Bryan Kegans MS CSCS, PES, CES Director of Strength and Conditioning Kyle Keese Strength and Conditioning Guyer Nutrition

Macronutrients Carbohydrates Lipids Protein Roles of Macronutrients:  Provide energy  Maintain structure  Provide functional integrity

Carbohydrates  Primary energy Source (especially during high intensity exercise or competition)  Adequate carbohydrate intake preserves tissue proteins.  Metabolic primer  Fuel for the central nervous system (CNS) and red blood cells.

Importance of Fiber Retains considerable water and thus gives “bulk” to the food residues in the intestines Binds or dilutes harmful chemicals Shortens transit time for food residues to pass through the digestive tract Most Americans only consume g per day compared to the recommended 38 g for men & 25 g for women under 50 years

Carbohydrates Stored as Glycogen  Glucose is stored as glycogen in mammalian muscle and liver (glucogenesis)  Glycogenolysis is the reconversion process of glycogen to glucose; it provides a rapid extra muscular glucose supply.  A limited amount of glycogen can be stored  Approx 15g per kg body weight

Lipids  Provide energy  Protect vital organs  Provide insulation from the cold  Transport the fat-soluble vitamins A, D, E, and K

Bad Fats Trans Fatty acids-found in magarine, commercial baked goods, and deep-fried foods. Typically account for 30,000 deaths per year from heart disease(6). Trans Fatty acids may impair arterial wall flexibility and function(6). Women with high tissue levels of trans fatty acids are 40% more likely to develop breast cancer(6). 0 trans fat on food label doesn’t necessarily indicate the absence of trans fat because the government allows 0.5g to still be considered zero.

Good Fats Nonhydrogenated Monounsaturated and Poly Unsaturated Fatty Acids. Consuming these fats can lower coronary risk below normal levels. OMEGA 3- Found in Shellfish, Salmon, Herring, Sardines, bluefish, mackeral, dark green leafy vegetables, flax, hemp, canola, soy, and walnut oils. One study stated that a reduction of 42% in heart attacks among men who ate 7oz or more of fish a week compared with men who did not eat fish(6).

Protein  Supplies amino acids for a variety of metabolic processes  Proteins, especially those in nervous and connective tissue, generally do not participate in energy metabolism.  Protein catabolism accounts for 2-5% of the body’s total energy requirements  However, the amino acid alanine plays a key role in providing carbohydrate fuel via gluconeogenesis during prolonged exercise.

Protein Protein catabolism accelerates during exercise as carbohydrate reserves deplete. Athletes who train vigorously must maintain optimal levels of muscle and liver glycogen to minimize lean tissue loss and deterioration in performance. Regular exercise training enhances the liver’s capacity to synthesize glucose from the carbon skeletons of non-carbohydrate compounds.

Bio-energenics A “very” brief explanation Depending on type of Exercise or Competition the body will use energy in three different ways. Understanding the three pathways for ATP creation is vital for proper sport preparation and exercise.

Fuel and the Intensity Continuum  For all-out, short-duration efforts the intramuscular stores of ATP and PCr provide the required energy for exercise (anaerobic metabolism).  Examples: 100-m dash; Lifting heavy weights  For intense exercise of 1 to 2 minutes duration, glycolysis provides the energy.  For top performance in all-out 2-minute exercise, a person must possess a well-developed capacity for both aerobic and anaerobic metabolism.

Fuel and the Intensity Continuum  When exercise progresses beyond several minutes, the aerobic system predominates with oxygen uptake capacity becoming the important factor.  **Energy systems do not act independently of one another but rather overlap and work together to supply the body with the energy needed

Energy System Breakdown

Sources of Energy for ATP Synthesis  Liver and muscle glycogen  Triacylglycerols within adipose tissue and active muscle  Amino acids within skeletal muscle donate carbon skeletons

Athlete Nutrient Recommendations An Optimal Diet  Supplies required nutrients in adequate amounts for tissue maintenance, repair, and growth without excess energy intake  Proper nutrition helps:  Improve athletic performance  Optimize programs of physical conditioning  Improve recovery from fatigue  Avoid injury

Pounds to Kilograms 1lb = lb Athlete * = 91kg

Recommendations Carbohydrates The NSCA recommends for Aerobic Athletes 8-10g/kg of Body Weight Anaerobic Athletes 5-6g/kg of Body Weight

Recommendations Carbohydrates 135lb Aerobic Athlete * = 61kg 61 * 8 = 488g of Carbohydrate per day 180lb Anaerobic Athlete * = 82kg 82 * 8 = 656g of Carbohydrate per day

Why So Many Carbs? Lima-Silva et al, 2011 Compared time to exhaustion in a high carbohydrate group (CHO) 80% of diet and a low carbohydrate group (LCHO) 10% of diet. Time to exhaustion in LCHO was significantly lower than the CHO. Gleeson, Greenhaff, & Maughan, 1988 Showed that a 24 h fast is detrimental to cycling performance at an intensity of 100% Vo 2 max: the mean endurance time (212±27 s) was lower when exercise was performed 24 h after the last meal than when the same meal was eaten 4 h before exercise (243±17 s). Maughan & Poole 1981 A similar loss of performance was seen when a low-carbohydrate diet was substituted for the normal mixed diet: exercise time at 104% of Vo 2 max was reduced from 4.87 min on a mixed diet to 3.32 min on a low-carbohydrate (3% CHO) diet. Greenhaff et al 1987 Reported that time to fatigue at 100% of Vo 2 max was reduced from 5.13 to 3.68 min after 3 days on a low-carbohydrate (10% CHO) diet.

Why So Many Carbs?

Glycemic Index  Carbohydrates differ in their rate of digestion and absorption.  The glycemic index provides a measure of how quickly these processes occur.

Use of Glycemic Index in Sports  Ingesting low-glycemic food is recommended in the immediate pre-exercise period provides a steady supply of slow release glucose from the intestinal tract during exercise.  Post-exercise meals should include high- glycemic foods in order to maximize glycogen replenishment

Glycemic Index

Carbohydrate Absorption Rate

Protein Recommendations  The RDA = 0.8 g per kilogram body mass represents a liberal requirement believed to be adequate for all people.  Dependent on the athlete, increases in protein may be require  General Public:.8g/kg body weight  Endurance athletes: g/kg body weight  Strength/power athletes: g/kg body weight  Vegetarians & adolescents should increase these values by 10%

Protein Research Kerksick et al, 2006 Showed that after 10 weeks of 4 day split resistance training program subjects that ingested a combination of Whey Protein and Casein protein had the greatest increases in fat-free mass as compared with whey protein coupled with BCAAs and L-Glutamine.

Protein Research

Is more protein really needed?  Both resistance training & endurance training “break down” protein (protein catabolism)  However, recent research has found that exercise may not necessitate increased protein consumption because training enhances our ability to preserve protein  Protein catabolism is greatest when carbohydrate stores are low  Thus, eating a high-carbohydrate diet (with adequate energy intake) conserves muscle protein in individuals who engage in hard training.

General Recommendation on Protein Supplementation Protein Supplementation can become extremely complicated. Therefore A serving of whey protein before and after training. A serving of Casein Protein at night before going to bed.

Fat Intake  The general recommendation is to not exceed 30% of daily calories from lipids.  Of this amount, most should be unsaturated fatty acids.  Research has shown a decrease in endurance performance in individuals’ who consume 20% or less calories from fat  Low-diets (<20%) may not allow for an athlete to ingest enough calories to maintain body weight & muscle mass

Fat a Human’s Friend Fat makes the human body the ultimate endurance machine. You can live up to 4 to 6 weeks without food. Why? Fat Stores!

The Energy Balance Equation  3500 extra kCal = 1 pound  If total food calories exceed daily energy expenditure, excess calories accumulate as fat in adipose tissue.  Goal: Energy intake = energy output

Understanding Serving Size

When and How EAT 6-7 TIMES A DAY It will speed up your metabolism, helps you become leaner. It will build muscle faster. It will increase your energy for workouts. It will help you get all the nutrients you need for everyday.

COMMON MISTAKES Skipping breakfast- body will go into starvation response- store food as fat for survival later. Lifting on an empty stomach. Drinking too many protein shakes- the body will take whatever it needs, and the rest will be excreted or stored as fat. Eating fried foods- saturated fats = a non lean body. Not eating until you feel hungry- eat every 3 hours. Not timing your meals out after workouts. (30 min, 2 hours, etc..) Not staying properly hydrated. Carry around a gallon of water.

HOW TO ADD QUALITY CALORIES Add 2 spoons peanut butter to things like toast, bagels, waffles, oatmeal, crackers, shakes, etc. Add granola to cereal, trail mix, yogurt, oatmeal, ice cream Add avocado to salads, sandwiches, wraps, chips, crackers, dips Eat sandwiches on wheat buns, subs, or bagels instead of on bread or a thin wrap Choose high calorie cereals, energy bars, granola bars, yogurts, etc. Cook vegetables and meat in Extra Virgin Olive Oil Make shakes with high calorie shake powder & add things like peanut butter, honey, chocolate syrup, some ice cream, etc to it Add nuts to cereal, granola, trail mix, oatmeal, yogurt, parfaits, ice cream, salads & eat plain Drink 2% milk, low-fat chocolate milk and/or some juice with meals and snacks Eat a snack (as mentioned above) right before you go to bed, 7 days a week

NUTRIENT TIMING The timing of your meals is very important to help your body recovery and rebuild from workouts. Following workouts your body needs nutrients that will help it repair and recover. If you miss a meal, your body will not properly complete this process. Never come to a workout on an empty stomach. Your body needs energy to perform at its best level. A missed meal may not affect you tomorrow, but may destroy your workout on Friday! 10, 2, 4 Rule: Dr. Pepper. Perfect time for a snack.

NUTRIENT TIMING WINDOWS ACTIVITYMEAL DESCRIPTIONEXAMPLES PRE 7 AM LIFT (1 Hr Before Lift) SnackWhole grains, H20, Supplement, Fruit POST 7 AM LIFT (30 Min Post Lift Quick Recovery 4:1 Carbs to Protein Chocolate Milk, Whey Protein, Gatorade Breakfast (2 Hr Post Lift) Well Balanced BreakfastWhole Grain, Lean Meat, Fruit, Milk SNACKAdditional Recovery Hunger Prevention H20, Calorie Replacement, PB & J, Smoothie LUNCH Well Balanced MealLean Meat, Veggies, Fruit, Whole Grains. PRE 4 TH BLOCK (1 Hr Before 4 th Block) SnackGranola Bar, PB & J, Fruit, H20 POST 4 TH BLOCK (30 Min Post Lift) Quick Recovery 4:1 Carbs to Protein Chocolate Milk, Whey Protein, Gatorade DINNERMost Nutritious Meal More Protein than Carbs Lean Meat, Veggies, Fruit, Whole Grains. BEFORE BEDSlow RecoveryCasein Protein Supplement

POST WORKOUT RECOVER Chocolate Milk Nutrition Facts Serving Size: 8 oz Amount per Serving Calories 170 Calories from Fat 25 % Daily Value * Total Fat 2.5g 4% Saturated Fat 1.5g 8% Trans Fat 0g Cholesterol 5mg 2% Sodium 260mg 11% Total Carbohydrate 28g 9% Dietary Fiber 0g 0% Sugars 27g Protein 8g 16% Vitamin A10% Vitamin C 0% Est. Percent of Calories from: Fat 13.2% Carbs 65.9% Protein 18.8% The Perfect Post Workout Should Consist of: g Carbohydrates Carbs replenish muscle glycogen levels from glycogen depleting exercise g Protein Protein is main ingredient in muscle tissue repair. 16 oz glass of 1% Low Fat Chocolate Milk 4:1 Ratio Carbs to Protein 340 Calories 56 g Carbs 16 g Protein

HEALTHY FAST FOOD CHOICES Try to limit to one meal a week, 1 cheat weekend = 6 day set back Good Choices Drink water over sodas- additional bad calories Make careful menu selections – pay attention to the descriptions on the menu. Order dressing on the side. Ask for fresh fruit instead of fries. Look for leaner meats. Don’t order “the works”. Ask for the restaurant for a nutritional data menu. What to AVOID!!! Dishes labeled deep-fried, pan-fried, basted, batter-dipped, breaded, creamy, crispy, scalloped, Alfredo, au gratin or in cream sauce are usually high in calories, unhealthy fats or sodium. Order items with more vegetables and choose leaner meats. Fating dressings and condiments Filling up on appetizers- bread, chips, bread sticks, etc….all empty calories. Salt- high in sodium, which leads to high blood pressure. Bacon- try pickles, lettuce, jalapeños, tomatoes. Buffets- even salad buffets. You will likely over eat to get your moneys worth.

Special Considerations for Female Athletes Osteoporosis-starts at early age 85% of teenage females are consuming inadequate amounts of calcium. 29 gallons of milk versus 49 gallons of soft drinks. Osteoporosis affects 28 million Americans of whom 80 to 90% are women. Osteoporosis is a progressive disease. Nearly 90% of bone mass accumulates by age 17.

The Female Triad Women who train intensely and emphasize weight loss often engage in disordered eating behaviors. This further decreases energy availability, reducing body fat to a point at which significant alterations occur in secretion of the pituitary gonadotropic hormones. Resulting in Amenorrhea-the cessation of monthly menstrual cycles for at least three consecutive months after establishing regular cycles. Cessation of menstrual cycle removes estrogen’s protective effect on bone making calcium loss more prevalent. The combination of disordered eating and amenorrhea can lead to osteoporosis which completes the female triad.

Risk Factors for Disordered Eating 1.Pressure to optimize and/or modify appearance. 2.Psychological factors-low self-esteem, poor coping skills, perceived loss of control, perfectionism, obsessive-compulsive traits, depression, anxiety, and history of abuse. 3.Underlying chronic diseases related to caloric use. 4.Preoccupation with appearance in revealing uniforms.

Shopping For Lean Proteins Bass Clams Flounder Halibut Mackerel Salmon Snapper Turkey Catfish Cod Game Meats Haddock Perch Shrimp Swordfish Tuna (fresh or canned in water) Chicken Egg Whites Grouper Lean Beef Pike Soy Beans Trout

Fibrous Carbohydrates & Vegetables Alfalfa Sprouts Bean, green, yellow, wax Broccoli Carrots Collard Greens Endive Lettuce, romaine, red lead Onions Radishes Tomatoes Turnip Greens Zucchini Asparagus Beet greens Brussels Sprouts Cauliflower Cucumbers Kale Mushrooms Peppers Spinach Tomato Juice Vegetable Juice Bamboo Shoots Broccoflower Cabbage Celery Eggplant Leeks Mustard Greens Pimentos Summer Squash Turnips Watercress

Complex Carbs Apples Berries Bread-100% whole wheat Buckwheat Green beans Nuts Potatoes Root vegetables Spelt Wheat Beans Barley Black-eyed-peas Cabbage Leafy Greens Oats Pumpkin Rye Squash Wheat Germ Beets Bran Broccoli Corn Lentils Pears Rice, brown, wild, puffed Shredded Wheat Sweet Potatoes Yams

Low Sugar Fruits Blackberries Cranberries Green Pears Strawberries Blueberries Granny Smith Apples Kiwi Fruit Boysenberries Green Apples Raspberries black

Fat Canola Oil Safflower oil Sunflower seed oil Evening primrose oil Salmon oil Flax seed oil Soybean oil

Tracking Nutrient Intake

Supplements Creatine Creatine Monohydrate is an ergogenic aid most frequently used in our society for muscle building. Creatine and creatine phosphate are natural nutrients essential for muscle contraction that are found in the skeletal muscles. Most of the creatine we require comes from foods such as meat, poultry and fish, but when dietary consumption is not providing adequate amounts, creatine can be synthesized from amino acids. Creatine is necessary to maintain the ATP necessary for muscle contraction and also minimizes lactic acid production which can allow one to train harder and longer. Most studies observed increases in muscle mass and performance with creatine supplementation. This hypertrophy could be due to the supplements ability to increase performance and volume in training. Creatine may not be as recommended for more endurance type sports due to the fact that increased muscle mass may hinder performance. Creatine supplementation therefore, is more beneficial to bodybuilders, wrestlers, football players and baskeball players who benefit from the weight gain that corresponds with increased muscle mass.

Taking Creatine It is recommended to cycle creatine supplementation by supplementing with it for 3 months and then stopping for 3 weeks and repeating the process. One teaspoon within 2 hours of a workout or anytime during rest days taken with a glass of juice is the recommended intake. One should not consume more than grams per day. The most observed side effect from creatine is water retention. Creatine has not been proven unsafe and can be a recommended supplement if increases in muscular hypertrophy or performance in anaerobic sport are the main goal.

Nitric Oxide The products available over the counter are amino acid combinations that boosts or enhances the production of nitric oxide in the body (L-arginine hydrochloride, L-arginine alpha-ketogluterate and L-arginine ketoisocaproate). Currently, there are no pure nitric oxide supplements in production. The closest molecule that is synthesized for production is 2-[nitrooxy]ethyl 2-amino-3-methylbutanoate (Bloomer et al., 2010). This is marketed as the "real nitric oxide" as opposed to a nitric oxide precursor. Chiseled Look, Pumped up muscles, builds muscle, greater weightlifting capacities, better blood flow, improved sports performance. L-arginine hydrochloride, L-arginine alpha-ketogluterate and L-arginine ketoisocaproate. Also supplemented with grade-seed extract, L-ornithine, L-carnitine. Cost can range from $ $69.99 per month. No improvements in VO2max (Sutherland et al., 2010). Improved 1RM bench press (Sutherland et al., 2010). Improved power output. 1.5g and 3g of arginine with grape-seed supplement. (Camic et al., 2010) Increased GH in blood with arginine and ornithine (6g, 4.4g) after heavy resistance training, which can lead to better recovery and possible increased muscle mass (Zajac et al., 2010). No increased nitrate/nitrite in blood after supplementing 2-[nitrooxy]ethyl 2-amino-3-methylbutanoate (Bloomer et al., 2010). L-arginine used to treat hypertension, renal failure, heart disease. Side Effects- Abdominal pain, bloating, diarrhea, gout, blood abnormalities, allergies, airway inflammation, worsening of asthma, and low blood pressure (MedlinePlus, 2010).

BCAA Amino acids are the building blocks of protein molecules. Of the twenty amino acids required by the human body, eight are considered essential amino acids because they cannot be synthesized in the body, and must be acquired from foods. The remaining non-essential amino acids are so named because they are manufactured in the body, and do not have to be ingested. They play an important role in the promotion of protein synthesis and the inhibition of protein degradation, with leucine being the most powerful stimulator of these processes (1, 2, 5). BCAAs account for 35-40% of the dietary essential amino acids in body protein and 14-18% of the total amino acids in muscle proteins (1). Many supplement companies imply that branched chain amino acids are a vital component to the nutritional strategy of all bodybuilders, serious athletes, or anyone interested in increasing strength and muscle mass. BCAA supplements are said to: Help promote muscle recovery from sports activities. Maintain optimal performance during exercise. Support the liver under times of stressful function. Support muscle tissue from breakdown and maintains lean muscle mass. Exert an anti-catabolic hormonal effect, supporting healthy testosterone and cortisol levels when used in conjunction with high-intensity resistance training. Promote increases in muscle strength and size (11, 12).

Continued Oral BCAA supplementation has been shown to increase muscle protein synthesis to an even greater extent when coupled with resistance training (6, 4, 5). Sufficient BCAA availability increases testosterone levels and decreases cortisol and lactate levels (6, 3). BCAA supplementation has been shown to reduce exercise induced muscle damage, delayed onset muscle soreness (DOMS), and muscular fatigue (1, 7, 8). BCAAs promote recovery for several hours or even days after exercise (1, 2, 4, 8). BCAAs play a similar role in increasing performance in and aiding in recovery from endurance exercise as well (3, 9, 10). Research seems to confirm the efficacy of oral BCAA supplements. BCAA products can be found in tablet, powder, and liquid form, and prices range from $10 to $80 depending on the brand and the quantity (11, 12). BCAAs are quite safe amino acids when the three BCAAs are provided in a ratio similar to that of animal protein (e.g., a 2:1:1 leucine:isoleucine:valine ratio) (2).

Caffeine Caffeine is the one of the most utilized ergogenic aids in the world. Caffeine is found in a naturally occurring plant alkaloid which is known as methylxanthine (Keisler & Armsey, 2006) Classified as a stimulant because of its lack of nutritional value and its potential ergogenic effects. Caffeine is found in many common drinks such as coffee, tea, chocolate, sodas, energy drinks, candies, frozen dairy products, puddings, and over the counter drugs. It is consumed on a daily basis by the majority of adults in the world and “is currently the most wide spread and indiscriminately used drug available to consumers of all ages” (Jacobson & Kulling, 1989). The effect of caffeine consumption is thought to help improve mental readiness, alertness, and stimulate the central nervous system. (Sokmen et al, 2008). Caffeine is thought to have potential effects on endurance athletes. The claim is that caffeine is supposed to help athletes overcome fatigue and therefore be able to perform and continue with their sport for longer durations, it is also thought that caffeine is able to decrease perception of exertion (Jacobson & Kulling, 1989 & Keisler & Armsey 2006). Caffeine appears to work best in situations where exercise lasts more than an hour (Jacobson & Kulling, 1989).

Continued Research shows that caffeine can “increase heart rate and blood pressure, it can elevate systolic blood pressure, produce bronchial dilation and relaxation of pulmonary smooth muscles” (Rogers & Dinges, 2005 & Keisler & Armsey, 2006). Caffeine can cause tachycardia, increased in anxiety, increased drowsiness, decreased alertness, peptic ulcers, impaired hand steadiness, tremors, nervousness, irritability, insomnia, seizures, chronic muscle tension, and arrhythmias. Caffeine appears to have negative effects on ones coordination, movement time, as well as vision and ones tracking ability. Some research suggests that the use of caffeine can cause diuresis as well as dehydration; however there is conflicting research on this topic (Rogers & Dinges, 2005) Research conducted by Sokmen et al 2008 shows that caffeine leads to dehydration is a myth, and their research showed “In chronic consumers acute caffeine ingestion did not alter fluid-electrolyte and physiologic responses during exercise in heat when compared to a placebo” (Sokmen et al 2008). Caffeine reaches its peak at levels anywhere from minutes after consumption and it has a half-life ranging from 2-7 hours (Jacobson & Kulling, 1989 & Sokmen et al 2008) It has been shown that as little as 70 mg and as large as 800 mg have an effect on performance. *The NCAA and IOC have placed restrictions on the dosage of caffeine. “The maximum allowable level with urinary testing is approximately 800 mg” (Keisler & Armsey, 2006). That is equivalent to 6-8 cups of coffee in a period of 1-2 hours.

Erythropoietin Erythropoietin (EPO) is a glycoprotein hormone that is produced in the kidneys and functions to promote red blood cell production and initiate production of hemoglobin. The avialability of oxygen plays a critical role in aerobic performance to manufacture ATP for energy. Athletes had already been experimenting with blood doping to increase oxygen carrying capacity before rEPO thus, as expected, experimentation of rEPO began early on after its’ development (1985). Between professional European cyclists died from myocardial infarction, stroke and pulmonary embolism which coincided with rEPO availability. Due to the increase in hematocrit there is increase in blood viscosity which increases the risks of thrombotic events (stroke and myocardial infarction). EPO use has been banned by the International Olympic Committee, USA Olympic Committee, International Cycling Union and the National Collegiate Athletic Association. Drug screening has proved challenging due to the nature of rEPO being so similar to the naturally appearing EPO. Birkeland et al, 1999 showed 4 weeks of rEPO supplementation on healthy male athletes caused an increase of hematocrit from 42.7%- 50.8% and an increase in VO2 max by 7%. The increase in VO2 was sustained three weeks after the trial was stopped. Ekblom, B. & Berglund, B showed that seven weeks of rEPO increased run time to exhaustion in recreational runners by 17%. Heamtocrit levels increased by 6- 11%. rEPO use is effective, as effective as blood doping, with the advantage that it can be used during training and competition and the positive effects are rapid.

Ephedra Ephedra has been sold as a fat loss supplement. The product is marketed across a large range of consumer, from the overweight/obese patient needing to lose weight to improve overall health, to the elite athlete trying to lean out to maximize performance. Other forms of the supplement such as Pseudoephedrine are found in popular decongestant medications across the globe. (Calfee., et al. 2006) When combined with caffeine, ephedra has been shown to help reduce body fat, when combined with a low caloric diet. Previous FDA recommendations warned against taking Ephedra for longer than periods of 1 week, and exceeding 25mg daily. Legally banned in FDA statement on ban “presents an unreasonable risk of illness or injury under the conditions of use recommended or suggested in labeling.” (Diepvens K., et al. 2006) Ban overturned in 2006, doses must remain below 10mg/daily. Only proven benefits of ephedra have been shown when taken in dosages of at least 20mg/daily. That dosage has been shown to increase heart rate and blood pressure. (Vukovich, M., et al. 2005) Negative reactions from past studies include hypertension, arrhythmias, anxiety, tremors, insomnia, seizures, paranoid psychoses, cerebral vascular accident, myocardial infarction, and death. (Calfee., et al. 2006) Two deaths directly attributed to ephedra: 2001, 22 year old healthy male sustained cardiac arrest while taking ephedra product, and 15 year old female sustained fatal arrhythmia while taking same product. Currently banned by The International Olympic Committee, NCAA, Major League Baseball, National Basketball Association, and National Football League.( Calfee., et al. 2006) While the benefits of combining ephedra and caffeine have been proven, the adverse health effects associated with the combination outweigh any possible benefit, and have lead to the supplement being banned by most overseeing athletic agencies.

References 1.Birkeland, K., Stray- Gundersen, J., Hemmersbach, P., Hallen, J., Haug, E., & Bahr, R. (2000). Effect of rEPO administration on serum levels of sTfr and cycling performance. Medicine & Science in Sports & Exercise, Bloomer, R. J., Willimas, S. A., Canale, R. E., Farney, T. M., & Kabir, M. M. (2010). Actue effect of nitric oxide supplement on blood nitrate/nitrite and hemodynamic variables in resistance trained men. Journal of Strength and Conditioning Research, 24, Calfee R, Fadale P. (2006). Popular ergogenic drugs and supplements in young athletes. Pediatrics Mar;117(3):e Calfee RFadale P 4.Diepvens K, Westerterp KR, Westerterp-Plantenga MS.(2006) Obesity and thermogenesis related to the consumption of caffeine, ephedrine, capsaicin, and green tea.Am J Physiol Regul Integr Comp Physiol Jan;292(1):R Epub 2006 Jul 13.Obesity and thermogenesis related to the consumption of caffeine, ephedrine, capsaicin, and green tea. 5.Camic, C. L., Housh, T. J., Zungia, J. M., Hendrix, R. C., Mielke, M., Johnson, G. O., & Schmidt, R. J. (2010). Effects of arginine-based supplements on the physical working capacity at the fatigue threshold. Journal of Strength and Conditioning Research, 24, Ekblom, B., & Berglund, B. (1991). Effect of erythropoietin administration on maximal aerobic power. Scandinavian Journal of Medicine & Science in Sports, Elliot, S. (2008). Review: Erythropoiesis- stimulating agents and other methods to enhance oxygen transport. British Journal of Pharmacology, Forte RY, Precoma-Neto D, Chiminacio Neto N, Maia F, Faria-Neto JR. (2006) Myocardial infarction associated with the use of a dietary supplement rich in ephedrine in a young athlete. Arq Bras Cardiol Nov;87(5):e Forte RYPrecoma-Neto DChiminacio Neto NMaia FFaria-Neto JR 9. Gleeson, M, Greenhaff, P, & Maughan, R. (1988). Influence of a 24 h fast on high intensity cycle exercise performance in man. European Jrn of Applied Physiology & Occupational Physiology, 57(6), Greenhaff PL, Gleeson M, Maughan RJ. The effects of dietary manipulation on blood acid-base status and the performance of high intensity exercise. Eur J Appl Physiol Occup Physiol 1987;56:331–7 11.Joyner, M. (2003). VO2MAX, blood doping, and erythropoietin. Bristish Journal of Sports Medicine, Kerksick, C, Rasmussen, C, Lancaster, S, Magu, B, & Smith, P. (2006). The effects of protein and amino acid supplementation on performance and training adaptations during ten weeks of resistance training. Jrn of Strength and Conditioning Research, 20(3), Lima-Silva, A, F Pires, R Bertuzzi, F Lira, and D Casarina. "Low carbohydrate diet affects the oxygen uptake on-kinetics and rating of perceived exertion in high intensity exercise." Psychophysiology (2011): Maughan RJ, Poole DC. The effects of a glycogen-loading regimen on the capacity to perform anaerobic exercise. Eur J Appl Physiol Occup Physiol 1981;46:211– McArdle, W, Katch, F, & Katch, V. (2009). Sport and exercise nutrition. Baltimore, MD: Walter-Klower. 16.Parisotto, R., Gore, C., Hahn, A., Ashden, M., Olds, T., Martin, D., et al. (2000). Reticulocyte parameters as potential discriminators of recombinant human erythropoietin abuse in elite athletes. International Journal of Sports Medicine, Saris, W., Senden, J., & Brouns, F. (1998). What is a Normal Red- Blood Cell Mass for Professional Cyclists? Lancet, Scott, J., & Phillips, G. (2005). Erythropoietin in Sports: A New Look at An Old Problem. Current Sports Medicine Reports, Sutherland, K. L., Greer, F., & Morales, J. (2010). VO2max and ventilatory threshold of trained cyclists are not affected by 28-day L-arginine supplement. Journal of Strength and Conditioning Research, 0, Tokish, J., Kocher, M., & Hawkins, R. (2004). Ergogenic Aids: A Review of Basic Science, Performance, Side Effects, and Status in Sport. The American Journal of Sports Medicine, Voet, W. (1999). Massacre à la chaîne. Calmann-Lévy. 22.Vukovich, M., Schoorman, R., Heilman, C., Jacob III, P., & Benowitz, N. (2005). Caffeine–herbal ephedra combination increases resting energy expenditure, heart rate and blood pressure. Clinical & Experimental Pharmacology & Physiology, 32(1/2), Zajac, A., Poprezecki, S., Zebrowska, A., Chalimoniuk, M., & Lanfort, J. (2010). Arginine and ornithine supplementation increases growth hormone and insulin-like growth factor-1 serum levels after heavy-resistance exercise in strength-trained athletes. Journal of Strength and Conditioning Research, 24,

References 1.Shimomura, Y., et al. (2006). Nutraceutical effects of branched-chain amino acids on skeletal muscle. Journal of Nutrition 136(2):529S-532S.2. 2.Shimomura, Y., et al. (2004). Exercise promotes BCAA catabolism: effects of BCAA supplementation on skeletal muscle during exercise. Journal of Nutrition, 134(6 Suppl):1583S-1587S. 3.Matsumoto, K., et al. (2009). Branched-chain amino acid supplementation increases the lactate threshold during an incremental exercise test in trained individuals. Journal of Nutritional Science and Vitaminology (Tokyo), 55(1): Shimomura, Y., et al. (2009). Effects of squat exercise and branched-chain amino acid supplementation on plasma free amino acid concentrations in young women. Journal of Nutritional Science and Vitaminology (Tokyo), 55(3): Weitzel, L.R., et al. (2009). Performance-enhancing sports supplements: role in critical care. Critical Care Medicine, 37(10 Suppl):S Sharp, C.P.M., Pearson, D.R. (2010). Amino Acid Supplements and Recovery from High-Intensity Training. Journal of Strength and Conditioning Research, 24(4):1125– Jackman, S.R., et al. (2010). Branched-Chain Amino Acid Ingestion Can Ameliorate Soreness from Eccentric Exercise. Medicine and Science in Sports and Exercise, 42(5): 962– Shimomura, Y., et al. (2010). Branched-Chain Amino Acid Supplementation Before Squat Exercise and Delayed-Onset Muscle Soreness. International Journal of Sport Nutrition and Exercise Metabolism, 20(3): Balage, M., Dardevet, D. (2010). Long-term effects of leucine supplementation on body composition. Current Opinion in Clinical Nutrition and Metabolic Care, 13(3): Greer, B.K., et al. (2007). Branched-chain amino acid supplementation and indicators of muscle damage after endurance exercise. International Journal of Sport Nutrition and Exercise Metabolism, 17(6): GNC website: Retrieved on Nutrabio website: Retrieved on Jacobson, B.H., Kulling, F.A. (1989). Review: Health and ergogenic effects of caffeine. British Journal of Sports Medicine. 23(1) Keisler, B.D., Armsey, T.D. (2006). Caffeine as an ergogenic aid. Current Sports Medicine Reports. 5: Rogers. N.L., Dinges., D.F. (2005). Caffeine: Implications for Alertness in Athletes. Clinic in Sports Medicine. 24(2). 16.Sokmen, B., Armstrong, L.E., Kraemer, W.J., Casa, D.J., Dias, J.C., Juselson, D.A., Maresh, C.M. (2008). Caffeine use in sports: Consideration for the athlete. The Journal of Strength and Conditioning Research. 22(3)