Sunday, April 21, 2013

True Or False: Glutamine For Glycogen Repletion. Enzymes Instead of NSAID. Drumming Burns More Kcal Than Jogging

Ever wondered how the "Modern-Day Samurai" of the Drummers of Japan keep in shape? Today's installment of True or False holds the answer to this and other questions ;-)
True or false? That's the title of this no longer new series at the Suppversity and it is the question I want to answer after you read the following three statements: (1) "You can use glutamine instead of carbs to replete your glycogen stores", (2) "The only ones who benefit from the use of enterically coated and purportedly systemically acting enzymes are the the manufacturers of respective supplements" and (3) "Drumming burns about as much energy as fast jogging"... hmm, I see you're scratching your head!?

Well, the unwritten rules of the game require that you make your prediction before you read the following paragraphs. So, true or false?

You can use glutamine instead of carbs to replete your glycogen stores

True. There is yet one big caveat. The gluconeogenic pathway, i.e. the transformation process of glutamine to glucose, delivers the lion's share of its end product directly to liver (Meijer. 1992). Therefore glutamine is rather an adjunct (to feed the liver) than a true carbohydrate alternative.

And what about Sustamine(R) & co? Whether the use of allegedly superior glutamine dipeptides like alanyl glutamine does provide an additional edge remains questionable. Aside from a slightly more pronounced increase in muscle glutamine with chronic Ala-Glu supplementation (Rogero. 2006), there is little evidence for theoretical and almost no evidence for real-world advantages of combining our bodies favorite gluconeogenic amino acids, glutamine and alanine into a dipeptide. A detailed analysis of the available literature, would yet be a topic for another installment of True or False - if you want that, suggest "Alanyl-glutamine is well worth the extra bucks", as a topic for a future installment in the comment area ;-)
What is yet worth mentioning is that the combination of carbohydrates and glutamine has been shown to actively promote the storage of skeletal muscle glycogen (Bowtell JL. 1999). Slightly superior effects than for l-glutamine alone have yet been observed by Hall et al. who supplied the participants of their study with 0.8g/kg glucose and iso-caloric amounts of whey or wheat hydrosolates (wheat is naturally high in glutamine; Hall. 1998).
Figure 1: Relative increase in muscle glycogen after the workout (Hall. 1998)
As the data in figure 1 goes to show you, both, whey and wheat hydrolysate shoveled an allegedly non-significantly greater amount of glycogen into the skeletal muscle of eight well-trained male cyclists in the course of the 3h recovery phase after a combined HIT glycogen depletion + HIIT workout - an effect that was probably facilitated by the ~2x higher increase in insulin.

Bottom line: I guess, no one of you will want to miss on the protein anabolic effects of a whey protein after your workout, right? Against that background the replacement of the latter with glutamine is not really an option. The existing increases in glycogen synthesis due to glutamine are thus practically irrelevant, since you will achieve just the same (if not superior) results with a complete protein source.

Systemic enzyme therapy is only beneficial for the manufacturers of respective supplements

Not necessarily. While the available literature is scarce and in large parts either official sponsored or suspiciously focused on certain products, the results would suggest that enzyme complexes such as Mucos Pharma's Phlogenzym, an enteric-coated formula that contains pancreatin (100mg), trypsin (24mg), chymotrypsin (1mg), bromelain (45mg), papain (40mg) and rutin (50mg) is on par if not superior to low-dose pharmacological therapies with NSAIDs (e.g. 2x50mg of diclofenac; cf. Tilwe. 2001).
Figure 2: Relative improvements in pain and joint tenderness and swelling after seven weeks on enzymes vs. conventional NSAID treatment in fifty 40-75year old subjects (Tilwe. 2001)
Similar results have been reported by Akhtar et al. and Singer, Singer and Oberleitner in 2004 and 2001, respectively. Contrary to Tilwe et al., Singer and his Austrian colleagues also observed that the beneficial effects of Phlogenzym lasted for three weeks after the therapy was ceased. The effects of the diclofenac control (identical dosing as in Tilwe, 2001), on the other hand, wore off immediately after the 63 patients in the Singer study stopped taking the drug.

No cheap alternatives? Scientific evidence for the efficacy of alternative non-enterically-coated enzyme preparations for the treatment of osteoarthritis & co is totally lacking. There are however some generic preparations which should have very similar effects. Selazym N, for example, has a similar ingredient profile, added selenium and costs less than 50% of the "original" (~$43 per month).
Despite the fact that the data in figure 2 would suggest that Phlogenzym should be the treatment of choice, the patients and physicians ranked diclofenac slightly higher on the efficacy and tolerability scale. Moreover, the authors of a Cocrane Review on the issue point out that
"In spite of the large number of publications in this area, there are few randomized controlled trials. Furthermore, most trials comparing two or more NSAIDs suffer from substantial design errors [...] Had studies employed appropriate doses of comparator drug, most would have been sufficiently powerful to detect clinically important differences in efficacy." (Watson. 2000; review awaiting update)
In view of the negative side effects of NSAIDs, it still appears as if the "natural" enzyme therapy would be the preferred first choice for everyone with osteoarthritic pain. If that does not work out, you can still resort to the classic NSAID-based therapy regimen.

Bottom line: Despite promising results in some studies, the fact that larger scale studies investigating the effects of Phlogenzyme on lateral ankle ligament injury (Kerkhoffs. 2004) could not confirm previously observed benefits in studies conducted by Hollmann et al. (1998) and Van Dijk (1994) support the notion that the ~$95 a month "on" Phlogenzyme at the respective effective dose of 6 tabs per day would cost you (estimate based on current price of €72.50 here in Germany) are wise-spent only if you suffer from chronic pain. Healthy physical culturists, on the other hand, should rather spend their money on other stuff.

Drumming burns about as much energy as fast jogging

It's about time for spring cleaning anyway: So if you are not into drumming, even cleaning can easily "burn" 1/4 of the calories you'd be expending on a jog/run + it has to be done, anyways (Puyau. 2004)
True! You know I am no advocate of calorie counting - not with respect to the energy content of foods and even less as far as the amount of energy you burn during a workout is concerned. If we do yet assume, ... just hypothetically obviously, that you want to burn as much energy as possible within the next 60 minutes, you would be ill-advised to go for a light jog if you got a drum kit in your basement.

As a soon-to-be-published paper from the UK shows, the estimated energy expenditure of a drummer during a live concert performance amounts to 623±168 kcal/h (8.1±2.2 METs). This is at least on par with a very paced jog.

And if you also take into account that the subjects of the study achieved peak heart rates of 186±16 bpm and 78.7±8.3% of their cycle ergometer peak oxygen uptake, the drums do probably even have an edge over a regular jog as far as their conditioning effects are concerned (De La Rue. 2013).

Bottom line: The scientists are absolutely right, when they write that "Rock/pop drumming should be considered as a viable alternative to more traditional forms of physical activity." And guess what, drumming is by far not the only largely underestimated "sportive activity" - other much more common activities, like my very own bike rides to the job, for example (learn more in the last installment of the Science Round Up) will likewise effect your general fitness level, energy expenditure and body composition - and that in a much more sustainable way than the "beat-me up" workouts of the average "It's quitting time!" gymbro.

And what's more, it's the regular, not the extraordinary energy expenditure that can cut your risk of biting the dust prematurely by almost 70%. According to a 2006 paper from the Journal of the American Medical Association (JAMA), for example, spending an additional 287kcal/day on "free-living activity" (that's 27min of drumming) can reduce the mortality risk of elderly individuals by -32% (Manini. 2006)!



As unfortunate as this may sound, but that's it already! Trust me, I do enjoy these "True or False" sessions about as much as you (hopefully) do, but one thing of which I know that it's true even without having to apply the sniff-test is that you'd not be waiting for the next installment to be published that eagerly, if I put out 10 of these items every day ;-) So be patient and enjoy the rest of your weekend - there are going to be more truths revealed and myths to be busted in the future.

References:
  • Akhtar NM, Naseer R, Farooqi AZ, Aziz W, Nazir M. Oral enzyme combination versus diclofenac in the treatment of osteoarthritis of the knee--a double-blind prospective randomized study. Clin Rheumatol. 2004 Oct;23(5):410-5. 
  • Bowtell JL, Gelly K, Jackman ML, Patel A, Simeoni M, Rennie MJ. Effect of oral glutamine on whole body carbohydrate storage during recovery from exhaustive exercise. J Appl Physiol. 1999 Jun;86(6):1770-7.
  • De La Rue SE, Draper SB, Potter CR, Smith MS. Energy Expenditure in Rock/Pop Drumming. Int J Sports Med. 2013 Apr 4. [Epub ahead of print]
  • Hollmann W. Efficacy and safety of hydrolytic enzymes and rutin in patients with distortions of the ankle joint. Clinical study report MU-694411, Idv-Datenanalyse und Versuchsplanung Gauting, 1998.
  • Kerkhoffs GM, Struijs PA, de Wit C, et al. A double blind, randomised, parallel group study on the effi cacy and safety of treating acute lateral ankle sprain with oral hydrolytic enzymes. Br J Sports Med 2004;38:431.
  • Manini TM, Everhart JE, Patel KV, Schoeller DA, Colbert LH, Visser M, Tylavsky F, Bauer DC, Goodpaster BH, Harris TB. Daily activity energy expenditure and mortality among older adults. JAMA. 2006 Jul 12;296(2):171-9. 
  • Meijer AJ, Baquet A, Gustafson L, van Woerkom GM, Hue L. Mechanism of activation of liver glycogen synthase by swelling. J Biol Chem. 1992 Mar 25;267(9):5823-8.
  • Puyau MR, Adolph AL, Vohra FA, Zakeri I, Butte NF. Prediction of activity energy expenditure using accelerometers in children. Med Sci Sports Exerc. 2004 Sep;36(9):1625-31.
  • Rogero MM, Tirapegui J, Pedrosa RG, Castro IA, Pires IS. Effect of alanyl-glutamine supplementation on plasma and tissue glutamine concentrations in rats submitted to exhaustive exercise. Nutrition. 2006 May;22(5):564-71.
  • Singer F, Singer C, Oberleitner H. Phlogenzym versus diclofenac in the treatment of activated osteoarthritis of the knee. A double blind prospective randomized study. Int J Immunotherapy 2001;XVII:135–41.
  • Tilwe GH, Beria S, Turakhia NH, Daftary GV, Schiess W. Efficacy and tolerability of oral enzyme therapy as compared to diclofenac in active osteoarthrosis of knee joint: an open randomized controlled clinical trial. J Assoc Physicians India. 2001 Jun;49:617-21.
  • Van Dijk CN. A double blind comparative study on the efficacy of MU-410 vs. placebo in patients with acute disruption of the anterior fi bulotalar ligament. Study Nr. 4903XV, Amsterdam, 1994.
  • Watson MC, Brookes ST, Kirwan JR, Faulkner A. Non-aspirin, non-steroidal anti-inflammatory drugs for osteoarthritis of the knee. Cochrane Database Syst Rev. 2000;(2):CD000142.