Happy. Healthy. Southie.

Supportive and non-judgmental advice from SBCHC's health experts.

Sports Supplements: Do They Really Deliver on Their Promises?

By: Ryan Narciso

Who wouldn’t want to be more muscular, stronger, faster, or burn fat more quickly? With rising rates of obesity and more of a focus on the role of exercise in a healthy lifestyle, the emergence of the market for sports supplements which claim to help people achieve their fitness goals makes a lot of sense. But do these supplements actually live up to their claims and are they safe for everyone to use? In this post, I will discuss my general thoughts when it comes to these supplements as a Sports Medicine physician, as well as dive deeper into the evidence behind a few of the most popular supplements.

 

Are dietary supplements generally safe?

One of the biggest challenges when it comes to evaluating supplements in terms of both safety and their effectiveness is a lack of oversight into what is actually in the products. The main reason behind this requires a brief history lesson. In 1994, a law was passed called the Dietary Supplement Health and Education Act (DSHEA) which allowed nutritional supplements to be introduced into the market without oversight from the FDA (Food and Drug Administration) as long as the supplements did not claim to treat, diagnose, or cure diseases. However, it still allows for claims like increased performance, more muscle mass, or fat burning without proof of these benefits. There is also no requirement for companies producing the supplements to ensure safety of the product or verify that what is on the ingredient list is a true reflection of what is actually in their supplement. As a result, there have been several cases of people getting very sick and even dying from dangerous contaminants in dietary supplements. Even when studies are done on the safety and effects of these supplements, they often do not include any people under the age of 18. This is an issue because up to 10-20% of high school athletes have tried sports supplements and there is little evidence to know how these products will affect their bodies.

 

Creatine

One of the most commonly used dietary supplements is creatine. Creatine is an amino acid which we make naturally in the liver. It plays a role in providing an energy source for muscle cells during short-term exercise. Creatine also plays a role in making proteins in the body and has been shown in some studies to improve performance for quick bursts of exercise, such as in sprinting or weightlifting. The most common side effects are weight gain as a result of making the body hold onto more water and stomach upset. Initial studies had raised concerns about the supplement damaging kidneys, though more recent studies have shown that it is typically safe in patients that have healthy kidneys as long as it is taken in the appropriate dose (3-5 grams per day).

 

Protein Powders/Bars

The use of protein powders or bars either as meal replacements or as snacks to increase protein intake is also a common practice. Most dietary guidelines recommend 1.2-1.4  g/kg body weight (0.54 – 0.64 g/ lb body weight) of protein per day in endurance athletes (runners) and 1.2-1.7 g/kg body weight (0.54- 0.77 g/lb body weight) in strength training (weightlifting) athletes to help fuel muscle recovery and health. There is evidence that eating protein within the first hour after a workout can further increase these benefits. But does it matter where the protein comes from? The short answer is probably not. Eating a healthy, varied diet with things like poultry, lean red meats and nuts/legumes can provide most people with enough protein to meet their daily needs, even when very physically active. Protein powders and bars are most helpful for those with more restrictive diets, such as those who are vegetarian or vegan, or those in whom their sport requires very strict attention to total calories consumed due to weight constraints like wrestlers or rowing athletes.

 

Pre-Workout Supplements

The use of pre-workout supplements has skyrocketed in recent years, especially with young adults. These supplements often claim to help improve energy and performance with exercise.

However, the majority of studies have shown minimal to no benefit in terms of athletic performance or body composition with the use of pre-workout. Typically the main ingredients in pre-workout are caffeine and other stimulants, which can lead to significant side effects if taken in too high of doses, including heart palpitations/abnormal heart rhythms, high blood pressure, and shortness of breath. One study found that side effects from dietary supplements result in about 23,000 Emergency Room visits a year in the US, with about 72% of those visits due to reactions to pre-workout or bodybuilding supplements. Even more scary, there have been several cases of military members and athletes passing away during physical activity due to conditions like heart attacks and strokes after taking pre-workout supplements which contained dangerous ingredients which were not on the product labels.

 

Take Home Messages

While there are studies that have shown some benefits of dietary supplements like creatine and protein powders in the right people, it is important to always check with your doctor first before taking a supplement. There is very little oversight on the purity of these supplements and whether their claims have been tested or even proven to be safe. I generally recommend that even my most active patients can get all of the nutritional needs for their bodies by eating a healthy balanced diet with appropriate portions of protein, carbs, and fats. For those interested in more information on the evidence behind and safety of some of the most popular dietary supplements, the NIH has a website for patients that can be found at https://ods.od.nih.gov/factsheets/ExerciseAndAthleticPerformance-Consumer/.

References: 

  1. Geller, AI, Shehab, N, Weidle, NJ, Lovegrove, MC, Wolpert, BJ, Timbo, BB, Mozersky, RP, and Budnitz, DS. Emergency department visits for adverse events related to dietary supplements. New England Journal of Medicine 373(16): 1531-1540, 2015.
  2. Herrin, SA, et al. Selected Issues for Nutrition and the Athlete: A Team Physician Consensus Statement. Medicine & Science in Sports & Exercise 45(12):p 2378-2386, December 2013.
  3. Food & Drug Administration. DMAA in products marketed as dietary supplements. 2018.
  4. Maughan, R. J., Burke, L. M., Dvorak, J., Larson-Meyer, D. E., Peeling, P., Phillips, S. M., Rawson, E. S., Walsh, N. P., Garthe, I., Geyer, H., Meeusen, R., van Loon, L., Shirreffs, S. M., Spriet, L. L., Stuart, M., Vernec, A., Currell, K., Ali, V. M., Budgett, R. G., Ljungqvist, A., Mountjoy, M., Pitsiladis, Y., Soligard, T., Erdener, U., & Engebretsen, L. (2018). IOC Consensus Statement: Dietary Supplements and the High-Performance Athlete. International Journal of Sport Nutrition and Exercise Metabolism, 28(2), 104-125.
Sports Medicine Specialist, Ryan Narciso, MD

Ryan Narciso

Ryan Narciso, MD, CAQSM is our Sports Medicine specialist. He sees patients for acute injuries and chronic conditions alike. He is especially interested in the treatment of Musculoskeletal Injuries and Diagnostic Ultrasound and Procedures. Dr. Narciso is available for appointments on Mondays and Wednesdays after a referral has been made by your Primary Care Provider.