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.