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Cayuga Sports Medicine Conference - Supplements Update 2010

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Title: Cayuga Sports Medicine Conference - Supplements Update 2010


1
Cayuga Sports Medicine Conference - Supplements
Update 2010
  • By Lee A. Mancini, MD, CSCSD, CSNAssistant
    Professor UMass Medical School
  • Faculty UMass Sports Medicine Fellowship
  • Certified Strength and Conditioning Specialist
    with Distinction
  • Certified Sports Nutritionist

2
Background
  • Former D-I athlete / 1999 Boston Marathon
  • Numerous Sprint / Olympic Distance Tris
  • 15 years as Certified Sports Nutritionist
  • 15 years as Certified Strength Conditioning
    Specialist
  • UMass Sports Medicine Physician
  • Sports Nutrition consultant
  • Boston Red Sox Organization
  • Lowel Devils (NJ AHL affiliate)
  • Worcester Ice Cats (STL Blues AHL)
  • Holy Cross
  • UMass Amherst
  • Assumption College
  • Nichols College
  • Lived in Ithaca my entire life - graduated from
    Lansing High School

3
Goals Objectives
  1. Review a brief history of supplements
  2. Discuss how to examine supplement claims
  3. Review some common supplements
  4. Examine supplements specific for triathletes
    endurance athletes
  5. Ask Questions!

4
Historical Perspective
  • Ancient History
  • Aztecs
  • Chinese
  • Greeks
  • Ergogenic
  • Ergon
  • gennan

5
20th Century Supplements
  • Brown-Sequard in 1889
  • 1950s Dr. Ziegler
  • Methandrostenolone
  • IOC
  • 1968 1st list of banned substances
  • 1976 Montreal Olympic Games

6
The Supplement Industry
  • Nutrition Labeling and Education Act (NLEA)
    11/9/1990
  • Dietary Supplement Health and Education Act
    (DSHEA) 10/25/1994
  • Multibillion dollar industry
  • 1994 8.3 billion
  • 1999 14 billion
  • 2009 23.7 billion

7
The Supplement Industry
  • 2002 Health Diet Survey
  • 73 - 18 and older had used in past year
  • 2006 J of Adolescent Health
  • 79 used in past year
  • 48 used in past month
  • Creatine - 8 vs. 2
  • Weight Loss - 7 vs. 15

Timbo, BB, Ross, MP, McCarthy, PV, Lin, CT.
(2006) Dietary supplements in a national survey
Prevalence of use and reports of adverse events.
Journal of American Dietetic Association, 106
(12), 1966-74.
8
Three Questions
  • Is it effective?
  • Is it safe?
  • Is it legal?

9
Is it Legal?
  • Governing bodies have banned substance lists
  • IOC, NCAA, UCI, USAC, WADA, MIAA
  • Triathletes - USAT falls under USADA
  • Law enforcement penalties
  • Possession
  • Federal offense
  • 1 year and 1,000
  • Selling
  • Federal felony
  • 5 years and 250,000

10
Is it Legal? - Selling Ones Soul
  • Sports Psychology1987
  • Take a banned substance guarantee gold medal -
    and not get caught
  • 195 of 198 said YES
  • Take a banned substance - top athlete for 5 years
    - and then die in year 6
  • Over 50 said YES

11
Supplements Triathletes
  • Ground rules
  • Specific supplements
  • Proven Performance effects
  • Side effects
  • USAT follows USADA prohibited list

12
Banned Substance List
  • S1 - AAS
  • Nandrolone
  • Clenbuterol (asthma in other countries)
  • S2 - hormones and related substances
  • EPO, hGH, IGF-1, hCG, insulin, corticotrophins
  • PRP given IM prohibited
  • PRP tendon injections - requires Declaration of
    Use
  • DM pts - need TUE for insulin

13
Banned Substance List
  • S3 - Beta-2 Agonists -
  • Salbutamol (Ventolin, ProAir, DuoNeb)
  • Salmeterol (Advair, Serevent),
  • Others need TUE (terbutaline)
  • Oral use is prohibited
  • S4 - Agents with Anti-Estrogenic Activity
  • Aromatase inhibitors
  • SERMs - tamoxifen
  • Other Anti-Es - clomiphene

14
Banned Substance List
  • S5 - Diuretics and Masking Agents
  • Masking Agents
  • Plasma Expanders - Albumin, Dextran, Glycerol
    (supplements banned)
  • Alpha-reductase inhibitors - Finasteride
  • Epitestosterone
  • Diuretics
  • Furosemide
  • Spironolactone

15
Banned Substance List
  • Prohibited Methods
  • M1 - Enhancement of O2 transfer
  • Blood doping
  • M2 - Chemical Physical Manipulation
  • Tampering
  • IV infusions (even if non-banned substance unless
    in hospital setting)
  • M3 - Gene doping

16
Banned Substance List
  • Prohibited Substances IN Competition
  • S6 - stimulants
  • Pemoline, Prolintane
  • Ephedrine and methylephedrine - U gt 10mcg/ml
  • Pseudophedrine - U gt 150mcg/ml (D/C gt24hrs prior)
  • Athletes w/ ADD/ADHD
  • Need TUE
  • Not Prohibited
  • Caffeine

17
Banned Substance List
  • S7 - Narcotics
  • Fentanyl, Morphine
  • S8 - Cannabinoids
  • S9 - Glucocorticosteroids
  • PO, IV, PR, IM - (DOE/TUE)
  • Topical
  • P1 - ETOH
  • P2 - Beta-Blockers

18
Commonly Used Banned Substances
19
Erythropoietin Blood Doping
  • Natural hormone secreted by the kidney formation
    RBCs
  • r-HuEPO,Darbopoetin (Aranesp)
  • Blood removed from athlete
  • 1984 - 10 U.S. cyclists
  • Hemopure (based on bovine Hgb)
  • 2001 Giro dItalia cycling marathon
  • Enhances erythropoiesis by stim proerythroblasts
    formation

20
Epo Doping - Physiology
  • Endurance Exercise
  • RBC mass and plasma volume increases
  • Hct Hgb decrease due to expanded plasma volume
  • By increasing Hgb Hct
  • increases O2 carrying capacity
  • decreases ratings of perceived exertion
  • increases VO2 Max

21
Epo - Proven Effects
  • EPO for 26 days at 50 IU/kg led to
  • 7 increase in power
  • 9 increase VO2 Max
  • Increase Hct
  • After 6 weeks of EPO - 17 increase in cycling
    time to exhaustion
  • IV r-HuEPO works in days

22
Epo Doping - Adverse Effects
  • Because of increased RBC volume - causes
    increased blood viscosity
  • HTN
  • Seizures
  • DVTs, PEs
  • Stroke
  • Case report - cerebral sinus thrombosis

23
Epo Doping - Summary
  • Proven Performance effects for Endurance Athletes
  • Significant Risks
  • Banned by IOC in 1990
  • Banned by USADA
  • Banned by UCI
  • UCI testing since 1997
  • Hct 50 for men, 47 for women
  • UCI Certificate

24
Ephedra
  • Chinese herb, 5000yrs
  • Comes from Ephedra sinica plant
  • Ma huang
  • Known to relieve respiratory ailments
  • Mixed into herbal teas
  • Sale of it alone is prohibited
  • Make methamphetamine


25
Ephedra -Mechanism of Action
  • Stimulant that mimics effect Norepi Epi
  • Increases fat burning, Heart rate
  • Thermogenic effect
  • Increases resting metabolism, calorie expenditure
  • Causes appetite suppression

26
Ephedra - Proven Effects
  • Over 52 studies in literature (Shekelle et al.,
    2003)
  • All studies were less than 6 months
  • Average 1.0kg per month greater than placebo
  • Doses ranged from 25 to 120mg per day
  • Dose related effect

27
Ephedra - Adverse Effects
  • Wide variety of side effects
  • Heart palps, HTN, anxiety, hyperthermia,
    headaches, cardiac arrhythmias
  • Effects all stopped 48hrs after discontinuing
  • FDA 800 adverse incidents - gt90 exceeded
    recommended doses
  • FDA 284 serious adverse events - 5 deaths, 5
    heart attacks, 11 strokes, 4 seizures
  • 50 of these people lt 30 yo

28
Ephedra - Summary
  • Proven effect on fat loss
  • 0.82 all sales, 64 adverse
  • 4/12/04 Government bans Ephedra
  • 2006 US Court of Appeals upheld
  • Legal Ephedra - bitter orange
  • UCI - U gt 10mcg/ml

2/17/2003
29
Legal Ergogenic Aids
30
Creatine
  • 1832 Chevreul - Greek word flesh
  • Made from Arg, Gly, Meth, 95 - skeletal muscle
  • CrP ADP gt ATP Cr, enz Creatine kinase
  • Intense exercise ATP used first 10 secs
  • Also buffers muscle pH - delays muscle fatigue
  • Over 150 studies done, 93 in the past ten years

31
Creatine - Proven Effects
  • Overwhelming evidence Meta-analysis (Nissen et
    al., 2003)
  • 1.09 increase in strength per week
  • Increase 0.36 LBM per week (2.2 kg in 6 weeks)
  • 15 lbs added to 1RM Bench Press (6 weeks)
  • 25 lbs added to 1RM Back Squat (6 weeks)
  • 61 Studies - 45 found to improve endurance
    performance (running, swimming, rowing, biking)
  • Ergogenic effect on repeated high intensity
    sprints (lasting 30 seconds to 3 minutes)

32
Creatine - What about longer distances?
  • Events lasting longer than 3 minutes - 25 studies
    - 8 found no improvement, 17 did
  • Improved times in 5M and 15M sprints but slower
    times in 6K runs (by 26 seconds)
  • Long distance endurance events - additional
    muscle mass and water retention may slow athletes
    down

33
Creatine - Adverse Effects
  • KIDNEY ISSUES?
  • Because creatinine is breakdown product of
    creatine - concern over kidney function
  • (Crowe et al., 2003) Four year study, NCAA 3 yr
    study
  • No significant adverse effects up to five years
    after ingesting creatine (Dempsey et al., 2002)
  • (Eur J of App Physiol 2008 - Gualano et al)
    Double Blind, Randomized - 3 months
  • BOTTOM LINE - NO evidence on any effect on kidney
    function

34
Creatine - Adverse Effects
  • Main reported side effect GI distress
  • Case reports of muscle cramping, No studies
    showed increased cramping
  • No effect on body fluid balance or heat
    regulation
  • (2009 - meta-anlysis J Ath Train - Lopez et al.
  • (Br J Sports Med - 2008 - Dalbo et al)
  • BOTTOM LINE - No increased risk of dehydration,
    cramping, or issues with sweating or heat
    regulation

35
Creatine - Summary
  • Most widely used supplement
  • 30 Pro teams supply
  • 50 Male Div 1 use
  • 14 High School
  • 75 High School informed from who?
  • Proven Strength Anaerobic effects
  • GI Cramping side effects
  • No effect on kidney function
  • For Triathletes not very beneficial
  • NOT BANNED by IOC, UCI, WADA, USAC

36
HMB ß-hydroxy-ß-methylbutyrate
  • Metabolite of Leucine
  • Found in catfish, citrus fruit, breast milk
  • Believed to preserve LBM during fat loss
  • Anti-catabolic
  • 1998 Sales 50-60 Million Dollars

37
Proven Recovery Effects
  • (Nissen et al., 1997) - Exercise induced muscle
    damage after heavy resistance training
  • 1.5g/day or 3.0g/day - decreased protein
    breakdown
  • Increased muscle recovery
  • (Knitter et al., 2000) - 3g/day HMB for 6 weeks
  • 20K run - monitored LDH, CPK levels
  • Statistically significant - LDH CPK levels post
    exercise in HMB group

38
Proven Performance Effects
  • Meta-analysis (Nissen et al., 2003) of 9 studies
  • 0.28 increase LBM per week (6-8 weeks)
  • 1.40 increase in 1RM strength per week
  • (Nissen et al., 1996) - 1.5g/day and 3.0g/day for
    6 weeks, increased strength
  • (Kreider, 1999) - 3g/day for 8 weeks
  • Increases in LBM, decreases fat mass
  • Increases in upper and lower body 1RM strength
  • (Lamboley, 2007 - Int J Sport Nutr Exerc Metab) -
    Aerobic training 3/wk x 5 wks (3g/day) - Inc
    VO2Max 13.4 vs. 8.4 placebo, no change in body
    comp
  • (Watson, 2009 - J Str Cond Res) - no side effects
  • 3 g/day - small increases in 1RM, small decrease
    in fat mass, small increase in muscle mass

The Blond Bomber - Dave Draper
39
Adverse Effects
  • No reported side effects from any studies
  • (Juhn, 2003) - Using HMB for 8 weeks
  • No change renal fx, LFTs, Lipid panel
  • (Crowe et al., 2003) - Using HMB for 6 wks
  • No change in serum Test, BUN, Cr, Chol, TGs

40
Summary of HMB
  • Not Banned
  • Safe at the present
  • Increases maximal strength
  • Maintains LBM, Decreases fat mass
  • Cost - 40 for 200 pills
  • 4 pills 1 gram HMB
  • Servings 4 pills x 3 times/day 12 pills daily
  • 17 day supply
  • 80 per month

41
Caffeine
  • 1 Drug used in the world
  • 82-92 adults use daily
  • Methylated xanthine alkaloid derivative
  • 1,3,7-trimethylxanthine
  • Metabolized in liver p450
  • 3 Main metabolites
  • Theobromine, theophylline,
  • Paraxanthine most potent

42
Caffeine - Mechanism of Action
  • Structure is similar to adenosine
  • Binds to adenosine cell membrane receptors
  • Found everywhere
  • Stimulates CNS, increases release of Epinephrine
  • Increases HR, MR, resp center output decreases
    perceptions of pain, fatigue
  • One main effect on performance is by increasing
    fat oxidation - which spares muscle glycogen

43
Caffeine - Proven Effects
  • Effects have been studied for 100 years
  • Most studies 2-9mg/kg per day (250-750mg)
  • (Costill et al., 1978) - 300mg, cycle at 80 VO2
    Max until exhaustion
  • 90.2 minutes vs. 75.5 minutes
  • Increase max power in cyclists from 904 Watts to
    964 Watts (also vs. placebo)
  • Decrease race times from marathons to short
    sprints lasting less than 90 seconds (Graham,
    2001)
  • Studies in all three components of triathlon
    supporting this

44
Caffeine - Adverse Effects
  • Anxiety, heart palpitations, trembling, and
    facial flushing
  • Dose related
  • Lethal half-dose of caffeine is 150-200mg/kg
    bodyweight about 100cups
  • Tolerance to caffeine appears after 4-5 days
  • Only takes 3 days of use to develop dependency
    and withdrawal symptoms after stopping
  • Mood shifts, headaches, tremors, fatigue - 12h
    to 7d

45
Caffeine - Summary
  • Banned 1962 IOC
  • Removed 1972
  • Urine 12mcg/ml 9mg/kg
  • 6-7 cups 700-800mg
  • Proven effects on performance
  • Because of side effects at higher doses -
    3-6mg/kg better
  • Because of tolerance withdrawal - better to not
    take daily, but prior to specific competitions
  • Definite benefits for triathletes
  • 2005 IOC Removed completely from banned list
  • UCI, WADA

46
Beta Alanine
  • ß-alanine is amino acid
  • Carnosine (ß-alanyl-L-histidine)
  • Enzyme carnosine synthetase
  • Frequent sprints
  • Animal protein
  • Supplementation can increase beta-alanine by 80
  • Chemical buffer in myocytes
  • Delays fatigue

47
Beta Alanine - Ergogenic Effects
  • Most research past 3 years
  • 2006 study by Hoffman in Nutr Research
  • College football players
  • 30 days of 4.5g/day vs. placebo
  • 60 sec anaer power test
  • 3 - 200 yd shuttle run
  • 2007 study by Derave in J Appl Physiol
  • 4.8g/day vs. placebo
  • 400M sprints
  • Knee extensions - 5 x 30 reps
  • 2008 study by Kendrick in Amino Acids
  • 6.4g/day vs. placebo
  • 10 week lifting program
  • Strength, LBM, Body Fat - no change
  • 2009 study by Smith in J Int Soc Sports Nutr
  • 1.5g qid (6g/day) x 3 weeks, then 1.5g bid
    (3g/day) x 3 weeks,
  • 22yo (46 men)
  • 6 weeks 6 x 21 minute cycling
  • VO2 TTE,VO2peak,LBM

48
Beta Alanine - Summary
  • Building block of carnosine
  • Legal - not banned by any sports governing body
  • No documented side effects
  • Ergogenic effects
  • Increases muscle carnosine
  • Reduces fatigue - blood pH, buffer
  • Some studies have also shown no improvement on
    performance

49
Nitrous Oxide / Arginine
  • L-Arginine alpha-ketoglutarate (AAKG)
  • Arginine is a conditionally essential AA - 60
  • athletes
  • 2 main effects
  • Acute - NO increase blood flow nutritient
    delivery - increase exercise capacity
  • Chronic - anabolic GH effects, protein synthesis

50
NO / Arginine - Ergogenic Effects
  • 1989 Study by Elam in J Sports Med Phys Fitness
  • 5 week progresive strength program
  • 1g arginine 1g ornithine
  • Increase muscle strength/LBM
  • 2006 Study by Campbell in Nutrition
  • 10 men (30-50yo), 4g/day
  • 4 days lifting/wk x 8 weeks
  • 1RM BP, Anaer power, aerobic capacity, Body comp,
    Quad endurance
  • Only 1RM, Anaer power, arg plt0.5
  • 2008 Study by Little in Int J Sport Nutr Exerc
    Metab
  • Power, Muscle End, Max Str, - No change in body
    comp
  • More studies continue to show benefits

51
NO / Arginine - Summary
  • L-Arginine alpha-ketoglutarate (AAKG)
  • Pre-Cursor NO
  • Increase protein synthesis
  • Increase GH levels
  • Increase strength/power
  • No documented adverse effects
  • BUT no evidence that it improves aerobic capacity
    or endurance performance
  • Legal - not banned

52
Macronutrient Ergogenic Aids
53
Carbohydrates
  • Macronutrient
  • Aids muscle recovery glycogen stores
  • Source of instant energy as well
  • Insulin spike
  • 6-8 CHO solution
  • 8 T in 1 Gallon

54
Carbohydrates - Proven Effects
  • Evidence shows CHO beverages better than H2O
  • Study - cyclists 70 VO2 max, improved TTE 30
    minutes
  • 2004 - Mouth wash study (6.4 maltodextrin)
  • Central Drive vs. Metabolic Drive
  • Aerobic endurance

55
Carbohydrates - Summary
  • Proven performance effects
  • No adverse side effects
  • Not Banned
  • But is there something better?

56
PRO vs. CHO
  • What about Protein?
  • J Am Col Nutrition - 2004
  • Whey vs. CHO - 10 weeks
  • Whey
  • more strength gains
  • more bodyfat loss
  • less lean muscle wasting
  • lower pre-workout cortisol levels
  • Greater BONE DENSITY

57
Protein Quality
  • Whey/ Milk Proteins are more effective than
    Hydrolyzed Soy Protein for stimulating Protein
    Synthesis AA deposition in muscle.
  • Greater Lean Mass gains with training
  • Greater Strength in long-term
  • J Am Coll Nutr. 2005 Apr24(2)134S-139S.

58
Protein Quality
  • July 2009 Study in J Appl Physiol
  • Whey vs. Casein vs. Soy
  • 10g EEA mix after strength training
  • Men and Women - 12 weeks
  • Whey - More BCAAs
  • NON-WORKOUT
  • 90 muscle recovery/growth vs. casein
  • 25 more vs. soy
  • WORKOUT
  • 125 more vs. casein
  • 30 more vs. soy
  • Whey greater body comp changes
  • Whey greater strength gains

59
Carbohydrate Protein - Proven Effects
  • Combination of 6g EAAs and 35g CHO
  • 10X Insulin, 3X AA, 4X Pro vs. CHO, PLA
  • Studies showing superiority
  • VO2 Max
  • 75 - 29 (24mins)
  • 85 - 40 (12)
  • Reduced post-exercise muscle damage
  • CPK - 216 vs. 1318
  • Ready, Saunders

60
CHO PRO - Proven Effects
  • Study by Kreider in 2002 - placebo, Carb,
    CHO/PRO
  • Resistance training - 10X more insulin, 3X
    increase AA in skeletal muscle, 3 1/2X increase
    in protein synthesis in skeletal muscle
  • CHO - repletes glycogen stores, creates anabolic
    environement through insulin
  • PRO - increases muscle growth decreases muscle
    breakdown (Rennie Tipton in 2000)

61
PRO CHO - BCAAs
  • BCAAs - 20 AA in body
  • Higher amounts in animal proteins
  • Oxidation rises 300 to 500 during exercise
  • Levels drop by 25 in the 90 minutes following a
    workout
  • 1999 study by Mero - showed increase LBM,
    decrease BF
  • 30K race times 330 to 305 hrs with BCAA
    supplementation vs water, and carb (Kreider 1999)
  • Greer et al. in 2007 in Int J Sport Nutr Exerc
    Metab - CHO, BCAA
  • Review by Negro (2008 J Sports Med Phys Fit) -
    DOMS, Imp immune function via exer-related
    cytokine production

62
Carbohydrate Protein - Summary
  • Proven Benefits
  • Safe
  • 4-21 Ratio
  • During After
  • Not BANNED

63
Case 1
  • 17yo male HS athlete
  • Test 2xs NL
  • Estradial 3xs NL
  • HDL lt10
  • LDL 252
  • 10 week cycle
  • Went from 145 to 190
  • What do you do?

64
Case 1Revisited
  • 17yo male HS athlete
  • 3 Months later
  • Off D-Bol
  • Test WNL
  • Estradial WNL
  • HDL 42
  • LDL 104
  • ECHO - WNL
  • Weight now 163

65
Scenario
  • 19yo patient comes to your office
  • Wants to start taking supplement X.
  • What do you say?

66
Supplement Pyramid - What should I take?
  • Solid Foundation
  • Base - T / N / R
  • Ask the 3 ?s
  • 2nd Tier
  • MVI / Ca/Vit D
  • Whey Protein/PC
  • Fish Oil
  • 3rd Tier

67
Wrapping it up
  • Educate
  • Open mind
  • Supplement Pyramid
  • Sports specificity

68
Caveat Emptor
  • One final warning
  • Delbeke et al., 2002
  • OTC Pyruvate
  • USAC Position Statement - 1/26/06
  • Warning Any athlete who takesdoes so at his or
    her own risk of committing a doping violation
  • UCI, US-ADA, WADA, or IOC
  • Remember, the athlete is ALWAYS responsible for
    what he or she puts into his or her body
  • 1-800-233-0393
  • (US-ADA)
  • www.usantidoping.org

69
On-line Resources for help
  • Important Web Sites
  • http//www1.ncaa.org/membership/ed_outreach/health
    -safety/drug_testing/banned_drug_classes.pdf
  • NCAA site on banned substances
  • http//www.theathlete.org/wada.htm
  • World Anti-Doping Agency

70
Thank You
71
References
  • Anantaraman, R., Carmines, A.A., Gaesser, G.A.,
    Weltman, A. (1995). Effects of carbohydrate
    supplementation on performance during 1 hour of
    high intensity exercise. International Journal
    of Sports Medicine, 16, pp. 461-465.
  • Armstrong, L.E. (2002, June). Caffeine, body
    fluid-electrolyte balance, and exercise
    performance. International Journal of Sport
    Nutrition Exercise Metabolism, 12(2), pp.
    189-207.
  • Audran, M., Gareau, R., Matecki, S. (1999).
    Effects of erythropoetin administration in
    training athletes and possible indirect detection
    in doping control. Medical Science in Sports and
    Exercise, 31(5), pp. 639-645.
  • Ball, T.C., Headley, S.A., Vanderburgh, P.M.,
    Smith, J.C. (1995). Periodic carbohydrate
    replacement during 50 min of high-intensity
    cycling improves subsequent sprint performance.
    International Journal of Sports Nutrition, 5, pp.
    151-158.
  • Barr, S.I. (1999). Effects of dehydration on
    exercise performance. Canadian Journal of
    Applied Physiology, 24 (2), pp. 164-172.
  • Bell, D.G., Jacobs, I., Ellerington, K. (2001).
    Effect of caffeine and ephedrine ingestion on
    anaerobic exercise performance. Medicine and
    Science in Sports and Exercise, 33(8), pp.
    1399-1403.

72
References
  • Below, P.R., Mora-Rodriguez, R., Gonzalez-Alonso,
    J., Coyle, E. (1995). Fluid and carbohydrate
    ingestion independently improve performance
    during 1h of intense exercise. Medicine
    Science in Sports and Exercise, 27, pp. 200-210.
  • Berglund, B., Birgegard, G., White, L.,
    Pihlstedt, P. (1989). Effects of blood
    transfusions on some hematological variables in
    endurance athletes. Medicine Science in Sports
    and Exercise, 21, pp. 637-642.
  • Berglund, B., Hemmingson, P. (1987). Effect
    of reinfusion of autologous blood on exercise
    performance in cross-country skiers.
    International Journal of Sports Medicine, 8, pp.
    231-233.
  • Branch, J.D. (2003, June). Effect of creatine
    supplementation on body composition and
    performance A meta-analysis. International
    Journal of Sport Nutrition Exercise Metabolism,
    13(2), pp. 198-207.
  • Brien, A., Simon, T.L. (1987). The effects of
    red blood cell infusion on 10km race time.
    Journal of the American Medical Association, 257,
    pp. 2761-2765.
  • Brown, G.A., Vukovich, M.D., Reifenrath, T.A.,
    Uhl, N.L., Parsons, K.A., Sharp, R.L., King,
    D.S. (2000). Effects of anabolic precursors on
    serum testosterone concentrations and adaptations
    to resistance training in young men.
    International Journal of Sport Nutrition and
    Exercise Metabolism, 10, pp. 340-359.
  • Buckley, J., Abbott, M., Martin, S., Brinkworth,
    G., Whyte, P. (2002). Effect of oral bovine
    colostrums supplement on running performance.
    Journal of Science and Medicine in Sport, 5, pp.
    65-79.

73
References
  • Buick, F., Gledhill, N., Froese, A.B., Spriet,
    L., Meyers, E.C. (1980). Effect of induced
    erythrocythemia on aerobic work capacity.
    Journal of Applied Physiology, 48, pp.
    R636-R642.
  • Cater, J.M. (2004). The effect of carbohydrate
    mouth rinse on 1-h cycle time trial performance.
    Medicine Science in Sports and Exercise, 36
    (12), pp. 2107-2111.
  • Catlin, D.H. MD, Murray, T.H. PhD. (1996,
    July). Performance-enhancing drugs, fair
    competition, and Olympic sport. Journal of the
    American Medical Association, 276(3), pp.
    231-237.
  • Chandler, J.V. Blair, S.N. (1980). The effect
    of amphetamines on selected physiological
    components related to athletic success. Medicine
    and Science in Sports and Exercise, 12, pp.
    65-69.
  • Coggan, A.R.,, Coyle, E.F. (1991).
    Carbohydrate ingestion during prolonged exercise
    effects on metabolism and performance. Exercise
    and Sport Sciences Reviews, 19, pp. 1-40.
  • Coombes, J.S., Conacher, M., Austen, S.K.,
    Marshall, P.A. (2002). Dose effects of oral
    bovine colostrums on physical work capacity in
    cyclists. Medicine Science in Sports and
    Exercise, 34 (7), pp. 1184-1188.

74
References
  • Costill, D.L., Dalsky, G.P., Fink, W.J.
    (1978). Effects of caffeine ingestion on
    metabolism and exercise performance. Medicine
    and Science in Sports and Exercise, 10, pp.
    155-158.
  • Cottrell, G.T., Coast, J.R., Herb, R.A.
    (2002). Effect of recovery interval on
    multiple-bout sprint cycling performance after
    acute creatine supplementation. Journal of
    Strength and Conditioning Research, 16(1), pp.
    109-116.
  • Coyle, E.F. (1992). Carbohydrate feeding during
    exercise. International Journal of Sports
    Medicine, 13(S1), pp. S126-S128.
  • Crist, D.M., Peake, G.T., Egan, P.A., Waters,
    D.L. (1988). Body composition response to
    exogenous GH during training in highly
    conditioned athletes. Journal of Applied
    Physiology, 65, pp. 579-584.
  • Dawson, R.T. (2001). Drugs in sport The role
    of the physician. Journal of Endocrinology, 170,
    pp. 55-61.
  • Delbeke, F.T., Van Eenoo, P., Van Thuyne, W.,
    Desmet, N. (2002, December). Prohormones and
    sport. The Journal of Steroid Biochemistry and
    Molecular Biology, 83(1-5), pp. 245-251.

75
References
  • Delbeke, F.T. (1996). Doping in cyclism
    Results of unannounced controls in Flanders
    (1987-1994). International Journal of Sports
    Medicine, 17 (6), pp. 434-438.
  • Dempsey, R.L., Mazzone, M.F., Meurer, L.N.
    (2002, November). Does oral creatine
    supplementation improve strength? A
    meta-analysis. The Journal of Family Practice,
    51(11), pp. 945-951.
  • Dolny, D.G., Lemon, P.W.R., Yarasheki, K.E.
    (1997). Moderate physical activity can increase
    dietary protein needs. Canadian Journal of
    Applied Physiology, 22(5), pp. 494-503.
  • Dorr, H., Ranke, M.B., Wuster, C. (2002).
    Effects of growth hormone on skeletal muscle.
    Hormone Research, 58(S3), pp. S43-S48.
  • Eichner, E. (1992). Better dead than second.
    Journal of Laboratory and Clinical Medicine, 120,
    pp. 359-360.
  • El-Sayed, M.S., Balmer, J., Rattu, A.J.M.
    (1997). Carbohydrate ingestion improves
    endurance performance during a 1h simulated
    cycling time-trial. Journal of Sports Sciences,
    15, pp. 223-230.
  • Fielding, R.A., Parkington, J. (2002). What
    are the dietary protein requirements of
    physically active individuals? New evidence on
    the effects of exercise on protein utilization
    during post-exercise Recovery. Nutrition in
    Clinical Care, 5(4), pp. 191-196.

76
References
  • Graham, T.E. (2001, 11). Caffeine and exercise
    Metabolism, endurance, and performance. Sports
    Medicine, 31, pp. 785-807.
  • Graham, T.E., Hibbert, E., Sathasivam, P.
    (1998). Metabolic and exercise endurance effects
    of coffee and caffeine ingestion. Journal of
    Applied Physiology, 85, pp. 883-889.
  • Green, A.L., Hultman, E., Macdonald, I.A.
    (1996). Carbohydrate ingestion augments skeletal
    muscle creatine accumulation during creatine
    supplementation in humans. American Journal of
    Physiology, 271(5), pp. E821-E826.
  • Haff, G.G., Koch, A.J., Potteiger, J.A., Kuphal,
    K.E., Magee, L.M., Green, S.B., Jakicic, J.J.
    (2000). Carbohydrate supplementation attenuates
    muscle glycogen loss during acute bouts of
    resistance exercise. International Journal of
    Sports Nutrition and Exercise Metabolism, 10, pp.
    326-339.
  • Haff, G.G., Lehmkuhl, M.J., McCoy, L.B., Stone,
    M.H. (2003). Carbohydrate supplementation and
    resistance training. Journal of Strength and
    Conditioning Research, 17(1), pp. 187-196.
  • Hargreaves, M. Snow, R. (2001). Amino acids
    and endurance exercise. International Journal of
    Sport Nutrition and Exercise Metabolism, 11, pp.
    133-145.
  • Haskell, S.G. (2003, May). Selective estrogen
    receptor modulators. Southern Medical Journal
    96(5), pp. 469-476.

77
References
  • Hawley, J.A., Burke, L.M., Angus, D.J., Fallon,
    K.E., Martin, D.T., Febbraio, M.A. (2000).
    Effect of altering substrate availability on
    metabolism and performance during intense
    exercise. British Journal of Nutrition, 84(6),
    pp.
  • Haub, M.D., Haff, G.G., Potteiger, J.A.
    (2003). The effect of liquid carbohydrate
    ingestion on repeated maximal effort exercise in
    competitive cyclists. Journal of Strength and
    Conditioning Research, 17(1), pp. 20-25.
  • Ivy, J.L., Goforth, H.W., Damon, B.W., McCauley,
    T.R., Parsons, E.C., Price, T.B. (2003).
    Effect of a carbohydrate-protein supplement on
    endurance performance during exercise of varying
    intensity. International Journal of Sports
    Nutrition and Exercise Metabolism, 13, pp.
    388-401.
  • Juhn, M.S. (2003). Popular sports supplements
    and ergogenic aids. Sports Medicine, 33(12), pp.
    921-939.
  • Kennedy, M.C. (2000). Newer drugs used to
    enhance sporting performance. Medical Journal of
    Australia, 173, pp. 314-317.
  • Kreider, R.B. (1999, February). Dietary
    supplements and the promotion of muscle growth
    with resistance exercise. Sports Medicine,
    27(2), pp. 97-111.

78
References
  • Kutscher, E.C., Lund, B.C., Perry, P.J.
    (2002). Anabolic steroids A review for the
    clinician. Sports Medicine, 32(5), pp. 285-296.
  • Lage, J.M.M., Panizo, C., Masdeu, J., Rocha, E.
    (2002). Cyclists doping associated with
    cerebral sinus thrombosis. Neurology, 58, pp.
    665.
  • Latzka, W.A., Montain, S.J. (1999, July). Water
    and electrolyte requirements for exercise.
    Clinics in Sports Medicine, 18(3), pp. 513-524.
  • Lemon, P.K. (2000). Beyond the zone Protein
    needs of active individuals. Journal of the
    American College of Nutrition, 19(5), pp.
    513S-521S.
  • Lemon, P.K. (1998). Effects of exercise on
    dietary protein requirements. International
    Journal of Sport Nutrition, 8, pp. 426-447.
  • Miller, S.L., Maresh, C.M., Armstrong, L.E.,
    Ebbeling, C.B., Lennon, S., Rodriguez, N.R.
    (2002, December). Metabolic response to
    provision of mixed protein-carbohydrate
    supplementation during endurance exercise.
    International Journal of Sport Nutrition
    Exercise Metabolism, 12(4), pp. 384-398.
  • Longobardi, S., Keay, N., Ehrnborg, C.,
    Cittadini, A., Rosen, T., Dall, R., Boroujerdi,
    M.A., Bassett, E.E., Healy, M.L., Pentecost, C.,
    Wallace, J.D., Powrie, J., Jorgensen, J.O.,
    Sacca, L. (2000, April). Growth hormone (GH)
    effects on bone and collagen turnover in healthy
    adults and its potential as a marker of GH abuse
    in sports A double blind, placebo-controlled
    study. The Journal of Clinical Endocrinology
    Metabolism, 85(4), pp. 1505-1512.

79
References
  • Mayhew, D.L., Mayhew, J.L., Ware, J.S. (2002,
    December). Effects of long-term creatine
    supplementation on liver and kidney functions in
    American college football players. International
    Journal of Sport Nutrition Exercise Metabolism,
    12(4), pp. 453-451.
  • Mottram, D.R. (1999, January). Banned drugs in
    sport Does the International Olympic Committee
    (IOC) list need updating? Sports Medicine,
    27(1), pp. 1-10.
  • Nissen, S.L., Sharp, R.L. (2003, February).
    Effect of dietary supplements on lean mass and
    strength gains with resistance exercise a
    meta-analysis. Journal of Applied Physiology,
    94(2), pp. 651-659.
  • Ready, S.L., Seifert, J.G., Burke, E. (1999).
    The effect of two sports drink formulations on
    muscle stress and performance. Medicine
    Science in Sports and Exercise, 31, pp. S119.
  • Rennie, M.J., Tipton, K.D. (2000). Protein
    and amino acid metabolism during and after
    exercise and the effects of nutrition. Annual
    Reviews in Nutrition, 20, pp. 457-483.
  • Roltsch, M.H., Flohr, J.A., Brevard, P.B.
    (2002, December). The effect of diet
    manipulations on aerobic performance.
    International Journal of Sport Nutrition
    Exercise Metabolism, 12(4), pp. 480-490.

80
References
  • Rowlands, D.S., Hopkins, W.G. (2002a, June).
    Effects of High-Fat and High-Carbohydrate Diets
    on Metabolism and Performance in Cycling.
    Metabolism, 51(6), pp. 678-690.
  • Rozenek, R., Ward, P., Long, S., Garhammer, J.
    (2002, September). Effects of high-calorie
    supplements on body composition and muscular
    strength following resistance training. Journal
    of Sports Medicine and Physical Fitness, 42(3),
    pp. 340-347.
  • Saunders, M.J., Kane, M.D., Todd, M.K. (2004).
    Effects of a carbohydrate-protein beverage on
    cycling endurance and muscle damage. Medicine
    Science in Sports and Exercise, 36 (7), pp.
    1233-1238.
  • Schoffstall, J.E., Branch, J.D., Leutholtz, B.C.,
    Swain, D.P. (2001). Effects of dehydration
    and rehydration on the one-repetition maximum
    bench press of weight-trained males. Journal of
    Strength and Conditioning Research, 15(1), pp.
    102-108.
  • Schumacher, Y.O., Grathwohl, D., Barturen, J.M.,
    Wollenweber, M., Heinrich, L., Schmid, A., Huber,
    G., Keul, J. (2000). Haemoglobin, haematocrit
    and red blood cell indiceds in elite cyclists.
    Are the control values for blood testing valid.
    Internation Journal of Sports Medicine, 21, pp.
    380-385.

81
References
  • Schwenk, T.L., Costley, C.D. (2002). When
    food becomes a drug Nonanabolic nutritional
    supplement use in athletes. The American Journal
    of Sports Medicine, 30, pp. 907-916.
  • Shekelle, P.G. MD, PhD Hardy, M.L. MD Morton,
    S.C. PhD Maglione, M. Mojica, W.A. MD, MPH
    Suttorp, M.J. MS Rhodes, S.L. MFA Jungvig, L.
    BA Gagne, J. MD. (2003, March). Efficacy and
    safety of ephedra and ephedrine for weight loss
    and athletic performance A meta-analysis.
    Journal of the American Medical Association,
    289(12), pp. 1537-1545.
  • Skolnick, A.A. (1996, February 7). Finding the
    most reliable dope on doping. Journal of the
    American Medical Association, 275(5), pp.
    349-350.
  • Smith, J. MD, Dahm, D.L. MD. (2000, December).
    Creatine use among a select population of high
    school athletes. Mayo Clinic Proceedings,
    75(12), pp. 1257-1263.
  • Smith, W.D. (2003). LC-ESI-MS/MS draws the line
    on doping. Analytical Chemistry, pp. 337A.
  • Wallace, J.D., Cuneo, R.C., Baxter, R., Orskov,
    H., Keay, N., Pentecost, C., Dall, R., Rosen, T.,
    Jorgensen, J.O., Cittadini, A., Longobardi, S.,
    Sacca, L., Christiansen, J.S., Bengtsson, B.,
    Sonksen, P.H. (1999). Responses of the growth
    hormone (GH) and insulin-like growth factor axis
    to exercise, GH administration, and GH withdrawl
    in trained adult males A potential test for GH
    abuse in sport. The Journal of Clinical
    Endocrinology Metabolism, 84(10), pp.
    3591-3601.

82
References
  • Warber, J.P., Tharion, W.J., Patton, J.F.,
    Champagne, C.M., Mitotti, P., Lieberman, H.R.
    (2002). The effect of creatine monohydrate
    supplementation on obstacle course and multiple
    bench press performance. Journal of Strength and
    Conditioning Research, 16(4), pp. 500-508.
  • Wilder, N., Gilders, R., Hagerman, F., Deivert,
    R.G. (2002). The effects of a 10-week,
    periodized, off-season resistance-training
    program and creatine supplementation among
    collegiate football players. Journal of Strength
    and Conditioning Research, 16(3), pp. 343-352.
  • Williams, M.B., Raven, P.B., Fogt, D.L., Ivy,
    J.L. (2003). Effects of recovery beverages on
    glycogen restoration and endurance exercise
    performance. Journal of Strength and
    Conditioning Research, 17, pp. 12-19.
  • Zawadzki, K.M., Yaspelkis, B.B., Ivy, J.L.
    (1992). Carbohydrate-protein complex increases
    the rate of muscle glycogen storage after
    exercise. Journal of Applied Physiology, 72, pp.
    1854-1859.
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