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Elevated Liver Enzyme Levels From Niacin (to cut cholesterol) -- what level is dangerous?

Background: I have engaged a Niacin regimen to cut cholesterol (vs. using statin drugs) because Niacin also raises HDL and cuts LPa and triglycerides (while statins only cut LDL).  I have been on this regimen since 2003 and the effect on my cholesterol/triglycerides and LPa has been more than as hoped for.  Just as with statin drugs, it is necessary to get regular blood tests (ideally every 6 months) to ensure there is no liver damage.  (I am in excellent health; my age is 45; weight: 165; height: 5'8" and I work out aerobically and heavily 3x per week.)  My blood/other results are as follows:

My numbers in late 2003 (before starting Niacin therapy which consisted of:
   500 mg of SR [sustained-release] AND 500 mg IR [immediate release] niacin at 8:00 AM;
   500 mg of IR niacin at 4:00 PM; and,
   500 mg of SR niacin in the evening):
(TC=total cholesterol; HDL, LDL are obvious; CRP=c-reactive protein)
TC=248; HDL=55; LDL=166; CRP=0.7; Triglycerides=136; Homocysteine=9.5; blood pressure: 120/80

Started niacin therapy 04/2004:

07/2004:
TC=157; HDL=60; LDL=83; Triglycerides=70; glucose=101; LP(a)=less than 7; blood pressure=100/60; Transferrin saturation: 47.8%
Liver enzymes (don't have these numbers but was told that they were not even slightly elevated).

02/2005:
TC=145; HDL=66; LDL=70; Triglycerides=46; LP(a)=less than 7; blood pressure=100/60
Liver enzymes are not even slightly elevated: AST=65

10/2006:
TC=91; HDL=33; LDL=48; Triglycerides=51; glucose=88; blood pressure=90/60
Alkaline Phosphatase=140
AST=57
ALP=47

12/2007:
TC=106; HDL=41; LDL=54; Triglycerides=55; glucose=100 (PSA=.6 <--not relevant for this)
Alkaline Phosphatase=137
AST=92
ALP=78

Because Alkaline Phosphatase was higher than 125, I cut 500 mg of IR niacin in the morning; therefore, my regimen became:
   500 mg of SR [sustained-release] niacin at 8:00 AM;
   500 mg of IR niacin at 4:00 PM; and,
   500 mg of SR niacin in the evening (11:00 PM)

Because of Liver enzyme levels and cholesterol that was reduced too much, I have cut my niacin regimen to the following in 12/2007 but have not yet taken another blood test to gauge the effects:
   500 mg of SR [sustained-release] niacin at 8:00 AM;
   500 mg of IR niacin at 4:00 PM; and,
   250 mg of SR niacin in the evening (11:00 PM)
(So, I additionally cut 250 mg of SR niacin in the evening.)

I have a number of questions:  I was told that normal liver enzyme levels were as follows:
Alkaline Phosphatase: 40-115
AST: 10-40  (Told to "worry at 100")
ALP: 9-60
I was told that with Niacin consumption, my liver enzymes would go to 2x to 3x these levels and as long as they did not exceed 2x to 3x these levels, this would be acceptable (in that it would not be indicative of long-term liver damage).
Questions:
1.  Is the above true?
2. Given my numbers above, am I O.K. or should I look for an alternative treatment for my cholesterol?
3.  If I am not O.K., what numbers would my liver enzymes (of each of these [and of any that I am not measuring]) have to come down to to make my regimen safe?
4.  What other things should I have measured and what levels should any other measurable results be within?
5.  Should I continue my Niacin and at what level?

Thank you for all your help with this.  Drug companies simply do not want to study niacin because it may prove superior to their complex (and expensive) alternatives.  Please could the professional who answers this query NOT be affiliated with and not be receiving any money from any drug company that produces statin drugs (or other drugs that purport to lower LDL).  Please could the person who responds let me know this is so.
7 Responses
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Avatar universal
I would just do 100mg a day. And take  a few days or week off. Let your body detox. Exercise and juicing and 1 sensible meal at night, fish and rice or chicken wrap using leaf as rap, etc is all you need.
Helpful - 0
Avatar universal
Your cholesterol drop is awesome. I would just do the normal niacin not the time release, heard a lot of bad things about that.
TC=248 to
TC=106

I am also encouraged to see even with time release no liver damage (AST: 10-40  (Told to "worry at 100") )

Thanks for the post. Exercise. Juice. Beets have lots of niacin too.  
Helpful - 0
350279 tn?1208013545
Get off the NIACIN! Doesn't matter if it SR or IR. But SR is much better. Yes, it does bring down Triglycerides, LDL.
But at the recommended dose of 1000mg at night with an 82mg aspirin you are cutting off your nose despite your face. There are other ways to lower Triglycerides.
I was on 1000mg p/n of Niacin ordered by my Primary Dr. The Niacin was terrible for me. My GI Dr. immediately took me off the Niacin.  
Helpful - 0
Avatar universal
Thank you for your posts.  The reason why I keep SR Niacin in my regimen (in spite of its potential dangers -- which, I do not believe, when taken at tolerable doses [which might be different for each individual as is the case with statins]), is that it is necessary to keep the liver constantly "engaged" because -- at least according to the theory of why both statin drugs and niacin work -- it is the process of the liver being engaged breaking down the Niacin that leaves it too "busy" to produce the cholesterol.
I am afraid that if I cut SR Niacin entirely, I will lose a good deal of the beneficial effect of having the Niacin "constantly around".

Nonetheless, what good is low cholesterol if you have destroyed your liver in the process (although I don't believe my liver numbers to-date indicate major damage -- just worried about the trend).  However, I have now modified my regimen to the following:
   250 mg of SR [sustained-release] niacin AND 500 mg of IR Niacin at 8:00 AM;
   500 mg of IR niacin at 4:00 PM; and,
   250 mg of SR niacin in the evening (11:00 PM)
(So, I have additionally cut my SR Niacin replacing another 250mg in the morning with another 500 mg of IR niacin in the morning instead.)  I hope to retest myself in mid-May and will let you know results.

By the way, while your cholesterol numbers are a good step in the right direction, from everything I have researched, you are not down to a level yet where you will prevent your coronary artery situation from deteriorating.  From the research, your LDL level should not be higher than 70 (as opposed to 100 that cardiologists now seem to have settled on [after being complacently satisfied with even higher levels for the past two decades]).

Thanks again for your posts.

Mike
Helpful - 0
Avatar universal
I stumbled upon your post via Google. Am I supposed to be a professional? I'm not. Am I allowed to answer?

There are some herbs that may help with fewer side effects (below). Studies are preliminary but are encouraging so far and I have read of no hepotoxicity with these suplements. If you try these, you might want to reduce your niacin even further, maybe even half and please only use the safer IR niacin.

Guggul (This seams to be the best)  http://www.all-about-lowering-cholesterol.com/gugulipid-guggul-lipid.html

Pterostilbene ( Blueberry extract) http://www.sciencedaily.com/releases/2004/08/040830090215.htm

Green Tea http://www.sciencedaily.com/releases/2007/10/071023163949.htm

There are more but haven't had the time to research them all.

Before I started this combination, my lipid profile was as follows:
TC 258
HDL 39
LDL 170
VLDL 49
Triglycerides 243

I'll be having another panel this month but when I donated blood a coulpe of weeks ago, my TC was 192. So, something is happening.

I've also been on a low carb diet and am hoping that my metabolic syndrome is under control. My hypertention has already dropped to 118/76!  It used to be in the 140's / 90's.


Craig

Helpful - 0
Avatar universal
Your total cholesterol is dropping so much that it's effecting your HDL.
I would cut all SR niacin and replace it with IR niacin. IR is much easier on the liver. You may want to take a couple of weeks off to let your liver recover and then titrate back up to where you left off at your reduced dosage.

IR niacin is in and out of your system quickly, allowing your liver to recover from dealing with it. The SR hangs around so your liver must deal with it for extended periods of time, not giving it much time to rest.

Obviously, you can already handle the IR so why subject your liver to the SR?

I bought some SR niacin but after doing some research and finding out about its effects on the liver, I wish I'd bought the IR. Instead of letting it go to waste, I crush the tablets up thus effectively turning them into IR niacin.

I actually like the flush! It's reminiscent of eating hot chicken wings or sashimi with tones of wasabi. I find it quite exhilarating. But clearly, I'm in the minority on this one.

Let us know how your numbers turn out on your next test.

Craig
Helpful - 0
Avatar universal
Slight correction to what I posted: The first cut to my regimen occurred AFTER the 10/2006 (and then I was retested in 12/2007).  After 12/2007, the second cut mentioned occurred.  The way it is ordered in my question, it looks like both cuts happened after 12/2007.
Helpful - 0
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