Your Supplements Are Contaminated & What's Worth Taking w/ Dr. Eric Helms (SSOF Ep 103)

Dr. Eric Helms0:27

Now, James, in my experience, that's how most athletes and fitness enthusiasts view supplements.

James de Lacey2:32

Yep, that's how I always have, too.

Dr. Eric Helms2:54

Right. If I can drop $30, $60 a month on this and there is maybe one animal study that says it could possibly do something for a mechanism that might help me, why not? I can just take it with my multi. Now, of course, that can pretty quickly turn into a $600 per month bill and you having a pill case like you're an 85-year-old cardiovascular disease carrier.

But assuming you do that with some kind of reasonable level of assessment and an understanding of science, I don't think that's at face value a wrong way to approach it. But that is only true if our assessment of there being a potential harm is accurate. And the reality is is that what is listed on the label is often not even there, and often things that are not on the label in the supplement industry are there and things that you would probably otherwise not want, especially if we're a tested athlete.

And there is a risk of harm not due to what the potential ingredient might be that could be basically neutral or positive, but just due to potential supplement contamination. And I think most people are not aware of how high the rates are of adulteration in the supplement industry. So once I started essentially digging into that and considering the magnitude of effect, and I'm like, all right, listen, if I'm going to approach this like a gambler, if I'm going to go to Vegas and I'm going to bet on a supplement, the reality is is that most of the time it's not going to help me.

And nine out of 10 times, if I bet on a new supplement, it's going to end up doing nothing for me, best case scenario. Fair enough. But the true reality is is that maybe two to three out of 10 times, even if the ingredient might not benefit me and I'm getting no effect out of it, something that's not in the supplement, an adulterated contaminant, could be harming me.

And I think that's just a message that needs to be spread more widely. And as we get into it on the show, I can start talking about some of the rates, the reasons, and the type of things that are actually found in adulterated supplements, and I think people would hopefully change their perspective.

James de Lacey4:50

I was actually doing a little bit of research on this myself a while ago and I came across a study. I actually just pulled it up now. 2022, Escalante, is that how you say his last name?

Only 8% of products with third-party tested certified, I think it was on Amazon on those ones, and there was a creatine product. So 92% of the creatine products on Amazon had no third-party testing. And then I guess if it's not from Creapure, which is I guess the most the gold standard of creatine, are you sure what you're getting? And then you mentioned obviously the contaminants. So what kind of contaminants are we talking about in these things? Is it just a matter of, hey, I might pop negative for a drug test, or is it adverse health effects that could be happening too?

Dr. Eric Helms5:40

Yeah, that's one thing. Like a common joke I've seen as I've been talking about this in the YouTube comments or the Instagram is, and what? Yeah, exactly. Oh no, Eric, please tell me the list of the contaminated supplements so I can definitely not buy them so I can take anabolics. And of course, it's tongue-in-cheek and I don't think people are actually serious about that.

But people who actually take anabolic steroids, they want to know exactly how much they're taking and in what form, because there is serious potential side effects. And when there is purposeful contamination of a supplement where the supplement company has included it in there to try to get a market advantage, they are trying to have an effect. It's not just that a drum or a conveyor belt wasn't well cleaned and some very small amount of a banned substance is in there and you could fail a drug test.

If we actually look at some of the FDA actions where they've been basically alerted to the fact that certain supplements might be adulterated and they've then decided to go seize them, so there was a study that was done in, I believe, 2017, and it covered the period of 2007 to 2016 on the range of contaminants that were identified by the FDA. And they included everything from antidepressants to laxatives to erectile dysfunction drugs, and many times these were for older drugs that are no longer prescribed. So like antidepressants that are no longer used, laxatives that maybe deemed not to be safe, erectile dysfunction drugs.

And you have to think about what are some of the mechanisms of action for some of these drugs. Erectile dysfunction drugs are actually affecting endothelial function. They're often potentially changing your blood pressure. They could have an interaction with, say, blood thinners or blood pressure medications, or they might be contraindicated with someone with certain congenital heart issues. So that's a big deal.

And laxatives, if used in excess, can cause some pretty serious dehydration and at least some very unpleasantness. But in some of the weight loss drugs, you'll see laxatives because laxatives will produce a weight loss effect. In some of the nootropics, you'll see antidepressants because you want a nootropic effect, there you go. And if anyone's ever watched one of the commercials or read one of the information packets of an antidepressant, the list of potential side effects are quite large.

SSRIs are serious drugs, and sometimes they can even cause depression in certain populations. And considering that these are present in weight loss drugs, pre-workout drugs—sorry, weight loss supplements, pre-workout supplements—and muscle-building supplements and testosterone-boosting supplements, these are also supplements that a lot of people, because they think, oh, they're just supplements and I think more is better, they will increase the dose on.

So yeah, there are definitely certain classes of supplements which have a higher likelihood of being contaminated, and those are specifically weight loss, energy, pre-workout, and muscle-building, as well as sexual health, testosterone-boosting supplements. Those categories are higher likelihood than, say, a multivitamin or a protein powder. But it's not to say that protein powders and multivitamins aren't also have a relatively high risk of being adulterated; it's just they're not the highest, and they're probably not going to be intentionally adulterated as often.

James de Lacey9:24

So are you saying that a lot of these nefarious companies intentionally adding some of these things? I remember, I don't know how long ago it was, the whole protein spiking thing when companies were spiking their protein. And maybe you can explain that as well for—

Are you saying that a lot of these nefarious companies intentionally adding some of these things? I remember I don't know how long ago it was, the whole protein spiking thing when companies were spiking their protein. Maybe you can explain that as well for the audience as well, but that was obviously nefariously done. Is this stuff an accident most of the time, or are companies just kind of cutting their stuff to maybe try to get a better effect, a bit of feeling for the person taking it?

Dr. Eric Helms9:51

Good, and I'm glad you asked it that way because it can give us a broad understanding of the reasons and the risks and the various ways this can occur. So protein spiking is specifically people adding lower cost amino acids into a protein powder to reduce the cost of producing it, but unfortunately reducing the quality of the supplement so that you're ending up with say less essential amino acids than you otherwise would in say whey protein.

And you can identify things like this by noticing that the price of the protein powder is quite low despite noticing that per 30 gram scoop it's got 25 or 26 grams of protein. That's like a high quality isolate or concentrate, and you're thinking, wait, hold on, why is this one of the cheaper proteins on the market even compared to say a milk protein concentrate? And this is supposedly a Whey Protein Isolate.

Now that's not going to harm you, protein spiking, but it is certainly illegal, and it is certainly nefarious and it's intentional, and it is a way for companies just to sell you a lower quality product that is disguised as a higher quality product. And that happens quite frequently, and that's a whole other issue than adulteration or contamination per se. It is technically them adding something that shouldn't be in there to it and removing things that should be in there from it and having an inaccurate label.

But what I was specifically referring to with those FDA seizures of adulterated products is intentional contamination by unscrupulous supplement companies that are trying to get their product to have a greater effect than it otherwise would to make people purchase it. But I would say that's probably rarer than simple contamination due to inadvertent contamination that probably occurs at the manufacturing level.

So that is, that's another problem. For those who don't know, this is true in the U.S., but also other countries. There is not necessarily an upfront enforcement of good manufacturing practices and ensuring label claims on supplements in the supplement industry. The way it works in the U.S. especially, where a lot of these supplements are sourced from, is that anyone can apply to, you know, you get a business license in whatever state you're in, you say you're setting up a company, you buy a capsule maker at Walmart, or you get powders and you get a label making company, you set up a URL or maybe just an Instagram page these days, and you set up PayPal.

People can buy the supplement and you say something's in it, but there's literally nothing to stop you from just putting say flour in a pill maker and saying that it is creatine and selling it.

And the only way that that is going to get corrected is if someone reports it to the FDA or produces an independent lab report and then eventually they might do something. So it is after-market regulation, post hoc if you will. And that's not true of every country, but it is of many. And that's very different to say the pharmaceutical industry, where you have to go through multiple trials to show both safety and efficacy to then release it.

And because supplements are supposed to only contain ingredients that could occur in the food supply, they're regulated in a similar way to food in that way in the U.S., where the assumption is that it's just a food product that's safe, it's all good. Although it's not a food product, it's a supplement. But it is only regulated after the fact.

So it's the kind of thing where there are many short-term cash grab mentality companies out there, but there are also lots of good actors in the supplement industry, larger companies who have a reputation, and it would harm them if they did do this. So it's a mixed bag.

But if we want to talk about overall rates, so we're considering everything that we've kind of talked about under that umbrella, estimations based upon recent reviews of this type of data is that somewhere between 10 to 30% of all supplements are adulterated. They have a contaminant, they have something in them that's not supposed to be there. And that is a shockingly high rate that I think most people would not expect.

And for anyone who's interested, and I, people are often so shocked by that I feel the need to send them to the study to read it. But there is a really good review that was done in 2023, it came out in I think September, and it's titled Prevalence of Adulteration and Dietary Supplements and Recommendations for Safe Supplement Practices in Sport.

It's an open access review, the lead author is Jadim, that's pronounced, that's the way you pronounce it, but it's J-A-D-I-M. And that was published in Frontiers in Sports and Active Living. So pretty high quality journal, it's a narrative review that goes over a lot of the data we're talking about today. But yeah, it is, it's a pretty significant issue.

And talking about unintentional doping, since you asked about that, the way it's supposed to occur is that not only are you supposed to have what your label claims, but then if we go up a level on the supply chain to the manufacturer, the manufacturer is supposed to follow what's called GMP, General Manufacturing Practices. And that's the legal requirement to do things in a safe way that's clean and reduces the potential of contamination, but it also covers a lot of other things like, do you have fire exits, do you have wheelchair accessible doors and things like that? It's a broad range of everything that a factory should have.

Now again, just like the products themselves are not tested or shown to be safe before they go on the market, they are supposed to be food products that are already established as safe. There's no regulation upfront on manufacturers, and manufacturers will often service multiple supplement companies and they'll make ingredients for a bunch of different supplement companies that source through them. There was a 2013 FDA report where they did go around and randomly survey some of these manufacturers, and they found that 70% of them were not meeting the GMP standards that were legally required.

So we have a consistent problem here where seven out of 10 manufacturers don't consistently meet the required manufacturing practices, and there is the occurrence of both intentional and unintentional doping or protein spiking for various reasons. And the endpoint is that somewhere between one and three supplements that you purchase probably has something in them you don't want there.

And if you combine that, because I know this is, there's a lot of athletes who are drug tested who listen to this podcast. You and I have both been in drug tested sport, and we can think of what would happen to us if we were to fail a drug test or our athletes were as coaches and the stigma that's attached to that. It's pretty significant, it's scary, it'll keep you up at night if you start thinking about this a lot.

The testing protocols that we have to detect very, very, very faint doses of banned substances are getting better and better and better and better and better. If you were to take your typical drug test from the late '90s compared to now in the 2020s, it is multiple factors more precise and accurate. You can find a very small amount of a banned substance in someone's urine to the point where it could have been a dosage that would not have any physiological effect.

Now the reason that precision is there is because people do things like trying to stop early enough so the drug clears out of their systems, they want to catch just that very faint metabolite, or they're trying to use other substances to cover it up. There's various ways people try to beat drug tests.

So there's this war being waged between anti-doping and doping that's always going on, and so much to the fact that there is now the process of having a much greater likelihood of catching someone who's doping by saving their urine or their blood for multiple Olympic cycles. A bunch of people in Beijing were caught like in, I think, eight years later, two Olympic cycles later. As we know in Olympic weightlifting, at the Beijing Olympics they found seven people out of the top 10 were doping, meaning that the precision of the tests at the time were not sufficient to catch them but they were years later.

So doping science is evolving, which means that you can have a very, very faint contaminant in there that didn't impact you at all, didn't impact your health, but as a drug tested athlete resulted in you popping positive.

So whether you're concerned about health and purposeful adulteration, which does occur based upon what we talked about earlier, or you're a tested athlete who wants to make sure you're not banned from sport for inadvertently getting a contaminant, this is something to be concerned about. And the rates at which that occurs are surprisingly high. There was a report that came out of I believe Norway where one quarter of doping failures over a 10-year span had an athlete claiming that it was due to an adulterated contaminant.

That's a lot, and it's also a very different thing for you to claim in front of the doping tribunal for your country's anti-doping federation that this was because of, my failure was because of a supplement contamination, versus say just making a post on social media like most people think. Oh yeah, you claimed that.

It was, you know, there's D-ball in your vitamin, sure bro. And that may often be the case that they are just covering their ass with a little publicity on social media, and it takes no effort to say that to your followers. But to actually make that claim as a defense in a doping tribunal is a whole other thing. You need to have a lawyer, you need to get your supplements tested, you need to save it, you need to have the foresight to do that.

And I've known athletes who have actually failed due to either food supplement contamination and they weren't able to successfully defend themselves because they didn't have the foresight to save it, they couldn't afford it, or the specific batch wasn't around anymore. And even considering all of that in those 25% of cases in this study in Norway, half of them were able to provide evidence, which means that at least half were probably actually inadvertently doping. And more than that who couldn't successfully defend themselves or weren't able to provide evidence probably were as well.

So I would guess that somewhere between 10 to 20% of athletes who are failing drug tests, it's due to inadvertent supplement contamination, if I'm trying to figure out what is half of a quarter. That's the minimum.

James de Lacey20:58

Yeah, it's a significant problem. Yeah, that's scary. I hope you're enjoying the chat so far. Before we get back to that, I just want to let you know that Sweet Science of Fighting is more than just a podcast.

We have a full training app with strength conditioning programs for strikers, grapplers, and MMA athletes, so you don't have to think about what you're doing and you're getting access to the latest scientific methods to improve combat sports performance. We have programs specifically for judo, for jiu-jitsu, for wrestling, MMA, boxing, Muay Thai is coming soon. All these things are going to be in the training app.

We also have a private community where some of the coaches that have been on the podcast are in there to help you with any training questions and any performance questions you have. For example, Andrew Usher and Casper Dvorak. We also have some online courses within the training app. They cover strength conditioning, mental skills, and weight cutting.

And finally, we now have Ryan Vos in the community, a second degree jiu-jitsu black belt who is there to break down any of your grappling matches that you want seen to by a second eye. He's currently breaking down videos on a separate Sweet Science of Fighting YouTube channel, and he will break down your video within the community. So if you have a match or a roll that you just recorded, you can upload that in there and Ryan will break that down for you.

So what are you waiting for? Jump down the description, you can check out the Sweet Science of Fighting Underground. Otherwise, enjoy the podcast.

That's scary for anyone who's competing in drug tested competition at all. I guess outside of maybe banned substances, is heavy metals a problem too in some? I think I've read something about greens powders potentially having heavy metals or something like that?

Dr. Eric Helms22:22

I've heard that as well, and that's something that I haven't looked into. That won't cause you to fail a drug test, and it's not necessarily an adulteration or a contaminant. It's that some of the... I mean, it is a contaminant, but it's not necessarily adulteration. But yeah, that's a whole other topic. And again, it comes out of quality control, right?

If you're getting your supplements assayed and tested, those things should show up. When you're testing to make sure that what's in it is... a certificate of analysis gives you that, doesn't it?

James de Lacey23:17

You can ask for a COA?

Dr. Eric Helms23:17

Yeah, yeah. So that's maybe a good segue to talk about what are the things you can do. Sometimes you will see supplements with seals on them, right? You might see GMP and you're like, oh great, so they do follow good manufacturing practices. Maybe.

Now, here's the thing. Any supplement company can say, yeah, these were made according to GMP, and legally they are supposed to. But that's just saying take our word for it. Now, if you see a third party seal saying that it's GMP, that's different. So one of the most common ones is the USP certified GMP. So USP is a company, United States Pharmacopeia, I believe is the name of it. I might be getting that a little wrong, I'll look it up as I say it.

But what they do is they're a third party that comes in and they audit the manufacturing plant to ensure that all the things go into what would be GMP, so that they guarantee, hey, if the FDA came in today, they would say the same thing we did. You met the good manufacturing practices. I said general early, it's actually good. But yeah, US Pharmacopeia, they're one of the more well-known ones who do that.

And a USP GMP stamp is different than just a company themselves putting a GMP on there. It's hard to tell if you're not an educated consumer to know the difference. And that is not the same as saying every single one of these supplements themselves were actually tested to see exactly, like you said, what is in it, what do we have, right?

And depending upon the person's level of risk aversion and the consequences to there being a potential contaminant in their supplement, you would probably want third party verification and testing of the supplements themselves, not just that the manufacturing practices where the supplement was made were up to snuff.

And there's a bunch of those. So one of the more common ones known internationally would be Informed Choice or Informed Safe for Sport. You'll see that on a lot of, like say, Optimum Nutrition or some of the other brands that have an international presence. If you're based in the US, you will sometimes see things like NSF certified Safe for Sport. There's lesser known ones like AIS Shield, excuse me.

But there's Consumer Labs, there's many. And they are basically these companies that will come in and they will test certain batch lot numbers and say, yeah, these only have what they're supposed to have. But yeah, there's BSCG, there's many. And you need to be aware of what their seals are, which companies they are, and what they actually do.

You don't want to be the consumer who's like, yeah, it said natural on the product, so I bought it. You kind of want to know what is a true third party seal and what are the actual third parties, because sometimes the supplement company will say, yeah, we do in-house testing to make sure that it's banned substance-free, and then you just have to trust the company. And that becomes a problem.

James de Lacey26:40

Again, as you mentioned with potential nefarious stuff and other contaminants. But I wanted to go down the road of actual supplements then that you would deem, I guess, efficacious or maybe worth taking in the grand scheme. Obviously now, now that, I guess, the balance of benefit to harm might be tipping the other way. So maybe just give your short list of maybe supps that you think are worth taking, and then there's a few other questions I have just on various supps.

I think I listened to your podcast with Eric, actually, on a couple of things, and obviously that tier system, et cetera. But maybe they start with your list.

Dr. Eric Helms27:11

Yeah, so I think the first thing to acknowledge is that the most effective supplement that exists on the market for any outcome that we've measured is creatine monohydrate, right? And creatine has an overall effect that, depending upon the data you look at and the outcome you're interested in, sits from trivial, which means it might be significant but it is an effect that is so small you would not notice the difference and it might not have a meaningful improvement in actual performance or body composition, up to say modest or moderate, barely just over small, which is worthwhile.

I mean, don't get me wrong, we would take small and moderate effects all day as coaches because those things can add up. And sometimes the difference, if you think about, let's say, an Olympic sprinter, you shave 0.1 of a second off of your sprint time and you move up a whole class of sprinting. You go from being, making the Olympic trials to getting a medal, right?

So I think that's worth noting that just because an effect is small... trivial, I mean, it's worthless. But I think when you weigh that against the potential risk, now we have a different story. So the way I like to classify supplements is taking my colleague Eric Trexler's classifications of having tier one, two, three, four, and five.

Real briefly, tier five means we actually have data that it harms performance or harms health, and most of the time this means it will or is off the market, but not always. Tier four, believe it or not, is where the most supplements sit, and that means we have conclusive evidence this doesn't do anything for you. Tribulus terrestris, BCAA in almost all contexts, right, glutamine in almost all contexts, very, very popular supplements, but that don't do what they claim, and we have sufficient evidence to actually show that is the case.

Most supplements that come out start at the tier above that, and that's tier three. And that's we have insufficient evidence to know whether it's useful or not useful. That's where most quote unquote new or novel supplements enter the market. And then eventually, based upon the scientific record and what is done on them and what's published, they move...

9.9 times out of 10 down to level 4, and it is the 0.1 that have an opportunity to go up. And we have level 2 and level 1, and it's easier to talk about level 1. Level 1 is we have conclusive evidence to show that there's no harm and there is a potential benefit that is relatively wide-ranging and pretty clear.

And these are all specific to outcomes. So I know you have a lot of fighters listening to this. I'm a competitive strength athlete and physique athlete and that's who I coach. So I'm often thinking of, say, strength and power performance, as well as some muscular endurance-related outcomes and, of course, body composition changes. So that's kind of my framing here.

And the only tier 1 supplement for that purpose is creatine. Everything else falls in tier 2, which is there is a positive effect but it is inconsistent, not always meaningful, or more often it only applies to specific outcomes, or there are caveats where you may decide it is or isn't worth it.

So the recommendations I have is that, look, if you're going to go to Vegas and if you're going to roll the dice, you at least better have a chance of having an effect. So if it's not a tier 1 or a tier 2 supplement, just the answer is don't take it, period. Because the best case scenario for a tier 3 supplement, this new thing that's got maybe half a mechanistic study and maybe a couple of rats it worked for something that's maybe not relevant to you, and it could be potentially positive—again, 9.9 out of 10 times it's going down, it doesn't do anything.

Sometimes it actually will harm you, and sometimes even if it wouldn't harm you, it's contaminated. But 0.1 out of 10 times it'll become tier 2.

And here's the reality: we have yet to see in the 30 years that creatine has been on the market something to actually make it to tier 1 and stay there and not end up getting banned or found out with more research that it's not actually tier 1. So the best case scenario, a reasonable assumption would be that it's going to be as good as creatine. And for the outcome you care about, we're talking about probably a small effect on average when we look at the most recent meta-analysis on creatine—not looking at lean body mass gain that includes a lot of the hydrated muscle increases in body water.

We look at actual changes in ultrasound, MRI, and computed tomography changes in muscle mass locally. Like, if we just look at the bicep and go, 'Okay, you took it, how much did it grow?'—it's a trivial effect, almost small.

So that's the best case. So if we want to bet on that, then we should never be taking tier 3 supplements because you're essentially having a less than 1% chance of getting a benefit that you probably will not even be able to notice, and a 10 to 30% chance of it containing an adulterated compound. So if you're going to take a supplement, first: is it tier 1 or tier 2?

Okay, great. The next step: can you get it third-party tested? And then and only then is it worth committing to that supplement. And that's why the list is something I can fit on one hand if I'm counting.

James de Lacey32:31

Okay. We'll go down that list in a second too. But regarding creatine as well, the idea of responders and non-responders—I would class myself as a non-responder, definitely. I mean, I still take it, but my body weight doesn't change at all. I don't feel any difference in the gym at all. Is there any research or any practical sides, like, does someone who notices—I mean, do they need to take more? Is it just something that you just take and you just don't have these effects? Is there anything behind any of that?

Dr. Eric Helms32:56

Great question, and we actually do have data on not only the existence of non-responders but we actually know why. And non-responders have higher baseline levels of muscle creatine. This means that for whatever reason, either through a combination of what is their habitual diet and then perhaps how efficiently does their body store the creatine that is in the diet that they consume, enter their muscles.

So for those who don't know, creatine is a combined amino acid or amino acid compound of three different amino acids, and it is stored in muscle. I mean, in other places too—we actually stored in the brain and a few other organs—but the predominant amount of it is stored in muscle. We carry muscle creatine, and just like when you load glycogen, when you load or take creatine, you gain weight because there is associated water weight gain with both.

So people who have done a little bit of muscle physiology or bioenergetics are probably familiar with the ATP-CP system or the phosphocreatine system. One of the ways which we recycle ATP rapidly for high output, high energy output short-term efforts like explosive power, within the first couple seconds it's whatever stored ATP is already in the muscle, and then for maybe up to 10 seconds it's predominated by the ATP-CP system.

And that is using muscle creatine to recharge those ATP batteries. And if you keep going on beyond that, A, you can't maintain that level intensity, and B, it starts to tap into glycogen and glucose. So anyway, that's why creatine is so helpful for strength and power athletes.

And the reason why some people don't respond to taking creatine is the reason why we take creatine in the first place. We take creatine because it's very difficult in the diet to get to the point where your muscle creatine stores are saturated, much like it's very difficult to regularly be consuming an amount of carbohydrate to have fully topped-off glycogen stores and why there are sometimes carbohydrate loading protocols that endurance athletes use.

Now, just like we get carbohydrates in the diet, we get creatine in the diet, and it is present in animal products. Not necessarily in all animal products—it's very low in eggs and it's almost non-existent in milk-based products—but it is in meat, just like we store muscle creatine, so do animals. So when you eat meat, you're consuming creatine. But the cooking process degrades it quite substantially. So the amount that we get in a modern diet is quite low compared to maybe what an actual carnivorous animal would have, another mammal, for example.

So for us, if you have a relatively low protein diet, if you're lacto-ovo vegetarian, or if you're vegan, all of those things will result in you having a higher chance of responding. And Burke and colleagues actually did a study, I want to say in 2004, where they showed that vegans and vegetarians respond much more robustly than your typical omnivore. And that's because they're consuming meat in their diet, the other one is not.

So if you're a non-responder, you may be better at capturing creatine from your food. You might have a relatively high protein intake, and you might also be someone who really likes rare steaks, sashimi, or other forms of meats where the creatine is much less degraded.

James de Lacey36:18

There you go. See?

Dr. Eric Helms36:18

Yeah, so that's actually a well-observed phenomenon. And the way you can tell is that if you're taking a high-quality creatine monohydrate that has been batch tested and you know what's actually in it, and you're taking it for the first time—and it does take, more than a month or so for the effects to fully wash out—you see no change in body weight.

Most people gain 1 to 2% of their body mass when they go and they finish the process of getting fully saturated muscle creatine stores. So that could be, say, three weeks of taking five grams a day, or it could be a one-week loading phase of taking 20 grams a day. Those are the more common two protocols, and I'm generalizing.

But anyway, so yeah, if you go through that process and there's no increase in body weight and you know you're taking a high-quality creatine—it's not some other weird form of creatine that's not monohydrate—you might already have topped-out muscle creatine stores, and you may not need to take creatine to benefit from it.

James de Lacey37:11

Okay, well that's good to know. It's good to know that you don't need to suddenly start taking 10 grams or some [expletive].

Dr. Eric Helms37:11

No, and go through double the thing. That's good.

James de Lacey37:35

And if we go down to your tier 2 list, it sounds like obviously people listening to this might be like, 'Hey, what about protein powders and vitamins and minerals?' I'm assuming those are, because of special use cases—for example, if you're deficient in protein or deficient in a certain vitamin and mineral, that's where actually you see the benefit versus diet, or you have the vitamins coming in and then it doesn't really matter?

Dr. Eric Helms37:35

Yeah, exactly. I'll give a really good example of a conditional tier 2, conditional tier 4, or conditional tier 1 supplement, depending upon the context: beta-alanine. Okay, so we talked about muscle glycogen, we talked about muscle creatine—let's talk about muscle carnosine. Carnosine is something we store in our muscles as well, and it acts as a buffering agent. As we do a high-intense exercise and pH changes that can interfere with muscle contraction, it's part of all the mechanisms of acute fatigue. And if you can buffer that acidity—and one of the physiological buffers is muscle carnosine—then you can keep going for a little bit longer.

Beta-alanine is a precursor to carnosine. Taking it directly is not bioavailable—it gets degraded and we can't therefore store it—so we take the precursor beta-alanine to get muscle carnosine levels higher to therefore have the ability to buffer fatigue. Okay, now the unfortunate thing...

Buffering only seems to really improve performance when we're talking about extended efforts of high intensity activity, typically in excess of about a minute, based upon some of the meta-analyses that have come out.

James de Lacey38:59

And 24 seconds, right? Something like that.

Dr. Eric Helms38:59

Or longer. I think that's because it's not like these are acute systems that work independently. So if you're a soccer player, you're going to be going longer than 20, 40 seconds, but you probably benefit from taking beta-alanine, right?

So beta-alanine is something that has been repeatedly studied in the context of resistance training, and only very inconsistently does it show an effect. And you typically have to do some silly things, like really high reps with 60% of one rep max in only like 30-second rest periods, and even then the minority of studies show a benefit. So I don't actually recommend it for bodybuilding, powerlifting, or weightlifting, even though it has a consistent small positive effect size that is shown across a lot of literature.

Now, if you're an 800-meter sprinter, you could make an argument that beta-alanine is just as important as creatine and it would be tier one. So powerlifter, tier four. 800-meter runner, tier one. And for maybe a strongman or a CrossFit competitor who does some work that beta-alanine might help for, but often not, and maybe not for this next competition they're going, it would be tier two. It's conditional, right?

So that's kind of the way we would conceptualize some of these things. And there are a few other ways that I would categorize something as tier two. Like, you have to really weigh the pros and cons. I think caffeine is kind of like our perennial tier two champ.

James de Lacey40:27

You mentioned, or I think it was your co-host Trix, mentioned on the podcast, on your podcast, about caffeine might not have the effect that we think it does on performance, and there's potentially the other stuff in the pre-workout that does. Do you want to maybe expand on that a bit?

Dr. Eric Helms40:52

Sure, yeah. So the few studies that have looked at pre-workouts that are multi-ingredient pre-workouts have shown some positive effects on performance, but it's difficult to disentangle whether it's the caffeine or it's the other supplements that are included in the ingredient profile. But that's not to say that there isn't consistently positive observed effects from caffeine for resistance training, but it's more often when you see pretty high doses of four to six milligrams per kilogram.

James de Lacey41:21

Yeah, it's crazy. I can't imagine taking anything like that.

Dr. Eric Helms41:21

So if you're a 200-pound male, for example, if you're my size, you're 91 kilos, you're going to want to take 350 to 400 milligrams of caffeine to kind of be in the middle of that dosing range, right? So, or at the top end of that dosing range, where there's a more consistently observed effect.

But here's the thing, and here's the issue with that: one, that effect, if you're regularly taking caffeine, we don't know how well it persists, because these are acute studies. Two, that acute impact on performance is not necessarily the same thing as a longitudinal effect on adaptation. Do we know that being able to lift slightly heavier loads or produce slightly higher power output in all these successive workouts is going to result in better adaptation long term?

It's not an unreasonable inference to make, but we don't actually have that data. To my knowledge, there's only one relatively low quality, low sample size study on longitudinal adaptations to just caffeine.

So it's actually a big reach for someone as a bodybuilder or powerlifter, like, "Yeah, if I take caffeine regularly before training, I lift slightly heavier loads, therefore more tension, more stress, bigger muscles, more strength, bada boom, bada bing, I'm stronger." Maybe. But we just don't know that for sure.

And there's habituation effects, so anyone who's been on a whole heap of caffeine – pre-workout, coffee in the morning, coffee in the afternoon, tea in the evening – and they go cold turkey knows that they actually experience, to some degree, withdrawal. And what we're not sure of, since caffeine is consumed by like 90% of adults in the world, whether when you enter one of these studies where they have you go off caffeine for a while to wash out the effects and then they supplement with caffeine, are we actually observing an ergogenic effect from caffeine, or are we observing the removal of the withdrawal ergolytic effects, right?

James de Lacey43:23

I lost you there, Eric. Can you hear me now?

Dr. Eric Helms43:23

Oh no, I got you back now. I got you back, we're good.

James de Lacey43:23

Okay, cool.

Dr. Eric Helms43:23

And since this is Riverside, it's got what I said. But what I said, James, was just that because nine out of ten adults use caffeine, and when you go into a caffeine study on performance, you have to stop taking it to then take it, and there's a crossover period or washout period, we don't know if we're actually seeing your normal performance, which is preserved because of a caffeine dependence, being greater than an ergolytic effect of withdrawal from caffeine.

And that hasn't been well teased out. It is possible – I don't think it's likely, but I think it's possible – that some of the effect of caffeine on performance is actually just getting caffeine-habituated people back to baseline. And some of the lower effects we see in people not taking caffeine is the effects of caffeine withdrawal.

So that's one thing to contend with. The other thing to contend with is this recent meta-regression published on how much and at what time can you take caffeine without having a negative effect on sleep. And this relatively large meta-regression kind of looked at three different common doses: something equivalent to a cup of coffee, around 50 milligrams; something equivalent to like an energy – your typical energy drink, not your crazy energy drink – of like 100 milligrams on average; and something close to your typical pre-workout, between 200 to 250 milligrams of caffeine.

And here's the bad news: taking that pre-workout anytime after around 10 a.m. still had a negative effect on sleep, on average, that was measurable – delayed time to fall asleep and reduced the amount of time spent in REM and deep sleep. So it impacted sleep architecture and also sleep latency.

Now, if you are habituated to caffeine, you'll be able to get around that sleep latency thing. Some people are like, "Yeah, I can have a cup of coffee and fall asleep five minutes later." That may be true, but that does not necessarily mean that you're going to have stage three or stage four sleep when you do it.

And there are some people who are fast caffeine metabolizers who are better able to shorten the half-life of caffeine and go to sleep and not have it negatively affect them. And there's some data to indicate they don't get affected by this, but we're talking probably like one out of ten people.

So nine out of ten people probably want to only take caffeine in a dosage of, say, 200 to 250 milligrams, and not higher, only for morning workouts. So now we have a very constrained use case of where this could potentially be beneficial without risking harm. Because if you told me, "Hey, I can give you 1% better performance in your workouts, but it's going to cost you a cumulative three and a half hours of sleep for a week," as a bodybuilder, I'm like, "No, I'm good.

No, thanks." Because the impact of sleep is so much more important than the absolute load that I might be lifting for my top set on leg press, for example.

So that's why caffeine, even though it's one of the most well-researched, a consistent positive finding, it's not going to move up to that top tier. But if you told me, "Hey, I'm competing in a powerlifting meet, and my opener is happening in an hour," I'd be like, "Take 300 milligrams of caffeine." I'm not worried about your adaptation to this powerlifting meet.

I'm worried about, can we get another two and a half kilos on the bar? So there is obviously a use case where it could be considered in a specific context: what's going to make me stronger in an hour? Caffeine is the best answer to that question for a substance that's not banned, right?

James de Lacey46:44

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That's funny you mentioned about the longitudinal stuff too, like long-term, if you're lifting heavier long-term, do we see that positive change? And the cluster set research, you don't see a positive change, even though the bar's moving faster, et cetera. So, yeah.

Dr. Eric Helms48:03

Yeah. And it may just be, we don't have studies that last...

A year, and it's not super clear whether the peak loads that you hit or the average loads are more important over time for accumulating strength. So it is, training is far more complex and you really do need to benefit the potential hit on recovery from training due to sleep being negatively impacted versus the outside chance of maybe having some small benefit from caffeine.

So yeah, the way I recommend caffeine to lifters is something like this: if you've got a morning workout and especially if you didn't get great sleep, yeah, take some caffeine. And don't take the amount shown in the research to benefit, take the smallest dose you need to get a perceived ergogenic effect because some of the caffeine benefit is probably reducing the withdrawal symptoms, some of the caffeine effect is probably placebo, and you just want to be able to reduce the ertic effect to get through your workout and not have it have a knock-on negative effect on your sleep.

Now the one good thing that did come out of that meta-regression was it showed that small doses of caffeine relatively later in the day are probably not going to impact your sleep very much if they're less than 50 milligrams. But again, that's considering you have to think about the cumulative dose because caffeine half-life is long.

So if you had a pre-workout at 8 a.m. and it was 300 milligrams of caffeine, which is—you can find pre-workouts like that, I've seen 400 now.

James de Lacey49:49

I know, it's getting crazy.

Dr. Eric Helms49:49

And sometimes people who take like the average body weight athlete is only like 175 pounds or 80 kilos. So that is like a five milligram per kilogram dose and we don't even have data on that. That's an additional 150 milligrams on top of the highest dose in this meta-regression.

So when do you, when can you take that and not have an effect? I don't know, 6 a.m. So yeah, if you've got an 8 a.m. workout, maybe you could take that. But then you would want to have no other caffeine for the rest of the day because by the time the half-life kicks in eight hours later, now you're at 200 milligrams in your system, and then you're at 100 milligrams eight hours later. So that's maybe the time you're going to fall asleep, so you don't want to then top up with another 50 milligrams.

James de Lacey50:41

Yeah, exactly. We actually have a question here in the live chat. I think this will be interesting to talk about. He's asking what's your recommendations for intra-workout supplements? So obviously I mean, we already pooh-poohed BCAA, which are often I guess marketed at intra-workout. But I guess typical intra-workout supplements now being marketed would be like intra-workout carbs, probably electrolytes as well, probably in that space. So is there anything that you typically recommend or is there a time to take them and then what would that be?

Dr. Eric Helms51:09

Great question. Yeah, so in the realm of strength and physique sport, it is very rare that I think you would get a benefit from intra-workout supplementation. It is really only restricted to situations where the energy output is so high that you're actually looking at potential depletion of glycogen and low blood glucose stores being an impairment. And that's why you see any endurance athlete, they have on board with them electrolytes and carbohydrates because they have that output.

But if you're doing let's say a two and a half hour Olympic weightlifting workout, let's be honest, at most maybe 20% of that time is actually lifting, the other 80% is sitting. Bodybuilding, even you shift it down a little bit and you could be doing antagonist supersets, but at most you've got a 60% of that time spent resting and 40% of that time spent training.

So I think it's just really important to remember that for strength and power-based training sessions, probably not needed at all unless it's like a lot of repeated sprint work or a lot of repeated work. So team sport-based training or endurance training that lasts in excess of an hour and a half, that's where you're potentially going to need it from a pure energy perspective.

And then the electrolytes portion—that is relevant to how much do you sweat, are you in a high temperature, high humid environment, are you losing electrolytes through sweat. And if that is the case, then absolutely electrolytes—that can be a much more acute issue.

So something like a Gatorade or any other sports drink that is a mixture of carbohydrates but not too much—I would say basically 30 to 60 grams at most per hour, when you look at gut tolerance is the data on this. And you probably don't need that much for most cases unless you're an endurance athlete. So your typical sports drink is a good idea and you can sip it throughout the workout or you can take it when you have a break, like taking the Gatorade at the halftime in a football or soccer game is a very common thing, right?

You may not get an opportunity to actually stop because the game is continuous, but if it's a training session then yeah, you can absolutely do that.

One interesting thing is that some performance does seem to be impacted in resistance training by carbohydrates, but it's not dose dependent. So my PhD student Andrew King led a meta-analysis that we did on peri- and pre-workout carbohydrate intake in the impact on resistance training performance.

Now very consistently we see no impact on power or force or strength production. So you can carb load all you want, you're going to squat the same amount, it's not going to make an impact. However, there was a relationship that seemed to be mediated by volume as well as the time spent after your last meal on the total amount of work you can do in a training session.

So if you compare the groups when you meta-analyze all of it—so it's not a huge effect—if you compare groups that are doing more volume and it's been say greater than eight hours since their last meals to groups that are doing shorter than eight hours and lower volume, that's in that first category where you might get a benefit from having pre- or intra-workout carbohydrate.

So if you're doing, and especially and it seemed to be more dominant in the leg training studies—there's nothing special about the legs, it's just that they have more musculature being recruited—so let's say you have a first, let's say you have an early morning leg workout, that is one of the times I would say you probably want to have a pre-workout meal with some carbohydrate in it.

Because you've had at least eight hours of sleep, maybe you had dinner at as late as 6:00 or 7:00 or 8:00 p.m. and a snack, but then you went to bed at 10:00 and now you're working out at say 9:00 a.m., we're looking at more than 12 hours of you having eaten food.

And we're looking at exercises that are high energy output, high forces, high load, and if there's a high volume there you could see that the total amount of work you're able to accomplish in that workout would be less if you went into it fasted or if you had a meal beforehand that consumed, that had no carbs, if you just had like a protein shake.

The interesting thing though is it did not seem carbohydrate dose dependent. So whether you had 20 grams of carbs or 100 grams before this made-up scenario didn't seem to make a difference. And that probably is due to a resistance training not just being dependent upon glycogen, but having that ATP, ATP-CP system going on, being long rest period, so you're actually even seeing the aerobic system get involved and replenishing some of the ATP in the muscle. But also due to the brain-mediated effects.

So we have seen that when you consume carbohydrate it impacts neural pathways. So there's carbohydrate sensors in the oral cavity that then can impact perception of effort and it can potentially impact the quote-unquote central governor—so central fatigue—and your ability to put forth effort. And we know this from carbohydrate mouth rinsing studies where someone will take Gatorade compared to a still sweet but non-carbohydrate containing, say sweetened beverage—so we're talking about like Gatorade or Powerade Zero versus Powerade—rinse it in your mouth and spit it out, and the carbohydrate-containing drink sometimes improves performance.

This is much more consistent when it's done intermittently through endurance exercise and maybe only like a quarter or a third of studies when you see it on resistance training, and only those with relatively high volumes and short rest period. So again, it is probably something to do with not the actual depletion of glycogen but the perception of fatigue.

And there's other data, there's a group led by Nahar Ruden—they published a series of studies where they found that like a placebo meal that actually reduced satiety compared to an—what the hell is a placebo meal, right? You're probably wondering. But like basically like a kind of an orange slushy yogurt mix that actually was made of artificial sweetener and had very, very low calories compared to like a sludge that actually had carbohydrates—they both outperformed a water-only condition, indicating that it is perception of hunger and those carbohydrate sensors that impact perception of fatigue and some combination might be mediating poor performance and why some people seem to do a lot better with a pre-workout meal or sometimes they can rescue their performance with the intra-workout meal.

So my recommendations there are you don't want to go to training sessions hungry. And if you're not doing continuous or repeated effort—you know, greater work-to-rest ratio, high intensity work in excess of an hour—it doesn't matter what the dose of carbohydrate is. You just want to have a little something something. And it can be even a mouth rinse if it's in the middle of a workout and you don't want to actually consume something. You can just sip on a Gatorade throughout and you would get any potential benefit most likely.

James de Lacey58:07

Interesting, okay. And I've got, before we wrap this up, well I've got one more I guess supplement to throw at you on your list, one of...

The more popular ones that's in all pre-workouts, L-citrulline. That's pretty much the go-to for everything now. And based on what you're saying about beta-alanine, L-citrulline potentially could be tier 2 or tier 1, depending on endurance athletes or not. Does that fit anywhere there for you?

Dr. Eric Helms58:30

Yeah, I would categorize citrulline and citrulline malate as a tier 2 supplement. The data is not necessarily super consistent, but it's actually been shown to increase muscular endurance and in some cases like power and resistance training performance, but also other types of performance. But we need a little more research, but there has been enough research to show a small effect when meta-analyzed. Actually, Dr. Trexler was one of the ones who led that meta-analysis that was published, I think, two years ago now.

The reason why I would sit it in tier 2 is like caffeine, we don't have longitudinal studies on adaptation. So for me to categorize something as tier 1, I need to see it impacting the direct outcome that I care about. So a lot of people, they'll buy a supplement because it supposedly will increase their testosterone levels by like 5%, and there's a big step from does it actually increase testosterone to does that increase in testosterone lead to a change in body composition, performance, or fat loss that I care about.

And 90% of the time, A, it does not even increase testosterone, or you think it does but you've only done one random test and you need like four serial tests in the same conditions because there's a huge amount of biological variability diurnally, meaning across the day, and just day to day within the same person that's impacted by sleep, diet, time of day.

So you need to know is it a real change, for one, and then did that real change actually result in anything? And the answer is probably not, or it's a really substantial impact on testosterone to where you're actually getting suppressed other hormones or endogenous production. So you want to see, not oh, it increased muscle protein synthesis, or oh, I saw it increased EMG, or oh, I saw it decreased RPE, or oh, I saw it increased this hormone or GH or whatever.

I want to see the actual outcome. Did it increase hypertrophy over time? That's the only reason why we want to buy that supplement if we care about hypertrophy. Did it increase strength adaptation over time? That's the only time.

So anything that's on an acute performance, it's probably in my book it's not going to climb out until we know. For citrulline, the reason why it doesn't climb to tier 1 in my book is because we don't have longitudinal data on it. It inconsistently improves short-term performance across a different spectrum. But we really want to make sure we're actually looking at the outcome of interest we care about, not something that might lead to hypertrophy downstream, but an actual increase in hypertrophy that's been measured and demonstrated over time as an example.

James de Lacey1:01:26

Not perfect. Final question from, let's say we'll plug your books at the end too, but he's asking sources of carbs for, and I guess sources of carb supplements, any you recommend?

Dr. Eric Helms1:01:26

Yeah, I don't think most people need to supplement with carbohydrates, to be clear. You really have to fit into that scenario that I was talking about earlier. And then in that case, really any sports drink is perfectly fine. You just want it to be fast digesting, and if you're sweating a lot, then with electrolytes. But ultimately, you're probably not going to be eating in the middle of a workout or anything like that. You want something that's quick digesting.

And if you want to eat a meal pre-workout, you probably want to give yourself at least an hour to digest and you need to consider gut tolerance. And you want something that is relatively low in fiber. And if you meet those requirements, and you also have a moderate protein intake and a low fat intake just so you can digest it more easily, and then just remember that especially for resistance training, the dose doesn't seem to matter.

So getting in 100 grams of carbs is not better than 30, and it might be worse just because you've got 100 grams of carbs and the associated food sitting in your stomach.

So figure out if it's for intermittent training and you just notice a personally better effect from pre-workout meals. Consuming something like a banana and a scoop of whey might just be just as good as a whole bowl of rice, because you're really not dependent upon that energy quickly. It takes a full day, for example, for carbohydrate stores to get topped off, and you're still going to be digesting the carbs you eat two hours before your workout while you're training and hours, hours later.

It is more so just about making yourself not feel full and potentially stabilizing blood glucose. But that's again, and that's not dose dependent. It's just the potential oral cavity sensing of carbohydrate and the beneficial effect of not feeling hungry, because those can both potentially lead to neural mediated reductions in performance.

James de Lacey1:03:19

Perfect. And Eric, to wrap this up, where can people find you? You're writing an updated version of your books, are you?

Dr. Eric Helms1:03:19

That's right. So we'll be releasing the third editions of my books sometime probably end of this year. And they've got a lot of great information on specific to resistance training performance. There's a nutrition and training book. So that's muscleandstrengthpyramid.com if you want to check those out.

And if you want to follow me on other platforms, Helms3DMJ on Instagram, a great place to check out the information. And if you want to stay up to date with the research and read about the stuff as it comes out, and the original place I published the article that has led to me talking about supplements, was in MASS Research Review.

And you can check out massresearchreview.com. And we have a big anniversary sale coming up starting in about a week, and that's, you can get subscriptions at 30% off. And we cover a ton of stuff going back all the way to 2017. You'll get access to seven years of back catalog. You'll never be able to get through it, so yeah.

James de Lacey1:04:15

Nice. Actually, what? He's got a question for you. Do you give out some courses? He's asking, do you have any courses?

Dr. Eric Helms1:04:15

We do, yeah. So if you're interested in learning a lot more about nutrition and training, but it's a little more resistance training, lifting, bodybuilding, powerlifting specific, go to 3dmusclejourney.com, click on Education, and you can see that we have the 3DMJ Vault. And we provide video courses because not everyone likes to learn from reading.

We have courses on nutrition fundamentals for lifters, we have courses on calculating your calories, calculating your macros, bodybuilding program design, training adherence, how to personalize your program so that it's easier to follow. And a lot of other great content like how to track nutrition, to how to train while you have injuries and work around them, and Q&As on hypertrophy, fat loss, muscle gain, etc.

James de Lacey1:05:13

Perfect. Yeah, and if you want a sample of that, if you go 3DMJ on YouTube, I think you guys put up little snippets of some of those course videos.

Dr. Eric Helms1:05:13

Absolutely. YouTube Team3DMJ, we have a lot of samples of those courses, and we have free courses. So go to 3dmjvault.com, and from there you can, yeah, that's a great place. 3dmjvault.com, tons of courses. Take a couple of the free courses, get samples of some of the paid courses, see if it fits what you're looking for. And if you like it, we'd be honored to have you there.

James de Lacey1:05:43

Perfect. I appreciate you coming on, Eric.

Dr. Eric Helms1:05:43

My pleasure, man.