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Tuesday, December 11, 2007

Nutritional Supplements, Creatine, Androstenedione, Protein Supplementation, The FDA on Supplements,

Nutritional Supplements

Athletes today are looking for competitive edges to improve performance. Many times, this involves nutritional supplementation. This does not only apply to highly paid professional or professional-bound collegiate athletes, high school athletes are purchasing nutritional supplements at a high rate. The inherent problem with nutritional supplements is that they are unregulated by the Federal Drug Administration, marketed without reproducible scientific research, and recommended by nonprofessional sales people. This article will focus on three or four of the most commonly purchased nutritional supplements. This article should not be viewed as an endorsement of these products nor a recommendation to consume them; it is being written for educational purposes only.


Creatine is a naturally occurring substance in the human body. It is an essential component of the anaerobic energy system. Creatine, when coupled with a phosphate (phosphocreatine or creatine phosphate), is used by the body to replenish Adenosine Triphosphate (ATP), the energy compound fueling muscle contraction. Creatine supplementation also does not seem to alter the body’s natural production of creatine the same way that steroid usage shuts down natural testosterone production.

Creatine is supplied either as a powder or in pill form. Athletes typically take a “loading dose" of 20 to 25 grams a day for one week; then begin a "maintenance cycle" of 3 to 5 grams per day. The "loading" and "maintenance" dosage recommendations differ from manufacturer to manufacturer. The athlete should take the "maintenance" dose for approximately one month and then cycle off for one month. The cycle then begins again with the "loading" dose. No clinical research has been done to determine if this is a safe and effective dosing regimen for creatine. Many physicians caution that the above dosages may be too high. Many professionals are recommending that the loading dose be eliminated and that the athlete only supplements with one-half of the recommended daily dose.

Creatine does have inherent problems, most notably making dehydration easier to occur. Creatine is a large, "water hungry" molecule: it requires more water to be stored in the muscle while taking the supplement. This extra water storage distends the cells, making the tensile strength of the muscle cell walls lower. Decreasing the tensile strength of muscle cell membranes will allow the muscle to be injured easier. Also, if the strength gain is as dramatic as the claims the additional muscle power could in effect lead a muscle damaging itself. Also, if the body is storing more water in the muscle cells, overall dehydration and dehydration illness could happen easier.

There have been no long-term (greater than 10 years) studies to investigate the affects of creatine on kidney, liver, and heart function. For this reason physicians and researchers are stressing the controlled use in adult populations with proper cycling off periods to return muscles to "normal hydration" and to allow the kidneys and liver to return to "normal function."

The affect on heart muscle is also not completely known. Does creatine supplementation cause enlargement of the cardiac muscle? Research is still pending on this question. There are many risks centered on cardiac hypertrophy and related diseases. The athletic population tends to have larger hearts than the non-athletic population; therefore greater enlargement due to creatine supplementation may lead to cardiac damage.

The issue of prepubescent or children early in puberty supplementing with creatine is an area of great concern. No research is currently being performed to test the possible adverse reactions in this population group. Strength training in prepubescent and early pubescent athletes is acceptable (without supplementation) utilizing body weight only. Weight training with traditional weights can cause damage to maturing bones, muscles, and tendons. Supplementing with creatine in this population group may also lead to damage in the same areas due to the increased ability to workout longer. It also may cause damage to the liver, kidneys, and heart in the physically immature individual.


Androstenedione, 4-Androstenediol, 19-Norandrostenediol, and 19-Norandrostenedione are essentially the same compound. This substance is a precursor to the androgenic steroids testosterone and estrogen. Since this compound can be metabolized into either gonadotropic steroid there is debate as to the efficacy of supplementation. The path of metabolism is determined by multiple factors within the endocrine system.

Studies have conflicting results as to the exact result of “andro” supplementation. Early studies showed that the level of estrogen, not testosterone, increased with “andro” supplementation. While, a study just released by the Harvard Medical School, concluded that “andro supplementation did increase testosterone levels.

These conflicting reports simply show that supplementation with hormones or hormone precursors is a guessing game at best. This is best explained by the fact that hormone production is a process mediated by other hormones. Whether the body needs testosterone or estrogen (in either male or female subjects) is governed by Adrenocortiotropic Hormone and Leutinizine Hormone. The balance of these two chemicals combined with the stress on the subject body determine if estrogen or testosterone is to be produced.

The bottom line is still that increased testosterone by itself does not improve the performance of an athlete. The training that develops coordination and sport specific skill must occur in conjunction with strength, power and speed development. The three areas are not mutually exclusive in developing athletic ability.

Protein Supplementation

Protein powders, shakes, and pill supplements have been a mainstay of the supplement business for years. These combinations of essential, branched-chain, or complex proteins all have individually superior claims. The bottom line is that if training levels do not exceed demands, the extra consumption of protein is metabolized out into increased adipose tissue (stored as fat) or is excreted in the urine. Either way, this is a tremendous loss of money.

There is one amino acid supplement to avoid, L-Tryptophan. This essential amino acid, when used in too high a volume can result in a condition known as eosinophilia myalgia syndrome. This syndrome is a fatal blood disorder with symptoms of fever, joint pain, skin rash, and death.

Other Supplements

There are far too many supplements for this small article to cover. The claims from these include: “increase muscle mass,” “decrease in body fat percentage,” “cleansing of the system,” and any other “catch phrase inserted here.” Many of these supplements tout themselves as “all natural” or “herbal” products. Do any of theses work? That is the ultimate question. Keep in mind that our body is a massive chemical reactor, and as with all chemical reactions, the environment determines the ultimate end.

Products that contain mawaung need special consideration. This herb contains the chemical ephedra. Ephedra is a central nervous system stimulant. Consumption of this herb can result in increased pulse, irregular heart beat, insomnia, headaches, seizures, heart attack, nerve damage, stroke, and symptoms consistent with hepatitis or psychosis. Will this happen to everyone? Probably not. Consumption of this herb should be limited to short term use of less that 20 mg per day. Ultimate Orange, Fit America, and numerous other supplements contain this ingredient.

Please keep in mind that prescription drugs can have serious negative interactions with nutritional supplements or herbal supplements. A complete listing of prescription drugs and their interaction with herbal remedies can be found on WebMD. Some examples of these dangerous combinations include the following.

Ephedra and Ginseng may increase the effects of stimulants.

Garlic and Ginkgo may enhance anticoagulant and antiplatlet drugs.

Grapefruit juice can be dangerous when combined with blood pressure medication.

High fiber herbs such as fennel seed, may bind to drugs delaying absorption of prescription medications.

St. John’s Wort may enhance the effects of narcotics and antidepressants, and enhance the effects of alcohol.

Siberian ginseng can enhance antibiotics.

The FDA on Supplements

The Federal Drug Administration (FDA) does not approve supplement claims, they merely attempt to regulate them. A nutritional supplement can not make a disease claim but can make a structure/function claim. This means that a supplement can make a claim of “muscle enhancement” but not “cures arthritis.” All nutritional supplements currently on the market are not FDA approved. They do not have to submit to the FDA’s proof of claims, side affect disclosure, and long-term health impact studies. A searchable database for side-effects of supplements can be found on the FDA's Nutritional Supplement Adverse Reaction web site.

The bottom line is that doctors and herbalists do NOT know all of the side-effects of their prescriptions. Please fully investigate the known and possible side-effects of any substance that you choose to ingest. Sources such as “muscle magazines” and internet chat rooms are not reliable sources. These recommendations are made on anecdotal evidence only, NOT scientific evaluation of the side-effects and effectiveness of a chemical. The best nutrition is found in whole foods, not a pill.

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