NSPA's Personal Training Journal - 3 CEC's NUTRITIONAL ERGOGENIC AIDS FOR ACTIVE PEOPLE Leslie Bonci, M.P.H., R.D.
Email: lbonci@uoi.upmc.edu |
Speed, Strength, Low body fat, increased muscle mass…. the athlete’s mantra. Whether one is an athlete, or advising clients, the lure of products promising increased muscle mass, stamina and quicker recovery is irresistible. The preponderance of products on the store shelves as well as the electronic marketplace has dramatically increased availability and accessibility, without the guarantee of purity, safety or legality. Those who work in the sports arena must be aware of products that athletes/clients choose to take, and offer guidelines for use, as well as information regarding side effects. The goal of nutritional ergogenic aids is performance enhancement, but unfortunately, several supplements may have the opposite effect, or act as ergolytic substances. Nutritional supplements are big business, and the list of products is growing daily. Athletes will continue to look for the magic bullet, and as highly disciplined as one might be regarding training, the same degree of care and perseverance does not necessarily translate to supplement use, where the potato chip theory, "No one can take just one" seems to apply. It is also important to note that what may work for you, may NOT be appropriate for your client(s) The important points about supplement usage include:
The efficacy of a product may be affected by fluid balance, meal composition, and training. Athletes who use supplements to substitute for food, fluid or activity are in for a rude awakening. All the creatine, vitamins and ephedra will NOT replace the fuel and activity. In addition, athletes who are already at the peak of physical ability and consume an optimal diet will for the most part realize little, if any benefit from supplement use. There is nothing wrong with the placebo effect, provided the supplement will not be harmful to the athlete. Why do athletes take supplements? The following table lists the most commonly cited reasons for use.
Which supplements are taken most frequently? Table-2 lists the most commonly used supplements.
The most frequently and widely used category of nutritional ergogenic aids are those with supposed anabolic effects, to mimic the benefits of steroids in a legal manner. Creatine is by far, the most widely used supplement taken by both recreational and professional athletes. Creatine is synthesized in the kidneys, pancreas and liver from amino acid precursors, methionine, arginine, and glycine. It is also found in meat, fish and poultry and is absorbed intact by the gut when ingested. The ergogenic effect of creatine is attributed to its ability to increase tissue creatine levels, resulting in increased work capacity for intense activity and expediting the exercise recovery rate. This effect is seen more with activities requiring maximal or near maximal effort , not those involving submaximal endurance exercise. These benefits are most likely to be seen with a loading regimen of 20-25 grams of creatine over 5-7 days, divided into 4, 5 gram doses. For optimal effect, each dose of creatine should be consumed with a meal containing 90 grams of carbohydrate, and without caffeine., which can counteract the ergogenic effect. Muscle hypertrophy and fluid retention can cause a weight gain of 4-7 pounds during the loading phase. This increase may be advantageous for the strength athlete, but less so for the athlete who must move quickly. The extra weight may be of a detriment than a benefit. Short term studies do not show an increase in muscle strains, cramps or muscle pulls with creatine, but encouraging the athlete to maintain optimal hydration status is crucial. Creatine loading is sufficient to achieve the ergogenic effect, as the creatine levels will fall to pre-supplementation levels 6 weeks post loading. Another appropriate loading dose is 3 grams per day over a 1 month time period. Use should be discontinued with training cessation or injury. Since studies have not been conducted on high school athletes, it would be prudent to dissuade this group from supplementing with creatine, however, since this is not always possible, try to encourage young athletes to use only ½ the dose, and reinforce the need for adequate training, fluid and fuel intake. Other anabolic agents include HMB (beta-hydroxy-beta-methyl-butyrate) which in clinical studies has resulted in an increased in muscle mass, but the number of studies has been quite small. Boron is a trace mineral involved in cellular functions, but does not increase testosterone levels as claims would suggest. It can suppress appetite and impair digestion in doses > 50 mg per day. Yohimbe is derived from the tree bark of a South American plant, and confers a stimulant effect, not an anabolic effect. Ingestion of this product can cause dizziness, nervousness, headaches, nausea, vomiting and increased blood pressure. It can also interact with blood pressure medication and can increase the toxicity of psychotherapeutic medications and may be harmful to the kidneys. Chromium is an essential mineral involved in blood glucose control, that can be taken in a dosage of 50-300 mcg/day, but it does not have any anabolic effects. The other supposed anabolic agents include Dehydroepiandrosterone (DHEA), Androstenedione, and Tribulus Terrestris (Tribestan). All of these are banned by the NCAA, NFL, USOC, and The American Tennis Federation. Recently, an article published in JAMA demonstrated the ineffectiveness of androstenedione as an anabolic substance or strength enhancer, but did demonstrate potential worrisome side effects including a decrease in serum HDL level and an increase in serum estrone and estradiol increasing the likelihood of gynecomastia.(breast enlargement). Several laboratory tests have shown that the amount of actual product in these supplements can vary dramatically. Protein is certainly essential for muscle growth and development, but food sources will typically suffice to meet needs. If any supplements are used, protein powders will confer far more benefits than amino acid supplements. The maximum usable amount of protein is 1 x body weight ( pounds) for the number of grams of protein per day. Some protein powders are very high in protein, plus whatever is being ingested through food. In addition, the body can efficiently use soy, whey, milk and egg as well as meat, fish, and fowl as protein sources. The research on amino acid supplementation is very preliminary, and has been associated with GI side effects which may negate any potential ergogenic benefits. In addition, selective amino acid supplementation is a very inefficient way to provide protein to the body, and can create an amino acid imbalance. ENERGY BOOSTERS Many athletes choose to take supplements to boost energy. The most common ingredients in these type of products are 1) ginseng, 2) ephedra, and 3) caffeine. Ginseng functions as an adaptogen, or immune system stimulant, but does not have an effect on performance. Athletes who choose to take ginseng should look for Panax ginseng standardized to 4-7% ginsenosides with the following dosing regimen: 100-200 milligrams per day for 2-3 weeks, then 1-2 weeks of no use Ephedra (Ma Huang) is a central nervous system stimulant that is found in many cold, cough and anti-asthmatic preparations. It is an extremely popular "fat-burning" supplement sold as Metabolife, Xenadrine, Herbal Rush, Energy Rush, Thermoburn or Thermofuel among others, Ephedra may delay fatigue by sparing the body’s glycogen reserves during exercise, BUT can also increase blood pressure, respiration rate, heart rate,anxiety, migraines, irregular heartbeat and cause insomnia and nervousness. Often times ephedra and caffeine will be in the same product, which can be detrimental to the heart. The maximum safe level of ephedra is 24 mg per day, but many of these products contain in excess of 300 mg/dose. This supplement is contraindicated in those with a history of heart disease or hypertension, kidney or thyroid disease, seizure disorder or diabetes. Caffeine is a stimulant that may work in certain athletes by increasing free fatty acid availability to delay fatigue, improve reaction time, and reduce the perceived effort of exertion. It tends to be most effective in caffeine-naïve, trained endurance athletes with a dose of 200-300 milligrams of caffeine 1 hour prior to the event. The legal limit of caffeine is 800 milligrams, but this level can cause nervousness, anxiety, irritability, headaches, diarrhea, increased urination and diarrhea. In addition to products such as Vivarin, No-Doz, and Excedrin, caffeine can be found in herbal forms: guarana, mate, and kola nut. Taroxotone is a caffeine supplement containing 450 mg of caffeine per dose. WEIGHT LOSS AGENTS The other category of supplements is weight loss agents. These products contain ingredients such as L-carnitine (may prevent lactic acid accumulation) but does not promote fat loss, quercetin (an antioxidant) important for the heart but not to lose body fat, Hydroxycitrate (a diuretic), ephedra and caffeine, and senna and/or cascara (herbal laxatives). Chitin or chitosan ( advertised as a fat trapper or fat blocker) is the ground up shells of insects and shellfish that may lower cholesterol, but does not lower body fat. It can bind with calcium, iron and magnesium, and interfere with the absorption of Vitamins A, D, E and K). Weight loss experienced with use of these products is primarily due water loss associated with the laxative/diuretic components, not fat loss. There is some research looking at CLA ( conjugated linoleic acid) for fat loss, but the studies have been small and are not conclusive yet. Stay tuned! VITAMIN-MINERAL SUPPLEMENTS With so many products to pick from, it can be a consumer’s paradise or nightmare. The goal of a supplement is to enhance the nutritional value of the diet. Not to have a well supplemented, crappy meal plan. Multi-vitamin mineral supplements are designed to be taken daily with the following guidelines:
ANTI-INFLAMMATORY SUPPLEMENTS So what should one take for those occasional, or chronic aches and pain if NSAIDS (Motrin, Advil or Aleve) are not the answer? The research suggests that the following supplements may be of benefit. The goal is to try one at a time, to see what works, and what doesn’t.
DANGEROUS SUPPLEMENTS GBL/GHB ( Gamma butyrolactone and gamma hydroxy butryric acid) sold as Rest-Eze, Blue Nitro, Revivarant G, Ecstasy, GH Revitalizer, GHR, Remforce, Renewtrient, Gamma G. To date, use of these products has resulted in 3 deaths and 100 adverse reactions including coma and breathing difficulties. Starcaps ( TONE) contain large doses of furosemide or Lasix, a prescribed diuretic. The following suggestions are applicable to health care providers working with athletes:
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