Dietary Supplements Risks and Benefits

- Nutrition and Health in Elite Hockey Players Dietary Supplements Risks and Benefits - Dipl. Sportlehrer - Dipl. Oecotrophologe - Institute of Biochemistry - momentum German Research Center of Elite Sports -

Top Athlete Standardized Athlete? One Size does not fit all! Quelle: www.howardschatz.com

Top Athlete Standardized Athlete? 146 kg, 183 cm ~ 8000 kcal pro Tag 43 kg, 153 cm ~ 1800 kcal pro Tag

Olympic Games London 2012 London 2012 Men s High Jump www.london2012.com http://www.london2012.com

Dietary Supplements Statements Leading sport organizations (IOC, FIFA, IAAF, ACSM) recommend that : athletes should ensure they have a good diet before contemplating supplement use individual nutrition consulting young athletes ~18% olympic athletes ~54% DS should not be used by underage athletes Maughan et al. (2007) dietary supplement use young athletes ~80% olympic athletes ~95% Braun et al. (2009) Supplement use requires individual assessment and advice by a qualified sports nutrition professional and medical practitioner. Maughan et al. (2007)

Dietary Supplements - Risks and Benefits Introduction Prevalence of Dietary supplements Groups of Dietary supplements Sports Drinks Sport Gels & Sport Bars Protein & Protein Components Micronutrients Ergogenic Aids Contamination & Doping Summary

AIS Supplement Classification System www.ausport.gov.au

Reference Intake Risk of Supplementation

Pilot Study DS use and micronutrient intake April/May 2011 27 athletes (15,6 ± 2,1 years) No athlete reported nutrition consulting before 12 athletes (44%) used DS 16 different products (14 x vitamins/minerals, 1x amino acids, 1x protein powder + VitMin) Athlet Nr. DS product Amount per week 1 Orthomol Sport 7 1 Am Sport Aminosäuren 70 g 1 Ferro Sanol 100mg 7 2 Biolectra Magnesium (365 mg) 6 3 Orthomol Sport 6 3 Cevitt Immun direct (C+Zink) 1 4 All Vital Zellschutz 17 4 All Vital Vitamin B Komplex 14 5 Ferro Sanol 100 mg 7 6 Champ Muscle 90 Protein Shake 15 g 7 Juice Plus Obst 3 7 Juice Plus Gemüse 4 8 Taxofit Eisen Plus Vitamin C (50mg + 50mg) 4 9 Magnesium 400 mg Kneipp 2 10 Magnesium Abtei 400 mg + C 80mg + E 12 mg 2 11 Magnesium, Kneipp Calcium 400mg + Mg 245mg + C 37 mg 7 11 Das gesunde plus Vitamin Sticks (Multivitamin) 7 12 Hämatopan 75 mg Eisen 7

Pilot Study DS use and micronutrient intake Vit. A Vit. D Vit. E Vit. B1 Vit. B2 Niacin Pantothenic Acid Vit. B6 Biotin Folic Acid Vit. B12 Vit. C Potassium Calcium Magnesium Iron Zinc Copper Mangan Fluoride Iodine 0% 50% 100% 150% 200% 250% 300% 350% Without DS < 100% RDA Vit. A 6 Vit. D 11 Vit. E 6 Vit. B1 3 Vit. B2 2 Niacin 1 Pantothenic Acid 6 Vit. B6 2 Biotin 3 Folic Acid 11 Vit. B12 6 Vit. C 2 Potassium 3 Calcium 4 Magnesium 2 Iron 6 Zinc 1 Copper 0 Mangan 3 Fluoride 12 Iodine 12

Pilot Study DS use and micronutrient intake 0% 100% 200% 300% 400% 500% 600% 700% 800% 900% 1000% 1100% 1200% Vit. A Vit. D Vit. E Vit. B1 Vit. B2 Niacin Pantothenic Acid Vit. B6 Biotin Folic Acid Vit. B12 Vit. C Potassium Calcium Magnesium Iron Zinc Copper Mangan Fluoride Iodine 1542% 2896%

Pilot Study DS use and micronutrient intake EFSA, 2006 DS use leads to exceed nutrient intakes higher than suggested Upper Intake Levels EFSA (11-14y; 15-17y) USA (14-18y) Iron NA 45 mg Magnesium 250 mg Supplement 350 mg Supplement Zinc 18-22 mg 34 mg Vitamine B6 15-20 mg 80 mg 3 athletes (99 mg, 111 mg, 121 mg) 3 athletes high dosage Mg products 2 athletes (19 mg, 38 mg) 1 athlete (163 mg)

Specific situations micronutrient requirement I. Athletes eat more, therefore they have a higher micronutrient intake

Zinc Intake (mg/day) Zinc intake of athletes (n=375) 35.0 30.0 male r= 0,90 female r= 0,85 25.0 20.0 < 100% RDA (DACH) m; 7% w; 7% 15.0 10.0 10 mg/day 5.0 Männer male Frauen female 7 mg/day 0.0 0 1000 2000 3000 4000 5000 6000 7000 Energy Intake (kcal/day)

Dietary Micronutrient Intake in Athletes (n=303) Vitamin and mineral supplements are not needed, if adequate energy to maintain body weight is consumed from a variety of foods. ACSM, Position Stand 2009 Energy Intake (kcal/day) and dietary micronutrient intake (amount/day) Zinc r = 0,90 Iron r = 0,90 Copper r = 0,89 Potassium r = 0,87 Magnesium r = 0,74 Calcium r = 0,66 Fluoride r = 0,62 Iodine r = 0,61 Niacine r = 0,90 Vitamin B2 r = 0,86 Pantothenic Acid r = 0,86 Biotin r = 0,84 Vitamin B1 r = 0,83 Vitamin B6 r = 0,83 Vitamin E r = 0,80 Folic Acid r = 0,76 Vitamin B12 r = 0,63 Vitamin C r = 0,52 Vitamin A r = 0,45 Vitamin D r = 0,17

Specific situations micronutrient requirement I. Athletes eat more, therefore they have a higher micronutrient intake Athletes might be in risk: - during weight reduction periods - in periods with low energy intake (weight class sport, ski jumper ) II. gender specific differences

Iron Intake (mg/day) Iron intake of athletes (n=375) 50.0 male; r= 0,91 female; r= 0,85 45.0 40.0 35.0 30.0 25.0 < 100% RDA m; 15% w; 67% 20.0 15.0 10.0 15 mg/day 12 mg/day 5.0 0.0 0 1000 2000 3000 4000 5000 6000 7000 Energy Intake (kcal/day) Männer male Frauen female

Specific situations micronutrient requirement I. Athletes eat more, therefore they have a higher micronutrient intake Athletes might be in risk: - during weight reduction periods - in periods with low energy intake (weight class sport, ski jumper ) II. III. gender specific differences Iron needs are higher for females than males - Iron supplementation could be of benefit for some females with respect to iron status - Supplementation without medical diagnosis should be avoided Seasonal needs

Vitamin D Status in young athletes (n=308) Braun & de Marées, 2013 (unpublished)

Serum 25(OH)D (ng/ml) Vitamin D Status in young athletes (n=308) 70 60 50 40 30 20 10 0 17 ng/ml 19 20 20 20 27 26 35 40 31 21 16 Jan (n=17) Feb (n=18) Mar (n=27) Apr (n=52) May (n=29) Jun (n=18) Jul (n=11) Aug (n=28) Sep (n=28) Oct (n=26) Nov (n=33) Dec (n=12) - Aug & Sep; 25(OH)D < 20ng/ml (11%) and <32 ng/ml (47%) of athletes - Nov bis Mai; 25(OH)D < 20ng/ml (58%) and <32 ng/ml (96%) of athletes Braun & de Marées 2013 (unpublished)

Specific situations micronutrient requirement I. Athletes eat more, therefore they have a higher micronutrient intake Athletes might be in risk: - during weight reduction periods - in periods with low energy intake (weight class sport, ski jumper ) II. III. gender specific differences Iron needs are higher for females than males - Iron supplementation could be of benefit for some females with respect to iron status - Supplementation without medical diagnosis should be avoided Seasonal needs - Vitamin D Status might be reduced due to season (endogenous synthesis reduced in winter month) - Dietary vitamin D intake does not compensate reduced synthesis

Dietary Supplements - Risks and Benefits Introduction Prevalence of Dietary supplements Groups of Dietary supplements Sports Drinks Sport Gels & Sport Bars Protein & Protein Components Micronutrients Ergogenic Aids Contamination & Doping Summary

Contamination & Doping Geyer et al 2004

Contamination & Doping Follow up 2011/2012 597 products 17 countries + Internet analysis of 43 anabolic steroids 4 products positive Reduced risk of contamination with anabolic steroids New risk with other substances (e.g. Stimulants) or faked products Geyer et al 2004

Contamination & Doping Problem: Methylhexanamine declared under different names Geranamin, Forthan Floradrene Dimethylamylamine, Dimethylpentylamine, Pentylamin, 2-amino-4-methylhexane 350 300 250 200 150 100 50 0 WADA Statistik für Methylhexanamin (Adverse Analytical Findings) 1 31 123 283 320 2008 2009 2010 2011 2012

Contamination & Doping

Contamination & Doping Doping Cases Sotschi 2014 Methylhexanamin Trimetazidine Methylhexanamin Methylhexanamin Pseudoephedrin N-ethyl-1-phenylbutan-2-amine Erythropoietin Dehydrochlormethyltestosteron Biathlon Skilanglauf Eishockey Bob Eishockey Bob Skilanglauf Eishockey

Contamination & Doping Weight loss product and training booster with Stimulants Nox Pump Declared Ingredient: Geranium Root Extract Not declared: Methylhexanamin (15 mg/kapsel)

Contamination & Doping LIDA Product: Meizitang slimming product Herbal diet capsules with sibutramine (15 mg/capsule) not declared on the label 50 h following a single administration of the tea, sibutramine metabolites were clearly detectable in a volunteer s urine and would have caused a failed doping test.

Contamination & Doping 14.07.2013 3 Sprinters positive for Oxilofrin www.spiegel.de

Contamination & Doping

Contamination & Doping Supplement faked with the stimulant Oxilofrin (bought in July 2013)

Contamination & Doping Dietary supplement Faked with Oxilofrin (April 2014)

Contamination & Doping Neuroenhancer, adulterated with stimulant Oxilofrine and other stimulants http://epiphanyd1.com/ online 09.09.2013

Contamination & Doping The Food and Drug Administration (FDA) has found o nearly 300 fraudulent products o promoted mainly for weight loss, sexual enhancement, and bodybuilding o containing hidden or deceptively labeled ingredients such as active ingredients in FDA-approved drugs or their analogs (closely-related drugs) other compounds, such as novel synthetic steroids, that do not qualify as dietary ingredients www.fda.gov

Contamination & Health risk

Contamination & Health risk http://www.fda.gov/safety/recalls/ucm375740.htm

Contamination & Doping What can athletes do? Athletes are advised to take supplements only from low-risk sources. Germany (www.colognelist.com) Netherlands (http://www.dopingautoriteit.nl/) These Databases list supplements from companies, which perform quality control for anabolic steroids and stimulants.

Summary Before contemplating supplement use, athletes should ensure to have a healthy, balanced and sport specific diet. For implementation, individual nutritional assessment by a qualified sports nutrition professional is advised. Evaluate DS use of your athletes. Why do they use them? What is really necessary? The non-critical intake of micronutrient supplements should not be underestimated and can lead to an intake higher than the upper intake level. Some athletes might benefit from micronutrient supplementation in some situations. Supplements can be contaminated or faked with illegal substances and can lead to a positive doping case. Supplements aggressively advertised for weight loss, reduction of fat mass, increasing lean body mass, are of high risk. If supplements are necessary take them from low risk sources.

- Nutrition and Health in Elite Hockey Players Dietary Supplements Risks and Benefits - Dipl. Sportlehrer - Dipl. Oecotrophologe - Institute of Biochemistry - momentum German Research Center of Elite Sports -