Are Your Cosmetics Safe?

11. June 2014 Dawn D (0)

If you are reading The Cureality blog chances are you care about your health. You care about what you eat. You want to remain healthy, free of disease, feel good and possibly even want to look and feel as vibrant as you were when you were 20. Many of us think of food all day long. Many of us love to eat. We plant gardens so we know our food is free of pesticides and other toxic chemicals. Food can be a cause of disease and it can minimize our chances of disease. We try and take care of our insides but did you ever wonder what in the world you apply to your skin on a daily basis? What do these products contain and are they safe? Why are there more endocrine disorders popping up. Could it be that some of things we apply to our skin every single day may be harmful to our insides?

A portion of the skin health section of Cureality will take a look at skincare products and cosmetics. Are the products we apply to our skin gluten-free, paraben-free and free of other harsh chemicals that can cause skin irritations and possible other unwanted diseases. I came across Mirabella cosmetics and I wanted to learn more about this particular product line so I tracked down John Maly, founder and CEO of Mirabella Cosmetics. Mr. Maly was gracious enough to take time out and answer my questions.This is what Mr. Maly has to say about Mirabella:

DD: Tell us about some key features about Mirabella, gluten-free cosmetics. What made you get started in a gluten-free line?

JM: We didn't start as gluten-free. Over time we have continued to make our line more beautiful AND more healthy for women. First we began with a mineral foundation. Then as we introduced new products, we made sure they were as clean and healthy, while still being fashion forward. We saw the benefits to our clients to take out those ingredients that didn't help them look and feel their best such as glutens, parabens and talcs.

DD: Some cosmetic companies carry partially gluten-free cosmetics. Are all of Mirabella products gluten-free, paraben-free and talc-free?

JM: Everything is paraben-free and talc free. And our brand is all gluten-free except our Skin Tint Creme foundation. That is a product that women love and we just cannot make the formula without a wheat protein to perform as well...yet! We will continue to work on it!

DD: Are there other ingredients in cosmetics that women should be cautious of using if they have skin sensitivities or allergies?

JM: Some women are sensitive to fragrance as well.This is another thing that we avoid with our brand. The biggest ingredients that women find that helps with their skin health is mineral products. They are natural and very breathable on a woman's skin.

DD: I think your velvet lip pencils are by far the most extraordinary lip pencil on the market. What are some of your other standout products your customers love?

JM: Pure Press Mineral Foundation is still our #1product. But the fastest growing product is Magic Marker Eyeliner. It is easy to use, doesn't smudge and lasts all day.

DD: Anything new on the horizon for Mirabella that you can share with us?

JM: In August we launch CC crème. This product has all the good for you ingredients to help with Anti-Aging like avocado oil, argan oil and Acai (Assai) berry. Plus it is a mineral formula, gluten-free, and paraben-free. And it has an SPF of 20. One of the biggest issues that women have with aging is lips. That is why we put Litchi Chinesis Fruit Extract in our Colour Vinyl lipstick. Then in your favorite Velvet Lip Pencil, we put Pomegranate Extract, Vitamin C and E in to assist with in Anti-Aging.

DD: Is Mirabella only sold in the US or do you have international distribution as well.

JM: We are sold in Canada, Australia, Finland and Russia.

DD: Where can we purchase your cosmetics?

JM: Our products are available at www.mirabellabeauty.com and at over 1,500 of the finest salons and spas. Go to our salon locator to find a retailer near you.

Keeping Up with the Kids

5. June 2014 Amber B (0)

On Saturday my husband and I took our niece Anna out her annual birthday date. That date started with a trip to the Humboldt park playground. As with most kids, Anna ran straight to the spider-web jungle gym which I have to admit it looked pretty cool. Just before she began to climb up, she turned to look at me and said “Auntie Amber, climb up too!”

I was not wearing my playground apparel on Saturday. I had a cute pair of pink loafers on, skinny jeans, tank and a jean jacket. But it did look like fun so I decided to climb. No problems yet. I was good to go climbing around on the ropey, spider web apparatus. But of course, just climbing around was not enough. Anna suggested that we should race. Not just to the top, but to the top of the jungle gym over the side, across the rope bridge and down the slide. This is when my skill was put to the test.

As you could have guessed, Anna smoked me during our race. Not only that, but the jean jacket was off and I was working up a sweat. Was I getting a workout from my 9-year-old niece? I think so. But we both were having so much fun. We continued to climb up and down the fake rock wall, monkey bars and run around the playground. It was a blast.

But as I looked around the playground, I was the only adult climbing around the playground and playing. The other adults were sitting on park benches watching. One parent near by had to decline the request of a child they were with to join them on the playground equipment. I felt really good that I could be there with my niece running around, climbing and swinging.

Keeping up with our kids, grandkids, nieces and nephews is really important as we age. Otherwise we sit on the sidelines. How do you train for the playground? Get in the weight room. Lift heavy things, jump, pull yourself up, move side ways, and challenge your body to do movements beside sitting or standing. If it’s been awhile or you’re just not sure where to start then get a trainer and join some group workouts.

It’s time to get moving. Because it starts out at the playground now but soon it will be mud runs, Frisbee, triathlons and weekend football games. You need to keep up!

4 Tips to Boost Kids Veggie Intake

3. June 2014 Lisa G (0)

Vegetables are arguably the most important food group, the key to any healthy diet. They are one of the most nutrient dense food groups and serve the foundation to healthy meals and snacks. A frequent comment from people enjoying the Cureality way of eating is, “I am eating more vegetables than I ever have in my life!”

This is great because plentiful consumption is associated with decreased heart disease, reduced weight, lower blood pressure, glowing skin and decreased risk of some cancers. However, perhaps you’re reading this and feeling great that you eat your veggies but struggle to get your kids to do the same. If you are a parent, who is simply trying to provide nutritious options to your kids, give these tips a try.

1. Add cheese or butter to enhance flavor and increase the absorption of fat soluble vitamins A, D, E and K. Younger kids like to dip foods, so often pairing with a dip, such as hummus, can increase intake.

2. Try the “rule of 15” — putting a food on the table at least 15 times to see if a child will accept it. Don’t give up after a few attempts. This can indeed be frustrating, but have patience and continue to offer a small portion to expose children to veggies without forcing intake. Often parents feel like it’s their job to just make their children eat something. I suspect most children will always select apple pie over an apple. It is important to set the stage, at an early age, with what is offered. In addition, being a good food model is important. You can’t expect your child to try broccoli, if you make negative comments about its taste, texture or smell.

3. Once a food is accepted, parents should use “food bridges,” finding similarly colored or flavored foods to expand the variety of foods a child will eat. If a child likes pumpkin pie, for instance, try mashed sweet potatoes and then mashed carrots. If a child loves corn, try mixing in a few peas or carrots. Even if a child picks them out, the exposure to the new food is what counts.

4. Allow children to engage, as able. When grocery shopping or offering a snack, ask your child which option they would like to eat (e.g. ask which healthy foods they would prefer, blueberries or strawberries, cucumbers or carrots, etc.). When children are included in more food decisions it can decrease resistance. Include children in age appropriate preparation, as well, for example cutting produce, making a vegetable soup, or selecting produce at the grocery store.

Lisa Grudzielanek, MS, RDN, CD, CDE
Cureality Nutrition Coach

When is the Best Time of Day to Workout?

2. June 2014 Amber B (0)

There are various theories about the best time of day to workout. At the personal training studio I own, training sessions start as early as 5:45am and the latest sessions start at 8pm. We have people that get up early and get their workout done first thing in the morning. We also have other people that get it done after work to release the stress of the day.

So which group is getting the better workout?

If you’re an early bird or have too many evening commitments then a morning workout is ideal for you. Here are some benefits to training in the morning.

1. Very few things can get in the way when you workout in the morning. (Except for the snooze button.) Later in the day extra phone calls, meetings and tasks can get in the way of getting your workout done.

2. After a strength or interval training session, your metabolism is elevated for hours after your workout. Enjoy these post exercise benefits while you are awake and active instead of when you are at rest.

3. Exercise will boost your energy. Use the momentum from a morning workout to arrive at work energized, present and focused instead of feeling sluggish because you just got out of bed.

4. Exercise on an empty stomach before breakfast is a great way to burn more body fat. Upon waking, the body is in a fasted state. Without ready available glucose in the bloodstream, the body is forced to use fat as an available fuel source for the workout.

However, some of us need our sleep or need to burn off the steam of a hectic workday. Here are some of the benefits of working out in the evening.

1. Getting enough sleep is crucial for health and recovery. If you have to skimp on regular sleep to get up for an early workout, the benefits of the workout start to diminish.

2. Instead of taking that stress of work home, you hit the gym after work. Even after the worst workdays, exercise will boost your mood. Friends and family will be grateful that you get your workouts (aka therapy session) completed.

3. Often people feel stronger when they workout in the evenings. When performing strength tests people tend to lift heavier during evening workouts. This could be due to the fact that they are more awake or that they have food fuel to utilize during their exercise session.

4. Research shows that you can build more muscle with evening workouts because cortisol levels are lowest in the evening. The result of this will be a higher testosterone to cortisol ratio leading to a less catabolic workout.

So which time of day comes out on top for the best workout time? In my opinion, it’s the time that you can do consistently. It’s the time that works best with your natural energy rhythms, work schedule, and family commitments.

Experiment working out at different times to see what works best for you. When you find the right fit, schedule your workouts on your calendar to build the exercise habit.

What is Cureality all about?

27. May 2014 William Davis (1)

“Looking over your medical record, Nancy, I’m a bit concerned about your risk for osteoporosis and hip fracture. It looks like your mom had a hip fracture at age 67. Is that right? ”

“Yes, she did,” Nancy responded. “And her life was never quite the same for the 15 years she lived after that.

“You’re 53 year old. Bone thinning develops over many years. Let’s get you scheduled for a bone scan.”

Two weeks later:

“Your z-score is 1.5, Nancy. This means you’ve got a mild form of osteoporosis called ‘osteopenia.’ Here: This is a prescription for alendronate, what used to be called Fosamax.”

“Aren’t there side-effects with that drug? A friend of mine said that her mom had a leg fracture from it.”

“Well, yes. All prescription drugs have potential side-effects. They’re rare, but they can happen and we can’t predict it. Besides leg fracture, there’s something called jaw osteonecrosis in which the jawbone dies and has to be surgically replaced. But would you rather run the risk of a hip fracture?”

“Before we jump to drugs, aren’t there natural things I could do first?”

(Big sigh.) “You can take calcium, but that only helps a bit. You’ve got to make a choice: Take the drug or risk a hip fracture.”

“I’m going to explore some natural remedies on my own first.”

Nancy’s dialogue with her doctor is fictional but based on similar encounters that occur thousands of times every day nationwide. Identify a problem, prescribe a drug. Natural remedies? “They don’t work.” “I don’t know anything about that.” “None of that is proven.” “I only practice evidence-based medicine.” You’ve probably heard a few of these explanations yourself if you ever question the wisdom of conventional medical care.

Each of Nancy’s fictitious interactions were no more 10 minutes long. If she is like most people, she will have one or two such interactions over the course of a year, unless she develops some acute illness. So she’s got something like 20-30 minutes per year to compress all of her “health” advice into the time allotted. 20-30 minutes per year to discuss bone health, nutrition, blood sugar issues, cholesterol issues, blood pressure, female issues, and all the other facets of health. Perhaps she has developed some chronic gastrointestinal complaints, too, and an odd rash on her elbows, maybe headaches a few times per week that she didn’t have before. Regardless, she’s going to have to make do with those few minutes, likely receiving one or more prescriptions or imaging procedures for each.

Such is the nature of modern healthcare: Provide the minimum interaction, address only a few, perhaps no more than one, problem, then prescribe a drug. This is, more often than not, wrong. Plain wrong. Tragically, awfully, unethically, unnecessarily wrong.

Let’s pick up again with Nancy. Upon learning of her osteopenia and long-term risk for hip fractures of the sort that changed her mom’s life and health irretrievably, Nancy started searching for solutions. Not only did she discover that, yes, there are indeed a number of safe and effective ways to deal with osteopenia. She also learned that such strategies have even been examined in clinical trials, some of the strategies pitted head-to-head with drugs and performed on a par, sometimes better, than prescription drugs. She also found that there are online communities that she could join and discuss her health situation with people all sharing the same health interests. During one such interaction at the start of her effort, when she was still a bit unsure and tentative, a woman she didn’t know but who shared a similar interest in restoring bone health, commented to Nancy, “Don’t sweat it, Nancy. I was in your shoes a little over a year ago. I followed a program for bone health: vitamin D, vitamin K2, magnesium, I made sure that I included leafy green vegetables at least once or twice per day, and I added strength training for a few minutes twice per week. I started with osteoporosis. My most recent bone density test showed that I reversed it completely—it’s entirely normal! So hang in there and be sure to share your questions and concerns with us here.”

THAT is what Cureality is all about. Cureality fills the gap of knowledge in health that is not being provided in a few minute-long medical interaction. Cureality reveals the astounding amount of credible, safe, scientific information that allows you to participate, sometimes take over completely, various aspects of health. You don’t have to fire your doctor; these efforts supplement the information and advice you obtain (or don’t obtain) in the doctor’s office. While critics may sometimes say that this can be dangerous or that misdiagnoses and dangerous treatments might be risked, our experience is the exact opposite: People do better by taking the reins of health themselves, choosing to use the health care system for acute or catastrophic illness—but not necessarily for health.

Our fictional woman, Nancy, returns to her doctor one year later after undergoing a repeat bone scan. The doctor opened her chart, clearly expecting to scold her for her foolhardy and careless attitude. Instead, he was speechless. After a pause, he said, “I don’t know how you did it, but your bone density is now normal, the density of a healthy 30-year old woman. Just continue doing what you’re doing.” He closed the chart and walked out.

Yes: “Just continue what you are doing”—not “Please tell me what you did so that I might learn something new,” or “Where did you learn about such strategies? I knew nothing about this!” Just “do what you’re doing.” Too often, that is the response you get that defines what modern health care has become.

You don’t want that kind of health care. Sure, it’s reassuring to know that the doctor and hospital are there in case you injure yourself or develop pneumonia. But obtain day-to-day health advice of the sort that keeps you slender, keeps blood pressure normal, maintains normal insulin and blood pressure responses, helps keep bowel health ideal, can even be used to reverse conditions such as autoimmune joint pain, diabetes, osteoporosis, or skin rashes, while costing next to nothing and yielding health care benefits for you and your family in multiple areas of health? That is the kind of health care you want.

That’s why we developed Cureality.

William Davis, MD
Author of #1 New York Times Bestseller Wheat Belly: Lose the wheat, lose the weight and find your path back to health, The Wheat Belly Cookbook, and Wheat Belly 30-Minute (or Less!) Cookbook published by Rodale, Inc.
Author, Track Your Plaque: The only heart disease prevention program that shows how the new CT heart scans can be used to detect, track, and control coronary plaque

How Can I Lose Weight Eating Fat?

26. May 2014 Lisa G Carbohydrates, Lipids, Nutrition (0)

For new comers to the Cureality nutrition approach, this question may invariably pop up. For many years, fats and oils, whether classified as good or bad, were demonized because they contain 9 calories per gram. Meaning, they contain more than twice the 4 calories per gram of carbohydrate or protein.

So this familiar logic stated, if you eat less fat, which by default meant more carbohydrate, you would eat fewer calories and lose weight. This misguided logic was based on the assumption that caloric density was the primary reason people either gained or lost weight. The result - obesity rates have climbed and low-fat diet recommendations have proven unsuccessful in thwarting the battle of the bulge.

Why? There are a multitude of reasons, as discussed in the Cureality Diet Track. The following two explanations are important to to avoid needlessly suffering on a low-fat diet.

1) Appetite satiation is drive by insulin response, not calorie density.

Meals that trigger a substantial insulin response trigger increased appetite and fat storage. Carbohydrates, such as whole grain bread, whole wheat waffles, and fruit juice trigger insulin release. Continuous insulin provocation equates to one heck of a time trying to lose weight, as insulin is a fat-storage hormone. In comparison, oils and fats are the least insulin provoking with protein a close second. Consuming adequate fat intake is essential to quench appetite and avoid the insulin surges and crashes that are the result of eating plenty of “healthy whole grains”.

2) Modern wheat increases appetite thereby increasing intake.

Portion control becomes a major challenge because the gliadin protein in modern wheat stimulates appetite to the tune of 400 calories more per day, 365 days per year. That’s a recipe for weight gain, not loss.

The Cureality nutrition approach encourages the generous use of healthy fats and oils to support healthy weight loss and cardiovascular health. These topics are discussed in much more detail in the Cureality Member Forum.

Lisa Grudzielanek, MS, RDN, CD, CDE
Cureality Nutrition Coach

Drowning in a Sea of "Endocrine Disrupter Toxins"

20. May 2014 Chris K Drug advertising (1)

In my previous post I spoke about the close connection between gut health and thyroid health. Of course, as someone who lives with Hashimoto’s Thyroiditis I have a keen interest in anything related to the thyroid.

Just today, I came across an article revealing the 100 most-prescribed drugs in America and was stunned at what drug topped the list with more than 23 million prescriptions in 2013 – levothyroxine – the most commonly prescribed drug for treating hypothyroidism (but not necessarily the best in my opinion).

Some observers have warned about a pending epidemic of thyroid disorders. I believe the revelation of a thyroid drug as the most prescribed drug in America suggests that this epidemic is already a “fait accompli” (that’s French for the more colloquial expression “it’s a done deal!”).

I also believe it is due, in part, to the grim observations of experts like Dr. Davis who warn that we are literally “swimming in a sea” of endocrine disruptors, toxins that disrupt our hormonal glands such as the thyroid, adrenals, pancreas, ovaries, and testes. I would go farther to say we are drowning in that sea. Here are just a few examples of how ubiquitous and pervasive these toxins are.

Bisphenol A (BPA) in plastic containers has gotten a lot of bad press recently yet it still considered by the FDA to be safe in certain applications even though it has been shown to disrupt the sex glands and bind to thyroid receptors.

Triclosan is commonly used in hand-sanitizers and similar applications. Triclosan is known to decrease circulating levels of the thyroid hormone thyroxine (T4).

Polybrominated diphenyl ether (PBDE) is common used to make flame retardant clothing. PBDEs have been shown to disrupt both estrogen and thyroid hormones. The effects of PBDE exposure both in utero and shortly after birth can persist into adulthood.

Perfluorooctanoic acid (PFOA) in Teflon coated pots and pans and even microwave popcorn bags has been detected in the blood of more than 98% of the general US population. PFOA has implicated as both a carcinogen as well as an endocrine disruptor associated with thyroid disruption.

With all these “thyro-toxins” floating about it might not seem you like have a fighting chance to achieve thyroid health. But, the first step is to educate yourself - then take action. It is the essential sequence in what I call “Informed, Self-directed, Healthcare” (ISH).

Now that you have a better understanding of how to navigate the “thryo-toxin minefield” there are also positive steps you can take to stack the odds in favor of a healthy thyroid. If you participate in the Cureality program make certain to check out the Thyroid Health Track for a powerful list of proactive steps you can take.

Chris K. (aka HeartHawk)
Cureality Member Advocate

Source: IMS National Prescription Audit, IMS Health.

Italian Food the Cureality Way

19. May 2014 Lisa G (0)

100% grain elimination is the theme that drives the Cureality nutrition approach. A common mistake made when eliminating grains is replacing wheat-based foods with gluten-free foods. Most gluten-free foods, as they are currently available in the supermarket, are made with rice starch, tapioca starch, cornstarch, and potato flour. These dried pulverized starches generate more insulin and blood sugar surges than wheat. Gluten-free foods made with these undesirable ingredients are free of the appetite stimulating gliadin protein and wheat germ agglutinin, a lectin protein unique to wheat that causes direct intestinal damage. However, at best they can be referred to as “less bad” or unwelcome additions to the diet. Increasing your intake of these junk carbohydrates is a recipe for weight gain, inflammation and sky high blood sugar.

When removing grains from the diet, the goal is to replace them with truly healthy alternatives that do not contribute to negative health consequences. There are several reasonable substitutions available that allow your favorite sauce and protein combos to shine in tasty pasta-like dishes. People following the Cureality nutrition approach frequently comment that they do not miss “real” pasta because of the available healthy replacements they have learned about and incorporated into their lifestyle.

Our nutritionist, Lisa G., is the champion at helping navigate this lifestyle. In this video, she demonstrates how to prepare spaghetti squash, which can be used to replace wheat-based pasta. In another video zucchini noodles are the star. Homemade meatballs, a zesty tomato sauce and zucchini “pasta” combine for a delicious meal. Who needs grains when you can enjoy meals that support increased energy and less joint pain?

Traveling, while being wheat-free and dairy-free. Can it be done?

16. May 2014 Dawn D Dairy products, Wheat-free (0)

Summer vacation is right around the corner. The temptation to deviate from your normal healthy eating habits may occur… but resist. So how in the world do you continue to eat The Cureality way when you're traveling internationally? Let me tell you how I do it. I would also like to add I am allergic to dairy and I avoid all wheat containing foods. This has been my way of life for years and actually is extremely simple for me to manage while away from my own kitchen.

I decided to pay Italy a visit. I knew I would be overwhelmed with wonderfully fresh smelling bakery, pasta, cheese, gelato, and pizza. All foods I either can't consume due to my dairy allergy or foods I choose to avoid because of their health effects.

I was correct in my food assessment: the grains, bakery, and gelato were in every nook and cranny I encountered. Food choices can be difficult while traveling but I ask numerous questions regarding ingredients and I am certainly not afraid to swap out french fries for grilled vegetables.

Here's what I did the first few days on vacation with my diet routine to minimize dietary booby traps:

Day 1:

Breakfast, Hmmmm….Italians like their bakery. WOW. Tough when most of the foods being served are grains and eggs with dairy mixed in. I had two hard boiled eggs, tomatoes, sausage and espresso.

Lunch: Arugula lettuce topped with a chicken breast, roasted peppers and tomatoes. A side of salmon and lots and lots of olive oil on top. Very tasty and filling with the olive oil.

Dinner: Hamburger (no bun) with tomato, mayo, lettuce topped with a mountain of sauteed spinach. Water and yes…Italian wine found it's place at the table.

Day 2:

Breakfast: I devoured two hard boiled eggs with lettuce, cucumbers, shredded carrots, tomato and pineapple slices. Two cafe Americanos and water.

Lunch: Lunch was spectacular: Beef tips, arugula, lettuce, shredded carrots, tomatoes, olive oil and raw salmon. Yes, I mixed it all together and it was fabulous. Plenty of water with the "frizzle."

Dinner: I'll be honest: I had a difficult time with this meal due to our location and choice of foods, but I managed. Another hamburger with no bun, salad with mixed vegetables, and a few potato wedges. Wine and water.

Day 3:

Breakfast: Hardboiled eggs were getting old. Nonetheless, I had two of them chopped with tomato. Deli meat--Italians love their deli meat as well. Cafe Americano and water.

Lunch: Seafood salad-shrimp, octopus and squid mixed with argulua, fresh tomatoes, cucumbers and olive oil. Water.

Dinner: One hefty salad with shrimp, pear slices, ginger, tomatoes, avocado and olive oil. Wine and water.

Day 4:
Breakfast: Scrabbled eggs/sauage and pineapple slices. Cafe Americano and plenty of water.

Lunch/Dinner: I had to combine these two meals today. I had a delicious meal of curried shrimp (I made sure there was no dairy in the curry sauce) and a very large plate of grilled vegetables. Wine and water.

My diet may not be the most lavish to some but I enjoy my choices. I'm confident I will have no troubles with the remainder of my vacation. I haven't eaten wheat for a number of years so I don't experience the craving for bakery, pasta, or pizza. Dairy, I simply have to avoid, because I truly experience ill-effects from consuming it. My experience with travel and food choices have always worked in my favor. Ask questions and resist putting on that 5-10 pounds of vacation weight.

Ciao-Ciao~

Niacin: What forms are safe?

20. April 2011 William Davis (52)

Niacin, or vitamin B3, remains a confusing issue for many people. It shouldn't be.

It doesn't help that most physicians and many pharmacists also do not understand the basic issues surrounding niacin. The only reason why there is any level of prevailing knowledge about niacin is that Kos Pharmaceuticals managed to "pharmaceuticalize" a niacin preparation, prescription Niaspan, that provided the revenue to fund professional "education."

Niacin can be helpful to increase HDL, reduce small LDL particles and shift them towards the more benign large particles, reduce triglycerides, and reduce lipoprotein(a).

So here's a brief description of the various forms that you will find niacin:

Immediate-release niacin--Also called crystalline niacin or just niacin. This is the original niacin that releases within minutes of ingestion. Because it releases rapidly, it triggers the most intense "hot flush." While this form of niacin works wonderfully well, is the safest, and is dirt cheap, the majority of people are simply unable to tolerate the intense flush. It also works best taken twice a day, generating two intolerable flushes per day.

Slow-release niacin--These preparations were popular in the 1980s, since the slow 12 to 24 hour pattern of release minimized the annoying hot flush. But, with prolonged use, it also became apparent that an unnaceptable frequency of liver toxicity developed. Unfortunately, this means that any niacin preparation that trickles niacin out over an extended period, including many of the slow-release preparations now sold in health food stores and pharmacies, have potential for liver toxicity. These preparations should be avoided.

6-hour release niacin--Releasing niacin more slowly than immediate-release niacin but more rapidly than slow-release niacin, 6-hour release (or what the Niaspan people call "extended-release" niacin) is nearly as effective as immediate-release niacin with approximately the same low potential for liver toxicity. It is far less liver toxic than slow-release niacin. 6-hour release niacin therefore offers the best balance between effectiveness and safety. Preparations that show this pattern of release include Niaspan ($180 per month), the poorly-named Sloniacin (about $8 per month), and Enduracin (about $7 per month) for 1000 mg per day. (Some Track Your Plaque Members have also determined that several other over-the-counter preparations have been demonstrated to share a similar pattern of release.)

Then there are the scam products that have no useful effect at all:

Flush-free or no-flush niacin--Inositol hexaniacinate, or 6 niacin molecules bound to the sugar, inositol, has no effect in humans, at least not with the dozen or so preparations that I've seen used. Nor are there any data to document the effectiveness of flush-free niacin. It's also more expensive.

Nicotinamide--This niacin derivative likewise has no effect on the usual targets for niacin treatment.

While I used to prescribe Niaspan, the ridiculous pricing and aggressive marketing really turned me off. I now advise my patients and our online followers to use only Sloniacin or Enduracin, unless you can tolerate immediate-release niacin.

Comments (52) -

Mikie
4/19/2011 7:08:18 PM |

How about this interesting source of Niacin ... drum roll please ....

Food.

Why the pills? I guess to a hammer the whole world is a nail.

Anonymous
4/19/2011 7:14:26 PM |

Humans need about 20mg daily of Niacin, which can be met thru diet.
Lipid modifying effects start to occur at levels above 1000 mg daily (sometimes not until 2000 mg). It is essentially a type of over dose reaction.

Tried niacin myself at only a few hundred mg daily. Was able to tolerate the flushing, but then had the pleasure of passing 2 kidney stones. Niacin has been given the boot ever since.

Anonymous
4/19/2011 7:47:12 PM |

Is there a relationship between niacin and kidney stones? I've had a kidney stone before and it isn't much fun.

I tried Niacin several times, IR, Niaspan, and Enduracin. But I ended up getting heart palpitations on each. I also kinda felt weird, tired and generally lousy. And strangely enough, even though I toughed it out for several months, my HDL went down a point (at 500mg/daily -- Niaspan & Enduracin)

Just wondering what can be done for those who are Niacin intolerant.

And I tried the aspirin beforehand, taking with food, etc. Didn't matter in my case.

Anonymous
4/19/2011 8:07:24 PM |

Well, great...just great.  I've been taking NOW Foods Double Strength Flush-Free Niacin (500 mg) for a few months and now I'm told its for naught at best, and possibly damaging my liver.  There is a slight difference in the chemical name - Inositol Hexanicotinate.  I don't suppose that is significant?

Anyway, I guess its back to the Sloniacin I took before.  At least that's considered safe.

Regardless, I'm ever so grateful for this blog.  I learn something from most every post - even when it means I've been doing something wrong.

Daniel A. Clinton, RN, BSN
4/19/2011 10:04:59 PM |

I know Niacin has the power to make some numbers change, but is there any sort of credible evidence directly studying Niacin's effect on outcomes like heart attack and death? I am not comfortable inferring a benefit from alledged "cholesterol lowering."

Tara
4/19/2011 10:12:41 PM |

Good reminder post, Doc!

Mikie-
I'm normally a proponent of getting your micronutrients from food, but in the case of therapeutic doses of niacin it's just not feasible. 1000mg of niacin= 19 pounds of yellowfin tuna, 17 lbs of chicken, or 500 cups of asparagus

Anonymous
4/19/2011 10:45:33 PM |

quote:
.. but is there any sort of credible evidence directly studying Niacin's effect on outcomes like heart attack and death? I am not comfortable inferring a benefit from alleged "cholesterol lowering."

It's interesting with niacin, even after discontinuation it seems to have an effect on mortality:

http://www.ncbi.nlm.nih.gov/pubmed/3782631

Anonymous
4/19/2011 11:09:27 PM |

Daniel,

It is my understanding that therapeutic doses of Niacin is VERY cardio-protective (assuming the person in question can tolerate it). Lookup the HATS, FATS & CLAS trials. Check out Dr. B G's blog for more info on this:

http://drbganimalpharm.blogspot.com/2009/09/cardio-controversies-dr-superko-md.html

John M.

Anonymous
4/19/2011 11:16:17 PM |

I've been taking SloNiacin at 1500 mg/day for quite some time. Recently my HDL went up to 60 mg/dl from 50. No problems with flushing or liver fuction or kidney stones. I've become interested in the use of Niacin plus bile acid binding resin (colestipol) to reduce plaque in arteries (PAD). The studies are old, 1980's and 1990's, and of limited number of patients. However on the Niaspan website they claim that Niaspan along with diet and a bile acid binding resin is FDA approved not only to slow down plaque buildup, but also to help reduce plaque that already exists. niaspan.com/heart-healthy/plaque-build-up.aspx ... They cite the old studies on the web page.

I wonder if the claim is substantially true about plaque reduction and FDA approval.

steve
4/19/2011 11:51:44 PM |

interesting post. My doctor said that Slo Niacin is less tolerated than Niaspan. He does not care which you use.

Separate question: what impact does Niacin have on blood sugars and homocysteine?

michael goroncy
4/20/2011 12:21:50 AM |

I have reason to treat aggressively this 'spooky' disease of the heart. The science and anecdotal experience of cardiologists (who stay on the 'cutting edge') like Dr Davis and a few others will attest to the overwhelming positive effects of NIACIN.
I have titrated my Nicotinic Acid (OTC ..100 tabs..cost $11) up to a daily dose of 1.5gm.
The intolerable flush I concluded is in the main...PSYCHOSOMATIC.
At first I thought the uncomfortable feeling was unnatural and possibly harmful but, the science convinced me that it was harmless. The tact I adopted was to enjoy the flush and look on it as a
wonderful healing zooming through the body. The actual flush cannot harm...the liver is another story.
Sheesh! The things you have to do to play mind games.
The use and other add on supplements have created excellent lipids (Iam thinking of entering them in the State Championships)
Learn to love the flush..small discomfort-huge benefits.

Bobby
4/20/2011 12:51:34 AM |

I have been taking good old regular niacin and actually like the flush--it makes me feel like it is doing something. However, my blood glucose is somewhat elevated (104) over what I believe it should be. My doctor isn't concerned , but I'm not sure. Any feed back?

Dr. William Davis
4/20/2011 2:22:21 AM |

That's great, Tara!

It would be a great episode of Man vs. Food.

Dr. William Davis
4/20/2011 2:23:55 AM |

A discussion of the downsides of niacin, even when done properly, sounds like it might be of help to many people.

I'l put it on the "to-do" list.

Dymphna
4/20/2011 2:29:15 AM |

Did anyone have nausea with higher levels of niacin? I've tried it but it makes me somewhat sick-feeling.

Any ideas?

Anonymous
4/20/2011 12:09:20 PM |

I'd second the notion to avoid real-slow release niacin...I looked in the mirror to see someone with yellow skin when taking some.

So what are the available 6 hour release brands?

And what about pomegranate extracts to help clear plaque buildup?

Renfrew
4/20/2011 12:37:06 PM |

Good thread.
I am taking a form of niacin that has 1000 mg of Niacin plus 20 mg of Laropiprant. The Laropiprant is a prostaglandin inhibitor and prevents flushes.
The brand name is "Tredaptive".

My LDL Cholesterol went from 160 to 120 within 1 month. Trigs from 75 to 55.

I combine the tablet with 500 mg of milk-thistle (for liver protection) and have not had any increase in liver enzymes.

That is really a workable compromise and easy to take as one tablet a day.

Not sure if this is available in the US though, I am living in Germany.

Anonymous
4/20/2011 1:06:25 PM |

I'd be interested in knowing more about the twice-a-day recommendation. I've been taking my immediate-release 2gm/day dose once a day for a couple of years now. (Yes, I get the flush--and my liver numbers are good.) Dr Davis seems to be saying to take (in my case) 1gm every 12 hours? Is this easier on the liver?

Anonymous
4/20/2011 1:22:59 PM |

Too many adverse effects from taking Niacin. It's not worth the risk.

Anonymous
4/20/2011 2:52:24 PM |

I would like to hear the author's opinions on the best forms of excersise for heart health.

Dr. William Davis
4/20/2011 3:17:43 PM |

Hi, Renfrew-

I believe you have earlier access to this preparation than we do.

This may an interesting, though prescription, possibility for those who have intolerable flushes.

Dr. William Davis
4/20/2011 3:19:36 PM |

Re: comments about the potential dangers of niacin.

We always have to weight the risks vs. benefits. If I have, for instance, a 45-year survivor of sudden cardiac death with 3 stents who I meet with BMI 23.0 and a lipoprotein(a) of 450 nmol/L, then niacin is a small price to pay.

Every situation is unique.

Anonymous
4/20/2011 4:45:00 PM |

In regards to the risks - can you direct me to research on that. A personal friend of mine had been on a research program in the past for a major pharma in northern Illinois. What they were trying to do was find exactly how niacin works so the process could be synthesized and patented. The project was not successful. In laying the groundwork for the project he had to look at past use of it in the treatment for heart disease. Older docs he interviewed had used up to 3 grams a day with no adverse effects to their patients. Used as a drug, my friend feels it is the safest non diet way to control Tri's and raise HDL. Personally I have take 2 grams a day for well over a year. No harmful effects, blood work normal.
Without statins, tri - 151, HDL - 32
With Crestor 10mg tri 80 to 100, HDL 45.
With 2 gram niacin - Tri 52, HDL 80.
I take regular niacin. After a while, you will experience almost no flushing. Your body will acclimate.
I tout the use of it because it seems a lot of docs have forgotten it's usefulness. Keep up the info when you can.

Anonymous
4/20/2011 4:59:05 PM |

I've taken immediate-release niacin since 2003 and the only time I developed elevated liver enzymes was when I split a 4 gram daily dose into three divided doses.  I can take 1 gram three times a day with no problems, or up to 2.5 grams twice a day with no problems.  However, HDL elevation seems to plateau at 3 grams a day.

Once in the last 3 years my doctor took me off niacin for 3 weeks to perform an NMR lipoprotein test.  With carbohydrate consumption under 70 grams a day and fat intake of 67%, my LDL particle count was over 2,000 and over 75% of them were small and dense.

Niacin is the only way for me to reduce my small, dense LDL to a safer level.  Diet and exercise is not enough.  I suppose this explains why every male (except for me) has a major heart attack or stroke by the age of 50.

Anonymous
4/20/2011 5:04:31 PM |

One reason aspirin blocks only part of the flush is that the flush is produced by two separate mechanisms. The most well known is the release of PGD2 from mast cells. The other, which is rarely mentioned, is the release of serotonin from platelets. Serotonin antagonists completely block the flushing due that mechanism (see "Niacin-induced â€œflushâ€ Involves Release of PGD2 from Mast Cells and Serotonin from Platelets: Evidence from Human Cells In Vitro and an Animal Model", Dean Papaliodis,2008, American Society for Pharmacology and Experimental Therapeutics"

Sara
4/20/2011 7:42:08 PM |

I think niacin and metformin are 2 of the most powerful and safest drugs for metabolic syndrome.

pjnoir
4/20/2011 9:39:57 PM |

High doses of Niacin will increase blood sugars - I'll take my chances with Chloresterol (mind is low enough) then mess with my sugars.

pjnoir
4/20/2011 10:07:25 PM |

*mine not mind
Sara- since blood sugars go up- how can it be a good choice to improve metabolism?

Might-o'chondri-AL
4/20/2011 11:00:14 PM |

? Anyone with input on the supposed benefit of taking Niacin every other day, instead of daily ?
Someone brought it up once in an old niacin post of this blog, but nobody else seemed to know about that dosing.

Christi
4/21/2011 12:16:02 AM |

You could also add Protandim to your daily regimen. Pubmed.gov studies have shown Protandim to be extremely helpful in heart disease. It reduces Oxidative Stress and inflammation in the cells. www.dailylifesource.com

christi
4/21/2011 12:18:13 AM |

You should also add Protandim to your daily regimen. I first was exposed to this product on the ABC Primetime news investigative report. Pubmed.gov has published peer reviewed studies that show Protandim is very effective with heart disease. Check out the ABC news program here: www.dailylifesource.com

Anonymous
4/21/2011 3:18:08 AM |

Christi:

I looked up on Wikipedia the supplement Protandim you mentioned. I am familiar with 4 of the 5 ingredients it contains and while the 4 have a good reputation, I am not impressed with the overall product. Most of the studies were conducted in an animal model. If I was looking to raise my endogenous antioxidant levels (SOD, catalase & glutathione) like Protandim claims, I would take GliSODin instead...probably in the form of Life Extension brand Endothelial Defense. I am sure Endothelial Defense is more cost effective and a has meaningful doses of better researched ingredients.

Pjnoir:

While it is true that Niacin can raise fasting glucose a few points, this can be more than made up for with a better diet and exercise. In fact, niacin might actually increase insulin sensitivity. Niacin is also extremely cardio protective. The HATS trial showed that Simvastatin+niacin reduced CHD events 89% less than the placebo group.

John M.

Anonymous
4/21/2011 6:42:52 AM |

Kenneth....
After a long period of utterly fruitless treatment with flush-free niacin as high as 4 grams a day, I started good old fashioned immediate release niacin.

The flushing is manageable. The key is in slowly titrating up to your target dose. I think I went up maybe 50 mg a day every two weeks. I've been at 500 mg twice a day for months. I only get bad flushing when I let myself get dehydrated or indulge in sugar or other pro-inflammatory foods ie fast food or chips, things you shouldn't be eating anyway.

There is some evidence that flavanoids can mitigate the flush, and I've had good luck with 600 mg or so of quercetin taken with my fish oil half an hour or so before the niacin. Baby aspirin helps, as does celebrex when I happen to take it for aches. I haven't been able to escalate the dose as I started getting muscle pains and fatigue even though my liver panels didn't indicate any problem. Everyone has different reactions, but don't write off niacin until you've given it a fair shot.

I will also tell you that Niaspan is NOT in fact flush-free either. I tried it for a short while and found that it simply delayed the flushing. The product literature says as much. The strategy is simply to put off the flushing until you're already asleep, and you pay hundreds of dollars more for that dubious benefit.

Hans Keer
4/21/2011 10:07:15 AM |

Why pills? Meat, vegetables and fruit deliver all the B3 you need.

Anonymous
4/21/2011 12:36:50 PM |

Even though I'm pre-diabetic, I've never experienced blood sugar elevation with niacin.

The tolerance to the flushing develops with continuous use. Although I've never tried it, every other day dosing may result in a more pronounced flushing effect.

I've also used quercetin concurrently with niacin and have noticed a decrease in flushing. I'm very fair-skinned and still experience flushing after all these years.

Anonymous
4/21/2011 12:50:54 PM |

What would be interesting if people who are using Niacin here tell us, what effect it had on their respective Cholesterol levels (HDL, LDL, Trigs).
And if they had any issues with increasing liver enzymes or higher bloodsuger.

Kent
4/21/2011 3:16:42 PM |

Just an observation on the (Niaspan or intermediate release verses the imediate release. I found Niaspan along with other LP(a) supplements (fish oil, Coq10, Pauling Protocol, low wheat) to work much better than the Intermediate release niacin. My LP(a) started at 198 and dropped to 45 with Naiaspan included in the regimen. I switched to imediate release and it went up to 150. I switched back to Niaspan and the LP(a) dropped back down. Has anyone else experienced this phenomena?

Leshme
4/22/2011 2:30:31 AM |

Since I began taking 1,000mg of regular niacin/day, my blood platelet count has hovered around 120,000. I have read online that niacin may cause a reduction in blood platelets. Can anyone comment?

Anonymous
4/22/2011 6:52:39 AM |

I use immediate release Niacin 2 grams a day. Have used as much as 4 grams a day.

I find that if I take any other supplements with plenty of fluid/food - usually a glass of tomato juice and a glass of water - and then wait for about 15 minutes before taking the niacin, I don't get a flush except maybe once a month and only slightly. I use capsules and pull them slightly apart so that I can seperate them before swallowing, otherwise I might get a flush at some random time in the future when the capsules finally break open. When I used to use tablets, I would chew them up so I wouldn't get a random flush at some future point.

Anonymous
4/22/2011 3:26:02 PM |

I took Niaspan for almost six months. My physician started me off at 700mg and I ended up at 1000mg by the time I was taken off of it. My blood work was somewhat better but nothing spectacular and it sure wasn't good enough for me to endure the extreme flushing I experienced three or four times a week. My whole body turned a dark apple red and I experienced extreme itching over every square inch of my body at once for thrity to forty-five minutes, as if I had millions of ants crawling on me. I've read comments about how people enjoy this experience and I cannot begin to comprehend that as it was like being tortured to me. I would scratch myself so much that I tore my skin. Flushing took place even after taking aspirin and eating yogurt thirty minutes to an hour prior to taking it. You can have your niacin. I'll stick to my Crestor.

Anonymous
4/22/2011 5:08:25 PM |

Dr. William Davis said...

    A discussion of the downsides of niacin, even when done properly, sounds like it might be of help to many people.

    I'l put it on the "to-do" list.
.................

I scheduled a general checkup in a few weeks, which I'm going to request a purines test, since I've read Niacin might affect gout sufferers.

I've not been diagnosed with gout, but as it runs in my family, and I've also read that even though females get it less - that changes after (menopause, which I've started).

Paternal grandfather suffered from diagnosed gout for years - he had many stomach bleeds from gout meds, so was taken off them. His last gout attack landed him in the hospital: Normal diet, IVF @ 125cc/hr, Foley output at end of day: ZERO.

Younger brother's first gout attack  in late 30's (has one kidney, which probably hastened things). Mother also thinks she had one gout attack after over-indulging on a roast too many days in a row - she recognized her toe as looking like granddaddy's (not her father).

So I'll play it safe and wait to see that my hormone situation didn't trigger high purine levels before starting slowly on SloNiacin.

Please consider including Gout/Niacin info in your article Dr. Davis, and correct any mis-info I might have misinterpreted. I'll ask my GP if he orders liver functions with checkups at my age.

Shreela

Jim (formerly anonymous)
4/22/2011 11:53:16 PM |

A Different Anonymous said...

    What would be interesting if people who are using Niacin here tell us, what effect it had on their respective Cholesterol levels (HDL, LDL, Trigs).
    And if they had any issues with increasing liver enzymes or higher bloodsuger.

    April 21, 2011

I gave my results much earlier.

I think that people here fail to understand that the very first successful Cholesterol lowering "drug" was niacin, plain old drugstore type.

Evidently, the first American drug trial of Niacin was run by William Parsons Jr. MD in 1955 who was then a Resident at Mayo clinic. The actual use of Niacin was pioneered by the Canadians, and Parsons heard about it from a visiting Canadian Physician.

There is therefore well over a half a century of use of Niacin for cholesterol control.

Many MD's did't like it, because it is an unregulated non-prescription substance. Now there is a prescription form which is very expensive and well promoted with big bucks and drug representatives to push it.

Dr. Parsons became less of a researcher and more of a clinician in later years. He has published a book "Cholesterol Control Without Diet : The Niacin Solution" which I suggest that you look at (library) or buy, if you are interested in the use of Niacin for cholesterol control.ISBN 0966256875 $14.95. 276 pages.

With the expensive prescription Niaspan, now made and sold and marketed by Abbott Laboratories,the classical resistance of MD's to use this treatment is falling. No vitamin supplement firm could do this level of marketing for a cheap generic pill.

From page 196:
"Since the 1996 edition, there have been no more significant reports of liver problems with niacin. ...... and yet there are still no more than the 18 cases we listed here, 5 of them questionable."

He also discusses the studies designed to make Niacin look bad, and Statins look good.

It can be said that there is considerable confusion as to how Statins actually work. The first theory was cholesterol lowering. As evidence for inflammation to be a more dominant mechanism for CHD, there are now more reports that Statins have anti-inflammatory properties. But after all of the millions and millions of dollars spent on Statin R&D, the exact behavior of Statins is still not understood in detail.

In fact, there were no real good theories for the painkilling behavior of Aspirin until sometime in about the 1960's or later.

There are tons of information about Niacin out there, you have to go look for them, or buy the books. Well, you can just ask somebody to feed the information to you. That still works as a labor saving device.

Anonymous
4/23/2011 2:23:35 PM |

Thank you for the reminder to check into my "Now" brand Niacin.

Now claims sustained release formula on the bottle but there is nothing in the ingredients to suggest any coating or binding.  Regardless, I have been taking 2grms for a long time last thing at night along with my 2.7grms omega3 and 20mg crestor. Trigs and LDL were well controlled with this combo but my HDL was still only 45.  Then I switched back to eating meat(saturated fat), lowered my grain intake and last blood test HDL was 67.  the down side was my LDL went up 10%

Regarding the Flush. If I awake after a few hrs into my sleep, often I will feel the flush/itchy skin.  Small price to pay for 90% reduction in a heart attack.

Trev

Anonymous
4/23/2011 2:45:06 PM |

http://www.scribd.com/doc/50437/Niacin#fullscreen:off

excellent summary of Niacin types and explanation for liver toxicity.
Trev

jbuch
4/26/2011 2:51:35 PM |

Excellent article on the Pharmacists knowledge of the different forms of niacin.

Inspired me to do some more digging and I found this excellent webpage which is a baseline discussion of the ARBITER 6 Trial, with excellent comments on Niacin myths and factoids.

http://www.theheart.org/article/1022265.do

In particular, look at the readers comments, evidently almost exclusively MD, numbers 34 to about 57. It is here that some of the common myths and factoids are noted, mostly with literature citations rather than unsubstantiated claims.

Below is one example.
---------------------------

Niacin Dissolution Rates
I recently came across an interesting paper on the dissolution rates of various niacin formulations. Niaspan was best in terms of slow dissolution, followed by Enduracin and Slo-niacin. For those interested:

Poon, Ivy O., Chow, Diana S.-L., Liang, Dong
Dissolution profiles of nonprescription extended-release niacin and inositol niacinate products
Am J Health Syst Pharm 2006 63: 2128-2134
------------------------

Susan
5/8/2011 7:20:26 AM |

You might want to take a closer look at Protandim, it's not a simple product and takes a bit of time to take in what it really does in the body. There is proof that it raises SOD in a human peer-reviewed study. Protandim is proven to increase catalase, glutathione, and a number of other endogenous antioxidants in addition to increasing SOD. The science is there, but how I really know it works is through what it has done for me and quite a number of people I know who have had notable improvements in their health. There is nothing wrong with glisodin, but it isn't in the same class as Protandim. Protandim is proven to work through the activation of the Nrf2 transcription factor, up-regulating the antioxidant response gene sequence that causes the body to produce it's own native antioxidant products in every cell of the body. This site explains more about it and has links to supportive science: www.radicalresults.net

yves
5/11/2011 12:37:31 AM |

Any insight as to whether Nicotinamide may be effective for those with fungal infections?
http://www.wellnessresources.com/studies/niacinamide_helps_combat_candida_albicans/

georgepds
5/20/2011 4:40:12 PM |

"Why pills? Meat, vegetables and fruit deliver all the B3 you need."

Because you would have to eat too much to get a clinical benefit

You need 1000 to 2000 mg, 4 oz of chicken gets only 14 mg.. so, for the clinical benefit, you'd have to eat ~400 oz of chicken, or about 25 pounds of chicken a day.. just a tad too much chiken for me

http://www.whfoods.com/genpage.php?tname=nutrient&dbid=83

Ken Levin
6/5/2011 11:00:23 PM |

Hi Dr Davis, I'm a new Track Your Plaque member and noticed two new studies claiming niacin was not helpful in reducing the incidence of heart attack. One study compared Zocor with and without niaspan (summarized in New York Times about a week ago) and one studied niacin (not sure which form, heard about the study through a physician) alone. Do these studies change your recommendations about niacin for Track Your Plaque members? Thanks in advance and thank you for your Track your Plaque program.

Jonathan
6/6/2011 5:03:29 PM |

All I could find around here locally was slow release niacin (capsule shaped tablet). I pop two 500mg and chew them. I get a real nice flush.

Jesse
6/24/2011 4:42:46 PM |

Dr Davis, can you comment on the studies mentioned by Ken Levin above? I would be interested to know the specifics about them, and if they hold nay water.

Thanks

M2
7/2/2011 6:17:01 PM |

Dr. Davis, very interested in a response to the niacin studies referenced by Ken and Jesse above.

Thanks!

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