Does Exercise Help Depression and Anxiety?

Running or jogging doesn't have to kill you to get benefit

Running or jogging doesn’t have to kill you to get benefit

I had an interesting conversation with a patient at the pharmacy that got me thinking about doing a post about this. This patient came a week or two ago and got a prescription for buspirone, which is used for anxiety. The patient was concerned with it because this person desperately wanted to get rid of the feeling of anxiety that they were suffering with.

The patient returned and I asked how it was going (We’ll call the patient Casey). The response was that not much had changed. Casey petitioned for more help, but this time to me, rather than the doctor.

My response?

Are you eating well? Are you doing any exercise at all?

Casey told me that neither was really in place. Casey also told me that a problem child at home was a great source of the anxiety. Casey also discussed how the previous week that he’d gone on a walk and that seemed to help a bit.

I’ve met others like Casey in the pharmacy before, and still see some of them. I’ve had people so anxious for their anxiety meds they were crying. I’ve seen people on the verge of hyperventilation. I’ve seen people, who on the surface appear normal, but after talking for a minute or two, they start divulging secrets about their lives that would make you and me stressed out too.

I used to get anxiety attacks. They would come at the most random times too. I remember once in high school in spanish class sitting at my desk, when suddenly I became hot and felt like I couldn’t breathe at all. I was more panicked about not feeling like I could breathe more than anything else. It wasn’t pleasant.

I don’t think during high school a lack of movement was my problem. I could eat anything and not gain a pound (being a male teenager has some advantages), but my diet probably was helping.

As I got older and started focusing more on my intake rather than my output, the attacks subsided. After learning about EFT (emotional freedom technique) or tapping, I was able to rid myself of the attacks all together.

Since I’ve graduated and been able to keep a more balanced routine, I haven’t had to do any tapping and the exercise is regular, rather than disjointed. Anxiety is nowhere to be seen, but I still get stressed from time to time. Between 4 kids, a wonderful wife, full-time job, blog, church duties, getting a house ready to sell, and writing a book, it’s hard to make sure I don’t go insane.

This is one reason I continue to exercise. It keeps my stress down, my happiness up, and bad things, like my wife’s recent trip where the windshield got busted, not so bad.

So What Kind of Exercise Should I Do?

In one study of depressed women [1], researchers found that aerobic running was just as good as weightlifting to reduce symptoms of depression compared to controls.

Another study showed pretty much the same thing; there was no real difference between aerobic and non-aerobic exercise in reducing depression. [2]

Another showed that aerobic exercise from 50-70% of maximal capacity was enough to decrease depression as well. [3]

One study showed that running was better than tennis which was better than softball, the latter having no effect. [4] While the findings were significant, even the authors noted that because they did nothing to conceal the reason behind the exercise, and even allowed some to choose which they were going to participate in, the results could have been different.

A study of men and women found that running helped more so with women than men, and was more influenced by the amount of physical fitness. [5]

In a study of men; exercise, meditation, and a comfy recliner all produced reductions in anxiety [6]. It should be noted that it was a quiet time in the recliner, not TV or kids time.

Another study showed similar benefits with walking/jogging at 70% maximum capacity. [7]

Of note, a study looking at relaxation training seemed to help introverts more than extroverts. [8] This really doesn’t have so much to do with exercise, but if you’re an introvert like me, relaxation may help in the anxiety department.

Swimmers seem to also derive benefit from exercise, feeling better after a swim than before. [9]

I think you get the point. Exercise is beneficial to reducing stress, anxiety and improving mood. Don’t worry if you can’t run a mile. Go for a walk. Don’t worry about not being able to do a push up, do knee push ups or on the wall. Do some squats. Take a walk with a significant other. Maybe you just need to run after the ice cream truck and give him a high-five for dispensing some of the best medication on earth (in moderation of course). Whatever it is, get moving and feel the anxiety or depression melt away.

CIAO

 

1.Doyne, Elizabeth J., et al. “Running versus weight lifting in the treatment of depression.” Journal of Consulting and Clinical Psychology 55.5 (1987): 748.

2.Martinsen, Egil W., Asle Hoffart, and Øyvind Solberg. “Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial.” Comprehensive psychiatry 30.4 (1989): 324-331.

3.Martinsen, Egil W., A. Medhus, and L. Sandvik. “Effects of aerobic exercise on depression: a controlled study.” BMJ 291.6488 (1985): 109-109.

4.Brown, Robert S., Donald E. Ramirez, and John M. Taub. “The prescription of exercise for depression.” The Physician and Sportsmedicine 6.12 (1978): 34-37.

5.Jasnoski, Mary L., David S. Holmes, and David L. Banks. “Changes in personality associated with changes in aerobic and anaerobic fitness in women and men.” Journal of psychosomatic research 32.3 (1988): 273-276.

6.Bahrke, Michael S., and William P. Morgan. “Anxiety reduction following exercise and meditation.” Cognitive therapy and research 2.4 (1978): 323-333.

7.Young, R. J. “The effect of regular exercise on cognitive functioning and personality.” British journal of sports medicine 13.3 (1979): 110-117.

8.Stoudenmire, John. “Effects of muscle relaxation training on state and trait anxiety in introverts and extraverts.” Journal of personality and social psychology 24.2 (1972): 273.

9.Berger, Bonnie G., and David R. Owen. “Mood Alteration with Swimming-Swimmers Really Do” Feel Better”.” Psychosomatic medicine 45.5 (1983): 425-433.

 

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What is Your Health Worth?

The answer to the above question really is priceless. Your health is one of the few things that truly affects you directly every single day. No one escapes it. Whether you feel like a million bucks or feel like someone just stomped a hole in you, you get to deal with your health and only you have the power to change it.

That’s right, only you have the power to change it. No one else can.

Sure you can visit a doctor to seek out treatment or advice, but it is you that made the decision to go, not the doctor. It is you that made the decision to take the prescribed medication. It’s you that decided to eat or not to eat something. It’s you that has control.

I thought it’d be fun to put some numbers up to look at this question. They won’t be exact, especially since everybody’s situation is different, but it will give an idea of money attached to healthcare.

Without any major hospitalizations here are a few things to consider:

If you have been diagnosed with hypertension at the age of 35 (something that isn’t uncommon) you can expect to be taking something for that, usually lisinopril is one of the first choices. You can get a 90 day supply at your local WalMart for $10. That’s $40/year. At first you’ll have a couple visits to the doc from the time you’re diagnosed as follow up to make sure you’re doing well on the medication. If you have a $35 copay that’s between $70-$105 total visits for the year, at least for the first year and assuming you go to the doctor for nothing else that year.

3 visits = $105

1 year of meds = $40

Total = $145

Subsequent years would look like this:

1-2 follow up visits/year = $35-$70

1 year of meds = $40

Total = $75-$110

Over 20 years ~ $1500-$2300

Now this is assuming a few things. First you don’t ever have problems keeping your blood pressure from going up after the initial diagnoses and treatment, which is rarely the case for most. This also assumes you have no problems with the initial medication and have to get it changed, although this wouldn’t add a whole lot.

If you’re on two blood pressure medications, this jumps to $2300-$3000 over 20 years. This of course is no mortgage but still it adds up. If you happen to be taking a beta blocker like metoprolol as one of those blood pressure medications your cholesterol might go up just enough to trigger a prescription for something like simvastatin. Add another 10 dollars a month for that one.

Simvastatin $120/year

Metoprolol (assuming the cheap immediate release) $40/year

Lisinopril $40/year

2 visits/year $70

Over 20 years ~ $5400/20 years or $270/year

If you become borderline diabetic because of the simvastatin and the metoprolol in combination or were already there and these push you over you might add some metformin into the mix for blood glucose control. Three months of twice daily metformin will run you another $40/year.

Total ~ $6200/20 years or $310/year

We’re still not even close to a mortgage, but we’re increasing.

Now we’ve only discussed the financial part of all of this. Metoprolol is also going to sap some of your energy because it prevents chemicals like epinephrine and norepinephrine from having their full phsyiological effect. What does this mean? Well as I said it will probably sap some of your energy depending on the dose. It won’t necessarily make you drowsy, but it will make you tired easily.

Simvstatin as well as others have the tendency to cause muscle pain and weakness. I’ve had members of my family experience this, and I’ve experienced it myself. Many older folks attribute this to older age. I call nonsense. Yes we do degenerate as time goes on but my own grandmother was able to walk again in her 80’s after stopping simvastatin. It really can be that bad for some.

I’ve talked to others who’ve told me about lisinopril or losartan (angiotensin converting enzyme inhibitor and angiotensin receptor blocker respectively) who describe feeling like people who are on metoprolol do, with a lack of energy. Not enough to keep them from being out and about, but enough to make a few dread having to do anything because they have no energy to do it with.

Instead of medications doing some physical activity 2-3 times per week and backing off on total calories every day will likely achieve what most medications are seeking to achieve. Going on a brisk walk and having only one plate at dinner are two things that go a long way in improving health.

Think about it for just a moment; if you have only 1 plate, or maybe a smaller portion, you save on food and caloric intake. Eating till you have to undo your pants button is ok on Thanksgiving, Christmas and your birthday,…ok and maybe 1-2 other times/year but that’s it. If having to loosen your belt regularly after eating is a habit I can tell you that the belt is only going to get tighter and tighter.

Taking a brisk walk or going on a hike or riding the bike or whatever it is you might find joy in will get your heart pumping and muscles working. Blood pressure will go down as some of the fat comes off and you will feel more energized and not get out of breath while doing things you love.

I personally wish I could go back to Tahiti now that my heart is conditioned better to be able to stay underneath the surface while snorkeling with the fish longer.

Having a plan and sticking to it will pay off dividens in the long run. It’s sad to see people who take their medications exactly as the doctor directs and have been doing so for a long time only to see them deteriorate. Don’t be a statistic. Change now! Plan for the future, however long that may be, and make a difference in your life.

I know the amount of money that we went over above isn’t a lot in the grand scheme of things, but that’s assuming you take the meds and nothing ever happens and you never deteriorate any further than where you are. Not having to deal with the side effects and not having to visit the doctor is worth going biking and feeling awesome at the same time.

CIAO

Are Pre Workouts Helpful?: Theanine

This will be the last post in this series. If you’ve missed the other posts take a look at them as I covered some of the other supplements that are taken pre workout to help energize and otherwise allow you to increase performance.

Today we’ll take a look at a substance that many people already consume but might not know it. I’m talking aboutL-theanine which is yet another amino acid that some pre-workouts use in their formulations. Theanine is also very common in teas but not found in coffee. Green tea is probably the most popular but not by any means the only source of this stuff.

Theanine...just another white powder? Maybe not!

Theanine…just another white powder? Maybe not!

Theanine is best known for its ability to calm the nerves and kind of acts as a de-stressor. It can also be used for mood enhancement and focus. It even improves the sleep of boys with ADHD. [1]

So why would you want this before going out to pump iron, kick the soccer ball or ride your bike through the hills?

Well to be quite honest you don’t. But to be brutally honest no pre workouts are ever “really” needed. You can work out and progress and do just fine without them. In fact the only things you really need to progress in training are good obtainable goals, good food, good rest and a good attitude. I know that doesn’t sell supplements but I’m not selling supplements.

So should we just stop the blog post there and call it a day. Nope!

Theanine has this ability, when paired with caffeine, to make the caffeine jolt not quite so jarring. For some it can stop the jitters but the science says that’s probably not going to happen. It also stops you from going into full freak out mode when you get the caffeine. I remember the first time I had an NO-Explode. After about 15 minutes I was bench pressing while simultaneously running around the indoor track and doing push ups while squatting, the whole while breathing like I’d just run the fastest 100m in human history. Ok so maybe not quite like that, but it FELT like I was doing that.

Theanine helps level that out. I don’t take caffeine everyday, nor everytime I work out so to help me keep it even keel the theanine is what I prefer.

What does Theanine do?

Theanine actually helps dopamine release in the brain but also releases other chemicals that cause the “restful” effect. In the frontal cortex dopamine is thought to play a role in attention. Some believe that a reduced level of dopamine in this area is part of the cause of ADHD. For myself this is the effect I notice when taken with caffeine. The caffeine amps my brain energy, so to speak, and the theanine is able to focus it or direct it better than with caffeine alone. But this is just my anecdotal experience and may not be yours.

I couldn’t find any studies that show that theanine is an ergogenic aid with one exception in mice. Mice given theanine were able to swim a bit longer than the placebo group. Researchers attributed this effect to increase dopamine and decreased serotonin. [2]

Taking theanine on its own will likely not help you lift more or heavier, run longer or help muscle recover more quickly. The drug to accomplish all of that is called testosterone and I’m definitely not recommending that.

What theanine does do is allow the brain to recover from exercise. [3] When given 50mg theanine after initiation of exercise. Brain wave patterns of cyclists decreased in intensity and shifted to lower frequencies with theanine administration. It decreased the time to onset of mental regeneration. In other words it helped the cyclist calm down their minds more quickly.

Another thing theanine does is help with immune function. In a study done with distance runners, researchers looked at immune function of runners with cystine/theanine combo vs placebo. The combo kept the immune system running better than the placebo after 10 days of training. [4]

Another study shows the same thing in resistance training in men. [5]

It should be noted in these studies that a combination of theanine and cystine was used which means we can’t extrapolate the effect solely to the theanine. We’d need another study using just theanine to be able to say that.

So theanine can help mice swim longer, make people have better immune function in combo with cystine after exercise, helps the brain recover after exercise, and according to yours truly can help focus your caffeine jolt (this last one is unscientific).

Theanine has also been shown to help relieve stress. In a study done with theanine, caffeine and placebo, subjects were given mental tests and their blood pressures recorded at intervals during the tests and after. They were also submitted to a cold pressure test (submerging your hand in ice water for a minute) which is used to raise blood pressure.

In the groups there were high responders and low responders. In the high responder group there was a significantly less increase in blood pressure with the mental tests with both caffeine and theanine, but not with placebo. There was no difference with the cold pressor test. In the low response group there were not differences noted between the 3 groups. [6]

one interesting finding was that in the high responders group caffeine actually reduced blood pressure which is somewhat counterintuitive to what a person might initially think. This didn’t hold with the low responders group. It’d be interesting to do a study and see what mechanisms make those different.

This study shows that there may be some people who just don’t respond to theanine like others which is important to note. Just because you take theanine doesn’t necessarily mean it’s going to help reduce your blood pressure from the pangs of psychological stress.

Another study looked at similar parameters but with the addition of caffeine and theanine together. In this study caffeine alone increased blood pressure, jitteriness and alertness. When combined with the theanine the blood pressure increase wasn’t present but the jitters and alertness persisted.[7] This is similar to what I’ve experienced just less jitters. I don’t really get jittery with caffeine anyway.

On a stress study of pharmacy students going out to do rotations in clinical settings, researchers gave students placebo or theanine to two groups. The baseline stress levels were significantly higher in the placebo group and after use of theanine the subjective stress was less in the theanine group.[8]

The problem with this is the baseline of the 2 groups. If the placebo group had higher initial stress levels it’s possible that the results were due to chance or the treatment group actually just had naturally lower stress levels that the theanine might have accentuated. It would have been a better study had randomization taken place and made the baseline equal between the two groups.

How much?

In the stress studies mentioned above 200mg and above were used. In the mental regeneration study a dose of only 50mg was needed to ilicit an effect. In the study of boys with ADHD it was 200mg twice daily with food. i was once listening to a pharmacist at a national pharmacy convention talking about using a couple of grams before her talk to help calm her nerves down. She said it worked!

A dose of 200mg would probably suffice for most people. If you have higher stress levels a higher dose might be required. I haven’t found any real side effects except for maybe nausea but I’ve personally never experienced it and have not heard any complaints from anyone.

Theanine isn’t required for a pre workout to be a great one. But it does seem to have some ability to regulate caffeine and focus. I find the focus helpful during intervals but others may not. Only trying some can really tell you for sure. It shouldn’t hurt you though to try some and if you’re not looking for a pre workout but something else to calm down in the evening or need something to help during the day, theanine may be your answer.

CIAO

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk

 

 

1.Lyon, Michael R., Mahendra P. Kapoor, and Lekh R. Juneja. “The effects of L-theanine (Suntheanine) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial.” Altern Med Rev 16.4 (2011): 348-354.

2.LI, Min, Xin-nan SHEN, and Guo-ying YAO. “Effect of theanine on delaying exercise-induced fatigue and its mechanism [J].” Acta Nutrimenta Sinica 4 (2005): 019.

3.JÃger, Ralf, et al. “Improving mental regeneration after physical exercise.” Journal of the International Society of Sports Nutrition 5 (2008): 1-2.

4.Murakami, Shigeki, et al. “Effects of oral supplementation with cystine and theanine on the immune function of athletes in endurance exercise: randomized, double-blind, placebo-controlled trial.” Bioscience, biotechnology, and biochemistry 73.4 (2009): 817-821.

5.Kawada, Shigeo, et al. “Cystine and theanine supplementation restores high-intensity resistance exercise-induced attenuation of natural killer cell activity in well-trained men.” The Journal of Strength & Conditioning Research 24.3 (2010): 846-851.

6.Yoto, Ai, et al. “Effects of L-theanine or caffeine intake on changes in blood pressure under physical and psychological stresses.” J Physiol Anthropol 31 (2012): 28.

7.Rogers, Peter J., et al. “Time for tea: mood, blood pressure and cognitive performance effects of caffeine and theanine administered alone and together.” Psychopharmacology 195.4 (2008): 569-577.

8.Unno, Keiko, et al. “Anti-stress effect of theanine on students during pharmacy practice: Positive correlation among salivary α-amylase activity, trait anxiety and subjective stress.” Pharmacology Biochemistry and Behavior 111 (2013): 128-135.

Are Pre Workouts Harmful or Helpful ? Caffeine

In the previous posts we’ve discussed citrulline, beta alanine, and creatine. You can find those here if you missed them:

https://pharmacybrute.wordpress.com/2014/08/27/are-pre-workout-supplements-harmful-or-helpful-creatine/

https://pharmacybrute.wordpress.com/2014/08/20/are-pre-workouts-harmful-or-helpful-beta-alanine/

https://pharmacybrute.wordpress.com/2014/08/14/are-pre-workout-supplements-harmful/

Today lets talk caffeine. Most people have had some sort of caffeine in their lives. It’s pervasive in many drinks from coffee to soda to energy drinks to gun etc etc etc.

caffeine

No doubt many of you have heard people complain about needing their morning boost and how they can’t think or do anything or maybe they’re just in a bad mood until they get their coffee. Maybe you’re that person. At any rate caffeine is popular and has been so for a really long time.

Does it help the workout though? And is it safe? And can you have too much? There are lots of questions. I’m hoping to answer a few in this post.

First some biology 101. I know that may sound boring but it is much more interesting than organic chemistry. Trust me.

One effect caffeine is thought to exert in the body is the blockade of adenosine in the brain. Adenosine is a neurotransmitter that gives us feelings of sleepiness. Basically it tells us that maybe, just maybe it’s time to go lie down and get some Z’s. Researchers think caffeine exerts its wakefulness effects by blocking adenosine so that other neurotransmitters predominate. This in turn wakes us up.

So caffeine blocks adenosine which is like saying caffeine blocks our “go to sleep signals” in our brain. So far so good.

Like all chemical messengers adenosine has a receptor that it binds to send the signal, like a lock and key. This is where caffeine exerts its effect. By blocking the receptor adenosine can’t bind and transmit it chemical signal.

So caffeine blocks the adenosine receptor which stops adenosine’s signal. Ok still good.

The body doesn’t like it when things get out of balance. By not getting the signal for adenosine, the cells with those receptors upregulate them. It’s like little kids when they aren’t in sugar balance. You know, when kids yell and scream until they get enough sugar. So too do our cells scream they want more adenosine to keep the balance. (Maybe not the best example, but you get my drift)

After a few days of upregulation, more caffeine is needed to achieve the same effects as before. Many people notice this with chronic coffee consumption or other forms of caffeine. One shot espresso just doesn’t seem to cut it anymore and a double shot is needed. More receptors needs more caffeine to block them.

When caffeine isn’t ingested people feel incredibly sluggish and can’t seem to function at all. It’s because adenosine receptors are being met by all the adenosine and the sleep and rest signal is very strong. This is usually coupled with a nagging headache. Yup, use of caffeine regularly will cause this. And the only seeming cure is more caffeine.

Ok so that was today’s biology lesson. What about pre workouts you ask? Well….

Caffeine is definitely present in many preworkouts. Many. In fact it is probably the most used stimulant on the planet. This is the compound in pre workouts that give the boost of energy to really get rolling.

How effective is it?

A review of studies looking at endurance concluded that caffeine does increase endurance in time trial studies. [1] They reviewed 21 studies with 33 different treatments but only 15 had significant effects. The average mean improvement was  3.2%. Not a ton. There was quite a bit of variability between studies including ingestion times and types of exercise employed.

The researchers concluded that doses between 3-6mg/kg were the most effective while doses at 9mg/kg were no more effective and those may be potentially problematic, especially if consumed regularly. That range for a 75kg person is 225-450mg.

One study looking at these doses saw no difference between 3mg/kg and 6mg/kg but both were significant over placebo. [2]

In another study looking at 5mg/kg in users of caffeine (300mg/day) and non-users (<50mg/day), researchers found that non-users responded more favorably than users. [3] While the heart rate was significantly higher in the caffeine group, it was by 3-6 bpm higher than in the placebo group and to me doesn’t seem like a cause for concern. That is of course provided you don’t have any pre-exisiting heart conditions in which case I’d say stay away from caffeine.

These results lasted  up to 6 hours in non users but were not seen for so long in the regular users.

Remember the adenosine we talked about earlier? It is this blockade of adenosine that seems to be the cause behind the better endurance, or at least perception of it according to the authors. 10 min after the start of exercise perceived exertion was significantly lower in the caffeine group than in the placebo group.

Perceived exertion was also less in the non-user group vs the user group which might indicate the idea of the receptor upregulation talked about. The authors concluded that although blood glucose was increased during exercise in the caffeine group, there wasn’t any evidence that the ergogenic effect of caffeine wasn’t from increase in fatty acid metabolism or utilization as has been previously thought.

What about muscle strength?

Caffeine has been tested on muscle strength in numerous studies. A meta analysis was done to see if there was overall a significant effect. [4] Researchers found that there was a significant increase in strength in knee extensors by about 7%. This effect wasn’t seen in other muscle groups. Endurance was also significant in open end point tests. In other words how long you could hold contraction vs intermittent contraction that you would normally see in regular activity. Doses ranged from 1mg/kg-9mg/kg.

In another study looking at the bench press, subjects were assessed as to their 1 rep max and then separated into placebo and caffeine groups. They were then asked to perform as many reps at 60% 1RM until failure. The caffeine group performed 22.4 +/- 3.0 reps vs 20.4 +/- 3.4 in the placebo group. They also lifted more weight, 1147.2 +/- 261.4 kg vs 1039.4 +/- 231.7 kg over placebo. [5] The dose used was 5mg/kg.

While the results of this study are significant I want to point out that most lifters don’t do one set to failure on bench and stop. While it’s certainly possible that this study could translate over into a more normal regimen of 3 sets of 10 or 5 sets of 5 we can’t be for sure based on this alone. After all if you do 3 sets of 10 reps spaced out with rest you are likely to achieve this same volume without caffeine or more.

In another review caffeine ingestion did increase some measures of sports teams performance. 11 of 17 studies showed beneficial effect of intake but it was more common in the well-trained athletes who hadn’t used caffeine. [6] The mean improvement was 6.5%.

In the strength portion the studies did also show significant improvement. Many endpoints were in the form of torque produced or total number of reps. There is some differences so it’s hard to gauge an overall effect and in what setting that caffeine will definitively produce results.

Other possible confounders are that these studies are free-living which means the subjects intake of food or supplements isn’t monitored. That always increases the chances that the results may be skewed.

It certainly does seem plausible however that caffeine could increase strength or power but the effect doesn’t seem to be as beneficial as with endurance, at least in my view.

Also because individuals are susceptible to caffeine at different levels, it’s hard to know if caffeine will actually make an individual perform better or not based on the studies. It’s like everything else with research; it tells us a good average, but where you as an individual fall on that continuum is up for debate.

Bottom Line

While I know this review isn’t comprehensive, there does seem to be enough evidence for the use of caffeine in performance sports where endurance is required and may be beneficial in overcoming mental blocks. I do have a few words of caution.

Everyone is different but taking caffeine in the evening may not be a great idea if you don’t already. Some people will have little problem getting to sleep but others will be staring at the ceiling making friends with the thousands of sheep they’ll be counting trying to get to sleep.

Most studies with no effect were below 3mg/kg. Many that were at 3mg/kg saw positive outcomes as the 6mg/kg. In other words if this is something to try don’t start at 6mg/kg. Start at 3mg/kg and see what happens.

Also if you are a regular consumer of caffeine, you may need to back off completely from caffeine for a week or two to see any benefit at all. Caffeine intake probably needs to be cycled as well to maintain any benefit. If you do need to stop intake for a bit, it is probably wise to back off over  a few days. A caffeine withdrawal headache might be in your future if you don’t.

People with abnormal heart rhythms would be wise to avoid caffeine, especially in the doses used for these studies. Caffeine is a stimulant and can cause big problems where small ones already exist.

Further caffeine can be taxing on the adrenals if higher doses are maintained over a period of time. This makes cycling a good idea. Be careful with anything that can stimulate your brain that has to be ingested. And having caffeine multiple times per day every day is probably not the best idea.

CIAO

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk

 

1.Ganio, Matthew S., et al. “Effect of caffeine on sport-specific endurance performance: a systematic review.” The Journal of Strength & Conditioning Research 23.1 (2009): 315-324.

2.Desbrow, Ben, et al. “The effects of different doses of caffeine on endurance cycling time trial performance.” Journal of sports sciences 30.2 (2012): 115-120.

3.Bell, Douglas G., and Tom M. McLellan. “Exercise endurance 1, 3, and 6 h after caffeine ingestion in caffeine users and nonusers.” Journal of Applied Physiology 93.4 (2002): 1227-1234.

4.Warren, Gordon L., et al. “Effect of caffeine ingestion on muscular strength and endurance: a meta-analysis.” Med Sci Sports Exerc 42.7 (2010): 1375-87.

5.Duncan, Michael J., and Samuel W. Oxford. “The effect of caffeine ingestion on mood state and bench press performance to failure.” The Journal of Strength & Conditioning Research 25.1 (2011): 178-185.

6.Astorino, Todd A., and Daniel W. Roberson. “Efficacy of acute caffeine ingestion for short-term high-intensity exercise performance: a systematic review.” The Journal of Strength & Conditioning Research 24.1 (2010): 257-265.

 

 

Are Pre Workout Supplements Harmful or Helpful? : Creatine

We discussed in the last two articles about beta alanine and l-citrulline and their benefit in pre workout supplements. Now lets take a look at one of the most known white powders used by beginners and pros alike; creatine.

If you missed the last two articles you can find them here:

https://pharmacybrute.wordpress.com/2014/08/20/are-pre-workouts-harmful-or-helpful-beta-alanine/

https://pharmacybrute.wordpress.com/2014/08/14/are-pre-workout-supplements-harmful/

Creatine is a chemical that is primarily located in human muscle. It helps the formation of ATP in the body which is our main source of energy. It is this energy that we all need to do anything and everything. Without ATP we die. Period. If we weren’t able to create ATP even for a couple of minutes, we’d fall over and probably die. That’s how crucial it is.

Creatine has been popular for several years and no doubt if anyone has been to a gym in recent memory you might have seen someone sucking down creatine in just about any color of the rainbow. There is a reason that so many people take it. It’s because it works.

One study showed that 1 rep max in arm flexion increased significantly more over placebo with creatine loading and maintenance. Fat free mass also increased in the creatine group but no difference was found in the placebo group. [1]

In another study, total work done during 3 Wingate tests. For those unfamiliar with the Wingate test you can find out more about it here:

http://www.sport-fitness-advisor.com/wingate-test.html

One rep max on the bench press increased significantly by 6% and total lifting volume was increased. [2] These effect took 2 weeks of supplementation to achieve.

In a group of seniors (over 65 years old) creatine increased fat free mass and strength compared to placebo over 14 weeks of training. No significant side effects were noted. [3]

In another study 1 rep max on bench press, leg press and maximal reps on preacher curls was increased in the creatine group over placebo. [4] This study looked at two forms of creatine, the monohydrate and the phosphate forms. There was no significant difference between the two indicating that the form of creatine one takes isn’t important.

Another study found yet a similar increase in strength in knee extensions and time to fatigue, but noted no differences in hand strength, leading the researchers to conclude that creatine helps large muscle groups but not small ones. [5]

In one study of patients with Amyotrophic Lateral Sclerosis (ALS), creatine was loaded as is typically done with weightlifters. Maximal voluntary isometric muscular contraction was increased after 7 days of supplementation in 70% of patients in knee extensors and 53% in elbow flexors. [6] While not a cure creatine may be helpful for some of the symptoms of ALS.

So if you get an Ice Bucket challenge, maybe along with a donation you can give someone with ALS some creatine.

Another trial showed similar results for people with Parkinson’s that were weight training. [7]

Football players were divided into a creatine group and placebo group and given 5g/day creatine with no loading phase. They trained for ten weeks. Bench press increased by about 3kg, squats by about 25kg, and power cleans by about 7kg over placebo. [8] One conclusion from this study is the lack of need for a loading phase if someone is to take this in the long term.

In a meta analysis of 22 studies, researchers found that,

the average increase in muscle strength (1, 3, or 10 repetition maximum [RM]) following creatine supplementation plus resistance training was 8% greater than the average increase in muscle strength following placebo ingestion during resistance training (20 vs. 12%)” [9]

The average increase in weightlifting performance was 14% greater with creatine.

As far as dangers with creatine…well I’m not aware of any. Some claim that it will hurt your kidneys. Well from all the studies I’ve seen that’s just not going to happen. There are anecdotal stories about people having kidney problems and while I’m not one to dismiss anecdotes I think that if it were a kidney killer the FDA would’ve stopped it by now especially since it isn’t regulated.

There are many more studies that looked at creatine. It is probably one of the most studied strength enhancing supplements around. Bottom line is that it works and is effective.

Do you need to take creatine? That’s up to you. I’m not advocating for or against on this one but if you choose to it should be safe and not cause problems.

Some people don’t like creatine because they think it makes a person look “puffy” and that the muscles just are getting inflated because of the water weight. It is true that creatine does pull more water into the muscle cell. This is important for the muscle to get stronger and function properly. This is also a cause of dehydration if you’re not adequately drinking water.

Many people will load creatine when they start taking it, but as seen in the football players this is probably unneccessary if taken for many weeks. Some people do experience nausea during the loading phase. If this is the case reducing to a maintenance phase dose should take care of that.

Because of how it works, it isn’t necessary to supplement with creatine just before workouts like caffeine would be. That means you can take it at night before bed if you want.

Creatine appears to be better utilized in the presence of insulin, meaning that many take it with juice or other high glycemic carbs. Whey protein can spike insulin quite high too. [10-11] So taking some whey right after might be one way to increase utilization.

Some people are of the opinion that creatine should be cycled. I haven’t seen any data one way or the other and seeing as how most studies of this nature don’t last more than 14 or 15 weeks it’s hard to know for sure. Cycling may be wise in the long term using it for 2 months and then off a month.

Review Points

-Creatine is effective at increasing strength and power with weight training

-Likely no loading phase is necessary

-Side effect profile looks safe

-5g/day is the typical given dose

-8% increases are the average in strength augmentation

-Creatine will likely increase fat free mass

-Because of osmotic effects it is important to stay hydrated while supplementing

-Taking whey or high glycemic carbs may increase uptake in the muscles

-Cycling might be a good idea in the long term

 

I’d like to hear from you. Have you noticed a difference with creatine? Have you had any adverse effects from it?

CIAO

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

 

1.Becque, M. Daniel, John D. Lochmann, and Donald R. Melrose. “Effects of oral creatine supplementation on muscular strength and body compositioin.” Medicine and Science in Sports and Exercise 32.3 (2000): 654-658.

2.Earnest, Conrad P., et al. “The effect of creatine monohydrate ingestion on anaerobic power indices, muscular strength and body composition.” Acta Physiologica Scandinavica 153.2 (1995): 207.

3.Brose, Andrea, Gianni Parise, and Mark A. Tarnopolsky. “Creatine supplementation enhances isometric strength and body composition improvements following strength exercise training in older adults.” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58.1 (2003): B11-B19.

4.PEETERS, BRIAN M., CHRISTOPHER D. LANTZ, and JERRY L. MAYHEW. “Effect of oral creatine monohydrate and creatine phosphate supplementation on maximal strength indices, body composition, and blood pressure.” The Journal of Strength & Conditioning Research 13.1 (1999): 3-9.

5.Urbanski, R. L., W. J. Vincent, and B. B. Yaspelkis 3rd. “Creatine supplementation differentially affects maximal isometric strength and time to fatigue in large and small muscle groups.” International journal of sport nutrition 9.2 (1999): 136-145.

6.Mazzini, L., et al. “Effects of creatine supplementation on exercise performance and muscular strength in amyotrophic lateral sclerosis: preliminary results.” Journal of the neurological sciences 191.1 (2001): 139-144.

7.Hass, Chris J., Mitchell A. Collins, and Jorge L. Juncos. “Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trial.” Neurorehabilitation and neural repair 21.2 (2007): 107-115.

8.PEARSON, DAVID R., DEREK G. HAMBX WADE RUSSEL, and TOM HARRIS. “Long-term effects of creatine monohydrate on strength and power.” The Journal of Strength & Conditioning Research 13.3 (1999): 187-192.

9.Rawson, Eric S., and JEFF S. VOLEK. “Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance.” The Journal of Strength & Conditioning Research 17.4 (2003): 822-831.

10.Claessens, Mandy, et al. “The effect of different protein hydrolysate/carbohydrate mixtures on postprandial glucagon and insulin responses in healthy subjects.” European journal of clinical nutrition 63.1 (2007): 48-56.

11.Morifuji, Masashi, et al. “Comparison of different sources and degrees of hydrolysis of dietary protein: effect on plasma amino acids, dipeptides, and insulin responses in human subjects.” Journal of agricultural and food chemistry 58.15 (2010): 8788-8797.

 

Are Pre Workouts Harmful or Helpful? Beta-Alanine

In part 1 of pre workouts (PW) we discussed that some manufacturers have added chemicals that are banned by the FDA as supplements to increase performance and what to look out for. Then we discussed that L-citrulline may be beneficial for exercise but the jury is still out and more studies need to be done. If you missed it check it out here:

https://pharmacybrute.wordpress.com/2014/08/14/are-pre-workout-supplements-harmful/

In this post lets take a look at beta-alanine (BA) and see if it merits your time or money.

Beta-alanine: Performance enhancer or just another white powder?

BA is a modified form of the amino acid alanine. When it enters the body it is transformed into carnosine which acts as a buffer to drops in pH. This is likely to occur with lactate production during exercise.

As an aside, BA can cause pins and needles or warmth when ingested. This is more likely to occur as the dose increases. While for some this is uncomfortable it is important to know that it isn’t harmful.

But is it useful?

STUDY TIME!

In the first study researchers looked at trained 400 meter sprinters. They separated the 15 young men into two groups, placebo and BA supplementation. It started as 2.4 g/day during the first 4 days, 3.6 g/day during the subsequent 4 days, and from then on 4.8 g/day until the end of the study which was 4-5 weeks.

Carnosine levels increased with supplementation and knee extension torque was increased, but time taken to run the 400 meter sprint was not decreased. [1] The authors noted that even in trained athlete’s carnosine levels can be raised but that 4-5 weeks of supplementation either wasn’t enough time or just wasn’t going to decrease sprint times.

In a rowing study, elite rowers from Belgium were separated into placebo and BA groups. Carnosine was measured in the soleus and gastrocnemius (calves) and performance was measured in 100m, 200m, 2000m and 6000m times. The BA dose was 5g/day as 1g doses every 2 hours for 7 weeks.

Carnosine increased as in the previous study. The increased amount of carnosine did improve performance in the 2000m race, although times were not significantly faster. What this means is that the athletes that had the greater increase in carnosine levels from baseline did in fact perform the tests more quickly. As a whole group there was no difference.[2]

In a cycling high intensity interval training study, 46 college aged men were given 6g/day of BA for 3 weeks then 3g/day for another 3 weeks or placebo. VO2 peaks power was measured (O2 utilization) and body composition as well. Subjects focused on 90-110% of individuals VO2 max during the first 3 weeks, then 115% VO2 max during the 2nd 3 weeks.

Diet was to stay the same during the protocol. Participants also performed total time to exhaustion tests at 110% VO2.

Maximal oxygen consumption and time to exhaustion improved in both groups from baseline to 3 weeks but only improved again from 3-6 weeks in the BA group. Ventillory threshold showed no changes except in the placebo group from 3-6 weeks. [3]

It makes sense that improvements would be seen in both groups as high intensity exercise repeated over time will increase fitness levels. The change from 3-6 weeks is what makes BA seem to outshine over placebo.

Although there was an increase in lean body mass in the BA group during the first 3 weeks I don’t look at these results with much attention. Since the diets weren’t controlled in ward setting there are far too many confounders to really pay attention to any “significant changes”.

The authors did not that the BA group did train at higher workloads and at longer periods of time over placebo, but no significant difference was noted.

In another cycling study 16 highly trained cyclists were separated into BA or placebo at 68mg/kg over 4 weeks and looked at muscle contraction power and average power over 4 minutes of cycling. Average power/repetition was significantly increased. Fatigue index was significantly reduced. Average power output was higher in the BA group but it didn’t reach significance. [4]

In a study of swimmers, BA was given to the test group at 4.8g/day for 4 weeks then 3.2g/day after for 6 weeks. Training set times were improved at 4 weeks with supplementation but not at 10. There was a very small but insignificant improvement in competition performance. [5] What gets me is that the test group didn’t have a very good mask compared to placebo. Because BA can cause paresthesia (pins and needles) it was easy for 12 out of 22 in the test group to tell they were downing BA while 12 out of 19 in the placebo group guess correctly because of absence of paresthesia and 3 could tell because of taste. That could have caused quite a confounding of results.

Think about it. If you knew you were getting a supplement, the real deal, could your psychology increase your performance alone? If you knew you weren’t getting the real deal would you try as hard? I guess we won’t know, at least not in this group.

It’s akin to giving some people a brand new corvette and some others a VW bug and seeing who is going to drive the speed limit more of the time. Need I say more?

Another study looking at rowers came up with mostly negative results. Similar to the above mentioned rowing study, rowers times decreased at the 750m mark and 1000m mark but the decreases were both less than 1 second. [6]

In an endurance test of leg extensors, participants held a leg extension in a machine until exhaustion. The active dose of BA was 6.4g/day as 800mg tabs 8x/day separated by 2 hours each compared to placebo over 4 weeks.

After 4 weeks the active group was able to increase time to exhaustion by over 9 seconds, compared to the placebo group which decreased in time. [7]

A meta-analysis concluded that supplementation was greatest for activities that last between 60-240 seconds and at a dose of 179g total is supplemented. Benefits above 240 seconds overall were significant but not as pronounced. The researchers also commented that it is beneficial in high intensity activities. Most of the studies were conducted on men so no real concrete conclusions could be made about the benefits in women. [8]

A review of the literature has come to similar conclusions about BA. [9] There seems to be enough evidence to support ergogenic effect for high intensity exercise and more research is needed to quantify it. It appears that people with lower starting carnosine levels may benefit more from BA than others whose baseline is higher, but again more research is needed.

Another issue with many of the studies is the small sample size. Small size makes it difficult to detect true benefit from anything. I personally believe there is a benefit to be more readily detected from BA supplementation, but until they can consistently prove it with larger samples I can only speculate.

Review Points

-Beta-alanine raises carnosine levels in cells which can buffer decreases in pH

-Beta-alanine appears to benefit exercise when:

* exercise lasts at least 60-240 seconds in duration

*doses are on a regular basis and probably at least 4-5g/day

-Doses can be multiple times a day and don’t have to be pre workout to be effective

-Beta-alanine appears to have no side effects other than paresthesia

As I stated before I think BA has potential to be useful. I use it myself and have felt both the paresthesia and increased endurance while lifting and sprinting. I would like to see more conclusive studies on it but I’m not holding my breath in the mean time.

Next we’ll discuss creatine.

CIAO

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

1.Derave, Wim, et al. “β-Alanine supplementation augments muscle carnosine content and attenuates fatigue during repeated isokinetic contraction bouts in trained sprinters.” Journal of applied physiology 103.5 (2007): 1736-1743.

2.Baguet, Audrey, et al. “Important role of muscle carnosine in rowing performance.” Journal of Applied Physiology 109.4 (2010): 1096-1101.

3.Smith, Abbie E., et al. “Effects of β-alanine supplementation and high-intensity interval training on endurance performance and body composition in men; a double-blind trial.” Journal of the International Society of Sports Nutrition 6.1 (2009): 1-9.

4.Howe, Samuel T., et al. “The effect of Beta-Alanine supplementation on isokinetic force and cycling performance in highly trained cyclists.” International Journal of Sports Nutrition and Exercise Metabolism 23.6 (2013): 562-570.

5.Chung, Weiliang, et al. “Effect of 10 week Beta-alanine supplementation on competition and training performance in elite swimmers.” Nutrients 4.10 (2012): 1441-1453.

6.Ducker, Kagan J., Brian Dawson, and Karen E. Wallman. “Effect of beta-alanine supplementation on 2000m rowing ergometer performance.” International journal of sport nutrition and exercise metabolism 23.4 (2013): 336-343.

7.Sale, Craig, et al. “β-alanine supplementation improves isometric endurance of the knee extensor muscles.” Journal of the International Society of Sports Nutrition 9.1 (2012): 1-7.

8.Hobson, Ruth M., et al. “Effects of β-alanine supplementation on exercise performance: a meta-analysis.” Amino acids 43.1 (2012): 25-37.

9.Culbertson, Julie Y., et al. “Effects of beta-alanine on muscle carnosine and exercise performance: a review of the current literature.” Nutrients 2.1 (2010): 75-98.