Food Supplements in atheletes -

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					  Food supplements

in the athlete
      Sophie Gosselin
    Emergency Medicine
          McGill
Objectives

• to better understand the pharmacology of the
  most popular molecules.

• know the most common and lethal adverse
  reactions associated with their use.

• to determine when ED physicians should
  – ask about them
  – suspect as potential cause for symptoms
  – suggest referral for nutritional counselling.
Food supplements


• Economic market of several billions of USD.



• Expansion in the last 5 years
   – Internet
   – Lack of regulation
   – Target group vulnerability
Food supplements

• Target group

  – Athletes

  – Teenagers
     • Body image
     • Peer pressure
     • Unsupervised
     • Unrealistic objectives about training
Food supplements

• Ergogenic aid:
  any means of enhancing energy utilization including energy
  production, control, and efficiency.

  – Stimulants; amphetamines, ephedrine, caffeine
  – Reduce tremor and HR; Beta blockers
  – Bodyweight gain or loss; AAS, GH, B2 agonists,
     diuretics

  Strategy is to increase energy consumption, metabolism
  while decreasing adipose tissue formation to the benefit of
  squeletal muscle
Food supplements

•   Creatine
•   Anabolic steroids
•   Clenbuterol
•   Amino acids
•   GHB
•   Chromium picolinate
•   Caffeine, ephedrine, Mg, , EPO, GH
Creatine

•   Formed in kidney, liver @ rate of 2 g/day
•   Meat and fish
•   Typical diet 1-2 g per day
•   95% in muscles (1/3 free Cr, 2/3 PCr)
•   Irreversible conversion to creatinine
Creatine

• Not for aerobic activities
• Acute side effects:
  – Gastrointestinal aches
  – Muscle cramping ( H2O retention in fibers)
  – No long term side effect if therapeutic doses
    and schedules
• Case reports of rhabdomyolysis or
  quadriceps compartment syndrome after
  use.
Anabolic steroids

• mid 1950’s strenght enhancing properties of
  testoterone.
• Minimizing androgenic effect while preserving
  anabolic ones.
• No synthetic molecule dissociating two properties
• Two categories IM vs PO group.
• Androstenedione most popular now.
• DHEA banned by FDA in 1996
   – Media attention cause manufacturers to sell it as
     nutritional aid rather than therapeutic drug.
   – Wild yams sold in health food stores.
Androstenedione

• Endogenously produced
• Prohormones
Androstenedione
• Ergogenic effects
   – Unclear rate of conversion to Testosterone when PO
   – Studies 300 mg/d users ingests 2-3 times this dose



• Anabolic effects
   – Induces protein synthesis
   – Binding to cell cytoplasm
   – Studies at best weak agents
• Androgenic effects
   –   Male differenciation in utero
   –   Maturation of external genitalia
   –   Secondary sex characteristics
   –   Regulation sperm production
Androstenedione

• Data on side effect in users is minimal.
• Some suggest aromatization to estrogen when PO.
• Unclear if produces the side effect of other AAS
   –   Hepatic failure
   –   Hepatocellular carcinoma
   –   Testicular atrophy
   –   Azoospermia
   –   Because no alpha 1 7 alkylation
   –   No increase LFT’s
Anabolic steroids

• Cardiovascular
   – Sudden death, AMI, cardiac hypertrophy
      •   Atherogenic model lipoprotein
      •   Thrombosis model clotting factors
      •   Vasospasm model vascular nitric oxide system
      •   Decrease HDL 53%, increase LDL 36%
      •   Increase fibrosis in myocytes
• Endocrine
   – Feedback inhibition of LH
   – Women and children most at risk
Anabolic steroids

• Musculoskeletal
   –   Growth spurt of adolescence
   –   Premature epiphyseal plate fusion and short stature
   –   Predisposition to tendons rupture with local injections
   –   Abnormal collagen fibers formation (type III)
        • tendinitis
• Metabolic
   – Abolish a negative nitrogen balance
   – Promoting retention Na, K, Po4
   – Decreased urinary excretion of Ca
• Psychiatric
   – Agressivity, mood swings, cognitive impairments
Anabolic steroids

• DHEA
• Few sides effects reporte
• Irreversible virilization of women, hirsutism, voice
  deepening, hair loss
• Irreversible gynecomastia
• Increase risk of uterine and prostate cancer that
  accompagnies unopposed elevation in testosterone
  or estrogen.
Clenbuterol

• Systemic B2 agonist (stimulant)
• Reduce fatigue, sensitivity to pain,
  bronchospasms, tremors
• Increase alertness, reaction time,
  concentration, endurance,
• Promotes muscle growth
• Large reduction in body fat
Clenbuterol

• Stimulate protein deposition in muscles by
  20%
• Reduces glycogen and body fat deposition
• Skeletal muscles:
  – Increases glycolytic capacity
  – Induces a true hypertrophy vs hyperplasia
  – Shift fiber type I (slow twitch) to II (fast)
Clenbuterol

• Approved in Europe, Canada for livestock.
• Most symtoms are tachycardia, tremors,
  headaches, dizziness, nausea, fever.
• Case report of ventricular arrhythmias but
  patient also undergoing hypocaloric diet.
Amino-acids
•   The protein shake
•   Daily requirement 0.8g/kg/d
•   Some benefit from extra 0,5g/kg/d
•   Beta hydroxy beta methyl butyrate
•   Glutamine
•   L-Carnitine

Anticatabolic effects
Amino-acids
• No studies have shown any benefit

• No major side effect

• No well designed studies either
GHB

• Popular in USA as liquid X
• Release GH and burn fat during periods of
  inactivity, such as sleep.
• Investigated to treat EtOH WD in Europe
• Use is illicit
• Potentiates dopamine R in brain and GABA R
GHB

• Side effects:
   – related to decrease LOC
   – absences types seizures.


• OD setting:
   –   Seizures
   –   Respiratory depression
   –   Exacerbation with Et-OH
   –   No response with naloxone
   –   Flumazenil in animals studies
Chromium picolinate

• Essential trace element
• Low GI absorption
• Popularity after found increase chromium loss
  during exercice

• Claims it increases glycogen synthesis
• Enhances action of insulin
• Increase incorporation of AA in muscles
Chromium picolinate

• Major side effects
• Use should be discouraged
• Part of many “combo products”

•   Anabolic steroid effect at dose of 200ug/day
•   Anecdotal report of anemia, cognitive impairment
•   Interstitial nephritis.
•   Gastritis and GI intolerance if
    – > 200 ug/d
    – more than one month “ treatment”
Route of administration

•   PO
•   IM
•   SC for EPO
•   Needle sharing
     – Across users
     – Across times
Available products

•   Different brands
•   Differents dosages
•   Purity issues
•   Combinations within same product
Drug abuse

• Users are adolescent
• Increased risk of engaging in other drug use
   –   marijuana
   –   Et-Oh
   –   Smoking
   –   IV drug use
Possible scenarios

•   Gastrointestinal symptoms
•   MSK: tendinitis, myalgias
•   Renal failure
•   Chest pain
•   Yearly “medicals” in sports clinics.
Parallel with Viagra, nitrates and chest pain
Conclusion
• Likely increase in incidence.
• Easy to get, unregulated
• Mosty long term adverse effects
• Symptoms that are frequent chief complaints
  in our ED.
• We might not know unless we ask
• Fragile, “uneducated”, unsupervised clientele.

				
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posted:5/9/2010
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