Beta-hydroxy-beta-methylbutyrate (or HMB) is often used to support muscle development in athletes⁸, but there is increasing evidence for its use in a clinical setting. So, how can it be used to support your patients?

Let’s start with the basics. Muscle is a dynamic tissue. It is continually in a cycle of synthesis and breakdown (or degradation). Building new tissue and breaking down old.^1-2 To maintain muscle mass, the goal is to ensure that muscle breakdown is not happening faster than muscle synthesis.²

But as we age, this can become more difficult, as muscle loss naturally accelerates due to muscle breakdown increasing and muscle synthesis reducing.³ This problem is compounded by hospitalisation, mobility limitations or catabolic illness. For example, in patients who are frail, have cancer or COPD.³

We know that protein plays a significant role in muscle health. But where breakdown is happening faster than synthesis, consuming dietary protein may not be enough to restore the balance³.

This is where HMB comes in. It has three mechanisms of action^{♱ * 4-5,29}. It supports muscle synthesis^°*4, whilst uniquely protecting muscle from breakdown. It helps to stabilise muscle cell membranes, thereby improving the repair of damaged muscle cells.^{°, * , **4,29,31}

HMB has been shown to double muscle protein synthesis.^°*4,30 and reduce muscle protein breakdown by half.^°*4,30

HMB also results in 10 times more muscle maintenance with the same protein intake.^**31

So, how do we get it? HMB can be found in very small amounts in some foods, such as avocados and asparagus.²⁸ But to get just 3g of HMB from diet alone, you would need to eat huge amounts of HMB-containing foods.²⁸

Prescribing and recommending nutritional support with HMB is clinically proven to improve your patient’s muscle mass, strength, physical performance, and quality of life.^{8-9,15-16,†,#,‡}

The benefits of oral nutritional supplements containing HMB are supported by evidence from over 18 clinical studies,^9-27 demonstrating the capability of oral nutritional supplements containing HMB in supporting muscle health, strength, physical performance, and quality of life.^{8-9,15-16,†,#,‡}

Prescribe or recommend nutritional support containing HMB for your patients today.

References:

1. Carbone JW & Pasiakos SM. Nutrients 2019;11(5):1136. 2. Tipton KD et al. Sports Med 2018;48(1):53-64. 3. Argilés JM et al. J Am Med Dir Assoc 2016;17(9):789-96. 4. Wilkinson DJ et al. J Physiol 2013;591:2911-23. 5. Deutz NE et al. Clin Nutr 2014;33(6):929-936. 6. Holeček m et al. J Cachexia Sarcopenia Muscle 2017;8(4):529-541. 7. Arazi H et al. Antioxidants (Basel) 2018;7(10):148. 8. Bear DE et al. Am J Clin Nutr 2019;109:1119-1132. 9. Peng LN et al. J Nutr Health Aging 2021;25(6):767-773. 10. Ashkenazi I et al. Geriatr Orhop Surg Rehabil DOI: 10.1177/21514593221102252 Published online 22nd May 2022. 11. Berton L et al. PLoS one 2015;10(11):e0141757. 12. Chavarro-Carvajal DA et al. Clin Nutr ESPEN 2022;48:291-297. 13. Cornejo-Pareja I et al. Nutrients 2021;13(12):4355. 14. Cramer JT et al. JAMDA; 2016;17(11):1044-1055. 15. De Luis DA et al. Eur Geriatr Med 2018;9(6):809-817. 16. De Luis DA et al. Nutr Hosp 2015;32(1):202-207. 17. Deutz NE et al. Clin Nutr 2016;35(1):18-26. 18. Deutz NE et al. Clin Nutr 2021;40(3):1388-1395. 19. Ekinci O et al. Nutr Clin Pract 2016;31(6):829-835. 20. Espina S et al. Nutrients 2021;13(11):3764. 21. Matheson EM et al. Clin Nutr 2021;40(3):844-849. 22. Malafarina V et al. Maturitas 2017;101:42-50. 23. Olveira G et al. Clin Nutr 2016;35(5):1015-1022. 24. Previtali P et al. Ann Surg Oncol 2020;27(6):2025-2032. 25. Ritch CR et al. J Urol 2019;201(3):470-477. 26. Standley RA et al. J Gerontol A Bio Sci Med Sci 2020;75(9):1744-1753. 27. Zana S et al. J Am Med Dir Assoc 2021;22(7):1358-1360. 28. Zhang Z et al. FASEB J 1994;8(4):A464, Abstr 2685. 29. Nissen SL & Abumrad NN. J Nutr Biochem 1997;8:300-311. 30. Engelen MPKJ & Deutz NEP. Curr Opin Clin Nutr Metab Care 2018;21(3):207-213. 31. Deutz NEP et al. Clin Nutr 2013;32:704-712.

† HMB (Beta-hydroxy-beta-methylbutyrate) is an active metabolite of leucine, among the constituent elements of proteins, naturally found in some foods, but in small quantities.
* Studied in healthy young males, over a period of 2.5 hours after receiving HMB supplementation.
°Compared to baseline at post-absorptive state.
**In a RCT including 19 healthy adults aged ≥60 years confined to bed rest for 10 days. CaHMB (3 g daily) prevented the decline in total LBM over bed rest (-0.17 ± 0.19 kg; p =0.23) in treated group versus control group (-2.05±0.66 kg; p =0.02)
# In a single arm open-label study of 148 patients aged 80±8.3 years with or at risk of malnutrition who consumed experimental product twice daily for 12 weeks as compared to baseline.
† An open label study of elderly (n = 35) patients with recent weight loss (>5% during previous 3 months) showed that 12 weeks supplementation of experimental product twice daily increased dietary intake, biochemical variables, and quality of life compared to baseline
‡In 62 community-dwelling pre-frail older people taking a specialised ONS vs nutritional counselling over 12 weeks.