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marylin monroe
Showing posts with label retinoic acid. Show all posts
Showing posts with label retinoic acid. Show all posts

Vitamin A Educates T-Cells, Joins Forces With Vitamin D Against Liver Cancer. Milk Better Than Sugary Electrolyte Solutions for Rehydration? Helicobactor Pylori: Probiotics from Breast Milk & Feces Better Than Amoxicillin!

Lactobacilli are hip, vitamin A is not - at the SuppVersity you still get news on both
1kg! That's the amount of weight you could probably lose if you rid yourself of all the microbes in your gut - from the weight of the bacteria alone, of course. Whether this would be a good idea or not, is however very questionable. On the one hand, we do have the still not fully understood studies on obesity-resistant germ free mice and an accumulating amount of evidence that having the "wrong" bacteria in the gut is at least associated with an increased obesity risk (Blaut. 2012). On the other hand, however, we are seeing new studies on the various benefits of having the "right" gut microbiome being published on an almost daily basis. So what?

Before we take a closer look at a definite benefit of having the "right" gut bacteria, though, let's start out with another likewise gut-related news item on the role of retinoic acid in T-cell education. In a way it's funny, it starts right where the bacteria reside, could have immune-modulatory effects that are way more pronounced and far reaching than probiotics and is still hardly discussed.

Vitamin A is of critical importance to (intestinal) T-cell education

If you have ever asked yourself how the immune cells in your body know what they are supposed to do, Catharine Ross' latest paper that was published in the American Journal of Clinical Nutrition and is based on a short talk the researcher from the Department of Nutritional Sciences at the Pennsylvania State University held at a conference earlier this year may provide at least some additional insides into the role a still way underrated molecule plays in this "T cell education" (Ross. 2012): Vitamin A!
Figure 1: Model of T cell differentiation, from uncommitted naive T cells into different T cell subsets that produce different cytokines and thus promote different functional activities (adapted from Ross. 2012)
As you can see in figure 1, retinoic acid does not simply promote the differentiation of regulatory T cells, which help to suppress inflammatory reactions, it also plays a significant role in normal mucosal immunity (in the gut, the airways and elsewhere) by modulating T cell activation and regulating cell trafficking. Moreover, vitamin A promotes antibody responses to T cell–dependent antigens. Needless to say that
"[...] in a state of vitamin A deficiency, inflammatory T cell reactions may be inadequately opposed and therefore become dominant [...] Although data from human studies are still needed, the framework now developed from studies in mice and rat models suggests that adequate vitamin A status, [...] is  important for maintaining a proper balance of well-regulated T cell functions and for preventing excessive or prolonged inflammatory reactions." (Ross. 2012).
Discovery a beta carotene derived vitamin A receptor blocker is only one of a couple of intriguing findings wrt to vitamin A.
One thing that sticks out from the complex interactions (see figure 1), really is the way by which the interaction of vitamin A with the T-cells in the gut crucially determine the efficiency of the 'fist line defenses' and their downstream effects on the whole organism. It is by no means co-incidental that diarrhea is rampant in areas of the "third world", where a large amount of the population is vitamin A deficient (Beaton. 1994). And in fact studies have shown consitently that
"RA is essential for 'imprinting' gut-homing specificity on T cells activated by intestinal DCs [dendritic cells] and suggested that MLN DCs are a source of RA that drives T cell differentiation toward the gut-homing phenotype" (Ross. 2012)
Moreover, oral tolerance to foreign antigens and thus an allergy free live requires a form of immune suppression, which can be proffered or hampered by sufficient and insufficient vitamin A intakes. In that, the exact effects of vitamin A will depend on the cytokine milieu the T-cells are exposed to. Examples are...
  • an exaggerated IL-17 response with vitamin A deficiency, on the one hand, and
  • an increase of the inflammatory response due to high vitamin A in an IL-15 environment 
Based on these observations, Ross rightly points out that "when RA is used for therapeutic purposes, it should be used cautiously in subjects with various inflammatory bowel conditions and sensitivities to dietary antigens." (Ross. 2012) People with gluten intolerance, celiac and other allergic reactions, for example would probably be better off avoiding the consumption of any form of supplemental vitamin A (on top of what's in their regular diet). Someone with high IL-17 and IL-6 levels as they have been observed in non-celiac inflammatory bowel disease, type 1 diabetes, multiple sclerosis and rheumatoid arthritis, on the other hand, could actually benefit from vitamin A's (especially ATRA) presence during activation of CD4+ T cells, because it will - even in the presence of IL-6 - "favor the development of the a Treg lineage at the expense of T cells secreting IL-17" and could thus help reduce chronic inflammation and keep autoimmune reactions at bay (Schambach. 2007; also Ramgolam. 2010).

More news

  • Figure 2: Who cares about cell viability, the survival time (in days) matters
    Combination therapy with vitamin A and a vitamin D (not D3, but calcitriol) analog EB1089 kills liver cancer cells. And it does so more effectively than any of the two molecules alone. That's the actually unsurprising result of a study that has been conducted at the Beijing Army General Hospital in China. The researchers injected nude mice with molecules that made them develop hepatocellular cancer. Afterwards, the rodents received either 10 μmol/L retinoic acid (vitamin A), 10 nmol/L EB1089 or both as a combination treatment.

    Compared to vitamin A or the calcitriol analog alone, the combination treatmend resulted in a significanlty higher reduction of the viability of hepatocellular cancer cells. Based on TUNEL analysis, Zhang et al. did also establish that individual cancer cells had a higher apoptotic ratio in the combined drug group than in the groups for which the drugs were used separately. Most importantly, however, the tumor weight was decreased and the mice on the combination treatment lived significantly longer (see figure 2; Zhang. 2012)
  • In the same publication, Pritchett and Pritchett recommend 1.0-1.5ml / kg body weight per hour of chocolate milk as the optimal post-workout drink to be consumed in the 2 h after a workout.
    Skimmed milk, the ideal post-workout rehydration formula? According to L James' paper in Lamprecht's compendium Acute Topics in Sport Nutrition, milk is a way better choice then the standard sugar + electrolyte rehydration formulas. Interestingly this is not due to the minerals in the milk, or the sugar, but, as James argues, a direct consequence of the milk proteins, which help restore "fluid balance after exercise-induced dehydration to a greater extent than a carbohydrate-electrolyte sports drink." As James points out it will yet have to be elucidated, whether the simple addition of whey protein to a standard sugar + electrolyte formula would exert similar effects (James. 2013).
  • Probiotics to kill Helicobacter Pylori? While not every bacteria stands a chance against the nasty gut bug H. Pylori, certain Lactobacillus spp. strains obviously do. At least, if the results of a recent in-vitro + in vivo rodent study by Pei-Shan Hsieh can be replicated in human studies.
    Figure 3: Urease activity in H. pylpori after co-incubation with the specific probiotic and resulting bacteriostatic ratio (100% = bacteria free; data adapted from Hsieh. 2012)
    Lactobacillus acidophilus TYCA08, L. acidophilus TYCA15, L. johnsonii MH-68, and L. salivarius subsp. salicinius AP-32 were the most effective strains the researchers from National Chung Hsing University in Taichung, Taiwan, analyzed. And believe it or not, the latter of these, i.e. L. johnsonii MH-68, and L. salivarius subsp. salicinius AP-32, both of which are  by the way found in feces, were even minimally more potent effective than Amoxicillin, a moderate-spectrum, bacteriolytic, β-lactam antibiotic used to treat bacterial infections. L. acidophilus TYCA15, however, steals the show. This probiotic that occurs naturally in breast milk reduced the urease activity of H. Pylori by -97.1% (see figure 3).

    In the consecutive rodent study, Hseieh et al. did yet still use 109 CFU/mL of either AP-32 alone, MH-68 alone, or an equal mix of cultures of the two strains and both, "either alone or as a mixture in powder form were effective in reducing H. pylori load in gastric mucosa and help in reducing gastric inflammation and in regulation of gastric acid production." (Hsieh. 2012)
Thats it for today and for this weekend. As mentioned yesterday, there was simply not enough time to do the necessary research for the follow up to the Athlete Triad Series, so that this will have to wait. So don't dig an even deeper whole in the mean time. Maybe you want to do some of the psychomotor tests mentioned in yesterday's news, and check whether you are already overtrained!? How steady are your hands, for example? And whatever the result may be, don't forget to enjoy the rest of the weekend!

References:
  • Beaton GH, Martorell R, Aronson KA, Edmonston B. McCabe, G, Ross, AC, Harvey, B. Vitamin A supplementation and child morbidity and mortality in developing countries. Food Nutr Bull 1994;15(4): 282–9.
  • Blaut M, Klaus S. Intestinal microbiota and obesity. Handb Exp Pharmacol. 2012;(209):251-73.
  • Hsieh PS, Tsai YC, Chen YC, Teh SF, Ou CM, King VA. Eradication of Helicobacter pylori Infection by the Probiotic Strains Lactobacillus johnsonii MH-68 and L. salivarius ssp. salicinius AP-32. Helicobacter. 2012 Dec;17(6):466-77.
  • James L. Milk Protein and the Restoration of Fluid Balance after Exercise. In Lamprecht M (ed): Acute Topics in Sport Nutrition. Med Sport Sci. Basel, Karger, 2013, vol 59, pp 120–126. 
  • Pritchett K, Pritchett R. Chocolate Milk: A Post-Exercise Recovery Beverage for Endurance Sports. In Lamprecht M (ed): Acute Topics in Sport Nutrition. Med Sport Sci. Basel, Karger, 2013, vol 59, pp 127–134.
  • Ramgolam VS, Markovic-Plese S. Interferon-beta inhibits Th17 cell differentiation in patients with multiple sclerosis. Endocr Metab Immune Disord Drug Targets. 2010 Jun;10(2):161-7.
  • Ross AC. Vitamin A and retinoic acid in T cell-related immunity. Am J Clin Nutr. 2012 Oct 10.  
  • Schambach F, Schupp M, Lazar MA, Reiner SL. Activation of retinoic acid receptor-alpha favours regulatory T cell induction at the expense of IL-17-secreting T helper cell differentiation. Eur J Immunol. 2007 Sep;37(9):2396-9. 
  • Zhang J, Zhang H, Zhang X, Yu Z. Synergistic effect of retinoic acid and vitamin D analog EB1089-induced apoptosis of hepatocellular cancer cells. Cytotechnology. 2012 Oct 16.

Circadian Rhythmicity: Retinol (Vitamin A) & Caffeine and Their Effects on the Central & Peripheral Clocks of the Body

Image 1: Is it a bad idea to "wake yourself up" with a pot of coffee in the morning, I mean from a circadian rhythm perspective?
In the last installment of this series we have been dealing with breakfast. Now, if you are following the mainstream advice neither of the two subjects of this installment should actually be a staple of it. Vitamin A, in its active form, retinol, is "bad and dangerous" and only present in such "evil cholesterol laden foods" such as eggs. And since coffee will sure give you a heart attack, you better stick to your calcium fortified orange juice, a minimal amount of white water, ah.. I mean low fat "milk" (learn more about the difference between white water and milk in "Mutant Milk!? New Research Fuels the Flames on Hushed Up Concerns About Ill Health Effects of Homogenized Milk") and - of course - "healthy cereals". And while you will hardly be able to argue that skipping a breakfast like that is probably the best you can do for your health, this was the topic of the last installment, while vitamin A and caffeine, will be what this episode of the Circadian Rhythmicity Series will be all about.

Vitamin A the circadian vitamin?

Only recently (officially, at least; preliminary results have been published ahead of print in March 2012, already; cf. Golini. 2012) a group of researchers from the Multidisciplinary Institute of Biological Research San Luis (IMIBIO-SL), at the National University of San Luis in Argentina found that contrary to the peripheral clock gene expression in the liver, which does not appear to be disturbed by vitamin A deficiency (Shirai. 2006), the superordinate (=master) clock gene expression in the hippocampus of rats housed at a regular 12h-light/dark interval gets profoundly compromised, when the rodents are fed a vitamin A (retinol, not beta carotene!) deficient diet (Navigatore-Fonzo. 2012). According to Navigatore-Fonzo et al. the effects are mediated by modified temporal patterns of the retinoic acid receptor in the hippocampus, which plays an essential role in the activation of a whole set of clock-genes that, in turn, have been implicated - among others in the anti-cancer effects of vitamin A, you've read about at the SuppVersity not too long ago!

In the light of these recent results many previously observed, but not fully understood effects of vitamin A deficiency, such as the permanent memory impairments (Etchamendy. 2003) and its repeatedly suggested involvement as a signaling molecule (and as it now turns out potential zeitgeber) in physiological (synaptic plasticity, learning and memory, sleep), as well as pathological (schizophrenia, depression, Parkinson disease, and Alzheimer disease) neurological conditions (cf. Tafti. 2007).

The fact retinol availability is so tightly regulated alone tells us something about its importance

Is there a fluctuation in serum retinol levels as well or is vitamin A only a prerequesite for the circadian rhythm to function normally? With the activity level of vitamin A depending on both the availability as well as the release and binding of retinoic acid from the stores (mostly) in the liver and to the respective binding proteins, which are also produced in the liver, it is obvious that the liver is the most important regulator of vitamin A metabolism (Buzio. 1989). Maybe this is also why it is protected against circadian disturbances subsequent to vitamin A deficiency.
Unfortunately, our understanding of the exact function of the retinol binding proteins is still very limited, what we do know, however, is that their release and renal clearance show a distinct circadian rhythm which is synchronized to meal ingestion and the excretion of (Buzio. 1989). Our understanding of these mechanisms is yet still too preliminary to make any supplement recommendations besides "don't avoid the full-fat vitamin A rich foods, we have been eating for ages!". This is all the more true, since the range, within which beneficial effects can be seen is not just very narrow, but will also depend on (a) your baseline vitamin A status and (b) the way your body metabolizes dietary and supplemental vitamin A, the latter of which usually comes in the form of retinyl palmitate.

At doses in the <10,000IU/day range vitamin A is regarded as totally benign, but even doubling that dosage, which was basically what Behr et al. did for their recently published paper on the potential anti-oxidant effects of vitamin A on menopausal increases in oxidative brain damage, when they  supplemented the diets of ovariectomized rats with 1,500IU /kg retinol palmitate (human equivalent ~20,000IU) per day, can result in profound increases in cerebral oxidative damage (Behr. 2012 Jul).

In conjunction with vitamin A's beneficial effect on serum markers of oxidative damage Behr et al. had observed in a previous trial with 500IU/kg and 1,500IU/kg per day (human equivalent ~6,700IU / ~20,000IU) in the same ovariectomized rodent model of menopause (Behr. 2012 Apr), the latest results from the laboratories of the Center of Oxidative Stress Research, at the Federal University of Rio Grande do Sul in Rio Grande do Sul, Brazil, only contribute to the emerging image of the hitherto hardly understood "Dr. Jekyll and Mr. Hide nature" of the (imho) most underrated vitamin there is (sorry, for the rant, but I won't get tired of raising the awareness that retinoic acid is, contrary to its overrated cousin, "vitamin D", a "real vitamin", in the sense that it is a substance we must necessarily get from our diet, while "vitamin D" is nothing but a cholesterol metabolite we should actually be able to produce ourselves, if we just got enough dietary cholesterol and sun exposure).
Figure 1: The profound loss of the rhythmicity of clock gene expression (BMAL1, PER1, top)  subsequent to three months of a virtually retinol free diet could not be restored after only 15 days on the regular rodent chow (same as control). These changes coincide with a similar loss of / shift in the expression of the antioxidant enzymatic cascade (shown here is the GPx activity) and subsequent increases shifts (deficiency) and increases in malondeyaldehyde expression (vitamin A refed group; bottom right - based on Fonzo. 2009
A closer analysis of the expression of selected markers of antioxidant activity and oxidative damage in the brain of vitamin A deficient rodents (3 months on a virtually retinol free diet) and vitamin A replete animals, who were fed the control chow for only 15 days after the depletion phase appears to confirm some of these results (Fonzo. 2009):
As expected, temporal patterns of CAT and GPx activities observed in the rat hippocampus were consistent with the rhythm of lipoperoxidation. While the lowest CAT activity occurs during the light period and, at least in part, brings lipid peroxidation into the maximal level, highest CAT and GPx activities, practically concur with the nocturnal peak of lipoperoxidation. Thus, antioxidant enzymes would have a complementary and proper timing for protecting hippocampus against peroxides, maintaining lipoperoxidation at controlled fluctuating levels, with the lowest MDA concentration occurring during the diurnal, anabolic, period in rats [...] the location of enzymes activity peaks during the night-feeding-period, may suggest the influence of feeding cycle, and macro or micronutrients, such as proteins, carbohydrates, aspartate, glutamate or some vitamins, on those rhythms, [...] the nocturnal peaks of CAT and GPx antioxidant activity seen in the hippocampus of our control rats would be in phase with the best time for performing learning and memory tests."
In this context it is interesting to see that the peak of CAT and GPX (in figure 1, only GPx is shown) does still coincide with the nightly (remember, rats eat during the dark period!) drop in GPX activity. The daily (=sleep / low activity phase) steady decline of which Fonzo et al. state that in coincides with the variation in the expression and activity of the BMAL1:CLOCK and the PER1 protein activity with
  • a peak in GPx and Cat activity following the the BMAL1 protein peak at the end-of-the-night/beginning-of-the-day in the control rats, and 
  • a trough of the Cat and GPx experssion after the negative regulator, PER1 protein peaks at the end of the activity phase during the day,
on the other hand, is profoundly disturbed in the vitamin A deficient animals that present with a complete loss of the BMAL1 and PER1 rhythm (figure 1, top). It does therefore appear obvious that we are (once more) dealing with two controlling mechanism:
  1. an "externally" modulated, food (in the widest sense) induced regulatory mechanism and 
  2. a fundamental, time- or rather light-dependent, centrally mediated circadian rhythm 
And while the latter of the two can be partly restored by vitamin A repletion. The 15-day repletion phase in the study at hand was obviously not long enough for the GPx and lipid peroxidation levels (as measured in malondyaldehyde TBARs) to return to their pre-intervention levels. If this is, as the scientists argue a result of transcriptional changes in the vitamin A receptor (RXR) "sensitivity", it is however likely that both the GPx peak activity (which should increase) and the closely related formation of lipid oxidation byproducts (MDA) should return to baseline, as soon as the stores are fully replete and the RXR levels have recovered.

From vitamins to ergogenics, from chronic to acute, from retinol to caffeine

Contrary to the effects of vitamin A which can be stored and released whenever our bodies deem it necessary, the impact of caffeine on the circadian rhythm is by the very nature of its metabolism acute and relatively short lived. This is at least true as long as the caffeine-induced circadian shifts do not lead to permanent deteriorations of the circadian rhythm. Intuitively, we all believe that caffeine can effect the circadian rhythm (or what our mainstream understanding is telling us, the circadian rhythm would be). It's not by chance that millions (ab?)use coffee and caffeine beverages on a regular basis to get going in the morning or keep going in the evening - times when our natural, undisturbed circadian rhythm should be telling us that our bed is the place our body would prefer to be, now.

One of the more exercise specific studies on this matter comes from the Exercise Physiology Laboratory at the University of Castilla-La Mancha in Toledo, Spain, where Mora-Rodríguez and his colleagues investigated the effects of a standardized caffeine containing (6mg/kg) or caffeine-free breakfast (ingested at 9:15AM) on early morning (10:00AM) or late afternoon (18:00PM) workout performance.
Figure 2: Hormone levels, performance and catecholamine levels on AM during AM and PM training sessions with or without caffeine containing breakfast (red = AM breakfast contained 3mg/kg caffeine); * indicates significant difference to AM (Placebo), PM trials were always performed on separate days with regular breakfast (based on Mora-Rodríguez. 2012)
As the data in figure 2 goes to show the whopping dose of 225mg of caffeine (note: in the graphical summary the scientists write 6mg/kg, if this is correct and the 3mg/kg that are repeatedly being mentioned in the text, then the dosage would have been 450mg) the twelve highly resistance trained men (75kg body weight; age 20; body fat 11%) did compensate for the "early morning weakness" of the participants and increased their bench press and squat performance as well as their isokinetic leg extensor strength (not shown in figure 2) to late afternoon levels, without inducing statistically significant changes in any of the measured hormonal parameters (growth hormone, testosterone, cortisol) compared to the placebo trial.

Short-term stimulation is not (yet?) equivalent to changes in circadian rhythmicity

Hack your training, not your rhythm? If the chronic use of caffeine and other stims to increase your performance at times of the day, where your circadian rhythm does not allow for maximal performance, entails possible negative downstream effects on the regular expression of your clock-genes, why don't you just train by the clock, then? Basically this is also what Hayes et al. suggested in their 2010 paper in Chronobiology International, where they state that despite the higher testosterone levels in the morning "an increased resistance exercise-induced T response [...] in the late afternoon [would suggest a] greater responsiveness of the hypothalamo-pituitary-testicular axis" later in the day - that this is bullshit, is something you should be aware by now, as the increased expression of testosterone has, as Hayes et al. have to coincide little to no influence on the hypertrophy response to training. Rather than that, they do therefore suggest to obey to the "individual responsiveness" and train whenever you feel you perform best (without the use of stims).
At times, when this is not possible, the use of stims (esp. caffeine, which is still among the "less damaging" stimulants on the OTC market), can provide temporary relief - as soon as even  3 cups of coffee only make you sleepy it is more than high time to take a break from caffeine and high intensity training (see "Tapering & Detraining - When and How to Take a Break")
For Mora-Rodríguez et al. these observations are a clear-cut sign of "circadian rhythm effects", but are they really related to changes in circadian rhythmicity? They blunt the morning reduction in muscle performance due to circadian rhythm - there is no debating that, but the study does not provide convincing evidence that this is due to changes in the expression of zeitgeber proteins and thus a direct consequence of a shift in circadian rhythmicity. If we take another look at figure 2, we would thus expect to see similar hormonal expressions, as well. After all, both the spike in cortisol in the morning as well as the steady decline of testosterone and even steeper decline in cortisol that occurs in the course of the day are both mediated by the circadian rhythm. The adrenaline spike in response to the ingestion of caffeine, which is unquestionably responsible for the observed performance enhancing effects in the study at hand, on the other hand, has nothing to do with circadian rhythmicity.
Did I mention that results from in-vitro studies suggest that cortisol spikes, esp. the huge spike in the morning, could act as a "reset switch" for the circadian clock? (cf. Balsalobre. 2000)
If anything, we could - based on the acute catecholamine response in the Mora-Rodíguez study, that chronic morning caffeine consumption could lead to subsequent downstream changes in the expression of zeitgeber genes, which would in turn trigger a 12h shift in circadian rhythmicity with low morning and high evening cortisol levels that would basically reverse the natural pattern as it was observed in the AM/PM(Placebo) trials.That this would entail a whole host of negative health effects is something you should by now be familiar and renders the (long-term) use of caffeine to "avoid the morning reduction in muscle performance due to circadian rhythm" at least highly questionable, as it would go- in the most fundamental sense of the word - against our nature. If chronic caffeine consumption did actually induce the aforementioned changes in circadian rhythmicity. So, the next question would be...

Are the effects of caffeine even of circadian origin / does it affect circadian rhythms?

The answer to this question is not exactly easy to find, as most studies follow the flawed assumption that "being more awake" would equal "being able to hack the circadian rhythm", when it could just as well be nothing more (and nothing less) than a highly effective way to outwit the latter. Against that background it's strange that Oike et al. were the only scientists I found that explicitly mention that it "remains unknown" "whether or not [caffeine] affects mammalian circadian clocks remains unknown" (Oike. 2011).

Figure 3: The in-vitro exposure of human osteosarcoma cells (a common model used in gene essays) messes with the previously mentioned clock genes Per2 and  Bmal1 genes (left) and the in vivo ingestion of coffee / administration of caffeine in drinking water did increase the locomotor activity period length of mice after normal lighting conditions (first two weeks lower panel) and constant darkness (upper panel, right; based on Oike. 2011).
Luckily Oike at el. did not just nag at the absence of reliable evidence for / against the effects of caffeine on circadian rhythmicity, but also conducted a couple of in vitro and in vivo studies, in the course of which they were able to show that notwithstanding it's disturbing effects in on clock gene expression in the petri dish (figure 3, left), the "real-world" test with coffee and caffeine did
  • lengthen the circadian rhythm of reporter gene expression in liver explants of the rodents, without affecting the time of the rhythm peak in the liver explants (not shown), while
  • left the period length in the likewise explanted suprachiasmatic nuclei unchanged, but delayed the peak time of the rhythm
the real world results of these somewhat schizophrenic modulatory effect of caffeine on the peripheral (liver) and central (suprachiasmatic nucleus) rhythm is an increased length of the circadian pattern in dark-exposed (=constant day for mice!) mice, without affecting the locomotor activity in the presence of appropriate light cues!
In other words: The effects of caffeine will only mess with your circadian rhythm if they are not overridden by appropriate light cues!
Similar results have been reported by Sherman et al. who made an even more complex experiment which the results of which will be part of the next installment of this series, as the inclusion of a restricted feeding regimen a la intermittent fasting with a minimalist 3h feeding window segues quite nicely into the discussion of the metabolic implications of caffeine and nutrient (esp. glucose) availability, we will take up in the next installment of the Circadian Rhythmicity Series.

Image 2: I admit that all this is not easy to understand and many of the implications on our everyday lives are yet not clear, either. I still hope you don't feel you have wasted your valuable time with this post.
Before I let you go, I do yet still want to give you the elevator pitch on this long and allegedly very complicated post. While much of what we have been studying today must still be considered preliminary (also on the expert level) there are three important and theoretically, as well as experimentally relatively well certain take home messages. The first pertains to the importance of light cues as the main regulators of the central clock gene expression in the brain, the second relates to the vital, hence "vitamin", importance of vitamin A for the integrity of the central clock, and the third relates to the modulatory effect certain molecules, such as caffeine, can have on the peripheral clocks.

The practical implications of these insights, on the other hand are pretty straight forward and for most of you probably no real news, anyway:
  1. stick to the "natural" dark/light cycle - reread episodes one and two of the series for tips on how you can make do so in our "light polluted" world
  2. get adequate amounts of vitamin A in your diet - there is no need to supplement, your body manges the levels of vitamin A very effectively, so that a piece of liver once in a while is a way better choice than a vitamin pill every day
  3. don't be scared of coffee - as long as you still stick to the natural cycle (see first point), your circadian rhythm may exhibit slight shift, it will yet only break if you use caffeine + light as in popping a caffeine pill and surfing on the Internet with your melatonin suppressing iPad (see episode I) in the middle of the night
Now, before you switch off your iPad and go to bed today, I suggest you check out the SuppVersity Facebook Wall, for the latest news - it is no coincidence that an item about the -57% reduced Parkinson's risk in habitual coffee drinkers who consume at least three or more cups per day, as well as a reference to the latest confirmation of the liver protecting effects of coffee there... ah, and by the way, it could be that we will be able to track those back to circadian gene expression (peripherally, obviously ;-) in the next installment, as well...

References:
  • Balsalobre A, Brown SA, Marcacci L, Tronche F, Kellendonk C, Reichardt HM, et al. Resetting of circadian time in peripheral tissues by glucocorticoid signaling. Science 2000;289:2344–7
  • Behr GA, Schnorr CE, Moreira JC. Increased blood oxidative stress in experimental menopause rat model: the effects of vitamin A low-dose supplementation upon antioxidant status in bilateral ovariectomized rats. Fundam Clin Pharmacol. 2012 Apr;26(2):235-49.
  • Behr GA, Schnorr CE, Simões-Pires A, da Motta LL, Frey BN, Moreira JC. Increased cerebral oxidative damage and decreased antioxidant defenses in ovariectomized and sham-operated rats supplemented with vitamin A. Cell Biol Toxicol. 2012 Jul 18.  
  • Buzio C, Mutti A, Capani F, Andrulli S, Perazzoli F, Alinovi R, Negro A, Rustichelli R. Circadian rhythm of proteinuria: effects of an evening meat meal. Nephrol Dial Transplant. 1989;4(4):266-70.
  • Fonzo LS, Golini RS, Delgado SM, Ponce IT, Bonomi MR, Rezza IG, Gimenez MS, Anzulovich AC. Temporal patterns of lipoperoxidation and antioxidant enzymes are modified in the hippocampus of vitamin A-deficient rats. Hippocampus. 2009 Sep;19(9):869-80.
  • Golini RS, Delgado SM, Navigatore Fonzo LS, Ponce IT, Lacoste MG, Anzulovich AC. Daily patterns of clock and cognition-related factors are modified in the hippocampus of vitamin A-deficient rats. Hippocampus. 2012 Aug;22(8):1720-32. 
  • Hammouda O, Chtourou H, Chahed H, Ferchichi S, Chaouachi A, Kallel C, Miled A, Chamari K, Souissi N. High Intensity Exercise Affects Diurnal Variation of Some Biological Markers in Trained Subjects. Int J Sports Med. 2012 Jul 12.
  • Mora-Rodríguez R, García Pallarés J, López-Samanes Á, Ortega JF, Fernández-Elías VE. Caffeine ingestion reverses the circadian rhythm effects on neuromuscular performance in highly resistance-trained men. PLoS One. 2012;7(4):e33807. Epub 2012 Apr 4. 
  • Navigatore-Fonzo LS, Golini RL, Ponce IT, Delgado SM, Plateo-Pignatari MG, Gimenez MS, Anzulovich AC. Retinoic acid receptors move in time with the clock in the hippocampus. Effect of a vitamin-A-deficient diet. J Nutr Biochem. 2012 Aug 16.
  • Oike H, Kobori M, Suzuki T, Ishida N. Caffeine lengthens circadian rhythms in mice. Biochem Biophys Res Commun. 2011 Jul 8;410(3):654-8. Epub 2011 Jun 13.
  • Shirai H, Oishi K, Ishida N. Circadian expression of clock genes is maintained in the liver of Vitamin A-deficient mice. Neurosci Lett. 2006 May 1;398(1-2):69-72.
  • Tafti M, Ghyselinck NB. Functional implication of the vitamin A signaling pathway in the brain. Arch Neurol. 2007 Dec;64(12):1706-11.

Put the "A" to the "D": Very High Dietary Vitamin A (Retinol, not Beta Carotene!) Content Ameliorates Visceral Adiposity and Improves Insulin Sensitivity in Obesity Prone Rats

What's the first letter in the alphabet? "D"? Well if you look at current research on vitamins, you would think so. Vitamin D is everywhere, vitamin A - if anything - its toxic antagonist. You, as a faithful student of the SuppVersity know better anyway: balance is where the magic lies; and thus you probably won't be surprised that not vitamin D, but vitamin A supplementation improves insulin sensitivity and ameliorates weight gain in a group of obesity prone rats on their favorite fattening stock-diet (Jeyakumar. 2011).
Image 1: Molecular structure of all-trans retinol
In the Journal of Diabetes, Obesity and Metabolism, Jeyakumar et al. published the results of an early 3-months intervention with a vitamin A-enriched diet (129mg vitamin A/kg diet) on visceral obesity and insulin sensitivity in 50days old obesity prone (WNIN/ob strain) rats:
Compared to stock diet-fed obese rats, vitamin A-enriched diet fed-obese rats had reduced body weight gain, visceral adiposity and improved insulin sensitivity as evidenced by decreased fasting plasma insulin and unaltered glucose levels.
Image 2: WNIN obese (A) and normal rat (B)
aged 12 months (image from Reddy. 2009)
The scientists explain their observations by another observation they made. Compared to rats fed the standard stock-diet, the vitamin A group exhibited an increased phosphorylation of the insulin receptor on the soleus muscle (this was the one the scientists used to access muscular insulin sensitivity via measuring gene transcription). By decreasing protein tyrosine phosphatase1B (PTP1B), consequently increasing insulin receptor phosphorylation and thus locally increasing insulin sensitivity, vitamin A had a glucose repartitioning effect, shuttling blood sugar into the muscle instead of having it converted to triglycerides that would consecutively be stored in the form of unhealthy visceral fat depots.

Although news like this usually go unrecognized, this is by far not the first study showing beneficial effect in obesity prevention and even treatment. In a 2005 study published in the Journal of Molecular Endocrinology Jeyakumar et al. had already published similar findings, indicating that an increase in dietary Vitamin A intake resulted "in a significant reduction in the adiposity index and retroperitoneal white adipose tissue (RPWAT) weight in obese rats" (Jeyakumar. 2005).

Jeyakumar et al.'s results stand in line with previous largely unrecognized studies on the effects of low vitamin A levels on adipose tissue development about which Ribot et al. (Ribot. 2001) write in the research journal Obesity:
Vitamin A-deficient diet feeding led to a marked increase of adiposity and to a small increase of body weight. Hypertrophy of white adipose tissue depots correlated with enhanced PPAR-gamma-2 expression. Hypertrophy of BAT, in contrast, correlated with a decrease of PPAR-gamma-2 expression that may contribute to the known reduced thermogenic potential of BAT under conditions of vitamin A restriction. Treatment with tRA [trans retinoic acid =vitamin A] triggered a reduction of adiposity and body weight that correlated with a down-regulation of PPAR-gamma-2 expression in all adipose tissues.
And in July 2003 Felipe et al. (Felipe. 2004) submitted a paper to the American Diabetes Association describing how
RA [retinoic acid] administration to normal mice resulted in reduced resistin mRNA levels in brown and white adipose tissues, reduced circulating resistin levels, reduced body weight, and improved glucose tolerance
in mice. While there appear so be a difference in the localization of resistine expression in rodents and humans (in rodents it is mainly released by fat cells, in humans and primates primarily by immune and epithelial cells), the negative effects of high serum levels of resistin on insulin sensitivity appears to be same in both species.

After all, that seems not so bad for a "vitamin", the reputation of which is almost as bad as that of the most fundamental building block of all your hormones: cholesterol. And guess what, foods such as eggs, liver and other organ meats are high in both: Vitamin A (as retinol not beta carotene, which many people have a hard time to convert) and cholesterol! Wouldn't this be a good reason to (re-)introduce these traditional, once highly appreciated foods back into your diet? One or two eggs a day (of course including the yolk), some liver once a week and a lot of sun and outdoor activity to bolster up both your vitamin A and D levels - what more could you ask for?

Vitamin A (Retinol) & Glucose Management | Part VIII of the "There is More To Glucose Control Than Low Carb"- Series. Plus: Retinol's Effects on Pancreas, Liver, Muscle and Fat

Vitamin A is not exactly known for being an anti-diabetes vitamin. If anything people will associate it with skin health... and SuppVersity Readers probably with anti-cellulite treatments | learn more
In the previous installments of this series I have addressed many of the "usual suspects" everyone associates with non-carbohydrate dependent improvements in blood glucose management. In today's installment of this series I will now take a look at an important vitamin of which only few would expect that it is in any way involved in glucose management: Vitamin A - real, pre-formed retinoic acid, not beta-carotene.

In view of the misleading news about the "involvement" of retinol binding proteins in the etiology of the diabesity epidemic and the bullocks about the negative effects of vitamin A on vitamin D, the vast majority of health junkies all over the web will probably associate high vitamin A intakes with insulin resistance, not -sensitivity.
You can learn more about this topic at the SuppVersity

Proteins, Peptides & Blood Glucose

SFA, MUFA, PUFA & Blood Glucose

Vitamin D & Diabetes

Glucose Manager Calcium?

Flush & No-Flush Niacin & Diabesity

Vitamin C & Glucose Control
Against that background it's funny that both human type II diabetics, as well as one of the most commonly used rodent models of type II diabetes, the streptozotocin-induced diabetic rat, show an impaired metabolic availability of vitamin A (Basu. 1989; Tuitoek. 1996).

As the scientists from the University of Alberta point out, the increased hepatic and the decreased plasma and retina vitamin A levels clearly "suggest a defect in the transport of the vitamin from the liver" - a defect of which it's not unlikely that it is the cause of the previously mentioned increases in retinol binding protein 4 (RBP4) that are so characteristic of the average overweight type II diabetic (Cho. 2006). Whether this problem can be resolved by the provision of supplemental vitamin A is albeit highly controversial.
Vitamin A is involved in body fat control (Bonet. 2003)
Low vitamin A status favors increases in fat deposition: The important effects of vitamin A on the proliferation of pre-adipocytes and adipose tissue morphology in general are often overlooked. In 2003, Bonet et al. were yet able to show that low levels of vitamin A are not just associated with insulin resistance and type II diabetes, they will also favor the deposition of body fat, which would otherwise be blunted by the negative effects of retinol on the activity of the body fat storage initiator C/EBPb (Bonet. 2003).
Basu & Basualdo, for example, argue that "subnormal vitamin A status in poorly controlled diabetic subjects may not respond to vitamin A supplementation". Even worse, if the vitamin A is not released into circulation and transported to the target tissue, where it appears to be dearly needed, it may "increase [the] load in the liver", eventually "leading to hepatoxicity" (Basu. 1997); and the increased levels of CRP and blood lipids Farhangi et al. observed in obese women in response to the ingestion of albeit exorbitant amounts of vitamin A (25.000IU/day; Farhangi. 2013).
Table 1: Overview of correlation coefficients of vitamin A and weight, BMI, tricep skinfold thickness (TSF), subscapular skinfold thickness (SST), total, HDL and LDL cholesterol, as well as triglycerides (Viroonudomphol. 2003)
In view of the fact that Viroonudomphol et al. have observed a negative correlation between weight, BMI, skinfold thickness, LDL & total cholesterol, triglycerides and hip circumference, on the one hand, and the serum retinol levels of overweight and obese subjects it is in fact a pity that a simple 10,000IU vitamin A supplement could do more harm than good to overweight and obese individuals with a messed up vitamin A metabolism (Viroonudomphol. 2003).
There are other things vitamin A can day for the diabetic patient -- It can promote wound healing, for example (Seifter. 1981). It can (at least in rodent trials) reduce the expression of resistin (Felipe. 2004), which is associated with increased levels of "bad" oxidized LDL cholesterol and is in itself a biomarker for the risk of heart failure (Salam. 2013; Takeishi. 2013). When it's administered with zinc at a daily dose of 25,000IU retinol can the improve serum apoprotein A-I, apoprotein B and the apoprotein B/apoprotein A-I ratio in patients with type I diabetes (Shidfar. 2013) and may thus directly reduce their heart disease risk.
Whether the potential side effects will yet occur in subjects, in whom the elevated glucose levels are adequately controlled is yet questionable. The results a group of researchers from the Ankara University presented in 2002 article in the peer-reviewed scientific journal Cell Biochemistry and Function, for example, would suggest that the addition of supplemental vitamin A to the standard insulin therapy in type II diabetes will not just help to keep the exuberant glucose levels in check, it may also blunt the oxidative reactions in diabetic heart and may thus "provide more benefits than use of either agent alone in the treatment of the "general characteristics of diabetes and the maintenance of antioxidant defense of diabetic heart and thus in the reduction of peroxidative stress-induced cardiac injury" (Zobalı. 2002).

Figure 1: Vitamin A affects several key steps in glucose metabolism (highlighted by dark arrows Berdainer. 2001)
In the pancreas, vitamin A deficiency leads to defects in both glucagon and glucose-stimulated insulin secretion (Chertow. 1987 & 1994), of which the latter can be restored with retinol palmitate supplements.

As Berdainer et al. point out, "glucose-stimulated insulin secretion is a complex process that requires the metabolism of glucose and the mitochondrial production of ATP" (Berdanier. 2001) - a process, in which the rate limiting enzymes that are regulated by retinoic acid (see Figure 1).
The vitamin A metabolite all-trans-retinoic acid is a real "anti-metabolic syndrome"-agent (Bonet. 2012)
An increase in skeletal muscle fatty acid oxidation is another not "glucose"-related benefit of vitamin A supplementation. As of now this effect has only been confirmed in rodent studies, where the administration of the potent vitamin A metabolite all-trans-retinoic acid (ATRA) lead to a 3.5x increase in PPAR-delta expression and corresponding increases in skeletal muscle fatty acid oxidation (Amengual. 2008) and increases in fatty acid oxidation in the liver (Amengual. 2010).

In conjunction with its ability to "brown" white fat cells and thus turn fat stores into fat furnaces (Mercader. 2006), the increases in skeletal muscle fatty oxidation will obviously also have secondary anti-diabetic effects (warning: ATRA is significantly more toxic than vitamin A and liposomal delivery reduces, but does not abolish these effects; cf. Ozpolat. 2003).
Glucokinase, which is thought to act as a glucose sensor, regulating insulin secretion and liver glucose uptake, is one of the enzymes regulated by retinoic acid in both the beta cell and the liver. Against that background it's no wonder that the systemic vitamin A deficiency that's so characteristic of insulin resistant and diabetic individuals worsens the already impaired glucose control.
Figure 2: In the absence of adequate vitamin A levels mature (myocyte) and immature (myoblast) muscle cells won't react to insulin by an increase in GLUT-4 expression and corresponding glucose uptake (Sleeman. 1995)
In conjunction with a reduction of the retinoic acid induced up-regulation of insulin-stimulated glucose transport via GLUT 4 in muscle cells (see Figure 2), the loss (?) of vitamin A that occurs at the onset of type II diabetes (Lu. 2000) is thus part of the often-cited vicious cycle of diabesity.

In that, the negative association between vitamin A and non-alcoholic fatty liver disease José Botella-Carretero et al. observed in morbidly obese subjects just another component of the under-appreciated involvement of vitamin A in the etiology of diabetes (Botella-Carretero. 2010) - an involvement of which we yet don't know whether it's causally, corellative or both.
Just as an aside: Vitamin A will also increase the expression of the master anti-oxidant glutathione in muscle tissue and promote the survival skeletal muscle precursor cells (El Haddad. 2012). It is necessary to preserve protein (Esteban-Pretel. 2010). And protects the muscle from the catabolic effects of corticosteroid overload (Aubry. 2009). Not glucose related, but not bad either, right?
Bottom line: There is little doubt that low vitamin A levels will contribute to the development of insulin resistance - both directly, by its negative effect on the pancreatic insulin production, and its insulin-induced glucose uptake in skeletal muscle tissues, as well as indirectly by its pro-obesogenic effects, and reductions in fatty acid oxidation and brown adipose tissue activity.

What is questionable, though, is whether the provision of supplemental vitamin A will have any direct or indirect beneficial effects on glucose metabolism in the average lean vitamin A sufficient individual and/or vitamin A deficient (pre-)diabetics. Against that background I would recommend to keep an eye on an adequate dietary vitamin A intake from eggs, dairy, butter, meat, fish and the occasional serving of liver and / or supplemental retinyl palmitate (e.g. 10,000 IU; 2-3x per week).
References:
  • Amengual, Jaume, et al. "Retinoic acid treatment enhances lipid oxidation and inhibits lipid biosynthesis capacities in the liver of mice." Cellular Physiology and Biochemistry 25.6 (2010): 657-666. 
  • Aubry, Evelyne M., and Alex Odermatt. "Retinoic acid reduces glucocorticoid sensitivity in C2C12 myotubes by decreasing 11β-hydroxysteroid dehydrogenase type 1 and glucocorticoid receptor activities." Endocrinology 150.6 (2009): 2700-2708.
  • Basu, T. K., W. J. Tze, and J. Leichter. "Serum vitamin A and retinol-binding protein in patients with insulin-dependent diabetes mellitus." The American journal of clinical nutrition 50.2 (1989): 329-331.
  • Basu, Tapan K., and Carlotta Basualdo. "Vitamin A homeostasis and diabetes mellitus." Nutrition 13.9 (1997): 804-806.
  • Berdanier, Carolyn D., et al. "Role of vitamin A in mitochondrial gene expression." Diabetes research and clinical practice 54 (2001): S11-S27.
  • Bonet, M. L., et al. "Vitamin A and the regulation of fat reserves." Cellular and Molecular Life Sciences CMLS 60.7 (2003): 1311-1321. 
  • Bonet, M. Luisa, Joan Ribot, and Andreu Palou. "Lipid metabolism in mammalian tissues and its control by retinoic acid." Biochimica et Biophysica Acta (BBA)-Molecular and Cell Biology of Lipids 1821.1 (2012): 177-189.
  • Botella-Carretero, José I., et al. "Retinol and α-tocopherol in morbid obesity and nonalcoholic fatty liver disease." Obesity surgery 20.1 (2010): 69-76.
  • Chertow, B. S., et al. "Effects of vitamin A deficiency and repletion on rat insulin secretion in vivo and in vitro from isolated islets." Journal of clinical Investigation 79.1 (1987): 163.
  • Chertow, B. S., et al. "Effects of vitamin A deficiency and repletion on rat glucagon secretion." Pancreas 9.4 (1994): 475-484.
  • Cho, Young Min, et al. "Plasma retinol-binding protein-4 concentrations are elevated in human subjects with impaired glucose tolerance and type 2 diabetes." Diabetes care 29.11 (2006): 2457-2461. 
  • El Haddad, Marina, et al. "Glutathione peroxidase 3, a new retinoid target gene, is crucial for human skeletal muscle precursor cell survival." Journal of cell science 125.24 (2012): 6147-6156.
  • Esteban-Pretel, Guillermo, et al. "Vitamin A deficiency increases protein catabolism and induces urea cycle enzymes in rats." The Journal of nutrition 140.4 (2010): 792-798.
  • Farhangi, Mahdieh Abbasalizad, et al. "Vitamin A supplementation, serum lipids, liver enzymes and C-reactive protein concentrations in obese women of reproductive age." Annals of clinical biochemistry 50.1 (2013): 25-30.
  • Felipe, Francisco, et al. "Modulation of resistin expression by retinoic acid and vitamin A status." Diabetes 53.4 (2004): 882-889. 
  • Lu, Jing, et al. "The metabolic availability of vitamin A is decreased at the onset of diabetes in BB rats." The Journal of nutrition 130.8 (2000): 1958-1962.
  • Mercader, Josep, et al. "Remodeling of white adipose tissue after retinoic acid administration in mice." Endocrinology 147.11 (2006): 5325-5332.
  • Ozpolat, Bulent, et al. "Pharmacokinetics of intravenously administered liposomal all-trans-retinoic acid (ATRA) and orally administered ATRA in healthy volunteers." J Pharm Pharm Sci 6.2 (2003): 292-301.
  • Salam, Gazbar, et al. "Relationship between Oxidized-LDL and Resistin Levels in Obese Diabetic Subjects." (2013).
  • Seifter, E., et al. "Impaired wound healing in streptozotocin diabetes. Prevention by supplemental vitamin A." Annals of surgery 194.1 (1981): 42. 
  • Shidfar, Farzad, et al. "Effects of combination of zinc and vitamin A supplementation on serum fasting blood sugar, insulin, apoprotein B and apoprotein AI in patients with type I diabetes." International journal of food sciences and nutrition 61.2 (2010): 182-191.
  • Sleeman, Mark W., et al. "Retinoic acid stimulates glucose transporter expression in L6 muscle cells." Molecular and cellular endocrinology 108.1 (1995): 161-167.
  • Takeishi, Y. "Resistin Is a Novel Biomarker for a Risk of Heart Failure." J Cardiovasc Dis Diagn 1.122 (2013): 2.
  • Tuitoek, P. J., et al. "Streptozotocin-induced diabetes in rats is associated with impaired metabolic availability of vitamin A (retinol)." British Journal of Nutrition 75.04 (1996): 615-622.
  • Tungtrongchitr, Rungsunn, et al. "The relationships between anthropometric measurements, serum vitamin A and E concentrations and lipid profiles in overweight and obese subjects." Asia Pacific J Clin Nutr 12.1 (2003): 73-79.
  • Zobalı, Fulya, et al. "Effects of vitamin A and insulin on the antioxidative state of diabetic rat heart: a comparison study with combination treatment." Cell biochemistry and function 20.2 (2002): 75-80.