Bridging the Gap - International Society Of Sports Nutrition

Bridging the Gap - International Society Of Sports Nutrition

Presented by:

Jan DeBenedetto


• What supplements are athletes consuming for

short term performance enhancement?

• Are these PES adversely affecting long term overall


• How do PESs affect “non-athletic” metabolic


• How are overtraining and supplements related?

• How can we effectively address bridging the gap

between acute performance supplementation

and over all health supplementation?

• In USA exceeds $3.5 billion annually and


• ~15% annual growth

• There are a lot of people buying these


• Not just an isolated few

• Not just a passing fad

• Professional athletes to weekend warriors to “40

year old housewives”

• Protein(s)

• Preworkout

• Intraworkout

• Postworkout

• Creatine

• Thermogenics/weight loss

• Nitric Oxide boosters

• TT boosters

• Posits that the spectrum of functions for a

micronutrient are managed by the organism such

that functions required short term survival take

precedence over those whose loss can be better


• Done via binding constants and targeted tissue


• Provides rationale for why modest daily V/M

deficiencies may increase risk of degenerative


• Two supporting studies

• Vitamin K

• Selenium

Ames BN PNAS 2006

McCann& Ames AJCN 2009

McCann & Ames FASEB 2012

• The official U.S. Institute of Medicine measure of inadequacy,

the EAR (Estimated Average Requirement; the RDA is set at 2 SD above the

EAR),most of the U.S. population is below the EAR for one or more V/M.

• The NHANES database that the percentages of the U.S. population that are

below the EAR are:

• magnesium 56%

• zinc 12%

• iron 16% of menstruating women

• vitamin B6 49% of elderly women

• folate 16% of adult women

• The U.S. population also has very low intake of

• vitamin D

• calcium

• potassium

• omega-3 fatty acids

• vitamin K

• ~700 protein products for sale on

• RDA of 0.8 gms/kg

Sports recommendations from 1- 2+gm/kg

depending on event and body size

• Various ways of measuring protein efficiency

• Primarily consumed to increase muscle

protein synthesis (and reduce muscle


• Also as a diet aid

• Whey protein

• Most anabolic

• BCAA content

• Rapid digestion

• Low allergenicity

• (-) cost

• Milk/casein

• Slower digestion

• Slightly less expensive than whey

• Soy

• Low fat/low cholesterol content

• Vegetarian

• Slower digestion

• Less expensive

• Egg

• Lactose free

• Paleo friendly

• Beef

• How much from meat vs. connective tissue?

• Beef concerns

• Paleo friendly

• Potential allergen issues

• Casein/Milk

• Soy

▪ 16 potential allergens

▪ GMO issues

• Egg

• Concerns over the animal feeding/drugs

• Grass fed? rbgh, residual antibiotics

Food allergen reaction thresholds. Ingested allergen dose (mg protein) vs. %

allergic responses in challenged patients.

Allergens: peanut, hazelnut, egg, milk, soy

• Increased levels of proinflammatory


• Increased metabolic acidification/acidosis

• HCY is and intermediate in methionine metabolism

(methylation cycle)

• Increase levels of methionine, increase HCY

• Elevated HCY is systemically proinflammatory and is

associated with increased incidence of:

• Total and CV mortality

• Stroke

• Dementias and Alzheimer's

• Bone fractures

• Preeclampsia

• Neural tube defects

• Reduced mobility and muscle mass in elderly

Verhoef P, de Groot LC

Semin Vasc Med. 2005

Selhub J. Food Nutr Bull


• Two major SNPs are associated with a

tendency to higher HCY levels

• MTHFR C677T and A1298G

• Inefficient reduction of folic acid to 5 MTHF

• High prevalence in Mexicans, Southern


• Diet responsive to foods rich in select vites

• Vegetables

• Folate (ideally 5 MTHF for some)

• B12

• RDAs are a joke relative to stability and absorption

• B6

• Some may require P5P

• Betaine/TMG

• Relatively high doses (1.5-3 grams)

• Serine

• Needed to convert HCY to cystathione (eventually


• Would be best consumed with the protein or


• Protein is the leading generator of metabolic


• Protein consumption of early humans

exceeds today’s average consumption

• Early man also consumed large quantities of

plants which balanced the metabolic pH

• Modern man does not come close…

• Modern Western Man is in a state of

chronic low grade metabolic acidosis

Adeva MM, Souto G Clinical Nutrition (2011)

Sebastian A. AJCN 2005

• Acid (Aging/Catabolic)

• Muscle wasting

▪ Glutamine release

• Bone loss

▪ Ca & Mg release

• Increased oxidation

• Increased inflammation

• Reduced thermogenesis

• Reduced cellular volume

• More rapid onset of muscle


• Suppresses Vitamin D


• Alkaline (Anti-aging/Anabolic)

• Muscle maintenance or


• Bone matrix maintenance

• Reduced oxidation

• Increased thermogenesis

• Reduced blood pressure

• Normal cellular volume

• Delayed muscle fatigue

• Increase hGH/IGF-1

Sebastian A. Eur J Nut 2001

• Stimulates muscle protein degradation and

depresses muscle protein synthesis

• Release glutamine from muscle to consume


• Ancestral K intake >10 grams, Na 666 mg

• Today K ~3 grams and Na 4.5grams

Caso G, Garlick PJ. Curr Opin Clin Nutr Metab Care 2005

• Protein 0.5g/kg to 1.5g/kg

• KHCO3 group (3.5gK)

• higher IGF-1 in both

• Increased Ca absorption in both

• Reduced Ca excretion in both

• Reduced NAE in both

Ceglia L, Harris SS, J Clin Endocrinol Metab 2009

• That proteolytic effect (of acidity)has been attributed

to two acidosis-induced disturbances in skeletal

muscle cells:

• stimulation of an ATP- and ubiquitin-dependent

proteolytic pathway

• enhancement of the oxidation of proteolytically released

branched chain amino acids (valine, leucine, and

isoleucine), preventing their reuptake for protein


• Trial–

• 60-120 meq KHCO3 (not NaHCO3)

• 18 days UNi excretion decreased 14.4gms

▪ Equivalent to 0.43kg of LBM

Frassetto L, J Clin Endocrinol Metab. 1997

Lemann J, Kidney Int. 1989

• Inhibition of SNAT2 by metabolic acidosis

reducing muscle protein synthesis and

increasing proteolysis

• SNAT2L-Glutamine (L-Gln) transporter, which

controls protein synthesis via amino acid–

dependent insulinsignaling through mammalian

target of rapamycin (mTOR).

• Could be through depletion of Gln

Evans, K et al. J Am Soc Neph 2008

Adeva MM

• Ketoacidosis induces >N excretion that can

be corrected by alkali

• Confusion on Paleo

• Everyone gets the >protein and the

• Select minerals and organic anion

bicarbonate precursors

• Addition of K

• Citrate, bicarbonate

• Addition of Mg

• Malate, Citrate

▪ Too much Mg citrate can have laxative effects

• Glutamine

• TBK 3500 mmoles mEq - 90% intracellular

• Average US intake is 1.5 – 2.5 gms/day

• RDA is 3.5 gms/day

• Loss of 1% (35mmol) disturbs delicate balance of

intra/extra cellular K

• Estimated Paleo intake was between 11 – 19


Cohn, Jay H Arch Intern Med 2000; 160

Sebastian, A. Semin Nephrol 2006

• >1000 mg; figs, molasses

• >500 mg; Nuts, avocados, lima beans, wheat


• > 250 mg; spinach, tomatoes, broccoli, winter

squash, carrots, bananas, cantaloupe,

oranges, mangos,ground beef, steak, pork,


• RDA of 400 mg

• Paleo intake estimated at ~1000 mg daily

• ~75% of US consumes less than the RDA

• Average US diet supplies 50-67% of RDA

• Vital for ~300 enzymes including stabilizing the

γ phosphate of ATP

• Necessary for proper K transport into cells

• Typical supplemental form (oxide) is poorly


• Glycinate, malate, citrate better bioavailability

• Tests for adequacy are often inadequate

• >100 mg / serving

• Pumpkin seeds, Brazil nuts, bran, wheat germ

• >50 mg / serving

• Halibut, almonds, cashews & other nuts, spinach,

soy beans, black & navy beans, artichoke hearts,

buckwheat, haddock, pike, legumes

• Certain amino acids share transporters

• As such skewing one too much may inhibit


• e.g. BCAAs can block brain uptake of tryptophan

▪ A potential issue with protein at bedtime???

▪ BCAA competition

• Caffeine is the most widely used

psychoactive drug in the world, being used

habitually by more than 80% of adults


• Absorbed well

• reaches peak levels 15-45 min

• Quickly metabolized to the stimulants

theophylline and theobromine

• 3-10 grams lethal

Fredholm BB et al. Pharmacol Rev 1999

• 99% absorption within 45 minutes of


• Half life of 2.5 to 5 hours

• Smoking reduces in half

• Oral contraceptive double it

• Theophylline 3-5x more potent inhibitor of

adenosine A1 and 2 receptors

• Effects are dose dependent

• FDA safety @ 400 mg daily limit

• Significantly blocks adenosine effects on A2A

(most potent) and A1 receptors already at the

low concentrations achieved after a single cup of


• To inhibit cyclic nucleotide breakdown via

inhibition of PDE, 20X higher concentrations are

required to block

• GABA receptors, 40 times higher concentrations

• To mobilize intracellular Ca depots,

concentrations of 100X higher are needed

• Moderate doses may protect against Parkinsons

• Adenosine reduces firing of selective

cholinergic neurons

• Caffeine increases firing

• Adenosine inhibits excitatory

neurotransmitters primarily

• Activation of A1 receptor lowers cAMP

• Adenosine needed for angiogenesis,

neutrophil function

• Caffeine lowers the threshold for exerciseinduced

beta-endorphin and cortisol release

• Caffeine increased salivary cortisol

• Resultant decline in the testosterone:cortisol


• Load was 6mg/kg caffeine

Laurent D, Schneider KE.

J Clin Endocrinol Metab. 2000

• Jittery, nervous, anxious

• Withdrawal

• Tired, sluggish, headaches

• Youth consumption

• Elevates cortisol secretion with stresses

• Mental & Exercise

• High consumption associated with elevated


• Linear dose response

• 358 sports supplements on

contain caffeine

• Many supplements contain caffeine as an

ancillary ingredient

• Levels reach up to 300mg per serving

• Risk of additive effects taking multiple


• Sleep disturbances

Roasted and ground coffee

Percolated 150 ml 40–170mg

Drip 150 ml 60–180

Decaffeinated 150 ml 2–5

Instant coffee

Caffeinated 150 ml 40–180mg

Decaffeinated 150 ml 2–8


Bagged 150 ml 28–44

Leaf 150 ml 30–48

Iced 150 ml 28–32

Chocolate bar

Milk 28 g 1–15

Dark 28 g 5–35

Baking chocolate 28 g 18–118

Soft drinks

Regular cola 180 ml 15–24

Caffeine-free cola 180 ml 0

Diet cola 180 ml 13–29

Debry (1994) and Barone and Roberts (1996).

• Chronic consumption of caffeine can reduce

its stimulatory effects

• Withdrawal or intermittent use can enhance

these effects

• A large and growing segment

• NO is also a precursor/substrate for highly

reactive free radicals by reacting with

superoxide anions

• Peroxynitrites

• Part of immune and inflammatory responses

• Supplemental arginine

• Increases creatine

▪ Requires methyl groups and can cause depletion

• may increase ADMA levels

▪ ADMA is toxic

• SOD scavengers

• Extramel®

• Glutathione


▪ Lipoic acid

• Select polyphenols

• Exercise can cause pain and many athletes

will resort to OTC medication thinking it is OK

for chronic use

• One should be cognizant of potential drug

nutrient interactions with chronic use

• As well as other side effects

• Including inhibiting resolvins and protectins

needed for healing

▪ Omega 3’s help facilitate this process


• Folate

• Iron

• Zinc

• Acetamenophen

• N-acetycysteine

• Vitamin C

• Aspirin

• Folate

• Iron

• Zinc

• Vitamin C

• Vitamin E

• Potassium

Moss M. J of Nutr &Enviro Med 2007

• Is your stimulant (or your coach) making you

write checks that your body can’t cash?

• Many personal trainers/ees don’t feel like they

are giving/getting $ or times worth unless the

exhaust their client

• New gyms pushing clients to limits too


• dopamine/endorphin addiction

• Athletes feel the need to push to the limit/failure

too often

• Leads to inflammation, pain, musculoskeletal

dysfunction, sleep issues, performance declines,

adrenal exhaustion, elevated cortisol, immune

dysregulation, disruption of HPA+++ axis,

reduced performance

• Endotoxemia

• Inflammation

• GI complaints

• Immune dysfunction

• Reduced performance

Clinical Science (2000)

98, 47–55

• Gln levels decrease dramatically after intense

exercise and may stay low 1-2 weeks post

• Not after moderate exercise

▪ Gln as a marker for optimal exercise??

• Pre & Probiotics

• CoQ10

• Moducare (B-sitosterol(BSS) and Betasitosterol


Agostini F, Biolo G Cur Op Clin Nut Met Care 2010

Bouic PJD et al Int J Sports Med 1999

• Multivitamin (above RDA) and mineral


• Omega 3

• Pre & Probiotics

• PES are fine and necessary for many athletes

to perform at peak levels

• PES can create it own set of metabolic needs

• Eating/supplementing for overall health is

essential to bridge the gap!

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