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Mitochondrial Function and Health - NED Infobite
Infobite 33_January 2023. Summaries of key research on mitochondrial function and health
2024
Abstract
The function of cellular mitochondria has far reaching effects on human health. This NED Infobite looks at different dietary types and specific antioxidants and their interplay with mitochondrial function, in particular in the relation to metabolic dysregulation and optimal physical performance. BANT's scientific NED InfoBites are designed to provide key elements of the latest research using plain language. They provide quick overviews on particular health issues and nutrition topics for a speedy introduction to the science. Visually attractive and easily shareable with clients and social media followers.
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Systematic review and meta-analysis of nutrient supplements for treating sarcopenia in people with chronic obstructive pulmonary disease.
Huang, WJ, Ko, CY
Aging clinical and experimental research. 2024;36(1):69
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Tobacco smoking and air pollution are leading causes of chronic obstructive pulmonary disease (COPD). Mortality and morbidity are on the rise worldwide due to the increase in COPD. COPD is a risk factor for sarcopenia, an age-related reduction in muscle mass and muscle strength. Non-pharmaceutical interventions, such as nutritional supplementation, are considered a management strategy for sarcopenia related to COPD, as they can address nutritional deficiencies and energy requirements in old age. This systematic review and meta-analysis included twenty-nine randomised controlled trials to assess the effects of nutritional supplementation for reducing sarcopenia in patients with COPD. The included studies used different nutritional supplements such as energy-type nutritional supplements, essential amino acids, essential amino acid-enriched nutritional supplements, whey protein, β-hydroxy β-methyl butyrate, creatine, creatine in combination with coenzyme Q10, vitamin D, vitamin B12, polyunsaturated fatty acids, magnesium citrate or nutritional antioxidant supplements. The intervention duration ranged from four weeks to twenty-four weeks. The result of this systematic review and meta-analysis showed a significant improvement in body weight, fat-free mass, and a 6-minute walk test. There was a non-significant improvement in handgrip strength and quadriceps muscle strength. Healthcare professionals can use the results of this study to understand the benefits of nutritional supplementation in improving body composition and muscle strength. However, further robust studies are required to evaluate the efficacy of nutritional supplementation in COPD patients due to the high heterogeneity of the included studies.
Abstract
Individuals with chronic obstructive pulmonary disease (COPD) are prone to malnutrition and sarcopenia as a result of nutritional deficiencies and increased energy metabolism. However, the effects of nutrient supplements (NS) on treating sarcopenia in patients with COPD are not well established from systematic evidence. This meta-analysis examined the effect of NS on sarcopenia in patients with COPD. A systematic search of multiple databases was conducted, and 29 randomized controlled trials involving 1625 participants (age, mean [SD] = 67.9 [7.8] years) were analyzed. NS demonstrated significant improvements in body weight (MD,1.33 kg; 95% CI, 0.60, 2.05 kg; P = 0.0003; I2 = 87%), fat-free mass index (MD, 0.74 kg/m2; 95% CI, 0.21, 1.27 kg/m2; P = 0.007; I2 = 75%), and 6-min walk test (MD, 19.43 m; 95% CI, 4.91, 33.94 m; P = 0.009; I2 = 81%) compared with control. However, NS had nonsignificant effects on handgrip strength (SMD, 0.36; 95% CI, - 0.15, 0.88; P = 0.16; I2 = 87%) and quadriceps muscle strength (SMD, 0.11; 95% CI, - 0.06, 0.27; P = 0.20; I2 = 25%) compared with the control. In conclusion, NS may be an effective treatment for improving body composition and physical performance in COPD. Future studies should explore the effects of intervention durations, specific NS types, or combined training in patients with COPD and sarcopenia.
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Impact of Melatonin Supplementation on Sports Performance and Circulating Biomarkers in Highly Trained Athletes: A Systematic Review of Randomized Controlled Trials.
Celorrio San Miguel, AM, Roche, E, Herranz-López, M, Celorrio San Miguel, M, Mielgo-Ayuso, J, Fernández-Lázaro, D
Nutrients. 2024;16(7)
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Melatonin (N-acetyl-5 methoxytryptamine) is an indolic neurohormone known for its antioxidant, anti-inflammatory, and immunoregulatory properties. Highly demanding training exponentially increases physical and biochemical demands, particularly in the skeletal muscle and the liver. This study aimed to critically review the effects of melatonin supplementation on sports performance and circulating biomarkers in highly trained athletes. This study was a systematic review of twenty-one randomised controlled trials. The dose of melatonin supplemented in the trials ranged from 5 mg to 100 mg, administered before or after exercise. Results showed that melatonin supplementation improved antioxidant status and inflammatory response. Additionally, it reversed liver and muscle damage, and moderate effects were also observed in modulating glycaemia, total cholesterol, triglycerides, and creatinine. Authors concluded that melatonin has a high safety profile. In fact, melatonin supplementation could act indirectly to improve performance by preventing tissue damage, reduce inflammation caused by reactive oxygen and nitrogen species, and restore circulating biomarkers in highly trained athletes during demanding exercises.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Diet and lifestyle modifications should always be made first to ensure that athletes have sufficient melatonin levels.
- Adequate light exposure at appropriate times and specific foods which contain melatonin may help.
- During periods of intense training, supplementation may be needed to reach adequate levels and to aid recovery.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
- High-intensity exercise can disrupt inflammatory and immune processes within the body resulting in inflammation, poor immune function, and poor recovery.
- Melatonin is a neurohormone that has anti-inflammatory and antioxidant properties, and has the potential to be of benefit to recovery following strenuous exercise.
- This systematic review of randomised control trials aimed to determine the effect of melatonin on sports performance and circulating health biomarkers.
Methods
- This was a systematic review of randomised control trials (RCTs).
- The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
- Studies that were included looked at the use of melatonin by trained sports professional and athletes.
Results
- 21 RCTs were included in the review.
- Melatonin doses ranged from 5mg to 100mg in the studies.
- Melatonin was administered either acutely or for periods of 3 to 30 days pre and post exercise.
- None of the studies were rated low risk of bias.
- Seven studies had a high risk of bias.
- There was a high degree of heterogeneity, which prevented a meta-analysis being performed.
- The study showed that melatonin supplementation had some effect on white blood cell count levels and immunoglobulins but results were conflicting.
- Moderate effects were seen on blood glucose, cholesterol, triglycerides, and phospholipids but did not affect high density lipoprotein or low-density lipoprotein.
- Improvements were seen in antioxidant status and inflammation.
- Reversal of kidney and liver damage was reported following supplementation.
- Promising effects were seen on sports performance with some studies reporting improvements in aerobic capacity, agility, and sprint performance.
- No effects were apparent on hormonal response of cortisol, testosterone, or growth hormone.
- No adverse effects were seen following melatonin supplementation.
Conclusion
- Melatonin supplementation may mitigate some of the damaging effects of extreme exercise.
- However, it is unclear as to how this might occur.
Clinical practice applications:
- Sufficient melatonin levels may be necessary in highly trained athletes.
- This may limit inflammation and oxidative stress and help prevent tissue damage and aid recovery.
- During periods of intense training or when quick recovery is needed, melatonin supplementation may be of benefit.
Considerations for future research:
- More studies on the mechanisms through which melatonin may be supporting athletic performance and preventing liver and kidney damage are needed.
- Studies on the effects of melatonin on mitochondrial function may be of benefit.
Abstract
Melatonin (N-acetyl-5 methoxytryptamine) is an indolic neurohormone that modulates a variety of physiological functions due to its antioxidant, anti-inflammatory, and immunoregulatory properties. Therefore, the purpose of this study was to critically review the effects of melatonin supplementation in sports performance and circulating biomarkers related to the health status of highly trained athletes. Data were obtained by performing searches in the following three bibliography databases: Web of Science, PubMed, and Scopus. The terms used were "Highly Trained Athletes", "Melatonin", and "Sports Performance", "Health Biomarkers" using "Humans" as a filter. The search update was carried out in February 2024 from original articles published with a controlled trial design. The PRISMA rules, the modified McMaster critical review form for quantitative studies, the PEDro scale, and the Cochrane risk of bias were applied. According to the inclusion and exclusion criteria, 21 articles were selected out of 294 references. The dose of melatonin supplemented in the trials ranged between 5 mg to 100 mg administered before or after exercise. The outcomes showed improvements in antioxidant status and inflammatory response and reversed liver damage and muscle damage. Moderate effects on modulating glycemia, total cholesterol, triglycerides, and creatinine were reported. Promising data were found regarding the potential benefits of melatonin in hematological biomarkers, hormonal responses, and sports performance. Therefore, the true efficiency of melatonin to directly improve sports performance remains to be assessed. Nevertheless, an indirect effect of melatonin supplementation in sports performance could be evaluated through improvements in health biomarkers.
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Polyphenol supplementation boosts aerobic endurance in athletes: systematic review.
Cao, G, Zuo, J, Wu, B, Wu, Y
Frontiers in physiology. 2024;15:1369174
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Prolonged high-intensity endurance training and competition can lead to exercise-induced fatigue, muscle function decline, and oxidative stress. Natural plant extracts, including polyphenols, have gained attention for their potential to enhance athletic performance and aid recovery. This study aimed to examine the role of polyphenol supplementation in improving aerobic endurance among athletes and individuals with regular exercise habits. This study was a systematic review of 11 studies, focusing on the impact of polyphenols on aerobic endurance. Results showed that flavonoid-rich compounds, providing 208 mg of polyphenols and 14.4 mg of flavonoids per 40 g in a water-soluble form, showed the most noticeable improvement in exercise performance during a 6-week supplementation period. Authors concluded that even though polyphenol supplementation demonstrated enhancements in several indicators of aerobic endurance exercise performance, it’s essential to interpret these findings cautiously due to the limited number of available studies.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Polyphenols may have specific benefits on exercise performance and metabolism in both performance and recreational athletes.
- It is important to understand that this is only seen at specific doses for sustained periods of time and compliance is essential for results.
Evidence Category:
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X
A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
Extreme exercise can lead to oxidative stress in the body, which can affect muscle function and impact training and performance in athletes. Polyphenols present in plants have antioxidant properties and have emerged as potential candidates to improve exercise performance. They also promote antioxidant defences and nuclear factor erythroid 2-related factor 2 (Nrf2) signalling, which is involved in mitochondrial biogenesis. Finally, they may also alter vascular function through promoting endothelial nitric oxide synthesis, which leads to vasodilation and increased blood flow. This systematic review aimed to summarise the current research on the effects of polyphenols on endurance exercise performance.
Methods
- The inclusion criteria involved randomised control trials on healthy athletes and sports people who were supplemented with polyphenols and compared to a placebo group both before and after tests of athletic or sports performance.
- No meta-analysis was conducted.
Results
- 11 studies with 220 participants were included in the systematic review. 164 were recreational and 56 professional athletes.
- Polyphenols assessed were grape seed extract, green tea extract, olive fruit water phytocomplex, Montmorency cherry powder, carob pods, Haskap berries, Vinitrox™ (polyphenols from grape and apple), Cardiose®, and grape juice.
- Substantial improvements were seen in the time taken to complete an exercise and fatigue times.
- Mixed results were seen in time to peak power output, endurance running distance, power output, exercise intensity, rate of perceived exertion, and speed.
- Improvements were seen in flow mediated dilation and tissue oxygenation index, but only one trial was found that assessed each of these.
- Heart rate and blood pressure showed no improvements with polyphenols and mixed results were seen with VO2, VCO2 lactate level, and carbohydrate oxidation.
- Prolonged use of polyphenols were shown to promote whole body fat oxidation.
- No improvements were seen in measures of antioxidant levels but only one study looked at these.
- Long-term rather than acute polyphenol supplementation was more beneficial.
Conclusion
Polyphenols improved aerobic endurance and exercise performance. However, there is insufficient evidence to support their use for improvements to several physiological and metabolic measures.
Clinical practice applications:
- Practitioners may like to consider the recommendation of long-term polyphenol supplementation to healthy athletes to improve aerobic endurance and promote fat oxidation.
- 208mg of polyphenols and flavonoids in a 14.4mg per 40g in a soluble form may have optimal effects.
- However, there may be limited effects on recovery times.
Considerations for future research:
- Further research could determine exercise specific dosage recommendations.
Abstract
In recent years, an increasing trend has been observed in the consumption of specific polyphenols, such as flavonoids and phenolic acids, derived from green tea, berries, and other similar sources. These compounds are believed to alleviate oxidative stress and inflammation resulting from exercise, potentially enhancing athletic performance. This systematic review critically examines the role of polyphenol supplementation in improving aerobic endurance among athletes and individuals with regular exercise habits. The review involved a thorough search of major literature databases, including PubMed, Web of Science, SCOPUS, SPORTDiscus, and Embase, covering re-search up to the year 2023. Out of 491 initially identified articles, 11 met the strict inclusion criteria for this review. These studies specifically focused on the incorporation of polyphenols or polyphenol-containing complexes in their experimental design, assessing their impact on aerobic endurance. The methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the risk of bias was evaluated using the Cochrane bias risk assessment tool. While this review suggests that polyphenol supplementation might enhance certain aspects of aerobic endurance and promote fat oxidation, it is important to interpret these findings with caution, considering the limited number of studies available. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023453321.
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Antioxidants in Athletes - NED Infobite
Infobite 25_March 2022. Summaries of key research on antioxidants in athletes
2024
Abstract
Intense exercise that competitive sports athletes participate in can negatively affect their pro-oxidative-antioxidant status. This NED Infobite brings research on various antioxidant compounds with potential to prevent adverse changes. BANT's scientific NED InfoBites are designed to provide key elements of the latest research using plain language. They provide quick overviews on particular health issues and nutrition topics for a speedy introduction to the science. Visually attractive and easily shareable with clients and social media followers.
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Effects of a Dietary Microalgae (Arthrospira platensis) Supplement on Stress, Well-Being, and Performance in Water Polo Players: A Clinical Case Series.
La Mantia, I, Maniaci, A, Scibilia, G, Scollo, P
Nutrients. 2024;16(15)
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Dietary supplementation has become a popular strategy among athletes to enhance physical performance, reduce fatigue, and accelerate recovery. Spirulina (Arthrospira platensis), a blue-green microalga, has gained attention due to its high protein content, essential amino acids, vitamins, minerals, and antioxidant properties. The primary aim was to investigate the impact of the spirulina and copper supplement on stress, well-being, and performance in water polo players. This study was a clinical case series involving 20 male water polo players. The participants were divided into two groups: one group received the spirulina supplement, while the other group received a placebo. Results showed that the spirulina group showed a significant increase in their Athlete’s Subjective Performance Scale (ASPS) scores from baseline to follow-up, compared to the placebo group, which saw a slight decrease. Additionally, there was a positive correlation between spirulina supplementation and reduced severity of ASPS scores. However, the levels of creatine phosphokinase (CPK), a biomarker for muscle damage, showed only slight differences from baseline to follow-up in the spirulina group. The authors concluded that a dietary supplement containing spirulina and copper may improve subjective performance measures and reduce muscular tension in water polo players. However, larger, randomised controlled trials are needed to confirm these findings.
Abstract
BACKGROUND A common tactic used by athletes to improve performance, lessen tiredness, and hasten recovery is dietary supplementation. We aimed to assess the role of a microalgae dietary liquid supplement additivated with Copper 22.5% NRV in water polo players' performance. METHODS Twenty male water polo players were split into two groups: ten (spirulina group) took a twice-daily nutritional supplement containing 15 mL of spirulina liquid extract (titrated in Phycocyanin 1 mg/mL) and additivated with Copper 22.5% NRV for eight weeks, and ten (the placebo group) did not take the supplement. Subjective evaluations were finished using the Athlete's Subjective Performance Scale (ASPS). Levels of the biomarker creatine phosphokinase (CPK) were also assessed. RESULTS The spirulina group's mean total ASPS score increased significantly from baseline to follow-up and was significantly better than that of the placebo group (p < 0.001). Conversely, ASPS ratings in the placebo group slightly decreased. A positive correlation between spirulina supplementation and less severe ASPS was found using correlation matrix analysis. However, there was a slight difference in CPK levels from the baseline to the follow-up in the spirulina group. CONCLUSIONS A dietary supplement comprising spirulina and copper may help water polo players' subjective performance measurements by lowering muscular tension. Larger, randomized controlled trials are yet required.
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Supplementation with selenium and coenzyme Q10 in an elderly Swedish population low in selenium - positive effects on thyroid hormones, cardiovascular mortality, and quality of life.
Alehagen, U, Alexander, J, Aaseth, JO, Larsson, A, Opstad, TB
BMC medicine. 2024;22(1):191
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In the human body, the thyroid gland has the highest content of selenium in proportion to weight. A sufficient intake of selenium is mandatory in order to avoid disturbance of the thyroid hormone balance. The primary aim of this study was to evaluate the impact of selenium and coenzyme Q10 (CoQ10) supplementation on thyroid hormone levels, cardiovascular mortality, and quality of life in elderly individuals. This study was a randomised, double-blind, placebo-controlled trial involving 443 elderly participants (average age 78 years) over a period of 4 years. Results showed: - elevated thyroid stimulating hormone (TSH) and low fT3 levels in those elderly people with the lowest selenium intake. - selenium/CoQ10 supplementation resulted in significantly increased fT3 and decreased fT4 levels. - lower TSH levels were associated with reduced CV mortality and improved measures of health-related quality of life. Authors concluded that a substantial part of the study population might suffer from suboptimal thyroid function due to an example of an insufficient selenium intake.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Low selenium was associated with elevated TSH levels and significantly increased CVM within 10 years.
- Supplementation with selenium and CoQ10 may be beneficial for those identified with even a mild selenium deficiency for reduced CVM and improved Hr-QoL.
Evidence Category:
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X
A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
- Important metabolic pathways in the cells require adequate supply of coenzyme Q10 (CoQ10) and selenoproteins for optimal functioning, however endogenous CoQ10 production decreases with age.
- Previous research reports selenium and CoQ10 supplementation reduced cardiovascular mortality (CVM) and improved health related quality of life (Hr-QoL) in the elderly with low selenium intake.
- Less focus has been on low selenium in thyroid hormone regulation and the association with CVM and Hr-QoL, therefore this study aimed to evaluate an intervention of selenium and CoQ10 on thyroid hormonal status, CVM and Hr-QoL.
Methods
- A randomised, placebo-controlled, double-blind 4-year study was executed with 414 participants aged between 70-88, identified with low selenium.
- 210 individuals were randomised to active intervention of selenium yeast (200μg/day) and CoQ10 (200mg/day) and 204 to placebo.
- Changes in hormone concentrations were assessed using t-tests, repeated measures of variance and ANCOVA, while CVM and Hr-QoL were evaluated with Short Form-36 (SF-36).
Results
- In the supplementation group there was a significant increase in free triiodothyronine (fT3) and reverse triiodothyronine (rT3), and a significant decrease in free thyroxine (fT4) and thyroid stimulating hormone (TSH) levels compared with placebo (p=0.03 in each).
- In the placebo group, TSH and fT4 above median values were correlated with increased 10-year CVM compared with mortality risk in those with TSH and fT4 below median (p<0.04 in both).
- In the supplementation group there was no difference in mortality rate according to TSH and fT4 levels.
- In the placebo group, TSH > and fT3 < median were correlated with a decline in items of Hr-QoL such as ‘vitality’, ‘bodily pain’ and social function’ as well as ‘composite physical score’ compared to those with TSH < and fT3 > median over 4 years.
- In the supplementation group there was no difference in Hr-QoL according to TSH and fT3 levels.
Conclusion
- Selenium and CoQ10 supplementation has a positive effect on thyroid hormones with reduced CVM and improved Hr-QoL in older adults.
- Changes in thyroid hormones may be explained by increased selenium-dependent deiodinases, important enzymes in thyroid hormone homeostasis.
Clinical practice applications:
- In light of these findings, routine testing of thyroid hormone levels of TSH, T3 and T4 is advisable.
- Individuals with low selenium concentrations presented with significantly higher TSH levels and higher CVM compared to those with higher selenium, thus monitoring those who may be at risk of low selenium status, may be prudent.
- Supplementation with selenium may help to restore deiodinase activity and thyroid hormone balance as well as have clinical implications for reduced CVM and inflammation.
Considerations for future research:
- Further research is needed to explore the impact of selenium status on human physiology.
- As results are reported as hypothesis generating, future research is necessary and would benefit from a more diverse ethnicity rather than only Caucasians, as well as a broader age range. Evaluation of hypothyroidism symptoms, as well as general health symptoms and risk factors for CVM would be of interest.
- Evaluation of C-reactive protein concentration in relation to T3 levels and relationship between inflammation, oxidative stress and selenium may be helpful.
Abstract
BACKGROUND Selenium-dependent deiodinases play a central role in thyroid hormone regulation and metabolism. In many European countries, insufficient selenium intake may consequently lead to adverse effects on thyroid function. In this randomised placebo-controlled double-blind study, we examined the effect of supplementation with selenium and coenzyme Q10 on thyroid hormonal status, cardiovascular (CV) mortality and health-related quality of life (Hr-QoL). METHODS Free T3, free T4, reverse T3, and TSH were determined in 414 individuals at baseline, and the effect of selenium yeast (200 µg/day) and coenzyme Q10 (200 mg/day) supplementation on hormone concentrations, CV mortality and Hr-QoL was evaluated after 48 months using Short Form 36 (SF-36). Pre-intervention plasma selenium was low, mean 67 µg/L, corresponding to an estimated intake of 35 µg/day. Changes in concentrations of thyroid hormones following the intervention were assessed using T-tests, repeated measures of variance, and ANCOVA analyses. RESULTS In the total population, the group with the lowest selenium concentration at baseline presented with significantly higher levels of TSH and lower levels of fT3 as compared to subjects with the highest selenium concentration. Supplementation with selenium and coenzyme Q10 for 4 years significantly increased fT3 and rT3, decreased fT4, and diminished the increase in TSH levels compared with placebo treatment (p = 0.03, all). In the placebo group, TSH and fT4 values above the median were associated with an increase in 10-year CV mortality, as compared with the mortality rate among those with TSH and fT4 below the median (p < 0.04, both), with no difference in mortality rate according to TSH and fT4 levels in the active intervention group. Similarly, TSH > median and fT3 < median were associated with a decline in mental Hr-QoL measures vs. TSH < and fT3 > median in the placebo group during 4 years of follow-up, but this was wiped out in the active group. CONCLUSIONS Supplementation with selenium and coenzyme Q10 had a beneficial effect on thyroid hormones with respect to CV mortality and Hr-QoL outcomes. The initial deficient selenium status was associated with an impaired thyroid function and the changes in thyroid hormone levels can be explained by increased activity of deiodinases. We conclude that a substantial part of the elderly study population might suffer from suboptimal thyroidal function with adverse clinical implications due to selenium deficiency. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov and has the identifier NCT01443780. Since it was not mandatory to register at the time the study began, the study has been registered retrospectively.
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8.
Mitochondria in health and disease
Alex Manos is one of the UK’s leading Functional Medicine practitioners who specialises in SIBO and gut-related disorders, as well as mould illness and mycotoxins. He is also very passionate about physical therapy, movement, resiliency, life coaching, nutritional therapy, and biohacking. He is a lecturer at various colleges and institutions including the Institute of Optimum Nutrition (ION) and on the MSc program at The Centre For Nutritional Education and Lifestyle Management (CNELM).
2023
Abstract
An enlightening conversation between Alex and Ray Griffiths about the importance of mitochondria in health and disease, to the extent that Ray has written a whole book on this topic. They delve into the mechanisms and explore how mitochondria orchestrate numerous processes in our cells and not just energy production. They discuss mitochondrial dysfunction and ways to support mitochondria including potential functional laboratory testing options. Ray believes that as practitioners, we should be looking at the research to see how mitochondria may be involved in the pathophysiology of any health condition that we are presented with, such is their key role as environmental sensors in the body.
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Plum supplementation and lipid profile: a systematic review and meta-analysis of randomised controlled trials.
Askarpour, M, Ghalandari, H, Setayesh, L, Ghaedi, E
Journal of nutritional science. 2023;12:e6
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The rate of nutrition-related non-communicable diseases is increasing worldwide. Lipid profile and its alterations have been used both as indicators of metabolic disorders and methods to evaluate patients’ response to dietary interventions. The aim of this study was to investigate the effectiveness of plums on improving parameters of lipid profile. This study is a systematic review and meta-analysis of nine randomised controlled trials with a total of eleven arms and 592 participants. Results show that plum can be beneficial in reducing triacylglycerols [triglycerides] in the unhealthy and low-density lipoprotein cholesterol in all individuals. However, no significant impact regarding blood triacylglycerols and high-density lipoprotein cholesterol levels, could be detected both in crude and subgroup analyses. Authors conclude that further clinical trials, taking advantage of a standard protocol of plum supplementation, should be conducted to elucidate the possible effect that plum supplementation might exert on lipid profile parameters.
Abstract
Plums are abundant in bioactive compounds which have been associated with numerous health benefits. In the present study, we aimed at examining the impact of plum supplementation on lipid profile of individuals. Electronic bibliographical databases were searched for relevant randomised clinical trials. Articles meeting our eligibility criteria were included for data extraction and final analysis. Weighted mean difference (WMD) was estimated using a random-effect model. Of the total articles retrieved in the initial search, nine articles were found to be eligible to be included in the analysis. Our results show that plum supplementation significantly improves total cholesterols levels in the unhealthy individuals. Moreover, plum supplementation reduces the LDL-c levels in the pooled sample (WMD = -11⋅52 mg/dl; 95 % CI -21⋅93, -1⋅11, P = 0⋅03, I 2 = 98⋅7 %) and also in some of the subgroups of individuals (dried plum, unhealthy subjects, duration more than 8 weeks). Moreover, it had a significant reducing effect on TC levels just in unhealthy subjects. Although plum supplementation did not have any significant impact on serum levels of TG nor HDL-c. Our results show that supplementation with plums is potentially effective in reducing serum total cholesterol and LDL-c.
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10.
Comparative effects of vitamin and mineral supplements in the management of type 2 diabetes in primary care: A systematic review and network meta-analysis of randomized controlled trials.
Xia, J, Yu, J, Xu, H, Zhou, Y, Li, H, Yin, S, Xu, D, Wang, Y, Xia, H, Liao, W, et al
Pharmacological research. 2023;188:106647
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Type 2 diabetes mellitus (T2DM), characterised by sustained hyperglycaemia and insulin resistance, remains a severe driver of chronic metabolic diseases such as cardiovascular diseases. The aim of this study was to investigate and compare the efficacy of vitamin and mineral supplements in the management of glycaemic control and lipid metabolism for type 2 diabetic patients to inform clinical practice. This study is a systematic review and meta-analysis of one hundred and seventy articles with a total of 4223 adults with T2DM. Participants were randomised to either the placebo/no treatment group (n= 6345) or to the treatment group (n= 7878). Results show that: - chromium was the most effective micronutrient for decreasing fasting blood glucose and insulin resistance. - vitamin K was the top-ranked micronutrient in reducing haemoglobin A1C and fasting insulin levels. - vanadium was the top-ranked micronutrient in total cholesterol reductions. - niacin was ranked as the most effective in triglycerides reductions and increasing high-density lipoprotein cholesterol levels. - vitamin E was the top-ranked micronutrient in low-density lipoprotein cholesterol reductions. Authors conclude that micronutrient supplements especially chromium, vitamin E, vitamin K, vanadium, and niacin supplements, may be more effective in the management of T2DM compared with other micronutrients.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Clinicians could consider the adjunctive effect of micronutrients supplements, such as chromium, vitamin E, vitamin K, vanadium, and niacin supplements in a nutrition protocol to manage T2DM and slow or prevent its complications.
- The study authors state that the vitamin and mineral supplements under review had a statistically significant improvement, however they did not reach the study threshold for clinical significance. Therefore they advise caution in utilising micronutrient supplements in the management of glucose and lipid metabolism for T2DM.
Evidence Category:
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X
A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Objectives
The aim of this systematic review was to evaluate the comparative effects of vitamin and mineral supplements on managing glycemic control and lipid metabolism for type 2 diabetes mellitus (T2DM).
Methodology
This systematic review is registered with PROSPERO and adhered to PRISMA-2020 guidelines for network meta-analysis
The Cochrane Collaboration’s risk-of-bias tool was used to assess eligible randomised trials
8 prespecified markers identified and assessed in this study : 1) HbA1c (%), 2) fasting blood glucose (mmol/L), 3) total cholesterol (mmol/L), 4) triglycerides (mmol/L), 5) fasting insulin (μIU/mL), 6) HOMA-IR, 7) LDL-c (mmol/L), and 8) HDL-c (mmol/L).
Results
- 170 RCT trials of 14223 participants with T2DM treated with vitamin supplements, mineral supplements, or placebo/no treatment were included
- Low to very low certainty evidence established chromium supplements as the most effective in reducing fasting blood glucose levels and homeostasis model assessment of insulin resistance (SUCRAs: 90.4% and 78.3%, respectively)
- Vitamin K supplements ranked best in reducing glycated haemoglobin A1c and fasting insulin levels (SUCRAs: 97.0% and 82.3%, respectively), with moderate to very low certainty evidence
- Vanadium supplements ranked best in lowering total cholesterol levels with very low evidence certainty (SUCRAs:100%)
- Niacin supplements ranked best in triglyceride reductions and increasing high-density lipo-protein cholesterol levels with low to very low evidence certainty (SUCRAs:93.7% and 94.6%, respectively)
- Vitamin E supplements ranked best in reducing low-density lipoprotein cholesterol levels with very low evidence certainty (SUCRAs:80.0%).
Conclusion
- Micronutrient supplements, such as chromium, vitamin E, vitamin K, vanadium, and niacin supplements, may be efficacious in managing T2DM
- It should be noted that the evidence certainty for all was low.
Clinical practice applications:
- Chromium plays an important role in carbohydrate and lipid metabolism and was the most effective micronutrient for decreasing fasting blood glucose, HbA1c, fasting insulin, and HOMA-IR reductions. More pronounced effects were seen for chromium than vitamin E, vitamin C, niacin, selenium, and magnesium supplements
- Vitamin K was the top-ranked micronutrient in reducing HbA1c and fasting insulin levels. The mechanism through which Vitamin K affects glucose metabolism is proposed as activation of the AMP-activated protein kinase/sirtuin 1, that in turn increases phosphocreatine 3-kinase and glucose transporter 2 to decrease insulin resistance and fasting glucose.
- Vanadium was the top-ranked micronutrient in total cholesterol (TC) reductions, where supplementation dosage should be carefully considered, as vanadium compounds can be moderately or highly toxic. Vanadium supplementation is only recommended in cases of vanadium deficiency or diabetes, hyperlipidemia, and hypertension, where the intake of vanadium from food should be enhanced in preference to supplementation
- Niacin was ranked as the most effective in triglyceride (TG) reductions and increasing HDL cholesterol levels. The dose of niacin could not be determined
- Vitamin E was the top-ranked micronutrient in low-density lipo- protein (LDL) cholesterol reductions.
Considerations for future research:
- Considering the clinical importance of these findings, new research is needed to get better insight into the efficacy of micronutrient supplements in managing T2DM
- Selenium homeostasis, selenoprotein, insulin signaling/secretion, and carbohydrate/lipid metabolism are linked in multiple and complex ways but the authors could not explain why chromium supplementation would lower blood glucose more effectively than selenium supplementation, and suggest more research is needed to clarify this
- While vitamin K status could be an emerging treatment target in T2DM prevention and management, it remains to be determined whether vitamin K supplementation has an advantage over other nutrients in terms of hypoglycemic effect, and further research is necessary
- The beneficial effect of vitamin E and niacin supplements regarding lipid metabolism warrant investigation through more rigorous comparative studies.
Abstract
Medical nutrition treatment can manage diabetes and slow or prevent its complications. The comparative effects of micronutrient supplements, however, have not yet been well established. We aimed at evaluating the comparative effects of vitamin and mineral supplements on managing glycemic control and lipid metabolism for type 2 diabetes mellitus (T2DM) to inform clinical practice. Electronic and hand searches for randomized controlled trials (RCTs) were performed until June 1, 2022. We selected RCTs enrolling patients with T2DM who were treated with vitamin supplements, mineral supplements, or placebo/no treatment. Data were pooled via frequentist random-effects network meta-analyses. A total of 170 eligible trials and 14223 participants were included. Low to very low certainty evidence established chromium supplements as the most effective in reducing fasting blood glucose levels and homeostasis model assessment of insulin resistance (SUCRAs: 90.4% and 78.3%, respectively). Vitamin K supplements ranked best in reducing glycated hemoglobin A1c and fasting insulin levels (SUCRAs: 97.0% and 82.3%, respectively), with moderate to very low certainty evidence. Vanadium supplements ranked best in lowering total cholesterol levels with very low evidence certainty (SUCRAs:100%). Niacin supplements ranked best in triglyceride reductions and increasing high-density lipoprotein cholesterol levels with low to very low evidence certainty (SUCRAs:93.7% and 94.6%, respectively). Vitamin E supplements ranked best in reducing low-density lipoprotein cholesterol levels with very low evidence certainty (SUCRAs:80.0%). Our analyses indicated that micronutrient supplements, especially chromium, vitamin E, vitamin K, vanadium, and niacin supplements, may be more efficacious in managing T2DM than other micronutrients. Considering the clinical importance of these findings, new research is needed to get better insight into this issue.