5+x Sleep Supplements that Work: Valerian, Beer, Cherries, Tryptophan, Theanine | Plus: Effects of Fats, Carbs and GI

While milk with honey is better than milk with glucose (Jalilolghadr 2011), it won't improve - if anything mess - with your sleep quality when it's consumed ≤ 1h before bedtime - noteworthy: the same goes for most foods, though.

While I have chosen it as the title image for today's SuppVersity "Sleep Supplement Special", there's actually surprisingly little (not to say "no") evidence that the notorious hot milk with honey will actually improve your sleep significantly.

That's in contrast to a number of supplements that are discussed in a recent review by scientists from the Northwestern University; a review that highlights both, the short-comings of the existing research on dietary supplements for insomnia and encourage health practitioners "to explore existing resources and partner with patients to understand their goals and advise on safe and effective use of dietary supplements" (Ring 2017).

Studies related to sleep and sleep supplements at the SuppVersity:

Sleep Like an Athlete!

Phenibut Addic- tive or Harmless?

All About GABA at SHR

Melatonin = Easy Fat Loss?

Letrozole? Use Melatonin Instead

Bone & Tooth? Melatonin Helps

Now, the question obviously is: What's safe and effective? By expanding on and elaborating their list of supplements, this article may help you - health practitioner or not - to distinguish promises from factual evidence.

• Valerian - The probably most prominent and certainly one of the best-researched natural sleep aid is the root of Valeriana officinalis - a sleep aid that works... for some.
  
  Since "[v]alerian and its constituent valerenic acid have demonstrated adenosine (A1 receptor) interactions, GABAA receptor (β3 subunit) agonism, and 5-HT5a partial agonism" (Ring 2017) it may be surprising that only 6/9 studies in a recent review by Bent et al showed no effect on subjective sleep quality. 
  

  

  Figure 1: Likelihood that valerian improved sleep quality calculated based on Meta-analysis of 6 studies reporting dichotomous outcomes for sleep quality (adapted from Bent et al. 2006).

  In addition, Bent et al (2006) highlight that "[m]ost studies had significant methodologic problems, and the valerian doses, preparations, and length of treatment varied considerably". More recently, a meta-analysis by concluded:

  "The qualitative dichotomous results suggest that valerian would be effective for a subjective improvement of insomnia, although its effectiveness has not been demonstrated with quantitative or objective measurements. Nevertheless, its use can be considered for some patients given its safety" (Fernández-San-Martín 2010).

  Objective evidence for the efficacy of valerian is thus still missing... possibly due to the use of low-dose / low-concentration supplements. Speaking of which... here are the dosage suggestions Ring et al. provide in their previously cited review.
  
  Dosage: It seems as if it took at least 300–900 mg of a standardized extract of 0.8% valerenic acid - the dosage Ring et al. recommend as an alternative for valerian tea (1.5–3 g of root steeped for 5–10 min in 150 mL of boiling water) - to be taken 30–120 min before bedtime. Effects seem to accumulate over time and may not be noticed with the first administration.

High saturated fat intakes linked to less recuperative slow-wave sleep: In their 2016 study, a randomized crossover inpatient study with 2 phases of 5 nights, St Onge et al. observed differential effects of high fiber and high saturated fat intakes on slow-wave sleep While greater fiber intakes predicted less stage 1 (P = 0.0198) and more SWS (P = 0.0286), the percent of energy from saturated fat predicted less SWS (P = 0.0422). 

• Hops - In (non-alcoholic) beer, hops seems to work wonders for some of us... but wait a minute: is that actually the small quantity of 2-methyl-3-buten-2-ol, xanthohumol, and myrcenol from Humulus lupulus and its effect on GABA that's responsible for these effects?
  
  The fact that non-alcoholic beer works (note: the alcohol in regular beer will reduce REM and boost SWS, but it will also mess w/ the nightly growth hormone production | Prinz 1980), as well, would suggest that it's at least not the alcohol that's responsible for the improvements in subjective sleep quality (assessed by questionnaires), decrease in sleep latency (=time it takes you to fall asleep), and improvement of overall global score of sleep quality improved (Franco 2012 & 2014).
  

  

  Figure 2: We better stay skeptical about the role of hops in the beneficial effects of non-alcoholic beers as it has been observed by Franco et al. in stressed Hungarian students in 2014. It's well possible that it's just the carb content of the beer that triggered the improvements in sleep latency and quality in Franco et al. (2014).

  On the other hand, the fact that hops extracts didn't yield comparably convincing results would suggest that there's more to beer than hops and/or the brewing process gives rise to metabolites that are driving an efficacy that cannot be achieved with commercial hops extracts - extracts that have, in contrast to the non-alcoholic beer, been tested in people with chronic insomnia. It is thus not clear if it's the preparation or the subject group (or both) that's responsible for the mixed results of hops only preparations (evidence in favor of valerian + hops combinations is more promising - even in insomniacs).
  
  Dosage: Unlike valerian and most of the other agents discussed in this overview, hops is not without side effects. When administered in high(er) dosages (HED ~64mg/kg) to mice in conjunction with ketamine, the mice resulted in a deep narcosis. For me, that's another reason to rather drink 300ml of a (non-alcoholic) beer with dinner (check out other health benefits of beer) than to take 120–400 mg of hop extract (ideally combined with 374–500 mg of valerian root extract) to up your sleep quality. Immediate effects can be expected.

Blindfolds and earplugs can improve your sleep quality significantly and help resynchronize a messed up circadian rhythm, which is important for both average Joes and athletes | learn more about "Sleeping like an athlete" in my article from June 2017!

Understanding the different sleep phases and their importance - focus on athletes: As Damian Davenne explains in a 2009 review, "[s]leep can be divided into two main electrical states which serve different basic functions. Slow wave sleep (SWS) is a state during which the brain reduces its activities and neuronal activity becomes synchronized. [...] This type of sleep is important for athletes because, without its presence at the beginning of the night, growth hormone cannot be released from the pituitary gland" (Davenne 2009). During rapid eye movement sleep (REM), on the other hand, the brain is very active - proposedly consolidating memories, including movement patterns.

It is thus not really surprising that studies have shown that, after REM sleep loss, procedural memory and motor skills can be affected (Stickgold and Walker 2007). Another relevant physiological phenomenon for athletes is the blockade of cortico-spinal pathways at the brain stem and subsequent suppression of motor activity, which induces a state of total muscle relaxation "that allows effective myofibril restoration" (Davenne 2009).

• Cherries (esp. tart cherries) - Cherries are well-known for their l-tryptophan content, if you fast forward to the corresponding section of this article it is thus not surprising that cherries/cherry-juice seems to be a highly promising sleep quality modulator.
  
  Next to the serotonin- and melatonin-precursor l-tryptophan, cherries contain a plethora of anti-oxidants, as well as pre-formed melatonin - a cocktail that may well explain why a randomized, double-blind, crossover study on the effect of tart cherries on older adults (age ≥ 65 years) with insomnia found that the consumption of an 8-oz serving of tart cherry juice twice daily for 2 weeks found a statistically significant reductions in insomnia severity (measured as minutes awake after sleep onset).
  

  

  Figure 3: Plot of the relative changes in selected markers of sleep quality; p-values for time x group effects indicate statistical significance for insomnia index and wake after sleep onset (Pigeon 2017).

  Moreover, another study in 20 healthy men and women (aged 18 to 40), which detected significant elevations in urinary melatonin, confirms that the benefits are not restricted to the elderly population in whom the natural production of melatonin is known to decrease. After all, the increase in melatonin Pigeon et al. detected in the urine of the subjects, who complained of insomnia but were otherwise healthy, came with significant increases in time in bed, total sleep time, and sleep efficiency (Pigeon 2010).
  
  Dosage: While pills are available, all promising research has been done using (tart) cherry juice (8 oz consumed 2x per day, chronically). Compared to whole fruits, the juices also have the advantage of being easier to stomach than the significant number of cherries you'd have to consume to get remotely close to the concentration of active ingredients in the currently available proprietary tart cherry drinks. Immediate effects cannot be expected.

Very low-carb and ketogenic diets shift the ratio of SWS to REM sleep in favor of the former: Whether it is a good or bad thing that Afaghi et al. (2008) observed a significant reduction in REM and a corresponding increase in slow-wave sleep (SWS) is still in the open. What is certain, though, is that (a) low-fat high-carb diets have previously been shown to have the opposite effect (Phillips 1975) and that (b) the pro-SWS effects of ketogenic diets can be used in the treatment of abnormal refractory continuous spikes and waves during slow sleep (Nikanorova 2009).

• L-tryptophan - The serotonin and melatonin precursor may actually help you fall asleep and stay asleep, but the # of studies is limited.
  
  Intriguingly, much of the existing evidence of tryptophan's efficacy is >35 years old, with a review by Ernest Hartmann (1982) highlighting three things
  • "the weight of evidence indicates that L-tryptophan in doses of 1 g or more produces an increase in rated subjective sleepiness and a decrease in sleep latency (time to sleep)",
  • "there are less firm data suggesting that L-tryptophan may have additional effects such as decrease in total wakefulness and/or increase in sleep time", and
  • "negative results occur in entirely normal subjects—who are not appropriate subjects since there is 'no room for improvement'"
  Mixed results are also reported in severe insomniacs and in patients with serious medical or psychiatric illness (details are beyond the scope of this SuppVersity article).
  

  

  Figure 4: Graphical illustration of the number (N=y) of studies showing significant, benefits, trends or no change according to a 1982 review in the Journal of Psychiatric Research by Ernest Hartmann (1982)

  As my plot of the number of studies showing significant benefits, trends and no effects highlights, a reduced sleep latency is what appears to be the most certain benefit you can get from 1g+ of l-tryptophan taken ~30 minutes before bed. Potential benefits may be seen from the same regimen (for the # of occasions you wake up and/or toss and turn, as well as the total sleep time.
  
  Dosage: No clear benefits have been observed for higher dosages (even though studies tested boluses of up to 15g), but it seems advisable especially for lower dosages to consume them "on empty", i.e. at least without other protein foods. Effects - at least the sleepiness - may be expected with the first administration.

High GI-carbs significantly speed up (-49%) how long it will take you to fall asleep: While high GI carbs (GI = 109) still have a bad rep, studies indicate that consumed 4h before bed will speed up the sleep latency of healthy individuals by a whopping 49% (9.0 ± 6.2 min vs. 17.5 ± 6.2 min for otherwise identical low-GI meals (GI =50) | Afaghi 2007)... to consume the meal 4h before bed is important, by the way. In the same study, Afaghi et al. observed that the same meal given 1 h before bedtime increased the sleep latency back to 14.6 ± 9.9 minutes. Other studies even suggest detrimental effects with high GI ingestion too close to bedtime (so stick to the 4h) - including milk + glucose (higher GI) vs. the notorious milk + honey mix (lower GI) when consumed ~60 minutes before bed.

General beneficial effects of carbs have been observed, among others, by Porter and Horne (1981) who provided six male subjects with a high-carbohydrate meal (130 g), a low-carbohydrate meal (47 g), or a meal containing no carbohydrate, 45 min before bedtime. The high-carbohydrate meal resulted in increased REM sleep, decreased light sleep, and wakefulness. As Halson et al. (2014) point out in their review, "the caloric content of the meals was [yet] not matched in the study".

• l-theanine - Usually supplements that are so heavily advertised as Just Chill™ and NeuroSleep™ don't work, but for these l-theanine things could be different.
  
  As the authors of the previously cited review in Current Sleep Medicine Reports point out in their review, "[s]everal studies have shown that intake of L-theanine significantly increases α-wave activity in different areas of the cerebral cortex, leading to a relaxed state without drowsiness" (Ring 2017).
  

  

  Figure 5: 200mg/day l-theanine reduce the cortisol release in response to stress (Kimura 2007).

  In conjunction with its ability to increase dopamine and serotonin, and reduce stress-related norepinephrine and cortisol levels, salivary IgA, and heart rate in response to an acute stressor. Plus: L-theanine has been shown in animal studies to partially reverse caffeine-induced reductions in slow wave sleep (Jang 2012) - effects that can occur even with your average morning Joe (i.e. not just with caffeine consumption late in the day | Landolt 1995).
  
  The reason why I still used "could" in the headline of this paragraph is that there is, more or less, only one convincing study to demonstrate beneficial effects on sleep quality in human beings: a 2011 study by Lyon et al. that investigated the effects of Suntheanine® (a branded l-theanine product) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD) and showed objective (actigraph) improvements in sleep percentage and sleep efficiency after 6 weeks.
  

  

  Figure 5: . (a) Sleep length, (b) sleep efficiency, and (c) intermittent awakening WASO data interpreted from actigraph measurements in 10 male subjects. The values represent mean § standard error. Statistical significance was measured using Student’s paired t-test (Rao 2015).

  Similar objective improvements in sleep efficiency and intermittent awakening (WAS) are also reported by Rao et al. (2015) for healthy subjects (see Figure 6).
  
  Dosage: While you will see recommendations ranging from 50 to 400 mg of L theanine taken 30–60 min before bedtime, the "proven" dosage is 200mg. That's more than 4 cups of high l-theanine green tea and thus not really achievable by consuming freshly brewed green tea before bed. As Ring et al. point out, you have to be careful, though, because "[l-t]heanine can have an antihypertensive effect, so it should be used with caution when combined with antihypertensive medications" (Ring 2017).
• Melatonin - Your body's own sleep aid is rather a circadian re-aligner than a true sleeping pill - that's why it works mostly for problems with falling asleep.
  The decrease in sleep onset latency can but doesn't necessarily result in increases in total sleep time. That's why many users who expected benzo-esque results are disappointed.
  
  On the other hand, melatonin has none of the nasty side effects of your average BZD-Z drugs: memory and cognition impairment, psychomotor retardation, or next-day hangover effects (if dosed correctly | Wilson 2010). Likewise, an often-heard of physical dependence has never been observed (Zhdanova 1996).
  
  Dosage: Dosing melatonin is difficult because the optimal dosage differs between individuals. Accordingly, Ring et al. (2017) suggest a dosage plan starting with 0.3mg and increasing to 3mg (max. 6mg) if the desired effects don't occur.
  .

Two Hours of Extra-Sleep Before Sleep Deprivation Minimize the Performance Decrements Due to 24h Sleep Deprivation | more

So, what works? Here's a list: (1) standardized valerian extracts (300-900mg) 60 min before bed, (2) non-alcoholic beer (0.3 L) with dinner, (3) tart cherry juice at a dosage of 8 oz consumed twice per day for days or weeks, (4) ca. 1g of l-tryptophan w/out amino acids competing for uptake (e.g. BCAAs) 30 minutes before bed, (5) l-theanine dosed at 100-400mg/d 30-60 minutes before bed, taking it thrice a day may boost the effect (w/out causing drowsiness) all work, are safe, and worth trying out.

Experimentation may be necessary to find out what works for you - one-size-fits-it-all advice is unwarranted!

The above is especially true for melatonin, which didn't make the A-list, because it's more of a circadian re-aligner than a sleep aid. This doesn't make it less useful, though - on the contrary: if used correctly (1-2h before bed at 0.3-6.0 mg depending on your tolerance) it can have far-reaching beneficial effects on both, your sleep latency, quality, and duration as well as your overall health.

What neither melatonin nor any other sleep aid can make up for, though, is sleep hygiene.

One supplement that has evidence to support its effect, which I still won't recommend, though, is (*) Kava Kava (Piper methysticum), which messes w/ the cytochrome enzyme cascade (CYP450), will affect the metabolism of both meds and other dietary supplements, and has been linked to liver failure (albeit outside of RCTs lasting up to 6 months | Clouatre 2004), as well as the following concoctions that are often recommended but don't have convincing scientific backup: (i) chamomile, despite proven interactions of apigenin in chamomille w/ the GABA receptor, (ii) passion flower, (iii) California poppy, (iv) skullcap, (v) lemon balm, (vi) St. John’s wort, (vii) lavender, and (viii) magnolia bark | Comment on Facebook!

References:

• Afaghi, A., O'connor, H., & Chow, C. M. (2007). High-glycemic-index carbohydrate meals shorten sleep onset. The American journal of clinical nutrition, 85(2), 426-430.
• Afaghi, A., O'Connor, H., & Chow, C. M. (2008). Acute effects of the very low carbohydrate diet on sleep indices. Nutritional neuroscience, 11(4), 146-154.
• Bent, S., Padula, A., Moore, D., Patterson, M., & Mehling, W. (2006). Valerian for sleep: a systematic review and meta-analysis. The American journal of medicine, 119(12), 1005-1012.
• Clouatre, D. L. (2004). Kava kava: examining new reports of toxicity. Toxicology letters, 150(1), 85-96.
• Davenne, Damien. (2009) "Sleep of athletes–problems and possible solutions." Biological Rhythm Research 40.1: 45-52.
• Dement, W C. (2005). "Sleep extension: getting as much extra sleep as possible." Clinics in Sports Med, 24: 251–268.
• Fernández-San-Martín, M. I., Masa-Font, R., Palacios-Soler, L., Sancho-Gómez, P., Calbó-Caldentey, C., & Flores-Mateo, G. (2010). Effectiveness of Valerian on insomnia: a meta-analysis of randomized placebo-controlled trials. Sleep medicine, 11(6), 505-511.
• Franco, L., Sánchez, C., Bravo, R., Rodríguez, A. B., Barriga, C., Romero, E., & Cubero, J. (2012). The sedative effect of non-alcoholic beer in healthy female nurses. PloS one, 7(7), e37290.
• Franco, L., Bravo, R., Galán, C., Rodríguez, A. B., Barriga, C., & Cubero, J. (2014). Effect of non-alcoholic beer on Subjective Sleep Quality in a university stressed population. Acta Physiologica Hungarica, 101(3), 353-361.
• Halson, S. L. (2014). Sleep in elite athletes and nutritional interventions to enhance sleep. Sports Medicine, 44(1), 13-23.
• Hartmann, Ernest. "Effects of L-tryptophan on sleepiness and on sleep." Journal of psychiatric research 17.2 (1982): 107-113.
• Jalilolghadr, S., Afaghi, A., O'Connor, H., & Chow, C. M. (2011). Effect of low and high glycaemic index drink on sleep pattern in children. JPMA-Journal of the Pakistan Medical Association, 61(6), 533.
• Jang, H. S., Jung, J. Y., Jang, I. S., Jang, K. H., Kim, S. H., Ha, J. H., ... & Lee, M. G. (2012). L-theanine partially counteracts caffeine-induced sleep disturbances in rats. Pharmacology Biochemistry and Behavior, 101(2), 217-221.
• Kimura, K., Ozeki, M., Juneja, L. R., & Ohira, H. (2007). L-Theanine reduces psychological and physiological stress responses. Biological psychology, 74(1), 39-45.9
• Landolt, H. P., Werth, E., Borbély, A. A., & Dijk, D. J. (1995). Caffeine intake (200 mg) in the morning affects human sleep and EEG power spectra at night. Brain research, 675(1), 67-74.
• Lyon, M. R., Kapoor, M. P., & Juneja, L. R. (2011). The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. Alternative medicine review, 16(4), 348.
• Ozeki, Makoto, Lekh Raj Juneja, And Shuichiro Shirakawa. "The Effects Of L-Theanine On Sleep Using The Actigaph." Japanese Journal Of Physiological Anthropology 9.4 (2004): 143-150.
• Nikanorova, M., Miranda, M. J., Atkins, M., & Sahlholdt, L. (2009). Ketogenic diet in the treatment of refractory continuous spikes and waves during slow sleep. Epilepsia, 50(5), 1127-1131.
• Phillips, F., Crisp, A. H., McGuinness, B., Kalucy, E. C., Chen, C. N., Koval, J., ... & Lacey, J. H. (1975). Isocaloric diet changes and electroencephalographic sleep. The Lancet, 306(7938), 723-725.
• Pigeon, W. R., Carr, M., Gorman, C., & Perlis, M. L. (2010). Effects of a tart cherry juice beverage on the sleep of older adults with insomnia: a pilot study. Journal of medicinal food, 13(3), 579-583.
• Porter, J. M., & Horne, J. A. (1981). Bed-time food supplements and sleep: effects of different carbohydrate levels. Electroencephalography and clinical neurophysiology, 51(4), 426-433.
• Prinz, P. N., Roehrs, T. A., Vitaliano, P. P., Linnoila, M., & Weitzman, E. D. (1980). Effect of alcohol on sleep and nighttime plasma growth hormone and cortisol concentrations. The Journal of Clinical Endocrinology & Metabolism, 51(4), 759-764.
• St-Onge, M. P., Roberts, A., Shechter, A., & Choudhury, A. R. (2016). Fiber and saturated fat are associated with sleep arousals and slow wave sleep. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 12(1), 19.
• Stickgold, R and Walker, M P. (2007). "Sleep-dependent memory consolidation and reconsolidation." Sleep Med, 8: 331–343.
• Wilson, S. J., Nutt, D. J., Alford, C., Argyropoulos, S. V., Baldwin, D. S., Bateson, A. N., ... & Gringras, P. (2010). British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. Journal of Psychopharmacology, 24(11), 1577-1601.
• Zhdanova, I. V., Wurtman, R. J., Morabito, C., Piotrovska, V. R., & Lynch, H. J. (1996). Effects of low oral doses of melatonin, given 2–4 hours before habitual bedtime, on sleep in normal young humans. Sleep, 19(5), 423-431.

330ml/d Beer for 30 Days Will Sign. Improve Healthy Men's Glucose Management | 58% Lowered Insulin Resistance!

Beer by the numbers.

With me being a German citizen, you probably suspect bias when it comes to the health effects of beer... and you're right: I hate beer! I don't know why, but I don't like the taste of it and only drink it when it's necessary to socialize. Accordingly, you may believe me when I tell you that a recent study from the Federal Inst. of Education, Science and Technology of Rio de Janeiro (IFRJ) found that drinking 330ml of alcoholic beer is not only not bad, but downright healthy.

From previous articles about beer, here at the SuppVersity, you will remember that non-alcoholic beer is an excellent sports drink (learn more in "The Ergogenic Effect of Nonalcoholic Beer Front- & Back Loading + 15 Beerish Health Facts Everyone Should Know" | read it).

Read about exercise- and nutrition-related studies in the SuppVersity Short News

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With the publication of Luciana C. Nogueira's latest study, it does now appear as if alcoholic beer had at least as many benefits as non-alcoholic beer, of which SuppVersity readers know that it has blood pressure lowering effect, a high magnesium content, contains glutathione precursors and active immunomodulatory peptides and proteins as well as the 35+ phenolic compounds (about 80–90% from malt and 10–20% from hops), etc. (learn more in the previously cited SuppVersity article).

Obviously, that's good news; after all, beer is the most consumed alcoholic beverage in the world. The fact that Nogueira's study showed significant positive health effects on fifteen healthy adult men (aged 20 to 57 y) in a 3x30 day study, is thus quasi-relevant for humanity ;-)

Figure 1: This is where getting healthy (by drinking beer) is the cheapest; source: statista.com.

In Treatment 1 (Baseline), the subjects, who were non-smokers, free of liver disease or any other disorder that could alter the metabolism of alcohol and had a habitual alcohol intake classified as low (0.1 to 9.9 g of ethanol per d) to moderate (10 to 30 g of ethanol per day), followed their usual diet without drinking any alcoholic beverage; in Treatment 2, subjects consumed 330 mL non-alcoholic beer (NAB); and in Treatment 3, the subjects drank 330 mL alcoholic beer (AB) per day.

Table 1: Characterization of beers—quality indicators (Nogueira 2017)

Please note: Not all beers are created equal! I cannot guarantee that your beer will have the same health benefits as the beer that was used in the study at hand. Since it was brewed in a commercial brewery and without any tricks (aside from milling the malt, which favors the action of enzymes on insoluble components), fermented for only 5 days and matured to achieve the best taste, I would yet suspect that the results apply to all Pilsen beers.

In contrast to what the wine industry has tried to make us believe for the larger part of both this and the previous century, beer turned out to have similar if nor more pronounced health benefits than wine (see Figure 2): It was found that the use of alcoholic beer (AB) for 30 d (16 g alcohol/d)

• reduced the blood insulin and fasting glucose, significantly, and
• significantly reduced insulin resistance. 

As the scientists rightly point out, their study is thus the first to demonstrate that "the daily intake of 330 mL AB could statistically change the lipid profile and insulin sensitivity of adult men" (Nogueira 2017) - now, the bad news is that the lipid profile worsened significantly.

Figure 1: Consuming 330ml of alcoholic beer for 30 days had impressive anti-diabetes effects (Nogueira 2017); insulin and fasting insulin resistance index on the primary, glucose on the secondary axis.

What is particularly surprising, though, is that the ill effect on the HDL/LDL ratio was much more pronounced during the 30 days in which the subjects consumed the non-alcoholic beer (16% lower HDL/LDL ratio; difference not statistically significant, though). That's in contrast to previous studies showing that moderate alcohol consumption in general, and beer, in particular, is associated with reductions in both, the triglyceride:HDL and the total cholesterol:HDL ratios in the long run (Huang 2017).

Improved glycemia ✓, but also HDL:LDL ratio ↘ 

Furthermore, consuming non-alcoholic beer elevated the subjects' triglycerides (66.4 vs. 80.6) to a similar extent as other sugary non-alcoholic beverages (89.5) and lacked the previously highlighted beneficial effects on blood glucose management that was also observed in epidemiological studies.

Figure 2: Type + amount of alcohol matter when it comes to the effect on one's type II diabetes mellitus risk (Kao 2001).

It does, therefore, appear logical to assume that it is the moderate alcohol consumption that's responsible for the improvements in glucose management and none of the various phenols which would/could be found in the non-alcoholic beer. To get to the bottom of the mechanism, though, we'd need molecular analyses complementary to the health parameters the scientists didn't run - that's a pity because other recent studies like Kim et al. (2009) seem to refute the idea that it's the alcohol that does the trick. In their study, the scientists from the Stanford University did not find sign. effects of moderate wine or vodka consumption - their study subjects were, however, insulin-resistant to begin with and the amount of alcohol that was administered was two times higher.

Figure 3: The latest meta-analysis of studies w/ a duration of at least 2 weeks seems to confirm that a moderate alcohol consumption improves glycemia, in this case, the long-term glucose gauge HbA1c in healthy individuals (Schrieks 2015).

Accordingly, I'd suggest we stick to the results of the latest meta-analysis by Schrieks et al. who came to the conclusion that "the current evidence suggests that moderate alcohol consumption may decrease fasting insulin and HbA1c concentrations among nondiabetic subjects" (Schrieks 2015).

PWO alcohol is not for male athletes. But before you rejoice, ladies. The ill health effects of a given amount of alcohol are more severe for the fairer sex. The study did not use beer as a test beverage, though | more.

What's the verdict? In contrast to what many people certainly believe, beer, at least when it's consumed in moderation (16g/d alcohol) and for "only" 30 days has profound anti-diabetic/pro-glucose-management effects in healthy young and middle-aged men.

The effects are probably in one way or another related to its alcohol content because the study at hand found no such effect of non-alcoholic beer.

The worsening of the HDL/LDL ratio that was observed in both, the non-alcoholic and alcoholic beer treatments, is not necessarily a reason for concern - especially if you have never had problems w/ blood lipids | Comment!

References:

• Franco L, Sánchez C, Bravo R, Rodríguez AB, Barriga C, Romero E, Cubero J. The sedative effect of non-alcoholic beer in healthy female nurses. PLoS One. 2012;7(7):e37290. Epub 2012 Jul 18.
• Huang, Shue, et al. "Longitudinal study of alcohol consumption and HDL concentrations: a community-based study." The American Journal of Clinical Nutrition 105.4 (2017): 905-912.
• Kao, WH Linda, et al. "Alcohol consumption and the risk of type 2 diabetes mellitus: atherosclerosis risk in communities study." American Journal of Epidemiology 154.8 (2001): 748-757.
• Koletzko B, Lehner F. Beer and breastfeeding. Adv Exp Med Biol. 2000;478:23-8. Review.
• Nogueira, Luciana C., et al. "Moderate Alcoholic Beer Consumption: The Effects on the Lipid Profile and Insulin Sensitivity of Adult Men." Journal of Food Science (2017): ahead of print.
• Schrieks, Ilse C., et al. "The effect of alcohol consumption on insulin sensitivity and glycemic status: a systematic review and meta-analysis of intervention studies." Diabetes Care 38.4 (2015): 723-732.

The Ergogenic Effect of Nonalcoholic Beer Front- & Back Loading + 15 Beerish Health Facts Everyone Should Know

Image 1: Erdinger Weißbräu Alkoholfrei your first choice for peri workout isotonic carbohydrate supplementation!?

Where else, if not from Germany, "The Land of Beer and Weißwurst" as it is falsely perceived by the average foreign Oktoberfest visitor, could the data for a study on the ergogenic effects of nonalcoholic beer originate from? In their recently published paper Johannes Scherr and his colleageas from the Department of Prevention and Sports Medicine at the Klinikum rechts der Isar of the Univerisity of Munich report that a 'forntload + post-supplementation' strategy (3 weeks before, 2 weeks after) with 1-1.5l/day of Erdinger Weißbräu Alkoholfrei led to statistically significant reductions in post-race total blood leukocyte counts (-9%) and interleukin-6 (-24%) and 66% lower incidence of upper-respiratory tract infections in the 58 beer-drinking subjects (age: 36-51y), when compared to their 63 peers(age:35-49y) who received an isocaloric control beverage, which differed from the beer only in terms of its polyphenol content (Scherr. 2012).

It's not all about Erdinger Alkoholfrei  - 15 Beerish Health Facts You Should Know

In fact, the ergogenic effects Scherr et al. observed in their most recent study are probably nothing but one of the manifold downstream effects of the nutrient dense non-alcoholic fraction of 'amber nectar', which consists of a whole host of bioactive ingredients with at least as many, mostly beneficial health effects (the following is in part based on Sohrabvandi. 2010; where other references were used, additional references are provided):

How exactly is nonalcoholic beer produced?

• Fermentation-free brewing and dilution procedures won't produce results European or US costumers will be happy with, therefore it is mostly used in Islamic countries
• Alcohol removal by vacuum destillation, adsorptive alcohol removal, dialysis, reverse osmosis, or osmotic distillation
• Restricted alcohol fermentation uses yeast that can only partially ferment the wort or represses or interrupts fermentation by applying different compositional and/or process procedures (interrupted fermentation technique)
• Fermenting with GMO bacteria which lack the alcohol dehydrogenase (ADH) enzyme and produce no or minimal amonts of alcohol.
• Reducing fermentable fractions / glucose content in wort by adjusting the concentration of sugar in the primary formulation so that no considerable sugar residue remains after the restricted fermentation period.
• Heating or pressurizing the wort to inactivate yeast cells and inhibit the subsequent alcoholic fermentation, as soon as the desired flavor profile of the wort was achieved

Note: The beer in the study at hand was brewed under tightly controlled temperature (the exact method is apparently a company secret, though).

• has potentially blood pressure lowering effect due to high potassium to sodium ratio (typically 4:1) 
• is relatively rich in magnesium and to less extent in phosphorous
• contains glutathione precursors and co-factors zinc, copper, selenium and amino acids
• features physiologically active immuno-modulatory peptides and proteins
• has 35+ phenolic compounds (about 80–90% from malt and 10–20% from hops)
• may prevent and improve obesity and type-2 diabetes, improve lipid metabolism, and suppress atherosclerosis due to beneficial health effects of the bitter substances in hops (Kondo. 2004)
• has been shown to improve sleep and lactation in women; probably due to bioactive molecules from hops (Koletzko. 2000; Franco. 2012)
• contains folate and glycine betaine which exert antimutagenic effects and reduce homocysteine
• has up to 6.2g fiber per liter
• its β-pseudouridine content may protect against radiation damage (Monobe. 2003)
• contains silicic acid which increases renal excretion of aluminum (Aluminum has been associated with age related diseases and neurodegeneration; cf. Krewski. 2007)
• is associated with higher hip mineral density in older men who drink 2 regular beers/day; probably due to its silicon content (Tucker. 2009)
• provides more antioxidants per day than wine to the U.S. diet (Vinson. 2003)
• exerts anti-oxidative effects on lipoproteins (=cholesterol) which are superior to that of its vitamin & antioxidants, alone (Vinson. 2003)
• unfortunately, allegedly gluten-free barley based beers contain significant amounts of hordein (=gluten) and are not suitabe for patients with celiac disease (Colgrave. 2012)

Now compare that to your average energy drink, which - as you should by now be aware of - may deliver zero fat calories and will still add 18g /day of body fat right to your frame, when consumed on a daily basis (cf. "Fat Content Per Energy Drink 0g, Body Fat Gain Per Energy Drink 18g!")

Image 2 (FOX): Homer always knew what Schütze et al. confirmed in 2009: "Beer consumption leads to [waist circumference] gain [...] closely related to overall weight gain. This study does not support the common belief of a site-specific effect of beer on the abdomen."

Implications: In view of the fact that carbohydrate supplementation is still common practice among endurance athletes, I don't see why a refreshing nonalcoholic beer (1.5l of Erdinger Weißbreu Alkoholfrei contain 375kcal and ~75g of carbohydrates)  that has been brewed according to the German purity law should not be at least as good as one of those sugar-laden electrolyte drinks or gels with artificial colorings and what not.

Moreover, the relatively high phenolic content of the beer (~400 mg of gallic acid equivalents per day), of which Scherr et al. speculate that it was the underyling reason for the observed benefits, could render the use of other polyphenolic supplements obsolete, save you money and keep you healthy and sane, as only few people are like me don't like the taste of beer and can thus sit in the Biergarten with nothing but plain water, while their friends hoist brew after brew... although, when I come to think about it: Maybe I should order some Erdinger later today? *rofl*

Note: The study was financed from a fund that was established by the Erdinger Weissbraeu, Werner Brombach GmbH. Contrary to some other researchers Scherr et al. do yet openly disclose the funding and state that "the funders had nodirect role in the study’s design, conduct, analysis, interpretation of data, and reporting" - and before you start lamenting, now, think about who finances and conducts the studies on pharmaceuticals...

References:

• Colgrave ML, Goswami H, Howitt CA, Tanner GJ. What is in a beer? Proteomic characterization and relative quantification of hordein (gluten) in beer. J Proteome Res. 2012 Jan 1;11(1):386-96.
• Franco L, Sánchez C, Bravo R, Rodríguez AB, Barriga C, Romero E, Cubero J. The sedative effect of non-alcoholic beer in healthy female nurses. PLoS One. 2012;7(7):e37290. Epub 2012 Jul 18.
• Koletzko B, Lehner F. Beer and breastfeeding. Adv Exp Med Biol. 2000;478:23-8. Review.
• Kondo K. Beer and health: preventive effects of beer components on lifestyle-related diseases. Biofactors. 2004;22(1-4):303-10.
• Krewski D, Yokel RA, Nieboer E, Borchelt D, Cohen J, Harry J, Kacew S, Lindsay J, Mahfouz AM, Rondeau V. Human health risk assessment for aluminium, aluminium oxide, and aluminium hydroxide. J Toxicol Environ Health B Crit Rev. 2007;10 Suppl 1:1-269.
• Monobe M, Arimoto-Kobayashi S, Ando K. Beta-pseudouridine, a beer component, reduces radiation-induced chromosome aberrations in human lymphocytes. Mutat Res. 2003 Jul 8;538(1-2):93-9.
• Scherr J, Nieman DC, Schuster T, Habermann J, Rank M, Braun S, Pressler A, Wolfarth B, Halle M. Nonalcoholic beer reduces inflammation and incidence of respiratory tract illness. Med Sci Sports Exerc. 2012 Jan;44(1):18-26.
• Schütze M, Schulz M, Steffen A, Bergmann MM, Kroke A, Lissner L, Boeing H. Beer consumption and the 'beer belly': scientific basis or common belief? Eur J Clin Nutr. 2009 Sep;63(9):1143-9. Epub 2009 Jun 24.
• Sohrabvandi S, Mousavi SM, Razavi SH, Mortazavian AM, Rezaei K. Alcohol-free Beer: Methods of Production, Sensorial Defects, and Healthful Effects, Food Reviews International. 2010;26:4, 335-352
• Tucker KL, Jugdaohsingh R, Powell JJ, Qiao N, Hannan MT, Sripanyakorn S, Cupples LA, Kiel DP. Effects of beer, wine, and liquor intakes on bone mineral density in older men and women. Am J Clin Nutr. 2009 Apr;89(4):1188-96.
• Vinson JA, Mandarano M, Hirst M, Trevithick JR, Bose P. Phenol antioxidant quantity and quality in foods: beers and the effect of two types of beer on an animal model of atherosclerosis. J Agric Food Chem. 2003 Aug 27;51(18):5528-33.

Adelfo Cerame - Road to The Wheelchair Nationals '12: Bring Your Cucumbers to Vegas! Or, How Intermittent Fasting Can Make a Road-Trip Bodybuilding Compatible

Image 1: When a bodybuilder heads to Vegas, its either for the Arnold or because he knows the difference between passion and obsession.

I don't know what to say, but somehow I think I am kind of jealous. My friend Adelfo is heading to Vegas and I am sitting here in the rainy cold, reading about how he is preparing not for the contest, but for three wild days in Las Vegas! I mean if it were for the Arnold's... but no, it is just for fun! And you know what? That is exactly what it takes to be successful - making bodybuilding your passion, not your obsession. How that works? Well, I guess I will hand over to Adelfo give you his rundown of the fundamentals, like choosing hard liquor over beer and making sure to be in a drunken stupor not before the bar, but before your feeding window closes ;-)

Viva Las Vegas! There is no life beyond, but a life with bodybuilding!

Las Vegas! That's the place to be... well, it will be for me over the next three days - belated birthday celebrations ;-) And yes, I remember that I have a show coming up in just a few weeks. Do you, by the way remember, that I told you these days were coming right at the beginning of my prep? You know that I am pretty meticulous, when it comes to planning things ahead and this belated birthday present is part of the plan, so to say. So, yes: I am nine weeks out, and going to be out f@cking around in Las Vegas for 3 days. Why? Simply because I can get away with it. Remember what the rapper Suga Free once said? "If you stay ready, then you ain't gotta get ready!"... exactly that, "staying ready", is what I have been doing since October 1st and this is why I am now able to enjoy life without the slightest touch of OCD.

Recipe of the week: My Leafless Crunchy Salad

I don’t know about you all, but I hate lettuce! It’s not filling at all! And it takes a whole bag just to fill you up! I prefer crunchy cucumbers, squash, zucchinis and fruit in my salad!

Ingredients:

• sliced cucumbers, zucchinis and squash
• a couple sticks of sliced celery
  (slice into small pieces)
• 2 cups of sliced strawberries
• 1-2 sliced kiwis
• ½ cup of blueberries
• ½ cup of cherry tomatoes
• 2-3 tbs. of sliced almonds
• 1 packet of truvia (stevia)
• red wine vinegar
• sea salt & pepper 

Macros: 30-40g of carbs (all from the fruits)/ 5g fat

Tip: Sprinkle sea salt, pepper, truvia, and red wine vinegar to liking. I don’t count macros in veggies, so load up on as much cucumbers, zucchini and celery as you want.

I am - and I hope this does not sound too narcissistic - at a point where I am really confident with my work ethic and the current level of my physique. So confident, in fact, that I can actually enjoy the upcoming days in Vegas without feeling guilty. And let's be honest, even if I made an effort to really f*** things up - how much permanent damage can you possibly do within 3 days?

A modified routine can keep you on track even when you are "behind the enemy lines"

Image 2: A recipe from Martin Berkhan’s LeanGains website - Vanilla Vodka, lime or lemon wedges, cinnamon & brown sugar… light in calories & carbs, and straight to the point after a couple shots!
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Will I try to mess things up? I guess, you should know me too well by now to buy that off me, aren't you? Obviously I will still be sticking to my routine: My fast and feeding protocols, my commitment to eat whole nutrient dense foods, and I will still train. To make that work, I will have to apply a few tweaks to my usual routine. First and foremost, I will have to reschedule the feeding and fasting windows, so that they allow me to stay up late and consume the one or other alcoholic beverage... and yes, practically, this means that I will be drinking alcohol only during my feeding hour. With regard to the type of beverages I will be selecting, it should be obvious that beer, with its tons of carbs and useless calories is a complete no-go.

I'll stick to the real man's choice: hard liquor ;-) 

 For a lightweight like me this has another advantage. My tolerance for alcohol is so low nowadays that all I would need is 5-6 shots… maybe 10, and I’m feeling a good mellow buzz for the night.

Traveling is no excuse to let yourself go!

Bodybuilder or traveling salesman, being on the road is not excuse to let yourself go. It may take a little planning and probably ain't as convenient as going to McDonald's but even a bodybuilder can maintain his regular nutritional regimen while traveling or being on vacationing. For me this means that

• Boiled chicken breast
• Cucumbers
• Fruits
• Whey protein
• Creatine monohydrate
• Quest bars (I’ll buy some at my gym after I train this Thursday morning before I hit the road)

are part of the luggage I am going to bring with me to Vegas. Five items... plus the simple rule to make sure to order animal meats and veggies, when I go out to dinner - that is all it takes!

Traveling-Tip: Whenever you are out on a short vacation like mine, make sure one of the days is a re-feed day ;-) I, for my part, am already looking forward to the all-you-can-eat buffets I am going to hit on Sunday...

Diet to live, don't live to diet!

I just realized that the thrill of anticipation has carried me away, somewhat, but I guess you got my main message, anyway. Whatever diet you are on, if it is not flexible enough to incorporate a short vacation weeks before you step on stage, it probably ain't worth sticking to, anyway. I mean, if you start living to diet, things begin to get out of hand... it's all about balance and setting the correct priorities at the right times.

Right now I am, by the way, at 1600 kcal per day, I decided not to take it down to 1400 kcal yet. I will re-evaluate this decision on the 1st of February, but as of now I've been enjoying the perks of increasing my calories, adding starchy carbs back into my PWO meals and having re-feed days every Sunday. And though I was initially afraid of water- or even fat gains, up to now it seems as if there have been nothing but benefits from the increase in calories, the re-inclusion of starchy carbs in my post-workout meals and the frequent re-feeds: My muscles feel fuller, my vascularity has improved, and to me it looks as if I was still getting leaner!? What do you think?

Image 3: December 24, 2011, diet was strictly protein + fat @1400kcal for the two weeks prior (left); January 13, 2012 back at 1600kcal and with 100g of carbs added back into my post-workout meals (right).

I’m still kind of baffled how my vascularity has improved. I guess it’s the organic russet potatoes, I’ve been eating after my workouts along with the SlinShot "nutrient repartitioner" by PurusLabs. I guess, you could also argue, though that the fuller muscles just shine a bit more, now that I am at an overall lower body fat level. But with all the nutritional, and training methods that I’ve been playing around with for the past couple of months it is difficult, ... no, it is impossible to pinpoint the one factor that is responsible for the success and that, as surprising as it may seem, actually is "the one" factor that will eventually make you succeed: Finding the right mix of dietary and training techniques that works for you, person A at timepoint T1. For me that was no-to-low carb at T1, but now that I have achieved a body fat level, where it becomes increasingly harder for my body to run on fat for fuel exclusively, an adequate intake of carbohydrates post-workout that will suffice to replenish my glycogen stores appeared to be exactly what was necessary to avoid stagnation or regress.

Three days in Vegas and still 8 weeks to go!

Image 4: The re-addition of starchy carbs into my Slinshot supplemented post-workout meals made a hell of difference in terms of vascularity.

After my Vegas weekend, I will be hitting my 8-week mark. On Monday, to be precise. And from there on, it is no more planned distractions, no more holidays and no more birthdays to celebrate! It’s just going to be eight solid weeks of proper dieting and intense training. More than enough time to make all the necessary adjustments to get ridiculously shredded without burning myself out. For now, however, I am going to enjoy the little mini vacation... my well-deserved break before I will be bound to the gym and the kitchen for eight full weeks, in the course of which I will try really hard to push to my personal limits with both my training and my nutritional regimen... so I guess we will see if, in those weeks to come, I will still be able to say that "this has been one of the easiest preps by far"... but for now, I will pack my clothes and food for the trip and hope that I am going to see you here, next Thursday, eager to hear, or I should say, read how the road-trip effected  my physique :-)