Sports Nutrition: Supplements and Diabetes
Today's athletes, young and old, are always looking for that extra edge to provide the difference between winning and losing. A term used in nutritional supplementation is ergogenic aid, which in the sports world is proposed to enhance performance. Famous athletes can fall prey to illegal supplementation (i.e., anabolic steroids) such as the host of baseball players chastised by the media in the summer of 2005. Supplements have been around for many years and athletes are often at a loss deciding whether to take supplements to improve performance or rely on a healthy diet. Knowing the health risk of supplements becomes more important when the athlete has diabetes. Unfortunately, there are not a lot of controlled studies on the effectiveness and/or risk of supplements and next to nothing as it pertains to an athlete with diabetes.
What information there is usually comes from the companies that manufacture the supplements and it typically highlights only the positive aspects rather than the risks associated with its use. It is easy to find a local store at the mall touting all the benefits of supplements, or search the Internet for the latest supplement to increase strength, speed or endurance. The media can influence young athletes easily by building up the stature of professional sports stars and just as quickly tearing them down when illegal use of supplements tarnishes their image.
A study conducted by Pediatrics in 2005 polled more than 10,000 girls and boys ages 12 to 18 and found that 8% of girls and 12% of boys used some form of supplement in an effort to become more buff. Boys were more often looking to gain weight through muscle mass while girls wanted to trim fat through supplementation. Boys were just about three times more likely to use supplements weekly to gain muscle mass. According to a study shown in Pediatrics in 2001 on creatine use among young athletes, creatine is a nutritional supplement that is purported to be a safe ergogenic aid in adults. Although as many as 28% of collegiate athletes admit taking creatine, there is little information about creatine use or potential health risk in children and adolescents.
The problem with many supplements is that they are not regulated sufficiently. The Food and Drug Administration (FDA) does not oversee the manufacturing, distribution, and usage of most supplements on the market today because they are not considered a drug. This article will discuss a few common supplements, illegal and legal, used by athletes and their affect on diabetes.
Supplement manufacturers claim in their literature to provide athletes with increased muscle mass, faster recovery, reduced fatigue, increased endurance, and less body fat. Some supplements are considered unsafe and are banned by many athletic organizations such as the National Collegiate Athletic Association (NCAA) or the International Olympic Committee (IOC). Listed below are three common supplements used by athletes today. The first, anabolic steroids, is condemned by all athletic organizations but it still is a problem with young athletes looking to get a leg up on the competition. Perhaps its increase use is to gain a college scholarship or even increase the chances of landing a professional contract.
In the 1930s, scientists discovered that anabolic steroids could assist in the growth of skeletal muscle in animals. This led to the use of synthetic compounds first by bodybuilders and weightlifters and then by athletes in other sports. Steroids are similar to the male hormone testosterone. Testosterone is produced naturally in males and in lesser amounts in females. Before steroids were studied by researchers their potential benefits and risks were unknown. They were claimed to not provide any benefit for athletes and may or may not cause health problems. Since then it has been well documented that significant gains in muscle size and strength occur but with the added risk of heart disease, liver problems, acne, and personality change (i.e., "roid rage"). Most information on the long-term effects of steroids comes from case reports rather than formal studies. Although, all major sports organizations have recognized their negative impact on individuals taking steroids and banned its use, many young athletes feel they are invincible and choose not to be concerned with the risk factors.
With approximately 80% of people with diabetes dying of a heart attack or stroke it seems silly to add steroid use, which increases the risk of heart disease. Many athletes feel invincible to these risk factors instead see fame and fortune with increased strength enabling them to perform better.
Protein (Amino Acid) Supplements
Another common ergogenic aid in the form of nutritional supplementation is protein. Amino acids are building blocks of protein. Some are synthesized in the body and called non-essential amino acids while others are needed in the diet and are called essential amino acids. Since there are 21 of these amino acids, the information on the benefits and risks become very confusing. Many athletes feel protein is the main ingredient needed for strength training. Protein shakes are common supplements used by strength athletes. If used appropriately they can fit into a healthy sports diet. It is true that athletes who are involved in strength training may need some extra protein but in reality, they already get enough through their diet. The average person needs .8 g protein/kg of body weight/day whereas an athlete may need to consume up to 2 g of protein/kg of body weight/day.
It is not just consuming protein that will add muscle mass and strength. It needs to be combined with strength training. In addition, it is probably more important to have carbohydrates on board rather than protein to give the body energy to perform in the weight room. Carbohydrates are the main fuel used during a single bout of strength training.
The concern with an athlete with diabetes is the stress on the kidneys over the long haul. It is common practice for individuals with known kidney disease to decrease the amount of protein in their diet to .6 g of protein/kg of body weight/day. Any excess protein ingested will be stored as fat or secreted through the urine. Even though there is not scientific data to show athletes are at risk with added protein in their diet, the medical community would rather be more conservative regarding the consumption of protein. Most young athletes have not had diabetes long enough to present with kidney disease so the question becomes is their diet high in protein increasing the risk later in life.
Creatine has probably become the most popular nutritional supplement used by athletes to increase muscle strength and size in conjunction with strength training. Creatine is a natural substance produced from the amino acids argine, glycine, and methionine. It is also found in high concentrations in many foods such as red meat. Some research has shown that creatine may assist the removal of glucose from the blood and decrease the production of glucose from the liver. With high intensity activity, depletion of creatine is associated with fatigue. The literature shows with increased creatine levels fatigue is delayed, recovery is faster, and performance is improved in individual bouts of exercise in a laboratory setting.
An athlete with diabetes taking creatine along with carbohydrates may need insulin adjustment. This is due to the insulin's heightened effect on the transfer of creatine into the muscles. There is also a concern with added stress to the kidneys with creatine use and dehydration, which can negatively effect sports performance.
One of the main problems with taking supplements as mentioned above is that they are not adequately regulated and when used in combination with other supplements there is virtual no way to determine the increased risk. Many athletes think incorrectly if 10 grams of a supplement is beneficial than 20 grams would be twice as effective. This thinking has led to mega dosing of supplements with no long-term data to support or refute their use.
Young athletes see sports personalities like Bill Romanowski, who played 16 years of professional football, admitting steroid use and spending in excess of $200,000 per year in supplements and doctor visits as being invincible. Only time will tell if his abuse of these supplements will take it toll on his heart, liver or kidneys.
For athletes taking insulin many of the supplements may increase their sensitivity to insulin as well as added stress to vital organs already at risk just from having diabetes. For that reason, it is imperative to discuss any use of supplements with the healthcare team. A better plan to follow may be to concentrate on a healthy diet in order to fuel the body for strength training which in turn improves sports performance.
- Chetlin, R., and Hornsby, G., 2002. Strength Training and Nutritional Supplements. Handbook of Exercise in Diabetes.
- Metzl, J., Small, E., Levine, S., and Gershel, J., 2001. Creatine Use Among Young Athletes. Pediatrics
[PubMed Abstract, Full Text HTML, Full Text PDF]
For More Information
- Creatine from Wikipedia
- Creatine Supplementation from Quackwatch
- Creatine Supplements from the American Academy of Orthopaedic Surgeons
Rick Philbin, MBA, M.Ed., ATC
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Last Updated: Friday September 07, 2012 11:16:08
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