With the death of a London Marathon runner now linked to a popular sports supplement, we had to ask

ABSTRACT: Its been a busy month for supplements. Ray Lewis gets caught using Deer Antler spray. New York Yankees catcher Francisco Cervelli claims that alleged PEDs he purchased from a Miami clinic were “legal ways to aid rehab and recovery.” And the death of a 30-year-old woman who ran the London Marathon is linked to DMAA, a legal-for-sale supplement found in many energy drinks. Despite the risks to career and health, the U.S. supplement industry is a $28 billion a year operation—and growing. We trust our supplements. They’re all-natural, chemical-free, pure, and clean. Even if they don’t work, they can’t hurt, we say. After all, they’re on the store shelves. So we take creatine before we lift, fuel with carbohydrate drinks on the bike and run, and pound down protein to recover. But do they make a difference? And most importantly: Can they harm us? HYPOTHESIS: Sports supplements are unnecessary at best and lethal at worst. METHODS: Enter DMAA, a drug originally developed by Eli Lilly to have the same effects as amphetamines without their addictive properties, says Pieter Cohen, M.D., an assistant professor of medicine at Harvard University with a special interest in supplements. Over the last seven years, DMAA has wound up on to the World Anti-Doping Agency’s list of prohibited substances and has been banned by the U.S. Defense Department and a host of European countries. It’s also in your energy drinks—Jack3d (until recently) and OxyELITE Pro being two of the more prominent brands—and appeares in 250 commercial products, according to a 2013 study in in JAMA Internal Medicine. The question: Is it natural and is it safe? RESULTS: It’s neither safe nor “natural.” While studies funded by supplement maker USPlabs found DMAA in the plant geranium, two follow-up studies—one in the Journal of Analytical Toxicology and the other by the University of Texas—found that DMAA does not exist in nature in the same structure as it does in supplements. DISCUSSION: There’s a low bar for safety and efficacy when it comes to your supplements. And it all goes back to the Dietary Supplement Health and Education Act of 1994 (DSHEA), Cohen says. In the early ‘80s and ‘90s, people were making outrageous claims—vitamin C can cure cancer, etc. But the Food and Drug Administration (FDA) spotted a problem: At high doses, many vitamins are dangerous. So the agency logically moved to “set limits on how much vitamins could be found in pills,” Cohen says. The backlash was fierce. People feared that the “FDA was making this power move to turn supplements into prescriptions drugs,” and the drive to regulate vitamins was crushed. Meanwhile, herbal ingredients, amino acids, and probiotics were thrown into the same regulatory mix as vitamins and minerals. Under the new laws, manufactures could make wild claims—last 10 times longer in bed, run at the speed of Usain Bolt—without repercussion. The only bar they had to pass: New ingredients had to “give some very minor amount of safety data to the FDA,” and anything sold as a supplement or found in food before the bill’s passing were grandfathered in as legal, Cohen says. “DMAA is like a poster child for why the laws do not work that regulate supplements,” he says. “It has no role to be sold as a supplement. It’s a pharmaceutical drug.” But back in 2006, the sports industry found one—since discredited—study linking DMAA to the plant geranium, and they introduced the drug into the sports supplement market. They had another bar to pass: “Even under the lax regulatory framework, you still have to submit safety data,” Cohen says. That was never done, and the FDA didn’t do a thing until the middle of last year and still hasn’t made a ruling. As of now, “it’s completely legal to sell a supplement with any amount of DMAA in the U.S,” despite warning letters issued by the FDA. In other words, you can buy amphetamine-like pharmaceutical drugs without prescription in any dosage. To make matters worse, you can’t actually trust the label. There’s often a large gap between the listed quantities and what you’re really getting, according to Cohen. Like Ephedra, we know DMAA doesn’t belong on store shelves. But can it kill? “It’s a true perfect storm when someone actually dies and someone can say conclusively that the supplement caused the death,” says Stuart Phillips, Ph.D., a leading researcher in the field of exercise metabolism. Deaths might not be common, but DMAA affects your blood pressure and can cause cardiac issues, he says. “Every now and again you get someone who is susceptible to those things,” and the person sometimes dies. At least that’s what some doctors speculate happened to a London Marathon runner who fueled-up on Jack3d. But the symptoms are often less severe—extreme dehydration, kidney stones (caused by the dehydration), and intense constipation, Cohen says. So who can you trust? Are any supplements safe? It’s a buyer beware market, but you can roughly categorize your sports supplements into three groups based on efficacy and risk: The pre-workout boosters, the muscle-builders, and the recovery powders. Pre-workout boosters include things like caffeine, DMAA, and Ephedra. According to Cohen, the only legal ingredient that works is caffeine. Just don’t buy it in supplement form; it’s cheaper and you’ll have a more accurate dose if you purchase a caffeine pill or drink a cup of coffee. About 100-200mg will likely do you well. If you pick a product that pushes the envelop—like DMAA—you’re running the risk of stroke and heart attack. “There’s no getting around it,” he says. The problems really start to show up with the muscle-builders, Cohen says. “They’re either not going to work, or they have shady, illegal designer steroid things in them which pose the same risks” as taking the real thing—liver problems, growth of breasts, etc. Luckily, the third category—including things like creatine and protein powder—is generally perfectly safe, according to Cohen. CONCLUSION: It’s a buyer-beware market in the world of sports supplements. So stick to the basics: caffeine, protein, creatine, and carbohydrate powders. http://www.outsideonline.com/fitness/The-Explainer-Are-Sports-Supplements-Killing-Us.html