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marylin monroe
Showing posts with label calcitriol. Show all posts
Showing posts with label calcitriol. Show all posts

What's the Optimal Dose of Vitamin D3 for Lean, Normal-, Overweight & Obese Women With Established Vitamin D Deficiency to Get 25OHD Back into the Normal Range?

Both ladies are D-ficient, but will probably need profoundly different amounts of D3 to get their 25OHD back in range.
Actually, I guess, I don't really have to tell you that there is not going to be guest post by Adelfo Cerame, today. Adelfo is busy with the last weeks of school, but will be back as soon as he has passed all the tests. And while I am not sure, whether or not you would call the latest on vitamin D supplementation an adequate replacement for a contest prep update from "your's truly", I suppose that it's better than nothing to bridge the time that still remains until the SuppVersity  Science Round-Up on the Super Human Radio Network is going to air (the show starts at 12PM, EST; the Science-Round-Up airs in the 2nd hour and will thus begin at 1PM, EST; click here to listen live or wait for the podcast // update: now available).

I am honestly not yet sure what exactly we will cover today, but among the things I am still thinking about how we can squeeze them into a 1h show are...
  • methylxanthines caffeine, theobromine and theophylline can bind to human DNA - what does that tell us about the purported health benefits of caffeine & co?
  • caffeine prevents memory impairment - in this case in a model of sporadic Alzheimer's disease
  • anti-Alzheimer's effect of CLA - plus a list of supplements that have been implicated in the prevention of Alzheimer's and other amyloid diseases such as Parkinson's, Cerebellar Ataxis, Amyotrophic lateral sclerosis and (hardly recognized as an amyloid disease) diabetes type II
  • the effect of body weight on the benefits of circuit training in older women - turns out that those who need it the most, namely the obese, also see the greatest benefits
  • Gum arabicum to ward off holiday weight gain - that this could actually work is at least what a recent human study would suggest
  • more on vitamin E, resveratrol, soldiers don't get hurt in battle, but by geranium (DMAA), ...
I think there should be something for everyone of you. Plus: If everything works out, this is going to be the first show to air live via Skype, so no nagging land line echoes and noise any more.

Let's get to the D-news, now

The general consensus among the vitamin D advocates currently is that 2,000 IU of vitamin D3/day is the minimum you need to bring low levels of 25OHD back into the normal range. A soon-to-be-published study by Gallagher, Yalamanchili and Smith that's available ahead of print on the website of the Journal of Steroid Biochemistry and Molecular Biology does yet contradict this notion - at least for women with a body mass <25kg/m² even the meager RDA of 400IU would be enough (Gallagher. 2012). That said the concise paper actually describes the results of two, not just one experiment, with
  • study 1 (ViDOS) being a one-year randomized, double-blind placebo controlled study (ViDOS – Vitamin D supplementation in Older Subjects) of increasing doses of vitamin D3 (400,  800, 1600, 2400, 3200, 4000 or 4800 IU/day vitamin D3 vs. placebo + calcium supplements to maintain calcium intake between 1,200-1,400mg/day) in 163 Caucasians, age 57–90 years; all vitamin D insufficienty, i.e. serum 25OHD ≤ 20 ng/ml (50 nmol/l), and 
  • study 2 (STOP IT) being a 3-year intervention study of calcitriol 0.25 mcg (the active form of vitamin D) twice daily, conjugated estrogens 0.625 mg  daily, a combination of both and placebo in 488 elderly women, age 65–77 years
Body composition indices for the studies at hand (i.e. percentages of total and regional fat and fat-free mass) were measured by dual energy X-ray absorptiometry (DEXA Hologic Delphi) at baseline and after 12 months.
Figure 1: Mean total body weight, total body lean mass, total body fat mass and serum 25OHD in different BMI subgroups of study 2 (STOPIT); right, corresponding calculated ratios (based on Gallagher. 2012).
Even the baseline data in figure 1 does actually yield some insights into the relation of BMI, adiposity and 25OHD levels. While the data on the left already shows that the fat mass increases almost linearly across the BMI levels, while the lean mass remains relatively stable (with the highest value in the overweight group, though), the ratios I calculated and plotted on the right-hand side of figure 1 make it even more obvious clear: The lean / fat mass ratio scales with the BMI. With identical levels in the normal- and overweight individuals and significant increases and declines in the lightest and heaviest study participants. Moreover, the 25OHD vitamin D to fat mass ratio drops most significantly between the low BMI and the upper normal zone, where I suppose even most of the "healthy" individuals will be hovering around these days.

Being lean is a positive predictor of increases in 25OHD with supplementation

That this latent "chubbiness" of the average Westerner may be of particular significance in view of the negative / non-significant outcomes in many of the vitamin D supplementation trials, becomes self-evident, when you take a closer look at the data in figure 2, however you will have to realize that my plot which comprises above all the highly relevant relative changes (middle, marked in red) tells a different story than the original plot from the study showing only the absolute changes (left, but in form of a line graph).
Absolute, relative (compared to baseline) changes and total 25OHD levels (ng/ml) after supplementation with low, medium and high amounts of vitamin D3 in lean, normal, overweight and obese women (based on Gallagher. 2012)
Accordingly, the conclusion of the abstract, which says that "the response to vitamin D is dependent on body weight" and that "women with BMI <25 kg/m² develop much higher levels of serum 25OHD after vitamin D supplementation compared to those with BMI of >25 kg/m²" (Gallagher. 2012) may be correct, but is somewhat misleading as it is open to be interpreted as 'lean women respond most favorably to vitamin D supplementation' - an interpretation that is not really sustainable in view of the relative changes I calculated for figure 2  (middle), yet by no means as incredible as the abstract of another vitamin D study, I dessicated back in September (see "Stronger & Leaner or Fatter & Less Muscular W/ 4,000IU Vitamin D3 - What if Abstract and Data Tell Different Stories?")

Bottom line: The data from this most recent investigation into the differential response of lean, normal, overweight and obese women to vitamin D3 supplementation shows that the absolute increases appear on BMI and that...
  • Always take vitamin D with fatty foods! (see "A Fat D-Ficiency")
    low dose supplementation (400 or 800IU/day) is probably only sufficient to rise and maintain adequate vitamin D levels in lean women,
  • medium dose supplementation (1,400 or 2,400IU/day) yields the most favorable outcomes in total 25OHD levels and 
  • high dose supplementation (3,200, 4,000 or 4,800IU/day) does not yield additional benefits in either the the normal-, overweight and obese subgroup and only marginally higher levels in the lean women.
Overall the study at hand would thus support the notion that a daily vitamin D supplement containing ~2,000IU is the best way to get deficient levels back up, esp. for lean women it should be no problem to cut back to 2x the RDA, i.e. 800IU after normal vitamin D levels are achieved. For the rest, future studies will have to show if low dose supplementation is enough.

These longissimus dorsi slices of mice on a normal and a vitamin D3 supplemented diet show that supplemental vitamin D3 can be used as a fat synthesizer and meat tenderizer in "meat-producing animals". (learn more)
The often-heard hypothesis that the decreased response to vitamin D supplementation in the obese would be a result of the preferential storage of vitamin D in the adipose tissue was not supported by data of the Ghallagher study "there is no evidence from the dose response curves that in obesity serum 25OHD is being deposited in fat" (Gallagher. 2012). In view of the fact that contrary to total vitamin D, which is in fact preferentially stored in adipose tissue (78%) over lean muscle (14%), 25OHD stores are distributed much more evenly with 33% being stored in body fat and 20% in muscle tissue in omnivores like humans and swine (the data is in fact based on a study in pigs; cf. Jakobsen. 2007).

Lastly, a beneficial effect of increase / normalized vitamin D levels on lean or fat mass was (once again) not observed in any of the studies; and that despite the fact that "body fat was an independent predictor of serum PTH", which decreased in response to calcitriol supplementation in study 2 (which is actually more of an adjunct for correlative analysis and as a data source to compare the results of study 1 to). In other words, normalizing your vitamin D levels without taking appropriate measures to counter what's probably behind both, the nasty body fat and the low vitamin D level is not going to make you lean or musclar - at least as of now, it rather appears as if this was yet another instance, where we are - if anything - treating isolated symptoms instead of the root causes of the obesity epidemic.

References
  • Gallagher JC, Yalamanchili V, Smith LM. The Effect Of Vitamin D Supplementation On Serum 25OHD In Thin And Obese Women. J Steroid Biochem Mol Biol. 2012 Dec 11.
  • Jakobsen H, Maribo A, Bysted HM, Sommer OH. 25-Hydroxyvitamin D3 affects vitamin D status similar to vitamin D3 in pigs – but the meat produced has a lower content of vitamin D. British Journal of Nutrition. 2007; 98 908–913.
  • Shephard RJ. Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med. 2003 Jun;37(3):197-206; discussion 206.

Leucine, Insulin & Vitamin D*: A Hypertrophy Boosting Triplet That Does Not Make It From the Dish to the Gym? Evidence & Counter-Evidence from Human Trials

If you could simulate a workout at the beach in the petri dish, its beneficial health effect would be all the rage ;-)
I am pretty sure all of you still remember the recent post about the literal muscle building effect of vitamin D, right (see "Vitamin D Builds Muscle")? Me too, and so I was almost tricked to believe I was looking at the Girgis study, when I scanned the contents of the latest issue of Molecular Nutrition & Food Research, in which you'll with the telling title: "1,25(OH)2-vitamin D3 enhances the stimulating effect of leucine and insulin on protein synthesis rate through Akt/PKB and mTOR mediated pathways in murine C2C12 skeletal myotubes". Ah, ok, I see that's not exactly easy to understand. Well, in plain English this means as much as...

Calcitriol boosts the anabolic effect of leucine & insulin

If your read the "Vitamin D Builds Muscle" article, you should actually remember the dichotomous nature of the effects vitamin D had on muscle cell hypertrophy (which goes up) and proliferation (which goes down). This was after all the most intriguing result of the Girgis study (go back). The new data from the paper at hand, which is likewise dealing with in-vitro effects of vitamin D, does now provide us with some additional information on the underlying mechanisms of the hypertrophy effects.
Figure 1: Protein synthesis, insulin receptor expression and the levels of p-AKT, p-mTOR, and p-70S6K, all regulators of skeletal muscle protein synthesis in muscle cells with and without additional 1,25(OH)2D3 in a leucine + insulin filled Petri dish (Salles. 2013)
If we go by the data in Figure 1 it's obvious that the latter is driven by a direct amplifying effect of 1,25(OH)2D3, the active form of vitamin D, aka calcitriol, on the leucine and insulin induced increase in muscle protein synthesis. Unfortunately, this does not tell us a word about the potential consequences of the anti-proliferative effects of vitamin D on long-term increases in muscle size and the repair of damaged muscle fibers.
Vitamin D and health - What the latest systematic review says: As long as you look at things at the population level or sit in your well-climatized lab next to the Petri dishes, vitamin D is king. When you look at the real world, of which I still believe that it is populated by individuals, the excitement appears to be unwarranted. The most recent systematic review that has been published today in the (most) prestigious medical journal The Lancet says: "The discrepancy between observational and intervention studies suggests that low 25(OH)D is a marker of ill health. Inflammatory processes involved in disease occurrence and clinical course would reduce 25(OH)D, which would explain why low vitamin D status is reported in a wide range of disorders." (Autier. 2013) -- in other words: Being sick will lead to reduction ins 25(OH)D and not vice versa.
It is nevertheless intriguing to see, how the myotubes that had been cultured in 1,25(OH)2D3 solutions at 0, 1, or 10 nM for 72 h reacted to the leucine and insulin challenges. 14–16% increases in fractional protein synthesis rates (FSR) and an increased expression of insulin receptors, of which we can hope that it would also translate into increased glucose uptake into the cells. Assuming that similar effects occur in vivo and in a normal vs. high vitamin D environment, these benefits would be more than just statistically significant.

Ok, that's an in vitro study, so why do you discuss it at all?

If the above is what you've just been thinking, you know me quite well by now. I would indeed not have wasted a whole SuppVersity article on this vitamin D paper, if it would not contradict the real-world results of a recent randomized, double-blind, placebo-controlled study from the University of Oslo so "nicely".  In this paper, a group of Swedish researchers probed the effects of provision of 1,000IU and 400IU of vitamin D3 per day on 251 healthy adult men and women (age 18-50 years; Knutsen. 2013). 

Despite the fact that the vitamin D levels of the subjects almost doubled, none of the strength and performance parameters, i.e. jump height, handgrip strength and the chair-rising test, showed pre vs. post differences that differed from those in the control group.
Figure 2: Relative pre vs. post changes in jump height, grip strength and the time it took the subjects to complete the chair test; no statistically significant inter-group differences were observed (Knutsen. 2013) vs. relative increase in strength (no inter-group differences) in obese, vit D deficient resistance trained individuals (Carillo. 2013)
This in turn raises the question, whether all our new enthusiasm about 'vitamin D' (in the broad sense, i.e. D3, 25(OH)D3 and 1,25(OH)2D3) was misplaced. That's unquestionably a tricky question and if those "enthusiasm" was triggered by the idea that vitamin D would have independent anabolic or ergogenic effects, the answer is probably "Yes". If we are yet talking about the general role of vitamin D in the complex concert of muscular health, the answer must be "No!" There are, after all exceptions to the "vitamin D does not build muscle rule" that applies so nicely to the Knutsen study - there aren't many, but they are there.

The study Carillo et al., for example (Figure 2, right). If you take a look at the results , it's easy to see that for the twenty-three overweight and obese (age: 26.1±4.7 y; BMI: 31.3±3.2 kg/m², body fat: 43%) subjects with insufficient vitamin D levels (25-hydroxyvitamin D: 19.3±7.2 ng/ml) the researchers from the Purdue University recruited for their experiment the 4000IU of supplemental vitamin D each of them received on a daily basis had the expected effect on the resistance training induced increase in peak power and reduction in waist-to-hip ratio (not shown). The effect size is however is pathetic and the only thing that was "significant" - imho statistically, only - was the peak power in the vitamin D group.
A brief note on 25(OH)D vs. 1,25(OD)2D3: I know that it may sound as if it sucks that taking D3 supplements won't increase the amount of calcitriol in your veins, but if it did, I know more than a handful of people whose trust in some gurus would already have cost them a kidney or even their lives. There is a good reason that calcitriol is a prescription drug, because a dysregulation of the 1,25(OH)2D3 levels in the blood will increase the calcium deposition in the organs and vasculature (Bas. 2006) and would thus have the opposite effects most people expect from their high dose vitamin D3 supplementation regimen.
Bottom line: On paper, the real world-evidence from vitamin D deficient obese individuals in Carillo's recent study does supports the notion that vitamin D is an important facilitator of skeletal muscle protein synthesis, what it does not do, though is provide the missing conclusive evidence that being in the upper tertile of the physiological range (not restoring deficiencies as in Ceglia. 2013, for example) has beneficial real-world effects on muscle strength or size.

If you take another look at the doses the vitamin D enthusiasts from the Girgis study bathed their cells in, that the Swedes used active vitamin D, i.e. 1,25(OH)2D3 and that there is no direct relation between vitamin D3 intake, the serum levels of 25(OH)D3 and the amount of calcitriol (1,25(OH)2D3) your cells are exposed to, it's actually not surprising that the muscle building effects don't translate from Jérôme Salles' calcitriol saturated Petri dishes into the real world of the 251 participants of the Knutsen and the majority of the other vitamin D3 supplementation studies, is it?
References:
  • Autier, P. et al. (2013) Vitamin D status and ill health: a systematic review. The Lancet Diabetes & Endocrinolog, Available online 6 Decembee
  • Bas, A., Lopez, I., Perez, J., Rodriguez, M., & Aguilera‐Tejero, E. (2006). Reversibility of Calcitriol‐Induced Medial Artery Calcification in Rats With Intact Renal Function. Journal of Bone and Mineral Research, 21(3), 484-490.
  • Ceglia, L., Niramitmahapanya, S., Morais, M. D. S., Rivas, D. A., Harris, S. S., Bischoff-Ferrari, H., ... & Dawson-Hughes, B. (2013). A randomized study on the effect of vitamin D3 supplementation on skeletal muscle morphology and vitamin D receptor concentration in older women. Journal of Clinical Endocrinology & Metabolism, jc-2013.
  • Knutsen, K. V., Madar, A. A., Lagerløv, P., Brekke, M., Raastad, T., Stene, L. C., & Meyer, H. E. (2013). Does Vitamin D Improve Muscle Strength in Adults? A Randomized, Double-blind, Placebo-controlled Trial Among Ethnic Minorities in Norway. Journal of Clinical Endocrinology & Metabolism, jc-2013.
  • Salles, J., Chanet, A., Giraudet, C., Patrac, V., Pierre, P., Jourdan, M., ... & Walrand, S. (2013). 1, 25 (OH) 2‐vitamin D3 enhances the stimulating effect of leucine and insulin on protein synthesis rate through Akt/PKB and mTOR mediated pathways in murine C2C12 skeletal myotubes. Molecular nutrition & food research.

Vitamin D Builds Muscle: 70% Reduction in Myostatin, 45% Increase in Myotube Size in 10 Days - So, What's the Catch? Plus: Where Could Retinoic Acid (Vitamin A) Figure In?

If rely on the results of the most recent study from Australia, the answer to the above question probably reads "Yes, to a certain degree it does".
It has been a while that a vitamin D study has made it into the SuppVersity news (see previous articles). The reason for that is simple. I am not interested in study no. 9235235 that discusses random associations of low vitamin D with whatever ailment is plaguing us or review no. 89359252 that presents a selection of papers and concludes: "Man, there are vitamin D receptors everywhere, so it must be the f*** most important vitamin in your body!" The upcoming publication of a paper in the scientific journal Endocrinology did yet appear to be a good reason to stop the vitamin D radio silence. It's an in vitro study, I know, but it could answer a question many of will be interested in.

Does vitamin D build muscle?

I guess all of you will tell me that, in view of the results of pertinent studies (cf. Girgis. 2013a), the answer is "no, it doesn't, but deficiency seems to hamper muscle growth and impair skeletal muscle function". This conclusion is hard to debate, especially in view of the fact that we don't even know what exactly vitamin D does in human muscle cells.

Exactly this, i.e. the question "what exactly happens, when muscle cells are exposed to vitamin D" must have been bother Girgis et al., too. Therefore they devised a very simple yet interesting in-vitro study in the course of which they treated C2C12 cells, which are a commonly used model (see bottom line for a comment on this) for human skeletal muscle with both, the active 1,25(OH)2D and inactive 25(OH)D form of 'vitamin D' and observed the effects on cell proliferation and growth.
Figure 1: Number of live cells (10^4/dish; middle) and images of the cells w/out & w/ 25(OH)D2 (Girgis. 2013b)
The first intriguing finding the scientists present in their paper is yet not related to the growth or proliferation of the cells, but to their ability to convert active into inactive vitamin D and vice versa. What we are talking about here, specifically, is the increased expression of CYP24A1. This enzyme is responsible for the 'deactivation' of active vitamin D into calcitriotic acid. This supposedly inactive metabolite (you never know with these vitamin Ds ;-) is then excreted in the urine. The reason that I mention this ostensibly unimportant observation is that the expression of CYP24A1 and CYP27B1, which will convert 25OHD into the active 1,25(OH)2D is evidence of the presence of an auto-regulatory vitamin D-endocrine system in muscle cells.

Ok, enough of the enzymes what about "getting big"?

Let's briefly forget about the mechanisms and return to the actual effects on growth and proliferation. Effects such as the 30-50% increases in G0/G1, a gene that's responsible for arresting the cell cycle, and the 30% and 20% decreases in Myc and Cyclin-D1 the scientists observed in response to both 25(OH)D and 1,25(OH)2D.

In view of the fact that these genes are necessary for the progression of the cell cycle, it is not surprising that the exposition to both forms of vitamin D brought the cycle to a screeching halt. In the end, this is yet a long-known phenomenon. The antiproliferative effects of 1,25(OH)2 D in muscle cells were first described in 1985 and are, as Girgis et al. point out, ...
"[...] they are consistent with antiproliferative effects of 1,25(OH)2 D in a number of other cells and tissues including skin, cancer cells and immune cells ." (Girgis. 2013b)
What's news though, is that the researchers were able to confirm that even 25OHD, the "prohormone" (Girgis. 2013b) to 25(OH)D2, displays antiproliferative effects in C2C12 cells.

Don't forget the "Underestimated Vitamin D Sources: Especially Eggs, But Also Chicken, Pork, Fish & Dairy Contain an Overlooked, Physiologically Relevant Amount of Ready-Made 25OHD" | read more
In that, it's important to acknowledge that these effects are not necessarily brought about by direct receptor interaction. They could also be mediated by the 'activation' of 25OHD via the previously mentioned CYP27B1. With CYP27B1 and its counterpart CYP24A1 the cells would thus be able to produce and clear active vitamin D on demand - and in this case the muscle cells were using it for anti-proliferative purposes.

"What? Vitamin D kills muscle growth?"

At first sight the cell-cycle arrest really suggest that high, and not the often cited low vitamin D levels should have anti-anabolic effects. Since muscle does not necessarily depend on proliferation, or more specifically cell devision, to grow this is yet not the case. At least up to a volume time-point your muscle cells and with them your total muscle volume can grow by simply taking up more protein. This process is called hypertrophy and it works quite nicely until a certain threshold is reached and myostatin pulls the emergency break (if you read my previous article "Getting Big Means Growing Beyond Temporary Physiological Limits" you will know that this is the point, when the activation and incorporation of satellite cells becomes important; learn more)
Figure 2: There may be less live cells, but once the cell cycle arrests, the cells that are bathed in serum with high amounts of acvite vitamin D 1,25(OH)2D grow like crazy, but probably only until they are 'ready to burst' (Girgis. 2013b)
Irrespective of all growth limits, it is thus no irreconcilable contradiction that the data in Figure 2 confirms that 'vitamin D builds muscle. Since proliferation and hypertrophy are independent (or rather mutually exclusive processes) the individual cell growth, while the total cell mass remains the same (remember: cell cycle arrest does not mean that the cell dies).
So, is this good or bad news? Whether the cell cycle arrest is a problem that could haunt you, in the long term, i.e. whence the limits of natural growth are reached (learn more) is something this study can't tell us, because...

... firstly, the cells the researchers used cells express proteins necessary for muscle contraction and display the morphology of individual fiber unit, but C2C12 cells are not adult muscle cells. With a varying degree of maturation, and mode (Langelaan. 2011) of glucose transport (Kotliar. 1992), even Girgis et al. have to admit that "effects in C2C12 cells do not always translate to adult muscle." (Girgis. 2013b) and ...

Figure 3: Primary C2 cells (chicken & mouse) were either untreated (A,C,E) or treated w/ 10 µM RA (B,D,F). A + B panels display satellite cells incubated w/ or w/out RA for 24 hr. C,D and E,F panels show satellite cells and C2 cells, respectively, after 48hr of incubation.
... sedondly, as with every in-vitro study, we cannot tell if the effects that are observed under direct exposition of cells to pharmacological doses of 1,25(OH)D will correspond with those of physiological levels of vitamin D - even high ones.
    In the end, we are thus as clueless as before. Even if everything works as it does in the  model, the data in Figure 2 would suggest that after a couple of days of increased hypertrophy, the myostatin levels are identical and the D-advantage disappears.

    When this 'growth limit' is reached it would require proliferative effects and new cells, or rather myonuclei, to grow further (learn more). With vitamin D alone, that's not going to happen. What could help though, is the villain of the average vitamin D enthusiast: Retinoic acid (RA) aka vitamin A. The latter has after all been shown to "induces adult muscle cell differentiation mediated by the retinoic acid receptor‐α", ten years ago (see Figure 2 from Halevy. 1993).

    Now you tell me: Isn't it funny how we always end up with vitamin A (learn more), whenever we realize that 'vitamin D, without vitamin A' sucks? That cannot be mere coincidence, can it?

    References:
    • Girgis, Christian M., et al. "The roles of vitamin D in skeletal muscle: form, function, and metabolism." Endocrine reviews 34.1 (2013a): 33-83. 
    • Girgis, Christian M., et al. "Vitamin D Signaling Regulates Proliferation, Differentiation and Myotube Size in C2C12 Skeletal Muscle Cells." Endocrinology (2013b): en-2013.
    • Halevy, Orna, and Orna Lerman. "Retinoic acid induces adult muscle cell differentiation mediated by the retinoic acid receptor‐α." Journal of cellular physiology 154.3 (1993): 566-572.
    • Kotliar, N., and P. F. Pilch. "Expression of the glucose transporter isoform GLUT 4 is insufficient to confer insulin-regulatable hexose uptake to cultured muscle cells." Molecular Endocrinology 6.3 (1992): 337-345. 
    • Langelaan, Marloes LP, et al. "Advanced maturation by electrical stimulation: Differences in response between C2C12 and primary muscle progenitor cells." Journal of tissue engineering and regenerative medicine 5.7 (2011): 529-539.

    On Short Notice: 250% More Testosterone From Oleuropein in Olive Oil? Obese Kids, TV, Twinkies & Tortilla Chips, Vitamin D Supplementation That Works, Coffee, Green or Gomchui Tea as Fat Blocking Orlistat Alternative and More!

    Image 1: A tablespoon of olive oil is probably not enough to boost your testosterone levels, right? Probably not, at least not by 250%, I should say.
    Another Saturday, time is flying by and we have no time to waste, because YOU will have to dig trough a whole host of pretty long and (hopefully) interesting "On Short Notice" news, today! So let's get to business and start out with the surprising testosterone boosting corticosteroid normalizing effects of a bitter phenol in extra virgin olive oil most of you will probably be consuming on a daily basis without even knowing its name - Oleuropein. When we are through with the human equivalent dosage calculations the scientists obviously forgot to do, we will make a detour to one of those problems that are particularly dear to my heart, childhood obesity and how watching TV and eating fatty and sugary foods make a dynamic duo that can increase your (grand-)son's, (grand-)daughter's, nephew's and niece's risk to become obese by up to 30%. We will then use our flux-compensator (edit: I used the term that's used in the German version, i.e. "flux compensator" before, but edited it after Gary pointed out that the DeLorian in the original US version had a "flux capacitor" and a brief "research" made it obvious that this is a mistake of whoever translated the term for the original Back to the Future movies) and jump forward in time and see that your hopefully by the non-obese daughters and nieces can reduce their risk of visceral obesity and thus increased mortality even if the just wash the dishes, take the dog for a walk and use the stairs instead of the elevator.

    Before we are eventually going to have a cup of gomchui tea, to evaluate if we can stand the taste so that we could ingest the 2-3 servings it would probably take to negate the negative effects of an occasional fatty slip on our diet, I will yet invite you to take yet a look at two studies from Saudi-Arabia, in which the researchers showed quite convincingly that vitamin D can actually have all those magical anti-obesity effects that it is hailed for, if... yeah, if you put the active calcitriol instead of its precursor cholicalciferol into the fatty chow of rodents. Sounds good? Well let's go, then!
    • Figure 1: While the results of the study, as well as the implications are impressive, the statement that one would get the respective human equivalent dose from "normal dietary intakes" is questionable, to say the least (see text for details) - and still the results of the study at hand only add to the nutritional value of the "liquid gold of the Mediterranean" with its proven antioxidant, antiinflammatory, antiageing, anti-viral, anti-microbial, anti-cancer, anti-aetherogenic and skin protectant effects (cf. Omar. 2010)
      Olive oil contains natural anabolic... well, sort of; at least according to research from the Laboratory of Nutrition Chemistry at Kobe Women's University in Japan, oleuropein, a phenolic compound in extra virgin olive oil did calm down the potentially catabolic corticosteroid overactivity in male rats fed a high protein (40%; from casein) diet (Oi-Kano. 2012). Allegedly, this alone does not yet make it an "anabolic", but with it's concomitant, but highly protein-dependent effect on the testosterone production in the testes of the male Sprague Dawley rats (see figure 1 - top, right), the ameliorative effect on the high corticosteroid expression on the high protein diet (+100% serum corticosteroids in the 40% vs.10% casein group w/out supplementation) and the consequently increased nitrogen balance (=higher net retention of protein) oleuropein aglycone does have much more of a natural anabolic than 99.9% of the expensive testosterone boosters out there.
      The increased secretion of noradrenaline and adrenaline (see figure 1 - top, right), as well as the downstream effect on the expression of uncoupling protein UCP-1 in BAT and the subsequent increase on thermogenesis should contribute to the "body recompositioning" effect of oleuropein, of which Oi-Kano et al. state that they will be particularly pronounced on a "high-fat diet, i.e., 30% fat diet" (Oi-Kano. 2012).
      The fact that humans have hardly any BAT is yet not the only problem, when it comes to the real-world significance of these results. With 10.3mg per rodent per day, i.e. 41mg/kg per day (human equivalent dose 6.68mg/kg), the "effective dose" of regular extra virgin olive oil would be unrealistically high, even if we base our estimate on the same (unpublished) data Oi-Kano et al. use in the discussion of their results and assume that there are 104 mg/kg oleuropein aglycone in extra virgin olive oil. The scientists do yet obviously believe that 5L of olive oil (80kg x 6.67mg/kg body weight divided by 104mg/L olive oil) would be a "normal dietary intake of extra virgin olive oil" - a statement that sounds even more laughable, when we use data from a study by Owen et al. which found that the oleuropein content of extra virgin olive oil ranges from 2.3 to 9.0mg/L (Owen. 2000), with higher levels of oleuropein in bitterer EVOOs (Gutiérrez-Rosales. 2003), or base our estimates on another study from Oi-Kano et al. in which they measured an oleuropein aglycone content of ~19mg/kg extra virgin olive oil (actually we would even hate to make up for the lower density of olive oil and divide that by 0.91 to convert it mg/L). And let's be honest in view of the sheer amount of studies investigating the beneficial effects of extra virgin olive oil in animals and humans, I doubt that a +250% testosterone boosting effect of "normal dietary intakes of extra virgin olive oil" could actually have remained unnoticed...
      It also remains to be seen if olive leaf extracts provide a better alternative. In 2008, Jemai et al. report that the Chemlali olive leaves they used in their rodent study, yielded 4.32 g oleuropein and 3.82g oleuropein aglycone per 100g dried leaves (Jemai. 2008). In view of the fact that the yield will necessarily depend on both the cultivar an the extraction method, you should thus make sure that any extract you buy has a standardized content of oleuropein / oleuropein aglycone. Moreover, if you are mainly interested in the better-established antioxidant, antiinflammatory, antiageing, anti-viral, anti-microbial, anti-cancer, anti-atherogenic and skin protectant effects of olive oil (cf. Omar. 2010),  5L /day are not necessary, anyway ;-)
    • Figure 2: Vicious cycle of childhood obesity (top); childhood obesity trends - state rates (data according to Childhood Obesity Action Network. 2009)
      In children under the age of 10 television watching increases risk of obesity by +30% This is the alarming result of a subgroup analysis (N = 1,696 schoolchildren) from the IDEFICS study, a large scale epidemiological study that involved a total of 15,144 children aged 2-9y from Italy, Estonia, Cyprus, Belgium, Sweden, Germany, Hungary, and Spain. Contrary to comparable analyses, which tend to simply correlate obesity data with data from a questionnaires on the total daily or weekly TV consumption, the Lissner study had a more sophisticated approach towards "TV watching" which included (a) the kids habitual television exposure time, (b) television viewing during meals, and (c) whether or not the children had a televisions in their bedrooms.
      After correlating these data with additional information about taste preferences, Lissner et al. found that all three aforementioned parameters, i.e. total TV consumption, watching TV during meals and having a TV in their room, were associated with profound (21-30%) increases in obesity risk.
      The actual novelty of these results is yet that all these TV watching behavior correlated (in most cases monotonously) with the propensity to eat sugary and/or fatty foods - and that despite the fact that the same kids who were eating nothing but chips and dingdongs, when they were sitting in front of the boob tube did not show similar preferences for fatty and sweet in the contextual different testing sessions all 1,696 kids had undergone.
    • Figure 3: A few steps a day can go a long way (based on Ayabe. 2012)
      Frequent everyday activity prevents visceral fat gain This is the result of a study which investigated the relationship between the frequency of everyday physical activity and visceral adipose tissue mass in 42 Japanese women, aged between 40 to 60 years (Ayabe. 2012). A brief look at the figure on the right will suffice to see that the problem of our society (and the US society probably even more than the European or Japanese) is not necessarily too little exercise, but much more fundamentally no movement at all during our everyday lives. I mean, 2 of the women did not even have 1 bout of 1-min moderate physical activity, 9 did not move for 3 min a day - is it a wonder we are having serious problems, then?
      Tip: Take a WALK! The results of another recently conducted study, which found that 30 min of brisk walking at approximately 60% of maximum heart rate after a meal reduce post-prandial lipidemia in healthy normolipidemic men, only corroborates the importance of daily physical activity (standing for 45min did not make a difference, btw; cf. Miyashita. 2012). While we do have the stress right after launch, we don't have the "exercise" that would historically be associated with the latter - and as of late this is not just the case for white collar workers like me ;-)
    • Active vitamin D does what vitamin D3 doesn't do, ameliorate the oxidative damage due to high fat diets. While the few vitamin D3 supplementation trials in rodents and humans were real non-starters, when it came to the purported effects of "everyone's darling vitamin" against diet induced obesity, diabetes, inflammation, etc. a group of Saudi Arabian researchers has just published the second of two papers within the past two months which deal with the effects of active vitamin D, aka calcitriol, on the diet induced damage in muscle and liver tissue (Alkharfy. 2012).
      Figure 4 (Zhu. 2012): Vitamin D3 is converted to the active metabolite 1,25(OH)2D3 by sequential 25-hydroxylation and 1a-hydroxylation. If this conversion does not take place (for possible reasons see text) , though, it could be that you don't see any benefits even from exorbitantly high amounts of supplemental vitamin D3
      In the July issue of Molecules, the scientists had already presented data on the preventive effect calcitriol had on the myocyte damage (weak, pre-degenerate mitochondria, loss of connections among myofibrils) they observed in the muscle fibers of mice who had been fed a high fat diet for 12 weeks. Now, roughly a month later, the researchers from the King Saud University in Riyadh, Saudi Arabia, report similar beneficial effects on weight-related systemic inflammation and ultrastructural changes of the liver during a 16-week rodent study. Compared to the non-supplemented mice, the mice on the calcitriol enriched high fat diet had reduced concentrations of TNF-α, CRP and IL-6 (p < 0.05) and a way higher insulin sensitivity (C-peptide and insulin levels of 539.4 ng/ml versus 718.9 ng/ml and 0.77 ng/ml versus 1.7 ng/ml, respectively; p <0.05). Moreover, the potentially toxic calcitriol protected the liver of the mice from the marked accumulation of fat droplets Alkharfy et al. observed in 60-70% of the hepatocytes of the mice that were fed the non-supplemented high fat diet.
      The profound weight loss the animals in the HFD + calcitriol trials experienced in both trials (even the LFD control did gain some weight!), should yet remind you that there is a good reason that you can't buy calcitriol over-the-counter at your local GNC and better don't reach out to whatever other sources you may just have been thinking about!
      That said, it is still remarkable that in a mouse model of prostate and breast cancer, dietary vitamin D3 (cholecalciferol) and thrice weekly injections of calcitriol worked equally well (Swami. 2012), while the cholecalciferol from your average vitamin D supplement sucks, when it comes to the metabolic effects everyone is promising you, you would see if you just bumped your 25-OHD levels to whatever novel heights. At least in the case of the obese rodents, a possible reason could simply be that obesity prevents it's conversion. That this appears to be the case is something we have already discussed in the context of the defect in the enzymatic cascade in obese patients in a previous installment of "On Short Notice". And if it's not obesity that hinders vitamin D from doing its purported job, you still got my hypothetical rants about the exuberant phosphate intake from the average western diet and its negative impact on the conversion of cholecalciferol to calcitriol (see "Hypothesis: Does Vitamin D 'Deficiency' Protect Us From Phosphorus Overload?")
    • Figure 5: ECGC may be more potent in the in-vitro essay (left, background; anti-lipase effect rel. to Orlistat), its susceptibility to digestion (bottom, right) renders it yet ineffective as a "fat blocker" (left, foreground; FFA during simulated digestion). Appropr. dosed (1-3 serv./day), coffee and gomchui tea thus appear to be better suited to reduce fat digestion and absorption (Cha. 2012).
      With di-O-caffeoylquinic acid, Gomchui (Ligularia fischeri) Tea easily outperforms coffee and green tea as an inhibitor of fatty acid breakdown in the stomach - what could in fact turn against you on an already fat-deficient (yeah, there is such a thing!) diet, could be a useful tool for the transient phase from diet-induced obesity to natural leanness on a totally revamped diet + exercise regimen, as well as the occasional "binge", you may planning to have if you are already following a healthy whole foods diet.
      Published in the July issue of the Journal of Agriculture and Food Chemistry a recent the study by Cha, Song, Kim and Pan  shows quite conclusively that a tea that's brewed from Lingularia fischeri (gomchui) can decrease the activity of the fat-digesting enzymes in your gut and thus minimize the energy influx from free fatty acids.
      What's also intriguing about this research is that green tea, despite having the highest content of EGCG and thus theoretically the most potent lipase inhibitor of all the three beverages (green tea, coffee and gomchui tea) had - as soon as a certain dosage threshold of 2-3 servings was achieved, the least effect on on lipase activity in the digestion model the scientists used. If your goal is to ameliorate the potential weight gain right after a binge, gomchui or even a strong black coffee would probably be better choices than a cup of green tea.
      Figure 6: The effect green tea extracts have on the synthesis (FAS), transport (CPT II) and oxidation (ACO) of fatty acids in the liver, depend on both EGCG and caffeine (Suigiura. 2012)
      In this context, it is also worth mentioning that a related study by Sugiura et al. that has been published in the Journal of Obesity found that the inhibitory effects of EGCG on FAS (fatty acid synthase, i.e. the exact opposite of lipase) expression in the liver, reach statistical significance only in the presence of caffeine (Sugiura . 2012).
      This would render the use of decaffeinated green tea extracts for weight-loss purposes at least less effective than the consumption of real green tea. You could probably still grasp the beneficial downstream effects of the anti-inflammatory effects of EGCG, but would miss out on the "fat burning" and "anti-fat depositioning" effects (esp. in the liver), as those are obviously reliant on the simultaneous presence of caffeine. Needless to tell you that this is exactly the way nature has intended it, right? I guess it's about time to have a cup of good tea now... or maybe coffee - or Gomchui?
    That's it already for today, but never mind, there will be more. In the next installmenta of "On Short Notice", my daily news-updates on the SuppVersity Facebook Wall (today with news on the muscle building effects of cortisol + IGF1 and more) and - from now on - every Thursday on Super Human Radio (click here to download the first installment of the thursdaily "Super Human Radio + SuppVersity Joint Research Update"). And aside from that there are of course your daily "regular" SuppVersity News!

    References:
    • Alkharfy KM, Al-Daghri NM, Ahmed M, Yakout SM. Effects of vitamin d treatment on skeletal muscle histology and ultrastructural changes in a rodent model. Molecules. 2012 Jul 31;17(8):9081-9. 
    • Alkharfy KM, Al-Daghri NM, Yakout SM, Ahmed M. Calcitriol Attenuates Weight-Related Systemic Inflammation and Ultrastructural Changes of the Liver in  a Rodent Model. Basic Clin Pharmacol Toxicol. 2012 Aug 21. 
    • Ayabe M, Kumahara H, Morimura K, Sakane N, Ishii K, Tanaka H. Accumulation of Short Bouts of Non-Exercise Daily Physical Activity is Associated with Lower Visceral Fat in Japanese Female Adults. Int J Sports Med. 2012 Aug 17.  
    • Cha KH, Song DG, Kim SM, Pan CH. Inhibition of Gastrointestinal Lipolysis by Green Tea, Coffee, and Gomchui ( Ligularia fischeri ) Tea Polyphenols during Simulated Digestion. J Agric Food Chem. 2012 Jul 25;60(29):7152-7. 
    • Childhood Obesity Action Network. State Obesity Profiles, 2009. National Initiative for Children's Healthcare Quality, Child Policy Research Center, and Child and Adolescent Health Measurement Initiative. Retrieved 06/02/2010 from http://wwww.nschdata.org/content/07obesityreportcards.aspx.
    • Gutiérrez-Rosales F, Ríos JJ, Gómez-Rey ML. Main polyphenols in the bitter taste of virgin olive oil. Structural confirmation by on-line high-performance liquid chromatography electrospray ionization mass spectrometry. J Agric Food Chem. 2003 Sep 24;51(20):6021-5.
    • Jemai H, Bouaziz M, Fki I, El Feki A, Sayadi S. Hypolipidimic and antioxidant activities of oleuropein and its hydrolysis derivative-rich extracts from Chemlali olive leaves. Chem Biol Interact. 2008 Nov 25;176(2-3):88-98. Epub 2008 Sep 7.
    • Lissner L, Lanfer A, Gwozdz W, Olafsdottir S, Eiben G, Moreno LA, Santaliestra-Pasías AM, Kovács E, Barba G, Loit HM, Kourides Y, Pala V, Pohlabeln H, De Henauw S, Buchecker K, Ahrens W, Reisch L. Television habits in relation to overweight, diet and taste preferences in European children: the IDEFICS study. Eur J Epidemiol. 2012 Aug 22.
    • Oi-Kano Y, Kawada T,Watanabe T, Koyama F,Watanabe K, Senbongi R, et al. Extra virgin olive oil increases uncoupling protein 1 content in brown adipose tissue and enhances noradrenaline and adrenaline secretion in rats. J Nutr Biochem. 2007;18:685–92.
    • Oi-Kano Y, Kawada T, Watanabe T, Koyama F, Watanabe K, Senbongi R, Iwai K. Oleuropein supplementation increases urinary noradrenaline and testicular testosterone levels and decreases plasma corticosterone level in rats fed high-protein diet. J Nutr Biochem. 2012 Aug 15. 
    • Omar SH. Oleuropein in olive and its pharmacological effects. Sci Pharm. 2010;78(2):133-54. Epub 2010 Apr 23.
    • Owen RW, Giacosa A, Hull WE, Haubner R, Spiegelhalder B, Bartsh H. The antioxidant/anticancer potential of phenolic compounds  isolated from olive oil, Europ. J. Cancer. 2000; 36:1235–1247. 
    • Sugiura C, Nishimatsu S, Moriyama T, Ozasa S, Kawada T, Sayama K. Catechins and Caffeine Inhibit Fat Accumulation in Mice through the Improvement of Hepatic Lipid Metabolism. J Obes. 2012;2012:520510.
    • Zhu J, DeLuca HF. Vitamin D 25-hydroxylase - Four decades of searching, are we there yet? Arch Biochem Biophys. 2012 Jul 1;523(1):30-6

    Sex-Dependent Low GI Advantage(s) & Vasodilating Effects of Insulin. Diet-Dependant Effects of Active Vitamin D on Glucose Metabolism. Plus: Supplemental Flaxseed Oil?

    It seems as if the glycemic index of her diet during puberty could determine on which side of this photoshopped divide a will end, when she's a young woman. Intriguingly, the association between high GI diets and high waist circumferences and obesity risk was not observed in the boys whose 5-year follow up data the researchers analyzed.
    "145mm" that's the SuppVersity figure of the Week and the number of additional millimeters the waist circumference of a 12-year old girl is going to increase until she's 17 for each 1-SD increase in dietary GL. In conjunction with the observation that each 1-SD increase in dietary fiber intake was associated with a concurrent 0.44 kg/m² decrease in mean BMI, in girls and a 145mm lower increase in waist circumference, in boys, these results from a soon-to-be-published paper clearly support the notion of the fattening high GI carbs for girls (Gopinath. 2013).

    The data does yet also raise the question, whether a higher activity level, a greater muscle mass or whatever something totally different is responsible for the non-significant effect the consumption of a high GI diet appears to have on the "strong sex". After all, even the devilish sugar sweetened soft-drinks which were associated with 4.45% higher body fat levels in girls who consumed one or more servings of the sugary glue per day, did not make a difference for the "young men" (suggested read: "Women Have a Much Higher Time Losing Body Fat Than Men")... ok, so let's see what else we've got "in the news today".

    The vasodilatory effects of insulin could be life saving 

     (Hornstra. 2013) -- As a SuppVersity reader you are way beyond the stage of bro-science and thus fully aware that insulin not the villain everybody believes it was. Aside from the fact that it prevents catabolism, which is probably the only thing the average bro knows about, it helps nourish your cells, it keeps your blood from turning into a sweet slurry and has potent vasodilatory effects (ever wondered why you cannot get a decent pump ever since you went low carb?)

    You don't still believe in the urban myth that adding fat to a high carb meal would blunt, the subsequent insulin spike, do you? Oh, you do? Well, in that case I recommend you take a look at one of the more recent installments of True or False (learn more)!
    There is just one downside to it: Insulin does these and all the other good things only to people like yourself. People who work out, eat clean and remain insulin sensitive. In that, you do however have overweight company, that's at least what the results of a recent study from the Department of Internal Medicine at the VU University Medical Center in Amsterdam clearly suggest. In order to elucidate the hitherto only partially understood local microvascular vasoactive effects of insulin and their impact on systemic vascular resistance. J.M. Hornstra and colleagues conducted a cross-sectional studied in 37 healthy, overweight subjects (age 25 – 55 years, BMI 25 - 30 kg/m²), in whom they measured the local insulin-mediated vasodilation in response and transcutaneous iontophoresis of insulin and compared them to the local effects of acetylcholine and sodium nitroprusside, a potent pharmacological vasodilator.

    What the researchers found was a clearcut inverse relationship between insulin-mediated vasodilation (r=-0.50; p<0.01) and the subjects' vascular resistance - a finding that was maintained after adjustment for age, sex, blood pressure and smoking and was not associated with local microvascular effects of acetylcholine.

    Bottom line: The results of the study at hand do thus corroborate to the notion... or I should better write "the proven fact" that insulin is not solely the fattening villain the current mainstream Internet paradigm says it was. It is a powerful hormone with physiological importance well beyond it's role in glucose management and the increased risk of cardiovascular diseases in type II diabetics and the average non-insulin sensitive overweight Westerner is not due to having too much insulin floating around in the system, but due to the non-responsiveness of the cells of the ever-increasing number of pre-diabetics.

    Low GI diets helps to shed >10% more during three months exercise intervention 

    (Solomon. 2003) -- In a way, you could say that the results of a soon-to-be-published study from the Department of Pathobiology at the Cleveleand Medical Clinic stands in line with both the SuppVersity Figure of the Week and the previous post on insulin's role in peripheral and systemic vascular resistance.

    In the study at hand, the ingestion of a low glycemic index diet, as it was prescribed to the 20 older, obese individuals who participated in a 3-months fully-supervised aerobic exercise program will did (a) improve the weight loss success of the subjects in the low GI (LoGIX) vs. high GI (HiGIX) groups by +10.5%, (b) improved their insulin sensitivity and should (this was not measured) thus have have had a beneficial impact on the vascular resistance of the overweight individuals and (c) promoted a lower respiratory exchange ratio (a low RER which is the ratio of glucose / fat oxidation is an indicator of in creased fatty acid and/or lowered glucose oxidation) during exercise and did thus help them to decrease the amounts of lipids floating around in their system.

    Study probes whether "Hitting Your Macros" is all that counts (read more)
    Bottom line: In the end, the results of the study at hand are not new, they only confirm what you will probably have known all along: The modulatory effects of low GI diets on the substrate utilization during exercise is highly relevant for the overweight and/or insulin resistant individual (skinny fat people included). With it's ability to improve and conserver insulin sensitivity, it is yet likewise important for the active individual and/or athlete trying to maintain his insulin naturally high insulin sensitivity without having to compromise his/her performance and endocrine health by running around glycogen depleted 24/7.

    All of you who did not see the discussion revolving around the necessity of high GI carbs and thus insulin spikes for glycogen repletion after a workout, I suggest you take a peak at the corresponding graph on I posted on Facebook earlier this week (go to the SuppVersity Facebook Wall). One thing you should keep in mind though, is the fact that "high GI diets" are not characterized by the occasional ingestion of "fast carbs" in the postworkout window - this alone is thus unlikely to cause the same ill health effects as a dietary protocol that does not even give your body the chance to clear the steady and rapid influx of glucose from the bloodstream (the "GL", i.e. the glycemic load may in fact be a better measure here, learn more)

    Diet- and tissue-specific effects on transcriptional regulation of glucose metabolism 

    (Alharfy. 2013) -- In what is unfortunately yet another rodent study on vitamin D, researchers from the College of Pharmacy at the , King Saud University in Riyadh, Saudi Arabia, took a closer look at the differential effect vitamin D (1,25-(OH)2D3, Rocaltrol(R)) supplementation exerts on the transcriptional regulation of insulin-sensitive in liver, muscle and adipose tissue in Male C57BL/6J mice on regular low fat or obesogenic high fat (+high carb) chow.
    Figure 1: Effect of vitamin D treatment on transcript levels of insulin sensitive genes in low-fat diet (LFD)- and high-fat diet (HFD)-fed mice (Alharfy. 2013)
    If you take a closer look at the data in figure 1, you see that in muscle tissue of LFD-fed mice, vitamin D treatment increased vitamin D receptor (VDR, not shown) to 2.03-fold and insulin receptor substrate (IRS-1) to 1.5-fold. An even more pronounced increase in IRS-1 (+140%; IRS proteins play a key role in transmitting signals from  insulin receptors to the intracellular pathways, as well as growth promotion) expression occurred in the mice that were fed the obesogenic high fat diet - in this case, the increase was yet accompanied by a -50% reduction in VDR expression (not shown) without having downstream effects on GLUT4 expression.

    Maybe some of you remember that I covered a study in which vitamin D3 lead to increased obesity levels in rodents back in October 2011 (learn more)
    In the liver of the mice receiving the species-appropriate low-fat diet, the provision of supplemental 150 IU/kg calcitriol (the active form of vitamin D!) did not induce any statistically significant trancriptional changes, whereas the -85% decrease in exogenous IRS-1 level in the HFD group and the concomittant upregulation of the hepatic vitamin D receptor expression (+260%) show that the liver could be a major target for the previously observed anti-obesity effects of active vitamin D (see "Active vitamin D does what vitamin D3 doesn't do"; read more). In lean mice, on the other hand, similar effects were absent and the expression of glucose transporters /GLUT-4) decreased by -30%.

    The decrease in hepatic GLUT-4 was yet still small compared to the rapid decline in GLUT-4 expression in the adipose tissue of the LFD group. Whether this could precipitate high blood glucose levels is yet about as uncertain as the implications of the highly elevated GLUT-4 expression in the HFD group. Theoretically the latter would help reduce blood glucose levels, but at an expense of profound increases in adipose tissue - that this is not very unlikely, is something you have read about here at the SuppVersity in October 2011, already (go back)

    So what do the scientists say?

    In view of the necessity to convert supplemental vitamin D3 to it's active form, it is questionable, whether the provision of the former would induce any of the changes Alharfy observed in the study at hand - learn more in a previous installment of the short news!
    As Alharfy et al. point out the absence of significant changes in GLUT-4 expression in response to the adminstration of physiologically highly significant amounts of the active form of vitamin D provides further evidence that the "insulin action in mammalian tissue is not a direct one" but are brought about by "intracellular mechanisms of insulin action mediated by IRS-1 and VDR" in the absence of any immediate effects on "glucose transport across major insulin-sensitive tissues, including adipose and liver in mice under LFD and HFD conditions". Consequently, the...
    "[...] antidiabetic effect of vitamin D may be directed through its anti-inflammatory action in obese conditions. Reduction in inflammatory cytokines production by vitamin D may play a role in decreasing insulin  resistance." (Alharfy. 2013)
    The scientists' conclusion does therefore stand in line with the observations of Waldron et al. about which you've probably read on the SuppVersity Facebook Wall about a month ago (Waldron. 2013).

    Based on the 25OHD response (remember: 25OHD is the precursor to calcitriol and will thus be lowered, when more calcitriol is produced from this 'storage form') the researchers from the New Cross Hospital, in Wolverhampton in the UK observed in response to inflammatory assaults, they were among the first to propose that "serum 25-(OH)D is a negative acute phase reactant [... and h]ypovitaminosis D may be the consequence rather than cause of chronic inflammatory diseases" (Waldron. 2013)

    Bottom line: While we are still far away from a proper understanding of the exact mechanisms which underly the observed correlations between low vitamin D levels and all sorts of (eventually) inflammatory diseases, the results of the study at hand corroborate the notion that D3 levels (=passive storage) have little to no direct effects on the etiology of the diabetes, cancer, and what not.

    Figure 2: Reductions (!) in all risk mortality calculated on the basis of NHANES data for each 10ng/ml increase in vitamin D up to the "magic" 21ng/ml margin from the Amer study (Amer. 2013)
    This would also explain why the vitamin D deficient ballet dancers from yesterday's SuppVersity Facebook news did benefit from supplementation, while the 10,000 participants in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004 in another recent study by Amer et al. did not have lower risks of all cause mortality, once their 25OHD levels were just above lowest margin of the normal range (see figure 2 + today's SuppVersity Facebook news; Amer. 2013). What it does not explain, though, is the fact that we see similarly increased risk of all-cause mortality among women with low (20 ng/mL) as well as high (50 ng/mL) levels of serum 25(OH)D (Melamed. 2008) or the 50% increase in mortality Michaëlsson et al. observed in 1194 elderly men (mean age at baseline, 71 years) with vitamin D levels below 18.5ng/mL and above 39.4 ng/mL during a median follow-up of 12.7 years (Michaelsson. 2010).

    In the end, studies such as the one at hand, would have to be conducted over long enough periods in human beings to finally identify the mechanism behind the non-linear effects of vitamin D on mortality and metabolic health in the these and other studies. Personally, I would hope that studies like the one by Amer et al. get some more mainstream attention and raise people's awareness of the simple paradigm "test first, supplement second".

    Flaxseed oil does not offer metabolic advantages over olive oil  

    If you don't like the feminine look and the size of certain body parts of this Greek statuette, you just found another reason to avoid flaxseed - at least if you are and want to stay male (learn more)
    (Kontogianni. 2013) -- With all the hype around fish oil, flaxseed oil has more or less been forgotten. If you ask the average Joe or Jane, about whether you should rather use olive or flaxseed oil if you wanted to improve your lipid metabolism and reduce inflammation, many of them will probably still answer: "Flaxseed, of course!"

    According to a recent study from the Harokopio University in Greece this is yet nothing but another urban myth. In their randomized cross-over study (2x6 weeks + 6 weeks washout in-between), the scientists found that it did not make a physiologically significant difference whether the 37 normal weight young subjects (age: 22 years) consumed 15 mL/day of either flaxseed oil or extra virgin olive oil.

    When it comes to the differences the scientists observed in response to the olive oil vs. flaxseed oil supplemented diet, you better have a magnifying glass ready, as the only highly visible change was allegedly not significant:
    Figure 3: Relative levels of inflammatory and biochemical parameters before and after the interventions; all data expressed relative to baseline / after washout = pre-crossover values (Kontagianni. 2013)
    Even the fatty acid composition in the cell membranes differed only in terms of the amount of alpha linoleic acid (short-chain omega-3), while the amount of what people often falsely label as "fish oil", namely the long-chain omega-3 fatty acids, DHA and EPA, did not change in either group.

    Oleuropein in olive oil is a natural testosterone booster (learn more)
    Bottom line: Aside from statistically non-significant decreases in total and LDL cholesterol in the flaxseed oil group and a physiologically irrelevant increase in the ALA content of the in the erythrocyte membranes,  there were surprisingly little differences between the two study arms.

    Now, you can certainly argue that the changes and potential benefits would have been more evident if the amount of flaxseed oil in the diet had been higher. On the other hand, you all should be aware that flaxseed oil goes rancid in no time, cannot be heated and tastes like a$$... this limits it's use as a regular part of your diet. What's more, if you take close look at the levels of hs-CRP in figure 3, you will have to admit that more flaxseed oil could also equal an increase in inflammation.



    That's it for today: Why? Well, I simply had no time to write more earlier today and other than briefly posting this no additional time to spend writing up additional short-news... but judged by the visitor counts on the last weekends, you are probably busy enjoying the weekend, as well. Enjoy your weekend, everyone!

    References:

    • Amer M, Qayyum R. Relationship between 25-Hydroxyvitamin D and All-cause and Cardiovascular Disease Mortality. Am J Med. 2013 Apr 17. 
    • Brown LJ, Midgley AW, Vince RV, Madden LA, McNaughton LR. High versus low glycemic index 3-h recovery diets following glycogen-depleting exercise has no effect on subsequent 5-km cycling time trial performance. J Sci Med Sport. 2012 Nov 12.  
    • Gopinath B, Flood VM, Rochtchina E, Baur LA, Louie JC, Smith W, Mitchell P. Carbohydrate nutrition and development of adiposity during adolescence. Obesity (Silver Spring). 2013 Mar 21.
    • Hornstra JM, Serné EH, Eringa EC, Wijnker MC, de Boer MP, Yudkin JS, Smulders YM. Insulin's microvascular vasodilatory effects are inversely related to peripheral vascular resistance in overweight, but insulin-sensitive subjects. Obesity (Silver Spring). 2013 Mar 20.
    • Kontogianni MD, Vlassopoulos A, Gatzieva A, Farmaki AE, Katsiougiannis S, Panagiotakos DB, Kalogeropoulos N, Skopouli FN. Flaxseed oil does not affect inflammatory markers and lipid profile compared to olive oil, in young, healthy, normal weight adults. Metabolism. 2013 May;62(5):686-93.
    • Melamed ML, Michos ED, Post W, Astor B. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008;168(15):1629-1637. 
    • Michaëlsson K, Baron JA, Snellman G, et al. Plasma vitamin D and mortality in older men: a community-based prospective cohort study. Am J Clin Nutr. 2010;92(4):841-848.
    • Solomon TP, Haus JM, Cook MA, Flask CA, Kirwan JP. A low glycemic diet lifestyle intervention improves fat utilization during exercise in older obese humans. Obesity (Silver Spring). 2013 Mar 20. 
    • Waldron JL, Ashby HL, Cornes MP, Bechervaise J, Razavi C, Thomas OL, Chugh S, Deshpande S, Ford C, Gama R. Vitamin D: a negative acute phase reactant. J Clin Pathol. 2013 Mar 1.

    There is More To Glucose Control Than Carbohydrates (3/?): Non-Carbohydrate Nutrients And Their Effects On Blood Glucose Management ➲ Vitamin D - The Sunshine Vitamin

    Is the vitamin D you produce at the beach you're visiting only rarely the secret to perfect glucose control?
    In the past two weeks you've learned much about the unquestionably beneficial effects of protein on glucose metabolism and the ambigous, since "context depend" effects of various fatty acids. Today, in the third installment of this series, we are leaving the "macros" behind and turning our heads towards the micronutrients.

    I have long thought about the micros I would include in today's installment, started out with vitamin D and realized: "Damn! 50% of my Sunday gone already." In other words, you will have to live with the fact that today's installment of this series is an homage to the hype.
    You can learn more about this topic at the SuppVersity

    Proteins, Peptides & Blood Glucose

    SFA, MUFA, PUFA & Blood Glucose

    Vitamin D & Diabetes

    Read these ➲ while waiting

    16 Weeks High Fat Diet

    Fat to Blunt Insulin?
    Vitamin D unquestionably is a top candidate for the "micronutrient with the most bullshit science published", and contrary to what the mainstream media articles would suggest, it's by no means the panacea as which it is depicted even in "scientific" reviews, of which I am pretty sure that 90% of them are solely written to get published - I mean, every editor wants a vitamin D article in his journal, right?

    Before this whole article turns into a rant, I'd suggest we take a look at the facts: It's beyond doubt that there are clear-cut (epidemiological determined) correlations between low vitamin D levels, insulin resistance and type II diabetes (Need. 2005). As a SuppVersity Reader you do yet know better than some of the previously mentioned scientists who will - without the blink of an eye - make the transition from "There is a correlation between low vitamin D levels and insulin resistance in our data" to statement like these:
    • Vitamin D is an acute phase reactant - but what are the impli- cations? Firstly, this would imply that serum 25-hydroxy- vitamin D is an unreliable biomarker of vitamin D status after an acute inflammatory insult (for the obese, even a meal is an acute inflammatory result; Blackburn. 2006). Secondly, hypovitaminosis D may be the consequence rather than the widely purported cause of a myriad of chronic diseases (Gama. 2012).
      "Low vitamin D causes / triggers insulin resistance." -- An excellent example of someone confusing correlation and causation. What is often accepted as a scientific fact, is possible. In view of the fact that vitamin D has recently been shown to act as an acute phase reactant in inflammatory conditions, it is yet rather unlikely. In fact, it appears more likely that what we are seeing here is a correllative reduction of vitamin D, whenever someone - like a type II diabetic, for example - is chronically inflamed (Waldron. 2013)
    • "Vitamin D supplements can be used to ameliorate insulin sensitivity." -- In an assertion like this, the authors go even one step further. After making the unwarranted conclusions that vitamin D triggers the onset of insulin resistance, they assume that supplemental vitamin D (usually D3), of which the current evidence shows that it does not elevate the levels of 1,25-hydroxy vitamin D, i.e. calcitriol, the only form of vitamin D, of which we actually have some rodent data that it's exogenous administration produces the anti-diabetic + weight loss effects everyone appears to expect from "regular" D3. An immediate effect of calcitriol on glucose uptake does yet not appear to exist - at least not in healthy individuals (Fliser. 1997).
    When you're looking at the previously cited study by Filser, you could rightly argue that it is unrealistic too expect an already "optimal" insulin sensitivity to improve... and you are right! Studies like the one by Fliser et al. can thus hardly serve as a yardstick to gauge the usefulness of vitamin D
    Figure 1: If we compare the fat "loss effects" of vitamin D supplementation in the studies by Zitterman (2009) and Salehpour (2012) in Figure 1 (left), and invoke the results of the latest meta-analysis by Pathak, et al. (2014) in Figure 1 (right), it is hard to argue Pathak's conclusion that the divergent results from previous trials would suggest that "Vitamin D supplementation did not decrease measures of adiposity in the absence of caloric restriction" (Pathak. 2014).
    The studies we have to look for are studies with subjects who have a compromised glucose metabolism or full-blown type II diabetes (note: we cannot look at studies in type I diabetes, because any benefits vitamin D would provide here are most likely related effects on the immune system). Studies like these, for example:
    • Inomata (1986) - 1-alpha (OH)D3 (active vitamin D) administration improves glucose tolerance in diabetic subjects
    • Nilas (1983) - No effect of vitamin D or its analogues on body weight or glucose management in post-menopausal women
    • Orwoll (1994) - No effect of calcitriol (active vitamin D) on glucose homeostasis in non-insulin-dependent diabetes mellitus
    Figure 2: The latest meta-analysis says: No long-term improvement in blood glucose management w/ vitamin D supplements (George. 2012).
    I could add one study after the other, but I know what you are thinking right now: Who cares about studies on vitamin D sufficient individuals?

    You're right. If we don't make the totally irrational, yet not uncommon assumption that the initially mentioned correlation between low vitamin D and low insulin sensitivity would apply beyond deficiency levels. There is thus no reason to assume that supplementation would help anyone with normal vitamin D levels so that we have to focus on those individuals with an impaired insulin resistance who are actually vitamin D deficient.
    "Our results suggest that hyperinsulinemia and/or insulin resistance are directly responsible for decrease of 25(OH)D levels in obesity." (Pergola. 2013) That's the logical conclusion from a closer analysis of the correlation between low vitamin D and insulin resistance that revealed that 25(OH)D levels are negatively associated with inflammatory parameters such as CRP and C3 and C4 levels, but not independently of BMI, body fat distribution, insulin levels, or insulin resistance.
    Unfortunately (for the average vitamin D enthusiast), the situation is not entirely unambiguous in this population either. Even in studies on vitamin D deficient subjects, you will find quite impressive null results (impressive, because the D-levels increase significantly, but nothing happened), though. Tai et al., for example, found no improvements in insulin sensitivity in spite of the fact that the vitamin D supplement they had administered to their 33 vitamin D insufficient subjects (serum 25-hydroxyvitamin D concentration ≤50 nmol/L; 12 with impaired glucose tolerance) increased their 25OHD levels from 39.9 ± 1.5 (SEM) to 90.3 ± 4.3 nmol/L (Tai. 2008).

    Rule of thumb: If anyone is actually likely to benefit, though, it's the overweight, inflamed (pre-)diabetic, for whom George et al. calculated a small effect on fasting glucose (−0.32 mmol/l) and a small improvement in insulin resistance (standard mean difference −0.25), but no improvements in long-term glucose management (HbA1c, see Figure 2) in response to vitamin D supplementation (George. 2012).

    Figure 3: No improvement in insulin sensitivity in people w/ normal, min. effects in those with compromised insulin sensitivity w/ vitamin D supplements, says meta-analysis (George. 2012).
    As with every "rule" there are exceptions to this one, as well. Nagpal et al. for example observed that the provision of three doses of vitamin D3 (120 000 IU each; supplemented group) improved the postprandial glucose excursions of the abdominally obese, but allegedly "apparently healthy" subjects (Nagpal. 2009). The results of a paper by Belenchia from 2013, on the other hand, violate the "no improvements in long-term glucose management rule". The scientists from the University of Missouri School of Medicine did after all find that adding 4,000IU/day of vitamin D to a standard life-style intervention lead to significant improvements in blood glucose management in their adolescent subjects with low baseline vitamin D levels (Belenchia. 2013).

    For someone with an established (=tested) vitamin D deficiency, supplementation does therefore appear to be clearly indicated. As long as you stick to reasonable amounts (see Recommendation I, below) there is little to no risk of doing any harm (although I know from anecdotes that some people react with fatigue to relatively slow quantities of vitamin D).

    Recommendation #1: Unless you are a sun-worshipper living in a country near the equator, you want to make sure to get ~1,000IU, if you are normal-weight and light-skinned, or 2,000IU, if you are overweight and/or dark-skinned (Gallagher. 2013; Ng. 2014), vitamin D per day from food or supplements.

    Figure 4: Increase in vitamin D levels in response to supplementation w/ different amounts of vitamin D3 in caucasian (!) women according to BMI categories (Gallagher. 2013)
    In that, it does not matter, if you get to those 7,000-10,000 IU per week by taking a single cap of a high dose vitamin D supplement once a week, or adding enough cod liver (oil), fatty fish, fortified dairy, oysters, or eggs (remember there is active vitamin D in eggs | learn more) to your diet. What is important, though is recommendation #2, which is:

    Recommendation #2: Get a 25OHD test done today and start supplementing with 20,000IU per week for 3 months, if the test comes back low - that's the dosage that has brought the low D3 levels of 30 club-level athletes in Close et al. (2013) back to the official and certainly not unreasonable target of >50 nmol/L.

    Needless to say that recommendation #3 would be to retest either after 3 months, in case you had low baseline levels and want to make sure your supplementation regimen brought them back up, or after 6 months, as part of a bi-annual checkup of all relevant health parameters, including the standard blood panel and HPTA function.
    Why shall I make sure my level is normal, if low vitamin D does not cause insulin resistance? That's a warranted question and I have an comprehensive answer. If vitamin D acts as an acute phase reactant this may mean that it protects your body from further pro-inflam- matory assaults - it's making a martyr of itself, so to say. If you have almost no "vitamin D martys" to sacrifice, this will accelerate your progress from insulin resistance to diabetes (cf. Forouhi. 2008)
    Bottom line: Things are, I am sorry to say that yet again, complicated. My personal assessment of the contemporarily available evidence is that the reduced vitamin D levels are correlatively and not causally linked to insulin resistance. We've known forever that chronic inflammation is a if not the most common cause of insulin resistance (Johnson. 2013) and vitamin D, whether it is an acute phase reactant or the panaceum everyone is trying to tell you it was, is reduced under inflammatory conditions.

    In view of the fact that the provision of additional vitamin D and restoration of "normal" (whatever that may be) levels of 25OHD3 in serum does not necessarily entail an improvement in insulin sensitivity, we must therefore assume that both, low vitamin D and insulin resistance have the same underlying cause and are thus complementary. Dies this mean, you should ignore low vitamin D levels? Probably not, but it certainly means that you better take a look at the way you eat, sleep and train if you are insulin resistant - irrespective of your vitamin D levels, by the way.
    References:
    • Belenchia, Anthony M., et al. "Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: a randomized controlled trial." The American journal of clinical nutrition 97.4 (2013): 774-781.
    • Blackburn, Patricia, et al. "Postprandial variations of plasma inflammatory markers in abdominally obese men." Obesity 14.10 (2006): 1747-1754. 
    • Close, Graeme L., et al. "The effects of vitamin D3 supplementation on serum total 25 [OH] D concentration and physical performance: a randomised dose–response study." British journal of sports medicine 47.11 (2013): 692-696.
    • Fliser, D., et al. "No effect of calcitriol on insulin‐mediated glucose uptake in healthy subjects." European journal of clinical investigation 27.7 (1997): 629-633.  
    • Forouhi, Nita G., et al. "Baseline serum 25-hydroxy vitamin d is predictive of future glycemic status and insulin resistance the medical research council ely prospective study 1990–2000." Diabetes 57.10 (2008): 2619-2625.
    • Gama, Rousseau, et al. "Hypovitaminosis D and disease: consequence rather than cause." BMJ 345 (2012): e5706-e5706.
    • Gallagher, J. Christopher, Vinod Yalamanchili, and Lynette M. Smith. "The effect of vitamin D supplementation on serum 25OHD in thin and obese women." The Journal of steroid biochemistry and molecular biology 136 (2013): 195-200. 
    • George, P. S., E. R. Pearson, and M. D. Witham. "Effect of vitamin D supplementation on glycaemic control and insulin resistance: a systematic review and meta‐analysis." Diabetic Medicine 29.8 (2012): e142-e150. 
    • Johnson, Andrew MF, and Jerrold M. Olefsky. "The origins and drivers of insulin resistance." Cell 152.4 (2013): 673-684.
    • Inomata, S., et al. "Effect of 1 alpha (OH)-vitamin D3 on insulin secretion in diabetes mellitus." Bone and mineral 1.3 (1986): 187-192. 
    • Nagpal, J., J. N. Pande, and A. Bhartia. "A double‐blind, randomized, placebo‐controlled trial of the short‐term effect of vitamin D3 supplementation on insulin sensitivity in apparently healthy, middle‐aged, centrally obese men." Diabetic Medicine 26.1 (2009): 19-27.
    • Need, Allan G., et al. "Relationship between fasting serum glucose, age, body mass index and serum 25 hydroxyvitamin D in postmenopausal women." Clinical endocrinology 62.6 (2005): 738-741.
    • Ng, Kimmie, et al. "Dose response to vitamin D supplementation in African Americans: results of a 4-arm, randomized, placebo-controlled trial." The American journal of clinical nutrition (2014): ajcn-067777.
    • Nilas, L., and C. Christiansen. "Treatment with vitamin D or its analogues does not change body weight or blood glucose level in postmenopausal women." International journal of obesity 8.5 (1983): 407-411.
    • Orwoll, Eric, Matthew Riddle, and Melvin Prince. "Effects of vitamin D on insulin and glucagon secretion in non-insulin-dependent diabetes mellitus." The American journal of clinical nutrition 59.5 (1994): 1083-1087.
    • Pathak, K., et al. "Vitamin D supplementation and body weight status: a systematic review and meta‐analysis of randomized controlled trials." Obesity Reviews (2014).
    • Salehpour, Amin, et al. "A 12-week double-blind randomized clinical trial of vitamin D3 supplementation on body fat mass in healthy overweight and obese women." Nutr J 11.1 (2012): 78.
    • Tai, Kamilia, et al. "Glucose tolerance and vitamin D: effects of treating vitamin D deficiency." Nutrition 24.10 (2008): 950-956.
    • Waldron, Jenna Louise, et al. "Vitamin D: a negative acute phase reactant." Journal of clinical pathology 66.7 (2013): 620-622.
    • Zittermann, Armin, et al. "Vitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markers." The American journal of clinical nutrition 89.5 (2009): 1321-1327.