Ingesting a preworkout supplement containing caffeine, creatine, β-alanine, amino acids, and B vitamins for 28 days is both safe and efficacious in recreationally active men

Pre-Workout Supplements and Their Effects on Cardiovascular Health: An Integrative Review

INTRODUCTION

Dietary supplements have become a popular aid for improving training performance. Pre-workout supplements contain a mixture of ingredients used to boost physical performance, with some components having been associated with the promotion of cardiovascular health. However, there is insufficient scientific literature on the effects of pre-workout supplements, and the studies often have conflicting results.

OBJECTIVE

The aim of this review was to analyze the impact of multi-ingredient pre-workout supplements on cardiovascular health, in order to identify the main adverse effects and the roles of the most common substances in these supplements.

METHODOLOGY

A systematic search was carried out in the Web of Science and PubMed databases by three independent researchers between January 2010 and August 2024. The inclusion criteria were available articles published in English. Articles that did not evaluate cardiovascular outcomes and the use of pre-workout supplements were excluded.

RESULTS

The 24 studies analyzed demonstrated an overall increase in supplement intake. Pre-workout supplements were associated with improved physical performance and possible cardiovascular changes, with these effects being classified as adverse or cardioprotective. This discrepancy in the results may be due to the different dosages and populations investigated (including active and non-active participants, and healthy participants or those with a history of cardiovascular diseases), as well as other factors that correlate with deleterious cardiac conditions.

CONCLUSIONS

Multi-ingredient pre-workout supplements may offer physical and cardiovascular benefits, including increased energy, focus, endurance, and strength during exercise, as well as having potential positive impacts on blood pressure and triglyceride, low-density lipoprotein (LDL), and homocysteine levels. However, due to the conflicting results of the analyzed studies, additional studies are necessary to fill in the knowledge gaps and establish clearer guidelines for the safe and effective use of these supplements.

Comparative effects of caffeine, beta-alanine, and their combination on mechanical, physiological, and perceptual responses to upper-body superset resistance training

Caffeine and beta-alanine are widely used in multi-ingredient pre-workout supplements believed to enhance resistance training, but their specific role in driving this effect remains unclear. The current study employed a randomized, triple-blinded, placebo-controlled and crossover experimental design to explore the acute effects of caffeine (200 mg), beta-alanine (3 g), or their combination (200 mg caffeine and 3 g beta-alanine; C+B-A) administered 30 min prior to resistance training (RT) on mechanical, physiological, and perceptual variables. Twenty-one young resistance-trained males (age = 23.5 ± 4.5 years, body mass = 82.1 ± 10.2 kg) visited the laboratory on six occasions: one familiarization session, one preliminary testing session for load determination, and four experimental sessions which differed only in supplementation condition and involved four supersets of bench press and bench pull exercises. The supplement condition did not significantly affect any mechanical variables (p ≥ 0.335), except for the velocity of the last repetition of the set, where beta-alanine produced lower values (0.383 m/s) compared to placebo (0.407 m/s; p < 0.05), with no differences observed for C+B-A (0.397 m/s) and caffeine (0.392 m/s). Heart rate was consistent across the different supplement conditions with the exception of the higher values observed immediately before the start of the RT session for placebo compared to caffeine (p = 0.010) and C+B-A (p = 0.019). Post-RT blood lactate concentration (p = 0.384), general and local ratings of perceived exertion (p = 0.177 and 0.160, respectively), and readiness (p = 0.281-0.925), did not differ significantly between supplement conditions. Selected supplements have minimal effects on performance and physiological responses in agonist-antagonist upper-body superset RT not leading to failure.

Does caffeine supplementation affect sleep in athletes? A systematic review of nine randomized controlled trials

OBJECTIVE

This systematic review aimed to assess the effects of caffeine supplements on sleep parameters among professional athletes.

METHODS

A systematic search of randomized controlled trials (PROSPERO: CRD42024505377) was performed from 1980 to December 2023 through Web of Science (ISI), Cinahl, Embase, CENTRAL, PubMed/MEDLINE, Scopus, and Scienceopen. The effect of caffeine supplement on all sleep parameters (e.g. duration, quality, insomnia), assessed through objective and subjective methods, was investigated among the athletic community.

RESULTS

Of 1469 records, nine trials were eligible for the current review. The studies showed varying results concerning sleep quality, quantity, efficiency, number of awakenings, sleep onset latency, and other sleep-related variables. These differences in findings may be attributable to factors such as the timing of caffeine consumption in relation to sleep time and the time of exercise, habitual caffeine use, and the dose of caffeine prescribed. Given the nature of caffeine, insomnia following ingestion is likely to occur.

CONCLUSIONS

This review explores the mechanisms by which caffeine influences sleep in athletes. While caffeine supplementation may enhance athletic performance, it could have a detrimental effect on sleep and therefore recovery. It is important that supplementation considers individual responses to caffeine so that it does not adversely affect sleep in this population.

PROSPERO REGISTRATION NUMBER

CRD42024505377.

Effects of Four Weeks of In-Season Pre-Workout Supplementation on Performance, Body Composition, Muscle Damage, and Health-Related Markers in Basketball Players: A Randomized Controlled Study

This randomized, double-blinded, experimental study investigated the effects of a four-week daily pre-workout supplementation (200 mg caffeine, 3.3 g creatine monohydrate, 3.2 g β-alanine, 6 g citrulline malate, and 5 g BCAA) vs. placebo (isocaloric maltodextrin) on anaerobic (jumping, sprinting, agility, and the running-based anaerobic sprint test: RAST) and aerobic (Yo-Yo intermittent recovery test level 1) performance, as well as on body composition and selective muscle damage/health-related blood markers in well-trained basketball players during the in-season period. Eighteen basketball players (age: 24.4 ± 6.3 years, height: 185.7 ± 8.0 cm, weight: 85.7 ± 12.8 kg, body fat: 16.5 ± 4.2%) were randomly assigned into two groups: pre-workout supplement (PWS, n = 10) or placebo (PL, n = 8). PWS consumption increased aerobic performance (PWS: 8 ± 6%; PL: -2 ± 6%; p = 0.004) compared to PL. A significant decrease was observed in peak (F = 7.0; p = 0.017), average (F = 10.7; p = 0.005), and minimum power (F = 5.1; p = 0.039) following 4 weeks of supplementation in both groups. No other significant changes were observed between groups (p > 0.05). In conclusion, the consumption of the current PWS over a four-week period appears to positively influence the aerobic performance of well-trained basketball players during the in-season period. However, it does not appear to mitigate the observed decline in anaerobic power, nor does it affect performance in jumping, sprinting, and agility, or alter body composition or selective muscle damage/health-related blood markers.

Risk or benefit? Side effects of caffeine supplementation in sport: a systematic review

PURPOSE

The aim of this study was to systematically review evidence on the prevalence and magnitude of side effects associated with caffeine supplementation in athletes.

METHODS

Systematic searches through the PubMed, VHL, Scopus, and Web of Science databases were conducted according to the PRISMA guidelines. Peer-reviewed articles written in English that reported the prevalence/percentage or magnitude/effect size of side effects after caffeine supplementation in athletes in a sports context were included. Studies were grouped by the dose of caffeine administered as follows: low =  ≤ 3.0 mg/kg; moderate = from 3.1 to 6.0 mg/kg; high =  ≥ 6.1 mg/kg. The magnitude of the side effects was calculated with effect sizes.

RESULTS

The search retrieved 25 studies that met the inclusion/exclusion criteria with a pooled sample of 421 participants. The supplementation with caffeine produced a higher prevalence or magnitude of all side effects under investigation when compared to placebo/control situations. The prevalence (magnitude) was between 6 and 34% (ES between 0.13 and 1.11) for low doses of caffeine, between 0 and 34% (ES between -0.13 and 1.20) for moderate doses of caffeine, and between 8 and 83% (ES between 0.04 and 1.52) with high doses of caffeine. The presence of tachycardia/heart palpitations and the negative effects on sleep onset had the highest prevalence and magnitude, in athletes using supplementation with caffeine.

CONCLUSION

In summary, caffeine supplementation in the doses habitually used to enhance physical performance produces several side effects, both after exercise and at least 24 h after the ingestion. However, the prevalence and magnitude of side effects with high doses of caffeine were habitually higher than with low doses of caffeine. From a practical perspective, using ~3.0 mg/kg of caffeine may be the dose of choice to obtain the ergogenic benefits of caffeine with the lowest prevalence and magnitude of side effects.

Effects of beta-alanine supplementation on Yo-Yo test performance: A meta-analysis

OBJECTIVE

The aim of this meta-analysis was to explore the effects of beta-alanine supplementation on Yo-Yo test performance.

METHODS

Nine databases were searched to find relevant studies. A random-effects meta-analysis of standardized mean differences (SMD) was performed for data analysis. Subgroup meta-analyses were conducted to explore the effects of beta-alanine supplementation duration on Yo-Yo test performance, and the effects of beta-alanine supplementation on performance only in Yo-Yo level 2 test variants.

RESULTS

Ten study groups were included in the meta-analysis. All studies included athletes as study participants. When considering all available studies, there was no significant difference between the placebo/control and beta-alanine groups (SMD: 0.68; 95% confidence interval [CI]: -0.30, 1.67). When considering only the studies that used supplementation protocols lasting between 6 and 12 weeks, there was a significant ergogenic effect of beta-alanine (SMD: 1.02; 95% CI: 0.01, 2.05). When considering only the studies that used the level 2 variants of the Yo-Yo test, there was a significant ergogenic effect of beta-alanine (SMD: 1.41; 95% CI: 0.35, 2.48).

CONCLUSIONS

This meta-analysis found that beta-alanine is ergogenic for Yo-Yo test performance in athletes when the supplementation protocol lasts between 6 and 12 weeks and when using the level 2 variants of the Yo-Yo test.

Carnosine and histidine-containing dipeptides improve dyslipidemia: a systematic review and meta-analysis of randomized controlled trials

CONTEXT

Cardiovascular disease is a major public health problem and represents a significant burden of disease globally. Lifestyle interventions have their limitations and an intervention that will effectively address cardiovascular risk factors to help reduce this growing burden of disease is required.

OBJECTIVE

Carnosine and other histidine-containing dipeptides (HCDs) have exerted positive effects on cardiovascular risk factors and diseases in animal and human studies. The authors conducted a systematic review and meta-analysis examining the effects of HCDs on cardiovascular outcomes in line with the PRISMA guidelines.

DATA SOURCES

The Medline, Medline in process, Embase, Cumulative Index of Nursing and Allied Health, and All EBM databases were searched from inception until January 25, 2019, for randomized controlled trials (RCTs) examining the effects of HCDs on cardiovascular outcomes, compared with placebo or controls.

DATA EXTRACTION

Basic characteristics of the study and populations, interventions, and study results were extracted. The grading of recommendations assessment, development, and evaluation approach was used to assess the quality of evidence for each outcome.

DATA ANALYSIS

A total of 21 studies were included. Of these, 18 were pooled for meta-analysis (n = 913). In low risk of bias studies, HCD-supplemented groups had lower total cholesterol (n = 6 RCTs; n = 401; weighted mean difference [WMD], -0.32 mmol/L [95%CI, -0.57 to -0.07], P = 0.01) and triglyceride levels (n = 6 RCTs; n = 401; WMD, -0.14 mmol/L [95%CI, -0.20 to -0.08], P < 0.001) compared with controls. In studies using carnosine, triglycerides levels were also lower in the intervention group vs controls (n = 5 RCTS; n = 309; P < 0.001). There were no significant differences in blood pressure, heart rate, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C) or the total cholesterol to HDL-C ratio between groups.

CONCLUSIONS

Carnosine and other HCDs may have a role in improving lipid profiles. Larger studies with sufficient follow-up are necessary to confirm these findings and explore the use of HCDs in the prevention of cardiovascular diseases.

SYSTEMIC REVIEW REGISTRATION

PROSPERO registration no.: CRD42017075354.

Plant-Based Foods and Their Bioactive Compounds on Fatty Liver Disease: Effects, Mechanisms, and Clinical Application

Fatty liver disease (FLD), including nonalcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD), is a serious chronic metabolic disease that affects a wide range of people. Lipid accumulation accompanied by oxidative stress and inflammation in the liver is the most important pathogenesis of FLD. The plant-based, high-fiber, and low-fat diet has been recommended to manage FLD for a long time. This review discusses the current state of the art into the effects, mechanisms, and clinical application of plant-based foods in NAFLD and AFLD, with highlighting related molecular mechanisms. Epidemiological evidence revealed that the consumption of several plant-based foods was beneficial to alleviating FLD. Further experimental studies found out that fruits, spices, teas, coffee, and other plants, as well as their bioactive compounds, such as resveratrol, anthocyanin, curcumin, and tea polyphenols, could alleviate FLD by ameliorating hepatic steatosis, oxidative stress, inflammation, gut dysbiosis, and apoptosis, as well as regulating autophagy and ethanol metabolism. More importantly, clinical trials confirmed the beneficial effects of plant-based foods on patients with fatty liver. However, several issues need to be further studied especially the safety and effective doses of plant-based foods and their bioactive compounds. Overall, certain plant-based foods are promising natural sources of bioactive compounds to prevent and alleviate fatty liver disease.

International society of sports nutrition position stand: caffeine and exercise performance

Following critical evaluation of the available literature to date, The International Society of Sports Nutrition (ISSN) position regarding caffeine intake is as follows: 1. Supplementation with caffeine has been shown to acutely enhance various aspects of exercise performance in many but not all studies. Small to moderate benefits of caffeine use include, but are not limited to: muscular endurance, movement velocity and muscular strength, sprinting, jumping, and throwing performance, as well as a wide range of aerobic and anaerobic sport-specific actions. 2. Aerobic endurance appears to be the form of exercise with the most consistent moderate-to-large benefits from caffeine use, although the magnitude of its effects differs between individuals. 3. Caffeine has consistently been shown to improve exercise performance when consumed in doses of 3-6 mg/kg body mass. Minimal effective doses of caffeine currently remain unclear but they may be as low as 2 mg/kg body mass. Very high doses of caffeine (e.g. 9 mg/kg) are associated with a high incidence of side-effects and do not seem to be required to elicit an ergogenic effect. 4. The most commonly used timing of caffeine supplementation is 60 min pre-exercise. Optimal timing of caffeine ingestion likely depends on the source of caffeine. For example, as compared to caffeine capsules, caffeine chewing gums may require a shorter waiting time from consumption to the start of the exercise session. 5. Caffeine appears to improve physical performance in both trained and untrained individuals. 6. Inter-individual differences in sport and exercise performance as well as adverse effects on sleep or feelings of anxiety following caffeine ingestion may be attributed to genetic variation associated with caffeine metabolism, and physical and psychological response. Other factors such as habitual caffeine intake also may play a role in between-individual response variation. 7. Caffeine has been shown to be ergogenic for cognitive function, including attention and vigilance, in most individuals. 8. Caffeine may improve cognitive and physical performance in some individuals under conditions of sleep deprivation. 9. The use of caffeine in conjunction with endurance exercise in the heat and at altitude is well supported when dosages range from 3 to 6 mg/kg and 4-6 mg/kg, respectively. 10. Alternative sources of caffeine such as caffeinated chewing gum, mouth rinses, energy gels and chews have been shown to improve performance, primarily in aerobic exercise. 11. Energy drinks and pre-workout supplements containing caffeine have been demonstrated to enhance both anaerobic and aerobic performance.

Caffeine's Effects on an Upper-Body Resistance Exercise Workout

Salatto, RW, Arevalo, JA, Brown, LE, Wiersma, LD, and Coburn, JW. Caffeine's effects on an upper-body resistance exercise workout. J Strength Cond Res 34(6): 1643-1648, 2020-The purpose of this study was to examine the effects of caffeine on an upper-body resistance exercise workout. Fifteen men (mean ± SD: age, 23.1 ± 1.9 years; body mass, 89.1 ± 13.9 kg; height, 175 ± 6.1 cm) volunteered to come to the laboratory 3 times. During visit 1, 1-repetition maximum (RM) values were determined for the barbell bench press, incline barbell bench press, and dumbbell bench press exercises. For visit 2, subjects consumed either 800-mg caffeine or a placebo. Subjects then completed 3 sets to failure of each exercise using 80% of their 1RM. Visit 3 was the same as visit 2; however, participants consumed the opposite treatment as visit 2. Various perceptual measures were recorded before, during, and after the workouts. The results indicated that participants completed significantly more repetitions per set for the barbell bench press (4.80 ± 2.66) and incline barbell bench press (4.91 ± 2.29) in the caffeine condition compared with the placebo condition (4.42 ± 2.56 and 4.36 ± 2.11, respectively). Higher arousal scores were found in the caffeine condition. For vigor, participants reported higher scores with caffeine before warming up (caffeine = 10.20 ± 4.11, placebo = 6.20 ± 3.23) and mid workout (caffeine = 13.53 ± 2.29, placebo = 11.13 ± 2.79). These results suggest that caffeine has an ergogenic effect on strength workout performance due, at least in part, to positive effects on workout perception. Athletes and recreational lifters may want to consider the ingestion of caffeine before a resistance exercise workout.

What Should We Do About Habitual Caffeine Use in Athletes?

Caffeine is a well-established ergogenic aid, demonstrated to enhance performance across a wide range of capacities through a variety of mechanisms. As such, it is frequently used by both athletes and non-athletes alike. As a result, caffeine ingestion is ubiquitous in modern society, with athletes typically being exposed to regular non-supplemental caffeine through a variety of sources. Previously, it has been suggested that regular caffeine use may lead to habituation and subsequently a reduction in the expected ergogenic effects, thereby blunting caffeine’s performance-enhancing impact during critical training and performance events. In order to mitigate this expected performance loss, some practitioners recommended a pre-competition withdrawal period to restore the optimal performance benefits of caffeine supplementation. However, at present the evidence base exploring both caffeine habituation and withdrawal strategies in athletes is surprisingly small. Accordingly, despite the prevalence of caffeine use within athletic populations, formulating evidence-led guidelines is difficult. Here, we review the available research regarding habitual caffeine use in athletes and seek to derive rational interpretations of what is currently known—and what else we need to know—regarding habitual caffeine use in athletes, and how athletes and performance staff may pragmatically approach these important, complex, and yet under-explored phenomena.

Histidine-containing dipeptides reduce central obesity and improve glycaemic outcomes: A systematic review and meta-analysis of randomized controlled trials

Supplementation with histidine-containing dipeptides has been shown to improve obesity and glycaemic outcomes in animal and human studies. We conducted a systematic review and meta-analysis of randomized controlled trials to examine these effects. Electronic databases were searched investigating the effects of histidine-containing dipeptides supplementation on anthropometric and glycaemic outcomes. Meta-analyses were performed using random-effects models to calculate the weighted mean difference and 95% confidence interval. There were 30 studies for the systematic review and 23 studies pooled for meta-analysis. Histidine-containing dipeptide groups had a lower waist circumference (WMD [95% CI] = -3.53 cm [-5.65, -1.41], p = 0.001) and HbA1c level (WMD [95% CI] = -0.76% (8.5 mmol/mol) [-1.29% (14.3 mmol/mol), -0.24% (2.8 mmol/mol)], p = 0.004) at follow-up compared with controls. In sensitivity analyses of studies with low risk of bias, waist circumference, HbA1c, and fasting glucose levels (WMD [95% CI] = -0.63 mmol/L [-1.09, -0.18], p = 0.006) were significantly lower in intervention groups versus controls. There was also a trend toward lower fat mass (p = 0.09), insulin resistance (p = 0.07), and higher insulin secretion (p = 0.06) in intervention versus control groups. Supplementation with histidine-containing dipeptides may reduce central obesity and improve glycaemic outcomes. Further studies exploring histidine-containing dipeptide use in obesity and diabetes prevention and treatment are warranted.

A Powderization Process for Encapsulating with Functional Biomaterials Using Nozzleless Electrostatic Atomization

Powderization of oils has been used as a method to enhance the stability of polyunsaturated fatty acids. Previously, we successfully powderized soybean oil via nozzleless electrostatic atomization. The process of nozzleless electrostatic atomization process was applied to the one-step process of encapsulating oil in wall materials. The encapsulation of oils in powder is dependent on the wall materials. The present study aimed to resolve the behavior of oil encapsulated in particles using a novel method of electrostatic atomization, and to investigate the effect of wall materials on the oil content in the encapsulated formulations. The size of particles surrounding oil was dependent on the type of wall materials used for encapsulation, and the oil content within the encapsulation decreased with increase in particle size. Furthermore, wall materials with higher hydrophobicity increased the oil content within the encapsulation, as more hydrophobic particles could absorb the oil more effectively. PRACTICAL APPLICATION: Nozzleless electrostatic atomization is a new method for preparing encapsulation of oil using various wall materials.

Efficacy of a nootropic spearmint extract on reactive agility: a randomized, double-blind, placebo-controlled, parallel trial

BACKGROUND

Proprietary spearmint extract (PSE) containing a minimum 14.5% rosmarinic acid and 24% total phenolic content, has evinced positive effects on cognition in individuals aged 50-70 with memory impairment after chronic supplementation. To address the growing interest in connecting mental and physical performance, the present study examined whether the nootropic effects of PSE translate into changes in reactive agility following daily supplementation with PSE.

METHODS

Utilizing a randomized, double-blind, placebo-controlled, parallel design, healthy, recreationally-active men and women (n = 142) received 900 mg of PSE or placebo (PLA) daily for 90 days. Reactive agility, our primary outcome, was determined by measuring the number of hits and average reaction time (ART) on a Makoto Arena II, a 3600 audio-visual device that measures stationary, lateral, and multi-directional active choice reaction performance. Safety was evaluated using complete blood count, comprehensive metabolic panel, and blood lipids. Measurements were evaluated on days 7, 30, and 90 of supplementation.

RESULTS

An overall treatment effect (p = 0.019) was evident for increased hits with PSE on the stationary test with footplates, with between group differences at Day 30 (PSE vs. PLA: 28.96 ± 2.08 vs. 28.09 ± 1.92 hits; p = 0.040) and Day 90 (PSE vs. PLA: 28.42 ± 2.54 vs. 27.02 ± 3.55 hits; p = 0.002). On the same task, ART improved (treatment effect, p = 0.036) with PSE at Day 7 (PSE vs. PLA: 0.5896 ± 0.060 vs. 0.6141 ± 0.073 s; p = 0.049) and Day 30 (PSE vs. PLA: 0.5811 ± 0.068 vs. 0.6033 ± 0.055 s; p = 0.049). PSE also significantly increased hits (treatment effect, p = 0.020) at Day 30 (PSE vs. PLA: 19.25 ± 1.84 vs. 18.45 ± 1.48 hits; p = 0.007) and Day 90 (PSE vs. PLA: 19.39 ± 1.90 vs. 18.66 ± 1.64 hits; p = 0.026) for the multi-directional test with footplates. Significant differences were not observed in the remaining Makoto tests. PSE was well tolerated as evidenced by no effects observed in the blood safety panels.

CONCLUSIONS

The findings of the current study demonstrate that consumption of 900 mg of PSE improved specific measures of reactive agility in a young, active population.

TRIAL REGISTRATION

clinicaltrials.gov, NCT02518165 . Registered August 7, 2015 - retrospectively registered.

Multi-ingredient pre-workout supplements, safety implications, and performance outcomes: a brief review

In recent years, a new class of dietary supplements called multi-ingredient pre-workout supplements (MIPS) has increased in popularity. These supplements are intended to be taken prior to exercise and typically contain a blend of ingredients such as caffeine, creatine, beta-alanine, amino acids, and nitric oxide agents, the combination of which may elicit a synergistic effect on acute exercise performance and subsequent training adaptations compared to single ingredients alone. Therefore, the purpose of this article was to review the theoretical rationale and available scientific evidence assessing the potential ergogenic value of acute and chronic ingestion of MIPS, to address potential safety concerns surrounding MIPS supplementation, and to highlight potential areas for future research. Though direct comparisons between formulations of MIPS or between a MIPS and a single ingredient are challenging and often impossible due to the widespread use of "proprietary blends" that do not disclose specific amounts of ingredients in a given formulation, a substantial body of evidence suggests that the acute pre-exercise consumption of MIPS may positively influence muscular endurance and subjective mood, though mixed results have been reported regarding the acute effect of MIPS on force and power production. The chronic consumption of MIPS in conjunction with a periodized resistance training program appears to augment beneficial changes in body composition through increased lean mass accretion. However, the impact of long-term MIPS supplementation on force production, muscular endurance, aerobic performance, and subjective measures is less clear. MIPS ingestion appears to be relatively safe, though most studies that have assessed the safety of MIPS are relatively short (less than eight weeks) and thus more information is needed regarding the safety of long-term supplementation. As with any dietary supplement, the use of MIPS carries implications for the athlete, as many formulations may intentionally contain banned substances as ingredients or unintentionally as contaminants. We suggest that athletes thoroughly investigate the ingredients present in a given MIPS prior to consumption. In conclusion, it appears that multi-ingredient pre-workout supplements have promise as an ergogenic aid for active individuals, though further information is required regarding long-term efficacy and safety in a wider variety of populations.

Acute hematological and mood perception effects of bitter orange extract (p-synephrine) consumed alone and in combination with caffeine: A placebo-controlled, double-blind study

The purpose of this study was to examine acute hematological and mood perception responses to supplementation with p-synephrine alone and in combination with caffeine during quiet sitting. Sixteen subjects visited the laboratory on 6 occasions and were given (in randomized double-blind manner) 103-mg p-synephrine (S), 233-mg caffeine + 104-mg p-synephrine, 240-mg caffeine, 337-mg caffeine + 46-mg p-synephrine, 325-mg caffeine, or a placebo (PL). The subjects sat quietly for 3 hr while completing mood state questionnaires every 30 min. Venous blood samples were collected at baseline (pre) and 3 hr (post) to determine immune, lipid, and chemistry panels. Compared with PL, no significant supplement differences were observed during the S trial with the exception of differential time effects seen in hematocrit (decrease in PL, no change in S), triglycerides and very low-density lipoproteins (no changes in PL, significant decreases in S), and iron (no change in PL, significant elevation in S). Supplements containing caffeine showed increased feelings of attention, excitement, energy, and vigor. These data indicate that consumption of 103-mg p-synephrine does not negatively impact acute blood parameters, does not augment the effects of caffeine, or produce stimulant-like perceptual mood effects.

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.

International society of sports nutrition position stand: Beta-Alanine

The International Society of Sports Nutrition (ISSN) provides an objective and critical review of the mechanisms and use of beta-alanine supplementation. Based on the current available literature, the conclusions of the ISSN are as follows: 1) Four weeks of beta-alanine supplementation (4-6 g daily) significantly augments muscle carnosine concentrations, thereby acting as an intracellular pH buffer; 2) Beta-alanine supplementation currently appears to be safe in healthy populations at recommended doses; 3) The only reported side effect is paraesthesia (tingling), but studies indicate this can be attenuated by using divided lower doses (1.6 g) or using a sustained-release formula; 4) Daily supplementation with 4 to 6 g of beta-alanine for at least 2 to 4 weeks has been shown to improve exercise performance, with more pronounced effects in open end-point tasks/time trials lasting 1 to 4 min in duration; 5) Beta-alanine attenuates neuromuscular fatigue, particularly in older subjects, and preliminary evidence indicates that beta-alanine may improve tactical performance; 6) Combining beta-alanine with other single or multi-ingredient supplements may be advantageous when supplementation of beta-alanine is high enough (4-6 g daily) and long enough (minimum 4 weeks); 7) More research is needed to determine the effects of beta-alanine on strength, endurance performance beyond 25 min in duration, and other health-related benefits associated with carnosine.

A multi-ingredient, pre-workout supplement is apparently safe in healthy males and females

Background

Pre-workout supplements (PWS) have become increasingly popular with recreational and competitive athletes. While many ingredients used in PWS have had their safety assessed, the interactions when combined are less understood.

Objective

The purpose of this study was to examine the safety of 1 and 2 servings of a PWS.

Design

Forty-four males and females (24.4±4.6 years; 174.7±9.3 cm; 78.9±18.6 kg) from two laboratories participated in this study. Subjects were randomly assigned to consume either one serving (G1; n=14) or two servings (G2; n=18) of PWS or serve as an unsupplemented control (CRL; n=12). Blood draws for safety panels were conducted by a trained phlebotomist before and after the supplementation period.

Results

Pooled data from both laboratories revealed significant group×time interactions (p<0.05) for mean corpuscular hemoglobin (MCH; CRL: 30.9±0.8–31.0±0.9 pg; G1: 30.7±1.1–30.2±0.7 pg; G2: 30.9±1.2–30.9±1.1 pg), MCH concentration (CRL: 34.0±0.9–34.4±0.7 g/dL; G1: 34.1±0.9–33.8±0.6 g/dL; G2: 34.0±1.0–33.8±0.8 g/dL), platelets (CRL: 261.9±45.7–255.2±41.2×10³/µL; G1: 223.8±47.7–238.7±49.6×10³/µL; G2: 239.1±28.3–230.8±34.5×10³/µL), serum glucose (CRL: 84.1±5.2–83.3±5.8 mg/dL; G1: 86.5±7.9–89.7±5.6 mg/dL; G2: 87.4±7.2–89.9±6.6 mg/dL), sodium (CRL: 137.0±2.7–136.4±2.4 mmol/L; 139.6±1.4–140.0±2.2 mmol/L; G2: 139.0±2.2–138.7±1.7 mmol/L), albumin (CRL: 4.4±0.15–4.4±0.22 g/dL; G1: 4.5±0.19–4.5±0.13 g/dL; G2: 4.6±0.28–4.3±0.13 g/dL), and albumin:globulin (CRL: 1.8±0.30–1.8±0.28; G1: 1.9±0.30–2.0±0.31; G2: 1.8±0.34–1.8±0.34). Each of these variables remained within the clinical reference ranges.

Conclusions

The PWS appears to be safe for heart, liver, and kidney function in both one-serving and two-serving doses when consumed daily for 28 days. Despite the changes observed for select variables, no variable reached clinical significance.

Safety of a dose-escalated pre-workout supplement in recreationally active females

BACKGROUND

Pre-workout supplements (PWS) have increased in popularity among athletic populations for their purported ergogenic benefits. Most PWS contain a "proprietary blend" of several ingredients, such as caffeine, beta-alanine, and nitrate in undisclosed dosages. Currently, little research exists on the safety and potential side effects of chronic consumption of PWS, and even less so involving female populations. Therefore, the purpose of the present study was to examine the safety of consuming a dose-escalated PWS over a 28-day period among active adult females.

METHODS

34 recreationally active, adult females (27.1 ± 5.4 years, 165.2 ± 5.7 cm, 68.2 ± 16.0 kg) participated in this study. Participants were randomly assigned to consume either 1 (G1) or 2 (G2) servings of a PWS daily or remain unsupplemented (CRL) for a period of 28 days. All were instructed to maintain their habitual dietary and exercise routines for the duration of the study. Fasting blood samples, as well as resting blood pressure and heart rate, were taken prior to and following the supplementation period. Samples were analyzed for hematological and clinical chemistry panels, including lipids.

RESULTS

Significant (p < 0.05) group by time interactions were present for absolute monocytes (CRL -0.10 ± 0.10; G1 + 0.03 ± 0.13; G2 + 0.01 ± 0.12×10E3/uL), MCH (CRL -0.13 ± 0.46; G1 + 0.36 ± 0.52; G2 -0.19 ± 0.39 pg), creatinine (CRL 0.00 ± 0.05; G1 -0.06 ± 0.13; G2 -0.14 ± 0.08 mg/dL), eGFR (CRL -0.69 ± 5.97; G1 + 6.10 ± 15.89; G2 + 14.63 ± 7.11 mL/min/1.73), and total cholesterol (CRL -2.44 ± 13.63; G1 + 14.40 ± 27.32; G2 -10.38 ± 15.39 mg/dL). Each of these variables remained within the accepted physiological range. No other variables had significant interactions.

CONCLUSION

The present study confirms the hypothesis that a PWS containing caffeine, beta-alanine, and nitrate will not cause abnormal changes in hematological markers or resting vital signs among adult females. Although there were statistically significant (p < 0.05) group by time interactions for absolute monocytes, MCH, creatinine, eGFR, and total cholesterol, all of the results remained well within accepted physiological ranges and were not clinically significant. In sum, it appears as though daily supplementation with up to 2 servings of the PWS under investigation, over an interval of 28 days, did not adversely affect markers of clinical safety among active adult females.

28 days of creatine nitrate supplementation is apparently safe in healthy individuals

BACKGROUND

Creatine monohydrate has become a very popular nutritional supplement for its ergogenic effects. The safety of creatine monohydrate has previously been confirmed. However with each novel form of creatine that emerges, its safety must be verified. Therefore, the purpose of this study was to examine the safety of a novel form of creatine, creatine nitrate (CN), over a 28 day period.

METHODS

58 young males and females (Pooled: 24.3 ± 3.9 years, 144.9 ± 8.0 cm, 74.2 ± 13.0 kg) participated in this study across two laboratories. Subjects were equally and randomly assigned to consume either 1 g (n = 18) or 2 g (n = 20) of CN or remained unsupplemented (n = 20). Blood draws for full safety panels were conducted by a trained phlebotomist prior to and at the conclusion of the supplementation period.

RESULTS

Pooled data from both laboratories revealed significant group x time interactions for absolute lymphocytes and absolute monocytes (p < 0.05). Analysis of the 1 g treatment revealed lab x time differences for red blood cell distribution width, platelets, absolute monocytes, creatinine, blood urea nitrogen (BUN):creatinine, sodium, protein, and alanine aminotransferase (ALT) (p < 0.05). Analysis of the 2 g treatment revealed lab x time differences for BUN:creatinine and ALT (p < 0.05). BUN and BUN:creatinine increased beyond the clinical reference range for the 2 g treatment of Lab 2, but BUN did not reach statistical significance.

CONCLUSION

Overall, CN appears to be safe in both 1 g and 2 g servings daily for up to a 28 day period. While those with previously elevated BUN levels may see additional increases resulting in post-supplementation values slightly beyond normal physiological range, these results have minor clinical significance and are not cause for concern. Otherwise, all hematological safety markers remained within normal range, suggesting that CN supplementation has no adverse effects in daily doses up to 2 g over 28 days and may be an alternative to creatine monohydrate supplementation.