Are Bigger Muscles Better? Antioxidants and the Response to Exercise

We’re positive toward some dietary antioxidants:

  • Vitamin C is one of our supplement recommendations.
  • We also recommend higher-than-typical dietary intakes of zinc and copper, key ingredients of the antioxidant zinc-copper superoxide dismutase.
  • We recommend high intakes of extracellular matrix material in soups and stews. This is rich in glycine, a component of glutathione, a key antioxidant. N-acetylcysteine, which provides the other amino acid component of glutathione, is one of our therapeutic supplements.
  • Although we don’t normally recommend supplementing vitamin E, it is listed among our optional supplements, and we believe significant numbers of people might benefit from supplementing mixed tocotrienols.
  • Although we don’t recommend supplementing it, our book notes the importance of dietary intake of selenium, which is critical for an enzyme that recycles glutathione.

A fashionable contrary view has arisen: antioxidants not only don’t help, they can do harm by interfering with oxidative signaling pathways.

Adel Moussa, proprietor of Suppversity, has promulgated this view, especially the idea that antioxidants interfere with the response to exercise. In a post last week, “Bad News For Vitamin Fans – C + E Supplementation Blunts Increases in Total Lean Body and Leg Mass in Elderly Men After 12 Weeks of Std. Intense Strength Training,” he looked at a new study by Bjørnsen et al [1]. In the comments here, Spor asked me to address Adel’s post, and other readers expressed interest too.

The Bjørnsen Study: Muscle Size

In this new study, Bjørnsen and collaborators put a group of elderly men on a strength training regimen. Half the men were put on supplements – 1000 mg per day of vitamin C and 235 mg (350 IU) per day of the alpha-tocopherol form of vitamin E – and half on placebo. They then assessed the response to 12 weeks of exercise.

Both groups gained muscle mass, but the placebo group gained more. Total lean mass, and the thickness of the rectus femoris muscle (one of the quadriceps), increased more in the placebo than the antioxidant group. The lean mass increase averaged 3.9% in the placebo group, 1.4% in the antioxidant group. Here’s the plot of muscle thickness in the rectus femoris:

Bjornsen Fig 1

This muscle increased in thickness an average of 16.2% in the placebo group, 10.9% in the antioxidant group.

So far, so solid: it looks like muscle size will be larger if you don’t take antioxidants.

Adel concludes:

[Y]ou shouldn’t fall for … the bogus false promise that suffocating all the flames by using exorbitant amounts of antioxidants (and I am as this study shows talking about 10x the RDA not just 100x the RDA) would be good for you, let alone your training progress and muscle gains…. [Y]ou cannot recommend extra-vitamins for people who work out – specifically not the elderly.

I disagree.

The Trouble with Biomarkers

We have to use biomarkers to assess health, because the things we really care about – like how long we will live – cannot be determined on the time scales we need to make decisions in.

But no biomarker is a perfect assessment of health. There are always regimes in which a biomarker can look “better” but health can worsen.

Muscle size is no different. Other things being equal, more muscle is better than less muscle. But there are ways to increase muscle size that harm health. We have to look at the increase in muscle size in the placebo group and ask: was this good or bad?

The Bjørnsen Study: Strength

Fortunately, Bjørnsen and colleagues also reported another key biomarker: strength, as indicated by 1 rep maximum weight. Here is the data:

Bjornsen Fig 2

The exercises that utilize the rectus femoris muscle, the one that grew biggest in the placebo group, are the leg extension (b) and leg press (c). And here we see something interesting: in both cases, the antioxidant group increased their 1RM by more than the placebo group. Yes, the improvement was not statistically significant. But it was there. According to the text, on average, the antioxidant group increased their leg press 1RM by 18.7%, the placebo group by 15.8%.

So the antioxidant group gained more strength but less size than the placebo group. Which group was made healthier by the program?

I’ll put my money down on this: the smaller muscle that can exert more force is the healthier muscle. A gargantuan but weak muscle is an unhealthy muscle.

Large Muscle Size Can Be a Sign of Poor Health

To see that large muscles may be unhealthy, consider the health condition of cardiomegaly – an enlarged heart. When the heart tissue is dysfunctional and incapable of exerting as much strength as it should, the heart grows larger to compensate. People who have such an oversized but weak heart often die an early death.

We should consider whether something similar was going on in the placebo group of the Bjørnsen study. Their leg muscles grew larger to compensate for weakness. They needed more mass to accomplish less than the antioxidant group.

What causes cardiomegaly? One contributing factor is a deficiency of antioxidants. When antioxidants are deficient, oxidative stress generated during exertion leads to lipid peroxidation and tissue necrosis.

One of my favorite nutritional studies – I always show it at the Perfect Health Retreat to demonstrate the existence of multi-nutrient deficiency diseases, diseases that appear only when you are deficient in multiple nutrients at the same time – is a study by Kristina Hill and collaborators at Vanderbilt in 2001. [2] The running title is “Myopathy resulting from combined Se and E deficiency” and that summarizes it well. Guinea pigs were put on one of four diets – a control diet, the control diet but deficient in vitamin E, the control diet but deficient in selenium, or the control diet with both vitamin E and selenium removed.

Something interesting happened to the guinea pig muscles:

Bjornsen Fig 3

These are quadriceps muscles – the same muscle whose size was altered in the Bjørnsen study. Panel (D) shows a healthy muscle from the control group. The muscle fibers are long, straight, and parallel to one another. Panels (B) and (C), the low vitamin E and low selenium groups respectively, are mildly damaged but still functional. However, in panel (A), the group deprived of both selenium and vitamin E, the muscle fibers are severely damaged. This muscle cannot exert force.

In the group deprived of both selenium and vitamin E, the loss of strength continued until the guinea pigs could no longer stand or move. At that point they lost the ability to feed and began to die of starvation. This happened in as little as 30 days. Here was the survival curve:

Bjornsen Fig 4

The last guinea pig died after 55 days.

Why did this happen? The guinea pig muscles were damaged by lipid peroxidation leading to cell death. They didn’t have enough antioxidants.

Hill et al didn’t measure muscle thickness, but it wouldn’t surprise me if at 20 days the guinea pigs on their way to an early death had the thickest and most massive quadriceps.

Can Muscle Size Be Used as an Indicator of Overtraining?

If growth in muscle size may indicate muscle damage from either overtraining or antioxidant deficiencies, we might be able to use the response to exercise to assess nutrition or exercise load.

Let’s look again at the Bjørnsen study. If the cross-sectional area of a muscle is proportional to the square of muscle thickness, then we can get a measure of strength per unit cross-section by taking the ratio of leg press 1RM to the square of rectus femoris thickness. That is 1.187/1.109^2 = 0.965 in the antioxidant group, 1.158/1.162^2 = 0.857 in the placebo group. Per unit cross-section, the antioxidant group lost 3.5% in strength, the placebo group lost 14.3%.

It looks like both groups may have damaged their muscles; the antioxidant group just did much less damage. It appears both groups were overtraining relative to their nutritional status. Perhaps if nutrition were better, the response to exercise would have been better, and strength per unit cross-section would have increased. Maybe the missing nutrients included antioxidants, and taking even more antioxidants may have enabled this rigorous training regimen (designed “to stimulate as much muscle growth as possible”) to take place without any impairment of health.

Is Bodybuilding Safe?

If large size can be an indication of damage in muscle, then many techniques which cause muscular hypertrophy will be health-damaging. The healthiest strength gains might come with only small size gains, as the muscle becomes more efficient. It is only unhealthy muscle that becomes super large.

If so, then bodybuilders, who are judged on the size of their muscles, not their strength, will be tempted to use health-damaging and muscle-damaging techniques, like antioxidant deficiencies, to expand their muscle mass. Presumably the winning bodybuilders will be those who use all effective techniques to grow muscle, including the health-damaging ones. So we should expect champion bodybuilders to die young.

I have not seen statistical evidence, but anecdotal lore suggests that champion bodybuilders do, indeed, die young, often of heart diseases (indicating muscle damage). Here are two Youtube videos memorializing bodybuilders who died young:

Conclusion

If you want me to believe that antioxidants are bad, the Bjørnsen study is not going to do it. It looks to me that the elderly men who were in the antioxidant group were the lucky ones. The 1000 mg of vitamin C and 350 IU of vitamin E they were taking daily improved their response to exercise. Indeed, for all we know their antioxidant intake may have been less than optimal!

The elderly men who didn’t get the antioxidants should worry about their hearts. If their leg muscles became large but weak, their hearts may have also.

Everyone who works out should be aware: when it comes to muscles, bigger is not the same as better. The healthiest muscles are those in a wiry physique – modest size, but able to exert a lot of force.

Finally, a pitch for our upcoming October 10-17 Perfect Health Retreat. Our advice is sensible, comprehensive, and increasingly well supported by guest experience. If you want to learn how to optimize health for the rest of your life, and have a great time doing it, please come join us.

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References

[1] Bjørnsen T et al. Vitamin C and E supplementation blunts increases in total lean body mass in elderly men after strength training. Scand J Med Sci Sports. 2015 Jul 1. http://pmid.us/26129928.

[2] Hill KE et al. Combined selenium and vitamin E deficiency causes fatal myopathy in guinea pigs. J Nutr. 2001 Jun;131(6):1798-802. http://pmid.us/11385070.

 

Leave a comment ?

49 Comments.

  1. Hi Paul – Thanks — the idea of a tradeoff between muscle mass past a certain point and health (if there is such a tradeoff) is an interesting one.

    However, I don’t think that professional bodybuilders dying young really proves much of anything on that question. Everyone in those videos almost certainly used enormous amounts of steroids and other performance enhancing drugs. To the extent they died young, it was likely from drug overuse, not just from having large muscles.

    Also – Maybe I am misremembering, but I thought I remembered from your second edition book that a high ratio of arm size to waist size was a good predictor of longevity? Of course, this accounts for both muscle mass and fat mass, so it’s measuring two things at once — still, it implies that (at least to a point), more muscle mass is better for health.

    Anyway, thanks for the thought-provoking post.

    • Hi Richt,

      Yes, in the general population being stronger and proxies for it like having more muscle are clear gains. Your point about the steroids and drugs reinforces mine — there are interventions which give bigger muscles but damage health. Steroids are one, antioxidant deficiencies are another.

      Best, Paul

  2. How interesting that you posted this when I just started some weight lifting last month (mainly body weight so far) after a very long time of being sedentary. And of course, I heard that same information about taking antioxidants right before or after a workout because they think it blocks exercise hormesis.

    Your perspective actually makes sense. I want to build more muscle for aesthetic reasons so I won’t be skinny fat anymore. But I definitely don’t want to be as big as body builder, and I want to live a long time.

    Perhaps I should take with a grain of salt the current wisdom that a beginner lifter could add up to 20-25 lbs of muscle in year one (about 0.5 lb a week). Do you think this might be based on people building damaged muscle instead of strong healthy tissue? I wanted to add 15-20 lbs of muscle in the next year

  3. “when it comes to muscles, bigger is not the same as better. The healthiest muscles are those in a wiry physique – modest size, but able to exert a lot of force.” Interesting. In many circles it is obvious the fact that force is different from body mass. Some people can be big but week, specially if they are training on machines. If you read any of the Pavel Tsatsouline, for example, he talks constantly about it. And he is not the only one. Cheers

  4. Charles Grashow

    Thoughts on this study re Vitamin C supplementation

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447163/
    Differing Relations to Early Atherosclerosis between Vitamin C from Supplements vs. Food in the Los Angeles Atherosclerosis Study: A Prospective Cohort Study

    Conclusions:

    Vitamin C supplementation is associated with accelerated early atherosclerosis measured by carotid IMT compared to a protective association with vitamin C from food. The adverse association of vitamin C supplementation may be greater in patients with higher serum cholesterol levels. The current results provide a potential mechanistic understanding for the observed differences between Vitamin C in supplements vs food in prior studies. Given these observations,vitamin C supplementation does not appear to be currently advisable for prevention or treatment of atherosclerosis.

  5. Paul,

    This is fascinating, and makes much sense. How *could* hypertrophy be a positive adaption when, at the very least, muscle mass consumes much more calories, even at rest? It’s almost certainly maladaptive.

    Paul, on the subject of antioxidants, I wonder if your recommendation for Vitamin C still holds, given some of the theories about the ill effects of iron (saw your Facebook link to that) and knowing that C enhances iron absorption. I’d be curious about your thoughts more generally on the iron theory, as it seems intriguingly explanatory, having both the mechanism and epidemiology to support it.

    Regards,
    Ryan

  6. Regardless of any theories, its well established in clinical evidence that isolated ascorbic acid (Vitamin C) is detrimental to athletic performance and recovery. There is also evidence that ascorbic acid is not acting as an antioxidant when taken in isolation, given the increase in oxidative stress biomarkers. However, plant-based vitamin C, anthocyanins, and other polyphenols have established performance enhancement benefits. The primary issue is isolation vs. broad-spectrum.

    Effect of vitamin C supplements on physical performance
    Braakhuis AJ
    Curr. Sports Med. Rep., 2012

    Effects of vitamin E and C supplementation either alone or in combination on exercise-induced lipid peroxidation in trained cyclists
    Bryant RJ, Ryder J, Martino P, Kim J, Craig BW
    J. Strength Cond. Res., 2003

  7. I suspect you are incorrect on this one. I suspect what you are seeing is that (roughly) 90% of strength adaptation is motor learning and efficiency and 10% is muscular growth.

    However, that only applies to newbie lifters…at some point you become perfectly efficient (or as much as you can be) and the only way to increase torque is with more muscle mass.

    • Hi Michael, I agree, to become very strong requires more mass. I am merely making the point that there are mass-increasing strength-reducing interventions, so it is wrong to blindly equate increased mass with improvement.

      • I agree with Michael. Mass is an indicator of strength. What is not an indicator of the skills often needed to demonstrate strength. I hadn’t seen the 90% number before, but it makes sense for anyone that has seen weight class Olympic lifters.

        This muscle part of this post has me puzzled. I hope you do a follow up where you go into the topic deeper.

  8. Paul, it seems clear that larger muscles can be stronger, more capable muscles in some contexts, even while they can be a sign of, and adaptation to, muscle pathology in other contexts. So by itself size doesn’t tell you anything about health, which to me renders your reasoning here speculative at best.

    For example, racing greyhounds have enormous hearts compared to other dogs, but extremely capable and healthy ones. Heart muscle that is both healthy and abundant lets them accelerate faster than a thoroughbred racehorse. Their large hearts are apparently a genetic adaptation, since they retain them in retirement. The skeletal muscles of racing dogs are also enormous. This arises from their training and subsides in retirement. But these are also very large, yet very healthy muscles, obviously. There is no comparison here to cardiomyopathy, with diseased, enlarged hearts that can barely function. I own healthy greyhounds with large hearts and had a cat with a large heart who could barely climb a step due to heart failure. The two contexts could not be more different.

    Similarly, natural bodybuilders with big muscles are often enormously strong and fit. They can easily lift weights the rest of us could not if our lives depended on it. There is again no comparison between this situation and diseased cardiac muscle that is barely sufficient to keep a person alive.

    It is interesting that the subjects in the study you cite showed an apparent inverse correlation between muscle size and strength changes. But I’d be cautious about interpreting the meaning of that observation. For one thing, it is far from clear how one might reasonably measure “strength,” or even what “strength” really means. At the very least demonstrations of “strength” such as 1RM rely on acquired skill and neuromuscular adaptation as well as underlying muscular capability. Many factors might explain the inverse correlation in that study (even if it’s real and reproducible, which it may well not be). Moreover, the physiological relationship between muscular size and apparent strength is not understood. Sometimes they don’t seem to correlate very well, but often they do, when people strength train. No one knows why. Individual differences seem very important.

    Dead bodybuilders? To say there are many possible reasons they died would be quite an understatement considering how many of them lived. All we really know, I think, is that big muscles are not a magic fairy dust for cheating the grim reaper.

    I don’t think enough is understood in this field at this point to draw the kinds of conclusions you did. Though you might be right. The studies purporting to show that antioxidant supplementation hurts positive responses to exercise suffer from the same problem. What seems clear enough is that many strength trainers who take vitamins seem to progress very nicely, so some humility about this subject might be in order.

    • Yes, it’s speculative. But so is the idea that 1 g vitamin C and 350 IU vitamin E are harmful. I’m merely presenting the alternative view.

    • I agree with Bill when it comes to bodybuilders. Many of those bodybuilders used PEDs, which is a huge confounder.

      Personally, I’m going to continue to lift weights and, consequently, will have larger muscles than if I did not. For me, lifting weights reduces stress much better than aerobics (which I also do).

  9. Sometime ago Scientific American did a nice review of the literature regarding dosing with antioxidants and concluded that it interferes with the body’s own anti oxidant system.
    Not sure you present compelling evidence.

    • Hi Steve,

      That’s a big topic! Of course antioxidants will modulate and potentially could disrupt oxidative signaling. But lack of antioxidants can make normal oxidative signaling tissue-damaging. So it is a question of finding the optimum. In this study, there were only two groups, and the 1 g vitamin C + 350 IU vitamin E group was healthier than the 0 supplement group. So this is a pro-supplementation study, for a moderate dose of supplements in an elderly population being stressed by rigorous exercise.

  10. Hi Paul,
    thanks for this article.
    I think that your reflection “the smaller muscle that can exert more force is the healthier muscle. A gargantuan but weak muscle is an unhealthy muscle” is interesting, and I understand your conclusion… but:
    when a natural weightlifter or a natural powerlifter trains to be stronger, his workout causes myofibrillar hypertrophy; we have stronger muscles, (naturally) bigger muscles, maybe healthy bigger muscle?
    You wrote: “many techniques which cause muscular hypertrophy will be health-damaging”. Probably many techniques, I agree.
    “The healthiest strength gains might come with only small size gains, as the muscle becomes more efficient. It is only unhealthy muscle that becomes super large.”
    Maybe your point is “SUPER” large: but it’s normal that a stronger muscle is a bigger muscle, and I think that it’s healthy, not unhealthy.
    Is healthy their hypertrophy?
    https://c2.staticflickr.com/4/3161/2756025403_d00a689eb2.jpg
    http://www.projectinvictus.it/index/wp-content/uploads/2013/03/Li+Hongli+Olympics+Day+5+Weightlifting+sJMe0nMez9Wx.jpg

    Probably yes, in my opinion. Yes, it’s not a SUPER hypertrophy, but a (healthy?) hypertrophy linked to strength.

    This drug-induced “monster” hypertrophy:

    https://www.t-nation.com/system/publishing/article_assets/2326/original/Bodybuilders.jpg?ts=1429134993

    https://www.t-nation.com/system/publishing/article_assets/2330/original/Matarazzo.jpg?ts=1429134994

    I really am sure it’s unhealthy.

    Bye,
    Mario

    • Hi ML,

      Yes. To be really strong, muscles need to become large. However, we really shouldn’t assess response to exercise by size, but rather by strength. And if Bjornsen had assessed by strength, he couldn’t have concluded that antioxidants impaired the response to exercise.

      Now, at some dose I’m sure the antioxidants would impair the response to exercise, and damage health. But that dose wasn’t reached in this study.

      Best, Paul

  11. “To be really strong, muscles need to become large”

    Again, I think this is much too simple. It is well known among those who strength train that some people become extremely “strong” (i.e., can lift heavy weights) without a lot of muscular hypertrophy. Others get huge muscles but can lift much less. Much of this difference appears to be genetic, though different training approaches may favor “strength” vs. hypertrophy. The basic biology of all this is far from understood. The long term implications for health and longevity even less so.

    What is true I think is that stimuli for increasing the capability of skeletal muscle, whether “exercise” or occupational or something else, generally lead to both size and apparent strength increases, with the relative change varying enormously depending on person and perhaps context. Many strength trainers get somewhat bigger muscles at the beginning and then plateau in hypertrophy but continue to get gradually “stronger” in terms of weight lifted for a long time afterward.

    • Thanks Bill. I should have said “larger” rather than “large”.

      • i dont understand where all the talk is from, that this WOULDN t be the case. First adaptations to strength training are clearly shown to be coordinative. past that point people become stronger by further increasing coordination and then hypertrophy. -and to become really strong they need to hypertrophy a lot, as they do. this is also explainable and has been explained as simple as forces being distributed over a bigger cross section. once the mass is achieved a period of specific strength training to increase inter- and intramuscular coordination leads to further increases in strength. more mass correctly “activated” = more strength

        • Producing the greatest levels of tension in muscles occurs at the speed of thought. This is easily demonstrated when a person lifts a gallon sized plastic jug they he/she thinks is filled with water – but is actually empty; the lifter jerks the jug with too much force. Muscles produce more tension IF you think the object is heavy or if it actually is. This post/discussion is incomplete in many ways; only one is that it fails to explain/account for the difference between myofibrillar growth vs sarcoplasmic growth and the type of training that accounts for each adaption. One type allows for huge strength gains while minimizing muscle girth while the other essentially causes muscles to uptake more glycogen and water. Inflammatory and peroxidation responses reflect a continuation of the ‘negative’ responses of sarcoplasmic training and overtraining in general by placing too much stress on muscle cells. In a nutshell, body builders train to failure – whereas smart, non-competitive power lifters train their nervous systems – not their muscles per se. Training muscles to produce near peak tension repetitively (not for a one rep max lift) demands NOT training to failure. One commenter mentioned Tsatsouline; he gets this and has written a book on it. Coordination is a less significant part of a the whole picture since it is more a fine tuning of motor skills and less of muscles’ overall ability to simply produce near peak or peak tension. Forcing a muscle to produce peak tension is necessary for what? Winning a competition or during fight or flight. Both ways of training (reps/exhaustion/sarcoplasmic vs. max recruitment) tend to result in injury when….? During fatigue of course. Training to failure OR for the 1 rep max is foolish when it comes to basic strength training. ‘Older’ people (in their 60’s and lower 70’s) who have never lifted weights (but posses generally healthy constitutions/frames and have not suffered significant injuries) can produce near peak forces with their muscles compared to when they were in their 30’s. This is due to neural recruitment. However, older cells/people AND untrained muscles cells are less resilient to stress, hence you’ll see more inflammation in the muscles of either ‘untrained’ young people or simply ‘older’ people – and this is what we’re trying to understand in terms of the effects of antioxidants in this article. Avoiding ‘wrong’ training and creating too much stress on the cells is the other half of the picture. Essentially, stress/weight lifting is a stress to cells. An excited or relaxed cell is synonymous with the flow of water and electrolytes in or out of the cell. Chronic fatigue and stress is synonymous with ‘overexcitation’ of your body (cells). Water held in a cell is a reflection of overstimulated swollen cells. Chronic excitation is synonymous with a fatigued cell – nerve or muscle. Go to a gym and watch… most people over train simply by going to failure. Most humans overestimate the correlation of increased muscle size with strength gains via weight training. Of course, larger people with more muscle are generally stronger – but the point is: significant strength gains are due to increasing neural activation. Building resilience via stress via ‘dosing’ the muscle with the proper stress and maintaining the cells’ ‘ready state’ (avoiding excessive inflammation) via antioxidant intake is another.

  12. Charles Nankin

    interesting research here on strength and mortality from the great team at s&c research. i have fwdd paul’s wondering out loud (!) about hypertrophy and health:

    Are strong people more resilient than weak people?
    If you have been around the fitness industry for a while, you have no doubt come across a great deal of sage wisdom from the famous strength coach Mark Rippetoe. Among many other quotable and entertaining sayings, Mark has the following, challenging proverb attributed to him:
    “Strong people are harder to kill than weak people and more useful in general” – Mark Rippetoe
    But is it really true? Are strong people more resilient? Do they last longer when put in challenging situations?

    One way we can answer this question is to look at the mortality rate in elderly populations and see how it is affected by baseline measures of strength. By testing strength in these elderly groups and then following them for long periods of time, it is possible to assess whether strong people survive longer than weak people.

    The study
    Association of regional muscle strength with mortality and hospitalisation in older people​, by Guadalupe-Grau, Carnicero, Gómez-Cabello, Avila, Humanes, Alegre, and García-García, in Age and Ageing (2015)

    What did the researchers do?
    The researchers took baseline measurements of strength in a very large cohort of elderly people and then followed them for an average of 5.5 years for mortality and for an average of 3.0 years for risk of hospitalisation. Here are the key details:
    Population = 1,755 institutionalised and community-dwelling Spanish people (985 females and 770 males), aged >65 years
    Intervention = four different measurements of strength (grip, shoulder abduction, hip flexion and knee extension) using a hand dynamometer, compiled into a composite measure
    Comparisons = four quartiles of strength (high, medium-high, medium-low, and low)
    Outcome = risk ratios for mortality and hospitalisation
    ​To combine the four measurements of strength into one composite measure, the researchers used the following calculation. Firstly, they assessed where each individual fell within the four quartiles for each strength measure. Secondly, they produced a composite or sum score for each individual as follows:
    Score = 1: one measure in the weakest quartile
    Score = 2: two measures in the weakest quartile
    Score = 3: three measures in the weakest quartile
    Score = 4: four measures in the weakest quartile
    So each individual had a score between 0 and 4 points, with those having 0 points having no weak areas and those having 4 points having weakness in all areas.

    What did the researchers find?
    Effect of sum score on mortality
    The researchers found that males and females with the worst possible sum score for strength (4 points) were 2.5 and 4.4 times more likely to die during the follow-up period, respectively, than similar individuals with the best possible sum score (0 points).

    Effect of sum score on hospitalisation risk
    The researchers found that males and females with the worst possible sum score for strength (4 points) were 1.8 and 2.8 times more likely to be hospitalised during the follow-up period, respectively, than similar individuals with the best possible sum score (0 points).

    Practical implications
    This study confirms previous investigations (mainly performed using grip strength) that have shown strength to be beneficially associated with reduced mortality and reduced risk of hospitalisation.

    What this study really adds to our knowledge is that strength measures across different parts of the body are additive when considering our risk profile.

    So being strong in just one area is not sufficient to reduce the mortality and hospitalisation risk in older age. Rather, being strong in multiple different movements and in both the upper and lower body is important.

    • Hi Charles,

      Very interesting study, thanks for sharing that.

      I wonder if what they are finding is mainly a matter of neurological health. We know that dementia leads strongly to mortality, and also that the brain often limits strength more than muscle capacity, it is wired to allow only safe exertion. As these elderly decline neurologically, their brain may not allow them to exert as much force.

      If so, the results may not transfer to a younger healthier population where the brain has an accurate idea of the body’s capabilities and muscle capacity is the limiting factor in strength.

  13. Weekend Link Love – Edition 357 | Mark's Daily Apple - pingback on July 19, 2015 at 8:10 am
  14. Very interesting, Paul! Thanks for, as usual, adding a more balanced view to the wild pro- and against swings in the blogosphere, this time in regards to antioxidants.

    So – for a take home message, where do you think the optimal balance for antioxidant supplements might lie? And are we to conclude then that it isn’t necessary to avoid antioxidant supplementation on workout days in order to maintain the hormetic effects of the exercise, as long as the dosage isn’t too high? Or would it still be better to use a higher dose on alternate days, away from exercise?

    Thanks!

    • Hi Web, I’m afraid there’s not necessarily enough evidence to declare a specific optimum, especially when you get to timing the nutrition around exercise. In general, I stand by the advice in our book and on our supplement recommendations page for an excellent balance of nutrition as a baseline program. The key is to be well nourished, and listen to your body – don’t let your workouts beat you up too much.

      If you are well nourished on rest days then you shouldn’t need supplementation on workout days, but a steady daily dose should be fine too – antioxidants on workout days might reduce size gains, but they also might protect you from injury and enable you to do more work, or avoid injury. However, just supplementing on rest days should work fine too – antioxidants that are useful will stay in your body for weeks, so the protection against injury should last more than one day.

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  16. Sergio Benvenuti

    Hi! Congrats for the awesome blog and book!
    In this topic though I think the analysis is a bit oversimplified.
    First, there are other ways of blunting hypertrophic response to typical gym training (sets of 6-12 reps close to failure with low rest time): taking NSAID and ice/cold therapies will decrease post training inflammation and, likely, muscle damage. The main factor for muscle growth (long term) is mionuclei increase, which is mainly due to muscle damage. Std bodybuilding techniques are very good at creating muscle damage and muscle inflammation, taking antioxidants decreases this effect. So, in my opinion, it makes no sense to train in this way and at the same time take stuff that kills the precise effects of the training. The question if bodybuilding-style training is “healthy” is a different one though.
    Second, your explanation for increase of strength/size ratio with vitamins is not very credible. Another possibility is: the supp group had less doms (delayed onset muscle soreness) and was able to train at higher intensity (the 60-80 y.o. subjects trained 3/week), this gave a higher effect on the neural component of strength. Also what would have happened if the scientists measured muscle stamina as well? Maybe placebo group had better improvement in mithocondrial density and substrate (glycogen/cp/fat) adaptations, stuff that give hypertrophy but no strength.
    Take a typical strength/power athlete like a gymnast/long jumper/weightlifter: they will train every day or more, a very high intensity, they will not chase muscle damage and they will typically use recovery aids like icing, so the next training session they’ll be able to train very hard and increase their neural capabilities.
    Compare with the typical bodybuilder: he will train a muscle every 4+ days, trying as much as possible to create damage, the next days those muscles will be swollen and very sore but he will not use them. His strength/size ratio will not increase much.
    Two different strategies for two different purposes. Its not obvious which one is healthier long term to me.

  17. This was an eyeopener. I agree that bigger is not always better.

  18. idealkraft Wochenschau – KW 31/2015 » idealkraft - pingback on July 31, 2015 at 2:31 am
  19. (Dvo)Tedenski pregled #13 - pingback on August 6, 2015 at 3:20 am
  20. What was the vitamin E form used in this study? DL-racemate or single natural enantiomer?

    Usage of single form (instead of mix of all relevant tocopherols) would also potentially worsen the results for supplement group… not to even talk about introducing un-natural form to body which cannot be operated by body chemistry. Or am I wrong here, I’m not that familiar with vitamin E (for example Mercola recommends using mix of all vitamin E forms).

    We should’t hop into conclusions about vitamin C when it’s used in tandem with E. But it might be wise to ingest antioxidants away from training.

  21. Paul,
    Thanks for this blog post, I enjoyed the write-up. Are you familiar with the Gliemann study in the Journal of Physiology in 2013? Somewhat related though not exactly the same topic, and was curious about your take.
    http://www.ncbi.nlm.nih.gov/pubmed/23878368

    • Hi JD,

      I think it’s much more plausible that resveratrol would inhibit the response to exercise than vitamin C. Vitamin C is naturally high in (strong) animals but resveratrol is not, for example; and resveratrol mimics some aspects of starvation which causes muscle loss.

      Thanks for the paper link.

      Best, Paul

  22. Hi Paul,

    I find this article fascinating. Friends of mine are convinced that for average people trying to get fit in the gym, that more muscle is always better regardless of strength. Partially for the metabolic cost and resultant energy balance, and partially for other benefits.

    Can you comment on what you think about having larger, relatively weak muscle to protect you from obesity and diabetes?

    Do you know if the science looking at strength and mortality looks at strength or muscle size?

    Thanks for your thoughts.
    R

  23. selenomethionine is organic selenium. Why not recommend it?

  24. Two words: Jack Lalanne

  25. Nice analysis and thinking out of the box ! I totally agree, that there likely is an increased requirement for antioxidants, particularly of the “foot soldier”, Vitamin C/ascorbate with increased frequency and intensity of muscle training, whether anaerobically or aerobically as the energy synthesis and so oxygen turnover is increased in the mitochondria and hereby likely an associated increased free radical production (the sparks from the bonfire – the combusting/oxidation of the hydrocarbons from fat/carbs with O2 ). While ascorbate is the fastest reacting antioxidant and also has the highest affinity to the hydroxyl radical, there’s likely also an increased need for the glutathione precursors, glycine, glutamate and cysteine. Moreover, hard training, with subsequent micro-tear and/or or intracellular disruption of the Z-bands of the myofibrils there’s likely also increased need for ascorbate for new collagen fibre repair and synthesis.

  26. To sum it up:

    Training without antioxidants = significantly bigger muscles
    Training with antioxidants = nonsignificantly stronger muscles

    The bigger muscles, being damaged, aren’t quite as strong as the smaller, healthier muscles. OK. But what if you train without antioxidants for a while, thus growing bigger muscles, then resume taking antioxidants? Won’t the bigger muscles become healthy, then? Won’t you end with healthy bigger muscles?

    A question worth pondering, especially by athletes training for a particular event.

  27. You’re trying to make to large of a lap here, AND you’re not taking into account the drug use in bodybuilding, and the lifestyle around the professionals. they are extremist in just about all aspects of life.

    Comparing professional bodybuilders to the average gym goer, even to a typical gymrat is laughable.

  28. How To Look Good Naked | Mike Daciuk - pingback on December 6, 2016 at 4:39 pm

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