International Journal of Sport Nutrition and Exercise Metabolism, 2017, 27, 325 -334
https://doi.org/10.1123/ijsnem.2017-0050
© 2017 Human Kinetics, Inc.
ORIGINAL RESEARCH
Athlete Information Sources About Dietary Supplements:
A Review of Extant Research
Bryan E. Denham
In the United States, the Dietary Supplement Health and Education Act of 1994 (DSHEA) classified dietary
supplements as a subcategory of food, exempting manufacturers from providing premarket evidence of product
safety and efficacy. Under DSHEA, agencies such as the U.S. Food and Drug Administration (FDA) cannot
inspect supplements until after the products have entered the marketplace. Recognizing that both limited
resources and DSHEA prevent the FDA from conducting broad-based inspections on a regular basis, disreputable manufacturers have spiked products with drugs such as anabolic steroids and amphetamines. With
contaminated supplements now causing athletes to fail drug tests and, in some instances, threatening public
health, it becomes important to examine sources of supplement information. This article reviews 53 studies
that have addressed athlete information sources about dietary supplements. It finds that athletes, in general,
rely heavily on coaches and trainers as well as friends and family for information. Relative to U.S. athletes,
those competing internationally appear more likely to seek information from a physician or nutritionist. The
article offers recommendations for individuals and organizations based on the most frequent information
sources identified by athletes.
In the United States, the Dietary Supplement Health
and Education Act of 1994 (DSHEA) classified dietary
supplements as a subcategory of food, exempting manufacturers from providing premarket evidence of product
safety and efficacy. Under DSHEA, agencies such as
the U.S. Food and Drug Administration (FDA) cannot
inspect supplements until after the products have entered
the marketplace (see, recently, Cohen, 2016; Kapoor &
Sharfstein, 2016; Starr, 2016), a policy stipulation that
has allowed disreputable manufacturers to spike supplements with actual drugs and drug analogs (Marcus &
Grollman, 2012; Outram & Stewart, 2015). Uncertainties
associated with product ingredients led Cohen (2009) to
apply the term “American Roulette” to the supplement
industry, with Marcus (2016) concluding that DSHEA,
in particular, “is arguably the worst health care legislative
act of the twentieth century” (p. 411).
In the case of sports supplements, which Eichner
and Tygart (2016) defined as “products marketed for
body-building, weight-loss, [and] pre-workout/energy”
(p. 304), rogue manufacturers have spiked supplements
with anabolic steroids and amphetamines (Baylis, 2001;
Geyer et al., 2008). In fact, the Designer Anabolic Steroid
Control Act of 2014 added 25 “designer steroids” found
in over-the-counter supplements to the list of Schedule
III Controlled Substances in the United States (Joseph &
Parr, 2015; LaBotz & Griesemer, 2016). Earlier, in 2009,
The author is with the Dept. of Communication at Clemson
University, Clemson, SC. Address author correspondence to
Bryan E. Denham at bdenham@clemson.edu.
FDA agents raided the Idaho warehouse of Bodybuilding.com, an online retail outlet specializing in sports
supplements, after 26 of 31 supplements the agents
had purchased contained at least one anabolic steroid
(Schmidt, 2009).
In addition to products spiked with actual drugs,
research has also identified supplements that contain
few, if any, active ingredients (Newmaster et al., 2013).
Analyzing 16 dehydroepiandrosterone (DHEA) “antiaging” supplements, Parasrampuria, Schwartz, and
Petesch (1998) found just seven to contain DHEA
content within pharmaceutical product specifications
of 90–110% of labeled claims. One product contained
no DHEA, and two contained trace amounts. In 2015,
14 state attorneys general asked the U.S. Congress to
investigate the supplement industry after a study found
that 80% of supplements purchased in four retail outlets
did not contain label ingredients or contained unidentified
contaminants (Esch, 2015).
Nevertheless, dietary supplement sales continue to
increase, and large numbers of supplement users continue
to believe that products have been tested for safety and
efficacy (Dodge, 2016). Discussing the global sports supplement market, Eichner and Tygart (2016) estimated that
between 14% and 18% of all products contain illicit contaminants, and it should be noted that even higher percentages of muscle-building supplements may contain actual
drugs. For instance, while companies have little incentive to spike calcium tablets with controlled substances,
adding a steroid to a muscle-building substance may
enhance the effects of that substance and increase sales
in the process. Researchers warn this type of problem
325
Downloaded by Ebsco Publishing on 07/19/17, Volume 27, Article Number 4
326 Denham
may worsen given steady increases in supplement revenue; global sales of sports supplements are expected
to reach $12 billion by 2020 (Eichner & Tygart, 2016).
Contaminated supplements have caused athletes to
fail drug tests (Deldicque & Francaux, 2016; Maughan,
2005; Maughan, Greenhaff, & Hespel, 2011), and
certain products have threatened public health. As an
example, in 2013 the Hawaii Department of Health
identified 44 individuals who had suffered “acute onset
hepatitis of unknown origin,” and Johnston et al. (2016)
later reported that 36 (82%) of the 44 had used the
supplement OxyELITE Pro. The product contained the
stimulant 1,3-Dimethylamylamine, also referred to as
DMAA, and its presence had left 14 of the 36 product
users hospitalized, with two individuals requiring liver
transplants and one person dying. In addition to potential
health risks, DMAA appears on the prohibited-substance
list of the World Anti-Doping Agency (WADA), and an
examination of news releases distributed by the United
States Anti-Doping Agency (USADA) between January
2010 and January 2015 reveals that more than 20 athletes
received suspensions because of supplements spiked
with DMAA.
Given threats to both health and eligibility, it
becomes important to examine sources of information
among athletes who use dietary supplements. Because
many athletes eventually become coaches and athletic
trainers, a spiral of misinformation may result when individuals choose to counsel one another without consulting
scientific literature or individuals trained in medicine
and nutrition. In fact, research demonstrates that dietary
supplement users, in general, tend to avoid discussing
supplement use with physicians, opting instead for advice
from coaches, friends, family members and media outlets
(Blendon et al., 2013; Robinson & McGrail, 2004). The
current article reviews 53 studies that have asked athletes
in the United States and those competing internationally
about sources of supplement information.
Method
For this review, the author gathered studies from six databases, including Google Scholar, Health Source, Health
& Safety Science Abstracts, Health Reference Center,
Medline, and Sport Discus, using the search term “dietary
supplements and sources of information.” Google Scholar
contains an unusually large number of studies without
subject classifications, and an expanded search term,
“dietary supplements and sources of information and
athletes,” helped to narrow the focus and the number of
records returned in that database. To be included in the
review, a study had to be published in 1994 or thereafter
(consistent with passage of DSHEA) and report original
quantitative or qualitative research identifying information sources provided by individuals participating in
sport or exercise. The author eliminated duplicate reports
returned from different databases, leaving 53 studies that
met criteria for inclusion.
For each study accessed, the author recorded the
names of the study investigators, the year of publication, the location of the research, a brief description of
the sample, and sources of information cited by study
participants. Where possible, the author recorded sources
of information in an ordinal manner, beginning with the
most frequent type of source mentioned and moving to
the least frequent. To systematize the reporting of research
results, the author established the following categories
based on information sources cited by participants in the
respective studies: (a) Coaches and trainers, (b) friends
and family (including teammates and other athletes), (c)
popular media (including Internet and magazines), (d)
nutritionist or dietician, (e) physician, and (f) other source
(including teacher, literature, self-education, fitness club
instructor, health-food store). The following section
describes patterns observed in the studies reviewed.
Results
In terms of geographic location, 22 of 53 studies analyzed
came from the United States, while four came from
Canada, three from Germany, three from Iran, two from
Italy, two from the United Kingdom (or Great Britain)
and two from Singapore. One study came from each of
the following: Australia, Brazil, Croatia, Greece, India,
Ireland, Korea, New Zealand, Portugal, Saudi Arabia, Sri
Lanka and Taiwan. Three studies included athletes from
multiple nations. Among all 53 studies, sample sizes
varied considerably, from 27 high school athletes who
used creatine (Smith & Dahm, 2000) to 6,421 athletes and
exercisers (Kao et al., 2012). Sources of supplement information also varied within and between study locations.
Studies Conducted in the United States
Table 1 identifies supplement information sources in studies conducted in the United States. Among these studies,
16 of 22 contained ordered lists of sources. Eight (50%)
of 16 studies identified coaches and trainers as the most
frequent type of information source. Five (31%) of 16
identified friends and family, and three types of sources—
physicians, popular media, and other—appeared first in a
single study. Observing a dearth of athletes citing physicians, Knez and Peake (2010) pointed out that just one
of 37 ultraendurance athletes had received supplement
information from a health professional.
Thirteen studies conducted in the United States
allowed the (current) author to identify the second most
frequent information source. Here, five (38%) of 13
studies identified a friend or family member, with three
(23%) identifying a coach or trainer, one indicating a
physician and one indicating a nutritionist. Three studies identified “other” sources (i.e., self-education, fitness
club instructor and health-food store). In studies that did
not contain ordered lists of information sources, friends
and family as well as coaches and trainers were named
the most frequently.
IJSNEM Vol. 27, No. 4, 2017
Downloaded by Ebsco Publishing on 07/19/17, Volume 27, Article Number 4
Table 1 U.S. Supplement Research Summaries Arranged Chronologically
Authors
Information
Year
Location
Respondents
Sources of Supplement
Kao et al.
2012
United
States
6,421 athletes and exercisers
In order, magazines, friends, Internet, professional
journals.
Torres-­
McGehee et al.
2012
United
States
185 college athletes
In order, strength coach, parents, athletic trainer.
Hornstrom
et al.
2011
United
States
185 female college athletes
In order, physician, athletic trainer, college courses,
dietician.
Knez & Peake
2010
United
States
37 ultraendurance athletes
1 athlete received advice from a health professional.
Duellman et al.
2008
United
States
61 high-school football players
39 protein users
In order, among protein users, coaches, friends,
media.
Hoffman et al.
2008
United
States
3,248 adolescents, adolescent
athletes, grades 8–12
In order, teacher, parent, physician, books and magazines, sport coach, trainer, friend, Internet, strength
coach, sibling. (Besides teacher and parent, sources
vary by age).
Malinauskas
et al.
2007
United
States
145 college athletes
In order, athletic trainers, coaches, physicians.
Godo et al.
2006
United
States
184 athletes aged 14–18 in
Florida
Coaches viewed as strongest determinant of behavioral intention regarding supplement use.
11% used supplements
regularly
Scofield
& Unruh
2006
United
States
139 adolescent athletes
In order, coaches, fitness clubs, health-food stores,
Burns et al.
2004
United
States
236 intercollegiate athletes
In order, athletic trainer, strength coach, dietician,
other source, magazine, physician, website.
Froiland et al.
2004
United
States
207 Division I college athletes
at one university.
In order, family, other athletes, strength coaches, athletic trainers, dieticians, friends, coaches.
Herbold et al.
2004
United
States
In order, family, friend, physician, coach, nutritionist.
162 collegiate female varsity
athletes 65.4% used supplement
at least monthly
Zawila et al.
2003
United
States
60 collegiate female runners
Magazines, parents, coaches, teammates.
Dunn et al.
2001
United
States
1,626 students, grades 6–9
In order, athletic trainers, coaches, parents.
Jacobson et al.
2001
United
States
Division I athletes at 16 schools Strength coaches and athletic trainers for men, university classes and nutritionists for women.
McGuine et al.
2001
United
States
1,349 high school football
players
Friends and parents.
Perko et al.
2000
United
States
1,737 adolescent athletes
Coaches, parents, physicians.
Smith
and Dahm
2000
United
States
27 high school athletes who
used creatine
In order, friends, health-food stores.
Juhn et al.
1999
United
States
52 college athletes who used
creatine
In order, strength coach, self-education, dietician.
LaBotz
and Smith
1999
United
States
750 NCAA athletes;
28% creatine users
Friends and teammates.
Wiita et al.
1995
United
States
54 adolescent cross-country
runners
Coaches, physician, nutrition professional, parents,
older runners.
Sobal
& Marguart
1994
United
States
742 high school athletes
Parents, doctors, coaches, friends.
IJSNEM Vol. 27, No. 4, 2017
327
328 Denham
Overall, among studies conducted in the United
States, athletes obtained information about dietary
supplements primarily from coaches and trainers as well
as friends and family. In select instances, a physician or
a nutritionist served as a primary source of information,
and while popular media appeared in source lists, they
were not a primary contributor.
Studies Conducted Internationally
Beyond the United States, 31 studies cited sources of
information about dietary supplements. Of these, 22
contained ordered lists of sources, and among the 22,
Table 2 reveals that seven (32%) studies identified
coaches and trainers as a primary information source, and
Downloaded by Ebsco Publishing on 07/19/17, Volume 27, Article Number 4
Table 2 International Supplement Research Summaries Arranged Chronologically
Sources of Supplement
Information
Authors
Year
Location
Respondents
Kelly et al.
2016
Australia
570 football players
Strength coach, dietician,
trainer, team mate, sport
scientist.
Kratzenstein et al.
2016
Germany
562 elite young athletes
Both groups cite parents.
Physicians a distant second
for athletes.
69 nonathletes
Graham-Paulson et al.
2015
Multiple nations
399 elite and nonelite athletes
232 used supplements
Nutritionist / dietician,
coach, and training partner /
athlete.
Sousa et al.
2015
Portugal
292 athletes, ages 12–37
In order, physicians and
coaches.
Wiens et al.
2014
Canada
587 athletes, ages 11–25
In order, family and friends,
coaches, athletic trainers,
medical doctors, sport nutritionists.
Aljaloud & Ibrahim
2013
Saudi Arabia
105 professional athletes
In order, physician, nutritionist or dietician, coach,
online, academic journal,
magazine.
98 used supplements
Bailey
2013
Canada
32 male bodybuilders
Magazines, personal experience, other bodybuilders.
Darvishi et al.
2013
Iran
78 male college athletes
In order, friends, then trainers and advertisements.
Giannopoulou et al.
2013
Greece
2,845 individuals ages 11–44 In order, coaches, physicians
and nutritionists.
2,783 athletes
Mazzeo et al.
2013
Italy
160 athletes, ages 18–30
In order, athletic trainer, physician, nutrition counselor.
Diehl et al.
2012
Germany
1,138 elite athletes, ages
14–18
In order, coaches, family,
physicians, media, nutritionists.
1,066 used supplements
Lun et al.
2012
Canada
440 high-performance athletes
In order, family and friends,
strength trainer, teammates,
coaches, Internet, exercise
physiologist, trainer, physician, naturopath, health-food
store.
Pumpa et al.
2012
Ireland
105 athletes in Ireland, ages
16+
In order, dieticians, then
friends, family and media.
Rodek et al.
2012
Croatia
44 members of National
Sailing Team
In order, self-education,
coaches, formal education.
IJSNEM Vol. 27, No. 4, 2017
Downloaded by Ebsco Publishing on 07/19/17, Volume 27, Article Number 4
Table 2 (continued)
Authors
Year
Location
Respondents
Bianco et al.
2011
Italy
207 fitness trainees
Sources of Supplement
Information
62 used supplements
In order, gym instructors,
Internet, word of mouth,
book / magazines, physicians, shopkeepers
Kaimian and Esfahani
2011
Iran
250 male, 250 female bodybuilders
In order, coaches, nutritionists, doctors.
Kim et al.
2011
Korea
183 Korean Olympians in
Beijing Games
In order, parents, coaches,
teammates.
De Silva et al.
2010
Sri Lanka
113 national-level athletes,
age 13–35
In order, coaches, sports doctors, friends.
Goston & Correia
2010
Brazil
1,102 exercisers
In order, self-education,
nutritionists, physicians,
physical trainers, friends,
clerk, advertisements, other.
Jessri et al.
2010
Iran
212 college athltes in Tehran
In order, coaches, media,
family members, university
classes, physician, nutritionist or dietician.
Kuo
2010
Taiwan
34 bodybuilders; 26 males, 8
females
Media and Internet, store
nutritionist, coaches, friends,
other bodybuilders.
Malik and Malik
2010
India
273 supplement users, age
16 and above; 63.8% used
supplements
Users cite coaches / instructors, friends and fellow gym
members.
Braun et al.
2009
Germany
164 elite adolescent athletes
In order, family, coaches,
physicians, physical
therapists, pharmacists, selfobtained information.
131 used supplements
Tian et al.
2009
Singapore
82 college athletes
Media, Internet, coaches,
fellow athletes.
Petroczi et al.
2008
United Kingdom
403 elite athletes, age 12–21
Self-education, health professionals, coaches, peers,
sport organizations.
Desbrow & Leveritt
2007
16 countries
140 endurance athletes
In order, self-education,
fellow athlete, magazines,
journal articles, Internet,
dietician, coach, advertisements, friend, doctor, trainer.
Erdman et al.
2007
Canada
582 high-performance athletes
Teammates, health food store
retailers, and magazines.
Striegel et al.
2006
Multiple nations
598 Master athletes
In order, physicians, pertinent literature, specialized
magazines, other athletes,
trainer, Internet, partner,
friends, newspaper, television, other.
Nieper
2005
Great Britain
34 elite junior athletes
In order, coaches, sport dieticians, physicians.
Crowley and Wall
2004
New Zealand
100 grade 9 and 10 athletes
Parents, coaches, friends.
70 use dietary supplements
Slater, Tan & Teh
2003
Singapore
160 adolescent and adult
athletes
123 used supplements
IJSNEM Vol. 27, No. 4, 2017
In order, other athletes,
coaches, media, family
members, health-care professionals, sales associates,
dieticians.
329
Downloaded by Ebsco Publishing on 07/19/17, Volume 27, Article Number 4
330 Denham
seven (32%) identified friends and family. Three (14%)
identified physicians, and four (18%) identified “other”
sources (i.e., self-education and gym instructor). One
study identified a nutritionist.
In addition, all 22 studies containing ordered lists
allowed the author to identify the second most frequent
information source. Here, eight (36%) of 22 studies
identified coaches and trainers, and five (23%) identified
nutritionists. Three (14%) identified friends and family,
and three (14%) identified physicians. Two (9%) of 22
studies cited popular media, and one cited “other” source
(i.e., literature).
Nine international studies did not indicate order
among athlete information sources. In terms of mentions, though, friends and family were mentioned in
nine (100%) of nine studies, with coaches and trainers
appearing in seven (78%). Popular media appeared in
four (44%) of nine studies, with nutritionists and other
sources appearing in three (33%) and four (44%) of nine,
respectively. Physicians appeared in one study.
As with studies conducted in the United States, then,
international studies identified friends and family, as well
as coaches and trainers, as key information sources about
dietary supplements. Athletes who participated in studies
conducted internationally appeared more likely to cite a
physician or nutritionist as an information source. In fact,
a notable pattern occurred when source types in all studies
conducted in the United States (N = 22) were compared
with source types for all international studies (N = 31).
While eight (36%) of 22 studies in the U.S. identified
a physician as an information source, and seven (32%)
mentioned a nutritionist, 19 (62%) of 31 international
studies identified a physician, while 16 (52%) indicated
a nutritionist. Percentages for coaches and trainers as
well as friends and family appeared relatively even in
aggregate comparisons.
Discussion
This article reviewed 53 studies that have addressed
athlete information sources about dietary supplements.
As indicated, disreputable manufacturers in the United
States have capitalized on the Dietary Supplement Health
and Education Act of 1994, adding drugs such as anabolic
steroids and stimulants to products before marketing
them. Athletes continue to fail drug tests because of
spiked supplements, and certain products have threatened
public health.
Studies conducted in both the United States and
internationally indicated that athletes seek information
about dietary supplements primarily from coaches and
trainers as well as friends and family. Given the frequency
with which coaches and trainers provide information,
an educational document distributed through athletic
associations might raise awareness of key issues, such
as the potential for disqualification and the possibility
of contaminant-related health problems. Valliant et al.
(2012) found that nutrition education improved both
dietary intake and nutrition knowledge among female
college athletes, and similar instruction on dietary supplements might protect athletes from suspensions and known
health risks such as drug-supplement interactions (Jordan
& Haywood, 2007). Ashar and Rowland-Seymour (2008)
suggested that physicians who communicate with patients
about supplements focus on regulatory issues, efficacy
and safety, potential drug-supplement interactions, and
approaches for monitoring adverse events and therapeutic
effects. Although coaches and trainers may lack advanced
medical training, they should be able to discuss the same
considerations with athletes. To facilitate conversations,
organizations such as the National Collegiate Athletic
Association (NCAA), the Amateur Athletic Union
(AAU), and international sport associations might consider distributing concise information materials to athletes
and athletic personnel.
Regarding institutional information sources, the
United States Anti-Doping Agency (USADA) has
instituted a computer application, Supplement 411, to
warn athletes of contaminated or otherwise hazardous
products. In addition, the website of the U.S. Food and
Drug Administration provides information about product ingredients, recalls, adverse events, and industry
requirements, and the Office of Dietary Supplements in
the U.S. National Institutes of Health (NIH) provides
a series of fact sheets. The Canadian Centre for Ethics
in Sport provides online information for athletes, and
the website of the World Anti-Doping Agency lists all
prohibited substances.
Given the relative popularity of friends and family
as information sources, athletic organizations might
consider implementing peer-education programs about
supplement risks. The Adolescents Training and Learning to Avoid Steroids (ATLAS) program (Goldberg et al.,
1996) as well as the Athletes Targeting Healthy Exercise
and Nutrition Alternatives (ATHENA) program (Elliot et
al., 2004) have demonstrated that drawing on the shared
goals of peers and teammates can improve knowledge
and reduce substance-related risk behaviors. Peer education can also increase awareness of applications such as
Supplement 411 while introducing educational documents
about dietary supplements. To facilitate this approach to
educating athletes, academic and professional meetings
in sport might include sessions that focus on “training
the trainers.”
Regarding the role of medical professionals, studies
conducted internationally showed a greater presence of
physicians and nutritionists as supplement information
sources. This pattern is suggestive of differing athletic
cultures or perhaps differing athletic structures. Athletes
living in less-populous nations may be advised through
centralized athletic organizations who retain physicians
and nutritionists to oversee athlete diets and health concerns. But it should be noted that physicians sometimes
lack knowledge of dietary supplements and supplement
regulations (Ashar, Rice, & Sisson, 2007). Given the
volume of supplements produced and consumed in the
United States and internationally, in addition to the
IJSNEM Vol. 27, No. 4, 2017
Athlete Information Sources 331
frequency with which adverse events have appeared,
material on dietary supplements should be included in
continuing education and recertification examinations
for healthcare providers. Organizations such as the
American College of Sports Medicine and the European
College of Sports Science should stress the importance
of understanding regulatory issues and problems that can
result from an absence of oversight. With sports supplement sales showing consistent increases, issues related
to product contaminants will almost certainly continue
to appear. Athletes and those who work in sport-related
environments should therefore understand the fundamentals of both supplement use and supplement risk.
Downloaded by Ebsco Publishing on 07/19/17, Volume 27, Article Number 4
References
Aljaloud, S.O., & Ibrahim, S.A. (2013). Use of dietary supplements among professional athletes in Saudi Arabia.
Journal of Nutrition and Metabolism, 2013, 1–7. PubMed
doi:10.1155/2013/245349
Ashar, B.H., & Rowland-Seymour, A. (2008). Advising
patients who use dietary supplements. The American
Journal of Medicine, 121, 91–97. PubMed doi:10.1016/j.
amjmed.2007.10.031
Ashar, B.H., Rice, T.N., & Sisson, S.D. (2007). Physicians’
understanding of the regulation of dietary supplements.
Archives of Internal Medicine, 167(9), 966–969. PubMed
doi:10.1001/archinte.167.9.966
Bailey, B. (2013). Ethnopharmacology and male bodybuilders’
lived experience with consuming sports nutrition supplements in Canada. Sport in Society, 16(9), 1105–1119. doi
:10.1080/17430437.2013.790890
Baume, N., Mahler, N., Kamber, M., Mangin, P., & Saugy, M.
(2006). Research of stimulants and anabolic steroids in
dietary supplements. Scandinavian Journal of Medicine
& Science in Sports, 16(1), 41–48. PubMed doi:10.1111/
j.1600-0838.2005.00442.x
Baylis, A. (2001). Inadvertent doping through supplement use
by athletes: Assessment and management. International
Journal of Sport Nutrition and Exercise Metabolism, 11,
365–383. PubMed doi:10.1123/ijsnem.11.3.365
Bianco, A., Mammina, C., Paoli, A., Bellafiore, M., Battaglia,
G., Caramazza, G., . . . Jemni, M. (2011). Protein supplementation in strength and conditioning adepts: knowledge,
dietary behavior and practice in Palermo, Italy. Journal
of the International Society of Sports Nutrition, 8(25),
1–6. PubMed
Blendon, R.J., Benson, J.M., Botta, M.D., & Weldon, K.J.
(2013). Users’ views of dietary supplements. JAMA Internal Medicine, 173, 74–76. PubMed doi:10.1001/2013.
jamainternmed.311
Braun, H., Koehler, K., Geyer, H., Kleinert, J., Mester, J., &
Schanzer, W. (2009). Dietary supplement use among
elite German athletes. International Journal of Sport
Nutrition and Exercise Metabolism, 19, 97–109. PubMed
doi:10.1123/ijsnem.19.1.97
Burns, R.D., Schiller, M.R., Merrick, M.A., & Wolf, K.N.
(2004). Intercollegiate student athlete use of nutritional
supplements and the role of athletic trainers in nutrition
counseling. Journal of the American Dietetic Association,
104(2), 246–249. PubMed doi:10.1016/j.jada.2003.11.013
Cohen, P.A. (2009). American roulette – contaminated dietary
supplements. The New England Journal of Medicine, 361,
1523–1525. PubMed doi:10.1056/NEJMp0904768
Cohen, P.A. (2016). The supplement paradox: Negligible benefits, robust competition. Journal of the American Medical Association, 316, 1453–1454. PubMed doi:10.1001/
jama.2016.14252
Crowley, J.J., & Wall, C. (2004). The use of dietary supplements
in a group of potentially elite secondary school athletes.
Asia Pacific Journal of Clinical Nutrition, 13, S39–S39.
Darvishi, L., Askari, G., Hariri, M., Bahreynian, M., Ghiasvand, R., Ehsani, S., . . . Khorvash, F. (2013). The use of
nutritional supplements among male collegiate athletes.
International Journal of Preventive Medicine, 4(Supplement 1), S68–S72. PubMed
de Silva, A., Samarasinghe, Y., Senanayake, D., & Lanerolle,
P. (2010). Dietary supplement intake in national-level Sri
Lankan athletes. International Journal of Sport Nutrition and Exercise Metabolism, 20(1), 15–20. PubMed
doi:10.1123/ijsnem.20.1.15
Deldicque, L., & Francaux, M. (2016). Potential harmful
effects of dietary supplements in sports medicine. Current
Opinion in Clinical Nutrition and Metabolic Care, 19(6),
439–445. PubMed doi:10.1097/MCO.0000000000000321
Desbrow, B., & Leveritt, M. (2007). Well-trained endurance
athletes’ knowledge, insight, and experience of caffeine
use. International Journal of Sport Nutrition and Exercise Metabolism, 17, 328–339. PubMed doi:10.1123/
ijsnem.17.4.328
Diehl, K., Thiel, A., Zipfel, S., Mayer, J., Schnell, A., & Schneider, S. (2012). Elite adolescent athletes’ use of dietary
supplements: Characteristics, opinions, and sources of
information. International Journal of Sport Nutrition and
Exercise Metabolism, 22, 165–174. PubMed doi:10.1123/
ijsnem.22.3.165
Dietary Supplement Health and Education Act of 1994. Pub L
No. 103-417, 1994. 103rd Congress, 2nd session, S784.
Dodge, T. (2016). Consumers’ perceptions of the dietary
supplement health and education act: Implications and
recommendations. Drug Testing and Analysis, 8, 407–409.
PubMed doi:10.1002/dta.1857
Duellman, M.C., Lukaszuk, J.M., Prawitz, A.D., & Brandenburg, J.P. (2008). Protein supplement users among high
school athletes have misconceptions about effectiveness.
Journal of Strength and Conditioning Research, 22(4),
1124–1129. PubMed doi:10.1519/JSC.0b013e31817394b9
Dunn, M.S., Eddy, J.M., Wang, M.Q., Nagy, S., Perko, M.A., &
Bartee, R.T. (2001). The influence of significant others on
attitudes, subjective norms and intentions regarding dietary
supplement use among adolescent athletes. Adolescence,
36, 583–591. PubMed
Eichner, A., & Tygart, T. (2016). Adulterated dietary supplements threaten the health and sporting career of up-andcoming young athletes. Drug Testing and Analysis, 8,
304–306. PubMed doi:10.1002/dta.1899
Elliot, D.L., Goldberg, L., Moe, E.L., DeFrancesco, C.A.,
Durham, M.B., & Hix-Small, H. (2004). Preventing
IJSNEM Vol. 27, No. 4, 2017
Downloaded by Ebsco Publishing on 07/19/17, Volume 27, Article Number 4
332 Denham
substance use and disordered eating: Initial outcomes of
the ATHENA (Athletes Targeting Healthy Exercise and
Nutrition Alternatives) program. Archives of Pediatrics
& Adolescent Medicine, 158(11), 1043–1049. PubMed
doi:10.1001/archpedi.158.11.1043
Erdman, K.A., Fung, T., Doyle-Baker, P.K., Verhoef, M.J., &
Reimer, R.A. (2007). Dietary supplementation of highperformance Canadian athletes by age and gender. Clinical Journal of Sport Medicine, 17(6), 458–464. PubMed
doi:10.1097/JSM.0b013e31815aed33
Esch, M. (2015, April 3). States call for probe of supplement
industry. Washington Post, p. A13.
Froiland, K., Koszewski, W., Hingst, J., & Kopecky, L. (2004).
Nutritional supplement use among college athletes and
their sources of information. International Journal of Sport
Nutrition and Exercise Metabolism, 14, 104–120. PubMed
doi:10.1123/ijsnem.14.1.104
Geyer, H., Parr, M.K., Koehler, K., Mareck, U., Schanzer,
W., & Thevis, M. (2008). Nutritional supplements crosscontaminated and faked with doping substances. Journal of
Mass Spectrometry, 43(7), 892–902. PubMed doi:10.1002/
jms.1452
Giannopoulou, I., Noutsos, K., Apostolidis, N., Baylos, I., &
Nassis, G.P. (2013). Performance level affects the dietary
supplement intake of both individual and team sports
athletes. Journal of Sports, Science, and Medicine, 12(1),
190–196. PubMed
Godo, J.R., Graves, S., O’Kroy, J.A., & Hecht, S. (2006).
Influences of dietary supplement use in South Florida
adolescent athletes. American Journal of Health Studies,
21(1-2), 91–98.
Goldberg, L., Elliot, D., Clarke, G.N., MacKinnon, D.P., Moe,
E., Zoref, L., . . . Lapin, A. (1996). Effects of a multidimensional anabolic steroid prevention intervention: The
Adolescents Training and Learning to Avoid Steroids
(ATLAS) program. Journal of the American Medical
Association, 276(19), 1555–1562. PubMed doi:10.1001/
jama.1996.03540190027025
Goston, J.L., & Correia, M.I.T.D. (2010). Intake of nutritional
supplements among people exercising in gyms and
influencing factors. Nutrition (Burbank, Los Angeles
County, Calif.), 26(6), 604–611. PubMed doi:10.1016/j.
nut.2009.06.021
Graham-Paulson, T.S., Perret, C., Smith, B., Crosland, J., &
Goosey-Toffrey, V.L. (2015). Nutritional supplement
habits of athletes with an impairment and their sources of
information. International Journal of Sport Nutrition and
Exercise Metabolism, 25, 387–395. PubMed doi:10.1123/
ijsnem.2014-0155
Hatch, O. (2014, October 27). Hatch marks 20th anniversary of
Dietary Supplement Health and Education Act (DSHEA)
[press release]. Retrieved at: http://www.hatch.senate.gov
/public/index.cfm/2014/10/hatch-marks-20th-anniversaryof-the-dietary-supplement-health-and-education-act-dshea
Herbold, N.H., Visconti, B.K., Frates, S., & Bandini, L. (2004).
Traditional and nontraditional supplement use by collegiate female varsity athletes. International Journal of
Sport Nutrition and Exercise Metabolism, 14(5), 586–593.
PubMed doi:10.1123/ijsnem.14.5.586
Hoffman, J. R., Faigenbaum, A.D., Ratamess, N. A., Ross, R.,
Kang, J., & Tenenbaum, G. (2008). Nutritional supplementation and anabolic steroid use in adolescents. Medicine
and Science in Sports and Exercise, 40(1), 15–24. PubMed
doi:10.1249/mss.0b013e31815a5181
Hornstrom, G. R., Friesen, C. A., Ellery, J. E., & Pike, K. (2011).
Nutrition knowledge, practices, attitudes, and information
sources of Mid-American Conference College Softball
Players. Food and Nutrition Sciences, 2(2). ID:4528.
doi:10.4236/fns.2011.22015
Jessri, M., Jessri, M., Rashidkhani, B., & Zinn, C. (2010).
Evaluation of Iranian college athletes’ sport nutrition
knowledge. International Journal of Sport Nutrition and
Exercise Metabolism, 20, 257–263. PubMed doi:10.1123/
ijsnem.20.3.257
Jacobson, B.H., Sobonya, C., & Ransone, J. (2001). Nutrition practices and knowledge of college varsity athletes.
Journal of Strength and Conditioning Research, 15(1),
63–68. PubMed
Johnston, D.I., Chang, A., Viray, M., Chatham-Stephens, K.,
He, H., Taylor, E., . . .. (2016). Hepatology associated
with the dietary supplement OxyELITE Pro – Hawaii,
2013. Drug Testing and Analysis, 8, 319–327. PubMed
doi:10.1002/dta.1894
Jordan, M.A., & Haywood, T. (2007). Evaluation of Internet
websites marketing herbal weight-loss supplements to
consumers. Journal of Alternative and Complementary
Medicine (New York, N.Y.), 13(9), 1035–1043. PubMed
doi:10.1089/acm.2007.7197
Joseph, J.F., & Parr, M.K. (2015). Synthetic androgens as designer
supplements. Current Neuropharmacology, 13, 89–100.
PubMed doi:10.2174/1570159X13666141210224756
Juhn, M.S., O’Kane, J.W., & Vinci, D.M. (1999). Oral creatine supplementation in male collegiate athletes: A
survey in dosing habits and side effects. Journal of the
American Dietetic Association, 99(5), 593–595. PubMed
doi:10.1016/S0002-8223(99)00145-5
Kapoor, A., & Sharfstein, J.M. (2016). Breaking the gridlock: Regulation of dietary supplements in the United
States. Drug Testing and Analysis, 8, 424–430. PubMed
doi:10.1002/dta.1892
Kao, T.C., Deuster, P.A., Burnett, D., & Stephen, M. (2012).
Health behaviors associated with the use of body building, weight loss, and performance enhancing supplements. Annals of Epidemiology, 22(5), 331–339. PubMed
doi:10.1016/j.annepidem.2012.02.013
Karimian, J., & Esfahani, P.S. (2011). Supplement consumption
in body builder athletes. Journal of Research in Medical
Sciences, 16(10), 1347–1353. PubMed
Kelly, V.G., Leveritt, M.D., Brennan, C.T., Slater, G.J., & Jenkins, D.G. (2016). Prevalence, knowledge and attitudes
relating to B-alanine use among professional footballers.
Journal of Science and Medicine in Sport. PubMed
Kim, J., Kang, S-k., Jun, H-s., Chun, Y-s., Trilk, J., & Jung,
S.H. (2011). Dietary supplementation patterns of Korean
Olympic athletes participating in the Beijing 2008 Summer
Olympic Games. International Journal of Sport Nutrition and Exercise Metabolism, 21, 166–174. PubMed
doi:10.1123/ijsnem.21.2.166
IJSNEM Vol. 27, No. 4, 2017
Downloaded by Ebsco Publishing on 07/19/17, Volume 27, Article Number 4
Athlete Information Sources 333
Knez, W.L., & Peake, J.M. (2010). The prevalence of vitamin
supplementation in ultraendurance triathletes. International Journal of Sport Nutrition and Exercise Metabolism,
20, 507–514. PubMed doi:10.1123/ijsnem.20.6.507
Kratzenstein, S., Carlsohn, A., Heydenreich, J., & Mayer, F.
(2016). Dietary supplement use in young elite athletes
and school children aged 11 to 13. Deutsche Zeitschrift
fur Sportmedizin, 67(1), 13–17 [Germany]. doi:10.5960/
dzsm.2015.203
Kuo, M.J. (2010). Meal planning and nutritional supplements
use among elite bodybuilders in Taiwan. British Journal
of Sports Medicine, 44(1), 140–141. PubMed
LaBotz, M., & Smith, B.W. (1999). Creatine supplement
use in an NCAA Division I athletic program. Clinical
Journal of Sport Medicine, 9(3), 167–169. PubMed
doi:10.1097/00042752-199907000-00009
LaBotz, M., & Griesemer, B.A. (2016). Use of performanceenhancing substances. Pediatrics, 138, E1–E12. PubMed
doi:10.1542/peds.2016-1300
Lun, V., Erdman, K.A., Fung, T.S., & Reimer, R.A. (2012).
Dietary supplementation practices in Canadian highperformance athletes. International Journal of Sport
Nutrition and Exercise Metabolism, 22(1), 31–37. PubMed
doi:10.1123/ijsnem.22.1.31
Malik, A., & Malik, S. (2010). Prevalence of nutritional supplements in gyms. British Journal of Sports Medicine, 44.
doi:10.1136/bjsm.2010.078725.147
Malinauskas, B.M., Overton, T.F., Carraway, V.G., & Cash,
B.C. (2007). Supplements of interest for sport-related
injury and sources of supplement information among
college athletes. Advances in Medical Sciences, 52,
50–54. PubMed
Marcus, D.M. (2016). Dietary supplements: What’s in a name?
What in the bottle? Drug Testing and Analysis, 8, 410–412.
PubMed doi:10.1002/dta.1855
Marcus, D.M., & Grollman, A.P. (2012). The consequences of
ineffective regulation of dietary supplements. Archives of
Internal Medicine, 172, 1035–1036. PubMed doi:10.1001/
archinternmed.2012.2687
Maughan, R.J. (2005). Contamination of dietary supplements and positive drug tests in sport. Journal of Sports Sciences, 23(9), 883–889. PubMed
doi:10.1080/02640410400023258
Maughan, R.J., Greenhaff, P.L., & Hespel, P. (2011). Dietary
supplements for athletes: Emerging trends and recurring
themes. Journal of Sports Sciences, 29, S57–S66. PubMed
doi:10.1080/02640414.2011.587446
Mazzeo, F., Motti, M.L., Messina, G., Monda, V., Ascione, A.,
Tafuri, D., . . . Monda, M. (2013). Use of nutritional supplements among south Italian students of physical training and
sport university. Current Topics in Toxicology, 9, 21–26.
McGuine, T.A., Sullivan, J.C., & Bernhardt, D.T. (2001).
Creatine supplementation in high school football players. Clinical Journal of Sport Medicine, 11(4), 247–253.
PubMed doi:10.1097/00042752-200110000-00007
Mkumbuzi, N.S., & Kaseke, F. (2015). Use of non-steroidal
anti-inflammatory drugs and nutritional supplements in
Zimbabwean football. South African Journal of Sports
Medicine, 27(1), 20–22. doi:10.7196/sajsm.577
Newmaster, S.G., Grguric, M., Shanmughanandhan, D., Ramalingam, S., & Ragupathy, S. (2013). DNA barcoding detects
contamination and substitution in North American herbal
products. BMC Medicine, 11, 222. PubMed
Nieper, A. (2005). Nutritional supplement practices in UK
junior national track and field athletes. British Journal
of Sports Medicine, 39, 645–649. PubMed doi:10.1136/
bjsm.2004.015842
Outram, S., & Stewart, B. (2015). Doping through supplement
use: A review of the available empirical data. International
Journal of Sport Nutrition and Exercise Metabolism, 25,
54–59. PubMed doi:10.1123/ijsnem.2013-0174
Parasrampuria, J., Schwartz, K., & Petesch, R. (1998). Quality
control of dehydroepiandrosterone dietary supplement
products. Journal of the American Medical Association,
280(18), 1565. doi:10-1001/pubs.JAMA-ISSN-00987484-280-18-jbk1111
Perko, M., Bartee, R., Dunn, M.S., Wang, M.Q., & Eddy, J.
(2000). Giving new meaning to the term “taking one for
the team”: Influences on the use/non-use of dietary supplements among adolescent athletes. American Journal of
Health Studies, 16(2), 99–106.
Petroczi, A., Naughton, D.P., Pearce, G., Bailey, R., Bloodworth,
A., & McNamee, M. (2008). Nutritional supplement use
by elite young UK athltes: Fallacies on advice regarding
efficacy. Journal of the International Society of Sports
Nutrition, 5(22), 1–8. PubMed
Pumpa, K.L., Madigan, S.M., Wood-Martin, R.E., Flanagan, R.,
& Roche, N. (2012). The development of nutritional-supplement fact sheets for Irish athletes: A case study. International Journal of Sport Nutrition and Exercise Metabolism,
22, 220–224. PubMed doi:10.1123/ijsnem.22.3.220
Robinson, A., & McGrail, M.R. (2004). Disclosure of CAM
use to medical practitioners: a review of qualitative and
quantitative studies. Complementary Therapies in Medicine, 12, 90–98. PubMed doi:10.1016/j.ctim.2004.09.006
Rodek, J., Sekulic, D., & Kondric, M. (2012). Dietary supplementation and doping-related factors in high-level sailing.
Journal of the International Society of Sports Nutrition,
9(51). PubMed
Saeedi, P., Mohd, N., Hazizi, A.S., Vafa, M.R., & Rahimi, F.A.
(2012). Nutritional supplement use among fitness club participants in Tehran, Iran. Appetite, 60(1), 20–26. PubMed
Schmidt, M.S. (2009, September 25). Agents raid nutrition firm.
New York Times, p. B12.
Scofield, D.E., & Unruh, S. (2006). Dietary supplement use
among athletes in central Nebraska and their sources
of information. Journal of Strength and Conditioning
Research, 20(2), 452–455. PubMed
Shaw, G., Slater, G., & Burke, L. (2016). Supplement use of
elite Australian swimmers. International Journal of Sport
Nutrition and Exercise Metabolism, 26(3), 249–258.
PubMed doi:10.1123/ijsnem.2015-0182
Sheppard, H.L., Raichada, S.M., Kouri, K.M., Stenson-BarMaor, L., & Branch, J.D. (2000). Use of creatine and other
supplements by members of civilian and military health
clubs: A cross-sectional survey. International Journal of
Sport Nutrition and Exercise Metabolism, 10(3), 245–259.
PubMed doi:10.1123/ijsnem.10.3.245
IJSNEM Vol. 27, No. 4, 2017
Downloaded by Ebsco Publishing on 07/19/17, Volume 27, Article Number 4
334 Denham
Slater, G., Tan, B., & Teh, K.C. (2003). Dietary supplementation
practices of Singaporean athletes. International Journal of
Sport Nutrition and Exercise Metabolism, 13, 320–332.
PubMed doi:10.1123/ijsnem.13.3.320
Smith, J., & Dahm, D.L. (2000). Creatine use among a select
population of high school athletes. Mayo Clinic Proceedings, 75(12), 1257–1263. PubMed doi:10.4065/75.12.1257
Sobal, J., & Marquart, L.F. (1994). Vitamin / supplement use
among high school varsity athletes. Adolescence, 29,
835–843. PubMed
Sousa, M., Fernandes, M.J., Moreira, P., & Teixeira, V.H.
(2015). Nutritional supplements use by Portuguese athletes. International Journal for Vitamin and Nutrition
Research, 83, 48–58. PubMed doi:10.1024/0300-9831/
a000144
Starr, R. (2016). Should states and local governments regulate dietary supplements? Drug Testing and Analysis, 8,
402–406. PubMed doi:10.1002/dta.1926
Striegel, H., Simon, P., Wurster, C., Niess, A.M., & Ulrich, R.
(2006). The use of nutritional supplements among master
athletes. International Journal of Sports Medicine, 27(3),
236–241. PubMed doi:10.1055/s-2005-865648
Tawfik, S., El Koofy, N., & Moawad, E.M.I. (2016). Patterns of
nutrition and dietary supplements use on young Egyptian
athltes: A community-based cross-sectional survey. PLoS
One, 11(8), e0161252. PubMed doi:10.1371/journal.
pone.0161252
Tian, H.H., Ong, W.S., & Tan, C.L. (2009). Nutritional supplement use among university athltes in Singapore. Singapore
Medical Journal, 50(2), 165–172. PubMed
Torres-McGehee, T.M., Pritchett, K.L., Zippel, D., Minton,
D.M., Cellamare, A., & Sibilia, M. (2012). Sports nutrition knowledge among collegiate athletes, coaches, athletic trainers, and strength and conditioning specialists.
Journal of Athletic Training, 47(2), 205–211. PubMed
doi:10.4085/1062-6050-47.2.205
Tsitsimpikou, C., Chrisostomou, N., Papalexis, P., Tsarouhas,
K., Tsatsakis, A., & Jamurtas, A. (2011). The use of
nutritional supplements among recreational athletes in
Athens, Greece. International Journal of Sport Nutrition and Exercise Metabolism, 21(5), 377–384. PubMed
doi:10.1123/ijsnem.21.5.377
Valliant, M.W., Emplaincourt, H.P., Wenzel, R.K., & Garner,
B.H. (2012). Nutrition education by a registered dietician
improves dietary intake and nutrition knowledge of NCAA
female volleyball team. Nutrients, 4(6), 506–516. PubMed
doi:10.3390/nu4060506
Wiens, K., Erdman, K.A., Stadnyk, M., & Parnell, J.A. (2014).
Dietary supplement usage, motivation, and education in
young, Canadian athletes. International Journal of Sport
Nutrition and Exercise Metabolism, 24(6), 613–622.
PubMed doi:10.1123/ijsnem.2013-0087
Wiita, B., Stombaugh, I., & Buch, J. (1995). Nutrition knowledge and eating practices of young female athletes. Journal
of Physical Education, Recreation & Dance, 66(3), 36–41.
doi:10.1080/07303084.1995.10607059
Zawila, L.G., Steib, C-S., & Hoogenboom, B. (2003). The
female collegiate cross-country runner: Nutritional knowledge and attitudes. Journal of Athletic Training, 38(1),
67–74. PubMed
IJSNEM Vol. 27, No. 4, 2017
Copyright of International Journal of Sport Nutrition & Exercise Metabolism is the property
of Human Kinetics Publishers, Inc. and its content may not be copied or emailed to multiple
sites or posted to a listserv without the copyright holder's express written permission.
However, users may print, download, or email articles for individual use.