Bodybuilding and Performance Enhancement Supplements: What You Need To Know
Why do some bodybuilders and athletes take dietary supplements?
Some bodybuilders and athletes use dietary supplements to try to improve their strength, muscle mass, and energy. However, many of these types of products contain harmful ingredients. Also, for some substances, including glutamine, choline, methoxyisoflavone, quercetin, zinc/magnesium aspartate, nitric oxide, and L-arginine, there’s no clear evidence that they improve athletic performance.
What dietary supplements are banned by the NCAA?
The National Collegiate Athletic Association (NCAA) maintains a list of banned substances and explains that some dietary supplements may contain banned substances not listed on the product labels. BMPEA (a phenethylamine) and DMAA (dimethylamylamine) are two examples of substances banned by the NCAA. More information on BMPEA and DMAA is given below.
Are dietary supplements necessary?
Most of us can meet all of our nutritional needs from food. Health care providers will recommend a supplement if needed—for example, vitamin D if you don’t get much sun and are low on vitamin D, or vitamin B12 if you have difficulty absorbing vitamin B12 from food (including many people over 50 and those with pernicious anemia or digestive disorders) or if you follow a vegan or vegetarian diet that does not include adequate levels of vitamin B12.
What is creatine?
Creatine is an amino acid produced by the body and a popular dietary supplement. It may somewhat enhance the effects of exercise on strength, muscle mass, and endurance. But creatine can have some short-term side effects, and its long-term effects haven’t been well studied.
Is creatine safe?
There have been reports that creatine may impair liver and kidney function. Creatine has also been linked to an increased risk of compartment syndrome, a condition where pressure builds in a muscle compartment and prevents blood flow. People at risk of kidney problems should check with their health care providers before using creatine and be carefully monitored while using it.
There are no data documenting the safety of creatine in children or adolescents. The American Academy of Pediatrics and the American College of Sports Medicine warn that teens should not use performance-enhancing supplements, including creatine, because of the possible health risks.
Do performance-enhancing dietary supplements work?
Studies have looked at a variety of supplements used for bodybuilding or to improve physical performance, including glutamine, choline, methoxyisoflavone, quercetin, zinc/magnesium aspartate, nitric oxide, and L-arginine. There’s no clear evidence these supplements improve athletic performance.
The results of studies on beta-alanine, an amino acid found in food and dietary supplements, are mixed but generally don’t show that it improves athletic performance significantly.
Are bodybuilding supplements safe?
- Dangerous hidden ingredients are an increasing problem in products promoted for bodybuilding, the U.S. Food and Drug Administration (FDA) warns. Consumers may unknowingly take products laced with prescription drug ingredients, controlled substances, and other ingredients.
- Bodybuilding supplements often are adulterated with anabolic steroids that are modified variants of male hormones designed to increase muscle mass.
- Liver injury from taking bodybuilding dietary supplements has increased in recent years. Bodybuilding products are the most common cause of liver injury linked to herbal and dietary supplement use.
- Products containing the stimulants BMPEA or DMAA can cause serious health problems.
- Supplements labeled as containing the herb Acacia rigidula often contain BMPEA, although BMPEA isn’t in the herb and isn’t a dietary ingredient.
- DMAA-containing products marketed as dietary supplements are illegal. In 2013, the FDA began taking action to remove these products from the market. However, DMAA is still found in some products marketed as supplements, including under different names, such as geranium oil.
- Some dietary supplements may interact with drugs or other supplements. Some vitamins and minerals are harmful at high doses. Talk with your health care provider before using a dietary supplement for bodybuilding or endurance.
For More Information
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Office of Dietary Supplements (ODS), National Institutes of Health (NIH)
ODS seeks to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, supporting research, sharing research results, and educating the public. Its resources include publications (such as Dietary Supplements: What You Need To Know) and fact sheets on a variety of specific supplement ingredients and products (such as vitamin D and multivitamin/mineral supplements).
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Center for Food Safety and Applied Nutrition (CFSAN)
Part of the FDA, CFSAN oversees the safety and labeling of supplements, foods, and cosmetics. It provides information on dietary supplements. Online resources for consumers include Tips for Dietary Supplement Users: Making Informed Decisions and Evaluating Information.
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Dietary Supplement Label Database
The Dietary Supplement Label Database—a project of the National Institutes of Health—has all the information found on labels of many brands of dietary supplements marketed in the United States. Users can compare the amount of a nutrient listed on a label with the Government’s recommended amounts.
- Alvares TS, Conte-Junior CA, Silva JT, et al. L-arginine does not improve biochemical and hormonal response in trained runners after 4 weeks of supplementation. Nutrition Research. 2014;34(1):31-39.
- Austin KG, McLellan TM, Farina EK, et al. Soldier use of dietary supplements, including protein and body building supplements, in a combat zone is different than use in garrison. Applied Physiology, Nutrition, and Metabolism. 2016;41(1):88-95.
- Bellinger PM. β-Alanine supplementation for athletic performance: an update. Journal of Strength and Conditioning Research. 2014;28(6):1751-1770.
- Candow DG, Chilibeck PD, Forbes SC. Creatine supplementation and aging musculoskeletal health. Endocrine. 2014;45(3):354-361.
- Deminice R, Rosa FT, Franco GS, et al. Effects of creatine supplementation on oxidative stress and inflammatory markers after repeated-sprint exercise in humans. Nutrition. 2013;29(9):1127-1132.
- Herriman M, Fletcher L, Tchaconas A, et al. Dietary supplements and young teens: misinformation and access provided by retailers. Pediatrics. 2017;139(2):e20161257.
- Knapik JJ, Steelman RA, Hoedebecke SS, et al. Prevalence of dietary supplement use by athletes: systematic review and meta-analysis. Sports Medicine. 2016;46(1):103-123.
- Ko R, Low Dog T, Gorecki DK, et al. Evidence-based evaluation of potential benefits and safety of beta-alanine supplementation for military personnel. Nutrition Reviews. 2014;72(3):217-225.
- Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: vegetarian diets. Journal of the Academy of Nutrition and Dietetics. 2016;116(12):1970-1980.
- Navarro VJ, Barnhart H, Bonkovsky HL, et al. Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology. 2014;60(4):1399-1408.
- Ronis MJJ, Pedersen KB, Watt J. Adverse effects of nutraceuticals and dietary supplements. Annual Review of Pharmacology and Toxicology. 2018;58:583-601.
- U.S. Food and Drug Administration website. BMPEA in dietary supplements. Accessed at www.fda.gov/food/dietary-supplement-products-ingredients/bmpea-dietary-supplements on December 14, 2020.
- U.S. Food and Drug Administration website. DMAA in products marketed as dietary supplements. Accessed at www.fda.gov/food/dietary-supplement-products-ingredients/dmaa-products-marketed-dietary-supplements on December 14, 2020.
- U.S. Food and Drug Administration website. Tainted body building products. Accessed at www.fda.gov/drugs/medication-health-fraud/tainted-body-building-products on December 14, 2020.
- Aguiar AF, Januário RS, Junior RP, et al. Long-term creatine supplementation improves muscular performance during resistance training in older women. European Journal of Applied Physiology. 2013;113(4):987-996.
- Cooper R, Naclerio F, Allgrove J, et al. Creatine supplementation with specific view to exercise/sports performance: an update. Journal of the International Society of Sports Medicine. 2012;9(1):33.
- Dolan SB, Gatch MB. Abuse liability of the dietary supplement dimethylamylamine. Drug and Alcohol Dependence. 2015;146:97-102.
- Kim HJ, Kim CK, Carpentier A, et al. Studies on the safety of creatine supplementation. Amino Acids. 2011;40(5);1409-1418.
- Mason BC, Lavallee ME. Emerging supplements in sports. Sports Health. 2012;4(2):142-146.
- Maughan RJ, Greenhaff PL, Hespel P. Dietary supplements for athletes: emerging trends and recurring themes. Journal of Sports Science. 2011;29 Suppl 1:S57-66.
- MedlinePlus website. Creatine. Accessed at medlineplus.gov/druginfo/natural/873.html on December 11, 2020.
- MedlinePlus website. Herbal remedies and supplements for weight loss. Accessed at medlineplus.gov/ency/patientinstructions/000347.htm on December 14, 2020.
- MedlinePlus website. L-Arginine. Accessed at medlineplus.gov/druginfo/natural/875.html on January 7, 2021.
- Office of Dietary Supplements website. Vitamin B12—fact sheet for consumers. Accessed at ods.od.nih.gov/factsheets/VitaminB12-Consumer/ on November 30, 2020.
- Office of Dietary Supplements website. Vitamin B12—fact sheet for health professionals. Accessed at ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ on November 30, 2020.
- Terjung RL, Clarkson P, Eichner ER, et al. American College of Sports Medicine roundtable. The physiological and health effects of oral creatine supplementation. Medicine and Science in Sports and Exercise. 2000;32(3):706-717.
NCCIH thanks David Shurtleff, Ph.D., NCCIH, for his review of the update of this publication.
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