Supplements are used by 40-59% of athletes, depending on their specific sport, competition level, and recovery needs. While athletes are often targeted with supplements claiming to improve their performance and stamina, not every supplement claim on the market is backed by evidence to really support its use. Ultimately, a personalized approach to supplementation that uses functional medicine lab testing where appropriate to determine an athlete's needs can help athletes improve their strength and endurance while meeting their recovery needs.

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Why Do Athletes Use Supplements?

Many athletes use supplements as part of their regular training or competition routines to support their performance and recovery or to fill in gaps in their diet and supplement calories to meet their energy needs. In an industry where the slightest competitive edge will mean the difference between winning and coming in second place, adjusting one's diet, training, and lifestyle comes with the territory. Supplements that can help increase muscle strength and power, improve endurance, and support a more efficient recovery are attractive to athletes at all levels as a way to finetune their sport.

The use of supplements can offer benefits, but they need to be considered within the bigger picture of an athlete's diet, training program, and adequate recovery time. Responses to supplements can depend on an individual's genetics, gut microbiome health, and daily nutritional intake. Monitoring lab work where possible helps to ensure supplementation remains appropriate and is in the best interest of an athlete's health.

Top Supplements for Athletes

The following is a list of the most beneficial supplements for athletes:

Creatine

Creatine is a well-researched supplement in the athletic world that has been shown to improve muscle mass, maximal power/strength, and performance of short-term high-intensity exercise, primarily by improving ATP production in musculoskeletal tissue. Creatine monohydrate is the most common form used to supplement dietary intake from meat. Dosages vary, with some athletes needing an initial 5-7 day "loading phase" of 20 grams per day in 4 split doses, followed by a "maintenance phase" of 3-5 grams once daily. About 20-30% of the population doesn't seem to benefit from creatine supplementation, so a little trial and error may be necessary here. It should also be noted that creatine is often reported to increase water retention after the loading phase, so sport-specific considerations apply here for sports with specific weight classes.

Beta-alanine

Beta-alanine is an amino acid found in poultry, meat, and fish. The body uses beta-alanine to make carnosine, a compound that serves as a buffer for lactic acid produced in the muscle and helps improve athletic performance. Supplementation with beta-alanine can enhance performance by increasing exercise capacity and decreasing muscle fatigue and soreness after training. It also improves muscle fiber firing rate for more efficient performance. The recommended dose of this supplement ranges from about 3-6 grams per day, though some may experience tingling or an "itch" in the hands, feet, or face at the higher end of that range - in which case, splitting the dose into two smaller portions may be more beneficial.

Vitamin D

Vitamin D helps keep inflammation at bay while supporting immune health and recovery. Vitamin D deficiency has been observed in athletes across most sports, with 26-36% of athletes having a deficiency depending on geographic location and diet. Additionally, vitamin D intake has been linked to increases in muscle size, strength, and power. Insufficient levels of vitamin D can be associated with low testosterone levels, a higher risk of injury and stress fracture in athletes, and suboptimal muscle function.  

Iron (Particular Importance for Menstruating Female Athletes)

Low iron levels are more common in menstruating female athletes, who are twice as susceptible to iron-deficiency anemia as their non-active counterparts. Inadequate iron levels have been linked to fatigue, decreased athletic performance, and an elevated resting heart rate. Iron is an important mineral that helps support overall metabolism and forms hemoglobin so that oxygen can be transported to the tissues, an important process for optimal athletic performance.  

Beetroot Juice (Nitrate)

Beetroot juice is a supplemental source of nitrate that helps to increase the efficiency of muscle contraction, boosts energy production in the mitochondria, and enhances blood flow to exercising muscle through its vasodilation effects. The performance-related benefits of beetroot juice occur as soon as 2-3 hours of supplementation, with benefits continuing as long as supplementation is consistent day—to—day. Additionally, beetroot juice has been found to improve power output while extending time to muscular exhaustion, which is important for competitive athletes. Athletes dealing with low blood pressure or who have a history of kidney stones should speak with their doctor before considering a beetroot juice supplement, beetroot juice may lower blood pressure and is also high in oxalates, a compound that can contribute to kidney stone formation in susceptible individuals.  

Electrolytes

Athletes commonly use electrolytes to help stave off dehydration. Electrolytes can help to maintain total body water, as even mild dehydration deficits (1-2% loss of body water) will increase cardiovascular strain and limit aerobic performance. Athletes training and competing in hot weather conditions have an increased need due to weather-related perspiration loss. Consuming electrolytes pre-, during, and post-training have been linked to better retention of minerals like sodium, calcium, and magnesium as compared to plain water or caffeinated sports drinks, helping ensure not just better athletic performance but better recovery as well. For elite athletes, an individualized hydration strategy may look at pre-exercise hydration status, electrolyte needs before, during, and after training, and may even include measuring fluid intake, urinary fluid loss, and analysis of sweat samples to personalize electrolyte/fluid intake for the athlete's unique needs.  

Supplemental Protein

While total calorie intake and protein intake in the long term plays the most crucial dietary role in facilitating adaptations needed for optimal athletic performance, protein supplementation pre- and post-workout is useful to optimize physical performance and positively influences the recovery process for both resistance training and endurance sports. With the use of supplemental protein such as whey protein, studies show there can be a significant rise in muscle protein synthesis and an increase in levels of essential amino acids and branched-chain amino acids (BCAAs), driving more fuel to the muscles that have just been working hard.  

Omega-3 Fish Oil

Omega-3 fat levels are important to help keep inflammation from a high training load at bay, and have also been linked to better recovery and lower post-training soreness in athletes. Studies have shown that athletes using fish oil supplementation have also experienced positive effects on cognition and have had lower inflammation overall.

Functional Medicine Labs to Test That Can Help You Determine Which Supplement is Best for You

Functional medicine labs are excellent for assessing your unique individuality. The following labs are beneficial:

Omega-3 Index

The omega-3 index is a simple blood test that can provide insight into the state of inflammation of an athlete and can help guide recovery plans and supplemental dosage needed to support optimal performance.  

Serum Ferritin and Hemoglobin

Evaluating iron levels by looking at hemoglobin and ferritin can help determine if an athlete is at risk of iron-deficiency anemia that can negatively impact athletic performance and oxygen delivery to the muscle tissue. Based on the results, an athlete and their support team can help make adjustments to the diet and supplement with appropriate dosage if necessary.  

Vitamin D

Assessing levels of vitamin D can help guide supplementation dosage and is of particular importance for athletes who are training inside most days or who live in areas of the world with less sun exposure during their training and competition season.  

Electrolytes

Regular monitoring of electrolyte levels can help ensure an athlete is meeting their individual needs for hydration and maintenance of mineral levels that are needed for optimal performance and recovery.  

Protein

There are a few aspects of testing using a functional medicine approach regarding protein supplementation needs. First, testing total protein levels can help determine if there's a gross inadequacy of protein to meet an athlete's needs. Additionally, using nutrition tracking apps to bring awareness to protein intake can be helpful in determining what an athlete's dietary intake of protein is before figuring out how much supplemental protein may be needed for optimal muscle health and performance.

Last, considering an athlete’s digestive efficiency is important to meeting protein needs. Organic Acid Testing (OAT) can help bring to light possible deficits in protein digestion and absorption of the amino acids it contains. Amino acids that are not digested and absorbed can be metabolized by bacteria in the gut to form organic acids. Elevations in these makers can reflect protein malabsorption or dysbiosis in the gut, indicating a need for more specific gut microbiome testing, like a comprehensive digestive stool analysis (CDSA). It should also be noted that a high dietary intake of polyphenols like grapes, green tea, wine, or grape seed extract can also increase these levels. Organic acid testing can be a good first-line approach to determining if further functional medicine lab testing for the gut is necessary to optimize protein digestion and absorption, particularly if an athlete is not progressing in protein-dependent processes like muscle growth and strength increases.

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Summary

Using supplements as ergogenic aids is not a new concept in the athletic world, but more and more athletes are understanding the need to personalize their approach to supplementation to meet their unique needs. Understanding the complex interplay between gut microbiome health, stress levels, and nutrient intake is an important component of a supplement plan for athletes. Functional medicine lab testing can help determine any problems in these areas that may be hindering performance and can help guide the dosage and duration of supplementation so that an athlete experiences maximum benefits for their sport.