High Intensity Training
Workshop and Performance
Optimization Roundtable
Sponsored by the
Human Performance Resource Center
September 13-14, 2010
Uniformed Services University for the Health
Sciences,
Bethesda, MD
Nutrition, Supplements, and High
Intensity Training Programs
Patricia A. Deuster, PhD, MPH
Professor and Scientific Director
CHAMP
Objectives
• Present picture of dietary supplement use
among active duty personnel
• Discuss concerns and red flags regarding
dietary supplements
• Describe nutrition and dietary supplements
information associated with extreme
exercise programs
• Introduce new DoD classification system
for dietary supplements
Supplement Use by Age
30
17 to 25 Yrs
Percent of Sampe (%)
**
26-34 Yrs
25
•35 Yrs
20
**
15
**
10
5
0
Body
Building
Performance
Enhancing
Weight
Loss
Supplement Use by Gender
Percent of Sampe (%)
30
25
Male
Female
**
20
15
10
**
5
**
0
Body
Building
Performance
Enhancing
Weight
Loss
Supplement Use by Service
Percent of Sampe (%)
30
**
25
Army
Air Force
Marines
Navy
**
20
15
10
**
5
0
Body
Building
Performance
Enhancing
Weight
Loss
Percent of Sampe (%)
Body Building Supplements
and Drinking
30
**
25
Abstain
Light
Moderate
Mod/Heavy
Heavy
20
**
**
**
**
15
10
5
0
Body
Building
Performance
Enhancing
Weight
Loss
US Army Survey
• 9.1% took combination products: CellTech,
Hydroxycut, Nitrotech, or Xenadrine)
• 37.5% took multivitamins/multiminerals
• 18.7% took protein and amino acids
• 17.9% used single vitamins/minerals
• 8.3% used herbal supplements
• 2.7% used steroid analogs
Lieberman et al. AJCN. July 28, 2010
Reasons for Use
US Army Survey
•
•
•
•
•
64.2% to improve general health
31.1% to increase energy
24.9% to increase muscle strength
16.7% to enhance performance
Persons who strength trained were 8.3
times more likely to take protein and amino
acid products
Lieberman et al. AJCN. July 28, 2010
•
•
•
•
•
•
Characteristics of Body
Building Supplement Users
18 to 25 yo
A Marine
Unmarried
BMI 25 – 30
Physically active
Heavy drinker
Stephens et al. found an association between the use of
ergogenic supplements and specific health risk behaviors.
Hidden Ingredients
Dietary supplements deliberately
contaminated with:
– Prescription drug ingredients
– Ingredients under clinical investigation w/an IND
– Ingredients approved as drugs in other countries
– Ingredients removed from US market for safety
reasons
– Analogues of prescription drug ingredients
– Controlled substances
12
Red Flags
• Product categories: weight loss, performance
enhancing, bodybuilding
• Label claims like:
– Alternative to [approved drug products]
– Do not take if you have any medical condition, if you are
taking any prescription medications, or if you are pregnant
– May cause positive result in drug test
• Labels primarily in a foreign language
• Directions and warnings resembling FDA
approved drug products
Trends from Iraq
• Warfighters are taking mostly combinations
of or “stacked” products readily available at
exhanges on base
• “RIP-ITs” are stocked at all DFACs (energy
drink supplements)
• Most readily available products:
NO products
Rip It® 16 oz Energy Drink
Side Effects
Observed in Theatre
• Multiple case reports of syncope, palpitations and
lightheadedness from NO products
• Warfighters who become dehydrated appear at
increased risk of side effects from caffeine and
other vasoactive components
• Case reports of liver toxicity, possibly secondary to
NO products
• Rhabdo also seen, but no clearly identifiable
supplement connection: possibly secondary to
heat, dehydration and vasoactive components
Various Programs
•
•
•
•
•
P90X
CrossFit
TRX®
Military Athlete
Gym Jones
P90X
Multiple supplements promoted
Nutritional Guideline:
Military Athletes
• 6 Days a Week:
– Eat lean meat, vegetables, fruit, nuts, seeds,
and drink water.
– Don't eat carbs (bread, spuds, rice) or sugar.
• 1 Day a Week:
– Cheat like a mother!
– Beer, pizza, ice cream - you name it!
Supplement Guideline:
Military Athletes
• Supplement diet with protein shakes &
creatine to improve strength & recovery
– Whey protein is best: Key ingredient is Leucine
– Drink 10 min before & 15 min after training
– Creatine - Take 20-25 grams/day for 5 days, then
continue with 5 grams/day afterward
• β-Alanine: Take to decrease fatigue,
improve recovery, cut body fat and
increase lean body mass
CrossFit
• No products promoted - but
http://www.nastyenergy.com/
TRX®
• Partners with Precision Nutrition
– No supplement promotions found, but must be
member to access information
Gym Jones
• No products promoted
• Blogs on nutrition
Gym Jones
• Drink solution containing 88-90% carbs and
10-12% protein
– Several supplements on the market that fit this
profile.
• Check ingredients to learn protein source
– Whey peptides are ideal for recovery
• Glutamine contributes to ammonia burden
– Soy protein does not readily produce ammonia
Proposed DoD DS
Classification System
• Combines potential benefit with
probability of adverse event to
estimate risk
• Can be used to assess
acceptability of risk
• May be used to prioritize resources,
develop educational materials, and
standardize response actions
• Can be revised as new evidence
and/or adverse events emerge
Dietary Supplement
Risk Matrix
Safety
Benefit
Minimal
Concern
High
Potential
Moderate
Potential
1-Safe
3-Safe
Low
Moderate
Concern Concern
High
Concern
2-Safe
7-Use w/ 9-Do Not
Caution
Use
4-Safe
8-Use w/
11-Do
Caution Not Use
Low
5-Use w/ 6-Use w/
Potential Caution Caution
10-Do
Not Use
12-Do
Not Use
http://www.humanperformanceresourcecenter.org/
Summary
• Supplement use is problematic, particularly
in the deployed setting
• Body building and performance enhancing
are primary supplements of concern
• Supplements co-exist with HIT programs
• Some HIT programs promote supplements
that could be harmful, especially in the
deployed setting
Protein/Creatine/Amino Acids/Nitric Oxide, Arginine
Brand Name/Supplement Name
Key Ingredients
BSN/Endorush**
L-Arginine-Alpha-Ketoglutaric (AKG) Acid
BSN/Cellmass**
Sodium Cratine Phosphate Matrix, Creatine Ethyl-Ester B-Alanine Creatinol-OPhosphate-Malic Acid Interfusion, Creatine-Alpha-Aminobutyric Acid Matrix
BSN/Epozine-O2**
L-Arginine AKG, L-Arginine Aspartate, L-Arganine Pyroglutamate, L-Arginine Ethyl
Ester, creatine sodium phosphate, creatinol-O-phosphate, Creatine Magnesium
Chelate,
BSN/NO-XPLODE**
L-Arginine AKG, Di-creatine malate, Creatine Ethyl-Ester B-Alanine Composite,
Sodium Creatine Phosphate Matrix, Creatinol-O-Phosphate Malic Acid Interfusion,
Creatine-Alpha-Aminobutyric Acid Matrix
BSN/Nitrix**
L-Arganine AKG, L-Arginine Ethyl Ester, Creatine Ethyl-Ester B-Alanine Composite,
Sodium Creatine Phosphate Matrix, Creatinol-O-Phosphate-Malic Acid Interfusion,
Creatine-Alpha-Aminobutyric Acid Matrix
BSN/True Mass
Whey protein concentrate, whey protein isolate, calcium caseinate micellar Casin
BSN/Volumize**
Leucine Alpha-Aminobutyric Acid Matrix, Valine Alpha-Aminobutyric Acid Matrix,
Isoleucine Alpha-Aminobutyric Acid Matrix, Leucine Nitrate, Valine Nitrate,
Isoleucine Nitrate
ProLab/Creatine Monohydrate
Creatine Monohydrate
ProLab/Pure Whey
Whey protein concentrate
ProLab/Advanced Whey Protein
Whey protein concentrate, whey protein isolate
EAS/100% Whey Protein
Whey protein concentrate, whey protein isolate
Muscletech/Na-NO Vapor Hardcore**
L-Arginine, Creatine Monohydrate
Creatine Monohydrate, Creatinol-o-phosphate, creatine taurinate, L-arginine, Lglutamine, L-leucine, L-isoleucine, L-valine
Creatine Monhydre, Creatine Malate, Creatine Taurinate, L-Lysine HCL, L-valine, Lvaline Alpha-ketoglutarate, L-isoleucine pyroglutamate, L-leucine Ketoisocaproate,
L-leucine pyroglutamate, L-leucine alpha-ketogluarate,
Protein/Creatine/Amino Acids/Nitric Oxide, Arginine
Brand Name/Supplement Name
Key Ingredients
Muscletech/IntraVol**
Muscletech/Anabolic Halo Hardcore**
Muscletech/Creakic
Body Fortress/Premium Protein
Muscletech/Mesotech Complete
Muscletech/Na-NOX9 Hardcore**
MRI/NO2 Platinum
MRI/NO2 Black
MRI/WAR (Workout Anabolic Recovery)
Muscletech/Celltech**
Creatine Monohydrate, L-Arginine
L-Leucine
Creatine Monohydrate
Whey Protein concentrate, whey protein isolate
Whey protein concentrate, Creatine Monohydrate, Amino Acids
L-Arginine
L-Arginine
Arginine Alpha-ketoglutarate
Amino Acids
Creatine Monohydrate
Muscletech/Nitrotech**
Whey protein concentrate, whey protein isolate, creatine monohydrate
** indicates proprietary blend and amount of key ingredients are unknown
Steroids/Prohormones
Brand Name/Supplement Name
Key Ingredients
Powerlab/Halotest-25
Powerlab/Pirmabol
4-cholor-17a-methyl-andro-4-ene3, 17b-diol
2a-17a-dimethyl-17b-hydroxy-5a-androstan-3-one
Powerlab/Androdrol
4-cholor-17a-methyl-androst-1,4-diene-3-17b-diol, 2,3a-epithio-17a-methyl-5aandrostan-17b-ol, 13-ehtyl-3-methoxy-gona-2,5(10)dien-17-one, 2a-17a-dimethyl-17bhydrox-5z-androstan-3-one, 6 bromoandrostenedione
GNC/Mega Man DHEA
dehydroepiandrosterone (DHEA)
Caffeine/Stimulants
Brand Name/Supplement Name
Key Ingredients
BSN/Endorush**
BSN/NO-XPLODE**
Premier Nutrition/Rocket Shot**
Stacker/Black Jax Energy Shot**
Muscletech/Na-NO Vapor Hardcore**
Xenadrine/Xenadrine Ultra & RZR-X**
Muscletech/Myoshock**
Muscletech/Gakic**
Twinlab/Ripped Fuel 5X
Twinlab/Ripped Fuel Extreme
Five Hour Energy/Five Hour Energy Shot**
BSN/Thermonex**
AMP/Energy Drink**
Full Throttle Energy Drink**
Monster Energy Drink**
MRI/Black Powder**
Red Bull Energy Drink
Methylxantine (Caffeine and Caffeine-Alpha-Ketoglutaric Acid)
methylxanthine (Caffeine)
Caffeine Anhydrous
Caffeine Anhydrous
Caffeine
Caffeine Anhydrous
Caffeine Anhydrous
Caffeine Anhydrous
Caffeine
Caffeine
Caffeine
Caffeine Anhydrous, Yerba Mate Leaf (25% caffeine),
Caffeine
Caffeine, Guarana
Caffeine, Guarana
Caffeine
Caffeine
** indicates proprietary blend and amount of key ingredients are unknown