Here’s what Tom Brady eats on an ‘average day’
Boston Globe

A lot of New England Patriots fans may say they’d like to be Tom Brady. But it’s a good bet that hardly as many aspire to eat like him.

Over the course of his NFL career, the 40-year-old quarterback has adopted a notoriously restricted and regimented diet, as part of his overall philosophy toward health and fitness.

In Brady’s new book, The TB 12 Method, which goes on sale Tuesday, the Patriots quarterback outlines what an average day of eating and working out is like in his shoes, or cleats. Or Uggs.

A lot of New England Patriots fans may say they’d like to be Tom Brady. But it’s a good bet that hardly as many aspire to eat like him.

Over the course of his NFL career, the 40-year-old quarterback has adopted a notoriously restricted and regimented diet, as part of his overall philosophy toward health and fitness.

In Brady’s new book, The TB 12 Method, which goes on sale Tuesday, the Patriots quarterback outlines what an average day of eating and working out is like in his shoes, or cleats. Or Uggs.

As he has done in the past, Brady advocates eating “real foods” and achieving balance — almost to an extreme. And while the outline indeed hawks a number of Brady’s pricey self-branded nutrition products, it also provides a first-person account of the eating habits that have fascinated and flummoxed his fans.

Morning
On an average day, Brady says he wakes up around 6 a.m. and “immediately” drinks 20 ounces of water with electrolytes. As he discusses at-length in the book, Brady stresses the importance of staying hydrated and says he drinks 12 to 25 glasses of water a day, always with his TB12 electrolyte concentrate added.

“I add electrolytes to virtually everything I drink,” Brady writes, including lemonade.

After his obligatory 20-ounce glass of water, Brady showers and goes downstairs to make some sort of smoothie.

“Typically, it contains blueberries, bananas, seeds, and nuts,” he says. “It’s nutrient dense, high in fat, high in protein, and high in calories.”

Once full of fruit and seeds, Brady says he works out roughly around 8 a.m., which is another thing about which he speaks at length — both in the book, as well as with any reporter who will listen (the key term to know is pliability; just ask Jon Gruden).

During his workout, Brady says he makes sure to drink more water, along with more electrolytes. Once finished, Brady says he has a protein shake made of one scoop of his self-branded protein powder, almond milk, and — of course — more electrolytes. And always within 20 minutes.

“Wait any longer and your body will begin seeking its own protein sources and start tearing down muscle you’ve just been building up,” he writes. Brady says he is committed to the “20-minute rule” and “rarely” does any intense workouts without a protein shake immediately after.

Also, it’s only 10 a.m. at this point. The days must feel long when you’re Tom Brady.

Around 11 a.m., Brady says he may have some snacks before lunch if he feels the urge. In fact, Brady encourages snacks.

A lot of New England Patriots fans may say they’d like to be Tom Brady. But it’s a good bet that hardly as many aspire to eat like him.

Over the course of his NFL career, the 40-year-old quarterback has adopted a notoriously restricted and regimented diet, as part of his overall philosophy toward health and fitness.

In Brady’s new book, The TB 12 Method, which goes on sale Tuesday, the Patriots quarterback outlines what an average day of eating and working out is like in his shoes, or cleats. Or Uggs.

As he has done in the past, Brady advocates eating “real foods” and achieving balance — almost to an extreme. And while the outline indeed hawks a number of Brady’s pricey self-branded nutrition products, it also provides a first-person account of the eating habits that have fascinated and flummoxed his fans.

“I never go long without snacking,” he writes.

It’s no coincidence then that he also sells $50 packs of his own TB12 snacks — which contain a lot of the same sort of foods that he puts in his aforementioned smoothies.

Afternoon
Finally, around noon, Brady has lunch, which he says is “often a piece of fish, but always with lots of vegetables.”

As he outlines in the book, Brady follows four general principles about combining food. The first is not to eat proteins with carbohydrates like potatoes or bread. The second is that mixing proteins or carbs with vegetables is “ideal” for digestion. Except for nightshades, of course.

“I make sure most of what I eat is alkalizing,” Brady writes.

In addition to his strict regime of mostly plant-based foods, Brady follows a so-called alkaline diet, which purports to minimize muscle inflammation. Long story short, he generally tries to limit “acidifying” foods — such as white rice and bread, but also cold cuts, pineapples, and yogurt, to name a few — to 20 percent of his diet. The other 80 percent he says should be made up of alkalizing foods, like Brussels sprouts, sweet potatoes, and dandelion greens.

From 2 to 5 p.m., if he’s feeling snacky again, Brady says he might have another protein shake, protein bar, or fruit, such as grapes, a banana, or an apple. Brady’s third principle of combining food is not to eat fruit with other food, which he says is bad for digestion.

“Eat fruits alone,” he writes. “They digest quickly. Other foods don’t.”

His fourth principle is not to drink much water with meals, for similar reasons.

“Drinking water with your meals can interfere with good digestion,” Brady writes. “Drink water half an hour before a meal, and then wait an hour before you have your next glass.”

Otherwise, Brady says he drinks his electrolyte-infused water as much as he can throughout the day.

Other snack candidates include chips and guacamole, hummus, raw vegetables, or yet another protein shake.

“I’m never lacking for protein, and some days I’ll have up to three or four scoops of protein powder,” he writes.

Evening
Dinner comes around 6 p.m. in the Brady household.

“Dinner is another nutrient-dense meal that includes a lot of vegetables,” he writes, without getting into specifics.

“I don’t really drink tea, but I might drink a cup of bone broth,” Brady says. He “rarely” drinks alcohol.

Elsewhere in the book, Brady includes meal recipes for burgers made out of chicken or salmon, accompanied by various salads of avocados and greens. There’s even a recipe for — gasp — pasta with creamy sauce.

“Personally, I don’t eat this often, for reasons I described earlier,” Brady says of the pasta, made of brown rice flour.

“But again, it’s always about balance,” he adds.

And for dessert? Nothing. At least not on “an average day.”

However, the book does include a recipe for Brady’s now-infamous avocado ice cream. Sometimes, he says, he’ll have another protein shake, if he’s working out hard the next morning, which on an average day, he probably is.

Brady writes that perhaps after his NFL career is over, he’ll loosen up his routine. But for now he’s happy with it:

“I enjoy how I eat, and what I eat, and never feel like I’m missing out.”

(CNN)The Food and Drug Administration has issued a final rule that throws water on claims that antibacterial soaps and washes are more effective than regular soap.

The new rule bans antibacterial soaps and body washes containing certain ingredients from being marketed, because the ingredients were not proved to be safe and effective for long-term daily use, the FDA said Friday.

The rule applies to antibacterial soaps and washes that contain one or more of 19 active ingredients, including the most commonly used chemicals triclosan and triclocarban, but it does not affect consumer hand sanitizers or antibacterial wipes.

“Consumers may think antibacterial washes are more effective at preventing the spread of germs, but we have no scientific evidence that they are any better than plain soap and water,” said Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, in a written announcement.

“In fact, some data suggests that antibacterial ingredients may do more harm than good over the long-term,” she added.

Companies will have one year to either remove the ingredients or no longer market their products before the final rule is effective.

The American Cleaning Institute released a statement in response in which it indicated that the FDA had data showing the safety and effectiveness of antibacterial soaps. Manufacturers plan to provide additional science and research to fill any data gaps, according to the statement.

“In the coming year, ACI and its member companies will submit additional safety and effectiveness data on the key ingredients in use in consumer antibacterial soaps today: benzalkonium chloride, benzethonium chloride and chloroxylenol.

Consumers can continue to use antibacterial soaps with confidence as they have for decades in millions of homes, offices, schools, daycare centers and other commercial settings,” said the statement by the American Cleaning Institute, a trade organization that represents the producers of cleaning products.

The FDA issued a proposed rule in 2013 that required the manufacturers of antibacterial hand soaps and body washes to prove that their products were more effective than plain soap and were safe for long-term use.

However, “antibacterial hand and body wash manufacturers did not provide the necessary data to establish safety and effectiveness,” according to the FDA’s new final rule. The FDA even noted that some manufacturers have started to remove certain active ingredients from their products.

What does the science say about antibacterial soaps? A 2007 paper published in the journal Clinical Infectious Diseases found that using triclosan-containing consumer soaps seemed to not offer an additional health benefit over using regular soap and water.

Rather, regularly using such antibacterial consumer soaps may be linked to the growth of dangerous drug-resistant bacteria, according to the paper.

“Those who are out washing with it in the community think they’re doing a good health measure when, in fact, they aren’t,” said Dr. Stuart Levy, professor of molecular biology and microbiology at Tufts University School of Medicine and a co-author of the paper.
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So, the new FDA rule “seems like a prudent step to prevent a possible, albeit theoretical, future adverse impact, and since the public still has the option of using hand sanitizers, which work faster and better than the current consumer ‘antibacterial’ soaps, I can be supportive of the ruling,” said Elaine Larson, associate dean for research at Columbia University School of Nursing and a co-author of the paper.

For the paper, researchers reviewed 27 studies on the potential hazards versus benefits of antibacterial soaps. The researchers concluded, “Further studies of this issue are encouraged.”

“This whole issue of antibiotics, where they do good and they don’t do good, has not been explained well enough to the public, but I think it can be now,” said Levy, who conducted some of the earliest studies on antibiotic resistance. “We sort of led the cause to eliminate the use of triclosan in washes, because quite honestly, it didn’t show any improvement.”

From CNN article dated Friday, September 2, 2016

Findings could have implications for children’s health, well-being

Boston, MA – More than half of all children and adolescents in the U.S. are not getting enough hydration—probably because they’re not drinking enough water—a situation that could have significant repercussions for their physical health and their cognitive and emotional functioning, according to the first national study of its kind from Harvard T.H. Chan School of Public Health.

The study also found racial/ethnic and gender gaps in hydration status. Black children and adolescents were at higher risk of inadequate hydration than whites; boys were at higher risk than girls.

The study appears online June 11, 2015 in the American Journal of Public Health.

“These findings are significant because they highlight a potential health issue that has not been given a whole lot of attention in the past,” said lead author Erica Kenney, a postdoctoral research fellow in the Department of Social and Behavioral Sciences at Harvard Chan School. “Even though for most of these kids this is not an immediate, dramatic health threat, this is an issue that could really be reducing quality of life and well-being for many, many children and youth.”

Drinking enough water is essential for physiological processes such as circulation, metabolism, temperature regulation, and waste removal. Although excessive dehydration is associated with serious health problems, even mild dehydration can cause issues, including headaches, irritability, poorer physical performance, and reduced cognitive functioning.

The researchers looked at data from 2009-2012 on more than 4,000 children and adolescents aged 6 to 19 years who participated in the National Health and Nutrition Examination Survey, a study of the health of U.S. children and adults conducted each year by the Centers for Disease Control and Prevention. They used urine osmolality—a measure of how concentrated a person’s urine is—to determine whether or not participants were adequately hydrated.

They found that a little more than half of all children and adolescents weren’t getting enough hydration. Boys were 76% more likely than girls, and non-Hispanic blacks were 34% more likely than non-Hispanic whites, to be inadequately hydrated.

Notably, nearly a quarter of the children and adolescents in the study reported drinking no plain water at all.

“The good news is that this is a public health problem with a simple solution,” said senior author Steven Gortmaker, professor of the practice of health sociology. “If we can focus on helping children drink more water—a low-cost, no-calorie beverage—we can improve their hydration status, which may allow many children to feel better throughout the day and do better in school.”

Other Harvard Chan School authors of the study included Angie Cradock, senior research scientist and deputy director of the Harvard Prevention Research Center, and research fellow Michael Long.

This study was supported by Cooperative Agreement No. 1U48DP001946 (including the Nutrition and Obesity Policy Research and Evaluation Network) from the Centers for Disease Control and Prevention’s Prevention Research Centers Program and a grant in memory of Melvin R. Seiden.

“Prevalence of Inadequate Hydration among US Children and Disparities by Gender and Race/Ethnicity: National Health and Nutrition Examination Survey, 2009-2012,” Erica L. Kenney, Michael W. Long, Angie L. Cradock, Steven L. Gortmaker, American Journal of Public Health, online June 11, 2015, doi:10.2105/AJPH.2015.302572.

Posted on: Harvard.edu

Heart Attacks and Water
How many folks do you know who say they don’t want to drink anything before going to bed because they’ll have to get up during the night?

The journey to a healthy body starts upon your healing regimen of following this water regimen by including hydrogen rich Travel Water in every glass of water you drink.

Tips from a Cardiac Specialist:

  • Drinking water at a certain time maximizes its effectiveness on the body
  • 2 glasses of water after waking up – helps activate internal organs
  • 1 glass of water 30 minutes before a meal – helps digestion
  • 1 glass of water before taking a bath – helps lower blood pressure
  • 1 glass of water before going to bed – avoids stroke or heart attack

Dr. Virend Somers is a cardiologist from the Mayo Clinic, who is lead author of the report in the July 29, 2008 issue of the Journal of the American College of Cardiology.

Add one(1) full squeeze of Travel Water every time you drink water. One full bottle will last you a week.

If you experience detox, don’t take any medication for restoring usual discharge. Your urine discharge will change in color from bright yellow to almost clear when you finish the entire first bottle.

You will experience deep sleep and achieve REM. You will regain your lost energy because you will regain your lost cellular hydration.

Be sure to use filtered tap water or any bottled spring water as it contains the minerals that Travel Water requires to conduct electricity to create the antioxidant negative ion. RO water and distilled water will reduce the efficiency of Travel Water.

Enjoy your new energetic, happy, and pleasurable days to come.

Hydrogen-Rich-Water-Plants

Watered with Travel Water (Left)

We performed a little experiment with our household plants. The plants had identical:
age, soil, container, organic fertilizer, exposure to light. The only difference is that we watered one with tap water, and the other with tap water mixed with hydrogen rich Travel Water drops.

The difference in healthy between the two plants is significant as seen in the photo. This is because Travel Water when mixed with tap water breaks down water molecules into smaller clusters which allow for better hydration. In addition, the hydrogen rich water delivers anti-oxidants that help reduce oxidation.

BOTTLED WATER IS BETTER THAN TAP.

Not necessarily. While labels gush about bottled water that “begins as snowflakes” or flows from “deep inside lush green volcanoes,” between 25 and 40 percent of bottled water comes from a less exotic source: U.S. municipal water supplies. (Bottling companies buy the water and filter it, and some add minerals.) That’s not really a bad thing: The Environmental Protection Agency oversees municipal water quality, while the Food and Drug Administration monitors bottled water; in some cases, EPA codes are more stringent. (source: WebMD)

PURIFIED WATER TASTES BETTER.

The “purest” water — distilled water with all minerals and salts removed — tastes flat; it’s the sodium, calcium, magnesium, and chlorides that give water its flavor. The “off” taste of tap water is the chlorine; if you refrigerate it in a container with a loose-fitting lid, the chlorine taste will be gone overnight. (source: WebMD)

BOTTLED WATER WITH VITAMINS, MINERALS, OR PROTEIN IS MORE HEALTHY THAN REGULAR WATER.

“Vitamins, color, herbs, protein, and all the other additions to water — those are a marketing ploy,” says Marion Nestle, Ph.D., professor of nutrition studies at New York University. Plus, the additives are usually a scant serving of the vitamins you really need in a day, adds Amy Subar, Ph.D., a nutritionist with the National Cancer Institute. Enhanced waters usually contain sugars and artificial flavorings to sweeten the deal and can pack more calories than diet soda. When it comes to providing fluoride, tap water usually wins, though that element is increasingly being added to bottled waters. (source: WebMD)

YOU NEED EIGHT 8-OUNCE GLASSES OF WATER EACH DAY.

The Institute of Medicine recommends about 91 ounces (a little more than 11 8-ounce glasses) of fluid daily for women. But here’s the thing: It expects 80 percent of that to come from water, juice, coffee, tea, or other beverages and the remaining 20 percent from food. That means if you drink a 12-ounce cup of coffee and a 12-ounce can of diet soda, you only need 48 more ounces (three 16-ounce glasses, or four soda cans’ worth) for the day. (source: WebMD)

AFTER AN INTENSE WORKOUT, BOTTLED WATER IS BEST.

There’s a reason volunteers hand out electrolyte water during marathons. If your workout lasts longer than an hour, you need to replace the water and electrolytes, such as sodium and potassium, that you’ve lost (that’s what sports drinks generally do). (source: WebMD)

Athletes add Travel Water Extreme Hydration drops to boost hydration by more than four times regular water and to get an added dose of anti-oxidants.

WATER BOTTLES ARE EASY ON THE ENVIRONMENT BECAUSE THEY CAN BE RECYCLED.

Wouldn’t it be nice? And it’s not just the bottles. Eco-costs include manufacturing, trucking, shelving, and marketing. And meeting the annual U.S. demand for plastic bottles requires enough oil to keep 100,000 cars on the road for a year, says Janet Larsen of the Earth Policy Institute. Sure, the 70 million empty water bottles the U.S. produces per day can be recycled, but the sad truth is, about 86 percent of them end up in the trash. Hardly worth it, for what flows out of the tap and into a reusable glass for free. (source: WebMD)

We tested Zico Coconut Water and Trade Joes Coconut water to see if these super drinks have anti-oxidant properties. What we found is surprising.

We used two ORP meters to measure each coconut water.

In the world that surrounds us, we do not see it, but there is a continuous exchange of electrons that takes place between substances in the air, in the earth, in water, and in our bodies. This phenomenon is known as ion exchange.

In an effort to reach a state of stability, substances that are lacking electrons are desperately seeking out electrons wherever they can: these substances are referred to as oxidizing agents. On the contrary, substances which have a surplus of electrons are capable of donating their extra electrons: these substances are referred to as reducing agents, or anti-oxidizing agents.

Oxidation-reduction potential, or ORP, is a measurement that indicates the degree to which a substance is capable of oxidizing or reducing another substance. ORP is measured in millivolts (mv) using an ORP meter.

A positive ORP reading indicates that a substance is an oxidizing agent. The higher the reading, the more oxidizing it is. As such, a substance with an ORP reading of +400 mv is 4 times more oxidizing than a substance with an ORP reading of +100 mv.

A negative ORP reading indicates that a substance is a reducing agent. The lower the reading, the more anti-oxidizing it is. As such, a substance with an ORP reading of -400 mv is 4 times more anti-oxidizing than a substance with an ORP reading of -100 mv.

Zico Coconut Water Antioxidant

We found these readings:
Zico Coconut Water is a free radical at +194 and Trader Joes is a free radical at +108. It’s also important to note that Trader Joes Coconut Water is acidic at 6.59 pH.

We added Travel Water drops to each of the coconut waters and we noted the following readings:
Zico Coconut Water at -084 ORP and Trader Joes Coconut Water at 39+ ORP a significant reduction in free radicals.

Zico_Coconut_Water

Prevent hangovers and give your body prime hydration. All with Travel Water.

Travel Water is the anti-oxidant liquid drops that you can add to every drink or dish to prevent a hangover and help your overall health. Sound like a miracle? That’s because it is.

How does it work exactly? Science. Like we all learned in biology, oxidation is bad. Especially for our cells. Travel Water drops contain electrically charged water that binds to oxidants. And lower cell oxidation means healthier cells.

But wait—why does healthier cells mean no hangovers? Simple. Hydration. Travel Water drops break down water molecules into smaller clusters, allowing for water to pass through cell walls easily.

Whether you’re out to a bar on a Friday night or having a few drinks at home, Travel Water eases the effects of a hangover, giving you a better (and more bearable) tomorrow.

Preventing hangovers isn’t Travel Water’s only benefit. In fact, it also promotes weight loss and overall health. Coupled with a healthy balance of foods in your diet, you’re on your way to your best and healthiest you. Strong is beautiful.

Consuming foods that are rich in antioxidants—like fruits, vegetables, nuts, and seeds—will help aid long-term results for weight loss. But what if instead of jam packing your diet with an overload of fruits and vegetables, you could use a simple additive like Travel Water?

Let’s be clear—we are not encouraging the elimination of fruits and vegetables, but rather, adding a supplement that will only help your journey to a healthier you. The food with the most antioxidants are also those that have qualities that help weight loss.

And, as always, physical exercise is important to building a stronger and healthier body.

Written by: Eliza

It is time we recognize that when it comes to sanitation and safety, what really matters most is what we put inside our bodies. Sometimes we get distracted on keeping the external part of ourselves clean that we neglect the importance of internal contamination which has more detrimental consequences to our health. We need to be more aware of the importance of what we choose to eat and drink which can nourish or damage our body
and well being.

The fruits and vegetables we eat usually contains sanitizing solutions such as chlorinated compounds and organic acids. Studies have proven that washing them with tap water is not enough to completely wash the pesticide residues away. These disinfectants have negative environmental effect and produce long term harmful health effects. Studies have shown that chlorine-based sanitizers can form potentially harmful disinfection by-products (DBPs) such as trihalomethanes, which could also be carcinogens. Animal laboratory experiments has shown these DBPs can cause cancer, reproductive and developmental problems. This is an alarming concern that lead researchers to consider electrolyzed water as a more safe, relatively less expensive and environmentally friendly alternative to traditional disinfectants used in the food industry.

Here are some great examples to show how effective electrolyzed water can be in the food industry. One study showed that electrolyzed water could eliminate the most commonly used pesticides which includes – Acephate, Omethoate and Dimethyl Dichloroviny Phosphate (DDVP). This study was done using spinach, cabbage and leeks which all showed that the level of pesticide residue decreased with prolonged immersion in electrolyzed water. After 30 minutes of immersing the vegetables in electrolyzed water, the acephate residues decreased to 74-86%, the omethoate residues was minimized to 62-75% and the DDVP residues was eliminated by 60%. Numerous similar studies have concluded that electrolyte water is efficacious in eliminating the residues of pesticides.

Even better is that studies demonstrated that adding electrolyzed water did not alter the Vitamin C and nutrient content of the vegetables and fruits in the process. Other similar researches was done using tomatoes, alfalfa seeds, sprout, cucumber and strawberry which consistently showed the same positive results.

The electrolyzed water works by combining a high available chlorine concentration and a high positive oxidation-reduction potential (ORP). The effect of electrolyzed water on pathogens was documented using a transmission electron microscopy (TEM) that allows us to get a high resolution image of the molecular structures. It showed that when the pathogens were exposed to electrolyzed water their outer walls become wrinkled and their
internal components change thus making the pathogens easier to penetrate and kill.

Many studies have been done showing time and again the effectiveness of electrolyzed water against numerous food-borne pathogens. The use of electrolyzed water to wash the fruits and vegetables is a proven and powerful way of getting rid of the pesticide residues in your food and ensuring it is safe to consume.

Now it is up to us to care and do something about about what we put inside our body. One way is by simply washing our food with electrolyzed water we could be rest assured that there wont be any significant pesticide residues and bacterial pathogens in them.

Written by: Karina Del Mundo

Cochrane Database Syst Rev. 2014;12:CD007411. doi: 10.1002/14651858.CD007411.pub3. Epub 2014 Dec 15.
Antioxidants for male subfertility.
Showell MG1, Mackenzie-Proctor R, Brown J, Yazdani A, Stankiewicz MT, Hart RJ.

BACKGROUND:
Between 30% to 80% of male subfertility cases are considered to be due to the damaging effects of oxidative stress on sperm and 1 man in 20 will be affected by subfertility. Antioxidants are widely available and inexpensive when compared to other fertility treatments and many men are already using these to improve their fertility. It is thought that oral supplementation with antioxidants may improve sperm quality by reducing oxidative stress. Pentoxifylline, a drug that acts like an antioxidant, was also included in this review.

OBJECTIVES:
This Cochrane review aimed to evaluate the effectiveness and safety of oral supplementation with antioxidants for subfertile male partners in couples seeking fertility assistance.

SEARCH METHODS:
We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO and AMED databases (from inception until January 2014); trial registers; sources of unpublished literature and reference lists. An updated search was run in August 2014 when potentially eligible studies were placed in ‘Studies awaiting assessment’.

SELECTION CRITERIA:
We included randomised controlled trials (RCTs) comparing any type or dose of antioxidant supplement (single or combined) taken by the subfertile male partner of a couple seeking fertility assistance with a placebo, no treatment or another antioxidant.

DATA COLLECTION AND ANALYSIS:
Two review authors independently selected eligible studies, extracted the data and assessed the risk of bias of the included studies. The primary review outcome was live birth; secondary outcomes included clinical pregnancy rates, adverse events, sperm DNA fragmentation, sperm motility and concentration. Data were combined, where appropriate, to calculate pooled odds ratios (ORs) or mean differences (MD) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I(2) statistic. We assessed the overall quality of the evidence for the main outcomes using GRADE methods.

MAIN RESULTS:
This updated review included 48 RCTs that compared single and combined antioxidants with placebo, no treatment or another antioxidant in a population of 4179 subfertile men. The duration of the trials ranged from 3 to 26 weeks with follow up ranging from 3 weeks to 2 years. The men were aged from 20 to 52 years. Most of the men enrolled in these trials had low total sperm motility and sperm concentration. One study enrolled men after varicocelectomy, one enrolled men with a varicocoele, and one recruited men with chronic prostatitis. Three trials enrolled men who, as a couple, were undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) and one trial enrolled men who were part of a couple undergoing intrauterine insemination (IUI). Funding sources were stated by 15 trials. Four of these trials stated that funding was from a commercial source and the remaining 11 obtained funding through non-commercial avenues or university grants. Thirty-three trials did not report any funding sources.A limitation of this review was that in a sense we had included two different groups of trials, those that reported on the use of antioxidants and the effect on live birth and clinical pregnancy, and a second group that reported on sperm parameters as their primary outcome and had no intention of reporting the primary outcomes of this review. We included 25 trials reporting on sperm parameters and only three of these reported on live birth or clinical pregnancy. Other limitations included poor reporting of study methods, imprecision, the small number of trials providing usable data, the small sample size of many of the included studies and the lack of adverse events reporting. The evidence was graded as ‘very low’ to ‘low’. The data were current to 31 January 2014.Live birth: antioxidants may have increased live birth rates (OR 4.21, 95% CI 2.08 to 8.51, P< 0.0001, 4 RCTs, 277 men, I(2) = 0%, low quality evidence). This suggests that if the chance of a live birth following placebo or no treatment is assumed to be 5%, the chance following the use of antioxidants is estimated to be between 10% and 31%. However, this result was based on only 44 live births from a total of 277 couples in four small studies.Clinical pregnancy rate: antioxidants may have increased clinical pregnancy rates (OR 3.43, 95% CI 1.92 to 6.11, P < 0.0001, 7 RCTs, 522 men, I(2) = 0%, low quality evidence). This suggests that if the chance of clinical pregnancy following placebo or no treatment is assumed to be 6%, the chance following the use of antioxidants is estimated at between 11% and 28%. However, there were only seven small studies in this analysis and the quality of the evidence was rated as low.Miscarriage: only three trials reported on this outcome and the event rate was very low. There was insufficient evidence to show whether there was a difference in miscarriage rates between the antioxidant and placebo or no treatment groups (OR 1.74, 95% CI 0.40 to 7.60, P = 0.46, 3 RCTs, 247 men, I(2) = 0%, very low quality evidence). The findings suggest that in a population of subfertile men with an expected miscarriage rate of 2%, use of an antioxidant would result in the risk of a miscarriage lying between 1% and 13%.Gastrointestinal upsets: there was insufficient evidence to show whether there was a difference in gastrointestinal upsets when antioxidants were compared to placebo or no treatment as the event rate was very low (OR 1.60, 95% CI 0.47 to 5.50, P = 0.46, 6 RCTs, 429 men, I(2) = 0%).We were unable to draw any conclusions from the antioxidant versus antioxidant comparison as not enough trials compared the same interventions. AUTHORS' CONCLUSIONS: There is low quality evidence from only four small randomised controlled trials suggesting that antioxidant supplementation in subfertile males may improve live birth rates for couples attending fertility clinics. Low quality evidence suggests that clinical pregnancy rates may increase. There is no evidence of increased risk of miscarriage but this is uncertain as the evidence is of very low quality. Data were lacking on other adverse effects. Further large well-designed randomised placebo-controlled trials are needed to clarify these results. Update of Antioxidants for male subfertility. [Cochrane Database Syst Rev. 2011] PMID: 25504418 [PubMed - indexed for MEDLINE]