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High levels of Niacin linked to heart disease, new research suggests

Old 02-20-24, 08:43 AM
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High levels of Niacin linked to heart disease, new research suggests

Less than a year ago I was reading how important niacin was in our diets. I guess dose really does make the poison

https://news.yahoo.com/high-levels-n...l&uh_test=0_00

High levels of niacin, an essential B vitamin, may raise the risk of heart disease by triggering inflammation and damaging blood vessels, according to new research.

The report, published Monday in Nature Medicine, revealed a previously unknown risk from excessive amounts of the vitamin, which is found in many foods, including meat, fish, nuts, and fortified cereals and breads.

The recommended daily allowance of niacin for men is 16 milligrams per day and for women who are not pregnant is 14 milligrams per day.

About 1 in 4 Americans has higher than the recommended level of niacin, said the study’s senior author, Dr. Stanley Hazen, chair of cardiovascular and metabolic sciences at the Cleveland Clinic’s Lerner Research Institute and co-section head of preventive cardiology at the Heart, Vascular and Thoracic Institute.

The researchers currently don’t know where to draw the line between healthy and unhealthy amounts of niacin, although that may be determined with future research.
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Old 02-20-24, 09:00 AM
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High levels of a lot of things are poisonous or dangerous. Even dihydrogen monoxide. Sometimes it seems that people realize that when something is good, then they think a lot must be better. That's not always the case.
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Old 02-20-24, 10:11 AM
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Taking high doses of niacin has been a popular way to reduce blood cholesterol and blood pressure while avoiding the side effects of statins. There have been several "take niacin" threads on here in years past though I haven't seen one in quite a while.
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Old 02-20-24, 10:36 AM
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Yes, too high levels of anything is bad for you, hence my comment above, ...dose makes the poison.


The main point I took away from the article is how much of our foods are fortified with various vitamins and minerals. So what else are we getting too much of?


Excerpt from the article in the OP


"The average person should avoid niacin supplements now that we have reason to believe that taking too much niacin can potentially lead to an increased risk of developing cardiovascular disease,” Hazen said.

Currently, Americans get plenty of niacin from their diet since flour, grains and cereals have been fortified with niacin since the 1940s after scientists discovered that very low levels of the nutrient could lead to a potentially fatal condition called pellagra, Hazen said.
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Old 02-20-24, 11:17 AM
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It is not Yahoo information, it's from NBC, Yahoo, just presents news from various sources. But specifically it's from the study’s senior author, Dr. Stanley Hazen, chair of cardiovascular and metabolic sciences at the Cleveland Clinic. I know Mayo is considered number one in the US, but Cleveland is nothing to sneeze at.

However, I will be interested in what Mayo has to say about this recent study.

The point of the thread is how much is too much? I don't know the answer, but it's a valid question.

I'm not, in the least, saying nor interpreting to stop the intake of niacin. One of the foods I grow is because it's a good source of niacin (leaves of the Passionflower vine).

I don't take supplements and I stay away from fortified foods which are mostly highly processed. I like to get much of my nutrition from naturally grown foods without use of soil amendments, nor x-icides (including so-called natural fertilizers/x-icides).




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Old 02-20-24, 11:24 AM
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What I learned from this is do not eat more than 32 bananas a day. Good talk.
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Old 02-20-24, 11:38 AM
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Originally Posted by blacknbluebikes
What I learned from this is do not eat more than 32 bananas a day. Good talk.
I like 'em with quite a few spots. That 32 a day takes up way to much counter space.
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Old 02-20-24, 11:57 AM
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I was taking niacin for a while, until I ran into the niacin flush. Of course that's time-dependent as well as dose-dependent, but I wonder where the "causes inflamation and blood vessel damage" threshold compared to the "causes niacin flush" threshold.
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Old 02-20-24, 01:17 PM
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Here is a article that gives a little more information and less trying to evoke emotions and knee jerk responses that the media loves to do now.

https://newsroom.clevelandclinic.org...ical%20studies.
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Old 02-20-24, 03:26 PM
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I didn't notice any hyperbole in the NBC article, it even meshed fairly well with the Cleveland Clinic link. However, I very much liked the video interview towards the bottom of the link...attached below.


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Old 02-21-24, 08:51 AM
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Originally Posted by work4bike
The point of the thread is how much is too much? I don't know the answer, but it's a valid question.
That is my biggest question. I read the Cleveland link and watched the accompanying video. He states that too much niacin is bad for you. In fact, he even seems to be implying that the foods we buy at the store may contain too much. Umm, okay, then how much is too much? Hmm, no answer to be found. So even if I were to analyze everything I consume to get an estimate of my daily niacin intake, I still wouldn't know if it's too much. Well, thanks for the big-nothing-burger scare. It would be nice if they had some actual answers before telling us that we are all going to get cardiovascular disease from niacin.

Even if this eventually turns out to be true, I think that much more research should have been done before making an announcement of this nature without any additional guidelines. For example, is too much niacin truly bad for everybody and where is that line drawn? Is it affected by certain other health factors such as diet, body type, pre-existing conditions, etc.? Like so many other studies that I hear about, until they can definitively answer all of that, I'm not going to lose any sleep over this. Don't tell me that my daily niacin intake is possibly going to kill me if you can't even tell me what the limit should be.
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Old 02-21-24, 09:58 AM
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I don't think any one food is too high in niacin, rather it's the accumulation of all the foods we eat that are artificially fortified and naturally contain niacin. I'm too lazy to count calories, let alone counting all the individual vitamins/minerals that the body needs. Who does that?

I don't think there's anything to be scared of...just live by the old saying, all in moderation. I think people most at risk of taking too much niacin are those that think more is better. We hear how good niacin (or whatever) is for the body (and that's absolutely true), but some people look to get more and more in everything they eat/drink.

Eat in moderation and eat real food as much as possible.



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Old 02-21-24, 10:28 AM
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My interpretation is that the researchers are excited about the pathway 4PY which is implicated in cardiovascular disease. The breakdown of excess niacin results in 4PY. Also, note that preclinical studies are mentioned. However, preclinical means animals or in vitro that may involve human cells. Preclinical studies provide direction for further research but are not conclusive for humans.

And, IMO, the results are a heads up to doctors that prescribe niacin to patients that cannot take statins. The goal of the prescription niacin is to prevent heart disease not create a pathway to the disease.

I am not an everything in moderation guy. Everything in moderation for me does not yield the results I want. This is a training and nutrition thread about cycling and most are looking for improved results - lower weight, less fat, more strength, more FTP, more endurance but less mediocrity.

From Cleveland Clinic article...

4PY, a breakdown product from excess niacin, and heart disease. Higher circulating levels of 4PY were strongly associated with development of heart attack, stroke and other adverse cardiac events in large-scale clinical studies. The researchers also showed in preclinical studies that 4PY directly triggers vascular inflammation which damages blood vessels and can lead to atherosclerosis over time.
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Old 02-21-24, 11:26 AM
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I skimmed the article.

This was an untargeted "metabolomic" study in two large cohorts of stable patients, tagged for undergoing elective cardiac evaluations and then followed for some period. That means they measured potentially thousands of metabolites (small, end products of breakdown pathways), without any hypothesis, in a search for associations with future major cardiac events in people who were already at high risk. This is not my area, but it looks like a good study and it's in a very good journal. However, because of the hypothesis-free approach and number of things they measured, spurious associations are possible. Also, even if the association is real, causation is a hunch at this point. Finally, the study was in a population in whom these metabolites might be more harmful than in healthy folks.

Got to amend this to say the finding in two independent cohorts makes the association pretty convincing.

Last edited by MoAlpha; 02-21-24 at 12:04 PM.
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Old 02-21-24, 11:36 AM
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And that's why the science of Health and Nutrition is so complicated. Thanks for your insight MoAlpha




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Old 02-21-24, 01:21 PM
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Here is is another link to the Extract: https://www.nature.com/articles/s41591-023-02793-8

So what kind of heart disease are we talking about? And in what population of risk specifying 2PY and 4PY?

The real statement is that High Doses of Niacin, and they dont say how high, can cause inflammation in the heart, in a genetically identified population.


OK... Stop my 500mg Niacin and go to a Statin? Then I just need to worry about killing my liver!

Well I will consider that this is interesting Click Bait leading to more Clicks for sure. And in a world of Publish or Perish Doc Hazen got his in...
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Old 02-21-24, 04:00 PM
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Originally Posted by zandoval
<snip>
OK... Stop my 500mg Niacin and go to a Statin? Then I just need to worry about killing my liver!

Well I will consider that this is interesting Click Bait leading to more Clicks for sure. And in a world of Publish or Perish Doc Hazen got his in...
The risk to one's liver from statins doesn't look that great: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766774/
It was reported that after a decade of follow-up, there was no association between statin use and liver-related mortality. In fact, the rate of liver-related mortality was significantly lower among statin users compared to nonstatin users.
Problems with statins more usually involve muscle pain. There are also alternative medications.
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Old 02-21-24, 04:43 PM
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Originally Posted by zandoval
Here is is another link to the Extract: https://www.nature.com/articles/s41591-023-02793-8

So what kind of heart disease are we talking about? And in what population of risk specifying 2PY and 4PY?

The real statement is that High Doses of Niacin, and they dont say how high, can cause inflammation in the heart, in a genetically identified population.


OK... Stop my 500mg Niacin and go to a Statin? Then I just need to worry about killing my liver!

Well I will consider that this is interesting Click Bait leading to more Clicks for sure. And in a world of Publish or Perish Doc Hazen got his in...
Maybe the logical conclusion is that when doctors start to consider high niacin, they should start with genetic screening. (Though I missed what kind of screening that might be.)
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Old 02-22-24, 08:05 AM
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Originally Posted by pdlamb
Maybe the logical conclusion is that when doctors start to consider high niacin, they should start with genetic screening. (Though I missed what kind of screening that might be.)
I don’t think there’s any way of knowing what caused the high metabolite levels. Could be genes, could be niacin intake, could be other things.
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Old 02-23-24, 01:34 PM
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Originally Posted by Carbonfiberboy
Taking high doses of niacin has been a popular way to reduce blood cholesterol and blood pressure while avoiding the side effects of statins. There have been several "take niacin" threads on here in years past though I haven't seen one in quite a while.
I was on prescription niacin for a while, maybe 10 years ago (Niaspan), mainly due to bad reactions to several statins. I finally found one that didn't give me any problems though.

Apparently, niacin gives better lab numbers, without positive effects on morbidity/mortality. The danger of chasing the numbers.

From, I think, WebMD, quoting a NEJM article. Can't get the full article due to a paywall.

WEDNESDAY, July 16, 2014 (HealthDay News) Niacin,
a commonly used cholesterol
treatment, doesn't reduce the risk of heart attack or stroke in people with hardened
arteries. What's more, the drug appears to have dangerous side effects, including a
potential increased risk of death, according to new research.
A largescale
clinical trial found that although niacin slightly improved levels of "good" HDL
cholesterol, it didn't seem to benefit cardiovascular health, reports the study in the July 17
issue of the New England Journal of Medicine.
At the same time, niacin increased the risk of serious side effects in patients "enough to
get people into hospital, typically," said senior study author Jane Armitage, a professor of
clinical trials and epidemiology at the University of Oxford in England.
The author of an accompanying journal editorial, Dr. Donald LloydJones,
added that
"people taking niacin need to have a conversation with their doctor sooner rather than
later to see whether it is appropriate to continue taking it and whether there are
reasonable alternatives." LloydJones
is chief of preventive medicine at Northwestern
University Feinberg School of Medicine and Northwestern Memorial Hospital in Chicago.
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Old 02-26-24, 10:32 AM
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Just an interesting video on the topic....Don't freak out you'll.


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Old 02-26-24, 11:27 AM
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Originally Posted by pdlamb
Maybe the logical conclusion is that when doctors start to consider high niacin, they should start with genetic screening. (Though I missed what kind of screening that might be.)
Genetic Screening... Yes!

Treating someone with Heart Disease and dangerous cholesterol/triglyceride levels is easy. Ya put um on a Statin and try your best to lessen the side effects.

But in a healthy population it can be different. Many times I can get my patients in the ball park by simply using Niacin and Fish Oil. In the population I treat I have allot of active, healthy, old ranchers that know enough about handling old stock to know they need to take care of themselves. Many times they are already taking vitamins, and have cut back on beer and cigarettes as well as watching their sugar. When these guys start to have high Cho/Trg levels I ask them to invest in a "Boston Heart Study". Most of the time its only partly covered by their insurance but it really is a game changer. It can give me a really good idea of what type of treatments will be effective.

https://bostonheartdiagnostics.com/t...-balance-test/

Do note that I am and old PA-C in a rural practice. Those in the big city or in an HMO will most likely have to discuss this study with a Cardiologist.
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Old 02-27-24, 09:39 AM
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Here is a good summary of the Nature Medicine article from Ars Technica:

https://arstechnica.com/science/2024...ck-and-stroke/

In it is the relevant salvage pathway:



The concern is that everything that contains wheat (bread, cereal, etc) is mandated to contain what is now suspected to be an over-dose of niacin. If you take pretty much any over-the-counter multi-vitamin, you are getting > 100% RDA of niacin, just in one vitamin pill. If you take specific B-supplements, you are probably getting a much larger over-dose.

Vitamin supplements, in general, are associated with an increased mortality rate. The reasons for this are not well understood. Although speculative, it is not impossible that part of this is due to excess niacin.

Lack of niacin in the diet was a major public health problem, as the Ars Technica article points out.

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Old 03-13-24, 07:39 AM
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I did the Niacin thing and the fish oil thing was while. But many studies have come out questioning the outcomes. From what I have read though, a diet high in fish (as apposed to beef for example) has been shown to be protective. Something in "real food" seem to be healthier than processed stuff.

A 2017 American Heart Association Science Advisory noted that omega-3 ish oil supplements
prescribed by a health care professional may help prevent death from heart disease in patients who
recently had a heart attack and may prevent death and hospitalizations in patients with heart
failure. However, there is a lack of scientiic research to support clinical use of these
supplements to prevent heart disease in the general population.
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Old 03-13-24, 01:50 PM
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I think it's best to get these nutrients from natural sources. The problem is that our huge food system is too dependent on monocultures which severely restricts our diet. Not only that, but it also restricts the diet of the food we eat, in other words, What Your Food Ate. Which is the title of a book written by Dr David Montgomery. He shows how what are food eats significantly impacts how healthy that food is when we eat it, including plant life.


Here's an example https://www.creativeprocess.info/int...ry-lf-mia-funk

It's not that Omega 3 is better for us than Omega 6, rather we're just getting too little Omega 3 in our diet, much of which can be blamed on our heavy use of grains, not just in our diets, but also in the diet of the meat we eat.



Here's a relatively short video of Dr Montgomery speaking



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