Cayuga Sports Medicine Conference - Supplements Update 2010

Cayuga Sports Medicine Conference - Supplements Update 2010

Cayuga Sports Medicine Conference - Supplements Update 2010

By Lee A. Mancini, MD, CSCS*D, CSNAssistant Professor UMass Medical School

Faculty UMass Sports Medicine Fellowship

Certified Strength and Conditioning Specialist with Distinction

Certified Sports Nutritionist

By Lee A. Mancini, MD, CSCS*D, CSNAssistant Professor UMass Medical School

Faculty UMass Sports Medicine Fellowship

Certified Strength and Conditioning Specialist with Distinction

Certified Sports Nutritionist

BackgroundBackground

Former D-I athlete / 1999 Boston Marathon Numerous Sprint / Olympic Distance Tris15 years as Certified Sports Nutritionist15 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…

Former D-I athlete / 1999 Boston Marathon Numerous Sprint / Olympic Distance Tris15 years as Certified Sports Nutritionist15 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…

Goals & Objectives 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!

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!

Historical PerspectiveHistorical Perspective

Ancient History Aztecs Chinese Greeks

Ergogenic Ergon gennan

Ancient History Aztecs Chinese Greeks

Ergogenic Ergon gennan

20th Century & Supplements20th Century & Supplements

Brown-Sequard in 1889 1950s Dr. Ziegler

Methandrostenolone IOC

1968 1st list of banned substances

1976 Montreal Olympic Games

Brown-Sequard in 1889 1950s Dr. Ziegler

Methandrostenolone IOC

1968 1st list of banned substances

1976 Montreal Olympic Games

The Supplement IndustryThe 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

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

The Supplement IndustryThe 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%

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.

Three QuestionsThree Questions

Is it effective?Is it safe?Is it legal?

Is it effective?Is it safe?Is it legal?

Is it Legal?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$

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$

Is it Legal? - Selling One’s SoulIs it Legal? - Selling One’s Soul

Sports Psychology…1987 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

Sports Psychology…1987 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

Supplements & TriathletesSupplements & Triathletes Ground rules Specific supplements Proven Performance effects Side effects USAT follows USADA prohibited list

Ground rules Specific supplements Proven Performance effects Side effects USAT follows USADA prohibited list

Banned Substance ListBanned 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

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

Banned Substance ListBanned 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

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


S5 - Diuretics and Masking Agents

Masking Agents Plasma Expanders -

Albumin, Dextran, Glycerol (supplements banned)

Alpha-reductase inhibitors - Finasteride

Epitestosterone Diuretics

Furosemide Spironolactone

S5 - Diuretics and Masking Agents

Masking Agents Plasma Expanders -

Albumin, Dextran, Glycerol (supplements banned)

Alpha-reductase inhibitors - Finasteride

Epitestosterone Diuretics

Furosemide Spironolactone


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

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


Prohibited Substances IN Competition

S6 - stimulants Pemoline, Prolintane

Ephedrine and methylephedrine - U > 10mcg/ml

Pseudophedrine - U > 150mcg/ml (D/C >24hrs prior)

Athletes w/ ADD/ADHD Need TUE

Not Prohibited Caffeine

Prohibited Substances IN Competition

S6 - stimulants Pemoline, Prolintane

Ephedrine and methylephedrine - U > 10mcg/ml

Pseudophedrine - U > 150mcg/ml (D/C >24hrs prior)

Athletes w/ ADD/ADHD Need TUE

Not Prohibited Caffeine


S7 - Narcotics Fentanyl, Morphine

S8 - Cannabinoids S9 - Glucocorticosteroids

PO, IV, PR, IM - (DOE/TUE)

Topical P1 - ETOH P2 - Beta-Blockers

S7 - Narcotics Fentanyl, Morphine

S8 - Cannabinoids S9 - Glucocorticosteroids

PO, IV, PR, IM - (DOE/TUE)

Topical P1 - ETOH P2 - Beta-Blockers

Commonly Used Banned SubstancesCommonly Used Banned Substances

Erythropoietin & Blood DopingErythropoietin & 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 d’Italia cycling

marathon Enhances erythropoiesis by

stim proerythroblasts formation

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 d’Italia cycling

marathon Enhances erythropoiesis by

stim proerythroblasts formation

Epo & Doping - Physiology 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

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

Epo - Proven EffectsEpo - 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

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

Epo & Doping - Adverse EffectsEpo & Doping - Adverse Effects

Because of increased RBC volume - causes increased blood viscosity

HTN Seizures DVTs, PEs Stroke Case report - cerebral

sinus thrombosis

Because of increased RBC volume - causes increased blood viscosity

HTN Seizures DVTs, PEs Stroke Case report - cerebral

sinus thrombosis

Epo & Doping - SummaryEpo & 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

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

EphedraEphedra

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

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

Ephedra -Mechanism of ActionEphedra -Mechanism of Action

Stimulant that mimics effect Norepi & Epi

Increases fat burning, Heart rate

Thermogenic effect Increases resting

metabolism, calorie expenditure

Causes appetite suppression

Stimulant that mimics effect Norepi & Epi

Increases fat burning, Heart rate

Thermogenic effect Increases resting

metabolism, calorie expenditure

Causes appetite suppression

Ephedra - Proven EffectsEphedra - 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

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

Ephedra - Adverse EffectsEphedra - 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 - >90% exceeded recommended doses

FDA 284 serious adverse events - 5 deaths, 5 heart attacks, 11 strokes, & 4 seizures 50% of these people < 30 yo

Wide variety of side effects Heart palps, HTN, anxiety,

hyperthermia, headaches, & cardiac arrhythmias

Effects all stopped 48hrs after discontinuing

FDA 800 adverse incidents - >90% exceeded recommended doses

FDA 284 serious adverse events - 5 deaths, 5 heart attacks, 11 strokes, & 4 seizures 50% of these people < 30 yo

Ephedra - Summary 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 > 10mcg/ml

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 > 10mcg/ml2/17/2003

Legal Ergogenic AidsLegal Ergogenic Aids

CreatineCreatine

1832 Chevreul - Greek word flesh

Made from Arg, Gly, & Meth, 95% - skeletal muscle

CrP + ADP => 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

1832 Chevreul - Greek word flesh

Made from Arg, Gly, & Meth, 95% - skeletal muscle

CrP + ADP => 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

Creatine - Proven EffectsCreatine - 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)

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)

Creatine - What about longer distances?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

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

Creatine - Adverse EffectsCreatine - 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

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

Creatine - Adverse EffectsCreatine - 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

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

Creatine - SummaryCreatine - 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

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

HMB ß-hydroxy-ß-methylbutyrate

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

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

Proven Recovery EffectsProven 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

(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

Proven Performance EffectsProven 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

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

Adverse EffectsAdverse 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

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

Summary of HMBSummary 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

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

CaffeineCaffeine

#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

#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

Caffeine - Mechanism of ActionCaffeine - 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

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

Caffeine - Proven EffectsCaffeine - 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

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

Caffeine - Adverse EffectsCaffeine - 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

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

Caffeine - SummaryCaffeine - 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…

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…

Beta AlanineBeta 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

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

Beta Alanine - Ergogenic Effects

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

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 2:1 minute cycling VO2 TTE,VO2peak,LBM

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 2:1 minute cycling VO2 TTE,VO2peak,LBM

Beta Alanine - SummaryBeta 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

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

Nitrous Oxide / ArginineNitrous 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


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

NO / Arginine - Ergogenic Effects

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] p<0.5 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

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] p<0.5 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

NO / Arginine - SummaryNO / Arginine - Summary


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


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

Macronutrient Ergogenic AidsMacronutrient Ergogenic Aids

Carbohydrates Carbohydrates

Macronutrient Aids muscle recovery

& glycogen stores Source of instant

energy as well Insulin spike 6-8% CHO solution

8 T in 1 Gallon

Macronutrient Aids muscle recovery

& glycogen stores Source of instant

energy as well Insulin spike 6-8% CHO solution

8 T in 1 Gallon

Carbohydrates - Proven Effects 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

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

Carbohydrates - Summary Carbohydrates - Summary

Proven performance effects

No adverse side effects

Not Banned But is there

something better?…

Proven performance effects

No adverse side effects

Not Banned But is there

something better?…

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

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

PRO vs. CHOPRO vs. CHO

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

Apr;24(2):134S-139S.

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

Apr;24(2):134S-139S.

Protein QualityProtein 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

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

Protein QualityProtein Quality

Carbohydrate + Protein - Proven EffectsCarbohydrate + 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

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

CHO + PRO - Proven EffectsCHO + 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)

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)

PRO + CHO - BCAAsPRO + 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 3:30 to 3:05 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

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 3:30 to 3:05 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

Carbohydrate + Protein - SummaryCarbohydrate + Protein - Summary

Proven Benefits Safe 4-2:1 Ratio During & After Not BANNED

Proven Benefits Safe 4-2:1 Ratio During & After Not BANNED

Case #1…Case #1…

17yo male HS athlete Test = 2xs NL Estradial = 3xs NL HDL <10 LDL = 252 10 week cycle Went from 145 to 190 What do you do?…

17yo male HS athlete Test = 2xs NL Estradial = 3xs NL HDL <10 LDL = 252 10 week cycle Went from 145 to 190 What do you do?…

Case #1…RevisitedCase #1…Revisited

17yo male HS athlete 3 Months later Off D-Bol Test = WNL Estradial = WNL HDL = 42 LDL = 104 ECHO - WNL Weight now = 163

17yo male HS athlete 3 Months later Off D-Bol Test = WNL Estradial = WNL HDL = 42 LDL = 104 ECHO - WNL Weight now = 163

Scenario…Scenario…

19yo patient comes to your office…

Wants to start taking supplement X.

What do you say?…

19yo patient comes to your office…

Wants to start taking supplement X.

What do you say?…

Supplement Pyramid - What should I take?

Supplement Pyramid - What should I take?

Solid Foundation Base - T / N / R Ask the 3 ?s 2nd Tier

MVI / Ca++/Vit D Whey Protein/P+C Fish Oil**

3rd Tier

Solid Foundation Base - T / N / R Ask the 3 ?s 2nd Tier

MVI / Ca++/Vit D Whey Protein/P+C Fish Oil**

3rd Tier

Wrapping it upWrapping it up

Educate Open mind Supplement

Pyramid Sports specificity

Educate Open mind Supplement

Pyramid Sports specificity

Caveat EmptorCaveat Emptor One final warning

Delbeke et al., 2002 OTC Pyruvate

USAC Position Statement - 1/26/06 Warning: Any athlete who takes…does 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

One final warning Delbeke et al., 2002 OTC Pyruvate

USAC Position Statement - 1/26/06 Warning: Any athlete who takes…does 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

http://www.usantidoping.org/

http://www.usantidoping.org/

On-line Resources for helpOn-line Resources for help Important Web Sites http://www1.ncaa.org/membership/ed_outreach/health-safety/drug_testing/banne

d_drug_classes.pdf NCAA site on banned substances

http://www.theathlete.org/wada.htm World Anti-Doping Agency

Important Web Sites http://www1.ncaa.org/membership/ed_outreach/health-safety/drug_testing/banne

d_drug_classes.pdf NCAA site on banned substances

http://www.theathlete.org/wada.htm World Anti-Doping Agency

http://www1.ncaa.org/membership/ed_outreach/health-safety/drug_testing/banned_drug_classes.pdf


http://www.theathlete.org/wada.htm



http://www.theathlete.org/wada.htm

Thank YouThank You

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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.

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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.

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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.

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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.

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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.

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.

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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.

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.


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.

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.

ReferencesReferences 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). Cyclist’s 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.

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). Cyclist’s 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.


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.

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.


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.

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.

ReferencesReferences 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.

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.

ReferencesReferences 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.

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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Cayuga Sports Medicine Conference - Supplements Update 2010