Supplements and their risks

Supplements refer to any of the products sold as “dietary or nutritional supplements”, “health supplements”, or “sports supplements”.

What you need to know about supplements

  • There’s an alarming increase in the number of supplements resulting in harmful side-effects (medical problems and fatalities) as well as positive drug tests in youth and adults alike (locally and globally).
  • Proper scientific analysis of products often reveal the extent of false claims of efficacy, presence of harmful and/or banned substances not listed on the label or incorrect dosages (see recent studies from SA, UK and Australia).
  • There is a lack of legislation and governance in the supplement industry locally and abroad – products can be advertised and sold with misleading claims, incorrect labeling, and lack of scientific-grade evidence of efficacy and safety.

Despite the marketing hype and product claims, the fact remains that the majority of supplements on the market have not been tested according to proper scientific and objective standards, and their claims of superiority, efficacy and safety cannot be guaranteed.

  • Be aware that supplement manufacturers and retailers (including pharmacies) may indeed claim that their product is ‘scientifically tested’ or ‘safe’, but at closer inspection the evidence may be insufficient, irrelevant, misinterpreted, not applicable to youth, or in the worst, fabricated.
  • Claims that the product is ‘natural’ or ‘herbal’ does not necessarily mean that it is harmless and cannot get you banned.
  • Many herbal components can have potent harmful side-effects, can lead to harmful interactions with other herbals or medications, and/or lead to a failed drug test.
  • Vitamins, minerals, anti-oxidants (and other nutrients) from supplements can more easily reach levels that exceed safety limits, which can cause negative health effects and block important training adaptations that will negatively affect your sporting performance.
    • Examples:  Large doses of Vitamin C (>2g/day) have not only been shown to block important training adaptations and reduce performance, but also increase muscle damage and delay recovery;
    • Large doses of anti-oxidants can block some of the health-enhancing effects of exercise; and have been linked to increased risk of certain cancers and a negative impact on cardiovascular health.
    • Certain vitamins / minerals in excess can impair immune function; limit the function (and beneficial effects) of others.
  • Reliance on supplements shifts focus away from the more important and proven methods of achieving optimal performance and health.

Other common pitfalls to look out for

  • Even supplements bought from a well-known company, store or pharmacy might contain harmful or banned substances.
  • If banned or harmful substances aren’t listed on the product label then it doesn’t guarantee that the product is indeed ‘clean’ or harmless.
  • The amount the product label says you should take could be excessive and with a ‘more is better’ mind-set one can reach toxic levels that could be harmful to your health and performance.
  • If a well-known sportsperson claims to use specific supplements it does not mean that it is safe or that it will work for you too.
  • Even apparently ‘harmless’ dietary supplements like vitamin and mineral supplements and protein shakes have been found to be contaminated with harmful and/or banned substances that are not declared on the label.
  • Be aware of false claims like ‘WADA’ (World Anti-Doping Agency) or ‘SAIDS’ (SA Institute for Drug-Free Sport) ‘approved’. Due to the known / unknown risks involved, WADA, SAIDS or any other anti-doping agency would never approve or endorse supplements. We advise athletes to take great caution when using any type of supplement.

Think twice before blindly believing the clever marketing claims, and ask yourself whether the risks are worth the limited or lack of benefits?

  • Here are some products / ingredients / claims of particular concern to look out for:
    • ‘Pro-hormone’ products / ingredients such as ‘DHEA’, ’19-nor’, ‘adrostene-dione’ or -‘diol’.
      • Claims of ‘hormone-like’ effects – the words ‘anabolic’, ‘mass builder’, ‘steroid-‘, ‘testosterone-‘, ‘growth hormone-like’ effects.
    • Products that claim to have ‘super energy’ and/or fat-burning effects (rapid weight loss, ‘cut’ or ‘ripping’) – these are likely to contain high doses of stimulants like caffeine / ephedrine / methylhexaneamine* which are harmful to your health;
      • *Methylhexaneamine has a long list of different names – DMAA, MHA, geranium oil, etc. etc., making it difficult to recognise when reading a label.
    • Watch out even if it says ‘natural’ or ‘herbal’ forms of pro-hormones or metabolites or fat burners (e.g. Tribulis terrestris, guarana, ephedra, mahuang etc.) – these are dangerous and have been linked to several cases of toxicity, deaths and severe disability.
    • Products like creatine and caffeine are not banned substances and there is a good body of research on it, done  ON ADULT ATHLETES. So, for the adults we have a good sense of their indications, dosage efficacy and safety limits,  side-effects and contra-indications. They do not work for everyone, in some they may negatively affect performance, and in some they may be harmful to health.  Be aware that there is very little research done on their efficacy and safety for children and adolescents.  Why?  For ethical reasons scientists (from credible research institutions) are very cautious using under 18’s as ‘guinea pigs’ due to the potential risk of  causing harm to aspects of health, growth and development.
    • – NOTE that these types of supplements, though not banned in itself, could be mixed or contaminated with banned / harmful substances, which may or may not be indicated on the label…
    • Products that claim to produce ‘incredible results’ – if it sounds too good to be true, then it normally is! The risk to benefit ratio is simply not worth it.


What about supplement-use in youth?

(Under 18 years of age)

  • Due to the substantial risks (known and yet unknown) related to supplement use, SAIDS supports the international consensus that sports supplements (including creatine, caffeine, prohormones, herbals etc.) should not be used in persons under 18 years of age (see SAIDS position paper for YOUTH).


Proven facts

  • Optimising one’s training, overall dietary intake, rest, recovery and sleep patterns are proven to have a far bigger impact on physique, performance and health than any sport supplement (or ingredient or formulation) tested to date can.
  • ‘Skimping out’ on any of the important aspects of nutrition and training cannot be replaced by the use of supplements.
  • Nutrients from supplements are not better than those you get from food, especially to build muscle, reduce body fat, enhance recovery, immune function and maintain overall health and performance short- and long-term.
  • A well-balanced diet can boost performance and eliminates the many risks that one faces when using supplements.
  • There are only a small number of supplement ingredients proven to assist exercise performance under certain specific conditions, mainly in adults, but even so, it is NOT a one-size-fits-all approach and one still cannot guarantee that it is 100% safe and risk-free, especially in youth!
  • Supplements are expensive – rather invest time and money in seeing a registered dietitian, who specializes in sports nutrition. This would be the best person to devise an individualized sport nutrition programme for you and, where appropriate, guide you on the correct use of supplements and how to minimize risks.


Do you need supplements to perform at your best?

    The simple answer is NO! The science gurus have conclusively proven that the cornerstone of optimal performance is to eat a well-balanced diet (with a variety from all food groups) and eat enough of it to meet your energy needs, to properly time your food intake (before/during/after workouts), to train intelligently and to allow for sufficient rest and recovery.

In some situations there might be a valid reason to use a particular dietary supplement. But a person’s age, circumstances, type of supplement, dosage and timing thereof should be established on an individualized basis and then constantly re-evaluated. It remains critical to follow a risk minimizing approach when selecting the applicable supplement. A registered dietitian with sports nutrition experience is the best equipped health professional to help you with this process.


How to minimise the risks

  • A dietitian can help you identify and implement a scientifically-proven nutritional and supplement programme based on:

1) Firstly, optimising your overall dietary intake, in a practical way that suits your needs and circumstances, and then secondly, assessing whether you need/could benefit from supplementation, then,

2) The type and amount of supplementation should be individualised to ‘fill the gaps’ if/when needed, it should be appropriate to complement your training and competition, rest and recovery goals.

It is not a one-size-fits-all approach!

3) The choice of supplement(s) should be critically evaluated – whether it has sound scientific proof with direct, supportive and well-executed research showing its effectiveness and safety for that individual; aspects of the product manufacturing process should be investigated to help identify low-risk supplements.

  • Note: Certain products or retailers may provide a ‘stamp of approval’ or logo indicating that their supplement(s) have been independently tested for ‘quality and/or safety’ and certified to be ‘free of banned substances’. Such testing is expensive and it invariably means that only some aspects of safety are being tested for, and in most cases, only on a random, infrequent basis. Though this helps to reduce some of the safety risks, it is important to know that:

1) the claims of efficacy of the formulation are not being tested for;

2) important safety aspects e.g. dosage, contra-indications, side-effects in young vs old are not being tested for; and

3) there might still be banned or harmful substances in the product that are not being tested for.

The level of testing therefor still does not provide a guarantee that taking the product will not harm your health or performance, or that an athlete wont test positive for a banned substance – so taking such products are still not risk-free.

A registered dietitian who specialises in sports nutrition is a valuable resource to help you maximise your health and sporting performance.