Nutrition and Nutritional Supplements in Sports

Objectives

Increase awareness that nutrition can affect an athletes performance Discuss current nutritional recommendations for athletes Review the 1994 Dietary Supplement Health and Education Act

Definition of a supplement Impact of this legislation

Discuss specific nutritional supplements commonly used by athletes

Do they work? Are they safe?

Review the Anabolic Steroid Control Act of 2004

Performance Influencing Factors

Genetics

Training Nutrition

and Conditioning

Determinants of the Athletes Energy Requirements

During

intense exercise prolonged exercise level of the athlete

Carbohydrate

stored in muscles and liver (glycogen) is predominant fuel source stores are predominant fuel source

During
Fat

Fitness
Well

trained endurance athletes burn fat more efficiently, sparing limited glycogen stores

Formula for Estimating the Bodys Calorie Requirements

Sedentary person

Weight (kg) x 25

Moderately active person

Weight (kg) x 30
Weight (kg) x 40 Weight (kg) x 45

Active person (endurance athlete)

Underweight person

kg = lbs / 2.2

Recommendations for Athletes

Carbohydrate

intake Pre-exercise meal Carbohydrate loading Protein intake Fat intake

Carbohydrates

Non-essential nutrient (human body can make sugar) Simple (sugars) and Complex (starches), Fiber Major fuel source for exercising muscle

4 Kcal/gram Bread, pasta, beans, potatoes, bran, rice, cereals 60 to 70% of total calories should come from carbohydrates Complex carbohydrates (starches) are preferable Athletes should consume 25 to 30 gm of carbohydrate for every 30 minutes of exercise Athletes should drink 6 to 8 ounces of water or sports drink for every 10 to 15 minutes of exercise

Athletes should ingest 6 to10 gm/kg/day

During exercise

Carbohydrates
After

exercise

Athletes

should consume 1.0 to 1.5 gm/kg immediately post exercise and again one hour later
To replace muscle glycogen stores To prevent gradual depletion of muscle glycogen stores over time caused by repetitive daily bouts of heavy exercise To decrease muscle breakdown

Why Complex Carbohydrates?

Compared to ingesting simple carbohydrates, ingesting complex carbohydrates:

Increases muscle glycogen stores better Improves performance and delays fatigue Promotes faster stomach emptying Causes less stomach upset and indigestion Leads to lower blood sugar and insulin levels Provides other beneficial nutrients

Fiber, vitamins and minerals

Pre-exercise Meal

Importance

Less hunger before and during exercise Maintains optimum glycogen stores
Emphasize complex carbohydrates (starches)

Recommendations

1 to 4 gm/kg about 1 to 4 hours prior to event Consume less closer to event

Avoid high fat and high protein foods

Slower gastric emptying can cause stomach upset

Can lead to crampy abdominal pain

Avoid high fiber or gas forming foods

Carbohydrate Loading
Increases

the bodys pre-exercise glycogen stores by 50 to 100% Benefits endurance athletes who compete for longer than 90 minutes
Can

increase endurance up to 20% Can increase performance by 2 to 3%

Carbohydrate Loading: One Example of How

Days prior to event Exercise duration 6 90 minutes 5 40 minutes 4 40 minutes 3 20 minutes 2 20 minutes 1 rest Carbohydrate intake 5 gm/kg/day 5 gm/kg/day 5 gm/kg/day 10 gm/kg/day 10 gm/kg/day 10 gm/kg/day

Protein

Athletes require more protein than non-athletes Protein promotes growth and repair

4 Kcal/gram Chicken, fish, egg whites, red meat, nuts 12 to 18% of total calories should come from protein

1.2 to 1.4 gm/kg/day recommended for endurance athletes 1.7 to 1.8 gm/kg/day recommended for strength athletes

Average American diet provides 1.4 gm/kg/day Adequate calorie intake is just as important as adequate protein intake for building muscles Too much protein intake can be bad

Excess protein calories are stored as fat Excess protein intake can lead to dehydration and may contribute to kidney problems

Fat

Major source of energy, serve as energy stores 9 Kcal/gram 25 to 30% of total calories should come from fat

Less than 10% of total calories should come from saturated fats Saturated, monounsaturated, polyunsaturated, trans

Cholesterol intake should be less than 300 mg/day Average American diet provides 37% of total calories from fat Good choices: Olive oil, nuts, avocados, fish oil Bad choices: Vegetable oil, margarine, beef fat, pork fat

Nutritional Supplements

1994 Dietary Supplement Health and Education Act

Definition of a supplement Any product that contains vitamins, minerals, amino acids, herbs, botanicals or a concentrate, metabolite, constituent, extract or combination of any of these ingredients Removed dietary supplements from FDA regulation on the front end FDA must prove a supplement is dangerous before its sale can be prohibited

Nutritional Supplements
1994

Dietary Supplement Health and Education Act

Manufacturers

do not have to provide scientific proof of claims Manufacturers cannot state product is meant to diagnose, treat, prevent or cure a disease but can make indirect suggestions Created a multi-billion dollar industry that continues to grow rapidly

Vitamins and Minerals

Essential nutrients

Human body needs these to produce energy

No evidence in U.S. studies that taking vitamin and mineral supplements improves athletic performance

Being deficient in vitamins or minerals is rare in the U.S. compared to the rest of the world Did population studied have some baseline deficiency treated with these supplements?

A few studies outside U.S. showed an effect

Vegetarian athletes are at risk for being deficient in vitamins B12, D, riboflavin, iron, zinc and calcium

Athletes who are strict vegetarians should take a multivitamin to prevent deficiencies and a calcium supplement (1000 mg/day) to help prevent bone loss

Vitamins and Minerals

Specific vitamins and minerals studied

Vitamin A and Vitamin D

No evidence of increased performance May have toxic effects at high doses

Vitamin E

No evidence of increased performance Toxic effects are rare

Anti-oxidant effect may help decrease exercise related muscle soreness No effect on strength Possible toxic effects at high doses

Vitamin C

Vitamins and Minerals

Specific vitamins and minerals studied

Vitamin B6

No evidence of increased performance Toxic over 200 mg/day (nervous system side effects)

Other anti-oxidants (Betacarotene, Bioflavinoids, Copper, Cysteine and Glutathione)

May help to protect against exercise induced muscle damage Study results are conflicting Should not exceed 100% U.S. RDA of anti-oxidants

Buyer beware!

Some supplements have been found to contain up to 3000% of U.S. RDA for vitamins and minerals

Creatine

Chemical name: Creatine-Monohydrate Naturally available in meat and fish NCAA study found creatine supplements used by 12% of college athletes A subsequent survey of high school athletes showed similar usage rates Does it work to

Increase muscle mass? Increase strength? Increase performance?

Is it safe?

Creatine

Studies showing (+) effects in healthy subjects published

Increased high intensity, intermittent exercise performance in squash players Increased cell hydration status and performance variables in Division I college football players more than training alone Augments repeated sprint cycle performance in hot environment without altering thermoregulatory responses Increases indices of high intensity exercise performance for both males and females Increased capacity of human muscle to perform work during alternating intensity contraction

Creatine

Recent studies with (+) effects (continued)

Ergogenic effect in elite ice hockey players Loading improves intermittent sprint capacity at end of endurance exercise to fatigue Adding creatine to glucose, taurine and electrolyte supplement promoted greater gains in fat and bone free mass, isotonic lifting volume and sprint performance during intense resistance and agility training Helped to prolong time maximal rate of power output could be maintained

Creatine

Studies with no effect in healthy subjects

Did not positively influence isometric strength in untrained (sedentary) males Did not increase performance or training volume over placebo in rowers that performed a high intensity rowing and strength program No statistically significant difference in strength or fat free mass gains after a resistance exercise training program
compared with post exercise protein supplementation

Creatine

Studies looking at safety of supplementation in healthy subjects

Retrospective study of 26 athletes who reported taking creatine between 0.8 and 4 years - blood chemistries including liver and kidney function were all within normal Neither 12 weeks of supplementation with training nor training alone had any effect on serum cholesterol, HDL, LDL, TG or creatinine levels Supplementation for 5 days had no effect on BP, serum creatinine, estimated creatinine clearance or plasma CK Oral supplementation for 5 days had no effect on GFR, total protein or albumin excretion rates and all remained normal

Creatine

Opinion

Supplementation in combination with high intensity strength training increases strength during high intensity intermittent exercise 7 to 8% more than training alone Supplementation probably increases performance in sports involving or requiring high intensity intermittent bursts of strength Long term effects (chronic use > 4 years) are not known and I share concern of some experts about potential for liver and kidney problems
Loading: 20 to 30 gm/day for one week Maintenance: 10 to 15 gm/day while training

Dosing

HMB

Chemical name: Hydroxy-Methylbutyrate Metabolite of leucine (amino acid) Available naturally in catfish, citrus fruits and breastmilk Some preliminary studies suggest that supplementation with HMB can suppress muscle protein breakdown One placebo-controlled study in weightlifters reported slightly better strength increases and greater lean mass increases in the group taking HMB No known adverse effects Dosing: 1 gm three times a day

Ephedra or MaHuang

Herbal forms of the stimulant ephedrine 80+ confirmed deaths related to ephedra use

Experts suspect many more unconfirmed deaths High blood pressure (most common) Palpitations and increased heart rate Seizure Thermoregulatory dysfunction Stroke Heart attack Sudden death Vasculitis Allergic myocarditis (one case reported) Acute hepatitis (one case report)

Adverse effects

Ephedra or MaHuang
Following

the death of two professional athletes, FDA banned sale of Ephedra as a nutritional supplement Since this time, manufacturers have started substituting other stimulants
Citrus

Aurantium

Orange extract Chemical structure very similar to ephedrine

Other Nutritional Supplements

Chromium Picolinate

No benefit demonstrated in studies Adverse effects: stomach upset, anemia, cognitive impairment, chromosome damage, interstitial nephritis No benefit demonstrated in studies Adverse effect: significant muscle weakness No benefit demonstrated in studies Adverse effect: eosinophilia myalgia syndrome

L-Carnitine

L-Tryptophan

Anabolic Steroid Precursors

Dehydroepiandrosterone (DHEA) and Androstenedione (Andro)

Chemicals that can be converted into testosterone in human biochemical pathways Naturally available in wild yams An early study done by a manufacturer of these products showed no significant increase in blood levels of testosterone Study looked at lower doses of these supplements than are usually taken and did not measure ratio of testosterone to epitestosterone (T:E ratio)

Anabolic Steroid Precursors

Subsequent independent scientific studies

DHEA Does not seem to have much if any effect on fat-free body mass and strength Androstenedione Causes a temporary increase in testosterone levels Has no effect on bodys ability to make protein Does not seem to have any effect on strength No long term effect on blood testosterone levels Chronic use causes increase in estrogen levels

Anabolic Steroid Precursors

Potential
May

adverse effects

cause liver damage In females

Can cause male features in women May increase risk of uterus cancer

In

males

Can cause female features in men May increase risk of prostate cancer

Anabolic Steroids and Anabolic Steroid Precursors

Are banned and tested for by the USOC, IOC, NCAA, NFL, NBA and MLB (finally!) NHL has no official policy and does not perform testing You can be disqualified from participating in college sports if you test positive for a substance banned by the NCAA

Whether or not you knew it was banned Whether or not the product was mislabeled

Buyer Beware!

IOC funded study by Shanzer (Germany) from 10/00 to 11/01

Analyzed 634 products labeled as non-hormonal nutritional supplements from 13 countries and 215 different suppliers

94 products (14.8%) were found to be positive supplements (contained anabolic steroid precursors not declared on the label) Anabolic androgenic steroid concentrations ranged from 0.01 to 190 micrograms per gram of supplement 23 products contained steroid precursors of nandrolone and testosterone 64 products contained steroid precursors of testosterone only 7 products contained steroid precursors of nandrolone only Percentage of positive supplements per country

25.8% of products bought in Netherlands 22.7% of products bought in Austria 18.8% of products bought in UK 18.8% of products bought in US (45 positive out of 240 tested)

Anabolic Steroid Control Act of 2004

Signed into federal law on October 22, 2004 Amends the Anabolic Steroid Control Act of 1990

Modifies the definition of anabolic steroids to include tetrahydrogestrinone (THG), androstenedione, and specified related chemicals Directs the U.S. Sentencing Commission (USSC) to review federal sentencing guidelines with respect to anabolic steroid-related offenses Amends guidelines to provide for increased penalties Authorizes the Attorney General to exempt from regulation any compound, mixture, or preparation containing an anabolic steroid that does not present a significant abuse potential Directs the Secretary of Health and Human Services to award grants for science-based education programs in elementary and secondary schools to highlight the harmful effects of anabolic steroids and to ensure that the NSDUH includes questions concerning the use of these drugs.

Source: Library of Congress

Conclusions

Nutrition plays an important role in an endurance athletes ability to perform Proper nutrition in combination with sound and proven training techniques can help endurance athletes to maximize their genetic abilities Creatine

Has been shown to increase strength during intermittent high intensity exercise Has not been shown to improve performance in endurance athletes Safety of long-term use is not known

Certain nutritional supplements have not demonstrated any performance benefit in studies

Conclusions

Certain nutritional supplements can have potentially dangerous side effects Further legislation is needed to address the dangers of some nutritional supplements Professionals in the community need to be resources of good information for athletes, parents and coaches

Physicians Physician assistants Nurse practitioners Athletic trainers School nurses Dieticians

References

Bemben MG, Bemben DA, Loftiss DD, Knehans AW. Creatine supplementation during resistance training in college football athletes. Med Sci Sports Exerc 2001;33(10):1667-73. Bemben MG, Tuttle TD, Bemben DA, Knehans AW. Effects of creatine supplementation on isometric force-time curve characteristics. Med Sci Sports Exerc 2001;33(11):1876-81. Bosco C, Tihanyi J, Pucspk J, Kovacs I, Gabossy A, Colli R, Pulvirenti G, Tranquilli C, Foti C, Viru M, Vira A. Effect of oral creatinine supplementation on jumping and running performance. Int J Sports Med 1997;18(5):369-72. Fuentes RJ and Rosenberg JM. Athletic Drug Reference 99. Durham (NC): Clean Data, Inc.; 1999. Green G. Innovations in Drug Testing. Presented at the American Medical Society for Sports Medicine Annual Meeting, Orlando (FL), April 2002. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkalloids. N Engl J Med 2000;343(25):1833-8. Jackson C. Vitamin and Mineral Use and Controversies for Strength Training. Presented at American College of Sports Medicine Annual Meeting, St. Louis (MO), May 2002.

References

Jones AM, Atter T, Georg KP. Oral creatine supplementation improves multiple sprint performance in elite ice-hockey players. J Sports Med Phys Fitness 1999;39(3):189-96. Kreider RB, Ferreira M, Wilson M, Grindstaff P, Plisk S, Reinardy J, Cantler E, Almada AL. Effects of creatine supplementation on body composition, strength and sprint performance. Med Sci Sports Exerc 1998;30(1);73-82. Mihic S, MacDonald JR, McKenzie S, Tarnopolsky MA. Acute creatine loading increases fat-free mass, but does not affect blood pressure, plasma creatinine, or CK activity in men or women. Med Sci Sports Exerc 2000;32(2):291-96. Nadir A, Agrawal S, King PD, Marshall JB. Acute hepatitis associated with the use of a Chinese herbal product, ma-huang. Am J Gastroenterol 1996;91(12):1436-8. NCAA. 2001-02 NCAA Banned-Drug Classes. Available at URL: [http://ncaa.org/sports_sciences/drugtesting/banned_list.html]. Poortmans JR, Auquier H, Renaut V, Durussel A, Saugy M, Brisson GR. Effect of short-term creatine supplementation on renal responses in men. Eur J Appl Physiol Occup Physiol 1997;76(6):566-67. Rico-Sanz J, Mendez Marco MT. Creatine enhances oxygen uptake and performance during alternating intensity exercise. Med Sci Sports Exerc 2000;32(2):379-85.

References

Romer LM, Barrington JP, Jeukendrup AE. Effects of oral creatine supplementation on high intensity, intermittent exercise performance in competitive squash players. Int J Sports Med 2001;22(8):546-52. Samenuk D, Link MS, Homoud MK, Contreras R, Theohardes TC, Wang PJ, Estes NA 3rd. Adverse cardiovascular events temporally associated with mahuang, an herbal source of ephedrine. Mayo Clin Proc 2002;77(1):7-9. Schanzer W. Analysis of Non-Hormonal Nutritional Supplements for AnabolicAndrogenic Steroids An International Study. Available through the official website of the International Olympic Committee 2002. Schilling BK, Stone MH, Utter A, Kearney JT, Johnson M, Coglianese R, Smith L, OBryant HS, Fry AC, Starks M, Keith R, Stone ME. Creatine supplementation and health variables: a retrospective study. Med Sci Sports Exerc 2001;33(2):183-88. Syrotuik DG, Game AB, Gillies EM, Bell GJ. Effects of creatine monohydrate supplementation during combined strength and high intensity training on performance. Can J Appl Physiol 2001;26(6):527-42. Tarnopolosky MA, Parise G, Yardley NJ, Ballantyne CS, Olatinji S, Phillips SM. Creatine-dextrose and protein-dextrose induce similar strength gains during training. Med Sci Sport Exerc 2001;33(12):2044-52.

References

Tarnopolosky MA, MacLennan DP. Creatine monohydrate supplementation enhances high-intensity exercise performance in males and females. Int J Sport Nutr Exerc Metab 2000;10(4):452-63. Vahedi K, Domigo V, Amarenco P, Bousser MG. Ischaemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for body building. J Neurol Neurosurg Psychiatry 2000;68(1):112-3. Vandebuerie F, Vanden Eynde B, Vandenberghe K, Hespel P. Effect of creatine loading on endurance capacity and sprint power in cyclists. Int J Sports Med 1998;19(7):490-95. Volek J. Nutritional Practices for Resistance Training. Presented at American College of Sports Medicine Annual Meeting, St. Louis (MO), May 2002. Volek JS, Mazzetti SA, Farquhar WB, Barnes BR, Gomez AL, Kraemer WJ. Physiological responses to short-term exercise in the heat after creatine loading. Med Sci Sports Exerc 2001;33(7):1101-8. Volek JS, Duncan ND, Mazzettti SA, Putukian M, Gomez AL, Kraemer WJ. No effect of heavy resistance training and creatine supplementation on blood lipids. Int J Sports Nutr Exerc Metab 2000;10(2):144-56.

References
Wallace B. Hormone Supplements and the Strength Athlete. Presented at American College of Sports Medicine Annual Meeting, St. Louis (MO), May 2002. Zaacks SM, Klein L, Tan CD, Rodriguez ER, Leikin JB. Hypersensitivity myocarditis associated with ephedra use. J Toxicol Clin Toxicol 1999;37(4):4859. http://www.usdoj.gov/ndic/pubs11/12620/steroids.htm