Niacin – a.k.a vitamin B3 – the neglected broad spectrum cholesterol drug!

 

Niacin - vitamin B3 - when taken in high dose acts as a powerful cholesterol drug. Niacin is unique among all available cholesterol drugs because it has beneficial effects across the entire lipid/lipoprotein spectrum, including the three components of atherogenic dyslipidemia. 
 
To learn the basics about atherogenic dyslipidemia, see my previous article "Why you need to look beyond your LDL - “bad cholesterol” - level". 
 
Niacin is especially noteworthy because it is the most potent drug available for raising HDL levels.[1, 2] Besides boosting  HDL levels, niacin also markedly lowers triglyceride levels while reducing LDL to a smaller degree.[1]
 
The table below provides an overview of the effects of popular drugs and supplements on blood lipids.[3]
 
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Effects of Testosterone Therapy for 3 Years on Subclinical Atherosclerosis Progression in Older Men

Clinical practice guidelines rely heavily on results from randomized controlled trials (RCTs), which is the gold standard for medical research. RCTs produce evidence considered to be of the highest quality. Because RCTs are resource intensive and costly, they are typically of relatively short duration, commonly lasting for around one year. 
 
Currently there are only a few placebo-controlled RCTs investigating the effects of testosterone therapy for a duration of 3 years [1-4], and medical societies have long been urging for more long-term trials evaluating the safety and efficacy of testosterone therapy.[5-7]
 
On August 11th 2015 a notable 3-year long RCT was published in JAMA (Journal of the American Medical Association), which attracted a lot of attention.[8] While interpreted by many as showing that testosterone therapy does not confer any benefits on atherosclerosis, sexual function and quality of life, a closer look at the data actually shows two important positive results…
 
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Niacin Supplements - what you need to know about niacin products

In a previous article I presented the wide array of health benefit of niacin – a.k.a vitamin B3 – supplementation, related to both its lipid and non-lipid effects "Niacin – a.k.a vitamin B3 – the Neglected Broad Spectrum Cholesterol Drug! "
 
In this article you will get critical information about the different niacin products and names, and what to look for when shopping niacin supplements…
 
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The “good” HDL cholesterol under attack! - Defending Niacin, aka vitamin B3

Niacin confers tremendous beneficial effects on both lipids, inflammation and endothelial function. For more, see my previous article:
 
 
 
Despite this, two media attention grabbing studies - AIM-HIGH and HPS2-THRIVE - did not find any benefits of niacin supplementation in heart disease patients who were already on intensive statin treatment. 
 
Here I will summarize these studies and expose their multiple flaws, which never made it to the headlines...
 
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Everything We Learned About TESTOSTERONE Is WRONG - video presentation by Dr. Morgentaler

Historically testosterone therapy was only indicated in men with pituitary tumors and testicular dysfunction. Dr. Morgentaler pioneered the field when he started to treat men – who did not have any underlying pituitary tumors and testicular dysfunction - with Low-T with testosterone therapy. His patients reported improved erections, libido, orgasm, as well as increased energy, mood, cognition and wellbeing.
 
This use of testosterone therapy in otherwise healthy men defied standard medical practice in the 1990s...
 
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Survival and cardiovascular events in men on testosterone treatment

On the surface, testosterone therapy is a controversial treatment because previous studies investigating the effects of testosterone therapy have been conflicting, with some studies showing supposed harm and others showing significant benefit.
 
Here I summarize the results of a new study published in The Lancet Diabetes & Endocrinology on May 7 2016, which addressed some shortcomings in previous studies by analyzing effects based on duration of testosterone treatment.[1]
 
 
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Remnant Cholesterol and non-HDL – What’s that? Why bother?

 
In a previous article "Blood Cholesterol Testing - don't let the routine standard lipid panel fool you!" I talked about the standard lipid panel that doctors use to check your “bad” cholesterol, aka LDL level. In "Why you need to look beyond your “bad" cholesterol” - level" I’ve also gone into some depth on why a myopic focus on LDL-C can do more harm than good.
 
In this article I will talk about 2 relatively unknown cholesterol parameters and explain why you want to keep an eye on these…
 
The routine standard lipid panel checks your levels of:
 
- Total cholesterol 
 
- LDL-C (or just LDL, low-density lipoprotein cholesterol, the “bad" cholesterol)
 
- HDL-C (or just HDL, high-density lipoprotein cholesterol, the “good" cholesterol) 
 
- VLDL-C (or just VLDL, very-low-density lipoprotein cholesterol) 
 
- Triglycerides (a.k.a. blood fats)
 
If you have read my previous articles you know the limitations of LDL-C and the standard lipid panel. However, while the advanced lipid panel gives you much more accurate information on your health status, the standard lipid panel is not totally worthless if you know what to look for…The caveat is, what to look for - non-HDL-C and remnant cholesterol – are not printed in your standar lipid test results. And your doctor may not even know about non-HDL-C and remnant cholesterol! That’s why I had to write this article…
 
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Testosterone Deficiency and Treatment - the FACTS

 
Testosterone deficiency and treatment is a very misunderstood and controversial topic among scientists, regulatory agencies (such as the FDA and EMA) and doctors, as well as the popular media.
 
On October 1, 2015, an international expert consensus conference about testosterone deficiency and its treatment was held in Prague, sponsored by King’s College London and the International Society for the Study of the Aging Male (ISSAM). The impetus for this meeting was to address the widespread misinformation and confusion about testosterone deficiency and testosterone therapy.[1]
 
The ultimate goal of this consensus conference was to document what is true or untrue about testosterone deficiency and testosterone therapy, to the best degree possible based on existing scientific and clinical evidence.
 
There were 18 experts from 11 countries on 4 continents. Specialties included urology, endocrinology, internal medicine, diabetology, and basic science research. Experts were invited on the basis of extensive clinical experience with testosterone deficiency and its treatment and/or research experience.
 
The final consensus on several key issues related to testosterone therapy was published in the form of 9 resolutions (i.e. firm decisions), coupled with expert comments.[2] These are summarized in table 1.
 
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Video Summary: Testosterone Deficiency and Treatment - International Expert Consensus Resolutions

In a previous article "Testosterone Deficiency and Treatment - the FACTS" I presented the conclusions from an International Expert Consensus Conference on Testosterone Deficiency and Its Treatment.[1]
 
Here I summarize the key points, and link to a video summary by Dr. Abraham Morgentaler, an internationally renowned testosterone scientist and clinician.
 
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Testosterone treatment is NOT associated with risk of adverse cardiovascular events – the RHYME study

It is well-documented that testosterone therapy effectively restores testosterone levels in hypogonadal men and improves many health outcomes, such as quality of life [1-4], libido [4, 5], metabolic parameters [5-9] and body composition.[4, 5, 9, 10]
 
However, a few conflicting studies raised concerns about the cardiovascular safety of testosterone therapy [11, 12], which in 2015 prompted the FDA to issue warnings to physicians and patients about potential cardiovascular risks of testosterone therapy.
 
In contrast, the European Medicines Agency (EMA) acknowledged the flaws of the conflicting studies and concluded that there is no consistent evidence of harm associated with testosterone therapy, regardless of mode of delivery.[13]
 
Here I summarize the cardiovascular results of the notable RHYME (The Registry of Hypogonadism in Men) study, which contrary to prior clinical trials, enrolled men with a wide range of comorbid illnesses and cardiovascular risk factors.[14] The aim was to evaluate the safety of testosterone therapy in a sufficiently diverse population to reflect real-world, clinical experience.[14]
 
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Dr. Pierce's Medical Organization Affiliations

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