Clinical trials have shown that supplementation of vitamin D and vitamin K2 can improve bone health and cardiovascular function in postmenopausal women. One small study among 15 healthy women indicated that three weeks of supplementation of 20 milliliters of extra virgin olive oil EVOO enriched with vitamins D, K and B6 can counteract bone loss.

Customer reactions to this product have been mostly positive. Verified buyer Robert W. Easy to take every morning. It's nice to know that if I am stuck in the office too much that I am still getting my essential D3 and K2.

Highly recommend this for anyone to get that extra boost in D3, especially if you work inside too long, or during the winter. NOW Foods is a family-owned supplement brand created to empower healthy living through natural products.

It offers a wide variety of products, including essential oils, multivitamins for kids , organic beauty products and even nutritional supplements for pets. NOW Foods Tart Cherry is our best tart cherry juice to reduce inflammation because it has a clinically-determined dosage of milligrams of tart cherry per daily serving and is made in a cGMP-registered facility for quality assurance.

Tart cherry juice is rich in polyphenols, especially anthocyanins. These antioxidative compounds are thought to play a role in reducing blood biomarkers for inflammation and oxidative stress.

Tart cherry juice is also thought to have sleep-promoting properties and is commonly found in natural sleep aids. Customers had good things to say about this supplement—its reviews have an average of 4. these tart cherry pills do work against gout.

Anytime I feel a flare-up coming, I take two pills every four hours or so and the flare-up goes away. Also great if you work out regularly, no more muscle pain. When this inflammatory response lingers for too long, occurs in healthy tissues or is consistently triggered by benign stimuli, it becomes a form of chronic inflammation.

The immune system plays a major role in inflammation and there are many mediators e. neutrophils, mast cells, T-cells, etc. At the cell level, an inflammatory response is communicated throughout the body via a cascade of molecular signals.

Consequently, chronic inflammation can affect a variety of body parts and organ systems and manifest as a number of different inflammatory diseases. The complex nature of inflammation can make it difficult to diagnose, determine its cause and select the appropriate course of treatment.

Nonetheless, there are several classic signs of inflammation in the body that can help you recognize if you have chronic inflammation. These signs include:. If you suspect that you have chronic inflammation, consult your healthcare provider for additional guidance.

Anti-inflammatory supplements are a type of dietary supplement designed to reduce inflammation and offer relief from inflammation-related symptoms, like pain and fatigue. Anti-inflammatory supplements come in an array of formulations and may have a single ingredient or a diverse blend of anti-inflammatory agents, depending on the supplement brand and manufacturer.

The diverse offering of anti-inflammatory supplements on the market enables consumers to address many different inflammation-related symptoms and diseases. As an over-the-counter OTC solution, anti-inflammatory supplements can be purchased in stores or online without a prescription.

Moreover, anti-inflammatory supplements tend to have fewer and less severe side effects than prescription anti-inflammatory drugs. Natural anti-inflammatory supplements may also have therapeutic benefits over OTC non-steroidal anti-inflammatory drugs NSAIDs , like Advil and Motrin.

Medhat Mikhael, a pain management specialist at the Spine Health Center at MemorialCare Orange Coast Medical Center in California. There is clinical evidence to suggest that anti-inflammatory supplements can be effective for lowering your inflammation levels. However, there is even more evidence that supports an integrative approach to inflammation and pain that goes above and beyond a supplement regimen.

An integrative health approach to inflammation includes interventions in addition to supplementation. Travis Scudday, an orthopedic surgeon with Hoag Orthopedic Institute in Southern California.

An integrative health strategy for inflammation will also include an anti-inflammatory diet and healthy lifestyle changes. An anti-inflammatory diet is one that excludes pro-inflammatory foods and emphasizes the consumption of foods that help fight inflammation. In addition to regulating your diet, making healthy lifestyle changes is a key factor for controlling chronic inflammation.

Anti-inflammatory supplements are generally safe to consume but may also cause unwanted side effects, including but not limited to :. Depending on the formula, anti-inflammatory supplements also have the potential to interact with your prescription medicine.

Consult your healthcare provider before taking dietary supplements if you take medication. The plethora of anti-inflammatory supplements available on the market can make it difficult to determine the best one for your needs.

Varying anti-inflammatory ingredients will target certain types of inflammation better than others. Consult your doctor and reliable health sources to determine which ingredients are best for your type of inflammation.

In general, never exceed the recommended dosage of any dietary supplement you purchase. Anti-inflammatory supplements come in various forms, including: pills, capsules, tablets, chewable gummies and powders.

Choose whichever form you are most comfortable taking on a regular basis. The best anti-inflammatory supplements are third-party tested and made in a regulated facility by a reputable manufacturer. Supplement brands with high quality products typically place a focus on transparency, evidence-based formulations and safety protocols.

Natural anti-inflammatory supplements are considered to be generally safe to consume. However, they may contain ingredients that you want to avoid. We chose our picks for the best anti-inflammatory supplements using a combination of criteria, including: product quality and safety, reputation of the manufacturer, third-party certification status, affordability and customer reviews.

Our selection criteria also emphasized supplements that contain natural anti-inflammatory ingredients. There is no magic bullet for fighting inflammation, but you can reduce inflammation faster by following an integrative approach that involves supplementation with natural anti-inflammatory agents, an anti-inflammatory diet and healthy lifestyle changes.

Yes, drinking water can reduce certain forms of inflammation. Hydration is particularly helpful against inflammation caused by environmental irritants and foreign invaders. The effect of coffee on your body depends on your genetics, age and health status. Coffee has anti-inflammatory properties, but some evidence suggests that it may increase inflammation in certain people.

The 1 vitamin for chronic inflammation depends on the nature of the inflammation you are dealing with. The most well-researched vitamins for chronic inflammation include vitamin A , vitamin D, vitamin K2, vitamin E , vitamin C and vitamin B6.

Yes, anti-inflammatory supplements are worth it, especially if other remedies have failed to provide you with relief. The right anti-inflammatory supplement can help you function, heal and feel a lot better. In addition to supplements, diet and lifestyle changes can reduce inflammation and improve your overall health.

If you suspect that you have chronic inflammation, consult your healthcare provider before you purchase an anti-inflammatory supplement and keep them informed of your progress over the course of your supplement regimen.

Sign In. SI Tickets. SI Shop. Deals Fitness Health Nutrition SI Tickets SI Shop Sleep Tech. By Gabrielle Hondorp Feb 14, By Matthew Dustin, fitness coach Feb 12, By Gabrielle Hondorp Feb 9, By Pete Nastasi, certified sports nutrition coach Feb 9, By Ashley Zlatopolsky Feb 8, By Sarah Falcone, BSN, RN Feb 8, In addition to this, it can be used to relieve arthritis pain and swelling.

Resveratrol is an antioxidant found in grapes, dark chocolate, peanuts, blueberries, and red wine. This potent anti-inflammatory compound protects against neurodegenerative disorders, cardiovascular disease, and cancer. Resveratrol contains compounds that help protect against oxidation, which is linked to systemic inflammation.

This potent supplement that fights inflammation is often used by people who are suffering from chronic conditions like ulcerative colitis , liver disease, and obesity. It also helps lower inflammatory markers, regulates blood sugar levels, lowers triglycerides, and helps to reduce body fat.

The body produces SAM-e S-adenosylmethionine naturally and uses it to regulate genes that control expression and behavior, which is why it can be used to help manage the inflammatory symptoms associated with certain liver conditions, osteoarthritis, and depression. The dosage is dependent on the inflammatory condition.

In addition to this, it can interact with a variety of medications, so it is vital that you speak to your integrative doctor before using it. High dosages of SAM-e can cause a number of digestive issues, including nausea, diarrhea, vomiting, and gas. The active ingredient in turmeric is curcumin.

Curcumin reduces the inflammation associated with metabolic conditions related to obesity. It also reduces insulin resistance and decreases blood glucose levels naturally. Unlike other supplements to fight inflammation, turmeric supplements can be taken with NSAIDs, provided the dose is low.

Curcumin increases the risk of those who have a bleeding disorder or take blood thinners; therefore, always consult your integrative medical doctor to determine if it is safe for you to take this anti-inflammatory supplement.

Zinc provides anti-inflammatory protection and supports the immune system. It works by decreasing oxidative stress in the body. Oxidative stress causes inflammation and has been linked to a host of medical conditions. Zinc supplements can reduce the risk of infections.

Zinc deficiencies have been linked with arthritis, inflammation, and pain. However, too much zinc can be dangerous. In addition to this, zinc can interact with certain antibiotics, calcium, and diuretics.

To ensure you are reaping the benefits of zinc without any of the dangers associated with too much zinc, speak with your functional doctor. An anti-inflammatory diet is based on foods that naturally reduce inflammation while avoiding foods that trigger inflammation. Some of the foods that have been linked with inflammation include fried foods, refined carbohydrates, red meat, and soda.

What is anti-inflammatory food? Anti-inflammatory foods reduce inflammation and relieve pain. Some of the best foods to incorporate into your diet include blueberries, strawberries, nuts, leafy green vegetables, tomatoes, and olive oil.

Chronic inflammation increases the risk of several dangerous, chronic medical conditions like heart disease, autoimmune disorders , and type 2 diabetes. Using supplements to fight inflammation, eating a healthy diet filled with anti-inflammatory foods, and using anti-inflammation vitamins and minerals help reduce inflammation and decrease the risk of disease.

If you are experiencing chronic inflammation , it is time to talk to your functional medicine doctor who understands how each system of the body works together to promote health. They will guide you how to use food, vitamins, minerals, and supplements to reduce inflammation and protect against disease.

Diet and Nutrition. Rose Wellness offers Holistic, Integrative and Functional Medicine services for treating chronic issues as well as for preventive care. Join us and take control of your health, your most important asset. Whole Foods Perhaps you get Holistic Therapies that Are Good for Managing Arthritis Pain.

Arthritis pain decreases the quality of life of millions of Americans. Hypothyroidism Natural Treatment Options. Thyroid disorders can occur in many forms, but hypothyroidism is one of the most common.

Symptoms of hypothyroidism are varied How Nutrition Boosts the Immune System and Fights Fatigue in Lyme Disease. Living with Lyme disease can be challenging, especially when facing the persistent symptoms that tend to accompany this condition. Biotoxin Illness. Lyme Disease CoInfections.

Ticks can transmit a variety of bacteria, parasites and viruses to humans. The most common tick-borne disease is Lyme disease Natural Treatment for Mold Sensitivity by Jennifer Jennings.

Jennifer Jennings, DNP, FNP-BC, IFMCP, our functional medicine practitioner, uses a functional medicine approach for identifying root causes of chronic Digestive Health. According to the National Institute of Health, 20 percent of the population suffers from chronic constipation. Constipation is defined as Hormone Replacement: A Holistic Guide.

Hormones are critical for nearly every basic function of your body. They are the messengers that tell your cells what Chronic Issues and Preventive Care for Men and Women. Ask Us. Functional Medicine is journey and works best when there is a mutual commitment between you and your functional medicine team.

Partnership between you, your physician, and your health coach provides consistency and adherence leading to better accountability and healthcare outcomes. For more details on our Subscriptions Plans, Click here. Our integrative physicians and healthcare providers treat various chronic illnesses and acute conditions including —.

For a complete list of conditions we treat, Click here. We believe in empowering you to have the freedom of choice to determine the best treatment options for your medical needs and avoid constraints placed by insurance companies.

However, we will help you receive any insurance benefits you may be entitled to. All costs for services rendered will be your sole responsibility. Most insurance companies offer some degree of reimbursement; however, you are encouraged to check with your insurance company about reimbursement prior to your appointment.

For conventional blood work, insurance companies frequently offer full coverage. Medicare - Our functional medicine practitioners have opted out of Medicare. If you are a Medicare beneficiary, you will not be entitled to any reimbursement from Medicare.

All costs for services including prescriptions and laboratory tests ordered will be your sole responsibility and will not be covered by Medicare. Further Information - If your insurance company needs further information, feel free to contact our office and our helpful staff will try to assist you.

Yes, we offer TeleHealth consults so you can connect with your healthcare provider from the comfort of your home. More than half of our patients prefer to use TeleHealth video conferencing option while saving valuable travel time.

Chondroitin is available in:. A dose of mg to 1, mg each day is common. Cinnamon is thought to offer many health benefits, from lowering blood sugar and cholesterol to reducing inflammation.

It contains a compound called cinnamaldehyde that gives the spice its fragrance but also appears to have potent anti-inflammatory effects.

Cinnamon, harvested from the bark of the cinnamon tree Cinnamomum verum , contains other compounds called flavonoids that also have anti-inflammatory properties.

These include flavonoids called catechins and procyanidins. Cinnamon supplements are available as:. A daily dose of around 1, mg is generally regarded as safe.

Curcumin is the bioactive compound of the spice turmeric. It is extracted and refined for use as a dietary supplement as well as a food coloring and cosmetic ingredient.

Curcumin also known by its chemical name diferuloylmethane is what gives the spice its bright yellow color. Studies suggest that curcumin has both anti-inflammatory and antioxidant effects. As an anti-inflammatory, curcumin may help relieve arthritis pain and reduce exercise-induced inflammation and muscle soreness.

It is available in the following formulations:. Manufacturers generally recommend between and 1, mg daily. It has branching roots and shoots, lush foliage, and red flowers. Its name comes from the tiny hooks that cover its fruit.

The secondary roots that grow out of the main roots are called tubers. The roots and tubers are used for pain relief and anti-inflammatory effects. They are also used as a digestive aid. Daily tuber dosage should be limited to 4. Fish oil supplements are made from the oils of cold-water fish, including:.

Fish oil is a source of omega-3 fatty acids EPA and DHA. Omega-3s have an anti-inflammatory effect by blocking inflammation cytokines and prostaglandins.

Cytokines are proteins that signal the immune system to do its job. Prostaglandins are natural chemicals in the body that are secreted when there is an injury or inflammation. Omega-3s can help if you have rheumatoid arthritis.

Fish oil supplements are available as:. The maximum dose for DHA and EPA is up to 3 grams daily. The seed of the flax plant contains omega-3 and omega-6 fatty acids. Some of the fat in flaxseed oil converts to EPA and DHA.

These are the same active ingredients in fish oil. Flaxseed is available as:. Capsules are available in 1, to 1, mg doses, but there is no recommended dose. A common intake of ground or milled flaxseed is about 2 to 3 tablespoons daily.

This can be added to your food throughout the day. Ginger is derived from the dried or fresh root of the ginger plant. It has been shown to have strong anti-inflammatory properties. This is similar to some nonsteroidal anti-inflammatory drugs NSAIDs , like Advil ibuprofen.

Ginger works by blocking chemicals that cause inflammation. Ginger is available in:. People sometimes use up to 1 gram of ginger in three divided doses per day. Gamma-linolenic acid GLA is a type of omega-6 fatty acid that is found in certain plant seed oils, such as:.

The body can change GLA into anti-inflammatory chemicals. The maximum dose is up to 3 grams daily. Green tea , made from the leaves of the Camellia sinensis plant, is known to be a potent antioxidant but also has significant anti-inflammatory effects as well.

Green tea is rich in anti-inflammatory compounds called polyphenols. This includes an especially potent polyphenol called epigallocatechingallate EGCG that can help reduce inflammation in blood vessels.

This may, in turn, reduce the risk of heart disease. When used as a dietary supplement, green tea is available in the following forms:.

Supplements manufacturers recommend between and 1, mg per day. You can also drink it as a tea three to five times daily, although it contains high amounts of caffeine that can cause jitteriness. Methylsulfonylmethane MSM is an organic sulfur compound that is naturally found in:.

However, as food is processed, the MSM is destroyed. MSM supplements are used to reduce pain and inflammation associated with arthritis. A common oral dose is 2 to 6 grams daily with meals. Quercetin is a chemical that is found in various foods, including:. Quercetin is recognized for having anti-inflammatory properties.

It blocks pro-inflammatory chemicals, such as leukotrienes and prostaglandins. Due to limited research, there is no recommended or usual dose. The maximum dose is up to 1 gram daily. Thunder god vine comes from the skinned root of a vine-like plant found in Asia.

The Chinese herbal remedy has been used to treat:. There have not been many studies on the benefits of thunder god vine done in the United States. As a result, there is no recommended daily dosage for the extract.

Turmeric is a perennial, lily-like shrub that mainly grows in India and Indonesia. It also grows in other tropical regions. Turmeric is part of the ginger family. The roots are dried to a yellow powder. Then they are used in foods, curries, and Ayurvedic medicine.

Turmeric is recognized for its anti-inflammatory properties. It works by blocking inflammatory cytokines and enzymes. A common dose for capsules is mg taken one to three times per day, but recommended dosages can vary widely.

Vitamin D is a group of fat-soluble vitamins commonly sold in supplement form. Vitamin D3 cholecalciferol and vitamin D2 ergocalciferol are the two forms most important to human health.

Vitamin D3 is more effective than vitamin D2 at raising vitamin D levels circulating in the blood in a form known as hydroxycholecalciferol, hydroxyvitamin D2, or 25[OH]D. Key Teaching Points: Long-lasting heavy training plan and competition can lead to chronic immune suppression in athletes, increasing infection risk.

Chronic exercise increases mobilization of neutrophils, decreases mobilization of lymphocytes, and decreases the absolute and relative numbers of neutrophils at rest. Nutritional deficiencies alter the immuno-system and increase infection risk. Nutrition can influence exercise-induced immune suppression.

Elite athletes competing at the highest levels can benefit from nutritional and supplementation support to improve immunity and reduce acute and chronic inflammations. Ticks can transmit a variety of bacteria, parasites and viruses to humans. The most common tick-borne disease is Lyme disease Natural Treatment for Mold Sensitivity by Jennifer Jennings.

Jennifer Jennings, DNP, FNP-BC, IFMCP, our functional medicine practitioner, uses a functional medicine approach for identifying root causes of chronic Digestive Health. According to the National Institute of Health, 20 percent of the population suffers from chronic constipation.

Constipation is defined as Hormone Replacement: A Holistic Guide. Hormones are critical for nearly every basic function of your body. They are the messengers that tell your cells what Chronic Issues and Preventive Care for Men and Women. Ask Us. Functional Medicine is journey and works best when there is a mutual commitment between you and your functional medicine team.

Partnership between you, your physician, and your health coach provides consistency and adherence leading to better accountability and healthcare outcomes.

For more details on our Subscriptions Plans, Click here. Our integrative physicians and healthcare providers treat various chronic illnesses and acute conditions including —. For a complete list of conditions we treat, Click here. We believe in empowering you to have the freedom of choice to determine the best treatment options for your medical needs and avoid constraints placed by insurance companies.

However, we will help you receive any insurance benefits you may be entitled to. All costs for services rendered will be your sole responsibility.

Most insurance companies offer some degree of reimbursement; however, you are encouraged to check with your insurance company about reimbursement prior to your appointment.

For conventional blood work, insurance companies frequently offer full coverage. Medicare - Our functional medicine practitioners have opted out of Medicare.

If you are a Medicare beneficiary, you will not be entitled to any reimbursement from Medicare. All costs for services including prescriptions and laboratory tests ordered will be your sole responsibility and will not be covered by Medicare.

Further Information - If your insurance company needs further information, feel free to contact our office and our helpful staff will try to assist you. Yes, we offer TeleHealth consults so you can connect with your healthcare provider from the comfort of your home.

More than half of our patients prefer to use TeleHealth video conferencing option while saving valuable travel time.

For more details on our TeleHealth services, click here. Functional Medicine is a journey and not a sprint and requires commitment to see long term sustainable results. Our functional medicine clinicians spend a significant amount of time with you starting with the first visit and make a time commitment to your health and well-being.

It typically takes 6 to 12 months to uncover and heal the different layers of health such as balancing the hormones and gut microbiome, enhancing effective detoxification, identifying inflammation and food intolerances, and personalizing your nutritional needs.

We strongly encourage you to have a separate primary care provider for your acute and emergency care conditions. Our practitioners specialize in functional medicine and cannot replace your primary care physician.

We are not available for same day acute issues or for insurance reimbursed physicals which are best handled by your primary care doctor. Looking for something else? State Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington Washington DC West Virginia Wisconsin Wyoming Other International.

index X. What Is Inflammation? Anti-inflammatory Supplements Getting your inflammation under control can be difficult.

Capsaicin Capsaicin is a compound found in peppers that cause them to be hot. Fish Oil Supplements Omega 3 fatty acids like those found in fatty fish lower inflammation. Quercetin Supplements Quercetin is a flavonoid found in a variety of fruits and vegetables.

Resveratrol Resveratrol is an antioxidant found in grapes, dark chocolate, peanuts, blueberries, and red wine. SAM-e The body produces SAM-e S-adenosylmethionine naturally and uses it to regulate genes that control expression and behavior, which is why it can be used to help manage the inflammatory symptoms associated with certain liver conditions, osteoarthritis, and depression.

Turmeric The active ingredient in turmeric is curcumin. Zinc Zinc provides anti-inflammatory protection and supports the immune system. Anti-inflammatory Food An anti-inflammatory diet is based on foods that naturally reduce inflammation while avoiding foods that trigger inflammation. Tags: Anti-inflammatory , Back Pain , Capsaicin , Chronic Pain , Chronic Pain Management , Curcumin , Fish Oils , Inflammation , Join Pain , Quercetin , Resveratrol , SAM-e , Turmeric , Zinc.

With the exception of two case studies, which showed improvements from supplementation Lewis et al. gov NCT, NCT Omega-3 fatty acid supplementation can increase MPS in response to hyperaminoacidemia or hyperinsulinemia Smith et al.

Recently, Gravina et al. Omega-3 fatty acids have anti-inflammatory properties and so could play a role in recovery from intense exercise, particularly if there is a large eccentric component. This concept is supported by studies where eccentric-exercise-induced DOMS was reduced following supplementation Jouris et al.

Concerns of fish oil or omega-3 fatty acid consumption would include heavy metal contaminants, bleeding, digestive problems, and increased low density lipoprotein reviewed in Erdman et al.

Additionally, since there are not sufficient data to indicate that decreased dietary or body levels of omega-3 fatty acids cause functional impairments, it is unclear if supplementation should be pursued by athletes, instead of including fatty fish in the diet as a source of omega-3 fatty acids.

Although vitamin D is most associated with bone health, the presence of vitamin D receptors throughout the body, including in skeletal muscle, indicate a role in other tissues.

Synthesis of vitamin D in skin cells, however, is dependent on factors including time of day of exposure, season, latitude, cloud cover, smog, skin pigmentation, skin area exposed, sunscreen coverage, and age.

Using these or similar cut points, it appears that many athletes are insufficient or deficient at various times of the year Halliday et al. Some data on elite and professional athletes also show a high percentage of deficiency and insufficiency Allison, Close et al.

The data on the effects of vitamin D supplementation on muscle function have been described as equivocal, with discrepancies in research in part caused by differences in baseline hydroxyvitamin D concentrations prior to supplementation Close et al. For example, Close, Russell, et al.

These data strongly suggest a role for adequate vitamin D in the adaptive process to intense exercise. In addition to muscle function, vitamin D supplementation may also be important for reducing risk of upper respiratory tract infections and stress fractures.

Studies in athletes Cox et al. One study in college athletes found that serum 25 OH D concentrations over the winter and spring were negatively associated with documented frequency of acute URTI Halliday et al.

Athletes with low vitamin D concentrations also experienced a higher number of days with upper respiratory symptoms and higher symptom-severity scores. Although additional studies are needed to confirm the effectiveness of correcting low vitamin D concentrations through supplementation, a recent randomized, placebo-controlled study in university athletes found that weeks of supplementation with 5, IU per day of vitamin D3 during winter training significantly increased salivary secretion rates of immune factors, namely cathelicidin and secretory immunoglobulin A He, Fraser, et al.

Concerning stress fractures, a study in Finnish military recruits found that stress fracture risk was 3. Again, while additional studies are needed, vitamin D supplementation may have an impact on reducing stress fracture risk. Based on the number of deficient athletes, it seems that supplementation is warranted in many athletes.

Thus, it is prudent to first identify deficiencies through blood work see Larson-Meyer et al. More research on the consequences of high-dose, longer-term vitamin D supplementation is encouraged, but indiscriminate high-dose vitamin D supplementation for athletes is not advised. Microbes in the gut influence gastrointestinal tract GIT functions, the immune system, and metabolite production in a variety of ways that exert influence on exercise.

The GIT microbiome primarily consists of a diverse array of bacterial species, each of which interacts with the host in a unique way. This influence ranges from beneficial, to neutral, to pathogenic or opportunistic, and the net effect of the GIT microbiome is a function of the combined effects of many different strains and their relative abundance.

By definition, probiotics are strains of bacteria that can maintain viability in supplement form for oral ingestion, survive the acidic gastric environment, adhere and colonize in the GIT, antagonize pathogenic bacteria, and provide health benefit s to the host athlete West et al.

There are dozens of bacterial strains used as probiotics, particularly those that produce lactic acid, but each strain is unique with respect to how it responds to and affects the GIT milieu, the GIT, the immune system components within the GIT, and all downstream systems of the body.

Thus, it is important to be specific about effects of each specific probiotic strain or combination of strains and not to generalize effects of one probiotic to all probiotics.

Research regarding athletes has been undertaken to evaluate the efficacy of probiotic supplementation to a prevent or relieve GIT problems during exercise, b reduce the impact of URTIs, and c improve endurance performance. While there is a variety of bacteria that have been used as probiotics in clinical studies in athletes, there is more consistency in the dosage and duration generally needed to produce benefits.

A single bacterium is a colony-forming unit CFU and dosages are expressed using this common terminology. The convention for naming bacteria is Species strain e. rhamnosus ]. A variety of strains within the Lactobacillus , Bifidobacterium , and, less frequently, the Streptococcus species are used as probiotics.

These bacteria are Gram-positive do not contain endotoxin. Strenuous and prolonged exercise place stresses on the GIT that increase the likelihood of discomfort, abdominal cramping, acid reflux heartburn , nausea, vomiting, diarrhea, and leakiness of the gut that may allow endotoxemia to occur de Oliveira et al.

Splanchnic hypoperfusion leading to ischemia in the gut is accepted as a principle cause, with additional contributions from nutritional, mechanical e. Probiotic support to increase resilience of the GIT against ischemia is of interest to athletes, particularly for those in prolonged endurance events that have the greatest occurrence of GIT problems that impair or stop performance.

Probiotics do not eliminate hypoperfusion of the GIT, thus moderate reduction in severity and duration of gastrointestinal symptoms and exercise-induced endotoxemia are the best outcomes that might be expected in clinical trials.

To this end, a number of clinical trials have measured small to moderate decreases in severity or duration of gastrointestinal problems attributed to use of L. rhamnosus , L.

fermentum , and two different multi-strain probiotics Haywood et al. However, in the L. fermentum trial, benefits were lower in female participants, and the decrease in severity was accompanied by a two-fold greater increase in the number of and duration of less-severe symptoms in male participants for the probiotic compared to placebo group.

The latter was proposed to be part of the adaptive response to probiotic colonization. Using a biomarker of gut permeability, a supporting clinical trial demonstrated that multi-strain probiotic reduced leakiness of the GIT as an underlying cause of GIT distress Lamprecht et al.

Upon reviewing the evidence, Pyne et al. Modulation of the immune system to increase defenses against URTIs is the potential benefit of probiotics for athletes that has been most extensively researched.

As a major gateway for pathogen entry, the GIT is heavily protected by the immune system. Two-way communication between the immune system and the GIT microbiome impacts immune defenses throughout the body.

Probiotics have been shown to enhance innate immunity first line of defense by upregulating immunoglobulins, antimicrobial proteins, phagocytic activity, and natural killer cell activity, and also to enhance acquired immunity by improving antigen presentation and function of T and B lymphocytes to neutralize pathogens and virally-infected cells Bermon et al.

The majority of placebo-controlled clinical trials assessing the efficacy of probiotics for reducing incidence, duration, and severity of URTI in athletes report beneficial outcomes, however, many different probiotics have been used and the differences in trial protocols and outcome measures complicates the drawing of more specific conclusions.

Pyne et al. An additional trial was unable to distinguish placebo and probiotic treatments because of unexpectedly low incidence of URTI in both groups Gleeson et al.

The different probiotic formulations used across these studies are too numerous to list, so for the sake of brevity, we conclude here that there are many probiotics that may decrease the negative impact on training or competition caused by URTI.

More research is needed to establish whether probiotics improve performance. There is some evidence that lowering GIT permeability may have contributed to a longer time to fatigue while exercising in the heat Shing et al.

The only other study to evaluate performance found no improvement in a short-duration, high-intensity exercise bout without heat stress with probiotic compared to placebo treatment Cox et al.

Much of the research on nutrition and the adaptive response to exercise focuses on dietary supplements that affect skeletal muscle tissue, MPS, and MPB.

However, nutritional interventions that could benefit connective tissue proteins would valuable as well reviewed in Baar, Shaw et al. Potentially, these supplements could be used to decrease muscle damage or DOMS in athletes.

Some groups have noted reductions in DOMS, CK, and inflammatory cytokines e. However, similar protective effects of curcumin and reductions in inflammatory makers e.

Tart cherry juice has been shown to decrease muscle damage and inflammatory markers following resistance, high-force eccentric, running, and cycling exercise reviewed in Bell et al. There are concerns that blunting inflammation may impair the adaptive response to exercise training.

However, at times, such as when there are multiple competitions in a brief period of time, faster recovery of strength or decreased soreness may be more valued by the athlete than adaptation Bell et al. Creatine monohydrate could be recommended for promoting recovery from, and muscular adaptations to, intense training; recovery from periods of injury that result in extreme inactivity; cognitive processing; and reducing severity of or enhancing recovery from mTBI.

Vitamin D insufficiency or deficiency appears common, and the benefits of replenishment with supplementation likely improve some aspects of muscle function. However, athletes should seek a blood test and guidance from a physician to confirm inadequate vitamin D status, and then guidance from a nutrition professional regarding supplementation.

There are several potential benefits of Omega fat supplementation on skeletal muscle, but more research needs to be conducted.

Like creatine monohydrate, omega 3-fatty acid may reduce severity of or enhance recovery from mTBI. At this time, a recommendation for fatty fish consumption, which would include increased intake of omega 3-fatty acids, protein, vitamins, and minerals, may be more appropriate for athletes than a recommendation for fish oil supplementation.

The majority of placebo-controlled clinical trials show that probiotic supplementation can reduce the incidence, duration, and severity of URTI in athletes. It is difficult to make more specific recommendations, as many different probiotic supplements were used in these studies.

However, it is unknown if these effects can enhance recovery in elite athletes or affect subsequent performance.

HMB cannot be recommended at this time, but more research on recovery of muscle injury during periods of extreme inactivity is needed.

Manuscript preparation and editing was undertaken by ESR, MPM, and DELM. All authors approved the final version of the paper. Allison , R. Severely vitamin D-deficient athletes present smaller hearts than sufficient athletes. European Journal of Preventive Cardiology , 22 4 , — PubMed doi No association between vitamin D deficiency and markers of bone health in athletes.

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