1. Eat to compete: Dietary Supplements
Supplementation among athletes is becoming more popular. There are many products on the market promising “fat burn”, increased muscle mass, and weight loss. What many athletes do not know is the impact of supplementation, if it is safe, if it meets its expectation, and if it is needed.

2. Dietary supplements on the market are:
NOT regulated
Could contain illegal substances
Could be costly
Could be harmful
The market is filled with various supplements promising weight loss, weight gain, or many other benefits for human health. Many people believe that supplements are necessary and supplementation is becoming more popular in the athletic population. However, supplements can be unsafe, costly, and give false claims.

3. Current laws on dietary supplements
No requirement for efficacy
(proof they do what they claim)
No requirement for safety
(proof they cause no harm)
Presently, according to law, dietary supplements do not have to prove efficacy (proof that they do what they claim) or safety (proof that they cause no harm) before they are placed on the market. The FDA can only remove a dietary supplement after the FDA has proven that the supplement does not work or is unsafe. Due to the number of dietary supplements on the market and the research needed for proof, it takes a great deal of time and money for the FDA to remove dietary supplements from the market.

4. FDA initiatives Implement process to evaluate dietary supplements
Set standards for consistency
Provide guidance on what claims can be made
The FDA made a step toward better regulating dietary supplements on November 4th 2004 when they identified key initiatives to further implement the Dietary Supplement Health and Education Act of The first initiative stated that the FDA will work with Federal partners to implement a process that evaluates dietary supplements. This process involves the FDA identifying a safety concern, determining whether it is a health problem, and then implementing the appropriate changes to eliminate the problem.
The second initiative involves the FDA setting industry-wide standards to help ensure dietary supplements are manufactured consistently. This would require the industry to follow standards for good manufacturing practices (GMPs) to ensure purity, quality, strength, and the exact composition of dietary supplements.
Finally the FDA recommends providing guidance to the industry on supplement claims including their definition and substantiated.

5. Advice for youth
Consult with a healthcare professional, MD, pharmacist, or registered dietitian
A well balanced diet including foods from a variety of food groups can provide the daily requirement for each individual. Therefore, supplementation is not needed. Many supplements contain contaminants, including illegal substances, and are unsafe to consume. Therefore, athletes who want to take supplements should consult with a healthcare professional before doing so.

6. Dietary supplements include
Any product intended to supplement dietary intake
Examples
Vitamins/Minerals
Herbs and Botanicals
Protein/Amino Acids
The FDA has broadened its definition to include not only vitamins, minerals and protein, but also herbs and other botanicals. Often times supplements are substances the FDA formerly classified as drugs or unapproved food additives.
Vitamins and minerals are generally considered safe if consumed in recommended doses. However, some supplements may have mega doses of vitamins that far exceed the recommended values. This is particularly important if the supplement is a fat soluble vitamin A, D, E, and K, which can be toxic if consumed in excess.
Herbal supplements are not regulated and can vary in potency depending on where they were grown. In addition, some herbal supplements can cause liver damage, abnormal heart rate, vomiting, etc. Protein and amino acids are believed to improve muscle strength, however, this has not been scientifically proven.

7. Herbs and Botanicals
Dietary supplements that contain extracts or active ingredients from plants
Some are harmful
Kava Kava is banned in Canada
Herbs and Botanicals are supplements that contain ingredients that come from the roots, berries, seeds, stems, leaves, buds, or flowers of plants
It is a common misconception that supplements made from plants are safe because they are "natural" or "organic
One example of a harmful herb supplement is Kava Kava. Kava Kava was banned in Canada in However, it is still on the market in the U.S. Kava Kava has been linked to a number of side effects including liver damage.

8. St. John’s Wort Suggested to help depression Negative side effects
No tests on long-term safety
St. John’s Wort has been proven to treat mild to moderate depression by alleviating some symptoms, including lack of activity, tiredness, fatigue, and disturbed sleep. However, St. John’s Wort has been associated with negative side effects, like gastrointestinal irritations, allergic reactions, and restlessness. Another problem is St. John’s Wort has not been tested for it’s long term safety. For more information visit the website

9. Ginkgo biloba Increases blood flow to brain
Large doses can cause restlessness, diarrhea, nausea, vomiting
Ginkgo biloba's has been proven to increase blood flow to the brain in many scientific studies. Enhanced blood flow has also been shown to alleviate disorders such as calf muscle blood vessel atherosclerosis and varicose veins. There are few mild side effects that may come with taking Ginko biloba, but if taken in large doses, it can cause restlessness, diarrhea, nausea, and vomiting.

10. Echinacea Believed to stimulate immune system
Studies use echinacea concentrate - not the same as what is sold
Echinacea is thought to be a stimulant to the immune system, making it a low risk and effective alternative to some cold medicines. Studies that have proven this to be true, tested Echinacea concentrate, not Echinacea sold in stores. Thus, Echinacea sold in stores may not be potent enough, and it is possible that additional substances are in Echinacea supplements. It is important to find out about the product manufacturer's reputation.

11. Ginseng Clinical tests show mixed results for claims
Ginseng is said to stimulates the immune system, elevate mood, and improve physical and mental performance. However, clinical data has shown mixed results for these claims.

12. Green tea
May boost immune system, increase metabolism, act as antioxidant, lower cholesterol and triglycerides
Green Tea has been proven in some studies to boost the immune system, help with weight loss, and also increase metabolism. Some other claims for green tea include: powerful antioxidant, lowers cholesterol and triglyceride levels, decreases blood clotting, and helps protect against some forms of cancer.

13. Ephedra Central nervous system stimulant and decongestant Claims:
Increases body fat loss
Improves athletic performance by increasing alertness and mental performance
Ephedra is an example of a dangerous plant extract, and is also known as Ma Huang, epitonin or ephedrine alkaloids, including ephedrine and pseudoephedrine. Ephedra is an extract of the Ephedra vulgaris plant and is marketed as a supplement to help with weight control and boost athletic performance. It is often combined with caffeine, which can augment its adverse effects Ephedra increases the body’s metabolism by stimulating many organs including the lungs, heart, and adrenal glands. However, stimulation of these organs can be life threatening.

14. Ephedra Negative side effects FDA banned in April, 2004
irregular heart rate, elevated blood pressure, dizziness, headache, heart attack, stroke, seizure, psychosis
155 deaths and over 16,000 side effects
FDA banned in April, 2004
Ephedra has been reported to be involved in over 16,000 adverse health reactions, including high blood pressure, heart attack, and stroke. The FDA has also linked ephedra to as many as 155 deaths. Among those deaths, include the death of Korey Stringer from the Minnesota Vikings. Following his death, the National Football League (NFL) became the first professional athletic association to ban ephedra. It was the death of Steve Bechler, a pitcher for the Baltimore Orioles, that escalated the FDA to consider banning Ephedra. About a year after Bechler’s death, on April 12th 2004, Ephedra and Ephedra containing products were officially banned by the FDA.

15. Risks of Herbal Supplements
No standards exist
Little scientific evidence is available
Can be potent
The FDA does not require testing of supplements for safety or effectiveness. Therefore, manufacturers of the herbal supplement can choose what to put in them. There has been some scientific research that shows benefits of herbal supplements; however, it is done on the supplements in their pure form, which generally is not the form sold on the market. Potency of an herbal supplement varies depending on where it is grown, growing conditions, such as soil and rainfall, and what part of the plant is used.

16. Resources Iowa Botanicals Research Center
Iowa State University Extension
There are resources available at Iowa State University if you have additional questions regarding herb/botanical supplements.

17. Creatine Natural substance produced by body Claims:
Improve muscle power during high intensity and short duration exercise
Creatine is a natural substance produced by the body and found in foods, like meats and fish. The body requires an average of 2 grams of creatine per day. On average, individuals obtain about 1 gram of creatine from the diet, and the rest is made up by the body. Creatine can easily be obtained from foods in the diet. The American College of Sports Medicine (ACSM) panel states that daily does of 3 grams of creative are as effective as 20 grams for increasing the amount of creatine stored in the muscle.
Creatine supplementation works by increasing the creatine content in muscles, which leads to enhanced performance during repeated bouts of high-intensity exercise. Creatine is one of the most popular supplements, and has been accepted as a safe and effective way to enhance athletic performance in professional sports.

18. Creatine problems
Could cause muscle cramps, headaches, diarrhea, and gastrointestinal pain; stress on kidneys
Long term effects are unknown
YOUTH: muscles develop more quickly than bone… increases risk of fractures
However, young athletes should be discouraged from taking creatine supplements for enhanced performance.
One reason is most of the studies done on creatine supplementation have been done on adult populations. Whether or not creatine supplements are effective or safe for children or adolescents has not be determined.
Secondly, no research studies have been done to examine the long-term consequences of creatine supplementation.
Thirdly, since they are not fully grown, it can cause their muscles to develop more quickly than their bones, which can increase the risk of injuries, especially fractures.
Lastly, like other dietary supplements, creatine is not tested by the FDA for safety or effectiveness.

19. Creatine Summary Pros Cons
Has been proven to increase energy in short duration, repetitive exercises (<60 sec)
Cons
No benefit in aerobic ability or endurance
Weight gained is mostly water weight and not muscle, which can hinder performance
Negative side effects are a possibility
Not approved by FDA and labels may be incorrect
Most research done on creatine has proven that creatine does provide the body with an increase in energy for use in short duration, repetitive exercises. This creatine “boost” does not occur until the third or fourth repetition. However, the cons of creatine use outweigh the pros.
First of all, creatine is only useful for certain exercises, which does not include aerobic or endurance activity.
Second, most of the weight that is gained from creatine use is water and not muscle, which can often hinder one’s performance.
Third, some short-term side effects that could come with creatine use include: muscle cramps, headaches, diarrhea, and gastrointestinal pain, and stress on kidneys. Since creatine has not been around for that long, the long-term side effects have not yet been determined.
Fourth, like all dietary supplements, the Food and Drug Administration does not control creatine. Therefore, they may not be safe, effective, contain the exacts ingredients and amount of ingredients as listed on the label, or produced under safe manufacturing procedures.

20. Protein/Amino Acids
Essential macronutrient found in the body and in food
Protein supplement food sources include
Egg
Soy
Whey
Protein/amino acids are a major component and the building block of muscle. For this reason, many strength and power athletes consume protein and amino acids believing that it will build muscle. Egg, soy and whey protein are popular protein supplements because they are considered high quality proteins.
Egg protein contains all eight essential amino acids, making it the standard to which all forms of protein are measured. It digests at a medium pace, supplying a sustained released of amino acids to the body.
Soy protein is a complete protein derived from soy beans that is generally very low in or free of fat, cholesterol, and lactose.
Whey protein comes from milk. During the process of turning milk into cheese, whey protein separates into the liquid whereas casein separates into the solid. Whey protein is considered to be a high quality protein because the amino acids it contains.

21. Amino Acids Supplements
Pre-digested protein
Claim
Because they are pre-digested, they will be absorbed better.
Fact
The body gets better use out of amino acids
if they are broken down from whole foods.
Amino acid supplements are simply pre-digested protein. Proponents of amino acid supplementation claim that because the amino acids are predigested, the body will absorb them better, leading to greater improvements in strength and muscle mass.
However, the opposite is true. The human digestive system was designed to process whole foods. Therefore, the body gets better use out of amino acids if they are broken down from whole foods. Some people think that taking amino acid powders is helpful for increasing their muscle mass, but these powders don't actually have any special muscle-building effects.
Amino acids are the building blocks of protein. Although it's scientifically true that they're required to build muscle in addition to enough exercise, the human body can easily get all the amino acids it needs from protein found in food. So, if you work out properly and eat a balanced diet with enough protein, taking amino acid supplements won't actually do anything for you - except maybe empty your wallet.

22. Amino Acid Supplements
Chicken
Breast
100% Whey Protein
Supplement
Protein/Serving
30 g /18 tablets
31 g / 3.5 ounces
23 g / 1 scoop
Price/31g of Protein
$4.03
$0.62
$0.93
This chart compares a common food, chicken breast, to a whey protein supplement and an amino acid supplement.
First, it compares the amount of protein in each RECOMMENDED serving. 1 serving of chicken breast is 3.5 oz. The recommended serving for the amino acid tablets 6 tablets, 3 times per day, equaling 18 total tablets/day. The recommended serving for the whey protein is 1 scoop.
Chicken breast has the most protein/serving.
Second, the price of the protein was compared. Thirty one grams of protein was used as the reference because there are approximately 31 grams of protein in 1 serving (3.5 oz) of chicken breast. This is equivalent to 1 and 1/3 scoops whey protein and 18 amino acid tablets.
The amino acid supplement was 6.5 times the price of chicken breast and the whey protein supplement was 4.3 times the price of the chicken breast.
This clearly shows that not only is there less protein in a recommended serving of amino acids supplements and whey protein, but they are also a lot less cost-effective.

23. Amino Acid Supplements
This graph compares the amount of 4 different amino acids in chicken breast, a whey protein supplements, and an amino acid supplement. The chicken breast, whey protein and amino acid supplement are in the portions that provide 31 grams of total protein (so comparing like amounts of protein)
The first amino acid is Glutamine. Glutamine is the most abundant single amino acid in the blood and in the muscle tissue, comprising up to 60% of the amino acid pool in skeletal muscle. It is an important muscle-building amino acid and helps replenish muscle after exercise.
The second amino acid is Alanine. In addition to being an important energy source for the muscles, brain, and central nervous system, Alanine also strengthens the immune system by producing antibodies and helps in the metabolism of sugars and organic acids.
Neither glutamine nor alanine is an essential amino acid – the body can manufacture glutamine and alanine. Thus, supplementation of these amino acids is unnecessary.
The last 3 amino acids are branched chain amino acids. Branched chain amino acids are especially important for the body because they are essential amino acids that help maintain muscle tissue and help prevent the breakdown of protein in muscles during exercise. Branched chain amino acids also increase protein synthesis, which is often decreased during intense training or dieting. By increasing protein synthesis, they allow the body to build lean muscle mass.
Although isoleucine, leucine and valine are essential amino acids, they can be obtained easily from food, such as chicken breast, rather than expensive supplements.

24. Protein Claims for supplementation Problems with supplementation
Supports muscle growth
Increases muscle strength and mass
Improves recovery
Problems with supplementation
Dehydration
Stress on kidneys
Increased calcium excretion
Reduced intake of vitamins, minerals, fiber, and phytochemicals
The list of protein supplements on the market is never ending. The marketing is intense promising anything from increased strength, energy, and/or muscle mass to losing weight, staying fit, and obtaining lean slender bodies. Although some studies have found an increased muscle size as a result of increased protein intake, few have reported an increase in strength. Large protein consumption in one setting that exceeds the body’s requirement will be converted into fat. It will NOT increase muscle mass.
There are problems with taking protein supplements including dehydration, stress on the kidneys, and increased calcium excretion. If the athlete is using protein supplements in lieu of dietary intake this may result in reduced intake of vitamins, minerals, fiber and other important nutrients.

25. Adolescent growth
Rapid growth and change increases need for iron and calcium
About 20% of adult height and 80% of adult weight are gained during adolescence. Because growth and change is so rapid during this period, requirements for all nutrients increase. Two are especially of concern, iron and calcium, because of the roles they play in the growing body.

26. Iron Anemia Food sources
common among adolescents
--> inadequate diet
Food sources
lean meat, fish, dried fruits, nuts, wholegrain breads
Supplementation
may improve learning, memory, and performance of iron-deficient adolescents
Anemia is common amongst adolescents, regardless of their physical activity. Iron deficiency is the main cause. An inadequate diet, such as one high in junk foods, is the chief reason for this problem. Teens on a weight-loss diets and/or partaking in intense and lengthy physical training also have increased risk for iron-deficiency. Iron needs can easily be met through a balanced diet that contains foods rich in iron. Some examples include: lean meat, fish, dried fruits, nuts, wholegrain breads, green-leafy vegetables, and iron-fortified cereals.
If these needs are not met, iron supplementation may be helpful. Iron supplementation significantly improves learning, memory, and cognitive test performance in iron-deficient adolescents (even if they are not deficient enough to become anemic) (Pediatric News, January 1997). Iron supplementation also improves the performance of iron-deficient, anemic athletes (American Journal of Diseases of Children, October 1992).

27. Calcium Deficiency Food sources Supplementation
decreased bone mineral density
-->inadequate diet
Food sources
dairy products (milk, yogurt, cheese)
Supplementation
beneficial if unable to get from food sources
The second common deficiency among adolescents is calcium deficiency. The recommended intake of calcium is 1300 mg/day. On average, most teens consume less than 1000 mg/day. Calcium deficiency can lead to decreased bone mineral density, which can increase one’s risk for breaking bones and can also increase the risk for osteoporosis later in life. It is especially important to have adequate calcium intake in adolescent years because people reach maximal bone density while they are adolescents or young adults and then gradually lose bone the rest of their lives. For athletes, calcium is required for muscle contraction. Without calcium, muscle contraction/performance is not possible.
Calcium needs can easy be met by consuming food rich in calcium, like milk, yogurt, dark-green vegetables, cheese, and other dairy products.
The best source of calcium is through foods, but calcium supplementation may be needed if they find it hard to get enough calcium through their diet. By just taking a 500-mg calcium supplement each day, adolescents can boost their intake from 80% to 110% of the recommended daily allowance (RDA). This results in a significant, measurable increase in bone density and bone mineral content of the spine (Journal of the American Medical Association, August 18, 1993).

28. If Using Supplements Choose supplements with: USP on the label
Consumer Lab seal of approval
Reputable drug companies
If supplementation is needed, such as iron or calcium, consult with a health care providers. Select a supplement that contains the USP or Consumer Lab designation.
First, USP (United States Pharmacopoeia) means that the supplement has passed certain tests for potency, purity, and uniformity. In order to have the USP label it must be proven that what is on the label is what is in the bottle, the substance does not contain harmful levels of contaminants, the substance will break down and release ingredients in the body, and the substance has been manufactured under safe, sanitary, and well-controlled conditions.
Second, the Consumer Lab symbol means that supplement meets quality standards and the quality claims on the label are true, the supplement contains the amount of ingredients stated on the label, the supplement does not contain common contaminants, and the supplement can be broken down and used by the body.
Look for reputable manufacturers that follow strict quality control procedures. For example, many of the multi-vitamin/mineral supplements are manufactured by well-known drug companies that also manufacture prescription medications. These companies are familiar with tests of safety and efficacy because they are required to meet those criteria for their prescription drugs. Avoid using product if the company is unable to answer questions.
Reputable companies should provide research to support claims.
Finally, if the claim sounds too good to be true, it probably is. Promise of rapid weight gain or loss should always be taken under consideration.

29. If Using Supplements
Watch for inaccurate and inappropriate health claims
1. Promises a quick fix
2. Sounds too good to be true
3. Lists of “good” and “bad” foods
The cons of taking supplements outweigh the pros. Be sure to look at the claims the supplement makes…many times this is an indication of whether it is a reputable product or not. (Read list on slide)
Currently the only supplement that has been shown to benefit short burst activity is creatine. However, the long-term effects are still unknown. Protein supplementation is not needed if the athlete is consuming a fairly balanced diet. Remember, protein is not stored, thus extra supplementation has not been proven to result in additional increased muscle mass.

30. If Using Supplements Remember that they don’t have to…
prove safety prior to marketing/selling
prove efficacy prior to marketing/selling
meet any manufacturing standards
FDA regulates dietary supplements under a different set of regulations than those covering "conventional" foods and drug products. The dietary supplement manufacturer is the one responsible for ensuring that a dietary supplement is safe before it is marketed. Unlike prescription drugs and food additives that must be proven safe and effective by the FDA before marketing, there are no provisions in the law for FDA to approve dietary supplements for safety or effectiveness before they reach the consumer. FDA is merely responsible for taking action against any unsafe dietary supplement product after it reaches the market. Some supplements may contain illegal substances that are not listed on the label.
Generally, manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements. However, manufacturers are to make sure that product label information is truthful and not misleading.

31. Conclusion Supplements are not needed with a balanced diet
Supplements are not regulated on the market and can be unsafe
Choose wisely and consult with a healthcare professional for more information
If the athlete has a balanced diet, supplementation is not necessary.
Supplements on the market are not regulated, thus can be unsafe, contain illegal substances not labeled, and can give false claims. Many supplements are also very expensive.
If an athletes decides to supplement, he/she should consult with a dietitian and do some background research before supplementing. After all, if a supplement is banned by the NCAA or any other athletic organization, the athlete may risk getting positively tested for illegal substances in the blood, and suspended from competition.

32. Funded by: Iowa Beef Industry Council, Midwest Dairy Association
Prepared by: Ruth Litchfield, PhD, RD, LD
Contributions by Emily Lasley, Lindsey Metcalf, Andrea Seminara and Karin Westberg

33. . . . and justice for all
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Many materials can be made available in alternative formats for ADA clients. To file a complaint of discrimination, write USDA, Office of Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue, SW, Washington, DC or call
Issued in furtherance of Cooperative Extension work, Acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture. Stanley R. Johnson, director, Cooperative Extension Service, Iowa State University of Science and Technology, Ames, Iowa.