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 http://ajl.sagepub.com/ American Journal of Lifestyle Medicine

 http://ajl.sagepub.com/content/2/4/293The online version of this article can be found at:

DOI: 10.1177/1559827608317769

2008 2: 293 originally published online 17 May 2008AMERICAN JOURNAL OF LIFESTYLE MEDICINE Karen Kuczmarski

Do Supplements Benefit Exercise?

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 American Journal of Lifestyle Medicine

293

Do Supplements Benefit Exercise?

Karen Kuczmarski, PharmD, CPh

DOI: 10.1177/1559827608317769. From Florida Hospital–Celebration Health, Celebration, Florida. Address for correspondence: Karen Kuczmarski, PharmD, CPh, Florida

Hospital–Celebration Health, 400 Celebration Place, Celebration, FL 34747; e-mail: karen.kuczmarski@flhosp.org.

Copyright © 2008 Sage Publications

 vol. 2 • no. 4

 Abstract:  It is a known fact that 

exercise will have beneficial effects on

one’s health. Nutritional supplementa-

tion is on the rise, resulting in a

billion-dollar industry. However,

because these medications are not 

regulated by the Food and Drug 

 Administration, it is difficult for the 

 public to determine what is safe and 

effective. Health care providers have to

be aware of this lack of knowledge and 

educate their patients on which supple-

ments are beneficial and which may be 

harmful to their health.

Keywords: supplements; protein;creatine; 1-carnitine; vitamins

 A 

re health and exercise priori-ties in our lives? According to the

Centers for Disease Control andPrevention (CDC), more than half of UScitizens do not include regular physi-cal activity in their weekly routine.1 TheCDC and the American College of SportsMedicine advise individuals to partic-ipate in at least 30 minutes of moder-ate exercise on most, if not all, days of the week.2 It has been established thatroutine exercise is beneficial at con-trolling weight, reducing depressionand anxiety, and decreasing one’s risk

for obesity, heart disease, type 2 dia-betes, hypertension, colon cancer, andearly death.3-5 From 2001 to 2005, CDCdata from the Behavioral Risk FactorSurveillance System (BRFSS) demon-strated an increase in the trend of regularphysical activity among men and womenfrom 48.0% to 49.7% and 43.0% to 46.7%,

respectively.6 Although it was not a hugeincrease, the hope is that these percent-ages will continue to rise each year. Allhealth care professionals should encour-age their patients to maintain a healthy,active lifestyle. When incorporating an exercise

regimen into a weekly routine, peopleshould always first consult a physician.This is imperative to develop a regimenthat is safe and beneficial for one’s ageand any preexisting health conditions.In addition, individuals should consult

their physician or pharmacist regard-ing any over-the-counter medications orsupplements they may use to enhancetheir physical training, specifically musclebuilding. Over-the-counter medicationsare often misconstrued as safe becausethey are available to the public without aprescription. However, vitamins, cough/

cold products, and pain medicationsare still drugs and should be taken only  when necessary, according to the labeleddirections. In addition, herbal supple-ments are viewed in the same mannerbecause they are considered “natural.”However, these are still medications andhave the potential for adverse reactions

and drug interactions. Herbal medica-tions are not regulated by the Food andDrug Administration (FDA) as prescrip-tion drugs because they are considereddietary supplements.7 Due to this lack of regulation, the manufacturer of the prod-uct is not required to undergo any clin-ical testing of the medication to proveeffectiveness of its so-called claim. Also,there is no method of control in placeto establish that the product is manufac-tured in sanitary conditions with pure,consistent amounts of ingredients.7 

Due to this, each batch of natural productsmay contain varying amounts of activeingredient as well as impurities.8 Therecan be several, if not hundreds, of ingredi-ents in many natural supplements, includ-ing those that may be contaminating theproduct such as metals, unlabeled pre-scription drugs, and microorganisms.8-11 

The FDA is allowed to step in and takeaction only if it is able to prove a prod-uct is unsafe through clinical evidence.12 Unfortunately, this typically occurs only after an individual has undergone asevere adverse reaction. In general, pur-chasing herbal or nutritional supplements with a USP Good Manufacturing Practice,

Unfortunately, as with most nutritional

supplements, there is little or no

evidence to support their safety and

efficacy, specifically long term.

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294

 American Journal of Lifestyle Medicine July • Aug 2008

or GMP, seal on the package label isrecommended.13,14 By maintaining thisstatus, the manufacturers are demonstrat-ing that their product is made in a cleanenvironment with consistent amounts of both active and inactive ingredients.13,14 

However, it does not prove the efficacy of the product. It also exhibits that themanufacturer has a method of produc-ing, packaging, labeling, and storing theproducts in a properly controlled envi-ronment.12-14 Periodic inspections must becompleted for the business to advertisethis rating.

So, what does all this talk about sup-plements have to do with exercise? Many individuals, specifically athletes or body-builders, use supplements as a means

to increase the results of their physicalactivity or training. In the United States,roughly $12 to $15 billion is spent onnutritional supplements.15 Athleticsupplements attribute to about $800million of that total.15 Unfortunately, as with most nutritional supplements, thereis little or no evidence to support theirsafety and efficacy, specifically long term.If a patient expresses interest in a supple-ment, a health care provider must fully explain the potential reactions, some of 

 which may be unknown, associated withthe drug’s use. In the long run, it is thepatient’s decision to weigh the risks ver-sus the benefits in choosing whether tosupplement. Protein, 1-carnitine, creatine,and multivitamins are some of the mosthighly sought supplements.

Protein is essential because it is com-posed of amino acids, which areinvolved in tissue and muscle growthand repair.16,17 It is available in meat,fish, eggs, and poultry or as whey,casein, egg, soy, or rice protein supple-ments.16,17 Amino acids, such as gluta-mine, lysine, leucine, and arginine, canbe found in free form in various supple-ments; however, it is not known whethertaking higher levels of these amino acidsmay be toxic.18 Protein provides someenergy, but it is mainly used by athletesafter physical activity. It is thought thatby supplying higher amounts of aminoacids after intense exercise, tissue dam-age may be repaired more rapidly, allow-ing for a much shorter recovery time.16 

 At this point, there is no strong evidenceshowing that consuming more protein oramino acids will increase muscle mass.16,17 In addition, protein consumed throughsupplementation has no added benefit when compared with that obtained from

food. Typically, supplements are used forconvenience because an individual willbe able to obtain the desired amount of protein in 1 serving. Protein requirements vary depending on the type of trainingone is undergoing. For strength athletes,most sources recommend protein intakeof 1.6 g/kg, and for endurance athletes,it is 1.3 g/kg.16,19 Typically, protein intakeis considered safe, but excessive proteinsupplementation can lead to dehydra-tion, gastrointestinal pain, or even kidney 

problems.16,18

Because protein is metabo-lized by the kidneys, it is important thatone stays well hydrated wheneverconsuming supplements.16,18

L-carnitine is an amino acid thatis used by athletes for its ability to“facilitate the transport and metabolismof long-chain fatty acids into the mito-chondria for beta-oxidation and energy generation.”20 Based on these actions,it is thought to enhance endurance andincrease fat burn.20,21 Typically, L-carnitine

is dosed at 2 to 6 g per day and has beenstudied for up to a period of 6 months.However, most evidence has shownthat the supplement does not providemuch benefit; therefore, it is not highly recommended.20,21

Creatine is often used by individuals who want to gain muscle mass.22,23 It issynthesized in the kidney and liver and isinvolved in the production of adenosinetriphosphate (ATP). ATP may be referredto as energy building blocks that allowmany processes to occur in the body,such as muscle contraction.22,23 By sup-plementing with creatine, it is thoughtthat one will have increased energy,muscle size, and strength.22,23 Creatineappears to have benefit in resistancetraining.15,22-27 There was no improvementdemonstrated in endurance training.22-25,27 Typically, dosing consists of a loadingdose of 5 g 4 times a day (4-6 days)followed by a maintenance dose of 2 g per day for up to 12 weeks.15,22,23  According to the Physician’s Desk 

 Reference , individuals supplementing with creatine should drink 6 to 8 glassesof water per day to prevent dehydra-tion.15,25,26 The most common adverseeffects noted with the medication include weight gain (1.6-2.4 kg), gastrointestinal

upset, nausea, dehydration, and musclecramping.15,22-27 In addition, any individual with kidney disorders may want to avoidsupplementation with creatine becausethere is conflicting evidence regardingits effect on renal function.28 In general,because long-term safety data are notavailable, use of creatine should belimited to no more than 12 weeks. Vitamins and minerals are often taken

at higher than the daily recommended value because it is thought that dur-

ing intense training, larger doses may bemore beneficial.24 However, a study com-pleted using 10 to 50 times the recom-mended daily intake of vitamins foundin a classic multivitamin proved after8 months to have no added benefit.24 Because vitamins A, D, B

3, and B

6may 

be toxic at higher doses, it is not recom-mended to consume mega-doses of vita-mins.24 A basic multivitamin with mineralsshould be sufficient for most individuals. With the amount of nutritional supple-

ments available today and the lack of randomized, long-term, controlled trialsto demonstrate safety and efficacy, it isalmost impossible to recommend use of asupplement without hesitation. However,as health care providers, it is our respon-sibility to evaluate our patients’ healthstatus and any medications they aretaking. We also can thoroughly researchcurrent data to provide patients with themost accurate knowledge available toaid them in making an informed decisionregarding supplementation.  AJLM

References

1. Centers for Disease Control andPrevention. Available at: http://www.cdc.gov/nccdphp/dnpa/physical/health_professionals/index.htm.

2. Pate RR, Pratt M, Blair SN, et al. Physicalactivity and public health: a recommen-dation from the Centers for DiseaseControl and Prevention and the AmericanCollege of Sports Medicine. JAMA.1995;273:402-407.

 at Midlands State University on November 19, 2012ajl.sagepub.comDownloaded from 

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 American Journal of Lifestyle Medicine vol. 2 • no. 4

295

3. Kruger J, Blanck HM, Gillespie C. Dietary and physical activity behaviors amongadults successful at weight loss mainte-nance. Int J Behav Nutr Phys Act .2006;3:17.

4. US Department of Health and HumanServices. Healthy People 2010:

Understanding and Improving Health.2nd ed. Washington, DC: GovernmentPrinting Office; 2000.

5. US Department of Health and HumanServices. Physical Activity and Health: Report of the Surgeon General . Atlanta,GA: US Department of Health and HumanServices, Centers for Disease Control andPrevention; 1996.

6. Kruger J, Kohl HW III. Prevalence of regu-lar physical activity among adults—UnitedStates, 2001 and 2005. Morb Mortal Wkly  Rep. 2007;56:1209-1212.

7. Fontanarosa PB, Rennie D, DeAngelis CD.

The need for regulation of dietary supplements: lessons from ephedra. JAMA. 2003;289:1568-1970.

8. Boullata JI, Nace AM. Safety issues withherbal medicine. Pharmacotherapy .2000;20:257-269.

9. Gilroy DJ, Kauffman KW, Hall RA,et al. Assessing potential health risks frommicorcystin toxins in blue-green algaedietary supplements. Environ Health Perspect . 2000;108:435-439.

10. Fugh-Berman A. Herb-drug interactions. Lancet . 2000;355:134-138.

11. National Center for Complementary and Alternative Medicine, National Institutes

of Health. Herbal Supplements: Consider Safety, Too. Available at: http://nccam.nih.gov/health/supplement-safety/. AccessedMarch 8, 2008.

12. Flanagan K. Preoperative assessment:safety considerations for patientstaking herbal products. J PeriAnesth Nurs .

2001;16:19-26.13. US Food and Drug Administration. Dietary 

Supplements . Available at: http://ods.od.nih.gov/factsheets/DietarySupplements_pf.asp#h7. Accessed March 8, 2008.

14. USP Verified Dietary Supplements . Availableat: http://www.usp.org/USPVerified/dietarySupplements/index.html?USP_Print. Accessed March 8, 2008.

15. Calfee R, Fadale P. Popular ergogenicdrugs and supplements in young athletes. Pediatrics . 2006;117:e577-e589.

16. Supplementwatch, Inc. Protein. Availableat: http://www.supplementwatch.com/

suplib/supplement.asp?DocId=1216. Accessed March 8, 2008.

17. Natural Standard Database. Protein. Available at: http://www.naturalstandard.com/. Accessed March 8, 2008.

18. Beltz SD, Doering PL. Efficacy of nutri-tional supplements used by athletes.Clin Pharm. 1993;12:900-908.

19. Tarnopolsky M. Protein requirementsfor endurance athletes. Nutrition.2004;20:662-668.

20. Supplementwatch, Inc. Carnitine . Availableat: http://www.supplementwatch.com/suplib/supplement.asp?DocId=1065. Accessed March 8, 2008.

21. Stuessi C, Hofer P, Meier C, Boutellier U.L-carnitine and the recovery fromexhaustive endurance exercise:a randomised, double-blind, placebo-controlled trial. Eur J Appl Physiol .2005;95:431-435.

22. Supplementwatch, Inc. 2008.

Creatine . Available at: http://www.supplementwatch.com/suplib/supplement.asp?DocId=1090. AccessedMarch 8, 2008.

23. Natural Standard Database. Creatine . Available at: http://www.naturalstandard.com/. Accessed March 8, 2008.

24. Schwenk TL, Costley CD. When foodbecomes a drug: nonanabolic nutritionalsupplement use in athletes. Am J Sports  Med . 2002;30:907-916.

25. Balsom PD, Ekblom B, Soderlund K, et al.Creatine supplementation and dynamichigh-intensity intermittent exercise.

Scand J Med Sci Sports . 1993;3:143-149.

26. Hultman E, Soderlund K, Timmons JA,Cederblad G, Greenhaff PL. Musclecreatine loading in men.  J Appl Physiol .1996;81:232-237.

27. van Loon LJ, Oosterlaar AM, Hartgens F,Hesselink MK, Snow RJ, Wagenmakers AJ.Effects of creatine loading and prolongedcreatine supplementation on body composition, fuel selection, sprintand endurance performance in humans.Clin Sci . 2003;104:153-162.

28. Pline KA, Smith CL. The effect of creatine intake on renal function. Ann Pharmacother . 2005;39:1093-1096.

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