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University of Miami Sports Nutrition Performance Guide

The Official Canes Supplement Guide

Lisa Dorfman, MS, RD, CSSD, LMHCUM Sports Nutritionist


ldorfman@miami.edu
305-854-1065

How to Use This Guide


As a college athlete, you are striving to reach your personal best in sports, health and life. Besides
training, nutrition is the most important influence on sports performance. Nutritionwhat you eat and
drink during training and competition can make the difference between:

the average athlete and aspiring professional,

the chronically injured and ill athletes and those who maintain good health, and

athletes who drag throughout their workouts and life vs. those who are energized and strive to
be the best in all aspects of their lives.

Sometimes it is tempting to take the easy way outdrink, consume, or even inject your way to more
energy, strength, muscle mass or weight loss, fat and lethargic workouts. Taking supplements is a risky
business in college sports. At best they can give you a quick boost of energy, speed or power but at worst
they can cause a positive substance test, eliminate you from playing colegicially or professionally, and
may even cause permanent damage to your body.
This supplement guide will help you understand the NCAA legal standpoint on supplements, sort out fact
from fiction on all the latest supplements and direct you towards selecting foods for a healthy diet
complete with the vitamins, minerals, protein and amino acids vs. supplements to meet the daily dietary
demands of your sport in addition to helping you prepare and recover from any competition.
Athletes who may benefit from calorie dense shakes and bars such as the University of Miamis Muscle
Milk shakes, bars and Gatorade products are:

those who cannot meet their caloric needs on a normal whole foods diet, and

all athletes as a post training or competition recovery fuel.

Sport drinks such as Gatorade replace valuable electrolytes lost through sweat, and muscle sugars needed
for energy during training and competition. Electrolytes help the bodys cells to communicate efficiently.
Electrolytes like sodium, which allows the body to retain fluids after consuming liquids, potassium,
phosphate, magnesium, calcium, and chloride, are vital elements that allow for optimal performance in
athletic challenges. After exercise, there is and increase in blood sugar levels, increase in loss of water
soluble nutrients, and an increase in urination which may call for vitamin and/or mineral supplements to
help athletes prevent dietary deficiencies or conditions such as iron deficiency anemia, lactose
intolerance, GI issues, or other special dietary restrictions such as vegetarianism which can compromise
the dietary intake and absorption of iron, calcium, B vitamins, and minerals.
Whether you can actually benefit from extra vitamins, minerals, shakes or bars is up to your personal
doctor or UM sports nutritionist. It is best not to purchase any products without their approval since you
can run the risk of toxicities which can impair your performance and/or be tainted with illegal substances.

You can meet with the UM sports Nutritionist Lisa Dorfman via email, in person or by phone to evaluate
your dietary needs. The consultation will include a nutritional evaluation to get an analysis of your current
diet to find out your dietary strengths and weaknesses in order to personalize a program just for you.
To make an appointment with Lisa Dorfman call 305-854-1065 or by email at ldorfman@miami.edu.

University of Miami Sports Performance Guide


Table of Contents
I.

Introduction
a. Energy Intake
b. What is a supplement?
c. NCAA rules and regulations: Legalities and contamination
d. Steroids and Hormones

II.

Supplemental Fluids
a. Sports drinks
b. Electrolytes
c. Energy drinks
d. Caffeine
e. Alcohol

III.

Muscle Building
a. Creatine
b. HMB
c. Chromium
d. ZMA

IV.

Amino Acids
a. Arginine
b. Beta-Alanine
c. BCAA
d. Glutamine
e. L-Carnitine

V.

Vitamins
a. Vitamin C

b. Vitamin B
c. Vitamin E
VI.

Minerals
a. Calcium
b. Iron

VII.

Fatty Acids
a. Omega 3 Fatty Acid
b. CLAs

VIII.
IX.
X.

Herbs
Appendix A: Evaluating Popular Sports Nutrition SupplementsEllen Coleman, RD
Appendix B: Sport/Nutrition Bars

Acknowledgement
With appreciation to my summer interns, Jacqueline Salk and Meredith Degnan for assisting me with the
completion of this guide.

Dietary Guide for Sports Training

To be successful in athletic performances, an athlete has to have a mixture of good genetics,


proper training and a healthy approach to diet and nutrition. The human body must be supplied
continuously with energy in order to perform its many complex functions. As a persons energy
demands increase with exercise, the body must provide additional energy or the exercise will
cease. Nutrients are needed by the body for providing energy, building body structures, and the
regulation of body functions. With that in mind, Lisa Dorfmans Hurricanes Sports Nutrition
Performance Eating Program was developed exclusively for the University of Miami athletes as
a general food guide for training and competition. While each and every athlete has varying
needs for calories, protein, fat, carbohydrates, vitamins and minerals based on many factors
including their age, weight, height, sex, genetics, health status, fitness & training level, the
2400-calorie plan for female athletes and 3500- calorie plan for male athletes can be used as a
starting point for getting adequate nutrition, building energy and endurance, developing lean
muscle mass and strength and preventing issues such as dehydration, vitamin and mineral
imbalances, and deficiencies which can impact training and performance.

Additional calories may be required for more intense training athletes, larger athletes, athletes
training more than 2 hours each day, athletes combining strength and endurance training, and
those athletes with high metabolism to meet daily energy requirements. When additional calories
are required, healthy food sources such as fresh fruits and vegetables, whole grains, legumes, anti
oxidants, beans and lean proteins like chicken, fish, seafood, turkey, egg whites, and non-fat
dairy are recommended. When additional calories cannot be met through food, approved sport bars and
shakes, ie NCAA Muscle Milk can be added to a daily diet. A listing of other sport bars can be found in
Appendix B.

Program Description

The program is suitable for healthy athletes ages 18-23. The program is moderately high in
protein and complex carbohydrates and low in fat, saturated fat and sodium. For men, the dietary
needs are 3500 calories & 116 grams of fat, and for women, it is 2400 calories and 80 grams of
fat per day. Inadequate calorie intake is associated with dietary deficiencies while excessive
calorie intake has short term consequences such as joint pain, injury and delayed recovery from
injury, illness, training and competition and long term consequences like obesity, type II diabetes
and high blood pressure.

Dietary Guide for Fitness and Sport


The most important component of successful sport training and performance is to ensure
adequate calorie intake to support energy expenditure, maintain strength, endurance, muscle
mass and overall health. Energy and nutrient requirements will vary with weight, height, age,
sex, and metabolic rate and with the type, frequency, intensity, and duration of training.

Recommended Daily Food Servings:


Men: 3500 calories
393 g carbohydrates (46%) 220 grams protein (26%), 108 grams fat (28%)
4 cups low fat milk, yogurt or dairy equivalent
9 pieces fruit (1 cup juice = 2 fruits)
3 cups vegetables or salad +
4 cups grains or starchy vegetables plus 4 slices bread
20 oz protein or protein substitutes(140 grams protein )
12 tsp fat (60 grams )
9 cups -2 liters water, sport drinks, sugar free tea, low cal fluids+
Food Servings and equivalents:
Food Group
Protein*

portion size
1 oz

calories

C (GM) F (GM) P (GM)

55-80

1-9

7-9

Starch/Bread*

1 bread/1/2 cup

70-90

15

1+

3-5

Vegetables*

1 cup

50

1+

Fruit

1 piece

50-70

15

Dairy*

1 cup

80-100

12

0+

Fat/oils

1 tsp

45

*varying fats depending on prep, sauces, oils, other additions

Menu example:
Men- 3500 calories

393 g carbohydrates (46%) 220 grams protein (26%), 108 grams fat (28%)
Breakfast

Lunch

Dinner

1.5 c ww, low sugar cereal


1 c low fat milk
1 banana
1 egg white omelet w/veggies
1-2 oz ham or Canadian bacon
1 cup Orange juice

1 cup OJ
2 c salad
8 oz chicken grilled
1 tbsp salad dressing
1 bag baked chips
1 cup 1 % milk

1 cup veg. soup


1 dinner roll
1 cup green salad
10 oz lean steak
1 cup rice and beans
cooked vegetables

Snack
sport bar or shake
fruit
water

snack
1 smoothie
and low fat milk
water

snack
1 breakfast/cereal bar
water

Women: 2400 calories


288 g carbohydrates (49%) 167 grams protein (28%), 61 grams fat (23%)

4 cups low fat milk/dairy or equivalent


4 pieces fruit (1 cup juice = 2 fruit servings)
3 cups vegetables or salad
2 cups starchy vegetables cereals or grains + 2 slices bread
15 oz protein(105 grams )
6 tsp fat(30 grams fat)
9 cups minimum water, tea, fluids+

Food Servings and equivalents:


Food Group

portion size

calories

C (GM) F (GM) P (GM)

Protein*

1 oz

55-80

1-9

7-9

Starch/Bread*

1 bread/1/2 cup

70-90

15

1+

3-5

Vegetables*

1 cup

50

1+

Fruit

1 piece

50-70

15

Dairy*

1 cup

80-100

12

0+

Fat/oils

1 tsp

45

*varying fats depending on prep, sauces, oils, other additions

Menu example:
Women- 2400 calories

288 g carbohydrates (49%) 167 grams protein (28%), 61 grams fat (23%)
Breakfast

Lunch

1 c ww, low sugar cereal


1 c lowfat milk
1 banana
1 c orange juice

1 c melon or pineapple
2 c salad
6 oz chicken grilled
1 tbls salad dressing
6 ww crackers

Snack
1 apple
1 breakfast bar

snack
1 smoothie with
low fat milk

Dinner
1 cup veg soup
1 dinner roll
1 cup green salad
8 oz grilled fish
cup rice and beans
1 c cooked vegetables
snack
1 yogurt
1 fruit

Consume adequate fluids through water, sport drink, unsweetened tea or sugar free soft drinks, flavored low sugar
waters, nonfat milk, smoothies

Snacks/beverages recommended for energy- Fresh fruit, veggies, low fat crackers, flatbread, yogurt,
whole grain crackers or cereal, pretzels or baked chips
All rights reserved. No part of this handout can be reproduced without the authors written permission.

Energy: Calories for Sport

Energy and nutrient requirements vary between individuals because of differences in weight,
height, sex, age, and metabolic rate. The time, duration, intensity, and frequency of training will
also greatly vary, therefore the determined energy needs for athletes will also vary. Individuals
who participate in an overall fitness program, i.e. thirty to forty minutes per day, three times per
week can generally meet their daily nutritional needs by following a normal diet providing
roughly 1,800-2,400 calories per day. Athletes with a more intense training demands can require
anywhere from 2,400 to over 10,000 calories per day (4). Meeting the caloric needs of athletes
may not be possible through a whole food diet alone, and may benefit from additional
supplementary shakes, cars and snacks. Inadequate amount of calories can cause muscles to
breakdown more easily. Moreover, breakfast is always a positive way to start consuming
adequate calories to prevent injuries. Breakfast foods such as fortified cereals, peanut butter with
whole grain bread, yogurt with fruit, and oatmeal are all good food choices containing much
needed nutrients for good quality physical performance.
Sports drinks, some weight gain shakes, bars, and gels help to get athletes extra energy for
their training, weight gain or competition. A multivitamin or singular vitamin or mineral can help
manage a deficiency such as an iron or calcium deficiency and electrolytes like potassium lost
through sweat. A dietary evaluation and/or blood test can help determine the need for a vitamin
or supplement before spending money on unnecessary and potentially illegal supplements.
When athletes do not take the time to change their diet but instead are tempted to add
supplements to their existing, and perhaps deficient, diet at a great expense. Most supplements
will not enhance an athletes performance and may even contain NCAA banned and illegal
substances which can increase ones personal health risk and possibly lead to elimination from
the team or school.
What is a dietary supplement?
Dietary Supplementdefined by the Dietary Supplement Health and Education Act as
something added to the diet, mainly vitamins, minerals, amino acids, herbs or botanicals,
metabolites/ constituents/extracts or combination of any of these ingredients. A supplement is
intended to aid in getting adequate nutrients from a healthy diet. Supplements can include
vitamins, minerals, amino acids, shakes, bars, and sports gels. Athletes attracted to using
supplements as a quick fix towards reaching their goal of increase muscle mass, metabolism,
stamina, and loss of body fat.
One thing an athlete must be aware of is the risk of contamination. Even seemingly
legal dietary supplements could have been contaminated with small amounts of prohormones or
other compounds found on the list of banned substance. This has been the cause of some positive
drug tests, and because an athlete signs a code of conduct, he or she is responsible for everything
that goes into his or her body. A guide to evaluating sports supplements can be found in
Appendix A
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NCAA Banned-Drug Classes 2007-08

The NCAA list of banned-drug classes is subject to change by the NCAA Executive Committee.
The term related compounds comprises substances that are included in the class by their
pharmacological action and/or chemical structure. No substance belonging to the prohibited class
may be used, regardless of whether it is specifically listed as an example. Many
nutritional/dietary supplements contain NCAA banned substances. In addition, the U.S. Food
and Drug Administration (FDA) does not strictly regulate the supplement industry; therefore
purity and safety of nutritional dietary supplements cannot be guaranteed. Impure supplements
may lead to a positive NCAA drug test. The use of supplements is at the student-athletes own
risk. Student-athletes should contact their institutions team physician or athletic trainer for
further information.

Banned Drugs: The following is a list of banneddrug classes, with examples of substances under
each class.
(a) Stimulants:

(b) Anabolic Agents:


anabolic steroids

methylenedioxymethamphetamine
amiphenazole (MDMA, ecstasy)
amphetamine
meclofenoxate
bemigride
methylphenidate
benzphetamine
nikethamide
bromantan
octopamine
caffeine1 (guarana)
pemoline
chlorphentermine
pentetrazol
cocaine
phendimetrazine
cropropamide
phenmetrazine
crothetamide
phentermine
diethylpropion
phenylpropanolamine
dimethylamphetamine
picrotoxine
doxapram
pipradol
ephedrine (ephedra,
prolintane
ma huang)
strychnine
ethamivan
synephrine (citrus
aurantium,
zhi shi, bitter orange)
ethylamphetamine
fencamfamine

androstenediol
methyltestosterone
androstenedione
nandrolone
boldenone
norandrostenediol
clostebol
norandrostenedione
dehydrochlormethyl- norethandrolone
testosterone
oxandrolone
dehydroepiandrooxymesterone
sterone (DHEA)
oxymetholone
dihydrotestosterone
stanozolol
(DHT) testosterone2
dromostanolone
tetrahydrogestrinone
(THG)
epitrenbolone
trenbolone
fluoxymesterone
gestrinone
mesterolone
other anabolic agents:
methandienone clenbuterol

The following stimulants are not


banned:
methamphetamine
pseudoephedrine

phenylephrine

11

(c) Diuretics and other Urine Manipulators:

(d) Street Drugs:

acetazolamide
hydrochlorothiazide
bendroflumethiazide
hydroflumethiazide
benzhiazide
methyclothiazide
bumetanide
metolazone
chlorothiazide
polythiazide
chlorthalidone
probenecid
ethacrynic acid
spironolactone (canrenone)
finasteride
probenecid
flumethiazide
triamterene
furosemide
trichlormethiazide
and related compounds

heroin
marijuana

tetrahydrocannabinol
(THC)3

(e) Peptide Hormones & Analogues

(f) Anti Estrogens

Corticotrophin (ACTH)

Anastrozole
Clomphene
Tamoxifen

Growth Hormone (hGH, Somatotrophin)


Human Chorionic Gonadotrophin (hCG)
Insulin like Growth Factors (IGF-I)
Luteinizing Hormone (LH)
Erythropoietin (EPO) Sermorelin
Darbepoetin

Effects of androgenic anabolic steroids in Athletes:


Skinacne and cysts, oily scalp
Hormonaldisturbance in endocrine and immune function
Physicalshort stature, tendon rupture
In kidspremature closing of growth plates
Malesincrease sex drive, acne vulgaris, enlarged breasts, testicular hypotrophy,
infertility.
Femalesclitoris enlargement, excessive body hair

12

Metabolicchanges in haemostatic system and urogenital tract, altered glucose metabolism,


immune system suppression, low thyroid hormone levels
Cardiovascularincrease blood pressure, depression of HDL, HDL2, and HDL3 cholesterol
Hepatic systemcancer, pelosis hepatitis, increased liver enzymes, jaundice
Mental HealthIncrease aggressive behavior, mood disturbances, i.e. depression, hypomania,
psychosis, homicidal rage, mania, delusions
InfectionHIV/AIDS, hepatitis (from injectable)
Athletic PerformanceIncrease strength, and lean body mass, no increase in endurance
performance.

Definitions of positive:
1. Caffeineif the concentration in urine exceeds 15 micrograms/ml.
2.

Testosterone an adverse analytical finding (positive result) based on any reliable analytical
method (e.g., IRMS,GCMS, CIR) which shows that the testosterone is of exogenous origin, or if
the ratio of the total concentration of testosterone to that of epitestosterone in the urine is greater
than 6:1, unless there is evidence that this ratio is due to a physiological or pathological condition.

3. Marijuana and THCif the concentration in the urine of THC metabolite exceeds 15
nanograms/ml.
Starting on the list of banned substances are supplements known as prohormones and anabolic
steroids. Prohormones are naturally derived precursors to testosterone and other anabolic steroids. They
are popular among body builders because they claim to naturally boost anabolic hormones. There is no
evidence that these compounds affect training adaptations, and may even reduce HDL (good cholesterol)
and increase LDL (bad cholesterol) (4). Androgenic-anabolic steroids, known as male sex steroid
hormones, are used to enhance athletic performance and appearance. Some of the effects, including
increased muscle mass, increased bone mineral density, and a decrease in body fat attract steroids to
athletes who wish to improve their performance. Short term administration of these drugs can increase
strength, body weight, and speed. However, some of the adverse effects associated with these steroids are
irreversible, especially in women, and can impact male and female liver, serum lipids, psyche and
behavior, and reproductive systems. Neither prohormones nor steroids should be consumed by student
athletes, as they are illegal and propose detrimental effects to the person taking them.

13

Popular Products that contain illegal ingredients:


Hydroxycut (Ephedrine)

Xenadrine (Bitter Orange)

Metabogenx (Ephedrine)

HydroXadrine (combination of hydroxycut and Xenadrine)

Thermospeed (Ephedrine)

Zantrex 3 (caffeine)

Fluids for Hydration


Hydration is very important for an athlete during competition in order to prevent dehydration. Accurate
hydration regulates the bodys temperature and is essential for an athletes comfort, optimal
performance, and safety in any physical activity. Dehydration is defined as percent loss in body weight
and can be extremely detrimental, even life threatening, to an athlete during performance. Dehydration
can result in a decrease in blood volume, skin blood flow, and sweat rate along with an increase in core
body temperature and muscle glycogen uptake (6). Dehydration also causes cramps, dizziness, fatigue,
increases chances of heat exhaustion and heat stroke. Sweating increases fluids and water loss, so it is
important to realize this factor and take it into account with training in climates such as Miami. Fluid
intake requirements increase as ambient temperature and energy expenditure increases. An adequate
hydrated state can be assured by a high fluid intake in last few days before competition. Here are some
guidelines for proper hydration:
o

A useful check is to observe the color of urine, which should be pale in color. An athlete
should not rely on this test if he/she is taking vitamin supplements, as the water-soluble B
vitamin riboflavin, can add a yellowish hue to urine.

Thirst is an unreliable sign to drink because a considerable degree of dehydration can occur
before the desire for fluid intake is evident.

In hot and humid environments, frequent consumption of small volumes of fluid are
recommended throughout exertion: 3-4 ounces every 15-20 minutes.

Suggested fluid intake for exercise:


o

Before exercise: Consume 16-24 fluid ounces two hours before practice or event and 12 fluid
ounces 15 minutes before.

During exercise: Consume 8-12 fluid ounces every 15 minutes for events last longer than one
hour. Use a 6-8% carbohydrate concentration and a small amount of electrolytes (500700mg/L Sodium)

After exercise: Try to ingest 150% weight loss; 1.5 Liters/kg body weight lost.
14

Sports Drinks
NCAA: Permitted
The main goal of a sports drink is to replace losses of nutrients and electrolyte levels with fluid intake and
to refuel depleted glycogen stores. Electrolytes are important to athletes involved in prolonged, high
intensity exercises. The primary electrolytes added to sports drinks are sodium and potassium, which
helps replenish the losses lost through sweating. Sodium maintains blood volume, helps to hydrate
athletes by increasing their own thirst mechanism and ensuring that they consume enough fluid, while
also increasing water absorption and fluid retention. Potassium is an important factor in action potentials
leading to muscle contraction. Proper hydration assists with the cooling of body temperature which is
vital to athletic endurance and performance. Consuming a carbohydrate-electrolyte sports drink can allow
greater performance by an athlete. (10).
Electrolytes: Potassium, sodium, chloride, and magnesium are mineral salts that can conduct electricity
when dissolved in water. For optimal health and athletic performance, it is important that you consumer
these nutrients in proper balance. Keep you salt intake low and your potassium intake high because to
much sodium chloride can disrupt this balance. Together electrolyte function in maintaining they bodys
water balance distribution, kidney and adrenal functions, acid-base balance, muscle and nerve cell
functions, and heart functions.

SPORTS DRINK
Accelerade
Allsport Body Quencher
Champion Nutrition MET II
Champion Nutrition Metabolol
Champion Nutrition Pro-Score 100
Champion Nutrition Revenge
Champion Nutrition Revenge Sport

Carbo Pro
Cytomax
Cytomax Cool Citrus
Cytomax Complete Whey
Cytomax Lite
Cytomax Pre-Formance
Cytomax Recovery
1st Endurance E3
Endurox R4
Extran Carbohydrate
Extran Thirstquencher

Exercise

Calories

Carbs

Protein

Fat

Sodium

Potassium

During

140
120
260
200
80
100
90
224
100
96
96
80
260
340
96
270
575
90

26g
32g
36g
24g
<1g
20g
23g
56.7g
20g
20g
3g
16g
35g
18g
24g
53g
145g
22g

6.5g

1g

86mg
100mg

20g
14g
17g
4g
0g
0g
0g

4g
5g
1g
0.5g
0g
0g
0g

190mg
110mg
200mg
210mg
190mg
85mg
100mg
0mg
80mg
100mg
150mg
65mg
50mg
100mg
270mg
220mg
0mg
122mg

After
Before
After
During
During
During
During
After
During
Before
After
During
After
During
During

16g
0g
26g
26g
0g
14g
0g
0g

1.5g
0g
2g
18g
0g
1g
0g
0g

110mg

15

Gatorade
G Plush G1 Hydration Formula
GU20
Hammer Nutrition HEED
Hammer Nutrition Perpetuem
Hammer Nutrition Sustained
Energy
Hammer Nutrition Recoverite
PowerBar Endurance
Powerade
PowerBar Recovery
Sport Quest Interphase
Spiz
Ultima
Ultragen

During
During
During
During
During
After
During
After
After
During
During
After

60
50
100
100
260

15g
12g
26g
25g
54g

0g

0g

0g
6g

0g
2g

343
120
70
140
90
172
517
25
320

73g
30g
17g
38g
20g
13g
94g
6g
60g

10.5g
10g
0g

1g
0g
0g

3g
25g
20g
0g
20g

0g
2g
5g
0g
0g

200g
340mg
240mg
62mg
231mg

60mg
80mg
40mg

112mg
74mg
160mg
110mg
250mg
190mg
580mg
75m
350mg

60mg

Energy Drinks
A competitive athlete is constantly training to become better in his or her sport. Because of this lifestyle,
one may complain about fatigue or running out of energy, and turn to an energy drink as a source of
replenishment. Most of these energy drinks contain carbohydrate and caffeine as the main ingredients,
along with other nutrients such as amino acids, vitamins, and minerals. Energy drinks also often contain
methylxanthines (caffeine), B vitamins and herbs. The high carbohydrate, typically sugars, provides
energy while the caffeine stimulates the central nervous system (2).
Most energy drinks contain > 18-25 grams of carbohydrate and 80 -360mgs of caffeine per eight
ounce serving. This high concentration will slow fluid absorption into the blood and impede rehydration
during exercise (2). This can cause a number or problems, including gastrointestinal disturbances,
nervousness, irritability, muscle twitching, headaches and respiratory problems which can decrease
performance. Energy drinks may also cause seizures due to the crash effect following the quick bursts
of energy it provides. Because of this, energy drinks should not be consumed before, during, or after
exercise when rehydration is crucial.

Energy Drink

Caffeine

5 Hour Energy Drink

40mg/fl. oz.

Amp Energy Drink

71mg/8 fl oz.

Red Bull

80mg/8.3 fl oz.

Rockstar Energy Drink-Original

80mg/8 fl. Oz

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Caffeine
NCAA: permitted within guidelines: see intake below.
Overview: Caffeine is a central nervous system and metabolic stimulant. It is readily absorbed in the
bloodstream after ingestion, as blood levels rise and peak around sixty minutes (6). The improvement in
performance is explained by increased fatty acid availability, which leads to a decrease in carbohydrate
metabolism and a consequent decrease in glycogen use.
Claim: Caffeine is sold to consumers as an energizing product claiming to increase endurance (and
overall) performance, along with increasing alertness.
Intake: If an athlete is testes for caffeine and his/her urine contains over 15 micrograms per milliliter, he
will be considered a violator of NCAA guidelines, and will fail the drug test.
Validity: In moderation, caffeine has no adverse health effects; however, it can be accompanied by an
upset stomach, nervousness, irritability, headaches, and diarrhea (14). There have been many studies that
support the notion that caffeine improves performance during endurance running and cycling, and also
short term, high intensity exercise. Caffeine is a diuretic, however, and may decrease the consumers
overall hydration. Small amounts of caffeine, (less than three mugs of coffee), consumed an hour before
exercise may increase overall stamina and performance (1).
Alcohol
NCAA: Not Permitted, not encouraged

Alcohol is a central nervous system depressant. Pure alcohol supplies 7 cal/gram and is a source
of energy that is metabolized more like fat. In order to be on top of ones game, an athlete needs
to train and perform intensely on both a mental and physical level. Alcohol has been described
as a performance impairing drug. It exerts an effect on most of the organ systems used by the
body during exercise, including the central nervous system, muscle energy stores, and the
cardiovascular system. Acute effects include effects on motor skills and physical performance,
while chronic effects eventually impede physical performance, leading to varying degrees of
muscle damage and weakness (16). Alcohol also effects motor coordination and depletes aerobic
capacity and endurance for up to 48 hours from the last consumed drink.
Effects on muscle development and recovery:
o

Alcohol use may cancel out gains from your workout by reducing protein synthesis and therefore
decreasing muscle build-up.

Alcohol causes dehydration and slows down the bodys ability to heal because it is a toxin that
travels through the blood stream to every organ and tissue.

Alcohol may prevent muscle recovery by decreasing your levels of human growth hormone and
testosterone, both of which are important in muscle growth and recovery.
17

Alcohol can deplete your sources of energy by altering your bodys ability to make ATP.

Effects on nutrition and endurance:


o

Alcohol use constricts metabolism and endurance.

Alcohol use may require increased conditioning to maintain weight because of the extra calorie
intake.

Alcohol use can inhibit the absorption to vital nutrients including thiamin, vitamin B12, zinc, and
folic acid.

Alcohol increases fatigue and increases blood pressure making the heart have to work harder and
expending more energy.

An athlete needs to be aware that alcohol has negative effects on motor skills, strength and power, and
aerobic performance. Alcohol causes abnormal heart rhythms in athletes, weakens cardiac and skeletal
muscles, slowly depletes vitamins in the body and interferes with the absorption and storage of new
nutrients. The goal of training is to reach peak performance, and athletes cannot reach that goal if they let
alcohol consumption get in the way.

Muscle-Building Supplements
Many athletes train to increase strength and speed to optimize their athletic performance. When
conventional methods, such as resistance training and diet, do not lead athletes to a quick fix, they may
look toward muscle building supplements to increase their lean muscle mass.
Creatine
NCAA: Not illegal, Not permitted

Overview: Creatine is a naturally occurring compound present in most muscle tissue. Creatine is

an amino acid normally produced in the body from arginine, glycine and methionine. Most of the
creatine in the diet comes from meat, but half of the bodys supply is manufactured in the liver
and kidneys. Phosphocreatine in the muscle provides the high energy phosphate for ATP
regeneration during the first seconds of high intensity exercise.
Claims: Supplementing with creatine is said to increase phosphocreatine stores in type II (fast twitch)
muscle fibers, which can improve contractile function by maintaining ATP turnover, reduce the need for
anaerobic glycolysis and lactic acid formation during intense exercise, and result in a higher
phosphocreatine synthesis during recovery from high intensity exercise.
Validity: Studies have shown an increase in peak power and total work were observed which positively
correlates with an increase in concentration of PCr in type II muscle fibers after supplementation.
18

Availability: The primary dietary sources of creatine are fish and red meat. Supplements can be found in
pill, wafer, and powder forms. Creatine absorption appears to be enhanced when consumed with a high
carbohydrate sports drink or juice.
Caffeine may counteract creatines benefits on acute intermittent exercise performance and taken in
combinations may exert adverse effects including an increase in dehydration.
Also, the use of creatine supplements may be unsafe for those using NSAIDs, renal medication, and
diuretics due to possible interaction (11).
Chromium
NCAA: Not illegal
Overview: Chromium is considered an essential mineral in the diet which potentiates insulin action which
is critical to the metabolism and storage of carbohydrate, fat, and protein in the body
Claims: It is a very popular supplement because manufacturers claim that it builds muscle and burns fat.
The stimulated amino acid uptake is thought to increase protein synthesis and muscle mass gain.
Validity: There has been some research which shows that chromium increases growth, decreases body
fat, enhances RNA synthesis, and positively influences the immune system. However, there has been no
research supporting the claims that chromium will lower body fat or increase lean muscle mass.
Availability: Chromium can be found in meat, dairy products, whole grain breads and cereals. It is
available as a single ingredient supplement as well as in combination forms which include: chromium
chloride, chromium nicotinate, chromium picolinate, high chromium yeast, and chromium citrate.
Some medications may interact with chromium, especially if taken on a regular basis. For example, betablockers, insulin, and non-steroidal anti-inflammatory drugs (ibuprofen and aspirin) may have their
effects enhanced if taken together with this supplement. On the other hand, antacids, corticosteroids, and
proton pump inhibitors may alter stomach acidity and may lead to impairment of chromium absorption or
enhance its secretion when taken in combination. (12).

ZMA Zinc monomethionine aspartate and Magnesium Aspartate


Overview: ZMA is a supplement used by bodybuilders and athletes. The supplement is a
combination of the minerals zinc and magnesium and vitamin B6. All three of these compounds
are important in biological processes
Claim: ZMA is said to raise testosterone and IGF-1 levels which may aid in gaining muscle size
and strength.
Validity: Most studies have found no effects on strength, hormone levels, or increased anaerobic
capacity due to taking ZMA supplements.

19

Beta-Hydroxy Beta Methylbutyrate (HMB)


NCAA: Not illegal, Not permitted
Overview: HMB is a metabolite of the essential amino acid leucine which is claimed to increase leanbody mass and strength and also to improve recovery. Protection against stress, reduced body fat, lower
blood cholesterol, and an improved immune function are also claims made by this supplement which has
grown in popularity in the past few years (6).
Claim: Promotes loss of body fat, helps build muscles, improved immune functions, increases strength
and speeds up recovery between workouts by decreasing post workout soreness.
Validity: There is little evidence to support these claims. While there have been studies conducted with
HMG have shown an increase in lean muscle mass, most of the findings are from one laboratory and need
to be confirmed by others as well. Also, studies that have shown an increase in muscle mass were
conducted on untrained athletes and the elderly. More information is needed when looking at the effect of
HMB on trained athletes.
Availability: HMB is not essential in our diets. It comes from animal and plant origin and there are small
amounts in citrus fruit, catfish, and alfalfa.

Amino Acids
The contractile proteins actin and myosin are the most abundant proteins in muscle accounting for
approximately 80-90% of all muscle protein, which contains all of the naturally occurring amino acids.
The most abundant amino acids are branch chain amino acids: leucine, valine, and isoleucine, which
account for 20% of total amino acids found in muscle protein. Amino acids generate a wide variety of
processes, constantly undergoing synthesis and degradation. Protein can not exist with out the correct
combination of amino acids. Amino acids are vital for healthy muscles, ligaments, tendons, organs,
glands, and most body fluids. They allow muscles to contract and hold water they also stimulate the
production of anti-bodies. Amino degradation has two main purposes: They get oxidized in the
mitochondria for energy, and lead to the synthesis of other compounds (such as neurotransmitters,
hormones, and other proteins).

Arginine
NCAA: Not illegal, Not Permitted
Claims: Many protein powders and energy shakes contain this amino acid, marketing it as a nitric oxide
producing, muscle-building supplement. Nitric oxide, in theory, is thought to be useful to athletes as it
opens the blood vessels allowing for greater circulation of oxygen to all the organs, muscles, and internal
systems. Additionally, it is said to stimulate the release of human growth hormone which in turn will
increase muscle growth and strength. Arginine is a protein synthesis and is necessary for the proper
function of burning fat and is excellent in would healing and bone repair.
Claims: Marketed to enhance muscle growth, strength, and to jumpstart the immune system.
20

Validity: Most studies have determines that arginine will not increase muscle mass, and in fact, may
cause numerous health problems including diarrhea, nausea, dizziness, and thickening of skin. Moreover,
arginine has been found to stimulate a relapse of the herpes virus (15).
Availability: Natural sources of arginine are found in brown rice, carob, chocolate, nuts, oatmeal,
peanuts, peanut butter, raisins, raw cereal, sesame and sunflower seeds, and whole wheat products.

Branched Chain Amino Acids (BCAAs)


NCAA: Not illegal, Not Permitted
Overview: BCAAs are three essential amino acids (leucine, isoleucine, and valine) present throughout
muscle tissue and are advertised as important muscle boosters during exercise as they may halt the
breakdown of muscle tissue during anaerobic activity. In theory, these amino acids prevent the build-up
of tryptophan in the blood during exercise, which, if left free in the blood, signal fatigue to the brain.
Claims: Manufacturers claim that BCAAs enhance performance and allow the athlete to overcome
fatigue. Decreases mental fatigue, increases fat free mass, minimizes protein degredation and loss of
mass,
Validity: Some evidence at high altitudes.
Availability: Dairy and red meat are good sources of BCAAs, as well as whey, protein, and eggs.

Beta-Alanine
NCAA: Not Illegal, Not permitted
Overview: Beta-Alanine is a non-essential amino acid made by our bodies. When combined with
histidine, another amino acid, it creates the dipeptide carnosine. Carnosine is important to our muscles
because it helps balance out the muscles pH, which in turn reduces fatigue. When lactic acid
accumulates in muscles, carosine works as a buffer by prolonging the ability of the muscle to do work.
Claims: Marketed as the next big bodybuilding supplement, beta-alanine is said to increase muscle mass,
strength, endurance, and also fight fatigue. A beta-alanine supplement is more effective than ingesting
straight carnosine as a supplement because your gastrointestinal tract will break carnosine down before it
can reach the muscles.
Validity: Carnisine has been shown to buffer the acidic properties of the muscle during intense activity.
Also, its presence in the muscle had direct correlation to the overall strength of the subject being tested,
along with an increase of muscle mass over a period of weeks during which beta-alanine was being
supplemented in the diet.
Availability: Beta-alanine is found in eggs, meat, chicken, plants, and some dairy. It is also synthesized
in the body. It can be found in supplement form in products like Athletic Edge Nutrition Intra Xcell, and
Millennium Sport Carnage.

21

Glutamine
NCAA: Not Illegal, Not Permitted
Overview: Glutamine is one of the most common amino acids in human muscle and the most abundant
protein in muscle tissue. The amino acid is needed to synthesize protein and transporting nitrogen
between tissues. Glutamine is needed by the body in times of extreme physical activity and when your
immune system is fighting off an illness.
Claims: Improve rapid water absorption, stimulation of muscle protein synthesis and muscle tissue
growth, increased immune system and prevention of infection, reduction in muscle soreness and
improved muscle tissue repair, and helps burn more fat while preserving the muscles and minimizing
discomfort.
Intake: 10g per day. Take immediately after training by mixing the powder with juice or Gatorade.
Intense training will drop plasma glutamine levels and low levels of glutamine have been a contributing
factor in athletic overtraining syndrome and an increased risk for infection that effects athletes during
training and competition.
Validity: Glutamine is thought to be relatively safe and well tolerated, yet is not recommended for those
with kidney disorders. Excessive doses may cause gastrointestinal problems.
Availability: Beef, fish, poultry, eggs, and dairy are good forms of glutamine in the diet. It is available as
a bulk powder-- essentially tasteless.
Powder brands: NOW glutamine powder, Precision

Engineered glutamine powder, Prolab Glutamine Powder, Syntrax Glu FM glutamine


powder.

L-Carnitine
NCAA: Not Illegal, Not Permitted
Overview: Carnitine is made from several amino acids in your body, mainly lysine and methionine. It is
a vitamin-like substance important for fatty acid transport.
Claim: In theory, supplementing carnitine will increase glucose metabolism, VO2 max, and reduce
lactate production during high intensity exercise. However, the most important claim resides in the fact
that carnitine is a fat burner, increasing fat metabolism and decreases fatty build up. Endurance athletes
use this supplement In order to spare muscle glycogen by the relying of fat oxidation.
Validity: Most controlled experiments have failed to show effects of carnitine supplementation. There
was no positive impact on fat oxidation or glycogen breakdown in endurance exercise. Neither VO2max
nor lactate accumulation were altered during high-intensity exercise (6).
Availability: Can be found in animal products like meat and dairy, and as a general rule, the redder the
meat, the higher the carnitine content. Forms of the dietary supplement are L-carnitine, acetyl-Lcarnitine, and propionyl-L-carnitine.
22

General Warning: Weight loss pills being bought on the internet can do you more harm than
good. Pills and supplements may contain hazardous ingredients without any warnings on the
labels. Many of the ingredients found in some supplements have been banned from the U.S. but
are still being used as key ingredients.

Vitamins
Vitamins are organic compounds needed in small quantities in the diet and are essential for specific
metabolic reactions in the body and for promoting growth and development. Vitamins reduce exercise
induced oxidative stress experienced by athletes. Athletes need more vitamins because of their higher rate
of energy metabolism and higher muscular and skeletal stresses. Essential vitamins like K and D, cannot
be produced by the body and therefore must be taken in by the diet. Reductions in body function and
impaired health are results of vitamin deficiencies, which can affect an athletes performance during
crucial times in competition. Although physical activity may increase requirements for some vitamins, it
can usually be met by consuming a balanced diet. Therefore, it is important to eat a wide variety of foods
to reach optimal vitamin intake since many vitamins work in concert to obtain maximum benefits.
To maximize vitamin intake from you diet try:
- eating a variety of colorful fruits and vegetables.
- Eat fresh fruits and vegetables, especially those in season.
- Steam or microwave vegetables rather than boiling them nutrients tend to seep out in boiling water.
- Dont overcook vegetables, long cooking times reduce nutrient content.

B Vitamins
NCAA: Permitted
Overview: Increased energy metabolism creates a need for more of the B vitamins that serve as

part of coenzymes involved in the energy cycles. Studies have shown, however, that athletes can
become depleted in some B vitamins so a dietary change or supplementation will improve
exercise performance. For some athletes, such as wrestlers, gymnasts, or rowers, who consume
low-calorie diets for long periods, a B vitamin supplement to meet the RDA may be appropriate.
Without the B vitamins, the body would be lacking the energy to function normally. Thiamin,
riboflavin, niacin, pantothenic acid, and biotin form coenzymes which help the body metabolize
the food we eat into energy. Vitamin B6 helps to metabolize amino acids while vitamin B12
increases red blood cells that move energy throughout the body. Many athletes do not get the
recommended amount of B vitamins through their diet.
Claims: This vitamin family is marketed as supplying energy to athletes to assist in their best
performance. They increase the oxygen carrying capacity and convert food to usable energy.

23

Intake: RDA for vitamin B6 is 2-2.5mg/day. RDA for vitamin B12 is 4-6mcg/day. B6 upper tolerance
is 100mg/day; if too much is taken, it could possible result in nerve damage in arms and legs.
Availability: B vitamins can be found in meat, dairy products, green, leafy vegetables, nuts, and enriched
grains, along with multi-vitamins.

Vitamin C
NCAA: Permitted
Overview: Vitamin C is involved in a number of important biochemical pathways that are

important to exercise metabolism and the health of athletes. Vitamin C is also an important
antioxidant that protects the body form free radical damage. It guards the bodys tissues from
oxidative stress, which can occur during competition and high intensity exercise, and helps the
immune system fight off disease and illness. Additionally, this vitamin helps with the absorption
of iron, which is also a very important ingredient in an athletes diet.
Claim: Many suppliers sell vitamin C as a key supplement for athletes in order to decrease the common
cold and sicknesses, and improve overall health. Vitamin C also helps for the connective tissue protein
known as collagen. Athletes involved in concussive sports require more collagen and therefore many
benefit from higher levels of vitamin C.
Validity: Vitamin C supplement has been shown to increase performance in those that were in a deficient
state, however, no improvement was shown in those with a healthy and adequate intake of the vitamin.
With regards to the immune system, however, vitamin C has been found to improve the healing process
overall.
Intake: The RDA for calcium is 90mg/day for men and 75mg/day for women. The upper limit intake is
2000mg/day. When taken in large doses, it is possible for vitamin C to interfere with the absorption and
metabolism of vitamin B12.
Availability: Fresh fruits and vegetables are the best source of this vitamin, especially strawberries,
broccoli, oranges, watermelon, red peppers, and kiwi. It is also found in many multi-vitamins. It is
advised that the proper precautions should be taken into account when cooking foods with Vitamin C
because it is easily destroyed in heat.

Vitamin E
NCAA: Permitted
Overview: Vitamin E encompasses a family of eight antioxidants, mainly alpha-tocopherol, which is the
only form that is actively maintained in its largest quantities in blood and tissue. Its main function in the
body is that of an antioxidant which intercepts free radicals and prevents a chain reaction of lipid
destruction.

24

Claim: Vitamin E is said to function as antioxidants, which is important in preventing oxidative damage
to cellular structure and function during exercise, supposedly optimizing preparation for competition.
Intake: RDA for vitamin E is 15mg/day for males and females.
Validity: According to Melvin H. Williams, Ph.D., FACSM, Vitamin E has been shown to enhance
oxygen utilization during exercise at altitude, but does not appear to be an effective ergogenic under sea
level conditions. A contemporary review indicated that although vitamin E supplementation may increase
tissue or serum vitamin E concentration, most evidence suggests there is no discernable effect on training,
performance, or rate of post-exercise recovery in either recreational or elite athletes (8).
Availability: Food sources for vitamin E are vegetable oils, nuts, whole grains, and green leafy
vegetables, liver and corn. It can also be found in a multi-vitamin.

Minerals
Minerals are inorganic compounds essential to life processes. Inadequate mineral nutrition is associated
with a variety of diseases including anemia, hypertension, osteoporosis, and diabetes (6). It is because of
this that minerals are necessary for optimal health and performance. Minerals provide a path for electrical
impulses that stimulate muscular movement and coordination. They strengthen the skeletal structure
keeping it resistant to fractures, and maintain an acid0-base balance in the blood and tissue critical for
endurance performances.
Their functions include:
o

building blocks for bodily tissues such as teeth and bones (Calcium and Phosphorus)

Enzyme function in metabolism (Magnesium, Copper, and Zinc)

Function of immune cells (Iron, Zinc)

Electrolytes (Sodium, Potassium, Chloride)

Calcium
NCAA: Permitted
Overview: Calcium is an important part of our bodys structure, making up our bones, teeth, parts of our
cells, and out phospholipids. Calcium is also a regulator when it comes to muscle contractions,
hormones, nerves, blood clotting, and many other vital parts of our system.
Claim: The main marketing for calcium is an improvement in bone density.
Intake: RDA for calcium is 1000-1300mg/day for adults. Low intake of this mineral can lead to
deficiencies and undesirable health conditions.
Validity: Supplemented calcium intake over the recommended amount showed higher bone density in
tested subjects. Athletic performance also increased bone density, as did sun exposure, which supports
the claim that vitamin D is a necessary component of calcium absorption and bioavailability (17).
25

Availability: Calcium can be found in dairy products such as yogurt, milk, and cheese, along with
sunflower seeds, tofu, dried beans and peas, lentils, dark green vegetables like broccoli, spinach, collards
and green peppers. The two main forms of the supplement are calcium carbonate and calcium citrate and
can also be found in multivitamins.

Iron
NCAA: Permitted
Overview: Iron as one of the most critical implications for sport performance. As a component of
hemoglobin, it is instrumental in transporting oxygen from the lungs to the tissues, making oxygen
available to the working muscles. This mineral also makes up part of the protein in muscles. If an athlete
has an iron deficiency, it will seriously hinder his or her endurance, immune system, and mood. Iron is
marketed for muscle function, energy utilization, and increasing oxygen capacity to the blood and
muscles. Athletes at risk for developing low iron stores are the rapidly growing male adolescent,

the female athlete with heavy menstrual losses, the athlete with an energy-restricted diet,
distance runners who may have increased gastrointestinal iron loss, hematuria, hemolysis due to
foot impact, myoglobin leakage, and those training heavily in hot climates with heavy sweating.
Iron deficiency anemia is a condition that causes endurance problems in athletes characterized by
the bodys poor oxygen carrying capacity.
Claim: Marketed for muscle function, energy utilization, and increasing oxygen capacity.
Intake: Those who may require an iron supplement include female endurance athletes, gymnasts,
vegetarians, and those undergoing restricted energy intakes. Prolonged consumption of large amounts of
iron can cause a disturbance in iron metabolism in susceptible individuals, with an accumulation in the
liver. Also, excess iron intake may reduce absorption of other cations, including zinc and copper.
Validity: There have been many studies that have found that female athletes and endurance athletes have
problems with iron deficiencies. This deficiency decreases immune system ability and increases fatigue,
irritability, and a short attention span.
Availability: The most easily absorbed iron is heme iron which comes from red meat or animal products.
Non-heme iron can be found in fruits, vegetables, and fortified cereals and its absorption can be enhanced
by consuming foods high in Vitamin C. Iron is also available in many multi vitamins.

26

Fatty Acids:
Omega 3 Fatty Acid
NCAA: Permitted
Overview: Alpha linolenic Acid or omega-3 fatty acid is an extremely important polyunsaturated fat
that aids in helping prevent heart diseases, pulmonary disease, and many other disorders. The body
metabolizes omega-3 fatty acids into prostaglandins and eicosanoids, which work similar to hormones.
Claim: Reduce triglyceride levels, smoothens muscle contractions, prevents blood platelets from
clumping together, and can reduce the risk of heart attacks. Studies have also shown that Omega-3 fatty
acid may reduce joint pain, stiffness, and inflammation. Lastly, omega-3 fatty acid has also been shown to
lower bad cholesterol and raise the good cholesterol.
Intake: People with bleeding disorders should consult a doctor before taking supplements.
Validity: Exact function are still not know for certain but research suggests that omega 3 fatty acid may
benefit the heart, blood clotting, and the dilation or relaxation of blood vessels.
Availability: Eicosapentaenoic (EPA) Acid and docosahexaaenoic acid (DHA) are found in fish oil. Cold
water fish provide the most abundant source of essential fatty acids. Fish sources include anchovies,
Atlantic halibut, bluefish, herring, Alaskan salmon, sardines, canola oil, walnuts, flaxseed, soybeans,
spinach, wheat germ oil and wild game.
* If youre concerned about mercury or PBCs than visit: www.ewg.org/safefishlist
CLA-Conjugated Linoleic Acid
Overview: CLAs belong to a family of many isomers of linoleic acid, which are found primarily in

the meat and dairy products of ruminants. CLA is used to build muscle, reduce body fat, and
induce an optimum cellular environment for improved health.
Claim: CLAs have been said to have various antioxidant and anti-tumor properties. Studies on
CLA in humans show a tendency for reduced body fat particularly abdominal fat, changes in
serum total lipids and decreased whole body glucose uptake. CLA supplementation has,
however, been shown to increase C-reactive protein levels, to possibly induce oxidative stress, to
reduce insulin sensitivity and to increase lipid peroxidation
Intake: CLA cannot be produced by the human body, but it can be obtained through foods such

as whole milk, butter, beef, and lamb


Validity: Studies on mice and rats show promising results in reducing mammary, skin, and colon

tumor growth. Further studies are necessary to establish clinical significance.

27

Availability: Kangaroo meat may have the highest concentration of CLA when compared with
other foods. Grass-fed ruminants like lamb and beef. Eggs are also rich in CLA, and it has been
shown that the CLA in eggs survives the high temperatures encountered during frying
Herbs
Herbs are non-woody plants or plant parts that are used both medicinally and therapeutically. Because
they can act like drugs, they may have potential side effects or interactions with foods, other herbs, or
medications (9). Phytochemicals, including flavonoids, phenols, saponins, and terpenes, are the active
ingredient in herbs. Many people use natural herbs to treat various health conditions as well as to
promote overall well being. Included below is a chart of some herbal supplements, along with their claim
and safety concerns.

Herb

Additional Names

Claimed to Benefit

Safety Concerns

Arnica

Mountain tobacco,
leapords bane,
wundkraut

Muscle pain, stiffness,


osteoarthritis

May increase effects of


anticoagulants (which
prevent blood clots)

Astragalus

Huang chi, huang qi,


milk vetch

Weak immune system,


fatigue

May increase with


immunosuppressant
drugs

Cayenne

Capsicum, red pepper,


African chilies

Musculoskeletal pain,
osteoarthritis, digestive
problems

Digestive disorders,
skin irritation

Cordyceps

Caterpillar fungus, dong


chon xai cao, semitake

Weak immune system,


poor endurance
performance

May reduce blood sugar


levels

Devils Claw

Grapple plant,
harpagophytum, wood
spider

Muscle pain, digestive


problems, fever

May interfere with


antidiabetic drugs

Echinacea

Purple coneflower,
black Sampson, Indian
head

Weak immune system,


colds, infections

May interfere with


immunosuppressants

Ginseng

Chinese ginseng,
ciwuija, Russian root

Poor endurance
performance, low
energy, weak immune
system

May interfere with


anticoagulants

28

Guarana

Guarana gum, zoom


coaoa, Brazilian cocoa

Excess body fat,


lethargy

Contains caffeine

Rhodiola

Golden root, Arctic root

Lethargy, fatigue, poor


endurance

May interact with other


herbs

Willow Bark

White willow, purple


osier, bay willow

Fever, muscle pain,


osteoarthritis

May interact with


coagulants.

One must hesitate when it comes to the attractive claims made for herbal supplementation. There is
insufficient research on the use of herbs by athletes, and therefore, there are no safe recommendations for
athletes use.

29

Appendix Areprinted with permission

Evaluating Popular Sports Supplements


Ellen Coleman, MA, MPH, RD, CSSD

Nutrition professionals often are asked to evaluate sports supplements that athletes currently use
or are considering using. This article describes a method for evaluating popular sports
supplements. Three commonly used sports supplementscreatine, arginine, and green teaare
reviewed here to illustrate the application of this evaluation method.
Primary Considerations in Evaluating Supplements
Safety and Effectiveness
The two most critical questions to ask are: Is this supplement safe? And is it effective?1 In considering the
risks and benefits of supplement and drug use, credible information on safety and effectiveness is
essential.1 Safety is paramount, because as the Hippocratic Oath states: Primum non nocere First, do
no harm.
The first step in determining effectiveness is to assess whether the claim made regarding the
supplement is reasonable from a physiological perspective.2 To determine this, the nutrition professional
must ascertain whether the supplements purported mechanism of action is biologically plausible. If the
supplement is unfamiliar, registered dietitians can visit Web sites that sell the product to identify the
ingredients and the supposed method of action.
The next step is to review the scientific literature and meticulously examine the quality and
quantity of studies provided to support the safety and effectiveness of the supplement.2,3 All supportive
research should be published in a reputable peer-reviewed journal and cited in the National Library of
Medicine database (PubMed) (www.ncbi.nlm.nih.gov/PubMed). The American Dietetic Associations
practice paper on dietary supplements provides guidelines for critically appraising the scientific validity
of research.3 For specifics on many supplements, several resources are available on the Internet to help
nutrition professionals evaluate sports supplements (see page 4).
Doping Status
Once safety and effectiveness have been established, it is important to consider whether the sports
supplement may cause the athlete to test positive for a prohibited substance. 1,4 Some apparently safe
supplements contain ingredients not declared on the label that are prohibited by the doping regulations of
the National Collegiate Athletic Association, International Olympic Committee, and World Anti-Doping
Agency.
Contaminants that have been identified by these groups include a variety of anabolic androgenic
steroids and ephedrine. Although the contamination usually is the result of poor manufacturing processes,
there also is evidence of deliberate adulteration of products by manufacturers. As a result, an
30

unsuspecting athlete may test positive for banned substances.4-6 Innocent ingestion of prohibited
substances is not an acceptable excuse. Athletes who test positive for banned substances are legally
responsible and subject to penalties. Several organizations screen supplements for prohibited substances
and certify products that pass testing (see page 4).
The undeclared inclusion of contaminants in supplements is not uncommon. The Medical
Commission of the International Olympic Committee found that of 634 tested nonhormonal nutritional
supplements from 13 countries, 14.8% contained substances that would have led to a positive doping test
but were not listed on the label.5 Italian researchers found that 12.5% of 64 nutritional supplements
contained banned substances (anabolic steroids and ephedrine) not declared on the label.6

Quality of the Product


As a final consideration, it is important to evaluate the quality of the sports supplement, because the Food
and Drug Administration does not review supplements prior to their market entry. The following four
factors should be examined when assessing supplement quality:

Identity (Does the products contents match what is printed on label?)


Potency (Does the product contain the amount of the ingredient claimed on label?)
Purity (Is the product free of unacceptable levels of contaminants?)
Bioavailability (Does the ingredient break apart properly in the body so that it may be assimilated?)

Several organizations are involved in testing supplements and certifying products that pass tests for
identity, potency, purity, and bioavailability (see page 4). It is recommended that products receive
certification from of these organizations. Some manufacturers may make the claim that their products are
pharmaceutical quality, but such a claim is meaningless.
Example: Evaluating Creatine
Creatine is used widely by athletes to increase muscle mass and improve performance during repeated
intervals of high-intensity, short-duration (<30 seconds) exercise. As phosphocreatine, creatine provides
energy for high-power muscular performance via the phosphagen system. Supplemental creatine increases
total creatine by 10% to 30% and phosphocreatine stores by 10% to 40%.7 Creatine supplementation also
increases muscle cell volume and muscle fiber hypertrophy.8 Thus, the purported performance benefits of
creatine supplementation can be reasonably explained by creatines methods of actionand, therefore,
these claims are biologically plausible.
A substantial body of research suggests that creatine supplementation represents a safe method to
enhance muscle size and strength during resistance training.8,9 While there is no strong scientific evidence
to support any adverse effects, to date few studies have focused on the safety of long-term creatine
usage.9 Daily supplementation with 5 g to 20 g of creatine for 0.25 to 5.6 years did not have any longterm detrimental effects on kidney or liver functions in highly trained college athletes. 10
Although not all studies report significant results regarding efficacy, the majority of scientific data
indicate that creatine appears to be an effective ergogenic aid for activities that involve repeated, short
31

intervals of high-intensity exercise.7-9 Short-term creatine supplementation (e.g., 20 g/day for 5-7 days)
may improve work performed during sets of maximal effort muscle contractions and repetitive sprint
performance by 5% to 15%.7 Long-term creatine supplementation may promote significantly greater
improvements in strength, fat-free mass, and high-intensity exercise performance.7 Chronic creatine
supplementation may allow the athlete to train harder and thereby achieve greater training adaptations and
performance gains.1,8
Thus, creatine appears to be both a safe and effective supplement for athletes who want to increase
muscle mass and improve performance during repeated bouts high-intensity exercise.

Example: Evaluating Arginine


Many athletes take nitric oxide releasing supplements containing arginine alpha-ketoglutarate to
enhance muscle size and strength. The non-essential amino acid arginine is the substrate for the nitric
oxide synthase enzyme, which catalyzes the oxidation of arginine to produce nitric oxide (a gas) and
citrulline. Nitric oxide is a key signaling molecule in the cardiovascular system and promotes
vasodilation.11
In theory, arginine alpha-ketoglutarate supplementation boosts nitric oxide production and
enhances vasodilation. This increases blood flow and oxygen transport to the muscles and promotes an
extended muscle pump during resistance training. The increased blood flow also enhances delivery of
nutrients to the muscles and removal of wastes from the muscles. The purported result: dramatic increases
in muscle size and strength.
The proposed method of action for arginine alpha-ketoglutarate stretches the bounds of
credibility. In atherosclerosis, the endothelium has a reduced capacity to produce nitric oxide and dilate
effectively. Healthy people, however, do not have reduced nitric oxide production or impaired endothelial
vasodilation and, therefore, they are unlikely to benefit from arginine alpha-ketoglutarate supplements.
There also is no evidence that arginine alpha-ketoglutarate supplements increase nitric oxide levels or
blood flow to the muscles in healthy people.11
Measuring nitric oxide is no small achievement, because the gas is highly reactive and has a very
short life. Clinical studies generally measure flow-mediated endothelium-dependent vasodilation of the
brachial artery to evaluate the effect of arginine supplementation on the vascular system .11
There is evidence that supplemental arginine may be beneficial in the clinical setting for patients
with atherosclerosis and associated endothelial dysfunction by improving endothelial function.11 Arginine
supplementation (6.6 g/day for 2 weeks) improved exercise tolerance and flow-mediated vasodilation of
the brachial artery in patients with angina12 and claudication.13
The majority of research suggests that arginine supplementation is safe and well-tolerated at doses
of 12 g or less per day in healthy individuals and patients with atherosclerosis.11-15 However, arginine is
not recommended following acute myocardial infarction, as 9 g/day of arginine did not improve vascular
stiffness measurements or ejection fraction but was associated with higher postinfarction mortality.16

32

Evans and colleagues examined responses to daily doses of 3, 9, 21, and 30 g of arginine for 1 week.
Five of the 12 healthy participants noted adverse effects (primarily diarrhea) with the 21 g/day dose, and
an additional five noted adverse effects (primarily diarrhea) with 30 g/day.14
Only one published study has evaluated the safety and efficacy of arginine alpha-ketoglutarate in
resistance-trained adult men.15 The subjects consumed 4 g of arginine alpha-ketoglutarate three times a
day (n=20) or placebo (n=15) and engaged in periodized resistance training 4 days a week for 8 weeks.
The researchers found that 12 g/day of arginine alpha-ketoglutarate significantly increased one repetition
max bench press, Wingate peak power performance, and plasma arginine levels, but it had no effect on
body composition, total body water, isokinetic quadriceps muscle endurance, and aerobic capacity. The
supplement appeared to be safe and well-tolerated.
Arginine alpha-ketoglutarate appears to be safe in doses up to 12 g/day, with the exception of its
contraindicated use following acute myocardial infarction. However, the data is woefully inadequate to
determine effectiveness. Only one study suggests that arginine alpha-ketoglutarate increases muscle
strength, and there is no evidence that it increases muscle size. Further research on the safety and
effectiveness of arginine alpha-ketoglutarate is warranted.

Example: Evaluating Green Tea Extract


A number of athletes and active people take green tea extract to increase their metabolic rate and promote
weight loss. Green tea extract contains tea catechins (primarily epigallocatechin gallate [EGCG]) and
caffeine.
In theory, the tea catechins and caffeine interact synergistically to augment and prolong the release
of norepinephrine by the sympathetic nervous system. Tea catechins inhibit catechol-O-methyltransferase,
the enzyme that degrades norepinephrine. Caffeine inhibits phosphodiesterase, the enzyme that degrades
cyclic AMP. The net result is that green tea extract (50 mg caffeine and 90 mg EGCG three times daily)
may reduce two brakes along the pathway of norepinephrine-activated thermogenesis.17
The purported beneficial effects of green tea extract on metabolic rate and weight loss appear
reasonable from a physiological standpoint. However, only a small number of studies have evaluated the
supplement for this purpose, and the results are mixed. 17-20
Several studies17-18 have found that green tea extract significantly increased 24-hour energy
expenditure by 4% to 8% (~80-179 kcal/day). Dosages studied were 50 mg caffeine and 90 mg EGCG
three times daily, and 200 mg caffeine from guarana and 90, 200, 300, or 400 mg EGCG three times
daily; these dosages are commonly found in green tea extract supplements). While the results of these
studies are provocative, other investigations suggest that the acute effect of green extract on 24-hour
energy expenditure does not translate into a sustained increase in metabolic rate or a clinically significant
weight loss over time.19,20 At present, the data is insufficient to support the claim that green tea extract
promotes an increase metabolic rate or weight loss.
While green tea is widely consumed as a beverage and generally regarded as safe, green tea extract
may not be safe. There have been case reports of acute liver toxicity associated with the use of green tea
33

extract.21,22 It seems prudent to advise against using green tea extract until further research clarifies the
safety and effectiveness of the supplement.

Conclusion
Discussing supplements with athletes is not easy. Nutrition professionals are concerned about safety,
while athletes desire a competitive edge. After assessing the athletes needs and goals, education should
include the potential risks/benefits (including doping) of using the supplement and guidelines on choosing
a quality supplement. If convincing data suggest that the supplement may endanger the athletes health, it
is prudent to advise against using the supplement, even if the supplement appears to be effective for the
purpose taken.
Ultimately the decision to use supplements lies with the athlete. If the supplement is safe,
regardless of effectiveness, consider working with the athlete to test the product on a trial basis, as this
helps to establish credibility.1,2

___________
Ellen Coleman, MA, MPH, RD, CSSD, a past chair of SCAN and an expert speaker on sports nutrition, is
the nutrition consultant for The Sport Clinic of Riverside, Calif., and author of Eating for Endurance, 4th
edition (Bull Publishing) and Diet, Exercise, and Fitness, 7th edition (Nutrition Dimension). She also has
provided consultation services to the Anaheim Angels baseball team and Los Angeles basketball team.

References
1. Dunford M. Dietary supplements and ergogenic aids. In: Dunford M, ed. Sports Nutrition: A Practice
Manual for Professionals. 4th ed. Chicago, IL: American Dietetic Association; 2006:116-141.
2. Butterfield G. Ergogenic aids: evaluating sports nutrition products. Int J Sports Nutr

Exerc Metab. 1996;6:191-197.


3. American Dietetic Association. Practice paper of the American Dietetic Association:
dietary supplements. J Am Diet Assoc. 2005;102:460-470.
4. Maughan R. Contamination of dietary supplements and positive drug tests in sport. J Sports Sci.
2005;23:883-889.
5. Geyer H, Parr MK, Mareck U, et al. Analysis of non-hormonal nutritional supplements for anabolicandrogenic steroids - results of an international study. Int J Sports Med. 2004;25:124-129.
6. Martello S, Felli M, Chiarotti M. Survey of nutritional supplements for selected illegal anabolic
steroids and ephedrine using LC-MS/MS and GC-MS methods, respectively. Food Addit Contam.
2007;24:258-265.

34

7. Kreider RB. Effects of creatine supplementation on performance and training adaptations. Mol Cell
Biochem. 2003;244:89-94.
8. Volek JS, Rawson ES. Scientific basis and practical aspects of creatine supplementation for athletes.
Nutrition. 2004;20:609-614.
9. Bemben MG, Lamont HS. Creatine supplementation and exercise performance: recent findings. Sports
Med. 2005;35:107-125.
10. Mayhew DL, Mayhew JL, Ware JS. Effects of long-term creatine supplementation on liver and
kidney functions in American college football players. Int J Sport Nutr Exerc Metab. 2002;12:453-460.
11. Gornik HL, Creager MA. Arginine and endothelial and vascular health. J Nutr. 2004;134: 2880S
2887S.
12. Maxwell AJ, Zapien MP, Pearce GL et al. Randomized trial of a medical food for the dietary
management of chronic, stable angina. J Am Coll Cardiol. 2002;39:37-45.
13. Maxwell AJ, Anderson BE, Cooke, JP. Nutritional therapy for peripheral arterial disease: a doubleblind, placebo-controlled, randomized trial of HeartBar. Vasc Med. 2000;5:11-19.
14. Evans RW, Fernstrom JD, Thompson J, et al. Biochemical responses of healthy subjects during
dietary supplementation with L-arginine. J Nutr Biochem. 2004;15:534-539.
15. Campbell B, Roberts M, Kerksick C, et al. Pharmacokinetics, safety, and effects on exercise
performance of l-arginine alpha-ketoglutarate in trained adult men. Nutrition. 2006;22:872-881.
16. Schulman SP, Becker LC, Kass DA, et al. L-arginine therapy in acute myocardial infarction: the
Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) randomized clinical trial. JAMA.
2006;295:58-64.
17. Dulloo AG. Duret C, Rohrer D, et al. Efficacy of a green tea extract rich in catechin polyphenols and
caffeine in increasing 24-h energy expenditure and fat oxidation in humans. Am J Clin Nutr.
1999;70:1040-1045.
18. Berube-Parent S. Pelletier C, Dor J, Tremblay A. Effects of encapsulated green tea and Guarana
extracts containing a mixture of epigallocatechin-3-gallate and caffeine on 24 h energy expenditure and
fat oxidation in men. Br J Nutr. 2005;94:432-436.
19. Kovacs EM, Lejeune MP, Nijs I, et al. Effects of green tea on weight maintenance after body-weight
loss. Br J Nutr. 2004;91:431-437.
20. Diepvens K, Kovacs EM, Nijs IM, et al. Effect of green tea on resting energy expenditure and
substrate oxidation during weight loss in overweight females. Br J Nutr. 2005;94:1026-1034.
21. Bonkovsky HL. Hepatotoxicity associated with supplements containing Chinese green tea (Camellia
sinensis). Ann Intern Med. 2006;144:68-71.

35

22. Molinari M, Kymberly DS, Watt TK, et al. Acute liver failure induced by green tea extracts: case
report and review of the literature. Liver Transpl. 2006;12:1892-1895.
A summary of key points is provided on page 4.

Appendix B
Sport Bars

FAT
7g

8g

5g

7g

23g

PROTEIN
15g
High P
21g
High P
22g
High P
15g
High P
15g
High P

Vits
&
Mins

6g

200

22g

14g

6g

200

14g

6g

Bear Valley

420

28g

17g
High P

13g

Luna Tea Cakes:


Berry Pomegranate

140

22g
59g
High
CHO
30g
High
CHO
53g
High
CHO
42g
High
CHO
30g
High
CHO

12g

2g

1.5g

3g

6g

10g

2-5g

SPORTS
BAR
Atkins Beakfast
Bar
Atkins Advance
Bar

VEGAN

CALS

Carbs

SUGAR

150

3g

1g

220

21g

0g

Balance Big Bar

200

17g

Balance Gold Bar

210

22g

Balance Outdoor

210

Balance Bar

Balance Bar Plus

Logia:
Bible Bar

150

Boulder Bar

220

Builders Bar

Carb Solutions
Clif Bar (lactose
free)
Clif Nectar (lactose
free)
For Diabetics:
DM Choice
For Diabetics:
Extend Bar

270
256

250

150
140
150

14g
51g
High
CHO
29g
High
CHO
19g
31g
High

8g

1g

20g
High P
23g
High P

3.5g

10-16g

5-12g

2g

20g

3g

5g

9g

6g

4.5g

10g

3g

1.5g

19g

36

CHO
Universal Nutrition:
Dr. Diet LowCarb
Bar
Universal Nutrition:
Dr. Diet LowCarb
Diet

234

2.6g

0g

19g
High P

8g

208

2g

0g

21g
High P

4g

27g
32g
High
CHO
42g
High
CHO
43g
High
CHO
53g
High
CHO
40g
High
CHO
45g
High
CHO

11g, Brown Rice

11g

4g

24g, Fructose

18g
High P

4g

24g, Maltodextrine,
Fructose, Dextrose

6g

3.5g

25g, Fructose

30g
Very high P

14g

11g

5g

6g

4g

7g

4g

3g

3g

9g

6g

8g

5g

9g

5g

Dr. Soy Bar

185

Elev8 Me

220

Power Bar:
Energize Bar

210

Met-RX:
Food Bar

420

Kashi:
Go Lean Bar

290

For Diabetics:
Glucerna

140

Power Bar:
Harvest
Cooke Pharma:
Heart Bar

240
190

4g

310

27g
32g
High
CHO

296

7g

230

24g

220

40g

190

24g

17g

180

24g

13g

32g
Very high P
33g
Very high P
16g
High P
10g
High P
5g
High P
10g
High P

140

15g

1g

8g

7g

180

24g

2g

10g

4.5g

130

1g

12g

5g

130

25g

3g

Mountain Lift Bar

220

34g

5g

Myoplex Life

190

27g

3g
12g
High P
15g
High P

2.5g

Met-RX

110

18g

6g

1.5g

Met-RX:
Protein Plus Bar
Universal Nutrition:
Hi Protein Bar
Twin Lab:
Ironman
Jenny Craig Bar
JCALAT:
Larabar
Clif:
Luna Bar
Clif:
Luna Glow
Clif:
Luna Nutz Ovr.
Choc.
Twin Lab:
Metabolift
Luna Tea Cakes:
Mint Chocolate

27g,
Sucralose,Maltodextrin,
Sugar Alcohol

11g

16g

37

Natural Krunch Bar


Genisoy:
Nature Grains
Natures' Plus
Nutiva Original
Solgar:
Optein Wellness
Bar
Luna Tea Cakes:
Orange Blossom
Power Bar:
Performance
Premier Eight:
Premier Elite
Premier Eight:
Premier Nutrition
Premier Eight:
Premier Protein
Pria Carb Select
Optimum Nutrition:
Protein Diet Bar
Twin Lab:
Protein Fuel
Power Bar
Protein Plus
Worldwide Sports
Nutrition:
Pure Protein Bar
SoyJoy
Raisin Almond

Y
N

230

41g

150

19g

210

11g

190

10g

130

30g

240

44g

160

2g

260

8g

200

12g

170

22g

180

3g

320

11g
High P
5g

12g
22g, Maltodextrine,
Fructose

10g

4g

9g

14g

6.5g
2g
High P
9g
High P
18g
High P
32g
Very high P
31g
Very high P

2g

1.5g

3g

4.5g

6g
8g
7g

12g

10g
22g
High P
35g
Very high P

290

24g

5g

2g

280

14g

32g
Very high P

5g

130

16g

11g

Shape Up Bar

220

30g

9g

Slim Fast Bar

120

22g

20g

Snickers Marathon
Genisoy:
Soy Nutty
Genisoy:
Soy Pro bar
Met-RX:
Source One
Twin Lab:
Soy Sensations
Shaman
pharmaceuticals:
Syn X Bar
All Terrain Foods:
Tahoe Bar
PHD Inc.:
Think!
Weider Nutrition:
Tiger's Milk

220

27g

18g

190

28g

220

33g

170

20g

180

23g

200

26g

200
200250

32g

140

1g

3g

4g
15g
High P
1g
High P
13g
High P
12g
14g
High P
15g
High P
15g
High P

5g
5g

6g
7g
3.5g
1.5g
5g
3.5g
5g
6g

29-36g

8g
8g
High P
6-10g
High P

9g

4-9g

18g

7g

5g

5g

38

Solgar:
Triumph Bar
Biochem:
Ultimate LoCarb
Bar
Biochem:
Ultimate LoCarb
Bar 2
Luna Tea Cakes:
Vanilla Macademia
Mead Jonhson:
Viactiv

170

33g

2g
High P

3.5g

270

2g

21g

10g

230

3g

150
120150

30g
20-29

Zone Dbl Chocolate


Zone Choc.
Caramel

200

20g

13g

210

20g

16g

Zone Choc Vanilla

200

21g

14g

Zone Perfect Peach

210

20g

13g

All Terrain Foods:


Zuma & Berkeley

180

36g

8g

20g
High P
2g
High P
4-6g
15g
High P
16g
High P
15g
High P
15g
High P

7g
4g
2-5g

7g
High P

7g
7g
7g
7g
1g

References
- For additional info on supplements visit: drugfreesports.org or www.consumerlab.com
1. Bahrke, M. & Yesalis, C. Performance Enhancing Substances in Sport and Exercise. Champaign:
Sheridan Books Inc. 2002.
2. Bonci, L. Gatorade Sports Science Institute: Energy Drinks: Help Harm or Hype? Volume 15.
Number 1.
3. Coleman, E. & Maughan, R. & Nelson, S. & Skinner R. Gatorade Sports Science Institute.
(2002). Volume 13. Number 4.
4. Dorfman, Lisa. Chapter 26, Nutrition for Exercise and Sports Performance.
5. Firth, G. & Manzo, L. University of Notre Dame: For the Athlete: Alcohol and Athletic
Peformance. 2004.
6. Gleeson, M. & Jeukendrup, A. (2004). Sport Nutrition: An Introduction to Energy Production
and Performance. Human Kinetics Inc. 231-265.
7. Journal of the International Society of Sports Nutrition. (2004). 1(1). (Kreider, R.B. &
Greenwood, M. Ed). 7-26.

39

8. Journal of the International Society of Sports Nutrition. (2004). 1(2) 1-6. Electronic Edition.
9. Kundrat, S. Gatorade Sports Science Institute: Herbs and Athletes. (2005). Volume 18. Number
1.
10. Montana State University. Sports Nutrition. 23 July 2007.
Http://btc.montana.edu/olympics/nutrition/eat15.html.
11. Natural Standard Monograph. (2008). Creatine.
http://www.naturalstandard.com/monographs/herbssupplements/creatine.asp.
12. Office of Dietary Supplements: Dietary Supplement Fact Sheet: Chromium.
www.dietarysupplement.info.nihgov/factsjeet/chromium.
13. Oregon State University: Linus Pauling Institute.
http://Lpi.oregonstate.edu/inforcenter/vitamins/vitaminE.
14. Rolfes, S. & Whitney, E. Understanding Nutrition. 10th Edition. Belmont: Wadsworth. 2005.
15. Schulman, R. Solve it with Supplements. New York: Rodale Inc. 2007.
16. The University Health Center: A Unit of the Division of Student Affairs, University of Georgia.
2007. http://www.uhs.uga.edu/aod/athletic-performance.html.
17. The University of Maryland Medical Center. American Ginseng. (2007).
Http://www.umm.edu/altmed/articles/american-ginseng-000248.htm.

40

41