issn-nova southeastern university conference

ISSN-NOVA SOUTHEASTERN UNIVERSITY CONFERENCE FEBRUARY 20, 2016

ABOUT THE SPEAKER ▪ Douglas S. Kalman PhD RD FISSN, FACN, CCRC ▪ ▪ ▪ ▪ ▪ ▪

Director, Nutrition, QPS-MRA (Miami Research Associates) Sports Nutritionist, Florida International University (D-1, 18 teams) Sports Nutritionist, The Blackzilians (MMA team) Sports Nutrition Consultant, United States Tennis Association (USTA) Co-founder, International Society of Sports Nutrition (ISSN) Co-editor JISSN, Nutrition & Metabolism

NOVEL INGREDIENTS IN THE WORLD OF DIETARY SUPPLEMENTS ▪ DSHEA 1994: A dietary supplement is a product intended for ingestion that contains a "dietary ingredient" intended to add further nutritional value to (supplement) the diet. A "dietary ingredient" may be one, or any combination, of the following substances: ▪ ▪ ▪ ▪

a vitamin a mineral an herb or other botanical an amino acid

▪ a dietary substance for use by people to supplement the diet by increasing the total dietary intake ▪ a concentrate, metabolite, constituent, or extract ▪ Dietary supplements may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. Some dietary supplements can help ensure that you get an adequate dietary intake of essential nutrients; others may help you reduce your risk of disease. Ref: http://www.fda.gov/AboutFDA/Transparency/Basics/ucm195635.htm

GOT TO START WITH ALPHA! ▪ Alpha, the “top dog”, or is it? ▪ Alpha-glycerylphosphorylcholine (“A-GPC”) ▪ Once ingested, metabolized into phosphatidylcholine, a source of choline. ▪ Circulating choline levels have relationship with biosynthesis of acetylcholine.

▪ Cholinergic processes are used for muscle contraction. ▪ RDBCT with x-over, 13 subjects, 600 mg dose x 6 days ▪ Isometric test of mid-thigh pull & upper body ▪ Significant effects for mid thigh pull, but not upper body ▪ Benefit for speed & power athletes for lower body force production? JISSN 2015;12:42

DOWN WITH D? ▪ Vitamin D is critical for bone health and calcium homeostasis, perhaps affecting athletic performance.

▪ Sports played outdoors typically has greater sun exposure. ▪ Study examined Vitamin D levels of professional American football players. ▪ 80 players, 1 NFL team. Mean age 26.5. ▪ Examined Vitamin D levels and relationship to injuries. ▪ Mean Vit D level was subpar at 27.4 ng/ml with Black players (25.6 ng/dl) significantly lower than White players (37.4 ng/dl). ▪ Vit D levels related to bone fracture. ▪ Optimal levels for sport are said to be ~80 ng/dl

Am J Sports Med 2015;43(5):1241-1245

POTENTIAL HEALTH BENEFITS OF CREATINE MONOHYDRATE ▪ Short-term supplementation resulted in an increase in strength, power, and lower-body motor functional performance in older women without any adverse side effects (Eur J Appl Physiol, Gotshalk LA (2008)) ▪ Supplementation reduces neural cell loss in acute and chronic neurological diseases (Brain Research Bulletin,R.H. Andres et al. (2008))

▪ It is most effective as a treatment paradigm in Huntington's and Parkinson's disease but appears to be less effective for ALS and Alzheimer's disease.(Neuromolecular Med , Dhihetty PJ(2008)) ▪ Supports Healthy Cognition even with sleep deprivation (Cook 2011 & Harris 2006) ▪ Research has found supplementation “increases muscle phosphagen levels, improves repetitive high-intensity exercise performance, and promote greater training adaptations.” (Amino Acids, Jäger R (2011))

DRINKABLE MAGIC WINGS? ▪ Many “energy drinks” are on the market. ▪ Studies do demonstrate the utility of some of these products for enhancing shortterm performance. ▪ Key common ingredients include taurine, caffeine and glucuronolactone. ▪ Study examining Sugar-free Red Bull vs Water plus caffeine (REE and RQ tested).

▪ Test period for 2 ours after drinking product. RDBCT with x-over. ▪ Great news! Sugar free Red Bull increased REE by 4% Huge!!! However, so did Water + 120 mg caffeine. Minor effect on RQ for SF-RB (enhanced CHO oxidation).

▪ Appears any effects of SF-RB are due to the caffeine.

Obesity 2015;23(1):16-19

FEMALE ATHLETE’S MATTER ▪ Females are typically underrepresented in exercise-nutrition studies.

▪ Citrulline is an amino acid which is produced by the urea cycle & is also a precursor for NO, that is, a vasodilator for normal function of pulmonary vasculature. ▪ 15 F in a RDBCT tested 8 gm Citrulline Malate vs Placebo for Upper & Lower Body Strength. ▪ Six sets of RTF for 80% 1RM for bench & leg press. Participants tested 1 hour post ingestion. ▪ Statistically improved BP (34.1 ± 5.7 vs 32.9 ± 6;p=0.045) ▪ Statistically improved LP (66.7 ± 30.5 vs 55.13 ± 20.64; p=0.03) ▪ RPE lower with CM (7.9 ± 0.3 vs 8.6 ± 0.2; p= 0.02)

▪ Prior studies demonstrate benefit in males, first one in females.

Eur J Nutr 2015 Dec 11 ePub ahead of print. http://www.ncbi.nlm.nih.gov/pubmed/26658899

EURYCOMA LONGIFOLIA ▪ Often known as “Malaysian ginseng” and Tongkat Ali ▪ Purported to affect male androgen hormones and other aspects of well-being. ▪ 63 moderately stressed adults RDCT for 4-weeks (200 mg/d Physta® or placebo). ▪ Outcomes tested: mood states (POMS), salivary cortisol, testosterone. ▪ Profile of Mood States: significant improvement over placebo in Tension (-11%), Anger (12%) and in Confusion (-15%). ▪ Significant effects on Testosterone (+37%) From ~300 mg/dl to ~500 mg/dl ▪ Significant reduction in Cortisol (-16%) versus Placebo.

▪ Tongkat Ali (Physta) via water extraction and standardization (US Patent to MIT along with Malaysian government #7,132,117) ▪ Recent study in older adults (50-72 y.o.) using 400 mg/d demonstrated positive significant effect on testosterone (total and free).

JISSN 2013, 10:28. Andrologia 2014;46(7):708-721. Phytother Res 2014;28(4):544-550.

TIMING MATTERS OR YOU ARE WASTING YOUR MONEY ▪ Do you Pre? ▪ RDCT with cross-over.

▪ Age ~55 y.o., ~93 kg & ~179 cm. ▪ Creatine dosed 20 grams 3-hr prior to training test vs. Placebo with 7-d washout. ▪ RTF at 70% 1-RM for 3-sets leg & bench press, 1 min rest b/w sets. ▪ Set effect observed. ▪ Decline in performance from Set 1 to 2 to 3 similar with CrM & Placebo.

▪ Bolusing creatine pre-training has no apparent benefit for upper or lower body muscle performance.

SERUM P53 ▪ In the serum of healthy subjects, the presence of p53 protein and anti-p53 antibodies are extremely rare. Mutations in this gene cause an accumulation of non-functional proteins, due to increased stability and a longer half-life of several hours compared with the 20 min half-life for wild-type p53. The accumulated protein then acts as an antigen, with subsequent development of antibodies (antip53 antibodies). ▪ Under stress P53 levels can accumulate resulting in cell cycle regulation, DNA replication & repair, cell stress response, cell differentiation and apoptosis.

▪ Question: can exercise increase apoptosis and what effect does Creatine have? ▪ RDBCT 20 g CRM x 7 d vs Placebo ▪ Aerobic exercise to exhaustion ↑ S p53 & IGF-1 levels. With Creatine S p53 resulted in ↓ levels & no effect on IGF-1. ▪ Creatine appears to help prevent apoptosis (programmed cell death).

J Res Med Sci 2015:20(8);733-738.

HOW IS YOUR CORTICOMOTOR EXCITABILITY? ▪ Interrupting oxygen supply compromises brain and other functions. ▪ Chronic energy disruption (ischemia) can have long-term consequences (disease states). ▪ Augmenting brain local energy stores may be neuroprotective and have a therapeutic role. ▪ 15 healthy adults Cr or Pla x 7 day (7d tx – 5 week washout) ▪ Hypoxic gas tx (10% oxygen) x 90 min – global O2 deficit, impaired neuropsychological processes.

▪ Hypoxic induced ↓ attentional capacity prevented by creatine. ▪ Supplemental Cr augments neural creatine (9%), ↑ corticomotor excitability & prevents decline in attention which occurs durinh severe O2 deficit.

▪ Creatine is neural and brain protective.

J Neurosci 2015;35(4):1773-1780

JUST BEET IT ▪ Nitrate ingestion improves exercise performance.

▪ Dietary sources of Nitrate & Nitrites exist. ▪ Beetroot is one such tasty food. ▪ RDBCT to consume 200 gram whole baked beetroot (200 g w/ ≥ 500 mg nitrate) VS cranberry relish (caloric placebo). ▪ Two 5km TTE 75 min after BR or CR (1x for each condition0 ▪ Beetroot running tended to be faster (12.3±2.7 vs 11.9±2.6 km/hr p=0.06)

▪ During last 1.1 mi (1.8 km) of the 5km, BR group was 5% faster (12.7±3 vs 12.1±2.8;p=0.02). ▪ RPE was lower with BR (p=0.04) ▪ Eat a BR 75 min training if looking to push it (↑HR & lactate exercise benefits from BR)

J Acad Nutr Diet 2012;112(4):548-552

CARNITINE ▪ L-carnitine can come in many different forms. Form does not effect function in the body.

▪ Recent RDCT 2x/day of 80 g CHO or 1.36 g L-carnitine + 80 g CHO ▪ Exercise at 50% VO2 max pre vs post for 30 minutes ▪ 73 of 187 genes relating to fuel metabolism were upregulated in Carnitine vs. Control after 12 weeks, with 'insulin signaling', 'peroxisome proliferator-activated receptor signaling' and 'fatty acid metabolism' as the three most enriched pathways in gene functional analysis.

▪ Weight and Fat gain in CHO only group, not in L-CARN group ▪ Long-term L-Carnitine use may augment beta oxidation in the obese

J Physiol. 2013 Sep 15;591(18):4655-66.

MUSCLE CARNTITINE ↑ - FAT MASS NO CHANGE

BURN BABY BURN ▪ L-carnitine group with significant increase in EE during moderate exercise.

▪ No effect on fat oxidation. ▪ Where does the energy burned go? ▪ Extra CHO = fat gain? (160 gm/d)

http://www.ncbi.nlm.nih.gov/pubmed/23818692

SOY WHAT? ▪ Soy is often thought as a controversial bean. ▪ Some believe soy has an estrogenic effect in men (it doesn’t), in facts has + effect on the T/E ratio & an additive effect with whey for muscle building1 ▪ Soy protein contains isoflavones, one which is known as genistein. ▪ Genistein is known to affect fatty acid metabolism. ▪ Specifically, the MOA is know known: genistein induced the expression of genes of fatty acid oxidation in the skeletal muscle of Zucker fa/fa rats and in leptin receptor (ObR)silenced C2C12 myotubes through AMPK phosphorylation. Furthermore, the genisteinmediated AMPK phosphorylation occurred via JAK2. Additionally, the genisteinmediated induction of fatty acid oxidation genes involved PGC1α and PPARδ. 2 ▪ Genistein increased fatty acid oxidation in both the control and silenced C2C12 myotubes, as well as a decrease in the RER in mice. ▪ Unexplored agent for potential use in enhancing FA oxidation.

1 http://link.springer.com/article/10.1186/1550-2783-4-4, 2

http://www.ncbi.nlm.nih.gov/pubmed/24013029

NITROSIGINE ▪ FDA GRAS unique compound comprised of arginine & inositol: inositol-stabilized arginine silicate. ▪ ASI has been previously shown to significantly enhance blood levels of arginine up to six hours post-dose1. Dose, 1500 mg/d. ▪ Interesting blood flow and exercise effects2:

1 Clinical

Pharm: Adv and Applica. 2015; 7:103-109, 2 FASEB Journal. 2015;29:748.2

NITROSIGINE - MOOD STATES AND RECOVERY PROFILE OF MOOD STATES - VIGOR

JISSN 2015;12(Suppl 1):P14

CELLULAR MUSCLE DAMAGE

ENHANCED COGNITIVE FLEXIBILITY

Harvey P. The effects of inositol-stabilized arginine silicate on cognitive function. 2015 American College of Nutrition Conference presentation. https://www.scripps.org/sparkle-assets/documents/acn_brochure_2015.pdf

RE-CONFIRMED ENHANCED COGNITIVE FLEXIBILITY


BETTER BRAIN UNDER STRESS


UNINTENDED EFFECTS? ▪ There are known-unknowns, unknown-unknowns and then there are clusterf@*&$.

▪ Endocrine disruptors may be associated with cancer and other diseases. ▪ Estrogenic endocrine disruptors are typically not wanted nor thought about. ▪ To measure if a product or compound is a disruptor, you test for 17β-Estradiol equivalent activity. One measures this by in vitro reporter gene assays (RGA). ▪ Of concern is 80% of 116 sport supplements tests are high in Estrogenic activity. ▪ 33 of 50 products tested further revealed significant levels of estrogenic disruptor activity. Levels in supplements higher than in typical omnivore diet!

▪ In 13 of the 50 tested products, the levels of estrogenic disruptor activity was higher than the known acceptable daily intake levels (ADI). ▪ Tested products included whey, DHEA, creatine, protein bars, power-bars, etc. ▪ Most at risk, adolescent males and post-menopausal women. Food Chem. 2014 Sep 15;159:157-65, http://www.nutraingredients.com/Research/Sports-supplements-expose-consumers-tohigh-levels-of-oestrogen-Study

NEMO – THE SUPPLEMENT SOURCE

Mar. Drugs 2014, 12(5), 2357-2382

BAMBI – YOU DEALER YOU ▪ Deer Antler Velvet is oft marketed as having special properties including containing natural growth hormones and IGF-like compounds. ▪ Products with DVA have made “Super Bowl” conversations (Ray Lewis, Baltimore Ravens). 1

▪ Recent analysis of six commercial DVA products revealed: ▪ METHODS: IGF-1 was extracted from the six deer antler velvet supplements using chloroform and acetonitrile precipitation methods. Ultra-performance liquid chromatography/tandem mass spectrometry (UPLC/MS/MS) methods were developed to measure intact IGF-1 protein and IGF-1 trypsin peptides using a triple quadrupole mass spectrometer. Five deer-specific and five human-specific multiple-reaction monitoring (MRM) transitions for intact IGF-1were measured as well as six deerspecific and seven human-specific MRM transitions for an IGF-1 trypsin peptide.2 ▪ RESULTS: The peak area from each MRM transition was used to calculate the product ion ratios relative to the most abundant transition. Product ion ratios measured in the supplements were matched to ratios measured in purified protein standards. A match to human IGF-1 was identified for all the MRM transitions measured in four of the supplements tested.

▪ CONCLUSIONS: The presence of a pharmaceutical protein, human IGF-1, was confirmed in four commercially available products sold as all natural, nutritional supplements. These methods can be used to screen additional products to further prevent the illegal sale of adulterated supplements. 1 http://news.nationalgeographic.com/news/2013/01/130130-deer-velvet-antler-spray-science-health-football-sports/, 2 Rapid

Commun Mass Spectrom. 2013 Oct 15;27(19):2170-8.

DOES INTRA MATTER? ▪ Intra – new marketing platform by DS companies to sell products & convince the consumer that nutrition during a workout matters. ▪ Recently, Branched Chain Amino Acids have been suggested as a nutrient for aiding exercise and nutritional status.

▪ A new thorough review paper states there is an optimal ratio for the BCAA’s: 23/1/1g relationship between leucine / isoleucine and valine amino acids. ▪ It is observed that there is a lesser degree of pain and muscle damage, less perceived exertion and mental fatigue, greater anabolic response in recovery period and improved immune response when supplemented with BCAAs. ▪ However the studies do not point to if there is a benefit to using BCAA pre or during training. ▪ Best bet, if training is not longer than 75 minutes and up to 2x a day coupled with a reduced caloric intake, no need for BCAA product.

Nutr Hosp. 2014 Nov 16;31(2):577-89, http://www.aulamedica.es/nh/pdf/7852.pdf

L-LEUCINE ▪ Leucine is derived from pig fur and duck feather, maize and soybean.

J Food Sci. 2013 Mar;78(3):H490-4.

HIGHLY-BRANCHED CYCLIC DEXTRIN ▪ Novel, highly branched cyclic dextrin (HBCD) produced from waxy corn starch using a branching enzyme has an average molecular weight of 400,000 D. ▪ HBCD has high solubility, low viscosity, and is tolerant to retrogradation. ▪ Gastric emptying time is shorter for drinks containing HBCD compared with glucose and standard dextrin due to having a much lower osmotic pressure. ▪ Exercise 1 hour, dose 15 gm HBCD, run for additional hour. ▪ The RPE increased during exercise and its increase was significantly less at 30 and 60 min after ingesting HBCD than maltodextrin.

ANABOLIC PLANTS ▪ Kampo medicine in Japan is the use of traditional plants for well-being.

▪ One such product that olds interest for Sport and Muscle Building is Kamishimotsuto. ▪ It contains is a supplement containing 13 different herbs including Phellodendron bark, Anemarrhena rhizome and ginseng. ▪ Lab based research indicates this Kampo herbal medicine has anabolic effects on mTOR pathway.

▪ What about exercise plus Kamishimotsuto? Dose 500 mg/kg, which is a HED of 81 mg/kg BW. ▪ RESULTS: KST supplementation for 7 d significantly increased basal p-Akt (Ser473) levels compared with PLA, phosphorylation of the signaling proteins and MPS at baseline were otherwise unaffected. p-p70S6K and p-rpS6 levels significantly increased 1 h and 3 h after exercise in the PLA group, and these elevations were augmented in the KST group (P < 0.05). Furthermore, MPS at 6 h after resistance exercise was greater in the KST group than in the PLA group (P < 0.05). ▪ CONCLUSIONS: While resistance exercise alone was able to increase p70S6K and rpS6 phosphorylation, Kamishimotsuto supplementation further augmented resistance exercise-induced muscle protein synthesis through mTORC1 signaling. ▪ Time for human studies! Expect to see this Kampo product in sport nutrition circles before long.

Nutrition. 2016 Jan;32(1):108-13

TIBET HAS THE ANSWERS ▪ Padma 28 – Tibetian medicine (legal in US as a dietary supplement).

▪ Traditional use for intermittent claudication, the product is also used for circulatory disorders with symptoms such as; tingling sensation, formication, feeling of heaviness and tension in the legs and arms, numbness of the hands and feet and calf cramps. ▪ No pure exercise studies yet. ▪ Positive studies in exercise with IC

▪ Early data shows enhance circulation and anti-inflammatory effects ▪ Worthy to explore similar to Beet Root or Citrulline.

Angiology. 1993 Nov;44(11):863-7, http://www.padma.ch/en/products/padma-28/, Journal of Vascular Investigation 1998; 4(3): 129-136.

POMEGRANATE BAM!

Appl Physiol Nutr Metab. 2014 Sep;39(9):1038-42

HMB ▪ In horses, HMB increased running performance by 10% ▪ Mechanisms of action either hemoglobin or increase in muscle mass ▪ Dose used 10gm/d (horses, in humans 3-6 gm most common) ▪ Higher nitrogen retention (15% over placebo) ▪ Cyclists apparently increased VO2 max and decreased lactate threshold ▪ May increase fatty acid oxidation within the muscle cell-mitochondria ▪ Appears to affect LDH activity, might impact myofibril integrity

▪ Newer training studies demonstrate no clear cut reduction of muscle damage. ▪ Appears to reduce sarcopenia (animal studies). Assoc. Equine Sports Med Proc.1998:23-24. Journal Strength Cond Res 2001;15(4): 491–497. FASEB J. 1998;12:A950 (Experimental Biology, abstract). 2009: http://www.biomedcentral.com/content/pdf/1743-7075-6-6.pdf. 2010: http://etd.lib.fsu.edu/theses/available/etd04232010-220447/

JUVEN® / MUSCLE ARMOR / REVIGOR ▪ Juven® is a medical food marketed by Ross Laboratories. Also sold as “EAS Muscle Armor” and “ReVigor”. ▪ Contains HMB, Arginine and Glutamine (patented combination with IP). ▪ HMB decreased proteolysis (down regulation of the ubiquitin-proteasome pathway), enhanced effect when combined with EPA (eicosapentaenoic acid) ▪ Dose 0.25 gm/kg HMB with 0.6 gm/kg EPA ▪ Cancer cachexia reversal. ▪ Enhances collagen deposition (wound repair) ▪ Enhances FFM in Stage IV cancer.

▪ Dose: 3gm HMB, 14 gm arginine, 14 gm glutamine = 3.59 gm Nitrogen

Cancer Res 2005;65(1):277-283. Cancer Res 2004;64:8731-8735. Annal Surg 2002;236(3):369-275. Amer J Surg 2002;183:471-479.

“MAKING BETA ALPHA” ▪ Delaying fatigue: ▪ Improve performance ▪ Improve exercise capacity

▪ Augment the effects of training through greater intensity and training volume

“Fatigue Makes Cowards of Us All” Vince Lombardi

POTENTIAL CAUSES OF MUSCLE FATIGUE ▪ Dehydration ~ 1 to 2%

▪ Energy Depletion ▪ Glycogen – Moderate Exercise Intensity (75% VO2max) lasting ~2 hours ▪ Phosphocreatine depletion – Explosive exercise ~ 15 seconds

POTENTIAL CAUSES OF FATIGUE CONT. ▪ Metabolite Accumulation from High-Intensity Exercise ▪ Rapid use of ATP and Glycogen anaerobically leads to a significant increase in Hydrogen ions (H+) with a drop in intramuscular pH (acidosis). ▪ Metabolic acidosis interferes with the muscle’s contractile process and the body’s ability to generate ATP.

▪ Types of Exercise that increase H+ levels ▪ Resistance training (Hypertrophy Rx) ▪ Repeated Sprints or repeated maximal muscle contractions with minimal rest ▪ Sports Example: Soccer, Basketball, Boxing, wrestling, rowing, cycling etc… ▪ And of course MMA (combat sports)

MUSCLE BUFFERING CAPACITY ▪ Muscle buffering capacity (MBC) is the ability to buffer or regulate H+ accumulation during high-intensity exercise ▪ 1st line of defense ▪ Intracellular Bicarbonate buffering system, ▪ Bicarbonate, amino acids, inorganic Phosphates, Creatine Phosphate ect..

▪ Intracellular non-bicarbonate buffering system ▪ Carnosine ▪ Scientist have suggested that carnosine may buffer H+ at a higher rate during intense exercise compared to Bicarb. System.

▪ 2nd line of defense ▪ Export of H+ out of the muscle cell ▪ Extracellular Bicarbonate buffering system (blood pH)

▪ MBC is related to Intracellular pH Threshold ▪ It is the maximum exercise intensity that can be maintained without exceeding MBC. ▪ Increasing Intracellular pH Threshold would increase MBC ▪ Research suggests that indirect anaerobic threshold measures (Lactate and Ventilatory Thresholds) may reflect Intracellular pH threshold. (Marsh et al. 1991).

INCREASING MUSCLE BUFFERING CAPACITY HAS BEEN SHOWN TO IMPROVE: ▪ Short (30 to 60s) to long (1-2min) sprint performance ▪ Repeated sprint performance ▪ Time to exhaustion ▪ Peak power output ▪ Anaerobic Threshold Measures ▪ OBLA ▪ Ventilatory Threshold

▪ Lactate Threshold ▪ Neuromuscular fatigue threshold

Raymer et al. 2007, Bell et al. 1988, Juel et al. 1989; Susuki et al.2004; Edge et al. (2007, 2006), Stout et al. (2007), Hill et al. (2007)

BETA-ALANINE GUIDELINES: ▪ It would appear that that 3 to 6 g β-alanine supplementation per day for at least 28 days may significantly increase skeletal muscle [carnosine] in trained and untrained Men and Women

▪ Increasing Carnosine levels (by β-alanine supplementation) appears to delay fatigue by increasing skeletal muscle buffering capacity.

▪ There appears to be a significant effect of beta-alanine supplementation on Anaerobic Threshold measures – (PWCFT, LT and VT) and Time to Exhaustion in men and women (trained and untrained)

▪ There may be an additive effect of supplementing β-alanine during high-intensity endurance or resistance training versus training alone on muscle carnosine levels

▪ There may be an additive effect of supplementing β-alanine and creatine during a resistance training program on training volume, muscle mass gains and body fat in trained athletes ▪ Acutely, pre-session, post session or pre next session of day. Typically part of a pre-training nutrition regimen.

QUESTIONS? ▪ Thank you for all attending! ▪ Please do not forget to Register for the June ISSN Annual Conference!

▪ Thank you to Dr. Antonio and NSU for hosting this conference ▪ Feel free to contact, if any questions ▪ [email protected]