Dr Adam Carey

Who are We?Who are We?Medical team (NHS consultant level)

15yrs improving performance and reducing stressWorld class businesses BP Ineos Lloyds BankWorld class businesses – BP, Ineos, Lloyds BankUnrivalled sports pedigree – RFU, WRU, ECB, Premiership Football

P bilit t d liProven ability to deliverFocused health screeningNutritionPsychologyExercise physiology

Ten years of elite sport…..Ten years of elite sport…..

1997 20031997 - 2003

2004 – 2006

20052005

2007 - 2011

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Sporting successes…..Sporting successes…..

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Thank youThank you

Worcester Warriors – Stuart Pickering and Dr Terrance GasperS g G p

Hull Tigers – Matthew Reeves

Dr Christian Cook and Dr Scott Drawer

UK Sport

Maxinutrition

Laurent Bannock

CorperfomanceTM

Corperfomance

What are your expectations?What are your expectations?

AgendaAgenda

Standard material for today:Performance continuum, diet/exercise, recovery support, optimizersG t h lthGut healthProteinBCAABCAACreatineGlutamineCaffeine

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Agenda additional thoughtsAgenda additional thoughts

What are the athletes issues?What are the athletes issues?Athlete screening

WhatatWhy

Basic strategiesGood health, hydration and sensible eating patternsFat lossLBM gain

Other lifestyle issuesEtohEtohSleep

Which supplement?Which supplement?TM

Supplements we may considerSupplements we may consider

ProteinCarbohydrates

ArginineBuffersCarbohydrates

FatsBCAA

BuffersBeta-alaninePhosphatesBCAA

LeucineCreatine

Sodium Bicarb/citrate

PSCreatineColostrumGlutamine

Herbals

GlutamineHMB

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Athlete Screening

UnderstandingUnderstanding Body Composition?Co pos t o

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Power based athelete

Body Mass Index Is it important?Body Mass Index – Is it important?

BMI (kg/m2) =Weight (kg)

Height squared (m2)

<18.5 kg/m2 Underweight

Height squared (m )

g g

18.5 - 24.9 kg/m2, Healthy weight

25.0 - 29.9 kg/m2, Overweight

30 0 34 9 kg/m2 Obese30.0 - 34.9 kg/m2, Obese

>35.0 kg/m2, Morbidly obese

Assessing body fatAssessing body fat

Why?

How?How?

In athletesIn athletes

Body fat distributionBody fat distribution

Abdominal fat is a risk factor for obesity related diseases

Can raise heart disease risk x4

Measured at umbilicusMeasured at umbilicus

Indication of visceral fat

Waist measurementsWaist measurements

Under-estimation of waist size by:Men by 3.1 inches (7.9cm)Women by 2.2 inches (5.5cm)

Waist to Stature RatioWaist to Stature Ratio

Keep your waist circumference less than half your heightIf you are 1.80m tall, your waist should be <90cm

Consistent for ethnicity, age and sex

Self monitoring potential

WSRWSR

di l i k t WSR 0 5cardiovascular risk at WSR >0.5

Id tifi l BMI t CVD i kIdentifies normal BMI at CVD risk:1:3 men and1:7 women1:7 women

Measuring body compositionMeasuring body composition

Gold standardsUnderwater weighingCT imaging

Practical alternativesSkin callipersBio-impedanceUltrasound

What is a normal body composition?

Body CompositionBody Composition

Description Women Men

Essential fat 10 13 9% 2 5 9%Essential fat 10 – 13.9% 2 - 5.9%

Athletic < 18% < 15%

Fit normal < 30% < 20%

Raised fat > 30% > 20%

Obesity by BMI alone misses 50% of people with raised fatObesity by BMI alone misses 50% of people with raised fat

Athlete Body CompositionAthlete Body Composition

Description Women Men

Essential fat 10 13 9% 2 5 9%Essential fat 10 – 13.9% 2 - 5.9%

Athletic < 18% < 15%

Power based < 16% < 12%

Endurance based < 14% < 10%

Varies by sport and often by position in a team sportVaries by sport and often by position in a team sport

What is normal in rugby?What is normal in rugby?

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What is normal in judo?What is normal in judo?

Gemma Gibbons

Euan Burton

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Euan Burton

Blood testsBlood tests

Clinical significance? – we’ll tell you what to worry about!Clinical significance? – we ll tell you what to worry about!

Normal ranges for all blood test found in report and include:Liver functionRenal functionCardiovascular system and blood lipidsCardiovascular system and blood lipidsHaematologyThyroid functionGlucose and insulin levelsFerritinB12 and folateB12 and folateVitamin DEssential fatty acid profile

Medical indicesMedical indices

Liver function

CholesterolCholesterol

Diabetes risk

Renal function

Haematology

Fatty LiversFatty LiversFat deposition in the liver – Insulin ResistanceLiver damage

10 year mortality raised by 50%Obese man on 15u a week cirrhosis risk x 19

AST>ALT 2:1 EtohALT> AST – FructoseGamma GT

LipidsLipids

Total cholesterol: <5 mmolL-1Total cholesterol: <5 mmolL 1

National average Men: 5.5 mmolL-1

National average Women: 5.6 mmolL-1a o a a e age o e 5 6 o

Low Density Lipoprotein (LDL): <3 mmolL-1

Food and genes

High Density Lipoprotein (HDL)Exercise and genes

Triglycerides

Lipids RatiosLipids Ratios

% HDL to Total cholesterol (>25%)% HDL to Total cholesterol (>25%)

T i l id t HDL ti ( 2 0)Triglycerides to HDL ratio (<2.0)

Insulin resistanceInsulin resistance

Fasting Insulinast g suHigher than normal>10miuL-1

Normal fasting glucose

Primary treatmentWeight lossExercise

Follow up investigationRepeatRepeatGlucose tolerance test

Pre diabetesPre-diabetes

Fasting glucoseFasting glucoseHigher than normal (>5.6mmolL-1)Not high enough to diagnose type II diabetes

50% progression to diabetes in 3-1050% progression to diabetes in 3-10 years

Nutritional indicesNutritional indices

Haemoglobin – who to watch out forIron – FerritinFolateVit B12Vitamin DRed cell essential fatty acids

Omega 3 indexHUFA ratio

Iron statusIron status

HaemogloginFerritin

Normal range12-150ng/ml in women12-30ng/ml in men12-30ng/ml in men

Too little – restless legs, tiredness, anaemiaToo much – iron storageToo much – iron storage

Vitamin DVitamin D

Steroid hormoneReceptors in 30 tissue typesEffects expression of >1000 genesImpacts

Calcium metabolism and bone mineralizationImmune functionInflammationInflammationMoodPerformance outcomes

Vitamin DVitamin D

40 60% pop lations ins fficient or deficient40-60% populations insufficient or deficient

Low levels recognized in athletesLow levels recognized in athletes (Willis Int J Sport Nutr Exer Metab 2008:18:204)

Risk factorsRisk factorsLiving above 35o N latitudeDark skinSun blockSeasonal variationTraining indoorsTraining indoorsClothingHigh body fats

Symptoms of low levelsSymptoms of low levels

FatigueGeneral muscle weakness/ achesJoint and back painsWeight gain – body fatHigh blood pressurePoor concentrationL dLow moodConstipation or diarrheaIncrease incidence of infectionsIncrease incidence of infectionsFailure to respond to training stimulus

R Keen MA RD, CISSN, CSSD,CSCS; ISSN 2010

What are adequate levelsWhat are adequate levels

>12ng/ml Sever deficient Rickets /OM>12ng/ml Sever deficient – Rickets /OM>20ng/ml Deficient>30ng/ml Insufficient>30ng/ml Insufficient- 31-40ng/ml Sufficient / Suboptimal in sport- 40-50ng/ml Optimal in sport?40 50ng/ml Optimal in sport?>200ng/ml ToxicityRDA or Adequate intakeq

In UK, recommendation for under 5 and over 65 yearsIn USA19 50 200IU/d19-50 years 200IU/day50-70 years 400IU/day> 70 years 600 IU/dayy y

Screening of UK SquadsScreening of UK Squads

Preseason screening 2010-2011

Worcester Warriors RFU Hull Tigers AFC

12% Deficient 13% Deficient

12% Insufficient 25% Insufficient

76% Suboptimal 45% Suboptimal

0% Optimal 17% Optimalp p

Estimated need 1000IU/30 days to increase 10ng/mlEstimated need 1000IU/30 days to increase 10ng/ml

Repeat squads testingRepeat squads testing

In season screening – Feb / March 2011

Worcester Warriors RFU Hull Tigers AFC

2% Deficient 0% Deficient

10% Insufficient 6% Insufficient

19% Suboptimal 12% Suboptimal

69% Optimal 82% Optimal

Maintenance typically 1000-2000IU/dayyp y y

Executives Screening (n=137)Executives Screening (n 137)

Percentage of BP execs in each Vitamin D category

22%43%

22%

35%

Deficient Insufficient Normal

Clinical impact in sports clubsClinical impact in sports clubs

25% reduction in all infections first 12 months

Further 30% reduction of infection rates of second season

Incidence of URTI reduced by 60%

Reduction in non training days due to URTI by 80%

Testing for vitamin DTesting for vitamin D

We use The Doctors Laboartory – UK’s biggestindependent lab.W h t t ti i ith TDL tWe have set up new testing service with TDL atwww.myvitdtest.comDi t tDirect to consumerAssesses Vitamin D and calciumOff d i l iOffers advice on supplementationAllows cheap, safe and accurate interventions

Basic manipulations

Healthy eating patterns and hydration?Healthy eating patterns and hydration?

Sports nutrition structurep

ErgosErgos

Supplements

High quality diet

A balanced plate of food?A balanced plate of food?

ProteinFibrous

Proteincarbs

Starchy carbsy

B L Ds s

Hydration in sportHydration in sport

Poor hydration remains a major issue in human performance

3% Dehydration

8% loss of speed8% loss of speed

10% loss of strength

Daily hydrationDaily hydration

Thirst is a poor mechanism

EFSA suggest 2.5L a day, 80% aswater (2 litres for a 80 kg man)

Much more needed around exerciseand in hot conditions

Hydration and exerciseHydration and exercise

Add 250ml for each 20 mins of exercise

Pre and post exercise weighing

100%-150% replacement of weight loss

Replace with what?Hydration and rehydration

Hydration statusHydration status

Urine volumeFrequencyNocturiaNocturia

Urine colourB vitaminsBeetroot etc

OsmocheckOsmocheck

Well hydrated 100 - 600 GreenGreen

Dehydrated 600 - 800 AmberAmber

Severe dehydration 800 - 1000 RedRed

Clown >1000

Fluid Balance

Water sourcesWater sources

Tap water – better than nothingTap water – better than nothing

Plastic or glassPlastic or glass

Reverse osmosisReverse osmosis

Cleaning Your WaterCleaning Your Water

Total Dissolved SolidsTap water 500mg/lClean water <20mg/lClean water <20mg/l

Jug filtersActivated carbon filters (chlorine)Ion exchange resin (softener)Sliver impregnatedSliver impregnatedNo microbiology protection

Properly Clean WaterProperly Clean Water

Quality reverse osmosis unitPurification and filtrationSediment and carbon filtersIon exchange resinWorkplace or home unitsWorkplace or home units

Hydration and Re-Hydration?y y

H iHypotonicWater

IsotonicLucozade sportGatoradeGatorade

HypertonicyRed BullGels

Dioralyte

Hydration strategiesHydration strategies

D i k l i hi k b h fDrink plain water, think about where from

Measure intake and establish habitMeasure intake and establish habit

Limit caffeinated drinks

Explore other hot drink options

Avoid carbonated sodasand sweetened drinks

Use sports mixes when required

Refined carbohydratesRefined carbohydrates

All the white stuff

Remind me why are refinedRemind me, why are refined carbohydrates so BAD?

Glycemic indexy

Insulin

Blood sugar Adrenaline

FatGlycogen

Am Pm

Eating refined carbohydratesEating refined carbohydrates

Blood Sugar

Insulin NIDDM

Storage

M&L glycogen or fat Fat Fat Fat Obesityg y g y

When would you use a refined b?carb?

Unrefined carbohydratesUnrefined carbohydrates

Blood Insulin resistance

Insulin

sugar Glucose

Am Pm

Are all sugars the same?Are all sugars the same?

Sugar and the Food IndustrySugar and the Food Industry

High fructose corn syrup available since 1975+20% sweeter than table sugarCh h lf th iCheaper – half the price

Adulterated food supplyAdulterated food supply

25% adolescents consume5% ado esce ts co su e15% calories from fructose

We need to reduce or avoidintake

Management of fructoseManagement of fructose

Has the same metabolic pathway as alcohol!

If glucose levels are low, gets converted intoglucose

If glucose levels are normal, get converted into fat

Historic intake – mainly fruits in season

Explosion of intake over last 30 years

Difference between Glucose and Fructose

Fructose(Alcohol)

Glucose

Liver glycogen

Cellular energyBrain

Whole body glycogenLiver fat

Fructose is metabolised like a poison

Why does it matter?Why does it matter?

Satiety suppressionSatiety suppression

E t i f t D d i ht i thl tEctopic fat – Dead weight in athletesInsulin resistanceHeart diseaseHeart diseaseDiabetesCancers

Uric acid productionpPushes up blood pressureDoubles your risk of gout

Fruit and fruit juiceFruit and fruit juice

Five a day?

Vegetables with added sugar?

Don’t juice?Fruit juice causes weightgain and diabetes

A balanced plates of foodA balanced plates of food

ProteinFibrous

Proteincarbs

Starchy carbsy

B L Ds s

Simple cases

Case 1Case 1

29 ld b l 124k 22% b d f t29 year old rugby player, prop, 124kg, 22% body fat

St li ith d d th kStruggling with speed around the park

Advice on reducing body fat?What strategiesHowWhenBig concern is not losing weight

Case 2Case 2

21 ld b l 2nd 98k 9% b d f t21 year old rugby player, 2nd row, 98kg, 9% body fat

St li ith t th d iStruggling with strength and size

Advice on reducing hypertrophyWhat strategiesHowWhenBig concern is not getting fat

What are your macro molecule strategies?

In balance and out of balanceIn balance and out of balance

H lth tiHealthy eatingStarchy carbohydrate restrictionK t iKetosis5:2 and it’s variationsNutrient timingManagement of treat mentality

Alcohol and its impact

Areas that alcohol impactAreas that alcohol impact“I feel sorry for people who don't drink. When they wake up in the 

i th t' d th ' i t f l ll d ” F k Si t

Metabolic impact

morning, that's as good as they're going to feel all day” ­ Frank Sinatra

Metabolic impactHormonal impactProtein synthesisRecoveryHydrationPotential ergogenic effectg gErgolytic effectPsychomotor effectsSleepSleepTeamshipSociety

Metabolic impactMetabolic impact

Alcohol is 7 calories/gram

Typical drink (1 unit) provides 8gTypical drink (1 unit) provides 8g

This results in a 25mg/L rise in blood alcohol levels

80mg/L is UK legal limit for driving = ~4-5 units 70kg man

A bottle red wine >1000kCal (5 pints beer)3 bottles a week equivalent the the calories in 1lb of human fat2 bottles of wine / week = 8th day of food2 bottles of wine / week 8 day of food

MetabolismMetabolism

Alcohol is detoxified by a group of 6 alcohol dehydrogenases

Alcohol is broken down to acetate in the liverAlcohol is broken down to acetate in the liver

Acetate is converted to Acetyl CoA

Acetyl CoA mitochondria energyprimary building block for FATp y g

24g alcohol results in a 73% reduction in total body lipid oxidation(AJCN 2000)(AJCN 2000)

Alcohol drives fat production

Other calories acquired when drinking and their impactAlcohol rarely served neat

Primary sugar in alcoholic beverages is fructose (HFCS)Primary sugar in alcoholic beverages is fructose (HFCS)

Fructose only metabolised in the liver and converted to Acetyl CoA

Acetyl CoA mitochondria energyprimary building block for FAT!!p y g

Fructose increases purine production gout, hypertension, CVD

Fructose is effectively managed as a poison

15% of adolescent calories come from fructose

Hormonal impact of drinkingHormonal impact of drinking

Alcohol reduces Testosterone levels for up to 48 hours

Alcohol increase Cortisol levels for 24 hours (c f central adipose)Alcohol increase Cortisol levels for 24 hours (c.f. central adipose)

2-3 units reduces GH release by as much as 70%

Alcohol reduces IGF1 by 35% (eIF2B 2000)

Alcohol is catabolic, inhibits growth and limits recovery

Impact on GI health and absorptionImpact on GI health and absorption

Alcohol causes a disbiosys of large bowel

Inhibits the absorption of A B C Ca and ZnInhibits the absorption of A, B, C, Ca and Zn

Leads to long term deficiency states

Alcohol excretion of Ca and Mg – long term bone weakness

Incidence of cramping increases by >30% after drinking (4-5 units)

Single biggest cause of diarrhoea in the UK!Single biggest cause of diarrhoea in the UK!

Muscle turnover, hydration and recoveryAlcoholic myopathy is a well recognised consequence of drinking

See a fall in LBM and increase in FMSee a fall in LBM and increase in FM

Alcohol inhibits protein synthesis specifically in type II fibres

Acute impact on recovery

Longer term impact on development – usually seen as failure to adapt

Alcohol is dehydrating causes:Alcohol is dehydrating, causes:HangoverReduced blood flow to muscles, which limits recovery further

Potential ergogenic aid?Potential ergogenic aid?

Alcohol is a central nervous system depressant

Get initial dis-inherbition feel stronger more confident reducedGet initial dis inherbition feel stronger, more confident, reducedsensitivity to pain

Clinically only benefit is in tremor shooting / snookerClinically – only benefit is in tremor – shooting / snooker

reaction timescoordinationbalancestrengthstrengthpower

4 units reduce anaerobic capacity following day by 25%

TeamshipTeamship

Number of studies showing that many team sports associated withdrinking culture, c.f. Olympic culture

Team players drink more than non-team players (students)

What is our culture?

How is it impacted by societies drinking habits?

Alcohol intake has doubled since 1950’s

A period of abstinence?A period of abstinence?

Not in the week – post match

A month off

Lent

12/52 trail12/52 trail

Cycled around important events

RecommendationsRecommendations

AlcoholKnow how much they drinkKnow how much they drinkHave periods offCelebrate things worth celebratingIdeally 24 hours after performance!Avoid within 48 hours of training/playingDo we need to impact player culture?Do we need to impact player culture?Can we change our culture?Do we lead by example

PS th d l h li d i kPS – there are no good alcoholic drinks,so choose you poison!

Sleep

What is normal?What is normal?

6 9 hours6-9 hoursHow can you monitor it – Sensewear armbandT littl i t d ith dToo little associated with poor recovery andincrease in body fatsToo much ?Too much – ?Sleep hygieneDisturbances for athletesDisturbances for athletes

EtoHTravelTravelChildren

Good sleep efficiencyGood sleep efficiency

% Sleep Efficiency

90%100%

% Sleep Efficiency

Normal

50%60%70%80% Normal

10%20%30%40%

0%10%

Poor sleep efficiencyPoor sleep efficiency% Sleep Efficiency

80%

90%

100%

Normal

50%

60%

70%

80% Normal

10%

20%

30%

40%

0%

10%

Supplements and strategies

Supplements we may considerSupplements we may consider

ProteinCarbohydrates

ArginineBuffersCarbohydrates

FatsBCAA

BuffersBeta-alaninePhosphatesBCAA

LeucineCreatine

Sodium Bicarb/citrate

PSCreatineGlutamineHMB

Herbals

HMB

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Additional protein?Additional protein?

Usually as a protein shakeWhey protein is a derivative of milkMilk consists of two types of protein: 1) Whey, and 2)CaseinB th i d h t i d b thl tBoth casein and whey protein are used by athletesIncrease the rate of protein synthesis (building muscle)D h f b li f l ( lDecrease the rate of catabolism of muscle mass (musclebreakdown),I f ll i i / ti itImprove recovery following exercise / activity

Who should consider a protein supplements?

Any athlete / active person aiming to:

increase their lean muscle sizeimprove their rate of recoveryimprove their rate of recoveryimprove immune healthreduce body fatreduce body fat

Physiological benefitsPhysiological benefits

Increases levels of muscular growth and recovery

Reduction in cortisol levels (stress hormone)

Increases strength gains

ResearchResearch

Of th t t f t i ( h d i ) h t iOf the two types of protein (whey and casein), whey proteinhas been demonstrated to have the greater benefit on musclegrowth and recovery after exercise and helps to lower bodyfat levels (Lands et al., 1999).The increased levels of muscle growth are likely to be as aresult of an increased rate of protein synthesis and due to aresult of an increased rate of protein synthesis and due to areduction in the levels of cortisol (Markus et al., 2000).Cortisol is a stress hormone, released during periods ofph sical or mental stress It is kno n to ha e a negati e effectphysical or mental stress. It is known to have a negative effecton muscle growth by increasing the rate of catabolism(muscle breakdown). This is of particular concern tob d b ildi / t th thl t i it ill li it thbodybuilding/strength athletes since it will limit theeffectiveness of training programmes by lowering potentialgains in muscle.

Types of wheyTypes of whey

There are two main types of whey protein: 1) wheyThere are two main types of whey protein: 1) wheyconcentrate, and; 2) whey isolate.Whey concentrate is just the basic form of whey after it hasb t d f ibeen separated from casein.Whey isolate normally goes through a special filtrationprocess in order to increase the concentration of protein.Typically whey concentrate may contain 70-80% proteinwhereas whey isolate would normally contain at least 90%protein, with a much lower level of carbohydrate and fat than

h t twhey concentrate.Whey isolate will also have a higher level of branch-chainamino acids (BCAAs).BCAAs have been demonstrated to be effective at helping tomaintain and increase muscle mass.

Whey protein isolateWhey protein isolate

Some whey isolate will also contain partially pre-digestedproteins – these have been pre-digested by a process ofenzymatic hydrolization which are more readilyenzymatic hydrolization – which are more readilyabsorbed into the blood stream and will therefore reachthe muscles more quickly.q yWhey protein isolate has proved particularly effective atpromoting gains in muscle mass. Subjects wereobserved to gain 8 pounds more lean muscle than whenusing whey isolate than subjects using concentrate(C ibb t l 2002)(Cribb et al., 2002)

Is Whey Effective?Is Whey Effective?Yes!: Whey protein has been shown to be effective inmany high quality research studies at increasing musclesize, muscle strength gains, and recovery from exercise

How much protein is required?How much protein is required?

G t d 0 8 /k b d i htGovernment recommend 0.8g/kg body weight

EIS recommend the range 1 2 1 5g/kg body weightEIS recommend the range 1.2-1.5g/kg body weight

Hypertrophy 1 8-2 5g/kg body weightHypertrophy 1.8-2.5g/kg body weight

MaintenanceMaintenanceEndurance athlete 1.5g/kgPower based, not trying to change 1.2g/kg body weight

How much are they getting from their diet?

Taking a protein supplementTaking a protein supplement

When broken down into 20-50g servingsRisks of large dosesTimings, every 2-3 hoursPre and post workout options (Levenhagen et al., 2002).Staying positive nitrogen balance over night?

40g prior to sleep improve post exercise overnight recoveryincreasing net nitrogen balanceincreasing net nitrogen balance

Evening intakeConsider using a slower digesting protein overnight suchConsider using a slower digesting protein overnight suchas casein and/or egg protein which will keep proteinlevels elevated for longer in the blood.g

ReferencesReferences

Cribb P J Williams A D Hayes A and Carey F (2002) The effectCribb, P. J., Williams, A. D., Hayes, A. and Carey, F. (2002) The effectof whey isolate and resistance training on strength, body composition,and plasma glutamine. Medicine and science in Sports and Exercise.34, S1688.Lands, L. C., Grey, V. L. and Smountas, A. A. (1999) Effect ofsupplementation with a cysteine donor on muscular performance.Journal of Applied Physiology. 87, 1381-1385.L h D K C C C l M G M D J B l M JLevenhagen, D. K., Carr, C., Carlson, M. G., Maron, D. J., Borel, M. J.and Flakoll, P. J. (2002) Postexercise protein intake enhances wholebody and leg protein accretion in humans. Medicine and Science inSports and Exercise. 34, 828-837.p ,Markus, C. R., Olivier, B., Panhuysen, G. E. M., Gugten, J. V. D., Alles,M. S., Tuiten, A., Westenberg, H. G. M., Fekkes, D., Koppeschaar, H. F.and De Haan, E. E. H. F. (2000) The bovine protein alpha-lactalbuminincreases the plasma ratio of tryptophan to the other large neutralincreases the plasma ratio of tryptophan to the other large neutralamino acids, and in vulnerable subjects raises brain serotonin activity,reduces cortisol concentration, and improves mood under stress.American Journal of Clinical Nutrition. 71, 1536-1544.

Branch Chain Amino Acids (BCAA)

What Are BCAAs?What Are BCAAs?

BCAA 3 ti l i id i l i l iBCAA -3 essential amino acids: isoleucine, leucine,and valineBCAA’s cannot be manufactured in the human bodyBCAA s cannot be manufactured in the human bodyThere are nine essential amino acidsBCAAs account for 35% of all the essential aminoBCAAs account for 35% of all the essential aminoacids found within muscle proteinRequired for protein synthesisRequired for protein synthesisUsed as an energy source during aerobic exerciseOccur in all rich protein sourcesOccur in all rich protein sourcesWhey protein contains high levels of BCAAs

Physiological BenefitsPhysiological Benefits

Stimulates muscle protein synthesis (muscle building)Decreases muscle protein catabolism (muscleb kd )breakdown)Helps to increase lean muscle massI d ti f l l tImproved preservation of muscle glycogen storeReduces muscle damage and soreness followingexercise (DOMS)exercise (DOMS)Improves immune functionM h d i fMay enhance endurance exercise performance

Some studies researchSome studies research

In skeletal muscles and the heart BCAA supplementation alone stimulatesIn skeletal muscles and the heart, BCAA supplementation alone stimulatesprotein synthesis and reducing muscle breakdown, as effectively as wholeprotein (May and Buse, 1989)

CBCAAs supplementation demonstrated to preserve and increase musclesize under extreme physical conditions where there would normally be a netloss of muscle tissue (Schena et al., 1992; Bigard et al., 1996)

Effect of BCAA supplementation during prolonged skiing at altitude, found itprevent a loss of body mass (Bigard et al., 1996)

Positive effect on immune function with BCAAs supplementation (Bassit etPositive effect on immune function with BCAAs supplementation (Bassit etal., 2000; Bassit et al., 2002)

During prolonged aerobic exercise BCAAs can be oxidized within theg p gmitochondria of skeletal muscles to produce aerobic energy (Shimomura etal., 2004, Rennie, 1996; Kobayashi et al., 1999). Therefore, during anyprolonged period of exercise, a significant amount of BCAAs, may bemetabolised and may lead to a depletion of BCAAs within muscles

And some moreAnd some more

77mg of BCAAs, per kg of bodyweight, before exercise results ina significant reduction in the amount of muscle breakdown(MacLean et al., 1994). To reduce muscle breakdown during( ) gexercise a 70kg athlete would consume around 5g of BCAAs.

It h l b d t t d th t BCAA b f d ftIt has also been demonstrated that BCAAs before and afterexercise reduces the levels of serum creatine kinase activity –which indicates reduced levels of muscle breakdown (Coombesand McNaughton, 2000; Nosaka, 2003)

BCAA supplementation before and after exercise appears toBCAA supplementation before and after exercise appears toincrease the recovery rate from exercise, as indicated by areduction in muscle soreness following exercise (Nosaka, 2003.

BCAA impact on central fatigueBCAA impact on central fatigue

BCAAs compete with trytophan for uptake into the brain.BCAAs compete with trytophan for uptake into the brain.During prolonged exercise BCAAs are used for fuel andthis leads to a decreased level of BCAAs in the bloodDecreased in BCAAs results in greater tryptophan uptakeinto the brainI d t t h l d t f li f ti d dIncreased tryptophan leads to feelings of tiredness andfatigue, and hence, reduced exercise performanceSupplementation with BCAAs during exercise keeps theSupplementation with BCAAs during exercise keeps thelevels of BCAAs elevated and helps to delay the build upof tryptophan in the brainResearch suggests that supplementing with BCAAs duringexercise may have a positive effect on exerciseperformance by reducing fatigue (Blomstrand et al 1991)performance by reducing fatigue (Blomstrand et al., 1991)

Are BCAAs Effective?Are BCAAs Effective?

Yes! In certain situations:Research has shown that BCAAs are effective for

h i l th d f ienhancing muscle growth and recovery from exerciseImprove immune health and may enhance enduranceexercise performanceexercise performanceMay impact central fatigueHow much 3 15g pre trainingHow much 3-15g pre trainingWhat ratio is needed?E ti l i id h bi i t th hEssential amino acids have bigger impact than wheyMay use just leucine?

How to TakeBCAA Supplements

The general recommendation 3-5grams of BCAAs 30minutes before exerciseFurther 3-5g within 30minutes of completing exerciseusually as a protein shakeNon-training days, recovery rate may be enhanced,and lean muscle mass maintained, by consuming 3-5 f BCAA 1 2 ti d i th d id5g of BCAAs, 1-2 times during the day – considertaking one serving first thing in the morning and onelast thing at night - again usually as a protein shakelast thing at night again usually as a protein shakeThere are no reports of any side effects associatedwith BCAA consumption (Shimomura et al., 2004).p ( , )

ReferencesReferencesBassit, R. A., Sawada, L. A., Bacurau, R. F. P., Navarro, F. and Costa Rosa, L. F. B. P.(2000) The effect of BCAA supplementation upon the immune system of triathletes. Medicineand Science in Sports and Exercise. 32, 1214-1219p ,

Bassit, R. A., Sawada, L. A., Bacurau, R. F., Navarro, F., Martins, E. Jr, Santos, R. V.,Caperuto, E. C., Rogeri, P. and Costa Rosa, L. F. (2002) Branched-chain amino acidsupplementation and the immune response of long-distance athletes. Nutrition. 18 (5), 376-pp p g ( ),37

Bigard, A. X., Lavier, P., Ulmann, L., Legrand, H., Douce, P. and Guezennec, C. Y. (1996)Branched-chain amino acid supplementation during repeated prolonged skiing exercises atpp g p p g galtitude. Int J Sport Nutr. 6 (3), 295-306

Blomstrand, E., Hassmen, P. and Ekblom, B. (1991) Administration of branched-chain aminoacids during sustained exercise-effects on performance and on plasma concentration ofg p psome amino acids. European Journal of Applied Physiology. 63, 83-88

Coombes, J. S. and McNaughton, L. R. (2000) Effects of branched-chain amino acidsupplementation on serum creatine kinase and lactate dehydrogenase after prolongedpp y g p gexercise. J Sports Med Phys Fitness. 40, 240-246

Kobayashi, r. shimomura, Y., Murakami, T., Nakai, N., Otsuka, M., Arakawa, N., Shimizu, K.and Harris, R. A. (1999) Hepatic branched-chain alpha-keto acid dehydrogenase complex in( ) p p y g pfemale rats: activation by exercise and starvation. J Nutr Sci. Vitaminol. 45, 303-309

ReferencesReferencesMay, M. E. and Buse, M. G. (1989) Effects of branched chain amino acids on proteinturnover. Diab Metab Rev. 5 (3), 227-245

MacLean, D. A., Graham, T. E. and Saltin, B. (1994) Branched-chain amino acids augmentammonia metabolism while attenuating protein breakdown during exercise. Am J Physiol.ammonia metabolism while attenuating protein breakdown during exercise. Am J Physiol.267, E1010-E1022

Nosaka, K. (2003) Muscle soreness and amino acids. Training J. 289, 24-28

Rennie, M. J. (1996) Influence of exercise on protein and amino acid metabolism. In:Handbook of Physiology, Sect 12: Exercise: Regulation and Integration of Multiple Systems(Rowell, L. B. & Shepherd, J. T., eds), Chapter 22. 995-1035. American PhysiologicalSociety, Bethesda, MD

Schena, F., Guerrini, F. and Tregnaghi, P. (1992) Branched-chain amino acidsupplementation during trekking at altitude The effects on loss of body mass bodysupplementation during trekking at altitude. The effects on loss of body mass, bodycomposition, and muscle power. European Journal of Applied physiology. 65, 394-398

Shimomura, Y., Murakami, T., Nakai, N., Nagasaki, M. and Harris, R. A. (2004) ExerciseP t BCAA C t b li Eff t f BCAA S l t ti Sk l t l M l d iPromotes BCAA Catabolism: Effects of BCAA Supplementation on Skeletal Muscle duringExercise. J Nutr. 134, 1583S-1587S

Creatine

What Is Creatine Monohydrate?What Is Creatine Monohydrate?

Creatine is a molecule that plays an important role in muscularcontractionsIt is converted to phosphocreatine which plays an important roleIt is converted to phosphocreatine, which plays an important rolein the re-formation of ATP (chemical energy source within cells)from ADP (pre-used ATP molecule).Normal creatine stores for a 70kg man total around 120g ofNormal creatine stores for a 70kg man total around 120g, ofwhich 95% is found in the muscle (Hunter, 1922)Creatine can be manufactured in the body from the amino acidsarginine glycine and methionine at a rate of 1 2g per dayarginine, glycine and methionine at a rate of 1-2g per day.We also consume about 1g of creatine, a day, in our diet fromfoods such as beef and tuna.Creatine is an alactic energy source (it can produce energy inthe absence of oxygen) that is capable of producing about 6-10seconds of energy during maximal effort

Physiological BenefitsPhysiological Benefits

Increases muscular strength and powerIncreased muscle sizeImproved sprint performanceCan increase bone mineral densityCan increase bone mineral densityCan Increase fatigue resistance

Who Should Take Whey CreatineSupplements?

Any athlete / active person involved in:Strength / power sports & bodybuildingStrength / power sports & bodybuildingRugby, American Football, & European Football, wherethere are repeated bouts of sprinting should benefit fromthere are repeated bouts of sprinting should benefit fromcreatine monohydrateIt also appears to be effective at increasing lean musclepp gmass and bone mineral density in older athletesProtective from head injuries and concussion

Some researchSome researchFollowing supplementation creatine stores can increase to amaximum of about 160g Once full creatine stores stay elevatedmaximum of about 160g. Once full, creatine stores stay elevatedfor around 14-21days but can be maintained for longer by taking asmaller maintenance dose

Phosphocreatine stores are important for muscular contractions

Supplementation with creatine enhances performance during highpp p g gintensity exercise (Nagle and Bassett, 1989)

Supplementation demonstrated to have the most positive benefits/when used with strength/power athletes or sprint athletes

A number of studies have demonstrated that creatine monohydrates pplements enhance performance d ring short term e ercisesupplements enhance performance during short term exercise(Greenhaff et al., 1993; Greenhaff, 1995; Maughan, 1995; Volek etal., 1999, and; Mujika et al., 2000; Anomasiri et al., 2004; Hoffmanet al., 2005))

More researchMore research

Creatine supplementation has been demonstrated to improvemuscular strength and size (Volek et al., 1999). In this study,nineteen male strength-trained athletes underwent 12 weeks ofresistance training Half were given creatine supplementation andresistance training. Half were given creatine supplementation andthe other half took a placebo or “inactive” supplement. Creatinesupplementation consisted of 20g of creatine monohydrate per day,for 5 days, followed by a maintenance dose of 5g a day for theremainder of the study Following the 12 weeks of training theremainder of the study. Following the 12 weeks of training thecreatine group increased fat free mass (muscle mass) by 6.3%compared to 3.1% in the placebo group. Muscle cross-sectionalarea increases were greater in the creatine group as well. Theg g pcreatine group also demonstrated greater gains in strength, withtheir squat and bench press strength increasing by 34% and 22.6%respectively, compared to 25.8% and 15% in the placebogroup. The increase in total body weight, and fat free mass,group. The increase in total body weight, and fat free mass,appears to be due, in part, to increased water retention within themuscle (Kutz and Gunter, 2003)

And more researchAnd more research

Similar improvements in strength and power were reportedp g p pby Rawson and Volek (2005). In this study subjects tookeither creatine monohydrate, or a placebo, whilst doingresistance training The researchers found that theresistance training. The researchers found that thecreatine group increased muscle strength by 20% whereasthe placebo group only increased muscle strength by12% Similarly weight lifting performance increased by12%. Similarly weight lifting performance increased by26% in the creatine group and only 12% in the placebogroup. In both cases the improvement in the creatinegroup was around twice that of the placebo groupgroup was around twice that of the placebo groupCreatine supplementation has also been demonstrated toimprove sprint performance in footballers (Mujika et al.,( j2000) and also improves football-specific skill performance(Ostojic, 2004)

Research in endurance sportsResearch in endurance sports

Creatine may also be beneficial for endurance cycling performance (PreenCreatine may also be beneficial for endurance cycling performance (Preenet al., 2001). Endurance cyclists may benefit from creatine supplementationthrough the way it allows them to recover quicker between the smallincreases in pace that commonly occur during cycling races. Total work,peak power, and cycling sprint performance have been demonstrated topeak power, and cycling sprint performance have been demonstrated tosignificantly improve following creatine supplementation (Gill et al.,2004). Also reduced levels of fatigue, during intense exercise, have beenfound following creatine supplementation (Hoffman et al., 2005). It appearsunlikely that creatine would be of significant benefit to endurance runners,y g ,due to the increased weight gain experienced following supplementation

It has also proved to be effective for swimmers (Anomasiri et al., 2004). Inthis study creatine supplementation significantly improved sprintingthis study creatine supplementation significantly improved sprintingperformance over the last 50m of 400m swimming competitions

Creatine is also believed to protect against loss of strength and muscle sizef ll i i ti it th h i j d l h l t t t i t thfollowing inactivity through injury, and may also help to protect against theage associated decrease in strength and lean muscle mass. In factresearch has shown that in older men (71 year olds), creatinesupplementation, caused a significant increase in muscle mass and a 3.2%increase in bone mineral content (Chilibeck et al 2005)increase in bone mineral content (Chilibeck et al., 2005)

Is Creatine Effective?Is Creatine Effective?

Yes!Creatine monohydrate has been proven to be perhapsth t ff ti t iti l l t f h ithe most effective nutritional supplement for enhancingmuscular strength, size and powerIt is one of the most widely researched sportsIt is one of the most widely researched sportssupplements and has shown beneficial effects in nearlyevery research study undertakene e y esea c s udy u de a e

How to take creatineHow to take creatine

C ti i ll t k i l di dCreatine is normally taken using a loading dose20g of creatine (split into four 5g doses) for 5 daysOften taken with simple sugars such to increase the uptake ofOften taken with simple sugars such to increase the uptake ofcreatine by muscleThis will elevate muscle creatine levels elevated for 14-21d21days.By taking a small maintenance dose (2-5g per day) you canmaintain the levels of muscle creatine levels for longer.gResearchers have found positive effects on performancewithout taking a loading dose (Anomasiri et al., 2004;Hoffmann et al 2005) Hoffman et al (2005) found that theHoffmann et al., 2005). Hoffman et al., (2005) found that theconsumption of just 6g of creatine monohydrate, for just 6days, significantly improved fatigue resistance

ReferencesReferencesAnomasiri, w., sanguanrungsirkul, S. and Saichandee, P. (2004) Low dose creatinesupplementation enhances sprint phase of 400 meters swimming performance. J Med AssocThai 87 (Suppl 2) S228 S232Thai. 87 (Suppl 2), S228-S232

Chillibeck, P. D., Chrusch, M. J., Chad, K. E., Shawn Davison, K. and Burke, D. G. (2005)Creatine monohydrate and resistance training increase bone mineral content and density inolder men. J Nutr Health Aging. 9 (5), 352-353g g ( ),

Gill, N. D., Hall, R. D. and Blazevich, A. J. (2004) Creatine serum is not as effective ascreatine powder for improving sprint performance in competitive male team-sport athletes. JStrength Cond Res. 18 (2), 272-275

Greenhaff, P. L. (1995) Creatine and its application as an ergogenic aid. International Journalof Sports Nutrition. 5, S100-S110

Greenhaff P L Casey A Short A H Harris R Soderlund K and Hultman E (1993)Greenhaff, P. L., Casey, A., Short, A. H., Harris, R., Soderlund, K. and Hultman, E. (1993)Influence of oral creatine supplementation on muscle torque during repeated bouts ofmaximal voluntary exercise in man. Clin. Sci. 84, 565-571

Groeneveld, G. J., Beijer, C., Veldink, J. H., Kalmijn, S., Wokke, J. H. and Van Der Berg, L.j j gH. (2005) Few adverse effects of long-term creatine supplementation in placebo-controlledtrial. Int J Sports Med. 26 (4), 307-313

Hoffmann, J. R., Stout, J. R., Falvo, M. J., Kang, J. and Ratamess, N. A. (2005) Effect of low-dose short-duration creatine supplementation on anaerobic exercise performance Jdose, short-duration creatine supplementation on anaerobic exercise performance. JStrength Cond Res. 19 (2), 260-264

ReferencesReferencesKutz, M. R. and Gunter, M. J. (2003) Creatine monohydrate supplementation on body weight and percentbody fat. J Strength Cond Res. 17 (4) 817-821

Maughn, R. J. (1995) Creatine supplementation and exercise performance. International Journal of SportsNutrition. 5, 94-101

Mujika I Padilla S Ibanez J Izquierdo M and Gorostiaga E (2000) Creatine supplementation andMujika, I., Padilla, S., Ibanez, J., Izquierdo, M. and Gorostiaga, E. (2000) Creatine supplementation andsprint performance in soccer players. Medicine and Science in Sports and Exercise. 32, 518-525

Nagle, F. J. and Bassett, D. R. (1989) Energy metabolism. In: Nutrition in exercise and sport. Ed.Hickson, J. F. and Wolinsky, I. Boca Raton. FL, CRC Press. 87-106Hickson, J. F. and Wolinsky, I. Boca Raton. FL, CRC Press. 87 106

Ostojic, S. M. (2004) Creatine supplementation in young soccer players. Int J Sport Nutr Exerc Metab. 14(1), 95-103

Preen, D., Dawson, B., Goodman, C., Lawrence, S. and Beilby, J. (2001) Effect of creatine loading on long-term sprint exercise performance and metabolism. Medicine and Science in Sports and Exercise. 33, 814-821

Rawson, E. S. and Volek, J. S. (2003) Effects of creatine upplementation and resistance training on musclestrength and weightlifting performance. J Strength Cond Res. 17 (4), 822-831

Volek, J. S., Kraemer, W.J., Rubin, M. R., Gomez, A. L., Ratamess, N. A. and Gaynor, P. (2002) L-carnitineL l i f bl ff k f f i A i J l fL-tartrate supplementation favouably affects markers of recovery from exercise stress. American Journal ofPhysiology. 282, E474-482.

Combining creatine and colostrum

Glutamine

What Is Glutamine?What Is Glutamine?

L-Glutamine abundant amino acid in the human bodyIt is non-essential, e.i. we can make itMakes up over 50% of the total amount of amino acidsMakes up over 50% of the total amount of amino acidsEssential for growthPlays an important role in liver functionServes as an important fuel for many tissues in the body(particularly the muscles, immune cells, and thegastrointestinal tract, and plays a role in the regulation ofg p y gprotein synthesis (Rennie et al., 1989).It is also regularly used by doctors and healthprofessionals to treat illness, injury and infection (smith,p , j y ( ,1990).

Physiological BenefitsPhysiological Benefits

Enhanced protein synthesisImproves the rate of recoveryImproved immune function and reduced risk of infectionIncreased levels of growth hormonegHelps to maintain the amino acid balance

The ResearchThe ResearchAlthough we produce glutamine, stores are rapidly depleted duringti f t i t h i l ti ittimes of stress or intense physical activityDuring periods of intense stress, such as, prolonged or intenseexercise, starvation, or trauma, the level of plasma glutamine maydecrease substantially (Castell 2003)decrease substantially (Castell, 2003)Regular exercise has been shown to deplete glutamine levels by45% in just 7 days (Newsholme, 1994)Following marathon running plasma glutamine levels have beenFollowing marathon running plasma glutamine levels have beenshown to decrease by around 20% (Castell and Newsholme, 1997)When glutamine levels are low, there is an increased risk ofinfectionThe consumption of oral glutamine has been shown to have abeneficial effect on immune function, and reduces the risk ofinfection following prolonged endurance exercise (Castell andNewsholme 1997; Castell 2003) and should be of benefit toNewsholme, 1997; Castell, 2003) and should be of benefit toathletes engaged in heavy exercise training (Antonio and Street,1999)

More researchMore research Glutamine maintains amino-acid balance in the body,ythereby enabling a greater synthesis of protein and apossible decrease in symptoms of overtraining (Bompa etal., 2003)Glutamine stimulates the synthesis of new protein withinmuscle cells, this leads to an increase in the size andstrength of the muscles. This increase in strength is partlyd t l t i l ll l i i ff t h bdue to glutamines muscle cell volumising effect, wherebythere is increased retention of water within muscle cellsGlutamine can be used as an energy sourceMaintaining a high level of glutamine in muscle tissue mayhelp to preserve the valuable stores of muscle glycogen(carbohydrate store within muscle tissue). It will also help( y )to increase the rate of glycogen re-synthesis in musclecells, following strenuous or prolonged exercise

And moreAnd more

Glutamine supplementation may efficiently lead to thepp y yrelease of growth hormone (Bompa et al., 2003)2 gram dose of L-glutamine, taken orally, can double thelevel of growth hormone in just 30 minutes (Welbournelevel of growth hormone in just 30 minutes (Welbourne,1995).When glutamine levels rise in the blood, it is detected bythe brain. The brain associates this rise in glutaminelevels with an increase in acidity in the blood and releasesgrowth hormone in order to regulate the acidity levelsg g yIn short, glutamine supplementation aids recovery fromprolonged or intense exercise, primarily, by reducing therate of muscle breakdown within muscle tissue It also aidsrate of muscle breakdown within muscle tissue. It also aidsimmune function, spares valuable stores of glycogen, andincreases levels of growth hormone

Is Glutamine Effective?Is Glutamine Effective?

Yes! In certain situations:Glutamine appears to be effective at preventing amino

id d l ti d h t i iacid depletion and enhances post exercise immunefunction & recovery

Who Should Take Glutamine?Who Should Take Glutamine?

Most athletes:Those that train intensively, or for prolonged periods ofti b fit f l t i l ttime may benefit from glutamine supplementsStrength/power athletes (weight lifters, body builders,rugby players american football players etc) andrugby players, american football players etc) andendurance athletes like triathletes, runners, cyclists etcshould all benefit from glutamine supplementss ou d a be e o g u a e supp e e s

How to TakeGlutamine Supplements

Health professionals generally recommend a dailydosage of 5-10 grams of glutamine split into 2-4dosage of 5 10 grams of glutamine, split into 2 4servingsAthletes would be wise to use a minimum dose of 2Athletes would be wise to use a minimum dose of 2grams in order to gain the benefit of increased growthhormone levelsIdeally this should be taken 30 minutes prior toexercise and again immediately after exerciseRemember there will be a big dose in a protein shake

ReferencesReferencesAntonio, J. and Street, C. (1999) Glutamine: a potentially useful supplement for athletes. Can JAppl Physiol. 24 (1), 1-14

Bompa, T. O., Pasquale, M. D. and Cornacchia, L. J. (2003) Chapter 6: Using NutritionalSupplements. In: Serious Strength Training. Human Kinetics. Leeds, United kingdom

Castell L (2003) Glutamine supplementation in vitro and in vivo in exercise and inCastell, L. (2003) Glutamine supplementation in vitro and in vivo, in exercise and inimmunodepression. Sports Medicine. 33 (5), 323-345

Castell, L. M. and Newsholme, E. A. (1997) The effects of oral glutamine on athletes afterprolonged exhaustive exercise Nutrition 13 (7-8) 738-742prolonged, exhaustive exercise. Nutrition. 13 (7-8), 738-742

Newsholme, E. A. (1994) Biomechanical mechanisms to explain immunosuppression in well-trainedand overtrained athletes. International Journal of Sports Medicine. 15, S142-147R i M J M L P A H d ll H S t l (1989) Sk l t l l l t i t tRennie, M. J., MacLennan, P. A., Hundall, H. S. et al., (1989) Skeletal muscle glutamine transport,intramuscular glutamine concentration, and muscle-protein turnover. Metabolism. 38 (8 Suppl 1),47-51

Smith, R. J. (1990) Glutamine metabolism and its physiologic importance. Journal of Parenataland Eternal Nutrition. 14, 40S-44S

Welbourne, T. C. (1995) Increased plasma bicarbonate and growth hormone after an oralWelbourne, T. C. (1995) Increased plasma bicarbonate and growth hormone after an oralglutamine. American Journal of Clinical Nutrition. 61, 1058-1061.

HMB

What Is HMB?What Is HMB?

Break down product of leucinePopular supplement in the 90’sp ppGood for early trainers to reduce DOMSDoes it do more?Does it do more?Recent studies suggest that 3g/day may increaseLBM, whilst reducing BFg

HMB metabolismHMB metabolism

Leucine is metabolized in muscles and fat rather thanLeucine is metabolized in muscles and fat, rather thanthe liverHMB provides the HMB CoA to build cholesterolpIntramuscular cholesterol allows the repairs musclemembrane to allow muscle growthgStatins that inhibit cholesterol formation have knownnegative impact on LBM causing pain, wastingHMB decreases markers of muscle damage –creatine kinase, lactate dehydrogenase, 3-methlyhistidine

3g HMB/day reduces plasma nitrogen by 42%HMB reduces muscle breakdown and increases LBM

HMB is ineffective?HMB is ineffective?

Study by R Kreider et al in 1999 suggested in trainedStudy by R Kreider et al in 1999, suggested in trainedathletes the HMB is not effectiveHowever in his studies the control group consumedg p330 kcal more each day than the training groupsThere was a dose dependent increase in LBM for thep3g and 6g groups, just not significant

To use HMB must have significant training loadMore effective in a hypocaloric rather thanhypercaloric environment

How to use HMBHow to use HMB

Need a significant training load

More effective in a hypocaloric rather thanhypercaloric environmenthypercaloric environment

3-6g/day in divided doses3 6g/day in divided doses

The future of HMB?The future of HMB?

Long term rat modelsLong term rat modelsHMB stopped aged related fat mass increaseHMB stopped decrease in muscle sizeHMB stopped decrease in muscle sizeWhen over trained got no increase in cortisol or lossin strengthin strength

May have a role in managing sarcopeniaMay have a role in managing sarcopenia

Arginine

What Is Arginine?What Is Arginine?

Arginine is a non-essential amino acid that is knownArginine is a non-essential amino acid that is knownto have anabolic (muscle building properties)

Arginine supplements are normally available as eitherL-Arginine, Arginine pyroglutamate or Arginine-alpha-ketoglutatrateketoglutatrate

Supplementing may increased protein synthesisSupplementing may increased protein synthesis,reduced muscle breakdown, elevated growthhormone levels, improved recovery, increased muscleblood flow, lactic acid and ammonia removal, reducedbody fat levels, and increased nitric oxide production.

Who Should Take Arginine?Who Should Take Arginine?

Possibly anyone, who wants increased muscle size,greater recovery

Since the main benefits of arginine supplementationcome from increased muscle protein synthesis andcome from increased muscle protein synthesis andenhanced growth hormone levels the people who willprimarily benefit are bodybuilders and strength athletesp a y be e a e bodybu de s a d s e g a e es

However, the increased muscle blood flow and lacticHowever, the increased muscle blood flow and lacticacid removal may also be beneficial to enduranceathletes.

Physiological BenefitsPhysiological Benefits

Naturally increases growth hormone levelsEnhances Nitric oxide productionpDilates blood vessels

ResearchResearchSupplementation with arginine is known to significantlypp g g yincrease growth hormone levels (Merimee 1965; Isidori etal., 1981; Elam, 1988; Di Luigi, 1999)

Growth hormone is one of the most important hormonesfor growth

It is known to significantly increase muscle mass as wellas decreasing body fat levels. It is well known that thepositive effects of any exercise training program arepositive effects of any exercise training program areprimarily due to the natural release of growth hormone inresponse to the exercise program (Kraemer 1992)

The positive effects that arginine supplementation has ongrowth hormone levels is one of the reasons why it hassuch a positive impact on muscle masssuch a positive impact on muscle mass.

And some moreAnd some more

Arginine is also known to dilate blood vessels primarily throughArginine is also known to dilate blood vessels, primarily throughincreased nitric oxide production. This is important since itincreases the amount of blood flow to the muscles. Theincreased blood flow allows greater delivery of hormones,g yprotein, carbohydrate and other nutrients to the muscles andtherefore aids muscle growth.

Other positive effects of increased muscle blood flow includeincreased muscular endurance, lower lactic acid and ammonialevels

Increased nitric oxide production, following argininesupplementation, is of great importance to athletes. As well ashaving an effect on muscle blood flow nitric oxide alsohaving an effect on muscle blood flow, nitric oxide alsostimulates muscle growth. Increased nitric oxide levels have apositive effect on muscle mass by stimulating an increase in therate of protein synthesis within muscle cells.

Is Arginine Effective?Is Arginine Effective?

Yes! In certain situations

Researchers have found that arginine is effective atenhancing both growth hormone levels and nitric oxideproduction and should therefore be of benefit forproduction and should therefore be of benefit forenhancing muscle growth.

How to Take ArginineHow to Take Arginine

1) L arginine this is the most basic type of arginine It has positive effects1) L-arginine – this is the most basic type of arginine. It has positive effectson growth hormone levels, muscle mass, body fat and nitric oxide. Becauseit is the most basic (free-form) type of arginine it needs to be taken at ahigher doseage (approximately 5g 30minutes before exercise to have ahigher doseage (approximately 5g 30minutes before exercise to have apositive effect) than the more advanced types of arginine

2) Arginine pyroglutamate – is made by binding L-arginine to pyroglutamic2) Arginine pyroglutamate is made by binding L arginine to pyroglutamicacid. It has the same positive effects as L-arginine but has a greater effecton growth hormone levels as it has a greater ability to cross the blood brainbarrier. You should take approximately 3g of arginine pyroglutamate,pp y g g py gcombined with L-lysine, 30minutes before exercise for best results

3) Arginine alpha ketoglutarate – is made by combining L-arginine with) g p g y g galpha ketoglutaric acid. It has the same benefits as L-arginine but has agreater effect on nitric oxide production. You should take approximately 3gof arginine alpha ketoglutarate 30minutes before exercise for best results.

ReferencesReferencesDi Luigi, L., Guidetti, L., Pigozzi, F. et al., (1999). Acute amino acid

l t ti h it it i i thl tsupplementation enhances pituitary responsiveness in athletes.Medicine of Science in Sport and Exercise. 31, 1748-1751

Elam R P (1988) Morphological changes in adult males fromElam, R. P. (1988) Morphological changes in adult males fromresistance exericise amino acid supplementation. Journal of SportsMedicine and Physical Fitness. 28, 35-39

Isiadori, A., Lo Monaco, A. and Cappa, M. (1981) A study of growthhormone release in man after oral administration of amino acids.Current Medical Research and Opinion. 7, 475-481

Kraemer, W. J. (1992) Influence of the endocrine system onresistance training adaptations. National Strength and ConditioningJournal 14 47 54Journal. 14, 47-54

Merimee, T. J., Lillicrap, D. A. Rabinowitz, D. (1965) Effect ofarginine on serum-levels of growth hormones Lancet 2 668arginine on serum levels of growth hormones. Lancet. 2, 668

Buffers

Buffering what’s it all about?Buffering – what s it all about?Acid / alkaline balance

2 types of Anaerobic Energy Systems:

ATP-PCr energy system -uses creatine phosphate

Lactic-acid (or anaerobic glycolysis) system that usesglucose (or glycogen) in the absence of oxygen

In anaerobic exercise Lactate builds up

Lactate threshold,when accumulate 4mmol,rest 1mmol - Best and most consistent predictores o est a d ost co s ste t p ed ctoof performance

Fox and Heskell formulaFox and Heskell formula

Buffering agentsBuffering agents

Phosphates

Na Bicarbonate or Na Ctirate

β−Alanine

Phosphate LoadingPhosphate Loading

Stimulate glycolysis

Delay anaerobic threshold

Increase phosphate for ATP and creatinephosphate resynthesisphosphate resynthesis

Buffer acidity during intense exercise

Phosphates Increase PowerPhosphates Increase Power

PhosphatesPhosphates

Improve cardiac function

Improve respiratory capacity

Effects of phosphate loading may be synergistic withcreatine, bicarbonate and carbohydrate loading

Simple and EffectiveSimple and Effective

PhosphatesTake 4 capsule am and pm for 3 daysp p ybefore day of event

On event day take 4 capsules at breakfast,4 at lunch and 4 thirty minutes before the4 at lunch and 4 thirty minutes before thematch

What Is Sodium Bicarbonate?What Is Sodium Bicarbonate?

Sodium Bicarbonate is more commonly known asBicarbonate of Soda, or baking soda

It is a mixture of sodium (salt) and bicarbonate (anacid buffer)acid buffer)

It i ft d b d thl t t hIt is often used by endurance athletes to enhanceathletic ability by buffering the build-up of lactic acid inthe bloodthe blood

Who Should Take Sodium Bicarbonate?

Any endurance athlete looking to improve raceperformancep

Athletes wanting to decrease the negative effects ofAthletes wanting to decrease the negative effects oflactic acid, may benefit from sodium bicarbonate

Those you can get to take it!

Physiological BenefitsPhysiological Benefits

Lowers blood lactate levels

Enhanced endurance performance

Improved recovery between exercise intervals

ResearchResearch

Sodium bicarbonate has been shown to improve endurance run,p ,cycling, and swimming performances

Sodium Bicarbonate is believed to work by buffering the build up oflactic acid, and may therefore reduce, the negative effectsassociated with increased blood acidity

I d idit i b li d t ff t th l l f f ti bIncreased acidity is believed to affect the level of fatigue by:1) inhibiting key enzymes used for the production of energy2) inhibiting the release of calcium ions during muscular contractions; and3) a reduced level of muscle fibre contractility (Bird et al. 1995)3) a reduced level of muscle fibre contractility (Bird et al. 1995)

In effect, sodium bicarbonate soaks up the fatigue inducing effectsof lactic acid. This reduces the level of blood and muscle acidityyand is believed to allow an athlete to exercise at a higher levelbefore they suffer the negative effects of increased blood andmuscle acidity

And moreAnd more

Research has demonstrated that sodium bicarbonateingestion improves 400m run time by 1.5secs(Goldfinch et al., 1988), 800m run time by 2.9secs(Goldfinch et al., 1988), 800m run time by 2.9secs(Wilkes et al., 1983), and 1500m run time by 4.1secs(Bird et al., 1995)

The main reason for the improved exerciseperformance following bicarbonate ingestion isperformance following bicarbonate ingestion isbelieved to be due to an increased removal of lactateprotons from the muscles and increased buffering ofacidity in the blood (Gledhill, 1984; Roth and Brooks,1990; Bird et al., 1995)

Sodium Bicarbonate LoadingSodium Bicarbonate Loading

Produces a significant performance enhancing effect inevents lasting 1-7mins

Similar gains likely in events lasting up to an hour

Average gain 1-3% over events from 400m to 30km

Is Sodium Bicarbonate Effective?Is Sodium Bicarbonate Effective?

Yes! In certain situations

Sodium Bicarbonate has been proved to be effective atimproving endurance performance by buffering the buildup of lactic acidup of lactic acid

How to TakeSodium Bicarbonate

Current research suggests that to gain animprovement in endurance performance, athletesshould consume 300mg of sodium bicarbonate per kgshould consume 300mg of sodium bicarbonate per kgof bodyweight (McNaughton, 1992)

Higher dosages (0.5g) sodium bicarbonate are likelyto cause gastrointestinal problems

Drink in 1L of water, or splitting the dose into severalsmaller doses taken throughout the day helps tosmaller doses, taken throughout the day, helps toreduce the negative side-effects.

ReferencesReferencesBird, S. R., Wiles, J. and Robbins, J. (1995) The effect of sodium bicarbonateingestion on 1500-m racing time. Journal of Sports Sciences. 13, 399-403

Goldfinch, J., McNaughton, L. and Davies, P. (1988) Induced metabolic alkalosisand its effects on 400m racing time. European Journal of Applied Physiology. 57,45 4845-48

Gledhill, N. (1984) Bicarbonate ingestion and anaerobic performance. SportsMedicine 1 177 180Medicine. 1, 177-180

McNaughton, L. (1992) Bicarbonate loading and its use in sports. InternationalClinical Nutritional Review 12 65-67Clinical Nutritional Review. 12, 65-67

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New developments β AlanineNew developments β−Alanine

Non-essential ααNon essential αα

7% all muscles7% all muscles

Combines with histidineCombines with histidineto make Carnosine

Carnosine primarily acts asa intracellular buffera intracellular buffer

AntioxidantNeural activator

Exercise and carnosineExercise and carnosine

When excerise, can only deplete available ATPby 20%!Due to build of metabolic waste H+Work load correlated to muscle carnosine levelsWork load correlated to muscle carnosine levelsCarnosine enhances max contractile speedAlso increases speed of nerve signal viaAlso increases speed of nerve signal viaactivation and protection of Na+/K+ ATPase

Carnosine;Carnosine;

f fIngestion of β−Alanine is rate-limiting information

P d t f /Produce greater force /power

Contract for longer delays neuromuscular fatigueContract for longer, delays neuromuscular fatigue

Inc maximum strength number of reps and time toInc maximum strength, number of reps and time toexhaustion in sub maximal exercise (Harris et al 2006)

Dose 4-5g/day

PhosphatidylserinePhosphatidylserine

Naturally occuring –fish, rice, green veg

Found cell MB of cells with high metabolicgactivity – brain & muscle

Early studies – role in cognitive functionImproves learningp gMay support mitochondrial Energy production

Nutrition and mental acuityNutrition and mental acuity

PS and athletic performancePS and athletic performance

St di 1990’ S l h d hi h b i f tiStudies 1990’s – Suppl enhanced higher brain function(without cognitive decline)

PS reduces exercise induced Cortisol – 1992

PS reduces perceived levels of muscle soreness -1998

2005 PS acts as an antioxidant

PS effect on intermittent exercisePS effect on intermittent exercise

Study in 20063 x 10min cycle @ 45,55 & 65% Vo2 maxThen 85% to exhaustion750mg / day for 10 days

Time to exhaustion increased by 29%!

CaffeineCaffeineWhy

Mental focusReduced perception of exertionF t b i h dFat burning enhanced

When30 mins before you need it4-6 hours before a rest period

How much2.5mg / Kg body weight, once a day2.5mg / Kg body weight, once a day

HowP l 50 t bl tProplus 50mg tablets

Performance supplementPerformance supplement

PS for training and matchesPhosphate loading - gamesBicarb loading (game days only)β−Alanine – Maxipower, but only 1.5g/serving