Nutrition for performance has been a primary concern for athletes due to its purported benefits in supporting physical activity, enhancing sports performance, and facilitating post-exercise recovery (1). Sports nutrition refers to the nutrients found in sports-related foods that enhance physical capabilities (1). Athletes across all levels of performance must ensure that they meet their nutritional requirements in order to complete their training programs and compete to their highest ability. Research has shown that improper or insufficient nutrient intake may have a negative effect on an athlete’s abilities, while good nutrition practices facilitate training adaptations and help to prevent overtraining (2). One way in which athletes attempt to optimize their nutrition is through dietary supplementation (DS), however this may not always be the best option, and one may wish to consider a “food first” (FF) approach before considering supplement use.

Dietary supplementation for performance has been in use by humans for thousands of years. In times of antiquity, athletes and soldiers consumed different parts of animals they thought would provide them with more speed, strength or agility to prepare them for the field or battle (3). Today, as opposed to involving the consumption of specific animal parts, DS is defined as “a food, food component, nutrient, or non-food compound that is purposefully ingested in addition to the habitually consumed diet with the aim of achieving a specific health and/or performance benefit” (4).

The prevalence of DS usage varies in the literature. A review investigating the prevalence of DS use by athletes worldwide found that between 11-100% of athletes use some form of DS (5). A second source suggests that the prevalence of DS use among athletes ranges from 40-70%, depending on the type of sport, training load, level of competition, age and sex (6).

While the use of DS is widespread across various levels of athletic populations, there may be reasons to be selective in their use. Recent studies have shown that the use of DS may come with risks, including inadvertent doping, adoption of doping behaviors (7), false claims of benefits (15), and health risks with improper use (16).

Inadvertent doping is defined as the unintentional use of a prohibited substance, the main causes being negligence and the misuse of DSs (7). This can lead to unintended consequences in the form of anti-doping violations and health risks (8). One of the potential causes of inadvertent doping is contamination with prohibited substances (7). A study by Kozhuharov et. al analyzed 3132 DSs, and found 875 of the supplements contained undeclared substances such as sibutramine, anabolic steroids, hygenamine, and 1,3-dimethylamylamine (9) all of which are restricted or banned (10, 11, 12, 13).

Furthermore, the use of DSs has been cited as a major predictor of doping behaviors (7). Athletes who use DSs have been shown to have a three and a half times more likelihood of doping usage than those who do not use DSs (7). For this reason, some have termed DSs as a gateway to the abuse of prohibited substances (7). The theorized pathway behind this “gateway hypothesis" involves the adoption of a behavior which is considered harmless (in this case, the use of DSs), possibly leading to taking up another habit, which is considered harmful (prohibited substances) (7, 14).

There is also evidence that DS manufacturers make false or misleading claims regarding their products. While the European Food Safety Authority (EFSA) studies the substances added to DSs, as well as their safety, there is a high degree of fraud due to labeling errors, omission of substances or errors in the analysis or declaration of the quantities of substances present in a DS (15). In a study exploring the claims made by sport drink manufacturers, 100 out of 114 claims were shown to suggest an unproven cause and effect, and the authors suggested modifying or removing the claims (15). Other DSs claim to encourage weight loss, increased energy, improved cognitive and physical performance and overall health improvements, however, most claims are unproven and lack scientific backing. In many cases, even those that report having a scientific backing may be based on studies with design or experimental flaws (7).

Dietary supplements may also pose health risks to consumers. Over 20,000 emergency room visits are attributed to adverse effects of DSs each year in the United States. The products with the highest cause for risk in these cases seem to be related to weight loss or increased energy. The risks stated include illness and even death (16).

In the face of the risks proposed from the use of DSs, some have suggested that a food first, or whole foods approach, be considered with regards to sports nutrition. A food first approach to sport nutrition has been defined as “where practically possible, nutrient provision should come from whole foods and drinks rather than from isolated food components or dietary supplements” (17). Before considering supplement use, one should ensure they are already practicing proper dietary and eating habits, combined with proper sleeping and training routines (8). Athletes may not be able to obtain the effects suggested by DSs without having these basic factors controlled, thereby undercutting their usefulness (8).

Various authors suggest reasons to consider using a food first approach (8, 17, 18). A study by Yasuda et. al suggests four such reasons (8):

1. Meals are useful for obtaining macro- and micronutrients, fiber, polyphenols and other active substances
2. Meals consisting of foods as opposed to supplements may improve psychological status. This is likely due to the fact that increased meal quality has been reported to improve depression and anxiety
3. The consumption of foods that require mastication may have a positive effect on cognitive functioning and gut microbiome, especially in older populations
4. A food-first approach is less risky than the consumption of supplements for anti-doping violations

A second article by Close et. al (17) echoes the prior statements in suggesting that athlete’s nutrition programs should prioritize food before supplements. Whole food sources offer energy and macronutrients, as well as a range of micronutrients, polyphenols, fiber, and other bioactive compounds. Consuming nutrients using a FF approach may also have a positive effect on inflammation, immune tolerance and neuroprotection. The National Athletic Trainer’s Association also suggests using a FF approach because nutrition in the form of whole foods contain a greater nutritional content than their pill, or powdered counterparts. Additionally, the vitamins and minerals in foods are typically better absorbed than their supplement counterparts (18).

The FF approach has even been suggested for elite athletes. A study produced by the Union of European Football Associations Expert Group promotes a “food first philosophy”, emphasizing food over supplements to meet nutritional requirements (19). The Japanese high performance sport center, who caters to the likes of Olympic and Paralympic athletes, has also suggested the use of a “meal first” approach for athletes, before considering the use of supplements (8).

While DS use is prevalent among many athletes, there may be drawbacks, including inadvertent doping, adoption of doping behaviors (7), false claims of benefits (15), and health risks with improper use (16).While supplement use most definitely has its place in sport nutrition, athletes may wish to consider a FF approach before adding supplements to their dietary regimens. The benefits of a FF approach include improved nutrient profiles, decreased risk of doping related allegations and behaviors and increased nutrient absorption, as well as being suitable for use by elite athletes (6, 17). Using this information, athletes and sports nutrition professionals will be best equipped to create nutrition programs that satisfy an athlete’s needs and promote peak performance.