Iterative assessment of a sports rehydration beverage containing a novel amino acid formula on water uptake kinetics.

PURPOSE: Rapid gastric emptying and intestinal absorption of beverages is essential for rapid rehydration, and certain amino acids (AA) may augment fluid delivery. Three sugar-free beverages, containing differing AA concentrations (AA + PZ), were assessed for fluid absorption kinetics against commercial sugar-free (PZ, GZ) and carbohydrate-containing (GTQ) beverages. METHODS: Healthy individuals (n = 15-17 per study) completed three randomised trials. Three beverages (550-600 mL) were ingested in each study (Study 1: AA + PZ [17.51 g/L AA], PZ, GZ; Study 2: AA + PZ [6.96 g/L AA], PZ, GZ; Study 3: AA + PZ [3.48 g/L AA], PZ, GTQ), containing 3.000 g deuterium oxide (D2O). Blood samples were collected pre-, 2-min, 5-min, and every 5-min until 60-min post-ingestion to quantify maximal D2O enrichment (Cmax), time Cmax occurred (Tmax) and area under the curve (AUC). RESULTS: Study 1: AUC (AA + PZ: 15,184 ± 3532 δ‰ vs. VSMOW; PZ: 17,328 ± 3153 δ‰ vs. VSMOW; GZ: 17,749 ± 4204 δ‰ vs. VSMOW; P ≤ 0.006) and Tmax (P ≤ 0.005) were lower for AA + PZ vs. PZ/GZ. Study 2: D2O enrichment characteristics were not different amongst beverages (P ≥ 0.338). Study 3: Cmax (AA + PZ: 440 ± 94 δ‰ vs. VSMOW; PZ: 429 ± 83 δ‰ vs. VSMOW; GTQ: 398 ± 81 δ‰ vs. VSMOW) was greater (P = 0.046) for AA + PZ than GTQ, with no other differences (P ≥ 0.106). CONCLUSION: The addition of small amounts of AA (3.48 g/L) to a sugar-free beverage increased fluid delivery to the circulation compared to a carbohydrate-based beverage, but greater amounts (17.51 g/L) delayed delivery.

Can an amino acid mixture alleviate gastrointestinal symptoms in neuroendocrine tumor patients?

BACKGROUND: Neuroendocrine tumors, although relatively rare in incidence, are now the second most prevalent gastrointestinal neoplasm owing to indolent disease biology. A small but significant sub-group of neuroendocrine tumor patients suffer from diarrhea. This is usually secondary to carcinoid syndrome but can also be a result of short gut syndrome, bile acid excess or iatrogenic etiologies. Recently, an amino acid based oral rehydration solution (enterade® Advanced Oncology Formula) was found to have anti-diarrheal properties in preclinical models. METHODS: A retrospective chart review of all NET patients treated with enterade® AO was performed after IRB approval. RESULTS: Ninety-eight NET patients who had received enterade® AO at our clinic from May 2017 through June 2019 were included. Patients (N = 49 of 98) with follow up data on bowel movements (BMs) were included for final analysis. Eighty-four percent of patients (41/49) had fewer BMs after taking enterade® AO and 66% (27/41) reported more than 50% reduction in BM frequency. The mean number of daily BMs was 6.6 (range, 3-20) at baseline before initiation of therapy, while the mean number of BMs at 1 week time point post enterade® AO was 2.9 (range, 0-11). CONCLUSIONS: Our retrospective observations are encouraging and support prospective validation with appropriate controls in NET patients. This is first published report of the potential anti-diarrheal activity of enterade® AO in NET patients.

Earlier Boston Marathon Start Time Mitigates Environmental Heat Stress.

PURPOSE: This study aimed to compare the wet bulb globe temperature (WBGT) index and other environmental parameters between early and late Boston Marathon race start times from 1995 to 2016. METHODS: Environmental data from 1995 to 2016 (excluding 1996) were used to compare two identical time frames using the 0900-1300 h start versus the 1100-1500 h start. This included the WBGT, dry bulb (Tdb), black globe (Tbg), wet bulb (Twb), solar radiation, relative humidity, and air water vapor pressure. To make comparisons between start times, the difference in the area under the curve (AUC) for each environmental variable was compared within each year with a Wilcoxon signed rank test with a Holm-Bonferroni correction. RESULTS: AUC exposures for WBGT (P = 0.027), Twb (P = 0.031), Tdb (P = 0.027), Tbg (P = 0.055), and solar radiation (P = 0.004) were reduced with an earlier start, whereas those for relative humidity and air water vapor pressure were not. Overall, an earlier race start time by 2 h (0900 vs 1100 h) reduced the odds of experiencing a higher flag category 1.42 times (ß = 0.1744, P = 0.032). CONCLUSIONS: The 2007 decision to make the Boston Marathon start time earlier by 2 h has reduced by ~1.4 times the odds that runners will be exposed to environmental conditions associated with exertional heat illness.

Randomized Study of enterade® to Reduce Diarrhea in Patients Receiving High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation.

High-dose chemotherapy frequently causes injury to the gastrointestinal mucosa, resulting in diarrhea. The purpose of the current study was to assess the tolerability and efficacy of enterade® in reducing ≥ grade 2 diarrhea (G2D) in association with high-dose melphalan followed by autologous stem cell transplantation (ASCT). We conducted a prospective, double blinded, multi-center trial in which 114 subjects were randomized to receive enterade® or placebo twice daily during the transplant hospitalization. Gastrointestinal toxicities (nausea, vomiting, oral mucositis and dysphagia) resulted in poor study compliance in both arms. Among subjects who were able to complete planned therapy (13%), the incidence of G2D was lower for those receiving enterade® as compared to placebo (16% vs 86%, p <0.03). Twice daily oral administration of enterade® and placebo following high-dose chemotherapy and ASCT was not feasible due to significant gastrointestinal toxicities.  Future explorations of enterade® should be conducted in populations capable of reasonable oral intake.
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Biological variation of resting measures of ventilation and gas exchange in a large healthy cohort.

PURPOSE: Resting measures of ventilation and gas exchange are impacted by a variety of physiological stressors, such as those resulting from a research intervention or an extreme environment. However, the biological variation of these parameters, an important statistical consideration for identifying a meaningful physiological change, has not been quantified. METHODS: We performed a retrospective analysis of 21 studies completed by the U.S. Army Research Institute of Environmental Medicine (USARIEM) from 1985 to present, totaling 411 healthy volunteers. First, we determined the intraindividual, interindividual, and analytic coefficients of variation (CVI, CVG, and CVA, respectively) and subsequently the index of individuality and heterogeneity (II and IH, respectively). Second, when deemed appropriate via these outcomes, we defined the accompanying static and dynamic thresholds, beyond which a significant deviation from normal is indicated. RESULTS: End-tidal partial pressure of oxygen (PETO2) and the respiratory exchange ratio (RER) approached the II threshold required to be considered useful in the static assessment of physiological deviations from normal. PETO2 and peripheral oxygen saturation (SpO2) approached the IH threshold required to be considered useful in the dynamic assessment of physiological deviations from normal. CONCLUSIONS: This analysis identifies RER and PETO2 as parameters that might be most useful when aiming to identify a meaningful ventilatory change following a research intervention or stressor. Alternatively, other parameters of ventilation and gas exchange, such as PETCO2 and VE, may be less useful for observing an anticipated physiological change.

Hydration for recreational sport and physical activity.

This review presents recommendations for fluid needs and hydration assessment for recreational activity. Fluid needs are based on sweat losses, dependent on intensity and duration of the activity, and will vary among individuals. Prolonged aerobic activity is adversely influenced by dehydration, and heat exposure will magnify this effect. Fluid needs predicted for running 5-42 km at recreational paces show that fluid losses are <2% body mass; thus, aggressive fluid replacement may not be necessary. Competitive paces result in greater fluid losses and greater fluid needs. Fluid needs for recreational activity may be low; however, carbohydrate consumption (sport drinks, gels, bars) can benefit high-intensity (≤ 1 h) and less-intense, long-duration activity (≥ 1 h). Spot measures of urine color or urine-specific gravity to assess hydration status have limitations. First morning urine concentration and body mass with gross thirst perception can be simple ways to assess hydration status.

Sweat rate prediction equations for outdoor exercise with transient solar radiation.

We investigated the validity of employing a fuzzy piecewise prediction equation (PW) [Gonzalez et al. J Appl Physiol 107: 379-388, 2009] defined by sweat rate (m(sw), g·m(-2)·h(-1)) = 147 + 1.527·(E(req)) - 0.87·(E(max)), which integrates evaporation required (E(req)) and the maximum evaporative capacity of the environment (E(max)). Heat exchange and physiological responses were determined throughout the trials. Environmental conditions were ambient temperature (T(a)) = 16-26°C, relative humidity (RH) = 51-55%, and wind speed (V) = 0.5-1.5 m/s. Volunteers wore military fatigues [clothing evaporative potential (i(m)/clo) = 0.33] and carried loads (15-31 kg) while marching 14-37 km over variable terrains either at night (N = 77, trials 1-5) or night with increasing daylight (N = 33, trials 6 and 7). PW was modified (Pw,sol) for transient solar radiation (R(sol), W) determined from measured solar loads and verified in trials 6 and 7. PW provided a valid m(sw) prediction during night trials (1-5) matching previous laboratory values and verified by bootstrap correlation (r(bs) of 0.81, SE ± 0.014, SEE = ± 69.2 g·m(-2)·h(-1)). For trials 6 and 7, E(req) and E(max) components included R(sol) applying a modified equation Pw,sol, in which m(sw) = 147 + 1.527·(E(req,sol)) - 0.87·(E(max)). Linear prediction of m(sw) = 0.72·Pw,sol + 135 (N = 33) was validated (R(2) = 0.92; SEE = ±33.8 g·m(-2)·h(-1)) with PW ß-coefficients unaltered during field marches between 16°C and 26°C T(a) for m(sw) ≤ 700 g·m(-2)·h(-1). PW was additionally derived for cool laboratory/night conditions (T(a) < 20°C) in which E(req) is low but E(max) is high, as: PW,cool (g·m(-2)·h(-1)) = 350 + 1.527·E(req) - 0.87·E(max). These sweat prediction equations allow valid tools for civilian, sports, and military medicine communities to predict water needs during a variety of heat stress/exercise conditions.

No effect of nutritional adenosine receptor antagonists on exercise performance in the heat.

Nutritional adenosine receptor antagonists can enhance endurance exercise performance in temperate environments, but their efficacy during heat stress is not well understood. This double-blinded, placebo-controlled study compared the effects of an acute dose of caffeine or quercetin on endurance exercise performance during compensable heat stress (40 degrees C, 20-30% rh). On each of three occasions, 10 healthy men each performed 30-min of cycle ergometry at 50% Vo2peak followed by a 15-min performance time trial after receiving either placebo (Group P), caffeine (Group C; 9 mg/kg), or quercetin (Group Q; 2,000 mg). Serial blood samples, physiological (heart rate, rectal, and mean skin body temperatures), perceptual (ratings of perceived exertion, pain, thermal comfort, motivation), and exercise performance measures (total work and pacing strategy) were made. Supplementation with caffeine and quercetin increased preexercise blood concentrations of caffeine (55.62 +/- 4.77 microM) and quercetin (4.76 +/- 2.56 microM) above their in vitro inhibition constants for adenosine receptors. No treatment effects were observed for any physiological or perceptual measures, with the exception of elevated rectal body temperatures (0.20-0.30 degrees C; P < 0.05) for Group C vs. Groups Q and P. Supplementation did not affect total work performed (Groups P: 153.5 +/- 28.3, C: 157.3 +/- 28.9, and Q: 151.1 +/- 31.6 kJ; P > 0.05) or the self-selected pacing strategy employed. These findings indicate that the nutritional adenosine receptor antagonists caffeine and quercetin do not enhance endurance exercise performance during compensable heat stress.

Sweat iron and zinc losses during prolonged exercise.

The purpose of this study was to examine the effects of a 2-hour exercise bout on sweat iron and zinc concentrations and losses in males and females. Nine male and 9 female recreational cyclists exercised at approximately 50% VO(2peak) in a temperate environment (Ta = 23 degrees C, RH = 51%). Sweat samples were collected for 15 min during each of four 30-min exercise bouts. No significant differences were observed between males' and females' sweat iron or zinc concentrations or losses. Sweat iron concentrations decreased significantly between 60 and 90 min of exercise. Sweating rates increased significantly from 30 to 60 min and remained constant during the second hour. Sweat iron losses were significantly lower during the second hour (0.042 mg/m2/h) than the first hour of exercise (0.060 mg/m2/h). Sweat zinc concentrations also decreased significantly over the 2-hour exercise bout. Dietary intakes of iron and zinc were not significantly correlated to sweat iron and zinc concentrations. Sweat iron and zinc losses during 2 hours of exercise represented 3% and 1% of the RDA for iron and 9% and 8% of the RDA for zinc for men and women, respectively. These results suggest a possible iron conservation that prevents excessive iron loss during prolonged exercise.