Supplements, creatine and nitrate (wk 9)

Question 1

What do supplements, sports nutrition and everyday nutrition fundamentals?

Answer 1

-Supplements -> potentially boosting performance via strategic use of a small number of nutritional ergogenic aids
-Sports nutrition -> consuming whole foods and fluids before, during and after exercise to promote optimal fueling, hydration and adaptation
-Everyday nutrition fundamentals -> choosing nutritious foods and fluids that support optimal health, fueling and recovery, by aligning energy intake and expenditure

Question 2

What is a dietary supplement?

Answer 2

-> A product taken by mouth that contains a ‘dietary ingredient’ intended to supplement the diet. They come in many forms: enriched foods (bread), functional foods (smoothies), sports foods (lucozades) and single or multiple nutrient/ mineral foods (multivitamins)

Question 3

Why do athletes take supplements?

Answer 3

-> Among 310 competitors at the IAAF World Championships 86% consumed supplements. Reasons for using supplements:
* To aid recovery from training (71%)
* For health (52%)
* To improve performance (46%)
* To prevent or treat an illness (40%)
* To compensate for a poor diet (29%)
Other reasons:
* For financial gain (sponsorship) or because products are provided free of charge
* As a ‘just in case’ insurance policy
* Because they know or believe that other athletes/ competitors are using the supplement(s)

Question 4

Are supplements taken by athletes worth it?

Answer 4

 Performance
 Health
 Insurance policy
 Free samples
- Financial
- Health
- Performance
- Drug test failure

Question 5

What is anti-doping?

Answer 5

-> Anti-doping regulations were developed over many years to promote fairness in sport and to protect the health of the athlete. Strict liability – The offence lies in having a prohibited substance in a sample and Prevalence of positive doping test is typically 1-2% in elite athletes.

Question 6

What are the risks of supplement use?

Answer 6

1. Contamination: poor quality control in manufacturing and storage
   -Supplements may contain undeclared prohibited substances, for example, due to poor manufacturing practices resulting in contamination of the raw ingredient or deliberate inclusion of ingredients not listed on the label
   -Rates of contamination could be as high as 10-25% of all supplements across Europe and the US, with more recent reports being as high as 38%
2. Absence or lower than declared levels of ‘actives’
   -Often supplements may not contain the actual amount of ingredient stated on the label in the final product, and some do not contain any at all
3. Presence of undeclared doping agents
   -One of the key factors that elite athletes need to consider within the complex world of supplements and sports foods is whether the consumption of these products could lead to an inadvertent case of doping
   -IOC research found 15% from 634 non-hormonal nutrition supplements contained undeclared steroids banned by WADA
4. Harmful to health/ performance

Question 7

What supplements are used to prevent or treat nutrition deficiencies?

Answer 7

Vitamin D, iron and calcium

Question 8

What are sports foods that provide a practical form of energy and nutrients?

Answer 8

-> In some situations, it is impractical for an athlete to consume ‘everyday’ or normal foods to meet their nutrition goals due to issues around preparation or storage: training schedules, gut comfort and energy budget:

Question 9

What is Ron Maughan’s rules of dietary supplements for athletes?

Answer 9

1. If it works, it’s probably banned
2. If it’s not banned, then it probably doesn’t work
3. There may be some exception

Question 10

What are evidence-based ergogenic aids?

Answer 10

Creatine, nitrate, caffeine, beta-alanine and sodium bicarbonate

Question 11

What is the FFNFO framework?

Answer 11

In word document

Question 12

What is creatine?

Answer 12

-> Endogenously synthesised from AA (arginine, glycine and methionine) in the liver, pancreas and kidneys. >95% is stored in skeletal muscle. Approximately 50% obtained from the diet.

Question 13

What are creatine stores?

Answer 13

-> About two thirds of intramuscular creatine is PCr with the remaining being free creatine. The total creatine pool (PCr +Cr) in the muscle averages about 120mmol/kg dry muscle mass. The upper limit of creatine storage appears to be about 160mmol/kg dry muscle mass. Vegetarians have been reported to have lower intramuscular creatine stores (90-100mmol/kg dm).

Question 14

What is the creatine turnover?

Answer 14

-Synthesis ~2g/day (1g endogenous and 1g exogenous (diet))
-Excretion ~2g/day (creatine (urine))
-Increasing muscle creatine levels -> Muscle total creatine content for 8 subjects. 4 x 5g (20g) creatine per day for 5 days. Total creatine content increased in all subjects.

Question 15

What are the effects of creatine?

Answer 15

-> Increase in maximum work and total work done in 30 seconds (isokinetic cycling). Creatine and muscle hypertrophy.

Question 16

Upper and lower body muscle hypertrophy from creatine:

Answer 16

-Upper body and lower body muscle hypertrophy ->
-The results suggest that creatine supplementation combined with RT promotes a small increase in the direct measures of skeletal muscle hypertrophy in both the upper and lower body.
-What are the effects -> Increased PCr resynthesis = Short-term, high-intensity exercise capacity to perform repeated bouts of high-intensity effort. Brain health – anti-inflammatory and anti-oxidant effects

Question 17

Creatine metabolism during exercise:

Answer 17

-> PCr levels higher in type II fibres than type I fibres. PCr levels decrease during maximal exercise (because its breakdown sustains high rates of ATP production). PCr can be depleted in ~10 seconds. 80% re-synthesised in ~4 minutes.

Question 18

Mechanisms of action - supplementation with creatine:

Answer 18

• Increased Cr stores of 30% = increased PCr resynthesis
• Increased muscle glycogen
• Increased growth factor expression
• Increased protein synthesis
• Decreased muscle damage
• Training harder, longer = increased lean mass/ strength

Question 19

What are creatine sources?

Answer 19

• Diet (red meet (beef pork) and some fish (tuna, salmon, cod, herring) – but not enough
• Creatine monohydrate (CM):
• White powder, 99% absorbed
• Significant amount of evidence
• Better uptake mixed with a carbohydrate containing liquid or food (consume quickly after mixing)
• Synthetic (suitable for vegetarians and vegans)

Question 20

What are the creatine loading protocols?

Answer 20

-> No acute effect- loading protocols
* Short, high-dose protocol: 20g/day (split in 4 doses) for 5 days and 0.3g/kg BM (split in 3-4 doses) for 5 days
* Long, low dose protocol: 3-5g/day for 20-30 days
* Maintenance dose: 2-5g/ day
* Washout period = 4-6 weeks

Question 21

When to consider creatine use?

Answer 21

• Single (+1-5%) and repeated bouts (+5-15%) of high-intensity exercise
• High-intensity max efforts <150 sec, largest effects on <30 sec tasks.
• Endurance exercise -> Recent evidence shoes that a combination of creatine and CHO loading may increase power output during repeated high-intensity sprint efforts during the late stages of prolonged stimulated TT cycling
• Concussion -> Improvements in cognitive processing in the brain and potentially reduced damage and enhance recovery from mild traumatic brain injury/ concussion

Question 22

What is the individual variability of creatine?

Answer 22

• Baseline levels of muscle creatine -> Individuals that have high muscle creatine levels will experience low creatine uptake from supplements, and vice-versa. Therefore, individuals with low muscle creatine levels (e.g. vegetarians) have the greatest potential for increases in response to supplementation
• Sport type -> In sports where performance is not determined by PCr availability (or fast ATP resynthesis) creatine supplementation will likely not have any effects (e.g. ultra-endurance or exclusively skill-based)

Question 23

What are the concerns for creatine?

Answer 23

• Increase in body mass (1-2kg) -> Likely as a result of water retention. It may be counteractive for the performance for endurance and/or weight-sensitive sports. Consider washout period (4-6 weeks) if using creatine.
• Myths -> There is no evidence that creatine supplementation causes kidney damage, muscle cramps, strains, damage/ injury, or affects fluid balance and heat dissipation

Question 24

What are the safety issues of creatine?

Answer 24

• No evidence of adverse effects with long term (4 years) creatine supplementation at appropriate dosages in healthy individuals
• Mild, temporary gut upset can occur but can be attenuated with split dose, longer loading protocol and avoidance of high fibre foods with ingestion
• Contamination: all supplements have a doping risk of some kind. Athletes should only use batch-tested supplements.

Question 25

What is nitrate?

Answer 25

-> Dietary nitrate (NO3 ). The ingestion of NO3 leads to enhanced nitric oxide (NO) bioavailability. High nitrate-containing foods include leafy greens and root vegetables. The average dietary intake of adults in western countries is 1-2 mmol/d (~60-120 mg/d) with vegetables providing about 80% of the total.

Question 26

What is nitric oxide?

Answer 26

-> Ingestion of dietary NO3 -> enhanced NO bioavailability (via the NO3-nitrite-NO pathway, reaction catalysed by bacteria in the mouth and the digestive system. NO plays an important role in the modulation of skeletal muscle function.

Question 27

What are the effects of nitric oxide?

Answer 27

* Increased no bioavailability = * Increased blood flow to muscle * Increased function of type II fibres * Increased efficiency of mitochondrial respiration * Increases muscle contractile function

Question 28

Draw the mechanisms of action of nitrate supplementation?

Question 29

What are the effects on exercise economy (O2) cost of exercise?

Answer 29

* NO3 supplementation (beetroot juice) -> lower O2 cost of exercise -Reduced ATP cost of muscle force production -More efficient mitochondrial oxidative phosphorylation

Question 30

What is the nitrate supplementation regime?

Answer 30

-> Acute dose (2-3h pre-exercise) – (5-9mmol) 310-560mg nitrate. Chronic supplementation (3-15 days pre-event) – 310-560mg nitrate per day + 310-560mg nitrate pre-event -Avoid the use of mouthwash or chewing hum with beetroot juice, as they interfere with its benefits -Beetroot juices may be useful for highly trained athletes, where performance gains seem harder to achieve

Question 31

Food sources of nitrate equivalent to 1x Beet IT sports shot (400g nitrate):

Answer 31

-Beetroot x 1 large (200g) -Bok choy x 1 medium (120g) -Rocket lettuce x 2 cups (150g) -Parsley x 2 cups (150g) -Silver beet spinach x 150g (1 cup) -Baby spinach x 2 cups (150g) -Fresh beetroot juice (500ml) -Celery x 2.5 cups (250g)

Question 32

When to consider nitrate use and individual variability:

Answer 32

-When to consider its use -> Prolonged submaximal exercise such as endurance events lasting 4-30 min. Training for aerobic fitness. High-intensity intermittent events with short duration and sprint efforts in individual and team sports. During exposure to hypoxic conditions e.g. altitude training. -Individual variability -> Few studies have investigated the impact of nitrate supplementation on female athletes. Athlete’s training status may also affect the supplement efficacy, with highly-trained endurance events (>65 ml/kg/min VO2max) not benefitting significantly.

Question 33

What are the concerns and safety of nitrate?

Answer 33

* Beetroot juice, particularly in concentrated form, can cause mild gut discomfort. Always practice in training first * Beetroot juice may cause a temporary pink colour to urine and stools. This is a harmless side effect but be aware * Mistaken use of nitrate or nitrite salt as supplements can be toxic * Chronic use of nitrate supplementation has not been studied; therefore, long-term effects are unknown (diets increase vegetables are generally beneficial for health) * Contamination: all supplements have a doping risk of some kind. Athletes should only use batch-tested supplements. -In highly trained individuals, performance benefits might be harder to harder to obtain. Further research in elite and female athletes is needed.