Dr. Oz refers to THF for Performance Enhancing Substance Information

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Beware Performance-Enhancing Substances

One of the most remarkable things about the great golfer Bobby Jones was that he never played golf as a professional. He was a lawyer by trade and won all of his 13 major championships as an amateur.

Now, nobody today is expected to walk out from behind an office desk and qualify for the U.S. Open golf championship – which theoretically can be done – or get an expensive new bicycle and take on the Tour de France. But a lot of weekend warriors and college kids in intramural sports are trying to look like they could do just that, with disastrous results.

Medical researchers recently held a press conference to sound the alarm about amateur athletes’ use of performance-enhancing drugs, such as dietary supplements, anabolic steroids (men ages 15-34 are the most frequent abusers) and weight-loss products (often abused by women in their late 30s).

PEDs directly alter the myocardium, blood vessels and metabolism of your cardiovascular system. You’re risking exercise-induced abnormal heart rhythm, as well as cardiovascular, psychiatric, metabolic, endocrine, neurologic, infectious, hepatic, renal and musculoskeletal disorders.

The Taylor Hooton Foundation (named after Taylor Hooton, who died in 2003 after anabolic steroid use), urges YOU to “Think beyond sports.” We agree. If you want to get stronger, faster and healthier, your formula should be 7-9 servings of fresh produce daily and plenty of sleep, in addition to 60 to 90 minutes of aerobic activity most days and two to three days of strength building a week.


Supplements: If you have an adverse event, report it

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“Adverse events” are unfavorable or unusual reactions/effects/illnesses that can occur with the use of some dietary supplements, just as they can with over-the-counter and prescription medications. Examples of adverse events include anxiety, headaches, increased blood pressure, vision problems, and stroke. Such adverse events may be due to one supplement taken alone or to combinations of supplements or to interactions between drugs and supplements.

Be sure to listen to your body, pay attention to how you feel, and keep a written list of all prescription medications, dietary supplement products, and over-the-counter medications you may be taking.

Tell your healthcare provider about any changes in your health status, particularly if you start to feel symptoms you did not experience prior to taking the supplement(s).

It is always best to talk to a healthcare provider or dietitian before taking any supplements.

To report an adverse event, or even if you suspect one, you can fill out a user-friendly form using the “Report an adverse event” by clicking here:  http://naturalmedicines.com/tools/natural-medwatch.aspx  Or call the number on the supplement label.


Is whey protein the way to go?

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Protein supports muscle growth and repair. People often turn to protein supplements (such as whey, casein, and soy) to optimize those effects, especially after a workout. However, whole foods, not dietary supplements, should be your first choice for protein. Whole-food protein sources such as lean meats, fish, dairy products, legumes, nuts, and seeds are just as effective as (in some cases more effective than) protein supplements. Whey protein products can be an acceptable, convenient, and efficient way to deliver protein when your needs are greater than you can get through diet or when normal dietary sources are not available.


Whey is a type of protein found in milk that contains all the essential amino acids (EAA) needed for muscle growth and repair. Dairy products, particularly milk, are the best “whole food” sources of whey protein. Whey protein also can be extracted from milk during the cheese-making process and concentrated into a powder. Whey protein powders can be sold as conventional foods or as dietary supplements and are often added to other food and supplement products, including gels, powders, sports/energy bars, and ready-to-drink shakes.

Are there any concerns with taking whey protein products?

Whey protein is generally considered safe to consume. Keep in mind, though, that whey comes from cow’s milk, so if you have a milk allergy you should avoid whey protein products. In the case of whey protein supplements, especially those marketed for performance enhancement, you also need to watch out for other ingredients that you might not want or need in your diet. Whey protein supplements also can contain other ingredients that might interact with certain medications, so talk to your doctor before taking them.

If I take a protein supplement, is whey protein the best type to take?

Whey is often considered superior to other types of protein such as casein (another milk protein) and soy. This is because whey is digested more quickly than casein and soy, which leads to a rapid increase in the levels of amino acids in the body. Whey also has a higher content of leucine, an important amino acid for building muscle. However, casein digests more slowly and can help prevent muscle breakdown, particularly after an overnight fast. Therefore, a combination of whey and casein, as found in a glass of milk, might be more beneficial than whey protein alone. More research is needed to compare the effects of whey versus other supplemental forms of protein, such as from beef and eggs and protein blends.

When can I use whey protein?

Whey protein products are acceptable when high-quality protein foods (animal- or plant-based) are unavailable or not practical or convenient, such as in theater. Overall it’s better to get your protein from whole foods, such as lean meats, fish, low-fat dairy products, legumes, nuts, and seeds, throughout the day at meals and snacks. Eating a variety of protein foods provides you with all of the EAA, plus essential nutrients such as vitamins and minerals that are important for performance and recovery. In general, service members consume enough protein through food sources alone and do not need protein supplements.

How much whey protein should I take?

If food sources of protein are not available, whey protein products can help you meet your overall protein needs, but there are no official whey protein recommendations. Keep in mind that most whey protein powders provide 20–30 grams of protein per serving or “scoop,” which is the same amount of protein in about 3–4 oz of meat, poultry, or fish. To learn how to calculate your own protein needs based on your body weight and activity level, see HPRC’s Protein Requirements infosheet. Going beyond the protein recommendations will not provide any additional benefits to your performance.


There is no clear benefit to consuming whey over other sources of protein. The International Society of Sports Nutrition, American College of Sports Medicine, Academy of Nutrition and Dietetics, and Dietitians of Canada recommend consuming protein from whole foods. When high-quality protein foods are not available or not practical, protein products that contain both whey and casein are acceptable and can be beneficial. Keep in mind that whey protein supplements might contain other ingredients, so it’s possible to get too much of something you don’t need or want. Read all labels carefully, and see if the supplement product has been evaluated by an independent third-party organization.


Is DMAA coming back?

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DMAA has been illegal for use as an ingredient in dietary supplements for more than 3 years. It still is, but just when you think it would be disappearing from the market, it seems to be on a slight rise again. Our online search of available dietary supplements with DMAA turned up 11 products we had never encountered before, in addition to 34 products still on the list since before DMAA became illegal. We also found 50 discontinued products with DMAA still being sold by third-party retail outlets.

Unfortunately, illegal substances of all kinds are readily available on the Internet. For example, ephedra has been illegal since 2004, when FDA acted on growing reports of severe adverse events, including deaths, associated with the popular weight-loss supplement ingredient. However, products containing ephedra are commonly marketed online. Even substances on the Drug Enforcement Agency’s list of controlled substances can be purchased online. Worse, laboratory testing of dietary supplement products sometimes reveals the presence of illegal ingredients even when they aren’t listed on the products’ labels.

Ingredients such as DMAA are not allowed in dietary supplements because, according to FDA, “they can be a health risk to consumers.” Stay informed, starting with the OPSS FAQ about DMAA and updated list of Dietary Supplements/Products Containing DMAA.


Energy drinks: different labels, same risks

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Most energy drinks are now labeled with Nutrition Facts instead of Supplement Facts, but that doesn’t automatically make them safe. The most popular energy drinks contain about 80–120 mg of caffeine per serving (8 oz.)—about the same amount of caffeine in an 8-ounce coffee. Caffeine isn’t necessarily a bad thing. When used appropriately, caffeine can boost mental and physical performance. But each energy drink can or bottle often contains more than one serving, making it easier to consume larger amounts of caffeine, especially if you drink more than one per day. Too much caffeine (>400 mg) can cause nervousness, shakiness, rapid heart rate, and trouble sleeping.

In addition to caffeine, energy drinks commonly contain amino acids, vitamins, and plant-based ingredients such as guarana (which also contains caffeine) and ginseng. Although these ingredients are generally safe, there still isn’t enough reliable information about their long-term safety or how combinations of these ingredients might interact in the body.

If you drink energy drinks, here are some things to keep in mind:

  • Be aware of how much caffeine (from all sources) is in each can or bottle, and limit the number you drink each day.
  • Avoid caffeinated foods, beverages, and medications while using energy drinks. You may be consuming more caffeine than you realize.
  • Don’t mistake energy drinks for sports drinks. Unlike energy drinks, sports drinks are designed to fuel and hydrate you during long workouts.
  • Don’t mix energy drinks with alcohol. Energy drinks can mask the feeling of intoxication but still leave you impaired.
  • Find other ways to energize yourself. It’s best to get the sleep your body needs, but you can try other ways to stay alert, such as exercising or listening to upbeat music.


Supplements: Can you spot a red flag?

Some dietary supplements on the market can contain unsafe ingredients and might even contain ingredients not listed on the label. If you are currently using or considering using a dietary supplement, ask yourself these questions to minimize your risk of consuming potentially harmful products.

Is it a high-risk dietary supplement? High-risk product categories include:
  • Bodybuilding
  • Weight loss
  • Sexual enhancement
  • Pain
  • Cognitive enhancement
Is the label missing a third-party certification/ verification label?

Third-party programs evaluate and confirm dietary supplements for purity and/or quality. Examples are:

  • Banned Substances Control Group (BSCG)
  • ConsumerLab.com
  • Informed-Choice, LGC Group
  • NSF International
  • United States Pharmacopeial Convention (USP)
Does the label or advertisement:
  • Claim to prevent or cure a wide range of unrelated diseases (e.g., concussion, cancer, AIDS, in addition to diabetes)?
  • Market the product with personal testimonials or use phrases such as “newest scientific breakthrough,” “secret formula,” “money back guarantee”?
  • Promise a “quick fix” (for example, lose 5 pounds in two days, cure impotency in 2 weeks, etc.)?
  • Indicate the product is approved by a government agency or professional organization, such as FDA, DoD, World Anti-Doping Agency (WADA), or U.S. Anti-Doping Agency (USADA)? None of these “approve” dietary supplements.
  • Offer “free trials”? After a certain time period, often insufficient to evaluate a product, you can be charged and subscribed to a monthly bottle renewal.
  • Have text in a foreign language or have any misspelled words?
  • Lack FDA’s required statement: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”
Does the supplement’s product label or website have statements such as the claims below?

These claims often indicate the supplement might contain unapproved dietary ingredients, prescription drug analogs, and/or ingredients not on the Supplements Facts panel.

  • An alternative to (or claiming to have similar effects to) an FDA-approved drug—e.g., “All natural alternative to XYZ.”
  • “Legal steroids” or “Legal prohormones.”
  • “Might cause a positive result in a drug test.”
  • “Natural cure.”
  • “For research purposes only.”
Did you receive solicitations (emails) offering products in the high-risk product categories?
Is the product on the OPSS High-Risk Supplement List or FDA’s Tainted Supplements page?

These products have been found to contain ingredients that can put your performance and/or career at risk.

Does the product contain ingredients on the WADA Prohibited list or any “ingredients” prohibited by DoD?
Is the product rated 7 or lower by Natural Medicines?

Natural Medicines rates commercial products on a scale of 1–10, based on safety and effectiveness, with 10 being the best and 1 being the worst.

If you answered “YES” to any of these questions, you might be consuming a product that poses a risk to your performance and health! Keep in mind that there is little to no reliable information on the combinations of ingredients found in dietary supplement products.

And remember: A supplement cannot replace a healthy diet, regular exercise, or medical drugs. But if you find you are eating well, maintaining a good weight and body composition, and still don’t have enough energy for normal work and exercise, we suggest you consult a physician before considering high-risk dietary supplements.


Chilling out with relaxation drinks?

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If you’re feeling stressed, don’t rely on liquid relaxation products to relieve your tension. While energy drinks are promoted to give you an extra boost, relaxation drinks* are marketed to do just the opposite and help you, well, relax. These products commonly contain the amino acid theanine, as well as several different plant-based ingredients. But the science doesn’t support the use of relaxation drinks to decrease stress or anxiety, and consumers should be cautious of two ingredients: kava and melatonin. Bottom line, if you’re feeling stressed, try to identify the cause, and then use stress management strategies backed by scientific evidence.

Do relaxation drinks work as they claim?

There is insufficient scientific evidence that relaxation drinks are effective for reducing stress or anxiety. Certain individual ingredients, such as kava, chamomile, valerian, theanine, and passionflower, are promoted to have anti-anxiety effects. However, with the exception of kava (see below), the evidence is limited, and more research studies are needed. Relaxation drinks may not actually make you feel relaxed, but several products warn that they can cause drowsiness.

What ingredients should I watch out for?

Kava (Piper methysticum) is a plant native to the South Pacific and is used to help with stress, anxiety, difficulty sleeping, and concentration. In 2002, FDA released a consumer advisory warning about the potential risk of severe liver injury associated with the use of kava-containing dietary supplements. You can read more about kava in this factsheet from the National Center for Complementary and Integrative Health.

Melatonin is a hormone made by the body that helps regulate your sleep. It’s also available as a supplement and is used as a sleep aid. According to the Food and Drug Administration (FDA), melatonin is not approved as a food additive for conventional foods, and it does not have GRAS (generally recognized as safe) status. Therefore, if your relaxation drink has a Nutrition Facts panel (indicating it’s a conventional food and not a dietary supplement) it should not contain melatonin. In fact, FDA has sent warning letters to several relaxation drink companies for selling beverages that were adulterated (containing an unsafe food additive) with melatonin. Melatonin can only be in products marketed as dietary supplements, and you should use them under the supervision of your doctor. Because melatonin causes drowsiness, flight personnel especially should be wary of products containing this ingredient. For more information, please read OPSS’s article about melatonin.

Kava and melatonin aren’t found in all relaxation drinks, so be sure to read the label to see what else is in the drink. Also note that most product labels state these products are not intended for children or those who are pregnant or nursing.


Until there is more research on relaxation drinks, service members should take caution with these products. Relaxation drinks have yet to be shown effective for reducing stress and anxiety, and some may contain ingredients that can negatively affect you and your ability to perform. Avoid consuming these products before missions, trainings, and operating any vehicles when alertness and readiness are of utmost importance. In the meantime, try to determine the cause(s) of your stress and find other ways to relax. Please visit HPRC’s Stress Management for more information.

*Note: Liquid supplements cannot be labeled or marketed with terms such as “drink” or “beverage,” but for the purpose of this article, we use the term “relaxation drink” to include both food and supplement products.


Why do some protein powders have Nutrition Facts labels while others have Supplement Facts labels?

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The Food and Drug Administration (FDA) has specific definitions for conventional foods and dietary supplements, but protein powders can fall into one or the other. There are no definitive guidelines for protein powders, and a product’s category (and, thus, label) depends on how the manufacturer intends the product to be used. If it’s intended to replace one or more items of a meal or diet (as with a conventional food), then it displays a Nutrition Facts panel. Otherwise, it should be labeled as a dietary supplement and display a Supplement Facts panel.

You should also be aware that if a protein powder is labeled as a dietary supplement and makes a “structure/function claim,” the law requires that the label carry a disclaimer that FDA has not evaluated the claim and the dietary supplement product is not intended to “diagnosis, treat, cure, or prevent any disease.” On the other hand, structure/function claims made for conventional foods do not require a similar disclaimer.

Please see this OPSS FAQ on labeling of dietary supplement products for more information.


2 14-year old girl weightlifters test positive for steroids!

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Egypt faces the possibility of being banned from weightlifting for up to two years by the sport’s governing body after five teenagers, including two girls aged 14, tested positive for steroids — a charge the head of the country’s weightlifting federation has rejected as “a conspiracy”.

The International Weightlifting Federation (IWF) confirmed that the five, and two 20-year-olds, tested positive at the African Youth and Junior Championships in Cairo last December.

The Egyptian Anti-Doping Committee and the Egyptian Weightlifting Federation said they were victims of a plot and an internal investigation by the federation suggested somebody with a grudge had doctored food eaten by the team. 

“There is a conspiracy against the Egyptian Federation behind doping cases,” Egypt Weightlifting Federation head Mahmoud Mahjoub said.

The Egyptian organizations provided no evidence to support a plot and Reuters could not independently confirm their accusations.

Under IWF rules, any country returning three or more positive tests within a year faces a range of sanctions and in serious cases can be suspended from the sport.

Asked about a potential ban under section 12 of the IWF Anti-Doping Policy, which sets out possible punishments for nations who have three or more positives in a year, the body’s legal counsel.  Eva Nyirfa told Reuters in a statement:


“In line with Article 14.3 of the WADC (World Anti-Doping Code) the IWF will not make any further comments on the cases until they are closed.”

Osama Ghoneim, head of the Egyptian anti-doping committee,told Reuters that the committee “had not been informed of any sanctions yet but the rules stipulate that the local federation must be sanctioned for three years and fined $250,000 if positive cases appear.”

Nine nations are already facing a ban after returning three or more via International Olympic Committee (IOC) retesting of samples taken at the 2008 and 2012 Olympics. Those nine cases were due to be dealt with by the IWF’s executive board later this month.

Doping has long plagued weightlifting despite efforts by the IWF to eradicate it. Russia was banned from the 2016 Olympics in Rio de Janeiro for “bringing weightlifting into disrepute” after a series of positive tests.

The news of the Egyptian cases come a week after the IOC warned that the entire sport faces exclusion from the 2024 Olympics if it does not provide a “satisfactory report” on how it will address its doping problem.


According to a list of names provided by the Egyptian federation to Reuters, two girls were aged 14 while two other girls and one boy were aged 15 to 17 when the IWF tested them in Cairo last December.

In January, the IWF said the two 20-year-olds, both junior gold medalists, were Ahmed Emad Gouda (men’s 77kg) and Alla Yasser Zaki (women’s 75kg).

None of the lifters who failed tests responded for comment when contacted by Reuters via the Egyptian federation.

The IWF’s legal department told Reuters it would not disclose further details about the cases because five of the seven were minors at the time of the sample collection. It said the WADA code prohibits them from commenting on such cases.

Khalid Qarni, the coach who was in charge of the national youth team and other international lifters, is now working in Saudi Arabia. He did not respond to a request for comment.

Mahjoub, the president of the Egyptian federation, was elected to the IWF’s executive board last month.


Should we really be drinking all those Energy Drinks?

On April 26, 2017, sixteen-year-old Davis Allen Crepe consumed a large diet soda, a large latte, and an energy drink within a short time frame. Two hours later he went into cardiac arrest and died. In June of 2014, sixteen-year-old Lanna Hamann was vacationing with family and friends in Mexico when she went into cardiac arrest and died after consuming several energy drinks in a short period of time.

Davis Allen Crepe

Figure 1. Davis Allen Crepe

Lanna Hamann

Figure 2. Lanna Hamann

Energy Drinks Lead to Hospital Visits

The number of annual hospital visits involving the drinks doubled from 2007 to 2011, the latest year for which data are available, according to a report by the Substance Abuse and Mental Health Services Administration.

In 2011, there were 20,783 reported emergency room visits in which an energy drink was cited as the primary cause of or a contributing factor to a health problem, compared with 10,068 in 2007. Such problems, which are typically linked to excessive caffeine consumption, can include anxiety, headaches, irregular heartbeats and heart attacks.

Energy drinks have been labeled a dietary supplement within the marketplace and are considered to be the highest in increasing consumer penetration. Although they are a small component of the non-alcoholic beverage industry, they are considered the most dynamic with 60% market growth. It is estimated that the US sales of energy drinks have brought them a market worth of $12.5 billion. The energy drink industry is being forced to change their marketing strategies and methods due to the targeting of a younger audience that are at risk for over consumption.

It is also estimated that 10% of high school students drink energy drinks. Why are so many young individuals turning to energy drinks? According to the 2011 sleep poll, by the time U.S. students reach their senior year in high school, they are sleeping an average of 6.9 hours a night, down from an average of 8.4 hours in the sixth grade.

Energy drinks can contain as little as 80 mg of caffeine (e.g., Red Bull) or as much as 500 mg of caffeine (2 oz serving of ALRI Energy shot). Certain brands of coffee are manufacturing products with very high levels of caffeine (e.g., Biohazard coffee contains 928 mg of caffeine in a 12 oz serving). Furthermore, the majority of energy drinks are not only caffeine based but also include a variety of B-vitamins with taurine and other amino acids and stimulants. Taurine is an amino acid that is naturally produced by the human body however, the version found in energy drinks is manufactured. Taurine helps regulate heartbeat, muscle contractions, and energy levels. Usually the body makes enough taurine so there is no need to supplement. A B-Vitamin deficiency is quite rare (mostly seen in vegans) or who drink heavy amounts of alcohol.

THF Bar Graph

Figure 3. Top 5 Ingredients in Energy Drinks.

What are the Risks?

The standard energy drink with 100-200 mg of caffeine is not our concern. The concern lies with products that contain high levels of caffeine with multiple stimulants. Many products are combining caffeine with stimulants such as Guarana Seed, Yohimbine, and Yerba Mate.

Combining high levels of caffeine with other stimulants may cause an electrical disturbance causing a life threating arrhythmia (i.e. heart palpitations). As we’ve seen in several cases in teens and adults, it could potentially lead to cardiac arrest and eventually death.

While energy drink ingredients such as caffeine have been widely studied, others haven’t. And, manufacturers are using mainly anecdotal evidence as justification of their use in their beverages or other products. Consumers should be aware of the ingredients contained in energy drinks and make educated decisions whether or not these beverages are the best choice for their bodies and those of their children.


Author: Tavis Piattoly, MS, RD, LDN
Taylor Hooton Foundation
Education Program Manager & Sports Dietitian