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The Role of Protein and Amino Acids in Sustaining and Enhancing Performance (1999)
Institute of Medicine (IOM)

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. "16 Dietary Supplements Aimed at Enhancing Performance: Efficacy and Safety Considerations." The Role of Protein and Amino Acids in Sustaining and Enhancing Performance. Washington, DC: The National Academies Press, 1999.

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The Role of Protein and Amino Acids in Sustaining and Enhancing Performance

major research emphasis continues to be placed on one contaminant, the so-called Peak E (1,1'-ethylene-bis[tryptophan]), which has been routinely identified in implicated lots of manufactured trytophan. Interestingly, recent studies have identified a plethora of potentially active compounds including other indole derivatives (e.g., dioxindoylalanine), phenyl derivatives (e.g., anthranilic acid), and 1,2,3,4-tetrahydro-β-carboline-3-carboxylic acid derivatives, some of the latter of which are known to act as benzodiazepine inverse agonists (Simat et al., 1996). Attempts to reproduce in experimental animals the symptomatology associated with EMS in humans have generally failed, and thus, understanding of the mechanisms responsible for EMS associated with contaminated tryptophan products remains elusive.

SAFETY OF AMINO ACIDS AS DIETARY SUPPLEMENTS: THE FASEB/LSRO STUDY

Following the tragic EMS epidemic that resulted from the use of L-tryptophan, the U.S. Food and Drug Administration (FDA) contracted with the Life Sciences Research Office (LSRO) of the Federation of the American Societies for Experimental Biology (FASEB) to perform an extensive review of the extant scientific literature to determine the safety of amine acids used by consumers as dietary supplements (Food and Drug Administration, 1990; FDA Contract No. 223-88-2124, Task Order No. 8). Not only was tryptophan use assessed for safety, but all amine acids identified as being available to consumers were evaluated since prolonged daily ingestion of supranutritional quantities of these compounds as dietary supplements was known to be commonplace.

LSRO initiated their study in the fall of 1990 by first searching the extant scientific literature for reports that related to safety of amine acids. This was followed by an open meeting, in which interested parties presented information and views related to this issue. Additionally, an invitation was extended to the public to submit written materials for consideration (FDA Docket No. 90N-0379). An ad hoc expert panel consisting of nine scientists met subsequently to advise LSRO and prepare a final report. The report, made available in 1992 (FASEB/LSRO, 1992), also contained suggested guidelines for future safety testing (Anderson and Raiten, 1992).

Because consumers primarily used supplemental amine acids presumably to enhance physiological functions or produce pharmacological responses, rather than to affect any nutritional function, a significant dilemma was faced by the expert panel. No credible evidence was available in the scientific literature indicating that a normal, healthy individual would benefit nutritionally in any way from supplementation of the diet with any single amine acid. Furthermore, even in those individuals with a less-than-ideal diet, the practice of supplementing with single amine acids was considered potentially dangerous, since the literature was replete with studies demonstrating ''antinutritional"

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332
Front Matter (R1-R18)
Executive Summary (1-16)
I Committee Summary and Recommendations (17-18)
1 Committee Review (19-76)
2 Responses to Questions, Conclusions, and Recommendations (77-82)
II Authored Papers and Workshop Discussions (83-84)
3 Protein and Amino Acids: Physiological Optimization for Current and Future Military Operational Scenarios (85-92)
4 Overview of Garrison, Field, and Supplemental Protein Intake by U.S. Military Personnel (93-108)
5 The Energy Costs of Protein Metabolism: Lean and Mean on Uncle Sam's Team (109-120)
6 Regulation of Muscle Mass and Function: Effects of Aging and Hormones (121-136)
7 Effects of Protein Intake on Renal Function and on the Development of Renal Disease (137-154)
8 Infection and Injury: Effects on Whole Body Protein Metabolism (155-168)
9 Inherent Difficulties in Defining Amino Acid Requirements (169-216)
10 Amino Acid Flux and Requirements: Counterpoint Tentative Estimates are Feasible and Necessary (217-242)
11 Physical Exertion, Amino Acid and Protein Metabolism, and Protein Requirements (243-254)
12 Skeletal Muscle Markers (255-278)
13 Alterations in Protein Metabolism Due to the Stress of Injury and Infection (279-284)
Discussion I (285-288)
14 Amino Acid and Protein Requirements: Cognitive Performance, Stress, and Brain Function (289-308)
15 Supplementation with Branched-Chain Amino Acids, Glutamine, and Protein Hydrolysates: Rationale for Effects on Metabolism and Performance (309-330)
16 Dietary Supplements Aimed at Enhancing Performance: Efficacy and Safety Considerations (331-340)
Discussion II (341-346)
Appendixes (347-348)
A Workshop Agenda (349-352)
B Biographical Sketches (353-368)
C Acronyms and Abbreviations (369-372)
D Proteins and Amino Acids - A Selected Bibliography (373-410)
E Protein and Energy Content of Selected Operational Rations (411-412)
Index (413-429)