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An Overview of Sports Supplements

Type of dietary supplement used to enhance athletic
performance

Can include vitamins, minerals, herbs, plants, and/or amino acids

Most are available as OTCs and do not require FDA approval
  Expected to follow FDA’s good manufacturing practices to ensure
  quality and safety of the product
  Not enforced as well as the quality control of prescription drugs
NFL, NCAA, and IOC have developed polices about sports
supplements
  Have banned use of steroids, ephedra, and androstenedione
Androstenedione and DHEA
Prohormones: broken down into testosterone in the body

Research shows that they do not increase muscle size, improve
strength, or enhance overall athletic performance

Side effects include ones similar to those of anabolic steroids:
  Cause hormone imbalances
  Lead to testicular cancer, infertility, stroke, and an increased risk of
  heart disease
  Teens may not reach full adult height if they use prohormones
  Can cause breast development and shrunken testicles in males
Creatine
 Formed in protein metabolism by the liver, kidneys, and
 pancreas

 Supplements are taken to improve strength

 Majority of users are teens

 Has not been found to increase endurance or aerobic
 performance

 Most common side effects are weight gain, diarrhea, and
 muscle cramps
   Can effect kidney function in people with kidney problems
Fat Burners/Thermogenics
Act as stimulants that increase metabolism

Ephedra-based products are extremely
dangerous & have been known to cause
heart problems, stroke, and death

  Has since become banned due to the severity
  of its side effects
Ephedra-free products are still known to
cause high blood pressure, heart attack,
stroke, and seizures

Many also contain high amounts of caffeine
Stimulants: Caffeine
 Caffeine
  Commonly used, but is regulated: limit is 12mg/mL
  in urine (approx. 3 to 6 cups of strong coffee)
  Side effects include increased heart rate, cardiac
  output, metabolic rate, and urine output
  High doses cause anxiety, insomnia, nervousness,
  and a decrease in EPO production
Stimulants: Amphetamines
  Used to increase muscular strength and
  endurance, acceleration, aerobic enzyme activity,
  as well as to play through painful injuries
  Side effects include headaches, sleeplessness,
  anxiety, cardiac rhythm disturbances, stroke,
  hypertension, coronary events, coma, and
  sometimes death
    These risks are increased in high temperatures due to
    the body not being able to cool itself effectively
Androgenic Anabolic Steroids
Synthetic version of testosterone

Prescribed to treat medical conditions such as muscle atrophy or delayed
puberty

Not allowed to be prescribed to enhance athletic performance

In 2005, AAS were classified as a controlled substance if held without
prescription

Male side effects: breast development, shrunken testicles, decreased sperm
count, and increased risk of becoming infertile or impotent

Female side effects: excessive facial and body hair, reduced breast size,
deepened voice and increased risk of masculinized female fetus

Both genders can experience acne, oily skin, jaundice, balding, tendon
rupture, heart attack, enlarged heart, increased bad cholesterol levels, mood
swings, rage, delusions or paranoia, and increased risk of liver
disease/cancer
Banned Substances and
Restricted Procedures
 Substances:                     Other Drugs and Procedures:

   Stimulants                      Blood doping
   Anabolic agents                 Local anesthetics
   Alcohol and beta blockers       Manipulation of urine samples
   (banned for rifle only)
                                   Beta-2 agonists permitted by
   Diuretics and other masking     prescription and inhalation
   agents
                                   Caffeine concentration in urine is
   Street drugs                    regulated
   Peptide hormones and
   analogues
   Anti-estrogen
   Beta-2 agonists
NCAA Nutritional Dietary
Supplement Warning
 Review the product and its label with your AD staff

 Supplements are not well regulated, some may cause a
 positive drug test result

 Many dietary supplements are contaminated with banned
 drugs that are not listed on the label

 Any product containing a dietary supplement ingredient is
 taken at your own risk
   If a student athlete tests positive for drugs as a result of taking a
   dietary/nutritional supplement, the athlete puts their eligibility,
   reputation, and their future in jeopardy
Drug Testing by NCAA
 Director is not notified any earlier than 2 days before testing

    Athlete usually only finds out the day before or just hours before they are tested
 Student athlete must sign a compliance form after being tested

    Confirm they understand the drug policy and consequences of failed drug tests
    Failure to turn the form in results in deeming the athlete as ineligible
 Must be accompanied by a witness during testing

 What if the student athlete tests positive?

    Suspension from athletic participation
    Second offense results in a year’s suspension from participation
    Third offense results in athlete being banned from NCAA competition
US Anti-Doping Agency
$9.5 million in funding since 2001 in attempts to deter the
use of prohibited sport supplements:
    Detection of exogenous growth hormone and its analogs,
    mimetics, and secretagogues
    Detection of O2 transport-enhancing substances and methods
    Detection of synthetic anabolic steroids
    Doping with genetic technology
    Ethical considerations
    Improved detection of naturally compounds
    Any many other facets of the field
Misrepresentation of
Active Ingredients
 Underrepresentation

   Unsafe because level of true intake is unknown
   Done in an attempt to get repeat customers because of effective product
 Overrepresentation

   Financial loss
   Done to cut production costs and increase profit
 Example:

   Quality Control of Dehydroplandrosterone Dietary Supplement Products
      Less than 50% contained 90-110% of amount on label
Unintentional Contamination
 Not following Good Manufacturing Processes (GMP)
 set by the FDA

 ~20% of OTC supplements in the US contain
 adrogens

   Mostly prohormones in low concentrations
 Health risk still relatively low

   Major risk is for athletes in terms of failing drug tests
Intentional Contamination
Classified as containing more than 1mg/g of androgens
   Health risk is high, especially for pregnant women, women, and children
         spontaneous abortion, solidifying of growth plates, deepening of voice, and
         sterilization

   Example: Parabolan-S (fizzy tablets) by Senesco-Pharma
      Said to contain prohormones, contains 17mg of Metandienone (Dianabol)
      per tablet
         More than 3 per day would total to a higher load than what intentional steroid users
         view as the highest acceptable daily dosage (50mg/day)

   Example: Gaspari Nutrition by Novedex Extreme
      Claims to be “non-anabolic and non-androgenic supplement”
      Contains androstatrienedione and 6-oxo-androstendione
         Converted to 1,4,6-testosterone
         Aromatase inhibitors and androgen receptor agonist
DSHEA
Regulates dietary supplements for the FDA

Can remove dietary supplements from the market

The DSHEA is responsible for:
 Dietary supplements on the market that do not label all
 of the contents within them
 Supplements that have non-FDA approved ingredients
Obtaining “Clean” Supplements
 Purchase products that are certified by US Pharmacopeia

   Ensured that it is produced under GMP
   Tested for quality, purity, and potency
   CONTENT tested
 National Science Foundation supplement certification

   Developed with NFL and NFLPA
   Product is produced under GMP
   Does not contain substances and/or
   metabolites banned by the NFL
FDA Recommendations
Consumers should protect              Avoid the following claims/phrases:
themselves from harm
                                         “Easy” fix for problems like excess
Supplements are DRUGS                    weight, hair loss, or impotency
                                         “Scientific breakthrough”,
   Consult Health Care Professional      “miraculous cure”, “secret
   before and during use                 ingredient”, and “ancient remedy”
Check the FDA’s Tainted Weight           Impressive-sounding terms, such
Loss Supplements list                    as “hunger stimulation point” and
                                         “thermogenesis”
                                         Product is safe because it is
                                         “natural”
                                         Undocumented studies or personal
                                         testimonials by consumers/doctors
                                         Promises of no-risk, money-back
                                         guarantees
Labeling of Multivitamins
 Not very accurate

   Percentages on label do not reflect absorption
   Absorption does not reflect biological effect and
   function at active site
 Lack of labeling of bioavailability makes it
 impossible to compare products

 Bioavailabilty is not standardized over all
 multivitamins or specific MVMs

   Due to inaccurate labeling, assumed dietary
   intake can be off by 25-50%
Compromisers of Bioavailability
 Homeostatic control
   To maintain homeostasis, the body will react to
   large doses of minerals/vitamins by increasing
   excretion
   Ingested amount will not effect utilization at site of
   action positively
 Definitions of bioavailability vary by individual
   Sex, age, physiological state
Inactive Ingredients
 Fillers, coatings, surfactants effect:
   Release of Ca, folic acid, and B12
   Absorption
   Metabolic processes
 Nutrient-nutrient reactions:
   Vitamin C with inorganic iron increases iron absorption
   Decrease magnesium and calcium to increase iron
   absorption
Testing of Vitamins
 Human testing is required

 Dissolution and disintegration standards are set by USP

   Not mandatory to abide by standards
 Acid solubility

   Not all vitamins and minerals apply to this test
      Lack of coverage, i.e. calcium solubility
 Drug interaction

   Little testing or research completed in this area
      Not required
      Interactions are not required to be posted or reviewed by the FDA
A Quick Comparison…
   Whole Foods                      Supplements
 Advantageous for athletes        Little variety
 Support an active lifestyle
                                  Isolated nutrients
 Contain essential nutrients to
 maintain optimal health and      Can do more harm than
 top performance during an
 endurance event                  good
 More complexity and variety
 “Food Synergy” – whole foods
 influence our health in
 complex and highly interactive
 ways
Whole Foods to Support
an Active Lifestyle
 Diverse and nutrient-dense sources of proteins and carbs

 Proteins

   Major structural component of muscle and other tissues in
   the body
   Help produce hormones, enzymes, and hemoglobin
 Carbohydrates

   Energy currency of the body
   Fuel muscle contractions
Whole Food Sources of Protein
Eggs

  Complete protein
  BV = 100
  Thiamine, riboflavin, pantothenic acid, folic acids, vitamin B12, biotin,
  vitamin D, vitamin E, and phosphorus
Soy:

  Complete protein
  Fiber, iron, calcium, zinc, B vitamins, antioxidants
Others

  Fish, chicken, beef, and milk are also great source of food protein
  Contain essential amino acids and many useful vitamins and minerals
Whole Food Sources of Carbs
 Best sources are:
   Whole grain foods
   Whole fruits and whole vegetables
 Whole food carbs can be used to:
   Provide the energy the body needs during
   exercise
   Support hydration of the body
   Contain electrolytes, fiber, and an array of
   vitamins and minerals
Summary
Most of the popular sports supplements carry heavy health
risks and bad side effects

Many sport organizations have banned a number of sports
supplements; if an athlete tests positive for a banned
substance they put their eligibility and their future in jeopardy

Lack of regulation of these supplements results in even
higher risk due to misrepresentation of the products and
contamination

Whole foods, such as fruits and vegetables, are a great
alternative to manufactured supplements and are much safer

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Sports Supplements

  • 1.
  • 2. An Overview of Sports Supplements Type of dietary supplement used to enhance athletic performance Can include vitamins, minerals, herbs, plants, and/or amino acids Most are available as OTCs and do not require FDA approval Expected to follow FDA’s good manufacturing practices to ensure quality and safety of the product Not enforced as well as the quality control of prescription drugs NFL, NCAA, and IOC have developed polices about sports supplements Have banned use of steroids, ephedra, and androstenedione
  • 3.
  • 4. Androstenedione and DHEA Prohormones: broken down into testosterone in the body Research shows that they do not increase muscle size, improve strength, or enhance overall athletic performance Side effects include ones similar to those of anabolic steroids: Cause hormone imbalances Lead to testicular cancer, infertility, stroke, and an increased risk of heart disease Teens may not reach full adult height if they use prohormones Can cause breast development and shrunken testicles in males
  • 5. Creatine Formed in protein metabolism by the liver, kidneys, and pancreas Supplements are taken to improve strength Majority of users are teens Has not been found to increase endurance or aerobic performance Most common side effects are weight gain, diarrhea, and muscle cramps Can effect kidney function in people with kidney problems
  • 6. Fat Burners/Thermogenics Act as stimulants that increase metabolism Ephedra-based products are extremely dangerous & have been known to cause heart problems, stroke, and death Has since become banned due to the severity of its side effects Ephedra-free products are still known to cause high blood pressure, heart attack, stroke, and seizures Many also contain high amounts of caffeine
  • 7. Stimulants: Caffeine Caffeine Commonly used, but is regulated: limit is 12mg/mL in urine (approx. 3 to 6 cups of strong coffee) Side effects include increased heart rate, cardiac output, metabolic rate, and urine output High doses cause anxiety, insomnia, nervousness, and a decrease in EPO production
  • 8. Stimulants: Amphetamines Used to increase muscular strength and endurance, acceleration, aerobic enzyme activity, as well as to play through painful injuries Side effects include headaches, sleeplessness, anxiety, cardiac rhythm disturbances, stroke, hypertension, coronary events, coma, and sometimes death These risks are increased in high temperatures due to the body not being able to cool itself effectively
  • 9. Androgenic Anabolic Steroids Synthetic version of testosterone Prescribed to treat medical conditions such as muscle atrophy or delayed puberty Not allowed to be prescribed to enhance athletic performance In 2005, AAS were classified as a controlled substance if held without prescription Male side effects: breast development, shrunken testicles, decreased sperm count, and increased risk of becoming infertile or impotent Female side effects: excessive facial and body hair, reduced breast size, deepened voice and increased risk of masculinized female fetus Both genders can experience acne, oily skin, jaundice, balding, tendon rupture, heart attack, enlarged heart, increased bad cholesterol levels, mood swings, rage, delusions or paranoia, and increased risk of liver disease/cancer
  • 10.
  • 11. Banned Substances and Restricted Procedures Substances: Other Drugs and Procedures: Stimulants Blood doping Anabolic agents Local anesthetics Alcohol and beta blockers Manipulation of urine samples (banned for rifle only) Beta-2 agonists permitted by Diuretics and other masking prescription and inhalation agents Caffeine concentration in urine is Street drugs regulated Peptide hormones and analogues Anti-estrogen Beta-2 agonists
  • 12. NCAA Nutritional Dietary Supplement Warning Review the product and its label with your AD staff Supplements are not well regulated, some may cause a positive drug test result Many dietary supplements are contaminated with banned drugs that are not listed on the label Any product containing a dietary supplement ingredient is taken at your own risk If a student athlete tests positive for drugs as a result of taking a dietary/nutritional supplement, the athlete puts their eligibility, reputation, and their future in jeopardy
  • 13. Drug Testing by NCAA Director is not notified any earlier than 2 days before testing Athlete usually only finds out the day before or just hours before they are tested Student athlete must sign a compliance form after being tested Confirm they understand the drug policy and consequences of failed drug tests Failure to turn the form in results in deeming the athlete as ineligible Must be accompanied by a witness during testing What if the student athlete tests positive? Suspension from athletic participation Second offense results in a year’s suspension from participation Third offense results in athlete being banned from NCAA competition
  • 14. US Anti-Doping Agency $9.5 million in funding since 2001 in attempts to deter the use of prohibited sport supplements: Detection of exogenous growth hormone and its analogs, mimetics, and secretagogues Detection of O2 transport-enhancing substances and methods Detection of synthetic anabolic steroids Doping with genetic technology Ethical considerations Improved detection of naturally compounds Any many other facets of the field
  • 15.
  • 16. Misrepresentation of Active Ingredients Underrepresentation Unsafe because level of true intake is unknown Done in an attempt to get repeat customers because of effective product Overrepresentation Financial loss Done to cut production costs and increase profit Example: Quality Control of Dehydroplandrosterone Dietary Supplement Products Less than 50% contained 90-110% of amount on label
  • 17. Unintentional Contamination Not following Good Manufacturing Processes (GMP) set by the FDA ~20% of OTC supplements in the US contain adrogens Mostly prohormones in low concentrations Health risk still relatively low Major risk is for athletes in terms of failing drug tests
  • 18. Intentional Contamination Classified as containing more than 1mg/g of androgens Health risk is high, especially for pregnant women, women, and children spontaneous abortion, solidifying of growth plates, deepening of voice, and sterilization Example: Parabolan-S (fizzy tablets) by Senesco-Pharma Said to contain prohormones, contains 17mg of Metandienone (Dianabol) per tablet More than 3 per day would total to a higher load than what intentional steroid users view as the highest acceptable daily dosage (50mg/day) Example: Gaspari Nutrition by Novedex Extreme Claims to be “non-anabolic and non-androgenic supplement” Contains androstatrienedione and 6-oxo-androstendione Converted to 1,4,6-testosterone Aromatase inhibitors and androgen receptor agonist
  • 19. DSHEA Regulates dietary supplements for the FDA Can remove dietary supplements from the market The DSHEA is responsible for: Dietary supplements on the market that do not label all of the contents within them Supplements that have non-FDA approved ingredients
  • 20. Obtaining “Clean” Supplements Purchase products that are certified by US Pharmacopeia Ensured that it is produced under GMP Tested for quality, purity, and potency CONTENT tested National Science Foundation supplement certification Developed with NFL and NFLPA Product is produced under GMP Does not contain substances and/or metabolites banned by the NFL
  • 21. FDA Recommendations Consumers should protect Avoid the following claims/phrases: themselves from harm “Easy” fix for problems like excess Supplements are DRUGS weight, hair loss, or impotency “Scientific breakthrough”, Consult Health Care Professional “miraculous cure”, “secret before and during use ingredient”, and “ancient remedy” Check the FDA’s Tainted Weight Impressive-sounding terms, such Loss Supplements list as “hunger stimulation point” and “thermogenesis” Product is safe because it is “natural” Undocumented studies or personal testimonials by consumers/doctors Promises of no-risk, money-back guarantees
  • 22.
  • 23. Labeling of Multivitamins Not very accurate Percentages on label do not reflect absorption Absorption does not reflect biological effect and function at active site Lack of labeling of bioavailability makes it impossible to compare products Bioavailabilty is not standardized over all multivitamins or specific MVMs Due to inaccurate labeling, assumed dietary intake can be off by 25-50%
  • 24. Compromisers of Bioavailability Homeostatic control To maintain homeostasis, the body will react to large doses of minerals/vitamins by increasing excretion Ingested amount will not effect utilization at site of action positively Definitions of bioavailability vary by individual Sex, age, physiological state
  • 25. Inactive Ingredients Fillers, coatings, surfactants effect: Release of Ca, folic acid, and B12 Absorption Metabolic processes Nutrient-nutrient reactions: Vitamin C with inorganic iron increases iron absorption Decrease magnesium and calcium to increase iron absorption
  • 26. Testing of Vitamins Human testing is required Dissolution and disintegration standards are set by USP Not mandatory to abide by standards Acid solubility Not all vitamins and minerals apply to this test Lack of coverage, i.e. calcium solubility Drug interaction Little testing or research completed in this area Not required Interactions are not required to be posted or reviewed by the FDA
  • 27.
  • 28. A Quick Comparison… Whole Foods Supplements Advantageous for athletes Little variety Support an active lifestyle Isolated nutrients Contain essential nutrients to maintain optimal health and Can do more harm than top performance during an endurance event good More complexity and variety “Food Synergy” – whole foods influence our health in complex and highly interactive ways
  • 29. Whole Foods to Support an Active Lifestyle Diverse and nutrient-dense sources of proteins and carbs Proteins Major structural component of muscle and other tissues in the body Help produce hormones, enzymes, and hemoglobin Carbohydrates Energy currency of the body Fuel muscle contractions
  • 30. Whole Food Sources of Protein Eggs Complete protein BV = 100 Thiamine, riboflavin, pantothenic acid, folic acids, vitamin B12, biotin, vitamin D, vitamin E, and phosphorus Soy: Complete protein Fiber, iron, calcium, zinc, B vitamins, antioxidants Others Fish, chicken, beef, and milk are also great source of food protein Contain essential amino acids and many useful vitamins and minerals
  • 31. Whole Food Sources of Carbs Best sources are: Whole grain foods Whole fruits and whole vegetables Whole food carbs can be used to: Provide the energy the body needs during exercise Support hydration of the body Contain electrolytes, fiber, and an array of vitamins and minerals
  • 32. Summary Most of the popular sports supplements carry heavy health risks and bad side effects Many sport organizations have banned a number of sports supplements; if an athlete tests positive for a banned substance they put their eligibility and their future in jeopardy Lack of regulation of these supplements results in even higher risk due to misrepresentation of the products and contamination Whole foods, such as fruits and vegetables, are a great alternative to manufactured supplements and are much safer