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Dirty Dozen: High Risk Sport Supplement Ingredients

Lara Gray, MS, RD, CSSD Senior Director of Education, Board Certified Sports Dietitian

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To help ensure the integrity of competition for athletes, sports organizations and fans worldwide.

Welcome!

Things to note:1. It is required by the BOC for Certified

Athletic Trainers that you are actively present in the live event AND complete the post-webinar survey in order to receive your CEU certificate.

2. CEU Statements of Credit (if applicable) will be emailed to attendees no later than Friday, March 1st.

3. Please use the “Questions” box in GoToWebinar. Questions will be reviewed by the moderator and answered at the end.

4. Download today’s handouts from the “Handouts” tab.

Learning Objectives

At the end of the presentation, attendees will be better able to:• Identify dietary ingredients that pose a threat to drug tested athletes.• Explain how high risk dietary ingredients are being used in sports

supplements.• Analyze sports supplements for high risk dietary ingredients.

Drug Free Sport International (BOC AP# P8729) is approved by the Board of Certification, Inc. to provide continuing education to Athletic Trainers. This program is eligible for a maximum of 1 Category A hour/CEU. ATs should claim only those hours actually spent in the educational program.

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40% - 100% ATHLETES USE SUPPLEMENTS

• Type of sport• Level of competition• Definition of

supplements

Garthe, Ina, and Ronald J. Maughan. "Athletes and Supplements: Prevalence and Perspectives." International journal of sport nutrition and exercise metabolism 28.2 (2018): 126‐138.

Today: An In-Depth Look

The Dirty Dozen in 2019

Stimulants1. Phenethylamines (PEAs)2. 2-aminoisoheptane3. AMPiberry4. Advantra Z, Citrus aurantium, bitter orange

5. Nelumbo Nucifera (Lotus leaf ), higenamine6. IGF-1 Contributors: Colostrum, Deer antler velvet7. Yohimbe, Yohimbine8. Noopept9. Ostarine10. Cannabidiol11. Clomiphene12. Green tea extract

1. Phenethylamine (PEA)Largest category of current “designer” drugs

Beta-phenethylamineß-phenylethylamineN-phenethylamine2-phenylethaneamineBeta-methyl phenethylamine (BMPEA), Acacia rigidula4-Fluoroethamphetamine

Often seen in products advertised for: Pre-workoutEnergyFocus“Lifestyle” productsThermogenic/ Fat-burnerWeight loss

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Endogenous and exogenousNaturally occurring or synthetic

Similar to amphetamine Similar side effects

CNS stimulants or hallucinogensMescaline (peyote)Designer psychadelics(Ecstasy/MDMA, 2C-B)

Phenethylamine (PEA)• Increases:

– Heart rate– Respiration– Blood pressure– Body temperature

• Similar structure to dopamine– Effects on the brain

• Can cause:– Hallucinations– Confusion– Depression– Dizziness– Nausea/vomiting– Diarrhea– Headaches– Body pains

Popular alkaloids in supplements -n-phenethyl dimethylamine (Eria jarensis (orchid) extract)HordenineN-methyl tyramine

Dopamine

Phenethylamine (PEA)

2. 2-aminoisoheptaneAconiti kusnezoffii, Aconite extractJuglans regia (Walnut bark)DMHA, dimethylhexylamine,Octodrine, 2-amino-6-methylheptane (synthetic), 2-metil-5-amino-eptano

2-aminoisoheptane

• Psychoactive CNS stimulant• Similar structure to DMAA,

AMP Citrate (DMBA), and Ephedrine

• Safety not establishedStudied as a drug in 1950sReemerged in 2012, peaking in 2018

• Not a legal dietary ingredientAdvertised as “legal” or “safe” alternative to other illegal stimulants

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2-aminoisoheptaneOften seen in products advertised for: Pre-workoutThermogenic/ Fat-burnerWeight loss

Reported side effects:• Mood swings• Tremors• Difficulty concentrating• Over-stimulation• Energy crashes• Anxiety• High blood pressure• Difficulty breathing• Tachycardia• Heartburn

3. AMPiberry

• 2016 Trademark owned by LeCheek Nutrition, Inc– 2015: LeCheek receives warning letter from FDA

• AMPilean and AMPItropin for listing AMP citrate– LeCheek owns Insane Labz

• Claims related to “The New DMHA”– Stimulant effects– “Smooth energy curve” with caffeine

• Other Claims– Diuretic (most evidence, but rodent models)– Fat loss

Juniperus communis(Juniper berry)

Seems oddly similar to AMP citrate (4-amino-2-methylpentane citrate) or 1, 3-dimethylbutylamine (DMBA)

Used in:Pre-workoutsEnergy

4. Advantra ZCitrus aurantiumBitter orange

Contains:• Synephrine• But also: tyramine, n-

methyltyramine, hordenine and octopamine

Patented for:Stimulating thermogenesisReducing weightIncreasing lean muscle massImproving athletic performanceSuppressing appetite

5. Nelumbo Nucifera(Lotus leaf ), Aconite,Higenamine (typically synthetic), Norcoclaurine, demethylcoclaurine

Beta-2 Agonist activity, Stimulant effects (cardiac) - tachycardia

Found in:• Pre-workout• Energy• Weight loss• Sleep (!)

Doses tested in humans: 2.5 – 5 mg

Doses found in supplements:0 - 60+ mg

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6. IGF-1 Contributors: Colostrum, Deer antler velvetIGF-1 = Insulin-like growth factor

WADA Prohibited under Peptide Hormones, Growth Factors and Related Substances

PED potential: Amplifies anabolic effects of human growth hormone

Side effects:Hypoglycemia, acromegaly, heart palpatations, tumor growth

Typically Found in:Recovery, Joint HealthMale HealthAnabolic, LibidoOverall Well-being

6. IGF-1 Contributors: Colostrum, Deer antler velvetIGF-1 = Insulin-like growth factor

WADA Prohibited under Peptide Hormones, Growth Factors and Related Substances

PED potential: Amplifies anabolic effects of human growth hormone

Side effects:Hypoglycemia, acromegaly, heart palpatations, tumor growth

Typically Found in:Recovery, Joint HealthMale HealthAnabolic, LibidoOverall Well-being

7. YohimbeYohimbine (a Rx drug), PausinystaliaYohimbe (from bark of tree in Africa)

Promoted for: aphrodisiac, erectile dysfunction, athletic performance (stimulant effects), weight loss

Found in: EVERYTHING with caffeine! (seemingly)Thermogenic/Fat burnerPre-workoutWeight lossTestosterone-booster

7. YohimbeSerious side effects (dose dependent):• Cardiac arrhythmia• Heart attack• Kidney failure• Seizure• Nausea/vomiting, diarrhea• Decreased libido• Muscle aches• Tremors• Dizziness, headache, vertigo• Insomnia• Anxiety

Significant stimulant activity –especially in association with other stimulants (i.e. caffeine)

Dosage in supplements:UnlistedInaccurate (25-150% of listed amount)

Not specifically banned in sport.

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8. NoopeptN-phenylacetyl-L-prolylglycine ethyl ester, noopeptide, Ноопепт or GVS-111 (Russian patent)

• A synthetic, more potent analogue of Piracetam (a nootropic)

• Nootropics: Promoted for neuro-cognitive enhancement

Not controlled substances Not FDA-approved drugs Not approved as a dietary

ingredient

Effects: Mild cognitive boost (only evidenced in those with cognitive trauma)Psychostimulant

Found in:Brain/Memory enhancersPre-workoutsSolo/bulk products

9. OstarineEnobosarm, MK-2866, GTx-024

Selective Androgen Receptor Modulator (SARM)• Research drug - NOT approved dietary

ingredients

• Similar to anabolic agents, but tissue specificity

• NOT approved for human use Amounts found in supplements 7-10 times higher than

researched in clinical trials Long term risks unknown

• Use is intentional (online purchase) or unintentional (supplement contamination) 410% increase in SARM-positive drug tests (2014-15 to

2017-18)

• Banned by ALL sport organizations Remain in the body 30+ days after use

10. CBDCannabidiol

• Research drug (i.e. Epidiolex) NOT a dietary ingredient

• Schedule I Controlled Substance

• No quality control• Not 100% “THC-free”• May contain other contaminants (pesticides, fungicides)

• Clinical evidence for therapeutic uses in humans is ABSENT

• High risk for all sport organizations• Specifically banned in MLB• Not TSA approved

10. CBDCannabidiol

Hemp Seed Oil vs CBD Oil•Cannabis seeds do not

contain CBD or THCHemp seedHemp oil (from seeds)

•Caution:“Hemp Oil” may be used synonymously with CBD OilHemp Extract = CBD, other cannabinoids

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11. Clomiphene

Clomiphene-positive drug tests for 2018-19 are already 82% of last year’s totals (with 6 months of testing left)

Selective Estrogen Receptor Modulator (SERM)

FDA-approved drug for fertility treatment• Not FDA-approved for men

Alters testosterone levels in men via negative feedback• Small dose = anti-estrogen• Large dose = estrogen effect

Used to counter negative side effects of anabolic steroids (i.e. gynomastia)

“We can send parcels all over the States.”

12. Green Tea ExtractCamellia sinensis

Found in:• EVERYTHING (seemingly)• Weight loss• MVI Products• Pre-workout/Energy• Anabolics• Protein Blends• Brain-boosting

Health risks:• Dizziness• Ringing in ears• Decreased iron absorption• Increased BP and HR• Liver damage

12. Green Tea ExtractCamellia sinensis

Popular for:• Caffeine content• Polyphenol content

Primary polyphenols: green tea catechinsantioxidant, anti-inflammatory, anti-carcinogenic properties- Epicatechin- Epicatechin gallate- Epigallocatechin- Epigallocatechin gallate

(most potent)

QUESTIONS?lgray@drugfreesport.com

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Upcoming Webinars, 12-1pm CST

3/12Recovery Nutrition TipsSpeaker: Katie Knappenberger, MS, RD, CSSD, ATC, Director of Performance Nutrition at Northwestern Athletics

3/27Addiction and the Young MindSpeaker: Megan Fowler, LMSW, Clinical Team Leader at First Call KC

Infographics

Available Now: https://www.drugfreesport.com/infographic-products/

QUESTIONS?

lgray@drugfreesport.com1. Phenethylamines (PEAs)2. 2-aminoisoheptane3. AMPiberry4. Advantra Z5. Higenamine6. IGF-1 Contributors 7. Yohimbe8. Noopept9. Ostarine10. Cannabidiol11. Clomiphene12. Green tea extract