Making Sense of Supplements

MAKING SENSE OF SUPPLEMENTS

No matter how hard you try, there is no escaping the endless stream of
advertising for the myriad of nutritional supplement products available today. From
protein and creatine, to caffeine and other more-controversial performance aids,
there is every imaginable supplement tailored to every health, wellness, and fitness
goal. Since each one claims it is the best and most effective formulation ever, how
do you help your circle of influence to make the right supplementation choices that
will actually support their goals?
This course will explore some of the most common trends in the nutritional
supplementation landscape, to help you separate research-supported hope from
marketing hype.
Learning Objectives
By successfully completing this course, you will have the ability to do the
following:
 Identify the position of supplementation within the hierarchy of
programming components.
 Describe the role of supplementation across various goals.
 Explain the strength of the evidence base for commonly used supplements.
 Communicate the pros and cons of supplementation.

Introduction to Dietary Supplements

The use of dietary supplements is widespread in the general population, and
its use is even higher among athletes and exercisers. Displaying an ability to
evaluate the validity, safety, and quality of dietary supplements marketed for
weight loss, muscle gain, or improved athletic performance is a way of
adding credibility and value for any influencer. Given the multi-billion-dollar
supplement industry, myriad products, advertisements, and claims to help
exercisers and athletes attain desired results from their use, as well as an apparent
lack of understanding of the way supplements are regulated, there is a need for
scientifically grounded guidance and an understanding of the marketplace.
Prevalence of Use
The prevalence of dietary supplement use in North America is
widespread. Approximately half of the general population report taking at least one
dietary supplement, with the most commonly used supplement being a
multivitamin and mineral formula (Blumberg et al., 2017). Dietary supplement use
is higher among older adults, with 63% of people over age 51 and 75% of
individuals over age 71 who report using at least one dietary supplement (Cowan
et al., 2018). The majority of health club members (84%) report taking a range of
products from multivitamins to protein powders. For adults in the United
States who reported making a serious attempt at weight loss, over 1/3 have used a
dietary supplement for that reason (Dickinson, Blatman, El-Dash, & Franco, 2014;
Morrison, Gizis, & Shorter, 2004; Pillitteri et al., 2008).
A systematic review of 159 studies revealed that athletes use dietary
supplements to an even greater extent, with the highest prevalence among elite
athletes compared to nonelite athletes (Knapik et al., 2016). As a nutrition health
enthusiast, most likely you have already been asked for guidance on which dietary
supplements can help support health, weight loss, muscle gain, and athletic goals.
No doubt it's already occurred to you to consider that in this information age,
knowing where to look is just as important as knowing what it means.
If you gain the knowledge to point others toward existing guidelines, based
on the body and strength of evidence related to supplements, your circle of
influence will place a high value on your ability to know where to look. This will
be true regardless of your targeted knowledge or participation in competitive
sports.
It is also important to take into consideration the hierarchy of nutritional
strategies for accomplishing the desired outcomes. The following model provides a
contextual overview of the impact each level has on an individual’s nutritional
status. Similar to Maslow’s Hierarchy of Needs (which is concerned with life as a
whole), foundational nutrition strategies need to be met before giving concern to
the next level.
Just like how physiological and safety needs must be met before one can
focus on psychological and self-fulfillment needs in Maslow’s model (Figure:
Maslow’s Hierarchy of Needs), daily energy requirements for health need to be
met before undertaking more specific dietary strategies and supplementation. This
can serve as a model for prioritizing daily, weekly, and overall dietary choices,
actions, and goals (1 = highest/foundational priority).
astephan/Shutterstock.com
FIGUREMaslow's Hierarchy of Needs

5 - Proper supplementation to support body composition, training, and

performance
4 - Meeting micronutrient needs based on nutritional gaps in the diet
3 - Tailoring carbohydrate and fat amounts and timing based on your
preferences and energy needs for training and competition
2 - Meeting daily protein requirements for the desired outcomes
1 - Daily energy needs according to your goal and demands of the activity
This model implies that daily energy needs, protein intake, and essential
nutrient requirements are of higher priority than supplements, including ergogenic
aids. These have a greater impact on the individual’s body composition or
performance goals when compared to supplements. However, this understanding
does not dismiss the potential benefits of certain dietary supplements on health, as
well as desired aesthetic or performance outcomes, when supplements are properly
selected, utilized, and added to a solid nutritional foundation.
Lacking this knowledge makes it difficult, even for well-read nutrition
enthusiasts, to navigate the information stream available to the general population
and athletes alike. It remains critically important to understand the regulatory
framework surrounding dietary supplements, the related body of research on any
particular ingredient of interest, and various independent agencies that test the
quality of supplements.
Learners' Corner
Taking an evidence-based approach to dietary supplements, including
criteria for proper selection of products, is a high-stakes endeavor. Nutrition
enthusiasts and influencers can aid in the prevention of wasteful spending, adverse
health effects, inadvertent doping, and subsequent suspensions from athletic
competition. The benefits are personal as well as communal, because enthusiasts
and influencers can individually gain the benefits afforded by certain dietary
supplements to support their own fitness, exercise, and athletic performance goals.
The art of translating personally gained experience, through the lens of impartial
evidence, is highly beneficial in the testimonial-laden world of nutrition.

Regulation of Dietary Supplements

Pressmaster/Shutterstock.com
The current laws governing dietary supplements should be taken into
consideration for proper selection and utilization for the general population as well
as athletes, regardless of competitive level or professional status. In the United
States, the regulation of supplements is dictated by the Dietary Supplement and
Health and Education Act (DSHEA) of 1994 (U.S. Food and Drug Administration,
2018). Under the provision of the DSHEA, dietary supplements, which include
herbs, botanicals, vitamins, minerals, and other ingredients, are regulated as food
products but not subjected to premarket testing or approval processes. By contrast,
over-the-counter medication and prescription drugs are subject to premarket testing
and approval by the U.S. FDA, including clinical trials.
Manufacturers of dietary supplements are responsible for adopting current
good manufacturing practices (cGMPs), which are standards and guidelines to
ensure the proper creation of supplements. Manufacturers are also obligated to
make accurate label claims; they are prohibited from marketing supplements to
prevent, treat, cure, or diagnose a disease. Similar to claims of product safety and
efficacy, label claims for supplements do not have to be approved by the Federal
Trade Commission (FTC) or the FDA prior to their sale and marketing. Hence,
individual supplement producers bear the responsibility for all of these
protocols: proper testing of raw materials, manufacturing of ingredients, and
verification procedures (for the identity, composition, and purity of finished
products).
To enforce these supplement manufacturing rules, as opposed to requiring
testing and approval of every dietary supplement prior to sale, the FDA performs
annual inspections of randomly selected manufacturing sites to assess compliance
with cGMPs. In the 2016 FDA Inspection Report of nearly 500 manufacturing
facilities, infractions were found at nearly 2/3 of the facilities (ConsumerLab,
2017). An average of six infractions were discovered at each facility, with the most
common infractions involving the lack of processes for verifying the identity of
raw ingredients and assessing purity, identity, and composition of finished
products. This lack of compliance to cGMPs by supplement manufacturers results
in poor product quality, including ineffective formulas and contamination with
hidden ingredients.
The FDA has the power to recall a product; it will do so after serious or
sufficient adverse events are reported or new, unapproved ingredients are
discovered. The FDA maintains an online database of over 900 supplements
that have been found to be contaminated with prescription drugs and illegal
substances (U.S. Food and Drug Administration, 2018). Contaminated supplements
have been purported to be the cause of negative health effects in the general
population as well as positive drug tests among athletes, resulting in suspension
from competition. However, there appears to be a general lack of awareness of the
buyer-beware supplement market as a result of the DSHEA. Fortunately, there are
methods and tools in place to ensure adherence to existing standards.
Guidelines for Supplement Selection
An evidence-based approach to dietary supplements includes evaluation of
their aspects, such as whether or not the ingredients are legal. Other aspects could
include whether or not a supplement is safe and effective based on the strength of
the research and the population studied; the potency of the formula, including the
dosages and ingredient forms; and whether the finished product has undergone
independent testing for accuracy of label claims, absence of contaminants, and
banned substances.
Strength of Research
The strength of the evidence on dietary supplements varies greatly, and the
body of research on safety and efficacy should be well-established. Credible
resources include the National Institute of Health’s Office of Dietary Supplements,
the Micronutrient Information Center of the Linus Pauling Institute, and other
reputable organizations such as the Academy of Nutrition and Dietetics and
the International Olympic Committee. All of these resources offer position papers
on various topics related to exercise and sports nutrition, supplements,
and ergogenic aids.
Scientific, peer-reviewed research reviews and clinical trials available on
PubMed are generally reliable resources with limitations to studies, sometimes
including a small number of participants, inadequate duration, and lack of control
over influencing factors (i.e., confounding variables). Studies performed on
animals that lack follow-up studies in humans, single studies, or case studies are
not considered adequate sources for recommending a dietary supplement.
Commercials and testimonials based on anecdotal evidence are the weakest forms
of evidence. The International Olympic Committee’s hierarchy of evidence for the
use of dietary supplements is presented in Figure: IOC's Hierarchy of Scientific
Evidence (Maughan et al., 2018).

FIGUREIOC's Hierarchy of Scientific Evidence

Guidelines for Supplement Selection
 An evidence-based approach to dietary supplements includes evaluation of
their aspects, such as whether or not the ingredients are legal. Other aspects could
include whether or not a supplement is safe and effective based on the strength of
the research and the population studied; the potency of the formula, including the
dosages and ingredient forms; and whether the finished product has undergone
independent testing for accuracy of label claims, absence of contaminants, and
banned substances.
Strength of Research
The strength of the evidence on dietary supplements varies greatly, and the
body of research on safety and efficacy should be well-established. Credible
resources include the National Institute of Health’s Office of Dietary Supplements,
the Micronutrient Information Center of the Linus Pauling Institute, and other
reputable organizations such as the Academy of Nutrition and Dietetics and
the International Olympic Committee. All of these resources offer position papers
on various topics related to exercise and sports nutrition, supplements,
and ergogenic aids.
Scientific, peer-reviewed research reviews and clinical trials available on
PubMed are generally reliable resources with limitations to studies, sometimes
including a small number of participants, inadequate duration, and lack of control
over influencing factors (i.e., confounding variables). Studies performed on
animals that lack follow-up studies in humans, single studies, or case studies are
not considered adequate sources for recommending a dietary supplement.
Commercials and testimonials based on anecdotal evidence are the weakest forms
of evidence. The International Olympic Committee’s hierarchy of evidence for the
use of dietary supplements is presented in Figure: IOC's Hierarchy of Scientific
Evidence (Maughan et al., 2018).

FIGUREIOC's Hierarchy of Scientific Evidence

USP’s Dietary Supplement Verification Program ensures these things: the
product contains the ingredients and amounts listed on the label; it's free from
harmful levels of specified contaminants (e.g., pesticides, heavy metals, or
microbes); it's made in a facility that is compliant to cGMPs; and it will break
down in the body within a specified time. Products are also tested annually to
retain the USP Verified mark (U.S. Pharmacopeia, 2018).
In addition to testing for ingredient identity and strength, testing for hidden
drugs and banned substances in sports is also conducted to varying degrees and
standards by BSCG’s Certified Drug-Free program, Informed Choice’s
Registration Process, and NSF International’s Certified for Sport program. These
programs may include random audits of manufacturing facilities and procedures
(per cGMPs) and random testing of finished products. On successful completion of
the certification process, products are permitted to include the certifier’s logo and
are listed on the certifier’s website.
NSF International offers a Certification for Sport program that includes
testing for banned substances listed by various sports organizations. Major League
Baseball, the National Hockey League, and the Canadian Football League require
members to only utilize NSF Certified-for-Sport products.
Several organizations recommend NSF Certified-for-Sport products,
including the National Football League, the Professional Golf Association, and the
Collegiate and Professional Sports Dietitians Association. Utilizing independently
tested products is particularly important for anyone working with athletes,
because they can test positive for a banned substance by using tainted supplements.
However, this is a critical point about third-party testing companies: They do
not evaluate either the efficacy of the products or truthfulness of all claims that
companies make about their products. Nutrition enthusiasts, athletes, and
consumers are advised to seek out additional information from credible resources,
such as those previously listed, as well as contacting companies to provide
information about product efficacy, which would include published research
related to their products. The legality of supplement ingredients must be
investigated for athletes in their respective sports, especially as they wouldn't want
to risk an investigation. Additionally, it is prudent for individuals who take
medications to consult their healthcare professional before adding dietary
supplements to the mix, as there may be potential interactions.
Learners' Corner
Guidelines for Selecting Dietary Supplements
1. Verify the ingredients are supported with solid evidence for efficacy and
safety from scientific reviews, reputable organizations, and/or well-designed
human studies.
2. Determine whether ingredient forms and dosages in product formulas match
evidence-based recommendations.
3. Check to see if the product is independently tested to verify label accuracy.
For athletes, third-party testing for banned substances is critical.
4. Request independent research from companies that will verify claims
regarding their products.
Quite frequently, supplement products cannot meet all four of these
guidelines. However, doFIT is one example of a supplement brand that always
strives to meet these criteria for its entire product line. Learn more about how
dotFIT supports their products with independent, third-party research by exploring
their Practitioner Dietary Supplement Reference Guide (PDSRG), 3rd Edition.
Dietary Patterns to Optimize Health
margouillat photo/Shutterstock.com
Despite the recommendations to choose a wide variety of nutrient-dense
foods and consume an appropriate level of calories to maintain a healthy body
weight, the food choices of many Americans are a sharp contrast to the Dietary
Guidelines for Americans (DGA). That contrast results in the overconsumption of
calories and underconsumption of essential micronutrients (vitamins and minerals).
The 2015–2020 DGA report identified key nutrients that are under-
consumed, including vitamins A, C, D, and
E, choline, potassium, magnesium, iron, calcium, and fiber. Adverse health effects
resulting from the underconsumption of calcium, vitamin D, potassium, iron, and
fiber were deemed a public health concern (U.S. Department of Agriculture &
Health and Human Services, 2015). Although overt micronutrient deficiencies are
rare in the United States and other developed countries, inadequate intake appears
to be common.
In addition to the lack of key nutrients, identified as a public health concern
by the DGA, a dietary analysis of 70 sedentary individuals and athletes revealed
insufficient intakes of 3 to 15 essential micronutrients in every individual diet
(Misner, 2006). Males lacked 40% of the vitamins and 54.2% of minerals,
while females were deficient in 29% of vitamins and 44.2% of the minerals
analyzed. Athletes had more micronutrient deficiencies than their sedentary
counterparts, while those reducing calories to lose weight were lacking more
micronutrients than those who did not reduce calories.
Another study, which analyzed three days of menus from four popular
diets (e.g., the South Beach diet, Atkins for Life, the DASH diet, and the Best Life
diet), concluded that individuals following any of these diets were highly likely to
become deficient in several micronutrients (Calton, 2010). Each diet failed to
provide the daily recommended levels of 12 to 21 micronutrients. Six
micronutrients were deficient in all four diets: vitamin D, vitamin E, biotin, iodine,
molybdenum, and chromium.
Considering estimates that 1/3 of adults in the United States are on a diet at
any given time, coupled with the data above, it is possible that many people are at
risk of developing micronutrient deficiencies over time.
Learners' Corner
Underconsumption of essential nutrients is a key public health concern. Data
shows that many Americans under-consume key vitamins and minerals that
support optimal health: vitamins A, C, D, and E, choline, potassium, magnesium,
iron, calcium, fiber, etc. Multivitamin and Mineral Supplements
Sufficient amounts of essential micronutrients, such as vitamins and
minerals, are required for normal growth and development, metabolism, and
longevity. Low consumption of micronutrients may result in a variety of
symptoms (negative mood, impaired focus and attention span, general fatigue, and
a lowered capacity to fight infections), yet these symptoms are often attributed to
factors other than micronutrient intake (Dong, Xun, Pe, & Qin, 2011; Huskisson,
Maggini, & Ruf, 2007; Yokoi & Konomi, 2017).
Additionally, even when low levels of overt deficiency aren't apparent,
emerging data suggests that inadequate intakes of micronutrients below daily
recommended levels may elevate the risk for chronic and age-related diseases such
as these: eye disease, osteoporosis, cancer, heart disease, and Type 2 diabetes
(Ames 2006; Angelo, Drake, & Frei, 2015).
The proper use of dietary supplements, particularly multivitamin and
mineral formulas, has been shown to help fill common and widespread nutrient
gaps (Bailey, Fulgoni, Keast, & Dwyer, 2012; Blumberg et al., 2017). Blumberg et
al. (2017) analyzed the intake of 17 nutrients in nearly 11,000 adults in the United
States, either from food alone or from food plus a multivitamin and mineral
supplement. Higher frequency of use eliminated inadequate intakes of all the
vitamins and minerals examined, with the exception of vitamin D, calcium, and
magnesium.
Hence, the intake of a daily multivitamin and mineral appears to be an
effective nutritional strategy on two fronts: avoiding common insufficiencies and
meeting recommended intakes based on age, gender, and life stage. Achieving
daily requirements for major minerals such as calcium, magnesium, iron, and other
essential nutrients, such as vitamin D and the omega-3 fatty acids DHA and EPA,
may require separate supplementation. Although dietary supplements do not
replace a healthful diet, they can help individuals achieve recommended intakes of
essential nutrients, which may play a supportive and critical role in healthy aging.
Helpful Hint
Use the values depicted in Figure: What Your Multi Should Contain to
help choose a quality multivitamin and mineral formula (adapted
from Schardt, 2016).

FIGUREWhat Your Multi Should Contain

Supplements for Muscle Gain and Recovery

Numerous dietary supplements are made commercially available and are
marketed for enhancing muscle mass, strength, weight loss, athletic performance,
and recovery from strenuous exercise. Other products are positioned as convenient
sources of energy and protein to fuel exercise and achieve target amounts of
macronutrients and micronutrients. Varying levels of evidence exist to support such
claims, from anecdotal to systematic reviews of several randomized controlled
trials.
The data presented in this chapter is categorized into solid, moderate, and
weak levels for various ingredients that claim to enhance common fitness goals
and athletic performance. The data includes a focus on the evidence and usage
application for those with sufficient human data on safety and efficacy.
Athletes and avid exercisers frequently seek out methods to accelerate
changes in body composition, or boost training sessions and competitive events, to
gain a performance edge. The desire for continuous improvements in strength,
physique, and performance has led to myriad supplements that tout various
benefits, though solid evidence exists for only a few ingredients (Table: Muscle-
Gain Supplements Strength of Evidence) (Kerksick et al., 2018).
As such, there is general consensus that protein, creatine monohydrate, and
essential amino acids are supported by strong evidence for enhancing resistance-
training-induced outcomes, including strength and muscle hypertrophy. The
research and recommendations for use will be reviewed in this section. There is
less evidence for the majority of ingredients in dietary supplements that claim to
enhance greater gains in muscle and improve recovery.
Muscle-Gain Supplements' Strength of Evidence
Strong Evidence Moderate / Mixed Weak / Lack of Evidence
Evidence
Protein BCAAs Arginine
Creatine monohydrate HMB Glutamine
Essential amino acids Phosphatidic acid ATP
Alpha-ketoglutarate
Prohormones

Creatine Monohydrate
Alex-M/Shutterstock.com
Creatine monohydrate is synthesized endogenously (i.e. within the
system) in the liver and kidneys from amino acids, then stored primarily in muscle
tissue. Its role is to regenerate intracellular ATP stores via the phosphocreatine
system during high-intensity activity. Creatine can also be obtained from food,
namely beef, poultry, and seafood (Table: Creatine Sources) (Tarnopolsky, 2010).
Supplementation with creatine monohydrate is backed by a plethora of
research studies that demonstrate its effectiveness at increasing muscular stores
and enhancing muscle mass in conjunction with resistance training (Kreider et al.,
2017; Kerksick et al., 2018). Greater gains in muscle tissue seem to be a result of
superior training adaptations due to increased, high-intensity workload
capacity. When compared to controls, individuals who supplement with creatine
monohydrate for one to three months have been shown to gain 1 to 2 additional
kilograms of mass (Volek et al., 1999; Helms, Aragon, & Fitschen, 2014).
Short- and long-term studies have demonstrated the safety of creatine
supplementation among healthy populations. The only significant side effect,
which is typically desired, is weight gain due to increases in water retention and
muscle mass (Kreider et al., 1999; Kreider, 2003).
Creatine Sources
 Source (8 oz serving) Crea
Beef (lean) 1.5 to
Pork 1.5 to
Herring 2.0 to
Salmon 1.5 to
Milk 0.05 g
Typical use includes two methods that have been shown to increase
muscular creatine stores by 20% to 40% (Kreider & Jung, 2011). The first method
includes a loading phase, lasting five to seven days and requiring consumption
of 20 to 25 grams daily, or about 0.3 gram/kilogram of body weigh in doses split
throughout the day; this is followed by a maintenance phase that consists of
consuming a daily dose of 3 to 10 grams, as the higher-maintenance dose is
probably more appropriate for individuals with greater muscle mass (Kreider et al.,
2003; Kreider et al., 2017). Another method involves gradually increasing
muscular stores by consuming a daily dose of 3 to 5 grams a day over three to four
weeks.
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 The first method may result in faster loading and a more immediate
performance benefit due to higher creatine stores. Co-ingesting
carbohydrate (with or without protein) with creatine monohydrate
increases uptake and muscular retention (Kreider et al., 2017). The
duration of creatine supplementation is dependent on the individual’s
desired outcome, length of high-intensity training phase, and time
restrictions due to competitive events. On cessation of use, creatine
stores normalize within four to eight weeks (Tarnopolsky, 2010; Kreider
et al., 2017).
 Getting Technical
 The research on creatine is extensive. Review Table: Key Research
on Creatine Monohydrate for a selection of studies that produced
significant results in favor of creatine supplementation.
 Despite marketing claims to the contrary, other forms of creatine have
not been proven to be more effective than creatine monohydrate;
these forms include creatine HCl, buffered creatine, alkalized creatine,
and creatine ethyl ester (Spillane et al., 2009; Jager, Purpura, Shao,
Inoue, & Kreider, 2011). Creatine monohydrate is thought to be the
most-effective dietary supplement for enhancing high-intensity
training, strength, and muscle mass. However, some individuals are
considered non-responders and do not experience these benefits; this
 is likely due to naturally elevated muscular stores of creatine (Harris,
Söderlund, & Hultman, 1992).
 Key Research on Creatine Monohydrate
Research Outcome Measured Dosing Protocol
Authors
Harris et al., Muscular creatine content 5 g, 4 to 6 times/day, for 4 to 10 days
1992 of the quadriceps femoris
N = 17; 5 females + 12 males
Hultman et al., Total muscular creatine 5 g, 4 times/day for 6 days, + 2 g/day fo
1996 stores 30 days

3 g/day for 28 days

N = 31; males
Vandenberghe Muscular creatine stores 5 g, 4 times/day for 4 days, + 5 g/day fo
et al., 1997 65 days + resistance training (10 weeks
Strength followed by detraining period)

Fat-free mass Same protocol for placebo group

N = 19; young, sedentary females

Volek et al., Muscular creatine stores 25 g/day for 1 week + 5 g/day for 11
1999 weeks
Muscle fiber hypertrophy
Same protocol for placebo group

N = 19; resistance-trained men

Kreider et al., Creatine stores Literature review of 500 studies

2003
Phosphocreatine stores
Protein
Protein provides quite a lot in the body: amino acids, the building blocks of
skeletal muscle, other structures, and various compounds such as enzymes and
hormones. Of the 20 amino acids, nine (9) are considered essential and must be
obtained from the diet because they cannot be synthesized endogenously. Animal
sources of protein provide all essential amino acids (EAAs), whereas plant
sources (except soy) are limited in at least one or more EAAs.
In general, protein sources considered to be high-quality are rich in essential
amino acids, are digested and absorbed well. For exercise and athletes, they are
superior for supporting training outcomes such as muscle hypertrophy, fat loss, and
enhanced recovery.
The ingestion of high-quality protein stimulates muscle protein synthesis
(MPS); the effect is enhanced with resistance training (Jäger et al., 2017). Thus,
maximally stimulating MPS may benefit those attempting to gain muscle tissue.
This has been investigated extensively in humans of various ages and training
experience levels. Protein intake greater than the recommended dietary allowance
(RDA) of 0.8 gram/kilogram/day of body weight has been shown to help
individuals performing resistance-training exercise to maintain protein balance,
build muscle mass, and improve body composition (Aragon et al., 2017; Cintineo,
Arent, Antonio, & Arent, 2018; Jäger et al., 2017; Morton et al., 2018).
A systematic review of 49 randomized controlled trials, which
included 1,863 participants who performed resistance training at least twice a week
for six weeks or longer, revealed a number of helpful points about protein
supplementation; it significantly increased strength, lean body mass, and muscle
size in healthy adults who were not restricting calories compared to placebo or
zero supplements (Morton et al., 2018). On average, resistance training enhanced
by protein supplementation induced a lean-body-mass gain of 27% and increased
the muscle fiber cross-sectional area by 38%. These increases were not further
enhanced with daily protein intakes greater than 1.62 gram/kilogram of body
weight (.73 gram/pound) and were more pronounced in trained individuals.
Room 76/Shutterstock.com
While older individuals did not appear to benefit from training-induced
increases and muscle protein supplementation, the average dose among older
subjects was 20 grams per day. It has been shown that higher dosages of up to 40
grams post-exercise are needed to achieve muscle protein synthesis rates similar to
younger counterparts, likely due to the anabolic resistance among older
individuals (Burd et al., 2013; Churchward-Venne, Holwerda, Phillips, & van
Loon, 2016; Wall et al., 2015).
The International Society of Sports Nutrition (ISSN) recommends a daily
protein intake of 1.4 to 2.0 grams/kilograms of body weight to build and maintain
muscle tissue for most exercisers; it should be split evenly throughout the day,
approximately every three to four hours (Jäger et al., 2017). Higher daily intakes of
approximately 3.0 grams/kilograms among highly trained athletes who are
restricting calories has been shown to preserve lean tissue and promote fat loss
with no adverse health effects. However, this did not yield greater increases in lean
mass compared to the intake of 2.2 grams/kilograms/day. MPS is stimulated with
protein ingestion and remains elevated for three to four hours. Thus, the goal of
consuming regular meals with protein is to keep the muscle synthetic response
optimal and continuous throughout the day.
After resistance exercise, skeletal muscle synthetic rates remain elevated for
up to 24 hours; although consuming protein immediately (1 hour) after training or
competition may not enhance hypertrophy if the athlete meets total daily intakes, it
may support recovery and subsequent training and performance (Cintineo et al.,
2018). Thus, the post-workout period offers an opportunity to consume a high-
quality protein dose to help reach daily targets, enhance MPS, and potentially
benefit continuous intense training. Additionally, appetite is often diminished after
intense activity. Consuming a protein-rich shake may be more feasible, especially
at training or competition venues.
Athletes and exercisers interested in optimizing muscle protein synthesis to
maximize gains in lean tissue may benefit from per-meal protein doses of 0.40 to
0.55 gram/kilogram, consumed across at least four meals to reach total daily
intakes of 1.6 to 2.2 grams/kilograms (Schoenfield & Aragon, 2018). Protein
sources should be selected with a full spectrum of essential amino acids and
adequate amounts of leucine (1.7 to 3.5 grams per dose), which is the primary
trigger of MPS, with the understanding that some sources have higher amounts of
leucine than others (Table: Protein Supplement Leucine Content). Protein
supplements typically contain one or more sources: milk, eggs, soy, peas, or rice.
Protein Supplement Leucine Content
Protein % Leucine
Supplement Type Content
Whey 11%
Casein 9.3%
Eggs 8.5%
Soy Isolate 8%
Peas 8%
Wheat 7%
Brown Rice 8%
Isolate
Whey
Whey and casein are derived from bovine milk, comprising 20% and 80%
respectively of the protein component of milk. Whey is particularly rich in EAAs
(50% by weight), with the highest leucine content, when compared to other animal
protein sources. Due to its solubility, whey mixes easily and is digested and
absorbed rapidly, rendering it a particularly popular supplement among exercisers
and athletes seeking to increase or preserve muscle mass during intense training
and/or dieting in preparation for competition.
It is available in three main forms: concentrate, isolate, and hydrolysate. All
three of these are widely available and marketed for inducing muscle gain.
Vergani Fotografia/Shutterstock.com
1. Whey protein concentrate is the liquid fraction of milk. Typically, it's
comprised of 80% protein with small amounts of carbohydrates, fat, and lactose.
This concentrate is less refined than the isolate form because it contains bioactive
ingredients such as beta lactoglobulin, alpha lactalbumin, and lactoferrin, which
play a role in immune system functionality (Bell, 2000).
2. Whey protein isolate contains a higher portion of protein by weight
(90%), due to additional filtration of whey concentrate, during which the bioactive
compounds, fat, and carbohydrates are removed. The isolate is typically costlier
than the concentrate form.
 3. Whey protein hydrolysate contains shorter amino acid chains (peptides),
which are formed by adding enzymes to either whey concentrate or isolate. These
enzymes are supposed to enhance digestion and absorption. Hydrolysate is often
the most expensive form of whey protein.
All forms of whey protein are rapidly digested and provide a high-quality
source of protein, which can help individuals reach total-daily-protein targets and
maximize muscle protein synthesis. This is particularly true when minimizing
calories during weight loss, or when consuming whole food sources is impractical.
You can see why many nutritional information sites promote the use of whey
protein in smoothies and other soft foods.
Lactose
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 Casein Protein
 Casein makes up 80% of the protein in milk. Although it is a complete
protein source, it contains less leucine and is insoluble in acid; it forms
clots in stomach acid, thereby leading to slower digestion and
absorption. As such, casein protein supplementation has been shown
to stimulate MPS to a lesser extent than whey protein
supplementation; in lean mass, it also leads to lower gains when
induced by resistance training (Cribb, Williams, Carey, & Hayes, 2006;
Tipton et al., 2004).
 However, there appears to be a benefit to consuming casein protein
prior to bedtime for stimulating MPS during sleeping hours. One study
showed that when a pre-bedtime dose of casein protein (27.5 grams)
and carbohydrate (15 grams) are combined with daytime resistance
training over several weeks, muscle strength and hypertrophy are
greater in healthy, young men compared to a calorie-free placebo
(Snijders et al., 2015). A narrative review by Trommelen & van Loon
(2016) revealed that among recreational athletes performing regular
resistance training, pre-sleep protein ingestion results in adequate
digestion and absorption during overnight hours; also, it revealed that
administering 40 grams of casein protein before bedtime leads to
greater amino acid availability and 22% higher MPS rates than does a
placebo. So apparently, there is some validity to the idea of having a
glass of milk before bedtime.
 At present, the research on pre-sleep protein ingestion and its effect
on MPS, strength, and muscle mass has been conducted with
casein. While the optimal protein types and dosages have yet to be
established, clearly there is potential benefit from the ingestion of pre-
sleep protein for enhancing muscle protein synthesis and exercise-
induced outcomes, as well as in reaching daily protein targets.
  Plant Protein
 Plant-based protein supplements are growing in popularity; they are
often composed of one or more protein sources from soy, peas, rice,
and others. In terms of stimulating MPS, soy protein has been shown to
be inferior to whey and casein due to lower leucine content, fewer
essential amino acids, and lower bioavailability (Tang et al., 2009).
Although soy is a complete, fast-acting protein due to its rapid
digestibility, its amino acids are not as bioavailable to skeletal muscle
tissue compared to whey and casein protein (Devries & Phillips, 2015).
Research examining the impact of plant-based proteins on muscle
protein synthesis and changes in body composition has utilized
primarily soy protein; thus, the data is limited (Morton et al, 2018).
 In theory, a plant-based protein source rich in EAAs and leucine with
high bioavailability would stimulate MPS and enhance the response to
resistance exercise. A randomized controlled trial compared the impact
on muscle mass, based on participants' ingestion of two daily doses of
25 grams of supplemental pea proteins, whey proteins, and
a placebo; during 12 weeks of resistance training, the whey and pea
protein groups experienced similar and significant improvements in
muscle thickness compared to those who took the placebo,
demonstrating potential viability for pea protein to enhance muscle
gain with additional studies needed (Babault et al., 2015).
Protein ingestion above the minimum recommended daily amounts (RDA)
improves resistance training outcomes, including strength and greater muscle
mass. Protein supplementation provides a viable means of optimizing the muscle
synthetic response over 24 hours. The benefits appear greater with whey and
casein, which are abundant in leucine and contain the full spectrum of EAAs
required to synthesize muscle tissue.
Health concerns resulting from high-protein intakes, broadly defined as
greater-than-minimum daily requirements of 0.8 gram/kilogram, were addressed in
two 2018 systematic reviews. Among 1,358 individuals across 28 randomized,
controlled trials, which compared protein intakes of at least 1.5 gram/kilogram
body weight (over 100 grams per day) to lower protein intakes, glomerular
filtration rates neither differed between groups nor impaired kidney functionality in
healthy individuals (Devries et al., 2018). A separate review and meta-analysis of
trials and observational data showed similar findings, with evidence suggesting
that protein intake above minimum requirements does not adversely affect blood
pressure (Van Elswyk, Weatherford, & McNeil, 2018). Something noteworthy is
the current Acceptable Macronutrient Distribution Range (AMDR) of 10% to
35% of total daily calories from protein, which can exceed the current RDA and
include previously noted optimal intakes for muscle hypertrophy.
Learners' Corner
Protein Supplementation Guidelines
 Ensure that total daily intakes are met, using 0.7 to 1.0 gram/pound (1.2 to
2.2 grams/kilograms). Trained athletes restricting calories may benefit from
more protein to preserve muscle and promote fat loss.
  To maximize MPS and hypertrophy, consume four meals with 0.2 to 0.25
gram/pound (0.4 to 0.55 gram/kilogram) of body weight per meal of high-
quality protein.
 Depending on meal frequency, there may be benefits in consuming a
protein-rich meal/snack in the post-workout period, especially with heavy
training volumes, multiple competitive events, or when meeting total daily
protein targets.
 A pre-bedtime protein dose of 30 to 40 grams may help maximize MPS
during sleeping hours.
Acceptable Macronutrient Distribution Range (AMDR)

Essential Amino Acids (EAAs)
These EAAs provide building blocks for muscle tissue and other bodily
proteins; the branched chain amino acids (BCAAs) leucine, valine, and
isoleucine are the most abundant in skeletal muscle (Table: Essential
Amino Acids). As previously noted, they cannot be produced in the body,
so therefore, they must be obtained from the diet. It is well-established that
complete protein sources, which contain the greatest amounts of EAAs, are
the most effective at stimulating muscle protein synthesis; it's noteworthy
that a synergistic effect does occur with resistance training.

Isolating EAAs from intact protein sources and delivering them in free form
has also been shown to stimulate MPS. EAAs as well as BCAAs are commonly
used supplements among those seeking improved recovery and greater
gains from intense training (Tipton, Gurki, Matin, & Wolfe, 1999).
Essential Amino Acids
Leucine Isoleucine
Histidine Lysine
Phenylalanine Threonine
A review of the evidence concluded that the consumption of EAAs has
potential value for enhancing muscle protein synthesis, at least when 6 to 12
grams are consumed before, after, or during exercise (Kerksick et al., 2018).
Borsheim, Tipton, Wolf, & Wolfe (2002) showed that 6 grams of EAAs
consumed as a beverage, for one or two hours after strenuous resistance
training, equally simulated muscle protein synthesis in six young (19 to 25
years), active men and women.

A follow-up study conducted with six young (average age 34 years) and
seven older (average age 67 years) healthy, physically active participants
demonstrated that 15 grams of EAAs dissolved in a noncaloric beverage
significantly increased muscle protein synthesis; no difference
showed between age groups and the results were independent of resistance
training (Paddon-Jones et al., 2004). This finding is in contrast to the blunted
muscle protein synthetic response to protein observed in older adults when
compared to younger counterparts. It suggests that EAAs are an effective
means of stimulating MPS, and can potentially aid in preserving muscle mass
and enhancing resistance training outcomes during aging.

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 When healthy, trained males consumed equal amounts of leucine via
beverages with EAAs, BCAAs, or leucine alone (during resistance exercise),
greater muscle protein synthesis occurred with EAAs; this indicated a synergistic
effect of the complete spectrum of EAAs (Moberg et al., 2016). Furthermore, 15
grams of EAAs combined with 30 grams of carbohydrates consumed in between
normal meals resulted in a greater anabolic effect than similar amounts of EAAs
from a whole food source; nor did the EAA-carbohydrate mixture reduce the
muscle synthetic response to protein-containing meals consumed throughout the
day (Paddon-Jones, Sheffield-Moore, Aarsland, Wolfe, & Ferrando, 2005). These
findings suggest that EAAs in free form may be more readily available to elicit
muscle protein synthesis than mixed meals.
Some studies have investigated the potential value of EAAs to reduce
perceived muscle soreness, decrease markers of muscle damage, or help maintain
force production; thus, they could provide valuable support during ongoing, high-
quality training sessions. A recent study demonstrated that BCAAs consumed in
dosages according to LBM (.22 gram/kilogram/day) while controlling for protein
intake (1.2 gram/kilogram/day) resulted in significantly lower muscle damage, less
soreness, and greater force production (VanDusseldorp et al., 2018). Therefore,
EAA or BCAA ingestion with adequate leucine may serve as a viable nutritional
strategy to maximize MPS throughout the day among young and older individuals.
This strategy may be particularly beneficial for those experiencing lower protein
intakes while restricting calories to promote fat loss, minimize the loss of lean
tissue, and support recovery from intense training.
Learners' Corner
Consuming 6 to 15 grams of essential amino acids with 1.7 to 3.5 grams of
leucine may maximize MPS and reduce muscle soreness. This may be particularly
helpful for those with lower protein intakes, who are restricting calories while
attempting to maintain muscle tissue.
Food for Thought
EAAs vs. BCAAs
Essential Amino Acids (EAAs) include the branched chain amino acids
(BCAAs), leucine, isoleucine, and valine. Adequate leucine (1.7 to 3.5 grams) and
all EAAs are required to stimulate muscle protein synthesis and build muscle
tissue. If EAAs are consumed to maximize MPS, BCAAs are likely unnecessary. If
the total daily protein intake is on the lower end (1.2 gram/kilogram), BCAAs may
be beneficial.
HMB (Hydroxy-Methylbutyrate)
Hydroxy-Methylbutyrate is a byproduct of the essential BCAA, leucine,
identified as the primary initiator of muscle protein synthesis. A review of the
research identified modest improvements in strength and muscle gain (0.5 to 1.0
kilogram) over a period of three to six weeks of resistance training and 1.5 to 3
grams per day of calcium HMB; this was particularly true for untrained individuals
compared to those not supplementing with HMB (Kerksick et al., 2018).
Among trained individuals, it appears that the duration of supplementation
may be an influencing factor on resistance training and body-composition
outcomes. In one trial with 24 resistance-trained individuals, randomized to either
3 grams per day of HMB free acid or a placebo taken over 8 weeks of progressive
resistance training, followed by 2 weeks of an overreaching cycle and 2 weeks of
tapered training, the supplement group significantly increased strength and lean
body mass compared to the placebo group (Wilson et al., 2014).
Among 24 highly trained male combat athletes (wrestlers, judokas, and
Brazilian jiu-jitsu practitioners), 12 weeks of supplementing with 3 grams per day
of calcium HMB resulted in a significant increase in fat-free mass and a significant
decrease in fat mass when compared to 12 weeks of placebo treatment (Durkalec-
Michalski, Jeszka, & Podgórski, 2017). Documented benefits of HMB
supplementation on strength and muscle mass involve the ability of HMB to
reduce exercise-induced muscle damage; this is predominately found in older,
untrained individuals and highly trained athletes undergoing periods of extreme
physical stress, such as severe caloric restriction and intense exercise (Holecek,
2017; Rowlands & Thomson, 2009).
However, a systematic review and meta-analysis of six randomized
controlled trials and 193 participants on the effect of HMB supplementation on
body composition and strength did not find any impact in trained and competitive
athletes (Sanchez-Martinez, Santos-Lozano, Garcia-Hermoso, Sadarangani, &
Cristi-Montero, 2018). One review of nine randomized controlled trials, which
included 3 grams/day of HMB free-acid supplementation with resistance training,
concluded that HMB may reduce markers of muscle damage and enhance strength
and muscle mass (Silva et al., 2017).
Another systematic review and meta-analysis of 18 studies and over 500
participants involving HMB supplementation and recovery concluded that HMB
improved markers of muscle damage in a time-dependent manner, with significant
improvements observed over at least 6 weeks of supplementation (Rahimi,
Mohammadi, Eshaghi, Askari, & Miraghajani, 2018). Hence, the body of literature
suggests HMB’s benefit as an anticatabolic and recovery agent, with the potential
for counteracting muscle loss during aging (Molfino et al., 2013; Phillips, 2015;
Woo, 2018). Daily doses of 3 to 6 grams are often split across the day with meals
and bedtime to enhance retention; up to an eight-week period, its use appears to be
safe (Nissen et al., 2000).

Supplements for Fat Loss

FIGURETrends in Obesity
With overweightness and obesity among U.S. adults and youth at an all-time
high and steadily increasing (Figure: Trends in Obesity), coupled with the
challenge to improve eating and exercise habits and maintain weight loss over the
long haul, the desire and appeal for a weight loss enhancement product is
unsurprising. One survey of 3,500 U.S. adults revealed that among those making a
serious attempt to lose weight, over 1/3 (33.9%) use at least one dietary
supplement (Pillitteri et al., 2008). This study also revealed widespread
misunderstanding regarding the regulation of dietary supplements; it
demonstrated the mistaken belief of many, that the safety and efficacy of
supplements are determined prior to their sale and advertising.
Widespread use and misperceptions of dietary supplement manufacturing
underscores the need for knowledgeable guides and educators - not to mention
medical professionals. Despite the plethora of weight-loss supplements in the
marketplace, the abundance of strong evidence to support their use is limited. This
section will review the research on popular dietary supplements marketed for
weight loss and, where appropriate, their applications for use.
Stimulants
Whether they are found in pill, capsule, or powder form, weight-loss
supplements often contain one or more ingredients that stimulate the nervous
system; they are routinely advertised as fat burners due to their impact on
metabolism. Commonly used stimulants include caffeine, green tea extracts,
ephedra, bitter orange, and capsaicinoids. These supplements may be combined
with herbs, other plant-derived ingredients, amino acids, and minerals.
Herbal sources of caffeine or other stimulants may be listed as an ingredient,
though without including the particular stimulant and the amount. Furthermore,
multi-ingredient weight-loss products are abundant in the marketplace, yet they
are rarely tested in clinical trials. This research gap makes it difficult to determine
safety and efficacy for consumers and practitioners alike.
Caffeine
Caffeine (1,3,7-trimethyl-xanthine) is a naturally occurring substance in
coffee beans, kola nuts, guarana seeds, yerba mate, and tea leaves; it is also
synthesized in a lab as caffeine anhydrous. It stimulates the nervous system and
has been shown to modestly increase daily energy expenditure, decrease energy
intake, reduce the perceived-effort-level of exercise, and improve feelings of
energy and alertness (Acheson et al., 2004; Harpaz, Tamir, Weinstein, & Weinstein,
2017).
ideatraveller/Shutterstock.com
Using a moderate caffeine dose of 4 milligrams/kilograms of body weight
from coffee, significant increases were observed in resting metabolic rate (RMR);
these increases ranged from 4.9% to 12% in normal-weight and obese individuals,
with a greater increase occurring among normal-weight persons (Acheson et al.,
1980; Bracco, Ferrarra, Arnaud, Jequier, & Schutz, 1995). Similarly, a single 100-
milligram dose of caffeine increased resting metabolism by 3% to 4% for 2.5 hours
in lean and formerly obese participants (Dulloo et al., 1989). Over a twelve-hour
period, taking a 100-milligram dose every two hours increased energy expenditure
by 8% to 11% in both groups. This equated to a significant daily increase of 79
calories in the formerly obese participants and 150 calories in the lean subjects. A
meta-analysis of six well-designed studies revealed that caffeine-only and caffeine
with catechins from tea significantly increased 24-hour energy expenditure by
4.8% and 4.7% respectively, when compared to the placebo. A caffeine-catechin
mixture also significantly increased fat oxidation (Hursel et al., 2011).
 Caffeine appears to work synergistically with exercise to increase energy
expenditure and fat oxidation and potentially decrease acute energy intake. In a
recent study, active healthy adults consumed a moderate dose of caffeine (3
milligrams/kilograms) 90 minutes before an hour of moderate-intensity exercise as
well as another dose 30 minutes post-exercise, which resulted in significantly
higher energy expenditure and fat oxidation. Fewer calories were consumed
two hours later, compared to a meal consumed after an exercise bout without
caffeine ingestion (Schubert et al., 2014).
Other studies have generated similar findings among sedentary women who
consumed higher dosages (5 to 10 milligrams/kilograms) prior to moderate
exercise, resulting in greater energy expenditure when compared to their exercise
without caffeine (Donnelly & McNaughton, 1992; Wallman, Goh & Guelfi, 2010).
Caffeine in coffee at a dosage of 6 milligrams/kilograms reduced the amount that
overweight and obese participants consumed three hours later and the next day,
compared to their consumption of water and a lower dose of caffeine (3
milligrams/kilograms). Another study found that, compared to a placebo, 300
milligrams of caffeine given 30 minutes prior to unlimited access to food reduced
intake in men (by 22%) but not women (Gavrieli et al., 2013; Tremblay, Masson,
Leduc, Houde, & Depres, 1988).
Other research found no immediate impact of caffeinated coffee on energy
intake in healthy males (Gavrieli et al., 2011). Two apparent benefits of caffeine
ingestion are a decreased sense of effort associated with exercise and an increase in
physical performance (Harpaz et al., 2017). This has relevant practical application
to exercise enjoyment and subsequent adherence, particularly during the early
stages of exercise adoption and during weight- and fat-loss plateaus.
Caffeine appears to be a viable weight-loss tool. However, fat-
burner supplements often include other ingredients, including green tea, capsaicin,
bitter orange, and ephedra, a substance which is now banned in the United States.
Green tea extracts (primarily EGCG), when combined with caffeine, have been
shown to increase metabolism and fat oxidation, and to modestly boost weight loss
and reduce waist circumference (Bérubé-Parent, Pelletier, Doré, & Tremblay,
2005; Dulloo et al., 2011; Hursel et al., 2011; Phung et al., 2010). However, green-
tea extracts alone do not appear to have the same impact (Janssens, Hursel, &
Westerterp-Plantenga, 2015; Thielecke et al., 2010).
A systematic review of 13 randomized, controlled trials that assessed the
effect of caffeine on weight loss determined a dose-response of caffeine on
reductions in fat mass, weight, and body-mass index; the review
suggested caffeine’s viability in promoting weight and fat loss (Tabrizi et al.,
2018). Overall, the research shows that caffeine in moderate doses increases
energy expenditure at rest and exercise and may decrease energy intake; therefore,
it appears to serve as a safe thermogenic weight-control aid among healthy adults.
See Figure: Caffeine Sources and Content for the average amounts of caffeine
contained in various popular sources.
 FIGURECaffeine Sources and Content
One of the common misconceptions swirling around caffeine is the notion
that caffeine use at normal and recommended intake causes dehydration; coffee
lovers everywhere will rejoice that this assertion has not been proven in the
research (Goldstein et al., 2010; Maughan & Griffin, 2003). A minor diuretic effect
may occur at rest but does not negatively impact fluid balance during exercise.
The American Medical Association recommends that teenagers limit their
daily intake of caffeine to 100 milligrams/day (Torpy & Livingston, 2013).
Because the half-life of caffeine in healthy adults is 5 to 6 hours, increased sleep
latency may occur if taken late in the day.
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Since the combination of other sources of caffeine can exacerbate side
effects, the practice is not recommended. The combination can include coffee;
energy drinks; and herbal ingredients such as ma huang (ephedra), citrus aurantium
(bitter orange), or other stimulants. Side effects of stimulants associated with
green-tea extracts include nausea, stomach upset, and increased blood pressure
(Jurgens et al., 2012).
Critical!
An adult intake of caffeine up to 400 to 500 milligrams per day appears safe
in healthy individuals; adverse side effects may also occur, including an elevated
heart rate, increased blood pressure, jitteriness, nervousness, and gastrointestinal
distress, and are more likely at higher doses (> 500 milligrams) and among novel
users (European Food Safety Authority, 2015; Torpy & Livingston, 2013; U.S.
FDA, 2013). Doses over 10,000 milligrams are considered fatal.
Learners' Corner
Low to moderate doses of caffeine at 3 to 4 milligrams/kilograms of body
weight, not to exceed 400 to 500 milligrams/day, seem to have a good bodily
effect. The doses modestly increase daily energy expenditure, decrease food intake,
and may help in supporting healthy weight management.
Other Stimulant Ingredients
The stimulants p-synephrine, the active ingredient extracted from bitter
Seville oranges (citrus aurantium), and ephedrine, derived from a native Chinese
plant (ma huang), are commonly included in weight-loss supplements. Quite often
they appear in combination with caffeine or other ingredients. In 2004, the FDA
banned ephedra as an ingredient in dietary supplements due to safety concerns, but
it may still be commercially available through various websites. As p-synephrine is
structurally similar to ephedrine, it is often marketed as an ephedra-free fat-loss aid
due to its apparent stimulatory effect on the central nervous system, energy
expenditure, and mild suppression of appetite (Stohs, Preuss, & Shara, 2012).
The safety of p-synephrine has been called into question after two small
studies with 25 total participants reported increases in their heart rate and blood
pressure (Bui, Nguyen, & Ambrose, 2006; Haller, Benowitz, & Jacob, 2005). The
trial conducted by Bui et al. was a randomized, crossover study with 15 healthy
adults who either consumed one dose of bitter orange (900 milligrams standardized
to 6% synephrine) or a placebo.
Conversely, a small trial with 20 healthy subjects demonstrated that a 50-
milligram dose of p-synephrine increased resting metabolism by 65 calories, when
compared to a placebo with no adverse effects on mood, heart rate, or blood
pressure (Stohs et al., 2011). Additionally, two larger and longer double-blind,
placebo-controlled trials with healthy subjects taking 49 milligrams of p-
synephrine once or twice a day, alone or in combination with other herbs for
two months, observed no significant changes in heart rate, blood pressure, or blood
chemistry (Kaats, Miller, Preuss, & Stohs, 2013; Shara, Stohs, & Mukattash,
2016).
In one review of over 20 published and unpublished studies, with over 350
subjects taking p-synephrine in doses up to 80 milligrams/day with or without
caffeine, and in doses of 132 to 528 milligrams/day or other ingredients for up to
12 weeks, the authors concluded that p-synephrine alone or as part of a multi-
ingredient supplement increases energy expenditure and resting metabolic rate
(Stohs, Preuss, & Shara, 2012).
Jung et al. (2017) studied the effects of a multi-ingredient, caffeine-
containing (284 milligrams) pre-workout supplement, with and without 20
milligrams of p-synephrine or a placebo; this study focused on exercise
performance and resting energy expenditure in 75 healthy active adults. It found no
adverse effects on heart rate, blood pressure, kidney function, or liver enzymes
relative to baseline values. Both treatment groups experienced increases in resting
energy expenditure, greater readiness to exercise with no improvements in
muscular endurance or anaerobic sprint capacity when participants' results
were compared to the placebo group, and no additional benefits of p-synephrine.
Capsaicin
Capsaicin is one of five naturally present capsaicinoids in red chili peppers.
It is purported to be a natural weight control due to its ability to stimulate
thermogenesis, increase body temperature, and decrease food intake (Belza &
Jessen, 2005; Westerterp-Plantenga et al., 2006; Whiting, Derbyshire, & Tiwari,
2012). Janssens et al. (2013) administered 2.56 milligrams of capsaicin to 15
normal-weight and overweight individuals before meals, three times a day and
during a 25% caloric deficit, and observed a significant increase in fat oxidation
over a 36-hour period.
Others have observed acute increases in energy expenditure between 5% and
20% with capsaicin intake, while others have not observed an effect, possibly due
to varying doses, study protocol, and/or small sample sizes (Saito & Yoneshiro,
2013). Additional research is required to determine whether capsaicin
supplementation can result in elevated energy expenditure over extended periods.
Capsaicin’s potential as a viable weight-loss aid may be due to its effect on
appetite and food intake. A small study conducted by Janssens, Hursel, and
Westerterp-Plantenga (2014) analyzed the effect of capsaicin ingestion with meals
three times a day while subjects were in energy balance and during a 25% calorie
restriction. During energy balance, there were significantly greater feelings of
fullness and satisfaction with capsaicin consumption and a 30% reduction during
dinner. During caloric restriction, participants reported a marked decrease in the
desire to eat after dinner compared to a control group, potentially mitigating the
negative impact of weight loss on appetite.
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A systematic review of eight randomized controlled trials on the impact of
capsaicin ingestion on food intake in normal-weight and overweight adults found
that a minimum dose of 2 milligrams consumed prior to meals significantly
reduced intake by 74 calories when compared to a placebo (Whiting, Derbyshire,
& Tiwari, 2014). A 12-week randomized, placebo-controlled trial with overweight
individuals, who supplemented with 4 daily milligrams of capsaicinoids, resulted
in significantly lower reported intake (257 calories/day), while those who
consumed a lower daily dose (2 milligrams) experienced an improved waist-to-hip
ratio compared to the placebo group. However, the 4 milligrams/day dose resulted
in gastrointestinal distress in 23% of the subjects, though no significant
improvements in body weight were observed (Urbina et al., 2017).
A review of 20 studies involving 563 participants on the potential for
capsaicin and capsaisinoids to influence body weight concluded that regular
consumption significantly reduces appetite and energy intake. Also, it raises daily
energy expenditure by 50 calories, and significantly decreases abdominal fat,
potentially leading to meaningful weight loss after one to two years of use
(Whiting, Derbyshire, & Tiwari, 2012). As with most weight-loss efforts, time is an
important and often under-appreciated factor.
Learners' Corner
Capsaicin may have a slight positive impact on energy expenditure, appetite,
and food intake when consumed in 2-milligram to 4-milligram doses before meals.
Pre-meal capsaicin ingestion appears to have a modest impact on both sides
of the energy-balance equation, potentially serving as a useful aid in managing
appetite and slightly increasing daily expenditure. Capsaicin is considered safe
when used in the amounts studied, though with 4 milligrams/day resulting in
reports of gastrointestinal distress, elevated insulin levels, and lower HDL
cholesterol levels among some study participants.
Starch/Fat Blockers and Other Common Weight Loss Ingredients
Various ingredients have been investigated for their potential to decrease
absorption of macronutrients (and their respective calorie content) to promote
weight loss; they are routinely included in supplements as fat blockers or
carbohydrate/starch neutralizers. Phaseolus vulgaris, extracted from white kidney
beans, inhibits the action of the digestive enzyme amylase, thus interfering with the
digestion of and absorption of carbohydrates and potentially preventing absorption
(Obiro, Zhang, & Jiang, 2008).
Daily dosages of Phaseolus vulgaris ranging from 500 to 3,000 milligrams,
for up to 12 weeks, have been shown to modestly enhance weight loss, albeit
inconsistently. In a randomized, double-blinded, placebo-controlled trial with 60
overweight subjects, those who consumed a proprietary form (Phase 2) before a
high-carbohydrate meal lost significantly more weight (6.4 pounds) compared to
subjects receiving the placebo (0.77 pounds) after 30 days (Celleno, Tolaini,
D’Amore, Perricone, & Preuss, 2007).
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Another randomized placebo-controlled study examined the effect of
Phaseolus vulgaris in conjunction with a reduced-calorie diet on body weight (Wu,
Xu, Shen, Perricone, & Preuss, 2010). After 12 weeks, the supplement group lost
an average of 6.4 pounds, while the placebo group lost an average of two pounds.
Conflicting results were also reported in a clinical trial with 39 obese adults;
they did not experience additional weight loss from consuming 1,500 milligrams of
Phase 2, twice daily and before meals for 8 weeks, while following a low-fat, fiber-
rich diet (Udani, Hardy, & Madsen, 2004).
A larger placebo-controlled trial with 123 overweight and obese individuals,
who were following a calorie-restricted diet, demonstrated that consuming 1,000
milligrams of Phaseolus vulgaris before meals, three times a day for 3 months,
resulted in significantly more weight and fat loss at 4.4 pounds, than the group who
consumed a placebo and lost 3.5 pounds (Grube, Chong, Chong, & Riede, 2014).
Based on the small number of trials thus far, Phaseolus vulgaris consumed prior to
meals may slightly enhance weight loss over a period of four to 12 weeks, with a
potential for minor side effects such as gastrointestinal upset.
Chitosan is another blocker supplement manufactured from shellfish. It is
marketed as a fat blocker, due to its ability to prevent absorption of dietary fat by
getting bound to it in the intestinal tract (Rios-Hoya & Gutierrez-Salmean, 2016).
One review of 15 trials and 1,219 participants concluded that chitosan results in
significantly greater weight loss of 3.7 pounds over 6 months, but many of the
trials have been of poor quality (Jull et al., 2008).
A 2018 meta-analysis of 14 randomized, controlled trials revealed that using
chitosan (0.34 to 3.4 grams/day) for 4 to 52 weeks, when compared to a placebo,
slightly reduces body weight (weighted mean difference of 1.01 kilogram) in
overweight and obese subjects (Moraru, Mincea, Frandes, Timar, & Ostafe, 2018).
Other commonly used ingredients in weight-loss supplements include conjugated
linoleic acid (CLA), L-carnitine, chromium, green coffee bean extract, and
hydroxycitric acid or HCA (garcinia cambogia), all of which are either lacking in
well-designed research or have shown virtually no impact on body weight
(Manore, 2012).
Meal-Replacement Formulas
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The use of protein-rich shake formulas has been shown to be an effective
strategy for reducing caloric intake and supporting weight loss and weight-loss
maintenance (Heymsfield, 2010). A review of six randomized, controlled
interventions showed the effect of reduced isocaloric diets, using one to two liquid
meal replacements or regular foods for at least 12 weeks; the review revealed that
overweight or obese adults lost significantly more weight after three months and
one year, without any reports of adverse events and better adherence in the partial-
meal replacement group (Heymsfield et al., 2003). Other work has demonstrated
the use of meal replacements for up to a year; they have increased total protein
intake and enhanced weight loss and fat mass while preserving fat-free mass in
obese subjects with metabolic syndrome (Chaiyasoot et al., 2018; Fletchner-Mors
et al., 2010).
In a randomized trial with young, overweight men in a 40% calorie deficit
combined with enhanced training (resistance, high-intensity interval, or sprint
interval) over six days a week, subjects consumed either a low-protein diet (1.2
gram/kilogram) or high-protein diet (2.4 grams/kilograms) using whey protein
beverages for four days (Longland, Oikawa, Mitchell, Devries, & Phillips,
2016). The high-protein group lost more body fat and gained significantly more
lean body mass compared to the lower-protein group, which maintained lean body
mass. This data and other studies demonstrate the value of higher protein intakes
and protein-rich shakes for promoting favorable changes in body composition
during weight loss.
Meal replacements appear to offer multiple benefits, including portion
control and the ability to induce a calorie deficit; it's a method for increasing
protein intake to aid in satiety along with providing structure, and convenience to
weight-loss plans. The Academy of Nutrition and Dietetics identifies the use of
meal replacements as an evidence-based strategy for weight loss and maintenance
in overweight and obese adults (Raynor & Champagne, 2016). Additionally, meal
replacements offer an opportunity to increase the diet quality of clients by adding
in nutrient-rich foods such as fruits, vegetables, and calcium- and vitamin D-rich
beverages.
Learners' Corner
Supplements promoted as fat burners have a limited impact on weight
loss; most ingredients lack quality evidence. However, using protein-rich meal
replacements one to two times per day has been shown to improve weight-loss
success, body composition, and maintenance of a healthy body weight.
Performance-Enhancing Supplements
Dietary supplements aimed at enhancing athletic or exercise performance
will typically target mechanisms that are involved with inducing fatigue in the
various energy systems. Both the phosphocreatine and glycolytic systems are
primary during high-intensity exercises of short duration, or with repeated bouts of
high-intensity effort over a prolonged period (i.e., team sports). The aerobic energy
system dominates endurance activities. Delaying or reducing fatigue in these
three systems can prolong maximal effort and increase time to exhaustion, leading
to improved measures of performance.
The ability of supplements to increase tolerance to intense training could
lead to greater work capacity and improve strength, power, and endurance. As
performance-enhancing products are considered to be ergogenic aids, they are
available as liquids, powders, bars, tablets, and more. Solid evidence supports the
use of a handful of ingredients, including creatine monohydrate, caffeine, beta
alanine, and sodium bicarbonate. The various mechanisms, evidence, and
applications for their use will be discussed.
Many others have limited, weak, or no evidence to support use at this time.
These lesser contenders are listed in Table: Performance Supplements Strength
of Research, which is based on several extensive reviews on dietary supplements
and athletic performance. These reviews include the "IOC Consensus Statement:
Dietary Supplements and High-Performance Athlete" (Maughan et al, 2018), the
scholarly review “Evidence-Based Supplements for the Enhancement of Athletic
Performance” published by the International Journal of Sport Nutrition and
Exercise Metabolism (Peeling, Binnie, Goods, Sim, & Burke, 2018), the
International Society of Sports Nutrition’s "Exercise & Sports Nutrition Review
Updates: Research & Recommendations" (Kerksick et al., 2018), and "The
Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the
American College of Sports Medicine: Nutrition and Athletic Performance"
(Thomas, Erdman, & Burke, 2016).
In addition to understanding the efficacy and safety of dietary supplements,
it would be wise for athletes and dedicated nutrition researchers to thoroughly
review the rules regarding dietary supplements and banned substances set forth by
their sport’s governing body. Definitely before engaging in consistent use, it would
be sensible to ensure products under consideration are independently tested
for banned or harmful substances. If it's sensible to restrain children from eating
things that look good but aren't good for them, it would make sense to do the same
as adults, who have a much greater store of accumulated experience and
knowledge.
Performance Supplements Strength of Research
Moderate/Mixed Weak Banned
BCAAs Arginine Androstenedione
Carbohydrate/ Carnitine Dimethylamylamine
Protein Shakes Deer (DMAA)
Citrulline Antler Velvet 1,3-
Essential Amino Glutamin dimethybutylamine
Acids e (DMBA)
Glycerol MCTs
HMB Ribose
Nitrate
Quercetin
Taurine
Creatine Monohydrate
Creatine monohydrate, as previously described, is supported by hundreds of
studies. These not only demonstrate its ability to increase strength and muscle gain,
but also its performance-enhancing effects for any activity during which the
phosphocreatine system is heavily taxed. Hence, creatine would potentially benefit
participants in sports that require repeated short bursts of high-intensity activity,
such as soccer, basketball, rowing, rugby, as well as some individual sports, such
as tennis and sprinting (Kreider et al., 2017; Maughan et al., 2108; Peeling et al.,
2018).
In 2003, Kreider’s earlier review in Molecular and Cellular
Biochemistry revealed that 70% of the 300 studies on the performance effects of
creatine supplementation reported significant improvements; none of the studies
reported significant negative impacts on performance. Ergogenic findings included
5% to 15% improvement in maximal power/strength as well as repetitive sprint
performance, but only minimal (1% to 5%) improvement in single-effort sprints.
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For example, young, trained males were randomized to consume 20 grams
of creatine monohydrate for five days or a placebo. The creatine group experienced
significant improvements in six 60-meter sprints and 100-meter sprints (Skare,
Skadberg, & Wisnes, 2001). Among highly trained junior swimmers whose
average age was 16 years, five days of creatine use at 20 grams/day led to
significantly reduced times in two maximal 100-meter races when compared to the
use of a placebo (Juhasz, Györe, Csende, Rácz, & Tihanyi, 2009).
Two more recent systematic reviews on randomized, placebo-controlled
trials had similar findings on strength performance. For exercises lasting less than
three minutes with more pronounced effects in activities less than 30 seconds,
creatine supplementation enhanced lower-body strength performance in over 60
studies with over 1,200 participants, and it also enhanced upper-body strength
performance in over 53 studies and 1,100 participants (Lanhers et al., 2015;
Lanhers et al., 2017). Performance improvements in endurance exercise are not as
well-supported; however, creatine may help enhance glycogen synthesis and aid in
thermoregulation due to its ability to draw fluid into muscle (Cooper, Naclerio,
Allgrove, & Jimenez. 2012; Kreider et al., 2017).
The ability to train more intensely and with greater workloads over time
enables users to improve muscular power, strength, and lean mass; this has been
demonstrated in males and females across a wide range of age groups, including
adolescents and older adults (Kreider et al., 2017). Nine weeks of creatine
supplementation and resistance training in elite football players resulted in
significant differences in strength, anaerobic power and capacity, lean body mass,
and body weight compared to the placebo and control groups (Bemben,
Bemben, Loftiss, & Knehans, 2001).
A large body of work on the safety of creatine supplementation indicates that
it does not result in muscle cramps, heat illness, dehydration, or any other adverse
health effect; the daily dosages under examination have ranged from 0.3 to 0.8
gram/kilogram of body weight, for individuals of various ages who have engaged
in use for up to five years (Schilling et al., 2001; Kreider et al., 2017). An
extensive discussion on the safety of creatine and clinical applications such as
neurodegenerative diseases, ischemic heart disease, and Type 2 diabetes is
presented in the International Society of Sports Nutrition’s position stand (Kreider
et al., 2017).
Learners' Corner
 Short-term use of creatine monohydrate at 20 grams/day, divided
into dosages of 5 grams taken four times a day for five to seven days, can enhance
anaerobic exercise capacity and performance. With a daily maintenance dose of 3
to 5 grams, continued use may improve strength, power, and performance due to
greater training adaptations.
Caffeine
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Caffeine is often included in preworkout-type supplements in the purified,
anhydrous form. In addition to caffeine’s stimulatory effect on the nervous system,
it also blocks adenosine receptors, thus resulting in mental alertness and other
cognitive benefits. Caffeine ingestion prior to intense exercise reduces rates of
perceived exertion, lowers pain, raises endorphin release, and improves fatigue
resistance (Maughan et al., 2018). A well-studied additive, it has demonstrated its
capacity as an effective ergogenic aid in short-term single and repeated bouts of
maximal strength and power, intermittent team sports, and endurance exercise
(Goldstein et al., 2010; Grgic, Mikulic, Schoenfeld, Bishop, & Pedisic, 2018).
Among trained cyclists, with low (100 milligrams/1.5 grams/kilograms) and
moderate (200 milligrams/2.9 milligrams/kilograms) dosages consumed during
exercise, timed trials were completed significantly faster compared to a trial with a
placebo; the moderate dose rendered better improvements than the low dose
(Talanian & Spriet, 2016). A systematic review, including 21 studies on endurance
time trials ranging from 5 to 150 minutes across a variety of sports, found that 3 to
6 milligrams/kilograms of caffeine consumed before or during exercise improved
performance by 3.2% on average with a range between 0.3 to 17.3%.
This range implies high variability in individual responses to caffeine and/or
varying methods utilized across studies (Ganio, Klau, Casa, Armstrong, & Maresh,
2009). However, as every athlete knows, even incremental improvements can
make quite a difference in completing a finish time or beating a personal best.
Among athletes who participate in team sports that require repeated sprints
over a prolonged period, 6 milligrams/kilograms of caffeine consumed an hour
before exercise trials resulted in noteworthy improvements (8.5% greater work
performed and 7% higher peak power) when compared to a placebo (Schneiker,
Bishop, Dawson, & Hackett, 2006). These findings were later replicated with
semiprofessional rugby players, who consumed 300 milligrams of caffeine or a
placebo prior to the trials (Wellington, Leveritt, & Kelly, 2017).
A review on the impact of caffeine supplementation on resistance exercise
concluded that 3 to 9 milligrams/kilograms, when ingested 60 minutes prior to the
activity, improves maximal strength, power, muscular endurance, and ratings of
perceived exertion. There were equivocal findings for pain perception, and most of
the research was conducted among males utilizing caffeine anhydrous in pill or
powdered form (Grgic et al., 2018).
The overall body of evidence points to dosages of 3 to 6
milligrams/kilograms of body weight, which was consumed approximately an hour
before resistance training or exercise with short, high-effort bursts. Participants
have also found success in using lower doses during endurance activities; the
effectiveness of use diminishes over time according to some, but not others (Ganio
et al., 2009; Goldstein et al., 2018). Intakes above 9 milligrams/kilograms of body
weight offer no additional benefits, are likely to increase the risk of side effects,
and may lead to a positive doping test by the International Olympic Committee
(IOC) or National Collegiate Athletic Association (Burke, 2008).
Caffeine appears to promote urine flow, but there is no evidence that it
disrupts fluid balance or causes dehydration at the recommended doses (Goldstein
et al., 2010). As noted, daily intakes of over 400 to 500 milligrams may cause side
effects, including irritability, nausea, insomnia, and restlessness. Caffeine is
contraindicated among those with heart disease, hypertension, thyroid disease, and
anxiety; it is not recommended during pregnancy and lactation. Individuals who
are taking medication should consult with their physician for possible interactions.
Learners' Corner
This is caffeine in a snapshot view. Particularly in anhydrous form, caffeine
has been established as an ergogenic aid for strength, power, intermittent high-
intensity, and endurance activities. The doses of 3 to 6 milligrams/kilograms of
body weight should be consumed an hour before exercise, or lower doses of 1.5 to
3 milligrams/kilograms can be taken during endurance exercise.
Beta Alanine
Beta alanine is a nonessential amino acid naturally present in animal meats
and produced in the liver. It combines with the amino acid histidine to form
carnosine. As a compound in skeletal muscle, it reduces fatigue during high-
intensity exercise by buffering the drop in pH, due to the work of hydrogen ions
that are produced when glycogen is broken down to lactic acid. Increasing
carnosine levels in skeletal muscle via beta alanine supplementation would benefit
users in any activity that relies on glycolysis for energy: weight lifting, football,
soccer, rowing, etc. Over a period of 4 to 10 weeks, daily intake of 4 to 6
grams has been shown to significantly elevate muscular carnosine levels among
trained athletes and untrained individuals with wide variation in the degree of
increase (Baguet et al., 2009; Harris et al., 2006; Trexler et al., 2015).
Performance improvements result from a reduced level of fatigue during
short-to-moderate intense activity levels (1 to 4 minutes). The IOC’s
recommendation is based on a certain weight (about 65 milligrams/kilograms) to
be ingested in doses of 0.8 to 1.7 grams, taken every 3 to 4 hours for 10 to 12
weeks; the potential for meaningful performance benefits was noted for continuous
or intermittent activity lasting between 30 seconds to 10 minutes (Maughan et al.,
2018).
Theoretically, supplementation would allow for increased resistance exercise
workloads, leading to greater adaptations such as strength, power, and lean mass
gain; this theory has yet to be established. Although beta alanine appears to be safe
in the recommended dosages noted for healthy individuals, reported negative side
effects include skin tingling and rashes, which appear to be harmless and
minimized when doses are divided (Trexler et al., 2015).
Learners' Corner
 This is beta alanine in a nutshell. For healthy individuals who perform
primarily high-intensity exercise lasting 30 seconds to 10 minutes, beta alanine
supplementation may offer a performance benefit. Typical use includes a loading
phase of two to four weeks, ingesting 4 to 6 grams daily in divided doses. Skin
tingling, a phenomenon known as paresthesia, is a reported side effect. It may be
minimized by taking daily doses in two to three smaller servings throughout the
day, and may diminish with continued use.
Sodium Bicarbonate
Sodium bicarbonate, commonly known as baking soda, aids in buffering the
acidity in the blood due to the production of hydrogen ions during sustained
strenuous exercise. This can potentially reduce fatigue and enhance performance
during short-term and intermittent strenuous exercise such as sprinting, tennis, and
boxing. Several short-term trials have established a modest enhancement of
athletic performance (McNaughton, Gough, Deb, Bentley, & Sparks, 2016). A
meta-analysis of 38 studies revealed a 1.7% improvement in a one-minute
sprint and a 2.7% improvement in repeated sprint performance, when participants
used a sodium bicarbonate dose of 0.3 gram/kilogram (Carr, Hopkinds, & Gore,
2011).
The overall body of evidence indicates pre-exercise dosages ranging from
0.2 to 0.4 gram/kilogram of body weight. This equates to 3 to 5 teaspoons of
baking soda taken approximately 60 to 150 minutes before the activity, which
improves short-term, high-intensity exercise performance by approximately
2% with benefits diminishing beyond 10 minutes (Siegler, Marshall, Bray, &
Towlson, 2012; Maughan et al., 2018). Short-term use appears safe, but the
unpleasant taste and resulting stomach upset are widely reported. Potentially, these
effects can be eliminated with split doses or the consumption of small amounts of
carbohydrate (Carr, Hopkins, & Gore, 2011). Therefore, trial experimentation
during practice sessions is recommended to assess tolerance.
Learners' Corner
You may know it as a common cleaning agent, but sodium bicarbonate can
also act as a buffering agent during high-intensity training between 60 seconds and
10 minutes. Typical use includes single doses of 0.2 to 0.4 gram/kilogram body
weight taken 60 to 150 minutes before exercise, or the user can split doses over a
period of three hours. GI upset is reported with use, and may be alleviated with
split doses and/or ingestion with some form of carbohydrate.
Summary
Although numerous products and ingredients are touted as amazing aids
in weight loss and the enhancement of muscle gain, few of these assertions are
supported with a solid body of quality evidence. Those products and
ingredients that have been thoroughly studied may modestly support weight-
management goals. Many can help exercisers and athletes to improve the quality of
their training sessions, leading to enhanced exercise-induced outcomes such as
greater strength, power, or muscle mass and the reduction of body fat. Of course,
this assistance is predicated on the establishment of a solid nutritional foundation,
including appropriate daily energy needs.
 Some ingredients such as creatine monohydrate, caffeine, beta alanine, and
sodium bicarbonate may boost measures of athletic performance. Athletes
interested in adding dietary supplements to improve performance are advised to
experiment during practice sessions; this reduced-risk method can help
them determine an appropriate protocol and mitigate side effects during
competitive events.
Data suggests that certain vitamins and minerals are widely under-consumed
in the United States and exacerbated with weight-loss diets, putting many
individuals at risk for adverse health effects. While supplements cannot replace a
healthful eating pattern, the use of appropriate multivitamins and other essential
nutrients has been shown to shore up inadequate dietary intakes.
Widespread and misunderstood use of dietary supplements, particularly
among athletes and exercisers, when coupled with loosely regulated industry
practices, warrants due diligence among nutrition enthusiasts. This is true whether
you're recommending products for supporting body composition or assisting others
in athletic-performance goals. Efficacy, safety, legality, and proper manufacturing
and independent testing should be evaluated before any recommended use.
Taking an evidence-based approach to dietary supplements is a valuable way
for you and your circle of influence to make wise buying decisions, while also
strongly pursuing your health, fitness, and athletic goals. It can be helpful to add to
your dietary or fitness regimen, provided that you know what you're adding, when
to add it, what dose to take, and when to ease off its use. The difference between
just enough and too much can be minimal, but it can have big consequences. Also,
don't be afraid to enlist the expertise of a medical professional for targeted advice.
In this course, you learned about:
 Supplement regulation and labeling requirements.
 Supplement strength of research and third-party testing.
 Protein supplementation considerations and protocols.
 Creatine supplementation considerations and protocols.
 Caffeine supplementation considerations and protocols.
 The role of dietary supplements for athletic performance.
 The role of dietary supplements for muscle gain.
 The role of dietary supplements for fat loss and body composition.
Supplements References
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