Niacin and blood sugar

We've been engaging in a conversation on the Track Your Plaque Forum on whether niacin raises blood sugar.

Yes, it does. In the vast majority of instances, however, the rise is trivial and without consequence. Typically, someone will start with a borderline elevated blood sugar of, say, 108 mg/dl. Niacin, 1000 mg per day, then raises blood sugar to 112 mg/dl. This small increase does not oblige any specific action, nor does it pose any excess risk.

Blood sugars in the normal range of <100 mg/dl tend not to show this effect. Higher blood sugars, e.g., 130 mg/dl, may show a more exagerrated effect but it is also rarely of great consequence. People who take medications for adult type II diabetes, or people with childhood-onset, type I diabetes will also experience rises in blood sugar. This is a somewhat larger issue in these people.

Niacin is best undertaken with a change in diet, specifically a reduction in processed carbohydrate foods, particularly evil and ubiquitous wheat products.This will often compensate for the blood sugar effect.

Niacin also shares many of the benefits of weight loss: rise in HDL, drop in triglycerides and small LDL.

Keep it all in perspective: If HDL is low, e.g., 30 mg/dl, or there is a significant small LDL pattern, or you have Lp(a), using niacin--vitamin B3--is quite safe and the most effective treatment we have. It's also a vitamin. Also recall the famous HATS Trial of simvastatin and niacin: simvastatin (Zocor) reduced heart attack risk 30%; adding niacin reduced heart attack risk an astounding 90%.

Very few strategies can yield the enormous benefits, both as a stand-alone treatment or in combination with others, that niacin can, whether or not blood sugar creeps up a few milligrams.

Comments (14) -

  • Anonymous

    9/19/2007 4:05:00 PM |

    Hi greg here- I 've posted before about diet. Just wondering how that is going at your other site. I think you were going to have something up soon.
    Thanks!

  • Dr. Davis

    9/19/2007 4:19:00 PM |

    Hi, Greg--

    It probably won't happen for 6-8 weeks. It's in the queue of projects.

  • Anonymous

    9/19/2007 4:30:00 PM |

    Is iron monitored as part of the Track Your Plaque program? What is a good level for men?

    Brian

  • Anonymous

    9/19/2007 4:31:00 PM |

    Is iron monitored as part of the Track Your Plaque program? What is a good level for men?

    Brian

  • Anonymous

    9/19/2007 4:40:00 PM |

    Thanks.
    I have a couple questions in the meantime.
    - On a low carb diet should I be concerned about the quality of meat I eat? I know grass-fed beef meat is better for me but expensive. Many people talk about the benefit of low carb and eating meat but WalMart meat is different from grass-fed for sure.
    - Also, organic veggies/fruits/dairy are better for me- or so they say- but expensive- what to do?
    - Also- as I said before I had success on South Beach but have gained all of the  weight back since adding in carbs some "healthy" some refined... they do seem to get addictive.
    Any advice other than avoiding them. Any success stories that you know of.
    Thanks!Greg

  • G, clinical pharmacist

    9/19/2007 5:55:00 PM |

    HI DR. Davis,

    I've really enjoyed your blog and your insights!  What are your thoughts on the negative effects of ACEs, betablockers and drugs like thiazides and sulfonylureas?  One of our prominent rheumatologists believe these meds (which are used at a 'quartet' for preventing CAD at the org that I work at) raises the ANA and other autoimmune titres.
    Thank you and strong work!!

  • G, clinical pharmacist

    9/19/2007 6:42:00 PM |

    btw, my middle name is 'vit D3 oil gelcap only' now!  thank you again for sharing!

  • Anonymous

    9/19/2007 7:36:00 PM |

    Dr. Davis, the same HATS trial that showed the large beneficial effects of statin-niacin combination also showed that a combination of antioxidants significantly blunts these effects. The antioxidant combination they used consisted of 800 IU of vitamin E (as d-alpha-tocopherol), 1000 mg of vitamin C, 25 mg of natural beta carotene, and 100 µg of selenium. Unfortunately none of the antioxidants was tested seperately.

    Is there any data that shows which of these anitoxidants was responsible for the reduced effectiveness of the statin-niacin combination? Do you advocate the use of any of these antioxidants for a person taking a statin-niacin combination, and if so, how much and why?

  • Dr. Davis

    9/19/2007 8:08:00 PM |

    LOL! That's great.

  • Dr. Davis

    9/19/2007 8:11:00 PM |

    I have a problem with thiazides and beta blockers, principally because of the HDL-reducing, small LDL-increasing effects. Also thiazides drop magnesium and potassium. I personally despite the thiazide diuretics and stop them every chance I get.

    Drugs have a place, as you know, but they are often used for the wrong reasons and without full knowledge of their negative potential. Vitamin D is a great anti-hypertensive, as is avoidance of wheat products.

  • Dr. Davis

    9/19/2007 8:19:00 PM |

    Unfortunately, there is very little independent verification of this effect outside of the HATS Trial. A similar effect was seen, for instance, in the ATBC Trial.

    I do not recommend willy-nilly use of antioxidants for their own sake, but for selected applications outside of antioxidation, e.g., coQ10 for statin muscle aches, vit C for Lp(a).

  • Dr. Davis

    9/19/2007 9:14:00 PM |

    No. We do not monitor iron.

  • G

    9/19/2007 9:14:00 PM |

    I was afraid you say that!! (we give a lot of thiazides d/t ALLHAT)  I'm not sure about Vit D as a BP med (but I'll take your word)...  Vit D in the first yr of life 2000 IU/d (don't know what form) significantly prevented Type 1 DM in a large Finnish study (see below).  And I just read in the latest AACE 2007 DM guidelines that early exposure to wheat gluten (yeah, your favorite food) may increase Type 1 Diabetes risks.

    THANK YOU for your response!

    Hypponen E, Laara E, Reunanen A, et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 2001;358:1500-3.

  • buy jeans

    11/3/2010 12:22:10 PM |

    Very few strategies can yield the enormous benefits, both as a stand-alone treatment or in combination with others, that niacin can, whether or not blood sugar creeps up a few milligrams.

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Your heart scan is just a "false positive"

Your heart scan is just a "false positive"

I've seen this happen many times. Despite the great media exposure and the growing acceptance of my colleagues, heart scans still trigger wrong advice. I had another example in the office today.

Henry got a CT heart scan in 2004. His score: 574. In his mid-50s, this placed him in the 90th percentile, with a heart attack risk of 4% per year. Henry was advised to see a cardiologist.

The cardiologist advised Henry, "Oh, that's just a 'false positive'. It's not true. You don't have any heart disease. Sometimes calcium just accumulates on the outside of the arteries and gives you these misleading tests. I wish they'd stop doing them." He then proceeded to advise Henry that he needed a nuclear stress test every two years ($4000 each time, by the way). No attempt was made to question why his heart scan score was high, since the entire process was outright dismissed as nonsense.

I'm still shocked when I hear this, despite having heard these inane responses for the past decade. Of course, Henry's heart scan was not a false positive, it was a completely true positive. I'm grateful that nothing bad happened to Henry through two years of negligence, though his heart scan score is likely around 970, given the expected, untreated rate of increase of 30%.

The cardiologist did a grave disservice to Henry: He misled him due to his ignorance and lack of understanding. I wish Henry had asked the cardiologist whether he had read any of the thousands of studies now available validating CT heart scans. I doubt he's bothered to read more than the title. The cardiologist is lucky (as is Henry) that nothing bad happened in those two years.

Do false positives occur as the cardiologist suggested? They do, but they're very rare. There's a rare phenomenon of "medial calcification" that occurs in smokers and others, but it is quite unusual. >99% of the time, coronary calcium means you have coronary plaque--even if the doctor is too poorly informed to recognize it.
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"You can't reduce coronary plaque"

"You can't reduce coronary plaque"

"I told my cardiologst that I stumbled on a program called 'Track Your Plaque' that claims to be able to help reduce your coronary calcium score.

"My cardiologist said, 'That's impossible. You cannot reduce coronary plaque. I've never seen anyone reduce a heart scan score."

Who's right here?

The commenter is right; the cardiologist is wrong.

I would predict that the cardiologist is among the conventionally-thinking, "statins drugs are the only solution" group who follows his patients over the years to determine when a procedure is finally "needed." In fact, I know many of these cardiologists personally. The primary care physicians are completely in the dark, usually expressing an attitude of helplessness and submitting to the "wisdom" of their cardiology consultants.

Quantify and work to reduce the atherosclerotic plaque? No way! That's work, requires thinking, some sophisticated testing (like lipoprotein testing), even some new ideas like vitamin D. "They didn't teach that to me in medical school (back in 1980)!"

Welcome to the new age.

Atherosclerotic plaque is 1) measurable, 2) trackable, and 3) can be reduced.

We do it all the time. (Amy still holds our record: 63% reduction in plaque/heart scan score.)

Though I pooh-pooh the value of statin drug studies, there's even data from the conventional statin world documenting coronary plaque reversal. The ASTEROID Trial of rosuvastatin (Crestor), 40 mg per day for one year, demonstrated 7% reduction of atherosclerotic plaque using intracoronary ultrasound.

I have NEVER seen a heart attack or appearance of heart symptoms (angina, unstable angina) in a person who has reversed coronary plaque (unless, of course, they pitched the whole effort and returned to bad habits--that has happened). Stick to the program and coronary risk, for all practical purposes, been eliminated.

A heart scan score is not a death sentence. It is simply a tool to empower your prevention program, a measuring stick to gauge plaque progression, stabilization, or regression. Don't accept anything less.

Comments (9) -

  • Angela

    5/10/2009 3:17:00 PM |

    "They didn't teach that to me in medical school (back in 1980)!"

    Unfortunately vitamin d is not mentioned in med school nowadays except for osteoporosis prevention...

    Dr. Davis -- thank you for your blog. I am a med student interested in REAL evidence based medicine (which makes me a bit unpopular between my teachers).

    I researched vitamin D after reading your blog, and decided to mega-dose on it. It's been 4 weeks now and my "inespecified mood disorder" (never met criteria for depression, but have never been really "well" since I was 16) is GONE. Like a "veil" has fallen or something. PMS is gone as well.Now I have discovered that the periods of my life in which I felt truly well were when I spent outside most of the day (I live in the mediterranean coast).

    I also had a single attack of MS some years ago, so vitamin D will help to prevent full blown multiple sclerosis.

    My comment is in no way related with atherosclerosis, but I just wanted to thank you, and congratulate you for having found a way to help people outside conventional medicine. I feel greatly inspired by your work.

    Regards,

    Angela Nicolas

  • antidrugrep

    5/10/2009 7:59:00 PM |

    "primary care physicians are completely in the dark"

    For the record, we aren't ALL in the dark. In fact, I stumbled across your website a few years ago as I was looking for supportive testimony from other practitioners who saw things clearly. In fact, I watched as you "caught up" with the idea of adding Vitamin K2 to your regimen - presumably based on the results of the 2004 Rotterdam Study.

    I hate to sound defensive, but such a sweeping generalization is uncharacteristically irrational of your posts up to now. Perhaps you haven't known any primary care "grunts" without a cranial suppository.

    Now you know at least one.

  • Kismet

    5/10/2009 9:43:00 PM |

    I guess it's just a matter of time until someone breaks the record again?

    I know you have talked highly of vitamin K2, I'm wondering if you've made it a staple of the TYP program already? I think there's all reason to do so.
    Below two studies using high doses of K1, but it should work via conversion to K2 (the epidemiology of K2 hints at the same phenomenon).

    Am J Clin Nutr. 2009 Apr 22. [Epub ahead of print]
    Vitamin K supplementation and progression of coronary artery calcium in older men and women.
    Shea MK, O'Donnell CJ, Hoffmann U, Dallal GE, Dawson-Hughes B, Ordovas JM, Price PA, Williamson MK, Booth SL.

    One of THE most impressive studies I've ever read:
    Thromb Haemost. 2004 Feb;91(2):373-80.
    Beneficial effects of vitamins D and K on the elastic properties of the vessel wall in postmenopausal women: a follow-up study.
    Braam LA, Hoeks AP, Brouns F, Hamulyák K, Gerichhausen MJ, Vermeer C.

  • pmpctek

    5/11/2009 4:10:00 AM |

    Over the last year, I have seen about a dozen physicians (for a reason other than heart disease).

    Be they a GP, cardiologist, pulmonologist, oncologist, or hematologist, they all tell me the same thing; we all "naturally" develop coronary plague as we age and that it can only be minimally "managed" by lowering our cholesterol with -insert your statin drug here.

    Every time I reply with; there is nothing natural about having calcified plaque build up in our coronary arteries at any age and that it can be very effectively managed by following Dr. Davis' "Track Your Plaque" protocol. (As I pull out your book to show them.)

    The physician then usually looks at me like I have two heads and dismisses me by standing up to signal that the visit is over.  Except for one physician, honestly, who responded by reaching for his script pad and saying that he would like to start me on an antidepressant medication right away... lmao.

    I have now given up looking for any local physician who would be willing to help me in any way with the heart scan/track-your-plaque program.

  • Dr. William Davis

    5/12/2009 1:06:00 AM |

    Antidrugrep--

    Actually, that generalization was intended principally for the sorts of primary care docs who wouldn't read a blog like this. You are clearly the exception.

    If you had responded that most cardiologists are knuckleheads out for a buck, I would have agreed, too.

  • Dr. William Davis

    5/12/2009 1:08:00 AM |

    Kismet--

    Thanks for the references. I hadn't seen the Shea study; the findings are interesting.

    We haven't had enough people have pre-K2 and post-K2 heart scans, so it's hard to know what effect it ADDS to the existing battery of strategies. Nonetheless, K2 is definitely on the list of most promising. Given its benign nature, I do encourage people to add it, though dosing remains entirely uncertain.

  • Anonymous

    6/2/2009 1:25:26 PM |

    I seem to be developing atherosclerosis at age 26 and I've been doing a lot of research. B12 and Vitamin D are related, but you should also be aware of magnesium. See the study at Comparison of Mechanism and Functional Effects of Magnesium and Statin Pharmaceuticals. In this study they basically explain how magnesium works as a natural statin and calcium channel blocker. If you do further research online you may become convinced, as I am, that magnesium deficiency is just as widespread as Vitamin D deficiency.

    You need to take a chelated form of magnesium, such as glycinate, because other forms (like magnesium oxide) are poorly absorbed by the body and not worth the money.

  • buy jeans

    11/3/2010 6:34:52 PM |

    I would predict that the cardiologist is among the conventionally-thinking, "statins drugs are the only solution" group who follows his patients over the years to determine when a procedure is finally "needed." In fact, I know many of these cardiologists personally. The primary care physicians are completely in the dark, usually expressing an attitude of helplessness and submitting to the "wisdom" of their cardiology consultants.

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    12/15/2010 7:58:47 PM |

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