What alternative supplements are prominent between some of female athletes?: A systematic review

Abstract

Athletes of all abilities, particularly elite athletes, are encouraged to use sports nutrition strategies that improve mental and physical performance while also supporting good health. These strategies include eating a wellbalanced diet with enough energy to meet the macronutrient and micronutrient requirements of training and competition, maintaining optimal body mass (BM) and composition, and implementing specific nutritional strategies before, during, and after training to improve performance. Female athletes experience injuries compared to male athletes so there needs to be good and appropriate injury prevention management for female athletes. This research method is a literature review with several stages. Eligibility Criteria, Information sources and search, Study Selection, Data collection Process. From 125 publications 100 articles remained after the first selection, which was adjusted for duplicates. After screening the abstracts, 70 were excluded. The full texts of 230 articles were screened using eligibility criteria. Finally, 30 studies on female/women athletes subjects were accepted for the qualitative analysis. In the articles that have been observed, several types of supplements used by female athletes appear, supplements, including iron supplements, calcium, types of drinks that contain high protein, packaged drinks that contain high creatinine, caffeine, melatonine, vitamin D, New Zealand Blackcurrant, sodium phospate. Despite the fact that female athletes outnumber male athletes in certain sports, literature on nutrient consumption and, in particular, supplement intake in female athletes is lacking. Even though female athletes are one of the groups prone to malnutrition, it is necessary to manage food intake while properly monitoring how to take supplements so that conditions in which female athletes experience malnutrition do not occur.

Headnote

Abstract:

Athletes of all abilities, particularly elite athletes, are encouraged to use sports nutrition strategies that improve mental and physical performance while also supporting good health. These strategies include eating a wellbalanced diet with enough energy to meet the macronutrient and micronutrient requirements of training and competition, maintaining optimal body mass (BM) and composition, and implementing specific nutritional strategies before, during, and after training to improve performance. Female athletes experience injuries compared to male athletes so there needs to be good and appropriate injury prevention management for female athletes. This research method is a literature review with several stages. Eligibility Criteria, Information sources and search, Study Selection, Data collection Process. From 125 publications 100 articles remained after the first selection, which was adjusted for duplicates. After screening the abstracts, 70 were excluded. The full texts of 230 articles were screened using eligibility criteria. Finally, 30 studies on female/women athletes subjects were accepted for the qualitative analysis. In the articles that have been observed, several types of supplements used by female athletes appear, supplements, including iron supplements, calcium, types of drinks that contain high protein, packaged drinks that contain high creatinine, caffeine, melatonine, vitamin D, New Zealand Blackcurrant, sodium phospate. Despite the fact that female athletes outnumber male athletes in certain sports, literature on nutrient consumption and, in particular, supplement intake in female athletes is lacking. Even though female athletes are one of the groups prone to malnutrition, it is necessary to manage food intake while properly monitoring how to take supplements so that conditions in which female athletes experience malnutrition do not occur.

Key Words: Female, athletes, supplementation

Introduction

Athletes of all abilities, particularly elite athletes, are encouraged to use sports nutrition strategies that improve mental and physical performance while also supporting good health. These strategies include eating a well-balanced diet with enough energy to meet the macronutrient and micronutrient requirements of training and competition, maintaining optimal body mass (BM) and composition, and implementing specific nutritional strategies before, during, and after training to improve performance.

Research conducted by Bakar in 2022 shows that often female athletes experience injuries compared to male athletes so there needs to be good and appropriate injury prevention management for female athletes (Bakar & Shaharudin, 2022)

On the other hand, Women's participation in competitive sports has increased in recent decades. This increase in participation has a positive impact on the world of sports by improving competition quality. However, it is becoming increasingly clear that high-intensity physical activity can have a negative impact on athletes' mental, social, and physiological health.

According to this, the majority of female athletes in Indonesia Supplement users are known not to have sufficient knowledge of supplement safety and benefits. Furthermore, young female athletes are a vulnerable group in terms of nutrition.

This is because they should need good nutrition during their adolescence to support the growth spurt, but young female athletes are also expected to perform optimally and achieve during competition (Aliyyan Wijaya & Riyadi, n.d.; Rosen et al., 2015)This research will identify the use of the supplement in female athletes so that it can be an alternative in the selection of the right supplement for female athletes

Material & methods

Eligibility Criteria

The PICOS strategy was defined as follows: "P" (participants) human subjects, "I" (interventions) oral LC treatment, "C" (comparisons) supplementation versus placebo, supplementation versus control, or pre- and post-supplementation, "O" (outcomes) muscle variables, and "S" (study design) randomized controlled trials, nonrandomized controlled trials, nonrandomized noncontrolled trials. Excluded studies met the following criteria: articles with no full-text availability, reviews, and case studies described in languages other than English Following that, the following eligibility criteria were applied: a) healthy human subjects; b) at least 12 weeks of supplementation; c) oral LC administration; d) no drug coingestion; e) no multi-ingredient supplementation

Information sources and search

The MEDLINE (via PubMed) and Web of Science databases were used to search the literature, which included all articles published from the beginning to February 2012. The terms "supplementation for women athletes" or "supplementation for female athletes" were searched for in conjunction with "exercise", "training", "athletic, and performance",

Study Selection

First, studies were evaluated using title verification between databases (duplicates were removed). The second assessment, conducted using abstracts, excluded studies in languages other than English, studies lacking full text, reviews, case reports, animal studies, and in-vitro studies. The final step was to analyze full manuscripts using the eligibility criteria described above.

Data collection Process

Each study's authors, year of publication, type of study, length of supplementation, dose of supplementation, and main effect were compiled. Finally, a thematic analysis was performed to synthesize and interpret all of the data that appeared in the included publications. Two authors (A.S., G.R.) worked independently on paper selection, data collection, and quality assessment, and all disagreements were resolved through discussion with the third author (R.O).

Results

Study Selection

125 publications were found using the search strategy described above. 100 articles remained after the first selection, which was adjusted for duplicates. After screening the abstracts, 70 were excluded because they were in languages other than English, lacked full text, or were review articles, case reports, animal or in-vitro studies. The full texts of 230 articles were screened using eligibility criteria. Finally, 30 studies on female/women athletes subjects were accepted for the qualitative analysis, with LC administered orally for at least 12 weeks with no drugs or other multi-ingredient supplements coingestion (Fig. 1).

Identification carried out by the authors in 35 articles shows that several supplements were given to female athletes, namely, among others, vitamin and mineral supplements as well as supplements taken from natural products such as vegetables and fruit. The detailed explanation is shown as follows at table 1(Dieny, Fitranti, Jauharany, & Tsani, 2021; Larson-Meyer, Woolf, & Burke, 2018)

Dicussion

In the articles that have been observed, several types of supplements used by female athletes appear, supplements, including iron supplements, calcium, types of drinks that contain high protein, packaged drinks that contain high creatinine, caffeine, melatonine, vitamin D, New Zealand Blackcurrant, sodium phospate. The following is the explanation:

Iron

There is no consensus recommendation for iron supplementation dosage, frequency, delivery method, or duration in IDNA athletes. All of these variables differed significantly across the review studies. The most common iron supplement used in the studies reviewed was ferrous sulfate (20% elemental iron [the percentage absorbed by the gastrointestinal tract]). A typical recommended treatment for IDA is 375 mg of ferrous sulfate twice daily, for a total of 150 mg of elemental iron. For reference, the recommended daily allowance of elemental iron for women (aged 19-50 years) is 18 mg per day, while men are only recommended 8 mg per day (Pedlar, Brugnara, Bruinvels, & Burden, 2018)

Calcium

The binding of calcium to troponin C is fundamental to muscle contraction, and therefore theoretically has an impact on performance. Certainly, calcium losses increase during exercise, largely through sweat, and such losses have been ameliorated by calcium supplementation of 800 mg day albeit in the presence of a low calcium diet. However, there is no evidence of calcium supplementation having a direct effect on athletic performance (Beck, von Hurst, O'Brien, & Badenhorst, 2021). Despite the fact that Ca is critical for muscle and cardiovascular function, Currently, there is no evidence that Ca supplementation has any direct effect on athletic performance for female athletes (only aerobic capacity has been studied). Nonetheless, calcium supplementation at oral doses ranging from 800 mg (over 8 days) to 1352 mg (single meal prior to exercise) or IV infusion at 156 mg (prior to and during exercise) may reduce post-exercise reductions in serum iCa and Ca loss, with lower doses having no effect

Despite the fact that Ca is critical for muscle and cardiovascular function, Currently, there is no evidence that Ca supplementation has any direct effect on athletic performance for female athletes (only aerobic capacity has been studied). Nonetheless, calcium supplementation at oral doses ranging from 800 mg (over 8 days) to 1352 mg (single meal prior to exercise) or IV infusion at 156 mg (prior to and during exercise) may reduce post-exercise reductions in serum Ca and Ca loss, with lower doses having no effect Creatine

Creatine supplementation increases lean body mass as well as strength, power, and efficacy in shortduration, high-intensity exercises. The increases in body mass were thought to be the result of increased intracellular water related to fluid shifts due to the osmotic properties of creatine. However, taking creatine in conjunction with a resistance training program yielded greater increases in body mass (Butts, Jacobs, & Silvis, 2018; Cavalcante et al., 2022; Tokatlidou, Xirouchaki, Kostopoulos, & Armenis, 2021).

Protein

Protein intake should be optimized in all athletes in order to maximize the efficiency of the skeletal muscle adaptive response to exercise training. The majority of studies evaluating the need for dietary protein have been conducted in men, with the majority of them involving resistance exercise training. Protein requirements in Female Athletes have primarily been studied using nitrogen balance methodology or by measuring muscle mass gains or losses during dietary interventions. If muscle mass accretion with resistance training is the goal, on some of our manuscripts on protein intake in female athletes found that protein intake of up to 1.6 g protein kg1 BW day1 was beneficial. sufficient to boost resistance training-induced gains in FFM by 27% on average in female athletes

Protein has muscle building and repair has made it an obvious focus of attention by athletes and coaches. Daily requirements for protein are increased due to a regular commitment to exercise and to support the synthesis of new proteins that accompanies the adaptive response to each workout or event. Indeed, the protein targets for athletes in heavy training are in the range of 1.2-1.6 g/kg body mass daily1 , which is up to double the amount recommended for sedentary populations. The highest recommendations for protein (1.6-2.4 g/kg body mass daily) are targeted to athletes who are undertaking weight loss programs. Such athletes usually desire to achieve "high quality weight loss" in which they reduce fat mass but retain muscle mass (AIS, 2021)

Caffeine

Caffeine is widely accepted as an endurance-performance enhancing supplement. The benefits of caffeine supplementation for endurance performance have been well-established. Most scientific research studies use doses of 3-6 mg/kg of caffeine 60 min prior to exercise based on pharmacokinetics (Kreutzer, Graybeal, Moss, Braun-Trocchio, & Shah, 2022). Caffeine, when consumed in a dose of 6 mgkg1 for 4 days by cyclists, does not induce tolerance to the ergogenic effects promoted by acute intake on physiological, metabolic, and performance parameters. Furthermore, when compared to the CP and PP conditions, CC and PC improved in both time and output power. In both the withdrawal and 4-day supplementation conditions, physiological and metabolic responses such as an increase in heart rate, minute volume, expired O2 fraction, blood lactate concentration (T2 and Recovery), and a decrease in expired CO2 fraction were similar (Morales et al., 2020) Melatonine

Recent findings indicate ingestion of melatonin prior to exercise enhances tolerance to training and improves competition. Apparently, the high concentrations of melatonin in the body at the time of physical activity can cause a decrease in sports performance, mainly due to the fact that this hormone has depressant effects on the sympathetic nervous system (López-Flores, Luque-Nieto, Costa Moreira, Suárez-Iglesias, & VillaVicente, 2018)

Vitamin D

a prolonged lack of vitamin D (25(OH)D) can lead to stress fractures in athletes since 25(OH)D insufficiency is associated with an increased incidence of a fracture. Stress fractures are not uncommon in athletes and affect around 20% of all competitors. Most athletes with a stress fracture are under 25 years of ageb(Chiang, Ismaeel, Griffis, & Weems, 2017; Knechtle, Jastrzębski, Hill, & Nikolaidis, 2021) additionally, another research showed that after controlling for body composition, smoking, and season, a prospective cohort study of 967 young, healthy men and women found that vitamin D status predicted endurance exercise performance but not strength or power. In a randomized placebo-controlled trial, safe simulated summer sunlight or oral vitamin D3 were effective in almost all participants in achieving clinically important vitamin D sufficiency. However, supplementing with vitamin D did not improve exercise performance, implying that vitamin D does not directly affect exercise performance (Carswell et al., 2018; Chiang et al., 2017).

New Zealand blackcurrant

Blackcurrant has a small, but significant, effect on sport performance, with no known detrimental side effects. There was an improvement in sport performance when supplementing with blackcurrant, 0.45 (95% CI 0.09-0.81, p = 0.01). The effective dose appears to be between 105 and 210 mg of total blackcurrant anthocyanins, prior to exercise (Braakhuis, Somerville, & Hurst, 2020)

Sodium phosphate

One emerging nutritional supplement that has shown some positive benefits for sporting performance is sodium phosphate. For ergogenic purposes, sodium phosphate is supplemented orally in capsule form, at a dose of 3-5 g/day for a period of between 3 and 6 days. A number of exercise performance-enhancing alterations have been reported to occur with sodium phosphate supplementation, which include an increased aerobic capacity, increased peak power output, increased anaerobic threshold and improved myocardial and cardiovascular responses to exercise (Buck et al., 2015)

Conclusions

Despite the fact that female athletes outnumber male athletes in certain sports, literature on nutrient consumption and, in particular, supplement intake in female athletes is lacking. Even though female athletes are one of the groups prone to malnutrition, it is necessary to manage food intake while properly monitoring how to take supplements so that conditions in which female athletes experience malnutrition do not occur.

As any athletic population chooses to take supplements to improve performance (as evidenced by the studies discussed above), female athletes should be aware of the potential risks of supplementation and be familiar with anti-doping regulations specific to their sport.

Conflicts of interest

The author declares no potential conflict of interest.

Sidebar

Published online: December 25, 2022

(Accepted for publication December 15, 2022)

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