Nutrition and sports supplements: fact or fiction

BACKGROUND: In an age of highly competitive sports, whether it be the high school student, the weekend warrior, or the professional athlete, more individuals are using "performance-enhancing" nutritional supplements. Many feel they are gaining a "competitive edge," without thinking of the potential consequences. Consumers are inundated with claims of strength, weight loss, and improved body definition, but they are rarely given information on the potentially harmful side effects. There are few large, multicenter, randomized trials of these various nutritional supplements that look at the purported claims and potential side effects. STUDY: We reviewed the available studies, including case reports, and researched data on five of the most popular performance-enhancing supplements, including androstenedione, creatine, chromium, ephedra, and protein and amino acid supplements. CONCLUSIONS: Of the reviewed supplements, only creatine may be marginally beneficial. The potential benefit would probably only be useful to the professional athlete and not the average person. All of the supplements reviewed have potentially harmful side effects; however, certain supplements clearly show harmful effects, and use should strongly be cautioned. In addition, ephedra should be withdrawn from the marketplace. At this time, without better-designed studies, these agents cannot be recommended.     

Nutrition

The favorable effect of a healthy diet on the initial development and the further progression of atherosclerosis has been demonstrated. The effect is significant even in patients with adequate pharmacological treatment. Nutrition should be calorie-adjusted high in fiber, low in total fat and in saturated fats (<10% of calories) and cholesterol (<300 mg/day). Mono-unsaturated fatty acids and omega-3 fatty acids have beneficial effects. Therefore fatty fish more than once a week, nuts, fruits and vegetables (>400 g/day) have a prognostically favorable effect, whereas the supplemental use of antioxidative vitamins is of no proven benefit. These recommendations result from the experience gained over generations in millions of people in different countries (Mediterranean and Asian) with a low rate of coronary events and a high life expectancy. These dietary habits are associated with a low rate of neoplasm and of osteoporosis. The recommendation for this type of diet is a class-I recommendation.     

老年医学团队工作

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The team approach

Teamwork is emerging like a model of prevailing reference in many working fields: the interaction and, above all, integration between several persons can be an instrument to empower the individual skills, allowing to reach different and higher levels of creativity and efficiency than the sum of the single members' capacities. However, the capacity of interaction, tolerance, and focusing on the problem is required to the members who also need training for this way of working. After a brief historical summary of some 'creative groups' experiences in the fields of literature, science and arts, a vast review of theoretical model references is presented. Starting from specific North-American guidelines, a hypothesis of nutritional teamwork is introduced. This hypothesis aims at optimizing therapeutic interventions, at the critical review of the provided services and at a greater care for the cost-benefit ratio.     

Doping and thrombosis in sports

Historically, humans have long sought to enhance their "athletic" performance to increase body weight, aggressiveness, mental concentration and physical strength, contextually reducing fatigue, pain, and improving recovery. Although regular training is the mainstay for achieving these targets, the ancillary use of ergogenic aids has become commonplace in all sports. The demarcation between ergogenic aids and doping substances or practices is continuously challenging and mostly based on perceptions regarding the corruption of the fairness of competition and the potential side effects or adverse events arising from the use of otherwise unnecessary ergogenic substances. A kaleidoscope of side effects has been associated with the use of doping agents, including behavioral, skeletal, endocrinologic, metabolic, hemodynamic, and cardiovascular imbalances. Among the various doping substances, the most striking association with thrombotic complications has been reported for androgenic anabolic steroids (i.e., cardiomyopathy, fatal and nonfatal arrhythmias, myocardial infarction [MI], intracardiac thrombosis, stroke, venous thromboembolism [VTE], limb arterial thrombosis, branch retinal vein occlusion, cerebral venous sinus thrombosis) and blood boosting (i.e., VTE and MI, especially for epoetin and analogs). The potential thrombotic complication arising from misuse of other doping agents such as the administration of cortisol, growth hormone, prolactin, cocaine, and platelet-derived preparations is instead speculative or anecdotal at best. The present article provides an overview on the epidemiological association as well as the underlying biochemical and biological mechanisms linking the practice of doping in sports with the development of thrombosis.