Ergogenic Supplements

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Ergogenic Supplements
Gregory R. Schrader Anne Arundel Community
College Biology Department Arnold, MD
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INTRODUCTION

• In a survey conducted by researchers, 40 of the
  U.S. population is thought to use
  vitamins/mineral on a regular basis
• Of that 40, 14 use at least 1
  herbal/nutritional supplement per week
• 4 of all Americans (12million) have taken a
  sport supplement at least once
• 1.2 million use them regularly
• From 1992 - 1999 sales of dietary supplements
  increased from 3.3 billion to 12 billion

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INTRODUCTION

• A study examined male and female division I
  varsity athletes
• Types of supplements used
• 73 energy drinks
• 61 calorie replacement
• 47 multivitamins
• 37 creatine
• 32 vitamin C
• Information obtained from
• Males store nutritionist, fellow athletes,
  friends, coach
• Females family members
• Reason for taking
• Males improve speed and agility, strength and
  power, weight/muscle gain
• Females health or inadequate diet

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INTRODUCTION

• In a survey of 198 Olympic-level athletes in 1995
• 98 said would take banned substance if
  guaranteed victory and undetectable
• 50 said would take same substance if it would
  allow a winning season for 5 years but result in
  death
• High school survey of steroid use
• Indiana Football players use rate 6, mean
  age 14, 15 began before age 10
• 1600 Canadian students 6th grade 2.8

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INTRODUCTION

• Dietary Supplement Health and Education Act
• Act passed in 1994 stating that the US Food and
  Drug Administration (FDA) is not responsible for
  regulating/guaranteeing the purity or safety of
  dietary supplements
• Designed to promote health and prevent disease
• Restriction label cannot claim to cure, prevent,
  or treat a particular disease
• Performance enhancing substances
• Performance effects and safety
• Lack of long term studies
• Lack of studies on pediatric and adolescent
  population

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INTRODUCTION

• Fact or Fiction
• Industry claims
• Media and word of mouth
• Current research

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POPULAR SUPPLEMENTS

• Creatine
• Androstenedione
• HMB
• Ephedrine/MaHuang
• L-arginine (amino acid)

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CREATINE

• Most popular nutritional supplement
• From 1997 2000 sales increased 3x to 300
  million
• First reported use in 1992 Summer Olympics
• Prevalence in college athletes reported as high
  as 48 in college male athletes
• Research studies reported
• out of 1300 high school football players 30 were
  using creatine
• creatine use in middle and high school athletes
  aged 10 to 18. (n 1103)
• Results
• 5.6 admitted taking creatine
• Creatine use was reported in every grade 6-12
• 44 of grade 12 athletes surveyed reported using
  creatine (approaches level of use in college
  athletes)
• Creatine use more common in boys and sports such
  as football, wrestling, hockey, gymnastics, and
  lacrosse

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CREATINE

• Synthesis in the body
• Creatine is found naturally in the body
• Synthesized in the liver, pancreas, and kidneys
  from amino acids apporx. 1-2g/day
• Also consumed from animal products
• American diet of meat and fish provide 1-2g/day

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CREATINE

• In the body
• Phosphocreatine resynthesizes ATP during maximal
  exercise
• Requires transport into muscle via Na symporter
• Depletion of phosphocreatine highly correlates
  with a reduction in force
• 95 of all creatine is located in skeletal muscle
• Breakdown to creatine at a rate of approx. 2g/day

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CREATINE

• Synthesis in the body
• Creatine is found naturally in the body
• Synthesized in the liver, pancreas, and kidneys
  from amino acids
• Also consumed from animal products

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CREATINE

• Exercise
• The beginning of intense exercise short duration
• ATP (ATPase) ? ADP Pi E
• Phosphocreatine
• Pi Cr ? PCr
• Energy buffer
• PCr ADP H ? Cr ATP
• Recovery
• Cr ATP ? PCr ADP
• BOTTOM LINE CREATINE PROVIDES IMMEDIATE
  ENERGY FOR MUSCLE WORK

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CREATINE

• Exercise
• Storage in dry muscle is 125mmol/kg dependent
  on fiber type
• Different fibers types
• Type II (fast twitch)
• High resting concentration
• Depletion rate greater
• Type I (slow twitch)
• Low resting concentration
• Depletion rate lower

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CREATINE

• Forms of Supplementation
• Liquid serum form usually 1oz serving/day no
  loading required
• Powder white chalky powder
• Loading - (4-5) 1 tspn serving (20-25g)/day for
  5-7days
• Maintenance -(1-2) 1 tspn servings (5-10g)/day
• Concentrate seen in pill and gum form dosages
  vary with product
• Creatine Complex Multiple forms in one powder
  (e.g., creatine ester, creatine monohydrate,
  creatine alpha-ketoglutarate, tri-creatine
  malate)

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CREATINE

• Industry claims
• Increase muscle mass by increasing the intensity
  of workouts
• Increasing power (force per unit time) by
  increasing creatine stores
• Workout longer and harder
• Improve memory and intelligence

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CREATINE

• Word of mouth
• The more the better
• Causes dehydration, cramping and headaches
• Take with drinks containing sugar or caffeine

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CREATINE

• Current findings
• Research is done with powder form of
  supplementation
• Avg. results with common prescribed loading
  (20-25g)/day
• Increase in muscle Cr are approx. 20
  (150-155mmol/kg)
• Extremely variable between individuals
• Based on initial stores
• Muscle strength increased up to 30 with short
  term supplementation
• In other anaerobic activities such as sprints in
  cycling, swimming, and track and field, there has
  been mixed results

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CREATINE

• Current findings
• Acute Effects
• Short term use of Cr can significantly enhance
  the maintenance of muscle force and power during
  exhaustive bouts of exercise
• Due to supplying the increase demand placed on
  the immediate ATP system
• Cr supplementation does not seem to enhance
  aerobic oriented activities

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CREATINE

• Current findings
• Acute effects (cont)
• Increase in body mass of .5 2 kg
• Most likely due to increased water retention
  shown as a decreased urinary volume

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CREATINE

• Current findings
• Chronic Effects
• Very few studies have investigated the benefits
  and risks of long term creatine use
• To Date
• Most common 4-9 days showed improvement in muscle
  strength and 1-2.3 increase in body mass
  (debatable whether water or protein)
• 4 weeks of creatine supplementation effects on
  total lifting volume(TLV) and work(TW), and body
  composition in Div. 1A football players
• Increase in muscle strength (45)
• Increase in muscle mass

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CREATINE

• Current findings
• Side effects
• No direct cause and effect relationship between
  negative side effects and creatine use
• GI distress, nausea, and muscle cramping have
  been attributed to Cr supplementation
• Long term use
• Down regulation of creatine transport protein
• Not clear on significance of this finding
• Those with existing kidney problems
• Limited data on elderly and no safety data on
  young adults

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CREATINE

• Current findings
• Long term use
• A review published in 2005 states a lack of well
  controlled long term studies
• Four studies ranging from 2 months to over 5
  years of creatine supplementation have been
  conducted since 2002
• Many variables measured kidney, muscle, and
  liver enzymes, lipid profiles, electrolytes, etc
• No adverse effects noted
• One study found that effects of creatine on
  muscle function and muscle total creatine content
  declined with long term use ( 2-3 months)

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CREATINE

• Current findings
• Creatine combined with glucose or caffeine
• Glucose shown to enhance Cr accumulation in
  muscle via insulin response to carbohydrate
  ingestion
• 90 100g of glucose per 5g of creatine needed to
  elicit effect. This proportion is difficult to
  consume
• Caffeine shown to decrease the effect of
  creatine supplementation

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CREATINE

• Current findings
• Dosages
• All research using creatine supplementation has
  shown that the recommended doses are most
  effective and more is not better
• Loading - (4-5) 1 tspn serving (20-25g)/day for
  5-7days
• Maintenance -(1-2) 1 tspn servings (5-10g)/day
  Research is done with powder form of
  supplementation
• Research suggests that the powder be scooped
  directly in the mouth with a few sips of water
• Loading phase may not be necessary
• Most individuals consume 12-14g/day in the
  non-loading phase

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CREATINE

• Memory and intelligence
• To early to tell
• Few studies have shown a significant improvement
  on working memory and intelligence
• Problems how cognitive variables are measured

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ANDROSTENEDIONE

• In the body
• Androstenedione is found naturally
• Serves as a precursor to testosterone

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ANDROSTENEDIONE

• Exercise
• Common knowledge
• Increase testosterone production
• Increase muscle mass

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ANDROSTENEDIONE

• Form of supplementation
• Many different ways to take androstenedione
• Taken alone sublingual form
• Combined with other drugs (stacked)
• Tri andro (three types of andro)
• Nor andro (two types of andro)

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ANDROSTENEDIONE

• Industry claims
• 337 increase in testosterone levels for 2-3 hrs
• Increase muscle mass and strength
• Natural alternative to anabolic steroids

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ANDROSTENEDIONE

• Word of mouth
• Get the benefits of steroids without the side
  effects
• Testosterone is not elevated long enough to get
  negative effects
• Cycling not needed

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ANDROSTENEDIONE

• Current findings
• researchers looked at the effects of short and
  long term oral androstenedione supplementation in
  30 healthy, normotesterogenic men
• Results
• total testosterone levels were not affected by
  short or long term use
• Serum estrone and estradiol (female sex hormones)
  increased concentration after 2, 5 and 8 weeks of
  use

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ANDROSTENEDIONE

• Current findings
• Results (cont)
• Knee extension strength and mean cross sectional
  area of type 2 muscle fibers increased
  significantly and similarly in placebo and andro
  groups
• Increased in FFM and decrease in FM were also
  similar in both groups
• Decrease in HDL cholesterol levels after 2 weeks
  of andro use and remained low weeks 5 and 8

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ANDROSTENEDIONE

• Current findings
• researchers looked at the effects of
  androstenedione-6 (androstenedione, 300 mg
  dehydroepiandrosterone(DHEA), 150 mg) serum
  testosterone levels in healthy, normotesterogenic
  young men
• Results
• Serum free and total testosterone were not
  affected
• Serum estrone and estradiol were elevated
• No difference in strength b/w 2 groups
• 12 decrease in HDL cholesterol levels

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ANDROSTENEDIONE

• Risks
• Increased cardiovascular risk
• Increased estrogen levels
• Irreversible gynecomastia(male breast formation)
• Premature epiphyseal closure

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HMB

• In the body
• Beta-hydroxy-metylbutyrate (HMB) is naturally
  produced from proteins containing the amino acid
  Leucine
• Used in protein synthesis

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HMB

• Form of supplementation
• Tablet form most common
• 750 mg tablets
• Dosage
• 3-4 tablets a day
• 1 morning
• 1 midday
• 1-2 pre-exercise

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HMB

• Industry claims
• Increase strength and muscle mass by acting as a
  precursor to muscle that supports repair
• Cycling not needed
• Safe at recommended dose

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HMB

• Current findings
• Researchers examined the effects of HMB on 70
  normal healthy individuals
• Divided into 2 studies
• Study 1 looked at the effects of different levels
  of HMB on protein proteolysis(breakdown)
• Results 1.5-3.0g/day of HMB showed a reduction
  in proteolysis
• Study 2 looked at the effects of 3g/day HMB on
  FFM compared to control
• Results significant gains in FFM at weeks 2-4-6
  for HMB group compared to control

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HMB

• Current findings
• Another study looked at the effects of HMB on
  trained athletes
• Results
• 3 or 6g/day dosage of HMB for 28 days did not
  show a reduction in proteolysis or increase FFM
  or strength

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HMB

• Adverse Effects
• Insufficient data to date lack of controlled
  long-term studies

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MaHuang/Ephedrine

• Estimated 3 billion doses sold in 1999

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MaHuang/Ephedrine

• MaHuang dried stems of the ephedra plant, has
  been used in traditional Chinese medicine for
  5,000 years.
• MaHuang/Ephedrine Medically used for colds
  and flu, fever, chills, headache, edema,
  bronchial asthma, lack of perspiration, nasal
  congestion, aching joints and bones, and coughs
  and weezing.

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MaHuang/Ephedrine

• Chemistry
• Primary active ingredient is ephedra
• Dominant alkaloid is Ephedrine, which is the
  chemical copy of the herbal compound used as a
  drug in medicine
• Pseudo-ephedrine is a chemical isomer that
  similar to ephedra
• Ephedra contains both Pseudo-ephedrine and
  ephedrine, referred to as the ephedra alkaloids

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MaHuang/Ephedrine

• Pharmacology of ephedra alkaloids
• a(alpha) ß(beta) adrenergic agonists
• Enhances Sympathetic NS stimulation
• Peripheral vasoconstriction
• Bronchodilation
• Elevation of blood pressure
• Cardiac stimulation
• Diureses
• Potent CNS stimulant

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MaHuang/Ephedrine

• Form of supplementation
• Natural herbal pill form
• Diet pills
• Energy pills
• Combination of diet and energy products with
  caffeine or natural caffeine such as kola nut,
  guarana, or tea.
• Combined in sport drinks

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MaHuang/Ephedrine

• Industry Claims
• Weight loss and thermogenesis
• Ability to open adrenergic receptor sites found
  in heart and lungs, thereby increasing metabolic
  rate and caloric consumption
• Net result is a release of fatty acids from
  stored fat cells.
• Quicker consumption of fat into energy.
• Improve muscle strength and development
• Improve athletic performance

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MaHuang/Ephedrine

• Industry claims (cont.)
• Benefits body building and endurance athletes by
  promoting thermogenesis
• Increase contractile strength of muscle fibers,
  allowing bodybuilders to work harder and heavier

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MaHuang/Ephedrine

• Current findings
• Current studies show no increase in muscle
  strength, time to exhaustion, oxygen uptake,
  perceived fatigue
• Looking at a three fold increase in the
  theraputic dose of ephedra showed an increase
  in strength and power during 30 seconds of
  maximal cycling
• Higher doses may have ergogenic effect also
  increases risk

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MaHuang/Ephedrine

• Current findings
• International Journal of Obesity (1993)
• Ephedrine and caffeine as a thermogenic formula
• Found to be safe and effective for thermogenesis
• Many studies have shown when combined with
  caffeine products, the thermogenic effect can be
  improved as much as 20. Ratio of 20 mg
  ephedrine to 200 mg of caffeine(100-150mg/cup of
  coffee), 3x day. Significant decreases in total
  body weight observed
• One study looked at endurance benefits of
  ephedrine combined with caffeine
• Dose 1mg/Kg ephedrine 5mg/Kg caffeine
• Increase in time to exhaustion
• Decrease in perceived fatigue
• Nausea and vomiting
• Increased heart rate

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MaHuang/Ephedrine

• Current findings
• Largest review to date (Shekelle et. al)
• Showed a modest short-term weight loss of
  .9Kg/month more than placebo
• Also showed 2.2 3.6 fold increase in
  psychiatric, autonomic, GI symptoms and heart
  palpitations

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MaHuang/Ephedrine

• Toxicology
• Large Doses ( 150mg/d) can cause
• Nervousness
• Headaches
• Insomnia
• Dizziness
• Palpitations
• Skin flushing
• Tingling and vomiting

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MaHuang/Ephedrine

• Contraindications
• High blood pressure
• Gastric ulcer
• Active heart disease
• Stimulant sensitive
• Pregnant
• Diabetes
• Thyroid dysfunction
• Difficulty in urination due to enlarged prostate
  gland

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MaHuang/Ephedrine

• Potential Health Hazards
• 1995 Bureau of Food and Drug Safety in Texas
  received approx. 500 reports of adverse events
  associated with ephedrine containing products
• 2001 study in NEJM listed adverse events ranging
  from permanent disability to deaths either
  definitely or probably related to ephedra
• Approx. 21 states have passed regulations that
  are more stringent then federal regulations.
  Ephedrine by prescription only.
• DEA is concerned over the potential use of
  ephedrine in the manufacturing of illicit drugs.
• December 31, 2003 Ephedra banned by the FDA
  followed death of Baltimore Oriole prospective
  pitcher death autopsy showed ephedra linked to
  heat related death
• April, 2005 U.S. gov. Judge removes ban based on
  testimony of manufactures claim that Ephedra has
  been safely used for many years

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MaHuang/Ephedrine

• Potential Health Hazards
• Health care provider awareness (FDA)
• Question clients about use of dietary supplements
  and herbal medications
• Report any adverse effects to dietary
  supplements, including those containing ephedrine
  to FDAs Med Watch Program 800-FDA-1088
• Consumers can report to FDA hotline 800-FDA-4010

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L-ARGININE

• In the body
• L-Arginine is a conditionally essential amino
  acid
• produced in the kidney and to a lesser extent, in
  the liver.
• Serves as a precursor to Nitric Oxide(NO)

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L-ARGININE

• Nitric Oxide
• Relaxes smooth muscle in blood vessels
• Decreases blood pressure
• Increases blood flow and delivery of nutrients

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L-ARGININE

• Form of supplementation
• Capsule 500 -1000mg 1-4/day
• Powder form
• 5000mg 3/day
• Combined with other drugs (stacked)
• Creatine-arginine-glutamine

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L-ARGININE

• Industry claims
• Increase muscle mass and strength
• Decrease body fat
• Reduce risk of heart disease
• Support healthy blood sugar levels
• Boosts energy
• Supports healthy sexual performance

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L-ARGININE

• Word of mouth
• Get multiple benefits without side effects
• Can take at all ages

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L-ARGININE

• Current findings
• No consistent findings in healthy individuals
• A few studies have looked at individuals with
  heart failure or hypertension
• Results
• Decreased heart rate response to exercise
• Improved blood flow (determined by a decrease in
  non-oxidative blood markers)

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L-ARGININE

• Problems
• No dosage recommendation
• No consistent data with healthy individuals
• No long term studies

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L-ARGININE

• Risks
• may worsen heartburn, ulcers, or digestive upset
  cause by medications.
• increase stomach acid by stimulating the
  production of gastrin
• may alter potassium levels, especially in people
  with liver disease.
• may alter the levels of chloride, sodium, and
  phosphate.

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L-ARGININE

• Risks
• may increase blood sugar levels
• Shown to aggravate symptoms of genital herpes

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Up and Coming Supplements

• Supplements to watch
• Cortisol Blockers
• Chromium

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Reasons Athletes Take Ergogenic Drugs

• Increase in strength and power
• Increase in endurance
• Increase in aggressiveness
• Increase in speed and acceleration
• Enhancement of competitive attitude
• Enhancement of concentration
• Enhancement of eye-hand coordination
• Diminishment of pain perception
• Diminishment of anxiety
• Diminishment of fatigue
• Weight Control

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Substance Abuse and Dependence
Defining symptom of Substance Abuse UCR Use,
followed by adverse Consequences, followed by
Repetition of use and consequences. Adverse
consequences may occur in areas of physical
health, emotional health, or social functioning.
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Substance Abuse and Dependence

• Signs and Symptoms
• Continued use despite recurrent problems
• Impaired Control
• Tolerance and Withdrawal

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Substance Abuse and Dependence
Tolerance more of the substance to get the same
effect that smaller doses once produced Withdrawal
athlete feels physically ill when he or she
stops or cuts down use of the substance Athletes
with withdrawal symptoms have physical dependence.
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Patterns of Substance Use
Hazardous Use (At-Risk Use) places the athlete
at risk of developing problems Substance Abuse
(Problem Use) the continued use of a substance
despite harmful problems or adverse consequences
resulting from its use Substance Dependence
(Dependent Use) most severe and characterized
by impaired control over use, adverse
consequences, and sometimes tolerance and
withdrawal
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Screening Questions

• Have you felt you ought to cut down on your drug
  use?
• Have people annoyed you by criticizing your drug
  use?
• Have you felt bad or guilty about your drug use?
• Have you ever used drugs the first thing in the
  morning to steady your nerves or to get the day
  started (eye-opener)?

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Ethical Implications

• Nutritional Need or Athletic Overconformity
• Overconformity in sport suggest that athletes
  preparing for competition exhibit forms of
  positive deviance not because they disregard the
  social values of society but because they are
  willing to go beyond them
• Excessive supplementation is an example of such
  behavior

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Supplement Conclusion

• Beneficial without adverse effects on individuals
  health?
• Advertising claims vs. truth
• Responsible use
• Abuse and dependence
• Ethical considerations