Glycerol, An Overlooked Ergogenic Supplement? 10-12g of Glycerol May Increase Lean Mass Without Training. Plus: Effects on Adrenals & AST + Lactate Response to Exercise

Interestingly, the study at hand suggests that glycerol may make you more musclar, even if you don't life. Crazy, but true (photo by awesomebody).

As a SuppVersity reader the potential ergogenic effect of the backbone of triglycerides are no news to you. The number of studies investigating the effects of glycerol on exercise performance and/or the adaptive response to exercise is yet low. Against that background, even a rodent study like the one by Eric Francelino Andrade from the Federal University of Lavras is worth its own SuppVersity article, I guess.

In said study, the Brazilian researchers evaluated the training adaptation and physical performance parameters in rats orally supplemented with glycerol,glucose, or saline, and submitted to moderate aerobic exercise.

Glycerol can be used in conjunction with creatine to hyperhydrate (Easton. 2007).

Creatine Doubles 'Ur GainZ!

Creatine, DHT & Broscience

Creatine Better After Workout

ALA + Creatine = Max Uptake?

Creatine lowers cortisol!

Build 'Ur Own Buffered Creatine

Thirty male rats were trained for 6 weeks and administered the supplements during the last 4 weeks of the experiment. Animals were distributed in a completely randomized factorial 2 × 3 design (with or without exercise and 3 substrates) and received 864 mg/kg body of either glucose or glycerol in solution.

For human beings this equals human equivalents of 140mg/kg or ~10-12g of both, glucose and glycerol, for an adult. If this amount of glycerol had the same effects on humans at it did on the rodents in the study at hand, this would mean that it would lead to non-significant increases in lean body mass, even if the men and women who take it, were not working out.

Figure 1: Overview of the study design (top) and changes in protein content (~lean mass) and fat content of the carcass of trained and untrained rodents in the glycerol, glucose and saline groups at the end of the study period (Andrade. 2014)

The data from the rodent study at hand does yet also suggest that glycerol may at the same time non-significantly inhibit the lean mass gains that occur in response to aerobic training.

Glycerol as an adrenal supplement?

In contrast to the previously cited changes in lean body mass, which are not the result of a simple increase in body water (that's the beauty of actually cutting your "hairy subjects" open - you don't have to use BIA or DEXA scans to measure their lean mass), the effects on the weight of the adrenals of the animals was statistically significant in both, the trained and the non-trained rodents.

Figure 2: Organ weights (top row) and lactate (middle row) and aspartate aminotransferase (AST | lower row) levels at the end of the study period and after workouts, respectively (Andrade. 2014)

In the exercise trained rodents, there was also a significant reduction in the protein oxidation marker AST in both, the glucose and glycerol group. An obvious sign that both, pure glucose and the polyol (sugar alcohol) compound were used as alternative fuel during the exhaustive workouts, with the latter providing greater reductions in lactate build-up than the former.

What do previous studies say? Previous studies suggests that both glycerol, as well as combined creatine and glycerol can be used to hyperhydrate before exercise and thus to reduce the thermal and cardiovascular strain (Easton. 2007). This practice can also increase the exercise performance of endurance athletes like cyclists (Montner. 1996). Consumed in large amounts of 80g and in conjunction with 2L water, glycerol has also been shown to decreases body weight in athletes & increase overall performance in sedentary subjects, as previously reported at in a previous article of mine.

What do we make of these results? The increased lean mass in the non-trained rats is good news for every couch potato. The non-significance of the difference in trained rats is good news for athletes. The same goes for the reduced AST and lactate levels which suggest that glycerol is effectively used as alternative fuel and thus a candidate for pre- and intra-workout supplements for low-carbers.

Both the increases in heart and adrenal weight are physiological responses to exercise. In that, it is good news that the heart weight did not increase more in the glycerol group, despite the increased adrenal weight in these rats (otherwise, this may be interpreted as a result of pathological stress). The possible mechanisms for the increased adrenal weight are thus not of sympathetic (stressful) nature. Rather than that, the increased adrenal weight "may be related to an increase in body fluid volume caused by glycerol, decreasing relative sodium concentration (hyponatremia) (Von Duvillard. 2004), and increasing mineralocorticoid (aldosterone) secretion and adrenal gland mass (Decaux. 2003)" (Andrade. 2014). Overall, the results of the study still confirm that the ergogenic effects of glycerol are beyond the well-known hyperhydration properties caused by this substance | Comment on Facebook!

References:

• Andrade, Eric Francelino, et al. "Adaptation to physical training in rats orally supplemented with glycerol." Canadian journal of physiology and pharmacology 93.999 (2014): 1-7.
• Decaux, Guy, et al. "Low plasma bicarbonate level in hyponatremia related to adrenocorticotropin deficiency." The Journal of Clinical Endocrinology & Metabolism 88.11 (2003): 5255-5257.
• Easton, Chris, Stephen Turner, and Yannis P. Pitsiladis. "Creatine and glycerol hyperhydration in trained subjects prior to exercise in the heat." International journal of sport nutrition and exercise metabolism 17.1 (2007): 70-91.
• Montner, P., et al. "Pre-exercise glycerol hydration improves cycling endurance time." International Journal of Sports Medicine 17.01 (1996): 27-33. 
• Von Duvillard, Serge P., et al. "Fluids and hydration in prolonged endurance performance." Nutrition 20.7 (2004): 651-656.

D-Finitively Relevant News: Vitamin D Supplementation Speeds Up Strength Recovery and Lowers Markers of Muscle Damage in Vitamin D-Sufficient Young Subjects

If we were all training at "Muscle Beach", we would probably not need any vitamin D3 caps to get our 25(OH)D levels into the recovery friendly 50ng/ml zone. They would already be there!

Ok, I know this looks odd, but it's really total coincidence that all the interesting vitamin D research is published in the last weeks of the year. Unlike the latest vitamin D articles, i.e.

• "Vitamin D Builds Muscle: 70% Reduction in Myostatin, 45% Increase in Myotube Size in 10 Days" |  learn more
• "Leucine, Insulin & Vitamin D*: A Hypertrophy Boosting Triplet That Does Not Make It From the Dish to the Gym?" | read more

today's SuppVersity article does yet leave little room for speculations about it's real-world significance. I mean, how could it, if the paper it discusses is titled "Supplemental vitamin D enhances the recovery in peak isometric force shortly after intense exercise" (Barker. 2013).

You can learn more about vitamin D at the SuppVersity

Vitamin D Builds Muscle

Leucine, Insulin & Vitamin D

Vitamin D = Fat Synthesizer

Overlooked D-Sources

Vitamin D For Athletes!

Vitamin D Helps Store Fat

The title does yet not "say it all". Moreover, what it doesn't tell you is the most important piece of information. The study period was short (35 days) the dose of vitamin D was relatively high (4,000IU) was conducted with "reportedly healthy and modestly active (30 minute of continuous physical activity at least 3 time/week) adult men with low, albeit normal vitamin D levels (25(OH)D ~ 30ng/ml)! The otherwise almost obligatory question about the potential relevance in "normal" human beings does thus become superfluous - and this is true for all the observations the scientists made, i.e.

• ... the linear relationship between baseline 25(OH)D levels and the increase in serum vitamin D in response to the with an up to 150% increase in subjects in the deficiency zone and less than 50% increases in subjects in the >40ng/ml range, ...
• ... the steady serum calcium levels, which make concerns about potentially kidney damaging increases in calcium from vitamin D3 supplementation obsolete, ...

... and, not to forget, the enhanced recovery in peak isometric force the researchers observed in their subjects after these had performed 10 sets of 10 repetitive eccentric-concentric jumps with a load of 75% of their respective body mass on their shoulders and a 20 sec rest period between each set.

For the researchers this is a model of a "muscle damaging event" (P< 0.05; ≈8% at 24-h), which was, as it was to be expected, associated with an increase in the circulating levels of the "liver enzymes"  alanine (ALT) and aspartate (AST) aminotransferase, of which many medical textbook will tell incorrectly tell you that they would indicate a strain on the liver / liver damage, when they are actually only markers of increase amino acid catabolism. The attenuation (P< 0.05) of the immediate and delayed (48-h, 72-h, or 168-h) increase in these enzymes in the vitamin D supplemented group  is thus an indicator of "muscle protective" or at least general protein sparing effects of supplementally increased vitamin D levels.

Figure 1: Strength recovery (%) from immediately post to 24 post workout, left; serum ALT values immediately after, 24h, 72h, and 168h after the exercise test (Barker. 2013).

The fact that the alleged decrease in muscle damage did not correlate with a decrease in muscle soreness does or doesn't negate the purported muscle protective effects of vitamin D. There is, as you should remember from Alex' excellent articles about DOMS, after all no direct link between ALT, AST, muscle damage and delayed onset muscle soreness, aka DOMS (learn more about DOMS). What is clear, though is that there was no consistent trend in the subjective measures of muscle soreness in the study at hand, so that Barker et al. are right, when they state that "[s]upplemental vitamin D was ineffective at abrogating muscle soreness in the SSC leg" (Barker. 2013). If it's an improvement in pain you are looking for, you'd be better off with one of the techniques Alex' discussed in part I of his article series.

Figure 2: It looks boring, but the linear association between the subjects baseline levels and the change in 25(OH)D and the ceiling effect at ~50ng/ml are also important results of the study at hand (Barker. 2013).

Bottom line: I guess you can't have it all, so I would not mourn over the lack of effect on muscle soreness. I mean, come on (!), this is one out of thousand (literally!) vitamin D studies with real-world relevance for you and me. A study that confirms that getting your 25(OH)D levels into the 50ng/ml range can actually have small, but stat. significant beneficial effects on your exercise performance (without negative effects on calcium, btw).

Furthermore, the fact that this increase to the 50ng/ml+ was achieved in all subjects with "only" 4,000IU D3 within only 35 days and was directly associated to their respective baseline level is an intruiging result on its own (see Figure 2). It does after all provide you with a rough guideline of what you have to do if your next 25(OH)D blood test comes back way below the 50ng/ml margin.

Against that background, there is no reason to frown about the fact that we still don't really know what vitamin D actually does to elicit its ameliorative effects on the performance decline in response to potentially muscle damaging stretch-shortening contraction. This was beyond the scope of the study at hand and cannot be investigated in isolated muscle cells... much contrary to the previously reported anabolic effects in the Petri dish, by the way, which may be exciting, but more or less irrelevant, if we can't observe corresponding increases in muscle hypertrophy in the real world.

References:

• Barker, T., Schneider, E. D., Dixon, B. M., Henriksen, V. T., & Weaver, L. K. (2013). Supplemental vitamin D enhances the recovery in peak isometric force shortly after intense exercise. Nutrition & Metabolism, 10(1), 69.

Lose(!) 33% Body Fat in 10 Days!? The Heavy Metal Obesity Link: Study Shows "Preventive Role" for Inorganic Cobalt in Obesity-Related Diseases.

Image 1: Cobalt - certainly not what you would expect to see at a health food store or pharmacy; with Kawakami et al.'s study this may change in the future (img Alchemist-hp)

"We are living in a toxic world!" - you have probably heard or read this sentence more than once and while I cannot deny that the environmental load of, among others, heavy metals appears to be increasing, I can however tell you that, according to a recent study from scientists from the Tukushima Bunri University in Japan, exposure to some of those heavy metals produces quite unexpected results in a rodent model of the metabolic syndrome and in lean controls. Instead of making them gain weight even more rapidly, the "toxic" (maybe we will have to reconsider that, just as we did in the case of chromium) heavy metal cobalt did not only reduce the weight of the white adipose tissue of the rodents, it increased leptin, adiponectin, and HDL-cholesterol, as well, and thusly "may have a preventive role in obesity-related diseases" (Kawakami. 2011)

This is certainly the 1001st time I am writing this, but I cannot emphasize often enough that the "high fat diet" researchers use in their studies has (in most cases) nothing to do with the Atkins or even a low-carb diet. Its main characteristic is that it is hypercaloric and high in fat and carbs. Please keep that in mind whenever you read about another study on the detrimental health effects of "high fat diets".

For 24days Kawakami et al. fed a group of seven-weeks-old male mice either a standard diet with 357.6kcal/100g or a hypercaloric (cf. red box above) high fat diet (HFD), where the latter induced obesity and dislepidemia within 2 weeks. After this initial phase, i.e. when the HFD mice were already obese and metabolically deranged, the scientists injected the animals with Sodium Arsenite (NaAsO2: 1.0 mg/kg bw), Mercuric Chloride (HgCl2: 1.0 mg/kg bw), Manganese Chloride (MnCl2: 5.0 mg/kg bw), Cobalt Chloride (CoCl2: 0, 1.3, 5.0, 7.5 mg/kg bw) or saline (control).

Figure 1: Modulatory effects of 10 days of heavy metal injection in mice on a high fat diet; values expressed as changes relative to animals on a normal diet (data calculated based on Kawakami. 2011)

Now, if you look at the data in figure 1, you will notice that the administration of Mercuric Chloride may have been most "effective" in ameliorating the HFD-induced increase in white adipose tissue (WAT) mass (HFD +70%; HgCl2 -14% vs. normal fed control), but those "fat burning" effects went hand in hand with profound elevations of the liver enzymes AST, ALT (in this case we can safely assume that these were not coming from the muscle tissue of the animals) and the blood urea nitrogen (BUN) levels, which indicate deteriorations of the kidney metabolism. Manganese and cobalt, on the other hand, had negligible or even beneficial effects (compared to HFD alone) on liver and kidney health and ameliorated the weight gain to +10% and +17%, respectively.

Figure 2: Adiponectin and leptin serum levels and mRNA expression in mice after 10 days on a high fat diet with simulatenous injection of mercury or cobalt; data expressed relative to normal fed control (calculated based on Kawakami. 2011)

What is particularly interesting about cobalt, though, is that it did not simply starve out the adipose tissue by poisoning it (like that was probably the case for mercury), but triggered exactly those metabolic adaptations scientists have been trying to provoke with drugs for years now: elevations in adiponectin and leptin (cf. figure 2), the two adipokines, researchers currently believe to be essential for successful weight loss / maintenance.

Figure 3: pAMPK/AMPK ratio after injection of different dosages of Cobalt chloride (calculated based on Kawakami. 2011)

In a follow up experiment, the scientists, also found that cobalt dose-dependently increases AMPK phosphorylation (for more on AMPK, I would like to refer you to the Intermittent Thoughts series) in white adipose tissue (WAT), muscle and liver of the animals (cf. figure 3). Of the three tested dosages, administration of 5mg/kg CoCl2 per day resulted in the most beneficial AMPK response, while with the maximal dose of 7.5mg/kg the negative / toxic effects appear to prevail (another of these bell-shaped dose-response curves, I guess).

Figure 4: Glucose tolerance test in mice on high fat diet with or without cobalt injections compared to mice on standard diet (control); values in mg/dl (data adapted from Kawakami. 2011)

Now, you are probably asking yourselves: "So what's the catch?". A brief look at figure 4 tells you that is ain't glucose intolerance, as the cobalt treated animals had the exact same response to the glucose tolerance test, as the mice on the normal diet - in other words: cobalt completely reversed the HFD induced glucose intolerance, and it did so not only without negative effects on blood lipids, but in the presence of a profound elevation of HDL levels and a reduction in LDL levels (cf. figure 5).

Figure 5: Relative (to normal fed control) changes in blood lipid in mice on a high fat diet with or without heavy metal injections (calculated based on Kawakami. 2011)

And as if that was not enough, the cobalt injections also eradicated the iincreases in free fatty acids and ameliorated the increase in triglycerides.

From the lab to the bedside?

Last but not least, and I hardly dare showing you this graph, because I would expect that some of you will already be googling a source of injectable cobalt (which would be plain out stupid, before any reliable safety data and confirmation of these results in controlled human trials are available), cobalt had almost identical effects when it was injected to the mice on the normal diet.

Figure 6: Relative changes in body composition and liver and kidney parameters due to heavy metal injection in non-obese mice on a standard diet (calculated based on Kawakami. 2011)

As figure 6 goes to show the mice lost 33% of their white adipose tissue and liver, as well as kidney function did not take a beating (HDL stayed the same, LDL decreased by -1%). Whether we will see a obesity or even just a weight-loss drug based on cobalt in the near future, does yet still seem questionable. In view of the fact that the number of "bad things" (cobalt is in fact an essential nutrient as it is the active center of vitamin B12 = cobal-amin) that have unexpectedly positive health effects is increasing day by day, we do yet obviously have to ask ourselves, whether there may be some major flaws in our current understanding of how our body works and how it deals and is effected by "toxins", oxidants and co.

Cordyceps Sinensis - Another Supplemental Non-Starter: Human Data Shows No Increase in Testosterone, No Strength Gains, No Improvements in Body Composition.

Image 1: As it turns out it's not necessary you start eating parasites (img nepaliproducts.com)

In view of the public attention adaptogens have gotten, ever since everyone is self-diagnosing him- / herself with "Central Fatigue Syndrom", I assume you will be aware that the parasitic fungus, Cordyceps sinensis (CS) that is found on larvae of Lepidoptera, and has been used for centuries in traditional Chines medicine as a tonic, has lately been marketed as powerful modulator of the hypothalamus-thyroid-pituitary axis (HTPA). Extracts from cordyceps have in fact been shown to have various biological and pharmacological actions on the liver, the kideys, the endocrine and the vascular system. It appears to stimulate erythropeoiesis (production of red blood cells) and haemopoiesis (formation of blood cellular compounds), and it exhibits immunomodulatory and anti-tumor activities.

Within the health and fitness community Cordyceps sinensis has yet been touted as "natural HCG" (human chorionic gonadotropin), because, just like the latter, it stimulates the release of luteinizing hormone and thus testosterone secretion in rodent models (mice and rat; cf. Huang. 2001; HSU. 2003; Huang. 2004). Not long ago, scientists have identified cordycepin as the active ingredient in the parasite extract - an ingredient, which, according to Pan et al., does not only stimulate steriodogenesis, but also exhibits anti-cancer effects by inducing apoptosis in MA-10 mouse Leydig tumor cells (Pan. 2011).

Illustration 1: Training protocol the subjects in the study performed  3x à week for a total of 8 weeks.

With its endocrine and haematopoietic effects, cordyceps looks like the perfect substitute for what you may call the "Tour de France performance package", i.e. the combination of testosterone (e.g. Landis) and erythropoietin (e.g. Riis). Consequently, one should expect that an 8-week (3 training sessions per week)randomized double-blind place-controlled study with sixteen previously not resistance-trained young volunteers (male, age: 19-25; BMI: 24kg/m²; body fat: 14.65%), like the one performed by Hsu et al. at the Graduate Institute of Sports Science at the National Taiwan Sports University, should show at least some measurable effects on strength and muscle gains and/or body composition of the subjects.

Figure 1: Muscle strength as maesured by 1RM after 8 weeks of strength training with (CS) and without (PL) Cordyceps sinensis supplementation (data based on Hsu. 2011).

Figure 1, however, shows no greater strength improvements in the Cordyceps sinensis (6 caps à 400mg of an extract containing 0.33% soluble protein, 5.81% sugars, 5.92µmol/g adenosine derivatives (5.92 µmol/g), 1.23µmol/g cordycepin and 8.81 µmol/g ergosterol) supplemented strength trainees (CS) compared to the subjects in the placebo group (PL). And even the +7% greater increase in 1RM strength on seated rows does not reach statistical significance.

Figure 2: Changes in body composition after 8 weeks of strength training with (CS) and without (PL) Cordyceps sinensis supplementation (data based on Hsu. 2011).

Similarly, the cordyceps supplement had no measurable beneficial effects on the accrual of lean or the loss of fat mass in the course of the 8-week strength training protocol (cf. figure 2). Although statistically non-significant, the subjects who received the CS supplement did in fact lose some lean mass and gain some fat mass... certainly not what you would have expected from the purchase of a "testosterone boosting adaptogen"!?

Figure 3: Testosterone levels after 8 weeks of strength training with (CS) and without (PL) Cordyceps sinensis supplementation (data based on Hsu. 2011).

A pros pos "testosterone boosting", as the data in figure 3 clearly shows, there was a "boost", but the latter was identical between groups and - as the body composition data in figure 2 shows - the placebo group, whose baseline testosterone levels were 7% lower than those of the subjects in the CS group, took greater advantage from this probably exercise-induced and in view of the diurnal fluctuations of serum testosterone statistically non-significant increase.

Figure 4: Changes in serum levels of BUN, Creatinine, ALT and AST after 8 weeks of strength training with (CS) and without (PL) Cordyceps sinensis supplementation (data based on Hsu. 2011).

It would be unfair though to say that the ingestion of 2.4g of Cordyceps sinensis was totally pointless. After all there was a non-negligable decrease in the purported "liver values" ALT and AST. Now, as a diligent reader of the SuppVersity you are among the few chosen ones who outsmart 99% of the general practitioners and know that the enzymes ALanine Transaminase (ALT) and ASpartate Transaminase (AST) are by no means "liver values", i.e. liver-specific. In fact, their elevation in hard training athletes is completely normal and an indicator of muscular, not hepatic, damage, as both, ALT and ALT, are expressed in skeletal muscle, as well (Petterrson. 2007). This does not change that - once again - beneficial effects that have repeatedly been observed in rodent studies did not translate to humans, but it could explain why Quinc, senior member on the Mind and Muscle Forum and a true believer in the potency of cordyceps maintains:

I can't say I have noticed any 1RM gains, but I have noticed a quicker recovery time between sets and more endurance. (Quinc. 2011)

In view of the beneficial effects on the amino acid transferase enzymes, it may well be that the scientists just measured the wrong parameters. If their subjects had participated in the Tour de France, it could well be that the CS group had survived a few kilometers more, before they had had to be picked up by one of the team vehicles ;-)

Transfats the Last Bastion of the "Bad Fats"!? Two New Studies Shed Some Light onto Their Impact on Your Health.

Image 1: The Meet the Fats campaign is part of the stultification... ah I mean educational program of the American Heart Association

Meanwhile, even mainstream dietitians are beginning to understand that fats, which have been a, if not THE staple energy source in human history are not the bad boys the anti-fat hysteria of the 1980s would make us believe. Even the American Heart Association begins to advocate the use of "healthy fats" as part of a "heart healthy diet" - unfortunately, the AHA guys still lump Sat (that is the obese guy in the left) Trans (that is the sleazy guy in green) together, although the evidence against poor Sat (who obviously represents all saturated fats) is less conclusive than that against Poly, his money-grubbing sister who would do everything for her sponsors from the corn-industry... well, be that as it may, today's charge is against Trans who is accused of arson, or whole body inflammation, to be precise ;-)

New evidence against Trans is provided by two teams of experts, one from Europe (Bendson. 2011) and the Middle East (Dhibi. 2011). In what I personally would consider battery, Nathalie T. Bendson and her colleagues from Denmark and France assigned 52 (formerly ;-) healthy women randomly to receive
either 15.7g partially hydrogenated soybean oil or control oil without any industrially produced  trans fatty acids (IP-TFA) on a daily basis. The results were not life-threatening, but certainly not desirable:

After 16 weeks, IP-TFA intake increased baseline-adjusted serum tumor necrosis factor (TNF) by 12% more in the IP-TFA group compared with controls. Plasma soluble TNF receptors 1 and 2 were also increased by IP-TFA.

With TNF-alpha's role in the modulation of endothelial and vascular smooth muscle cell function as well as endothelial cell-blood cell interaction and "the importance of such alterations for vascular dysfunction, the initiation and progression of atherosclerosis" (Kleinbongard. 2010), Bendson et al.'s asssumption that

the IP-TFA-associated increase in cardiovascular risk beyond the adverse effect explained by changes in blood lipids may be partly due to induction of systemic low-grade inflammation

is possibly correct. Nevertheless, the jury is still out on how bad TNF-alpha actually is, as its role in cardiovascular disease is actually quite ambiguous with the aforementioned low-grade inflammation on the one hand and its ability to protect your heart by ischemic conditioning on the other hand.

Figure 1: Trans fat content of fresh soy oil, oxidized soy oi and margarine (data based on Dhibi. 2011).

More comprehensive evidence comes from a rodent study by Dhibi et al. who fed 48 male Wistar rats one out of four experimental diets which were either high in fat and included 20% fresh soybean oil diet (FSO), 20% oxidized soybean oil diet (OSO) and 20% margarine (MG) or based on the standard chow (control) with a protein/carbohydrate/fat ratio of 17/62/4 for 4 weeks (Dhibi. 2011). The liver function of the rats, as evidenced by the elevated transaminase levels (ALT, AST) and the increases in alkaline phosphatase (ALP) and lactate dehydrogensase (LDH) in figure 2, took a major beating.

Figure 2: Relative changes in transaminases (ALT, AST), alkaline phosphatase (ALP) and lactate dehydrogensase (LDH) in rats after 4 weeks on diets containing 20% fresh soybean oil, oxidized soybean oil or margarine (data calculated based on Dhibi. 2011)

I suppose the sponsors of the American Heart Association won't like this observation, but it is as plain as the nose in your face that even the "transfat free, heart-healthy polyunsaturated soybean oil" led to statistically significant increases in alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) levels... what, ah... of course that is because the diet was high in fat - how could I forget that 20% fat is still way too much and humans, just like rats should eat a 62% carb 4% fat diet ... I guess that was enough sarcasm for one blogpost, so let's back to the facts, now.

Figure 3: Correlation  between  fatty  acid  isomers  in  the  diet  and  oxidative  stress
  parameters in rat’s liver and plasma hepato-specific enzymes (data based on Dhibi. 2011).

The changes in liver function were accompanied by profound reduction in antioxidant enzyme activity (SOD: superoxide dismutase; GPx: glutathione peroxidase; CAT: catalase) and increased accumulation of conjugated dienes (CD) and malondialdehyde (MDA), the respective correlations of which with the fatty acids isomers (trans fats from mono-unsaturated and poly-unsaturated fatty acids, as well as total transfat content) are plotted in figure 3.

Image 2: Rat liver histology.

Due to its scale (only two different transfat profiles, i.e. oxidized soybean oil and margarine) the study's statistical power is yet so small that we can only make a definite case against the total transfat content for decreases in catalase activity and oxidized polyunsaturated fatty acids for the accumulation of conjugated dienes. With correlations in the the >0.5 and <-0.5 range for many other suspects and crimes, I will yet leave it up to you, the jury, to decide, which members of the transfat family (I suppose the American Heart Associations Trans character must have a whole bunch of children, then - just like in every honorable mafia family ;-) are to be held responsible for which of these crimes against health, the ultimate result of which you see in the histological changes in the livers of the rats fed with oxidized soy oil (OS) and margarine (MG)... So, members of the Jury, on the Case of Trans Fatty Acid (and his mafia clan) vs. the Suppversity, what you say?

Liver Enzymes the #1 Marker of Insulin Resistance!? Plus: What Does the Correlation Bettwen HbA1C & ALT, AST and GPT Tell Us About Diabesity?

Just like type II diabetes, NAFLD is a life-style disease.

While it may not be obvious, today's SuppVersity post is very closely related to Sunday's post about supplements to battle insulin resistance. The recent revelation that the liver enzymes alanine transaminase (ALT aka GPT), aspartate transaminase (AST aka SGOT) and gamma-glutamyl transpeptidase (GGT aka gamma-GT) and not free fatty acid levels are the most reliable predictors of insulin sensitivity in overweight and obese, non-diabetic adults does after all show clearly support the notion that we (scientists, doctors, patiens) should pay much more attention to the liver. It's the liver that controls blood glucose, lipids and even our hormone levels, not the adipose organ. Therefore it is in the liver, our metabolic organ #1, is where the dark diabesity magic happens.

Heal the liver, cure the insulin resistance

Just in: A recent Stanford study shows that the use of VEGF inhibitors that are usually prescribed as cancer drugs can help diabetics manage their blood glucose levels, by increasing the expression of a protein (HIF-2alpha) that's usually expressed in response to hypoxic cell death and will - as a side effect - increase the expression of insulin receptors and thus restore hepatic insulin sensitivity and the optimal function of all the regularory processes that depend on it (Conger. 2013).

Usually you will think of being overweight and undermuscled, of insulin resistant myocytes (muscle cells) and adipocytes (fat cells) and about eating too much simple sugars, whenever someone is talking about the etiology of insulin resistsance. NAFLD, i.e. non-alcoholic fatty liver disease, on the other hand, is still often thought of as one of the long-term side effects of T2DM.

A recent study from the Children's Nutrition Research Centre at the University of Queensland does however suggest that the connection between having a messed up liver and being insulin resistant does not just start much earlier, than previously thought, but is probably also directly involved in the progression from being slightly insulin resistant to being a real diabetic.

Certainly, central adiposity (=high amounts of visceral, inter-organ fat) is and will always be one of the key risk factors for the development of insulin resistance and its progression towards full blown type 2 diabetes. Whether this is mainly a function of the spatial proximity of the constantly inflamed visceral fat depot to the liver is still a matter of current research. What we do know already is however that the presence of NAFLD is an independent risk factor for cancer and heart disease (Guebre-Egziabher. 2013)

Once the liver has taken a beating, the downstream effects are profound

One thing that's for sure, though, is that the downstream effect that occur, whence the liver is beginning to take a hit are profound:

• endocrine imbalances resulting from errors in the cytochrome enzymatic cascade that's responsible (among other things) for the conversion and clearance of all sorts of hormones
• messed up cholesterol levels and lipid profile with increases in LDL and VLDL lipoproteins and decreases in HDL
• chronically elevated  glucose levels due to lowered glycogen storage capabilities and a lack of control of the gluconeogenic processes in the liver that are no longer shut off when insulin is present, 
• increased fatique that's mediated at least in parts by the accumulation and build-up of toxic metabolic byproducts and environmental toxins the liver cannot handle any longer

The list goes on and on and I bet you that all 40 overweight and obese (body mass index≥25.0kg/m²) subjects with elevated ALT and AST values in the study at hand were already suffering from these problems.

Figure 1: Correltion coefficients for blood glucose, blood insulin and HbA1C (Gray. 2013)

No wonder that the data in Figure 1 confirms that there is no other parameter - including BMI, adiponectin, blood lipids, i.e. LDL, HDL, etc., I-CAM or ghrelin (the latter are not shown in the figure) that come remotely close as far as their reliability as markers of insulin resistance and the corresponding elevations of the long-term glucose marker HbA1C are concerned.

This does also mean that the study at hand would refute the results of previous experiments which suggest that the mobilization of FFA in the circulation promotes insulin resistance, however

Please remember: AST, ALT & CK will be elevated after workouts so take a couple of days off before you get blood work done.

"this [particular] study found no direct correlations between FFA and markers of insulin sensitivity. Furthermore, there were no clear correlations between markers of insulin sensitivity (glucose, insulin, HbA1C, or HOMA scores) and physical activity or self-reported fatigue. Fatigue scores were correlated with C-reactive protein, suggesting that inflammation may play a role, although there was no significant correlation with ICAM-1"(Gray. 2013)

Overall the currently data from the Gray study does therefore clearly support the notion that there is a  direct "link between liver function, adiposity, and the development of IR [insulin resistance]" (Gray. 2013) that goes well beyond the common understanding of 'adiposity begets insulin resistance, insulin resistance triggers NAFLD'.

---

Figure 2: Liver tissue in rodents fed a hypercaloric high sucrose diet with (B) and w/out (A) taurine.  Taurine inhibited the development of hepatic steatosis (Gentile. 2011)

Bottom line: While the results of the study at hand certainly shift the focus away from the fat cells and towards the liver, they do not change the fact that "insulin resistance and the subsequent development of T2DM remain primarily lifestyle disorders" (Gray. 2013). In other words, if you followed all the "non-quick fix" tips from part I of the "Restore & Keep Insulin Sensitivity" series, in the first place - you would not have to worry about insulin resistance or non-alcoholic fatty liver disease (NAFLD).

Still, with a new emphasis on the involvement of the liver, the way we approach insulin resistance with supplements may in fact change... Although, when you come to think about it two of the top-supplements from the first and second serving of insulin sensitizing supplements, you will realize that many of them (e.g. alpha lipoic acid, taurine, berberine, etc.) are also known "liver protectors" (Gentile. 2011; Valdecantos. 2012).

Similar data on both improvements in liver health and insulin sensitivity is available for NAC (Haber. 2003) and milk thistle (Maghrani. 2004), as well. It is thus not too far off to assume that whatever you do to protect your liver is also going to have beneficial effects on your glucose metabolism; and what's even better it will improve your blood lipids, make your that your endocrine system works optimally, protect you against the constant assault of environmental toxins and reduce your chance of being carried off by diabetes, cancer and heart disease... still not convinced? Well, then think about something my good friend Carl Lanore likes to say "liver has the words 'to live' or 'life'" in it ;-)

References:

• Gentile CL, Nivala AM, Gonzales JC, Pfaffenbach KT, Wang D, Wei Y, Jiang H, Orlicky DJ, Petersen DR, Pagliassotti MJ, Maclean KN. Experimental evidence for therapeutic potential of taurine in the treatment of nonalcoholic fatty liver disease. Am J Physiol Regul Integr Comp Physiol. 2011 Dec;301(6):R1710-22.
• Gray B, et al., Liver enzymes but not free fatty acid levels predict markers of insulin sensitivity in overweight and obese, nondiabetic adults, Nutr Res. 2013 [published ahead of print]
• Guebre-Egziabher F, Alix PM, Koppe L, Pelletier CC, Kalbacher E, Fouque D, Soulage CO. Ectopic lipid accumulation: A potential cause for metabolic disturbances and a contributor to the alteration of kidney function. Biochimie. 2013 Jul 27.
• Haber CA, Lam TK, Yu Z, Gupta N, Goh T, Bogdanovic E, Giacca A, Fantus IG. N-acetylcysteine and taurine prevent hyperglycemia-induced insulin resistance in vivo: possible role of oxidative stress. Am J Physiol Endocrinol Metab. 2003 Oct;285(4):E744-53. Epub 2003 Jun 10.
• Maghrani M, Zeggwagh NA, Lemhadri A, El Amraoui M, Michel JB, Eddouks M. Study of the hypoglycaemic activity of Fraxinus excelsior and Silybum marianum in an animal model of type 1 diabetes mellitus. J Ethnopharmacol. 2004 Apr;91(2-3):309-16.
• Conger K. Approved cancer drug potentially could help treat diabetes, researchers find. <http://med.stanford.edu/ism/2013/september/diabetes.html> retrieved September 16, 2013.
• Valdecantos MP, Pérez-Matute P, González-Muniesa P, Prieto-Hontoria PL, Moreno-Aliaga MJ, Martínez JA. Lipoic acid improves mitochondrial function in nonalcoholic steatosis through the stimulation of sirtuin 1 and sirtuin 3. Obesity (Silver Spring). 2012 Oct;20(10):1974-83.

Rhabdo & Liver Failure or Just an Intense Leg-Workout? What Your Doctor Does not Know About AST, ALT and CK - CK-Values of 10,000 IU+ Will not Necessarily Kill You

Intense training sessions will always increase ALT, AST & CK. Unfortunately doctors will never learn that in med-school.

I don't remember the exact number, but I am afraid that I have promised to write and post this article at least a dozen of times. After getting another three questions pertaining to elevated AST, ALT and CK values on the last lab report within the last two weeks, only, I think it's about time to live up to this promise and translate + update an older, German article, I've written about the very same subject several years ago (note: I decided against translating it, but will write a complete new article - with updated facts, obviously).

Let's first see what we are actually talking about. Typically you went for a routine blood work and get a call from the nurse that there was something wrong with your "liver"- or "muscle-enzymes". You are summoned into the doctor's office, where your concerned doctor is already waiting at his desk looking at you as if you were a criminal and an idiot: "Do you do steroids?"

No, creatine is not the reason your creatine kinase levels are increased?

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Build 'Ur Own Buffered Creatine

That's the standard questions you will hear, when you enter the office - usually with this accusing undertone that says: "There you have it, now you have to suffer the consequences". Usually, this is the moment, when your mind starts racing: "What does he want, I did never... oh, my! Maybe the wise-asses over at the FDA were right after all? Was one of the supplements I took tainted..."

*STOP!* Agonizing about what you could possibly have done wrong is not going to help you here. This is all the more true if we take into account that tit is very likely that you did not do anything wrong at all. Against that background I'd suggest you stop panicking and start reading today's SuppVersity article, which will inform you about (1) what exactly AST, ALT and CK are, (2) why your doctor is so concerned about their elevation, and (3) how you can find out if he is rightly concerned or you are in the midst of a fitness version of Much Ado About Nothing.

What exactly are AST, ALT and CK & how do you read them (in contrast to your Dr)

On the text-book level this question is easy to answer. I guess it'd be best if we started with the proper name, of which you'll see that they already give away half of the solution to the mystically ALT, AST and CK elevations and the rarely measured but often likewise elevated lactate dehydrogenase and myoglobin levels.

Table 1: Time in h before ALT, AST, etc. (➚) exceed reference, (☆) peak, (➘) are back to normal (Petterson. 2007)

• ALT - alanine transaminase
  formerly SGPT, serum glutamic-pyruvic transaminase
• AST - aspartate transaminase
  formerly SGOT, serum glutamic oxaloacetic transaminase
• CK - creatine kinase
• LD - lactate dehydrogenase
• Myoglobin - iron- and oxygen-binding protein

Instead of tackling them alphabetically, we will start with "C" as in "creatine kinase", because this muscle enzyme, every SuppVersity reader knows as a frequently used, but pretty unreliable indicator of muscle damage is - at least in my experience - the #1 reason you may receive an overanxious call from your doctor's receptionist.

Elevated CK = Intense workout ↛ rhabdomyolysis ⇆ cardiac infarction

Did you ever notice that most lab reports list two types of creatine kinase? No? Usually they are listed as CK-MM and CK-MB and denote two out of a total seven isoforms scientists and doctors who specialize in muscular disorders are regularly testing for:

• 

  Suggested Read: "Why training over the full ROM counts" | more

  CKB ➫ brain | BB-CK
• CKBE ➫ ectopic expression | n.a.
• CKM ➫ all muscle | MM-CK
• CK-MM  ➫ mostly skeletal muscle
• CK-MB ➫ mostly heart muscle
• CKMT1A, CKMT1B ➫ ubiqu. mitochondrial CK
• CKMT2 ➫  sarcomeric mitochondrial CK

For your purposes the funky mitochondrial CK values are irrelevant and testing brain CK levels is usually not necessary either. Knowing your CK-MM and CK-MB, however, can come very handy to exclude identify which muscles are affected (note: Being lovesick does not lead to elevated CK-MB levels ;-)

The CK-MM differntial diagnosis: Have you sustained a cardiac infarction?

I should have mentioned it before, but I believe you are smart enough not to take this article as an invitation to recklessly ignore your Dr's calls. The first thing you would want to do, when the doctor's receptionist is calling it to ask her for the exact CK-MM and CK-MB values.

Tip #1: Always insist on a print-out of all your lab values. The receptionist may say that she cannot pass confidential health information via the telephone, but neither she nor your doctor have the right to keep all or parts of your medical records from you. You paid for the lab report, so it's your property and the least your doctor can do, is handing you a copy or printout of the results. File the sheets in a folder for reference and make sure you never lose that folder.

Their ratio, i.e. the ratio of "skeletal specific" and "heart speficic" creatine kinase, can tell you whether it makes sense / is necessary to further investigate the presence of weak and not even noticeable cardiac infarction.

• A follow up on your heart health is indicated, if CK-MB is elevated and higher than 5% of the total CK (CK-MM) value | example: CK-MB = 200 + CK-MM = 1000

Despite the fact that the 'text-book' ratio of CK-MM to CK-MB for muscle is 99:1, the balance can be slightly off in response to intense exercise, even in the absence of cardiac damage. On the other hand, ca. 25% of the patients with acute myocardial infarctions and symptoms like chest pain, shortness of breath etc. don't even have elevated CK-MB levels, when they present in the ED (Karras. 2001).

Irrespective of all uncertainties, it is very unlikely that your heart has actually taken a beating, if you are and have always been symptom free and have a high CK-MM:CK-MB ratio. This is particularly true if you have been training in the days before the blood draw.

Figure 1: Serum creatine kinase levels (in µkat/L) of perfectly healthy young men after a single intense full-body workout (left); exercise selection (right) - all exercises were performed for 3 sets à 12 reps with 70% of the 1-RM max, the average total weight moved during a single workout was >10 metric tonnes (Petterson. 2007)

As the data in Figure 1 goes to show you, increased levels of creatine kinase in response to strenuous physical activity, such as the standardized resistance training regimen (full body, 3x12 reps on each exercise, training to failure, 60s rest between sets; total training volume in weight units 10,500kg) in a 2007 study by Petterson et al. are perfectly normal. If you look closer, you will also relize that ...

1. the creatine kinase elevations peaked 3-4 days after the workout
2. the peak values vary from 'well within range' (= within the green box) to 6x above normal

In subjects 9, 11, 12 and 15, who had CK values that peaked 158x-278x higher than the official upper reference limit for the tests Petterson et al. used (note: most labs will use IU references, where the 3.2 µkat/L from Petterson's study would equal 206IU/L), the amount of myoglobin, which is likewise an indicator of severe skeletal muscle damage, was even above the upper detection limit (2999µg/L). Without the accompanying information that the previously untrained subjects have been hitting the weights, it is thus more than likely that most doctors who are looking solely at the lab raport would assume the 15 subjects from the study at hand were suffering from borderline to full-blown Rhabdomyolysis (Greek: ῥαβδω rhabdo- striped; μυς myo- muscle; λύσις –lysis).

Tip #2: Tell your doctor, when you've been lifting before the blood draw! If your medical practitioner does not know you and your training practices you can hardly blame him for being concerned about your health, when your creatine kinase levels are 10x-200x elevated.

It goes without saying that neither the 'low -', nor the four 'high responders' in the Petterson study had to be transferred to the emergency room for impeding kidney damage in response to full-blown rhabdomyolysis and that despite the fact that their levels were - due to their low training status - much more pronounced than those of the average athlete.

If you train like an athlete you will have the creatine kinase levels of an athlete

Irrespective of the protective effects of regular exercise, even professional athletes have chronically elevated creatine kinase levels. Yet, despite the fact that a 1984 study by Jaffe et al. was by no means the first to conclude that a substantial fraction of professional athletes have elevated CK-MM and CK-MB levels (Jaffe. 1984), Vassilis Mougios' 2007 paper "Reference intervals for serum creatine kinase in athletes" was the first to present a set of scientifically verified reference intervals for creatine kinase levels in athletes (Mougios. 2007). 

Figure 2: Experimentally verified CK values in male and female athletes and calculated CK reference ranges for athletes and non-athletes (Mougious. 2014))

If you are training like an athlete, the reference values Mougious calculated based on data from 483 male athletes and 245 female athletes (aged 7–44 years; see Figure 2) are thus a much better benchmark to determine whether you should or shouldn't be concerned about the red exclamation mark on your lab report.

What you (could) have learned today: Before we are about to take a closer look at the "liver values" ALT and AST, next week, let's briefly summarize what you you could have learned today that may help you, when you're summoned to the doctors office and your doctor wants to call the ambulance to save your kidneys from the consequences of your "rhabdo":

• Elevations of >10,000IU can occur and last for days after intense workouts.
• Regular training lowers the exercise induced CK leakage from the 10,000+ range back to the 500-1,500IU range.
• Nevertheless, the CK levels of athletes will always be higher than that of sedentary controls.
• It can take up to a week for your CK levels to return to baseline. If you want to make sure that your high CK levels are caused by exercise and nothing else, you will have to take a full week (best 14-days) off, before you retest.

Before you go, I would like to point out that your doctor is right to be concerned. Even if he knew about the effects of exercise (most doctors don't), 99% of his patients are not going to the gym and doing breathing squats for reps. For those people CK-values in the 1k+ range are a serious cause of concern.

Reference:

• Jaffe AS, Garfinkel BT, Ritter CS, Sobel BE. Plasma MB creatine kinase after vigorous exercise in professional athletes. Am J Cardiol. 1984 Mar 1;53(6):856-8.
• Karras DJ, Kane DL. Serum markers in the emergency department diagnosis of acute myocardial infarction. Emerg Med Clin North Am. 2001 May;19(2):321-37. Review.
• Mougios V. Reference intervals for serum creatine kinase in athletes. Br J Sports Med. 2007 Oct;41(10):674-8. Epub 2007 May 25.