Supplements:  Science vs. Hype

In Brief: Aggressive marketing has led millions of recreational and elite athletes to use nutrition supplements in hopes of improving performance. Unfortunately, these aids can be costly and potentially harmful, and the advertised ergogenic gains are often based on little or no scientific evidence. No benefits have been convincingly demonstrated for amino acids, L-carnitine, L-tryptophan, or chromium picolinate. Creatine, beta-hydroxy-beta-methylbutyrate, and dehydroepiandrosterone (DHEA) may confer ergogenic or anabolic effects. Chromium picolinate and DHEA have adverse side effects, and the safety of the other products remains in question.

Nutrition supplements are a lucrative business in the United States. According to the Council for Responsible Nutrition (1), the retail sale of dietary supplements generated $3.3 billion in 1990, and revenues increase each year. This enormous expenditure is largely the result of aggressive advertising aimed at high school, college, and recreational athletes, all eager for anabolic-steroid-like gains through dietary aids. Riding the crest of the fitness wave, nutrition supplements appeal to millions of consumers willing to pay billions of dollars for alleged benefits that are too good to be true.

Unfortunately, these supplements are subject to little regulation by the US Food and Drug Administration (FDA). Advertised claims to the contrary, many supplements have not been subjected to the scientific scrutiny required of prescription drugs. Furthermore, given the size and continued growth of the supplement industry, the FDA will probably never be able to monitor its products effectively. The resulting lack of regulation can lead to unscrupulous advertising, impurities in manufacturing, and potentially dangerous reactions among supplement users.

Such potential outcomes obligate physicians to learn about current nutrition supplements so they can educate patients about the effects and risks of supplement use. Team physicians in particular can advise athletes, coaches, and administrators in these matters. Competing with slick advertisements and exaggerated claims can be difficult, but by using recent scientific research on commonly used supplements, their mechanisms of action, and possible adverse reactions, physicians can offer sound recommendations to patients who are either users or interested in trying these aids.

To learn more about specific supplements, read the rest of this Physician and Sportsmedicine article.