Ep #35: Should I Use Supplements?

You are listening to the Strong as a Working Mom podcast, Episode #35. If you’ve got questions about supplements, I’ve got answers. Let’s go.

Welcome to the Strong as a Working Mom podcast. If you’re balancing career, family, wellness, and some day sanity, you are in the right place. This is where high-achieving, busy, working moms get the tools they need to eat, move, and think. I’m your host, physician, personal trainer, and Certified Life Coach, Carrie Holland. Let’s do this.

Hey, how are you? What’s new, what’s good? So, what’s good here is that we are going to talk about supplements today. This episode is actually the result of a number of listener questions about various supplements. And I just want to say thank you to those of you who have reached out to ask about this. My goal, and it’s been my goal since the start of this podcast, is to give you the science, along with some sarcasm, related to exercise and nutrition.

I have said it many times, and I’ll keep saying it, but I’m a huge nerd. I like studies, and I like data. I like science. I also get really frustrated by the number of ridiculous claims that I see about products, teas, powders, programs, and systems that claim to get you all kinds of results. Like, weight loss, more muscle, glowing skin, getting faster, a better life, money, fame, just kidding. But in all seriousness, most of these claims are just not founded.

So, if I can give you the science and save you time, money, and disappointment, then mission accomplished. Because I do not believe that eating and moving need to be complicated at all. And the same applies when it comes to supplements. So that being said, I will add this caveat to what I’m about to share with you today.

I just said I like science, but science is dynamic. The science I’m giving you today may very well be irrelevant or disproven in five years. What we know to be true today may be the stuff that we laugh about in a few years, and I recognize that, and I own it.

So, if and when the time comes that this science changes, you can bet that I will make another episode entitled Supplements 2.0. And I will update you with whatever new science becomes available. Okay? I’m not too proud. What I’m sharing with you today may not be true in five years. And if and when that time comes, we’ll fix it.

The other thing to know here is just a word of caution: Supplements are not regulated. There is no way to know if a supplement is contaminated, and there’s no way to know if a substance has been added intentionally that is not included on the label. Supplements are generally not tested for contamination or accurate labeling. And they frequently contain unlisted substances.

However, there is an organization, NSF, the National Sanitation Foundation International, that does independent testing of supplements, including protein powders. If the NSF gives it a thumbs up, this supplement will be tagged “Certified for Sport,” and you should see it on the label. That designation means that the supplement contains what it says it does on the label and that there are no toxic metals within it. So, take that into consideration. Okay?

The last thing to note before we really dive into this is this, while I am a physician, I’m not your personal physician, and I’m not giving you medical advice today, okay? So, always use caution when you’re using any supplements.

Please talk with your doctor before you start any supplements, especially if you’re taking medications because you don’t want to be taking something that is going to interact with your prescription meds. All right?

With that said, let’s jump in. Let’s talk about some commonly used supplements and get to the real question for each and every one of them. Will it help you? And if so, how? Let’s start with an easy one, and that is caffeine. And when I say easy, I mean that the supplement has been well-studied, and there’s not a lot of argument around it.

Caffeine improves exercise capacity in multiple scenarios. So, during prolonged exercise, meaning greater than 90 minutes. Also, in sustained high-intensity training of like 20 to 60 minutes. And even in short bursts of one to five minutes.

There’s also literature to suggest that it is helpful for weightlifting and other activities, like throwing and jumping sports, by increasing your movement, speed, and power. All of this is to say that caffeine has use across a wide variety of sports. It improves your performance and your focus, and that is a win-win.

Caffeine gets into your bloodstream pretty quickly; 99% is absorbed within 45 minutes. And it peaks anywhere from 30 to 120 minutes after you drink it, with the average being about 1 hour to peak levels.

So, what exactly does caffeine do? It actually does quite a bit. It activates your brain and your nervous system to reduce tiredness. It increases adrenaline, your fight-or-flight hormone. It impacts endorphins to give you a happy feeling. And it may improve muscle performance by way of your central nervous system, but we’re not totally clear on the mechanisms of this yet.

The most important effect related to performance seems to be, though, a perceived reduced effort or pain. Meaning that caffeine can make you feel like you’re not working as hard as you are, and it allows you to work harder. And to me, that is the most fascinating effect.

The other cool thing about caffeine is that it’s relatively cheap, it is widely studied, and it’s safe. So, as for how much and how often, that is a bit of a hodgepodge. It can be taken in a single dose just before exercise, up to 200 mg or more, but smaller doses can also have an effect.

As I was preparing for this podcast and combing through the literature, I most commonly landed on anywhere from 200 – 400 mg, anywhere from 30 to 60 minutes before your workout. So, some literature suggests that there’s a benefit to taking smaller amounts of caffeine before and during your exercise.

And even if you’re a habitual coffee drinker, you’ll still get the effect. That was just demonstrated in an article from 2022. So, the thing to take note of here is that not everyone metabolizes caffeine in the same way. Your genetic makeup and the genes that you carry related to caffeine metabolism will most definitely have an impact on how caffeine affects you.

There are caffeine non-responders; I had no idea. These are people for whom caffeine has no impact on alertness, focus, or performance. And on the flip side, there are people who are more sensitive to the effects of caffeine. And may have a less-than-awesome response to it, in the form of irritability, tremors, totally messed up sleep, and a rapid heart rate, even at very low doses.

So, if you are someone who takes caffeine and notices no impact, you may be a non-responder. You can also develop tolerance to caffeine with repeated use, and this is especially true related to its stimulant effects.

If you’re new to using caffeine for athletic performance, start slow. Alright? On the low end, around 150 – 200 mg, and see how it impacts you. You may find that a little bit goes a long way. And as a frame of reference, most coffee, tea, and soda have anywhere from 50 – 150mg of caffeine. While your pre-workout and energy drinks will often have much more, on the order of 200 – 300 mg plus.

You want to ease into this unless you want to feel like you are buzzing. And then, on the other side, you will experience withdrawal symptoms when you cut it out in the form of headaches and tiredness. So, you want to be thoughtful about when you decide to cut out caffeine.

I personally just cut out my pre-workout drink because I didn’t feel like it needed it anymore. And I would prefer to start using it again when I get closer to my next triathlon. I will verify the headache and the fatigue is real, so you want to be ready for that. Okay?

The side effects of caffeine mostly happen when you take too much. You’ll notice shakiness, anxiety, dizziness, irritability, tremors, and GI upset; no good. And that impact is dose-dependent. So, you want to be cautious, especially at doses over 600mg; that is a lot of caffeine.

And you definitely want to discuss any sort of caffeine supplement with your doctor. Especially if you have high blood pressure, any heart disease, reflux, or GERD (Gastroesophageal reflux disease). But overall, caffeine gets a thumbs up.

Next, let’s talk about creatine. After caffeine, it’s generally one of the most commonly used and most popular supplements for performance enhancement. And like caffeine, it is one of the few supplements that has repeatable, solid, quality evidence to back up its use.

Creatine is effective at improving training and performance in short-duration, high-intensity exercise. So, it’s most common in powder form, and you can get it at the grocery store. How does it work? Getting a little nerdy here, creatine is a naturally occurring substance that comes from three amino acids.

Its primary role is to increase phosphocreatine stores in your muscle. Okay, so phosphocreatine is basically a source of energy in your muscle when you’re performing short bursts of high-intensity exercise. In plain English, creatine helps your muscles produce the energy it needs for things like heavy lifting and high-intensity training.

It basically helps you recover between heavy bursts of exercising. It’s a little more complicated than that, but I don’t think you want to hear lots of long chemical names and all that stuff, so I will spare you, okay?

The important thing to note here is that it helps for recovery in between bursts when you are going hard on the weights or your cardio exercise. It’s also been shown to increase fat-free mass, that’s muscle, and increase muscular power, strength, and recovery.

So, does it work? In a word, yes. And science backs this up. We now have an accumulation of data that suggests that using creatine will improve performance in repeated bursts of heavy exercise, so things like sprints and heavy lifting, with short recovery periods of up to 5 minutes.

Taking this into consideration, creatine may be helpful for sports that involve short intervals of high-intensity effort with short recovery periods. So, this would be things like football or tennis, for example.

The science is less helpful and less consistent regarding the use of creatine for endurance sports. What I found in the science is that your improvement in power and strength is best when you use creatine over time. Continuous supplementation, in the form of 2 – 3gm per day, has been what is found to maintain your muscle creatine stores.

And as for the formulation, stick with creatine monohydrate. This formulation is the one that’s most widely studied. The other formulations are often just more expensive and contain all kinds of impurities and other additives that are unnecessary.

The most common side effect noted from creatine is weight gain due to water retention. The other side effects have not been well documented but include reduced joint mobility and muscle cramping. So, as for the effect on your kidneys, creatine does not affect normal, healthy, functioning kidneys. If you have pre-existing kidney dysfunction, please talk to your doctor before you start taking it.

But I highlight creatine because it is one of the most widely tested supplements, with a long track record of safety. To summarize, creatine can increase muscle mass, strength, and exercise performance for things like weightlifting and high-intensity bursts of exercise.

It has really solid evidence to back up its use. And one large study went even so far as to name creatine the most effective supplement for building muscle mass. So, I almost definitely take that as a win.

All right. Next, let’s talk about BCAAs. So, BCAAs are branched-chain amino acids. To review, amino acids are the building blocks of protein. Your body uses protein for all kinds of processes, including building muscle. BCAAs are a group of three essential amino acids; leucine, isoleucine, and valine. These are the most abundant amino acids found in your muscles. And your body cannot make these amino acids on its own. That’s why they’re called essential amino acids. You have to get them from your diet.

You can get essential amino acids from food. Things like meat, dairy products, legumes, nuts, and seeds. And some studies suggest that the BCAAs that you get from eating one chicken breast are the equivalent of seven BCAA tablets. I’ll get to more on this later, but I wanted to mention that.

As far as what BCAAs can do for you, they have been claimed to do all kinds of things; reduce fatigue, boost endurance, and provide energy for your muscles during exercise, and even reduce muscle breakdown and soreness.

So, here’s the thing, do they work? This one is where the evidence is mixed, at best. There are some studies that report decreased fatigue in athletes who use them, but this is not at all across the board. And most importantly, using BCAAs was not shown to improve athletic performance.

The same is true for improving muscle soreness. Some users found improved soreness, others didn’t. And the users who did see benefit were newer, less trained people compared to habitual exercisers.

And we don’t have good science yet to say that BCAAs have a significant impact on the muscle repair process after exercise either. All of this is to say BCAAs do not have the best evidence to back them up to make them a slam-dunk choice. No studies have found a change in muscle function as a result of BCAA supplementation. And that is the key takeaway here.

While I’m talking about BCAAs, I’m going to add just a quick bit about glutamine because that’s another supplement that I get asked about commonly. Glutamine is a non-essential amino acid. Meaning your body can make it on its own. You can also get glutamine from food sources like eggs, beef, tofu, corn, and white rice, among other things.

Glutamine supplements have been touted to have effects ranging from improved immune function in athletes to increased stimulation of muscle protein synthesis and reduced muscle soreness. But these claims are not supported by repeatable evidence. Meaning glutamine does not have a significant impact on muscle mass or muscle performance. It may help to decrease soreness, but the evidence here is mixed. Some studies say it helps, and some studies say it doesn’t.

We also do not have enough data to speak to the long-term effects of glutamine use. Similar to BCAAs, glutamine is an amino acid supplement that you don’t absolutely need to buy. This is another one where I would probably just assume, save your money.

Alright, so let’s talk about beta-alanine. I’m going to touch on this because this is a supplement that’s getting more attention, and with good reason. Beta-alanine is also a non-essential amino acid, meaning your body can produce it on its own. You can also get beta-alanine from food sources like meat, poultry, and fish.

And there are some studies that suggest vegetarians and vegans have 50% less carnosine in their muscles compared to those who eat animal products. And this is important in just a second.

So, how does beta-alanine work? It’s pretty cool, actually. Beta-alanine combines with another amino acid, histidine, to produce a compound called carnosine; something that I just mentioned about vegetarians and vegans. Carnosine helps to decrease the lactic acid buildup in your muscles during exercise.

All right, so here’s why this matters. This is the cool stuff. It’s the lactic acid accumulation in your muscles that ultimately causes you to fatigue and poop out during exercise. That is “the burn.” So, when you’re running hard and your legs are on fire, or you’re sprinting on your Peloton, and you get to a point where you cannot pedal anymore, that is lactic acid talking.

Here’s the key thing to know: It’s the acidity in your muscles that limits how long you can exercise. So, if you can decrease lactic acid buildup in your muscle, you should be able to exercise harder for longer duration. And beta-alanine plays a role in this. It helps to reduce the acidity in your muscles during intense exercise.

The key takeaway here is that beta-alanine can help to increase your time to exhaustion by reducing muscle fatigue, and it may help increase muscular endurance, especially in older people. So, this is pretty cool stuff. This one is neat.

The side effects, when taken in large doses, are skin tingling and flushing, and it also may interact with some heart medications. As for dosing, when I looked, I found that it most commonly comes in doses of 800mg tablets. And the dosing was two 800mg tablets twice daily.

I also found, even in the pre-workout that I just weaned myself off of, you may find that it comes in some of your pre-workout drinks. But please, again, remember, the dosing of these supplements is unregulated, and the formulations and dosages are all over the map. So, please read your labels. Okay?

So, this one, beta-alanine, I think we’re going to see and hear more about it going forward. I think beta-alanine, even when I was preparing for this, is getting more literature to support its use. And we’re finding more, larger, higher quality studies that support its impact on exercise capacity and performance.

The tingling and flushing and potential interactions with heart meds are real, though, so we’re going to use this one with caution. Okay?

Next, let’s talk about protein supplements. This is probably the most common supplement I get asked about, and I want to break this down for you here. You know me by now, and I love to talk about protein. To review, protein is important for a number of reasons.

Protein takes the most energy, or most calories to digest, of any of the macronutrients of carbs, fat, and protein. It keeps you fuller longer. Protein regulates your hunger hormones, and it helps you to build and repair muscle after strength training.

We are also learning that it is becoming more and more important in the diet of peri- and menopausal women to prevent the weight gain that is so commonly associated with the transition into menopause. So, there are loads of reasons to be interested in protein.

At the same time, I get it. For many of you, protein is the hardest of the three macros to take in sufficient quantities. So again, for most people, I aim for about 20 – 30% of your total calorie intake to come from protein. This is not a hard and fast rule, but for purposes of weight loss, maintaining your weight loss, and for keeping muscle, this is the range that I try to hit. And there’s literature to support this.

But for some of you, getting in more protein is a challenge, so you’ve asked about protein supplements. So, your protein supplement can come from multiple sources. It can come from dairy, in the form of whey or casein. Your protein powder can also come in the form of soy, eggs, peas, and really there are numerous sources.

What happens is that the protein is extracted from these foods and then concentrated, and then along the way, flavors, fillers, sugar, and other additives may be mixed in. So again, that’s where you really want to read your labels.

I’m going to talk about whey protein specifically, as that is one of the most common forms of protein supplement. Whey is the liquid that separates from milk during the production of cheese. Whey protein, it is a complete protein. It has all the essential amino acids your body cannot make on its own. It’s especially high in leucine, which is an amino acid that triggers muscle growth. And it’s also very easily digestible, and it’s quickly absorbed by your gut.

Whey is more satiating than casein or soy protein, meaning it keeps you fuller longer. It is absorbed more quickly than other types of protein like casein. And some studies suggest that it might be better than other forms of protein for muscle growth.

So, here’s the question; does whey protein work? In a word, yes. The science on whey protein is pretty cool. And there is more and more robust evidence to suggest that supplementing with whey protein can help to increase muscle mass, improve recovery after heavy exercise, and increase muscular strength. So, keep your eyes open, as I imagine there is going to be much more science and literature about this in the future.

As for how much? One scoop of protein powder typically has, on average, 25 gm of protein. There’s wide variance around this, so again, read your labels. I generally do not recommend more than one scoop of protein powder per day. I did have a client that was taking three scoops a day, and that is just too much; I will get to this in a few minutes.

But three scoops of protein powder in a day is too much. If you overdo it on protein powder, you may be looking at unpleasant side effects like nausea, bloating, gas, and diarrhea. Because remember, often, these supplements come loaded with other things like additives, sweeteners, fillers, and chemicals; no good. That being said, most people can tolerate one scoop of protein powder per day.

As for the formulation of whey. Whey concentrate tends to be the cheapest, but it also contains less protein overall, because of the way that it’s processed. I tend to steer more towards the whey isolate and hydrolysate, as those generally have a higher concentration of protein by way of their processing.

What if you’re lactose intolerant? If you are lactose intolerant, you would want to opt for the isolated formulation of whey protein over the concentrate formulation. The whey isolate powder has lost most of the sugar or lactose during processing, and that’s what we want to get rid of. Okay?

Along these lines, I do want to touch on casein protein. Casein is a protein that, like whey, is also found in milk. It is different from whey in that it is absorbed and digested more slowly. So, as a result, your muscles see a more slow and steady exposure to amino acids.

So far, the science has shown that casein is not as effective as whey protein at promoting muscle protein synthesis. But it has been found to be more effective than soy protein for this purpose. It has also been found to reduce the rate of muscle protein breakdown. Most commonly, you’ll see this used at bedtime because of its slow-digesting properties.

When I was digging through the literature on this, I found that there’s more evidence to support the use of whey protein for the use of building muscle, but that very well may change in the future.

And as I said earlier, if you cannot tolerate milk-based protein powders, you’ve got options. Egg protein powders, while they are less well studied, have all nine essential amino acids. If you prefer a non-animal product protein powder, pea protein has all nine essential amino acids. And there are some small studies that back its use for workout performance and strength. It’s just less studied than whey protein.

Here’s the thing, though, if your goal is to simply bolster your protein intake, because of all the good things I mentioned that protein does for you, you can get it from whatever protein powder source you’d like, seriously. Whey simply just has the most scientific literature to back it up, but I don’t care where you get your protein powder from. Okay?

All right. One other supplement I want to cover is collagen. So, collagen is becoming huge, and the market for collagen supplementation has exploded in the last few years. And while it’s not so often used in relation to athletic performance, there are some studies that refer to its impact on joint mobility and joint pain. And I get asked about it a lot, so I thought I would cover it here.

Here’s what to know. Collagen is the most abundant protein in the human body. It is found in your bones, your skin, muscles, tendons, and cartilage. It’s what makes these structures strong. And you’ll get collagen from foods like meat, fish, poultry, eggs, soy, dairy, and legumes.

But in the last few years, collagen has been sold as a supplement to improve hair, skin, and nail health. And in some studies, collagen has been linked to improved joint mobility. So, collagen is most frequently sold in powder or pill form. And it’s often formulated with other vitamins and minerals, like vitamin C and biotin.

The majority of literature on collagen is related to skin and joint health, and less so related to sports performance. Does it work? In a word, maybe. There are a few studies, including one meta-analysis in 2019, that did show slight improvements in skin elasticity, hydration status, and the reduced appearance of wrinkles.

Some studies have found that collagen supplements have improved joint mobility. So, this is promising. There may be some real benefits to oral collagen supplementation. And we are only just seeing the tip of the iceberg related to the research on this.

As for how much, this is where my head started to spin. There is very wide variance on this from 100mg – 20gm or more at a time. Remember, these supplements are not regulated, so if you choose to take a collagen supplement, please go by the directions of whatever you’ve bought. This one literally was all over the map.

Here’s the problem that I have found with collagen supplements to date. The majority of the research related to collagen supplements is paid for by the collagen supplement companies. It is hard to swallow evidence that says collagen is so great for you when it’s being paid for by the company producing the collagen supplement it’s trying to sell you.

This is similar to studies funded by Coca-Cola, that say that sugar-sweetened beverages really aren’t that bad for you. I have to raise an eyebrow at this and wonder what the heck is going on, and whose interest is really at heart here?

When industries have a vested monetary interest in the outcome of their studies, that’s a conflict of interest. That being said, there are more and more non-industry-funded studies that are emerging about collagen supplements, and it is most definitely something to watch. So, for now, I give it a definitive maybe.

Alright, so there it is. We just covered a number of common supplements, including caffeine, creatine, BCAAs, glutamine, beta-alanine, whey, casein and other protein powders, and finally, collagen. Of everything that I’ve covered, caffeine and creatine have the largest and longest history of solid evidence to back up their use.

Next in line would be whey protein powders, followed by beta-alanine. There’s a maybe here on collagen. And for now, you can save your money on BCAAs and glutamine. Okay?

With all of this being said, I want to give you two important things to consider. If there is a supplement that you take, and you notice a benefit from it, by all means, take it. I am not here to poopoo your collagen supplement or your powder or your pills, or whatever system you take. If you like it, and it makes you feel good, and you feel that it makes a difference for you, then take it.

However, if you are on the fence about any of these things, and if you’re like me, and you like science and evidence to back up your decisions, then I hope what I’ve shared with you today allows you to make more informed choices. And again, I will say it again, loud and clear: This may change in one to five or more years. There may need to be a reboot of this entire episode, if and when more literature emerges that supports or refutes the use of any of these supplements.

So, remember, science is the art of proving what we know wrong. That is the beauty and the crazy of it. But if there is a supplement that you take, and you like it, and it helps, please go for it.

And then last, I want to make this one very clear. Ideally, you would get your nutrition from whole foods first. This is especially in relation to protein powders, but even the amino acids. Real whole foods should come before supplements.

If you are guzzling three protein drinks a day, plus two protein bars a day, in order to hit your protein goals, let’s talk. That is not the most satisfying, palatable, or desirable way to get in your protein. Plus, real whole foods likely have other nutrients, vitamins, and things we don’t even know about yet. So, by skipping out on those in favor of a bar or powder, you could be cheating yourself of other valuable nutrients.

A scoop of protein powder a day, fine. But I’m calling on Mies van der Rohe one more time here, “Less is more,” when it comes to processed protein supplements. Okay? Plus, I like to chew my food, and that includes my protein. Whole food first.

Awesome. I hope that this answers some of your questions about supplements. This one was a lot of fun to put together. And it was a result of a combination of questions from you. So, thank you. If you have other questions or topics that you would like me to cover in a future podcast, please send me a message at Carrie@carriehollandmd.com

I love hearing from you. And it has been really fun to answer your questions about eating, moving, and of course, thinking. Thank you again for hanging out with me, and I will catch you again next week.

If you like what you’ve been hearing, please review the show. I would love to get your feedback and ideas. Your suggestions have inspired episodes and will help me make the show better for you. And share this podcast with a friend, text a show link, share a screenshot, or post a link to the show on your social media. Be sure to tag me @CarrieHollandMD on either Instagram or Facebook, so I can follow along and engage with you.

This is how we get the word out to other working moms who want to feel strong, inside and out. If you know someone who wants to feel better or eat and move differently but she is too tired or too busy, it is time to change things up. And you know, making that change starts with how you think. And that is what we do here on the Strong as a Working Mom podcast. I’ll see you next week.

Thanks for listening to Strong as a Working Mom. If you want more information on how to eat, move, and think, so you can live in the body you want, with the mind to match, visit me at CarrieHollandMD.com.