Ms Jeni PearceHead of Performance Nutrition

High Performance Sport New Zealand

Auckland

8:55 - 9:20 Risks v Benefits for Supplements

Risk and Benefits of Supplements:

Health and Athlete Performance

Jeni Pearce

Head of HPSNZ Performance Nutrition

GP Conference Christchurch

August 2017

Popular Diets

The most popular are Gluten Free and Low FODMAP

Paleo appears to becoming less popular and has ‘morphed’ in to many variations

Need to listen carefully to what the person is actually doing

‘I no longer eat any dairy grains or legumes’ – Endurance athlete

‘I eat those paleo bars after training – rest of my food is the same’ – Power athlete

No research to support benefit to athletes performance

This intervention was effective for this GI symptom prone athlete;

Orthorexia is the term for a condition that includes symptoms of obsessive behavior in pursuit of a healthy diet. Orthorexia sufferers often display signs and symptoms of anxiety disorders that frequently co-occur with anorexia nervosa or other eating disorders

Orthorexia: When

healthy eating becomes

unhealthy and dangerous

At its simplest, clean eating is about eating whole foods, or "real" foods —

those that are un- or minimally processed, refined, and handled, making

them as close to their natural form as possible.

Nutrition in the News

https://www.tvnz.co.nz/shows/sunday/clips/th

e-secret-lives-of-fussy-eaters

Dietary Supplements in the work place

An American police officer took what was presented as a ‘natural’ weight-loss supplement to help him lose some excess kilos. The supplement also lost him his job – it contained amphetamine, which was detected in a routine urine test & led to him being fired.

P.A.Cohen (2009) American roulette – contaminated dietary

supplements. New England Journal of Medicine 361(16): 1523-1525

In 2009 the US Food & Drug Administration had identified more than 140 'natural' products containing active pharmaceutical ingredients, most of them marketed as dietary supplements - & this is regarded as the tip of the iceberg.

Picture Rio success

Competing for their country at the Olympic/Paralympic Games is the highest achievement for any of the world’s elite athletes

Small Margins

In the News

http://i.stuff.co.nz/sport/other-

sports/87745377/auckland-powerlifter-

suspended-for-a-year-for-unintentional-doping

Athletes have been banned in NZ?

Slide Courtesy Bob Murray USA ACSM 2016

Ergogenic aids

Dietary supplements

Sports drinks &

foods

Common dietary & sports supplements

Supplements that are on a WADA advisory / watch list e.g. Colostrum (IGF-1) & glycerol

OTHER

Why use Supplements?

Because others

are taking them

Everyday People, like Athletes, come in different shapes and sizes: Body Image is key reason non athlete’s use supplements

Different supplement use, costs

Supplement use in NZ 2009

Males + Females 71+ regular users, Females, especially 31-50yrs more

often use any supplement

Types Supplements

Oils (omega 3)

+ multivits/ multi

minerals most

popular (1/3

total usage)

followed by

herbals then

single nutrients

e.g. vitamin,

minerals

Supplements: Young adults

15-18 yr olds 34% males, 42% females report taking supplements (2008/9 survey) of which 18% males and 17% females take supplements regularly (1x wk)

Top 3 supplements Males: oil based (11%), multivitamin/minerals (8%) and sports (6%)

Top 3 Supplements Females: Multivitamin/mineral (14%), Herbal/vit/mineral (12%) and single vitamin (8%)

Very few studies are performed on this age group (ethics), most research is case reports or incidence data on use.

Concerns around Zinc – above RDI – supplementation (vit/min, fortified foods, drinks & bars) may place athletes at risk for exceeding the UL

RISKS

• Adverse Reaction

• Overdose

• Allergy reaction

• Contamination with heavy metals

• Containing banned substance of any athlete

• Interferes/reduces effectiveness medications

• Does not contain the stated dose – folate

• High dose individual nutrients inter with absorption of other nutrients (Mg, Zn, Cu, Fe and amino acids)

A closer look

Woman dies after

taking 'diet pills'

bought over internet

Eloise Aimee Parry,

21, from Shrewsbury,

‘burned up from the

inside’ after taking

tablets believed to

contain highly toxic

chemical

dinitrophenol

Death by Slimming

some ‘natural health products’ may have the potential (based on animal & in vitro studies) to help cancer patients manage the side effects of chemo- & radiotherapy, others significantly reduce the effectiveness of chemotherapeutic drugs.

Nutrient interaction affecting bioavailability and absorption at the gut

Example of a drug-nutrient interaction: Foods high in vitamin K, such as spinach,

broccoli, kale, fortified milks and supplements can keep warfarin from working

effectively.

Iron, copper, zinc, calcium, magnesium, manganese area similar – high dose of one

can interfere with the absorption of the other with iron being the most vulnerable

St. John’s wort, a popular dietary supplement, can affect many different medicines,

including selective serotonin reuptake inhibitors (SSRIs).

Discusses the risks of Asian herbal

products both intentional and

unintentional contamination with

heavy metals

In early 2000 WHO reported 70–80% of

the world populations rely on non-

conventional medicine mainly of herbal

sources in their primary healthcare.

Increasing growth in popularity of over-

the-counter (OTC) health foods,

nutraceuticals, and medicinal products

from plants or other natural sources in

developed countries. Increase in

popularity has also brought concerns and

fears over the professionalism of

practitioners, and quality, efficacy and

safety of their treatment methods and

products from herbal and natural sources

available in the market

Sources of information

Good news: low endorsement of celebrities – then why use them???

More good news: Advice from Doctor features strongly 87%

What is in dietary supplements?

Products vary from having a few ingredients to dozens of ingredients

4 ingredients

At least 50 ingredients

Both products are a whey protein supplement and claim to do the same thing.

What you see is not always what you get

NO

pre-market

approval

required for

supplementsPurity

Effectiveness

NZ supplement

industry worth

$300 MILLION

US industry

worth US$37

billion

Supplement companies have different priorities to elite athletes.

Some ingredients a class of their own

AMP Citrate

Dimethylamylamine

1-3-Dimethylamylamine

1,3-Dimethylbutylamine

Geranium Extract

Geranamine

Geranium Oil

Geranium Maculatum

Geranium Stem

Methylhexanamine

Forthan

Forthane 2-Amino-4-

methylhexane

4-methyl-2-Hexanamine,

1,3-DIMETHYL-

PENTYLAMINE,

1,3-Dimethylamylamine

4-Methyl-2-hexylamine

1,3-Dimethylpentylamine

4-amino-2-pentanamine

Pentergy

4-AMP

Ingredients do matter

As athletes, you are subject to anti doping testing. The wrong ingredient

present in the tiniest amount can be detected.

Inherent risks

Adverse reactions + allergy

Contraindications – medication interaction, pre surgery, pre existing conditions (cardiac, renal)

Excess or incorrect intake

Supplements for children

Supplements are not candy or lollies

Zinchttps://www.nrv.gov.au/nutrients/zinc

Zinc

https://www.nrv.gov.au/nutrients/zinc

Child: Example possible risk

Immune supplement x 2/d =3 mg zinc

2 x multivit/minerals/d = 2 .7mg zinc

RDI Zinc: 9-13y boys and girls = 6mg/day

+ Average (diet)

daily zinc intake

in NZ

girls: 9mg

boys: 12.9mg

Supplements = RDITotal: = 15-19mg/d =

3xRDI and close to the

UL 25mg/d

Chronic high zinc

intake: immune

suppression, anaemia

& interferes with

copper metabolism

Teen Example

+ immune 3 mg zinc

Multivit/min = 3 mg zinc +

RDI Zinc: 14-18y males 13mg/day & females 7mg/day

UL: 35mg

+ Average (diet)

daily zinc intake

in NZ

Girls: 9mg

Boys: 14mg

= Total:

Girls: 23 mg/day 3 x RDI

Boys: 28 mg/day 2 x RDI

Chronic high zinc intake:

immune suppression,

anaemia & interferes with

copper metabolism

Protein supplement:

1 x 30-40g 2-8mg/serve

Adult Example

30 mg zinc

+

7.5mg zinc

+

RDI Zinc: Men 14mg/day & women 8mg/day 31-50yrs

UL: 35mg/day (women)

40mg/day (men)

+ Average (diet) daily zinc

intake in NZ

Women: 9-10mg

Men: 13-15 mg

= Total:

Women: 48mg/day ↑UL

Men: 51-53mg/day ↑UL

Chronic high zinc

intake: immune

suppression, anaemia

& interferes with

copper metabolism

Multivit/min =RDA women and approx. 50% Men

Vitamin C

https://www.nrv.gov.au/nutrients/vitamin-c

Vitamin C

In the elite environment we are concerned about effect of high doses antioxidants

dampening adaptation metabolic pathways that could lead to improved performance

Maintenance dose

Children 2+yrs

1-2/d =260-520mg or

Acute dose

Children 2+ 2 x 2/d

1040mg/d or

10 glasses orange

juice

Children 2+yrs

1 gummy 2 x a day

= 10mg x 2

= 20mg

or 2 mandarins

Contamination risk

IOC funded research in 2004

634 products purchased from standard retail outlets in 13 different countries

Of all products analysed 15% were contaminated with steroids / pro-hormones

0

5

10

15

20

25

30

Netherlands Austria UK USA

Athlete: Must Know Responsibilities

Rule 3: Inadvertent doping

“..an athlete is responsible for any banned substance found in his or her sample, regardless of whether there was an intention to cheat”.

However, there is greater recognition of the issue of contaminated products, particularly supplements. If an athlete can show “no significant fault or negligence” to demonstrate that they didn’t intend to cheat, then they may receive a lesser ban.

https://www.wada-

ama.org/en/media/news/2016-

09/wada-publishes-2017-prohibited-

list

GP’s, Parents, Coaches and Sports Support Staff: Must Know Responsibilities

KEY CHANGE

6. Athlete Support PersonnelUnder the revised Code, athlete

support personnel are now explicitly bound by the new anti-doping rules. In particular, athlete support personnel:

will be investigated if an anti-doping violation involves a minor or they have provided support to more than one athlete who has committed a violation

Reference: http://drugfreesport.org.nz/uploads/site/assets/Fact_Sheet_on_the_World_Anti-Doping_Code_FINAL.pdf

Raising awareness

The WADA Code now places greater accountability on Athlete Support Staff in the fight against doping in sport.

If you don’t understand the obligations in the Code, then you are potentially placing yourself, and your organisation/career at risk.

http://www.itftennis.com/news/231260.aspx

What can you do?

https://e-learning.dfsnz.org.nz/

Coaches

Parents

Support staff (manager, medical,

nutritionist, S+C, Fitness Trainer)

Athletes

Drugfree sport NZ can not guarantee safety of any supplementAny product could contain a prohibited substance that is not

listed on the label

Make sure supplements are tested

Batch by batch only

Extensive certification

programme

A tested batch will have a certificate

Supplements & Athletes Greater performance gains can be made with good

coaching, training and good nutrition habits (including nutrient timing and recovery strategies)

Use of many sports supplements is unnecessary

Exceptions = correct a diagnosed health/medical issue e.g. iron deficiency, bone health and inadequacies,

Use of sport drinks, gels and bars to provide fluid and fuel during endurance based events.

Know the risks linked to the use of dietary supplements and consequences of an adverse analytical finding (…administer and trafficking violations) ANY athlete

Where do supplements fit?

Need solid

foundation ie

food groups

Key nutrients

– calcium,

iron, folate,

iodine, fibre

Maybe supplement Can’t benefit

from a

supplement

unless there

is a solid

foundation to

build on.

People who may need a little help with their diet:

ElderlyLiving alonePsychological disorders where people forget to eatSome medications – pain reliefDisrupted eating patternsLow energy availability – eating disorders, restrained eaters, orthorexia Anyone following fad diets that eliminate one or more food groupsVegans, vegetarians low experienceAllergy where avoid food group (fish)Pre and during pregnancy (folate, iodine, Iron)

Who can help?

Legislation

Dietary supplements are regulated under the Dietary Supplements Regulations 1985, which fall under the Food Act 2014. Medsafe is responsible for administering the dietary supplement legislation

Regulation of dietary supplements

Dietary supplements must comply with the Dietary Supplements Regulations 1985. The regulations describe a number of requirements including, but not limited to, labelling and maximum permitted daily doses for several vitamins and minerals.

Specific regulations apply to dietary supplements containing folic acid.

There is no pre-approval process for dietary supplements. It remains the responsibility of the sponsor (the person legally responsible for placing the product on the market) to ensure the product is made to an acceptable quality, is safe to use and complies with the law.

Seek professional support:The Role of the Dietitian: Well qualified in clinical nutrition,

www.dietitians.org.nz

GP Actions:Be aware the public often neglect to advise on supplement use

Ask detailed questions on use and source supplements/herbals

Ban celebrity endorsements - esp Elite Athletes unless the product has been third party tested

Treat supplement as a prescription and follow up in at least 3 months

Help raise awareness of toxic levels and disadvantages (e.g. cancer treatment, interaction with prescribed medicine

For any athlete ensure they are aware of the risk not just for the presence of a banned substance but to health, performance and allergy

Refer to a dietitian or registered Nutritionist for dietary assessment – aim for improvements in food intake first

Report overdoses of supplements to Poisons Information Centre on 0800 764 766.

Report an adverse event related to a supplement to the Centre for Adverse Reactions Monitoring (CARM) at the University of Otago

No supplement can be guaranteed 100% safe, effective, quality controlled unless independently tested – these are not regulated like medicines but used as such

https://drugfreesport.org.nz/supplements

Always Food First

Food tastes better and is often less expensive than adding supplements

If supplements are advised monitoring & follow up is essential

Thank you