Colestipol-niacin in coronary bypass patients isn’t equivalent to niacin monotherapy in “healthy” individuals and compliance with colestipol isn’t easy. We see similar effects with colestipol-statin if you dig the same older trials with better safety profiles on the statin.
I suggest you read all the high-dose niacin-related trials, many of them being combination therapies since all the niacin-only ones were flops for improving mortality - CDP, AIM-HIGH, HATS, FATS, and HPS-THRIVE (1 and 2) was enough for me to avoid high-dose niacin as when you go to the larger trials high dose niacin is rather unimpressive with slightly higher all-cause mortality in some and incredibly well-documented serious potential side effects.
There’s a pretty good reason why the medical community found high-dose niacin to be at the last resort therapy in very limited cases and most avoid it entirely. Megadosing vitamins generally have an overall poor track record in terms of increasing mortality slightly - which has been the case with high-dose niacin so far, so you better have really, really good evidence that any of the things you’ve cited actually matter. They’ve been unimpressive when put in context with similar scenarios and plenty of empirical data.
Why would you want to lower cholesterol? It’s been proven a thousand times over in research study after research study, that it’s a myth that elevated levels of LDL-c are dangerous or that it causes CVD. Yes, mainstream medical folks/doctors still subscribe to this myth, in part because it’s existed for so long and because of money (statins).
So I read up on those trials as you suggested. I think your conclusion from them is misguided. The only trials where niacin was shown to have no benefit was shown to have no benefit was when it was combined with statins (most recent trials). It was shown to have no extra benefit in other words. In trials where it was trialled alone, it was shown to have benefit. Including in the trials you yourself mentioned here. Here’s another from the 70s: Coronary drug project: experience with niacin. Coronary Drug Project Research Group - PubMed
From further reading I see that other B3s actually have similar effects on blood work despite initially not being thought to have. NAM, NR and NMN don’t come with the risks NA does as well. There are now multiple documented benefits from B3 supplementation from blood NAD+, to increased muscle mass and strength, reduced fat around organs, particularly the liver, and likely benefits for kidneys, something that is being further investigated in numerous ongoing trials because of promising results in preliminary ones. I think it’s mad not to take a B3 and have chosen NAM myself as it’s the cheapest and they all seem to confer the same benefit.
Having no additional benefit in the case of statins is a real issue. It’s hard not to gloss over it. It’s easy to assume that it’s just statin interaction when these add much larger trials to evaluate niacin.
As for the benefit on monotherapy - I suggest you repeat the potential benefit detected in the trials that is actually meaningful compared to alternatives. Blood NAD+ is not necessarily a meaningful marker. Regardless of the NR/NMN/other camp, I have found people gloss over a large part of the NAD cycle for how NNMT comes into play when describing the potential mechanism of NAD+ supplementation. Ignoring a big part of the biochemistry is an issue - it reeks of bias from the most influential proponents. You’re claiming potential benefits that don’t necessarily translate into real outcomes when mortality isn’t going down, but slightly up.
Did you check the side effects of the trials? Serious adverse events ie myopathy and worsened glucose control/new onset diabetes, infection, and bleeding.
Not to mention, niacin can increase the risk of gout and hyperuricemia. Elevations in LFTs are common - may lead to severe hepatotoxicity, jaundice, and fulminant hepatitis. “Protecting the liver” while potentially causing serious harm to the liver doesn’t seem to be particularly productive.
I’m not saying nobody should ever take high-dose niacin for any reason but it’s not looking particularly good in terms of efficacy or mortality. I’m saying for the average person, I don’t see the point of high-dose niacin when considering the potential for serious side effects generously using extended-release versions vs potential likely marginal benefits.
Even if I was in the small, highly specific patient population where one even would consider using it although somewhat shaky in the first place - I’d be very wary and look into highly specific forms ie Niaspan.
Yes, I recently started taking niacin and then nicotinomide and, not coincidentally, had a gout attack. The B3 products raise the blood’s uremic index, which can cause jagged crystals to form in the joints. B3 has been touted as a panacea, even for kidney disease. But if the kidneys are impaired and can’t remove all the uric acid from the blood, it will be deposited in the joints. Treatment may require a 10-day course in prednisone, followed by 20 days of low-dose colchicine, a gout medication that seems to work pretty well. A DPM said I should be able to run again.
Do I understand correctly that B3 (niacin) can cause a rise in Uric acid which can (potentially) lead to gout and/or kidney stones? While B5 (pantothenic acid) helps to clear uric acid and thus (potentially) prevents gout and kidney stones?
I am interested in investigating B5 for its AGE-clearing and antioxidant properties. I also have one kidney (although firing at an eGFR of 90), so kidney stones could be….problematic.
Pantothenic acid, a type of B vitamin (B5), is needed to help with the excretion process of uric acid. Stress often depletes the body of this vitamin, which may explain why gout flares during times of stress .
What about immediate release Niacin? Your thoughts? I’ve been taking IR Niacin for about a month and don’t mind the flush — kinda like the feeling — at about 1 g a day. I read about the hepatoxicity risks from the extended release version so that was a no go.
You have to be careful with Niacin and Rapamycin as they both raise blood sugar levels. This could be a problem and could actually decrease lifespan for some individuals such as diabetics.