Training in Hypoxia Accelerates Isometric Strength (+24%) + Size (+1kg) Gains as Well as Fat Loss (-4%) in 5-Week Study

In hypoxia you still have to work out intensely & consistently to get shredded.

This is not the first time you read about the almost marvelous effects a low oxygen environment can have on the adaptive response to exercise, but after reading it, you will hopefully agree that it was one of the most interesting SuppVersity articles about hypoxia.

The article discusses the results of a recent study from the Journal of Strength and Conditioning Research by Yan et al. In said study, the authors tested the effects of different levels of systemic hypoxia on the hormonal responses, strength, and body composition to 5-week resistance training.

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To this ends, Yan et al. recruited twenty-five "physically active" male subjects with previous resistance training experience and randomly assigned them to one out of 3 experimental groups that performed 10 sessions (2 sessions per week) of barbell back squat (10 repetitions, 5 sets, 70% 1 repetition maximum [RM]) under

• normoxia, i.e. in a regular gym (NR, FiO2 = 21%),  or
• severe (HH) or moderate (HL) hypoxia (HL, FiO2 = 16%; HH, FiO2 = 12.6%). 

Serum growth hormone (GH), testosterone (T), and cortisol (C) concentrations were measured before (Pre) and at 0 (T-0), 15 (T-15), 30 (T-30) minutes after exercise in the first and last training sessions. The subjects' one repetition maximum (1-RM), their isometric knee extension, isometric leg press (LP), and body composition were evaluated before and after the protocol.

Figure 1: Hormonal response to resistance training under normal or reduced oxygen conditions; inerestingly, the effects on the testosterone / cortisol ratio increased, while those on GH decreased over time (Yun. 2015).

As you can see in Figure 1, the hormonal response the scientists observed during the first and last sessions in hypoxia foreshadowed the significant differences in the adapative response Yun et al. observed. To be more specific, the benefits materialized during the post-tests in form of significant improvements in isometric LP strength and an exclusively significant increase in lean body mass in the hypoxia groups (meaning the increase in the normoxia group was not significant).

But you recently wrote that the hormonal response doesn't matter! Yes, I did. Actually, that's not even long ago (read up on it), but who said that the changes you see in Figure 1 mechanistically caused the increased adaptive response? That must have been the little bro in your ear, because I certainly didn't do so. With regard to growth hormone, we need to be careful, anyway. In the year 2000, Raastad et al (2000) already demonstrated that the growth hormone response to one and the same resistance training protocol is highly individual with both responders and nonresponders. Furthermore, the GH response has been shown to increase with intensity and glycogen demands and the latter are obviously increased when a lack of oxygen in the blood reduces the efficacy of the citric acid cycle. The study at hand does therefore not contradict the results of the study at hand that Ho et al. didn't find similar effect on GH with a low-intensity resistance training protocol in normoxia vs. hypoxia (Ho. 2014). In fact, the differential response would rather support the hypothesis that the different hormonal response is a correlate, not a trigger of the improved adaptational response in the Yun study.

In view of the fact that we are dealing with a moderate-intensity resistance training program, the former is as unsurprising as the significant isometric strength increases and lean mass changes in hypoxia are surprising.

Figure 2: Rel. Changes in strength and body composition over the course of only 5 weeks of training (Yan. 2015); please note that the absolute reduction in BF% was only 2% in the hypoxia and 1% in the normoxia group/s.

Whether these effects (see Figure 2) were in anyway mechanistically related to the significantly greater GH responses in the hypoxic training groups, however, remains questionable (see light blue box). The increased GH response could after all be a mere correlate of a different underlying mechanism that triggers both - the accelerated adaptive processes, subsequently increased gains and + fat lass and the temporarily elevated growth hormone levels. This hypothesis is further supported by the lack of differences between the training effects in the HL and HH group. If those were triggered by the observed acute changes in the so-called "anabolic hormones", the more beneficial testosterone to cortisol ratio (see Figure 1) would have had to trigger a greater adaptive response in the HH group. The fact that it didn't is quite revealing. After all, the testosterone to cortisol ratio is still regarded as the most important marker of anabolism by the average bodybuilding forum visitor.

The mask on the right does not simulate training in hypoxia and cannot be expected to help effortlessly shed 11% of body fat as it was observed in a 2013 study in trained athletes.

Ah... and now that we are already talking about the things people write in fitness forums, I should maybe mention that the "fitness masks" with which you look pretty much like Hannibal Lecter can not replace a hyperbaric chamber or a mask with separate low O2 air supply. Why? The masks make it harder to breath. That has a certain training effect, because it trains the diaphragm, but this effect is (a) much more pronounced in (relatively) untrained individuals than in athletes and (b) and achieved by totally different mechanisms (Stuessi. 2001), of which we cannot assume that they have the same extended (beyond the training session) metabolic effects that make "true" hypoxia so effective.

Bottom line: Even though the results of the study at hand are impressive, there's little doubt that training at high altitudes and in low oxygen environments is rather an endurance athlete than a strength athlete thing. If you scrutinize the data in Figure 2, the existing benefits in terms of size and strength gains are by no means as huge as the effects you see in endurance athletes in response to altitude camp training.

Figure 3: In a very similar study, Kon et al (2015) have recently demonstrated significant improvement in muscular endurance and a potent effect on muscular angiogenesis (the formation of new capillaries), but no significant extra-strength / -mass gains in response to 8wks training in hypoxia (14.4% oxygen).

This thesis, by the way, is supported by data from another recent 8-week RT-study by Kon et al. (2015) who found significant differences only for the muscular endurance (see Figure 3) and the level of VEGF, a protein that is responsible for improving the capillarization of skeletal muscle - both likewise rather endurance-specific benefits. And while this doesn't mean that gymrats cannot benefit from training in hypoxia, it does mean that you don't have to be furious that the owner of your local gym is to cheap to buy the equipment that would be necessary to reduce the oxygen levels beyond what the hundreds of sweating trainees will do ;-) | Comment!

References:

• Ho, Jen-Yu, et al. "Effects of acute exposure to mild simulated hypoxia on hormonal responses to low-intensity resistance exercise in untrained men." Research in Sports Medicine 22.3 (2014): 240-252.
• Kon, Michihiro, et al. "Effects of systemic hypoxia on human muscular adaptations to resistance exercise training." Physiological reports 2.6 (2014): e12033.
• Raastad, Truls, Trine Bjøro, and Jostein Hallen. "Hormonal responses to high-and moderate-intensity strength exercise." European journal of applied physiology 82.1-2 (2000): 121-128.
• Stuessi, Christoph, et al. "Respiratory muscle endurance training in humans increases cycling endurance without affecting blood gas concentrations." European journal of applied physiology 84.6 (2001): 582-586.
• Yan, Bing, et al. "Effects of Five-Week Resistance Training in Hypoxia on Hormones and Muscle Strength." The Journal of Strength & Conditioning Research 30.1 (2016): 184-193.

Scientifically Proven Fixes for Your Hunchback - Significant Improvements in Athletes Within 6 Weeks W/ Minimal Effort

In contrast to the routines I will discuss in today's SuppVersity feature article (thank you Timo for the inspiration), practicing the ab-pose has not been scientifically proven to help you fix your posture... although, when you look at how it's done, it's certainly not going to make things worse.

In contrast to 90% of the SuppVersity articles, the following text is not about a "recent study". No, it's my analysis of the existing evidence on stretching and exercise interventions to resolve a problem many of the guys at my gym developed either at their jobs, or as a consequence of doing nothing but bench presses and ballistic curls: the hunchback - or, as scientists would say, a "forward shoulder posture" (FSP).

Luckily, gymrats are not the only ones suffering from this problem. This is why an albeit small group of exercise scientists from has spent a considerable amount of time and effort to identify methods to reverse this ugly, and as a 2008 study in 40 university students whose pulmonary function decreased with increasing FSP degree shows (Ghanbari. 2008), even "breathtaking" problem.

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Since swimmers are one of the groups of athletes that appears to be most affected, it is only logical that they were also the subjects of a series of studies by scientists from the Virginia Commonwealth University and the University of Kentucky who investigated the a combined exercise and stretching intervention in two separate studies on hunched over swimmers (Kluemper. 2006; Lynch. 2010).

In the last mentioned study by Kluemper et al., the participants, 29 (14 male and 25 female) elite-level, high-school- and college-age competitive swimmers from 2 swim teams, performed a Theraband® latex-band base resistance training regimen consisting of (see Figure 1)...

• 

  Figure 1: Scapular retraction (top), external rotation (middle) and shoulder flexion for the lower trapezius (bottom | Kluemper. 2006).

  Scapular retraction - With the shoulder abducted to 90° in the scapular plane, the elbows flexed to 90°, and the forearms horizontal, the subject holds a section of the exercise band between the right and left hands and retracts the scapulae, stretching the band (Figure 1, top). The subject must maintain the original 90° position of the shoulders and elbows and then execute a controlled return to the starting position.
• External rotation - The upper arm is positioned at 90° of shoulder abduction and 90° of elbow flexion. The forearm begins in a horizontal position and externally rotates into a vertical position. The subject then executes a controlled return to the starting position. The exercise band is fixed in front of the subject at approximately waist height at the beginning of the exercise (Figure 1, middle).
• Shoulder flexion for the lower trapezius - With arms flexed to 90°, elbows fully extended, and palms down, the subject flexes the shoulders to 180° against the exercise-band resistance and then executes a controlled return to the starting position. The exercise band is again fixed in front of the subject at approximately waist height for the beginning of this exercise (Figure 1, bottom).

These exercises were performed three times per week during the subjectsʼ scheduled morning swimteam practice and with a built-in progression according to which the resistance (at the end of the third week the subjects progressed to the next higher level of resistance) and rep and set numbers progressed (see Table 1).

Table 1: Progression of the exercises | at the end of the third week the subjects progressed to the next higher level of resistance using the Theraband® latex band (Kluemper. 2006).

As the title of the study already tells you, this resistance training regimen was combined with partner-stretches for the pectoralis major and the pectoralis minor the scientists describe as follows:

Figure 2: Photos of the stretches for pectoralis major and minor (Kluemper. 2006) 

"The first stretch, for anterior chest muscles, required the subject to assume a supine position on a 5-in-diameter foam roll, which runs down the center of the back. The subjectʼs partner grasps the subjectʼs shoulders and slowly presses them down in the direction of the floor until instructed to stop and hold for 30 seconds. This was repeated twice per training session (Figure 2, top). The second stretch for shoulder internal rotators required the subject to assume a kneeling position in front of his or her standing partner and lace his or her fingers behind the head. The partner then reaches in front of the subjectsʼ arms and back behind the subjectʼs scapulae, lacing his or her fingers together, as well. The part ner pulls in a diagonal direction, both up and back from the subjectʼs trunk, until instructed to stop and hold by the subject (Figure 2, bottom). The stretch was held for 30 seconds and repeated twice per training session" (Kluemper. 2006).

Obviously, I wouldn't be telling you all that in detail if the result of Kluemper's study didn't show that this training combination of strengthening and stretching exercises can "reduce the forward shoulder posture present in most competitive swimmers" (Kluemper. 2006) - or, to be more precise, that doing these exercises only 18 times over the 6-week period was enough to significance reduce the scientists primary measure of FPS, i.e. the distance of the acromion from the wall (see Figure 3, left), when the subjects were standing with their backs against the latter in a resting posture (–9.6 ± 7.3 mm).

Figure 3: The photo on the left shows how the scientists measured how severe the subjects were hunched forward; the graph on the right shows the improvements in posture (reduction = subjects were standing less hunched over) - improvements which reached significance only during the especially important relaxed posture test (Kluemper. 2006).

Now, that's unquestionably a quite promising result for a six week study. It's also a result of which we are about to see that it may be that pronounced, because neither the stretches nor the resistance training were done just with the subjects body weight. While the latter, i.e. regular, non-partner-assisted stretches and relatively simple body weight movements can be effective, the increased resistance / force during the strength training and the stretches may explain why Kluemper et al. observed that impressive improvements in such a short timespan.

A 2015 study from the Illinois State University shows that the muscle-energy technique described in this box could be another treatment that can help you reduce your messed up posture by increasing the length of the pectoralis minor and reducing "the hunch" (Laudner. 2015).

Muscle energy techniques - an alternative treatment method? Being passively treated by a physiotherpist appears to be another method that can reduce your postural problems. In a very recent study Laudner, et al. (2015) were able to show that a treatment that involves what the researchers call "muscle energy techniques" will improvements the pectoralis minor length (PML) and forward scapular position in  applied to the pectoralis minor of asymptomatic female swimmers provided - likewise within six weeks. For the MET treatment, participants were asked to lie supine on a standard treatment table with the treatment arm off the table. The treatment arm was then passively moved into horizontal abduction, in line with the pectoralis minor and sternal fibers of the pectoralis major muscle fibers, until the end range of motion was reached.

Due to the possibility of glenohumeral instability among swimmers, the therapists proceeded cautiously in all participants during the MET application. The arm was held at this barrier for 3 seconds. The shoulder was then brought out of the stretch slightly, and the participant was instructed to ‘‘pull against the investigator’s resistance towards the opposite hip.’’ This contraction was performed isometrically with approximately 25% of the participant’s maximal effort for 5 seconds. Immediately after this contraction,  the entire sequence was repeated with the arm again being passively horizontally abducted to the new range of motion.

Obviously, this hypothesis is speculative, but it is hard to ignore the fact that the benefits in the previously cited 2010 study by Stephanie S. Lynch, which used "only" body weight strengthening exercises and regular stretches (see Figure 4), were significant, but, compared to the results of the Kluemper study, which used a progressive resistance training program and more intense, partner-assisted stretches, less pronounced.

Figure 4: Overview and description of the exercises in the Lynch study (Lynch. 2010).

In Lynch's study twenty-eight National Collegiate Athletic Association division I varsity swimmers performed the body-weight exercises that are depicted and explained in Figure 4 likewise three times per week, but for eight, not just six weeks, scheduled around their regular team practice and strength training sessions.

"Subjects in the intervention group were trained using an instructional video of the exercises as well as being provided with an illustrated handout. Descriptions of the exercises are shown in tables 2 and 3. Strengthening exercises targeted the periscapular muscles. Stabilisation of the scapula throughout the exercise routine was emphasized during instruction. Subjects performed three sets of 10 repetitions of all strengthening exercises. The stretching portion of the intervention aimed at increasing the flexibility of the pectoralis muscle group and the cervical neck extensors. [...] Subjects logged the number of times the training was performed. Random checks by the investigator were performed to ensure compliance as well as the correct execution of the exercises." (Lynch. 2010).

Lynch et al. selected the exercises "based on literature which suggests selective activation of the lower trapezius/middle trapezius and serratus anterior, lengthening of the pectoralis minor and improving deep cervical flexor function and improving posture" (Lynch. 2015).

Figure 5: Changes in forward head angle, shoulder translation and scupalar distance (Lynch. 2015); I deliberately chose the same scale for the primary axis as in Figure 3, even though a direct comparison is not exactly scientific.

As the data in Figure 5 goes to show you, there's little doubt that the the exercises worked. A direct comparison with the changes observed in the Kluemper study, however, appears to suggest that adding resistance / pressure during strength training and stretching can significantly accelerate the progress... although, it should be said that without a head to head comparison in a single study, this must remain a very speculative hypothesis.

A 1990 study by Lo et al. reports that 43.8% of athletes who are competing in sports with upper arm involvement complain about shoulder problems, learn how to fix them in six weeks!

Bottom line: Obviously the way I previously compared the two studies with different subjects and exercises is not exactly scientific - and still, I would be really interested to see a study test my hypothesis that the use of resistance bands and partner assisted stretches would produce greater improvements than body weight exercises and regular stretches, in general.

Until this head-to-head comparison will have been done and my hypothesis will have been confirmed, though, the only thing I can tell you "for sure" is that doing any of the previously outlined exercise + stretching regimes will help you to improve your posture | Comment on Facebook!

References:

• Ghanbari, Ali, et al. "Effect of forward shoulder posture on pulmonary capacities of women." British journal of sports medicine 42.7 (2008): 622-623.
• Kluemper, Mark, Tim Uhl, and Heath Hazelrigg. "Effect of stretching and strengthening shoulder muscles on forward shoulder posture in competitive swimmers." Journal of sport rehabilitation 15.1 (2006): 58.
• Laudner, Kevin G., et al. "Forward Shoulder Posture in Collegiate Swimmers: A Comparative Analysis of Muscle-Energy Techniques." Journal of athletic training 50.11 (2015): 1133-1139.
• Lynch, Stephanie S., et al. "The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers." British journal of sports medicine 44.5 (2010): 376-381.

Peri-Workout BCAA + Glutamine + Citrulline Consumption Blunts Muscle & Fat Loss Compared to Powerade Placebo

"Shed the fat, keep the muscle!" That's a promise you will find not literally, but analogously in every ad for BCAAs, but do they actually do that? Help you shed fat and retain muscle? Scientific prove to support this claim is, as of yet, missing.

With BCAAs it is just as it is with 99.9% of the supplements: Ads and product labels are full of scientifically unproven claims. One of these unproven claims is that the consumption of branched-chain amino acids would protect you from losing muscle while you're dieting ... the problem with this notion is - as sound as it may seem in view of the mTOR promoting effects of leucine, there's no study which would prove that guzzling BCAAs all day will in promote fat and blunt lean mass losses when you're cutting.... or I should say "as of now, there was no study...", right? After all, there's this new study by Dudgeon et al.'s the abstract of which tells us that "BCAA supplementation in trained individuals performing resistance training while on a hypocaloric diet can maintain lean mass and preserve skeletal muscle performance while losing fat mass" (Dudgeon. 2015).

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As we are going to see after taking a look at the design and results of Dudgeon's single-blind study in seventeen resistance-trained males (21–28 years of age) on hypocaloric diets, this is yet a potentially misleading conclusion. Not because it was wrong, but rather because it omits an observation that could be of paramount importance to dieters who have the free choice between the two treatments, the subjects of the study were randomly assigned to, namely...

• 14g of Xtend (BCAA) before after workouts or
• 14 g Powerade (CHO) before and after workouts

The supplements were consumed for a total study time of 8 weeks during which all subjects trained four times per week according to a standardized workout program and consumed a diet that was programmed (but not controlled) to contain roughly 35% less energy than the subjects required on workout days and approximately 10% less energy than required on off-days.

In the strict sense, this is actually no "BCAA study": Some of you may already have realized that the "BCAA supplement" the scientists used, i.e. Scivation XTend, is not really a "BCAA only" supplement. Next to only 7 grams of BCAAs per 14g of powder the subjects ingested before and after the workout, it also contains 1 g citrulline and 2.5 g glutamine and obviously a hell lot of flavorings, fillers and what not. Now, while the latter are not of any importance, both of the former have been heralded as muscle protectors, as well, with citrulline probably having the more convincing scientific data to back it up (it appears to act similar to leucine, by the way | Moinard. 2007; Faure. 2012; Ventura. 2013) outside of scenarios with extremely high glucocorticoid levels where glutamine unquestionably helps (Hickson. 1995 & 1997; Salehian. 2006). It is thus in my humble opinion at least highly imprecise to conclude that the provision of 2x7g of BCAA ameliorated the the fat to muscle loss ratio during the 8-week study.

Now you may be rightly asking yourselves why I am so vague with respect to the energy deficit. Well, everything we learn from the full text of the study is that all subjects were "provided an individualized caloric restricted diet based on individual data (body mass, body composition, resting metabolic rate, etc.)" (Dudgeon. 2015) - a diet the scientists describe as follows:

Table 1: W/ the Harris-Benedict equation you calculate the basal metabolic rate and multiply it with a factor (multiplier) that describes your activity level best to arrive at the "real" estimated energy requirements.

"The caloric-restricted diet was designed as an 8 week “cut diet” for reducing body fat, and used a modified carbohydrate-restricted diet approach (percent of total calories for workout days were 30 % carbohydrates, 35 % protein and 35 % fat and for off days were 25 % carbohydrates, 40 % protein and 35 % fat). Each individual’s daily caloric and macronutrient intake was determined using the Harris Benedict formula with an activity factor of 1.35 (lightly active individual engaging in light exercise 1–3 days/week) for workout days and 1.125 (sedentary individual) for off days" (Dudgeon. 2015).

Since the Harris-Benedict formula is only a really rough estimate of how much energy you actually need, my previous estimations of the energy deficit are as "accurate" as I can possibly be. The 1604kcal that are printed in red bold letters on top of the exemplary meal plan in Figure 2, however, suggest that the deficit on the off days was significantly larger. After all, the subjects' mean weight was >80kg and their daily energy requirements should thus be at least 2,000kcal - even on off days (and the table in which the macronutrient composition is listed actually says that the mean intake was 2046 and 2264kcal/day for the BCAA and CHO group respectively).

Table 2: Sample dietary card for a subject during an off, non-workout, day (Dudgeon. 2015).

In view of the fact that the response I got from the authors to an email in which I asked about the exact kcal deficit only referred me to the previously cited passage about the activity factors, I guess it is futile to further speculate about the energy deficit, of which I would still like to add that it was probably higher in the heavier and taller BCAA group. Why? Well, the BCAA group had plans with 2456 and 2046 kcal on workout and off days, the CHO group on the other hand were fed 2717 and 2264 kcal... Whatever, let's get to the more relevant, but not less confusing changes in body weight, lean mass and fat mass the researchers report for the BCAA and CHO groups:

Figure 1: Pre and post absolute mean body weight, body fat and lean body mass values before and after the 8-week intervention; * p < 0.05 for the difference within groups (no difference between groups | Dudgeon. 2015)

-0.1 kg and -2.3 kg of body weight, +0.4 kg and -0.9 kg of lean mass and 0.6 kg and 1.4 kg fat mass in the BCAA and CHO groups respectively - that's in line with the previously cited conclusion. The BCAA supplement blunted the small loss of lean mass in the CHO group, but if we look at the complete dataset, a somewhat different image emerges; one in which the two classic markers of body composition, namely the relative amount of body fat (aka "body fat percentage") and the lean mass as percentage of the total mass changed in a way that favors CHO over BCAA supplements:

Figure 2: Pre vs. post values for body fat % and lean mass %, the two parameters you would classically use to assess body composition (instead of absolute lean and fat mass); pre-to-post change on top of the post-bars (Dudgeon. 2015).

Now, I am not saying that the consumption of the BCAA (+citrulline + glutamine) supplement did not blunt the loss of lean mass - it obviously did. What I want you to keep in mind, though, is the fact that the consumption of 14g of BCAAs before and after workouts appears to suffocated any dieting efforts - after all, the subjects lost a practically irrelevant (and for whatever reason allegedly statistical significant) amount of 600g body fat; that's in contrast to the 1.4 kg of fat mass the subjects in the control group lost; and that's a practically relevant insight, even if this fat loss was allegedly statistically non-significant, because  it implies that BCAAs practically blunt fat loss.

Whey + Casein - A Superior Post-Workout Shake that Kicks Every Amino Acid Product's Ass | read more

So what do we make of this study? Well, first of all, I would like to come back to something fundamental: This is yet another BCCA study that did not make the practically most relevant comparison of BCAAs and cheap (whey) protein protein supplements, in which BCAAs have hitherto always failed. In my humble opinion that's a problem, after all having a carbohydrate supplement as control in a dieting study is nice, but eventually not relevant for the average trainee who is probably not really considering extra-carbs when he's dieting.  What a real trainee would have been interested in, is whether BCAAs can prevent muscle catabolism to a significantly greater degree than the cheap whey protein he's using anyway...

... and maybe, whether the latter has a similar negative effect on fat loss as the BCAAs in the study at hand - which leads me to the actual take home message of the study, which is, as usually, not as straight forward as the conclusion of the abstract suggested. When all is said and done, the study at hand does after all suggest that someone who is approaching the single-digit body-fat zone, where every gram of muscle that is not lost counts, could benefit from the apparent lean mass protective effects of BCAA the scientists observed in the study at hand. It does yet also indicate that someone who's "making weight" for a competition should take a second look at the data in Figure 1 + 2 and acknowledge that taking a BCAA supplement may be the reason he will fail to achieve his weight loss goal. You don't believe that? Well, let's do some scientifically not exactly kosher extrapolations: If you manage to lose 10 kg in 10 weeks without BCAAs, for example, the data from the study at hand suggests that your weight loss "on BCAAs" over the course of those 10 weeks would be as meager as 434 grams ... whether that's in fact the case (I doubt it ;-) will have to be studied in future studies, just like the effect of BCAAs, citrulline and glutamine, alone and whether using your regular whey protein before and after the workout wouldn't have the exact same, or even better effects | Comment on Facebook!

References:

• Dudgeon, WD; Page Kelly, E; Scheett TP. "In a single-blind, matched group design: branched-chain amino acid supplementation and resistance training maintains lean body mass during a caloric restricted diet." Journal of the International Society of Sports Nutrition  (2016) 13:1.
• Faure, Cécile, et al. "Leucine and citrulline modulate muscle function in malnourished aged rats." Amino acids 42.4 (2012): 1425-1433.
• Moinard, Christophe, and Luc Cynober. "Citrulline: a new player in the control of nitrogen homeostasis." The Journal of nutrition 137.6 (2007): 1621S-1625S.
• Hickson, R. C., S. M. Czerwinski, and L. E. Wegrzyn. "Glutamine prevents downregulation of myosin heavy chain synthesis and muscle atrophy from glucocorticoids." American Journal of Physiology-Endocrinology and Metabolism 268.4 (1995): E730-E734.
• Hickson, Robert C., et al. "Protective effect of glutamine from glucocorticoid-induced muscle atrophy occurs without alterations in circulating insulin-like growth factor (IGF)-I and IGF-binding protein levels." Experimental Biology and Medicine 216.1 (1997): 65-71.
• Salehian, Behrouz, et al. "The effect of glutamine on prevention of glucocorticoid-induced skeletal muscle atrophy is associated with myostatin suppression." Metabolism 55.9 (2006): 1239-1247.
• Ventura, G., et al. "Effect of citrulline on muscle functions during moderate dietary restriction in healthy adult rats." Amino acids 45.5 (2013): 1123-1131.

High(er) Dose Fish Oil (3g EPA+DHA per Day), an Effective Thermogenic for Older Women - 187 kcal/Day Higher RMR

This study is different from the average "fish oil is good for you" study and that's both refreshing and revealing. Speaking of "fresh" you got a 50/50 chance you buy fresh, not rancid fish oil.

I am not exactly a fan of fish oil supplementation, but I am neither ignoring the few gems among the bazillion of "fish oil is good for you" papers. Samantha L. Logan's and Lawrence L. Spriet's latest paper in the open access journal PLOS|ONE looks as if it was one of those gems. A gem that suggests that 3g of DHA + EPA per day (2 g/d EPA, 1 g/d DHA, to be precise) will not just lower the triglyceride levels of community dwelling older, healthy women by 29%, but also (a) increase their lean mass by 4%, (b) boost their functional capacity by 7% and (c) bump up their resting metabolic rate by 14%, their energy expenditure during exercise by 10%, and the rate of fat oxidation during rest and low-intensity cycling by 19% and 27%, respectively.

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What? Yep, now I got your attention, right? Well, the objective of the study was to evaluate the effect of fish oil (FO) supplementation in a cohort of healthy, community-dwelling older females. Now, in contrast to your average fish oil study, the scientists did not restrict themselves to measuring the effects on blood measures of insulin, glucose, c-reactive protein, and triglycerides, though. Their primary study outcomes included the effects on the subjects' metabolic rate and substrate oxidation at rest and during exercise as well as on body composition, strength and physical function.

For the study, twenty-four healthy females (66 ± 1 yr) were recruited and randomly assigned to receive either 3g/d of EPA and DHA or a placebo (PL, olive oil) for 12 wk. Exercise measurements
were taken before and after 12 wk of supplementation and resting metabolic measures were made before and at 6 and 12 wk of supplementation.

Figure 1: Relative changes in metabolic parameters at rest and during 30 min of exercise (Logan. 2015).

As you already know and can now see in Figure 1, the fish oil supplementation significantly increased the subjects' resting metabolic rates, energy expenditure during exercise and the rate of fat oxidation at rest and during exercise. What is kind of funny, though, is that the scientists either misreported the actual values or miscalculated the changes, because I used the data from their study to calculate the relative differences in Figure 1 and as you can easily see those are significantly different from the values reported in the introduction - values I copied directly from the abstract.

So, how did this work? As of now we don't really know that. It is most likely that EPA and DHA modulate energy metabolism by activating one or several PPAR receptors, which may then trigger increases in the levels several protein (FAT/CD36, FABPc, UPC3) and enzymes (acyl-CoA oxidase, CPTI) which control the mitochondrial fatty acid oxidation. Additional effects on PGC-1α, which is involved in regulating the genes involved in energy metabolism, as well as in mitochondrial biogenesis and function may augment the metabolic effects of the long-chain omega-3s. Effects of which we do yet not know how they are affected by and whether they require the incorporation of DHA and EPA into the cell membrane - obviously significantly more research is necessary.

Now the reason I am not going to spend time to find out, whether I or the researchers have made a mistake is that the statistically significant increase in resting metabolic rate for example amounts to 7kcal per hour, if the actual value is 2-5% lower or higher that's absolutely irrelevant. Since the same can be said for the other values, I think we all should be able to cope with any potential deviation from the actual data in the following overview I've compiled based on the (hopefully accurate) data from the tables in the full text of the study graphically in Figure 2.

Figure 2: Graphical overview of the absolute increase in energy expenditure and fat oxidation (Logan. 2015).

In conjunction with the marginal, but significant increase in lean mass, which does by the way only partially explain the increase in energy expenditure, these changes are not just statistically, but practically relevant - that's something even I, as a fish oil critic, have to admit ;-)

So, fish oil is a metbalic activator? Well, at least in this particular group of subjects, there's no debating that the 3g of combined EPA + DHA per day triggered statistically significant and as the data in Figure 2 shows even potentially practically relevant increases in energy expenditure at rest and during exercise.

Suggested Read: "TTA + Fish Oil Revisited - Increased Muscular N-3 Levels Compromise Heart & Skeletal Muscle Performance: 40% Reduced Endurance & 54% Lower Work Capacity in 9 Weeks" | more

As the authors highlight, though, "[f]uture research should also aim to test a greater number of participants and include a longer period of supplementation (ie. 1 yr) to determine whether the increase in metabolic rate results in changes in more robust changes in body composition" (Logan. 2015). In view of the complaints of their subjects who had difficulties stomaching the 5g of total fish oil that were required to achieve the desired dose of EPA + DHA, the scientists also argue that future studies have to investigate solutions that reduce the digestive issues (gastrointestinal discomfort) and whether you even need 3g of EPA + DHA or lower dosages would have the same effect... well, and obviously, it would be interesting to see if similar results could be observed in younger and / or male subjects | Comment on Facebook!

References:

• Logan, Samantha Louise. Physical Activity and Nutrition as Modifiable Lifestyle Factors for Healthy Aging in Older Adults. Diss. The University of Guelph, 2013.

Phosphorus, an Anti-Obesity Agent? 3x375 mg With Each Meal Strip Almost 4 cm Off Obese Waists in Only 12 Weeks

You knew that all these fat burning high protein foods are high in phosphorus?!

1 cm per week? What sounds like an advertisement for the next best useless fat burner, is in fact the rate at which the 47 obese, but otherwise "healthy" subjects in a recent study from the American University of Beirut had to tighten their belts (Ayoub. 2015)... Ok, I know that this is not DNP-like earth-shatteringly fast, but in view of the fact that the placebo group had to loosen their belts to accommodate for an additional 0.36 cm increase in waist circumference, it is still quite amazing. I mean, would you have expected that the amount of phosphorus of ca. 300 g salmon would have such an effect if there's no other difference in diet or physical activity between the two groups of overweight participants?

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Speaking of which,... there were 47 participants (placebo group n = 21; phosphorus group n = 26), 16 men and 31 women, who completed the intervention over the course of all subjects were requested to take three tablets that contained either 375 mg phosphorus or a placebo (Nutricap Labs, Farmingdale, NY, USA) with each main meal (breakfast, lunch and dinner) for 12 weeks (there were no detectable differences in size or weight between intervention and control envelopes | see Table 1).

Table 1: Overview of the baseline characteristics of the subjects in the placebo and phosphorus group (Ayoub. 2015).

Otherwise, the subjects had to maintain their regular dietary and (sedentary) physical activity habits. Whether this was actually the case, however, was unfortunately not monitored by the scientists -- I know that's a bummer, but it is (a) very unlikely that the subjects suddenly started to work out, when they were asked not to, and (b) unrealistic to assume that any effects on the diet that would not be a consequence of the phosphorus supplementation would occur only in the treatment, but not in the active treatment group. Changes in dietary intake that may have occurred in response to the phosphorus treatment, on the other hand, must be expected to occur in the real world as well and would thus only add to the practical relevance of the study at hand compared to a study, where the diet was standardized and potential effects on appetite intake could not have been measured, anyway (as we are going to see further down, this is actually an important fact, even though it would still be nice if we had at least data from food logs).

Figure 1: Weight, waist circumference and serum phosphorus levels expressed rel. to baseline (Ayoub. 2015).

If you look at the selected study outcomes in Figure 1 (please note the non-existing effects on serum phosphorus!), it is still sad that Ayoub et al didn't at least tell their subjects to run food logs, because now everything we have as a basis to speculate about the mechanism that triggered the 'weight and waist loss' are the highly unreliable appetite scores in Table 2; and the latter clearly suggest, but certainly don't prove that the effect was the result of a mere reduction in energy intake.

Table 2: Changes in subjective appetite scores from baseline to 12 weeks (Ayoub. 2015).

Since we don't have those food logs, though, we will have to rely on older studies and a few assumptions to make sense of the results. Well, then...

• there's firstly the evidence from observational studies linking high protein, high dairy and high whole grains intakes to reduced risk of overweight and metabolic syndrome - since a high intake of all three of these food groups is also associated with an increased intake of phosphorus, that's the first line of evidence which supports a mechanistic role of increased phosphorus intakes in weight management,
• there's secondly epidemiological evidence showing an inverse association between an individuals phosphorus status and his or her body weight and waist circumference, and 
• there's thirdly the well-known effect of phosphorus on ATP production, especially in the liver, of which previous studies suggest that it regulates afferent neural signals to the central nervous system which will result in a reduction in food intake (Friedman. 2007).

If we take all three lines of evidence into consideration, we are yet back to square one: the most likely, but unproven mechanism by which the addition of phosphorus to the diet helped the obese subjects in the study at hand lose weight is a reduction in energy intake.

Figure 2: In a previous study the addition of 500mg of phosphorus to a non-caloric or caloric pre-load has already been shown to significantly reduce the food intake during ad-libitum (pizza) lunch (Obeid. 2012).

The latter, by the way, is not just in line with the subjective appetite ratings of Ayoub's study participants, but also with the results of a previous study by Obeid et al (2012), in which the addition of phosphorus to a water, sucrose, fructose + glucose, or pure glucose preload that was administered before an ad-libitum meal lead to an additional attenuation of food intake (see Figure 3). Against that background it is actually very reasonable to assume that the same effect, i.e. a mere reduction in energy intake, is responsible for the 'weight and waist loss' in the study at hand, too.

If you're a loyal SuppVersity, you will probably remember that phosphorus supplements have also been shown to ameliorate the decrease of the active thyroid hormone T3 dieters experience as they progressively reduce their food intake | learn more

Disappointed that it all comes back to eating less, once again? I know the mechanism, a reduction in food intake, is not exactly exciting. It means, after all, that you can still not eat as much junkfood as you want and stay lean if you only supplement with enough phosphorus (in view of the potential diarrhea you may get from very high doses, I suspect you could eat as much as you want... but you certainly don't want to ;-).

With the previously reported beneficial effects of phosphate supplements against the metabolic slow down in response to significantly reduced energy intake, the study at hand does yet contribute another line of evidence that suggests that our diet may eventually not really be so much too high in phosphorus / -phates as we believe it was | Comment!

References:

• Ayoub et al. "Effect of phosphorus supplementation on weight gain and waist circumference of overweight/obese adults: a randomized clinical trial." Nutrition & Diabetes (2015) 5, e189; doi:10.1038/nutd.2015.38.
• Friedman, Mark I. "Obesity and the hepatic control of feeding behavior." Drug News Perspect 20.9 (2007): 573-8.
• Obeid, O. A., S. Dimachkie, and S. Hlais. "Increased phosphorus content of preload suppresses ad libitum energy intake at subsequent meal." International Journal of Obesity 34.9 (2010): 1446-1448.