supplements and youth athletes -...
TRANSCRIPT
Supplements and Youth
Athletes
Cody Blackford, MA, ATC, CSCS
Nutrition and Energy Basics
• Basal Metabolic Rate (BMR)
– the rate at which the body uses energy
[burns calories] while at rest to keep vital
functions [breathing, keeping warm] going.
• Total Daily Energy Expenditure (TDEE)
– Also called recommended daily intake (RDI)
Nutrition and Energy Basics
• Calculate Energy Expenditure – Females: BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x
height in inches ) - ( 4.7 x age in years )
– Males: BMR = 66 + ( 6.23 x weight in pounds ) + ( 12.7 x
height in inches ) - ( 6.8 x age in years )
Activity Level Factor
Little-to-None 1.2
Light (light exercise/sports 1-3 days per week) 1.375
Moderate (moderate exercise/sports 3-5 days per week) 1.55
Very (hard exercise/sports 6-7 days per week) 1.725
Extra Active (very hard exercise/sports & physical job or 2x training) 1.9
Calculating Energy Needs
Example
17 y/o male football player; 67” tall, 185 lbs
(82.7kg), linebacker; in-season (very active).
BMR = 66 + ( 6.23 x 185 ) + ( 12.7 x 67 ) - ( 6.8 x 17 )
= 66 + (1152.55) + (850.9) - (115.6)
= 1954 kcal/day
RDI = 1954 x 1.725
= 3,370 kcal/day
Nutrition Basics
• Macronutrients
– Carbohydrates: 9 kcal/g
– Proteins: 4 kcal/g
– Fats: 4 kcal/g
• How Much
– Carbohydrates: 3.9-10g/day*
– Proteins: 1.2-1.7g/day*
– Fats: 20-30% Total kcal/day
• % Based
– Carbohydrates: 45-65% RDI
– Proteins: 10-35% RDI
– Fats: 20-35% RDI
*Macronutrient Requirements
● Bagchi, D., Nair, S., & Sen, C. K. (Eds.).
(2013). Nutrition and enhanced sports
performance: muscle building, endurance, and
strength. Academic Press.
Calculating Macro Needs
• Using same player from previous example;
calculating how many daily kcals each from
carbohydrates, proteins, and fats.
• g/kg calculation:
– Carbs: 83kg x 3.9(8.0)g/kg/day =
324 - 664g/day (1296-2656kcal)
– Proteins: 83kg x 1.2(1.7)g/kg/day =
99.6 - 141g/day (398 - 564kcal)
– Fats: 3370kcal x .20(.30) =
674 - 1,011kcal/day = 75 - 112g
TOTAL KCALS
2368 - 4231kcals
There’s an app for that!
• MyFitnessPal
• Tap and Track
–Tracks kcals
–Breakdown of macros
–Breakdown in %
–Customizable
Dietary Supplements
2011 Sports Nutrition and Weight Loss
Report:
• “9% annual sales growth and $22.7 billion in
total sales were noted for sports nutrition and
weight-loss products in 2010.”
Dietary Supplements
“The term dietary supplement represents a wide
spectrum of products, including some fortified
whole foods, herbal products, and ergogenic aids
and products designed to improve work or
performance.”
Term “ergogenic” derived from Greek words ergon (work) and
gennan (to produce)
Dietary Supplement Health and Education Act (DHSEA) 1994:
• DHSEA requires manufacturers and distributors of supplements
to ensure safety of products before marketing;
– “No third-party screening ensures this has happened.”
Regulation
• Coaches, ATs, team physicians, and
administrators are responsible for knowing,
educating, and encouraging athletes to follow
the code of ethics dictated by their governing
body.
• Know TSSAA’s position or policy on doping
• NFHS website posts position statements on
sports medicine, supplements, ergogenic aids,
anabolic steroids, use of energy drinks, and
hydration.
Resources for Safety • MedWatch: http://www.fda.gov/Safety/MedWatch/default. htm
• Quackwatch: http://quackwatch.org
• Dietary warnings and safety information from the US Food and
Drug Administration: http://www.fda.gov/Food/
DietarySupplements/Alerts/default.htm
• Recall of products: http://www.fda.gov/Safety/Recalls/
default.htm
• Center for Drug Evaluation and Research: http://www.fda.
gov/Drugs/default.htm
• United States Anti-Doping Agency: http://www.
supplementsafetynow.com
• Reporting of dietary supplements: http://www.oig.hhs.gov/
oei/reports/oei-01-00-00180.pdf
• US Department of Agriculture Food and Nutrition Information
Center, dietary supplements (regulations, reports, and
warnings): http://fnic.nal.usda.gov/nal_display/index.
php?info_center¼4&tax_level¼2&tax_subject¼274&topic_
id¼1328
Evidence of Safety or Harm
• Manufacturer or distributor of product decides
whether to invest in third-party evaluation and
assurance regarding purity and truth in labeling
• Governmental regulation usually based on
postmarket safety of the product, with no truth
in labeling oversight.
• Purity of the product and truth in labeling are
not assured in many products.
!!! WARNING !!!
• Cases of dangerous contamination and adulteration are
well documented; these may be intentional or
unintentional – Cole MR, Fetrow CW. Adulteration of dietary supplements.
Am J Health Syst Pharm. 2003;60(15):1576–1580.
• US Government Accountability Office (2010)
– Report identified herbal products contaminated with
arsenic, lead, mercury, and pesiticide residues.
• International Olympic Committee Study (2004)
– supposedly non-hormonal muscle building
supplements purchased from U.S. companies
18.8% were adulterated with banned substances
Truth in Labeling
• Sometimes there will be more or less active
ingredient in a product than declared on the
label.
– 2001, study reports that 1 in 12 hormonal
supplements contained 90% to 110% of
labeled active ingredient
– 2000, analysis of 9 brands of
androstenedione (“andro”):
• 6 contained less than 90%
• 1 contained no androstenedione at all
• 1 contained 10mg of testosterone
What does this mean for athletes?
• Strict Liability means that the athlete is
responsible for the presence of the banned
supplement in his or her system, regardless of
how it got there.
• Athletes risk eligibility if they test positive for a
banned substance, even if it was unknowingly
consumed in adulterated supplements.
Third-Party Verification
• Typically tests for product dissolution, accuracy
of active ingredients as described on the label,
and detectable (tested) impurities or
contaminants.
• Third-party testing does not assure safety or
efficacy but assures truth in labeling and good
manufacturing practices for the batch of
product tested.
Third Party Verification: Truth in Labeling
Third Party Verification: Purity and
Banned Substances
Third Party Verification: Purity and
Banned Substances
Third Party Verification: Purity and
Banned Substances
Efficacy of Products
• Manufacturers and distributors of product do
not have to prove the product is effective
• Many ergogenic supplements only have
anecdotal or manufacturers’ claims of efficacy.
• Critical evaluation of scientific evidence -
“scientific evidence” - is a must.
Best Resource
Efficacy Resources and Fact
Sheets
Protein Supplementation
• Shown effective in muscle protein synthesis
(increasing muscle mass) when used in
conjunction with resistance exercise.
• Multiple types and digestion speeds
– Slow digesting
– Fast digesting
• Whey Protein
– Fast digesting
– Best when used following intense resistance
training to promote recovery
• Casein Protein
– Slow digesting
– Best used to prevent muscle protein
breakdown during fasting periods (over
night, mid-morning or afternoon snack)
Protein Supplementation
• Amount of protein dosage per ingestion
unclear.
– Most common recommendation is 20g
– Newer studies have shown up to 70g
• Depends on individual response
• Research individually to determine best whey
protein supplement for post-workout recovery -
based on flavor preference, price, ratings, etc.
Creatine (Cr)
• Most research proven performance enhancing
supplement
– 96 published investigations 1994-2003
– 2012 most recent update
• What it does: Regularly has shown increases
in strength, fat free mass, muscle morphology
with concurrent heavy resistance training.
• How it works: increases creatine storage and
promotes faster regeneration of ATP between
high intensity exercise bouts.
– More effective in high intensity, short
duration activities.
Creatine
• Cr Supplementation in Adolescents
– Concerns:
• safety of supplementation in this age
group not established and not
recommended by some authors.
• taking creatine could lead to more
dangerous performance enhancing
supplements.
Creatine in Adolescents
• International Society of Sports Nutrition:
– “younger athletes should consider a
creatine supplement under certain
conditions:
• puberty is past and he/she is involved in
serious competitive training;
• eating a well-balanced caloric adequate
diet;
• understand the truth concerning the
effects of creatine supplementation;
• supplement protocols are supervised by
qualified professionals;
• recommended doses must not be
exceeded...”
Creatine Dosage
• Mixed opinion
– Loading A: 20g/day (4 x 5g throughout
day) for first 5 days.
– Loading B: 20g/day (1g doses every 30-
minutes) for first 5 days.
• Better retention of Cr
– Maintenance: 3-5g/day for duration
following loading
– Daily single dose of 3-6g
– 3-5g before, 3-5g after workout
Creatine and Cramping
• Journal of Athletic Training (2009)
– No substantial evidence currently exists
showing that creatine supplementation
hinders the body’s ability to dissipate heat
or body fluid balance when appropriate
doses are consumed.
– Controlled experimental trials of athletes
exercising in the heat over a short period of
time resulted in no adverse effects from
creatine supplementation.
• Studies do not specify subject ages.
HMB
• Has been shown effective in decreasing the
amount muscle damage indicators associated
with resistance training.
– Recovery
• Effects on strength and muscle mass:
– Significant increase in fat-free mass and
strength reported when 3.0g/day of HMB
was supplemented in association with
resistance training for 7 weeks.
– 3.0g/day of HMB promotes gains in fat-free
mass and peak isometric torque during a
resistance-training program.
HMB
• Effects of decreased muscle breakdown
greater in untrained individuals, or those in the
initial phase of training.
– resistance-trained athletes may not respond
to HMB supplementation in the same
manner.
• Greater amounts per day (6g in one study) did
not elicit greater effects than the previously
studied 3g/day.
• Up to 8 weeks of supplementation appears to
be safe and does not adversely affect liver and
kidney function in young male adults.
Caffeine
• One of the most widely used ergogenic aids in
the world.
• Considerable amount of evidence for enhanced
aerobic endurance following caffeine ingestion:
– Reduced rating of perceived exertion (RPE)
– Breakdown of fats
– Sparing of muscle glycogen (uses up
energy stores slower)
• Research base regarding ergogenic effects for
high-intensity anaerobic and strength-based
performance not as well developed.
Caffeine
• Research studies documenting acute caffeine
ingestion for enhancing strength and power
performance are ambiguous; proven effects include
– 11-12% of total mass lifted at 60% 1RM bench
press
– Increases in repetition to failure during bench
press
– Increased number of repetitions and higher
peak heart rate during leg press to failure at
10RM
– Increased repetitions to failure during the first
set of a multi-set leg extension protocol
– Increases in peak torque during 3-5 repetitions
of leg extension and flexion
Caffeine
Majority of studies suggest that ingesting
caffeine in 5-7mg/kg doses will have positive
effects on resistance training exercise
performance.
HOWEVER….
Caffeine Warning
• Caffeine toxicity; symptoms include:
– Nervousness
– Anxiety
– Restlessness
– Insomnia
– GI upset
– Tremors
– Tachycardia
– Psychomotor agitation
– Death (rare cases)
• Mayo Clinic says 400mg a day appears safe for
adults; 100mg a day for adolescents.
Energy Drinks
• Caffeine is not the sole stimulant in most
energy drinks
– Guarana
– Bitter orange
– Ginseng
– Taurine
• Adverse effects usually due to caffeine
and additive effects with guarana
• Read labels!!
Energy Drinks
Other Common Supplements
• β-Alanine
– Carnosine substrate
– Carnosine acts as a buffer to H+ ions
• Slows acid buildup in muscles/delays
fatigue
• Branched Chain Amino Acids (BCAAs)
– Benefits of supplementation include muscle
recovery and increased immune system
function
• Nitric Oxide Stimulators
– Aim is to increase blood flow to working
muscles
– No conclusive evidence for this supplement
when used alone (usually in pre-workout
supplement form with other ingredients).
Evaluating Supplements
• Read the label
• Look for specific ingredients and their amounts
• Keep in mind that non-verified products may
not contain amount of ingredient listed
• Beware of “Proprietary Blend” or similar
wording
• Longer list of ingredients = more research
Evaluating Supplements
Evaluating Supplements
Easy Way to Recover
Sources American College of Sports Medicine, & American Dietetic Association. (2000). Joint Position
Statement: nutrition and athletic performance. American College of Sports Medicine, American Dietetic
Association, and Dietitians of Canada. Medicine and Science in Sports and Exercise, 32(12), 2130.
Bagchi, D., Nair, S., & Sen, C. K. (Eds.). (2013). Nutrition and enhanced sports performance: muscle
building, endurance, and strength. Academic Press.
Besco, R., Sureda, A., Tur, J. A., & Pons, A. (2012). The effect of nitric-oxide-related supplements on
human performance. Sports medicine, 42(2), 99-117.
Branch, J. D. (2003). Effect of creatine supplementation on body composition and performance: a
meta-analysis. International journal of sport nutrition and exercise metabolism, 13, 198-226.
Buell, J. L., Franks, R., Powers, M. E., Laquale, K. M., & Carlson-Phillips, A. (2013). National Athletic
Trainers’ Association Position Statement: Evaluation of Dietary Supplements for Performance
Nutrition. Journal of Athletic Training, 48(1), 1-13.
Clauson, K. A., Shields, K. M., McQueen, C. E., & Persad, N. (2008). Safety issues associated with
commercially available energy drinks.Pharmacy Today, 14(5), 52-64.
Cooper, R., Naclerio, F., Allgrove, J., & Jimenez, A. (2012). Creatine supplementation with specific
view to exercise/sports performance: an update. J Int Soc Sports Nutr, 9(1), 33.
Gallagher PM, Carrithers JA, Godard MP, Schulze KE, Trappe SW. Beta-hydroxybeta- methylbutyrate
ingestion, part II: effects on hematology, hepatic and renal function. Medicine and Science in Sports
and Exercise. 2000;32:2116-9.
Hobson, R. M., Saunders, B., Ball, G., Harris, R. C., & Sale, C. (2012). Effects of β-alanine
supplementation on exercise performance: a meta-analysis. Amino acids, 43(1), 25-37.
Sources
Orlov, A. (2015, January 31). How to Calculate Your BMR (And Why It Matters). Retrieved April 7,
2016, from http://dailyburn.com/life/health/how-to-calculate-bmr/
Reissig, C. J., Strain, E. C., & Griffiths, R. R. (2009). Caffeinated energy drinks—a growing problem.
Drug and alcohol dependence, 99(1), 1-10.
Sale C, Harris RC, Florance J, Kumps A, Sanvura R, Poortmans JR: Urinary creatine and
methylamine excretion following 4 x 5 g x day(-1) or 20 x 1 g x day(-1) of creatine monohydrate for 5
days. J Sports Sci 2009, 27:759– 766.
Sports, Cardiovascular, and Wellness Nutrition practice group of the American Dietetic Association:
http://www.scandpg.org and http://www.scandpg.org/sports-nutrition/sports-nutrition-fact-sheets
Cellucor C4
• Beta Alanine - building block of carnosine, a molecule
that buffers acid in muscles; can aid lean-mass gain
• Creatine Nitrate - more water soluble form of creatine;
no support for superiority to other forms of creatine
• Arginine AKG - alleged to increase nitric oxide
production, thereby resulting in vasodilation.
• L-Tyrosine - used to produce noradrenaline and
dopamine; supplemental appears to be anti-stress for
acute stressors; stimulant
• Tetramethyluric Acid - structurally similar to Caffeine,
and preliminary evidence suggests that it activates
similar signalling pathways.
The Curse
• L-Citrulene - a more effective method of increasing L-
arginine levels in the body than L-arginine
supplementation; results in reduced fatigue and
improved endurance for both aerobic and anaerobic
prolonged exercise.
– There is not enough evidence to support the claim
that L-citrulline supplementation improves power
output during exercise.
• Olive Leaf Extract - appears to have highly protective
effects against LDL oxidation and may also benefit
glucose metabolism and skin health.
ON Amino Energy
• Free Form Amino Acids for Rapid Uptake
• Essential Amino Acids including BCAAs
• Supports Recovery Before, During & After
Exercise
• Train Longer & Harder with beta-Alanine
• Natural Energizers & Antioxidant Support
• Supports Nitric Oxide Synthesis
MusclePharm Assault
• Red Beet Extract: high Nitrate content, said to
improve physical performance secondary to Nitric
Oxide. It appears to have some evidence for this
claim in healthy athletes
• Cinnamomom Burmannii: cinnamon; anti-
inflammatory; anti-oxidant; cardiovascular support;
blood-sugar lowering properties in animals
• Choline Bitartrate: mostly used for its cognitive
boosting properties (turning into acetylcholine, the
learning neurotransmitter).
• Glucuronolactone: improved metabolism, blood
flow, aerobic performance*
• Huperzine A: cognitive enhancer that inhibits an
enzyme that degrades the learning
neurotransmitter, acetylcholine