Fifty-two percent of North Americans spend $41 billion a year on over-the-counter food supplements. A review of 277 clinical trials on 992,129 participants, using 24 different supplements, found that nutritional supplements were not associated with increased lifespan or prevention of heart disease (Ann Intern Med, July 8, 2019;171(3):216-217).

Athletes and exercisers spend more than 14 percent of the $41 billion, or $5.67 billion, for supplements that are supposed to make them faster or stronger (Nutrition Business Journal, Supplement Business Report 2016). For example, supplement sellers recommend that athletes take up to five grams of creatine per day, about the amount of creatine found in 25 three-ounce steaks. Beetroot supplements are supposed to contain the amount of nitrates in a pound of beets, and fish oil supplement sellers recommend a dose of six grams of fish oil that would be found in six servings of salmon.
• Many sports supplements have no benefit beyond the placebo effect that is gained by taking anything, even when the athletes have been told that they are being given a placebo (J Sports Sci Med, 2007 Mar; 6(1): 21–28). This electronic survey of competitive, international and professional athletes found that 97 percent reported that placebos could improve sports performance and 73 percent reported that they personally had improved performances from placebos.
• Athletes lifted heavier weights when they were falsely told that they had been given anabolic steroids (Med Sci Sport Ex, 1972;4:124-126; The Sport Psychologist, 2000;14:272-278), or thought they had been given a new breakthrough sports pill (Med Sci Sport Ex, 2004;36, Supplement S171).
• Fifteen endurance runners, average age 27, ran 1.8 miles nine seconds faster after injecting themselves with a placebo than they did after taking no injections (Med Sci Sport Ex, Aug, 2015;47(8):1672-81). Nine seconds can be the difference between winning and losing many races.

Placebo Effects on Cycling Performance
Six highly-fit male cyclists did two time trials with no pills to establish a baseline for each cyclist, and three time trials where they were given pills labeled either “placebo”, “4.5 mg/kg caffeine”, or “9.0 mg/kg caffeine”, at random (Med Sci Sports Ex, Dec 2006;38(12):2159-64). Actually, all of the pills were placebos, with none of them containing any caffeine. Caffeine can enhance performance, so these experienced bicycle racers knew that if they were given caffeine, it could help them ride faster. On all three time trials the cyclists had their power measured on an objective power meter. The cyclists produced:
• 1.4 percent less power than baseline when they believed they had ingested a placebo,
• 1.3 percent more power when they believed they had ingested 4.5 mg/kg caffeine, and
• 3.1 percent more power when they believed they had ingested 9.0 mg/kg caffeine.
Furthermore, all of the cyclists reported that they felt benefits from the placebo pills labeled as containing caffeine.

How a Placebo Can Help You Move Faster
The limiting factor to how fast you can run or cycle over distance is determined by how fast you can bring oxygen into your exercising muscles. When your muscles start to run low on oxygen, lactic acid accumulates in your muscles which makes them burn and hurt, and you gasp for breath to increase your oxygen supply. You slow down because you are hurting from burning muscles and gasping for breath. People are willing to suffer more after being given a placebo than they are after receiving no suggestion of an advantage. When athletes believe that they have been helped, even though the pills or injections are worthless, this psychological benefit helps them to work through pain and suffering.

Caution! Your body talks to you and tells you when you are reaching your limits in endurance. If you ignore the warning signs of impending exhaustion and keep pushing yourself, you can pass out and even die. Remember the story about Pheidippides, who died after the first marathon? For the sequence of symptoms of impending doom, as I experienced them in a race, read my report on Heat Stroke. I am a physician and I wasn’t any smarter than Pheidippides.

The Placebo Effect Is Real
In a test of the placebo effect, people who suffered severe migraine headaches were divided into three groups that were given:
• no pills
• correctly-labeled 10-mg Maxalt pills (a recognized medication for migraine pain)
• pills correctly labeled as a placebo
The patients reported that the bottle clearly marked as a placebo was 50 percent as effective as the real drug, and far more effective than taking no pill at all (Science Translational Medicine, Jan 8, 2014:6(218):218ra5). The researchers felt that migraine sufferers felt less pain because their bodies produced their own pain hormones when they took the pills. The lead researcher said, “Even if they know it’s not medicine, the action itself can stimulate the brain into thinking the body is being healed.”

My Recommendations
North American athletes and exercisers spend almost $6 billion a year on food supplements advertised to make them become faster or stronger. The placebo effect may go a long way toward explaining why these supplements are so popular. It is hard to give yourself a placebo because you know that you are just taking a sugar pill. However, when a nutritional supplement is widely advertised and promoted as something that will help you, you may be persuaded to believe that it will deliver the advertised benefits, and so with the placebo effect, it actually does. Most of these products are of questionable value at best because their benefits would not exceed those of a placebo, but if the placebo effect they give you is real, you may not be wasting your money after all.