Sport supplements side effects

Transcription

1 Sport supplements side effects Dr Nenad Dikic Anti-doping agency of Serbia Usage of supplements is only the problem of athlete? Positive on THG! 1. Only responsible persons are athletes. Melissa Pri ce Kevin Toth Regina Jacobs John McEwen 2. Only athletes feel side effects. Positive on Stanozolol! Dwain Chambers Ben Johnson (1988) Canada - sprint Patrick Jarrett (2001) Jamaica - sprint Mabel Fonseca (2004) Irina Korschanenko (2004) Puerto Rico - wrestling Russia - shotput Anton Galkin ( 2004) Russia - Sprint James Brack (2004) Greece - Baseball

2 The problem of supplementation in sport Optimal nutrition Appropriate use of nutritional supplement products Responsibility Before supplementation Inappropriate Calories Fluids Calcium Iron... It is ironic that we spend much time addressing micronutrient issues when many athletes have nutritional issues of a more fundamental nature.

3 Concerns with Supplements 1. May cause positive drug tests 2. Non-regulated 3. Not necessary! 4. May be hazardous to Health 1. Supplements could be doping positive Supplements could be doping positive!

4 IOC Nutritional Supplement Analysis Country Products + ve % age Netherlands 31 UK 37 USA 240 Italy 35 Germany % % % % % Schanzer et al Analysis of Nutritional Supplements Results of an International Study 634 non-hormonal nutritional supplements purchased in 13 countries from 215 different suppliers 94 contained anabolic androgenic steroids not declared on label consumption of such nutritional supplements can lead to positive results in doping tests Int J Sports Med 2004;25:

5 2. Supplements are non regulated As a result of the Dietary Supplement Health and Education Act passed by Congress in 1994, products marketed as dietary supplements are not reviewed by the FDA for effectiveness or safety. Medical Letter,, 37:112, Nov. 24, Supplements are not necessary? If energy intake is high and a varied diet is consumed, supplementation of the diet with vitamins and minerals is not warranted, unless a specific deficiency is identified. Maughan R, Proc Nutr Soc, 2002

6 However supplements may be required by athletes who restrict energy intake, have severe weight-loss practices, eliminate one or more food groups from their diet, or consume high-carbohydrate diets with low micronutrient density. Position of Dietitians of Canada, the American Dietetic Association ion and the American College of Sports Medicine. Endorsed by the Coaching Association of Canada Supplements at the Sydney Olympics, Athletes tested 2,167 declared a medication or supplement 569 did not declare a medication or supplement 542 took more than 5 a day 1 athlete took 26! Corrigan B & Kazlauskas R Unpublished

7 Doping control by ADAS Doping control on 147 athletes 63% (94) use supplements Max number of supplements per athlete: 7 4. Supplements may be hazardous to health EPHEDRINE: Boosts metabolism; burns fat; increases alertness & endurance Side effects: anxiety; ventricular dysrhythmias; ; hypertension; hallucinations; addiction Banned by IOC, NCAA, NFL Am J Sports Med 2004;32(6):

8 Ephedra induced Coronary Spasm LAD Artery Coronary Spasm Adverse Events with Ephedra Alkaloids (Major reasons for use: weight loss or athletic performance) 140 reports reviewed Deaths: 10 Permanent Impairment: 13 Ongoing Treatment: 8 Full Recovery: 42 Unknown: 14 Of the 10 patients who died or had permanent disability 5 had no pre-existing existing conditions or concurrent risk factors. Haller & Benowitz, NEJM 2000

9 Possible Side Effects of Supplements Dehydration Heat-Related Injuries Nervousness and Dizziness Changes in Blood Pressure and Heart Rate Heart Attack Possible Side Effects of Supplement Use (con t( con t.) Strokes Seizures Psychosis Death Interaction with medications Positive drug tests due to contaminated supplement

10 Frequency of Adverse Effects Dehydration 40% Palpitations 24% Abdominal Pain 15% Dizziness or Confusion 13% Numbness of Extremities 2% Tremors 2% Source: MAJ S Corum, MBA, RD: Dietary Supplement Consumption in Active Duty Enlisted European Population, Feb-Nov Note: Preliminary Data Analysis Top Vitamins & Minerals Multivitamin Vitamin C Calcium Vitamin E Iron

11 Side effects Multivitamin various side effects. Vitamin C diarrhea and nausea, interfere with anticoagulant medications, should be avoided in individuals with a history of renal stones or hemachromatosis. Calcium constipation, increased risk of urinary stone formation and kidney dysfunction, interfere with the absorption of other minerals in the body. Vitamin E should be avoided in people with blood-clotting problems and in people taking anticoagulant medications. Iron certain diseases such as hemochromatosis should avoid taking iron supplements. Top Herbal Supplements Ginseng Garlic Ginkgo biloba Echinacea Guarana

12 Side effects Ginseng: Headache, insomnia, rash, anxiety, diarrhea, high blood pressure, hypoglycemic effect Garlic: Mild gastrointestinal discomfort, undesirable body odor, itching, rash, interfere with aspirin or anticoagulant medications Ginkgo biloba: Headache, dizziness, heart palpitations, and allergic reaction. No with aspirin, Vitamin E, garlic, ginger, Coumadin, or Heparin. May increase blood sugar in people with diabetes. Echinacea: Short-term fever, nausea, and vomiting. Should not be taken by people with diabetes, lupus, HIV, multiple sclerosis, turberculosis, or other auto-immune diseases. Guarana: May cause jittery nervousness, tremors, dizziness. Adverse effects increase dramatically if used in conjunction with ephedra-containing products. Variation of side effects Analysis of 25 commercial ginseng products from a local health food store. Concentrations of marker compounds were significantly different from the amounts indicated on the labels. Siberian ginseng products showed the most inconsistency (versus Asian ginseng). Liquid extracts varied more than powdered products. Variability from product to product was significant.

13 Top Supplements to Enhance Performance Among Men Creatine Ephedra Amino Acids Glucosamine Androstenedione Among Women Creatine Amino Acids Ephedra Glucosamine HMB 120 Frequency of food supplements VITAMINI MINERALI AMINOKISELINE ENERGETSKI NAPICI KREATIN BILJNI PREPARATI PROTEINI L KARNITIN GLUTAMIN UGLJENI HIDRATI OSTALO

14 Top vitamins and minerals Multivitamini Vitamin C Vitamin E Ostali 0 Multiminerali Kalcijum Magnezijum Elektroliti VITAMINI MINERALI Side effects Creatine: Weight gain, muscle cramping, nausea, diarrhea, kidney problems. Ephedra: Numerous side effects, including tremors, seizures, heart palpitations, heart attacks, strokes, increased blood pressure and even DEATH! NO if have high blood pressure, glaucoma, or enlarged prostate. NO with MAO inhibitors, guanethidine, or cardiac glycosides. Sale of this dietary supplement was officially banned on April 12, Amino Acids: Increased risk for dehydration and stress on the kidneys

15 Side effects Glucosamine: Minimal side effects. Many supplements sold do not actually contain glucosamine. Androstenedione (Steroid produced by the body): Acne, increased aggressiveness, increased LDL (bad) cholesterol, decreased HDL (good) cholesterol, decreased sperm production, stroke, heart attack, heart muscle damage, stunted growth in teens. Raises estrogen (female hormone) levels in men. HMB (beta-hydroxy-beta-methyl butyrate). HMB is part of the amino acid, leucine. More research is needed to determine possible side effects. None have been reported in doses of less than or equal to 4 grams per day. Ephedra-Free? supplements Has other stimulants: Bitter Orange (Synephrine) Caffeine Guarana Cola nut Mate Marketed as safer than ephedra products However, synephrine is virtually identical in action to ephedrine-containing products

16 Side effects Bitter Orange (Synephrine): May raise blood pressure or make hypertension worse. Can interact with many medications and cause increased side effects. Guarana: May cause jittery nervousness, tremors, dizziness. Caffeine: Increased irritability, increased urine output, dehydration, increased heart rate. May also cause stomach upset. Cola nut: Restlessness, stomach upset, excitability, and difficulty falling asleep. People with stomach ulcers should avoid cola nut. Mate (pronounced matay ): Associated with increased risk of mouth and throat cancer. DRUGS vs SUPPLEMENTS DRUGS Must be proven be safe before approved for the market. SUPPLEMENTS Must be proven harmful before removed from the market.

17 How do you know if a product is safe? You Don t.

18 16,2 mil Nutritional Supplements A veritable witches-brew of products Quality control and labeling issues Aggressive marketing practices Health consequences Need for review of regulatory practices

19 ?? Supplements cannot replace meals! Eat a Variety of Nutritious Foods

20 Choose Food Instead of Supplements Food Fun Offers variety Doesn t have to be expensive Contains other healthful substances Safe Supplements Boring Lacks variety Can cost a lot of money Doesn t contain other health benefits Can be dangerous to your health

21 Guidelines for Using Supplements Get objective information from a professional such as a Registered Dietitian, Nurse, or Doctor Obtain your health care provider s approval Read the label carefully Do not exceed dosage recommendations Discontinue use if you experience adverse side effects and report these to the FDA Guidelines for Using Supplements (con t Purchase supplements from reliable producers Be aware of sensational claims Do not take supplements if you are pregnant, breastfeeding, or taking prescription medications con t.)

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