I

The National Ribat University

Faculty of Graduate Studies & Scientific Research

Sports Supplements Used by Bodybuilders Attending

Sport Centers in Khartoum State, Sudan

A dissertation Submitted in Partial Fulfilment of the

Requirements of the Degree of MSc. in Human Nutrition

and Dietetics

By:Sarya Fathi Mohamed Hassan Amin

Supervised by:Dr. Siham Mohamed Osman Gritly

January 2017

I

اآلية

قال تعالى:

بِّ ِزْدنِي ِعْلًما" "َوقُل رَّ

(114طه:سورة )

II

Dedication

This dissertation is lovingly dedicated to my parents, who have been my

constant source of inspiration. They have given me the drive and discipline to

tackle any task with enthusiasm and determination in all walks of life.

I dedicate this dissertation with upmost gratitude to my family, siblings and

colleagues; whose words of encouragement and push for tenacity ring in my

ears, without their love and support this would not been made possibly.

I also dedicate this dissertation to all the athletes, coaches, trainers, and health

professionals who are passionate with knowledge.

The gratitude dedication should go to the sole of my role model “Dr. Osama

Fayed” Who always encouraged us to seek for knowledge.

III

Acknowledgments

First of all, I am grateful to God Almighty my creator, my strong pillar, my

source of inspiration, wisdom, knowledge and understanding. He has been the

source of my strength throughout this dissertation and on His wings only have I

soared.

I'm especially grateful to my supervisor Dr. Siham Gritly; who led me to pursue

this topic , and thanks for her intellectual encouragement, guidance and support

throughout this work.

My profound gratitude and deep regards goes to Professor Bahi-Eldeen

Magboul and Dr. Sumaia Qutbi for their immense knowledge and tremendous

contribution.

I’m obliged to the coaches, bodybuilders who agreed to participate in this

study, and all personnel who didn’t hesitate in help with available data.

I’m also indebt to the friendship and incredible contribution of my friends:

Alhareth Badawi, Mohammed El-tahir, Musab Mohammed, Ruba Al-asad, and

Norah Al-hweiriny who have constantly kept me grounded at times of struggle.

I would like to thank Noon Al-Khawad for her appreciated assistance with the

statistical analyses.

Last but not least, my indebtedness goes to all my colleague and friends who

went above and beyond for my triumph.

IV

Table of contents:

Content Page

I اآلية

Dedication II

Acknowledgments III

Table of contents IV

List of tables VI

List of figures VII

List of abbreviations VIII

Abstract in English IX

Abstract in Arabic X

Chapter one / Introduction 1

1.2 Statement of the Problem 4

1.4 Objectives of the Study 5

Chapter two/ literature review 6

2.1 Bodybuilding 6

2.2 Prevalence of Dietary Supplements among Athletes 6

2.3 Common Dietary Supplements Used by Athletes 8

2.4 Rationale for Dietary Supplements Use among Athletes 8

2.5 Nutrition for Bodybuilding 10

2.6 Nutritional Supplements for Bodybuilding 11

2.6.1 Creatine Supplement and Bodybuilding 12

2.6.2 Protein Supplement and Bodybuilding 13

2.6.3 Beta-Alanine (BA) Supplement and Bodybuilding 15

2.6.4 Beta-Hydroxy-Beta-Methylbutyrate (HMB) supplement and

Bodybuilding

16

2.6.5 Branched Chain Amino Acids (BCAA’s) Supplement and

Bodybuilding

18

2.6.6 Arginine (Arg) Supplement and Bodybuilding 19

2.6.7 Citrulline Malate (CitM) Supplement and Bodybuilding 20

2.6.8 Glutamine (Gln) Supplement and Bodybuilding 22

2.6.9 Caffeine Supplement and Bodybuilding 23

Chapter Three/ Methodology 25

3.1 The Site of the Study 25

3.1.1 Khartoum Locality Centers/ Gyms 25

3.1.2 Omdurman Locality Centers/ Gyms 26

3.1.3 Khartoum North Locality Centers/ Gyms 26

V

3.2 Study Design 26

3.3 Sample Size and Implementation 26

3.4 Inclusion Criteria 28

3.5 Exclusion Criteria 28

3.6 Preliminary Study 28

3.7 Data Collection Techniques 28

3.7.1 Primary data and information 29

3.7.2 Interview questionnaire 29

3.8 Statistical Analysis and Presentation 30

3.9 Limitation of the Study 31

3.10 Study Ethics 31

Chapter four/Results 32

Section One 33

Section Two 35

Section Three 36

Section Four 42

Chapter five/ Discussion 46

Conclusions 51

Recommendations 52

Chapter Six/ References 53

Appendix 71

VI

List of Tables

Table Page

Table(1): General Information about Bodybuilding Training Pattern 35

Table (2): Information about Supplements Use among Bodybuilders 37

Table (3):The Supplement Dose Used by Bodybuilders 38

Table (4): Availability of the Supplements used by Bodybuilders 39

Table (5): Influences on the Decision of Supplement Use 39

Table (6): Bodybuilders Information About the Side/ Adverse Effects

of Supplements

40

Table (7): Bodybuilders Information About the Benefits of Supplements 41

Table (8): Existence of Nutritionist at the Center/ Gym 42

Table (9): Role of Nutritionist in the Center/ Gym 43

Table (10): Reasons for not consulting a Nutritionist/ Dietician 44

Table (11): Chi- Square Test 45

VII

List of Figures

Figure Page

Figure (1): Distribution of Bodybuilders 33

Figure (2): Age of Participants 33

Figure (3): Prevalence of Supplements Use among

Bodybuilders

36

Figure (4): Types of Supplements Used by Bodybuilders 38

Figure (5):Special Dietary Regimen for Bodybuilding 42

Figure (6): Source of Nutrition and Supplements

Information

44

VIII

List of Abbreviations

Full statement Abbreviation

Adenosine Triphosphate ATP

Arginine Arg

Beta-Alanine BA

Beta-Hydroxy-Beta-Methylbutyrate HMB

Branched chain amino acids BCAA’s

Citrulline malate CitM

Creatine Monohydrate CM

Dietary Supplement DS

Essential Amino Acids EAA’s

European Food Safety Authority EFSA

Fat Mass FM

Food and Drug Administration FDA

Glutamine Gln

International Olympic Committee IOC

density lipoprotein-Low LDL

Phosphocreatine Pcr

Statistical Package for Social Sciences SPSS

Time Trial to Exhaustion TTE

IX

Abstract

Sports nutrition and sports supplements were imperative evolved worldwide.

They can affect body composition, metabolism and eventually performance of

athletes either positively or negatively. In Sudan, sport nutrition and use of

supplements have been recently introduced; along with scarce studies and

information on the area of sports supplements. This study was conducted to

investigate the sports supplements use among bodybuilders in Khartoum state

with regards to the prevalence of use, knowledge of the studied group about the

sports supplements benefits and adverse effects, and the sources that impact the

choices of athletes about sports supplements. This study is a descriptive and

cross-sectional study, carried out in Khartoum state. Hundred bodybuilder

athletes were participated from nine sport centers/ gyms across the state. An

interview questionnaire was used to obtain the needed data, then results were

statistically analyzed.

This study indicated a low prevalence of sports supplements among studied

group (23%). The most common type used were whey protein and serious mass

(18.6%), followed by (BCAA’s) (16.3%). Bodybuilders showed low level of

knowledge regarding supplementation (40%). Furthermore, the primary source

of nutritional information were coaches and the internet (36.6% and 32.4%

respectively). A strong significance was detected between the level of training

and the use of supplements (P <.05). Low prevalence of sports supplements use

were observed. The research recommended further large scale studies to be

conducted in order to enrich the country’s data base.

X

ملخص الدراسة

قد ؛ والتي تطورًا ملحوظًا على نطاق العالمالمكمالت الغذائيةاستخدام و ين شهدت مجاالتتغذية الرياضي ؛بالنسبة للسودان. لرياضييناألداء الرياضي لليوبالتا، ستقالباالو مالجس تكوينعلى اأو إيجابً اسلبً تؤثر

ندرة األبحاث فضاًل عن ،مؤخراً قد استحدثاستخدام المكمالت و ينالرياضياالهتمام بتغذية فإن وقوف على مدى استخدام المكمالت بهدف ال الدراسةأجريت هذه المتعلقة بهذا المجال.والدراسات

مدى و ، السيما مايخص الممارسات السائدة؛ األجسام بوالية الخرطومبناء رياضييالغذائية وسط إلىباإلضافة ، تمتدراستها التيلدى المجموعة المحتملة بفوائد المكمالت وآثارها الجانبيةلمامالمعرفةواإل

المكمالت استخدامفيما يخص التغذية و الرياضييناألكبر على معلومات المصادر ذات األثرمعرفة .الغذائية

رياضة سيمن ممار رياضي مائة حيث شملت .بوالية الخرطومالعرضية ةالوصفي هذه الدراسةتم إجراء . بصدد الحصول على المعلومات رياضية تسعة مراكزتم اختيارهم بطريقة عشوائية من ؛كمال األجسام

هذه الدراسة كشفت .لنتائج إحصائياً ، ومن ثم تحليالاتاالستبيانتخداماسعمل المقابالت بتم المطلوبة؛ كما تبين أن .%(23) استقصاؤهمتم ياضيين الذيناستخدام المكمالت الغذائية لدى الر نسبةي تدنعن حماض األ تليها%(، 18.6هي: واي بروتين وسيرياس ماس ) شيوعاً أنواع المكمالت الرياضية أكثر

اية الكافية رياضة بناء األجسام ليست لديهم الدر يممارسالجدير بالذكر أن .(%16.3)األمينية المتشعبةتتمثل في: مصادر معلوماتهممعظم كما أن %(،40) تبلغ نسبة هذه الشريحةحيث بالمكمالت الغذائية

ثمة داللة هامة أوضحت % على التوالي(. 32.4%، و 36.6المدربين الرياضيين واالنترنت بنسبة ) .(P<.05)ت واستخدام المكمال للرياضيين مستوى التدريبا قويًّا بين ارتباطً

البيانات اعدةقإلثراء أوسع؛ دراسات على نطاق المزيد من البإجراءتوصي هذه الدراسة . بالسودان التغذية الرياضية والمكمالت الغذائية بمجاالتالمتعلقة

1

Chapter One

1.Introduction

1.1 Background:

Sports nutrition refers to the specialized branch of nutrition that studies

food with significance to athletic performance. The importance of Sports

Nutrition lies in the fact that it has short-term and long-term effects on: body

composition, metabolism, and eventually the performance abilities of athletes.

According to the International Olympic Committee (IOC), the 2010 IOC

Consensus Statement was “Diet significantly influences athletic performance. A

diet that provides adequate energy from a wide range of commonly available

foods can meet the carbohydrate, fat, and, micronutrient requirements of

training and competition.” (Cook, 2015) Sports nutrition is also imperative in

highlighting all the following three areas: pre-training nutrition, nutrition during

the event, and post-event nutrition. (Penn Foster Inc, 2016)

In Sudan, the ministry of youth and sports represents the executive and

legislative authority for each young athletes; considering that youth are

corresponded to 40% of the state’s population as said by the statistics of (2008).

There are two sectors within the ministry of youth and sports: the sport sector,

concerning: the sport federations, sport clubs, playgrounds and stadiums,

football subsidiary unions, volleyball local federations, squares and fields… etc.

The second one is the youth sector which involves the youth centers and

organizations. In regard to bodybuilding, there are about 12 public centers and

120 private gyms having bodybuilding activity. ( Ministry of youth and sports,

2016)

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Within the field of sports; performance- enhancing aids have been

recognised as sports ergogenics. These ergogenics are categorized into:

nutritional aids, pharmacological aids, and physiological aids. Nutritional

supplements are classified as nutritional aids which serve to increase muscle

tissue, muscle energy supplies, and the rate of energy production in the muscle

(Greenwood et al. 2008). Moreover, Any training technique, mechanical device,

nutrition practice, pharmacologic method, or physiologic technique that can

improve exercise performance capacity and training adaptation are also

considered as ergogenic aids(Mahan, and Raymond, 2017). Ergogeneic aids

also include: anything designed to enhance performance (i.e.: Running shoes,

drugs, and even counselling by a sports psychologist, special diets and dietary

supplements). Mostly, ergogenic aidsendow with a psychological rather than

physiological edge. Some seem to enhance performance in certain types of

activities, some have no effect, and others can impair health and performance.

(Smolin & Grosvenor, 2010)

The term ‘dietary supplement’ (DS) means something which supplements

the diet. According to the U.S. Food and Drug Administration (FDA) 1994: “ A

dietary supplement is a product (other than tobacco) that is intended to

supplement the diet and bears or contains one or more of the following dietary

ingredients: a vitamin, a mineral, a herb or other botanical, an amino acid, a

dietary substance for use by humans to supplement the diet by increasing its

total daily intake, or a concentrate, metabolite, constituent, extract, or

combination of these ingredients”. This differs slightly from the European Food

Safety Authority (EFSA) definition which uses the term food supplement for “

A concentrated source of nutrients or other substances with a nutritional or

physiological effect whose purpose is to supplement the normal diet. They are

marketed in ‘dose’ form i.e. as pills, tablets, capsules, liquids in measured doses

3

etc”. Furthermore, EFSA stated that “Supplements may be used to correct

nutritional deficiencies or maintain an adequate intake of certain nutrients.

However, in some cases excessive intake of vitamins and minerals may be

harmful or cause unwanted side effects; therefore, information on maximum

levels are necessary to ensure their safe use in food supplements”. Nutritional

supplements are widespread used for sport, exercise and health goals.

Dietary/nutritional supplements, functional foods, nutraceuticals,

sports/performance-boosting supplements, ergogenic aids … etc are some terms

that are used interchangeably within both scientific publications and the

sporting field to describe products that claim to enhance health and/or sports

performance. (Castell et al. 2015)

The use of an ergogenic aid is a serious decision. Therefore, health risks

against potential benefits should be weighed before using an ergogenic

supplement. Many supplements can have dangerous interactions with other

drugs, and they can make existing health conditions worse too. Other

considerations are: validity of product’s claims, safety of the recommended

dose, and the ethical base of the taken supplement. (Smolin & Grosvenor, 2010)

4

1.2 Statement of the Problem:

Sudan is one of the developing countries where sport nutrition and use of

supplements have been recently introduced. Some supplements have an adverse

effect on both health and performance, and some are considered as illegal to be

used. The sports supplementation patterns in athletes are unknown. However,

athletes have a unique set of nutritional needs to balance the needs for growth

and development, and to optimize their performance. A large number of

athletes consider sports supplements as a requirement to give them a

competitive edge, and believe that a normal diet will not be sufficient.

Furthermore, Knowledge can be delivered by different providers including:

coaches, athletic trainers, sport dieticians, nutritionists, sport scientists, and

medical practitioners. Athletes also obtain information from other sources; such

as: school or tertiary-education programs, books, sport-specific magazines, the

mass media, and, increasingly, the Internet (Burns et al. 2004)(Jacobson et al.

2001)(Parr et al. 1984).

The researcher was interested by this area and tried to investigate the use

of sports supplements among bodybuilders in Khartoum state, Sudan. The

scarcity of studies and lack of information on the area of sports supplements in

Sudan attracted the researcher to study the different types of sports supplements

used by bodybuilders.

5

1.3 Justification:

For the last decades, people have paid a lot of care and attention for sport

and physical activities related to health. Thus, this study will evaluate the

prevalence of using supplements and the degree of awareness. This research

will hopefully provide useful information to assist future baseline data and

information for future research concerning the sport supplement used in Sudan.

1.4 Objectives of the Study:

1.4.1 General Objective:

To evaluate the prevalence of sports supplements used by athletes

attending bodybuilding centers in Khartoum state, Sudan.

1.4.2 Specific Objectives:

1. To compute the prevalence of sports supplements used by male

bodybuilders attending bodybuilding centers in Khartoum state, Sudan.

2. To assess the knowledge of the studied group about the sports

supplements benefits and adverse effects.

3. To explore the sources that impact the choices of athletes about sports

supplements.

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Chapter Two

2. Literature Review

2.1 Bodybuilding:

Principally, bodybuilding is an anaerobic recreation targeted on developing

muscular size and symmetry; wherein competitors are judged on muscular

appearance. However, a small endurance component is associated with the

duration of the exercising; which is addressed by the activity itself. In order to

be successful, athletes should maximize their muscular size, shape, symmetry,

and definition by including both large and small muscle groups.(Wildman &

Miller, 2004)(Rossow et al. 2013) During bodybuilding competitions, athletes

are assessed on their bodily or ‘aesthetic’ appearance and are typically required

to express an excessive degree of muscularity and symmetry, as well as low

levels of body fat. Cautious attention to nutrition and exercise conditioning is

undoubtedly important to become ‘competition ready’. There are numerous

methods used frequently in the preparation for contest such as: chronic energy

restriction, dehydration (water manipulation), sporadic eating and inappropriate

use of diuretics and supplements of anabolic steroids and ‘fat burners’

(Robinson et al. 2015)

2.2 Prevalence of Dietary Supplements among Athletes:

Between different sports and athletes at variance ages, performance levels

and cultural backgrounds; nearly half of all athletes are using supplements.

Internationally, the prevalence of supplement usage among athletes has been

7

estimated at 37% to 89%, with greater frequencies among elite and older

athletes.(Academy of Nutrition and Dietetics et al. 2016)(Castell et al. 2015)

Supplement use is more common in strength and power sports in

particular. According to TGI (Target Group Index, 2012 Product Book) survey,

supplement use differs between countries. The lowest use appears in Thailand

(3%), Argentina (8%) and Spain (9%), while there is a moderate use in France

(28%), Germany (32%),Great Britain (34%) and Russia (38%), and the highest

use is in USA (56%), Serbia (56%) and Denmark (72%).(Castell et al. 2015)

A meta-analysis of 51 studies on supplements, that involves more than

10,000 athletes at all levels and covers 15 sports, found that the mean

prevalence of supplement use among all subjects was 46%, with a large

variance between individual sports which ranged from 6% to 100%. (Sobal &

Marquart 1994) Studies on UK athletes found similar supplement use. One

study found that 59% of UK athletes used at least one supplement with another

showing 62% usage in British junior national track and field athletes. A study of

supplement usage in 286 Olympic athletes competing at the 2004 Athens

Olympics, found that 53% are taking supplements.(Castell et al. 2015)

Use of supplements is significantly affected by the performance level of

the athletes. It is expected to be higher with increasing performance level.

(Giannopoulou et al. 2013) Moreover, there is good evidence that supplement

use increases with age in elite athletes as well as in the general population.

Considerably, the recommended doses of dietary supplements are exceeded.

There is a common misunderstanding that doubling the dose will double its

8

work; but more does not necessarily mean better; certainly, excessive intakes of

some dietary supplements may do more harm than good (Castell et al. 2015)

2.3 Common Dietary Supplements Used by Athletes:

According to Castell et al, 2015, the most popular dietary supplements

used were multivitamins, followed by vitamin C, iron and B vitamins. A study

of dietary supplements usage in 286 Olympic athletes carried out in 2004 found

that vitamin C was the most common supplement affirmed by athletes (65%),

followed by multivitamins and minerals, iron, protein supplements, vitamin E,

Selenium and Zinc. A further larger study that include 874 UK athletes, found

that among 60% declared supplement use, the most common supplements were

multivitamins (73%) and vitamin C (71%), followed by creatine (36%), whey

protein (32%), echinacea (31%), iron (30%), caffeine (24%), magnesium (11%)

and ginseng (less than 11%). In 2009, A study of 113 German Olympic athletes

found magnesium to be the most popular (81%), followed by vitamin C (59%),

multivitamins (52%), iron (50%), zinc (42%), while ergogenic aids such as

creatine (20%) and caffeine (6%) were rarely used. (Castell et al. 2015)

2.4 Rationale for Dietary Supplements Use among Athletes:

Among other many motivations for use of supplements, the academy of

nutrition and dietetics, the American college of sports medicine, and dieticians

of Canada listed the following motivations: enhancement of performance or

recovery, improvement or maintenance of health, an increase in energy,

compensation for poor nutrition, immune support, and manipulation of body

composition. (Academy of Nutrition and Dietetics et al. 2016)Participants in a

9

Canadian study of dietary supplement usage reported that their reasons for

taking supplements were: to stay healthy (81%), to increase energy (55%),

immune system (52%), recovery, (49%), and overall athletic performance

(49%).(Wiens et al. 2014).

Other Common reasons for dietary supplements use by athletes as

suggested by Castell et al, 2015, include:prevention or treatment of nutrient

deficiency, particularly for the increased requirements by the

exerciseprogramme. The provision of a more nutrients in convenient form to

address nutritional needs/ goals around an exercise session especially where

foods are not practical as well as provision of a direct ergogenic effect. Also

they believe that dietary supplements are necessary as every top athletes are

consuming it. Interestingly, studies have also found that large numbers of

athletes are using supplements just because of others recommendations (i.e.:

colleagues, coaches) (Castell et al. 2015)

Body shape and improvement of physical performance were the most

frequent reasons addressed for sport supplement use among Egyptian athletes.

(Tawfik et al. 2016)63% of German athletes who used or had used supplements

stated that they did so either for health-related reasons [maintenance of health

(44%), improvement of immune functions (34%), and prevention(27%)] or

performance-related reasons which cited by only 43% of users [regeneration

(35%), improving performance (27%)]. 21% of the athletes reported using

supplements because it was recommended by others. (Braun et al. 2009)

In Saudi Arabia, results showed different reasons for using dietary

supplements among 93% of athletes. (43.8%) were using supplements for

10

performance, whereas 32.6% believed that improvement in health was a reason

for using dietary supplements. (Aljaloud & Ibrahim, 2013)

2.5 Nutrition for Bodybuilding:

Good nutrition is essential in assisting the athletes to train intensely, as

well as in muscle recovery and metabolic adaptations to endurance exercise.

Adequate energy should be obtained from a wide variety of available foodsto

provide adequate carbohydrates, proteins, fat and micronutrients.(Potgieter,

2013)

Concerning bodybuilding, numerous nutrition practices are experimented

and practiced by bodybuilders to maintain greater consistency in nutrition and

training habits throughout the year.(Wildman & Miller, 2004) Bodybuilders

nutritional needs vary during the off-season and pre-contest phases. During the

off-season (i.e.: no competitive events), they attempt to increase muscle mass.

Thus, it is valuable for the bodybuilder to be in positive energy balance to

ensure extra energy availability for muscle anabolism. Additionally, adequate

protein must be available to provide amino acids for protein synthesis. In

contrast, during the pre-contest phase for 6–12 weeks prior to competition,

bodybuilders attempt to retain muscle mass and reduce body fat to very low

levels., the bodybuilder should be in negative energy balance so that body fat

can be oxidised. (Lambert et al. 2004).

Furthermore, during the pre-contest phase, protein intake must be adequate

to maintain muscle mass. The composition of diets for bodybuilders should be

55–60% carbohydrate, 25–30% protein and 15–20% of fat, for both the off-

11

season and pre-contest phases. The difference is while the diet should be

slightly hyperenergetic (~15% increase in energy intake) during the off-season;

it should be hypoenergetic (~15% decrease in energy intake) during the pre-

contest phase (Lambert et al. 2004).

2.6 Nutritional Supplements for Bodybuilding:

On the subject of bodybuilding supplements, there are considerably a lot of

supplements that are used by bodybuilders and sold on the market.(Helms et al.

2014)Bodybuilding has two distinct phases: bulking phase (the systematic

attempt to gain weight and muscularity) and cutting phase (removing body fat

and minimizing muscle loss to achieve a defined aesthetic physique). Fat

burners were more popular in the cutting phase than any other

supplement.(King, 2014) Current research also shows that fat burners are still

the most prevalent supplement used when attempting a cutting phase (Karimian

& Esfahani, 2011). Other supplements used by bodybuilders to burn fat during

the cutting phase include choline and inositol. (King, 2014) More recently,

diuretics has been documented to be commonly used as a cutting agent by both

amateur and professional bodybuilders in the efforts to lose weight (Kennedy,

2008)

In the bulking phase, the more popular supplements were found to be

protein powder and amino acids (King 2014). Benardot (2000) suggested that

protein powder, creatine, and amino acids were most commonly used for

gaining weight or bulking (Benardot, 2000) Another study found protein or

weight gain supplement were more likely used by male bodybuilders while

attempting to bulk (Karimian & Esfahani 2011).

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Among all of these supplements, some of the most popular supplements

which are commonly used by bodybuilders and have a scientific evidence will

be discussed.

2.6.1 Creatine Supplement and Bodybuilding:

Creatine is endogenously produced at an amount of about 1 g/d. it is

Synthesized predominately in the liver, kidneys, and to a lesser extent in the

pancreas (Persky & Brazeau, 2001). The remains available creatine to the body

is obtained from the diet at about 1 g/d for an omnivorous diet. 95% of the

body’s creatine is stored in the skeletal muscle whereas the remaining 5% is

distributed in the brain, liver, kidney, and testes (Persky & Brazeau, 2001) In

clinical setting, creatine has been used and researched to investigate various

pathologies or disorders such as myopathies (Tarnopolsky 2011, Gualano et al.

2010). It is also used as an ergogenic aid for improving health and sports

performance in athletes. As an oral supplement, the most widely used and

researched form is creatine monohydrate (CM) (Cooper et al. 2012). Creatine

monohydrate (CM) considered as the most ergogenic and safe supplement that

is legally available (Buford et al. 2007). Supplementation of healthy adults has

not resulted in any reported adverse effects or changes in liver or kidney

function (Kim et al. 2011)

In spite of the form, creatine supplementation has regularly shown to

increase strength, fat free mass, and muscle morphology with concurrent heavy

resistance training more than resistance training alone. Moreover, it increases

creatine storage and promotes a faster regeneration of adenosine triphosphate

(ATP) between high intensity exercises which will improve outcomes, increase

performance and promote greater training adaptations. More recent research

13

suggested that creatine supplementation of 0.1 g/kg of body weight in

combination with resistance training improves training adaptations at a cellular

and sub-cellular level (Cooper et al. 2012)Numerous studies have found

significant increase in muscle size and strength resulted from adding creatine

monohydrate (CM) to a strength training program (Helms et al. 2014). Among

many of these studies, 1-2 kg increases in total body mass were observed after

loading of 20 g/day of creatine monohydrate (CM) for 4–28 days (Persky &

Brazeau, 2001)

2.6.2 Protein Supplement and Bodybuilding:

Athletes and bodybuilders are greatly concerned about protein powders.

Protein powders are supplying protein, as well as containing high amounts of

essential amino acids (EAA’s), which are significant for muscle recovery and

growth. The top most popular types of protein powders available on the market

include: Whey, egg, casein, pea, soy, and hemp (Arora, 2015). Protein powder

is also commonly used by athletes or active individuals who engage in exercise,

sport training and bodybuilding such as: mass gain protein, whey protein (WP)

and other different types of the protein powders to increase muscle synthesis

more than other proteins which gain from animal and plant source (Omar et al.

2016). Protein supplements are good in boosting protein intake while keeping

daily calories low, and in benefiting both athlete and non-athlete alike in muscle

growth and overall strength (Arora, 2015)

Milk contains two fractions of protein: whey protein (WP) and casein

protein. (Hulmi et al. 2010) Whey protein (WP) powder and casein powder

have two different types of uses. Whey protein (WP) powder is best used as a

meal supplement, while casein is best used for overnight recovery formula.

14

Whey protein (WP) powder has more benefit than casein when comparing

overall results on muscle growth and recovery. (Arora, 2015)

About 20% of the total protein in commercial bovine milk comes from

whey protein (WP). Direct and indirect evidence suggests that whey protein

(WP) may be an especially suitable protein to be used in conjunction with

resistance exercise to stimulate muscle hypertrophy (Hulmi et al. 2010) Whey

protein is a rich source of essential amino acids (EAAs), including the branched

chain amino acids (BCAAs) leucine, isoleucine, and valine. Therefore, it has

been studied for its potential ergogenic effects in conjunction with resistance

training. (Coburn et al. 2006) Whey protein (WP) is higher in leucine, absorbed

quicker and results in a more pronounced increase in muscle protein synthesis

(Volek et al. 2013)The branched-chain amino acid leucine is found in high

proportions in whey protein (WP) and was shown to be a potent stimulator of

muscle protein synthesis in humans (Steinmuller et al. 2014)(Hector et al. 2015)

Recent publication documented that, when combined with exercise, whey

protein (WP) supplementation was highly effective at reducing visceral adipose

tissue mass and increasing lean body mass (LBM) (Arciero et al. 2014)

Another investigation found that muscle protein synthesis after the consumption

of whey protein (WP) was approximately 93% greater than casein and

approximately 18% greater than soy (Antonio et al. 2014)

All studies have shown that supplementation of whey protein (WP) alone

or with carbohydrates immediately after and possibly before and during

resistance exercise can enhance the muscle hypertrophy response to resistance

training in healthy adults. Some studies also suggest that whey protein (WP)

15

may enhance recovery from heavy exercise and possibly decrease muscle

damage and soreness (Hulmi et al. 2010). Whey protein (WP) also found to

influence the response of cortisol following an acute bout of resistance exercise

by blunting its increase during recovery.(Kraemer et al. 2013)A meta-analysis

conducted by Miller et al. found a modest effect from whey protein (WP)

supplementation on lean body mass (LBM) retention and fat mass (FM) loss

compared with carbohydrate during energy deficit; however, it was noted that

currently there are not enough studies to compare whey protein (WP) with other

protein sources (Miller et al. 2014)

2.6.3 Beta-Alanine (BA) Supplement and Bodybuilding:

Beta-alanine (BA) is becoming an increasingly popular supplement among

bodybuilders. Once consumed, it enters the circulation and is up-taken by

skeletal muscle where it is used in carnosine synthesize (a pH buffer in muscle

that is particularly important during anaerobic exercise such as sprinting or

weightlifting) (Artioli et al. 2010).

Harris et al (2006) indicated that consumption of 6.4 g of beta-alanine

(BA) for four weeks on daily basis has been shown to increase muscle carnosine

levels by 64.2%. Other studies suggested that supplementation with beta-alanine

(BA) for 4–10 weeks has been shown to improve workload and time to fatigue

during high intensity cardio, improve muscle resistance to fatigue during

strength training, increase lean mass by approximately 1 kg, and significantly

reduce perceptions of fatigue. (Hill et al. 2007; Van Thienen et al. 2009; Sale et

al. 2011; Smith et al. 2009; Stout et al. 2007; Hoffman et al. 2008)

16

Additionally, the combination of beta-alanine (BA) and creatine

monohydrate (CM) may increase performance of high intensity endurance

exercise (Zoeller et al. 2007) and has been shown to increase lean mass and

decrease body fat percentage more than creatine monohydrate (CM) alone

(Hoffman et al. 2006). Hobson et al. (2012) conducted a meta-analysis of 15

studies on beta-alanine (BA) supplementation and concluded that beta-alanine

(BA) significantly increased exercise capacity and improved exercise

performance.(Hobson et al. 2012)

Harris et al. (2006) suggested that the long-term safety of beta-alanine

(BA) has only been partially explored. Presently, the only known side effect of

beta-alanine (BA) is the unpleasant symptoms of parasthesia reported after

consumption of large dosages; which can be lessen through consumption of

smaller dosages throughout the day (Harris et al. 2006)

2.6.4 Beta-Hydroxy-Beta-Methylbutyrate (HMB) supplement and

Bodybuilding:

Beta-hydroxy-beta-methylbutyrate (HMB) is a naturally occurring

metabolite of the amino acid leucine. Leucine has been shown to decrease

muscle protein catabolism and increase muscle protein synthesis. The effective

dose of beta-hydroxy-beta-methylbutyrate (HMB) has been established at 3g

per day (Eley et al. 2007; Smith et al. 2005; Eley et al. 2008; Smith-Ryan &

Antonio 2013).

Majority of studies with longer-duration have shown that beta-hydroxy-

beta-methylbutyrate (HMB) appears to be effective in the more intense,

17

periodized training protocols. Therefore, it may be beneficial to bodybuilders,

especially during planned over-reaching phases of training (Wilson et al. 2013).

Wilson et al (2014) signified that beta-hydroxy–beta-methylbutyrate (HMB)

enhances hypertrophy, strength, and power following chronic resistance

training, and prevents decrements in performance following the

overreaching.(Wilson et al. 2014)Furthermore, greater than twenty human

studies have demonstrated the effectiveness of beta-hydroxy-beta-

methylbutyrate (HMB) in increasing lean body mass, strength, decreasing

markers of muscle damage and reducing muscle soreness. It is also observed to

be beneficial in trained and untrained individuals, men and women, as well as

young adults and seniors. Two studies have demonstrated the effect of beta-

hydroxy-beta-methylbutyrate (HMB) supplementation on reducing exercise-

induced muscle damage. (Smith-Ryan & Antonio, 2013)

Concerning the safety of beta-hydroxy–beta-methylbutyrate (HMB), no

adverse effects have been observed on liver enzymes, kidney function,

cholesterol, white blood cells, hemoglobin, or blood glucose with beta –

hydroxy- beta-methylbutyrate (HMB) supplementation (Rathmacher et al. 2004;

Nissen et al. 2000; Gallagher et al. 2000). Moreover, two meta-analyses on

beta-hydroxy-beta-methylbutyrate (HMB) supplementation have concluded that

beta-hydroxy-beta-methylbutyrate (HMB) is safe and does not result in any

major side effects (Rathmacher et al. 2004; Nissen et al. 2000). It may actually

decrease blood pressure, total and low-density lipoprotein (LDL) cholesterol,

especially in hypercholesterolemic individuals and it is particularly effective in

catabolic populations such as the elderly and patients with chronic disease

(Fitschen et al. 2013).

18

2.6.5 Branched Chain Amino Acids (BCAA’s) Supplement and

Bodybuilding:

The most widely used supplements among bodybuilders are branched

chain amino acids (BCAA’s). They make up 14-18% of amino acids in skeletal

muscle proteins (Shimomura et al. 2006). Among the branched chain amino

acids (BCAA’s), leucine is known to have a particular interest because it

stimulates protein synthesis to an equal extent as a mixture of all amino acids

(Helms et al. 2014). Balage & Dardevet (2010) pointed out that all three amino

acids need to be consumed to prevent plasma depletion of any one of the

branched chain amino acids (BCAA’s) as the ingestion of leucine alone can lead

to depletion of plasma valine and isoleucine (Balage & Dardevet 2010) The safe

upper limit of leucine was set recently at 550 mg/kg bodyweight/day in adult

men (Elango et al. 2012) Various acute studies have shown that consumption of

either essential amino acids (EAA’s), branched chain amino acids (BCAA’s), or

leucine at rest or following exercise increases skeletal muscle protein synthesis,

decreases muscle protein degradation, or both.

There are few long-term studies of branched chain amino acids (BCAA’s)

supplementation in resistance-trained athletes have been conducted (Helms et

al. 2014). The use of branched chain amino acids (BCAA’s) between meals

may also be beneficial to keep protein synthesis elevated (Wilson et al. 2011).

Stoppani et al (2009) has indicated that branched chain amino acids (BCAA’s)

stimulate protein synthesis acutely. They also may be able to increase lean mass

and strength when added to a strength training routine (Stoppani et al. 2009)

19

2.6.6 Arginine (Arg) Supplement and Bodybuilding:

Arginine (Arg) is a conditionally essential amino acid. It becomes essential

under certain metabolic conditions including muscle trauma and

injury.(Campbell et al. 2004; Stevens et al. 2000). Among athletes,arginine

(Arg) had noted to be an emerging and growing trend (Maughan et al. 2011).

Moreover, it has become very popular in the food supplement industry since it

has been purported to be ergogenic (Álvares et al. 2012; Campbell et al. 2004;

Paddon-Jones et al. 2004; Shao & Hathcock, 2008; McConell, 2007; Kanaley,

2008)

Campbell et al (2004) stated that arginine (Arg) is involved in protein

synthesis, detoxification and conversion of ammonia to glucose, as well as

production of energy. In addition, arginine (Arg) has been purported to have

ergogenic potential. Athletes have taken arginine (Arg) for its role in: the

secretion of endogenous growth hormone, augmentation of nitric oxide, and its

involvement in the synthesis of creatine. (Campbell et al. 2004)

Concerning the ergogenic potential of arginine (Arg), there is some

evidence that infusion of arginine (Arg) increases glucose uptake during

prolonged exercise and reduces lipolysis. There is also some evidence that oral

arginine (Arg) supplementation can interact with exercise training to increase

the beneficial effects of exercise on capillary growth and insulin sensitivity.

(Sharma et al. 2016)

Adjacent to the popularity of arginine (Arg) as a nutritional supplement

used to increase muscle mass, it has been tested more recently as a potential

20

therapeutic in numerous acute and chronic disease states, including sickle cell

chest crisis, pulmonary artery hypertension, coronary heart disease, pre-

eclampsia and myocardial infarction, because of its bronchodilator and

vasodilator actions (Sharma et al. 2016). Stevens et al (2000) suggested that

arginine (Arg) can rapidly induce vasodilatation in skeletal muscle via

biosynthesis of vascular smooth muscle nitric oxide. (Stevens et al. 2000)

The effects of arginine (Arg) supplementation on performance are

controversial. Roughly, one-half of the acute and chronic studies on arginine

(Arg) and exercise performance have found significant benefits with arginine

(Arg) supplementation, while the other one-half has found otherwise (Álvares et

al. 2011). McConell (2007) concluded that there is a little impact of arginine

(Arg) supplementation on exercise performance in healthy individuals

(McConell 2007). In contrast, the rating for arginine (Arg) on increasing athletic

performance by The Natural Medicines Comprehensive Database (Theraputic

Research Faculty, 2012) fell under the category of Insufficient Evidence to

Rate. (Theraputic Research Faculty, 2012) The commonly consumed doses by

athletes are well below the observed safe level of 20 g/d and do not appear to be

harmful (Shao & Hathcock, 2008)

2.6.7 Citrulline Malate (CitM) Supplement and Bodybuilding:

Citrulline (Cit) is a non- essential amino acid that synthesized mainly from

glutamine (Gln), glutamate and proline endogenously. It can also be synthesized

from arginine (Arg) and ornithine (Bagchi et al. 2013)

21

Recently, citrulline malate (CitM) has become a popular supplement

among bodybuilders. There is a little scientific research in healthy humans with

this compound. Citrulline malate (CitM) is hypothesized to improve

performance through three mechanisms: participation in ammonia clearance

through the urea cycle, reduction of lactic acid accumulation, and by its

conversion to arginine (Arg). Seeing that arginine (Arg) does not appear to have

an ergogenic effect in young healthy athletes; so it is doubtful that citrulline

malate (CitM) will exert an ergogenic effect in the course of this mechanism

(Álvares et al. 2011; Pérez-Guisado & Jakeman, 2010; Pons et al. 2016)

Helms et al (2014) suggested that supplementation with citrulline malate

(CitM) for 15 days has been shown to be beneficial both during and after

exercise. During exercise, it has been shown to increase the production

adenosine triphosphate (ATP) by 34%. While after exercise, it increases the

phosphocreatine (Pcr) recovery rate by 20%, and reduces perceptions of fatigue

(Helms et al. 2014). Moreover, Pérez-Guisado & Jakeman (2010) indicated that

ingestion of 8 g citrulline malate (CitM) prior to a chest workout significantly

increased the performed repetitions by approximately 53% and decreased

soreness by 40% at 24 and 48 hours post-workout (Pérez-Guisado & Jakeman,

2010). Stoppani et al. (2009) reported that the consumption of a drink

containing 14 g branched chain amino acids (BCAA’s), glutamine (Gln), and

citrulline malate (CitM) during workouts for eight weeks increases the lean

mass by 4 kg, decreases body fat percentage by 2 kg, and increases 10 repetition

maximum bench press by 6 kg. Notwithstanding, contribution degree of

citrulline malate (CitM) to the observed outcomes is not clear. (Stoppani et al.

2009) Safety of citrulline malate (CitM) in the long-term use is unknown

(Helms et al. 2014)

22

2.6.8 Glutamine (Gln) Supplement and Bodybuilding:

Glutamine (Gln) is the most copious non-essential amino acid and

commonly consumed nutritional supplement which is synthesized and stored

mainly in the skeletal muscle. (Smith-Ryan & Antonio 2013; Gleeson 2008).

Along with its various physiological important roles, glutamine (Gln) is known

to be involved in the stimulation of protein synthesis and glycogen resynthesis

after exhaustive exercise (Smith-Ryan & Antonio, 2013). Quantities below 14

g/d of glutamine (Gln) supplementation appear to be safe in healthy adults

(Shao & Hathcock, 2008)

Despite the fact that there is little scientific evidence supporting the use of

glutamine (Gln) in healthy athletes, acute studies found that glutamine (Gln)

supplementation has not significantly improve exercise performance and

buffering capacity, help maintaining immune function, or reduce muscle

soreness after exercise (Gleeson, 2008; Helms et al. 2014). Other long-term

supplementation studies included glutamine (Gln) in cocktails along with

creatine monohydrate (CM), whey protein, branched chain amino acids

(BCAA’s), and/or citrulline malate (CitM). They have shown 1.5 – 2 kg

increases in lean mass and 6 kg increase in 10 repetition maximum bench press

strength (Stoppani et al. 2009; Colker et al. 2000). The role of glutamine (Gln)

in these changes is unclear. Candow et al (2001) have investigated the effects of

glutamine (Gln) supplementation alone in conjunction with a six week strength

training program. They concluded that there is no significant differences were

observed in muscle size, strength, or muscle protein degradation between

groups (Candow et al. 2001)

23

Although the previous studies do not support the use of glutamine (Gln) in

bodybuilders during contest preparation, glutamine (Gln) noted to be possibly

beneficial for gastrointestinal health and peptide uptake in stressed populations

(Camilleri et al. 2012). Therefore, it may be beneficial in dieting bodybuilders

who represent a stressed population. Taken together the results of previous

studies, use of glutamine (Gln) as an ergogenic supplement has not been

supported (Helms et al. 2014)

Piattoly et al (2013) declared that there is no effects noted either

immediately and 24 hours after the time trial to exhaustion (TTE). Findings

suggested that although glutamine (Gln) supplementation does not affect acute

recovery from exhaustive exercise; it increases endurance and restores and/or

improves power indices (Piattoly et al. 2013)

2.6.9 Caffeine Supplement and Bodybuilding:

Caffeine is perhaps the most common pre-workout stimulant consumed by

bodybuilders. Numerous studies support the use of caffeine to improve

performance during endurance, sprinting, and strength training (Green et al.

2007; Woolf et al. 2008; Duncan & Oxford, 2011; Mc Naughton et al. 2008;

Ivy et al. 2009; Carr et al. 2008; Glaister et al. 2008). However, use of caffeine

to improve performance in strength training has not been supported by all

studies (Hendrix et al. 2010; Williams et al. 2008).

Caffeine is considered as an effective ergogenic aid due to its stimulant

action, reduction of fatigue feelings, and increasing times to exhaustion.

Primarily, caffeine has been shown to influence resting metabolic rate, and

24

longer-duration endurance exercise by 20-50% (Smith et al. 2010). Moreover,

Beedie (2010) reported a significant reduction of pain response during

performance as a consequence of caffeine ingestion (Beedie, 2010)

Smith-Ryan & Antonio (2013) suggested that consumption of 3-6 mg/kg

of caffeine 60 minutes prior to exercise is likely to benefit the performance of

endurance, strength, and power athletes. Additionally, many studies found

increases in strength training performance with larger doses of caffeine

supplement. However, this dosage is at the end of the considered safe dosages

(6 mg/kg/day).

Regular consumption of caffeine may result in a reduction of ergogenic

effects. Other side effects include: anxiety, restlessness, and headache that may

impair performance. dramatic Responses to caffeine may be more if athletes

abstain from caffeine for at least 24 hours (Smith-Ryan & Antonio, 2013;

Helms et al. 2014) Therefore, it appears that 5–6 mg/kg caffeine taken prior to

exercise is effective in improving exercise performance. For athletes, use of

caffeine may need to be cycled in order to obtain the maximum ergogenic

effect. (Helms et al. 2014)

25

Chapter Three

3. Methodology

This chapter gives details on materials and methods used to evaluate the

prevalence of sports supplements used by bodybuilders. These include: study

design, sample size and implementation, inclusion and exclusion criteria , data

collection tools, data analysis and presentation, study limitations, and finally

ethics of the study. It is a descriptive, cross-sectional study. It is carried out on

bodybuilders in Khartoum state. The design is analytical and descriptive to

accomplish specific objectives.

3.1 The Site of the Study:

Khartoum state is the most populous state of the Sudan with an estimated

population of about 8 million people. It constitutes about (25%) of the total

population of Sudan. The state lies between latitudes 15-16 North and

longitudes 31,5- 34 East, at an altitude of 412 m above sea level in an area about

22.736 km2. It is located at the confluence of the White and Blue Niles where

both rivers form the Nile River. Khartoum consists of three cities: Khartoum,

Omdurman and Khartoum North. (Anon, 2016; Central Bureau of Statistics

Republic of Sudan, 2013; Un, 2016)

The centers that involved in this study were selected across the state.

3.1.1 Khartoum Locality Centers/ Gyms:

Khartoum is the capital city with a population of about 5129 person. It

located into the south of the Blue Nile (Ati et al. 2011; Central Bureau of

Statistics Republic of Sudan, 2013). Three sport centers were included from

Khartoum locality: Al-Sajana youth center, Burri sports club, Al-Qurashi gym.

26

3.1.2 Omdurman Locality Centers/ Gyms:

Omdurman is located to the west of the White Nile with an estimated

population of 513088 person (Ati et al. 2011; Central Bureau of Statistics

Republic of Sudan, 2013). There were two centers included from Omduram:

karari youth center, Al-Mohandiseen sports city.

3.1.3 Khartoum North Locality Centers/ Gyms:

Khartoum North lies on the north of the Blue Nile with a population of

about 608817 person (Ati et al. 2011; Central Bureau of Statistics Republic of

Sudan, 2013). Four centers were selected from this locality: Al-Shaabeia youth

center, Al-Etihad Albahrawi center, Magnom Fitness gym, and Family Club

gym.

An appreciated support of the coaches in each center was observed. The

sample age ranged between 17- 52 years.

3.2 Study Design:

This dissertation is a descriptive, analytical and cross- sectional study;

thatconsists of a quantitative data assortment.

3.3 Sample Size and Implementation:

A random sample was collected from nine public and privet sports

centers across the state. The centers were randomly selected using simple

random samplingand the bodybuilders were selected by means of convenience

sampling method during the period of the study. Convenience sampling

27

technique involves the selectionof the subjects using group that is

handy/available, most accessible (or volunteers) in terms of time, effort and

money. The research included a sample of 100 bodybuilders age 17- 52 years.

The sample size was determined using Slovin’s Formula:

[n= N/1+Ne2].

Where;

n = # of sample size

N = total population

e = confidence level

Given:

N = 568 residents

e = standard confidence level is 90% - 95%. The researcher used a

confidence of 90% for a better accuracy, which will give a margin error of 0.10

1. Computation for the Confidence Level:

e = 100% - 90%

= 10% = 0.10

2. Sample Size:

n= 568 / 1+568 (0.10)2

n=568 / 6.68

n= 85 respondents.

28

Attributable to the scarcity of studies have done in the area of sports

supplementation, and for the convenience and inducement of the results; the

researcher examined 100 bodybuilders instead of 85.

3.4 Inclusion Criteria:

The subjects who were eligible to participate in the study were male

bodybuilders attending the selected bodybuilding centers during the period of

the study.

3.5 Exclusion Criteria:

Females, and athletes who are not bodybuilders were excluded.

3.6 Preliminary Study:

Initially, articles and researches in relation to the topic were extensively

reviewed. in October 2016, a pilot study had been performed in Khartoum state.

The questionnaire was developed concerning the objectives whereas about 15

bodybuilders were chosen randomly. Participants in the pilot study were not

included in the main study. Time for filling the questionnaire and the

effectiveness of the questions were identified to achieve the research goals.

Some questions were excluded and others were added.

3.7 Data Collection Techniques:

Collection of data was obtained during the working hours from 06:00

p.m. to 09:00 p.m. Usually bodybuilders trained as groups; therefore the

29

researcher projected to visit each center more than one time in successive days

to ensure most coverage of the different bodybuilders groups. The first method

of data collection was through preliminary information obtained from previous

researches, articles and official sectors. The second method was an interview

questionnaire designed to recall information on different dimensions.

3.7.1 Primary data and information:

The primary data was collected in Khartoum, provided by some

personnel from different institutions such as Ministry of Youth and Sport,

Bodybuilding Federation and Rafeef company for dietary supplements. Other

information was obtained through reviewing previous articles, researches and

books.

3.7.2 Interview questionnaire:

An interview questionnaire was filled with 100 bodybuilders between the

ages

of 17 and 52 years from the previously mentioned centersto recall all the

necessary information. The questionnaire consisted of 26 questions divided into

the Four following sections:

a- Demographic Characteristics Section:

This included questions on the age and the distribution of bodybuilders

around Khartoum state.

30

b- Training Pattern Section:

This included questions about the initiation, reasons, duration and

frequency of bodybuilding training.

c- Use of Supplements Section:

This included questions on the use of supplements, reasons for either

consumption or no consumption, types consumed, supplement dose, availability

of the supplement, advice on using the supplement, and knowledge about both

the benefits and the potential side effects of the supplements.

d- Bodybuilding Nutrition and Nutritional Knowledge Sources Section:

This included questions on the degree of awareness about bodybuilding

nutrition, and from where they got the information concerning nutrition and

supplements and why.

3.8 Statistical Analysis and Presentation:

Statistical analyses were done using; the Statistical Package for the Social

Sciences program (SPSS) version 21. Then, the data were presented and

formulated into tables, charts and figures using Microsoft Office Excel 2007.

Data were also analyzed by means of chi-square test ( χ2) with a (P < .05)

significance level.

31

3.9 Limitation of the Study:

The researcher stumbled upon various following constrictions:

▪ Lack of similar published dissertations conducted on Sudan to reflect

back on.

▪ Lack of documented information regarding bodybuilding in Sudan.

▪ The working time in the bodybuilding centers was limited and at late

timing for the researcher.

▪ Large number of bodybuilders refused to participate and some centers

were unpractical to be reached by the researcher.

3.10 Study Ethics:

In this dissertation, a documented permission slip was given to the

institutions, centers and gyms authorities. Verbal authorization was achieved

concerning the selected centers and gyms. Vocal consent was also obtained

from bodybuilders in order to carry out the interview questionnaire.

32

Chapter Four

4. Results

This study was intended to investigate the use of sports supplements

among male bodybuilders attending sport centers in Khartoum state. Hundred

bodybuilders were participated in this study after their consent. Data was

collected from nine sites: Al-sajana youth center, Burri sports club, al-Qurashi

gym (Khartoum locality), youth center, al-mohandiseen sports city (Omdurman

locality), Al-shaabeia youth center, al-etihad albahrawi center, Magnom fitness

gym, and family club gym (Khartoum North locality).

The results of this descriptive and cross sectional study were presented in

tables, charts, and figures using SPSS version 21 and Microsoft Excel 2007.

Data were also analyzed by means of chi-square test whereas P-value less than

0.05 was considered significant. For more clarification and elucidation of the

results, the researcher divided this chapter into Four sections: section one

describes the demographic characteristics of the participated bodybuilders,

section two displays the general information about bodybuilding training

pattern, section three demonstrated information about the use of supplements

among bodybuilders, and finally section Four exemplifies the bodybuilding

nutrition and nutritional knowledge sources of the studied group.

33

Section One:

Figure (1): Distribution of Bodybuilders

Figure (1) describes the distribution of the bodybuilders participated in this

study. The majority of the bodybuilders were from Khartoum North locality

(38%), and Khartoum locality (34%).

Figure (2): Age of Participants

34%

28%

38%

Khartoum

Omdurman

KhartoumNorth

0%

20%

40%

60%

80%

15-25 26-35 > 35

63%

33%

4%

34

Figure (2) represented the age of participants. Most of the participant’s age

were between 15-25 years (63%).

35

Section Two:

Table(1): General Information about Bodybuilding Training Pattern

Frequency %

Startof

Bodybuilding

Sport

A month Ago 12 12%

3 months Ago 20 20%

6 months Ago 14 14%

>6 months Ago 54 54%

Total 100 100%

Level of Training

Beginner 22 22%

Intermediate 59 59%

Advanced 16 16%

Competitor 3 3%

Total 100 100%

Reasons of

Choosing

Bodybuilding

Sport

Increase Muscle Mass 18 11.1%

Fat Burn 11 6.8%

To Compete in Bodybuilding Competitions 19 11.7%

Tor Body Image 41 25.3%

Weight Gain 18 11.1%

Weight Reduction 13 8.0%

Overall Health 42 25.9%

Total 162 100%

Frequency of

Bodybuilding

Training

Everyday 10 10%

2-3 days/ week 49 49%

4-6 days / week 41 41%

Total 100 100%

Duration of

Bodybuilding

1-2 hours / day 93 93%

3-4 hours/ day 7 7%

36

Training >4 hours / day 0 0%

Total 100 100%

Table (1) shows that, the majority of the respondents were initiated the

bodybuilding sport before more than 6 months by (54%) while (12%) of the

respondents claimed that they started this sport more recently; about a month

ago. (59%) were intermediate bodybuilders. The most popular reasons for

choosing the sport of bodybuilding were for overall health and for body image

according to (25.9%) and (25.3%) of the bodybuilders. Almost half of the

bodybuilders (49%) were train 2-3 days per week and the majority (93%) were

spend 1-2 hours per day in the training session.

Section Three:

Figure (3): Prevalence of Supplements Use among Bodybuilders

Figure (3) indicated low prevalence of supplements use among the studied

bodybuilders by (23%)

0%

20%

40%

60%

80%

Yes No

23%

77%

37

Table (2): Information about Supplements Use among Bodybuilders

Frequency %

Reasons for not

using supplement

Expensive 6 6%

Not beneficial 4 4%

Not Available 2 2%

I don't Need It 36 36%

It's Harmful 25 25%

I don't Know about It 4 4%

Total 77 77%

Reasons for use

of supplement

Performance Enhancement 9 9%

Increase Muscle Mass 10 10%

Fat Burn 2 2%

Complement the Diet 2 2%

All 9 9%

Total 23 23%

Duration of

Supplement Use

by Bodybuilders

< Month 1 1%

Month 7 7%

2-3 Months 7 7%

6 Months 3 3%

> 6 Months 5 5%

Total 23 23%

As exhibited by table (2), (36%) of bodybuilders were not using

supplements because they believed that they don’t need it while (25%) stated

that supplements are harmful. Only (2%) claimed that supplements are not

available. The majority of bodybuilders (10%) were used supplements to

increase their muscle mass. Most of these bodybuilders were used the

38

supplements for short periods ranged between month and three months by (7%)

while only (1%) were used it for less than month.

Figure (4): Types of Supplements Used by Bodybuilders

Figure (4) displays that the most common types of supplements used by

bodybuilders were whey protein and serious mass by (18.6%).

Table (3):The Supplement Dose Used by Bodybuilders

Frequency %

As Recommended 23 23%

Don’t Use 77 77%

Total 100 100%

Table (3) indicated that all the bodybuilders were used supplements in

accordance to the instructions of use by (23%).

9.3%

16.3%

9.3%

18.6%

2.3%4.7%

18.6%

14%

4.7%2.3% 2.3%

39

Table (4): Availability of the Supplements used by Bodybuilders

Frequency %

Available at the Gym/ Center 1 1%

From Outside 20 20%

From the Coach 2 2%

Total 23 23%

Table (4) pointed that supplements were not readily available as reported

by the majority of the respondents (20%) who claimed getting the supplements

from outside.

Table (5): Influences on the Decision of Supplement Use

Frequency %

The Coach 7 7%

Dietician/ Nutritionist 1 1%

Friend 5 5%

Personal Decision 9 9%

Doctor 1 1%

Total 23 23%

As shown in table (5), most of the bodybuilders were decided to use the

supplements based on their own point of view as stated by (9%) and only (1%)

were advised by dietician/ nutritionist.

40

Table (6): Bodybuilders Information About the Side/ Adverse Effects of

Supplements

Responses

N %

Health problems (Cardiovascular, Renal, Liver) 38 30.9%

Water retention 3 2.4%

Cancer 7 5.7%

Muscle Breakdown 21 17.1%

Infertility 9 7.3%

Replacement of Food 1 0.8%

Not harmful 17 13.8%

Dehydration 1 0.8%

I don't know 26 21.1%

Total 123 100%

Table (6) presented the information of bodybuilders about the side/ adverse

effects of the supplements. A relatively high percentage of the respondents

affirmed that supplements are related to different health

problems(cardiovascular, renal, liver).

41

Table (7): Bodybuilders Information About the Benefits of Supplements

Responses

N %

Muscle Building/ Hypertrophy/ Shape 60 47.2%

Performance Enhancement/ Endurance and Fitness 22 17.3%

Complement the Diet 8 6.3%

Recovery 4 3.1%

Hydration 1 0.8%

Energy Booster 8 6.3%

I don't Know 24 18.9%

Total 127 100%

The overhead table shows that less than half of the respondents (47.2%)

believed that supplements were beneficial for muscle building/ hypertrophy and

shape.

42

Section Four:

Figure (5):Special Dietary Regimen for Bodybuilding

As illustrated by figure (5), about two thirds of the bodybuilders (66%)

were following a special dietary regimen for bodybuilding.

Table (8): Existence of Nutritionist at the Center/ Gym

Frequency %

Nutritionist Existence at

the center/ gym

Yes 11 11%

No 89 89%

Total 100 100%

Table (8) disclosed that only (11%) of the bodybuilders reported that there

were a nutritionist in the center/gym while the majority (89%) reported

otherwise.

0%

10%

20%

30%

40%

50%

60%

70%

Yes No

66%

34%

43

Table (9): Role of Nutritionist in the Center/ Gym

Frequency %

Role of

Nutritionist

Take Anthropometric Measurements 6 18.8%

Assess the Nutritional Status 8 25%

Calculate the Nutritional Requirements 3 9.4%

Plan the Diet 7 21.9%

Advice and Counsel 8 25%

Total 23 32

Table (9) demonstrated the role of nutritionist in the sport center/ gym.

Quarter of the respondents reported that the role of nutritionist is to assess the

nutritional status (25%). (21.9%) stated that the Nutritionist is taking the

anthropometric measurements while only (9%) assured that he/ she is

calculating the nutritional requirements.

44

Figure (6): Source of Nutrition and Supplements Information

Figure (6) illustrated that the majority of the bodybuilders (36.6%) were

refered to their coaches as source of informamtion concerning nutrition and

supplements. It also highlighted a large dependency on internet for obtain the

nedded informaion by (32.4%) of the bodybuilders.

Table (10): Reasons for not consulting a Nutritionist/ Dietician

Frequency %

Not available 29 34.7%

Not qualified 5 5.9%

Expensive 5 5.9%

I don't need them 38 45.2%

I don't know about them 1 1.2%

I don't have time 6 7.1%

Total 84 100%

36.6%

11.3%

2.1%

32.4%

13.4%

2.1% 0.7% 1.4%

45

Table (10) displayed the reasons beyond not referring to dieticians/

nutritionist as the source of nutritional information. As shown in the table

(45.2%) of the respondents assured that they don’t need them followed by

(34.7%) who reported that they were not available.

Chi- Square Test:

Table (11): Chi- Square Test

α= 0.05

p. value Chi-square Decision

Age will influence the use of supplement 0.392 1.874 Reject

Level of training will influence the Use of

supplement 0.011 11.108 Accept

As the p. value= (0.39) which is greater than (α= 0.05), therefore the

researcher rejected the null hypothesis: age of bodybuilder will affect the use of

supplements. As the p. value= (0.011) which is less than (α= 0.05), therefore the

researcher accepted the null hypothesis: level of training will affect the use of

supplements.

46

Chapter Five

5. Discussion

This study is designed to assess the prevalence of sports supplements used

by bodybuilders in Khartoum state using an interview questionnaire. The

groups under investigation were randomly selected from Khartoum North

locality (38%), Khartoum locality (34%), and Omdurman locality (28%). A

Total of hundred bodybuilders were participated in this study.

The objectives of the study were to: compute the prevalence of sports

supplements used by bodybuilders attending sport centers/ gyms, assess the

knowledge of the studied group about the sports supplements benefits and

adverse effects, as well as to explore the sources that impact the choices of

athletes about sports supplements in Khartoum state, Sudan.

Findings from figure (2) represented that, most of the participant’s age

were between 15-25 years (63%). Table (1) showed that, the majority of the

respondents were initiated the bodybuilding sport before more than six months

(54%) while (12%) of the respondents claimed that they started this sport more

recently; about a month ago. (59%) were intermediate bodybuilders. The most

popular reasons for choosing the sport of bodybuilding were for overall health

and for body image according to (25.9%) and (25.3%) of the bodybuilders.

Almost half of the bodybuilders (49%) were train 2-3 days per week and

the majority (93%) were spend 1-2 hours per day in the training session.

Training routine of the studied bodybuilders is consistent with other studies.

Thomas & Burns (2016) stated that several studies suggested no differences in

47

the efficacy between lower frequency and higher frequency training while other

research indicated that two or three training sessions per muscle per week may

produce up to twice the increase compared to one training session per week per

muscle group (Thomas & Burns, 2016).

Considering the use of sports supplements among bodybuilders, this study

indicated low prevalence of supplements use (23%) comparing to other research

that demonstrated 100% use of supplements by bodybuilders (Aljaloud, 2015).

About (61%) of the studied group believed that supplements were not needed

and may harm health. On the other hand, about (2%) stated that supplements

were not available. The majority of bodybuilders (10%) used supplements to

increase their muscle mass, while (9%) were used them for performance

enhancement [Figure (3), Table (2)]. Reasons for supplement use were in line

with other studies. In Canada, athletes declared use of supplements to stay

healthy, increase energy, immune system, recovery, and overall performance

(Wiens et al. 2014). Another study has reported that (65%) of elite athletes

believed that nutritional supplements may enhance performance (Carlsohn et al.

2011). Furthermore, Almukhtar et al. (2015) relayd bodybuilders use of dietary

supplements to: strength acquirement and body bulking (Almukhtar et al. 2015)

The most common types of supplements used by bodybuilders were whey

protein and serious mass (18.6%) [Figure (4)]. Serious mass is a protein powder

weight gainer which supports the growth of lean muscle mass. Ibanez et al.

(2014) reported a high use of protein powders(82.5%) among resistance-trained

men(Ibanez et al. 2014). Moreover, a high use of protein powder were observed

among male collegiate athletes and college students (69% and 40%

respectively) (Rosenbloom & Murray, 2015, Stuntz et al. 2014) The results

48

from the same previous study indicated that the majority of athletes (94.6%) use

protein powder to improve performance (Stuntz et al. 2014)Gokaya et al.

(2014) stated that whey protein is the most popular ergogenic aid consumed by

athletes (Gokaya et al. 2014)Interestingly, all bodybuilders (23%) reported

using supplements in accordance to the instructions of use. [Table (3)]

Regarding the availability of the sports supplements, the majority of the

respondents (20%) claimed getting the supplements from outside [Table (4)].

On the contrary to this, Aljaloud & Ibrahim (2013) declared that (65.3%) of the

Saudi professional athletes were buying supplements from trainers or

physicians, and less than (5.1%) were purchasing supplements from online

stores and other sources. (Aljaloud & Ibrahim, 2013). Most of the bodybuilders

were decided to use the supplements based on their own point of view as stated

by (9%) and only (1%) were advised by dietician/ nutritionist [Table (5)].

According to Wiens et al. (2014), athletic trainers were more likely to influence

strength athletes supplement choices (Wiens et al. 2014).

About one third of the respondents (30.9%) affirmed that supplements may

lead to different health problems(cardiovascular, renal, liver), while less than

half of the respondents (47.2%) believed that supplements were beneficial for

muscle building, hypertrophy and shape. Attentively, (40%) of the participants

were not confident about the benefits and side/ adverse effects of supplements

[Tables (6-7)].

Approximately, two thirds of the bodybuilders (66%) were following a

special dietary regimen for bodybuilding [Figure (5)]. The majority of these

bodybuilders (89%) reported that there was no nutritionist available in the

49

center/gym while only (11%) stated otherwise [Table (8)]. Quarter of the

respondents accounted that the role of nutritionist is to assess the nutritional

status (25%). (21.9%) stated that the nutritionist is taking the anthropometric

measurements while only (9%) assured that he/ she is calculating the nutritional

requirements [Table (9)].

The largest part of bodybuilders (36.6%) were refered to their coaches as

the source of informamtion concerning nutrition and supplements. Additionally,

a considerable dependency on the internet for obtaining the nedded informaion

were assertd by (32.4%) of the bodybuilders along with a low referal to

dietecains (11.3%) [Figure (6)]. These findings were fairly in conjunction with

several studies. Castell et al. (2015) considered coaches as an important source

of information on dieatary supplements. (Castell et al. 2015). Also, the main

sources of information for Canadian athletes were family, friends, coaches, and

athletic trainers. Conversely to this study, (48%) of the Canadian athletes were

met a dietician (Wiens et al. 2014). On the other hand, most Saudi professional

athletes (45.9%) stated that their main source of information on dietary

supplements was a physician, followed by nutritionist (28.5%) and coach

(11.2%) while less than (10%) referred to journals, magazines, and online

resources (Aljaloud, 2015). Bodybuilders who did not refer to dieticians as a

source of information were asked for their reasons. (45.2%) of the respondents

assured that they don’t need them while (34.7%) reported that they were not

available [Table (10)].

With regards to the Chi-square test, a strong significance was detected

between the level of training and the use of supplements (P= 0.01).

Correspondingly, most surveys found that supplement use were reported by

50

(80%- 90%) elite athletes around the world (Rosenbloom & Murray, 2015).

Weak significance was observed between age and use of supplements.

Similarly, younger Danish athletes were more prevalent in using supplements

(Solheim et al. 2016).

51

Conclusions and Recommendations

Conclusions:

This study was performed to investigate the sports supplements use

among bodybuilders in Khartoum state with regards to the prevalence of

use, knowledge of the studied group about the sports supplements

benefits and adverse effects, and the sources that impact the choices of

athletes about sports supplements. The researcher concluded that:

1. The prevalence of sports supplements use among bodybuilders was

found to be low (23%).

2. The most commonly supplements used were: whey protein, and

serious mass (18.6%).

3. The primary reason for supplement use was to increase muscle

mass (10%).

4. (40%) of the studied group have a low level of nutritional

knowledge regarding supplementation.

5. Low availability of nutritionists/ dieticians in the sport centers/

gyms.

6. Coaches were the main source of information concerning nutrition

and sports supplements.

7. Very few athletes (11.3%) have access to dietetic/nutrition

professional fordietary evaluation and nutritional counseling.Level

of training was significantly influence the use of supplements (P=

0.01)

52

Recommendations:

The researcher recommended the following:

1. Ministry of youth and sport should pay more attention regarding the

sports nutrition and supplementation by:

▪ Establishing a compulsory periodic educational programs for both

athletes and professional (coaches, athletic trainers, physicians… etc)

who were a major source of trusted information by uneducated

athletes.

▪ Setting eligibility criteria and regulations for certification and

registration of athletic trainers/ coaches … etc

▪ Recruiting a qualified dietetic/nutritional professionals to support

athletes in their choices through dietary evaluation and nutritional

counseling.

2. Ministries of Education/ higher education and scientific research should

put more effort with regards to the capacity building and training of

dieticians/ nutritionists by initiating a national accredited programs in

consistent with the international standards.

3. Bodybuilding federation should establish a valid, up to date data base to

facilitate further studies in this area.

4. Large scale studies were recommended to be conducted in order to

enrich the country’s data bases should be supported by collaboration and

coordination between different sectors and authorities.

53

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جامعة الرباط الوطين

كلية الطب- برنامج ماجستري التغذية البشرية والعالجية

استبيان حول استخدام املكمالت الرياضية من قبل رياضيي بناء األجسام

: البيانات األساسية: أوًلا

العمر:

25 - 15 26 – 35 > 35

...............................املركز/ الصالة الرياضية:................................................................

ثانياا: معلومات متعلقة برياضة بناء األجسام:

مىت بدأت ممارسة رياضة بناء األجسام؟ • منذ شهر قبل ثالثة أشهر أشهر 6قبل أشهر 6أكثر من

املستوى الرياضي: • مبتدئ متوسط متقدم حمرتف

72

]ميكن اختيار أكثر من إجابة هلذا السؤال [ملاذا متارس رياضة بناء األجسام؟ )اهلدف( • زيادة الكتلة العضلية حرق الدهون املشاركة يف منافسات بناء األجسام حتسني الصورة اجلسمانية زيادة الوزن نقصان الوزن ............:(.....................................................................أخرى)حدد

تدّرب يف األسبوع؟كم يوماا ت • يوميًّا 2-3 أيام يف األسبوع 4-6 أيام يف األسبوع

كم ساعة تتدّرب خالل اليوم؟ • ساعتني -ساعة ونصف 3-4 ساعات >4 ساعات

ثالثاا: استخدام املكمالت الرياضية:

هل تستخدم املكمالت الرياضية؟ • نعم ًل

إذا كانت اإلجابة )ًل( ملاذا؟ • سعرها مرتفع ليست مفيدة ليست متوفرة ًل أحتاجها

73

ضارة ًل أعرفها

إذا كانت اإلجابة )نعم( منذ مىت؟ • شهر < شهر 2-3 شهور 6 شهور >6 شهور

ملاذا تستخدم املكمالت؟ • حتسني األداء زيادة الكتلة العضلية حرق الدهون مجيع ما سبق حدد:أخرى(.........).............................................................................

]ميكن اختيار أكثر من إجابة [ما نوع املكمالت اليت تستخدمها؟ • كرياتني(creatine) ( األمحاض األمينة متفرعة السلسلةBCAA ) الربوتني واي بروتني(Whey protein) كيزين بروتني(casein protein) جلوتامني(Glutamine) ..........:(............................................................................أخرى)حدد

ما هو املقدار )اجلرعة( املستخدم من املكمل؟ )جم/اليوم( • .حسب التعليمات املرفقة حدد:..........أخرى(............................................................................)

74

من أين حتصل على املكمل الرياضي؟ • متوفر يف املركز/ الصالة الرياضية صيدلية حدد:..........أخرى(............................................................................)

من نصحك باستخدام املكمل الرياضي؟ • املدرب الرياضي اختصاصي التغذية حدد:..........أخرى(............................................................................)

ماذا تعرف عن املضار أو اآلثار اجلانبية للمكمالت الرياضية؟ •

........................................................................................................................................................................................................................................

........................................................................................................................................................................................................................................

ماذا تعرف عن فوائد املكمالت الرياضية؟ •....................................................................................................................

........................................................................................................................................................................................................................................

....................................................................................................................

رابعاا: معلومات عن التغذية:

هل تتبع أي نظام غذائي خاص ببناء األجسام؟ • نعم ًل

75

الرياضية؟هل يوجد اختصاصي تغذية باملركز/ الصالة • نعم ًل

]ميكن اختيار أكثر من إجابة [إذا كانت اإلجابة )نعم( ما هو الدور الذي يقوم به؟ • أخذ القياسات اجلسمانية تقييم احلالة التغذوية حساب السعرات واًلحتياجات التغذوية ختطيط الوجبات التوجيه واإلرشاد

ميكن اختيار أكثر من [من أين حتصل على املعلومات والنصائح املتعلقة بالتغذية واملكمالت الرياضية؟ • ]إجابة

املدرب الرياضي اختصاصي التغذية )وسائل اإلعالم )التلفاز، املذياع... اخل اًلنرتنت حدد:..........أخرى(............................................................................)

ملاذا ًل تستعني باختصاصي التغذية؟ • غري موجود غري مؤهل تكلفة اًلستشارة مرتفعة حدد:..........أخرى(............................................................................)