Fighters Guide to Supplementation


28 day challenge

Step 1. Gather information about the supplement.

Step 2. Find scientific information to determine safety and effectiveness.

The National Library of Medicine is a searchable database (Medline) that can be accessed via the Internet. You can view this database at www.ncbi.nlm.nih.gov/PubMed. Medline has millions of journal citations. Here you can enter a search term, such as creatine, and view citations, most of which have abstracts. You can also specify that the search be limited to review articles. Medline has some links to online journals, including some that allow for free downloading of articles (most require a fee). You can also find journals at university or hospital libraries.

Because of the vast amount of information available, Medline users can sometimes feel overwhelmed. To make it easier to find information about complementary and alternative medicine (CAM), the “CAM on Medline” database was created. CAM on Medline is a subset of the larger Medline database, and it contains only articles that are related to complementary and alternative therapies, including dietary supplements. You can view this site at www.nccam.nih.gov

You can monitor unsafe dietary supplements and obtain dietary supplement information by periodically checking the Food and Drug Administration’s Web site at http://vm.cfsan.fda.gov. Under the dietary supplements heading, you will find a section entitled “Warnings and Safety Information.”

Some Web sites evaluate dietary supplement information and are convenient references.

One of these sites is Quackwatch at http://www.quackwatch.com. Quackwatch is “a non-profit corporation whose purpose is to combat health-related frauds, myths, fads, and fallacies.”

Another site is SupplementWatch, Inc. at http://www.supplementwatch.com; this is “a self-funded, privately held corporation consisting of a small group of scientists, physiologists, nutritionists and other health professionals dedicated to educating people about the pros and cons of dietary supplementation.”

Information on both sites is evaluated by professionals with scientific backgrounds.

Step 3. Weigh the evidence and judge if the supplement is safe and effective.

Once you have gathered information, you should weigh and measure the evidence to determine if the supplement is safe and effective. You’ll want to answer these questions:
· What is the supplement’s biologically active ingredient and how does it function in the body?
· How strong is the scientific research?
· Have the studies been performed on athletes or non-athletes?
· Are the subjects endurance or non-endurance athletes, and for which sport are they training?
· Are the claims true, false, or overstated?
· If the supplement is being endorsed, is payment being received for the endorsement?



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Regulations on Supplements


NCAA Bylaw (Proposal No. 99-72) Nutritional Supplements for Division 1 Institutions


Vitamins and minerals

Energy bars

Calorie-replacement drinks (for example, Ensure, Boost)

Electrolyte-replacement drinks (for example, Gatorade, Powerade)


Amino acids



Creatine/Creatine-containing compounds








Protein powders


Supplements Containing Protein

Also during the July 26 telephone conference, the subcommittee, at the recommendation of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, determined that a supplement that contains protein may be classified as a non-muscle-building supplement, provided it meets all of the following conditions:

It is included in one of the four permissible categories set forth in;

It does not contain more than 30 percent of calories from protein (based solely on the package label); and

It does not contain additional ingredients that are designed to assist in the muscle-building process (see examples of nonpermissible supplements). To assist the membership in calculating the percentage of calories from protein contained in a particular supplement, please note that one gram of protein equals four calories. Therefore, the percentage of calories from protein contained in a nutritional supplement may be calculated by multiplying the number of grams of protein per serving by four and dividing the product by the total number of calories per serving.

The following are examples of this calculation:

Energy bar contains 24 grams of protein with a caloric value of 250. 24 grams times four = 96 calories. 96/250 = .384. Percentage of protein = 38 percent — as an example, this energy bar would not be permissible.

Energy bar contains 17 grams of protein with a caloric value of 250. 17 grams times four = 68 calories. 68/250 = .272. Percentage of protein = 27 percent — as an example, this energy bar would be permissible.

The term “nutritional supplements” as used by the NCAA is broader than the term “dietary supplements.” Nutritional supplements include carbohydrate/electrolyte drinks, energy bars, carbohydrate boosters, and vitamins and minerals. Vitamins and minerals are dietary supplements, but the other categories may include compounds that are dietary supplements. For example, many energy bars and sport drinks have added vitamins, minerals, and, increasingly, herbs. So what is the NCAA bylaw prohibiting?

Muscle-building supplements. Muscle-building supplements are performance enhancing; and if an institution could afford to provide them to student-athletes, that institution would have a competitive advantage over an institution that could not provide such supplements to their student-athletes.

Say I have an energy bar that contains protein. Does it fall into the category of a muscle-building supplement?
It depends. If the energy bar has more than 30% of the total calories from protein, it falls into the muscle-building supplement category.

How would you know if an energy bar falls into the muscle-building supplement category?
You need to look at the label and do a quick calculation. Let me show you how.
Step 1. Find the total number of calories in the energy bar.
Step 2. Find the grams of protein in the energy bar.
Step 3. Multiply the grams of protein by 4 calories per gram to determine the number of calories provided by protein.
Step 4. Divide the number of calories provided by protein by the total number of calories to determine the percentage of calories provided by protein.


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Creatine Monohydrate

  1. David Branch, PhD, Old Dominion University

 _Creatine is a naturally occurring amino acid derivative.

 _It is a popular nutritional supplement that is used by physically active people.

 _It has been reported to reduce fatigue in older people.

 _Uptake of creatine by muscle appears to be facilitated by concurrent carbohydrate ingestion.

 _Creatine is commercially available as powder, gum, candy, tablets, and gel.

 _There are no known contraindications to short-term use of creatine.

 _At present, no sport governing body has banned the use of creatine.


Name: Creatine monohydrate (creatine)

Description: Creatine is a naturally occurring amino acid derivative. The body needs approximately 2 to 3 g daily depending on body size and rate of turnover. Synthesis of creatine (~1g/day-1) occurs in the liver, pancreas, and kidney from the amino acids glycine, arginine, and methionine. Creatine is also obtained from the diet. Approximately 1 to 2 grams are provided daily by the typical American diet. Meat is an excellent source. Approximately 3 to 5 g of creatine can be found in each kg [2.2 lbs] of uncooked meat or fish.

Dietary creatine is absorbed intact by the small intestine and enters the bloodstream. Most (95 percent) of the body’s creatine is stored in skeletal muscle. Sixty to 70 percent of skeletal muscle creatine is phosphorylated, creating phosphocreatine (PCr), which is effectively trapped in the muscle where it is involved in the anaerobic production of adenosine triphosphate (ATP). Approximately 120 g [~4 oz] of creatine are in a 70 kg [154 lb] male (Williams, Kreider, & Branch, 1999). Creatine is nonenzymatically converted to creatinine, which is filtered by the glomeruli (kidney) and excreted in urine.

Usage: Creatine is used by athletes to increase lean body mass and improve performance in single and repetitive high-intensity, short-duration exercise tasks such as weightlifting, sprinting, sprint swimming, and cycling. It could potentially be beneficial to soccer, rugby and hockey players. There is no evidence to support the use of creatine supplements in middle- or long-distance running, and supplements may be detrimental to distance runners and distance swimmers (Casey & Greenhaff, 2000).

Prevalence: Creatine is a popular nutritional supplement that is used by physically active people from recreational exercises to Olympic and professional athletes. Creatine is one of the most frequently used dietary supplements (Morrison et al. 2004; Froiland et al. 2004; Herbord et al. 2004).

Chemical mechanism: PCr can donate its phosphate group to adenosine diphosphate (ADP) to form ATP. The enzyme creatine kinase catalyzes this phosphorylation-dephosphorylation reaction: PCr + ADP; Creatine + ATP. Theoretically, creatine supplementation can increase PCr concentration in the cell, providing a “phosphate shuttle” between the mitochondria and cytosol as well as a mechanism for rapid ATP resynthesis. Because PCr is a rapid source of high-energy phosphate, it is an important source of chemical energy for muscle contraction during high-intensity, short-duration physical activity. Creatine supplementation may aid in recovery between bouts of high-intensity exercise. Creatine may also play a role in buffering the acidity associated with high-intensity exercise (Williams et al. 1999).

Clinical evidence: Creatine appears to be preferentially absorbed by Type IIb white fast glycolytic muscle fibers (Casey et al. 1996). There is some evidence that creatine supplementation may reduce Type IIb muscle fiber atrophy in muscular diseases such as gyrate atrophy, mitochondrial cytopathy, and muscular dystrophy (Tarnopolsky & Parise, 1999). Creatine supplementation has also been reported to reduce fatigue in older people (Rawson, Wehnert, & Clarkson, 1999). Aging is associated with reduced creatine concentrations; thus, there is a theoretical basis for creatine supplementation. However, to date, studies of elderly humans have not shown a benefit of creatine supplements (Dempsey, Mazzone & Meurer, 2002; Tarnopolsky, 2000). More research is needed.

Scientific research: Since the early 1990s, the efficacy of creatine as an ergogenic aid has been studied extensively (Williams et al. 1999). Uptake of creatine by muscle appears to be facilitated by concurrent carbohydrate ingestion, suggesting an insulin-mediated mechanism (Green et al. 1996), whereas caffeine may counteract any ergogenic effect of creatine (Vandenberghe et al. 1997). People with low to normal endogenous muscle (creatine) may respond better to creatine supplementation than those with normal to high endogenous muscle (creatine) (Greenhaff, 1995).

Creatine supplementation has been reported to improve single or repetitive tasks of dynamic strength (such as an increase in the number of bench press repetitions) which lasts less than 30 sec. This may help athletes maintain or sustain force output for a longer period of time, thus completing more repetitions. This extra training stimulus may lead to greater strength or power gains. The ergogenic effect has been shown for a variety of athletes but a performance effect has only been shown for weight lifters. (Volek and Rawson, 2004)

Another consistent finding associated with creatine supplementation is increased total and lean body mass (~1 to 2 kg [~2.5 lbs.]). Since creatine is an osmotically active molecule, one possible mechanism for increased mass is water retention within the muscle fibers. Other possible mechanisms are increased protein synthesis secondary to increased training volume after creatine supplementation and increased protein synthesis or decreased protein degradation caused by a direct effect of increased cellular hydration (Volek et al. 1999). The literature suggests that creatine supplementation may actually impair performance in tasks such as distance swimming

and distance running, where increased body mass may also increase drag or otherwise decrease biomechanical efficiency (Juhn & Tarnopolsky, 1998; Williams et al. 1999). Most of the available literature has studied the effects of creatine on physically active males less than 30 years of age. The effect of creatine supplementation on women and other populations has received much less research attention.

Administration: Creatine monohydrate, the most common form of creatine, is commercially available as powder, gum, candy, tablets, and gel. It is available in pure form or combined with other dietary supplements (e.g., carbohydrates, amino acids, electrolytes, and herbal preparations). Creatine uptake appears to be increased with exercise and carbohydrate ingestion. Exercise possibly enhances creatine uptake by increasing blood flow (Persky & Brazeau, 2001).

Dosage: Creatine powder (four 5-gram doses daily) is normally ingested dissolved in ~250 ml [~8 oz] warm carbohydrate solution (Green et al. 1996). A common approach to creatine supplementation is an initial “loading” phase of 20 to 30 g/day for 5 to 7 days, followed by a “maintenance” phase of 2 to 3 g/day. However, the high dose loading phase may be replaced with a 28- to 30-day intake of 2-3 g/day. Both protocols have been shown to be effective in increasing muscle creating content (Greenhaff, 1995; Hultman et al. 1996; Greenhaff, 1996). These protocols increase creatine stores by ~17-22% (Rubinstein & Federman, 2000).

Contraindications: There are no known contraindications to short-term creatine supplementation in healthy people. However, it has been suggested that people with a history of renal dysfunction or diabetes should refrain from creatine supplementation (Juhn and Tarnopolsky, 1998).

Precautions: There are anecdotal reports of muscle cramping, strains, dehydration, and gastrointestinal distress associated with creatine supplementation, but no scientific literature currently exists that supports these adverse reactions. There has also been some concern about potential renal dysfunction associated with creatine supplementation, but no adverse renal effects were reported in 9 subjects following up to 5 years of supplementation with daily doses of up to 30 g [1 oz.] (Poortmans & Francaux, 1999). One study of (American) football players found no adverse effects from 2 years of creatine use (Mayhew et al. 2002; Ware, 2002). Nevertheless, the side effects of excessive daily doses and long-term supplementation are largely unknown, cannot be guaranteed and require further study.

  • Banned or permitted: At present, no sport governing body has banned the use of creatine. However creatine and creatine-containing compounds are on the nonpermissible list of the NCAA bylaw related to nutritional supplements. This bylaw prohibits coaches and other staff members of the institution from dispensing “muscle-building” supplements to student-athletes. It is also not permissible for an NCAA institution or its staff to sell or arrange for the sale of creatine or creatine-containing supplements.


Muscle and Strength Building Supplements

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Supplements to Build Muscle and Strength

Lars says that while a lot of guys in the gym take protein supplements, there’s also a lot of talk about taking andro. To help you answer Lars’ questions, read the article on androstenedione.


Charles E. Yesalis, MPH, ScD, Pennsylvania State University

 _Androstenedione is an anabolic-androgenic steroid hormone produced by the gonads and adrenal glands or by peripheral transformation.

 _It is an immediate precursor to testosterone and estrogen.

 _It is marketed as increasing blood testosterone concentrations for the purposes of increased strength, lean mass, and sexual performance. Often marketed as the “natural” anabolic steroid.

 _Daily dosages for oral preparations range from 100 to 1200+ mg/day.

 _Little is known about children’s or adults’ frequency of use of androstenedione.

 _Studies of healthy men taking oral androstenedione have mixed outcomes regarding the effects on serum testosterone levels. However, two long-term studies of androstenedione supplementation in strength-trained men failed to show significant increases in serum testosterone concentrations, strength, or muscle mass.

 _More than 25 potential androgenic and estrogenic effects have been documented. Acute adverse effects in men include increased estrogen levels and decreased HDL-C levels. There is a significant probability of virilization (masculinization) of women.

 _The Food and Drug Administration (FDA) has cracked down on the sale of dietary supplements containing androstenedione. At present, such supplements are illegal to market in the United States.

 _Androstenedione is banned by most sports governing bodies, including Major League Baseball.


Name: Androstenedione (Other substances that are chemically and pharmacologically related to androstenedione are also available: 5-androstenedione, 4-androstenediol, 5-androstenediol, 19-noradrost-4-enedione, 19-norandrost-5-enediol, and 19-norandrost-4-3n3diol. Along with DHEA, androstenedione is often described as a prohormone or hormone precursor.)

Description: Androstenedione is an anabolic-androgenic steroid hormone produced by the gonads (testes and ovaries) and adrenal glands or emanating from dehydroepiandrosterone (DHEA) by peripheral transformation. By itself, androstenedione is a relatively weak steroid whose anabolic-androgenic activity is one-fifth to one-tenth that of testosterone. Women’s production of androstenedione is approximately one-third greater than men’s production of androstenedione. In both men

and women, androstenedione is an immediate precursor to testosterone as well as estradiol and estrone (estrogens). Consequently, it makes sense that increased levels of androstenedione could be accompanied not only by increased testosterone levels but also by increased production of estrogens. There is evidence to suggest that androstenedione preferentially increases estradiol, not testosterone.

Aromatase, the enzyme that converts androstenedione to estrone and estradiol, is found in various cells, including skeletal muscle and fat. The conversion of androstenedione to testosterone is accomplished by the means of the enzyme 17-dehydrogenase, which is also found in most cells in the body. This enzymatic process, like others in the hormonal pathways, is regulated by the thermostatic-like feedback mechanisms that maintain homeostasis. Thus, if a male with normal testosterone levels ingested large amounts of androstenedione, one would predict, based on this feedback loop, that the body would produce only enough 17-dehydrogenase to result in a modest increase in testosterone production. The rest of the androstenedione would be metabolized and excreted. If, however, androstenedione does significantly increase serum testosterone levels, one would expect, in conjunction with strength training and conditioning, significant increases in anabolism and anticatabolism commonly associated with testosterone administration.

Usage: Androstenedione is marketed as increasing blood testosterone concentrations for the purposes of increased strength, lean mass, and sexual performance. Recommended daily dosages for oral preparations range from 100 to 1,200+ mg/day. Androstenedione and its analogs are also available as sublingual spray or percutaneous gel.

Prevalence: There is a lack of national-level epidemiologic data on the incidence of use of androstenedione (or other supplements) by either children or adults. However, the illicit use of anabolic steroids (a scheduled substance) among adolescents is well documented (lifetime use of 4 to 6% for males and 1 to 2% for females). Androstenedione use by youngsters increased fivefold after Mark McGwire’s 1998 admission of use (androstenedione supplements could legally be purchased in the United States at that time).

Chemical mechanism: See description section.

Clinical evidence: Androstenedione does not have any known clinical applications.

Scientific research: It is yet to be determined whether androstenedione significantly increases strength and lean mass by way of increasing blood testosterone levels. There are two studies lasting 8 and 12 weeks, respectively, that used healthy males (age 19 to 60) who were administered oral androstenedione in doses of 100 mg or 300 mg per day in conjunction with strength-training regimens. These studies failed to detect significant increases in blood testosterone levels, strength, or muscle mass. There have been several studies that have administered oral androstenedione for 1 to 7 days primarily to assess the effect on serum testosterone levels. A study using healthy young males

administered a single 100 mg or 300 mg dose each day of androstenedione for 7 days. Significant, although transitory, increases in serum testosterone concentrations with the single 300 mg/day dose were observed. No effect was observed with the single 100 mg/day dose.

Another study confirmed that oral administration of androstenedione at 100 mg/day did not significantly increase plasma testosterone concentrations and had no anabolic effect of muscle protein metabolism. Conversely, another study demonstrated a transitory increase in urinary testosterone (T) concentrations increased faster than that of epitestosterone (E), causing the T/E ratio in some of the androstenedione recipients to exceed the IOC-imposed 6:1 limit. This same study also administered a single oral dose of norandrostenedione to other volunteers, and high concentrations of the metabolites of the anabolic steroid nandrolone were found in the urine. A similar study evaluated the effect of a one-time administration of 100 mg of androstenedione or 100 mg of androstenediol and found significant increases in serum testosterone concentrations with both preparations. Thus, whereas some studies show significant increases in serum testosterone levels with oral androstenedione, others do not. More important, to date, no study has demonstrated an association between oral androstenedione and significant increases in strength and muscle mass.

Yet even more questions remain to be answered. Undoubtedly many androstenedione users are taking daily oral doses substantially higher than those used in the studies reviewed here. Therefore, what would be the effect of a 1 g or higher daily dose of oral androstenedione or one of its analogs for a prolonged period? Likewise, the effects of injecting an oil-based version of androstendione have yet to be articulated. In addition, the performance effects of androstenedione in adolescents and elderly males or among different races have yet to be examined. There is only one study of the effects of androstenedione on women. This study administered 100 mg per day to two women and found a significant increase in blood testosterone levels.

Administration: Daily dosages for oral preparations range from 100 to 1,200 mg/day. Androstenedione and its analogs are also available as a sublingual (beneath the tongue) spray or percutaneous (through the skin) gel.

Dosage: Recommended daily dosages for oral preparations range from 100 to 1,200+ mg/day.

Contraindications: Women should avoid using androstenedione, given the possibility of significant increases in blood testosterone levels and the attendant risk of virilization (masulinization). Sustained elevated testosterone levels in children have been associated with precocious puberty and premature epiphyseal closure leading to diminished adult height.

Precautions: More than 25 potential androgenic and estrogenic effects have been documented. Some of these side effects are serious, especially for female and adolescent users. At least three studies have reported a significant increase in blood

estrogen levels (estrone and estradiol) in healthy males with oral androstenedione supplementation. Elevated estrogen levels in males are associated with gynecomastia (enlarged mammary glands and breast tissue) and other feminizing effects as well as an increased risk of cardiovascular disease. One study also examined the impact of oral androstenedione on blood lipid levels and found a significant reduction (12%) in high-density lipoprotein cholesterol (HDL-C) that was sustained during the 8 weeks of the study. This reduction in HDL-C is highly consistent with the findings of numerous studies of the effects of oral anabolic steroids on blood lipid levels. If these decreased HDL-C levels are maintained, an increased risk of cardiovascular disease would result. The literature clearly supports the hepatotoxicity of many oral anabolic steroids. Since the oral androstenedione-related decrease in HDL-C is likely the result of an increase in hepatic triglycerol lipase activity, it is prudent to assume that prolonged use at high doses could adversely affect other aspects of liver structure and function. If oral androstenedione did substantially increase testosterone levels in males, then one would expect to observe testicular atrophy and infertility.

Banned or permitted: Androstenedione is specifically banned by name by the NCAA, USOC, and IOC. Most sports governing bodies in the United States, including Major League Baseball, have banned androstenedione. Also, the chemical analogs of androstenedione, such as norandrostenedione, share metabolites with certain anabolic steroids (e.g., nandrolone decanoate) that are banned by virtually all sport federations that administer drug tests. Androstenedione supplements containing anabolic steroids would result in the athletes testing positive for a banned substance.

Legality: Androstenedione was originally classified by the Food and Drug Administration as a dietary supplement. In 2004 the FDA sent letters to 23 companies that manufactured, marketed, or distributed androstenedione-containing dietary supplements and asked these companies to stop distribution. The FDA considers such supplements adulterated (not pure) and illegal to market.

Now it’s time to consider another popular dietary supplement, DHEA.



Professor Douglas S. King, PhD, and Gregory A. Brown, MS, Department of Health and Human Performance, Iowa State University

 _DHEA is a readily available nutritional supplement purported to increase serum testosterone concentrations, restore youth, and improve immunity.

 _Research indicates that DHEA supplementation does not increase serum testosterone concentrations or adaptations to strength training in men.

 _In women, DHEA causes increased serum testosterone concentrations and may cause increased acne and facial hair. The anabolic effects of DHEA ingestion in women are unknown.

 _The immune response to DHEA is unclear, and any positive effects appear to be limited to the elderly.

 _Although DHEA does not appear to have any anabolic effects, it is classified as an anabolic steroid and banned by many sport governing bodies.


Name: DHEA. Dehydroepiandrosterone is commonly abbreviated as DHEA or sometimes DHA. It is referred to as dehydroisoandrosterone in older literature. The steroidal name is 3 beta-hydroxy-5-androsten-17-one.

Description: DHEA is a weak steroid hormone secreted from the adrenal glands. It is often referred to as the “mother steroid” because it is a precursor to many other steroids including testosterone and estradiol. It can also be found in some plants (e.g., wild Mexican yams) or chemically synthesized.

Usage: DHEA is commonly taken to enhance serum testosterone concentrations. Serum DHEA concentrations decline substantially with age, so DHEA is also commonly used as an anti-aging supplement. By age 70 DHEA concentrations are only 20 to 30% of the levels found in 20- to 30-year-olds. DHEA is also purported to increase vitality, libido, and immunity.

Prevalence: The overall prevalence of DHEA use is not known.

Chemical mechanism: DHEA is a weak steroid hormone secreted by the adrenal glands in humans. The physiological importance of DHEA is not known, although the primary importance of DHEA appears to be as a precursor to more active hormones, such as testosterone and estradiol. In vitro, DHEA appears to have some immunostimulatory effects.

Clinical evidence: Physician-reported clinical observations regarding DHEA use are varied with no observable pattern of efficacy and are therefore impossible to interpret.

Scientific research: Many promoters of DHEA cite research demonstrating positive effects in rats. However, because rats do not normally have appreciable concentrations of DHEA in their circulation, the response to DHEA may be quite different in rats than in humans. The effect of DHEA ingestion in humans varies with age and gender. DHEA ingestion by women increases serum testosterone concentrations; and although women may experience anabolic effects, this has not been investigated. The use of DHEA by men does not increase serum testosterone concentrations, reduce body fat, or enhance the adaptations to resistance training. Studies have not shown that DHEA improves athletic performance.

Questions have been raised about the role DHEA may play in influencing dietary intake and changing body composition. In four studies of obese and lean rats, DHEA affected fat intake. In the first two studies both lean and obese rats decreased their fat intake after DHEA ingestion. In the third study this effect was observed only in obese rats. In contrast, the fourth study found that DHEA administration increased caloric intake in lean animals. Whether any of these effects occur in humans is unknown.

DHEA is purported to change body composition, specifically by decreasing body fat and increasing muscle mass with no change in body weight. Such studies resonate loudly with athletes. It should be pointed out that the often-cited study by Nestler and colleagues was conducted in only five healthy young men. The dose of DHEA was 1,600 mg and was administered daily for 28 days. A study of 15 healthy postmenopausal women also showed changes in body composition with 12 months of percutaneous (through the skin) DHEA, in this case a 10% DHEA cream. Other studies have not shown changes in body composition. Although the results may show some promise, a study population of about 50 subjects is too few to draw any conclusions. Clearly more research is needed.

In spite of positive effects of DHEA on immune function in vitro, the effects of DHEA ingestion on immune function in humans are less promising. Evidence suggests any positive immune effects would be seen only in elderly people.

Administration: DHEA is most commonly ingested in capsule or pill form. Topical and sublingual forms of administration have also been used, although there is no evidence to suggest that the results of sublingual and topical use are different from the results of ingestion.

Dosage: The dose of DHEA most commonly suggested is 50 to 100 mg per day. Dosages up to 1,600 mg per day have been investigated but do not increase serum testosterone concentrations in men. In women, larger doses produce greater increases in serum androgen concentrations and more pronounced side effects, such as acne and facial hair growth.

Contraindications: Use of this supplement is not advised for pregnant women or for people with hirsutism or acne. Because DHEA can alter the hormonal milieu and subsequent bone growth as well as sexual development, it is also not advised for persons under 18.

Precautions: The most commonly noted effects of short-term (1 to 6 months) use of DHEA in women include acne, facial hair growth, reduced serum HDL-cholesterol, impaired insulin sensitivity, and impaired glucose tolerance. Although side effects have not been reported in young and middle-aged men, elderly men may experience increased serum estrogen concentrations with DHEA ingestion. The effects of more long-term DHEA use are unknown.

Banned or permitted: DHEA is considered an anabolic steroid and is banned by many sport governing bodies, including the International Olympic Committee, NCAA, and the NFL. DHEA ingestion may cause an athlete to fail a drug screening.

Legality: Under the Dietary Health and Supplement Education Act, which was passed in 1994, DHEA is a legal substance in the United States and is available from many retail outlets, including health food stores and supermarkets. Prior to the passage of this act DHEA was a prescription drug. It remains a prescription drug in most countries due to its potential for abuse.


Chromium Picolinate

Brian Leutholtz, PhD, Old Dominion University

 _Chromium is an essential mineral found in a variety of foods, such as vegetables, cheese, and nuts.

 _It is used to increase muscle mass and strength and decrease body fat.

 _Animal studies were promising; however, studies in humans have not supported chromium picolinate as a nutritional sport ergogenic aid.

 _Taken in daily doses of 50 to 200 micrograms, chromium picolinate is safe. However, the long-term cumulative effects of supplementation have not been evaluated. People with diabetes or glucose intolerance should consult their physicians before using chromium.

 _Chromium supplements are legal and ethical.


Name: Chromium. Available in several forms such as chromium picolinate and chromium chloride.

Description: Chromium is an essential mineral. It is classified as a nutritional sport ergogenic aid because its use claims to increase muscle tissue, reduce body fat, and increase performance. Chromium is found in foods such as whole grains, brewer’s yeast, mushrooms, asparagus, cheese, and nuts. Chromium may even be found in beer and foods cooked in stainless steel cookware. Chromium by itself is poorly absorbed. Chromium supplements are available in salt forms, specifically chromium picolinate, nicotinate, and chloride. As a note of caution, the addition of picolinate makes for a very stable compound that is not absorbed in the same manner as dietary chromium. The chromium picolinate supplement can result in an increase in free radical production and cause oxidative damage to DNA and to cell membranes. More research is needed to determine whether there is a long-term effect in humans. In vitro studies suggest that forms other than picolinate (i.e., chromium chloride) are less likely to cause oxidative damage but more research is needed.

Usage: Chromium supplementation, primarily in picolinate form, has been taken in an attempt to increase muscle mass and decrease body fat.

Prevalence: Prevalence and incidence rates of use by athletes and consumers are unknown. Many users are bodybuilders who take chromium picolinate for an enhanced aesthetic physical appearance, specifically increased muscle and decreased body fat. Other consumers are nonathletes who want to lose body fat and improve their physical appearance or who have insulin resistance, such as those with type 2 diabetes.

Chemical mechanism: Chromium is thought to enhance insulin sensitivity. Insulin is regarded as an anabolic, or tissue-promoting, hormone. This tissue-promoting effect of insulin would enhance the transfer of amino acids into the muscle cell, stimulate protein synthesis, and reduce muscle breakdown, thereby enhancing muscle mass. Increasing insulin sensitivity also may improve the use and storage of glucose.

Clinical evidence: The clinical evidence supporting the claims for chromium supplementation came mainly from animal research and has not been supported in humans.

Scientific research: The animal research was initially promising because it revealed that animals may increase their muscle mass and reduce body fat as a result of supplementation. There have been at least 10 studies of chromium supplementation and body composition in humans who perform resistance exercise. Although the early studies appeared to show that chromium supplementation did result in a small (~1.8 kg) but significant increase in muscle mass and a decrease in body fat (~3.4 kg), subsequent studies did not replicate these results. The early studies were criticized for improper or unreliable body-composition testing methods. Recent studies using valid testing measurements have not reported any improvements in lean muscle mass or strength, body fat reduction, or aerobic performance.

It is very difficult to study chromium, and results are questionable if the proper research protocol is not followed. The study protocol should include a study period of 24 weeks or longer, supplementation of 200 micrograms of chromium, 400 micrograms of chromium and placebo, an exercise protocol, a determination of dietary chromium intake, the use of the most exacting methods for determining body composition, and a method for measuring improvements in performance (such as increased strength). Results from studies with such a protocol should be given serious consideration, whereas results from studies lacking such a protocol will likely raise more questions than they will answer.

Administration: Chromium picolinate is administered in pill form. The Dietary Reference Intakes (DRI) for adults range from 20 to 35 micrograms daily. These doses are considered an adequate dietary intake. The specific recommendations for adults are as follows: females age 51 and older, 20 micrograms; females age 19 to 50, 25 micrograms; males age 51 and older, 30 micrograms; and males age 19 to 50, 35 micrograms. Most research studies have used dosages of 200 to 400 micrograms.

Dosage: Chromium supplements of 50 to 200 micrograms are considered safe. The average daily intake of chromium from food is approximately 25 micrograms for adult females and 33 micrograms for adult males. Supplementing excess amounts for long periods has not been evaluated. However, in animal studies, it has been suggested that chronic supplementation with chromium picolinate may lead to accumulation in the body that results in DNA change.

Contraindications: Chromium supplements may improve glucose tolerance in people with poor glucose control. However, people who are glucose intolerant or have type 2 diabetes should consult their physicians before taking chromium supplements because chromium supplementation would be part of a treatment protocol.

Precautions: Taken in doses of 50 to 200 micrograms, chromium supplementation appears to be safe. Larger long-term doses require further study. In one case, a

chromium intake of 600 micrograms for six weeks was associated with renal failure. There are concerns that excess chromium can accumulate in tissues and that toxic side effects are possible with long-term use. Chromium is known to compete with iron, and one study of men who supplemented with chromium picolinate (180 micrograms for 8 weeks) found a decrease in transferrin saturation.

Banned or permitted: Neither the International Olympic Committee nor the U.S. Olympic Committee currently includes chromium supplements on their lists of banned substances.

Legality: Chromium supplements are legal and ethical.

Since many athletes ask about supplements that may help to build muscle mass, a good starting point is to review the physiological mechanisms for building muscle size and strength.

Let me summarize the process. An increase in muscle size and strength can occur with resistance training over time. Structural changes in the muscle are due to an increase in the number of muscle fibers, an increase in the size of the muscle fibers, or both. Gains in muscle size are usually accompanied by gains in muscle strength, but muscle size is not the only factor that influences muscle strength.

We need to consider the role played by nutrition, too.

Two nutritional factors are particularly important to support an increase in muscle size. These factors are energy (calories) and protein. Strength-trained athletes who are trying to increase muscle mass should increase their caloric intake by about 200 to 500 calories per day. These same athletes should consume about 1.4 to 1.7 g of protein per kilogram of body weight daily. Sufficient protein and energy intakes in the presence of resistance exercise can help increase muscle mass by 0.5 to 1 lb per week.

The need for additional protein and calories often has strength athletes wondering if they should use a protein supplement. Lars has some questions for you about supplementing with protein.

“Here’s the protein powder that I purchased.”



Serving Size: 70 g 2 heaping scoops

Servings per package: 10

Calories: 256

Protein: 20 g

Carbohydrates: 44 g

Fat: 0

Cholesterol: 0


ProCarb (glucose polymers, glucose, and sucrose), ProPlus (whey protein isolate, calcium caseinate, soy protein isolate), natural flavoring, artificial color

DIRECTIONS: Stir 2 heaping scoops into 8 ounces of water and drink slowly before and after working out.

You’ve hit on a very important point. The amino acids needed for muscle growth can come from either protein foods or protein supplements. Most men in the United States, including most strength athletes, consume more dietary protein than they need. Protein supplements should always be considered in light of the amount of dietary protein that is normally consumed.

Of course, it’s not the intake of protein alone that influences muscle growth. Athletes who want to increase muscle size and strength must perform resistance exercise and consume enough energy (calories), as well as enough proteins, so the muscles can respond to the stress of exercise and grow. Are you ready to summarize the scientific research on protein?

So far you’ve learned that proteins are found in food and protein supplements, that amino acids derived from food or supplements can stimulate muscle protein synthesis in strength-trained athletes, and that supplements may cause some side effects. Dehydration can occur because protein requires additional water to be metabolized. Athletes who take protein supplements are advised to drink more water. When athletes take in high protein levels they tend to take in less carbohydrate, and this can affect muscle glycogen stores. There is also a link between high protein intake and urinary calcium loss. Protein metabolism results in excess acid formation. To neutralize the acid, the body withdraws calcium carbonate from the bones. The carbonate is used to buffer the acid, and the calcium is excreted in the urine. Now it’s time to use the information you’ve obtained from your reading to judge the safety and the effectiveness of protein supplements.

Another thing athletes should know is that the legality of adrostenedione supplements has changed. Between 1994 and 2004, androstenedione could be legally sold as a dietary supplement in the United States. In 2004, the Food and Drug Administration sent letters to 23 companies that manufactured, marketed, or distributed androstenedione-containing dietary supplements and asked these companies to stop distribution on the basis that such supplements are adulterated (not pure) and therefore illegal to market.

“This is frustrating. It seems like the results of supplement studies are so confusing. Early studies show one thing, everybody gets excited about taking the supplement, and then later studies don’t confirm it. Why is it so confusing?”

It is very hard to study the effects of a supplement on performance. In early studies, the methods used are sometimes not exact enough. After some initial research has been done, researchers are better able to determine the best study protocol. In the case of chromium, it is a very difficult supplement to study. Now that a good protocol has been established, the results of the studies will be more meaningful. Keep your eyes open for more research studies on the effect of chromium.

Now you know that chromium is an essential mineral that acts on muscles indirectly by increasing insulin sensitivity. Animal studies have shown that chromium supplements can increase muscle mass and reduce body fat, but recent studies have not supported this claim in humans. Animal studies also suggest that excess chromium may accumulate and cause damage to DNA. Excess chromium can accumulate in humans too, so the long-term safety of chromium supplements is not known.

  • Wow! That was a marathon session. By now, you can see that evaluating dietary supplements takes time and information. Describing the active ingredient, identifying the chemical mechanism, summarizing the scientific research, knowing the recommended dosage, and recognizing the potential side effects help you to evaluate supplements. Once you’ve got the information, you can answer the important questions with confidence: Is it safe? Is it effective?

Fat Burning Supplements


Supplements to Lose Body Fat


Brian Leutholtz, PhD, Old Dominion University

 _Ephedra is a pharmacological sport ergogenic designed to mimic the effects of epinephrine and norepinephrine.

 _It is used to improve aerobic and anaerobic performance in endurance and power sports. It also may be used for weight loss and the treatment of asthma and common cold symptoms.

 _A therapeutic does of ephedra (ephedrine) is 20 to 25 mg. If taken as pseudoephedrine, doses may be 120 mg.

 _The available research is limited and does not support a sport ergogenic effect of ephedra. Some studies in obese individuals have reported an 8- to 9-pound short-term weight loss.

 _People with diabetes, hypertension, heart disease, and related conditions should consult their physicians before using ephedra or ephedra-like sympathomimetic compounds.

 _In April 2004, dietary supplements containing ephedrine alkaloids were banned in the United States by the FDA because such supplements posed an unreasonable risk of illness or injury. Ephedra is on the list of banned substances by nearly all sports governing bodies.

 _The FDA prohibits the sale of dietary supplements containing ephedrine alkaloids (ephedra).


Name: Ephedra (ma huang).

Description: Ephedra (ma huang) is a powerful stimulant (sympathomimetic) from the dried branches of a Chinese herb. It is classified as a pharmacological sport ergogenic because it is designed to mimic the effects of the natural, endogenous hormones such as norepinephrine (noradrenalin) and epinephrine (adrenaline).

Ephedra, ephedrine alkaloids, and ephedrine are terms that are often used interchangeably although they are technically different. Ephedra refers to a plant genus. Some species of ephedra contain ephedrine alkaloids in their stems and branches. Ephedrine is one example of an ephedrine alkaloid. Ephedra is the most commonly used term and refers to both herbal and nonherbal dietary supplements that contain ephedrine.

Ephedrine-containing dietary supplements may also contain caffeine. Caffeine contains the active ingredient methylxanthine, a compound known to enhance the weight-loss effect of ephedrine. In herbal dietary supplements the source of the caffeine may be guarana or kola nuts.

It is interesting to note that an herbal weight-loss supplement containing both ephedra and caffeine may list neither compound on the label. It is legal to list only the herbal source of the active ingredients, so the consumer may buy a supplement containing ma huang and guarana without realizing that the active ingredients in that supplement are ephedra and caffeine, respectively.

Usage: The sympathomimetic properties of ephedra (ma huang) may enhance muscle contractility, improve blood flow out of the heart, open bronchial airways, and increase blood sugar, thus theoretically improving aerobic and anaerobic performance. It also may be used for weight loss and the treatment of asthma and symptoms of the common cold.

Prevalence: Based on industry sales reports, in 1999 approximately 12 million people purchased ephedra (~3 billion “servings”). It was a popular supplement with athletes who wished to lose weight and who were looking for a source of “energy.”

Chemical mechanism: Research supports that ephedra increases metabolism through stimulation of the central nervous system, the sympathomimetic branch (“fight or flight” system). Ephedra-containing containing products also appear to temporarily reduce appetite. The increased metabolic rate and the suppression of appetite theoretically should result in weight loss.

Clinical evidence: As an ergogenic aid, the efficacy of ephedra has not been established in well-controlled research. Anecdotes, testimonials, and clinical experience account for the majority of claims. In 2003, a review of 8 published controlled ephedra trials (all but one studied ephedra in combination with caffeine) found insufficient evidence of improved performance.

Scientific research: The available research on ephedrine with caffeine as a performance enhancer is limited. In two trials using cycle ergometers, ephedrine and caffeine significantly increased time to exhaustion. In another study, military subjects ran 3.2 km with 11 kg of gear and those in the ephedrine/caffeine trial recorded faster times than those who took a placebo. In a fourth study, ephedrine and caffeine had no effect on treadmill walking.

Ephedrine in combination with caffeine is being studied to determine its ability to produce short-term weight loss. Caffeine enhances the action of ephedrine, so the ephedrine and caffeine combination is more effective than either compound alone. At the present time studies show that the use of ephedrine and caffeine by obese people could produce a short-term (4 to 6 months) weight loss of 8 to 9 pounds. It is unknown if a short-term weight loss has a meaningful long-term health benefit. An important point is that the studies have been conducted on obese subjects (usually with a BMI greater than 35), not on nonobese subjects. Other studies have reported no effect. It is likely that past study results have been mixed because the amount of active ingredient in the supplement has not been standardized (see the dosage section).

Administration: It is usually administered in pill or capsule form but can be taken through an inhaler for a more rapid response.

Dosage: A therapeutic dose of ephedra (ephedrine) is 20 to 25 mg. If taken as pseudoephedrine, doses may be 120 mg.

The safety of ephedrine-containing dietary supplements has always been controversial. Scientists never agreed on the dose of ephedrine considered safe. When dietary supplements containing ephedrine were legal, the Food and Drug Administration (FDA) proposed that not more than 8 mg of ephedrine alkaloids be used in a six-hour period or not more than 24 mg in a 24-hour period. Other scientists proposed that a single dose should not contain more than 30 mg of ephedrine alkaloids and that up to 90 mg of ephedrine alkaloids in a 24-hour period was safe. They suggested that recommended doses could be consumed for up to 6 months. At the time that ephedrine-containing dietary supplements were on the market, the dose found in various brands varied from that stated on the label. Some supplements contained other substances, including banned substances.

Contraindications: Several deaths and significant side effects have been reported. Anyone considering the intake of ephedrine alkaloids should consult a physician. People with diabetes, hypertension, and heart disease, pregnant or nursing women, and anyone under the age of 18 should be particularly cautious.

Precautions: The herb ma huang contains ephedra, thus stimulating the nervous system, and may interact with theophylline, cardiac medications, glycosides, and caffeine. Some people might have seizures and psychoses. Other reported side effects are nervousness, headaches, rapid heartbeat, and gastrointestinal distress.

In 2001, the NFL banned ephedra in the aftermath of the heat stroke death of Minnesota Vikings lineman Korey Stringer. An ephedrine-containing dietary supplement was found in his locker but toxicological tests for ephedrine were not conducted at the time of autopsy. The safety of ephedra was again brought to the forefront with the death of Orioles’ pitcher Steve Bechler in February, 2003. Bechler used an ephedrine-containing dietary supplement to help him “lose weight and get into shape” days before spring training. Bechler had borderline hypertension, liver abnormalities and reportedly had not eaten for 24 hours prior to his death (in an effort to lose weight). His death occurred while working out in hot, humid conditions.

Shekelle et al reviewed 16,000 adverse event reports and found that 21 serious events-heart attack (4), stroke (9), seizure (1), psychiatric problems (5) and death (2)- appeared to be related to the use of ephedrine-containing dietary supplements. In these cases ephedrine was thought to be the sole factor but the evidence was not strong enough to establish a cause and effect relationship. Ten other cases involved ephedrine as a contributing, but not sole, factor to serious adverse events. Based on this and other evidence, the Food and Drug Administration banned the sale of dietary supplements

containing ephedrine alkaloids in April 2004 because they presented a significant and unreasonable risk of illness or injury.

Banned or permitted: The sale of dietary supplements containing ephedrine alkaloids is banned in the United States. Most sports governing bodies list ephedrine alkaloids on their banned substances list.

Legality: Ephedra and related drugs are available in over-the-counter medications and by prescription. Dietary supplements containing ephedrine alkaloids cannot be legally sold in the United States.



Assistant Professor David Dyck and Lawrence Spriet, Department of Human Biology and Nutritional Sciences, University of Guelph, Canada.

 _Pyruvate is a 3-carbon metabolite that is produced during the metabolism of glucose.

 _Pyruvate is generally marketed in capsule form (0.5 to 1 grams); purity may be as low as 35%.

 _Pyruvate is claimed to reduce body fat and enhance exercise performance.

 _There is little basis to pyruvate’s putative weight-reducing or ergogenic effects. Very high dosages of pyruvate have been shown to reduce body fat in rodents and humans. However, such dosages are unrealistic and associated with unpleasant side effects. Few studies have examined the effects of pyruvate supplementation on aerobic endurance in humans, and the findings are contradictory.

 _Pyruvate supplements are consumed orally. It appears that pyruvate is poorly absorbed or rapidly cleared by the liver, preventing its blood levels from increasing.

 _There are no contraindications to pyruvate consumption; the most frequently reported side effect is gastrointestinal distress (flatulence, borborygmus) and mild nausea.

 _Pyruvate is not a banned substance.


Name: Pyruvate (pyruvic acid—sold in a salt form, usually as calcium pyruvate).

Description: Pyruvic acid is a 3-carbon metabolite that is produced in many cell types in plants and animals as a product of glycolysis (the pathway that metabolizes glucose). Thus, it is a naturally occurring compound. Its content in foods, such as citrus fruits and apples, is relatively low. Therefore, pyruvate must be consumed in supplement form to substantially increase its intake. Pyruvate is generally marketed in capsule form (0.5 to 1 grams). Pyruvate is usually not sold in pure form, and it often includes additional

compounds such as silica and capsicum (derived from chili peppers). Results from our laboratory indicate that purity of pyruvate supplements from different batches sold by one manufacturer ranged from 35 to 70%.

Usage: Claims for pyruvate generally fall under two categories: 1) as an aid in reducing body fat and 2) as an ergogenic, or exercise performance-enhancing, supplement.

Prevalence: The prevalence of this supplement is unknown.

Chemical mechanism: There is very little basis for a mechanism underlying putative weight-reducing or ergogenic effects. There is some evidence that high dosages of pyruvate in animals may increase plasma thyroxin and decrease insulin levels, resulting in a greater metabolic rate and reduced storage of body fat, respectively. In terms of improved athletic performance, two studies provide indirect evidence that relatively high dosages of pyruvate might improve glucose uptake by exercising muscle.

Clinical evidence: There are numerous anecdotal reports of pyruvate’s beneficial effects, primarily related to improved weight loss.

Scientific research: Several studies have demonstrated that the administration of very high dosages of pyruvate in combination with a structurally related compound dihydroxyacetone (the combination is referred to as DHAP) reduced body fat in rodents (Cortez, et al. 1991; Goheen, et al. 1981; Stanko & Adibi, 1986; Stanko, et al. 1978). Studies of humans have also demonstrated that pyruvate and dihydroxyacteone may increase fat loss (Stanko & Arch, 1996; Stanko, et al. 1992) but also with very high dosages (i.e., total dosage ranged from 22 to 90 g, and the actual amount of pyruvate varied from 15 to 53 g). A further factor that confounds the interpretation of the human studies is that the subjects were morbidly obese women who were confined to bed rest in a metabolic ward and only permitted to consume 500 to 1000 kcal/d. These findings have been criticized on the grounds that the conditions (morbid obesity, bed confinement, extreme caloric deficit) are so unique that they are of little relevance to the majority of the population attempting to lose weight (Sukala, 1998). Furthermore, the loss of body weight and fat reported in these studies (0.8 to 1.6 kg) are actually less than the loss induced by caloric restriction alone in the placebo group. More recent studies have also examined the effects of lower dosages of isolated pyruvate on weight loss (Kalman, et al. 1998; Stone, et al., 1999), but the results have been ambiguous.

Only three published studies have examined the effects of pyruvate supplementation on aerobic endurance in humans (Morrison et al. 2000; Stanko, Robertson, Galbreath, Reilly, Greenawalt, & Goss, 1990; Stanko, Robertson, Spina, Reilly, Greenawalt, & Goss, 1990). Two studies by Stanko et al. (1990) demonstrated that time to exhaustion during arm cranking and intense leg cycling was improved in untrained subjects after 7 days of supplementation with high dosages (100 g/day) of DHAP. However, a recent study by Morrison et al. (2000) using more realistic dosages of pyruvate (7 grams/day) for 7 days, found no improvement in cycling performance in well-trained cyclists. The importance of using trained versus untrained subjects in performance studies cannot be

overstated. Untrained subjects do not reliably push themselves to a true point of exhaustion, making them a poor choice for studying the effects of performance-enhancing supplements. The fact that realistic dosages of pyruvate did not improve exercise performance in motivated, well-trained cyclists who routinely push themselves to total exhaustion is strong evidence that pyruvate does not have significant ergogenic properties.

Administration: Pyruvate supplements are consumed orally. This is an important issue, because pyruvate must be efficiently absorbed into the blood to have any effect. The very chemical structure of pyruvate (a carboxylic acid) suggests that it should be degraded in the acid environment of the stomach. Furthermore, any pyruvate that is absorbed might be rapidly cleared from the circulation by the liver. In fact, we have demonstrated that acute dosages of pyruvate, ranging from 7 to 25 g, fail to increase its concentration in the blood (Morrison et al. 2000). There was also no change in blood glucose, lactate, or insulin after pyruvate consumption.

Dosage: Typically, dosages of pyruvate recommended by the supplement manufacturers are in the range of 1 to 2 grams per day. Consumers should keep this in mind when considering the findings of studies using more than 20 grams of pyruvate. This would require the consumption of 20 to 40 capsules per day. If one also considers that purity may only be 50%, then 40 to 80 capsules would have to be consumed to reach these dosages. However, there are no known dangers of overdosage.

Contraindications: There are no known contraindications associated with pyruvate.

Precautions: The most frequently reported side effect is the development of gastrointestinal distress (flatulence, borborygmus) and mild nausea. We have noted this effect with dosages of 15 grams and higher in our laboratory.

Banned or permitted: Pyruvate is not a banned substance.

Legality: Pyruvate is a legal substance.


Perhaps the single most-talked-about nutrition and exercise issue is the reduction of body fat. At the core of any weight loss discussion is the “energy in/energy out concept.” When “energy in” (food intake) is equal to “energy out” (physical activity and metabolism), then weight should be maintained. To reduce body fat, it’s recommended that people decrease food intake and increase physical activity over a period of months. Despite the simplicity of the energy equation,

reduction of body fat is far from simple. People are always looking for ways to easily reduce body fat.

Not only is the process of reducing body fat difficult, it takes time. Theoretically, a daily 500-kcal reduction (achieved through both a decrease in food and an increase in exercise) would result in weight (fat) loss of approximately 1 lb per week. For athletes, who are already at a high level of exercise, it may not be possible to increase activity without increasing the risk for injury. If athletes try to reduce food intake substantially, they actually cut down on the fuel needed to sustain their high level of training. So even athletes who are trying to lose just a little bit of body fat find it difficult and taking much longer than they had hoped. That makes “fat-burning” dietary supplements very appealing.

“What does it mean when a dietary supplement is described as ‘fat burning’?” It can mean almost anything, but most of the time “fat burning” refers to a compound that by itself helps to burn stored body fat. Often the implication is that the person doesn’t need to do anything but take the supplement and the desired goal, reduced body fat, will be met. The scientific studies that are cited to support the compound’s fat-burning properties are often performed on tissues or in test animals. The compound is studied in isolation, so it is not known how that compound would work in the presence of other elements or if taken by humans. Fat burning is an exceptionally powerful advertising term because a reduction in body fat is difficult to achieve and maintain.

“Here’s the label of a dietary supplement purchased on the Internet in 2003. It was advertised as a “fat-burning” supplement.

DIRECTIONS: 1 capsule 1 hour before working out

Supplement Facts : Serving Size: 1 capsule

Amount per Tablet

% Daily Value

Vitamin E 200 IU


ma huang extract 400 mg


*Daily Value not established

INGREDIENTS: Alpha-tocopherol, ma huang extract from stems and leaves, cellulose STORAGE: Keep tightly capped and store in a cool, dry place.

Keep out of reach of children.


Vitago Company 1389 E. Hill Street San Francisco, CA 94122

Research in this area is often difficult. Ma huang is an herb that contains ephedra. Ephedra’s active ingredients include the alkaloids ephedrine and pseudoephedrine. Unless herbal substances are standardized in the same way that medications are, the amount of active ingredients can vary tremendously from product to product and from batch to batch. Thus giving an explanation for inconsistent results recorded.

It is important to point out that the FDA used its regulatory authority to ban the sale of ephedrine-containing dietary supplements because the agency determined that there was a significant or unreasonable risk of illness or injury. This risk includes the possibility of death. There are over-the-counter medications that contain ephedrine, and ephedrine is also found in prescription drugs. People should always check with their doctor before taking ephedrine-containing medications.

Another important point for a parent or guardian to consider is that studies of dietary supplements are almost always performed in adults, not in adolescents. Teenage athletes are using dietary supplements to “get an edge” on the competition, but the safety and effectiveness information about supplements is almost always drawn from studies of adults. Even before it was banned, the FDA cautioned against the use of ephedrine-containing dietary supplements for anyone under the age of 18.

Studies are often quoted in advertisements, but the study results may be taken out of context. Sometimes the studies were done in animals rather than humans but this is not stated in the ad. Many weight loss studies are done on obese individuals, so the results may not apply to people who are non-obese. Studies of performance-enhancing supplements are best done in trained athletes. Training is a powerful influence on performance, and using trained athletes in supplement and performance studies can better control this variable.

Note also that distributorships are available for the sale of this supplement. Economic benefits, whether they come from endorsements, sales to friends, or distribution bonuses, are associated with product bias. Remind athletes to get information from someone who won’t benefit from their supplement purchase

  • While pyruvate supplements appear to be safe, there’s little scientific basis for claims that pyruvate supplements help athletes lose body fat and delay fatigue. Supplements that claim to reduce body fat without exercise are popular because society wants a ‘quick fix’, but there’s no convincing evidence that pyruvate supplements cause weight loss or improve athletic performance. Carefully examine any dietary supplement that is purported to burn body fat. As a certified athletic trainer, help athletes analyze the scientific studies to determine safety and effectiveness. A supplement that is not effective is a waste of money and can be quite dangerous if taken. There are new studies coming out regularly to discuss regulations as well as effectiveness.





Supplements Improving Poor Dietary Intake


Unit 6 – Supplements To Improve Poor Dietary Intake
Marie Dunford, PhD, RD, nutrition consultant, Kingsburg, California
 _Calcium is an essential mineral and a major nutrient necessary for proper bone health.
 _Absorption of calcium in adults is low. Vitamin D aids in absorption.
 _During childhood, adolescence, and early adulthood calcium helps to increase bone density. Adults need adequate calcium to slow the loss of calcium from bone.
 _Insufficient dietary calcium intake is common among young girls, female adolescents, and women. Female athletes often consume less than the recommended levels because of low-energy (low-calorie) diets and the avoidance of dairy products.
 _Athletes suffering from the female athlete triad—disordered eating, amenorrhea, and osteoporosis—are at great risk for loss of bone calcium and need supplemental calcium.
 _Calcium supplements are commonly prescribed for the prevention and treatment of osteoporosis.
 _Consult with a physician before taking calcium supplements. Calcium intakes above 2,500 mg per day are associated with toxicity.

Name: Calcium
Description: Calcium is an essential mineral and a primary component of bone. The best dietary sources are milk and milk products (e.g., cheese and yogurt) and tofu that has been preserved with calcium sulfate. Green leafy vegetables such as broccoli and kale provide less calcium than milk but are important sources for people who do not consume dairy products. Orange juice and soy milk may be fortified with calcium. Supplements are in the form of calcium carbonate, calcium citrate, calcium gluconate, and calcium lactate with calcium carbonate containing the highest percentage of calcium (40%). Bone meal or oyster shells may be the source of calcium in some supplements.
Usage: All but 1% of the calcium in the body is found in bones, where it is an integral part of the bone structure. The calcium stored in the bones also serves as a “bank account” providing calcium to the blood. Blood calcium levels are strictly regulated by hormones and must remain stable to supply the calcium that is necessary for muscle contraction, nerve impulse transmission, blood pressure maintenance, and blood clotting. Low calcium intake is associated with osteoporosis, hypertension, and colon cancer.
Bone health is influenced by genetic, mechanical (e.g., weight-bearing exercise), hormonal, and nutritional factors. Calcium is the major nutritional factor in the prevention and treatment of osteoporosis, a disease characterized by low bone density. From birth until approximately age 25, bone density increases as calcium is actively deposited in bone. An adequate calcium intake is needed at this time to ensure maximum bone density. After age 40 bones slowly decrease in density as calcium is reabsorbed from the bone. An adequate calcium intake at this time may help to slow the bone-density loss and delay the onset of osteoporosis. After menopause, loss of bone density increases significantly because a powerful hormonal influence, estrogen, is no longer present to help keep calcium in the bone. Postmenopausal calcium intake may help to slow the onset of osteoporosis. The role of supplemental calcium in preventing osteoporosis is controversial because the results of research studies have been mixed.
Prevalence: Calcium supplement intake is popular, especially with middle-aged and older women. The prevalence of calcium supplementation in the athletic population is unknown. A 1999 study of athletes in a Division I university found approximately 20% of the female athletes took supplemental calcium, whereas only a small percentage of the male athletes did.
Chemical mechanism: Calcium is found in both food and supplements as a relatively insoluble calcium salt. The acid pH and the presence of food in the stomach help to increase solubility. Absorption of calcium takes place in the small intestine and is considered poor with an estimated average absorption of 30% in adults. Men absorb more calcium than nonpregnant women do. Pregnant women have a greater absorptive capacity but only to approximately 50% of calcium intake. Although the body can increase its absorption slightly, when dietary intake is low, it cannot fully compensate for low dietary calcium simply by increasing absorption.

Calcium absorption requires the presence of vitamin D because vitamin D regulates the transport of calcium both through and between the cells of the small intestine. When blood calcium levels are low, vitamin D exerts its influence by increasing calcium absorption from the gut and increasing calcium retention by the kidney. Unfortunately, vitamin D activity decreases with age, and the absorption and retention of calcium in older adults is a problem. This is especially a problem if older individuals do not have exposure to ultraviolet light, one source of vitamin D.

The presence of lactose (milk sugar), lactase (the enzyme that breaks down lactose), and the acidic amino acids lysine and arginine are all factors that improve calcium absorption. On the other hand, decreased absorption is associated with diets high in fiber. Food such as whole grains and spinach are high in phytates and oxalates, compounds known to bind with calcium and reduce absorption.

High-protein diets and alcohol increase urinary calcium excretion. The metabolism of protein results in excess acid production. Calcium carbonate found in bones is withdrawn, and the carbonate is used to neutralize the acid. The calcium is then excreted in the urine. The diuretic action of alcohol also results in the loss of calcium via the urine. Some antacids contain aluminum at levels that increase urinary calcium excretion.

Clinical evidence: The use of calcium supplements in the prevention and treatment of osteoporosis is common but not without controversy. Some studies have shown that supplementation with calcium and vitamin D can reduce bone loss and deceases the risk for fractures in adults, including the institutionalized elderly. Other studies have not shown a protective effect. Slowing the loss of calcium from bone with supplements may be related to the site (radius versus spine versus hip) or the length of time since menopause (the body may respond differently during the first 5 years after menopause than 6 to 10 years postmenopause). Until calcium supplementation is proven to be ineffective, it is prudent to include it as part of the prevention and treatment for osteoporosis.

Daily calcium need varies according to age. Adolescents should consume 1,300 mg of calcium daily. It is recommended that adults age 19 to 50 consume 1,000 mg per day. After age 50, 1,200 mg of calcium daily is needed. Postmenopausal women not receiving hormone replacement therapy (estrogen) should consume 1,500 mg per day. As people age, energy (calorie) intake may decline, and many older people find it difficult to obtain 1,200 mg of calcium daily through food alone. Obtaining 1,500 mg solely from dietary sources is almost impossible. Insufficient dietary calcium intake is common among girls, female adolescents, and women. Boys and men consume more food and thus more calcium.

Scientific research:
Studies of athletes’ dietary intake report that male athletes age 19 to 50 generally receive enough calcium. Female athletes often consume less than the recommended levels, and this is attributed to low-energy diets and avoidance of dairy products. Of particular concern are those female athletes who suffer from disordered eating, amenorrhea, and osteoporosis, a syndrome known as the female athlete triad. In a quest to be thin they may engage in disordered eating and become amenorrheic. The decrease in estrogen production coupled with low calcium and energy intake can significantly decrease bone density at a young age. The risk for fractures is also increased.

In one study, bone densities of 14 amenorrheic female athletes were compared with those of 14 female athletes with normal menstruation. The average age of the 14 athletes with amenorrhea was 25 years. However, the density of their bones was equivalent to what would be expected of a 51-year-old. Although the women were young in chronological age, because of the amenorrhea, they were physiologically similar to postmenopausal women. When the amenorrheic women resumed menstruation, bone density increased but it remained below the average values for women of the same age who had never been amenorrheic. Those diagnosed with the female athlete triad received medical, psychological, and nutritional treatment including calcium supplements (1,500 mg daily) with vitamin D (400 to 800 IU daily).

Administration: Calcium supplements are ingested orally as pills or tablets. Supplemental calcium may also be obtained from antacids (e.g., Tums). Calcium carbonate contains the most calcium per pill, but absorption may be lower than from other forms. Calcium citrate is often prescribed for older women because it is not dependent on adequate stomach acid for optimal absorption. Calcium supplements are better absorbed when taken with food.

Dosage: The tolerable upper intake levels (UL) for calcium is 2,500 mg per day. Intakes above the UL are associated with toxicity. The recommended calcium intake for an adult is between 1,000 and 1,500 mg daily depending on age and menopausal status. Physicians often prescribe calcium supplements of 800 to 1,000 mg per day. This assumes a dietary calcium intake between 400 and 600 mg per day, the amount commonly consumed by people in North America.

The amount of calcium in a supplement also affects its absorption. Small doses (400 to 500 mg) taken more frequently are better absorbed than a single large dose. Many calcium supplements also contain vitamin D, a nutrient known to increase calcium absorption.

The ability of the tablet to dissolve depends in part on how it is manufactured. A simple test of dissolution is to put the calcium supplement in a half-cup of vinegar. Stir occasionally. After 30 minutes the table should be dissolved.

Contraindications: People with hyperparathyroidism, kidney disease, or a history of kidney stones should consult with a physician before taking calcium supplements.

  • Precautions: Calcium supplements should not be self-prescribed. Calcium supplements can inhibit the absorption of iron, zinc, magnesium, and phosphorous. When taken with tetracycline, the two compounds bind, impairing the absorption of both. Calcium supplements increase the risk of kidney stones in those people who are susceptible to them and, in rare cases, contribute to milk alkali syndrome, a condition of high blood calcium. A common side effect of calcium supplementation is constipation.
  • Supplemental calcium obtained from bone meal, oyster shells, or dolomite (limestone) may contain contaminants such as lead. If these sources are chosen it would be prudent to contact the supplement manufacturer to find out the amount of lead contained.
  • Some antacids (e.g., Rolaids) contain aluminum or magnesium hydroxides and increase calcium excretion. If antacids are used as a source of calcium, check the ingredient list for the presence of aluminum or magnesium hydroxide.
  • Banned or permitted: Calcium supplements are not banned by any athletic governing organization.
  • Legality: Calcium is a legal substance.

28 day challenge

Professor Ian Newhouse, Interdisciplinary Studies, Lakehead University
 _Iron is an essential trace element found in both animal and plant foods.
 _It is needed for oxygen delivery in the blood and electron transport in the mitochondria (critical for endurance performance).
 _Iron deficiency is the most common nutrient deficiency in the world. Female athletes are at high risk.
 _A correction of iron-deficiency anemia with iron supplementation will improve performance.
A correction of low serum ferritin levels with iron supplementation in nonanemic athletes will not improve performance.
 _The Dietary Reference Intake for adult males and postmenopausal females is 8 mg/day. Premenopausal adult females should consume 18 mg/day.
 _Supplemental iron is taken orally as a ferrous salt, and therapeutic dosages are recommended to be 100 mg/d of elemental iron for up to 3 months.
 _Iron is a legal substance, and its use is permitted by sport governing bodies.
Name: Iron (element name is Fe).
Description: Iron is an essential trace element found in both animal and plant foods. Dietary iron comes in two forms: heme and nonheme. The heme form is found in the meoglobin and myoglobin of animals and has greater bioavailability (10 to 35%) than the nonheme form (2 to 10%). Iron can exist in either a ferric (Fe3+) or ferrous (Fe2+) state. Supplemental iron is often a ferrous salt.
Usage: Iron is needed for oxygen and carbon dioxide transport (hemoglobin and myoblobin), electron transport (cytochromes), and activation of oxygen (oxidases and oxygenases). The critical functions that iron plays with oxygen metabolism and hence endurance performance provides the rationale for supplementation.
Prevalence: Iron deficiency is the most common nutrient deficiency in the world. Although the problem is most severe in developing countries, it is not uncommon in affluent countries. It is even more common among female athletes who have inadequate iron intake (sometimes caused by low calorie intake or eliminating red meat). A jeopardized iron balance in endurance athletes may be due to an inadequate dietary intake; malabsorption from the gut; or increased iron losses in the sweat, urine, or feces. Women are at increased risk because of menstrual blood loss. About 3 to 5% of American women have iron-deficiency anemia, and estimates of iron depletion without anemia (i.e., iron stores are low) run as high as 82% for elite female runners and 15 to 30% in male distance runners. Female athletes who consume a vegetarian diet appear to be at greatest risk for developing iron-deficiency anemia, although clearly not all female vegetarian athletes do so.
A common dietary supplement, especially among women, is a multivitamin and mineral supplement containing iron. One study of female distance runners noted that half of these women regularly ingested a dietary iron supplement. A variety of supplementation programs and monitoring schedules are recommended to ensure adequate iron status. A large portion of the population thus practices iron supplementation with or without prescription.
Chemical mechanism: Because iron is used in the formation of hemoglobin, myoglobin, and certain cellular enzymes, its role in aerobic performance is clear. In hemoglobin, iron increases the oxygen-carrying capacity of the blood approximately 65 times. In the cytochromes, iron, because of its ability to exist in either an oxidized state (Fe3+) or reduced state (Fe2+), allows electron transport to occur with the trapping of
chemical energy in the form of high-energy phosphates. A drop in hemoglobin levels, even if still within normal ranges, can significantly impair endurance performance. On the other hand, a low iron status, as indicated by very low serum ferritin levels but no drop in hemoglobin, probably doesn’t affect performance. Other than anemia, which will lead to lethargy and a drop in endurance performance, iron deficiency can impair temperature regulation and resistance to infection.
Clinical evidence: There is plenty of clinical evidence to prove that iron-deficiency anemia can be corrected with iron supplementation and will improve performance. There is lack of evidence to show that iron supplementation, without an increase in hemoglobin, will improve performance.
Scientific research: At present there is no scientific justification for iron supplementation if a preexisting deficiency is not present. Although iron supplementation generally raises serum ferritin levels, most research has found that unless hemoglobin levels are increased as well, no improvements in endurance performance would be expected.
Administration: Supplemental iron is taken orally.
Dosage: Therapeutic oral dosages of iron have typically been about 100 mg/day and in the form of ferrous (Fe2+) salts with a high bioavailability. Bioavailability is enhanced if iron is consumed on an empty stomach and with vitamin C. However, an empty stomach and dosages above 100 mg/d can be associated with gastrointestinal discomfort. Treatment may need to be maintained for up to 3 months. The Dietary Reference Intake (DRI) for adult males and postmenopausal females is 8 mg/day. Premenopausal adult females should consume 18 mg/day. Menstrual blood loss accounts for the higher needs of premenopausal women. Pregnant women meet their recommended intake (27 mg/day) with the use of an iron supplement.
Contraindications: Only people with low serum ferritins should be supplementing with iron. Some people (mainly men) have a genetic predisposition toward hemochromotosis in which faulty iron metabolism leads to a buildup of iron in the tissues. With this disease, the liver becomes enlarged and cirrhotic, and the skin develops a bronze hue. Excessive iron supplementation will exacerbate the problem.
Precautions: In addition to hemochromatosis, excessive iron intake can be linked to an increased risk of colon cancer. A theory also links high serum ferritins with cardiovascular disease, although epidemiological data have generally not been supportive of this link. An overdose of candy-flavored vitamin supplements containing iron may be fatal to young children. It should also be noted that an excess of any mineral could inhibit the absorption of another mineral.
Banned or permitted: Iron supplementation is not banned by any sport governing bodies.
Legality: Iron is a legal substance.
Vitamin C
Professor Scott Powers, Center for Exercise Science, University of Florida
 _Vitamin C (ascorbic acid) is a natural substance found in many common foods (e.g., tomatoes, potatoes, green vegetables, citrus fruits, strawberries).
 _It is used as an antioxidant. Vitamin C is used to treat colon cancer and is claimed to improve the recovery from colds and the flu. Some proponents of vitamin C also claim that supplementation with this water-soluble vitamin will improve human exercise performance.
 _To date, there is no conclusive evidence to indicate that megadoses of vitamin C are useful in the treatment of colon cancer. Although controversial, some evidence exists that vitamin C can reduce the severity of a cold. At present, there is limited evidence that vitamin C supplementation will improve endurance-exercise performance in humans.
 _Moderate supplementation (i.e., 0.25 to 1.0 grams/day) with vitamin C is considered safe and well tolerated by most healthy adults. Nonetheless, high doses of vitamin C (i.e., >2 grams/day) can be toxic and cause destruction of vitamin B12 and enhance iron absorption.
 _Vitamin C is a legal substance and its use is permitted by sport governing bodies.
Name: Vitamin C (ascorbic acid).
Description: Vitamin C exists in two chemical forms: ascorbic acid (reduced form) and dehydroascorbic acid (oxidized form). Both forms are interchangeable and have biological activity. Vitamin C is found in a variety of common foods including tomatoes, potatoes, green vegetables, citrus fruits, and strawberries.
Usage: Vitamin C (a water-soluble vitamin) is a common vitamin supplement and has been in use for many years. It has been argued that vitamin C supplementation may reduce the incidence and severity of colds; nonetheless, this issue remains controversial. Some vitamin advocates claim that vitamin C may also improve human exercise performance.
Prevalence: Prevalence rates and incidence of use of vitamin C by athletes and consumers are unknown. However, annual sales in the United States remain high.
Chemical mechanism: Vitamin C acts as a nonspecific reducing agent (i.e., donates electrons) and is important for several biological functions in the body. For example, vitamin C is required for the synthesis of collagen (component of connective tissue) and is an important biological antioxidant. Vitamin C plays an active role in the function of the immune system. The biological impact of vitamin C on human health continues to be investigated. However, a primary benefit of vitamin C comes from its antioxidant properties. As an antioxidant, vitamin C scavenges free radicals and reduces the potential for oxidative damage in tissues, an important issue for endurance athletes who are subject to great oxidative stress. Reduction of oxidative damage to tissues has been postulated to slow the aging process and reduce the risk of cataracts, heart disease, and cancer.
Clinical evidence: The efficacy of vitamin C as a prevention for coronary heart disease, as a prevention and treatment for colon cancer, and for shortening the duration of colds has been investigated primarily through epidemiological studies. At present, clinicians remain divided about the clinical usefulness of vitamin C supplementation to treat colon cancer.
Scientific research: There is growing literature on the effects of vitamin C as a prevention for heart disease, as a prevention and treatment for cancer and as a cold therapy. Epidemiological studies have shown that the consumption of vitamin C-containing foods is associated with a decreased risk for colon cancer. Studies remain divided on the ability of megadoses (i.e., 10 grams/day) of vitamin C to cure colon cancer. In contrast, scientific evidence does support the notion that dietary supplementation (1 gram/day) of vitamin C may decrease the severity of a cold. Dietary intake of vitamin C is linked to the prevention of heart disease, but the association is weak. A meta-analysis of nine studies suggests that subjects who supplemented with vitamin C (>700 mg/day) had a lower incidence of cardiovascular disease events than those who did not supplement with Vitamin C.
Several studies have also investigated the effects of vitamin C on muscular fatigue and human performance. To date, there is no convincing evidence that vitamin C supplementation will improve athletic performance in humans. Nonetheless, additional research will be required before a firm conclusion can be formed about the ergogenic potential of vitamin C in humans.
At the present time there is no established recommendation for additional vitamin C for endurance athletes. Those who recommend additional vitamin C usually suggest a daily 500-mg supplement. This is the dose used in scientific studies and would not likely result in a total vitamin C intake that exceeded the Tolerable Upper Intake Level (UL) of 2,000 mg.
Administration: Vitamin C is typically taken orally in tablet form.
Dosage: The Dietary Reference Intakes (DRI) for vitamin C for adult females is 75 mg/day and 90 mg/day for adult males. Female cigarette smokers should consume 110 mg/day and male smokers should consume 125 mg/day to overcome the rapid destruction of vitamin C in the lungs. The Tolerable Upper Intake Level (UL) is 2,000 mg (2 g) daily.
. Two grams or more per day causes destruction of some vitamin B12,enhances iron absorption and may cause diarrhea.
Contraindications: There are few contraindications for vitamin C supplementation. However, high doses (>2 grams/day) of vitamin C have been shown to cause stomach inflammation, diarrhea, and oxalate kidney stones in people with a history of kidney stones.
Precautions: To date, there are few (if any) reported harmful interactions between vitamin C and other common nutritional supplements.
Banned or permitted: Neither the International Olympic Committee nor the U.S. Olympic Committee currently includes vitamin C on their lists of banned substances.
Legality: Vitamin C is a legal substance and can be purchased at a variety of commercial outlets in the United States and around the world.
Vitamin E
Professor Scott Powers, Center for Exercise Science, University of Florida
 _Vitamin E is a natural substance found in many common foods (e.g., plant oils, nuts, whole-grain breads).
 _It is used as an antioxidant. Vitamin E is claimed to reduce the risk of heart disease, cancer, and other age-related diseases.

 _Some manufacturers of vitamin E also claim that supplementation with this fat-soluble vitamin will improve human exercise performance.
 _Although some studies of animals indicate that vitamin E can improve endurance-exercise performance, there is limited evidence that vitamin E supplementation will improve endurance-exercise performance in humans.
 _Vitamin E is considered relatively safe and well tolerated by most healthy adults. Nonetheless, vitamin E inhibits blood clotting and may be contraindicated in patients taking blood-clotting medications.
 _Vitamin E is a legal substance and its use is permitted by sport governing bodies.
Name: Vitamin E.
Description: The generic term “vitamin E” refers to at least eight structural isomers of two different classes of compounds (tocopherols or tocotrienos). Among these, a-tocopherol is the best known and possesses the most potent antioxidant activity. Vitamin E is found in a variety of foods such as plant oils, salad dressings, nuts, seeds, peanut butter, and whole-grain breads.
Usage: Vitamin E (fat-soluble vitamin) is a common vitamin supplement and has been in use for many years. Early evidence suggested that vitamin E supplementation could reduce the risk of heart disease and some types of cancer. Further, animal studies indicated that vitamin E supplementation might protect the heart during a heart attack. Finally, some manufacturers claim that vitamin E may also improve human exercise performance.
Prevalence: Prevalence rates and incidence of use of vitamin E by athletes and consumers are unknown but it is a popular supplement in the United States.
Chemical mechanism: The mechanisms underlying the alleged effects of vitamin E continue to be investigated. However, a primary benefit of vitamin E comes from its antioxidant properties. As an antioxidant, vitamin E removes free radicals and reduces the potential for oxidative damage in tissues. Reduction of oxidative damage to tissues has been postulated to slow the aging process and reduce the risk of cataracts, heart disease, and cancer.
Exercise increases the prevalence of free radicals. These free radicals escape from mitochondria, the lining of the capillaries, or inflamed cells. Strenuous exercise in a nonconditioned athlete results in oxidative damage to muscle tissue.
Clinical evidence: The efficacy of vitamin E to reduce the risk of heart disease and cancer has been investigated primarily through epidemiological studies of large populations.
Scientific research: There is growing literature on the effects of vitamin E on the cardiovascular system, aging, cancer, cataracts, and other health-related issues. Further, several studies have investigated the effect of vitamin E on muscular fatigue.
For example, several animal studies indicate that vitamin E can reduce free radical-mediated oxidative damage and improve endurance exercise performance. In contrast, there is no convincing evidence that vitamin E supplementation will improve athletic performance in humans. Studies of trained athletes do not show that vitamin E supplements reduce membrane damage as a result of exercise, although this may occur in untrained athletes. This difference can be explained by the fact that aerobic exercise training strengthens the athlete’s antioxidant capabilities via changes in enzymes. Nonetheless, additional research will be required before a firm conclusion can be formed about the ergogenic potential of vitamin E in humans. Indeed, many of the aforementioned human studies have had various methodological problems such as small sample size, lack of experimental control, and relatively short periods of vitamin E supplementation.
At least nine large epidemiological studies have investigated the relationship between vitamin E intake (diet and/or supplements) and coronary heart disease. A meta-analysis of these studies suggests that supplemental vitamin E does not significantly reduce the risk of heart disease.
Administration: Vitamin E is typically taken orally in capsule form. When vitamin E supplements are recommended for athletes, a frequent recommendation is 100 to 200 mg daily.
Dosage: The Dietary Reference Intakes (DRI) for vitamin E for adults is 15 mg/day. The Tolerable Upper Intake Level (UL) is 1,000 mg. Compared to other fat-soluble vitamins, vitamin E has a relatively low toxicity. Researchers who recommend the use of vitamin E for endurance athletes generally suggest a 100 to 200 mg daily dose.
Contraindications: There are few contraindications for vitamin E supplementation. However, doses above the UL have been shown to reduce blood-clotting time. Clearly, patients taking blood-thinning medications should consult their physicians before beginning vitamin E supplementation.
Precautions: To date, there are few (if any) reported harmful interactions between vitamin E and other nutritional supplements.
Banned or permitted: Neither the International Olympic Committee nor the U.S. Olympic Committee currently includes vitamin E on their lists of banned substances.
Legality: Vitamin E is a legal substance and can be purchased at a variety of commercial outlets in the United States and around the world.


28 day challenge


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David is a 5 ft 11 in. (or 180 cm) tall and 170 lb (or 77 kg)High school junior. Sprint swimming is his sport.
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