Quick Hit Summary

In Part II of our review of the 2013 ISSN Conference, we discuss those presentations that fell on the "research" side of the equation. Specific ones include those presented by Dr. Jacob Wilson, PhD, CSCS (HMB, Oral ATP, Phosphatidic Acid), Chris Lockwood, PhD & Mike Roberts, PhD (Comparison of WPH vs. Other Whey Protein Forms: What the Science Tells Us), Hector Lopez, MD (Omega 3 Fish Oil: A Keystone Nutritional Prescription for Athletes) and the keynote address speaker, Frank W. Booth, PhD (Basic Science Research in Exercise Science and Sports Nutrition: Where We've Been, Where We Are and Where We're Headed). Additionally I highlight a poster presentation by Dr. Jason Beam, PhD, CSCS entitled, "The effect of post-exercise caffeine and chlorogenic acid supplementation on blood glucose disposal and insulin sensitivity."

2013 ISSN Conference Review

This will be a 2 part article series reviewing the 2013 International Society of Sports Nutrition Conference. In Part I of the series, we'll focus on the "applied" sports nutrition presentations. In Part II, our attention will shift and we'll hone in on the "research" sport nutrition presentations.

• 2013 ISSN Conference Wrap-up Part I – Practical Application Presentations

• 2013 ISSN Conference Wrap-up Part II – Research Presentations

Many of the presentations could have fallen in either of these categories as obvious overlap is present between the categories. However, for reading ease (and to prevent me from wasting time by endlessly debating which one deserves to be put in which category!) I'll follow the ISSN's breakdown of the events.

Part I Review & "Preface" Thoughts to Part II

Figure 1. ISSN Logo. Image used with permission.

We covered A LOT of ground in Part I of our 2013 ISSN conference review. In case you haven't caught it yet, here is what you're missing:

• Brandon Marcello, PhD – Nutrition Strategies for Stanford Athletics

• Alicia Kendig, MS, RD & Jennifer Gibson, MSc, RD – Logistical Issues & Nutrition Strategies for Summer & Olympic Sport Athletes

• Paul Cribb, PhD (Nutrient Timing)

• David Sandler, MS (Research vs. Training Application)

• Carla Sanchez, IFBB Pro (Creating a Competitive Physique)

• Shawn Phillips (The Anatomy of A Successful Supplement)

• My thoughts on "The Art & Beauty of the Intelligent Disagreement"

Before we dive directly into Part II of our discussion, which focuses on the Research/Science track, please be aware that some of the research I share is so "fresh", it has yet to be formally published. Thus, I don't have full details on variables such as dietary intake, exact training protocols, timing of all supplements, baseline values, etc. Please keep this in mind when reading this report!

With this being said, consider my review to be "quick snapshots" of what's happening in each researcher's respective lab. As the research studies I discuss get formally published or I hear replies to some of the emails I've sent out (to the research teams), I will be sure to update this article!

Research/Science track

Dr. Jacob Wilson, PhD, CSCS – Effects of HMB Free Acid and Oral ATP on Human Performance

ISSN Position Statement – HMB: The details, background and in-depth discussion on HMB's mechanism of action, the different forms (HMB-FA vs. HMB-Ca), etc, is beyond the scope of this article, I refer you to the ISSN's HMB Position Statement for a more in-depth discussion on these areas.

Dr. Jacob Wilson presented twice at the ISSN conference. His first presentation focused on HMB-FA, Oral ATP & combinations of ATP + HMB. Unfortunately I was unable to attend this specific presentation due to a timing conflict with one of the other presentations I wanted to see. However, some of my friends attended it and shared with me the "high points" of the discussion. Additionally, I was able to catch some of the details from the poster session.

As late as a few years ago, it appeared that HMB was a supplement "dead in the water" with respect to research supporting its use in trained individuals. However, Dr. Wilson questioned if maybe the lack of results seen in these earlier studies were related to the training protocols which lacked the degree of intensity and novel training stimulus required to truly take advantage of HMB's ergogenic benefits (see sidebox). In yet to be published research, his team had 20 resistance trained males complete a 12 week training program that utilized undulating periodization (Monday – Hypertrophy emphasis w/ volume load of ~40,000 lbs, Wednesday – Power, Friday –Heavy). For reference, his "trained" participants had > 3 years of experience; their 1RM's for squat were ~ 1.7x bodyweight and for deadlift ~1.8x bodyweight. These men were randomized into one of two groups which consumed either HMB-FA (3g/d) or a placebo. All individuals were instructed on a diet that consisted of 25% protein, 50% carbs & 25% fat. At the end of the study, both groups had significant gains in overall body strength; however, despite having similar initial strength levels, those in the HMB group had significantly greater gains at the study's end. Positive benefits were also observed in muscle hypertrophy and fat loss in the HMB group as shown in Table 1. These gains occurred despite results indicating that both groups had similar kcal and macronutrient intake during the study.

Table 1. Changes in Strength & % Body Fat when combining HMB-FA supplementation with a 12 week undulating resistance training program. Baseline strength assessed via combined totals of squat, deadlift & bench press testing. Please note, the changes in body fat 's are not 100 accurate as they were based off my "eye-balling" the graph presented by Wilson JM¹³. Also "*" represents statistically significant vs. baseline; "#" represents statistically significant vs. placebo. Table created by Sean Casey. Data adapted from Dunmore et al¹² and Wilson¹³

Group	Baseline Strength	Final Strength	Initial % Body Fat	Final % Body Fat	Initial Quadriceps Thickness	Final Quadriceps Thickness
HMB-FA (3g/d)	430.4 kg	507.5kg (+18.3%)*#	~21%	~14%*#	50.7 cm	57.8 cm (+14.5%)*#
Placebo	422.2kg	447.5kg (+6.6%)*	~21%	~19.5%	49.6 cm	52.0 cm (+4.6%)*

Switching gears here, Dr. Wilson's lab has also been examining the potential ergogenic effects of oral ATP supplementation. Their early research seems to indicate that oral ATP supplementation may increase muscle blood flow during exercise.¹ This was shown in a pilot study where 12 resistance trained males took 400 mg ATP daily for 12 weeks. Additionally at weeks 1, 4, 8, and 12, individuals consumed 400 mg prior to completing an acute bicep curl training session (60 reps). Results indicated that at week 1, 8, 12, significant differences in blood flow were observed 0 and 3 minutes post exercise relative to baseline values. (Have we finally found the "holy grail" of muscle pump supplements?!)

What I'm not sure of is the exact mechanism leading to the increased blood flow observed in this pilot study presented at the conference. It was suggested, that supplemental ATP was carried on red blood cells (RBC) and released into the blood during muscular exertion. Although research has shown that intravenous ATP administration increases muscle blood flow, I have not seen anything to indicate that oral ATP or its metabolites (except uric acid) reach systemic circulation post ingestion. Doing a little digging post conference, I came across a 2012 study indicating that 5000 mg of oral ATP failed to increase circulating levels of ATP or its metabolites (uric acid being an exception) in human blood post ingestion.² A similar lack of effects on circulating ATP and its metabolites were observed in a four week study using 250, 1250 or 5000 mg ATP per day.³ Now, these latter research studies assessed whole blood which would have included the RBC fraction. Thus, I'm left scratching my head on this one … So stay tuned!

Figure 2 Changes in lean body mass following a 12 week resistance training program & various supplement protocols. For reference, baseline lean body mass for all 3 groups was ~67-69 kg. Image created by Sean Casey. Data adapted from Lowery et al.⁴

With respect to "stacking" these supplements, Dr. Wilson's lab completed a study in which trained individuals consumed ATP (400 mg/day), HMB-FA (3g/day), HMB-FA+ ATP (3g/day +400mg/day) or a placebo along with completing a 12 week periodized training program.⁴ On most performance measurements (strength, lean body mass, % body fat, etc) greatest benefits tended to be as follows: HMB-FA+ATP>HMB>ATP>Placebo. Decreases in % body fat were only observed in the HMB groups. Additionally, "during the overreaching cycle, strength declined in the placebo ( – 4.5%) group, but this decline was blunted in both the ATP ( – 2%) and HMB-FA (-.5 ) groups… the HMB-FA+ATP group continued to gain strength (+1.2)"

I should also note that most HMB supplements on the market today use the calcium bound version of the molecule, HMB-Ca, NOT the newer free acid form, HMB-FA, which were used in Dr. Wilson's research. The major differences between the two are that HMB-FA is absorbed much faster into the bloodstream (~30 minutes) and its been hypothesized that this may provide some additional benefits vs. HMB-Ca. I again refer you to the ISSN position stand highlighted in the sidebox.

In summary, when used in isolation, HMB-FA definitely looks pretty interesting. One thing I look forward to seeing in future study protocols are those which incorporate more peri-workout nutrition strategies to see what type of added benefit may be had when HMB gets added into the typical mix (ie- whey proteins, carbs, etc).

Dr. Jacob Wilson, PhD, CSCS – Phosphatidic Acid: Supplementing With The Anabolic Signal for Skeletal Muscle Hypertrophy

Figure 3. Effects of phosphatidic acid (PA) or placebo on body composition changes in conjunction with a 8 week resistance training program. Image created by Sean Casey. Data Adapted from Joy et al⁵

Side Thoughts on Dr. Jacob Wilson's Presentations … Both the PA as well as the HMB + ATP research presented by Dr. Wilson's research team produced some staggering gains, especially considering that they all used resistance trained individuals. These changes were significantly more than what I would have expected based on the supplements alone. Thus, I look forward to reviewing the full text versions of these studies when they're published as well as incorporating a little good ol' ME-search!

Dr. Wilson's 2nd presentation of the conference was on phosphatidic acid (PA), which may end up being the nutraceutical industry's next "supplement darling." For those of you who are not familiar with PA, it's a phospholipid present in muscle cells. During muscular contractions, specifically those which are more eccentric in nature; it gets released and stimulates the mTOR pathway, leading to increased protein synthesis and theoretically, gains in strength and hypertrophy. In a recently completed study (yet to be published), his research team had 28 resistance trained men complete an 8 week training program.⁵ They were assigned to either the PA group, which received 750 mg of soy derived PA, or a placebo group. At the end of the study, in comparison to the placebo group, it was found that those in the PA group had significantly better gains in lean body mass (2.4 kg vs. 1.2 kg; p=0.01) and tended to have greater decreases in fat mass (-1.3kg vs. -0.5kg; p =0.06). Additionally those in the PA group also had greater gains in leg press 1RM (52 kg vs. 32.5 kg, p=0.04).

Although these results are quite impressive, there is one important detail to keep in mind – neither of these groups supplemented their training with whey protein. Since both work via the mTOR pathway, it will be interesting to see if there is a synergistic relationship present when "stacking" these supplements or if a "ceiling effect" is observed with respect to acute and long term changes in body composition and performance. If I correctly recall from Dr. Wilson's presentation, this was one area they were hoping to investigate in future studies.

And as a side note… I would like to give a major "hat tip" to Dr. Jacob Wilson for going above and beyond the norm with respect to highlighting all the individuals who helped him in his research!

Chris Lockwood, PhD; Mike Roberts, PhD – Comparison of WPH vs. Other Whey Protein Forms: What the Science Tells Us

Dr. Lockwood & Dr. Roberts' talk centered on whey protein hydrolysates (WPH) and if there was any additional benefits of supplementing with them vs. standard whey protein concentrate (WPC). For those not familiar with the term hydrolysates, it's basically proteins which have already been broken down into much smaller protein fragments called di- and tri-peptides (2 to 3 amino acids in length). These bioactive peptides tend to be digested and absorbed into circulation much faster than their intact protein forms. Research completed by various groups has shown that WPH does appear to be superior vs. casein⁶⁷; for most individuals reading this article, I'm guessing that you're already aware of whey's superiority in this department. However, if you're anything like me, you're probably wondering, "Is WPH superior to other forms of whey protein such as WPC?"

In a yet to be published study, which both Dr. Lockwood & Dr. Roberts contributed to, 56 resistance trained males completed an 8 week training program (4 days/wk lifting – 2 upper & 2 lower). Participants were randomized to one of the following four supplement groups (supplements consumed both pre- and post-workout):

• Placebo: 30 g CHO
• WPC 80: 30 g of 80% WPC
• WPC 80+: 30 g of 80% WPC (high in lactoferrin)
• WPH: 30 g WPH

At the conclusion of the study, it was found that increases in lean body mass and strength were relatively the same for all three protein groups. However, those in the WPH group experienced significant decrease in fat mass, ~ 1kg (my estimation based off chart) during the time period; this was not observed in any of the other groups.

Looking at things from an acute perspective, Dr. Lockwood and Dr. Roberts both contributed to an acute animal based study in which mice, following an 8 hr fast, were gavage fed WPC or WPH. Blood samples were taken 15, 30 & 60 minutes following ingestion. Markers of lipolysis (ie – fat breakdown and release into bloodstream) were heightened in those in the WPH group vs. WPC group at 30 minutes.

Their presentation concluded with a review of some of the other health benefits associated with the bioactive peptides associated with WPH (cardiovascular, diabetes, immune standpoint). Rather than go into detail on them, I'll let you investigate that on your own.

Hector Lopez, MD – Omega 3 Fish Oil: A Keystone Nutritional Prescription for Athletes

Dr. Hector Lopez gave a presentation discussing fish oil and how he felt it was a "key" supplement for individuals concerned with their health. In his opinion, Dr. Lopez thought fish oil, more specifically the fatty acids EPA & DHA was the "Ultimate in Pleiotropy" due to the various physiological benefits established or suggested in many organ systems. During the presentation, Dr. Lopez went into discussion of the basic biochemistry of how omega 3's vs. omega 6's function in the body, emphasizing how a healthy balance between the two is needed for optimal health (Note – don’t confuse balance with complete elimination of one type!).

Is megadosing fish oil needed for healthy individuals already eating a low inflammatory diet? This was a topic I discussed with Adel Moussa in a February 2013 interview. His thoughts on the subject may come as a surprise to many of you!

One key area that Dr. Hector Lopez pointed out, which is often overlooked by many, is how EPA/DHA modulated the inflammation process via their influence on specialized pro-resolving lipid mediators (SPMs) such as resolvins, protectins and maresins. According to Norling & Serhan SPMs "control the duration and magnitude of inflammation by acting on specific receptors on separate cell populations to stimulate the overall resolution of inflammation."⁸ Thus, by speeding up/resolving the inflammatory process, the inflamed tissue returns back to "homeostasis" (ie – healthy response) vs. staying chronically inflamed which leads to scarring and fibrosis. Using an analogy, Dr. Lopez compared SPM's to forest firefighters who clear away "dry brush that may increase availability of combustible fuel for prolonging duration and magnitude of the fire."

In terms of supplementation, Dr. Hector Lopez's personal recommendation was supplementing with 2-6g of EPA +DHA. He also felt that the form one uses (krill vs. fish oil) doesn't make a big difference when used long term.

Frank W. Booth, PhD – Basic Science Research in Exercise Science and Sports Nutrition: Where We've Been, Where We Are and Where We're Headed

Dr. Frank Booth, a man with more than 40 years of research under his belt, gave the basic science keynote address. As a fan of history, I was quite fascinated with his presentation. In describing "Where We've Been", he went back to the "father" of exercise physiology, the legendary Hippocrates. Dr. Booth then recognized the "father" of modern day exercise physiology, the Danish professor August Krogh, the 1920 Nobel Prize winner who "discovered that exercise 'opens' capillaries." According to Dr. Booth, exercise and sports nutrition "married" in 1939 when Erik Hohwu-Christensen examined the concept of carbohydrate loading prior to endurance exercise. In this ground breaking study, an individual completed three cycling contests (to fatigue while maintaining a 176 watt output) in which they had mixed meals containing various amounts of carbohydrates (35g/d, 235g/d, 400g/d) for three days leading up to the event, results were as follows: 35g/day – 35 min to fatigue, 235 g/day – 180 min, 400g/d – 240 min. There you have it, the first modern day sports nutrition study; pretty cool, eh?!

In review of our current "Where We Are" state of knowledge, Dr. Booth discussed two primary areas that sports nutrition research has focused on since 1990 including 1) Macro-nutrient timing (pre-, intra- and post- workout) to maximize training adaptations and 2) The use of non-macronutrient supplements such as creatine, individual amino acids, etc, to support training. Dr. Booth also stated that during the current era, we've been able to greatly increase our understanding of the value that both protein and carbohydrate have with respect to exercise performance and adaptations via isotropic tracer technology.

With respect to "Where We're Headed", Dr. Booth stated that "omics" is the next frontier in exercise science and sports nutrition. For those not familiar with the term, it refers to genomics, transcriptomics, proteomics and metabolomics which are basically various branches of physiology that examine how our genes (ie – the human genome) and metabolites in a particular tissue are influenced by environmental factors (for our interest – nutrition/exercise). Ideally, in gaining a better understanding of these topics, we would be able truly individualize one's sports nutrition; matching macro & micronutrient intake to both his/her particular gene profile as well as the particular training phase they happen to be in during their yearly cycle. However, he stated that "we are eons away from personalized omics in the sports nutrition field." Dr. Booth felt that the greatest impact that we'll see with respect to the omics field during the next few years will be in regard to looking "at large data sets for safety and efficacy of ingredients."

Poster Session: Dr. Jason Beam, PhD, CSCS – Effects of Caffeine and Chlorogenic Acid on Insulin Sensitivity and Glucose Disposal Post Workout

I've incorporated most of the posters from the ISSN conference, which I found to be of interest, in the proceeding research sections. However, the one poster that I haven't mentioned yet, but did spend some time at, highlighted a study conducted and presented by Dr. Jason Beam, PhD, CSCS entitled, "The effect of post-exercise caffeine and chlorogenic acid supplementation on blood glucose disposal and insulin sensitivity". Previous research conducted by Pederson et al has shown that following a bout of exhaustive exercise, caffeine ingestion with carbohydrates increases glycogen resynthesis faster than carbohydrates alone⁹. However, little research has been done comparing the effects of chlorogenic acid, which is also found in coffee, vs. that of caffeine with respect to blood glucose and insulin disposal following exercise.

Thus, in their study, Dr. Beam and colleagues had ten trained male cyclists (VO2peak: 55.9±8.4 ml/kg/min) complete a 30 minute cycling bout at 90% HRmax (60% peak power) following an overnight fast on 3 separate occasions. Immediately following each cycling session, participants consumed supplements according to one of the following protocols: 1) 5mg/kg caffeine + 75g dextrose, 2) 5mg/kg chlorogenic acid (CA) + 75g dextrose or 3) 75g dextrose (placebo). Blood glucose and insulin levels were measured during the two hours that followed each bout. In analyzing the results, the research team found that the two hour area under the curve for blood glucose and insulin levels did not vary between groups nor did the insulin sensitivity index (ISI). However, there was a strong association between BMI and insulin AUC for all three groups, with higher BMI's requiring greater insulin outputs to achieve similar glucose disposal (AUC for the CAF (r=.71), CGA (r=.80), and PLA (r=.73) trials). His group concluded,

"…. The heterogeneity of our sample highlights the inter-individual variability in post-exertional response to caffeine and chlorogenic acid when dosage is based on body weight…We recommend that future investigations of glucose tolerance and insulin sensitivity utilize a sample that is homogenous in body composition and training status."

Figure 4. The seesaw balance between mTOR and AMPK. Image re-posted with permission from Adel Moussa. CLICK HERE for full story!

Dr. Beam as well as Dr. Josh Cotter (my poster session cruising comrade) and I started discussing applied implications from his study along with other research that has been presented on the topic. Dr. Beam felt that due to both caffeine and CA's effects on increasing AMPK activity¹⁰¹¹ which antagonizes mTOR to a degree, those who may benefit most from including them in their post workout are individuals who need rapid glycogen replenishment (athletes training 2x/day, etc). In contrast for those athletes where gains in muscle mass & strength was of highest precedence, it may be best to leave the caffeine and CA out of your recovery shake/meal regime. However, these latter ideas were merely speculation on his part.

In writing this section, I want to extend a thank you out to Dr. Beam who was great about clearing up some lingering thoughts I had on his study via post conference email communication.

Bottom Line

There is not much for me to add here except that I hope to see you all at the 2014 Conference!

References

¹ Ryan P. Lowery, Michael D. Roberts, Frank W. Booth, Jordan Joy, Clayton L. Cruthirds, John A. Rathmacher, Shawn M. Baier, John C. Fuller, Christopher M. Lockwood, Ralf Jäger, Joshua E. Dudeck, and Jacob M Wilson. Oral ATP administration improves blood flow response to exercise in an animal model and in resistance trained athletes.

² Arts IC, Coolen EJ, Bours MJ, Huyghebaert N, Stuart MA, Bast A, Dagnelie PC. Adenosine 5'-triphosphate (ATP) supplements are not orally bioavailable: a randomized, placebo-controlled cross-over trial in healthy humans. J Int Soc Sports Nutr. 2012 Apr 17;9(1):16. doi: 10.1186/1550-2783-9-16.

³ Coolen EJ, Arts IC, Bekers O, Vervaet C, Bast A, Dagnelie PC. Oral bioavailability of ATP after prolonged administration. Br J Nutr. 2011 Feb;105(3):357-66. doi: 10.1017/S0007114510003570. Epub 2010 Dec 6.

⁴ Ryan P. Lowery, Jordan Joy, John A. Rathmacher, Shawn M. Baier, John C. Fuller, Ralf Jäger, Stephanie M.C. Wilson, Jacob M Wilson. Effects of 12 Weeks of Beta-Hydroxy-Beta-Methylbutyrate Free Acid, Adenosine Triphosphate, or a Combination on Muscle Mass, Strength, and Power in Resistance Trained Individuals. 2013 ISSN Conference Poster.

⁵ Jordan M. Joy1, Ryan P. Lowery1, Joshua E. Dudeck1, Eduardo O. De Souza2, Ralf Jäger3, Sean A. McCleary1, Stephanie M.C. Wilson4, Martin Purpura3, Jacob M. Wilson*1. Phosphatidic Acid Supplementation Increases Skeletal Muscle Hypertrophy and Strength. 2013 ISSN Conference Poster.

⁶ Cribb PJ, Williams AD, Carey MF, Hayes A. The effect of whey isolate and resistance training on strength, body composition, and plasma glutamine. Int J Sport Nutr Exerc Metab. 2006 Oct;16(5):494-509.

⁷ Tang JE, Moore DR, Kujbida GW, Tarnopolsky MA, Phillips SM. Ingestion of whey hydrolysate, casein, or soy protein isolate: effects on mixed muscle protein synthesis at rest and following resistance exercise in young men.J Appl Physiol. 2009 Sep;107(3):987-92. doi: 10.1152/japplphysiol.00076.2009. Epub 2009 Jul 9.

⁸ Norling LV, Serhan CN. Profiling in resolving inflammatory exudates identifies novel anti-inflammatory and pro-resolving mediators and signals for termination. J Intern Med. 2010 Jul;268(1):15-24. doi: 10.1111/j.1365-2796.2010.02235.x. Epub 2010 Apr 28.

⁹ Pedersen DJ, Lessard SJ, Coffey VG, Churchley EG, Wootton AM, Ng T, Watt MJ, Hawley JA.High rates of muscle glycogen resynthesis after exhaustive exercise when carbohydrate is coingested with caffeine. J Appl Physiol. 2008 Jul;105(1):7-13. doi: 10.1152/japplphysiol.01121.2007. Epub 2008 May 8.

¹⁰ Spyridopoulos I, Fichtlscherer S, Popp R, Toennes SW, Fisslthaler B, Trepels T, Zernecke A, Liehn EA, Weber C, Zeiher AM, Dimmeler S, Haendeler. Caffeine enhances endothelial repair by an AMPK-dependent mechanism. J.Arterioscler Thromb Vasc Biol. 2008 Nov;28(11):1967-74. doi: 10.1161/ATVBAHA.108.174060. Epub 2008 Aug 28.

¹¹ Ong KW, Hsu A, Tan BK. Chlorogenic acid stimulates glucose transport in skeletal muscle via AMPK activation: a contributor to the beneficial effects of coffee on diabetes.PLoS One. 2012;7(3):e32718. doi: 10.1371/journal.pone.0032718. Epub 2012 Mar 7.

¹² KA Dunsmore, Ryan P Lowery, NM Duncan, GS Davis, JA Rathmacher SM Baier, EM Sikorski, TJ Morrison, MA Naimo, J Walters, Stephanie MC Wilson, and Jacob M WilsonEffects of 12 weeks of beta-hydroxy-beta-methylbutyrate free acid gel supplementation on muscle mass, strength, and power in resistance trained individuals. J Int Soc Sports Nutr. 2012; 9(Suppl 1): P5.

¹³ Wilson, JM. A Theoretical Model For HMB -The Interactive Supplement. Presented at ISSN Europa University, Orlando FL April 19 2013. Powerpoint presentation. Slide 35.