Why does the NCAA recommend against the use of dietary supplements?

Every time a student-athlete or a trainer asks us a question about a dietary supplement, we attach a standard warning, regardless of whether the listed ingredients are banned or not. Often, we are asked the questions, “why do you give this warning,” “what does it mean”, and “why do you suggest that student-athletes not use dietary supplements?” Below, is the standard warning we give, with an explanation of the statements.

“Products labeled as dietary supplements sold over the counter, in print advertisements and through the internet are under-regulated by the U.S. FDA. Whether a product is classified as a dietary supplement, conventional food, or drug is based on its intended use by the manufacturer.  Please be aware that some companies manufacturer dietary supplement and conventional food products*. Dietary supplements are at risk of contamination or may include ingredients that are banned under your drug testing policy.    Studies have found 12-25% of dietary supplements contain unlisted steroids, stimulants, or trace metals.” – Why are dietary supplements at a risk for contamination? Consider these points, (1) Manufacturers do not have to prove the safety and effectiveness of a dietary supplement before it is marketed. (2)Manufacturing facilities are virtually unregulated, they are required to adhere to Current Good manufacturing Practices (CGMPs) , but  unfortunately only an average of 5 inspections take place a month (consider the total number of products sold today…thousands!) (3)  A number of company’s contract manufacture their products and leave the sourcing of ingredients to the contracted company.  So the true identity of the ingredients can be cut or changed without the parent company ever knowing.  This was solidified by the FDA’s Brad Williams participating in an education program at Supplyside West, and he said the number one issue with companies inspected under the supplement GMP program has been failure to adequately test ingredients for identity. 

“We cannot guarantee the safety or purity of any dietary supplement product. Also, the claims made by manufacturers may not be backed up with reliable, scientific research. Student-athletes take any dietary supplement at their own risk.” Without proper testing of the finished product, there is no way to know if the ingredients, and their amounts, listed on labels are correct. You could be getting too much, too little, or none at all of the so-called “active” ingredients. Remember, products do not have to prove their level of safety or effectiveness before they are sold. Often, the “research” a company cites is not reliable, has been done by a party that has interest in the success of the product, or is not scientific in nature. Below are a few tactics used by Supplement Company’s:

·         Misrepresented clinical studies (results out of context, “University tested”, inappropriately referencing research results)

·         False, exaggerated, or purchased endorsements (How much money is the athlete making for saying he takes a product?)

·         Media distortion and false advertising (planted stories online, Company reps posing as local gym guy online in forums, “As seen on Oprah”)

·         Omitting relevant Facts (Product marketed to men but all research done on women)

“The REC does NOT recommend the use of any dietary supplement or manufacturer; please submit all dietary supplement questions to the REC.” While we realize that not all companies are trying to dupe consumers or engaging in dishonest practices, there is no easy way to tell between the “good” and “bad” companies.

“Please be aware that some companies manufacturer dietary supplement and conventional food products.  Products produced in the same manufacturing plant or by the same company could potentially have contamination issues.” Be aware that we have no way to know for sure that a product labeled as a conventional food product but still manufactured by a dietary supplement manufacturer is 100% safe, unfortunately.  If a company is manufacturing meal replacement bars, and shakes, but also manufactures DHEA, you could have a potential problem.

“Remember to report all medications and supplements to your sports medical staff, no matter how insignificant you believe them to be, it could save your life.” Your sports medicine staff needs to know what you are taking, even if it is something as simple as a vitamin. Medications and dietary supplements could pose health risk for some if combined. Those in charge of your health need to know everything you take to give you the best care, especially in case of an emergency.

Again, we realize that there may be benefits to some dietary supplements and that not all manufacturers engage in dubious practices. However, our first commitment is protecting the health and safety of student-athletes. Lastly, we are dedicated to helping protect the integrity of sportsmanship in all sports, and at this time that includes not suggesting dietary supplements.

Where do you get your information on dietary/nutritional supplements?

We know that at least 69% of student-athletes purchase their supplements at their local retail store (2009 NCAA Study).

I can’t tell you how many calls we get that include the following statements, “The guy at the nutrition store told me I should take Product X. He said it would be fine to take and doesn’t have anything banned in it. He said it is safe.” We’ve discovered a trend; often times the sales clerk is wrong in his/her assessment of the product and really has no clue what impact the product will have on athletes health or eligibility. So where do you get your information on dietary/nutritional supplements? Do you turn to the person at the “nutrition” store or perhaps through a web search? Do you ask friends, coaches, or family members? Why do you ask these individuals for help?

Often, when we try to educate about a certain supplement and warn student-athletes about potential complications of use, we are asked, “how do you know?” We have had individuals demand proof that dietary supplements can be contaminated, or why a certain substance should or should not be banned. We are more than happy to provide proof and offer solutions that will help the athlete stay healthy, both on and off the field, but our question is, why do you not demand the same proof from those who suggest products to you? Do you ask the person at the nutrition store how they know the product will help you gain muscle? What is their expertise? Do you demand scientific evidence?

When you search online, do you research the manufacturer’s claims? Do you ask your friend how they know a product will work for you? Do you request their qualifications?

We are also aware of a lot of direct marketing. Companies selling Deer Antler Velvet, male enhancement products, etc., are sending emails directly to student-athletes. They may be using your name in the subject line and might even know your sport. In copies we have seen, they are telling you how great their product is, that it is safe, AND that it is NCAA “legal” or “approved”. This type of marketing personalizes the message to you. This helps gain your trust. Ask yourself, who are they? How did they get my name and email? What type of information are they giving me? What do they stand to gain? Is it worth my health and/or scholarship/career?

Our point is this: Don’t believe something just because someone tells you that it is true. The fact is, most dietary supplements are not backed by reliable, scientific evidence. They could be a waste of money, they could be harmless but ineffective, or they could be dangerous. With most products, there just isn’t enough information to make the claims that are made at “nutrition” stores, in direct marketing, or on the web.

Proof:

Banned ingredients in supplement cause failed drug test at PanAm Games
U.S. Marshals Seize Products containing banned ephedrine for Dietary Supplements
HCG Diet – Products are Illegal
Tainted Weight loss products
Tainted Products Marketed as dietary supplements
Tainted Body Building Products: Includes warning letters, Enforcement, and Recalls

FDA reminder: Remember, FDA cannot test all products on the market that contain potentially harmful hidden ingredients. Enforcement actions and consumer advisories for tainted products only cover a small fraction of the tainted over-the-counter products on the market.

Dietary Supplement Q & A: What is considered a supplement?

If someone asked you, “Do you take supplements?” what would you say? What do you think of when you hear the term supplement? Do you think of those containers you see at the gym that are called things like Serious Mass, NO-Xplode, and Creatine? What about your multivitamin? The GU gel you take during training runs? How about the 5 hour energy shots you take before a game?

The answer to this question isn’t an easy one. After reading research on supplement usage rates, I was finding a wide range of answers and a wide range of products mentioned. A lack of understanding of the term “supplement” makes research on usage rates difficult. It is also challenging as we try to educate student-athletes on risks of supplement use, to both their eligibility and their health. To help you navigate through the murkiness, here are some definitions.

Dietary Supplement - As defined by the FDA , a dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates, and may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. They can also be in other forms, such as a bar, but if they are, information on their label must not represent the product as a conventional food or a sole item of a meal or diet.

Nutritional Supplement – Any product intended to supplement the food diet. This can include multivitamins, protein powders, sports drinks and gels, etc. Anything that is not a traditional food can fall into the nutritional supplement category.

Cold Weather Hydration

We are constantly reminded in the summer months and early fall to stay hydrated, but It's easy to forget about hydrating when it's cold outside, you don't feel hot and sweaty and many don’t associate cold weather with dehydration.  Unfortunately the reality is you're still losing moisture, both through sweating (sweat evaporates quickly in cold, dry air) and breathing.  Yes, breathing… when you exhale the air from your lungs, you probably notice it in the form of a small cloud, that cloud contains moisture from your body.   

Small levels of dehydration lead to significant decrease in physical and mental performance.  So as an athlete please remember to constantly monitor your level of hydration, and don’t wait until you fell thirsty to drink something, because this could be far too late.  The classic rule of thumb is to keep an eye on the color of your urine. Clear is ideal, less clear not so ideal and dark urine is bad and often means you're dehydrated.

Tips to stay hydrated

·         Drink something after waking up (milk, orange juice, water, etc…)

·         Drink throughout the day (carry a water bottle to class)

·         Drink even though you may not be thirsty

·         Avoid energy drinks before practice

·         Limit alcohol consumption

August 2010 blog on fall hydration

Hydration Chart – June 2011

Methylhexaneamine – Q & A

Q:  Can my dietary supplement which includes Methylhexaneamine (1, 3 Dimethylamylamine also listed as geranium oil or plant) cause a positive drug test?  More specific, will it cause a positive for Meth?

A:  We consulted with Clinical Reference Laboratory here in the KC Metro area and we discovered that Methylhexaneamine could cause a false-positive screen by immunoassay but would confirm as a negative sample after gas chromatography-mass spectrometry (GC-MS).  So simply put, chemically it is not methamphetamine nor will it ever create amphetamine or methamphetamine in the body.  The chemical structure is too simple to begin with and the body cannot make it into something more complex.

Methylhexaneamine is currently banned by most sport governing bodies including the NCAA and WADA under the stimulants drug class.   So Methylhexaneamine which is commonly found in weight loss preparations and pre-workout dietary supplements will cause a positive drug test for a stimulant.

Below is a recent report published in the Journal of Analytical Toxicology, Vol. 35, April 2011.  The report explains more indepth how a positive drug test can be registered.



Four Tips for Nutrition During Injury Recovery

Most athletes have heard of RICE (rest, ice, compression, and elevation), when it comes to injury recovery. But there is another aspect of injury recovery that many often forget - nutrition and diet. Are you eating to help your body recover? Read these four nutrition tips for injury recovery:

1. Remember that your activity level has decreased. You may put on weight if you eat the same portions you normally do as you are not burning as many calories. To keep your weight stable, pay attention to your caloric intake and stop eating when you aren’t hungry, even if you usually eat more.

2. Eat wholesome foods post injury to get the vitamins and minerals you need. Choose foods such as broccoli and spinach or citrus fruits, yogurt, lean meats and milk.

3. Be sure you are eating protein. If you have a diet lacking in protein, you are missing important nutrients, like iron and zinc, that can help healing. Eat a protein rich food at each meal.

4. The American Dietetic Association suggests getting plenty of the following nutrients to help the healing process: Vitamin C, Vitamin A and Zinc.

For more information on a healthy diet during injury recovery (or anytime), speak with a registered dietitian. You can find a sports dietitian in your area at http://www.scandpg.org/.

Resources:
http://www.active.com/nutrition/Articles/Injury__diet_and_recovery__Guidelines_for_nutrition_and_healing.htm
http://www.traxee.com/posts/1189-nutrition-for-injury-recovery
Handout from the American Dietetic Association http://www.lehighsports.com/assets/sportsmed/NutritionDuringRehab.pdf

Steroid use and injury

When I first started working at Drug Free Sport, I read Dan Clark’s book, “Gladiator: A True Story of ‘Roids, Rage, and Redemption”. I have to admit I learned a lot about the effects of steroid use from his story. We often warn student-athletes of the dangers of steroid use, breast development in men, acne, aggressiveness, etc., but reading about them in first person was an eye-opening experience. It was also from this book that I was first introduced to the link between steroid use and injury, something I think many people often overlook. As an athlete, this link is essential, because one injury could derail your career.
So what is the link between steroids and injury and why should you be concerned? Often the increase in muscle mass and increased speed, seen from steroid use, is not always followed by equal increases in tendon, ligament, and joint strength. These imbalances, along with rapid weight gain, increase the risk of injuries. Explosive movements already put an athlete at risk for injury, but can be made worse when the supporting elements around muscles aren’t trained or ready for these movements at such high speeds with so much muscle mass.

A study published in 2009, by The American Journal of Physical Medicine and Rehabilitation, found that self reported anabolic-androgenic steroid use was significantly associated with self-reported, medically diagnosed joint and cartilaginous injuries in comparison to non-users. These injuries included; disc herniations, knee ligament/meniscus injury, elbow injuries, stingers, spine injury, and foot/toe/ankle injury. It has also been suggested that the increase of tendon and ligament injuries in baseball is due to steroid use. Read more.

While more research is needed, the link between steroid use and injury is another risk added to a long list adverse effects.

Resources:

Self-Reported Anabolic-Androgenic Steroids Use and Musculoskeletal Injuries: Findings from the Center for the Study of Retired Athletes Health Survey of Retired NFL Players. American Journal of Physical Medicine & Rehabilitation: March 2009 - Volume 88 - Issue 3 - pp 192-200


http://psychcentral.com/news/2009/02/23/steroid-use-damages-health-later-in-life/4273.html

http://uncnews.unc.edu/content/view/2210/138/

http://onlineathens.com/stories/032911/spo_806925222.shtml

Dietary Supplements – The quackery of healing

A common claim of dietary supplements is their ability to heal. Whether it be healing an injury or helping cure a disease, there is always some substance, and in turn hundreds of dietary supplements, claiming to be beneficial. This can be dangerous, especially if individuals forgo regular medical treatment for a dietary supplement, believing that the supplement will cure them and they don’t need medical treatment. An athlete who believes the supplement they are taking is helping them heal faster, may begin training or competition before an injury has fully healed, causing more serious injury to ligaments, muscles, and joints. FDA labeling laws for dietary supplements prohibit companies from making claims that their products can cure, treat, diagnose, mitigate or prevent any disease.

We often refer to the claims made by these products as quackery. People believe these claims every day. Not only are there health consequences quackery can have economic consequences as well, causing individuals to spend money on a product that is not proven to work. Quackery can also cause a spread of misinformation and a push to weaken consumer protection laws.

Here are a some examples:

Debbie Benson died of breast cancer after refusing additional treatment after she had a lump removed. She went to a naturopath who gave her herbal treatments. Debbie ignored a swollen lymph node as she was told it was just an effect of the herbal products. When she finally went to the doctor, she found out it was cancer. She continued treatments with alternative healers but her condition deteriorated until she died .

In this story, Susan Fox and her husband were thousands of dollars in debt after pursuing a “work from home” project with Herbalife which required they purchase thousands of dollars in product, training materials, and phone plans. http://www.mlmwatch.org/13Victims/fox.html

Neuro Replete by CHK Nutrition. CHK has been at the center of attention for some time now because they have made health claims about their products. You can find additional information here: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm271703.htm

Cracking Down on Health Fraud - http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm137261.htm

FDA issues warning letters to marketers of unapproved "alternative hormone therapies" (items promoted for treatment or prevention of cancer, heart disease, and osteoporosis) http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2005/ucm108515.htm


H1N1 scams - http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm187728.htm

Recent conventions for illegally selling drugs - http://www.fda.gov/ICECI/CriminalInvestigations/ucm248636.htm

While there are may be alternative therapies for a condition, make sure there is sound, scientific evidence behind a product, substance, or therapy before you rely on them.

To learn more about quackery visit http://www.quackwatch.com/.

To learn about evaluating health information on the web visit http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/BuyingMedicinesOvertheInternet/ucm202863.htm

Alcohol: Is your consumption affecting you and your team?

The 2009 NCAA Study of Substance Use of College Student-Athletes leads me to believe yes.    Here are some of the statistics from the study:

·         Overall (Division I, II, II), 83.1 % of respondents indicated drinking within the last 12 months (this is true for both male and female).  This is an increase from the 2005 study (77.5%).

·         The majority of those reporting alcohol usage report frequency of use as less than two days per week.

·         Only 12.6 % reported never using alcohol.

·         Approximately 47 percent of those reporting alcohol usage report drinking six to 10 plus drinks in one sitting.

·         Fifty-four percent of the respondents indicated drinking during both their competitive and off seasons.

·         The majority of the respondents indicated obtaining alcohol from a friend, family member or teammate.

The survey also asked, “Why”, student-athletes used alcohol and, reasons not related to sports was ranked the highest amongst the other options.  For those that choose to abstain from alcohol consumption, not wanting the side-effects was the main reason.

Student-athletes are expected to be great at what they do, they are asked to maintain a high level of performance, both athletically and academically, all under the constant scrutiny of coaches, teammates, fans, and media.  Many problems start well before college and some escalate to levels that require intervention from coaches, parents, etc…Student-athletes are different from the rest of the student population and because of their constant exposure and elevated status on campus, college student-athletes are typically placed in situations that cause stress and anxiety.  Now this is not a valid excuse for a student-athlete to go on a drinking binge or neglect the rules obeyed by the rest of society, but we do understand that you are under constant pressure:

·         Balancing sports and academics

·         Adapting to social challenges

·         Success and failure on field and in classroom

·         Injuries

·         Weight management

·         Sports career ends due to injury or eligibility

Alcohol abuse is a chronic problem among college athletes, including football players. According to Dr. Gary Wadler, professor at New York University School of Medicine and author of "Drugs and the Athlete", alcohol is the No. 1 substance abused by athletes. It is estimated that college students in America drink about 34 gallons of alcohol every year.  Surveys have revealed that over 80 percent of college athletes are abusing alcohol, with a majority of athletes admitting that the drinking problem started before the end of high school.

How does alcohol affect me or my team?

                                                                                            

The following information represents the number of negative consequences experienced as a result of alcohol consumption in the last 12 months:

Experienced as a result of alcohol/drug use	Never	1-2	3-5	6+
Hangover	33.6%	25.7%	16.1%	24.6%
Missed Class	66%	17.8%	9%	7.3%
Poor Test or Project Performance	76.1%	15.6%	5.4%	2.8%
Missed or Late to Practice	93.8%	4.9%	1%	.3%
Poor Athletic Performance	79.3%	14%	4.4%	2.2%
Driven Under the Influence	76.9%	13%	4.8%	5.3%
Memory Loss	70%	17.3%	6.8%	6%
Done Something Later Regretted	62.4%	23.6%	10.4%	3.8%

Effects of Alcohol Abuse

Alcohol abuse has a variety of dangerous chronic and acute side effects on college athletes and their teams.  athletic performance can be hampered even with the smallest amounts of alcohol; some common side-effects are, hand tremors, slowed reaction time, poor balance, nutritional deficiencies, problems tracking, weakness, slowed hand-eye coordination. Lastly chronic alcohol abuse can cause myopathy, a condition that results in muscle weakness, damage or wasting.

Not every college student-athlete is at risk of being a substance abuser. Some individuals can drink responsibly and never abuse alcohol, but some individuals may develop a problem and will need help. As a coach, counselor, or concerned teammate it is important to note who might be at-risk for developing an alcohol-related problem.  Symptoms of substance abuse that may be observed in an athlete population include:

·         drinking in secrecy

·         feelings of guilt about drinking

·         lying about drinking

·         needing an increased amount of alcohol to produce the desired effects

·         alcohol-induced amnesia or blackouts

Student-athletes who display any of these symptoms might be experiencing problems related to their alcohol use.  If you don’t want the success of your team to suffer because of your own, or your teammate(s) alcohol consumption please become educated on the dangers of alcohol consumption and how to (if at all) consume it responsibly.

Many student-athletes struggle with stress management and choose poor coping strategies, such as alcohol.  If you want to learn more about coping strategies, or who to contact on your campus please consider the following:

Athletic Trainer	Registered Dietician	Coach
Parents	Campus Health Services	Off campus treatment centers
Individual groups on campus	Other Family members

Additional locations to search for information and help:

http://myplaybook.drugfreesport.com/

http://www.aa.org/?Media=PlayFlash

http://www.drugfreesport.com/rec (If you are a subscribing member please view Recreational Drugs)

http://www.smartrecovery.org/

http://www.befrienders.org/

http://www.factsontap.org/index.htm

http://teens.drugabuse.gov/

http://findtreatment.samhsa.gov/

http://www.bettyfordcenter.org/index.php