Peter Attia· MD
and I I see some benefits to niacin I don't think the HCL is a benefit but lowering april-b I'm gonna always consider that a good benefit but if it's nothing is happening there's something adverse going on which I don't understand look they took that extended release product off the market in Europe based on this trial in the United States still here but you just made it unaffordable so they don't want you using it immediate release not as soon as you're basically describing a vitamin at a mega dose one other little aside cuz I noticed people who ho take nice and remember these trials were done with massive pharmacological doses of niacin they didn't tell take a multivitamin with niacin in it which has there's nothing to lipids or lipoproteins so if you want to be a nice and player will you put in the coronary drug project committee release a niacin was four grams a day try that sustained-release knives wait so those patients took one gram four times a day yeah don't look their way up to it yeah you know so cuz many just hey if this is what you can take that's what you but they got on pretty high doses I will say Aniston's kudos to the docs and those trials in her extramural operations for tolerating yeah listen if you get not only flushing but massive pruritus can occur when you use immediately it's a scary phenomenon to a layman who experiences that who hasn't been warned I remember a call I got early in my practice like at 2:00 in the morning the guy thought he was gonna die he had dialed 9-1-1 because he just had an extensive pyretic reaction and he felt his whole body was on fire if he'd had a swimming pool he would have jumped into it but he co cuz he just thought his body was burning up and I just said you're gonna think I'm crazy shew two aspirins and just call me back in an hour it'll be gone I forget whether he did wound up in the ER nah now that's an extreme reaction but it occurs so and look I've took a nice in a couple years of myself on some of the beliefs before we knew a lot of this that cuz I could not tolerate a stat and her statin ezetimibe and I had an April B issue and I hadn't learned about intermittent fasting or follow the low carb diet at that time so and unfortunately niacin didn't even lower the April B and me did nothing but I tolerated it for whatever reason but did nothing and who knows what it did to my insulin resistance you know for me nice and sort of grew out of favor with patients even before the final trial I think just the exacerbation of insulin resistance became sort of problematic and by the way the last trial they did another trial because it was a branded product they took that extended-release niacin but they combined it with an anti itch compound and aha so everybody's can tolerate nice and now and they added it to a statin it was the heart protection study thrive and it was basically a duplication of the aim high trial nice increase in HDL cholesterol further reduction in zero outcome change and a lot of toxicity include much of the toxicity is glucose excavations you can have a glucose even so the Europe decided that said so they took that combo pill off the market I'm sure you can still get immediately I see in Europe if you want it you know it's an item and for God's sakes I megadose so I just don't like people out there who want to extol nicing fine but don't start telling nice and has a lot of data it's got zero Dedham and these are the same people who bash fibrates who do have two large randomized prospective trials Helsinki and VA head with fibrates and yet they never consider a fibrate they always ho Yool nice since the better drug and at least into the field trial nice or phenol fibrate had all these microvascular there's no prayer nice and reduces diabetic and retinopathy amputations kidney disease but yet there was that battle people bashed fibrates hold them through the high standard of you gotta hit your primary endpoint and ain't never held nice and and to be honest where you're the same that's what Ron Krause didn't that study so I understand what he's talking about there is some dad if you want to extol it but it's not the type of data you and I using so we'll go from the the stepchild to the poster child which we've already kind of alluded to which are repatha and prolly whant these two pcsk9 inhibitors and I'll just give a little bit of background obviously what's the name of the fellow up in Toronto who actually discovered this oh I thought it was in Texas Hobbs Helen Hobbs was the first person who discovered the I mean the actual family of pcs ACS family yes yes look there's at least 10 members in discovered I think because I grew up in Toronto I have a fondness for remembering anything that anyone from Toronto did