According to the FDA, supplements complement diets and contain one or more of the components: vitamins, minerals, amino acids, or plant derivatives such as caffeine. It can help with muscle recovery, treat some diseases and replace some deficiencies.

There are many marketed supplements. However, a few have actual scientific validity. The Australian Institute of Sports (AIS) classifies these into four categories:

• Group A: validated in terms of efficacy and safety. For example, Sports drinks, gel supplements, macronutrients in bars, and liquid meals.
• Group B: supplements that require more evaluation in studies such as quercetin, fish oil, collagen, HMB, and curcumin are in this group.
• Group C: All the supplements that are not categorized in group A or B
• Group D: banned according to the World Anti – Doping Agency. This list can be accessed at wada-ama.org. These include Ephedrine, sibutramine, Tribulus Terrestris

To analyze if a person needs supplements to improve their diet, a food diary is necessary with assistance from technology. A laboratory analysis can help detect possible deficiencies that can worsen athletic performance. The most common deficiencies are complete blood count, iron, ferritin, vitamin D, vitamin B12, and calcium.

To classify the exercise level, one needs to consider the duration and intensity of the exercise. Exercise of moderate-intensity (between 70-85% of the Heart Rate) and the amount can be classified as light, moderate and intense, according to Lear SA et al, 2017.

Light	< 150 minutes per week
Moderate	150 – 750 minutes per week
Intense	>750 minutes per week

Another way to evaluate the weekly intensity of physical activity is the measure in metabolic equivalents (MET) per minute. One MET or Metabolic Equivalent is the energy necessary to keep vital functions during rest).

Light	< 600 MET x minute x week
Moderate	600 to 3000 MET x minute x week
Intense	>3000 MET x minute x week

As a reference,  a 6 km / h run is equivalent to 6 METs. An athlete who runs 5 times per week for 50 minutes at that speed can calculate their MET as follows:

6 x 5 x 50: 1500 MET. According to the table above, this is classified as moderate exercise.

Athletes receiving supplements from groups A and B can gain performance advantages. For example, individuals who want to improve muscle hypertrophy during weightlifting activities can obtain an added source of protein. Around 2 g/kg/day of protein is required to optimize muscle gain. An athlete who weighs 100 kg needs around 200 grams of protein per day to reach the goal. Considering a chicken breast (total weight: 100 g) contains around 40 g of protein, one would need 5 pieces of this to meet the recommended amount or use supplements to reach the desired amount of protein. Underweight individuals can benefit from hyper proteins supplements, HMB, and essential amino acids.

Supplementation in Patients with type 2 Diabetes

The aim of supplementation in patients with type 2 diabetes is to reduce insulin resistance and improve metabolic status. Some supplement examples used are:

• Whey protein: Associated with increased protein synthesis and muscle recovery after training. In clinical trials, whey was linked to delayed gastric emptying and increased hormones that contribute to the reduction of postprandial blood glucose. In another study, patients managed to improve inflammatory parameters and cardiovascular risk through increased intake of Whey protein.
• Creatine: Mainly used in the elderly, its use is related to improvement in sarcopenia and functional performance reducing fatigue. The creatine intake leads to an increase in serum creatine therefore it is recommended for individuals who increase their creatinine to track their serum creatinine levels
• Vitamin D: Low levels of vitamin D have been correlated with many chronic diseases such as diabetes mellitus and cardiovascular disease. Some studies demonstrate that its supplementation can prevent diabetes and studies have shown that 4,000 units per day of vitamin D can slightly reduce the glycosylated hemoglobin by 0.3%.

However, vitamin D function has not yet been fully established.

In conclusion, dietary supplementation must be individualized to offer the correct amount of each macronutrient or vitamin and must be prescribed by a qualified professional such as a physician or dietitian.

At GluCare, we track the intensity of the patients’ physical activity using wearables. This data is streamed back to our care team where feedback is provided, and the information becomes part of the patient’s electronic medical record. Supplementation is also tracked through the app’s food logging feature so accurate individualization of supplementation can occur.

Reference: SBEM, Alexandre Hohl.2 edition.2021.Clannad.