The Truth about “Ergogenic” Supplements

1. The Truth about “Ergogenic” Supplements By Adam Morse, D.O. Dept of Orthopedic Surgery Garden City Hospital Garden City, MI

2. Introduction • Nutritional/Dietary Supplementation is a very lucrative buisness in the United States • Consequently there are millions of dollars spent annually on claims of weight loss, muscle building, and performance enhancement • They include Vitamins, Minerals, Anabolic Steroids, Amino Acids, Digestive Enzymes, Methylxanthines, Ephedrine, Fatty Acids, Coenzymes, Laxatives, Ginseng, Diuretics, Aminopolysaccharides, and many other products/extracts.

3. Introduction • With millions of claims being made in the industry, patients will be turning towards physicians to answer questions about them • Information sources are numerous, but the following was from a presentation at the May, 1999 annual AOSSM: an NFL perspective, meeting presented by Leslie Bonci, M.P.H., R.D.

4. Androstenedione • Adrenal Hormone • (+) Acts like testosterone, produces as anabolic effect, increasing lean muscle mass, and a decrease in body fat • (-) Testosterone spike, increased aggression, mood swings, banned by the NFL • Wouldn’t recommend it

5. Dehydroepiandosterone (DHEA) • Adrenal Hormone • (+) Anabolic effect • (-) Increases testosterone levels, banned by the NFL • Under no circumstances

6. Tribulus Terrestris • AKA- Tribestan, Triboxin • Plant hormone • (+) Anabolic effect • (-) Increases testosterone levels, banned by the NFL • Don’t use this

7. Gamma-Hydroxybutyrate (GHB) • Cellular component • (+) Anabolic effects • (-) Sedative effect similar to EtOH and tranquilizers, not approved for sale in the United States • Very powerful drug, may cause seizures or a comatose state

8. Yohimbine • Supplement derived from tree bark • (+) Anabolic effect, increased virility • (-) Stimulant, no anabolic effect, can cause dizzyness nervousness, HA, nausea, vomiting, increased BP, can interfere with BP medication and increase toxicity of psychotherapeutic medications • Don’t bother

9. Vanadium • AKA- Vanadyl sulfate • A non-essential trace mineral • (+) Anabolic effect, enhances insulin action • (-) No proven anabolic effect, at doses >10 grams / day can cause abdominal pain, cramping, green tongue, diarrhea, and weight loss • No reason to take it!

10. Boron • A trace mineral • (+) Increases testosterone levels • Involved in cellular function • >50 mg per day can decrease appetite and digestion • In a multivitamin supplement it is OK, otherwise more is not better!

11. Chromium • Essential mineral involved in blood sugar control • (+) Increases lean body mass, decreases fat • (-) May be helpful in diabetics in regulating blood sugar levels • Safe dose is 50-300 mcg/day, and more is not better

12. Branch Chain Amino Acids • Essential Amino Acids (isoleucine, leucine, and valine) • (+) Delay fatigue by sparing the bodies fuel source, glycogen, increases growth hormone levels and muscle mass • (-)May decrease fatigue, may cause nausea, vomiting, and diarrhea, may inhibit absorption of other amino acids causing an imbalance • Not necessary with proper diet

13. Conjugated Linoleic Acid • Naturally occurring fatty acid found in beef, lamb and dairy products • (+) Increased muscle gain, decreased body fat, antioxidant • (-)No effect on performance observed • Not necessary, better to eat beef, lamb, and dairy products

14. Creatine • Muscle fuel occurring naturally in meat and fish, and produced in the liver from 2 nonessential amino acids (glycine & arginine) • (+) Increased speed and muscle mass, and decreased effort of exertion • (-) Provides extra energy for short-burst activity • Causes water retension of 4-7 lbs, possibly later converting to muscle • Dose- 5gms qid for 7 days then 2 gms q day

15. Beta-hydroxy-beta-methyl-butyrate (HMB) • Amino Acid Derivative, not an essential nutrient • (+) Increased muscle mass, improved muscle repair • (-) 1 study showed prevention of protein breakdown with intense strength training • 3 mg / day

16. Calorad • Water and collagen • (+) Promotes weight loss • (-) Contains 4 gms poorly absorbed protein at 14 calories per tablespoon • Expensive, ineffective

17. Pyruvate • AKA- Fat assasin • Product of carbohydrate metabolism in Kreb’s cycle of glycolosis • (+) produces weight loss, increases body fat loss • (-) May cause weight loss in obese patients, but may cause diarrhea and stomach upset at effective doses • Exercise is safer and more effective

18. Glucosamine Sulfate & Chondroitin Sulfate • Aminopolysaccharides that are the structural components of ligamants, tendons, and joints • (+) Restores articular cartilage, alleviates pain • (-) Stimulates cartilage growth and prevents cartilage breakdown, alleviates pain comperable to 800mg motrin tid • Rare side effects includestomach upset, rash, drowsiness, and HA

19. Carnitine • Vitamin-like compound involved in breaking down fatty acids • (+) Decreases body fat • (-) May prevent lactic acid accumulation to delay fatigue in sprint type activities, D-carnitine may cause muscle weakness • Not effective, wouldn’t recommend it

20. Coenzyme Q • AKA: CoQ10, Ubiquinone • Produced by the body in the mitochondria • (+) Enhances performance, delays fatigue, prevents injury • (-) May be involved in energy release, is an antioxidant, may be helpful in patients with heart disease • Safe levels are 60-200 mg/day, very expensive

21. Digestive Enzymes • AKA- Bromelain, Trypsin, Phytin • Enzymes from foods • (+) Increased body fat loss • (-) Breaks down protein to amino acids, no studies to prove these are effective • Probably not worth it

22. Caffeine • A methylxanthine found in coffee beans, cocoa beans, cola nuts, and tea leaves • (+) Stimulant, increases plasma free fatty acid availability thus delaying fatigue, improves reaction time, and reducing perceived effort of exertion • (-) Stimulant that may cause nervousness, anxiety, HA’s, diarrhea, polyurea, dehydration • 200-300mg 1 hr prior to an event appears safe and effective, 800mg is max legal limit

23. Blue Nitro • AKA- Blue Nitro Vitality, Revivarant G, GH Revitalizer, GHR, Remforce, Renewtrient, Gamma G • Chemical compound- Furanone-di-hydro with gamma butyrolactone (very potent) • (+) Increases bodies human growth hormone, decreases fat, increases virility, combats stress, improves sleep • (-) No published studies, interacts with alcohol and other medications, may cause seizures or a comatose state. Dangerous!!

24. Dieter’s Tea • Senna, Cascara, Buckthorn, Aloe • (+) Promotes weight loss and fat loss • (-) Laxative effect causing diarrhea, vomiting, water loss, dehydration, hypotension, arrhythmia • Drink regular tea instead

25. Ephedrine • Drug found in herbal products containing Ma Huang, anti asthmatic medications, and many cold and cough preparations • (+) Increases boby fat loss • (-) CNS stimulant, may delay fatigue by sparing glycogen reserves, can increase BP, RR, HR, or cause insomnia and nervousness • Do not take with caffiene, theophylline, elavil, or psychotherapeutic medications • Max dose 24 mg / day

26. Ginseng • Root from an Asian plant, (Panax Ginseng) • (+) Enhances performance, improves recovery rate • (-) Immune stimulator, may cause insomnia, should not be used in patients with elevated BP, on coumadin, or psychotherapeutic drugs • 100-200mgs / day of 4-7% ginsenosides, 2-3 weeks on, 1-2 weeks off

27. Hydroxycitrate • AKA- Citrimax • Fruit acid extract from the Garcinia Cambogia plant • (+) Decreased body fat, increased muscle glycogen storage to delay fatigue • (-) diuetic effect, nothing else proven • Don’t recommend this

28. Thank you Adam Morse, DO Severe short timer’s syndrome