Blame the niacin

31. October 2006 William Davis (7)
Despite the fact that niacin is:

1) A vitamin--vitamin B3

2) One of the oldest cholesterol-reducing agents around with a long-standing track record of effectiveness and safety

3) Available as a prescription drug as well as a variety of "nutritional supplements"

most physicians remains shockingly unaware of its benefits, effects, and side-effects. Most, in fact, are either ignorant or frightened of advising their patients on niacin use. As a result, I commonly have to tell my patients to resume the niacin that their primary care physician has (wrongly) stopped because of itchy feet, grumpiness, groin rash, urinary tract infections, nightmares, diarrhea, hair loss, runny nose, etc. All of these are REAL reasons doctors have advised patients to stop niacin (though none were actually due to niacin).

Is niacin really that troublesome? No, it's not. In fact, if used properly, it's among the most effective and safe tools available for correction of low HDL, small LDL and other triglyceride-containing lipoproteins, lipoprotein(a), and dramatic reduction of heart attack risk. If added to a statin agent, the heart attack risk reduction can approach 90%.

Statins are just too easy for doctors to prescribe. Niacin, on the other hand, requires a good 15-20 minutes to describe how to use it. It could generate an occasional phone call from a patient who struggles with the annoying but largely harmless and temporary "hot-flush" feeling, a lot like a hot blush. Given a choice, most doctors would simply choose not to be bothered. For this reason, I'll commonly see many, many people with uncorrected low HDLs and other patterns.

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.

Here are the steps we advise that really make taking niacin easy and tolerable:

1) Take with dinner.

2) Take with 2 extra glasses of water. If you experience the hot-flush later on, drink an additional 2 8-12 oz glasses of water i.e., a total of 16-24 oz). Extra hydration is extremely effective for blocking the hot-flush.

3) Take a 325 mg, uncoated aspirin. This is only necessary in the beginning or with any increase in dose, rarely chronically for any length of time.


This is not to say that there aren't occasional people who are truly and genuinely intolerant to niacin. It does happen. But those people are a small minority, less than 5% of people in my experience. Niacin is far more effective and safe than most physicians would have you believe.
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Comments (7) -

  • madcook

    10/31/2006 6:12:00 AM |

    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!

  • Jim

    3/14/2008 4:03:00 PM |

    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

  • mill

    6/27/2008 5:43:00 PM |

    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?

  • Anonymous

    12/30/2008 10:15:00 PM |

    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

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Chocolate . . . for adults only

Chocolate . . . for adults only

30. November 2011 William Davis (22)
If you've got a serious chocolate addiction and you'd like to make it as healthy as possible, give this X-rated dark chocolate a try.
I call it X-rated because it is certain to not satisfy young, sugar-craving palates, but is appropriate for only the most serious chocolate craver. This is a way to obtain the rich flavors and textures of cocoa, the health benefits (e.g., blood pressure reduction, antioxidation) of cocoa flavonoids, while obtaining none of the sugars/carbohydrates . . . and certainly no wheat!

It is easy to make, requiring just a few ingredients, a few steps, and a few minutes. Set aside and save for an indulgence, e.g., dip into natural peanut or almond butter.

Ingredients:
8 ounces 100% unsweetened cocoa
5 tablespoons coconut oil, melted
1/2 cup dry roasted pistachios
1/4 cup whole flaxseeds or chia seeds
Truvia or other non-aqueous sweetener

Using double-boiler method, melt cocoa. Alternatively, melt cocoa in microwave in 15-20 second increments. Stir in coconut oil, pistachios, and flaxseeds or chia seeds. Stir in sweetener, mixing thoroughly. (Note that the sweetener must be non-aqueous, as water-based sweeteners will separate in the oils.)

Lay a sheet of parchment paper out on a large baking pan. Pour chocolate mixture slowly onto paper, tilting pan carefully to spread evenly until thickness of thick cardboard obtained. Place pan in refrigerator or freezer for 20 minutes.

Remove chocolate and break by hand into pieces of desired size.
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Comments (22) -

  • Geoffrey Levens

    11/30/2011 4:43:44 PM |

    If you substitute Fair Trade cacao for the cocoa you will avoid being party to child slave labor. Also, there are a lot of nutritionally beneficial compounds in raw cacao that are lost in the "Dutching" process used to make most cocoa.

  • Buckaroo Banzai

    11/30/2011 6:12:45 PM |

    Just tried it with a little Truvia.  The granules did not dissolve.  I've added some stevia which seems to mix in just fine.  Agree on fair trade/organic if you can find it.

  • Dee

    11/30/2011 7:12:30 PM |

    Truiva is maltodextos and stevia, not a true product.

  • cancerclasses

    11/30/2011 9:10:59 PM |

    As an alternate to the pan & parchment paper (too fussy, extra equipment & cost) you can pour the stuff into quart or gallon size regular or freezer zippy bags then lay the bag flat in your freezer.  Been doing this long time now with coconut oil & coco candy, works good & it's already in a bag for storage.  To eat just break it up in the bag before opening, no muss, no fuss.

  • Thomas Moore

    12/1/2011 12:40:24 AM |

    loved reading your various blog's, lot's of stuff to get my teeth into.  Don't worry I'll get through it slowly..........very slowly!!!!!!!!

  • Laura

    12/1/2011 12:52:03 AM |

    Actually Truvia is stevia and erythritol (not sure of that spelling) and it is a sugar alcohol that has very little if any impact on blood sugar and consequently insulin.  
    If you add the Truvia into the coconut oil and then melt and warm the coconut oil (stir the truvia occassionally) it will dissolve better.

  • Dr. William Davis

    12/1/2011 4:18:52 AM |

    Thanks, again, Cancerclasses! I also saw your wonderful suggestion on the Wheat Belly Blog.

  • Dr. William Davis

    12/1/2011 4:19:31 AM |

    Yes, while I am not a fan of the manufacturer, Cargill, I believe they have a good product in Truvia, which is erythritol and rebiana.

  • Lindas

    12/1/2011 6:58:39 PM |

    May seem silly, but how much would be a serving?
    AND  Is coconut really OK, I have read that most of the concern was with Hydrogenated processed coconut oil, not  organic?     How much is ok per day if eating coconut oil?

  • Lindas

    12/1/2011 7:00:13 PM |

    Sorry for being SO serious about chocolate...in the comment above....but just wondered!

  • Geoffrey Levens

    12/1/2011 7:04:26 PM |

    "Actually Truvia is stevia and erythritol (not sure of that spelling) and it is a sugar alcohol that has very little if any impact on blood sugar and consequently insulin."

    I am pretty sure that ANY sweet taste, including zero calories stevia and the nasty chem ones will all provoke an insulin response. Here's one study to that effect

    http://www.ncbi.nlm.nih.gov/pubmed/20619074
    Br J Nutr. 2010 Nov;104(10):1415-20. Epub 2010 Jul 12.
    Sweet-taste receptors, low-energy sweeteners, glucose absorption and insulin release.
    Renwick AG, Molinary SV.

  • Laura

    12/2/2011 1:10:00 AM |

    Geoffrey
    That most likely is an accurate observation.  I know that if I indulge in too much no-calorie sweetened food (even if very low carb) it can stall my weight loss.  An occassional indulgence or a little sweetner in my coffee with real cream in the morning doesn't seem to be a problem.  
    My BS doesn't seem to change but if that is because the insulin is kicking in that would explain the problem.

  • STG

    12/2/2011 3:09:00 AM |

    This chocolate sounds great! However, I found when I was eating dark chocolate my HbA1c was too high. Also, a little chocolate was good but more was better (carb creep). Since I have restricted fruit, eliminated "safe carbs" (e.g., potatoes and sweet potatoes) and eliminated dark chocolate, I have my HBA1c in a normal range.  For me that has meant retraining my relationship with food and not seeking out sweetness. At this point in time, almonds and plain cocoa powder actually taste sweet to me. I don't want to set-off the sweet cravings, so it is best for me to avoid anything sweet. That said, I am sure many of you can eat this chocolate with joy and health--go for it!

  • Jeanne

    12/3/2011 4:04:49 PM |

    This is the first time I've made anything like this, and it was wonderful. I used macadamina nuts, instead.

  • SkyKing

    12/5/2011 1:52:47 AM |

    Dr. Mercola advises to avoid Truvia and Purevia brands since they've undergone a ton of processing.

    I personally prefer to use the NuStevia brand.

  • Hans Keer

    12/5/2011 4:42:30 PM |

    Beware of the negative effects of theobromine in chocolate doc.

  • Dr. William Davis

    12/6/2011 5:22:39 PM |

    Eat all you want, Lindas, of the non-hydrogenated organic coconut oil and dark chocolate.

  • Dr. William Davis

    12/6/2011 5:23:47 PM |

    Yes, agreed. But I am skeptical that, with removal of wheat and limiting other carbohydrates, followed by substantial weight loss and return to ideal weight, that it has much practical significance.

  • Allison

    12/10/2011 11:10:25 PM |

    Do you mean unsweetened cocoa powder or do you mean unsweetened chocolate?  How do you melt cocoa powder?  I'm confused.

  • Dr. William Davis

    12/14/2011 2:51:37 AM |

    Sorry for the confusion, Allison. 100% chocolate or unsweetened baking chocolate, not the powder.

  • Al

    1/17/2012 6:27:21 PM |

    Can one use undutched cocoa powder, such as hershey's, and dissolve in the melted coconut oil? Is it ok to add some good quality 2x vanilla, and cinnamon to it? If the cocoa powder is ok to use, is the quantity the same as the baking chocolate of 8 oz?

  • Rmm0117

    2/4/2012 9:05:41 PM |

    What amount of sweetener?

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