Nutritional supplements: prevalence of use and contamination with doping agents

Polar licit and illicit ingredients in dietary supplements: chemometric optimization of extraction and HILIC-MS/MS analysis

Many dietary supplements claim the ability to enhance sports performance and to improve the fitness of the consumers. Occasionally, along with legal ingredients, illicit compounds may be added without being labelled, leading to unintended doping. Hence, the aim of this study was to develop an analytical method to determine a set of 12 polar (logDpH=7 from -2.0 to +0.3) compounds including diuretics, stimulants, β2-agonists, methylxanthines, and sweeteners. Hydrophilic interaction liquid chromatography was chosen as separation strategy, coupled with tandem mass spectrometry. The instrumental method was optimized using a two-step design of experiments (DoE). Firstly, a Plackett-Burman (PB) DoE was performed to identify the more influencing variables affecting peak areas and chromatographic resolution among temperature, water percentage in the mobile phase, and flow rate, as well as type and concentration of buffers. Secondly, a D-optimal DoE was set, considering only the most significant variables from the PB-DoE results, achieving a deeper understanding of the retention mechanism. Sample processing by salt-assisted liquid-liquid extraction was studied through DoE as well, and the whole method showed recoveries in the range 40-107% and procedural precision ≤11% for all analytes. Finally, it was applied to real samples, in which the four methylxanthines and two artificial sweeteners were detected and quantified in the range of 0.02-192 mg g-1. These values were compared to the quantities declared on the DS labels, when possible. Furthermore, a sequence of MS/MS scans allowed detection of a signal in one of the samples, structurally similar to the β2-agonist clenbuterol.

Prevalence, attitudes, and practices of dietary supplements among middle-aged and older adults in Asir region, Saudi Arabia: A cross-sectional study

The objectives of this study were to 1) identify the prevalence of dietary supplements (DS) among middle-aged and older adults; 2) determine attitudes toward DS and patterns of DS usage among middle-aged and older adults; and 3) assess the association of sociodemographic, clinical, and lifestyle factors with DS attitudes and DS usage. A cross-sectional online survey was undertaken among middle-aged and older adults. Data were collected by an online self-administered pretested questionnaire used as a study tool and distributed to respondents via social media applications. The DS usage prevalence among 501 respondents was 50.7%, and 53.5% of participants reported a positive attitude toward DS. The positive attitudes and higher usage of dietary supplements were statistically significant in higher proportions among older adults compared to middle-aged individuals. Significantly lower proportion of middle aged (54.9%) reported taking DS daily compared to 59.9% of older adults. A significant difference in the type of DS among the two groups was found for Omega-3 (p<0.001), minerals (p = 0.004), proteins (p = 0.002), fibers (p = 0.002), phytonutrients (p = 0.007), and probiotics (p = 0.015), with a higher proportion of middle-aged respondents reporting their use compared to older adults. Dietary supplement usage is a prevalent phenomenon among older adults and the middle-aged population. However, some undesirable practices regarding their use still exist in the community. Thus, there is a need of focussed health education to enhance attitudes and improve practices regarding the use of DS.

Simultaneous Analysis and Efficient Separation of Anabolic Androgenic Steroids in Dietary Supplement by a Validated HPTLC Method

Background

Using sports supplements is common among athletes. The presence of anabolic steroids in sports supplements as a hormonal contaminant can increase production efficiency. Since anabolic steroids cause health problems and result in positive doping tests in athletes, it is important to investigate their presence in the supplement preparations consumed by athletes.

Objectives

This paper aims to simultaneously determine ten anabolic steroids by high-performance thin-layer chromatography (HPTLC) method in sports supplements.

Methods

Chromatographic analysis was conducted on glass silica gel 60F254 plates. The extracts loaded on silica gel plates are subjected to programed multiple development (PMD) to separate anabolic androgenic steroids (AASs). Densitometric scanning is carried out at the wavelength of 245 and 366nm. The method was validated according to the ICH guidelines.

Results

Spots at retardation factor (Rf) 0.72 (elution system 1), 0.4 (elution system 1), 0.29 (elution system 2), 0.25 (elution system 2), 0.1 (elution system 1), 0.65 (elution system 2), 0.59 (elution system 1), 0.44 (elution system 1), 0.8 (elution system 3), and 0.82 (elution system 3) values were recognized as 19-nor androstenedione, 19-nortestosterone, methyl testosterone, clostebol, stanozolol, trenbolone enanthate, oxymetholone, oxandrolone, testosterone enanthate, and nandrolone decanoate, respectively. The linear ranges were 25 - 250 μg/mL for oxymetholone, 7 - 50 μg/mL for 19-nor androstenedione, 19-nortestosterone, and oxandrolone, and 3 - 20 μg/mL for methyl testosterone, clostebol, stanozolol, trenbolone enanthate, testosterone enanthate, and nandrolone decanoate. The developed method is validated by acceptable precision (CV < 20%) and good accuracy (94% < R < 114%). The value of limit of detection (LOD) for all derivatives was in the range of 0.02 - 0.16 μg/spot (20-160 μg/g of supplement), while limit of quantitation (LOQ) was found to be in the range of 0.06 - 0.5 μg/spot (60 - 500 μg/g of supplement). Fifty sports supplement samples as real sample were collected and analyzed. None of the samples screened positive using the HPTLC method.

Conclusions

In the present study, the fast, cheap, and simple HPTLC method could be used for the multi-residue analysis of ten anabolic androgenic steroids in sports supplements.

Herbs as an Active Ingredient in Sport: Availability and Information on the Internet

The use of supplements containing herbal active ingredients in sport has increased in recent years. Their consumption is explained by the benefits they may provide and because their natural origin do not involve health complications, from the point of view of the consumers. The aim of this study is to analyze the availability of four supplements (caffeine, turmeric, ginseng, cannabidiol) on the internet and understand the nature of these websites. A descriptive, observational, and cross-sectional study design was used. A detailed search was carried out with specifically developed software. The searches and data evaluation took 10 days. The websites consulted correspond to those that sell supplements, or some sport websites in the case of the Spanish ones, whereas those in English belong to pharmacies, parapharmacies, or herbalists. It is concluded that the websites do not provide adequate information to ensure proper consumption and lack advice on the choices of supplements and their administration guidelines.

Prevalence and Attitudes Towards Using Protein Supplements Among Female Gym Users: An Online Survey

Background:

Protein supplements have become a widespread practice amongst athletes and gym users worldwide. However, studies on the use of protein supplements among female gym users in Saudi Arabia are lacking.

Objective:

The aim of this study was to investigate the prevalence of protein supplement usage among female gym users and their attitudes towards protein supplementation in Riyadh city, Saudi Arabia.

Methods:

In this cross-sectional study, 502 female gym users aged ≥18 years completed a structured, self-administered online questionnaire on the usage of protein supplementation. Socio- demographic information, anthropometry, health status, exercise frequency, attitudes and knowledge regarding protein supplements were obtained.

Results:

The overall prevalence rate of protein supplement use among the study respondents was 36.3%. There were significant associations between the use of protein supplements and educational level (p< 0.05), the duration of being a gym member (p< 0.05) and frequency of gym visits per week (p< 0.05). Whey protein was the predominantly used supplement (57.8%), and the reason attributed to the use of protein supplement was muscle building (53.9%). The main sources of information regarding protein supplement use included the internet (30.2%) followed by gym coaches (25.3%).

Conclusion:

Our findings demonstrated that a considerable number of females exercising in gyms use protein supplements, and most rely on unreliable sources for decision-making of protein supplements use. Nutritional education and consultations regarding protein supplement use are warranted.

Lead content in weight loss food supplements

Introduction: The control and prevention of lead exposure are widely discussed topics that seem to be current health concerns for the next decades. Ingestion of lead into the human body can cause toxicity which can be acute or chronic. Possible sources of lead exposure can be, among others, water, food, drugs, and food supplements. The lead content in drugs is a strictly controlled parameter worldwide. The different Pharmacopoeias (European, British, USA) provide information about the limits for lead in every drug substance and also about the tests that should be performed. Regulation of food supplements does not require obligatory analytical control. Often, these products are not monitored to ensure the quality. At the same time, during the last two decades, the global use of dietary supplements has increased manifold.

Aim: This study aimed to analyse the presence of lead in food supplements used for weight control.

Materials and methods: We have analysed 30 different samples of food supplements for lead content. These supplements are all sold as weight loss products. The method of analysis consists of determination the lead concentration in food supplements using inductively coupled plasma mass spectrometry.

Results: We found that 4 of the analysed samples provide a lead intake of between 2.339 and 2.88 μg per day. The lead content in the other 26 samples was not significant.

Conclusions: The regulation of food supplements is rather liberal and loose. Often the exact amount of the main ingredients is not properly labeled and the purity of these products is not controlled. Food supplements are used by consumers of different ages and with different medical conditions. Our recommendation is that the lead content should be obligatorily monitored and indicated on the label of every food supplement. This would be especially useful for the prevention and control of lead exposure worldwide.

Determination of Ecdysterone in Dietary Supplements and Spinach by Ultra-High-Performance Liquid Chromatography-Tandem Mass Spectrometry

Ecdysterone is a naturally occurring steroid hormone of the ecdysteroid class. This group is widely marketed to athletes in dietary supplements as a “natural anabolic agent”, advertised to increase strength and muscle mass during resistance training, reduce fatigue and ease recovery. The aim of the study was to develop and validate a straightforward approach for identifying ecdysterone in dietary supplements by means of ultra-high-performance liquid chromatography–tandem mass spectrometry (UHPLC-MS/MS). Furthermore, due to the fact that ecdysterone is one of the compounds naturally occurring in spinach, the fit-for-purpose method for extraction and identification of ecdysterone in spinach is proposed. The validity of the developed method was confirmed with the use of a reference standard and the limit of detection (LOD) for ecdysterone was established at 1 mg/g supplement. The presence of ecdysterone was confirmed in all tested supplements at estimated concentrations ranging between 5 mg/g and 383 mg/g.

Potential propensity of traditional herbal materials ingested by collegiate athletes in South China for their consuming health care

In south China, traditional herbal medicines have been widely used as functional foods or dietary supplements for daily health care. Many plant-derived chemical substances with biological activity are inadvertently ingested by collegiate athletes daily through canton-style herbal tea or herbal slow-cooked soup. In the view of the complexity of herbal ingredients, it is still no full survey reported for the sports risk of plant-derived sports doping. This research is firstly a descriptive statistical analysis. Collegiate athletes with different socio-economic characteristics from medical colleges in 3 different regions in China participated in the questionnaire survey. Three survey forms, including the oral interview, email inquiry, handing out and recovering the questionnaires in live, were developed and performed by researchers. It was first found that collegiate athletes resorted to some traditional herbal materials to protect their health care that there were regional differences (P < .01). Collegiate athletes with Health Fitness and Traditional Wushu as their sports expertise showed a higher frequency of recognition or ingestion in the use of traditional herbal materials (P < .01), while their different living types and cuisine preferences did not seem to be associated with the ingestion frequency of traditional herbal materials. In addition, in the view of the significant differences in the use of herbal preparations to relieve sports stress among young athletes in different regions (P < .01), the findings strongly suggested that athletes should strictly control their use of various herbal preparations during sports training and competition, including herbal wines, herbal oils, topical plasters, analgesic tablets.

Profiles for identifying problematic dietary habits in a sample of recreational Spanish cyclists and triathletes

There is a lack of sufficient information on the dietary intake and nutritional supplementation of recreational endurance athletes throughout the year. The present observational study sought to assess the dietary intake and nutritional supplementation habits of recreational cyclists and triathletes from Spain. 4,037 cyclists and triathletes completed self-report measures. Nutritional profiles were developed and differences were examined according to sporting discipline and gender. Differences between groups were compared using the Mann-Whitney U or chi-squared test. Next, micro- and macro-nutrients were grouped according to whether or not guideline intake amounts were met. The clustering of dietary habits was then examined via K-means cluster analysis. Triathletes took more supplements than cyclists (X2 = 36.489; p value = .000) and females took more supplements than males (X2 = 5.920; p value = .017). Females and triathletes reported greater protein and CHO consumption than males and cyclists, respectively. Triathletes also reported a higher consumption of total fat, MUFA, PUFA, EPA, DHA and fibre. Females and triathletes tended to consume more vitamins and minerals than males and cyclists, respectively. Two main dietary habit clusters emerged which may be used to inform nutritional interventions targeting recreational athletes not meeting nutritional requirements. There is an imbalance in the main nutrients making up the diet of recreational Spanish athletes, characterised by insufficient CHO and excessive protein.

Doping Knowledge, Attitude and Practice of Pharmacists in Dessie, Northeast Ethiopia

Background

Doping includes tampering, possession; trafficking; administration, assisting, encouraging, aiding, conspiring a prohibited substance, and an anti-doping rule violation. Doping in sports is increasing and diversifying involving physiological, mechanical, and pharmacological techniques and becoming a serious public health problem. Pharmacy professionals have a vital role in the fight against doping. This study assessed the knowledge, attitude, and practice of pharmacists on the use of doping agents by sportsmen and women.

Methods

A community-based cross-sectional descriptive study was done targeting community pharmacists of Dessie city, Northeast Ethiopia. Structured questionnaires were distributed and collected between April and March of 2018. Data were analyzed using SPSS version 20.0. Linear regression was used and the level of statistical significance was set at a p-value <0.05.

Results

Of the 61 pharmacy professionals who participated in the study, 46 (75.4%) were males and 15 (24.6%) were females. Only 25 (41.0%) and 13 (21.3%) of the respondents said they watch and play sport regularly, respectively. The majority of the participants, 50 (82%), supported the prohibition of performance-enhancing drugs in sport. The majority of the respondents, 55.7%, agree that pharmacists are a potential source of doping agents. Only 27.9% of them mentioned World Anti-doping Agency (WADA) as the source of information about doping agents. Regarding identifying the WADA status of 13 agents, the average score out of 13 was 4.95, while 80.3% of them scored less than or equal to seven. Factors associated with knowledge of participants were being male (β = 4.48, p= 0.02) and regularly watching sport (β = 2.64, p= 0.01).

Conclusion

Even though the pharmacists' low knowledge score revealed that they need further specialized training on doping and anti-doping, majority of them support banning doping substances from sport. Pharmacy curriculum developers should consider incorporating specific topics or courses about doping agents.

Risk Associated with the Use of Selected Ingredients in Food Supplements

This review focuses on four new product categories of food supplements: pre-workout, fat burner/thermogenic, brain/cognitive booster, and hormone/testosterone booster. Many food supplements have been shown to be contaminated with unauthorized substances. In some cases, the ingredients in the new categories of dietary supplements were medicinal products or new synthetic compounds added without performing clinical trials. Some of the new ingredients in dietary supplements are plant materials that are registered in the pharmacopoeia as herbal medicines. In other cases, dietary supplements may contain plant materials that have no history of human use and are often used as materials to 'camouflage' stimulants. In the European Union, new ingredients of dietary supplements, according to European Food Safety Authority or unauthorized novel food. Furthermore, selected ingredients in dietary supplements may be prohibited in sports and are recognized as doping agents by World Anti-Doping Agency.

Suplementos alimentares: uma fonte de doping não intencional?

Resumo O excessivo consumo de suplementos alimentares, aliado a uma legislação inespecífica e a um controle de qualidade ineficiente, faz com que a saúde dos consumidores seja colocada em risco devido à possível existência de contaminantes, em especial pró-hormônios, esteroides anabolizantes e estimulantes. Estes compostos podem proporcionar um aumento do desempenho esportivo e acarretar uma série de efeitos adversos, sendo assim proibidos pela Agência Mundial Antidopagem. A contaminação de suplementos pode ocorrer de maneira deliberada ou através de más práticas de produção, em que são encontrados traços dessas substâncias. Todavia, ambos os casos exigem atenção, já que uma contaminação de apenas 0,00005% em massa pode levar ao doping. Neste sentido, estima-se que de 6,4% a 8,8% dos casos estejam relacionados ao consumo de suplementos contaminados. Perante estes fatos, os objetivos principais do trabalho foram: fazer uma revisão da literatura tanto em trabalhos nacionais quanto internacionais, no que concerne à contaminação de suplementos alimentares e sua relação com a dopagem não intencional, bem como orientar os consumidores a escolherem produtos mais seguros. Neste sentido, foi possível observar que os suplementos nacionais são, geralmente, mais seguros quanto à presença de substâncias proibidas, principalmente em relação à contaminação por agentes anabolizantes. Contudo, ainda é preciso um melhor controle de qualidade perante a contaminação/adulteração por estimulantes.

Characterizing the Dynamic Taste and Retro-Nasal Aroma Properties of Oral Nutritional Supplements Using Temporal Dominance of Sensation and Temporal Check-All-That-Apply Methods

Orally Disintegrating Tablets (ODTs) are used to restore the nutritional status of people suffering from swallowing pathologies such as dysphagia. ODTs are consumed without water intake and are easily swallowed. The main active compounds of ODTs are vitamins and minerals. These nutrients can have a bad taste or aftertaste, which can be masked by sweetening or flavoring. To ensure the effectiveness of masking strategies and to prescribe a product to patients with acceptable sensory qualities, it is essential to perform a precise and complete sensory characterization of these ODTs. Temporal dominance of sensations (TDS) and temporal check-all-that-apply (TCATA) methods were chosen to characterize the temporal sensory perceptions during the consumption of four ODTs varying in galenic forms and flavoring because of their particularly acute temporality in flavor perception. The ODTs presented common and individual sensory properties, mainly related to their galenic form and to the nature of the active ingredients. The use of a nose-clip to stop retro-nasal airflow showed that flavoring had a minimal impact on the sensory taste qualities of the ODTs. A comparison between the TDS and TCATA results indicates that these tests are capable of providing complementary information on the dynamic sensory qualities of the products studied. Although results were generally similar for both methods, TDS showed a greater number of differences in sensory taste attribute, whereas TCATA was more discriminating. These methods allowed for a better understanding of the evolution of sensory perceptions of these ODTs during their consumption, which could help to optimize masking strategies and develop new products with acceptable sensory properties.

Dietary Supplement and Food Contaminations and Their Implications for Doping Controls

A narrative review with an overall aim of indicating the current state of knowledge and the relevance concerning food and supplement contamination and/or adulteration with doping agents and the respective implications for sports drug testing is presented. The identification of a doping agent (or its metabolite) in sports drug testing samples constitutes a violation of the anti-doping rules defined by the World Anti-Doping Agency. Reasons for such Adverse Analytical Findings (AAFs) include the intentional misuse of performance-enhancing/banned drugs; however, also the scenario of inadvertent administrations of doping agents was proven in the past, caused by, amongst others, the ingestion of contaminated dietary supplements, drugs, or food. Even though controversial positions concerning the effectiveness of dietary supplements in healthy subjects exist, they are frequently used by athletes, anticipating positive effects on health, recovery, and performance. However, most supplement users are unaware of the fact that the administration of such products can be associated with unforeseeable health risks and AAFs in sports. In particular anabolic androgenic steroids (AAS) and stimulants have been frequently found as undeclared ingredients of dietary supplements, either as a result of cross-contaminations due to substandard manufacturing practices and missing quality controls or an intentional admixture to increase the effectiveness of the preparations. Cross-contaminations were also found to affect therapeutic drug preparations. While the sensitivity of assays employed to test pharmaceuticals for impurities is in accordance with good manufacturing practice guidelines allowing to exclude any physiological effects, minute trace amounts of contaminating compounds can still result in positive doping tests. In addition, food was found to be a potential source of unintentional doping, the most prominent example being meat tainted with the anabolic agent clenbuterol. The athletes’ compliance with anti-doping rules is frequently tested by routine doping controls. Different measures including offers of topical information and education of the athletes as well as the maintenance of databases summarizing low- or high-risk supplements are important cornerstones in preventing unintentional anti-doping rule violations. Further, the collection of additional analytical data has been shown to allow for supporting result management processes.

Muscle building supplement use in Australian adolescent boys: relationships with body image, weight lifting, and sports engagement

Background

The extent and implications of muscle building protein supplement use among adolescents is relatively unknown. This study aimed to describe the prevalence of protein powder, creatine, and anabolic steroid use in a sample of 14–16 year-old boys in Australia, and the predictors of actual use, and intentions to use protein powder.

Methods

Data were obtained from questionnaires with Australian adolescent boys aged 14–16 years from one independent boy’s school in Melbourne (N = 237). Hierarchical linear and logistic regressions were used to determine the predictors of intentions, and actual use of protein powder.

Results

49.8% of boys reported current use of, and 62% intended to use protein powder; 8.4% used creatine, and 4.2% used anabolic steroids. Higher levels of drive for muscularity, participation in weight training, and playing a greater number of sports were significant predictors of higher current use and intentions to use protein powder, but age, BMI, body esteem, and ethnicity were not.

Conclusions

Prevalence of muscle building supplement use was relatively high among this adolescent population. This research has implications for intervention and prevention programs to educate young boys about muscle building supplements to reduce negative physical and psychological health effects of their use.

An investigation on the metabolic pathways of synthetic isoflavones by gas chromatography coupled to high accuracy mass spectrometry

RATIONALE

Isoflavones are a group of flavonoids that may be of interest in sport doping because they can be used by athletes in the recovery periods after the administration of anabolic steroids, with the aim of increasing the natural production of luteinizing hormone (LH) and, consequently, the biosynthesis of endogenous androgens.

METHODS

The in vivo metabolism of methoxyisoflavone (5-methyl-7-methoxyisoflavone) and ipriflavone (7-isopropoxyisoflavone), respectively present in a dietary supplement and in a pharmaceutical preparation, was investigated. The study was carried out by the analysis of urinary samples collected from male Caucasian subjects before, during and after the oral administration of methoxyisoflavone or ipriflavone. After enzymatic hydrolysis and liquid-liquid extraction, all urinary samples were analyzed by gas chromatography/quadrupole time-of-flight (qTOF MS system/qTOF) electron ionization mass spectrometry (EI-MS).

RESULTS

Eight metabolites of methoxyisoflavone and six metabolites of ipriflavone were isolated. The corresponding accurate mass spectra are specific for isoflavone structures and revealed also a retro-Diels-Alder fragmentation.

CONCLUSIONS

When excreted in large amounts, the urinary metabolites of methoxyisoflavone and ipriflavone can be traced to potential confounding factors in doping analysis. As methoxyisoflavone and ipriflavone have been shown to inhibit the enzyme aromatase, thus interfering with the normal metabolic pathways of testosterone, the detection of their intake, by screening for the presence of their main metabolites in urine, might be helpful in routine doping control analysis.

Taste Perception of Nutrients Found in Nutritional Supplements: A Review

Nutritional supplements are prescribed when one’s nutritional status is not conducive to good health. These foodstuffs constitute concentrated sources of nutrients such as vitamins, minerals, amino acids, and fatty acids. For nutritional supplements to be effective, patients must consume the amount that has been prescribed for the recommended period of time. Therefore, special attention must be given to the sensory attributes of these products. Indeed, the presence of active compounds can cause an off-taste or aftertaste. These negative sensations can lead to a reduction in the consumption of nutritional supplements and reduce the effectiveness of the treatment. In this manuscript, we provide an overview of the sensory characteristics and the sensing receptor mechanism of the main compounds present in oral nutritional supplements, such as amino acids, minerals, fatty acids, and vitamins. Part of this article is devoted to the development of new masking strategies and the corresponding potential influence at the industrial level.

Prevalence and patterns of dietary supplement use in elite Spanish athletes

BACKGROUND

Dietary supplementation is a common strategy to achieve a specific health status or performance benefit. Several investigations have focused on the prevalence of dietary supplement use by athletes. However, information on how athletes manage the use and purchase of dietary supplements is scarce.

METHODS

Five hundred and twenty-seven high-performance athletes (346 males and 181 females), participating in individual and team sports, completed a validated questionnaire about use and purchase patterns of dietary supplements. The dietary supplements were categorized according to the International Olympic Committee (IOC) consensus.

RESULTS

Sixty four percent of the athletes (n = 337) used dietary supplements (median = 3; range 1 to 12). Age, sex, type of sport, level of competition, and professionalism influenced the prevalence of dietary supplement use (all p < 0.05). The most prevalent dietary supplement consumed was proteins (41%; n = 137), followed by amino acids/BCAA-based supplements (37%; n = 124). Additionally, as per group of supplements according to IOC consensus, 18% of the supplements were rated as having a low level of scientific evidence (e.g., glutamine, HMB, L-carnitine, etc). Most athletes (45%, n = 152) purchased dietary supplements in a store and 24% (n = 81) obtained them from a sponsor. Most athletes also (42%, n = 141) reported a self-organization of supplementation and did not consult with any professional. Last, 81% (n = 273) of athletes consuming supplements did not know any platform to check supplement safety/quality. For those who do not use dietary supplements (36% of the total sample, n = 190), most reported that they do not consider supplements necessary (72%, n = 137).

CONCLUSION

Dietary supplementation appears to be widely used in sport with a considerable proportion of athletes consuming supplements with low level of scientific evidence. Additionally, athletes seem to rely on inadequate sources of information and may be largely unaware of sources to detect supplement contamination.

Understanding the Use of Dietary Supplements among Athlete and Non-Athlete University Students: Development and Validation of a Questionnaire

BACKGROUND

The purpose of this study is to develop and test the validity and reliability of a questionnaire to evaluate dietary supplement use based on the Theory of Planned Behaviour (TPB).

METHODS

The questionnaire has sections on demographics, physical activity, dietary supplements, and cognitive constructs based on the TPB. Three stages are followed. In Stage 1, elicitation interviews are conducted on five varsity athletes, five physically active non-athletes, and five physically inactive University of Guelph (UofG) students. In Stage 2, comments and ratings of the TPB-based statements are gathered from 10 subject matter experts to check for content validity. In Stage 3, Cronbach's α is calculated to determine the internal consistency of the cognitive constructs by a pilot test on 84 Applied Human Nutrition UofG students.

RESULTS

Interviews assisted in the formulation of the cognitive constructs' statements, including intentions, attitudes, injunctive norms, descriptive norms, and perceived behavioural control. Content validity ensured that these constructs did not overlap. Few statements from the cognitive constructs were omitted based on findings from the reliability test, achieving acceptable Cronbach's α values across all constructs (≥0.70).

CONCLUSIONS

This supplement use questionnaire will be used in a future study to investigate the use and determinants of dietary supplements among Canadian athlete and non-athlete UofG students.

Identification of the designer steroid Androsta-3,5-diene-7,17-dione in a dietary supplement

A liquid chromatography-mass spectrometry (LC-MS) screen for known anabolic-androgenic steroids in a dietary supplement product marketed for "performance enhancement" detected an unknown compound having steroid-like spectral characteristics. The compound was isolated using high performance liquid chromatography with ultraviolet detection (HPLC-UV) coupled with an analytical scale fraction collector. After the compound was isolated, it was then characterized using gas chromatography with simultaneous Fourier Transform infrared detection and mass spectrometry (GC-FT-IR-MS), liquid chromatography-high resolution accurate mass-mass spectrometry (LC-HRAM-MS) and nuclear magnetic resonance (NMR). The steroid had an accurate mass of m/z 285.1847 (error-0.57 ppm) for the protonated species [M + H]⁺ , corresponding to a molecular formula of C₁₉ H₂₄ O₂ . Based on the GC-FT-IR-MS data, NMR data, and accurate mass, the compound was identified as androsta-3,5-diene-7,17-dione. Although this is not the first reported identification of this designer steroid in a dietary supplement, the data provided adds information for identification of this compound not previously reported. This compound was subsequently detected in another dietary supplement product, which contained three additional active ingredients.

Effects of placebo on bench throw performance of Paralympic weightlifting athletes: a pilot study

BACKGROUND

The aim of the present study was to analyse the effects of placebo on bench throw performance in Paralympic weightlifting athletes.

METHODS

The study involved four Paralympic weightlifting male athletes (age: 40.25 ± 9.91 years, weight: 60.5 ± 8.29 kg, height: 1.60 ± 0.15 m) that visited the laboratory in three occasions, separated by 72 h. In the first session, the athletes were tested for bench press one repetition maximum (1RM). The other two sessions were performed in a randomized counter-balanced order and involved bench throw tests performed either after taking placebo while being informed that the capsule contained caffeine or without taking any substance (control). The bench throw tests were performed with loads corresponding to 50, 60, 70 and 80% of the bench press 1RM.

RESULTS

According to the results, mean velocity (∆: 0.08 m/s, ES 0.36, p < 0.05) and mean propulsive velocity (∆: 0.11 m/s, ES 0.49, p < 0.05) at 50% of 1RM were significantly higher during placebo than control (p < 0.05). However, there were no difference between control and placebo for 60, 70 and 80% of 1RM (p > 0.05).

CONCLUSION

Our results suggest that placebo intake, when the athletes were informed they were taking caffeine, might be an efficient strategy to improve the performance of explosive movements in Paralympic weightlifting athletes when using low-loads. This brings the possibility of using placebo in order to increase performance, which might reduce the risks associated with ergogenic aids, such as side-effects and positive doping testing.

Knowledge, attitude, and practices regarding dietary supplements in Saudi Arabia

Objective:

The study was aimed at determining the characteristics and lifestyle choices of dietary supplement users and to assess knowledge, attitude, and practice related to dietary supplements in the health sciences students versus other individuals in Saudi Arabia.

Methods:

A descriptive cross-sectional, online questionnaire-based study was conducted on 351 participants (138 were health sciences students and 203 were not). The results were documented and analyzed using SPSS- version 22.

Results:

More than half of the participants consumed dietary supplements, 53.6% of the health sciences students versus 56.3% of the other individuals. Multivitamins were the most commonly used supplement in all participants (49%). Both groups believed that people might need dietary supplements more during specific times as pregnancy or recovery from diseases, with higher percentage in health sciences students than other people (43% versus 38%). Most of the students were somewhat aware about the facts concerning dietary supplements compared to others. Significant difference (P ≤ 0.05) was found concerning opinion and beliefs related to dietary supplements between the two groups. However, the health sciences students were not highly knowledgeable about the facts regarding supplements.

Conclusion:

The users of dietary supplements tend to incorporate these products into their lifestyles as part of a broader focus on healthy living. Many of health sciences students do not have accurate information about dietary supplements. It is important to strengthen the health science curriculum concerning this topic, with the aim of producing better-informed future professionals.

Development of an extraction method for anabolic androgenic steroids in dietary supplements and analysis by gas chromatography-mass spectrometry: Application for doping-control

Several studies have highlighted that nutritional supplements may contain undeclared anabolic steroids that are banned by the International Olympic Committee/World Anti-Doping Agency. Any kind of abuse with these drugs is extremely dangerous because of their side effects. Thus, the control of food additives in order to protect the best consumer health and to limit fraudulent practices in the field of sports is essential. This paper describes a simple and effective qualitative gas chromatography-mass spectrometry (GC-MS) method to detect anabolic androgenic steroids (AAS): androsterone, nandrolene, dehydroepiandrosterone, 5ɑ-androstane-3β, 17β-diol, dihydrotestosterone, testosterone, methenolone acetate, methandienone, boldenone and fluoxymesterone, in food supplements. Methyltestosterone was used as internal standard. Target compounds were extracted with a mixture of N-pentane and di-ethylether (7.5:2.5, v/v). A good extraction recovery was obtained by our method for all the AAS (R > 88%). Crude extract was derivatized with N-methyl-N-trimethylsilyl-trifluoracetamide. Separation was performed on a GC connected to quadrupole MS detector using a 5% phenylmethylsiloxane fused silica capillary column (30 m × 0.25 mm i.d.; film thickness, 0.25 µm). Helium was used as carrier gas with a flow rate of 0.3 µl min^-1 (measured at 6.1 psi 190 °C). The MS was operated in electron ionization mode (70 eV) and in selected ion monitoring (SIM). The mass spectra of the standard compounds were acquired in full SCAN mode (50-700 m/z) by infusion of a reference solution at 50 µg/ml. Three higher diagnostic ions were monitored for each compound of interest. All AAS get separated with good peak shapes and resolution factor. The total analysis time by our optimised method was only 20 min. The developed method was validated according to Laboratories International Standard regulations for specificity, precision in both liquid and solid matrixes, and memory effect. The Tolerance Interval was judged true. The limit of detection was about 10 ng/g for solid samples and 10 ng/ml for liquid samples. The developed method was then applied to the research of steroids in nine Tunisian commercially dietary supplements using for each compound of interest SIM mode for screening then SCAN mode for confirmation. One of the monitoring samples was positive to methandienone not declared on the label. Our analytical method can be beneficial for AAS screening in dietary supplements.

The Effect of Pycnogenol Supplementation on Plasma C-Reactive Protein Concentration: a Systematic Review and Meta-Analysis

Pycnogenol is a standardized extract from the bark of the French maritime pine. The aim of the present systematic review and meta-analysis was to clarify the effect of Pycnogenol supplementation on C-reactive protein (CRP) concentration. To identify eligible studies in order to find clinical trials which examined the effect of Pycnogenol supplementation on the level of CRP in adult participants, PubMed, Scopus, and Google Scholar were systematically searched until December 2017. Mean of CRP was collected to estimate the effect size of the supplementation. Potential sources of heterogeneity were explored by subgroup analysis. Five trials including 324 participants were included in this meta-analysis. Pooled effect size showed significant effect of Pycnogenol supplementation on CRP (−1.22 mg/dL, 95% confidence interval, −2.43, −0.003; I² = 99%, p_{heterogeneity} < 0.001). When the meta-analysis was subgrouped by dose of Pycnogenol, heterogeneity was attenuated in > 150 mg/d category (I² = 0.0%, p = 0.42). There was significant difference between-subgroup heterogeneity (p < 0.001). Furthermore, no evidence of publication bias for CRP (p = 0.27, Begg's test and p = 0.62, Egger's test) was seen. Present systematic review and meta-analysis suggested Pycnogenol consumption can decrease the level of CRP and have anti-inflammatory effect. So, Pycnogenol as an anti-inflammatory agent might be a priority in interventions. Further studies with large-scale and better design are needed to confirm this result.

Intended or Unintended Doping? A Review of the Presence of Doping Substances in Dietary Supplements Used in Sports

Introduction: The use of dietary supplements is increasing among athletes, year after year. Related to the high rates of use, unintentional doping occurs. Unintentional doping refers to positive anti-doping tests due to the use of any supplement containing unlisted substances banned by anti-doping regulations and organizations, such as the World Anti-Doping Agency (WADA). The objective of this review is to summarize the presence of unlabeled doping substances in dietary supplements that are used in sports. Methodology: A review of substances/metabolites/markers banned by WADA in ergonutritional supplements was completed using PubMed. The inclusion criteria were studies published up until September 2017, which analyzed the content of substances, metabolites and markers banned by WADA. Results: 446 studies were identified, 23 of which fulfilled all the inclusion criteria. In most of the studies, the purpose was to identify doping substances in dietary supplements. Discussion: Substances prohibited by WADA were found in most of the supplements analyzed in this review. Some of them were prohormones and/or stimulants. With rates of contamination between 12 and 58%, non-intentional doping is a point to take into account before establishing a supplementation program. Athletes and coaches must be aware of the problems related to the use of any contaminated supplement and should pay special attention before choosing a supplement, informing themselves fully and confirming the guarantees offered by the supplement.

Potential harmful effects of dietary supplements in sports medicine

PURPOSE OF REVIEW

The purpose of this article is to collect the most recent data regarding the safety of well-known or emerging dietary supplements used by athletes.

RECENT FINDINGS

From January 2014 to April 2016, about 30 articles have been published in the field. New data show that 90% of sports supplements contain trace of estrogenic endocrine disruptors, with 25% of them having a higher estrogenic activity than acceptable. About 50% of the supplements are contaminated by melamine, a source of nonprotein nitrogen. Additional data accumulate toward the safety of nitrate ingestion. In the last 2 years, the safety of emerging supplements such as higenamine, potentially interesting to lose weight, creatine nitrate and guanidinoacetic acid has been evaluated but still needs further investigation.

SUMMARY

The consumption of over-the-counter supplements is very popular in athletes. Although most supplements may be considered as safe when taking at the recommended doses, athletes should be aware of the potential risks linked to the consumption of supplements. In addition to the risks linked to overdosage and cross-effects when combining different supplements at the same time, inadvertent or deliberate contamination with stimulants, estrogenic compounds, diuretics or anabolic agents may occur.

In Vitro Metabolic Studies of REV-ERB Agonists SR9009 and SR9011

SR9009 and SR9011 are attractive as performance-enhancing substances due to their REV-ERB agonist effects and thus circadian rhythm modulation activity. Although no pharmaceutical preparations are available yet, illicit use of SR9009 and SR9011 for doping purposes can be anticipated, especially since SR9009 is marketed in illicit products. Therefore, the aim was to identify potential diagnostic metabolites via in vitro metabolic studies to ensure effective (doping) control. The presence of SR9009 could be demonstrated in a black market product purchased over the Internet. Via human liver microsomal metabolic assays, eight metabolites were detected for SR9009 and fourteen metabolites for SR9011 by liquid chromatography–high resolution mass spectrometry (LC–HRMS). Structure elucidation was performed for all metabolites by LC–HRMS product ion scans in both positive and negative ionization mode. Retrospective data analysis was applied to 1511 doping control samples previously analyzed by a full-scan LC–HRMS screening method to verify the presence of SR9009, SR9011 and their metabolites. So far, the presence of neither the parent compound nor the metabolites could be detected in routine urine samples. However, to further discourage use of these potentially harmful compounds, incorporation of SR9009 and SR9011 into screening methods is highly recommended.

Bioanalytical techniques in discrimination between therapeutic and abusive use of drugs in sport

The discrimination between therapeutic and abusive use of drugs in sports is performed using threshold concentrations or reporting levels, and the detection of the substances in a sample is only reported as an adverse analytical finding when the concentration exceeds the threshold or the reporting level. In this paper, the strategies of discrimination and the analytical methods used for the main groups of substances where the distinction is needed (β-2 agonists, ephedrines, glucocorticoids and morphine) will be reviewed. Nowadays, LC–MS is the method of choice for the analysis of these substances and, in most of the cases, a simple dilution of the urine sample is performed before the chromatographic analysis.

Scientific and Regulatory Perspectives in Herbal and Dietary Supplement Associated Hepatotoxicity in the United States

In the United States (US), the risk of hepatotoxicity linked to the widespread use of certain herbal products has gained increased attention among regulatory scientists. Based on current US law, all dietary supplements sold domestically, including botanical supplements, are regulated by the Food and Drug Administration (FDA) as a special category of foods. Under this designation, regulatory scientists do not routinely evaluate the efficacy of these products prior to their marketing, despite the content variability and phytochemical complexity that often characterizes them. Nonetheless, there has been notable progress in the development of advanced scientific methods to qualitatively and quantitatively measure ingredients and screen for contaminants and adulterants in botanical products when hepatotoxicity is recognized.

MECHANISMS IN ENDOCRINOLOGY: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions

Anabolic androgenic steroids (AASs) are appearance and performance-enhancing drugs (APEDs) used in competitive athletics, in recreational sports, and by body-builders. The global lifetime prevalence of AASs abuse is 6.4% for males and 1.6% for women. Many AASs, often obtained from the internet and dubious sources, have not undergone proper testing and are consumed at extremely high doses and in irrational combinations, also along with other drugs. Controlled clinical trials investigating undesired side effects are lacking because ethical restrictions prevent exposing volunteers to potentially toxic regimens, obscuring a causal relationship between AASs abuse and possible sequelae. Because of the negative feedback in the regulation of the hypothalamic-pituitary-gonadal axis, in men AASs cause reversible suppression of spermatogenesis, testicular atrophy, infertility, and erectile dysfunction (anabolic steroid-induced hypogonadism). Should spermatogenesis not recover after AASs abuse, a pre-existing fertility disorder may have resurfaced. AASs frequently cause gynecomastia and acne. In women, AASs may disrupt ovarian function. Chronic strenuous physical activity leads to menstrual irregularities and, in severe cases, to the female athlete triad (low energy intake, menstrual disorders and low bone mass), making it difficult to disentangle the effects of sports and AASs. Acne, hirsutism and (irreversible) deepening of the voice are further consequences of AASs misuse. There is no evidence that AASs cause breast carcinoma. Detecting AASs misuse through the control network of the World Anti-Doping Agency (WADA) not only aims to guarantee fair conditions for athletes, but also to protect them from medical sequelae of AASs abuse.

National Athletic Trainers' Association position statement: Preparticipation physical examinations and disqualifying conditions

OBJECTIVE

To present athletic trainers with recommendations for the content and administration of the preparticipation physical examination (PPE) as well as considerations for determining safe participation in sports and identifying disqualifying conditions.

BACKGROUND

Preparticipation physical examinations have been used routinely for nearly 40 years. However, considerable debate exists as to their efficacy due to the lack of standardization in the process and the lack of conformity in the information that is gathered. With the continuing rise in sports participation at all levels and the growing number of reported cases of sudden death in organized athletics, the sports medicine community should consider adopting a standardized process for conducting the PPE to protect all parties.

RECOMMENDATIONS

Recommendations are provided to equip the sports medicine community with the tools necessary to conduct the PPE as effectively and efficiently as possible using available scientific evidence and best practices. In addition, the recommendations will help clinicians identify those conditions that may threaten the health and safety of participants in organized sports, may require further evaluation and intervention, or may result in potential disqualification.

Dietary supplement and drug use and doping knowledge and attitudes in Italian young elite cyclists

OBJECTIVE

To explore use and attitudes toward drugs and dietary supplements (DS) and knowledge concerning doping in cycling.

DESIGN

Retrospective cross-sectional study.

SETTING

Professional cycling.

PARTICIPANTS

Elite under-23 male cyclists.

INTERVENTION

Anonymous semistructured questionnaire administered during race periods.

MAIN OUTCOME MEASURES

Use and attitudes toward DS and drugs, and doping knowledge.

RESULTS

Forty cyclists aged 19 to 23 years and practicing for 14 to 30 h/wk were interviewed. Previous use (last 3 months) of drugs or DS occurred in 33 of 40 (82.5%) and 39 of 40 (97.5%) cyclists, respectively. Almost all the subjects named at least 1 doping agent (range, 1-10). Within a fixed list of 18 substances (among which only 14 were doping agents), participants recognized 3 to 18 of them as doping agents. They recognized tramadol and sildenafil as doping agents, which are not doping agents, and failed to recognize probenecid and albumin, which actually are. Doping knowledge correlated with drug use (r2 = 0.1614; P = 0.01). Participants deemed doping prevalence high among cyclists in general but not in their own team (P < 0.0001).

CONCLUSIONS

Use of prescription drugs and DS was a common occurrence. Doping knowledge was poor and biased, and its relationship with drug use deserves consideration. Educational interventions are needed to improve knowledge and awareness about prescription drugs and DS use, as well as about doping.

Analytical methods for the detection of undeclared synthetic drugs in traditional herbal medicines as adulterants

Traditional herbal medicines (THMs) are gaining popularity worldwide as an alternative approach to prescription drugs for many reasons including a general perception that they are safe. But recently there have been number of reported studies that reveal adulteration of THMs with undeclared synthetic drugs, which may potentially cause serious toxic adverse effects. This paper reviews the various classes of synthetic drugs that were found to be adulterated in THMs worldwide. The main focus is to highlight newer analytical tools used to detect adulteration. Due to the advancement in hyphenated techniques like liquid chromatography tandem mass spectrometry (LC-MS/MS), gas chromatography-tandem mass spectrometry (GC-MS/MS) and other conventional tools, it has become possible to detect synthetic drugs and their structural analogues as adulterants even if they are present in small quantities. This review also gives an overview of health-related risks after consuming such spurious products and challenges for future perspectives to control such type of malpractices.

High-throughput bioaffinity mass spectrometry for screening and identification of designer anabolic steroids in dietary supplements

A generic high-throughput bioaffinity liquid chromatography-mass spectrometry (BioMS) approach was developed and applied for the screening and identification of known and unknown recombinant human sex hormone-binding globulin (rhSHBG)-binding designer steroids in dietary supplements. For screening, a semi-automated competitive inhibition binding assay was combined with fast ultrahigh-performance-LC-electrospray ionization-triple-quadrupole-MS (UPLC-QqQ-MS). 17β-Testosterone-D3 was used as the stable isotope label of which the binding to rhSHBG-coated paramagnetic microbeads was inhibited by any other binding (designer) steroid. The assay was performed in a 96-well plate and combined with the fast LC-MS, 96 measurements could be performed within 4 h. The concentration-dependent inhibition of the label by steroids in buffer and dietary supplements was demonstrated. Following an adjusted bioaffinity isolation procedure, suspect extracts were injected into a chip-UPLC(NanoTile)-Q-time-of-flight-MS system for full-scan accurate mass identification. Next to known steroids, 1-testosterone was identified in three of the supplements studied and the designer steroid tetrahydrogestrinone was identified in a spiked supplement. The generic steroid-binding assay can be used for high-throughput screening of androgens, estrogens, and gestagens in dietary supplements to fight doping. When combined with chip-UPLC-MS, it is a powerful tool for early warning of unknown emerging rhSHBG bioactive designer steroids in dietary supplements.

Intake of Nutritional Supplements among People Exercising in Gyms in Beirut City

The use of nutritional supplements among exercisers in gyms has been never investigated in the Middle East. The aim of the current study was to assess the prevalence intake of nutritional supplements and the potential influencing factors among people exercising in gyms in Beirut city. In this cross-sectional study, 512 exercisers, aged between 20 and 50 years, were randomly selected from gyms. The intake of nutritional supplements was reported among 36.3% (95% confidence interval 32.2–40.5) of participants, with a weak presence of medical supervision. Patterns of supplement use differed by gender and age. Men and younger exercisers were found to focus on supplements associated with performance enhancement and muscle building, while women and older exercisers were more concerned with health-promoting products such as vitamins, minerals, and herbal supplements. An appropriate dissemination of accurate and scientifically sound information regarding the benefits and side effects of nutritional supplements is highly recommended in the sports environment in Beirut city.

Metabolic studies with promagnon, methylclostebol and methasterone in the uPA+/+-SCID chimeric mice

The chimeric uPA(+/+)-SCID mouse model, transplanted with human hepatocytes, was previously validated as an alternative tool to study in vivo the human steroid metabolism. This humanized mouse model was now applied, in the framework of anti-doping research, to test different nutritional supplements containing steroids. These steroids, intentionally or accidentally added to a nutritional supplement, usually are derivatives of testosterone. Information about the metabolism of these derivatives, which is important to assure their detection, is quite limited. However, due to ethical constraints, human volunteers cannot be used to perform experimental excretion studies. Therefore the chimeric mice were selected to perform three separated excretion studies with superdrol (methasterone), promagnon and also methylclostebol. The urine of the humanized mice was collected 24h after a single dose administration and analyzed by gas chromatography-mass spectrometry (GC-MS). The results indicated the presence of several metabolites including a 3-keto reduced metabolite and numerous hydroxylated metabolites. Also phase 2 metabolism was investigated to update the complete picture of their metabolism.

Gateway to doping? Supplement use in the context of preferred competitive situations, doping attitude, beliefs, and norms

Nutritional supplement (NS) use is widespread in sport. This study applied an integrated social cognitive approach to examine doping attitudes, beliefs, and self-reported doping use behavior across NS users (n = 96) and nonusers (n = 116). Following ethical approval, 212 competitive athletes (age mean = 21.4, s = 4.5; 137 males) completed self-reported measures of doping-related social cognitions and behaviors, presented in an online format where completion implied consent. Significantly more NS users (22.9%) reported doping compared with nonusers (6.0%; U = 4628.0, P < 0.05). NS users presented significantly more positive attitudes toward doping (U = 3152.0, P < 0.05) and expressed a significantly greater belief that doping is effective (U = 3152.0, P < 0.05). When presented with the scenario that performance-enhancing substances are effective and increase the possibility of winning, NS users were significantly more in favor of competing in situations that allow doping (U = 3504.5, P < 0.05). In sum, doping use is three-and-a-half times more prevalent in NS users compared with nonusers. This finding is accompanied by significant differences in doping attitudes, norms, and beliefs. Thus, this article offers support for the gateway hypothesis; athletes who engage in legal performance enhancement practices appear to embody an "at-risk" group for transition toward doping. Education should be appropriately targeted.