Bigger, Stronger, Faster… But At What Cost?

Both recreational at competitive athletes are looking to enhance their performance. Many turn to purported ergogenic supplements.

Are these safe?

A number of readily available sports performance enhancing supplements, such as those marketed for body building, weight-loss and energy are often spiked with stimulants, anabolic agents, and even pharmaceuticals.

Most young athletes, coaches, and parents, are not educated or informed about the possibility of this adulteration and assume that supplements are safe, however, the US government does not have effective regulations in place to protect consumers.

Stimulants are a popular ingredient in dietary supplements and can lead to increases in blood pressure, loss of appetite, emotional instability, nervousness, jitteriness, and even social withdrawal.

Pharmaceuticals, which are found surprisingly often in dietary supplements, can have varying and unpredictable toxicological effects.

Even caffeine can have serious side-effects at high doses and in combination with other stimulants, including transient ischemia (lack of blood supply) resulting in adverse events in the brain and/or possibly sudden death in otherwise healthy individuals.

Some of the side-effects of these supplements are not always acute, but instead appear as delayed, chronic health problems, such as the long-term use of some bodybuilding supplements being linked to testicular cancer.


Eichner, A., & Tygart, T. (2015). Adulterated dietary supplements threaten the health and sporting career of up‐and‐coming young athletes. Drug Testing and Analysis.
Energy Drinks

“Energy drinks” are widely used by consumers in hopes of enhancing athletic performance.  These pre-workout products typically contain “proprietary blends” of multiple ingredients, including caffeine, dimethylamylamine, creatine, arginine, alanine, taurine, and phosphates.

While some dietary supplement labels instruct consumers to seek the advice of a healthcare professional before using the products, the labels usually do not disclose all ingredients or their precise amounts, and evidence to support the purported performance-enhancing benefits is generally sparse.

Some adverse effects reported in association with pre-workout supplements include gastrointestinal symptoms, cardiac arrhythmia, blood pressure increases, and potential effects on lipids and blood glucose.

One should also consider that energy comes from macronutrients, i.e. carbohydrates, fats and proteins. The so called “energy” from these supplements is sympathomimetic- stimulation which mimics the effects of the sympathetic nervous system.

Although evidence exists to support the performance-enhancement efficacy of some pre workout ingredients as standalone agents, data on combination products is scant, inconclusive, or conflicting, and the safety of these products may be compromised if users consume larger-than-recommended amounts or uses more than one product concurrently, which is often the case.


Eudy, A. E., Gordon, L. L., Hockaday, B. C., Lee, D. A., Lee, V., Luu, D., … & Ambrose, P. J. (2013). Efficacy and safety of ingredients found in preworkout supplements. American Journal of Health-System Pharmacy,70(7).
Getting “Jacked”

A 26-year-old male was presented to a military treatment facility in Afghanistan shortly after taking a weight-lifting supplement called Jack3d with a severe headache. He was subsequently found to have suffered a hemorrhagic stroke in his brain.

Jack3d active ingredients include geranamine, schizandrol A, caffeine, β-alanine, creatine monohydrate, and L-arginine α-ketoglutarate.

A review of the literature suggests that some of the constituent ingredients in Jack3d may predispose susceptible individuals to stroke and hemorrhage.

The product has no readily apparent disclaimer or warning regarding the risks or lack of data regarding the components.


Young, C., Oladipo, O., Frasier, S., Putko, R., Chronister, S., & Marovich, M. (2012). Hemorrhagic stroke in young healthy male following use of sports supplement Jack3d. Military medicine, 177(12), 1450-1454.

DMAA is a neurological stimulant which causes a quick spike of energy similar to Caffeine and other classical stimulants. It is not a highly studied compound in isolation. Although seemingly well tolerated in pre-workout supplemental form, DMAA has been linked to a cerebral haemorrhage in a case study with party pill usage

Schilling, B. K., Hammond, K. G., Bloomer, R. J., Presley, C. S., & Yates, C. R. (2013). Physiological and pharmacokinetic effects of oral 1, 3-dimethylamylamine administration in men. BMC Pharmacology and Toxicology, 14(1), 52.


Are there safe natural alternatives for performance enhancement?

JERF (Just Eat Real Food)

Eating a balanced diet of whole foods is essential.  Manipulating macro-nutrients (Carbohydrates, Proteins and Fats) and paying attention to pre and post work out “windows” can be a useful strategy to maximize anabolic gains, performance and recovery.

Depending one’s goal, sport and energy system used, the macronutrients can be manipulated accordingly to give that competitive edge and maximize the desired adaptations.

Sound Training

Nothing can replace sound exercise program design that takes into consideration the goals and needs of the individual (e.g. Stabilization, Strength, Power, Endurance and/or Sport Specific), focuses on the appropriate acute variables and has scheduled rest periods  (AKA Periodization).


Simply put, both exercise and competitive sports cause tissue damage and inflammation. Your body needs rest (planned days off) and adequate sleep to repair. Poor sleep and inadequate rest result in over-training,  poor repair, depressed immune function and recurrent injuries and illness.

Natural Supplement/Ergogenic Options and Strategies

Carbohydrates from food

Complex- High fiber foods found in vegetables, fruits and whole grains help to saturate glycogen stores in the liver and muscles and maximize energy availability for sustained release in both anaerobic and aerobic activities

Simple- Simple carbohydrates found in fruits, dried fruits, juice and refined foods (including sports bars) can be useful before, during and after a workout to keep energy levels high and quickly replenish glycogen stores. These have more application for performance and would be less desirable for those looking to enhance their physique

Vitargo-  Vitargo is a rapidly digestible carbohydrate supplement capable of delivering glucose to the blood, liver, and muscle at least twice as fast as other ordinary carbohydrates. Unlike other carbohydrate supplements that can cause digestive distress, Vitargo empties from the stomach faster and be absorbed into the body more quickly.

(See studies posted on website)

Protein Supplements

Whey Protein

Casein Protein

The combination of whey and casein protein has been shown to promote an increase in fat-free mass in conjunction with resistance training.

Antonio et al, found that consuming a high protein diet (3.4 g/kg/d) in conjunction with a heavy resistance-training program may confer benefits with regards to body composition and that there is no evidence that consuming a high protein diet has any deleterious effects.

Whey protein is a faster releasing protein, so would be good to have pre and post workout, whereas casein is slower to release, so would be good to take before bed, to aid in repair during sleep.

Antonio, J., Ellerbroek, A., Silver, T., Orris, S., Scheiner, M., Gonzalez, A., & Peacock, C. A. (2015). A high protein diet (3.4 g/kg/d) combined with a heavy resistance training program improves body composition in healthy trained men and women – a follow-up investigation. Journal of the International Society of Sports Nutrition, 12, 39.

Kerksick, C. M., Rasmussen, C. J., Lancaster, S. L., Magu, B., Smith, P., Melton, C., … & Kreider, R. B. (2006). The effects of protein and amino acid supplementation on performance and training adaptations during ten weeks of resistance training. The Journal of Strength & Conditioning Research, 20(3), 643-653.


A key limiting factor affecting exercise capacity during endurance sports is reduced carbohydrate availability coupled with an inability to effectively utilize alternative lipid fuel sources. Additionally, cognitive and physical decline associated with glycogen depletion is a limiting factor not present in those who are in a keto adapted state.  

Keto-adaptation can enhance human physical and mental performance and could be of benefit for some endurance athletes.

An important point to consider if switching to fat and ketones as the primary source of fuel vs carbohydrates, is that in anaerobic sports , such as weight lifting, sprinting, boxing and many team sports, ketones and fat will likely impede performance and carbohydrates are the preferred fuel source.

The process of fat adaptation takes several weeks and should be done under medical supervision.

Volek, J. S., Noakes, T., & Phinney, S. D. (2015). Rethinking fat as a fuel for endurance exercise. European journal of sport science, 15(1), 13-20.


Caffeine is a naturally occurring substance consumed in a variety of forms, and capable of producing multiple physiologic effects throughout the body.

The actions of caffeine are primarily mediated centrally via adenosine receptors.

Several studies have demonstrated an improvement in exercise performance in submaximal endurance activities. Its potential ergogenic effect in acute, high-intensity exercise is less clear.

Woof et al found that moderate dose of caffeine resulted in more total weight lifted for the chest press and a greater peak power attained during the Wingate test in competitive athletes.

A word of caution: Postexercise systolic blood pressure can increase  significantly after caffeine consumption. If taken as a “stack” with other stimulants, this could pose a risk for adverse (sometimes life threatening) events in susceptible individuals and under certain conditions (e.g. Hot weather)

The typical dose is 150-250 mg.

Woolf, K., Bidwell, W. K., & Carlson, A. G. (2008). The effect of caffeine as an ergogenic aid in anaerobic exercise. International journal of sport nutrition,18(4), 412.


Beet root Juice

Dietary supplementation with beetroot juice increases plasma nitrite concentration, reduces blood pressure and may positively influence the physiological responses to exercise. In addition, it has been found to enhance cardiovascular health, including blood pressure parameters.

Dose= About 1.5 cups

Wylie, L. J., Kelly, J., Bailey, S. J., Blackwell, J. R., Skiba, P. F., Winyard, P. G., … & Jones, A. M. (2013). Beetroot juice and exercise: pharmacodynamic and dose-response relationships. Journal of applied Physiology, 115(3), 325-336.


Creatine is perhaps the most well studied and one of the safest ergogenic aids commonly used. Chronic supplementation with creatine monohydrate has been shown to promote increase skeletal muscle mass, lean body mass and muscle fiber size. Furthermore, muscular strength and power can also increase after supplementing with creatine.


Antonio, Jose, and Victoria Ciccone. “The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength.”J Int Soc Sports Nutr 10, no. 1 (2013): 36.

Beta alanine

Supplementation with β-alanine has the ability to increase muscle carnosine. Carnosine plays a  role as a pH buffer and has the  potential to increase high-intensity exercise performance and capacity.

In addition, there is evidence for a potential therapeutic role for carnosine in ageing, neurological diseases, diabetes and cancer.

Dose: 2-5 g

Caution: Large doses of beta-alanine may cause a tingling feeling called paresthesia. It is a harmless side effect.

Sale, C., Artioli, G. G., Gualano, B., Saunders, B., Hobson, R. M., & Harris, R. C. (2013). Carnosine: from exercise performance to health. Amino Acids,44(6), 1477-1491.

Key Points


  • Many sports performance enhancing supplements, such as those marketed for body building, weight-loss and pre-workout/energy  are unsafe and can have adverse effects, including death
  • The best way to optimize performance is through a balanced diet, sound exercise program and adequate rest
  • Manipulating macronutrients based on one’s goals and sport can be an effective way to enhance performance
  • There are a number of effective (evidence-based) and relatively safe performance enhancing supplements, including: Vitargo, Caffeine, Beet Root Juice, Creatine and Beta-alanine
  • High doses of vitamins and minerals do not have super-physiological effects unless one is deficient and could adversely affect one’s health if taken in high doses long term



About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin