Dietary Supplements Targeted to Enhance Workouts and the Health Implications

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1 Dietary Supplements Targeted to Enhance Workouts and the Health Implications Matthew Vukovich, PhD FACSM Department of Health and Nutritional Sciences South Dakota State University

2 Dietary Supplements and Ergogenic Aids Dietary supplement a product intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin; a mineral; an herb or other botanical; an amino acid; a dietary substance for use by man to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above Ergogenic Aid Any substance, process, or procedure that may, or is perceived to, enhance performance through improved strength, speed, response time, or the endurance of the athlete.

3 Supplement Use Practice varies with type and level of sports nutrition practice Knowledge obtained from internet, discussion boards, friends and coaches. 50% to 90% of athletes use dietary supplements. Reasons for use Improved performance More muscle Poor diet Meets additional demands of training.

4 Sports Supplement Categories Protein Pre-Workout During Workout Post-Workout Stacks Enhance Training & Performance Natural Testosterone Support Growth Hormones Boosters

5 Efficacy and Safety Factors complicating the discussion of efficacy and safety Individual versus multiple ingredients Content versus label claim Contaminates intentional and unintentional Spiking Food, drug, supplement interaction Men and women Age of individual (young athletes versus master athletes) Studies funded by supplement companies.

6 Protein Protein needs of athletes can be as high as 2 to 3 times the RDA/RDI. 0.8 g/kg/day 2.4 g/kg/day Must consume adequate energy to support protein synthesis. Positive net protein balance occurs when protein is consumed throughout the day. Protein consumed before exercise and after exercise produces the same increase in net positive protein balance. Resistance training augments the increase in net protein balance Whey protein produces positive changes in testosterone, growth hormone, and IGF-I, promoting a positive net protein balance. Not observed with soy protein. Whey proteins promote a greater rise in whole-body protein synthesis than do casein proteins, the casein proteins attenuate whole-body proteolysis; the result is a greater retention of protein with casein than with whey.

7 Daily protein distribution - typical? - maximum rate of protein synthesis Catabolism Anabolism 10 g 15 g 65 g Total Protein 90 g A skewed daily protein distribution fails to maximize potential for muscle growth

8 Catabolism Anabolism Daily protein distribution - Optimal - maximum rate of protein synthesis 30 g 30g 30 g Total Protein 90 g ~ 1.3 g/kg/day Repeated maximal stimulation of protein synthesis increase / maintenance of muscle mass

9 Protein Supplements Safety Concerns Consumer Reports heavy metals Kidney no health risks with normal renal function. Bone Improves bone density.

10 Pre-Workout Supplements Marketed to Increase energy, focus and endurance. Stimulants Common ingredient is caffeine Dosages range from 50mg to 300mg per serving. May contain ephedrine, oxilofrine, or 1,3- dimethylamylamine Little to no support for other ingredients. Significant safety concerns.

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12 Claims and Research b-alanine -buffering agent - amino acid derivative increases muscle carnosine content, considered rate limiting for carnosine formation. 5g/d for 4 weeks Betaine derivative of glycine metabolized to di-methylglycine (DMG) and sarcosine Proposed to stimulate lipolysis, reduce lactic acid, inhibit lipogenesis, stimulate protein synthesis, stimulate GH & IGF-I release, stimulate insulin receptor signaling. 1g to 9 g/day. Research does not support claims. Taurine facilitates Ca 2+ dependent excitation-contraction processes, antioxidant. 5 g/day does not alter muscle taurine content or substrate metabolism N-Acetyl Cysteine- antioxidant chronic intakes of most antioxidants have a harmful effect on performance.

13 Claims and Research Citrullline increases arginine concentration, increase NO reduces lactate, 3 grams to 9 grams reduces time to exhaustion (ergolytic - hinders performance). BCAA - no acute affect at that dose. Huperzine A promotes immune and nervous system function memory Alzheimer s disease. 0.2 mg to.8 mg ( 200 mcg to 800 mcg) no improvement in performance Piper Nigrum Black Pepper antioxidant, antimicrobial memory Alzheimer s disease

14 Caffeine s Proven Effects Increases lipid oxidation Spares muscle glycogen Increases time to fatigue Prolonged submaximal (> 90 min) Sustained high-intensity (20-60 min) Short-duration supra-max (1-5 min) Likely beneficial in endurance sports No clear benefit in stop-&-go and strength/power events ~2 to mg/kg dose

15 Caffeine in Endurance Events o o Running o 4.2-sec faster 1.5-km o 1-3% faster 5-km o 24-sec faster 8-km o 50-sec faster 10-km military pack march o No change in 21-km race o Improved treadmill time-to-exhaustion in marathoners Cycling o 3.5% higher mean power in 40km race

16 Pre-Workout Supplements Safety Increased heart rate, arrhythmias, and blood pressure adolescents who sustained a recent TBI while playing sports had higher odds of recent energy drinks consumption than abstainers (Ilie, 2016) Decreases fine motor control

17 During Workout/Training Strength/Power Athletes Same as pre-workout energy Protein Endurance Athletes Carbohydrate sports drinks, gels, etc. caffeine

18 Enhance Training & Strength & Power Creatine Performance Loading phase 20 g/day for 3 days, Maintenance 3g/day More effective in trained vs. recreational vs untrained Performance improvements minimal Improves training adaptations

19 Endurance Enhance Training & Performance Various cocktail of ingredients with no supportive research. Caffeine, Ciwujia, DMG (n,n-dimethylglycine), Ginseng, MCT (medium chain triglycerides), Cordyceps sinensis (extracted from non-toxic mushrooms) Rhodiola Rosea (arctic root or golden root) Various diet modifications LCHF diets Paleo diets Train low Low CHO training days

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21 Cordyceps sinensis Considered one of the most valuable medicinal fungi in the Orient. It is naturally distributed in the eastern extension area of the Qinghai-Tibet plateau, at an altitude over 4000 m high. Parcell, et al g/d- 5-weeks 22 trained cyclists VO2peak, VT, time trial No effect on endurance capacity or performance Earnest, et al days 3g/d to 1g/day 17 competitive cyclists VO2peak, TTE, peak power, No effect on performance

22 Rhodiola rosea Also known as Arctic root, Golden root, or Crenulin Found in mountain regions of Siberia and Tibet Has a reputation of Stimulating the nervous system Decreasing depression Enhancing work performance Eliminating fatigue Preventing high altitude sickness DeBock, mg/d No acute effect on VO2 or TTF After 4wks no effect on VO2 or TTF

23 Adaptogens: Criteria for Defining Produces a non-specific response in an organism; i.e., an increases in power of resistance against multiple stressors including physical, chemical, or biological agents. Has a normalizing influence on physiology, irrespective of the direction of change from physiological norms caused by the stressor Is capable of influencing normal body functions more than required to gain non-specific resistance. Echinacea Ginseng Rhodiola-rosea

24 Ribose Research Dunne, g/d Rowers No affect on 2000m time Gallagher, g/d High-intensty cycling No affect on ATP or TAN No affect on performance Op T Eijnde, g/day No effect on isokinetic peak torque or power Kreider, g/d for 5 days 2, 30s Wingates No affect peak power, average power, torque, fatigue index, lactate, ammonia, glucose, or uric acid. Berardi, g over 36 hrs 6, 10s sprints ribose supplementation did not show reproducible increases in performance across all 6 sprints.

25 Anabolic Hormone boosters Focus is on building muscle and increasing muscle protein synthesis. Testosterone testosterone precursors Growth Hormone GH secretagogues IGF-I colostrum, deer antler velvet

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27 Biosynthesis of Androgens Cholesterol Cytochrome P450scc (desmolase) 17 α hydroxylase Pregnenolone 17-hydroxypregnenolone 17 α hydroxylase Dehydroepiandrosterone (DHEA) 17βHSD Androstenediol 3-βHSD 3-βHSD 3-βHSD Progesterone 17-hydroxyprogesterone Androstenedione 17 α hydroxylase 17 α hydroxylase C17 dehydrogenase/ 17βHSD Testosterone Estradiol Aromatase

28 Androgen and Estrogen DHEA-S DHEA Androstenedione Estrone (E1) DHT Testosterone Estradiol (E2) Estriol (E3)

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30 Tainted Supplements Such percentages are not comparable; instead they are provided as indications as to how difficult it is to ascertain or estimate the scale of this problem (Outram & Stewart, 2015).

31 Anabolic Hormone boosters Safety Contaminated products Hepatotoxicity Danazol C22-H27-N- O2 Fluoxymesterone C20-H29-F-O3 Methandienone C20-H28-O2 Methenolone C27-H42-O3 Methyltestosterone C20-H30-O2 Nandrolone C28-H44-O3

32 sexual enhancement, weight loss, and bodybuilding or athletic performance appeared to pose the greatest risk for patient harm due to product contamination with a pharmaceutical (Abe et al. 2015)

33 Efficacy and Safety Factors complicating the discussion of efficacy and safety Individual versus multiple ingredients Content versus label claim Contaminates intentional and unintentional Spiking Food, drug, supplement interaction Men and women Age of individual (young athletes versus master athletes) Studies funded by supplement companies.

34 Content versus label claim Gurley et al. (Am J Health Syst Pharm. 2000) 20 ephedrine containing products Content varied from 17% to 154% of label claim Cohen et al. (JAMA Internal Med. 2013) Caffeine Content varied from 27% to 113% of label claim in 25% of products Garg et al. (J Nutr Health Aging, 2013) 14 products Vitamin D3 2 registered formulations: 90% & 97% of label claim 12 supplements varied between 8% and 201% of label claim Manning et al. (J Herb Pharacother, 2003) Green tea analyzed for catechin content Catechin content ranged from 9% to 48% of label claims.

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38 HyperDrive 3.0 (ALR Industries) Ephedra Free Shredder (TBN Total Body Nutrition) Fastin (Hi_Tech Pharmaceuticals) Lean Pills (Line One Nutrition) Ephedra Free Tummy Tuck (TBN Total Body Nutrition) Methyl Drive 2.0 (ANS) Drop Factor (MTS Nutrition) Exile (AmericanMuscle Sports Nutrition Company) China White 25 Ephedra (Cloma Pharma Laboratories) Phenadrine (APS) Hypercor (Kat-a-lyst Nutraceuticals) MethylDrene 25 Ephedra Elite Stack (Cloma Pharma Laboratories) Maimi Lean (Skyline Nutrition) Eliminator X (Rok Hard Body Sports Nutrition)

39 FDA ments/productsingredients/default.htm a/sdnavigation.cfm?filter=&sortcolumn= 1a&sd=tainted_supplements_cder&page =1

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41 β-alanine β-alanine An amino acid derivative Synthesized naturally in the liver Increases carnosine concentrations within skeletal muscle

42 Carnosine is a buffer during high intensity exercise Short (30-60s) to long (1-2min) sprints Repeat sprints, Time to exhaustion, Peak power output, Anaerobic threshold

43 Smith et al, 2009 BA + HIIT 6.4 g BA/PL for 3 wks 3.2 g BA/PL for 3 wks Increase in: VO2max TWD Training volume LMB

44 3 to 6 g of βa per day for 4 weeks can elevate muscle carnosine content 60% and 80% in 10 weeks. βa most likely works by delaying fatigue through intra-muscular H+ buffering