Monday, May 29, 2017

Two New Papers, Review & RCT, Suggest: Nutrient Timing May Boost Lean Mass Gains by ~70%, ΔBF% by Factor 10+

"Hon, are you crazy? Don't check your Facebook or WhatsApp now, get the protein shake in, immediately" - After reading about the latest (unfortunately partly yet unpublished) research some trainers may actually say just that to their female clients if they don't gulp down their protein shakes immediately after their workout ;-)
There's no question that the prevalent notion that "if you don't get those 30+ grams of whey protein in, within the first 30 minutes after your workouts, you've wasted your time in the gym" is absolutely bogus, the last months have seen the publication/announcement of a handful of studies that support the notion that nutrient timing does, after all, still matter for gains and recovery.

As a SuppVersity reader, you will know both: That the majority of hitherto published research "refute the commonly held belief that the timing of protein intake in and around a training session is critical to muscular adaptations" (Schoenfeld 2013).

As a SuppVersity reader you will yet also be aware of the intriguing results of Hiroyasu Mori's 2014 study which, being published after the previously cited meta-analysis by Schoenfeld, Aragon and Krieger, suggests that one's individual training status may well determine whether timing protein supplementation around workouts will yield additional benefits or not - with athletes seeing benefits where noobs won't.
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As previously hinted at, I have been able to report on a number of studies in the SuppVersity Facebook News, recently, which seem to support the notion that timing does - when all's said and done - matter. More specifically, ...

Supplementing protein between meals may increase your lean mass gains 

Support for the notion that rekindling the protein synthesis by administering a protein shake between meals will increase the lean mass gains of resistance trained gymrats and minimize the amount of fat they gain over an average training period of 12 weeks comes from the Purdue University (Hudson 2017a).
Figure 1: Here's what Hudson et al. did before they arrived at the conclusion that in-between meal protein supplementation beats consuming protein supplements with meals if your goal is to gain lean mass.
In their systematic review, Hudson et al. investigated whether consuming a protein-rich supplement between meals (BET) versus with meals (WITH) would differentially influence adaptive changes in body composition while performing resistance training. 1938 articles were identified with PubMed, Scopus, Cochrane, and CINAHL using the keywords “dietary protein,” “body composition,” “muscle strength,” and “lean mass.” Data from the outcome variables whole body mass, lean mass, and fat mass were collected from randomized controlled trials assessing the effect of consuming protein-rich supplements during resistance training (> 6 to ≤ 36 wk; median: 12 wk).
Hudson et al. already produced data refuting their review... at least, at first sight, it would appear as if their second as of yet unpublished study would do just that, but if you look closely there are several important differences between the average study in the review (and the second study discussed further below) and Hudson's 16-wk RCT in which the authors sought to assess the effects of within-day protein intake distribution on dietary energy restriction and resistance-training-induced changes in body composition and cardio-metabolic health indexes.

Hudson's protein distribution while dieting study which didn't find a sign. difference between even and skewed protein intake IMHO doesn't refute the results of their latest review (Hudson 2017b). Why? There are three crucial factors to consider (see text in box).
Difference #1 obviously is that the 41 men and women (mean ± SEM; age: 35 ± 2 y; BMI: 31.5 ± 0.5 kg/m²), who performed resistance training 3 times/wk for 16 wk as part of this randomized, parallel-design study, consumed an energy restricted diet that with 750 kcal/d less energy than they requirement. Difference #2 is that the subjects consumed only 90 g protein/day in total - which is hardly enough to maintain muscle mass while dieting. And difference #3 is that the protein wasn't strategically timed around workouts in either the skewed (10 g breakfast, 20 g lunch, 60 g dinner; n=20) or even (30 g each at breakfast, lunch, and dinner; n=21) distribution pattern. Accordingly, I don't think that the results refute the previously made claim that more recent studies suggest that protein timing may well matter - especially in study populations with more training experience than the noobs in Hudson 2017b.
Thirty randomized controlled trials resulting in 55 individual groups met the inclusion criteria and were included in this review. If you take a look a the study characteristics it turns out that ...
  • the amount of protein that was supplemented ranged from 10 to 113 g protein/d in the between meals (BET | mean ± SD; 48 ± 26 g/d (n=40)) and 10 to 75 g/d in the with meals groups (WITH | 32 ± 23 g/d (n=15))
  • the frequency of supplementation ranged from 1–3 times daily in the BET and WITH groups (mean ± SD; 1 dose/d: BET: 37 ± 22 g protein/dose (n =18), WITH: 15 ± 5 g protein/dose (n=7); 2 doses/d: BET: 22 ± 10 g protein/dose (n=11), WITH: 19 ± 7 g protein/dose (n=5); 3 doses/d; BET: 24 ± 7 g protein/dose (n=11), WITH: 25 ± 0 g protein/dose (n=3))
Now, the methodological differences between studies unquestionably limit their comparability, but it is still quite telling that ...
  • supplementing protein in-between meals (BET) lead to increased mass gains in 73% of the studies, while adding it to meals (WITH) yielded extra gains in only 53% of the studies; 
  • subjects who consumed their protein shakes/supplements between meals were 5% more likely to make lean mass gains, in general, and 3.7x more likely to gain more than 1.5kg of lean mass (52% in BET vs. 14% in WITH group); 
  • 'only' 85% of BET group increased their lean-to-fat mass ratio (=reduced their body fat percentage significantly) compared to 100% of WITH groups - an observation that's probably a result of the fact that consuming the protein supplements between meals was more likely to increase the subjects' fat mass (73% in the BET groups gained body fat, but only 53% in the WITH group)
In spite of the potential issue with increased fat gain (probably due to an overall increased calorie intake, because the BET group didn't have the same immediate satiety effect that would suppress food intake during a meal we probably saw in the WITH trials), Hudson et al. are right to conclude that "consuming protein-rich supplements between meals was apparently more effective" compared to a 'consume your protein with meals'-strategy.

Supplementing protein before and after workouts appears to augment size and strength gains

Conducted in a similar subject group as half of the previously cited Mori study, namely in twenty-three recreational male bodybuilders who (a) had no current or past history of anabolic steroid use, (b) had been training consistently (i.e., 3-5 days per week) for the previous six months, (c) submitted a detailed description of their current training program, (d) had not ingested any ergogenic supplement for 12-weeks prior to the start of supplementation, and (e) agreed not to ingest any other nutritional supplements, or nonprescription drugs that may affect muscle growth or the
ability to train intensely during the study, the study found that...
"[s]upplement-timing represents a simple but effective strategy that enhances the adaptations that are desired from RE-training." (Coura 2017).
Before and after the 10-week intervention the scientists assessed the strength and body composition (using DEXA scans) response of their "bodybuilders" to a standardized resistance training workout designed to "specifically to increase strength and muscle size" (Coura 2017), wich consisted of high-intensity (overload) workouts using mostly compound exercises with free weights.
"Training intensity for the program was determined using repetition maximums (RM) from strength tests. Strength assessments consisted of the maximal weight that could be lifted once (1RM) in three weight training exercises: barbell bench press, deadlift and squat. Participants were required to successfully lift each weight before attempting a heavier weight. Training intensity for the program was determined using repetition maximums (RM) from strength tests. Once a designated RM was reached, the participants were encouraged by the trainer to increase the weight used" (Coura 2017)
This progressive overload program was divided into 3 phases, Preparatory (70-75% of 1RM), Overload Phase-1 (80-85% of 1RM), and Overload Phase-2 (90-95% of 1RM).
Update -- There's a "problem" with the Coura-study: While it was (at least temporarily) published as an individual paper, it appears as if Coura et al. simply copied the results from a previously published study by Cribb et al. With that being said. The data (and also their conclusions) are still valid. I am curious if we're going to learn more about what appears to be an extremely cheeky attempt at scientific fraud. In that case, I will update the article, again.
During all three of them, the subjects consumed identical protein, creatine plus carbohydrate supplements either
  • PRE-POST, i.e. just before commencing and straight after finishing workout, or
  • MOR-EVE, i.e. in the morning before breakfast and evening before sleep,... 
on each of their four workout days per week. The supplement of which subjects in both groups consumed the same amount of 1g/kg body weight twice a day, but - as previously highlighted - at different time points, contained (per 100g), 40g protein (from whey isolate), 43g carbohydrate (glucose), <0.5g fat, 7g CrM and was provided by AST Sport Science, Golden, Colorado, USA. In total, an 80kg participant would thus consume 32g protein, 34.4g carbohydrate, <0.4 fat and a 5.6g dose of CrM in each serving (a total of 1124kJ). As the authors explain, "the chosen supplement dose was based on previously reported intakes of this population and is similar to previous studies that involved protein or CrM supplementation close to RE" (Coura 2017).
Figure 2: Since I could not find a supplement that contained protein, carbs, and creatine at the given ratio in the current AST arsenal, I assume that the authors mixed the supplement from individual products yielding the given amounts of protein (32 g), carbohydrate (34.4g), fat (0.4g) and creatine monohydrate (5.6g) per serving.
Needless to say that the PRE-POST group ate and trained at similar times to the MOR-EVE group so that the scientists were able to effectively isolate the effect of supplement timing on the training outcomes of their AST-supported (AST provided only the supplements) 10-week study.
Figure 3: Body composition changes and changes in CSA (fiber types-I, IIa, and IIx)
*greater change compared to MOR-EVE (P < 0.05 | Coura 2017)
Outcomes of which you've previously read in the quote from the scientists' conclusion that they clearly suggest a superior effect of PRE-POST vs. MOR-EVE supplementation of this simple nutrient blend. A brief glimpse at the data in Figure 3 also shows that the PRE-POST strategy also increased the improvements in body composition, because it didn't just maximize the increase in lean mass gains (including the increased fiber size you see in Figure 2, right), but also reduced the already marginal fat gain into a ~1lbs loss of body fat.
If you didn't do it already, I would suggest that it's time to revisit my analysis of Mori's 2014 study wich shows improvements in net protein balance with protein timing + carbohydrate timing only in trained (here bodybuilding), yet not in untrained subjects | read more.
What should I know? With the recent study by Coura et al. (2017) we have study #2 suggesting that the popular practice of nutrient timing is useful - if not for training noobs - then for people with a significant history of strength training will benefit significantly from strategically supplementing not just with protein, but also with creatine and carbohydrate around workouts.

Wait a moment! That creatine and protein will augment your strength gains is not news, is it? Of course, it isn't. What is news, though, is that the review by Hudson and the RCT by Coura et al. show that the effects of protein or protein + creatine supps appear indeed to depend on their timing.

With the Coura study being #2 on a list of RCTs that suggest hat this timing effect may be most (if not only) important for seasoned strength trainees, it would be interesting to see future studies confirm whether training experience may indeed explain why the average protein timing study in Schoenfeld's, Aragon's and Krieger's often-cited 2013 meta-analysis found no advantage of timing protein/nutrient intake in the vicinity of your workouts. For you that means that it certainly won't hurt if you (a) make sure to get more than 3x20g+ boluses of protein to keep the meal-induced protein synthesis elevated during your feeding window (e.g. with two in-between meal protein shakes) and (b) place the corresponding extra-meals in the time before and after your workouts | Comment!
  • Cribb, Paul J., and Alan Hayes. "Effects of supplement-timing and resistance exercise on skeletal muscle hypertrophy." Medicine & Science in Sports & Exercise 38.11 (2006): 1918-1925.
  • Coura, Jim; Anbour, Mellissa. "Greater Muscle Hypertrophy During Resistance Training with Supplement Strategy." Drugs & Supplements in Exercise & Sport 1 (2017): 20-25.
  • Hudson, et al. "Effects of Consuming Protein-rich Supplements Between or With Meals on Changes in Body Composition with Resistance Training: A Systematic Review of Randomized Controlled Trials." The FASEB Journal 31.1 Supplement (2017a): 443-5.
  • Hudson, Joshua L., et al. "Evenly Re-distributing Daily Dietary Protein Intake Does Not Augment Changes in Body Composition and Cardio-metabolic Health Indexes." The FASEB Journal 31.1 Supplement (2017): 31-7.
  • Schoenfeld, Brad Jon, Alan Albert Aragon, and James W. Krieger. "The effect of protein timing on muscle strength and hypertrophy: a meta-analysis." Journal of the International Society of Sports Nutrition 10.1 (2013): 53.