The FDA permits dietary supplements to contain only "dietary ingredients," such as vitamins, minerals, amino acids, herbs, and other botanicals. It does not permit these products to contain pharmaceutical ingredients, and manufacturers may not promote them to diagnose, treat, cure, or prevent any disease [ ]. Like all dietary supplements, supplements used to enhance exercise and athletic performance can have side effects and might interact with prescription and over-the-counter medications.
In some cases, the active constituents of botanical or other ingredients promoted as ergogenic aids are unknown or uncharacterized. Furthermore, many such products contain multiple ingredients that have not been adequately tested in combination with one another. People interested in taking dietary supplements to enhance their exercise and athletic performance should talk with their healthcare providers about the use of these products.
Anti-Doping Agency maintain a list of products marketed as dietary supplements that contain stimulants, steroids, hormone- like ingredients, controlled substances, or unapproved drugs and that can have health risks for warfighters and others who take them for bodybuilding or other forms of physical performance [ ].
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The FDA requires the manufacture of dietary supplements to comply with quality standards that ensure that these products contain only the labeled ingredients and amounts and are free of undeclared substances and unsafe levels of contaminants [ ]. However, FDA notes that products marketed as dietary supplements for bodybuilding are among those most often adulterated with undeclared or deceptively labeled ingredients, such as synthetic anabolic steroids or prescription medications [ ].
As one example, some products sold for bodybuilding are adulterated with selective androgen receptor modulators SARMs ; these synthetic drugs are designed to mimic the effects of testosterone [ ]. Using such tainted products can cause health problems and lead to disqualification of athletes from competition if a drug test shows that they have consumed prohibited substances, even if they have done so unknowingly. FDA has warned against the use of any body- building products that claim to contain steroids or steroid-like substances [ ].
It recommends that a user contact their healthcare provider if they experience symptoms possibly related to these products, especially nausea, weakness, fatigue, fever, abdominal pain, chest pain, shortness of breath, jaundice yellowing of skin or whites of eyes , or brown or discolored urine. Some dietary-supplement firms have hired third-party certification companies to verify the identity and content of their supplements to enhance exercise and athletic performance, thus providing some extra, independent assurance that the products contain the labeled amounts of ingredients and are free of many banned substances and drugs.
The major companies providing this certification service are NSF nsf. Some ingredients in dietary supplements used to enhance exercise and athletic performance can interact with certain medications. For example, intakes of large doses of antioxidant supplements, such as vitamins C and E, during cancer chemotherapy or radiotherapy could reduce the effectiveness of these therapies by inhibiting cellular oxidative damage in cancerous cells [ ]. Ginseng can reduce the anticoagulant effects of the blood thinner warfarin Coumadin or Jantoven [ ].
Iron supplements can reduce the bioavailability of levodopa used to treat Parkinson's disease and levothyroxine Levothyroid, Levoxyl, Synthroid, and others, for hypothyroidism and goiter , so users should take iron supplements at a different time of the day than these two drugs [ , ]. Cimetidine Tagamet HB, used to treat duodenal ulcers can slow the rate of caffeine clearance from the body and thereby increase the risk of adverse effects from caffeine consumption [ ].
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Individuals taking dietary supplements and medications on a regular basis should discuss the use of these products with their healthcare providers. These organizations add that the best way to use supplements is as additions to a carefully chosen diet, that dietary supplements rarely have ergogenic benefits when not used in these conditions, and that there is no justification for their use by young athletes.
The National Federation of State High School Associations also expresses strong opposition to the use of supplements to enhance athletic performance by high school students [ 15 ]. The American Academy of Pediatrics adds that performance-enhancing substances do not result in significant improvements in most teenaged athletes beyond those that can result from proper nutrition and training basics [ 7 ]. Elite and recreational athletes perform at their best and recover most quickly when they consume a nutritionally adequate diet with sufficient fluids and when they have appropriate physical conditioning and proper training.
For more information about building a healthy diet, refer to the Dietary Guidelines for Americans [ 10 ] and the U.
Department of Agriculture's MyPlate [ 11 ]. The Dietary Guidelines for Americans describes a healthy eating pattern as one that:. This fact sheet by the Office of Dietary Supplements ODS provides information that should not take the place of medical advice.
We encourage you to talk to your healthcare providers doctor, registered dietitian, pharmacist, etc. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice. Updated: October 17, History of changes to this fact sheet. Find ODS on:. Strengthening Knowledge and Understanding of Dietary Supplements. Health Information Health Information. For Researchers For Researchers.
Summit on human performance and dietary supplements summary report. Nutr Today ; Nutrition Business Journal.
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Supplement Business Report New York, NY: Penton, The use of drugs and nutritional supplements in top-level track and field athletes. Patterns of dietary supplement use among college students. Clin Nutr ; Use of performance-enhancing substances. Pediatrics Jul; 1.
Bodybuilding, energy, and weight-loss supplements are associated with deployment and physical activity in U. Ann Epidemiology ; Prevalence of dietary supplement use by athletes: systematic review and meta-analysis.
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Sports Med ; Department of Agriculture and U. Department of Health and Human Services. Dietary Guidelines for Americans. Department of Agriculture. J Acad Nutr Diet ; International society of sports nutrition position stand: caffeine and performance. Supplements position statement , November 21, Exercise and oxidative stress: significance of antioxidants with reference to inflammatory, muscular, and systemic stress. Exerc Immunol Rev ; Acute exercise and oxidative stress: a 30 year history. Dyn Med The antioxidant effect of exercise: a systematic review and meta-analysis. Do antioxidant supplements interfere with skeletal muscle adaptation to exercise training?
J Physiol ; Vitamin C and E supplementation hampers cellular adaptation to endurance training in humans: a double-blind, randomised, controlled trial. Can supplementation with vitamin C and E alter physiological adaptations to strength training? Effects of ubiquinone supplementation and high intensity training on physical performance in humans.
Acta Physiol Scand ; Vitamin C and E supplementation alters protein signalling after a strength training session, but not muscle growth during 10 weeks of training. Oral administration of vitamin C decreases muscle mitochondrial biogenesis and hampers training-induced adaptations in endurance performance. Am J Clin Nutr ; Muscle redox signalling pathways in exercise.
Role of antioxidants.
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Food and Nutrition Board. Klein EA, Thompson Jr. JAMA ; Safety assessment of coenzyme Q10 CoQ BioFactors ; Sureda A, Pons A. Arginine and citrulline supplementation in sports and exercise: Ergogenic nutrients? Med Sport Sci ; Efficacy and safety of ingredients found in preworkout supplements. Am J Health-Syst Pharm ; L-arginine as a potential ergogenic aid in healthy subjects. Sports Med ;41 3 Safety and performance benefits of arginine supplements for military personnel: a systematic review.
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