WHAT DO WE KNOW ABOUT NUTRITIONAL SUPPLEMENTS?

Dr Mike IraniChairman IWF Medical Committee

and TUE Committee(IWF Drug Hearing Panel)

EWF Coaching & Scientific Seminar, Dublin, 7/8 Oct 2016

Distinction between:

Supplement v Substitute

In addition to. To replace.

Health v Improving Performance

Subtle difference:

Health improves performance,

BUT improving performance may not improve health

Literature Review

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Doping

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Literature Review

Nutrition

DopingNumber

For Example:

•Collagen hydrolysate: Joint pain in athletes

(Clark et al, May 2008)

•Milk-based protein + CHO: Isokinetic muscle performance

CK & myoglobin

(Cockburn et al, Aug 2008)

Anti-oxidants:

Vit E & Vit C:

Multinutrients; recovery, injury time

Atalay et al, June 2006)

[Lactate] blood;

V02 max

Aguila et al, Sept 2007)

No effect(Yfanti et al, July 2010)

More.......•HC03 Loading: “Small (worthwhile) benefits” – Acute doses

: ? Use

(Burke, March 2007)

•BCAA: Exercise induced muscle damage

Muscle – protein synthesis

Immune regulation

(Negro et al, Sept 2008)

•Beta-hydroxy-beta-methybutyrate (HMB):Minimal strength, lean body mass (untrained athletes &

patients). “Cannot be recommended”.

(Palisin, Aug 2005)

.... and of course: CREATINE!

•Most effective for short bouts of high-intensity physical activity

•No effect on force production

•Little evidence for isometric force production

•Little benefit for prevention of muscle damage or post-exercise soreness

•However performance in jumping, sprinting or cycling

•No adverse effects in short term use

(Bemben. 2005)

Carnosine

•Found in twitch fibres

•Made from L-histidine and beta-alanine*

•Evidence based improvement in performance

•Potential side effects?

(Derave et al, March 2010)

....not quite!

•No benefit to multiple sprint performance (Glaister, May 2006)

• Endurance

(Reardon et al, Oct 2006)

... Odd one: Quercetin• Muscle oxidative capacity & endurance in mice

•No effect in man

(Cureton, et al, Oct 2009)

Cocktails?

•Caffeine + creatine + HCO3: multiple-sprint performance

•Beta-alanine, colostrum: “Weak evidence”

•BCAA, HMB, ribose: No evidence (Kristiansen et al, April 2005)

Points to Note

Training v Competition• Isolated performance (e.g. single sprint) v team-sport (e.g.

football)

• Long term effectiveness

•Adverse effects: short + long-term

•Combination/ high doses of substances

(Bishop, Dec 2010)

• Legality of substance

(Irani, May 2012)

Adverse Effects•Overall few for intermittent, single use

•Anti-oxidants (Vit C/E) may affect inter-cellular signalling - muscle performance

•Vit E: all-cause mortality

•Creatine: renal stones + creatinine

(McGinley et al, 2009)

Glutamine

Useless in healthy humans

Glucosamine

May reduce post-exercise joint pain

Zinc• Free radical production

•?Effect on performance (Kara et al, Apr 2010)

Magnesium

• Free + total testosterone levels, especially in those who exercise(Cinar et al, Apr 2011)

• Maybe low in athletes’ diet(Czajan et al, 2011)

Iron

• Not justified (Rodenberg, July 2007)

Ginseng• Cannot be recommended (Palisin, June 2006)

•Carnitine

•No effect on exercise performance

Spriet et al, 2008)

•Arginine

•No influence

(Abel et al, June 2005)

L-Tryptophan

• Modified perception of fatigue (aerobic work)

(Javierre, May 2010)

Protein & Amino Acid Supplements

•“The use of these supplements for healthy, non-competitive adults engaged in recreational sport is

usually not warranted”

(Nemet, Wolach, Eliakim. Isr Med Assoc J, May 2005)

So what have we learnt?

• CHO + caffeine – helpful

• Protein only helps if CHO is low

• Iron if anaemic

• L-Tryptophan may reduce fatigue sensation

• ?Creatine (but large amounts)

• No evidence that other interventions help – especially for weightlifting

REMEMBER!

“The most important message is to use a nutritional

supplement only if it is deemed of benefit (and safe)

by a nutritional expert” (de Hon et al, Nov 2007)

Also REMEMBER“It is essential that an evidence-based

approach to the prescribing of medication and nutritional

supplements is adopted to protect the athletes’ health and prevent

them from testing positive in doping controls” (Tscholl,

Dvorak, Am J Sp Med, Jan 2010)

THE NEW ERA OF DOPING:WHAT & WHY?

Professor Mike Irani

Dublin, 7/8 OCTOBER 2012

How may we reduce positive doping tests?

•Education – who teaches?

•Penalty – does it work?

EDUCATION

•When is the best time?

•Who is the best teacher?

BEST TIME•Age 11-17y

•Males > females

•Cohorts, not necessarily “teams”

•Positive relationship between supplements and anabolic steroid consumption

•Injury

•Threat to sponsorship

BEST TEACHERWho do they ask?

•Strength coach: 37% M; 20%F

•But overall: 71% Athletic trainers

60% Coaches

41% Physicians

•Also media: 79% Internet

68% Magazines

52% TV

In Practice (Athens OG 2004)

Doping Control Form; TUE application:

•24.3% Declared use of medications or food supplements

•45.3% Food Supplements; 43.2% Vitamins; 13.9% Protein/amino acids

•Especially power sports

•NSAIDs 11.1%; Analgesics 3.7%

CANADIAN COMPETITORS USE OF SUPPLEMENTS & MEDICATION IN ATLANTA (1996) V SYDNEY (2000)

Atlanta % Sydney %(257/271) (300/304)

Dietary Supps 69 74

Vitamins 59(M) 65(M)66(F) 58(F)

(Boxing 91) (Swimming 76)

Minerals 16(M) 30(M)45(F) 21(F)

(Cyclists, iron 73)

Atlanta% Sydney%Nutritional 35(M) 43(M)

Supps 43(F) 51(F)

(cycling 100) (Creatine, amino acids)

Medication 61 54

(NSAID) (NSAID)

(Soft Ball 60) (Gymnasts 100)

(Huang et al, Jan 2006)

THANK YOU