chapter
chapter
15
16
Nutrition
and the
Ergogenic
Active
Female
Substances
Prof Jennifer Broxterman, RD, MSc
FN3373: Nutrition for Physical Activity
Lecture
11
Author name here for Edited books
Ergogenic Substances in
Sport & Exercise
Ergogenic Substances
• Definition of ergogenic substances:
– Substances used to improve exercise and athletic
performance by improving the production of energy
(Bucci, 1993)
Reasons for Supplement Use
• Why do athletes & non-athletes use ergogenic
substances?
–
–
–
–
–
–
To enhance performance in sport
To improve physical appearance
To prevent or treat injuries
To treat or cure illnesses or diseases
To be accepted by peers
To cope better with stress
Reasons for Supplement Use
• Many supplement companies advertise
benefits to taking their products (which may
or may not exist), including:
–
–
–
–
–
Weight or muscle gain
Increases in strength
Loss of body fat
Increases in energy and endurance
Enhanced recovery
Reasons for Supplement Use
Supplement Advertising
Regulation & Marketing of
Dietary Supplements
• Natural Health Products (NHPs) (Canada)
– NHPs are allowed to make a full range of both health
and therapeutic claims where supported by scientific
evidence
– Health Canada requires pre-marketing approval by the
product manufacturer in the sale of all NHPs
Regulation & Marketing of
Dietary Supplements
• Dietary supplements (United States)
– Companies are allowed to use claims of nutrition
support (e.g. structure-function claims) that link a
nutrient and a deficiency or describe the effect of an
ingredient on the body’s structure, function, or wellbeing
– Disease claims may not be made
– These claims do not require pre-market approval by the
FDA (however, a disclaimer is required on supplement
labels)
– Many claims displayed on product labels are
unsubstantiated (and it’s the consumer’s responsibility
to evaluate the health claims)
Categories of
Ergogenic Substances
Ergogenic Substances
• 2 main categories
– Ergogenic drugs: a drug that claims to prevent,
alleviate, or cure a physical or mental illness, or to
affect the structure or function of the body
• E.g. anabolic steroids, human growth hormone, erythropoietin
– Ergogenic substances: any substance that does not
claim to prevent, alleviate, or cure a disease; classified
as a dietary supplement
• e.g. caffeine
Ergogenic Substances
• Dietitians of Canada sports supplements
course classifies ergogenic aids into 5 major
classifications
1. Nutritional aids: mainly used to increase muscle
energy supply and the rate of muscle energy
production
E.g. a marathon runner may drink a sports
drink (containing CHO & electrolytes) to
prevent hypoglycemia, dehydration, and
restore electrolytes
Ergogenic Substances
• Dietitians of Canada sports supplements
course classifies ergogenic aids into 5 major
classifications
2. Physiological aids: substances or techniques
designed to enhance natural physiological processes
that generate physical power
•
E.g. blood doping, erythropoietin
(EPO), oxygen inhalation, blood
buffers (sodium bicarbonate),
human growth hormone (HGH),
testosterone
Ergogenic Substances
• Dietitians of Canada sports supplements
course classifies ergogenic aids into 5 major
classifications
3. Pharmacological aids: drugs designed to function
like neurotransmitters or hormones that are found
naturally in the body
•
E.g. anabolic steroids, Beta-2 agonists, diuretics and other
masking agents (e.g. lasix/furosemide)
Ergogenic Substances
• Dietitians of Canada sports supplements
course classifies ergogenic aids into 5 major
classifications
4. Mechanical aids: used to improve human body
biomechanics to increase work efficiency
•
•
•
•
Sportswear (e.g. swimming cap, running shoes, speed
skating suit, etc.)
Specialized sports equipment (racing
bike, bent ski poles)
Video surveillance (e.g. monitoring a
figure skating jump)
Wind tunnel testing (learn optimal aerodynamics)
Ergogenic Substances
• Dietitians of Canada sports supplements
course classifies ergogenic aids into 5 major
classifications
5. Psychological aids: designed to modify
psychological energy (also referred to as the athlete’s
level of arousal)
•
E.g. imagery, mental rehearsal, stress management
World Anti-Doping
Agency (WADA)
Doping in Sport
• Definition of doping:
– Use of prohibited substances and/or unfair methods
used to enhance athletic performance (World AntiDoping Agency, 2003)
• Doping in sport is banned to:
– Promote fair and equitable competition
– Protect the health of athletes
– Preserve the integrity of sport
• World Anti-Doping Agency (WADA)
– Created in 1999 to coordinate & monitor doping in
sport internationally
World Anti-Doping Agency
• WADA Code
– http://www.wada-ama.org/en/World-Anti-DopingProgram/Sports-and-Anti-Doping-Organizations/TheCode/
– Goal of the WADA Code:
• All athletes benefit from the same anti-doping procedures and
protections, no matter the sport, the nationality, or the country
where tested, so that athletes may participate in competition
that is safe and fair.
– The code specifies strict liability, meaning that an
athlete is responsible regardless of whether a violation
was committed unknowingly or intentionally
Prohibited Substances
• Prohibited list:
– Substances or methods that enhance (or have the
potential to enhance) sport performance, that are
harmful (or potentially harmful) to athletes, or that are
unethical are included in the WADA prohibited list
– List is revised each year
– Available in multiple languages
– Current WADA prohibited list: http://www.wadaama.org/en/Science-Medicine/Prohibited-List/
WADA Prohibited List
• Prohibited list:
– Prohibited at ALL TIMES
• E.g. anabolic androgenic steroids, growth hormone (GH),
insulin-like growth factor-1 (IFG-1), diuretics and other
masking agents, etc.
– Prohibited IN-COMPETITION
• E.g. stimulants, narcotics, cannabinoids, glucocorticosteroids
– Prohibited in PARTICULAR SPORTS
• E.g. Alcohol (archery, automobile, karate, powerboating, etc.),
beta-blockers (archery, darts, shooting, skiing/snowboarding,
golf, etc.)
Prohibited Methods
• Prohibited methods list:
– Methods used to avoid detection of drug
use are also banned by WADA
– Tampering (or attempting to tamper with) samples or
any part of doping control is strictly prohibited
– Blood boosting: practice of infusing extra red blood
cells into the body in an attempt to increase oxygen
carrying capacity
– Gene doping: non-therapeutic use or manipulation of
cells, genes, or gene expression specifically for the
enhancement of athletic performance
Prevalence of Use
Prevalence of Use
• Steroid use:
– Majority of available info re: prevalence is on anabolic
steroid use
– 4% of American high school students have taken
steroids illegally at some point (Center for Disease
Control, 2006)
– Males > females
– High school: highest use of steroids in football players,
wrestlers, and track & field male athletes
– Steroid abusers are more likely to use cocaine,
alcohol, and other drugs vs. non-users of steroids
Prevalence of Use
• Other ergogenic supplements:
– Use of ergogenic supplements is widespread in both
young and adult athletes
– 22-62% of high school athletes are using at least one
supplement (Scofield & Unruh, 2006), and this figure is
even higher in adults, collegiate athletes, and elite
athletes
– Multivitamin & mineral supplements are
most popular supplement used among
both athletes & non-athletes
Prevalence of Use
• Other ergogenic supplements:
– Elite athletes & athletes in sports that emphasize
muscle size (e.g. football, weightlifting, bodybuilding)
report the greatest supplement use (Erdman et al, 2006)
Evaluating
Ergogenic Substances
Evaluating Ergogenic Substances
• Evaluating the literature
– Athletes care little, if at all, about the science or
plausibility of a particular product
– An athlete’s primary concern is whether the product
enhances performance or achieves the desired result
or not
– Sports nutrition professionals need to offer reliable,
accurate information about the substances that are
available on the market
Evaluating Ergogenic Substances
• Role of the Sports Dietitian
1. Ax athletes’ level of knowledge &
belief about the product.
2. Do not demand that athletes stop
using all ergogenic substances.
3. Accept practices that are not
harmful or illegal – recommend
changes gradually.
4. Ax roll that the substance plays in
athletes’ overall diets; determine if
you need to address their dietary practices.
Evaluating Ergogenic Substances
• Role of the Sports Dietitian
5. Focus on enhancing practices that
are critical to performance.
6. Commend athletes for practicing
sound nutrition principles.
7. Address questionable supplementing practices only after you
have established trust and rapport
with athletes.
Critically Appraising the Evidence
• Randomization
– The best trials that produce the most reliable and valid
information about the efficacy of a given treatment are
randomized
– Participants are randomly selected to different
treatment groups
• Blinding
– Refers to hiding the assignment of groups/interventions
– Open-labeled, single-blinded, double-blinded, tripleblinded
Critically Appraising the Evidence
• Demographics
– It is important that each group participating in the
research study have similar characteristics
(demographics) to each other at the beginning of the
trial (randomization helps with this)
– Researchers should have identified key characteristics
of the subjects that they think may influence the
outcome of the trial (e.g. age, gender, severity of the
disease, etc.)
Critically Appraising the Evidence
• Similarity of Experience
– Important part of a clinical trial is that both groups (the
treatment group that receives the intervention) and the
control group need to be treated a similarly as possible
• Drop-Outs
– Researchers need to explain what happened to every
person who enrolled in the trial
– Reporting should always include an accounting of any
participant who does not complete a trial, particularly
including reasons for dropping out (to help calculate
how effective the treatment really is)
Critically Appraising the Evidence
• Intention-to-Treat Analysis
– Best kind of analysis takes into consideration what
happened to every participant in the trial
– Provides the most conservative estimate of the
treatment effect and takes into account that people stop
participating in trials or end treatments for all kinds of
reasons in real life
– ITT analysis ensures the results are not biased towards
the people who completed that trial (who might be
different from the general population)
Critically Appraising the Evidence
• Effect Size
– It is important to assess not only whether there is a
statistically significant difference between the groups,
but also how big that effect is
– Look at the minimal clinically important difference
• E.g. One group might have done 50% better than another
group, but if that is 50% of a 2 mm Hg decrease in BP
measure, then the effect size (1 mm Hg) is too small to be
clinically significant
– Beware of studies that report results only in
percentages!
Critically Appraising the Evidence
• Questions to ask about a research report
– Was the research done by a credible institution? A
qualified researcher?
– Is this a preliminary study? Have other studies reached
the same conclusions?
– Was the study done with animals or humans?
– Was the research population large enough? Was the
study long enough?
– Were methods to standardize dietary intake employed
before performance testing?
– Who funded the study?
Critically Appraising the Evidence
• Questions to ask about a research report
– Does the report avoid absolutes, such as “proves” or
“causes”?
– Does the report reflect appropriate context: e.g. how the
research fits into a broader picture of scientific evidence
and consumer lifestyles?
– Do the results apply to a certain group of people? Do they
apply to someone your age, gender, and health
conditions?
– What do follow-up reports from qualified nutrition experts
say?
– Did the researchers control for subjects’ diets
before/during the trial?
Additional Study Design Considerations
• Research considerations with athletic
populations and use of dietary supplements
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–
–
–
–
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Were the subjects trained or untrained
Were there at least 10 athletes in the study
Were there male and female subjects
What were the ages of the subjects
Were the subjects’ diets assessed and controlled
Was the sport supplement dose realistic and
comparable to typical intakes
– Was the supplement taken for a long enough duration
Additional Study Design Considerations
• Research considerations with athletic
populations and use of dietary supplements
– Was the quality of the supplement assessed (i.e.
bioavailability)
– Was there a placebo control used
– Were the performance outcome measures reliable and
valid
– Were the outcome measures/tests performed in the
“field” or in a “lab” setting
Common Ergogenic
Substances
Sports Drinks
Sports Drinks
• Claims & purported benefits
– Provides portable, quick, convenient source of fluids,
CHO, and electrolytes
– Delays fatigue by maintaining stable BG levels
– Stimulates the drive to drink with superior hydration
and rehydration compared to plain water
Sports Drinks
• Proven effectiveness of sports drinks
– Scientific literature supports the use of properly
formulated sports drinks to effectively enhance physical
performance when used appropriately
• Before exercise to assume optimum hydration and
euglycemia leading into physical activity
• During exercise to prevent dehydration, hypoglycemia,
and hyponatremia (low serum Na), which may lead to
fatigue and risk for injury (esp. in events >60 minutes)
• After exercise to help restore muscle glycogen, rehydrate,
and replenish electrolytes lost in sweat
• Beneficial in any heat-stress situation (e.g. high
temperature and/or humidity)
Optimal Composition of Sports Drinks
• For optimal gastric emptying and absorption,
sports drinks should contain:
– 4-8% CHO
– Contain a mixture of simple sugars (e.g. glucose,
sucrose, fructose, maltodextrin)
– Common electrolytes lost in sweat (e.g. Na, K, Cl)
– Water
• Little evidence to support the addition of:
– Vitamins, minerals, antioxidants, amino acids, herbal
supplements, or carbonation in sports drinks
Sports Drinks
• Legality
– Most standard, properly formulated sports drinks (48% CHO) are legal
– Athletes should check labels and exercise caution
when considering use of sports drinks containing
herbal supplements, protein, amino acids, caffeine, or
banned ingredients (e.g. ephedra) by WADA
Protein & Amino Acid
Supplements
Protein & Amino Acid Supplements
• Claims & purported benefits
– Increases and maintains muscle mass/lean body mass
(LBM)
– Increases strength and power
– Enhances exercise recovery
– Reduces body fat
Protein & Amino Acid Supplements
• Proven effectiveness of PRO & AA supplements
– Protein and/or AA supplementation for building muscle
have not been proven to be any more or less effective
than dietary protein, provided that sufficient food energy
is consumed
– There is little evidence that the use of commercial
protein supplements combined with resistance training
significantly increases LBM vs. a placebo  Further
research is warranted
– Studies report that an increase in protein will maintain
nitrogen balance during an exercise-induced energy
deficit
Protein & Amino Acid Supplements
• Proven effectiveness of PRO & AA supplements
– In the absence of CHO availability, BCAAs (leucine,
isoleucine, valine) are the preferred amino acids used as
fuel during high intensity exercise, however, there is little
evidence these supplements improve endurance
performance
– Whey protein has been found to be faster absorbed with
increased rates of muscle protein synthesis when at rest
and after resistance exercise in comparison to soy and
casein proteins
Protein & Amino Acid Supplements
• Other interesting findings
– Athletes need more protein than the RDA of 0.8 g/kg,
and in general, require between 1.2-1.7 g/kg (American
College of Sports Medicine, American Dietetic Association, and
Dietitians of Canada, 2009)
• Strength athletes: 1.6-1.7 g/kg BW/d
• Endurance athletes: 1.2-1.4 g/kg BW/d
• Vegetarian athletes: 1.3-1.8 g/kg BW/d
• Growing adolescent athletes: ~1.5 g/kg BW/d
• Ultra endurance athletes: 1.5-1.7 g/kw BW/d
– The maximum effective single dose of protein to build
muscle is ~35 g of high quality protein (milk, eggs, fish,
meat) at one time (Wolfe, 2009)
Protein & Amino Acid Supplements
• Legality
– Protein & AA supplements are legal, except for the
potential risk of undeclared ingredients prohibited by
WADA
Iron
Iron
• Claims and purported benefits
– Increases oxygen transport to cells (increases aerobic
capacity)
– Improves energy and work capacity
– Improves recovery and decreases fatigue
– Increases power and endurance in sports dependent
on the aerobic energy system
– Reduces lactic acid concentration and reduces muscle
fatigue
– Improves mental status and motivation for training
– Improves psychomotor development, intellectual
performance, and immune function
Iron
• Proven effectiveness of Fe
– Fe deficiency anemia impairs aerobic capacity,
endurance capacity, and exercise performance
– Fe supplementation increases athletic performance in
those with established iron deficiency anemia
– Growing evidence suggests that Fe supplements may
improve physical performance in Fe-deficient athletes
without anemia (esp. at high altitudes >2000m)
– Note: prophylactic (preventative) Fe supplementation
for athletes with normal Fe stores could have negative
effects on health and performance, since excess Fe
can act as a pro-oxidant
Iron
• Other interesting findings
– Athletes engaged in regular intense physical activity
have Fe requirements 30-70% higher than those who
exercise at low intensity or who are sedentary
– This increased need for Fe is attributed to the
combined effects of expanded blood volume and
shorter life span of RBCs due to the stress of intense
training & competition
Iron
• Athletes at higher risk for low iron status
– Endurance runners, pre-menopausal women,
vegetarians, adolescents in a growth spurt, and
individuals who restrict energy intake and/or avoid red
meat or animal protein (esp. in body conscious sports)
– It has been reported that as many as 26-60% of
female athletes are affected by Fe deficiency (Cowell
et al, 2003)
Iron
• Legality
– Fe supplements are legal and ethical
– However, as of 2010 WADA’s Prohibited List of
Substances & Methods does not allow blood injection
of supplements, such as Fe, unless performed
therapeutically in a hospital setting (WADA, 2010)
Creatine
Creatine
• Claims & purported benefits
– Increases LBM
– Speeds rate of recovery from short-term, high intensity
exercise
– Stimulates muscle strength and power
– Buffers lactic acid production
– Aids in thermoregulation
Creatine
• Proven effectiveness of creatine (Cr)
– Cr is an effective ergogenic aid
– Majority of research supports the efficacy of Cr
supplementation with short-term, high intensity anaerobic
exercise or sports specific to strength & power
– Cr supplementation has not been reported to be effective
for endurance/aerobic sports, where an increase in
weight could be detrimental to performance
– Vegetarian athletes and those who consume only small
amounts of animal proteins are reported to have lower
baseline Cr stores, and are more likely to respond
positively to Cr supplementation
Creatine
• Effective dose
– Most research on Cr supplementation is based on a
typical loading dose (20-25 g Cr divided into 4 to 5
doses) for 5-7 days, followed by 2-3 months with a
maintenance dose of 2-5 g/day
– Many athletes also take supplemental Cr in small
doses (3-5 g/day) over a lengthier duration, which
have been shown to be equally effective (Dunford &
Doyle, 2008)
Creatine
• Natural (endogenous) creatine
– Cr is synthesized endogenously (by the liver, kidneys,
pancreas, brain, and testes) from 3 AA: glycine,
arginine, and methionine
– Most (95%) of the body’s Cr is found in skeletal
muscle as phosphocreatine (PCr) and acts as a rapid
source of energy during intense exercise
– It takes about 2 g of Cr daily to maintain normal
muscle creatine levels
– The body produces ~1 g/day of Cr and another 1-2
g/day come from the daily diet (beef, pork, poultry,
cold water fish)
– Daily urinary losses of Cr are ~2 g/day
Creatine
• Legality
– Cr is a legal sports supplement and is not prohibited
by WADA
– Athletes should exercise caution when using Cr due to
the possibility of contamination and/or the presence of
undeclared illegal ingredients that may lead to positive
doping outcomes
Caffeine
Caffeine
• Claims & purported benefits
– Stimulates the central nervous system and skeletal
muscle contractions
– Improves aerobic/endurance exercise
– Improves anaerobic exercise
– Delays fatigue and decreases perception of effort
– Enhances fat loss
Caffeine
• Proven effectiveness of caffeine
– The consensus among research investigators is that
caffeine may enhance performance by facilitating work
capacity (endurance) and/or increasing power output (i.e.
short bursts of high intensity exercise)
– Coffee is less effective than pure caffeine as an ergogenic
aid; however, caffeinated beverages that also contain
electrolytes & CHO in concentrations similar to sports
drinks are more effective than caffeine alone as an
ergogenic aid
– There is no evidence that caffeine alone significantly affects
fat/weight loss (caffeine does increase the effects of
ephedrine, which is often found in weight loss supplements)
Caffeine
• Effective dose
– Caffeine appears to be an effective ergogenic aid for
endurance athletes when taken before and/or during
exercise in moderate quantities of 3-6 mg/kg BW
• E.g. 143 lb (65 kg) athlete = 195-390 mg caffeine
– Negative side effects include: anxiety, jitteriness, rapid
heartbeat, insomnia, irritability, inability to focus, GI
distress (caffeine has a laxative effect), elevated BP,
and severe headaches from sudden withdrawal 
exceeding 6 mg/kg BW is more likely to bring on
adverse reactions and may directly impair athletic
performance
Caffeine
• Legality
– Since 2004 caffeine was made legal by WADA and is
currently no longer prohibited, but continues to be on
their Monitoring Program
– Athletes may use caffeinated beverages without being
disqualified, as long as they do not exceed the legal
limit allowed in urine
– A positive doping test usually sets urinary caffeine at
15 mcg/mL
• It takes approx. 100 mg of caffeine to produce a urine profile
of 1.5 mcg/mL
• 4 cups of Starbucks coffee (4 cups x 250 mg caffeine/cup =
1000 mg caffeine) would reach the legal limit
Androgenic Prohormones
Androgenic Prohormones
• Claims & purported benefits
–
–
–
–
Increases endrogenous testosterone levels
Promotes gains in LBM, strength, and power
Speeds exercise recovery time
Enables greater training volume and intensity
Androgenic Prohormones
• Proven effectiveness of andro-prohormones
– Androgenic prohormones appear to be effective to increase
serum androgens (e.g. testosterone) and estrogens in
males when consumed orally in doses more than 300
mg/day; females may respond to as little as 50 mg/day
– Anabolic steroids may increase muscle size/strength by:
1.
2.
3.
4.
Increasing protein synthesis through increased androgen receptor
expression
Decreasing protein breakdown through competition with catabolic
hormones such as cortisol & other glucocorticoids for androgen
binding sites
Increasing the number of muscle fibres
Having psychological effects (e.g. increased aggression), which
may allow the athlete to train harder & longer
Androgenic Prohormones
• Adverse health effects
– Side effects associated with andro-prohormones are
substantial and include:
• Gynecomastia (breast enlargement in males), prostate CA,
testicular CA, pancreatic CA, decreased HDL-C, negative
psychological effects (e.g. “roid rage”), premature closure of
the epiphyseal “growth” plates in children/adolescents,
increased acne, reproductive dysfunction & virilization in
females (also deepening of the voice, increased facial & body
hair)
• Many of these side effects are irreversible and harmful
– Prohormone use is especially harmful to children,
adolescents, pregnant women, and those known or
suspected to have prostate or breast CA
Androgenic Prohormones
• Legality
– Use of prohormone supplements and steroids is
strictly prohibited by WADA, the International Olympic
Committee, the National Hockey League, the National
Football League, and many other national sport
leagues (e.g. NBA, NCAA, CFL)
– It is illegal to sell or prescribe androstenedione, DHEA,
DHEAS, or steroids unless warranted therapeutically
– Prohormones & AAS are banned by WADA and are
NOT RECOMMENDED for any situation due to
adverse health effects
Ethical Issues
Ethical Issues
• Winning at any cost
– Is it acceptable for athletes to use any
means available, including ergogenic
substances, in order to gain a
competitive edge?
• Famous Sports Illustrated survey w/ athletes:
– Would you use a banned substance if it was
undetectable and you were guaranteed to win?
 98% said YES
– Would you take the same substance if it allowed you
to win for 5 years, even if taking it would result in
death?  over 50% still said YES
Ethical Issues
• Winning at any cost
– Many athletes consider ergogenic drugs an essential
component of successful competition
– If many record-setting athletes are using them, other
athletes must also use them just to keep up and
complete “fairly” with others
Final Exam Update
• Date/Time: Mon. June 23, 2015 @ 1-4pm
• Worth: 35%
• Will be cumulative (greater emphasis on
lectures taught after the midterm)
• Format: multiple choice & some true/false
• Make sure you review your lecture notes, the in
class case studies and activities, and textbook
chapters to help you understand the material