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

Intake of Food Supplements, Caffeine, Green Tea and Protein Products among Young Danish Men Training in Commercial Gyms for Increasing Muscle Mass

Sixty-three men (15-35 years of age) regularly training in Danish gyms and supplement users were interviewed about the use of supplemental protein and food supplements, intake of caffeine- and (-)-epigallocathechin-3-gallate (EGCG)-containing supplements and beverages and any experienced adverse effects. Protein powder (60%), fish oil (54%) and multivitamin/mineral supplements (41%) were the most popular products. The daily supplementary protein intake (mean 0.42 g/kg body weight, users only) in adult men contributed substantially to their protein intake and exceeded the recommended allowance (0.83 g/kg body weight) for six adult participants (14%). Thirty-eight percent of the adult men exceeded the daily caffeine intake presumed to be safe (400 mg) with coffee as the main contributor. Thirty percent drank green tea and among this percentage, two participants had an extreme daily intake (1.5 and 2 -L). EGCG intake could not be estimated from the food supplements due to the lack of label information. Eighteen participants (29%) reported having experienced adverse effects but seventeen did not consult a physician or report the adverse effect to the Danish food authority. The most common adverse effects were insomnia, shaking, headache and palpitations, itching of the skin and stinging. Pre-workout products accounted for 53% of the adverse effects. Three adverse effects came after intake of two brands of supplements known to have contained substances such as 1,3-dimethylamine or derivatives of phenylethylamines previously having caused serious adverse effects.

Prevalence of Dietary Supplement Use among Athletes Worldwide: A Scoping Review

Athletes represent a major part of dietary supplement users. This scoping review aims to explore the prevalence of dietary supplement use among athletes worldwide, most commonly used supplements, sources of information on dietary supplements and their reasons for use of these supplements. PubMed, CINAHL, MEDLINE, and PsycInfo were searched for original research articles. Studies were included if they involved athletes, identified the prevalence of dietary supplement use, and were published after 2017. A total of 26 articles were reviewed. Prevalence of dietary supplement use varied among articles, but sex-based differences related to the types of used dietary supplements existed. Generally, the findings were consistent in terms of reasons for use and sources of information. Unfortunately, the lack of homogeneity regarding the definition of dietary supplements, definition of use, reporting timeframes, and data collection methods complicates the attempt to compare the findings among studies.

Dietary practices and supplement use among CrossFit® participants

Background

CrossFit® is a popular high-intensity functional training program. CrossFit® participants may practice popular diets or consume dietary and sports supplements to support their health or physical pursuits, but the specific dietary and supplement practices of CrossFit® participants remain unknown.

Methods

An electronic questionnaire was developed to collect data on practice of popular diets (i.e. Paleo and The Zone Diet®), dietary and sports supplement use, reasons for practicing a diet or using supplements, sources of information on diets and supplements, and various beliefs associated with nutrition among CrossFit® participants.

Results

Of the 2,576 complete responses (female 51.9%, male 48.1%, age 39.4 ± 11.1 years, body mass index 26.1 ± 3.9 kg/m²), 695 (27%) reported being a CrossFit® trainer or coach and 1,392 (54%) reported competing, or planning to compete, in CrossFit® or other fitness competitions. The average years of CrossFit® experience were 5.3 ± 3.1 years, and the average frequency of CrossFit® participation was 4.5 ± 1.1 days/week. Most participants (60.1%) reported practicing a particular diet. Macro Counting (18.6%), Intermittent Fasting (7.7%), and Paleo (6.1%) were the most frequently reported diets. The top reasons for practicing a diet were to improve overall health (45.6%), decrease body fat (29.2%), and improve CrossFit® performance (25.2%). The top sources of dietary information were the Internet (47.5%), coach/trainer (28.7%), and nutritionist/dietitian (26.2%). Most participants (67.3%) reported “Urine Color” as the best method to assess hydration. Additionally, most participants (82.2%) consumed at least one supplement, with protein (51.2%), creatine (22.9%), and pre-workout/energy (20.7%) being most popular. The top reasons for consuming supplements were to improve recovery (52.6%), improve overall health (51.4%), and increase muscle mass/strength (41.7%). The top sources of information on supplements were the Internet (53.1%), coach/trainer (27.0%), and peer-reviewed research (23.0%).

Conclusions

A large proportion of CrossFit® participants may practice popular diets or consume supplements with the intention of improving health or performance. These findings may support future research on the effects of various dietary patterns and supplements on CrossFit® performance.

Pre-bout hypertension in the combat sports athlete: clearance recommendations

Hypertension is one of the most prevalent medical disorders in the world and is associated with significant cerebrovascular and cardiovascular morbidity. Pre-bout blood pressure (BP) elevation is extremely common, and ringside physicians must accurately assess the accompanying risk of adverse cerebrovascular and cardiovascular events in the decision to allow participation in combat sports. It is strongly recommended that a ringside physician consider disqualifying a combat sports athlete with severe pre-bout hypertension (systolic BP ≥160 mm Hg and/or diastolic BP ≥100 mm Hg, or stage 2 hypertension in children when indexed by gender, age, and height) from that bout, if it persists despite rest and repeated measurement with accurate equipment. This recommendation is congruent with that of the American College of Sports Medicine, the American College of Cardiology, and the American Heart Association, which recommend non-clearance for sports or exercise testing when BP exceeds those thresholds. Severely elevated BP, as defined above, confers markedly increased risk of morbidity and mortality. Exercise further raises BP markedly. The combination of severely elevated blood pressure and cranial trauma during combat sports is a risk factor for intracranial hemorrhage with a direct impact on the morbidity and mortality associated with ringside combat sports events. Combat sports athletes with SBP ≥130 or DBP ≥90 - and their coaches and families, if available and the athlete consents - should be educated on the causes of hypertension, its acute and chronic risks, and the possible future implications for bout clearance, and the athletes should be referred for evaluation and management.

Liver and kidney function markers among gym users: the role of dietary supplement usage

Dietary supplements have been increasingly used by gym users and are often consumed without the guidance of a health professional. Moreover, the indiscriminate supplements use can have adverse health effects, such as changes in liver and kidney function. The aim of this study was to verify the association between dietary supplements intake with alterations in the liver and kidney function among gym users. A cross-sectional study was conducted with 594 gym users (mean age 37 (sd 14) years, 55·2 % women) from a city in southern Brazil. A questionnaire was used to evaluate the use of dietary supplements. The markers of the liver (alanine aminotransferase, aspartate aminotransferase (AST), alkaline phosphatase, γ-glutamyltransferase) and renal (creatinine and urea) function were also evaluated on a subsample of the study population. Data were analysed by binary logistic regression, adjusted for sex, age and education. The prevalence of dietary supplement intake was 36·0 %. Individuals who intake dietary supplements showed a higher prevalence to present slight alterations in the AST enzyme and in the urea after adjustments for potential confounders. In conclusion, the use of dietary supplement was associated with slight alterations in AST enzyme and in the urea among gym users. These findings show the importance of using supplements correctly, especially with guidance from professionals trained to avoid possible risks to health.

Dietary Supplement Use According to Sex and Triad Risk Factors in Collegiate Endurance Runners

ABSTRACT

Barrack, MT, Fredericson, M, Dizon, F, Tenforde, AS, Kim, BY, Kraus, E, Kussman, A, Singh, S, and Nattiv, A. Dietary supplement use according to sex and Triad risk factors in collegiate endurance runners. J Strength Cond Res 35(2): 404-410, 2021-This cross-sectional study evaluated the prevalence in the use of dietary supplements among elite collegiate runners among 2 NCAA Division I cross-country teams. At the start of each season from 2015 to 2017, male and female endurance runners were recruited to complete baseline study measures; the final sample included 135 (male n = 65, female n = 70) runners. Runners completed a health survey, web-based nutrition survey, and Triad risk assessment. The prevalence of dietary supplement use and Triad risk factors, including disordered eating, low bone mass, amenorrhea (in women), low body mass index, and stress fracture history, was assessed. A total of 78.5% (n = 106) runners reported taking 1 or more supplements on ≥4 days per week over the past month, 48% (n = 65) reported use of ≥3 supplements. Products used with highest frequency included multivitamin/minerals 46.7% (n = 63), iron 46.7% (n = 63), vitamin D 34.1% (n = 46), and calcium 33.3% (n = 45). More women, compared with men, used iron (61.4 vs. 30.8%, p < 0.001) and calcium (41.4 vs. 24.6%, p = 0.04); men exhibited higher use of amino acids and beta-alanine (6.2 vs. 0%, p = 0.04). Runners with bone stress injury (BSI) history, vs. no previous BSI, reported more frequent use of ≥3 supplements (61.5 vs. 32.8%, p = 0.001), vitamin D (49.2 vs. 19.4%, p < 0.001), and calcium (47.7 vs. 19.4%, p = 0.001). Low bone mineral density was also associated with higher use of vitamin D and calcium. Most runners reported regular use of 1 or more supplements, with patterns of use varying based on sex, history of BSI, and bone mass.

Risk Associated with the Use of Selected Ingredients in Food Supplements

This review focuses on four new product categories of food supplements: pre-workout, fat burner/thermogenic, brain/cognitive booster, and hormone/testosterone booster. Many food supplements have been shown to be contaminated with unauthorized substances. In some cases, the ingredients in the new categories of dietary supplements were medicinal products or new synthetic compounds added without performing clinical trials. Some of the new ingredients in dietary supplements are plant materials that are registered in the pharmacopoeia as herbal medicines. In other cases, dietary supplements may contain plant materials that have no history of human use and are often used as materials to 'camouflage' stimulants. In the European Union, new ingredients of dietary supplements, according to European Food Safety Authority or unauthorized novel food. Furthermore, selected ingredients in dietary supplements may be prohibited in sports and are recognized as doping agents by World Anti-Doping Agency.

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.

Common Habits, Adverse Events, and Opinions Regarding Pre-Workout Supplement Use Among Regular Consumers

The purpose of the present study was to examine characteristics of multi-ingredient pre-workout supplement (MIPS) users, their common patterns/habits of MIPS ingestion, and their associated feelings about the effectiveness and safety of this class of supplements. An online electronic survey was distributed through social media to assess self-reported supplementation practices and preferences among adult males and females who reported regular MIPS use. A total of 1045 individuals responded, with 872 of these individuals (males: n = 636, 72.9%; females: n = 233, 26.7%; mean ± SD; age = 27.7 ± 7.9 years; training age = 8.2 ± 7.3 years) completing the survey. The majority of respondents reported the length of current or past MIPS consumption as greater than one year (n = 630, 72.2%), with ingestion frequencies primarily of four (n = 210, 24.1%) or five (n = 212, 24.3%) days per week of training. In addition, the three most popular goals for ingesting MIPS were increased energy and focus (n = 776, 89.0%), muscular endurance (n = 325, 37.3%), and blood flow or “pump” (n = 322, 37.0%). Although most users reported ingesting one serving size with each use, 14% reported ingesting two or more, and 18% indicated they ingest MIPS more than once per day. Importantly, over half (54%) of the respondents reported experiencing side-effects following MIPS use, including skin reactions, heart abnormalities, and nausea. Females were more likely than males to experience these side effects, despite being less likely to consume two or more serving sizes per dose. Our findings also indicated that MIPS users should consume no more than the recommended serving size of a given supplement, as the potentially significant variability in the caffeine content of MIPS products is compounded as more doses are consumed. Furthermore, MIPS users should minimize the ingestion of other supplements which contain high levels of niacin and caffeine, as the concurrent consumption of such products may put users above the tolerable upper limits for these substances.