A few supplements that may be useful in specific situations. Potential risks of supplement use

Transcription

1 Hazards of Supplement Use in Recreational Sports Ron Maughan United Kingdom

2 Outline of talk Prevalence of use Cost-benefit analysis A few supplements that may be useful in specific situations Potential risks of supplement use

3 Reasons for supplement use Supplements are a multibillion dollar business Most of the money is made from recreational athletes rather than from elite performers Their concerns are different from those of the elite athlete

4

5

6 Surveys generally suggest that supplement use: Varies across different sports and activities Increases with level of training/performance Increases with age Is higher in males Is strongly influenced by perceived norms

7 Surveys generally suggest that supplement use: Varies across different sports and activities Increases with level of training/performance Increases with age Is higher in males Is strongly influenced by perceived norms But many surveys are flawed because of: Inappropriate sample selection Non-validated survey instruments Lack of clear definition of supplements

8

9 Scientists are cautious and often not good at communication The power of advertising Consumers generally do not discriminate between scientific evidence and advertising hype Supplement sellers often have large budgets and can use effective advertising

10 A closer look...

11 JUNE 11 TH One Athlete s day 10.10am 3g L-lysine with 30mg Vit B6 4 phosphate tablets 2 scoops protein powder 3 teaspoon acetylglutamine 3g Vit C 3 tablets detox 50 mg zinc Drank isotonic drink whilst training 1.45pm 3g L-lysine with 30mg Vit B6 3g Vit C 3 tablets detox 50 mg zinc 11.00pm 3g L-lysine with 30mg Vit B6 3g Vit C 3 tablets detox 1 scoop protein powder 3 teaspoon acetylglutamine

12 Issues in Supplementation Efficacy: does it work? If so, under what conditions? Safety: are there any possible adverse effects of acute or chronic use even in excessive doses? Ethics: is its use in sport legitimate?

13 What can the scientists tell us? Performance in laboratory tests varies by about 1-10% on a day to day basis For an effect to be detected, it must be bigger than the daily variation Small effects will appear as no effect

14 We can t measure this difference in the laboratory, so we have to recognise that our information is limited. LONDON MARATHON 2003 % diff 1 G. Abera (ETH) 2:07:56 2 S. Baldini (ITA) 2:07: J. Ngolepus (KEN) 2:07: P. Tergat (KEN) 2:07: S. Ramadhani (TAN) 2:08: A. El Mouaziz(MOR) 2:08: L. Bong-Ju (KOR) 2:08:

15 Athens Olympic Games 2004 Men s Coxless Four FINAL Official result3:30 ET 8/21/2004 Schinias Rowing Centre Schinias Name Country Time 1 Steve Williams James Cracknell Ed Coode Matthew Pinsent Great Britain 6: Cameron Baerg Thomas Herschmiller Jake Wetzel Barney Williams Canada 6:07.06

16 Final Kelly Holmes, Great Britain Tatyana Tomashova, Russia Maria Cioncan, Romania Natalya Yevdokimova, Russia Daniela Yordanova, Bulgaria Lidia Chojecka, Poland 3:57.90 NR 3:58.12 PB 3:58.39 PB 3:59.05 PB 3:59.10 PB 3:59.27 SB

17 The difficulties in assessing efficacy are magnified many times when there is a less well-defined endpoint Even with a very large investment of time and money, it is unrealistic to expect proof of efficacy in areas such as: Wound healing Immune health Weight gain Muscle soreness Joint health Weight loss

18 Evidence of Safety? People take risks in the pursuit of their goals Sometimes they need protection from the consequences of their own actions Safety of supplements is usually ignored

19 Costs and Benefits It is important to think through the process of supplement use by a thorough cost-benefit analysis. A full analysis cannot be completed for most supplements as several parts of the equation are unknown. The sensible athlete will want to see positive reasons for using any supplement. Costs Benefits Financial Health risks Performance Drugs Improved performance Insurance policy Better health Free samples

20 Supplements may be useful if: A diagnosed deficiency cannot be corrected easily and promptly by changes to the diet A nutrition solution cannot be implemented immediately An athlete will not eat a varied diet There may be a beneficial effect on health or performance with no risk

21 Supplements with something to offer Good evidence for performance effects in some situations: Creatine Caffeine Bicarbonate Β-Alanine? Nitrate? Some evidence for performance related or health-related effects: Arginine/glutamine Carnitine Echinacea Glucosamine Antioxidants Vitamin C Zinc

22 Supplements: Adverse effects Some products contain impurities (lead, broken glass, animal faeces, etc) because of poor manufacturing practice Some products do not to contain expensive ingredients listed on the label but only inexpensive materials

23

24 Magnesium: Of nineteen products, two failed testing. One contained almost 50% more magnesium than claimed. At its upper serving size the product also exceeded the allowed amount of lead. Creatine: Half of the creatine products passed the testing (ie, half failed!). One product contained less than 1% of the claimed amount of creatine and contained more creatinine than creatine. Sexual enhancement: Of 22 sexual enhancement products, only 9 (41%) passed. Nutrition bars: Of 30 products tested, 60% failed to meet labelling claims and only 12 products met all criteria.

25

26 Testing by the New York Department of Health and the UF Food and Drug Administration has found that these products contain high levels of lead and mercury, which can cause serious health problems

27

28 FDA Analysis of Spirulina: Vitamin B12 content is due mainly to contamination with animal or insect faecal matter 15 flies 164 fly fragments 41 maggots 59 maggot fragments 1 ant 5 ant fragments 1 cicada 1 cicada pupa 763 insect fragments 9 ticks 4 mites 1000 ostracods 2 hairs rat/mouse 10 bird feathers 10 water fleas...

29 Creatine Serum 3 g creatine per ml No side effects

30 Creatine (mmol/l) Creatine Serum mmol/l solution ,610 CREATINE SERUM CREATINE MONOHYDRATE (Harris et al., J. Sports Sciences 2004)

31 Plasma creatine (mmol/l) Creatine Serum g Cr monohydrate ml Cr serum 0 min 30 min 60 min (Harris et al., J. Sports Sciences 2004)

32

33

34 More serious Some folate supplements may contain less than 25% of the stated dose If folate supplements really reduce neural tube defects in pregnancy, this is serious

35 Supplements: Adverse effects Athlete specific problems: Some products contain impurities (lead, broken glass, animal faeces, etc) because of poor manufacturing practice Some products do not to contain expensive ingredients listed on the label but only inexpensive materials Some products contain doping agents that are not declared on the label

36 Take the money and run Six of seven British track athletes who tested positive for 19- NA in used the same company s dietary supplements

37 The IOC Study: Cologne, non-hormonal nutritional supplements were obtained in 13 countries from 215 different suppliers 11 different anabolic androgenic steroids were found 94 (15%) samples contained prohormones not declared on the label ("positive supplements") No reliable data were obtained for 66 samples (10%) Samples contained prohormones of nandrolone and testosterone In most supplements, only trace levels were present For details, see:

38 How does contamination occur? Contamination may occur from two main causes: 1. Cross-contamination during the production process: the same equipment and storage facilities are used for supplements and for doping agents 2.Deliberate adulteration: many products are completely ineffective. Adding pharmaceuticals may mean that the consumer sees a benefit from using the product

39 Can it be an accident? Undeclared ingredients in supplements Muscle building Anabolic steroids Tonics Weight loss Stimulants: caffeine, ephedrine Anorectics: sibutramine Male enhancement Viagra, Cialis

40

41

42 Label of a glutamine product Centro Espanol de Medicina y Fisioterapia del Deporte General Pardinas 92, 315 Madrid, Spain "We declare that GM (glutamine) is controlled and produced in a chemical and technical high standard, so that no contamination with banned substances occurs" Not declared ingredients: Oxandrolone µg per capsule German Sport University Cologne Institute of Biochemistry

43 Manufacturer s guarantees

44

45 500 ml of water containing 5 g of creatine and 1.0, 2.5, or 5.0 µg of 19-norandrostenedione. 2.5 µg in 5 g is % 2.5 µg in 500 g is %

46 1-T matrix 3 supplements ordered by telephone from U.K. company (U.S. manufacturer) Ingredients not indicated on the label: Metandienone in all supplements Caffeine+ephedrine+pseudoephedrine in one supplement Therapeutic dose of metadienone: 5-10 mg per day Recommended dose: mg per day (Geyer et al., 2004)

47

48

49 Some Hydroxycut products are associated with a number of serious liver injuries. The FAD has received 23 reports of serious health problems ranging from jaundice....to liver damage requiring liver transplant. One death due to liver failure has been reported to the FDA.

50 Remember: if it looks too good to be true, it probably is.

51

52

53

54

55 Eight U.S. referral centers that are part of the DILIN from Consecutive patients with liver injury referred to a DILIN center were eligible. The final sample comprised 130 (16%) of all subjects enrolled (839) who were judged to have experienced liver injury caused by HDS. 45 had injury caused by bodybuilding HDS, 85 by nonbodybuilding HDS, and 709 by medications. Liver injury caused by HDS increased from 7% to 20% during the study period. Bodybuilding HDS caused prolonged jaundice (median, 91 days) in young men, but did not result in fatalities or LT. Liver injury from non-bodybuilding HDS is more severe than from bodybuilding HDS or medications, as evidenced by more unfavorable outcomes (death or transplantation).

56 Not just liver... British Journal of Cancer (2015) 112, doi: /bjc Published online 31 March a.html Muscle-building supplement use and increased risk of testicular germ cell cancer in men from Connecticut and Massachusetts N Li et al

57 Epidemiological study to examine the relationship between use of muscle-building supplements (MBSs) and testicular germ cell cancer (TGCC) risk Population-based case control study including 356 TGCC cases and 513 controls from Ct and Ma The odds ratio (OR) for ever use of MBSs in relation to risk of TGCC was significantly elevated (OR=1.65, 95% confidence interval (CI): ). The associations were significantly stronger among early users, men with more types of MBSs used, and longer periods of use

58 JUNE 11 TH One Athlete s day 10.10am 3g L-lysine with 30mg Vit B6 4 phosphate tablets 2 scoops protein powder 3 teaspoon acetylglutamine 3g Vit C 3 tablets detox 50 mg zinc Drank isotonic drink whilst training 1.45pm 3g L-lysine with 30mg Vit B6 3g Vit C 3 tablets detox 50 mg zinc 11.00pm 3g L-lysine with 30mg Vit B6 3g Vit C 3 tablets detox 1 scoop protein powder 3 teaspoon acetylglutamine No acetylglutamine Caffeine

59 An unexpected consequence Many of the papers in the scientific literature have used commercially available dietary supplements Where there was an effect, this may have been due to the presence of an undeclared drug Where there was no effect, this may have been due to the absence of the active ingredient

60 Risk management Athletes, and those who care for them, should take precautions: Use supplements only when a benefit is likely Use supplements and doses that are safe Use products that are low risk BUT, how do you assess risk?

61

62 Does this guarantee purity? Use of supplements that have been batch tested reduces the risk It does not guarantee freedom from substances that cause harm or adverse finding There is a finite limit to sensitivity of tests Not all prohibited substances are tested for Human error and criminal activity are possible The active ingredient is not tested for

63 The use of supplements does not compensate for poor food choices and an inadequate diet. Athletes contemplating the use of supplements and sports foods should consider their efficacy, their cost, the risk to health and performance, and the potential for a positive doping test. IOC Consensus Statement on Sports Nutrition

64 Maughan s Rules of Dietary Supplements for Athletes 1. If it works, it s probably banned 2. If it s not banned, then it probably doesn t work 3. There may be some exceptions

65

66 Summary and Conclusions Some supplements contain ingredients that may cause an athlete to fail a drugs test or harm health In many cases, these are not listed on the label Athletes can manage the risk by limiting supplement use and by using products from safe sources Food contamination presents a challenge for the athlete and for those who are responsible for doping control

67 Thank you!