Coffee - 3 Cups Per Day Keep Insulin at Bay: You Better Start Today if You Want to Retain Your Insulin Sensitivity, and Stay Cancer & CVD Free Beyond Your Own Centennial!

I am not entirely sure how often I have used the sentence "consistency is key", here at the SuppVersity, but there is no way I don't reiterate it in the context of the never-ending debate over the pros and cons of habitual coffee drinking, once again. While much of the experimental evidence would suggest that coffee, or to be precise, caffeine the major methylxanthine in the brown brew is a bad sympathetic nervous system activator that stresses your body and will deteriorate your glucose and fat metabolism, the majority of the epidemiological evidence points into the exact opposite direction.

A paper that's going to be published in the next issue of AGE the Journal of the American Aging Association could however help not just to bridge the widening gap between the ever-increasing number of epidemiological studies showing between moderate caffeine consumption and metabolic, cardiovascular, neurological, and cellular health (see list at the end of this post) and the conflicting evidence from experiments that investigate the acute response to caffeine ingestion in both caffeine-naive individuals and habitual caffeine consumers.

Consistent caffeine consumption is the key to "chronic health" ;-)

I am pretty sure this study won't close the lit on the never-ending debate about the pros and cons of caffeine consumption - mostly because it's a rodent study, but also in view of the fact that there is no definite border between "habitual consumption" and "chronic abuse", when it comes to a substance the stimulating side-effects of which can keep you functioning (and training!), when your body would otherwise long have called a halt.

Against that background it is important to realize that the rodents in the study at hand were leading a happy, more or less stress-free life. They consumed what you would consider a "healthy" diet for a rodent and had free access to a wheel, the average male and female Wistar who has neither television, nor Internet or a PlayStation in his or her cage, will actually make good use of.

Figure 1: Body weight (in g), visceral fat weight (in g/kg body weight) and skeletal muscle glucose transporter 4 expression (GLUT4 activity relative to glucose breakdown) over the course of 24 months with or without the provision of the human equivalent of caffeine of roughly 3 cups of coffee in the drinking water (data based on Guarino. 2013)

Accordingly, you should not wonder, let alone be disappointed that there is no magical "fat destruction" such as the one we've seen about a months ago in the CLA-study (see "CLA Destroys Body Fat: Effect Borders Pathological Lipodystrophy!"). Remember: Consistency is key! And some of the benefits of today's coffee may not show before you are in your late 70s... but let's get back to the results data from figure 1 and their implications for your current and future health:

Additional observations:

• the decrease in visceral fat mass was not due exclusively to increased lipolysis
• the increase in insulin sensitivity induced by caffeine was not attributable to weight loss, increased NO production, caffeine-mediated antioxidant effects, decreased cortisol levels, or decreased SNS activity
• caffeine intake did not modify blood pressure, endogenous NO production, or antioxidant capacity in aged animals 
• caffeine administration restored Glut4 expression in the elderly group, but it was not able to increase Glut4 expression above amaximal level in the 12Mgroup

• the rodents were kept on a normal diet, a healthy body weight is thus only a sign of overall metabolic health (remember: skinnier does not equal healthier!),
• the 42% lower visceral fat levels in what would be middle aged rodents (12 months) is one of the most significant predictors of healthy aging (optimal brain and metabolic health + no cancer), and
• the maintenance of skeletal muscle GLUT4 expression is of fundamental importance to ward of those increasingly common "age-related" diseases of which we already know that they are at least precipitated by insulin resistance and high glucose levels, such as Alzheimer's and "regular" dementia (e.g. Rönnemaa. 2008; Accardi. 2013; Williamson. 2013)

Against the background of the previously mentioned conflict between experimental (caffeine induces stress and thwarts glucose and fatty acid metabolism) and epidemiological (caffeine correlates with metabolic health) evidence it is also important to mention that these beneficial effects were not negated by the dreaded stress-induced increases in non-esterified fatty acids (NEFA), which is the most commonly heard argument of the opponents of caffeine / coffee consumption. On the contrary, the ...

"[...] increase in insulin sensitivity induced by caffeine was not attributable to weight loss, increased NO production, caffeine-mediated antioxidant effects, decreased cortisol levels, or decreased SNS activity [so that caffeine effectively] restored [otherwise elevated] circulating NEFA in aged animals to values observed in young 3 M control rats." (Guarino. 2013)

In the absence of increased NEFA levels, an increased sympathetic tone (=higher catecholamine and cortisol levels) and in the presence of optimal GLUT-4 expression and low visceral fat levels in the young and middle aged rodents, there is actually no reason why we would see any of the putative negative effects on glucose metabolism of about which you will probably have read and heard numerous times in the laypress.

Figure 2: Glucose clearance during ITT (in % glucose/min), basal plasma and insulin levels (in mM) over the course of 24 months (basically one rodent lifespan) with or without the provision of the human equivalent of caffeine of roughly 3 cups of coffee in the drinking water (data based on Guarino. 2013)

And, as a matter of fact, the data in figure 2 does confirm just that: The chronic administration of caffeine at a dosage of which the researchers state, that it will generate plasma caffeine levels "comparable to those in moderate to low consumers of caffeinated beverages" (Guarino. 2013), i.e. people who drink about 3 cups of the delicious brew per day (300-500mg caffeine; Gasio. 2002), is probably one of the most delicious and convenient ways to ward off age-related declines in glucose tolerance... this does yet not mean that drinking coffee (let alone Coke or energy drinks) could make up for a sedentary lifestyle and (ab-)using caffeine pills and stims to keep functioning will probably even have the opposite effects.

Glucose management figures everywhere and so does coffee!

Did you know that the data from a recently published trial suggests that "14-day caffeine supplementation [at 5mg/kg body weight] can probably decrease exercise-induced inflammatory response (CRP elevation and Leukocytosis) following 30 min downhill running in male non-athletes" (Jafari. 2013)? That's actually pretty intruiging, as it shows that the already mentioned differences between the chronic and acute effects of trimethylxanthie aka caffeine are not restricted to its effect on overall and metabolic health, especially as, caffeine has hitherto not exactly been known as a an ergogenic the effects of which build up over time... in fact, rather the opposite is usually assumed, although the evidence for the decline of the ergogenic (not the stimulant!) effects of caffeine are still inconclusive.

In view of the major role of glucose management in all sorts of the metabolic, endocrine and neurcrine diseases, it is thus no wonder that study after study finds beneficial effects of moderate caffeine consumption on...

• risk of heart failure (Mostofsky. 2013)
• perceptibility to arrhythmia (Klatsky. 2011)
• venous thromboembolism (Enga. 2011)
• general cardiovascular disease (Bøhn. 2013)
• dementia & Parkison's (Cao. 2013; Campdelacreu. 2013)
• diabesity (Hjellvik. 2011; Matsuura. 2013)
• pancreatic cancer (Dong. 2011), as well as 
• bladder, breast, buccal and pharyngeal cancer (Yu. 2011) 
• colorectal, endometrial, esophageal cancer (Yu. 2011) 
• hepatocellular, leukemic, and prostate cancers (Yu. 2011)

And though, I could certainly extend this list by a dozen or so references for each item and half a dozen additional items, I guess I'd rather end today's blogpost on the note that coffee (and tea) contain way more than just caffeine. I would therefore suggest you don't rely on caffeine alone, but rather grab yourself an old-fashioned black cup of coffee (ad some creme if you can't stand it black, or coconut oil, if you like that better) and the time it takes to savor the aroma and taste of it... I can guarantee: That will exponentiation its health effects and will allow you to catch up on the 5 minutes you may have lost in no time.

References:

• Accardi G, Caruso C, Colonna-Romano G, Camarda C, Monastero R, Candore G. Can Alzheimer disease be a form of type 3 diabetes? Rejuvenation Res. 2013 Apr;15(2):217-21.
• Bøhn SK, Ward NC, Hodgson JM, Croft KD. Effects of tea and coffee on cardiovascular disease risk. Food Funct. 2013 Jun;3(6):575-91.
• Campdelacreu J. Parkinson disease and Alzheimer disease: environmental risk factors. Neurologia. 2013 Jun 13.
• Cao C, Loewenstein DA, Lin X, Zhang C, Wang L, Duara R, Wu Y, Giannini A, Bai G, Cai J, Greig M, Schofield E, Ashok R, Small B, Potter H, Arendash GW. High Blood caffeine levels in MCI linked to lack of progression to dementia. J Alzheimers Dis. 2013;30(3):559-72.
• Dong J, Zou J, Yu XF. Coffee drinking and pancreatic cancer risk: a meta-analysis of cohort studies. World J Gastroenterol. 2011 Mar 7;17(9):1204-10.
• Enga KF, Braekkan SK, Hansen-Krone IJ, Wilsgaard T, Hansen JB. Coffee consumption and the risk of venous thromboembolism: the Tromsø study. J Thromb Haemost. 2011 Jul;9(7):1334-9.
• Gasior M, Jaszyna M,Munzar P,Witkin JM, Goldberg SR. Caffeine potentiates the discriminative-stimulus effects of nicotine in rats. Psychopharmacology (Berl). 2002; 162:385–395 
• Guarino MP, Ribeiro MJ, Sacramento JF, Conde SV. Chronic caffeine intake reverses age-induced insulin resistance in the rat: effect on skeletal muscle Glut4 transporters and AMPK activity. Age (Dordr). 2013 Sep 14.
• Hjellvik V, Tverdal A, Strøm H. Boiled coffee intake and subsequent risk for type 2 diabetes. Epidemiology. 2011 May;22(3):418-21.
• Jafari A, Kherad N, Melekirad AA. Effect of short-term caffeine supplementation on downhill running induced inflammatory response in non-athletes. Journal of Cell. Winter 2013; 2(4):377-385
• Klatsky AL, Hasan AS, Armstrong MA, Udaltsova N, Morton C. Coffee, caffeine, and risk of hospitalization for arrhythmias. Perm J. 2011 Summer;15(3):19-25.
• Matsuura H, Mure K, Nishio N, Kitano N, Nagai N, Takeshita T. Relationship between coffee consumption and prevalence of metabolic syndrome among Japanese civil servants. J Epidemiol. 2013;22(2):160-6.
• Mostofsky E, Rice MS, Levitan EB, Mittleman MA. Habitual coffee consumption and risk of heart failure: a dose-response meta-analysis. Circ Heart Fail. 2013 Jul 1;5(4):401-5. Epub 2013 Jun 26.
• Nature.com Reviews. Heart failure: Moderate coffee consumption linked with reduced risk of HF. Nat Rev Cardiol. 2013 Jul 17;9(9):492.
• Rönnemaa E, Zethelius B, Sundelöf J, Sundström J, Degerman-Gunnarsson M, Berne C, Lannfelt L, Kilander L. Impaired insulin secretion increases the risk of Alzheimer disease. Neurology. 2008 Sep 30;71(14):1065-71.
• Williamson R, McNeilly A, Sutherland C. Insulin resistance in the brain: An old-age or new-age problem? Biochem Pharmacol. 2013 Sep 15;84(6):737-45.
• Yu X, Bao Z, Zou J, Dong J. Coffee consumption and risk of cancers: a meta-analysis of cohort studies. BMC Cancer. 2011 Mar 15;11:96.

Women Have a Much Harder Time Losing Body Fat Than Men, But Both Benefit From Doubling Their Protein Intake!

Image 1: Looks good, tastes good, is good - and contrary to zinc, ingesting 2x the RDA will help you lose body fat, instead of setting you up for insulin resistance.

Enough of useless (ALA, zinc) and useful (glutamin) supplements for at least 24h! Let's get back to what really counts: Training? No, not today,.. the other thing! The one, which is actually to be supplemented - your diet! Believe it or not - even after all those years, I am finding time and again that the food you put into your mouth has much more pronounced effects on the ways you look feel and perform than any of the countless useless and useful supplements. Accordingly and in response to the futile notion of "calories in vs. calories out" and the bomb-calorimeter representation of the human metabolism as a simple furnace, the past couple of years have seen an increasing public and (as of late) scientific interest in the effects varying macronutrient compositions will have on your ability to shed weight and, more importantly, to keep it off in the long run.

Submitted on December 30, 2011 and published in the latest issue of the Journal of Nutrition & Metabolism (9:55) the results of a "randomized clinical weight loss trial" comparing more or less isocaloric (-500kcal/day) weight loss regimen in 130 (58 male, 72 female) overweight middle-aged (40-56) subjects (BMI  =  32.5  ±  0.5 kg/m²) provide further insights into the real-world effects of  prescribed minimal protein intake levels on the outcomes of a 4 months weight loss and 8 months weight maintenance intervention (Evans. 2013).

RDA = 0.8g/bw vs. 2x RDA = 1.6g/bw protein - Round 1: Education & Adherence

In many of the previous posts on this issue (e.g. "High Carb vs. High Fat for Obese Type II Diabetics and What Really Happens, When Science Meets Real Life"), adherence or even an appropriate awareness of what "high protein" actually means turned out to be one of the main culprits as far as the significance of respective data is concerned (Krebs. 2013). In this respect, the subjects in the study by Evans et al. who were supported by a pretty extensive educational and support program that included

• the provision of electronic food scales and instruction on how to weigh and record food servings at all meals (logs were monitored for compliance on a weekly base!)
• a specific diet program with detailed instructions from a research dietitian including the menus, food substitutions and portion sizes
• an obligatory weekly 1 h meeting at the weight management research facility, where they received dietary counseling, had the ability to pose questions and instructions referring to the minimum of 30 min of walking 5 d/wk

constitute a positive exception from the average "study participant" who receives a handout with instructions and a clammy handshake for his/her willingness to step on the scale twice within a given time-frame.

Figure 1: Energy intake (total) from different macronutrients (left) and relative reduction compared to basesline in the 4-month weight loss and the subsequent 12 months "maintenance" period (based on Evans. 2013)

Based on the activity logs, the average amount of exercise was less than 100min/wk and not different between the two treatment groups. As far as the drop outs are concerned, there was yet a trend for lower drop out rates of the male participants in the protein compared to the carbohydrate group (9/28 vs. 18/30). 

Figure 2: Adherence to the prescribed macronutrient ratios was similarly "good" for men and women in both the high carbohydrate and high protein arm of the study (based on Evans. 2013)

The overall adherence to the prescribed nutrient ratios, i.e. 15% protein, 55% carbohydrates and 30% fat in the high carbohydrate and 30% protein, 40% carbohydrates and 30% fat in the high protein group was similarly good (the deviations were smaller than one standard deviation) among both men and women; and still, the net results of the study appear somewhat disappointing - at least if you make the all too common mistake of judging the outcome of an already intrinsically mislabeled "weight loss" intervention solely by the figures on your scale, which were, for the subjects in the study at hand, identical for both groups (PRO:-10.7  ±  6.8 %, CARB:-10.1  ±  6.2 %, expressed relative to body weight at baseline).

Feminists beware! Life is not fair...

A closer analysis of the data does yet reveal that despite an overall greater reduction in calorie intake in the high protein group (-31% vs. -22% in the weight loss phase and -27% vs. -16% in the maintenance phase) and slightly but statistically non-significantly greater body fat loss in the male participants on the high carbohydrate diet at the end of the maintenance phase, the "net" effect on the lean to fat mass ratio in men and women speaks in favor of increased protein intakes during phases of reduced energy intake.

Figure 1: It is obvious that compared to baseline the loss in body fat (expressed relative to baseline, left) was significantly more pronounced in the male compared to the female participants; the favorable effects of the high(er) protein diet on the lean to fat mass ratio (4% and 6% greater improvements) is yet of even greater importance for the ladies.

There is yet no denying that middle-aged women are - irrespective of their diets - having a substantially harder time losing body fat than men of the same age. In view of the fact that this is at least partly mediated by their significantly lower lean body mass to fat mass ratio (1.3 in women vs. 2.2 in men), the aforementioned protein sparing effects of "high" protein diets are of even greater importance for female dieters than for their male peers (cf. figure 3, right) - unfortunately, even the latter rarely rarely spare a thought about that, when their short-sighted and often likewise overweight Dr. tells them "you got to lose weight, if you want to see your grand children graduate, buddy!"

... and if you want sexual equality you got to lift weight and eat your meat ;-)

Against that background the results of the recently published exercise-only trial by Washburn et al. come to mind (cf. "Strength Training Ain't For Women -  Really!?" and Washburn. 2013). In the study at hand, The absence of at least a minimalist strength training regimen, as it was employed in the Washburn study, could in fact be one of the major reasons for the small overall effect size Evans et al. observed in their "walk in the park if you will" study. Eventually, the preservation of an already low amount of lean tissue mass is one thing, increasing the latter and thusly building the metabolic advantage of greater lean muscle mass, based on which the male study participants shed roughly 15% more body fat within the 12 month than their female peers is yet another one, of which I can hardly repeat often enough that it will not turn Angels into Divas over night (see image 2). And while you can easily regain 2 pounds of fat you lost, you will have to acknowledge that the lean mass you have either never built or lost over years of mainstream dieting, won't come back easily (cf. Beavers. 2011).

Image 2 (unkown Facebook source): Strength training and a high protein diet don't turn Angel's into Divas over night - what a pity ;-)

Bottom line: Regardless of whether you are a woman or a man, an angel or a diva, Homer Simpson, Peter Griffin, or Stanley Smith (cf. "Stocktaking, Goal Setting, -Tracking & -Resetting to Achieve a Healthy Weight & Shed Excess Body Fat"), greasy steaks, eggs, fish, dairy and a gym membership will not just have a much more pronounced impact on the outcome of your next diet, than all the diet products and books your money can buy, as an elementary part of your new lifestyle they will also lay the foundation of your future health - and what's even better: You will have more than enough extra years to spend all the money you would otherwise have spent on all those gimmicks, false promises, useless supplements and defacing cosmetic surgeries! Now you tell me eating a high(er) protein diet and spending time in the gym instead of the office was uneconomical ;-)

References:

1. Beavers KM, Lyles MF, Davis CC, Wang X, Beavers DP, Nicklas BJ. Is lost lean mass from intentional weight loss recovered during weight regain in postmenopausal women? Am J Clin Nutr. 2011 Sep;94(3):767-74. Epub 2011 Jul 27.
2. Evans EM, Mojtahedi MC, Thorpe MP, Valentine RJ, Kris-Etherton PM, Layman DK. Effects of protein intake and gender on body composition changes: a randomized clinical weight loss trial. Nutr Metab (Lond). 2013 Jun 12;9(1):55.
3. Krebs JD, Elley CR, Parry-Strong A, Lunt H, Drury PL, Bell DA, Robinson E, Moyes SA, Mann JI. The Diabetes Excess Weight Loss (DEWL) Trial: a randomised controlled trial of high-protein versus high-carbohydrate diets over 2 years in type 2 diabetes. Diabetologia. 2013 Apr;55(4):905-14. 
4. Washburn RA, Kirk EP, Smith BK, Honas JJ, Lecheminant JD, Bailey BW, Donnelly JE. One set resistance training: effect on body composition in overweight young adults. J Sports Med Phys Fitness. 2013 Jun;52(3):273.