Statinators spill the beans

Oftentimes people become so fixed in their thinking – and in their belief that everyone else thinks the same way – that they unwittingly raise the curtain and expose the wizard of their flawed thinking, showing it for what it really is.  Statinators have done just that in an article in the current issue of the Journal of the American College of Cardiology (JACC).

The study, Effects of High-Dose Modified-Release Nicotinic Acid on Atherosclerosis and Vascular Function, compares the increase in carotid artery plaque over a 12-month period in subjects taking niacin versus those taking a placebo.  It turns out that those subjects taking the niacin experienced a shrinkage of their plaque whereas plaque grew larger on those taking the placebo. The revealing hitch in this study is that both groups were on statins, which means the group on statins alone was the placebo group.  Therefore the data from this study shows that statins alone do not reverse the growth of plaque (at least not plaque in the carotid arteries) despite lowering LDL levels.  Taking the logic a little further, the data from this study gives weight to the idea that a lowered LDL doesn’t reduce plaque growth.

There is a lot we can glean from this study and the from the authors’ commentary on it.

Let’s take a look.

Researchers randomized 71 subjects–all of whom were on statins and all of whom had low HDL-C and either a) type II diabetes with coronary artery disease or b) carotid or peripheral atherosclerosis–into two groups.  The researchers did magnetic resonance imaging (MRI) studies of the carotid arteries of both groups, then started the subjects in the study group on niacin while the subjects in the other group got a placebo.  Subjects in both groups continued with their statin therapy.  At six months and one year later, MRI studies determined the degree of carotid atherosclerosis and whether it had increased, decreased or remained the same.

After one year, it was found that the subjects receiving the niacin along with their statin significantly reduced their carotid atherosclerosis as compared to those subjects on placebo.  And remember, the placebo group of subjects were also on statins and still experienced an increase in their carotid atherosclerosis.

Almost 90 percent (63) of the 71 subjects were males with an average age of 65.  As I’ve discussed previously, there is no evidence that statins provide any benefit in terms of decreased overall mortality to females of any age or to men over the age of 65 regardless of their state of health.  The only group that statins has shown to provide any benefit for in terms of decreases all-cause mortality (the only statistic that really counts) is men under the age of 65 who have been diagnosed with heart disease.  Even in that group, benefit is so small as to be questionable.  Knowing this, we can say (assuming an equal distribution of under 65 and over 65 to get an average of 65 years old for the group as a whole) that the majority of people in this study were taking statins unnecessarily.  Those males in the study who were under 65 and who had been diagnosed with heart disease were really the only ones who (according to all published research) may have received long-term benefit from the statin therapy.  This aside has nothing to do with study or its outcome, it’s simply my commentary on the widespread overuse of statins. So back to the study…

The authors reported on changes in blood values, blood pressure and body weight between the groups:

In the NA-treated [niacin-treated] group, mean HDL-C increased by 23% and LDL-C was reduced by 19% at 12 months. Triglycerides, apolipoprotein B, and lipoprotein(a) were significantly decreased by NA compared with placebo. CRP was decreased by NA compared with placebo (p = 0.03 at 6 months, p = 0.1 at 12 months). Adiponectin was significantly increased at both 6 and at 12 months (p < 0.01). From the safety perspective, minor transient elevations were noted in creatine kinase and liver enzymes, but no significant, sustained elevations (>3× the upper limit of normal for 2 weeks) were observed in any subjects. Fasting glucose did not change significantly, but glycated hemoglobin showed a small increase in the NA group versus placebo (p = 0.02 at 6 months, p = 0.07 at 12 months). Blood pressure and body mass index did not change significantly in either group.

As any of you who have taken niacin will understand, about 10 percent of the subjects dropped out because they couldn’t tolerate the flushing, itching and GI side effects of the niacin. (Some people have had good luck with taking niacin as inositol hexanicotinate, marketed as ‘No-flush Niacin’ though the tolerance for this form isn’t perfect either.)

Those subjects who were able to tolerate it had niacin (nicotinic acid) added to their statin dose and experienced a slight decrease in carotid plaque volume.  Meanwhile those on statins alone had their plaque volume increase.  Below is a representative MRI showing the difference:

NA images2

To the untrained eye, these kinds of studies are difficult to read.  Even to the trained eye, they can be misread, so there have been computer programs designed to calculate the plaque area so that it can be quantified.  You can see the results graphically below:

NA2

Before we all start thinking the combination of statins and niacin (nicotinic acid in the graph) is the second coming as far as atherosclerosis treatment is concerned, let’s be aware of a couple of facts.  First, these differences in plaque volume don’t really mean squat in terms of blood vessel functionality.  As the authors stated:

Neither aortic distensibility nor flow-mediated dilation of the brachial artery was significantly altered by [niacin] treatment.

The terms “aortic distensibility” and “brachial artery dilation” are measures of arterial function, and neither changed.  Also, as you can see from the MRI above, the differences in plaque size don’t seriously compromise the open area in the artery through which blood flows.

The fact that none of these indicators of functionality changed and the plaque shrinkage didn’t make a measurable dent in the blood-carrying capacity of the arteries means that none of these subjects really got any short term benefit from the therapy in terms of true risk reduction.  Maybe subjects who were worse would have, but we don’t know.  And maybe if the therapy continued for the long term, really remarkable changes between the two groups would begin to become manifest. But we don’t know that for sure, either.

What I found the most interesting about this study is what it didn’t say.  Or, I guess, a better way to put it is what it said, but probably didn’t intend to say.

If you were to ask any statinator worth his/her salt what it would take to really significantly reduce the risk for heart disease, he/she would tell you to try to get LDL-cholesterol levels below 100 mg/dl.  If you then asked, “Well, what about if we got those levels to 80 mg/dl, what then?”  You would be no doubt told that the risk for heart disease would then be minimal.

Well, the subjects on placebo – those on the statin alone – in this study had their LDL-cholesterol levels below 100 mg/dl.  In fact, at baseline their LDLs averaged 84 mg/dl and fell to 80 at six months and one year.  Yet their plaque continued to grow.

We can conclude from this study that reducing LDL to these low levels doesn’t stop plaque growth.  We might also conclude that LDL levels may not have a whole lot to do with heart disease.  We can’t really make that conclusion definitively from this data, but it sure adds strength to that hypothesis.

In an JACC editorial (available by subscription only) about this study, the author begins thus:

Despite the substantial clinical benefit offered by potent low-density lipoprotein (LDL)-reducing therapeutics such as statins, a majority of patients will still experience major cardiovascular events.

Hmmm. Let’s tease out all the information loaded into this one sentence.

Despite “substantial clinical benefit” provided by statins means the substantial treatment of lab values, i.e., LDL-cholesterol lowering.  Statins lower LDL-C; no one denies that.  But to what end?  The last half of the sentence tells us:  A “majority of patients will still experience major cardiovascular events.”  If what you’re trying to do is reduce LDL levels, sounds like statins are the drug of choice.  But if what you’re trying to do is reduce heart disease, maybe not.

We know for certain that statins reduce LDL, so the sentence also tells us that LDL may not have squat to do with heart disease, since significantly lowering it obviously doesn’t accomplish a lot.

Now, here’s how the authors of the paper started out in their introduction:

Atherosclerosis is a systemic condition in which coronary, carotid, and peripheral arterial disease frequently coexist.  In patients with atherosclerotic disease, low-density lipoprotein cholesterol (LDL-C) reduction with [statins] has consistently shown reduction in major cardiovascular events and mortality.  However, treatment of LDL-C with statins prevents only a minority of cardiovascular events.

Another few sentences filled with interesting truths.  What the authors say about statins reducing “major cardiovascular events and mortality” is true as long as the word ‘mortality’ is associated with ‘cardiovascular.‘  In those who take them, statins do indeed reduce the incidence of cardiovascular events and deaths due to cardiovascular events.  What isn’t said in this sentence is that the decrease in cardiovascular deaths the statins prevent is more than made up for by deaths from other disorders that statins likely cause. As far as your risk for death is concerned, taking statins is a zero-sum game: you don’t die from heart disease but you do die from something else within the same period.  What you want to do is not to die.  Or at least not for a long time.  You want to decrease your all-cause mortality, i.e., deaths from all causes, not simply switch from one form of death to another.

Also in the above paragraph, the authors – statinators to a man (or woman), I’m sure – state that treatment with statins “prevents only a minority of cardiovascular events.”  From this last sentence, we can once again draw the conclusion that – at least in the minds of true believers of the lipid hypothesis – lowering LDL doesn’t do diddly to reduce heart disease.  Yet they all continue to try to treat it by lowering LDL.

I’m glad researchers are looking at niacin as a supplement to be used in the treatment of heart disease.  As I’ll discuss below, they have ulterior motives in doing so, which is why they combined niacin with a statin instead of having an arm of the study with niacin alone.  About 12 or 13 years ago MD and I found ourselves FAB (flat-a**ed broke) after sending three children through expensive private universities.  We had just written and published Protein Power, but it hadn’t started to sell, and we didn’t know if it ever would.  Our agent approached MD (who can write like the wind) about being the ghostwriter for one of the major university family medical guides (I can’t tell you which one, but it’s one of the Harvard-, Johns Hopkins-, Mayo Clinic-type of giant family medical guides than many of you may have in your homes) for a nice chunk of change.  She didn’t want to do it, and I didn’t want her to do it, but we decided that she should because it would probably make Protein Power a success.  Why did we decide this?  Because that’s how fate works.  We reasoned that if we didn’t take the deal, Protein Power would die on the vine, and we would be wishing that we had taken it.  If we took it and Protein Power took off, then we would be wishing that we hadn’t taken the ghost writing deal and could buy our way out.  We took it, Protein Power took off (thank God), and MD bought out of her contract after having written about four fifths of the book.

During this awful project, I did a lot of the research and MD did all the writing.  Plus MD did all the teleconferences with the major university honchos whose names are actually on the book.  After each of these conferences she would run for the wine, because these guys (all were guys) were so detached from reality that it was impossible to deal with them.  They were so hidebound in their mainstream way of thinking that no amount of reasoning could dissuade them.  Which is why MD didn’t want her name anywhere on the book.  She didn’t want to be associated with such idiocy when she had had years of hands-on clinical practice teaching her that most of what these people – who probably hadn’t treated patients in years, if ever – believed was bunk.

Where this dreary tale is leading is that during the research for this book, we determined from all the published data out there that niacin was the only substance that had ever been shown to actually reduce all-cause mortality in cardiovascular patients.  That was in the mid-to-late 1990s and now they’re just getting around to evaluating it again.

So why after all these years are they now looking at niacin in conjunction with statins in this study?

Follow the money.

Robin Choudhury, in whose lab this study was done, is on the payroll of several statin manufacturers, including Merck.  The study was underwritten by Merck, the maker of Mevacor and Zocor.  Okay, so why would statinators and statin manufacturers want to add what is basically a nutritional supplement to their beloved statins?  A discussion in an online cardiology site tells the tale.

From heartwire (requires free registration):

The paper comes as anticipation builds for the ARBITER-HALTS 6 study results. ARBITER-HALTS 6 is an imaging study comparing changes in carotid intima-media thickness in patients treated with ezetimibe (Zetia, Merck/Schering-Plough) or extended-release niacin; market analysts are already predicting a win for niacin. As previously reported by heartwire, ARBITER-HALTS 6 was stopped early: full results will be presented Monday, November 16, 2009 at the American Heart Association meeting in Orlando, FL.

So, it appears that extended-release niacin is going to kick tail when compared heads up to Zetia, or at least that’s the way the market is betting it.  And that’s usually because the market has info that the rest of us don’t.  If niacin is the clear winner, the press will be all over it and many people (and their physicians) will be wanting to switch from other cholesterol-lowering drugs to niacin.

With this study in hand, Merck and the other statin manufacturers can say, “Don’t give up your statins; the science shows that statins plus niacin is the effective combo.”  Just keep your statin and add some niacin. And prescription niacin, to boot, so it all stays in the Big Pharma family.

Which is why – as heartwire reported – this paper is coming out now: to beat the rush.

We’ve learned a couple of things from this study.

First, we’ve learned that we have here a randomized, double-blind, placebo-controlled study showing that statins reduce LDL but don’t stop the progression of atherosclerosis, which, after all, is why we would take them.

And we have learned from reading between the lines in this study that statinators don’t really believe their own hype.  As Samuel Johnson said about second marriages, the statinator’s reliance on statins as a cure all for heart disease “is a triumph of hope over experience.”  Things haven’t really changed since MD wrote the family medical guide. If you’re worried about heart disease, take some niacin, the only substance yet that has been shown to decrease all-cause mortality. And it doesn’t have to be the prescription variety.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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76 thoughts on “Statinators spill the beans

  1. I’ve read on Dr. William Davis’s, Track Your Plaque Blog & Forum that taking Niacin should only been done under doctors supervision – and then single dose per day (possible liver tox issues) – AND NOT the no flush variety as it is non efficacious.

    However would you recommend taking Niacin – and what minimum-optimum dose would be effective and safe, purely as a preventative?

    Thank you,

  2. Hi Mike,

    I guess we are all concerned about heart disease. Long term low carbing improves your chances but clearly doesn’t make you immune. If I was to add niacin to the list of preventative supplements (like CoQ10 and krill oil) what sort of dosage should I be looking at, and does it need to be B3 on its own or would a B complex pill (easier to get here without prescription) do the same job?

    Oh, and while I’m here (sorry to be a pest) but do you think you could send Loren Cordain another polite reminder? Thanks in advance to both of you.

    Cheers,

    Malcolm

  3. Thanks for this Mike, I miss your study breakdowns!

    Forget “adding prescription niacin,” methinks that BP is working on a combined statin/niacin single pill to make sure those on their current statins can easily incorporate a vitamin that will actually prevent death!

  4. My husband suffered a heart attack at age 39 and has been on statins since then. He is now 54. Shortly after the MI, I started reading bad stuff about statins. I passed this info on to my husband, he, like most men, no offense, ignored what he didn’t want to hear. Some time later I got him to ask his doctor about taking niacin. The doctor said it couldn’t hurt and approved it. It tooks some adjustment and going to flush free, but he has taken it consistently for many years not. I think the doc managed to put him prescipt niacin, hooray for big pharma !!! After reading your post here I am so thankful that he started taking it when he did. He has not suffered another MI. He has very slowly come around to the concept of lowering his sugar intake and actually allows me to cook with butter. He does use “spray margarine” at the table still??? He still refuses to let go of the statins even though his memory is shot and he has constant muscle aches and pains. I have forwarded hundreds of articles about the side effects and inefficiency of these pathetic drugs but to no avale. I will try to get him to read this one too. Hopefully he will get the point and drop the cholesterol myth and the statin drugs. If not at least the niacin may be protection for his heart, if not his brain, his liver and everything else adversely affected by statins.

  5. Nice Work Dr. Eades

    It always make me suspicious when a study with images uses before and after pics that are obviously not at the same anatomic level. I am referring to the small veins showing flow related enhancement adjacent to the carotids on the Niacin images.

    Also, are those error bars I see? And why are they one- sided? I hope they didn’t inappropriately use single tailed distributions in their statistical assumptions. You can’t assume which way the change occurred, that is what you are testing! Color me skeptical of anything published by industry- funded academic cardiologists. At least the the private practice ones are honest about what they do. It reminds me of Ornish’s unrepeatable plaque regression studies ( with 5 variables changed at the same time)

    PS As a former academic, I could tell you stories you wouldn’t believe, but I’d risk being sued.

  6. Hi Dr. Eades,
    I am a 47 year old woman. I am a healthy weight, I don’t smoke, my blood pressure averages 116/75 and I eat healthy (at least compared to most American’s diets) and take good quality multi vitamin/mineral and antioxidant supplements on a daily basis (including 2000 mg of cold water fish oil). I don’t do fast food and I gave up red meat almost two years ago. I brisk walk every single day an average of 45 minutes and additionally I attempt to do some strength training two to three days a week. I don’t drink much alcohol though I am tempted to increase my consumption of wine since I’ve read so many good things about the Resveratrol in red wine.

    My only health issue is high LDL and Triglycerides (my HDL was high). It seems that high LDL runs in the family. My heart is healthy and there is no history of bad heart health on either my Mom’s or Dad’s side. My Gradparents lived to ripe old ages and relatively healthy (except one Grandma that died from Emphysema which was self induced from years of smoking). My Doctor is really pushing me to take statins to lower my LDL and Tgs but I am hesitant because I have a gut feeling that the cure (statin) is worse than the HDL problem especially since I don’t have any other health risk factors. I was enlightened to read your take on the findings regarding research with Niacin therapy. That statins lowered LDL but didn’t reverse the plaque. So maybe high LDL doesn’t cause the plaque that clogs the Carotid artery. So why are so many Americans on statin drugs? What are the ill effects of high LDL and Tgs? What (if anything) should I do to lower them? I prefer a natural remedy versus conventional Rx meds. I am also willing to alter my diet if there are foods I should or shouldn’t be eating. Your feedback would be greatly appreciated.

  7. Pursuit of money is ever-present. My 86 year old MIL takes Advicor (niacin + lovastatin). This combines a vitamin with a generic drug to create a patentable drug that is very expensive. Do primary docs even think about this stuff?

    Also–why would an 86 y.o. woman take a statin? Because my doctor sister-in -law tells her to, and she lives nearby. At the next visit, I will again push for dropping the statin.

  8. In video gaming parlance, I would say that you “pwned” the statinators.

    Please feel free to use this term in a future article.

    :)

  9. Welcome back! This was another good article – hope you’ll be commenting on the LA Times article on bariatric surgery. (I couldn’t believe they were advocating this surgery for normal weight people!!)

  10. Yes, statins are not great for all, but for some perhaps. What would you recommend for someone with documented coronary disease- calcium score- who cannot take Niacin? Seems that statin might be a reasonable choice for someone under 65 who low carbs and has hormone levels and weight all normalized.
    Most would say that the LDL levels of 80 for those with heart disease is still to high and 60-70 would be a more appropriate target. On top of which LDL particles amount and size are really what count. Perhaps these were not lowered enough to see meaningful regression.
    While studies are good to prove a case either way, Doctors must remember that the population they are treating when any patient walks in the door is N=1.

  11. Thank-you Dr. Eades for sharing your latest findings with us. If it wasn’t for doctors like you sticking your neck out to expose the real truth behind these cholesterol-lowering ( statin) drug studies, I would have never had the guts or the knowledge to take the action that I did of stopping the doctors from prescribing statin drugs to my 88 year old mom. My mom’s quality of life is a lot better (not perfect) but much, much better from being off of Lipitor. Thanks again.

  12. I’ve been taking immediate-release niacin for over 6 years now. For the first five years, I dutifully followed a “heart healthy” diet keeping down those deadly “saturated fat” and consuming a lot of polyunsaturated fats. My cardiologist was thrilled last year when my total cholesterol was 97 and my HDL was 42, up from 32 when I started niacin. Shortly thereafter, I started reading all this subversive literature on low-carb.

    Long story short, I now consider saturated fat a health food and most foods with sugars are now “too sweet”. I still take niacin to improve my lipids parameters. Oh, and eating this way raised my HDL to 76. My cardiologist still wants me on a statin because my LDL is way too high at 85! Unbelievable. If I were to push him on my elevated HDL, we would dismiss it saying that there have been no case studies proving that raising HDL that much helps. He’d be right though. In his world, there is no way to increase HDL 130%.

  13. Dr. Davis says the no-flush variety of niacin is worthless. He does have some strategies for avoiding the annoying side-effects though.

  14. I too am a wife of a hubby with Heart Disease and he has been following the Dr’s advice of statins but luckily has also been taking Niacin along with the drug. I will make a copy of your article to take to his next appointment but it probably won’t make a difference as he never sees the actual Dr but either the Nurse Pract. or the Dr’s Assistant each time.
    I would love to get him on a Low Glycemic Load diet at the least and hopefully keep him around many more years as he has one artery completely blocked and one at 40% blockage by age 55. His father died of HD and I am sure it runs in his family but circumstances beyond his control doesn’t allow him to know precisely.

  15. Hi All. Great article. I just subscribed to the newsletter and was impressed what was said about Niacin and Statines.

    I have a story to tell. I am 60 years old and 5 years ago I had 2 stents in my heart. The first thing my cardiologist wanted me to do was to start on massive doses of statins since my LDL cholesterol was over 190. He wanted me to have it under 80, at least 100. I tried them and very soon decided that I rather died faster that taking stains, they affected my exercise tremendously, something very important for the quality of my life.

    I started to read and get information on the matter and decided to start fish oil and niacin supplementation with some other changes in my exercise and eating habits.

    When the doctor learned that I had stopped statins and that I did not care what my LDL was since I was eating saturated fat, meat, low carb, etc., , he said to stop seeing him. I was glad he said that. At the moment the only 2 things I take care of is that my HDL is above 80 and triglycerides 70.

    Since then I have started my own web site on fish oil, http://www.omega-3-fish-oil-wonders.com/, and I feel like a million bucks.

    Best wishes,

    Alfredo E.

  16. Tina,

    Too bad about giving up red meat. Red meat is good for you as long as it has enough fat and you don’t overcook it (rare is plenty cooked). You can cook your meat in butter and deglaze a sauce out of the pan to increase the fat in your meals if your butcher won’t leave the fat on for you.

    High triglycerides are largely caused by grains and sugars. Eliminate grains and sugars from your diet to knock them down. The fat from the red meat will also push down the triglyceride’s and improve your large particle LDL’s.

    The two remaining supplements that may be considered “globally useful” are Vitamin D3 (4000-10,000 IU’s/day) and niacin (at least 1g/day of slo-niacin or another “nicotinic acid” product, nicotinamide will not provide the cholesterol/triglyceride benefit).

    Trust your instincts on the statins. They won’t help anything and will make many things worse. If your doctor threatens to fire you as a patient, find another doctor. If you can’t stand up to your doctor, at least supplement Co-Q10 100-250mg/day to make up for the damage the statins are doing to your body’s Co-Q10 synthesis. Good luck in either case, you’re starting a swim against the tide of “common knowledge” about fats, sugars, and the drugs surrounding heart health. For now, this is a difficult swim.

  17. Dr. Eades,

    I admire all your work and insights!

    If you have time, please comment as well on the newest findings about Crestor — the one that is MOST highly associated with causing diabetes, Metabolic Syndrome, higher serum insulin and HOMA (insulin resistance). I think the statinators have slipped up yet again… The wonderful Greeks unveiled it. I look forward to reading your brilliance.

    B R I N G I T O N !!!

    Rosuvastatin treatment is associated with an increase in insulin resistance in hyperlipidaemic patients with impaired fasting glucose.

    Kostapanos MS, Milionis HJ, Agouridis AD, Rizos CV, Elisaf MS.

    Int J Clin Pract. 2009 Sep;63(9):1308-13.

    AIM OF THE STUDY: The increase in physician-reported diabetes following rosuvastatin treatment in the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin study has raised concerns whether this statin exerts a detrimental effect on glucose metabolism. We assessed the effect of rosuvastatin treatment across dose range on glucose homeostasis in hyperlipidaemic patients with impaired fasting glucose (IFG), who are at high risk to develop diabetes mellitus.

    METHODS: The medical records of 72 hypelipidaemic patients with IFG on rosuvastatin 10 (RSV10 group), 20 (RSV20 group) and 40 mg/day (RSV40 group) were reviewed. The median follow up was 12.4 weeks. At the first visit, prior to rosuvastatin prescription and at the latest visit, serum lipid profile and indices of glucose metabolism, including fasting glucose, insulin and HOmeostasis Model Assessment (HOMA(IR)) index levels, were assessed.

    RESULTS: Rosuvastatin treatment improved lipid profile and was associated with a dose-dependent significant increase in HOMA(IR) values by 25.4%, 32.3% and 44.8% at the dose of 10, 20 and 40 mg/day (p < 0.01 for all, p < 0.05 for the comparison between groups), respectively, mirrored by correspondent increase in plasma insulin levels [by 21.7%, 25.7% and 46.2% in the RSV10, RSV20 and RSV40 group (p < 0.001 for all) respectively]. Baseline HOMA(IR) levels was the most important contributor (R(2) = 68.1%, p < 0.001), followed by the dose of rosuvastatin treatment (R(2) = 23.7%, p < 0.01), in a model that explained 91.8% of the variability in HOMA(IR) increase.

    CONCLUSION: In patients with IFG and hyperlipidaemia, rosuvastatin treatment was associated with a dose-dependent increase in insulin resistance.

  18. “If you can’t stand up to your doctor”
    I suggest everyone grows a back-bone. Come on, its your body, your choice what you take. Doc’s can’t force you to be on a statin.

    Tina, like Ross said get rid of those grains and sugars, bring back the red meat. Read Heart Scan Blog.

  19. This confirms what I’ve learned over the past three years, when I quit statins abruptly and began taking niacin (about 5.5 grams per day). I do experience a little flushing on occaision, but it’s not unpleasant and lasts only a couple of minutes. And my test results are vastly improved over those I experienced when I was under the care of an internist who completely swallowed the Big Pharma lie about statins and most other things. Between niacin, Diamond V XPC and various other supplements and my very-low-carb regimen I’m healthier than I’ve ever been and enjoying life without any health concerns.

    And this blog certainly helps me stay that way. Thanks, Dr. Mike.

  20. If you think that’s impressive, you should read Broda Barnes. The patients he treated had 100% immunity to type 2 diabetes, and heart disease rates among his patients were 96% lower than in the general population. He too, was a proponent of a diet high in saturated fat.

  21. “And it doesn’t have to be the prescription variety.”

    Now the highest concentration of over-the-counter slow-release niacin that I’ve seen so far is 500 mg. Is 500 mg daily enough or should one go up to 1 gm a day?

  22. If Niacin is the panacea for heart disease – why not eat foods rich in Niacin ie Most Meats espeically Liver and other organs.

  23. Thanks Doc for such timely information.

    I don’t know why people worry so much about niacin and the liver. Read what Abram Hoffer, MD had to say about niacin . He was the one to discover the lipid lowering in the early 1950’s. He then went on to treat several thousand patients with niacin for schizophrenia.

    http://www.doctoryourself.com/hoffer_niacin.html

    Designs For Health makes a product called Niacin CRT which stands for controlled release technology. It works and patients get very little or no flushing.

  24. I don’t understand why Dr. Davis is so against flush-free niacin. I know he says it does not work and he is quite adamant about it. But if you look at sites where people are reviewing their taking of it , many say it really worked well for them.

  25. I have noticed some here report that No-Flush niacin is not efficacious..hummm…I have been selling it for about 17 years and have UNTOLD success stories with it.
    Also no-flush has been used and studied in Europe extensively.

    The liv-tox problem has always been a problem of the time-release niacin.

  26. Megadoses of vitamin C also have shown to decrease plaques in Linus Pauling experiments. Why can’t they cell vitamin C bundled in ?

  27. Low methionine diets dramatically increase longevity (PMID 12543260). Niacin can deplete methionine (PMID 11895163). Niacin decreases mortality (PMID 3782631). Perhaps its methionine lowering ability plays a key role.

  28. Just letting you know I got a nasty, obscene virus and I’m pretty sure it came from a “funny calendar” link off your twitter page. I don’t know if you can remove it or not, but it was awful. Hopefully I’ve got better virus control now!

  29. Carlson’s makes a timed-release Niacin (real nicotinic acid) which doesn’t make me flush.

    The tablets are compounded with Brazil wax in a patented process which results in slow release.

    It’s also very reasonably priced.

  30. Another cool blog post. I do take the Slo-Niacin recommended by Dr. Davis on a daily basis. Also take my D3, K2, fish oils – eat *no* grains, no sugars, no high-PUFA oils, eat my share of saturated fats (love my butter from grass-fed cows). I’ve lost almost 40 pounds this year (and over 90 since 2006) overall, even though (sadly) I still have a long way to go. I really *did* have hopes this WOE would help resolve some of my health issues.

    But my blood sugars are still on the higher side, and my doctor has just put me on metformin, My blood pressure is high and I was also just put on a blood pressure medicine. My LDL was 165 in the tests I had two weeks ago (TC was 229, HDL – 52, TG- 65) and based on the Total and the LDL I got the sense my doctor was just *itching* to suggest a statin, except I said flat-out I would never consider it. But she definitely wants my total under 200 and my LDL under 100.

    Not to mention that just this week I was also diagnosed with Hashimoto’s Disease and am told that I must now take thyroid supplementation! LOL, I love my low carb/paleo/VLC way of eating and feel better on it than I have felt on anything else in years – but I seem to be picking up *more and more* medications rather than fewer! My only hope right now is in reading that high blood pressure and high cholesterol are two classic symptoms of Hashimoto’s. So if I can get that one thing under control maybe the other two will resolve better also.

  31. Debbie’s comment – “But SHE (the DOC) definitely wants my total under 200 and my LDL under 100. ”

    But whose body, metabolism or life is it anyway?

    I have this strong sense: Too many in the medical profession hanker to be treated as authority figures rather than advisors. In fact the narratives presented in much of TV advertising show a former sufferer smiling gratefully at a strong authority figure in a pose whose subtext is “petitioner’s boon granted”.

    I was lucky to have studied and dormed with many medical ingénues, and KNOW how scientifically illiterate the majority were. It was an insight to see them a few years trying to fasten the cloak of Authority round themselves when they acquired the right, together with the stethoscope, to accompany Mr or Dr Consultant on hospital clinical rounds!

    When Medicine delivered much of its success from placebo reactions to ingestion of mild-effect treatments which treated a minority of sufferers, it was necessary to preserve Authority – but even then it was a (mostly) Benevolent Authority!

    Nowadays, Medicine provides treatments, including high tech surgeries and a plethora of highly effective drugs, which DO intervene in ILLNESS. (Even here, it seems the rate of discovery of highly effective drugs, has stalled – vide (Dr) Le Fanu’s The Rise and Fall of Modern Medicine.)

    It is the rise in medical practice of treating the RISK of getting a condition, rather than the condition, that practice has failed. Risk is (badly) correlated with a lab reading, then the lab reading is corrected with a drug. None of these people can either fool or intimidate me, ‘cos I know they can never supply a SCIENTIFICALLY justifiable reason for much of what is proposed. In addition, in many cases, their actual skill levels are not great, and they are shilling either for Big Pharma or Big Insurer. In addition, one is depersonalised to a Lab Reading! This may be a reasonable response in an Emergency Room or a Battlefield, but not in a General Physician’s Office.

    PS NONE of the above rant applies to Drs Eades, from whom I get a strong sense of practicing an individualised medicine.

  32. The problem I find with all of this, including the study above, is that we want to prevent heart attacks and death. Are heart attacks and death positively associated with carotid artery thicknesses? It is my understanding that this relationship is weak. Carotid artery thickness is an intermediary result, which may or may not portend whether one has a heart attack or not. For instance, read this:

    http://junkfoodscience.blogspot.com/2008/11/questions-media-didnt-ask.html

    Or this:

    http://junkfoodscience.blogspot.com/2008/11/questions-media-didnt-ask.html

    I’d be more impressed if they continued the study long enough to get a sense for actual heart attacks and deaths.

  33. @Desmondo–Agree completely. But the deification of physicians is a two-way street. In reality, even graduates of medical schools are constrained by the bell curve. They are technicians, and half of them are below average technicians, at that. But that won’t do. We all want magic, and we all want to live forever. So our doctors are like the school children in Lake Woebegone: They’re all above average. It’s loathsome and pathetic at the same time. But what are you going to do? It’s also very human.

  34. Dr. Eades,

    I have a work colleague who is on statins. He’s on a low fat diet as well, the whole nine yards of doing damaging cardio, too. He’s slimmed down over the last year by avoiding junk but he’s still eating a lot of carbs. His skin as of late (maybe it’s just me looking closer after he told me he was on statins) looks, how should I say, rather weak. Meaning, like it has all of the strength of a person placing a heavy object in the middle of a wet paper towel, and then trying to lift it up. He looks slimmer now, but somehow less muscular and a certain sheen that his skins gives off that just looks more indicative of pathology rather than less. I can’t put my finger on it, this waxy look almost. Have you ever seen this look before, and is it common amongst those taking statins who are also topping it off with a low fat diet?

  35. @Paleogarden:

    That’s how my sister looks! About a month ago I saw her for the first time in several years and was struck by her skin–so translucent, puffy and fragile looking. We’re both late sixties, grew up on the coast before anybody knew about sun damage, so of course we’re showing it now. But hers seemed so much older to me. We both have very high cholesterol (maybe FH). She’s been taking Crestor, I’ve been eating butter. I have a lot of surface damage on my skin, but the structure is firm, if you know what I mean. We had breakfast together–she had a fat-free sugary yogurt with fresh peaches added. I had three soft boiled eggs and threw a bunch of butter in. We were both shocked at each others’ meal, but refrained from saying anything.

  36. Hi, i have a question. Do you think that the less carbohydrates we eat in the day, the easier it will be for us to burn fat? and to get more muscular? I mean can we burn fat more efficiently by ingesting 10 to 15 grams of carbohydrates a day compared to taking 60 grams of carbohydrates a day?

    Because remember that some low-carb diets are divided into 2 kinds. A real low carb diet and a higher low-carb diet of around 50 to 70 grams of carbohydrates a day like the phase 1 of the Protein Power low-carb diet, and the South Beach low-carb diet.

    Thanks and i would like to know what do you think

    .

  37. Hi Dr. Eades,

    Thanks for this amazing blog! I’ve always been interested in nutrition, yet only recently discovered this whole new world of “non-conventional” wisdom, which I apparently glossed over, like so many. In response to this post of yours, I actually had a question. In light of the data presented about statins and their insignificant efficacy for treating cardiovascular desease or all-cause deaths, I was wondering what you would recommend for someone, like me, who has familial hypercholesterolemia. At young age I always had cholesterol levels ranging from 400-500 and have been on Lipitor (20mg) now for about 5-6 years, I am currently 23 years old (cholesterol levels now slightly under 200). I’d love to stop taking them due to side effects, yet, I’m not sure if this would be best due to the large increase in cholesterol levels. My diet for the past few months has changed to the one you and Dr. Kurt Harris recommend, and plan on continuing it. My internist has always told my family that our diet is irrelevant as long as we’re on statins (hmmm…), so I’d appreciate another opinion. Thanks!!

  38. The ARBITER-HALTS 6 study has been released, but seems to also test niacin + statin against Zetia + statin (i.e., Vytorin).

    Why no study of niacin alone? Are the statinators that afraid?

  39. A cardiologist I persoanally know (who worships at the altar of statins) likes to say that the Scandinavian Simvastatin Survival Study proves that lowering LDL results in 30% reduced mortality in patiets with CAD. Have you analyzed this study previously, and if so, what are your criticisms about it?

    I have analyzed it, and I have multiple criticisms. I’ll need an entire post to describe fully.

  40. The main criticism I hear from cardiologists about the study you cite in this article is that the sample size is too small to make any conclusions. Do you think that criticism is valid?

  41. 1. With statins, I get pain in my joints, especially hips and shoulders.

    2. With niacin, I get facial flushing.

    3. With high doses of niacin, I get strange headaches accompanied by a brain-fog type of confused thinking.

    4. With no statins and no niacin, I feel great.

    Guess which option I choose? (you only get one guess.)

  42. I did low carb, high fat for a decade before dying (yes, I was clinically dead for nearly fifteen minutes receiving cpr until a rescue squad arrived to defibrillate me) for coronary artery disease. I had an emergent bypass and now take a medium dose statin along with enjoying a totally plant-based diet. My current numbers are total cholesterol 112, ldl 53, hdl 45 (these are sometimes reversed with similar values), triglycerides 68 and fasting glucose 86. There are several studies that document better maintenance of vein graft patency with statins. I receive niacin within a high-end vitamin (Life Extension Mix) that I take. How much niacin is necessary for an efficacious effect?

  43. The pains are sometimes reflected as something very badly; this is a warning of some ailment which we pruned to suffer. Sometimes we feel a pain in the waist and one in one of the kidneys which we can worry about. These pains are deceptive and sometimes the importance is not relevant. For this reason it is recommendable to get a physical control to recognize the ailment that causes the pain and power and to fight its origin. The pain in the waist, that can be acute or long lasting can return as chronic and is know to medics as lumbar pain. This is a disease that strikes millions of people throughout the world; findrxonline and said that according to statistics 70% of people who have suffered at some point in their life.

  44. My Dr gave me a prescription for Niaspan which would have cost 90 dollars for less than 100 tablets. I went to Vitamin World and picked up 200 tablets of niacin for $18. Good news for those who are interested–the flushing and itching is reduced with regular use.

  45. A story ran on national television two nights ago on the early signs of CVD risk showing up in young school age children. The story showed footage of public health officials screening children by taking their weight, blood pressure and testing their cholesterol (on the spot with a test kit). Apparently it only takes about 5 minutes to get the results of a cholesterol test done in this manner. One in six children were found to have high cholesterol which an official from public health stated in combination with saturated fat was “plugging the arteries” of these children.

    By this point I was starting to wonder what the motive is behind this campaign. Was it sincere concern over the development of CVD risk by our public health officials? if so, then they are either spectacularly incompetent or trying to deceive us. Whatever the reason I think it probable that the outcome will be that when the children with high cholesterol take their test results accompanied by the dire warnings that their arteries are clogging (pure, unsubstantiated speculation) home that most parents will rush their child to an MD who will promptly prescribe a good (expensive) brand of statin that they will probably be on for the rest of their life.

    To me this campaign reeks of a covert marketing program by the makers of statins whose real concern is their financial health.

  46. Maggie,

    I love your line: “She’s been taking Crestor, I’ve been eating butter.”

    I noticed our family’s skin has improved since eating lower carb and switching to pastured dairy.

  47. Another theory on why they are testing these nutrients (which as you mentioned is following the money) is because of their patent expirations. As you may know, Lipitor’s patent expires in 2010. Years ago when I was working in a phase I research facility, we were giving subjects statin’s (don’t know who’s statin) that were mixed with CoQ10. This of course would be consider a new drug by FDA guidelines. Here’s the kicker, once the pharmacokinetic/dynamic research came out “clean and safe”, the FDA would in essence fast track the approval of the new drug (statin/coQ10) because statin research already proved safety and coQ10 is an over the counter supplement. Voila! 10 more years of patent coverage on a new/old drug. I would have expected to see a statin/niacin drug released from Big Pharma.

  48. Jim Purdy, my father, in his eighties at the time, was getting shooting pains up his legs from his statin. The doctor told him to get CoQ10 over the counter. With only 30 mg, his pains disappeared. I tried to explain to him that statins fool around with the natural supply of CoQ10 in the body, and that at his age, it was not a good thing to be taking a statin, but he wouldn’t hear what I had to say.

    He ended up dying from cancer anyway, and I believe there is some evidence that statins encourage the formation of cancers in the body. I know that he was trying to extend his life by taking the heart meds that his doctor prescribed and it’s an irony that those meds probably shortened it.

  49. A story ran on national television two nights ago on the early signs of CVD risk showing up in young school age children. The story showed footage of public health officials screening children by taking their weight, blood pressure and testing their cholesterol (on the spot with a test kit). Apparently it only takes about 5 minutes to get the results of a cholesterol test done in this manner. One in six children were found to have high cholesterol which an official from public health stated in combination with saturated fat was “plugging the arteries” of these children.

    By this point I was starting to wonder what the motive is behind this campaign. Was it sincere concern over the development of CVD risk by our public health officials? if so, then they are either spectacularly incompetent or trying to deceive us. Whatever the reason I think it probable that the outcome will be that when the children with high cholesterol take their test results accompanied by the dire warnings that their arteries are clogging (pure, unsubstantiated speculation) home that most parents will rush their child to an MD who will promptly prescribe a good (expensive) brand of statin that they will probably be on for the rest of their life.

    To me this campaign reeks of a covert marketing program by the makers of statins whose real concern is their financial health.

  50. Thank you so much, Dr. Eades for sharing all the information in this and the other articles on Statins.
    After taking Lipitor for approx. 15 years my husband developed sever leg pains and his pharmacist told him to stop immediately which he did, and the pains went away.
    He has been off Lipitor for 6 months and on his last blood test his cholesterol was elevated and his doctor has now prescribed Crestor.
    I am positive after reading Protein Power if he limits his carbs his cholesterol will come down., It is sad indeed that there is so much controversy about this .Needless to say I am keeping up with all your tweets. Kindest regards
    Joan Mercantini

  51. I have given a great deal of study and thought to niacin as I am using it to treat liver disease – as an antifibrotic – and it appears to have worked.
    I use mainly niacinamide and no-flush niacin. These will lower LDL – it just takes longer; and raise HDL, perhaps more quickly.
    Niacin is converted to niacinamide, which requires glutamine (no problem on a high-protein diet), and any excess is converted to methyl-nicotinamide for excretion.
    this makes it a strong methyl-acceptor, which can cause the problems. For one thing, it lowers production of adrenaline, so can cause depression. But if you supplement B12 (preferably methylcobalamin) and folic acid you should never get these problems, at least I never did.
    High doses of niacinamide can elevate homocysteine, B12 and folate lowers homocysteine, so we’re OK there.
    Niacin(amide) protects nitric oxide production by lowering asymetrical dimethyl-arginine (ADMA), which inhibits NO.
    Niacinamide inhibits the activation of hepatic stellate cells (HSCs), which cause liver fibrosis and cirrhosis, and induces apoptosis of activated HSCs. This makes it very protective of the liver in chronic conditions such as Hep C or alcoholism. It is also proven to be effective against rheumatoid arthritis. In general it lowers symptoms associated with many autoimmune diseases and allergies. And of course it is the supplement of choice in schizophrenia and bipolar disorders.
    If it was a drug, it would be as popular as aspirin. Or, statins…

  52. Niacinamide can cause depression by lowering adrenaline. But if you have anxiety, this is a good thing; and niacinamide also elevates low serotonin levels. So it is more likely to help an anxious, depressed person than it is to depress a normal person, which takes a higher dose.
    Here we have a non-addictive vitamin which can replace statins, prozac and valium. Generally vitamins and antioxidants are talked up enough online and I feel no need to add to that. But niacin and niacinamide, because of their misunderstood reputation for toxicity (which happens in very rare cases, usually for good reasons) is neglected.
    So I have no hesitation in broadcasting the fact that this stuff is a panacea, in the same class as vitamin D and ascorbic acid. It needs (debateably) a little more care in its use, but can produce at least as impressive results.