Ree) eS) 4 Ergogenic Aids Gimmicks, or Dangers? Byer] analcelercaal LO 10.7 Evaluate whether dietary ergogenic aids are useful for increasing sports perform Athletes can be sitting ducks for quacks. Many are willing to try almost anything that is sold with promises of producing a winning edge or improved appearance, so long as they perceive it to be safe. Store shelves and the Internet abound with heavily advertised ergogenic aids, each striving to appeal to performance- conscious people: protein powders, amino acid supplements, caffeine pil, obtaining an ideal body composition for sports. as advertised? And most importantly, are they safe? This Controversy focuses on the sci- entific evidence for and against a few of the most common dietary supplements for athletes and exercisers. In light of the evidence, it concludes with what ‘many people already know: consistent training and sound nutrition serve an athlete better than any pill, powder, or sions athletes face about their tr regimens. After enjoying a fresh when the first things on their min tailgate parties and the last thing very last thing—was exercise, Pal and DJ have taken up running to the “freshman 15” pounds that h crept up on them. Their friendshi defined by bonding over extra-ch pizzas and fried chicken wings, n steroid replacers, ‘muscle builders,” vitamins, and more. Some people spend huge sums of money on these products, often heeding advice from a trusted coach or mentor. Table C10-1 defines ‘some relevant terms in this section and lists many more substances promoted as ergogenic aids. Do these products work supplement.*! Gr Additional ergogenic aids are listed in Table C10-2, = anabolic steroid hormones chemical messengers related to the male sex hormone testosterone that stimulate building up of body tissues (anabolic means “promoting growth"; sterol refers to compounds chemically related to cholesterol). androstenedione (AN-droh-STEEN-die-own) a precursor of testosterone that elevates both testosterone and estrogen in the blood of both males and females. Often called andro, itis oid with claims of producing increased muscle strength, but controlled studies disprove such claims. ® caffeine a stimulant that can produce alertness and reduce reaction time when used in small doses but causes headaches, ‘trembling, an abnormally fast heart rate, and other undesirable effects in high doses, ‘= camitine a nitrogen-containing compound, formed in the body from lysine and methionine, that helps transport fatty acids ‘across the mitochondrial membrane, Carnitine is claimed to “burn” fat and spare glycogen during endurance events, but it does neither. ‘= chromium picolinate 2 trace element supplement; falsely, promoted to increase lean body mass, enhance energy, and. burn fat 414 Chapter 10 Nut Paige and D) The story of two college roommates, Paige and DJ, demonstrates the deci- * Reteronce notes are found in Append F. focuses on 5-K races. Both wome compete to win, Paige and Di take their nutri regimens and prerace preparatio seriously, but they are as opposite sun and moon: DJ takes a tradi approach, sticking to the tried-an advice of her older brother, an all ‘creatine 2 ritrogen-containing compound that combines wit phosphate to burn a high-energy compound stored in musch ‘Some studies suggest that creatine enhances energy and stimulates muscle growth but long-term studies are lacking: digestive side effects may occur DHEA (dehydroepiandrosterone) a hormone made in the adre lands that serves as a precursor to the male hormone testo terone; recently banned by the FDA because it poses the ris of life-threatening diseases, including cancer. Falsely promo to burn fat, build muscle, and slow aging. energy drinks and energy shots sugar-sweetened beverages | various concentrations with supposedly ergogenic ingredient such as vitamins, amino acids, caffeine, guarana, carnitine, ginseng, and others. The drinks are not regulated by the FD! and are often high in catfeine or other stimulants. lergogenic (ER-go-JEN-ic) aids products that supposedly enhance performance, although few actually do so; the term ergogenic implies “energy giving" (ergo means “work”; geni means “give rise to”) whey (way) the watery part of milk, a by-product of cheese production. Once discarded as waste, whey is now recognize 438 a high-quality protein source for human consumption. and the Body's Responses{© Nonky Bes IapeSnetertrh com ete better than any pills ining serves an at F powders. cand field star. He tells her to train rd, eat a nutritious diet, get enough 3p, drink plenty of fluid on race day, ‘warm up lightly for 10 minutes re the starting gun. He offers only ‘ther bit of advice: buy the best- jty running shoes available every ie months without fail, and always on ‘Wednesday. Many an athlete admits Jhingly to such superstitions as weat- “jucky socks” for a good luck charm, Paige finds DJ's routine boring and ully out of date. Paige surfs the net for the latest supplements and genic aids advertised in her fitness zines, She mixes carnitine and prO- Bn powiders into her beverages, hoping ithe promised bonus muscle tissue to ip atthe weight bench, and she takes Thandful of “ergogenic” supplements to pumped up” for a race. Her counter ‘cluttered with bottles of amino acids, ine pills, chromium picolinate ‘even herbal steroid replacers sold ‘a promise of speedy recovery from rd runs, No matter what her goal, the net stores seem to have a “best fing” product for the job. Sure, it takes Soney (a fotof money) to purchase the ‘oducts and time to mix the potions nd return the occasional wrong ship- Controversy 10 ment—often cutting into her training time, But Paige feels smugly smart in hher modern approach. Surely, she will win the most races. Is Paige correct to expect an athletic ‘edge from taking supplements? Is she safe in taking them? Ergogenic Aids Science holds some of the answers to such questions, but finding them requires reading more than just adver- tising materials. It's easy to see why Paige is misled by fitness magazines— ads often masquerade as informative articles, concealing their true nature. A tangle of valid and ‘invalid ideas in ‘such “advertorials" can appear COn- vincingly scientific, particularly when accompanied by colorful anatomical figures, graphs, and tables. Some ads even cite such venerable sources as the ‘American Journal of Clinical Nutrition and the Journal of the American Medical ‘Association to create the illusion of cred- ibity, Keep in mind, however, that these “advertorials” are created not to teach, but to sell. Supplement companies bring, in tens of billions of dollars worldwide— and some unscrupulous sellers will gladly mislead athletes for a share of it Also, many substances: sold as “dietary supplements” escape regulation (see Controversy 7 for details). This means that athletes are largely on ‘their own in ‘evaluating supplements for effectiveness and safety. So far, the large majority of legitimate research has not supported the claims made for ergogenic aids. Athletes who hear that a product is ergogenic should ask, “Who is making this claim?” and “Who will profit from the sale?” Antioxidant Supplements Exercise increases metabolism, and speeded-up metabolism creates extra free radicals that contribute to oxidative stress. It stands to reason, then, that if exercise produces free radicals and oxidative stress, and if antioxidants from Foods can quell oxidative stress, then athletes may benefit from taking in more ‘antioxidants. Like many other logical ideas, however, this one falls apart upon scientific examination—research does rot support the taking of antioxidant supplements for athletic performance? In fact, free radical production may be ‘a necessary part of a complex signal ing system that promotes many of the beneficial responses of the body to physical activity? The possibilty exists that flooding the system with excess antioxidants may short-circuit the system and prevent the expected health benefits ‘or improvements in athletic performance from physical activity.* Caffeine Many athletes (but not al) report that caffeine from coffee, tea, energy drinks ‘and energy “shots,” and other sources provides a physical boost during sports.” Caffeine (3-6 me/kg body weight) may indeed improve performance, particu larly during endurance activities, such as cycling and rowing and, to a lesser extent, in high-intensity training ® A mild stimulant, caffeine may trigger fatty acid release, enhance alertness and concen- tration, and reduce the perception of fatigue. ‘Any potential benefits from caffeine must be weighed against its known adverse effects—high doses cause stomach upset, nervousress, iritability, headaches, dehydration, and diarrhea Even the caffeine in two to three cups of coffee for a 150-Ib person (5 me/ke body weight) increases the heart rate at a given workload.’ High doses of caf- feine can constrict the arteries and raise blood pressure, making the heart work harder than normal to pump blood to the working muscles. In addition, the acids in such drinks may erode tooth enamel other constituents can increase water and sodium losses and may impair the ability of cell membranes to heal after being wounded.® Competitors should be aware that college sports authorities prohibit the se of caffeine in amounts greater than 700 milligrams, or the equivalent of tight cups of coffee prior to competition. Controversy 14 lists caffeine doses in common foods and beverages. Instead of taking caffeine pills before an event, Paige might be better off 415engaging in some light activity, as DJ does. Pregame activity stimulates the release of fatty acids and warms up the muscles and connective tissues, making them flexible and resistant to injury. Caffeine does not offer these benefits, Instead, caffeine in high doses acts as a diuretic. DJ enjoys a Cup or two of cof- fee before her races, but the amount of Caffeine they provide is unlikely to cause Problems. ° Carnitine Carnitine is a nonessential nutrient that is often marketed as a “fat burner.” In the body, carnitine does help to transfer fatty acids across the membrane that encases the cell's mitochondria. (Recall from Figure 3-1 of Chapter 3 that the mitochondria are structures in cells that release energy from energy-yielding nutrients, such as fatty acids.) Carnitine marketers use this logic: “the more Carnitine, the more fat burned, the more energy produced”—but the argument is not valid. Carnitine supplementation neither raises muscle carnitine concen- trations nor enhances exercise perfor- mance. (Paige found out the hard way that carnitine often produces diarrhea in those taking it.) Vegetarians have less total body carnitine than meat eaters do, but introducing more has no effect on vegetarians’ muscle carnitine levels.1° For those concerned about obtain- ing adequate carnitine, milk and meat products are good sources, but more Importantly, carnitine is a nonessential nutrient. This means that the body makes plenty for itself, Chromium Picolinate Advertisements for chromium picolinate Products bombard consumers with Promises of trimming off the most stubborn spare tire and building up rippling muscles. Photos of impossibly fit people, Supposedly the “after” shots of those taking chromium picolinate supplements, tempt even People who know that fitness never results from taking a pill. Chromium is an essential trace min- eral involved in carbohydrate and lipid 416 metabolism. One or two initial reports Correlated taking supplements with reduced body fatness and increased lean body mass in male weight lifters, but most subsequent studies demon- strate no effect on body fatness, lean body mass, strength, or fatigue, The safety record of chromium picolinate is not unblemished. One athlete who ingested 1,200 micrograms Of chromium picolinate over two days’ time developed a dangerous condition of muscle degeneration, with the supple- ment strongly suspected as the Cause. Creatine Creatine supplements clearly do not benefit endurance athletes such as run- ners.'! For performance of short-term, repetitive, high-intensity activities such 4s weight lifting or sprinting, however, Some studies have reported small but Significant increases in muscle strength, Power, and size—attributes that sup- Port these activities. ? Other research Suggests no benefit, and study authors Suggest that resistance training alone during the study period, and not Creatine supplements, may account for improve- ments in studies that report benefits.23 Creatine functions in muscles as part of the high-energy storage compound Creatine phosphate (or phosphocre- atine), and, theoretically, the more cre- atine phosphate in muscles, the higher the intensity at which an athlete can train.* The confirmed effect of creatine, however, is weight gain—a potential boon for some athletes but a bane for others. Unfortunately, the gain may be Mostly water because creatine causes muscles to hold water. Large-scale, long-term safety stud- les are lacking, but short-term use of Creatine in doses suggested by manu- facturers has, so far, not Proven harmful for healthy adults. However, children as young as 9 years old are taking creatine at the urging of coaches or Parents, with unknown consequences, The American Academy of Pediatrics strongly discour- ages the use of creatine or any other ergogenic supplements in children younger than 18 years old, Meat, being muscle, is a good plier of creatine, so anyone who e meat consumes creatine in abunc Another safe source is the body's. creatine—human muscles can me the creatine they need. Buffers Sodium bicarbonate (baking soda) acts as a buffer, a compound that neutralizes acids. During high-inter exercise, acids form in the muscles may contribute to fatigue, Researct indicates that elite male athletes we ingest sodium bicarbonate (0.3 aK body weight) before performing hig intensity activities lasting from 1 to ant side effects, such as Bas and | diarrhea, may make this ergogenic impractical, even for elite male ai The buffering effect of the amine beta-alanine has recently received tion by exercise researchers.” A beta-alanine may increase the bod buffering ca pacity to some degree. research has yielded mixed or ni results on exercise performance. ® “pins and needles” sensation side has been noted. Amino Acid Supplements Some athletes—particularly body 6 ers and weight lifters—know that co suming essential amino acids is rea to increase muscle size.!° As mer ton in the chapter, for up to 48 hours fo ing exercise, muscles respond byb ing up the bulk and strength they to perform their work, Protein syntt is held back by a lack of essential 2 acids at the critical time. All essen- tial amino acids must be Provided fa maximum gains, not just a selected In addition, the essential amino acid Particularly leucine, signal muscles speed up their protein synthesis, The best source for these amino acids is food, not supplements, for s eral reasons. First, healthy athletes & Chapter 10 Nutrients, Py sica Activit and the Body's Rnutritious diet naturally obtain all amino acids they need from food, yan ideal balance not matched pplements. Second, the amount ino acids that muscles require a few grams—an amount easily led by any light, protein-containing More than this amount from sive supplements is unnecessary effective—muscles cannot store $ amino acids, and burn them off |. Third, single amino acid prepa- 5, even leucine, do not improve al performance or muscle gains.” arth, taking amino acid supple- can easily put the body in a sch-too-little bind. Amino acids ste with each other for carriers body, and an overdose of one nit the availability of another. . Supplements can cause diges- sturbances and, for some people cular, amino acid supplements ase a hazard (see the Consumer's of Chapter 6). y Protein to the high-quality protein in lean 225, milk, and legumes, whey S all of the essential amino acids, ng leucine, needed to initiate pport the building of new muscle -it is a complete protein. Once rded by-product of the cheese- ; industry, whey is now added to sods and supplements, including rinks, and powders for athletes. rotein is water soluble and stays ed in the digestive tract, where it ly digested and absorbed. Whey fe delivers essential amino acids loodstream more rapidly than oteins that require greater diges- esearch on whey's effects is s, but despite many claims to the y, no Clear benefits of whey for performance are evident beyond f other high-quality protein-rich believes that by taking a of amino acid pills and eating a of whey protein bars she can go n training and still gain speed on k, but this is just wishful thinking. Muscles require physically demanding activity, not just protein, to gain in size and performance. Instead of getting faster, Paige will likely get fatter—at 250 calories each, her protein bars contrib- ute 500 calories to her day's intake, an amount far greater than she expends in exercise. Dutifully, her body dismantles the extra protein, removes and excretes the nitrogen from the amino acids, uses what it can for energy, and converts the rest to body fat for storage. Recently, DJ, who snacks on plain raisins and nuts, placed ahead of Paige in seven of their ten shared competi- tions. In one of these races, Paige pulled out because of light-headedness— perhaps a consequence of too much caffeine? Still, Paige remains convinced that to win, she must have chemical help, and she is venturing over the dan- ger line by considering hormone-related products. What she doesn’t know is very likely to hurt her. Hormones and Hormone Imitators The dietary supplements discussed so far are controversial in the sense that they may or may not enhance athletic Performance, but most—in the doses commonly taken by healthy adults— probably do not pose immediate threats to health or life. Hormones, however, are clearly damaging and are banned by the World Anti-Doping Agency of the International Olympic committee, and by most professional and amateur sports leagues. Anabolic Steroids Among the most dangerous ergogenic Practices is the use of anabolic steroid hormones. The body's natural steroid hormones stimulate muscle growth in response to physical activity in both men and women. Injections of “fake” hormones produce muscle size and strength far beyond that attainable by training alone, but at great risk to health. These drugs are both illegal in sports and dangerous to the taker, yet athletes often use them without medical supervi- Controversy 10 Ergogenic Aids sion, simply taking someone's word for their safety. The list of damaging side effects of steroids is long, and includes: = Extreme mental hostility; aggres- sion; personality changes; suicidal thoughts. Swollen face; severe, scarring acne; yellowing of whites of eyes (jaundice). Elevated risk of heart attack, stroke; liver damage, liver tumors, fatal liver failure; kidney damage; bloody diarrhea. In females, irreversible deepening of voice, loss of fertility, shrinkage of breasts, permanent enlargement of external genitalia. In males, breast enlargement, per- manent shrinkage of testes, prostate enlargement, sexual dysfunction, and loss of fertility. = Many others. The group of substances discussed in this section is clearly damaging to the body. Don’t consider using these products—just steer clear. Human Growth Hormone A wide range of athletes, including weight lifters, baseball players, cyclists, and track and field participants, use hGH (human growth hormone) to build lean tissue and improve athletic perfor- mance. They inject hGH, believing that, because it isn’t a steroid itself, it will pro- vide the muscle gains they seek without the substantial risks of anabolic steroids. However, taken in large quantities, GH causes the disease acromegaly, in which the body becomes huge and the organs and bones enlarge. Other risks of hGH include diabetes, thyroid disorder, heart disease, menstrual irregularities, diminished sexual desire, and shortened life span. Steroid Alternatives Many athletes, and particularly school- age athletes, have tried herbal or insect- derived sterols hawked as “natural” alternatives to steroid drugs. The body cannot readily absorb these, nor does it Convert them into human steroids. These 417Products do not enhance muscle size or strength, but some may contain toxins. Remember: “natural” doesn't mean “harmless.” DHEA, a hormone produced in the adrenal glands and liver, is used by the body to make other important hormones, including androstenedione, testosterone, and estrogen. Supplements of DHEA or androstenedione produce unpredictable results. In males, such products may have little or no effect because male testes already produce sufficient tes- tosterone. In females, they may disturb hormonal balance, Producing a greater Proportional blood level of testosterone along with increased estrogens. No evidence supports using DHEA or andro- stenedione, and even if temporary gains in muscle strength could be achieved, the ill effects from excess steroid hor- Mones in the body can last a lifetime. Table C10-2 Arginine (an amino acid) Boron (trace mineral) Casein (milk protein) DMAA (dimethylamylamine) Metabolism Ephedra (ephedrine, ma huang) enhancement; improved of nervous energy and athletic performance alertness Coenzyme Q10 Enhanced exercise Ineffective (carrier in the electron performance transport chain) Gamma-oryzanol Increased muscle mass; Ineffective (plant sterol) 418 Increased muscle mass Increased muscle mass Increased muscle mass Increased energy, concentration, and Weight loss; muscle said to mimic anabolic steroids without side effects Although androstenedione and DHEA are still for sale on the Internet, the National Collegiate Athletic Association, the National Football League, and the International Olympic Committee have banned their use of in competition. The American Academy of Pediatrics and many other medical professional groups have spoken out against the use of these and other “hormone replacement” substances, Drugs Posing as Supplements Some ergogenic aids sold as dietary sup- plements turn out to contain powerful drugs. The FDA recalled a Potent thyroid hormone known as TRIAC for interfer- ing with normal thyroid functioning and causing heart attack and stroke. Another is DMAA, a Potentially harmful stimulant drug. DMAA is popularly sold as a “natu ral energy-booster” or “fat-destroyer,” but DMAA acts like adrenaline in the Ineffective Ineffective Generally well tolerated; may be ha people with heart disease body and is suspected of cau: Strokes or heart attacks, along wat attacks, seizures, and other adverse effects in users. Although the banned TRIAC and is acting on & others are likely to crop up tot Place because the demand is profits are high. Table C10-2 of them. Also, a dietary supplement « always what the label says it is. recent study, almost 19 percent: supplements sold to athletes were found to contain a steroid Another study demonstrated a creatine supplement contame with just 0.00005 percent of drug can produce a positive d An athlete taking such a supp Not only faces the physical unknown substances but also being falsely accused of doping: forever banned from competitic No adverse effects reported with do up to 10 mg/day; should be avoid As with all dietary protein, contributes to positive nitrogen balance Asstimulant, possibly similar to ephedrine or amphetamine May increase feelings Well tolerated by many people; tri allergic reaction in people with milk 2 Reports of fatal heart attack, cere! hemorrhage, liver and kidney failure, seizures, high blood pressure, and ra heartbeat Dry mouth, insomnia, nervousness, palpitation, and headache; blood pres spikes; cardiac arrest; banned by FDA an unreasonable risk to health Mild indigestion No adverse effects reported with short Use; no long-term safety studies those with kidney disease or women hormone-sensitive conditions Chapter 10 Nutrier Ce Activity, and the Body's ResponsesEnhanced exercise performance al (a 3-carbon ile that is part Improved hydration during exercise; regulation of body temperature during exercise; enhanced exercise performance Precursor of creatine Enhanced speed and endurance, mental, and sexual functions (beta-hydroxy- Increased muscle mass and strength Enhanced endurance Increased ATP production and enhanced high-intensity exercise performance sljelly (produced Enhanced stamina and ) reduced fatigue Buffers muscle acid; delayed fatigue; enhanced power and strength ium bicarbonate ing soda) imbe Weight loss; stimulant effects nclusion -general scientific response to ergo- ic claims is “let the buyer beware.” survey of advertisements in a en popular health and body-building zazines, researchers identified over Ineffective Inconsistent findings for improving hydration and regulating body temperature; ineffective for enhancing exercise performance Ineffective Ineffective Inconsistent findings Ineffective Ineffective No studies on human beings to date May buffer acid and delay muscle fatigue; more research is needed for definitive conclusions No evidence available 300 products containing 235 different ingredients advertised as beneficial, mostly for muscle growth. None had been scientifically shown to be effective. Athletes like Paige who fall for the promises of better performance through No adverse effects reported with moderate doses; large doses may cause hypertension, nervousness, sleeplessness, acne, edema, headache, and diarrhea; those with diabetes should be aware of hypoglycemic effects; should be avoided by those at risk for estrogen-related cancers, those with blood-clotting issues, and pregnant or lactating women May cause nausea, headaches, and blurred vision; should be avoided by those with ‘edema, congestive heart failure, kidney disease, hypertension, and other conditions that may be aggravated by fluid retention Potential amino acid imbalances High doses may stress the heart and cause panic attacks No adverse effects with short-term use and doses up to 76 mg/kg of body weight No long-term safety studies; digestive problems with short-term use (< 6 weeks) Naturally generated in body; submitted to USDA to become a Generally Recognized As Safe food additive (pending) No adverse effects with doses up to 12 mg/ day; should be avoided by those with a history of asthma or allergic reactions Gastrointestinal distress including diarrhea, cramps, gas, and bloating; should be avoided by those on sodium-restricted diets Kidney failure; seizures © Cengage Learning supplements are taking a gamble with their money, their health, or both. They trade one product for another and another when the placebo effect wears. thin and the promised miracles fail to materialize. DJ, who takes the scientific Controversy 10 Ergogenic Aids Breakthroug s, Gimmicks, or Dangers? 419approach reflected in this Controversy, faces a problem: how does she tell Paige about the hoaxes and still preserve their friendship? Explaining to someone that a long- held belief is not true involves a risk: the person often becomes angry with the one telling the truth, rather than with the source of the lie. To avoid this painful outcome, DJ decides to mention only the supplements in Paige's routine that are most likely to cause harm—the chromium picolinate, the overdoses of caffeine, and the hormone replacers. As for the whey protein and other supple- ments, they are probably just a waste of money, and DJ decides to keep quiet. Perhaps they may serve as harmless superstitions. 420 When Paige believes her perfor- mance is boosted by a new concoction, DJ understands that most likely the power of her mind is at work—the pla- cebo effect. Don’t discount that power, by the way, for it is formidable. You don’t need to buy unproven supple- ments for an extra edge because you already have a real one—your mind. And you can use the extra money you save to buy a great pair of running shoes— perhaps on a Wednesday? Critical Thinking 1. Most of the time, the buyer is wasting his or her money when buying an ergogenic aid to improve perfor- mance. Still, even well-educated ath- N letes often take them. What fore you think might motivate a coms to “throw caution to the wind” 2 buy and take unproven suppler sold as ergogenic aids? What rol might advertising play? . Divide into two groups. One grok will argue in favor of ergogenic t by athletes, and one group will z against the use of ergogenic aid by athletes. Each group will mat list of ergogenic aids that shoule allowed for use by athletes and of those that should not be allow Chapter 10 Nutrients, Physical Activity, and the Body's Responses