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Weight Training and Med Interaction
Apr 12, 2007

Dr. Bob, I have been working out for several years now and usually drink a "Speed Stack" (matabolism speed-up) before I work out. Since Finding out that I am positive, a year ago, my doctor told me to stop drinking/taking anything that might increase my metabolism. My doctor said that it might metablisize my meds (Atripla) faster. Do you agree with my doctor or do you think it's harmless to speed up!

Thank You -

Response from Dr. Frascino

Hi,

"Speed Stack" has a variety of products on the market. Most contain a hefty dose of caffeine. In addition, they contain other stimulants, like guarana and bitter orange, which contains synephrine, a new popular alternative to ephedrine. Ephedrine was the active ingredient in Ephedra, which the FDA banned in 2004 after it was linked to problems with heatstroke deaths among young athletes. I'll reprint an article from the New York Times below that discusses the potential health risks of Speed Stack and other energy drinks. Personally, I don't recommend these products. Potential drug-drug interactions with HIV meds and other drugs have not been studied. I prefer a fine espresso before hitting the gym. You might give that a try.

Dr. Bob

Energy Drinks Are Fueling Concerns

Tony Cenicola/The New York Times Published: June 19, 2006

THE cloudy purple drink in my glass had scarier instructions than most prescription drugs.

I was to drink only a quarter-bottle of EndoRush at a time, and only if I was over 18 or under 50. After 30 minutes, I would need to assess my tolerance. I could not have any other caffeine or expose myself to excessive heat after drinking EndoRush. Blood-pressure problems, depression or pregnancy would mean no EndoRush for me at all. If I could pass the tests, EndoRush, which can be bought at gyms and nutritional-supplement stores, promised to give me endurance, energy, performance and mental focus claims that its label points out have not been evaluated by the Food and Drug Administration. The drink draws its powers from a long list of ingredients, which range from stimulants like caffeine and the brain-enhancing drugs called nootropics to more than 4,000 percent (that's not a typo) of the daily requirement for Vitamin B12. It would take days to research thoroughly the two dozen unusual stimulants and amino acids in EndoRush. Well, now, maybe less. After just four ounces, my heart is beating, my face is flush and I feel the need to do something anything quickly. But would I want to work out feeling like this? EndoRush is at the extreme edge of the energy and sports drink continuum, but the concoction and its less-scary cousins are part of the fastest-growing slice of the beverage market. Driven by a combination of young consumers who mix energy drinks like Red Bull with vodka to keep the party going and athletes looking for any kind of edge, the category has grown by 130 percent since 2000. Energy and sports drinks combined were a $1.83 billion market in 2005, according to David Morris, an analyst with the Mintel market research group. It used to be that only the elite gym rat carried a bottle of water. Now a bottle of water is as common as expensive workout shoes. "The energy drink or sports drink is now the premium statement connected with exercise," Mr. Morris said. Energy drink manufacturers hand out samples at elite sporting events. Classic sports drinks like Gatorade can be found in some high school vending machines. Soccer players in elementary school drink Vitamin Water, which offers flavors like Tropical Citrus, an "energy" formula laced with more stimulants than a cup of coffee. As the market grows, so do concerns about the safety of combining so much stimulation with exercise particularly for the weekend or adolescent athlete. David Ellis, a sports nutrition expert and registered dietitian who helps train both collegiate and professional football players, says he is worried about the cavalier attitude athletes take toward energy drinks. "There is no getting away from these things," he said. "They are absolutely in every locker room." The point of drinking any fluid is to rehydrate the body. Tennis players can lose as much as two quarts of water an hour, and a professional football player working out in August can lose a quart and a half, said Jeff Zachwieja, a scientist at the Gatorade Sports Science Institute in Barrington, Ill. Water works best to replace those fluids, but sometimes athletes want more. Like other trainers who handle high-level athletes, Mr. Ellis says he understands the value in delivering electrolytes, water and even low levels of stimulants like caffeine to an athlete whose body may be compromised under the stress of performance. Intense physical performance knocks out the carbohydrates stored in an athlete's muscles. Adrenaline speeds the loss of electrolytes, including sodium and potassium, which are critical for nerve and muscle function. Sports drinks like Gatorade replenish carbohydrates through forms of sugar, and electrolytes with added salt and other minerals. Energy drinks take things a step further by adding stimulants. Some list straight caffeine on the label. An 8-ounce can of Red Bull, for example, has 80 milligrams of caffeine. The same amount of drip coffee has at least 100 milligrams. Speed Stack, a product from American Body Building, has 250 milligrams. But Speed Stack and other energy drinks have other kinds of natural stimulants, like guarana, derived from a South American plant, and bitter orange, which contains synephrine, a newly popular alternative to ephedrine. Ephedrine is the active ingredient in ephedra, once included in some diet and performance-enhancing drinks. The F.D.A. banned ephedra in 2004 after it was linked to heart problems and heatstroke deaths among young athletes. Although the ban is being challenged in the courts, most trainers tell their clients to avoid ephedra, which according to the F.D.A. has been a factor in thousands of health-related complaints and as many as 80 deaths, including that of Steve Bechler, a 23-year-old pitcher with the Baltimore Orioles who collapsed during a workout in 2003. The Broward County, Fla., medical examiner concluded that Mr. Bechler's use of ephedra contributed to his death from heatstroke. For some athletes, an energy drink laced with stimulants from various sources can cause problems because it is almost impossible to know how much stimulant actually is in each drink, Mr. Ellis said. Drinking too much can produce a false sense of well-being. "They help blunt your perception of pain," he said. "That might be good in the short term, but the bad news is if you don't feel the fatigue in a hot, humid environment, your body won't make you slow down to minimize overheating. Exertional heatstroke is a real possibility." Athletes who rely on energy drinks can begin an addictive cycle. "The question becomes, How do you get to sleep at night?" Mr. Ellis said. "Athletes who use too much are still gnashing their teeth with their hair standing up at 1 or 2 in the morning. A lot of times, they'll use alcohol to wind down. The stimulant-alcohol cycle is the quickest way to end an athletic career." Energy drinks are particularly appealing for young athletes. And brands like Hansen Natural Monster Energy, Sobe Adrenalin Rush and Arizona Caution Extreme Energy Shot are aimed at the young. A 2005 survey by the Simmons Market Research Bureau found that 62 percent of people ages 18 to 24 reported having used an energy drink during the previous week. That many of the stimulants in those drinks have not been approved by the government or are not even part of the common nutrition vernacular is part of the draw. "Instead of that being necessarily negative, the esoteric new ingredients appeal to the younger, more adventurous consumer," said Mr. Morris, the marketing analyst. Matt Sulam, who lives on Long Island, is a personal trainer with 17 years of experience. He said he indulged in the occasional diet Mountain Dew after a workout and encouraged hard-working clients who aren't excessively overweight to use sports drinks, which he calls "the E-ZPass of electrolyte replenishment." He said he didn't see anything wrong with athletes' wanting to drink something to give them a little more energy, but he counseled moderation and education. "These things aren't water," he said. "I tell people before you take anything read the labels and save your receipts because likely there's something in there that will not agree with you or raise your heart rate up past the point you're used to when you're exercising." Despite the many warnings, athletes seeking an advantage are unlikely to heed them, especially if they drink something and then have a great workout or a winning performance immediately afterward. Marc Lauzon, 45, has competed in five Ironman contests. His San Francisco company, TriBike Transport, helps triathletes move their bicycles to races. He spends a lot of time with high-performance athletes, and said he had seen a rise in the number of athletes devoted to certain energy drinks. But there is no way to test whether energy drinks help improve performance, he said. "You can do everything exactly right one day and have a great race and do it the same next time and have a really bad day," he said. "But when people try something and they happen to have a great day on it, they'll stick with it no matter what." Mr. Lauzon said he didn't use energy drinks. Instead, when he ran out of gas during some of his Ironman contests, he said, he turned to a more traditional drink: Coke. "It's amazing the boost you can get from it."


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