If you take niacin, you must exercise

We use a lot of niacin in the Track Your Plaque program.

Niacin:

--Increases HDL and shifts HDL towards the large, protective fraction

--Reduces small LDL--In fact, niacin is the best treatment we have to reduce small LDL after wheat elimination and carbohydrate reduction.

--Reduces fasting and postprandial (after-eating) triglycerides

--Reduces heart attack risk by 20-28%--even as a sole agent.


But . . . niacin also triggers higher blood sugar because it partially blocks the effects of insulin (insulin "resistance").

While the net effect of niacin remains positive, the provocation of insulin resistance is not such a good thing. Can it be minimized or eliminated?

Yes, through exercise. Here's one interesting observation in obese (BMI 34.0), sedentary men given placebo, exercise, niacin (1500 mg Niaspan, once per day), or niacin + exercise:





From Plaisance et al 2008.

Blood was drawn following a high-fat meal challenge. (Yes, a high-fat challenge, not a carbohydrate challenge. In this study, there were only 17 grams carbohydrates in the test meal, but 100 grams fat. More on this in future.) Exercise consisted of walking for 50 minutes at a moderate pace one hour prior to the meal challenge.

You can see from the graph that exercise partially corrected the increased insulin level provoked by niacin.

Judging from this and other studies, exercise can help minimize the insulin-blocking effects of niacin. It doesn't take much, just moderate exercise for at least 30 minutes.

Adequate sleep can also help, since sleep deprivation is a potent trigger for insulin resistance, only worsened in the presence of niacin. Vitamin D supplementation to achieve desirable blood levels (which I define as 60-70 ng/ml) is also an effective means to minimize this effect.

Comments (23) -

  • karl

    12/29/2009 11:16:55 PM |

    What about adding P-5-P to the Niacin?

    I've heard things about cinnamon lowering Blood sugar, but I'm not convinced.

  • Grandma S.

    12/30/2009 1:59:12 PM |

    Thank you for posting this.  I am exercising everyday sometimes twice a day to equal 45-60 minutes and see some help with the glucose level.  My LDLs continue to be around 100 and my Dr. wants to increase the Niacin.  Will that help?  It's a fine line, keep the sugars down and get the LDLs down. I appreciate your blog!

  • Renrew

    12/30/2009 2:42:42 PM |

    Cinnamon does reduce blood sugar but the effect is minimal, even at higher doses.

  • Adolfo David

    12/30/2009 3:06:07 PM |

    About Karl comment, you can add many supplements to niacin to counteract this effect. Chromium, resveratrol, standarized cinnamon, green tea extract... Life Extension has launched a niacin with quercetin for example (but now out of stock).

  • Nigel Kinbrum BSc(Hons)Eng

    12/30/2009 3:19:47 PM |

    Would reducing sugary/starchy carbohydrate intake be an effective way to reduce hyperglycaemia?

  • Anonymous

    12/30/2009 10:00:47 PM |

    Thanks for posting Dr. Davis.

    Is splitting 1500 mg of Niacin to two 750mg doses,one in morning, one in evening ok?
    Or should  the 1500 be taken all at once?

  • Anonymous

    12/31/2009 1:13:38 AM |

    Both times I started Niacin, I developed Gout.
    The second time I cut the tablets in half hoping to avoid another bout but still, Gout in a different joint.

  • Mark

    12/31/2009 4:56:24 AM |

    It has been my experience that over time (2-3 Months)the Slo-Niacin I use has less effects on raising blood glucose levels like it does at the onset. It is well advised that everyone should get in the exercise regardless of niacin intake.

  • Boris

    1/1/2010 3:48:15 PM |

    I took 500mg of Niacin every day to get my HDL up. Plus, there was niacin in my multivitamin. My HDL didn't go up at all. I exercise plenty too. All I got out of it were a few itchy flushes that made my ears feel clogged. I'm going to finish my bottle of Slo-Niacin and try a red yeast rice that was tested by Consumerlab.com.

  • Anonymous

    1/1/2010 8:29:23 PM |

    Regarding splitting the dose of Niacin.  I am pretty sure I have seen a post from Dr.D saying to take all at once.  

    I used to split my dose. I thought I was being smart by distributing the Niacin over the day.  My local pharmacist told me not to split the dose because of impacts to Liver function.

  • Anonymous

    1/2/2010 2:10:06 PM |

    I avoid sustained release niacin.

    I get around 80 mg niacin per day in a multivitamin and don't want to add extra.

    http://www.lef.org/LEFCMS/aspx/PrintVersionMagic.aspx?CmsID=114620

    pomegranate...

    Despite the patients’ advanced atherosclerosis, ingesting pomegranate juice produced statistically significant reductions in the thickness of their carotid artery walls, which is correlated with decreased risk for heart attack and stroke. After only three months, the average thickness declined by 13%, and after 12 months, the thickness dropped 35% compared to baseline. During this same 12-month period, the average carotid artery thickness of the placebo group increased by 9%.

  • Anonymous

    1/2/2010 2:39:54 PM |

    Thank you so much for posting this!  I have bee na niacin devotee for about 15 years, and wanted to get my LDL back up after a dx of T2D (with Antibodies) ... and having my niacin "taken away" by my internist.  MY Endo put me back on a lower dose of slo-niacin ... exercise is helping but I may need to up my anti-IR meds.

  • Anonymous

    1/4/2010 4:14:05 AM |

    When is the best time to take niacin?

    morning or night?

    before or after exercise or meals?

  • Dr. William Davis

    1/4/2010 11:27:02 PM |

    We've had best results dosing niacin with dinner or the largest meal of the day.

  • Anonymous

    1/12/2010 2:37:54 PM |

    Dr.Davis

    Just asking this again, could you could please help me out.

    Is splitting 1500 mg of Niacin to two 750mg doses,one in morning, one in evening ok?
    Or should the 1500 be taken all at once?

  • Anonymous

    3/19/2010 4:24:19 PM |

    I had a terrible time with Niacin and insulin resistance.

    I tried exercising but to keep my BG down, I would have to exercise 3 or 4 times a DAY, which is simply not feasible.  Oh, and I am a low-caber, too.

    I would exercise extreme caution in starting to use this, with any Diabetes. (I am a T1.5).

  • lnoonan

    5/19/2010 4:14:15 PM |

    Dr Davis,

    What kind of exercise would you recommend for a Senior lady who is handicapped?  It is difficult for her to do any exercise, so do you know of something she would be able to do while she is taking niacin?  Or, would it be better for her to stop the niacin since exercise is difficult and try other supplements?  Thanks for your help.

  • Anonymous

    5/27/2010 5:00:58 AM |

    Assuming your recommended Slo-niacin...is it better to split your doses up (500 mg morning and 500 mg at night) or take all 1000mg at once? If its better to take all at once is night or morning better?

  • kimberly

    8/11/2010 5:57:09 PM |

    I love to practice exercise, i think this activity is the best option to keep our total welfare and it is very fun. When we exercise frequently we can notice a change not only in our shape but in our mood too. Actually we can improve our sexual performance. When some cases when the erectil dysfunction present like a problem  to buy viagra is a great alternative, how ever you must to combine it with exercises and a good feed.

  • buy jeans

    11/4/2010 5:11:30 PM |

    While the net effect of niacin remains positive, the provocation of insulin resistance is not such a good thing. Can it be minimized or eliminated?

  • Anonymous

    12/15/2010 1:49:29 PM |

    Taking niacin before vigorous exercise has one benefit for me.  The flusing is minimized or even eliminated.

    I've seen different recommendations for dosing frequency.  Three times a day is the "standard" dosing regimen.  However, when I haved switched to three times a day dosing, I have experienced elevated liver enzymes.  I've never had a problem with twice a day dosing.

  • bob

    2/7/2011 4:55:57 AM |

    I am not aware of any data to support 24% risk reduction for MI with the use of Niacin, can you provide citations?

    Primary or secondary prevention?

    Bob Hansen MD

  • John

    6/2/2011 5:01:34 PM |

    Cinnamon doesn't lower blood sugar per se.  The apparent mechanism occurring here is a slowing down of carbohydrate absorption in the gut.  The mechanism is believed to involve a class of molecules known as flavonoids, which either reversibly compete for the glucose receptor or have their own receptor on the GLUT 2 (glucose transport 2) protein.  This action only slows down the absorption of carbohydrates, but all (that's 100%) sugar is absorbed into the body.  It is the only thing you intake that is absorbed 100% and it doesn't matter if it's glucose, sucrose, fructose, or a complex carb.  Anywho, not that I want to debate the finer points of carbohydrate biochemistry.  For more on flavonoids and GLUT2 you can look up this paper (Kwon O., Eck P., Chen S., Corpe C., Lee J-h., Kruhlak M., Levine M. (2007) Inhibition of the intestinal glucose transporter GLUT 2 by flavonoids. FASEB Journal 21, 366-77.).

Loading
Plant-based or animal-based?

Plant-based or animal-based?

The ideal diet for heart and overall health restricts carbohydrate intake. I say this because carbohydrates:

Make you fat--Carbohydrates increase visceral fat, in particular.
Increase triglycerides
Reduce HDL
Increase small LDL particles
Increase glycation of LDL
Increase blood pressure
Increase c-reactive protein


Reducing carbohydrates reverses all the above.

But here's a common mistake many people make when following a low-carbohydrate diet: Converting to a low-carb, high-animal product diet.

It accounts for a breakfast of a 3-egg omelette with cheese and butter, 4 strips of bacon, 2 sausages, cream in coffee. Low-carb? It certainly is. But it is a purely high-animal product, no-plant-based meal.

I believe a strong argument can be made that a low-carbohydrate but plant-based diet with animal products as the side dish is a better way to go.

Consider that:

1) Animal products have little to no fiber, while plant-based products like spinach, avocado, and walnuts and other raw nuts have substantial quantities.

2) Plant products are a source of polyphenols and flavonoids--This encompasses a large universe of nutrients, from epigallocatechins in tea, polymeric procyanidins from cocoa, to hydroxytyrosol from olives, and anthocyanins from red wine and eggplant. The inflow of these beneficial compounds needs to be frequent and generous, not piddly amounts taken infrequently.

3) Vitamin C--While it's easy to obtain, the fact that you and I need to obtain vitamin C from frequent ingestion of plant sources suggests that humans were meant to eat lots of plants. While it may require a few months of deficiency before your teeth fall out, imagine what low-grade deficiency can do over a long period.

4) Vitamin K1--Rich in green vegetables, vitamin K1 is virtually absent in animal products.

5) Tocotrienols--I've been watching the data on this fascinating family of powerful oil-soluble antioxidants unfold for 20 years. Tocotrienols come only from plants. (I recently had an extended conversation with the brilliant biochemist, Dr. Barrie Tan, who is incredibly knowledgeable about tocotrienols, having developed several methods of extraction from plants, including his discovery of the highly concentrated source, annatto. Be sure to watch for future conversations about tocotrienols.)

6) Meats and dairy yield a net acid load--While plant foods are net basic. At the very least, this yields risk for osteoporosis, since acids are ultimately buffered by basic calcium salts from the bones. Tissue and blood pH is a tightly regulated system; veering off just a teensy-weensy bit from the normal pH of 7.4 to an acidic pH of, say, 7.2, leads to . . . death. In short, pH control is very important. A net acid challenge from animal products is a lot like drinking carbonated soda, a huge acid challenge that leads to osteoporosis and other health issues.

Conversely, a pure plant-based diet has its own set of problems. Eating a pure plant-based diet can lead to deficiencies of vitamin B12, omega-3 fatty acids (no, linolenic acid from flaxseed will NOT cut it), vitamin K2, carnitine, and coenzyme Q10.

So, rather than a breakfast of 3-egg omelet with bacon, sausage, cream, and cheese, how about a handful of pecans, some blueberries, and a 2-egg omelet made with basil-olive oil pesto? Or a spinach salad with walnuts, feta cheese, and lots of olive oil?

Comments (78) -

  • Jezwyn

    4/19/2010 12:02:43 AM |

    Really? You're trotting out the anti-carnivore rant again?
    Would you like to back up your claim that we somehow need fibre?
    Or polyphenols and flavonoids, and tocotrienols, in the absence of the oxidised situations they counter?
    Do you consider that Vitamin C is absorbed better when dietary glucose is minimised, as the two require the same uptake system and glucose will hog that system if it's present?
    If we need Vitamin K1, why didn't the Inuit suffer debilitating deficiencies?
    Why didn't they die young of bone fragility if their blood pH was truly so dangerously affected by acid load?

    It seems like your ideas here are based on unproven theories, not practical, clinical scientific demonstrations. If you'd like to link to studies demonstrating how individuals following a carnivorous diet (preferably one based on pastured, wild animals) suffer in the manner you've outlined, I'd love to read them.

    I really respect your blog and your efforts with helping your patients find lifestyles that work for them, but uninformed, unsupported posts like these are very disappointing.

  • John Phillip

    4/19/2010 1:10:41 AM |

    Absolutely correct, as always.  I switched from the Standard American Diet 5 years ago to a raw, plant based diet of dark green leafy vegetables, nuts, seeds, healthy fats and lean protein... no low carb, highly processed or over cooked meats. Totally eliminated wheat and corn based foods, and especially anything with HFCS. My blood sugar has dropped to below 100 1 and 2 hour post prandial and my A1C is 4.5.  Also, triglycerides are 50 and VAP shows mostly large LDL.  It really works, and I have seen it work for others who have followed the same program.  I write about it at my blog: myoptimalhealthresource.blogspot.com. Having read Dr. Davis for years, I would like to thank him for his spot on information!

  • Mike

    4/19/2010 1:29:43 AM |

    How about crushing a nice 10oz grass fed, organic, free range steak along with that salad, and then the whole debate of plant vs animal debate is moot?

  • Jenny

    4/19/2010 1:29:43 AM |

    It's a myth that eating a high animal protein low carb diet will cause bone loss. Studies do not support this.

    http://www.ncbi.nlm.nih.gov/pubmed/16718399?dopt=Abstract

  • Anonymous

    4/19/2010 2:21:11 AM |

    to include more plant-based options in anyone's diet, this blog post from Chris Masterjohn seems to contradict your 6th point.

    So although I may arch an eyebrow at that point, I still agree that we shouldn't be consuming animal products ad libitum at the expense of plant-based options.

    Randy Watson

  • sr

    4/19/2010 3:57:51 AM |

    Do we really need fiber? I recall a chapter in Taubes' book saying that fiber doesn't do much for you if you're not constipated. And Vilhjalmur Stefansson went for 2 years without eating vegetables and had no problems with scurvy. Apparently anti-nutrients in carbs up our vitamin C requirements. If I recall correctly it uses the same GLUT transporters glucose does.

  • PRIDE MAFIA

    4/19/2010 4:23:35 AM |

    Lots of Carbs and  O-6 in nuts;this is good?

  • Alan

    4/19/2010 4:26:28 AM |

    No thanks.. I'll stick to the eggs meat and cheese and get plenty of Vit C in the process. You absolutely don't need plants in your diet, they aren't magic..

  • Gyan

    4/19/2010 5:35:30 AM |

    Vitamin-C can be supplied by raw green chillies.

    Is Vitamin-K1 required? I thought all vitamin-K1 does is to convert to K2.

    IS Fiber essential? if yes, then in what quantity?

  • Rick

    4/19/2010 5:58:42 AM |

    Dr Davis, Do the plant foods you list in your suggested breakfast menus at the end qualify as low carb?

  • David

    4/19/2010 6:40:59 AM |

    wow, I can just see the pro-animal fat nuts rushing to retort to this one... pardon the pun, but it's like red meat to a caged lion...

  • Ellen

    4/19/2010 9:52:51 AM |

    Actually, it wasn't UNTIL I ate more saturated fat (in the form of butter and coconut oil) that I saw a significant improvement in my HDL. Up until that point it was hovering around 50'ish. It shot up to 80 after incorporating the coconut oil. Unless you would consider coconut oil plant based even though it's mostly saturated fat?

    I sincerely attribute my improved HDL to saturated fat.

  • Torquemada

    4/19/2010 10:09:53 AM |

    but that... but that means we can't use low carb as an excuse to indulge in an orgy of gluttony with bacon, cheese mayo and steak.

  • Joachim

    4/19/2010 10:16:21 AM |

    Do you think eating a balanced plant/animal diet (low-carb) would be sufficient as an everyday diet/lifestyle?

    I've been doing a similar low-carb ketogenic diet the last 4-5 months and never felt better. I'm planning on doing the ketogenic diet again but my doctor and my girlfriend her dietician said that this diet is very bad for the liver and the cardiovascular system.

    The only drawback in my opinion is the lack of fruits in order to stay in keto.

    What's your take on this?

  • SamAbroad

    4/19/2010 11:14:39 AM |

    Oops, forgot to include the link to the paper:

    http://www.ajcn.org/cgi/content/full/71/3/682

  • Vlado

    4/19/2010 11:21:02 AM |

    I am on a fish diet where 50% of my calories are coming from it(wild salmon) and have finally gained an ideal weight but i also eat some fruits and dark chocolate as well.There is a lot to be said about acidity factor which means that we are meant to eat both heavy and light foods to balance. The most important omission from diet would be grains , processed foods and vegetable oils.

  • LeonRover

    4/19/2010 11:47:37 AM |

    I thought that one of the observations that explorer Steffansson made on the health of his Inuit hosts was the lack of scurvy in the settlement.

    I also believe that in the absence of plant food,it has been concluded that meat can supply sufficient Vitamin C to prevent scurvy.

    It seems to me that to conclude " that humans were meant to eat lots of plants" is a conclusion too far.

    I suggest that the "or" in your should not be read as "either/or" but the "logical or" meaning " one or both".

  • Tom M

    4/19/2010 1:29:13 PM |

    Utterly ridiculous suggestion. Regardless of all the details that have been covered by previous posters, do you consider eating modern fruit and vegetables to be 'in tune' with the way we were designed to eat?

    A plant based diet is only possible through modern means, mainly transportation. I'm sure American olive oil is fantastic.

    I really don't think you've thought this through. Where are the calories? Do you drink a pint of walnut oil a day? Keeping carbohydrates and  animal sources down leaves you incredibly limited.

    Lastly, the idea of a 'side dish' of meat is absurd. Picture the scene: Hunter Tom in England kills an Auroch, begins gorging on the bountiful fat surrounding it's kidneys but then remembers: 'oh, better stop, I have boiled nettles awaiting'.

    Get real, kids don't like vegetables for a reason.

  • Anonymous

    4/19/2010 1:41:04 PM |

    With the Inuit argument you should consider whether they consumed the gut contents of the animals they ate.

  • Stargazey

    4/19/2010 2:34:46 PM |

    So by this reasoning we should avoid fruits because of their citric acid content?

  • Gretchen

    4/19/2010 2:36:12 PM |

    Too many people assume that anyone on a LC diet is pigging out out on huge amounts of fatty meats and cheese, with no vegetables. This is simply not true.

    It's like criticizing someone on a low-fat diet by saying they're eating a breakfast consisting of two bowls of cereal, 3 cups of skim milk, 5 pieces of toast, 2 tablespoons of jam, and 3 glasses of OJ.

    If I choose to eat bacon and eggs, I'd have one poached egg with a quarter of a pat of butter, and 1 slice of bacon. Maybe 2.

    In your point 1 you're comparing spinach with meat. Apples and oranges. You need to compare a complete animal- protein-including meal with a complete animal-protein-lacking meal.

    Re point No. 2: you can get vitamin C from uncooked meat. Does this mean we're meant to eat uncooked meat?

    I eat plenty of LC vegetables. I just don't eat an all-vegetable meal because I need protein to stabilize my blood sugar and hold me until the next meal.

    It's very difficult to do a vegetarian LC diet because we need protein, and the usual vegetarian protein sources like beans and rice are too carby. The only exception is tofu, and one cannot live on tofu alone.

  • zach

    4/19/2010 3:05:36 PM |

    I totally disagree. The points on vitamin K and vitamin C are startling- very much at odds with my layman's research. Certain organ meats are sky high in vitamin C. The need for C also goes down on a low sugar diet. Conversion from K1 to the all important K2 is very poor in humans eating a plant based diet. Where is K2 MK4 found? Pastured eggs and dairy, seafood, organ meats, etc.

  • Kevin

    4/19/2010 3:05:36 PM |

    Ah, the voice of reason.  How the hell did you get in here?  

    Stuffing oneself with 5000 calories of fat every day made no sense when I was reading Atkins 15 years ago.  I think we evolved to be able to eat healthily using animal and vegetable sources.  Our modern health problems don't stem from anything more than excesses of everything.  Although it's much harder to ingest excess vegetables compared with meat.  

    kevin

  • Christopher Robbins

    4/19/2010 3:31:42 PM |

    The major problem I see in this recommendation is that without calorically dense, starchy carbs and/or a lot more fat it would be hard to take in enough calories. I can deal with the fat. Even Mark Sisson champions the Big Ass Salad. And Stephan at wholehealthsource has started including more veggies & carbs. I do think animal protein/fat should make up the bulk of the diet though.

  • Ellen

    4/19/2010 4:26:19 PM |

    Yeah, fiber's over-rated. So is olive oil. Olive oil never did *anything* for my lipid profile. Olive oil makes you fat.

  • Anonymous

    4/19/2010 4:44:00 PM |

    People evolves, even to feed on pasta: http://www.visitlimonesulgarda.com/index.asp?menu=13.58

    Thinking we're the same animal that fed on mammoths 10k years ago and that we have to eat that makes little sense.

    Thinking we all would react the same to an inuit diet, having inuits evolved for such a long time to survive where they live eating where they eat, makes no sense.

    There are many people on the planet that live health and diets vary a lot.

    Dr Davids, and anyone else for that matter, can only give pointers, but everyone has to find its own way to health and not expect it to be the same for every one and to be one single real truth.

    We are 6 billion mutants with 6 billion different ideal diets

  • Christine

    4/19/2010 4:46:00 PM |

    Now you're talking my language, Dr. D. Great post! I welcome more like this one. This reader wants to know everything you know on the subject of low carb plants vs high fat meat/dairy.

  • Chris Kresser

    4/19/2010 4:50:51 PM |

    Jezwyn, you took the words right out of my mouth.

    Let's see some proof for these claims.  You'll be hard-pressed to find it.

    Tell the Masai and Inuit that you need a diet high in plant foods to be healthy.

  • Ned Kock

    4/19/2010 4:56:23 PM |

    I tend to believe that a diet with plant AND animal products is at least quasi-optimal, in part for evolutionary reasons:

    http://healthcorrelator.blogspot.com/2010/02/lucy-was-vegetarian-and-sapiens.html

    But on the acid-base blood balance argument, there are a number of other issues to consider:

    - Lack of activity leads to bone demineralization, regardless of what you eat. Astronauts start losing bone mass soon after the start living in zero-gravity.

    - Higher protein intake is associated with higher dietary calcium absorption.

    - Higher serum levels of vitamin D are associated with increased serum calcium levels and bone mineralization. In fact, hypervitaminosis D leads to elevated serum calcium levels, even with low dietary calcium intake.

    - The Inuit, on a traditional diet of animal meat and fat, have among the lowest (if not THE lowest) rates of tooth decay in the world - and bone mineralization is correlated with teeth health (although the correlation is not 1).

  • Alan S David

    4/19/2010 5:03:46 PM |

    You describe my diet to a "t". Low animal products, lots of plant based. Low carb.So at 61, I am told I look in my 40's, rarely ( if ever) suffer from any of the common afflictions, and enjoy robust health. Gotta be something right about all this.
    Confirmed heavy animal products in your diet lead to all sorts of problems. Minimize them and you minimize the problems.

  • Dave, RN

    4/19/2010 6:18:31 PM |

    Aw man, you lose credibility when you publish stuff like this...

  • Anonymous

    4/19/2010 6:42:45 PM |

    I've been on a low carb diet for years, but my health was never so improved as when I finally cut all plant matter out of my diet.

    -Amber

  • schubie

    4/19/2010 7:09:33 PM |

    Is it my imagination or were the previous recommendations when I started reading this blog many months ago more evidenced-based pointing to specific studies, and lately they've been much shorter and more like "statements" of "fact" without any supporting documentation?

    I don't get it.

    Smells like someone's trying to court a little controversy to generate some buzz.

  • Martin Levac

    4/19/2010 7:40:56 PM |

    It's easy to forget the Stefansson all meat trial. It was supposed to answer all those questions and doubts about various deficiencies such as vitamin C or calcium. And it did in my view. So why does doubt still persist to this day?

    If you believe that you should eat plants, then go ahead an eat them. But for a PSA, stick to the facts.

  • Martin Levac

    4/19/2010 8:01:39 PM |

    Sorry, in my haste to bring an argument in favor of an all meat diet, I forgot this argument against a plant based diet.

    Dr Davis, you say "I believe a strong argument can be made that a low-carbohydrate but plant-based diet with animal products as the side dish is a better way to go."

    It's already been weighed and measured and found to be lacking. In comes Ancel Keys and his semi-starvation experiment. It is exactly the kind of diet you propose: Low carb plant-based diet with animal products as the side dish. The result? Emaciation and neurosis. But that was a low calorie diet, you say. And probably lacked many nutrients, you say. Yes and yes. In comes the Biosphere 2 project which tried to fix one of those problems by administering the full RDA in vitamins and minerals every day. The result? Still emaciation and neurosis but admittedly to a lesser extent. Maybe it would work with ample calories?

    I don't think it's merely a question of calories at this point. I think it's partly a question of essential nutrients found only in animal flesh. Or a question of the depleting nature of a high plant diet. In other words, eating a high plant diet requires more of those essential nutrients, including total calories, found only in animal flesh.

  • Anonymous

    4/19/2010 8:16:03 PM |

    Ok. I just found your blog. Now I'm really confused. These two questions I'd like answered:

    -Where do you agree/disagree with Esselstyn?

    -What am I supposed to feed my three year old. He eats oatmeal and fruit for breakfast? (It's supposed to be healthy!)

  • Aaron

    4/19/2010 8:21:16 PM |

    Great post -- and to the vegetable naysayers -- there is more evidence to suggest than not that veggies are a healthy addition one's diet.

    A low carb, non-veggie diet is an experiment -- "if" it turns out to be healthy, more power to it.

    In the mean time -- I'm sticking with the decent epistemological studies out there that support the use of veggies/fruit the diet.

  • pmpctek

    4/19/2010 8:50:19 PM |

    @ John Phillip,

    I accomplished all those milestones, plus my HDL is over 70 mg/dl, all on a heavy carnivore dominant diet. John, you curiously did not divulge your HDL level.

    @ Jenny,

    Agreed.  Myths are hard to kill.  This acid/alkaline theory of disease is clearly a long standing one.  

    Absence of renal and lung disease, the homeostatic mechanisms controlling the pH of our blood are incredibly robust and tightly regulated.  Even if you have poor regulation of bicarbonate concentrations in blood (dialysis patient) or you suffer from chronic respiratory acidosis (hyperventilation) it's not as though eating more plant foods and restricting meat and cheese will at all reverse the acidic condition these more serious underlying disturbances cause.

    Even if meat and cheese yields a heavy acid load, all that may result is slightly more acidic urine.  There is no credible evidence that proves the act of intentionally alkalizing your own urine by dietary restrictions prevents or treats any disease, makes you feel better, or anything else.

  • Scott Miller

    4/19/2010 10:52:37 PM |

    The evolutionary evidence indicates our paleolithic (pre-agriculture) ancestors ate a LOT of meat. It doesn't make any sense that meat is unhealthy to humans.

    And, the present-day evidence supports meat consumption, too.

    In my case, I've been on a ~10% carb diet (mostly salad and vegetable carbs, no grains, very little fruits) for 5+ years. My blood stats are outrageously healthy (at 48 yrs old). HDL = 98, trigs 47, VLDL = 4, C-RP = 0.2. A1c = 4.8.  I can go on and on. I look 10 years younger than I am, my VO2 max is 52 (and I do not do any cardio), bodyfat = 10%, and I have no arterial plaque.

    Sadly, I do not like seafood, so I eat red meat almost exclusively, plus a lot of coconut oil.

    I also take over 40 supplements a day, including K2 (K1 is far less effective, not sure why you like it more, versus the animal version of K), tocotrienols (agree these are amazing), and numerous supps that reduce glycation, inflammation, and brain degeneration.

    BTW, natural fed meats are greatly superior, but even grain fed meats are adequate. And red meat is healthier than chicken meat due to having significantly lower levels of polyunsaturated fatty acids.

  • thania

    4/19/2010 11:15:16 PM |

    I think in something so important as "nutrition", it is not possible to adopt an "one tooth paste menthality". It depends a lot on the environment, climate and hence the gut flora composition of each individual and the digestion issues.

    During the past year of being part of the low-carb, paleo/primal community. I have observed for some people eating plants even in small quantities cause bloating , gut discomfort and eliminating them and a carnivoros diet has almost saved their lives , are much healthier . On the other hand some of the fittest members eat huge amont of animal food + huge amont of plant food.

    As a mediterranean I am very used to eat plant food , and had concerns on eating VLC food due to acid/alkaline balance so did a bone densitometry through my traumatologist, to repeat it after 2 years feb 2010, and comparing the results ; there is a 10% bone density loss! Ofcourse in these 2 years of VLC I did a lot of mistakes with too much processed meat and LC junk foods at the beginning, and was an evolution towards the grass fed meat and realfood. And also the fact that a part from walking , I am quite sedentary too!

    For me never felt right to leave out the plant food so drasticaly when I was doing VLC,I can enjoy a nice juicy beef steak , but with a side of salad or some steamed veg , the joy is even more and feels much better on my guts and the BG levels.

    So is the matter of each personal biochemistry process and many factors influencing it.

    It is a question of indivitual trial and error and listening to ones body needs. Then decide to be carnivoros, VLC, plant based, animal based , paleo or primal.

  • David

    4/20/2010 12:14:26 AM |

    Dr. Davis,

    I'd definitely be interested if you personally see results with any of your patients taken delta gold. I've been taking it a year now. I'm just trusting the small clinical trials, and hope they are legit.

  • Dr. William Davis

    4/20/2010 12:50:56 AM |

    Maasai are plant-eaters as well as meat-eaters.

    Comment from Ethnobotany of the Loita Maasai   about the great "meat-eating Maasai" tribal culture:


    "Animals are kept both for economic reasons
    and as a source of food. Milk from cows, especially
    fermented, is the main traditional food of the
    Maasai. Herbal soup is an important part of the
    diet for most people, men and women alike, but
    especially for the warrior age group. It is taken as
    a health food by ordinary people and as a drug by
    warriors. Meat is usually eaten during ceremonies.
    Wild food, especially fruits, tubers, resins and
    roots, are still important, particularly to women
    and those taking care of animals in the field."

    Full-text here:http://unesdoc.unesco.org/images/0012/001266/126660e.pdf

  • Dr. William Davis

    4/20/2010 12:52:24 AM |

    David--

    As we do not use tocotrienols in the program, we have no formal experience with it.

    However, having had an extended conversation with Dr. Barry Tan, I have to say it is worth looking at again, though my in-depth interest dates back nearly 20 years.

  • Chris Kresser

    4/20/2010 12:52:24 AM |

    The Masai may eat some animal foods, but they certainly aren't a "side dish" as you recommend.

  • Dr. William Davis

    4/20/2010 1:18:04 AM |

    Inuits eat lots of meats, but also eat plants.

    Dr. Weston Price on observing the eating habits of the Inuits during the first 20 years of the 20th century (before substantial Western influence on the Inuit diet took root):

    "The food of these Eskimos in their native state includes caribou, ground nuts which are gathered by mice and stored in caches, kelp which is gathered in season and stored for winter use, berries including cranberries which are preserved by freezing, blossoms of flowers preserved in seal oil, sorrel grass preserved in seal oil, and quantities of frozen fish. Another important food factor consists of the organs of the large animals of the sea, including certain layers of the skin of one of the species of whale, which was found to be very high in vitamin C."

    Organ meats and the fat of cold water creatures are indeed richer in vitamin C than muscle meat that we consume. When is the last time you ate muktuk?

  • Chris Kresser

    4/20/2010 1:19:22 AM |

    Oops, that should have read "The Masai may eat some plant foods, but they certainly aren't a side dish as you suggest."

  • Adolfo David

    4/20/2010 11:46:16 AM |

    I agree with a low carb diet based on animal and vegetal products, but I diagree with a so high fiber diet. See 'Fiber Menace' book, recommended by Weston Price Institute.

  • Helen

    4/20/2010 2:11:43 PM |

    Help for the nut-allergic, please.

  • Adolfo David

    4/20/2010 7:23:12 PM |

    Dr David and all, you have a interesting tocotrienols report in Nutraceutical Magazine september 2009, its about newest tocotrienol supplement formulation, in page 42

    http://www.nutraceuticalmag.com/NBT/pdf/2009/NBT_SO09.pdf

  • Maris

    4/21/2010 2:37:41 PM |

    You're right. so all in all, the key is to balance everything and place more emphasis in eating plant-based foods than animal products, specifically meat. I've tried a low-carb diet upon my doctor's reccomendation due to my hypertension, and although it's not easy at first(coz I'm used to eating lots of carbs), I got used to it after some time.

  • PJ

    4/22/2010 1:48:05 AM |

    You lost me on this one.

  • Marius

    4/22/2010 5:22:24 AM |

    This is getting ridiculous. Carbohydrates are evil and animal products are bad. Yum, I'm looking forward to my dinner of olive oil, carrots and five different types of nuts! The Auschwitz diet, it really works!

    We only became human because our ancestors included increasing amounts of meat and animal fat in their diet, which provided enough energy/EFAs for our brains to grow, which made us more intelligent and able to get even more meat and fat. Had they kept to their plant-based diet, we would still be swinging from the trees.

    That, and cooked tubers. As in, potatoes.

    What you are promoting on this site is anorexia and food phobias.I'm sure eating so little that your heart atrophies is super "heart healthy".

    The article seems to be supported by vegan myths and our modern cultural bias/squeamishness against meat more than scientifically established facts.

  • Cotton Yarn Manufacturer

    4/22/2010 7:55:47 AM |

    Other skins such as those from large animals such as horse and smaller animals such as ... Plant-based parchment: Parchment paper. thanks for sharing the information.

  • Mike Turco

    4/22/2010 4:13:11 PM |

    That is a really interesting line of thought, and plus, I'm an on-and-off reader of your blog and really respect your opinions. I've been on the meat and cheese mostly diet, along with the occasional veggies, nuts, berries, melons, etc. Its a good way to eat, for me, but hey its a boring diet and I've been wanting some change and variety for quite some time. I'm going to take a crack at switching things up for a while, in the way that you are suggesting, and see how that goes for me. I certainly don't see any harm in giving it a shot. I'll comment back at some time in the future, probably on another post, and let you know how it goes. Thanks again for your insight. -- Mike

  • Apolloswabbie

    4/23/2010 2:10:26 AM |

    Jezwyn - were you going to just borrow my thunder or steal it?

    Kidding - I could not have made those points as well or concisely as you did, thanks.

  • Apolloswabbie

    4/23/2010 2:15:42 AM |

    "Thinking we all would react the same to an inuit diet, having inuits evolved for such a long time to survive where they live eating where they eat, makes no sense."
    No, it doesn't, but when it actually happened, euros who lived/ate with the inuit reported more than once that they thrived.  This was tested in a hospital setting and confirmed.  In other words, we've more EVIDENCE that the Inuit diet was not beneficial because they were some genetic mutant - it was beneficial for humans in general.  

    Congnitive dissonance?  only if you've bought the unproved conjectures so rampant in the science of diet.

  • Anonymous

    4/25/2010 2:14:00 PM |

    I think the reaction to this article was predictable. If an atheist tells a person of faith that they are wasting their time with prayer and they should just get on with making the most of this life, very few would expect a capitulation by the religious. IMHO, diet is a lifestyle, like religion, and generally ruled by a hefty dose of emotion.  Having view points out there for people to make up their own minds is terrific.  But in the end we have to decide what we believe in.

    great work Dr. D. stay the course and the debate will be healthy..pun intended.

  • Kevin

    4/25/2010 6:08:13 PM |

    Anonymous said...
    "I think the reaction to this article was predictable. If an atheist tells a person of faith that they are wasting their time with prayer and they should just get on with making the most of this life, very few would expect a capitulation by the religious. IMHO, diet is a lifestyle, like religion, and generally ruled by a hefty dose of emotion. Having view points out there for people to make up their own minds is terrific. But in the end we have to decide what we believe in."

    I agree.  Unfortunately the emotion in any hotbutton issue leads the insecure to spew vitriole which makes it harder to stay connected to the dialogue.

    I'm hoping the doctor continues to espouse his viewpoint here.

  • DrStrange

    4/25/2010 8:24:23 PM |

    Just read thru all the posts and what a hilarious set of temper tantrums!  Since we live in modern times, we can easily supplement K2, D3, and omega 3 (I certainly do on plant based diet)(for omega 3 I take about 200 mg/day of plant source DHA drops).

    There are studies and there are studies and you have to actually read the details to see what they are measuring.  A little more fruits and veg than the crappy SAD, as in the study cited above, will have relatively little benefit though even at the amounts in the study there was a slight benefit.  Many Masai in fact were found to have plenty arteriosclerosis, just huge arteries from much more exercise than you or I will ever do.  Inuit skeletons do show severe osteoporosis and they tended to died young from hard living in a very tough and unforgiving environment.  Look around the rest of the world, aside from Inuit and Masai, all traditional cultures ate very small amounts of animal based foods and mostly plants.

    Personally, my blood sugars postprandial were running 175-200 for several hours. Switched to no animal fat and reduced fat and calories and they would still spike but stay up much shorter duration.  Currently I eat 100% plants, getting about 35% fat from unsalted, raw nuts and around 150-160 grams of carbs per day. Carbs and protein also coming from about 1 1/2 cups beans per day. Protein is about 15% of calories. My postprandial sugars stay under 110 and usually are under 100, even with a little fruit tossed in for dessert...  Everybody has to find their own way but you guys really need to read research more carefully.

  • DrStrange

    4/25/2010 10:29:42 PM |

    I had a doc tell me once he seldom if ever talked diet w/ patients as getting them to change was likely harder than getting them to change their religion!  I think that was cop-out as it is so important but a lot of truth there as well.

  • jandro

    4/27/2010 6:33:52 AM |

    Stefansson's meat only trial is not conclusive, X-rays were use to measure osteoporosis which only detects it once there has been a 30% reduction in bone mass. Obviously, you are not going to lose 30% of bone mass in a year. You can read more about it here: http://donmatesz.blogspot.com/2010/03/paleo-diet-ph-does-it-matter-part-vii.html

    There are also frozen eskimo skeletons that show severe osteoporosis in women that are only 30 years of age.

    Eskimos were pushed to a really extreme environment in which we certainly did not evolve. Why anyone would use their diet as a model diet blows my mind.

    We evolved in East Africa with dry and wet seasons. Warm all year round. It allowed for plenty of vegetation to grow, and for plenty of animals to thrive.  Tribes living in that region have a diet high in both animal and plant products. It's low in fructose and most of the carbs are coming from tubers (yielding a net alkaline effect). Some nuts may be used as well but not to the extent it was used in this post.

  • Martin Levac

    4/27/2010 6:52:18 PM |

    Is there an association between meat consumption and calcium excretion?

    Is there an association between calcium excretion and bone loss?

    Is there an association between meat consumption and bone loss?

  • DrStrange

    4/28/2010 1:05:51 AM |

    Depending on what studies you read, there is an association w/ higher protein intake and bone loss, particularly for animal protein though I think plant too.  Amino acids are acids and need buffering.  If necessary, body will take alkaline minerals from bone to do the job.

  • Contemplationist

    4/28/2010 6:10:17 AM |

    Indeed what about the evolutionary argument that our ancestors survived mostly on animal meat (and its fat) ?

  • Bonnie

    5/2/2010 8:49:36 PM |

    You confuse me.

    Yesterday I ate 4 eggs, a pint of cream, 4 tablespoons of butter, 3 pieces of bacon (with all the rendered fat), about 6 oz of fatty beef steak, and a tin of sardines. I also ate 1 serving of sprouted pumpkin seeds, 1 cup of orange juice, 1 serving of brussels sprouts and 2 servings of spinach. From this I got 97% of DRIs for vitamins and 91% of minerals (I use CRON-O-Meter) in under 2500 calories.  48 grams of carbs.

    I'm not finding it at all difficult to exceed minimums for vitamins and minerals found mostly in plant foods while still eating a low-carb animal-based diet.

  • DrStrange

    5/4/2010 12:41:14 PM |

    "Yesterday I ate 4 eggs, a pint of cream, 4 tablespoons of butter, 3 pieces of bacon (with all the rendered fat), about 6 oz of fatty beef steak, and a tin of sardines."

    Bonnie, have you no concern about GMO diary (hormone forced milk production), nitrites/added hormones/stress hormones in bacon, GMO corn and petro chem and drug residue in beef, etc? Or are all these from organic, free-range animals fed their natural diets?

  • DrStrange

    5/4/2010 12:49:18 PM |

    "Indeed what about the evolutionary argument that our ancestors survived mostly on animal meat (and its fat)?"

    Contemplationist, read this

    http://diabetesupdate.blogspot.com/2009/09/lets-not-twist-history-to-support-our.html

    From looking at the diet of contemporary hunter gatherers, an argument could be made that the ancestral diet contained a great deal of plants, as well as insects, small birds, lizards, etc.  The meat eaten was not the bulk or even the majority source of calories and it was all very very lean.

  • Anonymous

    5/4/2010 2:50:16 PM |

    His advice makes sense for the vegans and vegetarians and low-fatters.  A huge step up for them and, most importantly, it's very 'foodie' and will appeal to them.

    The animal-based diet, on the other hand, appeals to people like me who are lazy and therefore used to eat the SAD diet.  Dinner: grilled hamburger topped with butter, sea salt and blue cheese on top of microwaved spinach.  Five ingredients.  Takes me five minutes.

    The answer to "Plant-based or animal-based?" is "YES!"  Ditch the grains and we can discuss everything else later.

  • DrStrange

    5/5/2010 1:42:01 AM |

    "The animal-based diet, on the other hand, appeals to people like me who are lazy and therefore used to eat the SAD diet. Dinner: grilled hamburger topped with butter, sea salt and blue cheese on top of microwaved spinach. Five ingredients. Takes me five minutes."

    Took me about 15 max to make mine:  Pre-cooked beans from fridge plus huge pile of chopped veg in pressure cooker.  Up to pressure and run for 60-90 seconds.  Bring pressure down fast, dump in bowl, add some nuts/seeds, and eat.

  • jpatti

    5/7/2010 6:59:53 AM |

    We evolved as neither herbivores nor carnivores, we're omnivores.

    It's always been normal for humans to eat BOTH plant and animal foods.

    I think everyone should eat at least half their food, by volume, as nonstarchy vegetables and low-sugar fruits - a wide variety.  

    That being said, meat, dairy and eggs, if raised on pasture, are darned healthy foods.

    I think raw milk, pastured eggs and pasture-raised butter are some of the healthiest foods one could possibly eat.  

    And besides being a health food in itself, butter makes getting your veggies in much more palatable, so... an artichoke dipped in butter ought to make all of us happy.  It certainly makes me happy.  ;)  

    Bacon, if from healthy animals and just smoked as opposed to being pumped full of nitrites and nitrates, is a fine food.  

    And if we all ate enough wild-caught shellfish, you'd be hard pressed to find all these iodine deficiencies you've been noticing.

    Animal foods are not a problem so much as the US system of mass-raising animal foods in an extremely unhealthy manner is a problem.  

    See http://www.eatwild.com to find good local sources of meat, dairy and eggs.  

    IMO, the "right" answer to breakfast can be the omelet, cooked in butter, stuffed to overflowing with fried peppers,  onions and mushrooms, with a bit of grated cheese over the top.  

    Eating plenty of vegetables does not preclude eating animal foods.

    And really, you'd be pretty hard pressed to do low carb as a vegan and get anything like sufficient protein and fat.  A vegetarian, yes, if you eat lots of eggs and dairy, but a vegan, no.  

    This isn't an either/or scenario, we do best eating both.

  • lightcan

    5/7/2010 2:39:10 PM |

    We could argue and fight for ever, Drstrange.
    Stress hormones? As if the animals that humans used to kill went down happy and peaceful listening to Vivaldi. Are your vegetables all organic? And they do not contain any toxins or anti-nutrients, or nitrates, they also provide you with all the vitamins and minerals you need? Good for you. Oh, no, you need to supplement. Just as well you can afford to do it.

  • DrStrange

    5/8/2010 7:20:11 PM |

    lightcan, not sure what you are going on about.  Really.  I was referring to the lifetime of tissues saturated in stress hormones of  industrial, factory raised animals which I have boycotted since the early 70's when I found out how they were being treated even then! And what does any of that have to do with supplements?  I take some because I am old and a bit paranoid but am quite sure I would be fine without (excepting B-12 and D).  As for organic, yes, probably 95% at least and since I don't buy meat which is expensive (especially free range/grass fed or wild caught which is only meat I would eat when eating it) but rather cheap organic beans instead, I can afford it.

    Not fighting or arguing really at all. I have no "beef" against someone eating meat if they feel the need.  But the research I have read really does show that a diet based on bacon and butter and blue cheese is basically a death sentence.

  • lightcan

    5/11/2010 10:42:55 AM |

    I don't think that a diet based on butter, meat, fish, eggs and some greens is unhealthy. You think the opposite. I'm sure you can find studies that you think support your stance. That's why I said that there is a lot of debate going on, even between specialists, and asking people if their meat is organic and stress hormones free doesn't help.
    Many people who care about their health (those that read these blogs, you and I included) are trying to do their best until the definitive answers come in. It's really hard for the majority of people to find quality food exactly because of those pervasive industrial food practices you talk about.
    All the best.

  • Anonymous

    10/30/2010 11:53:05 PM |

    I eat 100% plant foods and I feel the same as when I ate both plant and animal foods, except I feel much better stopping the toxic fish - way too much mercury for me. I think eating plant foods is much more convenient. I even eat soy, and don't understand why there's so much anti-soy stuff online.

  • mirckur

    2/8/2011 3:49:28 AM |

    That is very good comment you shared.Thank you so chat much that for you shared those things with us.Im wishing you chat sohbet to carry on with ur achivments.All the best .

  • Anonymous

    2/22/2011 4:44:33 PM |

    Seriously, I am sick and tired of hearing "Low carb"  you don't mean low carb, you mean low grains don't you because plants are carbs..

    Say what you mean, not what is popular

  • jpatti

    6/18/2011 10:08:09 PM |

    The biggest issue with these guidelines is NOT what they say to adults, but the fact that they're taught in school to children.  

    I was in-between the 7 food groups and the pyramid, went to school with the 4 food groups myself.  Meat, dairy, grains, fruits & veggies.

    People still think this way, have to remind hubby all the time that corn is a grain not a veggie.  Point being, we both "think" in the four food groups, and probably will our whole lives.  

    We learned this stuff with our alphabet and arithmetic.

    Anyways, the answer to the question is BOTH.  

    We are OMNIVORES.  Look at your teeth: you're not a herbivore, and you're not a carnivore.

    IMO, when you sit down to eat, half your plate should contain nonstarchy veggies.  In my opinion, NONSTARCHY vegetables is an entire food group.  If I'd designed the pyramid, that'd be at the bottom.  

    This is not a veggie-based diet though.  Cause veggies are low calorie, and diets are defined as high fat or high carb or whatever, based on the percentage of calories.  So... you can eat EITHER a high carb or high fat diet with half your plate covered with nonstarchy veggies, as it depends on what's on the other half of your plate.

    IMO, at least another quarter of your plate should be good protein - pastured beef, pork and poultry, free-range eggs, raw milk and yogurt and kefir and raw cheese, nuts and seeds, and (if you can tolerate the carbs) legumes.  I define "good" protein as ones that don't have bad fats with them - so largely saturated and monosaturated fats, with minimal PUFAs.

    The only other "rules" are... do eat broth and other sources of gelatin, do eat fermented foods, don't eat HFCS and don't eat PUFAs/trans fats.  

    The rest varies with the person - if bg issues, should stick to lower carb, etc, if not, eat french fries, whatever.

    Cause... if you eat half your food as nonstarchy veggies and a quarter as good sources of protein, and get some good broth and fermented foods in weekly, eschew HFCS and PUFAs, even if the REST of your diet consists of nothing but hot fudge sundaes you'd be coming out ahead of the VAST MAJORITY of people.  

    Course, you're BETTER off if you eat some starchy vegetables and fruit in this other 25%, but... veggies and protein sources with good fats... these contains the vast majority of the micronutrients any of us get.  

    This is a simple enough system to teach to a small child, which is what I think the guidelines should be aiming for.

Loading