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Sports Nutrition, Nutritional Sports Nutrition, Nutritional Supplements & Anabolic SteroidsSupplements & Anabolic Steroids
Sean T. Bryan, MD, FAAFP
Assistant Clinical Professor of Family Medicine,
Medical College of Georgia and
Mercer University School of Medicine
Program Director, SW GA Family Medicine Residency
Fellowship Director, SW GA Sports Medicine Program
Phoebe Putney Memorial Hospital
Albany, GA
2007 Sports Medicine Seminar for Coaches
OverviewOverview Increase awareness that nutrition can affect
athletic performance Discuss current nutritional recommendations
for athletes Review the 1994 Dietary Supplement Health
& Education Act Definition of a supplement Impact of this legislation
OverviewOverview Discuss specific nutritional supplements
commonly used by athletes Do they work? Are they safe?
Review the 2004 Anabolic Steroid Control Act Definition of an anabolic steroid Impact of this legislation
Help coaches answer questions and address concerns of athletes and parents
Performance Influencing FactorsPerformance Influencing Factors
Genetics
Training & conditioning
Nutrition
Determinants of the Athlete’s Determinants of the Athlete’s Energy RequirementsEnergy Requirements
During intense exercise Glycogen stored in muscles and liver is predominant
fuel source
During prolonged exercise Fat stores are predominant fuel source
Fitness level of the athlete Well trained endurance athletes burn fat more
efficiently thus sparing limited glycogen stores
Formula for Estimating the Formula for Estimating the Body’s Calorie RequirementsBody’s Calorie Requirements
Sedentary person Weight (kg) x 25
Moderately active person Weight (kg) x 30
Active person (endurance athlete) Weight (kg) x 40
Underweight person Weight (kg) x 45
RecommendationsRecommendations
Carbohydrate intakeCarbohydrate loadingProtein intakeFat intakePre-exercise meal
NOT “pre-game meal”
CarbohydratesCarbohydrates
Non-essential nutrient (human body can make sugar) Simple (sugars) and Complex (starches) Major fuel source for exercising muscle Athletes should ingest 6 to10 gm/kg/day
60 to 70% of total calories should come from carbohydrates Complex carbohydrates (starches) are preferable
During exercise 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
CarbohydratesCarbohydratesAfter 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?Why Complex Carbohydrates?
Compared to sugars, starches are better as a pre-exercise meal because they: Increase muscle glycogen stores better Improve performance and delay fatigue Lead to lower blood sugar and insulin levels Cause less stomach upset and indigestion Promote faster stomach emptying Provide other beneficial nutrients
Fiber, vitamins and minerals
Pre-exercise MealPre-exercise Meal
Importance Less hunger before and during exercise Maintains optimum glycogen stores
Recommendations Emphasize complex carbohydrates (starches)
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
Avoid high fiber or gas forming foods Can lead to crampy abdominal pain
Carbohydrate LoadingCarbohydrate Loading
Increases the body’s 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:Carbohydrate Loading:One ExampleOne Example
Days prior to event Exercise duration Carbohydrate intake
6 90 minutes 5 gm/kg/day
5 40 minutes 5 gm/kg/day
4 40 minutes 5 gm/kg/day
3 20 minutes 10 gm/kg/day
2 20 minutes 10 gm/kg/day
1 rest 10 gm/kg/day
ProteinProtein
Athletes require more protein than non-athletes 12 to 18% of total calories should come from protein Protein intake should be tailored to type of training
1.2 to 1.4 gm/kg/day recommended for endurance athletes 1.7 to 1.8 gm/kg/day recommended for strength athletes
ProteinProtein
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 contribute to dehydration
and possibly renal problems
FatFat
Major source of energy25 to 30% of total calories should come
from fat Less than 10% of total calories should come
from saturated fatsCholesterol intake should be < 300 mg/dayAverage American diet provides 37% of
total calories from fat
Nutritional SupplementsNutritional Supplements1994 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 SupplementsNutritional Supplements1994 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 MineralsVitamins 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 A few studies outside U.S. showed an effect
Did population studied have some baseline deficiency treated with these supplements?
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 MineralsVitamins 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
Vitamin C Anti-oxidant effect may help decrease exercise related
muscle soreness No effect on strength Possible toxic effects at high doses
Vitamins and MineralsVitamins 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
CreatineCreatineChemical name: Creatine-MonohydrateNaturally available in meat and fishNCAA study found creatine supplements
used by 12% of college athletesA subsequent survey of high school
athletes showed similar usage ratesMechanism of action
Unknown Energy source for exercising muscle?
CreatineCreatine Does supplementation:
Increase muscle mass? Increase strength? Increase athletic performance?
Is supplementation safe? Concerns about:
Increased muscle cramping Increased risk of muscle injury Increased risk of heat intolerance Increased risk of dehydration Increased risk of hepatic and/or renal disease
CreatineCreatine 9 studies showing (+) effects in healthy subjects
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
CreatineCreatine 9 Studies showing (+) 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
CreatineCreatine 4 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
Small placebo controlled trial in elite swimmers over 23 to 28 weeks - no statistically significant difference in maximal sprint test performance between groups
CreatineCreatine 5 Studies looking at safety 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 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
Oral supplementation for 7 days did not increase incidence of symptoms, compromise hydration or compromise thermoregulation in dehydrated trained men exercising in the heat
CreatineCreatine My opinion about creatine
In combination with high intensity strength training, creatine increases strength during high intensity intermittent exercise 7 to 8% more than training alone
Creatine increases performance in sports involving or requiring high intensity intermittent bursts of strength
Jumping, sprinting, cycling, hitting a ball Creatine does not help endurance athletes Long term effects (use > 4 years) are not known!
Dosing Loading: 20 to 30 gm/day for 5 to 7 days Maintenance:
3 to 5 gm/day 10 to 15 gm/day
Ephedra or MaHuangEphedra or MaHuang Herbal forms of the stimulant ephedrine 80 confirmed deaths related to ephedra use
Experts suspect many more unconfirmed deaths Adverse effects
High blood pressure (most common) Palpitations and increased heart rate Seizure Thermoregulatory dysfunction Stroke Heart attack Sudden death Vasculitis Allergic myocarditis (one case report) Acute hepatitis (one case report)
Ephedra or MaHuangEphedra or MaHuang Following the deaths of two pro athletes
(Korey Stringer & Steve Bechler), FDA banned sale of Ephedra as a nutritional supplement
Since this time, manufacturers have started substituting other stimulants “Ephedra Free” does NOT equal “safe”! Citrus Aurantium
Orange extract Chemical structure very similar to ephedrine
Anabolic Steroid PrecursorsAnabolic 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 PrecursorsAnabolic 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 body’s 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 PrecursorsAnabolic Steroid Precursors Potential adverse effects
May cause liver damage In females
Can cause hirsutism May increase risk of uterus cancer
In males Can cause gynecomastia May increase risk of prostate cancer May have legal implications May keep you out of MLB Hall of Fame
Anabolic Steroids AND Anabolic Steroids AND Anabolic Steroid PrecursorsAnabolic Steroid Precursors Are banned and tested for by the USOC, IOC,
NCAA, NFL, NBA and MLB 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!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 mcg/gm 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 2004Anabolic 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 Support for passing this law fueled by BALCO scandal
Anabolic Steroid Control Act of 2004Anabolic Steroid Control Act of 2004 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 National Survey on Drug Use and Health (NSDUH) includes questions concerning the use of these drugs.
Source: Library of Congress
749*749*
ConclusionsConclusions
Nutrition plays an important role in an athlete’s ability to perform
Proper nutrition in combination with sound and proven training techniques can help 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 remains unknown
Certain nutritional supplements have not demonstrated any performance benefit
ConclusionsConclusions Certain nutritional supplements can have
potentially dangerous side effects Further legislation is needed to address the
dangers of some nutritional supplements Health professionals in the community need to
be resources of accurate information for athletes, parents and coaches Physicians Nurse practitioners and physician assistants Physical therapists Athletic trainers School nurses Dieticians
Questions?Questions?Thank You!
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