Happy Mother’s Day!

Posted by on May 13, 2012 2 comments

Our New Book With Scribner’s; and PaleoFX DVDs

Posted by on May 12, 2012 76 comments

I have good news. We are going to be doing a new edition of our book with Scribner’s.

Last winter, Shou-Ching and I began exploring publishing options. We want to make a very professional cookbook; that project is very dear to Shou-Ching’s heart, and I am very excited about it too. It will be a “gourmet Paleo” home cookbook: delicious food that is extremely healthy, but can be made at home in 30 minutes or less. Recipes will draw upon cuisines from around the world.

Given the design and formatting issues associated with cookbooks, and the cost of printing in color, we began exploring the possibility of working with a major New York publisher.

At the same time, Scribner, one of the most prestigious New York imprints (home to Ernest Hemingway, F. Scott Fitzgerald, Kurt Vonnegut, Stephen King, Robert Heinlein, Thomas Wolfe, George Santayana, Edith Wharton, and many other great writers), decided to start a diet and health line. They wanted to have a Paleo book, and contacted us to see if we would produce for them a revised edition of Perfect Health Diet.

Well, long story short, we’ve reached an agreement; I’m reviewing the contracts today and we expect to sign them this weekend.

The new edition will be released in December this year, with prominent placement in bookstores in January. Scribner’s wants the new edition to have more of a weight loss focus: the tentative subtitle is Regain Health and Lose Weight By Eating the Way You Were Meant to Eat. The cookbook will likely be released a year later, around the end of 2013.

There is good news for foreign readers. Scribner’s has bought worldwide translation rights and foreign language editions will probably begin appearing in 2013. A Hungarian language version of the current edition is expected from Jaffa Publishers later this year.

We are extremely excited about the opportunity to work with Scribner’s. We see this as a tremendous opportunity to help bring Paleo, and the many health improvements that come with a Paleo diet, into the mainstream.

Given the timelines Scribner’s works under, the new manuscript has to be completed in June. This is an extremely tight deadline. We had plans for significant changes to the book in our second edition, and also plans for a separate book on obesity and weight loss. Weaving that material into the new Scribner’s edition, while also making the book more accessible to a popular audience but not lengthening it, is a big task.

In order to produce the best possible book by the June deadline, I need to focus my energies solely on writing. Until the manuscript is complete, therefore, I will probably do little or no blogging.

I do have one request. We would like to sprinkle “reader success stories” through the manuscript. If you’ve had success eating our diet, and haven’t left your story on the Reader Results page, please consider doing so. If we do use your story, I will contact you for permission and perhaps for edits or further information.

Thank you so much for your support. Publishing the original edition of Perfect Health Diet has been great fun, and we hope for even more excitement when the new edition comes out.

PaleoFX DVDs

PaleoFX has compiled a DVD set of the entire conference. The video is of extremely high quality, as you can tell by the highlight video below. The complete DVD set costs $197 before June 1, $247 after.

Keith and Michelle Norris did a tremendous amount of work organizing a great conference. To date, they have lost money, but hope to break even with good DVD sales. If you’d like to support Paleo gatherings, and see what you missed, this is a great opportunity to get professional-quality videos of your favorite Paleo speakers.

Caesar Salad

Posted by on April 29, 2012 31 comments

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?

Posted by on April 25, 2012 109 comments

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?

Yes.

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.

Conclusion

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.)

References

[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. http://pmid.us/20480523.

[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. http://pmid.us/21126339.

[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. http://pmid.us/19360005.