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Supplements for Triathletes: What Works?

The world of endurance sports is being inundated with supplements manufactured with the endurance athlete in mind. It’s easy to get wrapped up in supplementing. Before you know it you’re taking a handful of pills in the morning, a special powder for your water bottles, and another handful of pills in the afternoon. The goal of this series of posts is to help you understand which supplements appear to be effective through solid research, and which may not be worth the money.  Of course, individuals may have different needs, but for the purpose of this article, I am discussing the general endurance athlete population. But first, one important concept…

Although it is sometimes difficult to get all of the nutrients needed through diet, it is almost always better to try to meet your nutrient needs through foods than supplements. Foods, especially fruits and vegetables, have enzymes that optimize bioavailability (how much you absorb) of nutrients within the food. When nutrients are isolated to be made into supplements some of those enzymes are lost. Bioavailability of supplements varies depending on many factors, including the supplement quality, how the supplement is manufactured, what the supplement is, time of day you take it, what you take it with, and on and on. Some popular supplements have been shown to have absorption rates of less than 5%!  It is because of the variables above that you should strive to get the majority of your nutrients through an ultra-healthy diet. Put the same emphasis on diet as you do training.

Of course, there are supplements that appear to benefit endurance athletes in well designed, double blind studies. Below is a summary of well-researched supplements. There are more supplements that may be effective. This list is simply a list of those that consistently show to be effective.

The “A” List

The following supplements have consistently shown through quality, peer reviewed research to be effective for endurance athletes.

  • Multivitamin – although multivitamin supplements do not appear to improve performance in endurance athletes, they are generally an accepted general health strategy. Endurance athletes burn through a lot of nutrients during and after workouts, which can lead to depleted micronutrients. Even if these depletions are marginal, they can affect performance, recovery, and immune function. There is debate around the whether multivitamins are actually beneficial for athletes. A couple years ago a small study saw very slight performance declines in the athletes taking a multivitamin. After reviewing this study, there are many flaws to it and in my opinion it is not a valid conclusion. Therefore, I base my opinions on the many other studies that are well organized. These studies generally conclude that a multivitamin will not enhance performance, or may very slightly. However, I have yet to come across a study that tests micronutrients as part of the study. To truly understand the correlation between micronutrients and performance, a study of this sort should be performed. I can say, however, that through my experience with professional and elite amateur athletes that when we find deficiencies in an intracellular micronutrient test, then correct for those deficiencies, I typically get very positive feedback from the athlete about improved performance and quicker recovery. *Processing and brand make a difference with multivitamins, as a poorly processed multivitamin is not well absorbed. Take as indicated. My top choice for a multivitamin is from the Douglas Labs Klean Athlete line. Find it here: http://www.douglaslabs.com/product.cfm?litm=KA201344-60Must be ordered with a physician code, use the following: 2142213   
  • Fish Oils/Omega 3’s – fish oils should be an essential supplement for every endurance athlete. These super powered anti-inflammatory and antioxidant supplements are one of the most well-researched and supported supplements. They fight free radicals and oxidative stress, and reduce post-exercise inflammation. *Processing makes a difference. Omega 3’s in the triglyceride form have shown to be superior. The huge majority of omega 3/fish oil supplements out there are in the ethyl ester form because this form is easier and cheaper to produce. One over-the-counter brand that is in triglyceride form and can easily be found is Nordic Naturals. The ideal EPA to DHA ratio for athletes is 4:1. Most supplements are 2:1. This ratio is fine, but if you can find a 4:1 supplement (such as Nordic Naturals ProEPA) that is ideal. I recommend 1200-1800 mg per day with food. My top pick is Nordic Naturals ProEPA, which can be found online or in many health food stores and pharmacies.
  • Vitamin C – strenuous exercise increases production of free radicals, which can damage muscle tissue, increase muscle soreness, and create inflammation. Vitamin C is an effective antioxidant, and can be taken in high quantities safely, easily, and cheaply. Antioxidants fight the production of free radicals. Vitamin C is also an immune booster and high intensity training decreases immune function. Most professional triathletes and ultramarathoners I see have deficient immune systems throughout the peak of their training. There are well run studies that show vitamin C does reduce post-exercise muscle pain and speed recovery, then there are well run studies that conclude it likely does not. My opinion…vitamin C is easy to take, is cheap, boosts the immune system, and probably helps with recovery. I recommend taking it throughout the peak training season. My top pick for a vitamin C supplement is the Emergen-C packets, as they are bioavailable and easy to take. One packet per day (1,000mg) is adequate.
  • Iron (when indicated!) – iron should be taken under the guidance of a physician. I will repeat, iron should be taken under the guidance of a physician. The need for iron supplementation should be shown through blood testing (see my blog post on blood work monitoring). There are hundreds of thousands of endurance athletes blindly taking iron. When iron is indicated, this supplement can be essential to your well-being and ability to train and race. It can boost performance WHEN NEEDED. When taken in excess, it can be hard on the liver, cause gastrointestinal problems, inhibit zinc absorption (an important nutrient for athletes), and cause fatigue. There are several different forms of iron. My top choice is iron carbonyl, as it appears to be the most bioavailable form. Take as directed by a physician and be sure to supplement zinc when you are supplementing iron. Iron will typically cause increased intestinal gas. If you require iron supplementation, be sure to read my blog post about iron supplementation, as there are important steps to optimizing absorption of the supplement. My top pick for an iron supplement is Douglas Labs Time Released Iron (product number 7962). 90 capsules cost $10.20. Find it here: http://www.douglaslabs.com/product.cfm?litm=7962-90X  good zinc supplement also comes from Douglas labs, the Zinc Lozenges. Both must be ordered with a physician code, use the following: 2142213   
  • B12 (when indicated!) – when used correctly and at the appropriate time, B12 can help ward off anemia and pre-anemia. If you are monitoring your blood work during your training, a sudden change in the MPV (which indicates the shape of the red blood cells) and slight drop in hemoglobin and hematocrit suggest that it may be time to supplement B12 or increase your folate intake. Folate intake is best increased by using a vitamix type blender (see my blog post on Juicing). I have found that in high performing endurance athletes, B12 is often high in the blood, however deficient in intracellular (within the cell) micronutrient tests. More to come on this in a future blog post. B12 is best taken either sublingually (under the tongue), which can be found at almost any pharmacy or health food store, or via intramuscular injection, which costs more and typically requires a visit to a clinic.
  • Magnesium – research shows magnesium can increase lactic acid clearance, decrease muscle aches and cramping, and possibly improve power output and performance. Magnesium is plentiful in foods, however some studies show that in endurance athletes magnesium levels are very slow to rebuild once depleted by prolonged muscle use or training in hot, humid weather. In addition, alcohol, coffee, refined sugar, and high salt intake can deplete magnesium. Being we endurance athletes love our beer, coffee, and frequently partake in salty food binges, supplementation should be considered during peak training, especially if in hot, humid weather. Magnesium is also closely linked to potassium and calcium. When magnesium levels drop, potassium and calcium will soon follow. Drops in potassium result in severe muscle cramps. Drops beyond certain levels can be dangerous and will surely end your race and possibly send you on a ride to the hospital. 500-1000 mg/day during training (can be part of a multivitamin). For two days prior to a race, up to 1500 mg/day can be taken, however if it leads to an uneasy stomach, back off to your regular levels (too much can cause diarrhea). My pick for a magnesium supplement is Douglas Labs Magnesium Aspartate, a readily bioavailable form (product number 7405). 250mg per pill, 250 pills per bottle, $20.90. Find it here: http://www.douglaslabs.com/product.cfm?litm=7405-250X  Must be ordered with a physician code, use the following: 2142213   

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