How vitamins are made (by Ryan, age 8)

People that use vitamin supplements likely start with good intentions. But where do these products actually come from? Are vitamin supplements any more natural than white flour or pharmaceuticals?

Where do vitamin supplements come from?

When people think of drugs, most think “artificial.” When people think of vitamin supplements, most think “natural.”

But both drugs and vitamin supplements can be artificial or natural. Many vitamin supplements produced today are artificial. Meanwhile, the world of “natural” isn’t all hopscotch tournaments and fairy dances. Poison hemlock, hallucinogenic mushrooms, rhubarb leaves and sprouted kidney beans are all natural – and potentially deadly.

There are six categories of nutrients used in the manufacturing of vitamin supplements.

1. Natural source

These include nutrients from vegetable, animal or mineral sources. But before making it into the supplement bottle, they undergo significant processing and refining. Examples include vitamin D from fish liver oils, vitamin E from vegetable oils, and natural beta-carotene.

When a vitamin is marked “natural”, it only has to include 10% of actual natural plant-derived ingredients. The other 90% could be synthetic.

Consider vitamin E tocopherols, which can be extracted from vegetable oils (often soybean, due to low costs).

1. First, the soybeans are crushed and the protein is removed by precipitation.
2. Second, the resultant oil is distilled off to become bottled vegetable oil.
3. Third, the remaining materials are solubilized to remove any carbohydrates.
4. Fourth, the vitamin E is solvent extracted away from the remaining waxes and lecithin.

Synthetic alpha-tocopherol is a combination of eight isomers, natural alpha-tocopherol is just one isomer, and consuming various isomers can decrease bioavailability.

Natural vitamin E - notice the D-alpha tocopherol

Synthetic vitamin E (notice the dl-alpha)

Another example is vitamin D3. The manufacturing starts with 7-dehydrocholesterol (usually from wool oil), which turns into cholecalciferol (vitamin D3) when exposed to ultraviolet light.

2. Nature-identical synthetic

This includes nutrients completely manufactured in a lab with the molecular structure identical to the same nutrients occurring in nature. Manufacturers often prefer this process because of the cost and scarcity of natural resources. Most standard vitamin supplements on the market today are this type.

An example here would be vitamin C. Most vitamin C currently manufactured is synthetic, coming from China. Vitamin C is a weak acid. Many supplements use salt forms (sodium ascorbate, calcium ascorbate, magnesium ascorbate) to decrease acidity.

The most popular form of synthetic vitamin C is ascorbic acid. Naturally occurring vitamin C is the same molecule as synthetic ascorbic acid. But in food, ascorbic acid is found within the vitamin C complex among other compounds. The ascorbic acid in supplements is often derived from corn starch, corn sugar, or rice starch, and is chemically dependent upon volatile acids.

The method for vitamin C synthesis using two-step fermentation was developed by China in the 1960s:

Ascorbic acid production. From: Vandamme EJ. Production of vitamins, coenzymes and related biochemicals by biotechnological processes. J Chem Tech Biotechnol 1992;53:313-327.

3. Strictly synthetic

Centrum is strictly synthetic

These nutrients are manufactured in a lab and are different than the same nutrients found in nature. Synthetic vitamins can have the same chemical constituents, but still have a different shape (optical activity).

This is important because some of the enzymes in the human body only work properly with a vitamin of the correct shape. When we give the body concentrated forms of synthetic nutrients, it doesn’t always appear to have an appropriate delivery system.

Starting materials for strictly synthetic supplements can be anything from coal tar to petroleum to acetylene gas. These supplements are made in facilities via chemical manipulations with the goal of duplicating the structure of the isolated vitamin. Specific formulas for the process aren’t made available to the public (sorry, I tried).

An example is vitamin B1. Coal tar is a widely used foundational substance for this vitamin — typically a crystalline yellow coal tar (yes, this means it’s from coal, a fossil fuel). Hydrochloric acid is often added to allow precipitation. Then fermentation, heating, cooling, and other steps are completed until a final synthetic vitamin is created. It’s then dried and tested for purity before being shipped to distributors.

Now, to get a natural vitamin B1 supplement the process is quite different.

The food or botanical containing the desired vitamin is harvested and cleaned (let’s say wheat germ). It’s then placed in a vat to be mixed with water and filtered to create an extract and remove fibre (unlike in whole foods, where you want fibre). The post-filtration extract of the sourced food contains the nutrients found in the original whole food. It’s then dried and ready for packaging.

4. Food cultured

Example of a “whole food” labeled supplement

This involves the same process behind cultured foods like yogurt, kefir, miso, and sauerkraut. Nutrient supplements are often grown in yeast or algae. Culturing in and of itself creates nutrients and can make them more bioavailable.

Raw materials (minerals and some synthetic nutrients) are added to yeast/algae suspensions where they concentrate within cells. The yeast/algae are then harvested, ruptured, and made into a vitamin supplement. The theory here is that yeast/algae contain the nutrients they’re fed in a whole food complex.

Sometimes food cultured vitamins are combined with synthetic vitamins to increase potency (i.e., to bump up the milligram/microgram count on the label), since most have a low potency on their own. Remember, counting the milligrams of a synthetic vitamin might not be comparable to what’s found in whole foods.

5. Food based

One kind of food based supplement is made by enzymatically reacting synthetic and natural vitamins with extracts containing vegetable proteins and then making this into a supplement. This is not food cultured, because the nutrients are not grown into a whole food, as in the yeast/algae suspensions.

Manufacturers don’t often use concentrates or extracts derived from whole food sources because of low nutrient potency, fluctuating nutrient levels, limited shelf life. Nutrients are easily degraded by heat, pH changes, light, and oxygen.

Food based form of vitamin C

6. Bacterial fermentation

This includes nutrients produced by genetically altering bacteria. Genetically altered bacteria can produce nutrient by-products.

Examples include CoQ10, amino acids, ergocalciferol (vitamin D2), menaquinone (vitamin K2), riboflavin (fermentation of ribose), cyancobalamin (vitamin B12; this is exclusively obtained via fermentation processes, as the naturally occurring source of B12 is bacterial metabolic activity, think animal tissues/meat carrying bacteria), and melatonin.

For instance, vitamin D2 is made by artificially irradiating fungus. It’s not a naturally occurring form of vitamin D. The starting material is ergosterol, a type of plant sterol derived from fungal cell membranes. Ergosterol is turned into viosterol by ultraviolet light, and then converted into ergocalciferol (vitamin D2).

What you should know about vitamin supplements

Full scale vitamin production started during the 1930s with widespread distribution after World War II. Now, about 1/3 of Americans use vitamin supplements.

Nutrients from food?

Most people are interested in vitamin supplements because they fear they don’t enough nutrients from food.

This is a worthwhile concern: nutrients can be lost from soil due to fertilizers, pesticides, herbicides, irrigation, farming practices, and other causes. The USDA has reported that the nutrient content of vegetables has fallen since 1973. Of the vitamins we do ingest from whole food, absorption can range from 20 to 98%.

Do vitamin supplements prevent disease?

A 2002 study in JAMA concluded that adults would be better off taking a multivitamin supplement each day. The authors didn’t specify synthetic or natural. Other reviews have concluded that beyond treatment of deficiency, vitamin supplements don’t promote health or prevent cardiovascular disease and cancer.

Data indicates that vitamin supplements can actually lead to more cancer (specifically breast and prostate), cardiovascular disease, kidney damage (in those with diabetes), and fractures, while not helping prevent infections and sick days.

However, it’s important to remember that chances of certain chronic diseases can increase for those who are deficient in certain micronutrients.

The American Dietetic Association (ADA) recommends that the best nutritional strategy for optimal health and reducing the risk of chronic disease is to choose a wide variety of whole foods.

Other vitamin sources

Even if you aren’t popping vitamin supplements each day, if you consume fortified foods (think cereals, milks, breads, meal replacement shakes, etc.), it’s nearly impossible to avoid synthetic vitamins.

A report from the National Institutes of Health noted that individuals who consume high dose single nutrient supplements and fortified foods along with multivitamin/mineral supplements are at risk for undesirable effects.

Notice the synthetic vitamins added to Corn Flakes and Special K. Check out the ingredient listing.

Added vitamins and minerals in Special K and Corn Flakes.

What do supplement companies say?

Good question. I got busy with the phone and email to find out.

I called Centrum. They don’t have any information on where the nutrients in their products come from. They told me that their “vitamins are synthetic and the minerals are derived from natural sources.”

I called Bayer (the maker of Flintstone’s Vitamins) two times. They didn’t provide any response about where their vitamin supplements are derived.

I emailed CSPI. They said “most” vitamin supplements on the market are synthetic.

I emailed Vitamin Cottage. They believe that coal tar should not be a source for vitamin supplements since there are other non-petroleum materials that can be used. They also indicated that none of their vendors have C or B vitamins derived from coal.

I emailed Nature Made about vitamin B-1. They said: “We appreciate your questions concerning our supplements. Nature Made Vitamin B-1 is manufactured in a laboratory from chemicals. It is synthetically made in our manufacturing facilities in Southern California.”

I emailed GNC. They said: “GNC purchases vitamins, herbs, minerals, and other dietary ingredients from domestic suppliers as well as suppliers in many other countries from around the world. This will vary by ingredient.”

Summary and recommendations

With all of the data regarding nutrition and optimal health, the most convincing information tells us to focus on what we eat — not what we get from a pill bottle.

Synthetic vitamin supplements are isolated man-made chemical compounds, and appear to be in the same class as other synthetic pharmaceuticals.

Some supplements hold real benefit. For instance:

• folic acid for pregnant women
• iron for those who are anemic
• B-vitamins for those dealing with alcoholism
• vitamin D for those who’ve undergone bariatric surgery
• vitamin C for someone with scurvy

But in a situation where it’s possible to get nutrients from whole foods, choosing a supplement instead doesn’t seem to promote health, and taking supplements may actually cause harm.

The conclusion of an NIH State-of-the-Science conference in 2006:

“The present evidence is insufficient to recommend either for or against the use of MVMs [multivitamins/minerals] by the American public to prevent chronic disease.”

If you want to find a natural vitamin supplement, look for one with a label that indicates “naturally occurring food sources.” If the potency of the vitamin is higher than anything you would find in nature (e.g., 1000% vitamin B-3 per serving), the product likely contains synthetic ingredients.

To find out where your vitamin supplements come from, contact the company directly. A non-response or a generic response can go a long way in telling you what you’re getting.

Extra credit

Fortification of foods with vitamin B-3 has lead to intakes greater than twice what’s recommended, most notably in kids, who eat processed fortified foods. This higher intake of vitamin B-3 might lead to increased appetite and impaired glucose tolerance.

Capsules that enclose vitamin supplements can be derived from plant sources, like seaweeds, or animal sources like gelatin. Animal gelatin is from tallow, animal bone, marrow, or tissue scraps, and may include diseased tissues.

The tablet coating methylene chloride is a carcinogen.

Food color additives are often used in children’s vitamins. See All About Food Colour Additives for more.

The Dietary Reference Intakes (DRIs) are based on synthetic vitamins. We don’t fully understand how they translate to whole food alternatives.

Some manufacturers are currently trying to make an ergosterol precursor (cholestatetraenol) produced by yeast fermentation.

If you are interested in avoiding supplement contaminants, look for the NSF logo.

In North America, a majority of the raw materials for synthetic vitamin supplements are from the following companies:

• Arnet Pharmaceuticals Corporation – Davie, FL
• Botanical Laboratories, Incorporated – Ferndale, WA
• Contract Pharmacal Corporation – Hauppauge, NY
• Leiner Health Products Incorporated – Carson, CA
• Perrigo Company – Allegan, MI

I contacted all of these companies and got no response.

Further resources

New Chapter Organics, makers of food based vitamin supplements

All about Nutrient Deficiencies

All about Vitamins and Minerals

Infographic – scientific evidence for popular health supplements

Deciphering synthetic vs. natural supplement labels

References

United States National Library of Medicine. TOXNET.

Roan S. The dirt on dietary supplements. 2009.

Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for preventing gastrointestinal cancers. Cochrane Database Syst Rev 2008;3:CD004183.

Bjelakovic G, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev 2008;2:CD007176.

Bjelakovic G, et al. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 2007;297:842-857.

Sesso HD, et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2008;300:2123-2133.

Bolland MJ, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691.

Epstein D & Dohrmann G. What you don’t know might kill you. Sports Illustrated. May 18, 2009.

Cook NR, et al. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women’s Antioxidant Cardiovascular Study. Arch Intern Med 2007;167:1610-1618.

Vivekananthan DP, et al. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomized trials. Lancet 2003;361:2017-2023.

Vinson JA & Bose P. Comparative bioavailability to humans of ascorbic acid alone or in a citrus extract. Am J Clin Nutr 1988;48:601-604.

Hickey S & Saul AW. Vitamin C: The real story. Basic Health Publications. 2008.

Cooperman T, Obermeyer W, Webb D. Consumerlab.com’s guide to buying vitamins and supplements. Consumerlab.com. 2003.

McDougall J. http://www.drmcdougall.com/misc/2010nl/may/vitamins.htm

Ji Sayer. Research: Vitamins may increase the risk of death.

Ji Sayer. Is your multivitamin toxic?

Fletcher RH & Fairfield KM. Vitamins for chronic disease prevention in adults. JAMA 2002;287:3116-3129.

Orr KK & Hume AL. An evidence-based update on vitamins. Med Health RI 2010;93:122-124.

Huang HY, et al. Multivitamin/mineral supplements and prevention of chronic disease. Evid Rep Technol Assess (Full Rep) 2006;139:1-117.

Nutrition Business Journal.

Hannon-Fletcher MP, et al. Determining bioavailability of food folates in a controlled intervention study. Am J Clin Nutr 2004;80:911-918.

Cohn W, et al. Comparative multiple dose plasma kinetics of lycopene administered in tomato juice, tomato soup or lycopene tablets. Eur J Nutr 2004;43:304-312.

Lodge JK. Vitamin E bioavailability in humans. J Plant Physiol 2005;162:790-796.

Clement BR. Supplements Exposed. Career Press and New Page Books. 2010.

USDA Nutrient Content of the U.S. Food Supply

Linus Pauling Institute

Halwell B. Still no free lunch. (PDF)

Baker H, et al. Inability of chronic alcoholics with liver disease to use food as a source of folates, thiamin and vitamin B6. Am J Clin Nutr 1975;28:1377-1380.

Li D, et al. Chronic niacin overload may be involved in the increased prevalence of obesity in US children. World J Gastroenterol 2010;16:2378-2387.

Bates CJ & Heseker H. Human bioavailability of vitamins. Nutrition Research Reviews. 1994;7:93-127.

Neuhouser ML, et al. Multivitamin use and risk of cancer and cardiovascular disease in the Women’s Health Initiative cohorts. Arch Intern Med 2009;169:294-304.

Hill AM, et al. The role of diet and nutritional supplements in preventing and treating cardiovascular disease. Curr Opin Cardiol 2009;24:433-441.

Sesso HD, et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2008;300:2123-2133.

Gaziano JM, et al. Vitamins E and C in the prevention of prostate and total cancer in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2009;301:52-62.

Cook NR, et al. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women’s Antioxidant Cardiovascular Study. Arch Intern Med 2007;167:1610-1618.

Marra MV & Boyar AP. Position of the American Dietetic Association: nutrient supplementation. J Am Diet Assoc 2009;109:2073-2085.

Lichtenstein AH & Russell RM. Essential nutrients: food or supplements? JAMA 2005;294:351-358.

NIH State-of-the-Science Conference statement on multivitamin/mineral supplements and chronic disease prevention. NIH Consens State Sci Statements 2006;23:1-30.

Lawson KA, et al. Multivitamin use and risk of prostate cancer in the National Institutes of Health AARP Diet and Health Study. J Natl Cancer Inst 2007;99:754-764.

Sarnat R, et al. The Life Bridge. Herbal Free Press. 2002.

Vandamme EJ. Production of vitamins, coenzymes and related biochemicals by biotechnological processes. J Chem Tech Biotechnol 1992;53:313-327.

Padmini J. New technology for vitamin C production may end Chinese monopoly. Dec 23, 2004.

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• What should plant-based eaters be eating?
• Do plants provide enough amino acids?
• Where do most people go wrong?
• Will carbs from whole plant foods lead to excess body fat?
• Is it actually possible to gain muscle and fuel performance when eating plant-based?
• What’s the deal with soy?

The plant-based eating gurus are back for another round! For the first installment and more about our panelists, check out Part 1.

Before we get in to the details, let’s step back and ask the big philosophical question:

Q. Why a plant-based diet?

John Pierre: I feel that life should be about “we” not “me”. Most people eat only to benefit themselves, not considering the suffering and death of animals, the devastation to the environment, and the lack of resources that will be left for future generations. And of course, a properly followed plant-based diet gives you vitality, so it’s an easy choice for me.

Jon Hinds: Three big reasons:

1. I love animals, so I don’t want to harm them.
2. I want to help global cooling, so I don’t support the meat/milk industry.
3. It’s healthier for me, other people, and the planet.

Nathane Jackson: My mom passed away from cancer in the fall of 2009. During this time in my life, my research led me to the power of raw plant foods and the effect they have on our body.

Jack Norris: I want to contribute as little as possible to the death and suffering of animals.

Mike Mahler: I adopted a plant-based diet for moral reasons when I was 15 years old.

Jeff Novick: Philosophical reasons, health reasons, and because of the overall impact on personal and planetary health. Oh, and because it’s easier to sneak up on a carrot than a rabbit.

Take-home: Whether you’re concerned about the planet, animals, your community, or your own health, there are many reasons to move towards a plant-based diet.

Q. What supplements should plant-based eaters consider?

Novick: Focus on food first and centre your diet around the most nutrient dense foods.

Pierre: Each person is unique, so everyone needs different levels of nutrients according to their lifestyle.

Hinds: In fact, plant-based eaters’ supplement needs are largely the same as omnivores.

PROTEIN

Hinds: Protein supplements can be useful. The best options are combinations of hemp, brown rice and pea protein. Vega is a good source for all of these and Sunwarrior makes a quality brown rice protein powder. I take a plant-based nutrient powder called Source of Life Energy Shake.

Mahler: A quality protein powder isn’t mandatory, but can be useful to ensure optimal protein intake. I like to start each day with a shake — loaded with fruits, coconut oil or coconut milk, greens, and protein powder.

FAT

Mahler: Essential fats are important. Flax seed oil takes care of ALA, and ALA can convert to EPA/DHA (to a degree), but it’s still a good idea to take an algae- based DHA/EPA product (such as V-pure) to ensure adequate levels are met.

VITAMINS & MINERALS

Jackson: Everyone needs Vitamin D. Unless you live in the southern hemisphere and spend a half hour outside each day, you should take a supplement. I also recommend a quality organic vitamin B-12 product.

Pierre: Vitamin B12, sunshine or Vitamin D, and iodine or sea vegetables.  If you don’t get enough of these nutrients you can have problems with red blood cells (anemia), permanent neurological problems, symptoms that mimic dementia, elevated homocysteine levels (which may contribute to heart disease), depressed immunity, and a dysfunctional metabolism.

A 100% plant-based eater who consumes no fortified foods should consider Vitamin B-12.

Mahler: B vitamins are definitely important for energy, hormone optimization, and overall health. They get depleted when we are under stress.

Zinc and magnesium supplements are worth investigating since they are important for testosterone and insulin. I prefer Zinc citrate and transdermal magnesium oil.

Norris: Supplements are discussed here: http://www.veganhealth.org/

Take-home: Get most of your nutrition from a variety of whole foods. Beyond that, focus on getting adequate protein, B vitamins (especially B12), vitamin D, essential fatty acids, and minerals such as magnesium, iodine, zinc.

Q. What animal food do you feel causes the most health, body composition, and performance problems?

The experts are pretty much agreed: Milk does not do a body good.

DAIRY

Sorry, Bessie.

Hinds: Today, most every animal product is unhealthy, as they often contain toxins (antibiotics, steroids, pesticides and hormones) that lead to major diseases (heart disease, cancer, stroke, diabetes, arthritis).

And milk does a body bad. The intake of milk products doesn’t seem to improve bone health and can blunt the absorption of nutrients. Many people cannot tolerate dairy, but are encouraged to consume it by nutrition experts/coaches.

Jackson: Yes, dairy products have been put on a pedestal but are a leading contributor to many bodily dysfunctions. Not only are more people lactose intolerant than ever, but cases of cancer, diabetes, fibromyalgia, acne, arthritis, and irritable bowel have been cured by eliminating dairy products.

Pierre: I agree; dairy products are the worst. You are ingesting a hormonal secretion of a bovine. I don’t feel that the body is equipped to digest these secretions. Dairy can lead to inflammation, asthma, joint pain, congestion, and of course weight gain.

MODERN FARMING

Mahler: It’s not necessarily the “animal foods” per se that cause problems, but the way animal foods are being raised/processed.

Meat, dairy, and eggs from factory farms are the most problematic. These animals live in miserable conditions, are given antibiotics, and provided low quality feed.

If the animals aren’t healthy, do you think that you’ll be healthy eating them? Of course not!

Moreover, imagine the stress that these animals experience on a daily basis. The adrenaline and cortisol they produce goes into their tissues, and this is what people are eating.

If you support the level of suffering that these animals experience you shouldn’t be surprised when it comes full circle and causes human health problems. Even if you don’t care about animal welfare, consider having more respect for yourself and consuming meat, dairy, and eggs from animals that are treated humanely and fed optimal diets.

Take-home: Avoid dairy. If you eat animal products, make sure they’re organic and humanely raised.

Q. What do you eat in a typical day — and a non-typical day (travel days, busy days, the kids are sick, your juicer broke, etc.)?

Hinds: I start the day with water and some greens powder to alkalize my body. When at home:

• soaked oats, berries, nuts, Source of Life Energy Shake
• banana, mango, plant protein, nuts
• kale, butternut squash, pine nuts
• greens powder and water
• sprouted tortillas (Ezekiel brand), red pepper hummus, homemade veggie nut burgers, broccoli and peas
• greens powder and water

When traveling:

• greens smoothie at a health food store: spinach, mango, spirulina, raw nuts
• two pieces of fruit and/or some trail mix
• salad bar (usually at Whole Foods Market): kale, beets, corn, beans, pumpkin seeds
• greens powder and water (I travel with this stuff)
• if we’re eating at a typical restaurant like P.F. Chang’s, we’ll get sautéed spinach, green beans, and brown rice. Side orders are the way to go when traveling. At Mexican restaurants I’ll get sides of fajita filling (onions, bell peppers), black beans and red rice. This is a great meal; just make sure to say “no cheese!”
• greens powder and water

Jackson: The majority of the time I follow the schedule below. When I travel or go out to eat, I just rely on raw fruits and vegetables.

• water with lemon and cayenne pepper
• large bowl of mixed fruit — banana, dates, mango, grapes, apple or pear, goji berries, hemp seed and soaked sunflower or pumpkin seeds
• post workout smoothie — bananas, dates, carob powder, plant protein powder, goji berries, maca and coconut water
• large leafy green salad with raw vegetables and soaked nuts or raw hummus on dehydrated veggie wraps.
• green juice — cucumber, celery, kale, apples (sometimes beets, carrots, lemons, ginger, etc.)
• whatever I feel like (I tend to favor more protein and fat at this point in the day), e.g., raw zucchini pasta and raw pasta sauce, or raw mushroom & nut burgers, or large salad, or a juice/green smoothie
• plant protein powder, almond milk and peppermint oil

Novick: My diet is very simple and ordinary. It doesn’t change much, regardless of where I am. It’s almost entirely composed of foods in their natural form. While I’m not a breakfast eater, if I did, it would be oatmeal and fruit. Most of my lunches and dinners are centred around vegetables, intact whole grains, and legumes. I have a new DVD out called Jeff Novick’s Fast Food, which explains my theory and system based on 10-minute meals with no more than 5 ingredients, and can be done with no more than scissors and a can-opener for $3/day.

Mahler: I have some ideas here and here.

Take-home: Wherever you are and whatever you’re doing, it’s easy to get more plants into your diet with a bit of planning.

Q. Where do you get food and recipe ideas?

Hinds: I’m always reading plant-based eating books. My favourites are:

• The Thrive Diet by Brendan Brazier
• Superfoods by David Wolfe
• The Engine 2 Diet by Rip Esselstyn
• Skinny Bitch by Rory Freedman & Kim Barnouin

I usually keep it simple and just eat the foods I like. All my meals can be made in a few minutes.

Jackson: Most of raw foodies have blogs. If you type in “raw” or “vegan” before a recipe name you’re looking for, I can almost guarantee that you will find someone with a blog post/website recipe. I have a section on my blog titled RAWsome Vegan RAWcipes. I also like Dr. Gabriel Cousens and his Tree of Life café books as well as The Thrive Diet by Brendan Brazier.

Novick: I graduated from culinary school and was a former chef, so I make up recipes myself. Most of them come from playing in the kitchen with basic foods under the heading of “making things simple, easy and tasty.”

Mahler: I am half Indian and fortunate to have a mother who is a lifelong vegetarian. I learned the basics of plant-based eating from her and went on to personalize it for my training goals. I like Indian food, rich in beans and vegetables. The website vegsource.com has great recipes. Brendan Brazier and Robert Cheeke have great books on the vegan diet loaded with recipes.

Take-home: When it comes to plant-based eating recipes and inspiration, you’re only limited by your imagination and Google skills.

Q. For someone who eats a more animal-based and/or processed diet (read: most of North America), what’s one simple step they can take starting right now to eat more nutritious plants?

Hinds: I’ll give you three tips:

• Substitute rice milk or almond milk for cow’s milk
• Substitute veggie patties for meats
• Instead of snacking chips or pretzels, have an orange or an apple

Jackson: Green smoothies are a great way for adults (and kids) to incorporate leafy greens into their diet. Adding a handful of spinach into a fruit smoothie is a solid start.

Pierre: Eat fruits and/or vegetables with every meal. Make smoothies with fruits/vegetables. Enjoy vegetables with dips and herbal seasonings.

Mahler: Add a baby spinach salad to your daily meal rotation. Each time you eat, make sure 2/3 of your plate is comprised of vegetables.

Novick: As Nike always says, just do it!

Take-home: It’s easy to start incorporating more nutrient-rich plants to your diet with some simple substitutions or additions.

More resources

For more on plant-based eating, check out Precision Nutrition V3.0.

There are also resources in the PN Member Zone.

• For plant-based omega-3 supplement options, see here.
• For plant-based protein supplement options, see here.

Our panel

	Jon Hinds runs Monkey Bar Gym in Madison, WI.
	Nathane Jackson is an NSCA certified strength & conditioning coach and kettlebell trainer specialist in Toronto, Canada. Nathane is a pro fitness model, physique competitor, and fitness personality.
	Mike Mahler is a writer, strength trainer, and kettlebell instructor in Las Vegas, NV.
	Jack Norris is a Registered Dietitian and the President and co-founder of Vegan Outreach.
	Jeff Novick holds an MS and RD, is Vice President for Executive Health Exams International, lectures at the McDougall Program in Santa Rosa, California, and serves as an Adjunct Professor in the School of Health Sciences for Kaplan University.
	John Pierre is a nutrition and fitness consultant specializing in geriatrics, nutrition, fitness, women’s empowerment, green living, and cognitive retainment and improvement.

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Fish oil is, well, oil from fish.

It’s rich in two specific groups of omega-3 fatty acids known as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). DHA and EPA, along with alpha-linolenic acid (ALA), found in things like flax and walnuts, fall under the subheading of omega-3 fatty acids. (See All About Healthy Fats for more.)

EPA and DHA are often cited as being the beneficial components of fish oil. EPA and DHA actually originate in algae, which is the base of the food chain for fish. Fish consume these algae and thus concentrate high amounts of the beneficial fats.

Omega-3 fatty acid metabolism (click to enlarge)

Why is fish oil so important?

Overall health

Omega-3s are very important for health, including:

• cardiovascular function
• nervous system function and brain development
• immune health

Research shows that low DHA consumption (and blood levels) is associated with memory loss, difficulty concentrating, Alzheimer’s disease and other mood problems.

Cell membranes

Essential fats have an integral role in promoting cell health.

Cells in the human body have a fatty membrane (known as the lipid bilayer). This membrane is semi-permable: It regulates what gets into the cell and what goes out of it. The fluidity of cell membranes depend on the fatty acid composition of the diet.

• If the fatty membranes surrounding brain cells are relatively fluid, as they are with lots of omega-3s, then messages from neurochemicals such as serotonin can be transmitted more easily.
• On the other hand, if people eat too many saturated fats (which are solid at room temperature), without enough omega-3s, then these membranes become more rigid, and stuff can’t get through.

Fatty membrane of cells

Cells also require these good fats for repair and regeneration.

With lots of omega-3s, muscle cells become more sensitive to insulin, while fat cells decrease. This may mean that the body can divert more nutrients to muscle tissue.

Metabolic health

Finally, DHA and EPA can increase metabolism by increasing levels of enzymes that boost calorie-burning ability.

What you should know

We can’t make omega-3 and omega-6 fatty acids in our bodies, so we need to get them from our diets.

Omega-3 to omega-6 ratio

It’s easy for us to get omega-6 fatty acids. These are found in plant oils, for instance, and factory-raised animals (which are fed a lot of corn and soy) will usually have a lot of omega-6 too. (See All About Plant Oils for more.)

But it’s hard for people in Western countries to get omega-3 fats from dietary sources. We eat a lot more processed foods and a lot less wild game and plants than our ancestors did. And we don’t usually eat things like snails and insects, which are also high in omega-3s, although many folks worldwide still eat these as part of traditional diets. We rely heavily now on omega-6 vegetable oils.

We evolved with a fat intake ratio of about 1:1 omega-3 to omega-6 fatty acids. Now, it’s closer to 1:20.

Because omega-3s and omega-6s compete with each other for space in cell membranes and the attention of enzymes, the ratio matters more than the absolute amount consumed of either fat.

Fat heads

When it comes to fat intake, you (and your cells) really are what you eat.

Years of research has linked lower fat diets with aggression, depression, and suicidal ideation. Over time, the cells in your brain take on the dietary fat you consume. DHA is the active fat in the brain, and especially important throughout developmental stages.

Depletion of fish oil resources

About 1/3 of the world’s total fish catch goes toward fish meal/oil for farmed fish and other animals. Many open ocean fish like menhaden, anchovies, herring and mackerel are caught mainly for this purpose. Competition for fish meal/oil can drive up the price of fish, which pushes this food source out of reach for many of the world’s poorest.

For more, see All About Eating Seafood.

Summary and recommendations

Aim for 6-12 daily grams of total fish oil (about 3-6 grams of EPA + DHA) per day from a supplement company that doesn’t contribute directly to the depletion of fish (e.g., they use primarily fish discards). We suggest liquid fish oil, because it’s hard to take so many capsules, and because some supplement companies put lower-quality oil into capsules (or secretly cut it with soy oil). Buy from a reputable company.

Look for small-fish-based formulations (e.g. herring, mackerel). Small fish are lower on the food chain and less likely to accumulate environmental toxins. Or choose krill oil or algae oil (see All About Algae Supplements).

Add up the amounts of EPA & DHA listed on the back of the product and make sure the total is at least 300 mg per 1000 mg capsule. This will make it easier to get the suggested dose.

Avoid cod liver oil.

Find a fish oil supplement that you can tolerate the taste of, otherwise you won’t use it (unless it’s in capsule form).

Fish oil can taste much better when combined with your favorite protein powder in a super shake.

Avoid trans fats; they can interfere with EPA & DHA in the body.

Use fewer omega-6 rich vegetable oils, which will negatively alter your fatty acid ratio.

For extra credit

The amount of DHA in a woman’s diet determines the amount of DHA in her breast milk.

Omega-3 fats are not typically used in processed foods because of their tendency to oxidize.

NIH researchers have said that the billions we spend on anti-inflammatory drugs such as aspirin, ibuprofen, and acetaminophen is money spent to undo the effects of too much omega-6 fat in the diet.

It’s hypothesized that populations may drift toward a lower omega-3 intake because a faster metabolism (from high omega-3 intake) increases the need for food and the possibility of hunger.

Fish oil seems to be safe (except for those on blood thinning medications).

References

Borer KT. Exercise Endocrinology. Human Kinetics. Champaign, IL. 2003.

Mahan LK & Escott-Stump S. Eds. Krause’s Food, Nutrition, & Diet Therapy. 11th ed. Saunders Publishing, Philadelphia, PA. 2004.

Groff JL & Gropper SS. Advanced nutrition and human metabolism. 3rd ed. Wadsworth Thomson Learning. 2000.

Barnard ND, et al. Nutrition Guide for Clinicians. 1st ed. PCRM. 2007.

Hibbeln J, et al. Health intakes of n-3 and n-6 fatty acids: estimations considering worldwide diversity. Am J Clin Nutr 2006;83 (suppl):1483S-1493S.

Daviglus ML. Fish consumption and the 30-year risk of myocardial infarction. NEJM 1997;336:1046-1053.

Arterburn LM, et al. Bioequivalence of docosahexaenoic acid from different algal oils in capsules and in a DHA-fortified food. Lipids 2007;42:1011-1024.

Church MW, et al. Abnormal neurological responses in young adult offspring caused by excess omega-3 fatty acid (fish oil) consumption by the mother during pregnancy and lactation. Neurotoxicol Teratol 2009;31:26-33.

Nair GM & Connolly SJ. Should patients with cardiovascular disease take fish oil? CMAJ 2008;178:181-182.

Lee KW, et al. Effects of dietary fat intake in sudden death: reduction of death with omega-3 fatty acids. Curr Cardiol Rep 2004;6:371-378.

Jacobson TA. Beyond lipids: the role of omega-3 fatty acids from fish oil in the prevention of coronary heart disease. Curr Atheroscler Rep 2007;9:145-153.

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Glutamine is the most abundant free amino acid in the human body, making up about 60% of the skeletal muscle amino acid pool. (For more on amino acids, see All About BCAAs and All About Protein.)

Glutamine is a conditionally essential amino acid, which means that normally our bodies don’t need it from our diet. Exogeneous glutamine (in other words, glutamine we supplement or consume in food) is essential only under certain conditions, which include stress, trauma, muscular dystrophy, and illness, which can decrease glutamine levels by up to 50% (in severe cases). Because glutamine is a precursor for the structural unit of DNA and RNA, rapidly dividing cells are most likely to suffer from a shortage.

When we aren’t experiencing stress, trauma, muscular dystrophy or illness, our body produces enough glutamine on its own to supply our needs. The major part of endogenously produced (in other words, stuff our body makes) glutamine comes from skeletal muscle. Vitamin B3 and B6 are necessary for the production of glutamine from glutamic acid.

Why is glutamine so important?

Glutamine is a vital fuel source for the intestines and immune system that helps to keep defenses up against microbes. By nourishing these cells, it maintains the integrity of the GI tract.

Since the immune system is necessary for recovery from stress, glutamine may help during intense bouts of training. It may play a role in:

• Normalizing growth hormone
• Promoting glucose uptake after workouts
• Enhancing the hydration state of a muscle
• Reducing acid buildup with exercise (more on acid-base balance)

Yet it doesn’t seem that exercise decreases glutamine concentrations enough to compromise regular immune functions. This makes sense, since those who consume adequate energy from their diet tend to have a high glutamine intake. However, some people whose training and diet causes physical stress may benefit, e.g. people who are eating less food than necessary to modify body composition (in other words, dieting) or people whose training is extremely strenuous (such as elite athletes).

What you should know about glutamine

Where to find it

Cabbage and beets contain high concentrations of glutamine. (Eastern European grandmothers everywhere, rejoice! You have one more reason to encourage your “too skinny” grandchildren to eat the buraczki, borscht and holubtsi!) Other food sources include fish, beans and dairy.

Glutamine supplementation and dose

Typically, the consumption of any solo amino acid in high doses may hinder the assimilation of other amino acids. High doses of single amino acids can also result in bloating and diarrhea since they have osmotic properties. Yet glutamine supplements appear to be absorbed adequately and don’t create GI distress.

Glutamine supplementation has become routine to promote gut health in those with GI disorders, or those with HIV/AIDS, cancer, and other severe illnesses. Because glutamine has a rapid turnover rate, even high amounts (up to 30 grams each day) can be given without side effects. Most people will have a normalized plasma glutamine concentration by adding 20-25 grams over a 24 hour period.

In studies, glutamine supplement dosages have varied, including:

• 18 to 30 grams per day, by mouth
• 10 grams three times per day, by mouth
• 0.6 grams per kg of body weight per day (thus a 100 kg/220 lb person would consume 60 g daily)
• 14 grams of glutamine per day in combination with arginine and HMB for up to 24 weeks

Glutamine side effects and long-term use

There is little data regarding long-term usage (more than a few weeks) of glutamine supplements. No reported adverse effects have been attributed to short-term supplementation at less than 30 grams per day. Still, in some studies using high-dose intravenous administration of glutamine, patients developed elevated liver enzymes (indicating liver stress).

Other groups at risk:

• Those with diabetes should use caution when supplementing with glutamine because they tend to metabolize glutamine abnormally.
• Those who are sensitive to MSG (monosodium glutamate) may want to avoid glutamine supplements, due to glutamate inter-conversion.
• Those with epilepsy or bipolar disorder should be extremely cautious if considering glutamine and discuss it with their doctor first. Many anti-seizure medications work to block glutamate stimulation in the brain. And since the body metabolizes glutamine to glutamate, glutamine may interact negatively with anti-seizure medication.

Summary and recommendations

Will adding glutamine make a difference to your body if you are healthy? Probably not.

Will it harm you in doses of less than 30 grams per day? Probably not.

If all of your bases are covered with nutrition, exercise and recovery, and you have the money to spend each month on more supplements, then adding glutamine is fine. If you are undergoing a period of food restriction, then glutamine supplementation may improve nitrogen retention, decrease infection, and promote recovery from illness. Other situations that may benefit from glutamine supplementation include GI disorders, HIV/AIDS, and cancer.

For healthy individuals, the suggested reasons for taking glutamine supplements have received little support from well-controlled studies in healthy, well-nourished humans.

I contacted Dr. Michael Gleeson, a glutamine guru at the School of Sport and Exercise Sciences, Loughborough University, Loughborough England. His response was short and sweet:

Dear Ryan,

I do not see any point in supplementing glutamine for the healthy athlete/exerciser.

Regards,

Mike

For extra credit

Glutamine is a precursor for arginine.

A supplement blend containing glutamine has been shown to lower body fat, increase muscle mass, and increase strength when combined with 12 weeks of resistance training.

References

Wernerman J. Clinical use of glutamine supplementation. J Nutr 2008;138:2040S-2044S.

Choi SH et al. Glutamine on the luminal microbial environment after massive small bowel resection. J Korean Med Sci 2002;17:778-783.

Darmaun D. Role of glutamine depletion in severe illness. Diabetes Nutr Metab 2000;13:25-30.

Goodman MJ, et al. Abnormalities in the apparently normal bowel mucosa in Crohn’s disease. Lancet 1976;7:275-278.
Bertolo RF & Burrin DG. Comparative aspects of tissue glutamine and proline metabolism. J Nutr 2008;138:2032S-2039S.

Roth E. Nonnutritive effects of glutamine. J Nutr 2008;138:2025S-2031S.

Carvalho-Peixoto J, et al. Glutamine and carbohydrate supplements reduce ammonemia increase during endurance field exercise. Appl Physiol Nutr Metab 2007;32:1186-1190.

Groff JL, Gropper SS, Hunt SM. Advanced Nutrition and Human Metabolism. West Publishing Company, New York, 1995.

Institute of Medicine. The Role of Protein and Amino Acids in Sustaining and Enhancing Performance. National Academy Press: Washington DC, 1999.

Mack G. Glutamine synthetase isoenzymes, oligomers and subunits from hairy roots of Beta Vulgaris L. var. lutea. Planta 1998;205:113-20.

DiPasquale M. Amino Acids and Proteins for the Athlete: The Anabolic Edge. CRC Press: Boca Raton, FL, 1997.

Lohaus G. & Moellers C. Phloem transport of amino acids in two Brassica napus L. genotypes and one B. carinata genotype in relation to their seed protein content. Planta 2000;211:833-840.

Ziegler TR, et al. Glutamine and the gastrointestinal tract. Curr Opin Clin Nutr Metab Care 2000;3:355-362.
Ochs G. Complexity and expression of the glutamine synthetase multigene family in the amphidiploid crop Brassica napus. Plant Mol Biol 1999;39:395-405.

Labow BI & Souba WW. Glutamine. World J Surg 2000;24:1503-1513.

Gleeson M. Dosing and efficacy of glutamine supplementation in human exercise and sport training. J Nutr 2008;138:2045S-2049S.

Lininger SW, et al. A-Z guide to drug-herb-vitamin interactions. Prima Health, Rocklin, CA, 2000.
Mahan K, Escott-Stump S. Krause’s Food, Nutrition, and Diet Therapy. WB Saunders Company; Philadelphia, 2004.

Iwashita S, et al. Impact of glutamine supplementation on glucose homeostasis during and after exercise. J Appl Physiol 2005;99:1858-1865.

Scarpignato C, Pelosini I. Management of irritable bowel syndrome: novel approaches to the pharmacology of gut motility. Can J Gastroenterol 1999;13 Supp A:50A-65A.

Medina MA. Glutamine and cancer. J Nutr 2001;131:2539S-2542S.

Mithieux G. New data and concepts on glutamine and glucose metabolism in the gut. Curr Opin Clin Nutr Metab Care 2001;4:267-271.

Noyer CM, et al. A double-blind placebo-controlled pilot study of glutamine therapy for abnormal intestintal permeability in patients with AIDS. Am J Gastroenterol 1998;93:972–975.

Shabert JK, Wilmore DW. Glutamine deficiency as a cause of human immunodeficiency virus wasting. Med Hypotheses 1996;46:252–256.

Reeds PJ, Burrin DG. Glutamine and the bowel. J Nutr 2001;131:2505S-2508S.

Melis GC, et al. Glutamine: recent developments in research on the clinical significance of glutamine. Curr Opin Clin Nutr Metab Care 2004;7:59-70.

Vardimon L. Neuroprotection by glutamine synthetase. Isr Med Assoc J 2000;2 Supp:46-51.

Kraemer WJ, et al. Effects of amino acids supplement on physiological adaptations to resistance training. Med Sci Sports Exerc 2009 Apr 3 [Epub ahead of print]

Hankard R, et al. Is glutamine a ‘conditionally essential; amino acid in Duchenne muscular dystrophy? Clin Nutr 1999;18:365-369.

Stumvoll M, et al. Glutamine and alanine metabolism in NIDDM. Diabetes 1996;45:863-868.

Ligthart-Melis GC, et al. Glutamine is an important precursor for de novo synthesis of arginine in humans. Am J Clin Nutr 2008;87:1282-1289.

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Why is vitamin D so important?

Nearly every tissue and cell in our body has a vitamin D receptor. Without enough activated vitamin D in the body, dietary calcium cannot be absorbed. Calcium is essential for signaling between brain cells, development of bone, and tooth formation. Let’s be honest, nobody likes rickets.

Studies also reveal that low vitamin D levels in the body are associated with:

• Increased loss of muscle strength and mass as we age
• Increased risk of cancers
• Lower levels of immunity
• Higher blood pressure
• The development of neurological disorders
• The development of diabetes

Alright, so we just spend more time in the sun or pop some supplements. Not so fast.

Despite the importance of vitamin D, it’s estimated that anywhere from 30% to 80% of the U.S. population is vitamin D deficient. It’s likely worse among people with darker skin living in northern zones, as their skin pigmentation screens out the relatively limited sunlight more effectively.

If your skin is darker, you are at higher risk of vitamin D deficiency. Consider spending more time at the beach. Get your doctor to write you a note -- hey, that surfing trip is for medical reasons!

Vitamin D levels can also be affected by age and body fat levels. As we age, our ability to make vitamin D is reduced by 75%. Furthermore, vitamin D can get trapped in body fat, leading to a 55% reduction in blood levels for those who are over-fat.

What you should know about vitamin D

Vitamin D is a fat soluble vitamin that exists in various forms. The animal form is vitamin D3 (cholecalciferol) and the plant form is vitamin D2 (ergocalciferol). Vitamin D2 and D3 are not biologically active; they must be modified in the body to have any effect.

The active form of vitamin D is indeed a hormone and is known as 1,25-dihydroxyvitamin D3 [1,25(OH)₂D3] or calcitriol. (Feel free to use that as a conversation starter the next time you’re picking up a hot date.) Both vitamin D2 and D3 have been commercially synthesized and both forms seem to be effective at maintaining blood levels of vitamin D in the body.

The sun

Vitamin D isn’t really a “true” vitamin, as we don’t need food to attain it. Natural sunlight allows our body to create vitamin D and even destroys excessive amounts. How does that happen?

Step #1: We convert cholesterol to 7-dehydrocholesterol, which is a precursor of vitamin D3.

Step #2: When we are exposed to UVB radiation, 7-dehydrocholesterol in the skin is converted to vitamin D3.

Step #3: Vitamin D3 must then be hydroxylated in the liver and the kidneys to become active. At this point, it can exert its endocrine effect.

Vitamin D metabolism

Think you’re soaking up vitamin D through office/car windows? Wrong. Glass blocks virtually all UVB, preventing vitamin D from being made.

And sunscreen is similar. Applying sunscreen with an SPF of 15 will decrease the amount of vitamin D made in the body by about 99%. Hooray for basal cell carcinoma prevention. But bummer for vitamin D production.

Activated vitamin D has a serum half life of 2-3 weeks and its production in the skin is limited to 10,000-20,000 IU each day. Spending 20 minutes riding your bike outside in the summer sun produces 100 times more vitamin D than government agencies say you need. And once serum levels reach 150 nmol/L, any excess is inactivated. Thanks be to Mother Nature.

Vitamin D production via the sun can change throughout the year depending on where you live. If you live north of Atlanta, GA, you will make zero vitamin D from the sunlight between November and March. If you live below Atlanta, GA, you’ll be all right. It is possible to build some reserves of vitamin D, but these reserves won’t last longer than a few weeks.

Get yourself one of these bad boys — a portable Vitamin D meter!

Food

Vitamin D is extremely rare in foods. It’s found in fish, cod liver oil, mushrooms, liver and eggs – but usually not in substantial amounts (except in cod liver oil).

Farmed varieties of fish contain very little vitamin D compared to the wild varieties. The only reason we even get vitamin D from foods like milk and cereal is because these foods are fortified with it — it doesn’t naturally occur.

Breast milk contains low amounts, with about 25 IU per liter.

Thus, getting enough vitamin D from whole foods is virtually impossible; it truly is the sunlight vitamin.

Fortification studies in adults show that consuming 100 – 1000 IU of vitamin D each day results in increased blood concentrations by 15 to 40 nmol/L. Other data with supplements indicate that for every 100 IU of vitamin D we ingest, we raise our blood levels by 2.5 nmol/L.

What should my blood levels be?

Now, while vitamin D is fun to talk about, what really matters is our circulating 25-hydroxyvitamin D [25(OH)D] concentration. It lets us know how much vitamin D has been produced in our body from sun, food and supplements. Its half-life is 15 days. 1,25 (OH)₂D is not a good indicator of vitamin D status, as it has a short half life of only 15 hours and levels in the blood are regulated tightly by hormones and minerals. 1,25 (OH)₂D only starts to decline when a severe deficiency of vitamin D is present.

The most advantageous serum concentrations of 25(OH)D seem to begin at 75 nmol/L, with the optimal levels being between 90 and 100 nmol/L. Most people will be unable to reach these levels with an intake between 200 and 600 IU of vitamin D.

What intake is optimal?

An intake of greater than or equal to about 1000 IU may be needed for most of the population. For postmenopausal women and older men, 25(OH)D concentrations of less than 30 to 80 nmol/L are associated with negative health outcomes.

For infants at northern latitudes, studies suggest that 200 IU vitamin D2 per day may not be enough to prevent vitamin D deficiency. A meta-analysis in adults suggested that an increased intake of vitamin D₃ of 100 IU per day was associated with an increase in circulating concentration of 25(OH)D of 1 to 2 nmol/L. A recent study on women in Maine found that 800 IU of vitamin D per day was enough to reach and maintain adequate blood levels during the winter (for most of the women).

Levels of 25(OH)D producing health benefit

What levels of vitamin D intakes are associated with adverse effects?

Most studies do not report adverse effects with vitamin D supplementation. One study showed an increased risk of kidney stones with supplemental intakes of 400 IU vitamin D3 (along with 1000 mg calcium) each day in women aged 50 to 79 years.

The Merck Manual notes:

Taking very high daily doses of vitamin D—for example, 50 or more times the recommended daily allowance (RDA)—over several months can cause toxicity and a high calcium level in the blood (hypercalcemia).

Early symptoms are loss of appetite, nausea, and vomiting, followed by excessive thirst, weakness, nervousness, and high blood pressure. Because the calcium level is high, calcium may be deposited throughout the body, particularly in the kidneys, blood vessels, lungs, and heart. The kidneys may be permanently damaged and malfunction, resulting in kidney failure.

Some studies suggest that intakes up to 10,000 IU per day have not been associated with adverse effects. If you take more than 10,000 IU per day of vitamin D orally for more than 6 months, you are definitely at risk of becoming vitamin D intoxicated. And remember, we cannot become vitamin D intoxicated from excessive sunlight.

Summary and recommendations

Vitamin D deficiency is a disease of neglect. It’s up to us to get in the sun and/or use a supplement as needed. And the data seem to be pointing towards reaching “optimal” levels, not just “normal” levels.

Blood level classifications for 25(OH)D:

• Vitamin D intoxication: >/= 375 nmol/L
• Preferred range: 75-100 nmol/L
• Insufficient range: 50-75 nmol/L
• Mild deficiency: 25-50 nmol/L
• Moderate deficiency: 12.5-25 nmol/L
• Severe deficiency: <12.5 nmol/L

The total requirement for vitamin D (sun and food) is about 4000 IU/day to keep 25(OH)D levels above and/or around 100 nmol/L. Treating deficiency can require more. To normalize stores, adults require 3000-5000 IU per day for 6 to 12 weeks. As the potential for toxicity is present, work with your physician when beginning a supplementation regimen.

Full recommendations can be found in PN Version 3.0. They are very specific, so read them carefully. We will reprint them below:

Vitamin D (D2 is plant, D3 is animal)
South of LA/Dallas/Atlanta/Cairo

• 15-30 minutes of mid-day sun (15 for those with lighter skin, 30 for darker skin)
• OR 4,000 IU supplemental vitamin D2 daily

Around Portland/Chicago/Boston/Rome/Beijing

• From February – November
• 15-30 minutes of mid-day sun (15 for those with lighter skin, 30 for darker)
• OR 4,000 IU supplemental vitamin D2 daily
• From December – January
• 4,000 IU supplemental vitamin D2 daily

Around Edmonton/London/Berlin/Moscow

• From March – October
• 15-30 minutes of mid-day sun (15 for those with lighter skin, 30 for darker)
• OR 4,000 IU supplemental vitamin D2 daily
• From November – February
• 4,000 IU supplemental vitamin D2 daily

North of Edmonton/London/Berlin/Moscow

• From April – September
• 15-30 minutes of mid-day sun (15 for those with lighter skin, 30 for darker)
• OR 4,000 IU supplemental vitamin D2 daily
• From November – February
• 4,000 IU supplemental vitamin D2 daily

When using vitamin D supplements also consider adiposity, physical activity, baseline vitamin D and calcium status, oral contraceptive use, and race-ethnicity. All of those factors can impact needs.

For extra credit

During the winter, very little UVB reaches us, and thus, less cholesterol is used to synthesize vitamin D in the body. This is one of the reasons blood cholesterol levels may be higher during the winter months.

Serum 25(OH)D is the best indicator of vitamin D status.

Using a multi-vitamin to get vitamin D can be a problem. By the time enough vitamin D is consumed, you will reach toxic levels for other vitamins/minerals.

25(OH)D was isolated in 1970.

Why are vitamin reviews triggered in the IOM-sponsored DRI Committees? Funding. Remember that we need to maintain a separation between funding decisions and the essential autonomy of scientific process.

Some data has indicated a link between Crohn’s disease and vitamin D deficiency.

Vitamin D may help with alleviating psoriasis.

Some research has demonstrated that vitamin D supplementation may be immunosuppressive.

A classic sign of vitamin D deficiency is isolated and generalized muscle and bone pain.

Medications can decrease activity of vitamin D in the body. These include anticonvulsants, bile acid sequestrants, GERD medications, corticosteroids and heparin. There is also some potential negative interactions with calcium channel blockers and diuretics, which can interfere with blood calcium levels.

People with dark skin may require 5-10 times the amount of sun exposure to produce adequate vitamin D, compared to someone with light skin pigmentation.

A recent study suggested that vitamin D can help prevent cancer. The researchers write: “Raising the minimum year-around serum 25(OH)D level to 40 to 60 ng/mL (100–150 nmol/L) would prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year, and three fourths of deaths from these diseases in the United States and Canada… Such intakes also are expected to reduce case-fatality rates of patients who have breast, colorectal, or prostate cancer by half. There are no unreasonable risks from intake of 2000 IU per day of vitamin D3 , or from a population serum 25(OH)D level of 40 to 60 ng/mL.”

Further resources

Vitamin D Lecture

Vitamin D Council

References

Yetley EA, et al. Dietary Reference Intakes for vitamin D: justification for a review of the 1997 values. Am J Cline Nutr 2009;89:719-727.

Bischoff-Ferrari HA, et al. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006;84:18-28.

Moalem S. Survival of the Sickest. 2007. William Morrow Publishers.

Ginde AA, et al. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the third national health and nutrition examination survey. Arch Intern Med 2009;169:384-390.

Aloia JF, et al. Vitamin D intake to attain a desired serum 25-hydroxyvitamin D concentration. Am J Clin Nutr 2008;87:1952-1958.

Stroud ML, et al. Vitamin D: A Review. Aust Fam Phys 2008;37:1002-1005.

Michael Holick Vitamin D Pioneer Interview. Alternative Therapies 2008;14:64-75.

Vieth R, et al. The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 2007;649-650.

Schwalfenberg G. Not enough vitamin D: Health consequences for Canadians. Canadian Family Physician 2007;53:841-854.

Vieth R & Fraser D. Vitamin D insufficiency: no recommended dietary allowance exists for this nutrient. CMAJ 2002;166:1541-1542.

Higdon J. An Evidence Based Approach to Vitamins and Minerals. The Linus Pauling Institute. 2003. Thieme, New York.

Ward KA, et al. Vitamin D status and muscle function in post-menarchal adolescent girls. J Clin Endocrinol Metab 2009;94:559-563.

Heaney RP, et al. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2003;77:204-210.

Dietary Supplement Fact Sheet: Vitamin D. NIH Office of Dietary Supplements. Accessed 3/10/09.

Mora JR, et al. Vitamin effects on the immune system: vitamins A and D take centre stage. Nature Reviews Immunology 2008;8:685-698.

National Academy of Sciences. Beyond Discovery. Unraveling the Enigma of Vitamin D. Accessed 3/11/09.

Penckofer S, et al. Vitamin D and diabetes. Let the sunshine in. The Diabetes Educator 2008;34:939-954.

Nelson ML, et al. Supplements of 20 mcg/d cholecalciferol optimized serum 25-hydroxyvitamin D concentrations in 80% of premenopausal women in winter. J Nutr 2009;139:540-546.

Garland CF, Gorham ED, Mohr SB, Garland FC. Vitamin D for cancer prevention: global perspective. Ann Epidemiol. 2009 Jul;19(7):468-83.

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Creatine structure

Creatine is an amino acid derivative constructed from arginine, glycine and methionine. It is produced naturally by the body in the kidneys, liver, and pancreas at a rate of about 1-2 grams/day. Creatine can also be obtained from food (particularly red meat) and supplementation.

The uptake of creatine into muscle cells is an active process. 90-95% of creatine in the body is found in muscle.

Creatine is degraded into creatinine and excreted in the urine at a rate of around 2 grams/day.

Why is creatine so important?

The energy needs of brief, rapid and powerful movements lasting fewer than 10 seconds, such as a short sprint, are met by the phosphagen system. This system quickly replenishes the stores of adenosine triphosphate, or ATP, which provides energy to the working cells. Muscles have an existing amount of ATP hanging around ready for action, but only a little bit — enough for a few seconds. ATP is broken down by removing a phosphate, which turns it into adenosine diphosphate (two phosphates). To make more ATP, the muscles need to get the missing third phosphate from somewhere, quickly.

This is where creatine phosphate comes in. It takes one for the team by donating its phosphate so that ADP can become ATP again, and so you can finish that sprint.

Because creatine plays a major role in this system, more creatine means more potential ATP, which translates into improved performance on short-duration, high-intensity tasks. Because long-duration, low-intensity activities rely more on a different energy system, they are not typically enhanced by creatine — in other words, creatine will help a sprint but not a marathon.

Consuming creatine supplements can increase skeletal muscle free creatine (which makes up about 1/3) and phosphocreatine (which makes up about 2/3) concentrations. These are the naturally occurring energy pools that replenish ATP.

Uptake of creatine into muscle also has a cell volumizing effect by drawing water into the cell. Over the long term, this swelling may increase protein synthesis and glycogen storage.

What you should know

Creatine is taken as a supplement in the form of creatine monohydrate (mainly), because the phosphorylated creatine (creatine phosphate or phosphocreatine) does not pass through cell membranes.

Other forms of creatine supplements have not been heavily studied and may result in more of a by-product known as creatinine. A recent study found that “when compared to creatine monohydrate, creatine ethyl ester was not as effective at increasing serum and muscle creatine levels or in improving body composition, muscle mass, strength, and power.”

Creatine use can improve performance in high-intensity events (e.g., weight training, sprints, etc). Longer duration aerobic workouts may not benefit from regular creatine use.

When following high-dose creatine loading strategies, body mass can be increased by nearly 2 kg (over 4 lbs) in just 7 days. This is mainly due to increases in total body water. However, these rapid water gains are not necessarily associated with lower dose creatine use.

As previously mentioned, long-term use of creatine can stimulate muscle protein synthesis. Plus, when power and strength levels are enhanced, general muscular adaptation can occur indirectly.

The benefits of creatine supplementation may go beyond athletic performance: creatine may have neuro-protective effects on neurological diseases such as Huntington’s disease, Parkinson’s disease, amyotrophic lateral sclerosis (ALS, aka Lou Gehrig’s disease). More human trials are needed to confirm this.

For extra credit

Creatine appears to be safe to use while exercising in the heat.

Creatine does not appear to increase the risk of cramping or injury.

Combining caffeine with creatine shouldn’t negate its effects. (See Creatine Combinations)

Creatine supplementation may be even more beneficial in those on a plant-based diet, due to the lack of creatine consumption from food.

About 20 percent of creatine users are deemed “non-responders.” This may occur because they already have a high enough dietary intake of creatine from whole foods. Conversely, creatine supplementation may be even more beneficial for those on a plant-based diet, due to the lack of creatine consumption from food.

A standard omnivorous diet contains about 1 gram of creatine per day. Typically, additionally benefits occur with intakes of 3-5 grams per day.

Creatine supplementation may be more effective when combined with carbohydrates during the first few days of supplementation. This suggests that insulin may moderate its effects. However, after the first few days, carbohydrates may not be required.

Based on current data, long-term creatine supplementation does not result in adverse health effects.

Creatine supplementation may increase anterior compartment pressure in the lower leg so athletes may want to be careful with creatine supplementation if they’re prone to shin problems.

Summary and recommendations

If you decide to use a creatine supplement:

• Use the monohydrate form
• Consume 3-5 grams of creatine per day
• Dissolve the creatine in a warm beverage like green tea
• You can also take your creatine before and/or after workout sessions with your workout nutrition
• Take a break from creatine supplementation after using for 12-16 weeks

JB-approved creatine brand suggestion

References

Spillane, Mike, et al. The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels. Journal of the International Society of Sports Nutrition 2009, 6:6doi:10.1186/1550-2783-6-6.

Watson G, et al. Creatine use and exercise heat tolerance in dehydrated men. J Athl Train 2006;41:18-29.

Greenwood M, et al. Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem 2003;244:83-88.

Greenhaff PL, et al. Influence of oral creatine supplementation on muscle torque during repeated bouts of maximal voluntary exercise in man. Clin Sci 1993;84:565-571.

Green AL, et al. Carbohydrate ingestion augments skeletal muscle creation accumulation during creatine supplementation in humans. Am J Physiol 1996;271:E821-E826.

Green AL, et al. Carbohydrate ingestion augments creatine retention during creatine feeding in humans. Acta Physiol Scan 1996;158:195-202.

Schilling BK, et al. Creatine supplementation and health variables: a retrospective study. Med Sci Sports Exerc 2001;33:183-188.

Paddon-Jones D, et al. Potential ergogenic effects of arginine and creatine supplementation. J Nutr 2004;134:2888S-2894S.

Baechle TR & Earle RW. Essentials of Strength Training and Conditioning. National Strength Training Association, 2nd ed. Human Kinetics. Champaign, IL. 2000.

Borer KT. Exercise Endocrinology. Human Kinetics. Champaign, IL. 2003.

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Caffeine structure

What is caffeine?

Caffeine is a methylxanthine. Other common methylxanthines include theobromine and theophylline, which are found in cocoa and teas. Methylxanthines act as adenosine receptor blockers and phosphodiesterase inhibitors.

If you have no idea what we just said, here’s some further explanation.

Adenosine acts as the “brakes” in the central nervous system. So when its effects are blocked (by caffeine), stimulation occurs.

Phosphodiesterase is an enzyme necessary for the breakdown of the 2nd messenger protein cAMP within cells. As its “messenger” moniker implies, cAMP helps transfer signals within cells. If this messenger protein is not being broken down (caffeine prevents this breakdown), it will have a better opportunity to cause its stimulatory effects.

In other words, caffeine prevents the body from slowing things down at a cellular level.

Why is caffeine so important?

Caffeine is the most widely consumed stimulant in the world and occurs naturally among several plants such as coffee bean, kola nut, tea leaf, and cacao seed.

Considered a drug, caffeine is one of the most highly studied ergogenic aids.

Caffeine can decrease fatigue and increase mental alertness as a result of stimulating the brain. However, high doses of caffeine can produce anxiety and tremors.

Caffeine also increases the force and rate of the heart. Along with its derivatives, it can also relax the airways, which allows for increased oxygen consumption.

Wakefulness is probably the most common manifestation of caffeine consumption.

It’s important to note that caffeine consumption can increase the adverse effects of stimulant drugs such as amphetamines, methylphenidate (Ritalin, Concerta), and theophylline, causing nervousness, tremor, and insomnia. It can even counteract the anti-anxiety effects of medications like lorazepam.

Caffeine can increase the mobilization of fatty acids as a fuel during exercise. That’s one of the reasons caffeine consumption is popular among physique athletes.

What you should know

The good

Caffeine can increase performance, especially with endurance events. Athletes can typically last longer and work harder. But even brief bouts of activity can be improved with caffeine use. This may be due to increased alertness and awareness. Indeed, caffeine can be addictive for many athletes because of these performance benefits.

The bad

Caffeine consumption can decrease the effectiveness of serotonin and trigger the release of dopamine (two major neurotransmitters), which can make it even more addictive.

When someone nixes the caffeine from their daily routine, the adenosine accumulation is substantial, and without the blockade from caffeine, adenosine is free to exert its effects. The over-abundance can cause vasodilation (headaches), shakiness and stomach upset, which are all classic symptoms of caffeine withdrawal.

If caffeine is used regularly and at the end of the day, people may have trouble getting to sleep and sleeping well. Because sleep quality and duration affect the hormones that control appetite, hunger and satiety along with anabolism/catabolism, caffeine can ultimately detract from optimal body composition and performance despite its temporary enhancement.

Caffeine has effects on the gastrointestinal tract. It increases the production of stomach acid, with large amounts inducing stomach upset or acid reflux.

The ugly

While caffeine can improve athletic performance, it can also send you rushing to the restroom. It was long believed that caffeine acted as a potent diuretic. However, recent studies have disproved this hypothesis. Caffeine can, however, irritate the bladder and increase urinary urgency. Because of caffeine’s effect on the GI tract, it can also stimulate diarrhea.

It’s possible to build up a tolerance to caffeine. More caffeine may be needed over time to get the same stimulation.

While many studies indicate that caffeine can enhance performance, many studies also suggest it has no effects. It seems that a large individual variation exists.

For extra credit

• More than 400 mg of caffeine per day can result in anxiety and irritability.
• If trying to decrease daily caffeine consumption, do so in increments.
• Urinary caffeine levels above 12 mcg/ml are considered “doping.” This level is easily reached by 8 cups of coffee.
• 300-400 mg of caffeine intake increases urinary calcium excretion.
• Caffeine intake seems to increase the risk of first trimester spontaneous abortions.

Interestingly, new research out of the University of Toronto is starting to explain why caffeine seems to have such opposing effects in different research studies. Researcher Ahmed El-Sohemy and his team found that there are genetic variations in caffeine metabolism, which in the case of his research led to different heart disease outcomes.

Summary and recommendations

• 3-5 mg of caffeine per kilogram of bodyweight can provide a performance effect without health risks. At 3 mg/kg, an 80 kg person would need 240 mg of caffeine.
• If using caffeine to increase performance, try consuming it 30 to 60 minutes before the event/exercise. Blood levels of caffeine are maximized about 60 minutes after consumption, but effects are noticed by 30 minutes.
• Try to use caffeine when you actually “need it.” Repeated caffeine consumption can create a tolerance and lessen the benefit.
• Take caution if you plan on mixing caffeine with other supplements. Using multiple stimulants (e.g., synephrine, ephedra, forskolin, yohimbe, etc.) can put one at risk for sudden arrhythmic death.

More reading

The Caffeine Roundtable: Is It Time to Jettison the Java?

References

Armstrong LE. Caffeine, body fluid-electrolyte balance, and exercise performance. Int J Sport Nutr Exerc Metab 2002;12:189-206.

Armstrong LE, et al. Fluid, electrolyte, and renal indices of hydration during 11 days of controlled caffeine consumption. Int J Sport Nutr Exerc Metab 2005;15:252-265.

Baechle TR & Earle RW. Essentials of Strength Training and Conditioning. National Strength Training Association, 2nd ed. Human Kinetics. Champaign, IL. 2000.

Borer KT. Exercise Endocrinology. Human Kinetics. Champaign, IL. 2003.

Groff JL & Gropper SS. Advanced nutrition and human metabolism. 3rd Wadsworth Thomson Learning. 2000. ed.

Harvey RA, Champe PC eds. Pharmacology 2nd ed. Lippincott Williams & Wilkins. 2000.

Mahan LK & Escott-Stump S. Eds. Krause’s Food, Nutrition, & Diet Therapy. 11th ed. Saunders Publishing, Philadelphia, PA. 2004.

Pawlak L. Stop Gaining Weight. 1st ed. Biomed General. Concord, CA. 2004.

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Beta-alanine, also known as 3-aminopropanoic acid, is a non-essential amino acid.  It’s found naturally in the body, which can synthesize beta-alanine from the breakdown of pyrimidine nucleotides. We can also get beta-alanine from our diets via carnosine, and to a lesser extent from anserine and balenine.

Carnosine is a dipeptide –- a molecule made up of two amino acids bonded together — composed of beta-alanine and histidine. These dipeptides are found in chicken, beef, fish, and pork. (Think of the word “carnivore” to help you remember where to get carnosine.) In humans, carnosine seems to be concentrated in tissues that have a high energy demand, such as muscle and brain.

Source: University of Utah

Beta-alanine structure

Carnosine structure

Why is beta-alanine important?

During exercise (especially at high intensity), the formation of energy (ATP) and rise in hydrogen (H+) ions occurs.  The rise in H+ ions is mainly due to lactic acid production, which lowers the body’s pH (i.e. creating a more acidic state).  As the acidity rises, it’s harder to contract the muscle, and fatigue can result. Thus, if the body can combat the acidity, it can keep working harder.

Lactate concentration increases as exercise intensity increases

The body’s first line of defense against this acidic pH is inside the muscle cell.  Carnosine is able to buffer H+ ions in muscle cells.  This buffering can neutralize lactic acid and simultaneously increase ATP stores.

Carnosine also acts as an anti-glycation agent and antioxidant. Moreover, carnosine appears to help activate the enzymes responsible for muscle contraction.

Because carnosine is so important, beta-alanine is also important. Without enough beta-alanine the body can’t make carnosine effectively, which means that these essential cellular functions are impeded. Since most people usually have enough histidine (the other part of carnosine), and since consuming histidine by itself seems to have little to no impact on cellular carnosine levels, the limiting factor in carnosine synthesis is beta-alanine.

What you should know

Beta-alanine can enter a muscle cell and increase carnosine levels. In this case, beta-alanine is more like a means to an end –- carnosine.

If we increase carnosine levels in cells through beta-alanine supplementation, we can enhance intracellular buffering and reduce acid accumulation during exercise.  Therefore, in people doing exercise that causes significant alterations in cellular pH and high amounts of lactate in the blood, beta-alanine may improve performance and therefore lead to greater training adaptations.  Along with buffering lactic acid, beta-alanine supplementation may help with healing, muscle recovery, and muscle contraction.

Since the idea of beta-alanine supplementation is to elevate muscle carnosine levels, why not just supplement with carnosine?  Well, carnosine isn’t absorbed very well in humans.  When it’s consumed, it will actually be broken down into its respective amino acids (beta-alanine and histidine).  When those amino acids enter a muscle cell, they will join to form carnosine again.  Thus, someone who supplements with carnosine would really just be using it as a beta-alanine source.

Carnosine is found exclusively in animal tissues.  This makes sense as it’s concentrated in muscle and brain tissues.  Hence, a diet with minimal animal foods lacks carnosine (similar to creatine).  Reports have indicated that carnosine levels in those eating a plant-based diet are diminished.  The average daily intake of carnosine from foods is likely in the range of 50 – 250 milligrams.  This is only if a diet contains ~4 ounces of beef, pork, fish or chicken.

One month of beta-alanine supplementation (at 4-6 grams per day) can significantly increase muscle carnosine levels.  Extending the supplementation protocol over 2 ½ months increases muscle carnosine levels even further.  In untrained individuals, beta-alanine supplementation doesn’t seem to be quite as effective at raising muscle levels of carnosine.  This is important, as the extent to which carnosine can delay acidosis is relative to its content inside muscle cells.

A recent study found that resistance training for 10 weeks along with beta-alanine supplementation raised muscle levels of carnosine. Yet beta-alanine had no significant influence on strength, force, endurance or body composition.

For extra credit

Past studies have used chicken breast extract as a source of carnosine.  But it wasn’t very effective at increasing muscle levels of carnosine.

Creatine may promote strength and power during very brief bouts of exercise (6 reps or less), while beta-alanine may promote strength and power during slightly longer bouts (more than 7 reps).

When individuals supplement with more than 800 mg of beta-alanine at a single dose, they may notice parasthesia (e.g. “pins and needles” or tingling sensations).  This is because beta-alanine can bind to and discharge nerve receptors.  Onset can be rapid and last for hours.  Concurrently using carbohydrates with beta-alanine may blunt the parathesia.

Only after muscle levels of carnosine increase will performance changes be noticed.  This can take ~14 days.

Taking beta-alanine along with carbohydrates and during the peri-workout period may allow more of it into the muscle cell.

Carnosine may help those with autism.

Summary and recommendations

In theory, beta-alanine supplementation may help to delay fatigue, increase anaerobic threshold, increase power, increase strength, and increase muscle mass.  Still, the data is far from conclusive, with some studies showing a benefit and others showing no improvements.

Beta-alanine may be of use to highly trained athletes whose limiting factor is buffering excessive H+ production.  If you’re on a tight budget, you may want to hold off on using beta-alanine until more information becomes available.  However, if you like to be a guinea pig and have money to spend, it appears that controlled doses of beta-alanine shouldn’t cause harm.

References

Abe H. Role of histidine-related compounds as intracellular proton buffering constituents in vertebrate muscle. Biochemistry (Mosc) 2000;65:757-765.

Asatoor AM, et al. Intestinal absorption of carnosine and its constituent amino acids in man. Gut 1970;11:250-254.

Bakardjiev A, Bauer K. Transport of beta-alanine and biosynthesis of carnosine by skeletal muscle cells in primary culture. Eur J Biochem 1994;225:617-623.

Derave W, et al.  beta-Alanine supplementation augments muscle carnosine content and attenuates fatigue during repeated isokinetic contraction bouts in trained sprinters.  J Appl Physiol 2007;103:1736-1743.

Harris RC, et al. Muscle buffering capacity and dipeptide content in the thoroughbred horse, greyhound dog and man. Comparative Biochem Physiol A 1990;97:249-251.

Harris RC, et al. The absorption of orally supplied beta-alanine and its effect on muscle carnosine synthesis in human vastus lateralis. Amino Acids 2006;30:279-289.

Hill CA, et al.  Influence of beta-alanine supplementation on skeletal muscle carnosine concentrations and high intensity cycling capacity.  Amino Acids 2007;32:225-233.

Hipkiss AR.  Would carnosine or a carnivorous diet help suppress aging and associated pathologies.  Ann NY Acad Sci 2006;1067:369-374.

Hipkiss AR.  Glycation, ageing and carnosine: are carnivorous diets beneficial?  Mech Ageing Dev 2005;126:1034-1039.

Hoffman J, et al. Effect of creatine and beta-alanine supplementation on performance and endocrine responses in strength/power athletes. Int J Sport Nutr Exerc Metab 2006;16:430-446.

Kendrick IP, et al.  The effects of 10 weeks of resistance training combined with beta-alanine supplementation on whole body strength, force production, muscular endurance and body composition.  Amino Acids 2008;34:547-554.

Stout JR, et al. The effects of creatine and beta-alanine on physical working capacity at neuromuscular fatigue threshold. J Strength and Cond. Res 2006;20:928-931.

Stout JR, et al.  Effects of beta-alanine supplementation on the onset of neuromuscular fatigue and ventilator threshold in women. Amino Acids 2007;32:381-386.

Suzuki Y, et al.  Carnosine and anserine ingestion enhances contribution of nonbicarbonate buffering.  Med Sci Sports Exerc 2006;38:334-338.

Suzuki Y, et al. High level of skeletal muscle carnosine contributes to the latter half of exercise performance during 30-s maximal cycle ergometer sprinting. Jpn J Physiol 2002;52:199-205.

Tallon MJ, et al. The carnosine content of vastus lateralis is elevated in resistance trained bodybuilders. J Strength and Cond Res 2005;19:725-729.

Zoeller RF, et al.  Effects of 28 days of beta-alanine and creatine monohydrate supplementation on aerobic power, ventilator and lactate thresholds, and time to exhaustion.  Amino Acids 2007;33:505-510.

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Amino acids are the building blocks of protein. Branched chain amino acids (BCAAs) are so called because of their structure, which includes a “side chain” of one carbon atom and three hydrogen atoms. There are three BCAAs: leucine, isoleucine, and valine. Of these, leucine is the most heavily researched, and appears to offer the biggest physiological benefit. (More on that below.)

For the science geeks, these hydrophobic (water-fearing) amino acids are referred to as “aliphatic” (from the Greek aleiphar, or oil), as their central carbon attaches to a branched non-cyclic, open carbon chain.

BCAA structure. Source: University of Illinois

BCAAs provide the basis for protein synthesis and energy production (Harper AE et al 1984; Patti ME et al 1998; Xu G et al 1998; Anthony JC et al 2001). In fact, BCAAs can comprise up to one-third of muscle protein (Mero 1999). Because of their prevalence and involvement in protein synthesis and energy production, BCAAs are important to many metabolic processes.

However, if BCAAs are going to participate in these processes, they must be available to the body. This means we have to eat enough BCAAs, and at the right times, to enable such processes to occur.

Why is adequate BCAA intake so important?

The BCAAs are the only amino acids not degraded in the liver. All other amino acids are regulated by the gut and the liver before being circulated elsewhere in the body. However, BCAAs head directly into the bloodstream. This means that dietary intake of BCAAs directly influences plasma levels and concentrations in muscle tissue (Layman DK 2003). Interestingly, BCAAs are burned for energy (oxidized) during exercise, so they’re also an important exercise fuel.

Consuming BCAAs before training can increase uptake into muscle tissue (Mittleman KD et al 1998). This has many benefits:

1. BCAA supplementation may lower lactate levels after resistance training and improve muscular oxidation.
2. BCAAs may increase growth hormone (GH) circulation, which may be related to anabolic mechanisms causing muscle growth (De Palo EF et al 2001).
3. BCAA supplementation may decrease serum concentrations of the intramuscular enzymes creatine kinase and lactate dehydrogenase following prolonged exercise. This can decrease muscle damage and improve recovery (Coombes JS, McNaughton LR 2000).

Muscle is an important site of BCAA activity. There is an increased cell concentration and breakdown of BCAAs in muscle tissue (Layman DK 2003). BCAAs are continuously released from the liver and other internal organs to skeletal muscle so that the BCAAs can assist in maintaining blood sugar levels. Indeed, BCAAs may be responsible for up to 40% of blood sugar production during exercise (Ahlborg G et al 1974; Ruberman NB 1975; see also Layman DK 2003).

Glucose production from amino acids. Image from Medscape.com

What you should know

Because BCAAs are so important to muscle tissue, and because they help maintain blood sugar levels, it’s important to get enough to support your workouts. Consuming a carbohydrate, protein, and amino acid beverage during and after training can induce an insulin response, which helps transport BCAAs into cells. However, availability of leucine is more important than insulin. Within the muscle cell there’s one particular regulatory pathway for protein synthesis that’s stimulated by insulin, but dependent on leucine (Anthony et al 2000). In other words, protein synthesis (and hence muscle rebuilding) depends on how much leucine is available. And since BCAA levels decline with exercise, it makes sense to supplement with them during and/or after workouts (Mero 1999).

Because it’s so important to have leucine available for protein synthesis, if you train in a fasted state, or don’t eat after exercise, you’re going to lose more protein than you rebuild. However, if you eat adequate BCAAs during this time, especially leucine, you’ll enhance protein synthesis.

For extra credit

For the body to make new proteins, it needs an estimated daily leucine intake of between 1 to 4 grams/day (FAO/WHO/UNU 1985). That minimum intake needs to be met before leucine will be able to impact the insulin signaling pathway. But that’s just a baseline. Actual metabolic use, especially by athletes and people doing heavy resistance training, may be upwards of 12 grams/day.

There is a theory that BCAAs can limit central fatigue with endurance athletes, but it doesn’t appear to be supported by current data.

BCAA content of foods (grams of amino acids/100 g of protein)

Whey protein isolate 26%
Milk protein 21%
Muscle protein 18%
Soy protein isolate 18%
Wheat protein 15%

Source: USDA Food Composition Tables

Summary and recommendations

BCAAs play an important role in:

• Synthesis of proteins in general
• Glucose homeostasis (i.e. keeping blood sugar levels constant)
• Direct regulation of muscle protein synthesis (via insulin signaling cascade)

BCAAs’ potential impact on the aforementioned processes depends upon availability and dietary intake.

Adequate consumption of BCAAs may help manage body fat, spare muscle mass, and regulate glucose/insulin balance.

How can you put this knowledge to use?

Try adding BCAAs into your workout drink at a rate of 5 g BCAA per hour of training.

During periods of lower calorie intake, try adding a BCAA supplement every 2-4 hours during the day.

More reading:

Solving the Post-Workout Puzzle

Recovery Update

Advanced Workout Nutrition: Why Are You Still Drinking Gatorade?

References

Anthony JC, et al. Signaling pathways involved in translational control of protein synthesis in skeletal muscle by leucine. J Nutr 2001;131:856S-860S.

Anthony JC, et al. Orally administered leucine stimulates protein synthesis in skeletal muscle of postabsorptive rats in association with increased eIF4F formation. J Nutr 2000;130:139-145.

Ahlborg G, et al. Substrate turnover during prolonged exercise in man. J Clin Invest 1974;53:1080-1090.

Coombes JS, McNaughton LR. Effects of branched-chain amino acid supplementation on serum creatine kinase and lactate dehydrogenase after prolonged exercise. J Sports Med Phys Fitness 2000;40:240-246.

De Palo EF, et al. Plasma lactate, GH and GH-binding protein levels in exercise following BCAA supplementation in athletes. Amino Acids 2001;20:1-11.

FAO/WHO/UNU. Energy and protein requirements. Report of joint FAO/WHO/UNU expert consultation. WHO Tech Pep Ser 1985;724:1-206.

Garlick PJ. The role of leucine in the regulation of protein metabolism. J Nutr. 2005 Jun;135(6 Suppl):1553S-6S. Review.

Harper AE, et al. Branched-chain amino acid metabolism. Annu Rev Nutr 1984;4:409-454.

Layman DK. The role of leucine in weight loss diets and glucose homeostasis. J Nutr 2003;133:261S-267S.

Mero A. Leucine supplementation and intensive training. Sports Med 1999;27:347-358.

Mittleman KD, et al. Branched chain amino acids prolong exercise during heat stress in men and women. Med Sci Sports Exerc 1998;30:83-91.

Patti ME, et al. Bidirectional modulation of insulin action by amino acids. J Clin Invest 1998;101:1519-1529.

Ruberman NB. Muscle amino acid metabolism and gluconeogenesis. Ann Rev Med 1975;26:245-258.

Xu G, et al. Branched-chain amino acids are essential in the regulation of PHAS-I and p70 S6 kinase by pancreatic beta cells. J Biol Chem 1998;273:28178-28184.

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With the lack of variety in countless nutrition plans and the health of food dependent upon the ever-diminishing nutrients in soil, it’s no wonder that we’d be concerned with nutrient deficiencies. Add regular bouts of exercise, stress and medications to the mix, and all of the sudden we have a recipe for major nutrient scarcity.

How do you know if you’re deficient in nutrients? Nutrient deficiencies can have a variety of effects throughout the body. Often the signs are subtle -– perhaps you feel a bit “off” or your skin doesn’t look quite as glowing as it could. Occasionally the signs are more obvious. (For instance, it’s kind of hard to ignore your feet tingling, or uncontrolled muscle spasms.)

Now don’t worry –- we’re not trying to scare you into buying stock with GNC and loading up on vitamin pills, or trying to turn you into a nutrient hypochondriac. We simply want to highlight some of the physical manifestations of nutrient deficiencies.

As you read through the following, you may fit the criteria for some of the deficiency symptoms. Instead of self-diagnosing and slamming a bottle of “vitamin [fill in the blank],” your concern should simply warrant further investigation into eating patterns and habits. If you notice any of the symptoms/signs fit you, then jot down some notes and initiate a dialogue with your dietitian, naturopath, chiropractor or physician (whoever you work with and trust).

Try to find a “food form” of your desired nutrient before you stock up on supplement bottles. Research suggests that nutrients tend to work better together, and are found in more complex forms in nature. For example, there are over six hundred known carotenoids, which give plants their red or orange colours. We don’t know what all of them do yet, but we’re pretty sure that many are important. Just taking a beta-carotene supplement on its own probably isn’t the same –- in fact, as a few high-profile studies have shown, it may be actively harmful.

Also, as we indicate below, taking extra doses of certain vitamins doesn’t necessarily make things better. Nutrients work in complicated ways in the body, and they’re often related to one another (for example, as the amount of X increases, the body may make or absorb less of Y).

Here’s a handy guide to common deficiencies. Part 1 is organized by the body part affected, and alphabetized by part for easier navigation. Part 2 is organized by health conditions and people at risk for deficiencies.

Deficiencies by body part

Part 2: Who’s at risk?

Medication use

Aminosalicylic acid – Vitamin B12 deficiency
Amitryptyline – riboflavin deficiency
Anticoagulant therapy – vitamin K deficiency
Anticonvulsants – vitamin D deficiency, folic acid deficiency, vitamin B12 deficiency
Anti-thyroid therapy (methimazole, propylthiouracil) – iodine deficiency
Barbiturates – vitamin C deficiency
Carbamazepine – biotin deficiency
Cholestyramine – vitamin D deficiency
Colchicines – vitamin B12 deficiency
Colestipol – vitamin D deficiency
Corticosteroids – vitamin D deficiency
Cycloserine – pyridoxine deficiency, folic acid deficiency
Diethylenetriamine – zinc deficiency
Diuretics – zinc deficiency
D-penicillamine – zinc deficiency
EPO use – iron deficiency
Estrogen/oral contraceptives – vitamin C deficiency, folic acid deficiency
Ethionamide – pyridoxine deficiency
Hydralazine – pyridoxine deficiency
Imipramine – riboflavin deficiency
Iron megadoses – copper deficiency
Isoniazid – vitamin D deficiency, niacin deficiency, pyridoxine deficiency
Metformin – vitamin B12 deficiency
Methotrexate – folic acid deficiency
Neomycin – vitamin B12 deficiency
Nitrous oxide – vitamin B12 deficiency
Non-steroidal anti-inflammatory drugs (NSAIDS) – iron deficiency
Omeprazole – vitamin B12 deficiency
Penicillamine – pyridoxine deficiency
Pentamidine – folic acid deficiency
Phenothiazines – riboflavin deficiency
Phenytoin – biotin deficiency
Primidone – biotin deficiency
Probenecid – riboflavin deficiency
Pyrazinamide – pyridoxine deficiency
Pyrimethamine – folic acid deficiency
Salicylates – vitamin C deficiency, iron deficiency
Sulfasalazine – folic acid deficiency
Tetracycline – vitamin C deficiency
Triamterene – folic acid deficiency
Tricyclic antidepressants – riboflavin deficiency
Trimethoprim – folic acid deficiency
Valproate – zinc deficiency
Vitamin A megadoses – vitamin K deficiency
Vitamin E megadoses – vitamin K deficiency
Zinc megadoses – copper deficiency

There you have it. You’re now armed with more information than you ever wanted about nutrient deficiencies.

Again, if you are concerned about something, take notes and make an appointment with your health care provider. Also, the nutrition professionals of PN are always available on the forums to answer general questions.

Sources

Charney P, Malone A. ADA Pocket Guide To Nutrition Assessment. American Dietetic Association. 2004.

Escott-Stump S. Nutrition and Diagnosis-Related Care. 5th Ed. Lippincott Williams & Wilkins. 2002.

Lutz C, Przytulski K. Nutri Notes. F.A. Davis Company. 2004.

Mahan LK, Escott-Stump S. Krause’s Food, Nutrition & Diet Therapy. 11th Ed. Saunders. 2004.

Click here to join the waiting list.