Niacin And Mcad

[firewatcher]

My "bad" Cholesterol levels have been going up with my Creatinine and my endo wants me to start niacin. But I already flush heavily, possibly from MCAD. The flush that niacin produces is similar to a histamine flush, so would it be bad or make my "reactions" worse if I take it?

Niacin-induced "Flush" Involves Release of Prostaglandin D2 from Mast Cells and Serotonin from Platelets: Evidence from Human Cells in Vitro and an Animal Model

Dean Papaliodis, William Boucher, Duraisamy Kempuraj, Margaret Michaelian, Adams Wolfberg, Michael House, and Theoharis C. Theoharides

Department of Pharmacology and Experimental Therapeutics, Molecular Immunopharmacology and Drug Discovery Laboratory (D.P., W.B., D.K., M.M., T.C.T.) and Departments of Obstetrics and Gynecology (A.W., M.H.), Internal Medicine (T.C.T.), and Biochemistry (T.C.T.), Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts

Niacin lowers serum cholesterol, low-density lipoprotein, and triglycerides, and it raises high-density lipoprotein. However, most patients experience cutaneous warmth and vasodilation (flush). Acetylsalicylic acid (ASA) can reduce this flush, presumably by decreasing prostaglandin D2 (PGD2) release from macrophages. Here, we show that methylnicotinate induces significant PGD2 release from human mast cells and serotonin from human platelets. Intradermal injection of methylnicotinate induces rat skin vasodilation and vascular permeability. Niacin increases plasma PGD2 and serotonin in a rat model of flush. The phenothiazine prochlorperazine, the H1, serotonin receptor antagonist cyproheptadine, and the specific serotonin receptor-2A antagonist ketanserin inhibit niacin-induced temperature increase by 90% (n = 5, p < 0.05), 90 and 50% (n = 3, p < 0.05), and 85% (n = 6, p = 0.0008), respectively, in this animal model. These results indicate that niacin-induced flush involves both PGD2 and serotonin, suggesting that drugs other than ASA are required to effectively inhibit niacin-induced flush.

[morgan617]

I tried Niacin once many years ago, once being the operative word here. I don't have MCAD, don't even understand it. If you are prone to flushing already, I would guess it could easily make it worse, but I'm not sure it would affect the MCAD itself. The flushing from Niacin does stop after a bit. If it's been recommended, I'd just start at a very low dose and see what happens. If they know you have MCAD and are ok with you taking it, it's a question of how brave you want to be...I'm a huge weenie with meds.

An example of it not making things worse is, my liver enzymes are high because of my gall bladder, however I can still use tylenol, because the mechanism causing the enzyme problem is inflammation, not a liver disease per se. I hope that makes sense. So the Niacin may cause the flushing, but not because of the MCAD. I'd better stop, I am confusing myself here...good luck sweetie, morgan

[ajw4790]

Hiya,

I really don't have much of a clue... Doesn't niacin cause increased HR etc. too, and that would seem like it would make things worse. Even by itself vasodilation is bad for many of us.... One note I thought of was that they do make a non-flushing niacin that may be good to try first? I don't know...

[firewatcher]

I hate to think of what color I would turn. My Dad already said my flushing is worse than a "niacin flush," so what would it be plus a niacin flush?

[ramakentesh]

How could you resist the temptation not to see if it makes you feel worse or no different as a gauge of whether you suspicions about a MCAD disorder are correct?

I wouldnt be overly concerned.

[firewatcher]

How could you resist the temptation not to see if it makes you feel worse or no different as a gauge of whether you suspicions about a MCAD disorder are correct?

I wouldnt be overly concerned.

Um, pretty easily actually! I am very tired of playing chemistry set with my brain! IF it acts like a MCAD flush, then I'll suffer for days afterward, just like after a workout. It would be cool if that was an easy way to dx MCAD, just take a dose of niacin and see if you feel like duck doo for days after the flush...

[ramakentesh]

How do you know the post-flush malaise is MCAD related in your case?

[firewatcher]

How do you know the post-flush malaise is MCAD related in your case?

I don't, I'll be doing the methylhistamine test soon. However, things are better now on the "MCAD treatment:" Antihistamine, Zantac and Singulair. My PT told me last night that I was flushing less with my exercise. Anything that causes the flush, causes the worsening of headache, fatigue and tremor (think married thoughts ) I also don't with hives to sweater cuffs, or seat belts, or scratches, or allergy shots...so maybe it's working. Anecdotal evidence only, and a strong suspicion from my doc at Vandy.

[janiedelite]

My mom has carcinoid syndrome and needs a niacin supplement. There is a "No Flush Niacin" available.

I totally understand about wanting to avoid flushing. It wipes me out for days too. I hope you find something that works! As for me, I'm still on the antihistamines and flushing more than ever...

Janie

[ramakentesh]

Its just that flushing is pretty common in POTS - which in itself relates atleast in some cases to impaired control of vasocontriction/dilation. Flushing is very common in familial dysautonomia where mast cell disorders arent implicated.

Let us know how it pans out.

i was actually going to try Picamilon which is a combo of GABA and niacin and was shown to decrease cerebral vasoconstriction and improve blood flow. Maybe Ill think twice...

[ramakentesh]

One chem id love to see investigated in POTS is Adenosine. There appears to be nothing on it. Reduced adenosine receptors in the brain could result in a state of excessive sympathetic arousal.