Supplements, Pre/Probiotics, Sports Medicine

What is a adaptogenic herb that is theorized to help reduce anxiety and stress improve insomnia? What is the max dosage?

Ashwagandha up to 1250mg daily for up to 6mo

Is Ashwagandha safe in pregnancy? Can it be used when a pt has diarrhea, GI upset or N/V?

1. unsafe if preg

2. safe in diarrhea, GI, N/V

What are notable drug interactions with ashwagandha?

antidiabetes drugs, thyroid hormones

Review Safety Evidence Presentation

Learn how to classify drug interaction evidence presentation

What are the classifications for levels ABCD DDIs?

Which supplement is an essential fat soluble vitamin that builds up bone and support muscle and is indicated for pts with osteoporosis and deficiencies (rickets)? This is found in sunlight, fish and egg yolk.

4000 IU (100mcg) Vitamin D daily for adults

What are the ADE/DDI for vitamin D?

toxicity leads to hypercalcemia, azotemia and anemia

DDI: atorvastatin, diltiazem, verapamil

Which supplement is a popular traditional medicine, derived from a yellow flower, and is indicated for mild-mod depression symptoms and menopause symptoms?

900mg St. John’s Wort for up to 12 wks

What are the safety considerations for St. John’s Wort

1. ADE: diarrhea, dizziness, dry mouth, GI upset, fatigue, HA, insomnia, restless, sedation

2. unsafe in pregnancy and lactation

What are the DDI of St. John’s Wort?

contraceptives, omeprazole, warfarin, imatinib

major CYP3A4 inducer

Which supplement is found in fish, is a common ingredient in fish oil, and is indicated for hyperlipidemia and rheumatoid arthritis?

DHA + EPA 2 grams daily (Omega-3 fatty acids)

What are the safety considerations for omega-3?

1. ADE: belching, fishy aftertaste, loose stools, n

2. safe in preg/lactation and oral doses

3. DDI: antiplatelet, anticoag, antidiabetes, antihypertensive medications

Which supplement is used as a diuretic or stimulant to boost immune system and as an adaptogen (help body resist physiological and psychological issues). It is indicated for upper respiratory tract infection

200-400mg BID ginseng orally for 3-6 months

What are the safety considerations for ginseng?

1. safe orally and short term

2. safe in children

3. unsafe in pregnancy; avoid in lactation

What are the DDI for ginseng?

antidiabetes meds, immunosuppressants, monoamine oxidase inhibitors, warfarin(major)

What is the difference between prebiotics and probiotics?

1. prebiotic: non-digestible fibers that act as food to foster a favorable environment for beneficial bacteria to grow (found in high fiber foods like fruits, veggies, grains)

2. probiotics: live, beneficial bacteria that can improve gut health and reduce colonization caused by pathogenic organisms (found in yogurt, kimchi, pickles)

What are examples of prebiotic drinks?

bloom, poppi, olipop

What is the ISAPP recommendation for prebiotics?

3-5 grams per day and to increase intake gradually to avoid temporary gas, bloating, or stomach discomfort

people on low fiber diets and those looking to support metabolic or immune benefit the most from prebiotics. What are the benefits for prebiotics?

1. stool bulking → DEC constipation

2. better absorption of calcium and magnesium

3. reduced TGs in mild hypercholesterolemia

What are the benefits of probiotic used?

1. induce production of protective cytokines

2. inhib growth of potential pathogens

3. enhance antiviral activity

What are the indications for probiotics?

1. IBD

2. IBS

3. C. diff infection

4. necoritizing enterocolitis

5. diabetes

6. eczema and dermatitis

Review examples of probiotics

What are the benefits of protein?

1. repairs muscle tissue, muscle growth

2. builds and maintains lean body mass

3. reduce muscle soreness and speeds recovery

4. stabilizes blood sugar levels

5. weight management

6. immune function

The average adult needs 0.8g/kg/day. Athletes have an increased demand for protein because of muscle breakdown during exercise and muscle repair and hypertrophy. What are the recommendations for athletes?

Endurance: 1.0-1.6 g/kg/d

Strength: 1.6-2.0g/kg/d

Describe Whey Concentrate (WPC) as a protein source

1. cheapest, most common

2. byproduct of milk/cheese curds

3. 40-90% protein content: higher level of lactose, fat, and carbs

4. considerations: causes INC in sugar and carbs, may cause GI upset in lactose intolerance

Describe Whey Isolate (WPI) as a protein source

1. expensive

2. in a process that will remove fat and lactose from the compound

3. protein content: ≥90% leanest powder - complete amino acid profile, lactose free

4. Considerations: faster absorption than WPC

Describe Whey Hydrolysate (WPH) as a protein source

1. most expensive

2. whey thats been through hydrolysis and is predigested

3. protein content: 80% and 92%

4. Considerations: fastest absorption, less allergenic, used in medical nutrition and infant formulas, bitter taste

What is casein?

protein found in milk that is slow digesting (prevents muscle breakdown overnight) and is taken before bed OR between meals. It is high in calcium and bioactive peptides

What are plant based protein supplements?

1. source: soy, pea, rice, hemp, quinoa

2. lower in essential amino acids, dairy free, vegan friendly

3. high in fiber and phytonutrients

4. has slow absorption than Whey and requires combination of protein sources

Creatine monohydrate is naturally found in meat, poultry, and fish. How does it work and what does it enhance?

1. promotes ATP regeneration in skeletal muscle

2. improves exercise performance

3. enhances: power/speed bursts in short period of anaerobic activity, post exercise recovery, injury prevention, thermoregulation, rehabilitation

What is the recommended adult dose for creatine monohydrate and are there ADE?

1. 3-5g/d, loading dose is 20g/d (higher doses have no advantages)

2. ADE: GI upset, weight gain

3. many formulations

What are the clinical pearls of creatine monohydrate?

1. cheapest and best studied form

2. vegetarians have greater gains

3. safe for 5 years

4. additional hdyration not required

5. caution in renal dysfunction, may effect eGFR and CrCl readings → cystatin C will be a better reading

What is pre-workout?

it is consumed 30-60minutes before workout and it enhances performance, boost anabolic hormone secretion, improves muscle recovery, prevents fatigue.

What are the ADE and cautions for pre workout?

1. ADE: GI upset, irregular heartbeat, INC BP, insomnia

2. Caution: high doses

What are the safety concerns for pre workout?

What is caffeine?

a CNS stimulate that is found naturally in coffee/tea and is aval as PO, IV, topical, rectal. It is a lipophilic molecule that is 100% orally bioaval with rapid absorption (crosses BBB and placental)

What common products contain caffeine?

1. energy drinks

2. medicaitons

3. soda

4. chocolate/cocoa

5. coffee/tea

What are common benefits/uses of caffeine

1. stimulant: alertness, mood, focus, cognition, physical performance

2. analgesic adjuvant: HA relief

3. infant apnea

4. augmentation of seizure induction during electroconvulsive therapy

5. postdural puncture HA

What are the mild side effects of caffeine?

1. anxiety, restless, insomnia, irritability

2. facial flushing

3. INC urination

4. muscle twitches/tremors

5. tachycardia, irreg HR

6. GI irritation

What are the severe side effects of caffeine?

1. disorientation, hallucination, psychosis

2. seizures, arrythmias, ischemia

3. rhabdomyolysis

4. atrial fibrillation

What is the maximum daily caffeine intake that is considered safe?

400mg

What are the clinical pearls of caffeine?

1. tolerance: diminishing effects leads to higher consumption and higher risk of complications

2. genetic: may impact effects of caffeine

3. sensitivity: pts should consume based on their body’s response

4. combining products: be mindful of accidental overconsuming

Final Words to Know