A Common Sense Approach To Talking with Your Athletes About Supplements

Gregory Biren, PhD, CSCS Rowan University Health and Exercise Science Department [email protected] http://users.rowan.edu/~biren/ Supplements 1994 “Dietary Supplement Health & Education Act” (DSHEA) – enabled consumers to gain unobstructed access –established 1st legal definition FDA does regulate supplements, however limited control – Center for Food Safety & Applied Nutrition (CFSAN) oversees FDA’s activities on supplements – Office of Dietary Supplements (NIH) – drugs must undergo clinical testing & report findings to FDA – supplements manufacturers must notify FDA; but NOT required to test DSHEA May NOT be represented as conventional food (must be labeled as supplement) Requires some evidence that product is safe & effective Burden of proof for showing safety falls on FDA NOT manufacturer – FDA must PROVE that supplement taken under recommended doses is unsafe (if someone takes in excess NOT manufacturers problem) Literature to promote product – can’t be misleading?? – “statement has not been approved by FDA” – product is not intended to diagnose, treat, cure or prevent disease Statements of Nutritional Support

Supplements are allowed to carry claim statements in 1 of 4 categories 1. Claim of benefit relating to a classical nutrient deficiency disease (folic acid & neural tube defects) 2. Claim describing role of nutrient & effect on structure or function of body a. can’t say “prevents osteoporosis” but can say important in developing bone strength 3. Mechanism by which nutrient acts to maintain structure & function a. vitamin D ↑ absorption of Ca++ at small intestine & ↓ excretion at kidneys 4. Claim describing general well being from consuming nutrient (ie elevates mood states) “Supplement” Defined?

Any product (other Vitamins than tobacco) Minerals intended to Herbs/Botanicals supplement the diet that contains one of Amino acid more of the following Enzymes ingredients: Metabolite or combination of these ingredients Ergogenic Aids ???

Ergogenic “ergo”= work, “genic”= produce Ergogenic Aids - enhancing performance 1. Pharmacological – pertaining to drugs 2. Chemical – caffeine, phosphate, growth hormone 3. Nutritional – vitamins, minerals, carbohydrates They can work, but some at a cost!!!! Approach to Supplements 1. NOTHING can take place of a quality nutritional & exercise program 2. Ask why they want to use supplement • What do they know about it? 3. Evaluate their current nutritional program • get them to correct this first •“FOOD FIRST” 4. Educate them on what research says • show them how research can be manipulated • talk about side effects 5. Ask them how long do they plan to take this supplement • What are they going to do when they stop? 6. Be careful about cause and effect 7. Now they can make their own decision Protein Structurally similar to carbs & lipids (carbon, oxygen, & hydrogen), also contain nitrogen – amine group (N), carboxyl group & side chain Amino acids (basic building blocks) – 20 a.a., 8 essential Deamination – removal of nitrogen group in order to use protein for energy, carb or fat formation Transamination allows a.a. to be converted to other a.a. Functions: Enzymes, Antibodies, Transport molecules, Fluid & acid base balance, Hormones, Oxygen carriers, Structural proteins Energy ?? – **we DON’T store protein, use it or convert it ProteinsProteins Complete – contains all essential A.A. – meat, dairy, fish, poultry, eggs Getting all essential A.A. not problem for those regularly eating complete proteins, but.. Incomplete proteins (grains, greens, legumes) Complementary Proteins Quality of Protein RDA = .8 grams/kg: covers 98% of population Includes 25% reserve for differences vegetarian needs higher – must also make sure protein is complete or complementary What about athletes? 1.2-1.8 grams/kg >2 grams/kg waste ProteinProtein SupplementsSupplements

WheyWhey CaseinCasein ColostrumColostrum AminoAmino AcidsAcids

LeucineLeucine GlutamineGlutamine ArginineArginine AlanineAlanine BranchBranch ChainChain AminoAmino AcidsAcids (BCAA)(BCAA) ArginineArginine

Non-essential amino acid – suggested that body synthesis is insufficient for optimal health (semi-essential) – “L” - natural –“D” -synthetic Involved in reactions producing vasodilation & CV function by being converted to nitrous oxide (NO) Associated with ↓ symptoms of CAD, slow atherosclerosis – inhibits adherence of cells to vessel walls Due to conversion to nitrous oxide, exercisers supplement for the “pump” & to drive nutrients into muscle cells L-Carnitine An amino acid made in liver & kidneys from other amino acids – found in meat & dairy products Transfers fatty acids into mitochondria May help inhibit pyruvate conversion to lactic acid Claims – ↑ endurance – ↑ fat metabolism – Lower cholesterol & triglyceride levels Research on L-Carnitine

Research - patients with muscle weakness, kidney disease, on restricted diet may show benefit – this is due to loss of carnitine loss in kidneys May help vegetarians/diets low in animal proteins who are deficient in carnitine in diet Healthy populations show NO benefit from supplementation if diet is adequate No research indicates potential side effects Creatine N+ containing organic compound made in body from A.A. metabolism 95% is found in muscle Found in meat, poultry & fish – Body requires ~2g/day, more if active – body synthesizes 1 g/day (liver) – 1 gram/ 8 ounces of meat – vegetarians could be deficient Supplemental form creatine monohydrate Vital role in cellular energy production – Stored as phospho-creatine Claims – ↑ energy, ↑ lean tissue, ↑ muscle strength Creatine Claims backed up by research – >20 studies show improvement in HIGH intensity, short term activities (anaerobic sports) – Probably nothing for low intensity longer duration Benefits: – faster ATP turnover; delay PC depletion – delay dependence on glycolysis – facilitate recovery from repeated bouts of intense exercise Body mass ↑ 1-5 lbs** (regardless of testosterone concentration) Does ↑ weight come from muscle tissue or water retention? –probably combination Creatine Loading

“Loading phase” 20-30 grams daily for 5-7 days – PC levels rise, but remain high (↑ 30%) for only a few days, so.. Maintenance phase 2-5 g daily – **in addition to diet w/o maintenance phase creatine levels are normal by 35 days Alternative Loading – 3-5 g/day for 28 days gives same creatine levels Caffeine Most common stimulant in the world Claims – ↑ energy – Improves athletic performance –Promotes weight loss – ↑ metabolic rate ↑ release of epinephrine – glycolysis, lipolysis, CNS stimulant – ↑ release of Ca++ from SR, ↑ contractility Controlled/restricted drug in athletic competition – IOC & NCAA restrict use – 2-3 cups OK Caffeine

Cycling 80% max power to exhaustion Beyond 5 mg/kg no > effect – 5 mg/kg won’t reach IOC doping limits Proposed Mechanisms for Ergogenic Action

Acts directly on adipose tissue – acts indirectly on adipose tissue by stimulating epinephrine release – ↑ plasma fatty acids, ↑ fat oxidation Spares liver & muscle glycogen Produces analgesic effect on CNS ↑ motor-neuronal excitability (↑ motor unit recruitment – ↑ release of Ca++ & ↑ sensitivity of actin & myosin to Ca++ –May ↑ submax muscle contractions, does NOT ↑ max muscle contractions More on Caffeine People develop tolerance to caffeine – more needed for same effect Caffeine in coffee has < effect than caffeine pills If using as ergogenic aid for event, need to abstain 4-6 days prior Can produce restlessness, headaches, insomnia, nervous irritability, ↑ H.R. & BP Acts as a diuretic (dehydration) Chromium Trace mineral found in broccoli, wheat germ, nuts, egg yolks, apples (food processing removes chromium) Cofactor to ↑ insulin function Deficiencies: – ↓ insulin sensitivity (type 2 diabetes) Estimated 90% of adults consume < RDA, urinary chromium excretion ↑ with exercise Claims: – lower blood sugar & ↑ insulin sensitivity – reduces body fat & ↑ lean mass – suppresses appetite – ↓ cholesterol & triglyceride levels Chromium Supplementation & Resistance Training B-Hydroxy B-Methylbutyrate (HMB)

Metabolite from breakdown of leucine (amino acid) – Small amount found in protein rich foods milk & fish Claims – ↓ protein loss by inhibiting protein catabolism –muscle building –fat reducing Target resistance training athletes B-Hydroxy B-Methylbutyrate (HMB)

Research – HMB group showed blunted rise in proteolysis – Results seen within several wks. – By last week of study fat free mass changes were NOT sig. Used by NASA to prevent muscle wasting in astronauts No side affects have been seen at this time Dehydroepiandrosterone (DHEA)

Steroid hormone synthesized in adrenal cortex – precursor to testosterone, estrogen & cortisol –Levels ↓ with aging Claims – ↑ muscle mass, ↓ fat mass –Anti-aging – Stimulates sex drive Dehydroepiandrosterone (DHEA)

Little is know about long term effects & dosages Has been shown to ↑ testosterone level, muscle mass, promote feelings of well-being, & immune function, in 40-70 yr. – Results NOT substantiated in younger healthy populations Concerns (no research) about altered hormone profiles, liver abnormalities, ↑ risk of prostate & breast cancer, ↑ testosterone levels in females, gynecomastia in men (↑ estrogen) – side effects may not be noticeable for years Recent study showed dramatic differences in amount stated on label & actual (150%-0%) only 50% had proper amounts Androstenedione

Precursor (pre-hormone) of testosterone & estrogen b/c found naturally in meat can be called a “nutritional supplement” Claims – 100 mg ↑ testosterone levels 300% – suggesting in turn similar effects of testosterone – ↑ muscle mass and strength Banned in sports Controlled substance in other countries Androstenedione

Effects are NOT scientifically founded JAMA – “does not ↑ testosterone or enhance skeletal muscle adaptations (strength, size, lean body mass) in those with normal testosterone levels” – 300 mg 3’x/day showed ↓ HDL’s & ↑ in LDL (both 12%) – ↑ levels of estradiol and estrone, both may be related to CV disease & breast cancer & pancreatic cancer in men No long term research has looked at safety If anabolic effects occur, then you may have similar negative side effects as steroids Pyruvate 3 carbon molecule produced during glycolysis Claims: – Enhances weight loss and reduces weight regain –Decreases appetite – Elevated energy levels – Increased endurance levels – Increases muscle glycogen – Reduces fatigue Research has shown slight improvements in CV endurance & fat loss, also less regain of weight after diet However, supplemental levels in these studies they used 25-40 g/day Supplemental dosages contain 1-6 g per serving Ephedra (now banned)

Ma Huang (Chinese Herb) About 40 different herbs that contain ephedra like versions Function as “sympathomimetic” (mimics sympathetic nervous system) – similar in structure to amphetamines Used to be found in many weight loss supplements Claims: – ↑ alertness – Speeds metabolism – Aids weight loss – ↑ athletic performance – Mental sharpness Ephedra

Causes – ↑ cardiac output, muscle contractility, blood sugar, open bronchioles, suppress appetite, ↑ glycolysis & lipolysis Research is equivocal – people respond differently & doses vary widely in plants Study – showed men dieting were better able to maintain metabolic rate with ephedra (concern with weight loss is ↓ BMR) Improved effects when combined with caffeine & aspirin (ECA stack) Prior to ban, FDA proposed limit per dose of 8 mg & 25 mg/day Above studies used 60-75 mg/day Ephedra Study from U. of Arkansas tested 20 different ephedra products & found range of ephedra from 0- 18.5 mg/dose & lot to lot variations (up to 1000%) Other forms: ephedrine, norephedrine, methylephedrine, & norpseudoephedrine Ephedrine can be converted to “methamphetamine” (speed) FDA received over 1000 reports of adverse effects – Heart palpitations, , nervousness, elevated blood presure, insomnia, headaches, seizures, stroke, heart attack, & death Any product claiming to increase metabolism either does not work or has some stimulant in it Advice on Nutrition to Reduce Need for Supplementation

While athletic trainers and coaches should never recommend supplement use… We should promote optimal nutrition and show athletes how they can get nutrients through foods rather than supplements – if you don’t do this they choose supplements To cover a complete nutritional diet requires another presentation – Most athletes supplement pre, during, & post exercise – If we can provide information on this we can help our athletes focus on food rather than supplements Pre-Competition/Exercise Meal

Begins several days prior to competition Sig. loss of carbohydrate stores occurs over night – must pay attention to diet – causes dehydration Pre-comp meal serves to replenish carbs lost & to hydrate Minimize foods high in fats or protein (day of) – slow digestion, need is carbohydrate – protein use for energy facilitates dehydration Carbs absorbed fastest & prevent feeling of bloating or being full (avoid high fiber) Sample Pre- Competition/Exercise Meal 1. 4 hrs prior to event 1 gram/lb of carbs. (solid/ liquid) a. ie – 160 lb – 160 g of carbohydrate needed + water (12 oz) i. Total cereal (SKIM milk); banana; 16oz orange juice; glass of water? ii. 154 g of carbs, 24 g of protein, 4 g of fat 2. 1 hour prior .25 g/lb a. ie – 160 lb – 40 g + water (12 oz) i. 20 oz sports drink ii. 32 g of carbohydrates, fruit? 3. Within last hour prior is up to athlete ?? – definitely water – ie – sports drink During Competition/Exercise

Activities of low intensity & lasting <1 hr – water intake is fine When intensity is high &/or lasts >1 hr – carbohydrates are needed – spares carbohydrate stores – maintains blood sugar levels (prevents fatigue) – spares muscle use for energy (minimizes dehydration/holds on to muscle) 30-60 g of carbs/hr optimal (sports drink best source) – glucose absorption rate = 50-80 g/hr. – 14 grams/8 oz ideal drink (4-8 oz/15 min) – note: this will not offset what you use during exercise it will help though during intense exercise = 240 g/hr Recovery Nutrition Enzymes that control carbohydrate &protein synthesis (building) are very active 1st 2 hours after exercise – best time to improve carb stores & build muscle is right after exercise or practice Have drink & or fruit available (immediately) – .4? g/lb of carb each hour for 4 hours after workout Protein intake for recovery – .2-.3 g/lb within 4 hours after workout – continue regular carb & protein consumption for day 160 lbs = 250 grams of carbohydrates & 48 grams sport drink–20oz 32 g; trail mix (fruit/) = 30 g 2 cups spaghetti (sauce, meat); fruit juice; salad (mix of veg, cheese, dressing), 2 slices of bread 1730 cals, 234 g of carbs, 65 g of protein In Summary 1. NOTHING can take place of a quality nutritional & exercise program 2. FOOD FIRST (focus on eating properly first & then consider supplements; rather than worrying about what supplement to take) a. adequate nutrition CAN BE met with good diet 3. Some supplements have been shown to improve performance so don’t discount all 4. If we cannot provide proper information regarding supplements they will get their information somewhere (usually unreliable sources) 5. Most athletes will do what they want regardless of what you say, however, by educating them and helping them with their diet, we have the best opportunity to guide them towards appropriate decisions ResourcesResources www.supplementwatch.comwww.supplementwatch.com www.eatright.orgwww.eatright.org (American(American DieteticsDietetics Association)Association) www.cfsan.fda.govwww.cfsan.fda.gov (Center(Center frofro FoodFood SafetySafety && AppliedApplied Nutrition)Nutrition) http://www.nih.gov/http://www.nih.gov/ (National(National InstituteInstitute ofof Health)Health) gogo toto healthhealth gogo toto supplementssupplements [email protected]@rowan.edu (Greg(Greg Biren’sBiren’s email)email) SportsSports SupplementSupplement Encyclopedia.Encyclopedia. JoseJose AntonioAntonio && JeffJeff Stout,Stout, NutriciaNutricia InstituteInstitute ofof SportsSports ScienceScience Comments and Questions???

Thank You For Your Time

Gregory Biren, PhD, CSCS Health and Exercise Science Rowan University [email protected] http://users.rowan.edu/~biren/