Supplements - What are they and what do they do

By James Kennedy. 

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The global supplement industry was valued at over $160 billion in 2019. The supplement industry largely works by preying on people's insecurities, promising a magic pill solution that will allow them to achieve the photoshopped physiques on the side of the packet. The vast majority of these supplements do not provide any results and can be actively harmful to health and fitness. Some of them, however, have their place.
 In this article, we will review which supplements work, what they do, how to take them and when. This post will be most useful to the committed strength or physique athlete (Powerlifters, Olympic weightlifters, Strongman competitors, Crossfit etc), however the casual gym goer will also benefit by learning when to keep their cash in their pockets. 
 Supplement research is a growing and changing field; as such the way I think about supplements is in a tiered system. Tier 1 supplements have multiple scientific studies proving their efficacy. Tier 2 supplements have some or weak evidence of a performance enhancing effect and no known health risks associated with taking them (for healthy people). Tier 3 supplements are supplements with no evidence of a performance bonus and/or a potential health risk. 
 Whilst this tiered approach to supplementation has helped me understand what is worth my money and what isn’t, they are not fixed. Ongoing research and new studies in these areas can cause supplements to move tiers; however if you’re currently spending a lot of money on tier 2 or 3 supplements it may be worth putting the powder down and spending the money elsewhere. 
 Finally, I will finish this first article by making the key point. Whatever your health, fitness and physique goals the most important factors determining your success, in order, are:
 

1. Training 
   
2. Nutrition
   
3. Recovery 
   
4. Nutrient timing
   
5. Supplementation
   

 Supplements are a distant last despite the marketing hype - if your training, nutrition and recovery are in order you will be over 90% of the way to achieving your goals. Supplements supplement your hard work and dedication - get everything else dialed in first before spending money, time or mental energy on supplements. 


Tier 1 Supplements 
 

1. Creatine 
   

 Creatine is the gold-standard supplement by which all others should be judged. Multiple studies have shown it to be an effective and safe ergogenic aid for lifters across a range of ages, backgrounds and training levels. Creatine supplementation in resistance trained individuals has been shown to lead to strength gains, lean body mass increase, body fat reduction and increased muscular work capacity (i.e. you can do more reps before failure at a given exercise). Outside the gym, creatine benefits brain function and bone and cardiovascular health. If you could only take one supplement for the rest of your training life, creatine should absolutely be your pick. Creatine is a naturally occurring compound most abundant in red meats and fish - supplementing it is especially important for vegan and vegetarian athletes (most creatine supplements are vegan friendly). 
 How does it work
 Creatine is stored in the muscles, where it combines with phosphates to form phosphocreatine.  When muscles perform work they use ATP - adenosine triphosphate - as an energy source. During intense exercise bouts - a set of heavy squats or sprints for example - ATP demand within the muscle can increase over 500 times. The phosphocreatine in the muscle then allows for rapid replenishment of ATP during exercise, allowing the muscle to continue to work at the required intensity which increases the performance of the athlete. Creatine supplementation helps build up a store for replenishing ATP in the muscle, allowing you to push harder.
 How to take it
 When I first began reading about creatine and supplements in the early 2010’s, a lot of old-school bodybuilding types advocated for a loading phase, where for the first week you would take up to 20g a day. This is completely unnecessary. Take 3-5g daily, at any time. I use it in my pre-workout shake, however it can be taken intra or post-workout, or any other time of the day. 
 Combine with
 Creatine can be combined with protein to make a very effective pre or intra-workout meal. It can also be combined with caffeine, however if you take high doses of caffeine and load creatine (again, don’t do this), studies have shown the caffeine blunts the effectiveness of the creatine loading. 
 Potential side effects:
 Creatine is safe to use, however it causes the muscles to retain more fluid. Whilst this makes your muscles look ‘fuller’, it can cause bloating in the first week to ten days even without a loading phase. If the powder is incompletely dissolved, it can also cause gastro-intestinal distress. 
 A quick side note for physique models or bodybuilders prior to a photo shoot or show, do not add in creatine to your diet during the final 2-3 weeks of prep due to this bloating. If you already use creatine, don’t stop in this phase either as it will add to the deflated look some people get when incredibly (sub 5% body fat) lean. 
 Supplement Scam to check:
 Overpriced creatine variations. 
Creatine Monohydrate is all that is needed, creatine citrate or creatine nitrate or creatine ethyl ester and so on are overpriced products with no known advantages over creatine monohydrate. Whilst they have never been shown to outperform creatine, they do outprice it, with creatine monohydrate typically being £5-10 cheaper per unit than the alternatives. Bottom line is, don’t look for a solution to a problem that doesn’t exist, creatine monohydrate is safe, effective and cheap, ignore the fancy alternatives. 
 Bottom Line 
 Buy creatine monohydrate and take 3-5g daily, either pre, post or intra workout. 
 

1. Protein Powders 
   

 Protein powders are technically a food supplement rather than a performance enhancing supplement like creatine. Protein powders are designed to increase the level of protein in your diet and are especially useful for those on restricted calories as a way of keeping dietary protein high to maximise muscle retention whilst losing body fat. 
 How does it work
 Protein provides the building blocks for muscle (amino acids) and the stimulus for muscle growth through muscle protein synthesis (MPS). Protein should make up between 15-35% of a healthy diet depending on the amount and type of activity the individual does. For example, a marathon runner and weightlifter eating the same number of calories need vastly different amounts of protein and carbohydrates due to their different activities (long distance cardio requires higher carbohydrates than weightlifting, but causes much less muscle damage).

As proteins are a source of amino acids for MPS, the type of protein does matter to an extent. Plant based proteins are typically ‘lower quality’ - they contain less amino acids than animal proteins. Whilst this doesn’t mean the gym bros were right to say vegans or vegetarians can’t get jacked, it does mean those following a plant based diet should eat higher levels of protein and supplement with BCAA’s (to be discussed) to make sure they are maximising MPS. In terms of protein powders, vegan athletes should look for protein powders with around a 70:30 blend of pea:rice protein as this gives them a very complete amino acid profile for maximising MPS. 
 A common debate is between two types of milk derived protein: Whey vs Casein. For the amount of coverage this gets, you could be forgiven for thinking it matters. It doesn’t, unless you're trying to sell supplements. 
 Whey protein is a fast digesting protein, advertised as a pre or post workout protein, ideally suited to take advantage of the post-workout ‘anabolic’ window. Casein protein is slow digesting and is advertised as bedtime protein. It digests slowly throughout the night, allowing you to recover more effectively and improve your sleep quality. However, recent studies have shown protein timing doesn’t really matter, as long as you eat enough protein in total throughout the day. The supposed differences between Whey and Casein have not been shown in studies suggesting it doesn’t matter which you use. I have used both, Whey tends to make nicer protein shakes and smoothies than Casein powders. Casein is also slightly more expensive but it is down to personal preference which you use.
 How to take it 
 The data suggests - from both experimental studies and a recent meta-analysis - that MPS stops increasing when protein consumption is around 1.8g/kg of bodyweight per day. For simplicity, rounding up to 2g/kg of bodyweight when setting up your macros is fine, although going over this is probably excessive. If you have a high body fat percentage, it may be worth calculating protein by using 2g/kg of lean body mass (LBM). 
 For those in a large calorie deficit, such as bodybuilders in the final stages of competition prep, there may be a value of increasing protein above these levels. Keeping protein intake high when losing weight is important; it helps you to retain as much muscle as possible and makes you feel satiated (fuller) for longer. This improves your mood, making it more likely that you will achieve your weight loss goals and mean you're more pleasant to be around during a weight loss phase. For the vast majority of people however, 1.8-2g of protein per kg of bodyweight will be enough protein whether they are aiming to build muscle or lose weight.
 Protein intake should be spaced throughout the day to maximise MPS. The post-workout window is not more important than any other time of the day as long as the total amount of protein consumed within the day is high. Studies have shown that eating a mixed meal of protein and carbohydrates during training (a mixed protein and carbohydrate drink) does improve performance, however this is a minor boost vs consuming just protein or carbohydrates around the workout. If you can, a combined protein carbohydrate shake consumed either just before or during your workout is a good idea, however it’s not a deal breaker if you can’t.
 Combine with
 If you are consuming a protein shake as part of your workout routine - whether pre,intra or post-workout - combining it with a carbohydrate powder and creatine is a great idea. A basic recipe is 1 scoop protein powder (~25-30g protein), 1 scoop carbohydrate powder (dextrose or maltodextrin) and 3-5g of creatine. As discussed below, it is always best to buy these ingredients separately and combine them yourself. 
 If you are using protein powders as part of a meal or snack, it makes a great addition to overnight oats, smoothies or just mixed into a bowl of greek yoghurt. 
 Supplement Scam to check 
 Sometimes protein powders are filled with cheap ingredients to claim a higher protein content - a practice known as protein spiking. Protein powders quality (i.e. protein content per gram of powder) is commonly tested by measuring the nitrogen content of protein as a proxy for protein content. Some companies take advantage of this by dumping cheap, nitrogen rich compounds into their proteins which do not help build muscle. This leads to a high nitrogen count and a high apparent protein content despite the product being low quality overall. Thankfully there is a relatively simple check: Leucine and Branched Chain Amino-Acid (BCAA) content. 
 In Whey Protein, 11% should be leucine and 25% should be BCAA. For 25g of whey protein ~6.25g should be BCAA’s and ~2.75g should be Leucine. If the leucine or BCAA content is much higher or lower than this, or are not listed on the list of ingredients, this product may have been spiked and should be avoided. Another red flag is if the protein is cheap - if it seems too good to be true, it probably is. 
 Bottom line
 Protein powder is a useful tool to increase your overall dietary protein content, especially if you’re in a calorie deficit. Try and space your protein throughout the day, with some eaten around the workout and always check for protein powder spiking scams. 
 Tier 2 Supplements 
 Tier 2 supplements are supplements where there is some evidence showing their effectiveness in various situations however there may be a small body of literature, small effect size or a high proportion of non-responders within the studies. None of these supplements are critical to success; if you never take any of them it is highly unlikely you will look back in ten years and regret that decision. 
 

1. Caffeine 
   

 Caffeine supplementation has been shown to have an impact on aerobic endurance, strength endurance and maximal strength and power outcomes. Long term use of caffeine reduces it’s efficacy but due to it’s addictive nature if you stop using it performance dips drastically. The effect of caffeine on performance also varies widely from person to person, both in terms of physical and mental effect. 
 Within the broader health research, habitual caffeine consumption of below 400-600mg of caffeine a day has a positive impact on a range of health outcomes, although consumption in the afternoon to evening can severely impact sleep. For athletes, and all those who wish to perform at their best, this is a large drawback. Caffeine use should be curtailed in the afternoon to early evening to minimise the impacts on sleep and recovery. 
 Bottom Line
 If you are a habitual caffeine user, supplementing with caffeine powders or pre-workouts is not worth it. There are benefits to using caffeine around the workout for both physical and mental reasons - it will benefit your work capacity and your mentality in the gym. If you do decide to use a caffeine powder as a supplement, avoid pre-workouts with a large number of other ingredients as the additional stimulants can accentuate the negative effects of caffeine on sleep and anxiety. The best form of caffeine for a pre-workout is a simple cup of coffee.  
 

1. Beta-Alanine
   

 Beta - Alanine is a modified version of the amino acid alanine. When ingested, alanine acts as an acid buffer in the body, protecting the muscle from exercise induced lactic acid production. This supplement is therefore most useful for athletes who perform a significant amount of work in the alactic - aerobic zone, for example 400 - 1200m runners. It is of limited use for most strength athletes, although crossfit and strongman athletes may find it useful depending on what events they are training or competing in. Studies have also shown that it does increase reps to failure in the 8 to 15 rep range, suggesting that bodybuilders performing higher rep work may also benefit from supplementing with beta-alanine. 
 Similar to creatine, beta-alanine builds up in the body's cells over time so there is no time-dependent or loading phase required with beta-alanine supplementation. 2-5g, taken pre- exercise, is the recommended dosage. A common side effect to be aware of is paresthesia - tingling in the body - which is unsettling but harmless. 
 Bottom Line
 For most gym-goers it is an expensive luxury, however for crossfit athletes, strongmen and bodybuilders doing work in the aerobic-alactic zone it may provide some benefit. 
 

1. Citrulline Malate 
   

 Citrulline Malate or L-Citrulline supplementation is used to increase nitric oxide metabolism. Nitric oxide is a vasodilator, a compound which causes the relaxation of blood vessels and enhances blood flow to the muscle. Nitric oxide supplements theoretically enhance the pump chased by bodybuilders through this mechanism by increasing the blood flow to the muscles. A small body of scientific literature shows that there is a minor performance enhancing effect of supplementation; reducing fatigue and increasing aerobic and muscular endurance. Very few foods have high levels of citrulline, so supplementation is the only way to increase levels of dietary citrulline. Best results are achieved by taking 6-8g of citrulline or l-citrulline 1-2 hours prior to exercise. 
 Citrulline supplementation is beneficial, and there is a growing body of research into its use, short and long-term efficacy, however the long-term effects on health and performance are currently understudied. 
 

1. Nitrate supplements 
   

 Nitric oxide supplements aim to increase blood nitrate levels, with the aim of increasing nitric oxide levels, enhancing blood flow and helping the user achieve a pump. As seen with citrulline malate supplementation, there are ergogenic effects from increasing nitrate levels - mainly in improving strength endurance and work capacity as measured by reps to failure. However, unlike citrulline, it is possible to elevate blood nitrate levels and achieve the ergogenic effect of nitrate supplementation through diet by eating nitrate rich foods such as beetroot, spinach and pomegranates. As the required dose of nitrate can be reached through diet, eating a portion of nitrate rich foods with a meal an hour or two before training will achieve the desired results of the supplementation. For most people, concentrating on eating a healthy diet with a variety of vegetables should be prioritised over nitrate supplementation. 
 Tier 3 Supplements 
 Tier 3 supplements are supplements which are either unproven, unsafe or ineffective. Primarily, the use of these supplements is unlikely to benefit your performance and may have severe short and long-term consequences on your health. 
 

1. Amino Acid Supplementation
   

 Branched Chain Amino Acid’s (BCAA’s) and Essential Amino Acids (EAA) are safe however they are unlikely to provide any benefits for those eating a high protein diet. The theory behind BCAA or EAA supplementation is proven; amino acids, specifically leucine, are needed to stimulate muscle protein synthesis (MPS) which drives muscular hypertrophy in resistance trained individuals. By supplementing with BCAA or EAA between meals, MPS is theoretically maximised. 
 However, as discussed with protein powders, there is no time dependency to MPS if dietary protein levels are high. As amino acids occur naturally within protein, individuals eating a high protein diet, above 1.5g of protein per kg of bodyweight, do not need to supplement with BCAA or EAA. If you are eating a high protein diet there is no need to spend money on BCAA or EAA supplements.
 For the vegan and vegetarian athlete there may be a benefit to amino acid supplementation, as plant based proteins can be lower in amino acid quantity and do not have a complete amino acid profile. If you are using large amounts of vegan protein powder, for example if you are in a large calorie deficit, vegan athletes would benefit by supplementing with BCAA or EAA as it would be challenging to get all amino acids through diet alone. To do this, take 5-10g of BCAA or EAA with each meal dissolved in water (note - you should buy flavoured BCAA or EAA powder as unflavoured powders taste awful). 
 

1. Fat Burners 
   

 Fat burners as a term incorporates a large number of products and combinations of stimulants, supplements and minerals. These products are marketed as a way of speeding up fat loss by increasing resting metabolic rate, suppressing appetite, preventing nutrient absorption or increasing the rate of fatty acid release from cells. The evidence to support these claims is sadly lacking and they commonly contain supplements which are on the World Anti-Doping Agency (WADA) banned list. 
 These products also have a list of short and long term side effects, ranging from the hilarious to the scary. On the hilarious end, some male athletes who use fat burning products report getting erections which last for hours. The slightly more serious side effects include damage to the cardiovascular system, significant sleep disruption, reduced insulin sensitivity (the ability of the body to regulate blood sugar levels), significant gastrointestinal distress by blocking nutrient absorption. They can also cause intense feelings of anxiety and paranoia. 
 Using fat burners should be avoided. If you are going to use them, proceed with extreme caution; the benefits are non-existent, whereas the side effects are real, unpleasant and serious. 
 

1. SARMS
   

 Selective Androgen Receptor Modulators - SARMs - are a legal drug which replicates the effects of steroids with, theoretically, fewer side effects have become increasingly popular in the last few years. SARM’s, and steroids, work by artificially increasing the amount of testosterone in the body to increase strength and muscle hypertrophy gains. The effectiveness of SARM’s is undisputed, they have a similar impact on strength and hypertrophy as steroids. 
 The side effects and long term impact of taking SARM’s on health have not been well studied, but people have reported side effects such as significant reduction in testicle size and impotence due to the body stopping natural testosterone production. Further anecdotal reports of side effects include high blood pressure, tinted vision and skin rashes. Some of these side effects could be due to people being sold steroids instead of SARM’s, highlighting the final risk associated with buying SARMs. Quality control on SARM products is generally low, so often what you order is not what you receive. 
 If you want to use SARMs as they are a legal steroid alternative, that is your choice but treat it like a steroid cycle and take the necessary steps to ensure your health. Get blood work done before and after the SARM’s cycle and the subsequent PCT cycle to keep an eye on your general health and hormone levels. Make sure your diet, training and recovery is dialled in before you start taking SARMs. If you are an inexperienced gym-goer or an athlete who does not compete do not take SARMs and be aware of any products which may contain SARMs as they could cause you severe side effects. 



 Sources 
 https://www.jtsstrength.com/3-great-supplements-for-every-strength-athlete/
https://www.strongerbyscience.com/creatine/#Creatine_and_Caffeine
https://www.strongerbyscience.com/the-three-laws-of-protein/
https://examine.com/supplements/citrulline/#effect-matrix
https://www.strongerbyscience.com/reflecting-on-five-years-studying-protein/
https://www.strongerbyscience.com/nitric-oxide/
https://www.strongerbyscience.com/caffeine/
https://examine.com

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