Читать книгу Orthomolecular Medicine for Everyone - Abram Hoffer M.D. Ph.D. - Страница 53

In recent years, the amount of information that has accumulated with respect to cardiovascular problems, blood lipid (fat) metabolism, and the use of compounds to correct lipid abnormalities has expanded enormously. The problem is very complicated as there are several lipid fractions and each one has a different relationship with arteriosclerosis, heart disease, and stroke. Ideally, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, and lipoprotein(a) all should be in the normal range.

In 1955, Rudolf Altschul, M.D., James Stephen, M.D., and I (A. H.) discovered that niacin (but not niacinamide) lowered cholesterol levels, particularly LDLs.¹⁰ It was also subsequently found that niacin lowers triglycerides. Since then, over 2,000 studies have been completed, confirming our work and trying to discover exactly how niacin produces these results. Niacin should be considered as a broad-spectrum hypolipidemic substance. The antilipidemic drug Atromid-S (clofibrate) has been found to increase the death rate and increase the rate of gallbladder disease.

In a later study, we found that niacin not only lowered total cholesterol levels but, if the initial cholesterol levels of otherwise normal subjects were already very low, the cholesterol levels were increased by niacin.¹¹ It was not, therefore, simply a compound that lowered cholesterol but one that made cholesterol blood levels normal. Further studies demonstrated that the amount of HDL in the blood was much more important as a marker of cardiovascular health than the total cholesterol level. All the abnormal lipid fractions became more normal when subjects took niacin, making it the most effective substance known in this area.¹²

We are convinced that niacin can decrease significantly the incidence of coronary disease, but do not think B₃ by itself is the solution. Ideally, one would begin with a sugar-free orthomolecular diet (high in fiber, low in fat), then add niacin when needed, for its hypocholesterolemic effect. On niacin, all cholesterol values tend to cluster toward 180 mg, which may be considered to be the optimum level. It is wise to accompany niacin with pyridoxine (vitamin B₆, which plays a role in arteriosclerosis), ascorbic acid (to heal damaged intima), essential fatty acids, and zinc. Familial hypercholesterolemia will not respond to dietary management. The only effective combination is Colestipol, a bile acid sequestrant, and niacin, which reduces synthesis of LDL.

A coronary drug study involving niacin was completed in 1975 and the nearly 8,000 survivors were reexamined ten years later to determine whether the treatments had caused any deleterious side effects (except for death). Researchers found that the niacin-treated group lived two years longer and had an 11 percent decrease in mortality compared to all other groups.¹³ Had these patients remained on niacin after 1975, there is little doubt that the mortality would have been decreased even more and might have approached other findings of a 90 percent decrease.

The National Institutes of Health, in Washington, D.C., recommends that elevated cholesterol levels be decreased by diet, and when this is not adequate, by using substances such as niacin.

Niacin has the following therapeutic uses:

• It decreases LDL cholesterol. The higher the initial value is, the greater is the effect.

• It decreases triglycerides in the blood.

• It decreases lipoprotein(a) levels and elevates HDL levels.

• It inhibits free fatty acid mobilization.

• It has anti-inflammatory properties now considered important in cardiovascular disease.

• It restores intestinal permeability to normal levels.

These are important changes in the body but even more important and valuable is that it decreases the death rate, increases life span, decreases the ravages of hardening of the arteries, and decreases strokes and coronary disease.¹⁴ Niacin is classed as a vitamin, but it would be just as correct to classify it as an amino acid. There is no other single substance or combination of compounds that can reproduce these remarkable properties of niacin in terms of efficacy, long-term safety, and economy.

The cholesterol hypothesis of cardiovascular disease is by no means fully accepted and there is still a vigorous debate as to whether or not cholesterol ought to be given such a prominent role in this serious condition. The older, simple view that total cholesterol was directly associated with hardening of the arteries has to be modified, while the modern view is that HDL is the most important factor. The older view has controlled the field for over fifty years and is responsible for the massive use of drugs to lower total and LDL cholesterol levels. Earlier drugs, such as the fibrates, have been replaced by more modern and more toxic drugs, the statins. There is no question that statins will decrease high cholesterol levels and may even decrease the incidence of cardiac episodes. But there is very little hard evidence that lowering total cholesterol with these compounds has improved the overall health or, most important of all, has increased the life span of patients. Billions of dollars have been spent giving millions of patients statins based on an old hypothesis with no benefit and major side effects.¹⁵ We believe that these drugs should be used with the utmost caution.

However, using compounds that elevate HDL may be very effective. There are no drugs that will do this safely, leaving only niacin. There is powerful evidence that niacin does elevate HDL and, as we have said earlier, it does decrease the death rate. Edwin Boyle, Jr., M.D., of the National Coronary Drug Project and later research director of the Miami Heart Institute, in Miami Beach, reported much more striking results with niacin. Boyle reported, “In a large number of coronary patients of which we were due to have lost about sixty-two in the last ten years, according to insurance company mortality tables, only six are dead of coronary thrombosis as of today.”¹⁶ This is mortality data on patients already having suffered one coronary episode. We can conclude that giving niacin to patients before they have had their first episode will have an even better reduction in deaths from coronary thrombosis.

The New York Times recently reported that vitamin B₃ can boost HDL levels by as much as 35 percent when taken in high doses (about 2,000 mg daily) and it also lowers LDL levels and triglycerides up to 50 percent. Steven E. Nissen, M.D., president of the American College of Cardiology, stated, “Niacin is really it. Nothing else available is that effective.”¹⁷