ADATTOGENI NELLO SPORT: DAL MITO AL DATO SCIENTIFICO - Arrigo F.G. Cicero Medical and Surgical Sciences Dept - Ansisa

ADATTOGENI NELLO SPORT:
    DAL MITO AL DATO
      SCIENTIFICO
           Arrigo F.G. Cicero
   Medical and Surgical Sciences Dept.
Alma Mater Studiorum University of Bologna

INTRO…

L’impiego di piante o sostanze
   psicoattive è un fenomeno
comune a tutta l’umanità che da
 sempre ha cercato di scoprire
   modi per sopravvivere alle
 intemperie ambientali ed agli
        stress sociali…

Definition
      (Wikipedia-style)

A nontoxic substance and
especially a plant extract
that is held to increase the
body's ability to resist the
damaging effects of stress
and promote or restore
normal physiological
functioning.

A bit of «recent» history…

“On March 4, 1943, Iosip Stalin have
signed Order No 4654-p of the
People’s Commissars Council of the
Union of Soviet Socialist Republics
concerning research work “with the
purpose of finding tonic…
substances” for both soldiers and
persons working in the USSR
defense industry during the Second
World War”

EMEA Definition
        (Doc. Ref. EMEA/HMPC/102655/2007)

• An adaptogen is almost non-toxic to the recipient;
• An adaptogen tends to be non-specific in its
  pharmacological properties and acts by increasing the
  resistance of the organism to a broad spectrum of adverse
  biological, chemical, and physical factors;
• An adaptogen tends to be a regulator having a normalizing
  effect on the various organ systems of the recipient
  organism;
• The effect of an adaptogen is as pronounced as deeper are
  pathologic changes in the organism

How an adaptogen work ….
       Perhaps…

In order to avoid confusion …

…, it is necessary to differentiate the term ‘adaptogen’ from traditional
  herbal medicinal products of related action:
• TONICS are substances, which mitigate conditions of weakness or
  lack of tone within the entire organism, or in particular organs. The
  term is typical for traditional medicine, where tonics are used in
  conditions of “asthenia”. The tonic effect may be characterized by
  multiple doses that increase general well being and work capacity.
• STIMULANTS cause a temporary increase in work-capacity, which is
  followed by a period of decreased work-capacity. The stimulating
  effect may be characterized by a single dose that increases work
  capacity. The term is used in modern and in traditional medicine.
• In contrast to stimulants, ADAPTOGENS are reputed to cause an
  increased work-capacity that is not followed by a decrease

Stimulants vs. Adaptogens

Panossian & Wagner. Phytother Res 2005;19:819-838.

I have a dream…

• An evidence-based nutraceutical and
  botanical science
• RCTs on humans
• Adequate design
• Results reproducibility
• ... What else?

I have a dream…

• An evidence-based nutraceutical and
  botanical science
• RCTs on humans
• Adequate design
• Results reproducibility
• ... What else?

Overview of the molecular signalling
           pathways activated in skeletal muscle in
               response to endurance exercise

Free Radical
Biology and
Medicine 2016

Pleiotropic effects of catechins

Corti R et al. Circulation.
2009;119:1433-1441

Short term oral L-Arg improves pulmonary
vascular resistance in patients affected by
         pulmonary hypertension

                                 Nagaya N et al.
                                 Am J Respir Crit
                                 Care Med Vol
                                 2001;163:887–91

L-Arg aumenta FMD in acuto
          indipendentemente dalla dose

Bay Y et al. Am J Clin Nutr 2009;89:77–84

Beneficial effects of a long-term oral L-Arg
       treatment added to a hypocaloric diet and
      exercise training program in obese, insulin-
                resistant T2DM patients
150

140

130

120

110                                                                  Placebo
                                                                     L-Arg
100

 90

 80

 70
      WC_B     WC_Post   SBP_B     SBP_P    DBP_B     DBP_P

             Lucotti P et al. Am J Physiol Endocrinol Metab 2006;291:E906–12.

Beneficial effects of a long-term oral L-Arg
       treatment added to a hypocaloric diet and
      exercise training program in obese, insulin-
                resistant T2DM patients

65
60
55
50
45
40
35                                                                   Placebo
30
                                                                     L-Arg
25
20
15
10
 5
 0
     FPI_B   FPI_P   ADP_B      ADP_P    LEPT_B     LEP_P

             Lucotti P et al. Am J Physiol Endocrinol Metab 2006;291:E906–12.

Creatine supplementation influences
  body composition and substrate
          utilization at rest

     Eruk Huso M et al. J Appl Physiol 2002;93:2018–2022.

Combined creatine and protein
supplementation promotes muscle GLUT-4
 content and glucose tolerance in humans

     Derave W et al. J Appl Physiol 2003; 94: 1910–1916

Oxygen extraction (%) at maximal
                               exercise in CHF patients
% O2 Extraction (median)

                           60

                           50

                           40

                           30                                              Creatine
                                                                           Placebo
                           20

                           10

                           0
                                Pre                    Post

                                      Andrews R et al. Eur Heart J 1998; 19: 617–622

Creatine supplementation during
pulmonary rehabilitation in COPD
            patients

            Fuld JP et al. Thorax 2005;60:531–537.

Creatine supplementation
      improves brain
performance: a doube-blind,
 placebo-controlled, cross-
         over trial
 • Raven’s Advanced Progressive
 Matrices (RAPMs), validated as a
 measure of general ability with minimal
 dependence on cultural factors.

 • Wechsler Auditory backward digit span
 (BDS) task, loading on both short-term
 storage and verbal working memory
 functions supported by mid-ventrolateral
 and dorsolateral prefrontal cortex,
 respectively.

 Rae C et al. Proc R Soc Lond B
 2003;270:2147–2150

Putative determinants of the human
    muscle carnosine content

           Derave W et al. Sports Med 2010; 40(3):247-263

b-Alanine augments muscle carnosine
 content and attenuates fatigue during
repeated isokinetic contraction bouts in
            trained sprinters

          Derave W et al. J Appl Physiol 2007;103:1736–1743.

Effects of b-alanine supplementation on the
          onset of neuromuscular
    fatigue and ventilatory threshold in
              untrained women

                           Stout JR et al. Amino
                           Acids 2007;32:381–386

Effects of 28 days of beta-alanine and
creatine monohydrate on aerobic power,
 ventilatory and lactate thresholds, and
           time to exhaustion

                Zoeller RF et al. Amino Acids 2006

Effects of P. ginseng on Muscle Damage
 and Inflammation after Uphill Treadmill
           Running in Humans

                Am J Chin Med. 2011;39(3):441–450

The effects of P. notoginseng on delayed
onset muscle soreness and muscle damage
 in well-trained males: A double blind RCT

                        CTM 2013; 21:131—140

Conclusioni

• Un gran numero di nutrienti ed estratti
  vegetali sono stati sudiati in modelli
  preclinici per le potenziali attività
  adattogene
• L’evidenza clinica è limitata
• La qualità degli studi clinici disponibili è
  usualmente scarsa.

Per approfondimenti…

          www.sinut.it

Trattato Italiano di Nutraceutica
clinica. Scripta Manent Ed. 2017