Sleeping Like an Athlete: Supplement Smart to Complement Your Diet, Periodize Your Training, Practice Sleep Hygiene

Blindfolds and earplugs can improve your sleep quality significantly. The special beauty of blindfolds is: unlike earplugs, blindfolds may also be used to refresh 'other things' you may be doing beneath or on top of your sheets, which in turn will help those who are struggling with getting restorative sleep (learn more)

While every idiot will tell you that ZMA is "the shit" (it indeed is, literally) its purported benefits are either insufficiently proven or even disproven, as it is the case for the alleged  anabolic effect of ZMA, which clearly don't exist (Wilborn 2004) outside of the "alternative facts" supplement companies use in pamphlets people call "write ups". Obviously, this won't stop the bros at the gym from telling you: "Dat ZMA gives me an amazingly anabolic sleep, bro!"

The reasons ZMA (unfortunately) hasn't disappeared, yet, is still in the TOP10 of an unfortunately high number of supplement retailers' sales-lists, though, is not only bropaganda. It's bropaganda that appears plausible, because both, B-vitamins and magnesium, play an important role in the physiology of human sleep.

Learn more about the effects of GABA & co at the SuppVersity

GABA Diabesity Treatment

Phenibut Addic- tive or Harmless?

All About GABA at SHR

Melatonin = Easy Fat Loss?

Letrozole? Use Melatonin Instead

Bone & Tooth? Melatonin Helps

It is thus only logical that they made it on a list scientists from Portugal and Spain compiled and published in "Arch Med Deporte" in form of a review. A review which does, unlike a dozen of articles on fitness websites, mislead its readers to believe that supplements were the basis or at least necessary for optimal sleep in athletes.

Figure 1: Rules of optimal sleep hygiene for athletes - Sleep hygiene measures that may contribute to improving the quantity and quality of sleep in athletes (from Ordóñez 2017).

You wouldn't have believed such bogus, anyway, would you? I mean, we all know that the basis of optimal sleep ain't different for athletes vs. couch potatoes, it's always sleep hygiene. The rules of sleep hygiene, on the other hand, may well differ. Periodization and a sensible control of one's training volume and intensity, for example, are nothing you'd find on the average couch potato's list because he's already training way too little to get optimal sleep.

Why do we care about sleep as athletes (and wanna-be athletes)? (1) Performance - not sleeping enough has direct negative effects on your cardio-respiratory capacity and possible negative effect on maximum and sub-maximum strength levels; (2) recovery - a lack of sleep will impair your recovery and predispose you to overtraining, with all its nasty symptoms, such as depression, confusion, anger, fatigue and reduced vigour, as well as increased levels of catabolic hormones, such as cortisol, in rest and reduction of anabolic hormones, like GH, IGF-1 and testosterone; (3) injury risk - you'll be more likely to get injured, because of sign. reductions in cognitive performance and proprioceptive and neuromuscular alterations (+ the aforementioned recovery deficits); (4) infections - a lack of sleep will impair your immune competence which, in turn, will make you more susceptible to infections; (5) muscle loss and fat gain - the former are direct effects of the previously mentioned changes in the hormonal balance [see (2)].

For you, who is obviously not a sedentary couch potato, my first advice to "fix your sleep" is thus: make sure you're not following the invalid "more helps more" approach and have been overtraining for weeks (that's in contrast to overreaching | learn more). When you've your sleep hygiene ducks in a row, go ahead and read the following paragraphs about supplements:

• 

  Figure 1: Changes in sleep in response to TRYP (Silber 2010).

  the serotonin precursor tryptophan - while it is unquestionably essential for optimal sleep, the amount of the serotonin precursor tryptophan in our diet is usually more than high enough to fulfill our dietary requirements;
  
  still, if your intake is low and/or your requirements are increased (e.g. low niacin intake and/or requirements of the tryptophan based-vitamin) or you've been stupid enough to block the entry of tryptophan into the brain by guzzling BCAAs all day (learn more), taking at least 1g (best consumed on empty) before going to bed may help you fall asleep and improve subjective sleep quality
• vitamins from the B-complex - yes, here it is B-vitamin, but the infamous B6 (pyridoxin) from ZMA, is required only in very low doses and together with folate as a co-factor in serotonin synthesis; in fact, taking too much (which is what you will find in most ZMA products) can ruin your sleep by giving you the weirdest kind of dreams;

  

  Figure 1: Possible mechanisms of the influence of dietary components on the synthesis of serotonin and melatonin (from Peuhkuri 2012). One thing you should remember, though: Most of us get all the necessary nutrients from our diet, accordingly you must not expect exorbitant benefits from taking supplements.

  often forgotten, but at least as important, especially for athletes, whose requirements may be significantly increased, is vitamin B3 aka niacin, the endogenous production of which will otherwise be favored by your body over the synthesis of serotonin from tryptophan (Peuhkuri 2012); some evidence also exists for B12, which is necessary for the proper synthesis of melatonin, and should thus have possible positive effect on the quantity of sleep, especially in vegetarian athletes, who often don't get enough B12 from their meatless and thus in many cases cobalamine-deficient diet
• overrated, but important magnesium - while there's little doubt that magnesium is important for the 5-Hydroxytryptamine enzyacetyltransferase to convert 5-HT into N-Acetyl-5-Hydroxytryptamine and which is then transformed into N-Acetyl-5-methoxy tryptamine aka Melatonin, there's little evidence that taking extra Mg has beneficial effects on sleep; in fact, scientists have yet to establish, if low magnesium is the cause of just a corollary factor of sleep problems (Nielsen 2010 | this could still mean that Mg supplementation will solve the underlying problems that keep you awake, though) and beneficial effects of supplementation have only been established in elderly subjects (Abbasi 2012), where it has been found to reverse the age-related neuroendocrine and sleep EEG changes (Held 2002)

No such conclusive evidence exists for zinc, the third ingredient in the supplement everybody will name when you ask for "sleep supplements for athletes". While an older rodent study suggests that a full-blown zinc deficiency goes hand in hand with reduced melatonin levels (Abbasi 2012), there's no evidence that zinc deficiency is (a) causally involved, (b) a major problem in the average athlete and (c) no human data to support improved sleep with zinc. Similarly promising, but not fully convincing evidence exists for

• GABA and phenibut, which I've discussed in detail (see "GABA - An Effective Sleep Aid W/ GH Boosting Effects that Works Within 30 Minutes - Only 100 mg Pre-Bed Will Suffice" | read it, and "Phenibut, Addictive Sleep Aid With Unhealthy Hangover? Dosages, Effects, Side Effects and Safety Concerns" | read it), ...
• plain dietary calcium and potassium, which are, much like magnesium, essential for protein encoding that facilitates sleep and regeneration, ...
• dietary (or supplemental) L-ornithine, the anti-stress effects of which I've likewise addressed in previous articles ( "L-Ornithine an Anti-Stress Agent: Lower Cortisol, Higher DHEA, Better Sleep W/ Only 400mg of Ornithine Pre-Bed" | read more) and 
• reduced intakes of palmitic acid (aka hexadecanoic acid), which have been found to be significantly associated with difficulties falling asleep (Grandner 2014).

All these dietary links that have been outlined quite nicely by Zeng et al. a 2014 paper about their potential use in functional foods (see Figure 3):

Figure 3: Possible mechanisms of functional components in foods promote sleep (from Zeng 2014).

Certainly effective in some, but highly debated among both scientists and practitioners, is the last supplement on the list: melatonin. Useful dosages for athletes appear to range from 3-12 mg with higher doses not necessarily working better, but increasing the risk of side effects ranging from headaches over nausea and drowsiness during the day or nightmares, all of which could potentially negatively affect your performance. I would thus not necessarily call melatonin a "must have" supplement for athletes - well,... unless you're traveling over several time zones regularly. In that case, you can use it to combat jet lag and reprogram your internal clock; or, as a Cochrane Review says you could use its "remarkabl[e effectivity] in preventing or reducing jet lag [... whenever you cross] five or more time zones, particularly in an easterly direction, and especially if [you have experienced jet lag on previous journeys" (Herxheimer 2002).

Always remember: You want to control cortisol, not eradicate it if you want to melt away your belly fat, beat your personal bests and feel just great! Learn how to control cortisol.

So, what's the verdict then? I still maintain that overtraining is the #1 reason why athletes and gymrats will have trouble sleeping. It will still make sense to keep an eye on your B-vitamin, magnesium and tryptophan intake as a complement to practicing appropriate sleep hygiene (see Figure 1).

If nothing helps, a visit to the doctor who can exclude underlying physical problems like hyperthyroidism, adrenal problems, sleep apnea and a whole host of other health problems that may affect your sleep ... I can guarantee, though, in 99% of the cases not being able to fall asleep, cannot sleep through or cannot sleep at all a lack of sleep hygiene (unable to fall asleep) and/or overtraining (waking up at  1-3AM) are to blame | Comment!

References:

• Abbasi, Behnood, et al. "The effect of magnesium supplementation on primary insomnia in elderly: a double-blind placebo-controlled clinical trial." Journal of Research in Medical Sciences 17.12 (2012).
• Grandner, Michael A., et al. "Sleep symptoms associated with intake of specific dietary nutrients." Journal of sleep research 23.1 (2014): 22-34.
• Held, Katja, et al. "Oral Mg2+ supplementation reverses age-related neuroendocrine and sleep EEG changes in humans." Pharmacopsychiatry 35.04 (2002): 135-143.
• Herxheimer, Andrew, and Keith J. Petrie. "Melatonin for the prevention and treatment of jet lag." The Cochrane Library (2002).
• Ordóñez, Fernando Mata, et al. "Sleep improvement in athletes: use of nutritional supplements." Nº 135 (Murc Tlf (2017): 93.
• Nielsen, Forrest H., LuAnn K. Johnson, and Huawei Zeng. "Magnesium supplementation improves indicators of low magnesium status and inflammatory stress in adults older than 51 years with poor quality sleep." Magnesium Research 23.4 (2010): 158-168.
• Peuhkuri, Katri, Nora Sihvola, and Riitta Korpela. "Diet promotes sleep duration and quality." Nutrition Research 32.5 (2012): 309-319.
• Silber, B. Y., and J. A. J. Schmitt. "Effects of tryptophan loading on human cognition, mood, and sleep." Neuroscience & Biobehavioral Reviews 34.3 (2010): 387-407.
• Wilborn, Colin D., et al. "Effects of zinc magnesium aspartate (ZMA) supplementation on training adaptations and markers of anabolism and catabolism." Journal of the International Society of Sports Nutrition 1.2 (2004): 12.
• Zeng, Yawen, et al. "Strategies of functional foods promote sleep in human being." Current signal transduction therapy 9.3 (2014): 148-155.

Vitamins B1, B2, B5 & B6 & Glucose Management | Part VII of the "There is More To Glucose Control Than Low Carb"- Series. Any Real Benefit From Supplementing With "Bs"

Funny or obscene? A woman w/ low vitamin B and thus fortified cornflakes is among the "top images" Google will show you, when you search for B-vits

There is an often overlooked reason I am addressing thiamin (B1), riboflavin (B2), panthotenic acid (B5) and pyridoxine (B6) in one installment of the "There is More to Glucose Control Than Carbohydrates"-Series (read previous installments): They are all necessary to store glycogen in the liver (Supplee. 1942).

In general, a whole foods diet, as recommended in previous SuppVersity articles will easily cover the B-vitamin needs of the average sedentary and physically active individual - in spite of minimally increased requirements for B2 & B6, in particular (Manore. 2000; Woolf. 2008).

You can learn more about this topic at the SuppVersity

Proteins, Peptides & Blood Glucose

SFA, MUFA, PUFA & Blood Glucose

Vitamin D & Diabetes

Glucose Manager Calcium?

Flush & No-Flush Niacin & Diabesity

Vitamin C & Glucose Control

As a SuppVersity reader you do yet know that "adequate" and optimal intakes can differ significantly and the fact that the provision of additional B-vitamins does not have ergogenic effects does not exclude the possibility that it may have beneficial effects on blood glucose management.

The initially mentioned inability to convert glucose to glycogen and to store the latter in the liver, for example, would already set you up to increases in blood glucose levels. The latter will in turn increase the urinary loos of the water-soluble vitamins, so that a deficiency in one of the initially named B-vitamins could trigger a whole "pro-diabetic" cascade that leaves the by then (pre-)diabetic individual deficient even in those of the B-vitamins of which he or she is actually getting enough from his or her diet (+ supplements).

Annual spending Alzheimer patients >65y in the US from 2010 to 2050 (projection, in billion U.S. dollars;  Alzheimer's Association. 2010)

This article is exclusively about the beneficial effects of b-vitamins on glucose control: The conclusions I draw based on the evidence presented in this article do not affect potential cognitive benefits from "optimal" (=within the RDA) intakes of B-vitamins (in particularly folate, and B-12, which are not part of this overview, anyway) in the young (Herbison. 2012) and old , where they are furthermore "confined to participants with high homocysteine (above the median, 11 µmol/L) and that, in these participants, a causal Bayesian network analysis indicates the following chain of events: B vitamins lower homocysteine, which directly leads to a decrease in GM atrophy, thereby slowing cognitive decline" (Douaud. 2013).

Conclusive evidence for anti-diabetic or insulin-sensitizing effects of B-vitamin supplements is yet still scarce. Even the notion that (pre-)diabetics suffer from low levels of the said B-vitamins is still controversial. This does not mean, though, that there were no promising study results I could report. For thiamine, for example, ...

• 

  Figure 1: Effects of lipophilic thiamine on HbA1c (top) and insulin requirements (bottom) of type I diabetics (Valerio. 1999(

  Valerio et al. report that the provision of a lipophilic form of thiamine (benzoyloxymethyl-thiamin) at 50mg/day lead to improvements in HbA1c and reduced insulin requirements in children with type I diabetes (Valerio. 1999) - the difference between the active and the placebo arm of the study did yet not reach statistical significance
• Obrenovich et al. report in a 2003 that thiamine, or rather benfothiamine bocks the oxidative damage due to the presence of excessive amounts of glucose in the blood of a rodent model of diabetes - their results have been replicated in human studies by Stirban et al. an other researchers several times over the past decade (Stirban. 2006)

Corresponding evidence for riboflavin is hard to find. While there are studies that suggest the presence of reduced levels of this b-vitamin in both type I and type II diabetics, direct beneficial effects of vitamin B2 supplementation on glucose management have not been reported.

A very similar picture, i.e. reduced levels in type II diabetics, but no reports of direct metabolic benefits from the provision of supplemental vitamin B5 from randomized controlled human trials, emerges if you do a database search for panthotenic acid.

Figure 1: 2h glucose and insulin response to oral glucose tolerance test before (white) and after 25 days of B5 depletion (red), as well as during B5 refeed (violet) in a healthy male subjects (Bean. 1995)

The results of a study from the mid 1950s, when scientists still put healthy individuals on nutritionally deficient diets still indicate. After 25 days without significant amounts of panthotenic acid in the diet, the subjects' insulin sensitivity was notably compromised (Figure 1, red) and was not normalized within only 10 days on a diet with 133x the normal amount of panthotenic acid (Figure 1, violet).

Mind the vitamin <> vitamin interactions: Even if there is no reason for high dose pantothenic acid supplementation to inhibit the cellular uptake of glucose directly, it's well possible that it messes with glucose metabolism via interactions with other water solube vitamins like vitamin B6 aka pyridoxin, the excretion of which is increasing, whenever the intake of panthothenic acid exceeds an (in humans undetermined) sane threshold.

In fact, the extreme elevation of the insulin levels in the "reload phase" would rather suggest that extreme amount of vitamin B5 will compromise, not improve your insulin sensitivity - contrary to edema, severe fatigue, joint pains, reduced protein metabolism, reduced phosphorus, raised VLDL triglycerides, calcification (from calcium pantothenate), dehydration, gastrointestinal symptoms, and depression, a decreased insulin sensitivity is yet not on the "official list of side effects"* of high panthotenic acid intakes (*by "official" I refer to the lists everyone copies ad pastes from the major health information outlets on the Internet).

And what about B6? It's in all my supplements, so it must be good!

If I had to write the bottom line to today's installment of the "There is More to Glucose Control Than Carbohydrates" series now, it would probably be very short and certainly very disappointing for the various supplement junkies out there. Luckily (?) there is still one of the B-vitamins missing: Pyridoxine or vitamin B6 - and you should expect the only B-vitamin that can produce severe toxic effects when it is consumed in very high amounts chronically (peripheral nerve damage) should be able to bring about at least minimal increases in insulin sensitivity / cellular glucose uptake, as well, right?

Well, unfortunately, that's not the case. In 1980, already, a group of scientists from the Gandhi Medical College Hospital in India were able to show that the provision of 40mg of pyrodixine per day had "did not bring about any significant alterations in either the oral glucose tolerance or the insulin response to glucose" in thirteen adult maturity-onset diabetics - and that in spite of the fact that 7 of them were actually vitamin B6 deficient!

Mind the "hidden" B-sources: If you are still concerned that you may not be getting your Bs in, you are probably an OTC supplement junkie. In that case I suggest you briefly take a look at the pre-workout, post- workout and whatever other products in your stack... what? Oh, they all contain 10x the RDA and more of these B-vitamins - that's surprising, right?

A major disappointment? Although this article focused exclusively on the benefits of the water-soluble B-vitamins on glucose control, the results are still paradigmatic for the overall "potency" of vitamin-B-supplements. They are all the rage, but the benefits are overblown, in many cases simply non-existent.

If we discard the well established beneficial effects of benfothiamine on the side-effects of elevated blood glucose levels, and the highly disputed benefits of pyridoxine in diabetic peripheral neuropathies (alleviation of sympthoms, no change in nerve damage; Bernstein. 1988 & 1990), there is actually no reason to even consider taking extra amounts of any or all of these vitamins if you are (a) no diabetic and (b) no junk food eater - and let's be honest, if either (a) or (b) applies you have got more important issues to deal with than potentially suboptimal B-vitamin intakes and their effects on glucose tolerance.

Reference:

• Bean, William B., et al. "Pantothenic acid deficiency induced in human subjects." Journal of Clinical Investigation 34.7 Pt 1 (1955): 1073. 
• Bernstein, A. L., and C. S. Lobitz. "A clinical and electrophysiologic study of the treatment of painful diabetic neuropathies with pyridoxine." Current topics in nutrition and disease (USA) (1988).
• Bernstein, Allan L. "Vitamin B6 in clinical neurology." Annals of the New York Academy of Sciences 585.1 (1990): 250-260.
• Herbison, Carly E., et al. "Low intake of B-vitamins is associated with poor adolescent mental health and behaviour." Preventive medicine 55.6 (2012): 634-638.
• Manore, Melinda M. "Effect of physical activity on thiamine, riboflavin, and vitamin B-6 requirements." The American journal of clinical nutrition 72.2 (2000): 598s-606s.
• Supplee, G. C., R. C. Bender, and Z. M. Hanford. "Interrelated vitamin requirements. The influence of thiamin, riboflavin, pantothenic acid and vitamin B6 on liver glycogen reserves." Journal of the American Pharmaceutical Association 31.7 (1942): 194-198.
• Valerio, G., et al. "Lipophilic thiamine treatment in long-standing insulin-dependent diabetes mellitus." Acta diabetologica 36.1-2 (1999): 73-76.

Leucine + B6: 82% More Weight + Twice As Much Body Fat Loss in First 12 of 24 Weeks on -500kcal/day Diet W/ 2.25g Leucine + 30mg Pyridoxine - To Good to Be True?

Check your nutrition labels, I bet you get 2.25g+ leucine and 30mg of B6 from one of your supps already

I am sorry to say that and actually this is usually something that goes into the bottom line, but I do have serious doubts whether the results reported in this study can be replicated in any of you. Yes, it is a human study, but (a) the subjects, 12 men and 12 women, were obese (34.76 ± 2.57) and (b) if the mere addition of 2.25 g leucine and 30 mg vitamin B6 would have such profound effects, everyone who has ever taken a commercial BCAA product would have noticed a doubling in fat loss, already, as almost all of them contain 2.25g+ of leucine and tons of pyridoxine (B6).

So what are you saying here? Is this study a fraud?

I have no evidence that the study was a fraud and I am certainly not implying this, but you must wonder about the magnitude of the weight loss and fat loss difference between the regular and the NuShape supplemented dieters (-500kcal from baseline energy demands calculated simplistically by  1.3× result of the WHO formula for basal metabolic rate), who ingested 2x 1.125 g leucine and 15 mg pyridoxine per day (whether that's on empty is not disclosed in the paper).

Figure 1: Changes in insulin (μU/ml), HOMA-IR, waist circumference (cm), body weight (kg), fat weight (kg) after 12 (blue) and 24 weeks (orange), relative change from 12-24 weeks is indicated in % below the bars (Zemel. 2013)

According to the researchers, who have published corresponding data for rodents and an analysis of the effects of the same combination of leucine + pyridoxine on total fat oxidation (>30g increase per day in a randomized controlled study; Zemel. 2012), the specific effects on visceral obesity could be a result of the

"reductions of oxidative and inflammatory stress biomarkers, such as plasma malondialdehyde (MDA), 8- isoprostane F-2α, tumor necrosis factor-α, and C-reactive protein, as well as an increase in the anti-inflammatory marker adiponectin" (Zemel. 2013)

they observed in a previous trial after 4 weeks, even in the absence of weight loss (Zemel. 2012). This would certainly be beneficial for both the lean and the fat individual, but with already low levels of CRP, MDA and TNF-alpha as you, as a healthy follower of physical culture should have them, these changes will be so small that they are unlikely to have any visible effects on you.

There decreased weight / waist / fat loss within the 2nd two weeks in the supplement group (see figure 1, yellow arrow for the discussion of waist circumference as an example) does actually provide evidence that the effect size will decrease the learner you are... even "worse", but rather hypothetical: The effect could also be diminishing, because the human body get's used to the new steady influx of leucine and B6 and their beneficial effects on the mitochondria, Sirt-1 and AMPK expression (learn more; note: as stated in this older article of mine, it works also without resveratrol)

---

Learn more about leucine, HMB, B6, mitochondrial health and weight / fat loss in a previous post (read more)

Bottom line: You are probably already doing what 50% of the subjects in this (sponsored) study have been randomly assigned to, i.e. consuming an extra 2.25g of leucine and 30mg of vitamin B6 (this is ~3800% of the RDA) per day if you consume either a "sports multi", a "high potency B-vitamin" or simply the next best BCAA or other amino acid / protein product with added B6. So, let me ask you a question, then. Did you get ripped to the shreds from this practice? No? Well, in that case you will probably share my doubts about the relevance of the data and the usefulness of the said supplement.

References:

• Zemel MB, Bruckbauer A. Effects of a leucine and pyridoxine- containing nutraceutical on fat oxidation, and oxidative and inflammatory stress in overweight and obese subjects. Nutrients. 2012;4:529–541
• Zemel MB, Bruckbauer A. Effects of a leucine and pyridoxine-containing nutraceutical on body weight and composition in obese subjects. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 22 August 2013.

Ask Dr. Andro: Are Vitamin Supplements Bad For Me (2/2)? 3+1 = 666! The Raw Data Truth about the "Vitamins Kill!" Offspring of the Iowa Women's Health Study

Image 1: "Please Dr. Andro tell me I can keep taking my essential multivitamin! I am just too busy to eat healthy..."

I must admit that I feel kind of awkward as I am about to defend one of those supplements, I consider to be the most dispensable within the dietary regimen of a physical culturist: the so-called multi-vitamin! In essence these small, and lately more often than not large pills do not even fall into the category supplement. With dose-equivalents way beyond what you would actually need, "multivitamins" are not even "replacements", they are madness or, I should say, the mad outgrowth of the prevalent "more is more" mentality that is beginning to harm us on every level of our society... but I am digressing, here. Let's take a look at the actual study which brought about such an upheaval in the supplement-addicted health community on the Internet.

Dietary Supplements and Mortality Rate in Older Women

Image 2: Is this you? No? Maybe she is "The Average American", then? No? Well, but the study says "vitamins are bad for YOU" and she could be one of the subjects (img. medscape.org)

The title alone, actually made me click the study away, back in the day when I first hit upon it, on one of my regular searches for new stories on the medical databases of the World-Wide-Web; and unless you are an old women (I would hope there were some older women reading the SuppVersity, but I guess there are none), you should have disregarded the study, as well. After all, we all know how the game changes after menopause and guess what, of those women, 98.6% were post-menopausal (in case you ever see studies done on ovariectomized rodents, remember that those are "menopausal", too ;-). Ah, and in case you are a post menopausal women with Africa-American or Hispanic background, there is likewise little reason for you to read on, because 99.2% of the women in the study were white (if you question whether or not ethnicity really matters, when it comes to the health effects of vitamins, I suggest you take a look at some reviews like Carmel. 1999).

Now, if you are still with me at this point, I guess that you either are a post-menopausal white woman, or - and I suppose that this will be the case for the majority of you - you have been agitated by the heated debate on the net (and even regular mass-media) in the last couple of days and want someone to tell you that you did not reduce your life-expectancy by -15% by religiously taking your "essential" *rofl* multi-vitamin, everyday. We will see, whether I can be this person (in case it turns out I am not, I have seen more than enough "gurus" you will tell you exactly that, if you promise to buy their "all natural" or "superior source" product in the future).

The Iowa Women's Health Study - Mrs "not so average" American

So, let's see. What we have here is an offshoot of the Iowa Women's Health Study (IWHS), which is one of those highly over-estimate surveys, the media loves, because they boast of ten-thousands of "participants". In the case of the IWHS, "41836 women aged 55 to 69 years"... well, at least that were the women the scientists send their little questionnaires to back in 1986. Interestingly, this is also where the first bias (i.e. a deviation from "objectivity") came into play:

Respondents were slightly younger, had lower body mass index (calculated as weight in kilograms divided by height in meters squared), and were more likely to live in rural areas compared with nonrespondents.

So instead of the average American "older woman", the scientists suddenly had the "slightly younger" not just as obese, better off American older women, as their study object. Moreover, the number of participants dropped to 38772 women or, in other words, the scientists "lost" 7.3% of their study population even before the study actually began. Now, of those, the Mursu et al. selected 29230, who were the "elite" which responded to both the initial 1986 and the 2nd 1997 follow-up questionnaire.

Failure 1: Not representative of "The Average American"

"Ladies, give me as little information about your supplements as possible, please!"

The latter, i.e. the questionnaire, assessed the use of 13 supplements:

• multi-vitamins; 
• vitamins A, beta-carotene, B6, folic acid, B complex, C, D, and E; 
• iron, calcium, copper, magnesium, selenium, and zinc

Now, the scientists show off their wealth of knowledge and state that "[d]ifferent forms of vitamin D, cholecalcif-erol (D3) or ergocalciferol (D2), were not distinguished". While this is obviously important, it would have been even more important to distinguish between different forms of vitamin B6 (pyridoxin vs. P5P), B complex (you can have a complete one, one with equal doses, one particularly high in one B vitamin, etc.), vitamin E (I suppose you read the first installment?), iron (heme, non-heme, chelated, etc.), copper / magnesium, selenium, and zinc (oxide, chelated, etc.), because we know that these different forms of vitamins and minerals are not only differentially absorbed, but also exhibit differential effects on our health and well-being.

Failure 2: Ignorance towards the fact that
not all vitamins / minerals with the same label are created equal

And as if this had not been enough, the scientists did not even care if the ladies popped 1 or 23 of their beta carotene (I hope you do not still believe you can take endless amounts of that orange poison), magnesium, folic acid and B-complex pills.

Failure 3: Careless ignorance towards dosages

Raw foods are dangerous and so is raw data

Hence, the scientists got a set of data that was full of holes from a group of women who are by no means representative of "The Average American" (let alone every human being) - what did they do next? Well, obviously "raw data" is as dangerous as raw meat (or even raw milk), that is why the next step for every good scientists is data processing. In that Mursu et al. were particularly skilful as far as not revealing what they actually did was concerned:

In the minimally adjusted model, we adjusted the association for age and energy intake; in multivariable adjusted model, version 1, we additionally adjusted for educational level, place of residence, diabetes mellitus, high blood pressure, body mass index, waist to hip ratio, hormone replacement therapy, physical activity, and smoking status. For multivariable adjusted model, version 2, we added intake of alcohol, saturated fatty acids, whole grain products, fruits, and vegetables.

Even, or I should say, especially for a physicist, who is a 75% mathematician, the idea that by some sort of mathematical magic you could reliable subtract out all those influence, so that you get the "real picture" of what is going on, with an average human being is so hilarious that I avoid any further comment. Everything that goes beyond the "minimal adjustment" is so full of speculative hypothesis and mainstream paradigms (like "Whole grains are good for you! The more, the better!") that I will simply ignore this data... unfortunately these results of "3+3 = 666" mathematical manipulation were what the scientists (in their press releases) highlighted as their main results and what was accordingly taken up by the laymen (initially I wanted to write idiots, but that would be unfair, because laymen they are) in the editorial offices of the mass media.

Failure 4: Over-"analysis" of the data

Let's get to the raw truth

This would not be the SuppVersity, if I did not have something to offer that goes beyond the angry rants and criticism (see above) you probably have read elsewhere, anyways. So, I went through the pains of compiling and comparing the "real", i.e. the N=X data and not the calculated hazard ratios for you.

Figure 1: Raw data and minimally adjusted (age and caloric intake) data on the effect of taking vitamin A, beta carotene, vitamin C, vitamin D, vitamin E, and finally the multivitamins on overall mortality (data calculated based on Mursu. 2011)

Now, I want you to take a close look at the data for vitamin A, beta carotene, vitamin C, vitamin D, vitamin E, and finally the multivitamins. I don't know what you see, but I see only vitamin A and beta carotene scratching at the increased mortality margin of 1.0 (cf. dotted red line in figure 1). And, just for a better understand, two examples:

• the 1.04 as for vitamin A (minimally adjusted) in 2004-08 indicates a +4% higher risk and 0.80,
• the 0.80 for vitamin E (raw data) in 2004-08 indicates a -20% decrease in mortality risk

So, what would you say, how "dangerous" is taking vitamin pills if you do not process the data to death? Interestingly, things get really nasty, from here. And moreover, they get nasty, where you probably would not have expected it unless you are a very diligent student of the SuppVersity and are thus aware that messing with the methylation cycle via B6 or folic acid supplementation for no reason is not a good idea.

Figure 2: Raw data and minimally adjusted (age and caloric intake) data on the effect of taking vitamin B6, folic acid, B-complex, calcium, and magnesium on overall mortality (data calculated based on Mursu. 2011)

Given the fact that an increasing amount of "old" people are taking magnesium supplementation, I would say that in this case the age-adjustment is probably necessary - if you also consider that back in the 1980s this bias was smaller, since people were not told that taking mg supplements would be necessary for older folks, the respective adjustment will be "too small" and thus I would simply ignore the fact that the 1996 value still signifies a +2% greater risk of dying when you take a magnesium supplement (add to that that the study participants could have taken magnesium in the 10x recommended dosage and the scientists would not know that /see comment on dosage, above). What really surprises me, though is the enormous benefit that is (even in the raw data) associated with calcium supplements - 22% reduced risk according to raw data and 21% reduced risk with age/energy adjustment - impressive!

Figure 2: Raw data and minimally adjusted (age and caloric intake) data on the effect of taking iron, copper, zinc, and selenium on overall mortality (data calculated based on Mursu. 2011)

Last but not least - the worst offenders, the dreaded "heavy metals" ;-) Ok, I guess iron really is a bad guy (at least for post-menopausal women), but even copper, which has gotten such a bad rep, lately turns out to come pretty handy in the female part of the aging American population, ... interestingly only in the early to late 2000s - how come? I'll leave it up to you to make up your mind on this and other questions, but I assume that now, that you know the raw truth, you will not blindly follow Bjelakovic's campaign to "wake up [regulatory authorities] to their responsibility to allow only safe products on the market" (Bjelakovic. 2011), but rather scrutinize his "invited comment" to the Mursu study, which was published in the same issue of the Archives of Internal Medicine and has caused such an upheaval among the increasingly health conscious American and International public.

Energy Drinks Increase Resting Metabolic Rate, But Do Not Influence Energy Expenditure During Exercise

Ever wondered, whether the drink that was once rumored to contain "taurine from bull sperm" and similar fashionable "energy drinks" are of any use? Well, a recent study (Nienhuesser. 2011) coming from an international team of scientists showed that the consumption of each and every of the three energy drinks used in this study lead to a statistically significant increase in resting metabolic rate (RMR).

[...] in a randomly assigned cross-over design, the subjects consumed 473 ml of one of three commercially available energy drinks or a placebo and then RMR and RER [respiratory exchange ratio; i.e. a measure of the relative amount of fat/carbs that is used as fuel] were measured 1 hour later.  The subjects then engaged in 15 minutes of treadmill exercise at 50% of V02max, during which RER and oxygen consumption (VO2) were measured. RMR was not changed by placebo, but increased (P<0.05, means ± se) above baseline by 10 ± 2.5%, 15.0 ± 2.9%, and 15.3 ± 2.9%, following Energy Drink One, Energy Drink Two, and Energy Drink Three (respectively) [...]

In view of the stimulating effect, some of the ingredients (cf. Table 1) of these chemical containing beverages exhibit, these results do not come as a surprise.

Table 1: Listing of ingredients according to Nienhuesser. 2011

What may be surprising, however, is that the study results suggest that - at least from a "calorie expenditure" point of view - the consumption of an energy drink before exercise appears to be less effective than drinking it after exercise or at your desk at the office...