Home Posts tagged "Examine.com" (Page 3)

Cissus Quadrangularis Supplementation: What You Need to Know

Today's guest post comes from the guys at Examine.com, who take unbiased looks at all sorts of topics related to health and fitness.  They'll be discussing a supplement of which you may have never heard, but should be aware. This post is timely, as their popular Supplement-Goals Reference Guide is now on sale to celebrate their hiring of new researchers to kick out great new content.

Cissus Quadrangularis is a traditional medicine used to reduce inflammation and accelerate post-fracture bone regeneration. It is one of the "go-to" recommendations for athletes struggling with joint pain.

However, many authorities have not taken official positions on cissus because, despite the vast collection of anecdotal benefits, there have been few human studies on the supplement.

Studies published in eastern journals have suggested cissus speeds up bone healing, but the dosage amount was not disclosed. Also available as evidence is a documented failure to ease hemorrhoids and a study suggesting cissus can reduce weight in obese people. Researchers in the second study had funding issues and dosed the supplement in the form of gum, taken with water before a meal. Gum and water before a meal will reduce food intake, regardless of the kind of gum taken. Not very compelling evidence!

There is good news, however. The first preliminary human trial on joint pain in adult athletes and cissus has finally been published and results are promising. Adults with nonpathological joint pain due to exercise took 3,200mg of cissus daily. After eight weeks, subjects reported a reduction in joint symptoms by about a third.

The study lacked a placebo control, and cissus was not tested against a reference drug, so more evidence will be required determine cissus’ true efficacy.

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Muscles and Joints

Cissus has a few properties that may benefit the musculoskeletal system. The following has been observed in rats:

  • Cissus is anti-inflammatory agent, though with questionable potency.

  • It is a painkiller with a quick onset.

  • It has minor muscle relaxant and sedative properties, which occur within 30 minutes of supplementation.

Due to its mild sedative effect, high doses of cissus should not be used as a preworkout.

Effects on Bone

Cissus increases IGF signalling in bone cells, which promotes mineral retention and growth. These effects have been observed in low concentrations, which suggests oral supplementation is a suitable way to take cissus. Rodent studies have shown that cissus promotes bone growth, mineral density and increases the bone’s ability to withstand force.

There are numerous studies published in eastern journals that support cissus’ positive effects on bone regeneration, but methodologies vary and actual evidence is scant.

Other properties

The sedative effects associated with cissus supplementation are not well studied, but it has been observed to enhance sleep time in benzodiazepine-induced animals. This suggests that cissus might best be supplemented before bed.

The herb has also traditionally been used to reduce stomach ulceration. Animal studies support this property.

Take-aways:

  • Cissus quadrangularis is a well-known supplement for reducing exercise-induced joint pain.

  • There is a serious lack of scientific evidence for the effects of cissus quadrangularis.

  • It is a potentially relaxing compound, not suited for a preworkout.

  • Cissus quadrangularis has promising but unproven benefits for bone regeneration.

  • It the future, it may be used to treat and prevent ulcers.

Looking for more unbiased reviews of supplements - both popular and obscure - to which you'll constantly be referring for years to come?  Check out the Supplement-Goals Reference Guide; it's a fantastic product that is "Cressey Approved" - and on sale through this Friday at midnight. Perhaps the coolest part is that you get a lifetime of updates, so when new research emerges, the reviews are updated to reflect this new information.

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Strength and Conditioning Stuff You Should Read: 11/4/13

Here's is some strength and conditioning reading (and viewing) to kick off your week:

5 Tips to Keep Your Shoulders Healthy for the Long Haul - This is a guest post I wrote up for Greatist.com.

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Dreaming of a Title - In light of the World Series run by the Red Sox, CP's Elite Baseball Development Program was featured, with interviews with several of our pro guys.  Check out this video.

Boosting Recovery: Solutions to the Most Common Recovery Problems - This was an outstanding guest post by Examine.com's Kurtis Frank at Precision Nutrition.

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The Question I Hate to Be Asked

There's one question that I get almost daily, and in spite of the fact that it drives me bonkers, I still do my best to answer it:

What supplements should I take?

The problem isn't that there aren't some supplements out there that can really help.  Anyone who's done even a cursory review of the research can speak to the value of supplements like Vitamin D and fish oil.  And, anyone who has ever reviewed the typical teenage athlete's diet can appreciate that a greens supplement would go a long way.

The bigger issue is that this question is an example of the carriage getting put in front of the horse.  In other words, the people asking the question are usually getting way ahead of themselves and need to focus on proper diet first. 

If you don't know what a healthy diet actually includes, how can you know what you need to supplement (dictionary.com: "to complete") with to get to where you want to be?

It goes beyond that, as the supplement question opens a big can of worms for several reasons:

1. The margins in the supplement industry are absolutely absurd - As a result, there are a lot of unethical people who flock to this industry in hopes of making some serious cash, playing on people's ignorance and insecurities. This is why you see bold advertising claims, doctored-up before/after photos, and - shamefully - products that don't actually make their ingredients list.  Some companies may use cheap fillers to keep their costs down, or include banned substances unbeknownst to the consumer in order to improve efficacy.  As a result of all this, you can't just recommend a supplement anymore; you also have to take the reputation of the brand into account.

2. It's a dynamic industry - With big money and potentially world-changing discoveries to be made, the game is constantly changing.  New research is published daily, and new products enter the market just as frequently to complement the daily influx of brands.  Plus, new uses for old supplements are always being introduced.  As an example, we once thought creatine was just a supplement for athletic performance, and now it's being looked at as a valuable supplement in treating many chronic disease states. Unless you're reading journal articles full-time and asking around in the industry, it's hard to stay on top of all the new information.

3. Dosing matters - Using the creatine example again, we were once all taught that we needed to load creatine for the initial period - and most of us who did it spent the first 7-10 days on the supplement with gurgly stomachs and diarrhea.  Now, we know that's not really necessary.  And, contrary to what we were told back in the 1990s, you don't need to crush a load of simple sugars to get the muscles to "suck it up." How much you take, when you take it, and what it's taken with all impact a supplement's efficacy.

4. Supplements mean different things to different people - If a person is financially comfortable, he or she can likely afford a new-age and potentially marginaly effective supplement in hopes of some return-on-investment.  For someone else, that $40 might be a huge deal.  What works for one athlete won't matter nearly as much for another, too; the baseball players with whom I've spoken haven't really benefited at all from beta-alanine supplement, but the competitive cyclists and soccer players have thrived on it; the metabolic demands of the sport are entirely different.

Additionally, everyone has a different social perspective on what supplements mean.  I once had a mother ask me about creatine for her son, and she commented that she viewed creatine as a "gateway drug" like marijuana.  This backlash is only getting worse and worse because of the unethical actions of a few professional athletes (blaming supplements for positive tests) and supplement companies (not living up to label claims).

For all these reasons, I really outsource my supplement questions to people who stay much more up-to-date on the topics than I can.  At our facility, I'm fortunate to have a great nutrition folks who stay as up-to-date on the research as possible - and also has a great mindset from which to discuss things with athletes, coaches, and parents.

Fortunately for us, though, we also have the good folks at Examine.com and their expertise at our fingertips on this front, too. They're a 100% transparent, independent organization that scrutinizing supplement efficacy - and a whole lot more in the health and human performance industries. In other words, everything they publish comes from peer-reviewed journals and is without influence from supplement companies - so you don't have to worry about "bro science" infiltrating their findings.

Their offering has expanded dramatically since the site was founded over a decade ago, and with that in mind, I’m going to encourage you to check out Examine 2.0, the newly launched update to their flagship offering. Examine distills thousands of studies into actionable insights. They also include monthly updates of the latest research, helping you to stay on top of what’s new in the industry (and get CEUs in the process). Through 8/25, you can get a big discount as one of my readers at http://examine.news/cressey.

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Sleep: What the Research Actually Says

As a complete workaholic, I have a tremendous interest in the acute and chronic effects of sleep deprivation on both performance and health.  And, as a performance coach to many athletes who generally go to "work" from 1pm-1am each afternoon/evening and often consume far too much caffeine, I'm always looking for good material to pass along their way in hopes of helping them to realize how important sleep really is.  In this great guest post, Sol Orwell and Kurtis Frank provide just that.  It's a long read, but 100% worth it.  Enjoy! - EC
 

Sleep is a fun topic. Every few months or so, someone will put up a post talking about how important sleep is, how you need it, how if you don’t get enough of it you will get fat and disgusting and huge, yadda yadda yadda.

We’re not here to dispute that. What we are here to do is take an investigative look; sleep is entering the realm of “say something enough times, and it has to be true.” You’ll be hard-pressed to find any recent articles that have actually looked at the evidence surrounding sleep quality and quantity and how they affect your body. Mostly, the evidence we have is purposely restricting sleep in people and seeing what happens.

Prepare for some truthiness (we’ve also inserted some blockquotes to help guide you through).

Sleep Deprivation and its Effects on Hormones

The hormones that are most frequently stated to be affected by sleep are:

  • Insulin - one of the most misunderstood hormone there is (see James Krieger’s fantastic analysis on insulin)
  • Androgens - the muscle-building hormones
  • Growth Hormone
  • Cortisol, the “stress” hormone

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Insulin

Sleep deprivation doesn’t seem to affect insulin levels much, but there is definitely a decrease in insulin sensitivity in the fat cells and liver1,2. This decrease in sensitivity can happen as easily as getting half your normal amount of sleep for less than a week3,4 or even losing 90 minutes over a few weeks5. This lack of sleep, coupled with decreased sensitivity, is a risk factor for the development of type II diabetes.

Thankfully, these effects are quickly normalized upon recompensatory sleep.

The implications of reduced insulin sensitivity, beyond an increase in diabetes risk, are not too clear for an otherwise healthy person, as the decrease in insulin sensitivity affects all measured tissue (adipose, muscle, and liver) and is just due to impaired signalling through the insulin receptor.

Sleep deprivation reduces insulin sensitivity and glucose tolerance. This happens even after mild deprivation, but normalizes quickly once you’ve had enough rest.

Androgens and Testosterone

Testosterone is known for being affected by poor sleep (on a related note, you tend to sleep worse as you age, and this exacerbates sleep deprivation problems)6,7. Studies have shown that getting three fewer hours of sleep for five days reduced testosterone by over 10%8, whereas another study showed a 30.4%9 decrease! These reductions all happened within 24 hours of sleep deprivation10,11. Similar to insulin, getting enough rest quickly reverses this decline.

Sleep deprivation is associated with reduced testosterone. Akin to insulin, it normalizes once you get enough rest.

Growth Hormone

Growth hormone is actually a surprise in regards to sleep deprivation. For starters, we know that a large pulse of growth hormone occurs shortly after sleep begins, and in otherwise healthy young men, this accounts for roughly 50% of daily secretion. So would missing out on sleep impair growth hormone?

It depends on the duration of sleep.

Absolute deprivation of sleep for multiple nights can effectively suppress growth hormone. But neither an irregular sleep cycle (like a shift worker’s)12 nor only sleeping for four hours a night13 will adversely affect whole-day exposure to GH. It seems that the body compensates during daylight hours, and what is missed out on at night is adequately replaced during waking hours in those that are sleep-deprived.

Now, it is possible that the altered secretion patterns of GH can come with changes in its effects. However, the overall pattern is still pulsatile in nature (just biphasic rather than monophasic) and unlikely to be a huge issue.

Getting less sleep or having perturbed sleep changes the GH cycle, but does not reduce overall exposure to GH, as the body seems to compensate during waking hours.

Cortisol

Cortisol is the hormone that mediates the process of waking up, and under normal rested conditions, it’s elevated in the morning (to wake you) and suppressed in the evening (so you can fall asleep). It isn’t necessarily a bad hormone (the anti-inflammatory and fat-burning properties sound nice), but elevated cortisol also tends to be somewhat catabolic to muscle tissue, as well as being an indicator of other stress-related issues.

Sleep deprivation both dysregulates and increases whole-day exposure to cortisol. Imagine a graph where a line goes from high on the left to low on the right, and label it “what cortisol should do over time.” Sleep deprivation turns that line into a straight horizontal line, and then raises it up a tad on the Y-axis.

Interestingly, past studies were misguided a bit since they were only measuring morning cortisol concentrations and they kept on noting a decrease! Most recent studies that measured 24-hour exposure noted an increase – some as high as 50% – following four hours of deprivation each night for a week in otherwise healthy men.

Cortisol normally is high in the morning and low in the evening, but sleep deprivation normalizes this difference (lowering morning levels, increasing evening levels) and increases overall exposure to cortisol over a full day.

Sleep Deprivation and Physical Activity

Sleep deprivation has been noted to impair sprint performance and cardiovascular endurance14,15. There is conflicting evidence here: tests on cycle ergometers did not note much of an effect16,17, and the one study to assess weightlifting performance also failed to find any adverse effect18.

Despite these mixed reports on sleep deprivation, acute sports performance is enhanced by caffeine and/or creatine supplementation during a state of acute sleep deprivation. The latter only seems to apply to things that require a high degree of coordination and mental processing19.

It’s important to note that these studies had participants just skip sleep for one night. Real-world application is more chronic; you tend to lose a few hours every night, and it adds up. The impracticality of these studies makes it very hard to make solid conclusions.

(Note from EC: anecdotally, I could always “get away with” one night of sleep deprivation and then still demonstrate “normal” strength the next day. If I missed out on sleep two nights in a row, though, my in-the-gym performance went down the tubes after the second night)

Missing sleep for one night may or may not have adverse effects on performance, as the literature seems pretty split. There is a lack of research on realistic situations for chronic sleep deprivation.

Sleep Deprivation and Body Composition

Food Intake and Hunger

One of the more talked about effects of sleep deprivation as it pertains to body composition is that it somehow makes you eat a ton more food and then you get fat.

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The general idea (based on rat studies) is that sleep deprivation eventually (after five days or so) leads to increased food intake, but oddly this is not met with an increase in body weight; absolute sleep deprivation paradoxically causes fat loss and mild sleep deprivation just prevents weight gain.20 The increase in food intake is probably because of an exaggerated response to orexin, a wakefulness-promoting hormone that positively modulates hunger. Orexin increases as one is awake longer, causing more food intake as a side effect.21 Orexin also positively mediates energy expenditure, but it is not known if we can credit this for the observed weight-maintenance effects.

More practically speaking, studies in humans have noted an increased food intake of roughly 20-25% following a few hours of sleep deprivation for four days22,23. This is likely due to the brain’s response to food intake being enhanced, thus making food more hyperpalatable24,25.

It is unclear how sleep deprivation affects weights in humans. There is a very well-established correlation in society between obesity and sleep disturbances, but the studies currently conducted in people on weight loss programs with sleep deprivation control for food intake.

Sleep deprivation appears to increase food intake, likely due to the increased “pleasure response” to food. Paradoxically, this increased food intake might not be linked to more weight gain (rat studies confirm, human studies are somewhat unclear).

Metabolic Rate

It’s harder to make sense of the effects of sleep deprivation on metabolic rate. One study found that getting three fewer hours of sleep per day for two weeks resulted in a 7.6% reduction in metabolic rate26, whereas other studies showed no decrease22,27. To make it even more confusing, one study (on adolescent boys) found that less sleep resulted in more calories burned28; the participants burned more (being awake longer) and consumed less (decreased appetite).

In rats, chronic sleep deprivation is also known to greatly increase both food intake and the metabolic rate, resulting in weight loss (albeit a ton of other side effects such as lethargy, impaired cognition, and an aged visual appearance probably make sleep deprivation a bad diet strategy).29

So ultimately, it doesn’t appear that there is much evidence that poor sleep reduces the metabolic rate. More likely, being “tired” from lack of sleep tends to result in less physical activity30 and a possible increase of food intake could shift the balance of “calories in versus out” towards a surplus.

Nutrient Partitioning

There is one other interesting study that controlled for food intake and noted no differences in weight loss between groups (sleep deprived people and control both subject to intentional weight loss programs). This same study showed more lean mass lost and less fat mass lost in the sleep-deprived relative to control31.

Overall, it does not appear that a reduction in sleep directly suppresses the metabolic rate, but it may do so indirectly via reduced physical activity. Regardless of the metabolic rate, sleep deprivation during periods of fat loss may result in more lean mass lost and less fat mass lost than if one were fully rested.

Enhancing Sleep Quality

It seems that getting an adequate amount of sleep each night is quite important for those concerned with athletics and/or body composition. It would be a tad abrupt to just leave off on the importance of sleep without saying how to improve sleep, so the following are some tips that can be used to enhance sleep quality.

Timing Food Intake

Food intake can be quite effective in influencing the circadian rhythm: One way to avoid jet lag involves having a high-protein breakfast intermittently for three days (separated by low-calorie “fasting” days) at your destination’s time; the final meal is breakfast eaten after having arrived. This high-protein meal at your destination’s breakfast time should be able to reset your circadian rhythm. This is known as the Argonne Diet, and although it lacks scientific evidence to support it, the anecdotes are promising.

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It appears to play on the interactions between dietary protein and orexin, a wakefulness-promoting hormone highly involved in the circadian rhythm.31

Conversely, dietary carbohydrates may be able to promote relaxation (somewhat indirectly) secondary to an increase in serotonin synthesis, which then converts to melatonin. Since the conversion requires darkness to occur, this might mean a small serving of carbohydrate prior to sleep can promote restful sleep while focusing dietary protein earlier in the day might also work to regulate the sleep cycle.

Light Exposure or Deprivation

Both light exposure (blue/green or white lights; fluorescent or sunlight) and dark exposure (either absolute darkness, or an attenuation of white light into pink/red dim lights) can aid in sleep-cycle regulation. Both dark and light exposure have been investigated for restoring altered circadian rhythms seen with jet lag.32,33

The perception of light via the retina actively suppresses the conversion of serotonin into melatonin, and appears to have other neurological effects that promote wakefulness (in the morning) or otherwise impair sleep. Reddish lights appear to be less detrimental to sleep quality, and it is sometimes recommended to dim lights or switch to red lights in the evening to facilitate sleep quality.

For those of you at the computer frequently, this can be demonstrated with the downloadable software known as f.lux, which fades your computer screen to pink and reduces the brightness without affecting readability at a preset time every day.

Regulating your light exposure in the morning and evening may facilitate a more normal circadian rhythm and sleep quality. If light cannot be avoided outright, a transition from white light to red light at night may be helpful.

Supplementation

Supplementation to target sleep quality tends to stem from melatonin, which is a highly reliable and effective anti-insomniac agent that can reduce the time it takes to fall asleep. It is unlikely to do anything if you do not have problems falling asleep, but otherwise is a quite important and cheap supplement. The above light- and meal-manipulation strategies tend to work via melatonin manipulation anyways, and supplementation is an easy way to circumvent it.

Beyond melatonin, other possible options include generally relaxing compounds (lavender and l-theanine) or other endogenous agents that seem to regulate sleep (oleamide being the latest up-and-comer supplement). Lavender is actually an interesting option since it appears to be somewhat effective as aromatherapy as a “relaxing” scent, and aromatherapy may be the only way to continuously administer a supplement throughout sleep (via putting a few drops of lavender oil on a nearby object and continuing to breathe while you sleep).

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It should also be noted that restricting stimulants or anti-sleep agents (caffeine and modafinil mostly) should be advised if sleep quality is desired. Even if caffeine fails to neurally stimulate you anymore due to tolerance, it can still screw with sleep quality.

What You Should Have Learned

That was a lot of information and studies to throw at you all at once. We’ve summed up all the relevant points:

  • Reduced sleep for a prolonged period of time can decrease insulin sensitivity (and thus is a risk factor for diabetes); this is normalized when proper rest is attained.
  • Similar to the issue of insulin sensitivity, testosterone and other anabolic hormones are acutely suppressed with sleep deprivation and normalized shortly after proper rest is attained.
  • There is actually mixed evidence as to whether missing a night of sleep impairs workout performance. It would be safe to say that it does not help, and could potentially hinder.
  • Sleep deprivation is not adverse to weight loss per se, but it can cause you to overeat or move less.
  • Regardless of weight loss, limited evidence suggests an adverse effect on where the weight is lost (more lean mass lost, less fat lost).
  • Shifting the majority of your protein towards the morning, and perhaps having a small carbohydrate-containing meal at night, should theoretically aid in maintaining a proper circadian rhythm.
  • Manipulating light exposure for brighter white/blue/green lights in the morning and dimmer red/pink lights (or just darkness) at night definitely does aid in maintaining a proper sleep cycle.
  • If needed, melatonin can be used to help with sleep latency (time required to fall asleep) and abstaining from stimulants or introducing relaxing molecules (lavender and theanine) may aid in sleep quality.

About the Authors

Sol Orwell and Kurtis Frank co-founded Examine.com in early 2011. They’ve been collating scientific research on supplements and nutrition since then, and are working on a beginner’s guide to supplements.

Note: the references for this article are posted as the first comment below.

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