by Kim Schoenhals
Every physical action, voluntary or involuntary, is achieved through energy metabolism, or bioenergetics--the science of how the body extracts energy from food. To create energy, the body converts food into simpler compounds that are transported through the bloodstream for use in individual cells. Carbohydrates are converted to glucose (sugar), fats are converted to glycerol (a triglyceride) and fatty acids, and proteins are broken down into amino acids. Once in the cells, these nutrients are chemically transformed into the energy molecule adenosine triphosphate (ATP) through a metabolic process known as Kreb's Cycle. Legal steroid to help us bridge the gap between illicit drugs and legal supplementation. We offer legal steroids, which are excellent for sports and strength athletes.
ATP, which is produced in the mitochondria, is the basis for all energy within the human system. The production of ATP is achieved through the utilization of inherent and dietary nutrients such as vitamins, minerals and amino acids. In addition to fueling the body's ability to create energy, many nutrients--and botanicals--can enhance this process when taken as supplements.
Performance nutrition is a multi-billion dollar market worldwide, and sports nutrition consumers have more faith in supplements than the general population. According to the Natural Marketing Institute's (NMI) The Health & Wellness Trends Database--three years of trended data including more than 2,000 national consumer households--80.2 percent of sports nutrition supplement users believe vitamins and minerals are effective in preventing and treating various health conditions, as compared to 74.5 percent of the general population. In addition, 65 percent of athletes began using sports supplements to enhance performance and energy, and 24 percent of sports supplement users began taking supplements to improve overall health and wellness.
Enhancing immune function is of particular concern to athletes because exercise temporarily weakens the immune system.1 Vitamin, mineral and botanical supplementation can combat this phenomenon.
While a healthy diet is the basis for efficient energy production, adding supplements to a workout regimen can enhance ATP production, increase energy, decrease recovery time and attenuate exercise-induced cramps and muscle soreness, as well as preserve immune function that may suffer as a result of strenuous exercise.
Lactic acid, or lactate, is the culprit responsible for muscle soreness and cramping both during and following exercise. It is a natural compound produced in the muscles during exercise, but when it accumulates in high levels, it can cause cramps, spasms and soreness, as well as prolong recovery time between workouts. While lactic acid buildup has a tendency to damage muscle tissue, the body's natural antioxidant defense system protects against that damage, according to researchers at Osmangazi University in Eskisehir, Turkey.2
Antioxidants have been widely studied for their role in protecting muscle tissue from free radical production that may occur during exercise, and they are popular among athletes. For example, 30 percent of joggers and 28.1 percent of bodybuilders take antioxidants as compared to 16.4 percent of the general population, according to NMI. There is some contention that free radicals have the chance to damage muscle tissue during exercise, as the body activates its own antioxidant defense system even as it produces lactic acid. According to researchers at Toho University School of Medicine in Tokyo, the increased serum antioxidant concentrations that occur during anaerobic exercise prevent oxidative damage to skeletal muscle, even though lactate levels also significantly increase after exercise.3
While there is disagreement that free radicals damage muscle tissue during exercise, muscle soreness and cramping are a reality in the world of athletic performance. Antioxidant vitamin C may be able to reduce exercise-related muscle soreness in those who are unaccustomed to working out, according to Dylan Thompson, Ph.D., and researchers from the University of Bath in Swindon, England. They discovered that men (n=8) consuming 200 mg of vitamin C twice daily for two weeks experienced fewer aches and better muscle function after prolonged exercise than men in the placebo group (n=8).4
According to NMI, vitamin C is one of the more popular supplements among athletes. For example, 50 percent of joggers and 51 percent of bodybuilders take vitamin C, as compared to 45.4 percent of the general population.
Vitamin C's beneficial effect on muscle soreness may not occur with one-time supplementation. Thompson and another group of researchers at Loughborough University in Leicestershire, England, discovered that acute supplementation of vitamin C did not prove beneficial on exercise-induced muscle soreness and damage. The habitually active men (n=9) in this study consumed 1,000 mg of vitamin C just before exercise during one test and then consumed placebo during another. Researchers did not note any beneficial effects during the treatment period as compared to placebo. They concluded that this may be because the supplementation occurred at an "inappropriate" time.5
Antioxidant vitamins may also be useful in helping athletes adjust to high-altitude performance by reducing the symptoms of acute mountain sickness. In a placebo-controlled, double blind study, 18 subjects were randomly assigned to either an antioxidant regimen or placebo. Volunteers taking the supplement combination--1,000 mg/d of vitamin C, 400 IU/d of vitamin E and 600 mg/d of alpha lipoic acid--during a 10-day ascent to a Mt. Everest base camp at approximately 17,000 feet experienced higher oxygen blood levels and higher caloric absorption compared to the placebo group.6
Vitamin E has also been tested independently for its role in improving performance recovery by researchers at the College of Veterinary Medicine at the University of Florida, Gainesville. Eight adult racing greyhounds were given 680 IU/d of vitamin E (alpha-tocopheryl acetate) for seven days. Their blood concentrations of alpha-tocopherol were measured before and after racing prior to the supplementation regimen, as well as seven days after supplementation began. Results indicated that concentrations of alpha-tocopherol, a component of vitamin E, were significantly higher overall during treatment, although levels did not differ before or after racing. Researchers noted that vitamin E supplementation eliminated the typical after-racing decrease in alpha-tocopherol that was detected before supplementation began. They concluded that vitamin E may decrease oxidation during exercise, making it applicable in the realm of improving performance or recovery.7
Coenzyme Q10 (CoQ10) is another antioxidant thought to affect athletic performance. Otherwise known as ubiquinone, CoQ10 is produced in the body and is responsible for transporting energy from one enzyme to another during ATP production. As humans age, however, CoQ10 synthesis is affected and a deficiency can develop.8 A deficiency of CoQ10 can lead to "exercise intolerance," according to researchers at the Columbia University College of Physicians and Surgeons in New York.9
Although CoQ10 is responsible, in part, for energy production, there is a lack of evidence that the nutrient can improve physical performance. Researchers at the University of Parma in Italy studied 28 healthy male cyclists who were randomized into two groups--CoQ10 or placebo. Subjects underwent cardiopulmonary exercise testing at baseline and at the end of the eight-week study period. At the end of the study period, there was no difference between the two groups in physiological or metabolic parameters, although the CoQ10 group reached muscular exhaustion with higher workloads than the placebo group. Researchers concluded that CoQ10 oral treatment does not improve aerobic power, although it does seem to slightly improve tolerance to higher workloads, which could be due to its antioxidant activity.10
Astaxanthin, a naturally occurring carotenoid pigment and powerful antioxidant, may also have application in the realm of performance nutrition. While there is some speculation that astaxanthin can reduce muscle soreness in athletes, research on this topic is scarce. However, an unpublished human clinical trial conducted at Tennessee's University of Memphis demonstrated that astaxanthin (as BioAstin®, by Cyanotech Corp.) can reduce knee soreness after strenuous leg exercises. In addition, the study indicated that the athletes taking the supplement experienced a significantly stronger immune system response compared to the control group after exercise.
Aside from antioxidant vitamins, numerous B vitamins play a role in performance nutrition, as they are responsible for assisting in energy metabolism. Vitamin B supplements are fairly popular among athletes--25.4 percent of joggers and 33.3 percent of bodybuilders take B vitamins or a B complex as compared to 24 percent of the general population, according to NMI.
The body uses vitamin B3 (niacin) to release energy from carbohydrates. Vitamin B3 comes in two basic forms--niacin (also called nicotinic acid) and niacinamide (also called nicotinamide). Researchers at the Deakin University in Burwood, Australia, determined that niacin may improve carbohydrate metabolism during cycling in women who are unaccustomed to exercise. The women in the supplement group ingested 7.4 mg/kg body weight 30 minutes before exercise, 3.7 mg/kg at 0 minutes and 3.7 mg/kg after 30 minutes of exercise. Glucose kinetics were measured after exercise and researchers learned that glycerol (a three-carbon alcohol derived from the breakdown of fats) levels were suppressed throughout exercise. They concluded that during prolonged moderate exercise, subjects exhibited increased glycogen utilization, which compensated for carbohydrate oxidation.11
NADH (nicotinamide adenine dinucleotide), sometimes known as coenzyme 1, is the active coenzyme form of vitamin B3 and is necessary for energy production. NADH is utilized in the body during an oxidation process that fuels the ignition of ATP. Because it is not manufactured in the body, NADH must be obtained from dietary sources such as fish, beef and chicken, as well as foods that are made with yeast.
NADH has been linked to improved mental function and for treating the symptoms of chronic fatigue syndrome. Currently, some athletes take supplemental NADH as an ergogenic aid to improve performance. However, there are no published clinical trials demonstrating the safety or efficacy of this practice.
Some of the other B vitamins are also involved in energy production, although research proving their efficacy in performance nutrition is limited. Vitamin B1 is needed to process carbohydrates, fat and protein, and is required to produce ATP. Pantothenic acid (vitamin B5) is also involved in Kreb's Cycle and is essential for producing, transporting and releasing energy from fats. Vitamin B12 deficiency is known to cause fatigue, and injections of the nutrient have been used to combat the symptoms of chronic fatigue syndrome, although the efficacy of this practice is unproven. Vitamins B6 and B12 are also linked with reducing immunosuppression in athletes.
Similar to vitamins, minerals are also heavily involved in energy metabolism. Specifically, magnesium, zinc and chromium are integral for optimal performance, according to a research review conducted by Hank C. Lukaski, Ph.D., supervisory research physiologist at the Grand Forks Human Nutrition Research Center, an affiliate of the U.S. Department of Agriculture. Lukaski stated in his review that there is accumulating evidence supporting the hypothesis that magnesium and zinc are significant for promoting strength. However, he also stated the supportive evidence for chromium in performance is not well-established.12
Magnesium is a necessary nutrient for energy metabolism. It activates the body's store of B vitamins and assists in the formation of protein, fatty acids and ATP. "Magnesium is vital for energy release," wrote Kumar Pati, M.D., and Anthony James Degidio, D.O., M.D., in Vitamin & Herbal Digest (New Editions Publishing, 1996). "Our muscles and nerves need magnesium to function properly."
Zinc is also necessary for proper body function and is a component of more than 300 enzymes that support various body functions, including protein synthesis. Zinc's immune-boosting properties make it especially popular with athletes due to exercise-induced immunosuppression. Dietary deficiencies of protein and specific micronutrients have long been associated with immune dysfunction, according to a review on the importance of nutrition in athletes written by researchers at the University of Edgbaston in Birmingham, England. They suggested that adequate intakes of B vitamins, zinc and iron are necessary for maintaining immune function in athletes.13
Chromium, an essential trace mineral that helps the body maintain normal blood sugar levels, may also improve body composition by reducing fat and increasing lean muscle tissue. A large study conducted by researchers at the Health and Medical Research Foundation in San Antonio, Texas, determined that chromium picolinate supplementation can lead to significant improvement in body composition. Subjects (n=154) were randomly assigned to receive either 200 mcg/d or 400 mcg/d of chromium picolinate (as Chromax®, manufactured by Purchase, N.Y.-based Nutrition 21) or placebo for 12 weeks. At the end of the study period, researchers noted that subjects in both treatment groups exhibited significant improvements in body composition--reduced fat and increased lean muscle tissue.14
A smaller, more recent trial comparing chromium picolinate to placebo failed to duplicate these results. Researchers at California State University in Fullerton found no significant differences in the muscular strength or body composition of female softball players who took 500 mcg/d of chromium picolinate (as Chromax) for six weeks.15
Iron is another mineral that is useful in preventing immunosuppression and is also necessary for energy production. Iron deficiency can induce fatigue because it is an essential component of hemoglobin, which is responsible for transporting oxygen to the cells. Iron-deficient people tire easily in part because their bodies are starved for oxygen. Also, without enough iron, ATP cannot be properly synthesized. As a result, some iron-deficient people become fatigued even when they are not anemic.
Iron deficiency in non-anemics has been known to reduce muscle tissue oxidative capacity and endurance, although iron supplementation may be useful for reversing this condition. Two studies have demonstrated this effect of iron supplementation (50 mg/d). The first study--conducted at Cornell University in Ithaca, N.Y.--involved 41 iron-depleted, non-anemic women who were unaccustomed to aerobic activity. Researchers found that the women's difficulty tolerating aerobic exercise was reversed after six weeks of iron supplementation.16 A similar trial conducted by the same researchers included 49 women who supplemented with iron for six weeks and achieved an improved response to endurance training.17
The Majority of Sports Nutrition Users Say That Vitamins, Minerals and Herbs Are Effective & Important
Amino acids are the building blocks of protein, 20 of which exist to build the various proteins used in the growth, repair and maintenance of body tissues. Nine of these are essential amino acids that are not produced in the body and must be obtained from the diet.
Glutamine, the most abundant amino acid in the body, is converted to glucose when more is required by the body for energy. Reduced plasma glutamine concentrations have been linked to exercise-induced immune impairment, according to researchers at The Copenhagen Muscle Research Center in Denmark.18 However, according to a review written by researchers at Deakin University in Burwood, Australia, there are few controlled trials that support the supplemental use of glutamine for reducing immunosuppresion.19
An amino acid metabolite, L-carnitine, is created in the body from the amino acids lysine and methionine. L-carnitine assists the utilization of fat as energy by transporting fatty acids to the mitochondria, where ATP is created. Supplemental L-carnitine may improve athletic performance and aid in muscle recovery. Researchers from the Universidade de Sao Paulo in Brazil suggested L-carnitine's ability to improve aerobic capacity may be due to the nutrient's stimulation of lipid oxidation in muscle cells during long-term exercise.20 And, a study conducted by researchers from the University of Connecticut in Storrs determined that supplementing with a combination of 500 mg of L-carnitine and 236 mg of L-tartrate (as L-Carnipure®, manufactured by Fair Lawn, N.J.-based Lonza Inc.) can improve recovery from high-repetition muscle training.21
L-theanine, an amino acid derived from green tea, has applications in immune enhancement, stress management, and physical and mental relaxation. For these reasons, it may also be applicable to performance nutrition. One study demonstrated the effects of L-theanine (as Suntheanine®, manufactured by Taiyo Kagaku in Yokkaichi, Japan, and distributed by NutriScience Innovations, Fairfield, Conn., and Cyvex Nutrition in Irvine, Calif.) on alpha-brain waves in humans, which illuminate states of relaxation. Researchers from Taiyo Kagaku discovered that L-theanine encouraged relaxation in subjects without inducing drowsiness.22
Soy protein has also been studied in the realm of performance nutrition. As a protein, soy is a component of amino acids and may be helpful for improving lean body mass and reducing recovery time. According to a study conducted by researchers at Ohio State University, soy protein increases plasma total antioxidants, which can reduce tissue damage that might occur as a result of exercising. Researchers, who compared 40 mg of soy protein (as Solae™, manufactured by St. Louis-based DuPont Protein Technologies) to 40 mg of whey protein in 20 male collegiate athletes, also noted that the soy group demonstrated larger reductions in creatine kinase and myloperoxidase levels, which are markers for muscle damage and inflammation, respectively.23
Whey protein is a dairy-based source of amino acids that has been suggested for athletic performance, specifically in bodybuilding. Whey protein provides the body with the branched-chain amino acids leucine, isoleucine and valine, which are needed for muscle maintenance.
Researchers from St. Francis Xavier University in Nova Scotia, Canada, conducted a study to determine muscular adaptations during six weeks of resistance training in 36 men who were randomized to receive whey protein, whey protein combined with creatine, or placebo. The combination group experienced the best increase in lean muscle mass, although the whey group also had significant gains as compared to placebo. Men supplemented with whey protein also experienced greater improvements in lean tissue mass than men who only trained. And, men in the combination group had greater increases in lean tissue mass and bench press than those with whey only or placebo. Continued strength training for an additional six weeks without supplementation was found to maintain lean muscle mass and strength in all men.24
Sports Nutrition Users' Top Reasons For First Use of Sports Nutrition Products: Performance/Energy
Creatine is a popular sports nutrition supplement among both old and young athletes as an ergogenic aid, as well as for its ability to increase lean muscle mass and delay muscle fatigue. A survey of 1,349 high school football players conducted by researchers at the University of Wisconsin Hospital Sports Medicine Center in Madison indicated that 30 percent of the students had used creatine, with seniors (50.5 percent) being more likely to use the supplement than freshmen (10.4 percent).25
The fact that creatine use is popular among teenagers has been of some concern due to a lack of education and potential side effects. The Blue Cross and Blue Shield Association distributed an educational advisory to schools nationwide regarding "potentially dangerous" sports supplements, including creatine. The Foundation warned that long-term side effects of sports supplements are unknown and teens should consult a physician before starting regular supplement use.
The report also mentioned anecdotal evidence linking creatine to kidney problems. Aside from potential kidney problems, creatine may also cause leg and stomach cramps, especially if it is not taken with sufficient amounts of water. One study indicated that creatine supplementation led to abnormal increases in anterior compartment pressure in the lower leg at rest and following 20 minutes of level running at 80 percent of maximal aerobic power.26 However, a retrospective study of creatine use did not indicate a difference between creatine use and non-use groups with regard to muscle injury, cramps or other side effects. Researchers concluded that this data shows long-term creatine supplementation does not lead to adverse events.27
As for its beneficial effects, creatine has been touted for improving exercise performance and muscle recovery. A study conducted at the University of Birmingham in the United Kingdom demonstrated that oral creatine supplementation, compared to placebo, enhanced exercise performance in nine competitive squash players who took creatine monohydrate four times daily for five days.28
Another study conducted by scientists at the University of Saskatchewan in Saskatoon indicated that creatine supplementation may increase lean tissue mass in older men. Thirty men involved in a randomized, double blind study took .3 g/d of creatine for every 1 kg of body weight or placebo for 12 weeks. Both groups resistance trained three times per week. The creatine group had significantly higher scores for average power, lean tissue mass and fat mass. Study authors concluded that supplementation improved leg strength and endurance.29
Magnesium-creatine chelate may offer enhanced benefits to athletes, according to an animal study published by Max Motyka, M.S.R., Ph.D., director of the human products division at Clearfield, Utah-based Albion Advanced Nutrition.30 Animals supplemented with magnesium-creatine chelate outperformed animals supplemented with creatine monohydrate, creatine monohydrate plus magnesium oxide, creatine monohydrate plus magnesium amino acid chelate, or placebo. Motyka concluded that magnesium-creatine chelate (as Creatine MagnaPower™, manufactured by Albion) enhanced the animals' ability to generate and regenerate ATP for muscular performance.
Pyruvate is a product of ATP creation--it is created in the body during the metabolism of carbohydrates and protein. Research published in 1990 indicated that pyruvate supplementation enhanced exercise endurance, although more recent research indicates otherwise. Researchers from the University of Guelph in Ontario, Canada, supplemented nine recreationally active subjects with 7, 15 and 25 g of pyruvate for seven days. Performance tests to exhaustion indicated that the subjects taking oral pyruvate did not achieve enhanced performance during intense exercise.31
Conjugated linoleic acid (CLA), a fatty acid found mainly in milk fat, may have application in performance nutrition because of its propensity to reduce body fat and increase lean body mass. An animal study conducted at the University of Wisconsin in Madison determined that mice supplemented with CLA (as Tonalin® CLA, manufactured by Vernon Hills, Ill.-based Natural Inc.) exhibited 57 percent to 60 percent lower body fat and 5 percent to 14 percent increased lean body mass compared to controls.32 These results were duplicated by researchers at Pennsylvania State University in University Park when they sought to determine CLA's (as Tonalin CLA) mechanism of action.33
When researchers at the Scandinavian Clinical Research center in Kjeller, Norway, sought to duplicate these results in humans, they found that subjects taking 3.4 g/d and 6.8 g/d of CLA experienced a reduction in body fat; however, researchers did not note a difference in lean body mass between treatment groups and placebo.34
MSM (methylsulfonyl-methane) is a naturally occurring sulfur compound said to help maintain the body's protein structure and immune system. When used as a supplement, MSM is thought to improve injury recovery in athletes. A double blind, placebo-controlled study of 24 patients selected from the clinic of Ronald Lawrence, M.D., Ph.D., showed that patients in the treatment group (taking Lignisul™ MSM, manufactured by Carolwood Corp. in Greenville, Pa.) had a level of significant recovery (58 percent) compared to those taking placebo (33.3 percent).
Body Builders Are Three Times More Likely Than GP To Use Sports Nutritional Products
While numerous nutrients and compounds found in the human body can improve athletic performance by quickening recovery time and improving strength, various botanicals can also enhance performance by providing a jolt of energy and potentially reducing tissue damage.
Cordyceps sinensis, for example, is a traditional Chinese herb that may enhance endurance and exercise performance, according to researchers who presented at the annual meeting of the American College of Sports Medicine (Southwest Chapter) in November 2001. Researchers from the Center for Clinical and Lifestyle Research in Shrewsbury, Mass., tested 110 healthy, sedentary adults who were randomized to receive either Cordyceps or placebo for 12 weeks. Subjects in the treatment group exhibited an increase in overall maximal oxygen consumption (5.5 percent), an increase in work output on a bicycle (2.8 percent) and a 20-second reduction in the one-mile walk. Researchers concluded that Cordyceps (as CordyMax Cs-4, manufactured by Pharmanex) had a metabolic effect by improving oxygen consumption, energy metabolism and endurance performance.
Velvet antler (deer velvet) may also have application in the realm of performance nutrition, according to research published online by Velvet Antler Research New Zealand (www.velvet.org.nz). One study involving 51 male athletes who were randomized to supplement with New Zealand deer velvet or placebo demonstrated that velvet antler improved isokinetic strength and muscular endurance more effectively than placebo. A second study, which involved 30 athletes, indicated that those athletes taking New Zealand deer velvet powder for two weeks prior to treadmill exercise showed reductions of creatine kinase in their bloodstream, a marker for muscle damage. (These studies were commissioned by Velvet Antler Research of New Zealand, a joint venture between the New Zealand Game Industry Board and AgResearch.)
Guarana is another botanical suggested for athletic performance for its energy-enhancing ability. Guarana is an evergreen vine indigenous to the Amazon basin that has a similar effect on the human body as caffeine--it is known to stimulate the nervous system and increase metabolism. Because of this, the herb has been indicated in cases of over-stimulation.35
"The extract of the guarana plant, grown in Brazil, contains caffeine--many people's favorite pick-me-up," wrote Pamela Smith, R.D., in The Energy Edge (LifeLine Press, 1999). "It's chemically the same as an afternoon espresso. Yes, it's natural, but so are coffee beans. Caffeine is a stimulant that acts on your central nervous system and can speed up your heart rate."
Unlike guarana, ginseng is not a stimulant; rather, it is an adaptogen and has positive effects on the immune system. Ginseng is often promoted for its energy-boosting ability and is favored among athletes, with 21.2 percent of joggers and 19.8 percent of bodybuilders taking it as compared to 12 percent of the general population, according to NMI.
Ginseng supplements are created from three varieties of the plant: Asian ginseng (Panax ginseng), American ginseng (Panax quinquefolius) and Siberian ginseng (Eleutherococcus senticosus). A review of herbs and exercise performance suggested that Asian ginseng improves exercise performance, including muscular strength, oxygen uptake, work capacity, heart rate, alertness and psychomotor skills, in studies of eight weeks or longer.36 The same review reported that trials utilizing Siberian ginseng are mixed. Researchers from the University of Southern Mississippi in Hattiesburg conducted a study with nine highly trained cyclists who took either Siberian ginseng or placebo for seven days prior to performance tests. Cycling times were not improved in either group.37
Asian ginseng may prove to be beneficial to athletes by reducing injury and inflammation, according to researchers from the University of Leon in Spain.38 However, long-term supplementation with Asian ginseng does not have an ergogenic effect on recovery from short, high-energy exercise, according to researchers from Wayne State University, Detroit.39
Joggers Are Four Times More Likely Than GP To Use Ephedra
Probably the sports supplement that has received the majority of the past year's negative publicity is ephedra, also known as ma huang. However, this herb is particularly popular among athletes compared to the general population. According to NMI, joggers and bodybuilders are four times more likely to use ephedra than the general population.
Ephedra's active ingredients are the ephedrine alkaloids ephedrine and pseudoephedrine, which can be extracted from the plant or synthetically made--synthetic ephedrine alkaloids are considered by the Food and Drug Administration (FDA) to be drugs and are not permitted for use in dietary supplements.
Ephedra has received negative media coverage because of its suspected correlation with adverse events--ranging from increased blood pressure to death--due to its effect on the circulatory and nervous systems. Late last year, the Public Citizen Health Research Group (www.citizen.org) asked the federal government to ban the sale and production of ephedrine alkaloid dietary supplements and send out an immediate advisory concerning the possible health risks associated with these products. The letter reported that FDA's adverse event monitoring system showed that ephedrine alkaloid supplements were associated with more reports of death, myocardial infarction, cardiac arrhythmia, hypertension, stroke and seizure than all other dietary supplements combined.
The Ephedra Education Council (www.ephedrafacts.com) stated that the increased number of adverse events was due to a large increase in ephedra use during the same time period. Michael McGuffin, president of the American Herbal Products Association (AHPA), commented on the letter as well. "It's important that we acknowledge that ephedra is not a benign substance, and that there needs to be some government regulatory overview on this substance," he told INSIDER last year. "We agree with Public Citizen that there needs to be a change in the regulatory approach to this ingredient."
While FDA regulates the use of synthetic ephedrine alkaloids as drugs, Canada's government has acted against both natural and synthetic ephedra products. In January, Health Canada requested a voluntary recall of certain products containing either ephedra or ephedrine owing to their finding that the herb can pose a serious health risk. The products affected by the Canadian recall included those that have recommended doses exceeding 8 mg per serving or 32 mg/d, as well as combination products containing other stimulants promoted for weight loss, bodybuilding or energy.
Aside from the political battles being waged on account of ephedra, the scientific community has also brought arguments against the herb. Researchers from the New England Medical Center reviewed 37 adverse event reports involving ephedra use--in which 36 cited using the recommended dosage--and concluded that the herb is temporally related to stroke, myocardial infarction and sudden death.40
John Hathcock, Ph.D., vice president of nutritional and regulatory science for the Council for Responsible Nutrition (CRN), commented that observational studies tend to be flawed based on self-reporting and missing data--such as other medications or supplements the patients were taking, and how much of the herb they were taking. "Ephedra is safe and effective when used as directed according to the label and by those for whom the product is intended," he told INSIDER in January. "And that has to be limited by the label instructions about contraindicated substances and pre-existing health conditions that would preclude [ephedra use]."
In terms of ephedra's positive effects, the herb may improve athletic performance, according to a study conducted by researchers from the Defense and Civil Institute of Environmental Medicine in Toronto. Twelve runners randomly received either 4 mg/kg of body weight of caffeine, 0.8 mg/kg of ephedrine or a combination of caffeine and ephedrine. Products were given 1.5 hours before volunteers ran 10 km on a treadmill while carrying an 11-kg backpack. The ephedra groups exhibited statistically better run times--45.5 min. for ephedrine users, 45.7 minutes for caffeine/ephedrine users--than the caffeine-only (46.0 min.) or placebo (46.8 min.) groups.41
Androstenedione (andro), and related substances androstenediol and norandrostenedione, is another ingredient that has received negative media attention. The controversy surrounding andro arguably began when teens strove to mimic baseball's Mark McGwire to improve their athletic performance by taking the androgen hormone. Andro is produced in the adrenal glands and gonads and is converted to testosterone in muscle and bone.
As an anabolic steroid, andro has been banned by the Olympic Committee, the National Football League and the National Collegiate Athletic Association. And, its classification as a hormone led California's attorney general, Bill Lockyer, to file suit on Aug. 15, 2001, against almost three dozen manufacturers and distributors of andro supplements for violating the state's Proposition 65, the Safe Drinking Water and Toxic Enforcement Act of 1986. Lockyer cited the potential for the supplement to "produce serious reproductive health problems" if taken in doses of 200 to 300 mg.
The doses singled out by Lockyer as being potentially dangerous are typically recommended doses for enhancing body composition and muscular strength. However, researchers from East Tennessee State University who conducted The Andro Project--a trial involving 50 men conducted to discover the physiological and hormonal effects of 200 mg/d of oral androstenediol and androstenedione--determined that while the supplement can increase testosterone levels, it does not necessarily enhance performance.42
Dehydroepiandrosterone (DHEA), an adrenal-derived steroid, has also been banned by the Olympic Committee and several other sports organizations. DHEA is believed to build muscle mass, reduce fat and decrease recovery time following injury; however, clinical research demonstrating these claims is limited. Researchers from LGE Performance Systems in Orlando, Fla., determined through a 12-week, randomized, placebo-controlled, double blind trial with 40 healthy male subjects that DHEA does not independently elicit a statistically significant increase in lean body mass, strength or testosterone levels.43 The same results were found by researchers at Iowa State University in Ames44 and from a review done by researchers at the University of Massachusetts in Amherst.45
HMB (beta hydroxy-beta-methylbutyrate) is a metabolite of the essential amino acid leucine, a branched-chain amino acid. HMB is purported to assist in protein synthesis, acting as an anticatabolic agent and minimizing protein breakdown and cell damage that occurs during intense exercise. Researchers at the Academy of Physical Education in Warsaw, Poland, discovered that HMB supplementation acted in a similar fashion to creatine. During three weeks of progressive resistance-exercise training, 40 subjects were randomized to receive one of four treatments: creatine, HMB, creatine plus HMB, or placebo. All three treatment groups gained lean body mass, with the combination group gaining the most, creatine second and HMB third. In addition, all treatment groups improved in strength--the combination group, again, improved the most, with the HMB group exhibiting the second most improvement. Researchers concluded that creatine and HMB can increase lean body mass and strength, with better effects being evident with combination therapy.46
Another study was conducted by researchers at South Dakota State University to determine whether the increases in strength and fat-free mass during weight training with HMB supplementation seen in young men could be applied to elderly men as well. For this purpose, 31 men and women, aged 70 and older, were randomized to receive HMB (3 g/d) or placebo for eight weeks during a progressive resistance training program. Results indicated both an increase in lean body mass and strength with daily HMB supplementation.47
However, additional research has not shown these beneficial effects. Researchers at the University of Queensland in Brisbane, Australia, found that short-term HMB supplementation (40 mg/d per kg of bodyweight) did not demonstrate a beneficial effect on symptoms associated with muscle damage. Researchers concluded that if HMB can produce an ergogenic response, a pre-exercise supplementation longer than six days may be necessary.48
The countless dietary supplements available that are targeted toward athletes may seem slightly daunting. However, these products are all targeted to different aspects of performance nutrition: developing lean body mass, enhancing performance, combating immunosuppression, etc. With these topics in mind, manufacturers can choose which ingredients best fit their formulations, and consumers will be able to create a specialized regimen for their particular needs.