Today, the amateur and professional coach or athlete is inundated with information that encourages the utilization of various dietary supplements and drugs to improve performance. There is public confusion surrounding the definition of a supplement versus a drug. The 1994 Dietary Supplement and Health Education Act (DSHEA) defines a dietary supplement as “any product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” The Federal Food, Drug, and Cosmetic Act (FD&C Act) defines a drug as “any article (excluding a device) intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease and articles (other than food) intended to affect the structure or function of the body.”

In this article, we examine supplements that are permitted by the International Olympic Committee.

Protein

The ingestion of certain foods and nutritive supplements following exercise seems to be beneficial in preserving and improving athletic conditioning. Researchers have reported a positive hormonal state for muscle growth when carbohydrate and protein are consumed after weight training. It has been well established in the scientific literature that eccentric muscle actions lend greater trauma to the myofibers of skeletal muscle. The concentrations of growth hormone and insulin following exercise appear to be favorable for protein proliferation when carbohydrate and protein is eaten immediately thereafter. A multi-analysis review of the scientific literature supports the premise that protein metabolism is high during prolonged endurance exercise and intense anaerobic exercise and increases the need for specific protein. Many nutritionists consider whey protein as the best form of protein to use as a post-workout meal. This recommendation is based, in part, on the broad amino acid composition required of the human body inherent to whey protein.

Carbohydrates

The adequate consumption of carbohydrates is necessary for the preservation of protein for muscle tissue repair and maintenance. When the carbohydrate stores are significantly reduced, protein becomes an active fuel substrate to meet the metabolic demands of exercise. It is essential that the athlete consume carbohydrates before, during, and after exercise to sustain sufficient muscle glycogen levels. Muscle glycogen stores are most diminished during endurance exercise. Therefore, the ingestion of carbohydrateswithin 24 hours is crucial for the replenishment of muscle glycogen. It has been reported that the immediate intake of carbohydrates following exercise resulted in muscle glycogen restoration three times faster than that of a two-hour delay. The type of carbohydrate ingested is a key variable in the earliest replenishment following an extended bout of exercise. The post-exercise carbohydrate should have a high glycemic index that evokes a higher plasma glucose response following consumption. Some of the carbohydrates with a high glycemic index are corn flakes, honey, white bread, rice, carrots, and bananas. See chart below with some examples of foods in different glycemic index ranges:

HIGH	MODERATE	LOW
Cane, maple, corn syrup	Whole grain bread	Yogurt
Honey	Spaghetti, pasta	Peanuts
Bagel, white bread	Corn	Beans, peas
Potato	Oatmeal	Apple, Peach, Pear, Figs

Hydration

Many athletes and coaches are remiss regarding the importance of proper hydration relative to optimal performance and safety. Therefore, athletes should attempt to be well hydrated before, during, and after exercise. It is important that coaches know what the Heat Index is during practice as well as competitions to assist in hydration plans for their athletes. Athletes often fail to consume enough fluids during an extended bout of exercise for homeostasis. It is suggested that an individual ingest approximately 150 percent of the “water” weight lost during exercise to restore the fluid losses of perspiration and to maintain normal urinary production. Increased sodium intake following exercise assists in rehydration by maintaining blood osmolality and stimulating thirst. Most commercial sports drinks do not possess enough sodium for post-exercise replacement. Therefore, it may be necessary to ingest sodium-rich foods such as soups, pickles, pretzels, and pizza in addition to sports drinks.

Creatine

Creatine monohydrate, as a dietary supplement, has received much attention within the scientific community. Creatine supplementation received its initial notoriety as an ergogenic aid from its use by the British sprinters and hurdlers in the 1992 Barcelona Olympic Games. The basis for creatine supplementation is that it plays an important role in energy metabolism and adenosine triphosphate (ATP) reformulating. It seems to enhance muscle strength when accompanied with resistance training and improves short repetitive bouts of powerful activity. Carbohydrate ingestion with creatine may increase muscle uptake. The shorter and more intense activity is fueled through anaerobic energy production, while longer and less intense activity is fueled by aerobic energy production. Creatine is utilized in the reformulation of adenosine triphosphate particularly in anaerobic metabolism. Therefore, it is instrumental in decreasing the recovery time between sets of weight training or explosive exercise, which in turn allows for a greater volume of exercise to be performed and overload of the fast twitch muscle fibers. Research suggests that three grams of creatine per day will increase total muscle creatine to the same levels as five days of 20 grams of creatine per day for a period of roughly 30 days. A consensus of the data seems to show no serious side effects of creatine supplementation over a period of four years. However, further research is warranted regarding the long-term consequences, if any, of creatine supplementation.

Legality

(Please note that the NCAA rules concerning drug testing are not the same as USADA or WADA)
Of interest is rule 16.5.2.3 adopted by the NCAA, which regulates the nutritional supplementation of collegiate athletes. The rule states “an institution may provide only non-muscle building nutritional supplements to a student athlete at any time for the purpose of providing additional calories and electrolytes, provided the supplements do not contain any NCAA banned substances.” Coaches and trainers are allowed to give athletes supplements such as vitamins, minerals, caloric and electrolyte replacement drinks, and energy bars containing no more than 30 percent protein. Coachers and trainers are not permitted to dispense, sell, or arrange for the sale of supplements such as creatine, condroitin, glucosamine, amino acids, protein powders, and others substances for nutritive purposes. The purpose of the legislation is for institutions to provide only non-muscle building nutritional supplements for the purpose of providing additional calories and electrolytes, provided they do not contain any NCAA banned substances.

Sports medicine professionals and coaches must be ever conscious about the message and example set before their athletes. We all have an ethical and moral obligation to relay scientifically sound and medically safe information to the athletes entrusted to our care or supervision. Arguably, no supplement alone can ever replace the blood, sweat, and tears that mold and eventually shape the heart of a true winner not only on the athletic field, but more importantly – in life.