Even more Michael Pollan

"Eat food. Not too much. Mostly plants.

That, more or less, is the short answer to the supposedly incredibly complicated and confusing question of what we humans should eat in order to be maximally healthy. I hate to give away the game right here at the beginning of a long essay, and I confess that I’m tempted to complicate matters in the interest of keeping things going for a few thousand more words. I’ll try to resist but will go ahead and add a couple more details to flesh out the advice. Like: A little meat won’t kill you, though it’s better approached as a side dish than as a main. And you’re much better off eating whole fresh foods than processed food products. That’s what I mean by the recommendation to eat “food.” Once, food was all you could eat, but today there are lots of other edible foodlike substances in the supermarket. These novel products of food science often come in packages festooned with health claims, which brings me to a related rule of thumb: if you’re concerned about your health, you should probably avoid food products that make health claims. Why? Because a health claim on a food product is a good indication that it’s not really food, and food is what you want to eat."


Michael Pollan, author of my latest favorite book, The Omnivore's Dilemma, wrote a wonderful piece for the New York Times entitled "Unhappy Meals". You can find the full text at http://www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html?ex=1172120400&en=a78c20f4da0cdc7b&ei=5070. (Another favorite read of mine, The Fanatic Cook's Blog at , alerted me to Pollan's article. Incidentally, take a look at the Fanatic Cook's latest posts--very entertaining and informative. She's got incisive insight into foods as well as a great sense of humor.)

Pollan goes on to say that...

"...typical real food has more trouble competing under the rules of nutritionism, if only because something like a banana or an avocado can’t easily change its nutritional stripes (though rest assured the genetic engineers are hard at work on the problem). So far, at least, you can’t put oat bran in a banana. So depending on the reigning nutritional orthodoxy, the avocado might be either a high-fat food to be avoided (Old Think) or a food high in monounsaturated fat to be embraced (New Think). The fate of each whole food rises and falls with every change in the nutritional weather, while the processed foods are simply reformulated. That’s why when the Atkins mania hit the food industry, bread and pasta were given a quick redesign (dialing back the carbs; boosting the protein), while the poor unreconstructed potatoes and carrots were left out in the cold.

Of course it’s also a lot easier to slap a health claim on a box of sugary cereal than on a potato or carrot, with the perverse result that the most healthful foods in the supermarket sit there quietly in the produce section, silent as stroke victims, while a few aisles over, the Cocoa Puffs and Lucky Charms are screaming about their newfound whole-grain goodness."


Not everything Pollan says is new, but he says it so eloquently and cleverly that he's worth reading. If you haven't yet read Omnivore's Dilemma, or just want a condensed version of the book, the New York Times piece is a great piece of the world according to Michael Pollan.
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When niacin doesn't work

When niacin doesn't work

Dan had the usual collection of metabolic syndrome lipoprotein abnormalities:

low HDL of 28 mg/dl, triglycerides 280 mg/dl, 90% of his LDL particles were small.

Along with elimination of wheat and junk foods, exercise, and fish oil, I asked Dan to add niacin. I usually ask people to buy SloNiacin and begin at 500 mg per day with dinner, increased to 1000 mg per day at dinner after 4 weeks.

Dan came back several months later. His lab results:

HDL 40 mg/dl, triglycerides 76 mg/dl.

(We didn't repeat the full lipoprotein analysis, so no small LDL value was available.) Better, though still some room for improvement. I urged Dan to stick to his program, lose some more weight off his 260 lb frame, exercise, be strict about the wheat products.

Dan returned another few months later. Lab results:

HDL 29 mg/dl, triglycerides 130 mg/dl.

Dan had lost another 8 lbs and was reasonably compliant with his diet.

What's going on here? Why would he backtrack on HDL and triglycerides despite sticking to his program?

I asked Dan where he purchased his niacin. "I got it from Sam's Club. The pharmacist said to try this 'no-flush' kind so the hot flush wouldn't bother me."

Aha! It's no wonder. "No-flush" niacin, or inositol hexaniacinate, is an outright scam. It has virtually no effect on lipids or lipoproteins in humans. It's therefore no surprise that, by replacing real niacin with the no-flush variety, Dan's blood patterns began to revert back to their original state.

Let me be straight on this: No-flush niacin is a scam. It does not work: it does not raise HDL, reduce triglycerides, nor reduce small LDL. It's expensive, too, far more expensive than the real thing. It has no business being sold by stores like Sam's Club or your health food store.

SloNiacin (Upsher Smith) has become our preferred preparation. (I obtain no compensation of any sort for saying so.) We buy it at Walgreen's.

Comments (7) -

  • DietKing2

    9/20/2007 1:37:00 PM |

    Dr. Davis,
    While I thank you from the bottom of my heart (nice pun, eh?) for this information regarding the crappiness of flush-free niacin, it did cause me to go to bed last night all upset; yes, I've been taking the stuff religiously the last few months hoping it would drive my low HDL numbers up up up. Now I read this...grrr...
    Here's my question (yes, there's a question in here somewhere...) I'm willing to switch back to good old regular niacin, but how do I avoid that annoying flush I experienced the first time around, the one that caused me to switch to the inositol version to begin with? I eventually want to make it up to about 1500-2000mgs a day, but I have a feeling it's going to be tough!
    Any suggestions?
    Thanks!
    AdamWink

  • Anonymous

    9/20/2007 2:04:00 PM |

    Is there any issue with taking niacin first thing in the AM?

  • Dr. Davis

    9/20/2007 5:51:00 PM |

    Not as long as you eat and maintain good hydration. Remember that, upon awaking, you are quite dehdyrated.

  • Dr. Davis

    9/20/2007 5:54:00 PM |

    Two important ways :

    1) Drink lots of water, e.g., 16-24 oz if you have the flush.

    2) Increase no faster than 500 mg per month.

    Of course, you should only take higher doses of niacin with the assistance of your doctor.

    There is a larger discussion about this on the Track Your Plaque webwite, as well, under "Niacin: Ins and outs, ups and downs."

  • Anonymous

    7/13/2008 5:06:00 PM |

    I started niacin after seeing a study on the lipidsonline.org website.  I was encouraged by the results from the first analysis of my blood showing my HDL was up 20% to 42 and my LDL had crashed 25% to 58. This was 1grm "now" brand OTC Niacin combined with 40mg crestor.  However, my triGs were still high at 227.

    I raised the Niacin to 2grms and looked forward to the next blood test.  Success with TriG. Results were spectacular (105) and same with LDL (58).  But my HDL receded back to its old level of 30mg/dl.... very disappointing.  

    I asked my Dr to prescribe the Niospan in case the OTC niacin was variable..... OMG! C$280/200 tabs....... I'm in Canada so no wallgreens.  Will be trying to get some statement of quality control out of the Now product people.

    One other side effect of the higher Niacin... uber low resting diastolic.  Does this mean I should stop taking beta and ace inhibitors ?

  • buy jeans

    11/3/2010 12:22:55 PM |

    I asked Dan where he purchased his niacin. "I got it from Sam's Club. The pharmacist said to try this 'no-flush' kind so the hot flush wouldn't bother me."

  • scott bushey

    8/26/2011 12:39:20 PM |

    Just curious:

    If there is no correlation at all between high cholesterol and cardiac disease, why do you prescribe supplements like Niacin that optimize cholesterol?

    Thanks in advance,
    Scott

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