Adulterated dietary supplements threaten the health and sporting career of up‐and‐coming young athletes

High School Athletes' Use and Knowledge of (Safe) Nutritional Supplement Use: An Exploratory Study

The use of nutritional supplements can lead to doping risk and no data exist on high school athletes' use of certified third-party tested supplements. A cross-sectional cohort design was developed using an anonymous survey. Descriptive data for supplement use, use of third-party tested supplements, and knowledge in high school athletes were reported. A total of 225 high school athletes, ranging from 14-19 years of age, from a private high school in the western US, were included in the analysis of the results. A total of 94% (n=211) of athletes reported nutritional supplement use within the past year with an average of six (interquartile range: 3-9) individual supplements, ranging from 0-20 supplements per person. Most frequently reported were sports drinks (72%), vitamins (65%), sports bars (60%), protein powder (58%), caffeine (37%, as part of normal beverages, or 13% as a supplement), followed by creatine (23%). A total of 24% claimed to know for sure that all their supplements were third-party tested. In addition, the recognition of third-party testing organization icons was low (46% in supplement users vs. 14% in nonusers). Athletes also scored low in reporting how to find (22%) and how to order (25%) third-party tested supplements. In conclusion, almost all athletes in this study reported the use of multiple nutritional supplements annually. Only one-fourth of the athletes reported consistently using third-party tested supplements. Knowledge of where and how tested supplements could be purchased was limited in this high school athlete population.

Mass spectrometry in sports drug testing-Analytical approaches and the athletes' exposome

Test methods in anti-doping, most of which rely on the most modern mass spectrometric instrumentation, undergo continuous optimization in order to accommodate growing demands as to comprehensiveness, sensitivity, retrospectivity, cost-effectiveness, turnaround times, etc. While developing and improving analytical approaches is vital for appropriate sports drug testing programs, the combination of today's excellent analytical potential and the inevitable exposure of humans to complex environmental factors, specifically chemicals and drugs at the lowest levels, has necessitated dedicated research, particularly into the elite athlete's exposome. Being subjected to routine doping controls, athletes frequently undergo blood and/or urine tests for a plethora of drugs, chemicals, corresponding metabolic products, and various biomarkers. Due to the applicable anti-doping regulations, the presence of prohibited substances in an athlete's organism can constitute an anti-doping rule violation with severe consequences for the individual's career (in contrast to the general population), and frequently the question of whether the analytical data can assist in differentiating scenarios of 'doping' from 'contamination through inadvertent exposure' is raised. Hence, investigations into the athlete's exposome and how to distinguish between deliberate drug use and potential exposure scenarios have become a central topic of anti-doping research, aiming at supporting and consolidating the balance between essential analytical performance characteristics of doping control test methods and the mandate of protecting the clean athlete by exploiting new strategies in sampling and analyzing specimens for sports drug-testing purposes.

Prevalence of adulteration in dietary supplements and recommendations for safe supplement practices in sport

The prevalence of dietary supplement use among athletes continues to rise with 60-80% of athletes often reporting current or previous use of dietary supplements. While select dietary ingredients have been shown to improve acute performance and enhance training adaptations over time, it is important to still consider the risk vs. reward for athletes before opting to consume a dietary supplement. Previous work has indicated that certain dietary supplements may pose risks for inadvertent doping, may be susceptible to mislabelling, could be banned by certain governing bodies of sport, or pose health risks for certain populations. The purpose of the current narrative review is to summarize the prevalence of adulteration in dietary sport supplement products, outline the risks of inadvertent doping for athletes, and highlight best practices regarding safe supplementation strategies. Analytical studies have found anywhere from 14 to 50% of samples analyzed from dietary supplement products have tested positive for anabolic agents or other prohibited substances. It is important for the consumer to adhere to safe supplementation strategies, which include following serving size recommendations, cross-referencing ingredient profiles with the list of prohibited substances, choosing quality products that have been verified by a third-party certification program, and being cognizant of consuming multiple dietary supplement products with overlapping ingredient profiles. Once these practices have been considered, it is reasonable for an athlete to utilize dietary supplements as a strategy to optimize performance and health, with a low risk of failing a drug test (adverse analytical finding) and experiencing adverse events.

Are dietary supplement users more likely to dope than non-users?: A systematic review and meta-analysis

In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help international and national sport organisations understand the degree to which dietary supplement use is related to doping, the objectives of this systematic review and meta-analysis were to 1) compare the prevalence of doping between dietary supplement users and non-users and 2) identify whether supplement use is related to doping social cognitive factors. We searched for studies sampling athletes and that measured both dietary supplement use and doping in EMBASE, MEDLINE, PsychINFO, CINAHL and SPORTDiscus from database creation to May 2022. Risk of bias was assessed using JBI Critical Appraisal Checklist for cross-sectional studies and the STROBE checklist. Twenty-six cross-sectional studies, involving 13,296 athletes were included. Random-effect models revealed that doping was 2.74 (95% CI=2.10 to 3.57) times more prevalent in dietary supplement users (pooled prevalence = 14.7%) than non-users (6.7%), and that users reported stronger doping intentions (r=0.26, 0.18 to 0.34) and attitudes (r=0.21, 0.13 to 0.28) compared to non-users. Preliminary evidence also suggests that dietary supplement users were less likely to dope if they were more task oriented and had a stronger sense of morality. Results of the review are limited by the cross-sectional design used in all studies and lack of consistency in measurement of dietary supplement use and doping. Data indicate that athletes using dietary supplements are more likely to self-report doping Anti-doping policy should, therefore, target dietary supplement use in anti-doping education programmes by providing alternative strategies for performance enhancement or highlighting the safest ways they can be consumed. Similarly, as a large proportion of athletes use dietary supplements without doping, further research is needed to understand the factors that protect a dietary supplement user from doping. No funding was received for the review. A study protocol can be found here: https://osf.io/xvcaq.

Trends in dietary supplement use among athletes selected for doping controls

Background

Dietary supplements (DS) may be beneficial for athletes in certain situations, whereas incorrect or excessive use may impair performance, pose a risk to the athlete's health and cause positive doping tests by containing prohibited substances. To provide athletes with relevant and tailored information on safe supplement use, a better knowledge about DS trends over time and between sport disciplines are needed.

Methods

This study examines the use of DS among athletes who have participated in doping controls by extracting information derived from 10,418 doping control forms (DCF) collected by Anti-Doping Norway from 2015 to 2019.

Results

Overall, 51% of the DCFs contained information about at least one DS. National level athletes (NLA) more often reported using DS than recreational athletes (RA) (53 vs. 47%, p < 0.001). Athletes in strength and power (71%), VO2max endurance (56%) and muscular endurance sports (55%) had the highest proportion of DCFs with information about DS. Medical supplements were the most used supplement category for both genders and across all sports. Dietary supplements with a high risk of containing doping substances were most common among male, RA in strength and power sports. There were small and non-significant year-to-year variations in the prevalence of athletes using DS, while the number of products used concomitantly peaked in 2017 before declining in 2019 (2.30 vs. 2.08, p < 0.01). The use of medical supplements and ergogenic substances increased slightly for both NLA and RA from 2015 to 2019, while the use of all other supplement categories declined.

Conclusion

Half of the 10,418 DCFs contained information about DS, with variations within the athlete population. DS with high risk of containing prohibited substances were mostly seen in sport disciplines requiring a high degree of specialization in strength/power, including powerlifting and weightlifting, as well as in some team sports, such as cheerleading and american football.

Dietary Supplements: A Gateway to Doping?

Dietary supplements are widely used among athletes, but many may be unaware of the potential for unintentional doping, especially considering that supplements can often be contaminated with prohibited substances. The reason behind the widespread use of dietary supplements among athletes is often cited as being for the purposes of enhancing health or performance. However, many athletes turn to unreliable sources of information, and often lack knowledge of dietary supplement regulations. The aim of this narrative review is to explore the current research surrounding the psychological constructs (such as norms, attitudes, and beliefs) related to dietary supplement use among athletes that may lead to inadvertent doping. This review also covers possible programme structures that may be effective at preventing inadvertent doping.

Analysis and Screening of Commercialized Protein Supplements for Sports Practice

Recent years have seen a rise in the popularity of the consumption of sports-related supplements. However, the hypothesis is raised that it is necessary to analyze the quality aspects of these supplements in relation to the information provided on the label, to avoid associated risks and obtain the greatest possible benefit from their consumption. Therefore, the aim of this study has been to carry out an analysis or screening of the protein supplements that are currently marketed in Spain. We analyzed the labels of 52 protein sports supplements available both in physical stores and online. The analysis consisted of addressing three relevant aspects considering the labeling: (a) the legislative framework in which the supplements are marketed, (b) the quality of the protein, and (c) the presence of other ingredients according to the specifications of the label. In the legislative context, there do not seem to be any specific regulations to guarantee consumer protection, which can lead to unfair practices and misleading advertising. Most of the supplements analyzed to comply with the requirements of their current regulations. However, claims about their benefits that are not allowed under European legislation have been found in some of them. Regarding composition and according to label information, the supplements have been found to provide a sufficient dose of protein in terms of recommended protein intake per serving. Regarding the presence of other ingredients and according to the information on the label, most of them, except for egg supplements, contain other ingredients. Colostrum was also found in one of the supplements evaluated. The conclusions of the study reveal that, due to a lack of knowledge or misleading advertising practices, supplements are often not used properly. The information provided is essential for both professionals and consumers to avoid the risks associated with consumption, such as unintentional doping, interactions between ingredients that reduce the quality of the supplement, and consumption of supplements inappropriately, among others.

Sports Supplements User Profile Based on Demographic, Sports, and Psychological Variables: A Cross-Sectional Study

Despite the high prevalence of sports supplement (SS) use, efforts to profile users have not been conclusive. Studies report that 30–95% of recreational exercisers and elite athletes use SS. Research found has mostly focused on demographic and sports variables to profile SS users, but little research has studied the psychological factors that may influence the use of SS. The purpose of this investigation was to classify, describe, and differentiate the profile of users and non-users of SS, considering demographic, sports, and psychological variables. A total of 554 participants completed the questionnaire. Overall, 45% of recreational exercisers and elite athletes reported using supplements. There were significant differences found regarding the use of SS between men and women (51% vs. 49%, p = 0.002; OR = 1.799), and when training 4 or more days per week (p ≤ 0.001; OR = 1.526). Findings regarding the psychological variables have been found in the Adonis Complex. These results indicate that participants with greater concerns regarding physical appearance, tend to be SS users (p = 0.001; OR = 1.200). The results of this study fill a gap in previous research, and provide an approximate profile, including demographic, sports, and psychological variables of SS users.

Dietary Supplements Use among Athletes in Lebanon: Knowledge, Attitudes, Practices, and Correlates

Athletes are under the utmost pressure to reach excellence in their performance and achieve the desired outcomes in competitions, prompting them to use dietary supplements. Given the threats to both health and eligibility, it is crucial to observe the prevalence, sources of information, knowledge, attitudes, and practices (KAPs) among Lebanese athletes practicing their sports for at least two years. In the present paper, a cross-sectional study is performed using the snowball sampling method, in which a self-administered KAP questionnaire is used to collect data from 455 athletes (mean age: 27.4 ± 7.9 years; men: 73.1%) participating in four sports categories (ball games, combat sports, endurance sports, and weightlifting). Among the Lebanese athletes, the prevalence of dietary supplement (DS) use was 74%, where half of them had predominately used sports supplements. Athletes in Lebanon heavily rely on coaches (74%) and online sources, including webpages and social media (64%), as key information sources for DSs. The findings suggest that significant proportions of athletes show knowledge deficits and unsatisfactory attitudes towards multiple aspects related to supplementation. Moreover, education and sports type modulate the use of DSs among athletes. Furthermore, 34% reported using supplements without a recommendation from specialists, and 69% admitted to not reading the supplement's nutrition facts. This study urges the need for the regulation of concerned authorities and education programs to help overcome the existing challenges.

Dietary Supplements as a Major Cause of Anti-doping Rule Violations

Dietary supplements encompass a large heterogenic group of products with a wide range of ingredients and declared effects used by athletes for a multitude of reasons. The high prevalence of use across all sports and level of competition, combined with the well-documented risks of such products containing prohibited substances have led to several doping cases globally. Despite being a considerable concern and persistent focus of sport organizations and anti-doping agencies, the magnitude of anti-doping rule violations associated with supplement use is not well-known. This study examines 18-years of doping controls of a national anti-doping program to determine the relationship between the presence of prohibited substances in athlete's doping samples and the use of dietary supplements. In 26% (n = 49) of all the analytical anti-doping rule violation cases in the period 2003–2020 (n = 192), the athlete claimed that a dietary supplement was the source of the prohibited substance causing an adverse analytical finding. Evidence supporting this claim was found in about half of these cases (n = 27, i.e., 14% of all analytical ADRV's). Stimulants were the most prevalent substance group linked to supplements (n = 24), of which methylhexanamine was associated with 16 cases. High risk products were predominantly multi-ingredient pre-workout supplements (n = 20) and fat-burning products (n = 4). Anti-doping organizations should develop strategies on how to assist athletes to assess the need, assess the risk and assess the consequences of using various dietary supplements.

Muscle-building behaviors from adolescence to emerging adulthood: a prospective cohort study

•

Muscle-building behaviors in adolescence to emerging adulthood were studied.

•

Starting muscle-building behaviors is common from adolescence to emerging adulthood.

•

Prevalence of any protein powder/shakes use was 55.1% in males and 33.0% in females.

•

Prevalence of any steroids use was 6.7% in males and 5.4% in females.

•

Protein powder consumption was associated with future use of steroids.

This study aimed to identify patterns of change in muscle-building behaviors from adolescence to emerging adulthood and determine what adolescent factors predict new-onset muscle-building behavior in emerging adulthood. Prospective cohort data from a diverse sample of 1,535 participants followed from adolescence (baseline, M_age = 14.4 ± 2.0 years) to emerging adulthood (follow-up, M_age = 22.1 ± 2.0 years) from the population-based EAT 2010–2018 (Eating and Activity over Time) study were analyzed. Changes in muscle-building behavior were identified (starting, stopping, persistent use, or never use). Log-binomial regression models examined adolescent predictors of starting (i.e., new-onset) muscle-building behaviors in emerging adulthood. Prevalence of any use in adolescence (EAT 2010) and/or emerging adulthood (EAT 2018) was 55.1% (males) and 33.0% (females) for protein powder/shakes, 6.7% (males) and 5.4% (females) for steroids, and 19.4% (males) and 6.5% (females) for other muscle-building substances (e.g., creatine, amino acids). In particular, 22.6% (males) and 13.7% (females) started protein powder/shakes, 2.2% (males) and 1.0% (females) started steroid use, and 9.0% (males) and 2.0% (females) started other muscle-building substances during emerging adulthood. Adolescent protein powder/shake consumption was associated with starting steroids/other muscle-building substances use in emerging adulthood in males (adjusted risk ratio [ARR] 2.09, 95% confidence interval [CI] 1.29–3.39) and females (ARR 4.81, 95% CI 2.01–11.48). Adolescent use of protein powders/shakes may lead to a two- to five-fold higher risk of new use of steroids and other muscle-building products in emerging adulthood. Clinicians, parents, and coaches should assess for use of muscle-building behaviors in adolescents and emerging adults and discourage use of harmful products.

Prioritized Dietary Supplement Information Needs of 307 NCAA Division I Student Athletes

OBJECTIVE

To evaluate dietary supplement information needs among collegiate athletes.

METHODS

Three hundred seven (n = 154 male; n = 153 female) student athletes participating in a National Collegiate Athletic Association Division I team completed a dietary supplement survey. Qualitative coding addressed open-ended responses, and chi-square test of independence explored differences among athlete subgroups.

RESULTS

Five themes representing athletes' information needs included quality/composition (53.5%; n = 77), general information (31.9%; n = 46), nutrition information (30.6%; n = 44), performance (18.8%; n = 27), and body composition (13.2%; n = 19). Athletes with "no" or "minimal" (n = 63), vs "moderate" or "strong" (n = 195), perceived knowledge of supplement safety were more likely to list a question about supplement quality or composition (34.9% [n = 22/63] vs 21.5% [n= 42/195]; P = .03; chi-square = 4.6).

CONCLUSIONS AND IMPLICATIONS

Further research is needed to corroborate findings to inform educational efforts and promote safe and effective use of dietary supplements by student athletes.

An Investigation of Habitual Dietary Supplement Use Among 557 NCAA Division I Athletes

Background: Supplements may expose athletes to dangerous ingredients, banned substances, toxins or contaminants; however, few investigations assess use among collegiate athletes in the U.S.Objective: This cross-sectional study evaluated habitual dietary supplement intake, defined use ≥2 days/week over the past year, in NCAA Division I athletes.Methods: Male and female members of a NCAA Division I team, at two universities in southern California completed a 13-item survey. Among 705 eligible participants, 596 submitted surveys (84.5% response rate), 557 surveys included complete data. Chi-square (χ²) analyses evaluated differences among athletes based on sex, weight status, year in college, and sport-type. Independent t-test or ANOVA evaluated mean differences for continuous variables.Results: A total of 45.2% athletes (n = 252) reported taking supplements (≥2 days/week over the past year). Vitamin/minerals (25.5%, n = 142), protein/amino acids (24.6%, n = 137) were used most frequently. Male, vs female athletes, took more supplements overall (1.2 ± 0.1 vs 0.8 ± 0.1, p = 0.004) and indicated higher use of protein/amino acid products (34.2% vs 13.5%, p < 0.005), whereas, females reported higher use of vitamin/minerals (30.5% vs 21.1%, p < 0.05). Higher supplement use was also reported by athletes with BMI ≥ 30.0 kg/m² (vs <30 kg/m², 1.9 ± 0.3 vs 1.0 ± 0.1, p = 0.02), and athletes in ≥ third college year (vs first or second year, 1.2 ± 0.1 vs 0.9 ± 0.1, p = 0.03).Conclusions: Nearly half of NCAA athletes reported habitual supplements use, with significant variation in patterns based on sex, sport-type, year in college, and weight status.

Prevalence and Predictors of Higher-Risk Supplement Use Among Collegiate Athletes

Sassone, J, Muster, M, and Barrack, MT. Prevalence and predictors of higher-risk supplement use among National Collegiate Athletic Association Division I athletes. J Strength Cond Res 33(2): 443-450, 2019-This study aimed to identify the prevalence and predictors associated with the use of higher-risk dietary supplements, defined as supplements containing herbal ingredients, caffeine, or those classified for weight loss, muscle-building, or as a preworkout supplement, among 557 National Collegiate Athletic Association Division I male and female collegiate athletes. Although 252 (45.2%) athletes reported the use of a dietary supplement on ≥2 days per week over the past year, 46 (8.3%) athletes met criteria for higher-risk supplement use. Twenty (3.6%) athletes reported the use of herbal, 1 (0.2%) caffeinated, 5 (0.9%) weight loss, 28 (5.0%) preworkout, and 1 (0.2%) muscle-building supplements. Body mass index status (BMI ≥30 kg·m), sport-type (sports using the phosphocreatine energy system), and college year (≥4th year) were associated with the use of preworkout, muscle-building, or herbal supplements. A multiple regression analysis identified predictors of higher-risk supplement use including the number of dietary supplements used in the past year (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.7-2.7, p < 0.001), the reported motivation of taking dietary supplements to gain muscle and lose body fat (OR = 3.5, 95% CI = 1.1-11.7, p = 0.04), and the motivation to increase athletic endurance (OR = 3.5, 95% CI = 4.0, 95% CI = 1.6-9.9, p < 0.005). These factors may be considered as a part of a screening process to evaluate athletes with an increased risk of higher-risk supplement use and potential consequences to health or eligibility status.

Practical considerations when designing and conducting clinical pharmacokinetic herb–drug interaction studies

Pharmacokinetic herb–drug interaction (HDI) research has been ongoing for almost two decades and a significant body of information has been published on the subject, yet much of it is contradictory. Some of this disparity stems from the botanical dosage form itself, as product quality and dosage form performance can vary significantly among brands. Unless products are adequately characterized, HDI study results can be misleading. The purpose of this report is to identify several common weaknesses inherent in many prospective clinical HDI studies and to provide guidance in addressing these shortcomings. Topics such as study design, pharmacokinetic end points, product quality, dosage form performance, gauging clinical relevance, and efforts to minimize dietary influences while improving compliance are discussed.