Which supplements for weight loss and performance are actually worth the money? This is an area where the internet is permeated with outrageous claims and snake oil sales. Fortunately, Dr. Nelson looks at the clinical studies and provides us a summary of what some of the most popular supplements can and cannot do.
If you need help managing your weight and incorporating supplements into your diet, click here.
Dr. Mike T. Nelson….. Bio 1:52
Whey Protein….. 12:32
Increasing Blood Flow to the Muscle….. 36:39
DHEA & Pregnenolone….. 46:13
Mike’s Supplement Recommendations….. 47:24
Episode Wrap Up….. 51:14
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Supplements for Weight Loss and Performance with Dr. Mike T. Nelson — What to Try and Where to Save Your Money
Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I am here with my good friend, Dr. Mike T. Nelson. And today, we’re going to be talking about sports supplements. And why I’m so excited to have Mike on is because Mike and I both are critical examiners of the literature.
And I think with sports supplements, it’s one area where you see so much speculation about this nutrient causes this mechanism, but no one takes the time to say, but does that mechanism actually have an appreciable effect in body composition or speed or power?”
There’s a lot of fluff. There’s a lot of mechanism used as marketing fluff. And I know that Mike has gone through a really comprehensive review of the literature on a lot of these things to see what actual effect they have and if certain things are things you should think about using and, if so, what a reasonable expectation for an outcome might be.
So, Mike, thanks so much for coming on the show.
Dr. Mike Nelson: Yeah, thank you very much for having me. I appreciate it. And this’ll be a very fun discussion.
DrMR: Absolutely. I’m really looking forward to this one because there are a lot of different things we can talk about.
DrMN: Oh, yeah!
Dr. Mike T. Nelson Bio
DrMR: People may have remembered you from coming on maybe about a year ago now.
But can you give people a brief synopsis of your background and what you’re currently doing?
DrMN: Sure. Briefly, I did a bachelor of arts in natural science, and then I did a master’s actually in mechanical engineering, more biomechanics type stuff, did a short stint in the PhD program in biomedical engineering, then switched to kinesiology or exercise physiology department and did my PhD there.
My research for my dissertation was primarily on heart rate variability, which we’ve talked about in the past, and then also ergogenic effects of supplements. So I looked at Monster Energy drink to see, does it actually increase performance? Are there any other markers or things that may go awry with that?
I own my own business, which is Extreme Human Performance. So I work with some clients online. And I teach for Globe University, which again is mostly just online, do some work for Eat to Perform, Mindset Performance Institute, and consulting with other various groups.
DrMR: Nice, nice.
DrMR: So clearly, you’re the guy to speak to this. This is your background. This is your training. This is what you’re actively doing in terms of your clinical work with people and your research. So definitely excited to dig into some of the details regarding ergonomic or performance-enhancing supplements.
DrMN: Yeah, ergogenics, yeah.
DrMR: Yeah. So you said Monster Energy drink, which brings up caffeine.
DrMR: So maybe let’s start the dialogue with caffeine.
DrMN: Yeah, so caffeine is one of those, to me, fascinating molecules just because it’s been around forever. The use of ergogenics, or things that increase performance, which a lot of times are supplements, which is what you’re normally talking about then—that’s been around since the Greeks and Romans.
So that concept isn’t necessarily anything new. Caffeine has been around for a long time, and it’s probably one of the earliest supplements, I guess you could say. What’s interesting about caffeine is that it has multiple effects. So people know that if you drink coffee you tend to be less sleepy, which is more of a central effect actually through the adenosine receptors.
But there are also peripheral effects from caffeine itself. In general, it does increase lipolysis, so release of fatty acids and breaking them down, which people always jump to the conclusion that that must be really good for fat loss, which I’m sure we’ll get into a little bit. So it’s fascinating to me because it has different effects.
You can even go one step down and look at pure isolated caffeine—what’s called anhydrous caffeine—versus caffeine that’s in coffee. So coffee has a bunch of other chemical or polyphenols that have other effects, too. And then your body breaks down caffeine into three different metabolytes that may have slightly different effects, too.
In terms of performance, caffeine has a pretty good track record. So if you look at endurance performance, in general, it’s shown that caffeine does help performance. The catch is that it’s a pretty big dose. So for the average sized person, you’re looking at probably 200 to 400 mg of caffeine. So a standardized smaller cup of coffee has about 150 mg. But everything gets—mental models of caffeine get all screwed because a very large cup of coffee from Starbucks has 400 to 500 or maybe 600 mg of caffeine. The standardized caffeine and even something like that in coffee varies widely as a 2003 study. So endurance performance, generally beneficial.
Mechanism, pretty debatable. There was a really interesting study that compared caffeine and also aspirin because caffeine at a high enough dose does seem to inhibit pain a little bit. And if you think about what people are doing when they’re trying to run very long distances, a lot of that is just pain management to some level. So caffeine there probably works over multiple mechanisms.
And caffeine does seem to help with strength and power, though literature is not quite as clear on that. But again, the dose in most studies there is really high. You’re looking at usually a minimum of 400 mg of caffeine. So if you look at a Vivarin tablet, that’s about 200 mg. So it’s a pretty high dose. And if you go too high of a dose in people, it actually decreases your performance. So there’s kind of that happy medium there too. And performance-wise, they’re probably looking more at speed and power, although limit strength may go up a little bit too. So caffeine is probably one of the things that has the most data. Caffeine and probably creatinine are probably the two supplements that have the most data. And most of it is relatively beneficial.
The last on that too is that, when we’re talking about beneficial, we’re still talking in the single digit percentage. So it’s not like you’re going—if your deadlift is 300, you’re not going to go lift 400 just because you took caffeine. But if you’re pulling around 400 and maybe you get a small percentage bump, it could be 410, 420 on a good day. So to someone who’s been lifting for quite awhile and is an experienced athlete, those are definitely pretty big increases.
DrMN: So again, it depends on the population you’re looking at too.
DrMR: Gotcha. Okay, so performance it works well for. I want to come to fat loss in a second because I’m sure that’s something people are curious to get specifics on. But it’s also interesting that you say—but also, I think, pretty reasonable—that there is an ideal dose. And if you exceed that dose, performance goes down. And I’ve clearly noticed that with caffeine. I have a certain threshold that if I go over it, it just ends up making me tired and like I can’t think and—yeah. I learned that several times the hard way.
DrMN: Oh yeah. I’ve tested that too.
DrMR: Yeah. And at some point, we’ll be doing a review of coffee consumption and its implications for overall health. And I think I alluded to this in one of our previous podcasts. But it looks like from a health perspective—just to quickly go into coffee because most of the research looks at coffee consumption—it looks like coffee is neutral or may have a slight positive impact on metabolism and/or cognition. But there is some evidence, not clear evidence, but some evidence showing that certain gastrointestinal conditions may be aggravated by coffee. So just a quick aside there on coffee, more on that to follow. But what about caffeine and fat loss? What does the data there look like?
DrMN: Yeah, the data there, unfortunately in my opinion, is pretty unimpressive. Like I said, from a mechanistic standpoint, there is some pretty good data to show that caffeine does increase lipolysis. So lipolysis, as I mentioned, is the process of breaking down fat into basically smaller little pieces that can potentially be used or burned in what’s called fatty acid oxidation. And you need both of those processes. But a lot of the literature, a lot of it done at the Gatorade Sports Institute from the late 80s, early 90s and from different labs, showed that lipolysis isn’t really the rate-limiting step in fat loss.
So how it works is your body will break down more fat than what you can actually burn. So if you take caffeine and you get a little bit more bump, so you’ve got more free fatty acids floating around, if they’re not really ever used, it doesn’t matter. Your body just takes those little pieces and puts them back together. It’s called re-esterification.
So yes, caffeine can increase lipolysis. Does it matter as a direct mechanism for fat loss? Probably not. There is some data to show that resting energy expenditure can go up a little bit as people tend to move around more and things of that nature. There may be a slight anorexic effect, meaning that people tend to eat a little bit less when they’re using higher doses of caffeine.
But there’s also, in my opinion, a cost associated with that. So if you have to have a lot of caffeine every day to get by, you’ve got some other issues you probably need to work on. So one thing I track in my journal is how much caffeine I consume on a daily basis because I find that that’s a pretty good marker for my lifestyle issues. So if I find that my caffeine intake is going up higher and higher, pretty much always correlates with stress level, lack of sleep, poor nutrition—
DrMR: Right, yeah.
DrMN: A lot of other things. So from that aspect, I found that it’s a pretty good associate to other things going on. And for most people listening, it may be worth tracking on a daily basis.
DrMR: Yeah. That makes sense. Definitely, definitely. I think a lot of people probably notice that same thing, that the harder life is getting, the more caffeine they have a tendency to drink. And I’ve actually recently really throttled off caffeine.
And I really think I probably have better energy when I don’t drink caffeine or when I only use it maybe like once, maybe twice a week. But if I start going above that, I think chronically for me, it actually gives me less energy.
But you have to transition out of that mode of feeling like you need it and then letting your body balance out. And at least for me, my energy is definitely better when I’m pretty judicious with caffeine use.
DrMN: Yeah, I would generally agree with that. And if people are looking to cut back, just make sure they do it relatively slowly. So if they’ve been at a pretty high dose for awhile and they decide to go cold turkey, if they start getting headaches and stuff like that, then don’t go quite so extreme.
If you have three cups of coffee every day, try two for a week and then one. And then maybe try one day without any caffeine. So that’s, I find, much easier and less likely to get withdrawal symptoms and things of that nature.
DrMR: Definitely, definitely. Okay.
What about whey protein?
DrMN: I like it. It’s good.
DrMR: I know that there’s been some research on whey protein, of course, for muscle synthesis. Some of the studies I’ve seen that looked pretty relevant and pretty clinical and pretty real-world seemed to show that the addition of luecine to whey protein had a significantly positive impact on muscle protein synthesis in an older population.
But it seemed like the combination of whey and luecine was better for muscle mass than whey alone. But you know this literature a lot better than I. So what are your thoughts there?
DrMN: Yeah, so in your comment on that, in an older population, adding luecine to it may be beneficial. There’s not a ton of data in that area. The reason it may be beneficial is as people age they get what’s called anabolic resistance.
So a study done a couple years ago compared young, moderately active people in their 20s to older folks who were average age of 71. And what they showed was that the older people needed, as it turns out, an acute dose. So how much protein you would have at once, and then measuring muscle protein synthesis after that.
So what is sort of the anabolic response? How well does your body use it in order to help stuff amino acids into muscle? So to help muscle recovery and building. It did show that older people needed almost twice as much protein as younger people. So there is some data to show that possibly adding luecine to protein may make that more anabolic in older people who have anabolic resistance. And timing in those people may be more beneficial. So having it after they’ve done resistance training, again, may be more beneficial. Not a ton of data on that, but I think we’ll definitely see a lot more of that coming out.
If you’re younger, adding more luecine to a whey protein doesn’t seem to help. Whey protein itself probably maxes out the luecine threshold at around 2.5 to 3 grams. So if you take 20 grams of just whey protein, you have enough luecine to kick-start that building process and you have enough other amino acids as things to be used in the building process.
I explain it like if you’re starting an assembly line and you’re going to manufacture some new muscle, you need some energy to run the assembly. You also need something to start or turn on the assembly line, which would primarily be luecine. And you need something to actually do the building or the construction, which would actually be the amino acids in the protein.
So about a 20-gram or one-scoop dose of protein, at least the whey protein, is high enough in all of those to accomplish that. Again, an outlier being if you’re quite a bit older, you may need a little bit more with that. So in general, I think whey protein is a very good protein. You don’t need as much of it compared to other sources of protein.
The only thing to watch out for is that there are some people who can’t handle dairy very well. So the first thing I would do with them is to switch to a whey protein isolate. The whey protein isolates do not have much lactose in them.
And a lot of people have more issues with lactose. If they’re using a whey protein isolate and they know that there isn’t lactose in it and they’re still having issues, there may actually be something in the whey protein in and of itself. But other than that, I like it as a protein source.
DrMR: Gotcha. And you make a good point about the isolate. And many of the semi-elemental diet formulas will use a whey isolate that is very low or devoid of all lactulose. And they seem to work really well in patients with pretty advanced gastrointestinal distress and disease. So in a sensitive population, it worked pretty well and again probably, as you said, because of the low lactose content.
DrMN: Yeah, and one other thing that I’ve noticed too—and you may have noticed this—is that the whey protein hydrolysate—so hydrolyzed whey protein—that’s something where they enzymatically break it down into super small components or peptides. That seems to be even more non allergenic to a fair amount of people, probably because it’s broken down into such small pieces and it’s been pretty heavily processed.
So that’s one thing I’ve noticed too. So I may try that in people who are borderline and see if that works. The downside is that a lot of the whey protein hydrolysate, you’d have to order them usually specialty from a protein manufacturer. And they generally don’t taste very good.
DrMR: Right. The more you break down the molecules—
DrMN: Very bitter.
DrMR: The more bitter they are. Do you have a good, commercially available, partially hydrolyzed that you like that’s not bad tasting?
DrMN: I’ve ordered ones from True Nutrition before. And theirs are not too bad. The flavorings they use currently are pretty good at covering it. They also try to do a process which is called de-bittertizing it—still tastes a little funky. They don’t put any anti-foaming agents in them, so they do foam a little bit more, if that bothers people.
In terms of the commercial product, the Post from GenR8. They also make Vitargo. That one has a protein that’s hydrolyzed and also has lactose removed from it. And that’s combined with Vitargo, which is a carbohydrate. And that’s actually ELISA tested to be gluten free and everything else too.
DrMR: And it’s called Post from who?
DrMN: Post. I think it’s just the Post Workout from GenR8.
DrMN: So if you just look up Vitargo, they have two versions. It’s basically one that’s a carbohydrate and then one, I think it’s called just “Post,” which has carbohydrate and whey protein in it.
DrMR: Gotcha. And what’s the form of carbohydrate?
DrMN: It’s Vitargo, which is amylopectin that’s been specially processed so that it’s actually highly branched. And they’ve got some pretty cool studies showing that it’s absorbed through the stomach and the intestine quite rapidly. I use it if I’m really busy and with clients pre-training, so before a heavy weight training session because I’ve literally tried just drinking it with some protein walking to the gym. And I’ve never had any gastrointestinal issues. If you take a fairly large amount of carbohydrates and it doesn’t make it through your gut, it can feel not so good training.
The other thing that it works really well for is in athletes who have a two-a-day. So maybe they’re doing CrossFit or they’re doing American football or whatever. And they’ve got their, say, skill session in the mid-afternoon. And then two or three hours later, they’ve got a heavy duty weight training session.
So at that point, you’d want to replace glycogen, so stored forms of carbohydrate, as fast as you can. So there, speed is actually important because you’re going to do another pretty heavy session within a short period of time.
So I have used Vitargo at that point just because it’s absorbed more rapidly, easy for them to use. If you’re going to train in the next day, within 24 hours, timing just isn’t that important as long as your calories are high enough. But in those cases where you’ve got a short period of time or you’re using it during competitive event.
So I did just the recreational Strong Man a couple years ago. So I just used Vitargo with some hydrolyzed whey protein and caffeine. That worked well.
So they wanted something that was enough energy, but I was pretty nervous about doing it. I didn’t want anything that was going to really bug my stomach. So if I get the random last minute call of, “Oh, hey, I’ve got a big competition tomorrow. What do I do for fueling?” Hydration aside, I just find that Vitargo and the hydrolyzed whey protein works really well.
DrMR: Gotcha. And it certainly makes sense from a gastrointestinal perspective that that would work really well because, again, that sounds very similar to some of the liquid nutrition solutions that we use in patients with very sensitive GIs. And it’s trying to tip that balance between having the formula, the pre-digested, but not be so pre-digested that it tastes awful.
DrMR: And yeah, yeah.
DrMN: The other part too I’ve realized, as sure as you have too, is that people’s tastes are pretty wide ranging. I used to recommend stuff. I’m like, “Ah, this tastes great.” And they buy it. And they’re like, “That was the worst thing I’ve ever had in my life.” And I’m like, “Oh, you think that’s bad, you should try some other stuff.”
DrMN: I remember ordering a whey protein hydrolysate years ago from Protein Factory, which was one of the only places you could get the actual version. They tell you the daltons, which is basically the weight, so how much it’s been hydrolyzed. I remember ordering a 520.
And I thought I had put flavoring and a sweetener in it. And it turns out I didn’t check those boxes. So I put a full scoop in my little container. And I’m shaking it up. And I’m standing in my kitchen. And I drink it, and I literally spit it all out over my kitchen sink. Like, “Oh my, God, this is horrible!”
DrMR: Yeah. Yeah, you’ve got to get the right balance, absolutely.
DrMR: Have we talked about creatine yet?
DrMR: I have all these things in my head. Okay. I didn’t think we talked about it.
DrMR: But I’m trying to keep all these different questions in my head here. So let’s go into creatine because I’m sure that’s another one a lot of people have heard about, and they’re wondering about the performance effects. Typically, strength, power are the main things for creatine. But I’ve also heard some discussion that it may help with cognition too. So tell us a little bit about that.
DrMN: Yeah, so creatine is probably the most studied sports supplement ever. I think I typed in PubMed awhile ago “creatine monohydrate.” And I got 435 references.
DrMR: And most of those studies have been done in New Jersey, right?
DrMN: I don’t know. Have they?
DrMR: I’m just kidding.
DrMN: Oh, I was like—
DrMR: Bad Jersey Shore joke.
DrMN: Oh, okay. I gotcha. Anecdotal reports of [inaudible 23:09] creatine use has spiked in New Jersey. But yeah, so creatine is very well studied. It used to be extremely expensive. I remember when it first came out in the 90s, a buddy of mine was researching it. And he was telling me that he had a kilogram of creatine, which is 2.2 pounds, which nowadays is not that much. And it was thousands of dollars.
And so what creatine does is, in essence, it helps donate a phosphate group. So we’ve got ATP, which is the energy source for muscles and pretty much the whole body. And that gets broken down into a DP by pulling the phosphate off. So creatine helps basically regenerate those ATPs faster.
So that’s why it works really well for strength and power, outputs that are very short in duration. So two to maybe 10 seconds, probably somewhere around there, is most beneficial for it. It’s been available as a supplement since probably around the mid-90s or so. Now, it’s extremely inexpensive, which is good.
And the most common form is creatine monohydrate. They have tried over the years to come up with all sorts of different versions from creatine ethyl ester by attaching it to that to all sorts of crazy things. And so far, I haven’t seen any studies that show that any other form is superior to creatine monohydrate. Maybe a few of the salts may be equivalent. That’s probably a little bit debatable.
But I haven’t seen any other versions that are better. And the main reason is that people are trying to solve an issue that doesn’t exist. So creatine monohydrate is very well absorbed. We do know that it shows up in the muscle. It’s orally available.
There isn’t really any “problem” with it per se. Don’t really need to load on it. So a 5-gram dose every day is going to be pretty good. Studies where they compared taking 20 grams a day for two weeks versus just 5 grams a day for 30 days—at the end of the 30-day mark, both groups had the same amount of creatine stored in their muscle. If you’re in a super big hurry, you can argue that the two-week group got there a little bit faster. But for most people, two weeks probably isn’t going to be a huge deal. So I like it. It’s very cheap now, which is good.
You had mentioned that there are some really interesting studies looking at the neurology effects of it. Dr. Mark Tarnopolsky has done a lot of very interesting research on that. And what’s different is that you need higher doses to cross the blood-brain barrier to probably build up the creatine stores in the brain.
So in the neuro studies, most of the dose is around 20 grams per day. When he was presenting at the ISSM conference, I think last year or the year before, the initial studies were showing that it was much better than a lot of the drugs that they had been using.
There are some very interesting mice studies that show the mice who had creatine did much better in reduction of possible even brain trauma. So unfortunately, they had a little study where they whacked the mice on the head. The one had creatine. The other group didn’t. And the group that had creatine actually did much better.
Again, we don’t have a human study on that because I don’t know anyone that’s going to volunteer to get whacked in the head and take creatine or not take creatine.
DrMN: But anyone that I work with who does combative sports or American football or anything like that, I do recommend they probably take a higher dose of creatine, probably 10 to 20 grams a day. There doesn’t appear to be any side effects with that, maybe a little GI upset in people once in awhile. It doesn’t affect hydration or anything of that nature. So I think it’s probably a pretty good way of hedging your bets. We don’t know exactly how beneficial it is.
But on the downside, we’ve got a ton of data showing that it’s extremely safe even at higher doses. There are a couple studies that have gone back and looked at it for, I think, a year and a half, I think is one of the longest studies done in football players, I believe. Did not see any detrimental effects.
It’s been widely available as a supplement, like I said, since the mid-90s. And you just don’t really hear of any issues with it. So something that’s been—while it’s still purely anecdotal—consumed at that high level, it’s probably one of the most ubiquitous supplements around. You just don’t really hear about there being any issues with it.
DrMR: Gotcha. In terms of other—I don’t think it has any weight loss characteristics, but what about strength or power? What is the data there look like?
DrMN: Yeah, so it’s pretty good for strength and power, especially as you get into doing those in a more repetitive nature. So for example, if you’re doing something like a cluster set—it’s actually what I did today was trap bar deadlifts. So you may do one rep at a higher weight and then literally rest five to 10 seconds and then do another rep.
And you’re in the maybe three-to-four-rep range. It seems to help with that because you’re able to regenerate that ATP faster. Also, there are studies where they’re doing more volume at a higher load. You can do more, higher quality work using creatine versus not. In terms of absolute strength and power and speed, you can see some bump there too.
I think that a lot depends upon what your initial status of creatine was because some people say, “Oh, I’m a creatine non-responder. I took it, and it just did nothing for me.” And there is data to support that. In those cases, they’re probably already pretty saturated with creatine to begin with.
So creatine is stored in the muscle. And just like if I would take a glass of water and try to fill it. I can only cram so much water in the glass. Once it’s full, I can keep dumping water in it, and more is not going to go in. So if your creatine stores are already saturated, you eat a fair amount of red meat, things of that nature, taking creatine as a supplement, probably not going to be that beneficial from a muscle standpoint.
But if you are lower—most people are probably on the lowerish side—it is probably more beneficial. So I used to be a little bit more of a strict vegetarian, didn’t eat a lot of red meat, actually for many years didn’t eat red meat at all. So when I first took creatine, I noticed a pretty big difference.
Again, for supplements—big difference, you’re still talking in the single digit percentage. It’s not like everything doubled overnight or anything like that. I’ve tried cycling on and off it within the last couple of years. I don’t really notice a huge difference, to be honest. I still use it because I think it can be beneficial. There are potential neurological benefits. And there really aren’t many downsides. And it’s dirt cheap, too.
DrMR: Right. Okay. Cool. What about carnitine?
DrMR: Typically, you hear about carnitine for weight loss. One of the main mechanisms, at least as I understand it, is the carnitine shuttle, which is needed as part of the fat oxidation process. I’ve seen a couple of studies showing effect. But if my memory serves me correctly, the amount of the effect seemed not huge. So what about carnitine as a weight loss supplement?
DrMN: Yeah, it’s one of those things that’s been around for a long time. And when I always look at supplements—I actually got this from Dr. Richard Harris—that looking at the mechanism first will give you some insight. So if the physiologic mechanism makes sense and is accurate, maybe giving it as a supplement may be beneficial. At least, it’s physiologically plausible, which L-carnitine is.
What I looked at next, is it bioavailable? So if I ingest it, does it actually show up where I would expect it to? So for example, creatinine monohydrate gets across the gut, gets absorbed, and shows up in the muscle exactly where we would expect it to. With L-carnitine, I’d say it’s a very maybe.
There are a couple pieces of data that show that it may have a slight effect for fat loss. I talked to another guy who is doing some work at one of the labs that has done a lot of carnitine work. Research isn’t out yet, but according to them—again, this is unpublished—but they saw pretty big effect. And they expect that study to hopefully be out later this year or early next year.
One of the studies that was out showed that to get levels of it high enough, you may need a crap ton of carbohydrates to do that probably because it’s pushing up insulin at the same time. So there is an effect, but you have to take a ton of carbohydrates to cancel out the effect that’s there.
DrMN: And last thing, too, is that if you can stuff more fat into the mitochondria to be burned, I still think, from what I read, that the fatty acid oxidation—or how much is being burned—is still going to be a limiting factor. So I think that’s one of the downsides of carnitine.
There’s another one that’s by a slightly different mechanism, called astaxanthin, which is a red carotenoid, shows up, which is why crabs have that red color. And that seems to work by a slightly similar mechanism that it changes the CPT enzyme, so carnitine palmitoyltransferase I.
And in mice studies, it does a pretty good job of up-regulating how well your body can actually use fat. And there are some cool studies showing endurance swim times and things of that nature are better. Human studies on that—they’re really split. A couple of them—one of them in Med Sci a couple years ago didn’t show any performance enhancement there.
So I don’t know. I am still kind of up in the air I think. I have had clients use astaxanthin because it does have some other pretty cool antioxidant properties also. There doesn’t seem to be a downside there. L-carnitine for fat loss, in and of itself—I’m not entirely sold at this point.
DrMR: Gotcha. One thing about carnitine that I like and where we use it occasionally is with patients that have Grave’s disease.
DrMR: There have been a few trials showing pretty impressive anti-hyperthyroid effects of carnitine. And we’ve seen that in the clinic where it’s worked really well for people. I want to say there was a drug-to-carnitine comparative trial.
But I can’t remember if it was drug-to-carnitine comparative trial or if they just showed things like decreased pulse rate, decreased insomnia, decreased anxiety. But they definitely showed a favorable impact on hyperthyroidism with carnitine. So potential use for it there.
DrMN: What was the mechanism on that?
DrMN: I was just curious.
DrMR: There are a few different mechanisms that they propose in this paper. But this was probably two years ago when I read it. I can’t recall off the top of my head.
DrMN: No worries.
DrMR: We had been talking about an amino acid that was supposed to help with strength. And I want to say it was arginine. And I think there was a systematic review, examining the effects of arginine. And I had shot you a note saying, “Hey, this looks pretty interesting.” And then you said, “Yeah, it does. But you only get maybe a 2% increase—was shown to be the average increase.” So what about arginine?
DrMN: Yeah. L-arginine as an amino acid for strength training, in my opinion, is probably pretty worthless. It has a semi-plausible mechanism. So it’s primarily used for dilation of muscle, or to go to the gym and get a bigger pump. And it is true that it does serve in the nitric oxide pathway, which is the locally controlled pathway that regulates how much blood goes to the muscles. So it does have a plausible mechanism.
The downside is that it’s just not that orally available. So the best studies that show an increase were looking at 10 to 15 grams of L-arginine. And that was done by I.V. So if you give that much orally, you just have massive stomach issues and all sorts of stuff. So in theory, if you can alter nitric oxide locally, yeah, you may get a better pump or things of that nature.
There’s a little bit better data on L-citrulline, which acts in the same pathway, just in a different area. And there’s some pretty good data on that. I wouldn’t say it’s the best ever. But that definitely has a lot more data than L-arginine.
Increasing Blood Flow to the Muscle
Two other things too are that you actually want to target the local dilation. So if you look at a drug like nitroglycerin, or nitro as it’s called for heart patients they give it to—my grandma had it, and she’d put it under her tongue. And it would massively dilate vessels in the heart for people that had angina.
So when I was in school, one of the studies I did was using Monster Energy drink to look at local changes in blood flow. So we did a procedure called flow-mediated dilation where we’d take a blood pressure cuff. We’d stick it on your forearm. We’d use an ultrasound to look at the vessel in your upper arm.
And when we released the cuff after about three to five minutes, you have all this blood that rushes into the vessel. And when it sees that amount of sheer stress on the wall, so massive influx of blood flow, the vessel would then dilate. So it was proposed—and there’s some pretty good data on this, too—that that may be a marker for endothelial function. So how well your vessels can dilate in that vessel and then hopefully that transfers to how well your cardiac vessels can dilate. So in your times of stress, hopefully they can dilate to increase and reduce your risk of cardiovascular disease.
One of the studies we did, we wanted to compare it to a chemical control to see what the difference was. So the chemical control we used was nitro. And I was one of the subjects in that study. So I got to be in the hospital bed. And they come in. And they give you the nitro.
And holy crap! Does that dilate the hell out of your vessels! I felt like if I had to get up and run at that point, I would have been just flat out on the floor because it’s dilating all your vessels. And right after that, I got just the world’s biggest, massive headache because it’s dilating all the vessels there too.
DrMN: So you actually want more of a local dilation effect. The best thing for that is actually insulin. So by taking in a higher amount of a faster acting, insulogenic carbohydrate, you can get more of a local, muscle effect.
The last thing on that too, in terms of increasing blood flow to the muscle—does that actually enhance things like protein synthesis? Probably not. We were at a—with Dr. Lonnie Lowry and myself and some other guys—at a conference a few years ago at Experimental Biology.
And they presented some data where they used a drug that they infused into the vessel, dilated the hell out of the vessels, and then measured protein synthesis. And they didn’t really see any uptake at that point.
So all that to say, if you’re going to the gym and you want to get a better pump, just take in more carbohydrates first. That’s probably going to be one of the better ways to go.
DrMR: Gotcha. And I love the simple message because—
DrMN: Yeah. Go figure.
DrMR: Yeah, it’s easy to get wrapped into this billion dollar sports supplement industry. But yeah, you have to be a little bit skeptical and practical or you’re going to be parting with a lot of money and having really expensive urine.
DrMN: Yeah. Yeah, there’s some data on different types of nitrates that can be used. The FDA has cracked down a little bit on trying to make compounds out of them. It’s like creatine nitrate, things of that nature. Nitrates, as you know, show up in beets. So there is some data to show that that may be beneficial. But most of those studies were done looking at oxygen efficiency, not necessarily blood flow effects.
DrMR: Gotcha. Gotcha. What about echinacea to help with performance by boosting erythropoietin? I had seen a couple studies looking at the mechanism of echinacea increases erythropoietin. And erythropoietin essentially helps with blood production and can theoretically help with endurance because you’ll have more oxygen carrying capacity of your blood cells.
However, I then looked to see if there were any outcome studies. And I just gave this a quick glance. But I found the first two or three outcome studies I found showed that the echinacea didn’t have any favorable impact on endurance performance or whatever the outcome measure was being tracked. So any thoughts on that?
DrMN: The little bit I’ve seen, I would generally agree with that. I haven’t looked at any of that literature in depth, to be perfectly honest. But the couple things I’ve just seen in passing didn’t show any performance jumps that I’ve seen.
And that’s kind of the thing to be careful when people are reading research. And you may see that, “Oh, this increases EPO.” And then people go, “Oh, well, EPO increases performance.” And both those statements may be correct. But just because EPO went up does not automatically transfer to a performance increase either. And that’s what you see in a lot of studies.
On the flipside, you see that in studies looking at muscle breakdown, like creatine kinase in terms of soreness and things of that nature. I’ve done some peer reviews on a few of those studies. And I always like to look and see is there a performance measurement there? Because you may have more CK, for example. You may have more damaged muscle. But how much of that does that really affect your performance?
DrMN: And what you see is that there’s not this really nice, neat, linear relationship. Yeah, more CK is associated with damage. Yes, at some point, you get a lot of damage, you do have a short-term drop in performance. But they don’t perfectly mirror each other either. So it’s not like, oh, CK is up by 30%. Oh, performance dropped by 30%. It’s never that clean. So that’s what I always like to look to see if something has a plausible effect. Did it increase one of the markers?
And then next step is, did it actually enhance performance? And if you go even further down the rabbit hole—what type of performance is increased? So for example, in the study I did on Monster Energy drink, I actually did a ride time to exhaustion, meaning you just get on a bike. We had different things set up.
In essence, we see how long you can ride at set amounts of work rate until you can’t go anymore. A lot of that I did because it’s based on the early caffeine studies. A lot of them use ride time to exhaustion.
But people will correctly argue that, well, that doesn’t necessarily translate to pure performance. So to do pure performance, you’d want to look at more of a time trial because most athletes—let’s say you’re running a marathon or cycling 100 miles or whatever, you’re going a set distance. But you want to do it in the shortest amount of time. So time trials have a much better track record of translating more to real-life performance.
The downside with that is that you have to look to see how much practice people have doing that. So if you take a bunch of new athletes who haven’t done that, there’s actually a skill to how well you need to pace yourself to perform better. It’s like anyone who’s done a longer event that hasn’t practiced. They tend to go too fast too soon.
And their overall performance is less than too. So that’s where it gets kind of messy where it’s not quite as simple as what you would want to believe. So if you run a time trial and you see that just in pure order, let’s say the supplement is randomized, but after four trials, everyone got better regardless of supplement or not, probably have a pretty big learning effect there.
DrMN: So then what do you do?
DrMN: So yeah. It’s not always as simple as everyone would like.
DrMR: Sure. Sure. No, and those are all great points. And just to reiterate something that you had mentioned a second ago. Outside of some of the logistical difficulties of maybe setting up the ideal study parameters, just being practical and looking at outcomes is really, really important when people are trying to evaluate literature claims.
And we’ve made that criticism for many things in different gastrointestinal conditions and microbiota treatments that it’s easy to fall in love with the mechanism and get swept up in it. But we have to stay grounded in what the clinical effect is so as not to be misled.
DrMN: Yeah, and even looking at the outcomes, determining what group or population you’re looking at. So you may see a small increase. But if it’s an elite athlete, small increases are worth a lot to that population. To the average person looking to just get started exercising, they’ve got so many other things they need to worry about first.
DrMN: So I think that’s what people need to be careful too, that just because it’s significant via statistics doesn’t mean that it’s always clinically or relevant in sport. And the opposite is true too. If you’re P is 0.047, technically, if you use 0.05, it’s not significant. So we’d say there wasn’t really an effect. But in an elite athlete situation, there may possibly be.
So I always like looking at the raw data to see, oh look! Oh, wow! Seven people in that study actually did substantially better. Three or four or five didn’t. So it was kind of a wash. But if you’re one of those seven, it may actually be beneficial for you, statistics aside.
DHEA & Pregnenolone
DrMR: Sure, sure, sure. What about DHEA? Any comments on that?
DrMN: Not that much, to be honest. I think if you’re deficient or really low, you probably—I had this discussion with another guy about DHEA and Pregnenolone because they’re both technically hormones. And they’re both available over the counter. It’s debatable if different organizations test for them or not. I’m not a testing expert. I’m not sure how they could pick that up. My guess is that if you’re really stressed, they may be beneficial. Obviously, all hormones have a negative feedback loop attached to them. So you have to be careful with that. I don’t know. I guess I would put them in the maybe category. But I haven’t really seen a lot of data that has even really looked at that in terms of performance. I don’t know what you found in that area.
DrMR: Not much in the way of performance. More so for sex drive—
DrMR: Energy. Well, I guess energy could equate to performance. But I’ve never seen it looked at in the context of any kind of physical performance parameter.
DrMN: Right. Right.
Mike’s Supplement Recommendations
DrMR: So then what would you say to bring us to wrapping a lot of this stuff together—what would you say are some reasonable or pretty solid supplement recommendations that people should think about maybe incorporating?
DrMN: Yeah, the ones I like to recommend are, in general, from food sources. So whey protein is one or a protein supplement, just more as a convenience. I actually just talked to Dr. Stu Phillips today about this.
And he’s in the top protein researchers. And he was adamant saying that if you plan well and you pick your sources right, you can do pretty well without using a protein supplement, which I would agree with.
But for a lot of people, it just makes it an easy convenience also, which is nice. Creatine monohydrate—tons of studies showing that it’s generally beneficial, maybe some neurologic effects too, dirt cheap.
The other one I would put in there is probably fish oil. A lot of people are deficient in EPA and DHA, which are the fish oils themselves. The literature in terms of pure performance on that—pretty split. I wouldn’t say that it’s pure ergogenic.
But the basis that those are what hormones are made from and they’re basic building blocks I think is probably a good thing to look at. Outside of that, I think an occasional use, caffeine has a good track record, can be beneficial. So that’s the other one I would look at.
After that, I think you kind of get into a little bit more of the esoteric-type things. You could make an argument that if you’re really low in things like magnesium, that may be beneficial. Vitamin D is really split in the literature in terms of performance.
If you’re super low in the hopper, adding vitamin D may give you a little bit of a bump. It’s still up in the air about what level, from a pure performance standpoint, you would need for vitamin D to enhance performance.
We do know that if you’re not deficient, adding more vitamin D does not further enhance performance. It’s pretty clear on that. But Dr. John Cannell has made some pretty interesting arguments about vitamin D and when the Olympics were held in relation to sunlight and things of that nature. So possibly on that one again, but probably only if you’re really deficient in it.
DrMR: Gotcha. Cool. Well, those all seem pretty reasonable. Any other—
DrMN: Kind of a boring, unsexy list.
DrMR: Yeah, but I really think the people who listen to and follow the podcast have come to expect this reasonable sort of narrative.
DrMR: Because I unfortunately think, this day and age, you almost have to know as much about what not to do as what to do.
DrMR: Because there’s just so much information out there you have to be a little bit protective of what you’re going to do. So totally appreciate it.
DrMN: Yeah, my buddy Craig said a long time ago that if the average person just took the $200 they spent on supplements—they don’t even know what they’re spending it on—and just took that and bought higher quality food, they’d probably be pretty good. And the ones I mentioned, really not that expensive. Whey protein can add up a little bit, depending on how much you’re using. But in general, they’re really not that expensive.
So I would say start there. Make sure everything else is in line. And then if you want to experiment from there, by all means. The benefit of a supplement is there’s not much action required. You just kind of need to take it.
DrMN: So on that front, that makes it a lot easier. But in terms of big jumps in performance, probably not. But if you’re more of an elite athlete, those smaller jumps mean a lot more to you also.
DrMR: Yep. Yep, well said. Well said.
Episode Wrap Up
So, Mike, anything you want to make people aware of that you’re working on? And where can people track you down if they wanted to hear more from you?
DrMN: Sure. Always got all sorts of different projects and stuff going on. Best place to get a hold of me is probably just through the website, which is just MikeTNelson.com. That’ll probably get all redone at some point, but it’ll still work. You’ll find a place there to hop onto my newsletter. And that’s probably the best place to reach me. Most of the stuff I put out now is through the newsletter. So that’s where I would go.
DrMR: Gotcha. Cool. All right, my friend. Well, thank you very much for your time. As always, it’s been a great conversation. And I’m sure at some point in the near future, we’ll find another topic to dig into and pick apart.
DrMN: Yeah, for sure. Thank you very much. I appreciate all the good questions and nice discussion there. That was a good time.
DrMR: Absolutely. Same here, my man. Talk to you soon.
DrMN: All righty. Take care.
DrMR: All right. Bye-bye.
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