1	Steroids and Performance Enhancement Supplements Ellen Coleman, RD, MA, MPH The Sport Clinic
2	Anabolic Steroids Derivatives of male hormone testosterone Used to increase muscle size and strength Monitoring the Future Study found that lifetime steroid use: Reached new high of 3.7% among 12^th graders in 2001 Doubled since 1993 in 10^th graders Higher than use of PCP (angel dust)
3	Steroids: Side Effects Increased acne “Roid rage” – uncontrolled aggressive behavior Liver problems Unfavorable changes in blood fats: Increased LDL (bad) cholesterol Decreased HDL (good cholesterol) Blood clotting disorders
4	Steroids: Side Effects Men: Shrinkage of testicles – grapes to raisins Breast growth (gynecomastia) Balding Women: Growth of facial and body hair Deepening of the voice Enlarged genitalia
5	Steroids: Other Concerns Steroid users may share needles – increases risk of HIV and AIDS DEA Schedule III controlled substance: most steroids obtained via black market Mexico is primary source in southern CA Most black market steroids are counterfeit: no guarantee of purity or potency Injecting counterfeit steroids is about as sanitary as eating and drinking human waste
6	Steroids: Side Effects During use: Mania Homicidal thoughts and behaviors Grandiose or paranoid delusions During withdrawal: Depression Suicidal thoughts and behaviors Addiction
7	Ephedrine Central nervous system stimulant and decongestant Structurally similar to amphetamines: increases heart rate and blood pressure Claims: promotes body fat loss; improves aerobic and anerobic performance Ma Huang, Ephedra Sinica, Sida Cordifolia contain ephedrine
8	Ephedrine – FDA RAND study: evidence for ephedrine increasing performance insufficient RAND study: ephedrine promoted short-term weight loss – 1 lb per month over placebo FDA prohibited ephedrine-containing supplements in February 2004 due to unreasonable risk of illness and injury
9	Ephedrine Side effects: GI distress, dizziness, headache, irregular pulse, heart attack, stroke, seizure, psychosis and death Variable potency, poor quality control, banned substance
10	Caffeine Stimulant: increases epinephrine levels Does not promote body fat loss; mild thermic effect at best 5 to 6 mg caffeine/kg may improve short-term intense and prolonged aerobic exercise Guarana, Kola nut, Mate, Red Bull, No-Doze, Vivarin contain caffeine
11	Caffeine Side effects: diuresis, nausea, muscle tremor, palpitations and headache Caffeine increases effects of ephedrine Does not increase risk of dehydration
12	Citrus Aurantium Citrus Aurantium (bitter orange) contains synephrine Synephrine is a stimulant similar to caffeine and ephedrine Doesn’t appear to have same negative stimulant effects as ephedrine Modest thermogenic effect Further research required on safety, efficacy
13	Green Tea Extract Mild thermogenic effect: high content of catechin-polyphenols (EGCG) + caffeine Catechin-polyphenols norepinephrine levels (↓ norepinephrine breakdown) Green tea extract (90 mg EGCG; 50 mg caffeine) energy expenditure by 4% and fat use compared to caffeine + placebo
14	Conjugated Linoleic Acids (CLA) Isomers of linoleic acid (essential fatty acid) Claims: reduce fat deposition, increase lipolysis, enhance fatty acid oxidation 64 days of 3 g CLA/day: no effect on body composition or energy expenditure Further research warranted
15	Arginine for “Nitric Oxide” Nitric oxide synthase enzyme catalyzes oxidation of arginine to produce nitric oxide and subsequent vasodilation Theory: nitric oxide increases blood flow, oxygen transport, delivery of nutrients to muscle Claims: “Nitric oxide” supplements increase muscle size and strength
16	Arginine for “Nitric Oxide” No evidence that nitric oxide promotes greater muscle protein synthesis or improves muscle strength No proof that arginine influences nitric oxide levels in muscles Arginine may benefit patients with angina, claudication, heart failure
17	Creatine Increases Cr and CP content in muscles May improve high-power performance <30 seconds and delay onset of fatigue Increases body mass by ~ 3 to 7 lbs Loading: 20-25 g/day for 5 to 7 days; 5 g/day for one month Maintenance: 2-5 g/day
18	Creatine Side effects: weight gain Athletes using creatine must drink adequate fluids Lack of long-term safety data
19	Creatine May alter balance and agility Supplements with creatine or protein may also contain banned substances
20	Protein Requirements: Strength athletes: 1.6 – 1.7 g/kg/day Endurance athletes: 1.2 – 1.4 g/kg/day
21	Protein To gain 1 lb of muscle: 3,500 calories 100 g protein To gain 1 lb in a week 500 extra calories per day 14 extra g protein per day
22	Protein Excess protein (over 2 g/kg/day) not incorporated into muscle – increases amino acid oxidation Adequate calorie intake = ample protein intake Protein supplements are convenient but not superior to dietary protein
23	Timing of Protein Intake Fueling is critical before and after strength training Protein provides amino acids for muscle protein synthesis Carbohydrate increases amino acid uptake and restores muscle glycogen
24	Glutamine Major fuel for cells of immune system + gut Conditionally essential during periods of metabolic stress and critical illness Claims: reduces muscle catabolism and promotes tissue repair (increases muscle cell volume), reduces infections
25	Glutamine Benefits for preventing illness not well-established Adequate calorie and carbohydrate intake maintain normal glutamine status, boost immunity, stimulate muscle synthesis 0.5 g/lb for 6 weeks: no effect on body composition, catabolism, or performance
26	Whey Protein Claims: increases muscle mass better than other proteins, enhances immunity (20% of protein in milk) 20 g whey/day increased peak power, work capacity, glutathione compared to casein May enhance performance by reducing oxidative stress and subsequent muscular fatigue; further research warranted
27	“After testing positive for nandrolone, Fritz Aanes suffers two heartbreaks..” Lost the bronze medal Banned for two years from competition Protested drug test Denied taking steroids Lab confirmed dietary supplement contained nandrolone – not listed on label
28	Choosing a Supplement Products that have USP (United States Pharmacopeia) on the supplement label Products eligible for ConsumerLab seal of approval – www.consumerlab.com Nationally known food and drug companies with tight manufacturing controls
29	Choosing a Supplement Supplement label should provide appropriate and accurate information Be wary if statements are unclear or label makes preposterous claims Avoid products with claims that sound too good to be true No dietary supplement can guarantee optimum performance or health
30	FDA – Evaluating Supplement Information on Internet Look for sites run by government, university, or reputable medical/health association Is site’s purpose to educate or sell product? Is site’s information supported by research and cited in PubMed? Think twice about chasing the latest headline: science advances by small steps and slowly building towards consensus http://www.cfsan.fda.gov/~dms/ds-savvy.html
31	Final Thoughts By definition, a supplement is a substance to augment the diet Use proven dietary strategies for athletic performance, weight loss, and health Be aware of potential benefits/risks of dietary supplements and lack of quality control