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Define “athlete”…
Anyone who is physically active or exercises on a regular basis
We should all be working with athletes!
EXERCISE GUIDELINES 6 days/week (30-60 min)
US Surgeon General American Heart Association
All RD’s can apply Sports Nutrition strategies to their clients
We have a new board certification!
CSSD= Board Certified as a Specialist in Sports Dietetics
159 CSSDs in U.S. Sports Dietetics Practitioner:
experienced RD’s who apply evidence-based nutrition knowledge in exercise and sports. They assess, educate, and counsel athletes and active individuals. They design, implement, and manage safe and effective nutrition strategies that enhance lifelong health, fitness, and optimal performance.
Current Registered Dietitian (RD) status.
Maintenance of RD status for a minimum of 2 years by the date of the CSSD exam.
Documentation of 1,500 hours of specialty experience as an RD within the past 5 years (by the date the application is due).
o Deadline for Summer, 2008 CSSD exam is MAY 7!o Education can count toward up to 1200 hours until May, 2009.
Successful completion of CSSD exam.
Visit www.cdrnet.org for more information!
Become a CSSD!
My Philosophy
Performance
&
Health
through
Good Taste
Sports Nutrition:Recommendation Considerations Population of athlete
i.e.: child, Master’s, college/elite, non-competitive
Background
Exercise intensity
Exercise duration
Exercise frequency
Calorie Needs for Athletes
TEF
10-30%
5-10%
55-75%
Energy Expenditure Varies Widely!
Examples: Female Olympic Gymnasts 1900 kcals/day McNickols MSSE 55:187-91, 1996
High School Soccer Players (females)
3300 kcals/dayBurke et al J Sports Sci 24:675-85, 2006
Tour de France Cyclists 7069 kcals/day Saris et al Int J Sports Med 10:26-31, 1999
15-30 kcal/pound
Energy needs
Basic caloric requirements:
Sample:
160-pound marathon runner
160 X 25-30 = 4,000 – 4,800
Estimated Daily Energy (Calorie) Needs for Training
Training/workoutsCalories/#
120# 160# 280#
Low (sedentary)13 to 15 1,560 – 1,800 2,080 – 2,400 3,640 – 4,200
Active(30 to 60min/d )16 to 18 1,920 – 2,160 2,560 – 2,880 4,480 – 5,040
Moderate(1 to 1 ½ hr/d)19 to 21 2,280 – 2,520 3,040 – 3,360 5,320 – 5,880
High (1 ½ to 2 hr/d)22 to 24 2,640 – 2,880 3,520 – 3,840 6,160 – 6,720
Very High (2 to 3 hours/d)25 to 30 or more 3,000 – 3,600 4,000 – 4,800 7,000 – 8,400
Energy Needs
RMR Measurements in Real Athletes
Football player – 6’7”, 230#o Estimated: 2300, Measured: 3450
Female Gymnast – 5’1”, 130#o predicted: 1320, actual: 1160
Male Runner – 6’0”, 155#o predicted: 1620, actual: 1400
Male Rower – 6’4”, 210#o predicted: 2100, actual: 1750
Note: RMR estimation equations are not specific for athletes!
Calorie Considerations
When working with athletes, consider potentially huge fluctuation in calorie needs based on training periods, off-season, injury, growth, etc.
Teach concept of “Nutrition Periodization”
Injury and energy needs
• Female collegiate swimmer - 12,000yards/day (6/week) + weights 3 days/week
= 3800 calories/day
• Shoulder injury - no swimming = 2200 calories/day
• Shoulder surgery w/ complications
= 4000 calories/day
Meal Timing & Frequency
Guideline: Eat multiple times/day
Regardless of WEIGHT goals Problem: “Bottom Heavy” Diets
Time, schedule, avoiding eating before exercise
Importance Energy availability Protein synthesis BODY COMPOSITION
Inter-Day Energy Balance
Those with wide deviations in energy balance during the day have highest body fat – regardless of whether the energy deviations are surpluses or deficits
Muscle protein may be broken down to maintain blood glucose
Breakfast
Provide practical examples Sleep and time are precious to athletes Educate that people who eat breakfast
have: Better weight control More appropriate caloric intake Greater academic performance Greater energy availability Improved hydration status Better intake of fiber, calcium, iron, zinc, fruit,
and whole grains
Satiety Index of Breakfast Foods
0.0
30.0
60.0
90.0
120.0
150.0
180.0
210.0
Croissant
Source: Holt et al. European Journal Clinical Nutrition 1995, 49:675-690.
Yogurt –Strawberry
WhiteBread
Granola –Oats,
Fruits,Nuts
Special K CornFlakes
Bananas Eggs –Poached
WheatBran
Cereal(14g Fiber)
Oatmeal
Macronutrient Basics
Macronutrient Needs
Carbohydrate & protein needs may be better
expressed as absolute grams rather than as
% of kcals.
CHO
Protein
Fat
55-65%
15-20%
20-25%
Carbohydrates…FUEL
Carbohydrate Needs:
30 min – 1 hr moderate exercise: 4-6g/kg
1 hr intense training/day: 7g/kg
1-2 hrs intense training/day: 8-9g/kg
2-4 hrs intense training/day: 9-10g/kg
**Ultraendurance athletes: >12g/kg
150-lb Mom who does aerobics classes:
300g Carbs/day
150-lb Lance Armstrong:
800g Carbs/day
Carbohydrates: Practical Issues
Carbohydrate-loading really works “Glycogen Supercompensation” 3 days out…100-150 extra grams CHO + ↓exercise
Athletes benefit from carbohydrates during intense exercise (↑physical & mental, ↓fatigue) 30-60grams/hour recommended
Consider half-time and during-event carbohydrate options
Protein…Growth, Strength, Repair
Protein needs: 1.2-1.7g/kg Some research supports up to 2g/kg
…so, more than the average person, but not as much as many athletes regularly eat!
Protein Scorecard for Athletes
~10 grams protein in: 1 ounce meat, tofu, or equivalent 2 eggs 1 cup milk/yogurt or 1 ounce cheese 2/3 cup beans 1/3 cup nuts or 2T peanut butter
Animals & Plants
Protein: Is more better?
Food Supplements
+ + =
How much is too much?
Research has shown a CEILING above which no further benefits occur
.9g/kg 1.4g/kg 2.4g/kg
Pro
tein
syn
thes
is
No exercise
Strength trained
Tarnopolsky et al. JAP, 1992
200-lb athlete 80g
protein130g
protein220g
protein
Individuals with higher protein needs:
New training program
Energy restriction
o Intentional (diet)
o Non-intentional (extreme expenditure)
Vegetarians
Disease/disuse
Injury rehab
Young or old athletes These aren’t the people typically
using protein supplements!
What’s the big deal about getting too much protein?
“Don’t you just excrete it?”
Potential impact on: kidney, bone, hydration status, etc. ?
intake of other nutrients o Fat (can be excessive)o Carbohydrates (can be inadequate)o Vitamins & minerals (can be inadequate) o Fiber (can be inadequate)
hormonal regulation of muscle growth
If the athlete insists on following a high protein diet:
Focus on lean protein sources
Emphasize ample carbohydrates Encourage whole grains, fruits, veggies
Consider micronutrient supplement
Why should athletes follow a low-fat diet?
Allow for adequate CHO and protein intake
Minimize gastrointestinal upset
Control body weight
Prevent chronic disease
Keep athletes’ backgrounds in mind
Many genetically gifted in terms of body composition…never “worried” about nutritional intake before
Example…US Soccer National Team Member diet analysis: 62% kcals from fat
Teach sources of HEALTHY fats and their value: flax, fish, oils, avocado, nuts, seeds, etc.
Fast Food Education
Popular, realistic, only option for some budgets (especially teams)
Small changes, big difference: Egg and cheese on…
o …English Muffin = 10 grams of fato …Biscuit = 25 grams of fato …Croissant = 32 grams of fat
Sports RDs & Food Service
Use meal planning opportunities for EDUCATION!
Micronutrients
Do athletes have enhanced vitamin & mineral needs?
Consequences of micronutrient deficiencies may be greater to athletes than sedentary people
Use message of communication most influential to each athlete
EX: Calcium
General Vitamin & Mineral Needs
Recommend DRI, but <UL
Perhaps higher needs for: Sodium and electrolytes Iron Antioxidants
o Vitamin C & respiratory infections, muscle damage? B-vitamins
Stress Fractures
What is a stress fracture? A skeletal defect that results from repeated application of
stress that is less than that required to fracture a bone in a single loading, but greater than the bone’s ability to recover fully.
Stress Fracture Commonalities: 15% of female athletes in 5 year period at one DI
university 95% of all stress fractures occur in the lower extremities A study of 5900 college athletes revealed no significant
difference between male and female susceptibility to stress factors. However, when looking specifically at track and field athletes, women’s incidence for stress fracture’s was nearly doubled.
Feingold et al. Female athlete triad and stress fractures. Orthop Clin North Am. 2006 Oct;37(4):575-83.
Female Athlete Triad
Disordered Eating
Menstrual Abnormalities
Poor Bone Health
Remember that disordered eating exists on a continuum!
Amenorrhea most often due to energy drain – not very low body fat!
Female Athlete Triad’s effects on Stress Fractures
Osteoporosis, a BMD standard deviation of 2.5 below the normal level, characterizes the third component of the female athlete triad. Can result from depleted estrogen levels OR inadequate energy, protein, calcium, and/or Vit. D
intake associated with restrictive eating Always screen for TRIAD with menstrual abnormalities,
stress fractures, or restrictive eating
Calcium Needs for Athletes
Recommend 1500mg-2000mg/day especially for females, amenorrheic, high sweat loss (some calcium is lost in sweat)
Be prepared to recommend non-dairy sources and supplements
Age(years)
Calcium DRI(mg)
14-18 1300
19-30 1000
31-50 1200
>50 1200
Keeping Athletes On the Field
What athletes eat on a consistent basis can have a significant impact on their overall health and immunity.
By enhancing an athlete’s diet with more anti-inflammatory foods, athletes may recover faster and manage chronic inflammation better.
Antioxidants Antioxidants help protect the body from harmful
free radicals.
Free radicals can damage tissues, cells, and genes. They occur in the environment and are naturally produced by the body. A natural type of “rusting”
Antioxidants neutralize free radicals before damage to cells and tissue occurs.
Adapted from: Heber D., Bowerman S. What Color is Your Diet? (2001)
Colors Fruits and Veggies
Green Broccoli, Brussels Sprouts, Bok Choy, Cauliflower, Cabbage, Kale, Collards, Mustard Greens, Green Peppers, Kiwi, Spinach, Limes, Leeks, Avocados
Orange/Yellow Oranges, Tangerines, Yellow Grapefruit, Peaches, Lemons, Papaya, Pineapple, Nectarines
Red/Purple Red Grapes, Purple Grape Juice, Cherries, Berries, Plums, Prunes, Raisins
White Onions, Chives, Garlic
Immunity Nutrients
Carbohydrates Fluids Vitamin A Vitamin E Vitamin C
o higher levels may help reduce incidence of respiratory infections, overtraining syndrome, and muscle damage
Zinc Omega-3 fatty acids
o also important for joint health and decreasing inflammationo omega-3 fatty acids in fish oils (1-3 g/day with mixed DHA
and EPA) have also been found to reduce inflammation in and around the joints
o flax seeds/oil, borage oil, and evening primrose oil may also benefit
“I have NO ENERGY”
Common reason to consult with Sports RD
Distinguish type of “tired” and causes: Tired all the time Wake up tired in the morning, sleepy during day Fatigue upon exertion
o Could be: ↓calories, ↓carbs, “overtraining syndrome”, ↓quality overall, dehydration, mental health issues, iron deficiency
o Note that iron deficient athletes typically report fatigue during exercise
Iron Deficiency & Anemia in Athletes
Iron deficiency without anemia may have performance detriment Female athletes with Hgb > 12 g/dL, but low ferritin levels were
given iron or placebo for 6 weeks. Those on iron grew fitter and cycled faster. Thus, even women with ferritin greater than 12 g/dL can be “functionally anemic.”
What is appropriate ferritin goal for various athletes?
Consider relative anemia Value of baseline and routine screening
***Reference: GSSI Sports Science Exchange: Anemia and Blood Boosting, Randy Eichner, 2001. www.gssiweb.com.
Typically thought to be higher in females and endurance athletes
BUT in a recent study of 100 high-level basketball players, Low ferritin was found in 37% of females and
14% of males.
Full iron deficiency anemia was noted in 14% of females and 3% of males.
Dubnov and Constantini, Int. J. Sport Nutr. Exerc Metab. 14:30-37, 2004.
Incidence of Iron Deficiency & Anemia
Identify High Risk Populations Screen Properly – Hgb & Ferritin Educate on dietary iron content and absorption
considerations Blockers - tea, coffee, calcium, antacids (ex. Tums), H2
blockers (ex. Zantac), Proton Pump Inhibitors (ex. Prilosec) Enhancers - 100mg vit C/~30mg elemental iron, pots Food combinations - animal and vegetable sources
Supplement if necessary Monitor Side Effects Reassess Status
Iron Deficiency and Anemia
Therapy for Deficiency and Anemia
Typically FeSO4 325 mg (65 mg of elemental iron) 2-3x/day may be absorbed better between meals
Hemoglobin should rise about 1 g/dL each week, and half way to normal in 3 wks, and to WNL in 2 months.
Hydration
General fluid guidelines: At rest: Is it really 8 glasses a day?
• A recent study indicates that nearly half of all active people begin their workout inadequately hydrated.
Stover et al. Can J Appl Phys, 28:s105, 2003
Drink 2or3 cups 1-2 hours BEFORE exercise
At least 2 cups per hour of exerciseo Studies have repeatedly shown that people do not
do a good job replacing fluids lost through sweat
3 cups for every pound lost during exercise
Inadequate fluids result in:
performance (strength, speed, stamina) mental sharpness and willpower recovery metabolic rate perceived effort of exertion core body temperature risk of injury
Dehydration Impairs Attentiveness in Basketball Players
11 male players
Dehydrated to 1%, 2%, 3%, or 4%
As dehydration progressed, the players exhibited slowed response time and inattentiveness to cues (computer-based testing)
The authors determined these differences in response would likely lead to costly errors in a basketball game
Med. Sci. Sports Exerc. 2007 39:976-983
Heat Illness
DEHYDRATION allows the body to heat up faster!
Heat cramps
Heat exhaustion
Heat stroke Can be fatal Several cases of high school, college, and NFL tragedies
How can athletes tell if they are drinking enough?
Clear urine, frequent bathroom trips
Absence of thirst
Hydration…Practical Issues
Remember: Should be a focus in cold weather too! Drink on a schedule! Gulps over sips Swallow instead of spit In, not on Cool, not ice cold Taste preferences change during exercise
Sodium loss
Can be as high as 3000-7000mg per hour in the heat.
Note that athletes have different sweat rates, electrolyte sweat content, and these may change with training
Pass the salt!
Restricted sodium diets can actually be detrimental to athletes!
Athletes exercising in the heat should eat salty foods, add salt to meals, and use a sports drink containing sodium!
When to use which drink?
WaterVs. PropelVs. Gatorade Thirst QuencherVs. G2 (New)
How about Vitamin Water? Accelerade?
Long exercise (> 45 min to 1 hour)
Intense exercise
HOT, sweaty exercise
When performance matters
Stop and Go Simulation
One week apart, 9 male players completed 75 minutes of shuttle runs followed by intermittent running to fatigue (performance trial).
These intermittent, high-intensity shuttle runs were designed to replicate activity patterns of stop and go sports. They consisted of intermittent running, including maximal sprinting interspersed with less intense periods of running and walking.
The athletes drank either a 6.9% carbohydrate-electrolyte drink or placebo immediately prior to exercise (5 ml per kg) and every 15 minutes thereafter (2 ml/kg).
Nicholas et al., J Sports Sci. 1995; 13(4):283-290
RESULTS: Shuttle Run Test
Conclusion: A carbohydrate-electrolyte drink improved performance during intermittent, high-intensity exercise.
Nicholas et al. J Sports Sci. 1995; 13(4):283-290
0 2 4 6 8 10
Time of Exercise to Fatigue
CHO trialCHO trial
PlaceboPlacebo
8.9 min. 8.9 min.
6.7 min.6.7 min.
Other important sports nutrition issues
Dietary Strategies for Weight Gain
Gaining Lean Body Mass
Stimulus via exercise
Hormonal flux
Macronutrient ingredients
Strategies for Increasing Lean Body Mass
Increase caloric intake by 1000 to 1500/day Consider restrictive mindset in those trying to lose body fat
as well
Emphasize BALANCE of nutrients Carbs are needed for muscle gain…not just protein
Get adequate protein
Strategies for Increasing Lean Body Mass
Increase meal frequency (every 2-3 hours) Particularly important to split protein intake Maximize “fueling opportunities” Use liquid calories!
Eat before strength training 10g essential amino acids + carbs
Practice good recovery nutrition Consistency
Weekdays AND weekends, on AND off days Nutrition AND training
Diet Affects Hormones
Insulin anabolic impact on muscle, prevents breakdown Athletes need carbs!
Growth Hormone anabolic impact on muscle, prevents breakdown levels reduced by chronic high protein diet secretion inhibited by high levels of circulating fatty acids
Insulin-like Growth Factor-1 (IGF-1) initiates protein synthesis act of eating induces IGF-1 synthesis in muscle
Testosterone stimulates muscle growth testosterone levels are significantly reduced after a high fat meal or an episode
of “binge” drinking (> 4 drinks)
Cortisol stress hormone that interferes with muscle-building carbohydrate intakes may help blunt cortisol release
Meet Chris
20 year-old “gym rat” 5’10”, 170 pounds Goal: increase LBM…FAST! CAN’T gain weight and “I’ve tried everything” Claims to “eat all the time” Self-restricts carbohydrates because “I don’t do
cardio and I’m trying to cut body fat” Spends $180/month on sports foods/drinks
• Bars, shakes, energy drinks• Complains that healthy foods “cost too much”
Chris’ Current Diet
Breakfast: protein shake
Lunch: 2 cans tuna, 2 slices cheese, low-carb pita, nuts, unsweet ice tea
3pm: 2 energy drinks, protein bar
5-8: practice & workouts, recovery shake post workout
9:00: 2 chicken breasts, sweet potato, cottage cheese, 1/3 carton sugar-free ice cream (oops! Hungry and craving sweets)
11:00: protein shake
Nutritional Analysis for Chris
Energy Actual: 3700 cals (includes ice cream)Needs: 4700 cals (22 cals/lb + 1000)
CHO Actual: 175 gramsNeeds: 575 grams (50% cals)
Pro Actual: 350 gramsNeeds: <170 grams (1 gram/pound)
Main recommendations
Larger breakfastLots more carbs, especially throughout dayReplace protein with “safe” carbs such as oatmeal, fruits, veggies, brown rice, dairy, beansChange bars or shakes to carb-containing products or REAL foodAdd 100% juicesAdd multivitaminEat foods just for TASTE occasionally
Weight Loss…Practical Issues
They want it fast and easy Fad diets can have risky consequences
But do reduce carbs slightly, increase protein slightly Should be during off-season Rate should be 1-3 pounds/week Cut typical calories by 500-800 Do not jeopardize energy level for training Eat smaller portions more frequently Fill up on veggies, fruits, soups, lean proteins Increase fibers Reduce sugars and fats Watch liquid calories Hydrate especially well (athletes may mistake thirst for hunger)
Pre-competition meal
GOAL: Restoring liver glycogen, raising BS, preventing hunger, “settling stomach”
Ideally high carb (3-5g/kg), moderate protein, low fat, with fluids and salt and PALATABLE 3-4 hours before game Then use 1 hour “top off” CHO snack or drink Pre-comp meal CAN be closer to event if tolerated
(example of early morning events)
What to do with the athlete who says: “If I eat anything before I play I’ll throw up!”
THINK LIQUIDS!o Also produces lower stool residue for weight class sports or athletes
sensitive to “bulky” feeling
Recovery Nutrition
Defined: helping athletes bounce back for future exercise bouts Considerations:
o Intensity and duration of exerciseo When will athlete exercise again?
Nutritional Recovery Goals:1. Glycogen restoration2. Fluid/electrolyte replacement3. Muscle repair and adaptation
Recovery Nutrition
General daily diet & hydration status Pre-competition meal, fuel/fluids during
exercise Training status
Post-Exercise Recovery Period
WINDOW OF OPPORTUNITY for important gains
Recovery Nutrition(for intense, dehydrating exercise)
Ingredients & Timing Fluids
o 24 ounces for every pound lost during exercise within 2 hourso Need 150% of fluid loss to compensate for urine productiono Achieve body weight within 1% of “start weight” before next
sessiono Including sodium beneficial
Carbohydrateso .5 grams/kg body weight within 30 minuteso TOTAL of 1.5 grams/kg body weight within 2 hourso High glycemic index preferred
Proteino 10-20 grams protein within 30 minuteso Does protein source matter?
Barriers & Benefits to Recovery Nutrition
Barriers Suppressed appetite Food/fluid availability Habits, sport routine Perceived impact on weight
Benefits Enhanced performance in future exercise Lowered injury risk in future exercise Better compliance to training program Promotion of positive energy balance for weight gain Appetite control for meals
Personalize Recommendations
What recovery nutrition recommendations might you give these individuals?
Recovery Options
Regular foods & drinks
&/OR
Sports foods & drinks
Readily available
Easily transported and stored
Inexpensive (?)
Do-able DAILY
What does the research say about
post-exercise protein source?
Sports MNT
Cardiovascular Risk Factors
1. Age2. Sex3. Heredity4. High cholesterol and blood pressure5. Diabetes6. Obesity and overweight7. Physical inactivity8. Stress9. Tobacco, alcohol
Increased incidence of high cholesterol, HTN, pre-diabetes, and obesity among YOUNG athletes in some sports
Ethical challenge for Sports RD’s!
19 Year Old Male Shot-Putter
Weight = 295lbs.; Height 6’4” TC = 325mg/dL; LDL 185mg/dL Advice he practices:
Eat high volume of food 6 times per day Eat low fat diet Increase cardiovascular exercise
o But resistance from coach
Food treatment strategies Help athletes recognize that food can work FOR them Added: beans & legumes, nuts, margarines with plant sterols,
oatmeal, whole grain cereals, fresh fruits, avocado, oil-based salad dressings
TASTE= WOW!, TC down to 240 in 6 months
50 Year Old Male Runner
Runs about 6 miles/day, now training for marathon (his 5th)
Family history of HTN, recently diagnosed with HTN Advice he practices:
Eat a low sodium diet
Problem = consistent muscle cramping in longer runs
Food treatment strategies Increase dairy (currently 1 serving/day) Increase veggies to 4-5 servings of each/day Determine if he’s SALT SENSITIVE
o Many individuals ARE NOTo Experiment with Na content of diet and timing of Na intake
(before/during/after exercise only?)
Muscle Cramping Inventory
Adequate fluids? Adequate sodium?
Sodium loss via sweat VARIES individually Can be 3000mg/hour; case studies of
7000mg/hour Adequate other electrolytes? Adequate glycogen stores? Not a nutritional issue at all?
Gastrointestinal Issues
Some are more frequent with athletes Some are exacerbated by physical activity
Meal timing, dehydration, high calorie needs, hormonal effect on digestion, sports foods, jostling of stomach, shift of blood flow from GI tract to skeletal muscle, competition issues
Issues: GERD, IBS, “runner’s diarrhea, constipation, gastritis, Celiac
Issues to Address with GI Problems Timing/spacing Anti-inflammatory meds Hydration issues Low fiber Excessive sports foods Excessive sugar alcohols Excessive fruit juices or highly concentrated
drinks Caffeine/alcohol Food allergy or intolerance Lactose intolerance? Fructose intolerance? Dietary supplements
Athlete-Friendly/ GI-Friendly Foods
Probioticso Probiotics are live microbial foods and food supplements
that can be beneficial by improving microbial balanceo The most widely studied and utilized probiotics are the
lactic acid bacteria (Lactobacillus and Bifidobacterium species)
o Just 1 yogurt/day with active cultures enhances the body’s ability to enhance digestion.
Dried fruits or fruit bars (Fig bars, cereal bars)
Oatmeal, nuts, beans Value of liquid calories before/during activity
Current Sports Nutrition Topics on the Horizon Macro & micronutrients during exercise Nutrition periodization Inflammation Recovery and healing Food allergies & intolerances Sickle cell trait Heat illness/heat stroke Nutrition and genetics Fitness vs. Fatness and mortality/health What happens after competition ends
Changes in weight and nutritional needs, mental health status, results of concussion, long term effects of supplementation, orthopedic issues
Dietary Supplements
Most commonly used in sports: Anabolics or muscle builders Weight loss or fat loss supplements Energy boosters Herbs Vitamin-mineral supplements
Evaluate dietary supplements for:
1. LegalityCheck ncaa.org and other sport-specific guidelines
2. Safety
3. Purity
4. Effectiveness
Questions to ask…
1. Are claims backed in solid age-specific research?
2. What are the possible side effects?
3. Is the supplement legal, necessary and appropriate?
4. Is the company reputable?
5. Is it worth the risk? For athletes, the risk can be very
great.
6. Is the athlete doing everything possible with his or her diet FIRST before relying on a supplement?
NEW CONCERN: athletes and staff being so careful that they are missing out on potentially valuable supplements
Dietary Supplements…Mislabeled?
Extensive results of over 100 common nutrition supplements by Advance Supplement Testing Systems found:
Pyruvate: Label says: 500 mg per tabletTested at: 106 mg per tablet
Bulk Label says: 50 g protein; 0 g carbohydrate
Builder: Tested at: 4 g protein; 53 g carbohydrate
In many reviews: 20% of supplements contained a banned substance (not on the label)
Online tools for dietary supplement assessment
1. www.consumerlab.com: Obtain a listing of all categories of supplements that have passed their tests for quality and purity. Good overview of supplement categories, reasons for use, and safety. Yearly fee: $30.00
Online tools for dietary supplement assessment
2. www.naturaldatabase.com: Determine exact ingredients, potential benefits, potential side effects and drug/supplement interactions. Updated frequently by pharmacists. USP check. Yearly fee: $92.00
Online tools for dietary supplement assessment
3. http://www.nsf.org/Certified/Dietary/ : NSF Certified Dietary Supplements Program.
Verify the identity and quantity of dietary ingredients declared on product label.
Ensure the product does not contain undeclared ingredients or unacceptable levels of contaminants.
Demonstrate conformance to currently recommended industry GMPs for dietary supplements.
Growth Hormone (HGH)
Obviously banned. Side effects can include swelling, joint pain, diabetes symptoms, increased risk of some cancers.
Adequate sleep can increase levels.
High fat, excessive protein, high stress hormones can decrease levels.
Invasion of the Energy Drink
Energy drinks do not provide REAL energy…they just help athletes feel
energized.
Energy drinks are different from sports drinks
Contain caffeine, other stimulants, sometimes sugar, herbs, vitamins, etc.
Some safety concerns for athletes
Use nutrition, hydration, and lifestyle changes to improve energy level
Caffeine Common FormsCommon Form Average Amount of Caffeine
Fixx Energy Drink (20 ounces) 500 mg
Coffee, Drip (16 ounces) 170 mg
Rockstar Energy Soda (16 ounces) 150 mg
Sky Rocket Caffeinated Syrup (1 oz.) 100 mg
Diet Pepsi Max (16 ounces) 92 mg
Red Bull Energy Drink (8 ounces) 80 mg
Mountain Dew soft drink (16 ounces) 75 mg
Most soft drinks (16 ounces) 50 mg
Espresso, 1 ounce shot 40 mg
Brewed tea (8 ounces) 40 mg
Jolt gum (1 piece) 40 mg
Typical caffeine tabs: 200 mg/eachVivarin tablet: 200 mg/each
Energy Drinks
Some caffeine may enhance performance (dose for many athletes = 2mg/pound 1 hour before exercise)
Individual tolerance varies…some experience nervousness, jitters, headaches, tachycardia, GI symptoms
It’s difficult to determine how much caffeine (or other stimulants) is in energy drinks. 100 to 650mg have been reported.
Concerns with alcohol…putting one foot on the gas and the other on the brakes.
Combine with Caution!•Many manufacturers of “ephedra-free” products also commonly combine stimulants with aspirin-like substances in an attempt to mimic the “ECA Stack” with ephedrine, caffeine, and aspirin.
•Many caffeine-containing herbs and supplements interact with grapefruit juice (enhanced CNS effect).
•Watch for combinations like: (1) Willow bark, green tea, and bitter orange; (2) Green tea, mate, and kitjitsu; (3) Caffeine, green tea, mate, guarana, and willow bark
NO2 (arginine) based supplements
Amino acid necessary for protein synthesis. Found naturally in meat, fish, poultry, and dairy.
Arginine is the substrate for NOS enzyme, increasing NO (nitric oxide), causing vasodilation.
No long-term studies on safety. Several anecdotal reports of concerning symptoms (severe headaches, rapid changes in blood flow, syncope, blood pressure changes).
May pose high risk for athletes who have known or unknown vascular problems.
NO2 supplements
Warning ON LABEL: For men only and not intended for use by persons under 18. Do not use if you have a myocardial infarction (heart attack). May cause flushing and itching. Consult a medical doctor before use if you have been treated for, or diagnosed with, or have a family history of, any medical condition including (but not limited to) cardiovascular, central nervous system, or genito-urinary problems, cold sores, or if you are using any prescription or over the counter medication(s). Inhalation may amplify the inflammatory airway response in people with asthma. One scoop of this product contains about as much caffeine as between one and one and a half cups of coffee. Do not consume with other arginine products or other sources of caffeine (e.g., tea, coffee, or cola beverages). Do not take within 4 hours of exercising. Discontinue use and call a medical doctor immediately if you experience irregular heart beat, chest pain, dizziness, headache, nausea, or other similar symptoms.
Creatine
Creatine is synthesized in the liver, kidney, and pancreas and supplied through the diet
Primary food sources are meat and fish; usual diet in the U.S. provides 1-2g/day
Recommended dose: 3-5g/day NO LOADING period necessary unless need for rapid reach of maximal
phosphocreatine stores! Most studies of repetitive, short-duration (<30 sec.), high-
intensity tasks (strength training in particular) suggest modest improvement in performance
Maximize creatine in foods
Food Grams Creatine 8 ounces pork: 1.1 8 ounces salmon: 1.0 8 ounces beef: 1.0 8 ounces cod: 0.7
Supplemental Creatine Dose: 3-5 grams/day
Beta-Alanine
A non-essential amino acid found both in the body and in food (i.e. chicken)
Rate-limiting substance to carnosine production in the muscle cell
Carnosine buffers hydrogen ions in the muscle (delaying the “burn”)
Typical doses: 3-6 grams/day
Beta-Alanine Proposed Benefits:
Boosts explosive muscular strength & power output.
Increases muscle mass Boosts muscular anaerobic endurance Increases aerobic endurance Increase exercise capacity to train harder
and longer
Beta-Alanine
In one recent study in 15 trained male sprinters, beta-alanine supplementation (4.8g/day)
Increased muscle carnosine levels Attenuated muscle fatigue in repeated bouts of
exhaustive contractions Did not improve isometric endurance or 400m race
times.
Derave et al. J Appl. Physiology August 2007
10.1152/japplphysiol.00397.2007
One Last Thought…
Whenever possible, if you recommend against using a supplement, have a plan for helping your athlete meet the goal he felt the supplement was helping with.
For example, if amino acids are not recommended, provide a plan for the athlete to maximize amino acids in protein on a daily basis.
If stimulants are not recommended, show how to provide more modest boosts of caffeine in safe forms.
Important teaching concept
Fitness is more important than fatness!
Don’t let your recreational exercisers forget it! In a survey of women health club members, subjects
said they would rather have a car accident, lose a job, go through a divorce, and even get cancer than gain 50 pounds.
o GLAMOUR Magazine, 2005
LOSS OF PERSPECTIVE!!
For further information:
Gatorade Sports Science Institute www.gssiweb.com
SCAN www.scandpg.org
• Nutrition and athletic performance: position of the American Dietetics Association, Dietitians of Canada, and the American College of Sports Medicine. JADA 2000: 1543-56 (revision due 2007) …available on www.eatright.org
For further information:
American Council on Exercise www.acefitness.org
American College of Sports Medicine www.acsm.org
The Physician and Sports Medicine www.physsportsmed.com
