Saturday, May 28, 2011

Nissen on Niaspan

I'm assuming everyone knows that Niaspan has recently bombed as a supplement to a statin. There's a nice summary here.

Let's set out the Hyperlipid view. HDL is a surrogate for saturated fat consumption. Elevating HDL with a drug will not give the benefits of saturated fat consumption. Triglycerides are a surrogate for sugar consumption. Dropping their level with a drug will not improve health, only putting the sugar in a bin will do that...

Anyway, this one liner post is dedicated to Dr Rentaquote Nissen. From the above link:

"Niacin does all the things that doctors would expect to benefit patients, such as lowering bad cholesterol and triglycerides while raising good cholesterol" said Nissen, who prescribes it for his patients.

“This was the group everybody thought had the best chance at a benefit,” he said today in a telephone interview. “At this point, we have to take a deep breath and realize we’re not as smart as we thought we were.”

Nissen's mistake was to think he was smart in the first place. Big mistake. The glimmer of light is that he might realise he's been an idiot.

Peter

15 comments:

Stan (Heretic) said...

Disagree, Nissen is not an idiot, he is laughing all the way to a bank!

Peter said...

Sigh, probably true. The old mad vs bad discussion...

River said...

anyone comment on the daily amount of niacin...I'm a 60-year old male weigh 220 pounds
thanks

Peter said...

Not me I'm afraid, palmitic acid is my preferred HDL raising agent...

Peter

john said...

Peter completely agree on Palmitic acid being the best way to raise HDL.......but here is something for you to chew on. Palmitic acid from denovo lipogenesis is how Americans drive their leptin resistance. Its one of the pathways that cause metabolic syndrome. In my blog we are gonna talk about how the hypothalamus tells the difference between the good source palmitic acid we eat from the carbohydrate sourced palmitic acid that causes leptin resistance. The answer is gonna rock some. Dr. K Love the blog the last few days.

gallier2 said...

John, if you could provide a link to your blog would allow people to eventually find it...

Lucas Tafur said...

“At this point, we have to take a deep breath and realize we’re not as smart as we thought we were.”

This should have been the headline of the press release for AIM-HIGH.

karl said...
This comment has been removed by the author.
karl said...

Peter - your source(s) of palmitic acid?

I'm wondering how solid the science is that lectin and raised trygly cause leptin resistance.. We don't seem to know much with certainty - I think I know less about nutrition every time I read a new study..

Which of the many forms of HDL are we talking about?
http://www.youtube.com/watch?v=H_rPFF5X-pc

And then it appears there are so many forms of lectin ... everyday I know a little less..

About the only thing I'm confident of is that high BG seems to cause a number of health problems including CVD and Stephan seems to want me to doubt that!

karl said...

Niacin - are they throwing it over because it lacks patent protection?

I've read a lot about niacin over the years - one study won't convince me it has zero value - (I can't take the stuff my self - it isn't the flushing - causes palpitations ) I've also read that slow release Niacin - such as Niaspan - may not have the same effect as IR or even intermediate release niacin. It may be that the flush (which might be connected to a reduction of AA ) is what counts.

IR niacin seems to have some effect on reducing inflammation.

I don't think we know - very few studies on niacin alone - almost non on IR niacin.

Increasing some unspecified version of HDL by artificial means has not been shown to result in meaningful out comes..

engineering-health.org said...

@karl: The evidence of serum triglycerides causing leptin resistance is extremely strong. High triglycerides nearly instantly block leptin transport across the blood brain barrier with both in vitro and in vivo rat models (http://pmid.us/15111494). It would be interesting to see what the mechanism is here... since it's so instant I doubt the receptor is getting down-regulated, but is either not binding to the protein, or not getting endocytosed.

engineering-health.org said...

To clarify though, I haven't seen much evidence that high triglycerides from denovo lipogenesis are the primary cause of leptin resistance in present day humans. Many different compounds and mechanisms have been identified as inducing leptin resistance and likely contribute together in an obese person. Very high serum triglycerides _will_ result in leptin resistance, but you can also likely have leptin resistance by entirely different mechanisms.

David Isaak said...

Niaspan and Niacin aren't really comparable beasts. And all of the liver damage that has been reported over the years with "niacin" has been with the time-release variety...

In any case, treating the numbers is like assuming your lawn will be healtheir if you paint it green.

karl said...

engineering-health.org -

Dietary fructose seems the number one way of increasing trygly.

I'm trying to add some info here:

http://wiki.xtronics.com/index.php/Cardiac_Disease,_Carbohydrates_and_Weight_Loss#Leptin_resistance

digital said...

Coconut Oil contains palmitic acid.