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Success in sport is determined by genetic endowment and by the modulation of that innate talent by an appropriate training programme. When athletes train to the limits of what is possible, they inevitably look for other factors that may help them to gain an advantage over the opposition. Of these, nutrition is often seen as an ‘easy’ option, and it is undoubtedly true that the food choices that an athlete makes will have profound effects on the ability to sustain consistent and intensive training and to amplify the training response. Although some of the details are unclear and are the subject of debate, there is little doubt that good nutrition strategies can also optimise performance in competition.1
At the highest level of sport, competitors will all be genetically gifted, will have trained intensively and will have exploited all obvious performance-enhancement strategies. In the search for further gains, the use of dietary supplements is an attractive opportunity. Athletes may feel that normal foods may not meet their needs for essential nutrients, including vitamins and minerals, the requirement for which may be increased by hard training. It is also recognised that some substances can exert specific effects on a range of physiological and biochemical functions that affect either health or performance and this has led to the common use of a wide range of dietary supplements in sport at all levels.2 Many surveys show, though, that supplement use is also widespread in the non-athletic population, which has led to the growth of an industry that generates enormous profits.3
Not all aspects of supplement use are positive: some carry a high financial cost without offering any proven benefit, and others may be harmful to health and/or performance, especially if used inappropriately. Some supplements have also been shown to contain substances prohibited under the antidoping regulations that govern elite sport, often without these being declared in the label, leading to the imposition of penalties on athletes who may not have been aware of what they were ingesting.4 This has led many sports governing bodies to discourage the use of supplements by athletes, but the prospect of a performance benefit has to be weighed against the risk.
Lausanne 2017: expert panel meeting
To address concerns over the use of supplements, the Medical and Scientific Commission of the IOC assembled a panel of experts in Lausanne, Switzerland, in May 2017. The aim was to review all aspects of the use of dietary supplements by high-performance athlete. Participants were selected because of their experience and expertise in one or more relevant areas. Detailed discussion papers were prepared in advance of the meeting and were circulated to all participants to ensure an informed discussion.
Dietary supplements are a legitimate part of the high-performance athlete’s preparation
It was concluded, after 3 days of intensive discussion, that dietary supplements are a legitimate part of the high-performance athlete’s preparation that, when used appropriately, can play a role in maintaining good health, supporting effective training and optimising performance in competition. This marks a major departure from the previous stance that discouraged supplement use because of the potential for harmful effects. These conclusions were summarised in an Expert Statement that appeared on the IOC website shortly after the meeting.5 It was also recognised, however, that the evidence for the efficacy of many of the supplements used by athletes is limited and that even where some evidence does exist, little is derived from studies of elite athletes and few studies have used experimental models that resemble sporting contests. The Expert Statement also continued to emphasise that the use of supplements is not without some risks, especially for those athletes liable for testing for the use of prohibited substances. Serious adverse effects of supplements are fortunately rare, but include impairments of health and performance as well as the potential for unwitting ingestion of substances that are prohibited under the antidoping codes that govern elite sport.
An extended version of Expert Statement was published in April 2017 in the British Journal of Sports Medicine.6 This summarises the evidence that forms the basis of the expert review. A series of papers providing further detail on specific aspects of supplement use will be published in the International Journal of Sport Nutrition and Exercise Metabolism.
Although the ultimate responsibility for supplement use lies with the athlete, the support team that surrounds the elite athlete has an important responsibility to protect the athlete’s health and well-being while striving to maximise performance. Athletes and coaches have many other concerns and cannot be expected to fully appreciate all the nuances of potential risks and benefits for each supplement, but the support team should be well informed.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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