Christian Blouin

Professor Echols

English Composition II

26 October 2021

How do different supplements affect your body, are they effective and are they safe?

Dietary Supplementation

Taking supplements can be difficult, there are lots of types and lots of ingredients to

research. This essay will provide knowledge and information as to which supplements

consumers should take and which they should stay away from. The FDA (Food and Drug

Administration) defines a supplement as being: dietary ingredient such as a vitamin, mineral,

herb or other botanical; amino acid; dietary substance for use by man to supplement the diet by

increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or

combination of the preceding substances. ( U.S FDA, 2020) New supplements are researched

and discovered everyday, made to aid our bodies' dietary needs for improved athletic

performance and overall health. The traditional vitamin and multivitamin supplements remain

much more popular as opposed to other dietary supplements which are less popular. However,

many take supplements to help build muscle or improve their performance during an athletic

competition. Athletes take supplements not only to build muscle but also to improve recovery

times and help with focus. Even those who may not need supplementation for athletic purposes

still may take a vitamin or multivitamin supplement. The majority of supplements are not

effective in building muscle or providing dietary aid. Research has shown that supplements are

less effective for athletic performance than what is advertised; however, multivitamins and
vitamins have proven to be effective. Some supplement manufacturers may not be producing the

product consumers think they are, creating unsafe products.

Take a case involving an olympian named Jessica Hardy who sought out for an Olympic

gold medal in 2008, but when she tested positive for a performance-enhancing drug called

clenbuterol her legacy came to end. Clenbuterol is classified as “a synthetic drug that promotes

the growth of muscle and has been illegally used by athletes to enhance performance”(National

Library of Medicine, 2021). To Jessica’s knowledge, she had only taken nutritional supplements

specifically from a company that marketed themselves for health and wellness. Clenbuterol was

not found on the ingredients list of the supplement brand she took but was found present by the

Hardys defense team. The supplemental company found no evidence of contamination in their

supplements and found the ingredients listed on the product were accurate. Hardy convinced the

World Anti-Doping Agency that she had digested clenbuterol inadvertently through a

contaminated supplement (Aschwanden, 2014). Once again, a consumer was sold a product that

was contaminated in some way. Buying supplements off the shelves can be dangerous even if the

customers purchasing them think they know what they are putting into their body.

Risks associated with these supplements can vary based on person and type of

supplement. Supplement companies have had quite a reputation for creating dangerous products.

“FDA investigators have repeatedly found safety problems with supplements, including

dangerous ingredients-everything from diet pills containing a drug previously pulled from the

market due to safety concerns to body-building supplements packed with anabolic steroids.” The

number of dangerous ingredients and lack of safety concern is disheartening (Aschwanden,

2014). In 2007 the FDA found that nearly half of the 450 dietary supplement producers had

major manufacturing violations. Manufacturers have no obligation to report adverse events to the
FDA which limits the already high number of events reported. In the case of an adverse event, a

person's health care provider will report the events to the FDA. The FDA found that the plan for

action on following up for events reported about dietary supplements are significantly more

expensive and require far more resources than following up about a food product. This makes the

FDA less proactive in this regard. A lack of resources from the FDA allows for a majority of

supplement companies to get away with a contaminated substance, or a lack of care for the

wellbeing of their consumers. It is difficult to decipher which supplements are safe and which are

not without having prior knowledge about ingredients or effects of the product consumers may

purchase (NIH, 2021).

Although the risk is low, there is still a chance a consumer buys a contaminated product.

To help prevent this, in 2007 the FDA (Food and Drug Administration) was given the power to

regulate the manufacturing and packaging of supplements. The FDA was not given the power to

police, in other words, FDA could create rules to help prevent manufacturing or packaging fraud

but was unable to act if a rule was broken (Aschwanden, 2014). According to the New England

Journal of Medicine, an estimated 23,000 emergency department visits are related to adverse

reactions or events associated with different dietary supplements. This number is very high, think

about the number of people taking dietary supplements and how many are severe enough to be

hospitalized. People fail to recognize the safety concerns many of these supplements bring to the

table. Visits involving the use of supplementation but also including self-harm, drug abuse,

therapeutic failures, nonadherence, or withdrawal were excluded. These hospital visits were

strictly based on the effect of the supplement to the body. 88.3% of these visits were attributed to

events using only one supplement as compared to having used multiple. In many cases,

combining different supplements or taking a vast selection can be very harmful if not deadly to
persons doing so. 25% of these cases involved persons between the ages of 20 and 34, Patients of

65 or older were hospitalized 16% of the time as opposed to 8% of the time with younger

patients. Seeing that 25% of cases involving younger personnel truly exemplifies how dangerous

supplements may be if not taken properly. Of these cases, the most common reason for

hospitalization was associated with cardiac symptoms including palpitations, chest pains, and

tachycardia (Geller, 2015). Whether or not these patients had pre-existing medical conditions

was not stated. The vast world for supplementation can be quite scary. There are many products

to choose from and a risk associated with each product. It is important to know the ingredients in

each supplement and how they affect the body to avoid potential harm to yourself.

A study in 2018 conducted in the Journal of the American Medical Association (JAMA)

found many dietary supplements to be altered with pharmaceuticals such as steroids, or erectile

dysfunction. Jessica Hardys case was a prime example of this, the ingredient contaminated in her

supplement is very similar to that of a steroid. 48% of these tainted supplements were recalled

and the majority of the supplements were still listed on the shelves for sale (Journal of the

American Medical Association, 2018). “The majority of new dietary supplement ingredients are

introduced to the market without any safety evaluation by the FDA because of “loopholes, vague

language in the law, and lack of industry compliance” Without a stable law and stable regulation

from the FDA as to what manufacturers can and cannot do, companies will continue to be greedy

and maintain a low level of care for harming customers as long as they are making money. In this

journal, Pieter Cohen, a physician at Cambridge Health Alliance stated that a legislative proposal

was in the works to “require all products marketed as dietary supplements to be listed with the

FDA and give the agency authority to act against non-compliant products and the manufacturers

of such products.” (Washington Post, 2021)(JAMA, 2018). If this proposal were to pass it would
change the safety of supplements drastically as the FDA would have to approve supplements

before they were listed for sale. ”The FDA doesn't have the funding to police supplements, and

there is no systematic monitoring of safety and effectiveness”, says Peter Lurie, a former FDA

official (Washington Post, 2021). A lack of funding for the FDA leaves very little to no control

over what supplements are being sold. Many supplement companies can find different loopholes

to surpass government regulations and still list a dangerous product for sale with the FDA not

enforcing regulations. If this proposal passed, the end to dangerous supplements would be

significantly closer.

A dilemma in the works, these dietary supplements are widely used and a majority can be

dangerous and harmful from certain manufacturers. Under current law, if a substance was present

before the year 1994 then it is not considered a new ingredient in production. With this being

said, dietary manufacturers lose motivation to conduct any research towards the safety or

effectiveness of their products as they can use them regardless of what they find. This is as long

as the drug was present before the year 1994 (U.S FDA, 2017). It is difficult to know if a

supplement or an ingredient found in supplements is safe. However, in some cases, consumers

may be able to look for an NSF certification which shows the supplement has been tested by

ConsumerLab and is safe for use (U.S FDA, 2017). For this reason, the FDA developed the

Dietary Supplement Ingredient Advisory in 2017 which provides consumers with a list of

products that may not comply with FDA rules and regulations. This list is not providing

information for harmful ingredients, simply a list of ingredients that could be determined unsafe

and are in the process of evaluation.

Many companies make broad claims about what their supplements may or may not do to

the body. “A series of reports published on July 19, 2012, in BMJ (British Medical Journal)
found a "striking lack of evidence to support claims about improved performance and recovery

from supplementation” (Aschwanden, 2014). The National Athletic Trainers Association

acknowledged the position that the outcome of taking various performance-enhancing

supplements are often equivocal. However, a study in 2009 found that an estimated 85% of elite

track and field athletes took supplements despite the various studies presented (Aschwanden,

2014). Additional studies find that the vast majority of athletes and active adults continue to take

supplements. A survey of 1,248 students aged 16 or older in 5 U.S colleges in 2009-2010 found

that 66% reported the use of different dietary supplements (National Institutes of Health, 2021).

According to the National Institutes of Health, “dietary supplements may enhance performance

only when they add to and do not substitute for your dietary foundation.” A list of prominent

ingredients in many dietary supplements provided by the NIH lists the majority of ingredients as

having little to no effect or no clear evidence to back up claims made by many supplemental

companies. However, there is still a vast market for supplementation that has been proven

effective.

The majority of marketing for supplements is focused on muscle growth, a well-sought

aftermarket. Supplements to enhance athletic performance come in a variety of forms including

tablets, capsules, liquids, powders, and bars. The most common of these are amino acids, protein,

caffeine as well as creatine. Creatine is a naturally occurring compound found in your body

formed during muscle metabolism. Creatine supplement is used throughout the muscle building

industry and was found to help supply muscles with energy for short periods of time (National

Institutes of Health, 2021). Research found that creatine will “increase strength, power, and work

from maximal effort muscle contractions; over time helps the body to adapt to athlete-training

regimens” However this was found to be of little or no value for endurance training/ sports
(Berlatsky, 2014). Creatine proved to be beneficial despite a reputation of supplemental

companies creating vast claims about their products. Creatine does have a list of adverse effects

such as weight gain due to water retention, nausea, diarrhea, muscle cramps, as well as muscle

stiffness which can shy away some consumers.

A popular supplement taken in addition to creatine is a substance known as Betaine.

Betaine is a substance made in the body that aids liver function and helps to metabolize amino

acids. Betaine is also found in different foods such as beets, spinach as well as whole-grain bread

(National Library of Medicine, 2021). Betaine will offer modest strength and power-based

performance improvements in bodybuilders and cyclists due to a slight increase in creatine

production. The substance seems to be perfectly safe as there have been no adverse effects
reported as of March 2021. Arginine is another ingredient found in a variety of different athletic

and bodybuilding supplements. Arginine is an amino acid used in the creation of proteins. NIH

states that arginine “Increases blood flow and delivery of oxygen and nutrients to skeletal

muscle; serves as a substrate for creatine production; increases secretion of human growth

hormone to stimulate muscle growth.” Another popular supplement taken among much of the

United States is caffeine. Caffeine was found to have enhanced performance in endurance-type

activities such as running. Caffeine blocks the activity of a neuromodulator which reduces the

body's perceived pain and exertion during activity. Caffeine stimulates the central nervous

system, muscles, and other organs as well. Therefore, caffeine will enhance your arousal,

increase vigor and reduce your fatigue. Unfortunately, many adverse side effects are reported.

Caffeine may cause the following: “Insomnia, restlessness, nausea, vomiting, tachycardia, and

arrhythmia; risk of death with acute oral oses” (NIH, 2021). The next substance found to be well

researched and proven to have positive side effects was beet juice. Through nitric acid obtained

from beet juice, blood vesicles are dilated in the exercised muscle when oxygen levels are

declining. Although, ingestion of beetroot through powder in different supplementation has not

been proven effective; beet juice was found to improve performance and endurance in different

endurance-based exercises or competitions. The conducted research has found no evidence for

adverse side effects or safety concerns towards beet juice. Another popular ingredient found in a

variety of supplements are antioxidants. Antioxidants are: substances that prevent or slow

damages to different cells. Exercise increases the body's level of stress, with this being said,

research has found that supplements containing antioxidants could reduce skeletal muscle

damage, fatigue, and help to promote recovery in your contracted muscle.

 The National Institutes of Health has created a page dedicated to dietary supplements for

weight loss. Weight loss is another common reason many people look towards supplementation.

Weight loss supplements are sold in a variety of forms including herbs, minerals as well as fiber.

You can also find capsules, tablets, liquids, and even powders to supplement your diet.

Unfortunately, the majority of ingredients found in weight loss supplements have not been

researched thoroughly or have not been proven as effective as marketing may make them seem.

Companies do not typically research to determine if the product they create is safe or let alone

effective. When some companies conduct their research, it is typically done with a small group

of people over the course of a couple of weeks or a couple of months. For the FDA to determine

if a weight loss substance is effective, the weight loss supplement or ingredients in the

supplement must be studied with larger sample sizes for longer periods (NIH, 2021). This

process can take months or even years to complete which is why many companies will not bother

with thorough research.

Vitamin and multivitamin/ mineral supplements are quite popular amongst the

supplementation industry. These popular supplements are typically found in tablets varying in

composition as manufacturers have no regulation as to what ingredients go into each tablet or the

amount. The most common reason for taking an MVM (multivitamin/ mineral) is to aid people in

reaching their recommended dietary values that are not obtained from food. The majority of the

population should be able to meet recommended dietary values just from the food they eat.

However, many people will also take MVMs to try to help prevent chronic diseases (NIH, 2021).

However, some studies will attribute taking MVMs to preventing disease; it is difficult to suggest

this as the person taking MVMs are more likely to live a healthier lifestyle than those who do

not. Some may believe that MVMs could help prevent cancer or other diseases though research
to back this up is not thorough. A study provided by the Office of Dietary Supplements found

that women aged between 20 and 79 taking MVMs for 10 years were at no less risk for breast

cancer than nonusers. However, another study involving men and women aged between 50 and

71 taking MVMs for nearly 16 years found that the men and women had an 18% lower risk of

developing colon cancer than nonusers.

Supplementation is thought to be many things. It is thought to be dangerous, useful, safe,

or useless however, all of these are true. The vast majority of different supplements listed for sale

are not safe despite the FDA making an effort to stop this. Many supplements including creatine,

caffeine, amino acids, and protein can all prove to be very useful and very effective as long as

those taking them are using them properly. The majority of supplements are used for athletic

purposes and bodybuilding, therefore, the majority of supplements discussed are related to

muscle growth, muscle endurance and the overall effectiveness of each supplement. Even so,

other supplements such as MVMs have proven to be effective in some scenarios. However, a

lack of thorough research has yet to back this statement up. Supplements are over marketed and

can be effective but in most cases are not as effective as the majority of the population seems to

think.

Works Cited

Aschwanden, Christie. "Athletes, Stop Taking Supplements." Dietary Supplements,

edited by Noah Berlatsky, Farmington Hills, MI, Greenhaven Press, 2014.

Opposing Viewpoints. Gale in Context: Opposing Viewpoints,

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OVIC?u=dayt30401&sid=bookmark-OVIC&xid=f7c37d72. Accessed 13 Oct. 2021.

Originally published in Slate, 2012.

Berlatsky, Noah, editor. Dietary Supplements. Farmington Hills, MI, Greenhaven

Press, 2014. Opposing Viewpoints. Gale in Context: Opposing Viewpoints,

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OVIC?u=dayt30401&sid=bookmark-OVIC&xid=d3667ded. Accessed 13 Oct. 2021.

Cohen, Pieter A., editor. "Analysis of Ingredients of Supplements in the

National Institutes of Health Supplement Database Marketed as Containing a

Novel Alternative to Anabolic Steroids." Journal of American Medical

Association, 15 Apr. 2020, jamanetwork.com/journals/jamanetworkopen/

fullarticle/2764399?resultClick=24. Accessed 27 Oct. 2021.

"Dietary Supplements for Exercise and Athletic Performance." National Institutes of Health, U.S

Government, 29 Mar. 2021, ods.od.nih.gov/factsheets/

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"Dietary Supplements for Weight Loss." National Institutes of Health, U.S

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www.nejm.org/doi/full/10.1056/NEJMsa1504267. Accessed 13 Oct. 2021

National Library of Medicine. 23 Oct. 2021, pubchem.ncbi.nlm.nih.gov/compound/

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"Prohibited, Unlisted, Even Dangerous Ingredients Turn up in Dietary

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