Monthly Archives: April 2012

Caesar Salad

Caesar Salad was the invention of Caesar Cardini, an Italian-American restaurateur, who claimed to have created the first Caesar salad when his kitchen ran out of supplies on Fourth of July 1924. Wikipedia lists the traditional ingredients:

A Caesar salad is a salad of romaine lettuce and croutons dressed with parmesan cheese, lemon juice, olive oil, egg, Worcestershire sauce, garlic, and black pepper.

We used 2 egg yolks, ¼ cup olive oil, 1 tsp Thai fish sauce, 2 cloves garlic, juice of one lemon, and Dijon mustard.

You’ll also need lettuce and grated cheese. The classic ingredient is Parmigiano Reggiano (Parmesan) cheese, but we like Pecorino Romano as an alternative flavor.

Mix the ingredients in a bowl and add salt and pepper:

You can add some finely grated cheese to the sauce at this stage too.

Slice up one or two heads of romaine lettuce, mix the sauce over it, and top with grated cheese:

To make it an entrée, add beef slices or calamari with chopped nuts:

It’s extremely easy to make, and quite tasty!

Are Low Doses of Niacin Dangerous?

In Food Fortification: A Risky Experiment?, Mar 23, 2012, we began looking at the possibility that fortification of food, especially the enriched flours used in commercial baked goods, with niacin, iron, and folic acid may have contributed to the obesity and diabetes epidemics.

As this plot shows, fortification caused intake of per capita niacin intake in the United States to rise from about 20 mg/day to about 32 mg/day:

Multivitamins typically contain about 20 mg niacin, so (a) a typical American taking a multivitamin is getting 52 mg/day niacin, and (b) if the increase of 12 mg/day due to fortification is dangerous, then taking a multivitamin would be problematic too.

There wasn’t evidence of niacin deficiency at 20 mg/day. The RDA was set at 16 mg/day for men and 14 mg/day, levels that equalize intake with urinary excretion of niacin metabolites [source: Dietary Reference Intakes]. Fortification of grains with niacin was designed to make refined white wheat have the same niacin content as whole wheat, not to rectify any demonstrated deficiency of niacin.

B-vitamins are normally considered to have low risk for toxicity, since they are water soluble and easily excreted. But recently, scientists from Dalian University in China proposed that niacin fortification may have contributed to the obesity and diabetes epidemics. [1] [2]

Niacin, Oxidative Stress, and Glucose Regulation

The Chinese researchers note that niacin affects both appetite and glucose metabolism:

[N]iacin is a potent stimulator of appetite and niacin deficiency may lead to appetite loss [10]. Moreover, large doses of niacin have long been known to impair glucose tolerance [23,24], induce insulin resistance and enhance insulin release [25,26].

They propose that niacin’s putative negative effects may be mediated by oxidative stress, perhaps compounded by poor niacin metabolism:

Our recent study found that oxidative stress may mediate excess nicotinamide-induced insulin resistance, and that type 2 diabetic subjects have a slow detoxification of nicotinamide. These observations suggested that type 2 diabetes may be the outcome of the association of high niacin intake and the relative low detoxification of niacin of the body [27].

The effect of niacin on glucose metabolism is visible in this experiment. Subjects were given an oral glucose tolerance test of 75 g glucose with or without 300 mg nicotinamide. [1, figure source]

Dark circles are from the OGTT with niacinamide, open circles without. Plasma hydrogen peroxide levels, a marker of oxidative stress, and insulin levels were higher in the niacinamide group. Serum glucose was initially slightly higher in the niacinamide group, but by 3 hr had dropped significantly, to the point of hypoglycemia in two subjects:

Two of the five subjects in NM-OGTT had reactive hypoglycemia symptoms (i.e. sweating, dizziness, faintness, palpitation and intense hunger) with blood glucose levels below 3.6 mmol/L [64 mg/dl]. In contrast, no subjects had reactive hypoglycemic symptoms during C-OGTT. [1]

Of course 300 mg is a ten-fold higher niacinamide dose than most people obtain from food, but perhaps chronic intake of 32 mg/day (52 mg/day with a multivitamin) daily over a period of years have similar cumulative effects on glucose tolerance as a one-time dose of 300 mg.

Is There a Correlation with Obesity?

OK. Is there an observable relationship between niacin intake and obesity or diabetes?

There may be, but only with a substantial lag. Here is a figure that illustrates the possible connection [2, figure source]:

Niacin intake maps onto obesity rates with a 10-year lag. After niacin intake rose, obesity rates rose 10 years later. Note the scaling: a 60% increase in niacin intake was associated with a doubling of obesity rates 10 years later.

Obesity leads diabetes by about 15 years, so we could also get a strong correlation between niacin intake and diabetes incidence 25 years later. The scaling in this case would be a 35% increase in niacin associated with a 140% increase in diabetes prevalence after a lag of 25 years.

How seriously should we take this? As evidence, it’s extremely weak. There was a one-time increase in niacin intake at the time of fortification. A long time later, there was an increase in obesity, and long after that, an increase in diabetes. So we really have only 3 events, and given the long lag times between them, the association between the events is highly likely to be attributable to chance.

It was to emphasize the potential for false correlations that I put the stork post up on April 1 (Theory of the Stork: New Evidence, April 1, 2012). Just because two data series can be made to line up, with appropriate scaling of the vertical axis and lagging of the horizontal axis, doesn’t mean there is causation involved.

Is There Counter-Evidence?


If niacin from wheat fortification is sufficient to cause obesity or diabetes, with an average intake of 12 mg/day, then presumably the 20 mg of niacin in multivitamins would also cause obesity or diabetes.

So we should expect obesity and diabetes incidence to be higher in long-time users of multivitamins or B-complex vitamins.

But in fact, people who take multivitamins or B-complex vitamins have a lower subsequent incidence of obesity and diabetes.

One place we can see this is in the Iowa Women’s Health Study, discussed in a previous post (Around the Web; The Case of the Killer Vitamins, Oct 15, 2011). In that post I looked at a study analysis which was highly biased against vitamin supplements; the authors chose to do 11-factor and 16-factor adjustments designed to make supplements look bad. The worst part of the analysis, from my point of view, was using obesity and diabetes as adjustment factors in the regression analysis. As you can see in the table below, multivariable adjustment including obesity and diabetes significantly raises the mortality associated with consumption of multivitamins or B-complex supplements:

This increase in hazard ratios (“HR”) with adjustment for obesity and diabetes almost certainly indicates that the supplements reduce the incidence of these diseases.

Multivitamins are protective in other studies too. The relation between multivitamin use and subsequent incidence of obesity was specifically analyzed in the Quebec Family Study, which found that “nonconsumption of multivitamin and dietary supplements … [was] significantly associated with overweight and obesity in the cross-sectional sample.” [3]

Does this exculpate niacin supplementation? I don’t think so. In general, improved nutrition should reduce appetite, since the point of eating is to obtain nutrients. So it’s no surprise that multivitamin use reduces obesity incidence. But multivitamins contain many nutrients, and it could be that benefits from the other nutrients are concealing long-term harms from the niacin.


At this point I think the evidence against niacin is too weak to convict in a court of law.

Nevertheless, we do have:

  • Clear evidence that high-dose (300 mg) niacinamide causes oxidative stress and impaired glucose tolerance. If niacinamide can raise levels of peroxide in the blood, what is it doing at mitochondria?
  • No clear evidence for benefits from niacin fortification or supplementation.

Personally I see no clear evidence that niacin supplementation, even at the doses in a multivitamin, is likely to be beneficial. Along with other and stronger considerations, this is pushing me away from multivitamin use and toward supplementation of specific individual micronutrients whose healthfulness is better attested.

I also think that food fortification was a risky experiment with the American people, and stands as yet another reason to avoid eating grains and grain products. (And to rinse white rice before cooking, to remove the enrichment mixture.)


[1] Li D et al. Chronic niacin overload may be involved in the increased prevalence of obesity in US children. World J Gastroenterol. 2010 May 21;16(19):2378-87.

[2] Zhou SS et al. B-vitamin consumption and the prevalence of diabetes and obesity among the US adults: population based ecological study. BMC Public Health. 2010 Dec 2;10:746.

[3] Chaput JP et al. Risk factors for adult overweight and obesity in the Quebec Family Study: have we been barking up the wrong tree? Obesity (Silver Spring). 2009 Oct;17(10):1964-70.

Around the Web; Controversies Over Rice, Meat, and Warmth Edition

[1] Success Stories: Thanks so much to everyone who reports their results on the blog. Here are a few recent reports:

Matt, an amateur bodybuilder, reports success on PHD: “I’m getting leaner and my muscles are developing better. What’s really surprising is that my calorie intake is higher and I’m losing fat mass!!”

Robin reports that rice cured her constipation.

Karin reports that the ketogenic variant of our diet has cured migraines and other problems:

I’ve been on the keto diet for nearly a month and it is the best thing that has happened to me. I’m migraine free and medication free. My mood is incredibly stable, I fall asleep quickly and stay asleep all night, I have lots of energy, I can concentrate for hours on end, etc. I’ve lost weight also, a much loved side effect. Thank you for writing this!

Brian reports rapid progress against his diabetes.

Jeanie Graham Campbell on Facebook: “My husband is doing fabulously on the PHD…. I felt great. Once I get down to where I want to be (another 7 or so pounds), I’ll be rockin’ the PHD!!!”

Meanwhile, it’s not exactly a testimonial, but I want it known that “Super Newell” Wright can run down young criminals and retrieve stolen computers while carrying a 50 pound suitcase.

[2] Music to Read By: Levon Helm, drummer and singer for The Band, passed away last week. Here they were at Woodstock:

Here’s Levon singing “The Last Waltz”:

And one more for the road:

[3] Interesting posts since our last Around the Web:

Toxoplasma infection is a major cause of birth defects. Treatment of pregnant mothers improves the health of their babies.

Laura Schoenfeld reviews the people of PaleoFX – and the real stars.

Via Dr. Jay Wortman, two attempts to explain why Asian rice eaters are thin on 70% carb diets: Peter Attia and Andreas Eenfeldt offer three and six reasons respectively. I half-agree with half their reasons, but the comments on Dr. Eenfeldt’s post held the most interest. Is Robert Lustig the new Ancel Keys?

Paleo for Powerlifters discusses the benefits of rice consumption.

Paleo has become too limiting for Richard Nikoley. Jack Kruse is also progressing beyond Paleo: in his talk at TEDx Nashville (video not yet online) he reported self-injecting with MRSA. If you find Jack’s posts too long, you’re in luck: one of his fans is putting Jack’s best lines up on Twitter.

“Only Dave Asprey would come back from a Cloud Computing conference with frostbite.” A Paleo conference is the place for that … Keith Norris had a nice post on cold exposure, and Kamal Patel (in comments) reminds us, “What killed the dinosaurs?” Elsewhere, Kamal makes a case for Fire Perspirogenesis.

Melissa McEwen recorded a podcast, and it’s got “nude” in the title. It’s got “sauna” too, so maybe there’s something about Fire Perspirogenesis.

Pal Jabekk quotes Tristram Shandy.

Mark Sisson discusses 5 common nutrient deficiencies. Adam Bornstein of references Mark, Martin Berkhan, and Brad Pilon in explaining why he has taken up intermittent fasting.

Red wine turns materials into superconductors. (Via Instapundit) Might be a good beverage to consume while earthing.

Dr Briffa thinks earthing may work. I actually bought an earthing mat and put it under my keyboard so that my hands rest on it as I work, but haven’t noticed any effect.

Jimmy Moore has started experimenting with carbohydrates. He tried half a sweet potato per day, mashed with 3 tbsp butter and 1 tbsp honey or stevia, and found that his blood sugar was under control, but he gained a bit of weight.

Scroll down to read how CarbSane imagines the safe starches panel at AHS 2012 will go.

Carl Zimmer in the New York Times discusses a growing sense among scientists that science itself is getting dysfunctional.

That paper on plant microRNAs affecting gene expression in the liver is being questioned. No surprise there.

Don’t tell Ray Peat: Women who drink two cups of sugary soda per day are 37% less likely to become pregnant than women who drink two cups of tea a day. And a New Zealand woman died of a Coca-Cola overdose.

Don Matesz poses the “panda paradox”: Pandas didn’t evolve to eat bamboo but can survive on it. The inference, I guess, is that humans didn’t evolve to eat vegan but we might survive on it.

Via J Stanton, green tea may inhibit hepatitis C virus infection.

Matt Metzgar: what does chocolate have to tell us about food reward theory?

Wired wonders: if there are probiotic viruses, maybe we don’t want antiviral drugs.

Cogito Ergo Edo discusses the Leptin Marketing Miracle.

In the comments, André Risnes offered a corollary to Ewald’s hypothesis.

New Zealand confronts Marmageddon.

Via Newmark’s Door, why do children wet their beds? Constipation! Try giving them magnesium.

Is bee colony collapse disorder due to a corn pesticide in the high-fructose corn syrup that bee farmers have been giving their bees?

Chris Kresser discuss how stress upsets your gut. Chris has a terrific series on salt: this post has the meat of the matter.

Walter Willett defends that red meat study. But Prof Dr Andro says red meat is good for rats. Michael Greger reports that muscle meat is only about 10% of fast food chain burgers; the rest is “waste and by-products including connective tissue, nerve tissue, cartilage, bone, and in a quarter of the samples, Sarcocystis parasites.”

In our book we emphasized that, after processing by the digestive tract, all mammals eat high fat diets. Miki Ben Dor follows this line of thought in his analysis of the diet of chimpanzees.

Dr BG is back! With a major demything.

Jim Stogdill of O’Reilly Radar has started the Perfect Health Diet. Fit Element has had good results:

From my personal experience over the last few weeks adding back more of the safe starches have given me better energy than just eating vegetables alone as the only carb intake in a day. I’m no longer suffering from tremendous DOMS (delayed onset muscle soreness) and the recovery is quicker. I have lots of energy to do daily tasks and be quite active otherwise. And not to mention that I sleep so much better! Even more muscle definition is coming along in difficult areas such as thighs.

Yoni Freedhoff has the secrets to a happy marriage.

Via Tyler Cowen, the US government is stifling a breakthrough innovation: Tacocopters.

[4] In honor of our friends at Psychology Today:

[5] A culinary color wheel: From Nicole Kosek Caulfield, via Shari Bambino:

[6] Not the weekly video: Rocky’s speech to his son in kinetic typography:

Via Tony Federico. Original speech here.

[7] Shou-Ching’s Photo Art:

[8] Weekly video: The Great Bell Chant:

The Great Bell Chant (The End of Suffering) from R Smittenaar on Vimeo.

Slow Posting

I have a few urgent work deliverables, plus taxes, and haven’t had a chance to finish a blog post.

Even animals are disappointed in me (via Kamal Patel):

This sloth kind of feels like you should update your blog more frequently.

This baby bear is frankly shocked that you missed that deadline. Shocked.

At least I can always count on the Corgi!