contents sports...

www.complementarynutrition.org

Chris Mohr, MS, RD, PhD

T he dietary supplement industry is a

multibillion dollar w o r l d w i d e market. This is not surprising considering the marketing ef-forts and promises for athletes to become “bigger, faster, and/or stronger” by taking specific products. Although there is an abundance of research being published with respect to dietary supplements and ergogenic aids, research is a step behind the marketing and creation of new products by the industry. Unfortunately uniformed consumers continue to search for the magic bullet and believe that without some form of nutritional ergogenic aid, they cannot be successful or reach their goals. This article will provide a simple overview of a seven point assessment to determine if a particular supplement is beneficial. This same assessment will then be used to discuss three popular sports supplements: creatine, carbohydrate/protein supple-ments, and beta alanine.

IntroductionThe dietary supplement industry is

a multibillion dollar market with prof-its for the sports nutrition and weight loss division bringing in $16.8 billion dollars in 2005 (Table 1).1 Consumers,

unfortunately, are sold all sorts of prod-ucts through marketing, hype, and misin-formation. This is not uncommon among many product lines with dietary supple-ments as one.

Supplementing one’s diet for exercise enhancement is not a new phenomenon.

Ancient Greeks, who celebrated and embraced athletic competition and prow-ess, reportedly used supplements such as hallucinogenic mushroom plant seeds and ground dog testicles for their purported benefits.2

In the early 20th century, the maga-zine industry was born introducing another level to attract consumers to the benefits of nutrition supplementation. Coupled with these newer means of get-

ContentsSports Supplements 21

Chair’s Corner ..........22

Editor’s Notes ...........23

Members in the News ...............................23

Functional Foods .......30

Annual Report .............34

Have You Read? .........35

DPD News ..................37

Update on the Nutritional Genomics for Dietitians Initiative ...............................38

CPE Objectives ...........39

Upcoming Issues

• Winter 2008 Editor’s Deadline, November 1, 2007• Spring 2008 Editor’s Deadline, February 1, 2008• Summer 2008 Editor’s Deadline, April 15, 2008• Fall 2008 Editor’s Deadline, July 1, 2008

Fall 2007 Volume 10, Issue 2

Sports Supplements

continued on page 24Fall 2007 Volume 10, Issue 2

Table 1

Sports Nutrition Weight Loss 2005 Weight loss pills 1.626 Weight Loss LMRs* 2.047 Sports Supplements** 2.22 Low Carb Foods*** 1.871 Nutrition Bars 1.947 Sports & Energy Drinks 7.1 Total 16.81 ($ billions)* Liquid Meal Replacements, only those used for weight loss ** Powders, formulas, pills and prepared drinks *** Not including low-carb bars and meal replacements

Fall 2007 Volume 10, Issue 2www.complementarynutrition.org

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Chair’s Corner:Gretchen Forsell, MPH, RD, LMNT

NCC EDITORIAL STAFFEditor

Sarah Harding Laidlaw, MS, RD, CDECopy Editor

Rebecca Schauer, RDPublications Chair

Laura W. Lagano, MS, RDEditors

Christian Calaguas, MPH, RDDanielle Torisky, PhD, RD

CPE EditorKatherine Stephens-Bogard, RD

EML CoordinatorGretchen Forsell, MPH, RD, LMN

The views expressed in this newsletter are those of the authors and do not necessarily reflect the policies and/or official positions of the American Dietetic Association. We invite you to submit articles, news and comments. Contact us for author guidelines. Send change-of-address notification to the American Dietetic Association, 120 South Riverside Plaza, Ste. 2000, Chicago, IL 60606-6995. Copyright © 2007 Nutrition in Complementary Care, a Dietetic Practice Group of the American Dietetic Association. All material appearing in this newsletter is covered by copyright law and may be photocopied or other-wise reproduced for noncommercial scientific or educational purposes only, provided the source is acknowledged. For all other purposes, the written consent of the editor is required.

Annual Subscription Rates (in U.S. dollars, payable in U.S. funds)Individuals who are ineligible for ADA membership ........................................................................$35/yearBack issues.................................................................. $10 each, 4 for $35For international orders, add $5 shipping and handling per annual subscription and for each back issue order of 1–4 issues. For orders of 5 or more back issues, shipping is $6.50 and $1.50 for each additional issue. Make checks payable to NCC DPG#18 and mail to the Treasurer. See back cover for address. ISSN 1524-5209

Fall. For many fall is one of the most exciting times of the year. Kids are back in school, the harvest is in full swing and the bountiful harvest provides us with

some of natures greatest jewels, there is a nip in the air, the trees are starting to change and football is a key part of every week (had to say that living in Nebraska! Go Big Red).

Fall is also an exciting time as it is FNCE time. NCC has a variety of activities going on during FNCE and I hope to meet as many NCC members as possible during my time in Philadelphia. NCC Execu-tive Committee (EC) members will be at Product MarketPlace, DPG Showcase and our NCC Mem-ber Breakfast sponsored by the Promise Institute for Heart Health. Be sure to stop by and say hello! Many people at this time of year are getting ready for winter and winding down. Winter however is the time I like to get things going. Check out the NCC website for a new look! We are very excited about the new design and hope that the changes will make it easier for mem-bers to obtain the information needed. If there is some-thing you would like to see on the site, please let us know. Be sure to use the Natural Medicine’s Comprehensive Database: this member benefit can be used by members in almost every setting and with all types of patient groups.

In addition to the website, NCC will be offering more educational opportunities for members to learn more about complementary care. This ever changing area of prac-tice lends itself to opportunities for both our new mem-bers and members who have been involved in this area for years. Look for information on upcoming Webinars. NCC is refining some EC positions to balance the work-load and meet member needs. The Nominating Commit-tee is looking for members interested in being part of NCC leadership. Please consider this opportunity, it not only will your volunteering open doors both inside and outside of complementary care, but you will have a great time!! So, as I pack for FNCE, there is a nip in the air, and I know Indian Summer is right around the corner. Enjoy your fall, remember your own harvest. Take this time to reflect on all you have accomplished in your area of practice and begin to make plan for a more bountiful harvest next year.

Those of you who would like to contribute an

article or have topics that you would like to see

in future issues, please feel free to drop me an

email or give me a call – peaknut@cascadeac-

cess.com or 702-346-7968 – or contact any one

of the capable NCC leaders listed on the back of

the newsletter.


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Editor’s Notes:Sarah Harding Laidlaw, MS, RD, MPA, CDE

Welcome to the Fall issue of the NCC newsletter. As summer winds down many people are

focusing on the changing seasons and planning on how to stay in shape over the next few winter months. Here in the southwestern United States, we are still experiencing summer-like temperatures

although the accompanying wind indicates a change is in the air. It is not too soon for me as much of this summer has been spent training for a December Ironman competition in the southern hemisphere.

As many of you attended FNCE, you were privileged to interact with the many members of NCC and its Execu-tive Committee and hear many instructive presentations on cutting edge complementary nutrition. This edition of the newsletter will also provide some of that cutting edge infor-mation from the Promise Institute for Heart Health and from the National Center for Complementary and Alter-native Medicine. These articles will give readers an insight to some of the questions patients and clients may be ask-ing about the potential for sterols reducing cholesterol and are herbs, particularly hoodia and bitter orange really doing what they say they do for weight loss.

The CPE article on sports supplements is ideal for those who work with athletes of all levels, and may be of particu-lar importance to those working with high school students, body builders, endurance athletes, and their trainers. I read this article with interest to find out what the latest think-ing in supplementation is for exercise recovery and perfor-mance.

Once again, this year, I had to miss FNCE. I always enjoy the networking and the educational events, and the opportunity to see what is new in the marketplace, but time and other work related commitments do not allow it. FNCE is on my calendar for next year, however, and I hope to see many of you then. As always, I encourage those of you who are interested in contributing to the newsletter, who would like to offer suggestions for future issues, or to provide feed back on any issues, to contact me at [email protected] or to visit or email any one of the Executive Committee listed on the lack of the newsletter.

Save time and avoid missing important NCC and ADA news!

ADA makes it easy for you to update your contact information. Visit the online Business Center at http://www.eatright.org/obc to access your profile; e-mail [email protected]; fax changes to 312/899-4812; or call the Member Service Center at 800/877-1600, ext. 5000, from 8 a.m. to 5 p.m. Central time, Monday through Friday.

NCC 2006-2007 Service AwardsCongratulations to the following NCC members who,

in their service to the Practice Group, have received the fol-lowing awards:

Excellence in Service Susan Allen, MS, RD: Email Address: [email protected]

Excellence in Practice Gretchen Vannice, MS, RD: Email Address: [email protected]

Vijaya Juturu, PhD: Email Address: [email protected]

Members in the News….

Let your fellow NCC members know about your accomplishments. Email Sarah Harding Laidlaw, at [email protected] with information about YOU and YOUR business, innovative approaches to CAM, and achieve-ments.

Congratulations once again

to the following recipients who are NCC members for outstanding leadership achievements and contributions to the profession and practice of dietetics!

Marjorie Hulsizer Copher Award Penny M. Kris-Etherton, PhD, RD

Medallion Awards Georgia G. Kostas, MPH, RD Marilyn Laskowski-Sachnoff, MA, RD Vivan B. Pilant, PhD, RD


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ting information to the public was the birth of marketing that is seen today in popular fitness magazines. It wasn’t until the 1960s, however, that the evolution of sport-spe-cific- supplements would change the entire industry.

In the mid 1960s, Scandinavian research demonstrat-ed that carbohydrates had an almost “magical” power—the ability to delay fatigue in the working muscle.3-5 This research was taken to a laboratory at the University of Florida, whose sports team mascot is the “Florida Gator”, and Gatorade™ was born. What was initially created to help enhance the performance of the “Gators” football team has grown to become a 4.6 billion dollar company in the U.S. alone, dominating about 80% of sports beverage sales, and cornering a large segment of the supplement industry.1

Today the dietary supplement industry offers every-thing from pills and creams to nutritional bars and drinks. Products promise increased ability to gain muscle, lose fat, fight disease, improve recovery, and more. No wonder consumers, and even professionals, are confused. Research conducted on these products offers conflicting evidence, many studies have been poorly controlled, and dietary supplements don’t often get the attention they deserve at the University level, leaving sports supplement industry- sponsored “scientific studies” as questionable because of research bias. How does one wade through the hype and the evidence to determine which supplements may be effective?

Defining Dietary Supplements

First and foremost, it is important to understand the definition of a dietary supplement. Dietary supplements, as defined by the Dietary Supplement Health and Education Act of 1994, are “products (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: (A) a vitamin; (B) a min-eral; (C) an herb or other botanical; (D) an amino acid; (E) a dietary substance for use by man to supplement the diet by increasing the total dietary intake; or (F) a concentrate, metabolite, constituent, extract, or combination of any ingredient described in clause (A), (B), (C), (D), or (E)…”6 Next, it is important to clarify the definition of sports sup-plements also known as ergogenic aids. These fall within that aforementioned definition, but more specifically, ergogenic aid by definition means to increase the potential for work output. Not all ergogenic acids are dietary supplements: under the umbrella definition of ergogenic aids there are

two primary categories:

1. Performance enhancing techniques (mechanical such as shoes or psychological such as hypnosis).

2. Physiological enhancing substances (physiological, such as blood doping; pharmacological, such as anabolic steroids; and nutritional aids, such as carbohydrate loading, creatine, or protein).

Proposed Evaluative Process for Reviewing Supplements

The recommendations for ergogenic aids need to be evi-dence based and one must consider each unique situation to help guide consumers. A seven step assessment can be used to help health professionals determine if an ergogenic aid is beneficial to an athlete.

1. What is the physiological mechanism associated with the supplement?

Before evaluating a dietary supplement, it is wise to understand the proposed mechanism of action of the aid. In addition, one would want to have a solid grasp of exercise and nutritional biochemistry to understand what type of physiologic stress is occurring with the exercise, in order to determine if efficacy is plausible. For example, creatine phos-phate is useful in energy reactions to regenerate adenosine triphosphate (ATP), the body’s “energy currency.” The phys-iological mechanism for creatine therefore makes sense. The next step is to consider whether the supplement in question is necessary for the reaction to occur, may enhance the speed of the reaction, or will do nothing to change what normally goes on in the body. Very simply, would the supplement in question qualify as a nutrition ergogenic aid?

2. Is this product useful for the intended sport?

Certain supplements are designed for high-intensity, short-duration events such as weight lifting or sprinting. Others are designed to increase endurance. Therefore, depending on the sport one is involved in, certain supple-ments should not even be considered. This emphasizes the importance of understanding both exercise and nutritional biochemistry, since knowing how to relate the physical stress and demands of exercise with the type of nutrition that may be helpful can help one ascertain the necessary information before choosing an ergogenic aid. Again, using creatine as the example, consider the action of regenerating ATP in the body. This would not be very useful for long duration, en-durance events because the energy used for the event is not

continued from page 21

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primarily derived from the ATP-PC Pathway, but rather, it is predominantly derived from the B-oxidation pathway. On the other hand, sprinters for example, would derive a good portion of their energy on the short lived ATP.

3. Are there scientific, placebo-controlled studies to support or refute the claims being made for the supple-ment?

It appears that dietary supplements are being developed, improved upon, and launched on a daily basis. Well-con-ducted scientific studies take time in order to obtain fund-ing, have an institutional review board approval, recruit human subjects, conduct the study, analyze the data, and interpret the data, to ultimately present it at an appropriate biomedical conference and/or publish the study in a repu-table scientific journal. More time than appears to be spent on dietary supplements marketed to athletes. Many sup-plements on the market have not endured such regimented scrutiny, while others fortunately have. It is important to seek out the source of the data supporting the claims behind the supplements (industry supported versus independent testing, placebo-controlled studies, or double blind inves-tigations using standardized products) to determine if the supplement in question would be of benefit.

4. Have the results been duplicated?

It is also important to find out if the research has been duplicated. If one “study” was conducted in the laboratory of the company that produces the supplement, and there has never been any follow-up research conducted, one should be hesitant about putting too much faith in their claims. Data is readily available at no cost on PubMed (www.ncbi.nlm.nih.gov/pubmed), a resource of the National Library of Medicine and by accessing the NCC member benefit- the Natural Medicines Comprehensive Database (www.natural-database.com).

5. Is there adequate safety data on the particular dietary supplement?

The importance of long-term health can be difficult to communicate to athletes of any age, but especially to the young and otherwise healthy athlete. It is vital to stress, however, the safety concerns associated with dietary sup-plements. Like pharmaceutical agents, data can sometimes show promise and appear safe, then later it is determined that supplement XYZ had inherent side effects that were initially not elucidated.

6. What is the source of information regarding the di-etary supplement?

Did the athlete hear about the dietary supplement in question from a friend, coach, magazine? Some mainstream fitness magazines are owned by supplement companies with a large amount of advertising dollars coming from the supplement industry, so articles slanted towards product promotion are common. Magazines are a good way to be introduced to a product, but then the healthcare profes-sional must continue the investigative work to determine the validity of claims.

7. Is the product banned by any governing agencies?

This is of particular concern for collegiate and elite athletes. There are a number of products that are banned by the National Collegiate Athletic Association (NCAA), International Olympic Committee (IOC), United States Anti-Doping Agency (USADA), World Anti-Doping Agency (WADA), and the National Football League (NFL). Whether or not a product may work, it is not worth taking the risk. Several independent organizations are emerging to ensure the purity of dietary supplements. For example, one non-profit independent organization is the NSF, which assesses the purity of dietary supplements to ensure they meet their label claims. In addition to the testing done by the NSF, the stringent NSF standards ensure that the manufacturers of specific dietary supplements maintain good manufacturing practices (GMPs). As of now, the NFL accepts products that have undergone National Sanitation Foundation testing, since it can then be assured that those products are free from contamination.

Below is a review of three popular ergogenic aids, using the above seven-step process.

Nutritional Ergogenic Aids

Creatine monohydrate

Creatine is obtained from food, specifically meat, poul-try, and fish. The body synthesizes about 1 to 2 grams from the amino acids glycine, arginine, and methionine.7 When thinking about how the body generates energy, it makes sense that creatine may be of benefit to some athletes.

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Approximately 40% of the total creatine in the body exists as free creatine, with the rest bonded to phosphate, which forms phosphocreatine.8 The creatine phosphate energy system replenishes adenosine triphosphate (ATP). ATP is linked with high energy bonds, and these bonds each hold a considerable amount of potential energy to fuel bio-logical work (e.g., sprinting, lifting weights, moving heavy furniture, etc.). ATP is not an endless supply of energy, as there is only enough stored in our bodies to fuel about 5-10 seconds of explosive exercise. After this time the body continues to produce ATP, by relying on different energy system activation dependent on the length and intensity of the activity. During this energy production, ATP is hydrolyz ed to produce adenosine diphosphate (ADP). The phosphate bond splits liberating energy, but now it needs to be regen-erated as quickly as possible to continue to supply quick energy. Simply stated, creatine phosphate can help regener-ate ATP. The body stores creatine in the muscles; however, since our diet only supplies so much depending on specific food intake (animal protein consumption vs. a vegetar-ian diet, for example), stores may not be optimized. Sup-plementing with exogenous creatine is thought to enhance stores, allowing a more rapid recovery and regeneration of ATP.

Due to the nature of the energy systems, the creatine phosphate energy system provides energy for activities that use short bursts of speed and strength. Creatine has been shown to be beneficial for athletes who participate in these types of sports,8, 9 but not for those involved in long distance, more aerobic based events, such as running a marathon.10 Creatine is one of the most well researched supplements to date, and the results have been duplicated by many scientists and research laboratories around the world.

From the hundreds of studies conducted on this dietary supplement, creatine appears to exert no safety concerns when taken at the doses recommended.11, 12 Keep in mind, though, that most of the studies on this supplement have been conducted on young healthy males with mixed train-ing status and athletic abilities.12 At the time of writing, no governing bodies ban the use of creatine by athletes.

Recommended Dose: Recent research suggests the loading phase that was first introduced with the supplement may be unnecessary, and taking smaller daily doses of 3 grams has the same effect over one month’s time.13

Carbohydrate/protein supplements

Carbohydrate/protein supplements are currently the hot topic in the sports nutrition arena. For years, carbohydrates were thought to be the only necessary nutrient for recovery. More recently, however, data has suggested that protein may be beneficial as well.

As mentioned previously, Gatorade was created conse-quent to the realization that carbohydrates decrease muscle fatigue. As research continued to support the inclusion of carbohydrate pre-, during, and post-workout, other sports drink products were introduced. More recently, how-ever, researchers have explored the inclusion of protein to not only restore glycogen, but also enhance recovery from exercise.14-16

Glycogen is the storage form of carbohydrate in the muscles and liver, but for extended exercise bouts, these stores become depleted and fatigue occurs.7 The body is able to absorb a specific amount of carbohydrate during exercise17and this carbohydrate can be utilized as an imme-diate energy source. Despite the benefits of carbohydrates, however, researchers took notice that carbohydrates did not contribute to reducing muscle damage or maintaining pro-tein synthesis, which would normally otherwise decrease during activity. Scientists, therefore, began testing combi-nations of carbohydrates and protein and single amino acid combinations to determine the combined effect on perform-ance and recovery.14, 16, 18, 19

Rasmussen et al., measured the response of muscle pro-tein in men and women after they consumed a drink con-taining amino acids and carbohydrate after exercise.15 In this pilot trial, subjects (n=6) were given a treatment drink (6 grams of essential amino acids plus 35 grams of sucrose) or a placebo. The model used to determine protein kinetics suggested that only those consuming the carbohydrate/pro-tein supplements increased muscle protein synthesis. While this may not be a concern for weekend warriors, athletes and people who exercise most days of the week for as many as two to five times per day, may find benefits from this approach.

The data is mixed for longer distance events with some,14, 16 but not all,20 data demonstrating a performance benefit from the added protein, when energy is matched in the products being compared. At this point it appears that the primary benefit from the addition of protein (or poten-tially essential or branch chain amino acids only) is to help

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prevent muscle protein degradation and enhance recovery. This is a strong benefit, particularly for athletes who may participate in multiple training bouts each day.

It is well established that a carbohydrate and protein supplement is not harmful to individuals, considering that both macronutrients are part of the majority of foods we consume on a daily basis. Carbohydrate and protein are not banned by governing bodies; however, the NCAA has specific guidelines for the types and amounts of supple-ments (e.g., food products can provide no more than 30% of their total energy from protein) that can be distributed to athletes. Therefore, it is imperative to be become familiar with the bylaws of the respective governing bodies to ensure compliance with the guidelines.

Recommended Dose: Immediate post-exercise carbohy-drate needs are said to be approximately 1.0-1.2 g/kg of body weight (e.g., a 70 kg athlete would consume 70-84 g within the first hour, and then repeat every 4 hours). 21 This can be accomplished through solid or liquid food. Recom-mended protein needs vary among researchers, but current data by Tipton suggests an absolute range of post-training protein intake to be 6-20 grams,22 which is similar to that reported by Rasmussen et al.15 Other research has used a 4:1 ratio, and up to 7:1 of carbohydrate:protein with posi-tive results.14 Nevertheless, while the exact ratio has yet to be determined, it is prudent to recommend consumption of carbohydrates, protein, and fluids immediately following an exercise or training session.

ß-Alanine

Beta-alanine has recently surfaced in the sports nutrition arena. ß-alanine is the rate-limiting substrate for synthesizing carnosine within muscle.23, 24 Carnosine is a dipeptide (two amino acids bonded together) composed of beta-alanine and L-histidine, and is found in highest con-centrations in fast twitch (type II) skeletal muscle. In the literature, it has been consistently shown that intramuscular carnosine stores may be increased with supplemental beta-alanine.23-25

Increasing intramuscular carnosine stores may be use-ful for athletes because carnosine can act as a buffer to the build-up of hydrogen ions (H+) within exercising muscle. H+ ions tend to accumulate within muscle as the muscle contracts at higher exercise intensities. These accumulating ions produce metabolic waste products that decrease the pH and increase the acidity of the blood. The buildup of H+ ions in muscle is one of the major causes of fatigue and decreased

muscular performance; therefore, increasing the amount of this buffer may prolong a training session, or a working set of strength training exercise, and potentially prevent fatigue that occurs when exercising at a high intensity. Theoreti-cally, this product appears to make sense physiologically.

One recent study examined 28-days of beta-alanine supplementation on work capacity at fatigue threshold, ven-tilatory threshold, maximal oxygen consumption, and time to exhaustion in 22 women.26 This randomized, placebo controlled trial provided women with either beta-alanine or placebo, and had them perform a cycle ergometry test to exhaustion to determine the effects of beta-alanine. The re-searchers found that beta-alanine supplementation delayed the onset of neuromuscular fatigue, improved the ventila-tory threshold at submaximal workloads, and increased the time to exhaustion. It did not, however, affect maximal aerobic power. The authors concluded that beta-alanine supplementation appeared to show improvement, perhaps because of the elevated carnosine concentration in muscle.

While the data with this supplement is limited, the re-sults show promise. There is limited data, however, on this amino acid (or on its end product, carnosine, itself ) to sug-gest that it is, in fact, safe for all populations. At the time of writing, beta-alanine is not a banned substance with any governing bodies.

Recommended Dose: Because this supplement is rather new to the market, the dosing recommendations vary. One study published in the International Journal of Sport Nutrition and Exercise Metabolism used 3.2 grams/day, and showed it appeared to enhance training volume (more so than creatine alone) and had the greatest effect on body composition.27 The study by Stout et al., however, refer-enced above,26 started women on the same 3.2 grams/day dose for seven days, then increased the dose to 6.4 grams/day for the remainder of the study, making it impossible to compare the results from both studies since the dosing dif-fered. More research is warranted to ascertain the true effect and proper dosing, since this supplement is relatively new to the market.

The difference between obtaining an Olympic medal and not making the podium is often hundredths of a sec-ond. Athletes are continuously searching for a nutritional edge over their competitors. One primary concern, however, is not necessarily with the safety of the supplement itself, but rather the purity of the supplement. A recent investiga-tion measured the purity of 634 non-hormonal nutrition

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supplements from 13 different countries and 215 different suppliers.28 After analyzing the particular supplements to ascertain their contents, it was found that 14.8% con-tained anabolic androgenic steroids (banned substances) not declared on the label. Although this is a concern at a variety of levels, consider the simple fact that athletes could be taking these sports supplements, which appear to be benign, yet are tainted products. Sports organizations, such as the NFL, have a policy of “everything you take is your responsi-bility,” regardless if the product is a simple over the counter dietary supplement or a pharmaceutical grade supplement. With this policy, there can never be the argument that an athlete was “unaware” of what they were putting into their body.

Take Home Message

Regardless of your practice area within the field of nutri-tion, the seven-point assessment presented in this article can easily be used by healthcare professionals who may not be familiar with supplements. Athletes are often curious about what supplements can improve their performance, when in reality, the first target is their overall food intake program, and of course, the training. Unfortunately, athletes look to dietary supplements to enhance performance without regard to their diet, training, or overall lifestyle. The term dietary supplement in and of itself, defines its purpose-- to supple-ment the diet. Consuming adequate energy and fluids is the primary goal. Dietary supplements should then fill in the very tip of the “iceberg,” but only if they are proven to be safe, legal, and beneficial. A poor diet with added supple-mentation is still a poor diet.

Chris Mohr, MS, RD, PhD owner of Mohr Results, Inc a nutrition and fitness consulting company in Louisville, KY. Dr. Mohr has a bachelor and master of science degree in Nutrition and PhD in exercise physiology. He is a board certified spe-cialist in sports dietetics (CSSD). Contact Dr. Mohr at www.MohrResults.com

References

1. Sports Nutrition & Weight Loss Markets VI. Nutrition Business Journal. September, 2006:3.

2. Grivetti LE, Applegate EA. From Olympia to Atlanta: a cultural-historical perspective on diet and athletic training. J Nutr. 1997;127:860S-868S.

3. Hultman E. Studies on muscle metabolism of glycogen and active phosphate in man with special reference to exercise and diet. Scand J Clin Lab Invest Suppl. 1967;94:1-63.

4. Bergstrom J, Hultman E. A study of the glycogen metabolism during exercise in man. Scand J Clin Lab Invest. 1967;19:218- 228.

5. Bergstrom J, Hultman E. Synthesis of muscle glycogen in man after glucose and fructose infusion. Acta Med Scand. Jul 1967;182:93-107.

6. Bass IS, Young AL, Food and Drug Law Institute (U.S.), United States. Dietary Supplement Health and Education Act : a legislative history and analysis. Washington, D.C.: Food and Drug Law Institute; 1996.

7. McArdle WD, Katch FI, Katch VL. Sports and exercise nutrition. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

8. Bemben MG, Lamont HS. Creatine supplementation and exercise performance: recent findings. Sports Med. 2005;35:107- 125.

9. Kilduff LP, Pitsiladis YP, Tasker L, et al. Effects of creatine on body composition and strength gains after 4 weeks of resistance training in previously nonresistance-trained humans. Int J Sport Nutr Exerc Metab. 2003;13:504-520.

10. Balsom PD, Harridge SD, Soderlund K, Sjodin B, Ekblom B. Creatine supplementation per se does not enhance endurance exercise performance. Acta Physiol Scand. Dec 1993;149:521- 523.

11. Kreider RB, Melton C, Rasmussen CJ, et al. Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Mol Cell Biochem. 2003;244:95-104.

12. Terjung RL, Clarkson P, Eichner ER, et al. American College of Sports Medicine roundtable. The physiological and health effects of oral creatine supplementation. Med Sci Sports Exerc. 2000;32:706-717.

13. Hultman E, Soderlund K, Timmons JA, Cederblad G, Greenhaff PL. Muscle creatine loading in men. J Appl Physiol. 1996;81:232-237.

14. Ivy JL, Res PT, Sprague RC, Widzer MO. Effect of a carbohydrate-protein supplement on endurance performance during exercise of varying intensity. Int J Sport Nutr Exerc Metab. 2003;13:382-395.

15. Rasmussen BB, Tipton KD, Miller SL, Wolf SE, Wolfe RR. An oral essential amino acid-carbohydrate supplement enhances muscle protein anabolism after resistance exercise. J Appl Physiol. 2000;88:386-392.

16. Saunders MJ, Kane MD, Todd MK. Effects of a carbohydrate- protein beverage on cycling endurance and muscle damage. Med Sci Sports Exerc. 2004;36:1233-1238.

17. Jentjens RL, Underwood K, Achten J, Currell K, Mann CH, Jeukendrup AE. Exogenous carbohydrate oxidation rates are elevated after combined ingestion of glucose and fructose during exercise in the heat. J Appl Physiol. 2006;100:807-816.

18. Tipton KD, Elliott TA, Cree MG, Aarsland AA, Sanford AP, Wolfe RR. Stimulation of net muscle protein synthesis by whey protein ingestion before and after exercise. Am J Physiol Endocri-

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nol Metab. Jan 2007;292:E71-76.

19. Koopman R, Beelen M, Stellingwerff T, et al. Co-ingestion of carbohydrate with protein does not further augment post-exercise muscle protein synthesis. Am J Physiol Endocrinol Metab. Jul 3 2007.

20. Betts JA, Stevenson E, Williams C, Sheppard C, Grey E, Griffin J. Recovery of endurance running capacity: effect of carbohy drate-protein mixtures. Int J Sport Nutr Exerc Metab. 2005;15:590-609.

21. Burke LM, Kiens B, Ivy JL. Carbohydrates and fat for training and recovery. J Sports Sci. 2004;22:15-30.

22. Tipton KD, Witard OC. Protein requirements and recommendations for athletes: relevance of ivory tower arguments for practical recommendations. Clin Sports Med. 2007;26:17-36.

23. Harris RC, Tallon MJ, Dunnett M, et al. The absorption of orally supplied beta-alanine and its effect on muscle carnosine synthesis in human vastus lateralis. Amino Acids. 2006;30:279-289.

Become a member of the NCC Executive Committee

NCC is looking for an External Funding/Liaison Chair. This position works with various companies and or-ganizations to obtain funding for NCC programs and member services. If you are interested in volunteering please contact Gretchen Forsell, NCC Chair ([email protected]) for additional information

Sports Supplements24. Hill CA, Harris RC, Kim HJ, et al. Influence of beta-alanine supplementation on skeletal muscle carnosine concentrations and high intensity cycling capacity. Amino Acids. 2007;32:225-233.

25. Dunnett M, Harris RC. Influence of oral beta-alanine and L- histidine supplementation on the carnosine content of the gluteus medius. Equine Vet J Suppl. 1999;30:499-504.

26. Stout JR, Cramer JT, Zoeller RF, et al. Effects of beta-alanine supplementation on the onset of neuromuscular fatigue and ventilatory threshold in women. Amino Acids. 2007;32:381- 386.

27. Hoffman J, Ratamess N, Kang J, Mangine G, Faigenbaum A, Stout J. Effect of creatine and beta-alanine supplementation on performance and endocrine responses in strength/power athletes. Int J Sport Nutr Exerc Metab. 2006;16:430-446.

28. Geyer H, Parr MK, Mareck U, Reinhart U, Schrader Y, Schanzer W. Analysis of non-hormonal nutritional supplements for anabolic-androgenic steroids - results of an international study. Int J Sports Med. 2004;25:124-129.

Web site: www.ComplementaryNutrition.orgMember Electronic Mailing List:

Contact Gretchen Forsell to get connected([email protected]).

Visit our newly reformatted website!



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30

Jenna A. Bell-Wilson, PhD, RD, CSSD

Plant sterols, sometimes called phyto-sterols, are naturally occurring in a variety of foods. Small quantities of

plant sterols can be found in vegetable oils, nuts, grain products, fruits, and vegetables.

Plant sterols maintain cell membrane structure and function in plants similar to the biological function of cholesterol in humans. They also have a physical structure similar to that of cholesterol. The most common natural plant sterols are beta-sitosterol, campesterol, and stigmasterol. The average intake of plant sterols in Western countries is approximately 150-350 mg/day of plant sterols.1

While the mechanism of action is not completely understood, studies show that plant sterols block the absorp-tion of cholesterol in the intestine and increase cholesterol removal from the body. Because plant sterols have a similar structure to cholesterol, one hypothesis is that they displace cholesterol from the micelles. In this way, less cholesterol is presented to the lining of the intestinal wall in a form that can be absorbed.1,2 Plant sterols may also interfere with chylomicron formation in the enterocyte, thereby decreasing the amount of cholesterol in the blood. The third theory is that plant sterols block cholesterol absorption into the ente-rocyte and compete with cholesterol for access to cholesterol transporters at the gut wall.1 Regardless of the mechanism, plant sterol consumption can reduce cholesterol absorp-tion by 30-40%.3 Because plant sterols block absorption of cholesterol in the intestine and increase cholesterol removal from the body, plant sterol-containing foods are included in the recommendations for managing cholesterol.

The National Cholesterol Education Program (NCEP) guidelines include plant sterols within their Therapeutic Lifestyle Changes (TLC) for effective cholesterol lower-ing in adults with elevated cholesterol. NCEP reports that including 2-3 grams of plant sterols a day can help lower LDL-cholesterol by an average of 6–15%, based on stud-ies conducted mainly with spreads consumed at least twice a day with meals (individual subject results tended to vary widely).4 In agreement, the American Dietetic Association Evidence Analysis Library recommends plant sterol- and

stanol ester-enriched foods consumed two or three times per day, for a total consumption of two or thee grams per day; in conjunction with a cardioprotective diet to further lower total cholesterol by 4–11%, and LDL-cholesterol 7 – 15%. These data are also based on studies conducted primarily with spreads consumed at least twice a day with meals (indi-vidual subject results tended to vary widely).5

The Food and Drug Administration (FDA) has author-ized an interim significant scientific agreement claim for plant sterols and stanols and reduced risk of coronary heart disease. Significant scientific consensus claims are author-ized for ingredients when experts agree on the strength and consistency of the science. It is noted that foods containing plant sterols should be eaten twice a day with meals, and the claim indicates that “at least 0.4 grams of plant sterols per serving for a total daily intake of at least 0.8 grams, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.” 6

A New Form of Functional Food for Clients

As dietitians, finding dietary options for patients and clients to help them achieve their cholesterol goals can be a challenge. Often, patients and clients report confusion around what foods they should choose to meet their needs, and they find it difficult to know which foods offer the most benefit for managing cholesterol. This confusion and frus-tration can become a major barrier in the dietary manage-ment of cholesterol. Speaking in “food” is often the most effective means to help patients and clients, and offering a variety of options for effective cholesterol lowering helps them find the plan that best suits their lifestyle.

Plant sterol-containing foods provide another option to patients managing their cholesterol, because plant ster-ols can lower LDL-cholesterol in individuals with elevated blood cholesterol levels. In addition, for patients who have diabetes, plant sterols are effective at lowering LDL-choles-terol as part of a diet low in saturated fat and cholesterol.7,8

With the substantial scientific support behind plant sterols, and considering the NCEP recommendations, the food industry has responded. Foods containing plant sterols in meaningful amounts are now available for consumers to try. Commercially prepared foods that contain plant sterols range in calorie and nutrient contribution, and include soft margarine spreads, orange juice, snack bars, chocolate, and now a “mini-drink.”

Functional FoodsProduct Highlight for Cholesterol Management:Plant Sterol-Containing Promise activ™ SuperShots™

continued on page 33

The Natural Medicines Comprehensive Database website gives instant answers on herbal and dietary supplements, complete with brand name searches and Patient Handouts. The Database saves you time by offering highly researched information like...

• Patients on Coumadin could have their levels thrown off when they take ginger or garlic, or any of more than 65 different herbs.

• Women on oral contraceptives risk unwanted pregnancy when taking St. John’s wort. • Patients on omeprazole can have levels decreased 40% when they take ginkgo. • Soy might decrease the effectiveness of tamoxifen for breast cancer. • Echinacea might interact with lovastatin and other cholesterol drugs.

The Natural Database website is updated daily. Access to the Natural Database lets you search natural meds and learn more detailed, scientifi c information about:

– Safety and effectiveness ratings – Brand names and product ingredients – Interactions with drugs, foods, lab tests, and diseases – Dosages and mechanism of action, and much more

This information is especially important considering many people use, or have used, natural products...whether they say so or not. With the Natural Database you can easily provide helpful, scientifi c info on natural medicines.

U.S. News & World Report calls the Database “the scientifi c gold standard.” Other terrifi c reviews in JAMA, American Journal of Pharmaceutical Education, and others make it clear this is the best resource to use.

P.S. See reverse for access info and tips on how to use the Natural Database.

Login information on back

NCC has purchased access rights for you to useNatural Medicines Comprehensive Database

Natural Medicines Comprehensive Database • 3120 W. March Ln., P.O. Box 8190, Stockton CA 95208Tel: 209-472-2244 • Fax: 209-472-2249 • [email protected]

Dear NCC Members,

I am overjoyed and pleased to share with you that we, the Nutrition in Complementary Care Dietetic Practice Group (NCC DPG), has secured advanced online access to the Natural Medicines Comprehensive Database (“NMCDB”) for all of NCC. This member benefi t is exclusive to the NCC community. You can use this database to research dietary supplements, nutraceuticals, herbals and other items that your clients, patients, family or friends may ask you about. The database, which is updated daily, provides instant answers along with brand name searches and consumer handouts. The NCMDB is the premier database that is easy to navigate, modern in its knowledge, and thus, we now have a wonderful opportunity to expand our knowledge while helping others. Please use this member benefi t to your advantage and enjoy the great resource!

The reverse side of this letter provides access information and tips on how to use the Natural Medicines Comprehensive Database.

Sincerely,

Gretchen ForsellNCC Chair

!

To Use the Natural Database Online:

1. From your computer, go to the NCC - Nutrition in Complementary Care website:

www.complementarynutrition.org/members.

2. Login with your ADA # and password.

3. Click on the link to Natural Medicines Comprehensive DatabaseYou’ll now be logged into www.naturaldatabase.com, where you should see a box in the top-right corner asking for your User ID#.

4. Click the I Need a User ID# link (circled in red).

5. Follow the instructions on the resulting pages, and fi ll out the required information as needed. Be sure to make note of your User ID#.

If you forget your User ID#, it will be NCC-, 1st 6 letters of your last name, 1st letter of fi rst name, and the last 4 numbers of

your Social Security Number. Example: NCC-SMITHJ1234

Natural Medicines Comprehensive Database • 3120 W. March Ln., P.O. Box 8190, Stockton CA 95208Tel: 209-472-2244 • Fax: 209-472-2249 • [email protected]

To Use the Special Features on Natural Database:

Find info on safety, interactions, dosage, effectiveness, Patient Handouts, and more. You can also read the Clinical Management Series, covering natural meds usage in such areas as depression, PMS, and insomnia.

Click the Search button (circled in red). Then use any of these searches...

Search – By name of product, ingredient, drug, disease, etc.

Natural Product Effectiveness Checker – Enter the name of a medical condition or disease to fi nd a list of natural products and their effectiveness.

Disease / Medical Conditions Search – Shows medical conditions and which natural products might be effectivefor the condition.

Natural Product / Drug Interaction Checker – Shows potential interactions between any natural product, its ingredients, and any drug.

To Get the Natural Database CE:

Using your User ID#, you can take Natural Medicines CE courses. Just click on the Continuing Education button to select the course you’d like to take from your CE homepage.

from the menu on the left (under Member Resources).

!

Promise activ™ SuperShots™ is the first mini-drink with added plant sterols. It contains 2 grams of plant sterols per 3-ounce serving, in a form that is easy to consume with any meal. The drink offers patients a convenient and portable form to consume plant sterols. In addition to plant sterols, the mini-drinks contain 200 mg of omega-3 ALA per serv-ing (15% of the Daily Value; the ALA Daily Value is 1.3 g), 1300 mg of omega-6, and are a good source of vitamin E.

For additional information about cholesterol manage-

ment, plant sterols, and heart health nutrition, visit the Promise Institute for Heart Health Nutrition at www.prom-iseinstitute.org.

*This article was made possible by an educational grant to NCC from Unilever.

Jenna A. Bell-Wilson, PhD, RD, CCSD is a freelance nutrition writer and consultant. Contact Jenna at [email protected].

References

1. Trautwein EA. Proposed mechanisms of cholesterol-lowering action of plant sterols. Eur J Lipid Sci Tech. 2003;105:171-185.

2. von BK, Sudhop T, Lutjohann D. Cholesterol and plant sterol absorption: recent insights. Am J Cardiol. 2005;96:10D-14D.

3. Normen L, Dutta P, Lia A, Andersson H. Soy sterol esters and beta-sitostanol ester as inhibitors of cholesterol absorption in human small bowel. Am J Clin Nutr. 2000;71:908-913.

4. National Cholesterol Education Program. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285:2486-2497.

5. Plant Sterols and Stanols, Nutrition Management of Disorders of Lipid Metabolism. ADA Evidence Analysis Library [ 2007 ]. Available at: www.adaevidencelibrary.com.from: URL:www.adaevidencelibrary.com. Accessed 9/12/2007.

6. FDA Talk Paper, Food and Drug Administration, U.S. Department of Health and Human Services, September 5, 2000; available at: http://www.fda.gov/bbs/topics/ANSWERS/ANS01033.html. Accessed 09/12/2007.

7. Lee YM, Haastert B, Scherbaum W, Hauner H. A phytosterol- enrichedspread improves the lipid profile of subjects with type 2 diabetes mellitus--a randomized controlled trial under free-living conditions. Eur J Nutr. 2003;42:111-7.

8. Lau VW, Journoud M, Jones PJ. Plant sterols are efficacious in lowering plasma LDL and non-HDL cholesterol in hypercholes- terolemic type 2 diabetic and nondiabetic persons. Am J Clin Nutr. 2005;81:1351-8.

Functional Foods


continued from page 30

Join ADA’s cutting edge dietetic practice group, Nutri-tion in Complementary Care, at the 2007 Food & Nutri-tion Conference & Expo at the Pennsylvania Convention

Center in Philadelphia.

Sunday, September 30th, 8 am to 4 pm.Product Market PlaceConvention Center, Booth 7

Monday, October 1st, 8 to 9:30 am.NCC Priority Session: Ultra-Metabolism: The Causes of Obesity - an Integrative Approach to Weight Loss.

Kathie Swift, MS, RD, LDN, Nutrition Director, Ultra Wellness NCC Education Chair.Mark Hyman, MD, Medical Director, Ultra Wellness Edi-tor-in-Chief, Alternative Therapies in Health & Medicine.

NCC board member Kathie Swift and Dr. Mark Hyman will identify core clinical imbalances common to obesity; de-scribe laboratory tests for evaluating imbalances; and explain complementary and alternative therapies for obesity man-agement.

Monday, October 1st, 10:30 am to 1 pm.DPG ShowcaseConvention Center, Arch Street Bridge outside Expo Hall, Booth 12.

Tuesday, October 2nd, 6:15 to 7:45 am.NCC Breakfast Meeting: Food Innovations & Managing Risk Factors for CVD presented by Douglas Balentine, PhD, Director of Nutrition Science.

Designed specifically for NCC members, Dr. Balentine’s presentation will give attendees the inside scoop about ad-vancements in food innovations related to cholesterol and blood pressure management. Marriott, Room 407-409 Sponsored by the Promise Institute for Heart Health. Approved for 1 CPEU.

Yoga sponsored by NCC and ADAFCheck the FNCE Program Book for times and locations. Suggested donation: $15 for unlimited sessions

Bring your ADA member guests to these exciting events!For more information visit www.complementarynutrition.org


Annual Budget Report for 2006-2007Submitted by Andrea Hutchins, Treasurer

Revenues Expenses Excess (Deficit)Administration $99,840 $23,603 $76,237Newsletter $1,119 $27,209 ($26,090)Web Site $153 $13,398 ($13,245)FNCE $15,000 $31,573 ($16,573)TOTAL $116,112 $95,783 $20,329

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Nutrition in Complementary Care 2006-2007

The NCC-DPG has had another successful year of providing members with opportunities for net-working, professional development, and leadership

development.

Program of Work Outcomes:Networking: • Annual meeting and reception at FNCE in Honolulu, Hawaii, September 2006, including: The Traditional Hawaiian Diet: Paradise with Foods, Herbals and Supplements, You’ve Got Male! Healthy Strategies for Preventing the Early Deletion of Your Man, and DHA, Functional Foods & Infant Functional Outcomes—Viewing Pregnancy as a Link sponsored by Martek Biosci- ences. These exciting extracurricular activities drew > 100 individuals. • New member packets were sent to more than 250 new NCC members.

Professional Development: • Educational sessions including two Major Sessions at FNCE-Hawaii. • NCC co-sponsored many Regional Conferences on topics such as Nutrigtional Genomics and cardio- vascular health. • NCC organized an arrangement with the Oncology Nutrition DPG to share resources that overlap to better benefit all of our collective members. • The quarterly newsletters have continued to grow in content while also being a great source of CEU material for the members. • The NCC electronic listserv has undergone changes to be more user friendly. • The Lending Library (books, articles) added new items to the inventory of resources/items available to members.

Leadership Development: • Executive Committee meetings and conference calls: The NCC has met via conference call on a bi-monthly basis and in person at FNCE. Appro- ximately eight conference calls were held during the fiscal year coupled with an executive member listserv to deal with issues in real time.

• NCC has redeveloped the Member Web site. This is an ongoing project with the goal of a more use– friendly interface for our members. • NCC has sent Executive Committee members to the Leadership Training, Public Policy Workshop and to lobby when possible.

Miscellaneous: • NCC has secured continued sponsorship and continues to look for long-term strategic partners in order to help grow the DPG. Financial Report: • Is available in this issue of the newsletter

Thanks to the efforts and support of our NCC leaders, in-dustry partners, and you – our members, NCC continues to be a strong and effective practice group.

Annual Report

THANK YOU TO OUR SPONSORS

Without your generous contributions, many of the opportunities and member benefits would not be possible.

Platinum Promise Institute for Heart Health

Bronze Pharmavite


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• The quality of hoodia products varies widely. News reports suggest that some products sold as hoodia do not contain any hoodia.

Sources

Hoodia. Natural Medicines Comprehensive Database Web site. Accessed on 05/16/07.

Hoodia (Hoodia gordonii). Natural Standard Database Web site. Accessed on 05/16/07.

Chamomile Parts used include flowers, leaves, bark, fruit, seeds,

stems, and roots. Two types of chamomile are used for health conditions: German chamomile and Roman chamo-mile. While the two kinds are thought to have similar effects on the body, the German variety is more commonly used in the United States and is the focus of this fact sheet.

Common Names —chamomile, German chamomile

Latin Names—Matricaria recutita, Chamomilla recutita

What It Is Used For

• Chamomile has been widely used in children and adults for thousands of years for a variety of health conditions.

• The herb is often used for sleeplessness; anxiety; and gastrointestinal conditions such as upset stomach, gas, and diarrhea.

• It is used topically for skin conditions and for mouth ulcers resulting from cancer treatment.

How It Is Used

The flowering tops of the chamomile plant are used to make teas, liquid extracts, capsules, or tablets. The herb can also be applied to the skin as a cream or an ointment, or used as a mouth rinse.

What the Science Says

• Chamomile has not been well studied in people so there is little evidence to support its use for any condition.

From the National Center for Complementary and Alternative Medicine

Herbs at a GlanceHerbs at a Glance is a series of fact sheets that provides

basic information about specific herbs or botanicals—com-mon names, uses, potential side effects, and resources for more information. The following are resources newly posted to the NCCAM Website.

Hoodia

This fact sheet provides basic information about the herb hoodia--common names, uses, potential side effects, and resources for more information. Hoodia is a flowering, cactus-like plant native to the Kalahari Desert in southern Africa. Its harvest is protected by conservation laws.

Common Names—hoodia, Kalahari cactus, Xhoba

Latin Names —Hoodia gordonii

What It Is Used For

• Kalahari Bushmen have traditionally eaten hoodia stems to reduce their hunger and thirst during long hunts.

• Today, hoodia is marketed as an appetite suppres- sant for weight loss.

How It Is Used

• Dried extracts of hoodia stems and roots are used to make capsules, powders, and chewable tablets. Hoodia can also be used in liquid extracts and teas.

• Hoodia products often contain other herbs or min- erals, such as green tea or chromium picolinate.


There is no reliable scientific evidence to support hoodia’s use. No studies of the herb in people have been published.

Side Effects and Cautions

• Hoodia’s safety is unknown. Its potential risks, side effects, and interactions with medicines and other supplements have not been studied.

Have You Read?


Therapies: Have You Read... ?

• Some early studies point to chamomile’s possible benefits for mouth ulcers and certain skin conditions. In combination with other herbs, it may be of some benefit for upset stomach and for diarrhea in children.

• NCCAM-funded research on chamomile includes studies of the herb for generalized anxiety disorder and for chronic pain caused by children’s bowel disorders.


• There are reports of rare allergic reactions in people who have eaten or come into contact with chamomile products. Reactions include skin rashes, throat swelling, shortness of breath, and anaphylaxis (a life-threatening allergic reaction).

• People are more likely to experience allergic reactions to chamomile if they are allergic to related plants in the daisy family, which includes ragweed, chrysanthemums, marigolds, and daisies.

Sources

German chamomile. Natural Medicines Comprehen-sive Database Web site. Accessed on May 15, 2007.

Chamomile (Matricaria recutita, Chamaemelum no-bile). Natural Standard Database Web site. Accessed on 05/16/07

Chamomile flower, German. In: Blumenthal M, Gold-berg A, Brinckman J, eds. Herbal Medicine: Expanded Com-mission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:57-61.

Bitter Orange

The bitter orange tree is native to eastern Africa and tropical Asia. Today, it is grown throughout the Mediter-ranean region and elsewhere, including California and Flor-ida. Bitter orange oil is used in foods, cosmetics, and aroma-therapy, a therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled to promote health and well-being. products. Bitter orange oil from the tree’s leaves is called petitgrain, and oil from the flowers is called neroli.

Common Names —bitter orange, Seville orange, sour orange, Zhi shi

Latin Names—Citrus aurantium

What It Is Used For

• Bitter orange has been used in traditional Chinese medicine, a whole medical system that originated in China. It is based on the concept that disease results from disruption in the flow of qi and imbal- ance in the forces of yin and yang. Practices such as herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi. and by indigenous people of the Amazon rain forest for nausea, indi- gestion, and constipation.

• Current uses of bitter orange are for heartburn, loss of appetite, nasal congestion, and weight loss. It is also applied to the skin for fungal infections such as ringworm and athlete’s foot.

How It Is Used

The dried fruit and peel (and sometimes flowers and leaves) are taken by mouth in extracts, tablets, and capsules. Bitter orange oil can be applied to the skin.


• There is not enough scientific evidence to support the use of bitter orange for health purposes.

• Many herbal weight-loss products now use bitter orange peel in place of ephedra. However, bitter orange contains the chemical synephrine, which is similar to the main chemical in ephedra. The U.S. Food and Drug Administration banned ephedra because it raises blood pressure and is linked to heart attacks and strokes; it is unclear whether bitter orange has similar effects. There is currently little evidence that bitter orange is safer to use than ephedra.


• Because bitter orange contains chemicals that may speed up the heart rate and raise blood pressure, it

may not be safe to use as a dietary supplement. There have been reports of fainting, heart attack, and stroke in healthy people after taking bitter orange supplements alone or combined with caffeine. People should avoid taking bitter orange if they have a heart condition or high blood pressure, or if they are taking medications (such as MAO inhibitors), caffeine, or other herbs/supplements that speed up the heart rate.

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Have You Read?


• Due to lack of safety evidence, pregnant women should avoid products that contain bitter orange.

• Bitter orange oil used on the skin may increase the risk of sunburn, particularly in light-skinned people.

Sources

Bent S, Padula A, Neuhaus J. Safety and efficacy of citrus aurantium for weight loss. Am J Cardiol. 2004;94:1359-1361.

Bitter orange. Natural Medicines Comprehensive Database Web site. Accessed on 05/16/07.

Bitter orange (Citrus aurantium). Natural Standard Data-base Web site. Accessed on May 16, 2007.

Orange peel, bitter. In: Blumenthal M, Goldberg A, Brinck-man J, eds. Herbal Medicine: Expanded Commission E Mon-ographs. Newton, MA: Lippincott Williams & Wilkins; 2000:287-289.

U.S. Food and Drug Administration. FDA Requests Seizure of More Dietary Supplements Containing Ephedrine Alkaloids. U.S. Food and Drug Administration Web site. Accessed at www.fda.gov/bbs/topics/news/2006/new01325.html. Accessed on 05/23/07.

For More Information

Visit the NCCAM Web site and view:

• “What’s in the Bottle? An Introduction to Dietary Supplements”

• “Herbal Supplements: Consider Safety, Too”

NCCAM Clearinghouse Toll-free in the U.S.: 1-888-644-6226 TTY (for deaf and hard-of-hearing callers): 1-866-464-3615 E-mail: [email protected]

NIH Office of Dietary Supplements Web site: ods.od.nih.govLast accessed 09/16/07.

Herbs at a Glance is not copyrighted and is in the public domain. Last accessed at http: nccam.nih.gov/camonpubmed/, 09/20/07.

Collaboration between the American Dietetic Asso-ciation’s (ADA) Dietetic Practice Groups (DPGs) and the association’s policy initiatives and advocacy

program has been the source of several of the most signifi-cant nutrition and health breakthroughs in the past three years. In Washington DC and the states, issues affecting di-etetics practice in all specialty areas continue to bubble up.

“This kind of liaison was at the heart of ADA’s legislative work on the Older Americans and the Ryan White CARE Acts,” said Mary Hager, PhD, RD, FADA, who is part of ADA’s Washington team. “To create these kinds of collabo-rations, ADA reaches out – with DPG meetings at every Food & Nutrition Conference & Expo (FNCE), multiple conference calls with DPG leaders, extended conversations on practice issues and collaborations on legislative and regu-latory affairs.”

The scope of these conversations frequently is specific to DPG interests. “But there is one meeting where ADA focuses on the big picture, with attention going to strate-gic priorities for all practitioners,” Hager said. “Every DPG needs to be represented at ADA’s Public Policy Workshop to hear and see how public policy affects food, nutrition and health, and to be trained in messages and tactics for taking our causes to a higher level.”

In 2008, PPW is scheduled for February 4-6 in Wash-ington DC. To ensure broad representation and a legacy of informed advocacy, ADA again will offer each DPG a scholarship to cover the cost of registration.

“Considering that the 2008 PPW will be in the middle of the 110th Congress, it’s an important time for dietitians to look at the status of issues we care about, and to work for results while in Washington. Also, our dates coincide with Presidential primaries – and we’ll be in a place to witness landmark events,” she said.

Health care for Americans, nutrition and food safety is-sues, access to nutrition care services and food assistance are topics likely to dominate national headlines next year.

In 2007, PPW hosted a session on some of the emerg-ing and ongoing issues ADA members face in their areas of

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37

Have You Read? DPG News – Prepare for Public Policy Workshop

Continued on page 38


Ruth DeBusk PhD, RD

Nutritional genomics continues to move steadily forward as an evolving discipline and remains

one of ADA’s top areas of major impor-tance to the future of the dietetics pro-fession. NCC has been the home of the

effort to introduce nutritional genomics to the profession through the Nutrigenomics for Dietitians Initiative (NDI, now more correctly entitled Nutritional Genomics for Dietitians Initiative but still abbreviated NDI).The initial emphasis of NDI has been to raise awareness of this emerg-ing field and the many opportunities it presents for nutri-tion professionals. NCC has been active in this regard with various newsletter and website articles about nutritional genomics. As the science progresses and the applications of nutritional genomics begin to emerge, increasing emphasis is being placed on the need for education and practical training in this area. There are a number of books now available, ranging from easy-reading to conference proceed-ings. Textbooks, led by Krause’s Food & Nutrition Therapy under the guidance of its visionary editors Kathleen Mahan and Sylvia Escott-Stump, now include content devoted to nutritional genomics. FNCE and state dietetic associations routinely offer presentations, including half-day workshops, on aspects of nutritional genomics at the annual meetings. The Second Bruce Ames Symposium hosted by the Center of Excellence in Nutritional Genomics at the University of California, Davis on October 12-14 will provide three pre-conference workshops in this area specifically targeted to the needs of the registered dietitian. The first graduate level clinical nutrition course in nutritional genomics is currently being offered by the University of Medicine & Dentistry of New Jersey through its distance learning program.

If you’re feeling like you missed the boat, you haven’t! Nutritional genomics will touch virtually every aspect of dietetics. The learning curve is a bit steep so the time to begin developing your foundation is now. Pick an area that’s of interest to you and start familiarizing yourself with the lit-erature. Learn as you go. You don’t necessarily need years of genetics training before you begin. Contact NDI at [email protected] and suggest a way you can contribute to this grassroots movement. There’s much yet to

be done, from raising awareness to designing curricula and training programs to potentially developing an advanced credential that creates a unique niche for the RD nutritional genomics practitioner. Let’s proactively create our future!

Update on the Nutritional Genomics for Dietitians Initiative

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specialty. Join the discussion and be part of ADA’s voice on Capitol Hill and through out the country. Go to www.eat-right.org this fall to register, for scholarship applications and other travel-related details, or call ADA’s Washington office at 1 / 800 / 877-0877.

DPG News — Continued from page 37

DO YOU WANT TO MAKE A DIFFERENCE IN NCC?

Dear NCC member,

If you find NCC an invaluable resource, wish to make a difference in the field of nutrition and complementary care or simply want to develop stronger connections with other RD’s who share your interest and passion, consider running for a NCC elected office.

Fall marks the time of year when NCC begins its search for individuals interested in serving in leadership positions for the 2008-2009 fiscal year. To fill our November ballot, we are now taking nominations for Chair-elect, Treasurer, and 2 Nominating Committee Members for terms of office beginning June 1, 2008.

If you are interested in running for one of these positions or you would like to nominate someone, please contact Christine Pickett, MS, RD, NCC Nominating Chair, by Monday, October 1st.

Contact information: Phone: (805) 898-2114, Email: [email protected].

Position descriptions and additional information available.


After reading this CPE article, the reader will be able to: 1. Define dietary supplement and ergogenic aid. 2. Recognize the breadth and magnitude of the sport supplements industry. 3. Outline a seven point process for evaluating dietary ergogenic aids. 4. List 3 popular dietary sports supplements. 5. State the theoretical mechanism of action of each of the respective dietary sport supplements. 6. State the recommended dose of reviewed supplement(s).

This CPE activity is worth 1 CPEU.

1. Ergogenic aids are 21st century phenomenon. A. True B. False

2. Carbohydrate requirements immediate post exercise/ training are: A. 0.1 g/kg body weight B. 1.0-2.0 g/kg body weight C. 105 grams D. 2.0-5.0 g/kg body weight

3. Before, during and after training, a marathon runner would most likely benefit from: A. androgenic anabolic steroids B. 2.0-5.0 g/day creatine monohydrate C. carbohydrate-protein supplementation D. ß-alanine

4. Which segment of the dietary supplement industry, division of sports nutrition and weight loss, is the largest in terms of gross sales? A. Weight loss liquid meal replacements B. Creatine monohydrate C. Multivitamin-mineral supplements D. Sport and energy drinks5. All ergogenic aids are dietary supplements. A. True B. False

6. Which is not a role of protein in sport nutrition/performance? A. Spare carbohydrate from being used as energy B. Source of dietary creatine C. Prevent muscle protein degradation D. Enhance recovery from exercise

7. When evaluating and investigating the utility, safety and efficacy of a dietary aid, which is the least reliable source of information? A. Exercise physiology or nutritional biochemistry textbooks B. Peer-reviewed scientific journals C. Mainstream fitness magazines D. Sport governing bodies (i.e. NCAA, USOC, NFL)

8. Dietary ergogenic aids are products intended to: A. decrease potential for work output B. guarantee peak performance C. prevent dehydration D. increase potential for work output

9. Creatine monohydrate: A. buffers hydrogen (H+) ions within the exercising muscle B. more quickly regenerates ATP from ADP C. facilitates maximum replenishment of glycogen stores D. increases intramuscular carnosine

10. Which is not a purported benefit of ß-alanine? A. Decreases intramuscular carnosine levels B. Delays neuromuscular fatigue C. Increases time to exhaustion D. Improves ventilatory threshold at sub maximal workloads

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CPE Objectives and Questions–Sports Supplements

Answers:1. B 2. B 3. C 4. D 5. A 6. C 7. D 8. B 9. B 10. A

PLEASE CIRCLE THE CORRECT ANSWERS:1. A B 2. A B C D 3. A B C D 4. A B C D 5. A B 6. A B C D 7. A B C D 8. A B C D

9. A B C D 10. A B C D

CPE Reporting Form • FALL 207 - Sports SupplementsEXPIRATION DATE: 09/08Please print of typeName: _______________________________________Address: ______________________________________ADA Membership #: ____________________________Phone: _______________________________________Email address: _________________________________NCC Member Yes ____ N ____Date Test Completed: ___________________________This activity has been approved for one hour of CPE credit. You will be notified if hour is not approved.

Cost: $12 NCC Members $20 non NCC MembersMake checks payable to NCC-DPG #18

Mail to: Andrea Hutchins, PhD, RD, Treasurer 2006-2008 6062 Desoto Drive, Colorado Springs, CO 80922


Kathie Swift, MS, RD, LDNEducation Chair 25 Dan AvenuePittsfield, MA 01201Phone/Fax: [email protected]

Rita Kashi Batheja, MS, RD, CDNMember Services Chair825 Van Buren StreetBaldwin Harbor, NY 11510Phone: [email protected]

Christine Pickett, MS, RDNominating Chair90 Mission Canyon RoadSanta Barbara, CA 93105Phone: [email protected]

NCC LIAISON CHAIR(vacant)

ADA STAFF LIAISON

Danielle Bauer ADA Pracrice Manager120 Riverside Plaza #2000Chicago, IL 60606-6995Phone: 1-800-877-1600 x 4778Fax: [email protected]

ADMINISTRATIVE ASSISTANT

Katherine L. Bernard, MS, RD, CDN90 Panamoka TrailRidge, NY 11961Phone: 631-929-3834Fax: [email protected]

OFFICERS

Rita Kashi Batheja, MS, RD, CDNReimbursement/Public Policy Chair825 Van Buren StreetBaldwin Harbor, NY 11510Phone: [email protected]

Ruth DeBusk, PhD, RDTechnical Resource AdvisorDe Busk Communications, LCPO Box 180279Tallahassee, FL 32318-0279Phone/Fax: [email protected]

Gretchen Forsell, MPH, RD, LMNT Electronic Mail List Coordinator 2002 Highland DriveNorfolk, NE 68701Phone: 402-644-7256Fax: 402-644-7254 [email protected]

Dorothy Humm, MBA, RD, CDNNominating Committee Chair-Elect6558 4th Section Road, #159Brockport, NY 14420-2477Phone: 585-637-2675Office: 585-637-5430Fax: [email protected] [email protected]

Annie Griffin, RD, LDCPE Committee Chair13611 Fernlace Court NWPickerington, OH 43147Phone: [email protected]

Sarah Harding Laidlaw, MS, RD, MPA, CDENewsletter Editor1045 Raptor CircleMesquite, NV 89027Phone: 702-346-7968Fax: [email protected]

Rebecca Schauer, RD, LDCopy Editor2916 42nd Avenue SouthMinneapolis, MN 55406Phone: [email protected]

Carmen G. Llerandi-Phipps, MPH, RD, LD, AHFCANominating Committee Member PO Box 1765Loma Linda, CA 92354-0598Phone: 909-796-2271Office: 909-825-7084 2014Fax: [email protected]

Rick Hall, MS, RDOperations Advisor 3434 West Anthem Way #118-234 Anthem, AZ 85086 Phone: [email protected]

NCC 2007 - 2008 LEADERSHIP CONTACT INFORMATION EXECUTIVE COMMITTEE

Gretchen Forsell, MPH, RD, LMNT Chair 2002 Highland DriveNorfolk, NE 68701Phone: 402-644-7256Fax: 402-644-7254 [email protected]

Douglas S. Kalman, PhD,MS, RD, CCRC,FACNImmediate Past Chair Miami Research Associates6141 Sunset Drive #301Miami, Fl 33143Phone: 305-666-2368Fax: [email protected]

Mary Alice Gettings, MS, RD, LDN, CDEChair Elect205 Opal DriveCranberry Township, PA 16066Home: 724-766-7800Fax: [email protected]

Mary Harris, PhD, RDSecretary 2007 - 20094364 Haystack DriveWindsor, CO 80550-2596Phone: 970-686-2131Office: 970-491-7462Cell: 970-227-0026Fax: [email protected]

Andrea Hutchins, PhD, RD Treasurer 2006 - 20086062 DeSoto DriveColorado Springs, CO 80922Office: 719-262-4467Fax: 719-262-4416Home: Phone/Fax: [email protected]

Laura W. Lagano, MS, RD Publications Chair931 Bloomfield StreetHoboken, NJ 07030Phone: 201-963-4945Fax: [email protected]

Sarah Harding Laidlaw, MS, RD, MPA1045 Raptor CircleMesquite, NV 89027 PRSRT STD

US POSTAGE PAIDGrand Junction, CO

PERMIT 229

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