For further information please contact: The European Specialist Sports Nutrition Alliance

222 Southbank House, Black Prince Road, London, SE1 7SJ, UK Tel: +44 (0) 20 7138 3201 Fax: +44 (0) 20 7463 0691 Email: info@essna.com

www.essna.com

The European Specialist Sports Nutrition Alliance What is Sports Nutrition?

What are Sports Nutrition Products? Sports nutrition consists of products designed for and used by athletes, exercisers and sportspeople to improve their nutritional intake and/or some aspect of health, wellbeing, performance, muscle growth and/or recovery from exercise. The vast majority of sports nutrition products are formulated with natural ingredients, ranging from milk, fibres, sugars or vegetable starches to vitamins, minerals and more unique ingredients such as non-essential nutrients and herbs. Often, these products are referred to as sports “supplements”. However, since far greater than half of the aggregate sales of the sports nutrition industry is accounted for by carbohydrates, proteins and fats, the moniker “sports nutrition” is probably more appropriate because it reflects the fact that these products are primarily composed of the very same major constituents found in common foods. The modern sports nutrition product market is generally agreed to have been established in 1940, with the advent of Weider Nutrition. Initially this was a result of the demand, primarily by bodybuilders and strength athletes, for more convenient, nutrient dense and high-quality sources of nutrition that would help satisfy their additional requirements. However, as early as the 1930s, scientists began to realise that exercise performance could be improved by increased carbohydrate intake and so the first scientifically-inspired sports supplements were composed of sweets, starches and sugary drinks (Conlee, 1987). Prior to this, at the start of the 20th century, athletes often used alcohol, strychnine and other questionable ‘supplements’ before and during competition in the false belief that they would improve performance (Dunford, 2010). However, it is interesting to note that sports nutrition is a much older phenomenon than this. As far back as the Ancient Olympics of 500BC, athletes had recognised their enhanced requirement for nutrients by eating massive quantities of meat, bread, dried fruits and honey, along with various fungi and herbs, in an attempt to support athletic performance (Panayiotis, 2004).

As will be discussed, in the intervening decades since modern sports nutrition began to evolve, not only have participants and coaches of most other sports increasingly embraced the use of these products but thousands of scientific studies have elucidated many different benefits of various sports nutrition ingredients. As will be discussed, comprehensive reviews of the scientific literature have established that most athletes do have increased or unique nutritional requirements that are often not met by their diets due to a lack of knowledge, a lack of convenience or unwillingness to adopt dietary recommendations. Moreover, beyond being a means to satisfy essential nutrient requirements, many sports nutrition products, herbs and non-essential nutrients have been reported/proven in the scientific literature to have significant effects on performance, recovery, muscle size, muscle-building activity and mental/neurological function. In fact, some nutrients that have been introduced to the market as sports nutrition ingredients have been used and/or are being studied for their health benefits, including their ability to treat a variety of diseases. Disturbingly, when members of the public think of sports nutrition/supplement products, they often conflate them or their effects with performance-enhancing drugs. As will be elucidated, it has been the fringe, “black market” products (mostly from the United States) which have nefariously found their way into British and European shops and internet sites that have been responsible for the media reports, giving rise to this unfair impression. In fact, “hormonal” (steroid-like) products and strong stimulant products have been banned for several years in most European countries. In the UK, even stating or implying that a product increases testosterone or some other hormone (whether it does so or not) will cause that product to be deemed “medicinal” and not allowable for sale as a “food supplement”. Clear legislation has long been in place to protect consumers from any potentially dangerous ingredients or misleading claims and it is actually “black market” products that are virtually always the source of controversy. In fact, any health claim made on foods, including sports foods, needs to have been assessed and given a positive opinion by the European Food Safety Authority (EFSA). Rules governing health claims made of food were formally published on the 25th May 2012 and have been law since the 14th December 2012. Any sports nutrition product wanting to make any reference to the beneficial effect of a particular ingredient by way of a health claim, needs first to ensure that EFSA have provided a positive health claim opinion. The Myth of Contaminated / Adulterated Products

It has been stated in the media on several occasions that sports nutrition products routinely contain banned substances and that their processing and production is unregulated and poorly managed. The basis for these assertions has been a few isolated incidents and the inclination of athletes to blame sports supplements for their positive drugs tests. Virtually all performance-enhancing substances that are banned by organisations like WADA (The World Anti-Doping Agency) and the IOC (International Olympic Committee) are also banned from over-the-counter sale in the European Union.

Whilst no manufacturer of food, drink or supplements can “eliminate” the risk of adulteration or cross-contamination and thus risk to consumers, most industries are as vigilant as is possible in their responsibility to minimise risk. Garnering the trust of customers in your brand is just good business. In this regard, the sports nutrition industry is no different. In the sports nutrition industry the majority of companies manufacture their products to internationally-recognised quality control standards. Typically, companies will manufacture to an ‘ISO9001’ standard which entails a rigorous audit and full traceability of all procedures. Under this remit, all suppliers must also be ISO registered. Records are kept (and retained) of every batch of raw material that is received, including when it was made, who opened each container, who packed it, etc. and each raw ingredient supplier must ensure that there is a chain of custody from the time the material is received to the time it is delivered. At the receiving facility, it is then tested again before production begins. In the UK, Trading Standards visit manufacturing facilities to ensure adherence to these procedures. Many companies go a step further and have some or all of their finished products tested even for minute traces of banned substances (substances which can also be found in some foods) by an independent testing facility, so that professional athletes can be confident that they are not risking their careers by using sports supplements. So clearly, sports nutrition companies take product quality and their customer’s health seriously but it may be most relevant to know the outcome that results from all of this rigorous quality control of raw material procurement and product production. The fact is, the UK sports nutrition industry has a very enviable record of safety. Serious adverse events have been exceptionally rare and, when they have occurred, ingredients such as ephedrine and geranium (1,3 dimethylamylamine) have been identified as potentially harmful, deemed medicinal and thus effectively banned by the Medicines and Healthcare products Regulatory Agency (MHRA). In fact, numerous ingredients have been deemed medicinal in the absence of known adverse events (MHRA, A Guide to What is a Medicinal Product, 2008). The following is an explanation of all of the major categories of sports nutrition. It is notable that, in most cases, ingredients either have a long history of use in humans and/or have a body of research supporting their safety and efficacy.

Powdered Foods, Bars & Drinks Powdered foods, protein and energy bars, and drinks make up the vast majority of total sales of sports nutrition supplements. Typical products contain some form of whey, milk, egg, beef, gelatine or soy protein and/or some form of simple sugar or starch derived from corn, wheat or oats. Beyond these ingredients they may include micronutrients like vitamins and minerals and some may also contain amino acids, creatine and occasionally, certain herbs.

Carbohydrate Drinks These make up the biggest-selling category of sports nutrition products. The best-known examples, such as Lucozade, Powerade and Gatorade, simply contain water, sugar, starch, minerals, colours and sweeteners. Similar products are sold in powdered form to be rehydrated with water. Carbohydrate drinks typically contain no ingredients that are unique to sports nutrition. Protein Powders The vast majority of protein products are sold as powders to be mixed with water or milk. Most of them contain as their principal ingredient milk protein (whey protein and/or casein) but egg and soy proteins are also fairly common. These products are designed to be a convenient source of high-quality protein to meet the well-established increased needs of athletes and individuals who participate in heavy exercise (Tarnopolsky, 1992; Phillips, 2011). Amino Acids Amino acids are simply the building blocks that make up proteins. Bound together in small numbers, they are known as peptides and in large numbers, they are known as proteins. There are about 20 different amino acids commonly found in plant and animal foods. Eight of these amino acids are essential to sustain life and studies have established that these eight are almost exclusively responsible for protein’s ability to stimulate muscle growth and repair and some have a more potent effect in this regard than others (Børsheim, 2002; Tipton, 1999). This makes them obvious candidates to be used in sports nutrition products for recovery, repair and growth in hard-training sportspeople. The body digests and metabolises protein from the food we eat. During this process, enzymes in the gut break down the protein chains, resulting in amino acids and small peptides that are transported around the body in the bloodstream and used to rebuild tissue. The body is continually breaking down and building up tissues by metabolising amino acids and this creates a demand for amino acids and this demand has been proven to be greater in those who exercise (Tarnopolsky, 1992; Phillips, 2011). The healthy body has an almost unlimited capacity to metabolise any reasonable intake of protein and amino acids and there is no convincing evidence that they can cause harm to healthy users. Creatine Creatine is an amino acid-like molecule which is found in several common foods and is produced by the body (Brosnan, 2007). It was first discovered over 100 years ago and scientific studies starting in the early 1990s found that, by consuming this nutrient, high-intensity muscle contractions could be repeated for a greater duration (Volek, 2004; Rawson, 2003; Bemben, 2005). It was also found to rapidly cause increases in lean body mass in most users (Volek, 2004; Rawson, 2003; Bemben, 2005). Dozens of subsequent scientific studies have confirmed these effects. This led to marketing of creatine products to gym goers, who quickly realised its benefits and it soon became a very popular sports nutrition supplement. Since these original studies, there have been hundreds of published scientific investigations that have mostly confirmed these effects (Bemben, 2005). Initially there were questions about the potential effects of creatine on the kidneys and its possible influence on muscle cramps, bloating and interference with the body’s natural creatine production.

However, since then, several scientific papers and reviews have laid these fears to rest (Bemben, 2005). Perhaps more reassuring is that no serious side effects have been legitimately attributed to the use of this ingredient despite it being studied in thousands of research subjects and being used by millions of people for well over a decade. Micronutrients Vitamins & Minerals/Electrolytes Micronutrients can be found in multivitamin/mineral supplements and various sports nutrition products in a range of dosages that are generally similar to those found in mainstream nutritional supplements and fortified foods. Weight / Fat Loss support Weight and fat loss products are used by active and non-active people alike. However, because many active people exercise to improve their appearance, shed body fat and improve muscle tone, these types of products are particularly attractive to sports nutrition users. In the past, several so-called “fat burner” products have made unsubstantiated claims and some products appeared on the market which contained banned stimulants. Since then, this category has been highly scrutinised by the regulatory authorities in most EU countries. Currently, EU countries don’t allow the use of the phrase “fat burner” or allow any implication that these products cause weight loss unless they contain specific amounts of particular ingredients that have been approved to use a certain claim. Many countries also insist that the label state that these products should only be used in combination with a sensible diet and exercise program. Currently, the Nutrition and Health Claims Regulations dictate that only low-calorie meal replacements and a small number of ingredients are allowed to make claims about their ability to support weight and fat loss. Hormone Products This category includes products that are designed to support the production of desirable hormones and/or moderate the production of undesirable hormones. They are often composed of herbs, micronutrients and other nutrients which may have a moderate effect on various hormone levels or activity. No legitimate, legal, sports nutrition product contains any ingredients that can stimulate testosterone or growth hormone levels to an extent that they fall outside the clinically-accepted ‘normal’ range. As stated earlier, so-called ‘prohormone’ or ‘steroid-like’ ingredients are not allowed in food supplements. The European Food Safety Authority has reviewed the evidence and approved claims that various micronutrients contribute to the maintenance of normal testosterone levels. Just as Importantly, What “Aren’t” Sports Nutrition Products? By definition and by law, sports nutrition products can only contain food ingredients, natural herbal ingredients that have a substantial history of use, approved forms of vitamins and minerals and other ingredients that are generally regarded as safe. So again, legitimate sports nutrition products do not contain anything that cannot be found in foods and other mainstream supplements.

Steroids, prohormones, potent stimulants and other ingredients that have substantial effects on the metabolism, hormones or other body chemistry are banned and prohibited from being used in sports supplements. Furthermore, marketing and label claims that products have substantial effects on the metabolism, hormones or other body chemistry, beyond those effects that have been recognised by the European Commission via the European Food Safety Authority, are also explicitly banned. So sports nutrition products can neither contain dangerous ingredients, nor can they make claims about their effects without substantial evidence to support them. A recent example of how these regulations are enforced saw the UK MHRA (Medicines and Healthcare products Regulatory Agency) decide upon and remove products containing DMAA (1,3 dimethylamylamine - a strong stimulant) from the market in 2012. It should be noted that none of the major UK supplement companies brought a DMAA-containing product to market. The MHRA also removed from the market a variety of black market products containing prohormones, ephedrine/ephedra, yohimbe and other medicinal ingredients, which are not allowed in over-the-counter food supplements. Are they Safe & Effective? The media often depicts sports nutrition products as being ineffective or unnecessary and often accuses companies of using misleading claims. In fact, there is very strong and long-standing scientific evidence to support the usefulness and efficacy of many modern sports nutrition products. Proteins Some nutritionists and dieticians question the need for and safety of these products but, in fact, there is a large body of published scientific evidence that they can have several desirable benefits and no good evidence whatsoever that they have any harmful effects in healthy users. Their safety is obviated by the fact that despite decades of use by millions of people, no serious adverse effects have been reported as having resulted from the consumption of protein supplements. Regarding efficacy, comprehensive reviews of the scientific literature clearly demonstrate that athletes have higher protein requirements than sedentary individuals (Tarnopolsky, 1992; Phillips, 2011). Powdered protein products offer sportspeople a convenient means of meeting their increased requirements, without excess calories, fat or sugars. So they not only contain concentrated amounts of nutrients that the sportsperson desires, they have minimal amounts of nutrients that the individual wants to avoid. More specifically, most protein supplements contain higher concentrations of the essential amino acids and certain amino acids that have particularly significant muscle protein building effects (Ha , 2003; Churchward-Venne, 2012; Millward, 2008 ). The best-selling types of protein powder also have a higher nutritive value and deliver greater protein nutrition than common dietary proteins (Tang, 2009; Sindayikengera, 2006; Hoffman, 2004). For instance, the most common variety of protein powder - whey protein - has been shown in published scientific research to not only have superior protein nutrition versus other high-quality proteins but to also result in better gains in muscular performance, higher rates of muscle-building activity and greater gains in muscle mass when used by exercising subjects over time (Lands, 1999; Cribb, 2006; Hoffman, 2004; Hulmi, 2010; Baer, 2011).

Carbohydrates Active individuals and sportspeople also have higher carbohydrate requirements and, without adequate intake, exercise performance will often decline. Studies show that having a carbohydrate drink with electrolytes improves endurance performance in prolonged aerobic activities (Coso, 2008; Tsintzas, 1995). Carbohydrates are also the preferred source of extra energy for individuals who need to maintain or increase their body weight. Moreover, carbohydrate consumption stimulates greater insulin production, which promotes the entry of nutrients into cells and contributes to building and repairing muscle tissue (Børsheim, 2004). Fats Fat provides the majority of energy to individuals who exercise at low-to-moderate intensity (Horowitz, 2000). Fat is also required as an essential component of all of the cells in the body. Essential fats, such as the omega-3 fats found in fish and other foods, are not only required to sustain life but also have a number of reported positive effects on health (Tur, 2012). It is well known that many people don’t consume the minimum suggested intake of two servings of fish weekly and studies suggest that higher intakes confer greater benefits (Tur, 2012). For active people and sportsmen in particular, omega-3 fats may deliver further specific advantages by mitigating inflammation that is associated with heavy exercise training and therefore accelerating recovery (Tartibian, 2011). Other fats, such as CLA (conjugated linoleic acid) and MCTs (medium chain triglycerides) have been found to have other traits such as improved body composition or advantages in how they are metabolised and used for energy (Kennedy, 2012; Berning, 1996, Clegg, 2010). Amino Acids As alluded to in the protein powder section, the eight essential amino acids are responsible for building and repairing muscle and other tissues in the body (Børsheim, 2002; Tipton, 1999). Various of the amino acids have also been shown to have specific effects, such as stimulating the muscle-building process, improving blood flow, increasing hormone production, decreasing mental fatigue, increasing muscle mass and strength and a variety of other effects that are useful for sportsmen and those trying to build muscle (Pasiakos, 2011; Camic, 2010: Fisker, 1999; Fryberg, 1996; Wascher, 1997; Folland, 2000; Blomstrand, 2006). Creatine Creatine is the core component of creatine phosphate, which is essential to prolonging intense muscular contraction. Supplementing with creatine has been shown in dozens of scientific studies to significantly increase the body’s ability to repeatedly contract the muscles and to facilitate increased muscle size (Rawson, 2003). To date, there have been hundreds of studies on creatine, in thousands of research subjects and it has also been used by millions of people since it was introduced to the market over 15 years ago. In the course of all of this academic research and history of use and in long-term studies, there have been no credible reports of serious negative side effects having been demonstrated (Kreider, 2003; Jäger, 2011). Creatine has been shown to improve outcomes in

studies of patients who suffer from a variety of muscular and other diseases (Tarnopolsky, 2011; Jäger, 2011). Micronutrients This category comprises vitamins, minerals and trace elements. National and international surveys have demonstrated that a substantial percentage of the population does not achieve recommended intake levels of several micronutrients (Henderson 2003; Margaritis, 2005; Micheletti, 2001). Moreover, sportspeople and heavy exercisers may have increased requirements for some nutrients and taking supplemental amounts of some micronutrients may improve some aspects of the metabolism that may be beneficial to this population group (Margaritis, 2005; Woolf, 2006; Whiting, 2006, Micheletti, 2001). Despite a very longstanding and safe history of use, the European Commission has recently restricted the use of various forms of vitamins and minerals to those included on a positive list of micronutrient forms that the European Commission via the European Food Safety Authority have approved as safe. So quite a bit of scrutiny has been directed towards the safety of this category of products and ingredients recently. Weight/Fat Loss support A variety of products and ingredients used in fat loss support products have been shown in scientific research to induce weight loss, fat loss and to stimulate energy/fat metabolism and/or to decrease appetite (Hursel, 2011; Ludy, 2012; Keithley, 2005; Stohs, 2011; Westerterp-Plantenga, 2005; Onakpoya, 2011). As stated earlier, claims about the effects of fat loss support products have been severely restricted in Europe to those containing a handful of ingredients that have been granted approved claims. This category has been the subject of controversy over the years due to the use of ingredients which are strong stimulants and may have rare but severe side effects in some people. However, most countries restricted and/or banned the sale of strong, controversial stimulants like ephedrine, dimethylamylamine and synephrine extracts several years ago. Even in the case of caffeine, warnings are usually required, despite the fact that virtually all sports nutrition products have lower (usually substantially lower) levels of caffeine than can be obtained from a large cup of coffee (Crozier, 2012). So the controversial ingredients that have been the subject of safety concerns in the past have long been removed from this product category. Hormone Products Various ingredients have been studied and found to influence levels of hormones (Wilborn, 2010; Steels, 2011; Naghii, 2010; Topo, 2009). These include certain herbs, micronutrients and other nutrients. Again, as stated earlier, prohormones and testosterone-like ingredients and ingredients that substantially alter hormone levels in the body are not allowed and nor are products allowed to make claims that they have substantial effects on hormone levels.

Who uses Sports Supplements? The stereotype that only bodybuilders use sports supplements is exactly that. There are only enough bodybuilders to support a tiny fraction of the annual sales of sports nutrition products. The fastest growing segment of sports nutrition consumer is actually ‘lifestyle users’, who aren’t particularly athletic but are making a transition into doing more exercise Of course, the vast majority of professional and semi-professional sportsmen and athletes now use at least one form of sports supplement (Maughan, 2009; Huang, 2006). This has come about due to the substantial scientific and empirical evidence of their efficacy in improving recovery and athletic performance. However, again, this is only a small fraction of sports nutrition users. Interestingly, despite the general impression sometimes fostered by the media and the insistence amongst doctors and especially dieticians that they aren’t necessary, the vast majority of doctors and dieticians also use supplements (Dickinson, 2011; Dickinson, 2009, Dickinson, 2012). Are Sports Supplements Safe? There are four main attributes that underpin the safety of sports nutrition supplements: 1) they are comprised mostly of ingredients found in common foods 2) they are highly regulated and produced according to internationally-recognised standards 3) the vast majority of ingredients have a long history of use in humans 4) side effects from these products are extremely rare. Because the vast majority of sports supplements are composed of protein, carbohydrates, fats, creatine and micronutrients that are the same molecules found in common foods and which are typically ingested on a daily basis by humans, using these products as indicated is unlikely to result in unwanted side effects. Also, as stated several times in the preceding section, controversial and/or potentially-dangerous ingredients are already banned and have been removed from the market. Finally, the use of novel ingredients, which don’t have a long history of safe use in humans, is controlled in most EU countries.

Economic Considerations of the Sports Nutrition Market The global sports nutrition industry turns over in excess of $5 billion and is projected to be turning over $6.17 billion by 2018 (Global Industry Analysts, 2013). The UK market saw sales increase 14 per cent in 2011 and totalled $370 million and is projected to exceed $660 million by 2016 (a 12 per cent annual growth rate)(Euromonitor International, 2012). Therefore, sports nutrition represents a large and growing industry that generates significant tax revenues and is providing much needed employment opportunities in jobs that require and foster expertise in science and technology. Furthermore, the use of sports nutrition products promotes the achievement of optimum nutritional intake and health, which has implications for health care costs and social well being. In light of these economic and social benefits, we would urge politicians and regulatory bodies to consider the potential economic and social consequences of stifling this burgeoning sector of the economy. The European Specialist Sports Nutrition Alliance - About Us This briefing was prepared on behalf of ESSNA, the European Specialist Sports Nutrition Alliance. Set up in 2003 to campaign for appropriate European legislation on sports nutrition products, ESSNA is now the leading pan-European trade association in this field with over 30 Members representing a number of specialist sport nutrition businesses, from small ingredients makers, through trade associations and retailers to large multi-nationals.

Contact Us:

The European Specialist Sports Nutrition Alliance

222 Southbank House, Black Prince Road, London, SE1 7SJ, UK

Tel: +44 (0) 20 7138 3201 Fax: +44 (0) 20 7463 0691 Email: info@essna.com

www.essna.com

References and Credits All pictures courtesy of CNP Professional and Weider Publishing. Conlee RK. Muscle glycogen and exercise endurance: a twenty-year perspective. Exerc Sport Sci Rev. 1987;15:1-28. Dunford, M. Fundamentals of Sport and Exercise Nutrition. Human Kinetics, Jan 2010. Panayiotis J. Papagelopoulos, MD, DSc; Andreas F. Mavrogenis, MD; Panayotis N. Soucacos, MD. Doping in Ancient and Modern Olympic Games. Orthopedics, December 2004 - Volume 27, Issue 12. Tarnopolsky MA, Atkinson SA, MacDougall JD, Chesley A, Phillips S, Schwarcz HP. Evaluation of protein requirements for trained strength athletes. J Appl Physiol. 1992 Nov;73(5):1986-95. Phillips SM, Van Loon LJ. Dietary protein for athletes: from requirements to optimum adaptation. J Sports Sci. 2011;29 Suppl 1:S29-38. Børsheim E, Tipton KD, Wolf SE, Wolfe RR. Essential amino acids and muscle protein recovery from resistance exercise. Am J Physiol Endocrinol Metab. 2002 Oct;283(4):E648-57. Tipton KD, Gurkin BE, Matin S, Wolfe RR. Nonessential amino acids are not necessary to stimulate net muscle protein synthesis in healthy volunteers. J Nutr Biochem. 1999 Feb;10(2):89-95. Tarnopolsky MA, Atkinson SA, MacDougall JD, Chesley A, Phillips S, Schwarcz HP. Evaluation of protein requirements for trained strength athletes. J Appl Physiol. 1992 Nov;73(5):1986-95. Phillips SM, Van Loon LJ. Dietary protein for athletes: from requirements to optimum adaptation. J Sports Sci. 2011;29 Suppl 1:S29-38. Brosnan JT, Brosnan ME. Creatine: endogenous metabolite, dietary, and therapeutic supplement. Annu Rev Nutr. 2007;27:241-61. Volek JS, Rawson ES. Scientific basis and practical aspects of creatine supplementation for athletes. Nutrition. 2004 Jul-Aug;20(7-8):609-14. Rawson ES, Volek JS. Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance. J Strength Cond Res. 2003 Nov;17(4):822-31. Bemben MG, Lamont HS. Creatine supplementation and exercise performance: recent findings. Sports Med. 2005;35(2):107-25. Volek JS, Rawson ES. Scientific basis and practical aspects of creatine supplementation for athletes. Nutrition. 2004 Jul-Aug;20(7-8):609-14. Rawson ES, Volek JS. Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance. J Strength Cond Res. 2003 Nov;17(4):822-31. Bemben MG, Lamont HS. Creatine supplementation and exercise performance: recent findings. Sports Med. 2005;35(2):107-25 Bemben MG, Lamont HS. Creatine supplementation and exercise performance: recent findings. Sports Med. 2005;35(2):107-25

Bemben MG, Lamont HS. Creatine supplementation and exercise performance: recent findings. Sports Med. 2005;35(2):107-25 Henderson, L. et al. British Diet & Nutrition Survey, The Office for National Statistics and the Medical Research Council (http://www.food.gov.uk/multimedia/pdfs/ndnsv3.pdf), 2003. Tarnopolsky MA, Atkinson SA, MacDougall JD, Chesley A, Phillips S, Schwarcz HP. Evaluation of protein requirements for trained strength athletes. J Appl Physiol. 1992 Nov;73(5):1986-95. Phillips SM, Van Loon LJ. Dietary protein for athletes: from requirements to optimum adaptation. J Sports Sci. 2011;29 Suppl 1:S29-38. Ha E, Zemel MB. Functional properties of whey, whey components, and essential amino acids: mechanisms underlying health benefits for active people. J Nutr Biochem. 2003 May;14(5):251-8. Churchward-Venne TA, Burd NA, Mitchell CJ, West DW, Philp A, Marcotte GR, Baker SK, Baar K, Phillips SM. Supplementation of a suboptimal protein dose with leucine or essential amino acids: effects on myofibrillar protein synthesis at rest and following resistance exercise in men. J Physiol. 2012 Jun 1;590(Pt 11):2751-65. doi: 10.1113/jphysiol.2012.228833. Epub 2012 Mar 25. Millward DJ, Layman DK, Tomé D, Schaafsma G. Protein quality assessment: impact of expanding understanding of protein and amino acid needs for optimal health. Am J Clin Nutr. 2008 May;87(5):1576S-1581S. Tang JE, Moore DR, Kujbida GW, Tarnopolsky MA, Phillips SM. Ingestion of whey hydrolysate, casein, or soy protein isolate: effects on mixed muscle protein synthesis at rest and following resistance exercise in young men. J Appl Physiol. 2009 Sep;107(3):987-92. doi: 10.1152/japplphysiol.00076.2009. Epub 2009 Jul 9. Sindayikengera S, Xia WS. Nutritional evaluation of caseins and whey proteins and their hydrolysates from Protamex. J Zhejiang Univ Sci B. 2006 Feb;7(2):90-8. Hoffman, JR and Falvo, MJ. Protein - Which is Best? J Sports Sci Med. 2004 Sept; 3:118-130. Lands LC, Grey VL, Smountas AA. Effect of supplementation with a cysteine donor on muscular performance. J Appl Physiol. 1999 Oct;87(4):1381-5. Cribb PJ, Williams AD, Carey MF, Hayes A. The effect of whey isolate and resistance training on strength, body composition, and plasma glutamine. Int J Sport Nutr Exerc Metab. 2006 Oct;16(5):494-509. Hoffman, JR and Falvo, MJ. Protein - Which is Best? J Sports Sci Med. 2004 Sept; 3:118-130. Hulmi JJ, Lockwood CM, Stout JR. Effect of protein/essential amino acids and resistance training on skeletal muscle hypertrophy: A case for whey

protein. Nutr Metab (Lond). 2010 Jun 17;7:51. doi: 10.1186/1743-7075-7-51. Baer DJ, Stote KS, Paul DR, Harris GK, Rumpler WV, Clevidence BA. Whey protein but not soy protein supplementation alters body weight and composition in free-living overweight and obese adults. J Nutr. 2011 Aug;141(8):1489-94. doi: 10.3945/jn.111.139840. Epub 2011 Jun 15. Coso JD, Estevez E, Baquero RA, Mora-Rodriguez R. Anaerobic performance when rehydrating with water or commercially available sports drinks during prolonged exercise in the heat. Appl Physiol Nutr Metab. 2008 Apr;33(2):290-8. doi: 10.1139/H07-188. Tsintzas OK, Williams C, Singh R, Wilson W, Burrin J. Influence of carbohydrate-electrolyte drinks on marathon running performance. Eur J Appl Physiol Occup Physiol. 1995;70(2):154-60. Børsheim E, Cree MG, Tipton KD, Elliott TA, Aarsland A, Wolfe RR. Effect of carbohydrate intake on net muscle protein synthesis during recovery from resistance exercise. J Appl Physiol. 2004 Feb;96(2):674-8. Epub 2003 Oct 31. Horowitz JF, Klein S. Lipid metabolism during endurance exercise. Am J Clin Nutr. 2000 Aug;72(2 Suppl):558S-63S. Tur JA, Bibiloni MM, Sureda A, Pons A. Dietary sources of omega 3 fatty acids: public health risks and benefits. Br J Nutr. 2012 Jun;107 Suppl 2:S23-52. Tur JA, Bibiloni MM, Sureda A, Pons A. Dietary sources of omega 3 fatty acids: public health risks and benefits. Br J Nutr. 2012 Jun;107 Suppl 2:S23-52 Tartibian B, Maleki BH, Abbasi A. Omega-3 fatty acids supplementation attenuates inflammatory markers after eccentric exercise in untrained men. Clin J Sport Med. 2011 Mar;21(2):131-7. Kennedy A, Martinez K, Schmidt S, Mandrup S, LaPoint K, McIntosh M. tiobesity mechanisms of action of conjugated linoleic acid. J Nutr Biochem. 2010 Mar;21(3):171-9. Berning JR. The role of medium-chain triglycerides in exercise. Int J Sport Nutr. 1996 Jun;6(2):121-33. Clegg ME. Medium-chain triglycerides are advantageous in promoting weight loss although not beneficial to exercise performance. Int J Food Sci Nutr. 2010 Nov;61(7):653-79. Børsheim E, Tipton KD, Wolf SE, Wolfe RR. Essential amino acids and muscle protein recovery from resistance exercise. Am J Physiol Endocrinol Metab. 2002 Oct;283(4):E648-57. Tipton KD, Gurkin BE, Matin S, Wolfe RR. Nonessential amino acids are not necessary to stimulate net muscle protein synthesis in healthy volunteers. J Nutr Biochem. 1999 Feb;10(2):89-95. Pasiakos SM, McClung HL, McClung JP, Margolis LM, Andersen NE, Cloutier GJ, Pikosky MA, Rood JC, Fielding RA, Young AJ. Leucine-enriched essential amino acid supplementation during moderate steady state exercise enhances postexercise muscle protein synthesis. Am J Clin Nutr. 2011 Sep;94(3):809-18. Camic CL, Housh TJ, Zuniga JM, Hendrix RC, Mielke M, Johnson GO, Schmidt RJ. Effects of arginine-based supplements on the physical working capacity

at the fatigue threshold. J Strength Cond Res. 2010 May;24(5):1306-12. Fisker S, Nielsen S, Ebdrup L, Bech JN, Christiansen JS, Pedersen EB, Jørgensen JO. The role of nitric oxide in L-arginine-stimulated growth hormone release. J Endocrinol Invest. 22(Suppl 5):89-93, 1999. Fryberg, D. A. NG-monomethyl-L-arginine inhibits the blood flow but not the insulin-like response of forearm muscle to IGF- I: possible role of nitric oxide in muscle protein synthesis. J Clin Invest. 97(5):1319-28, 1996. Wascher TC, Graier WF, Dittrich P, Hussain MA, Bahadori B, Wallner S, Toplak H. Effects of low-dose L-arginine on insulin-mediated vasodilatation and insulin sensitivity. Euro J Clin Invest.27:690-695, 1997. Folland, J. P, Maas H, Jones DA. The influence of nitric oxide on in vivo human skeletal muscle properties. Acta Physiol Scand. 169(2):141-48, 2000. Blomstrand E. A role for branched-chain amino acids in reducing central fatigue. J Nutr. 2006 Feb;136(2):544S-547S. Rawson ES, Volek JS. Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance. J Strength Cond Res. 2003 Nov;17(4):822-31. Kreider RB, Melton C, Rasmussen CJ, Greenwood M, Lancaster S, Cantler EC, Milnor P, Almada AL. Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Mol Cell Biochem. 2003 Feb;244(1-2):95-104. Jäger R, Purpura M, Shao A, Inoue T, Kreider RB. Analysis of the efficacy, safety, and regulatory status of novel forms of creatine. Amino Acids. 2011 May;40(5):1369-83. Tarnopolsky MA. Creatine as a therapeutic strategy for myopathies. Amino Acids. 2011 May;40(5):1397-407. 12(7):e573-81. Jäger R, Purpura M, Shao A, Inoue T, Kreider RB. Analysis of the efficacy, safety, and regulatory status of novel forms of creatine. Amino Acids. 2011 May;40(5):1369-83. Henderson, L. et al. British Diet & Nutrition Survey, The Office for National Statistics and the Medical Research Council (http://www.food.gov.uk/multimedia/pdfs/ndnsv3.pdf), 2003. Margaritis I, Rousseau AS, Hininger I, Palazzetti S, Arnaud J, Roussel AM. Increase in selenium requirements with physical activity loads in well-trained athletes is not linear. Biofactors. 2005;23(1):45-55. Micheletti A, Rossi R, Rufini S. Zinc status in athletes: relation to diet and exercise. Sports Med. 2001;31(8):577-82. Margaritis I, Rousseau AS, Hininger I, Palazzetti S, Arnaud J, Roussel AM. Increase in selenium requirements with physical activity loads in well-trained athletes is not linear. Biofactors. 2005;23(1):45-55. Margaritis I, Rousseau AS, Hininger I, Palazzetti S, Arnaud J, Roussel AM. Increase in selenium requirements with physical activity loads in well-

trained athletes is not linear. Biofactors. 2005;23(1):45-55. Woolf K, Manore MM. B-vitamins and exercise: does exercise alter requirements? Int J Sport Nutr Exerc Metab. 2006 Oct;16(5):453-84. Whiting SJ, Barabash WA. Dietary Reference Intakes for the micronutrients: considerations for physical activity. Appl Physiol Nutr Metab. 2006 Feb;31(1):80-5. Micheletti A, Rossi R, Rufini S. Zinc status in athletes: relation to diet and exercise. Sports Med. 2001;31(8):577-82. Hursel R, Viechtbauer W, Dulloo AG, Tremblay A, Tappy L, Rumpler W, Westerterp-Plantenga MS. The effects of catechin rich teas and caffeine on energy expenditure and fat oxidation: a meta-analysis. Obes Rev. 2011 Jul; Ludy MJ, Moore GE, Mattes RD. The Effects of Capsaicin and Capsiate on Energy Balance: Critical Review and Meta-analyses of Studies in Humans. Chem Senses. 2012 Feb;37(2):103-21. Epub 2011 Oct 29. Keithley J, Swanson B. Glucomannan and obesity: a critical review. Altern Ther Health Med. 2005 Nov-Dec;11(6):30-4. Stohs SJ, Preuss HG, Keith SC, Keith PL, Miller H, Kaats GR. Effects of p-synephrine alone and in combination with selected bioflavonoids on resting metabolism, blood pressure, heart rate and self-reported mood changes. International Journal of Medical Sciences. 2011;8:295–301 Westerterp-Plantenga MS, Lejeune MP, Kovacs EM. Body weight loss and weight maintenance in relation to habitual caffeine intake and green tea supplementation. Obes Res. 2005 Jul;13(7):1195-204. Onakpoya I, Terry R, Ernst E. The use of green coffee extract as a weight loss supplement: a systematic review and meta-analysis of randomised clinical trials. Gastroenterol Res Pract. 2011;2011. pii: 382852. Epub 2010 Aug 31 Crozier TW, Stalmach A, Lean ME, Crozier A. Espresso coffees, caffeine and chlorogenic acid intake: potential health implications. Food Funct. 2012 Jan;3(1):30-3 Wilborn C, Taylor L, Poole C, Foster C, Willoughby D, Kreider R Effects of a purported aromatase and 5α-

reductase inhibitor on hormone profiles in college-age men. Int J Sport Nutr Exerc Metab. 2010 Dec;20(6):457-65. Steels E, Rao A, Vitetta L. Physiological Aspects of Male Libido Enhanced by Standardized Trigonella foenum-graecum Extract and Mineral Formulation. Phytother Res. 2011 Feb 10. doi: 10.1002/ptr.3360. [Epub ahead of print] Naghii MR, Mofid M, Asgari AR, Hedayati M, Daneshpour MS. Comparative effects of daily and weekly boron supplementation on plasma steroid hormones and proinflammatory cytokines. J Trace Elem Med Biol. 2011 Jan;25(1):54-8. Epub 2010 Dec 3. Topo E, Soricelli A, D'Aniello A, Ronsini S, D'Aniello G. The role and molecular mechanism of D-aspartic acid in the release and synthesis of LH and testosterone in humans and rats. Reprod Biol Endocrinol. 2009 Oct 27;7:120. doi: 10.1186/1477-7827-7-120. Maughan RJ, Depiesse F, Geyer H; The use of dietary supplements by athletes. J Sports Sci. 2007;25 Suppl 1:S103-13. Huang SH, Johnson K, Pipe AL. The use of dietary supplements and medications by Canadian athletes at the Atlanta and Sydney Olympic Games. Clin J Sport Med. 2006 Jan;16(1):27-33. Dickinson A, Shao A, Boyon N, Franco JC. Use of dietary supplements by cardiologists, dermatologists and orthopedists: report of a survey. Nutr J. 2011 Mar 3;10:20. doi: 10.1186/1475-2891-10-20. Dickinson A, Boyon N, Shao A. Physicians and nurses use and recommend dietary supplements: report of a survey. Nutr J. 2009 Jul 1;8:29. doi: 10.1186/1475-2891-8-29. Dickinson A, Bonci L, Boyon N, Franco JC. Dietitians use and recommend dietary supplements: report of a survey. Nutr J. 2012 Mar 14;11:14. doi: 10.1186/1475-2891-11-14. Schjultz, H. Sports Nutrition Market to top $6 billion by 2018, report says. FoodNavigator-USA.com. Feb 2013 Executive Summary, Euromonitor International Report. Sports Nutrition in the United Kingdom. June 2012