Vitamins and minerals, widely used by athletes and the general population are useful in correcting specific deficiencies that interfere with maximal physical performance (such as thiamin, vitamin C, sodium and especially iron1,2,3,4,5), and may be useful under certain conditions (for example greater requirements for sodium, potassium, magnesium and iron may be present in athletes who train for prolonged periods of time in hot weather6).
Metabolic processes, including the all important production of energy, are dependant not only on the macronutrients (proteins, fats, and carbohydrates) but also on micronutrients. Many vitamins and minerals act as vital coenzymes and cofactors in cellular energy generation.7 For example, mitochondrial functions are compromised by insufficient dietary intake of B vitamins and/or increased B vitamin needs.8,9
Frank deficiencies resulting in deficiency diseases are somewhat rare today in the industrialized world, marginal vitamin and mineral deficiencies are common. 10 These deficiencies are due to a variety of factors including poor diets (due for example to dieting, rushed meals, and unhealthy food choices), eating disorders, emotional or physiological stress (including intensive exercise), unhealthy lifestyles (including smoking, chronic alcohol abuse), certain diseases, malabsorption, and abnormal metabolism.11
While it's well known that frank deficiencies result in well documented diseases, even mild micronutrient deficiencies can result in a lack of well-being and general fatigue, reduced resistance to infections, increased incidence of various diseases, and impaired physical and mental performance.12,13,14,15,16,17
Certain vitamins and minerals have been shown to be important for athletic performance. For example a study examined the effect of thiamine supplementation on exercise-induced fatigue.18
The authors concluded that thiamine supplementation significantly suppressed the increase in blood glucose in the normal thiamine group and significantly decreased the number of complaints shortly after exercise in the subjective fatigue assessment of 30 items. Vitamin B6 is an essential co-factor necessary for the metabolism of protein and a useful supplement to take with any protein product. Usual dose for athletes is 25 mg daily.
Deficiencies and Physical Performance
In one study marginal deficiencies of thiamine, riboflavin, vitamin B6 and vitamin C resulted in decreased physical performance.19 A recent study looked at the effects of zinc deficiency on physical performance and found that low dietary zinc was associated with impaired cardio respiratory function and impaired metabolic responses during exercise.20
As well, it's been shown that physical activity is not only affected by marginal deficiencies but that it also depletes micronutrient status. For example, it's been found that riboflavin levels remain stable if no exercise is done but decrease with exercise.21 In one study it was found that riboflavin levels decreased with increasing levels of exercise and that these levels were restored when dietary riboflavin was increased.22
Vitamin B6, which is also lost as a result of exercise, is transformed by the body to pyridoxyl-5-phosphate (PLP), the active coenzyme form of vitamin B-6 and cofactor for over 100 enzyme-catalyzed reactions, including aminotransferases (involved in amino acid metabolism) and glycogen phosphorylase (involved in glycogenolysis).
Studies have shown that PLP levels increase during exercise, which in turn leads to an increase in its breakdown and excretion.23,24 As an example, it was calculated that marathon runners lose about 1 mg vitamin B6 during a marathon, equivalent to the DRI for an adult.25
As a result it has been suggested that persons who exercise frequently may be at risk for riboflavin and pyridoxine deficiency and likely should supplement with both.26
In a review on the nutrition of children and adolescents engaged in high-level sports activities, the authors recommended mineral and vitamin supplementations. They feel that for minerals, perspiration losses may be associated with dietary deficiency and possible vitamin deficiencies concern B1, B2, B6, B9, B12, C and D vitamins.27
But there's more to it than just preventing marginal deficiencies. The use of some supplements can actually prevent certain conditions and problems both in the short and long term.
For example, a recent study found that the use of 500 mg of vitamin C actually prevented complex regional pain syndromes (reflex sympathetic dystrophy or RSD) a serious condition that sometimes occurs after wrist fractures.28
In this study Four hundred sixteen adult patients (18 years or older) with a unilateral or bilateral wrist fracture (total 427 fractures) seen in the emergency department were randomly assigned to receive 50 days of placebo or vitamin C (daily doses of 200 mg, 500 mg or 1500 mg), regardless of whether the fractures were treated surgically or with immobilization. The study demonstrated that vitamin C taken at 500 mg a day for 50 days after the wrist fracture was effective in preventing RSD.
The Bottom Line
The bottom line is that anyone who exercises should be taking a good daily multiple vitamin and mineral supplement, to make sure that first of all they're not suffering from any marginal deficiencies and secondly as a preventative measure for some conditions and diseases.
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- Risser WL, Lee EJ, Poindexter HBW, West MS;Pivarnik JM;Risser JMH;Hickson JF. Iron deficiency in female atheltes: its prevalence and impact on performance. Medicine and Science in Sports and Exercise 1988;20(2):116-121.
- Eichner ER. The anemias of athletes. Physician and Sports Medicine 1986;14(9):122-125;129-130.
- Van-Swearingen J. Iron deficiency in athletes: consequence or adaption in strenuous activity. Journal of orthopaedic and sports physical therapy 1986;7(4):192-195.
- Clement DB, Sawchuk LL. Iron status and sports performance. Sports medicine 1984;1(1):65-74.
- Keul J, Jakob E, Berg A, Dickhuth HH, Lehmann M. Effect of vitamins and iron on performance and recovery in humans and in sports anemia. Zeitschrift fur Ernahrungswissenschaft 1987;26(1):21-42.
- Haralambie G. Electrolytes, trace elements and vitamins in exercise. International Course on Physiological Chemistry of Exercise and Training 1979;(1st).
- Huskisson E, Maggini S, Ruf M. The role of vitamins and minerals in energy metabolism and well-being. J Int Med Res. 2007 May-Jun;35(3):277-89.
- Depeint F, Bruce WR, Shangari N, et al: Mitochondrial function and toxicity: role of the B-vitamin family on mitochondrial energy metabolism. Chem Biol Interact 2006; 163: 94-112.
- Depeint F, Bruce WR, Shangari N, et al: Mitochondrial function and toxicity: role of B vitamins on the one-carbon transfer pathways. Chem Biol Interact 2006; 163: 113-132.
- Food Standards Agency: The National Diet and Nutrition Survey: Adults Aged 19 to 64 Years, Vol 3. London: The Stationery Office, 2003.
- Rucker RB, Suttie JW, McCormick DB, et al (eds): Handbook of Vitamins, 3rd edn. New York: Marcel Dekker, 2001.
- Institute of Medicine: Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B Folate, Vitamin B1v Pantothenic Acid, Biotin and Choline. Washington DC: National Academic Press, 1998.
- Institute of Medicine: Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium and Carotenoids. Washington DC: National Academic Press, 2000.
- Institute of Medicine: Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. Washington DC: National Academic Press, 2001.
- Fairfield KM, Fletcher RH: Vitamins for chronic disease prevention in adults. JAMA 2002; 287: 3116 - 3126.
- Lukaski HC. Vitamin and mineral status: effects on physical performance. Nutrition. 2004 Jul-Aug;20(7-8):632-44.
- Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging. 2006 Sep-Oct;10(5):377-85.
- Suzuki M, Itokawa Y. Effects of thiamine supplementation on exercise-induced fatigue. Metabolic Brain Disease 1996;11(1):95-106.
- van der Beek EJ, van Dokkum W, Schrijver J, et al: Thiamin, riboflavin, and vitamins B-6 and C: impact of combined restricted intake on functional performance in man. Am J Clin Nutr 1988; 48: 1451-1462.
- Lukaski HC: Low dietary zinc decreases erythrocyte carbonic anhydrase activities and impairs cardiorespiratory function in men during exercise. Am J Clin Nutr 2005; 81: 1045-1051.
- Winters LR, ooonn JS, Kalkwart HJ, et al: Riboflavin requirements and exercise adaptation in older women. Am J Clin Nutr 1992; 56: 526 - 532.
- Belko AZ, Obarzanek E, Kalkwarf HJ, et al: Effects of exercise on riboflavin requirements of young women. Am J Clin Nutr 1983; 37: 509 - 517.
- Manore, MM,Leklem JE, Walter MC. Vitamin B-6 metabolism as affected by exercise in trained and untrained women fed diets differing in carbohydrate and vitamin B-6 content. Am. J. Clin. Nutr. 1987; 46: 995??"1004.
- Manore MM: Effects of pal activity on thiamine, riboflavine, and vitamin B-6 requirements. Am J Clin Nutr 2000; 72(suppl): 598S-606S.
- Rokitzki L, Sags AN, Reuss F, et al: Acute changes in vitamin B6 status in endurance athletes before and after a marathon. Int J Sport Nutr 1994; 4: 154-165.
- Woolf K, Manore MM. B-vitamins and exercise: does exercise alter requirements? Int J Sport Nutr Exerc Metab. 2006 Oct;16(5):453-84.
- Jobin C, Duhamel JF, Sesboue B, et al. Nutrition of children and adolescents engaged in high-level sports activities. Pediatrie 1993;48(2):109-17.
- Zollinger PE, Tuinebreijer WE, Breederveld RS, Kreis RW. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study. J Bone Joint Surg Am 2007;89:1424-1431.