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Cayuga Sports Medicine Conference - Supplements Update 2010
Cayuga Sports Medicine Conference - Supplements Update 2010
By Lee A. Mancini, MD, CSCS*D, CSNAssistant Professor UMass Medical School
Faculty UMass Sports Medicine Fellowship
Certified Strength and Conditioning Specialist with Distinction
Certified Sports Nutritionist
By Lee A. Mancini, MD, CSCS*D, CSNAssistant Professor UMass Medical School
Faculty UMass Sports Medicine Fellowship
Certified Strength and Conditioning Specialist with Distinction
Certified Sports Nutritionist
BackgroundBackground
Former D-I athlete / 1999 Boston Marathon Numerous Sprint / Olympic Distance Tris15 years as Certified Sports Nutritionist15 years as Certified Strength & Conditioning Specialist UMass Sports Medicine Physician Sports Nutrition consultant
Boston Red Sox Organization Lowel Devils (NJ AHL affiliate) Worcester Ice Cats (STL Blues AHL) Holy Cross UMass Amherst Assumption College Nichols College
Lived in Ithaca my entire life - graduated from Lansing High School…
Former D-I athlete / 1999 Boston Marathon Numerous Sprint / Olympic Distance Tris15 years as Certified Sports Nutritionist15 years as Certified Strength & Conditioning Specialist UMass Sports Medicine Physician Sports Nutrition consultant
Boston Red Sox Organization Lowel Devils (NJ AHL affiliate) Worcester Ice Cats (STL Blues AHL) Holy Cross UMass Amherst Assumption College Nichols College
Lived in Ithaca my entire life - graduated from Lansing High School…
Goals & Objectives Goals & Objectives
1. Review a brief history of supplements
2. Discuss how to examine supplement claims
3. Review some common supplements
4. Examine supplements specific for triathletes & endurance athletes
5. Ask Questions!
1. Review a brief history of supplements
2. Discuss how to examine supplement claims
3. Review some common supplements
4. Examine supplements specific for triathletes & endurance athletes
5. Ask Questions!
Historical PerspectiveHistorical Perspective
Ancient History Aztecs Chinese Greeks
Ergogenic Ergon gennan
Ancient History Aztecs Chinese Greeks
Ergogenic Ergon gennan
20th Century & Supplements20th Century & Supplements
Brown-Sequard in 1889 1950s Dr. Ziegler
Methandrostenolone IOC
1968 1st list of banned substances
1976 Montreal Olympic Games
Brown-Sequard in 1889 1950s Dr. Ziegler
Methandrostenolone IOC
1968 1st list of banned substances
1976 Montreal Olympic Games
The Supplement IndustryThe Supplement Industry
Nutrition Labeling and Education Act (NLEA) 11/9/1990
Dietary Supplement Health and Education Act (DSHEA) 10/25/1994
Multibillion dollar industry 1994 = 8.3 billion 1999 = 14 billion 2009 = 23.7 billion
Nutrition Labeling and Education Act (NLEA) 11/9/1990
Dietary Supplement Health and Education Act (DSHEA) 10/25/1994
Multibillion dollar industry 1994 = 8.3 billion 1999 = 14 billion 2009 = 23.7 billion
The Supplement IndustryThe Supplement Industry 2002 Health & Diet Survey
73% - 18 and older had used in past year
2006 J of Adolescent Health 79% used in past year 48% used in past month Creatine - 8% vs. 2% Weight Loss - 7% vs. 15%
2002 Health & Diet Survey 73% - 18 and older had
used in past year
2006 J of Adolescent Health 79% used in past year 48% used in past month Creatine - 8% vs. 2% Weight Loss - 7% vs. 15%
Timbo, BB, Ross, MP, McCarthy, PV, Lin, CT. (2006) Dietary supplements in a national survey: Prevalence of use and reports of adverse events. Journal of American Dietetic Association, 106 (12), 1966-74.
Three QuestionsThree Questions
Is it effective?Is it safe?Is it legal?
Is it effective?Is it safe?Is it legal?
Is it Legal?Is it Legal?
Governing bodies have banned substance lists IOC, NCAA, UCI, USAC, WADA,
MIAA Triathletes - USAT falls under
USADA
Law enforcement penalties Possession
Federal offense 1 year and 1,000$
Selling Federal felony 5 years and 250,000$
Governing bodies have banned substance lists IOC, NCAA, UCI, USAC, WADA,
MIAA Triathletes - USAT falls under
USADA
Law enforcement penalties Possession
Federal offense 1 year and 1,000$
Selling Federal felony 5 years and 250,000$
Is it Legal? - Selling One’s SoulIs it Legal? - Selling One’s Soul
Sports Psychology…1987 Take a banned substance
guarantee gold medal - and not get caught
195 of 198 said YES Take a banned substance -
top athlete for 5 years - and then die in year 6
Over 50% said YES
Sports Psychology…1987 Take a banned substance
guarantee gold medal - and not get caught
195 of 198 said YES Take a banned substance -
top athlete for 5 years - and then die in year 6
Over 50% said YES
Supplements & TriathletesSupplements & Triathletes Ground rules Specific supplements Proven Performance effects Side effects USAT follows USADA prohibited list
Ground rules Specific supplements Proven Performance effects Side effects USAT follows USADA prohibited list
Banned Substance ListBanned Substance List
S1 - AAS Nandrolone Clenbuterol (asthma in
other countries) S2 - hormones and related
substances EPO, hGH, IGF-1, hCG,
insulin, & corticotrophins PRP given IM prohibited PRP tendon injections -
requires Declaration of Use DM pts - need TUE for
insulin
S1 - AAS Nandrolone Clenbuterol (asthma in
other countries) S2 - hormones and related
substances EPO, hGH, IGF-1, hCG,
insulin, & corticotrophins PRP given IM prohibited PRP tendon injections -
requires Declaration of Use DM pts - need TUE for
insulin
Banned Substance ListBanned Substance List S3 - Beta-2 Agonists -
Salbutamol (Ventolin, ProAir, DuoNeb)
Salmeterol (Advair, Serevent),
Others need TUE (terbutaline)
Oral use is prohibited S4 - Agents with Anti-
Estrogenic Activity Aromatase inhibitors SERMs - tamoxifen Other Anti-Es -
clomiphene
S3 - Beta-2 Agonists - Salbutamol (Ventolin,
ProAir, DuoNeb) Salmeterol (Advair,
Serevent), Others need TUE
(terbutaline) Oral use is prohibited
S4 - Agents with Anti-Estrogenic Activity Aromatase inhibitors SERMs - tamoxifen Other Anti-Es -
clomiphene
Banned Substance ListBanned Substance List
S5 - Diuretics and Masking Agents
Masking Agents Plasma Expanders -
Albumin, Dextran, Glycerol (supplements banned)
Alpha-reductase inhibitors - Finasteride
Epitestosterone Diuretics
Furosemide Spironolactone
S5 - Diuretics and Masking Agents
Masking Agents Plasma Expanders -
Albumin, Dextran, Glycerol (supplements banned)
Alpha-reductase inhibitors - Finasteride
Epitestosterone Diuretics
Furosemide Spironolactone
Banned Substance ListBanned Substance List
Prohibited Methods M1 - Enhancement of
O2 transfer Blood doping
M2 - Chemical & Physical Manipulation Tampering IV infusions (even if non-
banned substance unless in hospital setting)
M3 - Gene doping
Prohibited Methods M1 - Enhancement of
O2 transfer Blood doping
M2 - Chemical & Physical Manipulation Tampering IV infusions (even if non-
banned substance unless in hospital setting)
M3 - Gene doping
Banned Substance ListBanned Substance List
Prohibited Substances IN Competition
S6 - stimulants Pemoline, Prolintane
Ephedrine and methylephedrine - U > 10mcg/ml
Pseudophedrine - U > 150mcg/ml (D/C >24hrs prior)
Athletes w/ ADD/ADHD Need TUE
Not Prohibited Caffeine
Prohibited Substances IN Competition
S6 - stimulants Pemoline, Prolintane
Ephedrine and methylephedrine - U > 10mcg/ml
Pseudophedrine - U > 150mcg/ml (D/C >24hrs prior)
Athletes w/ ADD/ADHD Need TUE
Not Prohibited Caffeine
Banned Substance ListBanned Substance List
S7 - Narcotics Fentanyl, Morphine
S8 - Cannabinoids S9 - Glucocorticosteroids
PO, IV, PR, IM - (DOE/TUE)
Topical P1 - ETOH P2 - Beta-Blockers
S7 - Narcotics Fentanyl, Morphine
S8 - Cannabinoids S9 - Glucocorticosteroids
PO, IV, PR, IM - (DOE/TUE)
Topical P1 - ETOH P2 - Beta-Blockers
Commonly Used Banned SubstancesCommonly Used Banned Substances
Erythropoietin & Blood DopingErythropoietin & Blood Doping
Natural hormone secreted by the kidney formation RBCs
r-HuEPO,Darbopoetin (Aranesp)
Blood removed from athlete 1984 - 10 U.S. cyclists
Hemopure (based on bovine Hgb) 2001 Giro d’Italia cycling
marathon Enhances erythropoiesis by
stim proerythroblasts formation
Natural hormone secreted by the kidney formation RBCs
r-HuEPO,Darbopoetin (Aranesp)
Blood removed from athlete 1984 - 10 U.S. cyclists
Hemopure (based on bovine Hgb) 2001 Giro d’Italia cycling
marathon Enhances erythropoiesis by
stim proerythroblasts formation
Epo & Doping - Physiology Epo & Doping - Physiology
Endurance Exercise RBC mass and plasma
volume increases Hct & Hgb decrease due
to expanded plasma volume
By increasing Hgb & Hct increases O2 carrying
capacity decreases ratings of
perceived exertion increases VO2 Max
Endurance Exercise RBC mass and plasma
volume increases Hct & Hgb decrease due
to expanded plasma volume
By increasing Hgb & Hct increases O2 carrying
capacity decreases ratings of
perceived exertion increases VO2 Max
Epo - Proven EffectsEpo - Proven Effects
EPO for 26 days at 50 IU/kg led to 7% increase in power 9% increase VO2 Max Increase Hct
After 6 weeks of EPO - 17% increase in cycling time to exhaustion
IV r-HuEPO works in days
EPO for 26 days at 50 IU/kg led to 7% increase in power 9% increase VO2 Max Increase Hct
After 6 weeks of EPO - 17% increase in cycling time to exhaustion
IV r-HuEPO works in days
Epo & Doping - Adverse EffectsEpo & Doping - Adverse Effects
Because of increased RBC volume - causes increased blood viscosity
HTN Seizures DVTs, PEs Stroke Case report - cerebral
sinus thrombosis
Because of increased RBC volume - causes increased blood viscosity
HTN Seizures DVTs, PEs Stroke Case report - cerebral
sinus thrombosis
Epo & Doping - SummaryEpo & Doping - Summary
Proven Performance effects for Endurance Athletes
Significant Risks Banned by IOC in 1990 Banned by USADA Banned by UCI UCI testing since 1997 Hct 50 for men, 47 for
women UCI Certificate
Proven Performance effects for Endurance Athletes
Significant Risks Banned by IOC in 1990 Banned by USADA Banned by UCI UCI testing since 1997 Hct 50 for men, 47 for
women UCI Certificate
EphedraEphedra
Chinese herb, 5000yrs Comes from Ephedra sinica plant Ma huang
Known to relieve respiratory ailments Mixed into herbal teas
Sale of it alone is prohibited Make methamphetamine
Chinese herb, 5000yrs Comes from Ephedra sinica plant Ma huang
Known to relieve respiratory ailments Mixed into herbal teas
Sale of it alone is prohibited Make methamphetamine
Ephedra -Mechanism of ActionEphedra -Mechanism of Action
Stimulant that mimics effect Norepi & Epi
Increases fat burning, Heart rate
Thermogenic effect Increases resting
metabolism, calorie expenditure
Causes appetite suppression
Stimulant that mimics effect Norepi & Epi
Increases fat burning, Heart rate
Thermogenic effect Increases resting
metabolism, calorie expenditure
Causes appetite suppression
Ephedra - Proven EffectsEphedra - Proven Effects
Over 52 studies in literature (Shekelle et al., 2003) All studies were less
than 6 months Average 1.0kg per
month greater than placebo
Doses ranged from 25 to 120mg per day
Dose related effect
Over 52 studies in literature (Shekelle et al., 2003) All studies were less
than 6 months Average 1.0kg per
month greater than placebo
Doses ranged from 25 to 120mg per day
Dose related effect
Ephedra - Adverse EffectsEphedra - Adverse Effects
Wide variety of side effects Heart palps, HTN, anxiety,
hyperthermia, headaches, & cardiac arrhythmias
Effects all stopped 48hrs after discontinuing
FDA 800 adverse incidents - >90% exceeded recommended doses
FDA 284 serious adverse events - 5 deaths, 5 heart attacks, 11 strokes, & 4 seizures 50% of these people < 30 yo
Wide variety of side effects Heart palps, HTN, anxiety,
hyperthermia, headaches, & cardiac arrhythmias
Effects all stopped 48hrs after discontinuing
FDA 800 adverse incidents - >90% exceeded recommended doses
FDA 284 serious adverse events - 5 deaths, 5 heart attacks, 11 strokes, & 4 seizures 50% of these people < 30 yo
Ephedra - Summary Ephedra - Summary Proven effect on fat
loss 0.82% all sales,
64% adverse 4/12/04 Government
bans Ephedra 2006 US Court of
Appeals upheld “Legal Ephedra” -
bitter orange UCI - U > 10mcg/ml
Proven effect on fat loss
0.82% all sales, 64% adverse
4/12/04 Government bans Ephedra
2006 US Court of Appeals upheld
“Legal Ephedra” - bitter orange
UCI - U > 10mcg/ml2/17/2003
Legal Ergogenic AidsLegal Ergogenic Aids
CreatineCreatine
1832 Chevreul - Greek word flesh
Made from Arg, Gly, & Meth, 95% - skeletal muscle
CrP + ADP => ATP + Cr, enz = Creatine kinase
Intense exercise ATP used first 10 secs
Also buffers muscle pH - delays muscle fatigue
Over 150 studies done, 93% in the past ten years
1832 Chevreul - Greek word flesh
Made from Arg, Gly, & Meth, 95% - skeletal muscle
CrP + ADP => ATP + Cr, enz = Creatine kinase
Intense exercise ATP used first 10 secs
Also buffers muscle pH - delays muscle fatigue
Over 150 studies done, 93% in the past ten years
Creatine - Proven EffectsCreatine - Proven Effects
Overwhelming evidence Meta-analysis (Nissen et al., 2003)
1.09% increase in strength per week Increase 0.36% LBM per week (2.2
kg in 6 weeks) 15 lbs added to 1RM Bench Press
(6 weeks) 25 lbs added to 1RM Back Squat (6
weeks) 61 Studies - 45 found to improve
endurance performance (running, swimming, rowing, & biking)
Ergogenic effect on repeated high intensity sprints (lasting 30 seconds to 3 minutes)
Overwhelming evidence Meta-analysis (Nissen et al., 2003)
1.09% increase in strength per week Increase 0.36% LBM per week (2.2
kg in 6 weeks) 15 lbs added to 1RM Bench Press
(6 weeks) 25 lbs added to 1RM Back Squat (6
weeks) 61 Studies - 45 found to improve
endurance performance (running, swimming, rowing, & biking)
Ergogenic effect on repeated high intensity sprints (lasting 30 seconds to 3 minutes)
Creatine - What about longer distances?Creatine - What about longer distances?
Events lasting longer than 3 minutes - 25 studies - 8 found no improvement, 17 did
Improved times in 5M and 15M sprints but slower times in 6K runs (by 26 seconds)
Long distance endurance events - additional muscle mass and water retention may slow athletes down
Events lasting longer than 3 minutes - 25 studies - 8 found no improvement, 17 did
Improved times in 5M and 15M sprints but slower times in 6K runs (by 26 seconds)
Long distance endurance events - additional muscle mass and water retention may slow athletes down
Creatine - Adverse EffectsCreatine - Adverse Effects
KIDNEY ISSUES? Because creatinine is
breakdown product of creatine - concern over kidney function (Crowe et al., 2003) Four year
study, NCAA 3 yr study No significant adverse effects up to
five years after ingesting creatine (Dempsey et al., 2002)
(Eur J of App Physiol 2008 - Gualano et al) Double Blind, Randomized - 3 months
BOTTOM LINE - NO evidence on any effect on kidney function
KIDNEY ISSUES? Because creatinine is
breakdown product of creatine - concern over kidney function (Crowe et al., 2003) Four year
study, NCAA 3 yr study No significant adverse effects up to
five years after ingesting creatine (Dempsey et al., 2002)
(Eur J of App Physiol 2008 - Gualano et al) Double Blind, Randomized - 3 months
BOTTOM LINE - NO evidence on any effect on kidney function
Creatine - Adverse EffectsCreatine - Adverse Effects
Main reported side effect = GI distress
Case reports of muscle cramping, No studies showed increased cramping
No effect on body fluid balance or heat regulation (2009 - meta-anlysis J Ath Train -
Lopez et al. (Br J Sports Med - 2008 - Dalbo et
al) BOTTOM LINE - No increased risk
of dehydration, cramping, or issues with sweating or heat regulation
Main reported side effect = GI distress
Case reports of muscle cramping, No studies showed increased cramping
No effect on body fluid balance or heat regulation (2009 - meta-anlysis J Ath Train -
Lopez et al. (Br J Sports Med - 2008 - Dalbo et
al) BOTTOM LINE - No increased risk
of dehydration, cramping, or issues with sweating or heat regulation
Creatine - SummaryCreatine - Summary Most widely used supplement
30% Pro teams supply 50% Male Div 1 use 14% High School
75% High School informed from who?
Proven Strength & Anaerobic effects GI & Cramping side effects No effect on kidney function
For Triathletes not very beneficial NOT BANNED by IOC, UCI, WADA,
USAC
Most widely used supplement 30% Pro teams supply 50% Male Div 1 use 14% High School
75% High School informed from who?
Proven Strength & Anaerobic effects GI & Cramping side effects No effect on kidney function
For Triathletes not very beneficial NOT BANNED by IOC, UCI, WADA,
USAC
HMB ß-hydroxy-ß-methylbutyrate
HMB ß-hydroxy-ß-methylbutyrate
Metabolite of Leucine Found in catfish,
citrus fruit, & breast milk
Believed to preserve LBM during fat loss
Anti-catabolic 1998 Sales 50-60
Million Dollars
Metabolite of Leucine Found in catfish,
citrus fruit, & breast milk
Believed to preserve LBM during fat loss
Anti-catabolic 1998 Sales 50-60
Million Dollars
Proven Recovery EffectsProven Recovery Effects (Nissen et al., 1997) - Exercise induced
muscle damage after heavy resistance training
1.5g/day or 3.0g/day - decreased protein breakdown
Increased muscle recovery (Knitter et al., 2000) - 3g/day HMB for 6
weeks 20K run - monitored LDH, CPK levels Statistically significant - LDH & CPK
levels post exercise in HMB group
(Nissen et al., 1997) - Exercise induced muscle damage after heavy resistance training
1.5g/day or 3.0g/day - decreased protein breakdown
Increased muscle recovery (Knitter et al., 2000) - 3g/day HMB for 6
weeks 20K run - monitored LDH, CPK levels Statistically significant - LDH & CPK
levels post exercise in HMB group
Proven Performance EffectsProven Performance Effects Meta-analysis (Nissen et al., 2003) of 9 studies
0.28% increase LBM per week (6-8 weeks) 1.40% increase in 1RM strength per week
(Nissen et al., 1996) - 1.5g/day and 3.0g/day for 6 weeks, increased strength
(Kreider, 1999) - 3g/day for 8 weeks Increases in LBM, decreases fat mass Increases in upper and lower body 1RM
strength (Lamboley, 2007 - Int J Sport Nutr Exerc
Metab) - Aerobic training 3/wk x 5 wks (3g/day) - Inc VO2Max 13.4% vs. 8.4% placebo, no change in body comp
(Watson, 2009 - J Str Cond Res) - no side effects
3 g/day - small increases in 1RM, small decrease in fat mass, small increase in muscle mass
Meta-analysis (Nissen et al., 2003) of 9 studies 0.28% increase LBM per week (6-8 weeks) 1.40% increase in 1RM strength per week
(Nissen et al., 1996) - 1.5g/day and 3.0g/day for 6 weeks, increased strength
(Kreider, 1999) - 3g/day for 8 weeks Increases in LBM, decreases fat mass Increases in upper and lower body 1RM
strength (Lamboley, 2007 - Int J Sport Nutr Exerc
Metab) - Aerobic training 3/wk x 5 wks (3g/day) - Inc VO2Max 13.4% vs. 8.4% placebo, no change in body comp
(Watson, 2009 - J Str Cond Res) - no side effects
3 g/day - small increases in 1RM, small decrease in fat mass, small increase in muscle mass
The Blond Bomber - Dave Draper
Adverse EffectsAdverse Effects
No reported side effects from any studies (Juhn, 2003) - Using HMB for 8 weeks
No change renal fx, LFTs, Lipid panel (Crowe et al., 2003) - Using HMB for 6 wks
No change in serum Test, BUN, Cr, Chol, TGs
No reported side effects from any studies (Juhn, 2003) - Using HMB for 8 weeks
No change renal fx, LFTs, Lipid panel (Crowe et al., 2003) - Using HMB for 6 wks
No change in serum Test, BUN, Cr, Chol, TGs
Summary of HMBSummary of HMB
Not Banned Safe at the present Increases maximal
strength Maintains LBM,
Decreases fat mass Cost - 40$ for 200 pills
4 pills = 1 gram HMB Servings 4 pills x 3
times/day = 12 pills daily 17 day supply $80 per month
Not Banned Safe at the present Increases maximal
strength Maintains LBM,
Decreases fat mass Cost - 40$ for 200 pills
4 pills = 1 gram HMB Servings 4 pills x 3
times/day = 12 pills daily 17 day supply $80 per month
CaffeineCaffeine
#1 Drug used in the world 82-92% adults use daily Methylated xanthine alkaloid
derivative 1,3,7-trimethylxanthine
Metabolized in liver p450 3 Main metabolites
Theobromine, theophylline, Paraxanthine most potent
#1 Drug used in the world 82-92% adults use daily Methylated xanthine alkaloid
derivative 1,3,7-trimethylxanthine
Metabolized in liver p450 3 Main metabolites
Theobromine, theophylline, Paraxanthine most potent
Caffeine - Mechanism of ActionCaffeine - Mechanism of Action Structure is similar to adenosine
Binds to adenosine cell membrane receptors
Found everywhere Stimulates CNS, increases release of
Epinephrine Increases HR, MR, resp center output
decreases perceptions of pain, & fatigue
One main effect on performance is by increasing fat oxidation - which spares muscle glycogen
Structure is similar to adenosine Binds to adenosine cell membrane
receptors Found everywhere
Stimulates CNS, increases release of Epinephrine
Increases HR, MR, resp center output decreases perceptions of pain, & fatigue
One main effect on performance is by increasing fat oxidation - which spares muscle glycogen
Caffeine - Proven EffectsCaffeine - Proven Effects Effects have been studied for 100 years Most studies = 2-9mg/kg per day (250-
750mg) (Costill et al., 1978) - 300mg, cycle at 80%
VO2 Max until exhaustion 90.2 minutes vs. 75.5 minutes
Increase max power in cyclists from 904 Watts to 964 Watts (also vs. placebo)
Decrease race times from marathons to short sprints lasting less than 90 seconds (Graham, 2001)
Studies in all three components of triathlon supporting this
Effects have been studied for 100 years Most studies = 2-9mg/kg per day (250-
750mg) (Costill et al., 1978) - 300mg, cycle at 80%
VO2 Max until exhaustion 90.2 minutes vs. 75.5 minutes
Increase max power in cyclists from 904 Watts to 964 Watts (also vs. placebo)
Decrease race times from marathons to short sprints lasting less than 90 seconds (Graham, 2001)
Studies in all three components of triathlon supporting this
Caffeine - Adverse EffectsCaffeine - Adverse Effects
Anxiety, heart palpitations, trembling, and facial flushing Dose related
Lethal half-dose of caffeine is 150-200mg/kg bodyweight about 100cups
Tolerance to caffeine appears after 4-5 days
Only takes 3 days of use to develop dependency and withdrawal symptoms after stopping Mood shifts, headaches, tremors,
& fatigue - 12h to 7d
Anxiety, heart palpitations, trembling, and facial flushing Dose related
Lethal half-dose of caffeine is 150-200mg/kg bodyweight about 100cups
Tolerance to caffeine appears after 4-5 days
Only takes 3 days of use to develop dependency and withdrawal symptoms after stopping Mood shifts, headaches, tremors,
& fatigue - 12h to 7d
Caffeine - SummaryCaffeine - Summary Banned 1962 IOC
Removed 1972 Urine 12mcg/ml = 9mg/kg 6-7 cups = 700-800mg
Proven effects on performance Because of side effects at higher
doses - 3-6mg/kg better Because of tolerance & withdrawal
- better to not take daily, but prior to specific competitions
Definite benefits for triathletes 2005 IOC Removed completely
from banned list UCI, WADA…
Banned 1962 IOC Removed 1972 Urine 12mcg/ml = 9mg/kg 6-7 cups = 700-800mg
Proven effects on performance Because of side effects at higher
doses - 3-6mg/kg better Because of tolerance & withdrawal
- better to not take daily, but prior to specific competitions
Definite benefits for triathletes 2005 IOC Removed completely
from banned list UCI, WADA…
Beta AlanineBeta Alanine
ß-alanine is amino acid Carnosine (ß-alanyl-L-histidine)
Enzyme carnosine synthetase
Frequent sprints Animal protein Supplementation can increase
beta-alanine by 80% Chemical buffer in myocytes Delays fatigue
ß-alanine is amino acid Carnosine (ß-alanyl-L-histidine)
Enzyme carnosine synthetase
Frequent sprints Animal protein Supplementation can increase
beta-alanine by 80% Chemical buffer in myocytes Delays fatigue
Beta Alanine - Ergogenic Effects
Beta Alanine - Ergogenic Effects
Most research past 3 years 2006 study by Hoffman in Nutr
Research College football players 30 days of 4.5g/day vs.
placebo 60 sec anaer power test 3 - 200 yd shuttle run
2007 study by Derave in J Appl Physiol 4.8g/day vs. placebo 400M sprints Knee extensions - 5 x 30
reps
Most research past 3 years 2006 study by Hoffman in Nutr
Research College football players 30 days of 4.5g/day vs.
placebo 60 sec anaer power test 3 - 200 yd shuttle run
2007 study by Derave in J Appl Physiol 4.8g/day vs. placebo 400M sprints Knee extensions - 5 x 30
reps
2008 study by Kendrick in Amino Acids 6.4g/day vs. placebo 10 week lifting program Strength, LBM, Body Fat% -
no change 2009 study by Smith in J Int
Soc Sports Nutr 1.5g qid (6g/day) x 3 weeks,
then 1.5g bid (3g/day) x 3 weeks,
22yo (46 men) 6 weeks 6 x 2:1 minute cycling VO2 TTE,VO2peak,LBM
2008 study by Kendrick in Amino Acids 6.4g/day vs. placebo 10 week lifting program Strength, LBM, Body Fat% -
no change 2009 study by Smith in J Int
Soc Sports Nutr 1.5g qid (6g/day) x 3 weeks,
then 1.5g bid (3g/day) x 3 weeks,
22yo (46 men) 6 weeks 6 x 2:1 minute cycling VO2 TTE,VO2peak,LBM
Beta Alanine - SummaryBeta Alanine - Summary
Building block of carnosine Legal - not banned by any
sports governing body No documented side effects Ergogenic effects
Increases muscle [carnosine]
Reduces fatigue - blood pH, buffer
Some studies have also shown no improvement on performance
Building block of carnosine Legal - not banned by any
sports governing body No documented side effects Ergogenic effects
Increases muscle [carnosine]
Reduces fatigue - blood pH, buffer
Some studies have also shown no improvement on performance
Nitrous Oxide / ArginineNitrous Oxide / Arginine
L-Arginine alpha-ketoglutarate (AAKG)
Arginine is a conditionally essential AA - 60% athletes
2 main effects Acute - NO increase blood
flow & nutritient delivery - increase exercise capacity
Chronic - anabolic GH effects, protein synthesis
L-Arginine alpha-ketoglutarate (AAKG)
Arginine is a conditionally essential AA - 60% athletes
2 main effects Acute - NO increase blood
flow & nutritient delivery - increase exercise capacity
Chronic - anabolic GH effects, protein synthesis
NO / Arginine - Ergogenic Effects
NO / Arginine - Ergogenic Effects
1989 Study by Elam in J Sports Med Phys Fitness
5 week progresive strength program 1g arginine + 1g ornithine Increase muscle strength/LBM
2006 Study by Campbell in Nutrition 10 men (30-50yo), 4g/day 4 days lifting/wk x 8 weeks 1RM BP, Anaer power, aerobic
capacity, Body comp, & Quad endurance
Only 1RM, Anaer power, [arg] p<0.5 2008 Study by Little in Int J Sport Nutr Exerc
Metab Power, Muscle End, Max Str, - No change in
body comp More studies continue to show benefits
1989 Study by Elam in J Sports Med Phys Fitness
5 week progresive strength program 1g arginine + 1g ornithine Increase muscle strength/LBM
2006 Study by Campbell in Nutrition 10 men (30-50yo), 4g/day 4 days lifting/wk x 8 weeks 1RM BP, Anaer power, aerobic
capacity, Body comp, & Quad endurance
Only 1RM, Anaer power, [arg] p<0.5 2008 Study by Little in Int J Sport Nutr Exerc
Metab Power, Muscle End, Max Str, - No change in
body comp More studies continue to show benefits
NO / Arginine - SummaryNO / Arginine - Summary
L-Arginine alpha-ketoglutarate (AAKG)
Pre-Cursor NO Increase protein synthesis Increase GH levels Increase strength/power No documented adverse effects BUT no evidence that it
improves aerobic capacity or endurance performance
Legal - not banned
L-Arginine alpha-ketoglutarate (AAKG)
Pre-Cursor NO Increase protein synthesis Increase GH levels Increase strength/power No documented adverse effects BUT no evidence that it
improves aerobic capacity or endurance performance
Legal - not banned
Macronutrient Ergogenic AidsMacronutrient Ergogenic Aids
Carbohydrates Carbohydrates
Macronutrient Aids muscle recovery
& glycogen stores Source of instant
energy as well Insulin spike 6-8% CHO solution
8 T in 1 Gallon
Macronutrient Aids muscle recovery
& glycogen stores Source of instant
energy as well Insulin spike 6-8% CHO solution
8 T in 1 Gallon
Carbohydrates - Proven Effects Carbohydrates - Proven Effects
Evidence shows CHO beverages better than H2O
Study - cyclists 70% VO2 max, improved TTE 30 minutes
2004 - Mouth wash study (6.4% maltodextrin) Central Drive vs. Metabolic
Drive Aerobic endurance
Evidence shows CHO beverages better than H2O
Study - cyclists 70% VO2 max, improved TTE 30 minutes
2004 - Mouth wash study (6.4% maltodextrin) Central Drive vs. Metabolic
Drive Aerobic endurance
Carbohydrates - Summary Carbohydrates - Summary
Proven performance effects
No adverse side effects
Not Banned But is there
something better?…
Proven performance effects
No adverse side effects
Not Banned But is there
something better?…
What about Protein? J Am Col Nutrition - 2004 Whey vs. CHO - 10 weeks Whey
more strength gains more bodyfat loss less lean muscle wasting lower pre-workout cortisol levels Greater BONE DENSITY
What about Protein? J Am Col Nutrition - 2004 Whey vs. CHO - 10 weeks Whey
more strength gains more bodyfat loss less lean muscle wasting lower pre-workout cortisol levels Greater BONE DENSITY
PRO vs. CHOPRO vs. CHO
Whey/ Milk Proteins are more effective than Hydrolyzed Soy Protein for stimulating Protein Synthesis & AA deposition in muscle.
= Greater Lean Mass gains with training
= Greater Strength in long-term J Am Coll Nutr. 2005
Apr;24(2):134S-139S.
Whey/ Milk Proteins are more effective than Hydrolyzed Soy Protein for stimulating Protein Synthesis & AA deposition in muscle.
= Greater Lean Mass gains with training
= Greater Strength in long-term J Am Coll Nutr. 2005
Apr;24(2):134S-139S.
Protein QualityProtein Quality
July 2009 Study in J Appl Physiol Whey vs. Casein vs. Soy 10g EEA mix after strength training Men and Women - 12 weeks Whey - More BCAAs
NON-WORKOUT 90% muscle recovery/growth vs. casein 25% more vs. soy WORKOUT 125% more vs. casein 30% more vs. soy
Whey greater body comp changes Whey greater strength gains
July 2009 Study in J Appl Physiol Whey vs. Casein vs. Soy 10g EEA mix after strength training Men and Women - 12 weeks Whey - More BCAAs
NON-WORKOUT 90% muscle recovery/growth vs. casein 25% more vs. soy WORKOUT 125% more vs. casein 30% more vs. soy
Whey greater body comp changes Whey greater strength gains
Protein QualityProtein Quality
Carbohydrate + Protein - Proven EffectsCarbohydrate + Protein - Proven Effects
Combination of 6g EAAs and 35g CHO 10X Insulin, 3X AA, 4X Pro vs.
CHO, PLA Studies showing superiority
VO2 Max 75% - 29% (24mins) 85% - 40% (12)
Reduced post-exercise muscle damage CPK - 216 vs. 1318 Ready, Saunders
Combination of 6g EAAs and 35g CHO 10X Insulin, 3X AA, 4X Pro vs.
CHO, PLA Studies showing superiority
VO2 Max 75% - 29% (24mins) 85% - 40% (12)
Reduced post-exercise muscle damage CPK - 216 vs. 1318 Ready, Saunders
CHO + PRO - Proven EffectsCHO + PRO - Proven Effects
Study by Kreider in 2002 - placebo, Carb, & CHO/PRO
Resistance training - 10X more insulin, 3X increase AA in skeletal muscle, 3 1/2X increase in protein synthesis in skeletal muscle
CHO - repletes glycogen stores, creates anabolic environement through insulin
PRO - increases muscle growth & decreases muscle breakdown (Rennie & Tipton in 2000)
Study by Kreider in 2002 - placebo, Carb, & CHO/PRO
Resistance training - 10X more insulin, 3X increase AA in skeletal muscle, 3 1/2X increase in protein synthesis in skeletal muscle
CHO - repletes glycogen stores, creates anabolic environement through insulin
PRO - increases muscle growth & decreases muscle breakdown (Rennie & Tipton in 2000)
PRO + CHO - BCAAsPRO + CHO - BCAAs BCAAs - 20% AA in body Higher amounts in animal proteins Oxidation rises 300 to 500% during
exercise Levels drop by 25% in the 90 minutes
following a workout 1999 study by Mero - showed increase
LBM, decrease BF% 30K race times 3:30 to 3:05 hrs with
BCAA supplementation vs water, and carb (Kreider 1999)
Greer et al. in 2007 in Int J Sport Nutr & Exerc Metab - CHO, BCAA
Review by Negro (2008 J Sports Med Phys Fit) - DOMS, Imp immune function via exer-related cytokine production
BCAAs - 20% AA in body Higher amounts in animal proteins Oxidation rises 300 to 500% during
exercise Levels drop by 25% in the 90 minutes
following a workout 1999 study by Mero - showed increase
LBM, decrease BF% 30K race times 3:30 to 3:05 hrs with
BCAA supplementation vs water, and carb (Kreider 1999)
Greer et al. in 2007 in Int J Sport Nutr & Exerc Metab - CHO, BCAA
Review by Negro (2008 J Sports Med Phys Fit) - DOMS, Imp immune function via exer-related cytokine production
Carbohydrate + Protein - SummaryCarbohydrate + Protein - Summary
Proven Benefits Safe 4-2:1 Ratio During & After Not BANNED
Proven Benefits Safe 4-2:1 Ratio During & After Not BANNED
Case #1…Case #1…
17yo male HS athlete Test = 2xs NL Estradial = 3xs NL HDL <10 LDL = 252 10 week cycle Went from 145 to 190 What do you do?…
17yo male HS athlete Test = 2xs NL Estradial = 3xs NL HDL <10 LDL = 252 10 week cycle Went from 145 to 190 What do you do?…
Case #1…RevisitedCase #1…Revisited
17yo male HS athlete 3 Months later Off D-Bol Test = WNL Estradial = WNL HDL = 42 LDL = 104 ECHO - WNL Weight now = 163
17yo male HS athlete 3 Months later Off D-Bol Test = WNL Estradial = WNL HDL = 42 LDL = 104 ECHO - WNL Weight now = 163
Scenario…Scenario…
19yo patient comes to your office…
Wants to start taking supplement X.
What do you say?…
19yo patient comes to your office…
Wants to start taking supplement X.
What do you say?…
Supplement Pyramid - What should I take?
Supplement Pyramid - What should I take?
Solid Foundation Base - T / N / R Ask the 3 ?s 2nd Tier
MVI / Ca++/Vit D Whey Protein/P+C Fish Oil**
3rd Tier
Solid Foundation Base - T / N / R Ask the 3 ?s 2nd Tier
MVI / Ca++/Vit D Whey Protein/P+C Fish Oil**
3rd Tier
Wrapping it upWrapping it up
Educate Open mind Supplement
Pyramid Sports specificity
Educate Open mind Supplement
Pyramid Sports specificity
Caveat EmptorCaveat Emptor One final warning
Delbeke et al., 2002 OTC Pyruvate
USAC Position Statement - 1/26/06 Warning: Any athlete who takes…does so at
his or her own risk of committing a doping violation
UCI, US-ADA, WADA, or IOC Remember, the athlete is ALWAYS
responsible for what he or she puts into his or her body
1-800-233-0393 (US-ADA)
www.usantidoping.org
One final warning Delbeke et al., 2002 OTC Pyruvate
USAC Position Statement - 1/26/06 Warning: Any athlete who takes…does so at
his or her own risk of committing a doping violation
UCI, US-ADA, WADA, or IOC Remember, the athlete is ALWAYS
responsible for what he or she puts into his or her body
1-800-233-0393 (US-ADA)
www.usantidoping.org
On-line Resources for helpOn-line Resources for help Important Web Sites http://www1.ncaa.org/membership/ed_outreach/health-safety/drug_testing/banne
d_drug_classes.pdf NCAA site on banned substances
http://www.theathlete.org/wada.htm World Anti-Doping Agency
Important Web Sites http://www1.ncaa.org/membership/ed_outreach/health-safety/drug_testing/banne
d_drug_classes.pdf NCAA site on banned substances
http://www.theathlete.org/wada.htm World Anti-Doping Agency
Thank YouThank You
ReferencesReferences Anantaraman, R., Carmines, A.A., Gaesser, G.A., & Weltman, A. (1995).
Effects of carbohydrate supplementation on performance during 1 hour of high intensity exercise. International Journal of Sports Medicine, 16, pp. 461-465.
Armstrong, L.E. (2002, June). Caffeine, body fluid-electrolyte balance, and exercise performance. International Journal of Sport Nutrition & Exercise Metabolism, 12(2), pp. 189-207.
Audran, M., Gareau, R., & Matecki, S. (1999). Effects of erythropoetin administration in training athletes and possible indirect detection in doping control. Medical Science in Sports and Exercise, 31(5), pp. 639-645.
Ball, T.C., Headley, S.A., Vanderburgh, P.M., & Smith, J.C. (1995). Periodic carbohydrate replacement during 50 min of high-intensity cycling improves subsequent sprint performance. International Journal of Sports Nutrition, 5,
pp. 151-158. Barr, S.I. (1999). Effects of dehydration on exercise performance. Canadian
Journal of Applied Physiology, 24 (2), pp. 164-172. Bell, D.G., Jacobs, I., Ellerington, K. (2001). Effect of caffeine and ephedrine
ingestion on anaerobic exercise performance. Medicine and Science in Sports and Exercise, 33(8), pp. 1399-1403.
Anantaraman, R., Carmines, A.A., Gaesser, G.A., & Weltman, A. (1995). Effects of carbohydrate supplementation on performance during 1 hour of high intensity exercise. International Journal of Sports Medicine, 16, pp. 461-465.
Armstrong, L.E. (2002, June). Caffeine, body fluid-electrolyte balance, and exercise performance. International Journal of Sport Nutrition & Exercise Metabolism, 12(2), pp. 189-207.
Audran, M., Gareau, R., & Matecki, S. (1999). Effects of erythropoetin administration in training athletes and possible indirect detection in doping control. Medical Science in Sports and Exercise, 31(5), pp. 639-645.
Ball, T.C., Headley, S.A., Vanderburgh, P.M., & Smith, J.C. (1995). Periodic carbohydrate replacement during 50 min of high-intensity cycling improves subsequent sprint performance. International Journal of Sports Nutrition, 5,
pp. 151-158. Barr, S.I. (1999). Effects of dehydration on exercise performance. Canadian
Journal of Applied Physiology, 24 (2), pp. 164-172. Bell, D.G., Jacobs, I., Ellerington, K. (2001). Effect of caffeine and ephedrine
ingestion on anaerobic exercise performance. Medicine and Science in Sports and Exercise, 33(8), pp. 1399-1403.
ReferencesReferences Below, P.R., Mora-Rodriguez, R., Gonzalez-Alonso, J., & Coyle, E. (1995). Fluid and
carbohydrate ingestion independently improve performance during 1h of intense exercise. Medicine & Science in Sports and Exercise, 27, pp. 200-210.
Berglund, B., Birgegard, G., White, L., & Pihlstedt, P. (1989). Effects of blood transfusions on some hematological variables in endurance athletes. Medicine & Science in Sports and Exercise, 21, pp. 637-642.
Berglund, B., & Hemmingson, P. (1987). Effect of reinfusion of autologous blood on exercise performance in cross-country skiers. International Journal of Sports Medicine, 8, pp. 231-233.
Branch, J.D. (2003, June). Effect of creatine supplementation on body composition and performance: A meta-analysis. International Journal of Sport Nutrition & Exercise Metabolism, 13(2), pp. 198-207.
Brien, A., & Simon, T.L. (1987). The effects of red blood cell infusion on 10km race time. Journal of the American Medical Association, 257, pp. 2761-2765.
Brown, G.A., Vukovich, M.D., Reifenrath, T.A., Uhl, N.L., Parsons, K.A., Sharp, R.L., & King, D.S. (2000). Effects of anabolic precursors on serum testosterone concentrations and adaptations to resistance training in young men. International Journal of Sport Nutrition and Exercise Metabolism, 10, pp. 340-359.
Buckley, J., Abbott, M., Martin, S., Brinkworth, G., & Whyte, P. (2002). Effect of oral bovine colostrums supplement on running performance. Journal of Science and Medicine in Sport, 5, pp. 65-79.
Below, P.R., Mora-Rodriguez, R., Gonzalez-Alonso, J., & Coyle, E. (1995). Fluid and carbohydrate ingestion independently improve performance during 1h of intense exercise. Medicine & Science in Sports and Exercise, 27, pp. 200-210.
Berglund, B., Birgegard, G., White, L., & Pihlstedt, P. (1989). Effects of blood transfusions on some hematological variables in endurance athletes. Medicine & Science in Sports and Exercise, 21, pp. 637-642.
Berglund, B., & Hemmingson, P. (1987). Effect of reinfusion of autologous blood on exercise performance in cross-country skiers. International Journal of Sports Medicine, 8, pp. 231-233.
Branch, J.D. (2003, June). Effect of creatine supplementation on body composition and performance: A meta-analysis. International Journal of Sport Nutrition & Exercise Metabolism, 13(2), pp. 198-207.
Brien, A., & Simon, T.L. (1987). The effects of red blood cell infusion on 10km race time. Journal of the American Medical Association, 257, pp. 2761-2765.
Brown, G.A., Vukovich, M.D., Reifenrath, T.A., Uhl, N.L., Parsons, K.A., Sharp, R.L., & King, D.S. (2000). Effects of anabolic precursors on serum testosterone concentrations and adaptations to resistance training in young men. International Journal of Sport Nutrition and Exercise Metabolism, 10, pp. 340-359.
Buckley, J., Abbott, M., Martin, S., Brinkworth, G., & Whyte, P. (2002). Effect of oral bovine colostrums supplement on running performance. Journal of Science and Medicine in Sport, 5, pp. 65-79.
ReferencesReferences Buick, F., Gledhill, N., Froese, A.B., Spriet, L., & Meyers, E.C. (1980).
Effect of induced erythrocythemia on aerobic work capacity. Journal of Applied Physiology, 48, pp. R636-R642.
Cater, J.M. (2004). The effect of carbohydrate mouth rinse on 1-h cycle time trial performance. Medicine & Science in Sports and Exercise, 36 (12), pp. 2107-2111.
Catlin, D.H. MD, & Murray, T.H. PhD. (1996, July). Performance-enhancing drugs, fair competition, and Olympic sport. Journal of the American Medical Association, 276(3), pp. 231-237.
Chandler, J.V. & Blair, S.N. (1980). The effect of amphetamines on selected physiological components related to athletic success. Medicine and Science in Sports and Exercise, 12, pp. 65-69.
Coggan, A.R.,, & Coyle, E.F. (1991). Carbohydrate ingestion during prolonged exercise: effects on metabolism and performance. Exercise and Sport Sciences Reviews, 19, pp. 1-40.
Coombes, J.S., Conacher, M., Austen, S.K., & Marshall, P.A. (2002). Dose effects of oral bovine colostrums on physical work capacity in cyclists. Medicine & Science in Sports and Exercise, 34 (7), pp. 1184-1188.
Buick, F., Gledhill, N., Froese, A.B., Spriet, L., & Meyers, E.C. (1980). Effect of induced erythrocythemia on aerobic work capacity. Journal of Applied Physiology, 48, pp. R636-R642.
Cater, J.M. (2004). The effect of carbohydrate mouth rinse on 1-h cycle time trial performance. Medicine & Science in Sports and Exercise, 36 (12), pp. 2107-2111.
Catlin, D.H. MD, & Murray, T.H. PhD. (1996, July). Performance-enhancing drugs, fair competition, and Olympic sport. Journal of the American Medical Association, 276(3), pp. 231-237.
Chandler, J.V. & Blair, S.N. (1980). The effect of amphetamines on selected physiological components related to athletic success. Medicine and Science in Sports and Exercise, 12, pp. 65-69.
Coggan, A.R.,, & Coyle, E.F. (1991). Carbohydrate ingestion during prolonged exercise: effects on metabolism and performance. Exercise and Sport Sciences Reviews, 19, pp. 1-40.
Coombes, J.S., Conacher, M., Austen, S.K., & Marshall, P.A. (2002). Dose effects of oral bovine colostrums on physical work capacity in cyclists. Medicine & Science in Sports and Exercise, 34 (7), pp. 1184-1188.
ReferencesReferences Costill, D.L., Dalsky, G.P., & Fink, W.J. (1978). Effects of caffeine ingestion on
metabolism and exercise performance. Medicine and Science in Sports and Exercise, 10, pp. 155-158.
Cottrell, G.T., Coast, J.R., & Herb, R.A. (2002). Effect of recovery interval on multiple-bout sprint cycling performance after acute creatine supplementation. Journal of Strength and Conditioning Research, 16(1), pp. 109-116.
Coyle, E.F. (1992). Carbohydrate feeding during exercise. International Journal of Sports Medicine, 13(S1), pp. S126-S128.
Crist, D.M., Peake, G.T., Egan, P.A., & Waters, D.L. (1988). Body composition response to exogenous GH during training in highly conditioned athletes. Journal of Applied Physiology, 65, pp. 579-584.
Dawson, R.T. (2001). Drugs in sport – The role of the physician. Journal of Endocrinology, 170, pp. 55-61.
Delbeke, F.T., Van Eenoo, P., Van Thuyne, W., & Desmet, N. (2002, December). Prohormones and sport. The Journal of Steroid Biochemistry and Molecular Biology, 83(1-5), pp. 245-251.
Costill, D.L., Dalsky, G.P., & Fink, W.J. (1978). Effects of caffeine ingestion on metabolism and exercise performance. Medicine and Science in Sports and Exercise, 10, pp. 155-158.
Cottrell, G.T., Coast, J.R., & Herb, R.A. (2002). Effect of recovery interval on multiple-bout sprint cycling performance after acute creatine supplementation. Journal of Strength and Conditioning Research, 16(1), pp. 109-116.
Coyle, E.F. (1992). Carbohydrate feeding during exercise. International Journal of Sports Medicine, 13(S1), pp. S126-S128.
Crist, D.M., Peake, G.T., Egan, P.A., & Waters, D.L. (1988). Body composition response to exogenous GH during training in highly conditioned athletes. Journal of Applied Physiology, 65, pp. 579-584.
Dawson, R.T. (2001). Drugs in sport – The role of the physician. Journal of Endocrinology, 170, pp. 55-61.
Delbeke, F.T., Van Eenoo, P., Van Thuyne, W., & Desmet, N. (2002, December). Prohormones and sport. The Journal of Steroid Biochemistry and Molecular Biology, 83(1-5), pp. 245-251.
ReferencesReferences
Delbeke, F.T. (1996). Doping in cyclism: Results of unannounced controls in Flanders (1987-1994). International Journal of Sports Medicine, 17 (6), pp. 434-438.
Dempsey, R.L., Mazzone, M.F., & Meurer, L.N. (2002, November). Does oral creatine supplementation improve strength? A meta-analysis. The Journal of Family Practice, 51(11), pp. 945-951.
Dolny, D.G., Lemon, P.W.R., & Yarasheki, K.E. (1997). Moderate physical activity can increase dietary protein needs. Canadian Journal of Applied Physiology, 22(5), pp. 494-503.
Dorr, H., Ranke, M.B., & Wuster, C. (2002). Effects of growth hormone on skeletal muscle. Hormone Research, 58(S3), pp. S43-S48.
Eichner, E. (1992). Better dead than second. Journal of Laboratory and Clinical Medicine, 120, pp. 359-360.
El-Sayed, M.S., Balmer, J., & Rattu, A.J.M. (1997). Carbohydrate ingestion improves endurance performance during a 1h simulated cycling time-trial. Journal of Sports Sciences, 15, pp. 223-230.
Fielding, R.A., & Parkington, J. (2002). What are the dietary protein requirements of physically active individuals? New evidence on the effects of exercise on protein utilization during post-exercise Recovery. Nutrition in Clinical Care, 5(4), pp. 191-196.
Delbeke, F.T. (1996). Doping in cyclism: Results of unannounced controls in Flanders (1987-1994). International Journal of Sports Medicine, 17 (6), pp. 434-438.
Dempsey, R.L., Mazzone, M.F., & Meurer, L.N. (2002, November). Does oral creatine supplementation improve strength? A meta-analysis. The Journal of Family Practice, 51(11), pp. 945-951.
Dolny, D.G., Lemon, P.W.R., & Yarasheki, K.E. (1997). Moderate physical activity can increase dietary protein needs. Canadian Journal of Applied Physiology, 22(5), pp. 494-503.
Dorr, H., Ranke, M.B., & Wuster, C. (2002). Effects of growth hormone on skeletal muscle. Hormone Research, 58(S3), pp. S43-S48.
Eichner, E. (1992). Better dead than second. Journal of Laboratory and Clinical Medicine, 120, pp. 359-360.
El-Sayed, M.S., Balmer, J., & Rattu, A.J.M. (1997). Carbohydrate ingestion improves endurance performance during a 1h simulated cycling time-trial. Journal of Sports Sciences, 15, pp. 223-230.
Fielding, R.A., & Parkington, J. (2002). What are the dietary protein requirements of physically active individuals? New evidence on the effects of exercise on protein utilization during post-exercise Recovery. Nutrition in Clinical Care, 5(4), pp. 191-196.
ReferencesReferences Graham, T.E. (2001, 11). Caffeine and exercise: Metabolism, endurance, and
performance. Sports Medicine, 31, pp. 785-807. Graham, T.E., Hibbert, E., & Sathasivam, P. (1998). Metabolic and exercise
endurance effects of coffee and caffeine ingestion. Journal of Applied Physiology, 85, pp. 883-889.
Green, A.L., Hultman, E., Macdonald, I.A. (1996). Carbohydrate ingestion augments skeletal muscle creatine accumulation during creatine supplementation in humans. American Journal of Physiology, 271(5), pp. E821-E826.
Haff, G.G., Koch, A.J., Potteiger, J.A., Kuphal, K.E., Magee, L.M., Green, S.B., & Jakicic, J.J. (2000). Carbohydrate supplementation attenuates muscle glycogen loss during acute bouts of resistance exercise. International Journal of Sports Nutrition and Exercise Metabolism, 10, pp. 326-339.
Haff, G.G., Lehmkuhl, M.J., McCoy, L.B., & Stone, M.H. (2003). Carbohydrate supplementation and resistance training. Journal of Strength and Conditioning Research, 17(1), pp. 187-196.
Hargreaves, M. & Snow, R. (2001). Amino acids and endurance exercise. International Journal of Sport Nutrition and Exercise Metabolism, 11, pp. 133-145.
Haskell, S.G. (2003, May). Selective estrogen receptor modulators. Southern Medical Journal 96(5), pp. 469-476.
Graham, T.E. (2001, 11). Caffeine and exercise: Metabolism, endurance, and performance. Sports Medicine, 31, pp. 785-807.
Graham, T.E., Hibbert, E., & Sathasivam, P. (1998). Metabolic and exercise endurance effects of coffee and caffeine ingestion. Journal of Applied Physiology, 85, pp. 883-889.
Green, A.L., Hultman, E., Macdonald, I.A. (1996). Carbohydrate ingestion augments skeletal muscle creatine accumulation during creatine supplementation in humans. American Journal of Physiology, 271(5), pp. E821-E826.
Haff, G.G., Koch, A.J., Potteiger, J.A., Kuphal, K.E., Magee, L.M., Green, S.B., & Jakicic, J.J. (2000). Carbohydrate supplementation attenuates muscle glycogen loss during acute bouts of resistance exercise. International Journal of Sports Nutrition and Exercise Metabolism, 10, pp. 326-339.
Haff, G.G., Lehmkuhl, M.J., McCoy, L.B., & Stone, M.H. (2003). Carbohydrate supplementation and resistance training. Journal of Strength and Conditioning Research, 17(1), pp. 187-196.
Hargreaves, M. & Snow, R. (2001). Amino acids and endurance exercise. International Journal of Sport Nutrition and Exercise Metabolism, 11, pp. 133-145.
Haskell, S.G. (2003, May). Selective estrogen receptor modulators. Southern Medical Journal 96(5), pp. 469-476.
ReferencesReferences
Hawley, J.A., Burke, L.M., Angus, D.J., Fallon, K.E., Martin, D.T., & Febbraio, M.A. (2000). Effect of altering substrate availability on metabolism and performance during intense exercise. British Journal of Nutrition, 84(6), pp.
Haub, M.D., Haff, G.G., & Potteiger, J.A. (2003). The effect of liquid carbohydrate ingestion on repeated maximal effort exercise in competitive cyclists. Journal of Strength and Conditioning Research, 17(1), pp. 20-25.
Ivy, J.L., Goforth, H.W., Damon, B.W., McCauley, T.R., Parsons, E.C., & Price, T.B. (2003). Effect of a carbohydrate-protein supplement on endurance performance during exercise of varying intensity. International Journal of Sports Nutrition and Exercise Metabolism, 13, pp. 388-401.
Juhn, M.S. (2003). Popular sports supplements and ergogenic aids. Sports Medicine, 33(12), pp. 921-939.
Kennedy, M.C. (2000). Newer drugs used to enhance sporting performance. Medical Journal of Australia, 173, pp. 314-317.
Kreider, R.B. (1999, February). Dietary supplements and the promotion of muscle growth with resistance exercise. Sports Medicine, 27(2), pp. 97-111.
Hawley, J.A., Burke, L.M., Angus, D.J., Fallon, K.E., Martin, D.T., & Febbraio, M.A. (2000). Effect of altering substrate availability on metabolism and performance during intense exercise. British Journal of Nutrition, 84(6), pp.
Haub, M.D., Haff, G.G., & Potteiger, J.A. (2003). The effect of liquid carbohydrate ingestion on repeated maximal effort exercise in competitive cyclists. Journal of Strength and Conditioning Research, 17(1), pp. 20-25.
Ivy, J.L., Goforth, H.W., Damon, B.W., McCauley, T.R., Parsons, E.C., & Price, T.B. (2003). Effect of a carbohydrate-protein supplement on endurance performance during exercise of varying intensity. International Journal of Sports Nutrition and Exercise Metabolism, 13, pp. 388-401.
Juhn, M.S. (2003). Popular sports supplements and ergogenic aids. Sports Medicine, 33(12), pp. 921-939.
Kennedy, M.C. (2000). Newer drugs used to enhance sporting performance. Medical Journal of Australia, 173, pp. 314-317.
Kreider, R.B. (1999, February). Dietary supplements and the promotion of muscle growth with resistance exercise. Sports Medicine, 27(2), pp. 97-111.
ReferencesReferences Kutscher, E.C., Lund, B.C., & Perry, P.J. (2002). Anabolic steroids: A review for the clinician.
Sports Medicine, 32(5), pp. 285-296. Lage, J.M.M., Panizo, C., Masdeu, J., & Rocha, E. (2002). Cyclist’s doping associated with
cerebral sinus thrombosis. Neurology, 58, pp. 665. Latzka, W.A., Montain, S.J. (1999, July). Water and electrolyte requirements for exercise. Clinics
in Sports Medicine, 18(3), pp. 513-524. Lemon, P.K. (2000). Beyond the zone: Protein needs of active individuals. Journal of the
American College of Nutrition, 19(5), pp. 513S-521S. Lemon, P.K. (1998). Effects of exercise on dietary protein requirements. International Journal of
Sport Nutrition, 8, pp. 426-447. Miller, S.L., Maresh, C.M., Armstrong, L.E., Ebbeling, C.B., Lennon, S., & Rodriguez, N.R. (2002,
December). Metabolic response to provision of mixed protein-carbohydrate supplementation during endurance exercise. International Journal of Sport Nutrition & Exercise Metabolism, 12(4), pp. 384-398.
Longobardi, S., Keay, N., Ehrnborg, C., Cittadini, A., Rosen, T., Dall, R., Boroujerdi, M.A., Bassett, E.E., Healy, M.L., Pentecost, C., Wallace, J.D., Powrie, J., Jorgensen, J.O., & Sacca, L. (2000, April). Growth hormone (GH) effects on bone and collagen turnover in healthy adults and its potential as a marker of GH abuse in sports: A double blind, placebo-controlled study. The Journal of Clinical Endocrinology & Metabolism, 85(4), pp. 1505-1512.
Kutscher, E.C., Lund, B.C., & Perry, P.J. (2002). Anabolic steroids: A review for the clinician. Sports Medicine, 32(5), pp. 285-296.
Lage, J.M.M., Panizo, C., Masdeu, J., & Rocha, E. (2002). Cyclist’s doping associated with cerebral sinus thrombosis. Neurology, 58, pp. 665.
Latzka, W.A., Montain, S.J. (1999, July). Water and electrolyte requirements for exercise. Clinics in Sports Medicine, 18(3), pp. 513-524.
Lemon, P.K. (2000). Beyond the zone: Protein needs of active individuals. Journal of the American College of Nutrition, 19(5), pp. 513S-521S.
Lemon, P.K. (1998). Effects of exercise on dietary protein requirements. International Journal of Sport Nutrition, 8, pp. 426-447.
Miller, S.L., Maresh, C.M., Armstrong, L.E., Ebbeling, C.B., Lennon, S., & Rodriguez, N.R. (2002, December). Metabolic response to provision of mixed protein-carbohydrate supplementation during endurance exercise. International Journal of Sport Nutrition & Exercise Metabolism, 12(4), pp. 384-398.
Longobardi, S., Keay, N., Ehrnborg, C., Cittadini, A., Rosen, T., Dall, R., Boroujerdi, M.A., Bassett, E.E., Healy, M.L., Pentecost, C., Wallace, J.D., Powrie, J., Jorgensen, J.O., & Sacca, L. (2000, April). Growth hormone (GH) effects on bone and collagen turnover in healthy adults and its potential as a marker of GH abuse in sports: A double blind, placebo-controlled study. The Journal of Clinical Endocrinology & Metabolism, 85(4), pp. 1505-1512.
ReferencesReferences
Mayhew, D.L., Mayhew, J.L., & Ware, J.S. (2002, December). Effects of long-term creatine supplementation on liver and kidney functions in American college football players. International Journal of Sport Nutrition & Exercise Metabolism, 12(4), pp. 453-451.
Mottram, D.R. (1999, January). Banned drugs in sport: Does the International Olympic Committee (IOC) list need updating? Sports Medicine, 27(1), pp. 1-10.
Nissen, S.L., & Sharp, R.L. (2003, February). Effect of dietary supplements on lean mass and strength gains with resistance exercise: a meta-analysis. Journal of Applied Physiology, 94(2), pp. 651-659.
Ready, S.L., Seifert, J.G., & Burke, E. (1999). The effect of two sports drink formulations on muscle stress and performance. Medicine & Science in Sports and Exercise, 31, pp. S119.
Rennie, M.J., & Tipton, K.D. (2000). Protein and amino acid metabolism during and after exercise and the effects of nutrition. Annual Reviews in Nutrition, 20, pp. 457-483.
Roltsch, M.H., Flohr, J.A., & Brevard, P.B. (2002, December). The effect of diet manipulations on aerobic performance. International Journal of Sport Nutrition & Exercise Metabolism, 12(4), pp. 480-490.
Mayhew, D.L., Mayhew, J.L., & Ware, J.S. (2002, December). Effects of long-term creatine supplementation on liver and kidney functions in American college football players. International Journal of Sport Nutrition & Exercise Metabolism, 12(4), pp. 453-451.
Mottram, D.R. (1999, January). Banned drugs in sport: Does the International Olympic Committee (IOC) list need updating? Sports Medicine, 27(1), pp. 1-10.
Nissen, S.L., & Sharp, R.L. (2003, February). Effect of dietary supplements on lean mass and strength gains with resistance exercise: a meta-analysis. Journal of Applied Physiology, 94(2), pp. 651-659.
Ready, S.L., Seifert, J.G., & Burke, E. (1999). The effect of two sports drink formulations on muscle stress and performance. Medicine & Science in Sports and Exercise, 31, pp. S119.
Rennie, M.J., & Tipton, K.D. (2000). Protein and amino acid metabolism during and after exercise and the effects of nutrition. Annual Reviews in Nutrition, 20, pp. 457-483.
Roltsch, M.H., Flohr, J.A., & Brevard, P.B. (2002, December). The effect of diet manipulations on aerobic performance. International Journal of Sport Nutrition & Exercise Metabolism, 12(4), pp. 480-490.
ReferencesReferences
Rowlands, D.S., & Hopkins, W.G. (2002a, June). Effects of High-Fat and High-Carbohydrate Diets on Metabolism and Performance in Cycling. Metabolism, 51(6), pp. 678-690.
Rozenek, R., Ward, P., Long, S., & Garhammer, J. (2002, September). Effects of high-calorie supplements on body composition and muscular strength following resistance training. Journal of Sports Medicine and Physical Fitness, 42(3), pp. 340-347.
Saunders, M.J., Kane, M.D., & Todd, M.K. (2004). Effects of a carbohydrate-protein beverage on cycling endurance and muscle damage. Medicine & Science in Sports and Exercise, 36 (7), pp. 1233-1238.
Schoffstall, J.E., Branch, J.D., Leutholtz, B.C., & Swain, D.P. (2001). Effects of dehydration and rehydration on the one-repetition maximum bench press of weight-trained males. Journal of Strength and Conditioning Research, 15(1), pp. 102-108.
Schumacher, Y.O., Grathwohl, D., Barturen, J.M., Wollenweber, M., Heinrich, L., Schmid, A., Huber, G., & Keul, J. (2000). Haemoglobin, haematocrit and red blood cell indiceds in elite cyclists. Are the control values for blood testing valid. Internation Journal of Sports Medicine, 21, pp. 380-385.
Rowlands, D.S., & Hopkins, W.G. (2002a, June). Effects of High-Fat and High-Carbohydrate Diets on Metabolism and Performance in Cycling. Metabolism, 51(6), pp. 678-690.
Rozenek, R., Ward, P., Long, S., & Garhammer, J. (2002, September). Effects of high-calorie supplements on body composition and muscular strength following resistance training. Journal of Sports Medicine and Physical Fitness, 42(3), pp. 340-347.
Saunders, M.J., Kane, M.D., & Todd, M.K. (2004). Effects of a carbohydrate-protein beverage on cycling endurance and muscle damage. Medicine & Science in Sports and Exercise, 36 (7), pp. 1233-1238.
Schoffstall, J.E., Branch, J.D., Leutholtz, B.C., & Swain, D.P. (2001). Effects of dehydration and rehydration on the one-repetition maximum bench press of weight-trained males. Journal of Strength and Conditioning Research, 15(1), pp. 102-108.
Schumacher, Y.O., Grathwohl, D., Barturen, J.M., Wollenweber, M., Heinrich, L., Schmid, A., Huber, G., & Keul, J. (2000). Haemoglobin, haematocrit and red blood cell indiceds in elite cyclists. Are the control values for blood testing valid. Internation Journal of Sports Medicine, 21, pp. 380-385.
ReferencesReferences Schwenk, T.L., & Costley, C.D. (2002). When food becomes a drug: Nonanabolic nutritional
supplement use in athletes. The American Journal of Sports Medicine, 30, pp. 907-916. Shekelle, P.G. MD, PhD; Hardy, M.L. MD; Morton, S.C. PhD; Maglione, M.; Mojica, W.A. MD,
MPH; Suttorp, M.J. MS; Rhodes, S.L. MFA; Jungvig, L. BA; & Gagne, J. MD. (2003, March). Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: A meta-analysis. Journal of the American Medical Association, 289(12), pp. 1537-1545.
Skolnick, A.A. (1996, February 7). Finding the most reliable dope on doping. Journal of the American Medical Association, 275(5), pp. 349-350.
Smith, J. MD, & Dahm, D.L. MD. (2000, December). Creatine use among a select population of high school athletes. Mayo Clinic Proceedings, 75(12), pp. 1257-1263.
Smith, W.D. (2003). LC-ESI-MS/MS draws the line on doping. Analytical Chemistry, pp. 337A.
Wallace, J.D., Cuneo, R.C., Baxter, R., Orskov, H., Keay, N., Pentecost, C., Dall, R., Rosen, T., Jorgensen, J.O., Cittadini, A., Longobardi, S., Sacca, L., Christiansen, J.S., Bengtsson, B., & Sonksen, P.H. (1999). Responses of the growth hormone (GH) and insulin-like growth factor axis to exercise, GH administration, and GH withdrawl in trained adult males: A potential test for GH abuse in sport. The Journal of Clinical Endocrinology & Metabolism, 84(10), pp. 3591-3601.
Schwenk, T.L., & Costley, C.D. (2002). When food becomes a drug: Nonanabolic nutritional supplement use in athletes. The American Journal of Sports Medicine, 30, pp. 907-916.
Shekelle, P.G. MD, PhD; Hardy, M.L. MD; Morton, S.C. PhD; Maglione, M.; Mojica, W.A. MD, MPH; Suttorp, M.J. MS; Rhodes, S.L. MFA; Jungvig, L. BA; & Gagne, J. MD. (2003, March). Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: A meta-analysis. Journal of the American Medical Association, 289(12), pp. 1537-1545.
Skolnick, A.A. (1996, February 7). Finding the most reliable dope on doping. Journal of the American Medical Association, 275(5), pp. 349-350.
Smith, J. MD, & Dahm, D.L. MD. (2000, December). Creatine use among a select population of high school athletes. Mayo Clinic Proceedings, 75(12), pp. 1257-1263.
Smith, W.D. (2003). LC-ESI-MS/MS draws the line on doping. Analytical Chemistry, pp. 337A.
Wallace, J.D., Cuneo, R.C., Baxter, R., Orskov, H., Keay, N., Pentecost, C., Dall, R., Rosen, T., Jorgensen, J.O., Cittadini, A., Longobardi, S., Sacca, L., Christiansen, J.S., Bengtsson, B., & Sonksen, P.H. (1999). Responses of the growth hormone (GH) and insulin-like growth factor axis to exercise, GH administration, and GH withdrawl in trained adult males: A potential test for GH abuse in sport. The Journal of Clinical Endocrinology & Metabolism, 84(10), pp. 3591-3601.
ReferencesReferences Warber, J.P., Tharion, W.J., Patton, J.F., Champagne, C.M., Mitotti, P., &
Lieberman, H.R. (2002). The effect of creatine monohydrate supplementation on obstacle course and multiple bench press performance. Journal of Strength and Conditioning Research, 16(4), pp. 500-508.
Wilder, N., Gilders, R., Hagerman, F., & Deivert, R.G. (2002). The effects of a 10-week, periodized, off-season resistance-training program and creatine supplementation among collegiate football players. Journal of Strength and Conditioning Research, 16(3), pp. 343-352.
Williams, M.B., Raven, P.B., Fogt, D.L., & Ivy, J.L. (2003). Effects of recovery beverages on glycogen restoration and endurance exercise performance. Journal of Strength and Conditioning Research, 17, pp. 12-19.
Zawadzki, K.M., Yaspelkis, B.B., & Ivy, J.L. (1992). Carbohydrate-protein complex increases the rate of muscle glycogen storage after exercise. Journal of Applied Physiology, 72, pp. 1854-1859.
Warber, J.P., Tharion, W.J., Patton, J.F., Champagne, C.M., Mitotti, P., & Lieberman, H.R. (2002). The effect of creatine monohydrate supplementation on obstacle course and multiple bench press performance. Journal of Strength and Conditioning Research, 16(4), pp. 500-508.
Wilder, N., Gilders, R., Hagerman, F., & Deivert, R.G. (2002). The effects of a 10-week, periodized, off-season resistance-training program and creatine supplementation among collegiate football players. Journal of Strength and Conditioning Research, 16(3), pp. 343-352.
Williams, M.B., Raven, P.B., Fogt, D.L., & Ivy, J.L. (2003). Effects of recovery beverages on glycogen restoration and endurance exercise performance. Journal of Strength and Conditioning Research, 17, pp. 12-19.
Zawadzki, K.M., Yaspelkis, B.B., & Ivy, J.L. (1992). Carbohydrate-protein complex increases the rate of muscle glycogen storage after exercise. Journal of Applied Physiology, 72, pp. 1854-1859.