Dietary Supplements 101

Dietary Supplements 101
Amy Culp, RD, CSSD, LD
Sports RD – The University of Texas
[email protected]
What are supplements?
• Definition –
– Any vitamin, mineral, amino acid, herb, or other
botanical
• AKA –
– Dietary supplements, nutritional ergogenic aids,
sports supplements, therapeutic nutritional
products
• Includes sports drinks and protein bars.
Regulation?
• Dietary Supplement Health and Education Act of
1994.
– Placed dietary supplements in own category, separate
from food & drugs
– FDA = limited regulatory power
– FDA relies on supplement manufacturers to ensure
the safety of their products before it reaches the
consumer.
– The FDA only acts when a supplement has been
identified as unsafe after it has been on the market.
Which means….
• Supplement manufacturers can start selling
their product and do
have to prove:
Usage
• In 2008, 53% of the US population reported use
of a dietary supplement within the last 30 days.
• In 2007, 22-71% of adolescent athletes reported
use of supplements.
– Variation in percentages due to age range of those
studied, accessibility and the sports the participants
played.
• American Academy of Pediatrics recommends
that children under the age of 18 do not take
performance enhancing substances.
Where do athletes get
supplement information?
40%
35%
36.5%
30%
29.7%
29.3%
25%
20%
15%
15.6%
13.9%
10%
5%
0%
Coaches
Family
Physicians
Media
Dietitians
Bigger, Faster, Stronger
Be aware of the challenges
Offer solutions
Defining the problems
• Spiking: where a manufacturer specifically adds a raw
material to a formulation so the product has a desired
effect.
• Adulteration: where a product or raw material is
contaminated with an inferior material used to pass
known analytical testing parameters.
• Cross Contamination: inadvertent contamination due
to poor manufacturing conditions or poor cleaning
procedures.
• These issues happen in the US and as well as China
where the majority of raw materials are manufactured.
Contamination of supplements
• A recent study has shown that 15% of
supplements around the world are
“contaminated” or adulterated with anabolic
steroids.
– Of those purchased in the US, 19% were
contaminated.
– Products that were labeled as amino acids,
creatine and HMB were among the products that
tested positive for steroids.
– Energy drinks
Problems start with poor ingredient suppliers
• Many ingredients are sourced strictly on price
and overseas.
• Brokers and distributors make supply chain
safety and management very difficult, if not
impossible.
• Fact: 100% of synthetic Vitamin C, used in
supplements, fortification of bars, protein
drinks and food come from China. This is true
of most synthetic letter vitamins.
Next are a few slides of
poor ingredient suppliers in China.
Poor quality control
Poor condition of equipment
Pest control?
“Extras” find their way into materials
Steroids Use
• Anabolic steroids fall under the Controlled
Substances Act.
– Purchasing of these products without proper
medical consent is illegal.
• Companies are constantly formulating new
substances that have yet to be declared
steroids.
– A search of “legal steroids” returns over 8 million
results.
The new Ephedra:
Dimethylhexaneamine (DMAA)
• Also known as geranium,
1,3-dimethylamylamine (DMAA),
dimethylpentylamine (DMP) or
4-methylhexan-2-amine.
• Stimulant that is used for ADHD and can be
found in some nasal decongestants.
• Comparable to amphetamines.
– Constrict blood vessels and increase blood
pressure and heart rate.
DMAA, cont’d
• Over 40 reported serious adverse events including
death.
– i.e. cardiovascular events, lactic acidosis and heat stroke.
• FDA issued 2nd warning letter in April 2012 to
companies to remove DMAA due to safety issues.
• Despite warning letters, there were still over 75
products containing DMAA on the market in February
2013.
• DMAA List:
– http://hprc-online.org/dietarysupplements/files/DMAA_List.pdf
Find out motive,
then help find solution
Real food vs. Supplements
• All the nutrients needed to fuel performance can
be obtained from eating a variety of foods.
• Supplements are derivatives of nutrients that can
be found real foods. So why not eat the real
foods?
• While some vitamins and minerals can be better
absorbed from supplements, a mixed, food-based
diet has been shown to be the best way to meet
nutrient requirements.
• Supplements should be used to supplement a
well-balanced diet.
• Protein
Food vs supplement
– Muscle Milk (11 oz.) – 18 g
– 1 slice of turkey deli meat – 6 g
– 3 oz. (deck of cards) of chicken – 25 g
– 8 oz. (1 cup) of chocolate milk – 8 g
– 1 egg – 6 g
– Powders ~20 g
vs
Evaluating Supplements
•
•
•
•
Is it SAFE?
Is it EFFECTIVE?
Anything BANNED?
What is the QUALITY?
Reviewing supplements
• Safety: “First, do no harm.”
– Review the ingredients list for any
substances that may have an affect
on hormone levels or are labeled as stimulants
and/or steroid-like.
Reviewing Supplements
• Effective:
– Is it biologically plausible?
– What is supposed method of action?
– Supportive literature should be published in
reputable peer review journal and cited in the
National Library of Medicine database (PubMed)
– Seek out resources to assist evaluating
supplements (see resources)
Reviewing Supplements
• Doping/Safety
– Some supplements contain ingredients not declared on
the label
– “Verified” or “certified” does not mean it
was done by a reputable company.
– Research the company using the FTC and BBB to
determine if there are warning letters or enforcement
actions against them.
• The FDA requires that all ingredients be listed on the
bottle, but this is not always the case.
• Sometimes items are clearly labeled, but others require
more research.
• Look for 3rd party testing
Top 5 Red Flags
per Drug Free Sport
• Product claims to be “all natural,” “free of
contaminants,” or “certified.”
• Promoting ability to change testosterone or be an
“aromatase inhibitor.”
• “Reformulated” or “Back by popular demand”
• “Get our product before it is banned,” “The only
FDA approved pro-hormone,” or “ephedrine free”
• “Research based ingredients. Real results fast.”
Or when you visit the
website, you see…
Labeling examples
You may get asked about…
• DHEA (dehydroepiandrosterone)
– Hormone naturally produced in the body.
– Thought to increase muscle mass and improve
performance although studies are conflicting.
– Reported adverse events:
• Acne, hair loss, insulin resistance, hypertension and
mania
– Banned by the NCAA.
• AAKG (arginine alpha-ketoglutarate)
– Examples: N.O.-Xplode, Cellucor C4 Extreme,
Assault
– Amino acid that aids in protein synthesis and
promotes secretion of growth hormone.
– Claims: Nitric oxide is synthesized from arginine
and increases blood flow to the muscles.
– Insufficient scientific evidence is available to
determine it’s effectiveness.
– Adverse events:
• Few minor events have been reported including
diarrhea, bloating and exacerbation of asthma.
• Creatine
– Examples: Kre-Alkalyn (Registered with Informed
Choice), MM1000 Creatine, Endurance, NO shotgun
– Claims: Increase muscle mass and enhance
performance.
– One of most widely researched supplements
– Studies have shown it to be possibly effective in short,
high-intensity bouts of exercise.
– Adverse effects:
• Nausea, diarrhea, muscle cramping, 1 report each of
ischemic stroke and atrial fibrillation.
– Not banned
• β-HMB
– Beta-hydroxy-beta-methyl-butyrate
– Examples:
• HMB 1000, EAS Muscle Armor, Muscle Synergy
– Metabolite of the amino acid leucine.
– Claims: Help prevent muscle breakdown.
– Shown to be more effective in untrained
compared to trained individuals.
– Adverse effects:
• None have been reported at this time.
• Caffeine
– Found in coffee, tea, sodas and energy drinks.
– Claims: Stimulant and encourages fat metabolism
– Studies have shown a decreased rate of fatigue
when taken 1 hour before an event.
– Adverse events:
• Insomnia, gastric distress, dehydration and possible
caffeine dependence.
• Large quantities or in combination with other
substances can lead to serious events, including death.
– Up to 15 mcg/mL on a urine test is permitted by
the NCAA .
• Deer antler velvet
– Claim: velvet from immature deer antlers includes
insulin-like growth factor, or IGF-1, which
mediates the level of human growth hormone in
the body
– IGF-1 banned
– Possible doping behind natural sounding
ingredient fronts
–
Combination Products
• Jack3d
– Contains Arginine, Creatine, Caffeine and DMAA
– Remains on market post-FDA warning letters.
– Claims: Increase muscles strength by enhancing
ATP production.
– Manufacturer currently being sued
for the wrongful-death of a solider
who had a heart attack after taking
the recommended dose of Jack3d.
Reducing Risk
• Properly research a supplement beforehand to
ensure safety and possible side effects.
• Evaluate current intake and make sure a wellbalanced diet is being followed to ensure
proper nutrition.
• Investigate which functional foods can aid in
athletic performance and recovery in order to
eliminate the need for supplements that could
possibly be contaminated.
Resources
Resources
1.
2.
3.
4.
5.
6.
Consumerlab.com
Naturaldatabase.com
Supplementinfo.org
Supplementwatch.com
Usada.org (list of high risk supplements)
Sign up for email alerts from the FDA on
contaminated products being sold in the US.
https://service.govdelivery.com/service/subscrib
e.html?code=USFDA_198
3rd Party Testing
• Look for a company that is properly qualified.
– Just because they guarantee something doesn’t mean
it’s true.
• Should be accredited by the International
Standards Organization (ISO) and/or the
American National Standards Institute (ANSI).
• Examples:
–
–
–
–
Informed Choice
NSF International
United States Pharmacopeial Convention (USP)
HFL Sport Science
Phone apps
NSF Sport
• Search supplements by company or product to view those
tested for safety.
WADA Prohibited List
• Provides a current list of prohibited substances.
My Dietary Supplements
• Track the supplements you take.
• Review science-based, reliable information on dietary
supplements.
• Available at https://myds.nih.gov.
Reporting Adverse Events
• If you know anyone that has had an adverse
event from taking a supplement, report it!
• With the current laws, our participation can
help ensure the safety of others.
• Report any adverse events to MedWatch by
calling 1-800-FDA-1088 or online at
https://www.accessdata.fda.gov/scripts/med
watch/medwatch-online.htm.
Gaining Lean Mass
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Increase calories at meals and snacks
Eat every 3 hours
Eat before working out
Practice optimal recovery nutrition
Bedtime snack
Decrease high fat, low nutrient choices
Sleep & lift
Losing Body Fat
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Small, frequent meals
Increase fruits/veggies
Limit sweetened drinks
Limit fried foods
Balance plate
Sleep, proper training
Recover Faster
• Anti-inflammatory foods
– Deeply colored fruits/veggies
– Whole grains vs processed grains
– Healthy fat – avocado, nuts, seeds
– Fish/fish oil
– Clean out the pantry & make consistently good
choices
Food alternative
• Beets
– Recent research has shown that drinking beetroot
juice reduces VO2, which suggests a longer time to
exhaustion.
– Effective by increasing the levels of nitrates thus
increasing levels of nitric oxide.
– An alternative to arginine or citrulline
supplements or those that claim in boost nitric
oxide (N.O.) production.
Recovery Juice
• Tart cherry juice
– Speeds muscle recovery after exercise-induced
muscle damage.
– Likely due to its high antioxidant content and antiinflammatory properties.
– Some brands sell cherry juice with protein to
make an even more complete recovery drink.
NUTRITION CAN MAKE A GOOD
ATHLETE GREAT OR A GREAT
ATHLETE GOOD!
THANK YOU!