Dietary Supplements

What’s The Appeal?

  • Searching for the “magic pill”: The allure of a quick fix for health and performance issues.

  • Athlete perceptions: Many athletes perceive supplements as a way to enhance their performance and gain competitive advantages.

  • Finding “someone to say yes”: Athletes often look for affirmations from trainers, coaches, or peers regarding their supplement use.

  • Herbal and “natural” remedies: Increasing interest in organic or natural alternatives to traditional supplements.

  • Media influence: Marketing and advertising heavily influence public perception and athlete behavior regarding supplement use.

Influencing Factors

  • Pressure from multiple sources: Athletes face requests and encouragement from coaches, peers, and parents.

  • Increased competition: The rising level of competition among younger athletes leads them to explore new performance-enhancing methods.

  • “Drama” in professional sports: Events in leagues such as the NFL, NBA, MLB, and other sports create perceptions of ‘necessity’ in performance enhancement.

  • Desire for improvement: Athletes aspire to be bigger, faster, stronger, thinner, smarter, and younger to gain competitive advantages.

Risks Associated with Dietary Supplements

  • Unreliable sources: Many individuals rely on unverified information from magazines, social media, and fitness industry resources.

  • Lack of inquiry: Athletes often do not ask health professionals about the safety and efficacy of supplements they consider using (Ben-Arye et al., 2014).

  • Need for improved health history: There is a significant need for healthcare providers to inquire about supplement use during patient evaluations.

  • FDA Oversight:
      - Dietary supplements have very little regulatory oversight from the FDA.
      - Under the Dietary Supplement Health and Education Act (DSHEA) 1994, companies are responsible for informing the FDA but do not need formal approval to manufacture and market supplements.
      - Companies must report serious adverse events but face loose regulations regarding safety and effectiveness.
      - The industry is characterized by significant lobbying to maintain current regulations.
      - Financial statistics: The dietary supplement industry is worth over $20 billion, including $12 million from energy drinks/shots alone.

  • Side Effects and Health Risks:
      - Long-term consequences can include damage to bone, soft tissue, neurological systems, cardiovascular health, and organ (liver, kidney) failure.
      - Risks include adverse interactions with medications (both prescription and OTC), violations of banned substances, and contamination of products (e.g., heavy metals and pesticides).
      - Contaminated products: Serious health risks due to high-profile contaminants like arsenic, lead, and mercury found in some products marketed as dietary supplements.
      - Concerns over “Proprietary Blends,” where ingredient transparency is lacking.

Statistics on Supplement Use

  • General Findings:
      - Research predominantly conducted on adult male athletes; limited research available focusing on female, adolescent, or child athletes.
      - Notable funding for studies often comes from supplement companies, introducing potential biases.

  • Prevalence of Use:
      - 35-40% of the general population utilizes dietary supplements.
      - A meta-analysis of over 10,000 athletes indicated 46% usage in general and 59% amongst elite athletes.

  • Athlete-specific studies:
      - Jagim (2023): Reported that 60 to 80% of athletes use some form of supplement.
      - Jovanov (2019): Found 82.2% of athletes aged 15-18 years take supplements, with 54.5% specifically using protein.
      - Garthe (2017): Report indicated that between 40% to 100% of college athletes report using supplements.

  • Sources of Information:
      - Coaches are a prominent source (71% rely on ATCs) concerning supplement information.
      - Internet and magazines are notable sources of information, with 84% of males and 75% of females relying on online sources, and 70% of males and 67% of females deriving information from magazines.
      - College athletes often report reliance on athletic trainers for advice on supplement usage, expressing a significant interest in using supplements for injury treatment.

  • Substance Abuse Link:
      - NCAA male athletes using Performance Enhancing Substances (PES) show an increased tendency to use drugs and alcohol, regardless of their impact on performance.

  • Contamination Statistics:
      - Studies (Jagim, 2023) indicate that 10 to 30% of supplements contain prohibited substances.
      - Maughan (2005): Reported contamination rates suggesting that up to 1 in 4 supplements may be tainted; 18.8% of 240 tested US products contained illegal steroids.
      - International Olympic Committee (IOC) research indicates that 15% of 634 products were found to contain illegal or banned substances not indicated on labels.
      - HFL Sport Science (2007): Found that 25% of 52 tested products contained small amounts of banned substances.

Regulatory Environment for Supplements in Athletics

  • Dietary Supplements: College Athletes
      - NCAA Regulations:
        - Standardized compliance updates in August 2011 regarding supplements.
        - January 2017: Introduction of protein de-regulation.
        - January 2019: Allowed use of Omega-3 fatty acids.
      - NCAA Division I, II, and III Bylaws mandate the dissemination of a list of banned drug classes to all student-athletes, ensuring they have access to current information about substances that could affect their eligibility, including where to find updates on the NCAA website.
      - It is the student-athlete’s responsibility to consult with appropriate athletics staff before consuming any substance to ensure compliance with the regulations.

Banned Substance Classes

  • NCAA Policy on Drug Use: Under the principle of “strict liability,” all student-athletes are responsible for substances ingested.

  • Banned drug classes include:
      1. Stimulants
      2. Anabolic agents
      3. Beta blockers (fl** only)
      4. Diuretics and masking agents
      5. Narcotics
      6. Peptide hormones, growth factors, related substances and mimetics
      7. Hormone and metabolic modulators
      8. Beta-2 agonists

Supplement Classifications

  • Permissible Supplements (Can be provided by the athletic department):
      - Vitamins and Minerals
      - Energy bars
      - Carbohydrate Supplements
      - Sports Drinks
      - Omega-3 fats

  • Impermissible but Not Banned (Cannot be provided by athletic department):
      - Amino Acids
      - Conjugated Linoleic Acid (CLA)
      - Creatine
      - Garcinia Cambogia
      - Ginkgo
      - Ginseng
      - Glucosamine + Chondroitin (with MD Rx)
      - Glutathione
      - Green tea extract
      - HMB
      - Melatonin
      - Methylsulfonylmethane (MSM)
      - St. John's Wort
      - Tribulus
      - Yohimbe

  • Most Concerning Supplements (Banned or high risk according to AIS):
      - Pre-workouts (stimulants)
      - Energy drinks
      - Energy boosters
      - Prohormone/Hormone boosters
      - Weight loss products
      - Selective Androgen Receptor Modulators (SARMS)

Athletic Performance Aspects

  • Energy Drinks:
      - Often classified as supplements high in stimulants (like caffeine) and containing sugars or artificial sweeteners, potentially contributing to health risks.

  • DMAA:
      - A stimulant that has multiple names (1,3-Dimethylamylamine, methylhexanamine), which has been banned from use in many contexts including by the US Military.

  • Ephedrine/Ephedra:
      - Historically popular but banned since 2004 due to safety concerns. Most violations in NCAA found due to its use.

  • BCAAs (Branched-Chain Amino Acids):
      - Effectiveness debated; often overshadowed by the positive effects of Essential Amino Acids (EAAs).

  • Creatine:
      - Extensively studied showing potential benefits such as increasing muscle cell volume. Safe with appropriate usage and recommended to dose before or during exercise without excessive loading.

  • Caffeine:
      - Provides ergogenic effects such as improved reaction times; typically at dosing levels of 1-3 mg/kg.
      - Tolerance to caffeine can vary among individuals, with possible side effects including increased heart rate, anxiety, insomnia, and gastrointestinal distress.

Notable Case Study: Aegeline Recall

  • Case Background:
      - 10/3/2013: Reports of 30 acute liver failure cases in Hawaii traced back to a supplement called OxyELITE Pro manufactured by USP Labs.

  • Regulatory Response:
      - 10/25/2013: Widespread reports of liver issues leading to investigations and heightened scrutiny by
      - 11/10/2013: The product was officially recalled following severe health consequences including a death and patients awaiting liver transplants.

Proper Use of Dietary Supplements

  • Steps for Safe Supplementation:
      - Step One: Evaluate diet to identify deficiencies.
      - Step Two: Choose a reliable and safe supplement based on research and personal needs.
      - Step Three: Follow proper dosage and usage guidelines.
      - Step Four: Regularly re-evaluate the necessity and effectiveness of supplements taken.

Comparison: Supplements vs. Food/Beverage

  • Nutritional Content Example (Generic Table):
      - Serving sizes and nutritional breakdowns including Vitamins A, C, D, B6, B12, Iron, Calcium, and various macronutrients comparing supplements with whole foods.

Importance of Testing

  • Third Party Testing:
      - Certification from organizations like NSF Certified for Sport and Informed-Sport is crucial to ensure supplement safety and authenticity.
      - Products with the USP label are preferred for over-the-counter items.
      - Consumer Labs perform independent testing.

  • Consideration for Purchasing:
      - Beware of third-party resellers; verify that products are sold through legitimate channels to avoid counterfeit or contaminated products.

Resources for Information

  • Key databases and resources:
      - Natural Medicines Database, WebMD, FDA Tainted Supplement List, NCAA guidelines, USADA, NATA Position Statements.

Questions and Discussions

  • Engage in inquiries regarding dietary supplements and their impact on athletic performance, health, and safety.