Athletes are known to use substances, commonly dietary supplements, to improve performance. These are referred to as ergogenic aids. Athletes have used ergogenic aids since ancient times. Ancient Greek Olympians ate mushrooms to increase their chances to win the laurel wreath and Aztec athletes ate human hearts.

The ergogenic aid industry is massive, and most sporting magazines contain advertisements for new "revolutionary" ergogenic aids that are sold as dietary supplements. The world of sports is a competitive business. Athletes fear that others are taking something that will give them an advantage. This means that many athletes will try out new substances and supplements on the off chance that it will give them the edge over other competitors. Forgotten in the push to excel are the unknown dangers of unproven substances and the temptations for misuse and abuse. Dietary supplements can be harmful as well as useful.

What are supplements?

Prior to 1994, the term "dietary supplement" referred to products made of one or more of the essential nutrients, such as vitamins, minerals, and protein. Congress passed the Dietary Supplement Health and Education Act (DSHEA) in 1994, which expanded the definition so that dietary supplements now include herbs, or other botanicals (except tobacco), and any dietary substance that can be used to supplement the diet.

This has lead to many new dietary supplements, for example:

  • herbs and other botanicals
  • amino acids
  • extracts from animal glands
  • fibers such as psyllium and guar gum
  • compounds not generally recognized as foods or nutrients such as enzymes and hormone-like compounds

This new definition has meant that many substances that the FDA formerly classified as drugs or unapproved food additives have become readily available as dietary supplements. Thousands of dietary supplements are on the market. Many contain vitamins and minerals to supplement the amounts of these nutrients we get from the foods we eat. There are also many products on the market that contain other substances like high-potency free amino acids, botanicals, enzymes, herbs, animal extracts, bioflavanoids, and synthetically manufactured pro-hormones melatonin and dehydroepiandrosterone (DHEA), which exert drug-like effects on the body.

Supplement standards/regulations

The Food and Drug Administration's (FDA) review of the safety and effectiveness of these products is significantly less than for drugs and foods. Be cautious about using any supplement that claims to treat, prevent or cure a serious disease. The FDA has approved only a few claims for labeling, based on a review of the scientific evidence (for example, claims about folic acid and a decreased risk of neural tube birth defects). A recent court case prevents the FDA from regulating health claims on dietary supplement labels. Read carefully and think critically about the claims you see on the packages.

Supplement manufacturers do not have to prove that their products are safe! In the past, supplement manufacturers had to prove to the Food and Drug Administration (FDA) that their products were safe. Under current law, however, it has become the responsibility of the FDA to prove that a supplement is unsafe. With the high number of new supplements coming onto the market and the limited resources of the FDA, it is very likely that a product could cause harm before the FDA can take action. In addition, even after the FDA has declared a supplement unsafe, they then have to prove that the supplement is unsafe in the court of law.

Some dietary supplements may be harmful under some conditions. For example, many herbal products and other "natural" supplements have real and powerful pharmacological effects that can cause harmful reactions in some people or can cause dangerous interactions with prescribed or over-the-counter medicines. It does not necessarily mean that supplements marketed as "natural" are safe and without side effects.

Because of the lack of regulation with dietary supplements, athletes run the risk of consuming a dietary supplement that is contaminated. Steroid contamination, such as anandrolone and testosterone, have been documented. An athlete WILL test positive for drug use if they consume a dietary supplement containing banned substances such as anandrolone and testosterone. Some substances that could be present in the supplements are banned by the NCAA. Consuming them will jeopardize your eligibility. Visit the Gatorade® Sport Science Institute for more information.

Protein supplements

protein supplementThe list of protein supplements on the market is never ending. Protein supplements promise anything from increased strength, energy, muscle mass, weight loss, staying fit, and obtaining lean slender bodies. Today you can hardly find a gym where protein supplements are not be used or sold. But are these supplements really beneficial, and who should take them? What are the long-term effects?

For years, research studies have been studying their effects on muscle strength, and performance. The results of the different studies are conflicting with little to no data supporting the proclaimed benefits of protein supplements.

Currently, only creatine has been shown to benefit high intensity short duration exercise. However, a few other supplements including amino acids and Beta-Hydroxy-Beta-Methylbutyrate (HMB) have shown promise in some studies. More research is necessary to examine their effects on performance and health.

Amino Acids

amino acidsThe athlete's protein source needs to provide the essential amino acids (those not synthesized in the body), since non-essential amino acids can by made by the body when needed. The essential amino acids can easily be obtained from the diet by consuming quality proteins such as, egg, chicken, red meats, fish, or milk etc., thus supplementation is not necessary.

If supplemental amino acids are needed, the key to obtaining benefits from amino acids is the timing of consumption. Amino acids should be consumed either immediately prior to exercise, or during the recovery period 1-2 hours after exercise. A consumption of 0.1 g of essential amino acids per kilogram of body weight is recommended.

REMEMBER: the amount of protein that the body can utilize is limited. Large protein consumption in one setting that exceeds the body's requirement will be converted into fat. It will NOT increase muscle mass.


HMB is derived from an amino acid called leucine. HMB is believed to prevent muscle loss with intensive resistive training. Considering muscle breakdown always occurs with exercise, preventing this breakdown preserves and increases muscle mass. However, more research is necessary to verify the effects of this supplement.



What is creatine?
Discovered in 1832, creatine is a food constituent derived from animals. The compound is primarily found in skeletal muscle and is synthesized in the body and transported to muscle tissues. In muscles, creatine is used in short bouts of intense energy production in the form of creatine-phosphate. The end-product energy release from creatine-phosphate is creatinine, which is excreted by the kidneys in the urine.

Creatine in the body
Creatine is synthesized in the liver, the kidneys, and the pancreas. After production, it is transported in the blood to body tissues. The creatine transporter is limited in the amount of creatine it can transport. This means that even if a person consumes more creatine, the body has a maximum amount it can use.

Creatine in the diet
Although, creatine is synthesized in the body, it can be obtained from dietary intake and creatine supplementation. A good food source of creatine includes muscle meat, where 1.1 kg (about 2 1/2 pounds) of beef provides 5 g of creatine. A typical American diet, containing some meat, provides approximately 1 g of creatine daily. Creatine obtained from the diet can either be utilized as energy, or be stored in the body. For example, a 70 kg adult man can store approximately 120 g of creatine.

Role in exercise
Oral creatine supplementation increases muscle creatine-phosphate, which can enhance performance during repeated bouts of high-intensity exercise . The benefit of creatine supplementation for high intensity and short duration exercise has shown to be greater than low intensity and long duration exercise.

Creatine supplementation
Creatine is supplemented to improve muscle power output primarily in high intensity and short duration exercise. However, creatine has also been used to prevent breakdown of muscle mass during immobilization. In other words, it may prevent muscle wasting when a person is injured and/or unable to exercise.

Creatine supplementation involves a loading phase and a maintenance phase. For the best results, a loading of about 20 g of creatine monohydrate for 4 to 5 days is recommended. Thereafter, to maintain desirable levels of creatine, 3 g of creatine monohydrate per day should be consumed. The response to the supplementation varies depending on individual need. However, the best response will be seen the first three days of ingestion.

Effect of creatine Potential benefit
upPower Perform more exercise repetitions
upStrength Perform more exercise repetitions and enhance activities of daily living performance
upLean mass Functional recovery
downOxidative stress Long-term cellular protection

Side effects
Scientists are not sure whether long-term creatine supplementation is harmful to humans. Research on long term safety has been initiated, but currently no severe health implications have been identified. However, water retention and decreased urine production have been reported to cause weight gain with creatine supplementation. Other side effects reported are muscle cramps, headaches, diarrhea, and gastrointestinal pain.

Speculations that creatine supplementation could lead to kidney failure have not been proven. Clinical trials have shown no adverse effects of low-dose (1.5g), long-term (1-5 years) creatine supplementation on renal function. However, high doses for a prolonged period of time will increase the stress on the kidneys.

Conclusions on creatine:

  • Creatine supplementation has only been shown to be beneficial in those sports/exercise of short duration, high intensity.
  • Long term safety of creatine supplementation is unkown.
  • Creatine supplements, as other dietary supplements, are not well-regulated and could contain contaminants or illegal substances, which could jeopardize an athlete's health and eligibility.
Ergogenic Aid Proposed Action What Research Says Side Effects


steroid hormone that increases testosterone levels

no documented benefits



increases fat metabolism, thus sparing glucose and glycogen stores; stimulates the central nervous system




an important energy source for muscles


mild at high doses


delays fatigue and improves performance during high, intense bursts of exercise; builds muscle mass

supports, however there is limited data on long-term use



increases amount of steroids produced in the body

no benefit in health athletes

may be dangerous


prevents muscle breakdown, speeds up muscle repair, and increase lean body mass

limited; some strength benefits



helps build muscle and improves muscle repair

supports; high force outputs from their muscles, such as sprinters and weight lifters, need extra protein to ensure muscle maintenance



boosts antioxidant levels, enhances recovery

Supports, dietary sources offer same benefit



increases athletic endurance; decreases pain perception

no definite results; no benefit in trained athletes

potentially dangerous

Vitamin B 6 (Pyridoxine)

increases growth of muscle and decreases anxiety

no benefit unless individual has deficiency

mild at high doses

Vitamin B12 (Cobalamin)

increases growth of muscle

no benefit unless individual has deficiency


Vitamin C

acts as an antioxidant; increases energy production and aerobic reactions

no benefit unless individual has deficiency

mild at high doses

Vitamin E

acts as an antioxidant; increases aerobic capacity

no definite results



increases muscle mass and aerobic capacity

few studies; mostly negative


Source: Ahrendt DM. Ergogenic aids: Counseling the athlete. American Family Physician. 2001;63:913-22.

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