Creatine Non-Responder? Age+Meat Intake - Determinants of Creatine's Effect on PCr (±200%) + Probably Performance

Vegetarian strength athletes belong to the group of people who will probably benefit most from creatine supplementation. Their young, meat-eating peers, on the other hand, may well turn out to be non-responders, because they see highly individual, but overall only non-significant increases in phosphocreatine.

It has been a while since I published the last creatine article ("Dubious Effects of Creatine on Markers of CNS Adaptation and Heart Health in "Bodybuilders" - Reason to Be Afraid?" | read it); the last time that I addressed the issue of "creatine non-responders", i.e. reasons why people simply don't seem to benefit from creatine supplementation has been published in 2014, already, when I presented the results of a study suggesting that it's not a high dietary creatine intake from meat that makes the difference (learn more).

Needless to say, meat still made it on the list of possible determinants of the individual performance increases in response to creatine supplementation... I mean, it's meat - and we all know how people love to blame it for everything, these days ;-)

You can learn more about creatine at the SuppVersity

Creatine Doubles 'Ur GainZ!

Creatine Loading = Unnecessary

Creatine Pre or After Workouts?

1st Benefits of Creatine-HCL

The Real Bioavai-lability of Crea

No Ill Effect of Cre on CNS

Before we get into any further details, though, I have to point out that the soon-to-be-published study by Marina Yazigi Solis and colleagues from the Univerity of Sao Paulo did not actually test the performance effects of creatine. Rather than that the goal of the Brazilian scientists was to fill another gap in the extensive literature about creatine supplementation: the way(s) in which your creatine/phosphorylcreatine (PCr) response to creatine supplementation may be modulated by age, diet, and tissue. Or, as the scientists describe it: "[W]e aimed to determine whether the PCr responses vary as a function of age, diet, and tissue.

In their study, fifteen children, 17 omnivorous and 14 vegetarian adults, and 18 elderly were randomly assigned to consume either placebo and subsequently creatine (0.3 g/kg per day) or creatine and placebo for 7 days in a single-blind fashion.

Figure 1: Illustration of the phosphocreatine “shuttle” system (Guimarães-Ferreira 2014); as you can see PCr is - assuming you have the necessary energy in form of ATP available, automatically restored by creatine kinase - the loss in form of creatinine is, at least in healthy individuals, relatively low and may indeed be compensated for by the relatively small amount of creatine omnivores get from (esp. the red) meats in their diet.

PCr was measured via phosphorus magnetic resonance spectroscopy (31P-MRS) in muscle and brain using a whole body 3.0T MRI scanner (Achieva Intera, Philips, Best, The Netherlands) and a 14 cm diameter 31P surface coil.

The latest about "advanced creatines": A very recent review (Andres 2017) of the various currently available forms of creatine that are often advertised as "advanced creatine products" confirms previous assessments: it's all bogus. Creatine phosphate adds to the risk gastrointestinal symptoms and poses a CVD and kidney "health risk" because they will increase the already high consumption of phosphates with the Western diet. Creatine taurinate is simply unnecessary, you could as well take monohydrate and taurine. Unlike regular monohydrate, creatine ethyl ester will increase creatinine levels in serum - "probably due to the high conversion of creatine ethyl ester to creatinine in the gastrointestinal tract". Creatine orotate is a potential cancer promoter, as "orotic acid caused tumor-promoting effects in animal studies revealing a too low margin of safety in relation to the calculated human exposure". The forms of creatine (creatine pyruvate, creatine citrate, tri creatine malate, creatine pyroglutamate and creatine gluconate), Andres et al. investigated "are unlikely to pose safety concerns", but they aren't worth the extra bucks, either.

As you can see in Figure 2, the creatine supplement increased muscle PCr in children (p<0.0003) and elderly (p<0.001). What it did not do, however, was to produce significant increases in the meat-eating (=omnivorous) study subjects (the statistical significance of the changes were far from being below 0.05 | p=0.3348, a sub-group analysis for the amount and type of meat the subjects consumed was not performed and probably wouldn't have made sense in view of the relatively low number of participants).

Figure 2: Delta changes in PCr in response to creatine supplementation (i.e., creatine subtracted from placebo values) in muscle and brain (Solis 2017); with only 18 elderly subjects, it made no sense to distinguish omnivores vs. vegetarians.

What may be quite surprising is that the elderly subjects had greater PCr increases than children and omnivores (p<0.0001 for both). Less surprising, but also worth mentioning: children experienced greater PCr increases than omnivores (p=0.0022). When the scientists eventually compared vegetarians (p<0.0001) to omnivores, they found that the former were the ones with the most significant increase in PCr content and thus the subjects of whom you would expect that they'd see maximal performance gains, as well.

Chicken is not a good source of dietary creatine: Chicken has only very low levels of creatine (ca. 300-400mg/100g) and thus ~50% less than what you'd get from beef - moreover, chicken is always eaten well-done and cooking has been shown to decrease the creatine content of foods significantly, as Tarnopolsky, et al. point out in their 2010 review.

Table 1: Creatine content of some common foods (Tarnopolsky 2010).

Unrelated to your "gainz", but probably highly health-relevant in view of the effects of creatine on the brain, e.g. its protective effect in traumatic brain injury (Sullivan 2000) and its ability to boost brain performance (Rae 2003 + Rawson 2011), is that the study at hand found no increase in Brain PCr in any group, and delta changes in brain PCr (-0.7 to +3.9%) were significantly less pronounced than the increase in muscle PCr content (+10.3 to +27.6%; p<0.0001 for all comparisons).

For the elderly individuals that seems odd, as previous studies demonstrated measurable beneficial effects on the cognitive performance of elderly subjects (Rawson 2011), for the younger subjects, on the other hand, it was to be expected that the PCr levels and thus the availability of immediate response energy wouldn't increase significantly as Rawson et al. demonstrated in 2008, already, that "creatine supplementation does not improve cognitive function in young adults" (Rawson 2008).

Guanidinoacetic Acid (GAA) 'Superior' to Creatine in Terms of Bioenergetic & Health Effects on Brain, Muscle & More? | learn more

What does this mean for you? If you're a young (red) meat lover, the chance of seeing exorbitant increases in performance (muscular and cognitive) are slim.

While we may have to take into account that exercise will temporarily deplete the PCr stores, our bodies are well-equipped to restore them by "recycling" (see Figure 1), if there's no significant increase in the phosphocreatine (PCr) pool, it is thus unlikely that your ability to lift, sprint or perform other high(er) intensity activities that tap into your muscle PCr stores will increase.

If you are a baby-boomer or who trains regularly and consumes a vegetarian (let alone vegan) diet, on the other hand, your results could be outstanding - "could be" because the study did not test the actual performance benefits, but whether and to which extent the phosphocreatine stores were increased - Plus: It is guaranteed that there's a practically relevant genetic component, as well. I mean, you do remember that the CK response to workouts is also genetically determined and in some so high that your doctor may mistakenly believe you had been run over by a truck and the crushed protein was now clocking up your kidneys, right? | Comment on Facebook!

References:

• Andres, S., et al. "Creatine and creatine forms intended for sports nutrition."  Mol. Nutr. Food Res. 61, 1600772 (2017).
• Guimarães-Ferreira, Lucas. "Role of the phosphocreatine system on energetic homeostasis in skeletal and cardiac muscles." Einstein (São Paulo) 12.1 (2014): 126-131.
• Rae, Caroline, et al. "Oral creatine monohydrate supplementation improves brain performance: a double–blind, placebo–controlled, cross–over trial." Proceedings of the Royal Society of London B: Biological Sciences 270.1529 (2003): 2147-2150.
• Rawson, Eric S., et al. "Creatine supplementation does not improve cognitive function in young adults." Physiology & behavior 95.1 (2008): 130-134.
• Rawson, Eric S., and Andrew C. Venezia. "Use of creatine in the elderly and evidence for effects on cognitive function in young and old." Amino Acids 40.5 (2011): 1349-1362.
• Sullivan, Patrick G., et al. "Dietary supplement creatine protects against traumatic brain injury." Annals of neurology 48.5 (2000): 723-729.
• Tarnopolsky, Mark A. "Caffeine and creatine use in sport." Annals of Nutrition and Metabolism 57.Suppl. 2 (2010): 1-8.

BCAAs Mess W/ Vegan Glucose Management, Human Study Says - Do You Have to Stay Away From BCAAs, Now?

Are vegan athletes who supplement their low BCAA baseline diet with amino acid powders making an unhealthy mistake? At first sight a recent study from Poland suggests just that. Upon closer scrutiny, however, the practical relevance of the results appear less and less convincing.

It seems (and I have to admit that I fell for that logic, too) only logical that vegans, unlike omnivores and lactovegetarians run the risk of not getting enough BCAAs from their diet. After all, their diets allow the neither the consumption of dairy nor many of the other wonderful high BCAA protein sources.

Against that background, I would venture the guess that many vegan athletes spike their diets with copious amounts of the ubiquitous BCAA supplements, supplement vendors all around the globe are pushing on unsuspecting customers who have no clue that a new study claims that these supplements may ruin one of the often-heard benefits of vegan diets: improved glucose management and reduced diabetes risk (eg. -62% in Tonstad et al. 2013).

You can learn more about BCAAs & other amino acids at the SuppVersity

BCAAs Affect Your Microbiome

BCAAs Mess W/ Serotonin

BCAA Blunt Fat Loss, too!

Energy Drinks all About Taurine?

-43% Performan-ce W/ BCAAs

Taurine and the Microbiome

Based on the observation that BCAAs will reduce the glucose clearance rates in healthy human beings, in some (Tremblay 2005 | glucose uptake ↓ by 33%; Robinson 2015 | glucose uptake ↓ by 40% and 23% at low and high insulin levels, respectively), but not all (Everman 2015) pertinent studies and in view of the fact that

Bad news for BCAA-junkies | more

"[d]ata on the effect of a chronic supplementation with BCAA in humans are still limited making it impossible to clarify whether increased dietary BCAA themselves are sufficient to trigger IR-related diseases or whether the perturbations in BCAA levels only reflect an already developed insulin resistant state [here, the authors refer to the observation that people with metabolic syndrome have, across the board, significantly elevated BCAA levels in the blood]" (Gojda. 2017)

the authors speculated that supplementing healthy subjects with 20g of BCAAs (female subjects received only 15g to make up for their lower body weight) and comparing the results of vegan (=low BCAA intake) and omnivore (=high BCAA intake) subjects would yield valuable insights into the 'true' effects of BCAAs on human glucose metabolism.

Don't rejoice too early, omnivores: If you're an omnivore you may still be concerned about the literally 'depressing' effects of BCAAs - a supplement of which most research shows that it is useless if you have a high intake of quality protein, anyway.

Now, while I cannot tell in how far a single 12-week study can do that, i.e. contribute valuable insights into the 'true' effects of BCAAs on human glucose metabolism, I can tell you that the results Gojda et al. present in the European Journal of Clinical Nutrition will make at least the vegans in the SuppVersity audience sit up and question their use of BCAA supplements... at least for as long as they didn't read the rest of the article ;-)

Figure 1: At first sight, the changes in the subjects' basal glucose levels and their ability to clear glucose during the hyperinsulinemic euglycemic clamp test clearly suggest that 20g/15g/day BCAAs are bad for vegans (Gojda 2017).

It stands out of question, a -28% decrease in glucose clearance during the scientists' two-hour hyperinsulinemic euglycemic clamp test is quite a significant negative effect (the effect size, here, is d = 0.99; anything >0.8 is considered a "large" effect size). Before you freak out, however, it must be said that the metabolic rate of glucose clearance per unit of insulin, which is what I would consider a much better measure of insulin sensitivity, was decreased by a statistically highly non-significant, practically (check out the standard deviation in Figure 2) irrelevant 3%, only (addendum: I calculated the effect size, which is d = 0.08 and would thus confirm the lack of practical relevance of this finding, after all, anything < 0.2 is already considered a "small" effect size - 0.08 is thus quasi no effect).

Figure 2: Unlike the absolute glucose infusion rates during the hyperinsulinemic euglycemic clamp, the rates per unit of insulin were not affected by 3 months on 20/15g of BCAAs per day (Gojda 2017).

Nevertheless, the scientists are still confident to conclude that "[a] chronic increase in BCAA intake led to a decrease of IS only in vegans" (Gojda 2017) - and that despite the fact that they did not observe the typical increases in serum BCAAs seen in obese / metabolically diseased subjects during the supplementation period (only the levels of leucine increased from the 20g of BCAAs that contained leucine, valine, and isoleucine at a ratio of 4:1:1) and admit that previous studies in metabolically deranged people show "an improvement of glucose uptake after a long term high-BCAA protein supplementation" (Gojda 2017).

Obviously, the last mentioned real-world (i.e. meals vs. insulin clamp + glucose infusion as in the study at hand) effects may obviously be a mere result of an increased release of insulin in the otherwise insulin resistant subjects when they were fed cod and whey protein, the "high-BCAA protein sources" in Ouellet, et al. (2007) and Jakubowicz, et al. (2013), the two studies Godja et al. are referring to in the previously cited statement. With nothing but eventually elusive evidence from a single lab test with conditions that hardly resemble our everyday dietary glucose exposure, I would still be hesitant to jump on the 'BCAAs mess with your glucose metabolism'-train - and that's despite the fact that I have been very critical in previous articles about BCAA supplementation.

What's the message for the omnivores? There are two things omnivores should take away from the study: (a) the increased clearance of glu-cose in the hyperinsulinemic euglycemic clamp test the scientists observed in the omnivores is as misleading as the decrease in the vegan subjects, because it was likewise not complemented by an increased rate of glucose disposal per unit of insulin; and the former was (b) probably a mere result of an increased production of insulin (+63% in the omnivore subjects of the study at hand; p < 0.05) and thus the insulinotropic effect of BCAAs that has been pre-viously observed in both, healthy and (pre-)diabetic subjects, whose glucose levels improve with the consumption of high BCAA proteins merely due to an increase in insulin production. In conjunction with the hitherto not discussed omnivore-exclusive increase in the ex-pression of lipogenic genes FASN and DGAT-2, as well as corresponding increases in two additional lipogenic genes, PPARγ and SCD-1, the increased insulinemia with extra BCAAs in omnivores is in fact the only substantially 'bad news' of a study that, initially, appears to hold bad news only for vegans.

So what's the verdict, then? The practical significance of the study at hand is much lower than headlines like "BCAAs mess with vegans' glucose metabolism" would suggest - and that's despite its relatively long intervention period and the inclusion of a follow-up.

So why is it too early to freak out? Well, for one, the scientists "conclusion that BCAA could have a direct negative impact on IS in healthy humans" is based on a test the practical relevance of which remains questionable: the hyperinsulinemic euglycemic clamp test has little to nothing to do with the metabolic response to a complex meal; and even if we accept its results as reliable indicators of real-world changes in glucose sensitivity, there's still the lack of changes in the metabolic clearance rates for glucose on a per unit of insulin base. And while the scientists address the non-significance of this data in the limitations section of their paper, where they declare that the "statistical power of our study to show differences of MCR/I after the intervention was therefore only 7%", that doesn't explain that the MCR/I dropped by only 3% and thus 50% of the standard deviation.

Furthermore, the scientists did not observe the 'classic' changes in BCAA metabolism gene expression that have been observed in the previously hinted at studies that link a high serum BCAA level to insulin resistance (Newgard 2012). And it's not just genes that are involved in BCAA metabolism that didn't change in the vegans: the same goes for all other genes the scientists tested, as well.

No effect on MCR/I, no effect on the expression of metabolically relevant genes (including insulin receptor and glucose transporter expression), this leaves us with the 4% increase in serum glucose of which even a layman can see that it's very unlikely a result of the BCAA supplementation... if it was, the glucose level should not increase by another 8% after the three months supplementation period, should it? No, it shouldn't and you shouldn't freak out if you read elsewhere that "a recent study shows that BCAAs decrease your insulin sensitivity" | Comment!

References:

• Everman, Sarah, et al. "Effects of acute exposure to increased plasma branched-chain amino acid concentrations on insulin-mediated plasma glucose turnover in healthy young subjects." PloS one 10.3 (2015): e0120049.
• Gojda, J., et al. "Chronic dietary exposure to branched chain amino acids impairs glucose disposal in vegans but not in omnivores." European Journal of Clinical Nutrition (2017).
• Jakubowicz, Daniela, et al. "Incretin, insulinotropic and glucose-lowering effects of whey protein pre-load in type 2 diabetes: a randomised clinical trial." Diabetologia 57.9 (2014): 1807-1811.
• Newgard, Christopher B. "Interplay between lipids and branched-chain amino acids in development of insulin resistance." Cell metabolism 15.5 (2012): 606-614.
• Robinson, Matthew M., et al. "High insulin combined with essential amino acids stimulates skeletal muscle mitochondrial protein synthesis while decreasing insulin sensitivity in healthy humans." The Journal of Clinical Endocrinology & Metabolism 99.12 (2014): E2574-E2583.
• Tonstad, S., et al. "Vegetarian diets and incidence of diabetes in the Adventist Health Study-2." Nutrition, Metabolism and Cardiovascular Diseases 23.4 (2013): 292-299.
• Tremblay, Frédéric, et al. "Overactivation of S6 kinase 1 as a cause of human insulin resistance during increased amino acid availability." Diabetes 54.9 (2005): 2674-2684.
• Ouellet, Véronique, et al. "Dietary cod protein improves insulin sensitivity in insulin-resistant men and women." Diabetes Care 30.11 (2007): 2816-2821.

3.8 vs. 2.3 g/kg Protein + Exercise to Improve Body Comp. | Digestive Enzymes to Pimp Vegan Proteins | High Protein vs. MUFA Meals for GLP1 | ISSN Research Review '15 #3

"If some is good, more is better!" Unfortunately, this simple maxime does rarely apply when it comes to the physiological response to certain foods and/or supplements. For protein, however, it appears as if the relation holds - at least as long as protein does not become the only energy source in your diet.

I guess by now I can simply skip the lengthy introduction telling you about how I didn't want to cherry pick only three out of more than twenty newsworthy studies that were presented at the Twelfth International Society of Sports Nutrition (ISSN) Conference and Expo in 2015, when I started writing this series right (click here if you have missed the previous articles)?

Well, that's good because it leaves more room for a brief preview of the studies I am about to discuss in today's third serving of the SuppVersity ISSN Research Review 2015 - studies that are all related (in one way or another) to increased protein intake. Either in overweight or obese people, for whom higher protein meals increase the post-prandial increase of the "satiety hormone" GLP-1, or in vegans, vegetarians and everyone else who wants to make the most of his vegetable protein sources (pea and rice protein, to be precise) by adding digestive enzymes to the mix, or - last but not least - gymrats who ramp up their protein intake from 2.3 to 3.8 g/kg body weight to see even more pronounced improvements in body composition.

Read more about ISSN and other studies at the SuppVersity

Vitargo, Red Bull, Creatine & More | ISSN'15 #1

Pump Supps & Synephrine & X | ISSN'15 #2

High Protein, Body Comp & X | ISSN'15 #3

Keto Diet Re- search Update | ISSN'15 #4

The Misquantified Self & More | ISSN'15 #5

BCAA, Cholos-trum, Probiotics & Co | ISSN'15 #6

• High protein, high GLP-1, ... highly beneficial? As a SuppVersity reader you are aware of the far-reaching metabolic effects of GLP-1 on appetite (suppression | Näslund. 1999), glucose and fat metabolism, as well as thermogenesis (Lejeune. 2006). Against that background, you will know that the small, but statistically significant increase in GLP-1 Franklin et al. (2015) observed in their latest study which compared the effects of a high protein and high mono-unsaturated fat meal on the well-known incretin hormone may have significant long-term effects even though the blood glucose levels of the study's twenty-four overweight or obese participants (male/female: 12/12; age: 38.7 ± 15.3 (mean ± standard deviation) years; BMI: 31.6 ± 4.0kg/m²), who consumed isocaloric meals containing either 35.2% energy from fat and 20.7% from monounsaturated fat (HMF meal) or 31.9% energy from protein (HP meal), did not trigger differences in post-prandial glucose levels at 30, 60, 120, and 180 min.
  
  

  

  Figure 1: Levels of active GLP-1 in response to high protein (HP) or high MUFA (HMF) meals (Franklin. 2015).

  To believe that "simply eating more protein" is going to solve all your weight problems, though, would be short-sighted - especially for the overweight obese for whom the study at hand as well as previous studies investigating the effects of GLP-1 on glucose metabolism suggest that they may benefit to a lesser extent from protein induced increases in GLP-1 than lean individuals, in whom the "satiety hormone" will trigger much more pronounced β-cell responses that in in patients with sign. insulin resistance and pre- or full-blown type 2 diabetes (Kjems. 2003).
  
  If that sounds like you, using the high(er) protein meals in conjunction with an energy restricted diet to lose weight and thus to improve your insulin sensitivity can obviously still be beneficial. Without a planned, reasonable caloric deficit, however, high(er) protein intakes alone are probably not going to "cut it" (all puns intended).

Even if weight loss is the goal, training fasted and thus hungry does not appear to provide significant benefits. Learn more about this longstanding myth and the reality in my write-up of Schoenfeld et al's seminal paper on fasted cardio and fat loss. A paper that finally had a long-standing and die-hard fat loss myth tumble.

Are you hungry before your workouts? In this case you may be interested in the results of a paper by Nystrom et al.' who suggest that athletes have to use "more proactive strategies [...] to optimize training adaptations". Why's that? Well, of the 481 (240 women, 241 men) NCAA Division I athletes representing eleven intercollegiate sports from three universities in three athletic conferences (i.e., Atlantic 10, Atlantic Coast Conference, Conference USA) who participated in the researchers investigation into the nutrient timing habits of Division I NCAA athletes, 79% reported feeling hungry prior to training, practice or competition - and that despite the fact that most of them had breakfast. It is thus well possible that the amount and types of foods athletes eat before their workouts do still receive (too) little by athletes and their athletic departments which often provide post-workout meals, but fail to do so pre-workout.

• Pimp my plant protein - digestive enzymes can do the trick! Despite the fact that pea and other protein powders have become widely (and cheaply) available over the past years, vegan and vegetarian athletes and gymrats are still having a harder time satisfying their protein requirements than their omnivore competition or gym-buddies. Against that background and in view of the fact that more and more athletes are "going vegan" or at least vegetarian, the latest study by Julie Minevich (2015) and colleagues from the University of Tampa and the formulators, manufacturers and vendors of digestive enzymes and respective supplements from Chemi-Source and Increnovo LLC, was in fact published quite timely. A study that was designed...

  "to investigate if co-ingestion of a plant protein specific digestive enzyme blend (Digest-All® VP, a proprietary enzyme blend consisting of protease 6.0, protease 4.5, peptidase, bromelain and alpha-galactosidase, Chemi-Source, Inc., Oceanside, CA) can reduce the significant differences in amino acid appearance in the blood between plant and animal proteins" (Minevich. 2015).

  To this ends, 11 resistance-trained male subjects (age: 21.4 ± 1.5 years, body weight: 82.5 ± 3.9kg, height: 177.3cm ± 6.1cm | average training status of 2.3 years ± 1.9 years) were randomly assigned to receive either 60 g of whey protein concentrate, or the same amount of protein in form of a 70:30 blend of pea and rice protein concentrates (Veg), either alone or alonside the enzyme blend Digest-All® VP in a double-blind, crossover study. All supplements were provided on an empty stomach after a 12 hour overnight fast. The three testing sessions, in which blood was drawn immediately prior to, and at 30 minutes, 1, 2, 3, and 4 hours following consumption of the supplements, were separated by a washout period of 7 days.
  

  

  Figure 2: Time to achieve peak amino acid levels and total amount of amino acids that made it to the blood stream with whey protein, the pea + rice mix and the pea + rice mix w/ digestive enzymes (Minevich. 2015).

  Ok, I have to admit that the differences are not exactly staggering and the standard deviations (see error bars) are large, but still. One potentially important determinant of skeletal muscle metabolism, the time it takes for the serum levels of essential amino acids - including leucine - to peak, i.e. T_max in Figure 2, was visibly improved by the addition of digestive enzymes to the otherwise comparatively slow digested rice + pea protein mix (if you look at the error bars, you will see that this was just a "trend", though).
  
  If you also take into account that the digestive enzyme blend brought the area under the EAA curve (see Figure 2) and the peak amino acid levels (not shown in Figure 2) of the vegetable protein blend up to the same level as it was observed with whey protein, it would seem as if the study would provide the missing evidence of the usefulness of proteases and co. for people who want to make the absolute most of their vegetable protein supplements - what is missing, obviously, is data that would allow us to quantify the downstream effects on muscle gains and other practically relevant study outcomes.
• High protein + training = WIN?! You will certainly remember the impressive results of Antonio et al.'s 2014 study on the effects of a 4.4g/kg protein diet on the body composition healthy resistance-trained men and women (learn more). Right after said study had been published the authors promised a follow up that would combine a similarly high protein intake with a controlled exercise intervention and... voila! The first results of this study were presented at this year's ISSN meeting.
  
  For the corresponding experiment, Ellerbroek et al. recruited forty-eight healthy resistance-trained men and women in their early twenties. who consumed either 2.3g/kg body weight per day (NP) or 3.4g/kg body weight per day (HP) of dietary protein during the treatment period. Moreover, all subjects participated in a split-routine, body part heavy resistance-training program. Training and diet (everyday) logs were kept by each subject.

Learn everything about the previous study.

Don't worry! I am going to write a full review of this study as soon as it will be published. In theory I would have had to skip it just like the other studies, but since I would have been mad at me if for doing that if I were you, I decided to give summarize the little information you can find in the abstract. Against that background I hope you will understand that I will refrain from making any definite conclusions until I've read the full-text. The abstract does after all lack a lot of potentially relevant information, such as the type of workouts, the way the subjects achieved the increase in protein intake (dietary or supplemental protein), the adherence, actual protein, carb & fat intakes, etc.

• As the scientists point out in the results section of the abstract, their two-time point (Pre, Post) by two-group (NP, HP) repeated-measures analysis of variance (ANOVA) showed (a) significant time by group (p ≤ 0.05) changes in body weight with weight gains and loss in the normal and high protein groups, respectively (1.3 ± 1.3 kg NP, -0.7 ± 4.0 HP), as well as reductions in total and relative body fat in both groups (-0.3 ± 2.2 kg NP, -1.7 ± 2.3 HP), and % BF (-0.7 ± 2.8 NP, -2.4 ± 2.9 HP) - both as you can see in Figure 3 with significant advantages for the HP group.
  

  

  Figure 3: Changes in body weight, fat and fat free mass in the normal and high protein groups during the diet + training intervention; mind the error bars = high inter-individual differences (Ellerbroek. 2015).

  In the absence of any form of ill health effects due to the high protein intake (both groups consumed significantly more than the recommended daily allowance of 0.8g/kg), Ellerbroek et al. also found a significant time effect for the increase in fat-free mass  (1.5 ± 1.8 NP, 1.5 ± 2.2 HP), 1-RM on the bench and squats and vertical jump and pull-up performance - albeit without significant diet-induced inter-group differences.

So what's not in this issue? Poster presentations I decided not to discuss "at length" in this issue are the allegedly interesting presentation by Galvan et al. on the "[e]ffects of 28 days of two creatine nitrate based dietary supplements on bench press power in recreationally active males." Just as it was the case for the previously referenced studies on BCAAs, I'd rather wait for the full-text to be published before I make up my mind on whether creatine nitrate is the first form of "advanced creatines" that's actually worth it's money (unlike the rest of the pack | Jäger. 2011).

Blocking Inflammation is Like Cho- king the Fire: Long Term Weight-, Visceral- and Android-Fat Gain in Human Study Emphasizes Essential Role of TNF-α in Metabolic Control!

The same must be said of a study by Detzel, et al. (2015) in which the researchers compared the effects of functional animal proteins on mTOR and endotoxins like , pro-inflammatory compounds, that arise as a consequence of intense training. There's no debating: The way serum the derived protein supplements (BioBeef, SerumPro, and SuperSerum) were capable of neutralizing endotoxin is is interesting, but to comment on the practical usefulness of blending of high-quality protein sources with functional serum protein supplements (SuperSerum and SerumPro) the abstract that does not provide numbers to assess the relevance of the reductions in IL-8 cytokine production by THP-1 monocytes is simply not sufficient | Comment!

References:

• Detzel, Christopher J., et al. "Functional animal proteins activate mTOR and bind pro-inflammatory compounds." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P35.
• Ellerbroek, Anya, et al. "The effects of heavy resistance training and a high protein diet (3.4 g/kg/d) on body composition, exercise performance and indices of health in resistance-trained individuals-a follow-up investigation." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P37.
• Franklin, Brian, et al. "The effect of meal composition on postprandial glucagon-like peptide-1 response in overweight/obese participants." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P12.
• Galvan, E., et al. "Effects of 28 days of two creatine nitrate based dietary supplements on bench press power in recreationally active males." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P17.
• Jäger, Ralf, et al. "Analysis of the efficacy, safety, and regulatory status of novel forms of creatine." Amino Acids 40.5 (2011): 1369-1383.
• Lejeune, Manuela PGM, et al. "Ghrelin and glucagon-like peptide 1 concentrations, 24-h satiety, and energy and substrate metabolism during a high-protein diet and measured in a respiration chamber." The American journal of clinical nutrition 83.1 (2006): 89-94.
• Näslund, E., et al. "Energy intake and appetite are suppressed by glucagon-like peptide-1 (GLP-1) in obese men." International journal of obesity 23.3 (1999): 304-311.
• Nystrom, M. G., et al. "Nutrient timing habits of Division I NCAA athletes." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P33.
• Minevich, Julie, et al. "Digestive enzymes reduce quality differences between plant and animal proteins: a double-blind crossover study." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P26.

Vitamin B12 - A Nutrition Guide for Vegetarians & Vegans: From Nori to Mushrooms, Omnivores Can Benefit, Too!

With 77µg per 100g of the Nori leaves in the wrapping sushi makes an excellent B12 source, even if you stick to the vegan, no tuna version ;-)

If this is not your first visit to the SuppVersity you will be aware that I am not a exactly a proponent of vegetarianism let alone vegan dieting. Just like any other severely restrictive diet people who don't eat animal products are at an increased risk of nutrient deficiencies.

For vegetarians and even more so for vegans, it is not exactly easy to cover their daily requirements of vitamin A, vitamin D3, iron, cholesterol (yes, cholesterol is an essential nutrient!), n-3 polyunsaturated fatty acids and saturated fats. The most urgently needed nutrient for the average vegetarian / vegan dieter, however is vitamin B12, or cobalamin, as scientists say.

Actually dairy happens to be an excellent B12 source. Why not become lacto-vegetarian?

Dairy Has Branched-Chain Fatty Acids!

Is There Sth. Like a Dairy Weight Loss Miracle?

Foods, Not Ma- cronutrients Build Healthy Guts

Lactulose For Your Gut & Overall Health

Is There a "Fat Advantage" for Dairy Lovers

Want B12, But Hate Meat? Drink Milk!

Vitamin B12 is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins. It is normally involved in the metabolism of every cell of the human body, especially affecting DNA synthesis and regulation, but also fatty acid metabolism and amino acid metabolism. Neither fungi, plants, nor animals - including humans - are capable of producing vitamin B12. Therefore a sufficient intake of vitamin B12 is essential for optimal health.

Even in omnivorous humans, vitamin B12 deficiencies are frequent (Stabler. 2004). Among vegetarians and specifically vegans, it is yet rampant (Pawlak. 2013; Pawlak. 2014).

Figure 1: Reliable data on B12 levels is scarce. Based on surrogate markers and B12 deficiency symptoms scientists are still certain that "B12 deficiency as a worldwide problem." (Stabler. 2004) - one vegetarians are particularly susceptible to.

In the latest review by Pawlak et al. who included only studies that assessed serum vitamin B12 an reported actual percentages of vitamin B12 deficiency (40 studies total)...

• the deficiency prevalence among infants reaches 45%,
• the deficiency among the children and adolescents ranged from 0 to 33.3%, and 
• the deficiency among pregnant women ranges from 17 to 39%, dependent on the trimester

Adults and elderly individuals who follow a vegetarian lifestyle had a deficiency range from 0–86.5%. In general, higher deficiency prevalence was reported in vegans than in other vegetarians.  Accordingly, Pawlak et al. conclude that...

"[...]with few exceptions, the reviewed studies documented relatively high deficiency prevalence among vegetarians. Vegans who do not ingest vitamin B12 supplements were found to be at especially high risk." (Pawlak. 2014)

For vegans, specifically, the scientists recommend the routine use of vitamin B12 supplements to ensure adequate vitamin B12 intake and point out that "[v]egetarians, regardless of the type of vegetarian diet they adhere to, should be screened for vitamin B12 deficiency." (Pawlak. 2014)

Why is it so difficult for vegetarians and vegans to meet their requirements?

The Institute of Medicine’s recommended dietary allowance (RDA) of B12 needed to meet an adult’s requirement as 2.4mg per day. B12 is synthesized only by microorganisms, and this is why natural food sources of B12 are limited to meats and foods of animal origin.

 "Clams and beef liver are the highest sources of B12, containing about 84 and 71mg of B12 in a 3 oz serving (USDA. 2011). The amount of B12 found in a chicken varies from about 3.3mg in the entire chicken liver to 0.03mg in achicken’s neck. Pork contains between 0.3mg of B12 in each sausage patty to about 11.4mg in pork liver. 6 The content of B12 in fish ranges from about 9mg in one half of a fillet of sockeye salmon to about 0.5mg in a 3 oz serving of yellow fin tuna." (Pawlak. 2013)

Needless to say that a vegetarian or vegan person mustn't eat any of the aforementioned "good" B12 sources. The question is thus: Where can a vegan or vegetarian get his B12 from?

Diagnosis of low B12 levels is tricky! The most commonly used cobalamin essay has a sensitivity of "only" 62.6% and produces 22%+ false positives. An often-used alternative, the holotranscobalamin essay is a tad better, but with a sensitivity of 64.7% and 18.4% false positives, not exactly accurate, either (Carmel. 2013). Until now no 100% reliable test is available and studies like Salomon (2005) show that patients with "normal" plasma cobalamin levels, but symptoms vitamin B12 deficiency improve after treatment with the vitamin.

In view of the fact that the name of this website contains the word "supplement", the most obvious and probably safest source are supplements. In that, it's important to point out that not all supplements that promise to solve the vegetarian B12 problems will actually deliver.

Fourteen years ago, Micheal S. Donson tested the efficacy of sublingual cobalamine tablets, nutritional yeast, and probiotic supplements in a group of Hallelujah dieters and other raw-food vegetarians and found that only the former two, i.e. the sublingual cobalamine tablets and the nutritional yeast that contained 5µg of cyanocobalamin per tablespoon brought his subjects' depleted B12 levels back into the normal range. The probiotic supplement, on the other hand, was useless (Donaldson. 2000).

For patients with insufficient intrinsic factor production oral supplements are not suitable, though. For them, only injectable vitamin B12 will reliably bring their levels back up (Katz. 1972). People with low stomach acid, which often occurs with aging, as well, and people with gastric bypass (Smith. 1993) have similar, but less pronounced problems to cover their B12 requirements from oral sources (dietary and supplemental).

Now, supplementation and injections are nice, but isn't is possible to get your B12 from foods without having to eat meat and animal products?

In general, it is possible, but there is one major problem: The total content and bioavailability of vitamin B12 in food sources vegetarians and vegans can eat is comparably low.

Table 1: Content and bioavailability of selected "good" dietary sources of vitamin B12 (Watanabe. 2007)

If you take a look at the data in Table 1 you will see that the only source that can keep up with fish and meat are algae. Chloeralla in particular is an excellent source of dietary B12 for both vegetarians and, if I didn't miss yet another stupid dogma, vegans, as well (Watanabe. 2007).

In a previous study, Watanabe et al. (2002) have found that chlorella tablets, but not spirulina, which contains mostly pseudy vitamin B12 is a suitable source of vitamin B12 for man (and woman ;-).

In a more recent overview of vegetarian and vegan B12 sources, the researchers from the United Graduate School of Agricultural Sciences at the Tottori University in Japan (Watanabe. 2014) compiled a comprehensive overview of suitable B12 sources which includes...

• 

  Are "organic" vegetables worth it? Find out in a previous article.

  Vitamin B12-Enriched Beans and Vegetables Produced Using Organic Fertilizers or Hydroponics -- Previous research has shown that you can significantly increase the B12 content of spinach by adding an organic fertilizer such as cow manure. Practically speaking this is an increase to to approximately 0.14 μg/100 g fresh weight - that's huge considering the fact that "regular" spinach contains < 0.01µg/100g vitamin B12.
  
  In view of the fact that the RDA for B12 is 2.4 μg/day that's still too little to be able to cover your B12 needs from spinach alone. Still, in the future we may be seeing other "high B12" vegetables on the market even non-vegetarian dieters may benefit from.
• Fermented Beans and Vegetables -- The Vitamin B12 content of soybeans is low or undetectable. In the course of the fermentation process soybean products are yet loaded with B12, so that fermented soybeans (Tempe, a traditional Indonesian food that's made of fermented soybeans) can contain up to 8.0 μg B12 per 100g (Nout. 1990)
  
  Comparable increases in B12 content have been observed in vegetables that have been fermented with certain lactic acid or propionic bacteria (up to 10µg/100g; Gupta. 1998).
  
  

  

  "Pesticide pollution: Chinese tea may not be safe to drink," this is what you could read on the website of Greenpeace in 2012, already and obviously this has not changed over the last 2 years | read more

  Tea, of which most people forget that it is fermented (not green tea, though), as well can also contain significant amounts of vitamin B12. For black tea (Batabata-cha), scientists have shown that drinking 50 mL/day, equivalent to a daily dose of 1 ng Vitamin B12, for 6 weeks, compensated the B12 deficiency of B12 deficient rodents (Kittaka-Katsura. 2004). As Watanabe et al. point out, results like these "indicate that Vitamin B12 found in fermented black tea is bioavailable in rats." Unfortunately, the same cannot be said for human beings, where the consumption of 1–2 L of the fermented tea drink, which is equivalent to 20–40 ng of Vitamin B12, is not sufficient to meet the RDA of 2.4 μg/day for adult humans.
• Edible Mushrooms --  Zero or trace levels (approximately 0.09 μg/100 g dry weight) of Vitamin B12 were measured in the dried fruiting bodies of porcini mushrooms (Boletussp.), parasol mushrooms (Macrolepiota procera), oyster mushrooms (Pleurotus ostreatus), and black morels (Morchella conica).
  
  

  

  Figure 2: The micronutrients in nori and dried shiitake mushrooms complement each other perfectly (see bottom line for explanation)

  In contrast, the fruiting bodies of black trumpet (Craterellus cornucopioides) and golden chanterelle (Cantharellus cibarius) contained higher levels of Vitamin B12 (1.09–2.65 μg/100 g dry weight) than the above mentioned mushrooms (Watanabe. 2012).
  
  In addition, high levels of Vitamin B12 were detected in the commercially available dried shiitake mushroom fruiting bodies (Lentinula edodes), which are used in various vegetarian dishes. The Vitamin B12 contents of dried shiitake mushroom fruiting bodies (100 g dry weight) significantly varied and the average Vitamin B12 value is approximately 5.61 μg (Bito. 2014). 

In conjunction with algae and algae supplements the aforementioned vegetarian sources of B12 may in fact be sufficient to cover the daily requirements of 2.4µg of vitamin B12.

Milk has a built-in B12 absorption enhancer (learn more). Now you tell me: Who would ever doubt that nature knows best?

Bottom line: Of all vegetarian B12 sources, nori is the one marine source of vitamin B12, Watanabe et al. highlight in particular. The consumption of only 4g of dried purple laver (Vitamin B12 content: 77.6 μg /100 g dry weight) supplies the RDA of 2.4 μg/day. Moreover, nori can be easily consumed as a wrapping for rice and fillings and retains most of its precious B12 content upon heating (Miyamoto. 2009).

In conjunction with dried shiitake mushroom fruiting bodies that contain 18.9 mg of Vitamin D2 (ergocalciferol) and 2.0 mg of iron, both likewise micronturients vegetarians usually don't get enough of in their diets, the dried purple lavers that are rich sources of n-3 polysaturated fatty acids and can be easily integrated in Italian, French, and other forms of Western cuisine, are thus probably the best non-supplemental source of B12 vegetarians can get | Comment on Facebook!

References:

• Bito, Tomohiro, et al. "Characterization of vitamin B< sub> 12</sub> compounds in the fruiting bodies of shiitake mushroom (< i> Lentinula edodes</i>) and bed logs after fruiting of the mushroom." Mycoscience (2014). 
• Carmel, Ralph. "Diagnosis and management of clinical and subclinical cobalamin deficiencies: Why controversies persist in the age of sensitive metabolic testing." Biochimie 95.5 (2013): 1047-1055.
• Gupta, Uma, E. R. Rati, and R. Joseph. "Nutritional quality of lactic fermented bitter gourd and fenugreek leaves." International journal of food sciences and nutrition 49.2 (1998): 101-108. 
• Katz, Max, Sook K. Lee, and Bernard A. Cooper. "Vitamin B12 malabsorption due to a biologically inert intrinsic factor." New England Journal of Medicine 287.9 (1972): 425-429.
• Kittaka-Katsura, Hiromi, et al. "Characterization of corrinoid compounds from a Japanese black tea (Batabata-cha) fermented by bacteria." Journal of agricultural and food chemistry 52.4 (2004): 909-911.
• Miyamoto, Emi, et al. "Characterization of vitamin B12 compounds from Korean purple laver (Porphyra sp.) products." Journal of agricultural and food chemistry 57.7 (2009): 2793-2796.
• Nout, M. J. R., and F. M. Rombouts. "Recent developments in tempe research." Journal of Applied Bacteriology 69.5 (1990): 609-633.
• Pawlak, Roman, et al. "How prevalent is vitamin B12 deficiency among vegetarians?." Nutrition reviews 71.2 (2013): 110-117.
• Pawlak, R., S. E. Lester, and T. Babatunde. "The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature." European journal of clinical nutrition 68.5 (2014): 541-548. 
• Smith, C. Daniel, et al. "Gastric acid secretion and vitamin B12 absorption after vertical Roux-en-Y gastric bypass for morbid obesity." Annals of surgery 218.1 (1993): 91.
• Solomon, Lawrence R. "Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing." Blood 105.3 (2005): 978-985.
• Stabler, Sally P., and Robert H. Allen. "Vitamin B12 deficiency as a worldwide problem." Annu. Rev. Nutr. 24 (2004): 299-326.
• USDA National Nutrient Database for Standard Reference, Release 18.Vitamin B12 (mg) Content of Selected Foods Per Common Vitamin B-12 Measure, Sorted by Nutrient Content. 2005; Available at: http://www.nal.usda.gov/fnic/foodcomp/Data/SR18/nutrlist/sr18w418.pdf. Accessed 27 November 2011. 
• Watanabe, Fumio, et al. "Characterization and bioavailability of vitamin B12-compounds from edible algae." Journal of nutritional science and vitaminology 48.5 (2002): 325-331.
• Watanabe, Fumio. "Vitamin B12 sources and bioavailability." Experimental Biology and Medicine 232.10 (2007): 1266-1274.
• Watanabe, Fumio, et al. "Characterization of vitamin B 12 compounds in the wild edible mushrooms black trumpet (Craterellus cornucopioides) and golden chanterelle (Cantharellus cibarius)." Journal of nutritional science and vitaminology 58.6 (2012): 438-441.
• Watanabe, Fumio, et al. "Vitamin B12-Containing Plant Food Sources for Vegetarians." Nutrients 6.5 (2014): 1861-1873.

Processed Meat is Bad for You, But Only if You Are Already a Type II Diabetic - Reduced Satiety Hormones, Vitamin C and Glucose Control After Veggie vs. Meat Burger

Is your love for meat going to kill you? Not if you're not already a walking candy stick with sugar coated ateries and a beer belly.

I am pretty sure that the mainstream interpretation of the study at hand will be missing the important "but only if you ARE ALREADY a type II diabetic" in the headline of today's SuppVersity article. Meat bashing and vegetarian protein worshiping is simply too "en vogue" these days for the average "science journalist" to stick to the actual data and tell you that the ingestion of isoenergetic processed meat vs. vegan high carbohydrate meals leaves only one conclusion:

For healthy individuals, processed fatty meals produce a much more favorable postprandial peptide response compared to the "allegedly super healthy" (and morally superior ;-) acetic vegetarian plant-based burger meal (a couscous burger: boiled couscous, baked with onion, garlic, plant oil, spices, oat-flakes in a wheat bun with sesame seedsmeal).

Learn more about meat at the SuppVersity

Meat-Love: You May Eat Pork, too!

You Eat What You Feed!

Meat & Prostate Cancer?

Meat - Is cooking the problem?

Meat Packaging = Problem?

Grass-Fed Pork? Is it Worth it?

Apropos burger! Now that you know the constituents of the the vegetarian test meal the 50 type II diabetics and 50 healthy controls were forced to eat contains, it's about time to reveal that the processed meat meal was a standard fast food menu: cooked-pork seasoned meat in a wheat bun with sesame seeds, tomato, cheddar-type cheese, lettuce, spicy sauce, onion.

Table 1: Composition of the processed meat and vegetarian test meals (Belinova. 2014)

As you can see in Table 1 the veggie burger had a significantly lower caloric density, but delivered the same 455kcal per serving as its meaty counterpart.

In view of what you've read about the importance of energy density as a determinant of food intake and subsequent obesity risk in previous SuppVersity intakes, you'd be forced to believe that 56% lower nutrient density alone should be an unfair advantage for the vegetarian meal.

Figure 1: Differential reaction of markers of glucose management (plasma glucose and immonreactive insulin) and satiety (Ghrelin and GLP-1) in response to processed meat or veggie burger (Belinova. 2014)

As the data in Figure 1 clearly indicates, the low nutrient density alone couldn't make up for the low nutrient quality and protein content. At least in the healthy subjects (dashed lines),

"[t]he plasma concentrations of glucose-dependent insulinotropic peptide (GIP), peptide tyrosine-tyrosine (PYY) and pancreatic polypeptide (PP) were higher and the ghrelin concentration was lower after the [processed meat] M-meal." (Belinova. 2014)

Similarly, the postprandial increase in triglycerides (rectangles, solid lines; Figure 2), we see in the diabetic subjects is not present in the healthy individuals, either.

Figure 2: Changes in markers of inflammation (Belinova. 2014).

And the TBARS and vitamin C levels (see Figure 2), as well as the levels of glutathione and superoxide dismutase (all markers of the inflammatory response to the meal; not shown in figure 2) didn't differ between the allegedly bad meat and the allegedly healthy vegetarian meal, anyway.

My previous article "CHO Shortage in Paleo Land" deals w/ another instance of over-generalized data from studies on obese / sick subjects and the confu- sing consequences | learn more.

Bottom line: Don't fall for the tricks of vegetarian bloggers and mainstream science journalists who abuse hand-picked data from the study at hand to "prove" their personal (or the public) conviction that meat is bad and vegetarian meat "alternatives" are good for all of us - that's bullshit.

If there is anything the study at hand "proves", it is the already well-known, but commonly ignored  fact that overweight individuals with a BMI of 33kg/m² or more and significantly elevated HbA1c levels (indicative of full-blown type II diabetes) react totally different to foods than the ever-shrinking majority of people with normal insulin sensitivity | Comment on Facebook!

What? No, that's not a reason to lose your focus on unprocessed meats and whole foods, it just adds to the existing evidence that simple-minded over-generalizations from studies in obese subjects to the whole population will do more harm than good... what? No I didn't say anything about ketogenic diets and low carbing, did I?

References:

• Belinova, Lenka, et al. "Differential Acute Postprandial Effects of Processed Meat and Isocaloric Vegan Meals on the Gastrointestinal Hormone Response in Subjects Suffering from Type 2 Diabetes and Healthy Controls: A Randomized Crossover Study." PloS one 9.9 (2014): e107561.