Exercise and Gut-derived Phenolics Clinical Trial
Official title:
Influence of 2-Weeks Flavonoid Supplementation and an Acute 45-Minute Walking Bout or 2.5-h Running Bout on Plasma Levels of Gut-Derived Phenolics
PURPOSE:
1. PRIMARY: Using a randomized, parallel group design, this investigation will determine if
the combination of 2-weeks polyphenol supplementation (using the Reoxcyn flavonoid
supplement in capsule form) and one acute 45-minute brisk walking bout enhances the
translocation of gut-derived phenolics into the circulation. A comparator group of
runners (N=20) ingesting the flavonoid supplement for two weeks will be included (2.5 h
run, 70% VO2max).
2. SECONDARY: Data from this study will determine if 2-weeks supplementation of the Reoxcyn
flavonoid supplement is a sufficient time period to increase circulating levels of
gut-derived phenolics, extending data collected from the previous 12-week community
trial.
HYPOTHESIS: We hypothesize that an acute 45-minute brisk walking exercise bout (60% VO2max)
following 2 weeks of increased polyphenol intake will be a sufficient exercise stimulus to
increase gut permeability and the movement of gut-derived phenolics into circulation. If this
hypothesis is confirmed, these data would have broad public health appeal, demonstrating that
the combination of brisk walking and increased polyphenol intake augments circulating levels
of health-restoring small phenolic molecules derived from bacterial breakdown in the colon.
Research Design: Study participants (N=85) will be entered into the study and randomized to
the flavonoid or placebo supplement groups for 2 weeks, with these two independent groups run
in parallel (with N=80 anticipated to successfully complete all study phases). Supplements
will be administered in a double-blinded manner in capsule form. Study participants will
report to the research facility for baseline testing and orientation, and then pre-study and
after 2-weeks supplementation, and then again 24 hour later. Four blood samples will be
collected as shown in the Figure (pre- and post-supplementation, post-exercise/rest, and
24-hour post-exercise/rest). When reporting to the lab after 2-weeks supplementation, study
participants will be randomized to either sit or walk briskly on treadmills for 45 minutes. A
comparator group of 20 runners ingesting the flavonoid supplement and running 2.5 h in the
lab will be included to allow a comparison between moderate and intense exertion (and to
provide pilot data for a future study). Baseline Testing: One to two weeks before the start
of the study, study participants (walkers and runner) will be given an orientation to the
study and then provide voluntary consent. Instructions will be given for recording all food
and beverage intake in 3-day food logs (Thursday, Friday, and Saturday prior to starting
supplementation). Demographic and training histories will be acquired with questionnaires.
Height, body weight, and percent body fat (seca Medical Body Composition Analyzer 514
bioelectrical impedance scale, Hanover, MD) will be measured. VO2max will be assessed using
the Bruce's treadmill protocol, with oxygen consumption and ventilation continuously
monitored using the Cosmed CPET metabolic system.
Pre-Supplementation Lab Visit: On the first day of the study, participants (walkers and
runners) will return to the lab in a fasted state (9 or more hours with no food or beverage
other than water). Blood samples will be taken from an antecubital vein with subjects in the
seated position. Participants (walkers) will be given a 2-week supply of flavonoid or placebo
capsules organized into supplement trays to facilitate compliance. Runners will be given a
2-week supply of flavonoid capsules. The 3-day food record will be reviewed and collected by
the research team, and analyzed for nutrient and flavonoid content using the Food Processor
v. 11.1 (ESHA Research, Salem, OR). Each food/beverage will be assessed for macro- and
micro-nutrients, total flavonoids and subtotals for each of the six flavonoid subclasses, and
two individual flavonoid values (quercetin, EGCG). During the 2-day period prior to visit #3
to the lab, and during the entire day that includes visit #3, participants will be asked to
avoid food and beverages containing sucralose (Splenda) and mannitol. To avoid sucralose and
mannitol, participants will be asked to check ingredient lists for diet sodas, yogurt and
other dairy products, snack foods, chewing gum and candy, low-sugar products, toothpaste, and
mouthwash.
Post-Supplementation Lab Visits:
After the 2-week supplementation period, participants (walkers and runners) will return to
the lab in an overnight fasted state (on the same day of the week as the pre-supplementation
lab visit).
Participants will turn in the supplement tray to verify compliance with ingesting the
capsules. A blood sample will be collected. Participants (walkers) will be randomized to
either sit for 45 minutes in the lab or to walk briskly for 45 minutes on a 5% graded
treadmill at 60% VO2max (with metabolic monitoring during the first 5 minutes, and then at
15, 30, and 45 minutes) using the Cosmed CPET metabolic cart. Runners will run at 70% VO2max
on an ungraded treadmill for 2.5 h, with metabolic measurements made every 30 minutes. Water
will be given ad libitum for all participants, with no other beverage or food allowed. Just
prior to the sitting or walking lab sessions, and the 2.5 h run, participants will consume a
150-ml solution containing 1 g sucrose, 1 g lactulose, 0.5 g L-rhamnose, 1 g erythritol, 1 g
sucralose, 0.5 g mannitol.
Urine will be collected in plastic containers for 24 h in two separate fractions: 0-5 h and
5-24 h. No eating or drinking (except tap water) will be allowed during the first 5-h urine
collection. Participants will return the next morning in an overnight fasted state, provide a
blood sample, and turn in urine samples.
Urine collection guidelines to the subjects:
- You should collect every drop of urine during each collection period (5 hours from the
start of the exercise bout, and then the second collection lasting to the next morning
or 5 to 24 h from the start of exercise). It does not matter how much or little urine is
passed each time, as long as every drop is collected.
- Collect every drop of urine during the day and night in the two collection bottles (0-5
hours, 5-24 hours, beginning with the start of the lab exercise test session). Store the
bottles in the refrigerator. Be sure to collect any urine passed during bowel movements.
- Finish by collecting the first urine passed the next morning, adding it to the
collection bottle. Bring both urine collection bottles with you to the lab (i.e., the
morning after the exercise session when you will provide your final blood sample).
Flavonoid Supplement: Supplement and placebo capsules will be prepared by Reoxcyn Innovation
Group LLC (Salt Lake City, UT). (SEE supplementation information in attached file).
Ingredients will be the same as tested in the community trial: vitamin C (as ascorbyl
palmitate) (Green Wave Ingredients, La Mirada, CA), wild bilberry fruit extract (25% total
anthocyanins) (FutureCeuticals, Momence, IL), green tea leaf extract (50% EGCG) (Watson
Industries, Inc., Pomona, CA), quercetin aglycone (Novel Ingredients, East Hanover, NJ),
caffeine (Creative Compounds, Scott City, MO), and omega 3 fatty acids (Novotech
Nutraceuticals, Ventura, CA). Capsule fill ingredients and excipients include Nu-Flow 70R
(from rice hulls), tapioca from cassava root, natural bamboo silica, marshmallow root.
Placebo capsules will contain only the fill ingredients and excipients (without the active
ingredients). The daily serving for the walkers will be 2 flavonoid or 2 placebo capsules.
Two flavonoid capsules provides 329 mg flavonoids (American adult average, depending on the
study, is 240 mg per day). The daily serving for the runners will be 4 flavonoid capsules
(658 mg flavonoids). Participants will be given a 2-week supply of the either the flavonoid
or placebo capsules, with instructions on how to consume daily in split doses (1 with
breakfast and 1 with lunch, or double that amount for the runners). Study participants will
be allowed to add one extra capsule per day to increase consumption if one or two days of
taking the supplement are missed. Study participants will ingest 2 capsules (4 for the
runners) just after providing the blood sample during the walk/rest (or run) lab session.
SUPPLEMENT CAPSULES will be TESTED for flavonoid content pre- and post-study by Dr. Mary Ann
Lila (NCSU, Plants for Human Health Institute, NCRC).
Targeted Metabolomics Analysis:
Gut-derived phenolic metabolites will be purified from plasma by SPE using an automated
platform and in-house 96-well SPE protocol (60mg, 3mL; Phenomenex) for extraction of 100 μL
tissue. All analytes have been previously optimized for extraction efficiencies of between
80-100% recoveries with CV≤10%. Extracts will be separated and quantified via liquid
chromatography tandem-MS/MS involving previously published and validated methodologies.
Briefly, HPLC-ESI-MS/MS analysis will be performed using a SCIEX UPLC coupled 6500 +
MS/MS-QTRAP™ equipped with an electrospray ionization (ESI) Turbo-V source (blood and fecal
metabolites), with samples injected onto a Kinetex PFP column and mobile phase gradient
consisted of 0.1% formic acid (v/v) in water (A) and 0.1% formic acid (v/v) in acetonitrile
(B), and a 24 min separation time. The targeted metabolite analysis protocol has been
optimized and validated to detect greater than 200 analytes which are quantified relative to
authentic commercial and synthetic standards in our library, with putative Phase II
conjugates identified using fragmentation profiling involving 3-5 unique transitions. This
involves scanning over 1000 transitions corresponding to sulfate, glucuronide, methyl and
glycine conjugates. This SMRM methodology was previously optimized for the Rexocyn treatment
and provides a significantly more sensitive method than traditional multiple reaction
monitoring (MRM) scanning procedures, as it permits monitoring a greater number of
transitions per unit of time, in addition to allowing unique compound-dependent parameters to
be utilized for each analyte, resulting in enhanced sensitivity. Finally, metabolites will be
confirmed on the basis of retention time (using authentic and synthesized standards where
possible) and three or more precursor-to-product ion transitions. Seven-point matrix-matched
calibration curves ranging from 0 to 10 μM will be used for the analysis of flavonoids or
from 0 to 50 μM for the analysis of phenolic metabolites.
Intestinal Permeability, Urine Lactulose/Rhamnose:
Urine sugar concentrations will be determined by high-pressure liquid chromatography. Sucrose
in 0-5-h urine, lactulose/rhamnose (L/R) ratio in 0-5-h urine, and sucralose/erythritol (S/E)
ratio in 5-24-h urine will be used as indicators for gastroduodenal, small and large
intestine permeability, respectively.
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