Combined Turmeric, Vitamin C, and Vitamin D Ready-to-Drink Supplements Reduce Upper Respiratory Illness Symptoms and Gastrointestinal Discomfort in Elite Male Football Players.

Elite football is associated with the increased risk of illness, although targeted supplementation can reduce illness risk. This study assessed the effects of a supplement containing turmeric root within a black pepper and fat-soluble blend, vitamin C and vitamin D, on upper respiratory symptoms (URS), gastrointestinal symptoms (GIS), muscle soreness, and markers of inflammation and gut permeability in elite male footballers. Twenty-three footballers completed 3 weeks of no intervention (CON), followed by 16 weeks of daily consuming 60 mL of a commercially available supplement containing raw turmeric root (17.5 g, estimated to contain 700 mg of curcumin), vitamin C (1000 mg), and vitamin D3 (3000 IU/75 mcg) (SUP). URS and GIS were measured daily. Immediately (0 h), 40, and 64 h after six competitive matches (two in CON, four in SUP), the subjective soreness and plasma concentrations of creatine kinase [CK], c-reactive protein [CRP], and intestinal fatty-acid binding protein [I-FABP] were assessed. URS incidence (p < 0.001), GIS (p < 0.05), and plasma [I-FABP] at 0 h (p < 0.05) were greater during CON versus SUP. At 40 h, [CRP] was greater than 0 h during CON (p < 0.01) but not SUP (p = 0.204). There were no differences in soreness or [CK]. This study indicates that turmeric root, vitamin C, and vitamin D supplementation over 16 weeks can reduce URS, GIS, and post-match [I-FABP] in elite footballers.

Prebiotics for people with cystic fibrosis.

BACKGROUND: Cystic fibrosis (CF) is a multisystem disease; the importance of growth and nutritional status is well established given their implications for lung function and overall survivability. Furthermore, it has been established that intestinal microbial imbalance and inflammation are present in people with CF. Oral prebiotics are commercially available substrates that are selectively utilised by host intestinal micro-organisms and may improve both intestinal and overall health. OBJECTIVES: To evaluate the benefits and harms of prebiotics for improving health outcomes in children and adults with CF. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis Trials Register compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. Date of last search: 19 October 2022. We also searched PubMed and online trials registries. Date of last search: 13 January 2023. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs assessing the efficacy of prebiotics in children and adults with CF. We planned to only include the first treatment period from cross-over RCTs, regardless of washout period. DATA COLLECTION AND ANALYSIS: We did not identify any relevant trials. MAIN RESULTS: We did not identify any relevant trials for inclusion in this review. AUTHORS' CONCLUSIONS: This review did not find any evidence for the use of prebiotics in people with CF. Until such evidence is available, it is reasonable for clinicians to follow any local guidelines and to discuss the use of dietary prebiotics with their patients. Large and robust RCTs assessing the dietary prebiotics of inulin or galacto-oligosaccharides or fructo-oligosaccharides, or any combination of these, are needed. Such studies should be of at least 12 months in duration and assess outcomes such as growth and nutrition, gastrointestinal symptoms, pulmonary exacerbations, lung function, inflammatory biomarkers, hospitalisations, intestinal microbial profiling, and faecal short-chain fatty acids. Trials should include both children and adults and aim to be adequately powered to allow for subgroup analysis by age.

Distinguishing science from pseudoscience in commercial respiratory interventions: an evidence-based guide for health and exercise professionals.

Respiratory function has become a global health priority. Not only is chronic respiratory disease a leading cause of worldwide morbidity and mortality, but the COVID-19 pandemic has heightened attention on respiratory health and the means of enhancing it. Subsequently, and inevitably, the respiratory system has become a target of the multi-trillion-dollar health and wellness industry. Numerous commercial, respiratory-related interventions are now coupled to therapeutic and/or ergogenic claims that vary in their plausibility: from the reasonable to the absurd. Moreover, legitimate and illegitimate claims are often conflated in a wellness space that lacks regulation. The abundance of interventions, the range of potential therapeutic targets in the respiratory system, and the wealth of research that varies in quality, all confound the ability for health and exercise professionals to make informed risk-to-benefit assessments with their patients and clients. This review focuses on numerous commercial interventions that purport to improve respiratory health, including nasal dilators, nasal breathing, and systematized breathing interventions (such as pursed-lips breathing), respiratory muscle training, canned oxygen, nutritional supplements, and inhaled L-menthol. For each intervention we describe the premise, examine the plausibility, and systematically contrast commercial claims against the published literature. The overarching aim is to assist health and exercise professionals to distinguish science from pseudoscience and make pragmatic and safe risk-to-benefit decisions.

Exercise-induced bronchoconstriction in university field hockey athletes: Prevalence, sex differences, and associations with dyspnea symptoms.

Introduction: Exercise-induced bronchoconstriction (EIB) is a prevalent condition in athletes. EIB screening studies identify many athletes with undiagnosed EIB. Moreover, there is a poor relationship between EIB and dyspnea symptoms recalled from memory. Purpose: This study investigated: (I) the prevalence of EIB in British university field hockey athletes; (II) the effect of sex and diagnostic criteria on EIB prevalence; and (III) the association between EIB and contemporaneous dyspnea symptoms. Methods: 52 field hockey athletes (age: 20 ± 2 years; height: 173 ± 9 cm; body mass: 72 ± 10 kg; male = 31; female = 22) completed a eucapnic voluntary hyperpnea (EVH) test with multi-dimensional dyspnea scores measured 3-10 mins post-EVH. A test was deemed positive (EIB+) if a fall index (FI) ≥10% in FEV1 occurred at two consecutive time points post-test (FIATS). Two further criteria were used to assess the effect of diagnostic criteria on prevalence: FI≥10%, determined by a pre-to-post-EVH fall in FEV1 of ≥10% at any single time-point; and FI≥10%-NORM calculated as FI≥10% but with the fall in FEV1 normalized to the mean ventilation achieved during EVH. Results: EIB prevalence was 19% and greater in males (30%) than females (5%). In EIB+ athletes, 66% did not have a previous diagnosis of EIB or asthma and were untreated. Prevalence was significantly influenced by diagnostic criteria (P = 0.002) ranging from 19% (FIATS) to 38% (FI≥10%-NORM). Dyspnea symptoms were higher in EIB+ athletes (P ≤ 0.031), produced significant area under the curve for receive operator characteristics (AUC ≥ 0.778, P ≤ 0.011) and had high negative prediction values (≥96%). Conclusion: Overall, 19% of university field hockey athletes had EIB, and most were previously undiagnosed and untreated. EVH test diagnostic criteria significantly influences prevalence rates, thus future studies should adopt the ATS criteria (FIATS). Contemporaneous dyspnea symptoms were associated with bronchoconstriction and had high negative prediction values. Therefore, contemporaneous dyspnea scores may provide a useful tool in excluding a diagnosis of EIB.

Asthma and obesity: endotoxin another insult to add to injury?

Low-grade inflammation is often an underlying cause of several chronic diseases such as asthma, obesity, cardiovascular disease, and type 2 diabetes mellitus (T2DM). Defining the mediators of such chronic low-grade inflammation often appears dependent on which disease is being investigated. However, downstream systemic inflammatory cytokine responses in these diseases often overlap, noting there is no doubt more than one factor at play to heighten the inflammatory response. Furthermore, it is increasingly believed that diet and an altered gut microbiota may play an important role in the pathology of such diverse diseases. More specifically, the inflammatory mediator endotoxin, which is a complex lipopolysaccharide (LPS) derived from the outer membrane cell wall of Gram-negative bacteria and is abundant within the gut microbiota, and may play a direct role alongside inhaled allergens in eliciting an inflammatory response in asthma. Endotoxin has immunogenic effects and is sufficiently microscopic to traverse the gut mucosa and enter the systemic circulation to act as a mediator of chronic low-grade inflammation in disease. Whilst the role of endotoxin has been considered in conditions of obesity, cardiovascular disease and T2DM, endotoxin as an inflammatory trigger in asthma is less well understood. This review has sought to examine the current evidence for the role of endotoxin in asthma, and whether the gut microbiota could be a dietary target to improve disease management. This may expand our understanding of endotoxin as a mediator of further low-grade inflammatory diseases, and how endotoxin may represent yet another insult to add to injury.

Effects of Prior Voluntary Hyperventilation on the 3-min All-Out Cycling Test in Men.

INTRODUCTION: The ergogenic effects of respiratory alkalosis induced by prior voluntary hyperventilation (VH) are controversial. This study examined the effects of prior VH on derived parameters from the 3-min all-out cycling test (3MT). METHODS: Eleven men ( = 46 ± 8 mL·kg-1·min-1) performed a 3MT preceded by 15 min of rest (CONT) or VH ( = 38 ± 5 L·min-1) with PETCO2 reduced to 21 ± 1 mm Hg (HYP). End-test power (EP; synonymous with critical power) was calculated as the mean power output over the last 30 s of the 3MT, and the work done above EP (WEP; synonymous with W') was calculated as the power-time integral above EP. RESULTS: At the start of the 3MT, capillary blood PCO2 and [H+] were lower in HYP (25.2 ± 3.0 mm Hg, 27.1 ± 2.6 nmol·L-1) than CONT (43.2 ± 2.0 mm Hg, 40.0 ± 1.5 nmol·L-1) (P < 0.001). At the end of the 3MT, blood PCO2 was still lower in HYP (35.7 ± 5.4 mm Hg) than CONT (40.6 ± 5.0 mm Hg) (P < 0.001). WEP was 10% higher in HYP (19.4 ± 7.0 kJ) than CONT (17.6 ± 6.4 kJ) (P = 0.006), whereas EP was 5% lower in HYP (246 ± 69 W) than CONT (260 ± 74 W) (P = 0.007). The ΔWEP (J·kg-1) between CONT and HYP correlated positively with the PCO2 immediately before the 3MT in HYP (r = 0.77, P = 0.006). CONCLUSION: These findings suggest that acid-base changes elicited by prior VH increase WEP but decrease EP during the all-out 3MT.

Effects of Prior Upper Body Exercise on the 3-min All-Out Cycling Test in Men.

INTRODUCTION: Prior upper body exercise reduces the curvature constant (W') of the hyperbolic power-duration relationship without affecting critical power. This study tested the hypothesis that prior upper body exercise reduces the work done over the end-test power (WEP; analog of W') during a 3-min all-out cycling test (3MT) without affecting the end-test power (EP; analog of critical power). METHODS: Ten endurance-trained men (V˙O2max = 62 ± 5 mL·kg·min) performed a 3MT without (CYC) and with (ARM-CYC) prior severe-intensity, intermittent upper body exercise. EP was calculated as the mean power output over the last 30 s of the 3MT, whereas WEP was calculated as the power-time integral above EP. RESULTS: At the start of the 3MT, plasma [La] (1.8 ± 0.4 vs 14.1 ± 3.4 mmol·L) and [H] (42.8 ± 3.1 vs 58.6 ± 5.5 nmol·L) were higher, whereas the strong ion difference (41.4 ± 2.2 vs 30.9 ± 4.6 mmol·L) and [HCO3] (27.0 ± 1.9 vs 16.9 ± 3.2 mmol·L) were lower during ARM-CYC than CYC (P < 0.010). EP was 12% lower during the 3MT of ARM-CYC (298 ± 52 W) than CYC (338 ± 60 W; P < 0.001), whereas WEP was not different (CYC: 12.8 ± 3.3 kJ vs ARM-CYC: 13.5 ± 4.1 kJ, P = 0.312). EP in CYC was positively correlated with the peak [H] (r = 0.78, P = 0008) and negatively correlated with the lowest [HCO3] (r = -0.74, P = 0.015). CONCLUSIONS: These results suggest that EP during a 3MT in endurance-trained men is sensitive to fatigue-related ionic perturbation.

Immune nutrition and exercise: Narrative review and practical recommendations.

Evidence suggests that periods of heavy intense training can result in impaired immune cell function, and whether this leaves elite athletes at greater risk of infections and upper respiratory symptoms (URS) is still debated. There is some evidence that episodes of URS do cluster around important periods of competition and intense periods of training. Since reducing URS, primarily from an infectious origin, may have implications for performance, a large amount of research has focused on nutritional strategies to improve immune function at rest and in response to exercise. Although there is some convincing evidence that meeting requirements of high intakes in carbohydrate and protein and avoiding deficiencies in nutrients such as vitamin D and antioxidants is integral for optimal immune health, well-powered randomised controlled trials reporting improvements in URS beyond such intakes are lacking. Consequently, there is a need to first understand whether the nutritional practices adopted by elite athletes increases their risk of URS. Second, promising evidence in support of efficacy and mechanisms of immune-enhancing nutritional supplements (probiotics, bovine colostrum) on URS needs to be followed up with more randomised controlled trials in elite athletes with sufficient participant numbers and rigorous procedures with clinically relevant outcome measures of immunity.

Comparable reductions in hyperpnoea-induced bronchoconstriction and markers of airway inflammation after supplementation with 6·2 and 3·1 g/d of long-chain n-3 PUFA in adults with asthma.

Although high dose n-3 PUFA supplementation reduces exercise- and hyperpnoea-induced bronchoconstriction (EIB/HIB), there are concurrent issues with cost, compliance and gastrointestinal discomfort. It is thus pertinent to establish the efficacy of lower n-3 PUFA doses. Eight male adults with asthma and HIB and eight controls without asthma were randomly supplemented with two n-3 PUFA doses (6·2 g/d (3·7 g EPA and 2·5 g DHA) and 3·1 g/d (1·8 g EPA and 1·3 g DHA)) and a placebo, each for 21 d followed by 14 d washout. A eucapnic voluntary hyperpnoea (EVH) challenge was performed before and after treatments. Outcome measures remained unchanged in the control group. In the HIB group, the peak fall in forced expiratory volume in 1 s (FEV1) after EVH at day 0 (-1005 (sd 520) ml, -30 (sd 18) %) was unchanged after placebo. The peak fall in FEV1 was similarly reduced from day 0 to day 21 of 6·2 g/d n-3 PUFA (-1000 (sd 460) ml, -29 (sd 17) % v. -690 (sd 460) ml, -20 (sd 15) %) and 3·1 g/d n-3 PUFA (-970 (sd 480) ml, -28 (sd 18) % v. -700 (sd 420) ml, -21 (sd 15) %) (P<0·001). Baseline fraction of exhaled nitric oxide was reduced by 24 % (P=0·020) and 31 % (P=0·018) after 6·2 and 3·1 g/d n-3 PUFA, respectively. Peak increases in 9α, 11ß PGF2 after EVH were reduced by 65 % (P=0·009) and 56 % (P=0·041) after 6·2 and 3·1 g/d n-3 PUFA, respectively. In conclusion, 3·1 g/d n-3 PUFA supplementation attenuated HIB and markers of airway inflammation to a similar extent as a higher dose. Lower doses of n-3 PUFA thus represent a potentially beneficial adjunct treatment for adults with asthma and EIB.

A prebiotic galactooligosaccharide mixture reduces severity of hyperpnoea-induced bronchoconstriction and markers of airway inflammation.

Gut microbes have a substantial influence on systemic immune function and allergic sensitisation. Manipulation of the gut microbiome through prebiotics may provide a potential strategy to influence the immunopathology of asthma. This study investigated the effects of prebiotic Bimuno-galactooligosaccharide (B-GOS) supplementation on hyperpnoea-induced bronchoconstriction (HIB), a surrogate for exercise-induced bronchoconstriction, and airway inflammation. A total of ten adults with asthma and HIB and eight controls without asthma were randomised to receive 5·5 g/d of either B-GOS or placebo for 3 weeks separated by a 2-week washout period. The peak fall in forced expiratory volume in 1 s (FEV1) following eucapnic voluntary hyperpnoea (EVH) defined HIB severity. Markers of airway inflammation were measured at baseline and after EVH. Pulmonary function remained unchanged in the control group. In the HIB group, the peak post-EVH fall in FEV1 at day 0 (-880 (sd 480) ml) was unchanged after placebo, but was attenuated by 40 % (-940 (sd 460) v. -570 (sd 310) ml, P=0·004) after B-GOS. In the HIB group, B-GOS reduced baseline chemokine CC ligand 17 (399 (sd 140) v. 323 (sd 144) pg/ml, P=0·005) and TNF-α (2·68 (sd 0·98) v. 2·18 (sd 0·59) pg/ml, P=0·040) and abolished the EVH-induced 29 % increase in TNF-α. Baseline C-reactive protein was reduced following B-GOS in HIB (2·46 (sd 1·14) v. 1·44 (sd 0·41) mg/l, P=0·015) and control (2·16 (sd 1·02) v. 1·47 (sd 0·33) mg/l, P=0·050) groups. Chemokine CC ligand 11 and fraction of exhaled nitric oxide remained unchanged. B-GOS supplementation attenuated airway hyper-responsiveness with concomitant reductions in markers of airway inflammation associated with HIB.

Influence of oxidative stress, diaphragm fatigue, and inspiratory muscle training on the plasma cytokine response to maximum sustainable voluntary ventilation.

The influence of oxidative stress, diaphragm fatigue, and inspiratory muscle training (IMT) on the cytokine response to maximum sustainable voluntary ventilation (MSVV) is unknown. Twelve healthy males were divided equally into an IMT or placebo (PLA) group, and before and after a 6-wk intervention they undertook, on separate days, 1 h of (1) passive rest and (2) MSVV, whereby participants undertook volitional hyperpnea at rest that mimicked the breathing and respiratory muscle recruitment patterns commensurate with heavy cycling exercise. Plasma cytokines remained unchanged during passive rest. There was a main effect of time (P < 0.01) for plasma interleukin-1ß (IL-1ß) and interleukin-6 (IL-6) concentrations and a strong trend (P = 0.067) for plasma interleukin-1 receptor antagonist concentration during MSVV. Plasma IL-6 concentration was reduced after IMT by 27 ± 18% (main effect of intervention, P = 0.029), whereas there was no change after PLA (P = 0.753). There was no increase in a systemic marker of oxidative stress [DNA damage in peripheral blood mononuclear cells (PBMC)], and diaphragm fatigue was not related to the increases in plasma IL-1ß and IL-6 concentrations. A dose-response relationship was observed between respiratory muscle work and minute ventilation and increases in plasma IL-6 concentration. In conclusion, increases in plasma IL-1ß and IL-6 concentrations during MSVV were not due to diaphragm fatigue or DNA damage in PBMC. Increases in plasma IL-6 concentration during MSVV are attenuated following IMT, and the plasma IL-6 response is dependent upon the level of respiratory muscle work and minute ventilation.

The effects of inspiratory muscle training on plasma interleukin-6 concentration during cycling exercise and a volitional mimic of the exercise hyperpnea.

It is unknown whether the respiratory muscles contribute to exercise-induced increases in plasma interleukin-6 (IL-6) concentration, if this is related to diaphragm fatigue, and whether inspiratory muscle training (IMT) attenuates the plasma IL-6 response to whole body exercise and/or a volitional mimic of the exercise hyperpnea. Twelve healthy males were divided equally into an IMT or placebo (PLA) group, and before and after a 6-wk intervention they undertook, on separate days, 1 h of 1) passive rest, 2) cycling exercise at estimated maximal lactate steady state power (EX), and 3) volitional hyperpnea at rest, which mimicked the breathing and respiratory muscle recruitment patterns achieved during EX (HYPEX). Plasma IL-6 concentration remained unchanged during passive rest. The plasma IL-6 response to EX was reduced following IMT (main effect of intervention, P = 0.039) but not PLA (P = 0.272). Plasma IL-6 concentration increased during HYPEX (main effect of time, P < 0.01) and was unchanged postintervention. There was no evidence of diaphragm fatigue (measured by phrenic nerve stimulation) following each trial. In conclusion, plasma IL-6 concentration is increased during EX and HYPEX and this occurred in the absence of diaphragm fatigue. Furthermore, IMT reduced the plasma IL-6 response to EX but not HYPEX. These findings suggest that the respiratory muscles contribute to exercise-induced increases in plasma IL-6 concentration in the absence of diaphragm fatigue and that IMT can reduce the magnitude of the response to exercise but not a volitional mimic of the exercise hyperpnea.

The effect of a carbohydrate beverage on the physiological responses during prolonged load carriage.

Effects of a carbohydrate beverage on the physiological responses to load carriage were examined. Ten fit male participants (age: 28 ± 9 years, body mass: 81.5 ± 10.5 kg, VO(2max): 55.0 ± 5.5 mL kg(-1) min(-1)) completed two test conditions in random order, walking on a treadmill (6.5 km h(-1)) for 120 min, carrying a 25-kg backpack. At 0 and 60 min of exercise participants consumed 250 mL of a placebo (flavoured water) (PLA) or 6.4% carbohydrate (CHO) beverage. There were no differences in VO(2,) respiratory exchange ratio (RER), heart rate or EMG activity of m. rectus femoris, m. vastus lateralis, m. semitendinosus and m. biceps femoris between conditions at minute 5 of exercise. The increase in VO(2) between minutes 5 and 120 was less during CHO than PLA (8 ± 5 vs. 14 ± 6%, P = 0.036). RER decreased during PLA, from 0.96 ± 0.05 at minute 5 to 0.87 ± 0.04 at minute 120 (P < 0.001), but not during CHO (P = 0.056). Heart rate increased between minutes 5 and 120 during PLA (16 ± 10%, P < 0.001) and CHO (12 ± 6%, P < 0.001), with no difference between conditions (P = 0.251). EMG peak RMS did not change between minutes 7 and 107 during PLA or CHO for the leg muscles. However, individual responses in EMG were highly variable (i.e. both increases and decreases in RMS). It was concluded that carbohydrate intake during load carriage reduced the VO(2) drift, which could be partially attributed to higher carbohydrate oxidation rates. Despite muscle fatigue/damage previously being identified as a cause of VO(2) drift, it appears that carbohydrate had no effect on neuromuscular responses during load carriage.

Carbohydrate vs protein supplementation for recovery of neuromuscular function following prolonged load carriage.

BACKGROUND: This study examined the effect of carbohydrate and whey protein supplements on recovery of neuromuscular function after prolonged load carriage. METHODS: TEN MALE PARTICIPANTS (BODY MASS: 81.5 +/- 10.5 kg, age: 28 +/- 9 years, O(2)max: 55.0 +/- 5.5 ml.kg(-1).min(-1)) completed three treadmill walking tests (2 hr, 6.5 km.h(-1)), carrying a 25 kg backpack consuming 500 ml of either: (1) Placebo (flavoured water) [PLA], (2) 6.4% Carbohydrate Solution [CHO] or (3) 7.0% Whey Protein Solution [PRO]. For three days after load carriage, participants consumed two 500 ml supplement boluses. Muscle performance was measured before and at 0, 24, 48 and 72 h after load carriage, during voluntary and electrically stimulated contractions. RESULTS: Isometric knee extension force decreased immediately after load carriage with no difference between conditions. During recovery, isometric force returned to pre-exercise values at 48 h for CHO and PRO but at 72 h for PLA. Voluntary activation decreased immediately after load carriage and returned to pre-exercise values at 24 h in all conditions (P = 0.086). During recovery, there were no differences between conditions for the change in isokinetic peak torque. Following reductions immediately after load carriage, knee extensor and flexor peak torque (60 degrees .s(-1)) recovered to pre-exercise values at 72 h. Trunk extensor and flexor peak torque (15 degrees .s(-1)) recovered to pre-exercise values at 24 h (P = 0.091) and 48 h (P = 0.177), respectively. CONCLUSION: Recovery of neuromuscular function after prolonged load carriage is improved with either carbohydrate or whey protein supplementation for isometric contractions but not for isokinetic contractions.