Vitamins and supplements for athletes

A balanced diet and healthful lifestyle that includes enough sleep should be sufficient to give most people the energy that they need for their daily activities. However, athletes push their bodies to peak performance, so these individuals may need an energy boost.

In this article, we provide information on six vitamins and supplements that can help athletes beat fatigue and perform at their best.

1. B vitamins

B vitamins are vital for releasing energy in the body as they aid the metabolism of carbohydrates, fats, and proteins.

Although being deficient in one or several B vitamins can affect how well a person can exercise, there is little evidence to suggest that unnecessarily taking supplements will improve performance.

As a result, it is best to see a doctor to undergo testing before choosing to take a B vitamin supplement.

Female athletes may be at risk for deficiencies in B vitamins, which include:

  • vitamin B-12
  • vitamin B-6
  • niacin

Having a vitamin B-12 deficiency can make people feel weak and tired. As vitamin B-12 primarily occurs in animal products, vegans and vegetarians are more likely to develop a deficiency in this vitamin.

Learn how to incorporate vitamin B-12 into a vegetarian or vegan diet here.

2. Iron

Iron deficiency is common in athletes and can affect performance, according to some research.

While it can occur in males, this deficiency is more common in females, especially those in endurance sports. A Swiss review found that the rate of iron deficiency among teenage female athletes was up to 52%.

Additional research found that low iron levels can cause many adverse symptoms in female athletes, including reducing endurance and increasing the amount of energy that the body uses.

The authors suggested that people could take supplements to reduce these effects, but only if dietary changes could not meet their needs. They also note that people following vegetarian or vegan diets should take extra care to ensure that they meet their required daily intake of iron, as plant-based iron is less available to the body.

People should speak to a doctor before taking iron supplements and be sure to request a blood test to check their iron levels. Taking too much iron can cause uncomfortable and even dangerous side effects.

Those with sufficient iron do not need to take a supplement.

3. Calcium and vitamin D

Calcium and vitamin D help the body build and maintain healthy bones, teeth, and muscles. These vitamins can help athletes maintain muscle mass and reduce the risk of injuries, such as bone fractures.

Calcium is available in many foods, including:

  • dairy products, such as milk and yogurt
  • fortified nondairy milks, such as soy milk
  • dark green vegetables
  • fish with soft bones, including sardines and salmon

4. Coenzyme Q10

Studies have shown an association between low levels of coenzyme Q10 and increased fatigue. Coenzyme Q10 is an enzyme in the mitochondria, which are the parts of cells that generate energy.

Experts have linked some conditions with lower levels of coenzyme Q10 in the body, including:

  • neurodegenerative diseases
  • fibromyalgia
  • diabetes
  • cancer
  • mitochondrial diseases
  • muscular diseases
  • heart failure

Research has shown that coenzyme Q10 may improve both physical performance and “subjective fatigue” in healthy people engaging in physical activity.

The authors of a 2014 review stated that studies have consistently associated low levels of coenzyme Q10 with fatigue. However, they noted that the results were difficult to interpret, as research papers vary in their definition of fatigue.

The research on whether coenzyme Q10 supplementation is useful for athletes has produced mixed results. For example, a 2012 study of moderately trained men found no evidence that it benefitted their exercise capacity.

5. Creatine

Some athletes use creatine because it is a legal nutritional aid for sports performance. People can get creatine from red meat and seafood, but it is also available as a supplement.

Research has shown that supplementing with creatine can increase muscle mass and improve strength when a person combines it with strength training.

Older adults may also be able to use creatine to increase their lean muscle mass and muscle strength.

Commercial supplements often combine creatine with other substances. Researchers have found that a creatine supplement that also contained caffeine, taurine, and amino acids helped athletes feel focused and increased the time that it took for them to feel exhausted.

It is important to note that some of the funding for this study came from companies that make supplements and other products.

6. Ashwagandha

Ashwagandha is an Ayurvedic herb. A 2015 study explored the effects of ashwagandha on endurance in healthy athletic men and women.

People who received the root extract of ashwagandha had a significant increase in physical endurance after 8 and 12 weeks of treatment compared with the participants receiving a placebo.

Another study tested the effects of ashwagandha on the endurance of elite cyclists. After 8 weeks of treatment, the cyclists taking ashwagandha took longer to feel exhausted doing a treadmill test than the cyclists who received a placebo.

A number of vitamins and supplements may provide athletes with an added energy boost.


Vitamins and supplements can be a safe way for athletes to try to improve their performance, but more research is necessary to determine the effectiveness of some supplements.

It is crucial to speak to a doctor before starting to take any new vitamins or other supplements. These substances can interact with other medications that a person might be taking.

Taking too much of some supplements, such as iron, can cause adverse side effects. Also, some vitamins may be ineffective unless a person has an existing deficiency. A doctor can test for vitamin deficiencies and advise on how to correct them if necessary.

People who feel as though they have low energy despite exercising regularly may wish to consider other aspects of their routine before taking supplements. Eating a balanced, nutritious diet and getting enough sleep may also boost athletic performance.

Athletes following vegetarian and vegan diets may need to take particular care to ensure that they are obtaining enough of the above nutrients through their diet.



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Global Hunger Report 2019- child-wasting-Pristine Premixes

Child wasting in India at an alarming rate – Global Hunger Report 2019

India has slipped to 102 position in the Global Hunger Report 2019 out of 117 countries, slipping from its 2018 position of 95 and behind its neighbours Nepal, Pakistan and Bangladesh.

Seventeen countries, including Belarus, Ukraine, Turkey, Cuba and Kuwait, shared the top rank with GHI scores of less than five, the website of the Global Hunger Index that tracks hunger and malnutrition said on Wednesday.

India slips to 102nd rank in Global Hunger Report 2019

The report, prepared jointly by Irish aid agency Concern Worldwide and German organisation Welt Hunger Hilfe termed the level of hunger in India “serious”. In 2000, India was ranked 83 out of 113 countries. Now, with 117 countries in the fray, it has dropped to 102 rank. Its GHI score has also decelerated — from 38.9 in 2005 to 32 in 2010 and then from 32 to 30.3 between 2010 and 2019.

The share of wasting among children in India rose from 16.5 per cent in the 2008-2012 period to 20.8 per cent in 2014-2018, according to the report. Just 9.6 per cent of all children between 6 and 23 months of age are fed a “minimum acceptable diet”, it said. “India’s child wasting rate is extremely high at 20.8 per cent, the highest for any country in this report,” it said.

Countries like Yemen and Djibouti, which are conflict ridden and facing severe climate issues respectively, fared better than India on that front, according to the report. Neighbouring countries like Nepal (73), Sri Lanka (66), Bangladesh (88), Myanmar (69) and Pakistan (94) are also in the ‘serious’ hunger category, but have fared better at feeding its citizens than India, according to the report.

China (25) has moved to a ‘low’ severity category and Sri Lanka is in the ‘moderate’ severity category. However, India has shown improvement in other indicators such as the under-5 mortality rate, prevalence of stunting among children and prevalence of undernourishment owing to inadequate food, the report said.


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Lychee toxin yet another hazard for undernourished children - Pristine Premixes

Lychee toxin yet another hazard for undernourished children

Acute Encephalitis Syndrome: Is Lychee Fruit the real Reason for Children Deaths?

Muzaffarpur in Bihar has been hit by curious cases of Acute encephalitis syndrome (AES) for the past few months.  The cases that happened in Bihar’s Muzaffarpur, Vaishali, Sheohar districts have claimed more than 100 lives. Around 100 children have been admitted to various hospitals. The immediate reason behind the death has been attributed to Hypoglycaemia, i.e. low blood sugar level. Most of the cases have been reported from areas near Lychee orchards. 

According to a study, it may be due to the eating of Lychee among malnourished children. Lychee contains chemicals and substances that are kind of similar to Ackee, a Jamaican fruit. This fruit is the main reason for childhood acute encephalopathy disease named Jamaican vomiting sickness (JVS). 

What is AES?

AES is a common term to a condition affected to children with clinical neurological manifestations, which include mental confusion, disorientation, convulsion, or even coma. Meningitis caused by virus or bacteria, encephalitis caused by a virus, encephalopathy, cerebral malaria and scrub typhus caused by bacteria are collectively called acute encephalitis syndrome. Encephalopathy is biochemical in origin and is different from the rest. Even though there are different types of encephalopathy, in Muzaffarpur case, it is associated with hypoglycemia and hence called hypoglycaemic encephalopathy.

As per the study conducted by T Jacob John, virologist and pediatrician from Vellore and Mukul Das of Indian Toxicology Research, Lucknow, the clinical features of Ackee poisoning and Muzaffarpur AES are similar. The clinical features in these patients are stereotypical: Inconsistent presence of fever, brain oedema, absence of inflammatory cell response in cerebrospinal fluid and hypoglycemia, and sudden onset with prodromal phase. The clinical features and the preliminary epidemiological findings have supported that it may be due to acute non-infectious encephalopathy and not viral encephalitis. The children who are diagnosed with this condition are well and good till evening, but their condition worsens the next morning with brain function derangement and seizures. Malnutrition is considered as the main associated factor for kids affected by this condition. 

Is Lychee seed the real villain?

Lychee seeds contain a lower analog of hypoglycin A, namely methylene cyclopropyl-glycine (MCPG)14. MCPG is not found in the ripe or unripe lychee fruit, but it’s found to cause hypoglycemia and derangement of fatty acid β-oxidation in liver cell mitochondria in experimental animals.  As per reports, it is due to the toxicity of MCPG that has killed the children and this toxicity is due to the formation of MCPF-CoA, which in turn inhibits several dehydrogenases responsible for gluconeogenesis, causing depletion of glucose reserve in the body.

Usually, in the early morning, it is normal for the blood sugar to dip since there is no food intake for several hours. Malnourished children who had gone to sleep without a meal at night develop hypoglycaemia. The brain actually needs a normal level of glucose in the blood to function properly. And in this condition, the liver is unable to supply it and hence the alternate pathway of glucose synthesis (fatty acid oxidation) is turned on. This pathway is blocked by MCPG and ends up in death. The study says that in malnourished children, who had eaten lychee fruits the previous night on empty stomach, the situation proves fatal.

In another study done by Arun Shah of the Indian Academy of Paediatrics and appeared in Lancet Global Health journal in 2017, the children in the affected villages fell ill the next morning after eating them the previous night with symptoms like high fever, brain function derangement, and seizures. The doctors also say that the disease can be treated through an infusion of dextrose within four hours of the onset of the illness. Another technique is to ensure that no child goes to bed without a meal. The Lancet report had suggested the Bihar Government to keep children away from orchard gardens during April-June and also urged ministers to tackle the malnutrition in the various families.




Malnutrition in India - a mother feeding her child

Malnutrition in Children: India Has 22 million Wasted Children

India Has 22 Million Wasted Children; Poshan Abhiyaan Signals Govt’s Strong Commitment To Tackle Malnutrition in Children: Experts

An estimated 26 million children aged under five years are wasted in South Asia, which is over half  of the global burden of wasting. India is home to four out of five of these children and lies at the epicentre of this global public health problem, with 22 million children wasted, and over eight million severely wasted at any one time, according to the UNICEF, WHO and World Bank Group, 2018.

Malnutrition in Children- India has the highest level of child wasting in south Asia

In 2015 India committed to reducing the proportion of children suffering from wasting to less than 5%, a nutrition target of Sustainable Development Goal (SDG) 2. However, the prevalence of wasting (21.0%) and severe wasting (7.5%) remain very high in the country (National Family Health Survey-4 2015-2016) and have not fallen in the past decade, despite a 10 percentage point decline in stunting during the same period. This lack of progress towards the wasting target, and the persistently high numbers of children with wasting, is of immense concern.

In India, the prevalence of wasting is witnessed highest at birth (37%) and declines with age, a pattern seen in other South Asian countries such as Bangladesh. Over 30% of infants aged less than six months are wasted  in India, underlining the imperative to address growth failure in early life. In comparison, data from selected countries in West and Central Africa show the prevalence of wasting is relatively low at birth and increases in infancy, reaching a peak at around 12 months of age.

These contrasting patterns suggest that poor maternal nutrition and health may play a larger role in the causes of wasting in early life in India (and Bangladesh) than it does in other settings. Almost one quarter (23%) of women of reproductive age in India are thin (body mass index (BMI) <18.5 kg/m2), 11% have a low stature (height

Maternal thinness, low stature and anaemia predict low birth weight (LBW) and wasting in India. These findings indicate that a comprehensive response to wasting in India must include a strong focus on the prevention and management of growth faltering in infants under six months, including interventions to improve the nutritional status of women before and during pregnancy.

Another significant finding is the relationship between wasting and mortality in India and South Asia, which appears to be affected by different factors than in other regions of the world. The prevalence of wasting and severe wasting is higher in India and South Asia than in other regions, yet the Under-Five mortality rates are comparatively lower. These comparisons need careful interpretation and more research is needed to understand the relationship between mortality and wasting in India.


India has an array of government schemes and programmes to counter malnutrition and its underlying causes. However, it is evident from the continuing high prevalence of wasting that these schemes and programmes are not designed to address the burden adequately, or are not functioning optimally.

Currently the main approach to treat severe wasting in India is facility-based treatment, known as F-SAM. The guidelines for F-SAM, which provides inpatient treatment of SAM (Severe Acute Malnutrition) with medical complications, were released in 2011. A network of 1,151 nutrition rehabilitation centres (NRCs) has since been established across the country and these manage approximately 180,000 cases annually, which represents a small fraction of the annual caseload.

This existing inpatient infrastructure is neither sufficient nor intended to manage all children with severe wasting. Approximately 85-90% of children with severe wasting do not have medical complications and can safely be managed at community level. Indeed, the national guidelines on F-SAM recognise the need for the community-based management of severe wasting without medical complications. However, community-based management has been challenging to operationalise in the absence of national guidelines, which are currently in the process of being developed by the Government, although their content remains unclear.

India has well designed community-based public health systems and delivery platforms at facility and community level that can be leveraged by POSHAN Abhiyaan to support a comprehensive response to severe wasting. This should include four components: (i) the prevention of wasting and severe wasting, including relapse after successful treatment; (ii) early case detection of wasting through active screening; (iii) facility-based management of severe wasting with medical complications; and (iv) community-based management of severe wasting without medical complications.

Many nutrition-specific interventions to prevent wasting and other forms of malnutrition are delivered at community-level in India through Anganwadi Services under the umbrella of the Integrated Child Development Services (ICDS) scheme. Anganwadi centres, a nationwide network of rural community centres, provide health and nutrition services and pre-school education to a population of up to 1,000.

There are a host of schemes, programmes and services that target pregnant and breastfeeding women (PLW) with nutrition interventions. These include a take-home ration from Anganwadi centres; anaemia prevention and control under the Anaemia Mukt Bharat programme; antenatal care services, including dietary counselling through VHSNDs; and schemes such as Pradhan Mantri Surakshit Matrutva Abhiyaan that provide quality antenatal check-ups. Institutional deliveries are promoted through conditional cash-transfer schemes (Janani Suraksha Yojna and Pradhan Mantri Matru Vandana Yojna) and free services for delivery and early neonatal care (Janani Shishu Suraksha Karyakaram), and provide an important opportunity to support mothers in establishing good breastfeeding practices.

Under POSHAN Abhiyaan there is huge ambition to eliminate malnutrition in children and ensure that every child has access to quality services to address wasting across the continuum of care. This requires a cost-effective, integrated and sustainable approach that successfully prevents the development of wasting and provides care for those with wasting.

The infrastructure to deliver a comprehensive, community-based programme to prevent and treat wasting already exists in India; a vertical programme to address wasting is therefore unnecessary. There is an extensive network of community-based Anganwadi centres and community-health workers, together with health and nutrition schemes and programmes, into which components of a comprehensive approach can be integrated at scale.

Context-specific solutions to prevent malnutrition in children, particularly from developing wasting must be the priority. These solutions should be grounded in an understanding of the specific causes and drivers that lead to wasting. The high prevalence of wasting at birth in India suggests the need to improve the nutritional status of women before and during pregnancy and to ensure mothers have access to skilled support for early and exclusive breastfeeding. From six months of age, counselling on complementary feeding and continued breastfeeding and the prevention and treatment of diseases become important components of preventive approaches. These interventions are already part of existing health and nutrition schemes and programmes, but are not reaching children and women with the desired Coverage, Continuity, Intensity and Quality (C2IQ).

The introduction of monthly height measurements for all children during growth monitoring at Anganwadi centres will increase opportunities for the early detection of malnutrition in children. However, it is necessary to ensure that community health workers have the capacity (equipment, skills, time and motivation) to add this responsibility to their roles and increase community demand for services.

The Anganwadi centres currently cater to children with severe underweight and any children identified by health workers as having severe wasting with medical complications are admitted to inpatient care. The forthcoming community-based guidelines on the prevention and management of wasting will guide how treatment reaches children with severe wasting without medical complications at community level. Optimising the quality, production and distribution of rations under the Supplementary Nutrition Programme (SNP) and identification of the nutritional treatment that will be used to manage severe wasting at community level are needed so that treatment puts children back on the path to healthy growth. A strong referral system and tracking of individual children across the different programme components, from the community through to the inpatient facility, are also essential to ensure that children receive the full continuum of care on offer.

It is important to build the evidence base around this comprehensive approach to managing children with acute malnutrition in India and delivering services across the continuum of care. This learning could inform both India and other country contexts with a similar profile of wasting. Key evidence questions include a context-specific understanding of wasting in India; how to scale up screening using Weight For Height (WFH) at community level effectively; the modalities of managing growth failure in infants under six months old; and the cost-effectiveness of forthcoming guidelines to care for children with severe wasting at community level. In addition, a better understanding is needed of how to address challenging issues such as linkages and referrals between various programmes and schemes to ensure a continuum of prevention and care.

(This article has been edited by Outlook. The authors of the piece are:  Arjan de Wagt, Eleanor Rogers, Praveen Kumar, Abner Daniel, Harriet Torlesse and Saul Guerrero)

(Arjan de Wagt is Chief of the Nutrition section, UNICEF India; Eleanor Rogers is a Nutrition Specialist in the Nutrition Division of UNICEF India; Dr Praveen Kumar is a paediatrician and Professor of Paediatrics at Lady Hardinge Medical College and Kalawati Saran Children’s Hospital in New Delhi; Harriet Torlesse (PhD) is Regional Nutrition Advisor at the UNICEF Regional Office for South Asia; Saul Guerrero is a Nutrition Specialist at UNICEF HQ; Abner Daniel is a medical doctor with an MD in Community Medicine,  working as Nutrition Specialist in UNICEF, New Delhi. The findings, interpretations and conclusions in this article are those of the authors. They do not necessarily represent the views of UNICEF).


Source: outlook magazine 

Image credit: UNICEF



Vitamin D: The “sunshine” vitamin

Vitamin D — also known as the sunshine vitamin — is extremely important and has multiple effects on several systems in the body. Yet, the prevalence of vitamin D deficiency gets reported worldwide; it still remains an under-diagnosed and under-treated nutritional deficiency.

India being a tropical country has adequate sunlight throughout the year. Yet, the prevalence of vitamin D3 (an important compound in the vitamin D group) deficiency is very high in India;

65-70 per cent of our population is vitamin D deficient and for 15 per cent, it’s insufficient. In fact, worldwide, more than a billion people have low D3 levels. An increased level of melanin pigment in the Indian skin, which gives the skin a brown colour, also makes vitamin D absorption difficult.

Besides this, urban lifestyle — one in which people go to sleep late, have hardly any exposure to the sun in the morning hours, live in air-conditioned environs, tackle high levels of pollution and maintain poor diet — is one of the major contributors to the deficiency.

The role of Vitamin D

Unlike most vitamins (A, B, C, E, K), vitamin D functions like a hormone and every cell in the body has a vitamin D receptor. It is a fat-soluble vitamin and plays a vital role in our day-to-day physiological functions. The role of the vitamin is endless — it helps regulate blood pressure, prevents osteomalacia, helps fight depression, reduces stress and tension, reduces respiratory infections (strong immune system), improves insulin sensitivity, improves overall skin health and makes the skin soft, strong and smooth. Vitamin D3 acts as a steroid hormone in the body, like cortisol, which means it is anti-inflammatory.

It relieves the body of aches and pains by reducing muscle spasms; it improves the health of one’s joints, hair and nails; helps in differentiation of the cells; and improves cardiovascular strength by protecting the arteries. The list, in fact, goes on and on!

When vitamin D3 is low, the body is unable to absorb enough calcium from food, resulting in the production of the parathyroid hormone, which depletes calcium from the skeleton to maintain one’s pH levels.

Who are at risk?

  • The elderly.
  • The overweight or obese.
  • People who don’t eat enough fish or dairy products.
  • Those who live far from the equator, where there is little sunshine around the year.
  • People who use excessive sunscreen when going out.
  • Those who continuously stay indoors.

Symptoms of D3 deficiency

  • Poor immunity.
  • Pain in the bones and backache.
  • Chronic fatigue and tiredness.
  • Delayed healing.
  • Hair loss.
  • Muscular pain.
  • Chronic illness.

In such cases, a simple blood test called 25-hydroxy vitamin D should be done.

Can it cause cancer?

Vitamin D is an essential nutrient that researchers link to the prevention of an array of diseases — colds and flu to multiple types of cancer.

Recently, vitamin D deficiency and its association with the risk of several types of cancer is receiving considerable attention. Studies have found a protective relationship between sufficient vitamin D status and lower risk of cancer. Vitamin D and its metabolites reduce the incidence of many types of cancer by inhibiting tumour growth. A reduced level of vitamin D is associated with increased incidences and death rates from colon, breast, prostate and ovarian cancer.

A warning

However, for severe deficiencies, supplements should be consumed after diagnosis by a medical practitioner. That’s because, although rare, vitamin D overdose or toxicity can be as dangerous as its deficiency. It causes a build-up of calcium in the bloodstream. Symptoms include vomiting, nausea, stomach pain, constipation, diarrhoea, fatigue, dizziness and confusion. It can affect the liver, heart and brain. Too much vitamin D is also detrimental to bone health, leading to bone loss. In extreme conditions, it can damage the kidneys.

Vitamin D deficiency is incredibly common and neglected due to poor awareness.

Also, the symptoms are often subtle and non-specific, which makes it difficult to know if they’re caused by low levels of vitamin D or something else. If you think you have a deficiency, get your blood tested and consult your family physician. Fortunately, vitamin D deficiency is usually easy to fix.

Help at hand

  • In its most natural form, humans receive the required daily dose of vitamin D from exposure to the sun, especially the morning sun, between 7am and 1pm. You need to sun yourself for at least half an hour with 40 per cent of your body exposed. This practice may be repeated two to three times a week. Of course, one is not supposed to apply any sunblock cream during this time. Spending more time outdoors and enjoying sport of some kind (walking, running, cycling or swimming) are beneficial because physical exercises burn more calories, help reduce body fat and promote higher levels of vitamin D blood cells.
  • From a traditional point of view, one can do asanas such as Surya Namaskar (sun salutation) and also the traditional maalish (applying oil all over the body while sitting in the sun).
  • Though for severe deficiencies no food can actually provide an optimum supply of D3, but the following food, when taken regularly and in good quantities, maybe of help:
  • Vitamin D is a fat-soluble vitamin and so good fats should be taken to enhance its absorption.
  • Cod liver oil comes from the liver of the codfish and is considered extremely healthy. It helps ease joint pains and can be taken in capsule form or in the form of oil.
  • if you love mushrooms, you are covered. Dried shiitake mushrooms are a brilliant source of vitamin D3 as well as vitamin B. It is low in calorie and can be consumed daily.
  • Salmon is another good source of D3, Omega 3 and protein.
  • Sunflower seeds not only have vitamin D3 but also come with monounsaturated fats and protein.

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by Shikha Prakash