Apr 28, 2020
Supplement Savvy for Athletic Performance
Lisa Dorfman, MS, RD, CSSD, CCMS, LMHC, FAND

Athletes strive for excellence and will do anything, at times, to achieve success in sport. It makes sense that some athletes will do anything to have a competitive edge to fulfill the Olympic motto of “faster, higher, stronger” and often take it upon themselves to buy over the counter or online supplements to achieve their goals. At any given time, global estimates of supplement use among athletes range between 40%-60%.

Reasons for taking supplements include improving energy levels, strength, endurance, overcoming injury, avoiding illness, and compensating for a poor diet. And while athletes consume dietary supplements at a high rate, they are unaware of the risks associated with supplementation. Estimates suggest 86% of people polled are unaware that dietary supplements can have adverse effects; did not know the active ingredient (62%), side effects (57%), issues of contamination (36%), mechanism of action (54%), or recommended dose (52%.)

Photo: Mark Effinger / Creative Commons

The truth is, taking supplements can be risky business, especially when purchased from unverified sources. A recent review of supplement use among children and young adults found 977 single-supplement-related adverse event reports, with 40% involving severe medical outcomes, including death and hospitalization. Supplements sold for weight loss, muscle building, and energy were associated with almost three times the risk for severe medical outcomes compared to vitamins.

The Case for Supplementation

As a sports medicine team member, it is not unreasonable to consider recommending supplements to athletes. In a 2018 IOC consensus statement: dietary supplements and the high-performance athlete, “Some sporting bodies now support the pragmatic use of supplements that have passed a risk-versus-benefit analysis of being effective, safe and permitted for use, while also being appropriate to the athlete’s age and maturation in their sport.” Valid reasons for recommending supplements can include the management of micronutrient deficiencies, the supply of convenient forms of energy and macronutrients, provision of direct benefits to performance, or indirect benefits such as supporting intense training regimens.

Food-First Philosophy

 While nutrient intake research is limited some studies suggest competitive and elite athletes’ diets fall short of meeting calorie, carbohydrate, vitamin, and mineral requirements. Athletes who may be at risk for dietary deficiencies include those with clinical issues such as anemia; vegetarians, vegans, or athletes on restrictive diets with allergies, food sensitivities, or personal aversions where whole food groups are eliminated or avoided like dairy, whole grains, vegetables; athletes with eating disorders or who are undernourished due to low-calorie dieting or those trying to make weight for sport e.g., jockeys, wrestlers, rowers, boxers; athletes taking prescription medications, older master level athletes or those with a spinal cord injury.

When athletes do not meet minimal dietary needs, performance suffers, recovery is hastened, and illness and injury are potential consequences. Supplements used to correct and manage deficiencies include iron, Vitamin D, and calcium.

Other supplements may be recommended for meeting energy needs pre, during, and post-training and competition. These supplements provide practical, portable sources of carbohydrates, protein, and electrolytes such as shakes, sports beverages, bars, gels, and chews. Supplements that may enhance performance directly in some athletes include caffeine, creatine, nitrates, beta-alanine, and sodium bicarbonate.

  » ALSO SEE: Nutrition for high-intensity training

Before considering supplements for athletes, consider that they might actually be getting enough of some or all vitamins and minerals through their daily diet. Savvy athletes typically take advantage of the latest fortified foods on the market like cereals, beverages, and snacks, which may already have a high level of nutrients; extra vitamins, minerals, and compounds added such as antioxidants, electrolytes, omega-3 essential fats, energy boosters, etc. Sport shakes and bars often have 100% of many of the vitamins and minerals, often more as in the case of B vitamins.

The more foods one consumes with these extras, the more likely they will not only be meeting daily micronutrient needs but potentially exceeding them, increasing the risk for adverse reactions from excessive amounts. In addition, interactions between nutrients can interfere with the absorption and metabolism of each.

Supplement Savvy 

Once it is determined that an athlete may benefit from supplementation, what are the next steps? The IOC and other resources in this article offer protocols and guidelines for making intelligent supplement guidance decisions. The best way to get started is to work with a sports dietitian (RD/CSSD) to determine dietary adequacy, deficiency, and energy needs for the athlete’s specific sport. The sports dietitian can start by assessing the athlete’s diet with a three to seven-day food log, processed with available dietary analysis programs to determine whether a dietary deficiency at least on paper exists.

If the sports dietitian determines that the athlete might be at risk for a deficiency and the athlete is experiencing symptoms associated with deficiency such as lethargy, illness, or repeated stress fractures, then a blood test may be advised to determine if a vitamin or mineral deficiency actually exists. If the deficiency is Vitamin D or Iron for example, depending on the extent of the deficiency, a food or supplement protocol can be implemented to correct the deficiency.

Our role as coaches, trainers, and sports dietitians is to educate and guide our athletes on safe supplementation; when they are effective, what are the safest choices and how much is reasonable doses to meet optimal requirements for health and performance. By using evidenced-based resources, practical tools, and working in a team effort to determine the validity, efficacy, and safety of supplementation, we can keep our athletes safe and healthy for sport and for life.            

Lisa Dorfman, MS, RD, CSSD, CCMS, LMHC, FAND, The Running Nutritionist® is an award-winning Board Certified Sports Dietitian, recipient of the ’19 President’s Council on Sports, Fitness and Nutrition’s Community Leadership Award & ’17 DIFM National Excellence in Practice Award Licensed Mental Health Counselor, Certified Chef and Culinary Medicine Specialist, Certified Coach & Fellow of the Academy of Nutrition and Dietetics. A former professional triathlete, Lisa was a member for TeamUSA for the World Long Distance Duathlon Championships, served as the US Sailing Olympic and Paralympics Team Nutritionist for the Beijing Olympics & the Nutrition Expert for Zumba® Plate program. The author of 8-books, Legally Lean: Sports Nutrition Strategies for Optimal Health & Performance provides a 360° look at supplementation & the role of food bioactive compounds, recipes and periodization programs to enhance sports performance. @TheRunningNutritionist

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