13 The end of tracking: how to graduate away

from the micromanagement of your diet.

By Alan Aragon

16 Is vitamin D supplementation a legitimate

preventive measure against COVID-19?
By Alan Aragon
Copyright © April 1st, 2021 by Alan Aragon
Home: www.alanaragon.com
Correspondence: support@alanaragon.com

2 Psychology, food, and coaching.

By Jay Ashman

5 Relationship between energy availability,

energy conservation and cognitive restraint
with performance measures in male
endurance athletes.
Jurov I, Keay N, Hadžić V, Spudić D, Rauter S. J Int Soc
Sports Nutr. 2021 Mar 18;18(1):24. [PubMed]

7 Metabolic adaptations to weight loss: a brief

review.
Martínez-Gómez MG, Roberts BM. JSCR. 2021 Mar
3. doi: 10.1519/JSC.0000000000003991. Online ahead
of print. [PubMed]

10 Essential amino acid-enriched whey enhances

post-exercise whole-body protein balance
during energy deficit more than iso-
nitrogenous whey or a mixed-macronutrient
meal: a randomized, crossover study.
Gwin JA, Church DD, Hatch-McChesney A, Allen JT,
Wilson MA, Varanoske AN, Carrigan CT, Murphy
NE, Margolis LM, Carbone JW, Wolfe RR, Ferrando
AA, Pasiakos SM.. J Int Soc Sports Nutr. 2021 Jan
7;18(1):4. [PubMed]

Alan Aragon’s Research Review – April 2021 [Back to Contents] Page 1


Psychology, food, and coaching.
By Jay Ashman
___________________________________________
In the evidence-based world of nutrition, there are
established norms that hold up to the weight of the
evidence presented. By this time, we all know what they
are, and if you are a frequent reader of the AARR, you
should have first-hand knowledge of what those norms are:
1. Calories are king
2. Protein matters heavily
3. Carbs are not bad
4. Compliance is key
You can look at social media and see countless memes,
infographics, and posts about the four points above, along
with comparisons of seemingly healthy organic food to
their non-organic counterparts, but what you don't often
see is the psychology of food.
Why do people choose to eat the way they do?
Social norms and pressure
Each culture and social group has a normative style of
eating. The fitness world's peer pressure is wrapped around
buzzwords like macros, Paleo, keto, intermittent fasting,
and more. In other cultural groups, this is not the case.
A person can belong to more than one cultural/social
group. For example:
• African American/Figure Competitor/Hiking Club
Which group dynamic holds the most power over their
decisions? That depends on what they value at the moment
according to their current goals, stressors, and priorities.
As a coach, it is your job to navigate these waters to help
them achieve dietary homeostasis within the parameters of
their current life situation.
Alan Aragon’s Research Review – April 2021
Determining what your client needs at a specific time in
their journey requires a base understanding of how their
social groupings work, communicating with them to
evaluate their needs, and the level of accountability they
need to maintain a plan, loosen the reigns, or target in on a
specific goal.
Following social norms is an adaptive behavior, which is a
behavior that enables a person to get along in their
environment with success and the least conflict with others
(Higgs 2015). Food pressure is real in social situations,
family events, and even hobbies. It is the coach's job to
help the client navigate those situations effectively as
determined by the phase of their nutrition plan.
Types of eater
One of the significant roadblocks with nutrition coaching
is putting a square peg into a round hole. Would you give a
working mother of four the same type of coaching you
give to a Powerlifting competitor? This is highly
dependent on what type of eater they are and what is
coachable for them.
We are aware enough to know not every client needs to
barbell back squat, so that it would stand to reason not
every client needs to track macros for success if they react
viscerally to the idea of quantifying food in that manner.
There are four major types of eaters, according to
Associate Professor of Psychology Leslie Frazier of FIU. I
add a fifth type based upon what we see in our clients.
Internal eaters live and thrive off of the pleasure principle
when it comes to food. Stress eating, celebration eating,
sad eaters, or emotional eaters. They don't completely pay
attention to when hunger signals strike and often opt to eat
when their minds say, "eat." These people are prone to
binge eating or even eating disorders. Using their emotions
as a guide to eating removes the logic from the equation
and relies excessively on what feels good. There is a time
and a place for internal eating, but if this defines your
client's main eating habits, your coaching has to follow
suit to help them remove feelings from food.
[Back to Contents] Page 2
External eaters are more liable to fall into the section
above with social norms. They tend to eat according to
peer pressure or marketing. These are the types who would
be prone to buying that Soylent drink because they saw an
ad for it on Facebook and fell into the marketing hype. If
they are at a dinner with friends, they would be more
tempted to follow the crowd's eating style rather than stick
to their plan.
Restrained eaters are the keto types, Paleo dieters,
Carnivore cult, vegans, or any eating pattern that seeks to
remove rather than moderate. These types could be
classified as orthorexic by some due to the severe
restrictions they place on their eating habits. Habitual
macro trackers can also fall into restrained eaters, but only
if they exhibit signs of anxiety when they are in a situation
where tracking food intake is not possible.
Intuitive eating is using hunger cues to determine when
and what you want to eat. It is common to see the Intuitive
eating crowd parrot the superiority of this lifestyle, but
much like any eating plan, it takes time to learn correctly,
so your hunger signals aren't directing you to the chocolate
cake for four meals a day (Valencia 2020).
The fifth one, as defined by me, and I am confident many
of you, is Industrious eating. Industrious means diligent,
and these people are goal-oriented with eating plans in
such a way where they are "easy" clients to work with.
You give them the plan, and they implement it.
As a coach, you will have clients who fall into one or more
of the categories above. It is entirely possible to be an
Industrious Intuitive eater or an Internal Restrained eater.
This makes your job dynamic where if your only tool is
dishing out macros, you will be ill-equipped to handle a
person who rebels against the thought of weighing and
measuring food to the gram.
Telling someone to plan better without offering advice or
help to assist them with planning isn't coaching. That is
called berating.
How to use basic psychology to help
Chances are very few of you reading this are Licensed
Therapists; therefore, your scope of practice is limited to
Alan Aragon’s Research Review – April 2021
assisting rather than diagnostic and treatment. I cannot
reiterate this strongly enough if you are working with a
client who exhibits chronic binge eating disorder or an
eating disorder, you need to refer them to a licensed
professional to seek the help they need.
Binge-eating disorder is a severe eating disorder in which
you frequently consume substantial amounts of food and
feel unable to stop eating.
Almost everyone overeats on occasion, such as having
seconds or thirds of a holiday meal. But for some people,
excessive overeating that feels out of control and becomes
a regular occurrence crosses the line to binge-eating
disorder.
When you have a binge-eating disorder, you may be
embarrassed about overeating and vow to stop. But you
feel such a compulsion that you can't resist the urges and
continue binge eating (Staff 2018).
Binge eating is not the occasional splurge, holiday meal
gluttony, or overeating at the BBQ joint. It is chronic
overeating in specific contexts like:
• Eating enormous amounts of food in a specific
amount of time, such as over a two-hour period.
• Feeling that your eating behavior is out of control.
• Eating even when you're full or not hungry.
• Eating rapidly during binge episodes.
• Eating until you're uncomfortably full.
• Frequently eating alone or in secret.
• Feeling depressed, disgusted, ashamed, guilty, or
upset about your eating.
• Frequently dieting, possibly without weight loss.
Eating disorders such as bulimia and anorexia are also
critical needs for professional help. We are not equipped to
handle situations like that and can cause more damage to
the client with our unqualified intervention.
Aside from clinical needs, how can you use basic
Psychological techniques without playing Therapist?
Food Journaling: why did they choose to eat that food?
How did that meal make them feel? Did they choose it
[Back to Contents] Page 3
because they wanted to or because you felt a compulsion
to eat it? Having the client practice journaling feelings
during the initial process will help them understand why
they choose to eat as they do. This is ideal for clients who
are not familiar with nutrition coaching to help them form
a relationship with food based upon conscious choices
rather than emotional ones.
Triggers: what events trigger unhealthy habits? How can
they reframe trigger events into a positive outcome with
patterns? We all have these triggers. A bad day can trigger
diving into a bottle of bourbon for a few extra drinks or
ordering GrubHub burgers to go instead of eating the meal
you have prepped.
Positive affirmations: the science behind positive
affirmations is growing. As cheesy as it sounds to some,
there is immense validity in positive self-talk.
A study published in Social Cognitive and Affective
Neuroscience used functional magnetic resonance imaging
to discover that self-affirmation activates well-known
reward centers in the brain. This is similar to eating your
favorite meal or winning an award (Cascio et al., 2016).
Positive affirmations and positive coping include:
1. I know I need to change my habits, and I can do
this.
2. Am I hungry or craving this?
3. I had a bad day eating today, but I will do better
for myself.
4. I am going to succeed.
Using positive affirmations and coping is critical with your
coaching, as tough love only works for a certain
percentage of the population, and shaming is frowned
upon.
Reframing your coaching skills to assist someone who is
struggling with creating new habits is critical to their
success. "Macro harder," "plan better," or shaming
feedback only serves to stroke your own needs without
helping them.
The psychology of food is arguably the most critical part
of the coaching experience. Yes, calories matter, protein is
important, and compliance is crucial to success, but
without your professional guidance as they navigate ups
and downs, eating styles, weight shifts, vacations, social
events, family dinners, holidays, and more; they might as
well pay 9.99 for a monthly macro app with no coaching
than waste their money paying you for canned feedback
and a cookie-cutter approach to a growing issue with how
the population consumes food.
_______________________________________________
Jay is the Owner and Operator
of Kansas City Barbell in
Kansas City Missouri. A
seasoned veteran in training,
Psychology major, and PPSC
Coach, Ashman has navigated
building brands and
developing trainers from 5th
avenue in Manhattan to his
current location where people
travel from all over the state
to train with Jay.
Websites:
https://www.jayashman.com/
https://kcbarbell.com/
Social: https://www.instagram.com/fvckinashman/
_______________________________________________
References
Cascio, C. N., O'Donnell, M. B., Tinney, F. J., Lieberman,
M. D., Taylor, S. E., Strecher, V. J., & Falk, E. B. (2016).
Self-affirmation activates brain systems associated with
self-related processing and reward and is reinforced by
future orientation. Social cognitive and affective
neuroscience, 11(4), 621–629. [PubMed]
Higgs S. (2015). Social norms and their influence on
eating behaviors. Appetite, 86, 38–44. [PubMed]
Staff, M. C. (2018, May 5). Binge-eating Disorder. Mayo
Clinic. [Mayo Clinic]
Valencia, G. (2020, February 5). Psychology of Food.
[FIU]

Alan Aragon’s Research Review – April 2021 [Back to Contents] Page 4


Relationship between energy availability, energy
conservation and cognitive restraint with
performance measures in male endurance
athletes.
Jurov I, Keay N, Hadžić V, Spudić D, Rauter S. J Int Soc Sports
Nutr. 2021 Mar 18;18(1):24. [PubMed]
BACKGROUND: Low energy availability in male
athletes has gained a lot of attention in recent years, but
direct evidence of its effects on health and performance is
lacking. The aim of this research was to objectively
measure energy availability (EA) in healthy male
endurance athletes without pre-existing relative energy
deficiency signs during pre-race season. METHODS:
Twelve trained endurance athletes (performance level 3, 4,
and 5) participated in the cross-sectional controlled
laboratory study. Fat-free mass, exercise energy
expenditure, and energy intake were measured to calculate
EA. Resting energy expenditure was measured and
estimated to assess energy conservation. Three specific
performance tests were used to assess endurance, agility,
and explosive strength performance. For psychological
evaluation, the Three Factor Eating Questionnaire and a
short Well-being questionnaire were completed.
RESULTS: Mean EA was 29.5 kcal/kg FFM/day. The
majority (66.6%) had EA under the threshold for low EA
in females. Critical cognitive restraint (≥13) was reported
by 75% of participants. There were no differences in
performance, blood values, or psychological evaluation
when subjects were divided into two groups divided by EA
= 30 kcal/kg FFM/day. Cognitive restraint was negatively
associated with measured resting energy expenditure and
energy conservation (r = -.578, p = .025 and r = -.549, p =
.032, respectively). CONCLUSIONS: The mean EA
measured in this study supports the theory that the
threshold for low EA in endurance male athletes might be
under the threshold for females. In addition, we confirmed
cognitive restraint could be useful for early detection of
energy conservation. The high cognitive restraint as
measured in our sample stressed the need of eating
behavior screening in endurance athletes in order to reduce
risk of any disordered eating patterns. FUNDING
Alan Aragon’s Research Review – April 2021
SOURCE: The study was funded by the Slovenian
Research Agency (research grant: P5–0147). The funder
had no role in study design, data collection and analysis,
decision to publish, or preparation of the manuscript.
Strengths
Relative energy deficiency in sport (RED-S) is a cascade
of physiological problems associated with low energy
availability in athletes, typically as a result of under-eating
and/or over-training.1 Low energy availability is a causal
factor in the female athlete triad, characterized by
disordered eating, menstrual disruption, and eventually
bone loss.2 The present study breaks new ground by
objectively examining RED-S, in male athletes. A nice
touch was the assessment of psychological parameters,
with a special focus on cognitive restraint, which is
correlated with reductions in energy intake.
Limitations
The authors conceded that a more homogenous sample of
only one endurance discipline would be more optimal.
However, they disclaim this potential shortcoming by
mentioning that, “this is one of the largest sample sizes of
trained endurance athletes when measured with objective
EA methodology.’ Ultimately they acknowledge that
future research should compare different degrees of energy
availability in the same individuals, as opposed to the
cross-sectional design of the present study, which is
incapable of showing potential directions of causality. A
limitation I would add is that the results of the present
study could be limited to the subject profile (endurance
athletes), so generalizations to other populations warrant
caution.
Comment/application
Mean energy availability (EA, defined as energy intake
minus expenditure, divided by per kilogram of fat-free
mass) among the athletes was 29.5 kcal/kg FFM, 66% of
whose energy availability was below the threshold of what
is considered low EA in females (30 kcal/kg), below which
hormonal disruption is apparent.3,4 On a related sidenote,
De Souza et al5 recently reported that they were unable to
[Back to Contents] Page 5
substantiate the threshold of 30 kcal/kg FFM/day in a
carefully designed randomized controlled trial of
manipulating energy availability with diet restriction and
exercise.
Back to the present study… Between the two subgroups
(with EA ≥ 30 kcal/kg FFM/day and with EA < 30 kcal/kg
FFM/day), there were no differences in exercise
performance, blood parameters, or psychological
parameters (including cognitive restraint – which 75% of
the subjects exhibited). The authors thus concluded that
the threshold for low energy availability in men is
probably lower than 30 kcal/kg FFM/day. It’s notable that
the subjects were lean (averaging 10.2% body fat), and
trained more than 2 hrs/day, expending 1173 kcal daily.
And still, adverse symptoms of low energy availability
were not apparent despite EA below 30 kcal/kg FFM/day.
This study is the first to demonstrate this divergent finding
with women, where the latter EA threshold is accepted as a
benchmark of concern.
Closing out this discussion, I’ll quote an excerpt from a
recent review by Wasserfurth et al, who piled up a nice
bevy of EA-related opinions/recommendations: 6
“Although, to date, there are no guidelines prescribing
an optimal EA for high performance athletes, studies on
habitually sedentary, normal-weight women defined
45 kcal/kg fat-free mass (FFM) as a threshold at which
optimal energy balance can be achieved [16, 17]. In
contrast, a study on exercising men by Koehler et al.
used 40 kcal/kg FFM as a threshold for a balanced EA
and showed that this was still enough to support energy
balance [18]. However, an EA of 30–45 kcal/kg FFM is
already considered a reduced EA, and athletes should
only stay within this range for a short period of time, e.g.
when aiming to reduce body weight [19]. In any case,
clinical studies showed that an EA of < 30 kcal/kg FFM
appears to be a threshold at which severe health
implications can be observed after only 5 days in healthy
young women [17, 20, 21]. Therefore, low EA is
commonly defined as EA < 30 kcal/kg FFM. For males,
Fagerberg described a prolonged EA < 25 kcal/kg FFM as
critical [22].”
Alan Aragon’s Research Review – April 2021
References
1. Williams NI, Koltun KJ, Strock NCA, De Souza MJ.
Female Athlete Triad and Relative Energy Deficiency
in Sport: A Focus on Scientific Rigor. Exerc Sport Sci
Rev. 2019 Oct;47(4):197-205. [PubMed]
2. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S,
Constantini N, Lebrun C, Meyer N, Sherman R,
Steffen K, Budgett R, Ljungqvist A. The IOC
consensus statement: beyond the Female Athlete
Triad--Relative Energy Deficiency in Sport (RED-S).
Br J Sports Med. 2014 Apr;48(7):491-7. [PubMed]
3. Loucks AB, Thuma JR. Luteinizing hormone
pulsatility is disrupted at a threshold of energy
availability in regularly menstruating women. J Clin
Endocrinol Metab. 2003 Jan;88(1):297-311. [PubMed]
4. Loucks AB, Heath EM. Induction of low-T3 syndrome
in exercising women occurs at a threshold of energy
availability. Am J Physiol. 1994 Mar;266(3 Pt
2):R817-23. [PubMed]
5. De Souza MJ, Koltun KJ, Williams NI. The Role of
Energy Availability in Reproductive Function in the
Female Athlete Triad and Extension of its Effects to
Men: An Initial Working Model of a Similar
Syndrome in Male Athletes. Sports Med. 2019
Dec;49(Suppl 2):125-137. [PubMed]
6. Wasserfurth P, Palmowski J, Hahn A, Krüger K.
Reasons for and Consequences of Low Energy
Availability in Female and Male Athletes: Social
Environment, Adaptations, and Prevention. Sports
Med Open. 2020 Sep 10;6(1):44. [PubMed]
[Back to Contents] Page 6

Metabolic adaptations to weight loss: a brief
review.
Martínez-Gómez MG, Roberts BM. J Strength Cond Res.
2021 Mar 3. doi: 10.1519/JSC.0000000000003991. Online
ahead of print. [PubMed]
ABSTRACT: As the scientific literature has continuously
shown, body mass loss attempts do not always follow a
linear fashion nor always go as expected even when the
intervention is calculated with precise tools. One of the
main reasons why this tends to happen relies on our body's
biological drive to regain the body mass we lose to
survive. This phenomenon has been referred to as
"metabolic adaptation" many times in the literature and
plays a very relevant role in the management of obesity
and human weight loss. This review will provide insights
into some of the theoretical models for the etiology of
metabolic adaptation as well as a quick look into the
physiological and endocrine mechanisms that underlie it.
Nutritional strategies and dietetic tools are thus necessary
to confront these so-called adaptations to body mass loss.
Among some of these strategies, we can highlight
increasing protein needs, opting for high-fiber foods or
programming-controlled diet refeeds, and diet breaks over
a large body mass loss phase. Outside the nutritional
aspects, it might be wise to increase the physical activity
and thus the energy flux of an individual when possible to
maintain diet-induced body mass loss in the long term.
This review will examine these protocols and their
viability in the context of adherence and sustainability for
the individual toward successful body mass loss.
General commentary
One of the authors of this review is Brandon Roberts, who
has several articles in the AARR archive, the most recent
of which is in the Feb 20231 issue. It’s a collaboration
with Ryan Lefebvre titled, Energy expenditure
equations: a look into the past and future. If you have not
yet read that, I highly recommend it. Brandon dies
consistently excellent work, and his article with Ryan is no
exception.
Alan Aragon’s Research Review – April 2021
The present paper takes a well-organized and practical
look at the metabolic adaptation concept as it applies to
weight loss. Last month, Nuno Casanova examined
metabolic adaptation from the standpoint of comparing the
role of behavior change versus physiological shifts
amounting to adaptive thermogenesis. In contrast, the
present paper is less specialized, and more of a broad
overview of metabolic adaptation to weight loss, and it
delves into some brotacular applications such as diet
breaks and refeeds as means to mitigate the unfavorable
effects of metabolic slowing. Let’s hop through the key
subtopics within the paper.
Evolutionary origins & models
A long-standing question currently under investigation is,
what are the factors responsible for the decreased energy
expenditure resulting from weight loss? What causes
metabolic slowing? More specifically, what causes
decreases in energy expenditure which exceed what can be
predicted from losses in lean mass and fat mass – in a
process called adaptive thermogenesis (AT)?1 Why does
AT occur in the first place, and why are we so strongly
wired toward it?
According to the “thrifty gene hypothesis,”2 several
thousand years ago, natural selection would favor
individuals who could best survive famines (long periods
of food scarcity). Therefore, those most fit to pass their
genes to future generations where those who could best
conserve or economize the expenditure of energy. So, our
metabolically thrifty genetics have had disastrous
consequences in the modern “obesogenic environment”
that not only lacks periods of food scarcity, but also
presents a constant abundance and high-availability of
hyperpalatable, energy-dense foods that are prone to
passive overconsumption within sedentary conditions.
Other models of homeostatic setpoint drive include the
adipostat hypothesis (an axis connecting the brain, gut, and
adipose tissue)3 and the protein-stat hypothesis (where
bodyweight regulation is governed by the maintenance of
lean mass).4
[Back to Contents] Page 7
Components of energy expenditure
The figure above outlines the various components of
energy expenditure (and their coefficients of variation) are
listed above. The component with the greatest potential for
inter-individual variation is non-exercise activity
thermogenesis (NEAT), ranging 15-50% of total daily
energy expenditure.5,6
Physiological responses to body mass loss and
endocrine modulation of food intake
The figure above outlines the various components of
endocrine system’s influence on the regulation of energy
balance. These components include the relationship
Alan Aragon’s Research Review – April 2021
between changes in body tissue mass and their influence
on appetite-regulating hormones, and the role of lifestyle
& behavioral (environmental) factors, including physical
activity and diet composition. The following figure
outlines the basic components of metabolic adaptation:
Nutritional strategies to reduce metabolic adaptation to
body mass loss
It’s always great when authors muster the courage to offer
practical solutions to the problems presented by the
interaction of our biology and the environment. Here are
the strategies proposed to mitigate metabolic adaptation,
from a nutritional programming standpoint:
• Rate of body mass loss. A mix of data must be
grappled with in this area. A recent systematic review
& meta-analysis by Ashtary-Larky et al7 reported
beneficial effects of gradual (~0.2-1.2 kg/week)
instead of rapid weight loss (~1.2-2.2 kg/week on fat
mass, body fat percent, and resting metabolic rate in
individuals with overweight/obesity. However, fat-
free mass and anthropometric measures did not
significantly differ between the rates of weight loss. I
would add that this analysis was limited to obese &
overweight individuals. Therefore, Garthe et al’s
[Back to Contents] Page 8
 study on elite athletes8 was not included. However,
Garthe et al reported better retention of lean mass as a
result of slow weight loss (0.7%/week vs
1.4%/week).
• Keep protein high. To preserve lean mass, high-
protein diets, 1.2-1.5 g/kg in overweight individuals,
and up to ~2 g/kg in leaner individuals is likely to
guard against metabolic adaptation.9
• Carbohydrate & fat are broadly open to
individualized intakes. Quoting the authors, “Overall,
it seems that the distribution of carbohydrate and fat
is of little relevance when designing a nutritional plan
whose aim is to reduce metabolic adaptation and
prevent body mass regain.” The authors caution that
the majority of metabolic adaptation research is on
overweight and obese subjects. Lean individuals with
athletic performance goals should be mindful to not
undershoot carbohydrate intakes that can optimize
ergogenesis.
• Fiber can function as an agent of satiety. Overall, the
literature shows beneficial effects of fiber intake on
appetite control. Generally speaking, high-fiber foods
have a high satiety index.9
• Diet refeeds and diet breaks. Diet refeeds can be
defined as a strategy where calories and
macronutrients are increased to maintenance levels or
slightly above on 1–2 days per week, predominantly
by increasing carbohydrate intake.10 Diet breaks can
be defined as 1-2 week interruptions of hypocaloric
conditions where intake is raised to maintenance, or
are not specifically restricted. It’s worth noting that
the current literature on diet breaks is mixed, with the
latest example by Peos et al11 showing a general a
general lack of specific benefit from the week-long,
monthly diet breaks in terms of body composition
improvements, but reduced appetite was observed in
the group taking monthly diet breaks.
• Nondietary interventions are important. Increasing
physical activity EE and engaging in resistance
training should be combined with the aforementioned
nutritional strategies to maximally guard against
metabolic adaptation.
Alan Aragon’s Research Review – April 2021
References
1. Müller MJ, Bosy-Westphal A. Adaptive thermogenesis
with weight loss in humans. Obesity (Silver Spring).
2013 Feb;21(2):218-28. [PubMed]
2. Oʼrourke RW. Metabolic thrift and the genetic basis of
human obesity. Ann Surg. 2014 Apr;259(4):642-8.
[PubMed]
3. Cowley MA, Pronchuk N, Fan W, Dinulescu DM,
Colmers WF, Cone RD. Integration of NPY, AGRP, and
melanocortin signals in the hypothalamic paraventricular
nucleus: evidence of a cellular basis for the adipostat.
Neuron. 1999 Sep;24(1):155-63. [PubMed]
4. Millward DJ. A protein-stat mechanism for regulation of
growth and maintenance of the lean body mass. Nutr Res
Rev. 1995 Jan;8(1):93-120. [PubMed]
5. Levine JA, Vander Weg MW, Hill JO, Klesges RC. Non-
exercise activity thermogenesis: the crouching tiger
hidden dragon of societal weight gain. Arterioscler
Thromb Vasc Biol. 2006 Apr;26(4):729-36. [PubMed]
6. Levine JA, Eberhardt NL, Jensen MD. Role of
nonexercise activity thermogenesis in resistance to fat
gain in humans. Science. 1999 Jan 8;283(5399):212-4.
[PubMed]
7. Ashtary-Larky D, Bagheri R, Abbasnezhad A, Tinsley
GM, Alipour M, Wong A. Effects of gradual weight loss
v. rapid weight loss on body composition and RMR: a
systematic review and meta-analysis. Br J Nutr. 2020
Dec 14;124(11):1121-1132. [PubMed]
8. Garthe I, Raastad T, Refsnes PE, Koivisto A, Sundgot-
Borgen J. Effect of two different weight-loss rates on
body composition and strength and power-related
performance in elite athletes. Int J Sport Nutr Exerc
Metab. 2011 Apr;21(2):97-104. [PubMed]
9. Holt SH, Miller JC, Petocz P, Farmakalidis E. A satiety
index of common foods. Eur J Clin Nutr. 1995
Sep;49(9):675-90. [PubMed]
10. Campbell BI, Aguilar D, Colenso-Semple LM, Hartke K,
Fleming AR, Fox CD, Longstrom JM, Rogers GE,
Mathas DB, Wong V, Ford S, Gorman J. Intermittent
Energy Restriction Attenuates the Loss of Fat Free Mass
in Resistance Trained Individuals. A Randomized
Controlled Trial. J Funct Morphol Kinesiol. 2020 Mar
8;5(1):19. [PubMed]
11. Peos JJ, et al. Med Sci Sports Exerc. Continuous versus
intermittent dieting for fat loss and fat-free mass
retention in resistance-trained adults: The ICECAP Trial.
Med Sci Sports Exerc. 2021 Feb 12. doi:
10.1249/MSS.0000000000002636. [PubMed]
[Back to Contents] Page 9

Essential amino acid-enriched whey enhances
post-exercise whole-body protein balance during
energy deficit more than iso-nitrogenous whey or
a mixed-macronutrient meal: a randomized,
crossover study.
Gwin JA, Church DD, Hatch-McChesney A, Allen JT,
Wilson MA, Varanoske AN, Carrigan CT, Murphy NE,
Margolis LM, Carbone JW, Wolfe RR, Ferrando AA,
Pasiakos SM.. J Int Soc Sports Nutr. 2021 Jan 7;18(1):4.
[PubMed]
BACKGROUND: The effects of ingesting varying
essential amino acid (EAA)/protein-containing food
formats on protein kinetics during energy deficit are
undetermined. Therefore, recommendations for
EAA/protein food formats necessary to optimize both
whole-body protein balance and muscle protein synthesis
(MPS) during energy deficit are unknown. PURPOSE:
We measured protein kinetics after consuming iso-
nitrogenous amounts of free-form essential amino acid-
enriched whey (EAA + W; 34.7 g protein, 24 g EAA
sourced from whey and free-form EAA), whey (WHEY;
34.7 g protein, 18.7 g EAA), or a mixed-macronutrient
meal (MEAL; 34.7 g protein, 11.4 g EAA) after exercise
during short-term energy deficit. METHODS: Ten adults
(mean ± SD; 21 ± 4 y; 25.7 ± 1.7 kg/m2) completed a
randomized, double-blind crossover study consisting of
three, 5 d energy-deficit periods (- 30 ± 3% of total energy
requirements), separated by 14 d. Whole-body protein
synthesis (PS), breakdown (PB), and net balance (NET)
were determined at rest and in response to combination
exercise consisting of load carriage treadmill walking,
deadlifts, and box step-ups at the end of each energy
deficit using L-[2H5]-phenylalanine and L-[2H2]-tyrosine
infusions. Treatments were ingested immediately post-
exercise. Mixed-muscle protein synthesis (mixed-MPS)
was measured during exercise through recovery.
RESULTS: Change (Δ postabsorptive + exercise to
postprandial + recovery [mean treatment difference
(95%CI)]) in whole-body (g/180 min) PS was 15.8 (9.8,
21.9; P = 0.001) and 19.4 (14.8, 24.0; P = 0.001) greater
for EAA + W than WHEY and MEAL, respectively, with
Alan Aragon’s Research Review – April 2021
no difference between WHEY and MEAL. ΔPB was - 6.3
(- 11.5, - 1.18; P = 0.02) greater for EAA + W than WHEY
and - 7.7 (- 11.9, - 3.6; P = 0.002) greater for MEAL than
WHEY, with no difference between EAA + W and
MEAL. ΔNET was 22.1 (20.5, 23.8; P = 0.001) and 18.0
(16.5, 19.5; P = 0.00) greater for EAA + W than WHEY
and MEAL, respectively, while ΔNET was 4.2 (2.7, 5.6; P
= 0.001) greater for MEAL than WHEY. Mixed-MPS did
not differ between treatments. CONCLUSIONS: While
mixed-MPS was similar across treatments, combining
free-form EAA with whey promotes greater whole-body
net protein balance during energy deficit compared to iso-
nitrogenous amounts of whey or a mixed-macronutrient
meal. Trial registration: ClinicalTrials.gov, Identifier no.
NCT04004715 . Retrospectively registered 28 June 2019,
first enrollment 6 June 2019. FUNDING SOURCE: This
study was supported by the U.S. Army Medical Research
and Development Command. The study sponsor had no
role in study design or data collection, analysis, and
interpretation; writing the report, nor the decision to
submit the report for publication.
Strengths
This study addresses an interesting question with potential
applicability to military personnel, physique athletes,
weight class-based performance athletes, and wildland
firefighters. These populations have unique physiological
demands set forth by unavoidable energy deficits
combined with intensive physical work. These conditions
threaten muscle preservation, and the science of mitigating
it through protein and/or amino acid supplementation has
plenty of uncharted ground. A crossover design enabled all
subjects to undergo all 3 conditions. In addition to whole-
body net protein balance (synthesis versus breakdown,
measured via stable isotope infusion), muscle protein
synthesis (MPS) was measured. All exercise sessions were
supervised. Registered Dietitians designed the weight
maintenance diets for the 3-day run-in period. Total daily
protein was 1.6 g/kg during the 5-day hypocaloric period.
Limitations
As with all studies on short-term anabolic response, there
are still open questions about longer-term adaptation (i.e.,
[Back to Contents] Page 10
changes in body composition). A 30% energy deficit was
held for 5 days prior to testing. Ideally, future research
would carry out this framework over the course of several
weeks to see where the rubber meets the road in terms of
the manifestation of any ‘real’ advantages of any of the
treatments. The results of the present study would need to
be generalized with caution since they could be limited to
the profile of the subjects (healthy, young, non-obese
adults). It’s still unknown whether the findings would
apply to athletic/trained or diseased & older populations.
Another caveat is that the results could be limited to the
exercise protocol, which consisted of 24 minutes of load
carriage followed by 18 minutes of alternating trap bar
deadlifts and box step-ups followed by another 24 min of
load carriage.
Comment/application
As shown directly above, whole-body net protein balance
was greatest with the post-exercise ingestion of a
“proprietary” whey/EAA mix (EAA + W), whey alone
(WHEY) came in second, and in last place was a mixed
macronutrient meal of chili and beans (MEAL). Now,
Alan Aragon’s Research Review – April 2021
notice the top graph depicting the MPS results (as opposed
to whole body protein balance, which includes non-muscle
proteins). No significant differences – hence, no
advantages in MPS were seen among any of the 3
treatments. Here are the nutrient profiles of each:
As shown above, all 3 conditions were isonitrogenous
(meaning protein was equated). However, as I highlighted
in red, EAA content was highest in the best-performing
condition (at least in terms of protein synthesis at the
whole-body level). EAA + W had 5.3 g more EAA than
WHEY, and 12.6 g EAA more than MEAL. EAA + W
caused as greater increase in whole-body PS compared to
the other conditions, and it also reduced whole-body
protein breakdown to a greater degree than WHEY. Thus,
it’s apparent that the anabolic advantage was attributable
to the higher EAA content (which was associated with
higher circulating EAA levels).
The present study’s findings lend further support to
previous work by Park et al (from the same group of
researchers),1 who found that free-form EAA combined
with whey is more anabolic than a whey protein-based
recovery product, and that the response is dose-dependent.
So, once again, it appears that free-form EAA plus whey is
a potent agent of anabolism, above and beyond whey
alone, even in an isonitrogenous comparison (meaning that
the combo treatment contains less whey in order to
accommodate the EAA while keeping the comparison
isonitrogenous). But once again, this superiority of EAA +
Whey over whey alone was seen in terms of whole-body
protein balance, not muscle protein balance.
It would be interesting to compare the anabolic response of
30-50 g whey with 30-50 g EAA, just to purely exploit the
[Back to Contents] Page 11
anabolic capabilities of EAA. Of course, what we would Supplementation with 12 Weeks of Resistance
need to more definitively settle the glimmers of promise is Training on Strength, Body Composition, and Skeletal
a longitudinal (longer-term) study that measures effects on Muscle and Adipose Tissue Histological Attributes in
muscle hypertrophy. College-Aged Males. Nutrients. 2017 Sep 4;9(9):972.
[PubMed]
Thus far, branched-chain amino acid (BCAA) 6. Spillane M, Emerson C, Willoughby DS. The effects
supplementation on top of sufficient total daily protein (at of 8 weeks of heavy resistance training and branched-
least 1.6 g/kg) has failed to enhance muscular adaptations chain amino acid supplementation on body
to resistance training,2-6 with one exception,7 which was a composition and muscle performance. Nutr Health.
sketchy study, to put it lightly.8 These consistently null 2012 Oct;21(4):263-73. [PubMed]
findings of BCAA supplementation don’t inspire 7. Dudgeon WD, Kelley EP, Scheett TP. In a single-
confidence in the possibility of EAA added to sufficient blind, matched group design: branched-chain amino
protein intake causing any further magic. However, an acid supplementation and resistance training maintains
important component of scientific thought is keeping an lean body mass during a caloric restricted diet. J Int
open mind to all possibilities. Soc Sports Nutr. 2016 Jan 5;13:1. [PubMed]
8. Dieter BP, Schoenfeld BJ, Aragon AA. The data do
References: not seem to support a benefit to BCAA
supplementation during periods of caloric restriction. J
1. Park S, Church DD, Azhar G, Schutzler SE, Ferrando Int Soc Sports Nutr. 2016 May 11;13:21. [PubMed]
AA, Wolfe RR. Anabolic response to essential amino
acid plus whey protein composition is greater than
whey protein alone in young healthy adults. J Int Soc
Sports Nutr. 2020 Feb 10;17(1):9. [PubMed]
2. Bagheri R, Forbes SC, Candow DG, Wong A. Effects
of branched-chain amino acid supplementation and
resistance training in postmenopausal women. Exp
Gerontol. 2021 Feb;144:111185. [PubMed]\
3. DE Andrade IT, Gualano B, Hevia-LarraÍn V, Neves-
Junior J, Cajueiro M, Jardim F, Gomes RL, Artioli
GG, Phillips SM, Campos-Ferraz P, Roschel H.
Leucine Supplementation Has No Further Effect on
Training-induced Muscle Adaptations. Med Sci Sports
Exerc. 2020 Aug;52(8):1809-1814. [PubMed]
4. Aguiar AF, Grala AP, da Silva RA, Soares-Caldeira
LF, Pacagnelli FL, Ribeiro AS, da Silva DK, de
Andrade WB, Balvedi MCW. Free leucine
supplementation during an 8-week resistance training
program does not increase muscle mass and strength in
untrained young adult subjects. Amino Acids. 2017
Jul;49(7):1255-1262. [PubMed]
5. Mobley CB, Haun CT, Roberson PA, Mumford PW,
Romero MA, Kephart WC, Anderson RG, Vann CG,
Osburn SC, Pledge CD, Martin JS, Young KC,
Goodlett MD, Pascoe DD, Lockwood CM, Roberts
MD. Effects of Whey, Soy or Leucine

Alan Aragon’s Research Review – April 2021 [Back to Contents] Page 12


The end of tracking: how to graduate away from
the micromanagement of your diet.
By Alan Aragon
_______________________________________________
First things first: tracking is not always bad (or good)
It’s easy to read the title of this article and automatically
think that I’m denouncing the concept or practice of
tracking dietary intake. I’m not. This article is designed to
provide guidance for those who have been tracking for a
while (typically via an app and/or food scale), and feel
trapped into the routine. This is for the folks who want to
be able to abandon tracking, but fear that they will lose a
critical degree of control and awareness, the thereby slip
from their goals. I fully acknowledge that there are
individuals who don’t need or want to stop tracking. I
personally know a few who actually enjoy it (yes, I think
that’s weird, but hey – live and let live).
The dark side of tracking is that some folks simply dislike
it. They see it at as a tedious chore, at best. At worst, it
becomes a means of nurturing and reinforcing obsessive
behavior. For some people, it strengthens an unhealthy
degfree of perfectionism and micromanagement. Levinson
et al1 reported that ~75% of participants used My Fitness
Pal and that 73% of these users perceived the app as
contributing to their eating disorder. Furthermore, we
found that these perceptions were correlated with eating
disorder symptoms.
There are validity & reliability limits to tracking energy
and nutrient consumption, just as there are limits to
accurately tracking energy expenditure. Griffiths et al2
examined the accuracy of five of the most popular free
nutrition tracking apps had a tendency to report lower
values than the Nutrition Data System for Research
(NDSR); correlations with the NDSR ranged 0.73-0.96.
For those compelled to track energy expenditure, it’s
noteworthy that devices are prone to inaccuracty. Passler
et al3 compared five popular wrist-worn activity tracking
Alan Aragon’s Research Review – April 2021
devices with indirect calorimetry. Quoting their
conclusion: “The tested trackers could not show valid
results. Hence, it is concluded that current commercially
available activity trackers are most likely not accurate
enough to be used for neither purposes in sports, nor in
health care and rehabilitative applications.” A systematic
review by Evenson et al4 found that wearable devices had
higher validity for tracking steps, but lower validity for
tracking energy expenditure.
Good candidates for transitioning away from tracking
Those who have been tracking for a while (typically a
number of years) are the most common group asking how
to stop. The good news is, this group is in the perfect
position to stop tracking because they’ve been doing it
long enough to gain an accurate perspective of the caloric
& nutritive values of various foods & beverages in various
serving sizes that they consume. This is a very useful skill
which, in my observations, takes roughly 2-4 weeks to
become reasonably adept at. A lot of these folks crying out
for help have been tracking for years, and are now feeling
somewhat enslaved to it.
If your goal is to maintain, you’re a good candidate for
letting go of the reins. Those who are proactively trying to
lose or gain weight under tight, time-constrained deadlines
might not be ideal for attempts to wean off of tracking.
Now, if you want to try teaking an extended break (several
weeks at least) from tracking with maintenance as a gosl
during the break, this is a good setup for letting go of your
tracking habits.
Changing false perceptions
A common perceptual framework is that meticulous
tracking is what led to results, so stopping tracking will
lead to a lack of progress, and eventual undoing of hard-
fought results. While this unfavorable scenario is not
impossible, it shouldn’t automatically be presumed as
inevitable, or even probable. The act of tracking adds a
layer of accountability and awareness. However, it also has
the tendency to reduce flexibility and openness to
impromptu adjustments based on internal hunger and
[Back to Contents] Page 13
satiety cues. Now, the kicker is this – accountability and
awareness is entirely possible without the meticulous
tracking of dietary intake.
Proactively building awareness of internal cues
Also, it’s incredibly ironic that many people who track
everything down to the gram do not have an awareness of
when they are actually satiated or hungry. This is partially
due to the pressure of fulfilling the plan (the servings on
the menu, or the nutrient targets per meal or per day). This
gets combined with the shame of not doing so, which we
often see as a breached contract or broken promise with
ourselves, or a failure to perform. These elements actually
hinder the ability to build awareness of internal cues,
which is a legitimate, and very useful skill in and of itself.
Building awareness of internal hunger and satiety cues
involves purposely NOT sticking to a pre-planned script or
casting judgment on your perceived performance.
For those seeking a concrete way to approach this without
tossing all journaling out the window, a technique I’ve
successfully used with clients is something I call internal
cue awareness training (or nurturing); ICAT or ICAN. The
latter has a cool, optimistic ring. Here are the steps:
1) Before each meal, give yourself a hunger rating.
2) After the meal, give yourself a fullness rating. This can
be done via numerical ranking, I used a 5-point scale for
both hunger and satiety. A 3-point scale can be used if
you’re not the type with a broad range of hunger and
fullness sensations.
3) Write down what you ate, estimating the quantities to
the best of your ability (without actually measuring them).
4) Here’s the important part to not forget – write down
subjective feelings and thoughts after each meal.
And that’s it. That’s the journaling method. Over time
you’ll notice patterns and you’ll be able to draw
correlations between your hunger levels prior to eating and
your fullness levels upon ending the meal. You’ll notice
patterns of the types of foods you choose correlate with
hunger levels. The goal is not to obsess over what you’re
eating, but rather to find out what’s eating you. Depending
Alan Aragon’s Research Review – April 2021
on the goal (not everyone wants to lose weight), you’ll be
able to be more conscious of hunger and fullness levels,
and proactively make moves that align with your goal.
After 1-2 weeks of ICAN, it’s far more common for
people to either lose weight or maintain, rather than gain.
And at the end of the 1-2 weeks, your perception of hunger
and fullness, and your overall awareness of how your
emotional state affects eating behavior will be much
keener. If things don’t click by the end of the first week of
this exercise, run it for another week. Sometimes it just
takes more time to break through deeply ingrained
behavioral/psychological patterns – which in this case, is a
relative “numbness” fostered by sticking to a rigid script.
Gradually taking off the training wheels
It bears reiterating that awareness of body composition
progress (or maintenance of progress) is relatively simple
when you just open your eyes a little. What works well as
a mental safety net for those who are afraid of regaining
weight while not tracking their diet intake are two
elements: exercise performance and total bodyweight. If
the scale is stable (daily fluctuations are inevitable; similar
weekly averages are what to keep an eye on), and training
performance is maintained, these are reliable indicators
that you’re maintaining your body composition. If lifting
performance is maintained while bodyweight is stable,
that’s a good indicator that you’re not losing muscle. Of
course, there could be the welcome scenario of lifting
performance improving while bodyweight is stable, which
could indicate recomposition (simultaneous fat loss and
muscle gain).
Protein-tracking as the last step of graduation
Another strategy for those who aren’t ready to let go of
formal tracking is to only track protein and total kcals
while keeping all else flexible. Doing this while staying
mindful of hunger and satiety cues is effective and
significantly less tedious than tracking all of the macros.
The next step in the graduation process would be tracking
only protein. From that point, weighing and measuring
protein foods can be abaondoned once you’re comfortable.
Protein tracking by eye-balling food servings or portions
[Back to Contents] Page 14
you routinely consume gets easier with time. Once you’;re
comfortable, you can stop taking formal/written/app-
accounted records of your protein intake, and just maintain
a mental awareness of staying in the right ballpark.

Head-first into deep water

When someone asks how to stop tracking, I’m tempted to

say, “Just stop tracking.” The vast majority of people who
ask me that question have simply never tried it! Just
stopping cold is indeed one of the options. I’ve issued 30-
day “stop tracking & just live your life” challenges many
times. I’m not talking about YOLO-ing for a month, I’m
talking about maintaining mindful eating patterns and
choices conducive to the goals, just don’t track or obsess
over the details. If you have enough courage, don’t weigh
yourself for the full month. The overwhelming majority
brave enough to try this are pleasantly surprised to see that
they don’t gain weight, and any changes are minimal. Our
bodies are wired toward preserving the status quo, and the
30-day no-tracking challenge demonstrates this time and
time again. After you’ve made it past the month, you can
make decisions after reassessment. I dare you to try it.

References

1. Levinson CA, Fewell L, Brosof LC. My Fitness Pal

calorie tracker usage in the eating disorders. Eat
Behav. 2017 Dec;27:14-16. [PubMed]
2. Griffiths C, Harnack L, Pereira MA. Assessment of the
accuracy of nutrient calculations of five popular
nutrition tracking applications. Public Health Nutr.
2018 Jun;21(8):1495-1502. [PubMed]
3. Passler S, Bohrer J, Blöchinger L, Senner V. Validity
of Wrist-Worn Activity Trackers for Estimating
VO2max and Energy Expenditure. Int J Environ Res
Public Health. 2019 Aug 22;16(17):3037. [PubMed]
4. Evenson KR, Goto MM, Furberg RD. Systematic
review of the validity and reliability of consumer-
wearable activity trackers. Int J Behav Nutr Phys Act.
2015 Dec 18;12:159. [PubMed]

Alan Aragon’s Research Review – April 2021 [Back to Contents] Page 15


Is vitamin D supplementation a legitimate
preventive measure against COVID-19?
By Alan Aragon
_______________________________________________
Background
Vitamin D has been called the sunshine vitamin, due to its
dermal production upon exposure to the sun.1 Vitamin D,
called a vitamin but is technically a steroid hormone, is
required to maintain healthy bones via regulating serum
calcium homeostasis.2 Adequate intake of vitamin D (and
calcium) are crucial for preventing osteoporosis. Vitamin
D is also important for proper neuromuscular function, so
its demonstrated benefits on muscle strength and function
in the elderly3,4 are not too surprising. Vitamin D
deficiency has been defined as blood levels of 25-
hydroxyvitamin D (also called 25(OH)D) of less than 30
ng/mL.1 A blood vitamin D3 level of 40-60 ng/mL is
recommended by the Endocrine Society, which also
recommends a D3 intake of 1500 to 2000 IU for all
adults.1,5
Vitamin D & viral immune response
Vitamin D has been demonstrated to play significant roles
in immunity, including the production of antiviral
peptides.6,7 Low levels of vitamin D have been associated
with respiratory tract infections, the flu, and increased risk
for pneumonia.8 There is considerable literature
implicating vitamin D in the decreased risk for infectious
diseases.9 In vitro research has demonstrated vitamin D’s
role in respiratory function by potentially interfering with
the replication of respiratory viruses.10 In controlled human
interventions vitamin D supplementation has been shown
to reduce the risk of respiratory diseases.11,12
Vitamin D & COVID-19: potential preventive &
therapeutic mechanisms
COVID-19 is the respiratory disease resulting from
contracting the novel coronavirus (SARS-CoV-2).
Correcting vitamin D insufficiency has been shown to
Alan Aragon’s Research Review – April 2021
reduce the expression of the DPP-4/CD26 receptor,13
which is thought to be a factor in COVID-19 infection.
COVID-19 is associated with the increased production of
pro-inflammatory cytokines, pneumonia, and heart failure,
all of which are inversely associated with blood levels of
25(OH)D.8 Acute respiratory distress syndrome (ARDS,)
is the most important cause of COVID-19-related
morbidity and mortality.14 Overproduction of
inflammatory cytokines (including IL-6 and CRP) are
characteristic of ARDS, as is endothelial impairment and
increased barrier permeability. Vitamin D can mitigate
inflammatory reactions, which can inhibit the development
of ARDS. It’s also possible that adequate circulating
25(OH)D levels can assist in pathogen recognition and
stimulating adaptive immunity. Maintaining adequate
vitamin D status has been proposed to prevent the cytokine
storm, and favorably influence the outcomes of SARS-
Cov2.14 A recent pilot study by Castillo et al15 found that
calcifediol (the main metabolite of vitamin D) significantly
reduced the need for ICU treatment of COVID-19 patients.
Here come the studies (of the studies)
A systematic review and meta-analysis by Pereira et al
included 27 observational studies on the prevalence of
vitamin D deficiency in severe cases of COVID-19.16
Severe cases of COVID-19 were had 64% more vitamin D
deficiency versus mild cases. Vitamin D insufficiency was
associated with increased hospitalization and mortality
from COVID-19. A systematic review by Yisak et al17
found that 7 out of the 9 studies found a correlation with
vitamin D status and COVID-19 infection, severity, and
death. It was concluded that, maintaining sufficient
vitamin D levels has preventive and protective potential
against COVID-19.
Concluding perspectives
The RDA for vitamin D for individuals aged 14-70 years
is 600 IU/day, and this bumps up to 800 IU/day at 71 years
and up.18 Since the Endocrine Society, recommends a
vitamin D3 intake of 1500 to 2000 IU for all adults (250-
330% of the RDA), a good case can be made for
supplementing the diet with the latter dosing range.
Notably, vitamin D toxicity is not likely to occur below
[Back to Contents] Page 16
daily intakes of 10,000 IU.18 I’ll end this article with a
quote from a recent review by Brenner,19 which echoes the
protective and therapeutic potential of vitamin D amidst
the current pandemic:
“Despite remaining uncertainties with respect to optimal
dosing, evidence from vitamin D trials with other
endpoints suggests supplementation should preferably
be done on a regular basis rather than by occasional
high-dose bolus therapy. For patients with manifest
COVID-19 infection, initiation of high-dose
supplementation as early as possible after diagnosis
should be strongly considered whenever there are no
specific contraindications against such treatment. At the
very least, such strategies would help to reduce the
burden of established adverse consequences of
widespread vitamin D insufficiency and deficiency, which
would be a great achievement by itself.”
References
1. Chauhan K, Shahrokhi M, Huecker MR. Vitamin D.
[Updated 2021 Feb 18]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
Available from: [NCBI Bookshelf]
2. Stöcklin E, Eggersdorfer M. Vitamin D, an essential
nutrient with versatile functions in nearly all organs. Int J
Vitam Nutr Res. 2013;83(2):92-100. [PubMed]
3. Rejnmark L. Effects of vitamin d on muscle function and
performance: a review of evidence from randomized
controlled trials. Ther Adv Chronic Dis. 2011
Jan;2(1):25-37. [PubMed]
4. Halfon M, Phan O, Teta D. Vitamin D: a review on its
effects on muscle strength, the risk of fall, and frailty.
Biomed Res Int. 2015;2015:953241. [PubMed]
5. Pramyothin P, Holick MF. Vitamin D supplementation:
guidelines and evidence for subclinical deficiency. Curr
Opin Gastroenterol. 2012 Mar;28(2):139-50. [PubMed]
6. Gombart AF, Borregaard N, Koeffler HP. Human
cathelicidin antimicrobial peptide (CAMP) gene is a
direct target of the vitamin D receptor and is strongly up-
regulated in myeloid cells by 1,25-dihydroxyvitamin D3.
FASEB J. 2005 Jul;19(9):1067-77. [PubMed]
7. Wang TT, Dabbas B, Laperriere D, Bitton AJ, Soualhine
H, Tavera-Mendoza LE, Dionne S, Servant MJ, Bitton A,
Seidman EG, Mader S, Behr MA, White JH. Direct and
indirect induction by 1,25-dihydroxyvitamin D3 of the
NOD2/CARD15-defensin beta2 innate immune pathway
defective in Crohn disease. J Biol Chem. 2010 Jan
22;285(4):2227-31. [PubMed]
8. Ali N. Role of vitamin D in preventing of COVID-19
infection, progression and severity. J Infect Public
Health. 2020 Oct;13(10):1373-1380. [PubMed]
Alan Aragon’s Research Review – April 2021
9. Lang PO, Aspinall R. Vitamin D Status and the Host
Resistance to Infections: What It Is Currently (Not)
Understood. Clin Ther. 2017 May;39(5):930-945.
[PubMed]
10. Zdrenghea MT, Makrinioti H, Bagacean C, Bush A,
Johnston SL, Stanciu LA. Vitamin D modulation of
innate immune responses to respiratory viral infections.
Rev Med Virol. 2017 Jan;27(1). [PubMed]
11. Autier P, Mullie P, Macacu A, Dragomir M, Boniol M,
Coppens K, Pizot C, Boniol M. Effect of vitamin D
supplementation on non-skeletal disorders: a systematic
review of meta-analyses and randomised trials. Lancet
Diabetes Endocrinol. 2017 Dec;5(12):986-1004.
[PubMed]
12. Rejnmark L, Bislev LS, Cashman KD, Eiríksdottir G,
Gaksch M, Grübler M, Grimnes G, Gudnason V, Lips P,
Pilz S, van Schoor NM, Kiely M, Jorde R. Non-skeletal
health effects of vitamin D supplementation: A
systematic review on findings from meta-analyses
summarizing trial data. PLoS One. 2017 Jul
7;12(7):e0180512. [PubMed]
13. Vankadari N, Wilce JA. Emerging WuHan (COVID-19)
coronavirus: glycan shield and structure prediction of
spike glycoprotein and its interaction with human CD26.
Emerg Microbes Infect. 2020 Mar 17;9(1):601-604.
[PubMed]
14. Malaguarnera L. Vitamin D3 as Potential Treatment
Adjuncts for COVID-19. Nutrients. 2020 Nov
14;12(11):3512. [PubMed]
15. Entrenas Castillo M, Entrenas Costa LM, Vaquero
Barrios JM, Alcalá Díaz JF, López Miranda J, Bouillon
R, Quesada Gomez JM. "Effect of calcifediol treatment
and best available therapy versus best available therapy
on intensive care unit admission and mortality among
patients hospitalized for COVID-19: A pilot randomized
clinical study". J Steroid Biochem Mol Biol. 2020
Oct;203:105751. [PubMed]
16. Pereira M, Dantas Damascena A, Galvão Azevedo LM,
de Almeida Oliveira T, da Mota Santana J. Vitamin D
deficiency aggravates COVID-19: systematic review and
meta-analysis. Crit Rev Food Sci Nutr. 2020 Nov 4:1-9.
[PubMed]
17. Yisak H, Ewunetei A, Kefale B, Mamuye M, Teshome F,
Ambaw B, Yideg Yitbarek G. Effects of Vitamin D on
COVID-19 Infection and Prognosis: A Systematic
Review. Risk Manag Healthc Policy. 2021 Jan 7;14:31-
38. [PubMed]
18. Brenner H. Vitamin D Supplementation to Prevent
COVID-19 Infections and Deaths-Accumulating
Evidence from Epidemiological and Intervention Studies
Calls for Immediate Action. Nutrients. 2021 Jan
28;13(2):411. [PubMed]
19. Micronutrient Information Center, Linus Pauling
Institute, Oregon State University. Vitamin D. Updated
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[Back to Contents] Page 17
“You survived every single thing you thought you wouldn’t.”
– Kareem Burke

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