Dietary Supplements: Safe, Effective or

Neither? KEEP YOUR EDGE

Hockey Sports Medicine 2015 August 28, 2015

Dr. Ashley James, B.A., N.D.Naturopathic Doctor

Disclosure

• I have no relevant non-financial relationships to disclose.

• I am neither employed by nor affiliated with any supplement companies.

• I carry a dispensary in my practice in which I resell professional products.

Objectives

• What is a Naturopathic Doctor

• Mass market vs Professional supplements

• Safety and Efficacy

• 2 dietary supplement examples

What is Naturopathic Medicine?

• a distinct primary health care system that blends scientific knowledge with traditional and natural forms of medicine

• after a pre-med undergraduate degree Naturopathic Doctors (N.D.’s) complete a 4 year full time Doctor of Naturopathic Medicine program and 2 sets of licensing exams

• patients undergo a full history and physical exam in addition to standard medical diagnostic investigations

Naturopathic Medicine

Naturopathic Medicine• individualized treatments draw from one or all of

the following disciplines:

• clinical nutrition and supplementation• botanical medicine • acupuncture and Traditional Chinese Medicine• lifestyle counselling

• most N.D.’s work in multi-disciplinary practices with health professionals from other regulated professions

• N.D.’s are regulated by the RHPA in Canada

Dietary Supplements

Professional vs.

Health Food Store/Mass Market Supplements

Consumer Grade Supplements

• found in drug stores and health food stores

• made from cheapest components to maximize profit

• made to maximize shelf life

• laundry list of artificial colours, flavours, fillers, excipients, binders, preservatives

• include minimum amount of active ingredient for label use

Professional Supplements

• full label disclosure, including non-medicinals

• standardizations of herbal extracts to indicate primary active marker compounds

• therapeutic doses

Professional Supplements

• 3rd party testing for quality, stability, potency and purity at 3 stages:

• raw ingredients• during manufacturing• finished product

Dietary Supplements Safety and Regulation

Natural Health Product Labelling Laws in the

USA and Canada

DNA Barcoding detects contamination and substitution in North American herbal

products. BMC Med 2013. Newmaster SG et al. 1

• 44 products tested from 12 companies

• 59% of the products contained plants not listed on the label

• 48% contained contaminants or fillers not listed on the label

• 32% of the samples contained product substitutions

• only 2/12 companies had products without substitutions, contamination or fillers

Misleading Consumers

Urinary nandrolone metabolite detection after ingestion of nandrolone precursor.

Med Sci Sports Exerc. 2009. Watson P, et al.2

Watson P, et al.

• unlisted anabolic and androgenic steroids found in dietary supplements

• adding just 2.5 mcg of 19-norandrostenedione to a creatine supplement (0.00005% contamination) resulted in a doping violation in some individuals

NSF Certified for Sport

NSF Certified for Sport

• NHL league wide mandate helps take care of contamination issues in the locker room

• Players are still going to buy their own supplements!

• Educate, educate, educate

• BUT...does it ensure efficacy?

Supplements Efficacy and examples

Vitamin D

Vitamin D

• steroid hormone

• by some estimates one billion people worldwide have vitamin D deficiency or insufficiency

• geographic location, sun exposure, skin colour, intestinal absorption issues and kidney disease affect vitamin D status

• serum concentration of 25(OH)D best indicator of vitamin D status

Vitamin D• emerging evidence to support a direct

impact on athletic performance via enhancement of skeletal muscle function3,4

• good evidence to support that vitamin D deficiency indirectly affects athletic performance via immunity5:

• higher number of athletes presenting with URTI in deficient group

• increased number of URTI symptoms and severity of symptoms in deficient group

Vitamin D profile in National Football League players.

Maroon JC et al. Am J Sports Med. 20156

• players who were released during the preseason because of either injury or poor performance had significantly lower vitamin D levels

Labs

• test serum concentration of 25(OH)D (not covered by OHIP in Ontario)

• severe deficiency < 12.5 nmol/L

• deficiency < 30 nmol/L

• inadequate 30-50 nmol/L

• adequate > 50 nmol/L

Optimal dose to increase serum 25 (OH)D levels

• Controversial!

• Close GL (2013) showed 8 weeks of 5000 IU vitamin D3 daily raised serum levels from baseline 29 nmol/L to 103 nmol/L4

• Assess for intestinal absorption issues and test and retest

Probiotics What are they?

“Live microorganisms that, when administered in adequate amounts, confer a health benefit on the

host.”

(FAO/WHO 2001)

Probiotics Why?

• the human intestinal microbiota is a complex ecosystem

• contributes to maturation of the immune system

• provides a direct barrier against pathogen colonization

• digestion of essential nutrients

• potential cognitive and mood enhancing benefits7

Probiotics Human or Cow?

• Human strains

• high survival rates through various stomach pH

• maximal intestinal tract exposure

• Cow strains

• weak adherence to epithelial cells

• yogurt with lactobacillus cultures is just great marketing

• patients may be able to maintain a healthy microbiome with fermented foods and yogurt cultures once replaced with human strains

Probiotics Human or Cow?

Probiotic Dosing

• research appropriate strain(s) for individual situation

• probiotic activity must be guaranteed throughout production process, storage period and shelf life

• best refrigerated

The Cambridge Probiotic/Antibiotic Trial

• significant reductions of potentially harmful bacteria (coliforms, enterocci and S. aureus)

• minimized loss of lactobacilli bacteria

• significant reduction in antibiotic resistance

• 21 days of 100 billion CFU per dose

Conclusion

• It takes a village...

1. Newmaster SG et al. DNA Barcoding detects contamination and substitution in North American herbal products. BMC Med 2013 Oct 11:11-222. 2.Watson P et al. Urinary nandrolone metabolite detection after ingestion of nandrolone precursor. Med Sci Sports Exerc 2009 Apr; 41(4): 766-72. 3. Todd JJ et al. Vitamin D: recent advances and implications for athletes. Sports Med 2015 Feb; 45(2): 213-29.4. Close GL et al. Assessment of vitamin D concentration in non-supplemented professional athletes and healthy adults during the winter months in the UK: implications for skeletal muscle function. J Sports Sci 2013; 31(4):344-53.5. He CS et al. Influence of vitamin D status on respiratory infection incidence and immune function during 4 months of winter training in endurance sport athletes. Exerc Immunol Rev 2013;19:86-101.6. Maroon JC et al. Vitamin D profile in National Football League players. Am J Sports Med 2015 May;43(5):1241-5.

References

References7. Owen L el al. A double blind, placebo controlled, randomized pilot trial

examining the effects of probiotic administration on mood and cognitive function. Proceedings of the Nutrition Society 2014, 73 (OCE1), E29

8. Plummer NT et al. Effect of probiotics on preventing disruption of the intestinal microflora following antibiotic therapy: A double-blind, placebo-controlled pilot study. International Immunopharmacology 5 2005: 1091-1097.

9. Shuler FD et al. Sports health benefits of vitamin D. Sports Health 2012 Nov; 4(6):496-501.

10. Ogan D et al. Vitamin D and the athlete: risks, recommendations and benefits. Nutrients 2013 Jun 5(6):1856-1868.

11. Tsiaras WG et al. Factors influencing vitamin D status. Acta Derm Venereol 2011 Mar;91(2):115-24.

12. Close GL et al. The effects of vitamin D(3) supplementation on serum total 25(OH) D concentration and physical performance: a randomized dose response study. Br J Sports Med 2013 Jul; 47(11):692-6.

References

13. Pyne DB et al. Probiotics supplementation for athletes - clinical and physiological effects. Eur J Sports Sci 2015; 15(1):63-72.

14. Haywood BA et al. Probiotic supplementation reduces the duration and incidence of infection but not severity in elite rugby union players. J Sci Med Sport 2014 Jul; 17(4):356-60.

15. Hao Q et al. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev 2015 Feb 3;2.

Thank you!

ashley@therunnersacademy.com