Nutritional supplements are a multibillion dollar industry in the United States. They are advertised heavily and sold everywhere -- at supermarkets, nutritional supplement stores, natural food stores, through magazines and over the Internet.

They come in many forms, including powders, tablets, capsules and liquids. Many segments of the population use them, from preteens to elderly.

If they are legal, what's the problem?

The problem is this: They may contain ephedrine and anabolic steroid precursors among their ingredients.

Those substances may be performance enhancers, and they are banned by the NCAA as well as all national and international sports governing bodies.

Nutritional supplement use is widespread among college student-athletes. In the 2001 NCAA Study of Substance Use Habits of College Student-Athletes, which was the largest and most comprehensive study ever done in this area, 21,225 student-athletes from all sports and all divisions anonymously completed a detailed questionnaire. They represented 713 NCAA member institutions.

Of all the respondents, 29.2 percent indicated they currently used some type of supplement other than multivitamins (see Table 1 for a list of substances used).

At least 4 percent of the student-athletes used nutritional supplements containing banned ingredients. The percentage was probably higher, since many preparations contain multiple ingredients, and users don't always read the label carefully or remember all the ingredients.

Where do student-athletes get their nutritional supplements and why do they take them? The answers are interesting.

The main sources of nutritional supplements are a retail store (58.7 percent), followed by a nutritionist/dietician (9.1 percent), friend or family member (9 percent), strength coach (5.2 percent), coach (4.8 percent) and athletic trainer (4.5 percent).

The major reasons student-athletes use nutritional supplements are to improve athletics performance (27.3 percent), improve physical appearance (27.3 percent) and weight loss/
weight gain (19.7 percent).

What are the consequences of nutritional supplement use?

In spite of repeated NCAA warnings to member institutions during the past several years, many student-athletes are not absorbing the message. During July 1999 through July 2000, the last full year for which statistics are available, a total of 96 student-athletes received one-year suspensions resulting from drug-testing violations. Forty-three of them (45 percent) were from ephedrine and nandrolone metabolites, both of which are found in many nutritional supplements. In the previous year (1998-99), the percentage was even higher.

Forty-three out of 89 student-athletes (48 percent) who lost a year of eligibility resulting from positive tests had ephedrine or nandrolone metabolites detected in their urine. Table 2 shows how ephedrine or nandrolone positives caused loss of eligibility during the past 10 years.

There has been a disturbing trend in the last eight years. Ephedrine or nandrolone positives as a percent of total positives resulting in loss of eligibility have risen more than three-fold, from 13 percent in 1991-92 to 45 percent in 1999-00.

This rise has coincided with the widespread publicity given in the past few years to alleged or acknowledged use of DHEA, Andro and Norandro by professional athletes. It also coincides with widespread advertising of energy-boosting and weight-loss products containing ephedrine.

Reversing the trend will require a concerted effort by athletics administrators, coaches and trainers at all institutions in all three divisions. There are too many student-athletes who are using preparations that are available legally, but can result in their disqualification and loss of eligibility.

Until we have reached every student-athlete with the message that legal is not permissible, we have not done our jobs.

Arnold Mazur is a member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, and on its Drug-Testing/Drug-Education Subcommittee. He is a staff physician at Boston College Health Services.