Cycling CME

A unique CME learning experience for Physicians, PA-C's, and other Medical Providers who love to bike

Active CME:  Combining Continuing Medical Education (CME) and Bicycle Touring for the Healthcare Provider

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Supplements - Buyer Beware!

Dietary Supplements – “Buyer Beware”

When lecturing about sports supplements over the years, I have always included the warning, “Buyer Beware” for all who purchase or discuss over-the-counter supplements. Supplements, which are a multi-billion dollar industry, do not undergo the same strict safety and effectiveness evaluations as used with prescription drugs. In 1994, the Dietary Supplement Health an Education Act (DSHEA) was established but unfortunately with different regulations and lack of strict oversight as seen with prescription drugs. Unlike prescription drugs, dietary supplements are considered safe until proven unsafe. The lack of significant regulation and the large number of products are major challenges to assuring safety in the supplement world. As an example, in 1994 there were about 600 US supplement manufacturers with 4000 products. By 2000, there were more than 29,000 supplement products on the US market with few documented reference materials for these products and there are now over 85,000 supplement products on the US market. To add to this challenge of regulation and safety, there is no global consensus on how dietary supplements, natural health products and food supplements from other countries are even defined.

A recent study by Tucker et al in JAMA, illustrates the difficulties in regulation and potential harm of dietary supplements. The study was an analysis of the US Food and Drug Administration warnings from 2007 to 2016, which showed that unapproved pharmaceutical ingredients were identified in almost 800 dietary supplements. The most common adulterants were sildenafil for libido products, sibutramine in weight loss supplements and synthetic steroids or steroid-like ingredients found in muscle building supplements. Twenty percent of the products identified contained more than one unapproved ingredient.

Over half of all adults in the United States report taking dietary supplements. Those adults and medical providers should be aware of the possible contamination risk and lack of quality seen in the supplement world. As medical providers, it is important to educate ourselves and our patients on this topic. Remember, “Buyer Beware”!

Cycling CME


Dwyer, JT, et al. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients, 2018.

Tucker J, et al. Unapproved Pharmaceutical Ingredients Included in Dietary Supplements Associated With US Food and Drug Administration Warnings, JAMA Network Open, 2018.

What to think of the Ketogenic Diet?

One of my colleagues, Dr. Carmine Greco, exercise physiologist will again speak at our fall Cycling CME conference.  Carmine, who is in favor of a plant based diet, has done significant research on the ketogenic diet craze and will talk about this and fasting for our fall CME.  Here is an excerpt of his initial presentation on the ketogenic diet:

"The Ketogenic, or "keto" diet, runs contrary to everything you have been taught about nutrition.  Made popular (again) in the 1970's when Dr. Atkins released his first book advocating for a low-carbohydrate diet, the keto diet is enjoying another day in the limelight as researchers, celebrities and athletes are touting the advantages of this curious diet. The modern history of low-carbohydrate dieting dates back to at least the 19th century, when keto was a common treatment for epilepsy and type 1 diabetes. But is the diet more hype than hope? Is eating a diet comprised mostly of fat safe or even palatable?

Characterized by low-carbohydrate and high-fat consumption, recent research into the keto diet has demonstrated the promise of this seemingly bizarre diet for weight loss, improving cognitive function, physical performance and even treating a variety of diseases, including type 2 diabetes and cancer. Keto-style diets date back more than a century as a common treatment for disease, but it is only over the last 10-15 years that a resurgence of scientific interest has begun to legitimize the ketogenic diet. In fact, this "fringe" diet is now used as a front-line treatment of obesity and diabetes at a variety of medical clinics, including the well-known Duke Lifestyle Medical Clinic."

Carmine R. Grieco, PhD, CSCS, EPC

Assistant Professor of Kinesiology, Colorado Mesa University

Hopefully you will join us in October 2018 in Grand Junction Colorado as we discuss this diet both related to the patient with chronic disease as well as performance in the athlete.

Cycling CME