Before there were statins for lipid issues there was niacin. It has been extensively studied and used by hundreds of thousands of people with good lipid modulating results over many decades; and, unlike statins, it is not associated with peripheral neuropathy, rhabdomyolysis, etc. and, moreover, is one of the few substances that can increase the so-called "good cholesterol" HDL within favorable ranges, something statins can't do. (Recent headlines suggesting HDL-C might not be as beneficial as previously believed applies only to extremely high levels of HDL that only a tiny minority of people ever experience and is not an effect of niacin usage.) A couple studies in recent years claimed to find little benefit from niacin, but two of the researchers involved in those studies, which combined niacin with statins, wrote a two part rebuttal of their own findings, pointing out that niacin was used incorrectly in almost every way in those studies. It was far under-dosed, given at the wrong time of day (just before sleep and without meals) and in a form previously shown to be sub-optimal. The correct form for use is immediate release niacin in the form of nicotinic acid, not extended release and never "slow release" (which can be toxic to the liver as it stays in the system too long). And it should always be taken with meals for optimal absorption. It should never be taken just before bed on an empty stomach as the pharmacokinetics for niacin taken at that time are unfavorable. Some do not like the "niacin flush" and try to ameliorate it by taking aspirin, etc., but some of the research indicates this is not a good idea, as the flush itself is part of the therapeutic process and, in any event, in most people, it diminishes after a few weeks. Some actually report enjoying the flush; I am one of those peculiar people myself. In any case, niacin is emerging again as a substance with impressive pleiotropic effects that reach far beyond lipid modulation. One recent paper, for example, reports on what the authors call "niacin-mediated rejuvenation...of the aging central nervous system" through its
documented ability to restore myelination of aging cells, concluding that "niacin represents a safe and translationally amenable regenerative therapy for chronic demyelinating diseases" such as multiple sclerosis, Alzheimer's, Parkinson's, etc. A central feature of some forms of neuropathy is demyelination (e.g.,
CIDP: chronic inflammatory demyelinating polyneuropathy). So, in sharp contrast with statins, niacin, far from promoting PN, may help diminish it. My own situation involves idiopathic polyneuropathy in the lower legs, feet and hands, which I suspect relates to small vessel disease (in the complete absence of coronary artery plaque). I am currently trying niacin and a few other substances to determine results, applicable to my case. Incidentally, published case histories indicate statins should not be taken by anyone with Gilbert's Syndrome, as rhabdomyolysis may result; I have Gilbert's and had an acute episode of rhabdo after just a few weeks on statins; a certain number of people who do not have Gilbert's also suffer rhabdo, a very dangerous condition. This occurred several years ago, causing me to give niacin a try; my brother, who has a similar lipid profile (very high LDL-C) and has the same inherited Gilbert's also started on niacin at about the same time. After four months on daily dose of 2000 mg we both experienced very favorable lipid changes. Now, some years after I went off niacin, my LDL-C is (only recently) again very high and, with the advent of PN, I decided to try it again, this time for possible multiple benefits. Just an idea. Always consult with your doctor before starting any new medical protocol. Mine, fortunately, keeps an open mind and keeps up to date on the latest research findings, And, as all of you who suffer from PN know, "standard of care" is anywhere from non-existent to highly unsatisfactory in most cases. There are alternatives that need a lot more attention, and nicotinic acid, I submit, is one of them.