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Buyer Beware! Dietary Supplements, Student-athlete Eligibility and Health

A growing number of student-athletes lose eligibility and are suspended from their sport because they tested positive for an NCAA banned drug after consuming a dietary supplement that contained the banned drug. Many student-athletes (and some staff) erroneously believe that if a supplement product is legal, or obtained from a “health food store” or other retailer, that the product must be okay to consume. Research tells us otherwise: Olympic testing and other quality control testing of over-the-counter supplement products identified that between 15-25 percent of products contained a banned ingredient that is not on the label. Supplement products sold for weight loss, weight gain and sexual and sports performance present an even greater risk: many of these are contaminated or “spiked” with unlabeled stimulants and anabolic agents, which when consumed can result in the loss of a student-athlete’s eligibility.

Dietary supplement products do not have to prove efficacy, safety or purity before going to market. This came about in 1994 with the enactment of the Dietary Supplement Health and Education Act, DSHEA*.  Indeed, because DSHEA does not conduct a pre-market review of dietary supplement products (as opposed to what is required for over-the-counter drugs), anyone can “package” substances and sell them as dietary supplements, as long as they do not make a medical claim.

Health and Safety

In addition to concerns about eligibility, tainted dietary supplement products can have negative health effects on consumers. ConsumerLab.com tested more than 4,500 over-the-counter supplement products between 1999-2015, and found that 20 percent of vitamins and minerals, 43 percent of herbals, 24 percent of nutrition powders and drinks and 21 percent of other products failed their evaluations.

The products had too much, or too little, of the ingredients as listed on the label; or the wrong ingredient; or potentially dangerous or illegal ingredients; or were contaminated with heavy metals; or spiked with unexpected ingredients. Dietary supplement products are removed from production only after a number of serious “adverse events,” i.e. negative health outcomes, including death, are reported and documented to the FDA. This happened with the dietary supplement ephedra when it was implicated in 155 deaths and subsequently removed from dietary supplement products. Even vitamins and minerals, which are dietary supplements, have been implicated in thousands of adverse events.

Student-athletes are advised to check out any product, including vitamin and mineral supplement products, with the appropriate athletics staff before consuming.

Emerging Concerns

Most recently, the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports has heard a number of appeals of positive drug tests on behalf of student-athletes who have tested positive for selective androgen receptor modulators, SARMs, and selective estrogen receptor modulators, SERMs.  These were reportedly consumed by student-athletes who claim they only used legally obtained dietary supplements. In NCAA drug testing during the 2013-14 season, two student-athletes tested positive for SARMs; in 2016-17, 28 student-athletes tested positive and were sanctioned. SARMs are banned under the anabolic agents class of drugs, and SERMs are banned under the anti-estrogen class. Both classes are sanctioned as performance enhancing drugs. Although student-athletes may not realize they are taking a supplement with these banned drugs, ignorance is no excuse, as every student-athlete signs a drug testing consent form that warns of the risk of supplements and notes that student-athletes are responsible for anything they ingest. All NCAA member schools are required to educate student-athlete about NCAA banned drugs and the products that may contain them. A positive drug test resulting from an unlisted, banned ingredient still results in the loss of eligibility and withholding from a season of competition.

Per NCAA legislation, all member institutions are required to educate student-athletes about banned drugs and the products that may contain them.

The NCAA subscribes to Drug Free Sport AXIS, the only authoritative resource to provide the membership with a review of ingredients on a dietary supplement product or a medication to determine if the ingredients are banned. Member schools can contact AXIS at www.drugfreesport.com/axis (use password ncaa1, ncaa2 or ncaa3). Review of a product will indicate whether an ingredient on the label is banned, and conducting such a review can reduce the risk; however, no review of the label can guarantee 100 percent that a supplement product is safe.

Permissible Benefits and Food First Philosophy

Out of concern for student-athletes' health and safety, and a commitment to maintain fair competition, under Bylaw 16, the NCAA restricts the kinds of nutritional supplements member schools may provide to student-athletes. The intent of this nutritional supplement legislation is to allow institutions to meet the needs of student-athletes to replace calories and fluids expended in large amounts during training and competition through a carbohydrate or electrolyte supplement, but not to replace food as their source of nutrition, both for performance and health. Overall, the NCAA advocates a food-first approach to fueling performance due to its proven efficacy and reduced risk of harm compared to consumption of poorly regulated dietary supplements. Real food packages nutrients in the most efficient, effective and least expensive manner. Micronutrients packaged in capsules, pills and powders are not as compatible with digestive systems, and in many instances, become added waste, as the body either does not need in the amounts provided or cannot use it in the manner provided. Options for food first can be found at the “Sports Nutrition” resource tab on AXIS. To log in to AXIS and download the handouts, visit dfsaxis.com, select your organization (NCAA Divisions I, II or II), and enter the corresponding password: ncaa1, ncaa2, or ncaa3, respectively. (Note: Passwords are case-sensitive.)

In the event of a nutritional deficit concern, a student-athlete should be evaluated by a registered dietitian. The Sports, Cardiovascular and Wellness RDs, a practice group of the Academy of Nutrition and Dietetics, provides a resource to help institutions search for a sports dietitian and to understand the qualifications for this profession. Student-athlete health and performance benefit greatly from good nutrition, and good nutrition promotes health, which enhances performance!

*Dietary supplement products are products that contain an added dietary supplement ingredient identified by DSHEA, the Dietary Supplement Health and Education Act. https://ods.od.nih.gov/About/DSHEA_Wording.aspx 

Per DSHEA, the term “dietary supplement” -

  • “(1) means a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients:
    • “(A) a vitamin;
    • “(B) a mineral;
    • “(C) an herb or other botanical;
    • “(D) an amino acid;
    • “(E) a dietary substance for use by man to supplement the diet by increasing the total dietary intake; or
    • “(F) a concentrate, metabolite, constituent, extract, or combination of any ingredient described in clause (A), (B), (C), (D), or (E).
  • “(2) means a product that -
    • “(A)(i) is intended for ingestion in a form described in section 411(c)(1)(B)(i); or
    • “(ii) complies with section 411(c)(1)(B)(ii);
    • “(B) is not represented for use as a conventional food or as a sole item of a meal or the diet; and
    • “(C) is labeled as a dietary supplement.