| Abstract: |
Nutritional supplement use is common among athletes aiming to enhance performance, recovery, and health. However, variable regulatory frameworks and limited safety oversight create risks for inadvertent doping violations. This article provides a global overview of supplement use, relevant authorities, legislation, and safety measures, with a focus on third-party testing (TPT) as a risk-mitigation strategy. Data from six global regions—Africa, Asia, Australia/New Zealand, Europe, Latin America, and North America—were synthesized from peer-reviewed studies, governmental sources, and regional expert contributions. Reported supplement use ranged from 7% to 100% among athletes (variability within regions), with protein powders, vitamins/minerals, creatine, caffeine, and sports drinks being most prevalent. High-risk products (potential anti-doping rule violations), including certain herbal blends, preworkouts, and weight-management supplements, were reported across all regions. While some countries have robust regulatory systems, most lack harmonized or enforceable safety frameworks. TPT programs, which independently verify products for prohibited substances, remain concentrated in the global northwest (Europe, North America, and Australia/New Zealand); awareness and use of TPT certification vary widely, and even in regions with established systems, athlete adherence is inconsistent. Barriers to low-risk supplement use are limited TPT availability, cost, differences in labeling (including language), and cultural factors. Firsthand experiences and perceptions highlight widespread misconceptions about supplement safety and certification. The authors recommend expanded athlete and team-around-the-athlete education, improved global access to TPT low-risk supplements, and policy initiatives to harmonize safety standards. This work emphasizes the need for coordinated international efforts to protect athlete health and integrity while allowing access to evidence-based supplementation. Nutritional supplements are widely used by athletes around the world to support performance, recovery, and health. Commonly used products include protein powders, vitamins and minerals, creatine, caffeine, and carbohydrate-based sports drinks. While many of these can be safe and effective when used appropriately, supplements can also carry risks—especially when products are contaminated with substances banned in sport. Such contamination can lead to unintentional anti-doping rule violations, with potentially serious consequences for athletes' careers. This paper provides a global overview of how athletes use supplements, what types of regulatory systems are in place to ensure their safety, and how programs that independently test supplements—known as third-party testing (TPT)—can help reduce the risk of contamination. The perspective was written up coming from six major world regions: Africa, Asia, Australia/New Zealand, Europe, Latin America, and North America. Information came from scientific studies, official government documents, and expert contributions from each region. Across these regions, supplement use among athletes varies widely—from as low as 7% to nearly 100%—depending on sport, level, and local factors. Basic supplements such as protein powders and multivitamins are commonly used globally, but also higher-risk products such as preworkout formulas, herbal blends, weight-loss products, and proprietary blends are frequently reported by high-level athletes but to a lesser extent. These types of products are of concern because the literature has suggested that they are more likely to be contaminated with banned substances or include ingredients not listed on the label. Unintentional doping violations can result from taking such supplements, highlighting the need for better education and safer options. Many countries have systems in place to regulate supplements, but the strength and enforcement of these systems differ greatly. In Europe, North America, and Australia/New Zealand, there are well-established frameworks to monitor supplement manufacturing and labeling. These regions also have broader access to TPT programs that verify products for prohibited substances. In contrast, Africa, Asia, and Latin America often have less comprehensive regulations and limited access to certified, low-risk supplements. Cost, lack of local testing infrastructure, and language barriers further restrict access to safe products. TPT programs play a crucial role in reducing inadvertent doping risk as a result of supplement use. The programs recommended for athletes test nutritional supplements independently to ensure that they are free from banned substances. Products that pass these tests receive certification marks, helping athletes make safer choices. However, these programs are unevenly distributed worldwide and differ in how they operate. In some cases, athletes can easily check if a product batch is certified by scanning a barcode, while in others, verification requires searching online databases using batch numbers. This lack of consistency can discourage athletes from checking certifications and reduce the impact of these programs. Despite increased awareness in some regions, many athletes and even members of their support teams—such as coaches or nutritionists—remain unaware of which certification programs are trustworthy or how to recognize them. Misunderstandings about supplement safety are common, and in some countries, limited access to certified products has led sports organizations to recommend avoiding supplements altogether. However, this approach can also limit athletes' ability to use evidence-based supplements safely and effectively. Authorities responsible for supplement oversight typically include national food safety agencies or ministries of health. In many countries, supplements are treated under general food laws rather than having their own specific legislation. Although many nations claim to follow international Good Manufacturing Practice (GMP) standards, these are not always applied consistently, especially in lower-resourced settings. Some regions, such as Europe, have developed more harmonized approaches, while others—particularly in Africa and Latin America—still face fragmented or outdated systems. Across all regions, educational efforts about supplement safety exist but vary greatly in reach and quality. In Europe and North America, supplement education is often integrated into anti-doping and sports nutrition programs. In contrast, other regions rely more on regional workshops or outreach efforts that may not reach all athletes. Despite these differences, there is a shared global commitment to improving athlete education and reducing doping risk. Importantly, supplement safety should not be viewed as solely the athlete's responsibility. While anti-doping rules hold athletes accountable for what they consume, ensuring access to low-risk supplements requires cooperation among athletes, coaches, sports organizations, nutrition professionals, and regulators. A shared responsibility approach would better protect athletes from accidental doping. To move forward, several actions are needed: 1. Encourage a "food-first, but not food-only" approach: Athletes should prioritize balanced diets, but when supplements are necessary, they should be used responsibly with guidance from qualified professionals. 2. Expand and harmonize third-party testing: Broader global access to independently tested products is essential, particularly in underresourced regions. Standardizing testing criteria—such as which banned substances are screened and how often batches are tested—would strengthen trust in these systems. 3. Promote education for all stakeholders: Athletes, parents, coaches, and support staff should receive structured education on supplement safety and how to identify certified products. 4. Address behavioral and systemic factors: Beyond education, practical strategies—such as simplifying certification checks and making low-risk products easily available—can help athletes make safer choices. 5. Enhance policy and collaboration: Governments, sports organizations, and industry partners should work toward harmonized safety standards and improved regulation of supplement manufacturing and marketing. In conclusion, this global overview highlights that nutritional supplement use among athletes is widespread but unevenly supported by safety systems and education. While many athletes can access well-regulated products and reliable third-party testing, others—particularly in lower-resourced regions—face greater risks due to limited oversight and availability of certified supplements. Ensuring safe and informed supplement use requires shared responsibility among athletes, support staff, organizations, and regulators. Strengthening education, expanding access to tested products, and aligning global safety standards will be key to protecting athlete health and integrity while supporting fair competition worldwide. [ABSTRACT FROM AUTHOR] |