Are Sports Supplements Safe?

Written by Dr. Steve Chaney on . Posted in current health articles, Supplements and Health

Are There Any Sports Supplement Companies You Can Trust?

Author: Dr. Stephen Chaney

 

are sports supplements safe“Pump up your muscles”, “Explode your muscles”, “”Blast your fat”, “Annihilate your fat”, “Ramp up your energy”: The claims leap off the page of the ads for many sports and weight loss supplements.  But, are sports supplements safe?

The easiest way to ramp up your energy and annihilate your fat is to put amphetamines or other illegal stimulants in the supplement. The easiest way to pump up your muscles is to put steroids in the supplement. Unfortunately, there are always a few unscrupulous companies that are only too willing to do just that.

Well, the chickens have come home to roost. It’s been a bad few weeks for the sports supplement industry. It seems like every time you turned around there was another article about a sports supplement making fraudulent claims, containing illegal ingredients, or actually harming people. It makes you wonder whether you should just completely avoid sports supplements all together.

That would be unfortunate because sports supplements can help with hydration, endurance and recovery. They can help you maximize the benefits of your exercise program. Furthermore, there are a lot of reputable sports supplement companies out there. The problem is that there are a few “bad apples” in the industry, and the FDA is not really doing its job to protect the American consumer from their deceptive and dangerous products.

Even worse, when the FDA acts, major retail nutrition stores often drag their feet at actually removing the products from their shelves (https://healthtipsfromtheprofessor.com/are-dietary-supplements-safe/), and the unscrupulous manufacturers just switch to another equally dangerous stimulant.

It is, therefore, important for those of us who are nutrition educators to warn consumers like you about the dangerous products that are in the marketplace. The FDA will eventually act, but you need to know about those products now!

I have previously warned you about sports nutrition products containing the amphetamine-like stimulants DMAA (https://healthtipsfromtheprofessor.com/are-dietary-supplements-safe/), DEPEA (https://healthtipsfromtheprofessor.com/are-fat-burning-sports-supplements-safe/) and DMBA (https://healthtipsfromtheprofessor.com/supplements-to-avoid/). As you might guess from the names, these are all structurally related compounds. They have several other characteristics in common:

  • They are all synthetic amphetamine analogs.
  • The sports nutrition companies selling products with these ingredients tried to fool the public (and the FDA) by claiming that they were natural components of the herbal ingredients in their product.
  • None of them had ever been tested for safety and efficacy in humans. Some of them actually killed people before the FDA stepped in and banned them.

Amphetamine and amphetamine-like substances are popular in sports nutrition and weight loss products because they increase energy levels and speed up metabolism. Unfortunately, they also cause high blood pressure, arrhythmia, heart attacks and death.

Are Sports Supplements Safe?  Yes and No.

sports supplementsSports Supplements Containing a Form of Amphetamine

Yet another analog of DMAA called beta-methylphenethylamine (BMPEA) has appeared in the sports nutrition marketplace. It is an isomer of amphetamine that was first synthesized in the 1930’s. Because it is an analog of amphetamine, BMPEA is classified as a banned substance by the World Anti-Doping Agency. Unfortunately, its story is all too familiar.

The FDA first reported the presence of pharmacological doses of BMPEA in 43% of sports and weight loss supplements containing the herbal ingredient Acacia rigidula in 2012. The manufacturers claimed that the BMPEA in their products came from the Acacia rigidula even though there was no scientific evidence that it had ever been successfully extracted from Acacia rigidula.

BMPEA causes high blood pressure in animals and has never been tested for safety or efficacy in humans. Its close analog, DMAA, caused scores of deaths before the FDA finally banned it. However, the FDA did not warn consumers that supplements with the ingredient Acacia rigidula might contain BMPEA and might, therefore, be dangerous.

A group led by Dr. Pieter Cohen of Harvard University (Cohen et al, Drug Testing and Analysis, DOI: 10.1002/dta.1793, 2015) recently decided to analyze sports and weight loss supplements containing Acacia rigidula to see whether some companies had voluntarily removed DMPEA from their products over the last two years. One might hope that at least some of those companies might have been more motivated by protecting the health of their customers than by profit.

Not a chance! Dr. Cohen and his colleagues tested 21 products containing Acacia rigidula and found that 11 of them (52%) contained BMPEA – some in amounts as high as 94 mg/serving.

Dr. Cohen was quoted as saying “More than two years after the FDA’s discovery [of BMPEA in sports supplements], the FDA has yet to warn consumers about the presence of an amphetamine isomer in supplements. This is really about the FDA and why the FDA is not enforcing the law. This is a great example of how the FDA could so easily move now and not wait like it did with DMAA, wait until strokes and heart attacks had become front page news.”

After Dr. Cohen’s article became front page news several Senators called on the FDA to ban BMPEA. A week later the FDA finally caved in and announced that BMPEA was not a legal ingredient and that any products listing it on the label must be withdrawn from market. A skeptic might note that this was a full two years after the FDA discovered the existence of products containing BMPEA. The FDA’s announcement also did not cover BMPEA-containing products listing only Acacia rigidula on the label – which made up most of the BMPEA-containing products identified by Dr. Cohen and his colleagues. As the old saying goes, the FDA action was “a day late and a dollar short”.

Sports Supplements Containing Steroids

sports supplements containing steroidsA week later the FDA issued a warning to consumers to stop using a product call Tri-Methyl Extreme because of reports of serious liver damage in people using it. The product contained the anabolic steroids methyl-stenbolone, MAX LMG (a non-methylated prohormone) and epistane.

There are two important take home lessons from this incident.

  • The product actually claimed that it contained anabolic steroids. Anabolic steroids are known to cause liver damage, heart attack and stroke, testicular cancer, infertility and mood disorders. It is hard to imagine why anyone would use a product that claimed to contain anabolic steroids. Unfortunately, some people are willing to do almost anything that will increase muscle mass and strength.
  • The FDA often only acts once a product has either seriously injured or actually killed people. I tend to agree with Dr. Cohen that it would be far preferable for the FDA to be proactive and warn consumers about products that have the potential to do harm.

Sports Supplements That Cause Cancer

As if that weren’t bad enough, at about the same time a paper was published reporting that use of muscle-building supplements by young men may increase their risk of testicular cancer by up to 177% (Li et al, British Journal of Cancer, DOI: 10.1038/bjc.2015.26).

The incidence of testicular germ cell cancer in men 15-39 years old has increased 1.6-fold between 1975 and 2011. The reason for that increase is not known, but the authors of British Journal of Cancer article noted that the use of performance-enhancing supplements in that group has also increased dramatically during the same time period.

A previous study of testicular cancer patients reported that a high percentage of them (~20%) had used performance-enhancing supplements, but no control group was included in that study. Thus, the authors of this study set out to carefully match testicular cancer patients with healthy men of the same age and demographics – something we scientists call a case-control study.

The study compared 356 testicular cancer patients age 18-55 from Connecticut and Massachusetts with 513 controls that were matched by age, race, education, tobacco and alcohol use, exercise level, injury to testes or groin, and family history of testicular cancer. The results were pretty scary.

  • Use of muscle building supplements increased the risk of testicular cancer by 65% compared to men who never used that kind of supplement.
  • For men who started using muscle building supplements before they were 25, the risk of developing testicular cancer increased by 121%.
  • For men who used muscle building supplements for more than 3 years, the risk increased to 156%.
  • For men who used more than 2 types of muscle building supplements, the risk increased to a whopping 177%. That’s almost double.

This study did not identify the actual ingredients that caused the increased testicular cancer risk, but with so many of the muscle-building supplements on the market containing dangerous and/or illegal ingredients it is perhaps not surprising that they might increase cancer risk. After all, this demographic (young males) is the group most likely to choose the “Monster Muscle Builder” products rather the less glamorous, but safer, sports supplements.

Sports Supplements That Mislead

sports supplements companies that misleadAt the same time that we were hearing about sports supplements with dangerous and illegal ingredients and sports supplements that may cause cancer, the Advertising Standards Authority (the British equivalent of the FTC) accused a British sports supplement company of making false and misleading ingredient claims. That’s a polite way of saying they were lying!

In particular, they disallowed claims that:

  • CLA builds lean muscle and attacks fat stores, promotes fat loss, improves mood and focus and boosts energy.
  • Acetyl-L-Carnitine aids weight loss, burns fat, boosts energy, improves mental performance, and improves focus.

There were more claims they disallowed (click here for the complete report) (http://www.asa.org.uk/Rulings/Adjudications/2015/4/Protein-World-Ltd/SHP_ADJ_288571.aspx#.VS2VbJOk9RN), but I included those two because you’ve probably seen similar claims for those ingredients on this side of the Atlantic. Those claims are just as bogus in the United States as they are in England.

How To Choose A Sports Supplement Company You Can Trust

safe sports supplementsBy now you are probably convinced that you should never use a sports supplement product again. However, as I said above good sports supplements properly used can improve hydration, endurance, recovery and the results you obtain from your exercise program. Here are the questions to ask.  Are sports supplements safe?  They can be.   Which sports nutrition products can you trust? Here are some simple guidelines to help you choose a trustworthy sports supplement company.

  • Avoid the hyped claims. If the supplement makes claims like “Get ripped fast”, “Intense Energy”. “Extreme Energy”, “Eviscerate fat”, “Makes fat cells self-destruct” or “boosts testosterone”, you should run the other direction.
  • Ignore testimonials. The placebo effect is close to 50% for things like energy, and if an athlete “thinks” they have more energy every time they work out, they will get stronger.
  • Look for published clinical studies showing that the product is safe and effective. Those clinical studies should be published in peer-reviewed scientific journals. If the company just cites their own “studies” or “white papers”, ignore them. They may look impressive, but they have not been peer reviewed. You have no idea whether they are accurate.
  • I could tell you to look for rigorous quality control standards, but every company claims they have excellent quality controls. Instead I will tell you to look for supplements that are used by medal winning Olympic athletes. Why Olympic athletes? That is because Olympic athletes are more rigorously drug tested than any other athlete. They absolutely cannot afford to have any stimulants, steroids or other banned substances in their body at any time. They need products that are pure, safe and effective.
  • Finally, avoid products with artificial ingredients. While the risks associated with artificial sweeteners, artificial flavors and artificial colors are not as great as the risks associated with stimulants and steroids, they are still ingredients to be avoided. We simply do not know the long term health consequences of artificial ingredients.

 

The Bottom Line

  • There are a few bad apples in every barrel, and the sports supplement industry is no exception. Are sports supplements safe?  Over one two-week period lately we have learned:
  • Over 50% of sports nutrition products labeled as containing an innocuous sounding herbal ingredient were actually found to contain an amphetamine isomer called BMPEA that has been banned by the World Anti-doping Agency. After years of dragging its feet, the FDA finally banned some of the products containing BMPEA, but left many others on the market. As the old saying goes, the FDA was “a day late and a dollar short”.
  • Even though they are extremely dangerous, new sports supplements with anabolic steroids keep popping up online. Once again, the FDA has had to warn consumers not to use a new muscle building supplement containing steroids because several people using that supplement suffered severe liver damage.
  • A study reported that young men who use muscle building supplements may increase their risk of testicular cancer by up to 177%.
  • The British equivalent of our FTC has told a British sports supplement manufacturer that it must stop making false and misleading claims about ingredients like CLA and acetyl-L-carnitine. That is noteworthy because some sports supplement companies in the US make very similar claims for the same ingredients.
  • You shouldn’t necessarily avoid sports supplements because of a few bad apples. Good sports supplements properly used can improve hydration, endurance, recovery and the results you obtain from your exercise program. There are a few simple guidelines that can help you choose the good sports supplement companies and avoid the bad ones:
  • Avoid the hyped claims.
  • Ignore testimonials.
  • Look for published clinical studies showing that the product is safe and effective.
  • Look for supplements that are used by medal winning Olympic athletes. That’s because Olympic athletes absolutely need products that are pure, safe and effective.
  • Avoid products with artificial ingredients.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Do Omega-3s Lower Blood Pressure in Young, Healthy Adults?

Posted August 14, 2018 by Dr. Steve Chaney

What Is The Omega-3 Index And Why Is It Important?

Author: Dr. Stephen Chaney

 

Do omega-3s lower blood pressure in healthy adults?

omega-3s lower blood pressure young adultsThe literature on the potential health benefits of omega-3s is very confusing. That’s because a lot of bad studies have been published. Many of them never determined the omega-3 status of their subjects prior to omega-3 supplementation. Others relied on dietary recalls of fish consumption, which can be inaccurate.

Fortunately, a much more accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes. Using modern technology, it can be determined from a single finger prick blood sample. It is a very accurate reflection of omega-3 intake relative to other fats in the diet over the past few months. More importantly, it is a measure of the omega-3 content of your cell membranes, which is a direct measure of your omega-3 nutritional status.

A recent extension of the Framingham Heart Study reported that participants with an Omega-3 Index >6.8% had a 39% lower risk of cardiovascular disease than those with an Omega-3 Index <4.2% (WS Harris et al, Journal of Clinical Lipidology, 12: 718-724, 2018 ). Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk, while 8% or better is considered indicative of low cardiovascular risk. For reference, the average American has an Omega-3 Index in the 4-5% range. In Japan, where fish consumption is much higher and cardiovascular risk much lower, the Omega-3 Index is in the 9-11% range.

Previous studies have suggested that omega-3 fatty acids lower blood pressure to a modest extent. Thus, it is not surprising that more recent studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, those studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Unfortunately, there were no studies looking at that population. The current study was designed to fill that gap.

 

How Was The Study Done?

omega-3s lower blood pressure young healthy adultsThe current study (M.G. Filipovic et al, Journal of Hypertension, 36: 1548-1554, 2018 ) was based on data collected from 2036 healthy adults, aged 25-41, from Liechtenstein. They were participants in the GAPP (Genetic and Phenotypic Determinants of Blood Pressure) study. Participants were excluded from the study if they had been diagnosed with high blood pressure and were taking medication to lower their blood pressure. They were also excluded if they had heart disease, chronic kidney disease, other severe illnesses, obesity, sleep apnea, or daily use of non-steroidal anti-inflammatory medications.

Blood samples were collected at the time of their enrollment in the study and frozen for subsequent determination of Omega-3 Index. Blood pressure was also measured at their time of enrollment in two different ways. The first was a standard blood pressure measurement in a doctor’s office.

For the second measurement they were given a wearable blood pressure monitor that recorded their blood pressure over 24 hours every 15 minutes during the day and every 30 minutes while they were sleeping. This is considered more accurate than a resting blood pressure measurement in a doctor’s office because it records the variation in blood pressure, while you are sleeping, while you are exercising, and while you go about your everyday activities.

 

Do Omega-3s Lower Blood Pressure In Young, Healthy Adults?

omega-3s lower blood pressure young adults equipmentNone of the participants in the study had significantly elevated blood pressure. The mean systolic and diastolic office blood pressures were 120±13 and 78±9 respectively. The average Omega-3 Index in this population was 4.6%, which is similar to the average Omega-3 Index in the United States.

When they compared the group with the highest Omega-3 Index (average = 5.8%) with the group with the lowest Omega-3 Index (average = 4.6%):

  • The office measurement of systolic and diastolic blood pressure was decreased by 3.3% and 2.6% respectively
  • While those numbers appear small, the differences were highly significant.
  • The 24-hour blood pressure measurements showed a similar decrease.
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index. [In studies of this kind, a linear dose-response is considered an internal validation of the differences observed between the group with the highest Omega-3 Index and the group with the lowest Omega-3 Index.]

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

 

What Does This Mean For You?

omega-3s lower blood pressure young adults questionPerhaps I should first comment on the significance of the relatively small decrease in blood pressure observed in this study.

  • These were young adults, all of whom had normal or near normal blood pressure.
  • The difference in Omega-3 Index was rather small (5.8% to 4.6%). None of the participants in the study were at the 8% or above that is considered optimal.
  • Liechtenstein is a small country located between Switzerland and Spain. Fish consumption is low and omega-3 supplement consumption is rare.

Under these conditions, even a small, but statistically significant, decrease in blood pressure is remarkable.

We should think of this study as the start of the investigation of the relationship between omega-3 status and blood pressure. Its weakness is that it only shows an association between high Omega-3 Index and low blood pressure. It does not prove cause and effect.

Its strength is that it is consistent with many other studies showing omega-3 fatty acids lower blood pressure. Furthermore, it suggests that the effect of omega-3s on blood pressure may also be seen in young, healthy adults who have not yet developed high blood pressure.

Finally, the authors suggested that a diet rich in omega-3s might reduce the incidence of high blood pressure by slowing the age-related increase in blood pressure that most Americans experience. This idea is logical, but speculative at present.

However, the GAPP study is designed to provide the answer to that question. It is a long-term study with follow-up examinations scheduled every 3-5 years. It will be interesting to see whether the author’s prediction holds true, and a higher Omega-3 Index is associated with a slower increase in blood pressure as the participants age.

 

Why Is The Omega-3 Index Important?

 

The authors of this study said: “The Omega-3 Index is very robust to short-term intake of omega-3 fatty acids and reliably reflects an individual’s long-term omega-3 status and tissue omega-3 content. Therefore, the Omega-3 Index has the potential to become a cardiovascular risk factor as much as the HbA1c is for people with diabetes…” That is a bit of an overstatement. HbA1c is a measure of disease progression for diabetes because it is a direct measure of blood sugar control.

In contrast, Omega-3 Index is merely a risk factor for cardiovascular disease. However, if it is further validated by future studies, it is likely to be as important for predicting cardiovascular risk as are cholesterol levels and markers of inflammation.

However, to me the most important role of Omega-3 Index is in the design of future clinical studies. If anyone really wants to determine whether omega-3 supplementation reduces cardiovascular risk, high blood pressure, diabetes or any other health outcome they should:

  • Start with a population group with an Omega-3 Index in the deficient (4-5%) range.
  • Supplement with omega-3 fatty acids in a double blind, placebo-controlled manner.
  • Show that supplementation brought participants up to an optimal Omega-3 Index of 8% or greater.
  • Look at health outcomes such as heart attacks, cardiovascular deaths, hypertension, stroke, or depression.
  • Continue the study long enough for the beneficial effects of omega-3 supplementation to be measurable. For cardiovascular outcomes the American Heart Association has stated that at least two years are required to obtain meaningful results.

These are the kind of experiments that will be required to give definitive, reproducible results and resolve the confusion about the health effects of omega-3 fatty acids.

 

The Bottom Line

 

An accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes.

Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk while 8% or better is considered indicative of low cardiovascular risk.

Previous studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, these studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Until now, there have been no studies looking at that population.

The study described in this article was designed to fill that gap. The participants in this study were ages 25-41, were healthy, and none of them had elevated blood pressure.

When the group with the highest Omega-3 Index (average = 5.8%) was compared with the group with the lowest Omega-3 Index (average = 4.6%):

  • Both systolic and diastolic blood pressure were decreased
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index.

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

Let me translate that last sentence into plain English for you. The authors were saying that optimizing omega-3 intake in young adults may slow the age-related increase in blood pressure and reduce the risk of them developing high blood pressure as they age. This may begin to answer the question “Do omega-3s lower blood pressure in young, healthy adults?”

Or even more simply put: Aging is inevitable. Becoming unhealthy is not.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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