Supplement

Question 1

Dietary supplements

Answer 1

are widely used by athletes and fitness enthusiasts alike.

Question 2

Trainer Academy Scope of Practice

Answer 2

prohibits recommending specific dietary supplements.

Question 3

Dietary Supplementation

Answer 3

A dietary supplement is a product that is intended to supplement the diet, and that contains one or more of the following: vitamins, minerals, herbs or other botanicals, amino acids, or other dietary substances for use by a human to supplement their diet by increasing their total dietary intake or concentrates, metabolites, constituents, extracts, or combinations of these ingredients.

Question 4

Dietary Supplement Regulation

Answer 4

The regulation of Dietary Supplements (DS) is overseen by two government agencies: the Food and Drug Administration (FDA), and the Federal Trade Commission (FTC).

Question 5

FDA

Answer 5

is the major agency in the United States food supply that ensures food safety, monitoring, and inspection of animal products, sanitation, proper food labeling, food additives, genetically modified foods, and pesticides.

Question 6

FTC

Answer 6

regulates advertising, including infomercials, for dietary supplements.

Question 7

Dietary Supplement Health and Education Act (DSHEA)

Answer 7

was enacted to prohibit dietary supplement manufacturers and distributors from making false claims on supplement labels, to prohibit the manufacture and sale of adulterated dietary supplements, and categorized dietary supplements as food instead of drugs or dietary additives.

Question 8

Dietary Supplement Labeling Claims

Answer 8

Among the claims that can be used on dietary supplement labels, there are three categories of claims defined by FDA regulations: health claims, structure/function claims, and nutrient content claims.

Question 9

Health Claims

Answer 9

describe the relationship between a substance (whether a food, food component or dietary ingredient) and a disease or health-related condition.

Question 10

Authorized Health Claims

Answer 10

must be supported by a significant scientific agreement that the proclaimed benefit of a food or food component on a disease or health-related condition is true.

Question 11

Qualified Health Claims

Answer 11

have significant scientific agreement supporting the claim however there is insufficient evidence to approve them as health claims.

Question 12

Structure-Function Claim

Answer 12

describe the role of a nutrient or dietary ingredient intended to affect the normal structure or function of the human body.

Question 13

Nutrient Content Claims

Answer 13

describe the level of a nutrient in food using terms such as free, high, and low, or they compare the level of a nutrient in a food to that of another food, using terms such as more, reduced, and light.

Question 14

Supplements Versus Whole Foods

Answer 14

The skyrocketing sales and use of supplements in the United States continue to expand at a rapid pace.

Question 15

Target Population

Answer 15

The literature has made it clear that the consumers of dietary supplements are mostly middle-aged and older adults.

Question 16

Populations Who May Benefit from Supplements

Answer 16

Certain special populations may benefit from specific supplementation.

Question 19

Toxicity

Answer 19

While it is difficult for food to cause nutrient imbalances or toxicities, supplements can easily lead to toxicity and adverse effects when routinely ingested in higher doses. The extent of supplement toxicity in the United States is unknown, but many adverse events are reported each year from overconsuming vitamins, minerals, essential oils, herbs, and other supplements. Several committees, for example, the European Food Safety Authority (EFSA) and Institute of Medicine (IOM) have set tolerable upper intake levels (ULs) to prevent micronutrient toxicities.

Question 20

DRI Tolerable Upper Intake Levels

Answer 20

The DRI Tolerable Upper Intake Levels define the highest intakes of dietary vitamins and minerals that appear safe for most healthy people.

Question 21

Estimated Average Requirement (EAR)

Answer 21

The EAR assesses the average daily nutrient intake that is estimated to meet the requirements of 50% of the healthy individuals in a group.

Question 22

Dietary supplement toxicity

Answer 22

Dietary supplement toxicity is the umbrella term that encompasses vitamin overdosage, vitamin overload, and hypervitaminosis.

Question 23

Vitamin overdosage

Answer 23

Vitamin overdosage is obtained only upon administration of high doses of a vitamin, while vitamin overload may originate from a variety of factors.

Question 24

Hypervitaminosis

Answer 24

Hypervitaminosis is a condition of abnormally high blood levels of a specific vitamin, generally, vitamin A and D, that either manifests as acute or chronic and is characterized by specific symptomatology.

Question 25

Megadoses of fat-soluble vitamins

Answer 25

Megadoses of fat-soluble vitamins (A, D, E, K) can easily cause toxicity and should be taken with caution, particularly for individuals with medical conditions and pregnant women.

Question 26

Vitamin A toxicity

Answer 26

Vitamin A toxicity is most notable and can cause nausea, vomiting, headache, dizziness, and blurred vision.

Question 27

Folic acid overdose

Answer 27

While water-soluble vitamin toxicity is rare, folic acid overdose is common and can cause adverse events when taken in excessive doses, generally manifesting as reversible neurological complications.

Question 28

Iron toxicity

Answer 28

In the case of iron toxicity, observable side effects include coma or low blood pressure, which can sometimes be fatal.

Question 29

Iron overdoses

Answer 29

Iron overdoses can have long-term consequences on the intestines and liver, including intestinal scarring and liver failure.

Question 30

Calcium toxicity

Answer 30

Calcium toxicity is not as fatal as iron, but high calcium levels can cause serious heart rhythm disturbances, as well as kidney stones and damage to kidney function.

Question 31

Safety

Answer 31

Proving supplement safety is one of the many risks that the FDA bears under the DSHEA.

Question 32

Dietary Supplement and Nonprescription Drug Consumer Protection Act

Answer 32

In 2006, the Dietary Supplement and Nonprescription Drug Consumer Protection Act was signed into law, requiring mandatory reporting by manufacturers and retailers of known serious adverse events (AEs) related to dietary supplements and over-the-counter (OTC) medications.

Question 33

Common supplements with health and safety concerns

Answer 33

The most common supplements with health and safety concerns are those used for weight loss, performance enhancement (ergogenic aids), and sexual dysfunction.

Question 34

Adverse events among young adults

Answer 34

According to the FDA, these supplements have the highest risk of contamination and adulteration with unapproved dietary ingredients and pharmaceutical drugs.

Question 35

Choking on micronutrient pills

Answer 35

For adults 65 and older, adverse events were mostly attributed to choking on micronutrient pills.

Question 36

Banned dietary supplements

Answer 36

Up to date, only two dietary supplements have been banned by the FDA, Ephedra sinica in 2004, and dimethylamylamine (DMAA) in 2013, as being linked to cardiovascular toxicity and death.

Question 37

N-acetyl-L-cysteine (NAC)

Answer 37

More recently, the FDA announced that N-acetyl-L-cysteine (NAC), used for chronic respiratory conditions, fertility, and brain health, is no longer included in the definition of a dietary supplement.

Question 38

Office of Dietary Supplements (ODS)

Answer 38

The purpose of this entity is to increase awareness of dietary supplements, provide credible information to the public, and alert the public on current warnings and recalls as well as consumer tips for buying and taking dietary supplements safely.

Question 39

Dietary Supplement Label Database

Answer 39

On the government website, consumers can find basic consumer information and a Dietary Supplement Label Database of dietary supplements used in the United States.

Question 40

Reporting adverse reactions

Answer 40

In the event of a suspected serious health-related reaction or illness associated with a dietary supplement, alert a medical provider or healthcare professional knowledgeable in nutrition.

Question 41

Multivitamin & Mineral Supplements

Answer 41

Multivitamin/mineral Supplements (MVM) have gained public attention over the years and are considered one of the most popular supplements on the market.

Question 42

Commonly used supplements

Answer 42

In the years 2005–2012, the ten most popular of these, in order of decreasing prevalence of use, were vitamin D, vitamin C, calcium, cobalamin, vitamin E, folic acid, pyridoxine, niacin, vitamin A, and riboflavin.

Question 43

MVMs and chronic disease prevention

Answer 43

To date, there is no clear unanimity suggesting that MVMs help prevent chronic disease.

Question 44

Contraindication in MVMs use

Answer 44

The biggest contraindication in MVMs use is that they have no standard scientific, regulatory, or marketplace definitions.

Question 45

Botanical and herbal supplements

Answer 45

Botanical and herbal supplements are dietary supplements that are increasingly popular among the public.

Question 46

Common herbs and drug-nutrient interaction

Answer 46

In general, most of the common herbs used in the United States do not pose a risk for a drug-nutrient interaction (DNI).

Question 47

St. John’s wort

Answer 47

Out of the most commonly used herbal supplements, St. John’s wort is the most problematic and has been shown to reduce the efficacy of many drugs, including antiretrovirals for HIV, antirejection medications for organ transplants, oral contraceptives, cardiac medications, chemotherapy, and cholesterol medications.

Question 48

Performance-enhancing substances (PES)

Answer 48

Performance-enhancing substances (PES) are any substances taken in non-pharmacologic doses specifically used to improve athletic performance and alter one’s appearance toward a more muscular and lean body.

Question 49

Prevalence rates of PES

Answer 49

Among college athletes and nonathletes, prevalence rates of PES are also relatively high.

Question 50

Cognitive function enhancements

Answer 50

More recently, PES has become increasingly popular among adolescents and young adults and there is a growing trend of using PES as cognitive function enhancements for academic performance, attention, and memory, specifically through the use of neuroactive substances.

Question 51

Common legal PES

Answer 51

The most common legal PES that will be discussed in this chapter include: creatine, caffeine, protein and branched-chain amino acids (BCAAs), and beta-alanine.

Question 52

Pre-workout supplements

Answer 52

Pre-workouts are supplements ingested before an exercise session or sporting event intended to increase mental focus, endurance, blood flow, strength, power, aerobic and anaerobic capacity, or overall perceived increase in energy level.

Question 53

Beta-Alanine

Answer 53

Beta-alanine (β-alanine) is a non-essential amino acid commonly found in meat, poultry, and fish.

Question 54

Caffeine

Answer 54

Caffeine is a central nervous system stimulant ubiquitously found in a variety of food and beverages such as coffee, tea, energy drinks, pre-workout supplements, over-the-counter diet pills, and medications.

Question 55

Creatine

Answer 55

Creatine, usually sold as creatine monohydrate is an amino acid produced.

Question 56

Creatine

Answer 56

Creatine, usually sold as creatine monohydrate is an amino acid produced by arginine and glycine, two non-essential amino acids. Approximately 2 grams of creatinine can be obtained daily from dietary sources such as meat and fish.60

Question 57

Post-Workout Supplements

Answer 57

Protein as an ergogenic aid can be found in many foods, from animal and vegetable whole foods, powders, shakes, gels, and bars. Powdered protein can come from various sources, including eggs, milk (e.g., casein, whey), and plants (e.g., soybeans, peas, hemp). Some protein powders can contain protein from multiple sources (e.g., plant-derived).

Question 58

Branched Chain Amino Acids (BCAAs)

Answer 58

Branched chain amino acids (BCAAs) include leucine, isoleucine, and valine, three essential amino acids that are chemically structured with a branch side-chain that form one-third of the total protein in the body74 and are the only amino acids metabolized by the skeletal muscles.75

Question 59

Performance-Enhancing Drugs (PED)

Answer 59

Performance-Enhancing Drugs (PED) are pharmacological substances that are commonly used by competitive, professional, Olympic athletes, and non-athlete weightlifters to improve performance, muscle recovery, and prevent nutritional deficiencies.

Question 60

Androgenic-Anabolic Steroids

Answer 60

Androgenic-anabolic steroids (AAS) are synthetic derivatives of the male hormone testosterone. Testosterone is a male sex hormone and the most common androgen that helps promote the development and maintenance of male sex characteristics.

Question 61

Human Growth Hormone

Answer 61

Human growth hormone (HGH) is a naturally occurring metabolic hormone secreted by the pituitary gland. In healthy adults, HGH enhances carbohydrate and fat metabolism, helps to maintain sodium balance, and stimulates bone and connective tissue turnover.

Question 62

Erythropoietin

Answer 62

Erythropoietin (EPO) is a glycoprotein hormone that regulates red cell production and is produced by both the kidney and the liver. In adults, the kidneys are the dominant source of circulating erythropoietin, although the liver is an important contributor to erythropoietin production in the fetal and perinatal periods.

Question 63

Legality Issues and Regulations

Answer 63

The use of PEDs is banned in major sports organizations that regulate sporting competitions to protect the health and well-being of athletes and ensure fair play in Olympic sports.

Question 64

Substances prohibited only in competition

Answer 64

Those substances prohibited only in competition would include but not be limited to stimulants, marijuana, narcotics, and glucocorticosteroids. Also banned at all times are methods such as blood transfusion or manipulation, or intravenous injections in some situations.

Question 65

Prohibited List

Answer 65

It is important to remember that not all substances and methods are named on the Prohibited List. Even if not expressly named, a substance and method can be deemed prohibited if: • It is not currently approved by any governmental regulatory health authority for human therapeutic use (e.g. drugs under pre-clinical or clinical development or discontinued, designer drugs, substances approved only for veterinary use), or • It has a similar chemical structure or similar biological effect(s).

Question 66

Doping offense

Answer 66

Under World Athletics Rules, the presence of a prohibited substance in an athlete’s sample, the use of a prohibited substance, and prohibited method all constitute a doping offense.

Question 67

WADA’s List of Prohibited Substances and Methods

Answer 67

It is important that those who work with athletes acquaint themselves with WADA’s List of Prohibited Substances and Methods.

Question 68

NCAA bans

Answer 68

The National Collegiate Athletic Association (NCAA) also bans the use of PEDs and recreational drugs to protect the health of college athletes and ensure fair play.

Question 69

NCAA testing

Answer 69

The NCAA tests for steroids, peptide hormones, and masking agents year-round and tests for stimulants and recreational drugs during championships.

Question 70

Member schools testing

Answer 70

Member schools also may test for these substances as part of their athletics department drug-deterrence programs.

Question 71

Positive drug test consequences

Answer 71

A positive drug test will result in loss of eligibility and suspension from the sport, including the risk of negatively impacting health.

Question 72

Supplement recommendations

Answer 72

While making supplement recommendations is outside the Trainer Academy Scope of Practice, certified trainers can discuss research on the efficacy and safety of supplements, as long as they do not prescribe them to the client.