Separating Fact from Fiction in Nutritional Supplements

March 31, 2023 8 min read

There is no such a thing like a supplement that gives athletes magical powers. In fact, all supplement users should be aware of the medical, financial, and doping problems that may arise with its undiscriminated use. But first things first, what is a nutritional supplement?

According to the IOC (International Olympic Committee), a dietary supplement can be defined as: “A food, food component, nutrient, or non-food compound that is purposefully ingested in addition to the habitually consumed diet with the aim of achieving a specific health and/or performance benefit” (Maughan, et al., 2018).

Some of the typical forms in which we can find supplements are (Maughan, et al., 2018):

Functional foods: foods enriched with additional nutrients outside their typical composition (e.g., mineral or vitamin fortified products).
Formulated foods and sports foods: products formulated to provide nutrients and energy in a more convenient way compared with general foods (e.g., sports drinks, gel, bars, energy chews).
Single concentrated nutrients: concentrated nutrients from food or herbal sources provided in a practical way of consumption (e.g., sodium capsules, creatine tablets).
Multi-ingredient products: products that contain a combination of the elements described above to achieve a specific result (e.g., energy gel enriched with caffeine and creatine).

Overall, it is important to keep in mind that supplements are not a substitute for a balanced diet and should be used with caution under the supervision of a healthcare professional.

Understanding the Different Types of Supplements for Athletes: From Preventing Nutrient Deficiencies to Improving Physical Performance

There are innumerable supplements available in the market. All of them can be easily classified according to the reason why customers use them, as follows:

1. Supplements used to prevent nutrient deficiencies:

Most of the time, athletes use supplements to compensate for a deficit in a specific micronutrient or a set thereof. Even though deficiency of micronutrients can negatively affect athletic performance, most of them can be replenished through a good food-based nutrition plan without any extra supplementation.

Some of the micronutrients that most often athletes find they need to replenish are vitamin D, iron, and calcium (Maughan, et al., 2018). The supplementation protocol for vitamin D requires intake between 800 IU and 1,000-2,000 UI/day for the general population and 50,000 UI/week for 8 to 16 weeks for athletes (Heaney, 2008). And, when 1,500 mg/day of calcium is mixed along with 1,500-2,000 IU of vitamin D it has been shown to improve bone health (Thomas, Erdman, & Burke, 2016). When it comes to iron deficiency, female athletes need around 18 mg/day and male athletes 8 mg/day, however it should be noted that iron consumption should be always supervised by a healthcare professional (Thomas, Erdman, & Burke, 2016).

Keep in mind that the above recommendations work for athletes with a clinically proven deficiency of the nutrient, and supplementation must be closely supervised by a healthcare professional. Under no circumstances should you self-medicate, as risks may range from mild intoxication to death.

2. Supplements used to provide energy and nutrients when doing physical activities:

Most sports foods (also called sports nutrition products) use carbohydrates, protein, and fat as energy sources. Carbohydrates are commonly the best way to obtain energy for exercise due to their short absorption time and quick availability in the bloodstream.

Typical sports foods used by athletes include sport drinks, energy chews, energy bars, protein supplements, etc. (Maughan, et al., 2018). The vast array of options in the market, combined with a lack of clarity about their usage protocols, may create disinformation. Therefore, here is a simple guide you can use to determine the amount of carbohydrates you need to eat per hour based on the duration of your training (Jeukendrup, 2014):

Duration of training	Amount of carbohydrates to be eaten	Type of carbohydrates recommended
1-2 hours	30 g/h	Single or multiple types of CHO
2-3 hours	60 g/h	Single or multiple types of CHO
>2.5 hours	90 g/h	Multiple types of CHOS

3. Supplements with strong evidence to improve physical performance (in specific scenarios):

There are a few supplements that have sufficient scientific evidence to suggest they improve physical performance. There is a medical consensus that caffeine, creatine, sodium bicarbonate, beta-alanine, and nitrates can be considered performance-enhancing supplements. Below, you can find the accepted protocols and specific conditions that need to be met for their use to increase your physical performance (Maughan, et al., 2018):

Supplement	Description	Protocol of use
Caffeine	Stimulant that possesses benefits for athletic performance in endurance-based situations, and short-term, supramaximal and/or repeated sprint tasks. (Maughan, et al., 2018)	3-5 mg/kg, 1 hour before physical activity. (Christensen, Shirai, Ritz, & Nordsborg, 2017)
Creatine	Helps performance in sports involving repeated high intensity exercise, resistance, or interval training by leading to greater gains in muscular strength and power. (Maughan, et al., 2018)	4 doses of 5 g a day for 5 days, followed by one dose a day of 3 g. (Kreider, et al., 2017)
Sodium Bicarbonate	Improve the extracellular buffering capacity, increasing the high intensity exercise performance. (Maughan, et al., 2018)	300 mg/kg, 1-2 hours before exercise. (Stellingwerff, et al., 2019)
Beta alanine	Improve the intracellular buffering capacity, increasing the high intensity exercise performance. (Maughan, et al., 2018)	4 doses a day of 800 mg for 6 weeks. (Harris, et al., 2006) (Hill, et al., 2006)
Nitrate (beetroot juice)	Nitrate augments exercise performance by reducing ATP cost of muscle force production, increasing efficiency of mitochondrial respiration, and increasing blood flow to the muscle. Good for prolonged submaximal exercise. (Maughan, et al., 2018)	2 shots a day for 5-6 days. (Shannon, et al., 2017)

The Role of Placebo and Nocebo Effects in Supplement Use for Athletes

What about supplements not included in the last section? We all have a friend that says that some supplement worked fantastic for them. There are thousands of anecdotal cases, experts’ opinions, and general ideas of supplements that “work”, but the difference between those and the supplements listed before is the strictness of the papers, the replicability of the experiments carried on and the meta-analysis used to create the specific protocol shown above. In fact, the expected result of a supplement could be affected by many factors out of the athlete’s control; even the mind becomes an important factor, as we will see next.

In a recent study, the authors found that mouth rinsing with a pink non-caloric, artificially sweetened solution improves running performance and feelings of pleasure in habitually active individuals compared with the same colorless beverage (Brown, Cappozzo, & De Roeck, 2021). This is called the placebo effect. The study results proved that the pink beverage group could achieve an average of 200 meters more than the colorless beverage group. Besides, the mean speed of the pink beverage group increased by 4.4% and the pleasure sensation was enhanced in this group. As you can see even the color of the supplement could create a placebo effect for the athlete and hence the importance of being self-critical about the products that we consume.

In another study (Hurst, Foad, Coleman, & Beedie, 2017), the authors gave to a group of athletes an inert capsule described as “a substance which could negatively affect their performance” and the result was exactly that: the performance decreased, suggesting a moderate nocebo effect (the opposite of a placebo effect). This result shows us again the role of our brain in the sports performance and its susceptibility to positive or negative influences. In the same study, a group of athletes that had the serious intention to use supplements to improve their performance, received an inert capsule described as “a potent supplement which would improve performance”. The result: a minor but statistically significant improvement of the performance in a sprint test. The conclusion of the study is that both, a negative or a positive insight about a supplement can generate a placebo or a nocebo effect in the athlete.

Achieving Peak Performance: The Final Word on Supplementation

That is THE question. As we saw in the last section of this blog, our brain can be more powerful than the most "potent supplement," so, is the answer to be positive all the time and think only of achieving the goal? Well, certainly good vibes are essential in the improvement of performance, but good nutrition could be even better than a good mood.

Here is a step-by-step supplementation suggestion we made for you:

Start off with good food-based nutrition plan: all the substances that we can find in supplements can also be found in our regular diet. The cornerstone of improved physical performance is a diet that works for your needs. You can ask for help to your dietitian on this one.

After getting your diet taken care of, consider sports nutrition products: these provide you with energy in the form of carbohydrates, protein, and fat. As we saw previously, depending on the duration of the physical activity you pursue, you need to eat between 30-90 g of carbohydrates per hour, which without supplements would otherwise be difficult to achieve. There are plenty of options out there, but since you are already here, may we suggest you try products that offer multiple sources of carbohydrates and natural ingredients such as TITANIUM?

As a final step, consider supplementation with high scientific evidence (caffeine, sodium bicarbonate, beta alanine, creatine, and nitrates) under the supervision of your certified healthcare professional under two conditions: first, you are trying to accomplish a very specific goal and second, use them only if it is absolutely required. Consuming supplements with no scientific evidence and without frequent medical checkups may create a severe risk for you.

In summary, supplements should be seen as a tool to enhance an already solid foundation of nutrition and exercise. Starting with a healthy, balanced diet is crucial, followed by the use of sports nutrition products, and finally, only considering evidence-based ingredients under the guidance of a healthcare professional. Remember, supplements are not a shortcut to success, but a strategic addition to an athlete's overall performance strategy.