Supplements At Risk, Stopping the Niacin Flush, No-Fault Illness, "Solutions" Weight Loss Program

• Letter to Our Readers: Rants and Scams
• Supplements At Risk? DSHEA update
• Niacin -- How to Get Rid of the flush
• Rant 'o The Month -- Should You Be Blamed for Your Disease?
• Monroe Street Clinic News - Weight Loss Program

Letter to Our Readers -- Rants and Scams

In my practice I see and hear a lot of misinformation, some of it willful, some of it just mistaken. With so many claims out there, it's easy for the hopeful patient or unsuspecting consumer to be mislead. I hate to see money needlessly spent or sleep lost over unsupported claims and mistaken assumptions. To answer that concern, I'll be using our new rant 'o the month and the scam 'o the month feature to take on some of this misinformation. If you're wondering about some new cure-all, feel free to write and ask. I may just take it up in one of my monthly rants.

-- Douwe Rienstra, MD

Supplements At Risk? DSHEA update

About a decade ago, Congress debated whether to regulate dietary supplements as they do prescription medicine. To do so would have made supplements unavailable or too costly for most consumers. At the end of the debate, Congress passed the Dietary Supplement Health and Education Act of 1994 (DSHEA),which allowed consumers the continued right to buy and consume vitamin, mineral, herbal, and other nutritional supplements. While this act permits the production and sale of dietary supplements, the Food and Drug Administration (FDA) can regulate supplements proved harmful to consumers.

Now the US Senate is considering a bill that would reduce your ability to obtain nutritional supplements. Whereas the present law is an "innocent until proven guilty" law (the FDA has to prove a supplement harmful to get it off the market), the new law would be a "guilty until proven innocent" law, in which the supplement manufacturer, once challenged, would have to prove the supplement safe. For more info,check out The American Association for Health Freedom Website

Niacin -- How to Get Rid of the Flush

Dear Doctor,

I want to take niacin for my high cholesterol, but I don't want to flush. Can I take "flush-free" niacin? How does that compare to regular niacin?

--Chuck

Dear Chuck,

Niacin (also called nicotinic acid) can help lower high cholesterol. Unfortunately, niacin can also cause a flushing, burning sensation or redness of the skin as the blood vessels dilate. I will tell you how to decrease the flush, but first I'd like to give you some background on niacin, how it works, and why it causes a flush.

Niacin First Used to Cure Pellagra

Niacin, one of the B vitamins, has long been known to cure the deficiency symptoms associated with an inadequate diet. Once widespread, the deficiency was known as pellagra and the symptoms included rash, diarrhea, and mental derangement. Today, most multivitamin supplements contain niacin to prevent pellagra. About 15 to 20 milligrams a day of niacin is all it takes.

Niacin Combats High Cholesterol and Triglycerides

Niacin can also be an effective treatment for high cholesterol and triglycerides. Each day our livers make from 1000 to 2000 milligrams of cholesterol, which we require for brain structure and function, for production of vitamin D and for the manufacture of many important hormones. Triglycerides are the means by which fats are packaged for transport through the bloodstream. We need cholesterol and triglycerides, but too much of these substances can block our arteries and lead to heart disease. That's where niacin comes in. High doses of niacin, in the range of 1500 to 3000 milligrams a day, lower elevated levels of cholesterol and triglycerides about 90% of the time.

Niacin does this in a very nifty way. It interferes with the packaging of cholesterol for transport out into the blood vessels. It also increases the liver's ability to remove LDL cholesterol (the most concentrated form of cholesterol) from the circulation. Furthermore, niacin increases the liver's production of HDL cholesterol (which carries cholesterol back to the liver for disposal).

Niacin is usually very effective for elevated cholesterol, either alone or in combination with the prescription drugs, the statins. Like the statins, niacin has been shown to lower heart attack rates and increase longevity. However, there are many details that are important to the success and safety of niacin use. It's best to take this supplement under the care and guidance of your health care provider.

The Flush

Niacin can cause a number of side effects, the most notable being a flush. The flush comes from guard cells (called mast cells) stationed throughout the body. These cells respond to foreign material by initiating an immune response. High doses of niacin cause the mast cells to release histamines, which dilate the blood vessels. We experience this as a red flush and a sensation variously experienced as a burning, stinging, or flushing.

Flush Free Products

The term "no-flush niacin" can refer to any of the following preparations. None is prefect.

Inositol hexaniacinate -- Larger dose required, higher cost

Inositol hexaniacinate (also called inositol nicotinate) consists of niacin complexed with inositol. Inositol, a substance that is essential to lower life forms, occurs widely in the plant kingdom. It is also naturally present in muscle, blood cells and other tissues of the human body. Chemically combine inositol with niacin and you have a substance that is absorbed into the blood stream and then released slowly over a period of hours. This eliminates the flush. The downside: inositol hexaniacinate at an equal dose is less effective than plain niacin in lowering cholesterol, and it costs somewhat more. The upside: if you can't tolerate regular niacin, inositol hexaniacinate at the proper dose may be your ticket to a normal cholesterol.

NiaspanÆ -- Really Costly

NiaspanÆ is a prescription form of delayed-release niacin. It is safe and effective for high cholesterol. The last I checked, it cost $100 to $200 per month.

Other forms of sustained-release niacin -- Downright Dangerous

You can find other forms of sustained release niacin on the shelf of the drugstore or health food store. These can cause permanent liver damage and you should not use them.

Niacinamide -- Doesn't Work

Niacinamide (also called nicotinamide) is a chemical variation of niacin that does not lower cholesterol. Using a special dosing routine for several months, it may relieve the stiffness of osteoarthritis.

Diminishing the flush

When you take regular niacin, you can use the following measures to help decrease the flush.

-Take an aspirin a day for 3-4 days before starting the niacin. This stabilizes the membranes of the mast cells that cause the flush.

-Take an antihistamine 1 hour before taking the niacin. This combats the histamines released by the mast cells.

-Always take niacin at the end of a meal on a full stomach. This will decrease the rate of absorption.

-If you really find the flush distressing, and you are a methodical person, start with a dose of 100 milligrams after each meal and increase gradually to 500 to 1500 milligrams as you become adjusted to the flush.

-Do not take niacin with a hot drink such as tea or coffee, as that will increase the rate of absorption and increase the flushing.

Side effects of niacin

Excessive doses of niacin or niacinamide can cause nausea. High-dose niacin causes elevated liver function tests in some people. If you're taking niacin, you should be tested for this after a couple of months. The liver tests will return to normal once niacin is discontinued (with the important exception of over-the-counter sustained-release formulations, where the abnormal liver function tests can become permanent.)

Rant' O The Month -- Should You Be Blamed for Your Disease?

It makes me sad when a patient with a serious disease says, "I know I brought this on myself." Usually they picked up the idea from some so-called "holistic practitioner" who told them their illness is due to poor lifestyle, poor diet, their own (perhaps subconscious) volition, or even some sin from a past life. Let's get real. Nobody wishes to become ill or to develop cancer. Few people eat a perfect diet or have a perfect soul, but most of us, despite our weaknesses, aren't suffering from some terrible malady. Sometimes people just get sick and we don't know why. It's hard enough to be ill; let's not blame it on ourselves.

If you fall ill, know that it is not your fault. If your illness proceeded from some bad habit such as eating too much fatty food, remember you were doing the best your could at the time. If you see now that this habit led to ill health, don't blame yourself or anybody else. Instead, take responsibility for changing the habit. Focus on what you can do this minute, this hour, this day to improve your health.

Monroe Street Clinic News -- Solutions -- Our New Weight Loss Program

What?

Dr. Rienstra is combining forces with Janet Goldenbogen-Self, RN, RC to offer an integrated program to help people lose unwanted weight. The program, called "Solutions," helps people achieve and maintain healthy life habits that result in a more normal weight. The program incorporates recent scientific research about the physiological and emotional aspects of weight gain and weight loss.

Who?

Dr. Rienstra is member of the American Association of Bariatric Physicians, the national medical organization concerned with weight loss and weight management. Janet Goldenbogen is a registered nurse with a Doctorate in Naturopathic Medicine who brings ten years of experience in nutritional consulting and education to the program.

How? Medical services

Dr. Rienstra provides the expertise to detect medical conditions that contribute to weight gain or prevent weight loss. He monitors changes in conditions such as diabetes, hypertension, and elevated cholesterol and fine-tunes medications as a person loses weight. In addition, he may prescribe medications and/or supplements that enhance weight loss. Monroe Street Clinic staff monitor body composition during weight loss to ensure participants lose fat mass rather than lean body weight during the "Solutions" program.

How? Educational services

Janet Goldenbogen provides a three-pronged approach to healthy weight loss:

• Her "Consciousness of Eating" program provides realistic, science-based tips on day-to-day healthier living habits.
• "Don't Diet, Live It" is a supportive small-group program that takes an intensive and serious look at the emotions of eating and our relationship to food.
• Her cooking classes take you from the supermarket to the kitchen, and cater to a wide variety of dietary needs.

Course participants graduate to an on-going "Maintenance Program" as they advance from weight loss to weight stabilization.

For further information, call 385-5658 or check out our website.

To register for Janet Goldenbogen's September classes call 379-8134.