Sports nutrition is no longer just aimed at super fit athletes. A growing number of older people are exercising to recover from or prevent strokes, heart attacks, osteoarthritis and other ailments

From Tiger Balm to diclofenac gel, from sticking plasters to joint supports, community pharmacists already cater for sportspeople. However, this barely scratches the surface of this rapidly growing market. According to market research company Euromonitor, UK sales of sports nutritionals will reach £471m in 2018 (up from £301m in 2013), while a YouGov survey found that one in 10 men used a sports supplement at least once a week during 2012.

This demand for sports supplements offers a possible revenue stream for community pharmacists, says Sharon Morey, a nutritionist at Quest Vitamins. However, pharmacists need to stock the right items for the right people. For example, many body builders, strength athletes and martial art participants use high-protein supplements, but they usually buy these niche products from specialised shops, gyms or dojos.

In contrast, she says, vitamin and mineral supplements, enzymes and probiotics that aid rehabilitation, prevent injury or give energy levels a boost could fit well with community pharmacists’ existing product ranges – especially as growing numbers of older people exercise to recover from or prevent strokes, heart attacks, osteoarthritis and other ailments.

Mixed evidence

Sportspeople – from reluctant gym-goers taking their first tentative steps away from the couch to ironmen and women performing almost implausible feats – can now choose from a remarkably diverse range of supplements. Morey suggests that people participating in high-impact exercise or joint-intensive activities (e.g. martial arts) may benefit from glucosamine. Zinc can bolster the immune system, she argues, while vitamin C might aid recovery by mopping up free radicals generated by exercise and promoting production of new cartilage, which helps injuries heal.

Furthermore, there is now a growing body of evidence that suggests that vitamin C may alleviate exercise-induced respiratory symptoms. About 10 per cent of the general population experience exerciseinduced bronchoconstriction, a figure that rises to approximately 50 per cent in some competitive athletic events. A meta-analysis of three placebo-controlled trials involving 40 participants reported that vitamin C reduced the decline in post-exercise forced expiratory volume in one second (FEV1) by 8.4 per cent, which was equivalent to a 48 per cent improvement.

Although further research is needed, the authors comment that, “it seems reasonable for physically active people to test vitamin C when they have respiratory symptoms such as cough associated with exercise.”¹ But it is not all good news: a recent paper reviewed 12 studies assessing vitamins C and E with, in five trials, vitamin A. Seven studies reported that the vitamins neither improved physiological parameters nor enhanced the activity of antioxidant enzymes.

Two trials showed placebo was better – suggesting that the supplements may actually impair performance – and one gave mixed results. Just two studies suggested that antioxidant supplementation produced physiological improvements. However, the studies used different methodologies to assess different doses of vitamins taken at different times by people of different sex, age and athletic prowess.

Such variations make drawing conclusions about the advantages and disadvantages of antioxidant vitamin supplements difficult.² Nevertheless, despite their reputation, free radicals generated during exercise could help drive the biological adaptations that enhance performance – which might explain why some of the studies suggest that vitamin C could prove counterproductive. Andrea Braakhuis, from the US Olympic Committee, looked at 12 studies and found that vitamin C doses of over 1g/day “impaired sport performance substantially” in four studies.

In another four studies, the impairments were not statistically significant. Braakhuis concluded that approximately 0.2g of vitamin C a day from fruit and vegetables “may be sufficient to reduce oxidative stress and provide other health benefits without impairing training adaptations”.³

 

Food intake

Some athletes, including dancers, gymnasts and martial art participants trying to enter a weight category, restrict food intake. Others, ironically, eat an unhealthy diet, so some people taking part in sport could be left prone to vitamin deficiencies, especially in B6, folate, C, E and beta-carotene.⁴ In such cases, a multivitamin and mineral supplement may help, although encouraging a balanced diet is better.

Co-enzyme Q10 serves up a similar evidential curate’s egg. “Co-enzyme Q10 can help improve endurance and might be especially useful for older people,” says Sharon Morey. “Production of co-enzyme Q10 by the body slows down as you get older.”

In one study, taking coenzyme Q10 supplementation for 12 days increased the maximum time on a treadmill by an average of 23 minutes and improved swimming time over 100 meters, but not 800 meters, in 16 teenage swimmers.⁵ Another study enrolled 22 aerobically trained and 19 untrained people aged, on average, in their mid-20s. People who took co-enzyme Q10 supplements for 14 days tended to be able to work out for longer compared to placebo.

However, the improvement did not reach statistical significance and was relatively small: time to exhaustion increased from 12.9 to 13.3 minutes.⁶ Unfortunately, these studies did not examine any benefits over longer-term treatment or enrol older people. Once again, however, some studies did not find any benefit.

One study of 23 “moderately trained healthy men” aged between 19 and 44 years reported that “although in theory Q10 could be beneficial for exercise capacity and in decreasing oxidative stress, the present study could not demonstrate that such effects exist after supplementation”.⁷ Again, the studies used various methodologies, enrolled relatively small numbers and diverse cohorts, so drawing conclusions is difficult. Given the uncertainty, pharmacists could suggest that people take the supplement for three months and use a training log to record any change.

Advising customers

Some people start exercising only after a health scare, so it is prudent to check whether there are any interactions. “Sports supplements have very few interactions but is important to be cautious if people are taking concurrent medications,” says Sharon Morey. “For example, people with a history of kidney disease should not follow a high-protein diet, and that includes using supplements.”

Occasionally, even super-fit athletes might seek their local pharmacist’s advice. Most gym users need to drink a pint of milk to provide the protein they need. However, body builders, strength athletes and some martial art participants need more protein. “People taking high-protein products may seek help with bloating and discomfort,” Sharon Morey points out.

Many high-protein products include large amounts of whey – the liquid that remains after straining curdled milk – so pharmacists could suggest a milk-free alternative. Probiotics or digestive enzymes can also ease the feeling of bloating, says Morey.