Bodybuilding

Charlatans thrive in the field of nutrition perhaps more so than in any other area of medical science. A quick glance through the business pages of the phone book will likely reveal many nutritionists who claim to be qualified nutrition-related consultants. Some sports supplement consumers will undoubtedly wish to consult with a nutrition professional to individualize and optimize their supplement program. But to whom should one turn to for accurate, unbiased sports supplement advice?

A listing in the table does not imply endorsement for an included credential, as many questionable credentials have been included. Rather, the table features an array of possible sports supplement advisors, despite whether or not they are truly qualified.

In most instances, accreditation means that an educational institution’s course credits will transfer to another school. Accreditation does not guarantee scientific accuracy, but does demonstrate that the program is well organized. All respected educational institutions are accredited.

Some institutions grant degrees, such as BS, MS, and even PhD degrees, but are not accredited. And unfortunately, some dishonest individuals use titles that they have not earned.

Because certain titles are not legally defined in all states, the person bearing a given title mayor may not have obtained a degree through an accredited institution. For example, some states have reserved the title of nutritionist for practitioners who have completed an appropriate college degree, whereas in other states anyone can call himself or herself a nutritionist regardless of educational background. Fake degrees that have been accredited by phony accrediting agencies add to the confusion. A legitimate accreditation agency must be recognized by the US Department of Education. To find out if a degree is from a properly accredited institution, a person may refer to the Accredited Institutions of Post-secondary Education Programs Candidates, which is published by the American Council on Education. This directory is available at many libraries, and lists accredited institutions, professionally accredited programs, and candidates for accreditation.

Licensure refers to a particular state’s recognition of an individual’s competence. Competence is commonly determined by passing a state licensure examination. Licensing provides a way to ensure that practitioners have met minimal standards of education and experience. A revocation of licensure does not negate a person’s academic credentials. For example, an unlicensed medical doctor, although unable to practice medicine, can still use the designation of MD and, in some states, may still be able to provide services as a nutritionist. To find out if a nutrition practitioner is licensed in the state in which he or she practices, the consumer should contact that particular state’s health-licensing agency. A standard name for such an agency does not exist, so a consumer may have to search the state government pages of the phone book for the appropriate agency

Traditionally, the primary health professional who dispenses nutritional information is the registered dietitian (RD), which requires the completion of a bachelor’s or master’s degree approved by the American Dietetic Association (ADA). However, the distinction of RD alone may not be sufficient enough to prepare a dietitian to become familiar with all of the sports supplements because of its rapid progression. Therefore, an RD should ideally be a member of the Dietary Practice Group (DRG) for Sports, Cardiovascular, and Wellness Nutritionists (SCAN), a section of the ADA having over 5000 professionals devoted to the application of sports nutrition. Becoming a SCAN member requires nothing more of the RD (or other ADA member) than paying a fee, but it does ensure that the RD has access to the latest scientific information in the field.

Other scholastically qualified individuals who may be good resources for scientific information on ergogenic aids include exercise physiologists, pharmacists, nutrition researchers, and physicians. These degrees alone are insufficient if the individuals have not specialized in nutrition as it relates to sport or if they have not actively and intensively self-studied such information. For example, the most desirable MDs and DOs for sports supplement consultation are those who have completed residencies in bariatrics (obesity), sports medicine, and endocrinology, or who have specialized in clinical nutrition. The academic/research degrees of BS, BA, MS, MA, PhD, and EdD offer expertise in any number of fields, from history to psychology and so on. Therefore, qualified individuals who hold these degrees should have specific backgrounds in biochemistry, nutritional biochemistry, nutritional physiology, nutrition, nutrition science, muscle physiology, exercise physiology, exercise science, or sports pharmacology.

The most common credentials of nonrecognized nutritionists are attained through certification rather than formal education. The difficulty of becoming certified varies greatly among the certifying bodies, but most certification organizations are not as rigorous as those that offer programs for becoming licensed. In fact, many certification organizations are correspondence courses that allow open-book examinations, which are graded liberally. In the past, some certifying bodies charged a fee in exchange for a fancy certificate, which led to household pets becoming recognized certificate holders.

Fortunately for the consumer, the days of unreliable nutritional consultation are numbered. The ADA has been leading a successful movement to restrict or prohibit unlicensed individuals from disseminating nutritional information. Essentially, the ADA is making dispensing nutritional information by an unqualified person analogous to practicing medicine without a license.

To summarize, the consumer can check the qualifications of an individual providing sports supplement information by first looking for the credential or degree abbreviations listed after the person’s name. Next, the reputation of the degree-granting institution can be checked through directories of accredited institutions. The consumer can also contact the health-licensing agency of the state in which the consultant practices to find out if the consultant meets the state requirements to advise clients in nutrition. To find out if a person is qualified as an RD, the consumer may contact the ADA.

Even more influential with regard to dietary supplements, the DSHEA, legally known as Public Law 103-417, was signed by President Clinton on October 25, 1994 in response to concerned nutritional supplement consumers and manufacturers who needed reassurance that safe dietary supplements would remain available to those who want to use them.10,11 In fact, for the 2 years preceding the DSHEA, many congressmen reported that they received more correspondence and phone calls regarding dietary supplements than on any other subject, including the national deficit, healthcare reform, and abortion. Consequently, members of Congress approved the measure unanimously.

The DSHEA basically allows supplement manufacturers the freedom to market more products as dietary supplements and to provide information about product benefits so that consumers can make informed choices. Although the DSHEA was welcomed by manufacturers and consumers alike, in the eyes of some consumer advocates, it “weakened” the enforcement ability of the FDA, but not as much as its original sponsors had intended.

Ingredient and Nutrition Information Labeling

The most visible DSHEA-mediated change is written on the packaging of nutritional supplements. Through requirements of the DSHEA, dietary supplement labels have been redesigned to be more consumer friendly. A dietary supplement is easy to recognize because the product label reads “dietary supplement.” Among other requirements, supplement labels will provide a “Supplement Facts” panel, a clear identity statement, and a complete list of ingredients. Supplement labels will be further described in this chapter under “Consumer Savvy.”

Distinguishing Among Foods, Food Additives, and Nutritional Supplements

Historically, the FDA regulated dietary supplements as foods for several decades. This was done to ensure that their labeling was accurate and that the supplements were safe and “wholesome.” Under the 1958 Food Additive Amendments to the Federal Food, Drug, and Cosmetic Act (FD&:C Act), any new dietary ingredients for use in food or supplements were evaluated for safety. Frequently, the FDA previously viewed ingredients contained within dietary supplements as being analogous to substances that are added to foods. This perspective was problematic for supplement manufacturers because if a substance was not recognized as safe (GRAS) based on ample scientific literature, then the substance was categorized as a food additive, categorizing it in this way had several consequences for a dietary supplement.

According to the FD&:C Act, to market a food additive required petitioning the FDA for permission. To successfully petition often required much new research, money, and patience; it sometimes took the FDA more than 5 years to approve a new food additive. Because this previous system seemed unnecessarily complex, Congress amended the FD&C Act with the DSHEA to incorporate many provisions for dietary supplements. One major provision of the DSHEA is the precise clarification that the term “food additive” does not apply to dietary supplements. Hence, the DSHEA excludes the ingredients in dietary supplements (and therefore sports supplements) from the pre market safety assessment that is mandated for food additives or for new uses of previously established food ingredients. Binders, fillers, diluents (substances used to dilute), preservatives, and colors that may be used in nutritional supplements are still subject to food additive regulations (New and old ingredients are defined by the FDA with respect to whether they were marketed for nutritional supplement use in the US before or after October 15, 1994.)

The Supplement Police

With the new legislation, the regulatory role of the FDA was changed from that of evaluating pre market safety to policing the industry. Essentially, the FDA went from playing the role of the teacher granting a hall pass to assuming the role of the principal patrolling the hallways for violators. Thus, the burden of proof now rests on the FDA. However, dietary supplements are not exempt from all safety provisions.

What is a “Safe” Supplement?

The DSHEA categorizes a nutritional supplement as adulterated (impure, or of questionable safety) if it or one of its ingredients poses “a significant or unreasonable risk of illness or injury” when used as indicated on its label. If there are no directions on the label, then the supplement must not present a risk when used under normal conditions. Also, any new ingredient may be considered unsafe if there is inadequate information from which to draw conclusions about its safety.

The government did receive some new authorization as a result of the DSHEA. For example, the Secretary of Health and Human Services may proclaim a dietary supplement “to pose an imminent hazard to public health or safety,” which would effect an immediate ban on sales of the product.

Using Literature to Inform Consumers

Before the DSHEA, any publications used to promote dietary supplements could be regulated by the FDA as labels when used at the time of a prospective sale. Literature that claimed any role in the cure, mitigation, treatment, or prevention of any disease was particularly targeted. These claims, though not made on the product itself, would have made the supplement subject to regulation as a drug. So according to the old statutes, supplement sales­clerks should not have promoted products by showing customers any publications that claimed disease-prevention benefits This restriction was even true of scientific publications. Despite these restrictions, however, these marketing strategies were widely practiced.

The new legislature offers significant freedom to those who wish to use literature to market nutritional supplements. Furthermore, the publication must meet several criteria, it must not be false or misleading; it must not promote a particular brand or manufacturer; it must be presented with similar material in a balanced fashion that illustrates the sum of the available scientific literature; when displayed, it must be physically separate from the supplements; it must not have any additional information, such as product promotional literature, affixed to it. Given these amendments, a supplement salesclerk may now legally promote supplements by showing consumers scientific literature detailing the health benefits of particular supplements.