Availability. Due to their popularity and profitability, millions of American consumers are exposed to dietary supplements every day. Supplement exposure was once the exclusive domain of health food stores and organic markets, but has spread to large chain stores, the local grocery store and the Internet.

Population demographics. As the largest demographic group in America, the boomers are starting to turn 50 (about one every seven seconds). At this rate, people over 50 will account for more than 40 percent of the U.S. population within 20 years (about 130 million people). Why is this important? Mostly because folks in this demographic group tend to be concerned with maintaining their youthful activity levels by preserving their health and fitness -- which often includes regular exercise and nutritional supplements.

The self-care and prevention trend. The concept that it's better to stay well than to get well has taken hold over the past decade. Along with exercise, over-the-counter nutritional supplements represent a way for people to take responsibility for their own health and well-being.

How exercise compares

When debating whether to use supplements, remind clients of the many health benefits they are already getting from their exercise programs. Although it's easy to take the benefits of exercise for granted, it would be impossible to find a dietary supplement that can deliver the myriad of perks that can be had from regular exercise. At the start of each new year, Fitness Management publishes a "reasons to exercise" poster, displaying some of the top reasons and benefits of exercise. It's hard to imagine a dietary supplement that promises more than a handful of the 99 benefits on this year's poster.

Your role in sports nutrition

When it comes to dietary supplements and sports nutrition, there are a few ways to view supplements. At one extreme, someone could believe everything that they read and recommend that clients reach their health and fitness goals by swallowing pills and powders and spending hundreds of dollars on supplements each month. At the other extreme, someone could dismiss everything they read about supplements as hyperbole, and pass this cynicism along to clients by telling them that they're fools to consider any supplements. Clearly, neither extreme is the kind of thoughtful information that helps anybody.

Taking the middle ground, a person could try to balance the optimistic supplement claims with their own healthy skepticism by using the academician's way out -- saying that more research is needed before making a recommendation. Still another, more useful, approach is to use professional training and experience to appeal to a client's sense of logic. For instance, let's say that a client has been strength training on a regular basis for the past four months and now says that he read how HMB supplements (hydroxymethylbutyrate) can help him maintain muscle mass. Without knowing anything about HMB specifically, rely on training and experience to help the client weigh the pros and cons of starting a supplement regimen.

Although many supplements have been shown to be effective under certain conditions, set aside for now whether it can actually deliver on its health and fitness promises. Instead, try to focus on, and help the client understand, that an intelligent approach to exercise and diet are going to provide a much bigger "bang for the buck" than virtually any dietary supplement. Without the exercise program, the supplement is almost certain to fail in its promises. With the supplement, there may be an added benefit, but the magnitude of the effect will depend on a number of other factors related to exercise type and intensity, the adequacy of the individual's overall nutritional intake, and the body's response to the supplement.

Hot herbs and nutrients

What is it that makes one herb or supplement popular with the general public? The vast majority of dietary supplements, particularly herbals, had a long history of medicinal and therapeutic uses long before public interest became widespread. While there has certainly been a significant upswing in both the quantity and quality of scientific research on dietary supplements, the results from such studies generally serve as the basis for developing product claims relating to the function of the supplement in the body. Even though the specific ingredients and the research behind those compounds are important for detailed understanding of how and why dietary supplements may be beneficial, the most significant driver of public awareness of supplements is the media.

Top "fitness" nutrients

Fitness professionals recognize the importance of both training and nutrition for physical performance. The right balance of carbohydrates, proteins, fats, water, vitamins and minerals is necessary for optimal adaptations to training, yet many clients fail to eat the kind of diet they should. In some cases, a dietary supplement such as a daily multi-vitamin might be warranted as nutritional insurance, while in other situations, supplements may be used to induce very specific physiological effects, such as using ginseng tea as an afternoon pick-me-up. Outlined below are some of the more popular fitness-oriented supplements likely to be encountered.

Amino acids. Amino acids and various purified protein supplements are generally marketed to those trying to build muscle mass. More recently, however, high protein diets have again become popular, and protein-fortified products are available to promote weight loss and boost energy. Increasingly high doses of individual amino acids are touted for benefits outside of their traditional nutritional role in protein metabolism such as producing neurotransmitters, reducing inflammation and speeding exercise recovery.

Antioxidants. Antioxidants such as vitamins C and E, as well as a variety of phyto-chemical extracts from grapes, tea leaves and even pine trees, are often promoted as a way to combat the damaging effects of free radicals generated by intense exercise. Free radicals, which are reactive molecules produced in higher amounts during high-intensity exercise, have been shown to contribute to muscle damage, inflammation and perhaps muscle soreness. The theory behind antioxidant supplements is that they may aid in exercise recovery by interacting with free radicals before they can do their damage.

B-vitamins. B-vitamins are often recommended to athletes and avid exercisers because of their role in carbohydrate and protein metabolism. Sometimes positioned as "energy-formulas" or "stress-formulas," daily needs for certain B-complex vitamins such as thiamin, riboflavin and vitamin B-6, are often elevated for regular exercisers.

Iron. Iron is a popular supplement among athletes because of its role in transporting oxygen (via hemoglobin in red blood cells) in the blood. Although iron-deficiency anemia results in well-documented reductions in physical performance, most fitness enthusiasts are unlikely to require supplemental iron. It is generally ill-advised to supplement with iron unless iron deficiency is documented with a serum ferritin analysis. Even those at highest risk for low iron status (i.e., normally-menstruating female athletes) should consider having their iron status evaluated before taking iron supplements.

Hot sports supplements

When it comes to dietary supplements for improved fitness and performance, there are several that vie for the title of "most-hyped" sports supplement. Among the contenders are creatine, HMB (hydroxy-methyl-butyrate), HCA (hydroxycitric acid), pyruvate, carnitine, DHEA (dihydroepiandrosterone), vanadyl sulfate, chromium picolinate, whey protein, androstenidione, and ginseng -- among hundreds of other supplements and herbal preparations specifically touted for performance, weight loss, muscle building or general wellness. While supplements can be helpful if they are supported by a strong rationale, validated by controlled scientific trials and there is a clear need for the supplement for a given individual, they should be viewed with skepticism. [See related article, "Pills, Powders and Potions," page 50.]

For example, a relatively sedentary woman may be interested in using chromium picolinate because she saw ads touting it as a "fat burner." Without question, anybody doing little or no regular exercise can reap huge weight-control benefits from the right training program, which would be the obvious first step for this woman (instead of the quick fix promised by the supplement). After a few months of dedicated training, however, her weight-loss progress may begin to plateau. If this weight loss was slowing because she was having difficulty adhering to her diet late in the day, chromium supplements may help keep those late-day sugar cravings under control -- not a magical fat-burner, but often a helpful addition to a healthy diet and exercise program.

Exercise vs. supplementation

Although some of the popular dietary supplements may be helpful in specific situations for certain people, most pale in comparison to the benefits achievable through a regular fitness program. In most cases, the fitness plan, not the supplement, is responsible for doing the "heavy lifting" when it comes to delivering the key health benefits. The supplements may be delivering that "little something extra" that many need to get over a plateau or spur to a new level of fitness, but the supplements should always be viewed as just that -- supplemental to the larger program of diet and exercise. Saying that supplements are "good" or "bad" is overly simplistic. People should consider supplement use in the proper context of each individual's unique circumstance.

REFERENCES

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Chandler, R.M., et al. Dietary supplements affect the anabolic hormones after weight-training exercise. Journal of Applied Physiology 76(2): 839-845, Feb 1994.

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Johnson, W.A., et al. Nutritional supplements: Fact vs. fiction. Adolescent Medicine 9(3): 501-513, Oct 1998.

McBride, J.M., et al. Effect of resistance exercise on free radical production. Medicine and Science in Sports and Exercise 30(1): 67-72, Jan 1998.

Mujika, I., et al. Creatine supplementation as an ergogenic acid for sports performance in highly trained athletes: A critical review. International Journal of Sports Medicine 18(7): 491-496, Oct 1997.

Nielsen, P., et al. Iron supplementation in athletes. Current recommendations. Sports Medicine 26(4): 207-216, Oct 1998.

Vukovich, M.D., et al. Effects of a low-dose amino acid supplement on adaptations to cycling training in untrained individuals. International Journal of Sports Nutrition 7(4): 298-309, Dec 1997.

Williams, M.H., et al. Creatine supplementation and exercise performance: An update. Journal of American College Nutrition 17(3): 216-234, Jun 1998.

Williams, M.H. The Ergogenics Edge: Pushing the limits of sports performance. Human Kinetics: Champaign, Ill., 1998.