After attending the Food and Nutrition Conference in Nashville, Tennessee last month, I realized that the world of dietary supplements and sports nutrition products is much bigger than most of us imagined. Ellen Coleman, MA, MPH, RD, CSSD, did a fantastic job of relaying this message to us. In 2012, it was an $84 billion industry, and it's likely grown since that data was released.
The Dietary Supplement Health and Education Act (DSHEA) defines dietary supplements as "vitamins, minerals, herbs or other botanicals, amino acids, other dietary substances, and any concentrate, metabolite, constituent, extract, or a combination of any of these ingredients."
The concern is that the FDA does not have authority to require that supplements be proven safe or effective before they enter the market. The FDA also lacks mandatory recall authority, meaning that a supplement must be proven dangerous before it can be removed from the market.
Of all the supplements tested by the FDA between 2010 and 2012, approximately 70% failed to comply with basic Good Manufacturing Practices (GMP) regulations. More than half of adulterated dietary supplements recalled between 2009 and 2012 were still on store shelves six months later, which is of greater concern. GMPs are difficult to enforce and they do not guarantee product purity or potency.
So where does this leave us? We need to do more research to figure out what works and what doesn't.
Which Sports Supplements Work?
Athletes take supplements for many reasons, including getting bigger, stronger and faster; losing weight; and enhancing sexual performance.
Some supplements do, of course, improve athletic performance. These include creatine, leucine, HMB, bicarbonate, beetroot, pre-workout blends and post-workout products such as protein powder. The challenge has always been to assure that the supplement you are using is not only effective but also safe and legal.
Many sports supplement products include ingredients that, according to some study or other, offer benefits. But just because it's effective doesn't mean it's safe, which leads to our next point.
Which Sports Supplements Are Safe?
Athletes may unknowingly consume products laced with varying quantities of banned substances, such as anabolic steroids, novel anabolic steroids, amphetamines, and novel stimulants. The FDA has found more than 500 adulterated supplements, but the agency has limited resources to monitor the marketplace for potentially harmful supplements.
So how do you determine whether a supplement is safe?
Third party certification programs run by private organizations can help. Among them:
NSF: This is the gold standard program and it's used by MLB, MLBPA, NFL and NFLPA.
Informed Choice tests finished products at different levels:
- Stage I: Product/Ingredient assessment
- Stage II: Pre-registered sample testing—take 5 samples from various runs and does an analysis
- Stage III: Post-regulatory requirements
Informed Choice did a study to assess 58 supplements purchased from popular retail outlets and Internet sites in the U.S. What they found was alarming:
- Approximately 25 percent (13) contained small amounts of steroids
- 11.5 percent (6) contained banned stimulants
- The highest incidence of contamination was found in "testosterone boosters"—approximately 67 percent of products
- The second-highest incidence of contamination was found in "weight loss" products—29 percent of products.
- The third-highest incidence of contaminate was found in "muscle building" products—24 percent of the products.
Supplement 411: The USDA dietary supplement safety and education awareness resource.
How to Assess a Sports Supplement
Review the supplement label. Any of the following characteristics pose an elevated risk:
- The label lists WADA-prohibited substances. Click here for the list.
- It contains ingredients ending in -ol, -diol or -stene, or the ingredient contains several numbers, which indicate possible steroids or stimulants.
- Supplements marketed to bodybuilders often contain anabolic agents, hormones, aromatase inhibitors, weight loss stimulants, diuretics or even drugs.
- Supplements made by a company that sells products containing prohibited substances, products for bodybuilding, weight loss, pre-workout/energy or sexual enhancement
- "Proprietary blends"—if you see this, RUN! Only the total amount of blend is listed. It's impossible to know the amounts of individual ingredients, and the likelihood of a prohibited substance is high, or why would they not be transparent?
- Complicated products with lots of ingredients or unfamiliar ingredients. The more ingredients, the greater the risk for mistakes during the manufacturing process.
- The manufacturer of the product claims it has the same effect as prescription drugs. Alternative may contain undeclared prescription medication.
- The product claims to be "natural," but has the same effects as prohibited substances such as steroids, growth hormone, IGF-1 or EPO and may contain undeclared banned drugs. Keep in mind that cyanide is natural, too.
- Herbals and "natural" products. Herbs may contain compounds that have pharmaceutical activity and may contain a synthetic drug claimed to be isolated from herb. For example, DMAA (methylhexanamine) is a prohibited stimulant allegedly found in geranium oil.
If a product is unfamiliar, visit websites that sell it to determine its ingredients and supposed method of action (listed above).
It's also critical to meticulously examine the quality and quantity of studies that support the supplement's safety and effectiveness.
There are NO guarantees! An athlete may be extremely vigilant and still test positive for a prohibited substance or fall victim to negative health effects of a product. The only way for an athlete to completely eliminate the risks associated with dietary supplements is to avoid them altogether
That being said, it's on each athlete to be extremely cautious and do extensive research to learn what is safe, legal and effective. A board certified sports dietitian can do this also. Feel free to email me at email@example.com if you need support.
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