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    Old 02-07-2005, 11:54 AM   #1
    Lenin
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    Low Dose Niacin

    I'm a niacin flusher BIG TIME. There's no way I can take even 500 mg. even after 650 mg. aspirin and a big meal.

    I have been experimenting to see what I CAN tolerate in addition to my 10 mg. daiily Lipitor. I want to get my HDL up as high as I can without any alcohol. My LDL hovers around 80 and my HDL around 40 but I have heart disease (gosh, that's hard to type!)

    I break 500 mg. tablets into 4 equal pieces and I can JUST tolerate the flush from each piece. I am taking one piece with each meal without much difficulty other than a pincushiony itch and a red chest and face about 1/2 hour after the dose that lasts 1/2 hour.

    Now the GOOD NEWS:
    I found this Medscape article:
    [url]http://www.medscape.com/viewarticle/433220[/url]
    It spells out the very modest but real benefits of a tiny amout of niacin in addition to statin therapy. They used 50 mg. twice a day and got +2.1 mg/dL in HDL. I'm hoping that my 3 X 125mg. dosing gets a little more than that.
    My HDL has always been my weak point and stays up ONLY when drinking...Catch 22: too much drinking has been a problem for me and frequent long periods of teetotalling is my most workable control method!

    Last edited by Lenin; 02-07-2005 at 12:01 PM.

     
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    Old 02-07-2005, 12:23 PM   #2
    ARIZONA73
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    Re: Low Dose Niacin

    Lenin,

    Good luck with the niacin. But since you have had reactions to it in the past, have you ever tried or considered trying inositol hexanicotinate, the flush-free version? That's supposed to be effective too, only without the flush.
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    Old 02-07-2005, 01:27 PM   #3
    Lenin
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    Re: Low Dose Niacin

    ARIZONA,

    I will consider the inositol hexanicotinate when I use up my bottle of regular. I'm skeptical of the claims though that the IHex is in any quantitative way different from the timed or slow release formulations which seems riskier in regard to liver damage. I have to be doubly vigilant because of the statin use.

    It SEEMS that niacin causes flushing and that only less niacin per unit of time will mitigate that fact, so all the claims of DIFFERENCE from time-release from the Niaspan makers and the hexanicotinate providers may be window dressing...they all disperse the dose slowly over a longer period of time, only by different methods.

     
    Old 02-07-2005, 04:23 PM   #4
    ARIZONA73
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    Re: Low Dose Niacin

    Lenin,

    To be quite honest with you, I'm not exactly sure how inositol hexanicotinate is supposed to work. For the most part, I have always used the ordinary immediate release niacin, but I have tried the inositol hexanicotinate from time to time. The bottle I have in front of me is the Twinlab brand. The label says that each capsule contains 640mg niacin and 160mg inositol. Being that they are capsules, I doubt that it could be a time-release formulation. It says nothing about timed or sustained release. So, I can only conclude that the reason it is flush-free is because the niacin is bound to inositol. I know, it sounds like magic, right? But I've been taking ordinary niacin (250mg four times a day) for about 20 years, and I still feel some flushing from time to time, but not always. But I have never, never at any time experienced any flushing whatsoever with inositol hexanicotinate, even though a single capsule contains 640mg niacin. I know that Twinlab is supposed to be a reputable brand, so I have no reason to question the ingredients or purity of the product.
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    Old 02-07-2005, 04:59 PM   #5
    jtu91952
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    Re: Low Dose Niacin

    Lenin, i stopped taking my niaspan bcuz inspite of the adult asprin, i still got the flushing. I hafed the pill to 250 and still got the flushing. Can a person take less than 250? My hdl was 49, it has gone done from 65.

     
    Old 02-07-2005, 05:39 PM   #6
    ARIZONA73
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    Re: Low Dose Niacin

    jtu91952,

    Niaspan is a sustained-release form of niacin. I wouldn't advise breaking any sustained-release tablet in half. These products are enteric-coated, and therefore are designed to dissolve slowly over a period of several hours. Once you break the tablet in half, all bets are off, and it will most likely behave more like an immediate-release product.

    If you cannot tolerate the Niaspan, and still want to experiment with niacin, you have two options. You can either buy a low dose (~100mg) over the counter product and see how that works, or else you can try inositol hexanicotinate, the flush-free form.
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    Old 02-07-2005, 07:38 PM   #7
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    Re: Low Dose Niacin

    I agree with Arizona73. Niaspan should not be divided.
    I found that taking my aspirin 30 minutes prior to bedtime and then taking the Niaspan just before jumping into bed to be the best method. Usually I was able to fall asleep right away and had no flushing. However, there were nights I did not all asleep and had to endure the flushing for a half hour or so. This will not work if you like to watch TV after getting into bed.
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    Old 02-07-2005, 09:35 PM   #8
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    Re: Low Dose Niacin

    Lenin, I know that you have side effect problems with immediate release products but are concerned about liver enzymes with the sustained release. According to the Endurance Products website, the one I take, Endur-acin, had a drop-out rate of less than 4% in clinical trials at the University of Minnesota and Harvard University due to intolerance. And that was with 1500 mg., which is far more than it sounds you are interested in taking. As I recall in reading some of the research on it, the problems with liver toxicity had been negligible. I tried to find that article again, but something is amiss and pages are loading sooooo slowly tonight that I'm giving up. Most of the research reports were written by a Keenan and others. Perhaps you might want to check into the research on it and see if that might be an option for you.

     
    Old 02-07-2005, 10:16 PM   #9
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    Re: Low Dose Niacin

    I just came across this abstract from the Annals of Internal Medicine. According to it, no-flush preparations of OTC niacin contain no free nicotinic acid and should not be used in niacin therapy.

    [url]http://www.annals.org/cgi/content/abstract/139/12/996[/url]

     
    Old 02-08-2005, 05:11 AM   #10
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    Re: Low Dose Niacin

    Now I'm totally confused. I understand that the flush-free form may not contain niacin in its free form, since it is bound to inositol. However, how can it be of no use if it has been used successfully in European countries since the 1960s?
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    Old 02-08-2005, 05:29 AM   #11
    Lenin
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    Re: Low Dose Niacin

    Uff-Da,

    I'll conjecture from the article that that the "non-flush" products that contained ZERO free nicotinic acid were niacinamide preparations-(edit: oops just re-read they were the inositol formulations) they are often advertised that way. I don't doubt that they are useless for purposes of cholesterol control.
    I really think that niacin causes flushing and that any product that doesn't produce flushing in "flushable people", is not releasing niacin in any useful amount. My guess is that the inositol hexanicotinoate relies on low solubility of the product or even incomplete breakdown for its no-flush quality.

    BTW, several people in the first cited study actually had to quit because of the unbearable flushing from 50 mg. (I am flushable at 50 mg...but not "unbearably flushable.")

    jtu,

    Why not buy a bottle of 250 mg at the health food store and join me (I am going to a 125 mg. dose TWICE a day...because I can't remember to do ANYTHING three times!
    I can't seem to find the cheaper 500 mg. anymore but I have a BIG bottle...but then the 250 mg. are dirt cheap as well.

    I'm curious whether or not the flush will abate with a 125 mg. dose over time- it's still something of a misery!

    Arizona:
    On the apparent paradox of "no-free niacin" vs. "used in Europe since the 1960's", perhaps the products tests in the lab as an insoluble product but the BODY breaks it into its components...that's not all uncommon with comples organics. It would help explain its "time-release" quality.
    I wouldn't trust it though: maybe "No Pain, No Gain" is true yet again!

    More confusion:
    One of the purveyors posted THIS:
    Quote:
    In an open clinical trial, 16 patients with elevated cholesterol were given 1.2 gm of inositol niacinate daily for one month, and then 1.6 gm daily for up to 40 weeks. At the end of the test period, average cholesterol levels had decreased by almost 20 percent.
    Teeny study with no specifics...has anyone seen anything similar to this study other than in ads selling the stuff?

    Last edit:
    From a technical site:
    Quote:
    Biochemistry and Pharmacokinetics
    Inositol hexaniacinate (IHN) is the hexanicotinic
    acid ester of meso-inositol. This compound consists
    of six molecules of nicotinic acid (niacin) with
    an inositol molecule in the center (see figure). Pharmacokinetic
    studies indicate the molecule is, at least
    in part
    , absorbed intact, and hydrolyzed in the body
    with release of free niacin and inositol.1 It appears
    to be metabolized slowly, not reaching maximum serum levels until approximately 10 hours after
    ingestion.2
    So it's a time-release formulation by a different methodology. I would think that it should be grouped in with all other sustained release niacin formulations, perhaps the SLOWEST release of all with maximum concentration not achieved for 10 hours. Probably the "at least, in part" deserves further delving.

    I lied; one MORE edit.
    Quote:
    Hyperlipidemia: Studies report significant lipid-lowering effects of IHN at doses of 400 mg
    3-4 times daily.6 Welsh and Eade found IHN more effective than niacin in its hypocholesterolemic,
    antihypertensive and lipotropic effects.2

    Last edited by Lenin; 02-08-2005 at 06:37 AM.

     
    Old 02-08-2005, 01:51 PM   #12
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    Re: Low Dose Niacin

    All these conflicting studies certainly get confusing. And with more than 50% of people with heart attacks having normal cholesterol levels, it does make me wonder if we are all worrying about cholesterol and gulping pills for nothing. Will it be another case like the former recommendation to eat margarine instead of butter, where millions of people did so only to learn 20 or 30 years later that what they were doing was even worse for their health? Until more is confirmed about what really does cause CVD, though, I suppose those of us with concern about our health will continue to follow the medical prescription to "reduce that cholesterol" (and up the HDL).

    Has anyone tried a different approach, other than niacin, to try to raise HDL? I'm thinking of Pantethine in particular. I came across this quote from Southern Medical Journal last night, which looks like it might be promising for this purpose. It sounds safe enough, apparently no known liver toxicity problems, unlike niacin.

    Quote:
    Pantethine, a disulfide preparation of the vitamin pantothenic acid, has been shown to reduce total cholesterol and LDL-C by 10 to 15% and increase HDL-C by 20% when taken at doses of 600 to 900 mg.

     
    Old 02-08-2005, 02:08 PM   #13
    Lenin
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    Re: Low Dose Niacin

    Uff-Da,

    A good friend was using pantethine and got tired of the high price and later switched to pantothenic acid which is a great deal cheaper.
    Her jury is out on whether either helped her rather wretched numbers, not much if either did! She was on low carb and switched to lowISH carb, lower fat.

    Prices for 900 mg. pantethine run the gamut from $1 (Vitamin Shoppe)to $3.50 a day (Puritan Pride.) I'm sure some of the fancier brands go much higher.



    It's true what you say that we may all be played for jackasses with the worry about serum cholesterol, but then our only alternative is to play Russian roulette. Remember, we get to make the choice only ONCE!

    My judgement is that my earlier life of lots of butter, cream, meat, cheese, cold cuts, and cigarettes that tallied a steady 235-265 total cholesterol (with an HDL in the 20's) earned me a shiny new stent so THAT CERTAINLY wasn't the right way to go!

    Last edited by Lenin; 02-08-2005 at 03:05 PM.

     
    Old 02-08-2005, 04:34 PM   #14
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    Re: Low Dose Niacin

    Lenin - I had no idea Pantethine was that expensive for something that had only a modest effect. I didn't think the 10-15% lowering of LDL and TC was enough to make much difference, but 20% increase in HDL sounded pretty good, when there are so few things that seem to increase it. But one would think that your friend would have noticed a difference in her numbers if it really had that much effect on HDL.

     
    Old 02-08-2005, 05:15 PM   #15
    jtu91952
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    Re: Low Dose Niacin

    Lenin, i got my niaspan thru a prescription, it costed me $38. I didn't know niaspan could be purchased otc. I started taking it but stopped bcuz of the asprin situation. Besides the flushing started with the niaspan.

     
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