Niacin vs. low-carb weight loss


--Raises HDL and shifts HDL towards the healthier large (HDL2b) subclass.
--Reduces total LDL.
--Reduces small LDL particles.
--Reduces triglycerides and triglyceride-containing particles like VLDL and IDL (intermediate-density lipoprotein).
--Reduces fibrinogen.
--Reduces inflammatory responses.

Weight loss achieved through a low-carbohydrate (read "wheat-free") diet:

--Raises HDL and shifts HDL towards the healthier large (HDL2b) subclass.
--Reduces total LDL.
--Reduces small LDL particles.
--Reduces triglycerides and triglyceride-containing particles like VLDL and IDL (intermediate-density lipoprotein).
--Reduces fibrinogen.
--Reduces inflammatory responses.

Curious, isn't it? Niacin achieves virtually the same effect as weight loss achieved through a low-carbohydrate diet, particularly if free of wheat products. The only major difference is that niacin also reduces 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 program is (determined largely by your heart scan score).

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, 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, wheat-free diet can achieve many of the same effects. Use this strategy to full advantage.

Comments (28) -

  • Peter

    12/10/2007 9:17:00 AM |

    Hi Dr Davis, nice post

    The parallels you describe so neatly become self explanatory once you realise that niacin acts on the beta hydroxybutyrate receptor. Even without full blown ketosis, LC diets raise the level of the natural ligand for the receptor that niacin, at pharmacological dose rates, stimulates. And no flush from LC.

    Regarding LC diets as a means to weight loss alone misses their intrinsic health benefits.


    Nicotinic acid receptor subtypes and their ligands.
    Soudijn W, van Wijngaarden I, Ijzerman AP
    Med Res Rev. 2007 May;27(3):417-33

  • Dr. Davis

    12/10/2007 12:53:00 PM |

    Thanks, Peter. I wasn't aware of that.

  • keith

    12/10/2007 5:34:00 PM |

    In your experience have you seen a lipoprotein benefit to a wheat-free diet in people where there is little excess weight to lose, say 5 to 10 lbs?

  • Dr. Davis

    12/10/2007 11:29:00 PM |

    Yes, though the magnitude of benefit is usually less. In this case, small LDL in particular is largely genetically driven. You can only hope to suppress it to a minimum.

  • chcikadeenorth

    12/11/2007 2:48:00 PM |

    as soon as I started lc, after about three months my hdl went from 40 to 68 and stays there, I don't excercise much so its not due to anything but lc I assumed.

    However,my score from scan went from 183 in '04 to 390 in 07 so that alarmed me but my doc said if I didn't lc, as I lc most the time, calcium score could have been way is not only great for weigh loss but bg and craving control
    Thnx for comparison list, wish ADA would recognize this.

  • Anonymous

    12/11/2007 5:23:00 PM |

    Chickadee North - While I am a believer in reducing/eliminating processed carbs especially for people who have metabolic syndrome, are diabetic and/or overweight, you still had an increase in calcification of 30% per year.  That outcome is consistent with the results that occur when there is no intervention in terms of diet/drugs/lifestyle.  Thus, I am somewhat skeptical that the low carb diet kept you from having an even greater increase in calcified plaque.

  • Cindy Moore

    12/12/2007 3:57:00 AM |

    There are other benefits from low carb that you don't see with niacin. Lower BP, lessening (at minimum) of symptoms of many chronic diseases, lower blood sugar and insulin levels...all very important in today's world!

    Can you please comment on this article:
    "In middle-aged and older women considered to be at low risk for heart disease, calcium build-up in their heart arteries, an indicator of artery-clogging plaque, predicts the development of heart disease and heart-related events like chest pain, heart attack and stroke, new research shows."
    Doesn't plaque and calcium build up in the heart indicate heart disease?

  • Dr. Davis

    12/12/2007 1:04:00 PM |

    Yes, excellent points!

    I believe that study is yet another piece of evidence that heart scans (for coronary calcium and plaque quantification) are vastly superior to risk factor analysis, such as that in the Framingham equation. As the study points out, the Framingham risk equation mis-classified a substantial number of people as low-risk.

    Incomprehensibly, the report quotes some reviewers as saying "There is not enough evidence to support coronary artery calcium screening in low-risk women and they call for further studies to better identify who would benefit from such screening."

    This is another study among many that have shown similar results.  How many people have to die or have heart attacks needlessly before the deeply entrenched habits of the status quo are broken?

  • Stan

    12/12/2007 2:23:00 PM |

    Re: "In middle-aged and older women considered to be at low risk for heart disease, calcium build-up in their heart arteries, an indicator of artery-clogging plaque, predicts the development of heart disease..."

    I think this relates to Dr. Davis orignal post on low carb.  Since glucose metabolism involves a lot more calcium than lipid or ketone metabolism then perhaps excessive calcium build up may be a proxy for excessive glucose metabolism?

      It may explain a curious fact that anything that switches metabolism away from glucose (e.g. niacine acting towards ketone b., vitamin D3, fasting or L.C. diet) would also at the same time act protective against the coronary heart disease?  Interesting!

    Stan (Heretic)

  • Cindy Moore

    12/12/2007 4:12:00 PM |

    But my question is....If there are already calcifications doesn't that mean there is already Heart Disease?

    So the women with calcium plaques would HAVE heart disease, not be AT RISK of developing it?

    "...calcium build-up in their heart arteries, an indicator of artery-clogging plaque, predicts the development of heart disease..."

  • Anonymous

    12/12/2007 4:19:00 PM |

    Somewhat unrelated question:  
    Angiotensin II inhibitors like Benicar apparently have the additional effect of dramatically lowering Vitamin D 1,25D in the body, and some think this is useful for people with Lyme disease and chronic fatigue system ("Marshall Protocol" [Adherents of this protocol believe that in these diseases, opportunistic bacteria thrive on the additional Vitamin D.]

    However, for hypertensives who don't have CFS or Lyme disease, does this trait mean that drugs like Benicar, while reducing blood pressure, might be increasing coronary blockage by interfering with Vitamin D?  (I guess my questions are, Am I concerned with the right form of Vitamin D?  If  so, are angiotensin II inhibitors problematic for blocking Vitamin D?  Do they make Vitamin D supplementation pointless? If so, what's a better drug for hypertension?)

    Anyway, if this question is too far afield, ignore it, and thanks for a great blog.

  • d.rosart

    12/12/2007 5:09:00 PM |

    A few things we don't know about chickadee north;

    1 her age. (did she just enter menopause or premenopause?
    2 when she started her low carb diet.
    3 how often her heart was scanned between 2004 and 2007.
    Without knowing these, I think we have to give her doctor the benefit of the doubt.

  • Dr. Davis

    12/12/2007 10:36:00 PM |

    Yes, you are absolutely right.

    In arteries, calcium = atherosclerotic plaque, not risk for plaque. It is a risk for coronary "events" like heart attack, however.

  • Dr. Davis

    12/12/2007 10:37:00 PM |

    The Benicar/ARB and vitamin D connection is interesting. I've never heard of it. Do you have any data or references?

  • Anonymous

    12/13/2007 12:32:00 AM |

    Honestly, I'm a layperson and can't comment intelligently on it other than to suggest you look at

    Some of the things that jumped out at me were Benicar's (and to a lesser extent, other angiotensin 2 inhibitors) ability to block  at least one D3 variant, the idea that chronic fatigue/fibromyalgia/etc are the result of infection by a new form of bacteria that survives by hiding within immune system cells, the concept that because of this, D3 actually protects the bacteria in these patients, etc.

    It's all wayyyy out there, but fascinating, and I thought you'd be interested.  (At the very least, it might affect your choice of hypertension med.)

  • chickadeenorth

    12/13/2007 7:04:00 AM |

    I am 57 and am menopausal since 04, have lc since 03 and fell off wagon for almost a yr,was in extreme grief with death of kid sis and other significants in my life and neglected me.

    Had one scan in 04 at 186 and then second scan in 07 ( 2 weeks ago) and it was 390, so yes about 30% a yr.

    I assumed dropping A1C from 8 to 5.8 would have a bearing, no wheat products and eight loss of 80 lbs, way lower bp mostly about 110/68 or so would have given me less of  score.

    For 5 months in yr I run a B&B and work hard enough to make a sweat and in winter I walk.

    I only knew about Vit D and fish oil since coming here, few weeks back,  so take fish oil, its harsh to do as I have that HP bacteria and the fish oil makes allot of heartburn and distaste. I am waiting for the softgel Vit d 3 as can only get the dry form here, as well the l'arginine was ordered as well.
    My ldl is 97, my hdl is 68 and trig are 78.Ratio is 2.5, have not got advanced lipid profile back, should all be back this week and CRP and lip protein  were all low and within norm levels.

    I've been diabetic since 94 and needed insulin which I no longer need. I tried to use Actos as I read it reversed some plague so asked a doc for some, but it caused some chest pain and side effects so after 3 months I quit it.

    Stress has been a factor with husbands illness, many deaths and just finished testing for lung cancer( on my recent heart scan the radiologist noticed something in my lungs???? and suggested the rule out cancer??)(never smoked a puff in my life but my mental health patients smoked in my office for a few decades until I put a stop to it in 1980 and got my wrists slapped for doing that).

    Now I know I have no lung cancer am assuming my stress will decrease,husband being tested for asbestoses etc so lots of anxiety,I know thats not good for heart either,  typically I handle stress ok and use alot of humor in my life.

    So now you know more and can make some impressions. This doc doesnt really know me but felt had I continued with my program from Cdn Diabetic assc which was hi grains I would have had a higher score and my A1C couldn't get under 7.8 on insulin and I needed 158 units of humalog a day to keep it there so now I am not as insulin resistant , since lc, so maybe I would have a higher score if hadn't lc.

    I am only assuming and am only learning all about the TYProgram, I tried to introduce some oat bran daily but it spikes my BG way too much and I am aiming for AC under 5 so will stick with ground flaxSmile

    Anyone have some insight let me know, oh yes my vit d blood level was low as was DHEA, hormone levels of progesterone and all estrogens very low too from saliva test so using bio identical progesterone cream.

    I am assuming I will start on Niaspan to drop trig.

  • Dr. Davis

    12/13/2007 11:32:00 AM |

    Hi, Chickadee--

    I believe that you are on the right track. I encourage you to stay in contact through the Forum, where we can discuss your issues in more detail, along with feedback from other members.

  • chickadeenorth

    12/14/2007 3:51:00 PM |

    Yes I plan too and once all blood work back I am hiring you to do a consultation via scanner, how new age is that!!!

    I have had one diet pop a day as a treat for a sweet taste but am stopping that now too since reading about carbonation on the forum, lots of good info there for sure and dedicated membershipSmile

  • chickadeenorth

    12/15/2007 5:07:00 AM |

    Lipoprotein(a) in 2004 was 0.21g/l and in 2007 June was 0.09g/ there is hope for me yetSmileSmile
    I should have new NMR results in few days.

    This 04 one I had only been low carbing for one yr.So maybe prior to that it was higher, but never had it checked ??

    I am exited to know that and now to try your ideas as if I could do that without supplementation and often off the statins....then who knows whats next SmileSmile

    Thnx soooo much for all your insightsSmileSmile

  • Dr. Davis

    12/15/2007 2:29:00 PM |


    That's curious: a big drop in Lp(a) with low-carb diet. Although the diet clearly works, I've never seen such a a dramatic effect on Lp(a). Was there anything else you did?

  • chickadeenorth

    12/16/2007 2:49:00 AM |

    Yes I went off insulin, cozzaar,lipitor, slowly lost 80lb, ate only nutrient dense foods, more meat,eggs, only low gi veg,salads, olive oil daily,I am worried what if it was an error, will know in 2 days what new results are.
    Oh I ate a ton of ground flaxseed, chol went up &, and HDL went from 40 to 68 and stayed there,LDl went up in that time frame and Dr Westman from Duke said its probably big fluffy good ldl stuff as typically thats what occurs with people doing low carb and getting into ketosis...could higher hdl  move out sticky lipoprotein???

  • Dr. Davis

    12/16/2007 2:45:00 PM |

    Hi, Chickadee--

    If you're asking whether higher HDLs are more likely to reverse plaque, the evidence would suggest that it does. HDL is probably crucial for plaque regression, since it acts as a "scavenger" of cholesterol in atherosclerotic plaque.

  • chickadeenorth

    12/16/2007 11:59:00 PM | if I add excercise then my hdl should go even higher right?

  • Dr. Davis

    12/17/2007 2:17:00 AM |

    Yes, and the effect can be substantial if you're starting from a sedentary lifestyle.

  • chickadeenorth

    12/17/2007 6:20:00 PM |

    ...was thinking what I did, I also used a full dose adult ASA daily as read in (Edtmn Protocol( the ones who do the stem cell transplant for diabetes type I) that diabetics should use a higher dose of ASA, so have used that and folic acid 1 gr OD since 03. Dont know if this accounts for it.
    I am not sedentary from May to Oct as run a busy B&B and bust my butt but in winter I only curl and quilt and my Christmas gifo to myself is a gym membership, keeping in mind I have a terrible mind set about excercise so am working to change thatSmileMaybe I will get addicted to exercise rather than carbs.

  • weight loss

    10/4/2010 11:27:04 AM |

    The primary function of niacin, vitamin B3, is to metabolize fats, which can then produce a usable form of energy. Niacin, also known as nicotinic acid, is one of the B- complex vitamins, the water soluble vitamins, that all work together to covert the carbohydrates in our body into sugar, for the production and metabolism of our body's energy.

  • picklebird

    10/22/2010 7:54:52 PM |

    just found this site. I don't have any sign of heart disease as yet but my HDL is 6.

    I never met anyone with HDL that low, so that is why I'm taking niacin, 250mg split into thirds cuz the flushing and rash are awful, though brief.

    Already on low carb 35 - 45g per meal and lost 22 pounds since I was newly diagnosed diabetes 3 months ago.

    Question: how long to take niacin to see a rise in HDL? I don't want to take this stuff for more than 12 weeks.

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