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November 2009

Niacin and statins
Muscle strength lowers Alzheimer’s risk
Low fat diet lowers prostate cancer
Acetaminophen increases asthma
Carpal tunnel helped by ALA/GLA
Quercetin and blood pressure
General Information

Niacin and statins

A news release from Johns Hopkins Medicine suggests that adding niacin to the regimen of patients taking statins offers no further benefit for reduction of arterial wall thickness. It did not reverse the carotid disease or even slow its progression. (Johns Hopkins Medicine, November 18, 2009 Vitamin B niacin offers no additional benefit to statin therapy….) This kind of report begs for some commentary.

It has been known for 50 years that niacin is one of the best treatments for elevated cholesterol, and has other benefits for the heart. One review in 2005 concluded that it lowers all the atherogenic cholesterol fractions (LDL and VLDL), and Lp(a), and it raises the protective HDL cholesterol more than other treatments. It also reduces the progression of atherosclerosis, heart attacks, and mortality from heart disease. (Carlson LA, Nicotinic acid: the broad-spectrum lipid drug. A 50th anniversary review. J Intern Med. 2005 Aug;258(2):94-114.)

Other clinical trials have confirmed that it lowers mortality from heart disease and interferes with triglyceride production in the liver, while inhibiting the breakdown of the good HDL. (Malik S, Kashyap ML, Niacin, lipids, and heart disease. Curr Cardiol Rep. 2003 Nov;5(6):470-6; Shepherd J, et al., Nicotinic acid in the management of dyslipidaemia associated with diabetes and metabolic syndrome…. Curr Med Res Opin. 2005 May;21(5):665-82.; and Canner PL, et al., Benefits of niacin in patients with versus without the metabolic syndrome and healed myocardial infarction (from the Coronary Drug Project). Am J Cardiol. 2006 Feb 15;97(4):477-9.

What this recent report did not do was to evaluate whether adding statin therapy to patients already on niacin provides any further benefit compared to taking niacin alone. This would be a much more valuable study because niacin is safer and far less expensive than statin drugs (and it has benefits in other conditions also).

In another of their press releases, they noted that a study on niacin was halted prematurely. In spite of its benefits, the editorial authors said the focus of treatment or prevention for heart disease should be on drug therapies for cholesterol, blood pressure, and anti-platelet effects, in addition to diet, weight control, and exercise, and that statins should be the first treatment choice, not niacin, even though niacin raised the good HDL in this study (while the drug lowered it!). (Johns Hopkins Medicine, News Release November 15, 2009, Heart experts say early end to key study on benefits of niacin…premature.)

The bias against supplements is clear in the face of extensive evidence of the benefits (in this case of niacin), their low cost, and their safety. It would be interesting to see the study say that “statins offer no further heart benefits to patients already taking niacin.”

Muscle strength lowers Alzheimer’s risk

A new prospective study shows a relationship between maintaining muscle strength and the risk of developing Alzheimer’s disease (AD). Researchers evaluated more than 900 people without dementia at the start of the study and measured their strength in nine different muscle groups to give a combined strength score.

They followed them for an average of 3.6 years, during which time 138 persons developed AD. For every unit of greater composite muscle strength at baseline, they found a 43 percent decrease in the risk of AD. After adjustment for other variables, such as body mass index, physical activity, pulmonary function, and vascular diseases, this association of strength with lower AD risk persisted. (Boyle PA, et al., Association of muscle strength with the risk of Alzheimer disease and the rate of cognitive decline in community-dwelling older persons. Arch Neurol. 2009 Nov;66(11):1339-44.)

They also measured mild cognitive impairment (MCI), a precursor to AD, and found that this was also reduced in those with higher levels of combined muscle strength. The risk of MCI was 33 percent lower for each unit of higher strength. Those in the highest category of strength had 48 percent less risk than those in the lowest category. Maintaining muscle strength through resistance training (weights or elastic exercise bands, for examples) has other benefits, including a greater ability to participate in pleasurable hobbies and to manage the normal activities of daily living (things like lifting groceries or children).

Low fat diet lowers prostate cancer

Researchers studied 18 men with prostate cancer who had no prior therapy, and randomized them to receive either a low fat diet (15 percent of calories), high in fiber and supplemented with soy protein, or a typical Western diet containing 40 percent fat. They were on this program for four weeks, and serum was collected at baseline and after the interventions. They measured prostate specific antigen (PSA), sex hormones, insulin, insulin-like growth factors, and lipids. Aronson WJ, et al., Growth Inhibitory Effect of Low Fat Diet on Prostate Cancer Cells: Results of a Prospective, Randomized Dietary Intervention Trial in Men With Prostate Cancer. J Urol. 2009 Nov 13. [Epub ahead of print]
They then cultured prostate cancer (LNCaP) cells in media containing the before and after sera of the different groups. Serum from the men on the low fat diets reduced the growth of the LNCaP cells by 36 percent. The authors speculated that the risk of prostate cancer, as shown by other studies, was increased by Western diets (as well as sedentary lifestyles), possibly due to changes in serum hormones and cancer growth factors.

They noted in their study that the subjects on the low fat diet had lower triglyceride levels and lower omega-6 fatty acids, and a relatively increased level of omega-3 fatty acids. The better ratio of omega-3 to omega-6 fatty acids was correlated with a decreased serum-stimulated LNCaP cancer cell growth.

Acetaminophen increases asthma

The aspirin substitute, acetaminophen (Tylenol), is often administered to children as it is supposed to be safer than aspirin. However, research has sometimes shown that asthma is increased in people who use acetaminophen, but the data are conflicting. A new report evaluated 19 studies (cross-sectional, cohort, and case-control studies) of 425,140 subjects in total. (Etminan M, et al., Acetaminophen use and the risk of asthma in children and adults: a systematic review and metaanalysis. Chest. 2009 Nov;136(5):1316-23.)

The pooled results showed that asthma in children who used acetaminophen in the year prior to developing asthma was 60 percent higher than among those who did not use the drug. If they took the drug in the first year of life, their asthma risk was increased by 47 percent. They also found an increased risk of asthma in adults who took the drug.

Carpal tunnel helped by ALA/GLA

Carpal tunnel syndrome (CTS) is tingling and numbness with pain in the thumb and next two fingers due to compression of the median nerve that runs through the fibrous tissue channel on the inside of the wrist. This fibrous tissue might swell from repetitive motion injury, or it might be related to arthritis, diabetes, obesity, and sometimes other causes. In the most severe cases of this neuropathy, it may be treated with surgery, but other treatments are more appropriate. Often, supplements of vitamin B6 (pyridoxine) are very helpful (100-200 mg is usually enough).

A new study shows that other nutrients are also effective treatments. Italian researchers treated 112 subjects with moderately severe CTS with either a combination of alpha lipoic acid (ALA) and gamma-linolenic acid (GLA), or a multivitamin B complex. They used 600 mg of ALA and 360 mg of GLA and treated for 90 days. (Di Geronimo G, et al., Treatment of carpal tunnel syndrome with alpha-lipoic acid. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):133-9.)

At the end of the study, the ALA/GLA group had reduced symptoms and improved functional ability and improvement on their electro-myography testing. The multivitamin group also had significantly improved symptoms and functional scores, but less marked than those on the ALA/GLA combination.

It would be interesting to know what would happen if the patients were treated with both the ALA/GLA combination and the vitamin preparation. The daily multivitamin contained vitamins B1 (thiamine) 100 mg; B6, 150 mg; and vitamin B12 (cobalamin), 500 mcg, so these treatments could well be synergistic.

Quercetin and blood pressure

A review of research on the bioflavonoid quercetin (which gives a slight yellowish tinge to apples and yellow onions and is also found in green and black teas and in small amounts in many other foods) shows that it helps to control blood pressure and has other benefits. The authors note that in several kinds of animal studies, quercetin induced a progressive and sustained reduction in blood pressure. (Perez-Vizcaino F, Antihypertensive effects of the flavonoid quercetin. Pharmacol Rep. 2009 Jan-Feb;61(1):67-75.)

In a rat model of metabolic syndrome (obese rats on a high-sugar and high-fat diet) quercetin prevented the physical and functional damage in the heart, blood vessels, and kidneys. They also reported that high doses of quercetin in mild hypertension in humans significantly lowered blood pressure. This suggests that quercetin might be one of the reasons that diets high in fruits and vegetables lower blood pressure (the content of vitamin C, potassium, and magnesium might be other reasons that help explain this benefit).

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From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
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Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.

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