Meldonium (Mildronate): What is it and What does it do?

In light of recent media attention surrounding meldonium and its detection in elite athletes, we thought it best to share reliable information about the drug, its intended purpose, and potential use as a performance-enhancing substance.

Blog Article Contributed by Eric Smith, PharmD.

Expert Consultant for the Resource Exchange Center (REC), Powered by Drug Free Sport™

The World Anti-Doping Agency (WADA) added meldonium (Mildronate) to their 2016 Prohibited List in late September 2015. This modification—among others­­—went into effect January 1, 2016. WADA added meldonium as a prohibited substance due to “evidence of its use by athletes with the intention of enhancing performance.”

A Latvian pharmaceutical company with primary distribution in Eastern Europe and Russia manufactures meldonium under the brand name Mildronate. In the 1970s, Mildronate was developed to promote the growth of livestock. Currently, the drug is marketed to treat a variety of medical conditions including ischemic heart disease, heart failure, stroke, peripheral artery disease, and alcohol withdrawal.  Also indicated for use in healthy individuals experiencing physical and mental stress, Mildronate targets athletes as well.

Recent studies identified Mildronate as having anti-ischemic properties. Ischemia is a medical term used to describe a decrease in blood supply to certain parts of the body. A reduction in blood circulation minimizes the delivery and availability of oxygen and sugars needed by the body’s cells. Having anti-ischemic properties makes Mildronate beneficial for treating situations associated with decreased blood supply.   

The drug primarily functions to increase oxygen efficiency in certain body tissues. This makes sense when you reconsider that decreased blood supply (ischemia) reduces oxygen delivery to the tissues. Mildronate works to optimize energy production by interfering with energy pathways that use more oxygen (less efficient) and alternatively promoting pathways that use less oxygen (more efficient).

Mildronate achieves this by blocking pathways involved in carnitine production. Carnitine is an amino acid derivative used in the process of breaking fats down into fatty acids and converting them into energy.  Mildronate creates lower levels of carnitine thereby reducing the body’s ability to breakdown fats for energy.

The body adjusts by increasing the use of an alternative energy pathway called glycolysis.  Glycolysis is more efficient than fatty acid metabolism because it not only uses less oxygen, but also decreases the amount of toxins (such as lactic acid) that build up in cells during energy production.

For athletes, taking this medication could potentially increase muscle and nervous system oxygen efficiency. Using oxygen more effectively in working tissues may lead to performance enhancing benefits such as improved exercise tolerance, improved recovery, stress protection, and improved central nervous system functions. 

Isn’t biochemistry and pharmacology fun?

Mildronate is not approved by the Food and Drug Administration (FDA) for sale in the United States.

Summer Drug-Testing

Summer for student-athletes can be a huge temptation for experimenting with steroids to develop muscle and strength. Student-athletes who are, or have been injured, may look to steroids to shorten their recovery time and the drugs clear an athlete’s system before drug-testing resumes in the fall semester.  Often, athletes are not subject to drug-testing in the summer, so they believe they can clear traces of any banned– substance before they return to campus in the fall.

The purpose of any drug-testing program is to deter use, protect the clean athlete, and ensure a level playing field.  Summer testing was an obvious expansion of the good and effective drug-testing program in effect during the fall and spring semesters and in 2006, Drug Free Sport began testing a random selection of Division I student-athletes during the summer.  The program has expanded to Division II with emphasis on football and baseball participants because they are at a higher risk for abusing performance-enhancing drugs.

Initially, there were many questions about how the student-athletes would be notified, what would happen if the student-athletes were not on campus, etc.  In reality, many student-athletes are on campus during the summer, taking classes, working out in facilities, or working in the local community.  Student-athletes also must fill out a form before leaving campus in the spring letting Drug Free Sport know where they could be found during the summer.

In the beginning, summer drug-testing was challenging for Drug Free Sport staff because collectors were traveling all over the country to conduct the tests. Some of the top baseball players were playing in summer leagues all over the country and Drug Free Sport staff had to find them.  Then Drug Free Sport developed a system, where they would send collectors to summer leagues where a variety of Division I and II student-athletes were located.  The collectors spent a week at a summer league focusing on their roster for the random testing rather than focusing on a particular institution.

One example of a successful summer league testing schedule involved the Cape Cod summer baseball league.  Testing at the Cape Cod summer league provides the opportunity to test ten teams in five days.  When the student-athletes show up for a game, they are notified that they have been selected for a random drug-test.  Testing at summer leagues demonstrates the flexibility of the summer program.  Drug Free Sport collectors still go to campuses, but the process is much smoother now that a fair number of the testing can be done where the student-athletes are clustered.

Since 2006, the number of student-athletes tested in the summer has increased each year. As schools have become used to summer testing and the Drug Free Sport staff adapted to it, they have been able to increase the numbers.

To inquire about our sport drug-testing services for your organization, please contact us by phone at 816-474-8655.

Prescription and Over-The-Counter Drug Abuse

You may remember the days of childhood. It was common to get a cold, flu bug, or other type of illness. Trips to the doctor were never fun, but you knew that the word medicine meant a way to get better. Medicine helped get over the illness and back to school, back to the playground, and back with your friends. You knew that a doctor was prescribing you with the medication to help you recover. However, as you get older, you start to realize that some people abuse these same medications.

According to drugs.com, drugs that are safe and effective for use by the general public, without a prescription, are defined as over-the-counter (OTC) drugs. These drugs are often located on shelves in pharmacies, as well as non-pharmacy outlets. A few examples include grocery stores, convenience stores, and large discount retailers. In the U.S., there are more than 80 classes of OTC drugs. These range from allergy medications, to pain relievers, to weight loss products.

Some medications have psychoactive (mind-altering) properties and, because of that, they are sometimes abused. You could define abusing medications as someone taking a medication in ways or amounts other than what has been instructed in directions or by a doctor, or taken by someone other than the person for whom they are prescribed to. In fact, prescription and over-the-counter (OTC) drugs are, after marijuana (and alcohol), the most commonly abused substances by Americans, ages 14 and older. This is according to the National Institute on Drug Abuse.

 According to a study conducted by the University of Michigan, the most commonly abused prescription drugs are: opioid pain relievers, stimulants for treating ADHD (Attention Deficit Hyperactivity Disorder), and CNS (Central Nervous System) depressants for relieving anxiety. The most commonly abused OTC drugs are cough and cold remedies containing dextromethorphan.

Many people believe that prescription drugs and OTC drugs are safer to use than illicit drugs. This is only true when they are taken exactly as prescribed and for the purpose intended. When these prescription and OTC drugs are abused, they can become addictive and put abusers at risk for other adverse health effects. This includes overdose, especially when taken along with other drugs or alcohol.

There is more than one way for prescription and OTC drugs to be abused. These include taking a medication that has been prescribed for somebody else, taking a drug in a higher quantity or another manner than prescribed, and taking a drug for another purpose than prescribed.

We usually think of drug abuse issues as illicit drugs. However, licit drugs (legal for prescription) are a huge abuse issue. Whether they are being deliberately abused, or accidentally abused while taking them for a medical purpose, the results are disturbing.  People abuse over-the-counter (OTC) products to get high, zone out, hallucinate, etc.  Often times this abuse involves youth since these products are so readily available, either in the home medicine cabinet or simply for purchase.

The importance of educating our youth about the risks associated with the use and abuse of prescription and over-the-counter drugs need not go overlooked. Some of the same “medicines” that we have come to lean on during periods of illness, can harm our kids, family, and friends.

Drug Abuse and Addiction

As a student-athlete, you may know of someone who is struggling with drug abuse and addiction. It may be a close friend, a teammate, classmate or family member. Substance abuse and addiction can cause problems in the classroom, on the playing field and at home. It can often times leave individuals feeling alone and helpless, a potentially dangerous combination. It is for these reasons, that it is important to have a good understanding of the signs and symptoms of drug abuse and addiction.

Common signs of drug abuse and addiction:

-          Skipping class or flunking class, missing practice, and neglecting other day-to-day responsibilities

-          The use of drugs and/or alcohol during high risk situations (drinking and driving, before practice or a game)

-          Mood swings (fights with friends and/or family members, partners)

-          Legal issues (DUI, selling of drugs, possession charges)

-          A built up tolerance to drugs

-          Withdrawal symptoms

-          Constantly thinking about drug use

-          Understanding the risks of drug use, but continuing to participate

-          Losing interest in sports, socializing and other hobbies

Physical, behavioral and psychological warning signs:

-          Deterioration of physical appearance, grooming habits

-          Tremors, slurred speech

-          Bloodshot eyes, larger than normal pupils

-          Changes in appetite or sleep patterns

-          Sudden weight loss or gain

-          Always a need for extra money

-          Acting secretive about everything

-          Sudden change in friends

-          Lack of motivation

-          Anxious, fearful and paranoid

-          Angry outbursts and easily agitated

Recognizing that you or someone you know has a drug abuse or addiction problem is the first step, and often the most difficult step, on the road to recovery. Seeking help and finding support is crucial to any addiction recovery, and it takes a tremendous amount of courage to recognize that you or someone you know may need help.

If you feel that you or someone you know has an addiction problem, be proactive and contact any of the following individuals for support:

-          Family member

-          A close friend

-          A therapist or counselor

-          Your health care provider

-          Your athletic trainer, coach and/or another administrator

 Always remember, you are not alone and there are individuals that are willing to help!

 For more information on drug abuse and addiction, please visit the following resources:

http://www.mayoclinic.com/health/drug-addiction/DS00183 

http://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction

http://www.nlm.nih.gov/medlineplus/drugabuse.html

Challenging Student-Athlete Perceptions

According to the National Survey on Drug Use and Health (NSDUH), an adolescents perception of the risks associated with substance use is an important determinant of whether he or she engages in substance use. For example, youths who perceive high risk of harm are less likely to use drugs than youths who perceive low risk of harm. Thus, providing adolescents with credible, accurate, and age-appropriate information about the harm associated with substance use is a key component in prevention.

Social norms represent our perceptions of the behaviors and attitudes of others. Expectations about alcohol, marijuana, and other harmful substances can be powerful influences on behavior. Would you say most student athletes engage in the use of harmful substances? Would you say that most student athletes engage in alcohol, marijuana, or cigarette use? Our perceptions vary among individuals. Data from Prevention Strategies shows that 12.30% of student athletes use marijuana and 7.90 use cigarettes. The data that was provided validates that a very small percentage of student athletes are using tobacco products, marijuana, and alcohol.

Student athletes reported being drunk on an average of 1.4 times in the past 30 days. However, there were a range of answers on this question from 0 to 30 days and the most common answer was 0 days of getting drunk. This shows you that the perception should be shed in a positive light that most student athletes don’t engage in the use of harmful substances. You can also look at it from how you feel about teammates engaging in harmful substances. Out of 5,000 student athletes, 76.1% disapprove of their teammates getting intoxicated frequently.

Some other facts regarding alcohol may not surprise you. In a 2009 NCAA Study of Substance Use of College Student Athletes, overall (Division I, II, III), 83.1% of respondents indicated drinking within the last 12 months. This is factual evidence for both men and women. This is an increase from the 2005 study that showed 77.5%. This leaves the perception, and social norm, that there is an increase in young students engaging in alcohol use over the years. Only 12.6% of these students reported never using alcohol, 47% used alcohol less than two days per week, 54% indicated drinking during both their competitive and off season. The scary part about these statistics is that the majority of respondents indicated obtaining alcohol from a friend, family member, or teammate.

Student athletes are expected to be great at what they do. They are asked to maintain a high level of performance, both athletically and academically. All of this occurs under the constant scrutiny of coaches, teammates, fans, and media. Many problems start well before college and some escalate to levels that require intervention from coaches, parents, etc. Student athletes are different from the rest of the student population and because of their constant exposure and elevated status on campus, college student athletes are typically placed in situations that cause stress and anxiety.

Here are some examples of pressures that student athletes face:

· Balancing sports and academics

· Adapting to social challenges

· Success and failure on field and in the classroom

· Injuries

· Weight management

· Sports career ends due to injury or eligibility.

According to the Drug & Alcohol Addiction Recovery Magazine, coping strategies are tools for dealing with stress without returning to substance abuse. A coping strategy is a personal action plan. It identifies a particular stressor or trigger for substance use, includes an understanding of why or how that particular situation encourages an individual to use, and articulates specific physical and mental actions to counter this influence. It is highly recommended that individuals looking to avoid substance use should avoid places, people, and situations that are connected to their social challenges. Small things such as the time of day and music can also make a difference.

For example, if a recovering alcoholic returns to his favorite bar at night (his habitual time for drinking), sees all his old buddies drinking, and hears his favorite drinking song on the jukebox, his ability to avoid relapse becomes seriously compromised. The place, time of day, people and music are all triggering emotional responses that encourage him to drink. An effective coping strategy, in this case, is to avoid a situation that holds such strong triggers.

Student athletes need to realize that there will always be challenges you face in life. Athletes have a lot to lose. We see it all the time in amateur, collegiate, and professional athletics. There are harmful substances around us, people engage in them, but what will you do? What decisions will you make knowing the affects it can cause? The time will come when you will face challenging decisions. There are supporters around you; use them wisely and always remember that the decision is in your hands.

NCAA Championship Drug Testing

Drug-testing in the NCAA began in 1986 when testing at championship events began.  In 1990, it expanded to a year-round program in Divisions I and II and today, 90 percent of Division I, 65 percent of Division II and 21 percent of Division III schools conduct their own drug-testing programs in addition to the testing that occurs at the NCAA.  

Each year, approximately 13,500 samples are collected and analyzed through the NCAA's national drug-testing program, with the bulk of those tests focused primarily on performance-enhancing drugs (NCAA year-round testing). The NCAA tests at championship events in all three divisions at least once every five years and with some championships tested every year. During championship events, student-athletes are screened for steroids, diuretics and masking agents, stimulants, peptide hormones, anti-estrogens, beta-2 agonists, beta-blockers and street drugs. 

Recently, the NCAA’s Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS) voted to adjust the threshold for a positive marijuana test at NCAA championships to a level that is consistent with current best practices in drug testing, which will more accurately identify usage among student-athletes.

Beginning August 1, 2013, the threshold level for marijuana will change from 15 ng/mL to 5 ng/mL.  For years, Drug Free Sport has provided institutional clients the 5 ng/mL threshold in testing for marijuana.  Drug Free Sport has recognized testing at lower thresholds as a best practice for deterrence and we continue to provide our clients the best drug-prevention methods possible.

The CSMAS has also established a testing standard for synthetic cannabinoids (K2, Spice, etc.), which have not previously been tested for at NCAA championship events. The committee approved testing for those substances using the World Anti-Doping Agency (WADA) laboratory testing standard for level of detection.  Testing for synthetic cannabinoids will begin with the 2013 fall championships.

Drug Free Sport also has the ability to test for multiple metabolites of synthetic cannabinoids.  To learn more about testing for synthetic cannabinoids please contact Drug Free Sport at 816-474-8655.

Binge Drinking: Who is at risk and why should we be concerned?

According to the Centers for Disease Control and Prevention (CDC), binge drinking is “the most common pattern of excessive alcohol use in the United States.” Visit almost any campus, on any weekend, and I would be willing to bet that you will find students and student-athletes participating in binge drinking.

Let’s look at a few facts:

-          Binge drinking is said to be more common amongst young adults aged 18-34

-          The prevalence of binge drinking among men is twice as much as women

-          90% of alcohol consumed by youth under the age of 21 in the United States is in the form of binge drinking

We also know, according the 2009 NCAA Study of Substance Use of College Student-Athletes:

-          83.1% of respondents indicated drinking within the year (male and female)

-          47% of those reporting alcohol usage reported drinking six to ten plus drinks in a sitting (binge drinking)

-          54% of the respondents indicated drinking both during their competitive and off season

-          Student-athletes are at a higher risk for such behaviors

As you can see, it’s no mystery that student-athletes are at risk for, or are participating in the act of, binge drinking. Alcohol consumption has been and continues to be an issue at the collegiate level.

So what is “binge drinking” and why should we be concerned?

Binge drinking is typically defined as, for men, consuming five or more drinks within a period of two hours. For women, four or more drinks within the same time period is typically classified as binge drinking.

Some of the common issues that we see associated with binge drinking include:

-          Memory issues – disrupting sleep cycles and prohibiting one’s ability to retain information.

-          Hydration issues – decreasing the body’s state of hydration, which can be a real problem for student-athletes that are trying to perform at the highest level.

-          Injury issues – poor food choices, dehydration and depletion of nutrients can all lead to injuries.

-          Alcohol poisoning – always dangerous and can sometimes lead to death.

-          High blood pressure, stroke or other cardiovascular issues – it can and does happen.

-          Unintended pregnancy and sexually transmitted diseases – it can be prevented.

As you can see, none of the above issues associated with binge drinking is conducive to a student-athletes career. It is our job as educators to make sure that student-athletes are aware of the risks associated with the use of alcohol, and in particular, binge drinking. There is no one method that is a cure-all to this issue, but here are a few links that may be helpful.

myPlaybook

Expert Speakers

Prevention Strategies

Student-Athletes Speak Against Binge Drinking

APPLE Conferences

Following up this week on our May 8th 2012 blog titled "10 reasons why drugs, alcohol and/or supplements are still an issue in athletics," we explore:

           "The NCAA reported a 5.6 percent rise in alcohol consumption since 2005, with 83.1 percent of respondents reporting drinking alcohol in the past 12 months.."

This blog is titled 10 Reasons why drugs, alcohol and/or supplements are still an issue in athletics: Alcohol and it can be found on our myPlaybook blog at: http://myplaybook.drugfreesport.com/?p=717

"We are what we repeatedly do. Excellence then, is not an act, but a habit." Aristotle  

10 reasons why drugs, alcohol and/or supplements are still an issue in athletics: Marijuana 101

Following up this week on our May 8th 2012 blog titled "10 reasons why drugs, alcohol and/or supplements are still an issue in athletics," we explore our first reason:

           "In a 2009 study, the use of Marijuana amongst NCAA student-athletes had increased by   

            nearly 2 points over a period of 4 years. 22.6 percent of respondents claimed to have used 

            Marijuana within the last 12 months."

This blog is titled Marijuana 101 and can be found on our myPlaybook blog at: http://myplaybook.drugfreesport.com/uncategorized/marijuana-101/

"Tell me and I'll forget. Show me, and I may not remember. Involve me, and I'll understand."
-Native American Saying-

 

Introducing myPlaybook: Web-Based Drug and Alcohol Education for Student-Athletes

Drug Free Sport has partnered with Prevention Strategies to bring myPlaybook to colleges, universities, and high schools across the US. myPlaybook is a new, web-based, interactive drug and alcohol education program created specifically for student-athletes.

Background

Prevention Strategies is a research company devoted to providing online education products that aim to prevent alcohol and drug-related harm among teens and young adults. With the support of the NCAA, PS created a program specifically for student-athletes. Over 5,000 current student-athletes have already completed myPlaybook, giving PS data showing the program works to change attitudes, beliefs, and behaviors related to alcohol and drug use.

Because of our involvement with drug testing and the NCAA, Drug Free Sport partnered with Prevention Strategies to make myPlaybook available to institutions across the country.

The Program

myPlaybook is an evidence-based program designed to prevent alcohol and other drug related harm. This interactive, web-based program engages students using state-of-the-art instructional design. There are two separate programs for college and high school. The collegiate program was created specifically for student-athletes. The high school program is designed for the general student population and also includes an extra component for those participating in athletics.

Pilot studies have shown that the program works, with student-athletes demonstrating immediate gains in knowledge of NCAA drug testing procedures and banned substances, negative alcohol expectancies, and negative marijuana expectancies. Over 83% of students felt they benefited from taking myPlaybook.

The core program covers:

• NCAA Banned Substances & Drug Testing
• Alcohol
• Marijuana
• Performance Enhancing Drugs/Dietary Supplements
• Tobacco
• Prescription/Over-the-Counter Drugs

Booster sessions are offered for students who have completed the core program. The boosters contain content that is new and applicable to student-athletes along with content that reinforces the core program. The REC will help choose booster topics based on the questions student-athletes are asking the most.

Want to know more?

You can learn more about myPlaybook by visiting the website (click here) or contacting Ryan Carpenter (816-474-8655). You can also Click here to sign up. Drug Free Sport can set you up with a full user account so that you can see the program the same way student-athletes see it or you can choose to receive a one-on-one tour from a DFS staff member and ask questions as you learn about the program.

Substance Abuse Prevention

The year was 2000 and I was a junior in college, I was in the best shape of my life having completed football season and in the midst of a track season that would prove to be my best collegiate year of competition.  I was on top of the world, school was going great, sports were stellar and to top it all off I was a bachelor that lived alone!  I lived next door to a great girl that would always wave when we saw one another, and if given the chance she could talk for hours.  She seemed to have the perfect life, nice car, great style, plenty of friends, and what seemed to be a good boyfriend.  One evening, I got a knock on my door and my neighbor was standing in front of me crying.  I instinctively invited her in and tried to console her, but noticed immediately that something was not right.  Her speech was slowed, she was stumbling, and she seemed distant.  I didn’t think she was drunk, but still asked if she was drunk, she said no and I proceeded to ask what she had done immediately before coming to my apartment, and she nonchalantly answered “trying to end my life”…Thankfully, I was somewhat knowledgeable about how to handle a toxic agent being ingested or an overdose.  I immediately gave her milk to drink and sat her upright in a chair.  I grabbed the pill bottle she had ingested, and took her to the emergency room, where they pumped her stomach and checked her into the psychiatric ward of the hospital.  This story has a happy ending because she was released days later, and started receiving the help and attention that she needed and had been calling for, for so long.  She later told me that she suffered from depression, substance abuse (oxycotin), and Anorexia Nervosa.  To say the least I was utterly surprised!  I tell you this story, to help you understand that perceptions are not always reality, and as the old adage goes, you cannot always judge a book by its cover, so don’t be afraid to ask for help or offer help, we all need a ear, shoulder and kind heart from time-to-time.

Have you ever had a family member, friend or even neighbor that had issues with abusing drugs?  How about someone that had a body image disorder, anger management issues or the desire to end their life?  Well these are just a few of the topics that we covered the last two weekends with the APPLE Conference (1/21 -1/23 and 1/28 – 1/30.  The APPLE Conferences are led by the University of Virginia Gordie Center for Alcohol and Substance Education with assistance from the NCAA, Drug Free Sport, the Bacchus Network and the Gordie Foundation.  The great thing about the APPLE conferences is that they are focused solely on the student-athlete and the prevention of substance abuse and promoting health for student-athletes and athletics department administrators.  From the APPLE website,

“The goal of the APPLE conference is to assist colleges in promoting student athlete health and wellness by empowering teams of student- athletes and administrators to create an institution-specific action plan. “

There are individuals in our lives right now that could be experiencing or fighting and addiction, having trouble managing anger or image issues, and we could have no idea.  This is a problem, but we can do something to help, there are professionals at your schools, in your community and at the government level that can help you prevent substance abuse, but also recognize the signs of potential problems. 

I heard a number of wonderful presentations at the APPLE Conferences, and here are just a few of the professionals that spoke (power point presentations available to view here):

Linda Hancock is Director of the Wellness Resource Center at Virginia Commonwealth University (VCU) and a Family Nurse Practitioner.

Doug Everhart serves as the Manager of Alcohol Programs at the University of California-Irvine

Scott Goldman, Ph. D. is the clinical and performance psychologist for the University of Arizona's athletic department.

Matt Vogel works at the University of Wisconsin – La Crosse as a Health Educator and an adjunct Instructor for the Department of Health Education and Health Promotion. 

Erica Upshaw travels the country speaking to high school and college audiences and has reached more than 50,000 students with her program Keep Friendship Alive.

Craig Littlepage is in his eighth year as the Athletic Director of the University of Virginia.

Dr. Kelli Moran-Miller provides clinical and performance enhancement services at Virginia Tech, servicing the Athletic Department and Cook Counseling Center.

Resources:

Professional Organizations

American Academy of Pediatrics:  http://www.aap.org/  

American College of Sports Medicine:  http://www.acsm.org/  

American Dietetic Association:  http://www.eatright.org/  

American Society for Nutrition:  http://www.nutrition.org/about-asn/  

American Medical Association:  http://www.ama-assn.org/  

American Public Health Association:  http://www.apha.org/  

Institute of Medicine of the National Academies- Food and Nutrition Board:  http://www.iom.edu/About-IOM/Leadership-Staff/Boards/Food-and-Nutrition-Board.aspx  

Keep Friendship Alive:  http://www.keepfriendshipalive.com/

National Research Council:  http://sites.nationalacademies.org/nrc/index.htm  

National Institutes of Health:  http://www.nih.gov/  

National Library of Medicine:  http://www.nlm.nih.gov/  

National Eating Disorders Association: http://www.nationaleatingdisorders.org/

The National Center for Drug Free Sport Inc.:  http://www.drugfreesport.com/

College Drinking – Changing the Culture:  http://www.collegedrinkingprevention.gov/StatsSummaries/snapshot.aspx

Consumer Lab (subscription needed):  http://www.consumerlab.com/

National Institute of Health:  http://www.nih.gov/  

Mayo Clinic:  http://www.mayoclinic.com/

myPlaybook:  http://myplaybook.drugfreesport.com/ 

Healthfinder:  http://www.healthfinder.gov/  

Partnership for a Drug-Free America:  http://www.drugfree.org/

The Resource Exchange Center:  http://www.drugfreesport.com/rec/

Supplement Safety Now:  http://www.supplementsafetynow.com/

The Cleveland Clinic:  http://my.clevelandclinic.org/default.aspx

Taylor Hooton Foundation:  http://taylorhooton.org/

Journals

American Journal of Clinical Nutrition:  http://www.jneb.org/  

American Journal of Sports Medicine:  http://ajs.sagepub.com/  

American Society for Nutritional Sciences:  http://www.nutrition.org/  

Journal of American College of Nutrition:  http://www.am-coll-nutr.org/  

Journal of Applied Physiology:  http://jap.physiology.org/  

Journal of Nutrition Education and Behavior:  http://www.jneb.org/

Journal of the American Dietetic Association:  http://www.adajournal.org/

Physician and Sports Medicine:  http://www.physsportsmed.com/   

Nutrition Action:  http://cspinet.org/nah/index.htm  

News Letters

Insight Newsletter:  http://www.drugfreesport.com/newsroom/insight.asp

Nutrition Action Health Letter:  http://www.cspinet.org/