trial evidence, never use niacin except as a 4th line drug - way, way, way too many metabolic side effects. Unlike ezetimibe (Zetia) niacin worsens the absorption of sterols

Whilst other medications are aimed at lowering ldl and tc i think Niacin is the only one proven to increase hdl in addition[/quote]

Paul,

I'm guessing Dayspring is referring to the studies, such as the one last July (2014). This is from Gundry's support group:

Q: Just saw the results of this study today and wonder if Dr. Gundry will continue to recommend the use of Slo-Niacin as a supplement to complement the diet. Have been taking it but of course now second guessing myself

Steven Gundry: Oh nonsense! I was the discusser if this study at the American Heart Association. The bad effects of Niacin appeared when it was combined with an antihistamine that had been shelved because of severe side effects. Duh, I wonder what happened when they reintroduced it in combo form? Also, I reported at the American Heart Association that if you use niacin that it must have grape seed extract and pycnogenol to prevent the increase in blood vessel stickiness that niacin causes and that I discovered. Finally, these studies do not address that niacin is the only method of lowering Lp(a), the most sign infant cause of heart disease of any risk factor measured. Those of you with Lp(a), swallow your niacin!

I think this is the what Gundry is talking about: http://circ.ahajournals.org/cgi/content ... cts/A16318 where he talks about needing grape seed extract and pycnogenol. Thursday, I ordered another Lp-PLA2 test to see what the niacin is doing to mine. It will be a topic of discussion when I have my call with Gundry.

My take is Dayspring is looking at the published data, and Gundry has worked to ameliorate the negative effects with grape seed extract and pycnogenol. Gundry's MO is to prescribe and retest in 3 months. I look at my taking of niacin as an experiment.

Thanks so much for tracking that down, George. I appreciate your efforts. I knew the two men had different opinions on niacin and have been meaning to explore that. Here's a WebMD link discussing the study that found problems with niacin.

Niacin Doesn't Reduce Heart Problems: Study
http://www.webmd.com/heart-disease/news ... arch-finds

Side effects included a 55 percent increase in loss of blood sugar control among diabetics, and a 32 percent increase in new diabetes diagnoses, researchers found.

Scary. So, the antihistamine, laropiprant, is what raises blood glucose? I couldn't independently verify that, but here's an article generally supporting Gundry's position:

Laropiprant is the Bad One; Niacin is/was/will always be the Good One
https://riordanclinic.org/2014/07/larop ... -good-one/

We know that niacin raises HDL-C...but does anyone know if it raises HDL-P? Several recent studies have demonstrated that elevated HDL-C with low HDL-P is actually atherogenic.

There seems to be good evidence that niacin decreases Lp(a), but I still have questions about it's efficacy elsewhere... Has anyone tracked blood glucose elevations? Also, has anyone checked HDL-P before and after trialing niacin?

[quoteThere seems to be good evidence that niacin decreases Lp(a), but I still have questions about it's efficacy elsewhere... Has anyone tracked blood glucose elevations? Also, has anyone checked HDL-P before and after trialing niacin?][/quote]

Yes this would be interesting and although i will compare hba1c before and after Niacin , i have no means in Australia of testing HDL-P

link is from the world conference on Ir, diabetes and Cvd...... CAN NIACIN BE USED SAFELY TO ELEVATE HDL LEVELS IN PATIENTS WITH THE METABOLIC SYNDROME?
Steven R. Gundry, MD

http://www.wcir.org/view.php?ItemID=468

With regards to Laropiprant which is apparently a prostaglandin inhibitor added to the niacin to prevent flushing, i cannot help wondering if the big pharmaceuticals added it so they could have a patent or make money which they were unable to do with plain old niacin which is vitamin b3 and therefore not able to be manufactured by them and make them big profits.........particularly as people that dont like the niacin flush can prevent it with a plain old aspirin taken prior to the dose. Imho Laropiprant is an added variant and Niacin shouldnt be judged by being in combination with it, from what i have read niacin has been around for decades, so you would have thought there would have been more conclusive evidence either way for its use, particularly in relation to insulin resistance and blood glucose........

Hey Julie,

I pulled the more detailed NMR test last Thursday (along with all the Gundry tests on Tuesday). Don't have the results from either yet.

George

Juliegee wrote:Thanks so much for tracking that down, George. I appreciate your efforts.

We know that niacin raises HDL-C...but does anyone know if it raises HDL-P? Several recent studies have demonstrated that elevated HDL-C with low HDL-P is actually atherogenic.

There seems to be good evidence that niacin decreases Lp(a), but I still have questions about it's efficacy elsewhere... Has anyone tracked blood glucose elevations? Also, has anyone checked HDL-P before and after trialing niacin?

Hi Julie,

I'll post more details when I have time, but a quick summary from my NMR on niacin.

Ketones 1.7
Insulin 4.9
Glucose 88 mg/dL
LDL-P 1292
LDL-C 139 mg/dL
HDL-C 56 mg/dL
Tg 72 mg/dL
TC 209 mg/dL
HDL-P 31.1
Small LDL-P <90 (I assume below lower limit of measurement)
LDL Size 22.0 nm
Large VLDL-P 1.3
Large HDL-P 8.9
VLDL size - concentration of VLDL too low to determine size
HDL size 9.6
IR score <25 (looks like 7, eyeballing the graph)

Lp-PLA2 - 245 compares to 278 in January before niacin and 218 last June when eating meat based LCHF. Everything I'd tried after the 218 made it larger, so was concerned adding in the niacin it'd get worse still (<200 is ideal).

From an LDL-P perspective, my two prior best tests were a 36 hour fast and a carb nite.
Carb nite
LDL-P 1393
Small LDL-P 206
TG 55
HDL-P 28.8

36 hour fast
LDL-P 1286
Small LDL-P 237
Tg 94
HDL-P 29.5

My niacin was 1 g/day from Slo-niacin brand. Also took 200 mg/day of grape seed extract and 60 mg/day of pycnogenol.

The LDL-P of 1292 is less than the 50% percentile, so not awful. Obviously the small LDL-P is stellar.

When my wedding is over and my umteen tax returns are done, I'll post more data.

Paul, thanks for the link to the Gundry paper. It seems to answer ONE of my questions- re. the effect niacin alone may have on blood glucose; BUT given the fact that there are many moving parts to the Gundry protocol, it's hard to be sure. For instance, participants also lost a tremendous amount of weight and changed their diets, etc. It would be interesting to see a similar trial where participants remained weight stable on an isocaloric diet and added niacin as the only variable. Would blood glucose still have dropped?

Also, note that Gundry doesn't distinguish between HDL-C and HDL-P. Recent research has demonstrated a rise in the former without a concurrent rise in the latter contributes to a MORE atherogenic profile. That scares me a little. George, did your HDL-P go up on niacin? How about HDL-C? Or are there too many confounders to tell?

Congrats on a great NMR, George. Considering you are in ketosis (for heart health-correct?) it is really impressive. I'm a little surprised by your fasting insulin. Given HOW your diet, I would have expected a result in the 2-3 range. That tells me you are conquering some pretty stubborn genes, my friend. Are you in ketosis most of the time? What is the range of your BHB readings? If you had to break down your macronutrient ratios...what would you guess that they are?

Be sure to let us know when you and your beautiful homozygote bride are married. I will then officially dub you the E4 power couple...by virtue of the MOST 4s. Congrats!!!

Hi Julie,

I updated the post for Ketones - 1.7 at the time the last test was drawn. I don't sample blood ketones all the time, but I've noticed my urine ketones seem to be higher on niacin than what I would expect from my diet. I would expect maybe 0.5 mmol/L without niacin. I've been keto adapted for ~4.5 years but don't try to run ketotic all the time.

I've had insulin in the 3 range before - last summer. Again, don't sample all the time. Maybe the niacin making the liver crank out more glucose which needs more insulin to cover????

I'd have to put info into Cronometer to figure out macros. I don't usually weigh & measure stuff. I have added in some macadamia, brazil & filbert nuts in addition to the unfiltered EVOO on the fat side. For concentrated protein, it is two pastured eggs and maybe 4 oz shrimp. Lots of leaves & non-starchy veggies.

Thanks on the wedding! It is Saturday evening. Her dress has been modified for a climbing harness & well have the ceremony on the wall, with a photo shoot on the rocks on Friday (weather permitting).

George congratulations on the wedding and hope it all turns out well...........Have you and your fiancee reached a consensus on diet or do you eat differently? hope its ok to ask as i seem to recall you mentioning she was vegan i believe you were paleo at one time in the past.
I dont have a lot of understanding of the Nmr as we dont have it in Australia, and i was interested in your results because of the Niacin effect, as you know i am considering embarking on a small dose to increase my hdl.................I think mine may be one of the lowest here at 27.....
However i did get some comfort from this quote from the Pritikin longetivity centre.............................

And it is a low-fat, fiber-rich, Pritikin-style eating plan that is followed by populations who enjoy the lowest incidences of heart disease in the world, such as the people of Okinawa and other rural regions of Japan. They also, by the way, tend to have very low levels of HDL, often in the 20s and even lower.

I notice from your results George( besides all the very good stuff) and as Julie quickly picked out your fasting insulin level of 4.9 when it was 3.4
last year. Though your fasting glucose remains pretty much the same. Thats quite an increase and if its niacin related has me worried as mine is now down to 6 from a previous high of 17, and i dont want it going up any further. Julie also mentions latest research on hdlc and hdlp , and i can see your hdlc went up from 41 to 56 and hdlp to a lesser extent from 30.8 to 31.1...........................I dont know if there is a recommended ratio?

All fascinating stuff i just wish we had more pre and post niacin results like yours to make my decision easier. If i had an easier recourse to blood testing and the nmr test i would do a six month trial myself but not possible over here and asking my Gp for more blood tests would probably give him a coronary................

I believe I had a significant jump in HDL-P on Niacin. Will check priors later.


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pgf54 wrote:I notice from your results George( besides all the very good stuff) and as Julie quickly picked out your fasting insulin level of 4.9 when it was 3.4
last year. Though your fasting glucose remains pretty much the same. Thats quite an increase and if its niacin related has me worried as mine is now down to 6 from a previous high of 17, and i dont want it going up any further. Julie also mentions latest research on hdlc and hdlp , and i can see your hdlc went up from 41 to 56 and hdlp to a lesser extent from 30.8 to 31.1...........................I dont know if there is a recommended ratio?

Paul,

My insulin was 3.8 in January with Glucose at 84 mg/dL (4.67 mmol/L). I don't know how much to read into the variations. Diet is not perfectly constant. Your move from 17 to 6 is HUGE. People that push their diet to be really keto and exercise a lot can push insulin into the 2 or lower range. My diet may be carbier than it was, even though most of the carbs are leaves and other non-starchy veggies with a few berries. The common thought is that higher Tg readings come from excess carbs converted to fats. In my case, I've documented they come from slow processing of ingested (saturated?) fats. There is a tradeoff of how much of what to eat. I can push my insulin down with a "paleo" VLC/HF diet, but I end up with a much higher LDL-P value. The HDL-P of 30.8 was from my test eating the animal meat/sat fat diet which had an LDL-P of 1725 (~85 th % ile) vs my most recent 1292 (<50th % ile). Also the small LDL-P went from 609 (55 th % ile) to off scale low < 90 (~15 th % ile).

The other variable, which is hard to quantify, is stress. This can easily kick up glucose and require more insulin. I know I physiologically react to stress. Since the early 80's, I've had "white coat syndrome" with blood pressure. It is always fine (110/60) when I measure (sometimes as low as 90/50) and when giving blood (110/70). But have a doctor's office measure it and it goes up significantly. My glucose is fine if I measure it at home or if I order the test myself. If I have it measured at the doc's office, it goes up. None of my stress is awful, but it is a wild card in measuring all this.

Right now, I'd say the niacin is a benefit for me.