Important considerations for treatment with dietary supplement versus prescription niacin products

Modified Diet Supplementation With Group B Vitamins Changes Antioxidant Defense Activity Of Brain

The research aimed at effect of modified diet and supplementation with synthetic B vitamins on brain antioxidant status evaluation. Forty male Wistar rats were divided into 4 groups (n = 10); group I - fed Basic Diet (BD), groups II-IV - Modified Diet (MD), where wheat flour replaced 83.5 % wheat and sucrose replaced 50 % maize. Groups I-II received only water, while group III (MD + AS) was given an aqueous vitamins solution supplementing deficiency from diet modification (MD + Adequate Supplementation: B₁-0.94, B₂-0.48, B₆-0.5, niacin-1.9 mg); group IV (MD + ES) received a solution in order to supplement deficiency resulting from the change in diet and recommended prophylactic dose of vitamins (MD + Excessive Supplementation: B₁-3.1, B₂-2.3, B₆-2.4, niacin-6.65 mg). The experimental phase lasted 6 weeks. Blood serum was examined, to determine glucose and iron concentration; determination of FRAP in plasma, in brain tissue the activities of GST, GPx, CAT, SOD, SH content, and FRAP. It was found that MD and MD + AS did not influence cereal antioxidant status. In brain tissue, MD + ES group exhibited an increased glycaemia (7.49 mmol×l^-1 p = 0.038) and increased activity of antioxidant enzymes activity (GST 0,099 U/mg protein p = 0.005; GPx 0,039 U/mg protein p = 0.007). Brain tissue of rats also exhibited larger content of protein bond SH in comparison to BD, MD and MD + AS groups (SH 414.6 mmol/g wet weight p < 0.001; p < 0.005). These findings suggest that, an excessive supplementation with vitamins B and niacin, in sucrose rich diet, may lead to enhancing activity of cellular antioxidant defense in brain tissue of rats.

CE: Triglycerides: Do They Matter?

: Since the introduction of HMG-CoA reductase inhibitors, also known as statins, as an adjunct to diet in the treatment of hyperlipidemia and the greater emphasis placed on reducing low-density lipoprotein (LDL) cholesterol levels in the prevention of atherosclerosis and cardiovascular disease (CVD), there has been less focus on the value of lowering serum triglyceride levels. Many patients are aware of their "good" and "bad" cholesterol levels, but they may not be aware of their triglyceride level or of the association between high triglycerides and the development of CVD. In recent years, however, in light of the increasing incidences of obesity, insulin resistance, and type 2 diabetes, lowering triglyceride levels has gained renewed interest. In addition to the focus on lowering LDL cholesterol levels in CVD prevention, clinicians need to be aware of the role of triglycerides-their contribution to CVD, and the causes and treatment of hypertriglyceridemia.

B-Vitamin Levels in Human Milk among Different Lactation Stages and Areas in China

To determine the contents of B-vitamins in human milk in China, we analyzed 1778 human milk samples from the sample bank of the National High Technique R & D Program (863 Projects) which was a cross-sectional survey and covered 6419 human milk samples from healthy lactating mothers who were at different stages of lactation (0-330 days postpartum) in 11 provinces of China. The contents of free forms of six B-vitamins in these human milk samples were analyzed by using UPLC-MS/MS. The median concentrations of free form of 6 B-vitamins in colostrums, transitional milk, 15-180 d mature milk and 181-330 d mature milk were respectively as follows: thiamin 5.0 µg/L, 6.7 µg/L, 21.1 µg/L and 40.7 µg/L; riboflavin 29.3 µg/L, 40.6 µg/L, 33.6 µg/L and 29.6 µg/L; niacin 470.7 µg/L, 661.3 µg/L, 687.0 µg/L and 571.3 µg/L; vitamin B-6 4.6 µg/L, 16.1 µg/L, 62.7 µg/L and 80.7 µg/L; flavin adenine dinucleotide (FAD) 808.7 µg/L, 1162.8 µg/L, 1023.9 µg/L and 1057.2 µg/L; pantothenic acid 1770.9 µg/L, 2626.8 µg/L, 2213.0 µg/L and 1895.5 µg/L. The contents of 6 B-vitamins varied significantly among the different lactation stages and different areas (coastal area vs inland area, rural area vs urban area). The present study indicated that the concentrations of B-vitamins in colostrum were generally much lower than those in transitional milk and mature milk. Further studies are warranted for their roles and significance on B-vitamins in colostrum in nutrition and metabolism of neonates.

Effects of formulation design on niacin therapeutics: mechanism of action, metabolism, and drug delivery

Niacin is a highly effective, lipid regulating drug associated with a number of metabolically induced side effects such as prostaglandin (PG) mediated flushing and hepatic toxicity. In an attempt to reduce the development of these adverse effects, scientists have investigated differing methods of niacin delivery designed to control drug release and alter metabolism. However, despite successful formulation of various orally based capsule and tablet delivery systems, patient adherence to niacin therapy is still compromised by adverse events such as PG-induced flushing. While the primary advantage of orally dosed formulations is ease of use, alternative delivery options such as transdermal delivery or polymeric micro/nanoparticle encapsulation for oral administration have shown promise in niacin reformulation. However, the effectiveness of these alternative delivery options in reducing inimical effects of niacin and maintaining drug efficacy is still largely unknown and requires more in-depth investigation. In this paper, we present an overview of niacin applications, its metabolic pathways, and current drug delivery formulations. Focus is placed on oral immediate, sustained, and extended release niacin delivery as well as combined statin and/or prostaglandin antagonist niacin formulation. We also examine and discuss current findings involving transdermal niacin formulations and polymeric micro/nanoparticle encapsulated niacin delivery.

Acute liver failure secondary to niacin toxicity

A 17-year-old male was transferred to the pediatric intensive care unit for evaluation of acute liver failure. He was recently released from an alcohol treatment center with acute onset of chest pain. Cardiac workup was negative but he was found to have abnormal coagulation studies and elevated liver transaminases. Other evaluations included a normal toxicology screen and negative acetaminophen level. Autoimmune and infectious workups were normal providing no identifiable cause of his acute liver failure. He initially denied any ingestions or illicit drug use but on further query he admitted taking niacin in an attempt to obscure the results of an upcoming drug test. Niacin has been touted on the Internet as an aid to help pass urine drug tests though there is no evidence to support this practice. Niacin toxicity has been associated with serious multisystem organ failure and fulminant hepatic failure requiring liver transplantation. Pediatric providers should be aware of the risks associated with niacin toxicity and other experimental medical therapies that may be described on the Internet or other nonreputable sources.

Lipid-lowering agents and hepatotoxicity

Lipid-lowering therapy is increasingly being used in patients for a variety of diseases, the most important being secondary prevention of cardiovascular disease. Many lipid-lowering drugs carry side effects that include elevations in hepatic function tests and liver toxicity. In many cases, these drugs are not prescribed or they are underprescribed because of fears of injury to the liver. This article attempts to review key trials with respect to the hepatotoxicity of these drugs. Recommendations are also provided with respect to the selection of low-risk patients and strategies to lower the risk of hepatotoxicity when prescribing these medications.

Apple pectin for the reduction of niacin-induced flushing

BACKGROUND

Niacin, or vitamin B3, when used in high doses can significantly improve the levels of all major lipoproteins. Despite these benefits, the use of niacin is greatly limited secondary to benign yet bothersome cutaneous flushing primarily involving the face and upper extremities. Pretreatment with aspirin or other prostaglandin inhibitors has demonstrated significant reductions in niacin-induced flushing (NIF), but other treatment options are needed. Clinical and anecdotal evidence suggests the ingestion of pectin-containing fruits (eg, apple) mitigates NIF; however, clinical trials evaluating this are nonexistent.

OBJECTIVE

That pretreatment with encapsulated apple pectin would limit the incidence, severity, time of initiation, and duration of NIF.

METHODS

We enrolled 100 niacin-naïve subjects (n = 25 per group) and preteated them in a double-blind manner with apple pectin, apple pectin + aspirin, aspirin, or placebo, followed by a one-time 1000 mg dose of niacin extended-release (niacin ER). Subjects then assessed major flushing parameters hourly for the next 6 hours with a validated visual analog scale.

RESULTS

Apple pectin and aspirin each significantly lowered the duration of NIF and produced nonsignificant but positive improvements in all other major flushing parameters compared with placebo.

CONCLUSION

Apple pectin may potentially be an alternative to aspirin for the prevention of NIF. Larger trials are needed to further evaluate the benefit of pectin on NIF.