Aging-Related Sarcopenia: Metabolic Characteristics and Therapeutic Strategies

The proportion of the elderly population is gradually increasing as a result of medical care advances, leading to a subsequent surge in geriatric diseases that significantly impact quality of life and pose a substantial healthcare burden. Sarcopenia, characterized by age-related decline in skeletal muscle mass and quality, affects a considerable portion of older adults, particularly the elderly, and can result in adverse outcomes such as frailty, fractures, bedridden, hospitalization, and even mortality. Skeletal muscle aging is accompanied by underlying metabolic changes. Therefore, elucidating these metabolic profiles and specific mechanisms holds promise for informing prevention and treatment strategies for sarcopenia. This review provides a comprehensive overview of the key metabolites identified in current clinical studies on sarcopenia and their potential pathophysiological alterations in metabolic activity. Besides, we examine potential therapeutic strategies for sarcopenia from a perspective focused on metabolic regulation.

Safety assessment of L-Arg oral intake in healthy subjects: a systematic review of randomized control trials

L-Arg is a nonessential amino acid but has many physiological roles. Accordingly, L-Arg has been used in various fields, but there is only limited information available about its safety upon overdose. Generally, the no-observed adverse effect level (NOAEL) is used when setting the upper amount for chemical substances. Recently, systematic reviews have been used to assess the safety as well as the effectiveness and usefulness of them. Therefore, we conducted an assessment of the safety of the oral intake of L-Arg in healthy subjects using gastrointestinal symptoms as an index. We limited the study design to only double-blind randomized controlled trials and searched PubMed, Cochrane Library, EBSCOhost, and Ichushi-Web from inception until May 2021. Assessment of the quality of studies was conducted using the Cochrane Collaboration tool and Jadad score, and the random effects model was used for data analysis. Ultimately, 34 studies were selected for inclusion in this work. The dosage of L-Arg used in the studies ranged from 2000 to 30,000 mg/day (or/one-time dose), and the treatment duration was 1-84 days. The increased risk of gastrointestinal symptoms associated with L-Arg intake from 23 studies (647 participants in total) in which such symptoms were reported was 0.01 (95% confidence interval: - 0.02-0.04), which was not significant difference. NOAEL was estimated as 7531 mg/ one-time dose using a weighted change-point regression model (UMIN000046133).Registration and protocol: Umin.ac.jp as UMIN000046133.

Supplementation with Nitric Oxide Precursors for Strength Performance: A Review of the Current Literature

Nitric-oxide-stimulating dietary supplements are widely available and marketed to strength athletes and weightlifters seeking to increase muscle performance and augment training adaptations. These supplements contain ingredients classified as nitric oxide (NO) precursors (i.e., "NO boosters"). Endogenous NO is generated via a nitric oxide synthase (NOS)-dependent pathway and a NOS-independent pathway that rely on precursors including L-arginine and nitrates, with L-citrulline serving as an effective precursor of L-arginine. Nitric oxide plays a critical role in endothelial function, promoting relaxation of vascular smooth muscle and subsequent dilation which may favorably impact blood flow and augment mechanisms contributing to skeletal muscle performance, hypertrophy, and strength adaptations. The aim of this review is to describe the NO production pathways and summarize the current literature on the effects of supplementation with NO precursors for strength and power performance. The information will allow for an informed decision when considering the use of L-arginine, L-citrulline, and nitrates to improve muscular function by increasing NO bioavailability.

Oral Arginine Supplementation in Healthy Individuals Performing Regular Resistance Training

Resistance exercise training is well documented as having cardiovascular benefits, but paradoxically, it seems to increase arterial stiffness, favoring the development of high blood pressure. The present study investigates the potential effects of oral supplementation with arginine in healthy individuals performing exercise resistance training. We studied 70 non-smoking male subjects between the ages of 30 and 45 with normal or mildly increased blood pressure on ambulatory monitoring (for 24 h) and normal blood samples and echocardiography, who performed regular resistance exercise training for at least five years with a minimum of three workouts per week. They were divided into two groups in a random manner: 35 males were placed in the arginine group (AG) that followed a 6-month supplementation of their regular diets with 5 g of oral arginine powder taken before their exercise workout, and the control (non-arginine) group (NAG) consisted of 35 males. All subjects underwent body composition analysis, 24 h blood pressure monitoring and pulse wave analysis at enrollment and at six months. After six months of supplementation, blood pressure values did not change in the NAG, while in the AG, we found a decrease of 5.6 mmHg (p < 0.05) in mean systolic blood pressure and a decrease of 4.5 mmHg (p < 0.05) in diastolic values. There was also a 0.62% increase in muscle mass in the AG vs. the NAG (p < 0.05), while the body fat decreased by 1% (p < 0.05 in AG vs. NAG). Overall, the AG gained twice the amount of muscle mass and lost twice as much body fat as the NAG. No effects on the mean weighted average heart rate were recorded in the subjects. The results suggest that oral supplementation with arginine can improve blood pressure and body composition, potentially counteracting the stress induced by resistance exercise training. Supplementation with arginine can be a suitable adjuvant for these health benefits in individuals undertaking regular resistance training.

The effects of acute and chronic oral l-arginine supplementation on exercise-induced ammonia accumulation and exercise performance in healthy young men: A randomised, double-blind, cross-over, placebo-controlled trial

Objective

This study examined the effects of a single and chronic oral intake of l-arginine supplementation on blood ammonia concentration and exercise performance.

Methods

Sixteen healthy young men (mean ± standard deviation, 23 ± 3 years) participated in a randomised, double-blind, cross-over, placebo-controlled study. For the acute trials, the participants consumed 200 mL of water containing either l-arginine (5 g) or placebo (dextrin; 5.5 g) and performed cycling exercise at 75% of heart rate reserve for 60 min, followed by a 15-min cycling performance test. For the chronic trials, the participants continued to consume each designated supplement twice a day for another 13 days, and then repeated the same protocol as the acute trials at day 15. After a 14-day washout period, the participants changed the supplement and repeated the same protocol as above.

Results

Plasma ammonia concentrations were lower in the chronic arginine trial than those in both acute placebo (mean difference - 4.5 μmol/L) and acute arginine (mean difference - 5.1 μmol/L) trials (p < 0.05). There was no difference in plasma ammonia concentration between the chronic arginine and chronic placebo trials (mean difference - 1.2 μmol/L). No differences were found in mean power output during the performance test between the chronic arginine and chronic placebo trials (mean difference 0.5 W) or between the acute arginine and acute placebo trials (mean difference 0.0 W).

Conclusions

An acute and chronic oral intake of l-arginine supplementation did not attenuate exercise-induced increases in ammonia accumulation or had no significant impact on cycling performance.

How to Increase Muscle Mass in Critically Ill Patients: Lessons Learned from Athletes and Bodybuilders

PURPOSE OF REVIEW

Decades of research on nutrition and exercise on athletes and bodybuilders has yielded various strategies to promote anabolism and improve muscle health and growth. We reviewed these interventions in the context of muscle loss in critically ill patients.

RECENT FINDINGS

For critically ill patients, ensuring optimum protein intake is important, potentially using a whey-containing source and supplemented with vitamin D and leucine. Agents like hydroxyl β-methylbutyrate and creatine can be used to promote muscle synthesis. Polyunsaturated fatty acids stimulate muscle production as well as have anti-inflammatory properties that may be useful in critical illness. Adjuncts like oxandralone promote anabolism. Resistance training has shown mixed results in the ICU setting but needs to be explored further with specific outcomes. Critically ill patients suffer from severe proteolysis during hospitalization as well as persistent inflammation, immunosuppression, and catabolism syndrome after discharge. High protein supplementation, ergogenic aids, anti-inflammatories, and anabolic adjuncts have shown potential in alleviating muscle loss and should be used in intensive care units to optimize patient recovery.

Testosterone Boosters Intake in Athletes: Current Evidence and Further Directions

“Testosterone boosters” (TB)—are supplements that are claimed to increase testosterone levels in the human body. While the consumption of TB may be popular among athletes, there is insufficient evidence both about the safety and the real efficacy of TB. In our review, we searched MEDLINE/PubMed and Cochrane Library for studies on the effects of 15 substances that are claimed to increase testosterone levels Anacyclus pyrethrum; Bulbine natalensis; Epimedium (horny goat weed); L-arginine; L-carnitine; magnesium; Mucuna pruriens; pantothenic acid; selenium; shilajit Eurycoma longifolia (Tongkat Ali); Serenoa repens (saw palmetto); boron; Withania somnifera (ashwagandha); and Trigonella foenum-graecum (fenugreek) in athletes and healthy adults under 55 years of age. We found such studies regarding 10 out of 15 substances: L-arginine (3 studies); L-carnitine (2); magnesium (1); selenium (2); shilajit (1); Tongkat Ali (2); Serenoa repens (1); boron (3); ashwagandha root (2); and fenugreek (7). Many of them fail to prove the efficacy of these substances to increase testosterone levels. Tongkat Ali, ashwagandha, and fenugreek were the substances with the strongest evidence. The positive effect of magnesium and shilajit on testosterone concentration was shown in single studies. Conflicting data found that L-arginine, L-carnitine, Serenoa repens, selenium and boron do not appear to increase testosterone levels. There are almost no data on the safety profile of various TB components; however, certain TB components may be linked to coagulation, and pancreatic and hepatic disorders. Based on the review, the authors conclude that at present TB cannot be recommended for use by athletes due to insufficient data on their efficacy and safety.

L-Arginine Improves Endurance to High-Intensity Interval Exercises in Overweight Men

The effects of acute consumption of L-Arginine (L-Arg) in healthy young individuals are not clearly defined, and no studies on the effects of L-Arg in individuals with abnormal body mass index undertaking strenuous exercise exist. Thus, we examined whether supplementation with L-Arg diminishes cardiopulmonary exercise testing responses, such as ventilation (VE), VE/VCO2, oxygen uptake (VO2), and heart rate, in response to an acute session of high-intensity interval exercise (HIIE) in overweight men. A double-blind, randomized crossover design was used to study 30 overweight men (age, 26.5 ± 2.2 years; body weight, 88.2 ± 5.3 kilogram; body mass index, 28.0 ± 1.4 kg/m2). Participants first completed a ramped-treadmill exercise protocol to determine VO2max velocity (vVO2max), after which they participated in two sessions of HIIE. Participants were randomly assigned to receive either 6 g of L-Arg or placebo supplements. The HIIE treadmill running protocol consisted of 12 trials, including exercise at 100% of vVO2max for 1 min interspersed with recovery intervals of 40% of vVO2max for 2 min. Measurements of VO2 (ml·kg-1·min-1), VE (L/min), heart rate (beat per min), and VE/VCO2 were obtained. Supplementation with L-Arg significantly decreased all cardiorespiratory responses during HIIE (placebo+HIIE vs. L-Arg+HIIE for each measurement: VE [80.9 ± 4.3 L/min vs. 74.6 ± 3.5 L/min, p < .05, ES = 1.61], VE/VCO2 [26.4 ± 1.3 vs. 24.4 ± 1.0, p < .05, ES = 1.8], VO2 [26.4 ± 0.8 ml·kg-1·min-1 vs. 24.4 ± 0.9 ml·kg-1·min-1, p < .05, ES = 2.2], and heart rate [159.7 ± 6.3 beats/min vs. 155.0 ± 3.7 beats/min, p < .05, d = 0.89]). The authors conclude consuming L-Arg before HIIE can alleviate the excessive physiological strain resulting from HIIE and help to increase exercise tolerance in participants with a higher body mass index who may need to exercise on a regular basis for extended periods to improve their health.

Arginine and Endothelial Function

Arginine (L-arginine), is an amino acid involved in a number of biological processes, including the biosynthesis of proteins, host immune response, urea cycle, and nitric oxide production. In this systematic review, we focus on the functional role of arginine in the regulation of endothelial function and vascular tone. Both clinical and preclinical studies are examined, analyzing the effects of arginine supplementation in hypertension, ischemic heart disease, aging, peripheral artery disease, and diabetes mellitus.

Branched-chain amino acids do not improve muscle recovery from resistance exercise in untrained young adults

The purpose of this study was to investigate the effects of BCAA supplementation on muscle recovery from resistance exercise (RE) in untrained young adults. Twenty-four young adults (24.0 ± 4.3 years old) were assigned to 1 of 2 groups (n = 12 per group): a placebo-supplement group or a BCAA-supplement group. The groups were supplemented for a period of 5 days. On day 1 and 3, both groups underwent a RE session involving two lower body exercises (hack squat and leg press) and then were evaluated for muscle recovery on the 3 subsequent moments after the RE session [30 min (day 3), 24 h (day 4), and 48 h (day 5)]. The following indicators of muscle recovery were assessed: number of repetitions, rating of perceived exertion in the last RE session, muscle soreness and countermovement jump (CMJ) during recovery period (30 min, 24 h, and 48 h after RE session). Number of repetitions remained unchanged over time (time, P > 0.05), while the rating of perceived exertion increased (time, P < 0.05) over 3 sets, with no difference between groups (group × time, P > 0.05). Muscle soreness increased (time, P < 0.05) and jumping weight decreased (time, P < 0.05) at 30 min post-exercise and then progressively returned to baseline at 24 and 48 h post-exercise, with no difference between groups (group × time, P > 0.05). The results indicate that BCAA supplementation does not improve muscle recovery from RE in untrained young adults.

Effects of beta-alanine supplementation on muscle function during recovery from resistance exercise in young adults

β-Alanine supplementation has been shown to increase muscle carnosine levels and exercise performance. However, its effects on muscle recovery from resistance exercise (RE) remains unknown. The purpose of this study was to investigate the effects of β-alanine supplementation on muscle function during recovery from a single session of high-intensity RE. Twenty-four untrained young adults (22.1 ± 4.6 years old) were assigned to one of two groups (N = 12 per group): a placebo-supplement group (4.8 g/day) or an β-alanine-supplement group (4.8 g/day). The groups completed a single session of high-intensity RE after 28 days of supplementation and were then evaluated for muscle function on the three subsequent days (at 24, 48, and 72 h postexercise) to assess the time course of muscle recovery. The following indicators of muscle recovery were assessed: number of repetitions until failure, rating of perceived exertion, muscle soreness, and blood levels of creatine kinase (CK). Number of repetitions until failure increased from 24 to 48 h and 72 h of recovery (time P < 0.01), with no difference between groups. There was a significant increase in the rating of perceived exertion among the sets during the RE session (time P < 0.01), with no difference between the groups. No difference was observed over time and between groups in rating of perceived exertion in the functional tests during recovery period. Blood CK levels and muscle soreness increased at 24 h postexercise and then progressively declined at 48 and 72 h postexercise, respectively (time P < 0.05), with no difference between groups. In conclusion, our data indicate that β-alanine supplementation does not improve muscle recovery following a high-intensity RE session in untrained young adults.