Effects of Methylsulfonylmethane (MSM) on exercise-induced oxidative stress, muscle damage, and pain following a half-marathon: a double-blind, randomized, placebo-controlled trial

Evaluation of the Effects of an Undenatured Collagen Type-2-Based Nutraceutical (ARTHROSHINE® HA²) on Recovery Time after TPLO in Dogs: A Prospective, Randomized Study with Objective Gait Analysis as the Primary Outcome Measure

This randomized, prospective clinical trial investigates the impact of a novel undenatured collagen type 2 (T2NDC)-based nutraceutical, ARTHROSHINE® HA² (AS), on postoperative rehabilitation following Tibial Plateau Leveling Osteotomy (TPLO) in 50 dogs with unilateral cranial cruciate ligament rupture (CCLR). The patients were randomly allocated to either group A, receiving AS once daily for 24 weeks post-TPLO surgery, or group B, without any supplementation. Frequency matching was applied to enhance group comparability. Assessment of outcomes included computerized gait analysis and a validated owner questionnaire. AS supplementation was well received, without any reported side effect. Consistently, patients in group A exhibited significantly higher peak vertical force values during all follow-up assessments. By the 12-week mark, gait analysis indicated a return to a physiological gait pattern in group A, while group B achieved this normalization only by the 24-week point. The administration of AS post-TPLO surgery demonstrates promise in enhancing limb function, leading to faster restoration of a physiological gait pattern. The inclusion of AS, a T2NDC-based nutraceutical, in the post-TPLO rehabilitation protocol may contribute to improved limb function and an expedited recovery, potentially facilitating a quicker return to normalcy. It is noteworthy that subjective owner perceptions did not differ between the two groups.

Combined effects of green tea supplementation and eccentric exercise on nuclear factor erythroid 2-related factor 2 activity

PURPOSE

This study investigated whether combining eccentric exercise and green tea supplementation synergistically increased nuclear factor erythroid 2-related factor 2 (NRF2) activity, a transcription factor responsible for coordinating endogenous antioxidant expression.

METHODS

In a double-blinded, randomized, between-subjects design, 24 males (mean [SD]; 23 [3] years, 179.6 [6.1] cm, 78.8 [10.6] kg) performed 100 drop jumps following a 6 days supplementation period with either green tea (poly)phenols (n = 12; 500 mg·d-1) or a placebo (n = 12; inulin). NRF2/antioxidant response element (ARE) binding in peripheral blood mononuclear cells (PBMCs), catalase (CAT) and glutathione reductase (GR) activity, 8-hydroxy-2'-deoxyguanosine (8-OHdG) excretion, and differential leukocyte counts were measured pre-, post-, 1 h and 24 h post-exercise.

RESULTS

Exercise did not increase NRF2/ARE binding (p = 0.12) (fold change vs rest: green tea = [post] 0.78 ± 0.45, [1 h] 1.17 ± 0.54, [24 h] 1.06 ± 0.56; placebo = [post] 1.40 ± 1.50, [1 h] 2.98 ± 3.70, [24 h] 1.04 ± 0.45). Furthermore, CAT activity (p = 0.12) and 8-OHdG excretion (p = 0.42) were unchanged in response to exercise and were not augmented by green tea supplementation (p > 0.05 for all). Exercise increased GR activity by 30% (p = 0.01), however no differences were found between supplement groups (p = 0.51). Leukocyte and neutrophil concentrations were only elevated post-exercise (p < 0.001 for all).

CONCLUSION

Eccentric exercise, either performed alone or in conjunction with green tea supplementation, did not significantly increase NRF2 activity in PBMCs.

TRIAL REGISTRATION NUMBER

osf.io/kz37g (registered: 15/09/21).

Effect of Lactobacillus plantarum PS128 on neuromuscular efficiency after a half-marathon

Introduction: Lactobacillus plantarum PS128 (PS128) could be considered an antioxidant supplement to reduce muscle fatigue and improve exercise capacity recovery after vigorous exercise. Purpose: The purpose of this study is to investigate the effect of PS128 on muscle fatigue and electromyography (EMG) activity after a half-marathon (HM). Methods: The experimental design used a repeated-measures design with a double-blind approach. The participants either took two capsules of PS128 for 4 weeks as the PS128 group (PSG, n = 8) or took two capsules of a placebo for 4 weeks as the placebo group (PLG, n = 8) to ensure counterbalancing. The time points of the maximal voluntary isometric contraction (MVIC) and EMG activity test were set before probiotics were taken (baseline), 48 h before HM (Pre), and immediately at 0 h, 3 h, 24 h, 48 h, 72 h, and 96 h after HM. Results: EMG activity included median power frequency (MDF), integrated EMG (iEMG), and neuromuscular efficiency (peak torque/iEMG). The MVICs of knee extensors, analyzed by using an isokinetic dynamometer, showed a decrease from the Pre to 0 h (p = 0.0001), 3 h (p < 0.0001), 24 h (p < 0.0001), 48 h (p < 0.0001), 72 h (p = 0.0002), and 96 h (p = 0.0408) time points in the PLG. Sidak's multiple comparisons tests showed that the PLG was significantly lower than the PSG at 0 h (p = 0.0173), 3 h (p < 0.0001), 24 h (p < 0.0001), 48 h (p < 0.0001), 72 h (p < 0.0001), and 96 h (p = 0.0004) time points. The MDF of vastus medialis oblique (VMO) in the PLG was significantly decreased 24 h after HM and significantly lower than that in the PSG at all times points after HM. The iEMG of VMO in the PLG was significantly decreased 48 h after HM and significantly lower than that in the PSG at 0 h, 3 h, 24 h, 48 h, and 72 h after HM. Conclusion: The PS128 supplementation may prevent the decrease in MDF, iEMG, and peak torque after vigorous exercise. Recreational runners may consider implementing a probiotic supplementation regimen as a potential strategy to mitigate muscle fatigue following HM.

Rhodiola rosea supplementation on sports performance: A systematic review of randomized controlled trials

The aim of this systematic review was to determine whether the supplementation with Rhodiola rosea (RR), an herb that has been used for centuries for its various properties, can have an effect on muscle damage and physical performance. The databases PubMed, Web of Science, and Cochrane Library were used to find studies published until March 2023. Randomized controlled trials, healthy participants, and no use of other supplements. The search strategy was conducted by two independent reviewers, and specific information was extracted from the selected studies. Thirteen studies were included with 263 participants (198 men and 65 women between 18 and 65 years old). Two studies followed acute supplementation, 5 chronic, and 6 combined both. The results were heterogenous, having 11 studies with some positive effects, while 2 studies show no effect in variables such as rating of perceive exertion, heart rate, antioxidant capacity, blood lactate, creatine kinase, or C-reactive protein. Two limitations were found, firstly, the difference between supplementation and exercise protocols, and secondly, the existence of unclear or high risk of bias in most of the studies included. Acute supplementation with RR has a positive effect on endurance performance and rating of perceived exertion (RPE). Chronic supplementation has a positive effect on anaerobic exercise performance, but not endurance exercise performance. Chronic supplementation may positively impact muscle damage during exercise. However, more high-quality studies are needed to firmly establish the clinical efficacy of RR.

Distinct signatures on d-galactose-induced aging and preventive/protective potency of two low-dose vitamin D supplementation regimens on working memory, muscular damage, cardiac and cerebral oxidative stress, and SIRT1 and calstabin2 downregulation

Chronic administration of d-galactose (d-gal) in rodents reproduces the overproduction of reactive oxygen species of physiological aging. The present research shows for the first time distinct signatures on d-gal-induced aging (500 mg/kg, 6 weeks) and the preventive and protective potential of two vitamin D (50 IU) supplementation regimens (pre-induction and simultaneous, respectively) in two vital organs (heart and brain). d-gal-induced notorious alterations in working memory, a strong increase in brain malondialdehyde (MDA) oxidative levels, and strong downregulation of sirtuin 1 (SIRT1) in the heart and hippocampus and of calstabin2 in the heart. Cardiac and brain superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzymatic antioxidant capacities were damaged, brain calstabin2 was downregulated, and neuropathology was observed. Heart damage also included a moderate increase in MDA levels, serologic lactate dehydrogenase (LDH), total creatine kinase (CK) activities, and histopathological alterations. The used dose of vitamin D was enough to prevent cognitive impairment, avoid muscular damage, hamper cardiac and cerebral oxidative stress, and SIRT1 and calstabin2 downregulation. Most importantly, the potencies of the two preventive schedules depended on the tissue and level of study. The pre-induction schedule prevented d-gal-induced aging by 1 order of magnitude higher than simultaneous administration in all the variables studied except for SIRT1, whose strong downregulation induced by d-gal was equally prevented by both schedules. The benefits of vitamin D for oxidative stress were stronger in the brain than in the heart. Brain MDA levels were more sensitive to damage, while SOD and GPx antioxidant enzymatic activities were in the heart. In this order, the magnitude of SOD, MDA, and GPx oxidative stress markers was sensitive to prevention. In summary, the results unveiled distinct aging induction, preventive signatures, and sensitivity of markers depending on different levels of study and tissues, which are relevant from a mechanistic view and in the design of targeted interventions.

Triptolide Attenuates Muscular Inflammation and Oxidative Stress in a Delayed-Onset Muscle Soreness Animal Model

Delayed-onset muscle soreness (DOMS) is associated with exercise-induced muscle damage and inflammation, which is mainly caused by prolonged eccentric exercise in humans. Triptolide, an extract from the Chinese herb Tripterygium wilfordii Hook F, has been used for treating autoimmune and inflammatory diseases in clinical practice. However, whether triptolide attenuates acute muscle damage is still unclear. Here, we examined the effect of triptolide on carrageenan-induced DOMS in rats. Rats were injected with 3% of carrageenan into their muscles to induce acute left gastrocnemius muscular damage, and triptolide treatment attenuated carrageenan-induced acute muscular damage without affecting hepatic function. Triptolide can significantly decrease lipid hydroperoxide and nitric oxide (NO) levels, proinflammatory cytokine production, and the activation of nuclear factor (NF)-ĸB, as well as increase a reduced form of glutathione levels in carrageenan-treated rat muscles. At the enzyme levels, triptolide reduced the inducible nitric oxide synthase (iNOS) expression and muscular myeloperoxidase (MPO) activity in carrageenan-treated DOMS rats. In conclusion, we show that triptolide can attenuate muscular damage by inhibiting muscular oxidative stress and inflammation in a carrageenan-induced rat DOMS model.

Live and Heat-Killed Probiotic Lactobacillus paracasei PS23 Accelerated the Improvement and Recovery of Strength and Damage Biomarkers after Exercise-Induced Muscle Damage

Excessive, high-intensity or inappropriate exercise may cause muscle damage. How to speed up recovery and reduce exercise discomfort are currently very important issues for athletes and sports people. Past research has shown that probiotics can improve inflammation and oxidative stress, as well as improve exercise performance and antifatigue. However, further research is needed to confirm the recovery benefits for muscle damage. In this double-blind design study, all subjects were randomly assigned to placebo, a live Lactobacillus paracasei group (L-PS23, 2 × 1010 colony forming unit (CFU)/day), or a heat-killed L. paracasei group (HK-PS23, 2 × 1010 cells/day), and supplemented for six consecutive weeks. Afterwards, subjects completed 100 maximal vertical jumps to bring about exercise-induced muscle damage (EIMD). Countermovement jump (CMJ), isometric mid-thigh pull (IMTP), and Wingate anaerobic test (WAnT), as well as blood tests for markers of muscle damage and inflammation were made pre-exercise and 3, 24, 48 h post exercise. The results show that both L-PS23 and HK-PS23 supplementation significantly slowed the loss of muscle strength after muscle injury, and they significantly reduced the production of markers of muscle damage and inflammation (p < 0.05). In addition, L-PS23 and HK-PS23 had the benefits of accelerating the recovery and improvement of muscle strength, the blood markers of muscle injury and inflammation, and slowing the decline in testosterone concentrations (p < 0.05). Especially in the HK-PS23 supplemented group, there was a better trend. In conclusion, we found that L-PS23 or HK-PS23 supplementation for six weeks prevented strength loss after muscle damage and improved blood muscle damage and inflammatory markers, with protective, accelerated recovery and anti-fatigue benefits.

Effects of dietary methyl sulfonyl methane and selenium on laying performance, egg quality, gut health indicators, and antioxidant capacity of laying hens

Objective

This study investigated the effects of dietary methyl sulfonyl methane (MSM) and selenium (Se) on the laying performance, egg quality, gut health indicators, egg yolk Se content, and antioxidant markers in laying hens.

Methods

One hundred ninety-two 73-wk-old laying hens were randomly divided into four groups with eight replicates of six hens each. Four diets were prepared in a 2×2 factorial arrangement with or without MSM and Se. The trial lasted for 12 wk.

Results

There were no interaction effects or main effects (p>0.05) on laying performance and egg quality. However, feed intake increased in Se-fed hens (p = 0.051) and decreased in MSM-fed hens (p = 0.067) compared with that of hens in the control group. Dietary MSM increased (p<0.05) the ileal villus height and villus height:crypt ratio in hens compared with those receiving the non-supplemented control diet. Dietary MSM and Se did not affect the percentage of short-chain fatty acids in the ileal contents. Dietary Se enriched the Se content in egg yolk compared with that of the non-supplemented control diet (p<0.05). Dietary Se increased (p<0.05) glutathione peroxidase levels in the liver and serum samples compared to the control diet. The total antioxidant capacity in the liver increased (p<0.05) in laying hens that were fed MSM-supplemented diets than in hens fed the control diet. Dietary MSM significantly increased the relative superoxide dismutase levels in serum samples (p<0.05).

Conclusion

Supplementation with either MSM or Se independently improved the antioxidant capacity of laying hens. Furthermore, dietary Se produced Se-enriched eggs, but this effect was neither additive nor synergistic with dietary MSM.

Methylsulfonylmethane relieves cobalt chloride-induced hypoxic toxicity in C2C12 myoblasts

AIMS

In biology and medicine, hypoxia refers to reduced oxygen tension or oxygen starvation resulting from various environmental or pathological conditions. Prolonged hypoxia may lead to an imbalance in protein production and a loss of muscle mass in animals. The physiological response to hypoxia includes oxidative stress-induced activation of complex cell-signaling networks such as hypoxia-inducible factor (HIF), phosphoinositide 3-kinase (PI3K), and Janus kinase/signal transducer and activator of transcription (JAK-STAT). Methylsulfonylmethane (MSM) is a natural sulfur compound that regulates HIF-1α expression and provides cytoprotection from oxidative stress. In this study, we explored the anti-hypoxic activity and cytoprotective effect of MSM in cobalt chloride (CoCl₂)-induced hypoxic C2C12 mouse myoblast culture.

MATERIALS AND METHODS

We used western blotting, real time PCR, flow cytometry for molecular signaling studies and we also used MTT assay and ChIP assay along with comet assay for cellular processes.

KEY FINDINGS

MSM prevented the CoCl₂ induced cytotoxicity. Molecular markers of hypoxia, induced by CoCl₂, were normalized or reduced by MSM, which also inhibited the effect of CoCl₂-induced JAK2/STAT5b/Cyclin D1 and PI3K/AKT signaling. CoCl₂-induced oxidative stress results in activation of the NRF2/HO-1-mediated cell survival pathway and inhibition of DNA repair, both of which were prevented by MSM.

SIGNIFICANCE

We suggest MSM can be considered as a candidate drug for reducing the effects of hypoxia in both animals and humans.

Benefits on Hematological and Biochemical Parameters of a High-Intensity Interval Training Program for a Half-Marathon in Recreational Middle-Aged Women Runners

(1) Background: half-marathon races are popular among recreational runners, with increases in participation among middle-aged and women. We aimed to determine the effects of two half-marathon training programs on hematological and biochemical markers in middle-aged female recreational runners; (2) Methods: ten women (40 ± 7 years) followed moderate intensity continuous training (MICT), based on running volume below 80% V˙O₂max, and another ten women followed high intensity interval training (HIIT) at 80%–100% V˙O₂max, with less volume, and combined with eccentric loading exercise. Hematology, plasma osmolality, and plasma markers of metabolic status, muscle damage, inflammatory, and oxidative stress were measured before (S1) and after (S2) training and 24 h after the half-marathon (S3); (3) Results: both training programs had similar moderate effects at S2. However, the acute response at S3 induced different alterations. There was a greater decrease in cholesterol and triglyceride levels in MICT and reductions in markers of damage and inflammation in HIIT. Greater variability in some plasma markers at S3 in MICT suggests that there is inter-individual variability in the response to training; (4) Conclusions: HIIT led to better adaptation to the competition maybe because of the repeated exposure to higher oxygen consumption and eccentric loading exercise.

Effects of Dietary Organic and Inorganic Sulfur on Laying Performance, Egg Quality, Ileal Morphology, and Antioxidant Capacity in Laying Hens

Simple Summary

Oxidative stress caused by environmental and nutritional factors could be detrimental to poultry production. Dietary natural antioxidants could therefore be beneficial in limiting the deleterious effects of oxidative stress in chickens. Methyl sulfonyl methane is a non-toxic natural organosulfur compound with the chemical formula (CH₃)₂SO₂ and is known as methyl sulfone or dimethyl sulfone. Inorganic sulfate (e.g., sodium sulfate) is involved in the metabolism of many tissues and systems, as well as in important detoxication mechanisms. Dietary sulfur in either organic or inorganic forms exhibits beneficial antioxidant properties in various animals in vivo and in vitro. Therefore, our studies have been conducted to evaluate the role of organic and inorganic sulfur in laying hens.

Abstract

The present study was conducted to investigate the comparative effects of organic and inorganic forms of sulfur, methyl sulfonyl methane (MSM) and sodium sulfate (SS), on laying performance, egg quality, ileal morphology, ileal volatile fatty acids, and antioxidant and stress markers in various biological samples in aged laying hens. A total of 144, 73-week-old Lohman Brown-Lite laying hens were randomly assigned to one of three experimental diets: basal diet (CONT), CONT + 0.2% MSM (MSM), and CONT + 0.3% SS (SS). The trial lasted for 12 weeks. MSM and SS diets contained 0.07% of sulfur, either organic or inorganic. Dietary MSM did not affect egg production or feed conversion ratio at 12 weeks compared with the CONT group. Dietary sulfur did not affect egg quality except for the Haugh unit at 4 weeks, which was lowered (p < 0.05) in the SS group. Compared with the CONT group, a higher (p < 0.05) villus height to crypt depth ratio was observed in the SS group. Dietary sulfur did not affect the percentages of short-chain fatty acids in the ileum. Total antioxidant capacity of the liver increased (p < 0.05) in laying hens fed MSM- and SS-added diets compared with the CONT group. The MSM and SS groups were found to have lowered (p < 0.05) malondialdehyde (MDA) concentration in serum samples compared with CONT. Finally, dietary MSM had the lowest (p < 0.05) MDA concentrations in yolk samples. Taken together, our study showed that dietary organic and inorganic sulfur have positive effects on ileal morphology and antioxidant capacity in laying hens. However, SS-mediated inhibition in laying performance needs to be clarified.

Effect of Daily Oral Lactobacillus plantarum PS128 on Exercise Capacity Recovery after a Half-Marathon

A half-marathon (HM) is a vigorous high-intensity exercise, which could induce lower extremity musculoskeletal injury risks for recreational runners. They usually consume nonsteroidal anti-inflammatory drugs (NSAIDs) in order to shorten their return to play but ignore the side effects, such as peptic ulcers and renal and vascular disorders. Lactobacillus plantarum PS128 (PS128) could improve inflammation and oxidative stress by modulating the gut microbiota, thus potentially improving muscle damage and recovery. However, few studies have addressed the PS128 exercise capacity recovery 96 h after HM. Thus, this study aimed to investigate the effect of PS128 on exercise capacity and physiological adaptation after HM. A double-blind, randomized, placebo-controlled, counterbalanced, crossover trial was used for the experiment. HM was conducted at the beginning and end of the 4-week nutritional supplement administration. Eight recreational runners took two capsules (3 × 10¹⁰ CFU/capsule) of PS128 each morning and evening before meals for 4 weeks as the PS128 treatment (LT), or they took two capsules of placebo for 4 weeks as the placebo treatment (PT). In both treatments, an exercise capacity test (lower extremity muscle strength, anaerobic power, lower extremity explosive force, and aerobic capacity) and blood test (muscle fatigue, muscle damage, oxidative stress, and renal injury) were performed before the administration of the nutritional supplement (baseline), 48 h before HM (pre), and 0 h (0 h post), 3 h (3 h post), 24 h (24 h post), 48 h (48 h post), 72 h (72 h post), and 96 h (96 h post) after HM. There was no significant difference in the total duration of HM between PT and LT, but PT was found to be significantly higher than LT at Stage 4 (15,751–21,000 m) of HM (3394 ± 727 s vs. 2778 ± 551 s, p = 0.02). The lower extremity muscle strength measured using an isokinetic dynamometer in PT was significantly lower than that in LT at 72 h after HM. The lower extremity explosive force from the countermovement jump (CMJ) in PT was significantly decreased compared to 24 h prior. There was no significant difference between anaerobic power and aerobic capacity between the two treatments after HM. After HM, LT had lower muscle damage indices, such as myoglobin (3 h post-PT vs. -LT: 190.6 ± 118 ng/mL vs. 91.7 ± 68.6 ng/mL, p < 0.0001) and creatine phosphokinase (24 h post-PT vs. -LT: 875.8 ± 572.3 IU/L vs. 401 ± 295.7 IU/L, p < 0.0001). Blood urea nitrogen recovered in 24 h (24 h pre- vs. post-LT, p > 0.05) and higher superoxide dismutase was found in LT (96 h post-PT vs. -LT: 0.267 ± 0.088 U/mL vs. 0.462 ± 0.122 U/mL, p < 0.0001). In conclusion, PS128 supplementation was associated with an improvement in muscle damage, renal damage, and oxidative stress caused by HM through microbiota modulation and related metabolites but not in exercise capacity.

Remote Ischemic Preconditioning Reduces Marathon-Induced Oxidative Stress and Decreases Liver and Heart Injury Markers in the Serum

Clinical studies continue to provide evidence of organ protection by remote ischemic preconditioning (RIPC). However, there is lack of insight into impact of RIPC on exercise-induce changes in human organs' function. We here aimed to elucidate the effects of 10-day RIPC training on marathon-induced changes in the levels of serum markers of oxidative stress, and liver and heart damage. The study involved 18 male amateur runners taking part in a marathon. RIPC training was performed in the course of four cycles, by inflating and deflating a blood pressure cuff at 5-min intervals (RIPC group, n=10); the control group underwent sham training (n=8). The effects of RIPC on levels of oxidative stress, and liver and heart damage markers were investigated at rest after 10 consecutive days of training and after the marathon run. The 10-day RIPC training decreased the serum resting levels of C-reactive protein (CRP), alanine transaminase (ALT), γ-glutamyl transpeptidase (GGT), and malondialdehyde (MDA). After the marathon run, creatinine kinase MB (CK-MB), lactate dehydrogenase (LDH), cardiac troponin level (cTn), aspartate aminotransferase (AST), alkaline phosphatase (ALP), ALT, total bilirubin (BIL-T), and MDA levels were increased and arterial ketone body ratio (AKBR) levels were decreased in all participants. The changes were significantly diminished in the RIPC group compared with the control group. The GGT activity remained constant in the RIPC group but significantly increased in the control group after the marathon run. In conclusion, the study provides evidence for a protective effect of RIPC against liver and heart damage induced by strenuous exercise, such as the marathon.

Re-Evaluating the Oxidative Phenotype: Can Endurance Exercise Save the Western World?

Mitochondria are popularly called the "powerhouses" of the cell. They promote energy metabolism through the tricarboxylic acid (TCA) cycle and oxidative phosphorylation, which in contrast to cytosolic glycolysis are oxygen-dependent and significantly more substrate efficient. That is, mitochondrial metabolism provides substantially more cellular energy currency (ATP) per macronutrient metabolised. Enhancement of mitochondrial density and metabolism are associated with endurance training, which allows for the attainment of high relative VO2 max values. However, the sedentary lifestyle and diet currently predominant in the Western world lead to mitochondrial dysfunction. Underdeveloped mitochondrial metabolism leads to nutrient-induced reducing pressure caused by energy surplus, as reduced nicotinamide adenine dinucleotide (NADH)-mediated high electron flow at rest leads to "electron leak" and a chronic generation of superoxide radicals (O2-). Chronic overload of these reactive oxygen species (ROS) damages cell components such as DNA, cell membranes, and proteins. Counterintuitively, transiently generated ROS during exercise contributes to adaptive reduction-oxidation (REDOX) signalling through the process of cellular hormesis or "oxidative eustress" defined by Helmut Sies. However, the unaccustomed, chronic oxidative stress is central to the leading causes of mortality in the 21st century-metabolic syndrome and the associated cardiovascular comorbidities. The endurance exercise training that improves mitochondrial capacity and the protective antioxidant cellular system emerges as a universal intervention for mitochondrial dysfunction and resultant comorbidities. Furthermore, exercise might also be a solution to prevent ageing-related degenerative diseases, which are caused by impaired mitochondrial recycling. This review aims to break down the metabolic components of exercise and how they translate to athletic versus metabolically diseased phenotypes. We outline a reciprocal relationship between oxidative metabolism and inflammation, as well as hypoxia. We highlight the importance of oxidative stress for metabolic and antioxidant adaptation. We discuss the relevance of lactate as an indicator of critical exercise intensity, and inferring from its relationship with hypoxia, we suggest the most appropriate mode of exercise for the case of a lost oxidative identity in metabolically inflexible patients. Finally, we propose a reciprocal signalling model that establishes a healthy balance between the glycolytic/proliferative and oxidative/prolonged-ageing phenotypes. This model is malleable to adaptation with oxidative stress in exercise but is also susceptible to maladaptation associated with chronic oxidative stress in disease. Furthermore, mutations of components involved in the transcriptional regulatory mechanisms of mitochondrial metabolism may lead to the development of a cancerous phenotype, which progressively presents as one of the main causes of death, alongside the metabolic syndrome.

Redox-related biomarkers in physical exercise

Research in redox biology of exercise has made considerable advances in the last 70 years. Since the seminal study of George Pake's group calculating the content of free radicals in skeletal muscle in resting conditions in 1954, many discoveries have been made in the field. The first section of this review is devoted to highlight the main research findings and fundamental changes in the exercise redox biology discipline. It includes: i) the first steps in free radical research, ii) the relation between exercise and oxidative damage, iii) the redox regulation of muscle fatigue, iv) the sources of free radicals during muscle contractions, and v) the role of reactive oxygen species as regulators of gene transcription and adaptations in skeletal muscle.

In the second section of the manuscript, we review the available biomarkers for assessing health, performance, recovery during exercise training and overtraining in the sport population. Among the set of biomarkers that could be determined in exercise studies we deepen on the four categories of redox biomarkers: i) oxidants, ii) antioxidants, iii) oxidation products (markers of oxidative damage), and iv) measurements of the redox balance (markers of oxidative stress). The main drawbacks, strengths, weaknesses, and methodological considerations of every biomarker are also discussed.

Dietary Thiols: A Potential Supporting Strategy against Oxidative Stress in Heart Failure and Muscular Damage during Sports Activity

Moderate exercise combined with proper nutrition are considered protective factors against cardiovascular disease and musculoskeletal disorders. However, physical activity is known not only to have positive effects. In fact, the achievement of a good performance requires a very high oxygen consumption, which leads to the formation of oxygen free radicals, responsible for premature cell aging and diseases such as heart failure and muscle injury. In this scenario, a primary role is played by antioxidants, in particular by natural antioxidants that can be taken through the diet. Natural antioxidants are molecules capable of counteracting oxygen free radicals without causing cellular cytotoxicity. In recent years, therefore, research has conducted numerous studies on the identification of natural micronutrients, in order to prevent or mitigate oxidative stress induced by physical activity by helping to support conventional drug therapies against heart failure and muscle damage. The aim of this review is to have an overview of how controlled physical activity and a diet rich in antioxidants can represent a “natural cure” to prevent imbalances caused by free oxygen radicals in diseases such as heart failure and muscle damage. In particular, we will focus on sulfur-containing compounds that have the ability to protect the body from oxidative stress. We will mainly focus on six natural antioxidants: glutathione, taurine, lipoic acid, sulforaphane, garlic and methylsulfonylmethane.

Effects of Short-Term Green Tea Extract Supplementation on VO2 Max and Inflammatory and Antioxidant Responses of Healthy Young Men in a Hot Environment

Background:

Nowadays, the use of green tea supplements has increased. Studies have shown that green tea can have positive effects on anti-inflammatory and antioxidative factors, as well as improve aerobic performance capacity. Therefore, in this study, we investigate the effects of this supplement on inflammatory factors, total antioxidant capacity responses, and maximum oxygen uptake (VO₂ Max) of healthy young men in summer.

Methods:

This study is a double-blind randomized controlled trial (RCT) in which 15 young men (age 25.06 ± 2.1) were randomly assigned into the green tea (GT) and placebo groups. Subjects performed maximum aerobic exercises (shuttle run 20 m) in separate workouts (14 days) in summer. They consumed 640 mg green tea extracts or maltodextrin 90 min before exercise in a double-blind design. Blood samples were collected before and after the exercise and then evaluated in the biochemistry laboratory. In this study, one way analysis of variance (ANOVA) tests were used for the statistical analysis.

Results:

The results of this study show that green tea supplement significantly slowed down the increasing tumor necrosis factor alpha (TNF-α) (GT: 15.03 ± 4.31 [pg/ml], placebo: 31.38 ± 7.18 [pg/ml], [P = 0.000]); increased the total antioxidant capacity (GT: 1.04 ± 0.06 [mm], placebo group: 0.72 ± 0.04 [mm], [P = 0.001 VO₂]); and Max (GT: 44.43 ± 3.06 [ml/kg/min], placebo group: 34.88 ± 1.30 [ml/kg/min], [P = 0.001]) in the supplement group than placebo. In addition, no significant differences in interleukin 1 beta (IL-1β) was observed between thee groups (GT: 26.86 ± 5.05 [pg/ml], placebo group: 23.47 ± 3.16 [pg/ml], [P = 0.251]).

Conclusions:

The consumption of green tea supplements 90 min before aerobic exercise may decrease inflammation and oxidative stress factors and improve VO₂ Max in summer.

Muscle Injury in Bodybuilding Based on Mesoporous Multifunctional Nanomaterials for Sports Rehabilitation Training

As an important means of treating diseases, chemical-based drugs have always guaranteed people’s health and longevity. However, due to the nature of some drugs, their use in the medical field is limited. This study mainly discusses the treatment of muscle damage based on sports rehabilitation training mesoporous multifunctional nanomaterials in bodybuilding. The biological characteristics of the targeted control of mesoporous multifunctional nanomaterials for target drugs were studied by analyzing the regeneration of skeletal muscles of mice after gastrocnemius strain under computer control. The electrostatic interactions modified by the consensus binding between AS1411 and Dimer-PPTcDA on the surface of mesoporous silicon are used to block the pores, and the release of objective molecules depends on the concentration of the drug in the tendon cells and the time of action. In this system, AS1411 has both the characteristics of the target substance and the active site of the targeted stimulus response in the cell. After FAM is labeled AS1411, the fluorescence of FAM can be used to monitor the release of the drug in real time, so as to directly release the drug to the lesion, maintain local effectiveness, and greatly improve the biological activity of the drug. In addition, in the safety analysis of mesoporous multifunctional nanomaterials on cells, if the concentration of nanoparticles is 90 μg/mL, the cell survival rate is almost 100%. The results show that the mesoporous multifunctional nanomaterials have low cytotoxicity and cell activity is not affected. The smaller the particle size of mesoporous silicon, the easier it is to invade the focus cells. In addition, confocal microscopy imaging has also effectively demonstrated the targeting effect of mesoporous multifunctional nanomaterials on cells.

Effect of methylsulfonylmethane on oxidative stress and CYP3A93 expression in fetal horse liver cells

Objective

Stress-induced cytotoxicity caused by xenobiotics and endogenous metabolites induces the production of reactive oxygen species and often results in damage to cellular components such as DNA, proteins, and lipids. The cytochrome P450 (CYP) family of enzymes are most abundant in hepatocytes, where they play key roles in regulating cellular stress responses. We aimed to determine the effects of the antioxidant compound, methylsulfonylmethane (MSM), on oxidative stress response, and study the cytochrome P450 family 3 subfamily A (CYP3A) gene expression in fetal horse hepatocytes.

Methods

The expression of hepatocyte markers and CYP3A family genes (CYP3A89, CYP3A93, CYP3A94, CYP3A95, CYP3A96, and CYP3A97) were assessed in different organ tissues of the horse and fetal horse liver-derived cells (FHLCs) using quantitative reverse transcription polymerase chain reaction. To elucidate the antioxidant effects of MSM on FHLCs, cell viability, levels of oxidative markers, and gene expression of CYP3A were investigated in H₂O₂-induced oxidative stress in the presence and absence of MSM.

Results

FHLCs exhibited features of liver cells and simultaneously maintained the typical genetic characteristics of normal liver tissue; however, the expression profiles of some liver markers and CYP3A genes, except that of CYP3A93, were different. The expression of CYP3A93 specifically increased after the addition of H₂O₂ to the culture medium. MSM treatment reduced oxidative stress as well as the expression of CYP3A93 and heme oxygenase 1, an oxidative marker in FHLCs.

Conclusion

MSM could reduce oxidative stress and hepatotoxicity in FHLCs by altering CYP3A93 expression and related signaling pathways.

Alterations in Systemic Inflammatory Response Following a Half-Marathon Race with a Combined Curcumin and Pomegranate Supplement: A Feasibility Study

Endurance running training can lead to gradual accumulation of inflammation and soreness ultimately resulting in overuse injuries. Management of soreness and inflammation with pharmaceuticals (i.e. non-prescription pain relievers) during long-term training is not a suitable solution due to known side effects (e.g. gastrointestinal complications, etc.). Dietary polyphenols (i.e. curcumin, pomegranate, etc.) have been purported to reduce inflammation and muscle soreness, without these negative side effects making them ideal for use in an exercise model. The purpose of the present feasibility study was to explore the combined effect of optimized curcumin and pomegranate extract supplementation prior to (PRE) and after (4H and 24H) an organized half-marathon race on blood inflammatory proteins and inflammation-associated RNA. Daily supplementation (1000 mg/d) started 26 days before a half-marathon which doubled on days 27-31. Data were analyzed with R software and Welch t-test, significance set at p < 0.05. At both 4H and 24H, supplementation was associated with alterations in protein (IL-10, IL-13, IL-4, ITAC, MIP-1alpha, MIP-3alpha, BDNF, sIL-2Ralpha, and TNF-alpha; p < 0.05) and RNA (CCL22, GUSB, IL-6, LINC00305, NKILA, PTGES, THRIL, TRAF6, ARG2, CD1A, CD55, CFI, CSF2, CXC3CL1, CX3CR1, EDNRB, GATA3, LILRB5, THY1, CD3D, MRC1, GPR183, HAMP, MBL2, CASP3, B2M, KLRF2, PDCD1LG2, IL-10, PTGS2, TLR2, IL-6R, IL-8, IL-7R, MASP1, MYD88, TNFRSF1B, TNFRSF1A, and TIRAP; p < 0.05) biomarkers compared to control. Pathway classification of these biomarkers indicated supplementation may be associated with a more favorable muscle recovery profile. Our findings support the notion that combined curcumin and pomegranate supplementation may represent a useful addition to a comprehensive exercise training plan.

No Effect of New Zealand Blackcurrant Extract on Recovery of Muscle Damage Following Running a Half-Marathon

New Zealand blackcurrant (NZBC) contains anthocyanins, known to moderate blood flow and display anti-inflammatory properties that may improve recovery from exercise-induced muscle damage. The authors examined whether NZBC extract supplementation enhances recovery from exercise-induced muscle damage after a half-marathon race. Following a randomized, double-blind, independent groups design, 20 (eight women) recreational runners (age 30 ± 6 years, height 1.73 ± 0.74 m, body mass 68.5 ± 7.8 kg, half-marathon finishing time 1:56:33 ± 0:18:08 hr:min:s) ingested either two 300-mg/day capsules of NZBC extract (CurraNZ™) or a visually matched placebo, for 7 days prior to and 2 days following a half-marathon. Countermovement jump performance variables, urine interleukin-6, and perceived muscle soreness and fatigue were measured pre, post, and at 24 and 48 hr after the half-marathon and analyzed using a mixed linear model with statistical significance set a priori at p < .05. The countermovement jump performance variables were reduced immediately post-half-marathon (p < .05), with all returning to pre-half-marathon levels by 48 hr, except the concentric and eccentric peak force and eccentric duration, with no difference in response between groups (p > .05). Urine interleukin-6 increased 48-hr post-half-marathon in the NZBC group only (p < .01) and remained unchanged compared with pre-half-marathon levels in the placebo group (p > .05). Perceived muscle soreness and fatigue increased immediately post-half-marathon (p < .01) and returned to pre-half-marathon levels by 48 hr, with no difference between groups (p > .05). Supplementation with NZBC extract had no effect on the recovery of countermovement jump variables and perceptions of muscle soreness or fatigue following a half-marathon in recreational runners.

Dietary methylsulfonylmethane supplementation and oxidative stress in broiler chickens

Methylsulfonylmethane (MSM) is an organic, sulfur-containing compound widely used as a dietary supplement to improve joint health and treat arthritic pain. An experiment was conducted to study the effects of feeding 0.05% MSM to broilers exposed to diet-induced oxidative stress on tissue MSM distribution, growth performance, oxidative stress biomarkers, and immune responsivity. A total of 528 birds were allocated to 4 dietary treatments (fresh oil-no MSM, fresh oil-MSM, oxidized oil-no MSM, oxidized oil-MSM) as provided ad libitum to 11 replicate cages of 12 birds per treatment. Blood and tissue samples were collected to analyze MSM concentrations, and oxidative stress biomarkers including concentrations of thiobarbituric acid reactive substances (TBARS), total antioxidant capacity (TAC), total glutathione, and glutathione peroxidase (GPx) and reductase (GR) activities. Additionally, blood samples collected at day 25 were used to quantify T-cell (TC) populations using flow cytometry. Overall, MSM was quantified in all tissues and plasma samples of MSM-treated groups at all time points. Oxidized oil reduced (P = 0.006) feed intake over the 21-d feeding period, but MSM did not affect growth equally across time points. No effects (P > 0.2) of MSM or oil type were observed on TC populations. In the presence of oxidized oil, MSM reduced (P = 0.013) plasma TBARS and increased (P = 0.02) liver GPx at day 21, and increased (P = 0.06) liver GR at day 7. Irrespective of dietary oil type, groups supplemented with MSM showed higher plasma TAC at day 7 (P = 0.023), liver GPx activity at day 21 (P = 0.003), and liver GR activity at day 7 (P = 0.004) compared with groups not receiving MSM. In conclusion, 0.05% dietary MSM supplementation partially protected birds from oxidative stress but did not affect immune cell profiles.

Effects of Futsal Demands on Serum and Salivary Levels of Trace Elements and Minerals Detected by Total Reflection X-Ray Fluorescence

The aim of this study was to monitor the circulating and salivary ion concentrations by total reflection X-ray fluorescence (TXRF) in futsal players submitted to the futsal-specific intermittent shuttle protocol (FISP). TXRF may allow identification of changes in ion concentrations induced by physical efforts. Saliva and blood samples of 13 male futsal players were collected before (Pre) and after (Post) the FISP. Salivary and plasma ion levels were detected by TXRF, and differences from Pre to Post (paired t test or Wilcoxon test) and correlations between both biological fluids were determined (P < 0.05). All saliva samples presented phosphorus (P), sulfur (S), chlorine (Cl), potassium (K), calcium (Ca), iron (Fe), zinc (Zn), bromine (Br), and rubidium (Rb). S, Cl, Ca, Fe, Cu, Zn, Br, and Rb were detected in all blood samples. K, Cu, Br, and Rb presented reduced secretion rate from Pre to Post samples (P < 0.05). The salivary concentrations of K (r = - 0.53) and Zn (r = 0.54) were correlated with plasmatic concentrations. After FISP, salivary secretion of S (r = - 0.76), Cl (r = - 0.64), P (r = - 0.67), Mn (r = - 0.74), and Zn (r = 0.69) were correlated with plasma levels. We concluded that TXRF may be used to monitor salivary (P, S, Cl, K, Ca, Fe, Zn, Br, and Rb) and circulating (S, Cl, Ca, Fe, Cu, Zn, Br, and Rb) levels of several elements in futsal athletes. However, an acute bout of futsal-specific physical effort did not significantly imbalance ion concentrations in saliva or plasma.

Changes in the blood redox balance during a simulated duathlon race and its relationship with athletic performance

The duathlon is an endurance multisport event that consists of sequential running, cycling, and further running. Imbalance in the redox homeostasis is associated with fatigued status and underperformance in various sports; however, there are no corresponding reports regarding the duathlon. The purpose of this study was to examine the changes in the blood redox balance during a simulated duathlon race and to determine the relationship between performance and the redox balance. Eight male triathletes participated in a simulated race, consisting of a 5-km run, 30 km cycling, and a further 5-km run, with 5 min rest between two parts to collect the blood samples. The serum levels of reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP) were measured and BAP/d-ROMs ratio and oxidative stress index (OSI) were calculated. The d-ROMs levels after the first Run were significantly increased compared with the levels observed before the race. Moreover, BAP levels increased significantly over the race. The BAP/d-ROMs ratio also gradually increased through the race, while the OSI was gradually decreased. In addition, a significant relationship was observed only between d-ROMs levels after the first Run and the first Run performance. These results suggest that the redox balance shifts toward reduction (antioxidation) during the duathlon race and increased oxidant potential levels are negatively correlated with performance in the early stages of the race.

Protective effects of methylsulfonylmethane against ethanol-induced gastric ulcer in mice

BACKGROUND

When the gastric mucosa (GM) is damaged by external stimulation, gastric ulcer forms. The pathogenic factors for gastric ulcer are various, including excessive gastric acid secretion, GM damage, Helicobacter pylori infection, and other factors. The clinical cure rate for gastric ulcer can reach 85%-95%. However, the recurrence of gastric ulcer is still one of the challenges in clinical treatment.

AIM

To investigate the protective effect of methylsulfonyl-methane (MSM) against ethanol-induced gastric ulcer in mice.

METHODS

Mice were randomly divided into a blank control group, a gastric ulcer model group, and low-, medium, and high-dose MSM groups, with 10 rats in each group. GM tissue changes and ulcer index, histopathological changes, serum glutathione (GSH), superoxide dismutase (SOD), malondialdehyde (MDA), inflammatory factors [interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)], and the expression of connective tissue growth factor (CTGF) were observed.

RESULTS

MSM alleviated the pathological changes of ethanol-induced gastric ulcer in mice. MSM reduced the levels of MDA, GSH, and SOD in gastric tissue, decreased the levels of IL-6 and TNF-α in serum of mice with gastric ulcer, and increased the expression of CTGF protein.

CONCLUSION

MSM can alleviate ethanol-induced acute gastric ulcer in mice via mechanisms possibly related to scavenging oxygen free radicals, inhibiting lipid peroxidation, inhibiting the release of inflammatory factors, and increasing the expression of CTGF protein.

Oxidative Stress Parameters and Its Associations With Arterial Stiffness in Competitive Powerlifting Athletes After 12-Week Supervised Strength Training

Jürgenson, J, Serg, M, Kampus, P, Kals, J, Zagura, M, Viru, M, Zilmer, K, Zilmer, M, Eha, J, and Unt, E. Oxidative stress parameters and its associations with arterial stiffness in competitive powerlifting athletes after 12-week supervised strength training. J Strength Cond Res 33(7): 1816-1822, 2019-Available studies have not revealed a clear understanding of the impact of intensive strength training on arterial stiffness and oxidative stress (OxS) parameters, which may have a significant impact on further cardiovascular health of an athlete. The purpose of this study was to evaluate the effect of a 12-week supervised strength training program (SSTP) on oxidative stress indices and its relationship with arterial stiffness in powerlifting athletes. A total of 19 men (28 ± 6 years) exercised for 12 weeks (4 days per week with intensity 60-90% assessed from 1 repetition maximum, 90-120 minutes per session). Oxidative stress parameters and arterial stiffness (SphygmoCor 7.1) were measured before and after SSTP. The study results showed that total peroxide concentration increased and total antioxidant capacity decreased significantly after SSTP. There were no significant changes in carotid-femoral pulse wave velocity (cfPWV) or in the augmentation index. Correlation analysis revealed that the magnitude of the increase of cfPWV was significantly related to the increase of OxS. The current study demonstrated that a 12-week SSTP in powerlifting athletes produced significant changes in OxS indices, which were positively related to increased aortic stiffness. This novel finding may have significant implications about the effect of OxS on cardiovascular health after high-intensity strength training. Furthermore, strength and conditioningcoaches may have to consider the long-term exercise-induced changes in OxS on an individual level, where increased OxS leads to impaired arterial stiffness and cardiovascular health.

The Beneficial Effects of Lactobacillus plantarum PS128 on High-Intensity, Exercise-Induced Oxidative Stress, Inflammation, and Performance in Triathletes

A triathlon, which consists of swimming, bicycling, and running, is a high-intensity and long-term form of exercise that can cause injuries such as muscular damage, inflammation, oxidative stress, and energy imbalance. Probiotics are thought to play an important role in disease incidence, health promotion, and nutrient metabolism, but only a few studies have focused on physiological adaptations to exercise in sports science. Previous studies indicated that Lactobacillus supplementation could improve oxidative stress and inflammatory responses. We investigate the effects of Lactobacillus plantarum PS128 supplementation on triathletes for possible physiological adaptation. The triathletes were assigned to one of two groups with different exercise intensity stimulations with different time-points to investigate the effects of body compositions, inflammation, oxidative stress, performance, fatigue, and injury-related biochemical indices. L. plantarum PS128 supplementation, combined with training, can significantly alleviate oxidative stress (such as creatine kinase, Thioredoxin, and Myeloperoxidase indices) after a triathlon (p < 0.05). This effect is possibly regulated by a 6–13% decrease of indicated pro-inflammation (TNF-α, IL-6, and IL-8) cytokines (p < 0.05) and 55% increase of anti-inflammation (IL-10) cytokines (p < 0.05) after intensive exercise stimulation. In addition, L. plantarum PS128 can also substantially increase 24–69% of plasma-branched amino acids (p < 0.05) and elevate exercise performance, as compared to the placebo group (p < 0.05). In conclusion, L. plantarum PS128 may be a potential ergogenic aid for better training management, physiological adaptations to exercise, and health promotion.

Effects of ascorbic acid supplementation on oxidative stress markers in healthy women following a single bout of exercise

BACKGROUND

Ascorbic acid is a water-soluble chain breaking antioxidant. It scavenges free radicals and reactive oxygen species (ROS), which are produced during metabolic pathways. Exercise can produce an imbalance between ROS and antioxidants, leading to oxidative stress-related tissue damages. This study was designed to determine the effects of ascorbic acid supplementation on circulating biomarkers of oxidative stress and muscle damage following a single bout of exercise.

METHODS

In a crossover design with a 1 wk. wash-out period, 19 healthy women performed 30 min moderate-intensity cycling after ingesting 1000 mg of ascorbic acid (AA) or placebo. Blood samples were taken immediately before, immediately after and 30 min post-exercise to determine plasma albumin, total protein, glucose, oxidative stress and muscle damage markers.

RESULTS

Plasma albumin and total protein levels increased immediately after exercise in placebo alongside slight reductions in glucose (p = 0.001). These effects were absent in AA cohort. Ferric reducing ability of plasma and vitamin C levels in AA cohort significantly increased after exercise (p < 0.05). Superoxide dismutase activity was significantly elevated after exercise (p = 0.002) in placebo but not AA. Plasma malondialdehyde did not change after exercise in placebo but was significantly decreased in AA (p < 0.05). The exercise protocol promoted slight muscle damage, reflected in significant increases in total creatine kinase in all subjects after exercise. On the other hand, plasma C-reactive protein and lactate dehydrogenase remained unchanged.

CONCLUSION

Supplementation with ascorbic acid prior exercise improves antioxidant power but does not prevent muscle damage.

Nutritional and Supplementation Strategies to Prevent and Attenuate Exercise-Induced Muscle Damage: a Brief Review

Exercise-induced muscle damage (EIMD) is typically caused by unaccustomed exercise and results in pain, soreness, inflammation, and reduced muscle function. These negative outcomes may cause discomfort and impair subsequent athletic performance or training quality, particularly in individuals who have limited time to recover between training sessions or competitions. In recent years, a multitude of techniques including massage, cryotherapy, and stretching have been employed to combat the signs and symptoms of EIMD, with mixed results. Likewise, many varied nutritional and supplementation interventions intended to treat EIMD-related outcomes have gained prominence in the literature. To date, several review articles have been published that explore the many recovery strategies purported to minimize indirect markers of muscle damage. However, these articles are very limited from a nutritional standpoint. Thus, the purpose of this review is to briefly and comprehensively summarize many of these strategies that have been shown to positively influence the recovery process after damaging exercise. These strategies have been organized into the following sections based on nutrient source: fruits and fruit-derived supplements, vegetables and plant-derived supplements, herbs and herbal supplements, amino acid and protein supplements, vitamin supplements, and other supplements.