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Supplements: What You Ought to Know

Written by Dr. Skiba

My biggest beef with drug companies is that they market directly to the public. I don't like the fact that they are trying to horn in on the relationship between doctors and patients. You know how it goes: the company puts a commercial on television. You see some video of people frolicking in a field someplace, and all of them are smiling and laughing. Then, you hear a soothing voice telling you to "ask your doctor about MethylEthyBadS*%&", or, "ask your doctor if MethylEthylBadS*%& is right for you." Sometimes, they don't even tell you what the drug is supposed to do! Now, the company is not only trying to horn in, but is attempting to play on your paranoia. They want you to think there is something wrong with you, that there is a pill to make it better, and that your doctor is keeping this important information from you. It is wrong on so many levels.

The upshot of the drug companies, of course, is that they provide many medications that my patients would likely die without. Also, since they produce drugs, their medications undergo extensive testing to ensure that they do what the company claims they do. I can argue with their presentation, but when a company says that Epogen will raise the number of red blood cells circulating in your body, it is likely true.

I have a far bigger problem with supplement manufacturers. In their case, not only are they guilty of shady marketing, they are often guilty of trying to impersonate a drug company. The new ads for a particular supplement show packaging that very closely resembles that which the contraceptive pill comes in. Sometimes, the packaging resembles sample packets of legitimate drugs you may get from your physician. The company is trying to obscure two very important facts by this impersonation. First, they don't want you to know that the supplement they are pushing was most likely not subjected to extensive laboratory testing. Second, they don't want you to realize that they are not regulated by the Food and Drug administration.

That's right. There is almost no government oversight of supplement manufacturers.

Sure, you might see a small tag line that says, "These claims have not been evaluated by the FDA," or, "This product is not intended to treat any disease." That disclaimer takes up about three seconds of a sixty second spot insisting that this new supplement is heretofore unknown to science, and has been designed to make you sexier/thinner/hairier.

You may want to be sexier/thinner and/or hairier, but I am banking that if you are reading this, you are also interested in improving your endurance performance. So, let me get something out of the way: there are very few ways of doing that. I'll list them.

1. Pick parents who are more gifted athletically. (Too late to do that, sorry).
2. Train better/smarter. (Your best bet).
3. Take EPO. (Illegal, unsportsmanlike, and dangerous).
4. Take ephedra. (Dangerous, and now banned in the United States).
5. Take caffeine. (Yes, it works, and works better if you aren't already an addict).
6. Get better equipment.
7. Devise a better strategy.

My above comments should not be taken to mean that there will never be other ways to improve our performance. A company may, in fact, discover a supplement heretofore unknown to science. They probably will, someday. So, how will we know when that happens? Let me give you a couple of suggestions.

Mechanism of Action:
Any supplement will more than likely have to operate through a mechanism that is known to science. For example, there are many medications that cure strep throat, but all of them work by killing the bacteria that causes strep throat. Makes sense, right? In the same way, a supplement purported improve your VO2max could probably only operate in one way. It would need to improve the pumping capacity of your heart. (This is not strictly true; but will serve for most cases). So, we come to the first question you should ask: how is the supplement supposed to work? In drug terms, we would ask "what is the mechanism of action?" If there isn't a good explanation in plain English, you have reason to be suspicious.

Clinical trial:
Your next question ought to be, "How do they know it works?" The response would probably be "a trial". See if you can find out what kind of trial, and what the results were. It should have been placebo controlled, in other words, they should have given some people a sugar pill and some people the supplement, and then looked for a difference in performance. It should also have been double blind, in other words, the person providing the pill and the test subject should both have been unaware of which pill was given. In this way, the person will not be subject to influence from the provider, among other things. Finally, the performance test used should in fact be relevant to the type of exercise you are planning on doing. Creatine may give a sprinter a couple of seconds, but unless you see data showing that it will help you in a triathlon, don't believe it will.

Also, always look for a "P" value, and make sure it is less than 0.05. The "P" value indicates the statistical chance that the results were just random. In other words, if a study showed results with a P of 0.05, it means that there is a 5% probability that the results were due to chance alone. Thus, the odds are pretty good that the results are valid. 5% is the benchmark number most studies use. If you see results with a P value of 0.5, it means that there is a 50% chance that they were due to chance alone. If you saw something like that, you could be justifiably be skeptical

Finally, ask who did the trial, and how do the results benefit them. Was it the company? An independent group paid by the company? The local high school chemistry class? A university laboratory? You get the idea.

Believe in Science:
Scientists are professional skeptics. When something new comes on the market, they cannot help but test it and find out if it really works. Before you spend you hard earned bucks, find out what the scientists discovered. Surf over to Pubmed, and type in the supplement name (or the name of the active ingredient) and hit "search". You'll get a list of references involving the supplement, and a blurb on each reference telling what the study found. You might be surprised what you find. For example, a supplement was recently tested that a company claims improves VO2max. An independent group of scientists showed that this supplement does nothing of the sort. The company did not pull the supplement from the market. Rather, distributors now claim that there are "responders" and "nonresponders" to the active ingredients. (And, of course, that it is important to find out which you are because this is a really great product that could improve your VO2, sex appeal, eyesight, and quite possibly your curveball. But don't complain if it doesn't, because you might be a "nonresponder").

Right. A nonresponder. Like everyone studied by the scientists. Hmmm...

In any case, my goal isn't to prejudice you against any and all supplements. Some supplements have, in fact, been shown to work under certain circumstances (i.e. creatine, caffeine). I simply want to give you a framework to think about these things. Don't let yourself get suckered by some company's marketing department. You are smarter than that. Check out the claims. Think them over. If it sounds too good to be true, it probably is.

Until next time, keep training you brain. And your legs.

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