A Review of Magnesium, Iron, and Zinc Supplementation Effects on Athletic Performance

한국체육학회지, 2017, 제 56 권제 1 호, 797-806 The Korean Journal of Physical Education, 2017, 56(1), 797-806 http://dx.doi.org/10.23949/kjpe.2017.01.56.1.59 ISSN 1738-9666(Print) / ISSN 2508-7029(Online) A Review of Magnesium, Iron, and Zinc Supplementation Effects on Athletic Performance 마그네슘, 철, 아연보충제섭취가운동선수의퍼포먼스에미치는영향 Lee, Namju Jungwon Univ. 이남주 * 중원대학교 Abstract Athletes are usually engaged in hard physical training and therefore, they need to have increased demand for energy intake and micronutrients as well which are sufficient to meet their needs. This study focuses on minerals as dietary supplements and their efficacy to enhance athletic performance. This article reviewed previous mineral studies related to athletic performance including pro and cons of mineral supplementation effects. Among minerals, this study reviewed magnesium (Mg), iron (Fe), zinc (Zn), and combined minerals. Based on previous studies, Mg, Fe, and Zn have been considered to have or have not an effect on physical performance although they had various positive effects on the human body. In addition, combined minerals are generally shown to be effective to enhance athletic performance. Adequate nutritional intake is necessary for maintaining health and obtaining ideal performance in athletes and thus a mineral deficiency may impair athletic performance. To clarify an association of mineral supplementation and athletic performance, further studies need to consider various factors related to affect athletic performance. Key words: nutrition, mineral supplementation, performance 요약운동선수들은평소고강도의신체적트레이닝에노출되어있기때문에그러한필요에의해서많은에너지요구량과소량영양소의섭취가꼭필요하다. 따라서이연구는영양보조제로서의무기질이선수들의경기력을향상시키기위한효능에대하여초점을맞추어문헌연구를하였고운동선수들의경기력과연관된무기질섭취관련선행연구들을분석하여무기질섭취가경기력에미치는긍정적인영향과부정적인영향에대해서술하였다. 아울러이연구는무기질들중에서마그네슘, 철, 아연, 복합무기질을위주로선행연구들을조사하여인체의미치는전반적인영향을제외하고운동선수들의경기력에영향을미치는관점에서만서술하였다. 적절한영양소섭취는건강을유지하고이상적인경기력을위해서필수적이기때문에무기질부족은운동선수의경기력에영향을미치게됨으로운동선수의경기력과무기질보조제의정확한연관성을알아보기위한후속연구는운동선수의경기력에영향을미칠수있는다양한요소들을고려하여연구해야한다고보여진다. 주요어 : 영양, 무기질영양보충제, 경기력 This work was supported by the Jungwon University Research Grant (2016-102). * namju1210@gmail.com Copyrightc2017 KAHPERD

798 한국체육학회지제 56 권제 1 호 Introduction It has been well known that minerals are important to athletes for their involvement in athletic performance such as muscle contraction, nerve impulse, oxygen transport, enzyme activation, immune functions, antioxidant activity, bone health, and acid-base balance of the blood (Akabas and Dolins, 2005; Aoi et al., 2006; Maughan, 1999). Thus, minerals are essential for a wide variety of metabolic and physiological process in the human body. It has been known that about 20 minerals are needed to properly function in the human body and minerals are generally divided into two classes; macrominerals and trace elements (Maughan, 1999; Williams, 2005). Athletes are usually engaged in hard physical training and therefore, they need to have increased demand for energy intake and necessary micronutrients which are sufficient to meet their needs. Moreover, athletes want to maximize performance so they may try to use dietary supplements to obtain competitive advantages and thus high-performance athletes consumed more dietary supplements (Sousa et al., 2015). Additionally, a recent study (Kiertscher and DiMarco, 2013) investigated collegiate athletes supplement intake trend and it mentioned that maintaining health (70%), providing energy (22%), protecting joint and bones (21%), having muscle strength (19%), and improving performance (17%) were the most important reasons for taking nutritional supplements in athletes. Several previous studies proved that minerals are associated with enhancing and/or maintaining physical performance. Minerals are key regulators of health and performance and provide optimal function of the human body (Potgieter, 2013; Vaz et al., 2011, Veasey et al., 2015) and therefore, physiological impairment of the body is associated with micronutrient deficiency (Lukaski, 2004; Zimmermann, 2003). Especially, magnesium (Mg), iron (Fe), and zinc (Zn) have been considered to affect physical performance in athletes (Lukaski, 2000; Lukaski, 2004; Maughan, 1999; Morrison and Campbell, 1963) (Table 1). Based on the recommended dietary allowances (RDAs), Mg is 400mg/day, Fe is 8mg/day for men and 18mg/day for women, and Zn is 11mg/day for men and 8mg/day for women (Lukaski, 2000). Otherwise, it would be possible to evoke side effects when human takes a massive dose of minerals. Hypermagnesemia, defined as a plasma total magnesium Table 1. Exercise-related functions and deficiency symptoms of minerals Types Functions Deficiency Symptoms Magnesium (Mg) Iron (Fe) Zinc (Zn) Energy metabolism Muscle contraction Nerve conduction Hemoglobin synthesis Oxygen transport Carbon dioxide removal Glycolysis Nucleic acid synthesis Irritability Muscle weakness Nausea Anemia Cognitive impairment Immune abnormalities Growth retardation Immune abnormalities Loss of appetite

마그네슘, 철, 아연보충제섭취가운동선수의퍼포먼스에미치는영향 799 concentration greater than 1.2 mmol/l, is less common than hypomagnesemia; however, it can induce diarrhea and kidney malfunction (Moe, 2008). Also, Fe overdose can cause acute hepatic necrosis and lead to multi-organ failure and death especially in children (Abhilash et al., 2013) and extracellular Zn can induce numerous acute and physiological toxic effects in neurons by acting at their plasma membrane (Ekstein et al., 2012). Minerals is known to be effective in metabolism and the adverse effect of deficiency is well proved and easily demonstrated; however, it has been studied that vitamin and mineral supplementation does not enhance anaerobic exercise or prolonged endurance performance (Fry et al, 2006; Knechtle et al., 2008; Singh et al., 1992; Weight et al., 1988). Therefore, the purpose of this study was to review previous studies for further information related to mineral effect on athletic performance that would be need for athletes to provide any specific recommendation and/or prediction for their supplementation. This study focuses on minerals as dietary supplements and their efficacy to enhance athletic performance although minerals have various metabolic and physiologic process in the body. Effects of mineral supplements on athletic performance 1. Magnesium Magnesium (Mg) plays an important role in many cellular reactions as an antioxidant that protect the cell from damage and thus it is a physiological regulator in the human body. Mg also has an important role in glycogen breakdown, fat oxidation, and protein synthesis in the human body during exercise (Lukaski, 2000). Mg has important role in cellular metabolism and regulates neuromuscular, cardiovascular, immune, and hormonal functions (Lukaski, 2004). Based on the previous studies, elite athletes consumed Mg ranged from 45% to 117% of the daily recommended amount (Fogelholm et al., 1992; Knechtle et al., 2008). Several studies have investigated the effect of Mg supplementation on performance and they concluded positive effect of Mg supplementation on performance. Lukaski (2001) mentioned that Mg supplementation improved strength and respiratory function in athletes. Lukaski and Nielsen (2002) investigated the effects of Mg during submaximal exercise in 10 postmenopausal women, 45-71 years old, not receiving hormone replacement therapy. Red blood cell(rbc) count, Mg concentration, Mg retention and skeletal muscle Mg concentration were decreased when dietary Mg was restricted. Peak oxygen uptake (VO 2max), total and cumulative net oxygen uptake determined by using indirect calorimetry, and peak heart rate were increased by up to 1%. These findings indicate that dietary Mg depletion results in increased energy needs and adversely affects cardiopulmonary function during submaximal exercise. Another study (Brilla and Haley, 1992) investigated the effects of dietary Mg on strength improvement during a doubleblind, 7-week strength training program in 26 untrained subjects. Mg intake included diet to 8 mg/kg body weight/day. Each subject conducted 3 sets of 10 repetition leg press and leg extension for 3 times per week. Both groups gained strength, however, results indicated a significant increase of about 15% in the Mg group compared to the control and this implicated Mg intake

800 한국체육학회지제 56 권제 1 호 positively affected performance. Powers et al. (2004) also reported that Mg supplementation might improve cardiorespiratory function in athletes. They mentioned that exercise-induced oxidant formation can contribute to muscle fatigue and there would be needed to examine the effects of antioxidant supplementation on performance. On the contrary, Zimmermann (2003) reviewed that Mg supplementation does not affect performance when serum Mg is within the normal range of values and the review also suggested that the effect of Mg supplementation might be equivocal. In addition, Manore et al.(1995) investigated that Mg supplementation (250mg per day) of men during 12-week placebo-control trial increased VO 2max; however, they did not find improved performance under the program of aerobic or a combination of aerobic and anaerobic activities. Newhouse et al. (2000) also concluded that Mg supplementation effect on performance was equivocal under strength, aerobic, and anaerobic situation. Summarizing previous studies, it has been shown that Mg supplementation may be preferable for maintaining To date, there is limited evidence that Mg supplementation will improve human performance. Furthermore, it is currently unclear whether regular exercise increases the need for dietary intake of Mg supplements. Longitudinal studies would be necessary for verifying Mg supplementation effect in athletes. 2. Iron There is still debate in the literature that endurance athletes tend to have low iron (Fe) stores. Otherwise, Fe has been considered to have an important role for supporting protein and enzyme functions which is essential for physical performance especially in female athletes. Also, iron has been known to be essential for maintaining physical and cognitive performance (McClung et al., 2014). Fe plays an important role as the form of the hemoglobin and thus is associated with oxygen carrying capacity and exercise performance (Maughan, 1999; Morrison et al., 1963; Nielsen and Nachtigall, 1998; Williams, 2005). Therefore, Fe has been considered as one of the most critical minerals related to athletic performance. Several studies determined that Fe supplementation leads to an increase in aerobic performance capacity in athletes. Nielsen et al. s study (1998) mentioned that Fe intake and/or supplementation can improve performance. Similar with the study, Friedmann et al. (2001) investigated the effect of Fe repletion in 40 young athletes and they conducted 12-week study with Fe supplementation by 100mg for 2 times per day under aerobic and anaerobic exercise treatment. They found that only Fe treated group of maximal oxygen consumption and oxygen consumption were significantly increased compared to placebo group. In contrast, Fe intake did not evoke differences in athletic performance. Tsalis and colleagues (2004) conducted a supplementation and dietary randomized control trial for 6-month intervention of Fe supplement and Fe rich diet in 21 male and 21 female adolescent swimmers and they concluded that there was no significant difference in swimming performance although the results showed significant fluctuations of iron status during the training season, including an increase in erythrocyte parameters during moderate intensity training. Also, Burke et al. (2012) did a

마그네슘, 철, 아연보충제섭취가운동선수의퍼포먼스에미치는영향 801 dietary randomized control trial of Fe in 14 male and 14 female collegiate runners during 8 weeks and they found that there was no significant change in VO 2max between iron intake group and control group although female athletes had an increased hematocrit level. It has been noted that Fe deficiency anemia would be likely to be higher in athletic groups compared to healthy sedentary groups because they usually have exercise-induced increased plasma volume although they have more Fe amount in the blood (Beard and Tobin, 2000). Haas and Brownlie (2001) investigated that Fe deficiency impairs muscular performance in humans and they recommended that if an athlete easily fatigues and does not perform up to their athletic capacity, Fe deficiency anemia might be suspected In addition, it would be recommended that practical considerations for enhancing iron absorption may be taking vitamin C especially in female athletes (Alaunyte et al., 2015). Summarizing previous studies, it has been stressed that Fe supplementation may be effective for increasing aerobic capacity; however, it should be considered that Fe deficiency condition might affect the effect of Fe supplementation, which can cause different Fe supplementation effect in athletes. 3. Zinc Zinc (Zn) contains enzymes for macronutrient metabolism and cell replication and is involved in metabolism during exercise (Lukaski, 2000; Vallee and Falchuk, 1993). Zinc is an important factor for enhancing immune function by increasing neutrophils to produce reactive oxygen species (ROS) after exercise (Micheletti et al, 2001; Spector, 2000). Based on the previous studies, elite athletes consumed Zn ranged from 73% to 132% of the daily recommended amount (Fogelholm et al., 1992; Worme et al., 1990). Zinc also have a benefit for improving performance by recruiting fast twitch muscle fibers (Krotkiewski et al., 1982) and is involved in muscle energy production and protein synthesis, which is important to physical performance (Williams, 2005). Krotkiewski et al. (1982) conducted a study for estimating muscle strength and endurance in 16 women. All participants consumed 135mg Zn per day during 14 days in a double-blinded and crossover design. They had significantly higher dynamic isokinetic strength at angular velocity and endurance compared to placebo group. Based on the previous study (Micheletti et al., 2001), a Zn deficiency decreased body weight, latent fatigue, and endurance in athletes. Conversely, Wilborn et al. (2004) found that Zn with Mg supplementation did not show an ergogenic effect in athletes. They investigated 42 resistance trained males and 8-weeks of standardized resistance-training was conducted. Results indicated that Zn with Mg supplementation did not significantly increase serum Zn levels and no significant differences were observed between supplementation and placebo group in anabolic or catabolic hormone status, body composition, bench press and leg press, upper or lower body muscular endurance, or cycling anaerobic capacity. The study indicated that Zn with Mg supplementation during training did not enhance training adaptations in resistance trained populations. Previous studies determined that Zn supplementation have a positive effect on hematological parameters in athletes, which may lead to better athletic performance and enhanced

802 한국체육학회지제 56 권제 1 호 endurance. Kilic et al.(2004) conducted 4 week of Zn supplementation (3mg/kg) in 30 athletes and they were equally divided into 3 groups; Zn supplementation with exercise group, exercise only group, and Zn supplementation only group. The study found that the level of erythrocytes, leukocytes, thrombocytes, and hemoglobin in the Zn supplementation with exercise group was significantly higher compared to other 2 groups. Similar as the prior study, Polat (2011) investigated the combined effects of exercise and 8 week of Zn supplementation (2.5mg/kg) in 24 male kick boxers and they were randomly divided into 3 groups; Zn supplementation with exercise group, Zn supplementation without exercise group, and no supplementation without exercise group. This study also concluded that the level of erythrocytes, leukocytes, hemoglobin, and platelet in the Zn supplementation with exercise group was significantly higher compared to other 2 groups. Summarizing previous studies, the complication of Zn supplementation results in this review suggests that various endogenic condition in athletes may affect performance enhancement under different type of exercise; however, it seems that Zn supplementation effect on performance enhancement would be much clear when comparing any other mineral intake. 4. Combined minerals Weight et al. (1988) investigated the effect of vitamin and mineral supplementation on the running performance in 30 male trained athletes. The study was a 9-month, double-blind, crossover, and placebo-controlled design. All participants took maximal treadmill test before and after 9-month training combined with supplements. The essential finding of the study was that there was no significant effect of vitamin and mineral supplementation on maximal oxygen consumption, blood lactate, and peak running speed in athletes. Vaz et al. (2011) investigated 120-day consumption of 19 key vitamins and minerals in children although not in athletic population. Participants were given 40 g fortified (19 key vitamins and minerals) and unfortified choco-malt beverage, respectively, daily for 120 days and they found that multiple micronutrient supplementation improved as a 20-m shuttle test and step test by up to 18% increase. There was a within-subject increase in aerobic capacity and whole body endurance accompanied by a significant improvement in the status of 19 key vitamins and minerals. The study suggests that multiple micronutrient supplementation in similar populations may be beneficial in improving micronutrient status and enhancing aerobic capacity and endurance in children. Veasey et al. (2015) investigated the administration of a vitamin and mineral complex with guaraná effect on mental fatigue and performance. Forty active males consumed vitamin and mineral complex with guaraná or placebo prior to a 30-min run at 60% VȮ2max. Supplementation prior to exercise led to a small but significant reduction in Rating of Perceived Exertion (RPE) during exercise compared to the placebo. The vitamin and mineral complex with guaraná combination also led to significantly increased accuracy of numeric working memory by 2% and increased speed of picture recognition by 50 millisecond faster, compared to the placebo. These findings demonstrate that consuming a vitamin and mineral complex containing guaraná, prior to exercise, can positively impact subsequent

마그네슘, 철, 아연보충제섭취가운동선수의퍼포먼스에미치는영향 803 memory performance and reduce perceived exertion during a moderate-intensity run in active males. Habte et al. (2015) investigated combined mineral status of different distance runners and they reported that high performer runners had higher mean values of micronutrients. The low, medium and high dietary diversity terciles were 36.1, 60.9 and 3.3 % respectively. The mean ± Sd of dietary diversity was 5.44 ± 1.8. Prevalence of iron overload (Serum ferritin >200 μg/l) was 11 % and iron deficiency was 3%. The iron status of male athletes was significantly different by running-distance categories. In contrast, such difference was absent for female athletes. Recently, Kennedy et al. (2016) noted that multivitamins and minerals might exert increased fat oxidation by 13%, total somatic energy expenditure by 5% during task performance followed by 8-week supplementation in 97 healthy females. Jung et al. (2013) examined the effect of calcium, magnesium, phosphorus, and iron supplementation in oriental supplement on 928 varsity athletes and simliar as the previous studies, they concluded that athletes might have a positive effect of minerals on performance enhancement although oriental supplement had a small amount of combined minerals. Summarizing previous studies, many researchers have reported that consuming combined minerals and/or vitamins may be more effective way to enhance athletic performance and maintain health especially in athletic population rather than taking minerals or vitamins each. Conclusion Research designs of previous mineral studies may limit conclusions about dietary recommendations for optimizing performance. Although the benefits of mineral supplementation may depend on the mineral status of each athlete, it is natural that mineral supplementation would be the essential way to maintain and promote physical performance and protect against injury in athletes. Based upon previous studies, it clearly seems that adequate nutritional intake is essential for maintaining health and obtaining ideal performance in athletes and thus mineral deficiency may impair athletic performance. To clarify an association of mineral supplementation and athletic performance, this review suggests that future studies would have a prolonged treatment period (at least 12 weeks) with standardized conditions of administration (use of a pharmaceutical supplement preparation with known high bioavailability and a dosage per day and taken on an empty stomach). In addition, longitudinal studies would be necessary to better understand mineral supplementation effects on athletic performance. References Abhilash KP, Arul JJ, Bala D. (2013). Fatal overdose of iron tablets in adults. Indian Journal of Critical Care Medicine, 17(5), 311-313. Akabas SR, Dolins KR. (2005). Micronutrient requirements of physically active women: what can we learn from iron? American Journal of Clinical Nutrition, 81(5), 1246S- 1251S. Alaunyte, L., Stojceska, V., Plunkett, S. (2015). Iron and the female athletes: a review of dietary treatment methods for improving

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806 한국체육학회지제 56 권제 1 호 Sousa, M., Fernandes, M. J., Carvalho, P., Soares, J., Moreira, P., Teixeira, V. H. (2015). Nutritional supplements use in highperformance athletes is associated with lower nutritional inadequacy from food. Journal of Sport and Health Science, http://dx.doi.org/10.1016/j.jhs. 2015.01.006 Spector A. (2000). Review: Oxidative stress and disease. Journal of Ocular Pharmacology and Therapeutics, 16(2), 193-201. Tsalis, G., Nikolaidis, M. G., Mougios, V. (2004). Effects of iron intake through food or supplement on iron status and performance of healthy adolescent swimmers during a training season. International journal of sports medicine, 25, 306-313. Vaz M, Pauline M, Unni US, Parikh P, Thomas T, Bharathi AV, Avadhany S, Muthayya S, Mehra R, Kurpad AV. (2011). Micronutrient supplementation improves physical performance measures in Asian Indian school-age children. Journal of Nutrition, 141(11), 2017-2023. Veasey, R., Haskell-Ramsay, C. F., Kennedy, D. O., Wishart K., Maggini S., Fuchs, C. J., Stevenson, E. J. (2015). The effects of supplementation with a vitamin and mineral complex with Guaraná prior to fasted exercise on affect, exertion, cognitive performance, and substrate metabolism: a randomized controlled trial. Nutrients, 7, 6109-6127. Weight LM, Myburgh KH, Noakes TD. (1988). Vitamin and mineral supplementation: effect on the running performance of trained athletes. American Journal of Clinical Nutrition, 47(2), 192-195. Wilborn C. D., Kerksick, C. M., Campbell, Bb I, Taylor, L. W., Marcello, B. M., Rasmussen, C. J., Greenwood, M. C., Almada, A., Kreider, R. B. (2004). Effects of Zinc Magnesium Aspartate (ZMA) Supplementation on Training Adaptations and Markers of Anabolism and Catabolism. Journal of International Society of Sports Nutrition, 31;1(2): 12-20. Williams M. H. (2005). Dietary Supplements and Sports Performance: Minerals. Journal of the International Society of Sports Nutrition, 2(1), 43-49. Worme JD, Doubt TJ, Singh A, Ryan CJ, Moses FM, Deuster PA. (1990). Dietary patterns, gastrointestinal complaints, and nutrition knowledge of recreational triathletes. American Journal of Clinical Nutrition, 51(4), 690-697. Vallee BL, Falchuk KH. (1993). The biochemical basis of zinc physiology. Physiological Reviews, 73(1), 79-118. Zimmermann M. B. (2003). Vitamin and mineral supplementation and exercise performance. Schweizerische Zeitschrift für Sportmedizin und Sporttraumatologie, 51(1), 53-57. 논문투고일 : 2016. 11. 30 논문심사일 : 2016. 12. 13 심사완료일 : 2016. 12. 26