Weight loss or niacin: Which is better?

As I discussed in my last blog post, niacin can be a useful vitamin and nutritional supplement to correct many causes of heart disease. But, there is an alternative. Take a look:

Niacin (vitamin B3):

• Raises HDL and shifts HDL towards the healthier and more effective large (HDL2b) subclass.
• Reduces total LDL.
• Reduces the especially undesirable small LDL particles.
• Reduces triglycerides and triglyceride-containing particles like VLDL and IDL (intermediate-density lipoprotein).
• Reduces fibrinogen, a clotting protein that causes heart disease.
• Reduces inflammatory responses.

Weight loss achieved with a low-carbohydrate diet:

• Raises HDL and shifts HDL towards the healthier and more effective large (HDL2b) subclass.
• Reduces total LDL.
• Reduces the especially undesirable small LDL particles.
• Reduces triglycerides and triglyceride-containing particles like VLDL and IDL (intermediate-density lipoprotein).
• Reduces fibrinogen, a clotting protein that causes heart disease.
• Reduces inflammatory responses.

Curious, isn't it?

Weight loss achieved through a low-carbohydrate diet achieves virtually the same effect as niacin. This is especially true if wheat products are cut back or eliminated. Yes, wheat, the very same product that is a part of whole grains and fiber foods and often recommended as part of a "healthy" diet. The only major difference in cholesterol and related values is that niacin also reduces the hidden and potent cause of heart disease, lipoprotein(a), though even that distinction shrinks if monounsaturated fat sources like almonds are included in a low-carbohydrate program.

So which should you do first if you have any of the above patterns?

Well, it's a question of 1) severity, 2) how carbohydrate-rich your starting diet is, 3) how much weight you could stand to lose, and 4) how urgent your heart health program is.

A 250-lb, 5 ft 4 inch woman who suffered a heart attack and received two stents should be in a real hurry to achieve improvement in her low HDL cholesterol and other abnormal patterns, since she's already experienced a dangerous event; perhaps both strategies should be followed. Someone with the same low HDL pattern but no detectable heart disease might consider a carbohydrate-restricted diet alone. Another person with a risk in between these two extremes, as suggested by a heart scan score of 300, for example, might do one or the other, but add the second if inadequate results are obtained.

Niacin can also be very helpful if you've taken full advantage of weight loss through a carbohydrate-restricted program, yet still retain some of the abnormal lipoprotein patterns that could continue to grow coronary plaque. For instance, if HDL cholesterol rises from 28 to 40 mg/dl by eliminating wheat and reducing carbohydrates and losing weight, adding niacin could raise HDL to 50 mg/dl or higher.

As much as I love and use niacin for its broad array of plaque-controlling effects, a low-carbohydrate, reduced wheat diet can achieve many of the same effects. (In fact, in my program for reversal of heart disease I often urge patients to be entirely wheat-free, at least until their abnormal patterns come under control.)