Dietary supplements are sold and marketed in a legal no-mans land where practically anything goes. How did we get here and most importantly, what supplements will actually get you looking swole?
Dietary supplements are sold and marketed in a legal no-mans land where practically anything goes. How did we get here and most importantly, what supplements will actually get you looking swole?
You can call me Whey-brotein because I can be consumed if and when you need me.
Today we are going to talk about the wild and under-regulated world of dietary and sports supplements. And like so many things I cover on this show, this is a huge topic that could be an entire podcast in itself. Because as you probably all know by now, some of them work, but most of them are kind of trash, and some are even potentially harmful or even fatal.
In 2023 the supplement market was estimated at 68 Billion dollars and is projected to more than double to 163 Billion in the next ten years.
The US alone accounts for a third of global sales with 22.6 Billion dollars in sales in 2023.
Source: https://finance.yahoo.com/news/dietary-supplements-market-expected-grow-130000664.html
Now supplements come in a myriad of forms and intended outcomes- so we are going to attempt to keep our focus narrowly on the ones that are used to enhance our workout performance and aesthetic results because I know that's. what most of us are here for.
So I'm going to go over the most popular, best promoted and marketed fitness supplements and talk about which ones actually seem to have a benefit and are worth the money, and talk about which ones aren't useful, but first- I have to potentially bore you with the history of the industry and the state of regulation so we know how we got here. And what we discover is how damn hard it is to regulate even the dangerous ones, let alone the ones that are just ineffective bullshit.
So buckle up bitches.
Of course, we have to start with herbal medicine. That is the use of local plants in a given area which through centuries of learned knowledge and experimentation were passed down through the generations. Archeological evidence for medicinal use of plants dates back 60,000 years and written records date back 5000 years. So essentially we’ve always had this.
From our modern, science-based perspective, it can be easy to dismiss this type of medicine as ineffective, but many of these remedies were and are still effective, and there are also a number of modern medicines that are derived directly from herbal remedies as we learned to identify and isolate the active ingredients. For example, Willow bark led to the development of Aspirin. Cocoa Leaves led to the development of anesthetics and Opium poppies led to the creation of painkillers.
So we can't be dismissive of all herbal medicine, and indeed doing so would be very Eurocentric and Colonial of us. Most cultures around the world still maintain a proud heritage of herbal or what we sometimes call traditional medicine that can be very effective. But it's when things start getting sold and produced on an industrial scale that things start getting shady.
In the Western World this kicks off in the 1600’s when newspapers began advertising what are called ‘patent medicines’ and these are concoctions that promise to cure a variety of maladies, sometimes literally all of them, and the ingredients are secret or patent protected. Aside from newspapers, these elixirs were sold by showmen in traveling medical shows, often accompanying touring circuses. The salesman would put on a spectacular show where they use audience plants to demonstrate the effectiveness of their cure, and then skip town immediately before the poor suckers who bought the product only to discover it useless could demand a refund or worse.
In the United States, this type of fraudulent cure-all takes on the phrase Snake Oil. but as I learned from a great episode of the Podcast Maintenance Phase the truly wild thing is that snake oil exists and apparently actually works.
Snake oil arrived in the US with Chinese workers working on the continental railroad who would use this ointment on their joints. And we think this might have been effective because the particular type of snake used, native only to China, is extremely high in omega-3 fatty acids.
From here, I will generously call them entrepreneurial white folks who saw this genuine medicine and decided to start marketing a fake version using mineral oil and passing it off as rattlesnake or viper oil. So the phrase ‘snake oil’ became shorthand for any type of fraudulent health product.
We also saw that patent medications increasingly contain ingredients like cannabis, cocaine, alcohol, laxatives, or opium. Most horrifying of all, towards the late 1800s and early 1900s we actually saw medicines that contained radioactive ingredients such as uranium and radium, and one such product, Radithor, was sold as late as 1932.
Around the same time, we also saw increasing scrutiny of Food Safety, owing in part to the work of investigative Journalists like Upton Sinclair who exposed the unscrupulous and unsanitary practices of the meat packing industry. So the same year that Sinclair’s famous novel The Jungle was published, 1906 public outcry resulted in the passing of the Pure Food and Drug Act, which was the first permanent piece of legislation regulating the purity of food and drugs.
Initially, the US Department of Agriculture was responsible for enforcing these new rules, but by 1927 this department was splintered off to become what is now called the Food and Drug Administration, or the FDA for short.
Nevertheless, people were still selling radioactive beverages, mascara that could blind, and fraudulent cures for diseases like diabetes, so additional measures were necessary and in 1938 we got the Federal Food, Drug and Cosmetic Act, so for the first time meant that all products had to be shown to be generally safe before sale, and also that some medications would be available only via a prescription.
The act, however, had a blind spot in that it did not address the sale of vitamins, minerals, and botanical ingredients other than to stipulate that these products not list themselves as having dietary properties. In other words, vitamins and minerals and herbs could not say they were food.
https://www.ncbi.nlm.nih.gov/books/NBK216048/
Vitamins themselves had first been identified in the early 1900s and by 1922 product multi-vitamins were available for sale in the US, including some that promised relief from diverse problems such as pimples, constipation, nervousness, brain fog, and to loosen up accumulated bile….So basically they were hawking cleanses 100 years ago.,
https://supplementfactoryuk.com/blog/2018/05/the-history-of-vitamins/
Throughout the 20th century congress would attempt to refine the Food, Drug and Cosmetic Safety Act with further legislation being passed in 1958, 1973, 1976, and 1990.
But these successive acts were often contradictory when it came to supplements and there were a number of legal cases over the years that brought the FDA’s labeling requirements into contention with the First-degree right to free speech. So in the early 90s, they attempted to resolve this.
However the supplement industry saw this push towards greater regulation as a threat to their existence, so they began to spend a shit ton of money on a publicity campaign advocating against these regulations. At one point they had a television campaign where federal agents invaded actor Mel Gibson's house and tried to take away his Vitamin C- yes this really happened. And it worked, congress received more letters in 6 months opposing supplement regulation than they received during the entirety of the Vietnam war opposing that conflict.
So with the help of Utah Senator Orin Hatch, the Vitamin hand-delivered a law to Congress called the Dietary Supplement and Health Education Act, which, contradictory to its name, obfuscated the health benefits of supplements. This act put product safety into the hands of the manufacturers and removed the FDA. Under this law, the producers only need to show that they have followed good manufacturing practices and are not required to do any testing to verify the effectiveness or quality of their products.
When it comes to verifying ‘good manufacturing processes’ the FDA is hamstrung by both having a very small team of only 25 people assigned to supplements- but also the reality that supplement manufacturers are not required to register formally so we do not even have an accurate number of how many manufacturers there are. Instead, the FDA can only inspect facilities they are aware of and focus on products they've received specific complaints- and the burden falls on the FDA to prove the product is unsafe.
I watched a PBS Frontline episode from 2016 that highlighted two cases where a product was found to be unsafe.
In the first case, a company out of New York state was found to be selling a vitamin b-50 that contained Anabolic Steroids. This was only discovered after female users began complaining about masculinization symptoms and users of all genders reported mood disturbances. It turns out the company marketing the product had sub-contracted manufacturing to another company and because that company reused equipment that had not been properly cleaned between product lines, the vitamins had been cross-contaminated with some ‘male-enhancement’ product they were also manufacturing.
Of course, I'm curious what male enhancement product this was that contained steroids.
It was only after 6 months of frantic emails and phone calls to the FDA that the product was investigated by the FDA- and disturbingly, the woman who owned the company marketing the product reports that when she was visited by two FDA representatives she was told ‘We’ve received some concerns about one of your products, but don’t worry because it hasn't killed anyone’
The company ended up voluntarily withdrawing the product from the market, but 36 users ended up suing the companies responsible and we don't know the exact number of people affected.
The Frontline special then highlights another case, Where a fat-burning product sold primarily in Hawaii was responsible for 56 cases of acute hepatitis, with many of these people ending up needing a liver transplant and the eventual deaths of three people. In this case, it was the state of Hawaii that intervened long before the FDA to get the product withdrawn from sale.
Of course, the person in charge of the FDAs supplement company then moved on to be an industry spokesperson for the supplement industry in a classic case of a regulator becoming a highly paid industry insider once their assignment ends.
https://www.youtube.com/watch?v=G8LG0OY3Izs
But in spite of the apparent dangers the majority of Americans surveyed responded that they thought supplements were either safe or completely safe.
https://www.ncbi.nlm.nih.gov/books/NBK216048/
In 2015, the New York Attorney General Eric Schneiderman did an investigation where they bought supplements from multiple locations of 4 chain stores, Walmart, Target, GNC, and Walgreens, and conducted a DNA analysis to see if the plants in the pills matched those on the labels. Here’s what they found:
At GNC they bought 24 bottles and made 120 separate DNA tests and only 22% of these tests matched the genetic profile of the plants on the label,
The 90 tests run from samples purchased at Target fared a little better with 41% of the ingredients matching
Walgreens fared worse, with only 18% of the 90 tests conducted showing matching DNA
And finally, Walmart had an abysmal 4% DNA match
At each store, they found contaminants such as rice, wheat, daisy, spruce, clover mustard and even common houseplants.
As a result of this investigation, GNC and other companies such as the vitamin maker Nature Made have agreed to start providing DNA Barcoding for their products so that you can apparently verify that the ingredients on the label match those in the bottle. And I don't fully understand how DNA barcoding works, and I'm sure it's an imperfect system, but still it might be a good idea to look for supplements that have this labeling.
Now sometimes the supplements are exactly what they say they are- and they even work too well.
The most notorious supplement of the modern age is a Chinese herbal medicine called Ma Huang which was marketed in the West as Ephedra. While this plant has been used in traditional medicine for thousands of years in China, India and the Americas- in the West it was marketed as a weight loss drug.
The evidence suggests it is somewhat effective for weight loss- but only a modest 1.3 lbs of weight loss per month over a placebo. When combined with Caffeine it was more effective at 2.2 lbs lost per month. However, these studies only lasted four months so we don't have any long-term evidence of effectiveness and most likely someone is going to need to continue taking it for many months to see visible results. Meanwhile, it's relatively easy to lose twice this much weight in a month via a mild caloric deficit of 500 calories a day.
https://ods.od.nih.gov/factsheets/ephedraandephedrine-HealthProfessional/
In the 90’s this drug was everywhere- up to 12 million people reported using it. I still vividly recall the Hydroxycut and Trimspa commercials that regularly played on cable TV. Do you want a viper baby, want some money baby? Trimspa baby…
https://www.reuters.com/article/idUSKBN0OC2SQ/
But of course, with this many people taking something that wasn't properly studied, there was bound to be a lot of negative side effects, and indeed tens of thousands of reports were made of adverse reactions- from mild mood disturbances, insomnia, headaches, dizziness, trembling, dehydration, itchy skin, to heart arrhythmia, seizures, strokes, and Death.
And not just one or two deaths, over 150 deaths were reported to the FDA before the substance was eventually banned in 2004. It took the high-profile death of a major league baseball player using the substance to finally get enough attention to the matter to get the drug banned.
Prior to this death the supplement industry heavily pushed back against a ban- with our old friend Utah Senator, Orin Hatch saying there wasn't enough evidence to support a ban.
Now you might ask why Senator Hatch was so invested in the supplement industry- and that’s because his state, UTAH, was and still is the center for the US supplement industry with as much as a third of all supplements sold in the US coming from Utah-based companies.
Orin Hatch's son was employed as a lobbyist by the supplement industry during the time period he was saying there wasn't enough evidence to ban ephedra-
https://www.kuer.org/politics/2018-12-18/how-a-1994-law-supercharged-utahs-supplement-industry
And one super predatory aspect of the supplement industry based in Utah is the prevalence of MLMs or multi-level-marketing companies.
If you’re not familiar with MLMs- these businesses sell directly to consumers via independent representatives and you typically can’t buy their products in any sort of retail outlet. But the way that MLMs work is that in order to make money you need to recruit other people into selling for the business and you create a downline of salespeople who each give a cut of their sales upwards in the shape of a giant pyramid- but wait, it may be shaped like a pyramid, but its not a pyramid scheme because MLM’s are selling actual physical products- most of which are overpriced and ineffective- but a physical product exists.
But in order to sell products for a MLM you are required to order a minimum value of product per month to maintain your status and as a result, something like 93% of MLM salespeople lose money. In a true pyramid scheme, more than half of all participants make their money back so an MLM is actually worse financially….
But Mormon culture, particularly because of the patriarchal rules about what roles women are allowed to have, has fostered an environment of Mormon wives participating in MLMs, which are often selling supplements or essential oils. And I’ve seen some leaked team meetings where these ladies are encouraged to reach out to recently diagnosed cancer patients to shill their products.
If it's not clear already, I need to state unequivocally that cancer can't be treated naturally. Not by supplements, not by fasting, not by CBD, not by essential oils, not by crystals. Should you face a cancer diagnosis in your lifetime it's totally up to you if you wish to seek treatment or not, but know that there will be people looking to pray on you when you are at your most vulnerable.
Another cult-adjacent community obsessed with selling supplements is Fitness influencers. It seems like once a hot person on the internet reaches a certain follower count, a link to a supplement company almost always appears in their bios. Naturally, they receive a cut of any sales generated using this link. Or if you really have enough clout they might start their own supplement company.
The manufacturing of the product is farmed out to a third party and the new influencer lead company is basically just a branding and marketing operation, one that typically charges a premium for products of comparable quality and effectiveness. And we know the regulatory landscape is easy to navigate because they don't need to register the company or the products and do not need to prove safety or effectiveness.
And of course, this can be very misleading because we see these images of super fit people, and it's a convenient jump to think that taking whatever supplements they are advertising will make you look more like them- and we conveniently ignore the intense diet and lifestyle these people usually have, their superior genetics, and drug usage.
But…
Some supplements actually do work and will help to slowly transform your body. So knowing what does actually work can save you a lot of money and aggravation.
But know that regardless of what you take or don't, the process of fitness, specifically with an aesthetic outcome in mind is always going to be one of being highly consistent over a long period of time. Giving 80-90% effort for years is what it's going to take and you have to submit to that process and that slow, often imperceptible growth to be successful.
So now let's talk about specific supplements in more detail so I can try and help you figure out which ones are worth taking or not. And by all means, I’m not going to cover every single ingredient available and there are many things I’m not covering today that do work and have value, and many more that don't work- but that would take months to go over all of them so I’m going to narrowly focus on the supplements that are pushed by the fitness world.
And I’m going to start by covering the ones that have solid evidence for effectiveness, then I’ll move on to the ones with mixed evidence, and finally, the ones that don't work and are even dangerous. And per usual I will be citing research so you hopefully understand I’m not just pulling this out of my gaping asshole.
What ones work/solid evidence
Caffeine: The first supplement that actually seems to work we're going to talk about is everyone's favorite workplace crutch- caffeine.
The overly simple explanation of how Caffeine works is that rather than speed up the heart rate directly like other stimulants, it blocks the reception of the chemicals that make you feel tired or fatigued. So the performance boosting benefit is probably derived by making you feel less tired and able to better power through.
Caffeine is also very well studied, and admittedly at times, the results can be mixed depending on the methodology and hypothesis being tested. But in general, it seems to have a positive impact on aerobic endurance. In most studies on cyclists and runners, times improved in those who supplemented with caffeine.
As far as strength the results were more mixed, however, and this is a big however- it seems like when they look at people who already regularly consume caffeine the impact of a caffeine supplement before a workout leads to better performance, but if the person does not regularly consume caffeine, then the results might be negative even. So in short, if you already consume caffeine, having a coffee or energy drink 30-60 minutes before a workout will probably be helpful for you- if nothing else so that you feel less fatigued and more apt to complete the workout as planned.
https://chhs.source.colostate.edu/how-does-caffeine-intake-impact-exercise/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739593/
https://www.healthline.com/nutrition/caffeine-and-exercise#basics
Pre-workout- In the same vein a preworkout supplement can also be helpful for many people. The main reason for this is that most pre-workouts contain caffeine- but there are other ingredients as well, typically L-carnitine and Beta-Alanine which are both naturally occurring amino acids which help with muscular endurance and the conversion of fat into energy.
One study I found showed about a 10-20% improvement in strength and endurance- meaning participants were able to do up to 20% more work after taking the pre-workout. And since volume is the number one determinant of muscle growth that means you can potentially grow faster using pre workout.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664913/
Of course, some people do not respond well to pre-workout. I’ve gotten used to it now, but usually about ten minutes after ingesting it I get this sensation like there are pop rocks on my skin- and this is pretty alarming the first few times you experience it. And if you find caffeine makes you anxious, then pre-workout is probably not for you. Also because it has caffeine you probably want to wait two or three hours after your last coffee or energy drink before consuming it or you’re going to feel very very cracked out and sweaty.
But now comes this giant caveat with pre-workout and that is, a lot of pre-workouts contain other substances which are not currently legal. In a 2017 study, 10% of the supplements tested were found to contain banned stimulants. In another notorious example, some pre-workouts have been found to contain methamphetamine analoges, which are chemicals with slightly differing structures which act on the same receptors in the body.
So third party testing is critical- and I’ll get back to that at the end of the episode.
https://www.strongerbyscience.com/new-supplement/
Creatine- the next reliable friend we’ll cover is Creatine Monohydrate. It's a fitness bro trope at this point that we all need to be taking 10mg a day for life… but turns out there is decent evidence for this.
A meta-review that looked at 10 different studies found an aggregated improvement of skeletal muscle mass of about 11% versus nothing. Now 11% really doesn't sound like much, and it's certainly not going to radically transform your body, but it's enough to be visibly perceptible in a side-by-side’ comparison.
Furthermore, in younger people, the result was closer to 17% so if you're just starting out the difference might be more significant.
When you start taking it you will probably see an immediate jump in scale weight, because creatine causes more water to be stored in the muscles, which makes them look fuller. And unless you’re competing in a bodybuilding show you probably want to look fuller.
One note for my fellow PrEP takers here- one of the blood tests they run to make sure PrEP isn't negatively impacting your kidney function is creatine- so this test will be artificially higher than normal and may flag a concern for your provider. It might be best to take a break a few weeks ahead of any blood work so you get a truly representative number.
There is also some early evidence that long-term creatine use may improve brain function and memory- so it could be that creatine may be somewhat preventative of dementia- but we don't have enough evidence yet or you could bet we would have heard it being recommended to everyone by now.
Protein Powder- Now let's talk about the granddad of all supplements, protein powder.
To assess protein quality we use a metric called bioavailability which essentially says what amount of the protein consumed is actually useful by the body for rebuilding. On this scale, eggs score a perfect 100, meaning they are completely bioavailable. Moving down the scale cows milk scores a 91, Fish scores an 83, beef a 80, and chicken a 79.
And further down we have soy at 59, wheat at 54, and beans at only 49. So while these plants contain a lot of protein, like look at the protein content on pasta and be surprised by it, you need to eat twice as much of them to get the same usefulness to your body. These plants have other benefits that make up for their protein bioavailability, so I’m not telling you not to eat them, just take this into consideration if you’re counting macros and count these protein sources as half credit.
The great news is, that when isolated, milk, soy, and pea protein all score nearly 100 on the bioavailability index, so it’s super easy to supplement your protein needs with powdered supplements.
For vegans and vegetarians- pea protein is pretty ideal, though not super great tasting. Soy protein tastes a bit better, and in spite of the popular misconception that consuming it causes estrogen levels to rise, you would have to consume multiple times what any human reasonably would to see a noticeable difference in estrogen levels.
For those of us who eat animal products, Whey and Casein are cheap and effective. Whey is known for its rapid absorption which makes it ideal for post-workout refueling, whereas casein has a slower absorption time and is ideal for a before-bed shake. Concentrated egg protein is also available for people who can't tolerate dairy, but tends to be a bit more expensive than whey protein, which you can usually buy for less than a dollar per ounce online.
And while we're at it I need to tell you that there is zero difference between higher-end grass-fed whey proteins and cheaper brands. The key to assessing the quality of your protein powder is to buy one with the amino acid profile listed on the package and to total up the three branches chain aminos- leucine, isoleucine, and valine and make sure that that it equates to between 27 and 30% of the total grams in a serving. So a 30-gram scoop of whey should have between 8 and 9 grams of bcaa’s. If the amino acid profile isn't listed on the package then don't buy that protein.
As far as how much you need- well that really depends on how big you are, and how much protein you’re able to get from whole foods such as eggs or meat. For me, I eat whole proteins 2 or 3 times a day and then protein supplements twice more to make sure I'm hitting my target for the day- because it's so much easier to just chug a protein shake than it is to sit around and chew chicken breast. And some people will tell you this is bad, but the science suggests protein powders are maybe even better for you.
CARBS- On the same note, some people will say you need to get your carbohydrates from whole sources like fruits and vegetables and whole grains, but this also isn't true at all. Once carbs are broken down the body, it has no way to distinguish if the carbs in the bloodstream come from brown rice or from Gatorade. Now whole grains have other positive things like fiber and macronutrients that make it worthwhile to consume- but here again, I’m going to te tell you that there is nothing wrong with consuming carbs in the form of a sports drink or mass gainer shake if that’s what you need to get enough to fuel you. Particularly during an intense workout where the glucose in your muscles is rapidly depleted, consuming a sports drink with dextrose or other simple sugars is going to enable you to continue performing for longer. If I have to play 80 minutes of rugby, I’m damn sure going to want some sugar in the middle of the match to keep my muscle glycogen stores where they need to tackle and sprint and drive people.
And as I’ve said before, if you're a person like me who has trouble physically consuming enough food to meet your needs, then a mass gainer powder that has carbs and protein in it can be a great option. Don't expect the mass gainer to do anything that real food wouldn’t do, but if it's what you need to consume in order to meet your energy targets then that is totally fine. I buy a product called ‘Clean Gainer’ that has carbs from a mix of sources and I’ve been using it for almost a year now and it's made a huge difference to my ability to eat a sufficient quantity of food to grow.
Mixed evidence- now let's move on to supplements that may or may not have any benefit, meaning some studies show a positive result and others do not.
BCAAS/EAAS- We’ve already talked about BCAA’s or branched-chain amino acids. The body has 20 different amino acids, 9 of which are considered essential, meaning your body cannot make these and they must be consumed in food. But these three in particular, the branched-chain amino, are considered the building blocks for skeletal muscle. So, For a long time, I and many other people were taking BCAAS on their own with the thinking they would promote tissue growth and repair. But it turns out taking BCAA’s on their own have no impact on muscle growth.
However, more recently evidence has emerged that if you consume all 9 Essential Amino Acids either directly before or during a workout then that increases anabolic activity. So particularly if you’re working out fasted, or in a low-carb state, consuming up to 18 grams of EAAS before and during a workout may improve your results. I suspect we’ll start seeing more studies into this area in the coming years, so stay tuned.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561576/
Vitamin D- Ok the next fickle friend we're going to talk about is Vitamin D- which is naturally produced by our bodies when our skin is exposed to sunlight. And over the past few years, vitamin D has been said to do any number of things, including boosting your immune system, reducing anxiety and depression, promoting bone health, reducing inflammation and even inhibiting the growth of cancer cells.
Problematically in large human trials, none of these benefits have actually presented itself. The only benefits seem to be an improvement in bone health in people who are actually deficient already- and a modest reduction in mortality of cancer patients. That's it.
https://www.nature.com/articles/s41574-021-00593-z
Now many people are deficient so this is one of those where I think taking Vitamin D may still be beneficial- but it's not going to have a radical positive impact. I still take it daily because I live in a northern city where it's dark and cloudy half the year. And It's hard to take too much, so take this if you want.
All vitamins- on a related note, we should be suspicious of multivitamins in general. Theoretically, we should be able to get all the vitamins and minerals we need directly from food-
By my math- To get enough of the main vitamins, A, B, C, and D we would need to eat an entire sweet potato every day, a cup of egg whites, 2 salmon filets, a chicken breast, a handful of almonds, and a cup of broccoli. So for your average bodybuilder diet- you’re probably already getting your vitamins.
So if you’re eating mostly whole foods you’re going to be fine. But just like Vitamin D, I don't think taking a multivitamin is actively harmful. There are no long-term studies showing any significant health benefits, But it is possible to take too much of certain micronutrients so be sure that the daily dose listed on the package doesn't wildly exceed the recommended dose for an adult. If you see something that says 1000% of recommended IDUs then maybe don't take that one.
Fish Oil- The last one I'm going to talk about in this category is Fish Oil. Now there is evidence that omega-3 fatty acids contained in fish oil lower heart attack risks, and improve joint pain in people with arthritis- I personally take this because being on testosterone, which normally reduces your HDL cholesterol, I want to try and keep that up-
But a lot of fish oil supplements you can buy are not good quality- the PBS documentary cut a bunch of tablets open and discovered the oil inside was all rancid smelling- so the quality of the supplement probably makes a huge difference. The oil needs to be captured immediately when the fish is processed to keep it fresh- and many product lines aren't doing this. I actually recommend cutting one of your gel caps open and smelling the oil inside, but I also just recommend eating more oily fish if you can and want to.
No evidence- now let's move on and talk about the supplements being sold that are literally fishy- meaning there's no evidence they work at all.
Now if I tried to go over every ingredient marketed I would be here for ten hours- so I’m going to only cover the ones that I regularly see marketed in the fitness space.
Adaptogens- The first one I’m going to cover is Adaptogens. Now these are chemicals that supposedly help the body react to stress and protect the body from the damage caused by stress, particularly oxidative stress.
And this sounds great in theory- and indeed there have been studies that show that they can be effective in this regard- but all of these studies have been performed on rats- and we are not rats. The trials done on humans have been inconclusive or used very small sample sizes. So this one is a don't believe the hype situation- in that they may still be found to be beneficial but there is no evidence at the moment. Additionally, some of these substances promoted have been shown to have harmful effects, including inducing abortions.
Testosterone boosters/‘Legal steroids’ - Alright the next big category of shit that doesn't work I’m going to talk about, and I’m lumping these together intentionally are products sold as testosterone boosters or legal steroids. And I’m grouping these together because I looked at many of the product labels and found a bunch of common ingredients, and I figured it was worth going through all of these ingredients individually.
Now before 2004, when they were banned, many muscle boosting supplements contained substances called prohormones which converted to, or acted like anabolic steroids in the body. In fact, one study from 2004 looked at over 600 supplements labeled as non-hormonal and found 14.8% tested positive for anabolic agents. After the 2004 anabolic steroid control act, this number dropped to 0.7%. But safe to assume some of these products actually do contain steroids. And we know from the vitamin contamination case in New York I mentioned before, this is still happening sometimes.
Another common adulterant found in these supplements is Sildenafil, which is Viagra, one study of FDA complaints found this ingredient in 166 different supplements. While Viagra on its own is generally safe, it can be harmful when combined with other ingredients such as vasodilators.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407704/
This same study also found 269 supplements that contained steroids, or steroid precursors. The most common substance found these days is Ostarine, which is a SARM or selective androgen receptor, basically a synthetic steroid.
https://pubmed.ncbi.nlm.nih.gov/32048383/
So contamination is certainly a big risk from this category of supplements, but let's look at the ingredients on the labels. Again I looked at a bunch of supplement labels and wrote down all the active ingredients and looked up each of them
A lot of these products contain amino acids, which don’t do anything to build muscle mass or raise testosterone when they are isolated- many also contain other things like nettle, turmeric, ginseng, or ginger which are said to be anti-inflammatory, but have no benefits on muscle growth or testosterone levels.
So then I looked at the ingredients that supposedly raise testosterone and I found 12 which I’m going to talk about individually-
Ashwagandha- This is a shrub that grows in south and west Asia and Africa and has been also marketed as an adaptogen, so there’s that. But in humans, there has been one study that gave men a 300 mg daily dose for 8 weeks and looked at the effects on blood testosterone levels.
So in the study the mean testosterone level of participants given the substance rose from 403 to 477. So an increase of 18%. Which sounds great but is it really? Well going back to the testosterone episode- basically if someone is in the normal reference range for testosterone levels, they’re not going to feel a noticeable improvement in body composition, sexual function, energy, etc unless they raise their levels to the top of the reference range- so if the mean were raised to let’s say 700, then that would be impressive and impactful- but the reality is that most people aren't going to notice any perceivable effects from a 18% increase in testosterone levels.
Compare that to a medication like clomid which can literally double your blood levels and you can see why you're better off just going with the actual medication.
And this is a big point here to be made when we look at studies- studies only need to show a change beyond what could be achieved by random chance to be labeled ‘statistically significant’- So what happens when there is a study that shows a statistically significant improvement like 18% is that someone then takes that top line finding and then writes an article that changes to wording to something like this substance is proven to raise testosterone levels significantly, and while that's technically true, it's misleading because the conventional usage of the word significant is different than the scientific usage. But most of us will just stop at this headline rather than going looking for the original study and learning what the results might mean on an applicable level. The supplement industry relies on our innate laziness to build hype around the effectiveness of a product- and this will be a big theme with these ingredients
https://onlinelibrary.wiley.com/doi/full/10.1002/hsr2.741
Nigella sativa- Also known as black cumin seed. And I was able to find a study that showed when taken as a powder, it nearly doubled the testosterone levels of the subjects.
However, the subjects in this study were albino rats who had medically induced diabetes. So this is the other pattern that emerges when we look at these ingredients that are said to be quite in quote proven, is that the proof is often studies done on rodents, and rodents with specific circumstances- I guarantee that none of you listening are an albino rat with diabetes, so, therefore, we can't possibly say if this one might boost your testosterone. And in the few human studies we have done, there has been no observable change in testosterone levels.
DHEA- Our next suspect is DHEA, formally Dehydroepiandrosterone, but also sold as androstenolone or prasterone. And this chemical is a steroid precursor, meaning your body can convert it into a steroid like testosterone or DHT. And is made in the body naturally. And just like Ashwagandha, studies do show that taking it can raise blood testosterone levels, but only by a comparatively small amount. In a meta review of 42 studies The average blood level increase was 28. Just remember the normal range is something like 300 to 800 so at best this would be a 10% improvement.
DHEA does have some negative side effects which we need to be aware of, including the fact that it also converts to estrogen so it can lead to gynecomastia and other estrogenic symptoms- but it also negatively interacts with certain antipsychotic and bipolar meds, and when taken with SSRIs the most common type of antidepressant can induce manic episodes. Fun!
https://www.sciencedirect.com/science/article/abs/pii/S0531556520304587
Gamma Oryzanol- This is a chemical found in rice and wheat bran, so if you see either of those listed as an ingredient then it's because they're trying to introduce this substance.
In the case of this chemical, some studies show an improvement in muscle strength after taking it for several months. And theoretically adding more muscle strength should lead to more tissue growth- However other studies have shown no increase in strength. So this is a case where unless the studies overwhelmingly say it does something then we need to assume it probably does not actually do that thing.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164998/
https://pubmed.ncbi.nlm.nih.gov/9407258/
https://www.webmd.com/vitamins/ai/ingredientmono-770/gamma-oryzanol
Beta-sitosterol- this is also found in rice bran, and vegetable fats, and in plants, this chemical acts like cholesterol does in the human body- And cholesterol is one of the chemicals that gets converted into hormones, such as testosterone. However, in humans beta-sitosterol doesn't actually convert to cholesterol, so it can't possibly convert to testosterone. NEXT.
https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/beta-sitosterol#:~:text=Unlike%20cholesterol%2C%20beta%2Dsitosterol%20cannot,these%20plants%20in%20the%20diet.
Fenugreek- this is probably one of the most popular natural testosterone boosters. I was able to find two studies that did show an increase in testosterone levels that would be considered statistically significant. But yet again, when I pulled up the actual data, the increase was a little less than 10% and both of these studies were funded by companies which market the ingredient.
Meanwhile, two other studies showed no significant impact on blood hormone levels- so here again we have mixed results, and when the results are positive they are entirely underwhelming and suspicious because of who's paying for the research.
https://www.healthline.com/nutrition/fenugreek-for-testosterone#effect-on-testosterone
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278660/
https://www.tandfonline.com/doi/full/10.3109/13685538.2015.1135323
https://digitalcommons.wku.edu/ijesab/vol2/iss1/13/
Eurycoma longifolia (long Jack)- Well here we go again, another plant-based product that in studies can raise your blood testosterone level, but yet again when I go look at the actual numbers I find an increase of less than 10% in all but one of the studies.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9415500/
HornyGoat weed- The name sounds fun, and In studies on rodents this ingredient seems to improve erectile function- but in the same studies there was no change to blood testosterone levels, ang again, you are not a rat- so we don't know if it does anything for humans
https://www.ncbi.nlm.nih.gov/books/NBK583203/
Cordyceps- These are mushrooms that supposedly improve erectile function and boost testosterone, and yet again, the only studies that show this were done on diabetic rats.
https://www.hindawi.com/journals/bmri/2020/4198397/#conclusions
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824671/
Tribulus Terrestris- Otherwise known as Bindii is yet another plant marketed for boosting performance and increasing testosterone, and with this one there are a few human studies that did show it increased blood testosterone levels, but there are a few more that did not- so here we have another substance with inconclusive results Were almost done yall.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120469/
Saw Palmetto- This is a plant ingredient that apparently inhibits the conversion of testosterone to DHT- which means that more testosterone will stay circulating in the bloodstream. But yet again,
https://pubmed.ncbi.nlm.nih.gov/34161166/
https://www.liebertpub.com/doi/abs/10.1089/jmf.2021.K.0021?journalCode=jmf
https://ro.co/erectile-dysfunction/saw-palmetto-low-testosterone/
Turkesterone- Alright this is our final substance in this category, and this substance has become very trendy over the past few years with people like Andrew huberman claiming it has a stronger androgenic effect than even steroids.
And as should be completely expected at this point, there are studies that indicate that it might be effective at increasing muscle strength and size, but they were done in rats and no studies have been done on humans.
https://www.idealnutrition.com.au/turkesterone/
https://blog.nasm.org/turkesterone
Alright, so that was extremely tedious. But there are two more types of supplements to go over that we need to watch out for.
Fat burners- so these are any supplements that promise to do what the name suggests- increase the metabolism so that people can lose more weight than they would on their own. And these generally fall into two categories
The first category is the ones that simply don't do much of anything. Because when tested these products at best burn like 50 extra calories a day. If we just do the math on that, it would take 70 days to lose just one pound of body fat.
Even a drug like clenbuterol, which is used by bodybuilders for fat loss maybe only burns an extra one to two hundred calories a day- and that's a heavy hitter in this category. So even taking this drug it's going to take between 17 and 35 days to lose 1 pound of fat.
But the second category is the products that are contaminated, and therefore potentially dangerous.
In the meta review of products the FDA received complaints about i referenced before, the FDA found 264 products marketed for fat burning or weight loss that contained the drug sibutramine- which is banned in the US for weight loss because it increases your risk for a heart attack and other cardiac events
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324457/
Another study done on 110 random compounds purchased on the internet, that a little over 10% of them contained one or two amphetamine-like chemicals which the FDA has explicitly banned, and have been banned by the world doping agency.
So when you’re taking a fat burner, there's a 90% chance it does next to nothing, and 10% chance it's basically amphetamines.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6049786/
Diuretics- The last type of supplement we are going to talk about today is Diuretics or ‘water pills’. And these are intended to reduce water retention in the body- that water is then excreted by the kidneys and out through urine. And people often take these in combination with other measures such as limiting water intake, saunas, and wearing a ton of heavy clothing to drop as much weight as possible quickly. And this is a big problem in any sport with a weight category- so combat sports, wrestling, weightlifting and bodybuilding. In body building they are also used to give the body the tightest possible look.
But using diuretics puts serious strain on the kidneys and creates an electrolyte imbalance which can lead to heart problems, and sudden death. A Washington Post report found at least 2 dozen deaths in bodybuilding linked to diuretic usage, and many more incidents of lasting damage including ulcers and kidney failure.
And this is a much bigger conversation about these particular sports and how weight classes are handled and just to know for your own personal purposes that these are not something to fuck around with.
https://www.washingtonpost.com/investigations/interactive/2022/bodybuilding-extreme-training/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9885939/
Conclusion
So to wrap this all up here- and yet again I started writing this episode and it spiraled into weeks of research and my longest script yet
The supplement industry is wildly under regulated and people can essentially sell you whatever they want with no need to prove that their product is effective or even safe.
And why this industry is begging for real meaningful reform- I doubt that's going to happen given the financial power of the industry, so let’s leave you with some practical advice.