author name here for edited books chapter 15 nutrition and the active female 16 ergogenic substances...

Author name here for Edited books

chapter

15

Nutrition and the Active Female

16

Ergogenic Substances

chapter

Prof Jennifer Broxterman, RD, MScFN3373: Nutrition for Physical ActivityLecture 11

Ergogenic Substances in Sport & Exercise


• Definition of ergogenic substances:– Substances used to improve exercise and athletic

performance by improving the production of energy (Bucci, 1993)

Reasons for Supplement Use

• Why do athletes & non-athletes use ergogenic substances?– To enhance performance in sport– To improve physical appearance– To prevent or treat injuries– To treat or cure illnesses or diseases– To be accepted by peers– To cope better with stress


• Many supplement companies advertise benefits to taking their products (which may or may not exist), including:– Weight or muscle gain– Increases in strength– Loss of body fat– Increases in energy and endurance– Enhanced recovery

Supplement Advertising

Regulation & Marketing of Dietary Supplements

• Natural Health Products (NHPs) (Canada)– NHPs are allowed to make a full range of both health

and therapeutic claims where supported by scientific evidence

– Health Canada requires pre-marketing approval by the product manufacturer in the sale of all NHPs

Regulation & Marketing of Dietary Supplements

• Dietary supplements (United States)– Companies are allowed to use claims of nutrition

support (e.g. structure-function claims) that link a nutrient and a deficiency or describe the effect of an ingredient on the body’s structure, function, or well-being

– Disease claims may not be made– These claims do not require pre-market approval by the

FDA (however, a disclaimer is required on supplement labels)

– Many claims displayed on product labels are unsubstantiated (and it’s the consumer’s responsibility to evaluate the health claims)

Categories of Ergogenic Substances


• 2 main categories– Ergogenic drugs: a drug that claims to prevent,

alleviate, or cure a physical or mental illness, or to affect the structure or function of the body• E.g. anabolic steroids, human growth hormone, erythropoietin

– Ergogenic substances: any substance that does not claim to prevent, alleviate, or cure a disease; classified as a dietary supplement• e.g. caffeine


• Dietitians of Canada sports supplements course classifies ergogenic aids into 5 major classifications1. Nutritional aids: mainly used to increase muscle

energy supply and the rate of muscle energy production

E.g. a marathon runner may drink a sports drink (containing CHO & electrolytes) to prevent hypoglycemia, dehydration, and restore electrolytes


• Dietitians of Canada sports supplements course classifies ergogenic aids into 5 major classifications2. Physiological aids: substances or techniques

designed to enhance natural physiological processes that generate physical power• E.g. blood doping, erythropoietin

(EPO), oxygen inhalation, blood buffers (sodium bicarbonate), human growth hormone (HGH), testosterone


• Dietitians of Canada sports supplements course classifies ergogenic aids into 5 major classifications3. Pharmacological aids: drugs designed to function

like neurotransmitters or hormones that are found naturally in the body• E.g. anabolic steroids, Beta-2 agonists, diuretics and other

masking agents (e.g. lasix/furosemide)


• Dietitians of Canada sports supplements course classifies ergogenic aids into 5 major classifications4. Mechanical aids: used to improve human body

biomechanics to increase work efficiency• Sportswear (e.g. swimming cap, running shoes, speed

skating suit, etc.)• Specialized sports equipment (racing

bike, bent ski poles)• Video surveillance (e.g. monitoring a

figure skating jump) • Wind tunnel testing (learn optimal aerodynamics)

Ergogenic Substances• Dietitians of Canada sports supplements

course classifies ergogenic aids into 5 major classifications5. Psychological aids: designed to modify

psychological energy (also referred to as the athlete’s level of arousal)• E.g. imagery, mental rehearsal, stress management

World Anti-Doping Agency (WADA)

Doping in Sport

• Definition of doping:– Use of prohibited substances and/or unfair methods

used to enhance athletic performance (World Anti-Doping Agency, 2003)

• Doping in sport is banned to:– Promote fair and equitable competition– Protect the health of athletes– Preserve the integrity of sport

• World Anti-Doping Agency (WADA)– Created in 1999 to coordinate & monitor doping in

sport internationally

World Anti-Doping Agency

• WADA Code– http://www.wada-ama.org/en/World-Anti-Doping-

Program/Sports-and-Anti-Doping-Organizations/The-Code/

– Goal of the WADA Code:• All athletes benefit from the same anti-doping procedures and

protections, no matter the sport, the nationality, or the country where tested, so that athletes may participate in competition that is safe and fair.

– The code specifies strict liability, meaning that an athlete is responsible regardless of whether a violation was committed unknowingly or intentionally

Prohibited Substances

• Prohibited list:– Substances or methods that enhance (or have the

potential to enhance) sport performance, that are harmful (or potentially harmful) to athletes, or that are unethical are included in the WADA prohibited list

– List is revised each year– Available in multiple languages– Current WADA prohibited list: http://www.wada-

ama.org/en/Science-Medicine/Prohibited-List/

WADA Prohibited List

• Prohibited list:– Prohibited at ALL TIMES

• E.g. anabolic androgenic steroids, growth hormone (GH), insulin-like growth factor-1 (IFG-1), diuretics and other masking agents, etc.

– Prohibited IN-COMPETITION• E.g. stimulants, narcotics, cannabinoids, glucocorticosteroids

– Prohibited in PARTICULAR SPORTS• E.g. Alcohol (archery, automobile, karate, powerboating, etc.),

beta-blockers (archery, darts, shooting, skiing/snowboarding, golf, etc.)

Prohibited Methods

• Prohibited methods list:– Methods used to avoid detection of drug

use are also banned by WADA– Tampering (or attempting to tamper with) samples or

any part of doping control is strictly prohibited– Blood boosting: practice of infusing extra red blood

cells into the body in an attempt to increase oxygen carrying capacity

– Gene doping: non-therapeutic use or manipulation of cells, genes, or gene expression specifically for the enhancement of athletic performance

Prevalence of Use

Prevalence of Use

• Steroid use:– Majority of available info re: prevalence is on anabolic

steroid use– 4% of American high school students have taken

steroids illegally at some point (Center for Disease Control, 2006)

– Males > females– High school: highest use of steroids in football players,

wrestlers, and track & field male athletes– Steroid abusers are more likely to use cocaine,

alcohol, and other drugs vs. non-users of steroids

Prevalence of Use

• Other ergogenic supplements:– Use of ergogenic supplements is widespread in both

young and adult athletes– 22-62% of high school athletes are using at least one

supplement (Scofield & Unruh, 2006), and this figure is even higher in adults, collegiate athletes, and elite athletes

– Multivitamin & mineral supplements are most popular supplement used among both athletes & non-athletes

Prevalence of Use• Other ergogenic supplements:

– Elite athletes & athletes in sports that emphasize muscle size (e.g. football, weightlifting, bodybuilding) report the greatest supplement use (Erdman et al, 2006)

Evaluating Ergogenic Substances


• Evaluating the literature– Athletes care little, if at all, about the science or

plausibility of a particular product– An athlete’s primary concern is whether the product

enhances performance or achieves the desired result or not

– Sports nutrition professionals need to offer reliable, accurate information about the substances that are available on the market


• Role of the Sports Dietitian1. Ax athletes’ level of knowledge &

belief about the product.

2. Do not demand that athletes stopusing all ergogenic substances.

3. Accept practices that are not harmful or illegal – recommend changes gradually.

4. Ax roll that the substance plays inathletes’ overall diets; determine ifyou need to address their dietary practices.


• Role of the Sports Dietitian5. Focus on enhancing practices that

are critical to performance.

6. Commend athletes for practicingsound nutrition principles.

7. Address questionable supple-menting practices only after you have established trust and rapport with athletes.

Critically Appraising the Evidence

• Randomization– The best trials that produce the most reliable and valid

information about the efficacy of a given treatment are randomized

– Participants are randomly selected to different treatment groups

• Blinding– Refers to hiding the assignment of groups/interventions– Open-labeled, single-blinded, double-blinded, triple-

blinded


• Demographics– It is important that each group participating in the

research study have similar characteristics (demographics) to each other at the beginning of the trial (randomization helps with this)

– Researchers should have identified key characteristics of the subjects that they think may influence the outcome of the trial (e.g. age, gender, severity of the disease, etc.)


• Similarity of Experience– Important part of a clinical trial is that both groups (the

treatment group that receives the intervention) and the control group need to be treated a similarly as possible

• Drop-Outs– Researchers need to explain what happened to every

person who enrolled in the trial– Reporting should always include an accounting of any

participant who does not complete a trial, particularly including reasons for dropping out (to help calculate how effective the treatment really is)


• Intention-to-Treat Analysis– Best kind of analysis takes into consideration what

happened to every participant in the trial– Provides the most conservative estimate of the

treatment effect and takes into account that people stop participating in trials or end treatments for all kinds of reasons in real life

– ITT analysis ensures the results are not biased towards the people who completed that trial (who might be different from the general population)


• Effect Size– It is important to assess not only whether there is a

statistically significant difference between the groups, but also how big that effect is

– Look at the minimal clinically important difference• E.g. One group might have done 50% better than another

group, but if that is 50% of a 2 mm Hg decrease in BP measure, then the effect size (1 mm Hg) is too small to be clinically significant

– Beware of studies that report results only in percentages!


• Questions to ask about a research report– Was the research done by a credible institution? A

qualified researcher?– Is this a preliminary study? Have other studies reached

the same conclusions?– Was the study done with animals or humans?– Was the research population large enough? Was the

study long enough?– Were methods to standardize dietary intake employed

before performance testing?– Who funded the study?


• Questions to ask about a research report– Does the report avoid absolutes, such as “proves” or

“causes”?– Does the report reflect appropriate context: e.g. how the

research fits into a broader picture of scientific evidence and consumer lifestyles?

– Do the results apply to a certain group of people? Do they apply to someone your age, gender, and health conditions?

– What do follow-up reports from qualified nutrition experts say?

– Did the researchers control for subjects’ diets before/during the trial?

Additional Study Design Considerations

• Research considerations with athletic populations and use of dietary supplements– Were the subjects trained or untrained– Were there at least 10 athletes in the study– Were there male and female subjects– What were the ages of the subjects– Were the subjects’ diets assessed and controlled– Was the sport supplement dose realistic and

comparable to typical intakes– Was the supplement taken for a long enough duration

Additional Study Design Considerations

• Research considerations with athletic populations and use of dietary supplements– Was the quality of the supplement assessed (i.e.

bioavailability)– Was there a placebo control used– Were the performance outcome measures reliable and

valid– Were the outcome measures/tests performed in the

“field” or in a “lab” setting

Common Ergogenic Substances

Sports Drinks

Sports Drinks

• Claims & purported benefits– Provides portable, quick, convenient source of fluids,

CHO, and electrolytes– Delays fatigue by maintaining stable BG levels– Stimulates the drive to drink with superior hydration

and rehydration compared to plain water

Sports Drinks

• Proven effectiveness of sports drinks– Scientific literature supports the use of properly

formulated sports drinks to effectively enhance physical performance when used appropriately• Before exercise to assume optimum hydration and

euglycemia leading into physical activity• During exercise to prevent dehydration, hypoglycemia,

and hyponatremia (low serum Na), which may lead to fatigue and risk for injury (esp. in events >60 minutes)

• After exercise to help restore muscle glycogen, rehydrate, and replenish electrolytes lost in sweat

• Beneficial in any heat-stress situation (e.g. high temperature and/or humidity)

Optimal Composition of Sports Drinks

• For optimal gastric emptying and absorption, sports drinks should contain:– 4-8% CHO– Contain a mixture of simple sugars (e.g. glucose,

sucrose, fructose, maltodextrin)– Common electrolytes lost in sweat (e.g. Na, K, Cl)– Water

• Little evidence to support the addition of:– Vitamins, minerals, antioxidants, amino acids, herbal

supplements, or carbonation in sports drinks

Sports Drinks

• Legality– Most standard, properly formulated sports drinks (4-

8% CHO) are legal– Athletes should check labels and exercise caution

when considering use of sports drinks containing herbal supplements, protein, amino acids, caffeine, or banned ingredients (e.g. ephedra) by WADA

Protein & Amino Acid Supplements


• Claims & purported benefits– Increases and maintains muscle mass/lean body mass

(LBM)– Increases strength and power– Enhances exercise recovery– Reduces body fat


• Proven effectiveness of PRO & AA supplements– Protein and/or AA supplementation for building muscle

have not been proven to be any more or less effective than dietary protein, provided that sufficient food energy is consumed

– There is little evidence that the use of commercial protein supplements combined with resistance training significantly increases LBM vs. a placebo Further research is warranted

– Studies report that an increase in protein will maintain nitrogen balance during an exercise-induced energy deficit


• Proven effectiveness of PRO & AA supplements– In the absence of CHO availability, BCAAs (leucine,

isoleucine, valine) are the preferred amino acids used as fuel during high intensity exercise, however, there is little evidence these supplements improve endurance performance

– Whey protein has been found to be faster absorbed with increased rates of muscle protein synthesis when at rest and after resistance exercise in comparison to soy and casein proteins


• Other interesting findings– Athletes need more protein than the RDA of 0.8 g/kg,

and in general, require between 1.2-1.7 g/kg (American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada, 2009)• Strength athletes: 1.6-1.7 g/kg BW/d• Endurance athletes: 1.2-1.4 g/kg BW/d• Vegetarian athletes: 1.3-1.8 g/kg BW/d• Growing adolescent athletes: ~1.5 g/kg BW/d• Ultra endurance athletes: 1.5-1.7 g/kw BW/d

– The maximum effective single dose of protein to build muscle is ~35 g of high quality protein (milk, eggs, fish, meat) at one time (Wolfe, 2009)


• Legality– Protein & AA supplements are legal, except for the

potential risk of undeclared ingredients prohibited by WADA

Iron• Claims and purported benefits

– Increases oxygen transport to cells (increases aerobic capacity)

– Improves energy and work capacity– Improves recovery and decreases fatigue– Increases power and endurance in sports dependent

on the aerobic energy system– Reduces lactic acid concentration and reduces muscle

fatigue– Improves mental status and motivation for training– Improves psychomotor development, intellectual

performance, and immune function

Iron

• Proven effectiveness of Fe– Fe deficiency anemia impairs aerobic capacity,

endurance capacity, and exercise performance– Fe supplementation increases athletic performance in

those with established iron deficiency anemia– Growing evidence suggests that Fe supplements may

improve physical performance in Fe-deficient athletes without anemia (esp. at high altitudes >2000m)

– Note: prophylactic (preventative) Fe supplementation for athletes with normal Fe stores could have negative effects on health and performance, since excess Fe can act as a pro-oxidant

Iron

• Other interesting findings– Athletes engaged in regular intense physical activity

have Fe requirements 30-70% higher than those who exercise at low intensity or who are sedentary

– This increased need for Fe is attributed to the combined effects of expanded blood volume and shorter life span of RBCs due to the stress of intense training & competition

Iron

• Athletes at higher risk for low iron status– Endurance runners, pre-menopausal women,

vegetarians, adolescents in a growth spurt, and individuals who restrict energy intake and/or avoid red meat or animal protein (esp. in body conscious sports)

– It has been reported that as many as 26-60% of female athletes are affected by Fe deficiency (Cowell et al, 2003)

Iron

• Legality– Fe supplements are legal and ethical– However, as of 2010 WADA’s Prohibited List of

Substances & Methods does not allow blood injection of supplements, such as Fe, unless performed therapeutically in a hospital setting (WADA, 2010)

Creatine

Creatine

• Claims & purported benefits– Increases LBM– Speeds rate of recovery from short-term, high intensity

exercise– Stimulates muscle strength and power– Buffers lactic acid production– Aids in thermoregulation

Creatine

• Proven effectiveness of creatine (Cr)– Cr is an effective ergogenic aid– Majority of research supports the efficacy of Cr

supplementation with short-term, high intensity anaerobic exercise or sports specific to strength & power

– Cr supplementation has not been reported to be effective for endurance/aerobic sports, where an increase in weight could be detrimental to performance

– Vegetarian athletes and those who consume only small amounts of animal proteins are reported to have lower baseline Cr stores, and are more likely to respond positively to Cr supplementation

Creatine

• Effective dose– Most research on Cr supplementation is based on a

typical loading dose (20-25 g Cr divided into 4 to 5 doses) for 5-7 days, followed by 2-3 months with a maintenance dose of 2-5 g/day

– Many athletes also take supplemental Cr in small doses (3-5 g/day) over a lengthier duration, which have been shown to be equally effective (Dunford & Doyle, 2008)

Creatine

• Natural (endogenous) creatine– Cr is synthesized endogenously (by the liver, kidneys,

pancreas, brain, and testes) from 3 AA: glycine, arginine, and methionine

– Most (95%) of the body’s Cr is found in skeletal muscle as phosphocreatine (PCr) and acts as a rapid source of energy during intense exercise

– It takes about 2 g of Cr daily to maintain normal muscle creatine levels

– The body produces ~1 g/day of Cr and another 1-2 g/day come from the daily diet (beef, pork, poultry, cold water fish)

– Daily urinary losses of Cr are ~2 g/day

Creatine

• Legality– Cr is a legal sports supplement and is not prohibited

by WADA– Athletes should exercise caution when using Cr due to

the possibility of contamination and/or the presence of undeclared illegal ingredients that may lead to positive doping outcomes

Caffeine

Caffeine

• Claims & purported benefits– Stimulates the central nervous system and skeletal

muscle contractions– Improves aerobic/endurance exercise– Improves anaerobic exercise– Delays fatigue and decreases perception of effort– Enhances fat loss

Caffeine

• Proven effectiveness of caffeine– The consensus among research investigators is that

caffeine may enhance performance by facilitating work capacity (endurance) and/or increasing power output (i.e. short bursts of high intensity exercise)

– Coffee is less effective than pure caffeine as an ergogenic aid; however, caffeinated beverages that also contain electrolytes & CHO in concentrations similar to sports drinks are more effective than caffeine alone as an ergogenic aid

– There is no evidence that caffeine alone significantly affects fat/weight loss (caffeine does increase the effects of ephedrine, which is often found in weight loss supplements)

Caffeine

• Effective dose– Caffeine appears to be an effective ergogenic aid for

endurance athletes when taken before and/or during exercise in moderate quantities of 3-6 mg/kg BW• E.g. 143 lb (65 kg) athlete = 195-390 mg caffeine

– Negative side effects include: anxiety, jitteriness, rapid heartbeat, insomnia, irritability, inability to focus, GI distress (caffeine has a laxative effect), elevated BP, and severe headaches from sudden withdrawal exceeding 6 mg/kg BW is more likely to bring on adverse reactions and may directly impair athletic performance

Caffeine

• Legality– Since 2004 caffeine was made legal by WADA and is

currently no longer prohibited, but continues to be on their Monitoring Program

– Athletes may use caffeinated beverages without being disqualified, as long as they do not exceed the legal limit allowed in urine

– A positive doping test usually sets urinary caffeine at 15 mcg/mL• It takes approx. 100 mg of caffeine to produce a urine profile

of 1.5 mcg/mL• 4 cups of Starbucks coffee (4 cups x 250 mg caffeine/cup =

1000 mg caffeine) would reach the legal limit

Androgenic Prohormones


• Claims & purported benefits– Increases endrogenous testosterone levels– Promotes gains in LBM, strength, and power– Speeds exercise recovery time– Enables greater training volume and intensity


• Proven effectiveness of andro-prohormones– Androgenic prohormones appear to be effective to increase

serum androgens (e.g. testosterone) and estrogens in males when consumed orally in doses more than 300 mg/day; females may respond to as little as 50 mg/day

– Anabolic steroids may increase muscle size/strength by:1. Increasing protein synthesis through increased androgen receptor

expression

2. Decreasing protein breakdown through competition with catabolic hormones such as cortisol & other glucocorticoids for androgen binding sites

3. Increasing the number of muscle fibres

4. Having psychological effects (e.g. increased aggression), which may allow the athlete to train harder & longer


• Adverse health effects– Side effects associated with andro-prohormones are

substantial and include:• Gynecomastia (breast enlargement in males), prostate CA,

testicular CA, pancreatic CA, decreased HDL-C, negative psychological effects (e.g. “roid rage”), premature closure of the epiphyseal “growth” plates in children/adolescents, increased acne, reproductive dysfunction & virilization in females (also deepening of the voice, increased facial & body hair)

• Many of these side effects are irreversible and harmful

– Prohormone use is especially harmful to children, adolescents, pregnant women, and those known or suspected to have prostate or breast CA


• Legality– Use of prohormone supplements and steroids is

strictly prohibited by WADA, the International Olympic Committee, the National Hockey League, the National Football League, and many other national sport leagues (e.g. NBA, NCAA, CFL)

– It is illegal to sell or prescribe androstenedione, DHEA, DHEAS, or steroids unless warranted therapeutically

– Prohormones & AAS are banned by WADA and are NOT RECOMMENDED for any situation due to adverse health effects

Ethical Issues

Ethical Issues• Winning at any cost

– Is it acceptable for athletes to use any means available, including ergogenic substances, in order to gain a competitive edge?

• Famous Sports Illustrated survey w/ athletes:– Would you use a banned substance if it was

undetectable and you were guaranteed to win? 98% said YES

– Would you take the same substance if it allowed you to win for 5 years, even if taking it would result in death? over 50% still said YES

Ethical Issues• Winning at any cost

– Many athletes consider ergogenic drugs an essential component of successful competition

– If many record-setting athletes are using them, other athletes must also use them just to keep up and complete “fairly” with others

Final Exam Update

• Date/Time: Mon. June 23, 2015 @ 1-4pm• Worth: 35%• Will be cumulative (greater emphasis on

lectures taught after the midterm)• Format: multiple choice & some true/false• Make sure you review your lecture notes, the in

class case studies and activities, and textbook chapters to help you understand the material

author name here for edited books chapter 15 nutrition and the active female 16 ergogenic substances...

Documents

ergogenic aids

supplement use slide

nhps slide

testosterone slide

recovery slide

caffeine slide

stress slide

supplement advertising