Sports supplements: Are they worth all the hype?!

Sports nutrition continues to boom with interest in sports supplements extending beyond athletes and body builders. Your everyday gym goer wants to be lean and strong; strength has become a greater priority than the figures on the scales. There is a surge in fitness and health bloggers with their photos on Instagram and Facebook creating a desire and motivation to achieve a leaner body. Non-professional sports are becoming more and more competitive and individuals are increasingly more open to taking supplements in hope they will gain an added edge.

Although there is continued research and funding to show a given supplement can improve body composition or performance, very few supplements have been shown to be effective. Those that show effectiveness are often based on research conducted on a small number of male athletes (such as cyclists) and therefore, how can we be convinced that this will work for everyone?

Below are my top 5 supplements that have the most robust evidence and a good safety profile, but of course there is no substitute for disciplined training and a proper diet!

  1. Creatine:

Creatine phosphate is stored in your muscles and provides an excellent store of energy for very high intensity exercises (when oxygen supply to the muscles is insufficient). You will be using your creatine phosphate stores when you do an “all-out sprint” or lift maximum weights. Both of these examples cannot be maintained for very long and this is because the creatine phosphates are spilt to produce energy and they must be recycled. The recycling process requires oxygen so you will need to get your “breath back” in order to make more creatine phosphate.1

We consume creatine via meat and fish products and we can also make it in the liver; both of which amount to about 2g/day.  An average (70kg) athlete stores around 120g of creatine. Supplementation studies have shown that muscle creatine concentration can be increased by up to 20% using creatine supplements.2

This is achieved by creatine loading: 2

  • Consume 20-25 g/day of creatine over 5-6 days followed by 2g/day as maintenance or
  • Consume smaller amounts (around 3g/day) over 1 month.

Improvements in performance have been shown in weight lifters who loaded with creatine. Creatine supplementation can also cause weight gain (1-2 kg increase in total body mass has been documented after 20g/day loading with creatine for 4-28 days).2 Supplementation increases intracellular water in the muscle which may stimulate glycogen storage. However, there are responders and non-responders; it does not work for everybody! Lastly, anyone with kidney disease should avoid creatine supplementation as it may affect creatinine clearance.

Summary: Creatine supplements may allow maintenance of top speed/strength for longer but this does not always equate to improved performance.

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  1. Caffeine

Caffeine is a socially acceptable stimulatory drug. Caffeine can improve performance in endurance exercises such as running and cycling and also in high intensity sports such as rugby and soccer (from 1 to 3%).3 Caffeine is a central nervous system stimulant and works by reducing an athlete’s perception of effort and/or pain threshold.2 It has been used as an adjunct to weight loss but caffeine alone has not been shown to have an substantial effect on weight loss.  Unless you are already dehydration, caffeine has not been shown to negatively impact hydration status. Caffeine tends to work when 1-3 mg per kg body weight is consumed before or during exercise.4 A typical cup of coffee contains 80-100 mg of caffeine. You can also take caffeine supplements but if you drink coffee then you can just get your caffeine hit with coffee!

Caffeine is considered safe but excess (greater than 500 mg or greater than your own tolerance level) causes side effects such as increased blood pressure at rest and during exercise, increased heart rate, gastrointestinal distress and insomnia. Caffeine addiction has been documented with doses as low as 100 mg/day and sudden withdrawal can result in severe headaches, drowsiness, and inability to concentrate.1

Personally, I find a cup of coffee (although not a supplement!) before a run or the gym great for a boost but I do not take it before a competitive match because coffee heightens any nervousness I already have coming up to a game!

Summary: Caffeine can improve performance as it is a nervous system stimulant but in excess/above personal tolerance it can cause gastrointestinal distress, increased heart rate and insomnia.

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  1. Protein

The benefit of protein supplementation is more down to convenience than anything else! Protein supplements can be helpful for those going from work to training, or when it may not be possible to have a descent meal soon after training or for those with very high protein requirements; but protein supplementation itself is not more or less effective for increasing muscle mass than protein from food.2  Whey protein is a “fast acting” protein that is absorbed easily and therefore, its amino acids such as the branched chain amino acids- leucine, isoleucine and valine are quickly taken up by muscles. Ricotta cheese contains the highest amount of whey of any wholefood because it is made from whey protein. Casein is a “slow acting” protein with slower absorption compared to whey protein but it provides a more sustained rise in amino acids which may help supress muscle breakdown. Milk contains around 20% whey and 80% casein but all dairy products will contain a mixture of whey and casein. Milk is also rich in leucine which can minimise protein breakdown and is the only amino acid that by itself can stimulate protein synthesis! Research on other individual amino acids is mixed.2 For more on protein please read my recent blog what and when to eat to optimise sports performance

Summary: Protein supplements can be beneficial in enhancing muscle growth and recovery but has not been shown to be more superior to protein from food sources.

  1. Beetroot

Beetroot, spinach, rocket, carrots and most root vegetable contain nitrates. Nitrates can be converted in the body to nitric oxide which improves blood flow via vasodilation. Nitrate intake has been associated with enhanced exercise performance.1 A study by Murphy et al. in 2012 showed that whole beetroot consumption improved running time in 11 recreational fit men and women who ran 5km compared to those who consumed cranberry relish (12.3±2.7km/hr versus 11.9±2.6 km/hr).5  Furthermore, during the last 1.8 km of the 5-km run, running velocity was 5% faster (12.7±3.0 vs 12.1±2.6 km/hour; P=0.02) in the beetroot group. Although beetroot is a food and not a supplement it is worth a mention as the results have been very positive. Perhaps you could have a beetroot, spinach and carrot based smoothie pre-training!

Summary: Consumption of beetroot or an equivalent nitrate dose from other vegetables improves running performance in healthy adults.5

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  1. Probiotics

Athletes with prolonged, intense training often experience diarrhoea and upper respiratory tract infections. This is because vigorous exercise increases gastrointestinal permeability causing ‘leaky gut’. In 2011 West et al. showed that supplementation with a probiotic called Lactobacillus fermentum reduced the severity of self-reported symptoms of lower respiratory illness, use of cold and flu medication, and severity of gastrointestinal symptoms at higher training loads in Australian male athletes.6 Although this research was specific to male Australian athletes it may be worth a trial of this strain if you experience re-occurring diarrhoea and/or respiratory tract infections.

Summary: Athletes experiencing diarrhoea may benefit from a trial of probiotic bacteria called Lactobacillus fermentum.

If you would like to read more of my nutrition blogs then please like my facebook page Our Food Karma. For more regular updates and interaction please add me on snapchat with username: sharuuu000 and instagram as ourfoodkarma

References:

  1. Dunford, M. & Doyle, J.A. (2015). Nutrition for sport and exercise. (3rd edition) Stamford, CT: Cengage:
  2. Helms et al (2014). Evidence-based recommendations for natural bodybuilding contest preparation: nutrition and supplementation. Journal of the International Society of Sports Nutrition, 11:20
  3. Noakes, T.M. (2002). Love of running (4th Ed). Champaign, IL: Human Kinetics
  4. Burke, L.M. (2008). Caffeine and sports performance. Applied Physiology, Nutrition, and Metabolism, 33, 1319-1334.
  5. Murphy, M. et al. 2012 Whole Beetroot Consumption Acutely Improves Running Performance. Journal of the Academy of Nutrition and Dietetics 112;4:548-552
  6. West N.P, et al. (2011) Lactobacillus fermentum (PCC®) supplementation and gastrointestinal and respiratory-tract illness symptoms: a randomised control trial in athletes. Nutrition Journal, 10:30

A diet that can treat Autism, Attention Deficit Hyperactivity Disorder (ADHD), Depression and Schizophrenia?

I am currently researching diet strategies used in the management of different gut issues. This has come about because I have been asked to present at the NZ Society of Naturopaths and Naturopaths of NZ combined annual conference in Auckland in September. My presentation title is “Demystifying diets for functional gut problems” so here I am reviewing diets relating to gut problems!

Recently I wrote a blog on low FODMAPs diet for irritable bowel syndrome (IBS) Low FODMAP foods for IBS. In this blog I am going to focus on the Gut and Psychology Syndromes (GAPS) diet which claims to provide a natural treatment for Autism, ADHD, Dyslexia, Depression, and Schizophrenia.

What is GAPS?

Gut and Psychology Syndromes (GAPS) is a condition that is based on the connection between the function of the digestive system and the brain. It was coined by Dr Natasha Campbell-McBride in 2004 after her own child was diagnosed with learning difficulties. She believes “all diseases begin in the gut” and that the state of the digestive system links all the above mentioned conditions. She also believes that conditions such as asthma, eczema, allergies, eating disorders, and obsessive compulsive disorder can be vastly improved by following the GAPS diet.1

Healthy gut bacteria provide a physical barrier along the length of our intestines. These bacteria protect us from dangerous bacteria (pathogenic bacteria), viruses and fungi. They neutralise toxins, modify the immune system, ferment carbohydrates, produce vitamin K and B vitamins and even provide energy to the cells that line the intestines.1

If beneficial bacteria are weakened then the gut wall is considered open to invasion by various bacteria, parasites and yeast (Candida albicans). This can lead to chronic gut inflammation and malnourished intestinal cells. Intestinal cells are no longer able to function effectively and this results in impaired digestion and absorption “leaky gut”.1

In her book “Gut and Psychology Syndrome: Natural Treatment for Autism, ADD/ADHD, Dyslexia, Dyspraxia, Depression, Schizophrenia” Dr Campbell-McBride claims that once the intestinal lining is damaged, wheat and milk proteins are unable to be broken down by enzymes lining the gut wall and instead are absorbed intact. She explains that these proteins; gluteomorphines (wheat proteins) and casomorphines (milk proteins) can interfere with brain and immune system function.1

She also claims that abnormal gut flora can produce neurotoxins and cause the body to produce antibodies against its own cells in the brain and spinal cord.1 She explains that Candida albicans use glucose to form ethanol and acetaldehyde and that Candida overgrowth during pregnancy can affect child development (as the foetus accumulates toxins), and the infant then produces alcohol in their own gut. Dr Campbell-McBride links aldehyde production in the gut with altered myelin structure, which manifests as multiple sclerosis. She thinks this aldehyde production may be a cause of the neurologic picture of autistic and dyspraxic children. Aldehyde production binds to vitamin B6, preventing its use as a co-factor for neurotransmitters and fatty acid metabolism. She claims that mothers of GAPS children always have gut dysbiosis (imbalance).1

Diet and GAPS

Dr Campbell-McBride claims that sugar and processed carbohydrates increase Candida, Staphylococci, Streptococci, Clostridia and Bacteroids, and predisposes an individual to worms and parasites. She also claims that a high amount of grain intake predisposes individuals to IBS and bowel cancer. She even states that there were no cases of schizophrenia or coeliac disease documented in Ireland until post potato famine when grains became an integral part of the Irish diet! She explains in her book that diet plus other factors such as antibiotic use, surgery, chemotherapy, stress, pollution and oral contraceptive pills have a collective negative effective on beneficial bacteria.1

What does the GAPS diet entail?

The GAPS diet eliminates all complex carbohydrates and only allows smaller sized carbohydrates called monosaccharides (glucose, fructose and galactose) in the diet as these are relatively easy to absorb.  This means avoidance of all grains (wheat, millet, spelt, quinoa, and cous-cous etc), starchy vegetables and beans (potatoes, yams, parsnip, soybeans, mungbeans, bean sprouts, chick peas, and fava beans). All fresh fruit, honey and non-starchy vegetables (Table 1) are allowed. Homemade fermented yoghurt is allowed as the fermentation process breaks the carbohydrates into small sugars and the proteins into amino acids that can then be easily absorbed.1

 Table 1: Non starchy fresh veg and beans/ lentils allowed in the GAPS diettable 1 gaps diet

The GAPS diet involves the avoidance of proteins in wheat and dairy but allows easy to digest unprocessed proteins such as eggs, fish, and meat. There is an emphasis on liver, meat, bone and fish stock. She recommends avoidance of lean meats because she believes that we can only use meat fibers when they come with fat, collagen and other substances. She recommends eating meat that has a good covering of fat and to eat the skin of poultry and fish.1

Shelled/freshly shelled nuts and seeds are allowed but they should not be roasted, salted, coated or processed in any way. Seeds can be soaked in salty water for 12 hours to improve their digestibility. Fats are tolerated as they are not dependent on brush border enzymes (enzymes on the gut wall that help digest food). She recommends ghee made from organic butter, cold pressed oils and no processed oils.1

The GAPS diet starts off with an introduction diet which can last from a few weeks to a year, depending on the individual. This stage allows for gut healing and recovering. There are six stages and Table 2 includes some aspects of each stage.

 Table 2: Six stages of the Introduction dietTable 2 gaps diet

After the introduction diet is completed the full GAPS diet then should be followed for 2 years. The full gaps diet includes 85% meat, eggs, fish eggs, fermented dairy and vegetables. There needs to be 6 months normal digestion before including non-GAPS foods.

Is there evidence to support this diet?

There are no studies or published papers on the GAPS diet. Dr Campbell-McBride makes a lot of sweeping statements (she has never met a healthy vegetarian!) and even advises against vaccination in infants born to mothers with fibromyalgia, digestive problems, asthma, eczema, severe allergies, and autoimmune disorders because she claims that viruses from vaccines may survive and persist in GAPS individuals.1  

However it is recognised that 70% of our immune system is localised in the intestines (gut associated lymphoid tissue) and that gut microbiota can alter brain function.2  We know that poor diets can negatively alter bacteria in the gut, which can then affect our brain and cognitive function. The exact mechanism is still unknown but it may be via regulating immunity or hormonal and neural messages.2

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Many gastrointestinal diseases are associated with neurological affects e.g. migraines/headaches, brain fog, fatique and fainting. Untreated coeliac disease is associated with autistic and psychotic behaviours and neurological conditions. There is also an association with IBS and depression and anxiety.3

The GAPS diet is a traditional diet in many ways with the use of bone broths as a major part of the diet. When I was growing up there was always meat and vegetables in a saucepan together left on the stove which cooked for hours at low heat. This low heat cooking helped liberate nutrients from the bones. This is something I no longer practice but I have started keeping the bones from my roast chicken and lamb dinners to make soups and stews!

I think personally, because I truly believe nutrition can have profound effects on health that I would give this diet a try if I had a GAPS condition. However, I think the diet itself may be challenging, particularly because you need to be able to ferment all your own dairy products and some vegetables. I fermented cabbage before (saukerkraut) but I have not fermented my own dairy products; although I hear it is relatively simple and many people make their own kefir (fermented yoghurt). Fermenting food was not a major tradition in Ireland; apart from breads but bacteria/yeast are killed by the heat. Mead, the oldest alcoholic drink was made from fermented honey, water, herbs and spices! You would also need to get used of making your own breads with nut flours as otherwise it becomes quite expensive buying these breads. It may be extremely challenging for a parent to introduce these foods to a child with learning disabilities and it would require a lot of patience and perseverance. Likewise someone with a mental health condition may not feel motivated to make these changes and they would require a lot of support, and even with support unless they understand the value and are on board with the diet then compliance may be low.

Conclusion

Dr Campbell-McBride often uses indirect evidence as ways to give plausible explanations to her yet to be proven theories. I say yet because a lot of what she is saying may be true and in the future her diet may be recognised as a dietary management option for those suffering from learning disabilities and psychological disturbances. I also wonder if there could be some benefit of including some aspects of the GAPS diet (so it not as extreme) over the long-term e.g. reducing fermentable carbohydrates, including more bone broths and adding small amounts of fermented vegetable into the diet?

I hope you found this useful, if you would like to read more of my nutrition blogs then please like my facebook page Our Food Karma. For more regular updates and interaction please add me on snapchat with username: sharuuu000 and instagram as ourfoodkarma

References

  1. Campbell-McBride, N. Gut and Psychology Syndrome: Natural Treatment for Autism, ADD/ADHD, Dyslexia, Dyspraxia, Depression, Schizophrenia. 2015, (2nd edition) United Kingdom: Medinform Publishing.
  2. Holzer, P., Farz, A. Neuropeptides and the Microbiota-gut-brain-axis. Adv Exp Med Biol. 2014; 817:195-219
  3. De Magistris L, Siniscalco D, Bully C, Loguercio C. Gut-brain axis. A new revolution to understand the pathogenesis of autism and other severe neurological diseases. In Human Nutrition from the gastronenterologists perspective, 2016, pp49-65. E. Grossi, F. Pace (eds) Springer International Publishing Switzerland. DOI 10.1007/978-3-319-30361-1

 

 

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a condition that affects around 10-20% of adolescents and adults globally. Up to half of patients seen in gastroenterology clinics have IBS.1 It is also more common in women than in men and in individuals below 50 years.1

People with IBS experience recurrent abdominal pain or discomfort that is often associated with pain relief by bowel movement, onset of pain relating to change in stool frequency and/or onset of pain being related to a change in stool appearance.1 IBS symptoms can come and go and it can lead to bloating, wind, constipation, diarrhoea along with general frustration, embarrassment and impaired quality of life.

Some people with IBS are more prone to diarrhoea (IBS-D), while others are more prone to constipation (IBS-C), and then some people do not quite fit into either of these and are considered mixed (IBS-M).1

People with IBS-D tend to have poor absorption of certain carbohydrates, which are then rapidly fermented by bacteria in the gut. The fermentation process in the colon creates gas and can create a laxative effect as they draw water into the colon, which can in turn cause diarrhoea.2  

The cause of IBS is multifactorial and in recent years there has been a greater focus on the gut-brain connection. People with IBS tend to have heightened visceral sensitivity (they feel a sharper pain in response to a stimulus) which can influence gut motility.2 There are also psychological factors such as stress at play.

Below are some general recommendations for IBS (Table 1). Probiotics (good bacteria) may be helpful and if tried should be taken for four weeks. Different strains of probiotics may have different effects so you may need to try different strains.3

Table 1: General recommendations for IBS3

GENERAL REC

FODMAP Diet

If general lifestyle and dietary advice does not resolve symptoms then a low FODMAP diet is sometimes recommended.3 FODMAP stands for Fermentable Oligosaccharide, Disaccharide, Monosaccharide, And Polyols. These are a group of short chain carbohydrates that are poorly absorbed in the small intestine and can cause gas, pain and diarrhoea in susceptible individuals. The Low FODMAP diet was created by a team of researchers at Monash University in Australia in 2005. The diet is dietitian led and it can improve overall gastrointestinal symptoms by up to 86%.4

The FODMAP diet aims to reduce the total intake of fermentable sugars in your diet for 6 to 8 weeks. Foods can then be gradually re-introduced. It is important at this stage to monitor your tolerance to each of the foods re-introduced in order to assess if there are particular foods which are causing symptoms. A way of re-introducing a food might be to try a glass of milk or 2 slices of wheat bread.2

Below are examples of high FODMAP foods (Table 2) and low FODMAP alternatives (Table 3).

Table 2: High FODMAP foods2,4

HIGH fodmap

Table 3: Low FODMAP foods4

low fodmap

If you have IBS type symptoms then you should definitely go to see your doctor. If you are diagnosed with IBS and the general recommendations do not alleviate your symptoms then it might really be worth trying the low FODMAPs diet. The diet is recommended to be followed under the supervision of a dietitian trained in using this dietary approach. The diet will be tailored based on food records and direct questioning. You will be provided with alternatives and you can problem solve any issues such as eating out. There is also a low FODMAP diet app by Monash University which can be downloaded for a small fee but is really helpful. We still do not know the long-term effects of this diet but so far short-term studies have shown greater improvement in symptoms in those following low FODMAP diet compared to their normal diet.5-7

I hope you found this useful, if you would like to read more nutrition blogs then please like my facebook page Our Food Karma. For more regular updates and interaction please add me on snapchat with username: sharuuu000

References

  1. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterol. 2006; 130(5):1480-1491.
  2. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms:  The FODMAP approach.  J Gastroenterol Hepatol. 2010;25(2):252-258.
  3. National Institute of Clinical Excellence. Irritable bowel syndrome in adults: diagnosis and management. NICE guidelines [CG61]. Available from https://nice.org.uk/guidance/CG61/chapter/1-Recommendations Accessed 18th July 2016
  4. Nanayakkara WS, Skidmore PML, O’Brien L, et al. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clin Exp Gastroenterol 2016:9 131–142.
  5. Staudacher HM, Lomer MC, Anderson JL, et al. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr. 2012;142(8):1510–1518.
  6. Pedersen N, Andersen NN, Vegh Z, et al. Ehealth: low FODMAP diet vs Lactobacillus rhamnosus GG in irritable bowel syndrome. World J Gastroenterol. 2014;20(43):16215–16226 2010;25(8):1366–1373.
  7. Halmos EP, Power VA, Shepherd SJ, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterol. 2014;146(1):67–75.e65.