24 min read
Do you ever look at the back of your supplement label and wonder, “What the hell am I taking?”
And with strange, new extracts discovered and new drugs created regularly, it can feel like the wild west out there.
It can be even more confusing when these supplements are extracts from benign-sounding plants, like St. John’s wort or kava root. Still others have names hidden behind snore-inducing acronyms like SARMs.
Below is a list of 12 common supplements or ingredients that athletes should avoid taking:
Scroll to find out why each one made this list.
Dimethylamylamine, or 1,3-DMAA, is a stimulant with a chemical composition similar to the nasal decongestant ephedrine and the stimulant adrenaline.
Around the 1940s, DMAA was used as a nasal decongestant.
Today, it’s used for increased attention, weight loss, bodybuilding, and improved athletic performance.
It has even hit New Zealand’s party scene, known as “smileys.”
The company that sold over $230 million worth of DMAA supplements, USP Labs, admitted to a scheme to fraudulently sell these supplements as geranium products. 
DMAA is often touted as an extract from the plant geranium, but according to laboratory analysis, that’s BS. While trace amounts of DMAA have been found in geraniums (in a study funded by USP Labs) , most experts agree that DMAA is likely made synthetically in a laboratory. 
DMAA has been banned or made illegal by the following governments or agencies:
Although DMAA isn’t widely used in supplements after being banned by the FDA, as of 2019, it’s still available. And that means you still have to watch out for it. And like any illegal supplement, it has plenty of other names it’s sold under.
DMAA (or a similar compound) could be listed as:
DMAA causes an uptick in energy, similar to caffeine.
Many athletes take DMAA to improve performance. Like any stimulant, DMAA’s ability to increase attention and energy levels are its most attractive qualities.
The use of DMAA has been linked to several reports of serious, life-threatening side effects such as liver damage  and has even been linked to death. 
Claire Squires was a 30-year-old athlete who dropped dead during the London Marathon in 2013. Why would a healthy, young marathon runner inexplicably die during a race? According to the BBC, “The coroner said she died of cardiac failure caused by extreme exertion, complicated by DMAA toxicity.” 
According to the FDA, “[DMAA] is known to narrow the blood vessels and arteries, which can elevate blood pressure and may lead to cardiovascular events ranging from shortness of breath and tightening in the chest to heart attack.” 
It appears that DMAA is particularly harmful as a sports supplement in that extreme physical exertion makes the negative effects of DMAA even more pronounced.
This claim is supported in that in most cases of death or illness involving DMAA, users were in a high intensity situation, including endurance running, military training, and late night partying.  
Not only does DMAA seem particularly dangerous when combined with exercise, but also when combined with other stimulants such as caffeine and depressants like alcohol.
While one study found no negative impact of DMAA and caffeine ingestion , another study found that DMAA and caffeine significantly increased blood pressure in healthy men and women. .
And while there have been a few good studies examining DMAA dosing, perhaps the most compelling reason to avoid DMAA is lack of research. There may be a safe dosage , but at this time, there is not enough research to back that claim.
Many people look for alternatives to caffeine because for some people, over time caffeine can become less effective. Your body is always trying to maintain homeostasis.
When you take a stimulant, your body produces chemicals that lessen the effect of that stimulant. In practical terms, that means that the moment you even smell your morning coffee your body is already producing the necessary chemicals to reduce the effects.
How can you fight this natural response? Switch up your routine.
Changing the time of day or the medium by which you consume caffeine can be as effective as increasing the dosage AND it’s much, much safer than considering stimulants like DMAA.
MORE RESEARCH NEEDED
Geranium supplements appear to be a marketing friendly way of saying DMAA or MHA products.
Unlike DMAA products, geranium products are not illegal and are not banned by the FDA. But here’s the catch: most experts agree that the idea that a company could afford to extract a meaningful amount of MHA from a geranium plant is laughable. One expert states that
“A Chinese paper (Ping et al 1996) claims that MHA constitutes 0.66-1.0% of (presumably Chinese) geranium oil, though amines have never previously been reported in any essential oil.
Volatile amines do exist, but their chemical structure makes occurrence in an essential oil extremely unlikely. Even if the MHA was being extracted from geranium oil, at current wholesale prices of the oil, and assuming a 1% concentration, the cost of the extracted MHA would be about $20 per gram.
Then add the cost of extraction, product manufacture, plus distributor and retail mark-ups. Legally, “geranium oil extract” is not a banned substance, but this is looking like a very grey area.” 
Emphasis not by author.
So while geranium oils and extracts aren’t currently banned by the FDA, supplements claiming that they contain geranium extract are either making it synthetically in a lab or are including such a small dose that efficacy comes into question.
Bottom line? You might want to pass up products that list geranium in any form.
It’s also worth noting that geranium is a popular ingredient in sports drinks, as well as the supplement industry.
For more on side effects, interactions with other compounds, and alternatives, see: DMAA.
Kava, kava kava, or kava root is an herb found in the southern pacific islands. It’s traditionally brewed into a ceremonial beverage and originates from the islands around Fiji and mainland Australia. It has a long history of being used safely. 
Kava is made of six bioactive components called kavalactones.
Kava has properties that give it a hypnotic and psychotropic effect, giving it a high likelihood of abuse.
Randomized, placebo-controlled trials show kava to be very effective at reducing anxiety.
One study of 101 patients suffering from non-psychotic anxiety were studied in a 25 week trial using WS 1490, an extract of kava. The study notes that “adverse events were rare” and suggested kava extract as an alternative treatment for anxiety. 
It also appears that kava increases a feeling of well being in patients. That same study suggested kava could be an alternative to antidepressants. Another study found an increase in “cheerfulness.” 
The answer isn’t straightforward. Pacific Islanders have been safely drinking brewed kava roots for a very long time (some estimate 3,000 years), which is certainly strong evidence to suggest kava is relatively safe.
User reports suggest kava is a healthier social alternative to alcohol. What’s more, kava does appear to be a promising alternative to antidepressants and anxiety medication.
Despite potential benefits, kava has been banned in many countries.
Kava has been banned or flagged by the following governments or agencies:
Kava and your liver
So why did all of these countries ban the newest alternative to anxiety meds?
There is compelling evidence that suggests kava is a hepatotoxin, meaning it’s toxic to your liver.
The FDA issued an advisory on kava-containing dietary supplements in 2002, citing the “potential risk of severe liver injury.” 
In 2001, the FDA claimed kava was related to 26 cases of liver toxicity. However, more research is needed.
Animal studies do not appear to show a relationship between kava and liver toxicity, and all current human trials show that kava appears to be safe at a dose around 200-300mg.
Studies in humans that use way above the recommended dose of kava show increased liver enzymes. Chronic use is also linked to a nasty skin rash. More research is needed on how kava interacts with other drugs.
It appears that short-term use of the recommended dose may be safe, but its use is still not advised by the FDA.
Kava and your supplier
Whether or not kava is safe may depend on how it’s prepared. For example, in 2007, a safety panel of the World Health Organization (WHO) met to discuss whether kava was linked with 7 deaths and 14 liver transplants in Europe.
The panel suggested that liver toxicity may be linked to formulas that use the entire kava plant, instead of just the roots (which is traditionally, the part of the plant that is brewed).
But here’s the kicker: The FDA isn’t monitoring how kava products are prepared and dosed, so it is difficult to know what you’re getting.
Until more research is done on kava, and unless you source kava from a trusted supplier, it may be best to leave this one alone for now.
Kava could be listed as:
Little is known about how kava reacts with other drugs or medications. However, because of its hepatotoxic properties, it may be wise to avoid taking kava with other liver toxins, such as alcohol, or other supplements like aloe vera, black cohosh, cascara, chaparral, comfrey, or ephedra. 
St. John’s wort is a shrub native to Europe. While it contains a few active compounds, the one generally discussed with regard to supplements is hyperforin.
Hyperforin is often used to treat depression and symptoms of menopause. 
A meta-analysis of 23 randomized trials including 1757 outpatients investigated the effect of St. John’s wort on mild or moderately severe depressive disorders.
Researchers concluded that St. John’s wort is more effective than a placebo at treating mild and moderate depression. However, researchers also note that more evidence is needed for long-term effects. Whether St. John’s wort could be more effective with fewer side effects than traditional anti-depression medication isn’t known. 
St. John's wort is generally considered safe when used orally in appropriate doses. However, According to the Mayo Clinic, St. John’s wort can cause:
Do not take St. John’s wort if you take prescription medication
While St. John’s wort is considered safe when taken alone and at the appropriate dose, it appears on this list because it has adverse interactions with a bunchof pharmaceuticals. According to the Mayo Clinic, St. John’s wort reduces the effectiveness of many prescription drugs. Below are a few:
DHEA is a naturally occurring prohormone, meaning it increases the production of hormones like testosterone and estrogen.
Testosterone is known to improve muscle strength and enhance athletic performance, (along with a host of awful side effects). As you age, your levels of DHEA decrease. 
Synthetic DHEA is available and is often marketed as an anti-aging supplement.
Unless you’re a postmenopausal woman, you likely shouldn’t supplement with DHEA. DHEA may cause
And men can experience
DHEA may interact with antipsychotics like clozapine, seizure medication, estrogen, testosterone, and antidepressants. 
Selective androgen receptor modulators (SARMs) are a type of drug that is chemically similar to anabolic steroids.
SARMs are synthetic hormones that look and act like testosterone.
SARMs were invented to promote muscle growth and function and bone health without adversely affecting the prostate and cardiovascular system.  
Like steroids, SARMs promote muscle growth and weight loss, but to a lesser degree.
That isn’t to say they aren’t effective. A quick google image search of SARMs will bring up tons of shirtless bros showing off their mad gainzzzz.
Likely, at the expense of their testicles...but we’ll talk about that later. Research does show that SRAMs are effective at increasing lean muscle mass. 
There are all kinds of SARMs on the market, and some are stronger (with increased side effects) than others. These include
As of 2019, it’s legal to buy SARMs, although they are technically research drugs, and should not be marketed as dietary supplements.
SARMs mimic hormones in much the same way as anabolic steroids.
The intersection between steroids, hormones, and their impact on muscle growth is fascinating, albeit a little complex.
Here’s the breakdown.
Hormones are often depicted as chemical messengers that are dispatched with a set of instructions to bring to receptors on specific cells. Or, you can think of the hormone as a key and the receptor as the lock. Hormones control some of the most complex processes in your body, like growth, metabolism, and fertility.
Testosterone is a hormone that is most responsible for male sex characteristics, including muscle growth, male pattern balding, a low voice, etc. Anabolic steroids are chemically similar to testosterone, and therefore bind to testosterone receptors on muscle tissue. 
When athletes use steroids, they increase their testosterone levels by 10-100 times the normal level.  All those chemical receptors are flooded, and increased muscle appears.
However, testosterone is responsible for a lot more than just muscle growth, and steroids bind with more than just muscle cell receptors. That helps explain why steroid use, in both men and women, induces balding, changes sex organs, weakens tendons, raises cholesterol, and increases facial and body hair.
In women, steroid use can lead to an increase in miscarriages and even infertility. And among the host of side effects from steroids is a decrease in natural testosterone production. It’s a complex system.
Because of all these horrible and sometimes irreversible side effects, there is a clear need for drug companies to develop a steroid alternative for people suffering from age and disease-related muscle loss. 
Theoretically, SARMs mostly target receptors in muscle and fat cells and are supposed to ignore receptors in the prostate, liver, and brain. Theoretically, they aren’t supposed to break down into molecules that cause unwanted side effects.
While SARMs do appear to have fewer side effects than steroids, that doesn’t mean it’s time to start popping a bunch of unregulated pills.
Actually, SARMs are probably the most dangerous supplement on this list.
Claiming that SARMs are a safer alternative to steroids is like saying driving drunk is a safer alternative to driving with your eyes closed. Just because something is less stupid doesn’t mean it isn’t stupid.
In 2017, the FDA released a brief warning about potential dangers with SARMs. In the report, the FDA states:
“We are extremely concerned about unscrupulous companies marketing body-building products with potentially dangerous ingredients. Body-building products that contain selective androgen receptor modulators, or SARMs, have not been approved by the FDA and are associated with serious safety concerns, including the potential to increase the risk of heart attack or stroke and life-threatening reactions like liver damage.” 
Emphasis not by author
According to the FDA, SARMs can cause
Proponents of SARMs claim that these drugs won’t affect your natural production of testosterone. Studies show that this isn’t the case.
One study found that SARMs reduces testosterone production by 55%! 
And while the side effects of SARM appear to be minimal in small doses between 1-3 mg, bodybuilders are taking upward of 20 mg. 
And by the way, because anabolic steroids have greater side effects in women, the same may be true for SARMs.
Animal studies on the SARM cardarine were canceled because the drug caused cancerous growth in mice. While this was at a pretty high dose per body weight, it’s clear that early animal trials suggest SARMs might be carcinogens. 
Many proponents of SARMs cite two studies in their argument that SARMs are safe. But when you take a closer look at the studies, the only thing they prove is that more research is needed on SARMs at larger doses.
By the way, one of those studies was performed by GTx, Inc., a company that produces and sells SARMs. While this doesn’t mean the study is bogus, there is a clear conflict of interest.
GTx Inc.’s study saw no side effects (other than decreased natural testosterone production) at a dose of a mere 3 mg.  A similar study from Boston University saw little side effects at a dose no greater than 1 mg. 
The researchers in both studies conclude that at a low dose, SARMs could be a safer alternative for patients suffering from age or disease-related muscle-wasting conditions.
They do not say that SARMs are safe at the dose athletes are taking them, which according to forums, appears to be around 10-20 mg, which is tenfold the dosage studied.
There are three supplements every endurance athlete should take every day to stay strong. These supplements are safe and they won’t cause cancer, gynecomastia (moobs), testicular shrinkage, clitoral enlargement, or infertility.
Higenamine is a chemical found in plants, such as aconite, asarum, lotus, Lamarck’s bedstraw, and sacred bamboo. It’s also found in pre-workout supplements and weight loss supplements, despite appearing on the FDA advisory list.  
Higenamine could be listed as:
Higenamine is on the World Anti-Doping Agency (WADA) 2019 prohibited list. 
Higenamine works like a stimulant, and like most stimulants, it's often used to increase weight loss and improve athletic performance. And like most stimulants, it might cause or worsen heart arrhythmia. 
Higenamine also appears to have anti-asthmatic properties. 
Higenamine is a stimulant, and therefore may share the risks of other stimulants, such as the increased risk of arrhythmia, sleep problems, decreased appetite, increased blood pressure, and headaches.
However, the major reason higenamine is dangerous is that we don’t know much about it. Limited research exists on higenamine.
We know that it didn’t kill any rabbits at 50mg, but we’re lacking human studies. Furthermore, no long term studies have been conducted. 
Because higenamine is a stimulant, athletes with heart conditions should not take higenamine.
There is little research on higenamine that we are unaware of higenamine interactions with other drugs. Because higenamine is a beta-2 adrenergic agonist, you may choose not to take it with similar drugs, such as albuterol or ephedrine.
It’s already been mentioned, but caffeine is safe, reliable, and backed by volumes of good research.
Thousands of published research articles demonstrate thatcaffeine can improve time trial performance, decrease time to fatigue, and make endurance exercise seem easier.
Caffeine is arguably one of the best supplements for endurance athletes.
Octodrine is the trade name for Dimethylhexylamine (DMHA), a central nervous stimulant that increases the uptake of dopamine and noradrenaline.
It was originally developed as a nasal decongestant, but has recently resurfaced as a fat burning supplement, despite the FDA advising that it is not a dietary supplement. 
DMHA is similar in structure to DMAA, and although it’s been marketed as a safer alternative to DMAA, there is no strong evidence to back up this claim.
DMHA could appear as
Octodrine is a stimulant and is chemically similar to DMAA and decongestants like pseudoephedrine and ephedrine.
It is often marketed as a fat burner or pre-workout. Like most stimulants, it reduces appetite, increases energy and focus, and reduces perceived fatigue.
A 2018 study of online resources, such as websites and drug forums, looked for reported side effects of DMHA.
They consistently found reports of hypertension, dyspnoea (difficulty breathing) and hyperthermia. 
And like many supplements on this list, perhaps the biggest reason to avoid DMHA is that there is hardly any research available on the stimulant. We simply don’t know what the long term effects or drug interactions may be.
Ephedra is an herb used to make medicine. Ephedrine is one of the four active components of the plant. 
Ephedrine is able to induce fat loss via increasing the amount of fat available for fuel as well as by increasing heat expenditure. It has been implicated in increasing the metabolic rate by up to 5%. 
In clinical trials, ephedrine proved to be a reliable fat burner, especially paired with caffeine.
In a 6-month, randomized, double blind study of 167 participants, reachers saw substantial fat loss at a dose of 90 mg ephedrine taken with 192 mg of caffeine, taken daily. The ephedrine/caffeine group lost 5.6 kg, while the placebo lost 2.6 kg. 
Other studies suggest that ephedrine and caffeine could support long term weight loss.  
In December 2003, the U.S. Food and Drug Administration announced it was banning the sale of products containing ephedra.
After investigating over 16,000 reports of negative health effects from ephedra, the FDA blamed 155 deaths on the stimulant.  
Taking ephedra or ephedrine with drugs that increase heart rate could induce arrhythmia.
Bitter orange is like ephedrine lite.
Let’s back up.
Bitter Orange is a tree native to Asia that’s used to make traditional medicine.
It’s often used for weight loss, upset stomach, and exercise performance, but so far, research only supports its effectiveness as a topical treatment.
Bitter Orange oil, when applied to the skin, might help treat fungal skin infections like ringworm, jock itch, and athlete's foot. 
In foods, bitter orange is used in marmalades and liqueurs such as Triple Sec, Grand Marnier, Cointreau, and Curacao. 
Bitter orange may be labeled as
Bitter orange contains an active ingredient called synephrine that is similar to ephedra (active ingredient: ephedrine), and like ephedrine, bitter orange is a stimulant. Although, bitter orange is a much milder stimulant than ephedrine. 
Bitter orange has been linked to increased systolic and diastolic blood pressure in animal studies , although it doesn’t appear to raise blood pressure.
Bitter orange definitely isn’t the most dangerous supplement on this list, but you may consider a safer alternative. Especially because it doesn’t appear that bitter orange has meaningful impact on athletic performance.
Bitter orange (synephrine) is also considered a banned substance by the National Collegiate Athletic Association (NCAA).
We don’t know enough about bitter orange to know if it has any adverse reactions with other drugs.
Arnica is a topical, homeopathic remedy for a host of ailments, including arthritis symptoms, bruising, and sore throat.
Arnica has also been used to reduce swelling, decrease pain, and act as an antibiotic, but research supporting these uses is limited.
However, what’s disconcerting is arnica has recently shown up as an oral supplement.
This is a problem because arnica is toxic to your liver.
And while in the US you can find trace amounts in food, arnica has been banned in Canada.
As a topical treatment
Studies on its efficacy for treating arthritis symptoms topically have been positive.
Research shows using an arnica gel product twice daily for 3 weeks reduces pain and stiffness in people with osteoarthritis in the hand and knee.  
Arnica appears to be safe when used topically.
As an oral supplement and in a dose larger than what is found in foods, arnica could be dangerous.
Arnica is poisonous and has caused death.
In one report outlined in the Los Angeles Times, a plastic surgeon recommends arnica to a patient, who then recommends it to her mother.
She writes, “On the way home, I made a beeline for the local health food store to pick up a bottle of Arnica montana...Four days later, my mom called again. She was having abdominal pain, cramps and nausea.”
Her mother survived, but the author warns, even in homeopathic doses, arnica can have devastating effects.
Oral administration of arnica could cause:
Arnica may interact with painkillers and blood thinners.
Phenibut is a neuropsychotropic drug that was discovered in Russia in the 1960s.  Basically, it makes you feel good and can improve cognition.
Phenibut is a chemical similar to a brain chemical called gamma-aminobutyric acid (GABA). It is used as a recreational drug, medicine, and as a health supplement.
Phenibut is sold online as a supplement and nootropic. Phenibut has been used recreationally and can produce euphoria as well as addiction, dependence, and withdrawal. 
Phenibut is similar to the brain chemical called gamma-aminobutyric acid (GABA), which is a complicated way of saying, “the stuff makes ya feel good.” Because phenibut acts like GABA, it can boost dopamine levels.
Anytime a drug increases dopamine levels, there is a use for it in treating depression and anxiety. In Russia, it’s used to treat PTSD, depression, insomnia, low libido, vertigo, alcohol withdrawal, and anxiety. 
Of course, anytime a drug increases dopamine levels, there is a risk of abuse.
Phenibut is a popular recreational drug in Europe and the US. And according to Reddit, this stuff can get you really high. In this article, one user describes phenibut this way: “I’ve taken 1 gram once a week for six years and still enjoy that moment when I wake up, open my eyes and my world has changed for the better.”
Before you go searching for this stuff on the internet, you should consider that it’s illegal in the US, most of Europe, and Australia.
Phenibut has been banned or made illegal by the following governments or agencies:
It’s hard to find research on phenibut. And as one expert psychologist and pharmacological epidemiologist, Larissa Maier points out, “Few of these effects have been properly investigated through research, she says, and data on phenibut as a substance for cognitive and/or mood enhancement is sorely lacking.
The scant research that does exist is in German or Russian, and seems to be predominantly concerning animal trials, not human ones, so no one’s really sure what phenibut’s risks or long-term effects are.” 
While there isn’t much research available on phenibut, there are troublesome case studies. For example, some blame a mass overdose of seven college students. 
Phenibut’s side effects appear to be:
And as one journalist points out...sharting. 
But what is most disturbing about phenibut is withdrawal. For those using phenibut as an antidepressant or antianxiety medication, getting off the drug can cause intense rebound symptoms, like
And while there are reports of people using the stuff without any dependance, there are just as many reports of it being an intensely addictive substance.
Phenibut could be listed as:
While little is known about how phenibut interacts with other drugs, it is likely unsafe to take with anxiety, depression, or antipsychotic medication.
Matt Mosman (MS, CISSN, CSCS) is a research scientist, endurance athlete, and the founder and Chief Endurance Officer at EndurElite. Matt holds his B.S. in Exercise Science from Creighton University and his M.S. in Exercise Physiology from the University of California. Matt and his family reside in Spearfish South Dakota, where they enjoy running, mountain biking, camping, and all the outdoor adventures Spearfish has to offer.
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St. John’s wort
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Ephedra and ephedrine
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Bitter Orange and Synephrine
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