If the nutritional supplement that you're planning to take sounds too good to be true, it probably is.
It may also be spiked with something illegal and dangerous. It may contain substances banned by professional sports leagues, amateur athletic organizations, the FDA or the United States military. It is certain to be barely regulated and inadequately tested. Even if it contains only what it claims to contain and makes no outlandish promises, it probably adds nothing to your body that you could not get from a balanced meal. It is expensive, probably useless and potentially life- or career-jeopardizing. On the plus side, it is available at the mall, or with a few clicks on the Internet.
Supplements are a major part of an athlete's life. For some, they are nutritional aids they hope will provide a modest performance boost on the field or in the weight room. For others, they are a scapegoat for a failed drug test, or represent a chance to gain a competitive edge while working the fringes of legality. Some athletes take supplements that were recommended by trainers or friends. Some carefully read the ingredient labels. Most have no idea what they're taking, because ingredient labels are misleading or false, and many supposed "enhancers" (even banned ones) do nothing. And even the most responsible supplement consumer is faced with an industry that has little oversight and that manages to stay one step ahead of both the law and the leagues.
The athletes aren't the only ones risking health and reputation while wasting money. Supplements are everywhere. Consumers think they are filling dietary holes, getting a little extra pre-workout protein or using some natural "herbs" to curb appetites or boost energy. In fact, athletes and consumers alike are taking part in what one nutrition expert calls a "large-scale rodent study."
What You Don't Know
When it comes to nutritional supplements, it is more instructive to examine what we do not know than what we do know.
We do not know how big the supplement industry is. Estimates for industry revenues range from $2.8 billion to $28 billion and beyond. Industry insiders and critics alike are reluctant to put anything close to a precise number on the industry's size. CNN reported in 2011 that half of Americans use some kind of supplement, from simple multivitamins to mysterious powders sold over the Internet. One investment firm pegged the revenues for the entire nutrition industry at $108.3 billion in 2009.
One simple problem with determining the industry's scope is defining a "supplement." Vitamins and protein mixes fit the bill. Deer antler spray typically doesn't, though it broadly fits the category -- a supposedly natural, legal health aid. What about oxygenated water, which supposedly replenishes oxygen while you drink it (perfect for the athlete with gills)? The protein-packed recovery drinks at your local gym? The stimulant-laden stuff on the Internet that's marketed as a workout boost under one label and a "party pill" under another? Major manufacturers and trade organizations keep track of vitamin and herbal sales, but they are just the tip of the iceberg.
We do not know how many athletes use them. Most do, even if it's just a protein powder you can buy in your corner drugstore and that contains nothing newsworthy. But many are tempted to explore the hinterlands of the industry. "They have such a great motivation for it," said Juné Rogers, the director of drug programs and policies for the NFL Players Association. "We reward the biggest, fastest and strongest in our industry."
Athletes take supplements even though top nutritionists and trainers argue that they are useless. "They don't need any supplements if they are doing it right," according to David Lightsey, a health and safety speaker for the NCAA and professor at Bakersfield College who has also served as a consumer advocate for the National Council Against Health Fraud. It was Lightsey who referred to supplement use as a rodent study. He instructs NCAA players, trainers and coaches on the myths and dangers of supplement use, from the risks of getting tainted products to the simple questions of efficacy.
Of course, some athletes are seeking something that does more than cover a vitamin deficiency or provide some extra protein. And athletes who are not looking for that something extra sometimes get it anyway.
We do not know who is in charge. The Dietary Supplement Health and Education Act, passed by Congress in 1994, keeps the Food and Drug Administration at arm's length from the supplement industry. A supplement manufacturer need only provide the FDA with a "reasonable expectation of safety," and no proof whatsoever of efficacy.
Recent laws have given some regulatory power back to the FDA, but the government agency is still left to enforce complaints about spiked products or new substances after such items have reached the marketplace. As Lightsey points out, this puts the burden of proof in the public's hands, not the manufacturers'. "The FDA cannot step in. They have to prove that it's unsafe to take it out."
The Federal Trade Commission can act on false efficacy claims, but like the FDA, the FTC is forced to respond rather than prevent, and irresponsible marketers are savvy about circumventing fraud laws. (Think: vague claims, a big picture of Adonis on the label, a tiny disclaimer in the corner.)
That leaves the industry leaders to self-regulate. Organizations like the Council for Responsible Nutrition publish guidelines and encourage responsible practices, while at the same time helping manufacturers lobby to maintain their unique status on the periphery of FDA jurisdiction. The CRN condemns product spiking and "legal steroid"-style advertising claims, and it has partnered with the FDA on some initiatives, but it does not have enforcement powers. "We don't pretend to be a regulatory commission," said Steve Mister, president and CEO of the CRN. "We don't have guns and badges."
We don't know what these products do. Actually, scientists know a great deal about vitamins, proteins and amino acids, to say nothing of the steroids and stimulants that often find their way into performance-enhancing supplements. Experts know enough to assert that the phrase "supplement to a well-balanced diet" is self-contradictory in most cases, that for healthy adults a mega-dose of most products produces nothing but expensive urine, that protein powders provide nothing that you cannot get from roasted chicken and whole milk, and so on.
Unfortunately, that knowledge is drowned out by advertising claims, credulous media coverage and a misunderstanding of fundamental science among the general population, athletes and even athletic trainers. A headline about a new wonder-substance can fuel a health fad, but that headline could be based on an unsupported study or, worse, a press release from within the supplement industry itself that found its way onto the daytime talk circuit. "Health news is driven and motivated by headlines that have no application to your life," according to Lightsey.
Dr. Stephen Barrett, founder of the Quackwatch.com medical website and cofounder of the National Council Against Health Fraud, phrased the problem more succinctly: "I recommend that people don't take their advice from national talk show guests."
We don't know what's in the bottles. And unless we send every single batch of every single supplement to an independent lab for testing, we never will.
A Geranium By Any Other Name
Athletes must know what they are putting in their bodies. That's what the television personalities and talk-radio hosts say when an athlete gets suspended for using a substance that's legal for the general public but banned by sports leagues. It's a great nugget of common sense, except that it's nearly impossible to follow.
According to some studies, as many as 25 percent of sports supplements are "spiked" with something that's not on the label, typically steroids or stimulants. Mister and the CRN dispute that alarming percentage, noting that the studies in question focused on fringe products that make suspicious claims, not the vitamins in your local supermarket. Then again, those suspicious products are exactly what athletes -- professionals, amateurs and neighborhood gym rats -- are likely to gravitate toward when seeking something punchier than a shortcut to eating their vegetables.
"The potential for harm has gone up exponentially in the last few decades," according to Lightsey, who warns that some products contain "all the ingredients they can shove in" and that the energy surge you feel after taking a supplement is not protein or amino acids at work, assuming you've been eating properly. "Most athletes won't get the pop unless there's something else going in."
Even if the label is accurate, it's impossible to match the contents of a bottle with a list of banned substances. "Banned substances are called by slang or even made-up terms" on labels, according to Dr. Amy Eichner of the U.S. Anti-Doping Agency (USADA).
Take Methylhexaneamine, or DMAA, or geranium stem. DMAA is banned by the World Anti-Doping Agency (which regulates Olympic athletes and many others) and the U.S. military. The stimulant was recently linked to the deaths of two soldiers, as well as a woman running in the London Marathon. Products containing it are marketed as sexual aids and legal-high "party pills" when they're not being sold as workout boosters. The FDA warns that DMAA "narrows the blood vessels and arteries" and can cause symptoms ranging from "shortness of the breath to tightening of the chest and/or a possible myocardial infarction (heart attack)."
DMAA would seem like an easy substance to avoid, except that one list published by the Human Resource Performance Center named a total of 31 different aliases for DMAA, from polysyllabic chemical names, to brand names, to innocuous variations on "geranium" (the ingredient in supplements possesses only a passing chemical similarity to the substance found in flowers), to off-the-wall names like "crane's bill extract." A list of dozens of brand names follows the list of substance names, one even the most diligent consumer would strain to work through.
Multiply 31 names by hundreds of substances, and both athletes and consumers face a real dilemma. "Why would a player know that something like testosterone can be written umpteen different ways?" Rogers asked. "They are not scientists."
With NFL Players Association members risking a six-game suspension every time they enter a health food store, Rodgers and the NFLPA have prepared a multi-pronged response. An educational campaign called "Don't Take" warns players against taking substances that do not come from reputable sources. A new cell phone application called Aegis Shield will be given to all players. It will allow them to immediately search a database on any product (receiving banned, caution or OK results in real-time). It will also allow them to submit information about any substance not included in the database to Aegis Sciences, one of the chemical testing industry leaders, and get a response within 24 hours.
Rogers also has a hotline that connects players directly to her, and she works the phones to establish a rapport with players and their agents to discover what new products are becoming popular in locker rooms, so she knows what to track. "I stay in the loop and look for patterns," she said.
The U.S. Anti-Doping Agency, meanwhile, maintains a website called Supplement411.org that provides resources and testimonials; amateur athletes in USADA's jurisdiction also attend educational seminars and are warned about products with outlandish claims or unknown origins. "If an athlete doesn't recognize an ingredient, there's a risk," Dr. Eichner said.
Education and testing only go so far. The supplement industry is so poorly regulated that just about anyone can cook up products in their garage, then distribute them via the Internet, the backs of gyms and through word of mouth. One source said that the contents of a product may vary, not just from bottle to bottle, but from pill to pill, because the standards for manufacturing are set so low.
The Council for Responsible Nutrition expects its member organizations (which include many vitamin industry leaders, retail chains and raw ingredient providers) to adopt high manufacturing standards and avoid outlandish or "barely legal"-style efficacy claims. It has supported recent legislation that gave the FDA the teeth to prosecute the makers of spiked products and reclassify some substances as drugs. (DMAA is now under FDA regulation.)
"It's a tale of two industries," Mister said. The CRN has brought challenges against its own members and has turned down suppliers and manufactures who failed to meet the organization's criteria. "There's the mainstream diet supplement industry. But other companies are trying to hijack our industry."
Dr. Eichner disagrees with the notion that the problems of spiked and misleading products are limited to fringy "rogue" companies. "They are mainstream," she said. "That's the problem. The sports segment of the market is so huge."
Mad, Aggressive Desire
An athlete who types in dot-com instead of dot-org at the end of the Supplement411 address is sent not to the USADA's website, but to a portal that sells supplements. The item at the top of the best seller's list during a recent search was Jack3d, which promises "mad aggressive desire and ability to lift more weight, pump out more reps and have crazy lasting energy, along with sick muscle-engorging pumps." Jack3d was previously on the DMAA list, though it may have since changed its formula. Other items at the website are brazenly advertised as "still-legal."
Web address confusion aside, anyone with horse sense should see through such advertising claims. Other suspicious information is subtler. Search the Internet for information on the DMAA ban, and you quickly find an article by a "certified personal trainer" who also happens to run a supplement company. This expert believes that the "FDA and others should further research DMAA and put some solid facts together," before banning the substance he described (without substantiation) as a "great workout supplement and diet supplement." Not to worry, though: He lists a dozen products that work almost as well as the substance that the military and government deem too dangerous for the marketplace because it may cause heart attacks.
The supplement marketing problem for consumers is so extreme that scientific-sounding journals are often underwritten by supplement manufacturers, making it nearly impossible for someone without a background in nutrition or science to separate good information from misinformation or out-of-date information. "Anyone telling the truth in this industry is basically not heard," Lightsey said.
With the FDA nearly powerless and organizations like the CRN only representing a small segment of the industry, the inability to get accurate information about what's illegal, dangerous, or useless is a major public health problem. When it comes to athletes, Dr. Eichner stressed that the USADA is not anti-supplement. "It's about making an informed decision. We just want them to understand the risk. In the end, their health is their decision."
Lightsey was less diplomatic. "The athletes are playing Russian Roulette with their health when they take over-the-counter products."
And here is the worst part: There is no reason for them to do it.
Expensive Jars of Bananas
A recent Miami Herald article about the value of nutritional supplements contained some fuzzy mathematics. The overall tone of the article was skeptical ("Buyer Beware" was in the headline), but one of the quoted experts recommended protein supplements for "people seriously into bodybuilding."
The expert explained that a small chicken breast (the size of a deck of cards) contains 30 grams of protein, while an eight-ounce glass of milk contains eight grams. The average 150-pound person needs 54 grams of protein per day, but a bodybuilder needs 102 grams and "would have to eat chicken until it comes out his ears," according to the expert, who is credited as an "exercise physiologist."
Leaving aside the concept of a 150-pound bodybuilder for a moment, a quick calculation shows that this tiny chicken-and-milk meal provides 38 grams of protein, or 37 percent of the bodybuilder's needs. Give the bodybuilder 16 ounces of milk (what adult drinks eight ounces of anything with a meal?) and we are up to 46 grams and 45 percent of the percent protein needs for the bodybuilder, and 85 percent for the average person.
A chicken sandwich and a tall glass of milk is a typical lunch for a white-collar worker, not someone entering bodybuilding competitions, who presumably builds up a hearty appetite. Surely the body-builder does not need chicken coming out of his ears, nor does he seem to need a supplement, when a small lunch provides nearly half his needs and a breakfast of eggs and a snack-bag of peanuts can fill in the rest before dinner.
The Miami Herald physiologist is not the first expert to provide nutritional advice that even a layman call tell is not internally consistent. Lightsey gives his students an article written by a former Major League Baseball trainer and published in a scholarly-sounding magazine. The article contains two-dozen factual errors by Lightsey's count, and he tasks his students to find them.
Some of the purported errors cite out-of-date information. Others perpetuate pervasive myths about Recommended Daily Allowance levels, which are set well above our basic dietary needs and do not need supplementation to reach some kind of "optimal level." A few are just self-contradictions: The article claims that individuals should "appropriately supplement a well-balanced, whole-food diet" when the very definition of a well-balanced diet is one that meets all nutritional needs without the aid of supplement. Along the way, the article raises the specter of pesticides, as if the fear of an unwashed apple is worth delving into the world of unregulated pills and powders.
How did a professional athletic trainer become so misinformed? "A lot of team trainers are well trained. A lot are poorly trained," said Lightsey, who is in the business of training trainers. And how did the article get published with so many errors (and no scientific citations)? The journal it appeared in is underwritten by several manufacturers and retailers of supplements.
Just as much of the information athletes receive, even from reliable sources, is simply wrong, much of what they put in their bodies is no more useful than what Lightsey calls "an expensive bottle of bananas." The typical young male can only process about 20-30 grams of amino acids, the amount found in a few small glasses of milk; the rest is excreted. As the Miami Herald physiologist proves (somewhat inadvertently), a bodybuilder can get the protein he needs from some wholesome meals, and has little use for the surplus. A high school biology student could tell you that oxygen cannot get from the water you drink into your lungs, unless you are a species of fish.
As for Ray Lewis' Deer Antler Spray, its active ingredient is a form of Insulin. There is a reason diabetics must give themselves a shot instead of taking a pill or applying a spray: The stomach walls chemically obliterate Insulin, and the skin has a similar effect. What few scientific tests have been performed on antler products have found them useless, unless they are injected.
Of course, athletes sometimes get a rush from a product before using it, even if it is not spiked. Some athletes, particularly amateurs, do not get enough protein or calories before their workout, though Lightsey and others argue that it is a problem best solved with chicken and milk, not expensive powders. Others start taking products in their late teens and attribute the results of simple maturation or a commitment to exercise to their favorite supplement.
And then there's the placebo effect. "Personal experience is subject to a particular type of bias," according to Dr. Barrett of Quackwatch.com. If you believe something is helping you, it does help you, a phenomenon well known to psychologists, doctors and snake oil peddlers for generations. The placebo effect allowed the manufactures of "balance bracelets" to attract celebrity and athletic endorsements and build a multi-million dollar industry out of trinkets a few years ago. It convinces control groups in scientific studies that the sugar pills or tap water they consumed are performance enhancers, leading to actual performance increases.
It also convinces millions of individuals that they are benefitting from a product, when in fact their health or performance improvements may be illusory, or a coincidence. "The whole industry is built around coincidence," Dr. Barrett said.
If your diet is like mine, as opposed to Michael Phelps' or Tony Gonzalez's, multivitamins and other mainstream supplements are beneficial. But Barrett deflates the claims of even the most benign products you might find at a supermarket. Such products should stress that you do not need them if you eat right, he said. They should state that they contain so much of each ingredient that you probably only need to take a pill every three days. They should point out that all the products are the same, if manufactured responsibly, so your best bet is to buy the cheapest one, not the one that makes the best promises or is endorsed by the most reputable celebrity.
"That's how you sell it honestly," Barrett said. "If everyone was honest, there would be no more industry."
Dr. Barrett is blunt about what he feels needs to be done to bring the supplement industry under control. "Abolish the members of Congress protecting the industry, and then change the laws," he said.
The CRN, while endorsing some legislative measures, stresses that it's the FDA's job to enforce existing laws and bring manufactures of spiked or dangerous products to justice. "If you have a robust agency, that should not happen," Mister said. Mister also said that "consumers have to have an active hand in this," noting that a purchaser seeking a product that claims to be a near-steroid probably knows that he or she is doing something risky.
Barrett feels that the government could do more, even within current strictures. "The FDA could do a lot of simple things. It's just not the highest priority." Rogers worked for the FDA before joining the NFLPA, and she does not expect the agency to become more empowered in the current political and economic climate. "Even if they receive more authority, it would be an unfunded mandate," she said.
For Rogers and others working within leagues or amateur organizations, the solution boils down to educating athletes, providing resources, and fighting an often-losing battle against players who hear what they want to hear from word-of-mouth, advertisers, misinformed trainers and websites masquerading as impartial sources. "It's a balance of what we would like to see, and the reality," Rogers said. "If some of these things work, they are probably tainted, but no one wants to hear that."
In the meantime, athletes must know to distrust labels. They should steer clear of unknown suppliers. They should verify what information they have with league, union, or association professionals, not anonymous websites. They should know that even benign health claims are often unverified, that a proper diet can take care of all of their needs, even if they are marathoners or 300-pound defensive ends, and that substances that claim to be powdered antlers or geraniums can not only get them suspended but could cause health risks. All of that, or they should simply heed the "Don't Take" advice that comes from organizations protecting their health and interests.
The same goes for the general public. "They are just as savvy as the regular consumer," Rodgers said of NFL players. "They are just a microcosm."
Barrett, a veteran public health watchdog, takes the advice even further. "You should have a very high level of skepticism and suspicion," he said. "Never trust information provided by a maker of a dietary supplement, ever."