Archive for October, 2009

The Gluten-Free Diet: A New Diet Fad?

Gluten-Free Logo

by Leah Frankel, MS, RD

The last time you were in the grocery store or a health food mart did you notice the aisles filled with gluten-free foods? Ever wonder what those gluten-free foods are and if they provide any health benefits? We’re here to give you the rundown. Gluten-free foods are intended for people with celiac disease. But what is celiac disease? In honor of National Celiac Disease Awareness Month it only seems appropriate to learn a little about celiac disease and the role of gluten-free foods, since approximately 1 in 133 Americans are affected by celiac disease.

What is Celiac Disease?

Celiac disease, also called celiac sprue, gluten-sensitive enteropathy, gluten intolerance, and non-topical sprue, is an autoimmune disorder that is passed down genetically.  It affects affect both adults and children. When a person with celiac disease eats foods containing gluten (don’t worry we’ll explain what gluten is later on) their body responds with a strong an immune response that causes damage to the small intestine. In a normal, healthy individual villi (tiny hair-like projections in the small intestine) are designed to absorb nutrients in the small intestine (see the top two pictures below for an idea of what a normal intestine and villi look like).  In someone with celiac disease, the immune response to gluten causes the villi to be damaged and decrease in number, known as villous atrophy (the bottom two pictures below show atrophy of the villi in the intestines from celiac disease).  These individuals’ villi are unable to absorb nutrients leading to malabsorption (i.e. you don’t absorb the food you eat).

Celiac DiseaseWhile most people with celiac disease have a variety of symptoms, some have no symptoms at all. Symptoms in adults can include: change in appetite, weight loss, stomach cramping, fatigue, muscle cramping, pain in your bones and joints, abnormal stools, or weakness. In addition, celiac disease can manifest itself as Dermatitis Herpetiformis, itchy blisters most commonly found on the face, elbows, buttock, knees and ankles (you would know if you had these). In children, common symptoms include: projectile vomiting, stunted growth, and behavior changes in older children.

There are several tests that are used to diagnose celiac disease. The first is a blood test that checks for the presence of certain auto-antibodies in the blood. Auto-antibodies are antibodies that attack your body’s own tissues as opposed to normally functioning antibodies which attack foreign substances in the body like viruses and bacteria. The auto-antibodies we look for in celiac disease include immunoglobulin A (IgA), anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). Depending on the result of your blood work, a biopsy of the small intestine may be done to confirm the diagnosis of celiac disease. Finally, if the biopsy suggests the presence of celiac disease, improvement of your symptoms while adhering to a gluten-free diet would help confirm the diagnosis.

The only treatment option for those with celiac disease is to completely eliminate gluten from their diet. The effects of a gluten-free diet are seen almost immediately with symptoms resolving within a few days. After a few weeks on a gluten-free diet the small intestine will heal and begin to function normally. If celiac disease it not treated with a change in diet it can lead to long-term complications including osteoporosis, anemia, vitamin/mineral deficiency and cancer.

What is gluten and what constitutes a gluten-free diet?

celiac_diseaseGluten is a protein found in certain grains. It is responsible for the elasticity in dough and structure in bread. The easiest way to remember which grains contain gluten is the acronym BROW: barley, rye, oats and wheat.

There is some debate regarding whether oats need to be completely eliminated from the diet in people with celiac disease. It is possible that some people may be able to tolerate small amounts of oats. However, since there is no way to determine if someone will be able to tolerate oats, and oats are frequently cross-contaminated with gluten, it is best for people with celiac disease to avoid oats.  Verdict: No go on the oats.

People who follow a gluten-free diet can consume starches including: corn, rice, potato, beans, quinoa, millet, buckwheat, arrowroot, and nut flours. It is important to pay attention to ingredients that are derived from gluten as well including malt, modified food starch and bran. A gluten free diet does allow for plenty of unprocessed foods including meat, fish, fruit, eggs, and vegetables.

With an increased awareness of celiac disease, manufacturers are now providing gluten-free versions of many foods including pasta, pizza, cookies etc. In addition, many restaurants now offer a gluten-free menu or gluten-free options.

Is it a good idea to follow a gluten-free diet if I don’t have celiac disease?

Not necessarily. While there is no question that people with celiac disease should follow a gluten-free diet, eliminating any type of food from your diet comes with some risks and thus it may not be a good idea if you don’t have celiac disease. Many people following a gluten-free diet turn to gluten-free processed items to fill in their cravings for bread, pasta and cookies. Gluten-free products are typically lower in fiber, B Vitamins, calcium, Vitamin D, zinc, iron, and magnesium when compared with products containing gluten. Switching from whole wheat bread or cereal to products made with rice or potato flour can lead to a lack in fiber intake, causing constipation. In addition, many gluten-free items are higher in fat than their non-gluten-free counterparts including sweets like cookies, cakes and crackers.

On the other hand, there is one advantage to following a gluten-free diet: Individuals who follow a gluten-free diet are less likely to consume processed foods since many processed foods contain gluten. Yeah, it’s a stretch but we’re trying to stay positive.  Also remember, you don’t have to go gluten-free to keep your diet healthy.  Keep it well balanced with fruits, vegetables, lean proteins and whole grains!


10 2009

Know thy Liquor: What’s in a Drink?

by Leah Frankel, MS, RD |

Alcoholic DrinksIt’s Friday afternoon and after a long week of work you head to the bar for happy hour and order a margarita, but did you ever stop to think about what’s really in that drink? Drinks can be filled with hidden calories, sugar and sometimes even fat. So does that mean you should cut out drinking all together? Not necessarily. With a little help you should be able to navigate your way through a bar menu and enjoy your drink as a cocktail connoisseur!

Before we understand the nutrition in our drinks it’s important to understand what constitutes a “drink”:

  • 0.5 ounce of pure alcohol

  • 12 oz of beer (5% w/v)

  • 5 oz wine

  • 1.5 oz whiskey, rum, vodka etc. (80-proof)

alcohol breakdown

So when you’re out enjoying $1 pint night, after 3 pints (16 oz x 3 = 48 oz) you’ve actually had 4 drinks. Remember that moderate drinking is defined as one drink a day for women and two drinks a day for men, and no you can’t “save” up all your drinks for one night.  We appreciate your creative, “outside the box” thinking, however.

To better understand where the calories in your drink come from, it is essential to have some basic knowledge of where calories come from in general. In our diet there are three macronutrients that provide calories: carbohydrates, protein and fat. Both carbohydrates and protein provide 4 calories (kcal) per gram(g) (of carbohydrate or protein), but fat provides 9 calories per gram of fat. For instance if your cookie contained 10 grams of carbohydrates, 2 grams of protein and 5 grams of fat it would have a total of 93 calories.

Breaking that down:  (10 g carb x 4 kcal/g carb4) + (2 g protein x 4 kcal/g protein) + (5 g fat x 9 kcal/g fat)

Pure alcohol has 7 kcal per gram, which means it provides more calories per gram than protein or carbohydrates but less than fat.  However, most drinks, luckily, aren’t 100% alcohol (which would be 200 proof).

beer bellyWe know that alcohol has more calories that protein or carbs, but that’s not the only reason a few drinks can add up to a lot of calories. Mixers, whether it’s soda, juice, margarita mix or flavored liqueur, can add excess calories to a drink. It’s not uncommon to find martinis that look and sound more like desserts, consisting of creamy liqueurs and sugar-rimmed glasses. Many of these mixed drinks are also being supersized and can have up to 1,000 calories!

To play devil’s advocate, even though drinking can add inches to our waistline there are some benefits associated with moderate drinking. Moderate drinking (1 drink for women or 2 for men per day) has been linked with a reduced risk of heart disease and heart attacks in the elderly, if they are at increased risk for developing heart disease. Wine contains potassium which may help lower blood pressure, as well as flavonoids and resveratrol. Flavonoids have an antioxidant property which can help prevent blood clots and the formation of plaques in your arties. Resveratrol is found in grape skins and seeds and has been shown to increase HDL (“good”) cholesterol and prevent blood clots. Alcohol has been shown to improve appetite in the elderly or other populations with a poor appetite (enter drunk muchies).

Now to the magic numbers you’ve been waiting for…

Calories in common drinks (Note: Calories vary slightly depending on brand):

  • 12 oz regular beer: 150 kcalMargarita

  • 12 oz light beer: 100 kcal

  • 5 oz wine: 100 kcal

  • 12 oz wine cooler: 180 kcal

  • 1.5 oz 80 proof spirit (not including mixers): 100 kcal

  • 1.5 oz cordial or liqueur (not including mixers): 160 kcal

  • 8 oz Margarita: 336 kcal

  • 9 oz Pina Colada: 460 kcal

  • 6 oz Long Island Ice Tea: 350 kcal

Is it possible to enjoy a drink and watch your waistline?  Of course it is!

Healthy Drinking Tips:

  • Alternate your alcoholic drink with water or a low calorie non-alcoholic drink

  • Use low calorie or diet mixers whenever possible

  • Plan your alcohol consumption into your daily calorie intake like you would with food

  • Stay away from “sweet” drinks, the added flavored liqueurs are primarily sugar

  • Dilute your drink with club soda or sparkling water


10 2009

The Hangover: Make it go away!

by Joshua Goldman, MD, MBA

the-hangover-wallpaperIt’s 9am and you’re cuddling your fire truck-esk alarm as you wake up to realize that you’re already an hour late for work.  You sit up and immediately notice the pounding sensation in your head, reminding you of your alcoholic escapades from the night before.  It’s official, you’re hungover.  The question is “What do you do now?”  We’re here to offer a few suggestions to help mitigate hangovers with some preventive steps before and during drinking, and some hangover-relieving tricks for the morning after.

Rather than accepting a hangover as the unfortunate side effect of a night out, there are a few tricks to help reduce the likelihood of ever becoming hungover.  Here’s our recommendations:

  • Drink slowly (obviously).  Frank the Tank is well on his way to a hangover after beer bong number 3.

  • Eat a full meal before drinking.  One study showed that glucose (which your body gets from food) effectively inhibits the metabolic disturbances induced by ethanol (i.e. a hangover).  The glucose in the meal also helps build up a store of energy so you won’t feel as weak the next day.

  • Drink in moderation. For those of you who aren’t sure what this means, The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day (one drink = a 12-ounce bottle of beer, a 4-ounce glass of wine, or a 1 1/2-ounce shot of liquor).  WaterAlso, the average individual can process one of these alcoholic beverages per hour.  Two drinks in one hour makes you one drink drunk.  Five drinks in two hours make you three drinks drunk.  You follow?

  • Drink a glass of water in between alcoholic drinks. This will help you drink less alcohol while simultaneously hydrating you (remember that a large part of your hangover is dehydration).

We realize that these tips are not ideal for those of you looking to get a little wild during your night out on the town.  As such, here are some additional tips to help mitigate the pounding in your head that you will experience the next morning once the hangover has set in:

  • Replace all the fluids and electrolytes you lost. If you remember, alcohol is Rehydrating with Electrolyte Drinkdehydrating and, unfortunately, you lose a lot of electrolytes along with the fluid (mainly sodium, potassium, and magnessium).  There are a number of great electrolyte drinks (pedialyte, Gatorade Performance, Powerade, Smart Water, etc.) that can replace both water and electrolytes simultaneously.  If you prefer a more natural approach, water plus bananas and a salty snack can help replenish your fluids as well as the missing sodium and potassium.  You can also take a multivitamin to rapidly (and thoroughly) get all your needed minerals back on board.

  • Replenish your energy stores. Consume foods and drinks that contain fructose (such as fruit juice or honey). There is some evidence that fructose will help your body break down and eliminate the alcohol faster.  Also, remember that alcohol inhibits your body’s production of glucose (your body’s form of gasoline).  When you wake up the next morning, your body is in desperate need of glucose replenishment.  A healthy carbohydrate-rich meal will quickly replenish these glucose stores.  Add some protein (think eggs) to breakfast and you can simultaneously boost your body’s cysteine level which will help counteract the brutal effects of alcohol’s metabolites.

  • Stock up on Vitamin C. Vitamin C has been shown to increase your body’s level of glutathione, the chemical needed to breakdown alcohol that becomes depleted in hangovers (1).  Vitamin C also neutralizes free radicals (which are formed at an increasing rate during drinking) that can cause damage to your body in the aftermath of a night out.  Oranges or those tasty chewable Vitamin C tablet will both do the trick.

  • Get your liver back on track. In addition to Vitamin C, milk thistle is an excellent way to replace your liver’s glutathione stores (which you need to process all the alcohol you consumed).  You can also find glutathione in asparagus and spinach.  Eggs are rich in cysteine which is a building block of glutathione.  Vitamin B6, riboflavin, and selenium are required in the manufacture of glutathione (they can be found in most multivitamins) and are essential to getting your body back to normal.

  • Upset StomachBe gentle on your stomach. You spent a good portion of last night dumping the equivalent of battery acid into your digestive track.  It’s understandable that it’s not feeling so hot the next morning.  The alcohol you consume irritates the lining of your digestive track much like the way it is irritated with very spicy foods.  This irritation causes you to feel nauseous and makes it hard to eat.  To help your stomach heal, eat bland foods the next day and save the spicy peppers and chili sauce for another day.  If your upset stomach is sucking your will to live, try Pepto-Bismol (it acts as a temporary stomach lining protecting your irritated gut from its natural acid while it heals…yes, the picture on the pink bottle is true).

  • Get plenty of rest. Alcohol inhibits your ability to reach your most deep and restful phase of sleep.  As such, you will be tired regardless of the number of hours you spent in bed.  Try to take a midday nap to allow your body time to catch up on some much needed deep sleep.

  • Take an aspirin. Aspirin (as well as ibuprofen and naproxen) has been proven to be effective in minimizing the pain in many types of headaches including a hangover headache.  Avoid taking any medications for your hangover that contain acetaminophen (such as Tylenol), because it may cause liver damage when combined with alcohol.  Your liver is already angry; no need to push it over the edge with Tylenol.

House Call, MD’s Hypothetical Hangover Remedy:

In simplified terms, this is our best (scientifically supported) guess at what can get you back on track:

  1. A carbohydrate-rich breakfast with eggs on the side (but remember to keep it bland)

  2. Electrolyte-enhanced fluids…lots of them

  3. A multivitamin (make sure it has Vit B6, B12, riboflavin, and selenium)

  4. Vitamin C – Consume any way you’d like (OJ or oranges will kill two birds with one stone)

  5. Aspirin – One dose in the AM is probably all you need

  6. Rest – Try an afternoon nap…you look like you need it.

1. Johnston CJ, Meyer CG, Srilakshmi JC. Vitamin C elevates red blood cell glutathione in healthy adults. Am J Clin Nutr 58:103-5, 1993
2. Kera Y, Ohbora Y, Komura S (1989). “Buthionine sulfoximine inhibition of glutathione biosynthesis enhances hepatic lipid peroxidation in rats during acute ethanol intoxication”. Alcohol Alcohol. 24 (6): 519–24.


10 2009

Swine-Flu-Palooza!: Demystifying the H1N1 Virus

by Sarah Gilman-Short, MD 2010

Baby & Swine FluSo, unless you’ve been lucky enough to have spent the last, oh, six months living in a cabin nestled deep in the forests of Massachusetts, keeping track of your daily expenditures and reading classical Greek literature and Henry David Thoreau’s Walden, you’ve probably heard about Swine Flu. And, unless you are a much more rational person than I (which isn’t saying much), you’ve probably had at least one episode of terror in which you’ve been convinced that you have contracted the virus and will die imminently. In this article, we will attempt to sort through the mounds of information we’ve discovered and give you our takeaways what to do the next time your paranoia strikes because, as we all know, that paranoia has been known to recur.

What is this H1N1 business?

Swine Flu Virus EvolutionSwine flu = H1N1 Influenza. It was initially called Swine Flu because scientists thought that the virus looked genetically similar to influenza viruses that commonly infects pigs.  However, further study has shown that this is not correct, so the name was changed to H1N1, which is definitely less catchy, however kinder to the pigs who have gotten a bad rap recently (Note Egypt’s approach to eradicating swine flu).  The virus’ new name is much more scientific in nature.  All flu viruses (including those that affect humans, birds, and pigs) have an “H” and an “N” in the name, each followed by a number (the avian flu strain that has been worrying people is H5N1, for example).  The letters refer to two proteins (hemagglutinin and neuraminidase) on the surface of the virus. The different numbers refer to slight variations in the form of each protein. These variations are important because our immune system hones in on those proteins to attack the virus.

Okay, overwhelm me with numbers.

You asked for it, my imaginary inquisitive friend. According to the WHO, as of September 2009, there have been more than 300,000 laboratory confirmed cases of pandemic influenza H1N1, and 3,917 deaths in the 191 countries reporting.  Does that seem like a lot?  When a paranoid TV reporter relays the numbers it sure does.  But let’s talk about a little thing called perspective.  During the regular seasonal flu, an average of 36,000 people die from flu-related complications and more than 200,000 people are hospitalized, almost ten times as many people affected as H1N1.  In addition, approximately 250 million people die of malaria every year. Why don’t we harness some of our pig rage and redirect it towards mosquitoes (these are the nasty creatures spreading malaria around the world, one bite at a time).

Terror!  I think I have it!  Wait, how do I know if I have it?

The symptoms are surprisingly similar to your traditional seasonal flu which makes it’s diagnosis even more difficult.  Some of your symptoms may include:

  • Swine SymptomsFever (usually greater than 100.4 degrees)

  • Cough

  • Sore throat

  • Runny or stuffy nose

  • Body aches all over

  • Headache

  • Chills

  • Fatigue

If you do have it, you’re going to feel crappy in general.   You might also have vomiting and diarrhea.   Yeah, the flu sucks.  We’re really sorry.  One of the most distinguishing features of swine flu from the regular flu is an extreme fever that lasts for many days (we’re talking over 100.4 degrees).  Even then, this could be a sign of a bacterial infection as opposed to a virus.  Any sustained fever over 100.4 degrees warrants a visit to the doctor.  On that same note, do not take your temperature after a long work out in the middle of the day…you will be warm, we promise, it’s science.

Wait!  Aren’t you going to do anything?!

Most people who have the flu, even if it’s the H1N1, don’t need anything but sympathy and TLC from their doctor or self-appointed nurse (which we physicians are happy to provide, as long as it’s over the phone during daylight hours). You need to stay home for at least 24 hours after your fever goes away, drink liquids, rest up, and wash your hands a lot so you don’t spread your nasty bug. We know it’s boring, but if you need something to watch, we recommend Twin Peaks or Californication. Both fabulous shows.  If you want some more medically-minded sympathy, try House.

How do I know if I’m “most people?” I’m feeling pretty special right now.

PregnantOf course you are, and that’s why we love you.  If you’re older than age 65 or younger than age 5 (so precocious), pregnant, or have a chronic medical condition such as diabetes, heart disease, asthma and kidney disease, you are more likely to have more severe symptoms with the flu. You should definitely check in with your doctor if you have the symptoms we mentioned above and fall into one of these groups. Better to be safe than sorry.  Your doctor can prescribe an antiviral medication (two examples of antivirals are oseltamivir or zanamivir) to help minimize the effects of the flu and keep you from becoming seriously ill.

I think I’m getting really sick.  When should I be worried?

The reasons that you would call 911 or go to the ER for the H1N1 flu are essentially the same reasons you would seek emergency help in general. If have difficulty breathing, chest pain, your lips turn blue, you’re vomiting so much you can’t keep liquids down, you have a fever above 100.4 degrees for more than a day, or you’re so dehydrated you feel dizzy when you stand up or can’t urinate, you should worry. Get yourself to a hospital, stat! General hysteria is not recommended, but really sick people should go to hospitals.

Okay, now I’m scared again.  How do I prevent this all from happening?

Now’s the time to unleash your inner germaphobe.  Here are some general recommendations to prevent the spread of viral illnesses (yes, we realize they are really obvious…we just thought we should remind you):

  • Preventing Swine Flu with StyleWash your hands a lot

  • Avoid contact with sick people

  • Give the evil eye to that coughing man on the subway

  • Avoid touching your eyes, nose, and mouth (Yes, you can acquire the flu through your eyes.  You can acquire the flu through any mucous membrane for that matter so watch where you put your hands)

  • You can get the vaccine when it comes out this month (expected October 6th, 2009, Vaccine Info)

This year, you can get two vaccines: the regular flu vaccine (the one that comes out every year), and the specific H1N1 vaccine.  Many places will offer them both on the same day. The H1N1 vaccine is scheduled to be released to the public October 6th in a rolling fashion.  People at increased risk of infection or with a great risk of severe illness (including pregnant women, health care professionals, people with chronic disease, and anyone between the ages of 6 months and 24 years old) should get the vaccine. Again, better to be safe than sorry.  If you’re worried about the vaccine killing you, stay tuned for our article busting that ridiculous myth.  Yes, it’s science.

Your “Swine” Flu Takeaways: Get vaccinated. Don’t stress out. Don’t kill pigs…Kill mosquitoes instead.


10 2009

Cholesterol-Lowering Essentials: The future of Cholesterol Management in a Simple Vitamin

by Leah Frankel, MS, RD

Fish with NiacinHypercholesterolemia (high cholesterol) affects 37.7 million Americans and is a major cause of cardiovascular disease (American Heart Association, 2005). Numerous methods are used to lower cholesterol including change in diet, exercise or use of medications (usually a type of drug called a statin.  You’ve seen them plaguing your primetime TV commercials). However, research suggests that a simple vitamin may actually help improve cholesterol levels.

Niacin, previously referred to as Vitamin B3, is important in the function of the digestive system, skin, nerves as well as metabolism. The RDI (Recommended Daily Intake) for niacin ranges from 14 mg/day (females 19-70) to 16 mg/day (males 19-70). Food sources of the B vitamin include: dairy, produce, fish, eggs, lean meats, nuts, legumes and enriched breads and cereals.

There are two forms of niacin: nicotinic acid and nicotinamide (no need to memorize these names…they will not be on the test at the end of the article). Both of these forms have the same function when taken in milligram doses. However, when nicotinic acid is taken in gram doses, it works as a cholesterol lowering drug.  The effect of nicotinic acid as a cholesterol-lowering agent was first seen in the middle of the 20th century when Rudolf Altschul noticed that giving rabbits nicotinic acid caused their cholesterol levels to lower (1). At this time he also discovered that nicotinamide had no effect on lowering cholesterol.

Cholesterol & ArteriesSo how does it work? At approximately the same time that nicotinic acid was discovered to lower cholesterol levels, free fatty acids were observed to be precursors of LDL (free fatty acids are converted into LDL and remember that LDL is the bad form of cholesterol.  We outline the different types of cholesterol below). Nicotinic acid was found to lower concentrations of free fatty acids in a matter of minutes, with an increase in free fatty acid levels back to normal levels in approximately an hour. Studies done in rats explained this observation, because nicotinic acid was shown to prevent the release of free fatty acids that were stored as fat (2). Therefore, nicotinic acid is believed to lower cholesterol by preventing fat from being turned into LDL.

The two types of cholesterol we are most familiar with are HDL (high density lipoprotein) and LDL (low density lipoprotein); HDL is commonly known as the “good” cholesterol and LDL as “bad” cholesterol. LDLs are produced by the liver and carry cholesterol and other lipids (fats) from the liver to different areas of the body, like muscles, tissues, organs, and the heart. HDL is produced by the liver to carry cholesterol and other lipids (fats) from tissues and organs back to the liver for recycling or degradation. Once it was determined that high HDL levels would lower the incidence of cardiovascular disease the early findings that nicotinic acid would raise HDL became of some importance. Nicotinic acid has the unique property of modifying each type of cholesterol in a way that is beneficial in reducing the risks of vascular disease. It not only lowers LDL, it raises the concentration of HDL which is unique to nicotinic acid, and very effective in changing your cholesterol mix for the better.

Due to the role of nicotinic acid as an HDL-raising drug, it is now being considered as a complementary drug to be used with statins or other LDL lowering drugs. Nicotinic acid treatment was shown to increase HDL levels by 21% (3). In an earlier trial, when nicotinic acid was given with statins, it was seen that there was an increase in HDL by almost 30%, and a lowering of LDL cholesterol by 25-40%…pretty good if you ask us.  Other studies using nicotinic acid in combination with statins have found that there is a significant clinical benefit because there is a reduction in both coronary artery disease events (i.e. heart attacks) and mortality (i.e. you die). This is thought to be due to the rise in HDL, which is only seen with nicotinic acid.

The biggest problem with the use of nicotinic acid in lowering cholesterol is the side effects. There are two major side effects seen in patients taking nicotinic acid:

  1. Flushing (You feel warm and get red in the face.  Imagine passing gas in the middle of a first date – that feeling)

  2. Increased uric acid in the blood

A prolonged-release formula of nicotinic acid, also known as extended-release or ER, has been created to help minimize the side effects.

NiacinSo should we be consuming greater amounts of niacin in our diet to help manage our cholesterol?  The answer for now, is probably not. The tolerable upper limit (what is considered a “safe upper limit”) for niacin is 35 mg/day and as noted above niacin only has a lipid lowering effect when taken in gram doses (10-fold higher than what is safe today).  While consuming extra niacin will probably not lead to healthier cholesterol levels in its current formulation the research between the effects of nicotinic acid and cholesterol levels are promising as pharmaceutical companies are currently creating new forms of nicotinic acid, which will hopefully have less side effects allowing for more extensive use.


10 2009

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