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caffeine

  • Dear Readers,

    Welcome to the February 2017 issue of TotalHealth. February is National Heart Month, there are several articles on heart health in this issue.

    In our Studies section this month we report Kyolic Aged Garlic’s Hypertension Benefits Confirmed.

    Dallas Clouatre, PhD, in "Three Pillars Of GI-Tract Health" gives us a look inside at our GI tract. He describes the workings of the this body system, what can go wrong and how we can influence the GI-track to healthy working order. You'll be impressed with how complicated the whole operation is—even without much consideration from us.

    Elson Haas, MD, presents "Self Care And Stress Reduction." Guiding us on a tour by looking at ways to protect our body and heart from the negative effects of stress and to create better health. Beginning with a self-inventory, included is an explanation of the three major areas of stress for most of us and goes on to describe seven types of stress. You'll find this educational and healthful.

    In "Sugar Addiction and Fibromyalgia," Jacob Teitelbaum MD addresses the pitfalls of sugar and its influence on all of us, our heart health and hypertension. Included are suggestions on dealing with "sugar cravings."

    Gloria Gilbère, CDP, DAHom, PhD, shares her recipe for "Salsa Jovan—Nightshade Free." She suggests using it in place of salsa and salad dressing, using it with eggs, on burritos or to accompany chips and vegetables as a dip. It is a healthy and easy to make recipe. Gilbère includes all the health benefits of the ingredients for her natural health recipes.

    Stephen T. Sinatra, MD, FAAC, presents "For A Healthier Heart, Try the Mother Earth Rx." In this article, it's explained—"a well-established, but little known scientific fact that the surface of the Earth contains a subtle, natural, negative electric charge. You may have felt it sometime when walking along the wet sand at the beach and noticed a bit of tingling or warmth in your feet. That's it. You were getting charged up by Mother Earth." Read on for the heart benefits it offers and become familiar with the Mother Earth Rx.

    In "A Healthy Heart At Any Age," Ann Louise Gittleman, PhD, CNS, tells there are over 250 risk factors for heart disease that have been identified. However, you'll be relieved to know that a large number of these factors—including many that are especially dangerous—can be lowered with lifestyle choices and changes. Covered are effects of smoking, obesity, diabetes, and a sedentary lifestyle. Your daily choices have a significant influence on your health.

    Gene Bruno, MS, MHS, RH(AHG), in "Pros and Cons of Coffee and Caffeine" includes the sources of caffeine, how much is in each source and how it can effect various health issues. He also lists contraindications for caffeine intake and reminds those who are sensitive to caffeine to forego it.

    Charles Bens, PhD, in "Lowering Blood Pressure Naturally," defines high blood pressure, lists the causes, includes prevention using nutrition, which foods to favor and which to avoid and suggestions on exercise.

    In Pet Care, Shawn Messonnier, DVM, presents Part 2 of a four part series on cancer, many pet owners are seeking this information for their pets.

    Best in health,

    TWIP The Wellness Imperative People

    Click here to read the full February issue.

    Click here to read the full February issue.

  • Lack of energy is a constant theme in the lives of countless Americans. For many, tiredness is so routine that they accept it as a natural state. Family and work by themselves are exhausting; unexpected demands or a restless night can deplete the remaining energy reserves. What is to be done? The American answer is caffeine. Pick your flavor: coffee (then more coffee), energy drinks (which flavor and how tall?), sodas (nothing beats caffeine plus sugar!) and the list goes on. The idea is that, if the metabolism is flagging whip it harder or, better yet, throw in a quick burst of energy from a simple carbohydrate. Caffeinate, crash, repeat (perhaps several times throughout the day), then start over the next morning.

    And start over we do. Ninety percent of all American adults ingest caffeine daily. It is the go-to stimulant of choice, so much so that for a while Wrigley was producing eight stick chewing gum packs each stick of which contained as much caffeine as half a cup of coffee. To be sure, it is not as if caffeine has no benefits. After all, people consume caffeine mostly to improve productivity and related outcomes, not for pleasure. But what if the lack of energy is really just the body's response to a lack of rest (sound sleep usually is an early casualty of too much caffeine) and to a failure to recover from demands placed on it day in and day out? Under such circumstances, the daily caffeine fix is always needed and creates the conditions of its own demand along with downsides. Fortunately, it is possible to get off this merry-go-round.

    Controlling Caffeine
    Researchers have often wondered why it is that tea, despite its caffeine content, tends to relax individuals without making them drowsy. Similarly, those engaging in meditation practices may drink tea to dispel mental sluggishness and yet not become mentally agitated, as is typical with the consumption of too much coffee. Black and green teas give somewhat different answers. Black tea, for instance, contains one or more compounds that open up the peripheral circulation and also reduce blood levels of cortisol, the stress hormone. Likewise, blood platelet activation, which is linked to blood clotting and to the risk of heart attack, was lower in the tea drinkers in a clinical trial and this group reported a greater degree of relaxation in the recovery period after a stressful task.1 This is good news for the 65 percent of adult Americans who suffer from daily stress. L-Theanine, found in green and oolong teas, is more complicated. In one trial in which caffeine (250 milligrams) increased self-rated alertness along with jitteriness and blood pressure, theanine (200 milligrams) antagonized the effect of caffeine on blood pressure, but did not significantly affect jitteriness, alertness or other aspects of mood.2 At a lower level of caffeine consumption (150 milligram), theanine (250 milligrams) actually further improved the normal cognitive benefits of caffeine.3 Affects on stress per se also are found with theanine, with the degree of benefit depending on conditions and individuals.

    Various tests have demonstrated the anti-stress effects of L-theanine. One of the more revealing of these experiments examined brain wave patterns after the ingestion of theanine. This research built on the knowledge that humans produce specific patterns of electrical pulses on the surface of the brain that mirror brain states. The four primary wave patterns are known as the alpha, beta, delta and theta (a, b, d and q) brain waves, representing, respectively, 1) relaxed wakefulness, 2) excitation, 3) sound sleep, and dozing sleep.4

    In one experiment, 50 women volunteers (aged 18–22 years old) were divided into high-anxiety and low-anxiety groups. Each group was given either 50 or 200 mg theanine in water once a week. Their brain waves were measured during the 60 minutes after ingestion. The measurements were repeated twice during a two-month test period. The results were a marked increase in a-waves starting roughly 40 minutes after ingestion. Researchers concluded that theanine rapidly enters the system when ingested and that it heightens the index of the brain wave that is known to be linked to a state of relaxed wakefulness. Researchers also have explored whether the response to theanine might be influenced by the level of anxiety found in test subjects. As might be expected, the greater degree of change is found in those manifesting high anxiety.

    Theanine appears to protect against certain so-called "excitotoxins." It modulates the motor-stimulation associated with caffeine and it inhibits some of the actions of norepinephrine in the central nervous system, for instance. In tests with gerbils, theanine protected against the destruction of neurons induced ischemia, a condition that can lead to a rapid increase in glutamate in neurons and result in the death of these cells. Theanine taken in the evening may support improved sleep quality not by sedation, but through anxiolysis.5 The other herbs mentioned below also tend to improve sleep quality at least in part through the same mechanism.

    Saffron for Replacing Jitters with Emotional Balance
    Although small amounts of caffeine, meaning usually less than 400 milligrams per day, for the vast preponderance of individuals provides mostly an upside with little downside, excessive caffeine can lead to anxiety, physical and emotional "jitters," as well as insomnia. For many, black, oolong and green teas are more gentle alternatives to the concentrated caffeine of coffee, yet coffee is a preferred beverage for many. Moreover, caffeine is added to so many other pick-me-ups that individuals often are unaware of how much they are consuming throughout the day. Several herbs and spices are useful remedies to this excess. Saffron is one of these.

    Saffron is far more than merely a spice that gives color to rice and paella along with a distinctive aromatic signature. Crocins are the source of saffron's coloring properties, whereas its aromatic aspects come from picrocrocins and safranal. Medical texts from ancient Egypt, Persia and the Roman Empire attest to healing properties, including pain relief and calming effects. Similarly, Chinese and Indian healing systems ascribe these and more benefits to saffron. Other healing aspects include the treatment of coughs, better movement of nutrients into tissues and aphrodisiac qualities.

    At least eleven clinical studies have evaluated saffron for its impact on aspects of emotional balance, such as anxiety and depression. In comparative clinical trials, saffron intake after one or two weeks has proven to be comparable in efficacy to the drugs fluoxetine and imipramine. The mechanism of action seems to be the regulation of neurotransmitters.6 Other conditions that have been explored clinically with saffron include erectile dysfunction, vision, Alzheimer's disease and cosmetic benefits. In general, it is thought that there is a complementary action from more than twenty-five active compounds in saffron to yield the demonstrated clinical effects. One special extract that has been extensively clinically tested gives benefits when ingested at the level of 30 milligrams per day.

    Lemon Balm's Calming Effects, Sleep Benefits
    Another useful traditional herb is lemon balm (Melissa officinalis L.). Since the 19th Century, it has been recognized as being soothing during stress and anxiety. Lemon balm contains hydroxycinnamic and rosmarinic acids. Studies have shown that lemon balm consumption increases sleep quality, reduces stress and improves mood.7 Clinical trials have demonstrated the effects of lemon balm extract on cognitive health. Lemon balm improves cognitive performance by enhancing memory and accelerating the visual information processing.8,9 One high quality and tested extract is recommended at an intake level of 600 milligrams per day.

    Blue Dogbane Is a Bane for Stress
    Apocynum venetum L., commonly known as Luobuma in China, is a traditional and popular Chinese herb with a long history of use as a medicine and tea, both in Chinese and Uygur medicine. In fact, Apocynum venetum L. is mentioned in the ancient Dun Huang Manuscripts (written in the 5th to early 11th centuries A.D.) as a powerful longevity tonic. It especially is useful in cases of hypertension and anxiety.10 Among its other notable benefits is support for sleep. According to the official Chinese Pharmacopoeia, the herb calms the liver, soothes the nerves, treats palpitations and improves insomnia. As a tea in China, it is used especially for the elderly as a sleep aid and to reduce high blood pressure. Indeed, a commercial Luoboma "antihypertensive tea" is available commercially in the western province of China. Care should be taken to not confuse it with Indian Hemp (I), Apocynum androsaemifolium, poacynum pictum, I, or the blue dogbane native to Texas. Chinese White and Pink Dogbanes are inferior substitutes often presented as the same plant.

    Anxiety afflicts more than forty million Americans, hence is hardly a minor issue. As already explored above, caffeine and "energy" drinks aggravate anxiety, jitteriness and blood pressure. The exact mechanisms of blue dogbane's action, which likely are multiple, only partially have been elucidated. For instance, the herb inhibits superoxide generated from both the NADPH oxidase and the xanthine/xanthine oxidase systems in the arteries. The upshot of these actions is that there is more nitric oxide (NO) available locally to relax the vessels.11 Rather than taking multiple grams of L-arginine to provide a building block precursor for the production NO, just a little bit of this herb prevents the excessive destruction of NO and achieves the same benefit. The vasculature dilation effects of the blue dogbane extract, including in the brain, can be considerable. The benefits for relaxation, cortisol and stress reduction are significant. Clinical work indicates that the extract induces deeper sleep, meaning that it makes sleep more restful.12

    An interesting finding is that Apocynum venetum L. is a particularly rich source of isoquercitrin, the more active and much better absorbed form of the antioxidant quercetin. Some research suggests that Apocynum venetum L. is a safe alternative to St. John's Wort. Suggested consumption of the extract depends on its quality and the condition in mind; 50–150 milligrams represents typically suggested dosages.12

    Southern Ginseng
    Most Westerners have heard of ginseng and think that the Chinese name applies to only one species. However, in fact there are various "ginsengs" in Chinese medicine, each displaying particular benefits. Gynostemma pentaphyllum is "southern ginseng"; it also is called jiaogulan. It is considered to have powerful antioxidant and adaptogenic effects purported to increase longevity.13 The plant belongs to a family that includes cucumbers, gourds, and melons—its fruit is a small purple inedible gourd. It is little known in traditional Chinese medicine (TCM) because TCM is largely based on the dried materials that could be transported to the Imperial Court of the Chinese Emperors in Beijing. Research indicates significant effects of southern ginseng in the areas of blood glucose, improved insulin sensitivity, improved HbA1c (indicating improved glucose control in diabetics and reduced glycation) as well as other benefits.14

    Although local Chinese traditions long have reported adaptogenic effects, the impact of jiaogulan on stress and related conditions only recently has been explored by Western allopathic research. Nevertheless, a body of animal trials currently backs traditional uses to support human resilience to physical and mental challenges. For instance, a 2012 paper reports that oral administration of the ethanol extract of Gynostemma pentaphyllum can increase host defense in immunocompromised situations such as stress-induced immunosuppression.15,16 A report from the next year indicates that there are anxiolytic effects of an herbal ethanol extract from Gynostemma pentaphyllum in mice after exposure to chronic stress.17 In yet another model of chronic stress and related anxiety disorders in mice, gypenosides, proposed active ingredients in the herb, improved stress-induced anxiety disorders by modulating brain dopamine and serotonin activities and corticosterone levels.18 (Corticosterone in mice plays the same role as cortisol in humans.) Finally, a recent randomized, double-blind, placebo-controlled clinical trial lasting 12 weeks demonstrated that an extract of Gynostemma pentaphyllum led to significant decreases in total abdominal fat area, body weight, body fat mass, percent body fat, and body mass index. (BMI).19 It is likely that more than one mechanism of action was important in bringing about these clinical results.

    Magnesium
    Do not forget magnesium! An estimated 68 percent of Americans do not consume the recommended daily allowance for magnesium. Some attribute this to modern dietary patterns, such as a failure to consume green vegetables and less refined grains. Others have observed that reduced magnesium levels can be attributed to food refining, processing and the use of industrial fertilizers, which typically lack magnesium. Magnesium deficiency has been associated with poor sleep quality, muscle tension and anxiety. Raising tissue levels with oral supplementation of magnesium may promote more restful sleep and relaxation. Preferred forms include magnesium glycerophosphate, magnesium malate and magnesium threonate. Each of these forms exhibits special characteristics based on its ligand. Better results with magnesium supplementation are realized with chronic usage to build up tissue stores.

    Conclusion
    Too often, the demand for more energy really is just a symptom of inadequate rest and poor quality sleep. The majority of adults is chronically stressed and sleep deprived. Good sleep affects alertness, energy, creativity, indeed, mental and physical performance and productivity in general. The common solution to being tired and under-performing is to consume caffeine in the form of coffee and energy drinks. There are alternatives, however, to the "caffeinate, crash, repeat" model of daily existence. Some of these alternatives support the positive effects of caffeine while mitigating the side effects. Others moderate jitteriness and "wired" effects of stimulants by reducing the stress hormone release found with too much stimulation. A common benefit of this approach is to improve the ability to sleep without forcing slumber and to make the time spent sleeping more restful.

    References:

    1. Steptoe A, Gibson EL, Vuononvirta R, Williams ED, Hamer M, Rycroft JA, Erusalimsky JD, Wardle J. The effects of tea on psychophysiological stress responsivity and post-stress recovery: a randomised double-blind trial. Psychopharmacology (Berl). 2007 Jan;190(1):81-9. Epub 2006 Sep 30. Erratum in: Psychopharmacology (Berl). 2007 Jan;190(1):91.
    2. Rogers PJ, Smith JE, Heatherley SV, Pleydell-Pearce CW. Time for tea: mood, blood pressure and cognitive performance effects of caffeine and theanine administered alone and together. Psychopharmacology (Berl). 2008 Jan;195(4):569-77.
    3. Haskell CF, Kennedy DO, Milne AL, Wesnes KA, Scholey AB. The effects of L-theanine, caffeine and their combination on cognition and mood. Biol Psychol. 2008 Feb;77(2):113-22.
    4. Juneja LR, Chu D-C, Okubo T, Nagato Y, Yokogoshi H. L-Theanine––a unique amino acid of green tea and its relaxation effect in humans. Trends in Food Science & Technology 1999;10:199-204.
    5. Rao TP, Ozeki M, Juneja LR. In Search of a Safe Natural Sleep Aid. J Am Coll Nutr. 2015;34(5):436-47.
    6. https://www.naturalproductsinsider.com/whitepapers/2016/09/safrinside.aspx
    7. Cases J, Ibarra A, Feuillere N, Roller M, Sukkar S. Pilot trial of Melissa officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbances. Mediterranean journal of nutrition and metabolism. 2011; 4(3): 211-8.1.
    8. Scholey A, Gibbs A, Neale C, et al. Investigation of a Melissa officinalis special extract on Cognition II: Human study - Lemon balm extract administered in confectionary bars. Agro FOOD Industry Hi Tech2015; 26(2): 12-4.
    9. Kennedy D, Wake G, Savelev S, et al. Modulation of mood and cognitive performance following acute administration of single doses of Melissa officinalis (Lemon balm) with human CNS nicotinic and muscarinic receptor-binding properties. Neuropsychopharmacology 2003; 28(10): 1871-81.
    10. Xie W, Zhang X, Wang T, Hu J. Botany, traditional uses, phytochemistry and pharmacology of Apocynum venetum L. (Luobuma): A review. J Ethnopharmacol. 2012 May 7;141(1):1-8.
    11. Lau YS, Ling WC, Murugan D, Kwan CY, Mustafa MR. Endothelium-Dependent Relaxation Effect of Apocynum venetum Leaf Extract via Src/PI3K/Akt Signalling Pathway. Nutrients. 2015 Jun 30;7(7):5239-53.
    12. Yamatsu A, Yamashita Y, Maru I, Yang J, Tatsuzaki J, Kim M. The Improvement of Sleep by Oral Intake of GABA and Apocynum venetum Leaf Extract. J Nutr Sci Vitaminol (Tokyo). 2015;61(2):182-7.
    13. Blumert, Michael; Jialiu Liu. Jiaogulan: China's "Immortality" Herb. (2003: Badger, CA: Torchlight Publishing.)
    14. https://examine.com/supplements/gynostemma-pentaphyllum/
    15. Im SA, Choi HS, Choi SO, Kim KH, Lee S, Hwang BY, Lee MK, Lee CK. Restoration of electric footshock-induced immunosuppression in mice by Gynostemma pentaphyllum components. Molecules. 2012 Jun 25;17(7):7695-708.
    16. Shang X, Chao Y, Zhang Y, Lu C, Xu C, Niu W. Immunomodulatory and Antioxidant Effects of Polysaccharides from Gynostemma pentaphyllum Makino in Immunosuppressed Mice. Molecules. 2016 Aug 19;21(8).
    17. Choi HS, Zhao TT, Shin KS, Kim SH, Hwang BY, Lee CK, Lee MK. Anxiolytic effects of herbal ethanol extract from Gynostemma pentaphyllum in mice after exposure to chronic stress. Molecules. 2013 Apr 12;18(4):4342-56.
    18. Zhao TT, Shin KS, Choi HS, Lee MK. Ameliorating effects of gypenosides on chronic stress-induced anxiety disorders in mice. BMC Complement Altern Med. 2015 Sep 14;15:323.
    19. Park SH, Huh TL, Kim SY, Oh MR, Tirupathi Pichiah PB, Chae SW, Cha YS. Antiobesity effect of Gynostemma pentaphyllum extract (actiponin):
    20. a randomized, double-blind, placebo-controlled trial. Obesity (Silver Spring). 2014 Jan;22(1):63-71.

  • Athletic training is based on principles such as physical overload, meaning that the body is taxed to near its limits and then allowed to recover with the expectation that recovery will be quicker in the future for the same level of exertion and that the body will over-compensate at recovery and thus allow even more exertion upon the next challenge. This demand-and-response model clearly taxes bodily reserves. Some supplements, for example, protein, are aimed mostly at recovery and super-compensation. Others, such as creatine, also provide super-physiologic levels of substrates, in this case a substrate for the replenishment of adenosine triphosphate (ATP), allowing the muscles to go beyond their normal physiologic capacity. There is not much question but that both of these objectives can be achieved to some degree, meaning that supplements can be valuable for supporting and increasing physical performance and, used properly, can reduce the risks of injury.

    There is no one size-fits-all in supplementation, however. For instance, although it clearly is the case that supplemental amounts of certain antioxidants can help to maintain health and improve recovery, it also is true that the type, timing and amounts of antioxidants can exert other effects. Indeed, the physiological adaptations to exercise may be blunted when local oxidant production in the muscles is suppressed by supplemented antioxidants. Some aspects of muscle supercompensation in response to exercise challenges depend directly on the local formation of oxidants and free radicals.

    Protein
    The king of muscle building proteins probably is whey protein because of its high content of the branched-chain amino acid L-Leucine, which can induce muscle synthesis, but only if there are sufficient other nutrients available to sustain the creation of new muscle tissue. Whey protein is a favorite of most authorities and has the additional virtues, if it remains largely "natural" in its structure, of supporting the body's production of glutathione.

    Because protein sources are digested and absorbed at different rates, one of the more interesting findings of recent years is that a mixture of proteins with different rates of digestion and assimilation is superior to single protein sources. In this case, adding casein and soy protein to whey protein in human trials, especially in the recovery phase, appears to improve results. Clinical finds thus suggest that multi-protein blends, properly constructed, may trump any single source of protein for supporting athletic performance. Pea protein recently has attracted a great deal of attention.

    It is generally agreed that nutrients taken immediately after exercise are readily taken up into the muscles. Some studies have reported improved physical performance with the ingestion of carbohydrate-protein mixtures, both during exercise and during recovery prior to a subsequent exercise test.1 Consuming simple carbohydrates and carbohydrate-only supplements, even prior to workouts, has fallen out of favor.

    Also, it should be borne in mind that the initial meal of the day may play a large role in setting the flexibility of the metabolism for the rest of the day. A higher ratio of protein and fat at breakfast tends to make the metabolism of fat for energy easier throughout the day whereas excessive refined carbohydrates will have the opposite effect.

    Pre- and post-workout supplements generally involve a considerable volume of ingredients. The tub-versus-bar option is really only about convenience. Tubs will deliver protein that is much less expensive gram-for-gram and not necessarily have a ton of fillers. Protein bars almost of necessity will include sweeteners and binders because these are required to make the bars palatable and to hold them together. On a gram basis, as long as the same quality protein source(s) is being used, there should be little difference in efficacy between these two deliveries.

    Creatine
    Workout supplements often involve tradeoffs. For instance, why would an athlete have to take creatine if they are already supplementing with a protein? Are here any additional health benefits to a person that takes both?

    Creatine and protein do different things. Creatine primarily repletes a precursor to ATP to greater levels than can be accomplished under normal physiologic conditions. Creatine itself is not a "building block" for muscle tissue. Refined protein supplements seldom are sources of this compound. Although it is possible by taking extremely large amounts of arginine to provide the body with a means of increasing its own synthesis of creatine, this is not efficient. Some sources of protein, such as red meat, themselves can supply small amounts of creatine. However, again, this is not an efficient means of increasing muscle creatine levels compared to consuming creatine monohydrate directly. Athletes who benefit from creatine supplementation, therefore, should consume creatine for its particular benefits and protein for muscle repair/recovery/ augmentation.

    Creatine has well established ergogenic benefits for strength and greater performance in a number of areas of athletics, primarily events that are short term and explosive in nature as opposed to being oriented towards endurance. For those individuals who train heavily, there are obvious benefits. Body builders who desire the greater bulk similarly may find the muscle edema to be acceptable for aesthetic reasons. Nevertheless, it is true that creatine supplementation that is not coupled to training primarily will lead to a certain amount of muscle edema without other benefits. Likewise, most endurance athletes will not find the weight issue to be counterbalanced by sufficiently enhanced performance to make supplementation beneficial for their sport.

    Endurance
    Nutritional regimens in sports often are planned with specific goals in mind because different goals strongly influence the roles of carbohydrate, fat and protein in supplements for athletes. For instance, building muscle mass is a goal with requirements different to those for getting lean or maintaining balance in terms of muscle and bodyweight. Caffeine is a common ingredient used by most athletes despite the fact that caffeine does not seem to be an ergogenic aid except for those who do not routinely consume it via coffee, soft drinks, tea, etc.

    Pre-workout supplements, which usually are consumed 30 ?60 minutes prior to working out, are designed to increase energy during workouts and provide accessible calories to spare glycogen and thus extend time to failure. Common nutrients include nitric oxide precursors, such as forms of L-arginine and L-citrulline as well as vasodilating herbs. Some formulators suggest the addition of ribose, but others prefer to use ribose either after workouts and/or during workouts. Rhodiola, ginseng and astaxanthin are other supplements used to increase endurance, the latter for its role in improving the ability to metabolize fats for energy. Pre-workout energy drinks based on only carbohydrates or carbohydrates plus caffeine have not fared well in tests.2

    Post-workout supplements are intended to take advantage of a 30?60 minute window of opportunity following workouts during which cells are especially open to absorbing and utilizing nutrients for recovery, including replacing glycogen and restoring lean muscle that often is lost in endurance training. The focus of these products typically is on carbohydrates to replete glycogen and, to a lesser extent, protein quality and quantity. A favored approach is based on replacing glycogen as the key to athletic recovery and therefore pushes high glycemic carbohydrates as primary via ingredients such as waxy maize, maltodextrin and starches from potato and rice. Ribose is another ingredient often seen in these formulas. It should be kept in mind that the wisdom of chronic ingestion of high glycemic index carbohydrates has been challenged by a number of health authorities. Micronized protein increasingly is added to increase insulin response and muscle uptake of nutrients. Taking a good quality hydroxycitric acid (HCA) supplement during recovery has been shown to significantly improve the replenishment of muscle glycogen.3 A proper HCA supplement can be very hard to find?the most thorough research in the area of sports performance had to use a synthesized trisodium hydroxycitrate to achieve results.4 Similarly, a relatively pure potassium HCA salt is more efficacious than a potassium-calcium salt.5

    During (Intra) workout supplements are now common. Over the past decade, it has become more popular to consume nutrients during workouts and not just prior to workouts and after exercise. However, there does not appear to be a consensus as to whether intra-workout supplements should focus on carbohydrates alone or on combinations with small amounts of easily absorbed protein. Many products contain both. Common ingredients aside from the carbohydrates already named are branched-chain amino acids, glutamine, creatine and betaalanine. In recent trials, drinks that supplied less carbohydrate and replaced these calories with a moderate amount of protein led to significantly improved endurance performance in trained long-distance cyclists. It turned out to be the case that fewer calories with a lower level of carbohydrate and more protein worked better in extending time to exhaustion, reducing muscle damage and improving post-exercise adaptation to the challenge of exercise overload.

    Caffeine is another contentious topic. Caffeine has numerous natural sources, including coffee beans, tea, cocoa beans (chocolate source), kola nut, guarana and yerba mate. However, caffeine does not tend to improve athletic performance unless used in quite large amounts and only during competitions. Alternatives include specialized ginseng extracts, L-tyrosine (may increase blood pressure in some individuals), schizandra berry extract and ashwagandha extract. Astaxanthin has been shown to increase endurance performance.

    Endurance athletes in particular should pay attention to the issue of electrolytes. Although there are some unfortunate examples of excessive hydration in athletes, generally speaking, athletes can easily lose enough fluid to lead to reduced performance. Electrolytes, if nothing else, are necessary to bring ingested fluids to the isotonic molarity that will allow them to be readily absorbed by the body. Betaine, which is used in the manufacture of food and beverages, is well studied as a hydration agent. Betaine is an organic osmolyte that helps to stabilize metabolic functions in the face of dehydration and overheating. The usual electrolytes lost in sweat, of course, are potassium and sodium. Increasingly popular in Europe in this area is a combination of salts including potassium, sodium, magnesium and calcium in the form of glycerophosphates. Whether electrolytes are necessary beyond their role in promoting proper hydration remains highly debated.

    Conclusion
    Supplements can play important roles is exercise. The pure carbohydrate products in favor a few years ago, however, no longer are the best supported by research. Protein, protein/ carbohydrate mixtures and combinations of proteins from different sources now are favored. Similarly, athletes who are looking for performance enhancement rather than merely a psychological lift increasingly shy away from simple caffeine and other stimulants. Supplements should be picked for the sport (body building or endurance, for example) and keyed to the expected benefits.

    References

    1. Sports Med. 2010 Nov 1;40(11):941?59.
    2. J Strength Cond Res.2014 May;28(5):1443?53.
    3. Br J Nutr. 2012 Apr;107(7):1048?55.
    4. J Nutr Sci Vitaminol(Tokyo). 2005 Feb;51(1):1?7.
    5. Nutr Metab(Lond). 2006 Jul 17;3:26.