1
Q
What is an ergogenic aid?
A
- Ergo = “work”
- Genic = “to generate”
- Substances, products, or techniques that enhance physical performance
- May take many different forms
- Dietary supplements are only one form of ergogenic aid
- Many ergogenic aids are or may contain prohibited substances per World Anti-Doping Agency (WADA) Code
2
Q
What are the types of ergogenic aids? Describe them and give examples
A
3
Q
What is a nutritional supplement?
A
- Vitamins
- Minerals
- Herbs or other botanicals
- Amino acids
- Other dietary sources
- Any concentrate, metabolite, constituent, extract, or combination of these ingredients
- Not all nutritional supplements have an ergogenic effect
4
Q
Is the dietary supplement market big?
A
YES! The global dietary supplement market in 2019 was estimated at ~124 billion in sales worldwide (not even looking at pharmacological agents)
5
Q
What are the top supplements used by athletes?
A
- Multivitamins
- Vitamin C
- Protein products
- Sports drinks
- Sports Bars
- Energy drinks
6
Q
How many athletes use dietary supplements?
A
58-62% use some sort of dietary supplement. Costly!!
7
Q
How should you council an athlete who has supplement use?
A
Make it a safe, open conversation. Want to know what they are taking and not be condescending!
8
Q
How are sport supplements regulated by the government?
A
- Government of canada is responsible for protection of the public
- Through legislation, Health Canada and the Canadian Food Inspection Agency are given the authority to limit the sale of products, including drugs, food products, natural health products, and health supplements
- All Canadians are subject to federal legislation that controls the sale of many ergogenic aids
- Athletes are also subject to the WADA code that limits the use of numerous ergogenic aids to prevent cheating and harm to athlete health
9
Q
What is WADA and why was it established?
A
- The world anti-doping agency
- Foundation initiated by the International Olympic Committee
- Established to promote, coordinate, and monitor the fight against drugs in sports
10
Q
What does WADA do?
A
- Develops the policies and procedures for limiting the use of performance enhancing drugs and other strategies (e.g. banning masking agents like glycerol)
- The WADA code
→ Athletes in most sports are governed by the WADA Code either directly or indirectly
→ Athletes who violate the WADA Code can be banned from competition
11
Q
What can positive drug tests result in?
A
- Loss of scholarship
- Competition bans
- Stripping of medals
- Loss of sponsorship
- Monetary fines
12
Q
What are the three main safety issues with taking supplements?
A
- Supplements do not need to be proven safe or effective before entering the market (Not enough oversight)
- Good manufacturing practices are difficult to implement, monitor, and enforce (especially on a global scale)
- Funding to investigate complaints about sport supplements is very limited and enforcement is challenging
13
Q
How are conventional sport products regulated? What does this mean?
A
- Conventional sport products are typically regulated as “foods” not “drugs”
- Fluid replacement beverages, sport gels, protein powders, and meal replacement drinks
- Should have a nutrition facts panel or nutrient information on the label
- Burdon of proof of efficacy is lower than that required for pharmaceutical products
14
Q
How are non conventional sport products regulated and what are they?
A
- supplements, bars, gels, sport “beans”, tablets and capsules, amino acids preparations, energy drinks, and vitamin-mineral enhanced waters
- Regulated as dietary supplements or licensed natural health products
- Will have a natural health product number (NPN) or a Drug Identification Number (DIN) on the label if they are legally approved for sale in Canada
15
Q
Why should you still be careful with nutritional ergogenic aids that have passed regulation?
A
- Regulation of nutritional ergogenic aids and supplements in Canada is very loose
- Unapproved, ineffective products can still be sold!
- Even approved products are not risk free:
→ Can be toxic if taken in excess (e.g. iron)
→ Can interact with other supplements, medications, and foods - Remember, natural does not mean safe
16
Q
Define Off-Label Use
A
- The prescription or use of a drug or NHP for a purpose that has either not been approved by Health Canada (drugs) OR is being used for a purpose that is not the stated condition of use (NHP)
- E.g. Human growth hormone is being taken to promote muscle gain in an otherwise healthy adults
17
Q
Why is off-label use dangerous?
A
- There can be no guarantee of safety or efficacy when a drug or NHP is used as off-label
18
Q
What is Omnitrope used for? What is this an example of?
A
- Licensed for sale in Canada for the treatment of HGH deficiencies
- It is not licensed for use as an adjunct for sport training in athletes
- Growth hormone is in the category of Anabolic Agents on the WADA prohibited list and is prohibited at all times and for all levels of athletes, including elite, junior, and masters-level athletes
- This unapproved use of an approved drug is an example of off-label use
19
Q
Will the label on a sport supplement always be correct?
A
NO - subject to undeclared ingredients and contamination
- The addition of undeclared ingredients to seemingly harmless sport supplements is relatively common
- E.g. Anabolic steroids added to “muscle gain” products
- This is a concern for eite athletes because undeclared ingredients in a supplement may lead to a positive doping test
20
Q
Give an example of an athlete using a supplement that had undeclared ingredients/contamination
A
- Jessica Hardy (US Swimmer) was projected to win gold medal at Beijing 2008
- Took Advocare Arginine Extreme for strength and muscle mass gain. Looked up product, consulted with nutritionist/psychologist, contacted company
- Failed drug test bc of clenbuterol (anabolic steroid) that is used for veterinary medication for asthma in horses
- Clenbuterol from contamination
- Banned from 2008 Olympics and had 1 year suspension
21
Q
Are undeclared ingredients common?
A
Yes! Recalls of 65 dietary supplement products sold on bodybuilding.com because of undeclared ingredients. (US FDA partnership)
22
Q
Why would companies add undeclared ingredients?
A
- Without the addition of undeclared ingredients there is no effective outcomes. Nobody will buy the product if it doesn’t work
- E.g. Ultra Mass Stack - build slabs of lean hard muscle, increase musccle mass, strenght, and sex drive. Undeclared product = Trenbolone
23
Q
How often are NEA contaminated?
A
- 2001 IOC international study - 15% of 634 non-hormonal supplements have undeclared steroids
- 2007 USA study - 25% of 58 US supplements have prohibited steroids and 11% contained undeclared or prohibited stimulants
- 2008 UK study of 152 supplements - 10% contaminated with steroids or supplements
24
Q
What is inadvertent doping?
A
- Ingestion of substances that unbeknownst to the athlete can cause a positive test for doping
- E.g. creatine supplement containing undeclared anabolic steroids
25
What are the causes of inadvertent doping?
- Ignorance of what substances are banned
- Names in ingredients list are not recognized
- Manufacturer may not list all ingredients (Off-label)
- Product could be contaminated
26
What is strict liability?
- Cornerstone of WADA Code, strictness depends on governing body (NCAA less strict than WADA)
- Athletes are responsible for any prohibited sustance that may be found in their sample (regardless of how it got there); and
- Athletes who test positive for a prohibited substance, may face sanctions **regardless of how the prohibited substance got into their body**
- Athletes must declare medications they are using and can be exempt on a medical need
27
Give an example of strict liability with an athlete
- Silken Laumman (Canadian rower) tested positive for banned stimulant at 1995 Pan Am games, after taking a over-the-counter cold remedy
- Her and her 3 teammates stripped of medals
28
What is the controversy with Kamila Valieva?
- Russian figure skater tested positive for the banned metabolic modulator, trimetazidine at the 2022 Winter Olympic games
- Trimetazidine increases cardiac output, improves oxygenation, and reduces fatigue associated with a higher heart rate
- The IOC and Xourt of sport arbiration allowed her to compete at the 2022 Winter Olympics and to retain the gold medal she won in the skating teams competition
- This violates strict liability and remains a controversial decision
29
Are natural health products safer?
- Not necessarily safer or better
- People think natural is better and more pure and superior likely because and can effect their health
- Money people spend on these NHP could be used for other things like massage, coaching, a dietitian
30
What issues may occur due to NEA?
- cardiovascular issues
- Renal issues
- Hepatic Issues
- Seizures
- Medication interactions
- Exceeding micronutrient ULs
31
What are the cardiovascular issues associated with NEA?
Hypertension, cardiac issues and death have all been associated with dietary supplement use
32
What are the renal issues associated with NEA?
- Kidney damage can occur, especially with supplements that contain herbs (toxic)
33
~________ of drug induced liver injuries are from dietary supplements
20% - This is an example of a hepatic issue
34
Why are seizures a concern with NEA?
- Acute neurotoxicity can occur after ingestion of dietary supplements with sympathomimetic properties (e.g. Yohimbe Extract - known to be neurotoxic)
35
Why are medication interactions a concern with NEA?
- Athletes are not always truthful with healthcare providers when discussing supplements. There can be potential interactions between supplemental ingredients and medications
36
What are Tolerable Uppler limits?
UL are the highest level of nutrient intake that is likely to pose no risk of adverse health effects for almost all individuals in the general population. As intake increases above the UL, the risk of adverse effects increases
37
Should we be more worried about water soluble or fat soluble vitamins?
- Excess intake of the water soluble vitamins is less of a concern because they are generally excreted in the urine when in excess
- In some instances, supplementation with certain water soluble vitamins can be toxic
- Fat soluble vitamins as well as minerals are not easily cleared by the body and can become toxic at high levels
- Symptoms of toxicity include but are not limited to: changes to vision, bond and joint pain, skin changes, muscle weakness, diarrhea, increased risk of bleeding, skin flushing, heart arrythmias
38
What is the World Anti-Doping Agency? What does it do?
- WADA is a foundation initiated by the International Olympic Committee
- Established to promote, coordinate, and monitor the fight against drugs in sports
- Develops the policies and procedures for limiting the use of performance enhancing drugs and other strategies
- Athletes in most sports are governed by the WADA Code either directly or indirectly - must follow the prohibited list
39
What is on the WADA prohibited at all times list?
- Anabolic agents
- Peptide hormones, growth factors, related substances, or mimetics
- Beta-2 agonists
- Hormone and metabolic modulators
- Diuretics or masking agents
40
What are the types of anabolic agents prohibited by WADA at all times?
- Anabolic androgenic steroids
- Other anabolic agents
41
What are the types of peptide hormones, growth factors, related substances, or mimetics prohibited by WADA at all times?
- Erythropoietins (EPO) and agents affecting erythropoiesis
- Peptide hormones and releasing factors
- Growth factors and growth factor modulators
- These all suppress estrogen and increase testosterone
42
What are the types of hormone and metabolic modulators prohibited by WADA at all times?
- Aromatase inhibitors
- Selective estrogen receptor modulators
- Anti-estrogenic substances
- Agents preventing activin receptor IIB activation
- Metabolic modulators
43
What are the anabolic agents prohibited in competition?
- Stimulants - specified and non-specified ingredients
- Narcotics (pain relievers)
- Cannabinoids - all natural and synthetic except cannabidiol (legal status of cannabinoids in any state/country does not impact its standing as a WADA prohibited substance)
- Glucocorticoids
44
Why was Sha-Carri Richardson banned?
American sprinter, Sha-Carri Richardson was banned from competition at the Tokyo Olympic games owing to a positive doping test result for THC, the psychoactive compound in marijuana
45
What are the additional resources athletes can look at?
- NIH Office of Dietary Supplements
- Medline Plus for herbs and supplements
- Natural Medicine Database
46
What is the position of Canadian Centre for Ethics in Sport
"The CCES believes that the use of most supplements poses an unnaceptable risk for athletes and their athletic career. Ultimately, athletes are responsible for any prohibited substance that may be found in their sample; this is known as strict liability. If athletes who use supplements test positive for a prohibited substance, this can result in a violation being declared, regardless of how the prohibited substance got into their body. Serious sanctions may be imposed"
47
What is the Canadian Centre for Ethics in Sport?
Canadian WADA affiliate
48
How can you determine if athletes truly need a supplement?
- Is there evidence of them needing it, or adverse reactions?
- Is there allergies or a diagnosis for needing it?
- Go through the following diagram and see if it is a yes or no
49
What is jurisprudence for sports dietitians when it comes to nutrition supplements?
- There is an obligation to protect the public when offering nutrition recommendations
- The use of dietary supplements is an ever-changing and ever-challenging aspect of sports nutritition. Sports dietitians should be open-minded skeptics
- Sport dietitians must take great care to consider the pros and the cons recommending or appearing to recommend nutritional ergogenic aids to athletes
→ There are some supplements that are safe but not effective
→ There also may be some supplements that are effective but not safe, and these pose serious risk-benefit questions that ultimately can only be answered by athletes
50
What are the red flags of dietary supplements?
- Big claims
- Promise quick and unrealistic results
- "Alternatives" to prescription drugs
- Proprietory blends (doesn't share everything in the blend because its a 'secret')
51
What are the recommendations for 3rd party testing?
- Certifying program and labs accredited to International Standard Organization (ISO)17065
- Certifying program controls their certification mark
- Impartiality and written conflict of interest policies
- Methods to revoke certification and inform consumers
- Complaint and appeals process for clients
- Program certifies against NSF/ANSI 173 - NSF/ANSI 173 is the standard for evaluating dietary supplements
- Testing programs that certify ingredients, batches of products, and/or manufacturing facilities
- Athletes or athletic staff can send samples to independent labs for testing
52
What is an example of a product that has been NSF certified for sport?
- Products do not contain any of the approximately 270+ substances banned by major athletic organizations
- The contents of the supplement actually match what is printed on the label
- There are no unsafe levels of contaminants in the tested products
- The product is manufactured at a facility that is GMP registered and audited twice annually for quality and safety by NSF International
53
What should be certified for athletes to have proper informed choice when it comes to their nutritional products?
- Certified finished products - full manufacturing audit and regularly tested for a wide variety of WADA banned substances
- Certified raw ingredients - full manufacturing audit and every batch is pre-market tested for a wide variety of WADA banned substances
- Certified sites - assurance that facilities are equipped with adequate critical control procedures
54
What is the purpose of hydroxycut?
Weight management, increased energy
55
What are the ingredients in hydroxycut?
- C. canephora robusta
- Vitamin D, B vitamins, cardamom, plum, apple cider vinegar
- Caffeine
- Chlorogenic aid - polyphenol compound with antioxidant properites
56
What is the dosing and cost of hydroxycut?
- Dosing: 1-2 capsules/day, containing 100-200mg caffeine (similar to 1-2 cups of coffee)
- Cost: 19.99 for 30 capsules
57
What is the purpose of ephedra?
- Hydroxycut has been found to contain ephedra
- Subject to a "threshold limit", and is allowed for athletes as a "therapeutic use exemption"
- Banned in 2004 and 2009. Used in TCM to treat cold and flu sumptoms) need to be aware of this
58
What is the mode of action for hydroxycut?
- Blocks adenosine (neurotransmitter) which reduces feelings of pain/exertion
59
Does hydroxycut have a lot of evidence behind it?
Yes! Grade A evidence according to Australian Institute of Sport (AIS)
60
Is hydroxycut safe to use?
- CVD concerns: increased heart rate and blood pressure
- Caffeine not prohibited but under monitoring content. Large doses can cause insomnia
- Caffeine = grade A substance
61
What is the purpose/benefit of Nitric oxide (Nitrate)?
- Chronic/acute beetroot juice concentrate has been shown to improve the oxygen cost of energy, oxygen capacity, and overall sport performance
- Dietary nitrate can increase production of nitric oxide, which may help improve oxygen supply to muscles during exercise (blood pressure, blood flow, muscle contraction)
62
What is the dosing and cost of nitric oxide?
- Dosing: 350-500mg consumed 2-3 hours prior to activity or 6-8mmol daily several days prior to competition
- Cost: $32 Canadian for 5-8 doses of beetroot juice concentrate (70mL, 40mmol)
63
What are high sources of nitrates?
Usual diet 60-120mg/day of nitrates
64
How can aerobic performance influence efficacy?
Highly trained endurance athletes may not benefit from nitrates as much as less trained athletes
65
Is nitric oxide prohibited?
- Not prohibited under WADA - found naturally in foods (vegetables and fruit) and used as a preservative in meat products
66
What is the evidence for nitric oxide?
- Recent studies suggest nitrate supplementation can improve muscle power, sprint, and high-intensity intermittent exercise
- Not recommended by RDs - more benefits from training/diet alone
- Relatively expensive!
- Chronic use has not been studied, abdominal and GI discomfort, limited studies in athletes especially female
67
What are the ingredients in Branch chain amino acids (BCAAs)?
- L-leucine, L-Valine, L-Isoleucine in ALLMAX
- B-hydroxy B Methylbutyrate (HMB). Free acid and calcium form in B1
68
What is the dosing and cost of BCAA Allmax and B1?
ALLMAX BCAA: dosing 3-10g/day and $44.99/80 5g servings
B1: Up to 3g/day for 2 months (no safety concerns) and $49.99 for 30 3g servings
69
What is the purpose/benefit of BCAAs?
Inhibit muscle protein breakdown and increase muscle protein anabolism in exercise. Metabolite of leucine associated with increased muscle strength and development
70
Are BCAAs prohibited by WADA?
- ALLMAX: not prohibited by WADA - not a regulated product (could be subject to off label ingredients and contamination)
- B1: Not prohibited under WADA, often a vector of anabolic steroids, which are prohibited (not worth the reward)
71
Is there evidence to support BCAAs?
Little evidence, training alone may provide more benefit; AIS Grade C
72
What is the function of tribulus terrestris?
- Increase testosterone levels and muscle mass
- Increase testosterone/luteinizing hormone, anti-oxidant, anti-inflammatory, reduce BP/cholesterol
73
What is the evidence of tribulus terrestris?
- Not well studied, no concerns up to 3.21 mg/kg/d for 8 weeks
- Grade D: should not be recommended
74
What are the ingredients of tribulues terrestris?
Plant from traditional chinese medicine with over 70 compounds, including steroidal saponins and flavonoids
75
What is the dosing and cost of tribulus terrestris?
- Dosing: 3-6g root powder per day
- Cost: $29.99 90 3g servings
76
Is tribulus terrestris banned?
Banned (prohormone) high risk contamination, should not be used by athletes
77
What is the purpose of whey protein?
- Widely used in sport, known to help maintain and build muscle mass, improve recovery, increases satiety
78
What are the ingredients of whey protein?
- Whey protein concentrate (70%)
- Isolate (80%)
- Hydrosylate (90%) - faster absorption and uptake
- Soy lecithin
- % = protein per weight (measuring purity) when purity increases so does the cost
79
What is the dosing and cost of whey protein?
- Dosing: 20-30g
- Cost: $74.99 for 30 servings (each serving 500kcal)
80
Is Whey protein prohibited?
Not prohibited under WADA
81
What is the evidence of whey protein?
- No further benefit seen compared to eating more than 0.3g protein/kg body weight per meal or 1.2-1.6 g/kg/day protein
- Grade A
82
What is the purpose of glutamine?
- Increases protein synthesis, a conditionally essential amino acid
- Increase protein production and metabolism, improve recovery time
83
What is the ingredient of glutamine?
L-glutamine (easily absorbed in animal protein sources)
84
What type of diet may glutamine be beneficial for?
Vegetarian/vegan diet
85
What is the dosing and cost of glutamine?
- Dosing: 5-45g/day in divided 5g doses throughout the day
→ 3-6g/day in usual diet
- Cost: $39.99 for 120 750mg capsules
86
Is glutamine prohibited?
Not prohibited by WADA
87
What is the evidence for glutamine?
- Few studies found an improvement in sports performance
- No effect on muscle performance, body composition, or muscle protein degradation
- AIS grade C - need more research
88
Why do athletes want to take glutamine when under stress?
The body cannot synthesize glutamine from essential amino acids when under stress so becomes essential. Not much evidence to support this, need more evidence for general health practices (e.g. burns)
89
What are the ingredients for carnitine?
- L-carnitine, L-tartrate, often found in fat loss supplements
90
What is the dosing and cost of carnitine?
- Dosing: 2.4-3g L-carnitine, or 2-4g L-carnitine with L-tartate
- Cost: $39.99 for 120 doses of 735mg capsules
91
What is the risk with carnitine?
Should be avoided due to high contamination risk with banned substances
92
What is the proclaimed purpose/benefit of carnitine and who is it recommended for?
- Increase fat oxidation, reduce lactate accumulation, antioxidant, increase endurance
- Endurance athletes or sports over 30 minutes and heavy resistance training
- Vegetarian and vegan can benefit
93
What is the evidence for carnitine?
- few studies completed, suggest high co-ingestion of CHO for >12 weeks to increase uptake to muscle - eat during breakfast/supper
- AIS, grade B (supplementation should not occur before talking to a dietitian)
94
Of the supplements we talked about in class, which ones are the recommended ones?
NUTR 380
flashcards
Decks in class (12)
# Cards
-
Introductory Module - Role of the Sport Dietitian56
-
Eating Disorders in Athletes41
-
Module 1: General Nutrition Principles and Bioenergetics/Energy Systems During Exercise77
-
Module 2: Macronutrient Recommendations for Athletes86
-
Module 3: Energy Balance and Weight Management for Athletes62
-
Module 4: Anthropometric Measures and Body Composition in Athletes84
-
Module 5: Vitamins and Mineral Recommendations for Athletes and Exercise52
-
Module 6 - Fluids and Hydration71
-
Module 7 - Nutritional Ergogenic Aids94
-
Module 8 - Sport Nutrition Assessment and Nutrition Care Plan for Athletes83
-
Sweat Rates33
-
Module 9 - Nutrition for Specialized Athlete Groups79
