Nutritional Article of the week: Supplementation

[Mop]

The term Sports Supplements is new but the story remains the same. The desire to find a supplement that will produce bigger, leaner, muscles more quickly. Is there a supplement that will enhance muscle growth? Can you take a supplement that will provide more energy to train harder? What athlete doesn’t want to perform better? The Anabolic Steroid Control Act, passed in 1990, which outlawed steroids, had apparently sent many athletes looking for an alternative. These athletes received help in their search when Congress passed the Dietary Supplement Health Education Act (DSHEA) in 1994. DSHEA stated that dietary supplements were not drugs and not subject to FDA regulation. The supplement industry would regulate itself. The era of legal performance enhancing supplements had arrived. The supplement industry would provide athletes the safe steroid-like alternatives they were looking for and everyone would be able to reach their maximum goals.

This article is not intended to detail the pros and cons of each specific new supplement that has found its way into the fitness culture and claims to increase performance. It is intended to caution fitness professionals about the confusing world of supplement manufacturers.

A great deal of the interest in performance enhancing supplements can be traced back to creatine monohydrate. Promoted as a muscular performance enhancer, creatine became the model for this emerging industry. Next came the androgen steroid precursor supplements like DHEA and androstenedione, androstenediol and nor androstenedione. These supplements were promoted as ways to increase testosterone levels safely. Ephedra, caffeine, and guarana became the booster supplements to provide more energy or to facilitate weight loss. Many of these initial performance-enhancing supplements are now banned from use by athletic organizations because they were harmful to athletes. Many assume that the performance claims made by manufacturers are based on actual data, and that these agents must be safe because they are sold to the general public. Tragically, that simply is not the case.

David Schardt, associate nutritionist at the Center for Science in the Public Interest, when asked about performance enhancing supplements, revealed these disturbing facts, “The labels are often misleading, incomplete, and not a guide to using the product.” Larry Bowers, professor and director of the athletic testing and toxicology laboratory at the Sports Medicine Identification Laboratory at Indiana University Medical Center went even further. His laboratory was frequently asked to test performance enhancing supplements and found that what is on the label is not what is in the bottle. “Since there is no regulatory oversight of the compounds and there’s no one checking to see what’s in it, it could be anything.” How many times have we heard a professional athlete say he did not know the supplement he was taking contained ephedra or a steroid?

A recent survey of athletes and fitness regulars who took a performance-enhancing supplement revealed that 97% knew they caused harmful side effects or worse. People take these supplements because they want results and are falsely led to believe that performance-enhancing supplements are the answer. The time has come for healthcare and fitness professionals to convince clients that the best route to building muscle is the old fashioned way: eat a healthy diet and employ a commitment training regimen.

The fitness equipment industry has done its job providing us with state-of-the-art training equipment. We have the most qualified fitness professionals ever to instruct clients on how to use the equipment safely and how to avoid injury. However, we must practice what we preach. The commitment to what we know is right must be stronger than the desire to please.

Healthcare professionals learned this lesson the hard way. We created antibiotic resistant organisms simply because we gave our patients what they wanted - when we knew an antibiotic was not needed. The fitness industry professionals must not make that same mistake. Do not fall prey to the outrageous claims heard every day about new supplements. The data to support their efficacy is simply non-existent and the sports supplement industry has not proven itself reliable or ethical.

[Mop]

The Dietary Supplements Health and Education Act (DSHEA) of 1994 stated that nutritional supplements that do not claim to diagnose, prevent, or cure disease are not subject to regulation by the Food and Drug Administration (FDA). Many supplement manufacturers have concluded that DSHEA means that there is no requirement to prove claimed benefits, to show safety with acute or chronic administration, to commit to accepted quality assurance practices, or to follow the stringent labeling regulations followed for food products.

The nutritional supplement industry represents $2 billion a year growth industry with total global revenue sales projected to be in excess of $4.5 billion by 2007. Athletes from around the world are turning to nutritional supplements as a way to get bigger, faster and stronger and to have any edge possible over their competition. However, what many do not know or are finding out the hard way is that many of the supplements on the shelves do not contain the advertised amounts of substances in them or in the worst case, have additional substances in them that are not on the label. This can be of concern if the athlete has health issues where a certain herb or manufactured supplement could interfere with medications they are taking and for the elite athlete who gets drug tested at will, it could cause them to fail a test and be suspended from their sport.

Quality Assurance

Quality assurance of dietary supplements continues to be a concern, with some companies following good manufacturing practices (GMPs) while others do not. It is hard for athletes to know what products contain, especially when you consider that contamination of a supplement can occur at so many levels in the supply and manufacturing process. Avoiding companies that produce and sell prohormones such as nandrolone and testosterone derivatives, which result in positive drug tests, may not be enough to prevent purchase of contaminated products.

Since the release of the Schanzer report commissioned by the International Olympic Committee in 1999 showing 18% of all dietary supplements may lead to a positive doping offence, there has been increasing commercial awareness of the adverse publicity companies would face if proven to be connected with contaminated products.

The Problem

The problem is clearly widespread, as indicated by a study conducted by the International Olympic Committee laboratory in Cologne, Germany. Of 634 supplements purchased and tested from 13 different countries, 94 supplements (14.8% of total) contained prohibited substances. Another 10% showed that steroids may have been present but the analysis was not conclusive. This equates into a 1 in 4 risk of contamination with prohibited substances!

Products that tested positive were found to be purchased in the Netherlands (26%), Austria (23%), the United States (19%), the United Kingdom (19%), Italy (14%), Spain (14%) and Germany (12%), among others. Contamination levels of products tended to be small and highly variable among and within batches, making it difficult to identify the source of the contaminated supplement. Even though the prohibited substances that were found have not been officially published, they included the following types and/or categories:

Branched chain amino acids

Glutamine

Zinc

Chrysin

Tribulus Terrestris

Vitamins

Minerals

Creatine

Ribose

Conjugated linoleic acid

Carnitine

Guarana

Pyruvate

HMB

Protein powders

Herbal extracts

What’s Being Done

There are several industry-driven GMPs programs in place, though many experts continue to be concerned about sources of raw materials and guarantees for each batch of product. One industry program is under the National Nutritional Foods Association (NNFA), which has certified dozens of companies and has a strategic alliance with NSF International ( http://www.nsf.org ). Membership in NNFA requires compliance with its GMPs, and its web site ( http://www.nnfa.org ) lists companies that are members. NSF International has an athlete-certification program, and can test specific products for interested athletes. Two other resources include http://www.consumerlab.com , which has independently tested dietary supplements and has an Athletic Banned Substances Screened Products Program and the FDA, which has also presented an outline of a GMP program on its web site at http://www.cfsan.fda.gov.

No matter what programs or processes are in place, athletes who compete at the elite level are randomly drug-tested which leads to continued confusion and concern about how to make decisions regarding the use and purchase of dietary supplements. It would be hard to imagine completing a long training session without the replacement of carbohydrate, fluid, and electrolytes, and the products that provide these ingredients are vital to training and competition. Any product can be contaminated and there aren’t any industry standards in place to prevent this. The good news is that the industry is moving towards the creation of preventative standards, but it will surely take time.

Summary

As a result of all of this information, not much has changed except that legislation in various countries might make the supplement manufacturers more accountable. The principle of strict liability still applies so athletes must be extremely careful when choosing nutritional supplements. It doesn’t matter if the athlete knows if a banned substance is present in their nutritional supplement or if they know their supplement has been contaminated. Presence of sufficient levels of prohibited substances will result in either a temporary suspension or permanent ban from competition.

[Mop]

Nutritional supplementation has always generated strong interest in its promise to enhance athletic performance. No natural supplementation has generated as great an interest and commotion as creatine. Strangely enough, creatine supplementation is not new. Chanutin (1926) showed that it was possible to increase ones storage capacity of creatine by simply ingesting it orally. This information then led to a plethora of investigations to determine such things as creatine’s influence on performance, muscular size, recovery and muscle soreness. Today, the question is no longer "Does creatine work?" but instead, "What is the best way to take creatine for my goals?" This article will outline recent information regarding the optimal creatine supplementation methods to improve performance and size.

Creatine Study 1

Noonan D, Berg K, Latin RW, Wagner JC, Reimers K.

Effects of varying dosages of oral creatine relative to fat-free body mass on strength and body composition.

Journal of Strength and Conditioning Research, 12(2); 104-108, 1998.

The Experiment

The purpose of this study was to compare different dosages of creatine monohydrate on body weight, fat-free mass (underwater weighing), muscular strength (bench press), speed (40-yard dash) and explosive power (vertical jumps). Thirty-nine male college football players, age 18-25, performed 8 weeks of training; all were split into 3 groups. Group 1 received a placebo (sugar) drink, Group 2 received 100mg/kg/FFM (» 9 grams/day), Group 3 drank 300 mg/kg/FFM (» 26 g/day) in a sugar drink. Creatine has little taste to it and cannot be detected in a sugar drink, so subjects could not tell if they received just a sugar drink or the creatine.

The Results

Groups 2 and 3 improved their bench press by 5.78% and 5.8% respectively, while Group 1 did not show significant improvements (only a 1.29% increase). All three groups showed improvements in speed (40 yard dash). No changes were observed for all 3 groups regarding body weight, fat-free mass and vertical jump. Although changes, were not statistically significant, there were greater increases in body weight and FFM in Groups 2 & 3 compared to Group 1, suggesting that creatine supplementation does have some affect on these variables.

Creatine Study 2:

Vincent GK, Jenkins DG.

Effect of Oral Creatine Supplementation on Near-Maximal Strength and Repeated sets of high-intensity Bench press exercise.

Journal of Strength and Conditioning Research, 12(2); 109-10115, 1998.

The Experiment

Researchers compared the effects of creatine on body weight, body fat, bench press in eighteen male power-lifters, (average 27 years of age). All were preparing for a competition 8 weeks away. The study was done for 26 days during the hypertrophy phase of the lifters periodized training. The experimental group consisted of nine subjects who were given a creatine/sugar drink combination, while the placebo group consisted of nine subjects that received only the sugar drink. The subjects initially ingested 20 gms/day for 5 days (5 gram dose, 4 times per day) and then went to a maintenance dose of 5 gms/day for the last 21 days. The 3 RM bench press and Most-Reps-Performed (over 5 sets) were the methods used to assess strength changes; skinfolds and the Lifesize computer software (Nolds Sports Scientific, Sydney, Australia) were used to estimate Lean Body Mass changes.

The Results

Both groups improved their bench press. The creatine group improved strength performance by 8.9 kg (+/-) 3.3 kg and the placebo group increased by 2.5kg (+/-) 0 kg. This suggested that the resistance training program alone was effective in improving performance, however, the group who ingested the creatine had a better lifting performance. In addition, the creatine group was able to perform more repetitions (40% more) over the course of 5 sets than the placebo group (only 7% more). This result alone suggested that creatine may have a strong influence on the bodies ability to recover more quickly during a workout and therefore allow the athlete to perform more work during the exercise session. Body mass (as measured by weight) did increase more in the creatine group, however, since no intra-muscular measurements (biopsies), cross-sectional area or body composition itself were done, the researchers believe that most of the body weight increase was likely to be fluid retention within the cells (cell swelling).

Practical Application

Creatine supplementation appears to work on improving activities that involve anaerobic short-term, high-intensity training, and have no influence on aerobic performance. It would appear that creatine is also a safe, effective aid in helping athletes recover sooner and therefore train harder per session. This form of supplementation may prove useful for those individuals wishing to improve strength and body mass. Presently, creatine does not appear to increase muscle mass in the early stages of training, however, long-term lean tissue increases may result from the increased intensity and volume of training.

Andre’s Notes

Caution should be used when interpreting these or any other similar experimental results. There are many variables that need to be controlled for when performing studies involving supplementation. Variables such as training volume, training experience, initial creatine levels and absorption rates/quantities can all affect results. Experiments are difficult to perform and have many potentially hidden negative influences that can’t be controlled for and can change the end results. For example, half the subjects of the Noonan study had the flu during the post-testing week. No urinary creatine was measured, which would have offered insight regarding absorption quantities (i.e. how much of what is ingested is absorbed or lost). Also, many earlier studies that have shown little creatine influence used low (2-3g/dl) dosages without an initial high-dose loading week. Most studies (pro/against creatine) used small subject sample sizes (e.g. 6 -12/group); in research, sample sizes that are over 100-1000 per group tend to be considered more statistically powerful.

The only time that we can confidently say that a supplement is truly effective or ineffective is when it goes through years of experimental research by many different researchers using a variety of approaches that then shows a trend of similar results. Until then, it would be wise to view all experimental results involving supplementation with cautious optimism. Don’t just go out a buy a product because one study says it works. In terms of safety, there appear to be no adverse side effects with creatine supplementation, other than intestinal upset (usually for those who have taken more than is generally recommended).

That said, here is a brief synopsis of the most recent creatine supplementation recommendations:

use creatine monohydrate supplementation along with a sugar drink to facilitate loading (one needs to take almost twice as much creatine citrate to match the effects of monohydrate)
adjust the dose according to your body weight (maintenance approx.100mg/kg)
load for no more than one week (300mg/kg/day) and then go on to a maintenance cycle (100mg/kg/day)
stop every month or so, to stimulate the body’s own homeostatic production of creatine
take your full day of creatine intake in smaller amounts over the course of the day
always ensure that you ingest your creatine immediately after your workout
Happy Training!