The NCAA News - News and Features

May 11, 1998

Athletes buying trouble with dietary supplements

Some over-the-counter products have dubious benefits, may lead to failed drug tests

BY KAY HAWES
STAFF WRITER

Dietary supplements seem to be more popular than ever, and some of their consumers are student-athletes looking to enhance their athletics performance.

Whether the athletes are improving their performance is questionable, but it is certain that many of them are failing drug tests. Further, they may be putting their health in danger.

"We've had student-athletes fail drug tests because they took supplements," said Cindy A. Thomas, NCAA assistant director of sports sciences. "The supplement may not be banned, but some of its contents may be.

"You hear the student-athletes say on appeal, 'But the clerk told me it didn't have anything illegal in it.' Well, even if it's legal, that doesn't mean it's safe, and it doesn't mean that it's not banned by the NCAA."

And, not knowing that you were taking banned drugs is no excuse for testing positive. Student-athletes who have made that claim on appeal have not had their positive test results overturned, Thomas said.

Also, Thomas pointed out that institutions are responsible for educating their student-athletes about NCAA banned substances.

Ephedrine, banned by both the NCAA and the United States Olympic Committee (USOC), is an example of one compound often found in diet supplements and "performance" supplements targeted to athletes. Ephedrine may not be listed on the label. It may be listed instead as ephedra, Ma Huang, epitonin or sida cordifolia.

The Food and Drug Administration (FDA) has more than 900 reports of side effects of ephedrine, including heart palpitations, heart attacks, strokes and psychosis.

That doesn't keep the substance from being sold as part of supplements that promise to make your muscles ripple and boost your energy.

Navigating a labyrinth of products

If you took a quick look around a "health and nutrition" store, you might be amazed at the sheer number and variety of products available.

You can purchase everything from herbal tea and vitamins to flavored drinks, sports bars and powdered shakes. Some packages feature attractive and athletic-looking models with well-developed muscles, and other packages offer only the initials of the main ingredients.

Most of the displays feature the words "natural," "herbal" or "safe."

Products that have no information as to recommended dosage, ingredients or side effects, feature words like "ripped," "slim," "power," "boost," "fuel," "octane," "gas" and "energy."

A variety of products line the shelves, from botanicals to formulas containing animal hormones.

About the only thing that is missing is information on what the consumer is supposed to do with the products. The packages sometimes provide clues, but often only vague ones like "builds muscle," or "oriental sleep aid."

Books sold in the next isle extol the virtues of everything from St. John's Wort to carbohydrate loading to amino acids. The helpful clerk is happy to tell you that Product A is proven to do this and that Product B can cure that.

Do the products do what they promise? It's hard to say. Some of them have been tested, some haven't.

Are the products good for you or bad for you? Again, it is hard to say. Some of them have been tested extensively. Some of them have never been tested. Still others have been tested, but only for their positive properties and not for their long-term side effects.

What is certain though, is that student-athletes are using the products. They are looking to supplements to boost their bulk, provide an extra jolt of energy or drop a few pounds quickly.

"Any edge anybody can get, they're going to try to get it," said Bernie DePalma, head athletic trainer and physical therapist at Cornell University and member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS).

"There's no question that people are taking more stuff. There's just more of everything than there used to be. There's more training and more weightlifting. Now that there's no off-season and people train all year long, people are looking for an edge."

If it's for sale, it must be safe

Many student-athletes assume, as do other consumers, that a product is safe and will function as advertised if it appears on the shelves at their supermarket or health food store.

Americans must think the supplements are safe because sales are skyrocketing. By some estimates, approximately 100 million Americans now are taking dietary supplements, spending as much as $11.5 billion a year in health food stores alone.

Consumers assume that these products are government-approved or that they wouldn't be for sale. But when it comes to dietary supplements, that's not necessarily the case.

As a result of The Dietary Supplement and Health Education Act of 1994, many over-the-counter substances marketed as nutritional or dietary supplements are no longer regulated by the FDA.

They are not considered foods, either, so food labeling laws don't apply.

There is no requirement that the supplement's effectiveness or potential side effects be thoroughly researched, and what labeling requirements do exist are extremely fuzzy. The average consumer knows more about what is in a package of cookies than what is in an elixir that promises enhanced muscle growth.

"Labeling with dietary supplements is lightly and loosely regulated," said David Schardt, associate nutritionist at the Center for Science in the Public Interest, a consumer watchdog group.

"The labels are often misleading, incomplete and not a good guide to using the product," Schardt added. "Consumers in general don't realize that these products are not independently evaluated, and no one is reviewing the quality control of these products --what's actually in them and how much they contain."

One of the reasons the competitive-safeguards committee is concerned about the use of supplements is because little research exists.

"We're concerned," said CSMAS member Priscilla M. Clarkson, a professor of exercise science at the University of Massachusetts, Amherst, "mainly because we don't fully understand the action, efficacy and safety of many of these supplements.

"We're concerned with how they may interact with other supplements, how they may interact with medicine, food products, training. By and large, there's just not as much research on these products as one would like," Clarkson said.

Even those products bearing claims of research studies and "proven results," should be approached with a skeptical eye, Thomas cautioned.

"Data can be manipulated and reported in such a way to provide results that are misleading," she said. "The emphasis on results can be misleading. Did the company investigate potential side effects or just the performance-enhancing capabilities of the substance? What were the ages of the participants in the study? Were they athletes?

"It's a buyer-beware market. The consumer cannot be absolutely sure of what they're buying and what they're putting in their bodies."

Hidden dangers

Supplements are often touted as "natural" or "naturally occurring in your body." Thomas cautioned that these statements should not be interpreted as meaning the supplement is safe or healthy.

"Naturally occurring and organic doesn't mean safe, and it doesn't mean that it's not banned," Thomas said, noting that the NCAA tests for hormones produced in the body, such as testosterone, and that excessive levels are banned. The NCAA and the USOC also ban substances from plants, such as marijuana and ephedrine.

"There are a lot of natural substances out there that can kill you," Schardt said. "There's this idea that if it's natural, it's healthy. We know that some natural substances are beneficial, but natural is not a guarantee that something works or is safe."

Schardt also warned consumers that the purity of many supplements is in question. "The nature and origin of many of these supplements, especially the botanicals, doesn't give you a lot of confidence," Schardt said.

"Some of them are made overseas, and they pass through many hands before the end up in the bottle on the shelf. It's not true of all manufacturers, but it is true of some."

Failed tests, damaged health

In addition to ephedrine, other compounds banned by the NCAA may be found in supplements, such as dehydroepiandrosterone (DHEA), androstenedione and colostrum.

Other compounds, such as gamma-hydroxybutyrate (GHB), may not be banned but may have dangerous side effects. The FDA cautions that GHB can cause seizures, coma, respiratory arrest and death, especially when used with alcohol.

Herbal products and glandular extracts (typically from animals) can also cause an athlete to fail a drug test, as can products that convert to anabolic steroids once they enter the body.

"There are several supplements out there that are resulting in positive tests," said Larry Bowers, professor and director of the athletic drug testing and toxicology laboratory at the Sports Medicine Drug Identification Laboratory at Indiana University Medical Center in Indianapolis.

"One of them is norandrostenedione, which may be sold as Norandro 19. That chemical is converted in your body to nandrolone, which is a banned compound," Bowers said.

"There are a couple of others that are converted to testosterone in your body, including androstenedione."

Norandrostenedione and androstenedione were added to the NCAA's list of banned drugs in October. The NCAA ban on anabolic steroids is broad enough that it includes any substances that act as an anabolic agent, whether those substances are legally sold in stores or not.

Another reason athletes may fail a drug test goes back to the fact that the supplements' contents are not regulated. What's listed on the label may not be what's actually in the supplement.

Bowers reported that his lab tested a bottle of herbal "medicine" and quickly discovered the source of the positive steroid test.

"The outside of the bottle said it was a Chinese herbal medicine, but it turned out to be pure steroid," Bowers said. "Since there is no regulatory oversight of these compounds and there's no one checking to see what's in it, it could be anything."

Dosage is another issue. Even if student-athletes steer clear of banned products or those known to be harmful, they can still suffer negative side effects from too much of a particular compound.

Many of the products sold as supplements include little information as to proper dosage. Flavored creatine tablets, for example, are available in large glass bottles that say simply: "For best results, take at least one a day."

"Even when there are suggested and recommended dosages, the athlete mentality is often: 'If a little is good, then more is better,' " Thomas said.

Bowers pointed out that the dosage issue can be complicated by the lack of labeling requirements.

"Even if the name of the compound is on the label, the amount of the compound in the product can vary widely," Bowers said.

"So that means that one athlete could take a supplement and not test positive for a banned substance while the next athlete could. It would just depend on how much of that substance was in that particular bottle."

Don Catlin, director of the UCLA Analytical Olympic Laboratory at the University of California, Los Angeles, noted that avoiding supplements is the only way to be completely sure you are not taking a substance that is dangerous or that could lead to a positive test.

"The best thing is to avoid supplements completely," Catlin said. "They do sometimes contain drugs on the NCAA's list of prohibited substances. You can't tell from the label, because a lot of times they are incomplete or misleading."

The athletes' health and welfare

Athletic trainers, team physicians and coaches share the responsibility of educating student-athletes about supplements.

"An athlete has the ultimate responsibility," Cornell's DePalma says. "But it's also a shared responsibility that falls on the entire athletics department, because we're the ones who are supposed to be looking out for the student-athletes' health and welfare."

Student-athletes with questions about supplements should take those questions to their athletics department, Thomas said.

The 1996 (current edition) "Athletic Drug Reference" is an excellent resource on this topic, as is the "NCAA Sports Medicine Handbook," Guideline 2-J.

"An athlete should not self-medicate," cautioned Thomas. "An athlete should consult his or her team physician and athletic trainer and work out a nutritional plan that's right for that individual. It might involve a nutritional supplement, but at least you're doing it the right way, without relying on the 'expertise' of the clerk at the nutrition store."

DePalma said he would advise athletic trainers to steer student-athletes away from supplements.

"First of all, since supplements are not regulated, my opinion is that no athletic trainer should ever advise a student-athlete to take them," he said. "Why would you advise a student-athlete to take something that you know nothing about?"

As an institution, Cornell has decided that supplements are not in the best interests of the athlete.

"At Cornell, we've decided that no athletics personnel will endorse or distribute any supplement, including creatine," DePalma said.

"We're erring on the side of protecting the student-athlete," DePalma said. "Who's to say that they won't discover that creatine's long-term side effects link it with heart disease or something? Why take that kind of a risk with a young athlete?"

Some institutions have passed out DHEA to athletes. Other institutions continue to pass out creatine to athletes.

DePalma questions the wisdom of providing supplements to student-athletes.

"The question they have to ask themselves is this," DePalma said, "Are they 100 percent sure, without a doubt, that it's not going to harm the athletes later on down the road? Every institution has to make its own decision, but it just seems like an unnecessary risk."

Athletics directors who permit coaches to distribute these supplements also may be opening their institution up to future legal issues.

"I would recommend that the athletics department on a campus that is doing this should be in contact with their campus attorneys to be certain that they're not incurring any liability for the institution," said Elsa Kircher Cole, NCAA general counsel.

Clarkson also cautioned institutions against giving out supplements to athletes. "Because we don't know all the dangers of these supplements, it is likely that an adverse event could occur," she said.

"It wouldn't even have to be a life-threatening adverse event, but an adverse event nonetheless, and those institutions could get sued."

DePalma acknowledged that the institution can't control what student-athletes choose to take on their own.

"Obviously, it's not illegal to take supplements, so we don't know what athletes are choosing to do themselves," DePalma said. "But they know how we feel about it, and we've taken a pretty firm stance.

"I think athletes in general think they're invincible. They think that no drug test will ever get them and no harm will ever come to them."

Schardt also noted that young athletes are susceptible to the marketing tactics used to sell supplements.

"Athletes are the perfect market for supplements," Schardt said. "They tend to look for any edge, and that makes them vulnerable to these marketing pitches. Who could turn down the chance -- no matter how slim the chance might be -- to jump higher, run faster or be stronger?

"While it's difficult for a teacher or a coach to come out and oppose these products and all the marketing behind them, someone needs to tell (student-athletes) that most of these products don't work."