The dietary supplement industry is a $30 billion per year behemoth, and athletes of all levels are major consumers. Unfortunately, much of the product sold is worthless at best - and may even be harmful! - but not all supplements are snake oil. For an athlete interested in utilizing supplements to support their health and active lifestyle, it can be a daunting task to sift through this landscape. Admittedly, even many physicians are ill-informed when it comes to supplements. Even worse, perhaps, they are actively engaged in selling expensive lines of questionable products that instill an inherent bias in their recommendation. It can get messy!
In this article, I’ll give you my thoughts on dietary supplementation and how to determine which supplements may be right for you. As a transparent statement of my potential conflict, we sell a line of supplements at Podium. Thorne Research makes incredibly high quality products, but more importantly many are tested and certified to be free of banned substances. Twelve US Olympic programs use Thorne as their sole provider of supplements. I have many athletes in my practice who are routinely drug-tested, and I feel confident in Thorne’s guarantee of quality and purity. There are other great brands on the market, and fortunately Knoxville has an amazing resource for advice and supply in Eddie’s Health Shoppe! I send many patients to Eddie Reymond and can recommend him and his shop without hesitation. And now, on with the article…
Before we delve into the details of supplementation, the very nomenclature must be addressed. These substances, if used at all, should be supplemental to a healthy diet. You cannot eat poorly, take a daily multi-vitamin, and expect everything to be okay. The most important component of your dietary health is your diet! Whole, nutrient-rich foods must be the cornerstone of your regimen. If you are found to be in need of extra magnesium, ensure you are eating healthy amounts of spinach, pumpkin seeds, almonds, and other real foods. You are unlikely to fix the problem by adding a magnesium tablet to your cheeseburger diet.
Should you determine that dietary supplements may be helpful for you, the next concern is one of quality. A federal act passed in 1994 exempted supplement manufacturers from FDA oversight. This created a potentially dangerous scenario for consumers. In 2015, the state of New York tested “top selling” vitamins and supplements at GNC, Walgreens, Target, and Walmart. The results were appalling. Most of these supplements contained only powdered rice, fillers, and other inactive ingredients, like “house plants”. There was little, if any, of the substance the customer thought they were purchasing.
Given this background, an athlete’s first task is to ensure they are buying from a brand that takes their product seriously and utilizes good practice in their manufacturing. I would never recommend choosing a product blindly off a store shelf. Discuss specific products with someone knowledgeable on the topic.
Once that hurdle is cleared and you have a resource for quality dietary supplements, the next step is to determine which might be useful for you. This could be a very long conversation! A well-informed sports medicine physician or dietician should be consulted. I think athletes should undergo simple blood tests to determine whether they are in need of extra iron, magnesium, Vitamin D, or other nutrients. There is no reason to guess at the dosing. Work with your doctor to set up the appropriate panel of tests to help guide your diet and supplementation.
For athletes, there are some supplements that can be nearly universally helpful. Others should only be taken when insufficient levels are demonstrated through testing.
Multi-vitamin - It seems like practitioners are either adamantly for or against a daily multi-vitamin. To me, it’s an often misguided argument. Many doctors cite studies with irrelevant end-points. Do you care whether a group of 65-85 year old men with a history of heart attack lived longer when taking a multi-vitamin for 18 months? Unless you fall into that narrow category, the answer is probably “no”. Yet these types of studies are often used as rationale for multi-vitamins being worthless or unnecessary. As I see it, athletes have a very high nutrient demand. A good diet is paramount! But a high-quality multi-vitamin designed for athletic needs can play a very important role. The goal may not be increased longevity. Instead, ensuring adequate intake in the setting of high nutrient turnover could help with energy, vitality, and resilience in the face of a heavy load of training and racing.
Fish Oil - Omega 3 fats are beneficial to many athletes. They can balance Omega 3:6 ratios, help maintain healthy lipid profiles, decrease inflammation, and even combat muscle soreness after a workout.
Protein - An athlete requires between 1 and 2 grams of protein per kilogram of body weight per day, depending on their training goals. For many, this can be rounded to 1.5g/kg/day. That is a fairly large dose of protein. While dietary proteins are certainly best, many athletes can benefit from occasional protein supplementation to aid in maintaining or building muscle mass and supporting recovery from workouts. Additionally, certain amino acids like Glutamine can further aid this process.
Should Be Dosed Based on Blood Tests
Iron - An essential component in the transportation and utilization of oxygen as aerobic fuel, iron can be a “make or break” nutrient for endurance athletes. However, too much can cause health risks. An easy blood test can tell you whether you should increase your iron intake.
Vitamin D - This has certainly been a trendy vitamin over the past decade, and often with questionable evidence at best. However, we know that an individual’s level of Vitamin D impacts their muscular function, recovery, hormone formation, and immune status. While very high levels are not desired, we do see that athletes with high training loads and/or certain ethnic heritages are often low in this crucial nutrient. Again, a blood test can easily tell you if you need to add supplemental intake.
Magnesium - This mineral is abundant in the body, but there is a remarkable degree of insufficiency in athletes. Studies have shown that adequate levels of magnesium can decrease blood pressure, improve insulin sensitivity, possibly improve aerobic performance, and improve sleep – all beneficial to athletes.
Other supplements may also be situationally useful, but anything strong enough to have a positive effect may have a negative effect in the wrong setting. Vitamin C acts as an antioxidant, boosts immune function, and may even play a role in the healing of soft tissue injuries; however, larger daily doses have been shown to slow the rate at which athletes increase their fitness in response to training. Context is key, and working with a knowledgeable practitioner makes all the difference.
At the end of the day, high-quality supplements can be an important part of an athlete’s training and dietary regimen, but they should be considered as potent substances with the potential to help or harm, depending on context and individual need. Athletes should consult with their physician before starting a supplement regimen. For many, simple blood tests can guide dosing and determine need. Some supplements can have dangerous side effects or interact with medications, and some products can actually be detrimental to health and performance if taken inappropriately. Work with your doctor or a qualified nutrition expert to determine if supplementation could benefit you.