Anabolic Bytes - Edition I

[dinoiii]

Anabolic Bytes
Edition I

Author’s Note: I spend quite a bit of time in the company of fitness enthusiasts that desire body composition change. Through countless emails, clients who seek advice through consultation, and various case presentations in multiple metabolic clinics have kept me consistently busy and engrossed within an industry I have come to grow and love over the course of 14+ years. It was through these avenues that I learned that achieving various goals or solving problems in the shortest (read most efficient manner) time frame would be a welcome addition in many of their minds. Consistently encountering these situations, many of the people contacting me with some sort of dilemma and suggesting the application of my own sub-forum (for which I remain completely flattered) echoed the aforementioned point of view and encouraged me to undertake the task of writing a piece that allows them to view more of these various interactions which often remain “hidden” from the public eye.

That being said, Anabolic Bytes covers a wide array of common problems and real world scenarios I am approached with on a day-to-day basis. While they tend to have similar solutions which I felt would be of benefit in including in one succinct piece, it cannot be underscored enough to what significance. To those that choose to read it, so be it – I am not offended by those that do not. Oftentimes, criticisms stem from those stuck in the very close-minded mentality they accuse me of being – I have now learned to embrace criticism as essential fear and welcome it in continued fashion – it implies I have successfully accomplished a job I set out to do. This is a true reflection of my belief, however, that understanding a select body of facts well is far more important than possessing superficial knowledge of many facts of varying significance.

Readers will notice that I have always expressed an intolerance for trivia, and I do NOT encourage rote memorization (although occasionally, I will resort to mnemonics or other tricks that enable the reader to place bare facts into a context that allows for easier retention of the information). There is a significant difference between knowing something and knowing ABOUT something. I feel that it is this way of expression that would encourage the reader to become more involved and not act as though I had to water down my writing so we could be on the essential “same page.” This is what would be my expression of say, what talking down to someone might look like.

Without further adieu, Edition I includes the following topics to follow in one unique thread – call it the UN-official newsletter of Discount Anabolics:

For the Love of Science and Medicine Part III
Research Review
Q&A

I hope you enjoy Edition I.
All my Best
D_

[dinoiii]

For the Love of Science & Medicine Part III – Debut of the Butterfly Gland

Author’s Note: For the Love of Science and Medicine has moved to Anabolic Bytes format due to its similarity to Q&A format. The continued push to offer up free supps and the like in attempts to encourage interaction will become a reality a few issues from now. Stay tuned.

A 29 year old male with no significant past medical history recently had experienced an intentional 20-pound weight loss secondary to going on a crash diet (defined as -1500 calories off BMR in this case) about 3 weeks prior. He became fatigued, depressed, and discouraged. Moreover, despite his continuing efforts and continued decreasing calories, he couldn’t lose any more weight, exacerbating the cycle. He stopped exercising and whatever positive results he had gained from the diet had all come but come to a crashing halt.

Labs:
Sodium: 138 mmol/L [N: 132-142]
Potassium: 4.2 mmol/L [N: 3.6-5.0]
Chloride: 106 mmol/L [N: 101-111]
Carbon Dioxide: 26 mmol/L [N: 21-31]
BUN: 26 mg/dl [N: 8-24]
Creatinine: 0.9 mg/dl [N: 0.9-1.6]
Glucose: 92 mg/dl [N: 60-99]
Tot. Bilirubin: 0.9 mg/dl [N: 0.0-1.2]
Direct Bilirubin: 0.0 mg/dl [N: 0.0-0.2]
Indirect Bilirubin: 0.9 mg/dl [N: 0.0-0.1]
ALT: 13 IU/L [N: 16-49]
AST: 10 IU/L [N: 10-60]
Alk Phosphatase: 68 IU/L [N: 49-142]
Albumin: 3.8 g/dl [N: 3.2-5.5]
Calcium: 9.2 mg/dl [N: 8.4-10.7]
TSH: 1.378 uIU/ml [N: 0.318-5.50]
Free T4: 1.2 ng/dl [N: 0.8-1.8]
Free T3: 233 pg/dl [N: 230-420]

Unphased by his blood work, the man was convinced he had thyroid problems. Per suggestion by a worker at the local health food store, he started taking kelp. Shortly after starting the kelp, his symptoms became much worse. Over the course of the following month, he gained back 15 pounds of the weight he had lost. A repeat thyroid panel was done.

Labs:
TSH: 42.1 uIU/ml
Free T4: 0.6 ng/dl
Free T3: 98 pg/dl

Questions:

1) What would most likely explain the patient’s scenario as seen above?
2) What would the next step of this patient’s treatment likely include (inclusive of additional labs and/or medication you may opt for)?
3) What is the best approach to offering advice on how best to avoid a similar situation from occurring in the future?

[dinoiii]

Research Review

Author’s Note: Research Review will be a summary of VERY current works in the endocrinology and metabolic world from various journals and an interpretation that does NOT simply regurgitate author’s thoughts, reveal true funding sources should it impact study results, and offer us some things to think about in the world of body composition. Feel free to comment on any of the studies – offering up your own interpretation, the nature of this is to really stir up conversation on thoughts of what’s considered hot off the press. AB, Edition II will likely see an expansion of this section offering up an inclusion of more interactive processes and of course, we’ll talk free stuff down the line again.

Article #1:
Mai K, Bobbert T, Kullmann V, Andres J, Rochlitz H, Osterhoff M, Weickert MO, Bahr V, Mohlig M, Pfeiffer AFH, Diederich S, Spranger J. Free Fatty Acids Increase Androgen Precursors in Vivo. J Clin Endocrinol Metab. April 2006, 91 (4): 1501-1507.

Summary – While this is the first study to offer what may be considered reasonable evidence that elevation of FFAs increases production of androgen precursors (DHEA, androstenedione) in vivo, a few criticisms deserve note. The power of the study (greatly influenced by the lagging sample size – 8 healthy male volunteers) is grossly inefficient. How applicable the results are to the general public remains unanswered. The study ended up a comparative analysis of saline/heparin infusion versus Abbolipid (20%)/heparin infusion and was overall very short term, so a longer-term study is definitely needed.

It has been suggested in previous models (namely those reflecting women with Polycystic Ovarian Syndrome - PCOS) that elevation of circulating levels of FFAs would induce insulin resistance and hyperinsulinemia, perhaps en route to metabolic dismay, obesity, and in worst case scenario…diabetes. An interesting finding in this study was that short-term hyperinsulinemia had no effect on any of the investigated androgens, however, a corresponding insulin elevation lead to a decrease in the level of FFAs. Therefore, any direct effect of insulin might have been counterbalanced by the reduction of FFAs. In comparison, postprandial (post-meal) suppression of FFAs might explain decreased androgens after an oral glucose load.



Article #2:
Orwoll E, Lambert LC, Marshall LM, Phipps K, Blank J, Barret-Connor E, Cauley J, Ensrud K, Cummings S. Testosterone and Estradiol among Older Men. J Clin Endocrinol Metab. April 2006, 91 (4): 1336-1344.

Summary – One landmark may be suggested by this study. It is the largest cohort (5,995 community-dwelling, ambulatory men > 65 yrs. or better stated: non-hospitalized and still able to walk around) of older men in which sex steroid levels are available, and it suggests that testosterone AND estradiol, and their free fractions, tend to decline with age even among older men. One important notable drawback is the lack of accounting for substantial variation present in men in general.

The biggest positive of this study (presented as a large multivariate analysis) is the fact that it essentially offered confirmation of the results of smaller cross-sectional and longitudinal studies:
- older men had lower testosterone, estradiol, and free fraction levels than younger men
- reduction in free testosterone levels with age is more pronounced than total testosterone
- the rate of decline is seen to approximate 10% per decade ALMOST UNIVERSALLY
- variability of estradiol levels in older men was not as pronounced as testosterone and one of the most incredible findings was likely that which could be assumed here: estradiol (namely free and/or bioavailable) levels declined with age – which has earned a mixed review in former studies, however, more often than not it is thought that estradiol levels increase – please note that this is a new rationale hypothesized for our increased interest in potential pathogenesis of osteoporosis in males
- men with the highest levels of free testosterone had approximately twice the level of estradiol than those with lower levels – which makes sense and can likely be explained by aromatase activity

One of the more interesting findings from this study was the uncovering of supported racial discrepancies. When age and BMI were adjusted for, the total levels of serum estradiol and testosterone gave us some interesting things to think about in variability. A summary of various serum values follows:

Total Testosterone: Hispanic > African Americans > Caucasian > Asian
Free Testosterone: Hispanic = African Americans > Caucasians > Asian
Total Estradiol: Asian > African Americans > Hispanic > Caucasians
Free Estradiol: Asian > African Americans > Hispanic > Caucasians
SHBG: African Americans > Caucasians > Hispanic > Asian

[dinoiii]

Q&A

Author’s Note: Q&A goes on to replace “Unaswered Questions from Emails and PMs” because all of the questions featured are NOT simply questions “UN-”answered but an offering of interaction of behind the scenes offering NOT always visible to everyone, yet likely influences many of us at some point in our bodybuilding lifetimes. Also notice that names are still kept confidential at the discretion of the question-writer. One thing down the line is a contest series of sort for what may be considered “question of the month.” The kinks have to still be worked out though.


Question 1
Q: hello,
I have a question for you.

I am looking to lose a good amount of weight. I have been taking Lipodrene for about two weeks. I weigh about 310 and I do Cardio workouts for 25 minutes on the elliptical for 2 miles 3-4 times a week. I also eat a lot healthier than before I started, I eat a lot of Veggies, Fish, Chicken, and some others. I also drink tons of water through the day. I have read a few comments saying that working out hard 3-4 times or more a week when using Lipodrene can hurt your heart. I was wondering if you had any suggestions on what I should do. Should I decrease my Workout to 2-3 Days a Week or change what I’m doing. I was wondering if you had any suggestions or any ideas on what I should be doing, I don’t know much about what the best way to lose weight is. I would greatly appreciate some help, Thanks.

A: Actually, in theory, you getting on the elliptical trainer is more damaging to your heart (through oxidation) than your use of Lipodrene and/or ephedra-constituents. While a substantial body of historical evidence, clinical experience, and scientific data support the potent cardiovascular effects of ephedrine and related sympathomimetic compounds, so do they paint a consequent autoregulatory picture. The cardiovascular effects are more likely vascular than they are cardiac in nature. Any blood pressure issue that may be related to the use of such compounds has been shown through various trials to NOT be statistically significant when compared with placebo.

I am going to assume that you are not suffering any type of ill-fated side effect (rapid heart beat, increased blood pressure, palpitation, etc…) as I answer this question, but if you do – it is imperative to either stop taking the supplement or re-titrate your starting dose to be as safe as possible with it. You also failed to mention how many times each day you are taking the supplement, which would give a better idea (albeit not perfect) of total concentration (see below).

One worthwhile note is that Lipodrene like all ephedra commercial preparations contains various ephedrine alkaloids (ephedrine, pseudoephedrine/isoephedrine, norephedrine, methylephedrine, methylpseudoephedrine), tannins, and other constituents (like quinoline and 6-hydroxykynurenic acid) in variable concentrations – of which I am not aware of – but this the trouble with use of a whole herb. Some assumptions can be made about the concentration based on both species of ephedra used and part of the plant as follows:

Plant Part
Stem: appx. 0.5% - 2.5% alkaloids (with ephedrine accounting for 30-90% of the total alkaloid content)…a good rule of thumb is that the softer the stem is, the greater the alkaloid content tends to be. Therefore, a woody stem is likely closer to our approximation of 0.5% whereas a soft stem is upwards of 2.5% active alkaloids.
Fruits & Roots: Virtually NONE

Plant Species
Ephedra sinica: highest alkaloid concentration
Ephedra intermedia
Ephedra nevadensis: the North American species virtually devoid of alkaloids

Double-blind, placebo-controlled studies do have some valuable take home points that can likely be applied to this and any other ephedra product:

• Increases in mean systolic blood pressure (top number when reading a blood pressure) were dose-dependent (therefore, you will likely see greater effects with a higher dose – one of the likely reasons for the initial ban as it was easy for many the consumer to apply the more is likely better mentality).
Dose Dependent Nature of Systolic BP increases
Ephedra/Caffeine: 10mg/200mg = Avg. 5-7mmHg systolic BP increase
Ephedra/Caffeine: 20mg/200mg = Avg. 10-12mmHg systolic BP increase
Ephedra/Caffeine: 30mg/200mg = Avg. 14-20mmHg systolic BP increase
[Note: standardizations for ephedrine alkaloids were usually NOT judged and thus a limitation of such studies.]
• Changes in diastolic blood pressure (bottom number when reading a blood pressure) were variable (and therefore harder to predict).
• Heart rate increases occurred only at higher doses.
• All of the aforementioned conditions were confounded by the addition of caffeine.

It is very hard for me to offer up a lot of other advice without typical information like caloric intake and macronutrient breakdown attempts. I cannot judge what potential changes may need to be made in your workouts as you do NOT seem to tell me whether you are solely doing cardio and not lifting with weights, etc….however, if you can fill in those gaps, I would be glad to help in any way that I can.






Question 2
Q: Hi I was wondering how various supplements affect diabetes. I know that some supplements help with the absorption of fats and some can increase muscle and/or energy but what happens when they are taken by a diabetic?

A: I think you have asked a phenomenal question here. While the supplement choices are virtually endless, I will focus my answer here on what I feel to be the most important based on the most common complaints plaguing the patients I have seen.

It is common practice and with that good practice to prescribe supplementary vitamins and minerals for diabetics. This is primarily because most diabetics have chronically elevated blood sugars and ultimately urinate a lot. Excessive urination causes a loss of water-soluble vitamins and minerals. Perhaps this explains the two most common complaints of diabetics, generalized fatigue and side effect profiles that are representative of the cardiovascular sequelae that they are subject to without preventative measures.

Recall that water-soluble vitamins include: C and B-complex. That being said, doses of Vitamin C in excess of 500mg AT A TIME (which would be rationale to employ multiple daily dosing protocols) may interfere with the chemical reaction on your blood sugar (glucometer) strips. As a result, your blood sugar levels can appear ERRONEOUSLY low.

Niacin – one of the more common signs of niacin deficiency is the elevation of an enzyme by the name of 2,3 DPG (which displaces the oxygen molecule from hemoglobin and thereby allows it to diffuse into the surrounding cells). Diabetics are routinely deficient in 2,3 DPG, and this deficiency prevents a substantial amount of oxygen from being released into the cells. Deficiency of 2,3 DPG, therefore significantly impairs oxygen consumption and energy production in diabetics. To help with 2,3 DPG synthesis, I would consider at least 100mg of niacin 2-3 times per day.

Alpha Lipoic Acid + Thiamine (Vitamin B1) – these two items serve central roles in the Kreb’s Cycle by being nutrients essential for the production of something called acetyl-coenzyme A (CoA), the substance that essentially starts the cycle. Without adequate levels of this precious starting product, you’re literally dead in the water and energy levels take a hit. A 1996 Diabetologia article showed just how critical the authors felt that thiamine was for initiation of the Kreb’s cycle. So how does thiamine work? Lactic Acid is converted by thiamine into acetyl CoA. Alpha Lipoic Acid literally is the first item that literally aids in blood sugar modulation. In recent years, we have considered the “R” isomer (rather than the racemic mixture) to be the prominent component of creating this hormonal order and hopefully with it, thoughts of shunting sugars to appropriate tissue distribution (i.e. – muscle as opposed to fat). In diabetics, however, there are actually additional benefits that include but are not by any means limited to reducing incidence of cataracts in diabetic patients, prevention of kidney damage, and disruption of peripheral neuropathy complications commonly experienced by diabetic patients. One hypothesis is the powerful antioxidant power of this compound that leads to these positive effects. What doses are appropriate? A minimum of 100mg of thiamine 2-3 times per day (are you seeing a trend with B vitamins? Multiple daily dosing patterns are FAR SUPERIOR). For alpha lipoic acid, a starting dose of about 400mg is likely most appropriate dependent upon the degree of side effects seen. Be careful with ALA as it may induce hypoglycemic (low blood sugar) episodes used in conjunction with various hypoglycemic agents (for Type II Diabetics) and/or insulin preparations (for Type I and Type II Diabetics).

Magnesium - It works as an essential cofactor for the Kreb’s Cycle, but also almost all of the enzymes involved in the production of energy. 700-1000mg per day is an ideal range. I postulate that with subsequent blood pressure woes that tend to plague type II diabetics, magnesium taken in the potassium magnesium aspartate (or what I have written about as MPA in BodyOpus Reloaded article). Taking it in this form allows correction for disrupted Potassium:Sodium ratios which is at the base of hypertensive pathology, whereas it has been long-assumed sodium was of sole importance – potassium plays a bigger role here.

Manganese - Again, this is one of those Kreb’s cycle players, but it also activates the enzymes responsible for sugar metabolism. A study in a 1987 article from the American Journal of Clinical Nutrition saw about ONE HALF the level of manganese in diabetics versus nondiabetic populations. The dose: Establishing a dose here has been not as easy for me and any clients/patients. Watching for central nervous system toxicity (first described in 1937 by Chilean manganese minors who were exposed to manganese-containing dust and developed locura manganica or the better known – “Manganese Madness”), mania, insomnia, depression, and delusions, followed by anorexia, apathy, arthralgias, asthenia, headaches, irritability, lethargy, and lower extremity weakness. If toxicity signs and symptoms are not addressed, all of these eventually progress to alterations in gait and balance as well as tremor and Parkinson’s-like symptoms (including tremor and rigidity), consistent with manganese deposition in the basal ganglia. This is actually a substance where symptoms may not approve with withdraw of supplemental manganese which is perhaps why you can see my frustration. Therefore, based on recommendations placed by the Food and Nutrition Board, I have used successfully the following guidelines:

* 14-18 yrs. + during pregnancy – 9mg/day
* adults >19 yrs. + breast feeding/lactation – 11mg/day

to come up with a suggested correction dose of 10mg/day for MOST patients. Of course, volume of distribution is the lagging factor here for complete correction.

One of the trickier items you talk about is the weight and body composition changes that your question centers on. The reason this is complex with a diabetic is because of the prototypical medications that diabetics are on. Namely: insulin, sulfonylureas, and TZDs to name a few. Each of these items while “ANABOLIC” in nature should NOT fool you in to thinking that solely means muscle is in your future. They tend to lead to significant fat gain as well as muscle and oftentimes are rationale for many diabetics to become rather frustrated with their therapy and even at times become non-compliant. It’s kind of a conundrum really as fat gain of any sort (likely furthering the insulin resistance scenario) is NOT really what lends itself to the ideal diabetic treatment modality. Newer regimes inclusive of drugs like Byetta may be a step in the appropriate direction (with promotion of weight loss for the first time – it likely won’t be long before bodybuilders attempt to break into this market) proving to actually offer people the concurrent weight (fat) loss they are looking for.

This being said, insulin-mimicking agents, like glucose disposable drinks (which don’t necessarily need to cost a lot – i.e. – see BodyOpus: Reloaded for more info). In addition to cinnamon and alpha lipoic acid (racemic, R isomer, potassium salt, dihydro metabolite, etc…), cheap insulin potentiators include: chromium, vanadium (if dosed high enough), Gymnema sylvestre, and Lagerstroemia speciosa L. (standardized for corosolic/colosolic acid).

One thing to be careful about is when starting ANY of the insulin-potentiating items during concurrent use of various diabetes medications, it is very easy to promote hypoglycemic (low blood sugar) episodes. This is a very dangerous situation and I would advise you to use EXTREME caution when using ANY of them together. If you experience any of the following symptoms during employing any of these agents, it is advised to immediately STOP taking the supplement:

- sweating
- trembling
- tachycardia
- anxiety
- weakness
- hunger
- nausea/vomiting
- cerebral glucopenia (headaches, mental confusion, somnolence, personality changes, inability to concentrate, convulsions, and loss of consciousness)

Many of these aforementioned symptoms are brought about by the counter-regulation of epinephrine in the face of lowered insulin/blood glucose.

[dinoiii]

Question 3
Q: I'm currently on a low GI diet High Protein, High in Unsaturated Fat, Fibrous Vegetables and Fruit.

I'm taking Glucophage as follows
Week One- 850mg
Week Two-Seven 850mgx2 Daily
Week 8- 850mg

I know you do not recommend it but can you give me some suggestions on how to make this as safe as possible. Should I only be taking it on Carb-Up Days? Is it even beneficial if I'm already in ketosis?

A: I am making some assumptions from your question. First Assumption: you’re not diabetic, Second Assumption: Based on your question, you have NO idea what you’re doing. Satisfying both my assumptions - you’re right; I do NOT recommend the self-prescribed use of Glucophage (Metformin) at all!

Apparently, you are employing some type of CKD as is, so I ask why you feel the need for such a compound. Note: Ketosis is NOT necessary to experience success on such a diet. Ketosis compounded by the blood glucose-lowering effect of a compound such as Metformin can put you in a dangerously low hypoglycemic state if you are not careful. That being said, to make certain you are aware of what I am talking about – I am talking about coma-low! There is the potential for a VERY dangerous side effect known as lactic acidosis as well – in an unmonitored state, there is no way to be sure if this is happening and could be hard to differentiate between natural acidotic states of someone that simply works out. If a plasma level of lactate exceeds 3mM (of course, you would have no idea), immediate cessation of the drug is advised. Now, these are the most serious of side effects, however, up to 20% of patients experience diarrhea, abdominal discomfort, nausea, anorexia, and a metallic taste – doesn’t really sound pleasant does it.





Question 4
Q: Hello Dinoiii,

My name is ***********, I am 37 years old and have been monitoring the DA forums for about 8 months now. I finally decided to stop being just a spectator and join. Your medical knowledge which extends to fitness, supplements, diet and exercise is impeccable. I really enjoy reading your articles and help to other members. I would like to start a cycle of Halodrol for first time PH use. I am not sure how wise to perform a cycle but I would like to try.

Here are my stats:
Age: 37. Weight: 182lbs. Height 5' 8"
BF: Unknown (I apologize).
Weight training: 3 years, played Soccer and Cricket earlier years.
Current Medications: Theo -24 (THEOPHYLLINE) 300mg daily. Singulair 10mg. and ADVAIR Diskus 250mg inhaled once a day.

I read your articles on PCT and started aquiring your recommeded supplements.
Question 1. Is it wise to start a cycle of Halodrol while taking the above medications?
Question 2. Due to my paunch midsection (assuming I have unacceptable BF levels) should I wait until I get the midsection smaller before I take PH? Does BF affect the use of PH?
Question 3. IC3 use. For a 4 week cycle of Halodrol only, my PCT in theory should be 4 week cycle. How will I dose IC3? In your article, you indicated IC3 is dosed like a male birth control. Three weeks on and 1 week off. Can I use this dosing for my 4 week PCT?

I fully understand you are a busy man and you get millions of questions. Also I would like to apologize again for not having my true body fat level. I would like to thank you in advance for any help you can provide me.

Thank you

A: Well thank you for your kind words. I must ask first and foremost how your apparent asthma has been controlled. I am assuming the medications you mention to be maintenance. Something of the “rescue inhaler” variety would include the likes of albuterol. If you do use it, but fail to mention it because you don’t use it on a daily basis, I am more encouraged….otherwise, how often do you find yourself using it as of late (if greater than 2 times per week, it is likely time for an adjustment in your maintenance meds)? Do you know how your theophylline therapeutic levels been (or do you get them measured)?

I will move on to your questions hesitantly, as I will only speak hypotheticals in this situation because it seems you have already made up your mind about use and I judge you to be a responsible adult (37 yrs.) who has likely sought out your own examining doctor’s advice FIRST before embarking here. If you feel your doctor is unaware of Halodrol and its abilities (not unusual for physician’s to not look into pro- hormones), feel free to discuss the following with him before truly embarking on such an endeavor.

Question 1. I feel it is interesting that you have chosen to begin with something like Halodrol and personally don’t advise it. Methylxanthines like Theophylline are extensively metabolized by the liver (less than 15% is excreted unchanged in the urine). It would NOT be unusual to assume that the half-life of Halodrol while on something like Theophylline would be extended almost 2-fold. I think the theophylline would still obey first-order kinetics and allow a nice return to non-toxic levels if the Halodrol dose was cut in half, but in order to ever truly assess this, you would first need to get a set of liver function tests and theophylline levels done by your physician.

Question 2. A “Paunch” midsection huh? I actually laughed aloud at that one. It is likely a safe assumption to assume some aromatic conversion with increased androgen levels via increased levels of the aromatase enzyme – usual habitants of adipocytes (fat cells). There are likely mixed reviews, however, on what is a “safe” BF% level to begin use of various exogenous anabolic/androgenic substances. Some may side with it being ok if the substance used is non-aromatizable, but this doesn’t take into consideration the fate of newly acquired increased overall androgen levels. Some estrogen in this picture too is likely needed and may very well be a welcomed addition to the equation in a controlled fashion. If your thoughts are to include something like I3C, you may consider its addition before the cycle’s conclusion (i.e. – throughout).

Question 3. I like I3C and feel it can be dosed like a male birth control for simple estrogen control almost year-round and this is something I partake in myself, however, a 4-week cycle without anticipated lab values is tricky – it may or may not cause HPTA suppression and with it likely would not warrant the use of such an item in the first place. The “need” is therefore case-based, but the “general use” is likely not going to do much but benefit. I think the choice could be considered yours and a 3-on/1-off week dosing protocol would likely fit most appropriately for proper estrogen modulation.



Question 5
Q: I want to take your advice about switching out of Flax oil, and take more of a different EFA. You had mentioned CLA at 10 g a day. I was wondering if any CLA at 10g a day would be better or would be looking into a product like Sesamin or Sesamax better suite fat loss and muscle retention on a low-carb diet?

Thanks Dinoii

A: CLA is a funny molecule that consists of a number of various isomers – of which, we only consider a couple biologically active, and have focused our research attention. I have discussed on the forum in numerous posts how this molecule’s various isomers are extracted. The 10 grams per day that I suggest is not so focused on the total tally of CLA but the total concentration of biologically active isomers adjusted for volume of distribution (body composition of the average 200-pound bodybuilder).

The “conjugated” portion of this nutrient’s name refers to two double chemical bonds within its structure. The location of the bonds dictates a given isomer’s specific designation. For example, the cis-9, trans-11 CLA isomer (also known as rumenic acid, or c9t11) is the most common isomer found in ruminant-derived foods, and is believed to be one of the most biologically active isomers. Trans-10, cis-12 CLA (t10c12) is present in far smaller concentrations, but may play an especially important role in modulating health. These two isomers are considered the most biologically important forms of CLA for human health. Most commercially available CLA supplements include a roughly equal mixture of both at a rough 70-80% concentration. It is a good idea to look for Tonalin brand (potentially Clarinol as a second choice) to simplify what you are looking for.

You ask an interesting question and I want to make sure I am certain what you are asking before replying definitively. If you are asking if the use of Sesamin-type products in addition to CLA would be a good idea, then I am inclined to say yes. If you are asking if the use of Sesamin-type products should replace CLA, then I am inclined to say no.

Sesame seed lignans in particular are beneficial. Studies show that sesame lignans, including sesamin and sesaminol, enhance vitamin E’s absorption and availability, improve lipid profiles, and help normalize blood pressure. Animal studies show that sesame lignans enhance the burning of fat. One study demonstrated that sesame increases the activity of several liver enzymes that break down fatty acids. Optimizing the liver’s fat-burning capacity may promote fat loss and may account for sesame’s lipid-lowering effect.

Sesame lignans also boost the weight-loss effects of CLA. Japanese scientists studied whether dietary manipulations could enhance CLA’s effects in reducing body fat. They found that sesamin helped stimulate the loss of adipose tissue. Researchers think that sesame lignans increase CLA’s effects by stimulating a pathway of fatty acid breakdown called beta-oxidation.

Additional support would lend to an increased synergism, yet still, with the addition of guarana to this potent duo rather than ingesting any of the two products (CLA and/or Sesamin) alone. Very few companies take advantage of this – there are a few exceptions to this, however.





Question 6
Q: I know you from the forums and I was wondering what I should do. I'm twenty years old, very active but I feel that I have a low sex drive and possibly low testosterone levels. I am not able to ejaculate more than once a day, and sometimes I have no sexual urge for the next day too. I bought Tribex and took about half the bottle but stopped when I started my BSN stack. I was wondering if you might know anything that can cause this.

P.S. - I have never taken steroids or a pH.

Thanks in advance

A: One thing that jumps out at me (while I don’t think it was your intention, it still made me chuckle) – I am hoping you did NOT take half the bottle of Tribex at once in hopes for a jump start. Really to make any sort of definitive rationale to your obvious dilemma would likely require lab values and more information, but I would be hard pressed to bet my money on a short course of Tribex, but there’s always a first time.

If you are defining “sex drive” and “low testosterone” as implying erectile difficulties (i.e. – lack of sexual urge on alternating days) than there is likely a lot of wiggle room (no pun intended) in the form of potential etiology-uncovering and subsequent correction of your dismay. If your definition of low sex drive centers on your lack of actual ejaculation, this is a distinct difference and one that some women would likely say is OK in the face of continued erection.

Male erection problems are oftentimes caused by partially blocked arteries, the same kind of cholesterol and plaque blockages that cause heart attacks. In addition, doctors are now learning that erection problems are often a clue to how circulatory blockages elsewhere (consider the retinal vessels with vision change or kidney vessels with urinary issues – perhaps these are two examples of areas that can be used to assess circulatory etiology?).

The opposite is also true. There is increasing evidence that high cholesterol and heart blockages are often a precursor of erection problems. All of this being said, perhaps moving to the BSN stack you suggest (which I am assuming to include NO Explode and/or Nitrix) may be a step in the right direction toward vessel dilatation.

Nonetheless, I would get to the doctor very quick if this has become an impending issue with you.

[dinoiii]

Author'e Note:
The following is the transcript of a back and forth with a DA forum member about the potential status of a breast mass – I have included the initial 4 emails back and forth (subsequent emails have been omitted due to potential identity disclosures, but a case follow-up is subsequently offered).

Q: Hey Dinoiii,

This is ******** from DA,
I recently had some blood work done, as I discovered a lump beneath my left nipple. All values came back as normal, but I would like you to look over the values if you could, I would really appreciate it.

I recently, a few weeks ago, noticed a very painful lump underneath my left nipple. Any time I would press on it, it felt like a stabbing pain to my pec. I’ve been going to the doctor, and got blood work done, and just had a ultrasound taken this past friday. I have never done and prohormones or steroids. Again, my blood work came back normal, but I was wondering if you could look over the values for me, and maybe offer some advice for me in relation to the lump.

I know you are busy, so whenever you have time to reply would be fine, and I will list the values in the next email if you agree to help me out.

Thanks a lot.

A: "Normal" is a tricky word sometimes, but the fact that the "lump" was painFUL (vs. painLESS) is good indication that this is NOT something malignant, etc... My questions would center on whether or not you have either had any recent illness, sick contacts, or infections (that may or may not be related to the breast area)? No fevers, chills, fatigue, malaise, nausea, vomiting, diarrhea, constipation, changes in bowel or urinary patterns? You have not had any recent injury to the breast area? And don't worry, my expectations were not including PH's/PS's/AAS when I read your initial email just based on the symptomatology.

U/S is an interesting test, but may come back with very non-definitive answers. Have you since, gotten results of that test? They may choose to take a needle aspiration, but it really may turn out to be something as benign as a Lipoma (though I have not seen the mass to make any kind of definitive guesses). You could take a picture of it and send it via an attachment if that is not too much trouble. It never hurts to grab as many opinions as possible - but for now, I would have to support the examining physician's report from afar.

Send the lab values as you can. I am not certain what he was checking for with them. Maybe a WBC (white blood cell) count to r/o infective process? Also potentially a differential (Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils). If it looks more like a hematoma - a platelet count and PT, INR, PTT may be of some benefit. All should have been accomplished through basic CBC and Coagulation profile, but just shoot them this way and I would take a peak.

Q: Thanks a lot Dana,

I really appreciate your help. I believe the blood work was done because the doctor was looking for hormonal imbalances (gyno) in relation to my lump.

Heres the values:

Na+ 137 MMOL/L
K 4.1 MMOL/L
CL- 102 MMOL/L
CO2 30 MMOL/L
Glucose 91 MG/DL
BUN 15 MG/DL
CREAT 1.1 MG/DL
CA 9.4 MG/DL
AST 29 U/L
TBILI 0.7 MG/DL
ALT 28 U/L
ALK PHOS 78 U/L
PROTEIN TOTAL 7.5 G/DL
ALBUMIN 4.2 G/DL

TESTOSTERONE 567 ng/dL
TESTOS FREE 17.4 PG/ML
ESTROGEN 121 PG/ML

Interpretations:

Females:
Prebubertal <40 PG/ML

Adult Cycle:
1-10 DAYS 61-394 PG/ML
11-20 DAYS 122-437 PG/ML
21-30 DAYS 156-350 PG/ML
Postmenopausal/Castrate <40 PG/ML

Males:
Prepubertal <40 PG/ML
Adult: 40-115 PG/ML

HMG Treatment: 400-800 PG/ML

Everything looked within the ranges they said were normal, but my estrogen levels seemed at bit high as according to the interpretations above, adult male estrogen levels should be 40-115 PG/ML, not 121 PG/ML as mine was, though I don’t know how significant that much above is. My ultrasound results don’t come back till later this week, but I will update you when I get those results.

I have had no recent illnesses, infections, GF was sick though and had some contact :) though it was just a cold, no fevers, chills, vomiting, diarrhea, changes in bowel or urinary patterns. I’ve been taking the same supplements as I always have: whey, CEE, multivit, folic acid.

The only things that you mentioned that I have had happen lately include feeling more nausea lately while working out, seem to be getting headaches more often. I get plenty of sleep (8 hrs) and eat and drink well. I’ve been lately feeling more fatigued in the afternoon (though I’m getting plenty of calories in and don’t abuse stims). Not sure if this is in concurrence with the lump or just coincidence.

My age is 20, male, and I started noticing the lump in December after ending my x-factor cycle. It began as a sharp pain, then into a lump + pain, then not hurting as much lately but still a lump. The doctor said it could be due to many things, trauma (actually did get a hard hit in chest from baseball before the lump), hormonal imbalance, a cyst, buildup of fat and/or pus, or even cancer.

I’ll get the ultrasound results back to you when I get them.



Case Update: Looking over his labs, a few things can be assumed. Lab norms vary dependent upon the lab and this is due to the way that the tests are performed so I will take his values that were given to be normal with a minor elevation in estradiol. Suggestion of gyno would have to have been supported solely based on examining physician diagnosis, but I have not heard issues in follow up and personally I hope the lab values are not all that was used in making that suggestion. Prolactin, TSH, DHEAS, and in extremes estrone would likely have aided the diagnosis to a degree.

I have dealt with two different labs in my medical experience…LabCorp and Quest Diagnostics. What is considered “normal” still varies from that considered “optimal.”

LabCorp [during my time in Baltimore]:

Total Testosterone: Normal: 241-827 ng/dL (recently changed to upper limit of 1200), Optimal: 500-827 ng/dL (likely closer to 600-1200 these days)

Free Testosterone: Normal: 9.3-26.5 pg/ml, Optimal: 18-26.5 pg/ml

Estradiol: Normal: 3-70pg/ml, Optimal: 10-30 pg/ml

Quest Diagnostics [during my time in St. Louis and Chicago]:

Total Testosterone: Normal: 260-1000 ng/dL, Optimal: 500-1000 ng/dL

Free Testosterone: Normal: 50-210 mg/ml, Optimal: 150-210 mg/ml

Estradiol: Normal: 0-60 pg/ml, Optimal: 15-30 pg/ml

The mass ended up being quoted a “build-up of breast tissue” that seemed to subsequently digress. I never followed on it as the writer seemed content with this offering. Ultrasound is by no means diagnostic and certainly offers little about pathology. I would still question the diagnosis of gyno (more so on an etiologic sense) based on its presentation (lipomastia vs. gyno vs. mastitis) as a “build up of breast tissue” can suggest the latter two, with some potential in the former if in fact the fat build up impedes other tissues.

[dinoiii]

NEXT Edition

For the Love of Science & Medicine IV
Conclusion to FLSM III
Liver Love
Prostate Points
How to Look Good Naked in 30 days
Research Review
Q&A

[Jswoll]

1) What would most likely explain the patient’s scenario as seen above?
2) What would the next step of this patient’s treatment likely include (inclusive of additional labs and/or medication you may opt for)?
3) What is the best approach to offering advice on how best to avoid a similar situation from occurring in the future?
1) iodine
2)stop taking it, look at real root of problem ORIGNAL PROBLEM glycogen levels, but TSH that HIGH and no slight boost in T3, an insulin problem on top of that maybe...busy at work to think, synthetic thyroid will drop TSH and in a temp fashion bring up T3 and 4 discontinue and rebound (armour maybe?)
3) never list to GNC

[Clickster]

Nice writeup Dinoiii.

[LEARN]

dude dude

your post are freaking amazing you must spent a lot of time with these great post

[mikeyt]

Never cease to amaze.

[B-natural]

nice work D, really informative, what would be the required dosage of guarana for a 170lb individual? I am 23, and am on somewhat of a ketogenic diet for my competition. I am also taking 3pills of Scivation Sesamin and 6-8pills of Omega 3's daily