If you take niacin, you must exercise

30. December 2009 William Davis (23)
We use a lot of niacin in the Track Your Plaque program.

Niacin:

--Increases HDL and shifts HDL towards the large, protective fraction

--Reduces small LDL--In fact, niacin is the best treatment we have to reduce small LDL after wheat elimination and carbohydrate reduction.

--Reduces fasting and postprandial (after-eating) triglycerides

--Reduces heart attack risk by 20-28%--even as a sole agent.


But . . . niacin also triggers higher blood sugar because it partially blocks the effects of insulin (insulin "resistance").

While the net effect of niacin remains positive, the provocation of insulin resistance is not such a good thing. Can it be minimized or eliminated?

Yes, through exercise. Here's one interesting observation in obese (BMI 34.0), sedentary men given placebo, exercise, niacin (1500 mg Niaspan, once per day), or niacin + exercise:





From Plaisance et al 2008.

Blood was drawn following a high-fat meal challenge. (Yes, a high-fat challenge, not a carbohydrate challenge. In this study, there were only 17 grams carbohydrates in the test meal, but 100 grams fat. More on this in future.) Exercise consisted of walking for 50 minutes at a moderate pace one hour prior to the meal challenge.

You can see from the graph that exercise partially corrected the increased insulin level provoked by niacin.

Judging from this and other studies, exercise can help minimize the insulin-blocking effects of niacin. It doesn't take much, just moderate exercise for at least 30 minutes.

Adequate sleep can also help, since sleep deprivation is a potent trigger for insulin resistance, only worsened in the presence of niacin. Vitamin D supplementation to achieve desirable blood levels (which I define as 60-70 ng/ml) is also an effective means to minimize this effect.
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Comments (23) -

  • karl

    12/29/2009 11:16:55 PM |

    What about adding P-5-P to the Niacin?

    I've heard things about cinnamon lowering Blood sugar, but I'm not convinced.

  • Grandma S.

    12/30/2009 1:59:12 PM |

    Thank you for posting this.  I am exercising everyday sometimes twice a day to equal 45-60 minutes and see some help with the glucose level.  My LDLs continue to be around 100 and my Dr. wants to increase the Niacin.  Will that help?  It's a fine line, keep the sugars down and get the LDLs down. I appreciate your blog!

  • Renrew

    12/30/2009 2:42:42 PM |

    Cinnamon does reduce blood sugar but the effect is minimal, even at higher doses.

  • Adolfo David

    12/30/2009 3:06:07 PM |

    About Karl comment, you can add many supplements to niacin to counteract this effect. Chromium, resveratrol, standarized cinnamon, green tea extract... Life Extension has launched a niacin with quercetin for example (but now out of stock).

  • Nigel Kinbrum BSc(Hons)Eng

    12/30/2009 3:19:47 PM |

    Would reducing sugary/starchy carbohydrate intake be an effective way to reduce hyperglycaemia?

  • Anonymous

    12/30/2009 10:00:47 PM |

    Thanks for posting Dr. Davis.

    Is splitting 1500 mg of Niacin to two 750mg doses,one in morning, one in evening ok?
    Or should  the 1500 be taken all at once?

  • Anonymous

    12/31/2009 1:13:38 AM |

    Both times I started Niacin, I developed Gout.
    The second time I cut the tablets in half hoping to avoid another bout but still, Gout in a different joint.

  • Mark

    12/31/2009 4:56:24 AM |

    It has been my experience that over time (2-3 Months)the Slo-Niacin I use has less effects on raising blood glucose levels like it does at the onset. It is well advised that everyone should get in the exercise regardless of niacin intake.

  • Boris

    1/1/2010 3:48:15 PM |

    I took 500mg of Niacin every day to get my HDL up. Plus, there was niacin in my multivitamin. My HDL didn't go up at all. I exercise plenty too. All I got out of it were a few itchy flushes that made my ears feel clogged. I'm going to finish my bottle of Slo-Niacin and try a red yeast rice that was tested by Consumerlab.com.

  • Anonymous

    1/1/2010 8:29:23 PM |

    Regarding splitting the dose of Niacin.  I am pretty sure I have seen a post from Dr.D saying to take all at once.  

    I used to split my dose. I thought I was being smart by distributing the Niacin over the day.  My local pharmacist told me not to split the dose because of impacts to Liver function.

  • Anonymous

    1/2/2010 2:10:06 PM |

    I avoid sustained release niacin.

    I get around 80 mg niacin per day in a multivitamin and don't want to add extra.

    http://www.lef.org/LEFCMS/aspx/PrintVersionMagic.aspx?CmsID=114620

    pomegranate...

    Despite the patients’ advanced atherosclerosis, ingesting pomegranate juice produced statistically significant reductions in the thickness of their carotid artery walls, which is correlated with decreased risk for heart attack and stroke. After only three months, the average thickness declined by 13%, and after 12 months, the thickness dropped 35% compared to baseline. During this same 12-month period, the average carotid artery thickness of the placebo group increased by 9%.

  • Anonymous

    1/2/2010 2:39:54 PM |

    Thank you so much for posting this!  I have bee na niacin devotee for about 15 years, and wanted to get my LDL back up after a dx of T2D (with Antibodies) ... and having my niacin "taken away" by my internist.  MY Endo put me back on a lower dose of slo-niacin ... exercise is helping but I may need to up my anti-IR meds.

  • Anonymous

    1/4/2010 4:14:05 AM |

    When is the best time to take niacin?

    morning or night?

    before or after exercise or meals?

  • Dr. William Davis

    1/4/2010 11:27:02 PM |

    We've had best results dosing niacin with dinner or the largest meal of the day.

  • Anonymous

    1/12/2010 2:37:54 PM |

    Dr.Davis

    Just asking this again, could you could please help me out.

    Is splitting 1500 mg of Niacin to two 750mg doses,one in morning, one in evening ok?
    Or should the 1500 be taken all at once?

  • Anonymous

    3/19/2010 4:24:19 PM |

    I had a terrible time with Niacin and insulin resistance.

    I tried exercising but to keep my BG down, I would have to exercise 3 or 4 times a DAY, which is simply not feasible.  Oh, and I am a low-caber, too.

    I would exercise extreme caution in starting to use this, with any Diabetes. (I am a T1.5).

  • lnoonan

    5/19/2010 4:14:15 PM |

    Dr Davis,

    What kind of exercise would you recommend for a Senior lady who is handicapped?  It is difficult for her to do any exercise, so do you know of something she would be able to do while she is taking niacin?  Or, would it be better for her to stop the niacin since exercise is difficult and try other supplements?  Thanks for your help.

  • Anonymous

    5/27/2010 5:00:58 AM |

    Assuming your recommended Slo-niacin...is it better to split your doses up (500 mg morning and 500 mg at night) or take all 1000mg at once? If its better to take all at once is night or morning better?

  • kimberly

    8/11/2010 5:57:09 PM |

    I love to practice exercise, i think this activity is the best option to keep our total welfare and it is very fun. When we exercise frequently we can notice a change not only in our shape but in our mood too. Actually we can improve our sexual performance. When some cases when the erectil dysfunction present like a problem  to buy viagra is a great alternative, how ever you must to combine it with exercises and a good feed.

  • buy jeans

    11/4/2010 5:11:30 PM |

    While the net effect of niacin remains positive, the provocation of insulin resistance is not such a good thing. Can it be minimized or eliminated?

  • Anonymous

    12/15/2010 1:49:29 PM |

    Taking niacin before vigorous exercise has one benefit for me.  The flusing is minimized or even eliminated.

    I've seen different recommendations for dosing frequency.  Three times a day is the "standard" dosing regimen.  However, when I haved switched to three times a day dosing, I have experienced elevated liver enzymes.  I've never had a problem with twice a day dosing.

  • bob

    2/7/2011 4:55:57 AM |

    I am not aware of any data to support 24% risk reduction for MI with the use of Niacin, can you provide citations?

    Primary or secondary prevention?

    Bob Hansen MD

  • John

    6/2/2011 5:01:34 PM |

    Cinnamon doesn't lower blood sugar per se.  The apparent mechanism occurring here is a slowing down of carbohydrate absorption in the gut.  The mechanism is believed to involve a class of molecules known as flavonoids, which either reversibly compete for the glucose receptor or have their own receptor on the GLUT 2 (glucose transport 2) protein.  This action only slows down the absorption of carbohydrates, but all (that's 100%) sugar is absorbed into the body.  It is the only thing you intake that is absorbed 100% and it doesn't matter if it's glucose, sucrose, fructose, or a complex carb.  Anywho, not that I want to debate the finer points of carbohydrate biochemistry.  For more on flavonoids and GLUT2 you can look up this paper (Kwon O., Eck P., Chen S., Corpe C., Lee J-h., Kruhlak M., Levine M. (2007) Inhibition of the intestinal glucose transporter GLUT 2 by flavonoids. FASEB Journal 21, 366-77.).

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Red badge of courage

Red badge of courage

8. November 2006 William Davis (0)
A group of 60- and 70-somethings were standing in the anteroom to the cardiac rehabilitation center. All (males) had their T-shirts pulled up, comparing their coronary bypass scars.

It reminds me of war veterans comparing their war wounds. The scars of suffering, of having "conquered" and won a war with a common enemy, a badge of courage.

This is part of the broad social acceptance of bypass surgery and other major procedures for heart disease. Hospitals support it. They do it for the psychological support for patients enduring a difficult process. Often, talking about a shared experience can be a helpful purge for the fears and frustrations of a traumatic event.

Curious thing, though. I've actually had people request bypass surgery simply because all their friends have had one. No kidding. "I just figure my time is coming. I might as well get it over with."

Get the picture? We've had a battle with heart disease and the hospitals have won. The enormous success of hospitals over the last 20 years is not because of delivering babies, it's not from psychiatric hospitalization, it's not from cancer treatment. It's from heart disease. The largest floors in the hospital are usually the cardiac floors. The bulk of revenues and profit are from heart disease.

If I manufacture widgets and each widget I sell makes me scads of money, guess what? I want to sell more and more widgets. I'll persuade people they need my widgets even if they don't. Perhaps I'll even persuade them that buying one is a noble cause. Maybe I'll subtly suggest that I am a charitable operation and I only sell my products for the public good. I could even name my company after a saint. Personal profit--absolutely not!

Ignore the hype. See hospitals and their "products" for what they are: A necessary service--some of the time; profitable products that they hope to sell to more and more people most of the time.
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Heart Scan Frustration

Heart Scan Frustration

27. March 2008 William Davis (4)
Ideally, you get a heart scan and your doctor sits down with you and provides a rational, insightful discussion on what the results mean.

Is heart attack in your future? If so, when? Are blockages present? What is the role of other tests like stress tests and heart catheterizations? Do CT coronary angiograms add any important information? What is the role of cholesterol? Can diet or nutritional supplements impact on heart scan score?

But what happens if you are unable to get the answers you desire? What if you get brusque responses, or your doctor just doesn't know? Or what if there is a clear conflict of interest or the possibility of financially-tainted advice? ("You need a heart catheterization right away or you'll die of a heart attack!")

One example of this process was posted by a frustrated Member of Track Your Plaque who found that answers were virtually unobtainable from his/her doctors:

I underwent a heart scan a few weeks ago, based on a recommendation from a doctor. I assumed that, since I was paying for it, and I requested it, the results would be fully explained to me.

Late on a Friday afternoon, the radiologist who intrepreted it called me and said I would be receiving a report, and so would the doctor. I asked that she explain them to me. She said their policy was to give the report to the doctor and let him explain them. She did say I was in the 90th percentile for my age--and that 10% had a worse score. I asked where do we go from here, and she said, if you're not having symptoms, maybe lifestyle changes, but YOUR DOCTOR will let you know. I asked for a copy of the films and reports, and was told YOUR DOCTOR can request them. I called back a little later and she was gone. It was starting to sink in that I must have a terrible score. In the meantime, I did what I should have done before I went for the scan---looked up information on the internet, and read about calcium scoring. This website [Track Your Plaque] hadn't showed up in my Google search, so a lot of the information was useless.

I did manage to get the score of 186, with the breakdown per artery from someone at the clinic, but only after I insisted I paid for the test, I have a right to the information. 'Course having a score per artery didn't really help---what did it mean? ie: if a 72, how did that correlate to any blockages? Was it a big lump...or spread along the wall throughout the artery.

I had an appt. the following Tuesday with THE DOCTOR---a very busy doctor. After an hour and 1/2 wait in a crowded waiting room, I got to see him. We discussed briefly another issue, and he started walking out. I followed him out and said I wanted my full l5 minutes of time allotted in their scheduling, which seemed to irritate him.

I followed him into his office and said, WHAT ABOUT THE HEART SCAN? What do the numbers mean? He responded that he didn't know, he'd have to see the films, but don't worry--you're probably ok, and I should get a thallium stress test anyway. He said he couldn't intrepret the numbers, or give an opinion on where the plaque was or how it was configured.

I then went to the interventional cardiologist that afternoon and the thallium stress test was scheduled. I asked about the HEART SCAN, and again, no acknowledgment. I asked if he would get the films and explain the results, and again no acknowledment as he was walking out the door.

After this lengthy saga.....MY QUESTION IS....since this is a test you can order yourself (literature at center made mention of the tests you can get without a doctors request)......WHO IS THEIR FIDUCIARY RESPONSIBILITY TO WHEN IT COMES TO EXPLAINING THE RESULTS?

I learned more on this website [Track Your Plaque], and the emailed book then I did dealing with two doctors and the center itself. Thinking back, there was nothing but a brochure on the test at the center. No "Track your Plaque" stuff.



Day 2
I called the scanning center and relayed my dilemma. I was put in touch with another radiologist--a very informative one, who appeared passionate about heart scans as a preventive test. He compared them to mammograms. He hadn't heard about the "Track Your Plaque" program but was going to check it out. He said people varied in their responses to the test results, as well as doctors/cardiologists as to the next step. (ie: lifestyle changes..the next test, etc). He seemed to feel blockages of more than 50% for many cardiologists would indicated angioplasty and stenting.

I'm going back to review the films with him later this week. He wasn't that concerned with the 101 reading on the right artery. The 72 on the left he had concerns with and indicated the CAT test [CT angiography] would offer more as far as how much was there, and approx. blockage, and could be a baseline to compare to in the future. He said some cardiologists would go right to angioplasty...some to a CAT which is more conservative...some might watch and encourage lifestyle changes. He said the Heart Scan doesn't show soft plaque. He also said the internist who referred me was one of only a few in the city that felt strongly about the heart scan---and probably used it to take further action via a referral, and just didn't have time to discuss it, with the way medicine is run these days.



This Member's frustrated post pretty much sums it up:

1) Doctors don't seem to have the time nor motivation to be bothered about offering advice that leads to prevention of disease.

2) The tendency is to always ask, "Are heart procedures necessary?", not "How did this happen?" or "What can we do about this to keep it from getting worse?" How about diet, supplements, and other tools to use at home?

The obvious uneasiness of the radiologist, the last physician this Member spoke with, can just as easily lead to boneheaded advice: Maybe getting a stent isn't such a bad idea. Maybe a CT angiogram is an absolute necessity.

I hear comments like this every day. It is the reason why I continue to plug away at this program and try to set things straight.

By the way, subscribers to our Track Your Plaque Newsletter just heard about our latest success story, Roy, who dropped his heart scan score over 500 points. If you are yet not a newsletter subscriber, click here.


Copyright 2008 William Davis, MD
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Comments (4) -

  • Anonymous

    3/27/2008 12:23:00 AM |

    I wonder why this busy heart scan place doesn't make a movie about what each test score means, along with recommendations to correct abnormal scores. The patient could watch it before his follow up with the dr, then there'd be less questions using up busy doctors times.

    Each test segment could be recorded separately to make it easier on the dr in front of the camera, and for later on when different tests are added or removed from the heart scan, the movie could be re-compiled more easily with the different segments. Making movies on computers isn't nearly as difficult, or expensive, as a few years ago.

  • Anonymous

    3/27/2008 2:50:00 AM |

    Just wanted to say a rambling,  thanks for taking the time to write the blogs that you do and to have created the TYP web sight.  The program has made a difference for me, my family, and several friends who follow the TYP teachings.  

    In many ways you have a job that I used to say I wanted.  For many years I suffered from severe GI issues and was forced to go from doctor to doctor looking for a cure.  It was a miserable experience, as I was not only ill and tired, I also found myself all to often fighting doctors and nurses for information, and proper care.  
    I remember telling myself back then that if I ever found a cure for myself I was going to go back to college to try and become a doctor to help those with GI needs.  Not because I wanted to be a doctor, I didn't and now being close to 40 don't want to today, but because I knew what it was like to have GI issues, and what it was like to deal with the mainstream medical system.    

    You have a fan in me.  After what I had been through previous with hospitals, when I saw your TYP program it didn't take me long to realize what a wonderful system you have created.  I'm still surprised that as a doctor you are not afraid to recommend supplements.  After all the prescription drugs I had taken that helped very little and all to often had miserable side effects, if I have a choice I'd take natural supplements every time.  The only side effect I've had with them is feeling great.  No other doctor that I'd met was willing to recommend supplements even though i later figured out that fish oil was by far the best medicine for my gut issues.

    I enjoy promoting your proven to be successful heart program to others.  I don't know how successful I am at it, but want to see you succeed so do the little that I can.

  • moblogs

    3/27/2008 2:09:00 PM |

    I saw this today (British health site) and feel happy that the right path is being looked at: http://www.netdoctor.co.uk/interactive/news/theme_news_detail.php?id=18524357&tab_id=116

    On a non-heart note. I think England's (currently in America) Dr. Wakefield will one day get praise for outlining the MMR jab as a contributor to autism development. A D deficient body can't deal with mercury and severely D deficient bodies are now the norm with safe sun campaigns reached their peak in the mid 90s. What's more a D replete body may not need MMR...

  • Anonymous

    3/28/2008 6:17:00 AM |

    I can see where a testing center would be reluctant to share "Track Your Plaque" information since they serve a wide variety of doctors..cardiologists, and they don't want to step on their toes or interfere with their treatment plan.  

    The key is having a doctor--or better yet preventive cardiologist (how many of them are around?) that takes the necessary time to intrepret and counsel their patient on the significance of the heart scan, and makes alternatives available.  Of course that takes time...for some doctors it's easier to recommend the next test or referral and write out numerous prescriptions.  In my opinion, this is not good medicine and you should run as fast as you can from this type of fast medicine.

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