Cupping for Pain, Health & Performance | Must Be Good, if Phelps Does it, Right? Let's See What the 100+ Studies Say

The "cups" come in various forms and sizes... and no, there's no meta-analysis yet that can tell you what the optimal size and form for the treatment of a given disease / problem would be ;-)

"If Phelps does it, it must be good!" I am pretty sure that SuppVersity readers don't think like that this is why I'd like to invite you to join my brief research review on cupping, i.e. the use of cups that are sucked to specific acupuncture points on your back via a simply physics trick: After being heated with fire, the air in the cup expands rapidly only to decrease by the same extent after the pre-heated cup is placed on your back. The rapid reduction of the volume of air in the cup will will create a vacuum that will not just glue the cup to your skin, but literally suck some of your skin into the cup and the capillaries in the skin to rupture - no wonder Phelp's body was plastered with red "cup marks" during the Olympic games ;-)

With Phelps strongly believing in the practice, it is quite obvious that it would have worked its alleged recovery magic irrespective of whether the increased blood flow to the cupped area has any local or systemic health effects whic allegedly range from anti-viral therapy to blood pressure management - you call that "placebo effect".

Read previous True or False!? Articles at the SuppVersity

You Cannot Consume too Much Whey?!

Caffeine and Creatine Don't Mix, do They?!

Creatine is Better Taken After Workouts!?

Low Fat for Lean, Low Carb for Fat Individuals!?

Protein Timing Really Doesn't Matter!?

Nicotine Gums Will Help Fat Loss!?

From a science perspective, though, there is some preliminary evidence that Phelps' trust is / was not totally misplaced, though - here's an overview of what we know...

• Initial evidence of cupping to treat chronic neck pain (Lauche. 2013) - Chronic neck pain is a major public health problem with very few evidence-based complementary treatment options.
  
  It would thus be great, if the positive results of a 2013 study that tested the efficacy of 12 weeks of a partner-delivered home-based cupping massage, and compared it to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain, could be reproduced in a more tightly controlled  setting.
  

  

  Figure 1: Cupping vs. PMR home-treatment in a 12-week study in patients w/ chronic neck pain (Lauche. 2013).

  Primary outcome measure was the current neck pain intensity (0-100 mm visual analog scale; VAS) after 12 weeks. Secondary outcome measures included pain on motion, affective pain perception, functional disability, psychological distress, wellbeing, health-related quality of life, pressure pain thresholds and adverse events. Sixty one patients (54.1±12.7 years; 73.8%female) were randomized to cupping massage (n = 30) or progressive muscle relaxation (n = 31).
  
  After treatment, both groups showed significantly less pain compared to baseline however without significant group differences. Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds.
  
  "In conclusion, cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain. Both therapies can be easily used at home and can reduce pain to a minimal clinically relevant extent. Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger samples and longer follow-up periods are needed to confirm these results" (Lauche. 2013), the Lauche and colleagues from the University of Duisburg-Essen conclude.
• Preliminary evidence of a reduction of symptoms of osteoarthritis (Teut. 2012) - Scientists from the Charité University Medical Center in Berlin investigated the effectiveness of cupping in relieving the symptoms of knee osteoarthritis (OA) in a two-group, randomized controlled exploratory pilot study.
  
  

  

  Image 1: Much in contrast to most other studies, the osteoarthritis didn't use "cups" and heating, but this adaptable silicone cup at the knee (Teut. 2012).

  Patients with a clinically and radiological confirmed knee OA (Kellgren-Lawrence Grading Scale: 2-4) and a pain intensity > 40 mm on a 100 mm visual analogue scale (VAS) were included. 40 Patients were randomized to either 8 sessions of pulsatile dry cupping within 4 weeks or no intervention (control). Paracetamol was allowed on demand for both groups. Outcomes were the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, the pain intensity on a VAS (0 mm = no pain to 100 mm = maximum intensity) and Quality of Life (SF-36) 4 and 12 weeks after randomization.
  
  In addition, the subjects' use of Paracetamol was documented within the 4-week treatment period. Analyses were performed by analysis of covariance adjusting for the baseline value for each outcome.
  

  

  Figure 2: Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score and Visual Analogue Scale (VAS) for pain intensity after 4 and 12 weeks of cupping or control (Teut. 2012).

  21 patients were allocated to the cupping group (5 male; mean age 68 ± SD 7.2) and 19 to the control group (8 male; 69 ± 6.8). After 4 weeks the WOMAC global score improved significantly more in the cupping group with a mean of 27.7 (95% confidence interval 22.1; 33.3) compared to 42.2 (36.3; 48.1) in the control group (p = 0.001). After 12 weeks the WOMAC global score were still significantly different in favor for cupping (31.0 (24.9; 37.2) vs. 40.8 (34.4; 47.3) p = 0.032), however the WOMAC subscores for pain and stiffness were not significant anymore. Significantly better outcomes in the cupping group were also observed for pain intensity on VAS and for the SF-36 Physical Component Scale compared to the control group after 4 and 12 weeks. No significant difference was observed for the SF-36 Mental Component Scale and the total number of consumed Paracetamol tablets between both groups (mean 9.1, SD ± 20.0 vs. 11.5 ± 15.9).
  
  "In this exploratory study dry cupping with a pulsatile cupping device relieved symptoms of knee OA compared to no intervention. Further studies comparing cupping with active treatments are needed," Teut et al. conclude and forget to mention that everything could be placebo... after all, simply not doing anything is not a valid / significant "treatment" to evaluate the effects of cupping. This and the fact that the dosage of pain-killers are things you should keep in mind when evaluating the study results. 

"Wet" = bloody cupping - Geez!

"Wet cupping" is gorier than you'd expect: What doesn't sound like much is in fact a completely different way of cupping. While the previously described procedure (see introduction) may be a bit painful, it is totally non-invasive. That's in contrast to the so-called "wet-cupping" process aka "Hijamat bilshurt" in Unani medicine, which involves "the incising of skin either before the cup is placed or during the process of suctioning with needles placed at the base of the cup being used" (Akhtar. 2008). Overall a rather gory practice as the image to the left is one of the rather harmless photos you will find online.

• Promising effects in chronic low back pain, systematic review says (Huang. 2016) - It's just published as a letter, but the systematic review Huang and colleagues from Taiwan argue that "the research results show that cupping therapy is promising for pain control and improvement of quality of life, and minimises the potential risks of treatment" (ibid.). Huang et al. base this assessment on their review of one randomised controlled trial (RCT, level I evidence), six non-RCTs (level II evidence), 20 case reports (level IV evidence) and two mechanism-based reasoning studies (see Table 1):
  

  

  Table 1: Overview of studies with levels I and II evidence Huang et al. (2016) included in their review.

  In the RCT, the effective rate of the wet-cupping (see red box!) group was similar to that of the waiting-list group (p>0.05). Interventions in both groups decreased pain, disability and acetaminophen dosage, but a significant decrease in pain intensity according to the McGill pain questionnaire (p<0.01) and reduced consumption of acetaminophen (p=0.09) were seen in the wet-cupping group. Similarly promising were the results of the six non-RCTs: one showed that the visual analogue scale (VAS) score and the Oswestry disability index in the balance-cupping group were significantly lower than in the group with cupping with retention and diclofenac (p<0.05), but there was no difference between the cupping with retention group and the diclofenac-only group (p>0.05). The other studies individually showed that the effectiveness of cupping in decreasing VAS,  reducing recurrence rate and improving quality of life, was better than Western medication.
  
  It should not be forgotten, though, that the evidence is rather preliminary than water-tight. Accordingly, Huang et al. are 100% right, when they demand that "further studies are needed to determine the potential role of cupping therapy in the treatment of low back pain" (Huang. 2016).

Table 2: Estimate effect of cupping for pain management (all types of diseases) from 16 included trials (Cao. 2014).

Pain management appears to be the best proven area of application (Cao. 2014) - As the overview of studies from Cao et al.'s 2014 review in Table 2 indicates, the effect of cupping for pain management (regardless of type of diseases) from 16 included trials is mostly, but not exclusively positive (meaning the pain was reduced), albeit not always significant and in many cases potentially influenced by confounding factors / treatments and thus far from being convincing evidence.

• A plethora of additional possible benefits (Cao. 2012) - While pain management appears to be the closest to being a proven benefit of cupping, the literature that was reviewed among others by Cao, Li and Liu lists other purported benefits.
  
  The scientists from the University of Western Sydney and the Beijing University of Chinese Medicine managed to identify the impressive number of 135 RCTs published from 1992 through 2010; studies that were generally of low methodological quality, but investigated diseases ranging from herpes zoster, facial paralysis (Bell palsy), cough and dyspnea, over acne, lumbar disc herniation, to cervical spondylosis.
  

  

  Figure 3: Types of cupping therapy used in the studies in the meta-analysis (Cao. 2012).

  Unlike Phelps, most researchers used the "bloody" wet cupping - when all is said end done, not without negative effects as Cao et al. point out: "Meta-analysis showed cupping therapy combined with other TCM treatments was significantly superior to other treatments alone in increasing the number of cured patients with herpes zoster, facial paralysis, acne, and cervical spondylosis" (Cao. 2012 | check out the Figures for free). 

Figure 3: While it turned out to be a failure in this follow up study (data from Aleyeidi. 2015), wet, i.e. bloody, cupping aka "Hijama" is traditionally used in Indian medicine to treat hypertension (=elevated blood pressure), too - and guess what: initial evidence from other studies suggested that it works (Lee. 2010; Zarai. 2012).

Bottom line: Thanks to the placebo effect and its very likely effects on practitioners pain threshold, it does not seem appropriate to laugh about Michael Phelps or anyone else who uses (dry!) cupping to promote recovery and/or control back, knee or whatever other pain (cf. Cao. 2014).

In the absence of bulletproof evidence from sensibly controlled human trials, it would yet be similarly misguided to think of cupping as a decisive factor in Phelps' recent Olympia success and/or a traditional medicine technique that doesn't just cure pain but also high blood lipid levels, which was the goal of an inaccessible doctoral thesis Abeer Mohammed Kawthar announced at the King Abdulaziz University - for blood pressure, Kawthar, this time working with Aleyeidi & Aseri has, after all, only recently failed to replicate the results of previous studies that suggested a blood pressure lowering effect of wet, i.e. bloody, cupping (Aleyeidi. 2015) | Comment!

References:

• Akhtar, Jamal, and M. Khalid Siddiqui. "Utility of cupping therapy Hijamat in Unani medicine." Indian J Trad Knowl 7.4 (2008): 572-4.
• Cao, Huijuan, Xun Li, and Jianping Liu. "An updated review of the efficacy of cupping therapy." PLoS One 7.2 (2012): e31793.
• Cao, Huijuan, et al. "Cupping therapy for acute and chronic pain management: a systematic review of randomized clinical trials." Journal of Traditional Chinese Medical Sciences 1.1 (2014): 49-61.
• Huang, Chia-Yu, Mun-Yau Choong, and Tzong-Shiun Li. "Effectiveness of cupping therapy for low back pain: a systematic review." Acupuncture in Medicine (2013): acupmed-2013.
• Kawthar, Abeer Mohammed. "Effect of compining antilipids drugs with wet cupping on lipid blood level." (2007).
• Lauche, Romy, et al. "Effectiveness of home-based cupping massage compared to progressive muscle relaxation in patients with chronic neck pain—A randomized controlled trial." PloS one 8.6 (2013): e65378 [FFT]
• Lee, Myeong Soo, et al. "Cupping for hypertension: a systematic review." Clinical and experimental hypertension 32.7 (2010): 423-425.
• Teut, Michael, et al. "Pulsatile dry cupping in patients with osteoarthritis of the knee–a randomized controlled exploratory trial." BMC complementary and alternative medicine 12.1 (2012): 1.
• Zarei, Mohammad, et al. "The efficacy of wet cupping in the treatment of hypertension." ARYA Atheroscler (2012): S145-S148.

Stevia Kills Good Gut Bacteria - One Study Enough to Stop Using the Natural Sweetener? Probably Not in View of its Anti-Diabetes, Anti-LDL, Anti-Viral & Anti-Cancer Effects

Study indicates stevia kills healthy gut bacteria. So, how bad is it? Are the effects significant, will they have an impact on your overall health and does this mean you must not use stevia any longer?

A recent study from the Institute of Microbiology and Biotechnology at the University of Latvia in Riga shows the impossible: Stevia, the "natural" sweetener that's everybody's darling, could mess up your gut microbiome by killing large numbers of the beneficial Lactobacillus Reuteri bacteria in your tummy - exactly those bacteria of which several studies have shown that supplementing will help cure acute diarrhea in young children (Shornikova. 1997), is capable of reducing frequency and intensity of antibiotic-associated side-effects during eradication therapy for H. pylori. (Lionetti. 2006), confers broad-spectrum protection against disease in humans and animals (Casas. 2000), has cholesterol lowering effects (Jones. 2012) and much much more.

You can learn more about the gut & your health at the SuppVersity

Bugs Dictate What You Crave

Sweeteners & Your Gut

Foods, Not Ma- cros for the Gut

Lactulose For Gut & Health

Probiotics Don't Cut Body Fat

The Macrobiotic MaPi2.0 Diet

In view of the fact that it would appear as id Lactobacillus reuteri was clearly one of the "good guys" it seems that the results I. Denin a, P. Semjonovs, A. Fomina, R. Treimane and R. Linde report on their latest study in Letters in Applied Microbiology (Denin. 2014) were really bad news:

Figure 1: Influence of stevioside (a) and rebaudioside A (b) on biomass formation in Lactobacillus reuteri strains (24 h | Denin. 2014).

"In samples supplemented with stevia glycosides, the growth of all Lact. reuteri strains was slightly inhibited – however, a statistically significant concentration-dependent inhibitory effect was not observed for all strains (Fig. 1).

Comparing both the glycosides, the inhibitory effect of stevioside was more pronounced for strains 44 and 16, while the effect of rebaudioside A was more pronounced for strains 16 and 19. Statistically significant concentration-dependent inhib itory effect was observed for lactic acid and acetic acid synthesis. The decrease in lactic acid and acetic acid production was observed for both stevioside and rebaudioside A. [...] Although the inhibitory effect of stevioside on pH was observed at different stevioside concentrations, the effect was evident for all strains. Rebaudioside A had a more pronounced inhibitory effect on pH values of certain strains including Lact. reuteri 12, 16, 43 and 44" (Denin. 2014 | my emphasis).

The good news, however, is in the details: The inhibitory effect was "slight" (see quotation above) and the design of the study leaves it open, whether similar effects would occur in vivo and thus outside of a glycoside, stevioside and rebaudioside laden Petri dish.

Previous studies seem to refute significant effects of stevia on the human microbiome! In 2003, Gardana et al. found no effect of stevia on the make-up of human fecal cultures when they were incubated with either stevioside or rebaudioside A. Only the fact that bacteroides, i.e. the "enemies" of lactobacilli, were the most efficient in hydrolyzing Stevia sweeteners to steviol would suggest that there may be an overall effect on the human microbiome form stevia (ab-)use.

And while we have little in vivo evidence that stevia is bad for you, a brief review of the contemporary scientific literature on Stevia yields the following "proven" (mostly only in a handful, if not just a single study) benefits:

• Stevia has been implicated in diabetes and hyperlipidemia treatment and its effects on blood glucose levels are not a mere result of the corresponding reduction in sugar intake.

  

  Figure 2: Effects of stevia vs. diabetes drug Glibenclamide on blood glucose and lipid levels in diabetic rodents; data expressed relative to healthy control (Singh. 2014)

  In a recent rodent study that compared the effects of stevia against those of the often-prescribed diabetes-drug Glibenclamide, the natural sweetener outperformed the drug in many in its ability to reduce LDL and blood sugar and was not far off of what the Glibencamide did for the diabetic lab animals in terms of its effects on HDL and VLDL (see Figure 2).
  
  Previous human studies indicate that stevia extracts will also increase the increased 16 healthy human volunteers whose plasma glucose levels during an oral glucose tolerance tests were significantly lower after having consumed 5 grams of aqueous leave extract at regular 6-h intervals for 3 days (Curi. 1985).

  

  Figure 3: Effects of stevia and aspartame replacement of sucrose in test meals that were fed to obese and normal-weight volunteers on postprandial blood glucose levels (Anton. 2010)

  Moreover, in a more recent study by Anton et al. where stevia was compared to aspartame, it had the same beneficial effects on total energy intake and let to statistically significant reductions in postprandial glucose levels of both obese and lean study subjects (see Figure 3) that did not reach significance when the sucrose content of the test meal was replaced by aspartame.
• In-vitro stevia appears to have anti-cancer effects, as well. That's at least what studies by  Jayaraman et al. (2008) observed with stevia extracts. An effect that may be related to both it's anti-microbial, as well as its potent anti-oxidant activity (Tadhani. 2007) of the whole leaves and leave extracts of which Tahani et al. found that they contain significant effects of folic acid (52.18 mg/100 g) and vitamin C, as well as 130.76 μg catechin and 15.64 μg quercetin for leaves and 43.99 μg catechin and 1.57 μg quercetin for cellus at mg of water extracts, respectively.
  
  Furthermore, Tadhani et al.'s results showed that the leaf extracts contained higher amounts of free radicals, hydroxyl radicals and superoxide anion radical scavenging activities than those of the callus extracts or the anti-mutagenic effects Cariño-Cortés et al. report in their 2007 study. Whether anything similar can be observed with the white "stevia" powder that is used by most people to sweeten their foods is yet questionable - it's after all pure steviosid and thus devoid of all of the previously mentioned compounds.

  

  Figure 1: Several natural constituents of the stevia plant, including steviosides, which are the naturally sweet agents in stevia have potent anti-viral activity against Epstein-Barr virus; values in brackets
  represent % of untreated control dish (Konoshima. 2002)

  Another possible anti-cancer mechanism may be related to stevia's ability to kill viruses like the Epstein-Barr virus that has been implicated in the pathogenesis of Burkitt’s lymphoma, Hodgkin’s disease, non-Hodgkin’s lymphoma, nasopharyngeal carcinoma, and lymphomas, as well as leiomyosarcomas arising in immunocompromised individuals.in humans (Thompson. 2014).

Against that background it seems questionable that the new evidence of negative effects on allegedly healthy gut bacteria (just want to remind everyone that we have no clue what the optimal gut microbiome would look like) is significant enough to have us all reconsider our use of tiny amounts of stevia as a sweetener in our foods.

Read more about the effects artificial sweeteners have on the microbiome in a prevoius article | go ahead!

Interim conclusion: While I am not all too scared that stevia will mess with my gut microbiome in a way that makes me sick, fat and what not, I truly believe that the effects of artificial sweeteners on the make-up and density of the human gut microbiome is still massively under-researched - and that in spite of the fact that it could have a significant effect on the health of us all.

As s SuppVersity reader you will also be aware that this is not a stevia-specific effects. Only recently I have written about similar effects for a bunch of artificial sweeteners - an article I can only recommend to anyone who hasn't read it yet | Comment on Facebook.

References:

• Anton, Stephen D., et al. "Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels." Appetite 55.1 (2010): 37-43.
• Casas, Ivan A., and Walter J. Dobrogosz. "Validation of the probiotic concept: Lactobacillus reuteri confers broad-spectrum protection against disease in humans and animals." Microbial ecology in health and disease 12.4 (2000): 247-285. 
• Curi, R., et al. "Effect of Stevia rebaudiana on glucose tolerance in normal adult humans." Brazilian journal of medical and biological research= Revista brasileira de pesquisas médicas e biológicas/Sociedade Brasileira de Biofísica 19.6 (1985): 771-774.
• Deniņa, Ilze, et al. "The influence of stevia glycosides on the growth of Lactobacillus reuteri strains." Letters in applied microbiology 58.3 (2014): 278-284. 
• Gardana, Claudio, et al. "Metabolism of stevioside and rebaudioside A from Stevia rebaudiana extracts by human microflora." Journal of agricultural and food chemistry 51.22 (2003): 6618-6622. 
• Jayaraman, Sathishkumar, Muthu Saravanan Manoharan, and Seethalakshmi Illanchezian. "In-vitro antimicrobial and antitumor activities of Stevia rebaudiana (Asteraceae) leaf extracts." Tropical Journal of Pharmaceutical Research 7.4 (2008): 1143-1149.
• Jones, M. L., C. J. Martoni, and S. Prakash. "Cholesterol lowering and inhibition of sterol absorption by Lactobacillus reuteri NCIMB 30242: a randomized controlled trial." European journal of clinical nutrition 66.11 (2012): 1234-1241.
• Konoshima, Takao, and Midori Takasaki. "Cancer-chemopreventive effects of natural sweeteners and related compounds." Pure and applied chemistry 74.7 (2002): 1309-1316.
• Lionetti, E., et al. "Lactobacillus reuteri therapy to reduce side‐effects during anti‐Helicobacter pylori treatment in children: a randomized placebo controlled trial." Alimentary pharmacology & therapeutics 24.10 (2006): 1461-1468.
• Shornikova, Aino-Vieno, et al. "Lactobacillus reuteri as a therapeutic agent in acute diarrhea in young children." Journal of pediatric gastroenterology and nutrition 24.4 (1997): 399-404.
• Singh, Sunanda. "Antidiabetic, Antidyslipidymic and Antioxidative potential of methanolic root extract of Stevia rebaudiana (Bertoni) on Alloxan induced Diabetic Mice Sunanda Singh and Veena Garg Department of Bioscience and Biotechnology, Banasthali Vidyapeeth, Banasthali, Rajasthan, India." (2014). 
• Tadhani, M. B., V. H. Patel, and Rema Subhash. "In vitro antioxidant activities of Stevia rebaudiana leaves and callus." Journal of Food Composition and Analysis 20.3 (2007): 323-329. 
• Thompson, Matthew P., and Razelle Kurzrock. "Epstein-Barr virus and cancer." Clinical Cancer Research 10.3 (2004): 803-821.

The Pistachio Manifesto: Antioxidant, Metal Chelator, DNA Protector, Anti-Cancer Agent, Bug Killer (incl. H. Pylori & Herpes Simplex) & More. Have You Been Missing Out?

This is not exactly what I was talking about, when I said "going nuts", but in this case it would actually qualify as "going pistachios" ;-)

Walnuts, almonds and Brazil nuts, these are the stars among the hard-shelled fruits people tend to go nuts about (all puns intended ;-). Pistachios, on the other hand, get very little love. I have in fact written about their surprisingly low effective energy content and their highly bioavailable phenolic content before (learn more), but what the myriad of phenols in these small nutritional powerhouses the ancient Egyptians used as incense, preservative and breath sweetener, while their Iranian neighbors in the North East already knew about their beneficial effects on digestive, hepatic and kidney health (Avicenna. 2008) can do for our health has not been covered here at the SuppVersity.

So what is it pistachios can do for you?

With their traditional use as a remedy for digestive, liver and kidney issues, you already have an idea where this could be heading. The shelled fruits of which we know that they have been part of the human diet for at least 9,000 years and that's cultivated in the Middle East, United States and Mediterranean can however do more for you:

• 

  Histidine happens to be an excellent chelator and potential weight loss adjuvant, as well (learn more)

  Potent antioxidants: Different parts and constituents from P. lentiscus  have been shown in vitro radical scavenging properties They protect your LDL molecules from being oxidized and will thus have direct beneficial effects on your atherosclerosis and overall heart disease risk (Holvoet. 2004).
• Metal chelators: A 2011 study by Orhan et al reports that pistachios (P. terebinthus fruits) are potent metal chelators (on par with EDTA) and have an impressive radical scavenging activity. Interestingly engough, the Antioxidant activity of the fruits actually seems to increase, when they are roasted (Orhan. 2012).
• DNA protection: More or less a downstream effect from the high content of antioxidant compounds, specifically gallic acid, digallic acid and 1,2,3,4,6-pentagalloylglucose, and polyphenols have direct protective effects on cellular DNA and pro-carcinogenic mutations.
• Antimicrobial activity (incl. anti H. Pylori): Certainly among the most interesting effects are the anti H.Pylori effects of α- pinene, a compound from the essential oils in pastachios (speficifally P.atlantica var. kurdica). Other ingredients, like verbenone, rterpineol, and linalool showed high antibacterial activity against Escherichia coli, Staphylococcus aureus and Bacillus subtilis (Koutsoudak. 2005).
  
  

  

  You can battle H. pylori with probiotics, as well. If you want to learn more about this, I'd suggest you go back a couple of months and read the full story in the SuppVersity Short News from October 2012 (go for it)

  Sakami et al. report similar beneficial effects against pathologic bacteria (Porphyromonas gingivalis and Prevotella melaninogenica) antiplauqe activity on teeth by inhibiting bacterial growth in saliva (Sakagami. 2009). Özçelik et al. add noticeable anti-viral effects to the list of anti-microbial activities of pistachio species (Özçelik. 2005). The viruses tested in the study were Herpes simplex (DNA) and Parainfluenza viruses (RNA). The effects were significant for both Kernel and seed extracts.
• Anti-inflammatory activity: Extract of the resin of P. lentiscus var. Chia and its isolated phytosterol tirucallol exert direct anti-inflammatory effects on human aortic endothelial cells and inhibit the activity of adhesion molecules that express the inflammatory cytokine TNF-α (Tzakou. 2007). Tzakou et al. ascribe the effects to phytosterol that goes by the name if tirucallol - never heard of it? Me neither, but who knows on which supplement label you may find it in the future ;-)
• Digestive health: I already mentioned this in the introduction. One of the most important traditional uses of gums from Pistacio species is the management of gastrointestinal disorders; and that has been confirmed by several studies (Rahimi. 2009 & 2010; Farzaei. 2013). Resin of P. lentiscus has been shown to significantly reduced the intensity of gastric mucosal damage induced by pyloric ligation, aspirin, phenylbutazone, reserpine and restraint with cold stress  via its  antisecretory and cytoprotective activities (Al-Said. 1986)
  

  

  Figure 1: Improvements of acid regurgitation and heartburn in forty eight patients fulfilling Rome II criteria for functional dyspepsia were randomly assigned to receive either Pistachio var chia mastic gum 350 mg three times daily or placebo after three weeks (Dabos. 2009)

  A double- blind  placebo controlled trial, P. lentiscus gum lead to significant improvement of the symptoms of patients with functional dyspepsia  (Dabos. 2009). Extracts have been successfully tested in experimental models of acute colitis and IBS (Rahimi. 2013), and there is supporting evidence for beneficial effects of P. lentiscus var. chia resin in patients with established mild to moderate active crohn’s disease (CD) after 4 weeks of supplementation (Kaliora. 2007a,b).

• 

  Suggested read: Supplements to Preserve and Restore Insulin Resistance (read more)

  Antidiabetic activity: This is not about the nuts, but about a leaf extract, which has demonstrated significant acute postprandial  antihyperglycemic activity comparable to metformin and glipizide in starch-fed rats, in which it also lead to significant overall improvements in glucose tolerance (Kasabri. 2011). Unfortunately, a study by Kasibri et al. does not support these results - at least not for normoglycemic and streptozocin-induced hyperglycemic rats (Kasibri. 2004) on a regular diet.
  
  This would suggest that there is a direct correlation with carbohydrate intake, and voilá a 2007 human study confirmed that the gum, not the leaf extract can effectively, lower blood serum glucose levels in men... however, there is another "on the other hand attached here": this did not work for the female study participants (Triantafyllou. 2007).

• 

  The Protective Hull of These 61 Super Fruits Can Ward Off Cancer (more)

  Anti-cancer effects: In a relatively recent review of the literature, Giaginis & Theocharis call pistachio mastic gum a "conglomeration of effective anticancer drugs" (Giaginis. 2011) - probably not without reason, after all they cite a plethora of scientific data from peer-reviewed studies to support the anticancer activities of mastic gum and its major constituents and highlighting the various molecular mechanisms through which the triterpenoids work their anti-cancer magic.
  
  Rezaei et al., for example were able to show that the fruit extract of P. atlantica sub. kurdica exerts direct inhibitory effects on human colon carcinoma cells that was comparable to the drug Doxorubicin (Rezaei. 2012). Another example? Well what about the anti-breast cancer, anti liver-, anti cervical and anti skin-cancer effects of oleoresin (Almehdar. 2012)
• Hypolipidemic effects (=lowering high blood lipids): Extracts from P. vera  fruits have shown beneficial effects on HDL and LDL level in rabbit model of atherosclerosis, they exert positive effects on the lipid levels of patients with moderate hypercholesterolemia (Edwards. 1999). And have several animal studies to support their anti-artherogenic effects (e.g. Bakirel. 2003) 

Impressed? Well I'd hope so, after all this turned out to be more work than I initially thought, when I started to "just write a brief overview of the health effects of pistachios" ;-)

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Brazil nuts & selenium: "How much is too much?" A weighty question I addressed in a July 2013 SuppVersity article: "Brazil Nuts & Selenium: Are You Nuts If You Have More Than One Per Day?" (more)

Bottom line: Ok, I have to admit there is no scientific evidence that all the good things mentioned above are going to happen to you, if you have a handful of pistchios every other day, but you know what? It may still be a piece in the puzzle people often refer to as "healthy diet" - so if you are into nuts and can "afford" their relatively high energy content, go for it! After all, the above are only the "confirmed" effects.

Note: Actually everybody can "afford" eating nuts, it's more a question of being able to stop before the whole 500g family pack is annihilated... and trust me, if you love nuts, this can happen pretty fast, even if you have to shell them as it is the case with pistachios.  

Last but not least, in traditional Iranian medicine, certain ingredients in pistachios are known to exhibit various additional pharmacological activities incuding diuretic, lithontripic, anti-tussive, anti-rheumatic, anti-asthmatic, anti-hypertensive, and aphrodisiac effects of which Bozorgi et al. point out that the "are not [yet] supported by any current scientific documents and so, they could be considered  for investigating by researchers." (Bozorgi. 2013)

References:

• Almehdar H, Abdallah HM, Osman AM, Abdel-Sattar EA. In vitro cytotoxic screening of selected Saudi medicinal plants. J Nat Med. 2012 Apr;66(2):406-12.
• Al-Said MS, Ageel AM, Parmar NS, Tariq M. Evaluation of mastic, a crude drug obtained from Pistacia lentiscus for gastric and duodenal anti-ulcer activity. J Ethnopharmacol. 1986 Mar;15(3):271-8.
• Avicenna.The canon. Translated by: A . Shrafkandi. Soroush Press, Tehran. 2008.
• Bakirel T. The Investigation of the Effects of Pistacia terebinthus L. Upon Experimentally
  Induced Hypercholesterolemia and Atherosclerosis in Rabbits. Turk. J. Vet. Anim. Sci. 2003; 27: 1283- 1292.
• Bozorgi M, et al. Five Pistacia  species (P. vera, P. atlantica, P. terebinthus, P. khinjuk and P. Lentiscus): A review of their traditional uses, phytoche mistry and pharmacology. The Scientific World Journal. 2013.
• Dabos KJ, Sfika E, Vlatta LJ, Frantzi D, Amygdalos GI, Giannikopoulos G. Is Chios mastic gum effective in the treatment of functional dyspepsia? A prospective randomised double-blind placebo controlled trial. J Ethnopharmacol. 2010 Feb 3;127(2):205-9.
• Edwards K, Kwaw I, Matud J, Kurtz I. Effect of pistachio nuts on serum lipid levels in patients with moderate hypercholesterolemia. J Am Coll Nutr. 1999 Jun;18(3):229-32.
• Farzaei R et al. An evidence-based review on medicinal plants used for the treatment of peptic ulcer in traditional Iranian medicine, Int J Pharmacol. 2013 [ahead of print]
• Giaginis C, Theocharis S. Current evidence on the anticancer potential of Chios mastic gum. Nutr Cancer. 2011 Nov;63(8):1174-84.
• Holvoet P. Oxidized LDL and coronary heart disease. Acta Cardiol. 2004 Oct;59(5):479-84. Review.
• Orhan IE et al. Neuroprotective potential of some terebinth coffee brands and the unprocessed fruits of Pistacia terebinthus L. and their fatty and essential oil analyses. Food Chemistry. 15 February 2012; 130(4):882–888.
• Özçelik B, Aslan M, Orhan I, Karaoglu T. Antibacterial, antifungal, and antiviral activities of the lipophylic extracts of Pistacia vera. Microbiol Res. 2005;160(2):159-64. 
• Kaliora AC, Stathopoulou MG, Triantafillidis JK, Dedoussis GV, Andrikopoulos NK. Chios mastic treatment of patients with active Crohn's disease. World J Gastroenterol. 2007a Feb 7;13(5):748-53.
• Kaliora AC, Stathopoulou MG, Triantafillidis JK, Dedoussis GV, Andrikopoulos NK. Alterations in the function of circulating mononuclear cells derived from patients with Crohn's disease treated with mastic. World J Gastroenterol. 2007b Dec 7;13(45):6031-6.
• Kasabri V, Afifi FU, Hamdan I. In vitro and in vivo acute antihyperglycemic effects of five selected indigenous plants from Jordan used in traditional medicine. J Ethnopharmacol. 2011 Jan 27;133(2):888-96.
• Koutsoudaki C, Krsek M, Rodger A. Chemical composition and antibacterial activity of the essential oil and the gum of Pistacia lentiscus Var. chia. J Agric Food Chem. 2005 Oct 5;53(20):7681-5.
• Rahimi R, Mozaffari S, Abdollahi M. On the use of herbal medicines in management of inflammatory bowel diseases: a systematic review of animal and human studies. Dig Dis Sci. 2009 Mar;54(3):471-80.
• Rahimi R, Shams-Ardekani MR, Abdollahi M. A review of the efficacy of traditional Iranian medicine for inflammatory bowel disease. World J Gastroenterol. 2010 Sep 28;16(36):4504-14. Review. 
• Rahimi R, Baghaei A, Baeeri M, Amin G, Shams-Ardekani MR, Khanavi M, Abdollahi M. Promising effect of Magliasa, a traditional Iranian formula, on experimental colitis on the basis of biochemical and cellular findings. World J Gastroenterol. 2013 Mar 28;19(12):1901-11. 
• Rezaei PF, Fouladdel S, Hassani S, Yousefbeyk F, Ghaffari SM, Amin G, Azizi E. Induction of apoptosis and cell cycle arrest by pericarp polyphenol-rich extract of Baneh in human colon carcinoma HT29 cells. Food Chem Toxicol. 2012 Mar;50(3-4):1054-9.
• Sakagami H, Kishino K, Kobayashi M, Hashimoto K, Iida S, Shimetani A, Nakamura Y, Takahashi K, Ikarashi T, Fukamachi H, Satoh K, Nakashima H, Shimizu T, Takeda K, Watanabe S, Nakamura W. Selective antibacterial and apoptosis-modulating activities of mastic. In Vivo. 2009 Mar-Apr;23(2):215-23. 
• Triantafyllou A, Chaviaras N, Sergentanis TN, Protopapa E, Tsaknis J. Chios mastic gum modulates serum biochemical parameters in a human population. J Ethnopharmacol. 2007 Apr 20;111(1):43-9.
• Tzakou, O., Bazos, I. and Yannitsaros, A. (2007), Volatile metabolites of Pistacia atlantica Desf. from Greece. Flavour Fragr. J., 22: 358–362.

Are Camels the Better Cows? Cancer, Heart Disease, High LDL and Triglycerides, Diabetes, High Blood Pressure, Allergies, Viral and Bacterial Infections and Trace Mineral Deficiencies, Camel Milk Prevents or Fixes Them All!

Image 1: To the average inhabitant of the Western hemisphere camels are probably not the most beautiful animals under the sun; but hey, cows aren't either, hah?

When muscle-heads think of dairy, they think of whey, they think of casein, they think of cottage cheese... but I bet few of them will think of camels! Even if you just went by the mere amino acid composition (see. figure 2 at the end of the article), of which you, as an educated SuppVersity student should by now be aware that it does not give you the 'whole picture', as far as the biological effects of a given protein and peptide containing foodstuff is concerned, it appears that camel milk would at least make an excellent alternative for cows milk, in case global warming is progressing and Europe and the US turn into desert wastelands... but all jokes aside, muscle is not everything and I bet that after reading this article you will be interested to register for the US' first official camel milking seminar *rofl*

7+1 reasons you may want to slaughter your grass fed cows and replace them with camels

While the idea of drinking the milk of an ugly desert ship may appear hilarious at first, I guess my compilation of purported and scientifically established benefits of camels milk will have you reconsider if the Sheikh Hamdan bin Mohammed bin Rashed Al-Maktoum, Crown Prince of Dubai, may not have made a very good investment, when he spent $16.5 million dirham ($4.5 million USD) on the winner of a 2008 beauty pageant in the United Arab Emirates’ capital city of Abu Dhabi (FYI, the guy in image 1 is not the Sheikh, just tom make sure I don't get sued, here ;-):

Image 2 (DrCate.com): Homogenization makes milk more convenient, but it disrupts the natural structure of the fat globules and releases the otherwise bound xanthine oxidase of which scientists hypothesized that it could trigger heart disease, a hypothesis, btw., that was not disproven, but simply kept quiet for the past 25+ years (Deeth. 1983)

• Little to no xanthine oxidase (=reductase) - While the idea that XOR (xanthine oxidoreductase), which is supposedly released during homogenization of bovine milk, could be a potential contributor to overall inflammation and cardiovascular disease has disappeared from the 'scientific radar' within the past couple of years (cf. Deeth. 1983; Berry. 2004) , it may still be of interest (and for certain populations such as people with increased gut permeability even of great importance) that camel milk apparently contains little to no xanthine oxidase - irrespective of whether you drink it raw, pasteurized or homogenized (Baghiani. 2003).
• Anticancer effects - Camels milk has been shown to trigger apoptosis (controlled cell death) in human breast cancer and liver cancer cells via epigenetic mechanisms (Korashi. Feb 2012; Korashi. May 2012).
• Antibacterial & antiviral effects -Camel milk prevents gram positive bacteria from growing and reduces the amounts and activity of gram-negative cultures (el Agamy. 1992). With the latter being among the primary drivers of lipopolysaccharide (LPS) and endotoxin induced inflammation (Ulevitch. 1999), camel milk could thus help to reduce local and systemic inflammation. Aside from its activity against rotavirus, the lactoferrin faction from camel milk appears to have protective effects against hepatitis C, as well (Redwan. 2007).
• Camel milk whole- & beta-caseins act as natural anti-oxidants and ACE-inhibitors - As Salami et al have shown the whole casein and beta-casein (β-CN) faction(s) of camel milk exert Angiotensin Converting Enzyme (ACE)-inhibitory (=blood pressure reducing) and antioxidant activity after they were hydrolyzed in the stomach (Salami. 2011). In a previous study, the same researchers had already determined that the whey fraction of camel milk exhibits significant anti-oxidant and antimicrobial activities, as well, and that those were up to 100% greater (depending on the essay and fraction the scientists used) than those of bovine whey protein (Salami. 2010).



Figure 1: A certain part of the population in Rajasthan (India) who consumes camel milk on a daily basis has been found to have a significantly reduced incidence of diabetes (not a single one!), impaired fasting glucose (-6%/-11%) and impaired glucose tolerance (-10%/-10%) than both non-camel milk drinking parts of the Raica community or other non-camel milk drinkers from the same region (based on Agrawal. 2007)

• Profound and long-lasting anti-diabetic effects - Camel milk has a long history of being used to tread type 1 diabetes in the Middle East (see figure 1; cf. Mohamad. 2009). Studies from animal models (dogs, Sbou. 2010) and humans (Agrawal. 2009; Mohamad. 2009) improved blood glucose, microalbumenia and secondary symptoms such as diabetic neuropathy. Probably also as a consequence of the small, but biologically active natural insulin content of camels milk (Malik .2012), the type 1 diabetics in a 2009 study by Agrawal could even reduce their insulin medication by 32% from 41µ/day to 28µ/day. In the 2-year follow up, the researchers report that "out of 12 subjects receiving camel milk, insulin requirement in 3 subjects reduced to zero" (Agrawal. 2011) - try that with metformin, let alone some of the other 'diabetes prolongation drugs'.
• Improved lipid metabolism - The 24 type one diabetics who consumed 500ml of plain camel milk per day for 6 months in the aforementioned 2009 study by Agrawal et al. for example exhibited -30% decreases in LDL and -66% decrease in triglycerides.
• Camel milk is an extraordinary good source of trace minerals - According to Al-Awidi et al. Camel milk contains 7-20x and 1-10x higher levels of manganese and iron than human milk, more zinc and comparable amounts of selenium, copper and other protein bound and thus highly bioavailable trace minerals (Al-Awadi. 2001).

And best of all, based on studies on people with cow's milk allergy, we know that the incidence of allergic reactions to camel milk is not only much lower, but also that 80% of cow's milk allergy sufferers can actually ingest camel milk without any unwanted side-effects (Cardoso. 2010; Ehlayel. 2011).

Figure 2: Even if you go solely by the amino acid composition (here expressed relative to the total amino acids), camel milk protein could be a valid replacement for bovine proteins (data based on Davis. 1994 & Beg. 1987)

This is also worth mentioning, because the host of great effects I listed above do - at least in parts - also occur with the unwarrantedly vilified bovine (=cow's) milk, which also contains ACE precursors (Saito. 2008), exert anti-cancer effects (Gill. 2000), and so much more (see "suggested readings" at the end of this article).

So, in the unfortunate case that you "ain't got no camel handy" at the moment and, due to "the current economy" (I hate when people say that) lack the $1300 to $1700 (Debacle. 2006) to buy your own, obviously not  pageant winning $16.5 million dirham camel, and tolerate bovine milk, just stick to the milk of the farmer you trust. After all, even if Camels were the better cows, you better have a gallon of cows milk in the fridge than a camel in the Arabian desert, right? Ah, wait that was a bird in the hand, right? ... ah, whatever ;-)

Suggested readings:

• Ask Dr. Andro: Are Colostrum and Milk Products in General Healthy Muscle Builders, a Waste of Money or Toxic Waste?
• Childhood Asthma: Children Born to Mothers Who Consume Semi-Skimmed Milk 8% More Likely, Kids of Whole Milk Drinking Mothers 15% Less Likely to Develop Asthma
• The Fat Truth Behind the Dairy Weight Loss Miracle: MUFA and PUFA Impair, Saturated Fat and Plenty of Micronutrients Drive Full-Fat Dairy-Powered Fat Loss.
• Higher Calcium Intake Greater Fatty Acid Oxidation!? True: Chronic & Acute Effect Size Comparable to Caffeine
• Read all about milk here at the SuppVersity

References:

1. Agrawal RP, Budania S, Sharma P, Gupta R, Kochar DK, Panwar RB, Sahani MS. Zero prevalence of diabetes in camel milk consuming Raica community of north-west Rajasthan, India. Diabetes Res Clin Pract. 2007 May;76(2):290-6.
2. Agrawal RP, Dogra R, Mohta N, Tiwari R, Singhal S, Sultania S. Beneficial effect of camel milk in diabetic nephropathy. Acta Biomed. 2009 Aug;80(2):131-4. 
3. Agrawal RP, Jain S, Shah S, Chopra A, Agarwal V. Effect of camel milk on glycemic control and insulin requirement in patients with type 1 diabetes: 2-years randomized controlled trial. Eur J Clin Nutr. 2011 Sep;65(9):1048-52. doi: 10.1038/ejcn.2011.98. Epub 2011 Jun 1.
4. Al-Awadi FM, Srikumar TS. Trace elements and their distribution in protein fractions of camel milk in comparison to other commonly consumed milks. J Dairy Res. 2001 Aug;68(3):463-9.
5. Baghiani A, Harrison R, Benboubetra M. Purification and partial characterisation of camel milk xanthine oxidoreductase. Arch Physiol Biochem. 2003 Dec;111(5):407-14.
6. Beg OU, von Bahr-Lindström H, Zaidi ZH, Jörnvall H. Characterization of a heterogeneous camel milk whey non-casein protein. FEBS Lett. 1987 Jun 1;216(2):270-4.
7. Berry CE, Hare JM. Xanthine oxidoreductase and cardiovascular disease: molecular mechanisms and pathophysiological implications. J Physiol. 2004 Mar 16;555(Pt 3):589-606.
8. Cardoso RR, Santos RM, Cardoso CR, Carvalho MO. Consumption of camel's milk by patients intolerant to lactose. A preliminary study. Rev Alerg Mex. 2010 Jan-Feb;57(1):26-32.
9. Davis TA, Nguyen HV, Garcia-Bravo R, Fiorotto ML, Jackson EM, Lewis DS, Lee DR, Reeds PJ. Amino acid composition of human milk is not unique. J Nutr. 1994 Jul;124(7):1126-32.
10. Deeth HC. Homogenized milk and atherosclerotic disease: a review. J Dairy Sci. 1983 Jul;66(7):1419-35.
11. Gill HS, Cross ML. Anticancer properties of bovine milk. Br J Nutr. 2000 Nov;84 Suppl 1:S161-6. Review.
12. Ehlayel MS, Hazeima KA, Al-Mesaifri F, Bener A. Camel milk: an alternative for cow's milk allergy in children. Allergy Asthma Proc. 2011 May-Jun;32(3):255-8.
13. el Agamy EI, Ruppanner R, Ismail A, Champagne CP, Assaf R. Antibacterial and antiviral activity of camel milk protective proteins. J Dairy Res. 1992 May;59(2):169-75. 
14. Gill HS, Cross ML. Anticancer properties of bovine milk. Br J Nutr. 2000 Nov;84 Suppl 1:S161-6. Review.
15. Korashy HM, El Gendy MA, Alhaider AA, El-Kadi AO. Camel milk modulates the expression of aryl hydrocarbon receptor-regulated genes, Cyp1a1, Nqo1, and Gsta1, in murine hepatoma Hepa 1c1c7 cells. J Biomed Biotechnol. 2012;2012:782642. Epub 2012 Feb 27.
16. Korashy HM, Maayah ZH, Abd-Allah AR, El-Kadi AO, Alhaider AA. Camel Milk Triggers Apoptotic Signaling Pathways in Human Hepatoma HepG2 and Breast Cancer MCF7 Cell Lines through Transcriptional Mechanism. J Biomed Biotechnol. 2012;2012:593195. Epub 2012 May 13.
17. Debacle J. Long or Short Capital. Camels, The Next Big Thing. August 1, 2006. < http://longorshortcapital.com/camels-the-next-big-thing.htm > received on July 13, 2012
18. Malik A, Al-Senaidy A, Skrzypczak-Jankun E, Jankun J. A study of the anti-diabetic agents of camel milk. Int J Mol Med. 2012 Sep;30(3):585-92.
19. Mohamad RH, Zekry ZK, Al-Mehdar HA, Salama O, El-Shaieb SE, El-Basmy AA, Al-said MG, Sharawy SM. Camel milk as an adjuvant therapy for the treatment of type 1 diabetes: verification of a traditional ethnomedical practice. J Med Food. 2009 Apr;12(2):461-5.
20. Salami M, Moosavi-Movahedi AA, Ehsani MR, Yousefi R, Haertlé T, Chobert JM, Razavi SH, Henrich R, Balalaie S, Ebadi SA, Pourtakdoost S, Niasari-Naslaji A. Improvement of the antimicrobial and antioxidant activities of camel and bovine whey proteins by limited proteolysis. J Agric Food Chem. 2010 Mar 24;58(6):3297-302.
21. Salami M, Moosavi-Movahedi AA, Moosavi-Movahedi F, Ehsani MR, Yousefi R, Farhadi M, Niasari-Naslaji A, Saboury AA, Chobert JM, Haertlé T. Biological activity of camel milk casein following enzymatic digestion. J Dairy Res. 2011 Nov;78(4):471-8.
22. Redwan el-RM, Tabll A. Camel lactoferrin markedly inhibits hepatitis C virus genotype 4 infection of human peripheral blood leukocytes. J Immunoassay Immunochem. 2007;28(3):267-77.
23. Saito T. Antihypertensive peptides derived from bovine casein and whey proteins. Adv Exp Med Biol. 2008;606:295-317. Review.
24. Sboui A, Khorchani T, Djegham M, Agrebi A, Elhatmi H, Belhadj O. Anti-diabetic effect of camel milk in alloxan-induced diabetic dogs: a dose-response experiment. J Anim Physiol Anim Nutr (Berl). 2010 Aug 1;94(4):540-6.
25. Ulevitch RJ, Tobias PS. Recognition of gram-negative bacteria and endotoxin by the innate immune system. Curr Opin Immunol. 1999 Feb;11(1):19-22.

1.3g of Grape-Seed Extract Could Protect You From Oxidative Damage, Viral Infections, Obesity and Insulin Resistance, Reduce Your Heart Rate and Blood Pressure and Increase Your Nitric Oxide Production by >25%

Image 1: Bought in bulk, grape-seed extract is actually reasonably cheap... and it does not even taste as awful as some other herb / seed extracts ;-)

After initially being hailed as the yet another anti-oxidant panaceum, grape-seed extract (GSE) has been displaced by newer, fancier "superfoods" from the headlines of the major health and wellness newscasters. Therefore, even you, as a highly self-educated student of the SuppVersity could have missed out on a handful of recently released studies which reported antiviral effects of GSE (Su. 2011) and confirmed its ameliorative effect on diet-induced obesity (Ohyama. 2011) and (high) fructose-induced insulin resistance (Meeprom. 2011). Moreover, a meta-analysis of nine controlled with more than 300 human subjects and daily doses ranging from 250mg to 2,000mg of GSE, which was published in the Journal of the American Dietetic Association (Feringa. 2011), found that ...

[b]ased on the currently available literature, grape seed extract appears to significantly lower systolic blood pressure and heart rate, with no effect on lipid or CRP levels.

These results suggest that we (at least some of) the beneficial health effects that have been observed in rodent studies actually translate to human beings - something  we cannot (yet?) say for some of the next generation "panacea" ;-) This is also important in view of the significance of the results GSE-administration had on exercise-induced oxidative stress in a more recent study by scientists from the universities of Konya and Dicle in Turkey (Belviranli. 2011), which was published in the latest issue of the British Journal of Nutrition.

The experiments were carried out with 64 adult male Sprague Dawley rats who were randomly assigned to one of the following six groups:

• sedentary control (C, n=10), 
• chronic exercise control (CEC, n=11), 
• acute exercise control (AEC, n=11), 
• GSE-supplemented control (GC, n=10), 
• GSE-supplemented chronic exercise (GCE, n=11), and 
• GSE-supplemented acute exercise (GAE, n=11)

The rats in the treatment groups received a standardized GSE extract containing 54% dimeric, 13% trimeric, 7% tetrameric and <5% monomeric proanthocyanidines and undisclosed amounts of cathechines and oligomeric proanthocyanidines, at a daily dose of 100mg/kg body weight in their drinking water for 6 weeks.

Image 2: Click here to learn how to calculate human equivalent doses (HED)

Rat to human equivalent dosage calculation: If you have already read my dissertation on how to calculate the so-called human-equivalent-dose (HED), you will probably already have whipped out your calculator and are just about to type "100mg times the K-value for rats, which is 6; divided by the K-value for humans, which is 37" ... and what does your calculator tell you? Correct! The HED of 100mg/kg GSE in rats is 16.33mg/kg - in other words, if you weigh 80kg you will have to take roughly 1,300mg of grape-seed extract per day to mimic the dosage that was used in the study.

The dosage, according to the scientists, was chosen because it had elicited beneficial anti-oxidant effects in previous studies on alloxan induced diabetes (El-Alfy. 2005) and age-related oxidative damage (Balu. 2006). And, as Belviranli et al. had suspected, it exhibited similar protective effects against the oxidative stress triggered by both chronic, 5x a week treadmill exercise at 25m/min for 45 minutes, as well as, acute running on the treadmill at 30m/min until exhaustion.

Figure 1: Effects of acute or chronic exercise and grape seed extract (GSE) supplementation on plasma malondialdehyde (MDA) levels (data calculated based on Belviranli. 2011).

As you can see in figure 1, administration of 100mg/kg grape-seed extract per day augmented the beneficial effect of 6 weeks of chronic exercise on muscle MDA levels (-37% vs. -18% in the control group) and ameliorated the acute +22% increase in MDA levels due to increased lipid peroxidation during exhaustive treadmill running.

Figure 2: Effects of acute or chronic exercise and grape seed extract (GSE) supplementation on plasma nitric oxide (NO) levels (data calculated based on Belviranli. 2011).

GSE supplementation also increased the expression of nitric oxide (NO in  plasma; on average +25%) in all animals (cf. figure 2). Moreover, GSE ameliorated the increase in xanthine oxidase and adenosine deaminase activities due to acute exercise and triggered an overall increase in antioxidant enzyme activities.

So, even if your favorite anti-aging and health (onilne-)magazine or vendor appears to have forgotten about grape-seed extract. For a physical culturist like you and me, it may yet well be worth to (re-)include the extract from the seeds of the fruits of Vitis vinifera, which are a particularly rich source of vitamin E, linoleic acid and, most importantly, oligomeric proanthocyanidins, into our supplement regimen. And if the current study does not convince you, it may help, if I remind you of the 2006 study by Kijima et al. who were able to show that GSE due to its anti-aromatase activity can suppress tumor growth in a breast cancer model (Kijima. 2006) ... ah, and before I forget: don't be stupid and buy over-priced caps. Use google and find yourself a source of bulk grape-seed extract - don't worry the taste is not all too bad ;-)