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Are Pre-Workout Supplements Good for You? Taking a Look Behind the Smoke Screen

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Today’s guest post comes from Champion PT and Performance Strength Coach Rob Sutton (@rjsutton16).  Rob discusses the health concerns of many pre-workout supplements, and for good reason!  Rob shares a very personal experience of how he really hurt his own health from this class of supplements.  Great info for everyone.  I know I’m sticking to by cup of black coffee as my “pre-workout” supplement!

Are Pre-Workout Supplements Good for You?  Taking a Look Behind the Smoke Screen

When it comes to making gains in the gym, whether that be weight loss or muscle gain, many people often turn to supplements to help them reach their goals. A high number of gym goers use pre -orkout supplements to enhance their training experience in hopes of getting a better training session. This “pre-workout” class of supplements are promoted to give you more energy and stamina to get through a tough workout.

While there is most certainly a time and place for the right dietary supplements, I have a problem with the majority of these pre-workout supplements, which essentially are stimulants.

The Problem with the Supplement Industry

The supplement industry is a juggernaut. According to Forbes, what’s known as the Vitamins, Minerals, and Supplements group, reported nutritional supplements alone produced about $32 billion in revenue in 2012. By the year 2021, nutritional supplements plan to double in revenue to about $60 billion. Gone are the times where it was only meatheads looking to have muscles popping out of their eyelids, buying supplements. The general public and athletes everywhere are now using supplements to aid in their diet and increase performance.

My problem with the supplement industry is the misleading, sneaky, and deceptiveness that is present.

Companies use big words and outrageous claims to market their product to consumers. “Explosive Energy”, “Super Crazy Pumps”, “Increase Strength 317%”, “Growth Hormone Matrix”. All include buzzwords to help aid in claims and gimmicks that the companies want you to believe. And every company claims to provide the highest workout energy on the market. All use colorful labels and big fonts to blind your senses.

Have you ever read through the directions for pre workout supplements? Here some examples from popular pre-workout supplements:

  • “Warning: Use only in accordance with directions for use and warnings.”
  • “DO NOT exceed recommended dosage due to the extremely potent nature of ingredients contained in….”
  • “Assess your tolerance”.

What are we putting into our bodies? There are more warning labels on these than there are on heavy duty cleaning products.

How Pre-Workout Supplements Hurt My Health

Now, I was young once and fell into these traps before like so many others. Although, that has come with a price.

About 7 years ago I began experiencing an abnormal feeling in my chest. It was quite obviously in my heart. It felt as if my heart was skipping a beat. It was happening fairly often and I would notice it mostly at rest. I admit it was something I had ignored for many years. As it began to get worse, it was time to seek out medical advice. Long story short, I was diagnosed in 2012 with (Pre-Mature ventricular contractions, PVC’s). Through several holter monitors and experiments with supplements I was taking, I only remained using whey protein. After cutting out pre workout supplements, my PVC’s were diminished by 97.7%! It was determined the PVC’s were caused by a supplement I had been taking in years past. All bought through local nutrition stores.

There is 1 ingredient in particular that may have caused the heart arrhythmia that I continue to feel every single day. It’s called 1, 3 dimethylamylamine, or DMAA for short.

History of 1, 3 Dimethylamylamine (DMAA)

DimethylamylamineA brief history on DMAA, it was created in 1948 to be used as a nasal decongestant. It had a trademarked named called Forthane. The way the drug worked was via vasoconstriction. The blood vessels in the nose would constrict blood flow, leading to less mucus discharge. This is how many popular over the counter nasal decongestant meds work today but with the absence of DMAA.

Forthane was pulled from shelves in the early 80’s due to dramatic side effects including headaches, tremors, and high blood pressure. DMAA is what’s called a sympathomimetic drug. Which means its mimics the actions of the sympathetic nervous system. On an hourly basis at Champion, we are performing drills and exercises to relax the sympathetic nervous system not stimulate it. We are already stimulated enough!

Supplement companies use this drug because of its high stimulant properties. If DMAA was known to cause ill side effects 30 years ago, how is it still out there for the public to buy? It is in fact banned by the World Doping Agency and reads false positives for amphetamines on urine tests. There is a plethora of scientific journals and facts regarding this subject as well. But what I have learned from a very reputable Physical Therapist and Strength Coach Jeff Cavaliere in March 2011, is that through what we could call a loophole in the “system”, companies can include this ingredient by stating the source of the molecule. The source in this case is geranium oil. Which is an FDA approved food product. DMAA can be extracted from the geranium plant. Some research suggests that extremely small amounts are found in the plant itself. DMAA can also be seen on supplement labels under a giant list of other names including geranium extract, geranium oil extract, and methylhexaneamine, to name a few.

A list of all names and products known to contain the drug can be found here:

DMAACavaliere was ahead of the curve when he presented the problem with this drug in 2011 and the potential health problems related with a drug that causes the blood vessels to constrict. Constricting blood vessels and arteries, leading to high blood pressure, combined with exercise can be a harmful mix. Lets mix in a high amount of caffeine and even more ingredients with stimulant properties as well. This is when this subject was put on my radar and I began to research possible supplements that contained DMAA. And indeed I found some, and some I had taken in the past. The ingredient pictures shown are from 2 pre-workout supplement labels that I had used about 8 to 10 years ago. They have since been changed…. but why?

After Jeff Cavaliere turned me onto this issue, I discarded the supplements I had…sorry my heart just skipped a beat…. that included this potentially harmful chemical. And I then kept my eye on this topic in the future.

In 2012/2013 the FDA put its foot down on supplement companies, ordering them to pull this already illegal drug. As of April 11, 2013, the FDA received 86 reports of illnesses and deaths associated with supplements containing DMAA. These are just a few case reports associated with deaths and severe health problems linked to DMAA.

Hold on it gets better…

Companies began to comply with the FDA’s orders. One popular supplement company, also in April 2013 sent out an email to subscribers about a new formula for their pre workout supplement. Here’s what it stated:

“______has been our #1 selling pre-workout supplement for years and now it is no longer being produced. We are down to two flavors, ______and_______, and what we have in stock is it!! If you want to get your hands on some of the last remaining bottles, you should act fast…quantities on these are extremely limited and quickly selling off. Get it before this original formula is gone forever! Only $21.95!!”

This is complete BS!

Why are they creating a new formula? Because the old one is killing people!! So lets start giving this poison to as many people as we can for a discounted price. Like I said, misleading, sneaky, and deceptive.

The Center for Disease Control (CDC) had identified another product by the same company with DMAA in it. They identified 100 people who developed hepatitis from using this product. 47 of those needed hospitalization, 3 needed liver transplants, and 1 died.

What’s the Next Pre-Workout Ingredient to be Banned?

What will be the next ingredient that is in current supplements, to cause as big an uproar as 1, 3 dimeth? I bet you it’s out there.

Here are an unfortunate two possibilities. Beta-methylphenylethylamine (BMPEA) and Synephrine. Both have already had bad press and have been linked to health issues. An article published on WebMD talks about how in April of 2015, the FDA sent warning letters to five supplement companies whose products contain BMPEA, asking them to stop distributing products containing the drug.

This sounds strikingly similar to the beginning of the end of DMAA back in 2012.

In 2012, my cardiologist made me aware of the drug Synephrine. Synephrine, like BMPEA, and DMAA is a powerful stimulant. This was in one of, if not multiple pre workout supplements that I had taken in the past. (Refer back to photos). Synephrine is also disguised in many supplements just as DMAA was. It may also be labeled as Bitter Orange or Citrus Aurantium. Just as DMAA, the source of the drug is being labeled, which helps in the legality. Synephrine is not currently a banned substance.

Synephrine

Is it Worth the Risk?

Think about it, do we really need an exotic plant extract from China to help us lift more weight? Do we need to search for an ingredient buried at opposite ends of the earth to lose 10 pounds?

OVERWHELMING NO!!!

Work hard for your goals and they will come. What happened to eating properly, getting enough sleep, and staying properly hydrated. That is my pre workout.

How to Enhance Recovery Beyond Nutrition

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Today’s guest post comes from Kamal Patel and the team at Examine.com.  If you haven’t heard of Examine.com just yet, you’ve been missing out!  Examine.com is the web’s best resource for evidence-based information on nutrition and supplementation.  They are completely unbiased and only report on scientific fact, not speculation.  The nutrition and supplement fields are filled with anecdotal information, false beliefs, and downright inaccurate claims about efficacy.  Examine.com helps us sort through what is fact and fiction.  Be sure to check out the special offer from Examine.com at the end of this article.

 

How to Enhance Recovery Beyond Nutrition

Training sounds pretty simple on paper. Just eat right, sleep well, and lift a little bit more weight every workout. But every workout takes place in real life, and real life can make training pretty hard.

To improve at the rate that you read about on internet forums – hitting a 315 pound squat or 225 pound bench press after a year of training – you need to train like an athlete. That doesn’t just mean going to the gym three times a week and downing a protein shake afterward. Optimal training only occurs when daily life doesn’t get in the way.

Training like an athlete while working a full time job or going to school is not easy, but fixing weak points in your habits and lifestyle can help avoid training setbacks and plateaus.

Alleviating Soreness and Joint Pain

Exercise causes muscle and joint pain. The severity of the soreness and how long it takes to recover depends on diet and lifestyle, as well as the kind of exercise performed.

The basics

A high-carbohydrate diet is the first step to alleviating post-workout joint pain. A low-carbohydrate diet, while potentially useful for fat loss, is not ideal for resistance training.

People on a low-carb diet should eat the majority of their carbohydrates in the post-workout period. Going into a workout with low glycogen is not ideal for strength training, but if joint pain is interfering with exercise, fixing the problem should be a priority.

Magnesium deficiencies can also exacerbate joint pain and cause muscle cramping in athletes. The lack of other electrolytes, like potassium, can contribute to pain. Potassium deficiencies must be alleviated through dietary changes, since too much potassium on an empty stomach can cause potentially fatal cardiac arrhythmia.

 

Troubleshooting Joint Pain

If dietary changes don’t alleviate persistent joint pain, anti-inflammatory supplements may be able to help.

Anti-inflammatory supplements are not as potent as pharmaceuticals like aspirin, acetaminophen, and aleve. However, curcumin and fish oil are both used to alleviate joint pain in athletes. Though the research on these two supplements is done in the context of arthritis, the benefits should theoretically extend to athletes as well. More research is needed to confirm this effect.

Cissus quadrangularis can alleviate the joint pain that results from specific injuries. If your post-exercise joint pain has persisted for years, you may want to consider consulting with a physiotherapist.

Do not supplement high amounts of anti-inflammatory supplements to dull injury pain. Continuing to work out after an injury can exacerbate tissue damage and increased recovery time, leading to overuse of pain-reducing supplements and permanent damage.

 

Alleviating Fatigue and Lethargy

There’s nothing like proper rest and nutrition to facilitate training, but sometimes you can’t avoid staying up late to finish a paper or getting up extra-early to beat the boss to the office.

 

The basics

Running a caloric deficit is great for weight loss, but not as great for energy levels. Though some people can go for long periods of time on reduced calories, a crash is inevitable. If your diet is interfering with your daily energy, consider a less drastic deficit.

The occasional all-nighter won’t have a long-term effect on gym performance, but consistently poor sleep will. Aim for six to 10 hours of sleep every night, and make sure your sleep environment doesn’t affect your recovery.

A healthy sleep environment is:

  • A slightly cool room tends to facilitate sleep, while a puddle of sweat is awful to wake up in.
  • Smart phones and tablets just before bed will disrupt melatonin secretion, leading to a more difficult time falling asleep.
  • Ears don’t close like eyes do. Even if you sleep through the night, loud noises can still impair sleep quality.
  • Caffeine-free. Any compounds that impair sleep will lower sleep quality, even for veteran coffee drinkers that can drink a pot of coffee at 8:00 p.m.
  • Where you sleep and how long you sleep for should be the same from night to night.

A good sleep environment actually makes it easier to get out of bed in the morning, since improved sleep quality leaves you feeling more rested.

 

Troubleshooting sleep quality

Some sleep issues can be alleviated through supplementation. People that have issues with sleep latency, meaning they have trouble falling asleep, can supplement melatonin or lemon balm.

Melatonin is a hormone that regulates sleep, but people with no difficulty falling asleep will not experience any further sleep benefits.

Lemon balm is a light sedative used to alleviate intrusive thoughts that can interfere with sleep.

Supplements that improve sleep quality, as opposed to sleep latency, include glycine and lavender.

About three grams of glycine taken thirty minutes before bed will improve sleep quality, but the supplement becomes less effective after prolonged use. To use glycine in the long term, avoid taking it daily.

Lavender, used in aromatherapy, is associated with improved sleep. Rubbing lavender oil on a pillow before bed can also improve sleep, but some people may experience skin irritation due to long-term exposure of skin to oil.

If stress is causing reduced sleep quality or poor sleep latency, supplements called adaptogens can help the body adapt to stress, resulting in fewer stress-related side effects, like fatigue and anxiety.

The most popular adaptogens are ashwagandha, Rhodiola rosea, and Panax ginseng. Ashwagandha is sometimes supplemented by athletes because it may improve cardiovascular performance and muscular strength. Siberian ginseng is another adaptogen option for people that get sick often, though it has very little effect on physical performance.

Breaking through plateaus

There’s a lot of factors to keep track of during long term training. Hitting a plateau can be frustrating because it takes time to isolate the factor responsible.

 

The basics

Daily caloric intake is the biggest influence on physical performance. Carbohydrates are more effective for strength training than fatty acids, but both are necessary for busting through plateaus.

Addressing general energy levels, fatigue, and joint pain is also a vital aspect of breaking through a plateau.

 

Troubleshooting plateaus

Supplements that improve physical performance can be useful for breaking through training plateaus. Creatine is the go-to recommendation, while caffeine (400mg) can be used once or twice a week as a pre-workout supplement.  Please note that although 400 mg is listed as a low dose in some studies, this would be a relatively high dose for someone who is caffeine naive.

There is preliminary evidence that suggests cholinergics like CDP-choline and Alpha-GPC may improve physical performance in a non-stimulatory way, but more research is needed to confirm this effect.

 

Identifying Lifestyle Weaknesses

To facilitate effective training, learn to isolate the weak points in your habits and work to improve them. Start with obvious factors, like staying up too late, and address others as they arise, whether in training, at work, or in life.

 

Examine comKamal Patel is a nutrition researcher with an MPH and MBA from Johns Hopkins University, and is on hiatus from a PhD in nutrition in which he researched the link between diet and chronic pain. He has published peer-reviewed articles on vitamin D and calcium as well as a variety of clinical research topics. Kamal has also been involved in research on fructose and liver health, mindfulness meditation, and nutrition in low income areas.

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Food as Medicine

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Several months ago I was really taken aback by a TED talk by Dr. Terry Wahls, who discussed food and our diet’s role in our health.  Dr. Wahls was diagnosed with multiple sclerosis in 2000 and was soon in a wheelchair.  After years of medication and treatment with minimal improvement, she radically changed her diet in an attempt to give her body the nutrients it needed to help itself.  Within a year she was out of her wheelchair.

Here is a link of here motivating and thought provoking TED talk:

You can read more about Dr. Terry Wahls at her website.  It goes to show, we really don’t know as much as we think we do about the human body.  How can we go to the gym, workout, and pretend we are being healthy, then grab some food from a box or a bag.

The more I learn about nutrition, they more that I think we need to avoid processed foods as much as possible.  And heck, sometimes we think we are eating healthy when we aren’t!  Core Performance has a nice article on 10 food items that are more processed than you probably realize.  If you eat things from a bag or a box, you are probably not feeding your body as well as possible.

We talk a lot of sports medicine and performance here, but shouldn’t we all be putting our bodies in the best position to succeed?

 

The Use of Glucosamine and Chondroitin Sulfate for Knee Arthritis

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Glucosamine and Chondroitin Sulfate Pills for Knee ArthritisA recent review from the January 2009 issue of the Journal of Arthroscopy reviewed the use of glucosamine and chondroitin sulfate for knee osteoarthritis.  Considering the vast amount of people suffering from knee arthritis and the increasing cost of medical care for these patients, the use of any type of supplement to reduce symptoms is welcome.

Research into the efficacy of glucosamine and chondroitin sulfate is certainly not new with studies dating back to 1969.  However, the literature has been filled with many poorly controlled studies, some of which were funded by glucosamine manufacturers!This particular paper reviewed the results of 23 studies that involved double-blind, placebo-controlled, randomized control trials as well as several meta-analyses.

The effectiveness of Glucosamine and Chondroitin Sulfate

The overall results of the review show that there are inconsistent results, but that the results do favor improvement of pain and joint function in patients with arthritis.  The authors also note that one of the most consistent trends between studies involved the length of use of the supplement.  The best results from glucosamine appear to occur after several months of use.  Studies are referenced that show positive results in 3-6 months and even up to 9 months.

In general, if you looked hard enough, you could probably find more articles that say that the use of glucosamine is effective than you could find saying it is not effective.  I realize and agree that there is not overwhelming evidence in support of glucosamine or outlined the exact mechanism of symptom improvement.  However, when we start to run out of options for our patients, I would say there is enough evidence to support it’s use, as long as the supplement is safe.

The Safety of Glucosamine and Chondroitin Sulfate

A potentially more important finding of the current review was that the use of glucosamine and chondroitin sulfate appears to be safe, at least as safe as placebo supplementation.  To me, this is the most important finding for me clinically.  If we are going to recommend the use of a supplement with inconsistent findings, as long as the supplement is safe I have no problem recommending a patient try glucosamine.

Recommended Use of Glucosamine and Chondroitin Sulfate

I have spent a lot of time over the last several years trying to find a consensus statement on the use of glucosamine and chondroitin sulfate.  Unfortunately, this does not appear to exist.  I have taken information from many sources, including the excellent recommendations of noted orthopedist Dr. Frank Noyes of Cincinnati Sports Medicine and information from the Osteoarthritis Research Society International to provide the following information.  I recommend that you read Dr. Noyes’ recommendations, it is a great resource.  Also, realize that you should consult with your own personal physician before taking any supplements and that glucosamine may not be indicated for you personally.  The below information are just basic guidelines for healthcare providers when considering the use of glucosamine:

  • Cosamin DSGlucosamine should be taken with chondroitin sulfate to maximize it’s effectiveness
  • Supplements that include magnesium and vitamin C may help the absorption rate of glucosamine and chondroitin sulfate.
  • To date, the specific brand that has received the highest recommendations appears to be Cosamin DS.
  • Dosage should vary based on body weight:
    • If less than 120 lbs: G 1000mg + CS 800mg
    • Between 120-200 lbs: G 1500mg + CS 1200mg
    • If greater than 200 lbs: G 2000mg + CS 1600mg
  • Supplements should be taken for at least 3 months for noticeable results.  If no response within 6 months, may discontinue.

I have found decent results from the use of glucosamine in my patients, have you?

C VANGSNESSJR, W SPIKER, J ERICKSON (2009). A Review of Evidence-Based Medicine for Glucosamine and Chondroitin Sulfate Use in Knee Osteoarthritis Arthroscopy: The Journal of Arthroscopic & Related Surgery, 25 (1), 86-94 DOI: 10.1016/j.arthro.2008.07.020

Image by scottfeldstein