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Enhancing the performance of the athlete: Part 2.

In part 1 of this series, we discussed the foundation of enhancing athletic performance. This foundation is essentially the same as that for general health and well-being, with special emphasis on the unique lifestyle of the athlete. The athlete's lifestyle needs to be understood in order to find the weakness in the foundation. If sleep, nutrition, and exercise are not appropriate, then they should be addressed first before beginning any ergogenic supplement, technique, or training regimen. Without a lifestyle foundation uniquely tailored to the athlete, optimized performance will suffer.

Once weaknesses are addressed, the next step for enhancing performance should be appropriate supplementation. This does not necessary mean ergogenic aids as defined by the International Society of Sports Nutrition (ISSN) below (Table 2, p. 73). (1) For the athlete, we are talking about a high-quality multivitamin, vitamin D, and possibly other nutrients. Nonergogenic nutraceuticals to consider that have evidence of tempering inflammation, such as fish oil and/or curcumin, can be useful.

None of the vitamins and minerals in a typical multivitamin have enough evidence to be considered ergogenic aids. The same is true for fish oil and curcumin.

In part 2, we briefly discuss and highlight some vitamins and minerals that show promising evidence of being ergogenic and also review some of the known ergogenic supplements.

Part 3 will detail specifics on the known natural ergogenic aids and then briefly highlight substances (synthetic and natural) banned in sports competition.

Definition of a Ergogenic Aid

As stated in part 1, an ergogenic aid "is any training technique, mechanical device, nutritional practice, pharmacological method, or psychological technique that can improve exercise performance capacity and/or enhance training adaptations." (1) In other words, any natural substance that improves performance beyond health and wellness could be considered ergogenic if it has supporting evidence. By this definition, an athlete should not look to "most" vitamins and minerals and other nutraceuticals to enhance athletic performance. However, appropriate supplementation with nutraceuticals, whether ergogenic or not, can improve the health and well-being of the athlete.

Vitamins, Minerals, and other Nutraceuticals

It is now recommended by most medical organizations, including the AMA, that a low-dose multiple vitamin be consumed daily to promote health. Although there is a paucity of data showing that vitamins and minerals have any ergogenic effect, it stands to reason that athletes, similar to the general public, should also take a multivitamin and would probably benefit more in doing so relative to the average person. The nutritional status of an athlete significantly affects quality of performance, training, and recovery. (1,2) When considering vitamin and mineral supplementation for athletes, health-care providers should view their recommendations first in the context of nutrient adequacy and second, performance and recovery. Many athletes will be more susceptible to vitamin and mineral inadequacies, given the issues around nutrition and potential caloric deficits due to the intensity and duration of training and performance schedules. While there may be no conclusive evidence as of yet of vitamin and mineral supplements' benefiting performance, there is evidence showing that vitamins and minerals as well as other supplements can aid recovery and support. (1-5) If an athlete is clinically or subclinically deficient in any vitamin and mineral, then it is likely supplementation will improve performance.

The research databases are replete with evidence showing that many supplements not only prevent but also treat disease; however, this does not mean that these supplements also have ergogenic effects in a healthy athlete. Nutraceuticals such as glucosamine, curcumin, and [omega]-3 fats can aid in healing of cartilage and lessen joint pain and are useful for the athlete, but have yet to be shown conclusively to improve performance. Supplements such as zinc, glutamine, vitamin C, and vitamin A may support immune function and antioxidant capacity but do not have any conclusive evidence showing an ergogenic effect.

Most health-care providers trained in nutritional or functional medicine can probably state many theoretical reasons supported by evidence of how most, if not all, nutraceuticals have ergogenic effects. In fact, many coaches, trainers, and athletes have personal experience with nutraceuticals that appear to demonstrate ergogenic effects, but are not labeled as such. Nevertheless, most nutraceuticals clearly do not improve athletic performance beyond addressing any nutrient deficiencies, and also lack the evidence to support such use. Below is a table of just a few vitamins and minerals that are currently considered nonergogenic with their possible health benefits for the athlete.

Vitamin D

Special attention should be given to the athlete regarding vitamin D status. Vitamin D deficiency is now epidemic, and athletes suffer the same rates as the rest of the public. While vitamin D supplementation in those who are sufficient does not appear to improve performance, vitamin D delivered to deficient athletes does indeed improve performance. (6,7,10) In one study of elite female gymnasts, 77% were found to have vitamin D levels lower than 35 ng/ml and a full third had levels less then or equal to 10 ng/ml. (9) Vitamin D is stereotypically known for its role in bone metabolism. However, it is now known that there are vitamin D receptors all over the body, and as a consequence it affects the body in multiple ways. As far back as the 1930s, there were numerous reports of the beneficial effects of UV therapy on athletic performance. (10,11) There are also studies that suggest the season of training makes a difference. One of these studies showed that training in the summer months creates greater gains than the same volume of training in autumn or winter despite the same stimulus. (12)

In both older and younger individuals, adequate vitamin D status affects neuromuscular function and may have specific relationship to the maintenance of the fast twitch (type II) muscle fibers. (6,8,10,13,14) In a study on teenage athletes, vitamin D deficiency lowered muscle power and force. (15) Vitamin D levels are also related to myalgia, fatigue, and reduced motivation to exercise. Studies in older adults have shown that the level of vitamin D is correlated with the propensity to fall. A meta-analysis on vitamin D levels has shown a 20% reduction in the risk to fall. (16) This is likely due to vitamin D's ability to improve reaction speed, balance, and neuromuscular performance. Much of this may be explained by the ability of vitamin D to help maintain and even build type II muscle fibers. (6,8,10,13,14)

Athletes should be tested for vitamin D with a serum 25-hydroxy vitamin D test, with a target of between 50 to 100 ng/ml. If they are found to be deficient, then a combination of vitamin D supplementation and sun exposure is advisable.


Curcumin, one of the most well-researched nutraceuticals, is the active constituent in the herb turmeric. Curcumin sounds like the herb cumin, but has no relation to it. Curcumin is found only in turmeric.

The benefit for the athlete primarily comes from curcumin's powerful anti-inflammatory ability. Thus far curcumin has been studied against numerous anti-inflammatory medications and has done just as well or better. (18-21,23) Curcumin has a very real potential to support the athlete through its many anti-inflammatory effects while also supporting joint health. (22) Considering the numerous positive side effects and safety profile of curcumin, as opposed to the possible numerous negative side effects of most over-the-counter and prescription anti-inflammatories, one wonders why it is not recommended to athletes more.

Another possible benefit of curcumin is its effect on preventing fat gain. There are some intriguing studies showing that curcumin can help with fat loss. (24,25) To confirm this lipolytic effect of curcumin, many more studies are needed; however, this is just one of many potential benefits of taking curcumin for the athlete.

Although curcumin is not considered ergogenic, it can, at least in theory and based on current evidence, possibly support and extend the career of many athletes through its seemingly powerful anti-inflammatory effects.

Laboratory Evaluations for the Athlete

Individual nutrient deficiencies affect many aspects of physical performance, recovery, and immune function. Athletes, because of the imposed increases in metabolism, can be at higher risk for nutrient deficiencies. Serum testing is a reliable and useful tool for diagnosis of severe nutrient deficiencies but may be inadequate for certain vitamins and minerals. (17) Furthermore, serum testing does not give a clear picture of the functional status of the nutrient. In other words, to get a better idea of the intracellular status of a nutrient, other labs may be necessary. It can be useful for those working with athletes to use more functional tools for assessment of metabolism and nutritional needs.

As an example, doing a serum magnesium does not really tell the clinician anything about status of magnesium intracellularly unless it shows a frank deficiency. An analysis of intracellular nutrients can be a more valuable tool possibly indicating subclinical deficiencies or deficiencies not apparent on conventional lab tests. Functional lab tests can be extremely valuable for the athlete, and once any subclinical deficiencies are corrected, performance will most likely be enhanced.

There are now a wide range of laboratory analyses that can give more functional assessments of nutrition status. The ones that may be most beneficial are adrenal hormone profiles, organic acid testing, intracellular nutrient analysis, and amino acid testing. (17)

Critical Evaluation of Ergogenic Aids

It is important to be aware of the large gap that often exists between supplement marketing and supplement research. When evaluating whether a nutritional supplement might be useful, it is prudent to keep several things in mind.

A good first question to ask is, does the science make sense? Knowing the nutrient and its involvement in biochemical pathways is a key. If the mechanism of action makes sense from a biochemical perspective, then the supplemental aid may have merit.

The next question to ask is, can this nutrient actually be absorbed and utilized by the body? While a nutrient may seem as if it has ergogenic properties, if it cannot be delivered to the body in a safe, feasible, and usable form, it will not have much use. Other considerations include:

* Does it have any research suggesting an ergogenic potential?

* Are the studies in vitro or in vivo studies?

* Were they animal or human studies?

* Was the sample size big enough?

* How was the study designed?

* Was it well controlled?

Human clinical trials with a large sample size that are double blinded and placebo controlled are obviously most beneficial and should be weighed more heavily. Unfortunately, these types of studies often do not exist for sports performance supplements, thus accounting for much of the skepticism regarding ergogenic aids. Much of this skepticism is warranted, although discounting a supplement purely on the basis of lack of these types of trials is likely not wise.

Natural Ergogenic Supplements with the Most Evidence

The ISSN classifies ergogenic supplements in the following way (1):

* Apparently Effective. Supplements that help people meet general caloric needs and/or that the majority of research studies in relevant populations show is effective and safe.

* Possibly Effective. Supplements with initial studies supporting the theoretical rationale but requiring more research to determine how they may affect training and/or performance.

* Too Early To Tell. Supplements with sensible theory but lacking sufficient research to support current use. Note: Most supplements marketed as ergogenic aids fall into this category.

* Apparently Ineffective. Supplements that lack a sound scientific rationale and/or research has clearly shown to be ineffective.

Table 2 below is a list of natural ergogenic supplements supported by research and given the "ergogenic" label by organizations such as ISSN. It lists all the "apparently effective" and "possibly effective" natural ergogenic supplements considered safe and not banned by most prestigious athletic associations, along with their possible ergogenic benefits.

Obviously, a full treatment of all the natural compounds purported to have beneficial effects in exercise and body composition could fill an entire book. We have selected supplements demonstrating the most and best research supporting their use as ergogenic aids that are also supported by the ISSN and other athletic organizations.


Due to limited research, most nutraceuticals are not considered to be ergogenic. Any athlete who is deficient in a nutrient will probably improve performance once the deficiency is adequately addressed; however, this does not mean that the nutrient in question is ergogenic.

Lab tests for essential nutrients rarely go beyond analyzing frank clinical deficiencies. Is there a difference between optimal nutrient status and adequate nutrient status? In our opinion, there is a huge difference. For the athlete this distinction is rarely made. Even though more research is needed in this area, common sense dictates that optimizing nutrient status can enhance performance. Functional lab testing can play an important role in this goal. Again, optimizing the levels of nutrients using functional lab tests whether deficiencies are subclinical or clinical does not mean that the nutrient in question is ergogenic. On the other hand, these functional test can give the athlete a significant advantage because most athletes never are functionally assessed with labs.

Whether or not functional testing is done, it is prudent to supplement athletes with a high-quality multivitamin, just as it is for the general public. Interestingly, most athletes are not doing this either, and have many more reasons than the average person to do so when considering training and performance schedules.

There are supplements that appear to have ergogeniclike effects, such as curcumin or vitamin D. These nutraceuticals can potentially extend the career of an athlete. Unfortunately, much more research is needed before labeling either one of these nutrients true ergogenic aids.

So what are the so-called ergogenic natural supplements as defined by the ISSN? Table 2 lists them primarily due to the number of studies done on them. With more studies being done every day, this list will grow and probably include nutraceuticals such as curcumin and vitamin D. In part 3 of this series, each ergogenic aid in Table 2 will be discussed, if it was not previously discussed in part 1.


(1.) Kreider et al. ISSN exercise and sport nutrition review:research and recommendations. J Int Soc Sports Nutr. 2010;7:7.

(2.) American College of Sports Medicine position stand. Nutrition and athletic performance. Med Sci Sports Exerc. 2009;41 (3): 709-731.

(3.) Applegate et al. Effective nutritional ergogenic aids. Int J Sports Nutr. 1999;9(2):229-239.

(4.) Machefer et al. Multivitamin-mineral supplementation prevents lipid peroxidation during "the Marathon des Sables." J Am Coll Nutr. 2007;26(2):111-120.

(5.) Woolf et al. B-vitamins and exerciserdoes exercise alter requirements? Int J Sport Nutr Exerc Metab. 2006; 16(5):453-484.

(6.) Bartoszewska et al. Vitamin D, muscle function, and exercise performance. Pediatr Clin North Am. 2010;57(3):849-861.

(7.) Larson-Meyer et al. Vitamin D and athletes. Curr Sports Med Rep. 2010;9(4):220-226.

(8.) Hamilton et al. Vitamin D deficiency is endemic in Middle Eastern sportsmen. Public Health Nutr. 2010;15:1-7.

(9.) Lovell et al. Vitamin D status of females in an elite gymnastics program. Clin J Sport Med. 2008;18(2):159-161.

(10.) Cannell et al. Athletic performance and vitamin D. Med Sci Sports Exerc. 2009;41 (5): 1102-1110.

(11.) Erikssen et al. Seasonal variation in work performance and heart rate response to exercise: a study of 1,835 middle-aged men. Eur J Appl Physiol. 1979;42:133-140.

(12.) Sato et al. Low-dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke: a randomized controlled trial. Cerebrovas Dis. 2005;20(3):187-192.

(13.) Sorensen et al. Myopathy in bone loss of ageing: improvement by treatment with 1 alpha-hydroxycholecalciferol and calcium. Clin Sci. 1979;56(2):157-161.

(14.) Dhesi et al. Vitamin D supplementation improves neuromuscular function in older people who fall. Age Ageing. 2004;33(6):589-595.

(15.) Ward et al. Vitamin D status and muscle function in postmenarchal adolescent girls. J Clin Endocrinol Metab. 2009;94(2):559-563.

(16.) Bischoff-Ferrari et al. Effect of vitamin D on falls: a meta-analysis. JAMA. 2004;291(16):1999-2006.

(17.) Lord and Bralley. Laboratory analysis for integrative and functional medicine. 2nd ed. Duluth, GA: Metametrix Institute; 2008.

(18.) Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012 Nov;26(11):1719-1725. doi: 10.1002/ptr.4639.

(19.) Kuptniratsaikul V et al. Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis. / Altern Complement Med. 2009 Aug;15(8):891-897. doi:10.1089/ acm.2008.0186.

(20.) Satoskar RR et al. Evaluation of anti-inflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation. Int J Clin Pharmacol Ther Toxicol. 1986 Dec;24(12):651 -654.

(21.) Jurenka JS. Anti-inflammatory properties of curcumin, a major constituent of Curcuma longa: a review of preclinical and clinical research. Altern Med Rev. 2009 Jun;14(2): 141-153.

(22.) Henrotin Y et al. Biological actions of curcumin on articular chondrocytes. Osteoarthritis Cartilage. 2010 Feb; 18(2):141-9. doi:10.1016/j. joca.2009.10.002.

(23.) Funk JL et al. Turmeric extracts containing curcuminoids prevent experimental rheumatoid arthritis. J Nat Prod. 2006 Mar;69(3):351-355.

(24.) Ejaz A et al. Curcumin inhibits adipogenesis in 3T3-L1 adipocytes and angiogenesis and obesity in C57/BL mice. J Nutr. 2009 May;139(5):919-925. doi:10.3945/jn.108.100966.

(25.) Meydani M, Hasan ST. Dietary polyphenols and obesity. Nutrients. 2010 Jul;2(7):737-751. doi:10.3390/nu2070737.

by Jade Teta, ND, CSCS, and Keoni Teta, ND, LAc, CSCS

Keoni Teta, ND, LAc, is a naturopathic physician and acupuncturist practicing at the Naturopathic Health Clinic of North Carolina in Winston-Salem with his wife, Jillian, and brother, Jade, an integrative physician specializing in natural health, fitness, and body transformation. After graduating from Bastyr University, they cofounded Metabolic Effect, an international health and wellness company that focuses on balancing hormones for fat loss using rest-based exercise, sports nutrition, and lifestyle medicine. They are coauthors of The Metabolic Effect Diet and contributing authors to The Textbook of Natural Medicine, 4th ed.
Table 1: Potential Ergogenic
Nutraceuticals for the Athlete

Vitamin C     Enhances immunity,
              protects from oxidative
              damage, supports
              connective tissue, may
              prevent upper respiratory
              infections after intense

Vitamin D     Immune enhancement,
              protects against

Magnesium     May improve sleep,
              supports carbohydrate
              utilization, helps relax
              muscle tissue
              Deficiency may
              contribute to lower
              endogenous cone, of
              testosterone. It has yet
              to be demonstrated to
              boost hormone levels
              in someone with normal

Vitamin B6    When combined with
              vitamins B1 and B12, B6
              may increase serotonin
              levels and improve finemotor

Curcumin      Anti-inflammatory,
              possible aid for fat loss

Table 2

Supplement        Ergogenic    Benefits

Creatine          Apparently   [up arrow] intensity,
monohydrate       Effective    strength, power, lean mass,
                               weight maintenance

Water and         Apparently   endurance, resists fatigue
sports drinks     Effective

Weight gain       Apparently   body composition, muscle
powders           Effective    building, bulking

Protein (whey)    Apparently   recovery, lean mass, regulates
supplements       Effective    hunger,  [up arrow] insulin,
                               synergy with creatine,
                               supports glutathione

Carbohydrate      Apparently   endurance, recovery, muscle
supplements       Effective    gain via [up arrow] insulin

Essential amino   Apparently   [up arrow] recovery, [up
acids             Effective    arrow] protein synthesis,
                               [down arrow] protein breakdown

Branched chain    Possibly     [up arrow] recovery, [up
amino acids       Effective    arrow] protein synthesis,
(BCAAs)                        [down arrow] protein breakdown

Postexercise      Possibly     recovery, [down arrow] muscle
carbohydrate      Effective    breakdown
and protein

Low-calorie       Apparently   body composition
diet foods &      Effective

High-fiber        Possibly     body composition
diet              Effective

Sodium            Apparently   buffers lactic
bicarbonate       Effective    acid, resists

B-alanine         Apparently   resist fatigue, [up arrow]
                  Effective    force, [up arrow] training
                               volume, [up arrow] carnosine

Sodium            Apparently   resists fatigue, may (resting
phosphate         Effective    energy expenditure (weight

Caffeine          Apparently   [up arrow] intensity, [up
                  Effective    arrow] fat burn, improves
                               mental focus and fine motor
                               skills, [up arrow] endurance,

Green tea         Possibly     [up arrow] oxidation of fat
extract           Effective    d/t catechins

Calcium           Possibly     body composition

Conjugated        Possibly     body composition
linoleic acids    Effective

3-hydroxy         Possibly     protects muscle, may [up
[beta]-           Effective    arrow] strength and muscle
methylbutyrate                 gain, may be synergistic with
(HMB)                          creatine

Glycerol          Possibly     may help prevent dehydration
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Author:Teta, Jade; Teta, Keoni
Publication:Townsend Letter
Article Type:Report
Date:Jan 1, 2014
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