WHAT’S GOOD ABOUT CHOLESTEROL? Part 2 of 2

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Last time we talked about what cholesterol was, what HDL, and LDL were and how statin medications were very helpful for many people. This time we will talk about raising HDL.

If you remember, cholesterol is a kind of fat, so it doesn’t mix with blood, which is mostly water, very well. The liver has to mix the cholesterol with proteins and other stuff to get it to stay in the blood. This mixture of cholesterol (a lipid or fat) and protein is called a lipoprotein. If you take a blood sample and spin it really fast, it separates based on density. So different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called “bad” cholesterol because it transports cholesterol and other lipids from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called “good” cholesterol because it transports cholesterol and other fats from the cells lining the blood vessels to the liver. This can decrease the chance of blockages.

Medications like the statins are good at reducing the LDL, but what about increasing the HDL or “good” cholesterol? Weigh reduction and physical activity can each increase HDL up to ~25%, stopping smoking can increase HDL by ~5%, statins can increase HDL up to ~15%, and niacin can increase HDL up to ~35%.

If niacin is so good at increasing HDL, why isn’t it used more? There is a lot of confusion about types of niacin, side effects and how it should be used.

Vitamin B3 has two chemical names: niacin or nicotinic acid. There is a different form of niacin called nicotinamide. Both niacin and nicotinamide can be used to prevent niacin deficiency and to treat pellagra. Pellagra is a condition of niacin deficiency that includes rash, diarrhea and dementia. However, only niacin is useful to treat cholesterol problems.

If niacin is just a vitamin and is good at raising HDL, why don’t we all take it just in case? Although you can buy niacin without a prescription, I recommend anyone considering using it to consult their doctor first. Niacin has side effects. The most noticeable one is flushing of the skin and feeling very warm. Although this effect is not harmful, it makes many people uncomfortable enough that they quit niacin. Other common, nontoxic, reversible effects of large doses of niacin are dizziness, nausea, low blood pressure, fast heart beat, headache, and blurred vision. Of more concern is that niacin can raise blood sugar, cause gout, and like other cholesterol pills, niacin has rarely been associated with liver problems. Niacin should be avoided in people with chronic liver disease, severe gout, active stomach ulcers, and certain bleeding problems. It can be used with caution in people with diabetes and mild gout.

If your doctor wants to start you on niacin, they will probably want to do blood tests on your liver, uric acid and blood sugar before they start the niacin and periodically after that.

There are also different niacin preparations. The fast acting niacin tends to give people more flushing, but the slow acting tends to cause more liver problems. There is also a vitamin commonly called no-flush niacin that contains inositol hexaniacinate. Although it may have other beneficial properties, it will not help cholesterol levels.

As always if you have any questions or concerns about these or other products, ask your pharmacist.