The Female(?) Athlete Triad - Part II/III: LH, GH, IGF1, Insulin, Ghrelin, Leptin & Co Form a Self-Perpetuating Vicious Cycle

I usually rant against pizza and beer, but once the athlete triad has struck, they can be an occasional part of the "healing protocol".

In last Sunday's first installment of this series we have taken a look at the prevalence, etiology and fundamental cause of an entity that is, and I am repeating myself here, profoundly mislabeled as the "female athlete triad". In fact, it is, as we have learned in the last installment, neither an exclusively female thing, nor a triad. If anything, it is a quintet or sextet. To make that clear, and give you guys, who make the same mistakes, but usually with less detrimental consequences, I will once more refer to it as "athlete triad" = AT,  in this second part of the Female(?) Athlete Triad Series in which we will take a look at the endocrine underpinnings of the previously described consequences of the temporary and long-term energy deficiency we have identified as the single most important causative factor of the onset of the "triad" last Sunday.

Which endocrine factors are figuring, here?

Instead of overwhelming you with the details right from the start, I decided to compile a list based on a cross-section of the dozens of articles I have read in the course of my eventually futile quest for a single definitive answer to the question, "Which hormonal or metabolic consequence of restrictive eating and excessive training is to blame for the fatigue, the low sex hormones concentration,the  bone resorption, the anemia, the absence of menses / lack of libido, the performance decreases and the whole string of pathological features, we have explored in the last installment?"

"Refeeding is not an option, because you will only become fat!" FALSE! Yet another myth without substantial scientific foundation that probably arises from the disturbed self-perception of those affected by AT and AN. In fact, the fat stores are the last thing that will be restored (Golden. 2004). This is probably also one of the reasons why "refeeding" often does not appear to work, because the basal energy requirements will increase with every pound of lean tissue you add back to your frame, so that athletes suffering from the "triad" will have to continuously increase their energy consumption. Unfortunately, most athletes will fail to do the former (also because exercise & stress can blunt hunger) and instead react with an increase in workout intensity, now that they are finally able to work out, again. This, in turn, will restore or even exacerbate the energy deficit and thus worsen not improve their physiological problems, even if their scale shows that they have already gained 5-10kg. If you take a look at figure 1 you will also realize that, at least in women, a baseline level of total (not relative!) body fat appears to be necessary to maintain regular menses (in men to maintain normal total testosterone & SHBG, but not so much free testosterone levels or reproductive function).

• low luteinizing levels are unquestionably among the elemental features and causally responsible for the occurance of menstrual disorders / lack of libido and the correspondingly low estrogen and testosterone levels in women and men
• TSH levels are not a valid / reliable indicator for the presence of absence of AT, because they can be both slightly increased or normal in the presence of low T4 and low T3 levels, as  - and this is far more often the case - TSH can be low despite low free thyroid hormone levels (usually in the presence of a low T3/rt3 ratio; if anything this would be a good indicator of beginning or full-blown AT)
• the circadian cortisol rhythm is whacked in men and women, alike; characteristic are the absence of an appropriate cortisol spike in the morning as well as the normal decline in cortisol levels  in the course of the day; metaphorically speaking, as the athletes triad progresses, the "mountain range" turns into mesa and eventually into a plane lowland
• the quartet of (mostly) sub-clinical hypogylcemia, low insulin, extreme high / or totally blunted insulin sensitivity, low IGF-1 and high catecholamine levels cannot be seen in isolation, most detrimental are yet probably the first and last of these four glucose-related players in the AT concert, as the former entails the constant risk to run out of "brain fuel" (in the absence of alternative fuel sources) and can - in the absence of adequate corticosteroid expression - become potentially life-threatening and the latter, i.e. low IGF-1 levels and very low IGF-1 to IGF1 binding protein 4 being one of the, if not the central factor involved in the the long-term physical decline of muscle, bone, organ and even brain mass.

As I have repeatedly emphasized in the last installment, the underlying cause, the trigger, maintaining factor and thus most important setscrew of the athlete triad (female or male) is an over-exaggerated and / or  long-lasting (weeks to months, in the worst case years; see Sundgot-Borgen. 2000) discrepancy between energy intake and expenditure, your body will initially try, but eventually fail to compensate by

• tapping into its energy stores in form of body fat, muscle and organ mass, the insulating fat around nerves and organs, etc.,
• continuously decreasing its metabolic activity (esp. thyroid metabolism),
• shutting down non-vital, but energy-intensive (e.g. immune and reproductive system) bodily functions, to prioritize short term survival of the individual over long-term survival and the conservation of the species

Therefore it is an indispensable and in many cases even sufficient prerequisite to restore an adequate supply of nutrients, and abolish temporarily better reverse the discrepancy between "energy in" and  "energy out" (please read the information in the red box next to the list of the previous paragraph, as well).

And what about leptin, ghrelin, adiponectin ... ?

Figure 1: In female athletes, only total fat mass, not body fat % or BMI are associated w/ AT (here identified by amenorrhea; top, left); the correspondingly low pulsatile (not baseline, see lower left) of LH correlate negatively with ghrelin and positively with leptin (top, right); while LH and leptin show a lack of pulsality, the ghrelin levels are not simply elevated, they also have a higher pulse size, amplitude and total polsatile secretion compared to control and eumenorrhetic athletes (bottom; LH, ghrelin, leptin expressed relative to non-athletic control; based on Ackerman. 2013)

Similar to the facilitative effects of the "hunger high", the "evolutionary advantage" that's turning its ugly face on everyone, who's willing to dig a deep enough whole (see Part I), the endocrine imbalances, as well as the reduced leptin) or over-pronounced (adiponectin) release of adipokines and the disturbances of the glucose, fatty acid and cholesterol metabolism start to take on a life of their own.

And as if that alone would not already make it difficult enough to separate cause and effect, it does actually appear likely that the order may even be reversed over time - not unlike the chicken that will hatch and eventually lay an egg. 

As discussed in the last installment, the combination of over-exercising and fasting, which may at time-point T0 actually have been the root cause of the problem will often turn into a strategy to stave off the impeding total breakdown. It becomes sort of a conditioned response to the constant starvation, which  will then no longer manifest itself in the form of hunger, but as anxiety and an almost compulsive urge to exercise (this is particularly well-established for anorexics; Teufel. 2008). And while the latter can be motivated by the desire to increase athletic performance and/or lose even more body fat, it does have a very real, often under-appreciated, physiological underpinning.

If you like, you could argue that the urge of the starved athlete to exercise is yet another "evolutionary conserved" automatism that mirrors the well-known food-seeking behavior rodents display  in periods of food deprivation and in response to the stimulatory effects of ghrelin on the orexin neurons in the brain (Yamanaka. 2003).

From ghrelin to growth hormone to IGF-1 and back

At the same time, the combination of exercise, low triglyceride, low free fatty acid and exuberant levels of the "hunger hormone" ghrelin leads to an overexpression of growth hormone (Scacci. 2003), subsequent increases in adiponectin (Wölfing. 2008), which will in turn decrease progesterone and androstenedione production and LH receptor expression in ovarian cells (Lagaly. 2008) and GnRH and LH release in the pituitary (Rodriguez-Pacheco. 2007; Lu. 2008). The surprisingly high adiponectin levels (surprisingly in view of the often dangerously low levels of adipokine producing body fat) will further increase the borderline pathological insulin sensitivity and thus lower the already rock bottom blood glucose and basal, as well as (post-)prandial insulin levels even further.

Figure 2: Illustration of the self-perpetuating vicious cycle of the athlete's triad (AT)

With their suppressive effect on leptin (Böni-Schnetzler. 1999), the high growth hormone levels and low body fat reserves are probably the most important contributers to the pathologically low, in fact quasi non-existent basal leptin secretion (see figure 1). And the low insulin levels don't just compromise the normal food-induced prandial suppression of ghrelin (Murdolo. 2003), they also hamper the production of IGF-1 (especially in the liver), so that athletes who suffer from the "triad" cannot derive any anabolic benefits from their high growth hormone levels, since the latter are largely mediated by the stimulatory effect of growth hormone on the production of IGF-1... what you are seeing here is thus a self-perpetuating vicious circle, you can extricate yourself from only by a multi-faceted approach the pillars of which are an..

* in view of the insulinogenic effects of whey and the pro-IGF-1 effects of casein (Hoppe. 2009), and the anti-catabolic effects of CLA & omega-3 you should - if by any means possible - incorporate dairy products from preferably grass fed dairy (butter, milk, cheese, yoghurt, quark / curd cheese, fermented dairy and if you want protein powders) in your diet regularly, better daily.

1. adequate and continuous energy supply to control ghrelin levels and help stabilize blood sugar (and thus glucocorticoid) levels and restore normal leptin and adiponectin expression,
2. increased low GI (to avoid reactive hypoglycemia) carbohydrate and protein intakes to normalize glucose levels, suppress ghrelin, increase insulin and IGF-1 levels* (Foster-Schubert. 2008; suggested read: "Carbohydrate Shortage in Paleo Land"),
3. balanced intakes of all types of natural fats, with an emphasis on long-chain PUFAs from food including a reasonable amount of "bad" omega-6 fatty acids and w/out fish oil or other omega-3 supplements, which would further blunt the already compromised glucocorticoid response and the leptin secretion (Kratz. 2002; suggested read "Omega-3 and Low Cortisol"), and
4. profound reductions in training volume to lower GH, cortisol, catecholamin and energy requirements and a (temporary) reorientation towards low volume strength training that will help increase bone density and IGF-1 expression (Davee. 1990)

Now, this may sound hilarious, but for the time being, laziness, pizza and beer - in moderation - are actually your friends. In that, I am not suggesting that you have to copy the patient, Chris Kresser mentioned several times on the old "Healthy Skeptic" podcasts (now RHR) about a client, who "cured" his longstanding physiological, and as I suspect psychological problems with pizza and beer, but the third pillar of this guy's regimen is actually a must: Go out with friends and start to enjoy your life again! Without thinking about food and exercise and sticking to whatever form of restrictive "diet" all the time.

Figure 3: Development of BMI (blue), leptin (red), adiponectin (green) levels in 8 female adolescent malnourished AN patients (based on Modan-Moses. 2007)

Apropos, third pillar. I have already had my short intense workout for the day, I have eaten well, but I have not hung out with friends. In other words, I will postpone the in-depth discussion of the energy and nutrient requirements, useful and detrimental supplements and medications, as well as necessary and facilitative tweaks to your workout routine to the next week, add another Roman "I" to the second "II" in "Part II/II" in the preliminary headline of this post and leave you (hopefully not too frustrated) with the graphical illustration of the effects re-feeding, alone, and a normalization of the body weight from a BMI of 16kg/m² to ~19kg/m² can have on the skewed basal leptin and adiponectin in figure 3.

In view of the fact that other studies have shown that this increase in weight, which must not be confused with a mere increase in adiposity, i.e. body fat percentage (go back to figure 1 if you already forgot that the absolute not the relative fat mass counts and please remember that the latter includes the fat in the myelin sheaths of your nerves, the protective fat around the organs, the fat in your brain etc.), does help with the normalization of both insulin and ghrelin (Otto. 2001), growth hormone and IGF-1 (Argente. 1997) and is in some cases even sufficient to restore most of the endocrine abnormalities (Scheid. 2010), many of the lessons we will learn in the next (and according to my current plans last ;-) installment can also be applied to a lean bulk - and that goes irrespective of your gender and your whether or not you have already fallen victim to the athlete triad!

References

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Trimethylglycine aka Betaine Sets the Anabolic Stage for Increased Muscle Growth: Higher IGF-1 & Lower Cortisol - Statistically Significant, but Physiologically (Ir-)Relevant?

Figure 1: Betaine content (in mg/100g) in some common food items (data based on Craig. 2004). Makes me wonder if Popeye ate wheat germ as well or whether he was celiac and stuck to spinach to get his daily dose of pro-anabolic betaine?

Trimethylglycine (TMG) the sciency name for a molecule most of you probably know by the name "betaine" is actually no longer a new-comer to the supplement scene (please note that this is not betaine HCL(!), the stuff you will find in digestive aids). I have already written about its purported ergogenic effects several times and there are actually quite a handful of proprietary blends with mostly undisclosed, but judged based on the total serving size and amount of ingredients in them, hilariously underdosed amounts of the zwitterionic compound and a methyl derivative of glycine in it on the market.

Friends and followers of the SuppVersity will also be aware that betaine is also found naturally in a variety of food sources such as sugar beets, wheat bran, spinach, shrimp, and many others (see figure 1) and that it can be synthesized from choline in your body, when dietary intake exceeds your current metabolic demands (Ueland 2011).

What you probably don't know, however, is...

... that the latest study from the Human Performance Laboratory at the Department of Kinesiology,
of the University of Connecticut, shows that "betaine (vs. placebo) supplementation enhanced
both the anabolic endocrine profile and the corresponding anabolic signaling environment, suggesting increased protein synthesis" (Apicella. 2013).

Figure 2: Effects of a standardized full-body workout (see text for details) on growth hormone (µmol/L), IGF-1 (nmol/L) and cortisol (µmol/L) levels in 12 recreationally trained young men after 2 weeks supplementation with betaine (2x 1.5g/day) or placebo (data based on Apicella. 2013)

And if we temporarily lose sight of the fact that the devil is in the detail, the data in figure 2 certainly looks as if you should run to the next best store with fishing equipment and get yourself a huge pot of trimethylglycine, of which the shop assistant will probably tell you that "This is a good choice Sir! The carps love the sweet taste!" But I am digressing, so let's get back to what's really sweet, namely ...

• stable growth hormone levels (vs. -17% in the placebo group)
• an 18% increase in IGF-1 (vs. a -10% decrease in the placebo group), and
• a -5% reduction in cortisol (vs. a 6% increase in the placebo group)

- they all sound pretty sweet, as well. Especially in conjunction with the stable p-AKT levels the scientists observed, when they analyzed the tissue samples. Unfortunately (but earnestly), Apicella et al.'s conclusion, still contains one word, too many people who read the abstract, are probably going to ignore:

"Betaine (vs. placebo) supplementation enhanced both the anabolic endocrine profile and the corresponding anabolic signaling environment, suggesting increased protein synthesis." (Apicella. 2013; my emphases)

Which one is it? A tip: It is none of the words I emphasized in bold. After all, that would make it way too easy for you... ha? Yeah! I see you've done your homework. Suggest(-ing) is in fact the most important word in this and the conclusions of many objectively written scientific papers.

So, the study "suggests increased protein synthesis"...

... and this means it does not even prove that the protein synthetic response in the immediate vicinity of the workout was increased in response to the to the two weeks of BID (=twice daily) supplementation with 1.25 g of betaine. In other words, all we know is that the funky gene essays for p-AKT and serum tests for growth hormone, IGF-1 and cortisol "suggest" that it could be the case, if we assume that marginally higher IGF-1 levels, stable growth hormone levels and lower cortisol levels (rememeber we are not talking about increasing any of them into the supraphysiological range, here) would

1. result in increased protein synthesis and ultimately
2. greater lean mass accrual,

because, if we are honest, no one is interested in a number you can measure, when you infuse a marked amino acid into the circulation and check how much of it goes into the muscle, but doesn't come out of it, afterwards.

Something to remember: What I find remarkable - and this is by no means something you will see only in this study, neither is it "fraud" or whatever, is how by simply adding a break into the Y-axes of the graph and thus omitting the lower 80% of the bar Apicella et al. give the impression that the effects on IGF-1 were more than twice as large than they actually are... remember that, because you will encounter that in many studies, and reproductions of graphs from scientific papers, especially if they are used to market certain products.

What we want is to get bigger, stronger and all that faster, and whether the 12 recreationally trained men (age 19.7±1.2 years; lean body mass 65.2±8.8 kg; fat mass 15.6±8.5 kg; body fat percentage 18.7±7.0 %; BMI 28.2±4.0) would have gained even a single inch of muscle more on whatever body part, if they had performed a real workout instead of the funky "AES" (=acute exercise session) that consisted of

• 10x maximal vertical jumps without pause, 
• 1x 10-s isometric squat, 
• 1x 10-s isometric bench press on a smith machine, and
• 1x 10 min of repeated box lifting (RBL)

is more or less guesswork. In view of the previously discussed results from the researchers at the McMasters University in Ontario (see "Anabolic Workouts Revisited"; a brief reminder. the systemic hormonal response to an acute exercise bout is irrelevant, if anything higher cortisol levels correlate with greater increases in lean muscle mass) and the "statistically significant", but physiologically probably irrelevant increases and decreases in IGF-1 and cortisol at least highly questionably (please take a look at the additional information in the red box to the right, as well).

... but there are still way too many "ifs" in here!

The sheer number of "suggests", "is touted", "is likely", "also possible", "as we presume", etc. is honest and speaks in favor of the quality of the study, but against the reliability of the statement that followeed the initially cited "suggests" in the conclusion. Moreover, the researchers freely admit that...

"[...] the mechanisms by which betaine may have affected the hormones measured in this study are still unclear and require further research" (Apicella. 2013)

so that even the fact that betaine is an organic osmolyte and could thus help stabilize skeletal muscle protein, promote / maintain optimal hydration and protect against

• hypertonic stress (Alfier. 2006), 
• urea-induced inactivation of muscle myosin ATPases (Ortiz-Costa. 2002), and 
• structural changes in myosin due to urea accumulation (Ortiz-Costa. 2002)

does lend credibility to the hypothesis that betaine could help you build muscle, but it does not prove it. In conjunction with the results of previous trials, like...

Betaine does not increase nitric oxide While I have no idea why everyone is so keen about those nitrate supplements, one thing is for sure: Betaine has no effects on serum nitrate or nitrite levels. The vasolidation effect of beet roots / beet root juice is simply a result of the nitrate that's in there along with the betaine (+ the sugar and the insulin spike, which will also trigger an increased NO-response).

At least this is what a study by Bloomer et al. which consisted of three independent experiments using 1.25 and 5.00g B, acutely, 2.5g per day for 14 days, chronically, and a combination of chronic (6g for 7 days) + acute (6g acutely before the test) betaine supplementation (Bloomer. 2011).

• Hoffman. 2009 - 2.5/day for 14 days; jump squat, squat, bench press; "Two-weeks of betaine supplementation in active, college males appeared to improve muscle endurance of the squat exercise, and increase the quality of repetitions performed." 
• Lee. 2010 - 2x 1.25g/day for 14 days; bench squat and jump tests; "[Betaine] supplementation increased power, force and maintenance of these measures in selected performance measures, and these were more apparent in the smaller upper-body muscle groups."
• Hoffman. 2011 -  2.5g/day for 15 days; 5 training + testing sessions; "15 days of betaine supplementation did not increase peak CON or ECC force outputs during an isokinetic chest press but did appear to reduce subjective measures of fatigue to the exercise protocol"
• Trepanoswki. 2011 - 2.5g/day for 14 days; resistance training; "moderate increase in total repetitions and volume load in the bench press exercise, without favorably impacting other performance measures."
• del Favero. 2013 - 2g/day for 10 days; muscle strength and power, muscle PCr content, and body composition, three "familiarization sessions" preparing the participants only to perform the tests; "we showed that betaine supplementation combined or not with creatine supplementation does not affect strength and power performance in untrained subjects."
• Pryor. 2013 - 2.5g/day for 7 days; cycling performance; "betaine ingestion significantly increased average peak power (3.4%; p = 0.026), maximum peak power max (3.8%; p = 0.007), average mean power (3.3%; p = 0.034), and maximum mean power (3.5%; p = 0.011) in recreationally active males and females"

... there is still room for long-term improvements in muscle gains as a consequence of the general ergogenic effects of betaine (every rep more counts!), but it appears unlikely that the "anabolic" hormonal milieu observed in the study at hand are the fundamental cause of the latter.

Reminder: If you want to try it, you got to get yourself "trimethylglycine" (TMG) not "betaine HCL" and you better don't buy it in capped form if you don't have lots of money to burn. I just checked with the next best bulk supplier - they got 1kg for $33.50. Even if you double dose, i.e. take 2x 2.5g per day (most studies mixed it with Gatorade) this will last you for 200days(!), which is probably the time it will take until you can actually see and not just measure any potential, possible, suggested, etc. anabolic effects ;-)

References:

• Alfieri RR, Bonelli MA, Cavazzoni A et al (2006) Creatine as a compatible osmolyte in muscle cells exposed to hypertonic stress. J Physiol 576:391–401.
• Bloomer RJ, Farney TM, Trepanowski JF, McCarthy CG, Canale RE. Effect of betaine supplementation on plasma nitrate/nitrite in exercise-trained men. J Int Soc Sports Nutr. 2011 Mar 18;8:5.
• Craig SA. Betaine in human nutrition. Am J Clin Nutr. 2004; 80: 539–549.
• del Favero S, Roschel H, Artioli G, Ugrinowitsch C, Tricoli V, Costa A, Barroso R, Negrelli AL, Otaduy MC, da Costa Leite C, Lancha-Junior AH, Gualano B. Creatine but not betaine supplementation increases muscle phosphorylcreatine content and strength performance. Amino Acids. 2013 Jun;42(6):2299-305.
• Hoffman JR, Ratamess NA, Kang J, Rashti SL, Faigenbaum AD. Effect of betaine supplementation on power performance and fatigue. J Int Soc Sports Nutr. 2009 Feb 27;6:7.
• Hoffman JR, Ratamess NA, Kang J, Gonzalez AM, Beller NA, Craig SA. Effect of 15 days of betaine ingestion on concentric and eccentric force outputs during isokinetic exercise. J Strength Cond Res. 2011 Aug;25(8):2235-41.
• Lee EC, Maresh CM, Kraemer WJ, Yamamoto LM, Hatfield DL, Bailey BL, Armstrong LE, Volek JS, McDermott BP, Craig SA. Ergogenic effects of betaine supplementation on strength and power performance. J Int Soc Sports Nutr. 2010 Jul 19;7:27. 
• Ortiz-Costa S, Sorenson MM, Sola-Penna M (2002) Counteracting effects of urea and methylamines in function and structure of skeletal muscle myosin. Arch Biochem Biophys 408:272–278
• Pryor JL, Craig SA, Swensen T. Effect of betaine supplementation on cycling sprint performance. J Int Soc Sports Nutr. 2013 Apr 3;9(1):12.
• Trepanowski JF, Farney TM, McCarthy CG, Schilling BK, Craig SA, Bloomer RJ. The effects of chronic betaine supplementation on exercise performance, skeletal muscle oxygen saturation and associated biochemical parameters in resistance trained men. J Strength Cond Res. 2011 Dec;25(12):3461-71.
• Ueland PM. Choline and betaine in health and disease. J Inherit Metab Dis. 2011;34:3–15.

Exercise Science - True of False? Large Muscles First for Growth? Cooling Works Before & After Workouts? Senior Olympians Have Healthy Bones? Hypoxia + HIT = WIN?

I know it's difficult to resist guys, but first things first: Study confirms, you better train the large muscle groups of the upper body first, before you go progress to what many of you probably love the most... no, not what you think now, I am talking about training arms ;-)

I know that you probably think that I had forgotten about the exercise science quickie I announced in Saturday's installment of On Short Notice. Today's SuppVersity article is written proof that this is not the case. With topics that range from the redundancy of hypoxia training and intense workouts and the beneficial effects of training the large muscle groups first in your workout to the usefulness of the internal and external application of cold water and other stuff before and after workouts to elicit performance gains and speed up recovery and the unique benefits only heavy resistance training has to offer to elderly bones, I'd hope that everybody will find at least one item he / she is interested in.

And in the fortunate case that you know all the "right" to the true or false", already, you may want to pick up a couple of recent SuppVersity Facebook news to satisfy your cravings.

Adding hypoxia on top of already intense workout is probably useless

(Holis. 2013) -- No further improvement if intensity is already high!? Yep, that's at least what a recently published study by scientists from the University of Exeter would suggest. The researchers subjected 9 physically-active male participants to three weeks of intensive single-leg knee-extensor exercise training.

Erratum: Other than I initially wrote the study used identical training sessions for both legs with the sole difference being that one was trained under hypoxic and the other under normal oxygen conditions for 25 minutes (no cuffs here, thx David for the heads-up!).

Suggested read: A brief summary of a summary o the current state of the art as far as blood flow restricted (BFR) / Kaatsu training is concerned (read it).

When they evaluated the results, Holis et al. found that neither the most straight forward parameter, namely the time-to-exhaustion during incremental exercise nor the changes in muscle metabolite concentrations during the workout were significantly different between the leg that was trained under normal and that which was trained under hypoxic conditions. Now this does not necessarily mean that there may not be minimal or other benefits you could derive in the long run (I am thinking about mitochondrial biogenesis) by making an already intense routine even more intense by training under hypoxic conditions. However, if there was such an effect, it is  probably going to be minuscule and certainly not something anyone, but an Olympic athlete would benefit from.

Large muscle groups first! Common BB-wisdom confirmed once again

(Simã. 2013) -- You've certainly heard about the "growth promoting effects" of squats, deadlifts etc., right? Of course you have! And as a diligent student of the SuppVersity you will also be aware that this growth promoting effect is supposed to be the result of the workout induced endocrine response.

Want another Exercise Science Quickie? What about news on light training with high TUTs, the HIIT vs. Liss Formula for more T, DHT & cortisol and the effects your left leg has on your right one (learn about all).
.

"The results indicate that the GH concentration increased after both sessions, but the increase was significantly greater (p < 0.05) after the sequence in which larger muscle-group exercises were performed prior to the smaller muscle-group exercises. No differences were observed between sessions for TT [total testosterone], FT [free testosterone], SHBG [sex hormone binding globulin], C [cortisol], or the T/C [testosterone / cortisol] ratio at baseline or immediately after resistance exercise. These results indicate that performing larger muscle-group exercises first in an upper-body resistance-exercise session leads to a significantly greater GH response." (Simã. 2013)

Don't worry I am not going to discuss for the 1003rd time, whether the absence of any hormonal difference outside of the increased growth hormone response is good or bad for your gain. I just want your to memorize that the GH response corresponds with the workout volume, which was significantly higher, when the 20 male subjects trained the large muscle groups of the upper body before the smaller ones. So even if it was only a question of workout economy, the longstanding rule of thumb to train large muscle groups first would obviously still have its place in today's in parts sometimes ueber-scientificated workout planning.

Competitive sports is not a good means to protect your bone mineral density

(McCory. 2013) -- According to the latest study from the University of Pittsburgh Clinical and Translational Research Center old the mere participation in regular (intense), bot not strength specific physical activity alone does not offer any protective effect against age induced bone loss.

"Our results imply that participation in highly competitive senior athletics does not have a protective effect on BMD, perhaps because of a lower bodyweight or other confounding factors." (McCory. 2013)

Among the parameters which did apparently figure were (you guessed it) bodyweight, and calcium and vitamin D intake. The higher those three parameters were the better the bone mineral density.  Plus: The knee extension peak torque explained another 3.4% of the variance, but only in the hips.

Taking calcium supplement has been associated w/ prostate cancer and CVD in some, but not all studies (Baron. 2005; Spence 2013) With up to 14x elevated lead levels in some OTC calcium supplements the differences may well depend on whether you pick the wrong one (learn more).

That being said I personally believe we'd have seen very different study outcomes if the researchers had not made the common mistake of confusing "sports" with endurance exercise and would thus not have narrow-mindedly focused on those participants of the "Senior Olympics", who competed in running events longer than 400 m (n = 44; 28 males, 16 females), cycling events longer than 5K (n = 17; 11 males and 6 females), and any swimming event (n = 43; 25 males and 18 females). After all, a very recent study from the Catholic University of San Antonio did just confirm that high resistance circuit training (HRC) and heavy strength training can improve the bone mineral density in an elderly population (Romero. 2013).  And what's more, the high resistance had the added benefit of inducing significant improvements in body composition in the thirty-seven healthy men and women (61.6±5.3years) who participated in the randomized trial.

Is cooling a useful tool for performance recovery?

(Poppendieck. 2013) -- According to the latest review by scientists from the University of Saarbrücken, Germany, "the average effects of cooling on recovery of trained athletes were rather small (2.4%, g=0.28)" (Poppendieck. 2013) With a peak in performance increase roughly 4-days after the initially exercise bout and the greatest benefit being observed with endurance athletes, it does also look as if there were particular subgroups of athletes who'd benefit most: Those expose their bodies to several high intensity stimuli within a relatively short timespan, namely.

What about pre-cooling, then? With average performance increases of +8.6%, +6.0% and +4.2% endurance athletes performing open-end tests, graded exercise tests and time trials are the ones who benefit most. Similar effect was observed for intermittent sprints (+3.3%, g = 0.43), whereas performance changes were smaller during short-term, high-intensity sprints (−0.5%, g = 0.03). Across all sports included in the most recent review of the literature (Wegman. 2013), cooling the musculature before a training session will have a larger effect on performance in hot (+6.6%, g=0.62) than in moderate temperatures (+1.4%, g = 0.004).

The most promising cooling methods were cold drinks (+15.0%, g= 1.68), cooling packs (+5.6%, g = 0.70) and a cooled room (+10.7%, g = 0.49), whereas a cooling vest (+4.8%, g = 0.31) and water application (+1.2%, g = 0.21) showed only small effects. Regardless of the method, the best trained subjects (highest VO2Max) saw the greatest benefits.

For those who want to try it and don't have access to a cryotherapy chamber (effect +3.8%), I'd recommend to go "hard core" and do - irrespective of which muscle group you may have been training - a full-body water immersion. The latter has been shown to be 70% more effective than water immersion of individual body parts. The use of icepacks, on the other hand, will rather compromise than promote recovery (-1.4%).

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Two bad, one good news: The first bad news is that this was it for today - at least if you don't count the facebook news that are already available, e.g.

• Black cohosh for breast cancer prevention? The jury is still out there (learn more)
• Adiponektin does not work in women? With a low type II fiber count and correspondingly lower receptor density it is at least not as effective as in men (learn more)
• Whole grains taste like sh*t? That's at least what the participants of a recent epidemiological study thing and probably also the reason they won't eat them (learn more)

as well as as those I am still going to post within what probably would count as "today" at least for some of you.

These pics are more than 2 weeks old and I can tell you that Adelfo's "anatomy chart" physique has kept improving ;-)

The 2nd bad news is that there won't be a SuppVersity Science Round-Up tomorrow. I had hoped that my voice would recover, but since it failed me several times in the cause of the day, I heavily doubt that you would understand anything I would be grunting into the phone, anyway.

But don't worry, there is also good news. Tomorrow is one of those "every other week" Thursday's where Adelfo Cerame is "in the house" and will (at least that was the pan last week) fill you in on the differences between the current and previous content preps... and I can assure you that's going to be a post even those who are not planning to compete will probably find very useful (I hope you read this Adelfo, 'cause I am just rising the bar, here ;-)

References:

• Baron JA, Beach M, Wallace K, Grau MV, Sandler RS, Mandel JS, Heber D, Greenberg ER. Risk of prostate cancer in a randomized clinical trial of calcium supplementation. Cancer Epidemiol Biomarkers Prev. 2005 Mar;14(3):586-9.
• Holliss BA, Fulford J, Vanhatalo A, Pedlar CR, Jones AM. Influence of intermittent hypoxic training on muscle energetics and exercise tolerance. J Appl Physiol. 2013 Jan 10. 
• McCrory JL, Salacinski AJ, Hunt Sellhorst SE, Greenspan SL. Competitive Athletic Participation, Thigh Muscle Strength, And Bone Density In Elite Senior Athletes And Controls. J Strength Cond Res. 2013 Feb 25. 
• Poppendieck W, Faude O, Wegmann M, Meyer T. Cooling and Performance Recovery of Trained Athletes - a Meta-Analytical Review. Int J Sports Physiol Perform. 2013 Feb 02.
• Romero-Arenas S, Blazevich AJ, Martínez-Pascual M, Pérez-Gómez J, Luque AJ, López-Román FJ, Alcaraz PE. Effects of high-resistance circuit training in an elderly population. Exp Gerontol. 2013 Mar;48(3):334-40.
• Simão R, Leite RD, Speretta GF, Maior AS, de Salles BF, de Souza Junior TP, Vingren JL, Willardson JM. Influence of upper-body exercise order on hormonal responses in trained men. Appl Physiol Nutr Metab. 2013 Feb;38(2):177-81.
• Spence LA, Weaver CM. Calcium intake, vascular calcification, and vascular disease. Nutr Rev. 2013 Jan;71(1):15-22.
• Wegmann M, Faude O, Poppendieck W, Hecksteden A, Fröhlich M, Meyer T. Pre-cooling and sports performance: a meta-analytical review. Sports Med. 2013 Jul 1;42(7):545-64.