A 19 year old guy come in stating he is having a reaction to a pill. He took it this morning and about 1 hour later and it got the point of flushing, palpitations, headache, anxiety and now shortness of breath. Previous history is inhaler use for cough after bronchitis treatment about 2 months ago. Only recreational drug was tobacco which he stopped last year cold turkey. No history of this before and otherwise healthy.
As I was pulled out of another patient room, I enter and notice a red young skinny guy who seemed to be using his shoulders to breath with shaking anxiety. His physical exam was otherwise normal so I ordered a shot of steroid, high dose benadryl and an IV fluid to make him start peeing. I gave him reassurance and ask why would a young guy be taking Niacin (then I told him I was given a dose back in 1982 right before I went on stage for Mr Natural New Jersey.....it was supposed to increase "vascularity" to improve the way blood vessels protrude from the skin). Seems like his mom has a cholesterol issue and the doc said because of my young guys elevated triglycerides he would be fine taking over anything over the counter. "Redboy" went straight to GNC and bought regular niacin and here we are (should have read consumer labs reviews.)
Niaspan is the prescription form of it and docs prescribe the drug for lowering triglycerides and LDL levels. The theory was if you lover "Bad Cholesterol-LDL" the risk of a heart attack will decrease. Current thinking is to forget the standard LDL and pay attention to the small, more dense lipids (which require a more expensive blood test called a fractionated lipid panel). The family of medicines called Statins work to lower LDL but modestly change triglycerides and sometimes lower the good cholesterol (HDL). They have been broadly recommended to prevent high cholesterol in everyone according to studies (some of which are funded by drug manufacturers) The problem is medicines have side effects and I have had patients develop chronic muscle pain for up to 18 months after stopping the statin. I guess to fight heart disease it's back to exercise, nutrition change and relaxation therapy. (yes...the Beatles were right-see link)
Here is the reason why nutrition changes FIRST would be important unless there is an urgency in lowering blood levels. (like an evolving heart attack). One study (VA HIT) showed by lowering HDL using gemfibrozil the events of coronary heart disease decreased. So now the buzz words are: raise HDL!!! Gemfibrozil essentially works by not being absorbed from the gut and pulling out cholesterol with your poop. Hey, fiber would do that too right?!?! (see my video on fiber) Bottom line is sometimes in the midst of massive disease, we need medicines that can produce "massive" side effects. In the decades before disease strikes, over the counter supplements can sometimes cause side effects as well. Thus it would be prudent to take care of things before you get to advanced disease naturally with lifestyle changes. The only problem is most people don't feel symptoms at the beginning of bad health. Eating mostly plants, meditating and taking time off to walk doesn't seem to be inviting to the population who "drives thru" to eat. Deepak Chopra suggests always keeping life in balance. Eating industrialized food, sitting all day, always relying on adrenaline (caffeine and sugar) for "energy" is not part of being balanced with the universe. Fat zebra can't run from lion (unless lion is also fat) so bad zebra health results in not keeping up with the safety of the herd. You can sport your individual stripes but longevity comes when aligned with the universe.
