Turkesterone Containing Supplement Induces Subjective Perception of Improvement in Strength Among Gym Users in A Brazilian Community

In the search for muscular development, the use of liberated and/or prohibited dietary supplements is a widespread habit among professional and recreational athletes [1]. For recreational athletes, the indication and the use of dietary supplements is mainly based on knowledge and in the subjective ergogenic perception acquired through coaches, internet, family, and friends’ experiences [2]. Although this extensive and unregulated use, it is known that these products offer health risks due to their own composition and its side-effects, the presence of contaminants or by the simple lack of the active ingredient [3, 4].

Apart of the commonly used dietary supplements, such as creatine, b-hydroxy-b-methylbutyrate, sodium bicarbonate, caffeine, antioxidants, amino acids, proteins, and others, some studies have proved the existence of a growing consumption of plant-derived supplements [5]. Among these natural supplements, the most used and commercialized are those containing plantderived hormones such as ecdysteroids, phytoestrogens, vegetal sterols and other substances with referred hormone modulating properties and ergogenic effects [6, 7].

Ecdysteroids are a group of steroid hormones, of which the best known is Ecdysone, have a well characterized role in the process of molting in arthropods [8-11]. Ecdysteroids are also found in plants (phytoecdysteroids), although their role in these organisms is not yet clear [8, 12, 13]. Phytoecdysteroids serve in the regulation of gene expression by binding to specific receptors, leading to Protein synthesis and altered gene transcription [9-11].

Turkesterone, a phytoecdysteroid found in the Ajuga turkestanica extract (ATE) demonstrated possible anabolic action [10, 14, 15], without toxic and androgenic side-effects [8, 15, 16]. There is also in vitro and in vivo evidence that such kind of phytoecdysteroids exerts ergogenic actions in mammals [10, 11, 17, 18]. There is only one study that examines the impact of ecdysterones on human beings and have demonstrated that this substance has no impact on changes in fat free mass or anabolic/ catabolic hormone status [19].

Based only in low quality scientific evidence, there is a large (and unregulated) internet-based market, advertising these substances as legally allowed, non-toxic, and promising huge and easy anabolic effects.

Considering this situation, the aim of the present study is to analyze the socio-demographic characteristic and the subjective ergogenic perception of ATE-based supplements among recreational athletes (gym users) in a Brazilian population.

Study design

A cross-sectional research design was adopted to determine the ATE intake among recreational athletes (gym users) in 24 different gyms in the city of Uberaba-MG, Brazil. After the approval of the Ethics Committee, the data were collected over a 3-month period. (No 2.168.233).

Population

The number of participants was defined by a sample calculation, using a 90% confidence level and 5% margin of error, based on the city population (estimated at 328,000) and the percentage of gym users (11.2% of the Brazilian population), described respectively by Brazilian National Institute of Geography and Statistics (IBGE, the Brazilian Census Bureau) (https://cidades.ibge.gov.br/brasil/ mg/uberaba/panorama) and by de Sa et al. 2014 [20].

Based on these data, the total population practicing physical activity in the city of Uberaba was estimated to be 36,736, and the minimum number of participants calculated was 268 individuals. Initially, 320 male and female adults attending the gyms volunteered to participate in the study. Informed consent was signed before the participants completed the questionnaires. The practice of bodybuilding as a recreational activity and age above 18 years were used as inclusion criterion.

Selection of gyms

Twenty-four gym facilities from the city of Uberaba-MG, Brazil, were randomly selected from a list of all gyms registered in town. After approval of gyn administrators, the users seen at these gyms, in each visit, were approached and invited to participate.

Questionnaire

A 14-item questionnaire was adapted from the available literature [20, 21]. Pilot testing of the questionnaire was performed on 20 adults who met the eligibility criteria. Minor modifications were made in the questionnaire for conceptual clarity and cultural context. The final questionnaire was divided into the following sections: gender (male, female), age, family income, training frequency, periodicity, and consumption of supplements (yes/ no and type of supplement). For gym users who knew ATE, they were asked if they had used, the time of use, who indicated the use, the dosage used, the observed effect, and, finally, if the user would recommend the supplement.

Statistical analysis

The data were analyzed using the program GraphPad Prism 6.0 Software (GraphPad Software, San Diego-CA, USA). Descriptive statistics in terms of frequencies and percentages were used. Chisquared and Fisher’s exact tests were used appropriately to study the associations among dependent and independent variables. The median was defined as the “cut off” point for the analyzed ordinal variables. A Poisson regression model with robust variance estimation (IBM SPSS Statistics 21.0 Software) was used to assess association between ATE-use and the independent variables. Statistical significance was set at p < 0.05.

Initially, a total of 320 recreational gym users were included in the study, and from these, nine were excluded because their questionnaires were incomplete (Figure 1). Sixty-five respondents (20.9%) reported knowing ATE, and among these, 29 users and former users of this supplement (9.32%) were identified. Table 1 presents the sociodemographic characterization of the studied population. In all groups studied (Table 1), there is a predominance of males in the third decade of life, with monthly income between R$ 2,001.00 and R$ 5,000.00. Most of the included subjects, do their training more than 3 times per week, for less than four years, and consumed supplements, mainly proteins and amino acids.

Table 1: Sociodemographic profile and training habits of the studied population.

Table 2 describes that gym users consumed this supplement for a short time (maximum 4 months), following recommendation by nutritionists in most cases, with a dosage ranging from 200–1.000 mg/day (Table 2). Most of the participants reported mainly increased strength and disposition (34.48% and 27.59%, respectively), causing 65.5% of users to recommend the consumption of this supplement (Table 2), whereas almost 40% of the sample (n = 11) reported any positive effect associated with the ATE use.

Table 2: Data regarding the use and perception of the effects of the ATE supplement by its users.

It can be noted that the Chi-square analysis suggested that ATE users statistically present a higher frequency and total time of physical activity than nonusers (Table 3). Similarly, ATE users also consume more types of supplements than the nonusers (Table 3). Poisson regression model with robust variance estimation revealed a statistical association between ATE use with high frequency of physical activity and another supplement consumption (Table 3). There was also a significant association between positive subjective perception and ATE doses above 500 mg/day (Table 4). Finally, ATE-users would recommend its usage more frequently than nonusers (Table 4).

This study shows, for the first time, the prevalence of ATE use among recreational athletes and their perception about the effects of the ATE supplementation. The social demographic data gathered were very similar to those described in the literature for Brazilian gym users [20-26]. A slight male prevalence was evidenced among the survey participants, similar to other surveys on bodybuilding practice (60% to 80% were male) [20-26]. About the age of gym users, the predominant age group was 21-30 years, and this did not differ from other studies [21-27].

Regarding the use of ATE, 60% of the sample used it for a time less than 2 months (Table 2) and, utilize other supplements in a much higher percentage than in the nonusers (93.1% versus 42.5%; Table 1), suggesting that these gym users are willing to employ many ergogenic alternatives, even without solid scientific evidence as previously showed [1-3, 5, 19]. ATE users also practice bodybuilding longer and more often than nonusers (Table 3).

When put together, these data suggest that after reaching the limit of physical development and the consequent reduction in progress in muscle mass acquisition, many of the gym goers will use unconventional ergogenic methods, such as ATE, to improve muscular development [23]. A similar fact was observed among the users of anabolic steroids, where the most frequent use among those who practiced physical activity for a longer time and with a weekly frequency higher than the nonusers was detected [23].

When looking for factors associated with the consumption of supplements by gym users, Lacerda et al. [27] observed that the consumption of dietary supplements is more frequent among men, who exercise longer and more often per week. Other authors [28] found a similar situation, as well seen in this study (Table 3). Also, training more than five times a week was associated with the use of supplements in a study conducted in Belo Horizonte-MG [29], suggesting that gym users may be using ergogenic drugs to improve the effect of exercise perse.

Table 3: Contingency table demonstrating the associations between the use of ATE and sociodemographic data.

Lacerda et al. 2015 [27] also observed that the most frequent sources of indication for supplements were colleagues, gym teachers, and self-prescription, whereas nutritionists were scarcely mentioned as indicators of the use of these compounds. In the case of the ATE, the orientation by nutritionists was the most frequent source, and this is probably due to the ATE commercial propaganda [5].

Despite the relative higher ATE-use frequency, few scientific studies have tested the efficacy of ATE, many of which were performed on animals or a cell culture, with a partially purified extract or the structural analogues of Turkesterone [8, 10, 11, 17, 18], whereas only one study have been conducted on humans [19]. In this respect, there is a need for further studies on the efficacy of this commercial extract, since almost 40% of ATE users reported no ergogenic effects. Interestingly, those who noticed any positive effect used ATE in the dosage above 500 mg/day and would recommend the extract to their colleagues (Table 4). This can lead to greater dissemination of the product’s use without proper scientific proof [3, 5, 7].

Table 4: Contingency table showing the associations between the dose of ATK used and indication, subjective perception of effects and recommendation.

Despite the main limitations of this study, represented by sample size, and the possibility of underreporting of the use of ATE and other substances, (due to social and legal constraints related to anabolic hormones and other performance-enhancing drugs) there is no other study concerning the use of ATE containing supplement. With the presented data in mind, education about plant-derived supplements utilization, prescription, indications and sideeffects, should be implemented among recreational athletes, in reason to avoid uncontrolled and disseminated ATE and others phytoecdysteroids usage.

The present study is the first to notice the use and perception of the ergogenic effect of ATE in an uncontrolled Brazilian population. The users of this supplement were mainly young adult males. The ATE users have a positive perception of the ergogenic effect after consumption of this supplement. Most of them, are consumers of other supplements and spread among colleagues the supposed positive effects of the supplement.

Research support program of the University of Uberaba (PAPEUNIUBE).

The authors declare that there is no conflict of interest involved in the work.

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