Active patients may ask if they should use various nutritional supplements to enhance their athletic performance. Are these supplements effective? Or are they just dangerous?
Nutritional supplements and their use by athletes as ergogenic, or performance-enhancing, aids have been getting a lot of media attention in recent years. Professional athletes are not the only persons using ergogenic aids, however. Recreational athletes, or even those who just work out regularly at health clubs, also use these supplements. It is thus important to carefully evaluate the claims that are made about supplements and to educate patients to do the same.
Counseling patients to cultivate lifelong, healthy dietary habits is the most important intervention because a nutritionally sound eating plan is safer and more effective than taking supplements. Strategies include recommending a diet adequate in protein, carbohydrate, and fat and timing nutrient intake for optimal use by the body before, during, and after exercise. According to the American Dietetic Association and the American College of Sports Medicine on nutrition and athletic performance, if adequate energy can be obtained through the diet, vitamin and mineral supplements should not be necessary. (1) Vitamin and mineral supplements may be important, however, if athletes limit energy intake, eliminate certain food groups from their diet, take extreme measures to lose weight, or consume a diet high in carbohydrates but low in micronutrients.
When patients inquire about other nutritional supplements, you should explain the most recent research and inform them of any potentially deleterious effects. Be aware that athletes who try commercial supplements may want to use additional products and could eventually use a dangerous substance. To prevent serious health threats, communicate openly with athletically oriented patients, while cautioning them about disproven or dangerous supplements.
OVERSIGHT FALLS SHORT
The Dietary Supplement Health and Education Act of 1994 is the basis on which companies can make health claims about their products. (2) This legislation established a definition of dietary supplements and dietary ingredients; a framework to guarantee safety; guidelines for the literature available where the products are sold; the use of claims and support statements on product labels; a requirement for labeling of ingredients and nutritional value; and authority for the FDA to create standards of good manufacturing practices.
While this document was a good beginning, it did not go far enough, and it opened the door for supplement manufacturers to bypass the rigorous testing that drugs must go through conventionally. In addition, many products were classified as dietary supplements for no apparent reason, when they really should have been classified as drugs. Androstenedione, a precursor to testosterone, is one well-known example.
New dietary ingredients in supplements do not have to adhere to a clearly defined set of safety standards. Not all products include safety information on the label, an oversight that may prove dangerous to some persons because no regulation exists specifying the information required. Most reports of adverse effects attributable to dietary supplement use are not investigated, hindering assessment of the effect a supplement may have on consumer...