Table 1: Difference between drugs and dietary supplements

Objectives	Drugs	Dietary Supplement
Product contains	Contain chemical substances to treat or prevent any illness or disease.	Contain mineral, vitamin, herb or other botanical as well as amino acids.
Regulatory bodies	A clinical trial must ensure safety and efficacy. Regulatory bodies will review and provide the approval to manufacture.	Regulatory bodies cannot review the product, will analyze after post-marketing or consumer uses.
Manufacturing process	Following the standard guidelines and provide detailed labeling. (Ingredients, directions, route, causes, dose, use, and precautions)	Not having proper instructions, there are high chances of contaminations while manufacturing and poor labeling practices.
Available dosage forms	Available all types of dosage forms. Example: Oral, Parenteral, Topical, and Suppositories	Available only on oral dosage forms. Example: Tablet, Powder, and Liquid
Post-Market analysis	In case of any adverse effect observed, regulatory bodies will discover the product immediately.	Comparatively, product discovering will take more time than drugs.
Product recall process	Based on the complaint product will recall. Class I Drugs within 24 hours- 72 hours, Class II and III Drugs Max of 10 and 30Days.	Comparatively will take more time than drugs
Product safety	Safety and efficacy its must to enter the market (Included OTC drugs and with prescription drugs)	Without proven of safety and efficiency, the product will reach directly to consumers

In Sports, nutritional supplements products are primarily formulated and aimed at athletes to boost their nutritional intake, performance, and muscle mass (9). Nutrition supplement classification described in Figure 1.

Figure 1: Nutritional supplements classifications

MACRO-NUTRITION:

Each of the macronutrients needed in relatively large amounts has unique properties that affect health, but all of them are sources of energy. Macronutrients offer our body with calories, i.e., energy plus components for cell growth, overall repair, and immune function (10). On average, fats contain nine calories per gram, and carbohydrate plus proteins enclose four calories per gram (11). The United States dietary guidelines 2015-2020 suggested attaining ten to thirty-five percent of calorie needs from proteins, forty-five to sixty percent of calorie needs from carbohydrates, and twenty to thirty-five percent of energy needs from fats (11).

Carbohydrate:

Carbohydrate and fat are the two essential sources of fuel oxidized by skeletal muscles during prolonged, endurance-type exercise. The relative involvement of these fuels mainly depends on the intensity and period throughout the practice, as well as the athletes training status (12). The need for carbohydrates amongst athletes is of outmost significance. High carbohydrate dinner meals consumption at night before sports help to increase glycogen muscle reserves. In contrast, gels and sports drinks help power the working muscle as well as control blood glucose levels during practice or competition. Carbohydrate is invaluable for the regeneration of glycogen reserves following exercise or competition (13). More carbohydrates amplify both stamina as well as high-intensity intermediate routine caused by the amassing of carbohydrates in the liver and muscles in the form of glycogen. Athletes needs to refill their body's carbohydrate stores, mainly during the phase of intense working out or competition (14). With moderate or high-intensity exercise, carbohydrates are the primary energy molecule, and the depletion of glycogen is an important limiting factor. If the objective is to succeed throughout the practice session or during the game, it is recommended that optimal levels of carbohydrate given before and after training (15). Carbohydrates usually derived from natural food products such as vegetables, grains, nuts, and milk products are sugars and starch, including fructose, glucose, sucrose, and lactose. Carbohydrate supplements areavailable in the form of sports bars, shakes, and gels (13). The United States Dietary Guidelines 2015-2020 suggest that 45 to 65 % of carbohydrate energy needs to be produced, and a maximum of 10 percent will come from simple carbohydrates, that is, glucose and simple sugars (11).

Protein:

The involvement of either an amino or amine component differentiates proteins from carbohydrates and fats in a structural way. Proteins are common in the human body, and within our biochemistry, they are called action molecules. Studies have shown that nine essential amino acids cannotbe produced in an endogenous manner, and adequate quantities must be obtained in the food (16). Protein supplements have been suggested for sportspersons to muscle mass along with boost nitrogen maintenance, avoid protein breakdown throughoutthe sustainedworkout, encourage regeneration ofmyogliogene after increased exercise, and prevent the exercise. It is believed amino acids improve efficiency in many ways, by the secretion of anabolic hormones, for example, modifying the fuel intake during the workout, avoiding the harmful properties of heavy exercise and preventing depression (17). Evidence suggests that the anabolic impact of exercise decrease with rising time during recovery. As such, consumption of protein within 0–4h of exercise would be optimal for improving the synergistic impact of diet and exercise (18). Intake of protein needed to assist in metabolic adaptation, repairing, renovating, and generally ranges from 1.2 g / kg/day to 2.0 g / kg/day. High consumption can be seen across rigorous training or even when caloric intakes are limited for short periods (16).

Fat:

Dietary fat is an integral part of an athlete diet, supplying essential fatty acids, and improving fat-soluble vitamin absorption. Dietary fat is also necessary to ensure sufficient caloric intake to meet the increase in physical activity intensity (19). Diets high in carbohydrates (60 to 70 percent) and diets low in fat (10 to 15 percent) increases tolerance, and high-fat foods (60 percent) increases efficiency. Athletes on a high-carbohydrate (low-fat) diet may not consume as many calories as they consume and may not reach adenosine-adenosine levels in iron and zinc (20).

MICRO-NUTRITION:

Micronutrients include vitamins and minerals. These are important for several essential functions in the body and have to be consumed by food, andthe body cannot produce it. The United States dietary guidelines 2015-2020 suggested the daily nutritional goal of vitamins and minerals,as discussed in Table 2.

Table 2: Daily nutritional goal of Micro-Nutrients (11)

Micro-Nutrition	Child (Age 1- 3)	Female (Age 19- 30)	Male (Age 19- 30)
Vitamin A (mg)	300	700	900
Vitamin D (IU)	600	600	600
Vitamin E (mg)	6	15	15
Vitamin K (mcg)	30	90	120
Vitamin B6 (mg)	0.5	1.3	1.3
Vitamin B12 (mcg)	0.9	2.4	2.4
Vitamin C (mg)	15	75	90
Iron (mg)	7	18	8
Calcium (mg)	700	1000	1000
Copper (mcg)	340	900	900
Sodium (mg)	1500	2300	2300
Zinc (mg)	3	8	11

Vitamins:

Vitamins are macrobiotic amalgams, which are needed to support a healthy life in a minute amount. There are 13 known vitamins, of which four are fat-soluble, vitamin D, K, E, A and vitamin C and B are water-soluble. The fat-soluble vitamins are present in liver and body fatty tissues. They can settle in the body for a couple of days, at the time, which can even settle up to a couple of months. The water-soluble vitamins are not readily retained in the body and are flushed out with urine when overly ingested. Vitamin D is an active character in the muscle function, protein synthesis, immune function, cell growth, regulation of skeletal muscles, and also inflammatory response (21). Low levels of vitamin D can affect the health plus working outs of athletes. Studies have revealed that a few athletes are at threat for optimal vitamin D status that has led to stress fractures, serious illness, and poor muscle function (22).Vitamin D deficit is widespread amongst athletes (23).

Vitamin B deficiency can affect equally anaerobic as well as aerobic exercise, it has not publicized to get better the performance of generally healthy people. Vitamin B12, B6, and B1 affect serotonin release, an essential neurotransmitter involved in relaxation (24).

Vitamin C is an integral part of the diet, and exercise and can reduce the harmful effects of active oxygen species, including muscle damage, immune deficiency, and fatigue (25). Vitamin C supplements provide better performance, which involves the physical activity of people with vitamin C deficiency (26).

Vitamin E amplify oxygen consumption during training. Vitamin E acts as an anti-oxidant, especially in the position of the muscles and membranes of red blood cells. Anti-oxidant supplements might suggest reducing the effects of anti-oxidant stress on those who exercise regularly and severely (24,27).

Minerals:

Hundreds of biological processes include minerals and trace elements as micronutrients (28). The deficiency of iron is also widespread in athletes. Iron deficiency influence physical activities and must be taken care of. The primary system heading to iron deficiency are augmented iron requirement, increased iron loss, and inhibition of iron absorption caused by liver rashes. Iron deficiency is common and associated in sports, as all conditions of iron deficit may impinge on physical activities (29). Iron is an important constituent of transporting the oxygen along with the manufacturing of energy in human beings. For this reason, the essential micronutrient for athletes, especially female athletes who are taking part in fortitude sport, are at augmented jeopardy for iron deficit during menopause (30).

Calcium intake is an important factor in improving bone health and preventing osteoporosis. In addition to preventing osteoporosis, athletes should consider conditions such as bodybuilding related to bone health, loss of calcium from sweating, and sports trinity (31).However, it is fundamental in the contraction of muscle, functioning of the nervous system, hormonal secretion, thrombosis, and maintain blood pressure. It also contributes to the normal functioning of the brain and helps maintain an average heart rate (32).

Caffeine is useful for long-term high-intensity training (counting sports by teams such as football, field hockey, and rowing), however, performance improvement might be limited to athletes. Caffeine is an excellent ergogenic aid for long-term tolerance and has proven to be very useful in improving the efficiency of the test time. Caffeine effectively increases the effectiveness of various types when taken in small and reasonable amounts, such as 3 to 6 mg per kg. Also, taking high doses like greater than or equal to 9 mg per kg has no other benefit (33).

Creatine is the most common supplement to athletes in ergogenic nutrition. Studies continue to show that creatine supplements increase creatine levels in the intramuscular region that enlightens the progress seen in high-intensity exercise routine foremost to critical changes in exercise. Research shows that creatine supplements can improve post-recovery, injury prevention, thermoregulatory regulation, recovery, and neuroprotection of concussion (34).

Nitric oxide is taken as a supplement to improve the recovery strategies by increasing lactate excretion from the body in post-exercise. The study suggests that nitric oxide will have a positive effect on and recovery and exercise performance (35).

Sodium consumption during exercise might comprise a positive consequence on endurance routine, either by minimizing plasma levels or by reducing the jeopardy of exercise allied usinghyponatremia. The study has reported sodium supplements not improve the performance in training conditions (36)

Zincis useful in essential biochemical functions such as cell respiration, DNA replication, preserving cell membrane integrity, and free radical scavenging. Zinc deficiency in athletes might pave the way to anorexia, significant loss of weight, reduced fatigue and augmented jeopardy of latent fatigue and osteoporosis (37, 38).

Copper is one of the important trace minerals, which is crucial for survival. Copper is traced in every single one body tissues in addition to that it plays a role in building red blood cells, sustaining the nerve cells along with helping the immune system function properly. Also, the copper above aids the body produce collagen, suck up iron, plus the minor part in the production of energy (39).

Advantages of Dietary Supplements:

Sports nutrition has performanceenhancing targets. It enhances performance by improving overall health, improving pace, strength, and flexibility, increasing recovery time, which in turn will build more significant opportunities to exercise and compete as the body is more healthy and adapted to suit the excellent nutrition integrated with the workout scheme (40). Athletes are consuming supplements for various reasons,Table 3. Athletes generally take supplements, and in the endurance setting, a few supplements may have significance. Anti-oxidants can support an athlete who has already reached a plateau in terms of training adaptation, where the main objective is to promote recovery and quicker return to multi-stage event competition (41).

Table 3: Common reasons for supplement intake by athletes (42).

Substances	Purpose
Protein hydrolysate, protein powder, amino acids, essential amino acids; HMB	Muscle growth and repair
Caffeine, taurine, guarana	CNS stimulation
Caffeine, pyruvate, carnitine,	Fat reduction
Evening primrose oil, minerals, vitamins	General health
protein isolates and hydrolysates, whole protein powders, protein-carbohydrate bars, ginseng, drinks	Promoting recovery
Creatine, carbohydrate, bicarbonate, caffeine,	Exercise metabolism
Anti-oxidants, echinacea, zinc, glutamine, pycnogenol, lycopene	Immune function
Chondroitin sulphate, glucosamine,	Joint health
Carbohydrate gels, liquid meals, sports bars	Meal/replacement
Electrolyte supplements, sports drinks	Fluid and electrolytes

Muscle mass:

Athletes commonly consume protein supplements to gain more muscle plus strength and improve physique. Studies have suggested that if a workout review is satisfactory (example: duration, seize, and frequency) and food ingestion is as recommended, protein intake for bodybuilders can improve muscle mass and performance (43). Studies of athletes demonstrate that amino acid and protein supplements can enhance muscle protein synthesis and minimize muscle weakness, pain, and negligible and significant damage from exercise. Combined with foods rich in protein or, e.g., branched-chain amino acid preparations, primarily for people with some sort of metabolic disorder (44). Studies have found strong evidence that protein supplements cause significantgrowth in strength and muscle size. (45)

Control weight:

Systematic review and meta-analysis study has proven carnitine is a weight loss medication for adults (46). There is a lot of scientific evidence that protein intake surpasses the suggested dietary ingestion, i.e., 0.8g protein per kg per day, to support the maintenance of skeletal muscles and loss of fat in dietetic restrictions. Weight loss is often important for athletes to uphold muscle and reduce excess fat, which can improve athletic routine. The present references for protein intake in weight loss for athletes should be 1.6 g/kg to 2.4 g/kg protein per day (47).

Faster recovery:

Dietary supplements can contribute to the health, fitness, and leisure of athletes. Vitamin D, gelatin/collagen, probiotics, omega-3 fatty acids, and some anti-inflammatory dietarysupplements help to resistance and repair cells and tissues to maintain the athletes health frequently (48,49).

Disadvantages of Dietary Supplements:

The use of any supplement containing prohibited substance leads to unintentional doping (50). World Anti-Doping Agency has developed guidelines for athletes about the prohibited substances that should not be consumed in sports, both in competitions and out-of-competitions. Prohibited substances are anabolic beta-blockers, glucocorticoids, hormone, and metabolic modulators, stimulants, anabolic agents, beta-2 agonists, non-approved substances, diuretics and masking agents, narcotics, cannabinoids, mimetics, growth factors, peptide hormones, and related substances (51). WADA has banded these substances to promote sports integrity and protect an athlete's health. There is usually no guarantee provided by manufacturers that supplement products are free of banned substances.When athletes use additional supplements, it is at their own risk (52,53). Over the past ten years in India, National Anti-Doping Agency has banded 1038 athletes due to the positive test for using of doping substances (54). In 2016, an additional research survey in Australia, which tested 67 supplements products, purchased in Australia. They discovered that every five products contained one or more prohibited substances. It is important to note that none of the products found to have any prohibited items on their label list (55).

Some marketable dietary supplements sold by untruthful industrialists may contain banned substances (24). US Food and Drug recall the dietary supplement from the market due to improper labeling, presence of anabolic agents, and due to the presence of drug substances like sildenafil, unapproved drug substances (56). Natural or herbal supplement products may also cause risk to athletes because of some plants rare, naturally produce banned products. For example, cannabis Sativa naturally produces inhibited tetrahydrocannabinol (57).

Dietary Supplements and Sports Pharmacists:

Sports Pharmacists have the knowledge about drug profile, dietary supplements profile,and mechanism of action in the body, half-life, side effects, drug/food interactions, disease/drug interactions and much more about drug/supplements action in the body. Sports Pharmacists can play a potential role to advice athletes because of their advanced knowledge in dietary supplements profile. Sports Pharmacists can be involved in imparting awareness education to sports person, conducting drug research and testing to control usage of banned dietary supplements to prevent doping in sports. Sports Pharmacists can provide guidance to athletes on dietary supplements, over-the-counter and prescription drugs and products, inventory management, and records management (58).

CONCLUSION:

Dietary supplements boost the nutritional intake, performance, and muscle mass of the sports persons. Macronutrients and micronutrients are both sources of energy and have unique properties that affect the health.Supplements may contain prohibited substances, and this may lead to athlete fall under positive doping testing and also these prohibited substances are having severe adverse effect on the health. Sports Pharmacist with their knowledge about dietary supplements can play a vital role in the safe usage of supplements by sports persons and thereby can prevent doping in sports.

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

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DOI: 10.5958/0974-360X.2020.01090.2