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Thirty nine elite Australian swimmers (13 AIS, 26 OTHER) completed a standardized questionnaire regarding their supplement use during a pre competition camp. The data were compared with a similar study conducted 11 years earlier (11 AIS, 23 OTHER) and framed around the classification system of the Sport Supplement Program of the Australian Institute of Sport. The prevalence of supplement use remained constant over time (2009: 97%, 1998: 100%). However, the current swimmers used a greater number of dietary supplements (9.2 ± 3.7 and 5.9 ± 2.9; p = .001), accounted for by an increase in the reported use of supplements with a greater evidence base (Sports Foods, Ergogenics, and Group B supplements). In contrast, fewer supplements considered less reputable (Group C and D) were reported by the 2009 cohort (0.7 ± 1.0 and 1.6 ± 1.3; p = .003). AIS swimmers reported a greater use of Ergogenics (4.3 ± 1.8 and 3.1 ± 1.7; p = .002), and less use of Group C and D supplements overall (0.8 ± 1.2 and 1.3 ± 1.2; p = .012), which was explained primarily by a smaller number of these supplements reported by the 2009 group (1998 AIS: 1.5 ± 1.4, 2009 AIS: 0.2 ± 0.6; p = .004). Although the prevalence of supplement use has not changed over time, there has been a significant increase in the number and type of products they are using. The potential that these changes can be attributed to a Sports Supplement Program merit investigation.

In general, nutritional sports ergogenics are designed to enhance energy production and/or improve body composition, promoting muscle growth and decreasing body fat. Many of the nutritional supplements and pharmacological substances have been used during resistance training without knowledge about the effects on human metabolism caused by their chronic administration. Before the usage or prescription of any ergogenic aid, it is important to consider some questions about that substance: Is it effective? Is it safe? Is it legal and ethical? In this chapter we will discuss the most widely used drugs and supplements among individuals engaged in resistance training—testosterone, growth hormone and insulin growth factor-1, creatine, beta-hydroxy beta-methylbutyrate and caffeine—focusing on their effects on strength and body composition, the safety of their usage, and the mechanisms of action.

O objetivo do estudo foi verificar a prevalência do uso de suplementos alimentares nas academias da cidade de Porto Alegre. Foram entrevistados 316 indivíduos com idade entre 18-59 anos. A abordagem foi por voluntariedade, em 22 academias da cidade. Observou-se um expressivo uso de suplementos nutricionais pelos participantes (28,8%), e os homens utilizam mais suplementos do que as mulheres (p

This study was carried out to evaluate the creatine and maltodextrine dietetic supplementation of eventing horses. The experimental period consisted of 56 days, with 20 horses, which were randomly divided into four groups with different diets. Diets were: diet without supplement (Control); diet supplemented with creatine, 44.4 mg/kg body weight/day (20 g creatine/horse/day); diet supplemented with creatine, 88.8 mg/kg body weight/day (40 g creatine/horse/day); diet supplemented with maltodextrine, 222.2 mg/kg body weight/day (100 g/horse/day), during three days before each test. Every horse was submitted to three tests. Blood samples and heart rate were collected at rest, immediately after the tests and 10 and 20 minutes after the test. Supplementation with creatine (44.4 mg/kg body weight/day) and maltodextrine reduced plasma concentration of lactate in horses during tests. Supplementation of creatine and maltodextrine did not alter serum concentration of aspartate aminotransferase, γ-glutamyltransferase, urea or creatinine, but training affected blood biochemical variables in eventing horses.

Hypoxia elicits hematopoiesis, which ultimately improves oxygen transport to peripheral tissues. In part because of this, altitude training has been used in the conditioning of elite endurance athletes for decades, despite equivocal evidence that such training benefits subsequent sea level performance. Recently, traditional live high-train high athletic conditioning has been implicated in a number of deleterious effects on training intensity, cardiac output, muscle composition, and fluid and metabolite balance--effects that largely offset hematopoietic benefits during sea level performance. Modified live high-train low conditioning regimens appear to capture the beneficial hematopoietic effects of hypoxic training while avoiding many of the deleterious effects of training at altitude. Because of the logistical and financial barriers to living high and training low, various methods to simulate hypoxia have been developed and studied. The data from these studies suggest a threshold requirement for hypoxic exposure to meaningfully augment hematopoiesis, and presumably improve athletic performance.

Nutritional supplements are widely used by patients and athletes around the world for many different reasons. Many companies are thriving on this billion-dollar industry with little proof that these substances do what they are reported or suggested to do. Beta-hydroxy-beta-methylbutyrate (HMB) is a relatively new supplement on the ergogenic landscape. Studies of HMB supplementation have shown minimal gains in strength and lean body mass in specific populations, mainly untrained athletes and patients with wasting syndromes. HMB use in those athletes involved in regular high-intensity exercise has not been proven to be beneficial when multiple variables are evaluated. Unlike other ergogenics, with HMB no adverse events have been reported in association with short-term use. Despite these findings, HMB cannot be recommended as an ergogenic until further studies in larger groups reproduce early data. This review summarizes current literature on HMB, and provides the reader with information to better educate and treat patients and athletes.

The benefits of creatine (CR) supplementation are well documented, particularly during repeated bouts of high-intensity muscular activity. Most published experiments use mass-supported (cycle ergometry) activities as a means of evaluating creatine's efficacy, therefore minimizing any possible adverse effects of increased body mass associated with CR supplementation. This study aims to use both mass-supported and mass-dependent activities to assess the effectiveness of acute CR supplementation on a group of highly trained rugby players. A randomized, double-blind, crossover research design was utilized, with subjects receiving 20 g.d(-1) x 5 d of both CR and a glucose placebo (PL). Subjects were assessed via 10 x 6-second Wingate test and a 10 x 40-m sprint test on separate days, presupplementation and postsupplementation. A 28-d washout period separated the two treatments. No significant treatment (p > 0.05) or treatment by test interaction effects (p > 0.05) were observed for peak or minimum power output (W), peak or minimum running velocity (m.s(-1)), or fatigue index (%). No significant differences (p > 0.05) were found postsupplementation for body mass and percentage body fat. Although statistical significance was not achieved for any of the measured parameters, there were small improvements in performance that may be of benefit to rugby players.

Because of the medium chain triglycerides (MCT) specific physical and chemical properties, they have been used over the last 40 years in enteral and parenteral nutrition. Results from clinical practice lead some researchers in the early 80's to use them for ergogenics purposes. The hypothesis was based on the relationship between the oxidation rates of carbohydrate and fat. The increase in fat oxidation would promote glycogen sparing effect, and therefore, delay the time to exhaustion. The aim of the present paper is to review the effects of MCT supplementation upon endurance exercise performance. Most of the studies failed to prove the ergogenic effect of MCT. A few studies that showed the ergogenic effect of MCT administration used alternative experimental designs, such as high MCT dose (above from the previous established limit) or infusion. The chronic use of MCT by athletes is new and few studies have been done in this matter. These few studies showed controversial results. There is a strong tendency in the literature that MCT is not a viable strategy to increase performance during endurance exercise. The aim of this study is to discuss the effects of MCT use on endurance exercise.

ObjectivesTo help athletic trainers promote a “food-first” philosophy to support health and performance, understand federal and sport governing body rules and regulations regarding dietary supplements and banned substances, and become familiar with reliable resources for evaluating the safety, purity, and efficacy of dietary supplements.BackgroundThe dietary supplement industry is poorly regulated and takes in billions of dollars per year. Uneducated athletes need to gain a better understanding of the safety, eligibility, and efficacy concerns associated with choosing to take dietary supplements. The athletic trainer is a valuable athletic team member who can help in the educational process. In many cases, athletic trainers are asked to help evaluate the legality, safety, and efficacy of dietary supplements. For this position statement, our mission is to provide the athletic trainer with the necessary resources for these tasks.RecommendationsProper nutrition and changes in the athlete's habitual diet should be considered first when improved performance is the goal. Athletes need to understand the level of regulation (or lack thereof) governing the dietary supplement industry at the international, federal, state, and individual sport-participation levels. Athletes should not assume a product is safe simply because it is marketed over the counter. All products athletes are considering using should be evaluated for purity (ie, truth in labeling), safety, and efficacy.

In general, nutritional sports ergogenics are designed to enhance energy production and/or improve body composition, promoting muscle growth and decreasing body fat. Many nutritional supplements and pharmacological substances have been used during resistance training without knowledge of the effects on human metabolism caused by their chronic administration. Before the utilization or prescription of any ergogenic aid, it is important to consider some questions about that substance: Is it effective? Is it safe? Is it legal and ethical? In this chapter we discuss the most widely utilized drugs and supplements among individuals engaged in resistance training—testosterone, creatine, beta-hydroxy beta-methylbutyrate (HMB) and caffeine—focusing on their effects on strength and body composition, the safety of their utilization, and their mechanisms of action.

Nutritional ergogenic aids may be theorized to improve performance in athletics in a variety of ways, primarily by enhancing energy efficiency, energy control or energy production. Athletes have utilized almost every nutrient possible, ranging from amino acids to zinc, as well as numerous purported nutritional substances, such as ginseng, in attempts to enhance physical performance. This review focuses primarily on nutritional ergogenic aids thought to enhance performance by favourably affecting energy metabolism. Although most purported nutritional ergogenic aids have not been shown to enhance physical performance in well-trained, well-nourished athletes, some reliable scientific data support an ergogenic efficacy of several substances, including caffeine, creatine and sodium bicarbonate, but additional research is needed to evaluate their potential for enhancing performance in specific athletics events.

Well known, well detected and still used by athletes, clenbuterol is one of the β 2 -agonists which has no authorization for therapeutic use, contrarily to salbutamol, salmeterol and formoterol in the 2012 World Anti-Doping Agency list. However, clenbuterol is still detected in athletes’ antidoping test samples. Its ability to induce muscle hypertrophy but also its strong lipolytic action and the absence of androgenic effects have made it a prized substances by athletes, specially females, without scruples whose performance requires significant muscle strength. Like the effects of clenbuterol on the heart, the effects of clenbuterol on skeletal muscle are dependent on the doses used and duration of the treatment. If there is a consensus concerning the clenbuterol action on the phenotypic conversion from slow to fast type fibers and on the hypertrophy, there is, to our knowledge, no consensus concerning the effects of clenbuterol on the slow type fibers and slow profile muscles. There is also no consensus concerning the clenbuterol effects on performance. We will shortly reviewing the known operating mode, side and benefits effects of short and long term β-agonists, and specially clenbuterol, treatment on mammals

Endurance athletes often seek nutritional strategies inclusive of dietary supplements to maximize their performance. Effective supplement routines, however, are only beneficial when built on a sound training diet, training regimen, and an appreciation of dietary needs relative to their training schema. While traditional dietary interventions are based on the glycemic index of carbohydrate, coupled with the addition of protein quality and quantity, recent innovations have introduced the potential utility of long chain glucose polymers and dietary nitrates, such as beetroot juice. Consideration is also given to the utility of supplement strategies aimed at attenuating immune responses accompanying training and competition. A key to implementing successful supplementation routines is the appreciation that athletes should be considered on an individual basis and training volume and intensity must be taken into account.

Section I: Introduction Understanding Food and Food-Drug Synergy Wendy E. Ward and Lilian U. Thompson Section II: Cardiovascular Disease Lipid Sources and Plant Sterols: Effect of Food and Food-Drug Synergy on Cardiovascular Disease Risk Krista A. Varady and Peter J.H. Jones Antioxidant Phytochemicals and Potential Synergistic Activities at Reducing Risk of Cardiovascular Disease David D. Kitts Synergy of Portfolio Diet Components and Drugs in Coronary Heart Disease David J.A. Jenkins, Augustine Marchie, Julia M. Wong, Russell de Souza, Azadeh Emam, and Cyril W.C. Kendall The Role of Complementary Vitamins, Folate, Vitamin B6, and Vitamin B12, in Cardiovascular Disease Louise Mennen, Pilar Galan, and Angelika de Bree Food Synergy in Dietary Patterns and Risk for Chronic Diseases Rob M. van Dam Section III: Cancer Soy-Food and Soy-Drug Interactions in Prevention and Treatment of Cancer Jin-Rong Zhou Flaxseed, Lignans, n-3 Fatty Acids, and Drug Synergy in the Prevention and Treatment of Cancer Lilian U. Thompson Whole-Grain Component Synergy and Cancer Joanne Slavin Synergy and Safety of Antioxidants with Cancer Drugs Kedar N. Prasad Probiotics: Synergy with Drugs and Carcinogens in Diet Seppo Salminen, Hani El-Nezami, Eeva Salminen, and Hannu Mykkanen Section IV: Osteoporosis Synergy of Soy, Flaxseed, Calcium, and Hormone Replacement Therapy in Osteoporosis Wendy E. Ward Synergy of Protein, Fats, and Calcium Potential Synergies with Drugs for Osteoporosis Marlena C. Kruger and Raewyn C. Poulsen Section V: Inflammatory Disease, Hypertension, and Obesity Molecular Targets for Antiinflammation and Dietary Component-Drug Synergy Akira Murakami and Hajime Ohigashi Food and Food-Drug Synergies: Role in Hypertension and Renal Disease Protection Manuel T. Velasquez Milk Proteins in Food-Food and Food-Drug Synergy on Feeding Behavior, Energy Balance, and Body Weight Regulation Alfred Aziz and G. Harvey Anderson Section VI: Ergogenics Caffeine, Creatine, and Food-Drug Synergy: Ergogenics and Applications to Human Health Terry E. Graham and Lesley L. Moisey Section VII: Experimental Designs Designing Experiments for Food-Drug Synergy: Health Aspects Lyn M. Steffen Designing Experiments for Food-Drug Synergy: Safety Aspects V.J. Feron, J.P. Groten, R.J.J. Hermus, D. Jonker, I. Meijerman, G.J. Mulder, F. Salmon, and E.D. Schoen Index

Human growth hormone (GH) has a number of accepted medical uses, but has quickly become a popular ergogenic aid among athletes. The issue of performance-enhancing substances such as anabolic steroids and GH has drawn the attention of athletes, their parents, and politicians. On almost a daily basis, headlines about the status of doping in professional, international, and amateur sports seem to be more pervasive. The supraphysiologic effects of GH lead to lipolysis, with increased muscle volume. Due to the ethical limitations of studying the use of high doses of GH in isolation or combined with anabolic steroids, the scientific literature has not produced compelling results on its efficacy. GH has potential as an anti-aging drug and does lead to some improved athletic performance in isolated studies. Despite the lack of compelling data, GH seems to have developed a reputation among athletes for enhancing performance. The detection of illegal doping with GH has been the focus of a concerted international effort by the International Olympic Committee. A number of promising detection techniques may allow the detection of illicit GH use. This review on GH as an ergogenic aid includes a discussion of the basic physiology of GH and its actions, the accepted medical indications for its use, the results of scientific studies that assess whether it improves exercise performance or work capacity, and the scientific techniques under development to detect ergogenics with strong abuse potential.

The effect of creatine and caffeine supplementation on muscle torque generation and relaxation was investigated in healthy male volunteers. Maximal torque (Tmax), contraction time (CT) from 0.25 to 0.75 of Tmax, and relaxation time (RT) from 0.75 to 0.25 of Tmax were measured during an exercise test consisting of 30 intermittent contractions of musculus quadriceps (2 s stimulation, 2 s rest) that were induced by electrical stimulation. According to a double-blind randomized crossover design, subjects ( n = 10) performed the exercise test before (pretest) and after (posttest) creatine supplementation (Cr, 4 × 5 g/day, 4 days), short-term caffeine intake (Caf, 5 mg · kg−1 · day−1, 3 days), creatine supplementation + short-term caffeine intake (Cr+Caf), acute caffeine intake (ACaf, 5 mg/kg) or placebo. Compared with placebo, Cr shortened RT by ∼5% ( P < 0.05). Conversely, Caf increased RT (+∼10%, P < 0.05), in particular as RT increased because of fatigue. RT was not significantly changed by either Cr+Caf or ACaf. Tmax and CT were similar during all experimental conditions. Initial Tmax was ∼20% of voluntary maximal isometric contraction force, which was not different between treatments. It is concluded that Caf intake (3 days) prolongs muscle RT and by this action overrides the shortening of RT due to creatine supplementation.

Vandenberghe, K., M. Goris, P. Van Hecke, M. Van Leemputte, L. Vangerven, and P. Hespel. Long-term creatine intake is beneficial to muscle performance during resistance training. J. Appl. Physiol. 83(6): 2055–2063, 1997.—The effects of oral creatine supplementation on muscle phosphocreatine (PCr) concentration, muscle strength, and body composition were investigated in young female volunteers ( n = 19) during 10 wk of resistance training (3 h/wk). Compared with placebo, 4 days of high-dose creatine intake (20 g/day) increased ( P < 0.05) muscle PCr concentration by 6%. Thereafter, this increase was maintained during 10 wk of training associated with low-dose creatine intake (5 g/day). Compared with placebo, maximal strength of the muscle groups trained, maximal intermittent exercise capacity of the arm flexors, and fat-free mass were increased 20–25, 10–25, and 60% more ( P < 0.05), respectively, during creatine supplementation. Muscle PCr and strength, intermittent exercise capacity, and fat-free mass subsequently remained at a higher level in the creatine group than in the placebo group during 10 wk of detraining while low-dose creatine was continued. Finally, on cessation of creatine intake, muscle PCr in the creatine group returned to normal within 4 wk. It is concluded that long-term creatine supplementation enhances the progress of muscle strength during resistance training in sedentary females.

Athletes are always trying to get an edge on competitors, whether it is a training technique, drug or nutritional substance. World Anti-Doping Agency and other drug testing agencies ban many drugs and ergogenic aids, whether these substances have efficacy or not. However, athletes often overlook some of the more benign substances because they appear to have no effect. This presentation will look at regular milk and chocolate milk as nutritional ergogenics that have proven to maximise the anabolic effect of resistance exercise (regular milk) and also to shorten recovery time following high intensity exercise (chocolate milk). In addition, two legal ergogenics, creatine and β-hydroxy-methylbutyrate will be discussed as potential anabolic agents that may also prove efficacious.

Genetic endowment and proper training are the major factors contributing to athletic success in endurance and ultraendurance events. Proper nutrition, primarily adequate carbohydrate and fluid, prior to and during the event is also critical. Endurance athletes often utilize other nutritional substances or practices, often referred to as ergogenics, in attempts to obtain a competitive edge by enhancing energy utilization and delaying the onset of fatigue. Numerous nutritional ergogenics have been used in attempts to enhance endurance performance, but with several exceptions most have been shown to be ineffective, including bee pollen, L-carnitine, CoQ10, inosine, amino acids, alkaline salts, and vitamin E at sea level. Research findings are equivocal relative to the ergogenicity of caffeine, phosphate salts, and vitamin E at altitude. Loss of excess body fat, a nutritional practice, may be an effective ergogenic. Conversely, some agents such as alcohol may impair performance, an ergolytic effect. Additional research is necessary to support the efficacy of several nutritional ergogenics to enhance prolonged endurance performance, such as caffeine, phosphates, specific amino acids, and various commercial products. Such research should involve exercise tasks comparable in intensity and duration to that experienced in the marathon and similar endurance events.

Sports success is dependent primarily on genetic endowment in athletes with morphologic, psychologic, physiologic and metabolic traits specific to performance characteristics vital to their sport. Such genetically-endowed athletes must also receive optimal training to increase physical power, enhance mental strength, and provide a mechanical advantage. However, athletes often attempt to go beyond training and use substances and techniques, often referred to as ergogenics, in attempts to gain a competitive advantage. Pharmacological agents, such as anabolic steroids and amphetamines, have been used in the past, but such practices by athletes have led to the establishment of anti-doping legislation and effective testing protocols to help deter their use. Thus, many athletes have turned to various dietary strategies, including the use of various dietary supplements (sports supplements), which they presume to be effective, safe and legal.