MCTs and High Protein - One Will Turn You into a Metabolic Furnace, the Other Will Just Burn Money - #ShortNews 10/18

It's about time for some nutrition science news.

For today's installment of the #ShortNews, I've picked two hitherto unpublished studies the main results of which have been presented recently as part of the Proceedings of the Nutrition Society Summer Meeting. The studies by Carr et al. and Maher et al. deal with the metabolic effects of two dietary nutrients you'll all be familiar with: protein and medium-chain triglycerides aka MCTs.

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With both of them being conducted in healthy, normal-weight individuals and the use of sophisticated measuring equipment (eg. metabolic chamber in Carr et al.) and/or additional 'cardio' exercise, respectively, both small-scale studies are - in my humble opinion - worth looking at, even in their current pre-publication stage.

• Hunger ↘, satiety ↗, and 24h energy expenditure ↗ by 4.5% after high protein feeding (Carr 2018) - As a SuppVersity reader the sentence "[d]iets that are high in protein have the ability to keep an individual feeling fuller for longer and therefore have the possibility of reducing food intake" will be one you've read in this or a slightly modified version before.
  
  And yes, there's plenty of evidence to show that the manipulation of dietary protein intakes can help people shed weight, avoid weight gain, and significantly improve glucose management and body composition. Studies like the one at hand, i.e. randomized controlled trials in which the authors actually measure the effects of a high vs. normal protein diet on whole body energy expenditure, hunger, and satiety in a cohort of healthy, normal weight participants for more than just the post-prandial phase (here 36h) are yet pretty rare.
  

  

  Figure 1: The high protein diet (green line) was significantly more satiating than it's "energy-balanced" (how's 50% carbs energy balanced? But alas...) iso-caloric cousin the macro composition of which I had to guesstimate because the scientists only reveal that it had "an extra 30 % of energy as protein" (Karr 2018)

  With a study size of N=8 (5 female, 3 male), the trial K.Carr et al. conducted at the NIHR/Clinical Research Facility in Cambridge, isn't exactly what you'd hope for when it comes to 'optimal' statistical power. Still, the objective 36hr measurements of energy expenditure (EE), and subjective hunger and satiety levels (assessed by visual analog scales, hence subjective), Carr and colleagues assessed on two separate occasions in response to (a) a high protein (HP) and (b) energy balanced (EB) diet [macros see Figure 1, right] is one of the better studies on the acute effects of high protein intake - mostly, because the researchers used a metabolic chamber. Unlike the food questionnaires and scales of other studies, this technical device allowed them to assess the subjects' energy expenditure very precisely by the means of whole-body room indirect calorimetry... and the results the authors present in their paper speak for themselves:

  "The VAS measurements demonstrated that on average hunger was significantly less during the HP visit compared to the EB visit and satiety was significantly greater during the HP visit compared to the EB visit (P < 0.0001). Figure 1 presents results from VAS for satiety across the two interventions. Total EE for the HP visits were significantly higher compared to the EB visits (6.07 ± 3.58 kJ/min vs 5.81 ± 3.42 kJ/min, P < 0.0001)" (Carr 2018 | my emphasis).

  With the increased satiety and the concomitant +4.5% relative increase in energy expenditure the scientists measured in response to the HP diet, Carr et al. are right to point out that "[their] study [...] may have implications for future weight loss strategies" (Carr 2018). You shouldn't make the mistake to believe that the latter, i.e. the small thermogenic effect that amounts to 89.48kcal/day, alone, was enough to sustain long-term weight loss.
• MCTs are in fact gasoline for your metabolic fire (Maher 2018) - Just like Carr's previously discussed high-protein study, Maher's latest experiment that involved twelve healthy, normal-weight males (27 ± 11.43 years, BMI: 23.76 ± 2.85 kg/m²) didn't yield revolutionarily new results. It does, however, investigate a question that's probably relevant for many of you:
  
  What happens to a wanna-be or actual athlete like yourself, if you consume plenty of MCTs as part of your habitual diet? Will that shut down your appetite and turn you into a fat burning machine, as some MCT vendors promise?
  
  Well, we do know from previous research that medium chain triglycerides (MCT) increase energy expenditure (Ogawa 2007; Clegg 2013), and increase satiety and suppress food intake (Kinella 1985; Rolls 1988; Van Wymelbeke 1998).

Coconut oil contains max. 50% MCT: Coconut oil is not a good source of MCT. As discussed at length in my recent "coconut oil for health"-review coconut oil contains "only" 45-53% MCTs. It is thus not surprising that studies such as Kinsella et al. 2017 show consistently that the physiological effects of pure medium-chain triglycerides and coconut oil differ.

• 

  Figure 2: Exercise doesn't "just make you hungry" as some people who also claim that insulin was the sole reason we're fat want you to believe - check out the data from Schubert's 2013 meta-analysis.

  The effects of exercise on appetite regulation are equivocal, though. The only thing we can tell for sure is that acute exercise does lead to energy deficits (Schubert 2013) - this means, energy compensations take time and usually won't occur after a single bout of physical activity. If you review the most important results of Schubert's 2013 meta-analysis (see Figure 2), though, you will see that the majority of studies demonstrate beneficial effects on the subjects' energy balance, i.e. the induction of an energy deficit - in many cases a very significant one.
  
  As Maher et al. point out, "[t]hese effects are achieved through separate mechanisms, and thus there is potential for the combination of MCT and exercise to yield increased satiety" (Maher 2018).
  
  The aim of the study at hand was thus to elucidate the effects of MCT, exercise, or a combination of the two on subjective appetite sensations, energy intake and overall energy balance to answer the previously rised question about the "fat burning machine"... OK, that's not literally part of the outcome measures, but I guess you'll get what I mean.
  All subjects completed four trials in random order. After a 24 h standardisation period and a 12 h fast, participants consumed ...
  • a porridge breakfast which contained 165 kcal of either vegetable oil or MCT oil - followed by either sitting around for 4h or cycling for 1h at 65 % V̇O2peak after having sat around for 3h,
  • a multi-item buffet lunch ad libitum to satiation, after which they completed diet diaries for the rest of the day.
  Expired air samples (for calculation of energy expenditure) and subjective ratings of appetite, on visual analogue scales (VAS), were taken every 30 min only for the initial 4 hours. The analyses of these data showed no effect of either lipid or exercise condition on energy intake at the ad libitum meal (Control-Rest 6278.4 ± 1758.62 kJ; Control-Exercise 6785.2 ± 1370.5 kJ; MCT-Rest 6077.1 ± 1853.5 kJ; MCT-Exercise 6794.4 ± 2030.3 kJ; P ≥ 0.05). There were also no differences for the appetite and satiety VAS scores (all P ≥ 0.05) and no effect on ratings of nausea (P ≥ 0.05).
  

  

  Figure 3: This is probably how MCT producers will display the EE in kcal - minus the arrows with the calorie equivalent, obviously. The latter do, after all, reveal that the benefits are irrelevantly small (Maher 2018)

  What Maher et al. did observe, however, were significant main effects for breakfast (P = 0.031) and exercise condition (P < 0.001) on total energy expenditure. With the subjects who had the MCT breakfast having a significantly greater energy expenditure compared to the control, and - quite obvious - the exercise trials leading to greater energy expenditure than the resting trials (Control-Rest 198.2 ± 138.2 kJ; Control-Exercise 3045.8 ± 606.2 kJ; MCT-Rest 211.1 ± 186.6 kJ; MCT-Exercise 3272.4 ± 763.2 kJ).
  
  If we also take into consideration that the +7.4% "gasoline effect" of MCTs amounts to an increase in energy expenditure of only 54kcal (let's not even talk about the 3kcal increase in the sedentary condition), you will have to agree that it's very unlikely that you'll see weight loss wonders from simply upping your MCT intake - exercise to and fro. That's not the least because a cumulative effect, as it could have existed, or an additional effect of MCTs and/or exercise on energy intake did not exist.

Protein supplements are not necessary to get up to 45% of your energy from protein, but if you choose to eat chicken, cheese, meat, dairy & co, you should know these 8 Simple Rules to Minimize PROTOX! 

So what does this tell us? There's no magic 'nutritional bullet' that will make the fat on your abs melt away ... speaking of fat on your abs: This is one of the reasons I decided to discuss the two studies. They deal with normal-weight adults without metabolic derangement. People who may be unhappy with the aesthetics of their body. For them, and we know that from many previous studies,  different metabolic rules apply compared to those for whom fat loss is essential for survival (eg.morbidly obese type II diabetics, etc.) - rules you could summarize as one rule of thumb: Eat more protein (up to 45% of your energy intake) and don't trust the marketing claims of MCT producers, sellers, and social media celebrities that are pimpin' them | Comment!

References: 

• Carr, K., et al. “Hunger, Satiety and Energy Expenditure after High Protein Feeding.” Proceedings of the Nutrition Society, vol. 77, no. OCE4, 2018, p. E157., doi:10.1017/S0029665118001635.
• Clegg, Miriam E., Mana Golsorkhi, and C. Jeya Henry. "Combined medium-chain triglyceride and chilli feeding increases diet-induced thermogenesis in normal-weight humans." European journal of nutrition 52.6 (2013): 1579-1585.
• Kinsella, R., T. Maher, and M. E. Clegg. "Coconut oil has less satiating properties than medium chain triglyceride oil." Physiology & behavior 179 (2017): 422-426.
• Maher, T.J., et al. “The Effect of Triglyceride Chain Length Combined with Exercise on Appetite, Satiety and Energy Balance.” Proceedings of the Nutrition Society, vol. 77, no. OCE4, 2018, p. E156., doi:10.1017/S0029665118001623.
• Ogawa, Akiko, et al. "Dietary medium-and long-chain triacylglycerols accelerate diet-induced thermogenesis in humans." Journal of Oleo Science 56.6 (2007): 283-287.
• Rolls, Barbara J., et al. "Food intake in dieters and nondieters after a liquid meal containing medium-chain triglycerides." The American journal of clinical nutrition 48.1 (1988): 66-71.
• Schubert, Matthew M., et al. "Acute exercise and subsequent energy intake. A meta-analysis." Appetite 63 (2013): 92-104.
• Van Wymelbeke, Virginie, et al. "Influence of medium-chain and long-chain triacylglycerols on the control of food intake in men." The American journal of clinical nutrition 68.2 (1998): 226-234.

Eccentric Cycling Doubles Fat Loss: 24 Obese Teens Lose -3.4kg ('-10%') Body Fat in 12-Wk W/Out Dieting Efforts

This is how ecc. cycling works + it also happens to show the bike used in the study!

Eccentric cycling? How does it even work? I admit that I was asking myself the very same thing when I hit on Valérie Julian's (2018) latest paper... until I found the video on the right and realized: it's just a modern day torture machine.

A torture machine that doubled the urgently needed fat loss in 24 obese adolescents, though, and hence probably is worth considering - not only, but also because the benefits of eccentric endurance training on fat mass "remain underexplored" (Julian 2018).

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As the authors point out in the introduction to their paper, said lack of research is mostly due to several methodological:

"(a) the difficulty in isolating ECC and CON actions during typical everyday movements; (b) the rigorous methodology required to compare ECC and CON exercise in standardized experimental conditions of power output (ie, at the same mechanical power) or oxygen consumption (ie, at the same metabolic rate or oxygen consumption level, with mechanical power 3‐5 times higher during ECC cycling); and (c) specific ECC pedal ergometers have only acquired widespread usage in the last decade" (Julian 2018).

In obese adolescents, the study at hand is even the first to probe the impact of eccentric cycling. Now the question is: Why on earth would one even want to do that, i.e. cycling eccentrically? Well, here's the rationale: During #EccentricTraining, which forces your muscles to generate force by lengthening (developing tension to either decelerate movement or acting against gravity), your muscles are subjected to greater mechanical stress and respond with increased adaptational effects - that's at least the theory ;-)

Hold on, eccentric training is the thing you do for biceps curls, isn't it?

For most athletes eccentric training belongs into the realms of strength training and bodybuilding, though. To use it in endurance athletes and/or as "cardio" exercise to burn fat, is not exactly what people think aout when they hear about eccentric training. Few people know that there are at least three distinct types of ECC training, namely (a) #plyometricExercises (such as drop jumps, with contractions lasting milliseconds and producing thousands of watts of negative power), (b) classical ECC resistance exercises (protocols consisting of near maximal ECC contractions lasting few seconds, used to lift and lower weights), and (c) “continuous moderate load ECC exercises” as discussed by Hoppeler et al. in their 2016 paper in Frontiers of Physiology:

"This type of training has been characterizes as moderate load eccentric exercise. It has also been denoted RENEW (Resistance Exercise via Negative Eccentric Work by LaStayo et al., 2014). It is distinct from plyometric exercises (i.e., drop jumps) that impose muscle loads of several thousand Watts on muscles and tendons. It is also distinct from eccentric overload training whereby loads in a conventional strength training setting are increased in the eccentric phase of the movement to match concentric loads. Moderate load eccentric exercise (or RENEW) has been shown to be similarly effective as conventional strength training in increasing muscle strength and muscle volume.

Figure 1: Eccentric ergometer custom built for the Swiss National ski-team, capable of providing loads up to 2000 W. As shown, this ergometer can be used in a sitting and in a standing position (from Hoppeler 2014). You can see the machine that was used in the study at hand in the YouTube video at the top of this article.

However, as carried out at higher angular velocities of joint movement, it reduces joint loads. A hallmark of moderate load eccentric exercise is the fact that the energy requirements are typically 4-fold smaller than in concentric exercise of the same load. This makes moderate load eccentric exercise training the tool of choice in medical conditions with limitations in muscle energy supply. The use and effectiveness of moderate load eccentric exercise has been demonstrated mostly in small-scale studies for cardiorespiratory conditions, sarcopenia of old age, cancer, diabetes type 2, and neurological conditions. It has also been used effectively in the prevention and rehabilitation of injuries of the locomotor system, in particular the rehabilitation after anterior cruciate ligament surgery" (Hoppeler 2016).

As you can see in the video at the top of this article, as well as the photos from Hoppeler 2014 (Figure 1), a special motorized device is necessary to power this alternative training modality, which includes, next to cycling on special motorized ECC cycle ergometers, also downhill walking or running, and stepping exercises. As Juliann et al. point out, all four training modalities share one important characteristic: they lower the metabolic demand, compared with concentric training when performed at the same mechanical power (Peñailillo 2017).

Important note on the relevance of the practical results: The CON group trained on an Optibike Med 600, a regular ergometer no fancy special machine - CON's thus just plain cycling as you know it. This is different to resistance training studies in which subjects in the CON groups perform only the concentric portion of the exercise and hence don't represent regular training. CON-cycling, in the study at hand, on the other hand, is regular cycling.

Now, while this makes eccentric training "particularly suitable for patients with chronic pathologies, resulting in cardiac, respiratory, or muscular limitations to their exercise capacities" (Julian 2018), it is, indeed, not obvious why training less metabolically demanding would still promote greater fat loss than regular concentric training... Unless, however, you consider the energy demands of repairing muscle damage and the corresponding increase in resting energy expenditure, that is:

"Moreover, [eccentric training] modifies metabolic substrate use, increasing fat oxidation, and favors a postexercise decrease in blood lipid (which would participate in synthesize new cell membranes of injured muscles)" (Julian 2018 | my emphasis).

Thus, you will be getting more "calorie burning buck" for your bang... or, as the scientists phrase it:

"considering the similar or superior potential effects of ECC training on body composition and its lower metabolic demand, ECC training would be more efficient than CON training given the ratio of energy expenditure to net force or work production" (Julian 2018 | my emphasis).

In conjunction with increasing the energetic demands for muscle repair, eccentric training will - as previously highlighted - also provide a(n allegedly) more pronounced stimulus to skeletal muscle adaptation. Hence, it is not totally surprising that the body fat levels of the subjects were not the only parameter the scientists measured that improved more in the ECC vs. CON group.

Figure 2: The macronutrient composition of the diet the subjects were taught, but not forced to eat isn't exactly what contemporary research would describe as ideal for overall health, fat loss and lean mass preservation (Philipps 2018). 

Believe it or not, the fat was shed without dieting: Yeah, ... there were nutritional education sessions lasting 45 minutes every 2 weeks, but "there was no dietary restriction per se" (Julian 2018). Neither were the adolescents low-carbing or following a diet devoid of fat.

The diet the subjects were taught to consume had an age-dependent energy content of 40 to 50 kcal/kg/d (for 12-15 years) with a mean daily composition of macronutrients of 35% lipids, 55% carbohydrates, and 15% proteins (not exceed 0.9 g/kg/d) - protein deficient for weight loss if you go by the latest research.

Speaking of which, said subjects were twenty‐four adolescents aged 13.4 ± 1.3 years (BMI > 90th percentile), who were randomized to ECC or CON.

All subjects performed three cyclo‐ergometer sessions per week (30 min per session) for 12 weeks: two habituation, 5 at 50% VO2peak, and 5 at 70% VO2peak. 

Anthropometric measurements, body composition (using DXA), maximal incremental CON tests, strength tests, and blood samples were assessed pre‐ and post‐training. About the training protocol, the scientists write:

Figure 3: Study design (Julian 2018)

"The training program consisted of three phases. Phase 1 involved 2 weeks of habituation (ie, progressive increase in exercise intensity and session length) in order to protect subjects from DOMS. During the first sessions, a load corresponding to 20% VO2Peak was imposed, with exercise duration gradually increased by 10‐minute increments up to 30 minutes. Once the exercise duration reached 30 minutes, the exercise intensity ramped up progressively by 10% until achieving 50% VO2Peak.

Phase 2 consisted of 45‐minute sessions with a 10‐minute warm‐up on CON cycle ergometers at 30% VO2Peak then 30 minutes ECC or CON cycling at 50% VO2Peak, and a 5‐minute cool down. Phase 3 consisted of 45‐minute sessions with a 10‐minute warm‐up on CON ergocycles at 30% VO2Peak, 30 minutes ECC or CON cycling at 70% VO2Peak, and a 5‐minute cool down.

Patients were asked for a rating of their perceived exertion (RPE) during each exercise. During the whole 12‐week training, the duration of the session and loads was not increased if participants suffered from DOMS, as indicated by scores >3 on a visual analogic scale (0‐10 scale) or when the rating of the perceived exertion (RPE) of the session was >13 according to BORG (6‐20 scale)" (Julian 2018).

As highlighted as early as in the headline of this SuppVersity article, the analysis of the data the scientists generated with the protocol that is illustrated in Figure 3 yielded a quite astonishing result: The young, obese subjects reduced their body fat percentage by -10% while the subjects in the concentric training group lost only -4.2% (P < 0.05 | note: those are relative values, you can see the absolute changes in body fat percentage over the bars in Figure 4).

Figure 4: Changes in body composition and central parameters of glucose management (calculated based on Julian 2018 | the values for the body fat % and lean mass % differ because I didn't calculate them as the relative change in a parameter that is already expressed relative to the total body weight; I simply subtracted them -subjects went from 31% to 27% BF).

What the headline doesn't tell you, though, is that the increases in whole‐body lean mass (LM) percentage, as small as they were, was also significantly higher in the ECC compared to the CON group (ECC: 3.8% vs CON: 1.5%, P <0.05) - a result that seems to confirm the superior adaptive stimulus of ECC vs. CON training.

The large effect sizes shall not go unmentioned, either

By now, you'll probably not be surprised that the improvement in leg FM and LM percentages were greater in the ECC group (−6.5% and 3.0%, P = 0.01 and P < 0.01 | note: that's the difference between the relative values; the absolute changes were -1kg and -0.8kg), as well and came with significantly elevated increases in quadriceps strength in the ECC group (28.3% and 21.3%, P < 0.05).

Figure 5: Three of the changes in body composition were 'large' - that's something you don't see in every study.

Now, this is great, but let's be honest: Being strong and diabetic is a bummer, so the -19% reduction in HOMA-IR that occurred in the absence of significant differences in VO2peak improvement (ECC: 15.4% vs CON: 10.3%) may be the most important improvement the scientists observed in their 12-week study. And who knows if the subjects had eaten more protein (0.9g/kg is clearly not enough for optimal body composition changes in adolescents) the subjects would probably not just have seen relative gains in lean mass (lean mass:body weight), but actual gains.

Speaking of which, it is probably worth mentioning that the effect sizes for the lean leg mass and the reduction in leg fat were all 'large' (ES 1.07, 0.66, and 0.95, respectively). A 'large' effect (ES 0.85) was also observed for the reduction in waist circumference the scientists do not even report in the abstract to their study (see Figure 5 for an overview of 'large' effects).

Figure 6: Due to the increased training stimulus, the subjects conditioning (VO2Peak), cycling power and quadriceps strength increased significantly more in response to the eccentric vs concentric cyclic protocol. As the authors point out this makes eccentric cycling interesting even for endurance athletes who want to diversify and hopefully optimize their training routine (Julian 2018)

So what's the verdict, then? As highlighted in the previous infobox, there's a fundamental difference between resistance training and cycling training studies that compare the effects of eccentric vs. concentric training. After all, cycling is innately concentric. In the study at hand, the CON group was thus actually what you would usually call a regular control group (this would be different in an RT study where CON-only training is by no means "regular" training).

So, a realistic study protocol, a fair comparison, no diet and still exciting results? Well, yes and no. The way the scientists report their results are quite misleading. How's that? Well, with the percent change in body fat percentage, Julian et al. report the relative change of a relative parameter as their main outcome... the 10% reduction in body fat percentage, for example, is effectively only a 3% reduction in the body fat percentage measured by DXA - or, to put it differently: the actual values decreased from 31% to 28% and hence by 3%... obviously, 3% are 10% of the baseline level of 31% body fat percentage, so the scientists didn't misreport their results, but I have to say that I was a bit disappointed when I saw the actual values after having read about a "-10%" reduction in body fat percentage in the abstract of the study.

But let's not freak out. The most important message of the study at hand is that 12 weeks of progressive eccentric cycling training burns 2x more body fat than "regular" concentric cycling and induces profound improvements in glucose management - in the absence of deliberate dietary restrictions!

Whether that warrants Julian's conclusion that eccentric cycling training "represents an optimal modality to recommend for obese adolescents" (Julian 2018 | my emphasis) is imho still questionable. If you have access to the corresponding torture instruments, though, it's certainly worth trying - for fat loss and performance, by the way | Comment on Facebook!

References:

• Hoppeler, Hans. Eccentric Exercise: physiology and application in sport and rehabilitation. Routledge, 2014.
• Hoppeler, Hans. "Moderate load eccentric exercise; a distinct novel training modality." Frontiers in physiology 7 (2016): 483.
• Julian V, Thivel D, Miguet M, et al. Eccentric cycling is more efficient in reducing fat mass than concentric cycling in adolescents with obesity. Scand J Med Sci Sports. (2018): Ahead of print.
• Peñailillo, Luis, Anthony J. Blazevich, and Kazunori Nosaka. "Factors contributing to lower metabolic demand of eccentric compared with concentric cycling." Journal of Applied Physiology 123.4 (2017): 884-893.
• Phillips, Stuart M. "Higher Dietary Protein During Weight Loss: Muscle Sparing?." Obesity 26.5 (2018): 789-789.

Under Pressure: What's New on BFR & Compression Gear? Of Swollen Legs, Arterial Stiffness & Improved Bone Health

Is it all about pressure? Compression stocking and BFR cuffs revisited.

You will remember that I've covered the use of #BFR, i.e. blood-flow restriction in several articles over the past years. The number of posts on #compression stockings, on the other hand, is limited with only one dealing with the acute anti-heavy-leg effect of 'oma's socks' in the evening.

Today's special will address both, the latest research in everything tight... ;-) Ok, before the ambiguity gets out of hand, let's check out some of the latest studies:

BFR and Hypoxia Training are different from training w/ compression garments

BFR, Cortisol & GH Responses

BFR - Where are we now?

BFR as Add-On to Classic Lifts

BFR for Injured Athletes

BFR B4 Workouts = WIN!?

BFR + Cardio = GainZ?

• In healthy young women, compression stockings may have acute beneficial effects on lower leg swelling and muscle stiffness (Sugahara 2018): While previous trials have often yielded ambiguous results, the latest paper by scientists from Japan Women's University claims to "suggest that even for a short period of application, compression stockings have some positive effects against lower leg swelling" (ibid)... but there's more than the problem with the absence of a real control group of which the scientists say that "it is highly unlikely that the lack of control condition seriously affects the significance of our findings" (ibid) and claim:

  

  Prolonged standing may be as problematic as sitting | more.

  "Rather, the study design did not take into account the preventive effect of wearing compression stockings on leg fluid accumulation that could be induced by even a 20–30 min of sitting, although this was not the primary concern of this study" (Sugahara 2018).

  If that was actually the case, wearing some 'sexy' compression stockings at work may help you ameliorate the circulatory problems triggered by prolonged sitting (and as recently demonstrated even standing).
  
  Before we make further assumptions, though, let's briefly see what those "acute benefits" the Japanese researchers observed actually were.
  
  

  

  Figure 1: Volumes of foot (a), calf (b) and total lower leg (c) measured before and after an application of compression stockings. In each panel, small grey circles = individual data, whereas a large black circle = the group mean. The right panel shows the percent change expressed as mean and SD (n = 20 | Sugahara 2018).

  As previously pointed out, the study involved healthy young women. The N=20 ladies in the age of 18–23 years wore below‐knee graduated compression stockings after returning home in the evening. They were not allowed to lie down, but rested in a seated position for 30 min.
  
  Before and after the application of stockings, maximum calf, volume, circumference, extracellular water resistance (RECW) and muscle stiffness of the right lower leg were determined by tape measure, water displacement volumetry, segmental bioelectrical impedance spectroscopy and ultrasound shear‐wave elastography, respectively.
  
  Unlike the foot volume, the calf volume, and the total lower leg volume, as well as the muscular stiffness of the medial gastrocnemius muscle which only tended to decrease, the maximum calf circumference (vs. volume) decreased significantly (but probably not visibly | -0.35 cm) after the application of the stockings.
  
  In conjunction with the reciprocal of RECW (an index of extracellular fluid volume), it thus seems likely that compression stockings can a least partially reverse the accumulation of fluids in the legs that will occur not just in heart-diseased subjects, but also in healthy individuals.
  
  Obviously, the study at hand cannot provide hard evidence (=real-world outcomes) in terms of the downstream effects on our CVD risk. So, does that even matter?
  
  In view of the small (-1.0% or 0.35cm) reduction in calf circumference, the absence of significant effects on the total lower leg volume, and the lack of correlation between changes in the different parameters the scientists measured, the authors themselves cannot exclude that the stockings simply "pressed" the lower legs into a new shape:

  "More specifically, a brief application of compression stockings on swollen legs may result in greater compression pressure on more swollen part of the leg, affecting the fluid distribution within the lower leg before accelerating the fluid shift from the lower leg to the thigh. This possibility is particularly relevant to our experimental protocol, e.g. participants wore below‐knee stockings and rested in a seated position during the 30‐min application" (Sugahara 2018).

  If that was actually the case, though, we must, unfortunately, assume that using the sexy "compression lingerie" at the end of a workday for only 30 minutes will probably do very little for your risk for common circulatory disorders or other CVD risk factors. What it may help with, however, are tightly wound calf-muscles in the evening... and, we shouldn't forget that wearing them preventively at work may be the more relevant intervention, anyway.

This image from my article about the post-set application of BFR (learn more) shows how reliable BFR cuffs can look like - fundamentally different from the blood pressure cuffs at the doctor's office. You can learn more about BFR in the SuppVersity archives - please klick on "older articles" at the bottom to dig deeper into the archives.

BFR cuffs - The broader the better? Ok, that was not exactly the research question Mouser et al. (2018) tried to answer, but, I guess, you'll still get the idea. In their study, the scientists from the The University of Mississippi tested the effects of cuffs with a width of 10 and 12 cm, respectively, in 17 male and 14 female subjects on two separate occasions using ultrasound measures of blood flow, mean blood velocity, peak blood velocity and artery diameter from the posterior tibial artery at rest and during the application of 10% increments of the aortic pressure.

The results were quite unequivocal: "As long as relative pressures are applied, cuff width appears to have little to no effect on the blood flow stimulus during blood flow restriction at rest" (Mouser 2018). That doesn't mean, though, that you can achieve the same effect with parcel strings or the small and fragile cuffs docs use to get your blood for the lab.

Why 10 and 12 cm? I guess that's what you're asking yourself now. Well, it's worth mentioning that the scientists have already published a paper on the effects of cuff width in 2012 -  a paper with an IMHO practically more relevant comparison of 13.5cm and 5cm cuffs (Loenecke 2012). And while 5cm is still much wider than the previously mentioned cuffs at the doctor's office the scientists did find a significant difference due to the 8.5 cm difference - namely that broader cuffs can achieve the same reduction of arterial blood flow at much lower inflation pressures... for further details on choosing the optimal cuff width and material, pressure, arm circumference, sex, etc, I suggest you read Loenecke's free 2013 paper in Frontiers in Physiology and a 2016 follow-up study that was published in Sports Medicine (Jessee 2016).

• Small arteries stay stiff for a longer period following vibration exercises in combination with  blood flow restriction (Karabulut 2018): Aortic stiffness is, according to a 2012 paper in the Journal of Cardiovascular Translational Research (Tomiyama 2012), a potential trigger and perpetuator of (pre-)hypertension. What is particularly nasty is that the increased blood pressure will only worsen arterial stiffness and the consequent vicous cycle can lead you from
  'pre- to post-hypertension' (=death due to pressure-induced CVD).
  
  In view of the association of arterial stiffness with the onset and progression of hypertension, the study at hand sounds like bad news for you or your clients who use similar blood flow restricted vibration training regimen.
  
  The latter, i.e. using BFR as an adjunct to vibration training was exactly what the eight male subjects did in the study at hand: They performed static upper body (UB) and lower body (LB) exercises on a vibration platform with and without BFR. During the BFR sessions, BFR cuffs were placed on the arms or legs and inflated to a target pressure. Exercises consisted of eight 45‐s sets for UB, and ten 1‐min sets for LB. Arterial elasticity and hemodynamic variables were assessed before, at 10 min and 40 min postexercise. Repeated measures ANOVA was used to test the mean differences in related variables.
  

  

  Figure 2: Changes in large arterial elasticity values following (a) lower and (b) upper body static exercises. Values reported as Mean ± SE (Karabulut 2018)

  As previously hinted at,  the scientists found a significant difference between the BFR versus no‐BFR trials for the subjects' small arterial elasticity (P<0·05). As Figure 2 goes to show you, the result differed slightly for lower and upper body but a significant reduction in small artery elasticity was observed in both body parts.

Kaatsu, the Japanese version of BFR, with a rich tradition has an excellent safety profile (Nakajima 2018).

What about the general safety of #BFR? As Nakajima et al. point out in their 2006 review, blood flow restriction in form of the Japanese KAATSU training doesn't just have a long tradition but is still applied to all generations - from very young (<20 years old) to very old (>80 years old).

That alone does yet not warrant the conclusion that it's safe and side-effect free. Accordingly, the scientists questioned the "KAATSU leaders" or instructors in a total of 105 out of 195 facilities where KAATSU training has been adopted.

Based on survey results, 12,642 persons had received KAATSU training (male 45.4%, female 54.6%). Interestingly enough, the most popular purpose of KAATSU training in the study was to strengthen muscle in athletes and to promote the health of subjects, including the elderly. Approximately 80% of the facilities are satisfied with the results of KAATSU training with only small numbers of complications reported.

The incidence of side effects was as follows; venous thrombus (0.055%), pulmonary embolism (0.008%) and rhabdomyolysis (0.008%) - see Figure. "These results indicate that the KAATSU training is a safe and promising method for training athletes and healthy persons, and can also be applied to persons with various physical conditions," Nakajima et al. (2006) conclude.

• The obvious question now is: How bad is the impaired restoration of the blood flow in the small arteries? And the answer will hopefully calm you down: Probably not too bad. After all, the systemic effects (not shown in Figure 2) were not affected by BFR and, after plummeting at the 10-minute mark, returned to normal at the 40-minute mark in both the BFR and control trial - a delayed recovery you can see in Figure 2 for the small arteries was absent.
  
  Moreover, we cannot exclude the possible occurrence of an augmentation of the training effects and corresponding (positive) adaptations of the vasculature due to the increased physical demand of combined training (the scientists observed a significantly higher heart rate in the BFR trial. Needless to say that this does not apply for pre-existing vascular disease. They are probably better off if the stay away from BFR and/or perform it only under medical supervision.
• Logical, but also true? Intense exercise, especially weight-bearing exercise, has been shown to be a potent bone builder. BFR has been shown to augment the adaptive response to light(er) exercise. Does this mean BFR training can also build bone? Scientists from the Federal University of Paraíba tried to figure that out in their recent review of the literature (Bittar 2018) - albeit with moderate success.
  
  Bittar et al. searched for studies that analyzed the effect of low‐intensity (LI) exercises with blood flow restriction (BFR) on bone metabolism and compared it to the proven benefits of high‐intensity (HI) exercises without BFR. Two researchers, independently and blindly, selected the studies based on established inclusion and exclusion criteria.
  
  

  

  There are all sorts of different BFR regimen. In this study from the SuppVersity archives, the cuffs were applied before (3x5 minutes), not during the exercise and still: the increase in the putative marker of muscle damage, creatine kinase, was significantly ameliorated.

  While the initial electronic and manual searches had located 170 articles published in English, only four studies survived the screening process. The good news is that they seem to support the initially proposed rationale "that BFR training increases the expression of bone formation markers (e.g. bone‐specific alkaline phosphatase) and decreases bone resorption markers (e.g. the amino‐terminal telopeptides of type I collagen)" not just in response to strength training, but also "after both aerobic [...] exercise across several populations". Still, in the absence of methodological standardization of the samples, exercise type, intervention frequency or duration - more research will be necessary to quantify the effect size in a meta-analysis.

Meta-analysis suggests: Gymgoers may benefit most from wearing compression garments.

Bottom line: While the research investigating the health and performance effects of #compressionGarments and #stockings is still more-or-less in its infancy, the number of studies which probe the efficacy and safety of different types of #bloodFlowRestriction has increased rapidly over the past decade.

In that, one has to be careful, though, to avoid getting too excited about the pro-anabolic effects of blood flow restricted (low intensity) training and/or getting too anxious over the previously discussed transient ill effects on arterial stiffness.

Needless to say that the same applies to the performance and or health effects compression garments, too. For them, the latest meta-analysis concludes that "LLCGs [lower-limb compression garments is] not associated with improved performance in VJ [vertical jump], VO2max, VO2submax, Lactate, or RPE during high-intensity exercise" (da Silva 2018). This result clearly relativizes the measured, bu often small benefits in individual studies and reminds me to refer you to a more comprehensive review I blogged about last year - a review that seems to suggests that gymrats not endurance athletes, who made up the majority of the subjects in the studies reviewed by da Silva et al., may benefit most from the strategically timed use of compression garments | Comment!

References:

• Bittar, S. T., Pfeiffer, P. S., Santos, H. H. and Cirilo‐Sousa, M. S. "Effects of blood flow restriction exercises on bone metabolism: a systematic review." Clin Physiol Funct Imaging, 38 (2018): 930-935. doi:10.1111/cpf.12512
• da Silva, César Augusto, et al. "Association of Lower Limb Compression Garments During High-Intensity Exercise with Performance and Physiological Responses: A Systematic Review and Meta-analysis." Sports Medicine (2018): 1-15.
• Jessee, Matthew B., et al. "The influence of cuff width, sex, and race on arterial occlusion: implications for blood flow restriction research." Sports Medicine 46.6 (2016): 913-921.
• Loenneke, Jeremy P., et al. "Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise." European journal of applied physiology 112.8 (2012): 2903-2912.
• Loenneke, Jeremy P., et al. "Blood flow restriction pressure recommendations: a tale of two cuffs." Frontiers in physiology 4 (2013): 249.
• Mouser, J. G., Dankel, S. J., Mattocks, K. T., Jessee, M. B., Buckner, S. L., Abe, T. and Loenneke, J. P. "Blood flow restriction and cuff width: effect on blood flow in the legs." Clin Physiol Funct Imaging, 38 (2018): 944-948. doi:10.1111/cpf.12504
• Reed, Katharine E., et al. "The effects of lower-body compression garments on walking performance and perceived exertion in adults with CVD risk factors." Journal of science and medicine in sport 20.4 (2017): 386-390.
• Sugahara, I. , Doi, M. , Nakayama, R. and Sasaki, K. "Acute effect of wearing compression stockings on lower leg swelling and muscle stiffness in healthy young women." Clin Physiol Funct Imaging, 38 (2018): 1046-1053. doi:10.1111/cpf.12527
• Tomiyama, Hirofumi, and Akira Yamashina. "Arterial stiffness in prehypertension: a possible vicious cycle." Journal of cardiovascular translational research 5.3 (2012): 280-286.
• Vlachopoulos, Charalambos, Konstantinos Aznaouridis, and Christodoulos Stefanadis. "Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis." Journal of the American College of Cardiology 55.13 (2010): 1318-1327.

'Native' Whey, the Superior Whey? Transient Benefits on 'Recovery', No Size or Performance Gains in 12-Week RCT

'Natural' whey is filtered right out of skim milk, 'regular' whey from the liquid 'waste" that accumulates in the cheese production - that's at least how the scientists in the study at hand define 'natural' - in the literature 'natural whey' often refers to whey concentrate/isolate vs. hydrolysates, ie. quasi-predigested protein with a completely different peptide content.

I've discussed potential differences between 'native' whey protein and 'regular' whey protein supplements before. Unfortunately, the only evidence we've had, so far, has yet been the observation that it is digested even more rapidly than regular whey protein (learn more in my 2017 article) - a mere increase in speed, however, doesn't necessarily translate to significant, let alone practically relevant increases in muscle and/or performance gainz... without longitudinal studies, we're thus screwed when it comes to the interpretation of Hamarsland's 2017 study.

With the publication of a new study from the University Clermont Auvergne (Garcia-Vicencio 2018), data about the longitudinal effects of using 'native' vs. 'regular' whey consumption is finally available. So, let's see...

High-protein diets are much safer than some 'experts' say, but there are things to consider...

Practical Protein Oxidation 101

5x More Than the FDA Allows!

More Protein ≠ More Satiety

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Protein Timing DOES Matter!

High Protein not a Health Threat

...what Sebastian Garcia-Vicencio and colleagues actually did: They "assess[ed] if 'native' whey protein (NW) supplementation could promote recovery and training adaptations after an electrostimulation (ES) training program combined to plyometrics training" (Garcia-Vicencio 2018). More specifically, ...

• Subjects: Forty-two young moderately active men [21.5 ± 3.2 years (mean ± SD)] volunteered to participate in the study. The study utilized an independent group design that was double-blind, randomized and placebo-controlled. Participants were randomly assigned in a block fashion, to one of three supplement groups; (1) 'native' whey (NW | n = 17), (2) standard whey (SW | n = 15), (3) iso-caloric carbohydrate placebo (PLA; n = 10). 
• Supplementation: Participants were supplemented on only 5 days/week during a 12-week training program. Participants were supplemented with a 250-ml drink containing either 15 g of carbohydrates + 15 g of NW (Pronativ®), 15 g of carbohydrates + 15 g of standard whey protein from a cheese production process (SW group), or 30 g of carbohydrates for the PLA group (identical amount of protein, slightly higher carbs and lower fat in NW vs. SW).
  

  

  Figure 1: Amino acids composition (g) for 35 g (serving) of standard whey (SW) and 'native' whey (NW) proteins. | relative differences in SW vs. NW in the boxes (calculated based on Garcia-Vicencio 2018)

  The supplement was made from powder, diluted in water. The color, texture, and taste were similar to milk chocolate and were comparable and isocaloric between the different supplements.  Supplementation was given in a fasted state, 5 days per week at the same time of day, immediately after each training session (3/week; Monday, Wednesday, and Friday), and before breakfast, on non-training days (2/week; Tuesday and Thursday). No supplementation was given during the weekend days.

Suboptimally dosed on purpose: Are you asking yourself why the subjects were fed only 15g of whey and not 25-30 to max out the protein induced increase in protein synthesis? The scientists explain this choice very reasonably: "This suboptimal dose of protein was chosen, as recommended by Hamarsland et al. (2017), to avoid a ceiling effect in muscle protein synthesis that would have hidden any potential difference between protein qualities" (my emphasis in Garcia-Vicencio 2018).

• 

  Figure 2: Overview of the experimental protocol. Three testing sessions were organized before (T0), and after 6 (T1) and 12 weeks (T2) of training to evaluate the training adaptations. The recovery kinetics of neuromuscular properties were evaluated after the 1st (S1), 4th (S4), and last (S24) electrostimulation (ES) sessions.

  Training: During the first 6 weeks, the participants performed 3 ES training sessions per week. From weeks 7 to 10, one ES training session was combined w/ 2 plyometrics training sessions per week "to transfer the training adaptations into sport-specific movements" (ibid). Finally, the training volume was reduced (1 ES-training session + 1 plyometrics training session) during weeks 11 and 12 to allow tapering (Zory et al., 2010).
• Performance Testing: To evaluate training adaptations, three testing sessions were organized before (T0), and after 6 (T1) and 12 weeks (T2) of training (Figure 1). Anthropometrical characteristics, dimensions and neuromuscular properties of the knee extensor (KE) muscles and sprinting and jumping performances were the measured outcomes. Concentric power (P_max) was evaluated before, immediately after, as well as 30 min, 60 min, 24 h, and 48 h after the 1st, 4th and last ES training session. The maximal voluntary contraction torque (MVC), twitch amplitude, anatomical cross-sectional area (CSA) and maximal voluntary activation level (VA) were measured before (T0), and after 6 (T1) and 12 weeks of training (T2).

Now that you know everything there's to know about the study design, let's get to the results, of which I have to admit that they seem to suggest that the extra-investment you've to effect was worth it. How is that? What are the benefits? Check out Figure 3, as well.

• Improved recovery of activation patterns: P_max started to recover at 30 min in NW, 24 h in SW and 48 h in PLA. the adaptation kinetics in the maximal voluntary contraction (MVC) tests differed: MVC increased in NW and SW between T0 and T1, but an additional gain was only observed between T1 and T2 in NW. The voluntary activation level (VA) declined at T1 and T2 in PLA (−3.9%, p < 0.05), at T2 in SW (−3.5%, p < 0.05), and was unchanged in NW. 
• Maximal voluntary contraction: MVC increased between T0 and T2 in NW (+11.8%, p < 0.001) and SW (+7.1%, p < 0.05), but not PLA. A corresponding increase in muscle size (CSA) was not detected - the CSA increased in all groups but did not differ between groups.

That sounds strong (literally), no? It still would be stupid to start celebrating a new goto-supplement based on these results. How come? Well, let's start with the conflict of interest statement - I quote:

"PLR, JB, MB, VV, YC, and NB are employed by Lactalis, which is the funder of the study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest" (Garcia-Vicencio 2018).

Obviously, we must not assume that the fact that six authors work for Lactalis Ingredients, the company that also founded the study, would disqualify the results as biased, let alone that the data was forged. I mean, if you wanted to make 'native' whey shine, and were willing to fabricate data, you'd probably do that in wheys... ah, ways that would yield a significant inter-group difference.

What's the mechanism for the early recovery advantage of 'native' whey? We have no idea. That's partly because the study at hand wasn't designed to elucidate the mechanism of potential inter-group differences between the NW and SW group. The scientists refer to the previously referenced increased absorption speed and higher peak values of blood leucine as potential mechanisms to explain the rather disappointing advantages of 'native' whey. I doubt that this is the relevant difference, though: I mean, let's be honest: If you hear about improved leucine levels (higher peak, reduced time to peak), you won't think about a temporary amelioration of the acute reduction in the subjects' contractile properties, but rather about increases in protein synthesis that translate to longitudinally improved muscle gains.

The term "native" is usually used to refer to (whey) protein that has not been further processed in ways that change its protein structure (fig. from Yada 2017). That's in contrast to the study at hand, where the concept of nativity refers to being from a "natural" vs. "processed" (How much more 'natural' is skim milk compared to cheese whey, anyway?) raw material.

Since the amino acid make-up of Pronativ® (Lactalis Ingredients, Bourgbarré, France), a 95% (on dry basis) soluble milk protein isolate, didn't differ much from that of the standard whey protein, we will have to consider other potential mechanisms. Of these, differences in the amount and type of functional peptides or other nutrients between 'native' and standard whey are imho the most likely reasons for the neuromuscular resiliance of the subjects who consumed the 'native' whey that's produced directly from skimmed cow milk by "a mild physical separation membrane process" (quote from the paper, not from an ad ;-), not from residues of the cheese-making process.

I couldn't find evidence to support this hypothesis, though. Mostly because the term "native whey" is used inconsistently in the literature and usually refers to whey concentrate vs. hydrolysate, instead of distinguishing whey proteins according to their raw materials (see the figure from Yada 2017 and my caption on the left).

What I can tell you, though, is that "native whey" - in the sense of the study at hand, i.e. whey made from skim milk (SM) - and whey protein that's produced based on buttermilk differ significantly (Svanborg 2015) in terms of their casein nitrogen content (higher in SM | +155%), total fat (lower in SM | -91%), calcium (higher in SM | +15%), iron (lower in SM | -45%), magnesium (lower in SM | -66%), phosphatidylcholine (lower in SM | -86%), and lysophosphatidylcholine (higher in SM | 385%) concentrations.

Difference in macro-mineral content of different types of whey protein (buttermilk, 'native', concentrate, isolate) expressed as rel. difference to the mean for each mineral (based on Svanborg 2015, Whetstine 2005).

Unfortunately, I couldn't find a direct comparison involving whey concentrate and isolate, as well as 'native' whey (i.e. whey that was extracted directly from skim milk). To still illustrate what one would have to do to identify potential nutritional confounders I've combined data from Svanborg et al. 2015 with averages I calculated based on Whetstine et al 2005 to plot the relative differences in lactose, fat and macro-mineral content (with the control supplement in the study being a cheese-whey based isolate, the only difference that is pronounced enough would be the calcium content... and while calcium plays a role in neuromuscular facilitation (Katz 1968), it is imho unlikely that it is the only and decisive advantage of 'native' whey.

Eventually, we obviously need much more data (e.g. peptide-structure, phospholipids, etc.) from std./identical tests to make valid predictions about a potential nutrient-related mechanism behind the pro-regenerative effects of 'native' whey. In the meantime, we can probably console ourselves by reminding ourselves that the real-world advantage is marginal, anyway.

What I am asking myself, though, is whether the scientists really chose to present the relevant results only in relative, not in absolute terms (not even in additional tables). Was that really just "[f]or the sake of clarity" as they write in one of the captions. As I've previously emphasized for my own figures, graphs that plot the relative changes are indeed often easier to read, but they also tend to (over-)emphasize inter-group differences.

Figure 3: The only significant differences between 'native' whey (NW) and standard whey (SW) were detected in the maximal voluntary activation (that's not MVC!) and concentric power tests after 12 weeks and after the first 4 EMS sessions (my markup in Garcia-Vicencio 2018); all other tests failed to show significant advantages of 'native' over standard whey..

Speaking of which, significant inter-group differences were observed only for the change in the subjects' maximal voluntary activation level after 12 weeks (T2 | tested separately from regular workouts at least 24h after the last intense physical activity) and their change in concentric power right after the fourth EMS session. The practical relevance of these changes is questionable, but the scientists are right when they interpret this observation as evidence "that the NW group better coped with the physical demand of the training program during the first weeks" (Garcia-Vicencio 2018). In that, Garcio-Vicensio et al. probably mean that the neuromuscular impairments (note: that's not the real world athletic performance or the actual contractile force, which would be voluntary contraction, not voluntary activation) due to an intense, novel exercise stimulus such as the first EMS sessions in weeks 1-2 and the additional sprint and jump training in weeks 7-8 were ameliorated by the 'native' whey supplement.

A real-world performance (sprint or jump performance) or pro-anabolic effect in terms of increased muscle gains, which are obviously the changes people would be willing to pay for, was not observed in the study at hand. More specifically, the 12-week changes in sprint (-1.6% faster) and jump performance (+2.4% power during squat jumps), as well as knee extensor cross-sectional area (+8.3% CSA after 12 weeks) were identical for all three groups.

Lastly, I shouldn't forget to mention that there were no differences in markers of muscle damage - and that in spite of the previously described neuromuscular effects of 'native' vs standard: Neither the subjects' subjectively rated DOMS nor the CK-levels showed significant inter-group differences (for all three treatments) - a result that is consistent with the results of the majority of protein supplementation studies, and excludes another potential mechanism behind the ameliorated neuromuscular impairment in response to intense, novel exercise stimuli.

Suggested SuppVersity Classic Article: "Protein-Timing & Fasting: Fasted Sprints & the Remarkable Muscle↑, Fat↓ Effect of Timing Whey With vs. Between Meals" | read more.

Probably not worth the extra money!? When the scientists write in the discussion that "the differential effects of the supplements were particularly clear when considering the recovery kinetics of the concentric power" (Garcia-Vicencio 2018) that is, to say the least, 'ambiguous'. What the scientists should have written was not that the evidence was "particularly clear" for these parameters but that significant inter-group differences between the NW and SW groups existed only for two measures of the recovery kinetics - and, more specifically, only for the temporary maximal voluntary activation and the acute concentric power measured right after a bout of (at that time) still unaccustomed EMS.

Don't get me wrong, I don't want to trivialize these benefits, but it must be emphasized that the previously mentioned change in concentric power after an acute bout of electrical muscle stimulation rebounded after an initial adaptation phase and ended up being non-significantly higher in the standard (SW) vs. 'native' whey (NW) group (~18% vs. ~11% | see Figure 3). With the maximal voluntary activation being a rather theoretical advantage (if it doesn't result in greater force production as in the study at hand), this leaves us without any significant practical advantage in the long run, i.e. when the subjects have ample time to adapt!

Using casein protein pre-bed can be useful but probably only for those of us who cannot eat enough protein over the course of the day and use it to up their total protein intake | learn more.

Hence, any potential advantage of 'native' over standard whey is most likely to occur in the very beginning of the adaptation period and will materialize in form of an amelioration of temporary performance declines that occur in response to the unaccustomed muscular strain of starting a new workout program -- here, an EMS workout program the scientists chose because it is known to "generate[] recovery issues and potential blunted training adaptations" (Garcia-Vicencio 2018) that won't occur in response to either the strength & hypertrophy routine the avg. gymgoer is following or the progressive intense sprint training a pro-athlete may have been doing for years.

The study found no extra muscle gains, no performance increments, and also no reductions in delayed onset muscle soreness (DOMS) and, at best, 'measurable', but practically irrelevant changes in muscle activation patterns. Eventually, I would thus venture the guess that you, just like the subjects in the study at hand, wouldn't feel or see any benefits if you switched from your 20€/kg standard whey isolate to a 'native' whey isolate that will cost you 27€/kg and hence a premium of 35% (price estimated based on randomly selected 'native' (=Pronativ® based) vs. regular whey products on the European market) | Comment on Facebook!

References:

• Garcia-Vicencio, Sebastian, et al. "A moderate supplementation of native whey protein promotes better muscle training and recovery adaptations than standard whey protein–a 12-week electrical stimulation and plyometrics training study." Frontiers in Physiology 9 (2018): 1312.
• Hamarsland, Håvard, et al. "Native whey induces higher and faster leucinemia than other whey protein supplements and milk: a randomized controlled trial." BMC Nutrition 3.1 (2017): 10.
• Katz, Bo, and R. Miledi. "The role of calcium in neuromuscular facilitation." The Journal of Physiology 195.2 (1968): 481-492.
• Svanborg, Sigrid, et al. "The composition and functional properties of whey protein concentrates produced from buttermilk are comparable with those of whey protein concentrates produced from skimmed milk." Journal of dairy science 98.9 (2015): 5829-5840.
• Whetstine, ME Carunchia, A. E. Croissant, and M. A. Drake. "Characterization of dried whey protein concentrate and isolate flavor." Journal of dairy science 88.11 (2005): 3826-3839.
• Yada, Rickey Y., ed. Proteins in food processing. Woodhead Publishing, 2017.
• Zory, Raphael F., Marc M. Jubeau, and Nicola A. Maffiuletti. "Contractile impairment after quadriceps strength training via electrical stimulation." The Journal of Strength & Conditioning Research 24.2 (2010): 458-464.