ONLINE DRIVERS MEDIA

If you dont have ginger powder, just shred a fresh rhizome. Thats by the way what the researchers did, as well.

Yeah, we all know "Ginger is good for your glucose metabolism". We all know "there are dozens of rodent studies that support its benefits". And we also know that there is evidence from acute interventions that indicate that ginger can ameliorate the glucose response to oral glucose tolerance tests.

But do we know, whether the regular consumption of realistic amounts of pure ginger will have beneficial effects on the glucose levels of those who would benefit the most, i.e. type II aka "lifestyle" diabetics?
The results of the latest study from the Tehran University of Medical Sciences where scientists obviously dont depend on being able to produce patentable agents would suggest: There are benefits!

I have to admit, though, the ginger the 20-60 years old diabetics consumed was not provided in form of whole roots, but rather as a powder made of ginger roots.

"The under study patients were diagnosed with non-insulin dependent diabetes mellitus (NIDDM) by an endocrinologist on the basis of the results of the blood tests and met the criteria of the study. These criteria included: disease duration at least 2 years, HbA1c level of 6-8%, taking no antioxidant supplements such as selenium, zinc and beta-carotene for at least 3 months prior to the study, no smoking and drinking. Exclusion criteria of the study were insulin therapy at baseline or during the study, changes in the type or dose of medication, changes in diet or daily physical activity, any acute illnesses or some chronic diseases including kidney, liver, cardiovascular, and gastrointestinal diseases, smoking pregnancy and lactation, consumption of ginger or other botanical supplements, ginger hypersensitivity, and consumption of less than 80% of supplements during the study period." (Khandouzi. 2015)

Patients were divided randomly into two groups (experiment and control, 25 subjects in each) using computers random numbers to receive either ginger or placebo one capsule twice a day for 12 weeks. All subjects were permitted to consume their usual medications according to their physicians recommendation.

Regular ginger powder, nothing else!

The fresh rhizomes for the ginger powder purchased from local market and were ground as a fine particle after drying. The powder was delivered to a pharmaceutical lab (Tehran university of medical sciences, Iran) to prepare capsules containing 1 gram ginger in each. Lactose was also used to make placebo. Information on when the supplements were ingested is unfortunately, not available, but I assume "twice daily" means with breakfast and dinner or something like that.

Figure 1: Changes in fasting blood sugar, HbA1C, Apo-B/Apo-A1 and MDA levels (Khandouzi. 2015).

What is available, is the most relevant information, i.e. glucose, apolipoproteins and MDA levels we can use to access the effects on glucose and lipid metabolism and the peroxidation of polyunsaturated fatty acids.Parameters of which the data in Figure 1 tells you that they were significantly improved over the course of the 12-week study period. More specifically, this means:

• A 12% and 10% reduction in fasting blood glucose and HbA1c that may reduce many of the nasty chronic side effects of type II diabetes, such as its negative effects on heart health (Patel. 2008)
• A 28% reduction in the Apo B / Apo A-I ratio that signifies a significant reduction in coronary atherosclerosis risk (Van Stiphout. 1986)
• A 23% reduction in malondialdehyde (MDA) levels that signifies a reduction in coronary heart disease risk (Khan. 2000)

Overall, there is thus little question that something as simple as adding 2g of pulverized fresh Zingiber officinale rhizomes will have a significant impact on important health markers in middle-aged type II diabetics.
References:

• Khan, Mudassir Ahmad, and Abdul Baseer. "Increased malondialdehyde levels in coronary heart disease." J Pak Med Assoc 50.8 (2000): 261-264.
• Khandouzi, Nafiseh, et al. "The Effects of Ginger on Fasting Blood Sugar, Hemoglobin A1c, Apolipoprotein B, Apolipoprotein AI and Malondialdehyde in Type 2 Diabetic Patients." Iranian Journal of Pharmaceutical Research: IJPR 14.1 (2015): 131.
• Patel, Anushka, et al. "Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes." (2008).
• Schweizer, A., et al. "Comparison between vildagliptin and metformin to sustain reductions in HbA1c over 1 year in drug?naïve patients with Type 2 diabetes." Diabetic Medicine 24.9 (2007): 955-961.
• Van Stiphout, W. A. H. J., et al. "Is the ratio of apo B/apo AI an early predictor of coronary atherosclerosis?." Atherosclerosis 62.2 (1986): 179-182.

If you want to know how to get of pubertal acne, you got to ask professional pubescents ;-)

The study at hand is not only the first experimental verification of the efficacy of omega-3 + gamma linoleic acid supplementation in acne treatment, its also "paleo approved", because it cites a study by no one else but Loraine Cordaine himself ;-) Dont worry, I am just kiddin around. In spite of the fact that Cordains study "Acne vulgaris: a disease of Western civilization" (Cordain. 2002) is in fact the #1 on the reference list, the scientists from the Seoul National University College of Medicine refrain from (paleolithic) dairy bashing in their evaluation of "the clinical efficacy and safety of omega-3 fatty acids and of GLA for the treatment of mild to moderate facial acne." (Jung. 2014)

If you google "natural acne treatment" it will usually not take long until you find a reference to fish oil and gamma linoleic acid (as in borage or starflower oil). Against that background it is surprising that the Korean scientist are obviously the first to scrutinize the efficacy of 2,000 mg of eicosapentaenoic acid and docosahexaenoic acid and 400 mg ?-linoleic acid (from borage oil) in a parallel design dietary intervention study.

Long-standing "natural acne cure" now scientifically proven

The 45 participants with mild to moderate acne, were allocated to either of the intervention groups for 10 weeks, after which the effect on their skin was evaluated visually and via heamatoxylin, eosin and immunohistochemical staining of the lesions.
And what the scientists observed was ... positive, at least in the omega-3 group, the mean inflammatory acne lesion count was significantly reduced (from 10.1 ± 3.2 in week 0 to 5.8 ± 3.4 in week 10; p < 0.05).

Figure 1: Changes in inflammatory acne lesion counts with time (left, top), noninflammatory acne lesion counts with time (left, bottom), and changes in patients subjective assessment (VAS) with time (right; Jung. 2014)

As you can see in Figure 1, a similar change was observed in the GLA (9.8 ± 5.2 before vs. 8.0 ± 4.6 after 5 weeks vs. 6.6 ± 3.7 after 10 weeks, p < 0.05), but not in the control group (9.9 ± 4.3 before to 10.2 ± 6.2 after 10 weeks).

Figure 2: Before (top) and after (bottom) photos (Jung. 2014)

"Mean non-inflammatory acne lesion counts were also reduced by omega-3 and GLA supplementation (23.5 ± 9.2 to 18.9 ± 8.3, p < 0.05, and 22.8 ± 8.4 to 19.2 ± 7.2, p < 0.05, respectively) at final visits, whereas mean lesion count in the control group was unchanged (from 21.8 ± 9.7 to 22.0 ± 8.6). Significant differences were evident between the treatment groups and the control group after 10 weeks (p < 0.05)." (Jung. 2014)

In the end, there was no no significant difference between the two treatments for any of the measured parameters, so that it is probably up to you, whether you try to control the "fire within your skin" with GLA or DHA + EPA supplements.
References:

• Cordain, Loren, et al. "Acne vulgaris: a disease of Western civilization." Archives of Dermatology 138.12 (2002): 1584-1590.
• Jung, Jae Yoon, et al. "Effect of Dietary Supplementation with Omega-3 Fatty Acid and gamma-linolenic Acid on Acne Vulgaris: A Randomised, Double-blind, Controlled Trial." (2014).
• Wolf, Ronni, Hagit Matz, and Edith Orion. "Acne and diet." Clinics in dermatology 22.5 (2004): 387-393.

Can you hit the fat hard with choline?

I want to be honest with you. I am a huge fan of choline and truly believe that it is hugely under-appreciated, but the prominent relative (not absolute) increase in body fat loss in study at hand must be interpreted with caution - no matter how statistically significant the "choline advantage" may be.

Before we can get to said "cautious interpretation", lets briefly take a look at what exactly Gehan Elsawy, Osama Abdelrahman, and Amr Hamza from the Zagazig University and the Mansoura University in Egypt did to produce a 100% increase in body fat loss in their 22 female study participants (15 taekwondo and 7 judo athletes).
The idea was to clarify the magnitude of rapid body mass reduction among Egyptian judokas, in order to identify the scientific basis and justification for such practices. In that, the researchers were particularly interested in the effects of choline supplementation on bodymass reduction and leptin levels among their females taekwondo and judo athletes.

The athletes were divided into two groups, according to their body mass; the experimental group contained ten female athletes, and the control group twelve female athletes. At the time of enrollment, all the subjects were healthy, according to a medical information questionnaire, and none of the subjects had any specific dietary restrictions. Exclusion criteria included the use of any medication or supplement during the previous six months.

2.0g per day divided in two 1.0g doses of choline did the trick

For one week prior to a competition, the athletes in the experimental group took choline tablets (1.0 g) twice daily with a meal, equaling a total daily dose of 2.0 g (the scientists dont provide any information on the form of choline, they used, but their references suggest that it was PS, i.e. phosphatidylcholine). The control group received a placebo, and they participated in usual training (with 75% training intensity) at the same time as the choline group four times per week.

"According to Anni et al. (2011), choline supplementation appears to be safe and the authors recommend taking approximately 2.5 g one hour before a prolonged exercise session. The effective dose in sport studies is 0.2 g phosphatidylcholine 90% per kg of the body mass, which equals 2.1 g of choline for an 80-kg athlete. There is no requirement for a loading or maintenance phase and choline supplementation up to one hour before exercise has been shown to be effective in reducing fatigue." (Elsawy. 2014)

There was no standardized diet, there were no diet logs and there was no recording of training intensity and volume.
Things that were assessed are body weight, body fat (see red box above), serum and urinary choline, as well as back and leg strength.

Figure 1: Changes in leptin, plasma choline, body fat (%), BMI, leg & back strength within the last week of precompetition dieting with or without the addition of 2g of choline (undisclosed form) in a recent study by Elsawy et al. (2014).

Statistically significant differences were observed for plasma choline (obviously), leptin and the change in body fat (-1% vs. -2% in the choline group). It would be nice if we also knew if this affected the food and/or water intake and/or if we had confirmation from DEXA and caliper data that the body fat difference was more than just body impedance b*s* - unfortunately, none of these data are available.
References:

• Elsawy et al. "Effect of Choline Supplementation on Rapid Weight Loss and Biochemical Variables Among Female Taekwondo and Judo Athletes." Journal of Human Kinetics volume 40/2014, 77-82.
• Hanin I, Ansell GB. "Lecithin: Technological, Biological, and Therapeutic Aspects". Plenum Press, NY, 180-181; 1987.
• Slater, Gary. "Assessing Body Composition of Athletes." Sports Nutrition for Paralympic Athletes (2014): 189.
• Wurtman RJ, Hirsch MJ, Growdon JH. "Lecithin consumption raises serum-free-choline levels." Lancet, 1977; 2: 68-69

Vegetarian athletes do lack carnitine in their diets and muscle, but whether this has significant effects on their performance appears to be questionable based on the results of the study at hand.

In a recent study, researchers from the University Hospital Basel investigated whether the previously observed low carnitine levels of vegetarians could be compensated for by longterm oral treatment with 2g of l-carnitine to replenish the body carnitine pool. Furthermore, the scientists wanted to know whether this would have significant effects on (a) fuel metabolism and (b) physical performance of vegetarians and omnivores.

Novakova et al. hypothesized that "treatment with carnitine would increase plasma and possibly also skeletal muscle carnitine concentrations in vegetarians and would thereby improve skeletal muscle energy metabolism and physical performance" (Novakova. 2015).
As you already know from the headline of this article, the latter was not the case and that despite the fact that the data in Figure 1 indicates that the daily provision of 2x1g l-carnitine tartrate after breakfast and dinner, respectively, for twelve weeks lead to a significant increase of the muscular carnitine levels of the 16 vegetarian, 18-40 year-old subjects of the study at hand.

Figure 1: Study design (left) and total skeletal muscle carnitine levels according to biopsy (right | Novakova. 2015)

In the 8 omnivore subjects that served as a control, the non-choline supported (choline maximizes carnitine retention | learn more) provision of a total 2g of l-carnitine tartrate did not show a consistent effect on the total carnitine muscle content (Figure 1).
This observation in the omnivore control group is quite disappointing - specifically in view of the fact that 90% of the people who buy carnitine supplements probably eat meat.

Figure 2: None of the metabolically or performance relevant parameters changed sign. (Novakova. 2015).

In that, its probably a small comfort that the increase in muscle carnitine levels didnt pay off in terms of increased physical performance, anyway. A brief glimpse at the data in Figure 2 goes to show you: Neither of the tested metabolic and performance variables changes significantly from baseline to post-supplementation. If anything there as a minimal glycogen sparing effect which didnt reach statistical significance either (not shown in Figure 2). Most importantly, however, the VO2max and the RER of which you would hope that a supplement thats supposed to increase fatty acid oxidation would increase and lower them, respectively, didnt budge.
References:

• DiNicolantonio, James J., et al. "L-carnitine in the secondary prevention of cardiovascular disease: systematic review and meta-analysis." Mayo Clinic Proceedings. Vol. 88. No. 6. Elsevier, 2013.
• Koeth, Robert A., et al. "Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis." Nature medicine 19.5 (2013): 576-585.
• Micha, Renata, Sarah K. Wallace, and Dariush Mozaffarian. "Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus a systematic review and meta-analysis." Circulation 121.21 (2010): 2271-2283.
• Novakova, Katerina, et al. "Effect of l-carnitine supplementation on the body carnitine pool, skeletal muscle energy metabolism and physical performance in male vegetarians." European Journal of Nutrition (2015): 1-11.
• Wang, Zeneng, et al. "Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease." Nature 472.7341 (2011): 57-63.