Jul 22, 2019 1:14 PM

Bringing Clarity to the Murky World of Sports Supplements

Americans gorge themselves on vitamins and protein powders, hoping for personal transformation. But what does the science say?

LeBron James has a cramp. It’s the final minutes of a 2014 playoff game between the San Antonio Spurs and the Miami Heat. With his team down by four points, James takes a quick step, beats his defender, and jumps, sending the ball in a high arc toward the basket. It’s a beautiful shot, but the glory is short-lived: On landing, James can’t run. In fact, he can barely walk. After much whistle-blowing, the game stops and a flurry of players, trainers, and coaches escort the limping James off the court, eventually carrying him to the bench.

That fateful cramp took him out of the game, but it also thrust the biggest NBA star into a new entrepreneurial venture—sports supplements. Not satisfied with the options on the market, James set about developing his own line of specialized products; last fall, with celebrity partners Arnold Schwarzenegger, Lindsey Vonn, and Cindy Crawford, he launched Ladder. The company makes four workout supplements, promising better results through its high-quality ingredients and scientifically backed blends of superfoods, probiotics, and protein powders. “Supplements are only going to make a small difference but an important difference,” says Adam Bornstein, Ladder’s chief of nutrition. “If it works for LeBron, imagine the impact it would have on the average person.”

Dietary supplements are a more than $45 billion industry, and they got that way by promising outsize results in nearly every aspect of your physical well-being, from bigger muscles to better heart health. More than half of US adults regularly take some kind of supplement, whether fish oil, vitamin E, vitamin D, or protein powders. On the whole, these products are barely regulated. The US Food and Drug Administration treats dietary supplements like foods, not like drugs. That means the agency isn't authorized to approve a supplement's safety or effectiveness before it is marketed to consumers. To get a product off the market, the FDA must prove that it isn't safe or that its label is misleading.

Ladder says it’s in the 1 percent of manufacturers that voluntarily submit their products for independent testing by the nonprofit NSF International, whose “Certified for Sport” label verifies the supplements aren't contaminated with any illegal steroids, hormones, stimulants, or toxins.

Although dietary supplements are presumed safe until government regulators hear otherwise, the Centers for Disease Control and Prevention estimates that they cause some 23,000 visits to the emergency room every year, many due to cardiovascular problems. With booming demand and no premarket regulation, the industry has been flooded in recent years with a wide variety of products, many sporting their own proprietary blends.

Paul Thomas, a nutrition consultant at the National Institutes of Health, describes these products like snowflakes: “No two are alike.” That makes their effectiveness extremely difficult to study. Nutrients don’t work in a vacuum. Different combinations affect your body differently. Those special mixtures of amino acids and protein powders could have varying dosages and results. Blends are also frequently spiked with extra caffeine, sugars, steroids, or other ingredients that haven’t been tested at all.

“There have just been increasingly more products on the market with multiple combinations of ingredients that haven’t been assessed for safety,” says Patricia Deuster, director of the Human Performance Laboratory at Uniformed Services University. She estimates that between 60 and 80 percent of armed services members use some kind of supplement. “They think that the more ingredients, the better, when in fact we have no idea how these ingredients interact,” says Deuster. “It’s a public health risk.” (In 2012, after several deaths related to dietary supplements, the Department of Defense set up an education campaign called Operation Supplement Safety.)

Beyond fears of toxicity, there is also the question of efficacy. One popular supplement ingredient, an amino acid called beta-alanine, is supposed to help keep lactic acid from building up in your muscles. The International Society of Sports Nutrition notes that supplements containing between 2 and 4 grams of beta-alanine “are safe and efficacious … for up to 8 weeks.” (Ladder’s Pre-Workout pack, which contains beta-alanine, has 3 grams.) Thomas, who notes the research trials on beta-alanine have shown “really conflicting results,” says, “If you go for longer than eight weeks, we don’t know; if you go higher than that amount, we don’t know.”

With many supplement ingredients, Thomas adds, “the responses are very individualistic.” Some people respond really well to creatine, for example, while others respond just a bit or not at all. “Sometimes they actually can decrease your performance,” he says. Because most studies are conducted on young, college-aged men, it’s hard to tell whether the same results will apply to older athletes or to women. Similarly, all those tests are conducted in a highly controlled laboratory setting, which Thomas points out “has relatively little to do with how you are going to be in the wild.”

Nancy Clark, a sports nutritionist, is even more skeptical of the promise of supplements. “The people that need protein supplements might be your grandmother, who just doesn’t eat very much other than toast and tea,” she says. For regular people, a good diet should suffice. “The more you exercise, the hungrier you are, the more vitamins that you eat,” she says—“assuming that you’re eating broccoli instead of Skittles.”

None of this is to say that Ladder can’t help you. The company says it devotes considerable care to sourcing and quality control. It doesn’t include, say, ostarine and andarine in its formulations, which are considered untested drugs, are banned by the World Anti-Doping Agency, and are thought to cause serious health problems, including heart attack, stroke, and liver damage. Ladder restricts itself to ingredients that have been fairly well studied, such as whey protein and vitamin D. The company’s website reads like a Whole Foods inventory: non-GMO, gluten- and soy-free, sourced from peas and pumpkins and grass-fed cows. And because packaging is hardly ever trustworthy—and almost never so in the supplements world—Ladder also has all its products independently inspected by NSF.

If you are going to use supplements, researchers say you need to be clear about what you want to accomplish. Are you hoping to run faster, lift more, or have greater endurance? No one ingredient can help you do all those things better. Creatine can be great for high-intensity lifting, for example, but it won’t help you run a marathon or finish a triathlon. “In fact, because it causes you to retain some water, it will probably act as a detriment,” says Thomas.

You also need to be careful about dosage: More isn’t necessarily better. Too much caffeine leads to heart problems. A recent study suggested that large doses of vitamin D and calcium actually increase the risk of stroke. If you’re taking a supplement and you don’t feel an impact, the answer isn’t to take more; it’s to try something else. Deuster warns people to avoid any product that contains more than 200 percent of a given ingredient’s recommended daily value.

If you responsibly take a supplement, you might see an effect. Maybe. Even then, though, the real benefit may not be physical at all. “The placebo effect is very powerful,” says Deuster. If you think that extra powder will help you run, jump, and lift as well as LeBron, it just might.

Updated 7-23-2019, 4:30 pm EDT: This story has been updated to correct a quote attributed to Adam Bornstein; to clarify the distinction between federal regulation and third-party certification in the supplement industry; to clarify the amount of beta-alanine contained in a Ladder product; and to remove a statement about a link between whey protein consumption and kidney stones.