ISSN Position Stands On Supplements & Nutrition

The ISSN recently concluded their event where they took position stands on all things supplements and nutrition. One of the beauties of science and sports nutrition is everything is constantly changing. Sports researchers are always spending time and money exploring and learning more about human performance and the role that nutrition plays. Although it is a relatively new field, new findings and information are constantly being discovered.

Today we want to look at several position stands of the International Society of Sports Nutrition or ISSN for short. Sparked by the idea of Susan Kleiner, Ph.D. RD, the ISSN, was then cofounded by Jose Antonio Ph.D., Doug Kalman Ph.D. RD, Richard Kreider Ph.D., and Anthony Almada MSc. Together, they wanted to form an authoritative organization that could monitor research and develops a cohesive system on the effectiveness and use of nutrition and ergogenic aids. Since its inception in 2003, the ISSN has done just that, growing into the premier organization for authoritative information on all things nutrition and human performance.

ISSN recommendations

To act as benchmarks for the most popular topics, the ISSN has developed "stands" that lay out their conclusions on the known body of research. Then, as new research is done, the ISSN reevaluates its stands to perhaps change things they once thought were true (this is an actual scientific model) or add new discoveries.

The ISSN just reevaluated their stands, and we had the privilege of sitting in on their discussions today, and so now, we want to bring you the most up-to-date information on the ISSN's stands! And we'll also cover any other cool info given by these true experts.

ISSN Position Stands On Supplements & Nutrition

On February 12th, 2022, the ISSN held a live conference online where several leading experts in their fields covered their position stands with regards to supplements and nutrition. The conference was moderated by Jose Antonio PhD, Cassandra Evans MS RD CISSN, Veronica Mekhail CISSN. The event's experts covered the topics below:

Protein - Jose Antonio PhD FISSN
Creatine - Richard Kreider PhD FISSN
Caffeine and Energy Drinks - Erica Goldstein PhD CISSN
Beta-Alanine - Abbie Smith-Ryan PhD FISSN
Sodium Bicarbonate - Bryan Saunders PhD
HMB - John A Rathmacher PhD
Probiotics - Ralf Jager PhD FISSN
Diets and Body Composition - Trisha VanDusseldorp PhD FISSN
Nutrient Timing - Chad Kerksick PhD FISSN

ISSN Stand On Protein: Dr. Jose Antonio

The use of protein as a dietary supplement was one of ISSN's original focuses. Still today, one of Dr. Jose Antonio's favorite subjects is busting myths regarding protein and dangers to the kidneys. With that said, one of the great things about listening to true experts speak is that they will always teach you something new.

Dispelling Myths Of Protein And Kidney Damage:

Dr. Antonio started the stand on protein by addressing the issue of some making claims that protein will destroy your kidneys. Even after we had read the information on this before, Dr. Antonio brought up a point concerning heavy protein consumption evolution, and it makes a lot of sense.

When we look at the different physiological systems of man, we must realize that they have evolved for two main goals:

To reproduce
To survive

In this manner, we are very simple beings. That being said, our systems were built to keep us alive in the environment we found ourselves in. We did not have the luxury to pre-package our meals in little Tupperware containers to store in the fridge until feeding time during our hunting and gathering days. When we killed an animal, we ate it; all of it. This meant that we likely consumed well over the supposed max of "40g per serving," which our bodies supposedly can't digest.

Further, this meant that our organs would be forced to process substantial quantities of protein at given times. In Dr. Anotnios word's "It's stupid to suggest that this behavior would destroy our kidneys or that we would not be able to process this much protein" (Yes, he can be blunt, and we love it!). Our bodies would have adapted to be able to handle these loads as this was common practice among early humans.

An interesting thought, but there are obviously plenty of studies to back this up as well. For example, a 2-year study followed two bodybuilders who consumed a high protein diet (>2.2/g/kg) and monitored their blood work. All levels were acceptable and remained steady the entire study.

That said, assuming your kidneys are in working condition, eating high protein should be of no concern.

Benefits Of Protein On Strength And Performance:

Slight to moderate increase in strength.
No benefit to endurance performance other than helping mitigate breakdown.
Protein plus carbohydrates can mitigate soreness.

Benefits Of Protein On Body Composition:

Can improve muscle mass.
High protein diets, especially very high protein diets (>2.2g/kg), have been found to be very beneficial in body recomps.
Helps weight loss.

RECOMMENDED PROTEIN INTAKE, TIMING, AND OTHER CONSIDERATIONS:

The ISSN's recommended protein intake is much higher than the standard RDA:

The average trainee should eat at least 1.4-2.0 g/kg/day.
During times of weight loss, higher amounts are necessary to mitigate muscle loss.
Dr. Antonio actually believes in a much higher amount at 2.2g/kg/day (This is wholly Dr. Antonio's belief).
When possible, spread protein servings out within 3-4 hours.
Take 30-40g of casein protein 30 minutes before sleep for improved recovery and potential improvements in muscle mass.
Animal or plant protein is acceptable for the average person, assuming they eat sufficient amounts. Vegans may need to eat slightly more due to the decrease in bioavailability.

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ISSN Stand On Creatine: Dr. Rick Kreider

Other than protein, creatine has been another significant focal point of the ISSN due to the many false claims regarding its safety. This misinformation is even more alarming due to the sheer amount of benefits that creatine has been found to give. In fact, the ISSN has even warned that this misinformation can actually be detrimental to athletes involved in high-impact sports due to its role in brain health and recovery from concussions!

In reality, non-athletic benefits have been taking the lead as far as areas of new research. This is mainly because so many studies have been done to affirm creatine's benefits on performance. During that time, researchers have begun to identify a plethora of other benefits that creatine may have. Creatine is the closest we have to a miracle drug in many ways.

Creatine Facts:

The primary role is to increase the production of ATP in the ATP-CP (Phosphagen) metabolic system.
Beneficial in maximal intense events less than 30 seconds.
95% of creatine is found in muscle.
Creatine is consumed naturally in our diet.
Primarily in red meat and fish.
Vegans generally have lower creatine stores than meat-eaters.
Vegan and the elderly have lower natural stores, and so these groups respond better to supplementation.
Despite what some claims say, there are long-term studies up to 5 years on creatine safety that show it is safe in healthy individuals. In fact, this study was performed because this information has been known for some time.

Athletic Benefits Of Creatine:

Increase weight gain, in the form of muscle mass.
Increase power and strength.
Increase tolerance to heat.

The primary work mechanism is it allows more workload due to the extra ATP production, which results in various performance benefits.

Most worries about renal failure are centered around case studies that examine creatine use in patients with renal failure.

Non-Athletic Benefits Of Creatine:

Creatine has been found to be beneficial in a ton of non-athletic endeavors. While we can't go through the exact mechanisms, the areas below are currently being researched.

Injury prevention
Rehab
Brain and Spinal Cord
Creatine Synthesis Deficiency
Epilepsy
Pregnancy & Newborn Health
Creatine use in older adults
Muscle bone strength
Sarcopenia, obesity, frailty
Brain health
Glucose Management Diabetes
Glucose control
Immune response
Cancer
Can slow the progression of tumors
Heart Health & Disease
Vascular Health
Inflammatory Bowel Disease
Chronic Dialysis Patients
Post-Viral Chronic Fatigue

RECOMMENDED CREATINE DOSING:

Loading 15-25g/day results in 20-40% increase in 7 days. Then drop to 3-5g/daily.
A lower dose loading protocol of 3-5g results in 15-20% in 30 days.
A daily serving of creatine does not need to be eaten at once. You can divide throughout the day if you are prone to bloating.
No need to stop taking creatine once started unless there are side effects.
Creatine w/ carbs can help absorption, especially for "non-responders."

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ISSN Stand On Caffeine And Energy Drinks: Dr. Erica Goldstein

Along with protein and creatine, caffeine is one of the most well-researched and effective supplements on the market. Caffeine simply works. While we all know it can get you "hyped," this stimulation can actually improve performance on several variables, which we'll look at. However, what was most interesting about the latest research on caffeine had to do with the different effects people receive depending on their genotype.

Caffeine Facts:

The fastest absorption happens through the mouth. Therefore, gum can elicit the most immediate benefits.

Caffeine displays hepatic metabolism, meaning different genotypes respond differently.
AA Genotype "fast" metabolizers
AC or CC genotype "slow" metabolizers
For example, a study looking at a 10km time trial identified genotype differences in responses:

AA (fast) saw improvement and actually saw a dose-dependent response 2mg (4.8% improvement) 4mg (6.8% improvement)
CC saw a decrease in performance.
AC saw no alteration.

Some genotypes even see more significant anxiety.
It does not impair hydration or regulation of body temp.

Benefits Of Caffeine:

The greatest benefits are seen in endurance training.

Time to exhaustion & time trials.
As more research is being done, more minor benefits have been found for strength and power athletes, especially during long training sessions.
Can increase workload in the gym.
Improves performance on ballistic movements.
May improve anaerobic capacity events such as on Wingate test.
Highly individualistic.

RECOMMENDED CAFFEINE DOSING:

The threshold remains at 2mg/kg/bw.
Optimal benefits seen at 3-6mg/kg/bw.
Peak benefits have been seen 30-120mins after consumption.

Note: Be mindful of the individualistic responses.

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ISSN Stand On Beta-Alanine: Dr. Abbie Smith-Ryan

ISSN nutrition

The focal point of the discussion on beta-alanine revolved around the common errors found in the dosing and timing of beta-alanine. While beta-alanine is one of the few supplements deemed as "effective" by the ISSN, most people don't consume it properly as they rely on pre-workouts for their dose. This made dosing the main focal point on the discussion of beta-alanine.

Benefits Of Beta-Alanine:

Beta-alanine is most effective for high, intense events in the 2-4 minute range as well as "time to exhaustion" events.
Beta-alanine can also improve overall workload by mitigating fatigue, affecting hypertrophy and strength.

Errors In Dosing:

Mentioned numerous times in the presentation, beta-alanine is one of, if not the most misunderstood supplements on the market. This is mainly due to its association with "pre-workout." We got the chance to specifically ask Dr. Abbie Smith-Ryan about this. She confirmed our belief that beta-alanine has nothing to do with a pre-workout and can be taken at any point during the day.

Beta-alanine relies on chronic consumption as it works very similarly to creatine as we are increasing our stores. Therefore, timing has little effect on its effectiveness. However, in reality, consistency does, and this is one reason many people never genuinely benefit. It's because they only take it with their pre-workout.

Secondly, if you rely on pre-workout, you are likely underdosing anyways. Most pre-workouts only offer about 1.6-2.0g of beta-alanine. This is not enough (we'll lay out proper dosing below). This being said, you should get a stand-alone product to better control your dosing.

RECOMMENDED BETA-ALANINE DOSING:

4-6g/ day for 4 weeks.
Can divide into smaller doses throughout the day.
After loading, you can drop down to a smaller intake of 2-3g a day.
Beta-alanine takes 9 weeks to go back to baseline, so using a washout period can be advantageous.
Recommended consumption is 4 weeks supplementation followed by 4 weeks washout.
Consume with carbohydrates due to insulin release.
Beta-alanine can be taken in smaller doses throughout the day to mitigate paresthesia (tingling). *This sensation has zero effect on performance.

ISSN Stand On Sodium Bicarbonate: Dr. Bryan Saunders

Sodium bicarbonate is similar to beta-alanine in that it acts as a muscle buffer. However, beta-alanine works as an intracellular buffer while sodium bicarbonate works outside the cell.

Regardless, it's most effective at buffering the muscle when glycolysis is the primary metabolic system being used. These are high-intensity bouts with a duration of 30 seconds to 2 minutes. However, even after 2 minutes, glycolysis is still heavily involved, meaning that sodium bicarbonate can provide substantial benefits longer.

Benefits Of Sodium Bicarbonate:

Effective during single and multiple bouts of exercise.
Most effective for high-intensity exercise 30 seconds to 2 minutes.
It can also be used for all-out efforts during low-intense events. I.e., a sprint finishes after a 3-hour cycle.
Effective for any mode of exercise, assuming it falls under the proposed variables of time and intensity.

RECOMMENDED SODIUM BICARBONATE DOSING:

The threshold is 200mg/kg.
300mg/kg seems to be optimal.
Timing does not seem to be as important as peak levels can last 1:15-4:00 after consumption.
Single dosing: Consume >75-180mon prior to an event
Multi-Day dosing:

Optimal dosing- 0.5g/kg//day
0.125g/kg every 3-4 hours
Take 3-7 days before the event.

Additional Information:

Reactions to sodium bicarbonate are highly individualistic, so a person will need to see how their body reacts.
While generally taken before an event, supplementation while training has elicited benefits that last after supplementation. Likely due to greater workloads translating into more significant gains.
Taken with creatine or beta-alanine can provide enhanced benefits.

ISSN Stand On HMB: Dr. John A. Rathmacher

Beta-hydroxy-beta-methylbutyrate, or HMB, is a promising compound that has shown benefits in resistance training due to its relationship with leucine. One of the three branched-chain amino acids, leucine, is the primary amino acid responsible for signaling muscle protein synthesis.

Due to the large amounts of leucine required to maximize its effectiveness, it's believed that one of its metabolites may be the primary compound. The one compound that shows the most promise is HMB.

HMB has been found to attenuate muscle damage after workouts resulting in faster recovery. As our progression in resistance training is governed by recovery, HMB can play a pivotal role in resistance training for hypertrophy and strength.

Benefits Of HMB Supplementation:

Enhance recovery by mitigating muscle breakdown after training.
Assist in mitigating muscle loss while in a caloric deficit.
Possible enhanced benefits in Masters athletes or elderly population.
May increase hypertrophy and strength.

RECOMMENDED HMB DOSING:

Acute Dosing:

1-2g 30–60 minutes before exercise if consuming HMB-FA.
1-2g 60–120 minutes prior to training if consuming HMB-Ca.

Long-Term Dosing:

3g/daily for 14 days before the event seems to be optimal.

Learn more about HMB in our article: What Does HMB Do?

ISSN Stand On Probiotics: Dr. Ralph Jager

Over the past years, gut health has become an area of interest for performance on athletes. One of the practices which we can all perform is including the consumption of probiotics in our diet. Probiotics literally mean "pro, life." When we consume them, they can promote the growth of healthy bacteria in our gut.

As this is where the absorption of nutrients occurs as well as the jettison of junk, probiotics will have benefits that reach way past the local reaction. For example, benefits can include an improved immune system and better absorption of nutrients.

Facts Of Probiotics:

70% of the immune system is located in the gut, making a healthy gut vital for a healthy immune system.
Exercise of either long duration or high intensity can weaken our immune system.
Probiotics seem to have more essential benefits the more prolonged or more intense exercise is.

Benefits Of Probiotics:

Improving our gut health will have a vast array of benefits. Like creatine, the list is far too extensive to detail for each benefit. That said, here is a list of potential benefits.

Improve immune system (working out can weaken acute).
Acts as an anti-oxidant.
Decrease muscle damage.
Decrease inflammation.
Increase performance.
Improve time to exhaustion.
Increase AA from plant protein.
improved body composition and lean body mass.
Fix hormone imbalances such as low testosterone.
Improved cognition and mood.

RECOMMENDED PROBIOTICS DOSING:

There are many strains, and each one has a different function. Further, they are required in optimal amounts. Therefore, a person will need to assess what they require individually.

ISSN Stand On Diets And Body Composition: Dr. Trisha VanDusseldorp

The purpose of this stand is to simply help clarify and organize different diets by establishing several diet hierarchies. The ISSN has established 6 major hierarchies under which diets fall. By diets, the ISSN gives the definition of "The sum of energy and nutrients consumed from food and bev on a regular basis." This means a protocol that you follow for at least four weeks.

DIET ARCHETYPES:

Low Fat:

10-20% fat.
Fat and fat-free mass loss (not as bad as low energy).
Should consider eating high protein

Low Carb:

Generally, carbohydrate intake makes up anywhere between 45-65% of total calories.
There is no universal definition, but total calories from carbs <20% of total intake are a good starting point.
A diet of <20% carb tends to decrease mass and fat mass.
Resistance training seems to be vital for low-carb diets when it comes to preserving muscle mass.
Followers of low-carb diets should perform resistance training at least twice a week.

High Protein:

High protein diets are identified by those which contain >25% protein.
This also equates to 1.2-16g/kg/bw.
Keep in mind that the ISSN always recommends a protein intake of >1.2g/kg/BW.
Dr. Antonio likes very high protein diets and starts clients off at 2.2g/kg/BW.
Can preserve muscle mass without resistance training.
The highest thermogenic effect of all macronutrients (the energy it takes to digest and absorb).
Highest level of satiety.
Very effective for fat loss.

Intermittent Fasting (IF):

IF consists of planned periods of not eating.
Three main types:

Alternate day fasting: 24 hours of eating than 24 hours of fasting.
Whole day fasting: One or two days of fasting per week.
Time-restricted window: Planned blocks of time to eat, i.e., 18 hours fast followed by a 6-hour feeding window.

When calories are equated with regular feeding times, fat loss (or gain) is equal.
It may be able to suppress hunger.
Any seen weight loss likely comes from the smaller availability to eat.
It may be able to improve fat oxidation, which can mitigate muscle loss after a person has adopted it. However, muscle loss can occur before, so resistance training is essential to minimize this.

Keto:

Keto is its own subcategory under low carb as it attempts to alter our metabolism.
The goal is to train the body to use ketones for fuel rather than glucose.
50g carbohydrates or less or 10% carbs.
60-80% fat.
1.5g/kg/d protein.
It can help regulate appetite and decrease cravings.
It greatly improves fat oxidation.
Bodyweight decreases, fat-mass decreases, fat-free mass decreases (without resistance training).
Adherence is very low due to the highly restrictive nature of the diet.

Very Low Energy (VLE) And Low Energy (LE):

LE 800-1200 calories/day (VLE) 400-800 calories/day.
Can see a very aggressive weight loss of 1-2.5kg/week.
However, such fast weight loss means that muscle loss will be lost. Some populations have seen a 25% decrease in lean body mass.
Resistance training is vital.
High amounts of protein, as well as creatine supplementation, have been found to mitigate muscle loss.
Unless a person's weight has become a severe hazard, these are generally too aggressive.

RECOMMENDATIONS ON DIETS:

The ISSN doesn't promote any specific diet as a whole...
However, many individuals within the organization support high protein diets, especially Dr. Jose Antonio.
All diets have strengths and weaknesses.
Individuals must assess their needs and behavior to decide what type of diet will work best for them.
Adherence is the primary goal for choosing the proper diet.

Related:

ISSN Stand On Nutrient Timing: Dr. Chad Kerksick

Nutrient timing is a highly controversial subject (even though it shouldn't be), likely due to the high amount of nuance involved. Simply put, nutrient timing deals with how the timing of our nutrition can affect the outcome. There are so many factors to consider, such as:

Diet
Goals
Level of Training
Health Factors

With that understanding, this stand will try to lay out the most essential and wide-reaching variables.

Basic Concepts To Understand With Nutrient Timing:

The number one consideration is total calories and macronutrients

Are you eating the correct number of calories?
Are you eating the appropriate amount of macronutrients?
Are you a marathon runner only consuming 25% carbs?

BASIC CONSIDERATIONS FOR PROTEIN:

Adding protein can aid performance, stabilize glucose, promote glycogen.
Eating sufficient protein for your needs is vital. Before worrying about timing, be sure you are eating enough to meet your goals.
Athletes should eat 1.6-2.2g/kg/day.
Spread protein feeding to one every 3-4 hours (0.25-0.5g/kg).
20g should be a minimal dose.
As long as you eat every 3-4 hours, "post-timing window" is not as important as once thought. HOWEVER, if you can eat post-training, you should do it.
Consuming 30-40g casein 30 minutes before bed has been shown to speed up recovery and increase muscle protein synthesis when we sleep.

BASIC CONSIDERATIONS FOR CARBOHYDRATES:

Athletes should consume 6-12g/kg/day, dependent on their sports.
This does not include your average lifter.
How much post-training depends on if rapid recovery is necessary (4-6 hours).
If exercise is longer than 60 minutes, intra-workout carbohydrates should be eaten.
30-60g/hr.
Elite athletes will often consume >60g/hr.
Use higher GI foods (>70).
Can combine with caffeine.
Can combine with protein.
If on a low-carb diet, your carb intake should be centered around your training.

OTHER CONSIDERATIONS:

Timing for fat intake has little relevance in performance. Be sure to eat an appropriate amount (athletes should be around 30%).
Highly nuanced so an individual must decide what works for them
While food timing can add some benefit to performance, other variables should take priority, such as sleep, recovery, and hydration.
The average trainee doesn't really need to worry about any timing issues.

WRAPPING UP:

This post wasn't only meant for certified personal trainers to implement for their clients. We hope that you can take some of the insights of the ISSN position stands on supplements and nutrition and then put them into practice in your everyday life. As science is continually changing and improving our understanding, it's important to leave your preconceived notions at the door.

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