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marylin monroe
Showing posts with label alpha lipoic acid. Show all posts
Showing posts with label alpha lipoic acid. Show all posts

Science Round-Up Seconds: PGC-1 Alpha 4 Unlocks Muscle Growth, Alpha Lipoic Acid & Dietary N-6 Overload, Aspirin & Other NSAIDs Your Liver & Overall Mortality

Myotubes under the microscope - vehicle (top, normal size), clenbuterol (+100% protein content, middle), clenbuterol + PGC1a4 inhibition (+50% protein content, bottom)
Actually I would hope that you have by now already listened to yesterday's installment of the SuppVersity Science Round-Up. If you did, you are one of a group of highly privileged trainees who already knows why not all PGC1-alpha is created equal and how the alpha-4 isoform does appear to be the missing link between myostatin, on the one hand, and IGF-1 on the other. If you have already listened to the show, you may also have noticed that I was pretty excited about the publication of the Ruas paper (Ruas. 2012). Firstly this study has almost everything you could expect from cutting edge science: A in-vitro tudy to elucidate the basic mechanisms, an in-vivo rodent study involving both wild-type and genetically modified mice and - much to my own surprise - an in-vivo exercise part. And secondly, the results provides the missing link I personally have been looking for, when I wrote the Intermittent Thoughts on Building Muscle Series (click here for the summary and overview of the individual parts) - the link between IGF-1 and myostatin and the reason working out will always make you stronger and bigger and not bigger and weaker, as it is the case in the poor myostatin-knockout mice. Ah... I almost forgot: Third- and lastly, the fact that the researchers induced their hypertrophy effects in a specific part of their study by administering clenbuterol, which then did what I have likewise written about before (see "The Clenbuterol Myostatin Connection"), which is decreasing the expression of myostatin and thus producing skeletal muscle hypertrophy, yet as we now know not directly, but rather in consequence to its PGC-1 a4 promoting effects (+400%!) and the respective downstream effects on myostatin, which were non-existent, when the scentsts blocked PGC-1 a4 expresson (see images on the right)... 

I guess, you need to be somewhat geeky to find that exciting, but anyway. If you don't I'd still recommend you take a listen to the show - it's well worth it, even for totally normal exercise enthusiasts ;-)

And now for the actual seconds

Since the Ruas study appeared on my "radar" quasi in the last minute. We did not get to talk about several of the things I have announced and just to make sure you are not going to be disappointed, once you have gone through the following findings, I will address the acidity / alkalinity issue in a separate post in the future. It requires some more detailed elaborations - but the wait is going to be worth it ;-)

ALA rescues the liver from toxic N-6 overload

Actually this item would have fitted in pretty neatly with the things I explained about the different isoforms of PGC-1 alpha and how they appear to be regulated by diet / energy energy intake and expenditure via AMPK, on the one hand, and MAPKs, i.e. 'switches' that are triggered by stress, as the wear and tear of exercise, for example would be one. Now, we have already talked about the latter aspect, so that I guess I can get right to the not so novel, but still intriguing insights a  group of scientists from the Cerrahpaşa Medical Faculty Medical Biology Department at the Istanbul University  bring to the table as far as the former pathway is concerned (Kaya-Dagistanli. 2012).


In their 8-week experiment, Kaya-Dagistanli and her colleagues confirmed two things, of which I don't even know what would be the more important result:
Figure 1: Fibrosis and fatty degeneration scores in the control group (normal diet) and the high omega-6 group w/ and w/out ALA Kaya-Dagistanli. 2012)
  1. The administration of a diet that contained 60% fat from safflower oil, 20% kcal carbohydrate and 20% kcal protein (51% of the fat from n-6, n-6:n-3 ratio of 15.4) did produce major changes not only in the GSH levels, a measure of the total antioxidant capacity in the livers of the 24 Wistar rats, the relatively short time span was even enough to increase the fibrosis and fatty degenration scores by ~10x (see figure 1) compared to the rodents on the low fat standard chow in the control group (only 12% fat total, 39.1% n-6, n-6 : n-3 ratio of 9.3).
  2. The addition of 35 mg/kg DL-alpha lipoic acid (human equivalent: 5.7mg/kg; ~500mg/day) from week 4 to week 8 reduced both the negative effects of the omega-6 overload on GSH and the pathological degeneration of the liver, but could not fully restore it to normal levels.
Not just in view of the fact that ALA could not totally blunt the detrimental effects of the n-6 diet, but also in view of the fact that rodents on the regular diet did not see any benefits (remember: if you are not fat and metabolically deranged ALA ain't necessary, probably counterproductive; "Lean & Muscular W/ alpha lipoic acid?"), I personally gravitate towards (1), as far as the more significant finding is concerned. After all, it goes to show you that you simply have to the absolute (and relative?) amount of omega-6 fatty acids in your diets and can go without any such supplements as high dose fish oil and/or alpha lipoic acid. Bottom line: Don't bang your head against the wall and you won't need a helmet ;-)

NSAIDs liver cancer, chronic liver disease and other nasty ways to die

It's quite a happy coincidence that the December issue of the Journal of the National Cancer Institute held yet another intriguing study on the potentially beneficial health effects of the use of NSAIDs, which had been addressed in August already, when Jacobs et al. have gotten quite some public attention with their paper on aspirin use and the decrease in all-cause mortality (Jacobs. 2012). The novel paper that's based on prospective data on 300,504 men and women aged 50 to 71 years who had participated in National Institutes of Health-AARP Diet and Health Study and has been written by a group of scientist who actually work at the National Cancer Institute (Sahasrabuddhe . 2012), did not deal with a slightly different research question, i.e. does the use of aspirin and other NSAIDs offer protection against liver cancer (hepatocellular carcinoma) and death due to chronic liver disease, it also offers a slightly more sophisticated analysis of the (a) the frequency of NSAID use and potential interactions. Still, I decided to summarize the main findings of both, also in view of the fact that we are dealing  wih different cohorts (study subjects in the Jacobs paper were 100,139 men and women with no history of cancer in the Cancer Prevention Study II Nutrition Cohort).
Figure 2: Main results (hazard ratios) of two of the latest epidemiological studies into the effects of aspirin and other NSAIDs on liver cancer, death due to chronic liver disease (left) and aspirin alone on all cause mortality (right; data based on Sahasrabuddha. 2012 & Jacobs. 2012)
With the "demarcation lines" being present at 1.0 (meaning normalized risk) it is pretty easy to see that at least with respect to liver health and all-cause-mortality and solely based on epidemiological evidence, aspirin appears to be one of those "miracle drugs" everyone can benefit from. We have to be cautious however, when we compare everyone with ourselves, after all - and pretty much stands out of question - the protective effects of aspirin and the slightly less unambiguous and as far as hepatic cancer goes, even detrimental effects of other NSAIDs are mediated by...
  • the modulation of inflammation via inhibition of the COX enzymatic pathways necessary for the synthesis of prostaglandins
  • the ensuing decreases in epithelial proliferation and angiogenesis, as well as an
  • increased apoptosis (regular cell death) and ameliorations in the inflammatory response and inflammatory cytokines via non-COX mediated pathways
Now, if you remember the previous study about ALA and how useful it can be if you are the kind of person who hammer his head... ah, I mean who still has not gotten the message that the formerly hailed omega-6 PUFAs from the "healthy corn and vegetable oils" are not a bit healthy, on the one hand, and how superfluous (if not detrimental) the same supplement is for someone who does not exhibit exuberant inflammation to begin with, this certainly does put the results into perspective.



Apropos perspective, I am not quite sure how you like the perspective that this is it, for today, but I would be pleased if you took that as an incentive to come back tomorrow and check out the next installment of SuppVersity On Short Notice and for the time being, I still have a couple of facebook news, I am sure you will enjoy:
  • Scientists from the UK and New Zealand do pretty damn good job pimping the sales of low fat products - learn what the press release does not tell you (read more)
  • German scientists find: Bisphenol A clogs calcium channels - don't know if you'd agree with them that the good news is that it appears to be reversible (read more)
  • Grazing is for fat cows, only  - women who want to be lean better eat like a human, i.e. three square meals not more that's it - this will also help with blood triglyceride management (read more
  • more, much more ;-) 
Any you know, facebook is a fast media, so expect more news to be posted even before the official next SuppVersity article will hit the main site ;-)

    References:
    • Jacobs EJ, Newton CC, Gapstur SM, Thun MJ. Daily aspirin use and cancer mortality in a large US cohort. J Natl Cancer Inst. 2012 Aug 22;104(16):1208-17.
    • Kaya-Dagistanli F, Tanriverdi G, Altinok A, Ozyazgan S, Ozturk M. The effects of alpha lipoic acid on liver cells damages and apoptosis induced by polyunsaturated fatty acids. Food Chem Toxicol. 2012 Nov 28.
    • Ruas et al. APGC-1aI soform Induced by Resistance Training Regulates Skeletal Muscle Hypertrophy. Cell, December 7, 2012; 151:1319–1331. 
    • Sahasrabuddhe VV, Gunja MZ, Graubard BI, Trabert B, Schwartz LM, Park Y, Hollenbeck AR, Freedman ND, McGlynn KA. Nonsteroidal Anti-inflammatory Drug Use, Chronic Liver Disease, and Hepatocellular Carcinoma. J Natl Cancer Inst. 2012 Dec 5;104(23):1808-14.

      When Timing Matters - Alpha Lipoic Acid: Works Best, When it's Taken 30min Before a High Carb Meal. Can Easily Make You Hypo, if You Forget the Carbs or Have it on Empty

      A salad like the one the beautiful young lady is about to eat is not the kind of meal that would require pre-meal lipoic acid supplementation.
      Although I am not convinced that alpha lipoic acid (lipoic acid aka ALA) will actually partition glucose preferentially to muscle, because studies indicate that it will increase glucose uptake in fat cells, as well (and that at 10x higher glucose transporter expressions in fat vs. muscle cells; Estrada. 1996; Konrad. 2001), there is still good evidence that it can help people with (full-blown) insulin resistance stash away the glucose they consume, more effectively. To do so, it would appear logical that alpha lipoic acid has to be consumed in the vicinity of a meal.

      The question I am trying to answer today is thus: When do you have to take your alpha lipoic acid to ensure optimal glucose "repartitioning"?
      Learn more about the effects of your diet on your body composition at the SuppVersity

      Ladies, Beware! Dieting Makes Gymnasts Fat.

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      5 Tips to Improve & Maintain Insulin Sensitivity

      Carbohydrate Shortage in Paleo Land
      The answer to this question - and I should not have to tell you that - will obviously depend on the pharmacokinetics of alpha lipoic acid. Pharmacokinetics, as they were observed in healthy, not in sick people.

      Pharmacokinetics as they were described by Jens Teichert, Robert Hermann, Peter Ruus, and Rainer Preiss in a 2003 article in the Journal of Clinical Pharmacology (Teichert. 2003). In the corresponding experimental trial the plasma concentration-time courses, urinary excreted amounts, and pharmacokinetic parameters of alpha-lipoic acid metabolites were evaluated in 9 healthy volunteers after multiple once-daily oral administration of 600 mg racemic (=regular) alpha-lipoic acid.
      "The primary metabolic pathways of alphalipoic acid in man, S-methylation and β-oxidation, were quantitatively confirmed by an HPLC-electrochemical assay newly established prior to the beginning of this study. Major circulating metabolites were the S-methylatedβ-oxidation products 4,6-bismethylthio-hexanoic acid and 2,4-bismethylthiobutanoic acid, whereas its conjugated forms accounted for the major portion excreted in urine." (Teichert. 2003)
      The first important finding is that here was no statistically significant difference in the pharmacokinetic parameters Cmax, AUC, and t_max between day 1 and day 4. That's relevant because it means that any prescription we develop based on the results will remain valid for one week, one month and probably the rest of your life.
      No, there is no evidence that R-ALA is better than regular ALA: While there is one study showing that a high dose of S-ALA, the second of two isomeres you will find in regular ALA supplements will not increase the glucose uptake into insulin resistant muscle cells in the petri dish (Streeper. 1997), there is no study as of yet that would prove the superiority of R-ALA over racemic mixtures of both R-ALA and S-ALA in human beings. And effects such as those described by Streeper et al. for R-ALA have also been observed for regular ALA dozens of times (Jacob. 1996; Khamaisi. 1997; Weinstein. 2001).
      Moreover, despite the prolonged half-lives of the major metabolites compared to the parent drug, no evidence of accumulation was found. Unlike creatine, for example, alpha lipoic acid can thus not be cycled. It has to be taken continuously.
      Illustration 1: At least after only four days on ALA its pharmacology in healthy human subjects doesn't change significantly - taking it 30 min before a meal thus appears to be a valid strategy even for chronic use (Teichert. 2003)
      The data the scientists collected also indicate that the major pathway through which ALA is elminates is not, as you may expect urinary excretion. In the study at hand, only 12.4% of the administered dose were recovered in the urine after 24 hours as the sum of alpha-lipoic acid and its metabolites. As Teichert et al. point out,...
      "[t]he results of the present study revealed that urinary excretion of alpha-lipoic acid and five of its main metabolites does not play a significant role in the elimination of alpha-lipoic acid."
      This does also imply that biliary excretion, further electrochemically inactive degradation products, and complete utilization of alpha-lipoic acid as a primary substrate in the endogenous metabolism are more likely candidates for the primary pathways of excretion.
      Do you remember? ALA has only recently been shown to normalize the high fat diet induced synchronization issues of the internal clocks in rodents (learn more). Interestingly, this was achieved without having to time the ingestion of ALA by simply adding 0.2% lipoic acid to their diets. Against that background it is unlikely that "untimely" supplementation will, as it was the case for meltonin (learn more) - mess with the circadian rhythm. The issue of potential hypoglycemic episodes, on the other hand, is very real and should not be taken lightly - specifically by those of you who don't belong to the ever-increasing (still) minority of insulin-resistant (pre-)diabetics.
      What's really relevant is yet not how alpha lipoic acid leaves your body, but rather the time it takes for the serum levels to peak. A time-span, Teichert et al. quantify as ~30 minutes. A value that is in line with the timing a group of German scientists used in the first (and AFAIK only) human study that produced results that would warrant the hype surrounding the use of alpha lipoic acid as insulin sensitizers (Jacob. 1999).

      Figure 1: Increase in insulin-stimulated glucose disposal according to treatment (Jacob. 1999)
      In said study seventy-four patients with type-2 diabetes were randomized to either placebo (n = 19); or active treatment in various doses of 600 mg once daily (n = 19), twice daily (1200 mg; n = 18), or thrice daily (1800 mg; n = 18) α-lipoic acid.

      By the means of an isoglycemic glucose-clamp the authors of the study were able to confirm the results of a previous observations of an increase of insulin sensitivity in type-2 diabetes after acute and chronic intravenous administration of ALA.

      The data in Figure 1 (bottom) does yet also tell you that the alpha lipoic treatment did not work for all of the seventy four-patients; and interestingly, the efficacy didn't depend on the amount of the of ALA that was used - more is thus, once again, not necessarily better.

      The same timing was used in a 2011 study by Koh et al. who conducted a randomized, double-blind, placebo-controlled, 20-week trial, 360 obese individuals with 1200 or 1800 mg/d of alpha-lipoic acid or placebo.
      Figure 2: Changes in Body weight over the course of the 20-week study (Koh. 2011)
      Due to the longer duration of the study the scientists were also able to determine the one thing everyone is interested it: weight loss! As you can see in Figure 2, the subjects in the high dose alpha lipoic acid group lost a significant amount of weight, regardless of the fact that they were not even dieting. Needless to say that you cannot expect similar results if you are not obese and diabetic, but if you are significantly overweight or (pre-)diabetic, the Koh study provides a strong incentive to go and buy a bottle of 600mg ALA tablets.
      Figure 3: ALA can trigger hypoglycemic episodes, because it blunts gluconeogenesis in the liver (Khamaisi. 1999)
      Timing matter for non-diabetics, as well: And even if you are neither one, nor the other, timing matters. Taking alpha lipoic acid before a workout to increase AMPK and hope for increases in fatty acid oxidation is only going to increase your risk of going hypoglycemic (with all its recently discussed potentially obesogenic negative side effects). Similar effects can be expected if you've been fasting, then pop a couple of ALA pills and wait another 1-2h before you're finally giving your body what it will be craving for: sugar.

      You think that's just biased bullshit? Well, take a parting look at the data in figure 3. Do you really want to be that normoglycemic guy who ends up in acute hypoglycemia because ALA increased his cellular glucose uptake and inhibited gluconeogenesis, i.e. the production of glucose from fat and/or amino acids in the liver, to an extend that left him hypo?

      I don't think so. And I am pretty sure, the ravenous cravings and low energy levels you may be experiencing during and after these episodes are not going to help you achieve the perfect physique you may be thriving for | Comment on Facebook!
      References:
      • Estrada, D. Elizabeth, et al. "Stimulation of glucose uptake by the natural coenzyme α-lipoic acid/thioctic acid: participation of elements of the insulin signaling pathway." Diabetes 45.12 (1996): 1798-1804. 
      • Jacob, Stephan, et al. "The antioxidant α-lipoic acid enhances insulin-stimulated glucose metabolism in insulin-resistant rat skeletal muscle." Diabetes 45.8 (1996): 1024-1029.
      • Jacob, S., et al. "Oral administration of rac-α-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled pilot trial." Free Radical Biology and Medicine 27.3 (1999): 309-314. 
      • Khamaisi, Mogher, et al. "Lipoic acid reduces glycemia and increases muscle GLUT4 content in streptozotocin-diabetic rats." Metabolism 46.7 (1997): 763-768.
      • Khamaisi, Mogher, et al. "Lipoic acid acutely induces hypoglycemia in fasting nondiabetic and diabetic rats." Metabolism 48.4 (1999): 504-510.
      • Koh, Eun Hee, et al. "Effects of alpha-lipoic acid on body weight in obese subjects." The American journal of medicine 124.1 (2011): 85-e1. 
      • Konrad, Daniel, et al. "The Antihyperglycemic Drug α-Lipoic Acid Stimulates Glucose Uptake via Both GLUT4 Translocation and GLUT4 Activation Potential Role of p38 Mitogen-Activated Protein Kinase in GLUT4 Activation." Diabetes 50.6 (2001): 1464-1471. 
      • Streeper, Ryan S., et al. "Differential effects of lipoic acid stereoisomers on glucose metabolism in insulin-resistant skeletal muscle." American Journal of Physiology-Endocrinology And Metabolism 273.1 (1997): E185-E191.
      • Teichert, Jens, et al. "Plasma kinetics, metabolism, and urinary excretion of alpha‐lipoic acid following oral administration in healthy volunteers." The Journal of Clinical Pharmacology 43.11 (2003): 1257-1267. 
      • Weinstein, Randi B., Hans J. Tritschler, and Erik J. Henriksen. "Antioxidant alpha-lipoic acid and protein turnover in insulin-resistant rat muscle." Free Radical Biology and Medicine 30.4 (2001): 383-388.

      Intermittent Thoughts On Intermittent Fasting - AMPK III/III: Natural Rythmicity for Maximum Fat & Minimal Muscle Loss

      Image 1: The quest for fat loss, muscle size, health and longevity reminds me of the famous egg-laying wool-milk-sow.
      (img austria-lexicon)
      At the end of last weeks installment, I provided you with an extensive, yet obviously "incomplete" list of AMPK-"promoters", among which the  organosulfur compound alpha lipoic acid (ALA) turned out to be of chief interest in the subsequent enjoyable and inspiring "intellectual intercourse" I had with Banga, Dr. J, Bomb Jack and of course Lerner in the comments section of the post. Now, the fundamental question that arose from this discussion was how supplementation with ALA (or agents with similar effects on 5' adenosine monophosphate-activated protein kinase expression) could be used as a tool to promote fat, not weight loss while preserving or even building lean muscle mass and optimizing health and longevity - basically it's the quest for the egg-laying wool-milk-sow, an imaginary animal and a commonly used German metaphor for a jack-of-all-trades device. And I can assure you that an ultimate solution to this problem is just as hard to find as this mythical animal an image of which you can see on the right.

      When AMPK is the good guy, mTOR must not necessary be the bad guy

      We have learned in the past couple of installments that its modulatory effect on the AMPK/mTOR seesaw, which, even in your average citizen of the affluent Western hemisphere, is oftentimes imbalanced towards the "anabolic" mTOR side, these days. Against that background I have pointed towards the myriad of beneficial metabolic effects of AMPK activation, which could in fact ameliorate, if not reverse, many of the ailments that have befallen our fat-anabolic (remember without mTOR, fat cells cannot differentiate, cf. Bell. 2000, where blockage of the mTOR pathway with rapamycin inhibited adipocyte differentiation) society.
      Illustration 1: Lifestyle factors like nutrition, nutrient timing, sleep etc. determine the fundamental balance between AMPK and mTOR, but supps can skew / tweak the balance
      I hope that highlighting the merits of AMPK in the lat two installments of the series did not give the impression that mTOR its anabolic counterpart on the seesaw (cf. illustration 1) was "useless" or even dangerous, as the sheer amount of recently published studies on the implication of mTOR in the etiology of cancer could make you believe.
      Image 2: A breast cancer cell (img from The Guardian); if you want it (not yourselves!) to live longer, don't feed it with leucine, Ladies!
      The mTOR-cancer connection: In the course of these first 10 months of 2011 more than 16,000 studies have been published that focus or at leas mention the involvement of an (over-)stimulation of the mTOR pathway in cancer development. It is yet plain short-sighted stupidity to believe that measures like dietary leucine restriction (and subsequent down-regulation of the mTOR pathway) would protect you, let alone cure cancer. It is certainly correct that mTOR promotes proliferation in cancer cells, but it does so in about every other cell in your body. Moreover, studies on the effect of leucine deprivation on mTOR signalling in breast cancer patients showed that not only was "leucine restriction is not sufficient to inhibit mTOR signaling in most breast cancer cell lines", but was "associated with activation of survival molecule Akt, making leucine deprivation an undesirable approach for breast cancer therapy" (Singh. 2011). And with regard to the use of "true" mTOR inhibitors such as rapamycin, David Sabanti remarks in a recent review:
      As induction of apoptosis rather than cytostasis is increasingly considered a prerequisite for an effective anticancer agent, it will be crucial to understand when rapamycin has such effects and where it does not, and to learn how to trigger apoptosis with additional therapies.
      Now, the use of novel pharmacological mTOR-inhibitors aside, any dietary approach (such as leucine deprivation) would obviously prevent apoptosis, because it would act via mTORC1 inhibition to increase Akt-expression and (cancer-)cell survival (Sun. 2005; O'Reilly. 2005). Would you risk your "metabolic currency", i.e. your muscle, and sacrifice quality of life for the futile hope that you could thusly keep cancer "at bay"? I hope not, because in that case you still have not grasped the fundamental idea that in life its not about black and white, but about black and white and a balance between the two.
      This takes us back to the egg-laying wool-milk sow or, without the metaphorical ornamentation, the issue of losing fat weight, while gaining muscle weight. From all you have learned before, it appears quite obvious that - intermittendly fasted or not - gaining muscle and losing fat literally at the same time is virtually impossible. On the other hand, you could obviously first milk and fleece your egg-laying wool-milk sow and then collect the eggs, it has been laying before you grabbed, milked and fleeced it. I assume you will notice that, again, this is a cycle: milk, fleece, collect eggs,... milk, fleece, collect eggs, ... fast, train, feed... fast, train, feed. As you see, nature is not very inventive in her fundamental concepts. She will always rely on her tried and proven cyclicality. Now, if we cannot escape that, we can at least try to tweak it depending on our goals. While for Mr. Supp in illustration 1 this would be only a step to the left to help Mr. AMPK to get the better of Mr. mTOR) or a step to the right to help Mr. mTOR gain control over the AMPK/mTOR seesaw. For us, in the real world, the most obvious thing we could resort to in order to achieve similar results are supplements.

      When to take what to optimize fat loss and minimize muscle loss in the AMPK phase

      In the comments related to the last installment, Bomb Jack suggested that taking ALA during a fast to jack the naturally high AMPK level up even more, would theoretically make sense, but he mentions that he had seen "studies about [ALA] causing lean tissue loss on the long run". One of these studies was conducted by Yi Wang et al. in 2010 on 24 month old male C57BL/6 mice (Wang. 2010). Half of the mice received 0.75% alpha-lipoic acid in their drinking water for one month, the rest of the mice served as a unsupplemented control.
      Image 3: 22 month old C57BL/6 mouse, in view of the fact that mice live ~2.5 years this is already a granny; in other words, the 24 month old mice in the Wang study were really old.
      How much is 0.75% in the drinking water of mice in human equivalents? To calculate that you need to know that the mice in the study weighed ~30g, that the average mouse drinks ~5.8ml per day (Bachmanov. 2002) and that a 0.75% solution means that 100ml contain 0.75g of the given solute. Now you calculate the absolute dose per day, which would be 5.8ml/day * 0.75g /100ml = 0.435mg/day divide that by 30 to get the dose per gram of body weight and multiply it by 1000 to get the dose per kg => 14.5mg/kg. To get the human equivalent dose (HED) you then use the formula I explained before and your calculator will tell you that the HED of 14.6mg/kg in a mouse would be roughly 1.2mg/kg in a human being (~95mg for the average adult).
      Although the human equivalent (~95mg/day; cf. red box above) of the dose the mice received was way less than most commercially sold supplements contain and by far less than the 800mg - 1,200mg of alpha lipoic acid that has been used with positive results in many trials that involved diabetic patients, the results the Wang et al. observed were pretty pronounced. In the ALA group...
      • food consumption decreased: -18% - 4.50 ± 0.30 g/d vs. 5.50 ± 0.30 g/d in control mice
      • body weight decreased: -15.8% - 5.27 ± 0.62 g total body weight loss
      • energy expenditure increased:  +25% - 7.64 ± 0.10 kcal/kg0.75/h vs. 5.90 ± 0.10 kcal/kg0.75/h
      • glucose utilization increased: +10% judged by the respiratory quotient
      • insulin sensitivity increased: -47% area under the curve in glucose tolerance test
      • mitochondrial biogenesis increased: +138% relative abundance of mtDNA content
      • PGC-1α* in skeletal muscle increased: + 80.0% 
      • GLUT-4 in skeletal muscle increased: + 105.0%

        * PGC-1α ramps up thermogenesis, stimulates mitochondrial biogenesis, promotes the remodeling of muscle tissue, controls lipid and glucose metabolism (Liang. 2006)
      And all that was accompanied by significant increases in AMPK and decreases in mTOR and P70S6K phosphorylation. In view of the results of the Wilson study, which showed that a much smaller (~40%) increase in AMPK activity went hand in hand with decrease in protein synthesis we can safely assume that the latter is (unfortunately) responsible for both the desirable increases in energy expenditure, glucose metabolism and mitochondrial biogenesis, as well as the not so desirable loss of appetite (you do not need to eat, when you run on stored substrate) and body mass (cf. figure 2).
      Figure 1: Relative changes in phosphorylation status of AMPK, mTOR, p70S6K and 4E-BP1 in old mice supplemented with 0.75% ALA in their drinking water for 1 month compared to unsupplemented control (data calculated based on Wang. 2010)
      On the other hand, the decrease of the amount of phosphorylated Eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1), of which Anthony et al. have shown in 2002 that its phosphorylation (which usually occurs consequent to the activation of the mTOR pathway) is not necessary for the increase in protein synthesis that occurs upon leucine administration (Anthony. 2002), was not statistically significant. This could be important, as dephosphorylation of 4E-BP1 and not decreases in p70S6K appear to be hallmark features of cancer cachexia, i.e. profound muscle loss in cancer patients (Tisdale. 2008).
      Figure 2: Absolute (left) and relative (right) changes in body composition in old mice supplemented with 0.75% ALA in their drinking water for 1 month compared to unsupplemented control (data calculated based on Wang. 2010)
      And indeed, if you, as a diligent student of the SuppVersity who knows about the subtle differences between absolute and relative data, do not focus on the absolute (figure 3, left) but rather on the relative (firgure 3, right) changes in body composition, you will have to concede that the mouse grandpas underwent a transformation you would usually expect to see in the course of the contest preparation for a bodybuilding show. While the mice "on ALA" did lose ~20% of their body weight, they also cut down from 18% to 9% body fat and (-60% fat mass) and increased the relative amount of lean mass from 74% to 87%. For a 300lbs bodybuilder this would be like cutting 32lbs of fat while losing "only" 16lbs of muscle, to end up 48lbs lighter and with a body fat percentage of 9% at 252lbs - not yet really stage ready, but certainly not bad, given the fact that he would not even have to diet to achieve that result (remember: his appetite would have decreased and his energy expenditure increased).

      Rythmicity is the key when it comes to seesawing and supplementation 

      The mouse vs. human issue aside, the Wang study has another caveat in terms of drawing conclusions regarding the use of ALA and other AMPK promoters during an intermittent fast - the mice did not fast ;-) Reason would dictate, though, that ingesting ALA with drinking water 24/7 on a dietary regimen with constant food availability would actually be a disadvantage compared to taking ALA specifically at the onset of the fast (i.e. when your last meal would be digested) to keep AMPK, which would already been raising at that point (and thus mTOR declining) maximized in the course of the fasting period. On the other hand, taking ALA or any other AMPK promoter after your workout and before your meal would appear to be plain out stupid, as intermittent fasting does only make sense if you really reap the maximal anabolic benefit from the short feeding window. Against that background, popping alpha lipoic acid post workout and thus potentially increasing AMPK appears (remember that we do not have any studies explicitly investigating the effects of taking ALA post-workout vs. at other times of the day, so that these are just yet to be validated hypotheses!) to be counter-indicated, as it would potentially blunt the mTOR and p70S6K response to exercise and food-intake.
      Image 2: R- and S- isomer of alpha lipoic acid (Shay. 2010)
      "Alpha lipoic acid, yeah! But can I buy the cheap racemic mixture or is it worth paying the extra bucks for the R-ALA?" Actually, it was Daniel Spasic who posted a similar question on my Facebook pinwall and thus made me look into the purported advantages of R-ALA, again. 

      I mean we all "know" that R-ALA is the preferable form, but do you remember where you know that from? 

      Well, me neither and so I dug back into the host of studies BASF was doing back in the 1990s, until their business department finally realized that a natural anti-diabetes drug is not only non-patentable, but could also compromise the sales of patentable pharmacological drugs like Chlorpropamide (patented in the mid-1980s; cf. DrugPatentWatch) which happens to be made of Propylamine, which in turn - you guessed it - is produced by BASF and sold to BigPharma and the Agrobusiness who use the same ingredient to produce of Prochloraz, and other well-known fungicide... but I am getting taken away, here.

      Image 2: The scientific
      evidence pro R-ALA
      is quite conclusive;
      the S-isomer, however,
      could potentially negate
      its benefits and is
      useless, at best!
      The main point is that there is clear-cut evidence that the R-isomer has not only a longer half-life and a greater bioavailability (Herrmann. 1996), but is also the "true" anti-oxidant: In a 1997 study by Streeper et al., for example, S-lipoic acid had no effect on insulin-mediated glucose uptake in obese Zucker rats, while R-lipoic acid increased the latter by +64%. In the same study chronic intake of R-lipoic acid reduced plasma insulin and free fatty acid levels. S-lipoic acid, on the other hand, increased insulin levels and had no effect on free fatty acids - probably a direct consequence of the reduced expression of glucose-transporter protein (GLUT4) the scientists observed in the S-ALA supplemented rats. This may now sound like the racemic mixture, which is in fact the ~50/50 R-ALA/S-ALA mixture you can buy for a few bucks at every GNC would be toxic - this certainly ain't the case. On the other hand, would you buy an anticoagulant with an with vitamin K in it, i.e. a product with two active ingredients with partly antagonistic effect? I don't think so...
      And for those of you who like to think in images: Taking ALA right at the beginning of your short feeding window would be as if Mr. Supps from illustration 1 took a step to the left, just when Mr. mTOR turn on the right of the seesaw was about to gain momentum - Mr. Supps with his alpha lipoic acid would be a real spoilsport, then, wouldn't he? If, on the other hand, Mr. Supps knows how to play the game, he will follow the AMPK/mTOR seesaw's natural rythm, grab some alpha lipoic acid and step to the left, when, at the beginning of the postprandial phase (~2h after the last meal), it actually is Mrs. AMPK turn, wait until she has had her share and then jump to the right in order to hand Mr. mTOR a leucine-rich protein shake. By doing this, i.e. taking ALA at the onset of the fast, ~2h after the last meal and a leucine rich (post-workout-)protein shake to ramp up protein synthesis right at the beginning of the feeding phase, the natural rythm would not only be preserved, it would also be amplified. And what would translate into a more energetic seesawing in our metaphorical world or Mr. Supps, Mrs. AMPK and Mr. mTOR, should translate to improved fat loss during the fast and a pronounced muscle anabolic response to the daily "refeeds", as you may well call your meals if you compress the feeding window to <6h. If the mice in the Wang study had gotten this rythm right, they would probably have made it to the Mouse-Bodyduilding Masters ;-)

      The "hungry" side of neuronal AMPK activation

      Before I end, this pretty epic (in terms of the details we have covered) yet not very productive (in terms of how much ground we have made) installment of the Intermittent Thoughts, I want to briefly mention a very important and actually completely logical, since natural difference between the effects of increased AMPK phosphorylation in skeletal muscle and increased AMPK phosphorylation in the brain. While the former triggers all the fat-loss friendly adaptations you read about in this, as well as in previous Intermittent Thoughts, the later will have you forage through your fridge in no time - regardless of whether it's feeding time or not ;-)

      Illustration 2: The differential role of hypothalamic, liver and skeletal muscle AMPK expression (Long. 2006)
      You will certainly remember from previous installments that, in our eukarocyte ancestors, AMPK was the major cellular energy sensing mechanism and has been preserved by humans (and all other mammals) even in these days of nutritional abundance. AMPKs activation is thus a signal for your body that the respective cell is starving (to be precise that the intracellular ratio of ADP+AMP to ATP is rising) - if your brain cells are not already starving, it should therefore be obvious that, contrary to AMPK signalling from the muscle tissue, which usually means "Hey, if you want me to do some work for you, you better provide me with some energy! I see those lazy adipocytes over there have more than enough stored energy...", AMPK signaling from the brain indicates an acute emergency - after all, the biological equivalent of "women and children first" is "brain first! Who cares about the rest?" It should thus not surprise you that
      • an increase in cerebral AMPK phosphorylation results in increased food intake (Andersson. 2004), while dephosphorylation decreases food intake (Kim. 2004); 
      • genetically modified mice with no AMPK activity in the AgRP neurons were leaner and had an increased energy expenditure compared to wild-type mice (Claret. 2007)
      • ghrelin, the hunger hormone, triggers AMPK phosphorylation in the brain and thus increases food intake (Kola. 2008)
      With all that being said, you are probably happy to hear that alpha lipoic acid decreases or at least counters potential increases in AMPK activity in the hypothalamus (Kim. 2004).
      Update (10/29/2011) - The two AMPK-isoforms: As Mounier et al. report in a very recent paper the two isoforms of AMPK, i.e. AMPKα1 and AMPKα2 have very distinct effects on the mTOR induced increase in muscle protein synthesis, and thusly, muscle size (Mounier. 2011). As the scientists point out, AMPKα1 plays "a predominant role in the control of muscle cell size" (meaning it prevents exuberant hypertrophy), while AMPKα2 mediates "muscle metabolic adaptation" (increased glucose uptake, mitochondrial biogenesis, etc.), of which we have learned that they are so vital for our metabolic health.

      Close your eyes and lean out

      On that note, I will close today's lesson with an some interesting information from a study Jonathan P. has brought back onto my radar, recently. It's a study by Dworak et al. on ATP changes during sleep (Dworak. 2010), which underlines the importance of sleep, specifically when you want to lose weight, because at the onset of sleep, the reduction in neuronal activity goes hand in hand with a surge in brain ATP levels, which (as you have learned today) will reduce cerebral AMPK phosphorylation and its negative metabolic consequences. Prolonged waking, on the other hand, has been shown to increase AMPK activity in the brain (Wigren. 2009). So, what are you waiting for? That's all for today... lights out ;-)!

      Alpha Lipoic Acid, GABA, Taurine, Green Tea, Gooseberry & Fenugreek. Plus: Metformin the No.1 Drug? Supplements to Improve and Restore Insulin Sensitivity - Serving #1

      Don't forget, those caps and pills are not worth a penny without you committing to the all the lifestyle changes I outlined in episode one of this series.
      I am well aware that you had to wait for a full week for this 2nd part of the "Restore & Maintain Insulin Sensitivity" Series (read part I), so I am going to make no words about it and get straight to the annotated list of useful supplements.

      Just a reminder for the lazy asses: Don't even think about starting any of the supplements on the list, if you have not already cut your carbs to a low, but not very low level, got rid of all plain sugar in your diet, started to work out frequently, get enough sleep, avoid stims and control (not totally eradicate) your linoleic acid (omega-6) intake.

      Here we go, for serving #1

      In order to give you at least some guidance on where you may want to start, I will classify the supplements in 4 very broad categories with
      • [A] for supplements that are almost certainly useful,
      • [B] for supplements that are potentially useful and definitely worth trying,
      • [C] for supplements that are marginally useful and probably worth trying, and
      • [D] for supplements that are simply bullocks and not even worth trying
      Whenever I feel confident to do so, I will also suggest a concrete dosage - in some cases, such as GABA, I can however neither do the former, nor the latter, because there simply is too little quality research out there.
      • Did you know that continuous use of metformin during pregnancy significantly reduced the rate of miscarriage, gestational diabetes requiring insulin treatment and fetal growth restriction in women with PCOS who have long been advised to stop metformin during pregnancy (cf. Nawaz. 2008)?
        Metformin [A]: Technically it is not a supplement, but let's be honest, who except for the FDA cares? Many supplements work as effectively as pharmacological drugs, but as far as real insulin sensitizers are concerned metformin still appears to have the edge on the rest of the pack (supplement or drug): It has an excellent safety profile (even in gestational diabetes, which has long been thought of being the one area of application, where metformin was not the first line intervention of choice; cf. Lautatzis. 2013). It works via a similar mechanisms as dieting and exercise does (→ AMPK; this is actually imho it's main advantage - an advantage it shares with lipoic acid btw.). And metformin has only recently been shown not to inhibit the benefits of exercise on glycaemic control or fitness (Boulé. 2013).

        Moreover, hundreds of studies support the preventive effects of metformin against the manifestation of tumors of pancreas, breast, colorectum, liver, endometrium and ovary. The prognosis of diabetic cancer patients on metformin therapy seems be better, than in diabetics without metformin treatment (Anděl. 2013).

        So, if you belong those people who have real issues and not just slightly elevated blood glucose levels, have your metformin prescription filled - it's unquestionable an [A] among the agents that can help you restore your insulin sensitivity [I don't have to tell you that this is not an agent you would use simply to stay insulin sensitive, right?].

        One thing you should keep in mind though, is that it may lower your B12 levels. While this could be a simply results of increased usage and more recent studies question previous reports according to which metformin radically depletes B12 levels have been questioned lately, it probably won't hurt to take 500-1,000mg of methylcobolamine alongside your metformin.
      • Alpha lipoic acid (ALA) [A]: In a way lipoic acid, a naturally occuring organosulfur compound derived from octanoic acid, is a cousin of metformin. Unfortunately (for the future of alpha lipoic acid as an anti-diabetes agent and the diabetics who have ever since been treated with pro-obesogenic PPAR-agonists) the pharma industry realized that selling a natural and thus non-patentable anti-diabetes drug would not only generate a lower revenue, it would also hamper the sales of patentable and thus more profitable drugs.

        Don't take lipoic acid instead of working out. Why? Well, alpha lipoic acid has been shown to increase the arthesclerosis risk in a human trial by McNeilly et al. In the said study, 1g of alpha lipoic acid per day increased the cardiovascular disease risk, in 24 obese individuals with impaired glucose tolerance who participated in the experiment (McNeilly. 2012); the underlying mechanism was an increase in LDL oxidation that did albeit occur only in the "ALA only" but not the "ALA + exercise" group.
        Luckily, there are still more than enough animal and human studies (Jacob. 1999; Xiang. 2011; Porasuphatana. 2012) to support the beneficial effects lipoic acid will have on glucose management and hyperglycemic damage in (pre-)diabetics.

        In view of the fact that it could contribute to the development of heart disease precipitate hypoglycemic episodes (Khamaisi. 1990), has negative effects on appetite (which is the main mechanism by which it reduces weight gain in rodents) and appears to mess with lean mass gains - suggested reads ("You Could be Just as Lean, but More Muscular Without a Nutrient Repartitioner" (learn more); "Further Evidence Against Anti-Oxidant Supplementation: Vitamin E + Alpha Lipoic Acid Reduce Skeletal Muscle Mitochondrial Biogenesis" (read more) I would still not suggest you take high doses (>100-200mg) if you don't have problems with keeping your blood sugar levels in check.

        For those of you, who have established problems with managing their glucose levels, taking 2x250mg-600mg (with meals) would yet be a good point to start from (keep an eye on how it affects your glucose levels and adjust the dosage appropriately).

        With respect to the purported superiority of R-ALA vs. the regular (=racemic mixture) version of lipoic acid, I can only repeat that I am still waiting for someone to show me a study that would prove that R-ALA is more potent than regular the cheap racemic mixture that's been used in the vast majority of the currently available (mostly beneficial) studies.
      • Figure 1: GABA does effectively restore "almost" normal glucose levels in severly diabetic mice; the dosage is not mentioned in the FT or the supplemental material (Soltani. 2011)
        GABA [?]: No, the reason GABA (Gama-aminobutyric acid) is on the list is not that it will make you sleep better (although this may - for some(!) people, actually be the case). It's rather its direct protective and even restorative effect on pancreatic beta-cells (Soltani. 2011; Tian. 2013).

        Despite the fact that we have known about these effects for decades, up to now nobody seems to be interested to do or finance the research that would be necessary to make concrete and reliable dosage-recommendations. In fact, the evidence is still so scarce that we cannot even say: "Yes, GABA is definitely going to help" - if the prelminary evidence we have translates from the petri dish to the rodent cage and into the real world, it could however be the #1 agent on this list. Why? Well, this would basically mean that it could cure diabetes even when you have progressed from being insulin resistant to being a full-blown diabetic.

        The best evidence we have that this could in fact be the case does probably come from a 2011 study by Soltani, who have actually taken the important step from the petri dish to the rodent model and were able to show that  GABA restores β-cell mass and reverses diabetes in severely diabetic mice.

        Warning: Don't start out with 5g of GABA in one serving - esp. not on an empty stomach. This is not only going to give you parestesia (tingles), but could also have you gasp for air and have problems keeping on your feet, due to the profound actions on peripheral GABA receptors.
        Furthermore, human studies from the eighties have shown that 5g and 10g of GABA (consumed orally) exert direct insulinotropic effects (remember insulin resistance is not about too much insulin, but about the latter having no / too little effect on glucose uptake) and since oral GABA does not cross the blood-brain-barrier it's safe to be consumed by humans in relatively high doses (cf. Cavagnini. 1982). Still, as in the case of lipoic acid, GABA is not patentable and the stocks of the big players in the anti-diabetes drug business would certainly take a tumble, when someone actually proved that you could reverse diabetes by simply taking X grams of GABA everyday.
      • Taurine [B]: You will remember that I mentioned Taurine only 2 days ago in the context of the anti-diabetic effects of whey protein (read more). You will probably also remember the numerous previous posts on the beneficial effects of taurine specifically for people with diabetes or pre-diabetes (learn more about taurine). I will therefore stick to a brief overview of the direct and indirect (protection against negative effects of high blood glucose) benefits taurine has to offer for people with insulin resistance and high glucose levels.
        • Figure 2: The effects of taurine supplementation on glucose and insulin (top, left & right) 0, 6, and 12 weeks after beginning the taurine-supplemention in OLEFT rats (rodent model of diet induced diabesity), as well as the reaction to an insulin tolerance test and corresponding changes in insulin sensitivity (bottom, left & right; adapted from Kim. 2012).
          Taurine shows "independent of hypoglycemic effect in several animal model" (Ito. 2012)
        • It ameliorates both high glucose and lipid levels (Kim. 2012)
        • Taurine improves NO mediated blood glow in the corpus cavernosum (=battles erectile dysfunction) due to diabetes (Dalaklioglu. 2013)
        • Taurine exerts cardio-protective effects, partly via direct effects on the angiotensin II type2 receptor expression (Li. 2005)
        • It restores normal platelet aggregation in diabetics (Franconi. 1995)
        • Taurine protects the kidneys (Yao. 2009)
        • Taurine reduces mortality risk upon long-term administratio (rodent model; Franconi. 2004) 
        • It has a higher ability to reduce insulin resistance and stronger antioxidant properties than the diabetes drug glibenclamide (El Zahraa. 2012)
        • It protects the eye from diabetes induced damage (Hansen. 2001 Kim. 2007)
        • Taurine has protective effects against all components of the metablic syndrom (Hansen. 2001; Imae. 2012)
        • It increase the levels of conjugated tRNA, restore respiratory chain activity, and increase the synthesis of ATP at the expense of superoxide anion production (Schaffer. 2009)
        Beta alanine is the taurine antagonist #1: SuppVersity readers should know that (read more), but I guess I better repeat it: The "best" way to deplete taurine levels is the ingestion of copious amounts of beta alanine 24/7 (the side effects are similar to those of diabetes related taurine depletion, eg. Waterfield. 1993 → lowered protection against CCL induced liver damage). From a performance perspective there is as of now no evidence that you would need more than 2.5g of beta alanine per day, anyway. So why would you want to waste money and cellular taurine on additional beta alanine ;-)
        It should be mentioned thought that there are also studies which did not support the beneficial results reported above - they are not numerous, but may yield some insights into effective vs. uneffective dosage regimen.

        The 1.5g/day the overweight subjects with a predisposition for developing diabetes the subjects in a 2004 study by Brøns et al. received, may for example simply have been too little to exert any effects (Brøns. 2004). Based on the human equivalents of rodent studies, it appears most promising to distribute a daily taurine intake of 3g to max. 6g over your three main meals.

        Since taurine does also act as a gaba-ergic small molecule neurotransmitter (Albrecht. 2005), I would yet suggest you keep a close eye on (a) initial sedative effects and (b) longer term increases in anxiety - both of which have been reported in animal studies with allegedly higher and / or intracerebral administration of taurine.

        The effects on neurotransmitters, the diarrhea some users experience (esp. when they take it without food) and the fact that many, but by far not all studies confirmed direct inusulin sensitizing effects of taurine are the reason I'd still classify it as [B] level supplement - certainly one of the better ones, but still only "possibly beneficial".
      • Table 1: Within group changes in randomized controlled GTE supplementation study involving 20-65 year old type 2 diabetics with BMI > 25 kg/m² (Hsu. 2012)
        Green tea extract [C]: GTE can help with insulin sensitivity in two different ways. Firstly, it will help control the inflammatory processes that are (partly) responsible for the development of insulin resistance and it will secondly help you to "cut carbs" by simply blocking their digestion and assimilation (Forester. 2012; Williamson. 2013).

        And while the real world benefits of GTE supplementation in a 2012 study by Hsu et al. were not statistically significant, it may still be worth trialling a dose of 3x 200-500mg per day. That being said, unless you are specifically looking for the stimulant effects of GTE, you should consider using a decaffeinated extract because you do not really need the additional caffeine (cf. part I of this series). 

        The reason I still classified GTE as [C] as in "marginally useful" is that the study by Hsu is not the only human trial that did not find significant effects on insulin sensitivity. It is rather one of the few where you could actually argue that - though not significant - it may have had an independent effect on glucose management. In the majority of studies "green tea exhibited limited benefits in reducing FBS or HbA1c levels" and as Ruitang Deng puts it in his recent review: "Should not be recommended for managing hyperglycemia." (Deng. 2012) This does not mean that it cannot help ameliorate the side effects, but we are looking for agents that will actually help you lower your blood glucose levels and in this regard green tea extracts are only marginally useful.
      • Amla, gooseberry, or Emblica Officinalis call it whatever you want, but don't expect too much - it may work, but it's no comparison to the [A]-class supplements. Moreover, the results from the available human study could be distorted by additional ingredients in the supplement formulas the scientists used.
        Gooseberry (emblica officinalis) [C]: Studies by Mitra (2007), Faizal (2009), Iyer (2009) and Chen (2011) all provide evidence that the ingestion of extracts from Indian gooseberry (=Amla), an edible fruit from trees of the phyllanthaceae family can effectively improve blood glucose management.

        Due to the fact that the Gooseberry extract was administered in conjunction with other agents, it is however difficult to suggest an effective dosage, but it appears as if 100-150mg per day of gooseberry extract would be enough.

        In Iyer et al. even a single serving of fresh amla (~35g) got the job done, but the overall effect size is rather mediocre, thus Gooseberry is only "possibly useful" [C]. 
      • Fenugreek [B]: Also known as trigonella foenum-graecum L., fenugreek belongs to the plant family fabaceae (or leguminosae).

        Figure 3: Relative changes in response to glucose challenge (glucose AUC, glucose half-life and metabolic clearance rate) in 5 non-insulin dependent diabetic patients after consuming a diet supplemented with 25 g fenugreek seeds daily for 15 days; the data is expressed relative to the values the scientists measured in five likewise diabetic control subjects (Raghuram. 1994)
        Fenugreek seeds and extracts from the leaves have a decent amount of studies to support its anti-hyperglycemic effects - including clinical studies with human volunteers showing that dosage of only 500 mg of seed or leaf extracts given once or twice daily either alone or in combination with standard, synthetic anti-diabetic drugs such as metformin and glipizide provided beneficial effects on controlling plasma glucose levels (Deng. 2012).

        The reason I'd still classify it as [B] are (a) the fact that it takes a huge amount of the seeds (e.g. 25g; see figure 3) to elicit significant effects and (b) the fact that studies using extracts yielded ambiguous results. Contrary to the whole seeds, of which it seems that they exert their beneficial effects by similar mechanisms as dietary fiber, leaf extracs appear to exert a direct insulin sensitizing effect.

        In a study by Abdel-Barry et al. from the year 2000, 40 mg/kg aqueous extract powder from fenugreek leaves(!) in 10 mL distilled water lowered the glucose levels of 20 healthy male volunteers aged 20-30 years by 13.4% 4h after ingestion. Unfortunately, the hunger, frequent urination and dizziness one third of the subjects complained about, was not the only side effect - the subjects also had significantly reduces serum potassium levels; an observation of which the researchers rightly state that it warrants further investigation to ensure the long-term safety of fenugreek leaf extracts.

        Bottom line? Well, once again "possibly useful", but only if you actually have problems with insulin resistance and high blood sugar.
      "What? Where is there rest?" In case this is pretty much what you are thinking right now, I can calm you down, there will be at least another serving of pro-insulin sensitivity supplements. I simply don't have the time to write more today, but did not want to go back on my promise from last Sunday. So, be patient, there is going to be more: Promising supps such as cinnamon, vinegar, or grape seed extract, for example but also questionable stuff such as bitter melon or legume extracts.

      References: 
      • Abdel-Barry JA, Abdel-Hassan IA, Jawad AM, al-Hakiem MH. Hypoglycaemic effect of aqueous extract of the leaves of Trigonella foenum-graecum in healthy volunteers. East Mediterr Health J. 2000 Jan;6(1):83-8.
      • Anděl M, Skrha P, Trnka J. [Metformin: the overlap of diabetology and oncology]. Vnitr Lek. 2013 Aug;59(8):738-42. 
      • Boulé NG, Kenny GP, Larose J, Khandwala F, Kuzik N, Sigal RJ. Does metformin modify the effect on glycaemic control of aerobic exercise, resistance exercise or both? Diabetologia. 2013 Aug 23. 
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      • Cavagnini F, et al. Effects of gamma aminobutyric acid (GABA) and muscimol on endocrine pancreatic function in man.Metabolism. 1982; 31:73–77. 
      • Chen TS, Liou SY, Wu HC, Tsai FJ, Tsai CH, Huang CY, et al. Efficacy of epigallocatechin-3-gallate and amla (Emblica officinalis) extract for the treatment of diabetic-uremic patients. J Medicinal Food. 2011;14:718–23.
      • Dalaklioglu S, Kuscu N, Celik-Ozenci C, Bayram Z, Nacitarhan C, Ozdem SS. Chronic treatment with taurine ameliorates diabetes-induced dysfunction of nitric oxide-mediated neurogenic and endothelium-dependent corpus cavernosum relaxation in rats. Fundam Clin Pharmacol. 2013 Jun 14. 
      • Deng R. A review of the hypoglycemic effects of five commonly used herbal food supplements. Recent Pat Food Nutr Agric. 2012 Apr 1;4(1):50-60.
      • El Zahraa Z El Ashry F, Mahmoud MF, El Maraghy NN, Ahmed AF. Effect of Cordyceps sinensis and taurine either alone or in combination on streptozotocin induced diabetes. Food Chem Toxicol. 2012 Mar;50(3-4):1159-65. 
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      • Forester SC, Gu Y, Lambert JD. Inhibition of starch digestion by the green tea polyphenol, (-)-epigallocatechin-3-gallate. Mol Nutr Food Res. 2012 Nov;56(11):1647-54.
      • Franconi F, Bennardini F, Mattana A, Miceli M, Ciuti M, Mian M, Gironi A, Anichini R, Seghieri G. Plasma and platelet taurine are reduced in subjects with insulin-dependent diabetes mellitus: effects of taurine supplementation. Am J Clin Nutr. 1995 May;61(5):1115-9.
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      • Hansen SH. The role of taurine in diabetes and the development of diabetic complications. Diabetes Metab Res Rev. 2001 Sep-Oct;17(5):330-46. 
      • Hsu CH, Liao YL, Lin SC, Tsai TH, Huang CJ, Chou P. Does supplementation with green tea extract improve insulin resistance in obese type 2 diabetics? A randomized, double-blind, and placebo-controlled clinical trial. Altern Med Rev. 2011 Jun;16(2):157-63.
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      • Kim SJ, Ramesh C, Gupta H, Lee W. Taurine-diabetes interaction: from involvement to protection. J Biol Regul Homeost Agents. 2007;21(3-4):63-77.
      • Kim KS, Oh da H, Kim JY, Lee BG, You JS, Chang KJ, Chung HJ, Yoo MC, Yang HI, Kang JH, Hwang YC, Ahn KJ, Chung HY, Jeong IK. Taurine ameliorates hyperglycemia and dyslipidemia by reducing insulin resistance and leptin level in Otsuka Long-Evans Tokushima fatty (OLETF) rats with long-term diabetes. Exp Mol Med. 2012 Nov 30;44(11):665-73.
      • Lautatzis ME, Goulis DG, Vrontakis M. Efficacy and safety of metformin during pregnancy in women with gestational diabetes mellitus or polycystic ovary syndrome: A systematic review. Metabolism. 2013 Jul 22. 
      • Li C, Cao L, Zeng Q, Liu X, Zhang Y, Dai T, Hu D, Huang K, Wang Y, Wang X, Li D, Chen Z, Zhang J, Li Y, Sharma R. Taurine may prevent diabetic rats from developing cardiomyopathy also by downregulating angiotensin II type2 receptor expression. Cardiovasc Drugs Ther. 2005 Mar;19(2):105-12.
      • Mitra A. Effects of a composite of tulsi leaves, amla bitter gourd, gurmur leaves, jamun fruit and seed in type 2 diabetic patients. J Clinical Diagnostic Research. 2007;6:511–20.
      • McNeilly AM, Davison GW, Murphy MH, Nadeem N, Trinick T, Duly E, Novials A, McEneny J. Effect of α-lipoic acid and exercise training on cardiovascular disease risk in obesity with impaired glucose tolerance. Lipids Health Dis. 2011 Nov 22;10:217.
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      • Porasuphatana S, Suddee S, Nartnampong A, Konsil J, Harnwong B, Santaweesuk A. Glycemic and oxidative status of patients with type 2 diabetes mellitus following oral administration of alpha-lipoic acid: a randomized double-blinded placebo-controlled study. Asia Pac J Clin Nutr. 2012;21(1):12-21. 
      • Raghuram TC, Sharma RD, Sivakumar B, Sahay BK. Effect of fenugreek seeds on intravenous glucose disposition in non-insulin dependent diabetic patients. Phytotherapy Research. 1994;8:83–6.
      • Schaffer SW, Azuma J, Mozaffari M. Role of antioxidant activity of taurine in diabetes. Can J Physiol Pharmacol. 2009 Feb;87(2):91-9.
      • Soltani N, Qiu H, Aleksic M, Glinka Y, Zhao F, Liu R, Li Y, Zhang N, Chakrabarti R, Ng T, Jin T, Zhang H, Lu WY, Feng ZP, Prud'homme GJ, Wang Q. GABA exerts protective and regenerative effects on islet beta cells and reverses diabetes. Proc Natl Acad Sci U S A. 2011 Jul 12;108(28):11692-7.
      • Tian J, Dang H, Chen Z, Guan A, Jin Y, Atkinson MA, Kaufman DL. GABA regulates both the survival and replication of human ss-cells. Diabetes. 2013 Aug 30. 
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      • Xiang G, Pu J, Yue L, Hou J, Sun H. α-lipoic acid can improve endothelial dysfunction in subjects with impaired fasting glucose. Metabolism. 2011 Apr;60(4):480-5.
      • Yao HT, Lin P, Chang YW,Chen CT, Chiang MT, Chang L, Kuo YC, Tsai HT, Yeh TK. Effect of taurine supplementation on cytochrome P450 2E1 and oxidative stress in the liver and kidneys of rats with streptozotocin-induced diabetes. Food Chem Toxicol. 2009 Jul;47(7):1703-9

      Circadian Clock Normalization as Novel Mechanism Behind the Health Benefits of ALA in NAFLD & Diabesity | Plus: ALA For Athletes & the Obese - Yes/No + When to Take It?

      Yes, you can buy alpha lipoic acid as bulk powder, but if you still have intact mucosa and want to keep it intact, I suggest you swallow pills.
      Alpha lipoic acid aka "ALA" is a natural AMPK agonist that works similar to metformin. Developed by BASF and others as an anti-diabetes medication in the late 20th century, it's now a popular supplement that is prescribed as a "drug" to type II diabetics only rarely and only in Europe, yer not in the US.

      Based on the currently available evidence its anti-diabetic effects are comparable, but far inferior to metformin. In view of the fact that lipoic acid is also non-patentable and thus not exactly profitable, it's no wonder that it has disappeared from the radar of the medical establishment over the past decade.
      Learn more about lipoic acid here at the SuppVersity

      ALA Boosts Creatine Uptake

      ALA + More vs. Migraine

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      High EAA protein for fat loss

      ALA = Nutrient-Repartitioner?

      Anti-Anabolic Effects of ALA
      A recent study from the Linus Pauling Institute may yet well put the naturally occuring power-antioxidant, which is found at higher levels in organ meats and leafy vegetables such as spinach and broccoli, back onto the research agenda of top scientists all around the world.

      Lipoic acid  appears to reset and synchronize circadian rhythms, or the "biological clock" found in most life forms. The ability of lipoic acid to help restore a more normal circadian rhythm to aging animals could explain its apparent value in so many important biological functions, ranging from stress resistance to cardiac function, hormonal balance, muscle performance, glucose metabolism and the aging process.
      Figure 1: ALA had no direct weight loss effect, but it reduced the abnormal cortisol excursions and the increase in postprandial fatty acid synthesis in the old rodents (Keith. 2014)
      The findings were made by biochemists from the Linus Pauling Institute at Oregon State University, and published in Biochemical and Biophysical Research Communications, a professional journal.
      "This could be a breakthrough in our understanding of why lipoic acid is so important and how it functions. Circadian rhythms are day-night cycles that affect the daily ebb and flow of critical biological processes. The more we improve our understanding of them, the more we find them involved in so many aspects of life, "said Tory Hagen, the Helen P. Rumbel Professor for Healthy Aging Research in the Linus Pauling Institute, and a professor of biochemistry and biophysics in the OSU College of Science
      Almost one-third of all genes are influenced by circadian rhythms, and when out of balance they can play roles in cancer, heart disease, inflammation, hormonal imbalance and many other areas, the OSU researchers said. Of particular importance is the dysfunction of circadian rhythms with age.
      "In old animals, including elderly humans, it's well-known that circadian rhythms break down and certain enzymes don't function as efficiently, or as well as they should," said Dove Keith, a research associate in the Linus Pauling Institute and lead author on this study.
      If lipoic acid offers a way to help synchronize and restore circadian rhythms, this could be a quite significant result. In that it is yet important to know if the effects, the researchers observed only in the liver, are mediated by effects that are independent of the anti-oxidant effects of lipoic acid - or, to put it differently, if lipoic acid has direct or just indirect effects which are mediated by the blockade of pro-oxidant disturbances of the "circadian clock" of the liver.

      Figure 2: AMPK expression in white & brown fat and muscle (top, based on Prieto-Honta. 2012), and implications (bottom)
      I guess it would be pretty unsatisfying if I passed on this opportunity to review a handful of recent studies on the benefits of alpha lipoic acid, right? Well, then... I guess you will remember that I am skeptical about it's usefulness as a nutrient partitioner, right? Although we have only rodent data to support this hypothesis the increase in AMPK expression that would come at a very unfavorable moment, if you take your "repartioning supplement" shortly before or with a meal did after all leave the rodents in the previously discussed study by Prieto-Hontoria et al (2012) lighter and less muscular (see Figure 2, as well as previous article "Lean & Muscular W/ Alpha Lipoic Acid? You Could Be Just as Lean, But More Muscular W/out "Nutrient Repartitioner"!" | read more).

      That obviously doesn't mean that ALA was useless. In a different scenario - e.g. for someone with a high(er) baseline inflammation - alpha lipoic acid may well have beneficial "nutrient repartitioning effects". Examples? What about the seminal paper by Ko et al. (2011)?

      In said study, 360 obese individuals (body mass index [BMI] ≥30 kg/m2 or BMI 27-30 kg/m2 plus hypertension, diabetes mellitus, or hypercholesterolemia) were randomized to alpha-lipoic acid 1200 or 1800 mg/d or placebo. The supplement was consumed in three doses of 600mg timed 30 minutes before a meal. Now in my past articles I have often pointed out that supplement timing may be overrated. In the case of ALA it does yet make perfect sense for diabetics and insulin resistant obese people (!) to take it before a meal, in order to benefit from the insulin sensitizing effects of the AMPK activator alpha lipoic acid.
      Figure 3: Weight loss during 4-week induction and 16-week follow up in the placebo, 1,200mg and 1,800mg ALA groups (left) and relative weight loss at the end of the study in all "completers" (Koh. 2011)
      As you can see in Figure 3, the timely use of 600mg of alpha lipoic acid before each of the meals lead to significantly increased weight loss, specifically in the latter phase of the 20 week trial, in the course of which the subjects had to consume 600kcal less - but at least 1,200kcal/day - than their habitual diet would provide. Quite an impressive result of which the researchers from the University of Ulsan College of Medicine in Seoul say that its efficacy and safety (compared to other anti-obesity drugs) would "suggest that alpha-lipoic acid may be effective as an adjunctive medication for obesity" (Koh. 2011) - a medication, and you can see that in Figure 3, that helps with both: weight and fat loss!

      Whether ALA is or isn't for hard-training athletes / gymrats remains to be seen

      Unfortunately, studies on athlete subjects are quasi non-existent. What we know is that alpha-lipoic acid can be used to increase the accumulation of creatine in the muscle (learn more | baking soda is probably more effective, though) and that it diminishes the exercise induced oxidative damage without having significant beneficial (or negative) effects on exercise performance in the short run (Zembron-Lacny. 2009).
      ALA or R-ALA? There is no reliable evidence that R-ALA would produce superior effects in in vivo studies. The often cited study by Streeper et al. (1997), for example, was conducted on isolated, insulin resistant rat muscle in the Petri dish and is thus hardly representative of trained athletes. In fact, the vast majority of studies reporting metabolic benefits from the use of alpha lipoic acid used the racemic mixture of the R- and the allegedly "toxic" S- isomer of alpha lipoic acid. If you still insist on R-ALA make sure it's bound to sodium (Na), because the unbound version won't even make it into your blood-stream (Carlson. 2007).
      Otherwise you will find patent after patent with hilarious, scientifically unverified claims about "muscle building", "body recompositioning" and "performance enhancing" effects of ALA in athletes.

      Reliable evidence that any of these effects exist in athletes who follow a clean, whole foods based high(er) protein diet, however, is absent. If anything, one could cite a relatively exotic rodent study that was published in the Journal of Shaanxi Normal University (Natural Science Edition) in 2006. In said study, the Chinese scientists observed a glycogen preserving effect of ALA in rats who were trained to exhaustion (Xiong. 2006). Whether or not these or other benefits outweigh a potentially reduced adaptive response to exercise as it was observed for n-acetyl-cystein (NAC) by Michailidis et al. in 2013 remains questionable, though.
      Figure 3: Highly significant increases in PPAR-alpha are partly responsible for the reduced hepatic fatty liver synthesis and should help prevent NALD (Keith. 2014)
      Let's get back to the "clock issue": It remains to be seen if similar effects on the clock genes in the liver can be observed in older humans, as they have now been reported for rodents with the standard 600mg/day servings of alpha lipoic acid of which previous studies show that it can help with diabetes and non-alcoholic fatty liver disease.

      Until we don't know the exact mechanism by which alpha lipoic acid works its restorative magic on the clock genes of your liver, we cannot tell if it has to be timed appropriately, either. For melatonin, which is a cyclically produced hormone correct timing is a must. For lipoic acid it's probably irrelevant... at least if its effects are in fact mediated by the powerful antioxidant effects of lipoic acid | Comment!
      References:
      • Carlson, David A., et al. "The plasma pharmacokinetics of R-(+)-lipoic acid administered as sodium R-(+)-lipoate to healthy human subjects." Alternative Medicine Review 12.4 (2007): 343.
      • Dove Keith, Liam Finlay, Judy Butler, Luis Gómez, Eric Smith, Régis Moreau, Tory Hagen. Lipoic acid entrains the hepatic circadian clock and lipid metabolic proteins that have been desynchronized with advanced age. Biochemical and Biophysical Research Communications, 2014
      • Koh, Eun Hee, et al. "Effects of alpha-lipoic acid on body weight in obese subjects." The American journal of medicine 124.1 (2011): 85-e1.
      • Prieto-Hontoria PL, Pérez-Matute P, Fernández-Galilea M, Martínez JA, Moreno-Aliaga MJ. Effects of lipoic acid on AMPK and adiponectin in adipose tissue of low- and high-fat-fed rats. Eur J Nutr. 2012 Jun 5. [Epub ahead of print]
      • Streeper, Ryan S., et al. "Differential effects of lipoic acid stereoisomers on glucose metabolism in insulin-resistant skeletal muscle." American Journal of Physiology-Endocrinology And Metabolism 273.1 (1997): E185-E191.
      • Xiong, Zheng-ying, and Hai-bin LIU. "Effects of alpha-lipoic acid on glucose reserve and moving capacity of training rats [J]." 
      • Zembron-Lacny, A., et al. "Assessment of the antioxidant effectiveness of alpha-lipoic acid in healthy men exposed to muscle-damaging exercise." J Physiol Pharmacol 60.2 (2009): 139-43.