The Nail in the Coffin for Hoodia

Hoodia gordonii is a plant native to South Africa that has been touted as having weight loss benefits since the start of the last decade.  It is sold in many dietary supplements that claim it has the ability to reduce appetite, amongst a mirade of other claims.  Although this has been thoroughly debunked more than once, it still continues to persist as an ingredient in fat loss supplement formulas.  Many legitimate supplement companies no longer sell Hoodia alone as an ingredient for fat loss or weight reduction, but it seems many companies still put the ingredient in formulations promoted for the stated reason that it can reduce a persons appetite.  Usually, the listed amount is unclear as it is included in formulas that include an ingredient listing in a proprietary blend, leaving the consumer unable to determine how much Hoodia is actually included in each serving size of the supplement.  But, since there has never been any real consensus on how much Hoodia is needed to have an effect or what specific alkaloids or extracts from Hoodia have the purported appetite reduction benefits it doesn't make a whole lot of difference.

Nonetheless, the basis for Hoodia working as a fat loss/diet aid has its background in science - or at least an attempt by science and pharmaceutical companies trying to determine if Hoodia had potential to be sold and marketed as a fat loss drug.  Several large pharmaceutical firms, including Pfizer, expressed a real interest in investigating whether or not the extract of Hoodia could legitimately be used as an appetite suppressant, also known as an anorectic compound.  Since most all prescribed drugs that work to reduce appetite are stimulant based, such as Phentermine, an amphetamine like drug, and the recently removed from the market drug, Meridia (sibutramine).  Sibutramine was not a amphetamine, but chemically related to them.  It blocks the reuptake of serotonin, dopamine and norepinephrine.  Although this was effective in reducing appetite, it was shown to cause risk of cardiovascular events (read: heart attacks) in certain individuals, especially those who were already obese, had poor diets, and other risk factors that would have increased this risk, especially when combined with stimulant drugs.

So, when pharmaceutical companies stumbled across a potential appetite suppressant that didn't appear to have any of the negative side effects associated with stimulants it piqued their interest.  The main constituent contained within Hoodia that had the supposed appetite reduction potential was called P57.  Since natural plants can't be patented and sold as prescription drugs, the idea was that drug companies could develop a process to extract or synthesize P57 on their own and patent it as an anorectic weight loss drug.  When news started to come around that the Hoodia plant was being investigated by major drug companies for its potential to help aid in weight loss supplement companies jumped all over it, buying up the bulk raw material, putting it in capsules, drinks, and anything else they could think of and sold it with claims of miraculous fat burning properties.  Unfortunately, no actual research had been conducted that demonstrability showed Hoodia had any effect on fat loss or appetite reduction.  Some studies conducted on rats by institutes in South Africa, which had a large financial stake in helping show that their native plant had some potential, are all that exist.

But now, a major chemical and pharmaceutical firm, Unilever, has released the results of a $25 million dollar human study they conducted on Hoodia and found that it had absolutely no appetite reduction benefits over placebo. Whats more, the individuals who consumed the Hoodia experienced many negative side effects.

The report, published in the American Journal of Clinical Nutrition, shows [...]

In their trial, Unilever researchers randomly assigned 49 healthy, overweight women to one of two groups. Both groups stayed at a clinic and were given two servings of yogurt a day for 15 days. In one group's yogurt drinks, the researchers had mixed in 1,110 milligrams of Hoodia.

The women were allowed to eat as much as they wanted during their stay at the clinic, yet there was no difference in calorie intake or weight loss between the two groups. Along the same lines, Hoodia didn't stifle anyone's hunger.

However, the Hoodia-treated women didn't fare as well as the placebo group. They experienced 208 cases of side effects -- three times the number reported by women eating normal yogurt -- including headaches, nausea, vomiting and odd skin sensations.

They showed increases in pulse and blood pressure, and signs of liver damage.

 Unilever has since abandoned any further research or attempts to pursue Hoodia as an appetite reduction drug.  Hoodia is one supplement you want to avoid if you decide to use weight loss supplements.

Frederik Joelving. Would-be fat-fighter Hoodia nothing but side effects - Reuters 10/28/11 (Link to article on Pastebin)
Wendy AM Blom, Salomon L Abrahamse, Roberta Bradford, et al. Effects of 15-d repeated consumption of Hoodia gordonii purified extract on safety, ad libitum energy intake, and body weight in healthy, overweight women: a randomized controlled trial. Am J Clin Nutr. 2011 Nov;94(5):1171-81. Epub 2011 Oct 12.

Make your own Weight Gainer

Many people often ask me for recommendations on supplements and I'm often asked to recommend a protein shake or weight gainer.  Typically a beginner won't know the difference between the two and this is why there are ridiculous products on the market such as Russian Bear 5000 on the market.  For those who are unaware, Russian Bear 5000 is a weight gainer protein shake formula that advertises having 5000 calories per serving but the directions instruct that you drink it with an entire gallon of milk and there are 3 servings per container.

Most weight gainer products on the market are advertised and sold this way because of naivety on the part of the buyer.  A common weight gaining product such as Muscle Juice is a good example.  It is generally composed of cheap whey protein concentrate (high in fats and sugars), a large amount of high GI carbs from corn sugar such as dextrose or maltodextrin and the cheap gimmicky fat MCT (medium chain triglycerides).  These cheap ingredients all give added calories to the mix and make it look impressive on the label.  The problem is that these are mostly empty calories and simply don't add weight on like real food or a superior protein MRP (meal replacement powder) would.  Because of the high GI carbs included in these formulas, an insulin spike is produced, which would be ideal post workout, but when consumed throughout the day can begin to start insulin sensitivity issues and fat storage.  When you look at it from this point of view, combined with gainers are usually more expensive, you start to understand why they shouldn't be used.

Whey protein concentrate (WPC), although a decent source of protein, is not ideal for everyone.  As I mentioned, it is very high in fats and sugars, especially lactose, and for anyone who has trouble with dairy, that is a problem.  Oh the other hand, it does have some microfactions that are good for the immune system.  Will Brink does a good job of explaining the differences in his article The Whey it is.

The next problematic ingredient we commonly find in weight gainers is maltodextrin.  Although it is classified as a complex carb, it does not act this way in the body.  Again, consuming maltodextrin around the workout window (before/during/after) would be suitable because it a high GI carb, but all throughout the day as recommended by using a weight gainer product can lead to insulin sensitivity and unwanted fat storage.

The last common ingredient is MCTs as a source of fat.  Although MCTs were once generally touted as being beneficial because they were used as an energy source, they have been almost entirely debunked.  When combining MCTs as a fat with a high GI carbohydrate it is almost certainly going to end up being stored as fat and not used.  A much better source would be from a good fat that is high in omega 3s and 9s like olive, flax, or fish oil.

A much better method is to simply blend up your own healthy gainer which quality ingredients you pick that give you more better calories overall and is still within anyones budget.

Pogue's Shake Receipe

This is my own personal shake recipe that I use all the time.  It tastes great and you can tweak it yourself based on your own personal tastes and add/subtract calories as needed.  Mix the following into a blender for a rich smoothie:

• 3 cups of ice
• 1 cup of 2% milk (122 cals, 5g fat, 11g carbs, 8g protein)
• 1 banana (105 cals, 0g fat, 27g carbs, 1g protein)
• 2 cups of frozen strawberries (92 cals, 1g fat, 22g carbs, 2g protein)
• 1 cup of fat free plain yogurt (70 cals, 0g fat, 14g carbs, 4g protein)
• 2 tblspoons of Naturally More peanut butter (169 cals, 11g fat, 8g carbs, 10g protein)
• 1 tblspoon of olive oil (119 cals, 13g fat, 0 carbs, 0 protein)
• 1 teaspoon of creatine
• 1 scoop of Gaspari Myofusion (147 cals, 3g fat, 5g carbs, 25g protein)

That comes to a total of 814 calories, 33g of fat, 82g of carbs, and 50g of protein.  That is great for a weight gainer and includes good carbs and good fats.  Note that the numbers come from About.com's Calorie Count.  Obviously you can substitute Myofusion for the protein powder of your choice, including plain protein powder with no additives.  I choose Myofusion because it tastes good and Gaspari was nice enough to send me a free sample awhile back.  My other preference for protein is Optimum 100% Egg Protein.  Because I'm lactose intolerant and prefer non-dairy sources of protein, but although Myofusion does have WPC in it, they include lactase enzymes for digestion, so there is no problem.  I use Naturally More brand peanut butter which includes extra protein from flax seeds and contains good healthy fats along with fiber.  Obviously the creatine is optional, but if you are a trying to gain weight, it is highly beneficial and bulk powder is very cheap and blends easily. I use Cheap Supplements Creatine Monohydrate.

Recommended Articles:

• How much protein do you really need?
• Sports Supplements Guide for Beginners

Review: Pro Oats - High Protein Oatmeal

There's a very interesting new high protein oatmeal supplement on the market called Pro Oats that I was recently invited to try and give my review on.

Pro Oats are high grain rolled instant oats packaged in a multiple serving pack.  The manufacturers have added high grade whey protein isolate (WPI) to the oatmeal to give it added protein which gives it a total of 12g of protein per serving.  For comparison, looking at plain Quaker Instant Oats (I'll be using this comparison for the rest of the review),  has around 4g of protein per serving.  They've also added dried fruit for several varieties of flavors, including apple pie, peach, cherry and blueberry.  I tried the blueberry flavor.

The taste is on par with your average unflavored oatmeal, with the exception of the fruit which has added sugar to bring out the flavor.  You can also distinctly taste the WPI texture in the oats, but it's not unpleasant.  Although the blueberries are sweetened with sugar, I found the regular taste of the oats to be somewhat bland and added some Splenda to the rest of the oats compensate.  The carbohydrate (37g) and sugars (9g) are a bit higher than what I would like to see in a high protein oatmeal if the market is for bodybuilders/weight lifters or general fitness related people -- although the added carbs could be advantageous for an endurance athlete.  But, on the plus side, it also has a little bit higher amount of fiber (5g) than Quaker (3g).

All in all, I feel the flavoring of the product could be improved somewhat.  With the added sugar, I would have expected the product to be much sweeter, but you really only get a taste of flavor with the added fruit -- the rest of the oatmeal is completely unflavored.  My personal preference would also to use an artificial sweetener or stevia in place of the sucrose sugar since you're already going to be getting a good amount of low GI carbs from the oats themselves.  However, I like the idea of a high protein product and I hope that once the product starts making it to the retail market, Pro Oats will be able to be sold in larger packages and become more affordable.  A pack of 7 servings of Pro Oats currently sells for $7 on their website.

So, give Pro Oats a try and feel free to post your comments here of what you think.  Big thanks to Max Cascone @ Pro Oats for the samples!

How much protein do you really need?

The question most often asked by anyone started or involved in weight training is how much protein does a person need to consume per day, per meal, per hour, per serving, before bed, and so forth to increase muscle mass.  The answer usually devolves into a spouting of common broscience knowledge about how much protein can be absorbed at a time or that too much protein gets converted to fat and other rubbish.

In order to induce muscle hypertrophy (growth) an increased amount of amino acids needs to be consumed to increase and maintain protein synthesis and positive nitrogen balance.  This is plain to understand and most people know this.  But the real question boils down to exactly how much protein does a person really need to get to that level?  Although there are various factors involved, including whether or not the person is weight training and looking to add new muscle tissue, that individuals weight, and the type of protein being consumed, you are likely to get a straightforward answer in the amount of a certain number of grams -- depending on who you ask.

Supplement manufacturers often tout the claim that you need 1-2g of protein per pound of bodyweight daily in order to grow.  But is this really a realistic number and how did they come to this conclusion?  The truth is this is actually a serious exaggeration when looking at the scientific evidence, although it is somewhat lacking when looking at heavy weight training males who workout using a serious bodybuilding/mass building routine.  Nonetheless, these results can still be interpolated for the average person and we can probably all afford to bring our protein consumption down to a more realistic level.

A recent LA Times piece quoted bodybuilding.com moderator and all around nutrition guru Alan Aragon with some good realistic numbers on the quantities of protein a person should be consuming for steady growth.

Aragon deals with more ambitious populations. For new weightlifters aiming to both lose fat and build muscle, he recommends 1.7 grams of protein per kilogram of body weight per day. Those focused merely on adding muscle need only 1.4 grams, he says. [1]

A 180lb person would equate to 82kg so that would average out to 139g of protein per day for that person looking to build muscle.  Of course, most of the protein in a persons diet should be coming from whole food sources, and not protein supplements.  As Alan points out, protein shakes are more a matter of convenience.  It can be hard to consume that amount of protein per day from whole food sources, so powdered whey, milk, eggs or soy make it much easier to supplement additional protein into the diet.  This is especially true when a typically bodybuilder/weightlifter diet is composed around eating meals every 2-3 hours.

In a paper published by The Journal of the International Society of Sports Nutrition (JISSN), they go even further on the topic.

Protein Requirements for Resistance Trained Athletes

In a recent Meta Analysis on protein requirements Rand et al. defined the protein requirement in healthy adults as "the continuing intake of dietary protein that is sufficient to achieve body nitrogen equilibrium (zero balance) in an initially healthy person of acceptable body composition at energy balance and under conditions of moderate physical activity..." An individual's protein needs are assumed to have been met when the amount of nitrogen consumed is equal to the amount of nitrogen excreted or lost (zero nitrogen balance). In the occurrence that the amount of nitrogen consumed exceeds the amount of nitrogen lost then the individual is in a state of positive nitrogen balance, and is generally assumed to be in an anabolic state. Conversely when the amount of nitrogen excreted exceeds the amount of nitrogen consumed, the individual has entered into negative nitrogen balance, and is assumed to be in a state of net bodily protein loss (catabolic state). Based on this definition, the Recommended Daily Allowance (RDA), meant to suffice for 97.5% of the population is 0.8 grams of protein per kilogram of bodyweight. However, strength training athletes generally consume a great deal more than the RDA, with the rationale that their protein requirements exceed that of the general population. Therefore, a number of studies have examined athletes' protein requirements based on the nitrogen balance technique. [Italics added] [2]

The paper goes on to review a number of studies looking at protein intake in a variety of individuals, but noting specifically that those who are doing extensive bodybuilding and/or weight training will still more than likely need to exceed protein intakes of the average individual because of their need to increase muscle hypertrophy beyond standard levels. They also compare rates of digestion of different types of protein (fast vs. slow) and optimal protein timing, which can all get very confusing and bog down the average weight trainer who wants to skip the theoretical and get down to the nuts and bolts.  For those people, I encourage them to read Will Brink's article, The Religion of Pre and Post Workout Nutrition.

JISSN also includes a practical applications table of protein and amino acid consumption and supplementation at the conclusion of their article which can help shed some light on their conclusions.  I have reproduced the table below.  Interestingly, they recommend the consumption of essential amino acids (EAAs) in the place of a full source protein in many cases.

Variable of Interest	Practical Applications
Pattern of Digestion	Alternate normal meals with fast digesting sources of protein or EAAs.
Rate of Digestion	Protein balance is greater with slow proteins with no additional energy; however, when combined with a source of energy, whey protein produces A greater protein balance than casein combined with a source of energy.
Timing of Protein Ingestion	Consume EAAs or fast digesting protein prior to and immediately following exercise.
Protein Quality	An omnivorous diet appears to be optimal for fat free mass and indexes of performance, while supplementing with EAAs may enhance protein accretion along with normal protein feedings.
Amount per serving	Unsure, but Dangin et al. found an increase in protein synthesis from 23 to 33 grams of whey protein. This may be near the limit as 40 grams of EAAs did not increase MPS in comparison to 20 grams of EAAs.
Energy Source combined with Protein	Both carbohydrates and fats appear to spare protein equally. However, carbohydrates are still critical for maintaining intensity during resistance training.

The amount of protein that can be adequately consumed and digested in one sitting appears to be around the 30g mark and Will Brink makes the argument that it really doesn't matter, because as he says "You've gotta eat something."

The Counter Argument


In his anti-supplement book, Muscle, Speed, & Lies, author David Lightsey makes the case that none of these figures our accurate and the actual amount of protein necessary to be consumed daily -- even by weight training individuals is very low.  The text below is quoted from Chapter 5 "Protein and Muscle Mass: How much is Enough?"

Everybody knows muscle is mostly protein.  Everybody also knows that a lot of extra protein is required to build muscle and keep it healthy.  Right?  Well, actually, it's not.  Everybody is wrong.  Similarly, most people believe that muscle is anywhere from 75 percent to 100 percent protein.  In fact, muscle is roughly 70 percent water!  It contains only about 22 percent protein.  Stop here a moment, and do the math.  Let's say you want to add a pound of muscle to your current body weight per week.  If a pound of muscle contains 22 percent protein, how many grams of protein must you consume beyond your normal diet to achieve this goal? 22 percent of one pound (454 grams) = roughly 100 grams.  If one pound of muscle contains roughly 100 grams of protein, how many extra grams of protein will you need to consume per day?  100 grams/7 days = 14.3 grams per day. [Italics added] [3] 

Although this sounds like a grossly confused calculation for those of us raised to believe you need 1g of protein per pound of bodyweight,  Lightsey backs up his argument with advice from doctors and sports nutritionists.  His view of the supplement industry is extremely low, but he does make good points that I agree with -- namely that two of the most ergogenic substances you can consume are water and carbohydrates.

On the flip side of the coin, Will Brink, in his article Protein Myths that Will Not Die, counters this argument with one of his own.

Myth #4 “Athletes don’t need extra protein” 

Interestingly, there has not been much new research of note on this topic since I wrote the first version of this article in 1995. Now the average reader person is probably thinking “who in the world still believes that ridiculous statement?” The answer is a great deal of people, even well educated medical professionals and scientists who should know better, still believe this to be true.

[...]

For the past half century or so scientists using crude methods and poor study design with sedentary people have held firm to the belief that bodybuilders, strength athletes of various types, runners, and other highly active people did not require any more protein than Mr. Potato Head…..err, I mean the average couch potato.

For those of you who may need a brush up, one review paper on the subject by one of the top researchers in the field (Dr. Peter Lemon) states “…These data suggest that the RDA for those engaged in regular endurance exercise should be about 1.2-1.4 grams of protein/kilogram of body mass (150%-175% of the current RDA) and 1.7 – 1.8 grams of protein/kilogram of body mass per day (212%-225% of the current RDA) for strength exercisers” (“Is increased dietary protein necessary or beneficial for individuals with a physically active life style?” Nutr. Rev. 54:S169-175, 1996).

Another group of researchers in the field of protein metabolism have came to similar conclusions repeatedly (“Evaluation of protein requirements for trained strength athletes.” J. Applied. Phys. 73(5): 1986-1995, 1992.) They found that strength training athletes eating approximately the RDA/RNI for protein showed a decreased whole body protein synthesis (losing muscle jack!) on a protein intake of 0.86 grams per kilogram of bodyweight.

Conclusions

From all the research that's out there it appears that the best source of protein for any diet is from whole food sources.  The body is simply more apt at digesting protein from nature when combined with fats, carbs, enzymes, vitamins and minerals and the whole range of other ingredients found in a balanced and nutritious meal.  However, for a bodybuilder or weightlifter who is trying to add significant amounts of muscle mass in a short period of time, an increased amount of protein is necessary.  Obviously in a perfect setting that person would get all their protein from whole food sources.  But, in a fast paced world with our lives to lead, most of us will opt for the convenient option of supplementing with a protein shake or bar in place of a meal.  The most important times to consume these quick digesting proteins is around the workout period, where amino acids are needed quickly to be utilized by muscle tissue.  It appears from the research that the optimal amount of protein from a supplement that can be consumed in a single setting is around 30 grams.  According to JISSN, a fast digesting whey protein or even an EAA supplement appears to be your best choice for this purpose (although whey is a much cheaper alternative to the free form essential amino acids).

Sources


[1] Fell, James. Rethinking protein powder. Los Angeles Times.  September 27, 2010.
[2] Wilson, Jacob, et al. Contemporary Issues in Protein Requirements and Consumption for Resistance Trained Athletes. J Int Soc Sports Nutr. 2006; 3(1): 7–27. PMCID: PMC2129150
[3] Lightsey, David. Muscles, Speed, and Lies: What the Sport Supplement Industry Does Not Want Athletes or Consumers to Know.  The Lyons Press. 2006.

Homemade NO2 Preworkout Stack

NO2 blend products like SuperPump and NO-Xplode are all the rage nowadays.  These type of pre/during/post workout supplements don't fit into a particular category, but are generally meant to be used to give you a boost of strength, energy and a massive muscular pump during your workout that can be very motivating to help you out in the gym.  But, they sort of take a "kitchen sink" approach when it comes to what's in them.  Generally, they have a variety of different amino acids, including creatine and arginine especially.  They also have a blend of some type of carbohydrates and a delivery system to try and get them into your bloodstream as fast as possible. Some have BCAAs and others don't.  They often times use a lot of fancy proprietary ingredients and you can never tell how much exactly of anything you're getting.  And, a lot of times, they have different stimulants, such as caffeine and exotic herbal blends to give you an extra boost to lift harder and heavier.

Although these products provide a lot of good motivation from the extra energy and the visual pump you get during and after the workout the real question is whether they actually increase strength and body composition beyond that of the supplements that we know do, like creatine and whey protein.  Originally, an NO2 product was just made up of the amino acid arginine or an a derivative of it, such as arginine bound to malic acid or ketoglutarate (AAKG) in a certain delivery system like a powder or pill.  The intended purpose was to increase levels of nitric oxide in the blood and the theory was that this would increase blood flow to the muscles, delivering all the rich nutrients from food/vitamins and amino acids to help build muscle, but there is no scientific data that shows this to be true.  Mostly what supplementing with arginine did was just give users a very noticeable pump in their muscles, but not much else. This is probably due to the cellular volumizing effects of just allowing more water and glycol into the muscle during the workout.  Some studies done with arginine showed no benefit on body composition, strength, 1 rep max (1RM) or any other positive factors. But, arginine has always been one of those bastardized amino acids.  It always looks good on paper, but no one can really say it has positive effects for body composition or strength. [4] Some studies show it increases growth hormone levels when taken at certain times in certain dosages, and others show nothing. [5,6] But one thing the supplement companies have learned is that arginine absolutely provides a visual effect in the form of what bodybuilders and weight lifters refer to as the "pump".  This is when you are lifting and the muscle becomes fuller and harder and this effect typically lasts several hours after the workout, but it is only temporary.

A more recent trend, NO2 supplements can be placed in just about any category of ergogenic (muscle building) and contain any range of ingredients.  The trouble is that a lot of these products are very expensive for the amount of servings they provide.  In this article I'll go over some ways you can make your own NO2/preworkout supplement yourself with bulk powder ingredients blended together in portions that work.  You can add in other ingredients based on your budget and your goals.  Then, you can simply flavor the formula yourself with whatever you like and drink it before and/or during your workout to get that same effect of cellular volumization, strength, energy and hopefully even some real body composition and ergogenic benefits too!

Creatine


We'll start with creatine since we know that creatine has real life muscle building and strength effects. [1]  There are a lot of fancy creatines out there, such as creatine ethyl ester (CEE), Kre-Alkalyn, di-creatine malate, and so forth.  But, the only creatine that has been conclusively shown in studies to be effective is good ole' plain jane creatine monohydrate. [2]  That's not to say that the other creatines don't work -- they might even be better.  But no one has ever tested them side by side to determine that.  There was only one study comparing creatine monohydrate to CEE side by side and creatine monohydrate was shown to be superior in every way. [3] So, I'll show you a few examples of what creatine powder you might want to choose for your own blend and get that one based on your budget or if you're just feeling experimental and want to try one of the other more exotic creatines out there.  Ideally you want to be getting at least 5g of creatine per serving or per day, but you can go up to 10g if you wish.  Some creatines like CEE only require a dosage of 3g per serving however.

• Cheap Supplements - Creatine Monohydrate 500g $9 (5g per serving)
• Higher Power - Micronized Creatine 500g $12 (5g per serving)
• Higher Power - Creatine Ethyl Ester 500g $20 (2.5g per serving)
  
• SciFit Kre-Alkalyn Powder - 300g $24 (1g per serving) + FREE Gluta-Lyn, 300g (buffered glutamine - limited time offer)

I recommend the Higher Power brand creatine monohydrate for our NO2 mix.  It is the same price per gram as the Cheap Supplements brand, but it is also micronized for superior digestibility and absorption.

Arginine


Just like creatine, there are a lot of different forms of arginine you can pick from based on your budget and what you want to go with.  I wasn't able to find arginine ethyl ester in pure powder form though, so we'll just be looking at plain free form arginine, di-arginine-malate, and arginine-alpha-ketoglutarate (AAKG).  Any one of them would be fine, but I would probably pick AAKG, although regular arginine would be just fine.  As a commenter below pointed out, plain arginine has an unpleasant taste, giving AAKG a leg up over its amino acid cousin.  One study using AAKG showed an increase in 1RM, but no effects on body composition or overall strength.  [6] However, arginine does also have other positive effects such as vasodilation and the potential to increase growth hormone (GH) and insulin like growth factor (IGF) levels. [4,6] But, the main reason we add it is to get that great pump effect we desire from our NO2 mix.  The problem with high dosing arginine is that it can cause upset stomach and so we want to keep it within the low range, giving us the benefits, without the negative side effects, so we will try and keep it within the 5-10g range.

• Cheap Supplements - Arginine 250g $9 (5g per serving)
• Higher Power - AAKG Powder 1.1 Lbs. $26 (3g per serving)
• NOW - AAKG Powder 200g $21 (3g per serving)

I recommend the Higher Power AAKG arginine powder.  AAKG is what was used in one of the main studies looking at arginine for strength and body composition, but either of the two options would be also good.  The Higher Power brand is cheaper per gram than NOW.

Dextrose


I picked dextrose as the main carbohydrate for the NO2 mix for a couple reasons.  Firstly, it's dirt cheap.  Dextrose is the same thing as glucose, which is sugar in its simplest form. Ideally, you want a fast absorbing carbohydrate around the workout window (before/during/after) to replenish the ones that are being used during the exercise routine. Dextrose goes right into the blood stream to give you the insulin spike you want, and doesn't have any fructose in it to go through conversion in the liver. [7]  Sports drinks like Gatorade are good, but the fact that they have high fructose corn syrup is what takes away their advantage. [9] Other products have maltodextrin in them which is also not ideally suited for our purposes.  Dextrose is going to give you quick energy and get the ingredients in the blood stream faster.  As we know, creatine works best with a high GI (glycemic index) carb as it's delivery system, and so it's perfect for this.  Fructose is an extremely poor choice for this purpose and so I had to discount any product that had it or maltodextrin in it as I looked for suitable products for our blend.  Fructose is processed by the liver before it is released into the blood stream creating insulin resistance.  It also starts to create triglycerides from fat after consumption, leading to the potential to increase adipose (fat) tissue from repeated usage.  So, it's best to just stick with the basics and use dextrose. [8]  There are many special carbohydrate mixtures out there that have timed released formulas and other things like added amino acids and vitamins, but you shouldn't need those provided you already take a multivitamin daily and get plenty of protein from whole foods and/or protein supplements (like whey).

But, for low GI purists out there, you could also substitute dextrose for ground oatmeal powder, which is available premade by Protein Factory or you can blend it yourself.  In the past, I've found trying to blend oats into a powder to be a real chore, so I would just opt to buy the powder.  It should work just as well as dextrose, although possibly not quite as quickly and not as dramatic of an insulin spike will happen when you use it.  This is essentially a toss up between people who may be trying to follow a ketogenic diet routine (who would be going for the oats) or anyone else (who would choose dextrose).

• NOW - Dextrose Powder 10 Lbs $23 (4g per serving)
• Protein Factory - Oat Muscle (ground oatmeal powder) 3 Lbs $18 (40g per serving)

I would recommend the NOW Dextrose powder.


Beta Alanine


Beta Alanine increases skeletal muscle concentrations of an amino acid dipeptide, carnosine.  Carnosine acts as a pH buffer in the muscle, helping to reduce lactic acid build up.  Lactic acid causes the fatigue and the burning in the muscle after long periods of high intensity training, so supplementing with beta alanine can help reduce this.  It also appears to increase strength in some, making it a great combination to take with creatine.  There are speculations that anabolic steroid usage leads to increases in skeletal muscle carnosine levels, similar to how they also increase creatine production (another reason why steroids are so effective at muscle building).  The dosing for beta alanine can be in the range of 4-6g daily, but it should be consumed throughout the day as taking one large dose causes an unpleasant tingling and stinging sensation in the skin, possibly caused by histamine release. [12,13]  The recipe I have at the bottom of the page lists 1g of beta alanine for our blend, but you will need to consume around 6g daily from other sources outside our blend.  Because users cannot tolerate more than 1g of beta alanine per dosage, it must be spread out.  This can be a bit tedious, but there are products, like Molecular Nutrition's PeakBeta, which comes as a time released beta alanine capsule that can be swallowed and delivered into the body throughout the day.  Although its more expensive than the powder, it is more convenient to use, so it's a trade off that will have to be made if you decide to use beta alanine.  You may consume teaspoons of beta alanine powder at multiple intervals during the day, or use a time released capsule product.  You should base this decision on both convenience and your supplement budget.

Carnosine’s role as an intracellular buffer is undisputed given its location within the skeletal muscle of humans and its chemical structure (Harris et al. 1990). Consequently, there is potential for supplementation with b-alanine to result in improved exercise performance, especially during high-intensity exercise. [13]

• Cheap Supplements - Beta Alanine 250g $11 (1g per serving)
• NOW - Beta-Alanine Powder 500g $23 (2g per serving)

The NOW Beta Alanine appears to be the better deal at 5¢ per gram, so I would recommend that.  Alternately, you can use a time released beta alanine product.

Citrulline


Citrulline and citrulline malate (citrulline bound to malic acid) is a non essential amino acid that makes the conversion to arginine and arginine derivatives via enzyme pathways.  It was originally touted as being beneficial for aerobic exercise, but recent studies have shown that it has positive effects during anaerobic exercise.  For one, citrulline itself, when ingested, creates and causes the body to make and utilize some amino acids more efficiently. [10]

Citrulline-malate ingestion significantly increased the plasma concentration of citrulline, arginine, ornithine, urea, creatinine and nitrite (p < 0.05) and significantly decreased the isoleucine concentration from basal measures to after exercise (p < 0.05). Insulin levels significantly increased after exercise in both groups (p < 0.05) returning to basal values at recovery. [11]

Citrulline malate has also been shown to reduce post workout muscle soreness, also known as DOMS (delayed onset muscle soreness).  Although you can opt for the more expensive citrulline malate formula, l-citrulline alone would probably work just as well for your NO2 mix. I could not find it sold in bulk powder, only prepacked in capsules.  The dose for citrulline should be in the 1-5g per serving range.

• PrimaForce - Citrulline Malate, 200g $20 (2g per serving)

Taurine


Taurine is another amino acid that plays a key role in many exercise mediated actions.  It can increase endurance, strength and energy, as well as cause a great deal of cellular volumization and hydration to the muscles.  It's one of the main ingredients in Red Bull (along with sugar and caffeine) to give its users a positive feeling of well being and alertness.  It's also one of the cheapest ingredients here on our list, so that is another plus in adding it to our cocktail.  The dosage range can be anywhere from 1-6g per serving. [14]

• Cheap Supplements - Taurine 250g $8 (5g per serving)
• AllMax Nutrition - Taurine 400g $10 (3g per serving)
• Nimbus Nutrition - Performance Taurine 1000g $20 (5g per serving)

The Nimbus Nutrition brand appears to be the cheapest at 2¢ per gram.

Caffeine (Optional)


Since many NO2 products use a variety of different stimulants I thought I would include the option of adding caffeine in here.  Obviously we don't want to use caffeine in powder form since it would be hard to measure out and scoop, so the best idea is to buy it in tablet form and split it.  A 200mg caffeine pill split into 4ths would give you 50mg of caffeine, which should be sufficient for a good amount of energy.  If you feel like you need more, you could always take half the pill.  Pills can be split using a cheap pill splitter found at a pharmacy or just using a butter knife (press into the tablet, don't saw at it) and obviously scored tablets are best for this, but normally more expensive.  The other issue with adding too much caffeine is that it acts as a vasoconstrictor (restricting blood flow) while the other ingredients, arginine especially, are trying to act as vasodialators (expanding blood flow).  So you don't want too much caffeine with your NO2 blend or it will negate the effects.

• AllMax Nutrition - Caffeine, 200mg/100 Tablets $4

Flavoring

You can flavor your blend in whatever way you choose.  I would recommend buying unsweetened Koolaid packets and then adding the sweetener of your choice, such as Splenda (sucralose) which can be bought in large bags and is now sold as a generic product at most grocery stores or you could use Stevia powder.  Aspartame, saccharine, or sugar alcohols such as maltitol or xylitol would also be suitable alternatives, but obviously it is a personal choice.  You could use some table sugar (sucrose), but you wouldn't want to use much since you already have a high GI carb source from the dextrose, so an artificial sweetener would be preferred here.  Mix the Koolaid flavor of your choice and then sweeten to desired results per serving.  If you are blending it up all at once for use later in the day, you would not want to mix it in liquid, but leave it in powder form so the ingredients wouldn't break down or denature.

What's missing?


You may notice I left out a lot of popular ingredients found in many of these NO2 pre/during/post workout blends like BCAAs, Ribose [15,16], and Glutamine [17,18].  I still feel like the scientific evidence on these is very sketchy.  BCAAs may be a good idea, but their expense puts them at a disadvantage.  Ribose is basically just fancy and more expensive sugar, and we know from many, many studies that glutamine just simply is not orally bioavailable and never makes it into skeletal muscle tissue, making it a total waste of money.  I also didn't include any fancy or exotic herbs that may act as stimulants, nootropics, or insulin stimulating agents.  Although some of them may be advantageous, it's impossible to know what the proper dosage is and find it in a cheap enough form to buy in bulk and add it into our blend.  Not to mention flavoring a lot of these herbs is going to require some very fancy concoctions -- more so than Koolaid would cover up.  In reality, they are probably also not necessary and a lot of times just added on the ingredients list in a proprietary blend, so you, the consumer have no idea how much you're getting and whether or not it's even in a worthwhile amount.  Basically, it's a gimmick.  Still, you could always use any stimulant product you prefer in place of the caffeine, it's up to you.

The Home Made NO2 Cocktail


This blend should have all the main ingredients all the other fancy and more expensive NO2/preworkout blends on the market have, with real working ingredients that are actually scientifically shown to effect strength, body composition, endurance, energy, and stamina.   The ingredients here may even be more abundant than you are getting in one of the marketed blends since, as mentioned, all the ingredients are listed in a proprietary fashion not giving you a clear picture of what you are taking and in what amounts.

You can drink it before, during or after your workout -- although I believe that before or during would be optimal.  So, here are the ingredients you want in the proportions I recommend.  However, you are more than welcome to alter them to suit your needs and tastes.  You can increase the dosage of Beta Alanine beyond 1g if you are comfortable doing so.  Many users report an unpleasant tingling sensation in dosages beyond 20mg/kg (which would be approximately 1.6g for 180lb person). [13]

• 5g Creatine monohydrate
• 5g Arginine-alpha-ketoglutarate (AAKG)
• 20g Dextrose
• 1g Beta Alanine
• 2g Citrulline Malate
• 2g Taurine
• 50mg Caffeine

Mix into 16-32oz of water (with the exception of the caffeine tablet).  Add Koolaid powder and Splenda to your liking.  The dextrose will already be sweet, so you may want more or less depending on the flavor.  You may want to use a whole packet of Koolaid or more depending on the flavor of some of these amino acids, but start off small and decide for yourself.  Some flavors of Koolaid may work to mask certain unpleasant flavors with Tropical Punch probably being the most masking, but again, this is personal preference.

Related Articles:

• Rethinking BCAAs
• Sports Supplement Guide for Beginners

References

1. Tolson, David. Creatine Overview. Bulknutrition.com. Accessed 6/30/10.
2. Brink, Will. The Creatine Grave Yard. Brinkzone.com. Feb 20, 2009.
3. Spillane M., et al. The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels. Department of Health, Human Performance and Recreation, Baylor University, Box 97313, Waco, TX 76798, USA. J Int Soc Sports Nutr. 2009 Feb 19;6:6.

4. Campbell BI., et al. The ergogenic potential of arginine. Exercise and Sport Nutrition Laboratory, Baylor University, Waco, TX. J Int Soc Sports Nutr. 2004 Dec 31;1(2):35-8.
5. Zajac A., et al. Arginine and ornithine supplementation increases growth hormone and insulin-like growth factor-1 serum levels after heavy-resistance exercise in strength-trained athletes. Department of Sports Training, Academy of Physical Education, Katowice, Poland. J Strength Cond Res. 2010 Apr;24(4):1082-90.

6. Campbell B., et al. Pharmacokinetics, safety, and effects on exercise performance of L-arginine alpha-ketoglutarate in trained adult men. Exercise and Sport Nutrition Laboratory at the Center for Exercise, Nutrition, and Preventative Health Research, Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA.  Nutrition. 2006 Sep;22(9):872-81.
7. el-Sayed MS., et al. Exogenous carbohydrate utilisation: effects on metabolism and exercise performance. Centre for Sport and Exercise Sciences, Liverpool John Moores University, School of Human Sciences, U.K. Comp Biochem Physiol A Physiol. 1997 Nov;118(3):789-803.
8. Tolson, David. Carbohydrates and Exercise Performance. Bulknutrition.com.  Accessed 6/30/10.
9. Dolson, Laura. Fructose: Sweet, But Dangerous. About.com. October 09, 2008.

10. Pérez-Guisado J., et al. Citrulline malate enhances athletic anaerobic performance and relieves muscle soreness. Department of Medicine, University of Córdoba, Córdoba, Spain. J Strength Cond Res. 2010 May;24(5):1215-22.

11. Sureda A., et al. L: -Citrulline-malate influence over branched chain amino acid utilization during exercise. Research Group on Community Nutrition and Oxidative Stress, Laboratory of Physical Activity Sciences, Departament de Biologia Fonamental i Ciències de la Salut, University of Balearic Islands, Crtra. Valldemossa Km 7.5, 07122, Palma de Mallorca, Illes Balears, Spain. Eur J Appl Physiol. 2010 May 25.

12. Derave W., et al. Muscle carnosine metabolism and beta-alanine supplementation in relation to exercise and training. Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium. Sports Med. 2010 Mar 1;40(3):247-63.
13. Sale C., et al. Effect of beta-alanine supplementation on muscle carnosine concentrations and exercise performance. School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK. Amino Acids. 2010 Jul;39(2):321-33. Epub 2009 Dec 20.
14. Author unknown. Taurine.  Supplementwatch.com accessed via archive.org. 6/30/10

15. Kreider RB., et al. Effects of oral D-ribose supplementation on anaerobic capacity and selected metabolic markers in healthy males. Exercise and Sport Nutrition Laboratory, Center for Exercise, Nutrition and Preventative Health, in the Department of Health, Human Performance and Recreation at Baylor University, Waco, TX 76798-7313, USA. Int J Sport Nutr Exerc Metab. 2003 Mar;13(1):76-86.

16. Dunne L., et al. Ribose versus dextrose supplementation, association with rowing performance: a double-blind study. Sports Medicine Center, Ohio State University, Columbus, OH, USA. Clin J Sport Med. 2006 Jan;16(1):68-71.

17. Candow DG., et al. Effect of glutamine supplementation combined with resistance training in young adults. College of Kinesiology, University of Saskatchewan, Saskatoon, Canada. Eur J Appl Physiol. 2001 Dec;86(2):142-9.

18. Antonio J., et al. The effects of high-dose glutamine ingestion on weightlifting performance. Sports Science Laboratory, University of Delaware, Newark, Delaware 19716, USA. J Strength Cond Res. 2002 Feb;16(1):157-60.

Rethinking BCAAs

I've never recommended BCAAs to anyone who's asked me about them.  I generally tell them that they get a sufficient amount in their whey and that to supplement with the necessary dosages to get a beneficial advantage requires an extremely large dose -- which is extremely expensive.

But a new study funded by Scivation on their BCAA + Citrulline product, Xtend, had some interesting results.  In their study, thirty six men were given either 14g of BCAAs, or 28g of whey, or 28g of carbohydrate in the form of a sports drink (like Gatorade), or a placebo.  The group consuming the 14g of BCAAs had a decrease in body fat, increase in lean mass, and increase in strength after only 8 weeks.

That is a pretty interesting result considering the small amount of BCAAs ingested.  The general recommendation for BCAA consumption has generally been around 30g per day taken during the workout, but there has always been contention and a great deal of broscience around what the proper ratios should be for leucine, isoleucine and valine, with leucine being the most important of the three.  Over the years, there have been some interesting leucine supplements sold, but they have never really panned out in real life even though the studies are intriguing.  The most interesting of these being HMB (beta-Hydroxy beta-methylbutyric acid).  An old forum post I made answering a question about whether or not HMB was worthwhile includes some details on this supplement.

You'd really need to take closer to 10gm+ (probably closer to 30) per day [of HMB] for it to be effective. However, [...], there are more studies indicating little to no effect of supplementing with HMB than there are studies showing that it's effective, and most of those were done by the patent holder, Dr. Steve Nissen. Nissen patented it for multiple usages - originally to increase lean muscle mass in domestic farm animals, as well as mood elevation, lowering cholesterol, and of course - "anabolic" effects (nitrogen retention). You can view his patents for HMB here:

http://www.google.com/patents?q=Steve+Nissen+hmb

Unfortunately, HMB never panned out in the real world for many reasons. The first was because the cost was so high, most manufacturers put it in formulas with minuscule dosages, such as 500mg per serving. It was also introduced after creatine, which proved to be so successful that people were thinking anything was possible - and another amino acid metabolite sounded especially promising. So, when Bill Phillips, founder and former CEO of EAS, said that taking HMB made him "...feel like I'm on Deca [Deca-Durabolin]!" people believed him and bought HMB en masse and were all dissapointed with the results. The quote has since become the de facto joke of the supplement industry.

The other problem when you start supplementing with individual amino acids is that it can have an effect of throwing off the balance of the other EAAs that you want to have and would expect in a normal diet, which is why better results have been shown when using them in a combination (such as with BCAAs, or as I recommend, just using whole protein sources like whey or a full meal). Layne Norton (str8flexed) probably knows a whole lot more about leucine, since he co-authored a study of the effects of it when used during PW - Leucine Regulates Translation Initiation of Protein Synthesis in Skeletal Muscle after Exercise.

The other thing about HMB that was discussed early on was it's conversion to ketoisocaproate aka KIC (see HMB - Beta-hydroxy beta-methylbutyrate by Bryan Haycock) which is now available on it's own, patented and sold by Muscletech as GAKIC (Glycine-l-arginine-alpha-ketoisocaproic acid calcium) and Leukic (L-Leucine-ketoisocaproic acid calcium). There are also generic versions of this available [none I could find are still sold, if you find any, let me know] There appear to be more supplements with ketoisocaproate modified amino acids available. So, those might be better alternatives to HMB itself, since they are the compounds HMB would convert to anyway - although there have only been a few studies on them (see the last supplement the blog article I wrote that includes the study and the patents here).

Still, I have seen the very cheap version of HMB that you're referring to [this was HMB bound to calcium], so being so affordable now might make it worthwhile but it's hard to say. Previously, BSL sold a cheap HMB derivative that was modified in such a way as to avoid paying licensing fees to the patent holder, but I don't remember hearing much, if any, positive feedback on that. Maybe some company will come along and start selling HMB ethyl ester or HMB malate to try and make it more bioavailable (there are already companies selling leucine ethyl ester and I don't know if that is any better than the plain jane version).  

The Search for the Ultimate Post-Exercise Anabolic Supplement by Anssi Manninen, M.H.S.

 So, would I recommend BCAAs now?  Maybe, if you can afford them it comes out to about $1 a day and appears to have some good effects, at least during the eight week range.  The true test will to be if someone can duplicate this study.  There is a link to the study (in PDF) you can download below:

Consuming Branched-Chain Amino Acid Supplement During a Resistance Training Program Increases Lean Mass, Muscle Strength and Fat Loss

The Lindsay Lohan Deathwatch and her Mystery Kombucha Tea

With the recent onslaught of celebrity deaths over the past year, there has become a virtual cottage industry of websites, e-zines, and street paparazzi to watch a celebrities every move. Everywhere they go and everything they do is photographed , captured and logged for our endless consumption. The “new look” for the cult of celebrity worship isn't looking for a new hair style or who has a date to the Oscars. The “new look” is how that celebrity will look in a coffin.

I must also admit I follow with a grim morbid fascination the lives and deaths of the Hollywood elite. I am signed up to the Rotten Deadpool, where you are allowed to choose ten famous people you think will die over the next year. The only rule is you can't kill any of the people on your list. I currently have a score of 1 thanks to Gary Coleman (RIP). I also frequent findadeath.com for my death hag fix.

The fascination with the deaths of the rich and powerful, especially if they are in sorted detail, interests us all. Ever since the inception of the Hollywood system in the early part of the 20^th century, there have been glamorous stars dropping dead like flies. The first major Hollywood scandal was that of silent movie screen goddess, Olive Thomas, and her mysterious death from mercury poisoning while her husband, Jack Pickford, was in the next room. [1] To John Belushi and River Phoenix overdosing on speedballs, injected combinations of heroin and cocaine in our more contemporary era. You might think the Hollywood system would clamp down and put their stars in check to try and stop these kinds of things, but Hollywood is a meat grinder that can consume a person and spit them out. The sad truth is that a star is probably worth more dead than alive.

Lindsay Lohan is just the latest example in this 24/7 deathwatch. We've seen pictures and stories of her drinking, taking drugs, and engaging in all sorts of other reckless behavior. Now, in fairness to Ms. Lohan, she has never attempted to pass herself off as a role model for anyone. What she wants to do with her life, no matter how short she expects it to be, is up to her – so long as she doesn't endanger anyone else along the way. Which is far too often the case, unfortunately.

Lindsay Lohan has come up from the proverbial hard knock life of the child star into drug addled adolescence and adulthood with not a lot to show for it. But, this isn't Variety, so I'll get to what the readers of my blog are interested in with regard to this story. Both sources of this information come from tmz.com. As it is well known, Lindsay does a lot of partying. She goes to clubs and bars basically every night and gets drunk. What other substances besides alcohol she might obtain and ingest would be up for speculation. However, we do know she has been spotted in and around white powder on several occasions. This could either be powder cocaine or methamphetamine. She admitted in a previous interview to The Sun that she has experimented with cocaine. She also tested positive for cocaine in a urine test found by tmz.com.  Both cocaine and amphetamines increase dopamine output and give the user a feeling of invincibility and incredible euphoria. [2]

We also know she has prescriptions for both Adderall and Ambien. A combination of drugs most doctors probably would be hesitant to prescribe. Adderall is a drug of the amphetamine class and is prescribed for treatment of ADHD. It comes as a mixture of the L and D (right and left) isomers of various amphetamine salts which increase oral bioavailability and prolong the halflife of the drug to last throughout the day. Generally, the L isomer of amphetamine has been used for bronchial dilation to help with symptoms of asthma and congestion. The D isomer, dextroamphetamine, is much more potent in terms of brain action and is responsible for the euphoria which makes it a highly sought after drug. The amphetamines also block the reuptake of dopamine and norepinephrine, which gives it its stimulant properties and its user a feeling of well being. [3] Dextroamphetamine and its other amphetamine counterparts were originally sold as diet aids and antidepressants in the 1950s and 60s.

In an advertisement for Dexedrine (dextroamphetamine) for doctors circa the 1960s the following prescribing recommendations are made (click the link to see the picture).

Why is this woman tired?

Because she is physically overworked.  If this is the case, you prescribe rest, because rest is the only cure for this kind of physical tiredness

Because she is mentally "done in".  Many of your patients -- particularly housewives -- are crushed under a load of dull, routine duties that leave them in a state of mental and emotional fatigue.  For these patients, you may find "Dexedrine" an ideal prescription.  "Dexedrine" will give them a feeling of energy and well-being, renewing their interest in life and living.  Dexedrine (dextro-amphetamine sulfate, S.K.F.) is available as tablets, elixir, and Spansule capsules (sustained release capsules, S.K.F.) and as manufactured by Smith Kline & French Labortories, Philadelphia.

Ambien (zolpidem) is a hypnotic sleep inducing drug, not a barbiturate nor a benzodiazepine, although it acts similar to them. It is prescribed for short term relief of insomnia for around 14 to 30 days to get the users bodies circadian rhythm back in order on a regular pattern of sleeping during the night and being awake during the day. Using it beyond that period can cause addiction, as can Adderall, if abused or taken improperly. Both of these drugs have a fairly high abuse potential and users have been known to exceed the therapeutic dosages for these drugs and ingest them through other routes, such as snorting them nasally to increase the high that comes from the drug. Unfortunately, as with most any other drugs that effect neurotransmitters, both compounds will lead to tachyphylaxis, where the user most constantly increase the dose of the drug to receive the same pleasurable benefits. It is also interesting to note that the US Air Force uses this combination of amphetamine and Ambien for their long distance fliers. Adderall is known as the “go pill” while Ambien is known as the “no go pill”. Its used in this way to keep fliers awake and alert for long flights, and then back down to sleep from the use of amphetamine. [4] If it's good enough for the US military, surely its good enough for our Hollywood starlets!

Luckily for Ms. Lohan, Ambien will not show up in a standard NIDA-5 drug test, but her amphetamines will. The NIDA-5 is the most common drug test used today. It tests for the metabolites of some of the most commonly abused drugs: marijuana, cocaine, barbiturates, amphetamines, opioids (from codeine, heroin and morphine), and PCP. Since Ms. Lohan has a prescription for the Adderall, this would be overlooked on the test. [2] [3] [6]

So what about the tea?

Lindsay Lohan has been recently sighted drinking Kombucha tea. Kombucha is a mixture of bacteria and yeast that, after fermenting, becomes a sort of "elixir" with all sorts of acidic components that can possibly aid in increasing liver enzymes and increasing breakdown and removal of certain drugs and chemicals.  Although no studies have been performed on humans with kombucha, one study done with rats [7] demonstrated that it helped protect the liver from carbon tetrachloride, a now banned chemical with previous uses in fire extinguishers and as a CFC.

But, there are no human studies on kombucha tea, so its health effects are somewhat dubious, but it probably can't hurt so long as it's made in a legitimate facility and not homebrewed. One problem Ms. Lohan may have is that a byproduct created during the fermentation of kombucha tea is alcohol. Ms. Lohan is required to wear a SCRAM bracelet, which checks if the user has been consuming alcohol by testing if it has been excreted in their sweat. It does this using a process called continuous transdermal alcohol monitoring. Any ethanol that is consumed will come through the sweat pores at a certain measurable rate. The SCRAM bracelet can detect this at a consistent time frame and send the results back to monitoring stations via wireless internet. [8] So, then a question of whether or not the amount of alcohol in kombucha tea could trigger the SCRAM. It would probably depend on batch to batch and there would more than likely be an insignificant amount in commercially brewed preparations.  An article from the Mayo Clinic has more information on kombucha its sketchy benefits.

Overall, kombucha tea seems like one of those oh too common detox products sold which often times claim to clean built up toxins from the body and be high in antioxidants and other nonsense. That isn't to say that it isn't beneficial in some way, but for a person who might have a physiological substance addiction, she'll need more than this tea to help her.  Probably a more suitable compound with proven antioxidant and liver detoxifying properties like NAC would be better suited for her purposes.

Sources
[1] Anger, Kenneth.  Hollywood Babylon.  Simon and Schuster, 1975.
[2] Gahlinger, Paul.  Illegal Drugs.  Penguin Group, 2004.
[3] Adderall: Clinical Pharmacology.  rxlist.com  Retrieved 6/4/10
[4] Bonné, Jon. ‘Go pills’: A war on drugs?  msnbc.com. 1/9/03
[5] Lindsay Lohan -- Sobriety Down to a Tea.  TMZ.com. 5/26/10
[6] Drug Testing May Not Solve Lindsay's Problem.  TMZ.com. 5/25/10
[7] Murugesan GS, et al.  Hepatoprotective and curative properties of Kombucha tea against carbon tetrachloride-induced toxicity. J Microbiol Biotechnol. 2009 Apr;19(4):397-402
[8] Wigler, Josh.  Lindsay Lohan's SCRAM Bracelet: How Does It Work? mtv.com 5/24/10

Archive: Information on Lithium Orotate

This article was originally written and posted on a now defunct website which discussed topics involving incentive sites. Many incentive sites at the time had a trial offer for a product called Feel Serenity, which was a dietary supplement that contained lithium orotate. In order to receive a credit on these incentive sites to earn your prize, the member had to complete one of the trial offers, and there were a limited number to choose from. So, in order to reach your goal of getting the prize you had selected, a member had to complete an offer and then refer a certain number of people to also complete an offer under them. Since there were a limited number of offers, people would eventually have to pick some that they might not be interested in or understand. At the time, Feel Serenity allowed a person to pay around $5.00 to receive a 30 day trial of the product (I'm not sure if this is still indeed how the terms work) and then needed to contact the company to cancel the subscription, otherwise the person would be billed in monthly installments of $40/month and automatically be shipped it each month. So, because many people at the time were receiving a sample of the lithium product, I felt that people should understand what it was and how it worked, since lithium is sold in other forms as a powerful anti-depressant drug. Also, please note that I advise against purchasing the product from Feel Serenity and it's parent company, Urban Nutrition, as they have an extremely bad track record of continuing to bill people even after they have canceled. More information can be seen on the BBB and RoR.

Much of the information below is disorganized and may be hard to follow. However, I have attempted to recreate the forum thread as it was originally posted. Only the first portion of the article is mine, and parts of it have been updated for various reasons (broken links, new information, etc). Please also note that this article is incomplete and not a full description of the overview of lithium and lithium orotate. The facts and opinions of the information that was reposted by other individuals on the original thread, as reproduced here, are not entirely mine and have not been completely checked for facts. If you find a mistake anywhere here, please feel free to leave a comment or contact me regarding it. Always consult with a doctor before taking any dietary supplement, especially if you are on any prescription drugs and in particular if you are using any compounds for mood alteration as lithium orotate, along with it's usage and dosage would be best discussed with a medical doctor.

Information on Lithium Orotate

Many have you have probably seen, or even done the offer for "Feel Serenity" on some of these incentive sites. I wanted to go over briefly what the ingredients of this dietary supplement is, and how it works.

Feel Serenity is lithium orotate, or lithium bound to orotic acid; a salt of lithium. Lithium is an element, number 3 on the periodic table and labeled as Li. Lithium is a natural element, which can be found in our daily diets, and is also used to power certain types of batteries, amongst other things.

As a medication, lithium carbonate and lithium citrate is used to treat manic and bipolar depression. Lithium appears to be used in the brain to manufacture a number of neurotransmitters, including seretonin, dopamine and norephinepherine. Although scientists still are not completely sure how lithium treats depression, it is still the gold standard used to treat certain severe cases of bipolar disorder, and manic depression, in lieu of newer anti-psychotic drugs.
Lithium orotate is similar to lithium carbonate, except that there is more lithium mg to mg when compared to carbonate. It can be sold over the counter as a dietary supplement, because it is found in nature and is not regulated by the FDA as a drug, although it's technical legal status is not clearly defined. It is also not patented by anyone for use as a treatment for depression. Only the lithium carbonate & citrate versions are available by prescription. The other difference is that there are fewer studies supporting lithium orotate as treatment for depression, as well as it's safety (more on this below, than lithium carbonate, although one would expect them to be similar.
If you decide to try the sample of Feel Serenity, it would be a good idea to start off with one tablet daily. The typical dosage of lithium orotate is a dosage of 200mg per day. If you are taking any other types of medication, especially medication for depression, it would be wise to speak with a physician before using this supplement. Some of the most common side effects of lithium use can be headaches, and other odd physical sensations. Some individuals can already have sufficient lithium in their blood from dietary sources, and increasing consumption of lithium can have adverse effects on their health. However, lithium in small doses, for most people will have little effects, and may improve mood and outlook, and can normally be used without problems. Unfortunately, lithium itself can be toxic in large doses. The clinical dose of lithium in the form of carbonate and citrate is close to the toxic dosage. There have only been a few studies on the safety of lithium orotate itself, and two studies show contradicting evidence regarding it's safety as being harmful to the kidneys (please see the link at the bottom of the page to the Lithium Orotate Project for more information on this topic).

Over the counter lithium can be purchased by many manufacturers. GRL Lithium Orotate contains 64mg per serving and Nutrient Carriers contains 120mg. Solaray sells Lithium Aspartate, which is lithium bound to aspartic acid (a common amino acid) in a 5mg dosage. Since each of these forms of lithium is bound to another compound for whatever reason (such as increased stability, better bioavailbility, etc.) it will cause the total amount of lithium that is actually absorbed by the body less than what is on the label. Unique Nutrition sells lithium orotate bulk powder with one serving size being 100mg (I presume it comes with a scoop), and Beyond a Century sells it in power form as well.

Articles

• Lithium Salts
• Lithium Orotate
• Clinical Pharmacology and Information on Lithium Salts
• CrazyMeds.org Rundown on Lithium Orotate
• VitaminShoppe Health Guides: Lithium
• Lithium Orotate for Alcoholisim

Books

• Lithium Treatment of Manic Depressive Illness: A Practical Guide by Mogens Schou
• Depression and Mania: Modern Lithium Therapy by F. Neil Johnson
• Lithium Treatment of Mood Disorders: A Practical Guide by M. Schou & Mogens Schou
• Lithium: What You Should Know (Drug Abuse Prevention Library) by Daniel Eshom

Note: Consuming lithium may deplete your bodies stores of inositol, a B vitamin. You may want to consider supplementing with extra amounts of inositol if you plan to, or already use lithium.

Supplement Minimizes Common Lithium Side Effect

By Alan R. Gaby, MD

Healthnotes Newswire (February 3, 2005)—Supplementing with inositol can reduce the severity of psoriasis, a common side effect in people taking lithium medication, reports a study in the British Journal of Dermatology (2004;150:966–9). Psoriasis affects the skin, appearing as red patches covered by a silvery, flaky surface. Fingers and toenails may also be affected, with the lesions appearing as white-colored pits, ridges down the nail, yellowish spots, or thickness at the cut end.

Lithium carbonate is widely used to stabilize mood in people suffering from bipolar disorder (manic depression). It has also been used with some success to treat cluster headaches (a condition related to migraine), alcoholism, and selected cases of asthma. Although lithium is probably the most effective treatment available for bipolar disorder, it can cause a number of side effects, including tremor, kidney problems, visual impairment, and psoriasis. In most cases, these side effects can be prevented or minimized by carefully monitoring the dosage. Nevertheless, many people develop psoriasis or experience a worsening of pre-existing psoriasis when they take lithium.

Inositol is a member of the B-complex group of vitamins. Previous studies have shown that supplementing with inositol can reduce some of the negative side effects of lithium (such as excessive urination), without reducing its beneficial effects. Researchers therefore investigated whether taking inositol might also have a positive effect on lithium-induced psoriasis.

Fifteen people with psoriasis who were taking lithium participated in the new study. They were randomly assigned to receive 6 grams of inositol per day or a placebo for ten weeks. After a four-week "washout period" in which no treatment was given, the treatments were reversed, so that those initially taking inositol were given the placebo, and vice versa. The severity of psoriasis decreased by approximately 35% during inositol treatment, whereas the psoriasis worsened by about 60% during the placebo period. Thirteen of 15 people improved while taking inositol, but only 7 of 15 improved while taking placebo. In a separate group of people with psoriasis who were not taking lithium, inositol was found to be of no benefit; in fact, people fared somewhat worse with inositol than with placebo, although the difference was not statistically significant.

Inositol has also been shown to be an effective treatment for obsessive-compulsive disorder, panic attacks, and some cases of depression. According to one study, however, inositol supplementation appeared to cause abnormal elevations of mood (mania) in some people. To be on the safe side, people with mental disorders and those taking prescription medications should seek medical advice before taking inositol.

Alan R. Gaby, MD, an expert in nutritional therapies, testified to the White House Commission on CAM upon request in December 2001. Dr. Gaby served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Three Rivers Press, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Three Rivers Press, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). A former professor at Bastyr University of Natural Health Sciences, in Kenmore, WA, where he served as the Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor for Healthnotes, Inc.

Copyright © 2005 Healthnotes, Inc. All rights reserved.

Other supplements to look into to help with depression include:

• St. Johns Wort
• 5-HTP
• L-Tyrosine
• Fish Oil
• DLPA
  

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Lithium Orotate Studies:

Human

Alcohol. 1986 Mar-Apr;3(2):97-100.

Lithium orotate in the treatment of alcoholism and related conditions.

Sartori HE.

The subjects were 42 alcoholic patients (33 males and 9 females) who were treated with lithium orotate during an alcohol rehabilitation program in a private clinical setting for at least six months. They derive from a total number of 105 patients who received this treatment initially, while the remainder discontinued the treatment within six months. The data were collected from a private practice record and the follow-up varied between six months and 10 years. The 42 patients studied displayed a multitude of complaints in addition to chronic alcoholism. These included liver dysfunction, seizure disorders, headaches, hyperthyroidism, affective disorders. Meniere's syndrome, liver and lung cancers. Thirty-six of the 42 patients studied had been hospitalized at least once for the management of their alcoholism. Lithium orotate was given, 150 mg daily, with a diet low in simple carbohydrates and containing moderate amounts of protein and fat. In addition, calcium orotate (for hepatic involvement), magnesium orotate, bromelaine, and essential phospholipids (for cardiac problems), and supportive measures were instituted, if required. Lithium orotate proved useful as the main pharmacologic agent for the treatment of alcoholism. Ten of the patients had no relapse for over three and up to 10 years, 13 patients remained without relapse for 1 to 3 years, and the remaining 12 had relapses between 6 to 12 months. Lithium orotate therapy was safe and the adverse side effects noted were minor, i.e., eight patients developed muscle weakness, loss of appetite or mild apathy. For these patients, the symptoms subsided when the daily dose was given 4 to 5 times weekly.

Animal

J Pharm Pharmacol. 1979 Mar;31(3):161-3.

Kidney function and lithium concentrations of rats given an injection of lithium orotate or lithium carbonate.

Smith DF, Schou M.

A recent study by Kling et al (1978) noted the finding of higher lithium concentrations in serum and brain of rats after an intraperitoneal injection (2 mmol lithium kg-1) of lithium orotate as a slurry than of lithium carbonate in solution. The authors suggested that lithium orotate might offer advantages in the treatment of patients. We repeated the experiments of Kling et al but in addition examined the kidney function of the rats. Glomerular filtration rate and urine flow were markedly lower in rats given lithium orotate than in rats given lithium carbonate, sodium chloride or a sham injection. The renal lithium clearance was significantly lower, the kidney weight and the lithium concentrations in serum, kidney and heart significantly higher after injection of lithium orotate than after injection of lithium carbonate. The higher lithium concentrations could be accounted for by the lower kidney function. It seems inadvisable to use lithium orotate for the treatment of patients.

J Pharm Pharmacol. 1978 Jun;30(6):368-70.

Rat brain and serum lithium concentrations after acute injections of lithium carbonate and orotate.

Kling MA, Manowitz P, Pollack IW.

Eight hours after intraperitoneal injections of 1.0, 2.0, and 4.0m equiv Li kg-1, the serum and brain lithium concentrations of rats were significantly greater after lithium orotate than after lithium carbonate. While little serum lithium remained at 24 h after injection of 2.0 m equiv kg-1 lithium carbonate, two-thirds of the 2 h serum lithium concentration was present 24h after lithium orotate. Furthermore, the 24 h brain concentration of lithium after lithium orotate was approximately three times greater than that after lithium carbonate. These data suggest the possibility that lower doses of lithium orotate than lithium carbonate may achieve therapeutic brain lithium concentrations and relatively stable serum concentrations.

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The article below was posted in the original thread where this information appeared. It was posted by a user whose name was lost in the database. The article below was written by Michael Motter and was originally posted on a site called dr-bob.org in 2003. No modifications to the original article have been made. All credit for this article goes to Mr. Motter (or perhaps Dr. Motter by now).

What is Lithium Orotate?
By Michael Motter
Pre-Doc Psychology Student
James Madison University

About Lithium Orotate

Lithium orotate is a popular nutritional supplement that has been marketed in the United States under such names as "Serenity" (www.findserenitynow.com), "Advanced Research" (www.betterlife.com), and "Life Link" (www.nubrain-store.com) to name a few of the many brands that can be found via the internet. Many of these websites claim that lithium orotate is a natural alternative to mood stabilizer and antidepressant medication without any side effects. They claim that lithium orotate can benefit anyone who has migraine headaches, alcoholism, bipolar disorder, depression, or epilepsy.

These claims are backed by the research of Dr. Hans A. Nieper, a German physician, who first studied the use of lithium orotate for migraine headaches, alcoholism, depression, and epilepsy. Dr. Nieper’s article The Clinical Applications of Lithium Orotate: A Two Years Study (1973) concluded that lithium orotate is an effective treatment for migraine headaches, alcoholism, depression, and epilepsy. However, caution should be exercised when interpreting these conclusions. His findings are based on correlation studies and the subjective reports of his patients. Dr. Nieper simply administered lithium orotate to 64 patients that had been diagnosed with the various disorders discussed and used their subjective accounts as evidence of its effectiveness. There is no control group in which he made a comparison to or mention of how he went about controlling for extraneous variables that could have also accounted for their improvement. Thus, we have no idea if it was the lithium orotate or some other factor that accounted for his patient’s improvement. Other research by Satori (1986) suffers from the same flaws. His work supports Nieper's claim that lithium orotate is an effective treatment for alcoholism and migraine headaches. Again all evidence is based on subjective report and there is no control group in which he compares his findings.

What is Lithium:

Lithium is a mineral or more specifically an alkali metal that is present in the human diet in ultratrace quantities and is also found in some natural mineral waters (Physicians Desk Reference, 2003). The typical daily dietary intake of lithium is approximately 200 to 600 micrograms. Fish, processed meat, milk, milk products, eggs, potatoes and vegetables are rich sources of this mineral. In the United States lithium carbonate and lithium citrate are approved by the FDA for the clinical treatment of bipolar disorder (Food & Drug Administration, 2003). Carbonate (carbonic acid) and citrate (citric acid) are mineral carriers that transport lithium throughout the body. According to Yung (1984) many physicians have also begun to prescribe lithium carbonate and citrate for the "off label" treatment of migraine headaches, seizure disorders, and psychosis. It is important to note that "off label" usage is generally considered an option only after all traditional treatment methods have failed and it is not approved by the FDA.

How it Works:

Lithium is administered orally and is generally taken with food, although its absorption is not markedly affected by the presence of food (Physicians Desk Reference, 2003). According to McKim (2003) lithium carbonate, citrate, and orotate is administered orally and therefore it passes through the stomach into the gastrointestinal tract where it is absorbed by the capillaries into the blood stream. These minerals are then absorbed rapidly into the blood stream (80-100%). Peak levels in the blood occur between a half-hour and two hours with citrate and carbonate. Once in the blood it travels to the brain where it must cross the cell membrane or blood brain barrier. Lithium carbonate and citrate cross the blood brain barrier via active transport. Lithium levels in the blood need to be elevated so that there is enough of it to pass through the membrane in order to be therapeutic. Mckim (2003), reports that no one knows for certain but it is theorized that lithium ions concentrate outside of the membrane causing the potential to become less negative and causing depolarization. The voltage gated ion channels open which allow the sodium ions to rush in. It is hypothesized that the lithium ions replace sodium ions and cross through the blood brain barrier resulting in neutralization of the resting potential.

According to McKim (2003) lithium carbonate and citrate therapy requires reaching serum concentrations of lithium that are close to the toxic concentration. Lithium Carbonate and Citrate therapy requires serum levels of 1.0-1.5 mEq/L for acute mania and 0.6 – 1.2mEq/L for maintenance. During treatment lithium serum concentrations should not usually exceed 1.5 mEq/L. Mild to moderate toxic reactions may occur at lithium concentrations from 1.5 to 2 mEq/L, and moderate to severe reactions at concentrations above 2 mEq/L. Serum lithium concentrations should usually be monitored 3 times weekly and blood studies and urinalysis weekly during the initial period of administration and periodically as required thereafter.

Lithium orotate is administered orally and therefore it passes through the stomach into the gastrointestinal tract where it is absorbed by the capillaries into the blood stream. According to Nieper (1973) digestion breaks off the lithium mineral from the lithium compound when lithium is attached to carbonate and citrate which is then absorbed rapidly into the blood stream. Therefore, lithium orotate is coated with a special coating which supposedly protects the lithium orotate while it passes through the stomach acids. This coating protects the compound and allows it to be absorbed by the capillaries into the bloodstream with most of the lithium still bound to the orotate. According to Nieper (1973) the orotate carriers show a special affinity for tissues in which metabolism involves the blood brain barrier. Orotate supposedly uses passive transport to cross through the blood brain barrier. Because the lithium is still mostly attached to the orotate carrier, it diffuses across the membrane releasing the lithium to the other side and leaving little left in the blood stream.

Nieper (1973) reports that a mineral analysis of his patients whole blood and blood serum found that lithium orotate does not cause the approximate level of 0.02 ppm lithium in normal blood or serum to be exceeded by more than 30% (0.026 ppm). Lithium carbonate contains 18.8mg of elemental lithium per 100mg per 100mg (57mg per 300mg, 113mg per 600mg). Most lithium orotate compounds contains 3.83mg of elemental lithium per 100mg (4.8mg per 120mg). Lithium carbonate can cause serum to rise an average of 0.2 to 0.4 mEq/L after intake of 300 mg and 0.3 to 0.6 mEql/L after intake of 600 mg of lithium carbonate. It appears that lithium orotate does not contain enough elemental lithium per recommended dosage to cause lithium serum concentrations to rise beyond toxic levels. This may explain why they claim that lithium blood serum monitoring is unnecessary. It also raises the questions whether there is even enough lithium to cause any type of therapeutic effect.

Nieper (1973) claims that lower elemental doses of lithium can be administered when attached to orotate because most of the lithium doesn’t dissolve from the carrier until it passes through the blood brain barrier. Therefore, all of the lithium (theoretically enough to be therapeutic) goes to the brain and a minimal amount gets left behind in the blood. Thus the amount of lithium that enters into the bloodstream doesn’t reach toxic levels and doesn’t need to be monitored.
Lithium is excreted via the kidneys (renally). It is excreted rapidly and several daily doses are needed to maintain the therapeutic level. It is not metabolized; approximately 95% is renally excreted (saliva, sweat, feces 5%). Lithium is excreted unchanged in the urine. Renal excretion is biphasic, with rapid clearance of up to two-thirds within 6-12 hours followed by a slower elimination over the next twelve hours. The overall half-life is between 12 and 24 hours. The excretion rate varies considerably among individuals and increases with age. Half-life in geriatric patients and patients with impaired renal function is increased to 36 to 50 hours.

What Are The Side Effects:

Nieper (1973) claims that because of the low amount of lithium in the blood serum, the common side effects of lithium carbonate and citrate which include: diarrhea, frequent urination, dehydration, lethargy, nausea, skin rashes, tremor, thyroid dysfunction, and weight gain supposedly do not occur. The low levels also claim to make it safe for use with antithyroid, asthma, bronchitis, cystic fibrosis, emphysema, non-steroidal anti-inflammatory drugs (NSAID's), and sinusitis medication and diuretics which may cause interactions with lithium carbonate or citrate. It gives no mention of antipsychotic medication which can have interactions with lithium carbonate and citrate (McKim, 2003).

Nieper (1973) claims that lithium orotate does not have renal side effects because of its low dose. However, research conducted by Smith and Schou (1979) found that kidney functioning and urine flow were markedly lower in rats given a intraperitoneal injection (2 mmol lithium kg-1) of orotate than rats given carbonate, sodium chloride, or a sham injection. Renal lithium clearance was significantly lower. Kidney weight and lithium concentrations in serum kidney and heart were significantly higher in the orotate group which may be caused by the lower kidney functioning. Smith and Schou concluded that lithium orotate was not recommended as safe for humans. Smith (1976) reports that the pharmacokinetics of the lithium ion given as lithium orotate do not differ from lithium chloride or lithium carbonate when administered in rats. Though excessive secretion of urine and excessive thirst developed more slowly in rats given lithium orotate than in those given lithium carbonate or lithium chloride. Lithium orotate is recommended to be unsafe during pregnancy and breast feeding. Lithium passes into milk and its use should be avoided during lactation as concentrations are 33 to 50% of those in the mother's serum (McKim, 2003). Several anecdotal accounts of lithium orotate were found on internet chat rooms claiming that lithium orotate caused depression.

Comparison of the Different Forms of Lithium:

An overall comparison of the differences in costs, research efficacy, and side effects between lithium orotate and lithium carbonate or citrate shows that there is considerable difference in these three areas. The cost of lithium orotate varies depending on the website where it is purchased. For ninety 120mg tablets of Serenity the monthly cost is $39.99 per month or approximately $0.44 per pill. Two-hundred 120mg tablets of Advanced Research costs $12.99 per month or approximately $0.06 per ill. One hundred 135mg tablets of Life Link totals $12.00 per months or approximately $0.12 per pill. One hundred and fifty 300mg tablets of lithium carbonate or citrate on the other costs approximately $25.00 per month or almost $0.17 per pill.

Dr. Nieper and Dr. Sartori's claims are based only on subjective case study reports. A search on the National Library of Medicine’s (2003) website indicate that there have been no double-blind controlled studies on the effects of lithium orotate for any medical or health related purposes. Thus the claims made by Dr. Nieper and Dr. Satori are based on weak scientific evidence. Smith (1976) reports that pharmacokinetics of the lithium orotate do not differ from lithium chloride or lithium carbonate when administered in rats. Furthermore, according to Garbutt, West, Carey, Lohr, & Crews (1999) suggestions that it might be useful in treating alcoholism are unfounded. Lithium is not useful for treating patients who have alcohol dependence without other psychiatric conditions. There is limited research on the effects of lithium in primary alcoholics without comorbid mood disorders. According to Picket & O’Dell (1992) there is no credible research to support the supplemental or medically unsupervised use of lithium for any purpose. There are no indications for the supplemental use of lithium. If lithium dosage is too low, you will derive no benefit. There is little research on the claims that lithium orotate is absent of the side effects that accompany lithium carbonate or citrate. What research has been done by Smith and Schou (1979) indicates that the renal side effects of lithium orotate may be more severe than carbonate or citrate in rats.
Lithium orotate is not regulated by the FDA. It is marketed as a "dietary supplement". According to Dietary Supplement Health and Education Act (DSHEA) of 1994 (Food & Drug Administration, 2003) a dietary supplement is a product taken by mouth that contains a dietary ingredient intended to supplement the diet. The dietary ingredients in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates, and may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders (page 1).
Because it is not regulated by the FDA the claims that the various companies make about it’s effectiveness are not regulated by the government but instead by the company. A company is responsible for determining that its products are safe and that claims they make about them are substantiated by adequate evidence to show that they are not false or misleading. This means that the supplements do not need approval from FDA before they are marketed. Companies do not have to provide the FDA with the evidence it relies on to substantiate safety or effectiveness before or after it markets its products. In addition it is also interesting to note that Dr. Nieper has a history with the federal government. The 1994 FDA Import Alert states that Dr. Nieper was accused of importing numerous drugs into the United States without FDA approval (FDA, 1994).

Conclusion:

In conclusion there is some of anecdotal evidence that lithium orotate is an effective treatment for the various health concerns it claims to help. However, there have been no controlled research studies that validate these claims. Why Dr. Nieper never followed up his patients claims with more rigorous research remains a mystery. Is it possible that he was merely a "snake-oil" salesman trying to make a quick buck or is there something we are missing? It appears that many in the complementary and alternative healing community believe that there is something missing in modern medicine that does not fully address our health concerns. But even if this is the case and lithium orotate is beneficial, then it would seem logical to pursue further research. This would not only validate their claims but also reduce the risk of harm. Harm that has all too often occurred in the absent minded world of nutritional supplements, see ephedra and phen/fen.

References

Food and Drug Administration (1994). Automatic Detention of New Drugs Promoted by
Dr. Hans Nieper of West Germany. Retrieved June 26, 2003 from www.fda.gov/ora/fiars/ora_import_ia6628.html

Food and Drug Administration (2003). Dietary Supplement Health and Education Act (DSHEA) of 1994. Retrieved June 26, 2003 from www.cfsan.fda.gov

Garbutt, J.C., West, S.L., Carey, T.S., Lohr, K.N., & Crews, F.T. (1999).
Pharmacological treatment of alcohol dependence: a review of the evidence. JAMA, 281(14), 1318-25.

McKim, W. A. (2003). Drugs & Behavior: An Introduction to Behavioral
Pharmacology (5th ed.). Upper Saddle River, New Jersey: Prentice Hall.

Nieper, H. A. (1973). The clinical applications of lithium orotate: A two year study. Agressologie, 14(6), 407-411.

Physicians Desk Reference (2003). Lithium. Retrieved June 25, 2003 from
www.pdrhealth.com

Pickett, E.E., & O'Dell, B.L. (1992). Evidence for dietary essentiality of lithium in the rat. Biol Trace Elem Res, 34, 299-319.

Satori, H.E. (1986). Lithium orotate in the treatment of alcoholism and related conditions. Alcohol, 3(2), 97-100.

Smith, D. F. (1976). Lithium orotate, carbonate and chloride: pharmacokinetics, polyuria in rats. British Journal of Pharmacology, 56, 399-402.

Smith, D. F., Schou, M. (1979). Kidney function and lithium concentrations of rats given an injection of lithium orotate or lithium carbonate. Journal of Pharmaceutical Pharmacology, 31(3), 161-163.

Yung, C.Y. (1984). A review of clinical trials of lithium in neurology. Pharmacology, Biochemistry, & Behavior. 21, 1, 57-64.

Further Readings

Kling, M. A., Manowitz, P., Pollack, I.W. (1978). Rat brain and serum lithium concentrations after acute injections of lithium carbonate and orotate. Journal of Pharmaceutical Pharmacology, ;30(6), 368-70.

Nieper, H. A. (1999). The Curious Man. Avery Publishing Group.

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The information below was also posted by another individual, whose name and information has also been lost. However, it seems likely that this person is the owner of the website mentioned in this short op-ed piece.

Kidney study for lithium orotate had a flawed conclusion
Taken from the Lithium Orotate Works! website

*Note* The website above contains many pages of information about lithium orotate on various subjects.

Kidney Dangers of Lithium Orotate?

Is using lithium orotate dangerous? An Internet search will bring up a list of sites stating that it is. In every instance (found to date), this supposition is based solely on a single study done on lithium orotate in 1978. There is no other research or study of any kind which concludes that lithium orotate is dangerous to use.

And the much-quoted conclusion of the 1978 study is INCORRECT for the reasons explained below.

Flawed Conclusion of Kidney Study and Lithium Orotate

When researching for any problems or concerns regarding lithium orotate use, an abstract of a study done by Smith and Schou in 1978 can be found at PubMed.

This study compared the effects on kidney function of lithium carbonate and lithium orotate. Groups of rats were injected with equal amounts of lithium carbonate and lithium orotate (and a neutral injection of sodium chloride for the control group) and then examined.

The study found that renal lithium clearance was significantly lower, and kidney weight and the lithium concentrations in serum significantly higher after the injection of lithium orotate than after the injection of lithium carbonate.

The conclusion the study drew because of this lowered kidney function was that it seemed inadvisable to use lithium orotate for the treatment of patients.

However, a highly significant point which is completely unaddressed by this study is that the same amounts of lithium orotate and lithium carbonate were used. But people DON'T USE the same enormous amounts required for lithium carbonate when using lithium orotate.

An effective dose of lithium orotate typically contains 15 mg of elemental lithium compared to 126 mg of elemental lithium from lithium carbonate. More than 700% more lithium is used with lithium carbonate. Based on the information in the study stating that equal amounts of each item was used, THE STUDY ADMINISTERED 700% TOO MUCH LITHIUM OROTATE!

This conclusion of this study is skewed because it completely disregards the way lithium orotate is administered in actual use.

Ironically, this study which concluded that lithium orotate was inadvisable for treatment of patients was done as a direct follow-up study to one performed by Kling, Manowitz and Pollack in 1978. Their study suggested that lithium orotate could be used in lower amounts than required of lithium carbonate to achieve therapeutic results.

Other links on Lithium Orotate

• The Lithium Orotate Project - one of the best, most recent and up to date sites with information on lithium orotate with overview's of all the studies conducted on it, it's safety and it's legality as a supplement.
• Lithium: Profile of a Mood Stabilizer by HowStuffWorks.com - some good basic info on the compound lithium itself and how it works to treat bipolar depression and other conditions.
• About Hans Nieper, M.D. - considered to be, if not the "discoverer" of lithium orotate, then it's biggest proponent. Dr. Nieper also bonded orotic acid to many other compounds to try and increase their worth as dietary ingredients and drugs. However, some other people have a less positive view of the doctor, including Quackwatch for some of his purported cancer treatments - although the site doesn't discuss lithium orotate specifically.

Please visit the discussion at bodybuilding.com for more information on this topic.