FACT OR FICTION

Can Dietary Supplements Enhance Health

and Performance?
by Antonio S. Santo, Ph.D., R.D., CSSD and Laura J. Kruskall, Ph.D., R.D., CSSD, FACSM

not possessing direct laboratory findings that

LEARNING OBJECTIVE clearly show superiority. How about Ford versus
The reader can expect to learn about updates regarding the dietary Chevrolet? I am sure you can think of plenty of
other examples where you have been in a place
supplement regulations established by the U.S. Food and Drug
where you need to make a decision about a
Administration and how to professionally discuss the use of sup- purchase and perhaps have done so on emotions
plements with his or her clients. or anecdotal information rather than genuine
facts. So, you see, its not unreasonable to suggest
Key words: that manufacturers of dietary supplements will
Dietary Supplement Regulation, FDA Regulation, Fitness advertise in a way that negotiates for your emo-
Professional, Health, Performance tional confidence in their products. How can
you make the best informed decision about the
purchase of a dietary supplement and dissem-
inate this to your clients/patients? Lets take a
look at some of the basic elements to accomplish

A
recent breakthrough by scientists has these goals.
athletes pushing endurance world re- 1. Establish necessity for supplementation
cords. A new supplement, Extreme versus experimentation/curiosity.
VO2A, was shown to improve marathon times Nutrition science is a relatively young field
by 5 minutes! No side effects were reported, and of study in comparison with others and subse-
the long-term safety has not been established. quently has been subjected to an esoteric mys-
Are you interested? How can you get a hold of tique. Individuals and companies profit greatly
this new supplement? OK, you figured us out; from creating an artificial atmosphere where they
this is a fictitious report about a supplement that appear to clandestinely know information that no
doesnt exist (yet). However, the initial excite- one else does and they are now willing to share
ment and hope that you may have experienced this information with you if you purchase their
are the emotions that makers of
dietary supplements would like all Photo courtesy of www.tonysantophotography.com.
their customers to have when
purchasing their products. Before
you start thinking that this is going
to be a piece on bashing the dietary
supplement industry, consider
this: good marketing can help the
consumer feel good about his/her
purchase and to help choose one
brand over the competitors. For
example, if you are shopping for a
camera, some individuals will tell
you that they swear by Nikon cam-
eras over Canon cameras, despite
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Copyright 2012 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Can Dietary Supplements Enhance Health and Performance?

product, book, and so on. Good marketing strategies make us
believe that our food supply is nutritionally inadequate, and the
only way to correct our dietary shortcomings is through
supplementation. The truth of the matter is that for general
health and fitness, a diet that is varied, rich in fruits, vegetables,
and whole grains, lean with respect to meats, and consumed in
moderation provides us with optimal nutrition. For athletes,
supplements may be warranted if they have trouble consuming
sufficient and varied foods to meet their nutritional needs. For
example, the traveling athlete with several competitive events
planned in a short time frame may find it difficult to eat an
appropriate amount of food with the necessary nutrients and,
therefore, may resort to a meal supplement such as a milkshake to
fill the void. Some clinical conditions and special populations (e.g.,
celiac, cancer, renal, and elderly patients) may benefit from
dietary supplementation because of a persons inability to eat,
lack of motivation to eat, or difficulty in moderating nutrients
affected by their disease (Table 1). In these situations, it is best to
refer the person to a licensed/registered dietitian (RD).
2. Know how dietary supplements are regulated.
Dietary supplements are regulated by the U.S. Food and Drug
Administration (FDA) (7). Please see their Web site for a com-
plete description. Some of the key issues include the classifi-
cation, types of claims, and regulation regarding the ingredients.
Supplements are regulated by the FDA as foods, not food ad-
ditives or drugs. This means that FDA approval is not required
before a supplement is placed on the shelf for sale. On the con-
trary, food additives and drugs undergo rigorous testing before
they are approved for sale and use by the FDA.
One of the most confusing aspects about dietary supplements
for consumers is the permitted claims. The first category is
nutrient-content claims. These are approved by the FDA and may
be used for both foods and supplements (Table 2). Examples
include terms such as fat-free or excellent source. A

TABLE 1: When Should You Consider Taking a Dietary Supplement?

Reason Example(s)

Your physician prescribes it, and it is pharmaceutical grade (you must go h Prenatal vitamins.
to the pharmacy to obtain the supplement)
h After completing a blood test, your physician determines that your iron
stores are low and recommends an iron supplement at a specific dosage
for a specific amount of time.
Your physician recommends it, and it can be purchased over the counter h Your physician completes a serum vitamin D test and recommends that
you take a certain number of International Units (IU) per day.

You are consuming less than the Dietary Reference Intake (DRI) for
certain nutrients*
You are consuming less of a nutrient where the current DRI is being
evaluated (or there is not a DRI established), and there is significant
scientific agreement about the benefits of the supplement
You eat well, but want to make sure you are getting adequate vitamins
and minerals
h After a nutrition assessment by registered dietician (RD), it is discovered
that you are not meeting calcium needs with food. Your RD may recommend
a particular type and dosage of supplement to ensure that you are
meeting the DRI with a combination of foods and supplements.
h After a nutrition assessment by an RD, it is discovered that you are not
getting adequate B vitamins with food. Your RD may recommend a
particular type and dosage of supplement to ensure that you are meeting
the DRI with a combination of foods and supplements.
h After a nutrition assessment by an RD, it is discovered that you may
benefit from a fish oil supplement to obtain increased doses of omega-3
fatty acids (particularly EPA and DHA).
h Taking a once daily multivitamin/mineral supplement.y

When Should You Not Take a Dietary Supplement (or at Least Seek Advice From an RD or Qualified Health Professional)?
Somebody recommends it because it is good for him or her
A salesperson with little formal education in nutrition is trying to make a
commission
A person recommending it cannot provide a thorough summary of the
science behind the safety and efficacy of the supplement
h Just because a product works for one person does not mean it works for
everyone.
h Many people who sell supplements do not have formal education training
and credentials in nutrition and dietetics. Be cautious. Credentialed
individuals must disclose any profit/commission they are receiving by
selling a supplement.
h A person recommending a supplement should be able to discuss the
peer-reviewed science behind the supplement. This is
evidence-based practice.

In all of these examples, it should be noted that dietary supplements may interact with each other, with over-the-counter medications, and/or with prescription drugs.
*You need to have a thorough nutrition assessment completed by an RD for this.
y
Look for a multivitamin/mineral that contains no more than 100% of the daily value (DV) for the vitamins and minerals. Some people choose to take these a
few times per week instead of everyday.

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 TABLE 2: DA Approved Terms on Food Labels
Energy Terms
diet, dietetic: terms used to indicate that a food is
either a low-calorie or a reduced-calorie food
low calorie: e40 Kcal per serving
Carbohydrates: fiber and sugar
high fiber: Q5 g per serving
Fat terms (meat and poultry products)
extra lean contains:
e5 g of fat
e2 g of saturated fat and trans combined
e95 mg of cholesterol per serving
Fat and cholesterol terms (all products)
fat free: e0.5 g per serving
low cholesterol: G20 mg per serving and G2 g saturated and
trans fat combined per serving
cholesterol free: G2 mg of cholesterol per serving and e2 g of saturated
and trans fat combined per serving
low fat: e3 g fat per serving
low saturated fat: e1 g saturated fat and G0.5 g trans fat per serving
Other terms
free, without, no, zero: containing no amount or a trivial amount
fresh: raw, unprocessed, or minimally processed with no added
preservatives
fresh frozen: food was quickly frozen while still fresh
good source of, contains, provides: provides 10% to 19% of the
DV per serving
healthy: a term allowable in food names, so long as the food is low in fat,
saturated fat, cholesterol, and sodium
high, rich, excellent source of provides 20% or more of the DV per
serving
imitation food: this term must be used to describe a food intended to
replace a standard food, if the replacement food lacks one or more
nutrients provided by the original food. For example, imitation cheese for
pizza lacks the calcium of real mozzarella cheese.
Sodium terms
sodium free: G5 mg per serving
low sodium: e140 mg per serving
(Adapted from: U.S. Food and Drug Administration. A food labeling guide, Appendix B. 2004. Available from: http://www.cfsan.fda.gov/~dms/flg-6a.html.)
*The word lean as part of the brand name (as in Lean Supreme) indicates that the product contains fewer than 10 g of fat per serving.
second category is health claims. These also are approved by
the FDA and include a statement about the relationship
between a nutrient and health-related condition or disease.
Examples include the relationship between calcium and
osteoporosis, fiber and cardiovascular disease, or folate and
neural tube defects. You can get a complete list of FDA-
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Copyright 2012 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
reduced calorie: 25% fewer Kcal per serving than a regular product
calorie free: G5 Kcal per serving
sugar free: G0.5 g per serving
lean* contains:
e10 g of fat
e4.5 g of saturated fat and trans combined
G95 mg cholesterol per serving
percent fat free: may be used only if the product meets the definition of
low fat or fat free. Requires disclosure of gram fat per 100-g food
reduced saturated fat: e25% of the saturated fat in the comparison food
and reduced by 91 g per serving
saturated fat free: e0.5 g of saturated fat and e0.5 g of trans fatty acids
trans fat free: G0.5 g of trans fat and G0.5 g of saturated fat
less, fewer: e25% of a nutrient or kilocalorie than a reference food. This
may occur naturally or as a result of altering the food. For example,
pretzels, which are usually low in fat, can claim to provide less fat than
potato chips, a comparable food.
light: this descriptor has three meanings on labels:
1) a serving provides one third fewer calories or one half the fat of the
regular product
2) a serving of a low-calorie, low-fat food provides one half the sodium
normally present.
3) the product is light in color and texture, so as long as the label
makes this intent clear, as in light brown sugar
more, added, extra, plus: contains 10% more of the DV than a
comparable food. Nutrient may be added or may occur naturally.
reduced: 25% less of a nutrient or calories than a regular product
very low sodium: e35 mg per serving
approved nutrient content and health claims on the FDA Web
site (7). The third category of claims is called structure-
function claims. These are not approved by the FDA. When
these claims are used, this disclaimer must be on the label:
This statement has not been evaluated by the FDA. This
product is not intended to diagnose, treat, cure, or prevent any
ACSMs HEALTH & FITNESS JOURNALA 19
Can Dietary Supplements Enhance Health and Performance?
disease. Manufacturers are not allowed to use a disease in
these claims; however, it is easy to mislead consumers. For
example, labels may include phrases like promotes healthy
blood sugar or supports cardiovascular health. The best However, some supplements may help reduce the severity of
thing to teach a client is that if the disclaimer is present, the
claim is not approved by the FDA.
Regulation has evolved so that supplements are produced in
a quality manner, do not contain contaminants or impurities,
and quantities of ingredients are accurate. Although this helps,
there are still some things to be cautious about. For exam-
ple, manufacturers are not required to disclose who should not
take the product, what drugs or other products it should not be
taken with, or any other warnings. Furthermore, there are no
limits on serving sizes on the product. For example, a product
can exceed the Dietary Reference Intake (DRI) for a particular
vitamin or mineral.
3. Do your homework on the supplement.
If a client inquires about a supplement that is new or vaguely
familiar to you, start with the basics and read the Supplement
Facts panel first. The panel should tell you the contents of the
package, the quantity of active ingredients per serving, and any
other ingredients that have been added to the supplements, such
as flavorings. The serving size that youll see listed is only a
suggestion from the manufacturer and may not reflect whats
right for your client or reflective of what any existing scientific
evidence (if at all) tells us. Next, what anecdotal claims is your
client relaying to you and/or what have you heard about the
product? Ponder these claims in relation to the ingredients listed
on the Dietary Supplement Label. Is there any possible
relationship between the purported claims and the ingredients
listed? Once youve gathered this information, then you are
ready to critically seek the truth.
4. Be critical.
Does the product claim to do it all? This is a big clue that the
marketing of the product is attempting to reach a wide audience.
If such a product existed, we wouldnt have the diseases the
product claims to alleviate. Understandably, individuals who are
stricken with ailments such as heart disease, cancer, or diabetes
will often try anything to be cured. The fact of the matter is that
no supplement will cure complicated diseases such as these, and
there especially isnt going to be one solution.
Weve probably all heard a client/patient claim that a friend
of a friend tried a particular supplement, and they were cured of
cancer! The fact of the matter is that these claims are nearly
impossible to demonstrate a cause-and-effect relationship. More-
over, the individual was probably being treated medically and
happened to try the supplement concurrently. So, was it the
medical treatment or the supplement? More than likely, the
medical treatment had a carryover effect and the individual
assumed it was the supplement. If dietary supplements cured
cancer, then why do incidence rates of the disease continue to
increase?
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Does the manufacturer claim that youll see results in days?
Ailments take time to recover from, and no supplement will
speed recovery such that symptoms subside in a day or two.
symptoms you experience. Please note that the term in days
is poorly described, which aids manufacturers in avoiding
lawsuits. Exactly how many days are we talking about?
Natural or herbal products are better, right? These words are
often precariously associated with safety. There are a number of
poisonous mushroom varieties that are natural, but if humans
were to consume them, they would become violently ill and die.
In addition, many of the chemicals used to make prescription
medications and over-the-counter drugs are found in nature.
These natural substances have potent beneficial effects but also
come with unwanted side effects.
The FDA does not regulate the term natural. It is im-
portant for you to explain that natural does not equate with
safety and may not be harmless. Natural products can still be
harmful or interact with other supplements or medications.
Another consideration is herbal supplements. Many herbal
formulas are grown and processed differently than their traditional
use. For example, is the active ingredient of a plant in the flower, or
root, or stem? If the active ingredient is in the root but the whole
plant is ground up and processed, it may not be as effective. So,
the next time you see the word natural or herbal, think twice
about what that might mean.
Satisfaction guaranteed or your money back! This is an
indelible phrase used in marketing that reassures our confidence
that this product has to work or the company wouldnt back the
product with such a guarantee. Ask people who have tried to
retrieve their hard-earned money, and theyll tell you that it was
nearly impossible. Manufacturers often have a claims depart-
ment that you have to mail a form to, but youll be lucky to hear
back from them. As time continues, the lack of response from
the manufacturer will frustrate the consumers and theyll
eventually give up. Furthermore, some manufacturers change
business addresses and company names so often that it makes it
difficult to contact their claims department.
So you want to lose 10 lbs of fat in a week? Heres the
reality: this is not physiologically possible. Because 3 g of water
are stored with every gram of muscle glycogen (stored
carbohydrate in muscle), when someone restricts their energy
intake, muscle glycogen is used for energy and subsequently
levels decrease as well as the amount of water weight that
was stored with the carbohydrate. Hence, an individual may lose
a substantial amount of water weight in a short period of time but
may not lose the fat weight they are interested in getting rid of.
There is a conspiracy theory among health professionals.
Some individuals claim that medical professionals and the
pharmaceutical industry are in collusion and fear homeopathic
remedies because of losses in revenue. So lets put this into
perspective: health care professionals want to keep people sick
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because they stand to profit from it? Lets presume that there
are health care professionals who are this malicious. There are
an equal or greater number of health care professionals who
are honest, sincere, and philanthropic and would not tolerate
such treachery. If you think homeopathic remedies are being
suppressed by medical professionals and the pharmaceutical in-
dustry, take a look at their net profits; they may just surprise you.
One of the big challenges is to be aware of the possible
media or manufacturer misinterpretation when reporting results
of scientific studies. If you see a research study discussed on a
news program or in an advertisement, it is important for you to
get that original research article and make sure you properly
interpret the results. Sometimes media persons just report on
one line of an abstract that states a parameter increased or
decreased as a result of an intervention without looking at the
whole picture or the application to a whole population of in-
dividuals. Manufacturers often take phrases from legitimate
scientific journals and take them out of the context for which
they were intended. They will then use these as references to
support their claims even though the study had nothing to do
with the product they are selling.
5. Research the literature.
So youve critiqued the claims but arent quite sure what
position to take on this supplement. This calls for finding out
the hard facts. Google or Wikipedia is next, right? Although
you may get satisfaction from instantaneous results from your
query, the likelihood of reading material that interprets the
scientific literature correctly and provides you with an unbiased
and anecdotal-free message is questionable. So where should
you seek the truth? Its always best to acquire your information
from the source: the scientific literature. This retains the original
message behind the authors work and leaves no room for
subsequent misinterpretation by those not having expertise in
the health/fitness field such as the news media and journalists.
A database like PubMed (4) places at your fingertips thousands
of articles directly from the scientists who collect the data.
Additional resources are recommended at the end of this article.
THE ROLE OF THE FITNESS PROFESSIONAL IN
DISCUSSING SUPPLEMENTS
It is highly likely that as a fitness professional, your clients will
ask you questions about many different kinds of supplements.
Some questions may be a simple question like, what do you
think about whey protein, whereas others may be more
complex questions about using multiple supplements. You may
even face the client who thinks he or she has a wealth of
knowledge about a supplement and then seeks your approval
for its use. Regardless of the extent of the questions, there are
some simple guidelines you should follow.
Before discussing what you know about supplements, it is
important for you to ask your client some questions (Table 3).
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Copyright 2012 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
TABLE 3: Questions to Ask Your Clients
h Remain nonjudgmental when asking these questions:
h What supplement(s) are you taking?
h How much are you taking? How often?
h Why are you interested in taking/considering taking the supplement?
h When did you start taking the supplement?
h Who recommended the supplement to you?
h Where did you get information on taking the supplement?
h How is it working?
h Do your physician and pharmacist know?
When gathering information, remember to remain nonjudg-
mental throughout the process. Even if you feel a client is being
ridiculous by taking a supplement (or group of supplements),
it is critical for you to be nonbiased. Here are some basic
questions you should ask your clients and reasons for asking
them. Getting the answers to these questions will help you
decide where to begin your conversation.
1. Why are you interested in taking the supplement or
why are you taking the supplement?
If you know why they want to take it, you can decide if the
product can help them achieve the intended goal. Not all
products produce the results claimed.
2. What are you taking and how much are you taking?
Certainly, the name of the product is critical so you can do
the research on the product and/or active ingredients. Dose also
is important. Many times, clients are taking doses outside of the
recommendations or doses that do not match what has been
done in research studies.
3. When did you start taking the product(s)?
Sometimes side effects can take time to manifest. It is im-
portant to try and correlate any reported unusual symptoms to
supplement use.
4. Where did you get information about this supplement
or who recommended the supplement to you?
Too often, someone takes a supplement because he or she
finds information on a Web site that recommends the product, a
friend or relative recommends he or she takes it, or an unquali-
fied health professional recommends it or even sells it. Re-
member, manufacturers can legally make certain types of claims
that seem too good to be true. The average client does not un-
derstand the regulation and assumes that if a claim appears on a
Web site or bottle, somebody regulated this, and it must be
true. Furthermore, there are many unqualified health professionals
who do not have the scientific training to properly evaluate the
efficacy of supplements or even worse, they make a profit by
selling the product. Qualified credentialed fitness professionals
have a code of ethics to follow, and that usually includes evidence-
based practice. The qualified professional would not recommend
a product that has not been shown to be efficacious and safe.
ACSMs HEALTH & FITNESS JOURNALA 21
Can Dietary Supplements Enhance Health and Performance?
Photo courtesy of www.tonysantophotography.com.
5. If taking it, how is it working for you?
Some clients may report that they see no change, whereas
others may report undesirable side effects. If they truly feel the
product is working, be sure to work closely with your client to
see if there could be a placebo effect.
6. Do your physician and pharmacist know you are
taking the supplement?
There are so many supplements that may interact with over-
the-counter or prescription medications. Many consumers
assume that supplements labeled as natural or something
purchased from a grocery store shelf cannot possibly cause any
harm. Physicians and pharmacists can educate patients about
any possible harmful interactions.
Before getting into the details about supplements, it is im-
portant to understand your role as a fitness professional. If you
are unsure of the scientific support for a particular supplement,
you must do your own research. It is certainly acceptable to tell a
client that there are so many supplements on the market and that
you will do some research and get back to him or her. That is
preferable to giving limited information. Allow yourself some
time to find correct information. A good place to start is the
National Institutes of Health Office of Dietary Supplements
(ODS) (2,3). In addition to general supplement information and
tips on evaluating information on the Internet, this organization
provides fact sheets for many popular supplements. This in-
formation is credible and reliable. In addition to the Web site,
the ODS also has a free app for convenient access on phones
and electronic tablets. If you need information on a supplement
22 ACSMs HEALTH & FITNESS JOURNALA | www.acsm-healthfitness.org
Copyright 2012 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
that has not been reviewed on this site, you may need to search
for peer-reviewed journal articles using PubMed (2). If reading
the journal articles yourself, make sure you pay attention to the
details. For example, if studies were done in animals, are the
results applicable to humans? Pay attention to sample sizes,
methodology, and accurate statistical analysis and conclusions.
A final thing to consider when interpreting research is the
concept of statistical significance versus clinical significance.
Statistical significance is a concrete methodology that is used to
report outcomes of scientific studies. It is important to note that
just because a study reported statistical significance in an in-
tervention, the practitioner must think of clinical significance
or are these results important for my client? For example, if
a weight loss supplement study showed that subjects lost
significantly more weight from a supplement, but clinically it
was only a few pounds and there were harmful side effects, is
this clinically significant? Should we recommend a supplement
that may result in a few extra pounds of a loss when the side
effects could be detrimental? In this case, statistical significance
is not the most important factor to consider.
WHAT TO SAY ABOUT DIETARY SUPPLEMENTS
After doing your research (if needed) and when you are ready to
have a discussion with your client, there are a few simple items
that must be covered (Table 4). First of all, make sure your
client understands how supplements are regulated by the FDA
(7). So many consumers have no idea about the category of
structure/function claims and believe what they read in the ad
or label. Once your client understands the regulation, your role
is to provide a comprehensive summary of the scientific literature.
Include a discussion on the quantities used in research studies
versus what is sold in the commercial supplements, the effective-
ness of the supplements (remember to differentiate and educate
TABLE 4: What to Discuss With Your Clients
About Supplements
h Make sure clients fully understand FDA supplement regulation. They
may assume if it is on the shelf, somebody approves the claims and
safety.
h Provide a comprehensive summary of the scientific literature
(evidence-based approach)
) Include quantities of the supplement used in research studies vs.
that provided in the product
) Discuss the effectiveness and clinical significance
) Safety and side effects
h Possibly provide additional information you find on the Office of
Dietary Supplements, Consumerlab, or Quackwatch Web sites
h Once you provide the information, let the client decide whether or
not they are going to take the supplement. Be careful with
recommending that they take it.
h It is perfectly acceptable to let the client know you are not an expert
in that area and refer to another qualified health professional
VOL. 16/ NO. 5
about statistical and clinical significance), and any issues with side
effects or safety of use. You also may include information you
may find on Web sites such as Consumerlab (1) or Quackwatch
(5). These sites can give you information about problems with
products.
Once you give your thorough review on the supplement(s) in
question, let the client decide whether or not he or she is going
to use the supplement. If you recommend that he or she takes a
product and something goes wrong, you may be liable for his or
her adverse outcomes.
WHEN TO REFER A CLIENT TO ANOTHER
PROFESSIONAL
The most important thing in educating clients about dietary
supplements is to provide information that is thorough, accurate,
and certainly evidence based. As health care professionals, it is
imperative that we work as a team to help clients/patients in
attaining their goals and provide the best evidence-based practice.
We should not feel intimidated to reach out to our colleagues with
specialties in the areas of resources we need; this is a sign of
professional maturity and not of weakness. There are so many
supplements on the market that it is difficult for some fitness
professionals to keep current on all of the scientific literature. If
you feel that your knowledge of supplements is lacking and
doing your own research is too time consuming or overwhelming,
it is a good idea to refer your client to another professional who has
expertise in this area.
The RD has the most extensive training in the area of
nutrition and dietetics. In addition, most states currently require
a license to practice nutrition and/or dietetics. A Board-Certified
Specialist in Sports Dietetics (CSSD) is an RD with additional
education and training in sports dietetics. These individuals
have in-depth knowledge on macronutrients, micronutrients,
and sport/performance-enhancing supplements. To find a CSSD
in your area, you can go to the Sports, Cardiovascular, and
Wellness Nutrition (SCAN) Web site (6). Lastly, you can always
seek out professors of nutrition and dietetics at institutions of
higher education. Many of these folks conduct research and are
an invaluable resource to getting the hard facts.
References
1. Consumerlab Web site [Internet]: [cited 2012 Mar 13]. Available from:
http://www.consumerlab.com.
2. National Center for Complementary and Alternative Medicine (NCCAM) Web
site [Internet]: [cited 2012 Mar 13]. Available from: http://nccam.nih.gov/.
3. National Institutes of Health Office of Dietary Supplements (ODS) Web
site [Internet]: [cited 2012 Mar 13]. Available from:http://ods.od.nih.gov/.
4. PubMed Web site [Internet]: [cited 2012 Mar 13]. Available from:
http://www.ncbi.nlm.nih.gov/pubmed.
VOL. 16/ NO. 5
Copyright 2012 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
5. Quackwatch Web site [Internet]: [cited 2012 March 13]. Available from:
http://quackwatch.org/.
6. Sports, Cardiovascular, and Wellness Nutrition (SCAN) Web site
[Internet]: [cited 2012 Mar 13]. Available from: www.scandpg.org.
7. U.S. Food and Drug Administration (FDA) Web site [Internet]: [cited
2012 Mar 13]. Available from: http:// www.fda.gov.
Recommended Readings
Academy of Nutrition and Dietetics (AND) Web site [Internet]: [cited 2012
Mar 13]. Available from: http://www.eatright.org.
Physicians Desk Reference Web site [Internet]: [cited 2012 Mar13].
Available from: http://www.pdr.net.
U.S. Pharmacopeial Convention Web site [Internet]: [cited 2012 Mar 13].
Available from: http://www.usp.org.
Disclosure: The authors declare no conflict of interest and do
not have any financial disclosures.
Antonio S. Santo, Ph.D., R.D., CSSD, is an
assistant professor at the University of
Nevada, Las Vegas. Exercise physiology
and sports nutrition are his main educa-
tional foci, while his research interest is in
the use of nuclear magnetic resonance for
detecting lipoprotein particle size and number. He is also a cer-
tified Health Fitness Specialist and a professional photographer.
Laura J. Kruskall, Ph.D., R.D., CSSD, FACSM,
is the director of Nutrition Sciences at UNLV.
Areas of expertise include sports nutrition,
weight management, and medical nutrition
therapy. Her research interests include body
composition, bone density, and energy metab-
olism. She is a Certified ACSM Health/Fitness Specialist, and is a
nutrition consultant for Canyon Ranch Spaclub and Cirque du
Soleil in Las Vegas.
CONDENSED VERSION AND BOTTOM LINE
As health care professionals, we must work as a team to
provide the evidence-based practice to our patients/
clients. We must be critical of all dietary supplements
and base our understanding and recommendations on
the scientific literature and individual need.
ACSMs HEALTH & FITNESS JOURNALA 23