The Niacin Breakthrough

By Joseph M Keenan and Kathleen M Dunn

The Keenan Protocol for Heart Health and Healthy Aging

How today's niacin can help you achieve your heart health and healthy aging goals.

Niacin has come a long way since its discovery in the

• Language: English
• Publisher: Joseph M Keenan MD
• Release date: Jul 18, 2022
• ISBN: 9798986203225

Book preview

Copyright © 2022 Joseph M. Keenan, M.D. All rights reserved.

No part of this book, including interior design, cover design and illustrations may be reproduced, stored in a retrieval system or transmitted by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the authors and publisher, except for the inclusion of brief quotations in a review.

Although every precaution has been taken in the preparation of this book, the authors and publisher assume no responsibility for errors or omissions. The authors and publisher expressly disclaim any responsibility for any liability, loss, injury or risk, personal or otherwise, which is incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this book.

The information in this book is provided for educational purposes and general reference. It is not meant to be a substitute for medical advice or counseling. Consult a physician before making any changes to diet, exercise or other health habits as described in this book.

All trademarks are the property of their respective owners.

Published by Joseph M. Keenan, M.D.

ISBN: 979-8-9862032-0-1

ISBN: 979-8-9862032-2-5 (e-book)

Library of Congress Control Number: 2022909269

Cover illustrations by T. Bagirov, Nadiinko and Nilamsaridua / Shutterstock.com

Printed in the United States of America

To the memory of Charles Keenan, M.D., who was not only a loving and supportive brother, but an inspiring role model to whom I owe my success in my medical and academic career.

CONTENTS

Introduction

Why Niacin, Why Now?

Part 1 Background & Early Niacin Trials

1 This is Not Your Grandma’s Niacin

2 The Impressive Results of Early Studies

Part 2 Niacin in Action

3 How Niacin Improves Blood Lipids

4 Blood Lipid Benefits of Wax-Matrix Niacin

5 Blood Lipid Benefits of Polygel Niacin

6 Niacin Benefits Beyond Blood Lipids

Part 3 The Role of Statin Drugs

7 Faulty Science Tarnishes Niacin’s Reputation

8 The Side Effects of Statin Drugs

Part 4 Maximizing Your Success

9 Are You a Candidate for Niacin Therapy?

10 Niacin Forms that Work (and Don’t Work)

11 Working with a Doctor

12 Typical Treatment Protocols

13 How to Manage Side Effects

Part 5 Looking at the Bigger Picture

14 Diet & Lifestyle Habits that (Really) Work

15 Niacin, Oral Health & The BaleDoneen Method

Part 6 The Superfecta for Healthy Aging

16 Niacin & Youthful Cells

17 Dihydroberberine & Metabolic Health

18 Taxifolin & Antioxidant Defense

19 Mixed Tocotrienols & Brain Health (& More)

20 The Value of Wax-Matrix Formulas

At-a-Glance: Nicotinic Acid Protocol

At-a-Glance: Superfecta for Healthy Aging

References

Acknowledgements

About the Authors

Index

INTRODUCTION

WHY NIACIN, WHY NOW?

The first wealth is health.

— Ralph Waldo Emerson

If you or a loved one are in search of one of the safest and most effective therapies to help improve blood lipids and reduce the risk of cardiovascular disease, then this book is for you.

You're about to learn about niacin and how this simple B vitamin is one of the most underrated and underappreciated agents that you can use to help manage your blood lipids and cardiovascular health.

To me, the impressive benefits of niacin therapy for cardiovascular health have been hiding in plain sight for decades. What's been missing is a practical how-to guide that takes the frustration and confusion out of niacin therapy so you and your doctor can choose the best option for your individual needs. That's what this book is about, and you’ll learn all the details in the chapters that follow.

You'll also learn why an optimal intake of niacin is so important if you want to age with vigor and vitality, how niacin works to re-energize aging cells, and how it works hand in glove with other ingredients that can help you get within grabbing distance of the brass ring: healthy aging.

Real Benefits for Real People

It’s been over 50 years since niacin emerged onto the scene as the first therapeutic agent to reduce both coronary disease events and death. Over the decades, other options to improve blood lipids have been introduced, but none deliver the wide range of benefits that niacin offers.

Consider this: Niacin has the ability to reduce all of the artery-clogging lipid fractions associated with heart disease, heart attack and stroke. This is an impressive feat that includes the ability to reduce blood levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and very low-density lipoprotein (VLDL) cholesterol, as well as triglycerides.

Niacin is also the most effective therapy for raising a low blood level of high-density lipoprotein (HDL) cholesterol. Yes, the most effective. This is important because HDL helps pull cholesterol out of the plaque that can build up on the inner wall of arteries. This is the same plaque that narrows these blood vessels and limits blood flow to tissues. HDL can then carry cholesterol back to the liver where it’s cleared from the bloodstream. For this reason, HDL cholesterol is often referred to as the good cholesterol.

What's more, niacin is the only oral agent to significantly decrease an elevated blood level of lipoprotein (a), which is a serious inherited risk factor for heart disease. It’s also one of the most lethal forms of dyslipidemia. (Dyslipidemia is medical jargon for any type of condition characterized by abnormal amounts of lipids in the blood.)

Finally, niacin has non-lipid benefits to help reduce atherogenesis, the harmful process that leads to the buildup of plaque in blood vessels.

No other lipid-modifying agent can claim all these benefits. None.

In addition, niacin has been shown to work alone as a monotherapy or in combination with other lipid-modifying agents including statin drugs. Yet, many people are confused about niacin and how it works for cardiovascular health. It’s understandable. After all, niacin has undergone many changes over the decades, mostly to help reduce side effects like skin flushing that can occur in sensitive people. This niacin flush is harmless, but it can be unpleasant enough to be a nuisance.

Now, with the development of controlled-release nicotinic acid tablets, niacin therapy can be as comfortable as it is effective. In fact, today's controlled-release tablets are specifically formulated to help eliminate the excessive skin flushing and other challenges seen with its predecessors, and still deliver clinically impressive results.

As you’ll soon see, numerous clinical studies reveal just how effective the controlled-release form of nicotinic acid can be for just about anyone who struggles with abnormal blood lipids or is concerned about their cardiovascular health.

How do I know the tremendous value of this modern niacin therapy for heart health? As a family practice physician, I’ve been treating patients with cardiovascular disease for over five decades, and I’ve seen firsthand the dramatic impact that niacin therapy can have on their lives. Now, with the advent of today's controlled-release formulas, patients have an effective therapeutic option that's also well tolerated. That's a real bonus. After all, when a therapy is easy to take and doesn’t cause undue side effects, a patient is more willing to stick with it. It’s just human nature. And, with better compliance, a patient is more likely to reach their blood lipid goals faster. To me, niacin has been a valuable therapy since its discovery in the 1950s, but now it’s even better thanks to modern science.

As a researcher, I’ve collaborated with others to investigate and confirm the impressive benefits of niacin therapy for patients with abnormal blood lipids (dyslipidemia). Much of our research focus has been on the wax-matrix form of controlled-release nicotinic acid because this form has been shown to be remarkably well tolerated. You'll learn more in upcoming chapters and soon see that a solid research portfolio supports its use for patients with dyslipidemia.

As a professor emeritus in the Department of Family Medicine and Community Health at the University of Minnesota, I’ve taught doctors in training about how they can help their patients get the most out of niacin therapy using the wax-matrix form. I’ve also helped naturopathic doctors and other integrative healthcare practitioners who are eager to understand how best to use this therapy to help their patients.

Moving Beyond Diet & Lifestyle

Millions of people around the world are at higher risk of heart disease, stroke and heart attack because they have abnormal blood lipids and related risk factors. It’s a good bet that you don’t want to be one of them. After all, it’s no secret that heart disease can hamper your ability to do what you love, spend time with your family and friends, and enjoy your life to the fullest.

While diet and lifestyle changes can help, you may need more to get your heart health to where you want it to be. That’s why it’s so important for you to understand the full value of controlled-release nicotinic acid therapy as a safe, effective (and affordable) option to treat abnormal blood lipids and reduce your risk of cardiovascular disease. It’s one of the reasons I wrote this book.

When it comes to treating your cardiovascular issues, you'll want to be fully prepared to talk to your doctor about all your available options, including the types of controlled-release nicotinic acid that work (and those that don't). In this way, you can decide together on the treatment plan that can best address your individual needs.

A Chapter-by-Chapter Breakdown

Here’s a brief overview of what you’ll learn in the chapters that follow:

Chapter 1 looks back at how niacin has evolved over the decades. Niacin is an essential B vitamin for human health, but it’s also a well-researched therapeutic agent to manage abnormal blood lipid levels and cardiovascular risk, but only when you take it in the right type, the right amount and right delivery form.

In Chapter 2, you’ll learn why we owe a debt of gratitude to the pioneers of mental health research and how their work ushered in a whole new era of niacin therapy for the treatment of cardiovascular disease. While the early studies had yet to uncover how niacin works to improve blood lipids, the impressive results made it easy to see that niacin offered benefits for blood lipid control too valuable to overlook.

In Chapter 3, you’ll learn the various ways niacin works in your liver and, to a lesser extent, in fat cells, to exert its lipid-modifying actions.

Chapter 4 summarizes research related to the wax-matrix form of controlled-release nicotinic acid, while Chapter 5 does the same for the polygel form, another type of controlled-release nicotinic acid tablet worth considering. You’ll also learn about a few practical reasons why you may prefer the wax-matrix form.

Chapter 6 describes emerging research that reveals the benefits of niacin beyond blood lipid management, including its potential to help combat artery-clogging atherogenesis, support post-stroke recovery, and treat chronic kidney disease.

In Chapter 7, we switch gears to take a closer look at the faulty science behind two high-profile clinical trials that have unfairly tarnished the reputation of niacin as an effective lipid-modifying agent.

Chapter 8 outlines how statin drugs became the darling of blood lipid-modifying therapy, despite its limitations and safety concerns. You'll learn how safer, often more effective, niacin therapy was pushed to the sidelines, so much so that many doctors today are unfamiliar with niacin and its impressive therapeutic benefits.

In Chapter 9, you'll learn about the nuts and bolts of niacin therapy, who would benefit the most, and whether you would be a good candidate. Chapter 10 breaks down the different types of niacin so you understand the forms that work (and the forms that don't work) for cardiovascular health.

Chapter 11 discusses how to work with your doctor to maximize the success of nicotinic acid therapy, while Chapter 12 summarizes typical treatment protocols with different types of nicotinic acid formulations and what to expect in terms of blood lipid improvements.

In Chapter 13, you'll learn how to manage skin flushing and other potential side effects of niacin therapy. The good news is all reported side effects are temporary, easy to monitor, and easy to manage with simple strategies so you can fully benefit from niacin’s therapeutic action, comfortably.

Chapter 14 focuses on the diet and lifestyle habits that offer serious benefits for helping you enjoy a long, healthy life.

In Chapter 15, you'll learn about the BaleDoneen Method, an intriguing approach to improve cardiovascular health that begins with good dental health and includes niacin in its therapeutic toolbox.

Chapter 16 focuses on how niacin primes your body’s metabolic machinery for healthy aging, and how emerging research points to a potential role for niacin supplementation in the treatment of glaucoma.

In the chapters that follow, you'll learn about three more dietary supplements that complement niacin's role in healthy aging. You'll also learn why I call this combination the supplement superfecta for healthy aging.

Chapter 17 focuses on dihydroberberine, a highly bioavailable form of the naturally occurring plant compound berberine. Here, you'll learn about its impressive ability to help combat common age-related conditions like type 2 diabetes, high blood lipids and high blood pressure.

Chapter 18 focuses on dihydroquercetin (commonly known as taxifolin) and its antioxidant, anti-inflammatory and immune-supporting actions.

Chapter 19 is all about mixed tocotrienols, a form of vitamin E with powerful antioxidant properties that not only support brain health and cognitive function as you age, but also deliver surprising whole-body benefits.

Finally, Chapter 20 describes the value of wax-matrix formulas and how this innovation has been able to overcome many of the challenges that plague typical controlled-release tablets.

Let’s get started.

PART 1

BACKGROUND & EARLY NIACIN TRIALS

1

THIS IS NOT YOUR GRANDMA’S NIACIN

Knowing is not enough; we must apply. Willing is not enough; we must do.

— Johann Wolfgang von Goethe

If you eat a healthy diet, you’re likely consuming enough niacin to meet your body’s basic needs. In fact, it’s next to impossible to develop a deficiency of this essential vitamin if you’re eating a nutritious diet. For example, meat, fish, poultry and nuts are the main source of dietary niacin. Milk and eggs contain small amounts, but they are excellent sources of tryptophan, an amino acid your body can use to synthesize niacin (albeit, not efficiently). You add more niacin to your daily menu when you eat breads, cereals and other fortified foods.

If you take a daily multivitamin—which I strongly recommend—it’s pretty much a slam dunk that you’ll meet your basic niacin needs. Why? A good quality multi helps fill any nutrient gaps that may occur between the foods you choose to eat (whether by choice or circumstance) and what your body needs.

Niacin, The Vitamin

Nutrition scientists have known about the essential role of niacin for human health for decades. It’s a water-soluble vitamin and exists in two main forms: nicotinic acid and nicotinamide (also known as niacinamide). It belongs to the B vitamin family and was formerly known as vitamin B3, a term that lingers today, but for the most part, you’ll see it referred to as niacin.

Like most of the B vitamins, niacin primarily works as an enzyme cofactor, a biochemical sparkplug that activates cellular enzymes. This is true for either