Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ INTRODUCTION

Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ INTRODUCTION The use of dietary supplements and related products among athletes is high. Recent research indicates that the use of supplements in the United States ranges from 31% in high school football players to 57% in Division I university athletes and as high as 79% and 65% over the course of the college athletic career for males and females, respectively. The most commonly reported dietary supplements consumed by varsity athletes include multi-vitamins and minerals, creatine, vitamin C, B-complex vitamins, calcium, antioxidants, iron, vitamin E, zinc, chromium picolinate, vitamin B12, vitamin A, beta-carotene or carotenoids, vitamin B6, potassium. The most common reasons athletes give for taking dietary supplements are to improve athletic performance, build muscle, feel better, increase energy level, prevent disease, correct diet, increase endurance, and correct illness. They get most of their recommendations from a family member, friend, teammate, coach, trainer, nutritionist, dietitian, physician, or pharmacist. The most common reasons for not taking dietary supplements include personal or religious beliefs, adequate diet, and cost (too expensive). The idea of supplement use in swimming continues to be debated. Issues, such as health effects, ethics, contamination, research and regulation often enter the picture. Many questions remained unanswered, and the more we search for answers, the more questions we find. As coaches, we are faced with the challenge of balancing performance in the water with performance out of the water. We want our athletes to swim to their potential. We want them to succeed. The topic of dietary supplements is not the only one that stirs controversy in our sport, but it has taken quite a prominent place in our landscape. As leaders, we must be prepared to take a stand and to offer our athletes the guidance they need in order to make good decisions in swimming and in life. In 2002, USA Swimming enhanced its Sports Medicine and Science Network to include a series of Task Forces. Formed within the framework of the Sports Medicine and Science Network itself, task forces on Injury Prevention, Disordered Eating, Diabetes, Dietary Supplements, and Exercise & Illness were formed to increase awareness and facilitate the dissemination of the most up-to-date information on issues that directly impact our swimmers and coaches. USA Swimming’s Network Task Force on Dietary Supplements is comprised of medical and science professionals, athletes, coaches and government representatives who have expertise and a passionate interest in the topic as it pertains to swimming. The goal of this group is to discuss Dietary Supplements from a regulation and labeling perspective and the role of supplements in competitive swimming. Developing educational materials to better equip our athletes and coaches to manage the issues is a primary focus. Chaired by Dr Strib Ellison, USA Swimming's Network Task Force on Dietary Supplements met on April 27, 2005 at the Olympic Training Center in Colorado Springs. This day was devoted to addressing issues brought forward by developmental and National Team coaches. This guide is an organized compilation of the issues and includes quotes from athletes, coaches, medical professionals and government representatives, along with resource lists and practical use handouts. Its purpose is to assist you in formulating and/or re-visiting your take on dietary supplements so that you can play an active role in this component of your swimmers’ training, regardless of which side of the fence you (or they) are on. You are encouraged to generate photocopies from this guide to facilitate education and awareness within your club. We hope that you will find it valuable in your program. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 1 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ USA Swimming's Position on Supplements In an effort to maintain the integrity of our sport and the safety of our athletes, USA Swimming has taken a proactive role in making athletes and coaches more aware of the risks involved in the use of commercially available dietary supplements that have been linked to enhancing performance. Along with the US Anti-Doping Agency (USADA), USA Swimming considers dietary supplements “take at your own risk,” placing full responsibility for any effects and repercussions on the athlete. It is the role of USA Swimming to educate swimmers, coaches and parents on the issues of dietary supplements, including general and specific risks, normal values and toxicity, drug testing and drug interactions, stacking, and conventional dietary alternatives. It is also the role of USA Swimming to validate or repudiate via research review or sanctioned research the answers to the many questions that surround scientific and anecdotal evidence versus actual application. Any recommendations or opinions offered by USA Swimming regarding the use of dietary supplements are based on a yellow-orange-red light continuum Health & Contamination Risk Chart for Dietary Supplements and the most current publicly available scientific and consumer-specific information. Claims made by the manufacturers/ distributors of dietary supplements regarding the effectiveness of their products are not strictly regulated by the US Food and Drug Administration. Any commercial dietary supplement is susceptible to containing substances that may appear on the Prohibited Substance list(s) of FINA and/or the IOC. The potential exists for commercial supplements to contain substances that do not appear on the product’s list of ingredients (see Dietary Supplement Health and Education Act for more information). Statistics indicate that in some cases, the use of legal dietary supplements has been linked to positive test results for prohibited substances in athletics. The choice to use a dietary supplement is the sole responsibility of the athlete and one that should not be made in haste. An athlete is advised to weigh the options heavily, consider the consequences, and take responsibility for his/her actions. Feb/01, rev:Jul/03 CONTENTS Legislation & Labeling … … … … Purity & Contamination … … … Drug Testing … … … … … Health, Nutrition & Performance … … Research and The Big Three … … … Solutions / Alternatives / Decisions / Education Resources … … … … … Acknowledgements … … … … Definitions … … … … … Handouts … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 2 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ LEGISLATION & LABELING “I am not interested in using a product from a company that is not held to any standard other than their own.” ~Olympic Swimmer Why aren’t supplements regulated? Actually, supplements ARE regulated. Beginning in 1958, dietary supplements were regulated by the United States Food & Drug Administration (FDA). The purpose was to ensure that they were safe and that their labels were honest. Today, even after the passing of the Dietary Supplement Health and Education Act (DSHEA) in 1994, the FDA continues to be the regulatory body for dietary supplements. For example, when it comes to labeling, the label of a dietary supplement product is required to provide the name and quantity of each ingredient and is required to be truthful and not misleading. If the label does not meet these requirements, the FDA may remove the product from the marketplace or take other appropriate actions. In addition to regulating label claims, the FDA regulates dietary supplements by either refusing to allow new ingredients into the marketplace (or removing existing ones) for safety reasons. For example, a supplement manufacturer must notify the FDA of its intent to market a dietary supplement containing the new dietary ingredient, one not sold as a dietary supplement before 1994. The manufacturer must also provide information on how it determined that reasonable evidence exists for safe human use of the product. Furthermore, DSHEA granted the FDA authority to establish Good Manufacturing Practice (GMP) regulations. In 1995 the FDA stated their intentions to work with the supplement industry and solicit comments from other interested bodies to develop those regulations. In 2003, the FDA even proposed a new set of GMPs specifically for dietary supplements. The proposal remained open for public comment for ninety days. In October 2005, the FDA confirmed that the final rule for cGMPs remains one of the highest priorities for FDA to publish by the end of 2005. But until a final ruling on that proposal is made, the question still remains, "Who is checking?" The notion that supplements aren’t regulated likely comes from the “gaps” in the way they are regulated: • • • • Regulation Gap #1: The responsibility of ensuring that products are properly labeled lies with the manufacturer, and government resources to be proactive in checking up on them are limited. Regulation Gap #2: Supplement ingredients sold in the United States before October 15, 1994 are exempt from the intent to market regulation. Based on their history of use by humans, they are presumed to be safe and are therefore not subject to review by the FDA for safety. Regulation Gap #3: The responsibility of providing the safety evidence information lies with the manufacturer, and government resources to be proactive in checking up on them are limited. Regulation Gap #4: Once a dietary supplement is marketed, the FDA has to prove that the product is not safe in order to restrict its use or remove it from the market. In contrast, before being allowed to market a drug product, manufacturers must obtain FDA approval by providing convincing evidence that it is both safe and effective. Regulation Gap#5: Even when the final GMP ruling is made, government resources to be proactive in checking up on them will likely be limited. • As a result of these gaps in supplement regulation, the consumer is left to choose between trusting the manufacturers who are reaping the monetary benefits of the supplements industry or waiting for the FDA, Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 3 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ for whom the issue of dietary supplements in athletes falls fairly low on the priority list. Unfortunately, neither seems to be able to guarantee an answer. Our only proof right now is hindsight. Our only protection is critical thinking. What is the real difference between supplements, foods and drugs? What many people don’t realize is that dietary supplements are a category of foods. They are regulated as foods by the FDA, but they are regulated differently from other foods and from drugs. Whether a product is classified as a dietary supplement, conventional food or drug is based on its intended use. Congress and DSHEA define a dietary supplement as a product (other than tobacco) that: • • • • Is intended to supplement the diet; Contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and other substances) or their constituents; Is intended to be taken by mouth as a pill, capsule, tablet, or liquid; and Is labeled on the front panel as being a dietary supplement. *A supplement cannot be represented as the sole item of a meal. Most often, classification as a dietary supplement is determined by the information that the manufacturer provides on the product label or in accompanying literature, although many food and dietary supplement product labels do not include this information. Clearly, the reason the issue of dietary supplements is so confusing is that there is a significant amount of overlap between supplements and foods. Here are a few key points to help decipher the puzzle: Supplements can be identified by the “Supplement Facts” label or the word “supplement” on the container. Conventional foods have a “Nutrition Facts” label on the package. If it doesn’t have a Supplement Facts label or the word “supplement” on the container, then it’s a conventional food. Some products look like supplements or we might think of them as supplements (ex. Sobe, Gatorade, Red Bull), while they are actually conventional foods and bear a Nutrition Facts label. Some conventional foods have some of the same ingredients as supplements (herbs, amino acids, vitamins, minerals)…ingredients that we might caution our athletes against for healthand/or doping control-related reasons. Some conventional foods may also contain ingredients that could lead to a positive drug test (ex. poppy seeds). There are some products that bear neither a Nutrition Facts label nor a Supplement Facts label. It is best to consider these products off-limits because their regulation cannot be identified. Ingredients and food additives aren’t what make a product a supplement versus a conventional food. It’s the label. Foods with added herbals can be conventional foods or supplements, depending on how they’re labeled. Overlaps between conventional foods and ingredients emphasize the importance of reading the label. For more information and guidelines on how to read a Supplement Facts or Nutrition Facts label, please refer the sample labels at the end of this guide. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 4 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ PURITY AND CONTAMINATION “Contamination, intentional contamination even, is not an issue that grows with sport. There have been a number of studies showing Chinese herbs contaminated with arsenic and strychnine, etc. You need to be an educated consumer. When I was in Indiana, we got a bottle of a Chinese herbal preparation, and it was 100% pure methyl-testosterone. There wasn’t anything else in it. And it was being sold to consumers. It had Chinese writing on the label. So what we’re talking about didn’t start and won’t end with sport.” ~USADA Representative Why should we be concerned about taking supplements or recommending them to our swimmers? Despite the efforts of the FDA to regulate the supplement industry, there have been far too many cases of product contamination, many of which are affecting our sport and our athletes’ ability to feel comfortable with their decisions. Below are just a handful of examples. Nearly 20% of over-the-counter food supplements found to contain Nandrolone (a prohibited substance); No label warnings. The Times, September 20, 2001 Ginseng products from a local health food store contain marker compounds in amounts different from label; Significant product-to-product variability. American Journal of Clinical Nutrition 73:1101-1106, 2001 Unusual or unidentifiable ingredients in supplements advertised in bodybuilding and health magazines. Sports Medicine Two “mental enhancers” contain caffeine and ephedrine; neither is clearly declared on the label or declared at all. International Journal of Sport Nutrition and Exercise Metabolism 11:258-263, 2001 Researchers detect testosterone and various forms of androstenedione and 19norandrostenedion/diol in Chrysin, Tribulus Terrestris and Guarana. Deutsche Zeitschrift fur Sportmedezin 51:378-382, 2000 Norwegian weightlifter tests positive for Nandrolone 2 weeks before the Sydney Olympics and suspended for 6 months; Tests showed the supplement contained substances not listed on the label. USA Today - June 18, 2001 French sprinter tests positive at World Championships; Told French media his food supplement did not indicate it contained the banned substance nandrolone. "Naturally, nandrolone wasn't mentioned on the wrapper," he said. "I realized I might be lacking in magnesium and iron. I was trying to make up for this shortage." CNN SI.com - August 29, 2001 Did you know… Some of the “boosters” offered at popular commercial smoothie shops contain guarana, a powerful stimulant. To avoid smoothie contamination from boosters or contaminate blenders, consider making your own smoothies at home or switching to a store-bought drink such as Nouriche. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 5 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ It seems the only times we learn of a supplement's ingredients not matching its label is when an outside party decides to test it. This type of report has never been published by the FDA itself. One would like to think that the addition of "extra" ingredients to dietary supplements is usually not intentional. “Who is to blame for this mess? In my opinion the reasons are very simple. Money and fame. The vast sums of money and the celebrity status associated with winning have encouraged some athletes to take the extra risk as they seek to gain the extra edge.” ~Olympic Swimmer Is anything being done to address the issue of contamination? Fortunately, Nor-andro (the culprit in many contamination cases) is now controlled under the Anabolic Steroids Act (2004). Up until the Act, you could sell Nor-andro in bottles. People were making hundreds of metric tons of it, including tablets that were pure Androstenedione. They would make a product with Nor-andro, followed by another product, and the next thing you knew there was a trace of Nor-andro in the bottle. Just enough to cause a positive drug test. Cross-contamination. That’s probably how all these other products got contaminated. However, now that it can’t be sold as a dietary supplement because it’s controlled under the steroids act, there is no reason for a company to be making those 5 million pills. Consequently, there is less substance around to contaminate other things. Hopefully, putting them under the controlled substance act means that we won’t see any more contamination from Nor-andro-type products. However, that doesn’t protect us from this risk when the next big thing comes along. In addition, the FDA is authorized to issue Good Manufacturing Practice (GMP) regulations describing conditions under which dietary supplements must be prepared, packed and stored. As mentioned previously, the FDA published a proposed rule in March 2003 that is intended to ensure that manufacturing practices will result in an unadulterated dietary supplement and that dietary supplements are accurately labeled. Until this proposed rule is finalized, dietary supplements must comply with food GMPs. But these GMPs are primarily concerned with safety and sanitation, as opposed to supplement quality in the context of sport. The only contamination referred to in these GMPs is microbial contamination. It is important to note, however, that some manufacturers voluntarily follow drug GMPs, which are more rigorous. Some organizations that represent the dietary supplement industry have even developed their own unofficial GMPs. “You’re pretty much going to be on your own because that’s not what we, the government, are so interested in prioritizing to do. You have a big task ahead of you for addressing it, and it’s not an easy one. The powers-that-be are not interested in this issue.” ~FDA Representative How do we know who enforces GMPs and who doesn’t? Who are the rogue manufacturers? Most people in our position would define a “pure” product as one that contains exactly what the label says it contains. Nothing more and nothing less. Unfortunately, due to the regulation gaps identified in the legislation section of this guide, it is difficult to determine the true quality or purity of a dietary supplement product from its label alone. The degree of purity depends on quality control, which in turn depends on the manufacturer, the supplier and others in the production process. But bear in mind that there is a Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 6 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ reason why your Centrum costs more than the generic multi-vitamin. Bigger companies tend to make more of an effort to have (and follow) good manufacturing practices than their smaller, more “rogue” industry counterparts. Many larger, more established companies voluntarily have their own GMPs that are more stringent than the ones written up for foods. On the flip side, companies who start trying to save money, trying something different, that have less history, less invested and less to lose are the companies that tend to be less committed to maintaining a long-term reputation. So, there is some reassurance in the title and history of the company. One way to determine whether or not a company enforces GMPs is to speak directly to the person within the company who oversees that process. If you call a company and ask for the quality control officer and it either doesn’t have one or doesn’t know what a quality control officer is, you might conclude that there are no GMPs being set or followed in any of its manufacturing plants. Words of Wisdom… Beware The Rule-Breakers. Balanced information is fair, and there are always two sides to every story. Always recognize the fact that there ARE laws and there ARE good companies, and there may even be products that are legitimate in their claims to the general population. But for every “good” company, there are as many if not more “rogue” companies (rulebreakers), and the FDA simply doesn’t have/apply the resources we need to crack down on those targeting our swimmers. How can we tell which supplements are “clean” and which are contaminated? Why can’t you tell us what is safe and OK? If it were that simple, we would do it. Perhaps the most perplexing part of this problem of contamination and impurity is that there is a section of the food GMPs that allows the FDA to define maximum “defect action levels” (DALs). A DAL is a defect that is natural or unavoidable, even when foods are produced under all the GMPs regulations. Keep in mind that the FDA’s primary mission is to protect public health. So generally, these defects are not hazardous to health at low levels; they include rodent filth, insects or mold. These are the amounts considered acceptable in the food supply. What this means is that there are certain levels of substances that are allowed to enter foods, including supplements, that are considered acceptable for the general population. Chances are that if you look for a list of supplements that are “clean,” you won’t find one because no one can (or will) really make one. No one can be sure that a product doesn’t contain some trace amount of an ingredient. While this trace amount won’t be harmful to your health, it may impact a urine sample. The allowable limits of substances in the food supply are just too high compared to the limit needed to guarantee a “clean” product and a safe urine sample. The Predicament: “I think before we go too far down the road in putting all the responsibility on government and legislation, we have to look at the practicality. If I take 2-3 micrograms of nandrolone I can test positive. If I take 30 grams of protein supplement and it contains 1 part per 10 million of nandrolone, I’m going to test positive. This is way, way, way within the good manufacturing standards of the pharmaceutical industry. Are we asking the dietary supplements industry to apply a standard that is (a) not feasible and (b) not applied to pharmaceuticals? It’s such a part of the problem. The threshold for testing is set so low. A few micrograms of nandrolone is harmless. If you’re not tested in sport, it’s not an issue. You won’t notice anything, but you’ll find yourself producing a urine sample with a level above the threshold. And that’s why the issue has become so difficult to deal with. It would put restrictions on the industry Presented by it almost impossible to Network Task Force on Dietary Supplements wants.” would make USA Swimming and the produce supplements that the population Page 7 of 37 ~Physiologist and Supplements Expert Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ To add to the issue, dietary supplements are not required to be standardized in the United States. Standardization is a process that manufacturers may use to ensure batch-to-batch consistency of their products. In some cases, standardization involves identifying specific chemicals (known as markers) that can be used to manufacture a consistent product. The standardization process can also provide a measure of quality control. But no legal or regulatory definition exists in the United States for standardization as it applies to dietary supplements. Because of this, the term “standardization” may mean many different things. Some manufacturers use the term standardization incorrectly to refer to uniform manufacturing practices; following a recipe is not sufficient for a product to be called standardized. Therefore, the presence of the word “standardized” on a supplement label does not necessarily indicate product quality. “Drug companies are required to focus on keeping the purity of the product very, very high, and there are regulations where they have constant testing. But the level that we would be enforcing as a safety issue is probably higher than the level that you (USADA) are testing at, and that’s one of the problems with technology.” ~FDA Representative What about companies that guarantee purity? They don’t really exist. As sports organizations make more people aware of potential for inadvertent doping and the impact that it has on an athlete’s career, supplement companies have become more aware of the impact of contamination on athletes’ likelihood of buying their products. Therefore, some will offer rewards if their product is found to be contaminated, but beware the money “guarantee.” A million dollars after the fact doesn’t solve the problem. Question their incentives. In addition, keep in mind that labels that indicate that a product is endorsed by the United States Olympic Committee do not override the rule of strict liability. The rule of strict liability will always prevail. Words of Wisdom… Beware $1M Guarantees. If an athlete has already tested positive, it’s too late. A million dollars doesn’t solve the problem. Read the fine print. Most of these promotions guarantee UP TO a million dollars, depending on the net worth of the athlete at that point in time. There are a limited number of swimmers who fit this bill. Regardless, even a million dollars can’t bring back reputation and potential earnings. What are the warning signs of bad supplements or bad companies and what is the best way to find the safest supplements? Aside from directly asking a company’s quality control officer about its GMPs, one of the best resources available to help guide you in making a safe supplement choice is USA Swimming’s Health and Contamination Risk Chart for Dietary Supplements (see following section). The chart identifies the key ingredients that swimmers should stay away from under all circumstances, as well as the types of products and companies that pose the lowest risk. There are no brand names on the chart, as it would be impossible to present an all-inclusive list. Likewise, it would not be fair to single out just a few of the companies whose products contain the “bad” ingredients. Essentially, the chart depicts three categories of risk, and if a product or company possesses any characteristic of a category with a higher risk level, then that product or category automatically moves up to the next level of risk. Of course, you might not know all of the information about the company, in which case a simple phone call to the manufacturer is in order. Consider it your due diligence in learning about the product under consideration. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 8 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ Keep in mind too that while this chart was designed for dietary supplements, it can also be used to help determine the risk associated with conventional foods that contain ingredients similar to supplements (herbs, amino acids, vitamins, minerals)…ingredients that we might caution our athletes against for health- and/or doping control-related reasons. Generally, we feel more comfortable about these products because they are conventional foods, but the ingredients list is still just as important when contamination is a concern. Full-size color copies of the Health & Contamination Risk Chart for Dietary Supplements are available free of charge at www.usaswimming.org “Once you start moving towards the sports supplements, things that are feared and marketed towards performance, things that are marketed to say ‘you’ll recover fast,’ ‘you’ll build more muscle,’ etc, the reason companies are selling it is because there is something that may have some of these effects but are not ‘safe’ for athletes to take. ~FDA Representative Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 9 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ DRUG TESTING “Supplements are not the same as performance enhancing substances, but they do raise some of the same issues. They create health risks, and it is difficult for the layperson to determine where supplements stop and banned performance enhancing substances start.” ~Olympic Swimmer What happens if a swimmer tests positive, and he/she thinks it was from a supplement? What is the athlete’s recourse? In 2003, American swimmer Kicker Vencill tested positive for 19-norandrostenedione. It was traced back to his multi-vitamin, but he was still handed a two-year suspension. He missed the 2004 Olympic Trials because of it. In the Spring of 2005, he won a lawsuit against the dietary supplement company that made his multi-vitamin. Who better to answer these questions than Kicker himself. In May 2005, he reflected upon and shared with us what he learned from the experience. 1. How old were you when you started swimming? I was four, just turning five when I started swimming at a country club. It was summer league stuff. 2. What teams have you swum with throughout your career? My first club team was Wildcat Aquatics in Lexington, KY. I swam at Model High School when I was in high school. Then obviously, I swam in college at Western Kentucky University. During summers in college, I swam at Little Rock Arkansas Dolphins. I swam 1999-2001 there. I went to Nova after that. I’ve been training a little bit with Ford Aquatics out here, but Nova was my last club team for competition. 3. What were your goals when you were swimming with each of those teams? Well, I didn’t start swimming long course until I was about 17 years old, so my goal when I first started was to make my Junior National cut, which I did. Ultimately after that I was trying to make Senior Nationals. That was my goal. Once I made Senior Nationals, I was like “Let’s start making some National Teams.” 4. What was it like to represent your country at the 2001 World University Games? That was my first National Team, and I was pretty old considering it was my first one. I was about 22 or 23, so I was one of the older people on the team. It was definitely one of the best experiences of my life. The first time to represent the US in international competition. Even though it was considered kind of a second tier team, compared to Worlds, it was just great, a wonderful experience. I swam in an individual event and didn’t do so hot, but I was able to swim really well on the 400FR relay with three other guys and unfortunately we got touched out by Great Britain, and we got silver, but to come home with some hardware from my first meet, just the idea of representing the country and meeting new friends and going to China, it was just a wonderful experience. 5. You were selected for the 2003 Pan American Games Team but later removed. Why? Ultimately I was removed because I tested positive on a drug test on Jan 21, 2003. I went through the process of arbitration, to expedite the process because they had to give a listing of the Pam American Games roster for all sports so they had to figure out if I was going to be able to go. In June I had my arbitration and they found me guilty. I got a four year suspension and was not allowed to compete on the Pan American Team. 6. Tell us about the day you found out you tested positive. It was Feb 4, 2003 when I found out. Probably one of those days I won’t forget for the rest of my life. I came in from a morning workout and came up to the front door. I had gotten the mail that morning, but I saw a Fed Ex Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 10 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ package laid up against the door. I figured it was something for someone at the house. I picked it up and saw my name and saw that it was from USADA, and I was kind of like “Oh no, I’m in trouble.” I knew it couldn’t be good, because I had never gotten anything like that in that kind of form from USADA. Anything I had ever gotten before came in quarterly paperwork or in a small envelope…nothing like a Fed Ex. I opened it up and I read the letter, and I thought “What’s 19na?” I didn’t know what that was, and I was sitting there freaking out…I almost got sick…It was like a frantic situation because I didn’t know what any of the stuff was that I’d tested positive for, and I didn’t understand half the scientific stuff that was in the packet with it. I thought “What do I do?” 7. What was the process after that and how long did it last? The whole process of clearing my name has lasted about two and a half years. It’s hard to believe. Now that it’s over, it seems like it has gone by so quick, but there were times when it felt like it was taking forever. I had my arbitration on June 22nd in Indianapolis, and that’s where I got the suspension. I found out the day after my birthday that I was banned from swimming for four years, so that wasn’t a great birthday present. Then in November, I had my appeal case, and that’s when I provided information about having the contaminated supplements. That’s when they reduced the sentence from four years to two. Then after that, I was still not swimming, but I had to spend all this year getting ready for doing things with my lawyer to prepare for the lawsuit against the supplement company in light of the information that we found. That ended last week when the verdict was read. 8. What does the term “strict liability” mean? Strict liability means that you are liable and it’s very strict! It’s not something that I was really aware of until I was held accountable for it, but you’re liable for anything that you put into your body. Anything that you consume, whether it’s food, drink, vitamins, supplements. Whatever it might be, you’re responsible for it. If it’s in your urine you’re going to be held liable for it. I’ve learned through my process that it IS extremely strict. 9. Was it hard to accept that the rule of strict liability would be strictly applied by the US AntiDoping Agency (USADA)? Yes. I understand their position. They set a precedent, and they try to maintain that. They want to keep the sport clean, and I respect them for that. I respect them very much for that. I’m 100% for drug testing, and I’ve said this before and I’ll say it now, I’ll take a drug test anytime, anywhere. Unfortunately, I feel like I consumed the wrong thing at the wrong time, and I failed that drug test, and I paid for it dearly. But I understand why they have the strict liability. It’s hard for me sometimes to deal with the fact that I had such a low level of this precursor in my system, and it gave me no performance-enhancement, and I still had to be prosecuted, but that’s the strict liability. So I was treated like someone was treated that used something like a regular injected steroid. I was subject to the same punishment, and I received the same punishment. No matter how you look at it, that’s the position they take, and that’s the position they have to take. 10. When is your suspension over? I’m able to compete on May 22nd of this year, in six days, and my first meet is going to be in Irvine at the Speedo Grand Challenge. 11. What have you been doing the past two years? I worked at Home Depot a lot. I continued to stay active working out, not necessarily with swimming, but running and lifting weights. Right after the Olympics last year, I started getting back in. Swimming was just a difficult thing to do while I was in the depths of my punishment. In the early stages of it, it was really difficult to want to go to the pool and swim. I realized that I wanted to come back to swimming, and in light of that I knew that I needed to get prepared. I’d been out of the water for a while, so I started at the end of last summer and I’ve been pretty consistent since then. I’m in pretty good shape right now. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 11 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ 12. Why did you decide to sue the supplement manufacturer, and what was the result? The only reason we sued the company was because when I sent the four things I was consuming at the time of my positive test to an independent lab, their results showed the multivitamin was contaminated with three different steroid precursors and at that point, in talking with my lawyer, we thought that was definite grounds to pursue a lawsuit, which we did. After almost fours weeks in court, and two and a half years later, I have some vindication finally, and some good positive press about me. A jury of 12 people found that that company was liable and negligent, and the reason why I had a positive test result was because I consumed the vitamin and it had the steroid precursors in there that they manufactured. 13. Is there any comfort in having won your case? Nothing can ever rewind the clock and give me back what I lost. There was a risk involved in taking vitamins and supplements, and no matter what I say from here on out, organizations like USADA will say “He knew there was a risk.” I’m a happier person than I’ve been in two and a half years. But all the money in the world can’t rewind the clock. I’m very thankful I had a jury who recognized my innocence and looked at the facts and gave me a positive verdict. What’s nice about this is that I had a positive outcome here in the end and this can be water under the bridge and I can move on with my life. It’ll be something I’ll definitely carry for the rest of my life. It’s something I’ve learned from, and something that I want to do my best to protect others from. 14. Does winning the case make up for what you experienced or lost? This situation has weakened me but it has also made me stronger. I haven’t been in the pool for two years, but it has made me really respect myself. I wasn’t the number one 100 freestyler in the world, but when you think that there are six billion people on earth and I’m one of the top 50 freestylers in the world, that says something. And sometimes I think everyone takes for granted what they have in life. Swimming was something that sometimes I think I might have taken for granted, and this situation has made me realize and appreciate swimming fast, how much fun the swimming world is, the community, the friends I have, the coaches, being part of that is a wonderful experience. 15. What have you learned about the dietary supplement industry? Do you think that dietary supplements are safe? In my opinion, there are probably some reputable companies out there, and I’m not against supplements. But you have an issue with the industry. I learned personally that some manufacturing practices might be standard for the industry, but in my mind from a quality aspect for the consumer, they’re pretty poor. If others are like that in the industry, I’d tell everyone to beware. 16. Knowing what you know now, would you have done anything differently? Knowing what I know now, there’s no way. The only way I could ever take a multivitamin again is if it was approved by the FDA and I had a doctor prescribe it to me. It’s unfortunate I have to say that, but it’s the truth. I think it’s ridiculous to have to be scared to pick a multivitamin, but it’s the reality of the situation that athletes are faced with. So beware, coaches, parents and athletes. Be careful what you’re giving your kids. 17. What was the most difficult part of this experience? No matter what everyone says, everyone cares what people think of them, especially people in your community. I had overwhelming support from the swimming community, and I think I still do, maybe more now than ever. Just having to think that you’re viewed as a cheater, maybe not by everyone, but you have that black cloud hanging over your head. And I care about what people think about me when it comes to questioning my values and my integrity. That’s what I have a problem with. There was risk involved in what I did, but I consumed something that was contaminated. I can’t explain the whole thing to someone in a five minute conversation, but what that whole situation equals is “this guy disrespected his sport, himself, his family, his team, his team-mates, the whole swimming community and athletics in general by testing positive on a drug test.” And for someone who Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 12 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ came from a small town in the middle of nowhere in Kentucky where swimming doesn’t mean anything, and worked my way to a National and International level, only to be called a cheater when I knew it came from hard work, sacrifice and dedication…my family sacrificed, that’s the hardest part about it because having seen my family deal with this…I carry the burden of dealing with this, but my family has been affected by this and it’s hard to see that. 18. What do you hope the supplements industry and other athletes will learn from your lawsuit? I hope that we are able to come together and talk to kids. You don’t want them to drink and do drugs, but you have to talk to them about these things because if they do make those decisions, you want to inform them as much as you can. Supplements are something we don’t really want to talk about. It’s a tough situation. A lot of good people have been affected by the contamination in the supplement industry, but we have to provide athletes and coaches with information they can use to properly educate themselves or others about supplements. I want people to really think about what they’re consuming and realize that in taking this, they’re going to be held liable for it, regardless if it’s a multivitamin. And think, “Is the risk worth the improvements I might get?” To me it’s not worth it. If I test positive again, I’m done. I’m banned for life. I don’t ever, ever, ever want that to be the case. I know how the industry is. I’ve seen it. I’ve walked through that darkness for the last two years of my life and I don’t ever want to do that again. For me, it’s not worth the risk. I have friends who still take supplements, and that’s their choice. I tell them to just make sure that whatever you’re taking is reputable, but who’s to say what’s reputable and what’s not? 19. You’re returning to competition at the end of the month. What are your goals for this summer and what are you looking forward to? My goal is to make my National cut again. I want to come back. I can say it with a smile on my face…I’m smiling thinking about it right now…I can’t wait to see old friends, old team-mates and just be a part of a community I’ve been a part of my whole life. When it comes to the elite athletes and that genre of swimmers, it’s a tightknit family, and I feel a connection with all those people, whether it’s a meet, a trip or just training one day. We’re all family. We share something that a lot of people don’t share, and I feel that swimmers are a different breed. It’s going to be so exciting to be part of that atmosphere. To walk on the deck, put on a fast suit, get on the block and rip a good one. That’s what I’m looking forward to. This is about the journey of my life. Ultimately I would love to make the Olympic Team in 2008. That would be my ultimate goal and dream, as it has been for my whole life. But if that doesn’t happen, I’m just excited about getting on the blocks and racing one or a hundred more times. “Even if the government were to get involved and regulate it, they’re not going to regulate it to the level that we need it.” ~National Team Coach on realizing the predicament Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 13 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ HEALTH, NUTRITION & PERFORMANCE “I have used supplements in my swimming career, but knowing what I know today, I wish I hadn't. I never saw any benefit from them, and I now realize that one undisclosed ingredient or accidental contamination could have ended my career in disgrace and disappointment. I have not taken any supplements in three years, and I feel as good in and out of the water as I have ever felt. I am very careful and very protective of my body. I am always aware of what I consume and the risks associated with it. My health, my image, and the future of this sport are important to me and are worth protecting.” ~Olympic Swimmer Our kids are so busy, they don’t have time to eat well….Vitamins are okay just in case, right? No, vitamins are not okay “just in case.” First of all, there is no place for supplements in the diet of young athletes. Second, more is not always better, and as in the case of iron, more can actually be very dangerous. The only athletes who should be taking a vitamin or mineral supplement are those who have a documented deficiency in their intake of those vitamins and minerals. And when it comes to iron, the only athletes who should be taking an iron supplement are those who have been diagnosed by a medical doctor with an iron deficiency for which an iron supplement has been recommended. Iron is NOT suitable for the “just in case” scenario. Too much iron can be toxic to any person, regardless of age, physical stature, or competitive level. Words of Wisdom… Beware the “just in case” scenario. Many athletes are taking a vitamin and/or mineral supplement JUST IN CASE their diet is inadequate, but in most cases this is highly unnecessary. A caloric- and variety-adequate diet accounts for all of the vitamins and minerals required by an athlete to perform day-to-day and at competition time. If an athlete is maintaining body weight with an adequate caloric intake of food, this food should be coming from a variety of sources. If it’s not, there are resources to help (ex. Nutrition Tracker). Even the most renowned sport scientists are hard-pressed to identify single vitamins or minerals or combinations whose excess intake will enhance performance. Recommended intakes of nutrients are based on the amount needed before the nutrient begins to spill into the urine, the amount needed to maintain normal chemical concentrations in body tissues, and the amount needed to correct symptoms of deficiency. The needs of the entire population follow the normal distribution of a bell-shaped curve. That is, the nutrient needs of 97-98% of the entire population fall relatively close (ex. within 2 standard deviations) to the average daily requirement. Today, the Recommended Dietary Allowance (RDA) and Dietary Reference Intake (DRI) encompass the nutrient requirements for 97-98% of the entire US population. Some experts recognize that for certain segments of the population, these recommendations may be inadequate. Is it possible that elite athletes are in that remaining 2-3%? Well, there are several occasions when increasing the intake of a nutrient might be warranted: (1) if food intake is low, (2) if recommendations underestimate individual requirements, (3) if requirements change without a corresponding change in diet, and Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 14 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ (4) if cell functions impaired by disease need correction. It is true that exercise is a lifestyle factor that may change an individual’s requirements for certain nutrients by altering (1), (2) or (3) above. Exercise increases turnover/loss and the need for tissue repair. But regardless of activity level or training status, the real reason to increase the intake of nutrients is to optimize cellular function. The body must meet certain criteria in order to be considered in optimal working condition. For elite athletes involved in heavy training, the challenge is not to raise these criteria, but to eat enough of the right things to meet them. Meeting this challenge is very individual in that what is sufficient for one athlete might be too much or too little for another athlete. The first step in determining an individual athlete’s need for increased nutrient intake is determining the current nutrient status. An ideal and complete depiction of an individual’s nutrient status would include the combination of a dietary intake assessment, relevant biomarker tests (to determine normalcy of levels in body tissues and urine) and an assessment of deficiency symptoms. But we can start with a simple dietary intake assessment. All swimmers (and coaches) who are members of USA Swimming can use Nutrition Tracker, an online diet analysis program offered free of charge by USA Swimming. The program will tell you, based on your age, gender, body weight and daily activities, what your nutrient requirements actually are. Once you have entered your daily food intake, the program will then compare your requirements to your actual intake. Any deficiencies in intake are easily identified and pointed out. Intake deficiencies may warrant further exploration, including the biomarker tests and/or an assessment of deficiency symptoms, as mentioned above. If these assessments reveal a deficiency in dietary intake of one or more nutrients, then the second step is for the individual to increase the intake of that nutrient by increasing the intake of normal foods. This process holds true for every single nutrient, from the basic energy nutrient (carbohydrate, protein, or fat) to the most specific vitamin. “Why take a multi-vitamin when you can get 60% of your needs in two bowls of cereal?” ~Physiologist and Supplements Expert Speaking of energy nutrients, the foundation of every athlete’s diet should be carbohydrate. There is sufficient research to confirm the fact that carbohydrate serves as the primary energy source for all athletes and that deficiencies in carbohydrate and total energy intake are often the main contributors to major issues such as fatigue and immunosuppression. In addition, it has been demonstrated that inadequate carbohydrate intake can contribute to impaired amino acid metabolism and acid-base balance, both of which impact athletic performance. But of course, an athlete can’t rely on carbohydrate alone. A recurring theme in the research regarding dietary supplements is that athletes are tending to neglect the basics of nutrition in search for the convenient competitive edge. In 2000, the American College of Sports Medicine, the American Dietetic Association and Dietitians of Canada published a joint position statement regarding nutrition and athletic performance. It states: “It is the position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine that physical activity, athletic performance, and recovery from exercise are enhanced by optimal nutrition. These organizations recommend appropriate selection of food and fluids, timing of intake, and supplement choices for optimal health and exercise performance.” (ACSM, ADA, Dietitians of Canada, 2000) In addition, two of the key points made by the contributors to this position state: Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 15 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ 1. “During times of high-intensity training, adequate calories need to be consumed to maintain body weight, maximize the training effects and maintain health. Low-energy intakes can result in loss of muscle mass, menstrual dysfunction, loss or failure to gain bone, and increased risk of fatigue, injury and illness.” (ACSM, ADA, Dietitians of Canada, 2000, p 2131) 2. “The athletes at greatest risk of micronutrient deficiencies are those who restrict energy intake or use severe weight-loss practices, eliminate one of more food groups from their diet, or consume highcarbohydrate diets with low micronutrient density. Athletes should strive to consume diets that provide at least the RDAs/DRIs for all micronutrients from food.” (ACSM, ADA, Dietitians of Canada, 2000, p 2131) In line with these and other bodies of exercise and nutrition professionals, the Position Statement on Nutritional Supplements from the Sport Nutrition Advisory Committee of the Coaching Association of Canada suggests that nutrients such as carbohydrates, along with optimal training, may help keep athletes at peak performance level and that supplements are no short-cut to optimal performance. Complete published information on the development of RDAs and DRIs can be found online at the National Academy Press’ Dietary Reference Intakes – Application in Dietary Assessment (2000). What about athletes taking not just one supplement, but five, six and seven of them? It is common for routine dietary supplement users to incorporate two or more products into their daily routine. What the consumer must realize is that supplements are chemicals and that combining two or more can alter the intended effects and/or result in undesirable results. Unfortunately, research on the effects of taking multiple supplements and other ingredients simultaneously is scarce, but the point is that the use of multiple dietary supplements and other ingredients is not always simple math. One plus one does not always equal two. “The risk is always higher with the more products you take.” ~USOC Sports Nutritionist Not only is it important to know what a dietary supplement contains and how it might affect your body, it is critical to be aware of how it might interact with other supplements and foods that are being taken at the same time. This concept of “stacking” raises concern about any of the benefits proposed for dietary supplement use. There are variations of “stacking,” and here is how they may result in various effects: Additivity: 1+1=2. We like to think that if we take two supplements, the combined effect is equal to the sum of their individual effects. This is the simple and logical scenario. The effects of one supplement are independent of the other. No problem. For some combinations, this appears to be the case. One supplement works to its potential when another one is present, and both are able to achieve their proposed effect. For example, in order for calcium to be absorbed, vitamin D must be present. So when a recommended dose of a calcium supplement is taken in conjunction with a recommended dose od a vitamin D supplement, both are absorbed in the amount taken. Antagonism: 1+1=0. In some cases, the effects of one supplement may actually negate the effects of another. Theoretically, the net result would be that neither supplement is effective, but in many cases, the effect of one ingredient is diminished, while the effect of the other ingredient remains unknown. For example, calcium inhibits the absorption of iron. Therefore, a recommended dose of a calcium Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 16 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ supplement taken at the same time as the recommended dose of an iron supplement can defeat the purpose of taking the iron supplement. Synergism & Potentiation: 1+1>3. Synergism is the joint action of two parts so that their combined effect is greater than the algebraic sum of their individual effects. Potentiation is similar to synergism, but to a much larger degree. The combined effect of two products far exceeds the sum of their individual effects. For example, vitamin C enhances the absorption of iron. Therefore, taking a vitamin C supplement together with an iron supplement may enhance the function of iron. Most consumers would view this as a positive effect. More bang for the buck. However, the fact that something is good does not guarantee that more is better. In fact, when a supplement is more eccentric, such as one that proposes to boost the body’s natural production of testosterone, the effects may be unwanted, and in some cases, detrimental. These types of chemical reactions could be dangerous when there are toxicity effects of a particular ingredient. The bottom line is that more is not always better. The extent of synergistic and potentiation effects have not been quantified. In addition to combining supplements, there are other factors involving food, exercise and/or medications that can impact the desired effect(s) of a supplement or ingredient. Many of these would be considered antagonistic in the sense that a certain factor inhibits the proposed effect of the product. However, in some scenarios, the results can be just plain detrimental to performance and/or health. The stacking scenarios described here are the ones we actually know about. Given the astronomical number of dietary supplements on the market today and the variability among products, the number of potential stacking combinations appears indefinite. Without knowing the effects of these combinations of ingredients, it is impossible to advise and make clear and valid recommendations about them. For this reason, athletes are advised to obtain as many of the required nutrients as possible from a diet that consists primarily of conventional foods in quantities that have been recommended for their individual training scenario. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 17 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ RESEARCH & THE BIG THREE Science isn’t about certainty. Science is about probability. This might work, it might not. I can stand up in a room of athletes, if they’re all middle distance runners, and say probably it’s worth taking bicarbonate, probably it will help your performance. In 95 out of 100, it will probably do that. But for the other 5 it won’t. So if one athlete were to come to me and say should I as an individual take bicarbonate, will it help, I find it difficult to answer that question. ~Exercise Physiologist and Supplements Expert “It would be great if there were a lot of studies using elite swimmers. It would make our external validity very high.” ~USA Swimming Nutritionist Which “supplements” work and which ones don’t? Creatine, Caffeine, and Sodium Bicarbonate. These are the only three ingredients for which there is reasonable amount of scientific evidence suggesting that they really do what they say they’ll do. Not all are supplements. Not all are foods. The same level of consideration (critical thinking) should go into the decision-making process for each one. The use of creatine is widely reported among various sports, including swimming. While the short-term effects of using creatine have been studied, the long-term effects have not. There are some reports of risks associated with taking creatine, but the long-term evidence of risks remains inconclusive. The proposed effects of taking creatine in the doses recommended on the supplement labels have been supported by science. While there are dietary (food) alternatives to taking creatine, it is difficult to obtain the quantities recommended from food sources alone. There is a recommended daily intake for creatine. For more details, including the pros and cons of creatine, please refer to the detailed review in the Dietary Supplements Database at www.usaswimming.org. Caffeine is commonly consumed by athletes, including swimmers, before competitions. The short-term effects of caffeine on endurance and sprint performance have been studied in-depth, however the results of these studies remain controversial. The effects of caffeine on the performance of an athlete can be mediated by several factors that should be carefully considered. There are risks associated with caffeine supplementation and there are dietary alternatives. There is no recommended daily intake for caffeine. For more details, including the pros and cons of caffeine, please refer to the detailed review in the Dietary Supplements Database at www.usaswimming.org. The use of bicarbonate is widely reported among various sports, including swimming. While neither the short-term nor the long-term health effects of using bicarbonate supplements have been studied, the proposed effects of taking this supplement have been supported by science. However, there are numerous reports of gastrointestinal side effects associated with supplementing with sodium bicarbonate. There is no recommended daily intake for bicarbonate, and food sources are limited. There are other alternatives that may have the same effect. For more details, including the pros and cons of sodium bicarbonate, please refer to the detailed review in the Dietary Supplements Database at www.usaswimming.org. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 18 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ Words of Wisdom… Beware The Big Three. Creatine, Caffeine, and Sodium Bicarbonate. These are the only three ingredients for which there is reasonable amount of scientific evidence suggesting a benefit from using the ingredient. Not all are supplements. Not all are foods. The same level of consideration should go into the decision-making process for each one. There is often considerable variation in the conditions under which most dietary supplements are studied. For this reason, research results will vary, and solid conclusions are difficult. However, a supplement’s effect(s) on performance can usually be reported as trends. It is the purpose of the Supplements Database to report such information. “When it comes to a new article published on a new supplement or new methodology, it’s tough to act on it because we would never make a recommendation based on a single study. That’s part of why it takes too long to come to solid conclusions as to whether something works or doesn’t work. A single study just can’t take into account all of the different scenarios.” ~USA Swimming Nutritionist Am I putting my athlete at a disadvantage by telling them not to take supplements? The disadvantage must first be defined by you and your athlete. What exactly constitutes a disadvantage? Is it strictly performance-based? Or is there more to it than that? Assuming it is performance-based, keep in mind that even a supplement that works won’t address all of the factors that contribute to training and competition performance. Keep in mind too that without a deficiency, extra vitamins or minerals will not improve performance. The only time not taking a supplement could possibly put your athlete at a disadvantage is if the competition is taking the same supplement and both athletes have maximized their potential in all other areas affecting training and racing. The general consensus among respected sports physiology professionals is that too much emphasis is being placed upon dietary supplements and that nothing can compare to a sound resistance training program and consuming enough nutrition from food sources. “I think that the success at swimming and other sports is 99% athlete and coach. Given the choice between an above-average coach and all the supplements you can legally take, and an excellent coach and no supplements, I dare say that the excellent coach will bring you through every time if you do the right things.” ~National Team Physician “I’d rather see a kid come to practice and train a little harder and supplement by lifting ten more pounds or doing a few more push-ups. We’re so backwards in this process they’re all relying on some bottle to gain the edge.” ~National Team Coach Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 19 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ SOLUTIONS / ALTERNATIVES / DECISIONS / EDUCATION “If you want to take extra vitamins and minerals, taking them in foods is by-and-large the better option.” ~Exercise Physiologist and Supplements Expert If I don’t want to recommend supplements to my swimmers, what CAN I recommend? The most effective alternative to dietary supplements is a diet rich in foods from all of the foods groups. Following the Four Foundations to a diet rich in the essential nutrients may not be easy at first, but it is very simple: Eat a Variety of Foods From All of the Foods Groups. The food guide pyramid itself is far from perfect, but it makes a very important point. There are no magic foods or food groups, and no single food or group can provide all of the nutrients a person needs. Foods are divided into groups based on the nutrients (mainly vitamins and minerals) they provide. For example, the foods in the meat/beans group contain lots of nutrients, but are very rich in protein, iron, zinc and phosphorus. Foods in the milk group also contain protein and phosphorus, but are better known for their high calcium, riboflavin and vitamin A content. Some vegetables are excellent sources of non-heme iron, but meats are the only source of heme-iron. Grain foods are excellent sources of carbohydrate, but tend to lack the anti-oxidants provided by fruit, also an excellent carbohydrate source. So the point is that the only way to get a complete set of vitamins, minerals and every-yielding nutrients is by eating a variety of foods from all of the food groups. Eat Colorful Foods. Fresh, canned, frozen, dried or juiced. No matter how you look at it, fruit is an excellent source of carbohydrate. Not only does fruit provide carbohydrate in the form of natural sugars (versus refined sugar), the bright colors of fruits indicate that they are also excellent sources of vitamins and minerals, including a sub-group called anti-oxidants. Anti-oxidants “absorb” free radicals, neutralizing their effect in the body before their damage to muscle tissue can amount to much. A diet consistently rich in fruits (and other colorful foods, such as VEGETABLES) is apt to keep the body consistently supplied with anti-oxidants, which will assist the body in keeping free radical formation to a minimum. This is a good reason to eat lots of colorful foods during the recovery time between workouts. Colorful foods include, but are not limited to, Apples, Strawberries, Blueberries, Bananas, Oranges, Kiwi, Watermelon, Raspberries, Grapes, Mango, Papaya, Apricots, Red peppers, Broccoli, Corn, Squash, Carrots, Peas, Green beans, Tomatoes. Colorful foods DO NOT include: Skittles, Jelly Beans, M&Ms, Mike&Ikes, Fruit Loops, etc. Eat Early and Often, Including Recovery. Knowing how much carbohydrate, protein and fat to get in a day is good. But knowing when you should be getting those nutrients is even better. When it comes to optimal nutrition, timing really is everything. In general, follow these guidelines for incorporating carbohydrate, protein and fat into your day: • • • • • • Spread carbohydrate intake out over the course of the day (i.e. smaller meals and frequent snacks). This keeps blood sugar levels adequate and stable. Eat some carbohydrate before morning practice. Note: This can be in the form of juice. Eat carbohydrate in the form of a carb-electrolyte drink, such as Gatorade or Powerade, during workout IF workout is 90 minutes or longer. Gels are also acceptable. Eat carbohydrate and protein within the first 30 minutes after practice. This enables the body to replenish glycogen stores and repair muscle tissue. This is perhaps the most important time to eat!!!! Eat again (something substantial, like a real meal) before two hours post-practice has elapsed. This is critical to maximizing recovery!!!! Incorporate fat into the day at times that are not close to workout. Fat is necessary, but Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 20 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ contributes little to the workout or immediate post-workout recovery period. Part of the reason good nutrition is critical during recovery has to do with the fact that the body is extremely good at making the most of what it is given. Following exercise, the body is very sensitive to the hormone insulin. Insulin is that hormone that rises every time blood sugar rises. In other words, every time a swimmer eats carbohydrate, which causes blood sugar to rise, insulin goes up. Well, it’s insulin’s job to remove sugar from the bloodstream, and it does so by facilitating its storage as glycogen. Glycogen, the storage form for carbohydrate, is what the body taps into for fuel when exercise is very intense. This can happen quite a bit during a tough workout, which is why it’s important to see that glycogen is replenished before the next practice. Drink Early and Often, Including Recovery. Regardless of age or length of workout, all swimmers need fluids before, during and after practice to stay hydrated. This is easily accomplished with a couple of sips from the water bottle every 15-20 minutes. As swimmers progress and workouts get longer (>90 min) and tougher, they will also benefit from a supplemental fuel source. Drinks like Gatorade and Powerade are effective, but drinks that are too strong, or “concentrated,” can be prohibitive. Water is an excellent choice to replenish fluids after practice. It’s always wise to drink at least one cup. But after a tough workout, replenishing fuel stores is equally important. Often, a sports drink that is easily digested and quickly absorbed, such as Gatorade or Powerade can provide a convenient way to get some of this fuel within the first 20 minutes. Staying hydrated during the day is just as critical as hydrating during and after workouts. Most swimmers can do this by incorporating a variety of fluids into their daily diet, such as water, fruit juice, milk or soups. Some options for educating your swimmers and parents on the alternatives to supplements include inviting a nutritionist to speak to the team, requesting an online presentation from USA Swimming, participating in Nutrition Tracker and visiting the nutrition sections of the USA Swimming website. To locate a nutritionist in your area (or to find a referral), visit the online directory at www.usaswimming.org. My athlete is probably going to take a supplement. What is the best way to handle the situation? The most important thing you can do as a coach is be involved. Don’t turn away, even if you are completely against the use of supplements. Sometimes, an athlete’s inquiry about the use of supplements is a sign that he/she is not confident or happy with the way his/her performance is progressing. We know that supplements are not the answer to all problems. This may be a good time for a heart-to-heart to simply re-visit the athlete’s training and progression. Second, be realistic about our system, our sport and the industry. When it comes to the world of dietary supplements, food and sports, we know what we would like to see in terms of legislation, labeling and safety. But what we want isn’t always what we get, and the reality is that we have to work within the constraints that exist within our system. See the table called Dietary Supplements – The Real Deal for a refresher on what we want versus what we have. “The reality is that some of our athletes are going to supplement. When you’re in the grocery store, you should be able to say ‘I’m getting this supplement because it affects this part of my performance.’ One of the biggest problems we have in our sport at the elite level is that it’s wives’ tales and imagery with regards to taking something. Go back to what’s the efficacy of these things? What are they for? Why are they valued?” ~National Team Coach Third, know exactly what your athlete is considering, and be proactive in making sure he or she makes an ethical and justifiable decision. Again, even if you are against the use of supplements, your athlete needs guidance in making a good, personal choice. It is no longer acceptable for a swimmer to obliviously eat Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 21 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ or drink a product. It is true that the rules of strict liability will still apply, but helping kids make wise decisions is part of coaching (and parenting!). They trust you and look up to you. And just because they are considering a supplement doesn’t mean they are definitely going to use it. Dietary Supplements – The Real Deal IDEAL - WHAT WE WANT Supplements proven safe before going to market. FDA closely evaluating claims made by supplement manufacturers. Supplement labels that match container contents 100%. Legal-limit traces in supplements that match or are lower than legal-limit traces in doping control urine samples. Reduced potential for contamination with nandrolone. More athletes who believe they can achieve great things on diet and training alone. More athletes and coaches to obtain their information from the USA Swimming Dietary Supplements database. No athletes under the age of puberty taking dietary supplements and/or “performance supplements.” The FDA taking immediate action against any supplement that poses a risk to our athletes. The penalties to be higher for companies who break the rules. All companies strictly following Good Manufacturing Practices. Guarantees. REAL - WHAT WE HAVE Supplements proven harmful before taken off market. Supplement manufacturers bearing the burden of proof, post-market. Container contents that contain legal-limit traces of ingredients not identified on the label. Legal-limit traces that are higher than legal-limit traces in doping control urine samples. Reduced potential for contamination with nandrolone. Too many athletes who believe that supplements will make them super-stars. Too many athletes and coaches obtaining their information from fitness magazines and hearsay. Lots of athletes under that age of puberty taking dietary supplements and/or “performance supplements.” The FDA taking some action against supplements that pose a risk to our general population. Penalties in the line of $1,000 fines and facility closures, with the same companies re-opening at an address down the street. Some companies strictly following Good Manufacturing Practices. No guarantees. Of course, teaching athletes responsibility and critical thinking is easier said than done. Consider incorporating critical thinking tools, such as 12 Steps to Determining Safety, Effectiveness and Need or Cost-Benefit Analysis into your discussions with your athlete. (Copies of both of these critical thinking tools are located at the end of this Guide.) “Sometimes people just look for, hear or read what they want to believe, rather than being critical about it.” ~FDA Representative In addition, be sure to advise your athlete on the lures of supplement advertising, especially on the internet. Some cautions for website supplement advertising: Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 22 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ • • • • • • • Beware of ads and websites that will not offer product information, such as ingredients lists and Nutrition Facts. Beware of ads and websites that claim scientific studies and clinical trials have been done but do not report those references. Beware of ads that use "fancy" or "scientific" words and phrases to explain how their product works without offering a layman's explanation. These are used to impress and entice. Beware of ads that are selling products from other countries. Beware of ads and websites that provide comments from current users. Most times they only print the positive stories, and most times these are not from elite level athletes. Beware of ads that sell anything with the word "andro-" in it. Most of these products are prohibited. Beware of ads that sell products they claim will increase your free testosterone levels. If your testosterone increases but your epi-testosterone does not, your ratio of testosterone:epitestosterone may become too high. Products that increase testosterone levels are prone to containing other anabolic ingredients and possible Prohibited Substances. Beware of ads that sell products they claim will “boost your metabolism.” Many of these products contain stimulants in the ingredients. Beware of ads and websites that claim their statements have not been evaluated by the FDA. That means the US Food and Drug Administration has not determined whether or not what they are saying about their products is true. Beware of ads and websites that do not have the disclaimer that their statements have not been evaluated by the Food and Drug Administration. The fact is that no dietary supplement’s claims are required to be evaluated, and just because this statement doesn’t appear on the website, doesn’t mean it HAS been evaluated. Beware of ads and websites that claim their statements have been evaluated by the FDA...The majority have not. Beware of websites that will not allow you to return a product. Beware of ads and websites that focus on “Before” and “After” photos or photos of desirable bodies. It takes much more than a nutrient to cause these effects. Beware of ads that empathize. Don’t be fooled by sites saying they “know how you feel” or they “understand the confusion in choosing a dietary supplement.” This is their way of connecting with the consumer. Their goal is to get the consumer “on their side.” *A full-size handout copy of these bullet points is available at the end of this guide. • • • • • • • “It’s ok to be informed, but coaches really have to decide if it’s ethical or appropriate.” ~National Team Coach Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 23 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ CONSIDER THIS: Be a Research Critic. There are a number of instances wherein the research on a supplement or key ingredient has been published in abstract form only. Research published in this form is not subjected to the rigors of peer review. Experts suggest that if research is to be interpreted correctly, authors of studies on dietary supplements must be very clear in providing information as to the route of supplementation (ingestion versus injection), the matrix (food versus pill or serum), the purity of the supplement (to determine the exact quantity), and the physiological state (i.e. trained, untrained, aged, healthy, ill, etc) of the subjects being tested. Provision of this information would undoubtedly reduce confusion and allow for more critical review of the information regarding dietary supplements and performance. The American Dietetic Association stipulates that sound scientific evidence is essential before advising the public to change dietary and nutrient patterns. In addition, the Association suggests that cause-and-effect relationships can be tested most conclusively with prospective, randomized, double-blind, placebo-controlled supplementation trials and that rarely can a single study stand alone as scientific verification of a hypothesis. Therefore, the American Dietetic Association states the following: “It is the position of the American Dietetic Association that the best nutritional strategy for promoting optimal health and reducing the risk of chronic disease is to obtain adequate nutrients from a wide variety of foods. Vitamin and mineral supplementation is appropriate when well-accepted, peer-reviewed, scientific evidence shows safety and effectiveness.” (ADA, 1996) In support of the American Dietetic Association, and in an effort to reduce the risk to the human consumer, the well-respected American Society for Clinical Nutrition has taken measures to control and improve upon the quality of research and information that is being made available to the public. In 2000, the Editor-in-Chief for the American Journal of Clinical Nutrition stressed the need for well-designed, comprehensive studies on the proper medical use of neutraceuticals and other dietary supplements before these products become ingrained in medical practice without clear knowledge of their mechanisms, clinical efficacy, and safety (Halsted, 2000). He suggested that while the widespread use of “botanicals” as dietary supplements supports their inclusion in the realm of clinical nutrition, many studies regarding their use are funded by the very companies whose marketing profits rest on the scientific approval of their product. Therefore, research submitted to their journal must meet high ethical standards, including full peer-review using the criteria of scientific excellence, comprehensiveness, and relevance to the field of clinical nutrition. Papers must (1) present well-controlled clinical trials with adequate numbers of experimental subjects, (2) address the usefulness of the dietary supplement in the context of health benefit or disease prevention, (3) provide substantial data on efficacy and potential toxicity, and (4) list their sources of funding in a footnote on the title. Similarly, Haskell and Kiernan (2000) have published a paper that specifically addresses the issue that must be considered when researchers are studying the effects of dietary supplements in physically active people. To summarize, Haskell and Kiernan suggest that the collection of accurate and reliable data can be achieved using control groups, blind and random assignments, and adequate statistical power (i.e. adequate sample sizes). Improvements are needed in the areas of sample size, treatment effectiveness, sport- and athlete-specific testing protocols, and subject retention. They recommend that researchers begin to focus more on minimizing subject and investigator burden and developing procedures that accurately measure changes in performance among subjects at both the high and low ends of the performance capacity spectrum. Meeting these standards will help ensure the validity of the research and allow the consumer to accept conclusions made by the authors with confidence. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 24 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ RESOURCES “We need to do a better job on our end through Nutrition Tracker and link them to appropriate databases. ~National Team Coach “We are more than just swimmers and swim coaches. We’re people, and we need to get better as people, not just swimmers and coaches.” ~National Team Coach ____________________________________________________________________________________ Supplements-Related Websites: Dietary Supplements Database http://www.usaswimming.org/USASWeb/DesktopDefault.aspx?TabId=611&Alias=Rainbow&Lang=en (access via: www.usaswimming.org /Coaches /Doping Control /Supplements Info /TheSupplements Database) Health & Contamination Risk Chart for Dietary Supplements http://www.usaswimming.org/USASWeb/_Rainbow/Documents/ad13d97c-7292-417b-87e5a2821a0d954c/Theoretical_Safety_Rating.pdf (access via: www.usaswimming.org /Coaches /Doping Control /Supplements Info) FDA-CFSAN Overview of Dietary Supplements (FAQs) http://vm.cfsan.fda.gov/~dms/ds-oview.html Dietary Supplement Health & Education Act http://vm.cfsan.fda.gov/~dms/dietsupp.html Center for Food Safety and Applied Nutrition Dietary Supplements Info http://www.cfsan.fda.gov/~dms/ds-info.html Supplements and Drug Testing Slide Show http://www.usaswimming.org/USASWeb/_Rainbow/Documents/ce1cfe45-c805-452f-b00c12bf47f835c6/Supplements%20and%20Doping%20Control%20Oct04.pdf (access via: www.usaswimming.org /Coaches /Doping Control /Supplements Info) Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 25 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ ____________________________________________________________________________________ Nutrition-Related Websites: Nutrition Tracker http://www.usaswimming.org/USASWeb/DesktopDefault.aspx?TabId=676&Alias=Rainbow&Lang=en (www.usaswimming.org /available through Coaches or Swimmers or Parents sections) • To use this member feature, you will need to create a web account and then link it to your USA Swimming membership. To do this, click 'Sign In' at the top right of the page. Then click 'Create Account' and follow the instructions. When your account has been created, you must link your web account to your USA Swimming account on the 'Your Account' page. (see the 'Your Account' link at the top right-hand corner of this screen). If you would like to add the Nutrition Tracker link and logo to your club’s website, please call USA Swimming at (719) 866-4578. • USA Swimming Nutrition Section for Coaches http://www.usaswimming.org/USASWeb/DesktopDefault.aspx?TabId=278&Alias=Rainbow&Lang=en (access via: www.usaswimming.org /Coaches /Nutrition) USA Swimming Nutrition Section for Parents http://www.usaswimming.org/USASWeb/DesktopDefault.aspx?TabId=402&Alias=Rainbow&Lang=en (access via: www.usaswimming.org /Parents /Nutrition) ____________________________________________________________________________________ Drug Testing-Related Websites: USA Swimming Doping Control Section http://www.usaswimming.org/USASWeb/DesktopDefault.aspx?TabId=63&Alias=Rainbow&Lang=en (access via: www.usaswimming.org /Coaches /Doping Control) USADA http://www.usantidoping.org/ USADA Drug Reference Online http://www.usantidoping.org/dro Supplements and Drug Testing Slide Show http://www.usaswimming.org/USASWeb/_Rainbow/Documents/ce1cfe45-c805-452f-b00c12bf47f835c6/Supplements%20and%20Doping%20Control%20Oct04.pdf (access via: www.usaswimming.org /Coaches /Doping Control /Supplements Info) ____________________________________________________________________________________ Educational Presentations: • • USA Swimming offers a variety of live presentations to teams and clubs visiting the Olympic Training Center in Colorado Springs. Members of USA Swimming’s Sports Medicine and Science Network are also available to present nutrition lectures to local teams and clubs. To locate a nutritionist near you, use the online search featured in Nutrition-Related Website above. If a visit to the OTC is not part of your program, or you are unable to locate a nutritionist in your state, contact USA Swimming to request a live webcast. • Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 26 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ ____________________________________________________________________________________ For the Serious Reader and Research Critic: American Dietetic Association (ADA). (1996). Position of the American Dietetic Association: vitamin and mineral supplementation. Journal of the American Dietetic Association 96(1):73-77. (also available at www.eatright.org) Bettger WJ. (2000). Nutraceuticals for health and performance: introduction to the symposium. Canadian Journal of Applied Physiology 25(6):493-494. Borum PR. (2000). Supplements: questions to ask to reduce confusion. American Journal of Clinical Nutrition 72(suppl):538S-540S. Coyle EF. (2000). Physical activity as a metabolic stressor. American Journal of Clinical Nutrition 72(suppl):512S-520S. Eichner ER, Prentice B, King D, Ziegenfuss TN and Myhal M. (1999). Muscle builder supplements. Sports Science Exchange Roundtable 10(3). Gibale MJ. (2000). Nutritional supplementation and resistance exercise: What is the evidence for enhanced skeletal muscle hypertrophy? Canadian Journal of Applied Physiology 25(6): 524-535. Halsted CH. (2000). Dietary supplements and The American Journal of Clinical Nutrition. American Journal of Clinical Nutrition 71:399-400. Haskell WL and Kiernan M. (2000). Methodological issues in measuring physical activity and physical fitness when evaluating the role of dietary supplements for physically active people. American Journal of Clinical Nutrition 72(suppl):541S-550S. Jacobson BH, Sobonya C and Ransone J. (2001). Nutrition practices and knowledge of college varsity athletes: a follow-up. Journal of Strength and Conditioning Research 15(1):63-68. Krumback CJ, Ellis DR and Driskell JA. (1999). A report of vitamin and mineral supplement use among university athletes in a Division I institution. International Journal of Sport Nutrition 9:416-425. Manore MM. (2001). Vitamins and minerals Part I. How much do you need? ACSM’s Health and Fitness Journal 5(1):33-35. Swirzinski L, Latin RW, Berg K and Grandjean A. (2000). A survey of sport nutrition supplements in high school football players. Journal of Strength and Conditioning Research 14(4):464-469. Zeisel SH. (2000). Is there a metabolic basis for dietary supplementation? American Journal of Clinical Nutrition 72(suppl):507S511S. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 27 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ ACKNOWLEDGEMENTS USA Swimming would like to thank the following people for their contributions to this program and the Network Task Force on Dietary Supplements: Strib Ellison, MD Mike Bottom Ed Ryan, ATC Judy Nelson Ron Maughan, PhD Jason Woo, MD Ian McLeod, ATC, LMT Larry Bowers, MD Jim Bauman Kicker Vencill Dave Salo, PhD Kim Holmes Stacy Michael Special thanks goes to all of the athletes, coaches and staff who contributed to and edited this Guide. To Kicker in particular, we thank you for sharing your story so bravely and wish you the best for continued success. GO USA! For additional copies of this Guide, please call USA Swimming at (719) 866-4578 or go online at www.usaswimming.org The information published in this Guide is for educational purposes only and is not intended for diagnostic purposes or to replace the medical advice of a physician in practice. Readers are encouraged to consult a physician in all matters relating to health, particularly in respect to symptoms that may require a diagnosis or medical attention. USA Swimming makes no representations or warranties with respect to any information offered or provided in this Guide regarding treatment, action, or application of medication. Neither USA Swimming, nor any of its Members or Affiliates will be liable for any direct, indirect, consequential, special, exemplary, or other damages arising therefrom. All quotes within this Guide have remained anonymous in an attempt to maintain confidentiality. Neither USA Swimming nor any of its Members or Affiliates will be liable for any implications arising from assumptions made by the reader regarding any quote or its origin. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 28 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ DEFINITIONS Dietary Supplement - A product (other than tobacco) that is intended to supplement the diet; Contains one of more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and other substances) or their constituents; Is intended to be taken by mouth as a pill, capsule, tablet, or liquid; and is labeled on the front panel as being a dietary supplement. *A supplement cannot be represented as the sole item of a meal. DSHEA – Dietary Supplements Health and Education Act of 1994; The act changed the way dietary supplements are regulated in the United States and created a number of loop-holes for manufacturers, which demand resources that the federal government does not have. FDA – United States Food and Drug Administration CRN – Council for Responsible Nutrition; One of the dietary supplement industry’s leading trade associations representing ingredient suppliers and manufacturers. ODS - Office of Dietary Supplements; A division of the FDA; Mission is to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, stimulating and supporting research, disseminating research results, and educating the public to foster an enhanced quality of life and health for the U.S. population. Good Manufacturing Practices (GMPs) - Regulations describing conditions under which dietary supplements must be prepared, packed, and stored. Prohibited - If a medication/substance is prohibited it is not allowed to be used at any time. Examples of prohibited substances are anabolic agents, diuretics and peptide hormones. These substances are tested for during out-of-competition and in-competition testing. If a medication/substance is prohibited during competition it cannot be in the athlete’s system during competition. Examples of substances in this category are stimulants and narcotics. Take at Your Own Risk - Substances that are classified as “Take at your Own Risk” are not prohibited but the risk does exist for them to contain prohibited substances that are not clearly listed on the ingredients label. Dietary supplements fall in this category. The risk also exists for a supplement to contain anabolic steroid precursors (which turn into anabolic agents in the body). Permitted - Substances that are classified as permitted may be used and do not require any documentation prior to competition. They must be listed on a drug testing form at the time of testing. Strict Liability - The athlete is responsible for ensuring that no prohibited substance enters his/her system. The athlete may be subject to sanctions in the event that a prohibited substance is detected in his/her sample even if the consumption of the substance was unintentional. Inadvertent Doping – A doping action or procedure that is unintentional or unknowingly commited, often as the result of ingesting a product containing a prohibited substance that is not disclosed; Inadvertent doping is not excused and is subject 100% to the rules of strict liability. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 29 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ NCAA Bylaw 16.5.2.2 (Proposal No. 99-72) The NCAA News -- August 14, 2000 Division I institutions should note that pursuant to NCAA Bylaw 16.5.2.2 (Proposal No. 99-72), which became effective August 1, 2000, institutions may provide only non-muscle-building nutritional supplements for the purpose of providing additional calories and electrolytes, provided they do not contain any NCAA-banned substances. "Permissible non-muscle-building nutritional supplements are identified according to the following classes: carbohydrate/electrolyte drinks, energy bars, carbohydrate boosters, and vitamins and minerals." In adopting Proposal No. 9972, the NCAA Division I Board of Directors noted a lack of long-term studies on the possible side effects of muscle-building supplements and agreed that muscle-building supplements are performance-enhancing and provide a competitive advantage to those institutions that can afford to provide these supplements to their student-athletes. The Division I Academics/Eligibility/Compliance Cabinet Subcommittee on Legislative Review/Interpretations determined that it is not permissible for an institution to provide nutritional supplements to its student-athletes, unless the supplement is a nonmuscle-building supplement and is included in one of the four classes identified in Bylaw 16.5.2.2. Additionally, the subcommittee determined that it is not permissible for an institution or an institutional staff member to sell or arrange the sale of muscle-building supplements to student-athletes since this practice would be contrary to the rationale for the adoption of Proposal No. 99-72. Further, the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports developed a list of nutritional supplements/ingredients identified as permissible and nonpermissible under Bylaw 16.5.2.2. The committee considered input provided to it by relevant outside organizations. The legislation reflects a philosophy that proper nutrition based on scientific principles is one of the tenets to optimal performance. The following lists are not exhaustive but should be used as a guide to understanding the application of the legislation. Please note the example calorie calculations as they relate to the permissibility of energy bars. Permissible: Vitamins and minerals / Energy bars / Calorie-replacement drinks (for example, Ensure, Boost) / Electrolytereplacement drinks (for example, Gatorade, Powerade) Nonpermissible: Amino acids / Chrysin / Condroitin / Creatine/creatine-containing compounds / Ginseng / Glucosamine / Glycerol / HMB / I-carnitin / Melatonin / Pos-2 / Protein powders / Tribulus Supplements Containing Protein The Division I Academics/Eligibility/Compliance Cabinet Subcommittee on Legislative Review/Interpretations, at the recommendation of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, determined that a supplement that contains protein may be classified as a non-muscle-building supplement, provided it meets all of the following conditions: • • • It is included in one of the four permissible categories set forth in 16.5.2.2; It does not contain more than 30 percent of calories from protein (based solely on the package label); and It does not contain additional ingredients that are designed to assist in the muscle-building process (see examples of nonpermissible supplements). To assist the membership in calculating the percentage of calories from protein contained in a particular supplement, please note that one gram of protein equals four calories. Therefore, the percentage of calories from protein contained in a nutritional supplement may be calculated by multiplying the number of grams of protein per serving by four and dividing the product by the total number of calories per serving. The following are examples of this calculation: o o Energy bar contains 24 grams of protein with a caloric value of 250. 24 grams times four = 96 calories. 96/250 = .384. Percentage of protein = 38 percent -- as an example, this energy bar would not be permissible. Energy bar contains 17 grams of protein with a caloric value of 250. 17 grams times four = 68 calories. 68/250 = .272. Percentage of protein = 27 percent -- as an example, this energy bar would be permissible. This material was provided by the membership services staff as an aid to member institutions. Institutions may direct questions regarding this information to Damani Leech or Brad Hostetter at the NCAA national office. This information is available on the College Sports Network. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 30 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ USADA’S STATEMENT REGARDING DIETARY SUPPLEMENTS Reprinted with permission from USADA 2005. Supplements do not appear in the database because USADA is not able to provide a definitive answer as to the status of each product. VITAMINS, MINERALS, HERBS, AMINO ACIDS AND OTHER DIETARY SUPPLEMENTS The Dietary Supplement Health and Education Act (DSHEA) of 1994 specifically exempted vitamins, minerals, amino acids, herbs and botanicals, and their extracts and concentrates from evaluation for safety and efficacy by the Food and Drug Administration (FDA). The commonly held belief that the government approves these over-the-counter dietary supplements is incorrect. There is evidence that many products may not contain the ingredients listed on the label in the stated amount, may not contain the ingredients listed at all, or may be contaminated or adulterated with other prohibited substances not listed on the label. A State of California study documented the presence of other toxins such as arsenic and strychnine in herbal products. Anti-doping rules are based on the principal of strict liability (athletes are responsible for what is in their system). Since there are no regulations guaranteeing the actual content of these products, a positive test as the result of the use of any of these products could result in a doping violation. THE USE OF VITAMINS, MINERALS, HERBS, AMINO ACIDS AND OTHER DIETARY SUPPLEMENTS IS COMPLETELY AT THE ATHLETE'S OWN RISK OF COMMITTING A DOPING VIOLATION. ALL athletes are advised to be extremely cautious about the use of any vitamins, minerals, herbs, amino acids and other dietary supplements. No guarantee can be given that any particular supplement, including vitamins and minerals, ergogenic aids, and herbal remedies, is free from prohibited substances. Athletes or sporting bodies who accept sponsorship from supplement manufacturers do so at their own risk. Without an approved quality standard, USADA cannot guarantee the reliability of the manufacturing or labeling process, despite claims made by some manufacturers. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 31 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ IOC Consensus Statement on Sports Nutrition 2003 The amount, composition and timing of food intake can profoundly affect sports performance. Good nutritional practice will help athletes train hard, recover quickly and adapt more effectively with less risk of illness and injury. Athletes should adopt specific nutritional strategies before and during competition to help maximise their performance. Athletes will benefit from the guidance of a qualified sports nutrition professional who can provide advice on their individual energy and nutrient needs and also help them to develop sport-specific nutritional strategies for training, competition and recovery. A diet that provides adequate energy from the consumption of a wide range of commonly available foods can meet the carbohydrate, protein, fat, and micronutrient requirements of training and competition. The right diet will help athletes achieve an optimum body size and body composition to achieve greater success in their sport. When athletes restrict their food intake, they risk nutrient deficiency that will impair both their health and their performance. Careful selection of nutrient-dense foods is especially important when energy intake is restricted to reduce body and/or fat mass. Fat is an important nutrient and the diet should contain adequate amounts of fats. Athletes should aim to achieve carbohydrate intakes that meet the fuel requirements of their training programs and also adequately replace their carbohydrate stores during recovery between training sessions and competition. This can be achieved when athletes eat carbohydrate-rich snacks and meals that also provide a good source of protein and other nutrients. A varied diet that meets energy needs will generally provide protein in excess of requirements. Muscle mass is maintained or increased at these protein intakes, and the timing of eating carbohydrate and protein may affect the training adaptation. A high carbohydrate intake in the days before competition will help enhance performance, particularly when exercise lasts longer than about 60 minutes. Dehydration impairs performance in most events, and athletes should be well hydrated before exercise. Sufficient fluid should be consumed during exercise to limit dehydration to less than about 2% of body mass. During prolonged exercise the fluid should provide carbohydrate. Sodium should be included when sweat losses are high especially if exercise lasts more than about 2 hours. Athletes should not drink so much that they gain weight during exercise. During recovery from exercise, rehydration should include replacement of both water and salts lost in sweat. Athletes are cautioned against the indiscriminate use of dietary supplements. Supplements that provide essential nutrients may be of help where food intake or food choices are restricted, but this approach to achieving adequate nutrient intake is normally only a short term option. The use of supplements does not compensate for poor food choices and an inadequate diet. Athletes contemplating the use of supplements and sports foods should consider their efficacy, their cost, the risk to health and performance, and the potential for a positive doping test. Excessive training and competition are associated with some negative consequences. Robust immunity and reduced risk of infection can be achieved by consuming a varied diet adequate in energy and micronutrients, ensuring adequate sleep and limiting other life stress. Attention to dietary intake of calcium and iron is important in athletes at risk of deficiency but use of large amounts of some micronutrients may be harmful. Female athletes with menstrual disorders should be promptly referred to a qualified specialist physician for diagnosis and treatment. Food can contribute not only to the enjoyment of life, but also to success in sport. Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 32 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ Source: http://www.cfsan.fda.gov/~acrobat/foodlab.pdf Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 33 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 34 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 35 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 36 of 37 Dietary Supplements A Comprehensive Guide for Swim Coaches ______________________________________________________________________________ Beware the Lures of Supplement Advertising □ Beware of ads and websites that will not offer product information, such as ingredients lists and Nutrition Facts. □ Beware of ads and websites that claim scientific studies and clinical trials have been done but do not report those references. □ Beware of ads that use "fancy" or "scientific" words and phrases to explain how their product works without offering a layman's explanation. These are used to impress and entice. □ Beware of ads that are selling products from other countries. □ Beware of ads and websites that provide comments from current users. Most times they only print the positive stories, and most times these are not from elite level athletes. □ Beware of ads that sell anything with the word "andro-" in it. Most of these products are prohibited. □ Beware of ads that sell products they claim will increase your free testosterone levels. If your testosterone increases but your epi-testosterone does not, your ratio of testosterone:epi-testosterone may become too high. Products that increase testosterone levels are prone to containing other anabolic ingredients and possible Prohibited Substances. products contain stimulants in the ingredients. □ Beware of ads that sell products they claim will “boost your metabolism.” Many of these □ Beware of ads and websites that claim their statements have not been evaluated by the FDA. That means the US Food and Drug Administration has not determined whether or not what they are saying about their products is true. been evaluated by the Food and Drug Administration. The fact is that no dietary supplement’s claims are required to be evaluated, and just because this statement doesn’t appear on the website, doesn’t mean it HAS been evaluated. FDA...The majority have not. □ Beware of ads and websites that do not have the disclaimer that their statements have not □ Beware of ads and websites that claim their statements have been evaluated by the □ Beware of websites that will not allow you to return a product. □ Beware of ads and websites that focus on “Before” and “After” photos or photos of desirable bodies. It takes much more than a nutrient to cause these effects. □ Beware of ads that empathize. Don’t be fooled by sites saying they “know how you feel” or they “understand the confusion in choosing a dietary supplement.” This is their way of connecting with the consumer. Their goal is to get the consumer “on their side.” Presented by USA Swimming and the Network Task Force on Dietary Supplements Page 37 of 37