Articles, Blog

NIACIN BIOMARKERS pt 1: Lists & Correlations: FORD BREWER

November 4, 2019

If I’ve heard it once, I’ve
probably heard it a thousand times from my wife that if I would just listen I’d
learn a lot more. I have to admit she’s right; I’ve always learned more from
patients, other docs I was working with and now that I’m concentrating on the
YouTube channel, I’m learning a lot from the viewers.
Angie Stones, thank you for introducing this article. We’ll talk
about this article in just a minute. it’s a recent update that gets very, very deep
into or maybe very molecular (in the adjective sense of the word) into niacin.
So Tom Deck reviewed it, said “It’s a great, a good article”. He had some
interesting comments about apo c3, apo e VLDL, LDL, and small dense LDL. But
let’s go into the article itself. Now, before we do, I will have to say this:
According to the authors of the article, you know, there were only 18 people; There were 18 obese middle-aged men; 40s, 50s, 60s – that had metabolic syndrome. What they said was this – was that “hypothesis-generating study” whenever you see that term – it reminds me of this quote somewhere, and I decided to
look it up. Now, I’ve never heard of this guy, David Levithan ever before, but here’s the thing, the quote “Every answer creates new questions” and that’s the whole point
with this article. That’s what a hypothesis-generating
article is. So let’s go back. We’ll click on, and you Dr. Angie Stones’ link and you get to journal of
clinical epidemiology May – June 2018 “Niacin action
in atherogenic mixed dyslipidemia of metabolic syndrome: Insights from
metabolic biomarker profiling and network analysis”. It sounds very
deep and you noticed is – this niacin study group. Before I go there, I’ll just
make a comment – they really complicated the heck out of
that article title. Basically, what it’s saying is – they’re looking at
Niacin. As we all know, there’s a lot of questions about: A. the biggest question
is: Does niacin work or not? and B. If so or if not – why? and the reality is, they
did raise a lot of questions. And, again, we’ll get there in just a couple of
minutes but first, what is this niacin study group? The link didn’t take me anywhere so I actually tried looking up niacin study group in Wikipedia and a couple of other
places. I can’t find it. If anybody knows anything about the niacin study group,
I’d be very interested in hearing about that. There’s a – there’s. (these
study groups..) – for example, the statin Study Group.
Rory (Collins) is very Pro statins so, most of the time, if you see stuff coming out
of – from the statin Study Group, you’re gonna see pro statin results. Niacin
study group – I don’t know. I’ve never heard of it. I’d love to find out more
about it. Now, before I go through the details of this study, from here I put it
on my usual Adobe so we could see a little bit better and so I could mark it
up and unfortunately, I really geeked out. I ended up spending three hours on this
article because it’s very, very interesting. I’m jumping to this image. You can see this image is really talking
about clusters. So, for example, hdl-c increased, triglycerides decreased
significantly; over here, tissue necrotic necrotic factor – an inflammatory
component decreased. Now, if you look at this group up here, these are really more
of the lipid profiles: apoE apo B, Lp(a), LDL, apo, a1c, all
of these – for the most part you get improvements in the lipids (these green images) However, down in the bottom, this is all glucose metabolism related stuff and, as
you see, these greens are not always good because you get increase in HOMA IR.
Basically, HOMA IR very good and type of analysis. It’s a different, more
technical type of analysis of insulin resistance. So you got an increase in
insulin resistance. Now, these guys came in with a HOMA of what? 6 on average
the normal HOMA IR should be less than 2; certainly less than 3; so these guys,
as I said they were obese middle-aged man with – 19 middle-aged obese men with significant insulin resistance coming into the study.
Now, let’s look over here. So here we are at the top left; we have a cluster
associated with lipids and, again, for the most part significant improvements in
the lipids. In the bottom left we have the glucose metabolism area. Both of them have a little inflammatory marker IL-6. Down here with the glucose and TNF alpha, up with the with the lipids and now here’s the major cluster of the inflammatory
factors on the right. CRP took a major dive, high sensitivity
CRP c-reactive protein and tissue necrotic factor (tnf). The other
ones over here. All of those took significant decreases so that is a great
way to look at that picture in terms of of what they showed. Let’s go back to the
title page; this is the place that I looked it up – again, Journal of Clinical
Epidemiology. Here it was in the Elsevier – a group of journals.
They tried to charge me for it but I was able to get some get
some of these images either that or
I’ve been through the paywall in the past and forgot all about it. Now, I’m not
gonna – they did have a good introduction. This is going to be long enough and
geeky enough but get out – without getting into the introduction but I will tell
you as you go through this. Basically, this article shows time and time and
time again, as you get deeper into the molecular impacts of niacin, it’s a mixed
bag and that mixed bag could have resulted in some of the mixed bag of
impacts that we see. For example, the studies like AIM HIGH and HPS 2 Thrive.
Now, again this studies long enough; this video is gonna be long enough; I’m not
going to go through all the details on the introduction in the background, I’m
just gonna go to some of the images. This is sort of like
when I was a kid, I’d – you jump over all the text because you get really bogged
down. Unfortunately, I’m not that smart I didn’t jump over all the text, I read it.
That’s why I ended up spending a couple of hours on it. But the images often show
you the most important part of what’s going on. I had a mentor once, who would
go in any article & he’d go straight to the tables, the images.
And, again, he was right; they show you what you need to look at now.
Unfortunately, you can’t see all of the things on – on this image but, basically,
what they did – the vertical axis and the horizontal axis are both the lists.
The extensive list of the molecular biomarkers that they looked at. Now, the
– this green line that’s totally green right down the middle here is because
you’re looking at correlation. Top green is a one-to-one perfect correlation
bottom red is a negative. So, in other words, it’s significantly inversely
related and then gray is zero where it’s maybe not so clear. So, again, this perfect
green here is where the molecule is perfectly correlated with itself. apoE,
for example, is perfectly correlated with apoE here. The third one – down the third
one across. Now, let’s look at something that might be inversely related.
I saw those a few minutes ago; apo B, Homa, for example and well …
anyhow there were some interesting correlations in here and, unfortunately,
now that I’ve gone back and burned a couple more hours of time, I can’t find
this but that’s the way you look at this. You basically look at something like –
well, let’s just go ahead and look at it. HOMA – and it correlates perfectly with
HOMA. it correlates negatively (inversely) with TM and with total cholesterol is fairly inverse
to il-6. I guess that’s interesting. Total cholesterol is also negatively
associated with HOMA. So, again, you’re getting some decrease in total
cholesterol with niacin but an increase in the HOMA, so that’s what that means.
You can see that right here in the middle. Let’s look at things like tissue
necrotic factor, graphs – they don’t have them in alphabetical order and
c-reactive protein – Actually, a fairly grey type of correlation. Again, pardon me, maybe spending too much time on that. Let’s go into some of the conclusions
and discussions. Actually, in editing this video, I decided we really needed to
break here and that’s why you see the different background. On second thought,
what we’re going to do is go back cut this off now and as just a brief review
we’ve talked about Etiel and this group went way deep into studying the
molecular biomarkers associated with niacin. Again, thanks Dr. Stones for
recommending this article. In the next – the next video, it gets even geekier.
It starts going into clusters. There are 7 significant clusters of
biomarkers and we’ll get there next.


  • Reply Wildman Samurai April 11, 2019 at 11:04 pm

    I take Niacin everyday. Great stuff.

  • Reply hey you April 12, 2019 at 12:23 am

    These videos are super pro now!
    Wow Doc, Great work, thanks 🤩

  • Reply Ned Kelly April 12, 2019 at 12:49 am

    Human health status is very geeky to comprehensively understand, and very likely to get even geekier and more contradictory as more is realized and figured found out. It's gonna get real difficult to explain simply. I think you do an exceptionally fine job of explaining things to us, Dr Brewer, and hope you stick at it, you are literally saving life and needless suffering, and I for one thank you deeply. On a personal note I watched my comatose father take three weeks to die after a cerebral haemorhrage at 46, and his father died of a stroke in his 30's, so I've got a lot riding on countering CV inflammation, ( I take gram sized amounts of Vit C, plus do lots of other stuff) and pay a great deal of attention to what people who know what they're talking about say. Thank you again for all that you do.

  • Reply Stephen Grass April 12, 2019 at 2:12 am

    Oh great. Another “maybe.”

  • Reply 147DegreesWest April 12, 2019 at 3:22 am

    Good video- where is part 2? I feel like Cliff Hangar from Between The Lions!

  • Reply 147DegreesWest April 12, 2019 at 3:53 am

    Based on the article- the punchline is Niacin brought down Trikes and raised HDL- but made insulin residents worse. Anyone can access the article.

    The study group- all high Trig low HDL- seems like they would have benefited from a LOw Carb Diet to bring down the trigs.

    It does prompt one to speculate that niacin with metaformin might work with a low carb diet- but that might be too obvious

  • Reply Peter Vafeades April 12, 2019 at 8:45 am

    The correlations table is amazing, thank you for presenting these results

  • Reply John Bemery April 12, 2019 at 2:15 pm

    Hello Dr Brewer, I watched several of your videos a couple years ago, and lost track awhile, but just saw a couple today…wanted to say, your fogginess seems long gone, not sure what happened, but you are distinctly sharper. Well done! Keep up the whatever you are doing.

  • Reply Orlando Furioso April 12, 2019 at 4:32 pm

    While waiting on part two, I take 2 grams of nicotinic acid daily and have for a long time after a stint was installed years ago. Not as medical advice specific to me, but when the dust settles, so to speak, are you reconsidering your personal use of niacin? I believe you use the same brand as I do, being Rugby, but I don't use the timed release after some concerns from "SloNiacin" reported to contribute to liver problems. The timed release may be shorter duration than extended release, but I actually am now tolerant to flushing, so it's not a problem.

  • Reply stupendouus aroni April 12, 2019 at 5:14 pm

    Its nice to see more people looking into niacin. Did they make the difference between long release and short release niacins since they both have differences? Just curious. Anyway thumbs up 👍🏼.

  • Reply Agent99SP April 13, 2019 at 1:30 pm

    My doctor recently advised me to take 500 mg niacine twice daily, which I did. After about a week to 10 days, I noticed my resting heart rate was greatly elevated from normal, which felt terrible. I wondered if it were the niacin, so I went off it. After another week or so, the resting heart rate returned to normal. Am I intolerant to niacin or should I try a lower dose? My metabolic markers are good, but ldl-p is high. I want to reduce ldl-p, but don't want to mess up my insulin/glucose, etc. Hypothetically speaking, what would you advise a patient of yours about this?

  • Reply Ellen K April 13, 2019 at 7:58 pm

    My husband was being tested for A-fib, and the cardiologist asked for a list of drugs and/or supplements he takes. He said to stop taking all of them, (these are vitamins such as K2 (mk7) and b complex and c etc.) and that Niacin increases your stroke risk, and that there is no proof that it does anything for anyone. I mentioned the cholesterol regulating, and he shot that down, too. I'm still taking my niacin, though. I think it's improved my mental clarity, short term memory, and my sleep is a bit better. But it's confusing, so many doctors saying so many different things.

  • Reply jim mcmahon April 14, 2019 at 12:39 pm

    Question: Had a stent put in three months ago. Blood work numbers good. 5'7" 143 lb male, exercise… WHAT CAN I DO TO STABILIZE POTENTIAL HOT PLAQUE WITHOUT TAKING STATINS?

  • Reply Matthew Hunter April 19, 2019 at 8:18 pm

    My biggest concern with Niacin is the amount that I believe I heard you take exceeds the RDA by a substantial amount, and I've read, especially slow release can be hard on your liver, and kidneys, and can lead to concentrations of uric acid, gout, etc

  • Reply Darlene Paul April 20, 2019 at 9:13 pm

    I love learning this stuff with you Ford!

  • Reply Edward K. O'Brien May 5, 2019 at 11:21 am

    1.5g non-extended-release niacin taken for 60 days increased HDL by 30% (up to 72) and decreased triglycerides by 30% (down to 100). But FBG went from 90 to 100; A1C from 4.9 to 5.3. LP(a) stayed the same (150 nmol). Trade-off worth it?

  • Reply Akane Cortich June 14, 2019 at 1:59 pm

    as an aside on Niacin. 2019 Overview PubMed. "11. Conclusions

    A growing body of evidence highlights the key role of vitamin B3 in neuronal health. What is emerging is that niacin bioavailability is crucial for neuronsurvival and functions: indeed, vitamin deficiency has been recognized as a pathogenic factor for neurological deficits and dementia, as well as for neuronal injury and psychiatric disorders.

    Several molecular mechanisms are influenced by vitamin B3 (Figure 4), often strictly linked each other, thus making it difficult to define the precise mechanisms of action of this dietary metabolite. Although further research is needed, it may be speculated that optimal dietary intake of the vitamin will support neuronal health and delay neurodegeneration."

  • Reply Akane Cortich June 14, 2019 at 2:04 pm

    and also…2019 "In conclusion, our study demonstrates that higher niacin intake favorably modulates the effect of a lifestyle intervention on liver fat content. This suggests a beneficial effect of higher niacin consumption in reaching the therapeutic goals of a lifestyle intervention to improve hepatic steatosis. Intervention studies testing the influence of niacin-fortified foods on outcomes of a lifestyle intervention to treat NAFLD are now needed to validate this concept."

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