Sports Supplements: Pearls and Pitfalls.

Sports supplements can be generally divided into 3 categories: sports foods (foods/drinks containing macronutrients), medical supplements (vitamins/minerals used to treat deficiencies), and ergogenic supplements (used to benefit performance). Supplements are not regulated by the US Food and Drug Administration. They may get to the market and be contaminated with substances banned in sport or dangerous to health; and the contents may not contain what is listed on the label. When choosing to use a supplement, the safest practice is to choose a certified brand, which tests and authenticates label verification, quality, and lack of contaminants and banned substances for sport.

Education to legality and doping.

When planning actions to prevent doping in the general population, public health operators may collide against the interests of criminal organizations involved in illicit trafficking of drugs. In addition to technical and professional expertise, or clinical and pharmacological skills, also a deep knowledge of legal and social issues is strongly required to face the problem and assure the effectiveness of the preventive actions. Sports competitions, athletes training or adapted physical activity may all represent conditions and environments at risk for misusing or abusing drugs and dietary supplements. A correct approach to sport and physical activity implies respect of competition rules, attention to own body limits and knowledge of risk factors. Health education campaigns and preventive actions should also consider education to legality in the different settings. The comprehension of the complex net that is available to access doping, locally or globally through online Internet sites, is essential as well as the awareness of the huge economic burden of crime interests behind the illicit trafficking of drugs. A modern whole rounded approach needs to consider doping not only as a violation of sport rules but also of the own body health, representing almost a form of addiction involving individuals and communities, and being supported by crime. Within this frame, doping is considered not just as a sport violation or a risk factor for individual's health, but as a disease of the society, in the society, against the society. A peculiar equilibrium seems to prevail between crime external pressures and resigned internal acceptance, according to the 'mafia hypothesis' model, where hosts accept parasitism to avoid retaliation. Here, main contributes and topics from the Erice 53rd Course are summarized and reviewed, providing links and references for further studies in the field. Health education and education to legality represent two sides of a same question, concerning both the general population and the health authorities. In conclusion, education to legality is a key component for prevention of doping and a priority for public health operators involved in protecting population health.

Essential Features of Third-Party Certification Programs for Dietary Supplements: A Consensus Statement.

The presence of performance-enhancing drugs in dietary supplements poses serious anti-doping and health risks to athletes and military service members. A positive drug test, suboptimal health, or adverse event can ruin a career in either setting. These populations need to be certain in advance that a product is of high quality and free from performance-enhancing drugs and other banned substances. However, no regulatory authority conducts or mandates a quality review before dietary supplements are sold. Under the Food Drug and Cosmetic Act, the Food and Drug Administration does not have a role in the premarket safety review of dietary supplements. Due to the increasing demand for high-quality, properly labeled dietary supplements, multiple companies have stepped into this void by offering testing and quality review programs for dietary supplements. Each of these third-party programs has its own quality assurance program with varying testing components. It is difficult for consumers in the sport and military settings to assess whether a particular certification program reduces the risks enough so that they can use a product with confidence. This article puts forward the consensus of the authors on current best practices for third-party certification programs for dietary supplements consumed by athletes and military service members. Also discussed are important ways that third-party programs can develop in the future to improve access to safe, high-quality dietary supplements for these populations.

Multiple incidence of the prescription diuretic hydrochlorothiazide in compounded nutritional supplements.

Diuretic agents are prohibited in sports in- and out-of-competition according to the regulations of the World Anti-Doping Agency (WADA) because of their possible masking effects on other doping agents in urine samples, and their ability to produce fast acute weight losses. Despite previous studies reported adverse analytical findings (AAFs) resulting from contaminations at ppm level (µg/g) of medicinal products, and recommended to introduce reporting limits for diuretics in doping controls, these are not adopted in analyses performed by WADA-accredited laboratories. We report the case of an athlete with two AAFs for hydrochlorothiazide (HCTZ) at low urinary concentrations (<10 ng/mL), who declared the use of nutritional supplements prepared in a compounding pharmacy. His nutritional supplements were analyzed revealing HCTZ presence in different concentrations, at the ppm level (µg/g and ng/mL). With the aim of testing the plausibility of the observed urinary HCTZ concentrations with the nutritional supplement ingestion, a urinary excretion study with three healthy volunteers was performed. HCTZ-contaminated powder (6.4 µg/g of HCTZ) was administered to each subject in different dosages, reproducing the possible ingestion pattern occurred. Urine specimens were collected before and after ingestion of the powder, up to 24 hours, and underwent liquid-liquid extraction and liquid chromatography-tandem mass spectrometry determination. Post-administration specimens were found to contain HCTZ at concentrations of 5-230 ng/mL, which supported the accidental inadvertent intake of the prohibited substance by the athlete. This study makes the argument that the introduction of reporting limits for diuretics are warranted in doping control samples, in order to protect against inadvertent AAFs due to contaminated products.

Regulating the South African sport supplement industry: 'Whey' overdue.

The South African sport supplement industry has experienced rapid growth in recent years. Despite the massive market demand, this industry remains poorly regulated. From raw ingredient contamination to label compliance discrepancies, the sport supplement industry is an area of growing concern and warrants further public debate.

Doping in sport: an analysis of sanctioned UK rugby union players between 2009 and 2015.

To inform anti-doping policy and practice, it is important to understand the complexities of doping. The purpose of this study was to collate and systematically examine the reasoned decisions published by UK Anti-Doping for doping sanctions in rugby union in the UK since the introduction of the 2009 World Anti-Doping Code. Case files were content analysed to extract demographic information and details relating to the anti-doping rule violation (ADRV), including individuals' explanations for how/why the ADRV occurred. Between 2009 and 2015, 49 rugby union players and one coach from across the UK were sanctioned. Over 50% of the cases involved players under the age of 25, competing at sub-elite levels. Reasons in defence of the ADRV focused on functional use and lifestyle factors rather than performance enhancement. An a priori assessment of the "need", "risk" and "consequence" of using a substance was not commonplace; further strengthening calls for increasing the reach of anti-doping education. The findings also deconstruct the view that "doped" athletes are the same. Consequently, deepening understanding of the social and cultural conditions that encourage doping remains a priority.

Have prohibition policies made the wrong decision? A critical review of studies investigating the effects of DMAA.

In June 2012 DMAA (1,3-dimethylamylamine), an ephedrine-like vasoconstricting substance which had been included in many popular sports supplements, became a scheduled substance in Australia, following bans in several other countries. The underlying rationale for this ban was that DMAA use is unsafe. This paper aimed to critically review the available evidence on the acute and/or long-term harms of DMAA. Using five research databases (PubMed, Embase, ProQuest Health and Medical Complete, and Web of Science) and the key terms 'methylhexaneamine', 'DMAA', 'dimethylamylamine', '1,3-dimethylpentylamine' and '2-amino-4-methylhexane', 842 articles were identified once duplicates removed. Sixteen studies met the inclusion criteria and were included in the review. Of the included studies, eight were case studies, which reported on eight patients who presented to emergence departments. All were retrospective in their reporting. The patients displayed various outcomes; while the patients were presenting with serious problems, in most patients conditions subsided on cessation of supplement use. The remaining eight experimental studies were low powered, with a number of studies conducted by a single research group with industry ties, and broadly investigated the effects of DMAA on physiological outcomes. Mixed findings were apparent, although escalations of blood pressure were present on acute dosing, as well as decreases in measures of body weight and body fat. There is a shallow evidence base describing the adverse effects of DMAA and the dose above which such effects may occur. The scheduling of DMAA in many countries may now impede research efforts to determine whether there are safe doses at which DMAA can be consumed.

Efectos de la suplementación con testosterona sobre el rendimiento en resistencia / Efeitos da suplementação com testosterona sobre o desempenho da resistência / Effects of doping with testosterone on endurance performance

El dopaje en el deporte tiene su origen en la Grecia Clásica. Sin embargo, a lo largo del siglo pasado y hasta la actualidad, la utilización de este tipo de prácticas fraudulentas en el deporte ha ido en aumento. Entre las sustancias dopantes más utilizadas destacan la testosterona y sus derivados sintéticos, los anabolizantes sintéticos. A pesar de que estas sustancias prohibidas se han utilizado para la mejora del rendimiento en pruebas de fuerza y potencia, frecuentemente se detectan positivos en deportistas de resistencia. Los objetivos del presente estudio han sido informar acerca de los efectos ergogénicos de la suplementación con testosterona y anabolizantes sintéticos sobre el rendimiento en resistencia, a través de cambios sobre parámetros sanguíneos, así como los efectos secundarios que tienen sobre la salud. Para ello, se ha realizado una revisión en bases de datos como Elsevier, Medline, Pubmed y Web of Science incluyendo términos como testosterone, anemia, doping, endurance, erythropoietin, hepcidin e iron. La hepcidina se ha propuesto la principal reguladora de las reservas corporales de hierro y la suplementación con testosterona puede afectar a la síntesis de dicha hormona. Los efectos de la testosterona sobre la hepcidina podrían hacer mejorar tanto la capacidad de transporte como de difusión de oxígeno. De este modo, el dopaje con testosterona podría tener un potencial efecto ergogénico en modalidades de resistencia. Sin embargo, dichas mejoras pueden tener efectos negativos sobre el estado de salud del deportista, entre los que se encuentran trastornos metabólicos, orgánicos, psicológicos e inmunosupresión (AU)

Doping in sport has its origins in Ancient Greece. However, over the last century to the present, the use of such dishonest practices has increased. Among the most widely used performance enhancing drugs is the use of testosterone and its synthetics anabolics. Although these prohibited substances have been used to increase performance in test of strength and power, due to the ability to cause hypertrophy, very frequent it's detecting positive test doping by in endurance athletes by testosterone or synthetics anabolics. The aim of this study was to report the ergogenic effects of testosterone supplementation and synthetics anabolics on endurance performance, through changes on blood parameters. To this end, it has conducted a review in different databases such as Elsevier, Medline, Pubmed and Web of Science where terms such as testosterone, anemia, doping, endurance, erythropoietin, hepcidin and iron were included. Hepcidin has been proposed main regulator of body iron stores and testosterone supplementation may affect the synthesis of the hormone. The effects of testosterone on hepcidin could improve both transport capacity and oxygen diffusion. Thus, doping with testosterone could have a potential effect on ergogenic resistance patterns. However, such improvements can have negative effects on the health of the athlete like metabolic, organic, psychological disorders and immunosuppression (AU)

O doping no esporte tem suas origens na Grécia Antiga. No entanto, do último século para o presente, a utilização de tais práticas desonestas aumentou. Entre as drogas que melhoram o desempenho mais amplamente utilizadas são o uso de testosterona e seus anabolizantes sintéticos. Embora estas substâncias proibidas têm sido usados para aumentar o desempenho em testes de força e potência, devido à capacidade de causar hipertrofia, é muito frequentes detecção de doping por testosterona ou anabolizantes sintéticos no teste de atletas de endurance. O objetivo deste estudo foi relatar os efeitos ergogênicos da suplementação de testosterona e anabolizantes sintéticos sobre o desempenho de resistência, através de mudanças nos parâmetros sanguíneos. Para este efeito, procedeu a uma revisão em diferentes bancos de dados, tais como Elsevier, Medline, Pubmed e Web of Science, onde termos como a testosterona, anemia, doping, resistência, eritropoietina, hepcidina e ferro foram incluídos. Hepcidina foi proposto como principal regulador das reservas de ferro do corpo e a suplementação de testosterona pode afetar a síntese do hormonio. Os efeitos da testosterona sobre hepcidina poderia melhorar tanto a capacidade de transporte e difusão de oxigênio. Assim, a dopagem com testosterona pode ter um efeito potencial sobre padrões de resistência ergogênicos. No entanto, essas melhorias podem ter efeitos negativos sobre a saúde do atleta como metabolismo, distúrbios psicológicos orgânicos e imunossupressão (AU)

Dietary supplementation practices in Canadian high-performance athletes.

Dietary supplementation is a common practice in athletes with a desire to enhance performance, training, exercise recovery, and health. Supplementation habits of elite athletes in western Canada have been documented, but research is lacking on supplement use by athletes across Canada. The purpose of this descriptive study was to evaluate the dietary supplementation practices and perspectives of high-performance Canadian athletes affiliated with each of the country's eight Canadian Sport Centres. Dietitians administered a validated survey to 440 athletes (63% women, 37% men; M=19.99±5.20 yr) representing 34 sports who predominantly trained≥16 hr/wk, most competing in "power" based sports. Within the previous 6 months, 87% declared having taken≥3 dietary supplements, with sports drinks, multivitamin and mineral preparations, carbohydrate sports bars, protein powder, and meal-replacement products the most prevalent supplements reported. Primary sources of information on supplementation, supplementation justification, and preferred means of supplementation education were identified. Fifty-nine percent reported awareness of current World Anti-Doping Agency legislation, and 83% subjectively believed they were in compliance with such anti-doping regulations. It was concluded that supplementation rates are not declining in Canada, current advisors on supplementation for this athletic population are not credible, and sports medicine physicians and dietitians need to consider proactive strategies to improve their influence on supplementation practices in these elite athletes.

Anabolic-androgenic steroids and adolescents: recent developments.

Despite their classification as a Schedule III Controlled Substance, anabolic-androgenic steroids continue to be used by adolescents who seek increased muscularity as well as enhanced athletic performance. Although the potential side effects of steroids are relatively well known, problems with counterfeit substances and steroid-spiked dietary supplements have received less attention. Drawing on scholarly literature and reports from government units such as the Drug Enforcement Administration and the Food and Drug Administration, this article addresses those issues and makes recommendations for communicating with adolescents about the use of steroids.

Dehydroepiandrosterone to enhance physical performance: myth and reality.

Dehydroepiandrosterone (DHEA) is secreted by the zona reticularis of the adrenal cortex and is converted into potent sex steroids in peripheral target cells. As oral DHEA administration can lead to dose-dependent increases in circulating androgens, which may reach high supraphysiologic levels in women, it has been included in the list of prohibited substances by the World Anti-Doping Agency (WADA). However, evidence for an ergogenic activity of DHEA is still largely nonexistent. Randomized trials in elderly subjects with an age-dependent decrease in DHEA have provided little or no evidence for enhanced physical performance after long-term administration of DHEA, 50 mg/d, and smaller short-term studies in healthy male athletes using higher doses were completely negative. Thus the widely perceived performance-enhancing activity of DHEA is still more myth than reality. However, because studies in female athletes are still lacking, an ergogenic activity of high-dose DHEA in this population cannot be excluded but is expected to be associated with adverse events like hirsutism, acne, and alopecia.

Performance-enhancing drugs and supplements in women and girls.

Performance-enhancing substance use has been frequently discussed in the media. High-profile professional athletes have tested positive for performance-enhancing substances, while surveys indicate an escalating incidence of use among amateur athletes. Several articles have reviewed this concern in men's sports; however, this article discusses performance-enhancing drug and supplement use by women and girls.

Blood transfusions in athletes. Old dogmas, new tricks.

Blood doping consists of any illicit means used to increase and optimize oxygen delivery to the muscles and includes blood transfusions, administration of erythropoiesis-stimulating substances, blood substitutes, natural or artificial altitude facilities, and innovative gene therapies. The use of blood transfusion, an extremely straightforward, practical and effective means of increasing an athlete's red blood-cell supply in advance of competition, became rather popular in the 1970s, but it has suddenly declined following the widespread use of recombinant human erythropoietin among elite endurance athletes. Most recently, following implementation of reliable tests to screen for erythropoiesis-stimulating substances, blood transfusions have made a strong resurgence, as attested by several positive doping tests. Doping by blood transfusion can be classified as homologous, where the blood is infused into someone other than the donor, and autologous, where the blood donor and transfusion recipient are the same. The former case produces more clinically relevant side effects, but is easily detectable using current antidoping protocols based on erythrocyte phenotyping by flow cytometry and, eventually, erythrocyte genotyping by DNA testing. Since the donor and recipient blood are identical in autologous blood doping, this is less risky, though much more challenging to detect. Indirect strategies, relying on significant deviations from individual hematological profiles following autologous blood donation and reinfusion, are currently being investigated. For the time being, the storage of athletes' blood samples to allow testing and sanctioning of guilty athletes once a definitive test has been introduced may represent a reliable deterrent policy.

Testosterone prohormone supplements.

Testosterone prohormones such as androstenedione, androstenediol, and dehydroepiandrosterone (DHEA) have been heavily marketed as testosterone-enhancing and muscle-building nutritional supplements for the past decade. Concerns over the safety of prohormone supplement use prompted the United States Food and Drug Administration to call for a ban on androstenedione sales, and Congress passed the Anabolic Steroid Control Act of 2004, which classifies androstenedione and 17 other steroids as controlled substances. As of January 2005, these substances cannot be sold without prescription. Here, we summarize the current scientific knowledge regarding the efficacy and safety of prohormone supplementation in humans. We focus primarily on androstenedione, but we also discuss DHEA, androstenediol, 19-nor androstenedione, and 19-nor androstenediol supplements. Contrary to marketing claims, research to date indicates that the use of prohormone nutritional supplements (DHEA, androstenedione, androstenediol, and other steroid hormone supplements) does not produce either anabolic or ergogenic effects in men. Moreover, the use of prohormone nutritional supplements may raise the risk for negative health consequences.

Popular ergogenic drugs and supplements in young athletes.

Ergogenic drugs are substances that are used to enhance athletic performance. These drugs include illicit substances as well as compounds that are marketed as nutritional supplements. Many such drugs have been used widely by professional and elite athletes for several decades. However, in recent years, research indicates that younger athletes are increasingly experimenting with these drugs to improve both appearance and athletic abilities. Ergogenic drugs that are commonly used by youths today include anabolic-androgenic steroids, steroid precursors (androstenedione and dehydroepiandrosterone), growth hormone, creatine, and ephedra alkaloids. Reviewing the literature to date, it is clear that children are exposed to these substances at younger ages than in years past, with use starting as early as middle school. Anabolic steroids and creatine do offer potential gains in body mass and strength but risk adverse effects to multiple organ systems. Steroid precursors, growth hormone, and ephedra alkaloids have not been proven to enhance any athletic measures, whereas they do impart many risks to their users. To combat this drug abuse, there have been recent changes in the legal status of several substances, changes in the rules of youth athletics including drug testing of high school students, and educational initiatives designed for the young athlete. This article summarizes the current literature regarding these ergogenic substances and details their use, effects, risks, and legal standing.

Contaminated nutritional supplements--legal protection for elite athletes who tested positive: a case report from Germany.

A significant proportion of nutritional supplements manufactured worldwide contain non-listed contaminations with anabolic-androgenic steroids (AAS), whose ingestion may lead to positive doping test results. This will lead to the suspension of, and sanctions against, the athlete, since this group of active substances is prohibited by the anti-doping code of the World Anti-Doping Agency as well as by sports associations not connected with this agency. Considerable financial losses are often the consequence for a banned athlete. Based on an amendment to the law governing the manufacture and prescription of drugs (AMG) in Germany in 1997 and an increasingly extensive interpretation of the term "drug" by the Federal Supreme Court, preparations containing anabolic steroids or their precursors are to be classified as drugs and, therefore, are subject to compulsory declaration as stated by the AMG. If this obligation is not adhered to, the result may be a claim for damages by the athlete against the manufacturer of a preparation, if the athlete took the preparation thinking it was harmless as judged by the Anti-Doping regulations, but was then found to be positive in doping tests. The judges in the first case before the county court in Stuttgart decided in favour of the claim for damages with respect to lost bonuses, loss of earnings and accrued legal costs by a soccer player who tested positive and was therefore suspended. Based on the evidence presented, the court came to the decision that the soccer player's positive test result was due to the ingestion of nutritional supplements containing non-listed AAS. This procedure could set a precedent for other states to demonstrate that athletes who had tested positive due to contaminated nutritional supplements are not without legal protection.