KAHPERD International Sport Science Congress DIETARY SUPPLEMENTS FOR

KAHPERD International Sport Science Congress DIETARY SUPPLEMENTS FOR SPORT Melvin H. Williams, Ph. D, FACSM, Eminent Scholar Emeritus Old Dominion University, Norfolk, Virginia

Factors Affecting Endurance Performance Physique VO 2 max Social Factors Body Composition Biochemical factors Sport Performance Psychological Traits Others Nutritional Status Thermoregulation Submaximal exercise tolerance and efficiency

KEY DETERMINANTS OF SPORTS PERFORMANCE 1. Genetics Endurance Factor Gene

GENETICS AND SPORTS PERFORMANCE “The innate ability of Lance Armstrong, one of America’s elite cyclists, was demonstrated at age 15 when his aerobic capacity placed him in the upper 1 to 2 percent of athletes worldwide. ” Jay Kearney, Senior Sports Physiologist, USOC. Scientific American 274 (6): 44, 1996

GENETICS AND SPORTS PERFORMANCE “To become an Olympic athlete, choose your parents well. ” Per-Olaf Astrand

KEY DETERMINANTS OF SPORTS PERFORMANCE 1. Genetics 2. Training

UNITED STATES OLYMPIC TRAINING CENTER Training the Elite Athlete Three Key elements: - Physical Power - Mental Strength - Mechanical Edge Daniel Joyner, MD, Chairman Sports Medicine Committee

KEY DETERMINANTS OF SPORTS PERFORMANCE 1. Genetics 2. Training 3. Ergogenic aids

ERGOGENIC AIDS AND SPORTS PERFORMANCE Ergogenic aids include various substances or strategies which are used in attempts to enhance performance in sport, usually in attempts to affect favorably physical power, mental strength, or mechanical edge.

ERGOGENIC AIDS CATEGORIES • Mechanical or Biomechanical • Psychological • Pharmacological • Physiological • Nutritional

The first sports nutritionists • Paidotribes of the Ancient Olympic Games • Trainers or private coaches • Exercise training • Diet

Diets of Early Greek Athletes Vegetarian diets of country folk • Figs • Porridge (barley) • Olives • Honey • Meal cakes • Fruits • Legumes • Cheese • Wine

Primitive man endowed objects of nature, including animals and the foods they generated, with various characteristics such as courage, power, weakness and fear. Eating the heart or meat of various animals which were strong or aggressive would confer courage or strength, whereas those organs or meats of more timid animals would convey weakness and fear. Mc. Collum, E. A History of Nutrition. 1957.

Diets of Early Greek Athletes • Pythagoras - Alleged to introduce the meat diet • Flesh of oxen, bulls, goats and deer • Eurymenes of Stamos - Alleged to be one of the first meat eating athletes Applegate, EA, et al. J Nutrition 127: 857 S, 1997.

Greek Nutritional Ergogenic Aids (3 rd Century BC) Greek athletes drank wine or brandy or ingested mushrooms before competition because they believed that these products enhanced their performance. Voy, R. In The Olympic Book of Sports Medicine, 1988

Roman Gladiators • Alkaloids such as strychnine to improve their chances for survival in the arena. • Strychnine, an extract from the seeds of Strycnos Nox vomica; is a stimulant in small doses • Possibly the first herbal sport dietary supplement Voy, R. In The Olympic Book of Sports Medicine, 1988

Olympic Games 1896 - Rebirth in Athens

1890 - 1940: Research in Sports Nutrition • Experimental - Carbohydrate - Alcohol - Caffeine • Epidemiological - Dietary intake of athletes

Experimental Research involving exercise metabolism: Carbohydrate • 1901 - Zuntz - Used as energy source during exercise • 1920 - Krogh and Lindhard - More economical energy source

Field study • Boston marathon 1924 - Low blood sugar levels correlated with post-race fatigue symptoms 1925 - Diets supplemented with carbohydrates day before - Sugar provided before and during the event - Blood sugar normalized and reduced symptoms of fatigue - Faster times in general Gordon, B. JAMA 85: 508, 1925.

Dietary Srategies Used By Olympic Athletes (1900 -1936) • Alcohol • Alkaline salts • Caffeine • Phosphate salts • Vitamins • High carbohydrate diets • High protein (meat) diets

Olympic Games 1900 Olympic games marathon winner received brandy and strychnine tablets during the race, administered by physicians who followed him throughout. 1908 Olympic marathoners drank cognac to enhance performance Voy, R. Drugs, Sports and Politics Human Kinetics, 1991 Applegate, EA, et al. Journal of Nutrition 127: 857 S-892 S, 1997.

Alcohol: Use by Athletes In cases of extreme athletic exertion or in events of brief maximal effort, alcohol has been given to athletes to serve as a stimulant by releasing inhibitions and lessening the sense of fatigue. Boje, O. League Nations Health Bull Org. 8: 439, 1939.

Caffeine: A Food Drug 1939 Boje stated the use of pure caffeine preparations should be prohibited in athletic competition, but coffee and tea should not be forbidden altogether. Boje, O. League Nations Health Bull Org. 8: 439, 1939.

ERGOGENIC FOODS • Gelatin • Honey • Lecithin • Wheat Germ Oil

Limited Research • Exercise Science Journals - Journal of Applied Physiology - European Journal of Applied Physiology - Research Quarterly • Nutrition Journals - Journal of the American Dietetic Association - American Journal of Clinical Nutrition

Research Design • Poor Methodology - No placebo - Lack of double-blind protocol - Improper repeated-measures procedures - Improper performance tests - Improper statistical procedures

Use of Nutritional Ergogenics by Athletes • Anecdotal information • Tradition and dogma • Misleading advertisements • Misinterpretation of research

Research Misinterpretation Carbohydrate Some coaches attempted to feed their athletes about a half-pound of sugar a day - honey, dextrose tablets or other forms of sugar, as an immediate sources of energy.

Sports and Fitness Boom (1960 s and Beyond) • Sports competition for females - Title IX • Age-group competition - Road races - Marathons • New sport opportunities - Triathlon • Media coverage - TV: ESPN • Money - Fame and fortune

OLYMPIC GOLD Citius Altius Fortius Cashius Swifter Higher Stronger Richer NBC rights to Olympic Games 1996 - $466 Million 2000 - $705 Million 2004 - $793 Million 2008 - $894 Million Cash awards for Gold, Silver or Bronze Medals Individual athletes: up to $20, 000 or more

Importance of Sports Nutrition A minor, seemingly negligible mistake in the diet may ruin many months and years of hard training at the critical moment. L. Prokop, IOC Sports Medicine Advisor Assuming other factors such as ability and training are similar, it is diet that makes the difference in the performance of a world-class athlete. Diet now seems to determine what happens in that one-tenth of a second for runners and swimmers, or that last one-half inch for jumpers or throwers, or that extra ounce of energy that is needed for a champion in the strength events. D. Hanley, Team physician for US Olympic Teams

Use of Nutritional Ergogenics by Athletes • Anecdotal information • Tradition and dogma • Misleading advertisements - Endorsements by athletes • Scientific research-based recommendations

Improved Research Techniques • Muscle biopsy - Carbohydrate Bergstrom, J. , et al. J Acta Physiol Scand 71: 140 -150, 1967

Best research-based knowledge today: Carbohydrate requirements for endurance athletes - Types - Amounts - Timing - Delivery system Grandjean, A. J Nutrition 127: 874 S, 1997.

USOC GUIDELINES ON DIETARY SUPPLEMENTS Primary goal of any nutrition program for athletes: Consume a diet that meets nutritional requirements

KEY POINTS 1. In general, athletes consuming wellbalanced diets will obtain all essential nutrients 2. A nutrient deficiency can impair sports performance 3. Correcting a nutrient deficiency returns performance to normal 4. Some athletes may need dietary supplements a. Weight-control sports b. Older athletes

IRON STATUS IN ATHLETES The prevalence of iron deficiency anemia is likely to be higher in athletic populations and groups, especially in younger female athletes than in healthy sedentary individuals.

USOC GUIDELINES ON DIETARY SUPPLEMENTS • Use of nutritional supplements may be indicated in some circumstances • However, nutritional supplements are just that: Supplements • Supplements are not substitutes for a good diet

Symposium: Science and Policy of Performance-Enhancing Products “Dietary supplements are widely used by all types of athletes: male and female, young and old, professional and amateur. ” Donna de Varona, Former Olympian Fomous, C. , et al. Med Sci Sports Exer 34: 1685, 2002.

Consumer Use 1. U. S. Consumers spend about $20 billion annually on dietary supplements 2. Sports supplements account for about 9% of sales 3. About 46% of physically active persons use supplements 4. About 100% of strength/power athletes use supplements Dancho, C, and Manore, M. ACSM=s Health & Fitness J 5(6): 7, 2001.

DIETARY SUPPLEMENTS CAN THEY HELP IMPROVE YOUR SPORT PERFORMANCE?

Guidelines for Evaluating Claims of Sports Suppliments ACSM, ADA, DC 1. What evidence is given for using the sport supplement? Is it testimonial or a scientific study? 2. What is the quality of the science? What is the reputation of the author and the journal? Was the study sponsored by the manufacturer? 3. Does the experimental design meet these criteria? Hypothesis driven Double-blind, placebo controlled Adequate and appropriate controls used Appropriate dose of supplement/placebo used

Guidelines for Evaluating Claims of Sports Suppliments ACSM, ADA, DC 4. Were appropriate research methodologies and statistical analyses used? 5. Are the results presented in an unbiased manner and do the conclusions follow from the data? 6. Is the product safe and legal or permitted by athletic organizations?

EFFICACY CATEGORIES: • Those that perform as claimed • Those that may perform as claimed, but currently there is insufficient evidence • Those that do not perform as claimed • Those which are dangerous, banned or illegal and consequently should not be used ACSM, ADA, DC. Med Sci Sports Exer 32: 2130, 2000

Many dietary supplements, including vitamins and minerals, when consumed in excessive amounts, may pose significant health risks.

VITAMINS - POTENTIAL ERGOGENIC ROLE 1. Cofactors For Energy Metabolism B Vitamins 2. Nervous Function B Vitamins 3. Hemoglobin Synthesis B-6, B-12, Folate, C 4. Antioxidant Function A, C, E 5. Immune Function B-6, A, C, E

VITAMIN SUPPLEMENTS 1922 Scientist suggest athletes may need more vitamins 1932 Japanese Olympic swimming team partly attributes victory over Americans to vitamin B-1 supplementation 1968 American athletes taking as much as 10, 000 mg vitamin C daily, or receiving injections of 1, 000 mg vitamin B-12 an hour before competition 1972 Eighty-four percent of US Olympians use vitamin supplements 1980 US cyclists injecting vitamins B and C Cureton, T. Swimming Technique. 1969 Sherman, H. , and Smith, S. The Vitamins. 1922. United States Senate. Proper and Improper Use of Drugs by Athletes, 1973. Williams, M. Nutritional Aspects of Human Physical and Athletic Performance. 1985.

VITAMIN SUPPLEMENTS • PERFORM AS CLAIMED • MAY PERFORM AS CLAIMED B complex • DO NOT PERFORM AS CLAIMED A Thiamin Riboflavin Niacin B 6 Pantothenic Acid B 12 Folate Biotin C D E K Choline Multivitamin • DANGEROUS, BANNED, OR ILLEGAL

VITAMIN SUPPLEMENTATION: NEUROTRANSMITTER FUNCTION • Increase Serotonin - Thiamin - Pyridoxine - Vitamin B 12

MINERALS: MAJOR FUNCTIONS FOR PHYSICAL ACTIVITY • Key Components of Various Compounds • Metalloenzymes • Bone Structure

MINERAL SUPPLEMENTS: LAUSANNE CONSENSUS CONFERENCE Of the minerals and trace elements essential for health, particular attention should be paid to iron and calcium status in those individuals (athletes) who may be at risk. Lausanne Consensus Conference. J Sports Sci 9: iii, 1991.

LIVE HIGH, TRAIN LOW • Reside in special low atmospheric pressure home to simulate “Living high” to stimulate production of natural erythropoietin and increased production of red blood cells (RBC) • May need additional dietary iron for hemoglobin saturation • Technique used by elite endurance athletes Khalid Khannouchi, Paula Radcliffe, and Lance Armstrong Live high, train low. Runner’s World. 38 (1): 64, 2003

• PERFORM AS CLAIMED • MAY PERFORM AS CLAIMED Phosphates • DO NOT PERFORM AS CLAIMED Boron Calcium Chromium Copper Iron Magnesium Potassium Selenium Sodium Vanadium Zinc • DANGEROUS, BANNED, OR ILLEGAL

PURPORTED ERGOGENIC MECHANISMS • Arginine, ornithine, lysine - Stimulate anabolic hormone production • Glutamine - Enhance immune functions • BCAA and tryptophan - Prevent central fatigue • Aspartates - Spare glycogen, prevent ammonia, central fatigue

• PERFORM AS CLAIMED • MAY PERFORM AS CLAIMED Aspartates • DO NOT PERFORM AS CLAIMED Arginine BCAA Glutamine Glycine Lysine Ornithine Tryptophan • DANGEROUS, BANNED, OR ILLEGAL

HERBAL PRODUCTS MARKETED TO ATHLETES • R-1 Sport Supplement - Panax ginseng - Siberian ginseng • Sport. Pharm - Ma Huang - Guarana - Cayenne Pepper - Ginger root

• PERFORM AS CLAIMED • MAY PERFORM AS CLAIMED • DO NOT PERFORM AS CLAIMED Bee pollen Capsicum Gamma oryzanol Ginseng Tribulus Yohimbine • DANGEROUS, BANNED, OR ILLEGAL Ephedra (Ma Huang) Ciwujia Hydroxycitrate

SAFETY OF EPHEDRA META-ANALYSIS Use of ephedra is associated with increased risk of psychiatric, autonomic or gastrointestinal symptoms, and heart palpitations. Shekelle, PG. , et al. JAMA 289: 1537 -45, 2003. COMPARATIVE CASE SERIES Products containing ephedra accounted for 64% of all adverse reactions to herbs in the United States, yet these products represented only 0. 82% of herbal product sales. The relative risks for an adverse reaction in persons using ephedra compared with other herbs were extremely high. Bent, S. , et al. Ann Intern Med 138: 468 -71, 2003.

Alcohol Dimethlyglycine (B-15) Androstenedione Glycerol Caffeine HMB Carnitine Inosine Choline Octacosanol Co. Q 10 Pyruvate Creatine Ribose DHEA Sodium bicarbonate

REGULATORY STATUS • Food - Ingredient in coffee, tea and soft drinks • Dietary supplement - Ingredient in product claiming alertness • Drug - Ingredient in over-the-counter migraine products Fomous, C. , et al. Med Sci Sports Exer 34: 1685, 2002.

CAFFEINE • Sports drinks • Sports gels • Sports bars Fomous, C. , et al. Med Sci Sports Exer 34: 1685, 2002.

CREATINE SUPPLEMENTS: FORMS • Powder • Pills • Candy • Chews • Gels • Serum • Micronized Runners Advantage. TM Male Runners Advantage. TM Female Teen Advantage Serum Creatine

• PERFORM AS CLAIMED Alkaline salts Caffeine Creatine • MAY PERFORM AS CLAIMED Glycerol DHAP • DO NOT PERFORM AS CLAIMED Androstenedione Carnitine HMB Inosine Octacosanol Omega-3 fatty acids Pyruvate Ribose Co. Q 10 MCTs Pangamate (B 15) Taurine • DANGEROUS, BANNED, OR ILLEGAL Alcohol Androstenedione DHEA

RESEARCH NEEDS “The lack of credible information from well-controlled studies of many dietary supplements raises issues of caution and concern. ” Costello, R, and Coates, P. J Am Coll Nutr 20: 21, 2001.

FOOD AND DRUG ADMINISTRATION: 10 YEAR PLAN (2010) Science-Base 1. Strengthen the science base - Develop core of well-trained scientists 2. Strengthen research efforts - Develop broad-based research agenda - Human studies 3. Office of Dietary Supplements - Established a network of research centers

SPORTS PERFORMANCE RESEARCH • Enhanced Research Methodology - Virtual reality • Simulate actual sport competition - Noninvasive techniques • Study molecular functions during exercise

CASE STUDY RESEARCH Overall, research data suggest that caffeine may play an ergogenic role in endurance exercise performance of varying durations by altering neuromuscular or metabolic factors. However, although group studies suggest caffeine use may produce significant endurance performance improvements in recreational and elite athletes, based on individual variability how caffeine will affect any given individual is not known. Spriet, L. L. Int J Sport Nutr 5: S 84 1995

THE HUMAN GENOME PROJECT The Human Genome Project has spelled out the 3. 1 billion chemical letters of the average human’s DNA code - 999 out of every 1, 000 letters are identical among all people. Onein-a-thousand variations determine differences among individuals. Fischer, J. U. S. News & World Report October 23, 2000

GENETICS AND SPORT PERFORMANCE HUMAN GENE MAP FOR PERFORMANCE & HEALTH FITNESS - Performance and health-related fitness - Adaptation to acute exercise - Training induced changes GENATHLETE Case-Control Study • List of genetic markers of endurance performance examined - Erythropoietin - Mitochondrial DNA variants HERITAGE Family Study • Individuality in trainability of phenotypes governing endurance performance is highly familial and primarily genetically determined. Bouchard, C. , et al. In Endurance in Sport, 2000. Hagberg, J. M. , et al. Exer Sports Sci Rev 29: 15, 2001. Rankinin, T. , et al. Med Sci Sports Exerc 36: 1451, 2004

CASE STUDY RESEARCH Responses to exercise interventions are often highly variable among individuals, and research has indicated that response to exercise may be mediated in large part by variation in genes. Responder Non-Responder Bray, M. S. J Appl Physiol 88: 788, 2000.

DIET, GENETICS, AND METABOLISM Tools to study interrelationships: Nutrigenomics Proteomics Metabolomics Arab L. Proc Nutr Soc 63: 167 -72, 2004 Chadwick R. Proc Nutr Soc 63: 161 -6, 2004 Kaput L, Rodriguez R. Physiol Genomics 16: 166 -77, 2004 “In five years we’ll have a lot of information on how your genes influence your responses to different foods” John Milner, National Cancer Institute. 2002

CASE STUDY RESEARCH • Individualized genetic screening - Individual genetic blueprint - Sport trait characteristics - Response to training - Response to nutritional intervention or supplementation

SPORTS SUPPLEMENTS Sports nutritionists need to embrace new issues, such as the role nutrition may play in regulating the expression of genes during and after exercise training sessions. Spriet, LL, Gibala, MJ. J Sports Sci 22: 127 -41, 2004.

NUTRITION AND EXERCISE FOR HEALTH AND SPORT • Currently, advice is based on group studies • As technology costs come down, individual testing is feasible - Exercise training for enhanced health and sport performance - Diet/supplements for enhanced health and sport performance - Combined exercise/diet for enhanced health and sport performance

DIETARY SUPPLEMENTS FOR SPORT DIETARY SUPPLEMENT WEB SITES NIH Office of Dietary Supplements: www. dietary-supplements. info. nih. gov Food and Nutrition Information Council: www. nal. usda. gov/fnic/

OLD DOMINION UNIVERSITY www. odu. edu