The Niacin Heart Attack Study: A Primer on Scientific Hysteria

Episode Summary:
Does Niacin really increase your risk of a heart attack? In this episode, Aimee goes all out breaking apart the recent study on niacin and heart attack risk. She critiques the study's methodology and highlights the misleading conclusions drawn by the authors. She emphasizes the importance of considering the study population, which consisted of individuals with existing cardiovascular disease, and the lack of examination of niacin intake in the participants. Aimee also questions the researchers' failure to address other factors that could contribute to elevated levels of niacin metabolites, such as impaired metabolic function. She concludes that the study's suggestions to eliminate niacin fortification are unwarranted and irresponsible. In this episode, Aimee summarizes the pros and cons of this research so you can decide whether you should be concerned.

Key Takeaways:

• The study suggesting that niacin may increase the risk of heart disease is based on flawed methodology and misleading conclusions.
• Niacin has long been used and respected as a lipid-lowering agent, and its efficacy is still a topic of debate in comparison to statins.
• The study population consisted of individuals with existing cardiovascular disease, which is an important factor to consider when interpreting the results.
• The researchers failed to examine the niacin intake of the participants, making it unclear whether supplemental niacin was a contributing factor.
• Other factors, such as impaired metabolic function, could lead to elevated levels of niacin metabolites and should have been considered in the study.

Notable Quotes:

• "To point a finger at niacin fortification is irresponsible and unwarranted at this stage." - Aimee
• "These researchers did not consider the impact that an impaired metabolic system might have on cellular stress and production of these metabolites." - Aimee
• "This paper is a fantastic example of research authors spinning the data and the media taking it even further to create clickbait." - Aimee

Resources:

Photography by: Dai Ross Photography
Podcast Cover Art: Lilly Kate Creative
Work with Aimee
Ferrell, M., Wang, Z., Anderson, J.T. et al. A terminal metabolite of niacin promotes vascular inflammation and contributes to cardiovascular disease risk. Nat Med 30, 424–434 (2024). https://doi.org/10.1038/s41591-023-02793-8

Additional Research citations and resources are at  Blasphemous Nutrition on Substac

Find Research Citations and Transcript at Blasphemous Nutrition on Substack

Work with Aimee

Photography by: Dai Ross Photography

Podcast Cover Art: Lilly Kate Creative

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Transcript

0:00

Hey Rebels, welcome to Blasphemous Nutrition. Consider this podcast your pantry full of clarity, perspective, and the nuance needed to counter the superficial health advice so freely given on the internet. I'm Aimee, the unapologetically candid host of Blasphemous Nutrition and a double degreed nutritionist with 20 years experience. I'm here to share a more nuanced take. On living and eating well to sustain and recover your health. If you've found most health advice to be so generic as to be meaningless, or so extreme that it's unrealistic, and you don't mind the occasional f bomb. You've come to the right place. From dissecting the latest nutrition trends to breaking down published research and sharing my own clinical experiences, I'm on a mission to foster clarity amidst all the confusion, and empower you to have the health you need to live a life you love. Now let's get started. Greetings ladies and gentlemen, boys and girls, friends and foes. Welcome back to Blasphemous nutrition. Today is a bonus episode, brought to you by bad science. Last week I had someone ask me whether or not, they should stop taking their B vitamins due to a study that was dropped and pushed through major media outlets. It's been suggested that food fortification and niacin specifically might give you a heart attack. Now since you can't schedule stupid, I'm popping into your ears today to give you the rundown on this paper. And my honest thoughts about what's being said here. This piece of. And I'm air quoting here. Research somehow made it to publication. And leaps to these conclusions that niacin might kill you. And they came to this without ever looking at the niacin intake in the study population. Like, what the hell are these people doing and what the fuck kind of standard does science even have any more? In this study. Which I linked to in the show notes, it is suggested that supplemental niacin may increase heart disease risk. Nevermind that niacin therapy has long been used and respected as a lipid lowering agent all on its own before statins came along. That said since the advent of statins, the efficacy of niacin has come into question. I do not have an opinion on this as I've not delved into the research on niacin therapy for reducing the risk of death from cardiovascular disease. Although it's effective at lowering cholesterol levels. So going back to this study that was released last week and published in nature. This study was titled,"A terminal metabolite of niacin promotes vascular inflammation and contributes to cardiovascular disease risk." Now I personally feel that this title is inherently misleading. Here's why. Firstly this study was done in stable cardiac patients. If you have existing cardiovascular disease. You're at increased risk of a heart attack. Did the media share that the study participants were cardiovascular disease patients? No. The study itself looks at metabolites of a niacin containing compound called NAD. Metabolites are compounds that are kind of leftovers. When a molecule is broken down, they are often recycled by the body and reused to make that product again. Right. So we can take those metabolites and then recycle them and create an idea again, or they're flushed out of the system. It just, it depends upon the metabolite. Or nicotinamide adenine dinucleotide is a coenzyme found in all human cells. It is a complex molecule that plays an essential role in generating energy within our cells. Niacin is a B vitamin that is used to make this compound NAD. Which is then used in the cell to generate energy for the cell. NAD is also involved in various other cellular processes, including DNA repair, as well as regulating our gene expression. In this paper, the authors immediately suggest that the fortification of niacin in the food supply may be leading to intakes that could contribute to cardiovascular disease. They include a chart showing the fortification of the food supply. And the estimated intake of niacin through fortification within the population, which approaches the recommended upper limit of 35 milligrams. Now it is worth noting that this upper limit was created to avoid the skin flushing and itching that can happen with higher doses of niacin. Not because consuming more than 35 milligrams is known to be toxic. So then the authors justify their position that niacin may induce death based upon a meta analysis of three clinical trials. In which one to three grams of slow release niacin now. That's 1000 to 3000 milligrams or 28 to 85 times the dose commonly consumed in the food supply. So they justify their position that niacin could induce death based upon studies showing much higher doses of niacin intake, given a long side, a statin medication. The authors of the meta analysis. Report that the association that they found with, increased death due to niacin Staten combos was marginally significant, a 10% relative risk increase of death from all causes But the quality of that evidence appeared to be sound. So to summarize all of that. The authors of the niacin paper released last week are suggesting that fortification. That is bringing consumption levels up towards 35 milligrams might be contributing to deaths from heart disease because of three studies in which people were taking extremely high doses of niacin alongside statins. And showed a marginally significant 10% relative risk of dying from anything. That is the premise with which they begin this research paper. Now in their actual research, they looked at people with existing heart disease and measured those metabolites of NAD. When I took a closer look at who was included in the study, they had a very classic profile of somebody with existing heart disease. In many of these people, there were concurrent diabetes, hypertension, and elevated lipids, and many of them were also being treated with some combination of statins, beta blockers, aspirin, or ACE inhibitors. Very, very common for people who have existing heart disease, as well as existing hypertension. Okay. These are not healthy. Healthy people. This is essential to consider when we're looking at what is. Being released into the wild as it were, and the suggestions that are being made. So after they measured the blood of these people with cardiovascular disease, they observed that after three years time major adverse cardiovascular events, like heart attacks were significantly higher in those who had the highest levels of these metabolites that were measured. The authors of the paper, say. And I'm quoting."Although previous reports indicate that these two metabolites are produced from niacin slash NAD and there are circulating levels are elevated when niacin slash NAD. And a D is an excess. Little is known about these metabolites. And their potential biological activities have rarely been studied." And that's true. Like we don't know a lot about these metabolites. And, you know, a nod to these researchers for finding this association. This is interesting. And now here's what they did. Right. They took into account other cardiovascular disease risk factors when analyzing for that signal. Right. Like, okay, we see this. We see this association, let's make sure that it's not something else at play. Okay. So they took into account those other risk factors. And their observations show that those with the higher levels of NAD metabolites do have increased risk of cardiac events. They also did some genetic testing and found a gene that might contribute to increased circulating levels of these metabolites. And then followed up with that with what near, as I can tell appears to be some fairly quality testing on knockout mice, to confirm that having that genetic variance does lead to increased NAD metabolites in mice. And one of those metabolites specifically caused elevated inflammation, markers, suggestive of arterial damage in mice. When the mice were injected with that metabolite. But here is what they totally failed to address. While taking high doses of niacin is shown to increase these metabolites in the blood. These researchers never looked at whether the participants they were studying were taking any fucking supplemental niacin at all. They're jumping on niacin because it's included in an energy producing compound. That's broken down into other metabolites. Which are associated with the heart attacks and inflammation. Other things will increase these metabolites situations that cause an increased breakdown of NAD, for instance. A situation where the cell has higher energy demands or greater stress. If a cell is under duress, it may be producing more energy. Therefore it would be. Breaking down more NAD, right? It would be metabolizing more NAD. As it's using up existing stores. Okay. So do you remember the role that I said NAD had in DNA repair? Disease processes tend to exacerbate DNA damage leading to an increased need of NAD. And DNA damage itself leads to disease. In fact, it's been noted that someone with impaired metabolic or liver function. Can have an imbalance in NAD metabolism. The liver plays a really crucial role in metabolizing NAD. And liver dysfunctions actually quite common. nonalcoholic fatty liver disease is estimated to be 25% worldwide and adults. And upwards of 37% of American adults have nonalcoholic, fatty liver disease, whether or not they've actually been diagnosed. Okay. And this is according to N Haynes data. It is extremely common in individuals with obesity or type two diabetes. Nonalcoholic fatty liver disease. Indicates a compromised liver. So. What if we have a situation where the liver can't do its job well. And the breakdown of these natural compounds is impaired contributing then to elevated levels, which may be problematic. These researchers did not consider this at all, nor did they address the impact that an impaired metabolic system might have on cellular stress and production of these metabolites as a sign themselves of a struggling system? Much like black smoke billowing out of your car might be suggestive that you're not going to be able to drive it much longer. Now I'll admit what I'm pondering here is total speculation. But it's no more speculative than their stupid ass assumption that niacin fortification is to blame. There are details in this study. I do not know. How much of that circulating metabolite was given to the mice. And how does that compare to what was in the blood? Of the individuals. Now I couldn't find these details in the paper and these things matter precise amounts of compounds given might be buried in the tables and the supplementals of this paper. Admittedly, I did not go through all those fine details. but even if they were there, it doesn't directly translate to humans. I've probably already spent too much of my life in a fury about this, but these things are so important to me to peel back the layers a bit. Right. And reveal how much gets blown out of proportion and how much. Freaking drama and panic. Is created with such certainty. In the face of so many unknowns. And appropriate conclusion to this research would have looked like this. Hey. We went looking for previously unknown markers in the blood that might increase the risk of cardiovascular disease. And we found these two. They're related to the metabolism of NAD. And we observed that the higher these metabolites are the greater, the risk of death in people who have preexisting cardiovascular disease. When we injected these metabolites directly into mice. With genetic variances we observed that there's increased inflammation. And this warrants further research. That is all that can be said about the study. To point a finger at niacin fortification is irresponsible and unwarranted at this stage. And to suggest elimination of niacin fortification is outright stupid. While fortification is found in processed foods. I'm willing to bet my house that removal of niacin from processed foods is not going to reduce heart attacks. Removal of processed foods and substituting them for unprocessed foods might reduce heart attacks. This is of course my own bias and additional studies are needed in this area as well. With every research paper, researchers are supposed to declare their conflicts of interest in their research. Now, while, not everybody does this, these researchers did due diligence and revealed the following. Two of them are co-inventors of patents related to cardiovascular diagnostics and therapeutics. I'm interpreting this to mean cardiovascular testing and new cardiovascular medications, but that's not clear. They've also received royalty payments for their inventions and discoveries. One of them is a paid consultant for drug companies and has received research funding from many pharmaceutical companies. And yet another is a consultant for several pharmaceutical companies and has received financial compensation. Called honoraria for his editing and authorizing of the publication in which this paper was published. Maybe this strong affiliation is why nature would bother publishing such hysterical speculation in the first place. Regardless, these individuals have a vested interest in finding things which may lead to new ways to diagnose and treat heart disease. There are financial and career interests. Lie here. Now, this is not inherently bad. However, they seem to have made some seriously questionable speculations in their desire to find new markers of heart disease and possibly new therapeutics to address these markers. But Hey, careers will be made. So quality science is an afterthought, right? If you've been wondering or worried about the news regarding this study, I do hope that this rundown of what the paper actually said and what the authors actually did helps to put your mind at ease. This paper is a fantastic example of research authors spinning the data. And the media taking it even further to create clickbait. Honestly, the timing for this could not be better as next week. I will be releasing a multi-part series on scientific literacy to help explain why we see what we see and hear about science. And how it's. So flip-floppy, whackadoodle crazy. And some of the shenanigans that get in the way of being able to ascertain reality from the data. Be sure to subscribe, to make sure you get those episodes. It's more important than ever to be a savvy skeptical. Sassy consumer, and to protect your health and your wallet from the pervasive marketing bullshit and unnecessary drama that keeps us addicted to doom scrolling. I'm doing what I can to peel back the layers and tell you everything. I know. All right folks. Stay tuned later this week, your regularly scheduled episode will be dropping. It'll be about the two questions you need to ask yourself before you eat your next meal until next time, my Blasphemous buddies. Any and all information shared here is for educational and entertainment purposes only and is not to be misconstrued as offering medical advice. Listening to this podcast does not constitute a provider client relationship. Note, I'm not a doctor, nor a nurse, and it is imperative that you utilize your brain and your medical team to make the best decisions for your own health. The use of information on this podcast or materials linked to this podcast are at the user's own risk. No information nor resources provided are intended to be a substitute for professional medical advice, diagnosis, or treatment. Be a smart human and do not disregard or postpone obtaining medical advice for any medical condition you may have. Seek the assistance of your health care team for any such conditions and always do so before making any changes to your medical, nutrition, or health plan. If you have found some Nuggets of Wisdom, make sure to subscribe, rate, and share Blasphemous Nutrition with those you care about. As you navigate the labyrinth of health advice out there, remember, health is a journey, not a dietary dictatorship. Stay skeptical, stay daring, and challenge the norms that no longer serve you. If you've got burning questions or want to share your own flavor of rebellion, slide into my DMs. Your stories fuel me, and I love hearing them. Thanks again for tuning in to Blasphemous Nutrition. Until next time, this is Aimee signing off, reminding you that truth is nuanced, and any dish can be made better with a little bit of sass.