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David C. Nieman, Giuseppe Valacchi, Laurel M. Wentz, Francesca Ferrara, Alessandra Pecorelli, Brittany Woodby, Camila A. Sakaguchi and Andrew Simonson

; Amin et al., 2015 ; Di Gesso et al., 2015 ; Kay et al., 2017 ; Williamson et al., 2018 ). Although more human trials are needed, with stronger designs, limited and inconsistent data indicate that flavonoid supplementation may attenuate postexercise oxidative stress ( Decroix et al., 2018 ; Myburgh

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J. Mark Davis, Catherine J. Carlstedt, Stephen Chen, Martin D. Carmichael and E. Angela Murphy

Quercetin, a natural polyphenolic flavonoid substance present in a variety of food plants, has been shown in vitro and in animal studies to have widespread health and performance benefits resulting from a combination of biological properties, including antioxidant and anti-inflammatory activity, as well as the ability to increase mitochondrial biogenesis. Little is known about these effects in humans, however, especially with respect to exercise performance. The authors determined whether quercetin ingestion would enhance maximal aerobic capacity and delay fatigue during prolonged exercise in healthy but untrained participants. Twelve volunteers were randomly assigned to 1 of 2 treatments: (a) 500 mg of quercetin twice daily dissolved in vitamin-enriched Tang or (b) a nondistinguishable placebo (Tang). Baseline VO2max and bike-ride times to fatigue were established. Treatments were administered for a period of 7 days using a randomized, double-blind, placebo-controlled, crossover study design. After treatment both VO2max and ride time to fatigue were determined. Seven days of quercetin feedings were associated with a modest increase in VO2max (3.9% vs. placebo; p < .05) along with a substantial (13.2%) increase in ride time to fatigue (p < .05). These data suggest that as little as 7 days of quercetin supplementation can increase endurance without exercise training in untrained participants. These benefits of quercetin may have important implications for enhancement of athletic and military performance. This apparent increase in fitness without exercise training may have implications beyond that of performance enhancement to health promotion and disease prevention.

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Amy M. Knab, David C. Nieman, Nicholas D. Gillitt, R. Andrew Shanely, Lynn Cialdella-Kam, Dru A. Henson and Wei Sha

The effects of a flavonoid-rich fresh fruit and vegetable juice (JUICE) on chronic resting and postexercise inflammation, oxidative stress, immune function, and metabolic profiles (metabolomics analysis, gas-chromatography mass-spectrometry platform) in elite sprint and middle-distance swimmers were studied. In a randomized, crossover design with a 3-wk washout period, swimmers (n = 9) completed 10-d training with or without 16 fl oz of JUICE (230 mg flavonoids) ingested pre- and postworkout. Blood samples were taken presupplementation, post–10-d supplementation, and immediately postexercise, with data analyzed using a 2 × 3 repeated-measures ANOVA. Prestudy blood samples were also acquired from nonathletic controls (n = 7, age- and weight-matched) and revealed higher levels of oxidative stress in the swimmers, no differences in inflammation or immune function, and a distinct separation in global metabolic scores (R2Y [cum] = .971). Swim workouts consisted of high-intensity intervals (1:1, 1:2 swim-to-rest ratio) and induced little inflammation, oxidative stress, or immune changes. A distinct separation in global metabolic scores was found pre- to postexercise (R2Y [cum] = .976), with shifts detected in a small number of metabolites related to substrate utilization. No effect of 10-d JUICE was found on chronic resting levels or postexercise inflammation, oxidative stress, immune function, and shifts in metabolites. In conclusion, sprint and middle-distance swimmers had a slight chronic elevation in oxidative stress compared with nonathletic controls, experienced a low magnitude of postworkout perturbations in the biomarkers included in this study, and received no apparent benefit other than added nutrient intake from ingesting JUICE pre- and postworkout for 10 days.

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Steven R. McAnulty, David C. Nieman, Lisa S. McAnulty, Worley S. Lynch, Fuxia Jin and Dru A. Henson

Consumption of plant flavonoids, antioxidants, and n-3 fatty acids is proposed to have many potential health benefits derived primarily through antioxidant and anti-inflammatory activities. This study examined the effects of 1,000 mg quercetin + 1,000 mg vitamin C (QC); 1,000 mg quercetin, 1,000 mg vitamin C, 400 mg isoquercetin, 30 mg epigallocatechin gallate, and 400 mg n-3 fatty acids (QFO); or placebo (P), taken each day for 2 wk before and during 3 d of cycling at 57% Wmax for 3 hr, on plasma antioxidant capacity (ferricreducing ability of plasma [FRAP], oxygen-radical absorbance capacity [ORAC]), plasma oxidative stress (F2-isoprostanes), and plasma quercetin and vitamin C levels. Thirty-nine athletes were recruited and randomized to QC, QFO, or P. Blood was collected at baseline, after 2 wk supplementation, immediately postexercise, and 14 hr postexercise. Statistical design used a 3 (groups) × 4 (times) repeated-measures ANOVA with post hoc analyses. Plasma quercetin was significantly elevated in QC and QFO compared with P. Plasma F2-isoprostanes, FRAP, and vitamin C were significantly elevated and ORAC significantly decreased immediately postexercise, but no difference was noted in the overall pattern of change. Post hoc analyses revealed that the QC and QFO groups did not exhibit a significant increase in F2-isoprostanes from baseline to immediately postexercise compared with P. This study indicates that combining flavonoids and antioxidants with n-3 fatty acids is effective in reducing the immediate postexercise increase in F2-isoprostanes. Moreover, this effect occurs independently of changes in plasma antioxidant capacity.

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Manuela Konrad, David C. Nieman, Dru A. Henson, Krista M. Kennerly, Fuxia Jin and Sandra J. Wallner-Liebmann

This study tested the acute anti-inflammatory and immune-modulating influence of a quercetin-based supplement consumed by endurance athletes 15 min before an intense 2-hr run. In this randomized, crossover study, 20 runners (11 men, 9 women, age 38.4 ± 2.1 yr) completed two 2-hr treadmill runs at 70% VO2max (3 wk apart). Subjects ingested either 4 quercetin-based chews (Q-chew) or placebo chews (PL) 15 min before the runs. The 4 Q-chews provided 1,000 mg quercetin, 120 mg epigallocatechin 3-gallate, 400 mg isoquercetin, 400 mg each eicosapentaenoic acid and docosahexaenoic acid, 1,000 mg vitamin C, and 40 mg niacinamide. Subjects provided blood samples 30 min before, immediately after, and 1 hr postexercise and were analyzed for plasma quercetin, total blood leukocytes (WBC), C-reactive protein (CRP), 9 cytokines (IL-6, TNFα, GM-CSF, IFNγ, IL-1β, IL-2, IL-8, IL-10, and IL-12p70), granulocyte (GR) and monocyte (MO) phagocytosis (PHAG), and oxidative-burst activity (OBA). Plasma quercetin increased from 80.0 ± 26.0 μg/L to 6,337 ± 414 μg/L immediately postexercise and 4,324 ± 310 μg/L 1 hr postexercise after ingestion of Q-chews, compared with no change in PL (p < .001). Exercise caused significant increases in, CRP, GM-CSF, IL-10, IL-1β, IL-2, IL-6, IL-8, TNFα, GR-PHAG, and MO-PHAG and decreases in GR-OBA and MO-OBA, but no differences in the pattern of change were measured between Q-chew and PL trials. Acute ingestion of Q-chews 15 min before heavy exertion caused a strong increase in plasma quercetin levels but did not counter postexercise inflammation or immune changes relative to placebo.

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Denis M. Pelletier, Guillaume Lacerte and Eric D.B. Goulet

Lately, the effect of quercetin supplementation (QS) on endurance performance (EP) and maximal oxygen consumption (VO2max) has been receiving much scientific and media attention. Therefore, a meta-analysis was performed to determine QS’s ergogenic value on these variables. Studies were located with database searches (PubMed and SPORTDiscus) and cross-referencing. Outcomes represent mean percentage changes in EP (measured via power output) and VO2max between QS and placebo. Random-effects model meta-regression, mixed-effects model analog to the ANOVA, random-effects weighted mean effect summary, and magnitudebased inferences analyses were used to delineate the effects of QS. Seven research articles (representing 288 subjects) were included, producing 4 VO2max and 10 EP effect estimates. Mean QS daily intake and duration were, respectively, 960 ± 127 mg and 26 ± 24 d for the EP outcome and 1,000 ± 0 mg and 8 ± 23 d for the VO2max outcome. EP was assessed during exercise with a mean duration of 79 ± 82 min. Overall, QS improved EP by 0.74% (95% CI: 0.10–1.39, p = .02) compared with placebo. However, only in untrained individuals (0.83% ± 0.78%, p = .02) did QS significantly improve EP (trained individuals: 0.09% ± 2.15%, p = .92). There was no relationship between QS duration and EP (p = .69). Overall, QS increased VO2max by 1.94% (95% CI: 0.30–3.59, p = .02). Magnitude-based inferences suggest that the effect of QS on EP and VO2max is likely to be trivial for both trained and untrained individuals. In conclusion, this meta-analysis indicates that QS is unlikely to prove ergogenic for aerobic-oriented exercises in trained and untrained individuals.

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Kevin S. O’Fallon, Diksha Kaushik, Bozena Michniak-Kohn, C. Patrick Dunne, Edward J. Zambraski and Priscilla M. Clarkson

The flavonoid quercetin is purported to have potent antioxidant and anti-inflammatory properties. This study examined if quercetin supplementation attenuates indicators of exercise-induced muscle damage in a doubleblind laboratory study. Thirty healthy subjects were randomized to quercetin (QU) or placebo (PL) supplementation and performed 2 separate sessions of 24 eccentric contractions of the elbow flexors. Muscle strength, soreness, resting arm angle, upper arm swelling, serum creatine kinase (CK) activity, plasma quercetin (PQ), interleukin-6 (IL-6), and C-reactive protein (CRP) were assessed before and for 5 d after exercise. Subjects then ingested nutrition bars containing 1,000 mg/d QU or PL for 7 d before and 5 d after the second exercise session, using the opposite arm. PQ reached 202 ± 52 ng/ml after 7 d of supplementation and remained elevated during the 5-d postexercise recovery period (p < .05). Subjects experienced strength loss (peak = 47%), muscle soreness (peak = 39 ± 6 mm), reduced arm angle (–7° ± 1°), CK elevations (peak = 3,307 ± 1,481 U/L), and arm swelling (peak = 11 ± 2 mm; p < .0001), indicating muscle damage and inflammation; however, differences between treatments were not detected. Eccentric exercise did not alter plasma IL-6 (peak = 1.9 pg/ml) or CRP (peak = 1.6 mg/L) relative to baseline or by treatment. QU supplementation had no effect on markers of muscle damage or inflammation after eccentric exercise of the elbow flexors.

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David C. Nieman, Courtney L. Goodman, Christopher R. Capps, Zack L. Shue and Robert Arnot

the recording process. The 3-day food records were analyzed for nutrient and flavonoid content using the Food Processor v. 11.1 (ESHA Research, Salem, OR). ESHA’s port utility (v. 4.0) was used to upload the Flavonoid Values for USDA Survey Foods and Beverages (FNDDS) 2007–2010 database ( Sebastian et

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David C. Nieman, Courtney L. Capps, Christopher R. Capps, Zack L. Shue and Jennifer E. McBride

because of the recording process. The 3-day food records were analyzed for nutrient and flavonoid content using the Food Processor version 11.1 (ESHA Research, Salem, OR). ESHA’s port utility (version 4.0) was used to upload the Flavonoid Values for USDA Survey Foods and Beverages (FNDDS) 2007

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Matthew David Cook and Mark Elisabeth Theodorus Willems

Epidemiological studies have indicated that high intake of dietary polyphenols is associated with lower risk for multiple diseases ( Ivey et al., 2017 ; Kuriyama et al., 2006 ). Based on chemical structures, there are four groups of polyphenols, that is, phenolics, flavonoids, stilbenes, and