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Alcohol: A Primer

Get the facts here and the booze elsewhere! 

A contentious topic in the nutrition industry: Alcohol. It’s an addiction, a hindrance, an inhibitor of sense and yet, it’s a pleasure, a social convention and an aggregator of sensations.
 

Did you know? When water was unsafe to consume in Europe, alcohol proved to be a better option for hydration!

 

Why do we drink? 

 

For a multitude of reasons! They’re not just excuses to get sloshed, people. We’re talking about actual scientific facts here. 

 

Let’s get serious.

 

The primary factor that causes humans to consume alcohol is dopamine. When you drink alcohol, it increases the flow of dopamine, which in turn stimulates the pleasure and reward center of the brain. The direct correlation of drink = reward is as simple as it gets. 

 

Did you know? Young adults who love sugar have a predisposition towards alcohol, and are more prone to getting addicted to it.

 

Other factors that incentivise us to drink alcohol include: 

  • appealing taste 
  • stress relief
  • loosens inhibitions  
  • social courtesy
  • assists sleep

 

How does drinking affect us? 

 

Although we humans consume for recreation, alcohol is a toxic substance that can cause a lot of damage to our bodily functions. The toxic-flusher of our bodies – the liver is the organ that is particularly sensitive to alcohol intake.

 

Fatty liver is a common occurrence in those who drink more than 15ml of alcohol per day. While this doesn’t show symptoms and is reversible, binge drinking and excessive alcohol consumption leads to inflamed liver, or worse, cirrhosis.   

 

Physiologically, when we drink we lose control of our inhibitions. Yes, this makes socialising easier but it also increases and encourages risk-taking behaviour. 

 

The World Health Organization estimated that over 3 million people die every year due to alcohol consumption. This constitutes 5% of all deaths!

 

When does drinking become an addiction? 

The simple drink = reward correlation we spoke of earlier? Both a blessing and a bane, an excessive increase in dopamine levels is an addictive factor. Further, alcohol acts on the prefrontal cortex which reduces our inhibitory control and amps up our risk-taking behaviour. These coupled with pre-existing addiction tendencies, lifestyle, environment and company all play a role in creating an alcohol addiction. 

 

We’ve covered the why, the how, and the when. It’s now time for the what.

 

What can you drink? 

 

Leaving aside the physiological and psychological effects of alcohol we’ve outlined above, there’s sure to be times when you do indulge in a sip (or glass) (or bottle) of alcohol. Here’s what you can do to minimise the impact. 

 

Lay. Off. The. Cocktails. 

 

Cocktails, margaritas, fancy shots – therein lies the path of sugaryness. It’s ideal if you stick to hard liquor and a mixer (water, soda or ice). Do make sure to curtail the number of drinks and keep hydrated throughout. 

 

So that’s the high and low of it all. We are not in the business of morals, ethics or sanctity. You’ve read the science, now it’s time for you to make the choices that work for your lifestyle! 

 

Cheers and see you soon,  

 

References

  1. https://www.wdl.org/en/item/3956/
  2. Kampov-Polevoy, Alexey, et al. “Sweet-Liking Is Associated with Transformation of Heavy Drinking into Alcohol-Related Problems in Young Adults with High Novelty Seeking.” Alcoholism: Clinical and Experimental Research, vol. 38, no. 7, 2014, pp. 2119–2126., doi:10.1111/acer.12458.
  3. Crabb, David W. “Pathogenesis of Alcoholic Liver Disease. Newer Mechanisms of Injury.” The Keio Journal of Medicine, vol. 48, no. 4, 1999, pp. 184–188., doi:10.2302/kjm.48.184.
  4. Bergheim, Ina, et al. “Treatment of Alcoholic Liver Disease.” Digestive Diseases, vol. 23, no. 3-4, 2005, pp. 275–284., doi:10.1159/000090175.
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All About Sleep

Sleep is for the weak? No, sleep is for the species! 

 

“If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made” – Dr Allan Rechtschaffen

 

Have you ever thought about why we need to sleep? Guess what…

 

Nobody knows!

 

From an evolutionary standpoint, sleep is rather confusing. When the body is at rest, it forsakes all the aspects that constitute humanity. One can’t gather sustenance, socialise, mate, protect offspring and worst of all, sleep leaves you vulnerable to predation. And yet, lack of sleep causes serious physiological and psychological damage to our bodies. Let’s take a gander into the world of zzzs…

 

Types of Sleep 

 

The recommended daily amount of sleep is 7 – 8 hours for adults. However, this comes with a disclaimer. The sleep referred to here includes total sleep and type of sleep, both are required for optimal body functioning. Over and above this, it’s ideal if one sleeps at the time when the body is ready to sleep and not otherwise. 

 

If you were a biology student, I’m sure you’ll remember hearing about REM sleep in school. REM or Random Eye Movement sleep is usually when you get dreams and/or nightmares. Non-REM sleep is commonly known as deep or slow wave sleep. 

 

Circadian Rhythms: We all have an internal body clock which controls when we wake and sleep, which usually follows a 24-hour repetitive pattern. This circadian rhythm affects the working of every single cell, tissue and organ of our bodies! 

 

Off the rhythm 

 

It’s not just dancers that need to maintain a rhythm, our body mechanisms need to as well! When there is an alteration in your circadian rhythm, everything feels ‘off’. Consecutive shifts from our rhythms, whether due to poor or disturbed sleep or lack of sleep entirely, leads to sleep deficiency and ultimately, sleep deprivation. 

 

I’m so sleepy…

 

An oft-spoken phrase, isn’t it? Sleep deficiency has become the new norm, in fact, it’s begotten the term ‘sleep epidemic’. An occasional night awake is expected, but several nights up late binge-watching shows, staring at the ceiling or simply being unable to sleep? It’s not optimal in the slightest. 

 

Microsleeping: Those brief moments of sleep that happen while you’re still awake? If you’ve experienced this, you’ve been microsleeping. A symptom of sleep deficiency, microsleep can’t be controlled and often happens without your awareness.

 

Insufficient sleep on a regular basis interferes with every aspect of our lives: work, school, driving and even social situations. Retention and reaction capabilities are hindered. Gauging  other’s emotions is tough when you haven’t slept enough, and you will find yourself frustrated and anxious when socialising. 

 

All this and more is why we should prioritize sufficient and appropriate sleep. 

 

But, how?

 

Creating a sleep routine is a requisite for sustainable balance in life. Start small. And no, we’re not recommending you count 100 sheep a night, then 200, and so forth. Find a rhythm that works for you! Whether it’s keeping a sleep diary, setting reminders to get ready for bed, or even asking your significant other to wake you up (a parent would be more reliable), make sure you maintain that routine.  

 

The more consistent you are with your routine, the sooner you’ll see results in your day-to-day life. You’ll notice you’re more refreshed in the mornings (no more cranky monday blues), improved concentration at school and work, and a drastic reduction in your midday naps! Do comment below on what helps you sleep, we’d love to hear from you. 

 

See you on the flip side,

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Diabetes 101: We’ve got the Deets!

One of the disorders that’s now a household name, Diabetes has certainly had a global impact in the recent years. With data showing alarming future projections of diabetes cases across the world, let’s first understand this disorder in its entirety. 
 

 
Let’s get real, folks: “A touch of sugar” does not create diabetes. Even sugar consumption cannot cause diabetes on its own. But let’s find out what does: 

 

The deciding factor is insulin. If your body cannot make any, you have type 1 diabetes; if your body doesn’t utilise or make insulin, you have type 2 diabetes. The former is irreversible and lifelong care is required. Type 2 diabetes is majorly a lifestyle disorder which can be managed and in most cases, reversed.
 

 
Now that we’ve understood the role insulin plays in our bodies, let’s narrow down on what happens when there’s an insulin resistance. When you consume food, the digestion does its job and breaks it down to glucose. Now since insulin cannot grab the glucose from the bloodstream, the excess remains and elevates your blood glucose levels.      

 

So how do you know whether you have diabetes or not? Your biomarkers confirm them. When testing for diabetes, the main parameters one checks are fasting blood sugar, post-prandial blood sugar, HbA1c, HOMA-IR and urinary glucose levels.   

 

Does nutrition have an impact on insulin resistance?   

It most certainly does. The how, is still in the works. Even in the scientific world there’s a heated discussion on which nutrition guidelines have a sustainable effect on reversing and/or managing diabetes. Is it the macronutrient composition or the energy activity? How does one examine evidence from previously conducted trials? Is there a truly sustainable method of eating that can without-a-doubt reverse type 2 diabetes?

 

Rest easy, we’ve got the facts compiled for you.

 

There has been a degree of consensus in these areas…

 

A priority is Weight Management, since weight loss goes hand-in-hand with improvements in glycemia, blood pressure and lipids. Maintaining the required Energy Balance is another, where guidelines recommend portion control along with physical activity. Evidence-based Dietary Patterns such as higher intake of vegetables, fruit, whole grains, nuts, legumes and yoghurt, tailored to the individual. Certain Foods to Avoid or reduce include processed red meats, refined grains and sugars for prevention and management of type 2 diabetes. 

 

Whereas in these areas, there remains uncertainty in guidelines…

 

An issue most contentious in type 2 diabetes management is the optimal macronutrient composition, with variations among countries, nutritionists and those with diabetes themselves. While fish intake is recommended to manage cardiovascular risks, there’s a spectrum of association with diabetes: positive, negative or none at all! There has been consistent beneficiary evidence on yoghurt but other dairy products have yet to be conclusively examined. Oils and which type is preferable is still debated, though olive oil has shown evidence of potential benefits.  

 

So what exactly does a person with diabetes eat?

 

Well, therein lies the work. Those with diabetes have had a multitude of diet options thrown at them: paleo, keto, vegan and more. The fact remains that a ‘standardised diet’ does not work in the long term, period. Within the existing nutrition guidelines, one must craft a personalized meal plan based on their food preferences, lifestyle conditions and environment. Do remember that nutrition is an evolving process, it is advisable for those with diabetes to consult a nutritionist before making drastic nutritional shifts. 

 

Among the plethora of studies undertaken, the Mediterranean diet has attracted multiple diabetes trials. A 12-month trial found that participants on a low carb Mediterranean diet demonstrated greater weight loss, improved glycemic and HDL levels! However studies have yet to conclude if the same will continue in the long run.

 

Okay, but is exercise really that necessary? 

 

Exercise is recommended for people regardless of any disorders. Those with diabetes are particularly encouraged to exercise to improve cardiovascular and overall fitness, weight control and to enhance their quality of life. Exercise and resistance training may benefit and improve glycemic control. 

 

Did you know that the type and timing of your meals impact your blood glucose responses to exercise? People with diabetes and insulin dosages have to ensure that their insulin levels and carbohydrate intake are coordinated to reduce hypoglycemia. Care has to be taken with pre-workout and post-workout meals – consuming the appropriate quantity of carbs in accordance with blood glucose levels.

 

So with exercise and nutrition in check, can type 2 diabetes be reversed? 

 

Although once considered irreversible and progressive, recent years have seen a shift in management and reversal of type 2 diabetes. Despite this, there is little evidence on the sustainability and lasting effect of such reversal and the potential for remission. The question of the hour is which plays a more predominant role in achieving remission: energy deficit or macronutrient composition. For more on this, keep an eye out for our next blog post in this series. 

 

Until we meet again,

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Soy and Oestrogen

Soybean is the richest source of protein among plant sources. It contains around 35g of protein per 100g. It is said to be a complete protein as it has all 9 essential amino acids. It is also low on carbohydrates (12g/100g) and high in fibre (21g/100g). Then why is it that this superfood has become a topic of controversy in the recent times? Read to learn more about soy, its origin, uses, benefits and controversies surrounding it.

About soy
Soybean the “king of beans” serves as a key source of high quality protein among plant sources. Since the 1950s, global soybean production has increased 15 times over. The United States, Brazil, and Argentina together produce about 80% of the world’s soy. Soy which was traditionally consumed in Asian countries, is now consumed all over the world. It is very versatile and can be used to produce soy milk, tofu, tempeh, soy sauce, natto, soy chunks, etc. Soy and its benefits in chronic disease prevention have been researched upon for over 25 years now.
 
What is the connection between soy and Oestrogen?
Oestrogen is an important sex hormone, produced by the endocrine system, that is responsible for the development of female body and the secondary sexual characters. It is responsible for the growth of breasts, hips being wider in women than in men, regulation of menstrual cycle, among other functions. For this reason, it is termed as a “female sex hormone”. Men also have oestrogen receptors and oestrogen in their bodies but to a much lower extent compared to women. 
Soy has a type of phytoestrogen called isoflavones (genistein and daidzein) that is similar to oestrogen in terms of chemical structure. Phytoestrogen can bind to oestrogen receptors in humans and can have a relatively weaker oestrogenic or anti-oestrogenic effect i.e. have an effect similar to but weaker than that of oestrogen or act against oestrogen. Due to this property of soy, it has become the topic of controversy with myths associating soy with disruptions in hormone levels in men, development of male breasts, etc. First let us look at the benefits of soy and then discuss the truth about these controversies.
 
Benefits of soy for women

  1. PCOS- Soy may be beneficial to women with Polycystic Ovarian Syndrome, commonly known as PCOS. It is a metabolic, endocrine and reproductive disorder seen in women of reproductive age. PCOS is characterized by a variety of signs and symptoms. Menstrual irregularities, obesity or excess androgen could be a sign of this disease. In a study that administered soy isoflavone to women with PCOS for a period of 12 weeks. Significant improvement was seen in insulin resistance, hormonal status, triglycerides level and biomarkers of oxidative stress in the women studied. 
  2. Breast cancer– Oestrogen hormone stimulates the growth of secondary sexual characteristics including breasts in women. It also stimulates the growth of breast cancer cells. Some studies on soy consumption in women show a protective effect against breast cancer (due to the anti-oestrogenic effect of soy in premenopausal women).
  3. Menopause- It is a widespread belief that soy is beneficial to postmenopausal women and that the phytoestrogen in soy (which has weak oestrogenic effects in humans) helps in regulating oestrogen level after menopause as there is a decline in oestrogen production. Some studies have reported a reduction in the intensity and frequency of hot flashes during menopause in women given soy isoflavone supplements.

 
Other benefits of soy for all

  1. Cardiovascular diseases- Many studies have reported beneficial effects of the isoflavones in soy on blood pressure, glycemic control, obesity and inflammation. A study in which participants included soyfoods in their diet (total quantity corresponding to 30g/day protein) for 12 weeks, a significant improvement was observed in biomarkers associated with cardiovascular risk.
  2. Cholesterol- Soy protein has been proven to have a hypocholesterolemic effect in both normocholesterolemic and hypercholesterolemic people. It lowers LDL cholesterol level and is also associated with a significant decrease in the ratio of plasma LDL cholesterol to HDL cholesterol. Therefore, soyfoods are beneficial for lowering cholesterol levels.

 
Why men fear soy
It is a common misconception among men that eating soy-based foods will lead to lowered testosterone levels or gynecomastia which is the development of male breasts. This fear is rooted in the fact that soy contains phytoestrogen which is perceived as an equivalent of oestrogen, the “female hormone”. Therefore consuming soyfoods is associated with the fear of reduced masculinity in men. But studies conducted on humans have shown that this is not the case. The effect of eating soy in both groups were studied but there were no significant changes in Testosterone levels in men. Consumption of soybeans or soy-based products on a daily basis did not cause any compromise in the virility or reproductive health in men. Nor did it have any other feminizing effects on the men involved in the studies at an intake level that was equal to or even considerably higher than the amount typically consumed by Asians.
 
Soy and thyroid
Recent studies have found an association between soy and thyroid function. There is a lot of confusion surrounding this and whether consuming soybeans are safe or not as studies are yielding mixed results. Let’s take a look at the existing evidence we have so far.
Soy is suspected to interfere with thyroid function but in whom? Animal studies have shown that when animals with pre-existing compromised thyroid function (such as hypothyroidism) and/or low iodine intake consume soy foods, there could be some disruption in their thyroid function. The exact component in soy responsible for this goitrogenic effect is still unclear. However, studies done on humans have not observed the same effect and the result is still inconclusive as to whether people with impaired thyroid function should avoid soy. Therefore, it is suggested that people with an underactive thyroid and those taking thyroid medication consume soy with caution. It is advisable to get sufficient iodine through the diet if consuming soy products. 
A healthy individual with an optimum thyroid function can consume soy products without any fear as long as the iodine intake is sufficient. It is important to meet your iodine requirement if you are consuming a lot of soy products.

References

  1. Effects of Soy Protein and Soybean Isoflavones on Thyroid Function in Healthy Adults and Hypothyroid Patients: A Review of the Relevant Literature
  2. Effects of soy isoflavones on estrogen and phytoestrogen metabolism in premenopausal women.
  3. Goitrogenic and estrogenic activity of soy isoflavones.
  4. Soybean isoflavone exposure does not have feminizing effects on men: a critical examination of the clinical evidence
  5. Clinical studies show no effects of soy protein or isoflavones on reproductive hormones in men: results of a meta-analysis.
  6. The Effects of Soy Isoflavones on Metabolic Status of Patients With Polycystic Ovary Syndrome.
  7. Effect of soy on metabolic syndrome and cardiovascular risk factors: a randomized controlled trial.
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Supplement Series #4 – Collagen, is it worth your money?

What is Collagen?
Collagen is the most abundant protein in mammals forming about 25% of the total protein content in the body. It is an essential part of the connective tissues in the body. The main components of collagen are 3 non-essential amino acids namely, glycine, proline, and hydroxyproline. The different arrangements of these amino acids results in different varieties of collagen leading to different functions and site of incorporation.

What are the types of collagen?
A collagen molecule is formed by twisting together 3 long chains of amino acids to form a tight coil giving it a great tensile strength. Many of these long collagen chains join together to perform their specific function. The way these chains join at specific sites results in different types of collagen giving it specific characteristics and functions. More than 20 types of collagen have been identified so far. Some of the common types of collagen are:

IMost abundant collagen of the human body; present in scar tissue, the end product when tissue heals by repair; found in tendons, the endomysium of myofibrils, and the organic part of bone
IIArticular cartilage and hyaline cartilage
IIICollagen of granulation tissue; produced quickly by young fibroblasts before the tougher type I collagen is synthesized; reticular fiber
IVBasal lamina; eye lens
VMost interstitial tissue; associated with type I; associated with placenta

 
What are the functions of collagen?
Collagen in majorly secreted by fibroblast. It is sometimes referred to as the body’s scaffolding. The word collagen is derived from Greek and means “glue producer.” 
Collagen fibers support body tissues, it is a major component of the extracellular matrix that supports cells. Collagen and keratin give the skin its strength, waterproofing, and elasticity. Loss of collagen is a cause of wrinkles.
Connective tissue consists primarily of collagen. Collagen forms fibrils that provide the structure for fibrous tissue, such as ligaments, tendons, and skin. Collagen also is found in cartilage, bone, blood vessels, the cornea of the eye, intervertebral discs, muscles, and the gastrointestinal tract.
 
How can I get collagen naturally?
Since collagen is found in connective tissues, foods such as chicken skin, pork skin, beef and fish are great sources of collagen. Collagen obtained by this method is usually broken down to individual amino acids and are used up for formation of other proteins. There are not enough studies to show if collagen levels increase in humans upon consumption of these foods.
Another natural source of collagen is gelatin, a substance commonly used in cooking and derived from cooking collagen.
 
What are the types of Collagen Supplements available?
Collagen initially became famous as injectable solutions to help tighten skin and remove wrinkles. This fell out of trend as it didn’t last long and incited allergic reactions.
However, in recent years hydrolysed collagen supplements have flooded the market. Hydrolysed collagen are collagen threads broken into smaller peptides and chains to aid in easy absorption. Hydrolysed collagen is available majorly as powders. It’s also seen in the form of skin creams or tablets.
A thing to note here is that these supplements are generally marketed as Type-I Collagen or any of the 20 odd collagen types but it doesn’t make a difference which one you pick. While this is talking about the location from which the collagen was extracted, the hydrolysed collagen is already broken and used to form the different forms of collagen as required by the body.
 
Who would benefit from collagen supplementation and does it really work?
Although the body naturally produces collagen, the rate at which it is produced drops as we age. After a point, the rate at which collagen is produced is not enough to keep up with the body’s demand. Since collagen forms an essential part of the connective tissue, there are multiple benefits for taking collagen supplements.
SKIN HEALTH: Collagen production reduces as you age and this leads to dry and wrinkled skin. Studies have shown that supplementing collagen has improved skin elasticity and reduced dryness. The general conclusion is that collagen slows down skin ageing however more studies are needed to confirm the sole role of collagen in this process.
Joint Health: Ageing leads to deterioration and breakdown of joints. Studies have shown that collagen supplementation not only helps promote joint health but also helps alleviate joint pain.
Muscle Mass: Collagen is also a part of the muscle tissue and forms about 10% of muscle tissue. Multiple studies have shown that people taking collagen supplementation while exercising tend to put on more muscle mass and strength.
Heart Health: Collagen fibres line the inner walls of arteries and are shown to lead to weaker arterial walls. Studies have shown an improvement in arterial wall elasticity and reduction in stiffness when supplemented with collagen.
 
Are collagen supplements safe to take for vegans?
Collagen for manufacture of supplements is majorly obtained from animal sources such as bone broth and protein. However, a few vegan and vegetarian alternatives have started appearing online.

References

  1. Lodish H, Berk A, Zipursky SL, et al. Molecular Cell Biology. 4th edition. New York: W. H. Freeman; 2000. Section 22.3, Collagen: The Fibrous Proteins of the Matrix. Available from: https://www.ncbi.nlm.nih.gov/books/NBK21582/
  2. High Yield Orthopaedics. JavadParviziMD, FRCS, Gregory K.Kim MD Associate Editor. https://doi.org/10.1016/B978-1-4160-0236-9.00064-X
  3. Zdzieblik D, Oesser S, Baumstark MW, Gollhofer A, König D. Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: a randomised controlled trial. Br J Nutr. 2015;114(8):1237–1245. doi:10.1017/S0007114515002810
  4. Proksch, E., Schunck, M., Zague, V., Segger, D., Degwert, J., & Oesser, S. (2014). Oral Intake of Specific Bioactive Collagen Peptides Reduces Skin Wrinkles and Increases Dermal Matrix Synthesis. Skin Pharmacology and Physiology, 27(3), 113–119. doi: 10.1159/000355523
  5. Kumar, S., Sugihara, F., Suzuki, K., Inoue, N., & Venkateswarathirukumara, S. (2014). A double-blind, placebo-controlled, randomised, clinical study on the effectiveness of collagen peptide on osteoarthritis. Journal of the Science of Food and Agriculture, 95(4), 702–707. doi: 10.1002/jsfa.6752
  6. Sibilla, S., Godfrey, M., Brewer, S., Budh-Raja, A., & Genovese, L. (2015). An Overview of the Beneficial Effects of Hydrolysed Collagen as a Nutraceutical on Skin Properties: Scientific Background and Clinical Studies. The Open Nutraceuticals Journal, 8(1), 29–42. doi: 10.2174/1876396001508010029

 

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The FODMAP Diet

In a recent article about Irritable Bowel Syndrome, I had spoken about the advantages of following a low FODMAP diet to help ease the condition. I thought it would be helpful to delve deeper into the subject of what FODMAPs are and how following a low FODMAP diet can help few people.

What are FODMAPs?
FODMAP is an acronym that stands for Fermentable Oligo-, Di-, Mono-saccharides And Polyols. It’s a fancy name for scientific classification of certain food groups that contain short chain carbohydrates. A few examples of these short chain carbohydrates are:
 

Oligosaccharides(More than 2 Carbs joined together): Wheat, rye, legumes and various fruits and vegetables, such as garlic and onions.
Disaccharides(2 Carbs joined together): Milk, yogurt and soft cheese. Lactose is the main carb.
Monosaccharides(Single Carb molecules): Various fruit including figs and mangoes, and sweeteners such as honey and agave nectar. Fructose is the main carb.

Polyols(Sugars with hydroxyl groups in them): Certain fruits and vegetables including blackberries and lychee, as well as some low-calorie sweeteners like those in sugar-free gum.
 

What are the roles of FODMAP in the gut?
FODMAPs are found in a majority of food groups in varying concentrations and play an essential role in gut health. They are classified as prebiotic foods that boost the growth of healthy gut bacteria. Even in individuals without any intestinal discomfort, FODMAP foods are poorly digested and passed out in the stool. The friendly gut bacteria use these foods as fuel producing methane as a by-product. They are essentially what would constitute the dietary fiber in your diet.
 

While the FODMAPs play an essential role in a normal individual, they tend to cause discomfort in individuals with gastrointestinal issues such as IBS. In such individuals, the undigested FODMAPs tend to move into the colon where bacteria use up the food as fuel and produce hydrogen gas a by-product leading to symptoms such as gas, bloating, stomach cramps and pain. Another thing to note here is that FODMAPs are osmotically active, which means that they can draw water into your intestine and contribute to diarrhea.
 

What is a low FODMAP diet?
A low FODMAP diet is a process of completely eliminating foods high in FODMAPs for a period till you see an improvement in quality of life. Then there is a systematic reintroduction of FODMAP foods one at a time to identify your tolerance level for these foods and to identify trigger foods for symptoms.
 

A low FODMAP diet is not a long term diet or the ultimate solution to your ailments. It is an analytical process to find what works best for you to improve your quality of life.
 

Who would benefit from a low FODMAP diet?
A majority of the studies and research related to FODMAPs have been conducted in adults with Irritable Bowel Syndrome. A few preliminary studies have also established an advantage of following a FODMAP diet in individuals with inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis.
 

It is important to note that a few foods classified as FODMAPs may cause intolerances irrespective of intolerance to FODMAPs common examples of which are Lactose and Fructose intolerances.
 

It is thus essential to rule out all of these factors and establish that it’s absolutely essential to get on a low FODMAP diet before you start the process. As explained before, FODMAPs are essential for normal body function and restricting them unless needed could lead to adverse effects.
 

A doctor would recommend a FODMAP diet after eliminating all intolerances through a breath test and after ruling out most gastrointestinal disorders which can be treated by other means. In most cases, a low FODMAP diet is reported as a secondary measure when there’s no response to primary treatment methods.
 

How would one go about following a low FODMAP Diet?
As mentioned before, this is not a long term diet. It is a very systematic process that involves 3 stages and it’s not advisable to go about these steps without the guidance of a dietitian and/or a doctor. The stages are as follows:
 

Stage 1 – Restriction: This stage involves cutting out all foods high in FODMAP from your diet for a period of 3 – 8 weeks depending on how long it takes for symptoms to disappear. While a few people might find relief in symptoms within a week or so, some might take the entirety of 8 weeks.

If no relief in symptoms is seen after 8 weeks, the individual has to immediately stop trying out the diet as FODMAPs form an essential part of the diet and cannot be restricted for longer.
Stage 2 – Reintroduction: Once the symptoms have subsided, the next step is to reintroduce FODMAP rich foods one at a time for a period of ~3 days each. The aim of this step is to identify what FODMAPs you are able to tolerate and how much of it you can tolerate.
Stage 3 – Personalization: The final stage involves taking information from the Reintroduction stage to personalize and tailor the list and amount of FODMAP foods you can consume without triggering any symptoms of discomfort.
 

Where can I find a list of FODMAP foods?
Although a majority of FODMAP food lists are available online, the most comprehensive list of FODMAP foods is maintained by King’s College London and Monash University.
 

What’s the Bottom Line?
FODMAP foods form an essential part of an individual’s diet. They constitute to the dietary fiber of an individual’s diet and boost the growth of good gut bacteria. Avoiding FODMAPs completely is close to impossible to do as a huge variety of foods contain them in varying concentrations and doing so would also have adverse effects. But in individuals with certain gastrointestinal disorders such as IBS would be able to lead a better quality of life if they are able to identify their trigger FODMAP foods and avoid them. It is also essential to have this as a last resort and go through the process with the guidance of a doctor and a dietitian.
 

References

  1. Barrett, J. S., & Gibson, P. R. (2012). Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Therapeutic Advances in Gastroenterology, 5(4), 261–268. doi: 10.1177/1756283×11436241
  2. Ong, D. K., Mitchell, S. B., Barrett, J. S., Shepherd, S. J., Irving, P. M., Biesiekierski, J. R., … Muir, J. G. (2010). Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. Journal of Gastroenterology and Hepatology, 25(8), 1366–1373. doi: 10.1111/j.1440-1746.2010.06370.x
  3. Staudacher, H. M., Whelan, K., Irving, P. M., & Lomer, M. C. E. (2011). Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. Journal of Human Nutrition and Dietetics, 24(5), 487–495. doi: 10.1111/j.1365-277x.2011.01162.x
  4. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome. Halmos, Emma P. et al. Gastroenterology, Volume 146, Issue 1, 67 – 75.e5
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Inflammation – The Basics

The terms Inflammation and anti-inflammatory diet are being tossed around lately and I thought this would be a great time to share some information on these topics. So let’s delve into what these things mean, who would benefit from an anti-inflammatory diet and how to go about it.

What is Inflammation?
The word inflammation is a widely misunderstood term considered to be something that causes harm to our body. The truth is, inflammation is an essential pathway of your immune system to protect your body from something as simple as a small cut to fighting a severe infection. The process of inflammation includes increased blood flow at the site of injury/infection, dilation of capillaries, white blood cell infiltration, and production of chemical mediators to manage the condition.
While inflammation is a natural process that aids the body in certain conditions, it can occur too little causing it to go unnoticed by us before it’s too late (e.x., diabetes, cardiovascular disease) or too much causing a bad reaction (e.x., autoimmune diseases such as rheumatoid arthritis).
What triggers inflammation?
The most common trigger for inflammation is when your body is responding to a stimulus either in the form of a foreign body such as a bacterial infection or when it’s repairing an injury. However, there are certain factors that have the ability to trigger inflammation.
Diet – Various food groups such as sugars, trans fats and refined products have been linked to promoting inflammatory reactions in the body. 
Stress – Multiple studies have shown that chronic stress has a pro-inflammatory response as the hormone cortisol (more commonly known as the stress hormone) is also involved in regulating inflammation.
Excess weight – Although excess weight gain is listed as a trigger for inflammation, this is a bit of a conundrum as inflammation can also lead to weight gain. Different pathways have been linked to show that overeating and excess fat in the body can trigger inflammation.
Alcohol Consumption – While maintaining your limits while consuming alcohol is advisable, drinking too much impairs liver function and may even cause build up of toxic byproducts triggering inflammatory reactions in your body.
Smoking – Multiple studies conducted among smokers has indicated a clear increase in various inflammatory markers. Also there is a clear decline in these markers after they quit smoking indicating a correlation between the two.
What are some of the foods that trigger inflammation?
Various studies have concluded that certain food groups tend to induce or cause an inflammatory reaction leading to adverse effects. Some of them are listed below:

    1. Sugars and Fructose – Studies conducted in animal models and human trials have been shown to induce inflammatory reactions leading to diseases such as obesity, diabetes, etc., What’s more, the high concentration of fructose in refined sugars and high fructose corn syrup plays an adverse role in developing these diseases.
    2. Trans Fats – Trans fats are one of the unhealthiest food options out there and are mostly found in fried fast food items. It is shown that there is a spike in inflammatory markers such as C-Reactive Protein when consuming a diet high in Trans Fats


What is an anti-inflammatory diet?
A prolonged inflammation in the body is characterised by oxidative stress and altered glucose and lipid metabolism in our fat (adipose) cells, muscle, and liver. Making dietary changes can aid in managing oxidative stress and inflammatory pathways.
Anti-inflammatory diets are rich in antioxidants, plant polyphenols and other components that help reduce inflammatory responses. The usual prescription for an anti-inflammatory diet includes foods low in refined carbohydrates, high in soluble fiber, high in mono-unsaturated fatty acids, a higher omega-3 to omega-6 ratio.
The mediteranian diet is considered a good example of an anti-inflammatory diet as it is rich in fruits, vegetables, nuts, whole grains, fish, and healthy oils. The advantage here is that it not only helps reduce inflammation in your body but substitutes your diet with healthier options leading to a better overall health.
Some of the commonly prescribed foods for an anti-inflammatory diet are Berries(rich in antioxidants), Fatty Fish(rich in omega-3 fatty acids), Avocados(high in fiber), Turmeric(contains curcumin, a powerful anti-inflammatory compound).
Who would benefit from an anti-inflammatory diet?
An anti-inflammatory diet is usually prescribed for people suffering from an inflammation based condition such as:

    • Rheumatoid Arthritis
    • Psoriasis
    • Asthma
    • Eosinophilic Esophagitis
    • Crohn’s Disease
    • Colitis
    • Inflammatory Bowel Disease
    • Lupus
    • Hashimoto’s Disease

In addition to this, it might help manage lifestyle conditions such as diabetes, obesity and heart disease.
Although staying on this diet might help reduce the occurrence of inflammation, it may not be the ultimate solution. It is important to consult your physician and continue any medication prescribed. 
It is also considered to be a healthy diet in general as it incorporates a diet high in the major macronutrients and excludes highly processed and refined foods.

References

  1. What is an inflammation? National Center for Biotechnology Information. 
  2. Hunter P. Stress, Food, and Inflammation: Psychoneuroimmunology and Nutrition at the Cutting Edge. EMBO Reports.
  3. Hunter, Philip. The Inflammatory Theory of Disease. EMBO Reports, Nature Publishing Group, Nov. 2012
  4. Galland, Leo. “Diet and Inflammation.” Sage, 7 Dec. 2010
  5. Foods that fight inflammation. (2017, August 13).
  6. Sheldon Cohen, Denise Janicki-Deverts, William J. Doyle, Gregory E. Miller, Ellen Frank, Bruce S. Rabin, and Ronald B. Turner. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. PNAS, April 2, 2012 DOI: 10.1073/pnas.1118355109
  7. University of Oslo. “Being overweight causes hazardous inflammations.” ScienceDaily. ScienceDaily, 25 August 2014
  8. Makki K, Froguel P, Wolowczuk I. Adipose tissue in obesity-related inflammation and insulin resistance: cells, cytokines, and chemokines. ISRN Inflamm. 2013;2013:139239. Published 2013 Dec 22. doi:10.1155/2013/139239
  9. Wang HJ, Zakhari S, Jung MK. Alcohol, inflammation, and gut-liver-brain interactions in tissue damage and disease development. World J Gastroenterol. 2010;16(11):1304–1313. doi:10.3748/wjg.v16.i11.1304
  10. Kianoush S, Yakoob MY, Al-Rifai M, et al. Associations of Cigarette Smoking With Subclinical Inflammation and Atherosclerosis: ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health). J Am Heart Assoc. 2017;6(6):e005088. Published 2017 Jun 24. doi:10.1161/JAHA.116.005088
  11. Lee J, Taneja V, Vassallo R. Cigarette smoking and inflammation: cellular and molecular mechanisms. J Dent Res. 2012;91(2):142–149. doi:10.1177/0022034511421200
  12. Tibuakuu M, Kamimura D, Kianoush S, et al. The association between cigarette smoking and inflammation: The Genetic Epidemiology Network of Arteriopathy (GENOA) study. PLoS One. 2017;12(9):e0184914. Published 2017 Sep 18. doi:10.1371/journal.pone.0184914
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Irritable Bowel Syndrome

Irritable Bowel Syndrome(IBS) is one of many bowel disorders that can cause anything from mild discomfort to extreme bowel issues. IBS belongs to a group of bowel disorders classified as non inflammatory bowel disorders as opposed to Inflammatory Bowel Disease which is characterized by inflammation of the intestines. So read further to understand what is IBS and how to manage the condition.

What Is Irritable Bowel Syndrome(IBS)?
IBS is classified as a functional gastrointestinal disorder where there are issues as to how the gut and brain work together. IBS is characterised by multiple symptoms such as stomach cramping, abdominal pain, bloating and changes in bowel movement. It is a chronic condition that tends to occur in people aged 20-45 and is seen more commonly in women.
What are the Symptoms of IBS?
IBS displays a varied range of symptoms. Some of the common symptoms are:

    • pain in your abdomen (often related to your bowel movements)
    • changes in your bowel movements (diarrhea, constipation, or in some cases, both)

A few of the other symptoms are:

    • feeling bloated/gassy
    • feeling very full
    • mucous discharge in your stool

The symptoms of IBS tend to occur in episodes of symptom free periods followed by periods of severe burst of symptoms. Certain trigger foods might cause the onset of symptoms.
What are the causes of IBS?
The muscles lining the intestine play a vital role in pushing the food mass through the intestinal canal. As the food gets digested and water gets absorbed through the intestinal walls, undigested material forms the hard stool. In the case of IBS, the muscles tend to push the food through the canal too fast or too slow causing diarrhea or constipation respectively.
Although we are unable to pin-point what could cause this malfunction at this point of time, many theories have been put forth such as, oversensitive nerves in the intestine, intestinal muscle disorders,inflammations of the intestinal wall and genetics. Psychological stress and food intolerances are thought to be triggers as well.
What are the risk factors of IBS?
A few of the risk factors associated with IBS are as follows:

    • Age – IBS tends to occur in people of the 25-50 age groups
    • Gender – IBS seems to be more common in Women than Men. It is thought that the female hormones play a role in this
    • Family History – Genes or a shared environment or both in combination may play a role in risk of IBS
    • Mental Health Problems – Anxiety, depression and other mental health issues are associated with IBS


What are the types of IBS?
Based on the type of symptoms, IBS can be divided into 3 types namely:

    • IBS-C – IBS with constipation characterised by Infrequent stools and constipation
    • IBS-D – IBS with diarrhea characterised by frequent stools and diarrhea
    • IBS-A – IBS with alternating constipation and diarrhea


Are IBS and IBD the same?
Although IBS and IBD share a lot of symptoms, they are completely different disorders. While IBS is characterised by multiple symptoms, it is not a disease in itself and is not considered to be as dangerous as IBD. IBD on the other hand causes inflammatory reactions and causes damage to the intestine leading to intestinal bleeding, rectal bleeding, ulcers, etc.,
A simple non-invasive test to differentiate between the two is to take a fecal calprotectin test which measures the presence of certain antibody proteins in the stool. A positive result indicates the presence of IBD while the negative test could mean that the symptoms may be caused due to IBS and needs further testing for confirmation.
How is IBS diagnosed?
After a review of your symptoms and their frequency, a doctor would recommend certain tests to diagnose IBS. This includes physical examination for bloating, tenderness or pain. IBS is mainly diagnosed by ruling out the presence of other disorders such as IBD and food intolerances(Gluten, Lactose, etc.,). The doctor might also recommend a routine blood and stool test and in some cases an upper GI endoscopy or a colonoscopy.
What is the low FODMAP diet?
FODMAP stands for fermentable oligo-, di-, and monosaccharides and polyols. It is a class of carbohydrates that are not well absorbed in the intestine for some people. This leads to food items getting accumulation in the intestine and fermented by the gut bacteria leading to release of gas.
These conditions tend to trigger IBS in individuals. The list of foods that are classified as FODMAPs is extensive and is maintained by the International Foundation for Functional Gastrointestinal Disorders and it is recommended to go on a low FODMAP diet and introduce one food at a time to identify the trigger food.
How does IBS affect quality of life?
Although there are very few complications associated with IBS, mental health and quality of life are the biggest complications individuals with IBS tend to face. Some people may feel they’ve lost control over their body as they can never be sure when they would have to go to the toilet.
Another issue is that it could be embarrassing to talk about issues with their bowel movements or passing a lot of wind often. 
Can IBS be treated?
IBS is a chronic condition that does not have a complete treatment as of now. But the condition can be managed by changes in diet, lifestyle, certain medications and in some cases, mental health therapies. The process of finding what treatment works best is a trial and error process in order to identify certain trigger foods or conditions.
Based on the type of IBS, individuals may be prescribed with fiber supplements or laxatives to treat their condition.

References

  1. Irritable bowel syndrome: Overview
  2. Definition & Facts for Irritable Bowel Syndrome, NIDDK
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Basics of Rice

Rice has been the staple food for us in India for ages and also for the most part of Asia. Though this has been the natural trend, a lot of fear and speculation have risen over this wonderful crop due to misinformation and twists of truth. I plan to outline the basics and bust some myths in this blog post.


What are the origins of Rice?
Based on archaeological evidence, the earliest occurrence of Rice can be traced back along the Yangzi River Valley of China dated back to 11,000–12,000 BC (1).Two of the most common domesticated sub-species of Rice are indica and japonica. Rice plays a major role in India and is cultivated in more than a quarter of the agriculture land in the country. There has been an explosion in the variety of rice cultivated in India and includes but is not limited to Basmati rice, Ponni Rice, Hansraj, etc.,
Where are we going wrong?
Though we’ve been consuming Rice as a staple for centuries, there’s been a sudden boom in speculation over the consumption of rice and its link to lifestyle diseases such as Obesity and Diabetes. But have you heard of the Okinawa Diet?
People belonging to the Okinawa Island and a few surrounding islands of Japan have some of the highest recorded life expectancy in the world (2). But the fact remains that rice is a daily staple for the people belonging to this region. The highlight here is the proportion of rice to vegetables and other macros. The Okinawa Diet is not about including or excluding certain food items but it is an eating style.
The important takeaway here is to make sure you practice good portion control and include enough vegetables and good protein souces in your diet along with the right amounts of rice.
What are the types of Rice and how do I choose? 
From the 2 subspecies of rice, there are siad to be over 40,000 varieties of rice. The most commonly known forms of rice are White Rice, Brown Rice and Red Rice.
The rice grain consists of 3 parts – the bran, the germ and the endosperm. Brown Rice is unprocessed rice that contains all three parts of the grain while white rice is processed to remove the bran and the germ giving it a cleaner whiter look. Brown rice is slightly higher in dietary fiber and certain micronutrients and contains a much lower glycemic index than white rice (4,5).
Red rice is another variety which is high in a compound known as anthocyanins. This compound confers antioxidant properties to red rice. It is also commercially available as hulled and unhulled grains. 
So which one do I choose? Although each of these rice have their pros and cons, it all comes down to your personal choice. Even if a few varieties have a few nutritional benefits, it doesn’t outweigh the other choices as long as you’re maintaining portion control and getting all the nutrients you need from other sources.
Now I’d like to address some of the common myths associated with rice starting with the most common one:
Will eating rice after 6 pm cause me to put on more weight than usual?
There is no link between eating certain foods after a certain time and putting on weight. Whether you’re eating at 6 am or 6 pm the energy content of rice and all other food items remain the same. What you need to ask yourself is whether this cup of rice I’m about to eat fits within your day’s macro requirement or you’re going overboard.
Is it ok to eat rice when you’re diabetic?
Another common misconception is that it’s a sin to eat carbs if you’ve been diagnosed with diabetes and you should avoid rice at all cost. This makes no sense as the alternative given is rotis and other such options which again are full of carbs. What’s important in such conditions is to practice portion control by reducing your rice intake and substituting with vegetables. There is no need to avoid rice altogether.
Are Dosa and Idlis better alternatives to rice?
Here’s another simple thing that people get confused about. The fact remains that one of the major components for making these dishes is rice. Not just that, the dal used to make these batters aren’t just a source of protein. They are also loaded with carbs! Not saying that either is better or worse. The fact is it doesn’t really make a huge difference.

References

1) Megan Sweeney, Susan McCouch, The Complex History of the Domestication of Rice, Annals of Botany, Volume 100, Issue 5, October 2007, Pages 951–957
2) Boyle, Marie A.; Long, Sara (2008), Personal Nutrition (7 ed.), Stamford
3) https://farmer.gov.in/cropstaticsrice.aspx
4) Glycemic index for 60+ foods
5) Glycaemic Index (GI) of an Indian Branded Thermally Treated Basmati Rice Variety : A Multi Centric Study

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Supplements #3

Athletes are a group that use supplements for a myriad of reasons



We are back with our supplement series for the month! So far, we have covered protein and protein related supplements and commonly used vitamin and mineral supplements. While the former is still a never ending list, this article aims to cover more performance oriented supplements. Athletes use supplements for a variety of reasons:

    • To aid in faster recovery from training
    • General health benefits
    • For performance benefits
    • To treat illnesses
    • To compensate for a poor diet



Athletes are always on the lookout for something to boost their performance. This article will cover supplements whose efficacy is backed by science. These supplements have been extensively researched and have been found to benefit different types of sports. If you are an athlete, why not give this a read!

Nitrate:

What is Nitrate?
Nitrate is a molecule that plays an important role in the nitrogen cycle and also in cardiovascular health, blood pressure and exercise performance.

Where do you find nitrates and how does it actually work?
Dietary sources of nitrates include fruits, vegetables and processed meats (1). Vegetables such as beetroot, celery, spinach, rocket (argula) and lettuce are rich in nitrate. High amounts are also found in cabbage, kohlrabi,parsley and fennel (1). Dietary nitrate is converted to nitrite (by bacteria in the mouth and gastrointestinal tract) and further reduced to nitric oxide (1). This nitric oxide is what causes vasodilation (widening of the blood vessels) and results in decreased blood pressure. Nitric oxide also seems to play a role in calcium handling, glucose uptake, neurotransmission and muscle force production.

Why would athletes find supplementation beneficial then?
The content of nitrate found in green leafy vegetables and beetroot vary with soil conditions, time of year and even storage. Hence, like any other supplement, as the specific dose of nitrate is known, athletes would benefit from its usage. This is beneficial when performance is a goal. It has been shown that dietary nitrate supplementation lowered oxygen uptake during moderate to heavy intensity exercise in healthy participants (2). A recently published systematic review and meta-analysis concluded that dietary nitrate supplementation can positively impact endurance exercise capacity (3).

What about the dosage?
About 5-9 mmol of nitrate ingested 2-2.5 hours before an exercise session for about 1-28 days is effective (4,5).

Would only athletes benefit from nitrate?
Not only does dietary nitrate help in performance, since nitrate lowers blood pressure (6), it could potentially help in the general population as well. Not everyone needs to supplement with nitrate! Inclusion of good amounts of beetroot and green leafy vegetables into your daily diet is a great starting point!

Caffeine

What is caffeine and where is it found?
Caffeine is the most widely used psychoactive drug or stimulant. Yes! It is a drug! Like we all know, it is found in coffee beans, tea leaves and cocoa beans. Infact, as you would have all noticed caffeine is also added to energy drinks and soft drinks. However, the amount of caffeine in these sources vary. Caffeine is now available as pills, gels and even gums!

How does it act as a well known stimulant?
We all know that drinking a cup of coffee is the best wake me up drink! The stimulatory effects of caffeine are attributed to its effect on the central nervous system. Caffeine is a competitive inhibitor of adenosine which is responsible for relaxation. Caffeine thus binds to the adenosine receptors in the brain and stimulates the nervous system. (7)

Is caffeine a fat burner?
Caffeine does seem to increase metabolic rate and fat oxidation (8). However, as a standalone supplement it is not effective in reducing body weight. While it does boost fat metabolism marginally (9), the effects of caffeine are highly variable from person to person.

Why do athletes supplement with caffeine?
Caffeine has been shown to improve performance across a variety of sports. Endurance performance (7, 10) and team sports (11) performances have seen an improvement with caffeine supplementation. Infact, the position stand on caffeine from the International Society of Sports Nutrition (12) recognises its performance benefits on strength, sprint and power based sports as well. Acute ingestion has also been shown to increase pain tolerance and perceived effort (13).

What is the dosage and duration of caffeine supplementation?
The suggested dosage for caffeine supplementation ranges from 3-6 mg/kg body weight about 30-60 minutes before the onset of exercise (12).

Are there any side effects of caffeine consumption/supplementation?
Excessive caffeine consumption, greater than the recommended dosage could result in dependency, anxiety and gastrointestinal discomfort. Caffeine consumption in the evenings might interfere with sleep quality later at night as well.

Caffeine and nitrate are two supplements that have extensive research backing their efficacy. In fact, any supplement that you choose should be effective for the particular sport you are using it for! It is evident that caffeine works well across sports while nitrate might work best for an endurance based sport. With the supplement series, our aim is to ensure you all are educated and make an informed choice when it comes to nutritional supplements.

References

1) Hord N, Tang Y, Bryan N. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. The American Journal of Clinical Nutrition. 2009;90(1):1-10.
2. Pawlak-Chaouch M, Boissière J, Gamelin F, Cuvelier G, Berthoin S, Aucouturier J. Effect of dietary nitrate supplementation on metabolic rate during rest and exercise in human: A systematic review and a meta-analysis. Nitric Oxide. 2016;53:65-76.
3) McMahon N, Leveritt M, Pavey T. The Effect of Dietary Nitrate Supplementation on Endurance Exercise Performance in Healthy Adults: A Systematic Review and Meta-Analysis. Sports Medicine. 2017;47(4):735-756.
4) Jones A. Dietary Nitrate Supplementation and Exercise Performance. Sports Medicine. 2014;44(S1):S35-45.
5) Naderi A, de Oliveira E, Ziegenfuss T, Willems M. Timing, Optimal Dose and Intake Duration of Dietary Supplements with Evidence-Based Use in Sports Nutrition. Journal of Exercise Nutrition & Biochemistry. 2016;20(4):1-12.
6) Siervo M, Lara J, Ogbonmwan I, Mathers J. Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis. The Journal of Nutrition. 2013;143(6):818-826.
7)Graham T, Spriet L. Metabolic, catecholamine, and exercise performance responses to various doses of caffeine. Journal of Applied Physiology. 1995;78(3):867-874.
8)Acheson K, Zahorska-Markiewicz B, Pittet P, Anantharaman K, Jéquier E. Caffeine and coffee: their influence on metabolic rate and substrate utilization in normal weight and obese individuals. The American Journal of Clinical Nutrition. 1980;33(5):989-997.
9) Jeukendrup A, Randell R. Fat burners: nutrition supplements that increase fat metabolism. Obesity Reviews. 2011;12(10):841-851.
10) Pasman W, van Baak M, Jeukendrup A, de Haan A. The Effect of Different Dosages of Caffeine on Endurance Performance Time. International Journal of Sports Medicine. 1995;16(4):225-230.
11) Stuart G, Hopkins W, Cook C, Cairns S. Multiple Effects of Caffeine on Simulated High-Intensity Team-Sport Performance. Medicine & Science in Sports & Exercise. 2005;37(11):1998-2005.
12) Goldstein E, Ziegenfuss T, Kalman D, Kreider R, Campbell B, Wilborn C et al. International society of sports nutrition position stand: caffeine and performance. Journal of the International Society of Sports Nutrition. 2010;7(1):5.
13) Duncan M, Stanley M, Parkhouse N, Cook K, Smith M. Acute caffeine ingestion enhances strength performance and reduces perceived exertion and muscle pain perception during resistance exercise. European Journal of Sport Science. 2013;13(4):392-399.

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