Athletes are a group that use supplements for a myriad of reasons



We are back with our supplement series for the month! So far, we have covered protein and protein related supplements and commonly used vitamin and mineral supplements. While the former is still a never ending list, this article aims to cover more performance oriented supplements. Athletes use supplements for a variety of reasons:

    • To aid in faster recovery from training
    • General health benefits
    • For performance benefits
    • To treat illnesses
    • To compensate for a poor diet



Athletes are always on the lookout for something to boost their performance. This article will cover supplements whose efficacy is backed by science. These supplements have been extensively researched and have been found to benefit different types of sports. If you are an athlete, why not give this a read!

Nitrate:

What is Nitrate?
Nitrate is a molecule that plays an important role in the nitrogen cycle and also in cardiovascular health, blood pressure and exercise performance.

Where do you find nitrates and how does it actually work?
Dietary sources of nitrates include fruits, vegetables and processed meats (1). Vegetables such as beetroot, celery, spinach, rocket (argula) and lettuce are rich in nitrate. High amounts are also found in cabbage, kohlrabi,parsley and fennel (1). Dietary nitrate is converted to nitrite (by bacteria in the mouth and gastrointestinal tract) and further reduced to nitric oxide (1). This nitric oxide is what causes vasodilation (widening of the blood vessels) and results in decreased blood pressure. Nitric oxide also seems to play a role in calcium handling, glucose uptake, neurotransmission and muscle force production.

Why would athletes find supplementation beneficial then?
The content of nitrate found in green leafy vegetables and beetroot vary with soil conditions, time of year and even storage. Hence, like any other supplement, as the specific dose of nitrate is known, athletes would benefit from its usage. This is beneficial when performance is a goal. It has been shown that dietary nitrate supplementation lowered oxygen uptake during moderate to heavy intensity exercise in healthy participants (2). A recently published systematic review and meta-analysis concluded that dietary nitrate supplementation can positively impact endurance exercise capacity (3).

What about the dosage?
About 5-9 mmol of nitrate ingested 2-2.5 hours before an exercise session for about 1-28 days is effective (4,5).

Would only athletes benefit from nitrate?
Not only does dietary nitrate help in performance, since nitrate lowers blood pressure (6), it could potentially help in the general population as well. Not everyone needs to supplement with nitrate! Inclusion of good amounts of beetroot and green leafy vegetables into your daily diet is a great starting point!

Caffeine

What is caffeine and where is it found?
Caffeine is the most widely used psychoactive drug or stimulant. Yes! It is a drug! Like we all know, it is found in coffee beans, tea leaves and cocoa beans. Infact, as you would have all noticed caffeine is also added to energy drinks and soft drinks. However, the amount of caffeine in these sources vary. Caffeine is now available as pills, gels and even gums!

How does it act as a well known stimulant?
We all know that drinking a cup of coffee is the best wake me up drink! The stimulatory effects of caffeine are attributed to its effect on the central nervous system. Caffeine is a competitive inhibitor of adenosine which is responsible for relaxation. Caffeine thus binds to the adenosine receptors in the brain and stimulates the nervous system. (7)

Is caffeine a fat burner?
Caffeine does seem to increase metabolic rate and fat oxidation (8). However, as a standalone supplement it is not effective in reducing body weight. While it does boost fat metabolism marginally (9), the effects of caffeine are highly variable from person to person.

Why do athletes supplement with caffeine?
Caffeine has been shown to improve performance across a variety of sports. Endurance performance (7, 10) and team sports (11) performances have seen an improvement with caffeine supplementation. Infact, the position stand on caffeine from the International Society of Sports Nutrition (12) recognises its performance benefits on strength, sprint and power based sports as well. Acute ingestion has also been shown to increase pain tolerance and perceived effort (13).

What is the dosage and duration of caffeine supplementation?
The suggested dosage for caffeine supplementation ranges from 3-6 mg/kg body weight about 30-60 minutes before the onset of exercise (12).

Are there any side effects of caffeine consumption/supplementation?
Excessive caffeine consumption, greater than the recommended dosage could result in dependency, anxiety and gastrointestinal discomfort. Caffeine consumption in the evenings might interfere with sleep quality later at night as well.

Caffeine and nitrate are two supplements that have extensive research backing their efficacy. In fact, any supplement that you choose should be effective for the particular sport you are using it for! It is evident that caffeine works well across sports while nitrate might work best for an endurance based sport. With the supplement series, our aim is to ensure you all are educated and make an informed choice when it comes to nutritional supplements.

References

1) Hord N, Tang Y, Bryan N. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. The American Journal of Clinical Nutrition. 2009;90(1):1-10.
2. Pawlak-Chaouch M, Boissière J, Gamelin F, Cuvelier G, Berthoin S, Aucouturier J. Effect of dietary nitrate supplementation on metabolic rate during rest and exercise in human: A systematic review and a meta-analysis. Nitric Oxide. 2016;53:65-76.
3) McMahon N, Leveritt M, Pavey T. The Effect of Dietary Nitrate Supplementation on Endurance Exercise Performance in Healthy Adults: A Systematic Review and Meta-Analysis. Sports Medicine. 2017;47(4):735-756.
4) Jones A. Dietary Nitrate Supplementation and Exercise Performance. Sports Medicine. 2014;44(S1):S35-45.
5) Naderi A, de Oliveira E, Ziegenfuss T, Willems M. Timing, Optimal Dose and Intake Duration of Dietary Supplements with Evidence-Based Use in Sports Nutrition. Journal of Exercise Nutrition & Biochemistry. 2016;20(4):1-12.
6) Siervo M, Lara J, Ogbonmwan I, Mathers J. Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis. The Journal of Nutrition. 2013;143(6):818-826.
7)Graham T, Spriet L. Metabolic, catecholamine, and exercise performance responses to various doses of caffeine. Journal of Applied Physiology. 1995;78(3):867-874.
8)Acheson K, Zahorska-Markiewicz B, Pittet P, Anantharaman K, Jéquier E. Caffeine and coffee: their influence on metabolic rate and substrate utilization in normal weight and obese individuals. The American Journal of Clinical Nutrition. 1980;33(5):989-997.
9) Jeukendrup A, Randell R. Fat burners: nutrition supplements that increase fat metabolism. Obesity Reviews. 2011;12(10):841-851.
10) Pasman W, van Baak M, Jeukendrup A, de Haan A. The Effect of Different Dosages of Caffeine on Endurance Performance Time. International Journal of Sports Medicine. 1995;16(4):225-230.
11) Stuart G, Hopkins W, Cook C, Cairns S. Multiple Effects of Caffeine on Simulated High-Intensity Team-Sport Performance. Medicine & Science in Sports & Exercise. 2005;37(11):1998-2005.
12) Goldstein E, Ziegenfuss T, Kalman D, Kreider R, Campbell B, Wilborn C et al. International society of sports nutrition position stand: caffeine and performance. Journal of the International Society of Sports Nutrition. 2010;7(1):5.
13) Duncan M, Stanley M, Parkhouse N, Cook K, Smith M. Acute caffeine ingestion enhances strength performance and reduces perceived exertion and muscle pain perception during resistance exercise. European Journal of Sport Science. 2013;13(4):392-399.

PCOD/PCOS.
This term is commonly heard of nowadays. We see several women diagnosed with this condition. But what is it? Do we really know?
This article aims to cover the basics of Polycystic Ovarian Syndrome (PCOS) or Polycystic Ovarian Disease (PCOD). We believe it is imperative to have basic knowledge about the conditions that are seen today and make ourselves more aware.
What is PCOS?
Polycystic Ovarian Syndrome, commonly known as PCOS is a metabolic, endocrine and reproductive disorder seen in women of reproductive age (1,2). It is characterised by a myriad of signs and symptoms associated with ovarian dysfunction and androgen excess (1,2). The signs and symptoms associated with PCOS varies from person to person, and will be discussed in the coming section.

Why does it occur?
The exact cause for PCOS remains mostly unknown. It is said to be a multifaceted disease (1) in which a variety of factors play a role in the development. These include environmental and/or genetic influence, diet, lifestyle, ovarian steroidogenesis, abnormal insulin signalling and excess oxidative stress. (1,2).
What are the signs and symptoms?
As mentioned earlier, PCOS is characterized by a variety of signs and symptoms. Any combination of these symptoms could indicate the possibility of PCOS. Menstrual irregularities, obesity or excess androgen could be a sign of this disease. However, in order to standardise the signs and symptoms, the Rotterdam Criteria is used as a rule of thumb (3). The presence of any two of the three symptoms listed in Table 1 are used to diagnose the presence of PCOS. (3,1) To confirm the presence of polycystic ovaries, an ultrasound is performed by the gynaecologist.
However, it is to note that although widely used, the Rotterdam criteria for diagnosing PCOS has been questioned due to a paucity in data (4).
In addition a fasting lipid panel, BMI, waist circumference a 2-h glucose challenge test must be done (4,5). Also, screening for thyroid disorders is important as thyroid disorders are a common cause of menstrual irregularity (5).

Table 1: Signs and symptoms associated with PCOS.

Hyperandrogenism Hirsutism
Acne
Androgenetic Alopecia
Acanthosis Nigricans
High circulating testosterone and androstenedione
Menstrual Irregularity Oligomenorrhea (infrequent menstruation)
Amenorrhea (absence of menstrual cycle)
High circulating Luteinizing Hormone levels
Polycystic Ovaries on Ultrasound >/= 12 follicles in each ovary
Follicle size between 2 and 9mm (+/- >10ml ovarian volume)

Presence of 2 out of 3 of these symptoms are used to diagnose the presence of PCOS.

Are there different types of PCOS?
While most people assume that excess adiposity and irregular or absence of menstrual cycle is only associated with PCOS, it is imperative to know that it is not the case. As seen above, 2 out of 3 of the symptoms presented could indicate the manifestation of PCOS. Hence, it is a spectrum. Once again, the Rotterdam criteria (3) divides these into 4 phenotypes, as seen in Table 2:

PHENOTYPE CRITERIA
Frank or classic polycystic ovary PCOS chronic anovulation, hyperandrogenism, and polycystic ovaries
Classic non-polycystic ovary PCOS chronic anovulation, hyperandrogenism, and normal ovaries
Non-classic ovulatory PCOS regular menstrual cycles, hyperandrogenism, and polycystic ovaries
Non-classic mild or normoandrogenic PCOS chronic anovulation, normal androgens, and polycystic ovaries


What are the risks?

Insulin resistance (IR) is considered as an important manifestation in PCOS (6). Increased insulin and Luteinising Hormone levels could lead to anovulation (7). As a result of IR, PCOS is said to increase the risk for Type II Diabetes and gestational diabetes for the individual (8). Impaired glucose tolerance (8) and obesity are additional contributing factors to this.
Obesity is also an important feature of PCOS. However, it isn’t inherently caused by PCOS, but rather could also be due to lifestyle and environmental influences (1). Women with PCOS have more visceral fat and subcutaneous fat distribution (9). Whether obesity leads to PCOS or whether PCOS leads to obesity is still debatable (5).
Due to the nature of the symptoms women with PCOS could have a higher chance of being infertile. Infertility is more commonly associated with the existence of PCOS than healthy women (10). However, there still remains a gap in the literature on the influence of the different phenotypes on female fertility. More controlled studies are needed looking at the degree of infertility in each phenotype and the outcomes on pregnancy (1).
What is the treatment like?
Due to PCOS presenting itself as a spectrum, there is no single universal treatment. Most treatments are symptom based, targeting the issues pertaining to androgen excess,insulin resistance, hirsutism, acne and oligoovulation (1,2). In addition, lifestyle counselling should be provided in all cases in order to prevent or treat obesity (2).
Women with Classic PCOS symptoms are likely to resume their cycles on dietary and lifestyle interventions. Dietary interventions such as consuming high fibre and protein rich foods can help with weight loss in those with PCOS. Infact, a recent review addressing nutritional management of PCOS (11) concluded that the diet composition of those with PCOS should be low in saturated fat and contain sufficient fibre from whole grains, legumes, fruits and vegetables. In addition, consumption of carbohydrates with a low glycaemic index was recommended. Soy protein has also been to have favourable effects on BMI, glycaemic control and triglycerides in those with PCOS (12)
Oral Contraceptive Pills (OCPs) are commonly used to address menstrual irregularities and hyperandrogenism (2). This helps in reducing the secretion of luteinizing hormone and decrease free testosterone levels (Costello 2007). Metformin, is another anti-diabetic drug that is used to target insulin sensitivity. Though studies using Metformin show mixed results, it is used in pregnancy complications in women with PCOS (2). However, using OCPs does have certain side effects such as mood swings, weight gain, nausea and bloating among others (13). This also varies with the dosage and type of hormone in the OCP.
Inositol is a recent development in PCOS treatment. It is marketed as Myo-inositol (MYO) and D-chiroinositol (DCI). MYO has shown to improve insulin resistance in those with PCOS. Infact, a recent meta-analysis concluded that MYO supplementation may be beneficial in improving the metabolic profile of women with PCOS (14).
While the exact cause for PCOS is unknown, it has affected a number of women globally. It is crucial to not let this go undiagnosed. Moreover, it is also important to seek treatment from professionals. It is clear that PCOS is a multifaceted disease,that needs both medical and lifestyle interventions. There are a wide variety of treatment options available. Thus,it is not something to be feared, rather something that needs your attention.

References:

1) El Hayek S, Bitar L, Hamdar L, Mirza F, Daoud G. Polycystic Ovarian Syndrome: An Updated Overview. Frontiers in Physiology. 2016;7(124).
2) Escobar-Morreale H. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology. 2018;14(5):270-284.
3)Rotterdam, E. A.-S. P. C. W. G. (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility. 2004;81(1):19-25.
4) Azziz R. Diagnosis of Polycystic Ovarian Syndrome: The Rotterdam Criteria Are Premature. The Journal of Clinical Endocrinology & Metabolism. 2006;91(3):781-785.
5) Kamangar F, Okhovat J, Schmidt T, Beshay A, Pasch L, Cedars M et al. Polycystic Ovary Syndrome: Special Diagnostic and Therapeutic Considerations for Children. Pediatric Dermatology. 2015;32(5):571-578.
6) Sıklar Z, Berberoğlu M, Çamtosun E, Kocaay P. Diagnostic Characteristics and Metabolic Risk Factors of Cases with Polycystic Ovary Syndrome during Adolescence. Journal of Pediatric and Adolescent Gynecology. 2015;28(2):78-83.
7) Dunaif A. Hyperandrogenic anovulation (PCOS): A unique disorder of insulin action associated with an increased risk of non-insulin-dependent diabetes mellitus. The American Journal of Medicine. 1995;98(1):S33-S39.
8)Randeva H, Tan B, Weickert M, Lois K, Nestler J, Sattar N et al. Cardiometabolic Aspects of the Polycystic Ovary Syndrome. Endocrine Reviews. 2012;33(5):812-841.
9) KIRSCHNER M, SAMOJLIK E, DREJKA M, SZMAL E, SCHNEIDER G, ERTEL N. Androgen-Estrogen Metabolism in Women with Upper BodyVersusLower Body Obesity*. The Journal of Clinical Endocrinology & Metabolism. 1990;70(2):473-479.
10) Hart R, Doherty D. The Potential Implications of a PCOS Diagnosis on a Woman’s Long-Term Health Using Data Linkage. The Journal of Clinical Endocrinology & Metabolism. 2015;100(3):911-919.
11) Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R. Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017;11:S429-S432.
12) Karamali M, Kashanian M, Alaeinasab S, Asemi Z. The effect of dietary soy intake on weight loss, glycaemic control, lipid profiles and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome: a randomised clinical trial. Journal of Human Nutrition and Dietetics. 2018;31(4):533-543.
13) Consensus statement on the use of oral contraceptive pills in polycystic ovarian syndrome women in India. Journal of Human Reproductive Sciences. 2018;11(2):96.
14) Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocrine Connections. 2017;6(8):647-658.

Talking about menstruation is still a taboo. Hushed voices and whispers is how we communicate. It is extremely important to be aware and know how the monthly menstrual cycle works. This brief blog post highlights the basics of the menstrual cycle. 

What is menstruation?
Menstruation is the elimination of the endometrium (the thick uterine lining) through the vagina. The menstrual fluid is composed of blood, mucus and cells (from the endometrium). Menstruation is your body preparing itself for pregnancy each month. If you do not get pregnant, menstruation occurs.  The ‘menstrual cycle’ is the period during which this occurs. Menstruation is commonly referred to as ‘period’.

How long does the cycle last?
The menstrual cycle starts on the day of the first day of your period  and ends on the day before the next period. In general, this duration is about 28 days, but varies from woman to woman. This also changes through the course of your life, as several external factors such as stress and lifestyle can affect the menstrual cycle.

What are the phases of the menstrual cycle?
The menstrual cycle consists of the following phases:

Follicular phase: 
The follicular phase starts on the first day of menstruation and ends with ovulation (release of mature egg from the ovary). Ovulation occurs mid-cycle, approximately 2 weeks before menstruation starts.

During this phase, the follicular stimulating hormone (FSH) is released 

This stimulates the ovaries to produce a number of follicles, which contain immature eggs.

During ovulation, one mature egg is released. In this phase, the lutenising hormone (LH) increases, which triggers ovulation.

The follicular phase lasts for about 10-22 days, but this can vary from cycle-to-cycle.

Luteal phase:

Post ovulation, the ruptured follicle forms what is known as corpus luteum.

This releases more amount of the hormone progesterone and some estrogen

These ensure that the lining of the uterus remains thick for the egg to be planted.

If pregnancy does not occur, the corpus luteum breaks down and progesterone levels fall.

This leads to the thickened uterine lining to shed, which marks the onset of menstruation. 

The luteal phase typically lasts about 14 days, but between 9 and 16 days is common. During this phase is when one can experience mood swings, bloating, tiredness and even anxiety. 

Menstruation: The lining of the uterus is shed out via the vagina. This stage usually lasts from 3-7 days, but again, varies from woman to woman. In fact, this can also differ from one cycle to the next. The onset of menstruation (menarche) is usually around the age of 11-14 years old. However, several factors such as ethnicity, age, height, weight and even genetic factors affect the onset of menstruation. 

Can certain foods help ease symptoms felt during the menstrual cycle?
In general, a diet rich in vegetables, fruits, whole grains, nuts, seeds and good quality protein can help provide all the nutrients necessary to handle menstrual cramps, the most common issue faced by women. Magnesium rich foods (or supplements) could help relieve these cramps and also help with irritability and anxiety.  Some magnesium rich foods are almonds, spinach, dark chocolate, cashews and avocados.

How long does one menstruate?
Menstruation lasts until a woman reaches a stage called menopause, post which she will stop menstruating. This usually happens between the late 40s and early 50s of a woman’s life. 

What are some common problems associated with menstruation?
Oligomenorrhea:  This is a condition where the menstrual cycle is infrequent. While there is some variation from cycle to cycle, intermittent periods without cycle could be a sign of oligomenorrhea.  Conditions like PCOS and hyperthyroidism could also be associated with oligomenorrhea.
Amenorrhea: This is a condition where the menstrual cycle is entirely absent.
Premenstrual Syndrome: Commonly known as PMS,  these are a group of symptoms that occur before the start of the menstrual cycle. Symptoms include but are not limited to acne, mood swings, sore breasts and even food cravings.
Premenstrual Dysmorphic Disorder: Known as PMDD, this is a hormone based mood disorder that is a more severe form of PMS. The exact cause for this is unknown.  Nervousness, agitation, depression, severe fatigue, sleeplessness, paranoia and anger are some of the associate psychological symptoms. Besides these, nausea, constipation, acne, dizziness, hot flashes are come of the other symptoms. It is to be noted that the symptoms of PMDD are very severe and tends to affect several aspects of one’s life.

References:

1) Understanding your menstrual cycle [Internet]. Office on Women’s Health. 2019 
2) Menstrual cycle [Internet]. Victoria State Government. 2019.
3) Johns Hopkins Medicine.Premenstrual Dysphoric Disorder (PMDD) [Internet]. 2019.
4) Johns Hopkins Medicine. Premenstrual Syndrome (PMS) [Internet]. 2019.

Our body is regulated by a wide variety of hormones that ensure optimal functioning of the body.
What is insulin and what is its function?
Insulin is a hormone produced by the pancreas that is needed for the use or storage of body fuels (1). For this very reason, insulin is known as an anabolic hormone. Anabolic hormones are those that help in building new tissue. Insulin also regulates blood sugar levels in your body. For example, when you eat a meal, the meal is digested and broken down to glucose. In response to the rise in glucose, the pancreas secretes insulin which ensures the glucose enters the fat, muscle and liver. As blood glucose levels drop, insulin levels also respond similarly. 
In addition to regulating blood glucose, insulin also plays a role in the creation of fat and inhibits the breakdown of fat. This is the reason why insulin is feared by most, which will be addressed later on.

What is insulin resistance and insulin sensitivity?
Insulin sensitivity  tells us how sensitive the body is to insulin. This varies from person to person. Physical activity and eating choices have a positive effect in increasing insulin sensitivity. 
Insulin resistance is known as decreased responsiveness to insulin (1). That is, the tissues have decreased sensitivity to insulin. If the body is resistant to insulin, the body tries to counter the situation by producing more insulin. Insulin resistance can be caused by several factors including excess adiposity and even a sedentary lifestyle. Insulin resistance is also observed in those with Polycystic Ovarian Syndrome (PCOS).
Do carbohydrates spike insulin, and thus increases storage of fat?
This is the biggest myth with regards to insulin. Fat is created through a process known as lipogenesis and is broken down through a process known as lipolysis. Insulin is known to stimulate lipogenesis and inhibit lipolysis. This means that increased levels of insulin leads to fat storage right? Wrong. 
There exists another enzyme known as Hormone Sensitive Lipase (HSL) whose main function is to break down stored triacylglycerols in the adipose tissue i.e., lipolysis (2). Insulin inhibits the action of HSL. So once again, increased insulin levels must be the issue right? What is interesting to note here is, even consumption of fat can suppress HSL activity (3), when insulin levels are low in the body. The study concluded that insulin was not needed to suppress HSL. Hence, if you are overeating beyond your required energy intake, you will still not see weight loss changes, despite insulin levels being low.
Does only carbohydrate stimulate insulin release?
In healthy individuals, insulin is released in response to meals.  Infact, only few people are aware that protein stimulates insulin too! A study by Boelsma et al. (4) measured the insulin response to two meals,one Low Protein High Carbohydrate (LP/HC) and the other High Protein Low Carb (HP/LC). They found that the protein rich meal stimulated insulin as well!
Another study (5) assessed the insulin response of four different types of protein shakes, egg, tuna, whey and turkey. They found out that the insulin response was the highest after the whey protein meal. The whey protein shake also reduced appetite to a greater extent compared to the rest of the test shakes. 
How does insulin play a role in diabetes?
Diabetes is classified into two types;
Type 1 diabetes: In this case, the pancreas does not produce insulin or is producing very little. We know insulin is needed to regulate blood sugar levels, So in this case, blood sugar builds up in the bloodstream, which can be dangerous to health. This is also known as juvenile diabetes.
Latent Onset Type 1 diabetes: This is a condition that presents itself in adulthood. This is characterised by insulin requirements to treat hypogylcaemia and prevent ketogenesis (6).
Type 2 diabetes: The cause for type 2 diabetes is most likely associated with Insulin Resistance. As a result, the pancreas secretes more insulin like mentioned before. This increases blood sugar leading to prediabetes and consequently diabetes. 
There are several diet plans focussing on lowering carbohydrate intake in order to ensure that insulin levels are normal. These plans are rigid and keep carbohydrates to a bare minimum, while focussing on fat and protein intake. Little are they aware that protein spikes insulin too! Besides, the actual issue to address is the overall diet and other behaviour modifications of the individual. This along with adherence will ensure a sustainable lifestyle to follow.

References:

1) Mahan L, Raymond J. Krause’s food & the nutrition care process. 14th ed. Elsiever.
2) Kraemer F, Shen W. Hormone-sensitive lipase. Journal of Lipid Research. 2002;43(10):1585-1594.
3) Evans K, Clark M, Frayn K. Effects of an oral and intravenous fat load on adipose tissue and forearm lipid metabolism. American Journal of Physiology-Endocrinology and Metabolism. 1999;276(2):E241-E248.
4) 10. Boelsma E, Brink E, Stafleu A, Hendriks H. Measures of postprandial wellness after single intake of two protein–carbohydrate meals. Appetite. 2010;54(3):456-464.
5) Pal S, Ellis V. The acute effects of four protein meals on insulin, glucose, appetite and energy intake in lean men. British Journal of Nutrition. 2010;104(8):1241-1248. 
6) Lasserson D, Fox R, Farmer A. Late onset type 1 diabetes. BMJ. 2012;344(apr30 1):e2827-e2827.

We are back with our supplement series for the month! Incase you haven’t read our previous article, click here. This month we will be covering some supplements that are seen very commonly in households. Do you and your family take these supplements? If so, are they really necessary?

1) Multivitamins: Multivitamins are supplements that usually contain a combination of vitamins and minerals and sometimes, other ingredients as well (1). While they’re available in several forms, the most commonly observed mode is through tablets or capsules. These supplements are easily available in  local pharmacies and even online platforms. Each essential vitamin and mineral have a preset requirement, known as the Recommended Dietary Allowance (RDA), which varies with age and gender. Most of the constituents in multivitamins are close to these recommended amounts. However, is it mandatory that everyone takes a multivitamin? Not necessarily. Those who are at risk of deficiencies and the dosage from the multivitamin supplement is sufficient to reverse it, benefit from its consumption. Even in these cases, purchasing the individual vitamin/mineral supplement might be better. Why does everyone consume them though? People consume multivitamins with an attempt to improve ‘health’. A good indicator of this is mortality, or the ability to live. A 2013 meta-analysis concluded that multivitamins had no significant effect on mortality risk (2). Further, there is insufficient evidence to conclude the role of multivitamins in preventing cancer and chronic diseases (3). In terms of health, multivitamins play a bleak role. Targeted supplementation seems to be more beneficial. Although, if you do plan on buying a multivitamin because the dosage does negate your deficiency, this link will provide tips on how to buy a good one (4) 
2) Vitamin D: Vitamin D is a fat soluble vitamin. The sources of vitamin D are primarily exposure to sunlight and foods such as egg yolks, fish like salmon and fortified foods. This particular vitamin is extremely important for calcium metabolism, which is in turn responsible for maintaining healthy bones and even nerve conduction. The RDA for vitamin D is 400-800 IU/day. However, a particular review reports that vitamin D deficiency in Indians range from 50-94% in healthy individuals (5). So, what causes the deficiency? Decreased exposure to sunlight and insufficient sources of vitamin D from the diet are the primary causes. So do you need to supplement with Vitamin D? If your blood tests indicate you have a deficiency or sub optimal levels, then yes. These supplements must be taken along with a fat source or meals. Our advice would be to go get yourself tested and then take a call!
3) Iron: Iron is a very essential mineral that enables your red blood cells to carry oxygen to your tissues. Iron is found in a wide variety of plant and animal sources such as green leafy vegetables, beans, lentils, nuts, seeds and meat. The iron from animal sources is more bioavailable (better absorbed) than those from plant sources. Vegetarians, worry not! Combining an iron source with vitamin C sources increases the bioavailability of iron. So keep that in mind! Do you need to supplement with iron? This again depends. Only if you are deficient, iron supplementation is necessary. Iron deficiency causes anemia, which seems to be seen primarily in premenopausal women who do not consume enough iron through their diet and also lose iron through menstruation (6). Iron deficiency anemia is just one type of anemia. We will be covering this in depth in our upcoming articles. Iron deficiency manifests through symptoms like fatigue, weakness, pale skin and shortness of breath. If you have been feeling very tired and exhausted, you might know where to look at. Get a blood test done to check your iron levels. To prevent yourself from a deficiency or sub optimal levels, ensure your diet has iron rich food!
(4) Fish oil:  Omega 3 fatty acids, eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) are commonly referred to as fish oil. These are essential fatty acids, which means that your body cannot make them and must be obtained from diet. They’re found in fish and phytoplanktons. Our staple diets are rich in omega-6 fatty acids which are found in eggs, meat and oils. To balance the ratio between Omega-6 and Omega-3 in the body, consumption of fatty fish like salmon is encouraged. While you would have heard that seeds like flax and chia contain omega-3, they actually contain alpha-linolenic acid (ALA), which is a precursor to EPA and DHA. However, research suggests that ALA does not provide the same benefits as supplementing with EPA and DHA (7). However, the link between fish oil and cardiovascular disease is debatable. For those who do not consume fish (ie; vegetarians and vegans) supplementation of fish oil or microalgae (phytoplankton) might be beneficial.
This article covered commonly used household supplements. While this list is exhaustive, we will aim to cover more in the coming series and keep you informed.

References:

  1. National Institutes of Health. Multivitamin/mineral supplements.
  2. Macpherson, H,Pipingas,A, Pase, MP. Multivitamin-multimineral supplementation and mortality: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition.2013;97(2):437-444.
  3. Huang HY, Caballero B, Chang S, Alberg AJ, Semba RD, Schneyer CR et al. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Annals of Internal Medicine.2006;145(5):372-85.
  4. Examine. Do you need a multivitamin?
  5. P Aparna, S Muthathal,Nongkynrih, B,Gupta, SK.Vitamin D deficiency in India. Journal of Family Medicine and Primary Care.2018;7(2):324-330.
  6. Fernández-Gaxiola, AC, De-Regil, LM.Intermittent iron supplementation for reducing anaemia and its associated impairments in menstruating women. The Cochrane database of systematic reviews. 2011;10: CD009218.
  7. Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B et al. n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. The American Journal of Clinical Nutrition. 2006;84(1):5-17.
  8. National Institues of Health. Omega-3 fatty Acids.
  9. Can I eat flax seeds instead of fish or fish oil for omega-3s?

Eating this causes weight gain.
Eating this increases cravings.
Eating this gets you addicted to it.
Meet the new villain in the health and fitness industry, sugar.
 

 
White sugar has got a bad reputation in the health industry for a while, since we moved away from fat. Leaving aside weight gain, white sugar or sucrose has been said to be ‘addictive’.
Addiction is defined as “the fact or condition of being addicted to a particular substance or activity.” It indicates psychological dependence. Addiction is commonly used in the context of drugs or alcohol and has now been extended to sugar. If sugar alone was really that addictive, we would be eating sugar straight out of the bag right? Do we really see people carrying bags of white sugar and secretly eating them when no one is watching?
 
But sugar is more addictive than cocaine!
 
This statement is used over and over again, but it shows how a research paper can be entirely misinterpreted. The study measured dopamine response to food and drugs in rats (1). They found that dopamine levels increased when the rats received food as a reward and also when cocaine was injected in them. This only shows that cocaine can increase dopamine levels similar to food reward. It does not imply that sugar is more addictive than cocaine.
 
What does the research actually say?
 
Animal studies addressing sugar addiction employ a method of depriving the rodents of sugar for a certain period and then allow free access to food (2). This is usually 12-16 hours of deprivation followed by 12 hours of access to food. Hence this addiction like behaviour is usually observed in rats that have intermittent access to sugar (2). This restriction is what possibly increases the reward value of sugar. This behaviour is very similar to when we restrict ourselves from certain food groups don’t you think? More importantly, in these studies, rats were given liquid glucose, sucrose or saccharin. Humans don’t consume in isolation, but rather in combination with fat and several other ingredients which results in a highly palatable food.
 
Maybe it’s about the palatability?
 
Evidence from animal models suggests that hyperpalatable and highly processed foods could potentially be addictive (3). Foods like pastries, cakes, doughnuts and the likes are a mixture of carbohydrates, fat, sugar and flavouring that makes it very energy dense and palatable. It is not made of just sugar. Rather, sugar is one of the ingredients. Moreover, most evidence stems from studies done in animals with limited trials in humans.
 
More recently,
 
A study in 2017 (4) examined whether sugar containing foods could bring about possible ‘addictive like’ behaviors based on clinical criteria for substance dependance. This cross sectional study studied 1495 participants for signs of food addiction for particular food categories in accordance with accepted clinical criteria (DSM-IV).  They found that most of these ‘addiction like’ problems were towards high fat savoury and high fat sweet foods and NOT foods containing mostly sugar or low fat savoury foods.
 
This is what research has to say. The vast majority of the community has misinterpreted these research studies. These are done primarily in rodents who were restricted from sugar for a stipulated time period. It suggests that foods that are hyper palatable (ie; taste good) have greater reward value. These are also energy dense in nature. Sugar addiction as a stand alone has very limited and weak evidence. It is imperative to understand this as demonising sugar is a reductionist approach. Next time someone says sugar addiction is real, you know exactly what blog post to show them!

REFERENCES:

1. Hernandez L, Hoebel B. Food reward and cocaine increase extracellular dopamine in the nucleus accumbens as measured by microdialysis. Life Sciences. 1988;42(18):1705-1712.
2. Westwater M, Fletcher P, Ziauddeen H. Sugar addiction: the state of the science. European Journal of Nutrition. 2016;55(S2):55-69.
3. N. Gearhardt A, Davis C, Kuschner R, D. Brownell K. The Addiction Potential of Hyperpalatable Foods. Current Drug Abuse Reviews. 2011;4(3):140-145.
4. Krieger J. No, you’re not addicted to sugar [Internet]. Weightology. 2017.

You’re eating a banana while working. You suddenly notice an email from your boss that you haven’t replied to. You shove the banana down your throat and your fingers swiftly start typing a reply, while you struggle to chew the banana. You are done typing a few seconds later, but notice that your banana is gone! You check under your desk, maybe you’ve dropped it? Then it hits you. You’ve eaten it, but it doesn’t feel like it at all!

Could you relate to the above?

When was the last time you really had a look at what was on your plate and enjoyed a meal? With technology entering every aspect of our lives in addition to ‘hustling’ (read: being busy) 24 x 7, we seldom pay attention to the food we eat. We mindlessly eat what is within our reach, not realising the consequences. We wolf down our food without chewing, phone in hand and rush to our laptops to send out emails. What can be a good 10-15 minutes spent on just eating is now a 5 minute hastily done job!

Mindfulness is defined as being aware or conscious of something.  Mindful eating involves being aware of the food you eat and getting rid of distractions that might interfere with your eating experience. It also involves noticing the texture, the colour and flavor of the food. Mindful eating primarily relies on hunger and satiety cues, to initiate eating. Further, it incorporates the practice of not being critical or judgemental of the food you are eating . For example, if you really want a doughnut, by all means eat it. Do not label it as a ‘bad’ food. By looking at the first few principles, it is clear that we do not adhere to it,considering our busy lives.

But how do we incorporate mindful eating on a daily basis? This is very simple:

  • Eat when you are hungry
  • Differentiate between actual hunger, boredom, stress and other emotions
  • Ensure that when you eat a meal, you do not have any distractions. This means, no screens
  • Try and eat in silence
  • Chew your food thoroughly
  • Notice the texture, flavour and smell of what is in front of you
  • Eat until you are nearly full

These can be used as starting points to slowly adopt mindful eating as a habit. Start by applying these principles to one meal a day, and then gradually increasing the frequency. Mindless eating habits often takes a toll on our health. Being aware of what we eat and how we eat also matters.

REFERENCES:

  1. Nelson J. Mindful Eating: The Art of Presence While You Eat. Diabetes Spectrum. 2017;30(3):171-174.
  2. Harvard Health Publishing. 8 steps to mindful eating – Harvard Health [Internet]. Harvard Health. 2019. 

Gut health is currently the new buzzword in the health and fitness industry. Products claiming to improve your gut and its function are slowly increasing. This might make you wonder what the fuss is all about! Gut microbes, microbiota, microbiome… What do these terms mean? Why is the gut so important? Read on to find out!

What is the gut and gut microbiota?
The gastrointestinal tract or in simple terms, the digestive system which starts from the mouth and ends at the rectum, are collectively termed as the gut. However, what people usually refer to when they use the term ‘gut’ is the intestines.
The gut, all the way from the mouth to the rectum contain a number of microorganisms (also called microbes) that are tiny microscopic organisms which are not visible to the naked eye. Microbiota refers to all the microorganisms living in the same environment, while microbiome refers to all genes of these microbes. So, the gut microbiota refers to the large community of microbes that reside in the gut.
What is the function of the gut microbiome?
The gut microbiota plays an important role in digestion, absorption and metabolism of food (1). Beyond this, the gut bacteria are also thought to play an important role in obesity (1), immune function (2) and also influencing mood (3) . In fact, our gut bacteria is said to have an impact on most of our physiological functions, directly or indirectly (2). While the research around the gut microbiota is ongoing, it is clear that it is a key factor in several aspects of the body’s optimal functioning.
What are the common gut related disorders and why does it occur?
In certain situations (for example, a disease condition) the microbes that reside in your gut can be disrupted. This will be different from the microbe community that was present when your body was healthy. This is termed as dysbiosis (2). Dysbiosis can be caused by change in eating habits, bowel movements and even medications taken when one is ill. (2). However it is to note that what changes in the microbiota are helpful or not is still being looked into.
Some of the most common gut related disorders you would have come across are constipation, indigestion and diarrhoea. However, conditions like Irritable Bowel Syndrome (IBS), Crohn’s disease, Celiac disease, lactose intolerance and colitis are also gut related.
What can I do for a healthy gut?
The following simple tips can be incorporated in order to ensure your gut microbes are functioning well in order to support your body’s optimal functioning;
Diverse diet: As mentioned before, a large and diverse community of microbes reside in our gut. To support these microbes, our diet needs to be equally diverse. Our food serves as substrates for these microbes to thrive. It is clear that the diversity of our diet determines the diversity and richness of the gut microbiota (4). The increasing number of fad diets is also an issue of concern as it encourages elimination of food groups, which in turn affect the diversity of the gut microbiota (5). Fibre intake and polyphenols also play key role in shaping the microbiome. Low intake of fibre paired with high fat and sugar intake may reduce certain microbe groups in the gut (6). Polyphenols are found in foods like tea, chocolate, spice, seasonings,herbs and even fruits and vegetables. Interactions between polyphenols and the gut microbes can also impact health (7).
What can you do? Ensure your diet is diverse by varying the foods you eat on a daily basis. Consume fibre rich food such as whole grains, lentils/legumes, fruits and vegetables. Aim for at least 25-30g of fibre a day. Fruits and vegetables, also ering rich in polyphenols provide an additional benefit.
Fermented foods: Fermentation is a natural process by which bacteria break down substances into simpler forms. Examples of fermented food are kimchi, yoghurt, kefir among several others. These are commonly termed as ‘probiotics’ since they contain live cultures of microorganisms in them! While the research on probiotics is still ongoing, they do seem to show promising effects on enriching the existing gut flora (8). Why not give this a go?
Stress: This is something that affects each one of us on a day to day basis. While everyone knows that extreme stress is unhealthy, little do we know that stress also affects the diversity of microbes in the gut (9). Yes, you heard that right! While we do know how stress negatively affects several aspects of health, it also has an impact of the tiny bugs living in your gut.
In conclusion, gut health is a growing area of research. While there are a number of questions unanswered, the field seems vast and promising. It is clear that the gut plays an important role in several aspects of human health. Hence, it is necessary for us to understand this and nourish the gut by living a healthy lifestyle.

REFERENCES:

1) Ursell L, Metcalf J, Parfrey L, Knight R. Defining the human microbiome. Nutrition Reviews. 2012;70(Suppl 1):S38-S44.
2) Shreiner AB, Kao, JY, Young, VB. The gut microbiome in health and disease. Current Opinion Gastroentology. 2015;31(1):69-75
3) Dash S, Clarke G, Berk M, Jacka F. The gut microbiome and diet in psychiatry: Focus on depression. Current Opinion in Psychiatry. 2015;28(1):1-6.
4) Makki K, Deehan E, Walter J, Bäckhed F. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host & Microbe. 2018;23(6):705-715. 
5) Heiman M, Greenway F. A healthy gastrointestinal microbiome is dependent on dietary diversity. Molecular Metabolism. 2016;5(5):317-320.
6) Sonnenburg E, Sonnenburg J. Starving our Microbial Self: The Deleterious Consequences of a Diet Deficient in Microbiota-Accessible Carbohydrates. Cell Metabolism. 2014;20(5):779-786.
7) Ozdal T, Sela D, Xiao J, Boyacioglu D, Chen F, Capanoglu E. The Reciprocal Interactions between Polyphenols and Gut Microbiota and Effects on Bioaccessibility. Nutrients. 2016;8(2):78.
8) Bell V, Ferrão J, Pimentel L, Pintado M, Fernandes T. One Health, Fermented Foods, and Gut Microbiota. Foods. 2018;7(12):195.
9) Konturek PC,Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. Journal of Physiology and Pharmacology. 2011;62(6):591-599.

With several people engaging in fitness and sports, the belief that supplements are the magical key to improvements in performance is making the rounds. Vitamin and mineral supplements are widely used by the general population, which we will address later. This article will cover supplements commonly used by fitness enthusiasts and athletes. Are you using supplements backed by evidence for its efficacy or are you just burning a hole in your wallet? You’ll find out now!

To begin with, what are supplements? Supplements are defined as “a concentrated source of nutrients or other substances with a nutritional or physiological effect.” (1). Like the name suggests, they are to be used to correct nutritional deficiencies or support specific physiological functions. To put it in simple terms, in the absence of food providing adequate nutrients, supplements can be used. That is, to supplement a diet. Supplements are commonly sold as pills, powders, tablets or capsules with a specific dose. The nomenclature of ‘supplements’ varies globally. While in Europe, they are termed as food supplements, in USA they are known as dietary supplements. The Food Safety and Security Act in India have also listed ingredients that a product should contain in order to be classified as a supplement. (2)


(1) Whey Protein: Whey is a milk protein and the water soluble part of milk. Whey protein by itself is marketed in three main forms. (3)

  • Whey isolate: Contains higher percentage of protein (~85-90% or more) since lactose and fat are removed.
  • Whey concentrate: Lower percentage of protein (~80% or more) compared to isolate since lactose and fat are not removed.
  • Whey hydrolysate: Partially pre digested to aid rapid absorption.

Why whey protein? Do we really know why it is this popular? Or are we just consuming it because everyone else is? Whey protein is rich in essential amino acids compared to its counterparts such as eggs, soy and meat. In specific, it is rich in branched chain amino acids (BCAA) which play an important role in muscle protein synthesis. In fact, whey protein has a biological value (BV) that is greater than the BV of an egg by 15%! (3). BV denotes how fast and how well our body can use the protein consumed. Apart from this, one scoop of whey protein gives anywhere between 20-25g of protein (or more based on the brand)! Convenient isn’t it? its property of rapid digestion, concentration of amino acids and convenience is what makes it popular.

How does whey fare when compared to other protein sources? A study by Tang et al. in 2009 (4) compared the effects of whey hydrolysate, casein (another milk protein) and soy protein isolate on mixed muscle protein synthesis (MPS). It was found that whey protein stimulated mixed MPS to a greater extent compared to soy and casein, both at rest and after exercise. However, soy stimulated mixed MPS greater than casein in both scenarios.

Do you have to consume whey? That depends! Like I mentioned before, whey protein provides 20-25g of high BV protein per scoop and if you are unable to meet your daily protein requirements through your diet, then go ahead. Vegetarians who find it difficult to incorporate complete protein sources into their diet or those involved in strength and endurance training who require higher levels of protein will find supplementing beneficial. You can still consume whey otherwise, simply because it is convenient and light on the stomach. In fact, whey can be added to oatmeal and smoothies to increase the protein content. At the end of the day, it is a matter of personal preference. Remember, it is a supplement.

(2) Casein : Casein is also a milk protein like whey and is a complete protein. The difference between whey and casein lies in their digestion. Contrary to whey which is rapidly digested, casein is a slow digesting milk protein. Casein, like any other protein can be used to meet daily protein requirements but whey seems to be the ideal post workout protein of choice.
However, casein releases amino acids at a much slower rate, so ideally it can be taken before bed, to aid in recovery.

(3) Branched Chain Amino Acids : Branched Chain Amino Acids or commonly known as BCAAs are a group of three amino acids Leucine, Isoleucine and Valine. They are also Essential Amino Acids which means they need to be obtained from the diet. Supplementing BCAAs are popular as it is thought to stimulate muscle protein synthesis (6). Contrary to this, a recent review concluded that BCAA supplementation alone cannot promote muscle protein synthesis (6).

Does BCAA consumption help in preventing fatigue? Serotonin regulates feelings of arousal, sleep and mood and is thought to be linked to central fatigue after vigorous exercise (7). The amino acid Tryptophan is a precursor to serotonin production. Post a bout of exercise, there is a decrease in BCAAs in the plasma and an increase in free tryptophan, thus increasing the free tryptophan/BCAA ratio. It is thought that supplementing with BCAA could balance this increase and delay fatigue (7). However, most studies provided a combination of BCAAs and carbohydrates during exercise (8). Although BCAAs are thought to reduce markers of muscle damage and soreness after strenuous exercise, its efficacy in doing so post high intensity exercise is questionable (9). Further, there is no direct positive link between BCAA supplementation and reducing markers of muscle damage.

Do you need BCAAs? Honestly, no. If you are able to maximise your daily protein intake and meet them via complete proteins, supplementation with BCAA is not necessary. Complete proteins such as eggs, meat, dairy, whey protein, tofu and other soy products already have BCAAs. Maximise your protein through food/other supplements everyday and save some $$$ on the BCAA!


(4) Glutamine : L-glutamine is an amino acid that is found in protein rich foods like meat, eggs, dairy and tofu. Our body can make glutamine, but there are times when our requirements exceed how much our body produces. So, it is a conditionally essential amino acid. It is to be noted that it does become an essential amino acid only during critical illness or injuries (10).
If you are taking glutamine to build muscle or improve body composition, then hold on to your money. Studies have consistently shown that consuming glutamine does not affect body composition (11). In fact, glutamine does not augment rates of muscle protein synthesis in healthy individuals either! Studies have used doses up to 900 mg/kg lean mass and noticed no increase in lean mass or muscle protein synthesis (12). If you are perfectly healthy, with no serious injury or illness, then glutamine isn’t for you.

What about recovery? Glutamine is widely recommended for aiding recovery post training. A recent study did find that co-ingestion of glutamine and leucine (another amino acid) did in fact lead to faster recovery compared to a placebo. Muscle soreness did not differ between the two. (13). Besides strength recovery, it could help in reducing muscle soreness after strength exercise (14,15). Supplementation of glutamine around exercise does seem to enhance strength recovery and possibly reduce muscle soreness.


Like mentioned before, glutamine becomes an essential amino acid in the critically injured or sick individuals. Although exercise also acts as a stressor, immunosuppression observed after exhaustive exercise is not due to plasma glutamine (16). But, what glutamine could benefit is the intestine. Glutamine is thought to be more relevant than glucose as an energy substrate for the gut (17). Hence it could help in reducing exercise induced dysfunctions of the gut.

Thorough research is needed before starting supplement usage. First, it is imperative to understand if there is evidence for the efficacy of the supplement. Second, think about what the use of the supplement is and if it is applicable to your sport/physical activity. Finally, make sure you purchase your supplements directly from the manufacturer’s website. Make sure that the brand you buy is authentic and widely used. Supplements from third party websites could be adulterated/contaminated. The ‘informed sport’ icon on the product is one way to ensure that it is safe. With this in mind, always tell yourself that these are just supplements to a well balanced diet.

References:

 
(1) EFSA. Food supplements.
(2) Health Supplements and Nutraceuticals Emerging High Growth Sector in India
(3) Smithers, GW. Whey and whey protein- from ‘gutter to gold’. International Dairy Journal. 2004; 18(7): 695-704
(4)Tang, JE, Moore, DR, Kujbida, GW, Tarnopolsky, MA, Phillips, SM. Ingestion of whey hydrolysate, casein, or soy protein isolate: effects on mixed muscle protein synthesis at rest and following resistance exercise in young men. Journal of Applied Physiology. 2009;107(3): 987-992.
(5) Examine. Casein protein.
(6) Wolfe, RR. Branched-chain amino acids and muscle protein synthesis in humans: myth or reality? Journal of the International Society of Sports Nutrition. 2017; 14(1): 1-7.
(7) Blomstrand, E. Amino acids and central fatigue. Amino Acids. 2001;20 (1):25-34.
(8) Blomstrand, E. Role for Branched-Chain Amino Acids in reducing central fatigue. The Journal of Nutrition.2006;136(2):544S-547S.
(9)Fouré A, Bendahan D.Is Branched-Chain Amino Acids Supplementation an Efficient Nutritional Strategy to Alleviate Skeletal Muscle Damage? A Systematic Review. Nutrients.2017;9(10):
(10) Lacey,JM, Dr. PH, Wilmore, DW. Is glutamine a conditionally essential amino acid?Nutrition Reviews. 1990;48(8):297-309.
(11) Ramezani Ahmadi, A, Rayyani, E, Bahreini, M, Mansoori, A. The effect of glutamine supplementation on athletic performance, body composition, and immune function: A systematic review and a meta-analysis of clinical trials. Clinical Nutrition. 2018;1-16
(12) Candow, DG, Chilibeck, PD, Burke, DG, Davison,KS, Smith-Palmer,T. Effect of glutamine supplementation combined with resistance training in young adults. European Journal of Applied Physiology. 2001; 86(2):142-9.
(13)Waldron,M, Ralph C, Jeffries O, Tallent J, Theis N, Patterson SD. The effects of acute leucine or leucine-glutamine co-ingestion on recovery from eccentrically biased exercise. Amino Acids.2018;50(7):831-839.
(14) Street,B, Byrne,C, Eston, R. Glutamine Supplementation in Recovery From Eccentric Exercise Attenuates Strength Loss and Muscle Soreness. Journal of Exercise Science and Fitness. 2011;9(2):116-122.
(15) Legault, Z, Bagnall, N, Kimmerly, DS. The Influence of Oral L-Glutamine Supplementation on Muscle Strength Recovery and Soreness Following Unilateral Knee Extension Eccentric Exercise. International Journal of Sports Nutrition and Exercise Metabolism. 2015;25(5):417-426.
(16) Hiscock,N, Pedersen, BK. Exercise-induced immunodepression- plasma glutamine not the link. Journal of Applied Physiology.1985; 93(3): 813-822.
(17) Cruzat,V, Rogero, MM, Keane, KN, Curi, R Newsholme, P. Glutamine: Metabolism and Immune Function, Supplementation and Clinical Translation. Nutrients. 2018; 10(11):1-31.

With a variety of new diets making the rounds, it becomes difficult to gauge which is the right one for you as an individual to follow. A lot of information is available, but which is actually factually correct is the bigger question!  Off late, fasting diets have been making the rounds, with intermittent fasting in the spotlight. This article aims to provide an unbiased view on intermittent fasting, so you can decide if it is sustainable to follow!

What is intermittent fasting? How is it different from the conventional weight management strategies?
Intermittent fasting (IF) involves cycling normal daily caloric intake (feeding) with periods of fasting or severe energy restriction. The period of fasting is not a true fast where food and/or water is not allowed (1).  In comparison, the conventional weight management strategy, continuous energy restriction (CER) that is, a calorie deficit, is used to induce weight loss by creating a daily energy deficit.
How does it work?
There are several fasting regimes and modified fasting regimes being practiced. The most popular IF methods are:

  • 5:2 diet, which involves 2 days (consecutive or non consecutive) of ‘fasting’ (energy intake of ~500kcal and ~600kcal are allowed for men and women respectively) and 5 days of regular eating patterns per week (1)
  • The Alternate Day Fast (ADF) involving alternate days of fasting and feeding (1)
  • The 16/8 diet, characterised by fasting for 16 hours a day and eating within an 8 hour feeding window.


What does the science say?

Weight loss: Intermittent fasting, like the media has portrayed, is not a magical diet to help induce weight loss. Rather, it is a tool to induce an energy deficit. However, if you compensate for the meals skipped during the feeding period, you wouldn’t observe results. A recent meta analysis of 4 studies concluded that IF methods are suitable for inducing short term weight loss, however, the variability between the study duration and participant characteristics (2) . Rather, intermittent fasting methods have been found to induce similar weight loss (3, 4) or no significant difference in weight loss (1) when compared with CER. This further strengthens the argument that while IF can induce weight loss, it is merely a tool to induce an energy deficit.
Metabolic outcomes:  You must think, if not weightloss maybe IF has an effect on metabolic outcomes like triglycerides, glucose and cholesterol among others? A systematic review and meta analysis of IF and CER found no significant differences  in glucose, HbA1c, triglycerides, HDL and LDL cholesterol (3).  Further, another systematic review showed that insulin and insulin sensitivity was comparable between IF and CER methods (5). However, definite conclusions cannot be drawn due to the varying methodologies of the individual studies. Further research is needed in order to understand this completely.

Should I try it?
Intermittent fasting is not for everyone. That is, if you are pregnant, breastfeeding, have a history of or an existing eating disorder, are extremely underweight or are on medication that require food intake, kindly avoid practising this regime.
If you are  person that does well without a meal and are comfortable with periods of fasting, you could give this a shot!

References:

(1) Harris L, Hamilton S, Azevedo L, Olajide J, De Brún C, Waller G et al. Intermittent fasting interventions for treatment of overweight and obesity in adults. JBI Database of Systematic Reviews and Implementation Reports. 2018;16(2):507-547. 
(2) Ganesan K, Habboush Y, Sultan S. Intermittent Fasting: The Choice for a Healthier Lifestyle. Cureus. 2018;10(7):e2947.
(3) ioffi I, Evangelista A, Ponzo V, Ciccone G, Soldati L, Santarpia L et al. Intermittent versus continuous energy restriction on weight loss and cardiometabolic outcomes: a systematic review and meta-analysis of randomized controlled trials. Journal of Translational Medicine. 2018;16(1):371.
(4) Sundfør T, Svendsen M, Tonstad S. Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: A randomized 1-year trial. Nutrition, Metabolism and Cardiovascular Diseases. 2018;28(7):698-706.
(5) Barnosky A, Hoddy K, Unterman T, Varady K. Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings. Translational Research. 2014;164(4):302-311.

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