Chapter 16 - Supplementation

Question 1

supplement

Answer 1

• food
• food component
• nutrient
• non-food compound

that is purposefully ingested in addition to the habitually consumed diet with the aim of achieving a specific health and/or performance benefit

the least important part of the picture for athlete nutrition

Question 2

the food first approach

Answer 2

1. the primary goal of the sports nutrition plan for the athlete is to ensure that macronutrient and micronutrient intake is optimized in a diet based on natural, whole foods. In theory, athletes who follow this approach should be free of any unnecessary macro- or micronutrient deficiencies that can readily be corrected by food
2. The second tier to this approach is sports nutrition, which involves the manipulation of macro- and micronutrients in the diet to maximize recovery, adaptation, and performance
3. the third tier is supplements, which may be considered as a bonus to the diet, when all other areas are covered.

Question 3

how does one make suplemment decisions?

Answer 3

cost-benefit analysis

Question 4

potential costs of taking supplements

Answer 4

For athletes who compete under the World Anti-Doping Code, a major cost may be a ban from the sport. This is because supplements can contain prohibited substances as detailed by the Anti-Doping Code and, thus, the athlete can inadvertently test positive for a banned substance, leading to an anti-doping rule violation

Question 5

what is the WADA?

Answer 5

World Anti-Doping Agency

Question 6

supplement contamination

Answer 6

Some individual products or categories of products are considered to have a higher risk of contamination due to the country of origin, the manufacturer, the type of product, and the range of declared ingredients

However, common supplementations such as vitamin C, multivitamins, and minerals have in rare cases also been shown to contain prohibited substance

Question 7

third-party testing companies

Answer 7

when an organization that is not the supplement company itself evaluates a dietary supplement and declares it free from contamination and, most importantly, shows that the product contains what it claims on the label

includes
1. an audit of the manufacturing process
2. an evaluation of the product’s quality
3. an evaluation of labeling to ensure it is accurate and compliant with regulations

The NSF Certified for Sport initiative is a recognized third-party certification in the United States that helps confirm that sports supplements and sports nutritional products do not contain substances banned by many major athletic organizations

Question 8

what do the USADA and WADA state about responsibility around doping within athletic populations?

Answer 8

athletes are 100% responsible for what is in their body

Question 9

what are the 4 categories of sports supplements?

Answer 9

1. Nutrient supplements for the treatment or prevention of nutrient deficiencies
2. Sports foods providing energy or nutrients when it is impractical to consume everyday foods, such as sports drinks and protein supplements
3. Performance supplements that directly enhance exercise capacity
4. Supplements that provide indirect benefits through recovery, body composition management, and other goals

Question 10

Performance Supplements that Directly Enhance Exercise Capacity

beta-alanine

Answer 10

is the rate limiting precursor to carnosine synthesis

Carnosine is a highly abundant physicochemical buffer in muscle (Harris, et al., 1990), that acts as an immediate first defense against changes in pH.

Studies demonstrate that 3–6 g per day is required to elevate muscle carnosine. This must be taken daily for about four weeks before benefits are noticed

Question 11

describe the metabolic conditions where beta alanine is important

Answer 11

Anaerobic glycolysis is the dominant energy source during high-intensity exercise. As duration of the high-intensity exercise increases, the hydrogen ions produced when lactic acid disassociates to lactate overcome the intracellular buffering capacity and the pH of the muscle falls, contributing to the onset of fatigue. One such intracellular buffer is carnosine, of which the amino acids beta-alanine and histidine are precursors

Question 12

what causes “the burn” that people associate with exercise?

Answer 12

the build of matabolites (by products of metabolism/energy production)

specifically, it’s the presence of hydrogen ion by-products from anaerobic glycolysis that cause that “burn” or acidic feeling in your muscles when exercising

this acidic feeling can limit our exercise performance and can make it harder to sustain our workload

Question 13

what is beta alanine supplementation good for?

Answer 13

There is likely to be little to no effect of β-alanine on maximal explosive voluntary contractions, whereas exercise of longer than 4 minutes is improved with beta-alanine supplementation. An exercise timeframe of 0.5–10 minutes appears to benefit most from beta-alanine supplementation, with protocols lasting >10 minutes showing little benefits

The results show that β-alanine supplementation confers significant positive overall effects on exercise performance, supporting the effectiveness of increased muscle carnosine to improve exercise

Question 14

parasthesia

Answer 14

An abnormal sensation of the skin (tingling, pricking, chilling, burning, or numbness) with no apparent physical cause

it is advised that if considering a beta-alanine supplement, it should be taken for a minimum of 2–4 weeks at a dose of 4–6 g/day ingested at several time points throughout the day (1–1.5 g every 3–4 hour) to avoid acute side effects

Question 15

Performance Supplements that Directly Enhance Exercise Capacity

caffeine

Answer 15

Caffeine is a central nervous system stimulant and an adenosine receptor agonist. It prolongs endurance performance, increases lipolysis, and increases mental alertness

1. improve performance, such as central nervous system stimulation
   **2. reduced perception of fatigue
   **3. increased fat oxidation
2. decreased reliance on muscle glycogen
3. increased release of beta-endorphins
4. increased neuromuscular function

Athletes should aim for 3–6 mg per kg body mass, taken 10–60 minutes pre-exercise

Question 16

beta endorphins

Answer 16

Peptide hormone that is produced in certain neurons within the central nervous system and peripheral nervous system

a primary role of beta endorphins is opiate/pain reduction

Question 17

buccal mucosa

Answer 17

A membrane that forms the inner lining of the cheeks and lips

Question 18

factors influencing caffeine absorption

Answer 18

1. form of caffeine (gum, tablets, liquid). Gum seems to have best absorption
2. genetics - 95% of caffeine absorption is regulated by a single gene (CYP1A2) - variation in this enzyme likely determines whether individuals are fast or slow caffeine metabolizers

Question 19

Performance Supplements that Directly Enhance Exercise Capacity

Creatine

Answer 19

a naturally occurring amino acid compound found primarily in red meat and seafood

Creatine forms the basis of phosphocreatine (PCr) in muscle, a high-energy phosphagen required for rapid ATP resynthesis. Elevating creatine stores therefore elevates PCr, allowing the athlete to perform high-intensity work for longer. Consequently, creatine is shown to improves speed, strength, power, and high-intensity exercise capacity.

and about 50% of daily requirements (about 1–3 g of creatine per day) is obtained from the diet.

Suggested doses are 5 g, four times per day for 4–5 days, followed by 3 g per day.

Question 20

what is creatine good for?

Answer 20

There is a large base of evidence to support the use of creatine to increase many aspects of training and performance. These include
* increased single and repetitive sprint performance
* increased work performed during sets of maximal effort muscle contractions
* increased muscle mass and strength adaptations during training
* enhanced glycogen resynthesis
* increased anaerobic threshold
* increased work capacity

Question 21

what sports are responsive to creatine supplementation?

Answer 21

Because the PCr system is a rapid mechanism of ATP resynthesis, sports that typically benefit from creatine supplementation are sprint, strength, and power-dominant sports. When used at the recommended doses described above, there is no evidence that creatine supplementation, even over prolonged periods, is associated with any side effects in healthy individuals.

Question 22

Performance Supplements that Directly Enhance Exercise Capacity

Nitrate - Beetroot

Answer 22

Research on nitrates shows improved exercise efficiency when the diets of recreationally active people have been supplemented with nitrates

Collectively, studies show that nitrate supplementation both lowers the oxygen cost of exercise and improves endurance exercise performance.

The suggested dose is 8.4 mmol nitrate (approximately two ‘shots’ of commercially available beetroot juice) taken 1–7 days, pre-exercise.

Question 23

Performance Supplements that Directly Enhance Exercise Capacity

Sodium Bicarbonate (baking soda)

Answer 23

used to buffer changes in pH that occur during highly intense exercise

The ergogenic potential of NaHCO3 is based on its capacity to create a more alkaline environment, thereby creating a greater hydrogen (H+) gradient between the muscle and extracellular fluid compartments

This facilitates the transport of H+ out of the muscle produced due to the dissociation of lactic acid to lactate and H+. In more simple terms, NaHCO3 acts as a buffer against the drop in pH that occurs during intense exercise.

time to peak is variable between people (15-85 minutes)

The suggested dose is 200–300 mg per kg body mass.

Question 24

side effects of sodium-bicarbonate

Answer 24

gastrointestinal discomfort, including vomiting and diarrhea

This may abolish any of the performance-enhancing effect of the supplement.

strategies to ameliorate the side effects of NaHCO3 have been developed with some success. For example, adding enteric coating to NaHCO3 capsules allows them to bypass the stomach, and enteric-coated NaHCO3 have been demonstrated to attenuate GI symptoms when compared to encapsulation in gelatin. Importantly, in addition to reducing GI symptoms, the enteric-coated capsules also have proven efficacy as an ergogenic aid for high intensity cycling performance

Question 25

enteric coating

Answer 25

Resists dissolution under acidic conditions but is freely soluble at the more basic conditions of the intestinal tract.

Question 26

risk factors for micornutrient defficiencies

Answer 26

* Eliminating food groups from diets either due to food dislikes, allergies, or moral reasons * Low-calorie diets often used when attempting to reduce body fat * Very low-fat diets, which could affect the absorption of fat-soluble vitamins * A lack of variety in the diet * A lack of sunlight exposure (including constant use of sunscreens or protective clothing) ## Footnote It is highly unlikely that the athlete will be deficient in any micronutrients if they do not fit into one or more of the above categories

Question 27

how to assess for micronutrient deffiencies

Answer 27

complete a detailed food diary and get this analyzed by a suitably qualified individual, such as a dietician or sports nutrition consultant. It is important when completing a food diary that sufficient days are recorded (at least 7) and that the athlete write down everything they eat or drink and attempt to accurately establish portion sizes.

Question 28

# Supplements that Provide Indirect Benefits Through Recovery Calcium

Answer 28

From a recovery perspective, emerging evidence indicates that **athletes lose significant calcium in sweat, which could lead to bone loss.** Therefore, replacing this lost calcium could reduce bone mass loss. However, only a small amount (~1g) of calcium is required to offset this effect, so the use of supplementation may not be required, as this can easily be obtained from the diet. ## Footnote Effective dose: 1 g

Question 29

# Supplements that Provide Indirect Benefits Through Recovery Collagen

Answer 29

Because musculoskeletal injuries make up 50% of all injuries in sports, nutritional interventions that increase collagen synthesis and strengthen soft tissue structures could have an important effect on injury rates. New evidence suggests that collagen supplements given pre-exercise could improve collagen synthesis, thus preventing injuries and promoting tissue repair during recovery from a soft tissue injury. Collagen needs to be taken pre-exercise with vitamin C for collagen synthesis to occur. ## Footnote Effective dose: 15 g gelatin taken 1 hour pre-exercise with 48 mg vitamin C

Question 30

# Supplements that Provide Indirect Benefits Through Recovery Fish Oil

Answer 30

The impact of dietary polyunsaturated fatty acids (PUFAs) on the immune system is well documented, and specifically the effects of omega-3 PUFAs α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is found in nuts and seeds, whereas EPA and DHA are the main components of fish oil. Increasing omega 3 intake, particularly EPA and DHA, is suggested to reduce inflammation and even promote muscle protein synthesis. However, high doses of fish oils are required for effects on muscle protein synthesis. ## Footnote Effective dose: High risk: 1–3 g EPA +DHA per day and consistent intake of omega-3–rich meals each week Moderate risk: 0.5–2 g EPA +DHA per day and consistent intake of omega-3–rich meals each week Low risk: 0.5–1 g EPA +DHA per day and consistent intake of omega-3–rich meals each week

Question 31

# Supplements that Provide Indirect Benefits Through Recovery Probiotics

Answer 31

Evidence supporting probiotic supplementation is growing each year. Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Health benefits of probiotics are strain- and dose-dependent. **Probiotics have been shown to reduce the likelihood of URIs and are suggested to improve general gastrointestinal function, as well as reduce exercise-induced gut damage.** ## Footnote Effective dose: >20 billion CFUs taken daily. Multispecies strains including those from lactobacillus and bifidobacterium species are the most widely studied.

Question 32

# Supplements that Provide Indirect Benefits Through Recovery Turmeric

Answer 32

Turmeric is a spice derived from the turmeric plant and contains phytochemical components such as diarylheptanoids, a class including numerous curcuminoids such as curcumin, demethoxycurcumin, and bisdemethoxycurcumin. Turmeric has anti-inflammatory properties, potentially reducing post-exercise muscle soreness, and supplementation may have the potential to facilitate tendon healing. However, turmeric has poor bioavailability, and most of the research has not been performed in humans yet. ## Footnote Effective dose: 2.5–5 g turmeric root extract twice per day 180–1000 mg/day curcumin (studied in sports research) Intake may be most beneficial post-exercise for attenuating symptoms of muscle damage

Question 33

# Supplements that Provide Indirect Benefits Through Recovery Vitamin D

Answer 33

Vitamin D (discussed in previous chapters) is an essential micronutrient primarily produced in the skin when exposed to adequate sunlight. Lack of sunlight exposure due to geographical location, cloud cover, wearing long clothing, wearing sunscreen leads to low, and in some cases, deficient, levels of vitamin D. Correction of vitamin D levels is essential for immune function, bone health, heart health, and muscle repair. ## Footnote Effective dose: Serum concentrations >50 nmol/L required. Supplementation during winter with 2,000 IU/day is effective. This should not be taken as a weekly dose, and higher doses are not necessarily more effective. Testing of vitamin D status is recommended

Question 34

# Supplements that Provide Indirect Benefits Through Recovery Zinc Acetate

Answer 34

required for DNA synthesis and an enzyme cofactor for immune cells Zinc deficiency results in impaired immunity and zinc deficiency is not uncommon in athletes ## Footnote Effective dose: 7 mg/day for women and 9.5 mg/day for men.

Question 35

when to dose calcium prior to exercise

Answer 35

an acute dose of calcium prior to exercise has shown promising results. Consuming a 1000 mg calcium supplement or during exercise has been shown to attenuate exercise-induced increases in markers of bone loss. It is important to note, however, that supplementation is not necessarily needed to achieve the benefit of pre-exercise calcium. Research shows that a calcium-rich pre-exercise breakfast meal containing ~1350 mg of calcium consumed ~90 minutes before a prolonged and high-intensity bout of stationary cycling reduces exercise-induced bone loss. Therefore, careful meal planning can mitigate the need for supplementation.

Question 36

What is the recommended nutrient intake for zinc?

Answer 36

7 mg/day for women and 9.5 mg/day for men.

Question 37

What is the greatest influencing factor regarding the efficacy of beta-alanine supplementation?

Answer 37

exercise duration

Question 38

What is the recommended dietary allowance (RDA) for omega-3 fatty acids?

Answer 38

there is none

Question 39

What is the epithelium lining the inner surface of the cheeks and lips?

Answer 39

buccal mucosa