Nutritional supplement series

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INTRODUCTORY REMARKSPart 29 includes two supplements which are tradi-tionally paired (phlogenzym and wobenzym) and which have been popular in the Eastern Bloc coun-tries though hardly, if at all, used by athletes in the UK and USA. Phosphatidylserine (a phospholipid present in cell membranes) and plant sterols (sev-eral of which have been dealt with in the previous issues of this series) are also discussed here.

PHLOGENZYM AND WOBENZYMM K RanchordasThe active ingredients found in phlogenzym are the hydrolase trypsin, the endopeptidase bro-melain and the biofl avonoid rutin. Trypsin is a digestive enzyme produced by the pancreas and secreted into the small intestine, where it hydro-lyses proteins. Bromelain is a proteolytic enzyme obtained from pineapples, and rutin is a biofl a-vonoid found in many plants, fruits and vegeta-bles but the richest source is buckwheat. Similarly, wobenzym also contains trypsin, bromelain and rutin but also includes the proteolytic enzyme papain, the endopeptidase chymotrypsin and pancreatin which is an extract from the pancreas of animals that contains pancreatic enzymes.

Phlogenzym and wobenzym are commonly known as hydrolytic enzymes or systemic enzymes and have been purported to possess anti-infl ammatory, fi brinolytic and analgesic proper-ties as well as having positive effects on oedema. Studies investigating the effi cacy of phlogenzym and wobenzym in the athletic population are lacking but several studies have investigated their effects on recuperation following injury, disease and health.1–7

In a double-blind prospective randomised study, phlogenzym was compared with diclofenac in the treatment of activated osteoarthritis of the knee in 63 patients.1 Phlogenzym supplementation for 3 weeks in doses of six tablets per day (540 mg bro-melain, 288 mg trypsin, 600 mg rutin) was found to be more effective than diclofenac in reducing pain over the 3-week period and phlogenzym was superior to diclofenac in reducing pain 3 weeks after supplementation had stopped.1 In a similar study, phlogenzym supplementation was found to be just as effective and well tolerated as diclofenac in the management of osteoarthritis over 3 weeks of treatment.5

Studies investigating phlogenzym supplemen-tation for the treatment of lateral ankle ligament injury is mixed. Two clinical trials have found

positive effects,2 3 but a separate, larger study that recruited 721 patients found no positive effects.4 After injury, phlogenzym has been reported to decrease fi brin deposits and restore microcircu-lation in rabbit skeletal muscle.6 Phlogenzym supplementation in conjunction with dietary counselling and acupuncture was more effec-tive in treating rotator cuff tendinitis compared with an exercise group.7 However, these fi ndings should be interpreted with caution as the group that received phlogenzym also received diet coun-selling and acupuncture; therefore, the signifi cant improvement could have been attributed to other factors as there was no treatment group that solely received phlogenzym.

Although studies in the athletic population are lacking and fi ndings have been mixed, the research investigating the effects of phlogenzym and wobenzym suggests that they could be used as an effective anti-infl ammatory and analgesic. However, future research should also investigate the potential mechanisms of action.

PHOSPHATIDYLSERINEN BurdPhosphatidylserine is a phospholipid that can be found in the brain and muscle cell mem-branes, and among other bodily cell membranes. Phosphatidylserine supplementation occurs to, expectantly, improve cognitive function, prevent muscle soreness and/or increase exercise capacity (eg, time to exhaustion). Original work assessing the potential of phosphatidylserine supplementa-tion to enhance the mental/physical performance used phosphatidylserine derived from bovine cor-tex; however, the risk of transferring infectious disease makes this source no longer viable.8 9 Instead, soya-derived phosphatidylserine, which is molecularly different from a bovine-derived source, has surfaced as a usable alternative.9 The ‘optimal’ supplementation regime for the soya-derived phosphatidylserine remains to be truly defi ned (typical daily doses range from 100 to 500 mg), although ergogenic effects on the perfor-mance have been reported to manifest at higher daily doses (ie, ~800 mg/day).8 As for dietary sources, all organ meats and fi sh represent the dietary sources of phosphatidylserine.10

To come to the point, a paucity of data exists to suggest that supplementation with soya-derived phosphatidylserine will increase exercise perfor-mance/capacity, decrease postexercise cortisol responses, or improve mood state.8 11 Moreover,

1Department of Sport, Sheffi eld Hallam University, Sheffi eld, UK2Department of Human Movement Sciences, University Medical Centre, Maastricht, The Netherlands3Biology Department, Drake University, Des Moines, Iowa, USA4Australian Institute of Sport, Canberra, Australia5Performance Infl uencers Limited, London, UK6Green Templeton College, University of Oxford, Oxford, UK

Correspondence to LM Castell, Green Templeton College, University of Oxford, Oxford OX2 6HG, UK; lindy.castell@gtc.ox.ac.uk

Received 4 December 2011Accepted 4 December 2011

A–Z of nutritional supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance—Part 29M K Ranchordas,1 N Burd,2 D S Senchina,3 L M Burke,4 S J Stear,5 L M Castell6

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Nutritional supplement series

Br J Sports Med 2012;46:155–156. doi:10.1136/bjsports-2011-090836156

the riddance of bovine-derived phosphatidylserine for human consumption (precluding our ability to compare these results to a soya-derived source) and the uncertainty of whether exog-enous phosphatidylserine is, in fact, incorporated into cellu-lar membranes point out that more questions than answers still remain with regard to the potential ergogenic effects that plant-derived phosphatidylserine supplementation can have in healthy athletes.

PLANT STEROLSD S SenchinaPlant sterols are also known as phytosterols (or phytostanols when saturated). Most commonly, phytosterols are produced from a cycloartenol precursor which makes their synthesis different from animal sterols (zoosterols) which are derived from a lanosterol precursor. Various phytosterols have been discussed previously in this series including γ-oryzanol,12 octosanol and policosanol,13 and supplements containing Cissus quadrangularis.14 15 No direct ergogenic properties have been found from these phytosterols.

Several studies have demonstrated that sitosterol is the most abundant phytosterol in plants and consequently in Western diets. Ultramarathon runners supplemented with β-sitosterol capsules displayed fewer cellular markers of infl ammation (particularly those related to neutrophils) after a race compared with placebo-treated controls, suggesting that phytosterols may mitigate the effects of acute, strenuous exercise on immu-nity.16 However, in a study of trained runners subjected to an exercise bout of increasing intensity until exhaustion, the heart rate and blood lactate were uninfl uenced by phytosterols.17 In a study of older sedentary adults, 6 months of endurance training reduced plasma cholesterol levels while increasing the absorp-tion of phytosterols contained in a normal diet,18 suggesting that phytosterols may have benefi cially regulated plasma lip-ids. A separate study of middle-aged and older-aged sedentary adults demonstrated that 8 weeks of endurance training com-bined with sitosterol supplementation was associated with decreases in blood low density lipoproteins and triglycerides, but with increases in high density lipoproteins, effects that were more strongly manifest when exercise and sitosterol ther-apies were combined.19 The current limited research suggests that β-sitosterol may mitigate the exercise-associated dysreg-ulation of immune function and improve blood lipid profi les, though it has no direct ergogenic effects.

CONCLUDING COMMENTSAlthough phlogenzym and wobenzym were used in ath-letic populations in the Eastern Bloc countries, there is little evidence of properly conducted studies having shown any benefi cial effects. Indeed, there is no reported evidence of an ergogenic effect per se of either of these compounds. Phosphatidylserine’s main purported effect in athletes appears to be that of postponing fatigue. Problems with the risk of con-tracting the prion diseases have made bovine phosphatidylser-ine usage untenable. The soya-based alternative has not so far been specifi cally demonstrated to be effective against fatigue, muscle soreness or poor mood states, as was claimed it should

be. More studies may yet show this supplement to have ergo-genic properties but it is not obvious at present. As described in the article above, several plant sterols have already been examined in the previous articles in our A to Z series. The most abundant phytosterol is sitosterol. There are differing outcome data from studies using sitosterol supplementation in terms of immune function and plasma lipid regulation. No precise effect on the athletic performance of phytosterols in general, including sitosterol, has been observed.

Competing interests None.

Provenance and peer review Commissioned; not externally peer reviewed.

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 M K Ranchordas, N Burd, D S Senchina, et al. 

Part 29−−ergogenic aids for health and performance

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