10 - Dec - 2013

Alan Aragons Research Review December 2013 [Back to Contents] Page 1

Copyright December 1st, 2013 by Alan Aragon

Home: www.alanaragon.com/researchreview

Correspondence: [email protected]

2 A critique of the recent multivitamin rant in the

Annals of Internal Medicine. By Alan Aragon

5 The effects of a combined resistance training and endurance exercise program in inactive college females: does order matter? [Reviewed by Brad Schoenfeld, PhD, CSCS, CSPS, FNSCA]

Davitt PM, Pellegrino J, Schanzer J, Tjionas H, Arent SM. J

Strength Cond Res. 2013 Dec 27. [Epub ahead of print]

[PubMed]

7 No evidence of dehydration with moderate daily coffee intake: a counterbalanced cross-over study in a free-living population. Killer SC, Blannin AK, Jeukendrup AE. PLoS ONE 9(1):

e84154. doi:10.1371/journal.pone.0084154 [PLOS ONE]

8 Supplemental vitamin D enhances the recovery in

peak isometric force shortly after intense exercise. Barker T, Schneider ED, Dixon BM, Henriksen VT, Weaver

LK. Nutr Metab (Lond). 2013 Dec 6;10(1):69. [Epub ahead

of print] [PubMed]

9 Glycogen resynthesis in skeletal muscle following

resistive exercise. Pascoe DD, Costill DL, Fink WJ, Robergs RA, Zachwieja

JJ. Med Sci Sports Exerc. 1993 Mar;25(3):349-54.

[PubMed]

11 The Dirty Dozen: 12 common diet guru fallacies.

By Mike Howard

15 Interview with Bret Contreras.

By Alan Aragon


A critique of the recent multivitamin rant in the Annals of Internal Medicine.

By Alan Aragon

____________________________________________________

What provoked the rant?

To understate things, the Annals of Internal Medicine is a big

journal. Its been around since 1927, and is one of the most widely cited journals of its kind. So, when their editors speak up

about something, the word spreads far and wide. In this case,

Guallar et al leveled a volley of righteous indignation against

vitamin and mineral supplementation.1 The title of the article is

one of the most provocative Ive seen in the peer-reviewed literature: Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. That is a serious call to arms; its tone is very certain and absolute. It doesnt fit the tentative, open-ended nature of scientific research; its more like a permanent stamp of blood in wool. The question is, how strong

is the scientific support of this adamance?

The 3 papers presented as proof of uselessness

Guallar et als rant is based upon three recent papersall published in the Annals of Internal Medicine. First up, a

systematic review by Fortmann et al examined the benefit and

harm of vitamin & mineral supplements in community-dwelling,

nutrient-sufficient adults for the prevention of cardiovascular

disease (CVD) and cancer.2 Guallar et al reported that these

authors found no clear evidence of a beneficial effect of

supplements on all-cause mortality, cardiovascular disease, or

cancer. However, they omitted an important detail: two large

trials totalling 27,658 subjects found lower cancer incidence in

men taking a multivitamin for more than 10 years.3,4

Notably,

this was seen despite Fortmann et als analysis only including adults with no known nutritional deficiencies.

Next up, Guallar et al cite a randomized controlled trial (RCT)

by Grodstein et al, who found that long-term use of a daily

multivitamin did not provide cognitive benefits in male

physicians aged 65 years or older.5 However, Guallar et al omit

Grodstein et als acknowledgment that the subjects of their study may have been too well-nourished to see any benefit from

multivitamin supplementation. To quote their concession of this

studys limitation:5 When cognitive benefits have been observed in other trials of nutriceuticals, these benefits are

usually in groups with inadequate dietary intakes of the relevant

vitamin. In contrast to Grodstein et als findings, Grima et als recent meta-analysis of RCTs found that multivitamin

consumption enhanced immediate free recall memory.6

The third highlighted study was by Lamas et al, who reported

that high-dose multivitamins and multiminerals did not

significantly reduce cardiovascular events in patients on standard

medications after myocardial infarction (MI).7 First of all, this

finding is hardly a strong basis for proclaiming the universal

uselessness of multivitamin supplementation, since obviously

not everyone has suffered an MI and is on meds to manage it.

Secondly, Guallar et al once again skip mention of this studys main limitation, which according to the authors was

considerable nonadherence and withdrawal which may well have confounded the results. Specifically, 46% of the subjects

discontinued the vitamin regimen, and 17% of the subjects

dropped out of the study completely. Overall, these studies paint

a mixed picture of multivitamin supplementation, but its best described as having neutral-to-minor benefit.

Adverse potential?

Guallar et al cited 3 papers to support their concern of not just a

lack of effects, but adverse effects of vitamin and mineral

supplementation. First up, a systematic review by Huang et al

found an overall lack of evidence to prove the presence or

absence of benefits of multivitamin supplementation for

preventing chronic disease and cancer.8 As for adverse effects,

they explicitly concluded that prolonged consumption of

multivitamins appears to be safe. Furthermore, they conceded

the following point of importance: Evidence accumulated to date suggests potential benefits of multivitamin and mineral

supplements in the primary prevention of cancer in persons with

poor nutritional status or suboptimal antioxidant intake.

Next up, Guallar et al cite a systematic review by Bjelakovic et

al, which found that overall, antioxidant supplements were

associated with neither higher nor lower all-cause mortality.9

However, beta-carotene, vitamin E, and higher doses of vitamin

A were associated with higher mortality. I tend to agree with the

authors conclusion that, The optimal source of antioxidants seems to come from our diet, not from antioxidant supplements

in pills or tablets. Notably, they acknowledged that the trials were conducted mostly in countries without known antioxidant

deficiencies, so supplementation in the face of sufficiency may

have simply been redundant.

The final study Guallar et al cited to support adverse potential

was a meta-analysis by Miller et al, who found a dose-

responsive increase in all-cause mortality with vitamin E

supplementation greater than 150 UI/day.10

They concluded that

high-dose vitamin E (at or more than 400 IU/day) appears to

increase all-cause mortality. However, they also acknowledged

that the trials indicating this lacked statistical power due to small

subject numbers. Furthermore, these subjects had chronic

diseases, thus compromising relevance to healthy populations.

It should be noted that the aforementioned studies examined the

supplementation of isolated nutrients, not a multi. A recent

systematic review by Alexander et al found that multivitamin-

multimineral (MVM) supplementation in healthy adults does not

increase all-cause mortality or cancer incidence, and may

provide a slight protective benefit.11

Furthermore, they stated

that, It is also important to note that RCTs in nutritionally deficient populations have observed benefits of MVM

supplementation. Collectively, these studies do not build a strong case to support Guallar et als absolutism against vitamin & mineral supplementation, but they do raise questions about

non-deficient folks supplementing with high doses of isolated

antioxidant vitamins. Now let's take a look at populations that

Guallar et als editorial completely overlooked.


Dieters should not be ignored

While a fair body of data casts doubt upon the benefits of

vitamin & mineral supplementation in non-deficient populations,

it would be a mistake to automatically assume that this is the

case with all populations. Calton recently analyzed the

micronutrient sufficiency of four popular diet programs by

comparing their content of 27 essential micronutrients with

whats officially recommended by Reference Daily Intake (RDI) standards. The findings were interesting and concerning:

12

The Best Life Diet (Mediterranean-type) was 55.56% sufficient, providing 100% of the RDI for 15 out of 27

essential micronutrients, and contained 1,793 calories.

The DASH diet (low-fat) was 51.85% sufficient, providing 100% of the RDI for 14 out of 27 essential micronutrients

and contained 2,217 calories.

Atkins for Life diet (low-carbohydrate) was 44.44% sufficient, providing 100% RDI sufficiency for 12 out of

27 essential micronutrients, and contained 1,786 calories.

The South Beach Diet (low-carbohydrate, minimizes saturated fat) was 22.22% sufficient, providing 100% RDI

sufficiency for 6 out of 27 essential micronutrients and

contained 1,197 calories.

All four diet plans failed to deliver 100% sufficiency for the selected 27 essential micronutrients, based on RDI

guidelines, when followed as recommended by their

suggested daily menus using whole food alone.

Six micronutrients (vitamin B7 (biotin), vitamin D, vitamin E, chromium, iodine, and molybdenum) were identified as

consistently low or nonexistent in all four diet plans.

A typical dieter on any of these four popular diet plans would be, on average, 56.48% deficient in obtaining RDI

sufficiency, and lacking in 15 out of the 27 essential

micronutrients analyzed.

Whats notable is that with the exception of the South Beach Diet checking in at just under 1200 kcal, the other diets were not

aggressively low in total energy. Yet, essential micronutrient

shortfalls were substantial. Calton makes the important point that

only Atkins and Best Life diets required followers to take a daily

multivitamin. He concludes the study by recommending that all

dieters take a multivitamin due to the high likelihood of

incurring micronutrient deficiencies. Based on his analysis of a

wide range of diet types that for the most part were not

starvation plans, I would have to agree.

In addition to the aforementioned dieters, vegetarians (especially

vegans) fall into the food-restriction camp, and thus are

candidates for supplementation. The key micronutrients of

concern in fully plant-based diets are iron, zinc, vitamin B12,

vitamin D, calcium, and possibly selenium.13-16

Vegetarians are a

similar case to dieters in that the consumption of a moderately

dosed, full-spectrum multivitamin/mineral supplement could

provide protective benefits with minimal risk.

Athletes should not be ignored

Athletic populations have a tendency to create their own unique

set of problems. Bodybuilders are a good example of this since

they are known for their food particularities, both in terms of

food exclusion and food abundance. Kleiner et al examined the

pre-contest dietary habits of male & female junior national &

national-level competitors.17

Despite consuming adequate total

calories, women were described as remarkably deficient in calcium intake. This isnt surprising since dairy is often on the banned list of pre-contest foods. Subsequent work by Kleiner et

al on nationally ranked elite bodybuilders found that men

consumed 46% of the RDA for vitamin D, while women

consumed 0% (yes, zero percent) of the RDA for vitamin D, and

only 52% of the RDA for calcium, in addition falling short of the

recommended intakes of zinc, copper, and chromium.18

Serum

magnesium levels in females were low despite dietary

magnesium intakes above the RDA.

In a similar vein, Misner investigated the adequacy of food alone

for providing 100% of the RDA or newer RDI of the daily

micronutrient requirements in the diets of 14 endurance athletes

(both professional and amateur) and 6 sedentary subjects.19

Males had deficiencies in 40% of the vitamins and 54.2% of the

minerals. Females had deficiencies in 29% of the vitamins and

44.2% of the minerals. Food alone in all 20 subjects failed to

meet the minimal RDA-based micronutrient requirements for

preventing deficiency diseases. These data clearly do not support

the vitamin and mineral supplements are useless mantraespecially in conditions where high energy expenditure is

combined with a poor or incomplete selection of foods.

Potential bias should not be ignored

A common thread among vitamin/mineral supplementation

analyses showing a lack of efficacy is that theyre consistently published in high-profile medical journals. The same thing

happens with non-pharmaceutical therapies such as fish oil

supplementation.20

A contrasting example is recent work by

Earnest et al who found that the co-ingestion of a multivitamin

and omega-3 supplement synergistically lowered homocysteine,

C-reactive protein, and triglyceride levels in subjects with high

baseline homocysteine levels.21

Is this a case of political foul play? Theres no way to know, but one cant help but wonder. While the dietary supplement industry is huge, the drug industry generates roughly a hundred

times more revenueand this is a conservative estimate. The drug industry has the financial power to bully the little guys, and

it cant be assumed that this never happens. Of course, the other side of the coin is that the supplement industry can play the same

game of selectively publishing positive-result studies. However,

this would be mostly confined to comparatively obscure

journals; it rarely happens in the medical journals at the upper

tier of prestige and exposure.

Conclusions

It cant be over-emphasized that a poor diet with a multi is still a poor diet. There are a multitude of biologically active and

beneficial compounds within the matrix of foods that are not

inand may never make their way intoa multivitamin/mineral supplement. Its important to think of micronutrition not just in terms of essential vitamins & minerals, but also in terms of

phytonutrients & zoonutrients; compounds that are not classified

as vitamins or minerals but can optimize health and prevent


disease. This is why attaining a variety of foods both within and

across the food groups is important for covering all the

micronutrient bases. However, as the evidence indicates, this is much easier said than done. Guallar et als editorial indeed contains valid points of contention with vitamin and mineral

supplementation. Nevertheless, its one-sided and highly omissive rather than objectively reflective of the full range of

evidence. Ill end off with a partial list of populations at-risk for micronutrient deficiencies, who stand a good chance of

benefiting from supplementation:22

Women of childbearing age (folate, vitamin D, iron)

Pregnant and lactating women (vitamin B6, folate, vitamin

D, iron)

People on any of the popular weight loss diets (multiple

micronutrients)

Obese individuals (multiple micronutrients)

Infants, children, and adolescents (vitamin D)

People with dark-colored skin (vitamin D)

Those who cover all exposed skin or using sunscreen

whenever outside (vitamin D)

Older adults (vitamin B12, vitamin D, zinc)

Low socioeconomic status (multiple micronutrients)

Patients who have had bariatric surgery (multiple

micronutrients)

Patients with fat malabsorption syndromes (fat-soluble

vitamins A, D, E, and K)

Alcoholics (vitamin A, B vitamins)

Smokers (vitamins C and E)

Vegans and those with limited intake of animal products

(iron, zinc, vitamin B12, vitamin D, calcium)

People taking medications that interfere with the

absorption and/or metabolism of certain micronutrients

(e.g., proton pump inhibitors used to treat heartburn may

impair vitamin B12 absorption; frequent aspirin use can

lower vitamin C status).

People whose diets are not adherent to the USDA

nutritional guidelinesthe vast majority of Americans

(multiple micronutrients)

References

1. Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER. Enough is enough: stop wasting money on vitamin and mineral supplements. Ann Intern Med. 2013;159(12):850-851-851.[AIM]

2. Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013 Nov 12. doi: 10.7326/0003-4819-159-12-201312170-00729. [Epub ahead of print] [PubMed]

3. Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, Roussel AM, Favier A, Brianon S. The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med. 2004 Nov 22;164(21):2335-42. [PubMed]

4. Gaziano JM, Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M, Manson JE, Glynn RJ, Buring JE. Multivitamins in the prevention of cancer in men: the Physicians'

Health Study II randomized controlled trial. JAMA. 2012 Nov 14;308(18):1871-80. [PubMed]

5. Grodstein F, OBrien J, Kang JH, Dushkes R, Cook NR, Okereke O, Manson JE, Glynn RJ, Buring JE, Gaziano MJ, Sesso HD. Long-term multivitamin supplementation and cognitive function in men: a randomized trial. Ann Intern Med. 2013;159(12):806-814-814. [AIM]

6. Grima NA, Pase MP, Macpherson H, Pipingas A. The effects of multivitamins on cognitive performance: a systematic review and meta-analysis. J Alzheimers Dis. 2012;29(3):561-9. [PubMed]

7. Lamas GA, Boineau R, Goertz C, Mark DB, Rosenberg Y, Stylianou M, Rozema T, Nahin RL, Lindblad L, Lewis EF, Drisko J, Lee KL. Oral high-dose multivitamins and minerals after myocardial infarction: a randomized trial. Ann Intern Med. 2013;159(12):797-805-805. [AIM]

8. Huang HY, Caballero B, Chang S, Alberg AJ, Semba RD, Schneyer CR, Wilson RF, Cheng TY, Vassy J, Prokopowicz G, Barnes GJ 2nd, Bass EB. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Ann Intern Med. 2006 Sep 5;145(5):372-85. [PubMed]

9. Bjelakovic G, Nikolova D, Gluud C. Antioxidant supplements to prevent mortality. JAMA. 2013 Sep 18;310(11):1178-9. [PubMed]

10. Miller ER 3rd, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005 Jan 4;142(1):37-46. [PubMed]

11. Alexander DD, Weed DL, Chang ET, Miller PE, Mohamed MA, Elkayam L. A systematic review of multivitamin-multimineral use and cardiovascular disease and cancer incidence and total mortality. J Am Coll Nutr. 2013;32(5):339-54. [PubMed]

12. Calton JB. Prevalence of micronutrient deficiency in popular diet plans. J Int Soc Sports Nutr. 2010 Jun 10;7:24. [PubMed]

13. Craig WJ. Health effects of vegan diets. Am J Clin Nutr. 2009 May;89(5):1627S-1633S. [PubMed]

14. Calvo MS, Whiting SJ, Barton CN. Vitamin D intake: a global perspective of current status. J Nutr. 2005 Feb;135(2):310-6. [PubMed]

15. Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr. 2003 Sep;78(3 Suppl):633S-639S. [PubMed]

16. Strhle A, Waldmann A, Koschizke J, Leitzmann C, Hahn A. Diet-dependent net endogenous acid load of vegan diets in relation to food groups and bone health-related nutrients: results from the German Vegan Study. Ann Nutr Metab. 2011;59(2-4):117-26. [PubMed]

17. Kleiner SM, Bazzarre TL, Litchford MD. Metabolic profiles, diet, and health practices of championship male and female bodybuilders. J Am Diet Assoc. 1990 Jul;90(7):962-7. [PubMed]

18. Kleiner SM, Bazzarre TL, Ainsworth BE. Nutritional status of nationally ranked elite bodybuilders. Int J Sport Nutr. 1994 Mar;4(1):54-69. [PubMed]

19. Misner B. Food alone may not provide sufficient micronutrients for preventing deficiency. J Int Soc Sports Nutr. 2006 Jun 5;3:51-5. [PubMed]

20. Kwak SM, Myung SK, Lee YJ, Seo HG; Korean Meta-analysis Study Group. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials.Arch Intern Med. 2012 May 14;172(9):686-94. [PubMed]

21. Earnest CP, Kupper JS, Thompson AM, Guo W, Church T. Complementary effects of multivitamin and omega-3 fatty acid supplementation on indices of cardiovascular health in individuals with elevated homocysteine. Int J Vitam Nutr Res. 2012 Feb;82(1):41-52. [PubMed]

22. Linus Pauling Institute, Oregon State University. Micronutrient Information Center: Multivitamin/mineral Supplements. August, 2011. [LPI-OSU]


The effects of a combined resistance training and endurance exercise program in inactive college females: does order matter? [Reviewed by Brad Schoenfeld, PhD, CSCS, CSPS, FNSCA]

Davitt PM, Pellegrino J, Schanzer J, Tjionas H, Arent SM. J

Strength Cond Res. 2013 Dec 27. [Epub ahead of print]

[PubMed]

______________________________________________________

BACKGROUND: While both endurance (E) and resistance (R)

exercise improve various health and fitness variables, there is

still debate regarding the optimal ordering of these modes of

exercise within a concurrent bout. PURPOSE: The purpose of

this study was to determine the effects of performing E before R

(E-R) or R before E (R-E) on strength, VO2max, and body

composition over the course of an 8-wk exercise program.

DESIGN: Inactive college females (N = 23, 19.8 0.22 yrs;

61.0 2.5 kg) were randomly assigned to either an E-R (n = 13)

or an R-E group (n= 10). Subjects trained 4 d/wk over the 8-wk

study. The E portion consisted of 30 min of aerobic exercise at

70-80% HRR. The R portion utilized a 3-way split routine with

subjects performing 3 sets of 8-12 repetitions for 5-6 different

exercises using a load equal to 90-100% 10RM. There were 2

days of testing before and after 8 wk of training to determine

performance and body composition. RESULTS: There were

significant improvements in chest press (P


the BodPod can only assess global changes in fat mass and lean

mass throughout the body. There were no direct measures of

hypertrophy obtained. It would have been beneficial to use a

direct measurement tool (i.e. MRI, ultrasound, etc) to evaluate

specific muscle changes in the limbs.

Another potential issue is the lack of dietary control in the study.

Subjects were instructed to eat their usual diet with no attempt to

provide nutritional advice by the researchers. You can bet that

the untrained college students who participated in the study were

not eating optimally for muscle gain. At the very least, the

researchers should have taken dietary records pre-study and at

the end of the study to assess whether there were significant

differences in dietary intake (both in terms of total calories and

macronutrients consumed). The lack of control here raises

questions as to whether any there were any confounding issues

from this variable.

Finally, it is important to point out that this study did not explore

whether the inclusion of aerobic exercise to a resistance training

program has a negative effect on muscular adaptations. There is

quite a bit of evidence that concurrent training impairs muscular

adaptations. There is nothing gleaned from this study to

counteract such evidence. It would have been interesting if the

researchers included a resistance training-only group to compare

outcomes versus the combined groups.

____________________________________________________

Brad Schoenfeld, PhD, CSCS, CSPS, FNSCA, is a

lecturer in the exercise science department for

Lehman College and is the head of their

human performance laboratory. His primary

research interests focus on elucidating the

mechanisms of muscle hypertrophy and their

application to resistance training. He has

published over 40 peer-reviewed journal

articles and currently serves on the Board of

Directors for the NSCA. He is author of the

book, "The M.A.X. Muscle Plan" which is

available at all major bookstores and on

Amazon.com. He maintains an active blog on his website:

http://www.lookgreatnaked.com/


No evidence of dehydration with moderate daily coffee intake: a counterbalanced cross-over study in a free-living population.

Killer SC, Blannin AK, Jeukendrup AE. PLoS ONE 9(1):

e84154. doi:10.1371/journal.pone.0084154 [PLOS ONE]

BACKGROUND: It is often suggested that coffee causes

dehydration and its consumption should be avoided or

significantly reduced to maintain fluid balance. OBJECTIVE: The aim of this study was to directly compare the effects of

coffee consumption against water ingestion across a range of

validated hydration assessment techniques. DESIGN: In a

counterbalanced cross-over design, 50 male coffee drinkers

(habitually consuming 36 cups per day) participated in two trials, each lasting three consecutive days. In addition to

controlled physical activity, food and fluid intake, participants

consumed either 4200 mL of coffee containing 4 mg/kg

caffeine (C) or water (W). Total body water (TBW) was

calculated pre- and post-trial via ingestion of Deuterium Oxide.

Urinary and haematological hydration markers were recorded

daily in addition to nude body mass measurement (BM). Plasma

was analysed for caffeine to confirm compliance. RESULTS:

There were no significant changes in TBW from beginning to

end of either trial and no differences between trials (51.51.4

vs. 51.41.3 kg, for C and W, respectively). No differences

were observed between trials across any haematological

markers or in 24 h urine volume (2409660 vs. 2428669 mL,

for C and W, respectively), USG, osmolality or creatinine.

Mean urinary Na+excretion was higher in C than W (p = 0.02).

No significant differences in BM were found between

conditions, although a small progressive daily fall was observed

within both trials (0.40.5 kg; p


Supplemental vitamin D enhances the recovery in peak isometric force shortly after intense exercise.

Barker T, Schneider ED, Dixon BM, Henriksen VT, Weaver

LK. Nutr Metab (Lond). 2013 Dec 6;10(1):69. [Epub ahead of

print] [PubMed]

BACKGROUND: Serum 25-hydroxyvitamin D (25(OH)D)

concentrations associate with skeletal muscle weakness (i.e., deficit in

skeletal muscle strength) after muscular injury or damage. Although

supplemental vitamin D increases serum 25(OH)D concentrations, it is

unknown if supplemental vitamin D enhances strength recovery after a

damaging event. METHODS: Reportedly healthy and modestly active

(30 minute of continuous physical activity at least 3 time/week) adult

males were randomly assigned to a placebo (n = 13, age, 31(5) y; BMI,

26.9(4.2) kg/m2; serum 25(OH)D, 31.0(8.2) ng/mL) or vitamin D

(cholecalciferol, 4000 IU; n = 15; age, 30(6) y; BMI, 27.6(6.0) kg/m2;

serum 25(OH)D, 30.5(9.4) ng/mL) supplement. Supplements were

taken daily for 35-d. After 28-d of supplementation, one randomly

selected leg performed an exercise protocol (10 sets of 10 repetitive

eccentric-concentric jumps on a custom horizontal plyo-press at 75% of

body mass with a 20 second rest between sets) intended to induce

muscle damage. During the exercise protocol, subjects were allowed to

perform presses if they were unable to complete two successive jumps.

Circulating chemistries (25(OH)D and alanine (ALT) and aspartate

(AST) aminotransferases), single-leg peak isometric force, and muscle

soreness were measured before supplementation. Circulating

chemistries, single-leg peak isometric force, and muscle soreness were

also measured before (immediately) and after (immediately, 1-h [blood

draw only], 24-h, 48-h, 72-h, and 168-h) the damaging event.

RESULTS: Supplemental vitamin D increased serum 25(OH)D

concentrations (P < 0.05; [almost equal to] 70%) and enhanced the

recovery in peak isometric force after the damaging event (P < 0.05;

[almost equal to] 8% at 24-h). Supplemental vitamin D attenuated (P <

0.05) the immediate and delayed (48-h, 72-h, or 168-h) increase in

circulating biomarkers representative of muscle damage (ALT or AST)

without ameliorating muscle soreness (P > 0.05). CONCLUSIONS:

We conclude that supplemental vitamin D may serve as an attractive

complementary approach to enhance the recovery of skeletal muscle

strength following intense exercise in reportedly active adults with a

sufficient vitamin D status prior to supplementation. SPONSORSHIP:

This work was funded in part by the Intermountain Research and

Medical Foundation (Salt Lake City, UT, USA) (TB).

Study strengths

This study is innovative since its the first to directly assess supplemental vitamin D on strength recovery after exercise damaging enough to induce a prolonged (1-3 days) deficit in peak isometric force in humans. Its also an interesting study in light of emerging data showing that vitamin D plays an important role in the regulation of skeletal muscle function, including contractility and myogenesis.

3-5

Study limitations

The authors acknowledged a handful of interesting limitations. This design was unable to identify if supplemental vitamin D acted to decrease fatigue, or decrease muscle damage, or both. They speculate that the latter might not be the case, since vitamin D enhanced recovery the first 24-h and not thereafter. However, this cant be verified since no muscle biopsy was taken. Another limitation was that subjects were not randomized/grouped according to vitamin D status prior to

supplementation. Also, there was a small number of reportedly healthy and active subjects, who were for the most part vitamin D sufficient prior to supplementation. The generalizability of the results to other populations is therefore unknown.

Comment/application

As shown above (SSC = stretch-shortening contraction, CON = , contralateral control, Bsl = baseline), supplemental vitamin D3 at a daily dose of 4000 IU for 28 days enhanced recovery in peak isometric force shortly after the intense exercise. In addition, vitamin D3 lowered the increase in circulating biomarkers of muscle damage. However, short-term recovery was enhanced, but delayed recovery was not, suggesting the possibility that vitamin D3 attenuated fatigue rather than acted on mechanisms that counteract muscle damage. Still, the suppression of the rise in ALT & AST leaves the anti-muscle damage mechanism still open to being possible.

The authors concluded that, even in vitamin D sufficient subjects, supplementation appears to be an attractive complementary approach to enhance the recovery of skeletal muscle strength following intense exercise... This is good news, considering that supplemental D3 is inexpensive and easily accessible. The dose used in the present study (4000 IU) happens to be the tolerable upper intake level set by the Institute of Medicine.

6 This is far below toxicity thresholds, which are

estimated to be well above 20,000 IU/day.7

Vitamin D supplementations health-related hype recently took a hit from a systematic review by Autier et al, which failed to show an effect of vitamin D supplementation on disease occurrence, including colorectal cancer.

8 However, to quote an

editorial in the same journal:9 Despite the growing body of

evidence indicating that vitamin D is unlikely to prevent non-skeletal disorders, there is strong support for its use from many prominent members of the research community, which is fuelled by the relatively low toxicity of vitamin D, the glimmer of positivity from some trials, and the large body of evidence from prospective observational studies.


Glycogen resynthesis in skeletal muscle following resistive exercise.

Pascoe DD, Costill DL, Fink WJ, Robergs RA, Zachwieja JJ. Med Sci Sports Exerc. 1993 Mar;25(3):349-54. [PubMed]

BACKGROUND/PURPOSE: The purpose of this investigation was to determine the influence of post-exercise carbohydrate (CHO) intake on the rate of muscle glycogen resynthesis after high intensity weight resistance exercise in subjects not currently weight training. DESIGN: In a cross-over design, eight male subjects performed sets (mean = 8.8) of six single leg knee extensions at 70% of one repetition max until 50% of full knee extension was no longer possible. Total force application was equated between trials using a strain gauge interfaced to a computer. The subjects exercised in the fasted state. Post-exercise feedings were administered at 0 and 1 h consisting of either a 23% CHO solution (1.5 g.kg-1) or an equal volume of water (H2O). RESULTS/CONCLUSIONS: Total force production, preexercise muscle glycogen content, and degree of depletion (-40.6 and -44.3 mmol.kg-1 wet weight) were not significantly different between H2O and CHO trials. As anticipated during the initial 2-h recovery, the CHO trial had a significantly greater rate of muscle glycogen resynthesis as compared with the H2O trial. The muscle glycogen content was restored to 91% and 75% of preexercise levels when water and CHO were provided after 6 h, respectively. SPONSORSHIP: None listed. Study strengths

This study was innovative since it was the first to ever examine

the influence of post-exercise carbohydrate on muscle glycogen

synthesis after high-intensity resistance exercise. Most preceding

research examined glycogen synthesis after cycling, and none of

them examined the effect of resistance training under conditions

where pre-exercise feeding was controlled. A crossover design

was implemented which allowed subjects to undergo both

conditions and minimize inter-individual variation. Total force

production (assessed via computerized strain gauge) was equated

between trials.

Study limitations

The authors described the subjects as unfamiliar with weight training. This potentially limits the applicability of the results to untrained populations. The results might further be limited to the

resistance exercise protocol (6-rep leg extension sets using 70%

of 1 RM with 30 seconds of rest between each set), which

depleted glycogen by 28.7% in the water (H2O) trials and 32.5%

in the carbohydrate (CHO) trials. A greater (or lesser) degree of

glycogen depletion could have yielded different rates of

glycogen synthesis from what was seen in the present study. In

the event of greater glycogen depletion, its possible that a greater rate of synthesis could have occurred. As reported in an

epic review by Jentjens and Jeukendrup, when glycogen

concentration decreases, glycogen synthase activity increases.10

A final limitation of the present study was the 6-hour post-

exercise assessment period. This leaves open questions about

what might have transpired with a longer assessment period.

Comment/application

As depicted above, the main finding was that muscle glycogen

content did not significantly increase during the initial 2 hours of

recovery in the H2O condition, and the rate of muscle glycogen

synthesis in the CHO condition was significantly higher (12.9

versus 1.9 mmol/kg/hr with H2O). From the 2-hour point

onward, glycogen synthesis rates were not significantly different

between the conditions. By the end of the 6 hour period,

glycogen levels reached 91% of pre-exercise levels in the CHO

condition, while in the H2O condition glycogen levels were

significantly lower, reaching 75% of pre-exercise levels. Ive seen these results misinterpreted as saying that glycogen was

almost fully replenished in the H2O condition, given the 75%

figure. However, keep in mind that glycogen levels in the H2O

and CHO conditions were only depleted to 71.3% and 67.5% of

their starting levels, respectively. Clearly, the CHO conditions increase from 67.5% to 91% is far more substantial than the

H2O conditions increase from 71.3% to 75% of starting levels.

Interestingly, the rate of glycogen synthesis seen in the CHO

condition (12.9 mmol/kg/hr) was lower than what has been seen

in previous studies using high-intensity exercise and no post-

exercise CHO. Glycogen synthesis rates in the latter research

ranged 15.6-39.6 mmol/kg/hr.11-13

However, fair comparisons

cant be made since these studies were carried out in various fed states, which could have increased the availability of glucose

and insulin, thereby expediting glycogen repletion.

Previous research by Robergs et al compared the glycogenolytic

effects of high-intensity (70% of 1 RM) and low-intensity (35%

of 1 RM).14

The amount of work done between the two

conditions was equated, and no significant differences were seen

in the amount of muscle glycogen depletion (38.9% in the high-

intensity condition and 37.9% in the low-intensity condition).

During the 2-hour recovery period (which had no caloric

feeding), glycogen synthesis rates in the high- and low- intensity

trials were 11.1 & 7.2 mmol/kg/hr, respectively. This is much

higher than the 1.9 mmol/kg/hr seen in the H2O trials of the

present study. Robergs et als use of trained subjects could explain this difference, since trained subjects have been seen to

have double the rate of post-exercise glycogen storage than

untrained subjects.15


1. Maughan RJ, Griffin J. Caffeine ingestion and fluid balance:

a review. J Hum Nutr Diet. 2003 Dec;16(6):411-20. [PubMed]

2. Silva AM, Jdice PB, Matias CN, Santos DA, Magalhes JP, St-Onge MP, Gonalves EM, Armada-da-Silva P, Sardinha LB. Total body water and its compartments are not affected by ingesting a moderate dose of caffeine in healthy young adult males. Appl Physiol Nutr Metab. 2013 Jun;38(6):626-32. [PubMed]

3. Boland RL. VDR activation of intracellular signaling pathways in skeletal muscle. Mol Cell Endocrinol. 2011 Dec 5;347(1-2):11-6. [PubMed]

4. Ceglia L.Mol Aspects Med. 2008 Dec;29(6):407-14. Mol Aspects Med. 2008 Dec;29(6):407-14. [PubMed]

5. Barker T, Henriksen VT, Martins TB, Hill HR, Kjeldsberg CR, Schneider ED, Dixon BM, Weaver LK. Higher serum 25-hydroxyvitamin D concentrations associate with a faster recovery of skeletal muscle strength after muscular injury. Nutrients. 2013 Apr 17;5(4):1253-75. [PubMed]

6. Linus Pauling Institute, Oregon State University. Micronutrient Information Center: Vitamin D. Updated June 22, 2011. [LPI-OSU]

7. Heaney RP. Vitamin D: criteria for safety and efficacy. Nutr Rev. 2008 Oct;66(10 Suppl 2):S178-81. [PubMed]

8. Autier P, Boniol M, Pizot C, Mullie P. Vitamin D status and ill health: a systematic review. The Lancet Diabetes & Endocrinology. Volume 2, Issue 1, January 2014, Pages 7689. [Lancet]

9. [No author listed] Vitamin D: chasing a myth? The Lancet Diabetes & Endocrinology. Volume 2, Issue 1, January 2014, Page 1. [Lancet]

10. Jentjens R, Jeukendrup A. Determinants of post-exercise glycogen synthesis during short-term recovery. Sports Med. 2003;33(2):117-44. [PubMed]

11. Hermansen L, Vaage O. Lactate disappearance and glycogen synthesis in human muscle after maximal exercise. Am J Physiol. 1977 Nov;233(5):E422-9. [PubMed]

12. Hultman EH. Carbohydrate metabolism during hard exercise and in the recovery period after exercise. Acta Physiol Scand Suppl. 1986;556:75-82. [PubMed]

13. Peters Futre EM, Noakes TD, Raine RI, Terblanche SE. Muscle glycogen repletion during active postexercise recovery. Am J Physiol. 1987 Sep;253(3 Pt 1):E305-11. [PubMed]

14. Robergs RA, Pearson DR, Costill DL, Fink WJ, Pascoe DD, Benedict MA, Lambert CP, Zachweija JJ. Muscle glycogenolysis during differing intensities of weight-resistance exercise. J Appl Physiol (1985). 1991 Apr;70(4):1700-6. [PubMed]

15. Hickner RC, Fisher JS, Hansen PA, Racette SB, Mier CM, Turner MJ, Holloszy JO. Muscle glycogen accumulation after endurance exercise in trained and untrained individuals. J Appl Physiol (1985). 1997 Sep;83(3):897-903. [PubMed]


The Dirty Dozen: 12 common diet guru fallacies.

By Mike Howard

____________________________________________________

Introduction

Diet gurus operate largely in a cloud of cognitive bias, logical

fallacies and faulty generalizations. The ability to think critically

about issues of health, nutrition, exercise and fat loss (or any

realm of life for that matter) can do wonders when it comes to

forging your own path to phenomenal health. Nutrition is a

highly controversial and decidedly polarizing subject sparking emotionally-fuelled opinions that are on par with religion and

politics. As with religion and politics, diet philosophies also

possess extremists.

The first step in adverting dietary/training BS is the skill and

instinct to recognize these pitfalls of logical thinking in both gurus and ourselves. So here is a quick guide for critical thinking

so you can side-step the nonsense and make your own informed

choices.

COGNITIVE BIASES

Confirmation bias

Of all the cognitive biases out there, the confirmation bias is the

most prominent. It is the tie that binds all of the logical fallacies

together. Confirmation bias is the phenomenon whereby we

selectively intake information that aligns with our beliefs whilst rejecting that which does not.

We all succumb to confirmation bias to some degree. The

diet/training gurus (and by extension their followers), however

fall into this trap- hook, line and sinker - and for good reason.

They often have substantial financial interest in being right when it comes to certain theories. Throw ego and reputation into

the fray and you can see how gurus will fight tooth-and-nail to

keep their sacred cows from being slayed. To give an example, in early 2012, 2 studies were released

within a week of each other - one that proposed red meat

contributed to an early death and one that showed rice intake to

coincide with increased diabetes risk.

Ingroup bias

The cousin of confirmation bias is ingroup bias. This is like

confirmation bias, but in a group where an entrenched tribalism,

if not a cult-like mentality, pervades. Ingroup bias is rampant

when it comes to nutrition camps and we neednt look any further than support forums and Facebook groups to see

evidence of this. Here are some of the characteristics of ingroup

bias: The group displays excessively zealous and unquestioning

commitment to its leader and his philosophy, no matter if

he is alive or dead, and regards his belief system, ideology,

and practices as the Truth, as law.

Questioning, doubt and dissent are minimized or discouraged with the ingroup.

The group is elitist, claiming a special, exalted status for itself, its leaders, and especially its founder. For example,

the founder is often spoken of as a special being, an avatar,

if not a Messiah. Or the group sees its leader and its

members as part of a special mission to save humanity.

The group has a polarized us-versus-them mentality - an outsider vs. insider doctrine.

The leader is not accountable to any authorities particularly those of the scientific community.

Consider themselves and their authorities to be forward thinkers and feel that if the rest of the world would just get it we would be one big happy, healthy, and lean planet.

Their way of eating, and their authorities who espouse it are victims of persecution by the media, crooked scientists

and government.

INFORMAL FALLACIES

Correlation/causation

Killing turkeys causes winter Eating rice will cause black hair Sounds absurd, right? While these are jovial examples, the premise remains the same. In diet book lore, we see Chinese rural populations ate very little protein and fat and lived long

lives The French eat lard, butter, drink wine and are healthier than Americans Polynesians eat high amounts of saturated fat and thrive. These are examples of correlation two separate events that happen to coincide with each other. This

doesnt mean that rural Chinese populations lived long lives BECAUSE they ate diets lower in protein, or that the French are

healthier BECAUSE they drink wine and eat lard.

The correlation/causation fallacy is a go-to strategy of the diet book industry and its associated gurus. Your local bookstore and

Amazon diet book sections are an endless source of this fallacy.

To wit; The China Study a supposed grand slam of cumulative scientific data is based on nothing more than many observational

studies. Seems there was some cherry-picking going on the part

of its author T. Colin Campbell with health blogger Denise Minger delivering a thorough pick-apart of the tome. Dyed-in-

the-wool vegans and vegetarians, however will continue to

parade this book around as evidence of their way of eating (remember the confirmation bias?).

Perhaps the most recently-relevant and yet classic example of

the correlation/causation fallacy is the best-selling book Wheat

Belly by Dr. William Davis. Davis demonizes wheat products blaming its consumption on everything from obesity to Count-

Chocu-litis. And while it seems logical to blame the obesity

epidemic on our collective penchant for croissants, toast and

other wheat-filled products there are too many other factors to consider not the least of which is increased calories from EVERY food source.


The best way to approach this topic is to ask questions. First

question should be what did they control for? We have to remember that there are dozens if not hundreds of variables that

can change the outcome of a study.

False dilemma (false dichotomy, fallacy of bifurcation, black-

or-white fallacy)

The false dilemma is where two alternative statements are held

to be the only possible options, when in reality there are more.

One of the most common examples of this phenomenon in the

past 15 years has been low-carb vs. low-fat. It always boggled

my mind whenever I read about such comparisons and reflected

on how narrow-minded these arguments seemed to be as though these were the only 2 options of dietary patterns we had.

One of the most important lessons we can learn from nutrition

and training is that these realms operate in many shades of grey.

And while breaking things down to either/or propositions is

easier on our brains and more alluring in headlines things arent that simple. Weve relegated the complexities of the human body and the intricacies of diet and training into internet

memes and all-or-nothing banality.

Internet debates bubble over with strong opinion on with

whether its healthier to be vegan or paleo, eat 6 meals a day or every other day, train like a bodybuilder or do Crossfit, organic

vs. conventional, GMO vs. non-GMO. The polarization of these

topics is perhaps the single biggest cause of internet rage today.

I also happen to think its the largest impediment to open-minded learning.

Fallacy of the single cause

Insulin makes us fat Eating the wrong combinations of foods make us fat Carbs make us fat, toxins make us fat These are the premises of some of the bestselling diet books in history. As we will see later, this is one of the most

prominent diet book lies out there. The reality of the situation is

that obesity and disease have a plethora of contributing factors.

The problem is that people dont want to hear that something is complicated. We would much rather learn that we are doing one

thing wrong and so long as we correct that one thing we will be

on the road to Thinsville. We are told that eating the right foods

and eliminating certain things will magically balance out our

hormones and our hunger signals will fall into place and we will

no longer have any cravings.

Weight regulation is an incredibly complex and multi-layered

science with genetic, behavioral and psycho-socioeconomic factors intertwining. This diagram illustrates the multi-layered

issue of weight regulation.

We insult the intelligence of our audiences and steer people the

wrong way with this single cause/solution thinking. Dieters may

feel that there is something wrong with them when these simple,

cookie-cutter solutions dont work for them the result being frustration and self-blame.

So, next time you are scrolling through an article or in the fitness

section of your magazine rack and see an ad out of the corner of

your eye declaring The one weird tip to reduce belly fat, The single reason we are fat or The one easy fix for 6 pack abs be very skeptical.

Appeal to nature

Whether you have your finger on the pulse of health and

nutrition or not, surely youve noticed what I would call a natural fetish when it comes to products/systems. The word natural itself conjures up dreamlike images of pastures, mountains, plants and such.

An appeal to nature then is judging the merit of an intervention based solely on whether it is natural or unnatural. If savvy marketing has taught us anything its that natural = good and synthetic = bad. Natural is associated with

the utopic visions of safety and conjures up images of healthy

and thriving whilst synthetic or unnatural makes us think of processing, chemicals, toxins and the like. The truth of course is that plenty of manufactured (the so-termed

unnatural) foods, products and such are perfectly safe while many of the much-lauded naturally-occurring plants and botanicals are decidedly unsafe. Instead of kissing under the

mistletoe, try eating it and see how it makes you feel. (Hint:

DONT it might kill you).

The take-home point here is that interventions should be judged

on individual circumstances and weight of evidence not whether something is natural or not. And while there are many flaws of conventional medicine, there are also questions of

safety and effectiveness when it comes to supplements and

herbal remedies. To quote noted skeptic Ben Goldacre: A flaw in aircraft design does not mean we should turn to magic

carpets. In the end, individual context is everything. There may be a place for both (or neither).

RED HERRING FALLACIES

Appeal to authority

Dr. Oz says Jillian Michaels does it this way, Hes written a book on the subject, Shes a College Professor These are all examples of appeals to authority. This is a logical trap whereby people rely on the word of an authority

figure, rather than the body of research. It implies that because

of ones credentials, reputation, status and the like, their word should be taken as fact.

No single individual has all the answers when it comes to

nutrition regardless of how intelligent or convincing they may appear. You can be Oprahs go-to doctor, an internet fitness sensation with YouTube hits rivaling Gangnam Style, a ripped girl in a magazine or an otherwise shredded Hollywood

celebrity. Im here to tell you it doesnt make your opinion any more valid without the requisite science to back up your claims.

Appeal to emotion

Health and wellness are inherently emotional topics. Appealing

to emotions is a tactic whereby an argument is made due to the

manipulation of emotions, rather than the use of valid reasoning.


Like many cult leaders, gurus play on emotions to maximize

buy-in. Its not uncommon for gurus to play on heart strings, fears and insecurities to make their philosophies all the more

compelling.

Are you tired of being fat? You are a victim of bad information I will show you the way You wouldnt eat a cute puppy, would you? Then why would you eat a pig? The food industry wants you to be fat Women will want to date you if you follow these rules What you are doing might be killing you

In short, the message is that we need the gurus guidance. We are not only broken, flawed and unattractive but we are also

incapable of seeking our own solutions. These messages arent overt, mind you they are subtle.

So whether gurus play on fear, insecurity, hope, frustration or

any other combination thereof, there is an emotional draw in

place to make premises and philosophies appear more legitimate.

The straw man fallacy

When discussions of contentious nature arise, you can bet on the

straw man fallacy to make an appearance. A straw man argument is when one person attempts to argue a point by

substitutes a distorted, exaggerated or misrepresented version of

that position.

Examples abound in guru-land particularly when methods are questioned:

Skeptic: Eating Paleo isnt necessary for optimal health. Guru: Well I guess we should just eat the way the food pyramid dictates then.

Successful dieter: I lost and maintained weight eating Atkins-style. Guru: If you only eat steak and cheese all day you will lose weight but get sick.

Skeptic: Calories matter most in weight regulation. Guru: Calorie counting is obsessive and food quality matter more than quantity. Or So youre saying 3500 calories of salmon and cauliflower is the same as 3500 calories of jelly beans?

As you can see from the above examples, straw man fallacies are

used to detract from the actual argument by shifting to an easier

target. Its a form of putting words in ones mouth in an attempt to make the gurus position sound better.

If you question any guru, you can almost guarantee to have a

straw man thrown your way.

Bandwagon fallacy (appeal to popularity):

This fallacy dictates that because something is popular it must be

valid. Without even getting into diet book examples, this past

year, lots of people twerked and did the Harlem Shake but

this hardly makes them worthy of opening up schools to teach

these styles or make them the wave of the future.

Whether I express criticism of CrossFit, low-carb, pole dancing,

gluten-free or any other popular health fad, Im often met back with Well millions of people cant be wrong. Kristen Stewart was the highest grossing actress in 2012 and 50 Shades of Gray

was the bestselling book. You see where Im going here. Many of these fitness and nutrition miracles have come and gone throughout the years. We have seen various permutations of

low-fat diets, Beverly Hills, grapefruit and cabbage soup, Atkins

to South Beach to the maple syrup cleanse to KimKins to

Paleo/Ancestral/Primal and Wheat Belly. But if these trends

were really revolutionary as the creators and followers claim, they would have staying power and a wealth of scientific

literature to back them up.

FAULTY GENERALIZATIONS

Cherry picking (suppressed evidence, incomplete evidence)

Cherry picking is a big one in guru land. This is the act of

pointing at individual cases or data that seem to confirm a

particular position, while ignoring a significant portion of related

cases or data that may contradict that position. This is especially

prominent in diet books that operate under the guise of being

scientific usually written by a doctor or other health professional.

Its quite common for these gurus to generate conclusions based on very selective citations. In nutritional science, very little is

cut and dried. The body of scientific research is rarely

unanimous with bits and pieces here and there contributing to a vast puzzle. There are particular gurus who have been known in

skeptic circles as notorious cherry pickers. Gary Taubes is one example. His 2007 tome Good Calories,

Bad Calories was hailed as a masterpiece by low-carb

enthusiasts. Seven years of supposed impartial scouring of the

dietary data led him to a series of hypotheses when it came to

obesity. His book was chock-full of scientific references,

footnotes and expert interviews. To the uninitiated, his theories

were a slam dunk and his book was infallible in the low-carb

world the ultimate vindication after years of being demonized. While Taubes makes a very compelling case for disassembling

the lipid hypothesis (saturated fats and cholesterol as causal

factors in heart disease), the wheels come off thereafter. James

Krieger of Weightology Weekly provides an excellent dissection

of Taubes carbohydrate hypothesis and other missteps here.

Taubes certainly isnt the only author to cherry-pick, however given his massive index of references it seems only fitting to

pick on him. Campbells China Study falls into a similar trap. Most recently, we see the anti-grain/gluten brigade upon us.

They too cherry-pick studies to prove certain theories, when in reality they rely on observational research and studies that show

partial truths that are extrapolated.

I firmly believe that health advocates have a responsibility to

deliver honest information to the public. This means being open


to the weight of evidence and bringing forth their information as

their belief/best guess/whats worked for them and not as fact.

Hasty generalization (fallacy of insufficient statistics, leaping

to a conclusion)

When it comes to gurus and diet books, hasty generalizations

come mostly in the form of making broad-based statements.

Sugar is toxic, wheat causes diabetes, fat makes you fat, fat cant make you fat. Many of the universal qualifiers dropped with reckless abandon by gurus at best lack context and

are more often than not patently false.

As frustrating as it may be for the average person, the answer to

just about every fitness or nutrition question on the planet is It depends. Every intervention is subject to individual circumstance. We cant put something as structurally complex as food into something as complicated as the human body and

make simple predictions about the outcome.

To wit, moderate sugar consumption within the context of an

active individual who eats maintenance level calories will not be

negatively impacted. Excess sugar consumption in the inactive

person eating more calories than their body needs can have

negative consequences on blood sugar regulation and

subsequently health.

The best policy is to avoid advice that makes broad-based

recommendations especially ones that seem unreasonably extreme. The answer is usually somewhere in the middle.

Final thoughts

Sharpening your critical thinking skills will help you fine-tune

your BS detector. When looking at nutrition, training, or any

other health intervention, be sure to ask the right questions, ask

for evidence and in the name of all that is holy and sacred,

ENJOY the process. I would encourage open-minded

skepticism. There may be a fine line between skepticism and

closed-mindedness, but the line between open-mindedness and

gullibility is even finer.

____________________________________________________

Mike Howard has been actively involved in the fitness industry since 1996 - amassing more than 10,000 hours of in-the-trenches experience helping people achieve phenomenal health - working with a diverse number of individuals of varying ages, goals and abilities. Mike specializes in fat loss, corrective exercise and youth fitness. In addition to personal training and coaching youth, Mike is an accomplished writer, with over 350 articles to his credit. He has been published in Diet Blog, The

Vancouver Sun, Impact magazine and has been a guest on the Good Life Show, with Jesse Dylan an internationally syndicated radio show. Mike Currently writes for internationally-acclaimed fat loss expert Tom Venuto for his Burn the Fat site.

Web: www.coreconceptswellness.com Facebook: https://www.facebook.com/coreconceptswellness Twitter: https://twitter.com/CoreConceptsMH


Interview with Bret Contreras. By Alan Aragon

____________________________________________________

What follows is an interview with my colleague and personal

friend, Bret Contreras. My questions are in bold. Enjoy the

discussion, and big thanks to Bret for the insight & expertise!

____________________________________________________

First off, thanks for agreeing to do this interview amidst

your hectic schedule. I want to start by asking how exactly

you became interested in concentrating your focus on the

glutes. I realize that many tongue-in-cheek (no pun intended)

assumptions that can be made here, but it's clear that you

have launched and maintained a consistently scientific

investigation of this area. Please let us in on the background,

since I personally have not seen it discussed in articles to the

general public.

Hi Alan! First off, thanks for interviewing me - I appreciate it.

Okay...about the whole glute obsession. When I was 16 years

old, I was playing golf with my sister's boyfriend. I was about to

t-off on the 9th hole and he stated, "Dude, you have no ass. Your

back literally goes right into your legs." Unfortunately he was

right. I decided from that point forward to learn as much as

possible about glute training, for my own benefit. This passion

has continued even to this day. In fact, I'm still learning a lot

about the glutes. Not only from my own experiments - I have a

force plate and EMG unit - but also from pulling up journal

articles. I'm working on my first review paper on the glutes for

my PhD, and I had to laugh. I did a standard search using

various terms in several databases and ended up with 90 articles

pertaining to gluteus maximus EMG and resistance training or

rehab. However, I searched through my folder consisting of over

1,000 articles on the glutes and found 50 more studies that didn't

come up under the standard search. This goes to show you the

research value of "obsession"...or at least the limitations of

review papers where the authors haven't been studying the field

for a considerable amount of time.

Thanks for the candid answer, Bret. Given the high volume

of glute research you've reviewed, what would you say are

the most glaring methodological limitations of the current

body research, and where do you think the largest gaps are

in this area of research that need to be filled?

Great question Alan. Here are some things I'm interested in

seeing in time:

1. What is the true gluteus maximus maximum voluntary isometric contraction (MVIC) position in

electromyography (EMG)? The gold standard is the prone

bent leg position with manual resistance applied to the

distal posterior thigh, but there are a number of MVIC

positions used in the literature for the gluteus maximus.

Which one truly reflects the maximum voluntary

isometric capacity of the gluteus maximus? Is there a new

(unused in the literature) position that outperforms all of

them?

2. Which exercises elicit the highest mean and peak gluteus maximus EMG activation - back squats, deadlifts, hip

thrusts, lunges, or back extensions?

3. Can low or moderate loads match the gluteus maximus EMG activation elicited during heavy load training if sets

are taken to technical failure?

4. Is there a meaningful difference between surface EMG and fine wire EMG data for the gluteus maximus?

5. If identical relative loads are used, does gluteus maximus EMG activation increase with increasing squat depth?

(The only study on this topic used the same loads for

partial, half, and deep squats, but lifters are stronger with

partials, so the increased loads might offset the increased

depths)

6. How accurately does EMG reflect actual mechanical tension (muscle force) in the gluteus maximus? Can EMG

be useful in guiding hypertrophy protocols (does

progressive overload via an exercise that elicits higher

EMG activation lead to greater hypertrophy than

progressive overload via an exercise that elicits lower

EMG activation)?

7. Which protocol maximizes hypertrophy of the gluteus maximus? Which method maximizes mechanical tension

in the gluteus maximus? Which method maximizes

metabolic stress in the gluteus maximus? Which method

maximizes muscle damage in the gluteus maximus? Is

there an optimal combination of these three factors that

maximize the hypertrophic response?

8. Is glute training useful in eliciting a postactivation potentiation (PAP) effect? Does low load glute activation

prior to walking positively impact gait performance?

Squat performance? Deadlift performance? Jumping

performance? Sprinting performance? What glute training

methods are most useful for eliciting PAP?

9. The literature on the architecture and muscle moment arms for the gluteus maximus typically involves

examining cadavers of the elderly. How would the

measurements changed if examining younger, athletic

individuals? Do elite sprinters have a greater percentage

of type II fibers in the gluteus maximus than amateur

sprinters? Do elite sprinters have greater gluteus maximus

moment arms and physiological cross-sectional area

(PCSA) than amateur sprinters? How do the PCSA and

moment arms of the gluteus maximus change when

maximally contracted? How does glute training impact

PCSA and moment arms of the gluteus maximus? How

does gluteus maximus hypertrophy affect performance?

These are just some of the many gaps that we have in the

literature at the moment.


As expected, those are a lot of gaps in the literature. But of

course, the beauty of it is that science can continue to march

forward and plug away at them. Do you have any hypotheses

at the tip of your tongue regarding any of those lingering

questions? I'd like to hear what sort of speculations (or

unpublished observations) you might have.

Im no stranger to hypothesizing Alan, so Ill gladly pony up some speculation.

My pilot data with MVIC positions shows that the prone bent leg

hip extension against manual resistance (gold standard) is neck-

and-neck with wide-stance-feet-flared standing (end range hip

extension with abducted and externally rotated hips). There are a

couple of other positions that are close too, but its too early to tell.

I think the hip thrust will outperform all other exercises in mean

and peak gluteus maximus EMG activation.

I think that heavy loading will outperform lighter loads to failure

in peak activation (and far greater for mean activation) for the

gluteus maximus (even when focusing on just the last ten reps in

the lighter load set).

I think that fine wire and surface EMG for the gluteus maximus

will yield very similar results.

I think that with identical relative loading, there wont be any significant differences in gluteus maximus EMG activity with

increasing squat depth.

I think well find that gluteus maximus EMG is fairly representative of muscle force (with one caveat that the data isnt gathered under fatigue), however some modeling to take into account changing moment arms, muscle lengths, and

innervation zones will lead to even more accurate estimations. I

also think that utilizing a progressive approach for exercises that

elicit greater EMG activation will produce greater hypertrophic

adaptations than exercises that elicit lower EMG activation for

the gluteus maximus.

I think that protocols that incorporate the exercises and methods

that elicit high levels of mechanical tension along with very high

levels of metabolic stress and tolerable levels of muscle damage

for the glutes will elicit the greatest hypertrophic response. I

think that heavy hip thrusts will maximize tension in the glutes,

high rep hip thrusts will maximize metabolic stress in the glutes,

and squats and lunges will maximize muscle damage in the

glutes.

I think that over time well discover that glute activation is quite useful in eliciting a PAP affect and that specific protocols can

benefit squatting, deadlifting, sprinting, jumping, and walking

performance.

I think well find that glute hypertrophy increases torque production through both increased PCSA and muscle moment

arm length and that this leads to greater hip extension torque

production during squats, deadlifts, and jumps, and even greater

horizontal force and power production during sprinting. Im not sure if well find that elite sprinters have a greater type II fiber

type percentage than amateur sprinters, but Id love to see this data along with data on the hamstrings.

Of course, Im probably wrong in several of these hypotheses, and Ill be sure to announce any new findings in the research as I discover them.

Fascinating stuff! I noticed that a lot of the questions

surround the topic of EMG activation. This reminds me of a

recent Facebook thread that set off a lot of fireworks. Can

you tell me what you feel are the main contentions or

complaints some people have with EMG use that are not

well-supported by the scientific literature?

People seem to either think that EMG is the end-all/be-all in

determining exercise efficiency, or that it's completely useless.

Like most things, the truth is somewhere in the middle. I'm not

quite comfortable discussing the various complaints that people

have with EMG. Although I've downloaded and read hundreds

of EMG articles, I know what it takes to truly know something,

and I haven't done my homework in this context. While there are

excellent textbooks on EMG, expert opinion doesn't rank that

high on the hierarchy of evidence. I've never seen review papers

written on various topics such as surface versus fine wire EMG

activation, surface EMG and cross-talk, or fine wire EMG and

disrupted motor patterns. So to form an educated opinion, I'd

need to conduct an extensive review of the literature in order to

feel confident with my knowledge in this area. But what I can

say is that research in these areas is quite variable, so one could

cherry-pick articles to show both ends of the spectrum.

Moreover, the research is highly dependent on the muscle being

examined. For example, using surface EMG to examine the

gluteus maximus is going to be more valid than using surface

EMG to examine the transversus abdominis (a deep muscle).

As for whether EMG can be used to predict the hypertrophic

response to training, I'm aware of no research in this area.

However, since two recent articles which have used MRI to

show that activation is related to hypertrophy

(HERE and HERE) it's reasonable to speculate that EMG could

do the same. In my own experience as a lifter, personal trainer,

and researcher, I can say with confidence that EMG is useful in

demonstrating that the most popular exercises seem to be the

best at activating the various muscles. For example, squats and

lunges usually show up as the highest activators for the vastis,

deadlifts and glute ham raises for the hammies, hip thrusts for

the glutes, dumbbell bench press and weighted dips for the pecs,

behind the neck press and lateral raises for the delts (rear delt

raises for the rear delts), shrugs for the upper traps, bent over

rows for the mid-traps, tricep extensions for the tri's, chins and

curls for the bi's, pull-ups and rack pulls for the lats, hanging leg

raises, weighted crunches, and ab wheel rollouts for the abs, and

standing calf raises for the calves.

EMG is used in the research in a number of ways:

To compare muscle activation across different exercises To see if regional activation (functional subdivisions)

exist in the muscles

To see the effects of tweaking exercise form on muscle activation


To see if unstable surface training increases or decreases muscle activation

To determine the isometric positions that elicit the highest activation (used for normalization purposes called

MVICs)

To examine the effects of cueing and attentional focus on muscle activation

To examine muscle activation during bloodflow restriction training, high rep training to failure versus

heavy weights, and special techniques such as drop sets

and rest pause

To examine the EMG-angle curve, peak activation time-points, and minimum activation time-points during

exercises or sports activities

To examine rate of EMG rise during heavy or explosive movement

To examine muscle activation during sticking regions in the powerlifts

To examine muscle activation differences in elite versus novice athletes

For biofeedback training To examine muscle onset times To examine whether myoelectric silence occurs (such as

during stoop lifting)

To examine differences in muscle activation in normal subjects versus subjects in pain

To examine asymmetries To examine muscle activation differences between ideal

form and poor form (such as knee valgus)

To examine gender differences in muscle activation during various tasks

To examine muscle activity during different phases or portions of a sporting task (such as the braking,

propulsive, and swing phases in sprinting, along with the

acceleration and maximum speed phases)

To compare different types of activities (such as vertical jumps, horizontal jumps, and lateral jumps)

To learn more about the bilateral deficit To examine the effects of increasing intensity of load or

effort on muscle activation

To examine the effects of fatigue on muscle activation To determine the level of cocontraction To help estimate muscle force, intraabdominal pressure,

and spinal loading in modeling studies

To examine muscle activation in the elderly or in special populations, and to identify neuromuscular diseases

It should be mentioned that sports scientists utilize many tools

and methods to help them answer questions, each of which

inherent strengths and weaknesses. As previously mentioned,

EMG is no exception; it definitely has its pros and cons. But the

same can be said for every biomechanical tool, including force

plates, accelerometers, linear position transducers, isokinetic

dynamometers, force treadmills, MRI, and ultrasound. With

regards to determining exercise efficiency, a good practitioner

will rely upon a variety of information, some of which may

include:

1. Discussing exercise with fellow lifters, trainers, and coaches, attending seminars, and/or watching videos

pertaining to resistance training

2. Reading magazines, books, blog posts, and published literature pertaining to resistance training

3. Performing an exercise and feeling the burn

4. Intentional inducement of delayed onset muscle soreness (DOMS) by performing many sets of a certain exercise

5. Muscle palpation during exercise performance

6. Biomechanical analysis of the exercise in terms of movement patterns, joint angles, actions, and ROM's,

muscle lengths, muscle actions, muscle fiber origins,

insertions, and lines of pull

7. Biomechanical analysis of the exercise in terms of joint torques, moment arms, muscle forces, joint forces, and

spinal loading (these require inverse dynamics and

computer modeling)

8. Surface and fine wire ectromyography (EMG) activation (examining mean & peak along with the entire pattern)

9. Magnetic Resonance Imaging (MRI) activation (including T2 weighted imaging immediately after the

session to estimate activation or 48 hours afterward to

estimate damage)

10. Blood samples (examining levels of hormones, lactate, creatine kinase)

11. Training ones self and/or clients and examining the effects (even better if variables are controlled and the

scientific method is utilized)

12. Conducting longitudinal training studies and examining the training effects (this is where a number of tools can

be used to examine gains in flexibility, strength, power,

hypertrophy, speed, and/or stamina, which can include

technology such as goniometers, ultrasound,

tensiomyography (TMG), mechanomyography (MMG),

computed tomography (CT scans), near-infrared

spectroscopy (NIRS), motion capture, dual energy x-ray absorption (DXA), biopsies, isokinetic dynamometers,

and force plates)

As you can imagine, each of these have inherent strengths,

weaknesses, and limitations. One strength of EMG is that it

gives you numerical data so you're not relying solely on

subjective feedback.

Loving the responses, Bret. In your experience training

clients, what are the most common challenges to achieving

satisfactory hypertrophy in the glutes? You can answer this

from either a biomechanical perspective, behavioral


perspective, or both. What sort of 'original' solutions do you

feel you have come up with to surmount these challenges?

I'll break this answer up into four categories:

Genetics

In a study (click HERE) involving 45 male gluteal CT scans, the

minimum muscle volume was 198 ccm and the maximum was

958 ccm. This shows that some folks have nearly 5 times the

glute volume as other folks. Simply put, some lucky individuals

can develop amazing glutes from just doing cardio, while others

can barely alter their gluteal shape even when doing everything

right in the weightroom and the kitchen. That said, I've never

trained anyone who didn't improve at all as long as they were

consistent with their training.

Mind-Muscle Connection

Some individuals fire their glutes like crazy on every compound

lower body movement, while others hardly fire their glutes at all.

Seasoned personal trainers know this since this is easy to detect

via palpation or even examining the wrinkles and divots that

form in clients wearing tight fitting clothing such as spandex.

McGill showed that strongmen of different calibers activated

their glutes uniquely, with the better performer turning his glutes

on earlier and activating them to a higher degree during

strongman exercise (click HERE). Lewis and Sahrmann showed

that cueing glute contractions during prone hip extension

resulted in greater glute activation and lower hamstring

activation (click HERE). Glute re-education has been shown to

eliminate hamstring cramping and reduce hamstring EMG

activity during sprinting (click HERE). Glute max EMG

biofeedback training has been shown to improve EMG

amplitude and gait function and performance (step length,

walking velocity, and cadence) in spinal cord injury patients

over a control group that received standard physical therapy

exercise. Together, these studies show that gluteal activation is

important and improvable. Sadly, many lifters focus on quantity

rather than quality. You see them hoisting hundreds of pounds in

a sloppy, partial range fashion with little control and focus on

the movement. Old school bodybuilders spoke of the "mind-

muscle connection" and the importance of being able to fire a

muscle to very high capacities during exercise. Lifters who

haven't paid their dues voluntarily squeezing their glutes (Mel

Siff called this "loadless training") and performing low-load

glute activation exercises should spend around a month working

on this aspect of glute training.

Inferior Exercise Selection

There's a Phoenix-based trainer who specializes in training

bikini competitors. The only glute exercise he has his ladies

perform is the bodyweight lunge. It's no surprise that his clients'

glutes suck. Some of his ladies snuck over and started training

with me, and lo and behold their glute shape improved

drastically over the course of two months. I employ a variety of

gluteal exercises in my training and am always sure to include a

type of hip thrusting/bridging movement, a squatting/single leg

squatting movement, a deadlift/hip-hinge movement, and a

couple of lateral/rotational accessory movements. The glutes can

handle a lot of volume, especially when exercise selection is

carefully considered.

Insufficient Intensity

THIS article by Steele rightfully pointed out that there are two

primary types of intensity: intensity of load, and intensity of

effort (well, he suggested load and effort be used on their own

without the word intensity). Many clients think that they train

with sufficient intensity, but they don't. They just don't know

how to push themselves. Two days ago, a lady visited me to

train. She is a trainer herself and in fact trains numerous bikini

models. She thought she knew how to train the glutes, but after a

quick 45-minute session with me, she realized that her glute

training regimen was quite inferior. By tweaking her form and

encouraging her, she was able to use much heavier loads and

attain many more repetitions than she was currently achieving in

her own training. The next day, she emailed me to tell me that

her glutes had never burned so badly during her workout and

that her glutes have never been so sore in all of her life. Don't get

me wrong; my goal is never to elicit excessive soreness as I feel

that it's counterproductive to strength gains. However, this goes

to show you that even experienced lifters are guilty of assuming

that their training is on track, when it can actually be much more

productive with proper exercise selection and intensity. Im certain that in around two months, this ladys glutes will look much better.

That concludes the interview, Bret. Once again, thank you

very much for your time.

Bret: The pleasure was all mine Alan. Thanks for asking

excellent questions and proving me with the opportunity to

educate your subscribers.

____________________________________________________

Bret Contreras has a masters degree from ASU, a CSCS certification from the NSCA, and is currently pursuing his PhD from AUT University. He has a Strength & Conditioning/Biomechanics-based research review service at StrengthandConditioningResearch.com. Bret maintains a regular blog at BretContreras.com.

Alan Ara

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10 - Dec - 2013