We are bombarded with advertisements for pills to lose weight, build muscle and increase our performance. This marketing must be separated from scientific data. The Food, Drug, and Cosmetic Act defines “drug” as anything intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease and anything other than food intended to affect the structure or function of the body. These specific words permit the FDA to stop the marketing of products with unsubstantiated claims on their labels. The marketing of dietary supplements is under the control of the U.S. Food and Drug Administration [FDA] according to a different set of rules—the Dietary Supplement Health and Education Act of 1994 (DSHEA). These rules [DSHEA] define dietary supplements as vitamins; minerals; herbs or other botanicals; amino acids; other dietary substances to supplement the diet by increasing dietary intake; and any concentrate, metabolite, constituent, extract, or combination of any such ingredients. Although many such products (particularly herbs) are marketed for their alleged preventive or therapeutic effects, the 1994 law has made it difficult or impossible for the FDA to regulate them as drugs. Today, the only way the FDA can eliminate a supplement is to prove it is unsafe. Ingredients that are useless are allowed as long as they are harmless. Also, the FDA cannot practically ensure that the ingredients listed on product labels are actually in the products. Thus manufacturers of supplements are responsible for evaluating the safety and labeling of their products before marketing. The supplement companies are expert at advertising their products through magazines, radio and television broadcasts, and the Internet. In summary, the 1994 Dietary Supplement Act does not require dietary supplements to be safe or effective before they are marketed. The FDA does not have the ability to evaluate a dietary supplement before it enters the marketplace. The FDA is permitted to restrict a substance if it can be proven to be harmful.
The reason you may need supplements is that with vigorous exercise, your body needs time to recover and repair and build new muscle. Supplements may help your body recover and prevent injuries. Most supplements are not needed if you do not exercise vigorously on a regular basis. If you are eating a high-protein diet and are exercising vigorously, you cannot consider yourself to be part of the general population: you are an exception. Still, many recommendations for supplements are without a scientific basis, and are part of the culture of healthy supplements and bodybuilding.
Fish Oil-Still a Question-Possible Yes Fish oil contains two essential omega-3 fatty acids that our bodies need and must obtain from food: docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These essential fatty acids are present in salmon, mackerel, sardines, flaxseed, chia seeds, walnuts and canola oil. You need them. The negative data comes from a negative study evaluating prostate cancer prevention in men taking selenium and Vitamin E [Brasky TM, et al. 2013. JNCI 10]. The study was negative, but did reveal an increased prostate cancer risk in men with higher blood levels of long-chain polyunsaturated fatty acids. This was based on a single blood test and was not randomized nor prospective [level 3 or 4]. In addition, taking fish oil supplements did not improve the natural history of patients with known coronary risk factors [Roncaglioni MC, et al. May 9, 2013. NEJM]. There are multiple studies that do show that the combination of fish oil and exercise increase protein synthesis in muscle cells and improve insulin sensitivity [Heikkinen A, et al. 2013. Int J Sport Nutr Diet 100:1-21] [Sanchez-Benito JL, et al. 2007. Nutr Hosp 22(5):552-559]. Fish oil has anabolic properties and is useful in building muscle despite not being able to improve heart disease and possibly increasing prostate cancer risk.
Whey Protein-Yes There are multiple studies showing that whey protein rapidly stimulates protein synthesis and increases muscle hypertrophy. Whey protein is best taken early post-exercise [Phillips SM. June, 2010. Summer Meeting Nutrition Society, Edinburgh]. This is not controversial—whey protein after exercise will help you build muscle. You must be careful which protein powder you choose, since some of the popular protein products may contain relatively high amounts of cadmium, arsenic and mercury. I recommend whey powders from farms in New Zealand.
Creatine-Yes -with caution Creatine makes more ATP in the mitochondria available for muscular activity, and this longer duration of muscle contraction enhances the power of athletes over a short period of time. Creatine is not important for endurance athletes. Taking approximately 20 g of creatine per day for 7 days shows a measurable increase in power production during short-duration resistance exercises to muscle failure. Creatine has not been shown to improve long-duration endurance exercise. Elevated muscle creatine enhances exercise performance by matching ATP supply to ATP demand. An increase in body weight from 1 to 2 lbs is common after 1 week of creatine supplementation due to an increase in intracellular water. There is little data on long-term creatine use. Creatine allows users to train more intensely. Few adverse side effects have been found with creatine use in healthy individuals [Kraemer WL, Volek JS. July 1, 1999. Sports Medicine Clinics, Elsevier]. In addition, a meta- analysis performed at the University of Regina, SK, Canada, in 2014 showed improvement in bone mineral density and muscle growth in older adults with the addition of creatine supplementation to resistance training. If you have a history of renal dysfunction, you should not take creatine, because it will increase the level of serum creatinine that your physician uses to measure your renal function. I recommend the minimum maintenance dose of 1-2 gm per day, with frequent vacations from use for older adults.
DHEA-Still a Question-Possible Yes DHEA is available commercially as a supplement and is aimed at improving libido and well-being. There is little evidence to support the use of DHEA for this purpose. Dehydroepiandrosterone (DHEA) is a precursor for the production of androgens and estrogens in non-reproductive tissues. Levels of DHEA decline with age. It has been postulated that restoring the circulating levels of DHEA to those found in young people may have anti-aging effects and improve well-being and sexual function. There is no randomized prospective scientific data to support this. In patients with adrenal insufficiency, there is some positive data.. The studies of DHEA therapy in patients with adrenal insufficiency suggest that this group is the most likely to derive health benefits from DHEA supplementation.
There is one interesting positive study [Yen, et al. 1995. Annals of the New York Academy of Sciences 774:128-142]. In this study, men and women over the age of 50 took 50 mg of DHEA daily. DHEA levels rose to those of young adults within two weeks.
The subjects had their immune systems assessed through the measurement of lymphocytes, T-cells and natural killer cells. The DHEA increased the levels of these cells by 67% in men and 84% in women. A follow-up study using 100 mg of DHEA showed that the subjects also experienced gains in lean body mass and an increase in muscular strength. The male subjects also experienced a significant decrease in body fat. There are no long-term studies of elderly subjects taking 100 mg of DHEA daily.
TESTOSTERONE – THIS TOPIC REQUIRES A SEPARATE BLOG ENTRY
According to the U.S. Library of Medicine and the U.S. Institute of Health, testosterone is a hormone made by the testicles in men. It is the most important androgen (male) hormone in the body. Androgens such as testosterone are often called “steroids” or “anabolic steroids.” Testosterone is important for:
- Keeping bones and muscles strong;
- Making sperm;
- Maintaining sex drive;
- Making red blood cells; and
- Feeling well and having energy in general.
As you become older, testosterone levels slowly drop. This can lead to various signs and symptoms which may include:
- Low sex drive;
- Problems having an erection;
- Low sperm count;
- Sleep problems such as insomnia;
- Decrease in muscle size and strength and in bone density;
- Increase in body fat;
- Depression; and
- Trouble concentrating.
HCG—HUMAN CHORIONIC GONADOTROPIN—THIS TOPIC WILL BE DISCUSSED IN A SEPARATE BLOG ENTRY HCG is indicated in the prevention of testicular atrophy associated with the long-term use of testosterone.
HMB-YES HMB [B-hydroxyl-B-methylbutyrate] is an effective supplement in adults for increasing lean body mass based on a meta analysis and multiple scientific studies [Vukovich MD, et al. 2001. J Nutr 131:2049-2052]. HMB and a mixture of other branch chain amino acids improve protein metabolism and increase lean body mass in elderly and chronically ill subjects. HMB benefits athletes, defined as 3 weeks or more of resistance-training, 2 or more times a week [Nissen SL, Sharp RL. 2003. J. App. Physiology 94(2):651-659]. HMB has data supporting its use to augment lean mass and strength gains with resistance training.
VITAMIN D AND CALCIUM-YES According to the National Institute of Health Office of Dietary Supplements, older adults are at an increased risk of developing Vitamin D insufficiency. Older skin cannot synthesize Vitamin D efficiently. Many adults spend little time outdoors, and they may have inadequate dietary intake of this vitamin. Many adults with hip fractures in the United States have low serum Vitamin D levels at <30 nmol/L (<12 ng/mL) .