Why expensive Zetia. Niacin appears to outperform Zetia.

http://www.webmd.com/cholesterol-management/news/20091116/niacin-tops-zetia-in-cutting-artery-plaque

While in this study the expensive Niaspan was used, you can by Slo-Niacin dirt cheap.

http://www.costco.com/Browse/Product.aspx?Prodid=11118583

Why do insurance companies pay for Lovaza? They are usually very picky and Lovaza would seem an obvious "soak" job?

How did it get on approved drug lists?

Dr. Davis,

Your correspondent should tell his brother to ditch the Zetia too. The research makes it clear it does not prevent heart attack and may worsen health. Statins appear to be helpful because of their impact on inflammation, not because they lower LDL cholesterol. Zetia lowers cholesterol in a mechanical way that has no impact on inflammation.

Why is a 44 year old being subjected to open heart surgery? Quacks.

As an internist not categorically opposed to statins (although I agree with starting with nutrition first, which is why I read this blog), there are generic alternatives for this person's brother. If my patients need Western drugs, I start with cheap generics whenever possible. Zetia has dubious benefits of ANY kind, and costs a fortune. And of course Dr. D is right that there are many cheaper sources of fish oil; I usually point my patients in that direction.

I often feel "standard" American-style medical practice is intended to waste as much money as possible. People need to be able to trust their docs to execute plans that are not only based on the research evidence, but are cost effective. There is no culture of cost-effective medicine in this country, because health care was defined by the Americans as a for-profit arena.

"Prescribe unto others as you would have them prescribe unto you."

Lovaza fills a void created by bad government and insurance policy. According to IRS rules, over the counter supplements cannot be covered by many insurance handlers. My work's HSA is like this. Fish oil / omega-3 is technically considered an over the counter supplement. The folk making Lovaza more than understand the benefits of omega-3 and want to sell it to the folks who want their insurance to pay for it. So they made it into a "drug" and sell it as such. It's a brilliant marketing plan and it seems to be working for them. The sad part is that it is working! It shouldn't! Same thing goes with Lovastatin. Why not take a good red yeast rice? Oh well... you pay for what you don't know.

-- Boris

Your post, Dr Davis, seems more a call for better health care, the kind we here in the United Kingdom get under our National Health Service, than a call for different fish oils or different meds.

The NHS does have it's problems, sure, but they're nothing like the problems this person you describe has.

It's ironic that her brother is trying to be a "good" American by paying his bills and not filing bankruptcy.
If only his doctors, insurance companies, and drug mNUFcturers had a similar ethic.  It seems that for them, being a good American is maximizing their income regardless of who they take it from.
Ordinary Americans have been sold this "good" American concept from birth.  It's propaganda.  Far too many special interests have used it to enrich only themselves.

Your brother should not be paying anything for drugs to lower cholesterol.

Cholesterol is not the enemy, nor is saturated fat.

The real enemy is chronic inflammation that comes from several sources but mainly from a high grain diet (too much omega 6).

Please, read http://www.omega-3-fish-oil-wonders.com/good-fats.html

Best wishes,
Alfredoe

I have read with interest the comments concerning Lovaza. I was put on it in 2008. I have tried numerous times to ask GSK through emails & ph calls the calorie make up in the gelcap. No one seems to know! Not the Doctor who put me on it, the pharmacist, or anyone from GSK!!! As a diabetic who has lost 140 lbs, following my diet plan is very important to me. Any suggestions on who can make them give up the big calorie secret?
Thanks,
Beverly

Had this reader not been aware that her brother could take fish oil as a nutritional supplement, he likely would have been denied the benefit of omega-3 fatty acids in slashing the risk for recurrent cardiovascular events. You and I can buy wonderfully safe and effective fish oil as a nutritional supplement, but there won't be a sexy drug representative to sell it, nor an expensive dinner and payment for a trip to Orlando to hear about it.

Beverly,
A rough estimate for the caloric content of each Lovaza capsule would be approximately 8-10 calories.  Since each capsule contains roughly 1 gram of total fat.

Any particular types of snacks helpful when taking niacin? I sometimes eat a handful of nuts, or an apple,  when taking niacin, hoping it will reduce the possibilty of flush -- just curious if some foods are better than others.

Also, since niacin can raise histamine, has any studies been done on taking an anti-histamine along with high dose niacin? Or how about some vitamin C (natural histamine reducer) at the same time as niacin?

And finally, any real differences between Niaspan, Slo-Niacin and Enduracin (besides cost)? The only difference I can find is that Slo-Niacin might tax the liver a bit more, since it takes longer to fully absorb. The others are absorbed within 6-8 hrs, I believe.

What about the use of Quercetin. There is a recent article showing it may inhibit the niacin flush. At least that was the result in rats. The study was published in the British Journal of Pharmocology Jan 2008
Anne

Dr Davis, the flush of Niacin has been of little bother to me. However each winter when I go to Florida from my cold north home, the Niacin itchy rash appears on my chest. This year I finaly found that Benadryl extra strength eliminated it after three applications. It has to be the increased sunshine that kicks it in. I hope others may find this helpful...Niacin is a life saver and still vastly under rated. Thanks for your informative blogs. Over&Out

I've noticed what seems to be a correlation between flushing and eating spicy foods -- foods that contain peppers containing capsaicin.  Has anyone else noticed this?

It seems that I can pretty much count on getting a flush response 30-60 minutes after eating spicy food.  

Dr. Davis, any thoughts?

Nice post - and I swear I don't know how doctors do it, repeating your self over and over.  I forward your blog wittings to family and friends.  And because of that I'm the one they naturally come to when looking for TYP advice.  

For what ever reason, no matter how many times I repeat myself, people forget two items with niacin:  1)hydrate to limit flush 2) avoid time release niacin as that can dangerously poison your liver - along with telling your doctor you are taking niacin. Grrrrr.........

Sorry, as a long-time niacin user I have to say the advice to increase hydration is good in general, but inadequate in itself to quickly eliminate a niacin flush. You can test this yourself. The next time you experience a big flush, go consume a large quantity of water...see if your flush quickly reduces.  It won't.

On those rare occasions when water by itself is insufficient, then an adult (325 mg), uncoated aspirin or 200 mg ibuprofen can also be used to accelerate relief.

"Sorry, as a long-time niacin user I have to say the advice to increase hydration is good in general, but inadequate in itself to quickly eliminate a niacin flush. You can test this yourself. The next time you experience a big flush, go consume a large quantity of water...see if your flush quickly reduces. It won't."

Okay. And as a long-term niacain user, myself, who just read this earlier tonight and who just tried drinking water when experiencing a flush, I will say that it does work. For me, at least.

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