Getting in the Game

The unexpected force behind sports nutrition.

Written By:
Ryan Velez
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Years ago, sports nutrition was the domain of professional athletes. However, interest in this field is rapidly expanding, and the various sports products that were once targeted at a specific demographic have now hit the mainstream. This is reflected not only in public perception, but in financial fact, as the sports nutrition sector, currently the second-largest market segment in the supplement industry, was projected to have a compound annual growth rate of 24.1%, and was projected to reach $91.18 billion in 2013 (1).

Why Sports Nutrition, Why Now?
Trisha Sugarek MacDonald, B.S., M.S., director of research and development and national educator at Bluebonnet Nutrition Corporation, Sugar Land, TX, notes, “the times they are a changin’. Sports nutrition isn’t just for serious athletes anymore.” Sugarek MacDonald believes that interest in sports nutrition is growing in part from increased household incomes worldwide and people aspiring toward healthier lifestyles, especially a healthy body weight.

According to Richard Parker, senior analyst at Datamonitor, in addition to bodybuilders, athletes and sports hobbyists, sports nutrition buyers now include a new group that he dubs “lifestyle users”(2). These users aren’t athletes or even always athletically inclined, but see sports nutrition products as a sort of stepping stone in building healthier lives.

The rise of lifestyle users is causing a bit of a paradigm shift among industry professionals as well. Tim Hammond, vice president of sales and marketing at Bergstrom Nutrition, Vancouver, WA, describes his company’s vision of sports nutrition as a broader category catering to the demands of an active lifestyle, as opposed to a specific set of functions. He also mentions that sports nutrition research can stand to reach a much broader range of end users, some of which may not even actively use any sports nutrition products.

Dallas Clouatre, Ph.D., consultant for R&D, Jarrow Formulas, Inc., Los Angeles, CA, also notes what he calls the “crossover appeal” in sports nutrition products, such as weight loss and nutrition for the elderly, and the list doesn’t end there. Grace Manzano, director of marketing for sports nutrition at Natrol, Chatsworth, CA, mentions that offering immune-support products along with traditional sports supplements is another way to spread sports nutrition into new areas.

As sports nutrition experiences an influx of consumer and scientific interest, not only are more general uses being found for sports nutrition products, but supplements from other areas are proving useful in sports nutrition as well. Pycnogenol, an extract derived from French maritime pine bark, is considered to be a powerful antioxidant traditionally used to help lower cholesterol and maintain blood sugar. While some have suggested it as an aid for athletes, only recently has scientific study proven its worth, with one study showing a significant increase in athletic performance in a group supplemented with Pycnogenol as opposed to a placebo. In addition, the Pycnogenol group experienced a decrease in oxidative stress and fatigue during recovery (3). One important thing to know about this study is that the test group included both professional triathletes and recreational athletes, suggesting a versatility that can even include the ever-important lifestyle user.

In addition to putting a spotlight on the sports nutrition industry, these lifestyle users also bring a new set of consumer concerns and preferences. Bob Green, chairman of Advantra Z, Inc., West Caldwell, NJ, harkens back to the origins of sports nutrition, where an extreme athlete-focused demographic was willing to “do anything” to achieve their goals. Green continues with the fact that some sports nutrition products of that time contained stimulants and other unhealthy ingredients, including banned substances. But now, as he puts it, “Today’s more mainstream audience wants to increase energy and improve athletic performance, but they’re unwilling to accept even the possibility of negative cardiovascular and central nervous system side effects. And who can blame them?”

The lifestyle users’ desire for maximum output without any unhealthy shortcuts is driving changes in both content and marketing of sports nutrition products. John Urban, category brand manager of NOW Sports, Bloomingdale, IL, remarks that the average person has always been a major focus for his company, so to make products more appealing to them, the company has made sure to include no artificial flavors, colors or sweeteners in its products.

One major way that companies appeal to this new section of the customer base is through education. The everyday athlete can often be intimidated by complex formulations, says Emma Cutfield, registered holistic nutritionist and national educator at Vega, Burnaby, BC, Canada. To counter this and make sports nutrition more accessible, she emphasizes the importance of being proactive when it comes to education. To take advantage of this, her company provides digital and print media education, as well as hosting education workshops. Cutfield finds digital media particularly useful because “(it) especially allows consumers to be educated on their own terms…this is often more approachable and less intimidating for the average person who may not yet consider themselves ‘athletes.’”

The Right Choice for the Right Time
One new focus of sports nutrition that applies to lifestyle users and professional athletes alike is catering to differing stages of the workout. While this interest is triggering growth in pre-, intra- and post-workout products, Sugarek MacDonald says this shouldn’t be called a trend, so much as a revolution of the sports nutrition market. “The human body is a well-oiled, mean machine,” she explains, “and like a car, it needs fuel. The more pure the fuel, the better the performance.” Finding the best fuel, though, is a two-step problem.

When discussing pre-workout nutrition, there is a relative degree of freedom with regard to what nutrients are ideal. In fact, according to Michael Crabtree, CPT/CSCS, ISSN, CISSN, sales manager of sports nutrition and supplements at Bioenergy Life Science, Ham Lake, MN, there is no one necessary demand, and working out without pre-workout supplementation can still yield results. However, this isn’t to say that it is useless; far from it, as a matter of fact. The point of pre-nutrition is to “supply the system with nutrients specific to the general goals of the athlete or participant,” says Crabtree. This mirrors what many experts have concluded: it’s not just a matter of what is best, but best for what?

One common goal of pre-nutrition is to raise enough energy to get one ready for a workout. During the pre-workout period, which generally ranges from two to four hours preceding a workout, carbohydrates serve as a good option to keep energy levels high prior and into a workout. According to Sugarek MacDonald, research shows that consuming simple carbohydrates during this time period improves muscle and glycogen stores and helps to maintain blood glucose levels, especially in conjunction with amino acids like arginine, lysine and the branched chain amino acids (BCAAs). This can allow for a decreased amount of time to complete a physical activity like jogging a certain distance or a set of pushups.

However, she discourages consuming complex carbohydrates one hour or less prior to a workout due to the potential to induce hyperinsulinemia (i.e., increase in plasma insulin), which lowers blood glucose and can potentially interfere with athletic performance by causing fatigue. For muscle builders, Clouatre recommends that another pre-workout goal should be making sure adequate amino acids and nutrients are available to promote muscle synthesis during the proper time window.

Another option is caffeine, which is used in many of the more popular energy supplements. While some of our experts consider caffeine a useful ingredient, it must be used with caution, especially when looking at some of the more popular options. Green remarks, “There are many energy supplements on the market today that deliver short-term effects those consumers can ‘feel.’” Unfortunately, these ingredients can generate negative effects as well. Some of these possible negative side effects include jitters and quick drops in energy. Research shows that sugar, another component in some of these energy supplements, only provides blood glucose boosts for around 10—20 minutes before dropping, says Lisa Lent, founder and CEO of Vitalah, Watsonville, CA (4). Cutfield suggests several natural options like green tea and yerba mate for a pre-workout energy boost due to their high antioxidant content.

What is ideal for intra-workout nutrition hinges somewhat on the timespan of the workout, as the demand for a 20-minute workout is different than a 60-minute one, but there is a general set of nutritional and practical needs that should be addressed. Marc Stover, director of marketing at Twinlab Sports Nutrition, New York, NY, explains it well when he says that an”intra-workout product that doesn’t hydrate and isn’t easy to consume/mix and provide stamina isn’t a great idea.” Electrolytes and beta-alanine are two nutrients that he considers to fulfill this aim well.

For longer workouts, functional carbohydrates once again appear as a viable source of energy, as well as medium-chain triglycerides. Cutfield recommends dates and coconut oil as intra-workout food options, and also mentions gels that combine some of these ingredients into an easy-to-consume package in the middle of a workout.Urban suggests maltodextrin and amylopectin as sources for some of these vital carbohydrates, and also mentions that his company offers chewables for another easily consumable option.

While traditionally, protein is a post-workout supplement, it may have some usefulness in the middle stage as well, says Susan Hazels Mitmesser, Ph.D., director of nutrition research at Solgar, Leonia, NJ. She mentions that research shows small amounts of protein, when added to carbohydrate-containing drinks, can further boost endurance, something very valuable for longer workouts. However, these amounts must remain small, as Sugarek MacDonald mentions cramps, a sore stomach and excessive flatulence as consequences for consuming too much protein mid-workout.

While pre- and intra- workout nutrition varies by the duration and intensity of the workout, post-workout nutrition is more universal. Stover breaks it down to “the three R’s: replenishment, rebuilding and refreshment.” Shawn Baier, COO of Metabolic Technologies, Inc., Ames, IA, notes that of the different stages, he sees a particulary high interest in recovery, and this universality is possibly part of the reason why. Proper post-workout nutrition enables the participant to recover faster and minimize muscle stiffness and soreness. The 30–60-minute period after a workout also serves a vital window of opportunity where cells are especially open to absorbing nutrients, adds Clouatre.

For post-workout meals, both Sugarek MacDonald and Cutfield recommend a protein/carbohydrate blend ranging from a ratio of 3:1 to 4:1. The aim of this blend is to both accelerate protein synthesis and replenish muscle glycogen. Several studies have shown a correlation between the amount of muscle glycogen present in the body and fatigue, particularly after strenuous physical activity (5).

Bryan See, regional product manager at Carotech Inc., Edison, NJ, also emphasizes the role antioxidants play in recovery. “High oxygen consumption is involved during sporting activities or strenuous exercises. This increased consumption of oxygen leads to elevated free radical production,” he explains. Free radical buildup can interrupt nutrient delivery and interfere with muscle contraction, necessitating antioxidants to reduce the buildup (6). One ingredient that See recommends is tocotrienol, a member of the vitamin E family scientifically proven to be a powerful antioxidant (7). See says both powders and gel capsules containing tocotrienol are available.

Two minerals that can also play a useful role in recovery are magnesium and potassium, says Max R. Motyka, M.S., R.Ph., director of sales and marketing at Albion Human Nutrition, Clearfield, UT. Both minerals are involved in the contraction and relaxation of skeletal, smooth and cardiac muscle, and adding these to a post-workout routine can help reduce cramps.

Some ingredients may even be viable at multiple times. Urban describes creatine, an organic acid that traditionally supplies energy to muscles, as something useful both before and after a workout for providing energy, particularly after strenuous bursts of activity like sprints or power moves.

Hydration Innovations
One of the most common intra- and post-workout choices is sports drinks, a fact reflected in the approximate $7.4 billion in sales they made in 2013 (8).”Liquid or gel sports nutrition products are the easiest to consume mid-workout because the body is in ‘fight or flight’ mode with reduced digestive capacity,” explains Cutfield. Not only do sports drinks come in an ideal delivery system for the intra- and post-workout stage, but they also consolidate several necessary functions, one of which is hydration.

Maintaining proper hydration at all workout stages by replenishing fluids promotes health, safety and optimal physical performance of individuals participating in regular physical activity, says Hazels Mitmesser. Sports drinks also provide carbohydrates to stave off fatigue during a workout, and replenish electrolytes, which are vital minerals like sodium and potassium that are lost through sweating (9). These electrolytes are some of the most important components of sports drinks, as Sugarek MacDonald says that not replenishing them can potentially cause muscle weakness, cramping and dehydration.

However, while some of the most popular sports drinks have everything the participant needs, they may have other components that are not as helpful. While scientific study has yet to completely verify one side or the other of this debate, there is some concern that certain sports drinks possess large amounts of sugars, salt and caffeine that may harm the body in other ways while helping it recover from a workout. Concern is especially high in regard to sports drinks and youth, with one study suggesting that some sports drinks may be linked to obesity in teens (10).

However, there are alternatives that can circumvent some of these concerns while still keeping what makes sports drinks so popular. Crabtree recommends making one’s own sports drinks, stating, “if one does not wish to consume the undesirable aspects of commercial products, one should consider purchasing and blending the desired constituents directly.” He goes on to mention that those who choose this path should only do so with a professional’s advice. With this said, powders and liquid add-ins are sold that contain electrolytes, and when mixed with water, these can fulfill a sports drink’s function with minimal additives. Cutfield continues this train of thought, but says retailers “can help consumers to understand how to identify minimally processed and functional carbohydrates (such as coconut palm nectar) versus refined carbohydrates (such as glucose syrups and maltodextrin).” She also considers sports nutrition bars to be a valid and more satiating intra- and post-workout option, with varieties specifically geared for each stage.

Special Deliveries
The demands of lifestyle users have necessitated innovation in taste and delivery format. When catering products to the everyday athlete and lifestyle users, Stover emphasizes a focus on “making the taste as appealing as possible, the packaging as approachable and understandable as possible, and the products as easy and convenient to use as possible…we also like to deliver choice.” One method that he suggests to further the idea of choice is multiple delivery options for the same products, for example, offering aminos in tablet, liquid and powder form. This suggests that if the proper delivery systems are in place, there is no limit to the amount of beneficial supplements and products that can make headway not only in sports nutrition, but even beyond that into functional foods and other categories.

According to Kevin Owen, Ph.D., NAFTA head of technical marketing and scientific affairs at Lonza Inc., Allendale, NJ, some of the newer delivery formats being utilized for sports nutrition products include foods, gels, shots, dissolvable strips and sprays, “all of which provide the consumer with the option to use desired products according to their preference, and on their own terms.” Owen anticipates shots and effervescent deliveries to gain particular interest in the near future due to their portability and immediate usability. Consumers who have difficulty swallowing pills may be drawn to shots due to the fact that both offer a similar single-dose delivery system versus a sports drink or a powder.

As the demand for more delivery options grows, the science behind them needs to advance as well. Karen Constanza, food scientist at TIC Gums, White Marsh, MD, explains, “product developers are challenged with creating innovative, consumer-friendly beverages that maximize nutritional value without negatively impacting sensory attributes. “ According to her, creating new individual hydrocolloids and synergistic hydrocolloid solutions are key ways to add variability while still making sure that all the essential nutrients are present and bioavailable, especially for fortified beverages. The fortified beverage market is estimated to grow 8–10% between 2012 and 2017, so striking the balance between nutrient content and palatability is paramount (11).

Constanza adds that some of these new blends not only help prevent sedimentation of ingredients like minerals and cocoa powder, but “are capable of emulsifying high-oil loads while minimally altering beverage viscosity.” She mentions that this technology allows product developers to add nutritionally fortified oils, such as omega-3s, while still producing a stable beverage. The health benefits of fish oil infused in a tasty shake? Such an item may be on the horizon.
 
The Power behind Protein
When many people think of sports nutrition, one of the first things they think of is protein. This perception is reflected financially, with Euromonitor noting that protein products sales are expected to hit $7.8 billion by 2018 in the United States alone (12). Protein’s popularity largely stems from the idea that in conjunction with exercise, it is the key to building muscle. While this certainly isn’t false, many people in the sports nutrition industry believe that protein is only one part of a larger muscle-building equation.

Crabtree defines protein as “the macronutrient that provides for the structural and functional components of muscle tissue.” Adding protein into the system during times of stress spares the muscle tissue already in existence, and allocates elements needed to synthesize new muscle tissue, he continues. This is in tune with the popular opinion that protein plus exercise equals muscles, but one thing to consider is the variety of proteins available on the market, including whey, casein and egg. Vegetarians can also turn to pea, soy or rice proteins, mentions Manzano.There are also developments being made regarding delivery options for protein as well as other supplements. Urban notes that there are single-serving protein packets available for those interested in maximum portability.

Whey is one of the more popular options (13), and Sugarek MacDonald attributes this to not just the fact that whey is a fast-acting protein, but that the amino acid profile of whey is very close to that of human muscle. Whey is also easy to digest, with a minimal amount of fat, adds Hazels Mitmesser. Sugarek MacDonald considers isolates to be stronger, especially for bodybuilders and professional athletes, due to the high elemental protein amount per serving.

Crabtree differs from this view, saying that “there are various forms of protein, most of which differ as to the rate of digestion as opposed to functionality. The various forms of protein: whey, casein, and hydro-isolates; with regard to functionality, are miniscule in difference.”

However, both Crabtree and Manzano agree that different proteins may be most efficient at different times. According to Manzano, whey is the most applicable protein for post-workout use, whereas casein may be better suited for a between meal snack or to be taken at night. Another thing to consider is allergies or other food sensitivities, particularly with proteins derived from egg or soy.

Regardless of the scale of difference between various proteins, it is still important for consumers to pick what matches their workout style, and for retailers to offer enough variety to satisfy them. In fact, these proteins may be better together than alone. Clouatre mentions that recent trials show that a mixture of proteins with different rates of digestion and assimilation can be superior to single protein sources.

One aspect of protein that is more universally agreed upon is that it cannot work alone, with several other components necessary to maximize muscle building. One of the most critical, according to Baier, is beta-hydroxy-beta-methylbutyrate (HMB). A metabolite of the BCAA leucine, HMB contributes to muscle building by helping to prevent protein breakdown. Minimizing the amount of protein breakdown allows newer muscle to grow faster, improving strength and body composition. Stover also agrees on the value of supplements like HMB, calling the relationship between it and protein “truly synergistic.” Cutfield suggests looking for protein supplements with high amounts of BCAAs like leucine, isoleucine and valine to stimulate protein synthesis during exercise.

One major thing to remember is that several vitamins and minerals play key roles in repairing and building muscle proteins in response to training, says Lent. Consistent intense training may also increase micronutrient requirements by increasing metabolism, degradation rates or bodily losses of these key nutrients. Deficiencies in these minerals can be exacerbated by extremely intense workouts or in people who were lacking certain minerals to begin with. For these reasons, she suggests that people looking to build muscle also take a powerful multivitamin with their protein. B vitamins, vitamin D, zinc and magnesium are some of the main vitamins Lent believes that athletes should be aware of.

The Future of Sports Nutrition
As sports nutrition expands to meet the needs of the lifestyle user and everyday athlete, the applications for the professional athlete grow as well. Sugarek MacDonald says that contact sports, or repeated head trauma, may lead to toxic buildup of proteins such as tau and TDP-43 in the brain and spinal cord, which can cause a variety of neurodegenerative conditions, including Alzheimer’s and Parkinson’s. This is far from a distant future concern, as See calls our attention to a recent $765-million class-action lawsuit against the National Football League from at least 4,500 ex-NFL footballers who suffered concussions during their time as players. Some of the footballers openly admitted to suffering severe depression and some memory loss.

With sports nutrition making scientific and financial leaps due to the surge of interest from lifestyle users, studies are now underway to see if sports supplements can help those dealing with the aftereffects of contact sports, and potentially make some new headway into brain health. While there is no scientific conclusion one way or the other, some of these results do show promise.

Crabtree is quick to say that “supplementation cannot mitigate the effects of angular momentum on the brain, or the impact of the brain against the side of the skull; both of which are direct results of contact sports, and the origin of sports concussion.“ However, he does believe that when these effects become evident, healthy fats and cofactors like vitamin E can lessen both symptoms and long term consequences. Not all fats may be ideal, though. MacDonald cites one study where the omega-3 acid known as EPA was tested in an animal model with amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). The study showed that dietary supplementation of EPA could potentially accelerate the disease (14).

Clouatre proposes approaching this from a different angle, as “a problem improving capillary and other tissue resistance to bruising, fluid leakage and similar traumas.” His solution is to take nutrients that support capillary and venous integrity, which are present in herbs and extracts like hesperidin, diosmin and butcher’s broom.

Some studies centered on vitamin E are showing more positive results. See cites a 2011 study using tocotrienol derived from red palm oil, where dogs were fed 200 mg of a tocotrienol supplement daily over the course of 10 weeks. Some results included smaller stroke-induced lesion volume, loss prevention of white matter fiber tract, as well as triggered and increased blood flow through collateral arteries to the ischemic area (15). Phase-I and II human clinical trials on neuroprotection are currently ongoing at Ohio State University, and a recent study has also been published suggesting that taking the complete spectrum of vitamin E may lessen mild cognitive impairment as well as Alzheimer’s risk (16). WF

Select Sports Nutrition Products

Advantra Z: Advantra Z.

Albion Human Nutrition: Creatine MagnaPower.

Bergstrom Nutrition: OptiMSM.

Bioenergy Life Science: D-Ribose.

Bluebonnet Nutrition: Extreme Edge Whey Protein Isolate, Extreme Edge Pre Workout Formula Extreme Edge Post-Workout Formula, CarboLoad Formulas, Diet Chrome Formula.

Carotech: Tocomin SupraBio, Tocomax.

Horphag: Pycnogenol.

Jarrow Formulas: L-Arginine, Acetyl-L-Carnitine, Acetyl-L-Carnitine, Arginate, Astaxanthin, L-Citrulline, CoQ10 QH/ Ubiquinol, Optimal Plant Protein.

Lonza: Carnipure L-carnitine.

Metabolic Technologies: HMB, BetaTOR.

Natrol: SURGE, Beta Charge, Immune Fit, Recover and Repair, Athlete Multi Tri System, Co-H2O and EDGE.

NOW Foods: Product categories include amino acids, lean body composition, energy and endurance, mass building, protein powders.

Solgar: Whey To Go Protein Powders.

TIC Gums: Ticaloid Ultrasmooth, TICAmulsion A-2010, Ticaloid Pro Series.

Twinlab: Fat burners, pre-workout formulas, proteins, and weight gainers.

Vega: Vega Sport Pre-Workout Energizer, Vega Sport Sugar-Free Energizer, Vega Sport Electrolyte Hydrator, Vega Sport Endurance Gel, Vega Sport Energy Bar, Vega Sport Recovery Accelerator, Vega Sport Performance Protein, Vega Sport Protein Bar.

Vitalah: Oxylent and Children’s Oxylent.

References
1. Private Label Nutraceuticals, “Sports Performance Supplements: 2013 Growth and Market Trends,” www.privatelabelnutra.com/supplement-manufacturer-blog/sports-performance-supplements-2013-growth-and-market-trends/, accessed July 14, 2014.
2. Datamonitor, “Exercise and Sports Nutrition: Consumer Trends and Product Opportunities,” www.datamonitor.com/store/product/exercise_and_sports_nutrition_consumer_trends_and_product_opportunities_?productid=CM00044-007, accessed July  21, 2014.
3. G. Vinciguerra, et al., “Evaluation of the Effects of Supplementation with Pycnogenol on Fitness in Normal Subjects With The Army Physical Fitness Test and in Performances of Athletes In The 100-Minute Triathlon,” J. Sports Med. Phys. Fit., 53 (6), 644–654 (2013).
4. R.D. Strand, “Energy Production,” www.brads-healthy-lifestyle.com/athletes_1.html, accessed July 18, 2014.
5. N. Ørtenblad, H. Westerblad and J. Nielsen, “Muscle Glycogen Stores and Fatigue,” J. Physiol. 591 (18), 4405–4413 (2013).
6. Pacific Health Labs, “What Causes Muscle Fatigue (and how you can beat it!),” www.pacifichealthlabs.com/blog/what-causes-exercise-fatigue/, accessed July 15, 2014.
7. E. Serbinova, et al. “Free Radical Recycling and Intramembrane Mobility in the Antioxidant Properties of Alpha-Tocopherol And Alpha-Tocotrienol,” Free Radical Biol.  Med. 10: 263–275 (1991).
8. “Sports Drink Evolution,” Food Business News, www.foodbusinessnews.net/articles/news_home/Consumer_Trends/2013/08/Sports_drink_evolution.aspx?ID=%7B6AA703FC-F917-444F-9581-C48A48C2E3DD%7D&cck=1, accessed July 15, 2014.
9. E. Magee, “What to Drink When You Exercise,” WebMD, www.webmd.com/fitness-exercise/features/what-to-drink-when-you-exercise, accessed July 15, 2014.
10. R. Zimmerman, Medscape.com, “Sports Drinks, Not Just Sodas, Drive up Weight in Teens,” www.medscape.com/viewarticle/791326, accessed July 15, 2014.
11. TIC Gums, “TICAmulsion A-2010: Advanced Technology for High Oil Load Emulsions,” www.ticgums.com/high-oil-emulsions-paper, accessed July 16, 2014.
12. Euromonitor, “Sports Nutrition in the U.S.” www.euromonitor.com/sports-nutrition-in-the-us/report, accessed July 16, 2014.
13. D. Smith, “The Ultimate Guide to Protein Supplements,” http://greatist.com/fitness/protein-supplement-nutrition-guide, accessed July 16, 2014.
14. P.K.Yip et al., “The Omega-3 Fatty Acid Eicosapentaenoic Acid Accelerates Disease Progression in a Model of Amyotrophic Lateral Sclerosis, “ PLoS One, 8(4), 2013.
15. C. Rink, et al., "Tocotrienol Vitamin E Protects Against Preclinical Canine Ischemic Stroke By Inducing Arteriogenesis,” J. Cerebral Blood Flow & Metabolism, 31, 2218–2230 (2011).
16. F. Mangialasche, et al., “High Plasma Levels of Vitamin E Forms and Reduced Alzheimer’s Disease Risk in Advanced Age,” J. Alz. Dis. 20 (4), 1029–1037 (2010).

Published in WholeFoods Magazine, September 2014