Is Sloniacin safe to use without a doctors supervision?  (I have low LDL, but it is almost all "B" particles. Triglycerides are pretty close to target range.)  What dose do you usually start patients out at?

Could someone please explain how Abbot and Glaxo Smith Kline obtained patents for Niaspan and Lovaza? And why doctors prescribe these when essentially the same things are available over the counter?

I wrote up an article on my blog illustrating my experience with the healthcare industry back when I was trying to earn a living as an insurance peddler. See http://chl-tx.com/2009/09/how-to-get-the-best-deal-on-health-care/

I hate how the drug companies cry about how much they spend on research.  Most research is funded by government grants with the bill footed by the taxpayer.  Then they make us pay for it again when we purchase the drugs.  What a scam.

I paid a lot less than $5 for 100 tabs of house brand Niacin at Safeway(aka Vons, Randalls).

I took 1,500 mg for several months. I got a warm flush for 15 to 20 minutes that was bad at all. My LDL went way down after a few months, and HDL went up a bit.

Cheap is good, if it works.

Typos, typos, typos...

I paid a lot less than $5 for 100 tabs of [500 mg] house brand Niacin at Safeway(aka Vons, Randalls).

I took 1,500 mg [a day] for several months. I got a warm flush for 15 to 20 minutes that was [NOT] bad at all. My LDL went way down after a few months, and HDL went up a bit.

Cheap is good, if it works.

At least she didn't insist on the name-brand like that Lovaza guy.

Be careful with switching.

Be careful with liver effects.

http://cholesterol.emedtv.com/niacin/types-of-niacin-p2.html

I was trying niacin supplements, and I started out with 500 mg each morning, which initially caused uncomfortable flushing. The flush got less uncomfortable over the next few weeks, and then I added another 500 mg at bedtime. The flush came back, but gradually got less uncomfortable over the next week, and then BAM!!! I suddenly started getting the worst headaches I have ever had. A couple of ibuprofen would make the headache bearable, and I did not immediately associate the headaches with the niacin, since the onset of the headaches was several days after I upped the dose to a gram a day. The headaches persisted, and after the 3rd day of those horrible headaches, I decided it had to be something I changed recently, and the niacin was the only thing that made sense.

So I omitted the niacin complete the next day. No headache. Ok, since I had taken 500mg for several weeks without getting headaches, I took 500mg the following day -- BAD HEADACHE. I divided the tablets using a pill-splitter to get a 250mg dose -- BAD HEADACHE. Nuts. I cut it out completely, no headache.

I get about 50mg of niacin in a multi-B-vitamin tablet without headache, but I wonder if I have somehow sensitized myself to niacin, which would mean that I won't be able to get the cholesterol effects I was after.

I'm also wondering if maybe there is some interaction between the niacin and some other vitamin or mineral (or food). I haven't taken any of the 500mg pills for over a week (no headaches at all during that time), and I may try 250mg tomorrow morning (and carry a dose of ibuprofen with me just in case). But I'm interested in seeing if anyone else has had a similar experience.

Niacin can do wonders. In the distant past I used it to control and stop knee pain which had troubled me for several years. A true life saver given what NSAIDs were doing to the stomach.
In time, it apparently caused the heart
to start skipping beats. In rare persons, it may cause myopathy of the heart muscle; therefore, I stopped it.
And when higher than 100 mgs per day
are reintroduced the heart starts to
skip beats again even years later.
I am not saying don't use it but it can have side effects so be alert. There are
alternatives to niacin if it doesn't fill the bill. For example pantethine and fenugreek seed for blood lipids and fish oil, boswellia, and MSM/DMSO2/dimethylsulfone for joint pain.


Trig

Is there a big difference between big drug companies and street drug dealers.  Hmm.

Be careful of timed release niacin...can cause jaundice.

I think consumers in the EU recently lost the right to use herbs/supplements (?)...coming to the US soon?

Very important that we protect drug company profits...since main street is going down the tubes?  

Brent--

I believe that, ideally, any form of niacin is best taken under supervision.

That said, it is sad to realize how few healthcare practitioners actually know or care about using niacin. The only reason there is some awareness is because of, of course, drug industry marketing of Niaspan.

Thanks Doc,

I am curious as to the release time you have given on Sloniacin. Is that release time you quoted from the manufacturer?  

From what I gathered there were 3 types of Niacin, imediate release (IR), extended release (ER), and slow release (SR). With Niaspan and Enduracin being in the (ER)camp and Sloniacin being in the (SR) camp, being a bit harsher on the liver.

Kent,
There is no clinical differentiation between SR and ER.

Kos funded a dissolution study comparing Niaspan and 7 non-prescription niacin products labeled as SR or Timed-Release, including Endur-acin and Slo-Niacin. The results were graphed and compared, and Niaspan was the slowest, with Endur-acin virtually identical.  slo-niacin was a bit quicker.

Kos and Abbott have gone to great lengths to perpetuate the myth that the Niaspan dissolution is unique, that non-prescription products are longer acting, and therefore more hepatotoxic.  The reality is if you dose them once daily like Niapsan, you have the same kinetics and dynamics. Dosing twice daily makes them easier to tolerate, but means that one must be more careful in determining you max dose before liver enzyme elevation occurs - hence physician monitoring especially during the dose escalation period.  For many ER niacin users dosing twice daily, 1500mg is a total max daily dose.  With respect to results (dynamics) the twice daily regimen increases the LDL response, but lowers the HDL response somewhat as compared to ER once daily.
So how you take it may also depend on your lipid goals and what else you are taking.  
I can tell you first-hand, that the majority of the medical community is not aware of this published dissolution data, or the pharmacodynamic differences in dosing regimen.
Any one who receives push-back from their physician should provide them with the article, "Dissolution Profiles of Extended Release Niacin...." American Journal of Health-System Pharmacy, 2006

Good info. Does anyone know of a doctor in Sioux Falls, SD that is up to date on this and other treatments/tests that Dr. Davis discusses on this blog? My current GP doc has no idea on much of this.

your best bet is to find a certified lipidologist.  go to learnyourlipids.com and put your city and zip in.  it will tell you there are several near you.

Here is a start to self education but it is best to Pubmed all of these issues; just enter Niacin and then start reading. Sometimes all you need is to read "conclusion." Very well organized. pubmed.org

I read it for the fun of it. Is pubmed everything we need to make informed choices? Nope, not at all, but like I said, it is a good solid start.

Dissolution profiles of nonprescription extended-release niacin and inositol niacinate products.
Poon IO, Chow DS, Liang D.

College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX 77004, USA.

Abstract
PURPOSE: The dissolution profiles of nonprescription extended-release niacin and inositol niacinate products were studied using the prescription extended-release niacin, Niaspan, as a reference.

METHODS: Seven nonprescription extended-release and 12 nonprescription inositol niacinate products were collected from community and online pharmacies in the United States. Extended-release Niaspan was used as a reference. Dissolution profiles were examined by the United States Pharmacopoeia dissolution test, using a paddle method. Release samples were removed every 30 minutes for up to 240 minutes. Niacin was quantified by high-performance liquid chromatography.

RESULTS: Ten out of the 12 inositol niacinate products were capsules and 6 of the 7 extended-release formulations were tablets. During the initial 30-minute dissolution study of inositol niacinate products, free niacin was released to various degrees. One product achieved fast dissolution, with >30% cumulative release of niacin. The cumulative percentage of niacin released at 240 minutes of all inositol niacinate products was statistically different (p < 0.0001). The majority of these products reached a plateau of releasing niacin in one to two hours, which was maintained until the end of the study. Six out of the seven extended-release niacin products had extended-release profiles. Five products showed a statistically higher dissolution rate (p < 0.05) than that of Niaspan.

CONCLUSION: Significant variations in dissolution profiles were noted among the 7 nonprescription extended-release and 12 nonprescription inositol niacinate products in vitro, and their dissolution rates were not comparable to that of the prescription extended-release niacin. Further studies are warranted to correlate such dissolution data with their in vivo efficacy.

Alot I read online says to use IR niacin to avoid liver toxicity, which can occur with slow release. Any thoughts on the issue? Any brand recommendation for IR niacin? Thank you.

Its a great Blog. Medical tourism, which is the practice of traveling from one place to another for medical care, is no longer limited to patients seeking conventional treatments and thus leads to Pancreatic cancer treatment India.

I bought a bottle of 1,000 tabs of 500 mg IR Niacin, Rugby brand, for about $29, shipped. I'm at 2 a day with modest and very manageable flushing most of the time. I've only been at the full dose for about two months so I don't yet know the results but I'm due for preliminary bloodwork soon. IR niacin is supposed to be the least hepatotoxic and most effective for most lipid parameters (LDL excepted). It is certainly the cheapest.

For those going this route, don't jump in with 500 mg a day right off. Get a bottle of 100 mg and work up slowly. I started with 50 mg and went up 50 mg every two weeks.

If it turns out I need 1,500 a day and the flushing becomes unmanageable I might go to Slo-Niacin.

Dr. Davis, can you please explain how the money for insurance premiums goes to drug companies?

Anonymous, Why are you anonymous?

Is the cost of developing and marketing a supplement-turned-drug that great?

Yes. Have you ever performed a drug trial? The paperwork is mind-boggling. It costs millions to create a protocol, get it approved, recruit sites, recruit patients, monitor sites, collect data, follow up adverse reactions, compile the data and resolve queries about how the data was entered.

And if the FDA has significant objections or questions about what you've done, you get to do another trial to resolve those issues.

All of that has to happen before the first ad goes on paper. I'm not saying the FDA's procedure is wrong, but it costs mega-millions to do it.

Great post, Dr. Davis.  My doctor strongly advised me to take Niaspan to lower my triglyceride levels which were 240.  I asked her about Slo Niacin because it was so much less expensive, and she recommended against it b/c it's not regulated and you don't know how much of the medicine you are really getting in OTC form.  So I took the Niaspan and 6300 mg fish oil for 3 months and it did lower my triglycerides to 112.  I also cut out bread and most other bad carbs - pizza, potatoes, sweets other than dark chocolate.

There's a kernel of truth to the concern that OTC/supplement products are not as well regulated as pharmaceuticals, but it's a concern that's WAY overblown by the medical profession and the drug companies who train most of them these days.

For one thing, the pharm drugs are not as well regulated as many assume. There's not an FDA inspector running or overseeing tests on every batch that goes in a bottle. Plenty of problems come to light still despite staggering fines levied by the FDA.

Second, the supplement industry is no longer run by hippies stuffing capsules in a garage in Northern California. It is a big-money industry with plenty of good chemists and equipment and manufacturing standards both voluntary and regulatory. It can take a bit of research, but there are plenty of good products out there. For many things like Niacin, the OTC versions are available from generic drug producers with very long track records of quality.

Lastly, for most applications like lipids, the proof is in the numbers. If we're talking about digoxin, yes, it makes a huge difference if delivery isn't controlled down to the microgram. With niacin, honestly, what difference does it make if you get 520 mg one day and 485 the next? None. If the product is fairly tight, you'll get consistent results with your lipid numbers.

I was taught that for the best results you take the full spectrum of vitamin B's, never separate them. If you take only one you create an imbalance that causes problems with the levels of the remaining B's.
My question is why the obsession with lipids, target ranges and having good numbers? The only true test is in how you are doing. Why the extra strain, is this to be healthy or avoid getting sick? There is a difference. What is the true goal here?
The whole cholesterol thing was never a proven problem, but an assumption that has been used to make billions of dollars trying to get the levels down, with no evidence that doing so is in any way helpful, but the means to lowering the count has proven harmful. I see worrying about reaching certain levels, as unneeded stress, which is bad in and of itself.
If it's toxic to take too much, why strive for higher levels when getting the flush is a sign you've got enough in your system already?
Cost aside, getting the right kind of vitamin is more important, the natural vs the artificial, the best absorption rate.

Life is balance, the body strives for it, knows how to get it, just needs the materials to do it best for you.

It's an absolute shame that the FDA is going after Sloniacin for speaking the truth.
http://bit.ly/eebWnM

Sloniacin has to remove all references to cholesterol, lipids, statins etc. from their website, brochures and product label. Sloniacin has already shut down their website.

I don't need this product, but I feel for the folks on fixed incomes who won't know about this cheap alternative to Niaspan.

I want to scream.

I had an opportunity to speak with Dr. Blanchet for a few minutes recently.  A great doctor and a nice guy.

He's in Boulder, Colorado.  Here's the web site link I was able to contact him through.  (I've separated out the link onto two lines to ensure that the complete link appears in comments.  You'll need to put the two lines together as a single URL to paste into your browser.)

http://www.bch.org/caregiver/
physiciandetail.cfm/184

If I lived close to Boulder, Colorado, I'd be working to make him my primary care physician.

Dr. Davis:

Thank you!

About profitability: My calcium scan in California cost $500. The new-ish GE scanner that was used costs $1.8 million. I estimate that the $500 fee can only yield about $100 gross margin under high-patient-volume circumstances.

-Rich

I am not one to moan about the costs of running a scan center, since I've never had any financial interest in a scan center (despite numerous accusations of "secret arrangements," etc.), but costs of running a center also include:

1) $12,000 or so a month upkeep. No kidding. The GE's of the world, though they do great engineering work, make many times their investment back just from the rich  maintenance contracts. I've seen these maintenance contracts break the back of many independent scan centers.

2) Because physicians are so hard to educate on the value of heart scans, scan centers by necessity rely on advertising, which is very costly.

3) Paying physicians to read scans. I can tell you from personal experience, since I do read scans and receive a small fee for each reading, that the reading fee is paltry. If I were doing this for money, I wouldn't waste my time. But it's not about money. It's about providing a necessary and important service.

This is why independent scan centers have struggled across the country. It is getting better, but mostly because of the adoption of the new CT technologies by hospitals.

Here are the actual prices those lucky enough to live in USA can get a Coronary Artery Scan ("heart scan") — EBT examination of heart with calculation of coronary calcium score. Includes all interpretations and comprehensive report. Radiologist examination of chest images. Report sent to patient and physician if requested. (For repeat scans, calcium volume scoring and notation of rate of progression or reversal)
If claim is submitted to the insurance company and it is denied because it is considered "Not a Covered Benefit" $440
35% Discount if paid at the time of service (Patient waives the rights to receive Health Insurance Claim Form) $395
Anyone who thinks those prices are unreasonably high should see prices in the UK where Coronary Artery Scans cost £525.
However, as it costs me about that to get my car serviced in the UK and there's no guarantee the work won't be done by an untrained lad on a job creation scheme, it's still good value.

Is an EBT scan the same as a CT scan? My understanding is that it's the same thing...only faster. True? Are the levels of radiation the same?

Thanks!

Paul

Has any had a scan in the Bay Area? I know that Walnut Creek and San Jose offer sites...  Any recommendations?  I'm thinking about getting my dad and husband xmas gifts...  I thought the price was bout $199 but I guess prices are higher now...inflation? being Calif?

THANKS in advance!

What is it with all you William/ Bill cardiologists...  all achieving medical miracles in a world of super-sized ego's and Pharma-driven gimmicks...

Dr. Davis, You mentioned that for patients with Type 2 diabetes in your book (yes, finally got my hands on a copy! -- will need to order FAR in advance for Xmas gifts this yr! I'm giving the 'gift of life'!!) that reversal is rare?

Now with so many tools (and the ability for you to post and share your progress) it seems like that is no longer true? Would you say so in your practice? and to what degree at this current time? what if pts are really really extremely aggressive with carbs, exercise and dramatic wt loss?

BTW, the patient we discussed earlier (it's been about 1 mon now)is now doing substantially better.  He's exerting without angina! THANK YOU SO SO MUCH!! We actually stopped Actos and I think that made a huge difference also. (When combined with insulin, there appears to be a large increase in CHF (although person had no edema, PND or other signs), just shortness of breath with any exertion.)
We're normalizing the Vit D and I think that has made the h-u-g-e-s-t difference (besides possibly the Actos -- no echo so don't know?). I haven't had a chance to start as many as the other interventions yet but will. He's doing a lot more raw nuts as well (and no wheat). DO you think the omega-6's are bad -- found in wheat, corn products? (I don't recall reading that here yet?) Especially for certain subpops? like high Lp(a) like my friend?

Other labs have come back. I was wondering if I could get your thoughts briefly?
CRP 0.5 (yes couldn't BELIEVE it!)
DHEA-S 275 ug/dL
TESTOST 440 ng/dL
lipoprotein(a) 110 (wow)
PTH 23
Fructosamine 300 (we're getting there)
Home glucose averages now 140s (1hour postprandially -- getting better! my goal normal < 120-130)

Specifically, is there room to go with DHEA (for the Lp(a))? alpha-lipoic acid (not mentioned in book or blog? any experience yet?)  

(L-carnitine and the Heart Bar are scheduled for his next visit)
I am so grateful for all your commentary and advice...

Thanks, G.

I don't know much about the San Jose center, but I do know that the Walnut Creek scanner is an EBT device. They are also very interested in prevention/reversal there.

The entire vitamin D concept is new since I wrote Track Your Plaque in 2003. Since then, I have seen type II diabetics drop their heart scan scores with addition/correction of vitamin D blood levels.

For Lp(a), I nearly always try niacin first, then DHEA and/or testosterone as adjuncts. However, there may be little room for much testosterone supplementation, given a "middling" testosterone level. DHEA works better in females, but can still exert some effect in males (using doses of 25-50 mg per day in males). I've been disappointed with l-carnitine's effect, for the most part.

I've not systematically used lipoic acid. I'm presuming you mean to enhance insulin responsiveness. When I have tried it, the results were small, but only in a few patients.

Wheat avoidance, vitamin D, and exercise exert enormous effects, as you are witnessing. Keep up the great work with your people!

Hi! Thank you for responding! I'm so relieved that your seeing the same progress in Type 2 DM's (and Dr. Blanchet as well)!
I had thought as much...  I know when you published the book, it was already 'out-dated' by 12-18months, right? Your frustration is palpable but you are so correct, I certainly would not be of such enormous help to the individuals I work with if I hadn't come across your information 6-8wks ago (to share the hopefulness of actual CAD secondary and primary reversal)! Keep up the strong work!
Regarding lipoic acid, it has been mentioned by people studying longevity (many of course support the same lifestyle changes as you -- the CRON-ers, Bruce N. Ames, etc). It is usually mentioned in conjunction with L-carnitine for mitonchondrial rejuvenation.

I appreciate the info on the Walnut Creek site! We'll be checking it out! Take care, G

I get more impressed every time I read this blog!

I am thinking about firing my Cardiologist and would like to know about Heart Scan Centers in Portland, OR as well as a Cardiologist to refer.

Briefly, my medical history is that I have survived a Stroke in May 2004.

In 2006, I didn't feel well and went to my Primary Doctor. He did a Nuclear Stress Test in his office. I was advised to not take my Beta Blockers for the test. I experienced a life threatening arrhythmia during the test. I went home and was advised to take my Beta Blocker for another test the next day. This time I was told things were fine.

Three months later I had chest discomfort which brought me to the ER. No heart attack but sent to a Cardiologist for more testing. Again, round two of the Nuclear Stress Test and was advised not to take my Beta Blockers. I voiced my hesitation. Not being a Cardologist, I proceded to take the test. This time I had V-Tach.

I have had a triple bypass on my left Coronary Artery and a stent the size of Rhode Island in my right Coronary Artery. Surprizing, no MI at any time.

I have lost close to 35 pounds since surgery and am an avid bicycler. I have pedalled close to 600 miles during the month of August during lond distance events.

The more I read about diets and heart disease, it appears to me that the AHA Cardiac Diet is a waste of time.

Help me, Doc! Point me in the right direction!

Hi, Larry--

For the closest scan center, see our Scan Center listings on the www.trackyourplaque.com website. However, be warned that we rely on people like you to update us and thus the listing is neither complete or up-to-date. (As we grow, we clearly need to hire somebody just to keep this service updated.)

I would invite you to look at our membership website, www.trackyourplaque.com. At your stage of the game, while a heart scan may or may not be possible anymore, the principles of the program still apply. I would suggest to you that, given what you've told me, the causes of your heart disease have yet to be uncovered. This will be crucial for long-term prevention/slowing/reversal of your disease.

We are only starting to develop a listing of interested physicians. However, a lipidologist might be someone to look for in your area.

My heart disease was caused by smoking. I stopped smoking in 1993 after a lifetime of abuse. High blood prsseure was the cause of the stroke. My carotid arteries are clear.

My LDL was 29 after surgery and my HDL was 65. I believe that exercise is key to me, but I must 'feed the machine' that propels me on my bike.

Thanks for the imput, I will look into it..

Don't forget about lipoprotein(a), a very important pattern that is hugely ignited by smoking.

Hi Dr, Davis,

You wouldn't believe the trouble i'm having trying to get someone to give me a CT Heart Scan without trying to talk me into a Coronary CTA. Every facility I've talked to keeps harping on the issue that calcium scoring only shows "hard" plaque...and not soft. I also had a nurse today tell me that 30% of the people that end up needing a coronary catheterization had calcium scores of ZERO. That doesn't sound right to me. What determines whether or not someone needs a coronary catheterization anyway?

As always - thanks in sdvance for your response!

Paul

Paul-

Please see an upcoming Heart Scan Blog on this question. I am embarassed and angered that scan centers dispense such information.

Paul--

A full length report on this topic is on the Track Your Plaque website. I would invite you to take a look. Both devices are reasonable choices for a heart scan, though EBT has less than half the radiation exposure of a 64-slice device.

At first, your blood sugar level may rise so slowly that you may not know that anything is wrong. One-third of all people who have diabetes do not know that they have the disease. If you do have Type 2 Diabetes Symptom, they may include: Feeling thirsty. Having to urinate more than usual, Feeling more hungry than usual, Losing weight without trying to. http://diets-diabetes.blogspot.com/

Good Day!!! heartscanblog.blogspot.com is one of the most outstanding innovative websites of its kind. I take advantage of reading it every day. Keep it that way.

That's probably the best, most concise summary of why heart scanning makes sense that I've ever heard. And it comes from a primary care physician in the trenches. With just a few paragraphs, Dr. Blanchet, in my view, handily trumps the arguments of my colleagues arguing to maintain the status quo of cholesterol testing, stress tests, and hospital procedures.

Very nice Data i like it so much thanks a lot for this great contribution.


Smith Alan