Nutrition and Nutritional Supplements in Sports

1. Nutrition and Nutritional Supplements in Sports

2. Objectives • Increase awareness that nutrition can affect an athlete’s performance • Discuss current nutritional recommendations for athletes • Review the 1994 Dietary Supplement Health and Education Act • Definition of a supplement • Impact of this legislation • Discuss specific nutritional supplements commonly used by athletes • Do they work? • Are they safe? • Review the Anabolic Steroid Control Act of 2004 • Help providers answer questions and address concerns of athletes, parents and coaches

3. Performance Influencing Factors • Genetics • Training and Conditioning • Nutrition

4. Determinants of the Athlete’s Energy Requirements • During intense exercise • Carbohydrate stored in muscles and liver (glycogen) is predominant fuel source • During prolonged exercise • Fat stores are predominant fuel source • Fitness level of the athlete • Well trained endurance athletes burn fat more efficiently, sparing limited glycogen stores

5. Formula for Estimating the Body’s Calorie Requirements • Sedentary person • Weight (kg) x 25 • Moderately active person • Weight (kg) x 30 • Active person (endurance athlete) • Weight (kg) x 40 • Underweight person • Weight (kg) x 45 • kg = lbs / 2.2

7. Carbohydrates • Non-essential nutrient (human body can make sugar) • Simple (sugars) and Complex (starches) • Major fuel source for exercising muscle • Athletes should ingest 6 to10 gm/kg/day • 60 to 70% of total calories should come from carbohydrates • Complex carbohydrates (starches) are preferable • During exercise • Athletes should consume 25 to 30 gm of carbohydrate for every 30 minutes of exercise • Athletes should drink 6 to 8 ounces of water or sports drink for every 10 to 15 minutes of exercise

8. Carbohydrates • After exercise • Athletes should consume 1.0 to 1.5 gm/kg immediately post exercise and again one hour later • To replace muscle glycogen stores • To prevent gradual depletion of muscle glycogen stores over time caused by repetitive daily bouts of heavy exercise • To decrease muscle breakdown

9. Why Complex Carbohydrates? • Compared to ingesting simple carbohydrates, ingesting complex carbohydrates: • Increases muscle glycogen stores better • Improves performance and delays fatigue • Promotes faster stomach emptying • Causes less stomach upset and indigestion • Leads to lower blood sugar and insulin levels • Provides other beneficial nutrients • Fiber, vitamins and minerals

10. Pre-exercise Meal • Importance • Less hunger before and during exercise • Maintains optimum glycogen stores • Recommendations • Emphasize complex carbohydrates (starches) • 1 to 4 gm/kg about 1 to 4 hours prior to event • Consume less closer to event • Avoid high fat and high protein foods • Slower gastric emptying can cause stomach upset • Avoid high fiber or gas forming foods • Can lead to crampy abdominal pain

11. Carbohydrate Loading • Increases the body’s pre-exercise glycogen stores by 50 to 100% • Benefits endurance athletes who compete for longer than 90 minutes • Can increase endurance up to 20% • Can increase performance by 2 to 3%

12. Carbohydrate Loading:One Example of How Days prior to eventExercise durationCarbohydrate intake 6 90 minutes 5 gm/kg/day 5 40 minutes 5 gm/kg/day 4 40 minutes 5 gm/kg/day 3 20 minutes 10 gm/kg/day 2 20 minutes 10 gm/kg/day 1 rest 10 gm/kg/day

13. Protein • Athletes require more protein than non-athletes • 12 to 18% of total calories should come from protein • Protein intake should be tailored to type of training • 1.2 to 1.4 gm/kg/day recommended for endurance athletes • 1.7 to 1.8 gm/kg/day recommended for strength athletes • Average American diet provides 1.4 gm/kg/day • Adequate calorie intake is just as important as adequate protein intake for building muscles • Too much protein intake can be bad • Excess protein calories are stored as fat • Excess protein intake can lead to dehydration and may contribute to kidney problems

14. Fat • Major source of energy • 25 to 30% of total calories should come from fat • Less than 10% of total calories should come from saturated fats • Cholesterol intake should be less than 300 mg/day • Average American diet provides 37% of total calories from fat

15. Nutritional Supplements • 1994 Dietary Supplement Health and Education Act • Definition of a supplement • Any product that contains vitamins, minerals, amino acids, herbs, botanicals or a concentrate, metabolite, constituent, extract or combination of any of these ingredients • Removed dietary supplements from FDA regulation on the front end • FDA must prove a supplement is dangerous before its sale can be prohibited

16. Nutritional Supplements • 1994 Dietary Supplement Health and Education Act • Manufacturers do not have to provide scientific proof of claims • Manufacturers cannot state product is meant to diagnose, treat, prevent or cure a disease but can make indirect suggestions • Created a multi-billion dollar industry that continues to grow rapidly

17. Vitamins and Minerals • Essential nutrients • Human body needs these to produce energy • No evidence in U.S. studies that taking vitamin and mineral supplements improves athletic performance • Being deficient in vitamins or minerals is rare in the U.S. compared to the rest of the world • A few studies outside U.S. showed an effect • Did population studied have some baseline deficiency treated with these supplements? • Vegetarian athletes are at risk for being deficient in vitamins B12, D, riboflavin, iron, zinc and calcium • Athletes who are strict vegetarians should take a multivitamin to prevent deficiencies and a calcium supplement (1000 mg/day) to help prevent bone loss

18. Ephedra or MaHuang • Herbal forms of the stimulant ephedrine • 80 confirmed deaths related to ephedra use • Experts suspect many more unconfirmed deaths • Adverse effects • High blood pressure (most common) • Palpitations and increased heart rate • Seizure • Thermoregulatory dysfunction • Stroke • Heart attack • Sudden death • Vasculitis • Allergic myocarditis (one case reported) • Acute hepatitis (one case report)

19. Ephedra or MaHuang • Following the death of two professional athletes, FDA banned sale of Ephedra as a nutritional supplement • Since this time, manufacturers have started substituting other stimulants • Citrus Aurantium • Orange extract • Chemical structure very similar to ephedrine

20. Anabolic Steroid Precursors • Dehydroepiandrosterone (DHEA) and Androstenedione (“Andro”) • Chemicals that can be converted into testosterone in human biochemical pathways • Naturally available in wild yams • An early study done by a manufacturer of these products showed no significant increase in blood levels of testosterone • Study looked at lower doses of these supplements than are usually taken and did not measure ratio of testosterone to epitestosterone (T:E ratio)

21. Anabolic Steroid Precursors • Subsequent independent scientific studies • DHEA • Does not seem to have much if any effect on fat-free body mass and strength • Androstenedione • Causes a temporary increase in testosterone levels • Has no effect on body’s ability to make protein • Does not seem to have any effect on strength • No long term effect on blood testosterone levels • Chronic use causes increase in estrogen levels

22. Anabolic Steroid Precursors • Potential adverse effects • May cause liver damage • In females • Can cause male features in women • May increase risk of uterus cancer • In males • Can cause female features in men • May increase risk of prostate cancer

23. Anabolic Steroids and Anabolic Steroid Precursors • Are banned and tested for by the USOC, IOC, NCAA, NFL, NBA and MLB • NHL has no official policy and does not perform testing • You can be disqualified from participating in college sports if you test positive for a substance banned by the NCAA • Whether or not you knew it was banned • Whether or not the product was mislabeled

24. Buyer Beware! • IOC funded study by Shanzer (Germany) from 10/00 to 11/01 • Analyzed 634 products labeled as non-hormonal nutritional supplements from 13 countries and 215 different suppliers • 94 products (14.8%) were found to be “positive supplements” (contained anabolic steroid precursors not declared on the label) • Anabolic androgenic steroid concentrations ranged from 0.01 to 190 micrograms per gram of supplement • 23 products contained steroid precursors of nandrolone and testosterone • 64 products contained steroid precursors of testosterone only • 7 products contained steroid precursors of nandrolone only • Percentage of positive supplements per country • 25.8% of products bought in Netherlands • 22.7% of products bought in Austria • 18.8% of products bought in UK • 18.8% of products bought in US (45 positive out of 240 tested)

25. Anabolic Steroid Control Act of 2004 • Signed into federal law on October 22, 2004 • Amends the Anabolic Steroid Control Act of 1990 • Modifies the definition of anabolic steroids to include tetrahydrogestrinone (THG), androstenedione, and specified related chemicals • Directs the U.S. Sentencing Commission (USSC) to review federal sentencing guidelines with respect to anabolic steroid-related offenses • Amends guidelines to provide for increased penalties • Authorizes the Attorney General to exempt from regulation any compound, mixture, or preparation containing an anabolic steroid that does not present a significant abuse potential • Directs the Secretary of Health and Human Services to award grants for science-based education programs in elementary and secondary schools to highlight the harmful effects of anabolic steroids and to ensure that the NSDUH includes questions concerning the use of these drugs. • Source: Library of Congress

26. Conclusions • Nutrition plays an important role in an endurance athlete’s ability to perform • Proper nutrition in combination with sound and proven training techniques can help endurance athletes to maximize their genetic abilities • Certain nutritional supplements have not demonstrated any performance benefit in studies

27. Conclusions • Certain nutritional supplements can have potentially dangerous side effects • Further legislation is needed to address the dangers of some nutritional supplements • Professionals in the community need to be resources of good information for athletes, parents and coaches • Physicians • Physician assistants • Nurse practitioners • Athletic trainers • School nurses • Dieticians

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