Chapter 27: Ergogenic Aids and the Female Athlete

1. Chapter 27: Ergogenic Aids and the Female Athlete Jacalyn J. Robert-McComb, Ph.D., FACSM Shannon L. Jordan, M.S. Texas Tech University Health, Exercise, & Sports Science

2. Learning Objectives • Discuss potential reasons female athletes take supplements • Highlight likely supplements female athletes take • Describe the ergogenic and ergolytic effects of these supplements • Discuss standard dosages

3. What is an Ergogenic Aid and Why Do Women Take Them? • Ergogenic aids are items or substances which enhance performance. • Collegiate female athletes report taking supplements for the following reasons: • to improve health; • to compensate for an inadequate diet; and • to gain more energy.

4. According to Kristiansen, et al. (2005) and Froiland, et al. (2004), • Female athletes use energy drinks and carbohydrate/meal replacement products the most. • Protein products, amino acids, creatine, fat burners, caffeine, multivitamins, iron, and calcium are some of the most frequently used products.

5. Protein and Amino Acids • Most common forms: • Powders • Bars • Meal Replacers • Amino Acids

6. Listed Reasons Why Females Take Protein Supplements (Kristiansen, 2005) • For enhanced recovery • The taste • To provide Energy • To meet nutritional needs • For enhanced performance • To develop greater muscle strength • ‘I Don’t Know’

7. Forms of Protein Soy Protein vs.Milk Protein Soy protein Lacks the essential amino acids, lysine, and methionine; also contains less branch chained amino acids than milk proteins. Milk protein Casein protein is a milk protein as is whey protein. Net protein synthesis is higher with casein protein than with soy protein. Casein protein has a higher biological value because the slow release property keeps the amino acids from being released rapidly and degraded in the liver into urea (Luiking, Deutz, Jake, et al., 2005). Whey protein is considered rapid release when compared to Casein (slow release preferred).

8. Glutamine • Commonly a component of weight-gain products (a small % of female athletes take this supplement). • Claims: • Enhance protein Synthesis • Offset immunosuppression • However, no long term studies substantiating these claims or ruling out adverse effects

9. Carnitine • Synthesized from lysine and methionine. • Most healthy humans synthesize carnitine • Athletes take L-Carnitine for: • Weight loss purposes • Increased muscle mass • Enhanced β-oxidation • Enhanced recovery from high intensity • exercise.

10. L-Carnitine (an isomer )Findings Effective weight loss agent for obese subjects, however, findings were inconclusive for non-obese subjects (Karlic & Lohninger, 2004). Research findings have shown that athletes who have taken L-carnitine to enhance recovery from exercise have : • Decreased creatine kinase • Decreased Catabolism of purines • Decreased free radical formation • Decreased reported muscle soreness

11. L-Carnitine Dosage Available as a prescription or OTC Daily recommendations are 2-3.5g/d Amounts in excess of 4g/d may result in gastric distress A lethal dose (LD) of 630g/d for humans has been determined from animal studies (Calfee & Lohniger, 2004)

12. Creatine • Composed of: • Arginine (non-essential amino acid) • Glycine (non-essential amino acid) • Methionine (essential amino acid) Average Daily Requirement is 2g/d. • Body produces 1-2g/d. • Best sources of dietary creatine are meat and fish • Vegetarian athletes may have lower muscle creatine stores.

13. Fat Burners and Energy Supplements • The following supplements will be highlighted: • Chinese Ginseng • Siberian Ginseng • Ephedra (Ma Huang) • Bitter Orange • Caffeine

14. Creatine Supplementation Benefits And Recommended Dosage • Optimum usage is for sports with a high percentage of ATP-PC system utilization. • No effects have been found on submaximal efforts • No effects have been found for aerobic endurance activities • Dosage • Loading phase: 5g/d, 4 X’s/d up to 7 days • Maintenance phase: 2g/d for 3 months • Increases muscle creatine stores 10-25% • When creatine is taken with carbohydrates absorption is enhanced. • When creatine is taken with caffeine absorption is inhibited.

15. Ginseng • Reported Benefits: • Improved Mood • Improve Performance • Increase Alertness • Increase Fat Utilization • Two Main Types of Ginseng: • Chinese Ginseng (Panax ginseng) • Siberian Ginseng (Eleutherococcus ginseng)

16. Chinese Ginseng • Reported Benefits (Bucci, 2000; Winterstein & Storrs, 2001) • Improves Strength • Improves aerobic capacity • Requires at least 8 weeks of supplementation with athletic training to see benefits. • Recommended Dosage: • 1-2g/d • Varies based on powder vs. root extract

17. Chinese Ginseng • Reported Side Effects (Bucci, 2000; Winterstein & Storrs, 2001): • Sleeplessness • Nervousness • Hypertension • Dermatological problems • Morning diarrhea • Euphoria • Rx Drug Interactions: • Phenelzine (A monoamine oxidase inhibitor)

18. Siberian Ginseng • Distant relative to Chinese ginseng • Contains different compounds than Chinese ginseng • Previous studies were not conducted well and are unreliable • The few well-designed studies have failed to show an ergogenic benefit (Winterstein & Storrs, 2001).

19. Ephedra • Contains ephedrine and other alkaloids • Sympathomimetic • α and β-agonistic properties • Facilitates catecholamine release • Stimulates the CNS • Uses: • Energy Booster • Fat Burner • Athletic Performance Booster

20. Ephedra • Also called Ma Huang • Studies often pair ephedra with caffeine • Legality of ephedra is still being determined • May be banned by various athletic governing bodies

21. Ephedra Research Findings Many studies also involve caffeine, therefore, the effects due to ephedra are hard to separate from caffeine (Shekelle, et al. 2003). Studies without caffeine do not support the claim of enhanced athletic performance (Calfee, 2006; Bucci, 2000) Claims of weight loss have been substantiated, although many of those studies also contained caffeine (Powers, 2001; Shekelle, et al., 2003).

22. Side Effects of Ephedra (Calfee, 2006; Powers, 2001; Shekelle, et al., 2003 ; Winterstein & Storrs, 2001). • Headache • Tremors • Hypertension • Arrhythmias • Insomnia • Nervousness • Increased heart rate • Note: It has also linked to several deaths!

23. Bitter Orange: A Replacement for Ephedra • Citrus aurantium • Common ingredient in many “Ephedra Free” fat burners • Contains synephrine • Similar effects as ephedra • Commonly paired with caffeine (Bucci, 2000)

24. Caffeine • Varsity female athletes listed these reasons for taking caffeine: • Enhanced Performance • More Energy • Increased alertness • Taste • Listed forms Taken: • Beverages • Tablets • Energy Bars, Drinks, and Gels • Chocolate

25. Caffeine: Mode of Action (Graham, 2003) • Chemical structure resembles adenosine • Binds to adenosine receptors • Stimulates release of epinephrine • Direct mode of action on muscle function • Causes sarcoplasmic reticulum to release more calcium • Caffeine has been reported to: • Enhance β-oxidation • Spare Muscle Glycogen • Sustain Muscle Force Longer

26. Caffeine and Performance • High Intensity Exercise (Doherty, et al., 2004): • Lower Perceived Exertion • Increased Glycolytic Performance* • Increased Blood Lactate* * Not all studies have shown increased performance in glycolytic activities and blood lactate (Greer et al., 1998) • Endurance Exercise: • Main concept id that of fatty acid moblization and glycogen sparing • Prolongs Endurance Exercise ** • ** Mechanism behinds enhanced endurance performance not completely understood

27. Caffeine: Adverse Effects • Mild Diuretic • Dehydration not likely if athlete is properly hydrating • Tachycardia with Exercise • Increased Blood Pressure • Gastrointestinal Distress • Habituation/Addiction There are also effects when discontinuing use: • Headache • Fatigue • Possible Flu-like Symptoms (Ghram, 2 001; Mangus & Trowbridge, 2005)

28. Caffeine: Dosage Caffeine paired with ephedra is potentially harmful and should be avoided (Powers, 2001; Mangus & Trowbridge, 2005 ). Dosage: Endurance Exercise: 3-5mg/kg Since most beverages are variable in the amounts contained, tablets are probably the most effective method.

29. Anabolic-androgenic Steroids (AAS) AAS are synthetic derivatives of testosterone. Adolescent female usage is estimated between 2-5% (Congeni & Miller, 2002; Faigenbaum et al., 1998). Collegiate use may be higher (Evans, 2004) Women typically have <10% the amount of testosterone of men (Evans, 2004). Testosterone and AAS bind to androgen receptors inside the cytoplasm and are transported to the nucleus. This leads to an increase of structural and contractile proteins. (Congeni & Miller, 2002; Calfee & Fadale, 2006; Evans, 2004)

30. AAS: Ergogenic Effects • Anabolism • Anti-catabolism • Aggression • May lead to more intense training • Gains: • Muscle Hypertrophy • Strength Gains • Lean body Mass Increases (Congeni & Miller, 2002; Tokish, et al., 2004)

31. AAS: Adverse Effects • Virilizing Effects: • Hirsutism • Voice Deepening • Male-pattern Baldness • Enlargement of the Clitoris • Menstrual Irregularities • Reduced Breast Size • Continued…………

32. AAS: Adverse Effects Continued • Increased Blood Pressure • Left Ventricular Hypertrophy • Decreased HDL • Hepatic Abnormalities • Dermatological Problems • Psychological Effects • Mood swings • Aggression • Note: Some of these effects are irreversible! The adverse effects far outweigh the benefits for women (Congeni & Miller, 2002; Calfee & Fadale, 2006; Evans, 2004)

33. AAS: Withdrawal Symptoms and other Repercussions • Withdrawal Symptoms: • Depression and Anger (Congeni & Miller, 2002; Calfee & Fadale, 2006) • Injection Related Complications: • Inflammation from repeated use of injection site • Bacterial Infections • Infectious Diseases • Hepatitis B and C • HIV (Calfee & Fadale, 2006; Evans, 2004)

34. Multivitamins • Female athletes stated these reasonsfor taking multivitamins: • Meet Nutritional Needs • Boost Immune System • Boost Energy • Increased Alertness • Habit From Childhood (Kristiansen, et al., 2005; Froiland, et al., 2004) • Many multivitamins marketed as performance vitamins include other herbal supplements. • Athletes, trainers, coaches, and medical Professionals need to be aware of the extra ingredients in the OTC (over the counter) multivitamins since multivitamins are not subject to FDA regulation.

35. Iron • Women in general tend to have more iron deficiency issues than men. • Possible causes of iron deficiency: • Underestimated Menstrual Blood Loss • Inadequate Dietary Intake • Increased Loss from Sweat • Gastrointestinal Blood Loss in Runners • Even slight anemia will negatively impact performance! • (Beard & Tobin , 2001; Nielsen & Nachtigall, 1998)

36. Iron Supplementation • Forms of Iron: • Different forms are absorbed differently • OTC products are unregulated • A Rx Multivitamin with Iron may be the appropriate route for a female athlete with an iron deficiency. • Athletic Performance has not been improved by supplementing non-anemic athletes with iron • Side Effects of Supplementing with Normal Ferritin Levels: • Gastrointestinal Distress • Constipation • (Beard & Tobin , 2001; Nielsen & Nachtigall, 1998)

37. Calcium • Female athletes stated these reasonsfor taking calcium: • Strengthen Bones • Lactose Intolerance • Low Dietary Intake • Dietary protein should be monitored relative to calcium. (Kristiansen, et al., 2005; Froiland, et al., 2004)

38. Calcium: Protein Ratio Increased dietary protein may lower urinary pH and increase calcium excretion (Barzel & Massey, 1998). Increased calcium intake can offset the elevated calcium losses (Dawson-hughes, 2003) 20:1 is the typical recommended ratio for a middle-aged woman (Heaney, 1998). An athlete’s need may be different due to an increased protein consumption to maintain a positive nitrogen balance. Use of the dietary journal is key to assess nutritional consumption information.

39. Summary Many times athletes do not understand supplements, regulations, or how to read the labels on these supplements. OTC supplements are unregulated by the FDA and the product may be adulterated with products not listed on the label, some of which may be banned by athletic governing bodies. Athletes, coaches, trainers, and medical professionals should be well versed on brands, supplements, and regulations before recommending use of a product. Always check the rules of your particular governing body for legality of the supplement in question!