I've taken prescription Niaspan for over an year and a half.  Several times I've had an unintended "untoward" reaction, more than a blush, more than a flush... more like a niacin storm!  Each time I've learned something new, however.  Yes, hydration is very important.  There are certain foods and drugs which apparently dam up the same metabolic pathway as niacin, and can cause a pretty nasty reaction.  Among these, at least for me, are certain long acting antibiotics (Zithromax), spicy chai tea, pepperoni (not supposed to go there anyway!) and very spicy foods, if taken near the time of Niaspan dosing.  I was advised by my Dr. that Benadryl syrup would help to shorten the duration of the "storm".  Mostly it's a case of dietary management and timing of dosage.  The good done by niacin certainly still outweighs the occasional bad side effects!

Another comment about niacin from this long-time niacin user, maybe folks will find it useful...
Dr. Davis's advice to hydrate heavily to prevent/reduce flushing is, alas, not completely effective. One can easily prove this for oneself. The next time you experience a big flush, consume as much water as you are able, and see if the flush quickly resides..does it?  No. Hydration is certainly great advice, I'm not knocking it, but as a flush reduction strategy, it isn't enough. One commentor here mentioned quercetin.  It seems some recent research on certain flavonoids (quercetin, luteolin) have produced good results,better than aspirin, which was mentioned in this thread.  One needs to experiment and see if supplements such as these do help, taken maybe 30-45 minutes before the niacin dose. I have some other comments on niacin strategies I've hardly seen mentioned anywhere, but I'll wait until (1) I see my posts are approved (I'm new here), and (2) that people are interested. Let's see if there is any feedback. Regards, Jim

I've been taking niacin  2 times daily for 6 months and dropped my cholestral from 240 to 162.  Can I go back to once daily?

I have seen some research papers that report that NIACIN, Nicotinamide and/or SAMe ( maybe also other methyl donors such as TMG ) can cause Parkinson's disease. I wonder if niacin can be converted to Nicotinamide in the body. Please see their abstracts and URLs below. Thank you.



Niacin Metabolism and Parkinson’s Disease

Tetsuhito FUKUSHIMA1)
1) Department of Hygiene & Preventive Medicine, Fukushima Medical University School of Medicine
Abstract
Epidemiological surveys suggest an important role for niacin in the causes of Parkinson’s disease, in that niacin deficiency, the nutritional condition that causes pellagra, appears to protect against Parkinson’s disease. Absorbed niacin is used in the synthesis of nicotinamide adenine dinucleotide (NAD) in the body, and in the metabolic process NAD releases nicotinamide by poly(ADP-ribosyl)ation, the activation of which has been reported to mediate 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinson’s disease. Recently nicotinamide N-methyltransferase (EC2.1.1.1) activity has been discovered in the human brain, and the released nicotinamide may be methylated to 1-methylnicotinamide (MNA), via this enzyme, in the brain. A deficiency in mitochondrial NADH:ubiquinone oxidoreductase (complex I) activity is believed to be a critical factor in the development of Parkinson’s disease. MNA has been found to destroy several subunits of cerebral complex I, leading to the suggestion that MNA is concerned in the pathogenesis of Parkinson’s disease. Based on these findings, it is hypothesized that niacin is a causal substance in the development of Parkinson’s disease through the following processes: NAD produced from niacin releases nicotinamide via poly(ADP-ribosyl)ation, activated by the hydroxyl radical. Released excess nicotinamide is methylated to MNA in the cytoplasm, and superoxides formed by MNA via complex I destroy complex I subunits directly, or indirectly via mitochondrial DNA damage. Hereditary or environmental factors may cause acceleration of this cycle, resulting in neuronal death.

Key words:
nicotinamide N-methyltransferase, 1-methylnicotinamide, poly(ADP-ribosyl)ation, mitochondria, complex I

Pasted from http://www.jstage.jst.go.jp/article/ehpm/10/1/10_3/_article


Parkinson's disease: the first common neurological disease due to auto-intoxication?
A.C. Williams1, L.S. Cartwright2 and D.B. Ramsden2
From the Divisions of 1Neurosciences and 2Medical Sciences, University of Birmingham, Birmingham, UK
 
Parkinson's disease may be a disease of autointoxication. N-methylated pyridines (e.g. MPP+) are well-established dopaminergic toxins, and the xenobiotic enzyme nicotinamide N-methyltransferase (NNMT) can convert pyridines such as 4-phenylpyridine into MPP+, using S-adenosyl methionine (SAM) as the methyl donor. NNMT has recently been shown to be present in the human brain, a necessity for neurotoxicity, because charged compounds cannot cross the blood-brain barrier. Moreover, it is present in increased concentration in parkinsonian brain. This increase may be part genetic predisposition, and part induction, by excessive exposure to its substrates (particularly nicotinamide) or stress. Elevated enzymic activity would increase MPP+-like compounds such as N-methyl nicotinamide at the same time as decreasing intraneuronal nicotinamide, a neuroprotectant at several levels, creating multiple hits, because Complex 1 would be poisoned and be starved of its major substrate NADH. Developing xenobiotic enzyme inhibitors of NNMT for individuals, or dietary modification for the whole population, could be an important change in thinking on primary and secondary prevention.


Pasted from http://qjmed.oxfordjournals.org/cgi/content/full/98/3/215

see also
http://www.springerlink.com/content/d5wurtwylvpcy04q/


But,on the contrary,the paper below seems to suggest that niacin protects from Parkinson's.

Title: Does diet protect against Parkinson's disease? Part 4 – vitamins and minerals
Author(s): Isabella Brown
Journal: Nutrition & Food Science
ISSN: 0034-6659
Year: 2004 Volume: 34 Issue: 5 Page: 198 - 203
DOI: 10.1108/00346650410560343
Publisher: Emerald Group Publishing Limited
Abstract: This paper is the fourth in a series on Parkinson's disease and diet and investigates the role which antioxidant vitamins A and C, niacin and selenium may have on the incidence of the disease. Oxidative stress is believed to be a key factor in the development of PD and all of these have a role in preventing oxidative stress mediated cell damage. Dietary information was obtained via questionnaires. Vitamin C was found to reduce the risk of PD by 40 per cent in one study, although this was not supported by other studies. Niacin was associated with an at least 70 per cent reduced risk of PD incidence in a number of studies. No evidence was found to support a role for vitamin A or selenium. There is a need for further research to support or disprove the roles of these antioxidant vitamins within the aetiology of PD.
Keywords: Diet, Diseases, Lifestyles, Vitamins
Article Type: Research paper
Article URL: http://www.emeraldinsight.com/10.1108/00346650410560343

One of the ways to deal with coronary heart disease is by eating healthy there is no magical pill in this case, it's just as simple as that.

Have a serious discussion and press for confident answers if you find your doctor reflexively telling you that the wart on your thumb should be blamed on niacin.

The proper diet is essential for diabetic treatment. It helps magically in patients suffering from diabetes. It provides relief from symptoms and various complications in diabetics. Many diabetic patients can control their blood glucose by losing weight and that is possible only be proper diet.

Regards
Alexa

Nice post Bill. People really need to get this info into their heads.

Great meeting you  on the cruise!

Please could you provide links to the interventional controlled (not observational) studies that have shown a link between eating meat and cancer risk, that separate the effect from eating junk food, and the fact that vegetarians are more likely to eat healthily in general than meat eaters due to the widespread and incorrect belief that saturated fat is harmful to health.

Also, could you explain lack of cancer in traditional tribal societies with a high meat intake? You would need to do this before stating that meat intake necessarily increases cancer risk.

Hi doc,

Great blog. How do you explain the Inuit, Masaai, Komi (Siberia), Native American and similar cultural groups whose diets seemed to subsist primarily on animal products? ie. including my ancestors.

Perhaps its an emphasis on wild/grass-fed/raw dairy(or as close to) animal products as opposed to the grain-fed animal products which encompass the majority of the US that you need to be addressing?

Thanks.

Interesting point of view.  Can you please provide references to support your claims?

Great diet, and yes, it seems that we should talk about healthy eating instead of weight loss or diets. Anyway the purpose of any diet is to move your eating habits to new healthy level.

Thanks for sharing and possibility to comment! Welcome to visit Ideal Weight Blog to find some recipes and great articles! Thanks!

Just on the nitrate/nitrite subject: as far as I know nitrate is a naturally occurring compound and the human exposure to it is mostly through  consumption of vegetables, and to a lesser extent water and other foods...

http://www.efsa.europa.eu/en/scdocs/scdoc/689.htm

I would say there are 3 primary pitfalls of low-carb dieting:

1) Being too low in carbohydrates - being in ketosis is anti-metabolic and induces insulin resistance, and probably why Atkins suggested that his diet "tends to shut down the thyroid."  

2) Too much protein - this strains the thyroid as well, and encourages gluconeogenesis, which is also problematic - especially when in ketosis and insulin resistance is extreme.  

3) Extremely high in omega 6 polyunsaturated fat.  Eating a low carb diet with lots of pork fat, chicken skin, peanut butter, and nuts - the typical standbys of many low-carb dieters, provides an astronomical amount of omega 6.

By my best guesses, I was consuming 15+ grams of omega 6 while on a low-carb diet.  I've since cut that back to less than 3 grams per day and the change has been dramatic.  Of course the 400 grams of carbs per day helps too.

Dr. Davis,
Thank you for this post.  I'm certainly culpable of the "common errors" you mention.  I find that making daily decisions on what to eat difficult. I want to eat healthy and have some variety. Here's the question.  What do you eat?  What did you have for breakfast this morning?  What did you eat last night?  What do you keep in the fridge and on the counter to make following your dictates easier.
I don't want to over-think it but all this information is overwhelming.  I feel like a scientist and my body is the research subject.
Thank you for your blog.  I've learned a lot but need some direct guidance.
Sincerely,
Dana Law
San Diego, Ca

Why is "Calories in vs. calories out" a faulty concept?

Have you really read the meat leading to cancer literature carefully or do you just think it's like that? Others like Gary Taubes and Eades (who I really trust when it comes to research) have found no evidence that meat cause cancer.

On sodium nitrate, I totally agree. I get so mad when I'm walking in the grocery stores. All meat has sodium nitrate added. Grrr.

I share your thought about dairy. But do you really mean that butter triggers insulin spikes?

Most nitrite is form your own spit and originally ingested by eating vegetables.  

I believe the epidemiological studies (which also typically find fat to have bad associations...) have more to do with a lack of fruits/vegetables/polyphenols than anything that is bad about meat.  

Also, I don't think glycemic index or the insulinotropic nature of certain proteins matters one lick for people that are healthy.  I can eat a boiled potato for breakfast without my blood sugar breaking 100... I don't think diabetes is an overuse injury - more likely, it is cause by damage to the liver and then pancreas from PUFA and fructose overconsumption.  

I think Matt Stone is correct about the top three problems with Atkins.

If you're really concerned about your nitrite intake, watch your celery, arugula and spinach (and many other vegetables) consumption, too. Nitrites galore. Though it's not nitrites and nitrates in and of themselves that are linked to cancer, it's the nitrosamines that can form from them.

Sodium nitrite isn't primarily a colour fixative, it's a an anti-bacterial agent. Meats cured with sodium chloride only have to be done quite carefully to avoid botulism. Nitrite has been used since the 16th century to preserve meat. Modern cured meats also add sodium ascorbate, and ascorbates have been shown to inhibit nitrosation reactions and thus the nitroamine level in these cured meats is usually at undetecable levels.

Nitrites are produced in our mouths from bacterial reactions to the nitrates in food and water, and at least 70% of our dietary nitrite comes from this salivary nitrite (which came from our food and water). The nitrites and nitrates we then ingest are mostly either excreted fairly promptly or used to make nitric oxide. Human gastric secretions have a pH which isn't condusive to nitrosamine formation, and also include ascorbates which reduce nitrosamine formation, and keeping one's vitamin C at good levels will also have an effect. People with achlorhydria will obviously be more susceptible to nitrosamine formation. But interestingly, there are studies which now suggest that nitrite consumption is a good thing: http://www.ncbi.nlm.nih.gov/pubmed/20005970 - and branched-chain amino acids are also suggested as suppressing the effect of nitrosamines. However the amount of nitrosamines you get from smoking is definitely Not Good, and no amount of ascorbate will ameliorate it.

So, a good intake of nitrates and nitrites primarily through vegetables, some fruit, and some cured meat is good: the vegetables and fruit contain ascorbates as does your body, and most of hte meat should have it added also, minimising the formation of nitrosamines, leaving your body to get on with making use of the nitr*tes to make needed nitric oxide. (Oral nitric oxide/arginine supplements are rubbish though - the studies showing their benefit used intravenous/injected supplement.)

Personally, I'll take nitrites over botulism, thanks.

Hmmm, I've never been on a cruise, but if I did go on one, I'll bet I'd have to eat somewhat differently than I do at home, regardless of the carb count.  Between not having access to the pastured bison and wild game, raw dairy, "backyard" eggs, and organic CSA produce subscription, and so on that make up most of my family's daily diet, and no access to a kitchen, my meals on a cruise would hardly be representative of my usual diet.  

I'll bet LC cruisers are as prone to anyone when it comes to the excesses of endless supply of prepared foods on cruises, but I'm not sure we can assume that's the way they always eat.  Most people  eat somewhat differently on vacation, whether it's because they are on somewhat of a "diet vacation", or because they have to make the best of what's available.  When I was on vacation in Italy I had a gelato every day, but I certainly don't do that at home (it was a conscious decision to take a slight vacation from my diet and enjoy a local specialty for a limited time).  And I've been places where it was impossible to get eggs cooked in real butter instead of the ubiquitous "griddle grease" hydrogenated veggie oil, let alone pastured eggs and humanely produced bacon (seriously, we breakfasted at a tiny roadside diner outside Twenty-Nine Palms that had NO butter on the premises).  

And not all LC eaters are following an Atkin's diet plan, though I understand the Atkins label has become be a generic term for LC eating.  I've read an Atkins book (as well as at least a half dozen other LC diet books).  I eat LC (& GF now) but I've never followed specifically an Atkin's diet plan, nor do I describe myself as at Atkin's dieter.

I think the points you make point out that even on low carb, people can and do still rely on far too much industrial food.  It's convenient and it's everywhere (hard to avoid, esp when dining away from home).  Frankly, one of the reasons cruise vacations hold little appeal to me is the idea of having to nothing to eat all week but cr@p industrial food, no matter how talented the chefs may be at making it look and taste good.   I may be making a sweeping assumption, but somehow I don't imagine that cruise chefs are simmering their own bone broth stocks, curing charcuterie themselves, and making their own cheese (or even sourcing from small artisan vendors  very much).    I'd be extremely surprised if cruise ship food ingredients weren't offloaded from US Food tractor trailer trucks.  That's what I've seen at many land-based resorts.  When I travel,  as much as possible, I want to try the local traditional foods and specialties, prepared as authentically as possible.  That might mean eating more of something than usual (and less, too).

Isn't it also an Atkins diet error that low-carb eaters tend to be on a constant and frantic quest for processed fake food items that are pretend substitutes for the food that got them in trouble in the first place?  And many of them have made Jimmy Moore, a huge hawker of low-carb substitutes and a less-than-successful low-carber, their role model.  

I noticed on Swedish physician Dr. Andreas Eenfeldt's blog that his description of his experience on the cruise was that "[t]he big difference with Sweden is that many are fond of low-carb versions of traditional junk food, sugar, and so. Low carb cake, low carb icecream, low carb potato chips, diet sodas ... In my eyes seemed to just those participants who ate such did not have the same persuasive power of the diet. To put it nicely. Perhaps it was the roundest of them all, the man [Andrew DiMino -- Carbsmart.com?] who handed out the various "low carb" products that are advertising for his company. [Google translation]

People I know who have been totally unsuccessful on Atkins have gleefully loaded up on "substitutes" that probably have derailed them.  And the Atkins company that sells this crap will forever keep the Atkins mantra from the gaining the credibility it probably deserves.

also curious as to how butter could cause a rise in insulin. butter has even less/no carbs compared to cheese, and in previous posts you've said cheese doesnt cause blood sugar rises...

also many health food stores, grocery co-ops, and whole foods and trader joes sell either no nitrate-added or uncured deli meats and bacon. applegate and niman ranch are brands that sell these foods.

Bill you said:

"Excessive consumption of animal products--Non-restriction of fat often leads to over-reliance on animal products. Higher intakes of red meats (heme proteins?) have been strongly associated with increased risk for colon and other gastrointestinal tract cancers. It is not a fat issue; it is an animal product issue. We should consume less meat, more vegetables and other plant-sourced foods."

I don't think this is true Bill. As far as I'm aware, there is no good evidence to support protein as cancer causing. Dr. Eades has debunked this on his blog.

Andrew, scroll down and see the section on conservation of energy for why calories in vs out is faulty: http://entropyproduction.blogspot.com/2009/02/all-medical-science-is-wrong-within-95.html

Ditto what Tim said. My understanding is that it's the whey in dairy that is insulinogenic (tho it's a bit like the glycemic index ... it depends on when and what you eat it with).

Butter should not be as big a problem. One of my go-tos is ghee from grass-fed cows. The small amount of milk solids left in butter are removed when ghee is made.

If you cut out animal protein, dairy, and carbs, there's not much left to eat.

The protein sources favored by vegetarians, beans, rice, and grains, make blood sugar increase too much for people with diabetes.

One can not live on tofu and fat alone, and anyway some people say too much soy is not good.

I don't know why people have a prejudice against dairy. See this:

http://care.diabetesjournals.org/content/29/7/1579.full

If you have a diabetic tendency, it means your beta cells aren't producing enough insulin, so a food that helps them along is good.

Well said Dr. Davis!  We were certainly appreciative of your presence on the Low-Carb Cruise.  THANK YOU so much for all of your contributions...we need to get you back on the podcast later this year.

Too many calories on a high fat diet? Good luck keeping that up. I can't get 2000 most days. Too full.

Why were there traditional societies that used dairy as a staple yet were free of CVD and diabetes, including the super long lived people on the border of Eastern Europe and Central Asia?

Copy and paste the above argument for "eating too much meat."

Low carb may not be for everyone, but the biggest problem with some low carbers is probably too much n-6 from processed meat. Lots of nuts aren't that good for you either.

What is the alternative for animal protein? Soy, gluten,beans, nuts all cause other problems?

Please suggest some sample of improved Atkin diet.

Again Low carb is NOT zero carb. Many atkins folks don't really read the diet. I used atkins succesfully last year and eat more veggies then I ever did. It is not all about meqat meat meat or even high protein. And as much as I enjoy your blog- you still have a huge fear of fat. With Atkins I have improved my metabolic problems.

I've been concerned to learn, here and elsewhere, that dairy products are insulinogenic, particularly since I can't seem to manage a reasonable diet without a fair amount of them.  (Nuts don't do well with me, soy is a no-go, I can only eat so much meat, my family has egg-allergy issues, and the fish that is non-contaminated, sustainably caught, not-BPA-canned, not-fed omega-6 and dioxin-laced stuff in a disgusting fish farm, is wicked expensive and logistically impossible to get fresh for my family more than once a week....)

On the other hand, there are several dairy-reliant cultures that are quite long-lived and healthy, and dairy-consuming people in our own culture tend to be healthier than non-dairy eaters.  So maybe something mitigates the insulin question with dairy.  Just saying.

In the end, you have to eat something, and sometimes reading this blog I feel I can't eat anything.  Like Dana Law, I'd like a better picture of what an ideal, or at least acceptable, day's or week's diet would look like from your point of view.

I've followed Atkins for these last three years, losing 80lbs in the process, so am quite familiar with what's permitted and not.

Atkins did not recommend consuming any milk, nor was much yogurt or cottage cheese permitted. Hard cheese, cream cheese and heavy cream are allowed, but the Atkins diet permits less than 2-3 oz per day.

Butter is allowed liberally, but is 100% fat so can't be very insunlinotropic, if at all.

Because I raise dairy goats, until three years ago, I drank goat milk freel.  Now I never drink it, though I do have a glass of very sour kefir now and then, after the probiotics have cultured most of the lactose into lactic acid.  The kefir I drink is very tart. Most people don't like it that sour. lol

The "Atkins is High-Protein" myth is often bandied about by anti-low-carb groups. I track my daily intake on FitDay and it's usually about 15-18% protein, 65-70% fat, and 10-20% carbs... pretty much what Atkins recommended; even 20% protein is not especially high protein.

My carbs come mostly from eggs, green vegetables, heavy cream for coffee, berries and other LC fruit, and certain nuts and seeds, like flax.  Peanut butter is very carby, and not freely allowed in Atkins.

I recommend reading the old Atkins book to understand what his diet really contains. Read the 1972 version, as the newer books (after 1999) were changed by Atkins Nutritionals to allow low-carb junk food that they conveniently sell.

I don't want anybody to hear "don't eat meat" here.

I think that you should eat meat. I am a former vegetarian and I don't particularly like meat. Despite this, I do feel that humans are meant to be carnivorous. I just don't believe that piling your plate high with animal products several times per day is the ideal way to eat.

Dr. Davis, you sure it was "Atkins low-carbers" you were with?

"Excessive consumption of animal products"

At least with DANDR 2002, as you go up higher on the rungs, meat is replaced somewhat by veggies.  Personally, I eat around 200g of meat per day.  Of that, less than 90g is red meat (the rest is fish.)

"Consumption of cured meat"

I love bacon as much as the next guy, but in even Dr. Atkins stated in DANDR 20002 that one should "try to avoid meat and fish products cured with nitrates, which are known carcinogens."

As for dairy, it's not taboo but still has to be fitted into the carbs you are allowed per day.

This is the second blog post since the trip you have me scratching my head.  I hit your 60-60-60 markers using oat bran all the while being IGT and sporting an A1c of 4.8%.  (And before anyone asks, in DANDR 2002 Dr. Atkins mentions oat bran to bring down your cholesterol levels.)

Dr. Davis says:

"I just don't believe that piling your plate high with animal products several times per day is the ideal way to eat."

Try to do that for an extended period of time. I lasted about 2 weeks. Now I have a very small meaty breakfast, and a modest size meaty dinner, and I'm STUFFED. Been like this for years. Can't eat lunch-not hungry.

You prefer plant foods which is great, but you're not in a carnivore's shoes. From our perspective, what you say is rather silly because many of us actually worry about not getting enough calories! Fat is filling. I'm a 6ft, 165 lb male and I can barely get 2000 calories I feel so full.

Amen to Zach. I'm a PUFA-phobe, and if there's no grass-fed meat or butter in my diet, where am I going to get my fat?
Nuts? (PUFAs)
Soy? (Won't eat it unless it's fermented--like miso)
SUPER-skeptical about your claim regarding insulinotropic dairy. If it is so chronic disease-inducing, wouldn't the Swiss of the Loetschental Valley been prematurely "toes up in the dirt" of the emerald green countryside before Weston Price would have arrived to find out how spectacular their health was because of the dairy they consumed?

Brilliance abounds here: http://www.paleonu.com/panu-weblog/2010/3/18/sat-fat-or-pufa-which-one-do-you-fear.html

Hey, Gretchen,

Thanks for the link!  Good to know, and I was wondering about whether producing more insulin would be good or bad for me.  I had gestational diabetes, so I do have a diabetic tendency.  I'll keep eating my yogurt, then.

Helen

Here's a good take on the conventional "wisdom" of nitrates: http://junkfoodscience.blogspot.com/2008/07/does-banning-hotdogs-and-bacon-make.html

Matt:

"Being too low in carbohydrates - being in ketosis is anti-metabolic and induces insulin resistance, and probably why Atkins suggested that his diet 'tends to shut down the thyroid.'"

I generally find your thoughts to be spot-on, so there's no need to manipulate Atkins' quote to enhance your point.  What he said was that dieting in general tends to shut down the thyroid.

"[P]rolonged dieting [including ‘this one’] tends to shut down thyroid function."

Dr Davis -
Could you please post your "typical" breakfast, lunch, and dinner? I've been reading this blog for awhile (and it's great), and have read a lot of what NOT to eat, but haven't read much on what TO eat. What should our 3 square meals/day look like?

I knew that dairy was insulinotropic, but like Emily, I was surprised to see butter on the list as butter is mostly fat, and clarified butter entirely fat.  As I understand, it is protein-rich foods like beef, chicken, and fish, that provoke unexpectedly high insulin responses, so I thought it was either the sugars or the protein in dairy, not the fat, that spiked a rise in blood sugar.  Is butter really insulinotropic like other dairy products containing lactose sugars and proteins?

Another comment about dairy and weight gain:

I have noticed that melted cheese in particular - a warm, creamy fat with some carbs and protein - is highly palatable.  Full-fat yogurt, whipped cream, and guacamole are similarly irresistible.  I could not consume more than a couple tablespoons of olive oil yet have no trouble gobbling down a few slices of cheese melted onto a piece of chicken or beef.  I'm trying to shave off 5 more pounds to reach my goal, so I've given up all dairy except for clarified butter, which I use to saute veggies.  Will see if this works.

Most of the low-carbers on the cruise seemed to be overweight.  I don't know if some of them were just starting eating low carb.  I think this is what prompted Davis' post.  If you are still overweight doing low-carb - are you doing something wrong? Should slimness be a goal every low-carber can meet (apart from all the other health benefits)?

Hi, Fred!

We had some great conversations. I learned a lot from your "slow-burn" discussions and I've been applying them to my workouts.

Good to see you here! I will be detailing some of the fat/animal product/cancer discussions in future.

"I do feel that humans are meant to be carnivorous. I just don't believe that piling your plate high with animal products several times per day is the ideal way to eat."

I'm scratching my head trying to reconcile these two statements.

How about eating animal products to hunger once or twice a day?

Haggus--

Excellent point.

What Bob Atkins called "the Atkins Diet" was somewhat different from what is commonly practiced as "the Atkins Diet."

As time passes, I continue to marvel at how much he got right.

How high is "too high?" I say this not to be a smart aleck or to overlook the wisdom in "you'll know it when you see it," but this is a bit too vague to be of much use.

Clearly a largely plant-based diet supplemented with a decent amount of animal protein will trump loading up heavily on animal products to the exclusion of plant-based foods. But there's far too many vague generalizations being bandied about by so-called dietary experts these days and not a lot of concrete recommendations that can be tailored to fit a person's unique context.

-Bob Sutcliff

Wow. Echoing a few other commenters, I'd really like some guidelines on what a good diet would look like.

Jenny said: "I track my daily intake on FitDay and it's usually about 15-18% protein, 65-70% fat, and 10-20% carbs... pretty much what Atkins recommended...."

Whenever I read this sort of thing, I get confused. 15-18% of WHAT? the total calories? and if so then how do I translate that percentage into actual amounts (like grams or ounces?)

I'm sure most of you can straighten me out on this once and for all. Thanks!

Dr. Davis,

it would be great after such lengthy and detailed discussions about this topic to give us a typical sample food or meal list for a day of yours.
Looking forward to it.

Renfrew

Fred Hahn: I'm mixed up about your two posts here, "People need to get this into their heads" and "Not true."

I would also like to see a typical day in the life of Dr. Davis.

Anon-  Yes, they mean a % of total calories.  You can figure it this way:

1g Protein = 4 cals
1g Carb = 4 cals
1g Fat = 9 cals

So if a person eats 2000 cals/day and 18% was from protein, then that person ate approximately 360 cals of protein.  Divide 360 by 4 and you get 90 grams of protein.

I agree that there are many low carbers who follow their eating plan less than optimally. I see them posting on the low carb forums I follow. But as one who was also on the cruise, I don't think you can really equate cruise eating with what people eat on a normal day-to-day basis!

I had resolved to eat only "real food" on the cruise, as I almost always do at home, and I had resolved not to snack. And I was pretty good about my resolve. I didn't snack, ate only three meals a day, avoided the flour, sugar, even the sugar-free cheesecake and other things provided.

But did I eat exactly the way I would eat at home? No, I didn't. I undoubtedly ate more than I would have eaten at home, and probably certainly more protein sources than I would have eaten at home. The last night of the cruise I even broke down and had one of the sugar-free margaritas, and I had a half glass of red wine at the comedy show.

And I'm sure my PUFA intake was higher than I would normally like. We had no control over how foods were prepared in the kitchen after all, or very little.

But this was 5 days out of my life, not a lifetime of eating. I didn't gain any weight on the cruise and indeed have even hit a new low this week since being back. Overall I've lost more than 100 pounds.  

I'm not convinced of the meat/cancer link either - though too much protein raises my blood sugar so I don't normal OD on protein much. I was never a vegetarian but often thought I could have gone that way as I'm not all that crazy about meat. But now I have an "It's them or me" attitude and look for meats I  enjoy better - just not too much.

Apparently Matt Stone has challenged my son to try out a super-low-calorie, essentially fat-free diet, based on 1930s research by Evans and Strang, and I'm following his progress with interest. But at the moment it's not for me. I still love my butter and coconut oil.

But we are all so different, and what works for one may not work well for another. But I wonder how many low carbers eat at home the same way they ate on the cruise?

Well said Dr. Davis!

Jimmy this is not at all what you promote.  I am confused by your comment.

Dr. Davis, are you choosing to ignore all those who have asked you to defend your claims (and the great questions asked).  This is the first post I have ever read by you that makes me shake my head.  

Sally Sue

Anon said: "Whenever I read this sort of thing, I get confused. 15-18% of WHAT? the total calories? and if so then how do I translate that percentage into actual amounts (like grams or ounces?)"

Percentages of my daily food intake. I used percentages because everyone has a different calorie ceiling where we stop losing weight. The ceiling calorie limit usually changes as you lose weight; but the percentage of Protein, Fat and Carbohydrates should remain the same.

My daily calorie limit is now around 1500 calories; when I weighed 80 lbs more, it was closer to 2000 calories; and at 2000 calories back then I was losing 3-4 lbs a week.  Either way, the grams/oz of Potein/Fat/Carbs that I eat probably won't relate well to you; but percentages can and will.

By the way, I use a food-tracking program called FitDay, that calculates your food entries into P/F/C, and into grams/oz and percentages, and also gives daily vitamin/mineral counts as well as for individual foods.  It's really quite interesting to compare the nutrition counts of different foods; that way you can see what's really worth eating.  Meat contains a lot more than just protein... it has a lot of essential vitamins and minerals, actually.

FitDay is free online, but the purchased version is much more convenient; I paid $25 three years ago and consider the money well spent.

You should track your own food intake to see for yourself what percentages your current diet contains... you might be surprised. Food tracking, whether through FitDay or some other program, is the single most useful thing that helps keep me on track.

Red meat and intestinal cancer isn't strongly linked.  In fact, it seems to be dissolving under tougher scrutiny.

http://www.medicalnewstoday.com/articles/73040.php

"Recent studies published in the journal Cancer Science have disproved the common myth that consumption of red meat increases colorectal cancer  risk."

Eat for health, not for weight loss. I agree.

However, if, perchance, you believed that you ate for health, yet the same diet kept you fat, or God forbid kept you emaciated, would you really be eating for health then?

Re Anonymous and "percentages."  This drives me crazy too.  Without a total daily calorie count, percentages are meaningless.  So what if I eat "10%" carbs, if I am noshing on 6000 calories a day?

To answer your question: yes, you do have to do some simple math.  First, figure out the number of calories in the given percentage, using a hypothetical total daily caloric intake.  40% of 2,000 calories, for example, would be 800 calories.  A carb has roughly 4-5 calories per gram, so that would equate to around 200 grams of carbs.  Protein is similar.  Fat, on the other hand, has 9 calories per gram.  So those 800 calories would be slightly less than 90 grams of fat.

Once you start doing it, it gets easier.  Practice on food labels!

Anon - most food values are given as a % of calories.  For example if you are eating 2000 calories/day of which 70% is fat, then you're eating about 155 gms of fat per day (2000 x 0.70 = 1400/9 = 155 gms). Fat has about 9 calories/gm; carbs & protein each have about 4 calories/gm.

As for "...15 to 18% of what" that would depend on what you're eating.  Three ounces of white fish (raw) has about 16 gms of protein; 3 oz of beef chuck (raw) has about 28 gms of protein.

Beth:

That doesn't prove that calories in vs. calories out is faulty.  The calories in vs. calories out concept is simply the theory that you will lose weight if you eat below BMR, regardless of what foods you eat.  The Thermodynamics argument is misapplied to this concept, IMO.

Perhaps we are simply thinking of two different concepts.

Some highlighted words from the original post: overconsumption, excessive consumption, and too many calories. The point seems to be that a little rich food goes a long way. Oh, and don't eat food that causes cancer.

Sue said,"Most of the low-carbers on the cruise seemed to be overweight. I don't know if some of them were just starting eating low carb. I think this is what prompted Davis' post. If you are still overweight doing low-carb - are you doing something wrong? Should slimness be a goal every low-carber can meet (apart from all the other health benefits)?"

I was on the cruise and yes, many of the cruisers were overweight.  Some are just starting a low carb lifestyle, and some are not.  I personally have lost over 150 lbs on low carb and maintained that loss for nearly 2 years now.  I consider that a success, however, I am not thin by any means and am working on about 50 more lbs.  I took the advice from many of the speakers, Dr. Davis included, and have worked it into my daily routines.  As a registered nurse, I am aware of nutrition both mainstream and low carb.  I do my research.  I try to eat cleanly most of the time.  Life interferes sometimes, much as is does for anyone who is human and as I know it has for some of the individuals who were on the cruise.  I do believe individuals who are or have been morbidly obese are vastly different from your average American with 30 lbs to lose.  Everything happens on a grander scale.  We lose weight bigger and gain weight bigger.  All I know is I've lost 100+ lbs using the Standard American Diet--twice.  Within a year I gained it back--twice.  Finding a low carb diet has saved my life.  I eat in normal portion sizes, I maintain. Is it for everyone? No.  Is it the only way? No.  But it is one way that works for many people who really need it.  

Thanks Dr. Davis, for your presentation.  I truly enjoyed it.

"Higher intakes of red meats (heme proteins?) have been strongly associated with increased risk for colon and other gastrointestinal tract cancers."

Really? Strong association? If that's true, then how do you explain this?:
http://www.ajcn.org/cgi/content/abstract/ajcn.2008.26838v1

Hilary said:

"Really? Strong association? If that's true, then how do you explain this?:
http://www.ajcn.org/cgi/content/abstract/ajcn.2008.26838v1"

Hilary, I have not formed an opinion one way or the other on this issue yet, but the study you cite was "Supported in part by the Cattlemen's Beef Board, through the National Cattlemen's Beef Association, and the National Pork Board."

Re my question as to how to translate percentages of protein, fat and carbs into grams, I should've have asked my trusted friend "google" instead of taking up someone's time here. So please forgive me.

But Thanks! to those who responded. Your explanations were very helpful.

Meanwhile, I found a site which will do all that computation for me and thought I'd pass it on.
http://www.freedieting.com/tools/nutrient_calculator.htm

Hi I was on the cruise and thoroughly enjoyed it. Sue, Yes I am overweight according to my BMI of 29, I was on the cruise the first year by the second i was 20 pound lighter by the time I got on this years cruise since last year I have lost 54 pound. Yes I am still as you say overweight but I am doing something about it. Sorry I wasn't "normal" for this year but I will be for next year. Snacks were handed out but the message was clear that these are treats and a preferable treat than something high carb and sugar loaded. There were new people there and others who have been doing it a while and of those we are all less than when we started. We had some excellent speakers i.e. Dana Carpender who spends her life educating us how to make foods using our own ingredients she even said you can put weight on eating low carb as we still can make the wrong choices. We all have the same problem with food do we not but we are prepared to be educated by the fabulous speakers who went to help us and gave their time freely to pass on their knowledge.

A big big thank you to them and you Dr Davis

Ailsa who came one the cruise all the way from the UK.

I've been reading your blog for a couple years and really enjoy doing so. I think you've got it wrong on the Atkins diet, though. I don't know where you got your information and I'm pretty sure you didn't read the books. Milk and yogurt aren't on the "diet". Atkins also told you to not eat cured meats. As far as calories are concerned, Atkins also told people to not eat too much! So... I'm having a lot of difficulty with this article in particular & wanted to pipe up. I'll go back to readin' the rest of your blog now. Thanks for all your efforts in keeping this blog up and running. -- Mike

Dr. Davis, have greatly enjoyed your insights on this blog over the year. Have had your book for a couple of years. Have noticed great benefits from your vitamin D recommendations. When is your updated Track Your Plaque book coming out? I thought it was coming out toward the end of last year? Any ETA on it? Very interested in seeing your recommendations as it relates to diet? Typical recommended breakfasts, lunchs, and dinners?

George

This seems consistent with Ray Peat's advice as far as meat meat is concerned- he recommends balancing meat intake with gelatin so as to not get too much iron (hemeprotein afterall) as well as the fact that it has a less inflammatory amino acid profile (muscle is high in tryptophan and histidine wheras gelatin has no tryptophan and lots of glycine and proline...)

Also he mentions that he always drinks coffee when he eats red meat so as to block iron overload even more!

Of course he has no problems with milk, butter and cheese consumption but prefers the latter b/c curds have a better amino profile than whey.

Over the years, I've looked closely at the studies associating red meat with colorectal cancer, and it appears to be impossible from them to separate the effects of modern meat production practices from that of the meat. In other words, it is as likely as not that what's wrong with the red meat is what we put into it, and how it is grown, versus any attribute of the meat itself.

However, whatever the cause of the problem, it pays to at least limit consumption of red meat that you buy in a supermarket.

Hi Dr Davis,

Thanks for sharing your comments. I am a big Atkins Diet follower, and we all need to remind ourselves to keep the intake of "processed" meat & foods to a minimum. Vegetables are a good way to go! Thanks for providing us <a href ="http://atkinsdietinformation.blogspot.com>Atkins Diet</a> followers with such relevant and important information

Cheers,

John

I think it's bizarre to associate ANYONE'S eating habits on a cruise with what their day-to-day life is like.

My normal food would not be available on a cruise: homemade yogurt and kefir made from fresh raw whole milk mixed with berries, pastured eggs with dark yellow yolks cooked in pastured butter, pastured meat, fresh organic fruits and vegetables, homemade chocolate made with coconut oil, cocoa, almonds and stevia... I don't see a cruise line providing food like this.

So, I'd probably do sugar-free cheesecake too, or wind up overeating fresh fruit, just cause there'd not be any of my food there.

When I travel, I do Wendy's burgers using the lettuce as a bun if hitting a drive-through or really crappy salad bars with not much beyond iceberg lettuce.

Sometimes, you do the best you can with the circumstances... cause to eat really WELL, you pretty much need a kitchen.

This article contains huge inventory of knowledge and telling about the diet and what to eat or not.

healthty diet is important..nice article about diet

Thanks for sharing this very useful tips.

Really some truth to the fact that people from Mediterranean areas are seldom obese despite eating a very high fat diet? Did science get it all wrong before? Was there a national conspiracy to force people to eat boring, healthy foods? Thanks for your good suggestion.

Welcome to visit-
weight loss accelerator.
Cheap Calorad

I haven't eaten meat or dairy in long time. Humans don't need meat or dairy. I think meat is disgusting and I'm glad I don't have to eat it. I've seen meat-eaters B-12 deficient, so this shows eating meat doesn't necessarily make someone sufficient in B-12. Methylcobalamin B-12 works great. Eating red meat apparently increases colon and breast cancer risk. I think meat was meant to be an option, just like grains or legumes. Humans were designed to survive on many different things. Plant foods are affordable and bearable for me - meat is not.

Overconsumption of dairy products--Dairy products, especially milk, yogurt, cottage cheese, and butter, are potent insulinotropic foods, i.e., foods that trigger insulin release. There can be up to a tripling of insulin (area-under-the-curve) levels. This is not good in a world populated with tired, overworked pancreases, exhausted from a lifetime of high-carbohydrate eating.

hey guys,
you out there had some great conversations that help me learn a lot from your, atkins diet, "slow-burn" discussions, meat consumption and being vegetarian.

Nice exchange of great ideas, keep going guys and thanks Dr. Davis.

What do you make of this 'physiological insulin resistance' and its role in creeping weight gain on too low carb
http://www.lowcarbconversations.com/344/22-barbara-rose-dean-dwyer-paleo-guy-weston-price-gal-discuss-body-image-more/#comment-306963040

Hi, Lance--

I've not heard this argument before. If you've got the references for the studies showing this effect, I'd be happy to take a look.

In real life, I've not seen this play out. People who restrict carbs, lose visceral fat, drop HbA1c, glucose, and insulin. Maintaining the diet does not, over the years, allow recrudescence of the phenomena of insulin resistance.