43 replies to this topic

[niner]

After twisting my doctor's arm to order a VAP test, I've discovered that I have high lipoprotein(a). This is a bad thing, as it is aggressively atherogenic. I'm just beginning to learn about it; so far, the Berkeley Heat Lab's Clinical Reference Manual is the best survey of the literature I've found. I happened across a discussion in a cardiology forum that seems to have a lot of practical information from clinicians who deal with it on a regular basis. They are really sold on Niacin as the best treatment for high lp(a), which was also the conclusion of the Berkeley Lab review. My lp(a) from the VAP test is 28mg/dL, and their target for it is <10. Most of the primary literature made it sound like <30 was OK, but there is a lot of inconsistency in measurement of lp(a), and apparently you need to multiply the VAP numbers by 4 (At least I think that's the conversion factor; I'm still looking into it.) to compare to the literature. Thus my lp(a) is 112... not good. This is the sort of thing you find in people who appear to be in great shape and have good conventional CVD markers, then they drop dead of an MI in their 40's. Lipoprotein (a) is an evolutionary adaptation; it enhances blood clotting when you get slashed by a saber-toothed tiger or the guy in the cave across the street, but is now just a thrombogenic/atherogenic bad actor.

One of the ways to deal with high lp(a) is to be more aggressive with your other CVD risk factors. My total LDL is borderline high (147) by conventional measure and 126 by VAP. My HDL is 81, Trigs are 69, and LDL size profile is the healthy type A. The obvious thing to do here would be to push the LDL down to <100, and I'm considering a low dose statin, in addition to niacin. William Davis at TYP pushes high dose (6g/d) fish oil for treatment of lp(a), along with normalization of hormones with physiological doses of DHEA. My T is on the low side, so that's something to think about, complicated by a bad family history for prostate cancer. As far as lp(a) treatment goes, Davis is an outlier compared to the cardiologists at theheart.org. (the forum linked above) I'm taking 2g fish oil at the moment, and will probably stay there, or maybe go to 3.

What do you guys think about lp(a) and its treatment? Does any know if the VAP factor of 4 is the right way to look at it?

[rwac]

Do you know if your testosterone levels are good? Because low testosterone levels in combination with higher cholesterol points to a lower metabolism, you might want to consider increasing your metabolism instead of statins.

You may also want to read these:
http://chriskresser....-disease-part-3
http://blog.choleste...k-low.html#more

I'd be wary of long term fish oil supplementation.

[Lufega]

What's your TSH value ? Are you using any iodine ? You could have also measured Lp(a) on its way down since you've mentioned in other posts how you cut out wheat, etc. It might simply be an issue of sticking to your current diet and maybe tweaking it with extra niacin, iodine, coconut oil, etc.

[niner]

What's your TSH value ? Are you using any iodine ? You could have also measured Lp(a) on its way down since you've mentioned in other posts how you cut out wheat, etc. It might simply be an issue of sticking to your current diet and maybe tweaking it with extra niacin, iodine, coconut oil, etc.

My TSH is 1.51 mIU/L. What do you make of that? The lab gives a normal range of 0.34-5.6. I've been using iodine for about 2 years (225mcg), and I've noticed a significant improvement in mood, at the least. Everything I've read about lp(a) says that it's entirely genetically determined and that diet and exercise won't move it at all. Niacin is looking better all the time; statins less so. The data on statins with lp(a) is really mixed. Some papers find atorvastatin brings down lp(a) significantly, I found at least one experienced clinician who says it raises lp(a), though there are a couple other statins that he says are lp(a)-neutral.

A data point is my younger brother, who over his entire life has been more health conscious and in better shape than me (until the last 4 years or so where I've really come around). For some reason he had a carotid ultrasound, and they found a moderate level of plaque. Since lp(a) has a strong genetic penetrance and is a dominant trait, he has at least a 50% chance of having high lp(a). I should probably get a heart scan...

[rwac]

My TSH is 1.51 mIU/L.

Thats "normal", but people with normal values (like yours truly) do benefit from some thyroid supplementation. I'm currently on 10-15mcg T3 daily. You might also want to make sure you're getting enough selenium which is needed to convert T4 to T3.

I would recommend some OJ to help the liver, but you're low-ish carb right?

[rwac]

Triiodothyronine rapidly lowers plasma lipoprotein (a) in hypothyroid subjects.

[niner]

My TSH is 1.51 mIU/L.

Thats "normal", but people with normal values (like yours truly) do benefit from some thyroid supplementation. I'm currently on 10-15mcg T3 daily. You might also want to make sure you're getting enough selenium which is needed to convert T4 to T3.

I would recommend some OJ to help the liver, but you're low-ish carb right?

Thanks. I recently started supplementing selenium, as it happens, since I didn't think I was getting a lot in my diet. How would OJ help the liver? I'm low-ish carb, but not fanatical about it. T3 is an interesting idea; what does it do for you? I've always been on the hypothyroid side, symptomatically speaking, though it's never shown up in blood work. Funny how much better I feel now that I'm getting a little iodine.

[rwac]

Thanks. I recently started supplementing selenium, as it happens, since I didn't think I was getting a lot in my diet. How would OJ help the liver? I'm low-ish carb, but not fanatical about it. T3 is an interesting idea; what does it do for you? I've always been on the hypothyroid side, symptomatically speaking, though it's never shown up in blood work. Funny how much better I feel now that I'm getting a little iodine.

Get Selenium MethylSelenocysteine if you can, it's the amino acid form, and probably the most effective. Or you could eat some liver and/or shrimp.

T3 raises the metabolism. Very useful when your metabolism is low, like CFSish. I was using 125mcg/day at one point.

That's one side of the equation. The other side is the fact that "low thyroid" may be a symptom of other issues. There are reasons why your body wouldn't want to increase metabolism, and turn metabolism down by converting T4 & T3 to RT3.

Like for example, if you didn't have enough protein, or enough liver glycogen stores. Gluconeogenesis doesn't count I believe the resultant glucose is saved for the brain. So you can't raise metabolism when there is not adequate nutrition. Additionally according to Peat, PUFAs can cause thyroid resistance by blocking entry of T3 into cells.

Also, there's things that can interfere with generation of thyroid hormone, cruciferous vegetables also contain goitrogens and should be avoided.

So it turns out that I was actually unwise to force things by dosing T3 very frequently, every hour/half-hour.

Sugar is pretty good, and fills up the liver glycogen stores. OJ is a good source of sugar and vit C.

[APBT]

I'm late to the party, but, I'd suggest a VAP re-test to confirm your significantly out of range result (a good idea with any test result that seems skewed).

Since crucifers have mounds of documented health benefits, I'd be reluctant to avoid them as rwac suggests in post #8. Unless of course there was an identifiable cause/effect. Alternatively, why not try bumping up your iodine slightly?

Any updates? Clarification of the VAP factor of 4? Did you have a heart scan?

[nameless]

I'm also a bit late to the party... I never saw this thread originally, and would have probably missed it (so many subforums here it's easy to miss posts).

I'll offer a couple of suggestions. And yeah, an Lp(a) of 28 is high, but at least it's not insanely super high. I'm sort of surprised you never got it tested years ago. I too recommend a retest.

Thyroid-wise, I doubt you'll find any doctor willing to treat with a TSH of 1.5. I'll rephrase that to... you won't find any doctors who will treat with a TSH of 1.5. It is worth getting your free t3/t4 and antibodies tested, just to see how you convert T3, but unless your thyroid shows up ravaged by nodules, I don't expect any endo will treat you. The thyroid/cholesterol studies don't show much of a correlation unless TSH > 2.0. And for endos, they will only consider treating if TSH > 3, and if less than 5, usually only if antibodies come back high.

For your Lp(a), although I don't normally recommend high dose fish oil to people, it's something to consider. I'll offer up my own experience, which could potentially be helpful...

My own Lp(a) usually goes about 4-5 on a VAP test. My HDL stinks, but thankfully I don't have a double whammy of bad Lp(a) too. But after I got back one test I noticed my Lp(a) plummeted down to 1. I had no idea why at the time, and perhaps it was just a fluke or bad test, but what I did different at the time was:

I was testing out celadrin for joint pain.
I had gotten some free samples of Barlean's emulsifed fish oil (the flavored ones). They supposedly have up to 9x more bioavailability.

I even wrote to Dr. Davis, as it was such an odd result, I was curious what could have caused it. He theorized it was the emulsified fish oil. So, I can't say it'd work for you, but it's worth a try. I didn't megadose it or anything either, I think I was around 1-1.2g EPA/DHA daily. But if it does in fact absorb a lot better, perhaps that was the reason.

It's just a trial of one, so who knows... could have been a test error, fluke or something else. The risk/reward in your case is slanted towards reward though, in my opinion, so it's worth a try.

Edited by nameless, 16 April 2012 - 07:37 PM.

[tham]

Take Hijuven (tocopherol nicotinate) to knock down Lp(a).

http://www.ncbi.nlm....pubmed/7839688/

http://www.ncbi.nlm..../pubmed/2149270


As mentioned in my previous posts here, it is an esterified compound
of E and niacin by the Japanese drug firm Eisai, where they market
it as "Juvela" in Japan. "Hijuven" is the brand name in Malaysia, Thailand
and other SEA countries.

http://www.mims.com/...Hijuven softcap

http://www.rad-ar.or...kekka.cgi?n=831


The esterification eliminates the flushing. However, some people over
here whom I recommended it to, complained of extreme fatique and
malaise (likely due to vitamin E), my brother-in-law said he itched
all over, likely due to niacin.

You can't get it in the US, so if you have some friends in Japan or
Asia, you could ask them to get it for you. Not exactly cheap, current
price here is now about RM 90 for a 100-softgel box. The studies
used 3 softgels a day, 200 mg each.

The other drug firm which makes it is the German firm Mack, since taken
over by Pfizer. They call it Renascin, 100 mg caps.

The bonus is, tocopherol nicotinate will also helped to dilate your
clogged-up coronary and peripheral arteries. It has been used in
intermittent claudication.


Have you also tested Lp-PLA2 ? If high, start by taking extra
Chinese yellow pears and green tea.


The links are no longer there, but I managed to find the Korean
study on my computer.

http://www.longecity...post__p__125664

Attached Files

•  LP-PLA2 HERBS.pdf   833.76KB   18 downloads

Edited by tham, 21 April 2012 - 11:06 PM.

[niner]

Thanks for the advice, guys. I'd been thinking it was time for an update. It's awfully easy to miss a thread if you aren't here constantly. I guess that's how I missed these replies until now...

Any updates? Clarification of the VAP factor of 4? Did you have a heart scan?

I have an echocardiogram scheduled for tomorrow, and a heart scan next week. I find it kind of surprising, but the heart scan isn't covered by my otherwise-good insurance. It's only $129 though, which seems like a pretty good deal. I called up Atherotech, posing as a physician, and managed to talk to one of their scientists. She said that it was at least a factor of three, and I've found cardiologists who say four. The reason for this is that the Atherotech test is quantifying the non-variable part of the lp(a) molecule. Their test ignores the hypervariable kringle domains. I think, though I'm not sure, that this does a better job of quantifying the atherogenicty, possibly at the expense of getting a better sense of thrombogenicity. At any rate, I will be testing again, and might choose a different test in order to get a better picture of it. I've been taking SloNiacin for about 6 weeks; 500mg twice a day. The flushing is pretty well under control if I take it with a meal. I'll probably need to raise the dose some, since I'm at the low end of the effective range. I've also been taking 10mg of Lipitor (atorvastatin). I'm not thrilled with it. I've had some myalgia from it, and thought I may have had some effect on memory, though that may have just been stress. I stopped the Lipitor yesterday, and will see how I feel without it for a while. I also picked up some Livalo (pitavastatin), a Japanese statin the Lilly has bought into. It's very good for people who don't do well with other statins. They'll give you a month's worth for free, so there's at least no financial cost to check it out. It's hydrophilic, and very potent; I'll be taking 1mg.

I'm sort of surprised you never got it tested years ago. I too recommend a retest.

Yeah, I think I need to find a new doctor who's a little more up to date. The guy spends too much time seeing patients and not enough time staying on top of the science. It's a tradeoff; he'll see me on very short notice if I'm sick, which a lot of practices don't do a good job on. At least the cardiologist has a clue; he even gave me a journal reference, which I take as a good sign. I think anyone who's interested in quality health care should get one of the advanced lipid panels at least once, although a Dec 2010 paper on the current status of lp(a) only recommends testing people who already have some other CVD risk. That would have missed me, I think. Sometimes the recommendations that are good for society overall may not be so great for you individually.

I had gotten some free samples of Barlean's emulsifed fish oil (the flavored ones). They supposedly have up to 9x more bioavailability. I even wrote to Dr. Davis, as it was such an odd result, I was curious what could have caused it. He theorized it was the emulsified fish oil. So, I can't say it'd work for you, but it's worth a try. I didn't megadose it or anything either, I think I was around 1-1.2g EPA/DHA daily. But if it does in fact absorb a lot better, perhaps that was the reason. It's just a trial of one, so who knows...

Davis is sold on high dose fish oil, but like you, I'm not that comfortable with high doses of HUFAs. Since niacin seems to agree with me, I'll probably stick with that, but the Barleans might be worth a look. I'm taking 2g of ordinary fish oil now, and could exchange it with the Barleans, for example.

Take Hijuven (tocopherol nicotinate) to knock down Lp(a). http://www.ncbi.nlm....pubmed/7839688/ http://www.ncbi.nlm..../pubmed/2149270 As mentioned in my previous posts here, it is an esterified compound of E and niacin by the Japanese drug firm Eisai, where they market it as "Juvela" in Japan.

Thanks tham, I'll look into that.

[nameless]

When getting tested again, I recommend using a VAP, just so you know what effect the statin + niacin had. You could get a different lipoprotein test (NMR) at the same time, or shortly thereafter, to see how the tests differ. But when I do that sort of testing, I like to use the same labs, just so there is less variability.

I would have also recommended doing niacin alone, at first... then a statin, if needed. Again, just to see what is helping and what isn't. You can always drop the statin later if you want, I guess, though. If you have some possible myalgia from the Lipitor, don't forget to take CoQ10/Ubiquinol. A lot of doctors overlook that. If the Livalo doesn't agree with you, there is also red yeast rice to consider -- generally much less side effects from it than full strength statins. Although most of the good studies have used xuezhikang or an extract not available in the US.

Interesting about tocopherol nicotinate... I recall reading about it briefly years ago, but forgot all about it. If no flush, why hasn't US companies turned it into a drug yet? I couldn't tolerate either IR or slow release niacin myself, but it would be a decent option for me to try. If I could find it here, that is.

[niner]

Yeah, for comparison purposes it should be the same test. I'd also like to see what the numbers look like from the other test. Ideally, I'd do them at the same time if I could get that past the insurance company or it didn't cost very much. I don't think a VAP is actually all that expensive, but I don't have the exact numbers.

Statins have essentially no effect on lp(a) as I understand it. The only reason I'm doing the statin is to lower the overall atherogenic background. My LDL has always been a little high, though considering my good HDL, trigs, and particle size distribution, I wouldn't dream of using a statin if it weren't for the elevated risk from the lp(a). I was taking ubiquinol the whole time, though I might have been dosing too infrequently. I was taking 100mg twice a week until I ran out a couple weeks ago, then entered the wrong expiration date for my credit card which delayed my latest Swanson's order by a week. I'm not really perceiving a difference without it yet.

Funny that tocopherol nicotinate isn't easy to get in the US. You'd think that avoiding the flush would be worth a lot to people. I'm not having that much of a problem with the flush now, however, so that reduces my need for a different agent. SloNiacin is a pretty good brand. It was the one used in the biggest niacin study, so there's a lot of data behind it; more in fact than the high-dollar Niaspan, and it's also cheap. Thirteen bucks for a hundred tabs at WalMart or Costco.

One thing I've heard from a couple different sources is that lp(a) responds gradually to both niacin and fish oil. Over literally years of continual use of either of those, lp(a) levels continue to drift downward.

[nameless]

The thing I find strangest is how drug companies haven't tried to release tocopherol nicotinate as a drug. Niaspan makes a ton of money, and Merck tried (and failed) to get FDA approval for Cordaptive. Unless its data isn't as strong as regular niacin, perhaps?

Have you looked at the AIM-High study yet? They pulled the plug on their big niacin study, due to no benefit, but they muddled the results a bit by including other drugs. The participants also had very well controlled LDL, which could explain why Niacin didn't help. Just wondering if they ever did a breakdown on participants with high Lp(a)... I haven't checked on that study in a while.

If Lipitor did in fact cause some myalgia, I would up the ubiquinol dose to 50-100mg/day or EOD. Or take regular CoQ10, 100mg/daily. Healthy origins CoQ10 is cheap at iHerb... giant bottle for around $50 (which would last you close to a year). I use that, although at 3x daily, so it doesn't last me quite that long.

Slo-Niacin is a decent brand, so if it works to reduce your Lp(a), just stick with it. I tried Niaspan, IR niacin, and Enduracin... fatigue and eventually heart palpitations with all. Oddly the flush was the least of my worries (although I did experience some of that too). And yeah, I have read it takes time. That's what I found odd about my emulsified fish oil experience. It was fast, maybe I took it 1-2 months, and my Lp(a) dropped like a stone.

Edited by nameless, 23 April 2012 - 02:45 AM.

[steampoweredgod]

in mice resveratrol blocked all adverse effects on lifespan from complete morbid obesity, so it is extremely potent anticardiovascular antiaging compound if it works likewise in humans(trebbled human cell survival to gamma radiation so it does seem to be pretty potent at doing something to human cells).

There's also vitamin k2mk7 which is said to block calcification of arterial tissue and other nonbone tissue.

EGCG or green tea is another potent all around protector

Nuts a small serving daily is said to be the MOST POTENT lifestyle intervention, delaying cardiovascular events by almost half a decade. Adding more healthspan years than lifelong exercise or vegetarianism according to seventh day adventist population study. Nuts are the best source of fatty antioxidants that accumulate, and have multitocopherol vitamin e plus lots of other fatty antioxidants that protect cellular membranes.

The two longest lived persons if I recall correctly 122 119 years where addicted to chocolate, and they didn't have the high purity stuff we have today. Consuming small servings of dark chocolate or buying a dark chocolate extract may be recommended, and as fatty antioxidant rich compound it may also block many aspects of aging.

other extremely potent interventions are light to moderate calorie restriction, and protein cycling(protein fasting periods of several tens of hours.). Protein fasting is potent mtor inactivator that will raise coq10, increase neural resistance to toxins and anoxia even beyond the highest levels of calorie restriction, and will overall strengthen and rejuvenate the entire body via increasing autophagocytosis and increasing the natural superantioxidants the cell normally generates, it will also alter membrane structure in a positive way.

Edited by steampoweredgod, 23 April 2012 - 10:11 AM.

[steampoweredgod]

Do you know if your testosterone levels are good? Because low testosterone levels in combination with higher cholesterol points to a lower metabolism, you might want to consider increasing your metabolism instead of statins.

You may also want to read these:
http://chriskresser....-disease-part-3
http://blog.choleste...k-low.html#more

I'd be wary of long term fish oil supplementation.

the little people of somewhere, don't recall exact place, have low metabolism because of pituitary mutation(which drastically knocks down thyroid and insulin pathway), iirc. Their lifespan due to low metabolism is about 90ish higher than those not affected by low metabolic mutation. IIRC, it is similar to ames mutation in mice which drastically extends lifespan and can stack with calorie restriction for combinatorial synergistic lifespan extension, iirc.(btw in c. elegans two interventions that each yielded moderate lifespan extension combined yielded 6x extension iirc. So we cannot dismiss what such could do to some organism like a human, theoretically two 50+% extension intervention may synergistically interact to yield far more than imagined.)

Mutations that knock down insulin and insulin like growth factor reduce cancer mortality from 5% to 0%... and according to some doctors grant immunity to diabetes.

The problem with knocking thyroid function and metabolism and slowing the rate of aging, is TSH stimulates unnatural growth so it has to be knocked out too.

As far as I can tell, knocking some of the hormone systems and driving drastically down metabolism seems more like a plus(cancer mortality reduced to zero, diabetes risk eliminated, longevity extended), than a minus. Doctors should actually work on disabling them intelligently to extend healthspan.

Edited by steampoweredgod, 23 April 2012 - 10:28 AM.

[niner]

Have you looked at the AIM-High study yet? They pulled the plug on their big niacin study, due to no benefit, but they muddled the results a bit by including other drugs. The participants also had very well controlled LDL, which could explain why Niacin didn't help. Just wondering if they ever did a breakdown on participants with high Lp(a)... I haven't checked on that study in a while.

Here's a paper that just came out which gives a thoughtful evaluation of AIM-HIGH. Wow, that study was a mess. I think that a lot of knucklehead doctors are going to take it to mean "niacin doesn't work" (in general), but that wouldn't at all be a correct interpretation.

[rwac]

The problem with knocking thyroid function and metabolism and slowing the rate of aging, is TSH stimulates unnatural growth so it has to be knocked out too.

As far as I can tell, knocking some of the hormone systems and driving drastically down metabolism seems more like a plus(cancer mortality reduced to zero, diabetes risk eliminated, longevity extended), than a minus. Doctors should actually work on disabling them intelligently to extend healthspan.

The important thing to do is reduce TSH (almost shut it down).

As for metabolism: individual mice with high metabolism have greater mitochondrial uncoupling and live longer.

[steampoweredgod]

The problem with knocking thyroid function and metabolism and slowing the rate of aging, is TSH stimulates unnatural growth so it has to be knocked out too.

As far as I can tell, knocking some of the hormone systems and driving drastically down metabolism seems more like a plus(cancer mortality reduced to zero, diabetes risk eliminated, longevity extended), than a minus. Doctors should actually work on disabling them intelligently to extend healthspan.

The important thing to do is reduce TSH (almost shut it down).

As for metabolism: individual mice with high metabolism have greater mitochondrial uncoupling and live longer.

yeah but do those mice live longer than ames mutant mice? nope knocking the hormone systems of mammals extends maximum lifespan as good as calorie restriction at least in mice, and similar mutations suggest it leads to 90+lifespan in humans, iirc. Plus ames mutation stack with calorie restriction, not every intervention does, meaning if CR works in humans it could stack with an ames like attack on hormones dealing to extremely long lifespan.

[APBT]

Niner, thanks for the update.
LEF is currently running their annual blood testing sale.

Here's a link to their VAP Plus test:
http://www.lef.org/V...=search&key=vap

Here's a link to a stand-alone VAP test:
http://www.lef.org/V...=search&key=vap

As an FYI (you likely know this) niacin can negatively impact blood sugar. I have a family member who's type 2 diabetic (controlled with a stack of meds) and a statin (not sure which one) for high TC and LDL. He had low HDL (mid 20s). His GP prescribed Niaspan, which he had to discontinue after two months because his blood sugar shot through the roof (200+ fasting). The Niaspan did however raise his HDL to the upper 30s; still low.

[albedo]

I am not sure how sound is all this but when looking at lp(a) I recollect treatment with niacin as well as using lysine and proline. You might look into it too. I gave a try once during 3-4 months with lysine to protect (i think successfully) from an herpes outbreak. I noticed better lp(a) numbers which can be purely coincidental as I recollect reading lysine/proline's benefit being rather in protecting arteries from plaque build-up from the higher aggressiveness of lp(a) rather than lowering its value.

[poolboy]

Niner, thanks for the update.
LEF is currently running their annual blood testing sale.

Here's a link to their VAP Plus test:
http://www.lef.org/V...=search&key=vap

Here's a link to a stand-alone VAP test:
http://www.lef.org/V...=search&key=vap

As an FYI (you likely know this) niacin can negatively impact blood sugar. I have a family member who's type 2 diabetic (controlled with a stack of meds) and a statin (not sure which one) for high TC and LDL. He had low HDL (mid 20s). His GP prescribed Niaspan, which he had to discontinue after two months because his blood sugar shot through the roof (200+ fasting). The Niaspan did however raise his HDL to the upper 30s; still low.

You need to get this relative on Benfotiamine right away. His/her Methylglyoxal level is causing these symptoms, not the niacin. Complete endothelial disfunction

Get them on 600 - 1200 mg daily.

see all the research
http://scholar.googl...1,24&as_sdtp=on

[poolboy]

One more thing to add:

if you take more than one b vitamin, you generally have to raise the others because they are all co-factors in metabolism. As in the case mentioned above, raising B3 (niacin) has likely made B1 (thiamine) and B6 too low -- the rising blood sugar would likely indicate thiamine supply is short. In diabetes, increased Methylglyoxal interacts with thiamine, causing less of it to be available for transkelotase and processing of sugar. This creates kind of a feedback loop --MG builds blood sugar which raises MG which raises blood sugar.....
Add the niacin on top and the body falls even shorter of the thiamine needed. Intervene with high benfotiamine and some P5P. (Thanks, this is my area of research

[niner]

if you take more than one b vitamin, you generally have to raise the others because they are all co-factors in metabolism. As in the case mentioned above, raising B3 (niacin) has likely made B1 (thiamine) and B6 too low -- the rising blood sugar would likely indicate thiamine supply is short. In diabetes, increased Methylglyoxal interacts with thiamine, causing less of it to be available for transkelotase and processing of sugar. This creates kind of a feedback loop --MG builds blood sugar which raises MG which raises blood sugar.....
Add the niacin on top and the body falls even shorter of the thiamine needed. Intervene with high benfotiamine and some P5P. (Thanks, this is my area of research

Thanks for that info, poolboy. If your blood sugar is normal and you have a diet that is low in simple carbs and low in high-AGE foods, it sounds like your risk of falling into this sort of feedback loop while using high dose niacin would be low. Is that a safe assumption? Would it be a good idea to take a "B Complex" when using high dose niacin?

[poolboy]

The short answer is yes. the open ended part is no one knows what ratio is optimal, but supplementing some of everything would be better than one being way out of whack.

[poolboy]

Niner, you may find this helpful. It's a study done on diabetic atherosclerosis, but it may be relevant to your situation anyway.


"LDL was decreased in size by 11% on modification by MG suggesting that MG modification of LDL causes particle remodelling to an atherogenic form. "

(Methylglyoxal)

' class='bbc_url' title='External link' rel='nofollow external'>http://diabetes.diabetesjournals.org/content/60/7/1973.full']Glycation of LDL by Methylglyoxal Increases Arterial Atherogenicity
MG modification of LDL forms small, dense LDL with increased atherogenicity that provides a new route to atherogenic LDL and may explain the escalation of cardiovascular risk in diabetes and the cardioprotective effect of metformin.

→ source (external link)

Maybe your doctor would give you metformin ? It might be good as a protection.

[APBT]

One more thing to add:

if you take more than one b vitamin, you generally have to raise the others because they are all co-factors in metabolism. As in the case mentioned above, raising B3 (niacin) has likely made B1 (thiamine) and B6 too low -- the rising blood sugar would likely indicate thiamine supply is short. In diabetes, increased Methylglyoxal interacts with thiamine, causing less of it to be available for transkelotase and processing of sugar. This creates kind of a feedback loop --MG builds blood sugar which raises MG which raises blood sugar.....
Add the niacin on top and the body falls even shorter of the thiamine needed. Intervene with high benfotiamine and some P5P. (Thanks, this is my area of research

Curious, if you don't mind, when you say, "...this is my area of research," are you referring to diabetes, B vitamins, blood sugar control? Also, is this your profession, or you're an enthusiastic lay person researching this for personal interest?

What are your thoughts on Isohumulones for blood sugar control? http://www.longecity...0-isohumulones/

[tham]

The thing I find strangest is how drug companies haven't tried to release tocopherol nicotinate as a drug. Niaspan makes a ton of money, and Merck tried (and failed) to get FDA approval for Cordaptive. Unless its data isn't as strong as regular niacin, perhaps?

Requiring at least $250 million (that was the amount I read maybe
two decades ago) and three phases of trials, what do you think the
chances are that Eisai would spend that much on what is basically
synthetic vitamin E in order to market it in your country ?


As pointed out before, it's the money politics that your FDA is playing.

This kind of ridiculous scenario can happen only in the USA. Tantamount
to a glass of lemonade costing maybe $1 being turned into some "miracle
fountain of youth" and resold for $50.


Colchicine has been around for the past two centuries, and Colchicum
autumnale has been used by the Greeks for gout for the past 3,000 years.

http://worldseedsupp...utumnale-autumn



" .... gave URL Pharma a three-year marketing exclusivity agreement[3] in exchange
for URL Pharma doing 17 new studies and investing $100 million into the product,
of which $45 million went to the FDA for the application fee. URL Pharma raised
the price from $0.09 per tablet to $4.85, and the FDA removed the older unapproved
colchicine from the market in October 2010 both in oral and IV form, but gave
pharmacies the opportunity to buy up the older unapproved colchicine. "

http://en.wikipedia....e_United_States

http://www.nejm.org/...56/NEJMp1003126



In effect, it's corruption in guise. Your FDA pockets a "commission",
for their "approval" and the drug firm earns billions more by jacking
up the price over 50 times as a pretext for selling an "approved drug".

All for some simple paperwork to "approve" a drug taken from a plant
used since time immemorial by ancient cultures.

[niner]

"LDL was decreased in size by 11% on modification by MG suggesting that MG modification of LDL causes particle remodelling to an atherogenic form. "

Thanks, poolboy. I appreciate your insights on these blood sugar-related issues. Methylglyoxal is certainly a bad actor in general; this is yet another reason to keep it low. My HDL particle size distribution was "the good kind", skewed toward the larger end. (Figuring that out was the main reason I wanted to get the VAP test in the first place.) That might be due to my relatively low carb diet. I just got back the results from a heart scan, and I had a Calcium score of ZERO! That's pretty good news, and does tend to validate my current diet. The odds that I'll be adopting my doctor's "heart healthy" high carb, high PUFA, low SAFA diet are now precisely zero.

I'm still taking 500mg of extended-release niacin twice a day, and am tolerating it reasonably well. I just dropped the NSAID I was taking with it to suppress flushing, and things seem ok, but I probably need to double the dose of the niacin yet. I dropped the 10mg Lipitor due to muscle pain. I have a bottle of a newer hydrophilic statin called Livalo (pitavastatin) that is supposed to be a lot better with respect to side effects, but I haven't started it yet. I think that given the state of my coronary arteries, I might nuke the whole statin idea.

I still have some concern that the atherogenicity of lp(a) is more of a problem for cerebral arteries than coronary, and have a couple pieces of family history that back that up: My younger, healthier brother had some carotid plaque show up on ultrasound, and there's a history of stroke and TIA's on my mother's side. I'd like to get a carotid ultrasound to see what's going on there.