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Niacin & Diabetes

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  • Niacin & Diabetes

    Hey there.

    Got a little bit of the scoop on niacin from Dr Brewer, and then read some studies on my own. As with so many americans, much of my family has both blood glucose & blood lipid issues. Based on what i've looked at, it seems that niacin would likely help at least by raising HDL for some of my family members.

    My concern w/ niacin has to do with its effects on blood glucose. I've read trials where ER niacin + crestor raised HDL (vs statin monotherapy), but also raised fasting glucose. The increase wasn't massive, but raising FPG certainly makes me concerned about what impact it would have on peak levels of blood glucose, which is where a lot of the damage is done.

    At this point, the two questions I have are about weighing benefits/risks: (1) is it advisable for someone w/ advanced prediabetes & already taking a statin (rosuvastatin/crestor) to take niacin? Is the blood sugar impact/liver worries/other potential side effects worth the benefit (probably a bump in HDL)? (2) My other lingering question was about why niacin isn't recommended for someone who isn't in 50+ range, but has elevated & slowly creeping blood lipid levels. Would someone like Dr Brewer recommend a lower dose (250-500mg ER?) of niacin daily for someone in that situation, to lower LDL and raise HDL?


  • #2
    The initial increase in BG from niacin averages only around 5 points and is relatively insignificant. It usually dissipates after a few weeks to a month. The benefits of niacin FAR outweighs that effect. Just track your FBG and postprandial BG after you start and keep a BG log.


    • #3
      Originally posted by fatmax
      Try metformin to decrease your BG.
      Doctor won't prescribe it. He's dense and sees no problems and says I'm healthier than most of his patients .... He's not up to date on glucose and inflammation it appears. Didn't know what Lp(a) was.


      • #4
        Take a look at your triglycerides level. People tending towards metabolic syndrome often have high triglycerides that tends to suppress HDL-C levels. Niacin will suppress triglyceride production and thus reduce the triglyceride-rich VLDL particles that eventually shrink down to the small dense LDL particles that are atherogenic. At the same time some of the HDL particles are delayed for uptake in the liver resulting in the higher HDL-C levels. If this sounds like your case, then yes niacin will help. Find a different doctor if you are pre-diabetic and your doctor won't prescribe metformin. Metformin is cheap enough that it might cost you more to go through your insurance company with a co-pay vs. just buying it over the counter yourself (with a prescription).


        • #5
          Well that's the big question. Am I prediabetic? I have been taking niacin for a year. I think it HAS raised my A1C. Prior to taking it my A1C was 4.9 and a year later on low carb diet and same exercise (a lot) and niacin it's now 5.3.


          • #6
            I have been taking niacin 2-3000 mg per day divided into 3 doses for more than 30 years, ever since reading the 8-week Cholesterol Cure book. I had triglycerides 1300 and TC 400 at that time. It is my understanding that nicotinamide and ER non-flush niacin is ineffective for cholesterol reduction &/or increasing HDL. You have to begin low & slow with niacin, starting 100 mg 3 times/day to diminish the flushing , and increase dosage 50-100 mg/day every third day until desired dose is reached. My CAC was 186 in 1999 & I haven't repeated because treatment is same. (I know I have plaque, just trying to keep it cool. Recently had 2hour OGTT & MACR (thank you for the info Dr Brewer) and both were optimal. I now take Twin Labs Niacin 1000 mg (Amazon) 3 times per day with normal liver enzymes & FBS + keto diet. I am 5'10, 215# (I know, working on it) No CV events so far, take no prescription meds but considering starting ramipril/rosuvastatin low dose


            • #7
              Sounds great Paul! I too switched from non flush to flush after my liver enzymes went high. Now they are back to normal. I take 500, 3 times a day. My CAC was zero. But I was started on it due to my Lpa....which is all over the place. I'm still trying to figure out if the niacin changed my A1c, because mine was good before I started taking it.


              • #8
                According to the Bradley Bale/Amy Doneen Beat the Cardiac Gene book the HgbA1C is not a very reliable test. Can be normal range even when insulin levels & 2 hour OGTT are elevated indicating pre-diabetes & insulin resistance. I also take berberine 500 mg 3 times/day which is supposed to have a metformin-like effect on glucose


                • #9
                  I have been taking berberine for a year. Don't think it does anything positive for me.


                  • #10
                    I agree with both. HgA1C is not enough. And Berberine tends to be a pea-shooter, underpowered.


                    • #11
                      In most discussions about niacin, there seem to be two things seldom discussed, one positive and one negative.
                      + Niacin as a cheap NMN/NR alternative to increase NAD+
                      - Niacin increasing Insulin levels
                      With a good understanding of the many different forms of niacin, especially the SR/ER/Prolonged Release quagmire, it seemed a no brainer to take it when it also potentially increases NAD+ levels.

                      As I am working to earn my Internet Medical Degree (iMD) , I have been taking hundreds of health tests and learning about pre-diabetes. HOMA-IR is a poorly understood and seldom discussed diabetic/MS tool. How many people can explain the differences between HOMA-IR v1, HOMA-IR v2, HOMA-B v1, and HOMA-B v2, much less calculate them? Even with the HOMA-B v2 results, good luck finding agreement on threshold values. These calculations did highlight the fact that although my HbA1c and FG were relatively unchanged, my insulin had skyrocketed since starting niacin and this is exactly what the science says.

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                      Here is one study showing a 61.8% increase in Insulin which might be what I am seeing.

                      Who else is taking Niacin and has monitored their insulin in addition to FG and HbA1c?


                      • #12
                        Good to hear from you. I hope that all is well if you are still in Beijing. I think that the two points that you listed on niacin were previously discussed, but just in case I will make a couple of comments. Niacin gets taken up by the liver, and beyond the effects on lipids, the liver will either convert the niacin to nicotinamide as a reservoir of vitamin B3 for the entire body or methylate it in order to pee it out. High levels of nicotinamide will suppress important sirtuin activity, and thus the liver won't keep more than a certain amount around. Note that the liver and other tissues will convert the nicotinamide into NAD+ as necessary, but that process requires ATP (energy input). The advantage of NMN/NR is that those will be converted to NAD+ before the NAD salvage path that results in nicotinamide. The disadvantage is that oral NMN/NR is almost completely taken up by the liver on the first pass and thus that is where the NAD action takes place. Unless a person takes intravenous NMN/NR, only a small amount of it gets to other tissues. The NAD+ increase of levels in the blood is a result of NAD+ leaking out of the liver cells. Unfortunately that NAD+ doesn't get taken up by other tissues, and according to Chris Masterjohn probably leads to an inflammatory response as NAD+ should generally not be present in the blood. That extra NAD+ made in the liver is likely good for the liver. Chris Masterjohn does think that modest long-term NMN/NR supplementation as we age would have a beneficial effect, but it is probably a waste of money for younger people.

                        Dr. Brewer covered the negative effects of niacin supplementation on glucose and thus insulin levels, and it is likely that those decrease in time for most people.

                        Over time I have switched from being most concerned about FBG to A1C and now think that what is most important is what happens post-prandial. I did look at HOMA-IR in the past, and I eventually did a Kraft insulin survey which provided, as a one time marker, info on my glucose metabolism (worse than I thought but I also had just traveled half-way around the world and thus my sleep/metabolism wasn't normal to say the least).
                        Last edited by Tom; 06-17-2020, 01:51 AM.


                        • sthubbar
                          sthubbar commented
                          Editing a comment
                          Tom, good to hear from you. I can't find the access to this forum on the new website and can only find it through old emails. Yes, the recent outbreak in Beijing is disconcerting. 56 days with zero new cases and only 1 person left in the hospital, and then BAM! 100+ cases over the weekend. All schools are closed after only being open for 1 week. My company sent all non-essential people home to work for at least 2 weeks.

                          As far as niacin, I did search for information and all I could find was this thread where there is a discussion about FB and HbA1c and no real discussion about the insulin impact. As I showed in my labs, the FB and HbA1c were unchanged, it was only the insulin that tripled. Isn't it the insulin that burns up the arteries more than the glucose? Either way, it is something I am going to watch closely.

                          As to the Niacin/NMN/NR discussion, I appreciate the perspective you shared. Dr Sinclair, and others seem to look at the data and come to a different conclusion.

                        • Tom
                          Tom commented
                          Editing a comment
                          Yeah, on a recent video Dr. Brewer mentioned that there have been some changes to the Forum website address. The Forum website address should be stable now I think given the time frame that he mentioned.

                          I think that high insulin is as bad as high glucose, but the problem is when to measure it. Fasting glucose/insulin levels from a HOMA-IR has some value as does FBG and A1C measurements. An OGTT along with insulin level measurements is better and a Kraft insulin survey the best indicator of metabolic health. However, most people don't generally get any of those often enough. There is a company called Meterbolic I think that has started to market insulin level kits for use outside a lab. However, that kit is evidently quite expensive and still not ready for mass marketing. I think that it will be ideal when a home generic insulin measurement device becomes cheap enough that most people can afford it.

                          I think that post-prandial is the best time to measure because we can do it often, and it gives a real indication of how a person's body is metabolizing particular foods. Of course a CGM would be ideal, and I think that will become more common over time.

                          I have bought and used a good bit of NR so I believe that there is something to be said for taking either NR or NMN as Chris Masterjohn opined. NMN is more difficult to manufacture than NR, and so the reason that I haven't taken NMN is that I don't have enough confidence in the companies promoting it. Dr. Sinclair has said on numerous occasions that he doesn't endorse any of the NMN products. I have been waiting years for human studies that show a definitive benefit from taking NR or NMN. I wish that there were such human studies. I don't discount what Dr. Sinclair has said about NMN, but he has acknowledged the lack of published human studies on its benefits. The benefits seen in mice/rats don't seem to translate equally into humans given the significant difference in metabolism rates.
                          Last edited by Tom; 06-17-2020, 09:45 AM.

                        • ChrisDQ
                          ChrisDQ commented
                          Editing a comment
                          Hi guys. Sorry for the missing "Forum" button at the new site. There are changes going on, and the button was accidentally removed. Our webmaster has just brought it back. You should be able to access forums again through the new site's menu.