Scientific Research of Premium Hydration + Creatine
CLINICAL STUDIES ON THE FOLLOWING INGREDIENTS:
CREATINE
Creatine Prevents the Structural and Functional Damage to Mitochondria in Myogenic, Oxidatively Stressed C2C12 Cells and Restores Their Differentiation Capacity
Abstract
Creatine (Cr) is a nutritional supplement promoting a number of health benefits. Indeed Cr has been shown to be beneficial in disease-induced muscle atrophy, improve rehabilitation, and afford mild antioxidant activity. The beneficial effects are likely to derive from pleiotropic interactions. In accord with this notion, we previously demonstrated that multiple pleiotropic effects, including preservation of mitochondrial damage, account for the capacity of Cr to prevent the differentiation arrest caused by oxidative stress in C2C12 myoblasts. Given the importance of mitochondria in supporting the myogenic process, here we further explored the protective effects of Cr on the structure, function, and networking of these organelles in C2C12 cells differentiating under oxidative stressing conditions; the effects on the energy sensor AMPK, on PGC-1α, which is involved in mitochondrial biogenesis and its downstream effector Tfam were also investigated. Our results indicate that damage to mitochondria is crucial in the differentiation imbalance caused by oxidative stress and that the Cr-prevention of these injuries is invariably associated with the recovery of the normal myogenic capacity. We also found that Cr activates AMPK and induces an upregulation of PGC-1α expression, two events which are likely to contribute to the protection of mitochondrial quality and function.
Source: Barbieri E, Guescini M, Calcabrini C, Vallorani L, Diaz AR, Fimognari C, Canonico B, Luchetti F, Papa S, Battistelli M, Falcieri E, Romanello V, Sandri M, Stocchi V, Ciacci C, Sestili P. Creatine Prevents the Structural and Functional Damage to Mitochondria in Myogenic, Oxidatively Stressed C2C12 Cells and Restores Their Differentiation Capacity. Oxid Med Cell Longev. 2016;2016:5152029.
https://pubmed.ncbi.nlm.nih.gov/27610211/
Role of Creatine Supplementation in Conditions Involving Mitochondrial Dysfunction: A Narrative Review
Abstract
Creatine monohydrate (CrM) is one of the most widely used nutritional supplements among active individuals and athletes to improve high-intensity exercise performance and training adaptations. However, research suggests that CrM supplementation may also serve as a therapeutic tool in the management of some chronic and traumatic diseases. Creatine supplementation has been reported to improve high-energy phosphate availability as well as have antioxidative, neuroprotective, anti-lactatic, and calcium-homoeostatic effects. These characteristics may have a direct impact on mitochondrion's survival and health particularly during stressful conditions such as ischemia and injury. This narrative review discusses current scientific evidence for use or supplemental CrM as a therapeutic agent during conditions associated with mitochondrial dysfunction. Based on this analysis, it appears that CrM supplementation may have a role in improving cellular bioenergetics in several mitochondrial dysfunction-related diseases, ischemic conditions, and injury pathology and thereby could provide therapeutic benefit in the management of these conditions. However, larger clinical trials are needed to explore these potential therapeutic applications before definitive conclusions can be drawn.
Source: Marshall RP, Droste JN, Giessing J, Kreider RB. Role of Creatine Supplementation in Conditions Involving Mitochondrial Dysfunction: A Narrative Review. Nutrients. 2022 Jan 26;14(3):529.
https://pubmed.ncbi.nlm.nih.gov/35276888/
Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial
Abstract
Creatine supplementation is in widespread use to enhance sports-fitness performance, and has been trialled successfully in the treatment of neurological, neuromuscular and atherosclerotic disease. Creatine plays a pivotal role in brain energy homeostasis, being a temporal and spatial buffer for cytosolic and mitochondrial pools of the cellular energy currency, adenosine triphosphate and its regulator, adenosine diphosphate. In this work, we tested the hypothesis that oral creatine supplementation (5 g d(-1) for six weeks) would enhance intelligence test scores and working memory performance in 45 young adult, vegetarian subjects in a double-blind, placebo-controlled, cross-over design. Creatine supplementation had a significant positive effect (p < 0.0001) on both working memory (backward digit span) and intelligence (Raven's Advanced Progressive Matrices), both tasks that require speed of processing. These findings underline a dynamic and significant role of brain energy capacity in influencing brain performance.
Source: Rae C, Digney AL, McEwan SR, Bates TC. Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial. Proc Biol Sci. 2003 Oct 22;270(1529):2147-50.
https://pmc.ncbi.nlm.nih.gov/articles/PMC1691485/
Creatine supplementation and cognitive performance in elderly individuals
Abstract
The purpose of this study was to examine the effect of creatine supplementation on the cognitive performance of elderly people. Participants were divided into two groups, which were tested on random number generation, forward and backward number and spatial recall, and long-term memory tasks to establish a baseline level. Group 1 (n = 15) were given 5 g four times a day of placebo for 1 week, followed by the same dosage of creatine for the second week. Group 2 (n = 17) were given placebo both weeks. Participants were retested at the end of each week. Results showed a significant effect of creatine supplementation on all tasks except backward number recall. It was concluded that creatine supplementation aids cognition in the elderly.
Source: McMorris T, Mielcarz G, Harris RC, Swain JP, Howard A. Creatine supplementation and cognitive performance in elderly individuals. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2007 Sep;14(5):517-28.
https://pubmed.ncbi.nlm.nih.gov/17828627/
Effects of creatine on mental fatigue and cerebral hemoglobin oxygenation
Abstract
While the role of creatine in preventing muscle (peripheral) fatigue for high performance athletes is well understood, its biochemical role in prevention of mental (central) fatigue is not. Creatine is abundant in muscles and the brain and after phosphorylation used as an energy source for adenosine triphosphate synthesis. Using double-blind placebo-controlled paradigm, we demonstrated that dietary supplement of creatine (8 g/day for 5 days) reduces mental fatigue when subjects repeatedly perform a simple mathematical calculation. After taking the creatine supplement, task-evoked increase of cerebral oxygenated hemoglobin in the brains of subjects measured by near infrared spectroscopy was significantly reduced, which is compatible with increased oxygen utilization in the brain.
Source: Watanabe A, Kato N, Kato T. Effects of creatine on mental fatigue and cerebral hemoglobin oxygenation. Neurosci Res. 2002 Apr;42(4):279-85.
https://pubmed.ncbi.nlm.nih.gov/11985880/
Effect of creatine supplementation and sleep deprivation, with mild exercise, on cognitive and psychomotor performance, mood state, and plasma concentrations of catecholamines and cortisol
Abstract
Rationale: Sleep deprivation has a negative effect on cognitive and psychomotor performance and mood state, partially due to decreases in creatine levels in the brain. Therefore, creatine supplementation should lessen the negative effects of sleep deprivation.
Objectives: The objective of this study was to examine the effect of creatine supplementation and sleep deprivation, with mild exercise, on cognitive and psychomotor performance, mood state, and plasma concentrations of catecholamines and cortisol.
Method: Subjects were divided into a creatine group (n=10) and a placebo group (n=9). They took 5 g of creatine monohydrate or a placebo, dependent on their group, four times a time a day for 7 days, immediately prior to the experiment. The study was double blind. Subjects undertook tests of random movement generation (RMG), verbal and spatial recall, choice reaction time, static balance and mood state pre-test (0 h), after 6, 12 and 24 h of sleep deprivation, with intermittent exercise. They were tested for plasma concentrations of catecholamines and cortisol at 0 and 24 h.
Results: At 24 h, the creatine group demonstrated significantly less change in performance from 0 h (delta) in RMG, choice reaction time, balance and mood state. There were no significant differences between groups in plasma concentrations of catecholamines and cortisol. Norepinephrine and dopamine concentrations were significantly higher at 24 h than 0 h, but cortisol were lower.
Conclusions: Following 24-h sleep deprivation, creatine supplementation had a positive effect on mood state and tasks that place a heavy stress on the prefrontal cortex.
Source: McMorris T, Harris RC, Swain J, Corbett J, Collard K, Dyson RJ, Dye L, Hodgson C, Draper N. Effect of creatine supplementation and sleep deprivation, with mild exercise, on cognitive and psychomotor performance, mood state, and plasma concentrations of catecholamines and cortisol. Psychopharmacology (Berl). 2006 Mar;185(1):93-103.
https://pubmed.ncbi.nlm.nih.gov/16416332/
MAGNESIUM
Role of Magnesium in Skeletal Muscle Health and Neuromuscular Diseases: A Scoping Review
Abstract
This scoping review examined the biological role of magnesium in skeletal muscle function, including its effects on muscle metabolism, muscle fiber integrity, regeneration, and recovery from exercise-induced damage. The review also explored the potential relevance of magnesium supplementation in conditions characterized by muscle weakness and atrophy.
Methods: A systematic search of PubMed was conducted following PRISMA-ScR guidelines, covering all studies published up to May 2024. From 305 studies identified, 20 met the inclusion criteria — four preclinical and 16 clinical studies. Studies were evaluated by a technical expert panel of five medical specialists with expertise in skeletal muscle disorders.
Results: Magnesium was found to act as a cofactor for over 300 enzymes and to play a central role in ATP metabolism, protein synthesis, muscle contraction, and oxidative stress regulation. Preclinical research demonstrated that magnesium helps modulate pathways governing skeletal muscle homeostasis, may counteract muscle proteolysis by inhibiting calcium-dependent degradation pathways, and promotes myogenic differentiation through mTOR signaling and activation of key muscle regeneration genes. Clinical studies showed that magnesium supplementation may improve muscle mass, respiratory muscle strength, and post-exercise recovery, and may reduce muscle soreness and inflammation in active individuals and clinical populations. Hypomagnesemia was frequently observed across multiple muscle-related conditions and was associated with muscle weakness, cramping, fatigue, and impaired muscle recovery. The review also noted that individuals who are physically active, eat less than recommended, or experience increased sweat losses may be particularly at risk of suboptimal magnesium levels.
Conclusion: The evidence suggests that maintaining adequate magnesium levels — through dietary intake or supplementation — may have meaningful implications for muscle mass, power, and physical performance, particularly in populations at risk of muscle atrophy or weakness. The researchers highlighted magnesium's potential as a therapeutic adjunct alongside exercise training in older adults and those experiencing muscle decline, while noting that further research is needed to fully define optimal dosing strategies and long-term outcomes.
Source: Sara Liguori, Antimo Moretti, Marco Paoletta, Francesca Gimigliano, Giovanni Iolascon. Role of Magnesium in Skeletal Muscle Health and Neuromuscular Diseases: A Scoping Review. International Journal of Molecular Sciences, 2024, 25(20), 11220. DOI: 10.3390/ijms252011220.
https://www.mdpi.com/1422-0067/25/20/11220
Effects of Magnesium Supplementation on Muscle Soreness in Different Types of Physical Activities: A Systematic Review
Abstract
This systematic review examined the effects of magnesium supplementation alone — without other combined supplements — on muscle soreness in physically active individuals. It also aimed to identify the optimal type, timing, and dosage of magnesium supplementation for reducing exercise-induced muscle soreness and supporting recovery.
Methods: Three electronic databases — PubMed, Scopus, and Web of Science — were searched following PRISMA 2020 guidelines and pre-registered with PROSPERO. From 1,254 articles identified, four randomized studies met all inclusion criteria, comprising 73 physically active participants between the ages of 19 and 27. Included studies examined magnesium supplementation in the context of resistance training, long-distance running, basketball, and professional cycling. Only studies using magnesium supplementation in isolation — without co-supplementation with other substances — were included.
Results: All four included studies reported positive effects of magnesium supplementation on muscle soreness and recovery markers. One study using magnesium glycinate found that supplementation significantly reduced perceived muscle soreness at 24, 36, and 48 hours post-exercise compared to the control group, and meaningfully improved feelings of recovery. A separate study found beneficial effects on blood glucose levels and muscle soreness following a strenuous 10 km downhill run. Two studies in team and endurance sport athletes found that magnesium supplementation offered a protective effect against exercise-induced muscle damage markers. The review also found that during intense exercise, magnesium is redistributed from the plasma to working tissues, and that prolonged or high-intensity exercise may deplete magnesium stores — potentially contributing to greater lactate accumulation, reduced glucose availability, and increased muscle soreness.
Conclusion: Magnesium supplementation may reduce muscle soreness, improve recovery, and help protect against exercise-induced muscle damage in physically active individuals. The researchers concluded that those engaged in regular intense exercise may benefit from a magnesium intake approximately 10–20% above the standard recommended daily allowance, ideally taken in capsule form around two hours before physical activity. The authors noted that magnesium citrate and glycinate forms may offer favorable bioavailability, and that further larger studies are needed to establish definitive type, timing, and dosage recommendations.
Source: Maria Grazia Tarsitano, Federico Quinzi, Katia Folino, Francesca Greco, Francesco Pio Oranges, Claudia Cerulli, Gian Pietro Emerenziani. Effects of magnesium supplementation on muscle soreness in different types of physical activities: a systematic review. PMCID: PMC11227245, PMID: 38970118. Journal of Translational Medicine, 2024. DOI: 10.1186/s12967-024-05434-x.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11227245/
Magnesium Matters: A Comprehensive Review of Its Vital Role in Health and Diseases
Abstract
This comprehensive review examined the wide-ranging physiological roles of magnesium in human health, with particular attention to its involvement in energy production, muscle function, cardiovascular health, metabolic regulation, bone health, and mental well-being. The review also explored the health consequences of magnesium deficiency and the potential therapeutic implications of supplementation across multiple chronic conditions.
Methods: A narrative review synthesizing findings from preclinical, epidemiological, and clinical studies examining magnesium's role across cardiovascular disease, type 2 diabetes, musculoskeletal health, psychiatric disorders, respiratory disease, and osteoporosis. The review drew on experimental studies, randomized controlled trials, meta-analyses, and epidemiological data to characterize magnesium's physiological significance and the consequences of deficiency or insufficiency.
Results: Magnesium was found to act as a cofactor for over 300 enzymatic reactions — and by some estimates over 600 — including those central to ATP synthesis, protein synthesis, DNA replication, and glucose metabolism. In muscle physiology specifically, magnesium regulates calcium homeostasis by blocking calcium channels during muscle relaxation, preventing excessive calcium influx and the muscle spasms, cramps, and weakness associated with low magnesium levels. Magnesium deficiency was linked to increased neuromuscular excitability, impaired muscle recovery, and reduced exercise performance. In studies of older adults, lower magnesium levels were associated with reduced muscle mass and physical performance, and supplementation demonstrated improvements in muscle strength, endurance, and exercise tolerance. The review also found that magnesium supports the Mg-ATP complex required for all glycolytic enzymes and energy transfer reactions in muscle cells. Additionally, adequate magnesium intake was associated with reduced low-grade inflammation, lower oxidative stress markers, and improved insulin sensitivity — all of which may indirectly support muscle preservation during weight loss or aging.
Conclusion: Magnesium is an indispensable mineral with broad implications for musculoskeletal, metabolic, and overall health. The review concluded that ensuring adequate magnesium intake — particularly for older adults, physically active individuals, and those eating significantly less than usual — may help preserve muscle function, support energy metabolism, reduce exercise-induced soreness, and protect against age-related physical decline. The authors noted that magnesium supplementation presents a well-tolerated, evidence-supported strategy for addressing deficiency in at-risk populations, while recommending consultation with healthcare professionals for individualized dosing.
Source: Ghizal Fatima, Andrej Dzupina, Hekmat B Alhmadi, Aminat Magomedova, Zainab Siddiqui, Ammar Mehdi, Najah Hadi. Magnesium Matters: A Comprehensive Review of Its Vital Role in Health and Diseases. PMCID: PMC11557730, PMID: 39539878. Cureus, 2024. DOI: 10.7759/cureus.71392.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11557730/
Unlocking the Power of Magnesium: A Systematic Review and Meta-Analysis Regarding Its Role in Oxidative Stress and Inflammation
Abstract
This systematic review and meta-analysis evaluated the antioxidant and anti-inflammatory effects of dietary and supplemental magnesium by examining its impact on established biomarkers of oxidative stress and inflammation. The review also assessed the bioavailability of different magnesium supplement forms and their relevance for clinical use.
Methods: A systematic search of PubMed was conducted following PRISMA guidelines and pre-registered with PROSPERO, covering studies published from 2000 to 2025. From 51 identified articles, 28 met the inclusion criteria — encompassing both animal and human studies. Six of these were included in a formal meta-analysis examining the effects of magnesium supplementation on nitric oxide, total antioxidant capacity, malondialdehyde, glutathione, and C-reactive protein (CRP). A separate meta-analysis aggregated all oxidative stress biomarker data using Z-score standardization. Study quality was assessed using the Cochrane Risk of Bias-2 tool.
Results: The meta-analysis found a statistically significant reduction in CRP levels with magnesium supplementation — a marker of systemic inflammation — with minimal heterogeneity across studies, suggesting consistent anti-inflammatory effects. However, no conclusive effect on other oxidative stress biomarkers, including total antioxidant capacity, malondialdehyde, or glutathione, was observed across the meta-analysed studies. In animal studies, magnesium deficiency consistently led to increased oxidative stress, elevated pro-inflammatory cytokines, and mitochondrial dysfunction — all of which were reversed or reduced with magnesium supplementation. Human studies more broadly showed that magnesium supplementation was associated with improvements in glycaemic control, insulin sensitivity, lipid profile, and blood pressure, particularly in individuals with type 2 diabetes or cardiovascular conditions. Regarding bioavailability, the review confirmed that organic magnesium forms — including magnesium glycinate and magnesium citrate — are generally better absorbed and better tolerated than inorganic forms such as magnesium oxide, with magnesium glycinate specifically noted for its minimal gastrointestinal side effects and suitability for long-term daily use.
Conclusion: Magnesium supplementation may exert a meaningful anti-inflammatory effect, evidenced by a significant reduction in CRP levels. Its direct antioxidant effects on other biomarkers remain less certain and may depend on baseline magnesium status, the form of supplement used, and individual health conditions. The researchers concluded that further well-designed, adequately powered clinical trials are needed to fully characterize magnesium's role in oxidative stress modulation, and emphasized that magnesium glycinate and citrate represent the most evidence-supported forms for supplementation due to their superior bioavailability and tolerability.
Source: Violeta Cepeda, Marina Ródenas-Munar, Silvia García, Cristina Bouzas, Josep A. Tur. Unlocking the Power of Magnesium: A Systematic Review and Meta-Analysis Regarding Its Role in Oxidative Stress and Inflammation. Antioxidants, 2025, 14(6), 740. DOI: 10.3390/antiox14060740.
https://www.mdpi.com/2076-3921/14/6/740
SODIUM & POTASSIUM
The Implications of Sodium and Potassium on Muscle Fatigue: A Literature Review and Dynamic Mathematical Model
Abstract
This literature review and dynamic modeling study examined how shifts in sodium and potassium levels during repeated muscle stimulation affect muscle membrane excitability, force generation, and fatigue. The study sought to bring together existing electrophysiological evidence into a coherent, interactive model capable of predicting short-term muscle fatigue based on electrolyte changes alone.
Methods: A systematic search of PubMed and Google Scholar was conducted using terms including muscle fatigue, sodium, potassium, electrolyte balance, membrane potential, and action potential. From 98 potentially relevant studies, 29 were selected based on inclusion criteria requiring sodium or potassium values before or after muscle contraction. These data were used to construct a dynamic mathematical model using STELLA® software, drawing on established physiological parameters including normal intracellular and extracellular concentrations of sodium and potassium, diffusion coefficients through the t-tubular network, and Na+-K+ ATPase pump activity rates.
Results: The review found clear evidence that electrolyte balance — specifically the relationship between sodium and potassium inside and outside muscle cells — plays a significant role in muscle membrane excitability and fatigue. During repeated high-intensity muscle stimulation, potassium accumulates in the extracellular t-tubular network while sodium becomes depleted there, causing progressive membrane depolarization. As the membrane becomes more depolarized, voltage-gated sodium channels lose responsiveness to nerve signals, calcium release from the sarcoplasmic reticulum is reduced, and muscle force generation declines. The combined effect of increased extracellular potassium and decreased extracellular sodium was found to act synergistically to reduce membrane excitability. The mathematical model produced results consistent with published experimental values, including average t-tubular potassium concentrations during intense exercise and the characteristic pattern of declining force generation over time. The rate of the Na+-K+ ATPase pump, the diameter of muscle fibers, and the architecture of the t-tubular network were all identified as major determinants of how quickly fatigue develops.
Conclusion: Plasma electrolyte levels — particularly sodium and potassium — appear to correlate meaningfully with muscle force generation and the rate of fatigue. The researchers concluded that maintaining adequate electrolyte balance is essential for preserving muscle membrane excitability and physical performance, with practical implications extending beyond athletics to cardiac, neural, and general muscle function. The authors noted that the model requires further refinement and human testing, and that additional electrolyte channels not included in the current version may introduce some error.
Source: Aaron Jones, Robert Davidson, PhD. The Implications of Sodium and Potassium on Muscle Fatigue: A Literature Review and Dynamic Mathematical Model Using STELLA® Software. Logan College of Chiropractic, 2012.
https://www.logan.edu/mm/files/LRC/Senior-Research/2012-aug-15.pdf
Influence of Hydration and Electrolyte Supplementation on Incidence and Time to Onset of Exercise-Associated Muscle Cramps
Abstract
This randomized controlled study examined whether consuming a carbohydrate-electrolyte beverage — compared to no fluid intake — could reduce the incidence of exercise-associated muscle cramps or delay their onset in individuals with a history of cramping during physical activity.
Methods: Thirteen college-aged men with a documented history of exercise-associated muscle cramps completed two counterbalanced trials in a hot environment. In one trial, participants consumed a carbohydrate-electrolyte beverage containing sodium, potassium, and chloride at a rate matching individual sweat loss. In the other, participants consumed no fluids. Both trials used an identical calf-fatiguing protocol designed to induce cramping. Cramp incidence and time to onset were the primary outcomes.
Results: No statistically significant difference in the overall incidence of cramps was found between the two conditions — nine participants cramped in the electrolyte trial versus seven in the dehydration trial. However, among the seven participants who cramped in both trials, time to onset was more than doubled in the electrolyte trial — participants were able to exercise for an average of nearly 37 minutes before cramping, compared to under 15 minutes when dehydrated. Participants who cramped also had significantly higher sweat rates than those who did not. The findings suggested that while electrolyte and fluid supplementation did not prevent cramps entirely, it meaningfully delayed their onset, allowing for substantially longer exercise duration.
Conclusion: Consuming a carbohydrate-electrolyte beverage before and during exercise in a hot environment may delay the onset of exercise-associated muscle cramps, allowing individuals to exercise longer before cramping occurs. However, dehydration and electrolyte loss alone do not appear to be the sole causes of exercise-associated muscle cramps, as the majority of participants still cramped even when hydrated and electrolyte-supplemented. The researchers concluded that local muscle fatigue likely plays a significant and independent role, and that electrolyte replenishment may be most beneficial in lower-intensity or longer-duration activity where fatigue accumulates more gradually.
Source: Alan P Jung, Phillip A Bishop, Ali Al-Nawwas, R Barry Dale. Influence of Hydration and Electrolyte Supplementation on Incidence and Time to Onset of Exercise-Associated Muscle Cramps. PMCID: PMC1150229, PMID: 15970952. Journal of Athletic Training, 2005, 40(2), 71–75.
https://pmc.ncbi.nlm.nih.gov/articles/PMC1150229/
Postexercise Rehydration: Potassium-Rich Drinks Versus Water and a Sports Drink
Abstract
This randomized crossover study compared the rehydration effectiveness, fluid retention, thirst-quenching ability, tolerance, and palatability of four different beverages following exercise-induced dehydration — including a potassium-rich drink, fresh coconut water, a conventional sports drink, and plain water.
Methods: Twelve healthy, physically active adults were dehydrated to approximately 2% of body mass through exercise in an environmental chamber set to 32°C. On four separate days in randomized order, participants consumed one of four beverages — fresh coconut water, bottled water, a conventional sports drink, or a potassium-rich experimental drink — at a volume equal to 120% of their body mass loss. Urine output was collected and self-reported perceptions recorded over three hours to assess fluid retention, thirst, tolerance, and palatability.
Results: Plain water produced significantly higher urine output than either the sports drink or the potassium-rich drink, indicating lower fluid retention. Fluid retention was significantly greater for the sports drink than for water. The potassium-rich drink and fresh coconut water produced fluid retention outcomes comparable to the sports drink — though not statistically superior to it. All four beverages were well tolerated and palatable. Thirst increased immediately after exercise but returned to baseline after consuming a small volume of any beverage. No drink maintained a fully positive net fluid balance over the full three-hour observation period, though the deficit was significantly greater with water than with the sports drink.
Conclusion: The addition of potassium in coconut water and the potassium-rich experimental drink did not produce rehydration benefits beyond those already provided by a conventional sodium-containing sports drink. The researchers concluded that sodium remains the primary electrolyte driver of fluid retention after exercise, and that potassium-rich drinks may offer comparable — but not superior — rehydration to sodium-containing sports drinks. Plain water was the least effective option for post-exercise fluid retention.
Source: Alexandra Pérez-Idárraga, Luis Fernando Aragón-Vargas. Postexercise Rehydration: Potassium-Rich Drinks Versus Water and a Sports Drink. PMID: 25017113. Applied Physiology, Nutrition, and Metabolism, 2014. DOI: 10.1139/apnm-2013-0434.
https://pubmed.ncbi.nlm.nih.gov/25017113/
Potassium Intake, Skeletal Muscle Mass, and Effect Modification by Sex: Data from the 2008–2011 KNHANES
Abstract
This large cross-sectional study examined the association between dietary potassium intake and skeletal muscle mass in the general adult population, with particular attention to whether the relationship differed between men and women.
Methods: Data from 16,558 adults aged 19 and older were drawn from the Korean National Health and Nutrition Examination Survey (KNHANES) conducted between 2008 and 2011. Daily potassium intake was assessed via 24-hour dietary recall. Appendicular skeletal muscle mass — the combined muscle mass of both arms and legs — was measured using dual-energy X-ray absorptiometry (DXA) and expressed as a skeletal muscle index (SMI). Low muscle mass was defined using established Asian Working Group for Sarcopenia thresholds. Participants were divided into five groups by potassium intake level, and associations with low muscle mass were analyzed using logistic regression models with multiple levels of adjustment, including protein intake, energy intake, physical activity, and common health conditions.
Results: Higher dietary potassium intake was associated with a graded increase in skeletal muscle index across the study population. In men, higher potassium intake was significantly associated with lower odds of low muscle mass even after full adjustment for energy intake, protein intake, physical activity, and health conditions — with those in the highest potassium intake group showing meaningfully lower odds of low muscle mass compared to those in the lowest group. In women, the association trended in the same direction but was attenuated after adjusting for total energy intake, suggesting that overall dietary quantity may play a larger role in muscle mass outcomes in women. The researchers proposed that potassium may help preserve muscle mass through multiple mechanisms, including neutralizing mild metabolic acidosis — which can accelerate muscle protein breakdown — and by improving insulin sensitivity and reducing chronic inflammation, both of which are associated with muscle loss.
Conclusion: Higher dietary potassium intake may be associated with a lower risk of low skeletal muscle mass, particularly in men. The researchers concluded that potassium may support muscle preservation through acid-base regulation, improved insulin sensitivity, and reduced inflammation — suggesting that adequate potassium intake could be a meaningful dietary factor in maintaining muscle mass alongside protein and exercise. The authors noted that the cross-sectional design limits causal conclusions and that future clinical trials are needed.
Source: Yu-Ji Lee, Mirae Lee, Yu Mi Wi, Seong Cho, Sung Rok Kim. Potassium intake, skeletal muscle mass, and effect modification by sex: data from the 2008–2011 KNHANES. PMCID: PMC7456505, PMID: 32861249. Nutrition Journal, 2020. DOI: 10.1186/s12937-020-00614-3.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7456505/
CALCIUM
Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation
Abstract
The aim was to meta-analyze randomized controlled trials of calcium plus vitamin D supplementation and fracture prevention. Meta-analysis showed a significant 15 % reduced risk of total fractures (summary relative risk estimate [SRRE], 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87).
Introduction: Calcium plus vitamin D supplementation has been widely recommended to prevent osteoporosis and subsequent fractures; however, considerable controversy exists regarding the association of such supplementation and fracture risk. The aim was to conduct a meta-analysis of randomized controlled trials [RCTs] of calcium plus vitamin D supplementation and fracture prevention in adults.
Methods: A PubMed literature search was conducted for the period from July 1, 2011 through July 31, 2015. RCTs reporting the effect of calcium plus vitamin D supplementation on fracture incidence were selected from English-language studies. Qualitative and quantitative information was extracted; random-effects meta-analyses were conducted to generate summary relative risk estimates (SRREs) for total and hip fractures. Statistical heterogeneity was assessed using Cochran's Q test and the I (2) statistic, and potential for publication bias was assessed.
Results: Of the citations retrieved, eight studies including 30,970 participants met criteria for inclusion in the primary analysis, reporting 195 hip fractures and 2231 total fractures. Meta-analysis of all studies showed that calcium plus vitamin D supplementation produced a statistically significant 15 % reduced risk of total fractures (SRRE, 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87). Numerous sensitivity and subgroup analyses produced similar summary associations. A limitation is that this study utilized data from subgroup analysis of the Women's Health Initiative.
Conclusions: This meta-analysis of RCTs supports the use of calcium plus vitamin D supplements as an intervention for fracture risk reduction in both community-dwelling and institutionalized middle-aged to older adults.
Source: Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, Liu S, Looker AC, Wallace TC, Wang DD. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int. 2016 Jan;27(1):367-76. doi: 10.1007/s00198-015-3386-5. Epub 2015 Oct 28. Erratum in: Osteoporos Int. 2016 Aug;27(8):2643-2646. doi: 10.1007/s00198-016-3699-z. PMID: 26510847; PMCID: PMC4715837.
https://pubmed.ncbi.nlm.nih.gov/26510847/
Influence of Dietary Calcium Intake on Skeletal Health and Body Composition in an Italian Elderly Population
Abstract
Calcium is crucial for bone health and other physiological functions. This study evaluates dietary calcium intake's effects on bone mineral density (BMD), body composition, and fragility fractures among 173 elderly men and 939 women aged 55 and over in Siena, Italy. Using a food frequency questionnaire, the study found that average calcium intake was significantly higher in men compared to women. Increased calcium intake correlated with lower body fat mass in women and was positively associated with lean mass in men. Participants with a history of fractures also showed lower dietary calcium intake. The findings suggest that inadequate calcium intake is prevalent, particularly among individuals with low BMD and a history of fractures, underscoring the importance of adequate dietary calcium for skeletal health.
Introduction: Calcium plays vital roles in physiological processes, with 99% found in bones. Adequate calcium intake is key for achieving peak bone mass and preventing age-related bone loss. The study focuses on the elderly population, particularly in terms of how dietary patterns may affect calcium intake, BMD, and fracture risk.
Methods: The study cohort comprised elderly individuals (55+) visiting Hallym University Kangdong Sacred Heart Hospital. Daily dietary calcium intake was assessed using a validated food frequency questionnaire. Bone mineral density was measured via dual-energy X-ray absorptiometry (DXA) at various skeletal sites. Statistical analyses were performed to determine associations between calcium intake and health outcomes.
Results: Males exhibited a mean calcium intake of 898.4 mg/day, while females averaged 821.95 mg/day, indicating a significant gender difference (p < 0.01). Calcium intake inversely correlated with fat mass in women (p < 0.05) and positively with lean mass in men (p < 0.05). A higher prevalence of fractures was observed among those with lower dietary calcium intake; 24.3% of women and 27.8% of men reported fractures. Regression analyses indicated that calcium intake was positively associated with BMD at several skeletal sites, particularly in men.
Discussion: The findings indicate that many individuals, especially women, consume insufficient levels of dietary calcium, which has negative implications for bone health. The study also highlights the potential relationship between dietary calcium, body composition, and fracture history, emphasizing the importance of targeted nutritional interventions in this demographic.
Conclusion: Inadequate calcium intake is a concern among the elderly population, correlating with lower BMD and higher fracture risk. A diet rich in calcium, particularly from dairy sources, is recommended to support skeletal health and reduce the risk of frailty in older adults.
Source: Caffarelli, C., Al Refaie, A., Mondillo, C., Cavati, G., Lora, A., Gennari, L., Nuti, R., & Gonnelli, S. (2025). Influence of Dietary Calcium Intake on Skeletal Health and Body Composition in an Italian Elderly Population. Nutrients, 17(13), 2073. DOI: 10.3390/nu17132073. PMCID: PMC4828511. PMID: 27095961.
https://www.mdpi.com/2072-6643/17/13/2073
References:
- https://www.mdpi.com/2072-6643/17/13/2073
- https://pubmed.ncbi.nlm.nih.gov/27610211/
- https://pubmed.ncbi.nlm.nih.gov/35276888/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC1691485/
- https://pubmed.ncbi.nlm.nih.gov/17828627/
- https://pubmed.ncbi.nlm.nih.gov/11985880/
- https://pubmed.ncbi.nlm.nih.gov/16416332/
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