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Review

Protein and Essential Amino Acids to Protect Musculoskeletal Health during Spaceflight: Evidence of a Paradox?

by
Kyle J. Hackney
1,* and
Kirk L. English
2
1
Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58102, USA
2
Exercise Physiology and Countermeasures Laboratory, JES Tech, Houston, TX 77058, USA
*
Author to whom correspondence should be addressed.
Life 2014, 4(3), 295-317; https://doi.org/10.3390/life4030295
Submission received: 13 March 2014 / Revised: 19 June 2014 / Accepted: 23 June 2014 / Published: 11 July 2014
(This article belongs to the Special Issue Response of Terrestrial Life to Space Conditions)
Versions Notes

Abstract

: Long-duration spaceflight results in muscle atrophy and a loss of bone mineral density. In skeletal muscle tissue, acute exercise and protein (e.g., essential amino acids) stimulate anabolic pathways (e.g., muscle protein synthesis) both independently and synergistically to maintain neutral or positive net muscle protein balance. Protein intake in space is recommended to be 12%–15% of total energy intake (≤1.4 g∙kg−1∙day−1) and spaceflight is associated with reduced energy intake (~20%), which enhances muscle catabolism. Increasing protein intake to 1.5–2.0 g∙kg−1∙day−1 may be beneficial for skeletal muscle tissue and could be accomplished with essential amino acid supplementation. However, increased consumption of sulfur-containing amino acids is associated with increased bone resorption, which creates a dilemma for musculoskeletal countermeasures, whereby optimizing skeletal muscle parameters via essential amino acid supplementation may worsen bone outcomes. To protect both muscle and bone health, future unloading studies should evaluate increased protein intake via non-sulfur containing essential amino acids or leucine in combination with exercise countermeasures and the concomitant influence of reduced energy intake.

1. Introduction

Humans possess an intrinsic desire to explore the unknown. The initial conquest of space occurred on 12 April 1961 with Soviet Union cosmonaut Yuri Gagarin’s solo orbital flight. Less than a month later on 5 May 1961, Alan Shepard became the first American in space. The remainder of the decade was filled with humans traveling to space, climaxing on 20 July 1969 with the Apollo 11 Moon landing. However, all of the 1960s space missions were less than two weeks in duration. In 1971, the Soviet Union launched Salyut 1, its first orbiting space station which was later manned for 23 days. Over the next decades, the duration of missions grew increasingly longer as America and the Soviet Union each launched orbiting space stations; the American Skylab 4 mission lasted 84 days in 1973–1974 and the Soviet Salyut 6 hosted a 185 day mission in 1980. This was followed by the Russian space station Mir which was manned for the majority of its time in orbit from 1986–2000. From 1981–2011, the American Space Shuttle made regular flights lasting 2–17 days and in collaboration with international partners, transported crewmembers to the International Space Station (ISS) for stays of ~6 months after the turn of the millennium.

As the duration of microgravity exposure is increased and manned missions beyond low earth orbit (e.g., to Mars) are once again considered, the potential impact on musculoskeletal physiology is substantial. Specifically, losses in muscle strength, power, and endurance are problematic both from an operational and individual standpoint. Operationally, high levels of muscle function are needed both during spaceflight tasks (e.g., during extravehicular activity to free jammed hardware, or to move large mass/high inertia objects) and in the event of an emergency egress from a vehicle. An emergency egress in a gravitational environment would likely involve high force/power activities like opening a hatch, raising oneself and other crewmembers out of the vehicle, and running from the vehicle, all of which may be performed while wearing a space suit with a mass of >100 kg [1]. From an individual health perspective, upon return to Earth’s gravity, astronauts may be at increased risk for falls, injury from an accident, osteoporosis [2], and/or experience difficulty with activities of daily living [3].

This paper addresses the importance of preserving musculoskeletal health during long-duration spaceflight and examines the seemingly paradoxical effects of amino acids on muscle and bone. Recommendations for future nutrition and exercise countermeasures to prevent spaceflight deconditioning will also be detailed.

2. Musculoskeletal Health and Spaceflight

2.1. Skeletal Muscle

In the absence of gravitational loading, skeletal muscle enters a de facto state of disuse [4,5]. Given the complexity of spaceflight research and the few crewmembers available to study, data on the effects of spaceflight on human muscle are relatively sparse. Regardless, the loss of skeletal muscle mass has been a consistent, yet unwelcomed, feature of spaceflight. A synthesis of the available data (Table 1) suggests that the rate of muscle mass loss is not linear across the duration of a mission and that the greatest losses occur in the antigravity muscles (lower back, abdominals, thighs, and lower legs) [4]. Significant atrophy of the knee extensors (−5% to −15%), knee flexors (−5% to −14%), plantar flexors (−6% to −15%) and muscles of the intrinsic lower back (−10%) has been documented even during short-duration missions of 9–17 days [6,7,8]. During longer duration missions on Mir (115–197 days) and the ISS (161–192 days), it appears that the muscles of the intrinsic lower back (rotatores, multifidus, semispinalis, spinalis, longissimus, iliocostalis, −16%) and the ankle plantar flexors (soleus, gastrocnemius, −13% to −17%) are the most influenced by microgravity exposure (or the countermeasures for these muscles groups are not as efficacious) [8,9]. Of the plantar flexors, the soleus shows greater losses in fiber size and force production than the gastrocnemius [9,10].

A decrease in the rate of muscle protein synthesis (−46%) appears to be the primary mechanism underlying unloading-induced muscle atrophy [11]. This causes rapid decreases in muscle fiber cross-sectional area (CSA) with short-duration spaceflight eliciting greater losses in type II fibers while type I fibers experience greater atrophy after long-duration missions [4]. For example, Edgerton et al. [12] showed that the CSA of vastus lateralis muscle fibers were 16%–36% smaller after 11 days of spaceflight, with the reductions in type IIb > type IIa > type 1. Similar observations were made in soleus (−26% in type IIa, −15% in type 1) [13] and lateral gastrocnemius muscle fibers (−10% in type IIa, −7% in type I) [14] after 17 days of spaceflight. However, more recent analyses from long-duration ISS crewmembers’ plantar flexors suggest that fiber mass was most affected in the following order: soleus type I (−33%) > soleus type II (−29%), gastrocnemius type I (not reported), and gastrocnemius type II (−5%) [10]. The authors noted that there is a direct association between pre-flight fiber size and the degree of atrophy (r = 0.87), suggesting that larger fibers lose the most size during microgravity exposure [9,10]. The functional consequences of these negative adaptations are reduced force, contractile velocity, and power [10], which ultimately result in less energy transfer to the tendon and skeleton for joint movement.

2.2. Bone

Another significant maladaptation to long-duration spaceflight is a loss of bone mineral from the skeleton (Table 2) [15,16,17,18,19,20,21,22]. Data from the three Skylab flights suggest that urinary calcium levels increased approximately 80% (169–306 mg∙d−1 on average) compared to pre-flight during the first month of microgravity exposure and remained elevated for the duration of the mission [23]. Net intestinal absorption of calcium also declined approximately 7%, while plasma total calcium showed a small increase [23]. Markers of bone resorption (urinary hydroxyproline) were also elevated by 34%. Ultimately, bone mineral loss was reported in weight-bearing bone such as the calcaneus, but not in non-weight-bearing bones (e.g., the radius or ulna).

Table
Table 1. Human Spaceflight and Skeletal Muscle Adaptations.
Table 1. Human Spaceflight and Skeletal Muscle Adaptations.
AuthorYrSpace EraN (Gender)Flight DurationExercise CountermeasuresHighlighted Adaptations
Thorton [24]1974Skylab23(M)28 dBicycle ErgM.Volume (Girth Circ.): ↓4.5% Legs; Strength. (Isok): ↓20% Legs
Thorton [24]1974Skylab 33(M)59 dBicycle Erg., MK-I, MK-IIM.Volume (Girth Circ.): ↓5% Legs, Strength (Isok): ↓20% Legs
Thorton [24]1974Skylab 43(M)84 dBicycle Erg., MK-I, MK-II, Thorton Passive TreadmillM.Volume (Girth Circ): ↓2% Legs, Strength. (Isok): ↓7% Legs
Leblanc [7]1995STS4(2M2W)8 dShuttle ErgM.Volume (MRI):↓6.3%, Gastr, ↓3.9% Ant. Calf. ↓8.3% Ham, ↓6.0% Quad, ↓10.3% L.Back
Edgerton [12]1995STS8(5M3W)5–11 dShuttle Treadmill, LBNPF. CSA: ↓11% type I &, ↓24% type II VL in 5 d, ↓16%–36% type II loss > type I in 11 d
Widrick [13]1999STS/Mir4(M)17 dNRF. Diam/: ↓8% in Sol. type I
Akima [6]2000STS3(?)9–16 dNRVolume (MRI): ↓5.6% to 15.4% KE, ↓8.6% to 14.1% KF, ↓8.4% to 15.9% PF
Leblanc [8]2000STS/Mir4(M)17 dNRVolume (MRI): ↓10% AE & IB, ↓5%–7% Quad & Psoas, ↓3% in Ham & AL
Leblanc [8]2000STS/Mir16(15M1W)115–197 dNRVolume (MRI): 14.6% AL, ↓16.9% Gast, ↓16.8% Sol, ↓10.1% Quad, ↓12.7% Ham, ↓15.9% IB, and ↓4.4% Psoas
Riley [25]2000STS4(M)17 dNRF: A Band ↓17% Filaments, ↑9% Short Filaments
Koryak [26]2001Mir7(M)6 moNRStrength (Isom): ↓42% TS, Strength: (Evoked Forces): ↓26% Po TS, ↑15% Pt TS
Trappe [14]2001STS4(M)17 dNRF.CSA: ↓7.4% Type I Gast, ↓10.1 Type IIa Gast, ↓7.4 Type I Sol. ↔ Calf MVC or Force Velocity Relationship
Lambertz [27]2001Mir14(M)90–180 dCycle Erg., TreadmillStrength (Isom): ↓2%–30% PF in 12 of 14 subjects
Narici [28]2003STS4(M)17 dNRM.CSA (Girth Circ.): ↓8% Calf., Strength (Evoked Forces) ↓24% Peak Twitch; ↓22% Tetanic Force at 50 Hz; ↓19.5% Specific Forces at 50 Hz of TS
Tesch [29]2005STS4(M)17 dNRM. CSA (MRI): ↓8% KE & Gluteal. Strength (Isom): ↓10% KE,
Strength (Isok): ↓9% KE (CON), 11% KE (ECC)
Trappe [9]2009ISS9(?)6 moCEVIS, TVIS, VELO, iREDM.Volume (MRI): ↓13% Calf, ↓15% Sol, ↓10% Gast. Calf Peak Power ↓32%, Force-Velocity ↓20%–29% across 30–300°/sec
Fitts [10]2010ISS9(?)6 moCEVIS, TVIS, VELO, iREDF.CSA: ↓33% type 1 Sol > type II Sol > type I Gast. > type II Gas
Gopalakrishnan [30]2010ISS4(M)181 dCEVIS, TVIS, VELO, iREDM.Volume (MRI): ↓10 calf, ↓4 thigh
Smith [31]2012ISS8(6M2W)160 dCEVIS, TVIS, iREDLean mass (DEXA): ↓2% total body
Smith [31]2012ISS5(3M2W)134 dCVIS, TVIS, AREDLean mass (DEXA): ↑3% total body

STS = Shuttle transport system, ISS = International space station, CEVIS = Cycle ergometer with isolation system, TVIS = Treadmill with isolation system, iRED = Interim resistive device, VELO = Russian velociped bicycle exercise device, MRI = Magnetic resonance imaging, CSA = Cross-sectional area, Pec/Lats = Pectoralis major/lattisimus dorsi, Gastr = Gastrocnemius, Ant = Anterior, Ham = Hamstring, Quad = Quadriceps, VL = Vastus lateralis, Sol. = Soleus, KF = Knee flexors, KE = Knee extensors, PF = Plantar flexors, IB = Intrinsic back, TS = Tricpes surea, Circ. = Circumference, Isok = Isokinetic, Isom = Isometric, Erg = Egometer, LBNP = Lower body negative pressure, F. = Fiber, M. = Muscle, Diam. = Diameter, CON = Concentric, ECC = Eccentric, MVC = Maximal voluntary contraction, d = Days, Yr. = Year, mo = months, M = Men, W = Women. NR = Not reported.

Table
Table 2. Human Spaceflight and Skeletal Adaptations.
Table 2. Human Spaceflight and Skeletal Adaptations.
AuthorYrSpace EraN
(Gender)		Flight
Duration		Exercise CountermeasuresHighlighted Adaptations
Whedon [23,32]1976Skylab 23M28 dBicycle Erg↑Urinary calcium, ↑hydroproxyproline, ↑nitrogen and phosphorus excretion
Whedon [23,32]1976Skylab 33M59 dBicycle Erg., MK-I, MK-II↑Urinary calcium, ↑hydroproxyproline, ↑nitrogen and phosphorus excretion
Whedon [23,32]1976Skylab 43M84 dBicycle Erg., MK-I, MK-II, Thorton Passive Treadmill↑Urinary calcium, ↑hydroproxyproline,↑nitrogen excretion, phosphorus excretion
Stupakov [33]1984Salyut 68(NR)75–184 dKTF and penguin suitCalcaneus BMD (Photon absorptiometry): ↓0.9% to19.8%
Organov [34]1991Salyut 77(NR)4–8 moNRLumbar spine BMD (CT): ↓−7.5% to −10.8%
Miyamoto [16]1998STS2(1M1F)8–14 dCycle ErgometerSpine (DEXA): ↓3%, ↓Metacarpal (MD): 1%–3%
Smith [35]1999STS/MIR3M115 dNR↑50% Urinary calcium, ↑50% Collagen crosslink excretion
Vico [36]2000MIR15(14M1W)1–6 moNot ReportedBMD(DEXA):↓1.8% Tibial cortical bone, BMD(DEXA):↓5.4% Tibial cancellous bone
Leblanc [37]2000MIR18(17M1W)4–14 moBunge Resistance, Treadmill, Cycle ErgometerTotal BMD(DEXA): ↓0.35% per month, Trochanter BMD(DEXA): ↓1.56 per month
Smith [38]2004ISS11(9M2W)128–195 dNR↓25-hydroxycholecalciferol, ↑75% deoxypridinoline, ↑40% n-telopeptide
Smith [39]2005STS/MIR13(12M1F)4–6 moNRN-telopeptide, pyridinoline, and deoxypyridinoline ↑>55% above preflight levels
2005STS/MIR6M4–6 moNRCalcium absorption ↓49% in-flight
Lange [40]2004ISS14(13M1W)4–6 moNRHip aBMD(DEXA): ↓1.4%–1.5% per month, Spine vBMD(QCT):↓0.9% per month
Smith [31]2012ISS8(6M2W)48–215 dCEVIS, TVIS, iREDTotal BMC(DEXA):↓4%, Total BMD(DEXA): ↓3%, Pelvic BMC(DEXA): ↓12%
Smith [31]2012ISS5(3M2F)48–215 dCVIS, TVIS, AREDTotal BMC(DEXA):↓1%, Total BMD(DEXA): ↔0%, Pelvic BMC(DEXA): ↓2%

STS = Space transport system, ISS = International space station, CEVIS = Cycle ergometer with isolation system, TVIS = Treadmill with isolation system, iRED = Interim resistive device, VELO = Russian velociped bicycle exercise device, DEXA = Dual x-ray absorptiometry, BMD = Bone mineral density, BMC = Bone mineral content, QCT = Quantitative computer tomography, CT = Computer tomography, d = Days, Yr. = Year, mo = Months, KTF = Exercise device (acronym unknown), M = Men, W = Women, NR = Not reported.

Negative bone adaptations have also been observed more recently after long-duration spaceflight [36]. Grigoriev and colleagues found bone mineral density loss was greatest in the pelvis (−11%), lumbar vertebrae (−6%), and femoral neck (−8%) after 4.5–14.5 month missions [41]. Virtually every astronaut on missions longer than 30 days has lost bone in some region [17]. The extent of bone loss is variable and depends on a variety of factors such as pre-flight bone density, previous exercise experience, diet, and physical activity. On the ISS, average rates of bone loss are 0.9% per month and 1.2%–1.5% per month in the spine and hip, respectively [40]. Perhaps, even more alarming than the loss of bone is the lack of recovery after return to Earth [42]. Of the three Skylab astronauts that lost calcaneus bone, only one showed recovery during the first 90 days post-flight, and all four continued to lose bone for the next five years [15,43]. This lack of recovery or plasticity of bone is important not only for mission success in astronauts participating in multiple flights, but also could enhance fracture, renal stone, and injury risk once back on Earth [2,3,44].

Overall, musculoskeletal alterations during microgravity exposure are moderate in magnitude. Although future missions to Mars, the Moon, or an asteroid may involve periods of exposure to gravitational forces, musculoskeletal health will remain a serious problem for humans both during and after space missions. Exercise and nutrition have been the most widely studied countermeasures to date and remain the primary targets for integration and optimization.

3. Exercise in Space

Exercise has been extensively studied and employed to combat disuse-related adaptations that are inherent to the space environment [45]. While early missions of the 1960s did not incorporate in-flight exercise, the next four decades of spaceflight saw a significant emphasis placed on in-flight exercise countermeasures [46]. Exercise hardware evolved from astronauts running in their socks on a slick plate (the Skylab 4 “treadmill”) to advanced equipment such as a fully motorized treadmill with vibration isolation [47] and a strength training device (the Advanced Resistive Exercise Device; ARED) that provides constant forces up to 273 kg with inline flywheels that simulate the inertial forces of weightlifting in normal gravity [48,49]. These advances reflect the complexities of attempting to replicate the physiologic influence of continual exposure to Earth’s gravity which acts even on sedentary (but ambulatory) individuals. Musculoskeletal protection during the early years of the ISS was challenging [9,10,50] with the interim Resistance Exercise Device (iRED) providing only modest loading capability (136 kg) [31]. Improved outcomes have been observed since the deployment of ARED and an updated treadmill [31]. Due to the cost and limited opportunities to conduct exercise countermeasures research during actual spaceflight, bed rest has been used to evaluate the efficacy of a range of exercise countermeasures.

Bed rest is synonymous with physical inactivity and is employed experimentally as a ground-based analog to more efficiently investigate spaceflight-induced physiological adaptations. This model originated with Soviet scientists who are reported to have raised the foot of the beds of cosmonauts who had recently returned from spaceflight in order to eliminate the cosmonauts’ sensation of slipping off the foot of the bed [51]. Further work by the Soviets found that a 6 degree head down tilt elicited the optimal compromise between comfort and physiologic adaptations; thus, 6 degree head down tilt is the bed rest model most commonly employed in spaceflight research [52]. The cephalid fluid shift induced by this slight head down tilt initiates a systemic diuresis, reducing blood volume ~10%–15% in 1–2 days; this directly mimics what occurs in space as body fluids migrate headward in the absence of Earth’s gravity [51]. Numerous studies have utilized prolonged bed rest to evaluate adaptions and countermeasures. A full detail of these studies is beyond the scope of this review, but many exercise countermeasure studies have included: resistance exercise [53,54,55], aerobic exercise with and without lower body negative pressure [56,57,58], artificial gravity via a centrifuge [59,60], and vibration [61,62]. With the exception of vibration, these countermeasures have been largely successful at the prevention of muscular deconditioning in bed rest, but due to practical issues (e.g., prohibitively large mass, lack of transport vehicles, cost), most have not been similarly implemented in spaceflight. Finally, there is a confounding factor which is somewhat unique to spaceflight that influences exercise training outcomes; spaceflight is associated with a voluntary energy restriction [38] and to date, this important modifying factor has only been included in one bed rest study [63,64].

4. Nutrition in Space

The history of nutrition in spaceflight is well-documented [65,66,67,68,69]. With the exception of Skylab 4 where crewmembers consumed 99% of predicted energy requirements, data suggest that crewmembers consume less energy inflight than pre-flight [69]. During Space Shuttle missions, Lane et al. [70] determined that on average, energy intake was only 68% of predicted requirements. Similarly, on more recent long-duration ISS missions, energy intake was only ~80% of recommended values [38]. A well-known consequence of negative energy balance during unloading is enhanced muscle protein loss [71], which is largely facilitated by a reduction in muscle protein synthesis [11,72]. Overall, this results in a 5%–10% loss of body mass during spaceflight [38,73].

The U.S. Recommended Dietary Allowance (RDA) for protein is 0.8 g∙kg−1∙day−1 [74]. However, the RDA for protein in the general population has been critically questioned [73,75] and could underestimate protein needs by as much as 40% [76,77,78]. Studies also demonstrate that protein intakes between 1.2 and 2.0 g∙kg−1∙day−1 are safe and not associated with renal dysfunction [78,79,80]. In addition, short term (7 day) studies in body builders and athletes suggest that protein intakes up to 2.8 g∙kg−1∙day−1 failed to correlate with renal impairment as evidenced by creatinine clearance, albumin excretion rate, or calcium excretion rate [80].

Ground-based negative energy balance studies in ambulatory subjects have provided insight into the protective effect of protein on lean mass during periods of reduced energy intake. With traditional caloric restriction diets, a significant portion of total weight loss is lean mass [81]. Demling et al. [82] showed that a protein intake of 1.5 g∙kg−1∙day−1 supported lean mass gain during a 20% energy deficit. In another study, a higher protein diet (1.4 g·kg−1·day−1) during 12 weeks of caloric restriction was shown to reduce the loss of lean mass (−1.5 kg) compared to a similar isoenergetic diet containing the RDA for protein (−2.8 kg lean mass) [83]. A similar 16 week study evaluated the concomitant effects of different protein intakes with exercise to protect lean tissue during caloric restriction. Together, resistance exercise and a higher protein diet actually increased lean mass during caloric restriction; these results contrasted with those of a control group that consumed a hypocaloric diet containing the RDA for protein and performed the same exercise program but incurred a significant decrease in muscle mass [84]. Importantly, the higher protein group also saw greater increases in strength [84]. Finally, Layman et al. evaluated the effects of four dietary groups during caloric restriction: a higher protein diet (1.5 g·kg−1·day−1), a moderate protein diet consuming the RDA, and each diet combined with resistance exercise [85]. After 16 weeks, all groups experienced significant losses in body mass and fat mass with the greatest losses in the higher protein plus exercise group. Despite having the largest body mass losses, only the higher protein plus exercise group did not lose lean muscle mass [85]. The mechanism underlying these positive results is the critical provision of a threshold amount of leucine at each meal (≥2.5–3 g, equal to the content of ~30 g intact protein) which maximally stimulates muscle protein synthesis, sparing lean tissue during caloric restriction [86]; resistance exercise acts synergistically to enhance this effect [85,86].

In spaceflight, protein intake is recommended to be 12%–15% of total energy consumed at a 60:40 ratio of animal to plant sources [87,88]. On the ISS, protein intake was recently reported to be 102 ± 29 g∙day−1 or ~1.4 g∙kg−1∙day−1 [38] which is consistent with the protein levels now recommended (1.2–1.7 g∙kg−1∙day−1) for strength and endurance athletes [89,90]. However, the protein recommendations for spaceflight are based on the assumption that total energy needs have been met. As previously discussed, this prerequisite is rarely met during spaceflight [71]. Thus, negative energy balance in the mechanically unloaded environment of space undermines the otherwise adequate daily protein intake, which results in poor muscular outcomes despite the performance of exercise countermeasures. A recent report from spaceflight documented that adequate energy intake with a protein intake of 1.4 g∙kg−1∙day−1 coupled with exercise countermeasures maintained bone mineral density (or attenuated bone mineral density losses) and increased lean mass during six months on the ISS [31]. Because muscle protein synthetic pathways are blunted during mechanical unloading (e.g., spaceflight, bed rest) [91,92,93], protein intakes between 1.5 and 2.0 g∙kg−1∙day−1 may be needed during voluntary caloric restriction and exercise to maintain muscle mass during space missions. If energy intake is adequate during spaceflight, the current recommended protein intake (~1.4 g∙kg−1∙day−1) in combination with advanced exercise countermeasures [49] may be effective [31,73]; however, whether this is optimal remains unknown [94]. This range of protein intake (1.5–2.0 g∙kg−1∙day−1) is consistent with recent recommendations from the U.S Armed Forces for soldiers to maintain muscle mass and strength during periods of sustained metabolic demand and negative energy balance [95]. Exercise countermeasures (or the absence thereof) also appear to modulate the response to additional dietary protein. In light of recent evidence that demonstrates poor outcomes for muscle with increased protein intake (1.6 g∙kg−1∙day−1) during unloading in the absence of any exercise countermeasures [55,96], we wish to emphasize the importance of combining exercise countermeasures with increased protein intake for optimal muscular protection during spaceflight. If exercise countermeasures cannot be performed either due to injury or hardware failure, a more modest protein intake of 1.0–1.4 g∙kg−1∙day−1 may be appropriate to minimize skeletal muscle turnover [55] although this has not been experimentally evaluated in spaceflight. The degree of benefit provided by additional protein in the diet likely depends too on protein quality (i.e., amino acid content). In particular, the essential amino acid leucine has been shown to be a potent stimulant of muscle protein synthesis [97]. Whole foods that contain all of the essential amino acids (leucine, lysine, histidine, phenylalanine, valine, threonine, tryptophan, isoleucine, methionine) are known as complete proteins while those not containing all the essential amino acids are considered incomplete [98]. Also, the rate of intact protein digestion into individual amino acids may influence aminoacidemia and protein accretion [99], which has prompted research into the use of free crystalline amino acids for faster delivery into circulation, especially in combination with exercise [100,101].

5. Exercise and Amino Acid Supplementation on Earth

Exercise training (resistance and aerobic) is needed as the first line of defense against microgravity-induced musculoskeletal deconditioning as it increases muscle protein synthesis [102] and places mechanical forces on bone to stimulate formation [103]. Skeletal muscle signaling pathways are also very responsive to acute nutritional intake [97]. For example, consumption of free essential amino acids increases the rate of muscle protein synthesis [100,101]. The stimulatory effect of essential amino acids on muscle protein synthesis is enhanced in combination with other potent anabolic stimuli such as exercise [104]. Drummond and Rasmussen reported that resistance exercise alone produced a 40% increase in muscle protein synthesis above fasted levels [97]; intake of essential amino acids and carbohydrate elicited a 100% increase in muscle protein synthesis over the same fasted baseline, while exercise plus essential amino acids and carbohydrate acted synergistically to produce the greatest rise in muscle protein synthesis (145%) [97]. Bird et al. [105] showed that resistance exercise training alone increased muscle fiber CSA, but that resistance exercise supplemented with essential amino acids and carbohydrate synergistically improved training adaptations, apparently due to an attenuation of post-exercise muscle protein degradation [105,106]. Together, these reports suggest that resistance exercise and essential amino acid intake enhance muscle protein synthesis and may also inhibit muscle protein breakdown, both of which are needed for optimal muscle protein accretion [72]. The subjects in these studies were not in an energy deficit or mechanically unloaded as observed in space; therefore, it is tenuous to extrapolate these ground-based results to the space environment. The only study to combine exercise and essential amino acid supplementation during mechanical unloading with a mild, 8% energy deficit found that exercise plus essential amino acid supplementation was more effective than essential amino acids alone to protect muscle during bed rest [64]; an exercise-only group was not studied.

6. Protein and Amino Acids for Musculoskeletal Health during Spaceflight: A Paradox?

Evidence suggests that free amino acid ingestion (with or without carbohydrate) and resistance exercise provide a potent, synergistic anabolic stimulus for skeletal muscle [101,107,108,109,110,111,112]. However, there is concern that increasing amino acid intake during spaceflight may increase bone resorption [113,114]. According to the acid-ash hypothesis, diets high in acid-forming substances (anions: amino acids, phosphorus, chlorine) and low in base-forming substances (cations: sodium, potassium, calcium, magnesium) can lead to lower bone mineral density and greater fracture risk [115,116]. Briefly, bone loss occurs because the body requires base and base precursors to buffer acid load. Approximately 80% of total body carbonate is located in the hydrogen shell surrounding bone [117]. Without adequate base or base precursors, carbonate is mobilized from bone to buffer the acid load in the blood [118]. Thus, fruits and vegetables are considered protective to the skeletal system because of their potassium content, while proteins and grains are considered detrimental because of their sulphate and phosphate production [118].

There is both scientific support [119,120,121,122] and opposition [118,123,124] to the acid-ash hypothesis as it pertains to the Earth-based general population. It is also not clear how exercise, a stimulus that also alters acid-base balance [125] and is beneficial to bone [103], moderates this relationship. For example, individuals who perform resistance exercise have greater bone mineral densities than those who do not participate in resistance exercise [126] and body builders (a group that is known to consume large amounts of protein and amino acids) have greater bone mineral densities than other athletes that typically do not consume large amounts of protein (e.g., endurance athletes) [127].

It can be argued that the unique environment of space causes different metabolic and adaptive responses compared to what is observed on Earth and thus the relationship between protein intake and bone resorption changes. Smith and Zwart have described the potential for a low grade metabolic acidosis during unloading [67] and suggest that the ratio of animal protein to potassium intake predicts the rate of bone resorption during bed rest [67,113]. Similarly, in a 28 day bed rest study, Zwart et al. [114] showed that supplementation of essential amino acids (~49.5 g∙day−1) and carbohydrate (~90 g∙day−1) during 28 days of bed rest had a negative effect on urinary markers of bone breakdown (n-telopeptide and deoxypyridinoline) and calcium. Interestingly, in the same subjects, Paddon-Jones et al. [128] reported that supplementation protected participants against decreases in lean mass and muscle protein synthesis. Strength loss was also greater in controls compared to the supplemented group [128]. Essential amino acid supplementation also protects muscle function during bed rest in the elderly [129]. With these apparently opposing adaptations to essential amino acids supplementation in skeletal muscle and bone during unloading, there appears to be a paradox as it pertains to the protection of musculoskeletal health. It is important to note that none of these studies included resistance exercise or reduced energy intake. Currently, only one study provides insight into this multilevel interaction (unloading × essential amino acid supplementation × exercise × reduced energy intake) [63,64]. This 28-day bed rest study reduced energy intake by 8% and assigned participants to one of three groups: (1) essential amino acid supplementation only; (2) resistance training with essential amino acids provided five minutes before training; or (3) resistance training with essential amino acids provided three hours after training. Mid-thigh muscle CSA declined 11% with essential amino acids only, but was maintained in the two groups that performed resistance exercise coupled with essential amino acid supplementation. The greatest loss of lower body muscle strength was also observed with amino acid intake only (−22%), while both resistance exercise plus amino acid supplementation groups showed attenuated strength loss (~7%) [63]. To our knowledge, markers of bone resorption have not been published from the groups in this study, therefore, it is not known if resistance exercise can attenuate the negative bone outcomes that are associated with a low grade metabolic acidosis during unloading. A recent study from the ISS that included exercise countermeasures (Table 2) suggests that higher protein intake was associated with loss of pelvic bone mineral content, but significant relationships were not observed at other bone sites [31]. It should also be noted that the majority of pelvic bone mineral content loss occurred with low intensity iRED resistance exercise countermeasures (−12%) compared to higher intensity ARED resistance exercise countermeasures (−2%), suggesting that exercise intensity may also mediate the effects of protein intake on bone during spaceflight.

7. Perspective and Recommendations for Future Research

Optimizing dietary intake and resistance exercise to preserve both muscle and bone during prolonged spaceflight is a difficult task. Even if energy balance is achieved, the current diet may not optimize the effectiveness of exercise countermeasures for the protection of muscle mass and strength. In the opinion of these authors, the diet is tailored to maintain bone parameters at the expense of skeletal muscle mass (i.e., low acid with Vitamin D and calcium supplementation). We are not attacking this philosophy, particularly given that skeletal muscle is quite plastic, while bone is not. We are simply spotlighting it and wish to emphasize that it will be very difficult, if not impossible, to maintain pre-flight muscle mass levels with a dietary paradigm that emphasizes bone over muscle. Below, we discuss two dietary strategies to enhance muscle parameters without negatively affecting bone. The overall focus of these strategies is to increase total protein intake into the recommended range (1.5–2.0 g∙kg−1∙day−1) by supplementing free essential amino acids in close temporal proximity to exercise countermeasures.

7.1. Non-Sulfur Containing Essential Amino Acids

The essential amino acids are indispensable to the nutritional stimulation of muscle protein synthesis [100]. However, as previously discussed, increased acidity from amino acids in the diet may lead to increased bone resorption, especially during unloading [114]. Net endogenous acid production from sulfur-containing amino acids (methionine, cysteine, homocysteine, and taurine) are the greatest contributor to decreased blood pH as they can produce sulfuric acid from incomplete oxidation [130]. Of the essential amino acids, only methionine is sulfur-containing [130]. Methionine is also the initiating amino acid in the synthesis of eukaryotic proteins, including skeletal muscle [130]. Therefore, it is critical for translation initiation, but because most residues are subsequently removed, it is not important to protein structure [130]. As such, it may be possible to increase total protein intake to >1.5 g∙kg−1∙day−1 via non-sulfur-containing essential amino acid supplements in combination with resistance exercise and not see detrimental effects on acid-base balance, particularly if potassium is also supplemented during unloading. Future bed rest or limb suspension research in this area is warranted to elucidate a dietary strategy that is beneficial for both muscle and bone during spaceflight.

7.2. Leucine

Because up-mass and volume are always severely limited in spaceflight and will be so particularly for long-duration exploration missions, the mass and volume of a supplement is a key consideration in its potential implementation; for example, a 45 g·day−1 essential amino acid supplement (3 × 15 g·day−1) equates to 8.1 kg for a single astronaut over a 6-month mission. Ideally, a supplement should be low-volume while still retaining the potent anabolic effects of a full complement of essential amino acids. Over the past 15 years, leucine has emerged as just such an essential amino acid for its singular regulation of muscle protein synthesis [97]. Leucine is a branched-chain amino acid that stimulates muscle protein synthesis in vitro [131,132], in rats [133], and in humans [111,134] while the other branched-chain amino acids, valine and isoleucine, are, alone, ineffective and inhibitory, respectively [131]. Together, all three branched-chain amino acids stimulate muscle protein synthesis, but without leucine, the others are ineffective [135]. Leucine exerts this protein synthetic effect by stimulation of mRNA translation initiation [131,136]. Specifically, in rat muscle preparations, leucine-stimulated translation initiation (and protein synthesis) is facilitated by increased binding of the elongation initiation factor 4E (eIF4E), elongation initiation factor 4G (eIF4G) assembly, possibly secondary to increased eIF4G phosphorylation; these effects were seen independent of activation of the mammalian target of rapamycin (mTOR) pathway as phosphorylation of eukaryotic initiation factor (eiF)4E binding protein-1 (4E-BP1) and 70-kDa ribosomal protein S6 kinase 1 (S6K1) was not increased with supraphysiologic levels of leucine [137]. A PI3-kinase inhibitor in this study also clearly demonstrated leucine’s ability to stimulate muscle protein synthesis in the absence of insulin’s effects. Nevertheless, insulin still has potent synergistic effects with leucine on mTOR activation, subsequent translation initiation via phosphorylation of S6K1 and 4E-BP1 and assembly of eIF4G and eIF4E, and ultimately, muscle protein synthesis [133,137,138,139].

Leucine has also been shown to stimulate muscle protein synthesis in humans via the mTOR pathway and its downstream targets, S6K1 and 4E-BP1 [140]. Young adults given a 10 g essential amino acid drink with either 1.8 or 3.5 g leucine similarly increased muscle protein synthesis and net balance over a 3 h period. Although synthetic responses were similar, a slightly greater decrease in muscle protein breakdown was seen in the high-leucine group [140]. Further, extra leucine was associated with a prolonged increase in insulin as well as enhanced anabolic signaling, particularly of 4E-BP1 [140]. In light of these findings, leucine has been investigated as a potential intervention to prevent the muscle loss associated with aging and unloading. Verhoeven et al. supplemented healthy older men with 2.5 g leucine with each of their three daily meals (7.5 g·day−1). After 3 months of supplementation, no changes in lean mass, strength, insulin sensitivity, or lipid profile were observed [141]. They found similar non-effects in a group of older Type II diabetic men who followed the same supplementation regimen for 6 months [142]. However, the subjects in these studies already consumed a moderate protein diet (~1.0 g∙kg−1∙day−1), were ambulatory, and were not in an energy deficit, which may explain their lack of response to supplemental leucine. Trappe et al. also evaluated leucine as a countermeasure during 60 d bed rest in young women, but reported losses in lean mass and strength similar to or worse than controls [55]. It is plausible that leucine may only influence changes at the whole body level in individuals who are in a compromised state (e.g., inactive or consuming a low protein/energy diet). Evidence for this may be found in results from Casperson et al. who reported that 14 d supplementation with 4 g leucine meal−1 (12 g·day−1) in healthy older adults consuming the RDA for protein resulted in increased basal and post-prandial MPS as well as greater mTOR, S6K1, and 4E-BP1 expression [143]. Leucine appears well-suited both to increase total protein intake to 1.5–2.0 g∙kg−1∙day−1 and to act synergistically with exercise countermeasures to create an optimal anabolic environment during long-duration spaceflight. In contrast to previously discussed supplements containing all the essential amino acids, a leucine supplement could be 10–15 g∙day−1, reducing supplement mass or volume by 67% or more. However, further work is needed to evaluate the efficacy of leucine supplementation during unloading and particularly its interaction with negative energy balance and exercise.

In summary, prolonged exposure to microgravity significantly impairs musculoskeletal health. Exercise is the primary countermeasure against deconditioning; however, spaceflight appears to be associated with a restriction in energy intake which may undermine exercise effectiveness. With negative energy balance and exercise countermeasures, protein intake ≤1.4 g∙kg−1∙day−1 is likely insufficient to maintain skeletal muscle mass. Adequate total energy intake is the first dietary priority for long-duration spaceflight; however, with negative energy balance and exercise, supplementation of additional protein to achieve intakes of 1.5–2.0 g∙kg−1∙day−1 (particularly from non-sulfur containing essential amino acids or leucine) may offer secondary protection. Consistent with these recommendations, future unloading studies should evaluate the concomitant effects of non-sulfur containing essential amino acid and/or leucine supplementation with exercise in the context of energy restriction on both skeletal muscle and bone outcomes.

Author Contributions

As first author, Kyle J. Hackney performed the initial literature review and wrote the first draft of the manuscript. Co-author, Kirk L. English contributed additional research and edited manuscript drafts. Both authors have read and approved the final published manuscript.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Norcross, J.R.; Clowers, K.G.; Clark, T.; Harvill, L.; Morency, R.M.; Stroud, L.C.; Desantis, L.; Vos, J.R.; Gernhardt, M.L. Metabolic Costs and Biomechanics of Inclined Ambulation and Exploration Tasks in a Planetary Suit; NASA Technical Paper, TP-216125. NASA: Washington, DC, USA, 2010.
  2. Sibonga, J.D. Spaceflight-induced bone loss: Is there an osteoporosis risk? Curr. Osteoporos. Rep. 2013, 11, 92–98. [Google Scholar] [CrossRef]
  3. Sayson, J.; Lotz, J.; Parazynski, S.; Hargens, A.R. Back pain in space and post-flight spine injury: Mechanisms and countermeasure development. Acta Astronaut. 2013, 86, 24–38. [Google Scholar] [CrossRef]
  4. Narici, M.V.; de Boer, M.D. Disuse of the musculo-skeletal system in space and on earth. Eur. J. Appl. Physiol. 2011, 111, 403–420. [Google Scholar] [CrossRef]
  5. Fitts, R.H.; Riley, D.R.; Widrick, J.J. Functional and structural adaptations of skeletal muscle to microgravity. J. Exp. Biol. 2001, 204, 3201–3208. [Google Scholar]
  6. Akima, H.; Kawakami, Y.; Kubo, K.; Sekiguchi, C.; Ohshima, H.; Miyamoto, A.; Fukunaga, T. Effect of short-duration spaceflight on thigh and leg muscle volume. Med. Sci. Sports Exerc. 2000, 32, 1743–1747. [Google Scholar] [CrossRef]
  7. LeBlanc, A.; Rowe, R.; Schneider, V.; Evans, H.; Hedrick, T. Regional muscle loss after short duration spaceflight. Aviat. Space Environ. Med. 1995, 66, 1151–1154. [Google Scholar]
  8. LeBlanc, A.; Lin, C.; Shackelford, L.; Sinitsyn, V.; Evans, H.; Belichenko, O.; Schenkman, B.; Kozlovskaya, I.; Oganov, V.; Bakulin, A.; et al. Muscle volume, mri relaxation times (t2), and body composition after spaceflight. J. Appl. Physiol. 2000, 89, 2158–2164. [Google Scholar]
  9. Trappe, S.; Costill, D.; Gallagher, P.; Creer, A.; Peters, J.R.; Evans, H.; Riley, D.A.; Fitts, R.H. Exercise in space: Human skeletal muscle after 6 months aboard the international space station. J. Appl. Physiol. 2009, 106, 1159–1168. [Google Scholar] [CrossRef]
  10. Fitts, R.H.; Trappe, S.W.; Costill, D.L.; Gallagher, P.M.; Creer, A.C.; Colloton, P.A.; Peters, J.R.; Romatowski, J.G.; Bain, J.L.; Riley, D.A. Prolonged space flight-induced alterations in the structure and function of human skeletal muscle fibres. J. Physiol. 2010, 588, 3567–3592. [Google Scholar] [CrossRef]
  11. Stein, T.P.; Larina, I.M.; Leskiv, M.J.; Schluter, M.D. [Protein turnover during and after extended space flight]. Aviakosmicheskaia i Ekologicheskaia Meditsina 2000, 34, 12–16. (in Russian). [Google Scholar]
  12. Edgerton, V.R.; Zhou, M.Y.; Ohira, Y.; Klitgaard, H.; Jiang, B.; Bell, G.; Harris, B.; Saltin, B.; Gollnick, P.D.; Roy, R.R.; et al. Human fiber size and enzymatic properties after 5 and 11 days of spaceflight. J. Appl. Physiol. 1995, 78, 1733–1739. [Google Scholar]
  13. Widrick, J.J.; Knuth, S.T.; Norenberg, K.M.; Romatowski, J.G.; Bain, J.L.; Riley, D.A.; Karhanek, M.; Trappe, S.W.; Trappe, T.A.; Costill, D.L.; et al. Effect of a 17 day spaceflight on contractile properties of human soleus muscle fibres. J. Physiol. 1999, 516, 915–930. [Google Scholar] [CrossRef]
  14. Trappe, S.W.; Trappe, T.A.; Lee, G.A.; Widrick, J.J.; Costill, D.L.; Fitts, R.H. Comparison of a space shuttle flight (sts-78) and bed rest on human muscle function. J. Appl. Physiol. 2001, 91, 57–64. [Google Scholar]
  15. Whedon, D.G.; Rambaut, P.C. Effects of long-duration space flight on calcium metabolism: Review of human studies from skylab to the present. Acta Astronaut. 2006, 58, 59–81. [Google Scholar] [CrossRef]
  16. Miyamoto, A.; Shigematsu, T.; Fukunaga, T.; Kawakami, K.; Mukai, C.; Sekiguchi, C. Medical baseline data collection on bone and muscle change with space flight. Bone 1998, 22, 79S–82S. [Google Scholar] [CrossRef]
  17. Smith, S.M.; Heer, M. Calcium and bone metabolism during space flight. Nutrition 2002, 18, 849–852. [Google Scholar] [CrossRef]
  18. LeBlanc, A.; Shackelford, L.; Schneider, V. Future human bone research in space. Bone 1998, 22, 113S–116S. [Google Scholar]
  19. Rambaut, P.C.; Goode, A.W. Skeletal changes during space flight. Lancet 1985, 2, 1050–1052. [Google Scholar] [CrossRef]
  20. Goode, A.W.; Rambaut, P.C. The skeleton in space. Nature 1985, 317, 204–205. [Google Scholar] [CrossRef]
  21. Johnson, R.B. The bearable lightness of being: Bones, muscles, and spaceflight. Anat. Rec. 1998, 253, 24–27. [Google Scholar] [CrossRef]
  22. Oganov, V.S.; Bogomolov, V.V. [human bone system in microgravity: Review of research data, hypotheses and predictability of musculoskeletal system state in extended (exploration) missions]. Aviakosmicheskaia i Ekologicheskaia Meditsina 2009, 43, 3–12. (In Russian). [Google Scholar]
  23. Whedon, G.D.; Lutwak, L.; Reid, J.; Rambaut, P.; Whittle, M.; Smith, M.; Leach, C. Mineral and nitrogen metabolic studies on skylab orbital space flights. Trans. Assoc. Am. Phys. 1974, 87, 95–110. [Google Scholar]
  24. Thorton, W.E.; Rummel, J.A. Muscular deconditioning and its prevention in spaceflight. Biomedical Results from Skylab; National Aeronautics and Space Adminstration: Houston, TX, USA, 1975. [Google Scholar]
  25. Riley, D.A.; Bain, J.L.; Thompson, J.L.; Fitts, R.H.; Widrick, J.J.; Trappe, S.W.; Trappe, T.A.; Costill, D.L. Decreased thin filament density and length in human atrophic soleus muscle fibers after spaceflight. J. Appl. Physiol. 2000, 88, 567–572. [Google Scholar]
  26. Koryak, Y.U. Electrically evoked and voluntary properties of the human triceps surae muscle: Effects of long-term spaceflights. Acta Physiol. Pharmacol. Bulg. 2001, 26, 21–27. [Google Scholar]
  27. Lambertz, D.; Perot, C.; Kaspranski, R.; Goubel, F. Effects of long-term spaceflight on mechanical properties of muscles in humans. J. Appl. Physiol. 2001, 90, 179–188. [Google Scholar]
  28. Narici, M.; Kayser, B.; Barattini, P.; Cerretelli, P. Effects of 17-day spaceflight on electrically evoked torque and cross-sectional area of the human triceps surae. Eur. J. Appl. Physiol. 2003, 90, 275–282. [Google Scholar] [CrossRef]
  29. Tesch, P.A.; Berg, H.E.; Bring, D.; Evans, H.J.; LeBlanc, A.D. Effects of 17-day spaceflight on knee extensor muscle function and size. Eur. J. Appl. Physiol. 2005, 93, 463–468. [Google Scholar] [CrossRef]
  30. Gopalakrishnan, R.; Genc, K.O.; Rice, A.J.; Lee, S.M.; Evans, H.J.; Maender, C.C.; Ilaslan, H.; Cavanagh, P.R. Muscle volume, strength, endurance, and exercise loads during 6-month missions in space. Aviat. Space Environ. Med. 2010, 81, 91–102. [Google Scholar] [CrossRef]
  31. Smith, S.M.; Heer, M.A.; Shackelford, L.C.; Sibonga, J.D.; Ploutz-Snyder, L.; Zwart, S.R. Benefits for bone from resistance exercise and nutrition in long-duration spaceflight: Evidence from biochemistry and densitometry. J. Bone Miner. Res. 2012, 27, 1896–1906. [Google Scholar] [CrossRef]
  32. Whedon, G.D.; Lutwak, L.; Rambaut, P.; Whittle, M.; Leach, C.; Reid, J.; Smith, M. Effect of weightlessness on mineral metabolism; metabolic studies on skylab orbital space flights. Calcif. Tissue Res. 1976, 21, 423–430. [Google Scholar]
  33. Stupakov, G.P.; Kazeikin, V.S.; Kozlovskii, A.P.; Korolev, V.V. [evaluation of the changes in the bone structures of the human axial skeleton in prolonged space flight]. Kosmicheskaia Biologiia i Aviakosmicheskaia Meditsina 1984, 18, 33–37. (In Russian). [Google Scholar]
  34. Oganov, V.S.; Rakhmanov, A.S.; Novikov, V.E.; Zatsepin, S.T.; Rodionova, S.S.; Cann, C. The state of human bone tissue during space flight. Acta Astronaut. 1991, 23, 129–133. [Google Scholar] [CrossRef]
  35. Smith, S.M.; Wastney, M.E.; Morukov, B.V.; Larina, I.M.; Nyquist, L.E.; Abrams, S.A.; Taran, E.N.; Shih, C.Y.; Nillen, J.L.; Davis-Street, J.E.; et al. Calcium metabolism before, during, and after a 3-mo spaceflight: Kinetic and biochemical changes. Am. J. Physiol. 1999, 277, R1–R10. [Google Scholar]
  36. Vico, L.; Collet, P.; Guignandon, A.; Lafage-Proust, M.H.; Thomas, T.; Rehaillia, M.; Alexandre, C. Effects of long-term microgravity exposure on cancellous and cortical weight-bearing bones of cosmonauts. Lancet 2000, 355, 1607–1611. [Google Scholar] [CrossRef]
  37. LeBlanc, A.; Schneider, V.; Shackelford, L.; West, S.; Oganov, V.; Bakulin, A.; Voronin, L. Bone mineral and lean tissue loss after long duration space flight. J. Musculoskelet. Neuronal Interact. 2000, 1, 157–160. [Google Scholar]
  38. Smith, S.M.; Zwart, S.R.; Block, G.; Rice, B.L.; Davis-Street, J.E. The nutritional status of astronauts is altered after long-term space flight aboard the international space station. J. Nutr. 2005, 135, 437–443. [Google Scholar]
  39. Smith, S.M.; Wastney, M.E.; O’Brien, K.O.; Morukov, B.V.; Larina, I.M.; Abrams, S.A.; Davis-Street, J.E.; Oganov, V.; Shackelford, L.C. Bone markers, calcium metabolism, and calcium kinetics during extended-duration space flight on the mir space station. J. Bone Miner. Res. 2005, 20, 208–218. [Google Scholar]
  40. Lang, T.; LeBlanc, A.; Evans, H.; Lu, Y.; Genant, H.; Yu, A. Cortical and trabecular bone mineral loss from the spine and hip in long-duration spaceflight. J. Bone Miner. Res. 2004, 19, 1006–1012. [Google Scholar] [CrossRef]
  41. Grigoriev, A.I.; Oganov, V.S.; Bakulin, A.V.; Poliakov, V.V.; Voronin, L.I.; Morgun, V.V.; Shnaider, V.S.; Murashko, L.V.; Novikov, V.E.; LeBlank, A.; et al. [clinical and physiological evaluation of bone changes among astronauts after long-term space flights]. Aviakosmicheskaia i Ekologicheskaia Meditsina 1998, 32, 21–25. (In Russian). [Google Scholar]
  42. LeBlanc, A.; Schneider, V. Can the adult skeleton recover lost bone? Exp. Gerontol. 1991, 26, 189–201. [Google Scholar] [CrossRef]
  43. Tilton, F.E.; Degioanni, J.J.; Schneider, V.S. Long-term follow-up of skylab bone demineralization. Aviat. Space Environ. Med. 1980, 51, 1209–1213. [Google Scholar]
  44. Whitson, P.A.; Pietrzyk, R.A.; Pak, C.Y.; Cintron, N.M. Alterations in renal stone risk factors after space flight. J. Urol. 1993, 150, 803–807. [Google Scholar]
  45. Hagan, R.D.; Schaffner, G. Exercise Countermeasures Used during Space Flight. In Proceedings of the Second Joint EMBS/SMES Conference, Houston, TX, USA, 23–26 October 2002.
  46. Beyene, N. The art of space flight exercise hardware: Design and implementation. In Proceedings of the Space 2004 conference and Exhibit, San Diego, CA, USA, 28–30 September 2004.
  47. McCrory, J.L.; Lemmon, D.R.; Sommer, H.J.; Prout, B.; Smith, D.; Korth, D.W.; Lucero, J.; Greenisen, M.; Moore, J.; Kozlovskaya, I.; et al. Evaluation of a treadmill with vibration isolation and stabilization (tvis) for use on the international space station. J. Appl. Biomech. 1999, 15, 292–302. [Google Scholar]
  48. English, K.L.; Loehr, J.A.; Laughlin, M.A.; Lee, S.M.C.; Hagan, R.D. Reliability of Strength Testing Using the Advanced Resistive Exercise Device and Free Weights; NASA Technical Paper, TP-214728. NASA: Washington, DC, USA, 2008.
  49. Loehr, J.A.; Lee, S.M.; English, K.L.; Sibonga, J.; Smith, S.M.; Spiering, B.A.; Hagan, R.D. Musculoskeletal adaptations to training with the advanced resistive exercise device. Med. Sci. Sports Exerc. 2011, 43, 146–156. [Google Scholar]
  50. Lee, S.M.; Moore, A.D.; Everett, M.E.; Stenger, M.B.; Platts, S.H. Aerobic exercise deconditioning and countermeasures during bed rest. Aviat. Space Environ. Med. 2010, 81, 52–63. [Google Scholar] [CrossRef]
  51. Pavy-Le Traon, A.; Heer, M.; Narici, M.V.; Rittweger, J.; Vernikos, J. From space to earth: Advances in human physiology from 20 years of bed rest studies (1986–2006). Eur. J. Appl. Physiol. 2007, 101, 143–194. [Google Scholar] [CrossRef]
  52. Atkov, O.Y.; Bednenko, V.S. Hypokinesia and Weightlessness: Clinical and Physiologic Aspects; International University Press: Madison, WI, USA, 1992. [Google Scholar]
  53. Alkner, B.A.; Tesch, P.A. Knee extensor and plantar flexor muscle size and function following 90 days of bed rest with or without resistance exercise. Eur. J. Appl. Physiol. 2004, 93, 294–305. [Google Scholar] [CrossRef]
  54. Shackelford, L.C.; LeBlanc, A.D.; Driscoll, T.B.; Evans, H.J.; Rianon, N.J.; Smith, S.M.; Spector, E.; Feeback, D.L.; Lai, D. Resistance exercise as a countermeasure to disuse-induced bone loss. J. Appl. Physiol. 2004, 97, 119–129. [Google Scholar] [CrossRef]
  55. Trappe, T.A.; Burd, N.A.; Louis, E.S.; Lee, G.A.; Trappe, S.W. Influence of concurrent exercise or nutrition countermeasures on thigh and calf muscle size and function during 60 days of bed rest in women. Acta Physiol. 2007, 191, 147–159. [Google Scholar] [CrossRef]
  56. Schneider, S.M.; Lee, S.M.; Macias, B.R.; Watenpaugh, D.E.; Hargens, A.R. Wise-2005: Exercise and nutrition countermeasures for upright vo2pk during bed rest. Med. Sci. Sport Exerc. 2009, 41, 2165–2176. [Google Scholar]
  57. Lee, S.M.; Schneider, S.M.; Boda, W.L.; Watenpaugh, D.E.; Macias, B.R.; Meyer, R.S.; Hargens, A.R. Lbnp exercise protects aerobic capacity and sprint speed of female twins during 30 days of bed rest. J. Appl. Physiol. 2009, 106, 919–928. [Google Scholar]
  58. Watenpaugh, D.E.; Ballard, R.E.; Schneider, S.M.; Lee, S.M.; Ertl, A.C.; William, J.M.; Boda, W.L.; Hutchinson, K.J.; Hargens, A.R. Supine lower body negative pressure exercise during bed rest maintains upright exercise capacity. J. Appl. Physiol. 2000, 89, 218–227. [Google Scholar]
  59. Stenger, M.B.; Evans, J.M.; Knapp, C.F.; Lee, S.M.; Phillips, T.R.; Perez, S.A.; Moore, A.D., Jr.; Paloski, W.H.; Platts, S.H. Artificial gravity training reduces bed rest-induced cardiovascular deconditioning. Eur. J. Appl. Physiol. 2012, 112, 605–616. [Google Scholar] [CrossRef]
  60. Caiozzo, V.J.; Haddad, F.; Lee, S.; Baker, M.; Paloski, W.; Baldwin, K.M. Artificial gravity as a countermeasure to microgravity: A pilot study examining the effects on knee extensor and plantar flexor muscle groups. J. Appl. Physiol. 2009, 107, 39–46. [Google Scholar] [CrossRef]
  61. Garman, R.; Gaudette, G.; Donahue, L.R.; Rubin, C.; Judex, S. Low-level accelerations applied in the absence of weight bearing can enhance trabecular bone formation. J. Orthop. Res. 2007, 25, 732–740. [Google Scholar] [CrossRef]
  62. Mulder, E.R.; Gerrits, K.H.; Kleine, B.U.; Rittweger, J.; Felsenberg, D.; de Haan, A.; Stegeman, D.F. High-density surface emg study on the time course of central nervous and peripheral neuromuscular changes during 8 weeks of bed rest with or without resistive vibration exercise. J. Electromyogr. Kinesiol. 2009, 19, 208–218. [Google Scholar]
  63. Brooks, N.E.; Cadena, S.M.; Vannier, E.; Cloutier, G.; Carambula, S.; Myburgh, K.H.; Roubenoff, R.; Castaneda-Sceppa, C. Effects of resistance exercise combined with essential amino acid supplementation and energy deficit on markers of skeletal muscle atrophy and regeneration during bed rest and active recovery. Muscle Nerve 2010, 42, 927–935. [Google Scholar] [CrossRef]
  64. Brooks, N.; Cloutier, G.J.; Cadena, S.M.; Layne, J.E.; Nelsen, C.A.; Freed, A.M.; Roubenoff, R.; Castaneda-Sceppa, C. Resistance training and timed essential amino acids protect against the loss of muscle mass and strength during 28 days of bed rest and energy deficit. J. Appl. Physiol. 2008, 105, 241–248. [Google Scholar] [CrossRef]
  65. Lane, H.W.; Kloeris, V.; Perchnok, M.; Zwart, S.R.; Smith, S.M. Food and nutrition for the moon base. Nutr. Today 2007, 42, 102–120. [Google Scholar] [CrossRef]
  66. Perchonok, M.; Bourland, C. Nasa food systems: Past, present, and future. Nutrition 2002, 18, 913–920. [Google Scholar] [CrossRef]
  67. Smith, S.M.; Zwart, S.R. Nutritional biochemistry of spaceflight. Adv. Clin. Chem. 2008, 46, 87–130. [Google Scholar] [CrossRef]
  68. Stein, T.P. Nutrition in the space station era. Nutr. Res. Rev. 2001, 14, 87–118. [Google Scholar] [CrossRef]
  69. Smith, S.; Zwart, S.R. Nutrition issues for space exploration. Acta Astronaut. 2008, 63, 609–613. [Google Scholar] [CrossRef]
  70. Lane, H.W.; Smith, S.M.; Rice, B.L.; Bourland, C.T. Nutrition in space: Lessons from the past applied to the future. Am. J. Clin. Nutr. 1994, 60, 801S–805S. [Google Scholar]
  71. Biolo, G.; Ciocchi, B.; Stulle, M.; Bosutti, A.; Barazzoni, R.; Zanetti, M.; Antonione, R.; Lebenstedt, M.; Platen, P.; Heer, M.; et al. Calorie restriction accelerates the catabolism of lean body mass during 2 wk of bed rest. Am. J. Clin. Nutr. 2007, 86, 366–372. [Google Scholar]
  72. Phillips, S.M.; Glover, E.I.; Rennie, M.J. Alterations of protein turnover underlying disuse atrophy in human skeletal muscle. J. Appl. Physiol. 2009, 107, 645–654. [Google Scholar] [CrossRef]
  73. Stein, T.P. Weight, muscle and bone loss during space flight: Another perspective. Eur. J. Appl. Physiol. 2013, 113, 2171–2181. [Google Scholar] [CrossRef]
  74. Council, N.R. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients); National Academies Press: Washington, DC, USA, 2005. [Google Scholar]
  75. Wolfe, R.R.; Miller, S.L. The recommended dietary allowance of protein: A misunderstood concept. Jama 2008, 299, 2891–2893. [Google Scholar] [CrossRef]
  76. Elango, R.; Ball, R.O.; Pencharz, P.B. Individual amino acid requirements in humans: An update. Curr. Opin. Clin. Nutr. Metab. Care 2008, 11, 34–39. [Google Scholar] [CrossRef]
  77. Humayun, M.A.; Elango, R.; Moehn, S.; Ball, R.O.; Pencharz, P.B. Application of the indicator amino acid oxidation technique for the determination of metabolic availability of sulfur amino acids from casein versus soy protein isolate in adult men. J. Nutr. 2007, 137, 1874–1879. [Google Scholar]
  78. Skov, A.R.; Toubro, S.; Ronn, B.; Holm, L.; Astrup, A. Randomized trial on protein vs. carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int. J. Obes. Relat. Metab. Disord. 1999, 23, 528–536. [Google Scholar]
  79. Brenner, B.M.; Meyer, T.W.; Hostetter, T.H. Dietary protein intake and the progressive nature of kidney disease: The role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N. Engl. J. Med. 1982, 307, 652–659. [Google Scholar] [CrossRef]
  80. Poortmans, J.R.; Dellalieux, O. Do regular high protein diets have potential health risks on kidney function in athletes? Int. J. Sport Nutr. Exerc. Metab. 2000, 10, 28–38. [Google Scholar]
  81. Krieger, J.W.; Sitren, H.S.; Daniels, M.J.; Langkamp-Henken, B. Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: A meta-regression 1. Am. J. Clin. Nutr. 2006, 83, 260–274. [Google Scholar]
  82. Demling, R.H.; DeSanti, L. Effect of a hypocaloric diet, increased protein intake and resistance training on lean mass gains and fat mass loss in overweight police officers. Ann. Nutr. Metab. 2000, 44, 21–29. [Google Scholar] [CrossRef]
  83. Leidy, H.J.; Carnell, N.S.; Mattes, R.D.; Campbell, W.W. Higher protein intake preserves lean mass and satiety with weight loss in pre-obese and obese women. Obesity 2007, 15, 421–429. [Google Scholar] [CrossRef]
  84. Josse, A.R.; Atkinson, S.A.; Tarnopolsky, M.A.; Phillips, S.M. Increased consumption of dairy foods and protein during diet- and exercise-induced weight loss promotes fat mass loss and lean mass gain in overweight and obese premenopausal women. J. Nutr. 2011, 141, 1626–1634. [Google Scholar] [CrossRef]
  85. Layman, D.K.; Evans, E.; Baum, J.I.; Seyler, J.; Erickson, D.J.; Boileau, R.A. Dietary protein and exercise have additive effects on body composition during weight loss in adult women. J. Nutr. 2005, 135, 1903–1910. [Google Scholar]
  86. Devkota, S.; Layman, D.K. Protein metabolic roles in treatment of obesity. Curr. Opin. Clin. Nutr. Metab. Care 2010, 13, 403–407. [Google Scholar] [CrossRef]
  87. Lane, H.; Grigorov, E.; Bourland, C.; Agureev, A.; Pierson, D.; Doborovolsky, V. Nutritional Requirements for International Space Station: Mission up to 360 Days; Johnson Space Center: Houston, TX, USA, 1996; Volume #28038. [Google Scholar]
  88. Lane, H.; Pool, S.; Huntoon, C.L. Nutritional Requirements for Extended Duration Orbiter Mission (30–90 d) and Space Station Freedom (30–120 d); Johnson Space Center: Houston, TX, USA, 1992; Volume #32283. [Google Scholar]
  89. Rodriguez, N.R.; DiMarco, N.M.; Langley, S. Position of the american dietetic association, dietitians of Canada, and the American college of sports medicine: Nutrition and athletic performance. J. Am. Diet. Assoc. 2009, 109, 509–527. [Google Scholar] [CrossRef]
  90. American Dietetic Association; Dietitians of Canada; American College of Sports Medicine; Rodriguez, N.R.; Di Marco, N.M.; Langley, S. American college of sports medicine position stand. Nutrition and athletic performance. Med. Sci. Sports Exerc. 2009, 41, 709–731. [Google Scholar] [CrossRef]
  91. Biolo, G.; Ciocchi, B.; Lebenstedt, M.; Barazzoni, R.; Zanetti, M.; Platen, P.; Heer, M.; Guarnieri, G. Short-term bed rest impairs amino acid-induced protein anabolism in humans. J. Physiol. 2004, 558, 381–388. [Google Scholar] [CrossRef]
  92. Breen, L.; Stokes, K.A.; Churchward-Venne, T.A.; Moore, D.R.; Baker, S.K.; Smith, K.; Atherton, P.J.; Phillips, S.M. Two weeks of reduced activity decreases leg lean mass and induces “anabolic resistance” of myofibrillar protein synthesis in healthy elderly. J. Clin. Endocrinol. Metab. 2013, 98, 2604–2612. [Google Scholar] [CrossRef]
  93. Glover, E.I.; Phillips, S.M.; Oates, B.R.; Tang, J.E.; Tarnopolsky, M.A.; Selby, A.; Smith, K.; Rennie, M.J. Immobilization induces anabolic resistance in human myofibrillar protein synthesis with low and high dose amino acid infusion. J. Physiol. 2008, 586, 6049–6061. [Google Scholar] [CrossRef]
  94. Deutz, N.E.; Wolfe, R.R. Is there a maximal anabolic response to protein intake with a meal? Clin. Nutr. 2013, 32, 309–313. [Google Scholar] [CrossRef]
  95. Pasiakos, S.M.; Austin, K.G.; Lieberman, H.R.; Askew, E.W. Efficacy and safety of protein supplements for U.S. Armed forces personnel: Consensus statement. J. Nutr. 2013, 143, 1811S–1814S. [Google Scholar] [CrossRef]
  96. Dirks, M.L.; Wall, B.T.; Nilwik, R.; Weerts, D.H.; Verdijk, L.B.; van Loon, L.J. Skeletal muscle disuse atrophy is not attenuated by dietary protein supplementation in healthy older men. J Nutr. 2014, 144. [Google Scholar] [CrossRef]
  97. Drummond, M.J.; Rasmussen, B.B. Leucine-enriched nutrients and the regulation of mammalian target of rapamycin signalling and human skeletal muscle protein synthesis. Curr. Opin. Clin. Nutr. Metab. Care 2008, 11, 222–226. [Google Scholar] [CrossRef]
  98. Phillips, S.M.; Tang, J.E.; Moore, D.R. The role of milk- and soy-based protein in support of muscle protein synthesis and muscle protein accretion in young and elderly persons. J. Am. Coll. Nutr. 2009, 28, 343–354. [Google Scholar] [CrossRef]
  99. Boirie, Y.; Dangin, M.; Gachon, P.; Vasson, M.P.; Maubois, J.L.; Beaufrere, B. Slow and fast dietary proteins differently modulate postprandial protein accretion. Proc. Natl. Acad. Sci. USA 1997, 94, 14930–14935. [Google Scholar]
  100. Tipton, K.D.; Gurkin, B.E.; Matin, S.; Wolfe, R.R. Nonessential amino acids are not necessary to stimulate net muscle protein synthesis in healthy volunteers. J. Nutr. Biochem. 1999, 10, 89–95. [Google Scholar] [CrossRef]
  101. Volpi, E.; Kobayashi, H.; Sheffield-Moore, M.; Mittendorfer, B.; Wolfe, R.R. Essential amino acids are primarily responsible for the amino acid stimulation of muscle protein anabolism in healthy elderly adults. Am. J. Clin. Nutr. 2003, 78, 250–258. [Google Scholar]
  102. Phillips, S.M.; Tipton, K.D.; Aarsland, A.; Wolf, S.E.; Wolfe, R.R. Mixed muscle protein synthesis and breakdown after resistance exercise in humans. Am. J. Physiol. 1997, 273, E99–E107. [Google Scholar]
  103. Schwarz, P.; Courteix, D.; Karlsson, M. Exercise and bone. Eur. J. Sport Sci. 2006, 6, 141–144. [Google Scholar]
  104. Rasmussen, B.B.; Tipton, K.D.; Miller, S.L.; Wolf, S.E.; Wolfe, R.R. An oral essential amino acid-carbohydrate supplement enhances muscle protein anabolism after resistance exercise. J. Appl. Physiol. 2000, 88, 386–392. [Google Scholar]
  105. Bird, S.P.; Tarpenning, K.M.; Marino, F.E. Independent and combined effects of liquid carbohydrate/essential amino acid ingestion on hormonal and muscular adaptations following resistance training in untrained men. Eur. J. Appl. Physiol. 2006, 97, 225–238. [Google Scholar] [CrossRef]
  106. Bird, S.P.; Tarpenning, K.M.; Marino, F.E. Liquid carbohydrate/essential amino acid ingestion during a short-term bout of resistance exercise suppresses myofibrillar protein degradation. Metabolism. Clin. Exp. 2006, 55, 570–577. [Google Scholar] [CrossRef]
  107. Wolfe, R.R. Skeletal muscle protein metabolism and resistance exercise. J. Nutr. 2006, 136, 525S–528S. [Google Scholar]
  108. Tipton, K.D.; Sharp, C.P. The response of intracellular signaling and muscle-protein metabolism to nutrition and exercise. Eur. J. Sport Sci. 2005, 5, 107–121. [Google Scholar] [CrossRef]
  109. Tipton, K.D.; Rasmussen, B.B.; Miller, S.L.; Wolf, S.E.; Owens-Stovall, S.K.; Petrini, B.E.; Wolfe, R.R. Timing of amino acid-carbohydrate ingestion alters anabolic response of muscle to resistance exercise. Am. J. Physiol. Endocrinol. Metab. 2001, 281, E197–E206. [Google Scholar]
  110. Rennie, M.J.; Tipton, K.D. Protein and amino acid metabolism during and after exercise and the effects of nutrition. Annu. Rev. Nutr. 2000, 20, 457–483. [Google Scholar] [CrossRef]
  111. Rennie, M.J.; Edwards, R.H.; Halliday, D.; Matthews, D.E.; Wolman, S.L.; Millward, D.J. Muscle protein synthesis measured by stable isotope techniques in man: The effects of feeding and fasting. Clin. Sci. 1982, 63, 519–523. [Google Scholar]
  112. Hulmi, J.J.; Kovanen, V.; Selanne, H.; Kraemer, W.J.; Hakkinen, K.; Mero, A.A. Acute and long-term effects of resistance exercise with or without protein ingestion on muscle hypertrophy and gene expression. Amino Acids 2009, 37, 297–308. [Google Scholar] [CrossRef]
  113. Zwart, S.R.; Hargens, A.R.; Smith, S.M. The ratio of animal protein intake to potassium intake is a predictor of bone resorption in space flight analogues and in ambulatory subjects. Am. J. Clin. Nutr. 2004, 80, 1058–1065. [Google Scholar]
  114. Zwart, S.R.; Davis-Street, J.E.; Paddon-Jones, D.; Ferrando, A.A.; Wolfe, R.R.; Smith, S.M. Amino acid supplementation alters bone metabolism during simulated weightlessness. J. Appl. Physiol. 2005, 99, 134–140. [Google Scholar] [CrossRef]
  115. Tucker, K.L.; Hannan, M.T.; Kiel, D.P. The acid-base hypothesis: Diet and bone in the framingham osteoporosis study. Eur. J. Nutr. 2001, 40, 231–237. [Google Scholar] [CrossRef]
  116. Barzel, U.S.; Massey, L.K. Excess dietary protein can adversely affect bone. J. Nutr. 1998, 128, 1051–1053. [Google Scholar]
  117. Green, J.; Kleeman, C.R. Role of bone in regulation of systemic acid-base balance. Kidney Int. 1991, 39, 9–26. [Google Scholar] [CrossRef]
  118. Fenton, T.R.; Lyon, A.W.; Eliasziw, M.; Tough, S.C.; Hanley, D.A. Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance. J. Bone Miner. Res. 2009, 24, 1835–1840. [Google Scholar] [CrossRef]
  119. Buclin, T.; Cosma, M.; Appenzeller, M.; Jacquet, A.F.; Decosterd, L.A.; Biollaz, J.; Burckhardt, P. Diet acids and alkalis influence calcium retention in bone. Osteoporos. Int. 2001, 12, 493–499. [Google Scholar] [CrossRef]
  120. Kerstetter, J.E.; Mitnick, M.E.; Gundberg, C.M.; Caseria, D.M.; Ellison, A.F.; Carpenter, T.O.; Insogna, K.L. Changes in bone turnover in young women consuming different levels of dietary protein. J. Clin. Endocrinol. Metab. 1999, 84, 1052–1055. [Google Scholar]
  121. Dargent-Molina, P.; Sabia, S.; Touvier, M.; Kesse, E.; Breart, G.; Clavel-Chapelon, F.; Boutron-Ruault, M.C. Proteins, dietary acid load, and calcium and risk of postmenopausal fractures in the e3n french women prospective study. J. Bone Miner. Res. 2008, 23, 1915–1922. [Google Scholar]
  122. Meyer, H.E.; Pedersen, J.I.; Loken, E.B.; Tverdal, A. Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Am. J. Epidemiol. 1997, 145, 117–123. [Google Scholar] [CrossRef]
  123. Fenton, T.R.; Lyon, A.W.; Eliasziw, M.; Tough, S.C.; Hanley, D.A. Phosphate decreases urine calcium and increases calcium balance: A meta-analysis of the osteoporosis acid-ash diet hypothesis. Nutr. J. 2009, 8, 41. [Google Scholar] [CrossRef]
  124. Fenton, T.R.; Eliasziw, M.; Lyon, A.W.; Tough, S.C.; Hanley, D.A. Meta-analysis of the quantity of calcium excretion associated with the net acid excretion of the modern diet under the acid-ash diet hypothesis. Am. J. Clin. Nutr. 2008, 88, 1159–1166. [Google Scholar]
  125. Lindinger, M.I.; Kowalchuk, J.M.; Heigenhauser, G.J. Applying physicochemical principles to skeletal muscle acid-base status. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2005, 289, R891–R894, Authors’s reply please refer to R904–R910. [Google Scholar] [CrossRef]
  126. Colletti, L.A.; Edwards, J.; Gordon, L.; Shary, J.; Bell, N.H. The effects of muscle-building exercise on bone mineral density of the radius, spine, and hip in young men. Calcif. Tissue Int. 1989, 45, 12–14. [Google Scholar] [CrossRef]
  127. Morel, J.; Combe, B.; Francisco, J.; Bernard, J. Bone mineral density of 704 amateur sportsmen involved in different physical activities. Osteoporos. Int. 2001, 12, 152–157. [Google Scholar] [CrossRef]
  128. Paddon-Jones, D.; Sheffield-Moore, M.; Urban, R.J.; Sanford, A.P.; Aarsland, A.; Wolfe, R.R.; Ferrando, A.A. Essential amino acid and carbohydrate supplementation ameliorates muscle protein loss in humans during 28 days bedrest. J. Clin. Endocrinol. Metab. 2004, 89, 4351–4358. [Google Scholar] [CrossRef]
  129. Ferrando, A.A.; Paddon-Jones, D.; Hays, N.P.; Kortebein, P.; Ronsen, O.; Williams, R.H.; McComb, A.; Symons, T.B.; Wolfe, R.R.; Evans, W. Eaa supplementation to increase nitrogen intake improves muscle function during bed rest in the elderly. Clin. Nutr. 2010, 29, 18–23. [Google Scholar] [CrossRef]
  130. Brosnan, J.T.; Brosnan, M.E. The sulfur-containing amino acids: An overview. J. Nutr. 2006, 136, 1636S–1640S. [Google Scholar]
  131. Buse, M.G.; Reid, S.S. Leucine. A possible regulator of protein turnover in muscle. J. Clin. Investig. 1975, 56, 1250–1261. [Google Scholar] [CrossRef]
  132. Hong, S.O.; Layman, D.K. Effects of leucine on in vitro protein synthesis and degradation in rat skeletal muscles. J. Nutr. 1984, 114, 1204–1212. [Google Scholar]
  133. Crozier, S.J.; Kimball, S.R.; Emmert, S.W.; Anthony, J.C.; Jefferson, L.S. Oral leucine administration stimulates protein synthesis in rat skeletal muscle. J. Nutr. 2005, 135, 376–382. [Google Scholar]
  134. McNurlan, M.A.; Essen, P.; Milne, E.; Vinnars, E.; Garlick, P.J.; Wernerman, J. Temporal responses of protein synthesis in human skeletal muscle to feeding. Br. J. Nutr. 1993, 69, 117–126. [Google Scholar] [CrossRef]
  135. Vary, T.C.; Jefferson, L.S.; Kimball, S.R. Amino acid-induced stimulation of translation initiation in rat skeletal muscle. Am. J. Physiol. 1999, 277, E1077–E1086. [Google Scholar]
  136. Anthony, J.C.; Anthony, T.G.; Kimball, S.R.; Vary, T.C.; Jefferson, L.S. Orally administered leucine stimulates protein synthesis in skeletal muscle of postabsorptive rats in association with increased eif4f formation. J. Nutr. 2000, 130, 139–145. [Google Scholar]
  137. Bolster, D.R.; Vary, T.C.; Kimball, S.R.; Jefferson, L.S. Leucine regulates translation initiation in rat skeletal muscle via enhanced eif4g phosphorylation. J. Nutr. 2004, 134, 1704–1710. [Google Scholar]
  138. Svanberg, E.; Moller-Loswick, A.C.; Matthews, D.E.; Korner, U.; Andersson, M.; Lundholm, K. Effects of amino acids on synthesis and degradation of skeletal muscle proteins in humans. Am. J. Physiol. 1996, 271, E718–E724. [Google Scholar]
  139. Preedy, V.R.; Garlick, P.J. The response of muscle protein synthesis to nutrient intake in postabsorptive rats: The role of insulin and amino acids. Biosci. Rep. 1986, 6, 177–183. [Google Scholar] [CrossRef]
  140. Glynn, E.L.; Fry, C.S.; Drummond, M.J.; Timmerman, K.L.; Dhanani, S.; Volpi, E.; Rasmussen, B.B. Excess leucine intake enhances muscle anabolic signaling but not net protein anabolism in young men and women. J. Nutr. 2010, 140, 1970–1976. [Google Scholar] [CrossRef]
  141. Verhoeven, S.; Vanschoonbeek, K.; Verdijk, L.B.; Koopman, R.; Wodzig, W.K.; Dendale, P.; van Loon, L.J. Long-term leucine supplementation does not increase muscle mass or strength in healthy elderly men. Am. J. Clin. Nutr. 2009, 89, 1468–1475. [Google Scholar] [CrossRef]
  142. Leenders, M.; Verdijk, L.B.; van der Hoeven, L.; van Kranenburg, J.; Hartgens, F.; Wodzig, W.K.; Saris, W.H.; van Loon, L.J. Prolonged leucine supplementation does not augment muscle mass or affect glycemic control in elderly type 2 diabetic men. J. Nutr. 2011, 141, 1070–1076. [Google Scholar] [CrossRef]
  143. Casperson, S.L.; Sheffield-Moore, M.; Hewlings, S.J.; Paddon-Jones, D. Leucine supplementation chronically improves muscle protein synthesis in older adults consuming the rda for protein. Clin. Nutr. 2012, 31, 512–519. [Google Scholar] [CrossRef]

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Hackney, K.J.; English, K.L. Protein and Essential Amino Acids to Protect Musculoskeletal Health during Spaceflight: Evidence of a Paradox? Life 2014, 4, 295-317. https://doi.org/10.3390/life4030295

AMA Style

Hackney KJ, English KL. Protein and Essential Amino Acids to Protect Musculoskeletal Health during Spaceflight: Evidence of a Paradox? Life. 2014; 4(3):295-317. https://doi.org/10.3390/life4030295

Chicago/Turabian Style

Hackney, Kyle J., and Kirk L. English. 2014. "Protein and Essential Amino Acids to Protect Musculoskeletal Health during Spaceflight: Evidence of a Paradox?" Life 4, no. 3: 295-317. https://doi.org/10.3390/life4030295

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