High Intensity Training Workshop and Performance

Optimization Roundtable

Sponsored by the Human Performance Resource Center

September 13-14, 2010Uniformed Services University for the Health

Sciences, Bethesda, MD

Nutrition, Supplements, and High Intensity Training Programs

Patricia A. Deuster, PhD, MPHProfessor and Scientific Director

CHAMP

Objectives• Present picture of dietary supplement use among

active duty personnel

• Discuss concerns and red flags regarding dietary supplements

• Describe nutrition and dietary supplements information associated with extreme exercise programs

• Introduce new DoD classification system for dietary supplements

Supplement Use by Age

0

5

10

15

20

25

30

BodyBuilding

PerformanceEnhancing

WeightLoss

17 to 25 Yrs

26-34 Yrs

≥ 35 Yrs

**

****

Supplement Use by Gender

0

5

10

15

20

25

30

BodyBuilding

PerformanceEnhancing

WeightLoss

MaleFemale **

**

**

Supplement Use by Service

0

5

10

15

20

25

30

BodyBuilding

PerformanceEnhancing

WeightLoss

ArmyAir ForceMarinesNavy

**

**

**

Body Building Supplementsand Drinking

0

5

10

15

20

25

30

BodyBuilding

PerformanceEnhancing

WeightLoss

AbstainLightModerateMod/HeavyHeavy

**

**

**

****

US Army Survey

• 9.1% took combination products: CellTech, Hydroxycut, Nitrotech, or Xenadrine)

• 37.5% took multivitamins/multiminerals

• 18.7% tookprotein and amino acids

• 17.9% used single vitamins/minerals

• 8.3% used herbal supplements

• 2.7% used steroid analogsLieberman et al. AJCN. July 28, 2010

Reasons for Use US Army Survey

• 64.2% to improve general health

• 31.1% to increase energy

• 24.9% to increase muscle strength

• 16.7% to enhance performance

• Persons who strength trained were 8.3 times more likely to take protein and amino acid products

Lieberman et al. AJCN. July 28, 2010

Characteristics of Body Building Supplement Users

• 18 to 25 yo

• A Marine

• Unmarried

• BMI 25 – 30

• Physically active

• Heavy drinker

Stephens et al. found an association between the use of ergogenic supplements and specific health risk behaviors.

Hidden Ingredients

Dietary supplements deliberately contaminated with:– Prescription drug ingredients – Ingredients under clinical investigation w/an IND– Ingredients approved as drugs in other countries– Ingredients removed from US market for safety

reasons – Analogues of prescription drug ingredients– Controlled substances

12

Red Flags• Product categories: weight loss, performance

enhancing, bodybuilding• Label claims like:

– Alternative to [approved drug products]– Do not take if you have any medical condition, if you are taking any

prescription medications, or if you are pregnant– May cause positive result in drug test

• Labels primarily in a foreign language• Directions and warnings resembling FDA approved drug

products

Trends from Iraq

• Warfighters are taking mostly combinations of or “stacked” products readily available at exhanges on base

• “RIP-ITs” are stocked at all DFACs (energy drink supplements)

• Most readily available products:NO products

Rip It® 16 oz Energy Drink

Side Effects Observed in Theatre

• Multiple case reports of syncope, palpitations and lightheadedness from NO products

• Warfighters who become dehydrated appear at increased risk of side effects from caffeine and other vasoactive components

• Case reports of liver toxicity, possibly secondary to NO products

• Rhabdo also seen, but no clearly identifiable supplement connection: possibly secondary to heat, dehydration and vasoactive components

Various Programs

• P90X

• CrossFit

• TRX®

• Military Athlete

• Gym Jones

P90X

Multiple supplements promoted

Nutritional Guideline: Military Athletes

• 6 Days a Week: – Eat lean meat, vegetables, fruit, nuts, seeds,

and drink water.– Don't eat carbs (bread, spuds, rice) or sugar.

• 1 Day a Week:– Cheat like a mother!– Beer, pizza, ice cream - you name it!

Supplement Guideline:Military Athletes

• Supplement diet with protein shakes & creatine to improve strength & recovery– Whey protein is best: Key ingredient is Leucine– Drink 10 min before & 15 min after training– Creatine - Take 20-25 grams/day for 5 days, then

continue with 5 grams/day afterward

• β-Alanine: Take to decrease fatigue, improve recovery, cut body fat and increase lean body mass

CrossFit

• No products promoted - but

http://www.nastyenergy.com/

TRX®

• Partners with Precision Nutrition– No supplement promotions found, but must be

member to access information

Gym Jones• No products promoted

• Blogs on nutrition

Gym Jones

• Drink solution containing 88-90% carbs and 10-12% protein– Several supplements on the market that fit this

profile.

• Check ingredients to learn protein source– Whey peptides are ideal for recovery

• Glutamine contributes to ammonia burden

– Soy protein does not readily produce ammonia

Proposed DoD DS Classification System

• Combines potential benefit with probability of adverse event to estimate risk

• Can be used to assess acceptability of risk

• May be used to prioritize resources, develop educational materials, and standardize response actions

• Can be revised as new evidence and/or adverse events emerge

Dietary Supplement Risk Matrix

1-Safe 2-Safe7-Use w/ Caution

9-Do Not Use

3-Safe 4-Safe8-Use w/ Caution

11-Do Not Use

5-Use w/ Caution

6-Use w/ Caution

10-Do Not Use

12-Do Not Use

Minimal Concern

Low Concern

Moderate Concern

High Concern

Safety

Ben

efit

HighPotential

ModeratePotential

LowPotential

http://www.humanperformanceresourcecenter.org/

Summary

• Supplement use is problematic, particularly in the deployed setting

• Body building and performance enhancing are primary supplements of concern

• Supplements co-exist with HIT programs• Some HIT programs promote supplements

that could be harmful, especially in the deployed setting

?

Protein/Creatine/Amino Acids/Nitric Oxide, Arginine Brand Name/Supplement Name Key IngredientsBSN/Endorush** L-Arginine-Alpha-Ketoglutaric (AKG) Acid

BSN/Cellmass** Sodium Cratine Phosphate Matrix, Creatine Ethyl-Ester B-Alanine Creatinol-O-Phosphate-Malic Acid Interfusion, Creatine-Alpha-Aminobutyric Acid Matrix

BSN/Epozine-O2**L-Arginine AKG, L-Arginine Aspartate, L-Arganine Pyroglutamate, L-Arginine Ethyl Ester, creatine sodium phosphate, creatinol-O-phosphate, Creatine Magnesium Chelate,

BSN/NO-XPLODE**L-Arginine AKG, Di-creatine malate, Creatine Ethyl-Ester B-Alanine Composite, Sodium Creatine Phosphate Matrix, Creatinol-O-Phosphate Malic Acid Interfusion, Creatine-Alpha-Aminobutyric Acid Matrix

BSN/Nitrix**L-Arganine AKG, L-Arginine Ethyl Ester, Creatine Ethyl-Ester B-Alanine Composite, Sodium Creatine Phosphate Matrix, Creatinol-O-Phosphate-Malic Acid Interfusion, Creatine-Alpha-Aminobutyric Acid Matrix

BSN/True Mass Whey protein concentrate, whey protein isolate, calcium caseinate micellar Casin

BSN/Volumize**Leucine Alpha-Aminobutyric Acid Matrix, Valine Alpha-Aminobutyric Acid Matrix, Isoleucine Alpha-Aminobutyric Acid Matrix, Leucine Nitrate, Valine Nitrate, Isoleucine Nitrate

ProLab/Creatine Monohydrate Creatine MonohydrateProLab/Pure Whey Whey protein concentrateProLab/Advanced Whey Protein Whey protein concentrate, whey protein isolateEAS/100% Whey Protein Whey protein concentrate, whey protein isolateMuscletech/Na-NO Vapor Hardcore** L-Arginine, Creatine Monohydrate

Creatine Monohydrate, Creatinol-o-phosphate, creatine taurinate, L-arginine, L-glutamine, L-leucine, L-isoleucine, L-valine

Creatine Monhydre, Creatine Malate, Creatine Taurinate, L-Lysine HCL, L-valine, L-valine Alpha-ketoglutarate, L-isoleucine pyroglutamate, L-leucine Ketoisocaproate, L-leucine pyroglutamate, L-leucine alpha-ketogluarate,

Protein/Creatine/Amino Acids/Nitric Oxide, Arginine Brand Name/Supplement Name Key Ingredients

Muscletech/IntraVol** Creatine Monohydrate, L-ArginineMuscletech/Anabolic Halo Hardcore** L-LeucineMuscletech/Creakic Creatine MonohydrateBody Fortress/Premium Protein Whey Protein concentrate, whey protein isolateMuscletech/Mesotech Complete Whey protein concentrate, Creatine Monohydrate, Amino AcidsMuscletech/Na-NOX9 Hardcore** L-ArginineMRI/NO2 Platinum L-ArginineMRI/NO2 Black Arginine Alpha-ketoglutarateMRI/WAR (Workout Anabolic Recovery) Amino AcidsMuscletech/Celltech** Creatine Monohydrate

Muscletech/Nitrotech** Whey protein concentrate, whey protein isolate, creatine monohydrate

** indicates proprietary blend and amount of key ingredients are unknown

Steroids/Prohormones Brand Name/Supplement Name Key IngredientsPowerlab/Halotest-25 4-cholor-17a-methyl-andro-4-ene3, 17b-diolPowerlab/Pirmabol 2a-17a-dimethyl-17b-hydroxy-5a-androstan-3-one

Powerlab/Androdrol4-cholor-17a-methyl-androst-1,4-diene-3-17b-diol, 2,3a-epithio-17a-methyl-5a-androstan-17b-ol, 13-ehtyl-3-methoxy-gona-2,5(10)dien-17-one, 2a-17a-dimethyl-17b-hydrox-5z-androstan-3-one, 6 bromoandrostenedione

GNC/Mega Man DHEA dehydroepiandrosterone (DHEA)   

Caffeine/Stimulants Brand Name/Supplement Name Key IngredientsBSN/Endorush** Methylxantine (Caffeine and Caffeine-Alpha-Ketoglutaric Acid)BSN/NO-XPLODE** methylxanthine (Caffeine)Premier Nutrition/Rocket Shot** Caffeine AnhydrousStacker/Black Jax Energy Shot** Caffeine AnhydrousMuscletech/Na-NO Vapor Hardcore**  CaffeineXenadrine/Xenadrine Ultra & RZR-X** Caffeine AnhydrousMuscletech/Myoshock** Caffeine AnhydrousMuscletech/Gakic** Caffeine AnhydrousTwinlab/Ripped Fuel 5X CaffeineTwinlab/Ripped Fuel Extreme CaffeineFive Hour Energy/Five Hour Energy Shot** CaffeineBSN/Thermonex** Caffeine Anhydrous, Yerba Mate Leaf (25% caffeine), AMP/Energy Drink** CaffeineFull Throttle Energy Drink** Caffeine, GuaranaMonster Energy Drink** Caffeine, GuaranaMRI/Black Powder** CaffeineRed Bull Energy Drink Caffeine** indicates proprietary blend and amount of key ingredients are unknown