Take a niacin "vacation"

I've been seeing a curious niacin phenomenon that has not, to my knowledge, been reported anywhere in the medical literature.

People with lipoprotein(a), or Lp(a), are best treated with niacin, particularly given the relative lack of other effective therapies. I now have seen approximately 10 people with great initial responses to niacin, only to observe Lp(a) levels slowly drift back up to the starting level over a period of 2-3 years.

In other words, if starting Lp(a) is 200 nmol/l (approximately 80 mg/dl), drops to 70 nmol/l on niacin. Then, over 2-3 years of treatment, it drifts back to 200 nmol/l. Very frustrating.

Somehow, your body's Lp(a) manufacturing mechanism circumvents the niacin, sort of like antibiotic resistance (without the bacteria, of course).

My response to this, though untested, is to have people take an occasional "niacin vacation". I don't mean take a trip to the Bahamas while on niacin. I mean take 2 weeks off from niacin every three months or so. My hope is that the occasional vacation from niacin will allow the body to continue to respond and suppress "resistance". When resuming niacin, you may have to escalate the dose gradually to avoid re-provoking the "flush".

The same "resistance" seems to develop to testosterone in males: an initial drop followed by a gradual increase. Curiously, I've not seen this in females with estrogens, which seems to generate a durable Lp(a) suppressing effect. For this reason, an occasional testosterone "vacation" might also be considered.

So far, I've advised several people to try this. The long-term success or failure, however, is uncertain. I know of no other solutions, however.

If you have Lp(a) and are on long-term niacin, you should consider talking about this issue with your physician. Like many aspects of Lp(a), while fascinating in its complexity, much remains uncertain. Stay tuned.

Comments (2) -

  • David

    3/10/2009 7:45:00 PM |

    Any updates on this "niacin resistance" phenomenon? It's been awhile since this post, so maybe you've developed a better feel for what's going on and how to deal with it? Are you still recommending the 2 week break every three months or so?

    Maybe revisiting this subject would be a good idea for a new post in the near future?

    That was a lot of question marks.

    David

  • Anonymous

    3/18/2011 3:06:24 AM |

    My theory: I believe this is a limiting reagent type issue.  Niacin flushing is a histamine reaction that occurs with the conversion of niacin into nicotinamide. The histamine reaction itself is the cause of the lipid altering effects of niacin supplementation(no flush, no effect.) Chronic use of niacin can deplete histamine levels and people typically find that flushing lessens over time. No flush, no effect, lipids start going back out of whack.  A vacation would allow histamine levels to build back up. This would also help explain your hyper-responders.

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Noodles without the headaches

Noodles without the headaches

If you are looking for a wheat-free noodle or pasta, shirataki noodles are worth a try.

Shirataki noodles are low-carbohydrate (less than 3 g per 8 oz package) and, of course, do not trigger all the unhealthy effects of wheat--no blood sugar/insulin provocation, no addictive brain effects (exorphins), no gluten-mediated inflammatory effects.

(I advise avoiding gluten-free pasta alternatives made with rice flour and other common gluten alternatives, since they trigger blood sugar, small LDL, and growth of visceral fat just like wheat.)

I made a stir-fry using the shirataki-tofu noodles, shown below. (Tofu is added to make the noodles more noodly in consistency, as opposed to the chewier non-tofu variety.) The noodles were a lot like the ramen I used to eat as a kid. They were filling and tasted great in the sesame oil, soy sauce, tofu, and vegetables I used.


The noodles are easy to use. Just drain liquid out of package. (The noodles come in water.) Rinse in collander 30 seconds, then boil for 3 minutes. Add to your stir-fry or other dish. Some manufacturers, such as House Foods, also have angel hair and fettucine style noodles.

Comments (26) -

  • Kathryn

    10/14/2010 3:05:32 PM |

    Well, since you touch on it, i'd be very interested in what you think about GF alternative flours.

    I know you have said in various places to avoid wheat & "corn starch."  Also indications that oats are not very good for us either.  But there are so many other grains.  Amaranth & quinoa are both supposed to be high in protein. Buckwheat?  Corn meals?  Millet?  I could go on & on.

    Are nut & coconut flours the only option to living low carb?  

    I try to keep your recommendations in mind, but frankly, i struggle with giving up all grains.

    Thanks.

  • Kent

    10/14/2010 3:13:18 PM |

    Dr Davis, I certainly appreciate you looking for alternatives to the destruction wheat poses, but seems like this product may have issues as well?

    Wouldn't the problems with soy greatly out weigh anything positive one could gain from using tofu?

    This was taken from an article on Dr. Mercola's site concerning tofu. http://articles.mercola.com/sites/articles/archive/2008/09/18/what-s-so-bad-about-tofu.aspx

    "Many health-conscious Americans, in an effort to improve their eating habits, have switched to eating tofu in place of meat or eggs. The soy industry would have you believe that this is a smart move for your heart health, but in reality processed soy, which includes tofu, is not a health food.

    You are much better off eating organic eggs, grass-fed meat and raw dairy products than you are eating processed soy.

    "Unlike in Asia where people eat small amounts of whole soybean products, western food processors separate the soybean into two golden commodities--protein and oil. There's nothing safe or natural about this,” Dr. Daniel says.

  • Nancy

    10/14/2010 3:18:11 PM |

    To Kent:  shirataki noodles are available WITHOUT soy, but you have to order those online, mostly the grocery store variety has soy.  The ones from MiracleNoodle.com are soy free.  I buy mine online at amazon.com, try this link: http://www.amazon.com/JFC-White-Shirataki-Noodles-16-0/dp/B002GDH5Y8/ref=sr_1_6?ie=UTF8&s=grocery&qid=1287069415&sr=1-6

  • Anna

    10/14/2010 3:31:32 PM |

    I don't miss noodles enough to bother with these, but I have tried them.  They work best with Asian-style noodle dishes better than Italian-style dishes, IMO.  I used the noodles made without tofu, however, as I make antibodies to soy, so I avoid it.

    One thing to note for those who try these noodles for the first time - when the package is first opened the aroma is slightly fishy.  They are NOT spoiled.  The smell will go away when they are drained and rinsed.  I tossed two packages before I discovered that was normal.  

    Dana Carpender, a popular low carb cookbook author and blogger, had a post up on her Hold The Toast blog not long ago about these noodles.

    Kathryn,

    Quinoa, and maybe amaranth (I haven't looked at the protein content of that one)  IS higher in protein (and the protein is more complete) than the common grains, but I wouldn't say it is HIGH in protein.  It still has a considerable amount of starch.  That's probably fine if for those who have a robust glucose tolerance.   But I need to limit starches, so I still limit these foods.  I might toss in a handful of quinoa to a pot of stew to thicken it up, but per serving, that's not much at all.  

    The longer I cook for my family with little or no without grains, the less I miss them.   I'd like my son to grow up without a huge craving for grain foods.

  • Marc

    10/14/2010 3:35:43 PM |

    Anna, you beat me to the punch.

    I call these noodles "FISH STRINGS"
    They smell bad Wink

    I guess it's better then pasta, but all in all, it's still a pretty processed product.

    Marc

  • Nancy

    10/14/2010 4:03:14 PM |

    Try Kelp Noodles sometime. I get them at Whole Foods, in the Deli case (refrigerated).  They're virtually tasteless and when cooked have a great noodle texture.

    I much prefer them to Shirtaki noodles.

  • Hans Keer

    10/14/2010 4:24:26 PM |

    Sorry doc, But now you avoid the gluten from grains and you introduce the lectins from the legume soy. This leads to a leaky gut and autoimmune diseases http://bit.ly/a9Gvjk

  • malpaz

    10/14/2010 5:28:28 PM |

    soy noodles??!?! tofu....for real?

  • Tommy

    10/14/2010 6:27:24 PM |

    "Unlike in Asia where people eat small amounts of whole soybean products, western food processors separate the soybean into two golden commodities--protein and oil. There's nothing safe or natural about this,” Dr. Daniel says."

    While I agree with the soy issue and stay away from processed soy (I do eat a little fermented soy tempeh) I am not sure about these reports I've read about the Japanese eating soy in small amounts. A Japanese friend of mine who recently came back to the U.S. after living in Japan for a few years says that there are actually Tofu stands on the street much like hot dog vendors in the U.S. He says they have tofu of all kinds (even flavored) and it is a popular snack. According to him Tofu is everywhere in Japan. He was puzzled when I mentioned the reports of low soy/tofu consumption in Asia.

  • Anonymous

    10/14/2010 7:03:38 PM |

    I tried shirataki noodles for the first time and loved them. I agree Asian dishes would be absolutely delightful with these noodles.

    @Kent. I have heard a fair amount about this Dr. Mercola you speak of. Sounds like he's not the most sciencific guy out there. Is he just out there trying to sell his products and really not caring about the science part of it?

    See below:
    http://www.sciencebasedmedicine.org/?p=2116

  • Nancy

    10/14/2010 7:44:14 PM |

    Dr Mercola is one of the only sane voices out there and he is right about soy.  And yes he IS science based, the difference is he tells the truth and doesn't hide the truth and just dole out pills like most doctors.

  • Tommy

    10/14/2010 8:30:57 PM |

    http://www.quackwatch.com/11Ind/mercola.html

  • Nancy

    10/14/2010 9:07:18 PM |

    of course the government tries to silence Dr Mercola, if they knew about the Heart Scan blog they'd try to silence its author as well since it doesnt recommend the food pyramid and tons of grains to support the US dept of Agriculture, LOL.  Its so obvious.

  • Kathryn

    10/14/2010 9:39:32 PM |

    Tommy, if you are interested in good, alternative medicine & natural ways of healing, Quackwatch is NOT the place to get your info.  He is paid much money to present his very biased (in favor of conventional medicine) articles.  

    If he doesn't yet have an article on what Dr. Davis does here, he probably soon will.

  • Dr. William Davis

    10/14/2010 10:03:30 PM |

    Let me add a qualifying comment.

    This, and perhaps some other ideas and suggestions in future, are simply meant to help people who seek replacements for familiar wheat-based foods.

    However, I believe that we should still focus primarily on real foods, not substitutes. Real eggs, real meats, real vegetables, real nuts, etc.

    Foods like shirataki noodles are meant to be occasional fun dishes.

    For the majority of people, I do not share Joe Mercola's fear of soy, provided you take an iodine source such as kelp tablets.

  • Dr. William Davis

    10/14/2010 10:04:43 PM |

    Hi, Kathryn--

    Gluten-free foods are candy, unfortunately.

    Here's my previous post on this issue: http://heartscanblog.blogspot.com/2010/07/what-increases-blood-sugar-more-than.html

  • Anonymous

    10/14/2010 10:05:48 PM |

    Quackwatch busted:  http://www.gaia-health.com/articles251/000277-quackbusters-are-busted.shtml

  • Tommy

    10/14/2010 10:21:28 PM |

    I have never read or followed Quackwatch and have no interest. While Googling Mercola that popped up. Ionly  posted it only as a statement that for every claim of life saving/altering advice one can point out there are just as many who disagree with it and show data to support their disagreements with all these doctors and gurus, diets etc.

    I continue to be amazed at the support "both" sides of all this diet stuff show; all with supporting data and studies.  It sort of reminds me of the Helmet law wars the bikers used to have with the Government. For every proof (with studies) of the safety of helmets there was  also a counter (with studies) of the danger.  It seems the same with diet.  I feel like I'm watching a tennis match...lol. My head goes back and forth, back and forth...

  • rhc

    10/15/2010 1:43:22 PM |

    @Tommy
    I totally agree! I've been on both sides and they both have their 'scientific' proof. Also, everyone seems to want to or have to lose weight. That too is quite frustrating for me since I've been slender all my life and have no high BP or triglycerides - just have to watch my blood sugar. And here too both sides have their proof that it works. UGHHH!!!

  • PJNOIR

    10/15/2010 2:15:12 PM |

    I've tried these and really have tried to give them a place but they taste like rubber. The worst.

  • Carl

    10/15/2010 2:46:02 PM |

    Spaghetti squash. Problem solved.

  • Derek H

    10/15/2010 7:58:13 PM |

    Right on Carl, spaghetti squash rocks.

  • Eva

    10/16/2010 4:54:32 AM |

    SHiritaki noodles with soy are typically about 20% soy so that's not going to be a ton of soy unless you eat them often.  The other 80% is fiber from a tuber.  You actually don't need to boil these noodles, just rinse well and then add to your dish at the last minute to heat them.  Over cooking makes them more rubbery.  YOu really only need to heat them.  They also will NOT soak up liquid so make sure your sauce is plenty thick before adding the noodles.  If anything the noodles tend to release a bit of water back into the dish.  I don't normally eat soy but am OK with the small amount in an occasional dish of shiritaki noodles.

  • Alex

    10/17/2010 11:37:06 AM |

    I'm very sensitive to starches, and grains, pseudo-grains, and starchy tubers all spike and crash my blood sugar. Beans, however, do not. When I want to indulge in pasta, I buy mung bean fettuccine at the healthfood store. They're made from whole mung beans, not refined mung bean starch, like the translucent, mung bean based, Asian noodles.

  • Anonymous

    10/18/2010 8:38:20 PM |

    I use zucchini and yellow squash as a great low-carb replacement for noodles. Not only do they lack carbs, but they are a decent source of some vitamins and minerals.

  • carpjm

    10/26/2010 5:21:10 AM |

    Check out miraclenoodle.com, they have the soy free and have tons of varieties, try the orzo!!!

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