Article

The effect of phosphatidylserine on golf performance

Increnovo LLC, 2138 E Lafayette Pl, Milwaukee, WI 53202, USA. .
Journal of the International Society of Sports Nutrition (Impact Factor: 1.91). 12/2007; 4(1):23. DOI: 10.1186/1550-2783-4-23
Source: PubMed

ABSTRACT

A randomized, double-blind, placebo-controlled study was performed to evaluate the effect of oral phosphatidylserine (PS) supplementation on golf performance in healthy young golfers with handicaps of 15-40.
Perceived stress, heart rate and the quality of the ball flight was evaluated before (pre-test) and after (post-test) 42 days of 200 mg per day PS (n = 10) or placebo (n = 10) intake in the form of a nutritional bar. Subjects teed-off 20 times aiming at a green 135 meters from the tee area.
PS supplementation significantly increased (p < 0.05) the number of good ball flights (mean: pre-test 8.3 +/- 3.5, post-test 10.1 +/- 3.0), whereas placebo intake (mean: pre-test 7.8 +/- 2.4, post-test 7.9 +/- 3.6) had no effect. PS supplementation showed a trend towards improving perceived stress levels during teeing-off (mean: pre-test 5.8 +/- 2.0, post-test 4.0 +/- 2.0, p = 0.07), whereas stress levels remained unchanged in the placebo group (mean: pre-test: 5.1 +/- 2.0, post-test: 5.1 +/- 3.1). Supplementation did not influence mean heart rate in either group.
It is concluded that six weeks of PS supplementation shows a statistically not significant tendency (p = 0.07) to improve perceived stress levels in golfers and significantly improves (p < 0.05) the number of good ball flights during tee-off which might result in improved golf scores.

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Journal of the International Society
of Sports Nutrition
Open Access
Research article
The effect of phosphatidylserine on golf performance
Ralf Jäger*
1
, Martin Purpura
1
, Kurt-Reiner Geiss
2
, Michael Weiß
3
,
Jochen Baumeister
3
, Francesco Amatulli
4
, Lars Schröder
4
and
Holger Herwegen
4
Address:
1
Increnovo LLC, 2138 E Lafayette Pl, Milwaukee, WI 53202, USA,
2
ISME, Weingartenstrasse 2, D-64546 Mörfelden-Walldorf, Germany,
3
Department of Sport and Health, University of Paderborn, Warburger Str. 100, 33098 Paderborn, Germany and
4
Department of Sport and Health,
Institute of Sports Medicine and Golf Academy, University of Paderborn, Warburger Str. 100, 33098 Paderborn, Germany
Email: Ralf Jäger* - ralf.jaeger@increnovo.com; Martin Purpura - martin.purpura@increnovo.com; Kurt-Reiner Geiss - isme.gmbh@t-online.de;
Michael Weiß - weissm@mail.uni-paderborn.de; Jochen Baumeister - jochen@sportmed.upb.de; Francesco Amatulli - amatulli@zitmail.upb.de;
Lars Schröder - schroeder@sportmed.upb.de; Holger Herwegen - herwegen@sportmed.upb.de
* Corresponding author
Abstract
Background: A randomized, double-blind, placebo-controlled study was performed to evaluate
the effect of oral phosphatidylserine (PS) supplementation on golf performance in healthy young
golfers with handicaps of 15–40.
Methods: Perceived stress, heart rate and the quality of the ball flight was evaluated before (pre-
test) and after (post-test) 42 days of 200 mg per day PS (n = 10) or placebo (n = 10) intake in the
form of a nutritional bar. Subjects teed-off 20 times aiming at a green 135 meters from the tee area.
Results: PS supplementation significantly increased (p < 0.05) the number of good ball flights
(mean: pre-test 8.3 ± 3.5, post-test 10.1 ± 3.0), whereas placebo intake (mean: pre-test 7.8 ± 2.4,
post-test 7.9 ± 3.6) had no effect. PS supplementation showed a trend towards improving perceived
stress levels during teeing-off (mean: pre-test 5.8 ± 2.0, post-test 4.0 ± 2.0, p = 0.07), whereas
stress levels remained unchanged in the placebo group (mean: pre-test: 5.1 ± 2.0, post-test: 5.1 ±
3.1). Supplementation did not influence mean heart rate in either group.
Conclusion: It is concluded that six weeks of PS supplementation shows a statistically not
significant tendency (p = 0.07) to improve perceived stress levels in golfers and significantly
improves (p < 0.05) the number of good ball flights during tee-off which might result in improved
golf scores.
Background
Phosphatidylserine (PS) is an essential component of all
biological membranes and is required for normal cellular
structure and function. The participation in physical activ-
ity often challenges a variety of physiological systems;
consequently, the ability to maintain normal cellular
function during activity can determine sporting perform-
ance. PS has been established as a safe oral supplement [1]
capable of attenuating the serum cortisol [2,3] and creat-
ine kinase [4] responses to acute exercise stress. In addi-
tion, PS has been reported to improve subjective measures
of overtraining such as perceived muscle soreness and
Published: 4 December 2007
Journal of the International Society of Sports Nutrition 2007, 4:23 doi:10.1186/1550-2783-4-
23
Received: 11 July 2007
Accepted: 4 December 2007
This article is available from: http://www.jissn.com/content/4/1/23
© 2007 Jäger et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0
),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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well-being [5]. These finding suggest that PS partly coun-
teracts the stress-induced activation of the hypothalamo-
pituitary-adrenal (HPA) axis [6].
In addition to physical stress, PS supplementation bene-
fits subjects suffering from mental stress. PS supplementa-
tion has been reported to improve mood in a sub-group
of healthy young adults when faced with a stressful men-
tal task [7] and blunted both serum ACTH and cortisol,
and salivary cortisol responses to the Trier Social Stress
Test (TSST) [8].
A recent study by Kingsley et al. showed no effect of oral
PS supplementation on markers of muscle damage or per-
ceived soreness, however, PS tended to improve sprint
and exercise performances when compared to placebo [9].
These findings do suggest that PS might possess ergogenic
properties. The effective daily dosages in sport studies
range from 300 to 800 mg PS for short-term application
(10–15 days) and from 300 to 400 mg PS for 3 to 4 weeks
for mental stress [10]. The lowest effective dose for ath-
letes is yet unknown [10].
These findings suggest that PS supplementation might be
beneficial for sports demanding high levels of concentra-
tion and coordination such as the game of golf. The golf
swing requires the interaction of the central nervous sys-
tem and skeletal muscles as well as the correct combina-
tion of power, velocity and endurance. The golf swing is a
complex motion and especially teeing off and putting cre-
ates high levels of tension. Salivary cortisol levels have
been reported to significantly increase in elite male golfers
[11,12]. Individual and external expectations [13] and the
importance of the first stroke result in mental stress during
tee-off. This might result in negative effects on perform-
ance due to an inaccuracy in striking the ball. The tee-off
from a stationary location such as a driving range is an
ideal study exercise since it allows the easy measure of the
effects of stressors on performance parameters such as ball
flight. Additional stress can be created by a time restriction
between tee offs and by the creation of competitive target
task.
Based on this background, the present study assessed the
effects of PS supplementation on perceived stress and per-
formance in golfers during tee-off from a driving range.
For the first time, a functional food (nutritional bar) was
used as study material in a nutritional intervention study
on golf performance. This study further investigates the
yet lowest daily dose of PS supplementation when faced
with a stressful task.
Methods
Subjects
Twenty healthy volunteers gave their informed written
consent to take part in this study, which was approved by
a university ethics committee. The subjects were recruited
from the university of Paderborn golf course and other
local golf courses. Exclusion criteria on admission were
smoking, the use antihistamine or central nervous system
medication and apparent physical and mental disease at
the time of the study. The subjects were instructed to avoid
changes in their diet and their physical, mental and golf
specific training habits during the study.
Study Protocol
A randomized, double-blind, placebo-controlled study
was performed over a period of six weeks. Subjects were
required to report to the study site on three separate occa-
sions. During pre-screening physical health as well as
inclusion (male, handicap 15–40, age 20–55) and exclu-
sion criteria were measured and recorded. The subjects
were familiarized with the equipment and the test proce-
dure. Subjects were asked to avoid physical and mental
stress, excess food and alcohol intake (limit one beer or
one glass of wine) on the day before the pre-test and were
instructed to get sufficient night sleep (minimum six
hours of sleep). On day one (pre-test) subjects received a
standardized breakfast and were not allowed to train or
consume caffeine or any other stimulants. Health and
overall condition was checked (anamnesis, electrocardio-
gram, and blood works). Blood works was measured prior
to the test to ensure that none of the subjects suffered
from a potentially performance reducing disease. The
parameters included blood cell count, hemoglobin, glu-
cose, lipids, urea, creatinine, gamma-GT and ferritin. One
subject showed hyperferritinemia without signs of a
tumor or hemochromatosis and one subject had hyperli-
pidaemia. No volunteer showed abnormalities that would
exclude him from the study. The health check was fol-
lowed by a standardized warm up which did not include
practice shots. The 10 minute warm up consisted of a golf
specific eight step warm-up program of one minute each:
1. stationary jumping and running with upper body rota-
tion, 2. upper body rotation and arm lift, 3. back and forth
leg weight distribution, 4. upper body rotation simulating
swing movement, 5. golf swing with horizontal club, 6.
left and right arm one arm swing, 7. left and right arm hor-
izontal swing, 8. golf swing without ball contact, followed
by two minutes of golf swings with ball contact. After the
warm up subjects teed-off 20 times in 15-second intervals
and were asked to hit a target at a distance of 135 meters.
The time restriction of 15 seconds was intended to create
stress in the study subjects. The hit-a-target task was
intended to create competition among subjects and hence
to create additional stress. Due to different handicaps sub-
jects were free to choose their individual club (excluding
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a pitching wedge) which had to be identical for the pre-
and post-test. The heart rate was measured using a POLAR
S810
®
heart rate monitor and analyzed with Polar Preci-
sion Performance Software (Polar, Finland). Perceived
stress was measured after the series of tee-offs using a Vis-
ual Analogue Scale (VAS): 1 (low stress) to 10 (maximum
stress) [14,15]. The quality of each ball flight was recorded
by a professional golf trainer immediately after the ball hit
the ground after tee-off. A good ball flight (hit) was
defined as "correct flight", "draw" and "fade", whereas all
other ball flights were recorded as a miss (see figure 1)
[16,17]. The ball flight "draw" starts to the right and ends
on target due to a left spin of the ball whereas the ball
flight "fade" (starts to the left) hits the target due to a right
spin of the ball [16,17].
The subjects reported back to the study side after six weeks
(post-test). Subjects reported that their individual physi-
cal, mental and golf specific training habits of 2–3 golf
training sessions per week were unchanged during the
supplementation phase and that they avoided additional
physical and mental stress. The individual handicap was
identical with pre-study training conditions. Exercise and
measurements were repeated under conditions matching
the pre-test. The tests were performed in May (pre-test)
and June (post-test) during the same time of the day in the
morning. The temperature during the tests was measured
at 21–23°C. The wind speed was below 1 Beaufort.
Reliability of the ball flight measurement
The reliability of ball flight expert rating was investigated
in a separate test. Two golfers (handicap 0) produced nine
good ball flights ("correct flight", "fade" or "draw") and
nine misses (all other ball flights) in random order. Two
experts rated the ball flights independently from each
other. The relationship of two expert ratings was signifi-
cant (p < 0.001) with a contingency coefficient of C =
0.673. The ball flight measurement is a reliable method to
investigate the performance of golfers.
Experimental conditions
The subjects were assigned in random order to either the
PS (n = 10), or the placebo (n = 10) group. The 42-day
supplementation period was started immediately after the
pre-test and was continued until the day before the post-
test. Subjects in the phosphatidylserine group received
one nutritional bar (IQ PLUS brain bar, Giventis, Ger-
many) per day containing 200 mg soy-based PS, while the
others received corresponding placebo bars. Each bar had
a weight of 35 g, providing 149 kcal, 4.8 g protein, 20 g
carbohydrates, 5.5 g fat and vitamins (1.4 mg vitamin B1,
1.4 mg vitamin B6, 42 mg vitamin C, 4.6 mg vitamin E,
2.8 niacin and 4.2 mg pantothenic acid).
Statistics
Statistical analysis was carried out using SPSS software
(version 11.0, SPSS Inc., Chicago, IL). Group data were
expressed as mean ± SD and statistical significance was set
at the p < 0.05 level. Subject characteristics were compared
under supplementations groups using independent sam-
ple t-tests (table 1). Pre/Post and PS/placebo differences
were analyzed by ANOVA (GLM) with post-hoc t-test and
Bonferroni correction.
Results
Ball Flight
Phosphatidylserine supplementation significantly
increased (<0.05) ball flight accuracy (mean number of
good ball flights: pre-test 8.3 ± 3.5, post-test 10.1 ± 3.0),
whereas placebo intake (mean number of good ball
flights: pre-test 7.8 ± 2.4, post-test 7.9 ± 3.6) had no effect
on performance (see figure 2).
Heart Rate
Phosphatidylserine (mean heart rate: pre-test 113.8 ± 17.7
bpm, post-test 111.3 ± 20.2 bpm) and placebo supple-
mentation (mean heart rate: pre-test 114.3 ± 11.7 bpm,
Table 1: Subjects characteristics at pre-test
PS (n = 10) Placebo (n = 10)
Age (years) 33.1 ± 7.5 31.4 ± 4.5
Bodyweight (kg) 77.6 ± 7.8 84.6 ± 13.2
Height (cm) 181.3 ± 8.8 183.6 ± 5.0
Handicap 26.8 ± 7.5 27.8 ± 8.0
Data are mean ± SD. No significant pre-test group differences were
found (p > 0.05).
Schematic representation of potential ball flights: correct flight, fade and draw were rated as a hit, all other ball flights were rated as a missFigure 1
Schematic representation of potential ball flights: correct
flight, fade and draw were rated as a hit, all other ball flights
were rated as a miss.
Correct
Flight
Draw
Fade
Slice
Push
Pull-
Slice
Push-
Slice
Hook
Pull
Push-
Hook
Pull-
Hook
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post-test 111.1 ± 15.7 bpm) did not significantly lower
mean heart rate during the series of tee-offs.
Perceived Stress (VAS)
Phosphatidylserine intake showed a trend towards
improving perceived stress levels during tee-off on a driv-
ing range (mean: pre-test 5.8 ± 2.0, post-test 4.0 ± 2.0, p =
0.07), whereas perceived stress levels remained
unchanged in the placebo group (mean: pre-test: 5.1 ±
2.0, post-test: 5.1 ± 3.1) (see figure 3).
Discussion
The relationship between stress and sports performance is
an extremely complex one and involves the interaction
between the nature of the stressor, the cognitive demands
of the task being performed and the psychological charac-
teristics of the individuals performing it [18]. Paradoxical
performance effects ('choking under pressure') are the
result of inferior performance despite striving and incen-
tives for superior performance [19]. Experimental find-
ings of decrease in performance are associated with four
pressure variables: audience presence, competition, per-
formance-contingent rewards and punishments, and ego
relevance of the task [19].
The primary finding of this investigation was that oral
supplementation with 200 mg PS for six weeks in form of
a functional bar significantly improved the number of
good ball flights in a group of male golfers with a handi-
cap of 15–40. Furthermore, PS intake resulted in a trend
of improved perceived stress levels during tee-off. These
results suggest that the effective dose of PS supplementa-
tion to combat distress might be lower than previously
described.
Unpredictability and uncertainty resulting in worry and
strain, combined with ego-involvement, are considered
the key psychological elements of both HPA activation
and distress [8]. While the placebo group showed the
expected increase in distress, the PS group showed stable
values, suggesting a quicker habituation to the stressor,
which may then result in improved performance.
The study protocol did not allow studying the mechanism
by which PS affects perceived stress and performance. The
very moderate increase in heart rate indicates that physical
load did not influence the result of this study. The pro-
posed mechanism of action is the counteraction of stress-
induced activation of the hypothalamo-pituitary-adrenal
(HPA) axis in accordance with previously reported studies
on physical [2,3] and mental stress [8]. However, the pro-
Phosphatidylserine supplementation showed a trend towards improving perceived stress levels during tee-off on a driving range, whereas perceived stress levels remained unchanged in the placebo groupFigure 3
Phosphatidylserine supplementation showed a trend towards
improving perceived stress levels during tee-off on a driving
range, whereas perceived stress levels remained unchanged
in the placebo group.
Perceived Stress Levels (1-10)
0
1
2
3
4
5
6
7
Placebo

PS
Pre
Post
8
Phosphatidylserine supplementation significantly improves the number of good ball flightsFigure 2
Phosphatidylserine supplementation significantly improves
the number of good ball flights.
0
2
4
6
8
10
12
14
Placebo PS
Pre
Post
*
Number of hits
(correct flight, draw and fade)
Page 4
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posed mechanism of action remains speculative without
supplemental data from further studies that investigate
the in vivo pharmacological actions of PS during stress
creating golf exercise.
The moderate increase in stress levels in the placebo group
indicate that further research is required to investigate the
effects of PS supplementation under competition condi-
tions since the elite golfer experienced elevated cortisol,
heart rate, cognitive and somatic anxiety, and lower self-
confidence during competition compared to practice [13].
The effect of stress on golf performance might be easier to
study on subjects with a lower handicap since their golf
swing is more automated and more stable under various
conditions [11].
Conclusion
It is concluded that six weeks of PS supplementation
shows a statistically not significant tendency (p = 0.07) to
improve perceived stress levels in golfers and significantly
improves (p < 0.05) the number of good ball flights dur-
ing tee-off which might result in improved golf scores.
Competing interests
KRG is the inventor of patent "Food Item For Increasing
Cognitive Capacity" (WO 02/078464). All other authors
declare that they have no competing interests.
Authors' contributions
All authors participated in the design of the study. MW
analyzed statistics and MW, FA, LS and HH collected data.
RJ, with the support of MW and HH, drafted the manu-
script. JB validated the ball flight test method. All authors
have read and approved the final manuscript.
Acknowledgements
The authors would like to thank Dr. Michael Kingsley, University of Wales
Swansea, and Bill Yanko, Golf Professional, Member of the PGA, for a crit-
ical reading of the manuscript and Cargill Texturizing Solutions, Lise-Meit-
ner-Str. 30, D-85354 Freising, Germany, and Giventis GmbH,
Weingartenstr. 2, D-64646 Mörfelden, Germany, for funding this research
and Chemi Nutra, 4463 White Bear Pkwy, Suite 105, White Bear Lake, MN
55110, USA, for funding the manuscript publication.
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    • "Thus, the findings are applicable to many consumers who golf but do not follow a rigid diet or exercise program. To date, extremely limited research is available exploring the potential impact of various nutritional agents on golf performance, with one of the only published accounts reporting an improvement in stress hormone levels and shot-making after phosphatidylserine supplementation [2]. The disadvantages of the present study primarily revolve around the pilot nature of the investigation and the lack of female subjects. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Limited research exists examining the impact of nutrition on golfing performance. This study’s purpose was to determine the impact of daily supplementation with an over-the-counter dietary supplement on golf performance. Methods Healthy men (30.3 ± 6.9 y, 183.1 ± 5.6 cm, 86.7 ± 11.9 kg), with a 5–15 handicap were assigned in a double-blind, placebo-controlled manner to ingest for 30 days either a placebo (PLA, n = 13) or a dietary supplement containing creatine monohydrate, coffea arabica fruit extract, calcium fructoborate and vitamin D (Strong Drive™, SD, n = 14). Subjects ingested two daily doses for the first two weeks and one daily dose for the remaining two weeks. Participants followed their normal dietary habits and did not change their physical activity patterns. Two identical testing sessions in a pre/post fashion were completed consisting of a fasting blood sample, anthropometric measurements, 1-RM bench press, upper body power and golf swing performance using their driver and 7-iron. Data were analyzed using two-way mixed factorial ANOVAs and ANCOVA when baseline differences were present. Statistical significance was established a priori at p ≤ 0.05. Results ANCOVA revealed significantly greater (post-test) best drive distance (p = 0.04) for SD (+5.0% [+13.6 yards], ES = 0.75) as well as a tendency (p = 0.07) for average drive distance to increase (+8.4% [+19.6 yards], ES = 0.65), while no such changes were found with PLA (−0.5% [−1.2 yards], ES = 0.04 and +1.3% [+2.8 yards], ES = 0.08, respectively). Both groups experienced significant increases in body mass and 1-RM bench press (p < 0.001). No other significant group × time interactions were found. For the SD group only, within-group analysis confirmed significant improvements in set 1 average (+8.9%, p = 0.001) and peak velocity (+6.8%, p < =0.01). No changes were noted for reported adverse events, pain inventories, quality of life or any measured blood parameter. Conclusions SD supplementation for 30 days significantly improved best drive distance more than placebo. Supplementation was well tolerated and did not result in any clinically significant changes in markers of health or adverse events/side effect profiles.
    Full-text · Article · Jan 2015 · Journal of the International Society of Sports Nutrition
  • Source
    • "Consistent with this possibility, previous studies have shown that certain phospholipids can improve athletic performance [26]. For example, PC increases endurance by preventing exercise induced declines in choline levels and PS by blunting exercise induced increases in cortisol [27] and improving mental performance under stress [28]. However, no study has yet investigated the effects of long-term PS supplementation in combination with resistance exercise on potential gains in muscular hypertrophy. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction The lipid messenger phosphatidic acid (PA) plays a critical role in the stimulation of mTOR signaling. However, the mechanism by which PA stimulates mTOR is currently unknown. Therefore, the purpose of this study was to compare the effects of various PA precursors and phospholipids on their ability to stimulate mTOR signaling and its ability to augment resistance training-induced changes in body composition and performance. Methods In phase one, C2C12 myoblasts cells were stimulated with different phospholipids and phospholipid precursors derived from soy and egg sources. The ratio of phosphorylated p70 (P-p70-389) to total p70 was then used as readout for mTOR signaling. In phase two, resistance trained subjects (n = 28, 21 ± 3 years, 77 ± 4 kg, 176 ± 9 cm) consumed either 750 mg PA daily or placebo and each took part in an 8 week periodized resistance training program. Results In phase one, soy-phosphatidylserine, soy-Lyso-PA, egg-PA, and soy-PA stimulated mTOR signaling, and the effects of soy-PA (+636%) were significantly greater than egg-PA (+221%). In phase two, PA significantly increased lean body mass (+2.4 kg), cross sectional area (+1.0 cm), and leg press strength (+51.9 kg) over placebo. Conclusion PA significantly activates mTOR and significantly improved responses in skeletal muscle hypertrophy, lean body mass, and maximal strength to resistance exercise.
    Full-text · Article · Jun 2014 · Nutrition & Metabolism
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    • "PS has been shown to blunt stress induced increases in cortisol (Starks et al., 2008) and to significantly decrease b-1 power in the right hemispheric frontal brain regions before and after stress (Baumeister et al., 2008). These beneficial effects result in an increase in performance during a calculus test (Parker et al., 2011) and an increase in motor skills in golf players (J€ ager et al., 2007). Protein kinase C (PKC) plays an important role in controlling memory relevant signalling process. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioural disorder of childhood, affecting 3–5% of school-age children. The present study investigated whether the supplementation of soy-derived phosphatidylserine (PS), a naturally occurring phospholipid, improves ADHD symptoms in children. Methods Thirty six children, aged 4–14 years, who had not previously received any drug treatment related to ADHD, received placebo (n = 17) or 200 mg day–1 PS (n = 19) for 2 months in a randomised, double-blind manner. Main outcome measures included: (i) ADHD symptoms based on DSM-IV-TR; (ii) short-term auditory memory and working memory using the Digit Span Test of the Wechsler Intelligence Scale for Children; and (iii) mental performance to visual stimuli (GO/NO GO task). Results PS supplementation resulted in significant improvements in: (i) ADHD (P < 0.01), AD (P < 0.01) and HD (P < 0.01); (ii) short-term auditory memory (P < 0.05); and (iii) inattention (differentiation and reverse differentiation, P < 0.05) and inattention and impulsivity (P < 0.05). No significant differences were observed in other measurements and in the placebo group. PS was well-tolerated and showed no adverse effects. Conclusions PS significantly improved ADHD symptoms and short-term auditory memory in children. PS supplementation might be a safe and natural nutritional strategy for improving mental performance in young children suffering from ADHD.
    Full-text · Article · Mar 2013 · Journal of Human Nutrition and Dietetics
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