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REALIZE: There are risks associated with using supplements

Dietary supplements are risky because they could contain prohibited substances that can cause a positive anti-doping test or ingredients that cause health problems.

This section is designed to help you realize that:

  • You can be harmed by supplements
  • Laws and regulations cannot always protect you from dangerous products
  • Doctors, coaches, and peers may not understand the risks of using supplements and could recommend an unsafe product to you
  • Your reliance on dietary supplements may be unnecessary

REALIZE: Athletes’ health and careers can be harmed by supplements

REALIZE: Laws and regulations may not protect you from dangerous supplements because…

  • Supplements are not evaluated or approved by the FDA before they are sold

    Dietary supplements are a special category of food and are regulated in a post-market manner by the U.S. Food and Drug Administration (FDA). To be considered a dietary supplement, a product must a) contain ingredients that have a history of use in the food supply, b) be taken by mouth and swallowed (like a food), c) be advertised only to improve the diet or to provide nutrients, and d) must have a supplement facts panel on it. In the eyes of the law, a product must meet all of the criteria above to be considered a dietary supplement. However, the FDA doesn’t check to make sure products meet these criteria before they are sold. It is important to realize that contaminated products make it to store shelves on a regular basis.

  • Some supplement companies buy impure or contaminated raw ingredients

    Most supplement companies don’t grow or produce their own ingredients but buy them from ingredient suppliers all over the world. Some ingredient suppliers improve their profits by offering cheap, impure, degraded, or contaminated ingredients. Some suppliers will even pad the desirable but expensive ingredients with fillers, a practice known in the supplement industry as “fairy dusting.” Even though supplement companies are required by law to test their ingredients on arrival or demand a certificate of analysis from the ingredient supplier, the tests some companies use to confirm the identity of ingredients are not robust enough to detect contaminants, and certificates of analysis can be faked. It’s important to realize that you can’t look at a supplement label and know the true ingredients.

  • Some supplement companies do things wrong without realizing it

    Some supplement companies want to make safe products but make mistakes, such as: labeling their products incorrectly, making illegal advertising claims, manufacturing their products with the wrong ingredients or the wrong dosages, accidentally buying adulterated ingredients, or including illegal or novel ingredients without realizing it. It’s important to realize that even well-meaning companies can unknowingly sell contaminated supplements.

  • Some supplement companies deliberately spike their products with performance-enhancing drugs

    There are plenty of companies that deliberately sell products that contain steroids, stimulants, and other drugs with little regard for the safety or health of their consumers. Their primary goal is to use pharmaceutical agents to deliver results, and they market their products as dietary supplements because it makes them easier to sell and appear safe. Even though they are not technically “supplements,” they are packaged and labeled just like legitimate supplements. It’s important to realize that some companies will deliberately sell “supplements” that contain prescription or experimental drugs.

  • The internet makes it easy to get away with selling illegal supplements

    The internet makes it very easy to distribute unsafe or illegal products because it can be very hard to track down and prosecute the people behind a web store. Some sites are based in other countries, which makes it even more difficult, if not impossible for the FDA to enforce regulations. Buying a product from a “reputable” online nutrition store is also no guarantee. Several mainstream, trusted, web-based nutrition stores have sold products that contain prohibited or adulterated ingredients. It’s important to realize that the internet is filled with illegal supplements that contain prohibited and harmful substances.

  • It is very difficult to remove dangerous products from store shelves.

    Since supplements are regulated in a post-market manner, a product will usually need to yield an adverse event report saying someone has been hurt or sickened before the FDA will investigate. If the FDA determines that a product is dangerous in some way, they usually allow the company to continue selling the product as long as they promise to fix the problem. In extreme cases, the FDA can ask the company to recall the product, but even if the FDA demands a recall of the product (which rarely occurs), recalls are not always effective. For example, more than half of the supplements recalled between 2009-2012 were still on store shelves six months later. And even if the company recalls the product from stores, it’s very unlikely you will be contacted about a product that you have already purchased. For these reasons, it’s important to realize that the FDA often cannot prevent dangerous products from being sold.

REALIZE: Doctors, trainers, coaches, and parents may not understand the risks that supplements pose

Doctors may be unaware of the contamination or quality issues in the supplement industry, and they may not realize that supplements pose anti-doping risks to athletes. Coaches, teammates, parents, and friends also may not have all the facts when it comes to dietary supplements, or they might have other interests in mind influencing their decision to recommend supplements. It is important to realize that someone you trust could unknowingly recommend a dangerous or contaminated product to you.

It’s always important to be an informed consumer, especially when it comes to dietary supplements. U.S. Anti-Doping Agency Chief Science Officer Dr. Matt Fedoruk explains why supplements are so risky and how you can minimize the risks of supplement use.

REALIZE: Your reliance on supplements might be unnecessary

Do your assumptions about dietary supplements stand up to scrutiny? Often, supplement companies overstate, and consumers overestimate, the benefits of using supplements. You may believe some of the statements below, but it’s important to realize your expectations may not be realistic:

  • Assumption: “I can't get everything I need from my diet.”

    Realize: A well-balanced diet usually delivers all the nutrients required for athletes. Most sports dietitians recommend a food-first approach to nutrition.

  • Assumption: “I don't have time to prepare and cook everything I need.”

    Realize: Eating a balanced diet does require extra time and effort, but there are many examples of athletes who do this very successfully in spite of their busy training and competition schedules.

  • Assumption: “My body is under a lot of strain and I need immune boosters to keep from getting sick.”

    Realize: Despite their claims, there is little credible evidence that supplements “boost” your immune system or keep you from getting sick. In fact, dietary supplements are not allowed by law to advertise that they cure or prevent any disease, including colds or the flu.

  • Assumption: “Even if it's not proven, but there is a chance that a supplement works, it's worth it.”

    Realize: This approach relies entirely on the supposed benefits of a supplement and completely ignores the risks.

  • Assumption: “They work.”

    Realize: There are a few supplement ingredients that might be beneficial for some athletes in certain sports and under certain conditions. Ultimately, your sport and your body composition will determine your nutritional needs. Some athletes think a supplement works because they feel something when they take it, but this might be due to the presence of stimulants or other contaminants in the product.

  • Assumption: “Everyone uses supplements and they might gain an advantage over me.”

    Realize: Your peers might not know about the risks around supplements and they may simply believe the advertising promises of the product. If you decide to use a supplement, make your decisions based on scientific evidence of effectiveness and safety.

  • Assumption: “Supplements are a natural and safe way to enhance health.”

    Realize: Many ingredients used in dietary supplements are not extracted from plants, but are instead highly manufactured, and even “natural” herbs can be toxic in certain dosages. In addition, the USADA High Risk List has multiple examples of “all-natural” products that contain prohibited substances.

In conclusion, many athletes believe they must take dietary supplements in order to compete at the best of their abilities; however, it is important to REALIZE that there are real risks and safety issues associated with dietary supplements.

If, at this point an athlete or consumer believes that taking a dietary supplement is still necessary, the next step is to become fully informed about and RECOGNIZE risk when you see it.

ABBY RAYMOND VIDEO TRANSCRIPT

My name is Abby Raymond and I’m a 15 year old U.S. Olympic Weightlifter, and I used to be a gymnast, so when I stopped doing that I got into Crossfit, and then Crossfit is what took me to weightlifting. I really wanted to pursue weightlifting at an elite level because I just loved everything about it and I had that gut feeling that it was what I was supposed to be doing. When I started competing at the elite level, supplements were a part of my nutrition plan. I took a protein powder and a pre-workout. I got in touch with a family friend because they had just started their own supplement company, and they introduced me to their products and asked if I wanted to try it. And me and my dad even explained to them that I was randomly drug tested by USADA, and they kind of laughed and just shook it off and said I would have nothing to worry about with their products. At the time, I knew that there was always a risk with using supplements, but because I was guaranteed that I wouldn’t have a problem with their products, I thought it would be O.K. to use.

About three weeks after I started using the products, I was drug tested for the first time. USADA came to my house after I got done working out, and I was kind of excited but a little nervous too, because I didn’t really know what to expect, but, then again, I felt kind of honored that they wanted to test me. And then I just went on training for a couple weeks after, because I was training for the American Open. And I ended up going there and I had a really good meet. I think I went five for six and broke two American records, so I was pretty excited, and I took second, overall.

But then, the day after I competed, I got a call from USADA saying that I tested positive for a drug called Ostarine. And I was really, really confused when I first heard that. And I didn’t really know what I should have been feeling. And my family was really confused, too. It was just a whole bunch of, like, chaos, I guess. I don’t know, because we didn’t know where we should go from here. And I remember I just cried that whole night, because I couldn’t believe that this had happened and I didn’t know how it had happened. And I just kept asking the questions over and over again, like, how and why. And then we got the products I was taking tested, and when they came back positive, it was really difficult to hear that. We called the owners right away. Even the owners, they didn’t know where it was being made, where it happened. So I think it was just an accident for everybody. Knowing that the supplement that was contaminated came from somebody that I trusted, it showed me that even if you trust the person, you can’t always trust the product.

I started to accept the situation more and I made peace with it, almost. Like it happened and I’m a strong believer that things happen for a reason. And I didn’t know the reason at the time, I think this is the reason now, so I can help other people and help them not to make the same mistake I did.

DR. MATT FEDORUK ON SUPPLMENTS VIDEO TRANSCRIPT

MATT FEDORUK, USADA Chief Science Officer:

Depending on where you look for the answer, you can actually find lots of different answers to the question of, “What is a dietary supplement?” Legally, by definition, the FDA defines a dietary supplement as a product that contains a dietary ingredient that is taken by mouth. And dietary ingredients are things like vitamins, minerals, herbs, botanicals, things that are used to supplement our diet that can usually be found in food.

Athletes and consumers need to be aware that because supplements aren’t tested in the same way as medications, they don’t have to go through clinical trials, they don’t have to go through efficacy trials, each lot number doesn’t have to be tested in humans before it goes on the market. So, some of the dangers that we see are related to either those contaminants that we find in those products that consumers are using larger amounts that they might not be aware of, or they’re using multiple products at the same time that lead to a synergistic effect. So, a good example, for example, if you’re using an energy drink and then, on top of that, you’re using a pre-workout supplement, and you may have had sugary foods for breakfast, as well, and all those things compounded on itself could lead to cardiac events, for example, or digestive problems because of the amount of caffeine and sugar that you’re taking into your body. So, in that way, those are relatively mild events, but more dangerous events come from products that maybe contain anabolic agents, and we’ve seen that in the past with manufacturers that have anabolic steroids in their products at pharmacological dosages. And when athletes use these things, some of these steroids, which are synthetic molecules, they can have liver toxicity effects. And we’ve seen athletes being admitted to the hospital and those effects that they’re seeing on their bodies, they don’t know where they’re from, and it takes doctors a long time to figure it out, and they have to go down the list and figure out what’s causing this. So, that’s really scary when it comes down to health effects that are life and limb type of situations, that athletes could have permanent and irreversible effects from.

I think, right now, we’ve gone through various phases over the last decade with what we see in products. I think the stimulant category is still a big red flag for USADA and TrueSport. Those are substances that companies are intentionally adding to supplement products to provide an energy boost or provide a performance-enhancement. And those aren’t always listed on the label and companies are always changing those ingredients in order to remain, kind of, one step ahead of the regulatory authorities. They think that they should be defined as dietary ingredients, but, in fact, many of these substances don’t meet the legal definition of a dietary ingredient. And so, they’re intentionally added in order to provide this type of boost that athletes are looking for or to substantiate the claims that are on the label. So, I think the stimulant category continues and will continue to be this ever-moving target for USADA and TrueSport.

I think educating yourself around supplements is really critical because at face value it doesn’t seem like a complicated area, but it’s fraught with landmines, and we need to be informed consumers to understand what the risks are and how to minimize those risks in order to make sure that we’re protecting our athletes and ourselves against those risks and those detrimental effects that could be caused through supplement use.