Taking Supplementation Seriously Part IV

In past articles, we presented the case for insuring nutritional sufficiency of the essential vitamins and minerals through supplementation. There is little debate that these micronutrients are requisite for human survival, and that their supplementation may be an apt course for some. A healthy diet also provides several other nutritionally-beneficial elements which, like the vitamins and minerals, are not always present at optimal levels and thus can potentially benefit from supplementation.

Here is a list of five dietary supplements that are worth considering as additions to the multivitamin. They are not meant to represent the "best" or "most useful" of the supplement field (which has little meaning given the individuality of metabolism); rather, these choices represent common dietary constituents that primarily function to broadly improve health and well-being (as opposed to addressing a single aspect of it). Each has a defined, critical role in normal human metabolism, and all but one are only obtainable through the diet.

Omega-3 fatty acids and whey protein are sources of essential fatty and amino-acids, the two remaining classes of essential nutrients after the vitamins and minerals. Fiber supplements provide this oft-deficient dietary macronutrient, which along with probiotic bacteria are a major determinant in intestinal function and the maintenance of healthy gut microflora. Supplementing with the nutritionally non-essential Coenzyme Q10 can augment the levels of this general purpose fat-soluble antioxidant and critical component for cellular energy generation, which may be of particular significance for older consumers.

Note that this list is a starting point; there are many additional dietary supplements that truly "supplement" the diet with nutrients that are often missing or suboptimal (phytonutrients such as carotenoids, isothiocyanates, and polyphenolic antioxidants are notable examples), as well as several well-studied natural ingredients that address specific health concerns but may not be "normal" constituents of the diet (herbal supplements such as milk thistle or saw palmetto fall into this category).

Omega-3 fatty acids. Omega-3 fatty acids are long-chain polyunsaturated fatty acids from fish, shellfish, algae, or seed oils that have well-established roles in human nutrition, both as building blocks for the cell membranes of the brain, and as precursors to the human body's own natural anti-inflammatory system. Sufficient intake of omega-3s has been associated with reduced risk of heart disease, may facilitate healthy levels of circulating cholesterol and triglycerides, and may help maintain a healthy heartbeat and blood pressure. A balanced inflammatory response also relies on sufficient omega-3 fatty acids for the synthesis of endogenous anti-inflammatory factors.

Alpha-linolenic acid (ALA), a constituent of seed oils from flax, perilla, and chia, is an essential nutrient for humans. The principle omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from marine oils are not considered essential to human nutrition (we can make these from dietary ALA), but there is evidence some people may have trouble synthesizing sufficient levels of these fatty acids on their own, making them a good supplement choice. Omega-3 fatty acids from krill (a cold water crustacean) are in a potentially more bioavailable form (phospholipids) and contain high levels of the fat soluble antioxidant astaxanthin. Initial studies of krill oil suggest it may have a more potent lipid-lowering effect than other cold-water fish oils, meriting its choice as an omega-3 source.

Whey Protein. It's not a capsule, and might be better described as a food product, but whey deserves consideration for increasing the amount of high-quality protein and essential amino acids in the diet. Whey protein is the "soluble" protein fraction from milk, and is commonly sold as a concentrate (most often about 70 percent protein with very low amounts of milk sugar or fat) or isolate (>90 percent protein, usually fatand lactose-free ), as well as in flavored pre-mixes or ready to drink beverages. Diets which are higher in protein have been associated with better glycemic control, normalized blood lipids, and have been shown to promote greater fat reduction, thermogenesis, and energy expenditure than high carbohydrate or high fat diets. Protein can also be more satiating than other macronutrients. "Fast proteins," like whey, are quickly digested and absorbed, which results in large, rapid increases of amino acids in the bloodstream following a meal, signaling fullness. Compared to other common protein supplements (soy, casein), whey exhibits superior appetite suppression when taken with a meal as 25 percent of total calories.

Many of the health benefits of whey have been attributed to its high concentration of branched chain amino acids (BCAAs), a group of three nutritionally essential amino acids (leucine, isoleucine, valine). BCAAs serve as muscle fuel (which is why whey is often considered a “sports” supplement), but they may also stimulate the bodies basic satiety response. BCAAs also aid in fat loss, preserve lean body mass, and may help to lower insulin levels following a meal.

Probiotics: Probiotics are living microorganisms, which upon ingestion in sufficient numbers, exert health benefits beyond general nutrition. Probiotic bacteria and yeast can reside on the surfaces of mucosal tissues (such as the gastrointestinal or upper respiratory tract) and provide a living barrier to environmental insults. Probiotic bacteria function in a variety of ways; they can inhibit the growth or block the attachment of rival pathogenic bacteria, they can improve the barrier function of mucosal membranes (providing protection from pathogens or toxins), they bolster immune function, produce vitamins, and enhance mineral absorption. Probiotic bacteria can play significant roles in systemic detoxification by trapping and metabolizing harmful dietary compounds or heavy metals. The production of the short chain fatty acids by probiotic bacteria in the intestines (from the fermentation of dietary fiber) improves the detox function of the liver and skin; this may also contribute to some of the anti-carcinogenic properties of dietary fiber.

Probiotic supplements come in a myriad of forms and formulations, encompassing a wide variety of bacterial species and potency (probiotic potency is expressed in colony forming units—CFU—which is a measurement of the number of bacteria per serving.) A good starting point for general health maintenance would be a multi-strain product (having more than one type of bacteria) at a moderate potency (3–10 billion organisms); this is similar to the probiotic intake from a diet that contains fermented foods.

Fiber Supplements: Fibers are polysaccharides (complex carbohydrates) that are indigestible by humans, yet have some significant roles in general health maintenance. The bulk of fiber and its resistance to digestion lend it satiating properties in the stomach; these same properties also cause it to increase the bulk of stool and hasten the transit of digested food through the intestines. This increase in gastric motility helps to minimize exposure of colonic epithelial cells to potential carcinogenic compounds or other dietary toxins. Dietary fibers can bind up bile acids and cholesterol, and prevent them from being re-absorbed; this facilitates the body’s ability to rid itself of excess cholesterol. Some fibers can also be specifically digested (fermented) by beneficial colonic bacteria into short chain fatty acids (like lactate or butyrate), which have their own health benefits throughout the body. Fermentable or prebiotic fibers (such as inulin and fructooligosaccharides) are available as supplements as well and are an appropriate complement to probiotics.

There is convincing evidence that fiber intake reduces the risk of colon and breast cancers and cardiovascular disease; it has also been associated with healthy body weight, serum cholesterol levels, blood sugar control, and blood pressure. Unfortunately, the overwhelming majority of adults in the United States do not get the daily recommended intake of fiber, which is 38 grams/day for men 19–50 (30 grams/day for men over 50) and 25 grams/day for women 19–50 (21 grams/ day for women over 50). Even a modest increase to 20 grams a day from average current dietary levels has been estimated to reduce the rate of colorectal cancer by 40 percent. The fiber in our diets is heterogenous, containing several types of gums, pectins, lignans, cellulose, beta-glucans, fructans, and digestion-resistant starches. A good choice in fiber supplements would contain a mixture of multiple fiber types.

Coenzyme Q10. Despite being the only member of the list that isn’t a nutritionally essential nutrient or a major component of the diet (young, healthy people can make sufficient CoQ10 for their metabolic needs), the potential health benefits of CoQ10 merit its consideration as part of a supplement regimen, especially in older consumers. CoQ10 is a fat-soluble substance that is an essential component of the energy production system in cells. It is found in each cell in the body, but is particularly concentrated in tissues which have large energy requirements (like the heart). There are also substantial amounts of CoQ10 in the blood, protecting circulating lipids (LDL and HDL) from oxidative damage. Supplemental CoQ10 has been the subject of numerous studies, particularly in applications for improving cardiovascular health (as in subjects with chronic heart failure, exercise-induced angina, or hypertension); it may also be protective of the cardiovascular system in diabetics. CoQ10 continues to be the subject of academic research, and is beginning to find acceptance as a supplement amongst mainstream medical practitioners.

The average diet contains only a small amount of CoQ10, which is generally poorly absorbed (by some estimates, as little as two to three percent of dietary CoQ10 is absorbed). Variability in absorption also appears to be age-dependent; case reports suggest decreased fractional absorption in older patients. Several "enhanced absorption" strategies and products have been developed to overcome this hurdle, with improved uptakes verified by clinical data. Recently, the second naturallyoccurring form of CoQ10 (ubiquinol) has been introduced into the supplement market (CoQ10 supplements have typically been in the form of ubiquinone.) Ubiquinol is absorbed more efficiently than ubiquinone, especially in individuals who have difficulty absorbing CoQ10.

Protein supplements are commonly used by people as part of a fitness program, and indeed there is good reason to do so. In fact, protein is one of the most important substances for the maintenance of good health and vitality. It is of primary importance in the growth and development of all body tissues including muscles, blood, skin, hair, nails and internal organs. Protein is also needed for the formation of hormones, enzymes and antibodies. In addition to being the major source of building materials for the body, protein may be used as a source of heat and energy. Each gram of protein provides four calories. This energy function of protein is spared when sufficient fats and carbohydrates are present in the diet.¹ While any protein source can serve these functions, whey protein provides distinct advantages as a source of supplemental protein.

WHEY PROTEIN IN GENERAL
Whey, a by-product of cheese manufacturing, contains proteins. These include alpha-lactalbumin, beta-lactoglobulin, lactoferrin, serum albumin, lysozyme, and immunoglobulins A, G, and M² and relatively large amounts of the amino acid cysteine.³ Whey also contains carbohydrates, primarily lactose, and the minerals calcium, sodium, phosphorus, and potassium.⁴

Whey protein is derived from whey and tends to provide a higher concentration of essential amino acids than other protein sources.⁵ Also, whey protein typically contains 24 percent branched chain amino acids, which are readily oxidized as an energy source during stress. In addition, whey protein is also a source of cysteine, a precursor to the vital intracellular antioxidant glutathione (GSH),⁶ which is depleted by oxidative stress, which occurs during exercise, infections, trauma, or major surgery.⁷ In fact, some researchers think that whey protein may help play a role in cancer prevention by providing GSH precursors and increasing levels of GSH in the tissues.⁸ This is consistent with animal research showing that protein from whey may protect against certain cancers.^9,10,11

Whey protein varies in the immunoglobulins and other proteins present, depending on the processing method used to produce the final form of whey protein.¹² These forms include whey protein isolate, whey protein concentrate, and hydrolyzed whey protein. This article will focus on whey protein isolate.

WHEY PROTEIN ISOLATE
Arguably, the best way to process whey protein isolate (WPI) is via cross-flow ultrafiltration. This process preserves protein microfractions and separates the protein from whey without the use of heat or damaging chemicals. As a result WPI is virtually fat and lactose free, is extremely digestible, and has a good taste. WPI does not tend to cause gas, bloating or other gastrointestinal distress.¹³ Furthermore whey protein isolate is easily digested and absorbed, and has received the highest score (1.14) of any protein tested according to the Protein Digestibility Corrected Amino Acid Score (PDCAAS), the preferred method for evaluating protein quality.¹⁴

WPI AND BODYBUILDING
Clinical research shows that taking 1.2–1.5 grams WPI per kilogram of body weight, per day in combination with strength training for 6–10 weeks increased lean body mass, strength, and muscle hypertrophy compared to placebo. ^15,16,17 In one double-blind study,¹⁸ recreational bodybuilders supplemented their normal diet with WPI (1.5 grams per kilogram of body weight, per day) or another protein for 10 weeks. The results were that the WPI group experienced a significant gain in lean mass compared to the other protein group (11 lbs versus 1.76 lbs) and a significant reduction in fat mass compared to the other protein group (-3.3 lbs versus +0.44 lbs). The bodybuilders also achieved significant improvements in strength.

WPI supplementation also results in higher blood amino acid concentrations compared to some other protein sources. This results in greater stimulation of protein synthesis,¹⁹ thus providing the foundations for preservation and production of muscle mass. Several studies involving supplementation with whey protein have been shown to be effective in augmenting the effects of resistance exercise, particularly when supplementation occurs in the hours surrounding the exercise training.²⁰ Research in healthy volunteers showed that consuming 10 grams WPI following exercise can stimulate muscle protein synthesis, which could potentially lead to increased muscle hypertrophy.²¹ Research also shows that men who ingest 45 grams of WPI had significantly increased levels of insulin. In research, WPI increased insulin secretion to a greater extent than HWP.²²

WPI AND FAT LOSS WPI and one of its components, glycomacropeptide (GMP), were fed to a group of rats, while other rats received a standard diet. The results were that body-weight gain was 21 percent lower on the WPI diet. GMP has an effect of reducing fat mass and insulin levels.²³ A meal replacement drink containing 15 grams of WPI enriched with GMP (GMP-WPI) was given to 72 participants, twice daily for 12 months. The results were that the participants lost fat weight, and decreased total and LDL cholesterol, triglycerides, glucose, insulin, and blood pressure.²⁴ One reason that WPI may be effective for fat loss is that it is better at creating a sense of fullness than other types of protein types. In research, feelings of fullness were greater after consuming WPI.²⁵

WPI AND GSH
Thirty-one healthy subjects given WPI produced increased levels of GSH. Those who ingested 45 grams daily of WPI had the highest increase in GSH, 24 percent.²⁶ This increase in GSH may be part of the reason that, in other research, WPI enhanced the ability of a chemotherapy drug to destroy cancer cells.²⁷

WHO NEEDS SUPPLEMENTAL PROTEIN?
While everyone needs protein, there are specific population groups that could benefit by supplemental protein. In addition to athletes/bodybuilders (as previously discussed), this includes pregnant women, those who have undergone bariatric surgery, young children who are picky eaters, some adolescent girls and older adults.

PREGNANT WOMEN
The protein RDA for women is 46 grams per day. The protein RDA for pregnant women is 71 grams per day. That’s 25 grams more per day than non-pregnant women.²⁸ Since pregnancy is often associated with indigestion and heartburn, ²⁹ it may make sense to supplement protein intake with an easily digested protein such as WPI.

BARIATRIC SURGERY PATIENTS
Individuals who have undergone bariatric surgery often experience a reduction in protein intake.^30,31 This is problematic since increasing protein intake to at least 60 grams per day is recommended to help those who have undergone bariatric surgery retain more lean mass (i.e., Muscle).^32,33 Given that bariatric surgery may be associated with digestion and absorption issues (i.e., gastric dumping syndrome),³⁴ the use of an easily digested protein such as WPI makes sense for supplementing protein intake.

CHILDREN WHO ARE PICKY EATERS
Research³⁵ has shown that children who are picky eaters are more likely to consume less than the recommended amounts of protein (i.e., meat and alternatives) as well as fruit and vegetables. Furthermore, research³⁶ has also shown that some top sources of protein for children include pizza, beef and burgers, which often contribute substantial saturated fat. WPI is a healthy, low-fat option for supplementing protein intake in children.

ADOLESCENT GIRLS
According to the National Health and Nutrition Examination Survey,³⁷ 7.7 percent of adolescent females consume protein levels below their estimated average requirement.

While the reasons for this are not clear, protein supplementation may have value

OLDER ADULTS
Muscle mass and function is progressively lost with aging, so that by the age of 60 many individuals have reached a threshold where function begins to be affected. Increasing protein intake may help. Dietary protein intake helps stimulates muscle protein synthesis and may lead to improved muscle mass, strength and function over time, which in turn may help improve health outcomes in older individuals. Some researchers suggest that the optimal protein intake for an older individual is greater than the RDA.³⁸ Since protein intake tends to decline with age, especially among 7.2–8.6 percent of older women consuming protein levels below their estimated average requirement,³⁹ this suggestion has merit.

CONCLUSION
Protein is important for multiple functions in the body, not the least the repair growth of muscles. As a supplemental source, whey protein offers several advantages and has significant research to support its use.

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