TeaCrine®, Tribulus, Cordyceps, ALA, Sesamin, Fish Oil & More - The Latest Supplement Science (November 2016)

Many currently available supplements lack sufficient scientific backup.

It has been a while since I published the last supplement science update - the recent release of the latest edition of the Journal of Dietary Supplements reminded me of that. In issue 1 of volume 14 of this journal that "addresses important issues that meet a broad range of interests from researchers, regulators, marketers, educators, and healthcare professionals" (Aims & Scope according to the publisher) you will find studies on (you already know that from the headline) "TeaCrine®, Tribulus, Guarana, ALA, Sesamin, Fish Oil & More", studies the design and results of which I will briefly summarize for you in the following paragraphs:

Read about rather exercise-related studies at the SuppVersity

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• TeaCrine® performs again: New data on safety, dosing and time course of effects (Ziegenfuss. 2016) -- You've read about theacrine (not to be confused with l-theanine although both are naturally occurring in tea) in previous SuppVersity articles. It's a purported cognitive and physical performance enhancer and its patented variety, which is extracted from Camellia assamica variety kucha tea, is now part of many pre-workout formulas.
  
  In their latest study, Ziegenfuss et al. (2016) who generated most of the currently available TeaCrine® (TC) research examined the "subjective dose–response, daily changes in cognitive and psychometric parameters, and changes in gas exchange and vital signs" (Ziegenfuss. 2016).  As the authors point out, these particular study outcomes "were chosen to better ascertain the previously reported animal and human outcomes involving theacrine administration" (ibid.).
  

  

  Figure 1: Relative changes (calculated based on arithmetic mean of 95% confidence interval) in self-reported fatigue, focus, and willingness to exercise in the chronic administration trial (Ziegenfuss. 2016).

  The study had two parts: Part 1 (chronic administration) was a randomized, open-label, dose–response investigation in nine healthy participants  (3F, 6M) who consumed either 400 mg TC per day or 200 mg TC per day and recorded the subjective changes in cognitive, psychometric, and exercise attributes using 150-mm anchored visual analog scale (VAS) before, and 1, 4, and 6 hours after ingestion every day for 7 consecutive days.
  
  Part 2 (acute administration) had a different design, with 15 healthy subjects (7F, 8M)
  participating in a randomized, double-blind, placebo-controlled, crossover investigation in which all participants ingested a single 200 mg dose of TC or Placebo (PLA).
  Just like in part 1 (results see Figure 1), VAS questionnaires were used to detect subjective changes in various aspects of physical and mental energy along with changes in gas exchange and hemodynamic parameters before, and 1, 2, and 3 hours after acute ingestion.
  
  What the scientists found was a similar increase in energy, focus, and concentration with both dosages of theacrine. Interestingly enough, the subjects' willingness to exercise, anxiety, motivation to train and libido increased only in the low-dose group receiving 200mg/d for 7 days while it was unchanged in the higher-dose group who took 400 mg of the supplement on a daily basis.
  

  

  Figure 2: Graphical summary of the most important take-home messages of the study at hand.

  Now this, i.e. the U-shaped dose-response curve (cf. Figure 1) is yet only one of three important insights into how you should supplement with this natural purine molecule: It can be derived from (a) Ziegenfuss' et al.'s acute administration study that you (A) don't have to take theacrine chronically for a week (or longer) before you see beneficial effects. On the other hand, the results from the long(er)-term study show (B) no habitation effect, i.e. the dreaded decrease in efficacy you see with other stimulants such as caffeine.
  
  Speaking of which, since theacrine does not have any of caffeine's (mild) adverse side effects such as increased heart rate or changes in systemic hemodynamics (more safety data can be found in Hayward. 2015), theacrine could, in fact, make a good adjunct to caffeine in pre-workout supplements or fat loss adjuvants. To award teacrine the "SuppVersity seal of ergogenic approval", it would yet be nice to see independent research on the combination of the two, i.e. caffeine and theacrine - research that would prove that theacrine does, indeed, add meaningfully to the benefits of caffeine when it's co-consumed with the world's favorite stimulant. For l-theanine there's some such evidence, as you've learned earlier this year at the SuppVersity, for theacrine, on the other hand, the one study that investigated the potential nootropic effects of this combination found only subjective, yet no objective benefits (Kuhman. 2015).
• Tribulus disappoints again: No beneficial effects in men with unexplained infertility (Roach. 2016) -- With their latest study, researchers from the Cairo University in Egypt add to the confusion over the efficacy of tribulus terrestris supplements. Unlike the others of other recent studies, Roaiah, et al. didn't find any measurable benefits in the 30–50-year-old patients with unexplained infertility who participated in their three-months study.
  

  

  Figure 3: The relatively low dose of regular tribulus powder didn't have a measurable effect on the hormone levels of the infertile men in the 3-months study at hand (Roaiah. 2016).

  The authors, themselves, attribute the different study outcomes primarily to differences in the dosage regimen with studies yielding positive results using twice the amount that was used in the study at hand (meaning 1,500 mg/day instead of 750 mg/day in three divided doses). Personally, however, I would suspect that the type of the supplement [raw powder vs. saponin extract as it was used in Wilk, et al. (2016)] may better explain the sign. inter-study differences. If that's indeed the case it wouldn't make sense to pick up the next best TT supplement at your local GNC and hope for results. Rather than that, it would be wise for studies to finally settle if it's the product quality and, more specifically, the saponin content and composition that makes all the difference.
• Cordyceps (militaris) surprises again: Study finds performance benefits during high-intensity exercise tests w/ chronic supplementation (Hirsch. 2016) -- Cordyceps is not just the third purported ergogenic in today's installment of the SuppVersity Supplement Research Update, it's also one of those supplements where we simply don't have enough evidence to be sure that it's worth the significant amount of money you have to pay for a monthly supply of 4g/day of this peculiar mushroom.
  
  With the data in Figure 1 and the fact that it is now offered in bulk at prices that would allow you to get a one-month supply for less than $15, cordyceps may be a candidate for your "next supplement to test-drive"-list.
  

  

  Figure 4: Phase II changes in performance measures (A) maximal oxygen consumption (VO2max), (B) ventilatory threshold (VT), and (C) time to exhaustion (TTE) presented as 95% confidence intervals (Mean ± (1.96 × SEM)) | ∗indicates a significant improvement, as determined by 95% CI (Hirsch. 2016).

  You should be aware, though, that it took Hirsch et al. the analysis of 95% confidence intervals and thus some statistical shenanigan to be able to report significant improvements in total time to exhaustion (TTE) after one (+28.1 s) and three weeks (+69.8 s) and three weeks before the small, but measurable increases in VO2max (+4.8 ml/kg/min) and ventilatory threshold (+0.7 l/min) surfaced. If cordyceps does indeed work it is thus, just like creatine, whey and other better-proven ergogenics, a thing that has to be consumed chronically - unlike caffeine and its stimulating cousins' (including theacrine, see above) whose immediate effects are probably the reason why they are so popular.

While it is no longer a popular fat burner ingredient sesamin may be an anti-inflammatory, blood glucose management improving adjunct to the supplement regimen of any type II diabetic according to a new human study (Mohammad. 2016).

What else have we got? Alright, with the three most interesting studies being discussed in detail we can turn to the noteworthy, but not exactly super-interesting studies on guarana, ALA, carnitine, magnesium and fish oil. And no, we're not talking about stacking them. Rather than that, the latest research from scientists all around the world suggests that there are (A) no benefits of 2x50mg /day of guarana in neck cancer patients during chemotherapy (Martins. 20016), (B) potential benefits of carnitine and alpha lipoic acid (ALA) may prevent the onset of diet-induced type II diabetes in humans just like they did in a recent rodent study (Abdelkarem. 2016), (C) significant benefits of sesamin (you may remember this oil from various OTC fat burners) as an anti-inflammatory T2DM supplement (see Figure to the right) and (D) small but significant reductions in muscle soreness in response to resistance training after one week on 6g of fish vs. soybean oil (Tinsley. 2016) | Comment!

References:

• Abdelkarem, Hala M., Laila H. Fadda, and Abeer AG Hassan. "Potential Intervention of α-Lipoic Acid and Carnitine on Insulin Sensitivity and Anti-Inflammatory Cytokines Levels in Fructose-Fed Rats, a Model of Metabolic Syndrome." Journal of Dietary Supplements (2016): 1-11.
• Habowski, S. M., et al. "The effects of Teacrine TM, a nature-identical purine alkaloid, on subjective measures of cognitive function, psychometric and hemodynamic indices in healthy humans: a randomized, double-blinded crossover pilot trial." Journal of the International Society of Sports Nutrition 11.1 (2014): 1.
• Hayward, Sara, et al. "Safety of Teacrine®, a Non-Habituating, Naturally-Occurring Purine Alkaloid Over Eight Weeks of Continuous Use." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P59.
• Hirsch, Katie R., et al. "Cordyceps militaris Improves Tolerance to High-Intensity Exercise After Acute and Chronic Supplementation." Journal of Dietary Supplements (2016): 1-13.
• Kuhman, Daniel J., Keanan J. Joyner, and Richard J. Bloomer. "Cognitive performance and mood following ingestion of a theacrine-containing dietary supplement, caffeine, or placebo by young men and women." Nutrients 7.11 (2015): 9618-9632.
• Martins, Suelen Patrícia dos Santos, Cynthia Lemos Ferreira, and Auro del Giglio. "Placebo-Controlled, Double-Blind, Randomized Study of a Dry Guarana Extract in Patients with Head and Neck Tumors Undergoing Chemoradiotherapy: Effects on Fatigue and Quality of Life." Journal of Dietary Supplements (2016): 1-10.
• Mohammad Shahi, Majid, et al. "Effect of Sesamin Supplementation on Glycemic Status, Inflammatory Markers, and Adiponectin Levels in Patients with Type 2 Diabetes Mellitus." Journal of Dietary Supplements (2016): 1-12.
• Roaiah, Mohamed Farid, et al. "Prospective analysis on the effect of botanical medicine (Tribulus terrestris) on Serum testosterone level and semen parameters in males with unexplained infertility." Journal of Dietary Supplements (2016): 1-7.
• Tinsley, Grant M., et al. "Effects of Fish Oil Supplementation on Postresistance Exercise Muscle Soreness." Journal of dietary supplements (2016): 1-12.
• Wilk, Michał, et al. "Endocrine Responses to Phys^ical Training and Tribulus Terrestris Supplememtation in Middle-Age Men." Central European Journal of Sport Sciences and Medicine 13.1 (2016): 65-71.
• Ziegenfuss, Tim N., et al. "A Two-Part Approach to Examine the Effects of Theacrine (TeaCrine®) Supplementation on Oxygen Consumption, Hemodynamic Responses, and Subjective Measures of Cognitive and Psychometric Parameters." Journal of dietary supplements (2016): 1-15.

Exercise Research Update Nov. '14 (2/2): Vibration Training for Athletes, Caffeine Muscle Size & Power, Time to Psyche Up, Myostatin Resp. to Strength & Comb. Training & More

Vibration training is for lazy men & women, only - right? It cannot speed up the adaptation process in athletes, right? And it certainly has no effects on body composition, right? Not exactly, scroll down and find out why.

For those of you who haven't read yesterday's first installment of this research update, I highly suggest you head over now, or after you've read today's follow up on additional vibration training for athletes, caffeine and the effect of muscle size on the strength boosting effects of caffeine, the benefits of and perfect time to psyche up before a sprint event and the muscular myoastatin response to strength, interval and combined training, to make sure you don't miss half this research update.

And if you are not interested in any of these news you may still appreciate the bottom line with a brief review of the latest evidence for the differential or identical effects of strength and hypertrophy training on the acute biochemical and neuromuscular responses justify the classification of strength- and hypertrophy-type resistance exercise.

You can learn more about coffee at the SuppVersity

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• Additional vibration training valid for athletes to develop both strength and hypertrophy of the lower limbs, study shows. The researchers randomly assigned forty-one (32 men and 9 women) recreationally active subjects (21.4 ± 3.0 years old; 172.6 ± 10.9 cm; 70.9 ± 12.3 kg) to either two (G2) or three (G3) vibration training sessions per week for six weeks and measured the changes in maximum isokinetic strength, body composition, and performance in vertical jumps from the beginning to the end of the training cycle (Martinez-Pardo. 2014).
  
  The vibration training stimulus consisted of uniform vertical oscillations. holding an isometric quarter squat position with the feet shoulder-width apart - no fancy exercises or headstands on the plate ;-) After the familiarization week, subjects trained 2 or 3 days per week for 6 weeks (with the exception of the C G) using a vibrating incremental training program that began with 8 sets per session and increasing by 1 set weekly.
  
  

  

  Figure 1: Change in body composition over the course of the 6-week study period (Martinez-Pardo. 2014)

  The frequency of vibration (50 Hz), amplitude (4 mm), time of work (60 seconds), and time of rest (60 seconds) were constant for G2 and G3 groups, the increases in lean mass were not: While the G2 group gained "only" 0.9 ± 1.0 kg, while the subjects in the G3 group who participated  in three weekly vibration training sessions had a whopping 1.5 ± 0.7 kg more lean mass after only 3 sessions per week x 6 weeks = 16 sessions on the vibration plate.
  
  As it was to be expected, neither the total fat mass, nor the fat percentage (measured reliably by DEXA) changed statistically significantly and the bone mineral content, and bone mineral density of the men and women in both groups didn't change at all (previous studies show that vibration training can increase bone density or at least reduce the bone loss in people who are at risk of osteoporosis | de Zepetnek. 2009). 
• Caffeine & muscle power - Larger muscle groups benefit more, study shows. Right from the labs of the University of Edinburgh comes the news that 6 mg/kg caffeine (CAF) increase the isokinetic peak torque of the knee extensors, ankle plantar flexors, elbow flexors and wrist flexors proportionally to the respective size of the muscle group.
  

  

  Figure 2: Relative increase in isokinetic peak torque values of the 4 muscle groups for the CAF vs. placebo treatments at an angular velocity of 60°/s (Timmins. 2014)

  More specifically, statistical analyses revealed a significant increase in isokinetic peak torque from PLA to CAF (p = 0.011) for all, but significant difference in isokinetic peak torque between muscle groups (p < 0.001).
  
  As the scientists point out, "[t]his research may be useful for competitive and recreational athletes aiming to increase strength-power performance," because they now know that (a) caffeine works and (b) that it will work better for larger vs. smaller muscle groups.

• 

  Figure 3: Mean change in performance for each condition and time interval. A) Overall 30-m sprint time. B) Acceleration phase of the sprint, i.e. 0- to 10-m lap time (Hammoudi-Nassib. 2014)

  Is it time to "psyche up", already? Scientists investigate relationship between time interval between psyching up and sprint performance. In their latest study researchers from the Tunisian Research Laboratory Sports Performance Optimization National Center of Medicine and Science in Sports (CNMSS) found that imagery techniques were specifically effective in enhancing the performance on the phase of acceleration (0–10 m) and on the overall sprint (0–30 m) when they were used immediately before performance and at 1- and 2-minute intervals.
  
  When the subjects were asked to use the same technique 3- and 5-minutes before the sprints, though, no effect was observed. As the researchers point out, their "findings support the hypothesis that the potential effect of the PU [psyching up] strategy on performance vanishes over time." (Hammoudi-Nassib. 2014)
• Skeletal muscle myostatin response is identical for strength training (ST), interval training (IT) and concurrent training (CT), study finds. Researchers from the University of São Paulo tested the differential effects of the previously mentioned training regimen in thirty-seven physically active men over the course of an 8-week training period and found that ...
  

  • 

    Figure 3: No sign. difference in myostatin response to training (de Souza. 2014)

    Type IIa and type I muscle fiber CSA increased from pre- to posttest only in the ST group (17.08 and 17.9%, respectively). 
  • The SMAD-7 gene expression significantly increased at the posttest in the ST (53.9%) and CT groups (39.3%). 
  • The MSTN and its regulatory genes ActIIb, FLST-3, FOXO-3a, and GASP-1 mRNA levels remained unchanged across time and groups. 
  Moroever, the one repetition maximum increased from pre- to posttest in both the ST and CT groups to a similar extent (ST = 18.5%; CT = 17.6%).
  
  In spite of the fact that the scientist say that their "findings are suggestive that MSTN and their regulatory genes at transcript level cannot differentiate muscle fiber CSA responses between CT and ST regimens in humans" (de Souza), one could still speculate that the non-significantly lower myostatin levels in the ST-only group (see Figure 3) may already have been enough to cause the small, but significant difference in typeIIa and type I fiber CSA increase from pre- to postttest the researchers observed.

Photo from FighterDiet.com -- Powerlifting training can yield similar results as classic hypertrophy training. Is this because the acute biochemical and neuromuscular responses do not differ | learn more 

Before I call it a day, I would still like to draw your attention to yet another study that was published in the latest issue of the Journal of Strength and Conditioning Research, one that tried to answer the question, whether "the acute biochemical and neuromuscular responses justify the classification of strength- and hypertrophy-type resistance exercise" (Nicholson. 2014) and found that the only difference between strength and hypertrophy type workouts - despite their significant different intensities, volumes, and rest times (STR: 4 × 6 repetitions, 85% 1 repetition maximum [1RM], 5-minute rest periods vs. HYP: 4 × 10 repetitions, 70% 1RM, 90-second rest periods) - was observable in the acid-base response to the workout. Accordingly, Nicholson et al. conclude that "practitioners to look beyond the classification of RE workouts when aiming to elicit specific physiological responses" (Nicholson. 2014). Maybe that's also why powerlifting- and hypertrophy-like workouts have been shown to yield very similar outcomes in recent studies (learn more)?

References:

• de Souza et al. "Effects of Concurrent Strength and Endurance Training on Genes Related to Myostatin Signaling Pathway and Muscle Fiber Responses." Journal of Strength and Conditioning Research 28.11 (2014): 3215–3223.
• de Zepetnek, JO Totosy, Lora M. Giangregorio, and B. Catharine Craven. "Whole-body vibration as potential intervention for people with low bone mineral density and osteoporosis: a review." J Rehabil Res Dev 46.4 (2009): 529-542.
• Hammoudi-Nassib et al. "Time Interval Moderates the Relationship Between Psyching-up and Actual Sprint Performance." Journal of Strength and Conditioning Research 28.11 (2014): 3245–3254.
• Martinez-Pardo et al. "Effect of a Whole-Body Vibration Training Modifying the Training Frequency of Workouts per Week in Active Adults." Journal of Strength & Conditioning 28.11 (2014):3255–3263.
• Nicholson, et al. "Do the Acute Biochemical and Neuromuscular Responses Justify the Classification of Strength- and Hypertrophy-Type Resistance Exercise?"  Journal of Strength & Conditioning 28.11 (2014): 3188–3199.
• Timmins & Saunders. "Effect of Caffeine Ingestion on Maximal Voluntary Contraction Strength in Upper- and Lower-Body Muscle Groups." Journal of Strength & Conditioning 28.11 (2014):3239–3244

Study Says: Wheat Belly is All in Australians' Head. And in Fact, the Peer-Reviewed Scientific Evidence for Non-Celiac Gluten-Sensitivity is Scarce, But Probably Not Non-Existent

From a paper in the Journal of Cereal Science: Histological structure of wheat grain showing bioactive components which are related to the fiber fraction of wheat and are present in whole meal but absent in refined flour. (Brouns. 2013).

A recent study from the CSIRO Food Futures National Research Flagship and the University of Adelaide says: The data indicate that many adult Australians are consciously avoiding consumption of wheat foods, predominantly without any formal diagnosis. Reported symptoms suggest a physiological but not allergenic basis to this behavior.

Can this be? Can your "gluten intolerance" really be in your head? Certainly it can, it's what scientists call a nocebo effect: A situation, where a harmless substance taken by a patient is associated with harmful effects due to negative expectations or the psychological condition of the patient.

But wheat is no harmless substance, right?

Certainly not. At least not for those people who suffer from celiac disease. As far as the ever-spreading gluten-intolerance is concerned, though, more and more scientists voice concerns over the ever-increasing number of self-diagnosed gluten-intolerant individuals strike one food item after the other from their already short list of "gluten kosher" foods.

Social influences on Australian "wheat avoiders" (Golley. 2014)

Surprisingly, it's not the Internet that makes people go gluten-free. That's at least what the "wheat avoiders" in Sinead Golley's study claim. For them individuals in their surrounding had a much greater impact on their decision to go gluten free. It's their naturopath, their alternative medicine practicioner, friends, family and, surprisingly, even the doctor. And that in spite of the fact real illnesses (from asthma to IBS) were rare among the "wheat avoiders". Non-wheat food intolerances and allergies, on the other hand, were significantly more prevalent among the wheat avoiders than among their wheat eating (generally healthies) peers.

In an enlightening paper with the telling title "But we're not hypochondriacs: The changing shape of gluten-free dieting and the contested illness experience" in Social Science & Medicine, Lauren Renée Moore wrote only a couple of months ago:

"[T]his research suggests that self-ascriptive looping results in a greatly expanded illness prototype, and that gluten-free individuals promote a broadened illness prototype and self-diagnosis to their friends and families. Some work to promote the diet further. As a result, self-ascriptive looping can function as one vector in the diet's growing popularity." (Moore. 2014).

The so-called looping effect describes how categories are continually redefined as the people within them change. The group of "gluten intolerant" individuals, once only celiacs, has thus over time transformed into an amalgam with celiac patients on the one end and real hypochondriacs on the other end of the extreme. And they all have one thing in common. For each of them, his or hear gluten intolerance is absolutely real.

In view of the way this illness prototype or rather its contemporary realization is constantly changing it's no wonder that it has lost all resemblance to what doctors call "gluten intolerance". The logical consequence: Patients feel misunderstood and blame their "doctors for their failure to correctly diagnose the problem." (Moore. 2014)

The illness is real, and so are the risks

In the end, it's thus not a question of who's wrong and who's right. For the "patients" who have now become their own doctors their illness is absolutely real. The previously asked question, whether wheat is a harmless substance or not is thus no longer practically relevant for them and they are willing to pay the price - literally that is by paying significantly more money for (oftentimes) nutritiously inferior foods from the "gluten-free" industry (Hallert. 1998; Long. 2010).

Figure 1: 0.548% of the US citizens are "gluten-free" spec. middle-aged + older women are jumping aboard - for what? Well the only potentially health-relevant differences between wheat eaters and non-wheat eaters are lower TSH (thyroid gaspadel) and higher HDL values - and no one knows if those weren't present before going gluten-free (DiGiacomo. 2013)

Money is yet not the only concern researchers have with the increased trend towards gluten-free "elimination diets". Many of them warn that this trend entails a significant risk for the self-diagnosed gluten intolerant individual, who may not just be risking his health by consuming unnecessarily restrictive diets with potentially serious dietary imbalances, but could also be overlooking a much more serious health issue that's the actual cause of their symptoms (Monsbakken. 2006; Teufel. 2007) - or as Golley apptly puts it: The most serious risk is the delay in diagnosis and treatment of potentially serious underlying medical condition, due to self-diagnosis of symptoms as due to a food intolerance.

What about the physiological side?

As the previous remarks have shown, there is little doubt that the contemporary trend towards "gluten-free" diets is a socio-psychological phenomonen that's not (yet?) rooted in conclusive scientific evidence that would point towards general detrimental effects of wheat consumption on non-celiac human beings (Brouns. 2013).

Table 1: Trends in publication on celiac disease (CD) and non-celiac gluten sensitivity (NCGS) during the last decades (Catassi. 2013). It's not as if researchers were not interested in non-celiac-gluten-sensitivity (NCGS).

And still, there is a significant difference between the absence of conclusive evidence and the claim that "no data justifies a negative opinion about whole-wheat products in a healthy population" you will find in Brouns', Buuls' & Shewry's unquestionable not exactly impartial review of the literature in the Journal of Cereal Science (Brouns. 2013). If you look closely and without the wheat-colored glasses the National Association of Wheat Growers may have sponsored, you will find a handful of studies which do suggest that the consumption of high amounts of wheat and gluten has general detrimental effects on our health:

• Wheat amylase trypsin inhibitors may drive intestinal inflammation via activation of toll-like receptor 4 -- Yvonne Junker et al. report in a 2012 paper that the natural α-amylase/trypsin inhibitors in wheat "may fuel inflammation and immune reactions in other intestinal and non-intestinal immune disorders." (Junker. 2012).
• Auto-immune reactions could be triggered without the expression of T-cell specific antigens -- Using recent evidence from celiac patients as an example, Ludvig M. Sollid & Bana Jabri argue that the constant exposure to certain immuno-modulating substances such as gluten, could be exogenous factors which "might be identified as drivers of autoimmune processes, in particular when evidence for T cells with specificity for self antigens driving the disease is lacking." (Sollid. 2013)
• Low-fermentable, poorly-absorbed, short-chain carbohydrates could contribute to symptoms (at least those related to IBS) experienced by non-celiac-gluten-sensitivity patients -- With the low-fermentable, poorly-absorbed, short-chain carbohydrates, i.e. fermentable oligo-, di-, and mono-saccharides and polyols, aka FODMAPs an international group of scientists suspects another of the blogosphere's usual suspects may be to blame.
  
  

  

  Figure 2: A low FODMAP diet will progressively reduce the symptoms of NCGS (Biesiekierski. 2013)

  The data from a 7-day low FODMAP study does actually appear to support a relevant interaction of FODMAPs and gluten sensitivity (Biesiekierski. 2013).
  
  The results do yet require experimental verification and further research should try to reveal the underlying mechanism which could explain the reduction in gluten sensitivity in response to the low FODMAP diet, will yet have to be elucidated - an involvement of the gut microbiome, by the way, is not impossible.

The interaction with non-fermentable short-chain carbohydrates and the influence of the gut microbiome are also two key points in Aziz' and Sanders' recent editorial "Patients Who Avoid Wheat and Gluten: Is That Health or Lifestyle?", in which they emphasize the role of excessive fermentation from small intestinal bacterial overgrowth in the etiology of what many people think was "gluten intolerance". Whether "SIBO" (small intestinal bacterial overgrowth) and "gluten intolerance" are co-incidental or whether one is actually responsible for the other will yet have to be determined in future studies. Studies of which the data in Table 1 suggests that they will be done, as the relative research interest in non-celiac gluten sensitivity is continuously growing.

Bottom line: In the end, it may not even be important if non-celiac gluten sensitivity is a real or a social-psychological epidemic. If you are "infected" and avoiding gluten-containing foods and or non-fermentable short-chain carbohydrates helps you, do it! As long as you keep an eye on your micronutrient intake and don't live off ready-made processed gluten-free junk, it's probably not going to harm you - physiologically that is.

It's not always easy to be "gluten-free", even for animals (Gulls Comic)

As far as to the psychological side effects are concerned, I am yet not sure, whether the constant (perceived) need to double check each and every product level is not going to drive one or another of the mostly already OCD-ridden anti-wheat-warriors to insanity.

Reference:

• Biesiekierski, Jessica R., et al. "No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates." Gastroenterology 145.2 (2013): 320-328.
• Brouns, Fred JPH, Vincent J. van Buul, and Peter R. Shewry. "Does wheat make us fat and sick?." Journal of Cereal Science 58.2 (2013): 209-215.
• Catassi, Carlo, et al. "Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders." Nutrients 5.10 (2013): 3839-3853.
• DiGiacomo, Daniel V., et al. "Prevalence of gluten-free diet adherence among individuals without celiac disease in the USA: results from the Continuous National Health and Nutrition Examination Survey 2009-2010." Scandinavian journal of gastroenterology 48.8 (2013): 921-925.
• Golley,  Sinéad  et al. "Motivations for avoiding wheat consumption in Australia: results from a population survey." Public Health Nutrition (2014). First view available on CJO2014. 
• Hallert, C., et al. "Quality of life of adult coeliac patients treated for 10 years." Scandinavian journal of gastroenterology 33.9 (1998): 933-938. 
• Junker, Yvonne, et al. "Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4." The Journal of experimental medicine 209.13 (2012): 2395-2408.
• Long, K. H., et al. "The economics of coeliac disease: a population‐based study." Alimentary pharmacology & therapeutics 32.2 (2010): 261-269.
• Moore, Lauren Renée. "“But We’re Not Hypochondriacs”: The Changing Shape of Gluten-Free Dieting and the Contested Illness Experience." Social Science & Medicine (2014).
• Monsbakken, K. W., P. O. Vandvik, and P. G. Farup. "Perceived food intolerance in subjects with irritable bowel syndrome–etiology, prevalence and consequences." European journal of clinical nutrition 60.5 (2006): 667-672. 
• Sollid, Ludvig M., and Bana Jabri. "Triggers and drivers of autoimmunity: lessons from coeliac disease." Nature Reviews Immunology 13.4 (2013): 294-302.
• Teufel, Martin, et al. "Psychological burden of food allergy." World Journal of Gastroenterology 13.25 (2007): 3456.

"Now You Can Eat All The Crap in The World and Still Lose Weight" Psychological Liberation After Taking a Purported "Fat Burner" is an Overlooked Risk Factor for Obesity

Yeah! I am in the active arm of the study! Now I Can Eat All The Crap in The World and Still Lose Weight!

I have been waiting for this study to be conducted for years and am by no means surprised that a group of scientists from the Tunghai University and the National Sun Yat-sen University in Taiwan found that "[u]sing weight-loss supplements may produce unintended consequences on
dietary self-regulation." I mean, don't we all know someone who succumbed to the psychological
liberation when he or she was using a weight-loss supplement? Yes, we do! 

Is it any wonder that weight loss pills suck, if the experiment Yevvon Y. Chang and Wen-Bin Chiou conducted confirmed what we expected altogether?

You can learn more about fat burners at the SuppVersity

Capsaicin as a Thermogenic

Piperine vs. Silbutramine

New Ephedra Sources?

Inflammation = True Fat Burner

Fat Oxidation ￪￪ w/ Caffeine

High Calcium Diets = Fat Burner?

After consuming a purported weight loss pill, the 70 young women who had been recruited for the experiment and were randomized to receive a pill of which half of them was told ...

• "the test pill will help you to attain weight loss" - active arm of the study

while the other half was told that the little pills they were supposedly taking in the "Biology Department" and during a functional food test, got the information

• "the test pill is a placebo that will be used in a future study" - placebo arm

before they were send to a student restaurant for a lunch buffet - the buffet, where the magic happened and the psychologically liberating effect of the weight loss pills took full effect.

"The food in this buffet, which remained consistent over the course of the experiment, consisted of six healthy items (e.g., fruit, salad with Japanese dressing, vegetable pizza, steamed bean cu steamed fish, and sugar-free green tea) and six less healthy items (e.g., chocolate cookies, French fries, fried chicken, cheeseburgers, soda, and custard). Healthy and less healthy items were identified by two nutritionists blind to the purposes of the experiment." (Chang. 2014)

Other than you may have expected, the "heavier" ladies neither ate more, nor less healthy foods. What did have an impact on the number of food items and, more importantly, the type of food (healthy vs. unhealthy) the young women ate was the message the message they'd received, when they had taken the weight loss pill.

Figure 1: Relative differences in total, unhealthy and healthy food intake in subjects who believed that they consumed the weight loss pill; data expressed relative to control group (Chang. 2014)

As you can see in my plot of the study results in Figure 1, the women who had been told that the pill the had taken was an effective fat burner, consumed more food and made unhealthier food choices than the control group who believed they had consumed an ineffective placebo supplement.

Based on a previous analysis of the participants general attitude towards weight loss supplements, the scientists were also able to determine that the "now you can eat all the crap in the world and still lose weight" effect was more pronounced in those young ladies with a positive attitude towards weight loss pills and a firm believe in their efficacy.

Suggested Read: "Forgotten Dieting Aids: Choline, Carnitine, Caffeine and the Anti-Weight-Loss Plateau Effects of Sugar and Phosphates" | more

Bottom line: I am not telling you not to support your weight loss efforts by using a stim-based fat burner. These products can keep you going, suppress appetite and will help you function in your everyday life, when your calorie intake drops and the lack of energy takes it's toll.

NONE of the currently available OTC fat burners will actually "burn" the fat you are to lazy to lose. If you are taking these products to have the occasional slice of pizza every other day, you are doomed to fail. Sales of indulgences like this may work in the confession box, but they don't work on the (body fat) scale.

References:

• Chang, Yevvon Y., and Wen-Bin Chiou. "The Liberating Effect of Weight-Loss Supplements on Dietary Control: A Field Experiment." Nutrition (2014).

Exercise Threesome: 40g of Galactose = 17% More Stamina Than W/ Same Amount of Glucose ☆ Faster Sprints W/ Psychological Tricks ☆ 10% Lower Insulin W/ Exercise

A neat threesome, anyone?

A threesome is always quite entertaining, especially, when it's one that can help you (a) increase your stamina, (b) boost your sprint performance, and (c) decrease your fasting insulin levels by 10%. Ok, I have to admit it will probably not suffice if you only read the following paragraph, but buying 40g of galactose, playing a couple of psycho-games on yourself and the adherence to the regular exercise program you are already performing anyway (right!?) is something you will probably manage to do, as well.

• 40g galactose before a workout will increase your stamina (O'Hara. 2014) -- Basically that is already the main finding of a recent study by John P. O'Hara et al... well, aside from the fact that the same dose of glucose didn't produce similar benefits - but let's tackle one thing after the other...
  
  The researchers evaluated the effects of the pre-exercise (30 minutes) ingestion of galactose (Gal) or glucose (Glu) on endurance capacity, as well as glycaemic and insulinaemic responses.
  
  To this ends 10 trained male cyclists completed three randomised high-intensity cycling endurance tests. Thirty minutes prior to each trial cyclists ingested 1 litre of either
  
  • 40g of glucose,
  • 40g of galactose, or
  • 40g of a placebo
  in a double blind manner. The protocol comprised: 20 minutes of progressive incremental exercise (70% to 85% maximal power output (Wmax)); 10x90 second bouts at 90% Wmax, separated by 180 seconds at 55% Wmax; 90% Wmax until exhaustion.
  
  Blood samples were drawn throughout the protocol. As the headline already told you the times to exhaustion were longer with glactose (68.7+/-10.2 minutes, P=0.005), interestingly that was true for both the placebo (63.9+/-16.2 minutes) and the glucose (58.5+/-24.9 minutes) trial.
  
  In view of the anti-lipolytic effects of high insulin, it's probably also worth mentioning that the ingestion of 40g of performance-increasing galactose supplement did (at least from a statistical perspective) not increase the participants insulin levels, at all.

• 

  SuppVersity HIGHLY Suggested Read: " Brocebo? Add 10kg to Your Bench in Days with Sugar-Based "Anabolic Steroids". Old Study Shows, Many "Natural Anabolics" Could Work Solely via Placebo Effects" | read more

  Psyching yourself up will boost your sprint performance (Sarra. 2014) -- A soon-to-be-published study in the Journal of Strength and Conditioning Research that investigated the effect of "psyching-up" (PU) strategies, in this case preparatory arousal and imagery strategies, would improve the performance of 16 male sprinters (age 20.6 +/- 1.3 years, body mass 77.5 +/- 7.1 kg, height 180.8 +/- 5.6 cm).
  
  If we sprint forward to the results, we'll see that the imagery and preparatory arousal strategies did in fact contribute to performance increases in the short-distance sprints (from 0 to 10-m). The imagery strategy also increased the performance in the 30-m sprints.
  
  And you know what? These "psyching-up" strategies work even if you don't buy a useless supplement take it before your workout and ignite the "placebo afterburner"
• Work out to decrease your fasting insulin levels by 10% (Conn. 2014) -- In spite of the fact that we all believe we knew that regular exercise will have beneficial effects on  insulin sensitivity, there is very little comprehensive data on the average effect size.
  
  A recent meta-analysis from the University of Missouri provides just that: A "Systematic Review and Meta-Analysis of Outcomes Among Healthy Adults", which reveals what the subheading to this item in today's exercise news-quickie already told you: The average participant in one of the 78 papers that were included in the analysis showed statistically lower fasting insulin levels (6.9mU/L) than the control subjects (7.9 mU/L).

Bottom line: If you are already working out regularly, you may want to try to psyche you up, while you're guzzling a galactose drink before your next workout and let me know what happened, after you tore down the gym... if you are not, I mean, not working out, on the other hand, the decrease in insulin you can achieve with a minimal amount of physical activity should be reason enough to get your ass off the couch... and no, I am not talking about walking to the fridge to get another bottle of coke and some ice-cream to satisfy your sweet tongue ;-)

Reference:

• Conn V. S. et al. "Insulin Sensitivity Following Exercise Interventions: Systematic Review and Meta-Analysis of Outcomes Among Healthy Adults." J Prim Care Community Health. (2014) Jan 27. [Epub ahead of print]
• Hammoudi-Nassib, S. et al. "Effects of psyching-up on sprint performance". Journal of Strength & Conditioning Research. January 28, 2014 [accepted manuscript].
• O'Hara, J.P. et al. "The Effect of Pre-exercise Galactose and Glucose Ingestion on High-Intensity Endurance Cycling". Journal of Strength & Conditioning Research. January 28, 2014 [accepted manuscript].

Who Is Making Your Healthy Food Choices? 19+ Exemplified Arguments It Could be a Clever Advertising Psychologist

Image 1: How free is your "free choice" really when it comes to when, what and how much you eat or consume? Are you controlled by cunningly placed triggers and cues?

One, if not the most important ideal of the modern Western world is (supposedly) "freedom"! *hold the obligatory minute of silence, here* And still, the whole system would probably collapse in no time, if we were not all slaves to a whole host of endogenous and exogenous constraints, restraints and compulsions, which influence our public and private behavior and decisions. From the shirts we wear at a club to the foods we buy at the grocery, more often than not, our choices have little to do with the deliberate decision the term seems to imply. Take the obese 300lbs person from across the street for example - does he chose to eat his family pizza alone in front of his telly, when he comes home from the office? What about the bag of chips? Did he chose to eat the whole bag, before he gets up from the couch and continuous with some fat-free popcorn, or did it "just happen"?

Behavioural economics + Social psychology + Neuroscience = POWER!

Over the past few decades, behavioural economics, social psychology and neuroscience have uncovered a complex network of hard-wired trigger => action pairs and instinctual processes which govern our day-to-day choices. And over time, this knowledge about psychological mechanisms, which may originally have evolved as a means to cope with the complexities of life without having to rationalize for hours over the vast amount of choices and their individual consequences, has developed into one of the most important and probably single-most effect marketing tools of the 21st century.

Therefore, I did decide to use the recent publication of a pertinent paper in the journal of the Internationals Association for the Study of Obesity as an opportunity to tackle a few of the endless subtle and no so subtle messages by which the food, entertainment and fitness industry is trying to guide your and my daily dietary and behavioral choices into those directions which will generate the greatest revenue for them.

Hardwired (food-)choices: From Pavlov's bell to the priming effect of "fat free" stickers

Image 2: "Peel me I'm Fat Free" - I would laugh, if it wasn't so maddening.

From an evolutionary perspective it does make sense that our brain is designed to process contextual stimuli automatically: the neurons that transmit signals from our senses to the brain are directly connected to motor neurons, so people can respond reflexively, without having to make a conscious decision (Libet. 1991).

There is yet plenty of evidence which suggests that what was intended to facilitate survival can - assuming a "false" wiring - can turn against us, these days.

Here are a couple of examples:

• It takes only 20ms for the average consumer to identify his favorite cookie and 1/3 of a second to make his / her choice (Milosavljevic. 2011) - even if they were there, when we are in a hurry (and let's be honest, aren't we constantly "on the run"?) chances that we would even see, recognize and think about healthier alternatives right next to our staples, the Snickers, Oreos, Twinkies or Syntha-6 Decadence Protein Bars of this world, are not close to, they simply are zero.
• Consumers pick products based on brands / recognizable labels, without taking a closer look at what they are buying (MacVean. 2009) - If it says "weight watchers approved", it must be good, for weightloss and "all natural corn sugar" is certainly healthy, right? Ah,.. and if "Whole Foods" sells it, you don't have to think twice, it's whole food, man!
• Exposure alone and subliminal familiarization renders products more attractive (Zajonc. 2001; Auty. 2004) - It does not have to be one of those dubious "drink coca cola" inserts that was (supposedly) run in single frames in the movie theaters back in the day, when the pictures started moving (for the efficacy of which there is by the way some scientific evidence; cf. Copper. 2002) for us to react to constant exposure by being more attracted to a certain product. This effect is particularly pronounced though, if we are not noticing how it is pushed on us. And the "cholesterol causes heart disease hypothesis, the current carb scare or the rampant vitamin D craze are contemporary examples which show that this also works for "non-material" goods or concepts.
• Preference for heuristic choices (Scheibehenne. 2007) - We gravitate towards so-called heuristic choices, i.e. we like to base our "decisions" on exactly one and only one (often learned) parameter. For food, for example this has become the amount of fat the food contains for an unfortunate majority of the folks who say of themselves that they "eat healthy". If you either know which parameters these are or invest enough new marketing dollars to replace an old by a new heuristic parameter, you can sell rancid plant oils as cholesterol-lowering super-margarine and push your latest testosterone booster onto people because it contains the highest amount of bulbine of all products that are currently on the market. For the former you can simply rely on the ground-breaking *rofl* work of the government, with the latter you will have to pay a handful of "reps" (these are people who frequent the major bulletin boards and tell other people whatever you pay them for) to install the bulbine natalensis acid contet as the novel #1 criteria for people to look for in a testosterone booster.

I guess, this should be enough to recognize the picture that's emerging here: In essence, the way (food-)marketing works is not all too different from the often laughed-about "Pavlovian conditioning" by which dogs were made to salivate, whenever Dr. Pavlov rand his famous bell. The main difference is though that people are drilled to buy (the technical term is "priming" vs. "conditioning"), not to dribble. And since this won't work without the actual deed, i.e. the purchase, being possible, when they see the "no fat" or "low fat" sticker, we call this "priming" not conditioning ;-)

From Mac Donald's to your local sushi bar - they all how to push your buttons

Now that you are familiar with some of the fundamental mechanism, let's take a look how the evil clown with the red hair and the innocently smiling manager of your local sushi place exploit your (hard-)wiring to help you you make the "right" food choices at their restaurants - "right" obviously for them, not necessarily for you!

• Restaurant or Supermarket - Where's the Difference?

  According to their different business model supermarkets employ other techniques to persuade you into buying things you don't need and certainly shouldn't eat. The way managers of supermarkets, grocery stores and even your local farmer take (unfair?) advantage of fundamental human psychological wirings, when they press the buttons on remote control of your subconsciousness is the same for all salesmen and women:

  • Omnipresence - <5% of the US citizens have no supermarket within half a mile of their home and when it's close and convenient, they buy
  • Expanding and constantly revised product range - From 7,000 in the 1970s to >40,000 products, today; individual supermarkets have >50,000 items in one store (!), needless to say the vast majority are processed foods
  • Special arrangement of the products - From simple surveys to video and eye-tracking, lighting and perfume; setting up the perfect store setting has become a science in it's own right. End-isles which account for for 30-40% of all sales are only one of the countless examples of how you are lead to buy stuff you don't need or shouldn't eat (Sorensen. 2003 & 2008)
  • Slogans and keywords - Against the background that the average customer will read no more than 8-12 lines of text on an average shopping trip, it is of paramount important to make those count (Sorensen. 2008)
  • Structured chaos - Not sorting soups, cereals and co and forcing people to search for what they want within a range of similar / related products will increase sales, esp. of new products (Larson. 2006).
  • Using XXL cartonages - They convey the notion of "making a bargain" or "getting more for one's money" regardless of the content (Mayer. 2008)
  • Putting Mickey and the Ice Age characters on whatever you want kids to buy - While the right cartoon characters render even fruit as attractive to kids as candy, they are mostly (ab-)used by candy producers to outdo one another (De Droog. 2011)
  • "Buy X, get Y for free" incentives - When costumers see those, their brain goes into hibernation (Wansink. 1998)
  • Providing a decent range - Five different types of fruity ice cream increase the chance that customers buy one of those by 21% over having only a binary choice between fruit and chocolate, for example (Sela .2009); too many choices, e.g. 20 types of icecream, will yet overwhelm customers (Iyengar. 2000; Schwartz. 2003).
  Being next door - Since most of the decisions to eat-out are made spontaneously (>64% for the younger generation; >52% for the 60+ agers), the redheaded clown will soon open his 13,000+ (US only) franchise restaurant right next to your local sushi place, to increase his chance that you pick him, and not the sushi guy, whenever you spontaneously decide to "eat" out.
• Placing unhealthy items first - Items that come first on the menu, even better on the upper right hand of the menu, will get picked first (Hadden. 1997; Dayan, 2011). Smart move of owner of the sushi place that he placed the overpriced junk right in this "sweet spot" of his menu.
• Hiding expensive stuff in the bargain section - If you did not notice that the Sushi Master Plate is not one of the bargain, although it is listed in a box in the upper right corner on the bargains page, the manager of your local sushi store, must have read that Poundstone's "Priceless: The Myth of Fair Value (and How to Make Advantage of It" twice ;-)
• Not being afraid of labeling the calories - The redheaded clown has no problem to publicly display the caloric value of his junkfood on the Internet. After all, he has hired enough experts to know that you, just as the participants in most of the pertinent trials won't really care (Harnack. 2008; Elbel. 2011; Vadiveloo. 2011)
• Using a traffic light system to highlight "healthy" foods - Your sushi bar manager has decided against the calories and for the classic traffic light system, to guide the food choices of lean women to overpriced foods with a green light (Temple. 2011), and increase his sales of desserts - how come? Well, the average (not necessarily lean and female, though) consumer who picks an item with a green light (=healthy), will feel inclined to make up for this "sacrifice" by ordering a neat dessert (Heathcote. 2011).
• Not using the world "healthy" explicitly - With "healthy" being perceived as synonymous with "less palatable" and "untasty", the redheaded clown is well aware that putting to much of an emphasis on the term "health" could compromise his sales (Raghunathan. 2006).
• Serve repeated customers smaller servings - Your sushi bar guy knows his customers and that they won't notice, when he gradually reduces the amount of expensive raw tuna on their plates. After all, the majority of people have long given up on judging their satiety by how much they eat (e.g. Orlet Fishe. 2003; Levitsky. 2004; Steenhuis. 2009). As long as they eat the same "number" as the last 27 times they have been at the sushi place, they will be happy and satisfied for the rest of the day.
• Offering only tongs at the salad bar - You may not have realized that, but the tongs at the salad bar increase the revenue of your local sushi bar by 8-16%! Those 8-16% by the way, people will eat less, when loading stuff on their plates is made minimally less convenient (Rozin. 2011) - so don't wonder if they replace the tongs with chopsticks next month ;-)
• Playing the right kind of music - Your burgers taste like crap, not a problem if you serve them with the right music. People don't drink enough liquor on one of the afterhours parties at your bar? A couple of songs related to music and your business will flourish (Spence. 2010)
• Recommend food to your (overweight) costumers - Ever wondered why the nice young waitress at the Sushi place keeps telling your obese aunt Mary that they did now offer Häagen-Dazs super premium ice cream? She is probably aware of the results of a 1983 study by Herman et al., which showed that obese customers are highly "obedient" to social influence (Herman. 1983) - whether it's obedience and not rather the good feeling of someone else suggesting that she can have that large bowl of icecream on top of her sushi that makes your aunt forget about all your dietary advise is certainly debatable, the results, on the other hand, are conspicuous :-(

Now, eating out is unfortunately not the only occasion, when our right and ability to chose freely is corrupted by clever marketing strategists. The subconscious messages are so omnipresent that you can be sure that even your local farmer has more than just a rudimentary understanding of what it takes to convince you that it is well worth to pay the +50% more for the "omega-3 eggs" of his pastured hens; if he hadn't he would already have been put out of business by another guy, who will tell his clients that the beautiful yellow color of the yolk was a sign of how well he was treating his chicken, when it is in fact nothing but the colorful testimony of his cheap sweet corn-based feed pellets.

Implications: The German word "Zeitgeist" is - at least in my humble opinion - probably the term which captures the idea of how certain social paradigms, or I should clarify the paradigms of the social circles we belong to or want to belong to, influence our "freedom of choice" best. Yet, in the end, it does not even matter, whether you, your friends and everyone from your social milieu shops at the local farmers market, the classical supermarket or Whole Paychecks, as my friend Carl Lanore from Super Human Radio likes to refer to a certain not exactly cheap supermarket chain that has successfully green-washed his image, ...

• your decisions to shop at whichever of the available "markets" you chose are rarely as reasonable as you persuade yourself they were.
• at the very moment you've set your foot amidst the market stalls or grabbed yourself one of those XXL caddies, (too) many of us have already handed over the reins completely

This is why I would hope that this post can help you to identify at least some of those perceived "choices" as automatisms and primed behavior triggered by the afore listed psychological tricks supermarkets, restaurants and the rest of the salesmen and women, who are alway interested in their, yet rarely in your best (unless you are one of those poor critters who considers their money "his best"), avail themselves, these days.

References:

• Auty S, Lewis C. Exploring children’s choice: the reminder effect of product placement. Psychol Mark. 2004;21: 697–713.
• Cohen DA, Babey SH. Contextual influences on eating behaviours: heuristic processing and dietary choices. Obes Rev. 2012 May 3.
• Dayan E, Bar-Hillel M. Nudge to nobesity II: menu positions influence food orders. Judgm Decis Mak 2011; 6: 333–342.  
• de Droog SM, Valkenburg PM, Buijzen M. Using brand  characters to promote young children’s liking of and purchase requests for fruit.J Health Commun. 2011; 16: 79–89.
• Elbel B, Gyamfi J, Kersh R. Child and adolescent fast-food choice and the influence of calorie labeling: a natural experiment. Int J Obes 2011; 35: 493–500.
• Harnack LJ, French SA, Oakes JM, Story MT, Jeffery RW,  Rydell SA. Effects of calorie labeling and value size pricing on fast food meal choices: results from an experimental trial. Int J Behav
  Nutr Phys Act 2008; 5: 63–63.
• Heathcote F, Baic S. The effectiveness and acceptability of a traffic light labelled menu with energy information to signpost customers towards healthier alternatives in a table service restaurant. J Hum Nutr Diet 2011; 24: 390–391.
• Hedden J. Maximize menu merchandising power. Restaurants USA. 1997. < http://wwwrestaurantorg/business/ magarticlecfm?ArticleID=477 > retrieved July 17, 2012. 
• Herman CP, Olmsted MP, Polivy J. Obesity, externality, and susceptibility to social influence: an integrated analysis. J Pers Soc Psychol 1983; 45: 926–934. 
• Iyengar SS, Lepper MR. When choice is demotivating: can one desire too much of a good thing?J Pers Soc Psychol. 2000; 79:995–1006.
• Levitsky DA, Youn T. The more food young adults are served, the more they overeat. J Nutr 2004; 134: 2546–2549.
• Larson R. Core principles for supermarket aisle management. J Food Distrib Res. 2006; 37: 101–105.
• Libet B, Pearl DK, Morledge DE, Gleason CA, Hosobuchi Y, Barbaro NM. Control of the transition from sensory detection to sensory awareness in man by the duration of a thalamic stimulus. The cerebral ‘time-on’ factor. Brain 1991; 114: 1731–1757
• Meier BP, Robinson MD, Caven AJ. Why a Big Mac is a good Mac: associations between affect and size.Basic Appl Soc Psychol. 2008; 30: 46–55.
• Milosavljevic M, Koch C, Rangel A. Consumers can make decisions in as little as a third of a second. Judgm Decis Mak 2011; 6: 520–530. 
• Orlet Fisher J, Rolls BJ, Birch LL. Children’s bite size and intake of an entree are greater with large portions than with age-appropriate or self-selected portions. Am J Clin Nutr 2003; 77: 1164–1170.
• Poundstone W. Priceless: The Myth of Fair Value (and How to Take Advantage of It). Hill and Wang: New York, 2010.
• Raghunathan R, Walker RE, Hoyer WD. The unhealthy=tasty intuition and its effects on taste inferences, enjoyment, and choice of food products. Adv Consum Res 2006; 33: 450–451. 
• Rozin P, Scott S, Dingley M, Urbanek JK, Jiang H, Kaltenbach M. Nudge to nobesity I: minor changes in accessibility decrease food intake. Judgm Decis Mak 2011; 6: 323–332. 
• Schwartz B.The Paradox of Choice: Why More is Less. Ecco, Harper Collins: New York, 2003.
• Sela A, Berger J, Liu W. Variety, vice, and virtue: how assort-ment size influences option choice.J Consum Res. 2009; 35: 941–951.
• Sorensen H. The science of shopping.Mark Res. 2003;15: 30–35.
• Sorensen H. Long tail media in the store. J Advert Res 2008; 48: 329–338.
• Spence C, Shankar MU. The influence of auditory cues on the perception of, and responses to, food and drink. J Sens Stud 2010; 25: 406–430.
• Steenhuis IH, Vermeer WM. Portion size: review and  framework for interventions. Int J Behav Nutr Phys Act 2009; 6: 58.
• Temple JL, Johnson KM, Archer K, Lacarte A, Yi C, Epstein LH. Influence of simplified nutrition labeling and taxation on laboratory energy intake in adults. Appetite 2011; 57: 184–192.
• Vadiveloo MK, Dixon LB, Elbel B. Consumer purchasing patterns in response to calorie labeling legislation in New York City. Int J Behav Nutr Phys Act 2011; 8: 51.
• Wansink B, Kent RJ, Hoch SJ. An anchoring and adjustment model of purchase quantity decisions.J Mark Res. 1998; 35: 71–81.
• Waldrop J. Most restaurant meals are bought on impulse. American Demographics 01634089. 1994; 16.
• Zajonc RB. Mere exposure: a gateway to the subliminal.Curr Dir Psychol Sci 2001;10: 224–228

Chronically Fatigued? Taking a Meditative Time-Out With Qigong Twice Weekly Will Improve Mental + Physical Symptoms by ~50% & Increase Telomere-Length by 75%!

Image 1 (myrtlebeachalternatives): This picture captures the essence of Qigong artistically.

Adelfo took the word "holiday" to the heart and totally forgot about his blogpost, today. I guess this means I will have to pull something of interest out of my hat (or head?) and what would be better suited than a post about taking timeouts, well sort off... In a recently published paper in the Annals of Behavioral Medicine, R.T. Ho and his (or her?) colleagues from the University of Hong Kong report on the truly amazing progress a group of chronic fatigue patients made in the course of a 4-months Qigong intervention program (Ho. 2012).

Qigong means "life energy cultivation" and that's exactly what it does - it helps you cultivate the life energy that's so easily lost in our hectic and allegedly productive lives.

The participants in the intervention study took part in supervised Qigong exercise training (Wu Xing Ping Heng Gong, 五行平衡功) twice a week for five consecutive weeks. After this introduction period the 51 women and 13 men were advised to follow up on what they had learned in the supervised sessions and continue to practice their meditation techniques at home. Physical functioning and mental functioning were assessed by the Chinese version of the Medical Outcomes Study 12-Item Short-Form Health Survey (Ware. 1996; Lam. 2005) and telomerase activity was tested by a commercially available kit TeloTAGGG telomerase PCR ELISA (Roche) in the peripheral blood mononuclear cells before and after the 4-month intervention.

Video 1 (click to play): Qigong introduction video - whenever you meet this guy in your park, don't jog along laughing, join him!

What's Qigong?  Literally Qigong means nothing less than the "life energy cultivation". The idea behind this special form of meditation is to develop a special kind of awareness for yourself and your body and to breath, move and exercise in a way that is conducive to healing and meditation. Simplistically speaking it is a mixture of Chinese medicine, martial arts and philosophy that was developed to cultivate and balance you qi (chi), which is the afore mentioned "life energy" and to awaken your true nature. You may have seen and probably laughed about practitioners who have been moving (and most of all breathing) rhythmically on one of the greens in your local park while you were jogging along frantically listening to the latest hiphop or techno beats. I guess after reading the whole post you will look differently at those "freaks", whenever your paths cross next time...

If you take a look at the data in figure 1 (see below) you will have to agree that no matter how ridiculous a stupid Westerner like you or me may feel an "exercise" like this may be, the effects of this unconventional "workout + meditation" routine are beyond any doubt amazing!

Figure 1: Changes in physical and mental features of chronic fatigue (left) and telomerase length (right) in response to 5 weeks of supervised and 4 months (total) of a twice weekly Qigong program (based on Ho. 2012)

Just imagine what a fuss the pharma industry would make, if they had come up with some sort of serotonergic-dopaminergic double-whammy that would not simply spike you up or numb you, but return your physical and psychological functioning to normal, while at the same time saving your cells from aging prematurely by lengthening your telomerase (the enzyme that is responsible for the repair of cellular DNA)?

We would not have to turn to the Chinese to know better ... "Mens sana in corpore sano!"

Now you could certainly say that this is Chinese witchcraft and nothing a Western medical practitioner or scientists would let alone should rely on, but let's be honest:  Where has the $84-billion dollar psychiatric drug industry taken us, so far? Yeah, they have increased their own market and shareholder value, the patients overall well being let alone their life-expectancy still suck and that despite the fact that the Greek philosopher Thales from Miletus already knew that a "healthy soul" (mens sana) and a "healthy body" (corpore sano) are complementary sides of one and the same coin.

Image 2: Meditation is for hippies and losers who don't make it in our hard economy, right?

According to the medical paradigm of the 20ths and 21st century, which is keeping the aforementioned multi-billion dollar industry in (big) business, however, the intricate connection between psychology and physiology the forefathers of Western civilization were still well aware of, is a simple mechanistic one: One psychological well-being is a simple function of your neurotransmitter balance and if the latter is off, all you need to do is to take the right drug and you will bounce back into your highly productive self whose sole purpose it is to drive the economy to new heights. Rest, recuperation, relaxation, ... let alone meditation, that's for freaks and loser for those weaklings who cannot cope with the demands of the life of the 21st century, the economic selection pressure is going to to take care of those losers, right?

As sarcastic as it may sound, there is - as so often - more than just a grain of truth in the "economic selection pressure" hypothesis - yeah, I mean, look around: Those who fully subscribe to the idea are already falling victim to it. When the Ritalin-rush will finally wear off and their telomerase will have reached a length that allows for no more than another couple of weeks on this earth some of them will probably look differently at the "ridiculous clowns" in Central Park...

References:

1. Citizens Commission Human Rights International. Psychiatric Labels: The Facts Behind the Billion Dollar Marketing Campaign. < http://www.cchrint.org/psychiatric-disorders/ > retrieved July, 5 2012
2. Ho RT, Chan JS, Wang CW, Lau BW, So KF, Yuen LP, Sham JS, Chan CL. A Randomized Controlled Trial of Qigong Exercise on Fatigue Symptoms, Functioning, and Telomerase Activity in Persons with Chronic Fatigue or Chronic Fatigue Syndrome. Ann Behav Med. 2012 Jun 27.
3. Lam CLK, Tse EYY, Gandek B. Is the standard SF-12 Health Survey valid and equivalent for a Chinese population? Qual Life Res. 2005;14:539-547.
4. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity.Med Care. 1996;34:220-233.

Of the 1.8 New Year's Resolutions We Make Every Year, 23% Fail Within Two Weeks: A Humorous Scientific Outlook on the Fallacy of New Year's Resolutions.

Image 1: I don't know about this "smart ass" in particular, but I would assume you have had enough "smart asses" post their knowledgeable tips on their blogs to get along without another "12 useful tips for 2012" from me, right?

I guess at least those of you who have been following this "blog" (I hope that you would agree that the SuppVersity has become more than another "blog") have come to "know" me well enough not to expect me to provide you with the 1001 list of ten, or at it has become fashionable as of late, twelve super-duper congenial tips to achieve your goals in 2012. Change, and this is the one wisdom I want to give you to take along for the next year, change rarely is something that comes over night or is "triggered" by the adherence to any fixed plan. Change is the result of the accumulation of small steps, dx/dt, as we physicists would say, i.e. covering an infinitesimal distance (=dx) within an infinitesimal short timespan (=dt). If we now denote steps that take you further towards your goal as positive and steps by which you depart from your ultimate goal as negative than any year in which the integral over dx/dt would be positive, or in non-physicist terms, where the number of infinitesimal steps you have taken towards your goal was greater than the ones by which you have distanced yourself from what you want to achieve, a successful year! Consider that before you file 2011 as another "lost" year.

Enough smart ass new years advice for 2011!

But hey, didn't I say, I would not give you wise ass advice? I guess we should get back to science then... after all the "-versity" in the name of this site denotes that we are doing serious stuff here, doesn't it? So, take my hand and descend (for the last time in this year) with me into the archives of science. The first thing we hit on is an editorial from the most prestigious medical journal in the world, The Lancet, in which the contemporary editor of the journal has the following well-phrased advice for you (I did not say I would not provide you with wise ass advice from others ;-)

The opening of a new year leads all of us to take some stock of the past and to formulate a certain number of resolutions for the future, and the frame of mind which is thus indicated should be indulged in, but only with moderation. To spend too much time in thinking over what has gone by will interfere with the work that lies under our hand; to make resolutions that are too large and too numerous for our powers is to court disappointment. None the less every thoughtful man will use his past experience to guide him in the future both as to what he will do and as to how he will do it. (The Lancet. 05. January 1907)

Image 2: New Years Eve is for most of us the time, when we simply cannot ignore the necessity to make a change, any longer.

Somehow, this reminds me of some of the "best tips, tweaks, tricks" and, above all, "common pitfalls to avoid in 2012", I have been reading elsewhere around the web over the course of the last days. I mean we all know that the more good intentions we have, the more likely they are to never materialize into significant changes. Being aware of this circumstance, Judith Stoner Halpern who wrote the editorial to January issue of the not just as famous *rofl* International Journal of Trauma Nursing suggests that (Halpern. 2001) "perhaps the best New Year’s resolution that we can make would be to learn how to make a better resolution"

Interestingly, and this is probably the first thing that goes beyond "conventional new year's resolution wisdom", the first reason she invokes is the time of the year!

An easy answer is to blame January 1. For one half of the world, it falls in the middle of winter, and for the other half, the middle of summer. This is not the most opportune time to enact a dramatic change. The middle of a season often causes us to feel a lack of commitment; this may be part of the reason that ancient cultures chose spring or fall as the time to start anew. For some, January 1 may feel like an artificial time for change.

When you come to think about it, this is actually quite a reasonable argument. With the "winter blues" upon us January certainly is not the best time to "blossom". The neo-paleolithic folks many of us recently believe we are, we should better crawl up in our dugouts and set up our plan of attack in order to mimic the "ancient cultures" and start anew in spring.

Does understanding the psychology of change hold the key for success?

The question yet remains, how do we instigate a new-or restart? A possible answer may come from Freeman and Dolan's theoretical model of change that in turn is based on a previous model by DiClemente that has been extensively discussed in the scientific literature on psychotherapy. According to the model, the authors propose in their 2001 paper in Cognitive and Behavior Practice, there are 10 stages. Where the last one, maintenance marks the (temporary) achievement of preferably positive "change".

Figure 1: The psychology of change - an illustration based on the "revisited stages of change model by Freeman and Dolan (Freeman. 2001)

If you take a closer look at my graphical illustration, you will realize that you have (hopefully) already overcome the initial stages of

• noncontemplation, where, in your everyday oblivion, you do not even consider making a change
   
• anticontemplation, where you are trying to convince yourself that you are "just fine the way you are" or that it would be impossible to make a change, anyways
   
• precontemplation, where you are thinking and often dreaming about what would happen if you were able to make a change

Interestingly, for most of us the realization that another year is almost over usually makes us go through these stages (many of you may skip the 2nd one, some may get stuck there), automatically. So even if you are not one of Freeman and Dolan's persons, chances are that you are now, as they put it "directly and actively considering change" and have "reached a point of readiness to engage in the change process." 

Sitting in your neo-paleolithic dugout - or, for those who have not been infected by the paleo-virus in the course of 2011, simply in your cozy home - it is now about time to lay out your plan of attack!

Action planning is the stage of change when the therapist and patient have collaboratively developed a treatment focus and treatment plan. The therapetnic process has begun and the patient is beginning to make plans on how change will occur. The key phrase with this group is, "I plan to change."

Now, I don't know whether you have a therapist, or not (note: this is nothing to be ashamed of - I would even count the people I know that are in psychotherpeutical care among the few relatively sane human beings which populate this planet ;-), are working with a trainer, nutrionist or just a good friend who will help you on your way. In the end, it will always be about your commitment to your plan to change and eventually your success. That you have to determine the latter based on the integral over the steps in the right and steps in the wrong direction is something I have mentioned before. Freeman and Dolans model, however, provides a theoretical framework to understand this sometimes annoying, often frightening and in many cases discouraging back-and-forth even better.

Figure 2: Reported success rates at different timepoints in the new year and at 2 year follow up (data based on Norcross. 1989).

What are typical New Year's Resolutions? I must admit that I was quite disappointed about the lack of scientific data on the real-world outcome of New Year's Resolutions. Similar to the previously discussed issue of holiday weight gain which turned out to be at least less pronounced than everyone would have it (cf. "Santa is Coming to Town"), there is almost no realiable, non-specific, i.e. not related to only one goal (mostly smoking cessation), scientific data that would proof that the majority of new years resolutions fail.

In one of the two peer-reviewed studies I could come up with (both based on the same dataset), Norcross et al. report that their 213 study participants "made an average of 1.8 New Year’s resolutions" (Norcross. 1989). Among those, smoking cessation (30%) and weight loss (38%) together accounted for two-thirds of the resolutions. Other non-idiosyncratic New Year's Resolutions revolved around relationship improvement (5%), reduction in alcohol consumption (2%), and an increase in monetary savings (2%). A cursory glance at figure 2 does yet suffice to see that the difference between the real and the commonly assumed "success"-rates is much less pronounced than in the previously cited case of holiday weight gain. With a 23% chance of failure after no more than 2 weeks and a drop out rate of  57% after three months, chances that the average 16-75 year old citizen of northeastern Pennsylvania is able to realize his resolutions for the new year really isn't very high. A reported (do we believe those guys?) success rate of 19% after 2 years is nevertheless more than what my personal observations would suggest.

Lapses are integral parts of change - accept them work, through them, or fail

Image 3: If your New Year's resultion incorporates letting go of junk food, thinking of Mark Haub, the "Twinkie Diet Professor", probably would not be one of the "behavioral skills" to incorporate in your mental toolbox.

Let's assume you are a carbohydrate-addict and decided to cut back on carbs in the next year. Do I see you tremble in apprehension? Well, this is actually an apprehension of the prelapse phase, a phase that is "characterized by active and often overwhelming cognitions related to the reversal of the changed behavior" the carb-junkie you are, even the thought of having to put down your twinkies and dingdongs (whatever the latter may be) is getting you all psyched up. If it was already January the 1st, this would be the moment, when you are eating your eggs and bacon for breakfast, look at the cereals your brother is shuffling down his throat and think to yourself: "How can I possible endure that for the rest of my life?" Then you remember the words of the mighty paleo guru Robb Wolf to "give it a shot for thirty days" and gag down the last piece of bacon.

Psychotherapists refer to simple tricks like this as "behavioral skills", i.e. (mostly cognitive) techniques by which you can "short-circuit the prelapse before it leads to the old behaviors."

Figure 3: Successful and unsuccessful strategies to stay on track; * indicate statistically significance for success (data based on Norcross. 1989).

Which "behavioral skills" are most helpful? In the aforementioned study, Norcross and Vangarelli also analyzed which methods the participants successfully (figure 3, green) and unsuccessfully (figure 3, red) applied to achieve their aims. As you can see planning ahead (contingency management), managing "dangerous" stimuli, exercise (obviously not the way to distract yourself from the temptations if your new years resolution was to exercise more) and, above all, taking one step after the other, were the most effective strategies in the toolboxes of the 213 study participants, of whom only 18% said that "nothing hindered their resolution". Among the remaining 82%, most invoked their own lack of willpower (34%) as the fundamental obstacle. 16 subjects found that the realization of their resolution was not compatible with their lifestyle and 8 maintained that they had not been serious enough about their resolution.

(Un-?)fortunately, you are human and thusly destined to let reason go and fall back to old, oftentimes bad habits. So, there will come a day, when you will be sitting next to your meanwhile "no longer so loved ones" (after all, they are allowing themselves to eat all those jummy junk right next to you at your table ;-) and stare at the twinkies and dingdongs they are indulging. Suddenly a thought crosses your head: "Wasn't there this funky professor who lost a ton of weight on the twinkie diet?" You reach out and, probably much to the secret delight of your "formerly loved ones" who have been jealous of how fast you have been losing weight in the course of the last weeks, grab one of the twinkies that have been waiting for so long for you to take appropriate care of them... I guess I don't have to tell you the rest of the story, do I?

What is important, though, is that whenever lapses like this happen is that you always remember that no matter how many twinkies you may have eaten, how many training sessions you may have skipped, and/or how many cigarettes you have smoked, it is still your choice:

• You can either return to the anticontemplative phase by persuading yourself that you could shed off the extra points just as well on twinkies and dingdongs - and even if that would not work, why would you have to make a change, in the first place? After all, you feel "fine just the way you are"!
   
• Or you can analyze what triggered your temporary loss of memory and inability to apply one of the various behavioural skills that have prevented you from "lapsing" before.

I guess, it is not difficult to tell that option #2 would be the way to go. You have to go back to the drawing board. Not to start all over again, but to develop new skills and cognitions and to practice old to make sure that your next dt/dx's will be positive again. In that the ability to accept your own fallibility and the insight that a bunch of twinkies won't ruin the admirable success of the previous weeks, may be one of the key elements that will eventually enable you to achieve your contemporary goals, maintain your success and reach for the stars.

Along these lines, I wish all of you, my dear silent and not so silent readers, your families and loved ones, a successful, happy and, above all, healthy year 2012.