1

Protein supplements intake among gym-goers in

Lebanon

Nadine Massaad

University of Balamand

28/05/2015

2

Acknowledgement

First, I would like to thank my mentor miss Aline Rizkalla who helped me all the way through

the review of every draft and enlightening me about the requirements to complete the project.

Second, I would like to thank the gym goers who accepted to fill the needed survey and the

owners of Zahle and Ashrafiyeh gyms.

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Table of contents

Abstract-------------------------------------------------------------------------------------------------4

Introduction -------------------------------------------------------------------------------------------- 5

Literature Review -------------------------------------------------------------------------------------7

Rationale ----------------------------------------------------------------------------------------------10

Aims and Objectives --------------------------------------------------------------------------------11

Research Question ---------------------------------------------------------------------------------- -11

Methodology ----------------------------------------------------------------------------------------- 12

Study Design --------------------------------------------------------------------------------- 12

Sampling and Recruitment -----------------------------------------------------------------12

Data Collection ------------------------------------------------------------------------------13

Data Entry and Data Management --------------------------------------------------------13

Data Analysis --------------------------------------------------------------------------------13

Results ------------------------------------------------------------------------------------------------14

Discussion -------------------------------------------------------------------------------------------- 26

Limitations -------------------------------------------------------------------------------------------29

Ethics -------------------------------------------------------------------------------------------------30

Conclusion -------------------------------------------------------------------------------------------31

Survey ------------------------------------------------------------------------------------------------32

References -------------------------------------------------------------------------------------------35

4

Abstract

Introduction: Nowadays, the use of protein supplements became very trendy and body builders’

aim is to promote the growth of their bones extensively to get the perfect body shape. The

importance of consuming protein additives or amino acids is still controversial and its necessity

is still under study. Is it a need to help gym goers build muscles or is it just a myth and could

lead to undesired side effects?

Aim: Evaluate the total use of protein supplements by gym-goers whether shakes, powder or

formulas for muscle building; their efficacy and contribution to the total protein intake per day

Design: A descriptive cross-sectional study

Methods: a questionnaire was administered to 50 gym-goers with various body shapes and sizes

of lean muscle mass to report on the use of any protein supplements and whether they undergone

any valuable changes during their exercise along with the presence of knowledge about the

background and effects of the supplement consumed

Results: 40% of the participants recorded the intake of protein supplements. 60% of the

supplementers were between the ages of 15 to 24, 20% for each of the age ranges 25 to 34 and

35 to 44 years old. 40% were motivated by gym instructors while 30% were influenced by the

media. 60% of the total participants attended the gym to be in good shape, 24% for health

benefits and the rest to exercise. 70%, 20% and 10% of supplementers recorded getting their

supplements from the gym, nutritional stores and online stores respectively.

Conclusion: The study will help us review what athletes and gym-goers consider when taking

protein supplements and to estimate the prevalence of the use of protein supplements in Lebanon

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Introduction

Globally, body shape is one the main concerns for both males and females. Both genders

refuse to be overweight and tend to do the impossible to attend the perfect body form.

The use of supplements was known to be an additional nutritional intervention to prevent illness

and maintain a good health. However, now the use of protein supplements, whether vitamins,

minerals, protein, creatine and other ergogenic compounds, has been in great increase and

reached about 85% among athletes and gym-goers (Maughan et al., 2007). It became the primary

source for improving the athletic performance and increase lean body mass. Furthermore, in the

USA the sales of dietary supplements including sports shakes, energizers, creatinine, vitamins

and minerals, have reached 17.1 billion $$ with an increase of 10% expenses by each customer

each year (Food and Drug Administration, 2002). Each type of ergogenic compounds can play a

different role in the body; for example, during high-intensity exercise, creatine gives a boost of

energy that is required during weightlifting or to recover after this intensive exercise but has

shown no beneficial outcomes for endured training practices. As for DHEA

(dehydroepiandrosterone), it can help in great testosterone production and has been the primary

additive pursued by athletes to improve their performance. Finally, caffeine plays an important

role as a stimulant for the central nervous system and help in the metabolism of fat stores during

strenuous exercise (World of Sports Science, 2015).

Given the opportunity, individuals tend to increase the consumption of protein supplements to

enhance their muscular development and promote the growth of muscles in size and strength,

neglecting the fact that these supplements may present adverse side effects. Misuse can result by

either taking the wrong doses per day or not even reading the labels on these supplements that

had shown a lack in assigning the objective description of the product as discovered by the Life

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Science Research Office (LSRO) of the Federation of American Societies for Experimental

Biology: “They found limited data that documented the extent to which protein supplements are

used and little information on safety.”(Wolfe, 2000). In addition, seduced by the various results

that may be marked after the usage, people tend to forget that protein and amino acid abuse can

lead to deleterious effects on the long run, such as gout, increased body fat, dehydration, kidney

overload, calcium loss, diarrhea, bloating, loss of bone mass, if not taken under the supervision

of a physician or a dietitian (Oliver et al., 2011). And although a study done by Gontzea et al

showed that individuals undergoing strenuous exercise go through a negative nitrogen balance

which may require supplementation, however, the body’s adaptation during exercise will

compensate and restore normal stores and maintain nitrogen balance in the body even without

any addition of nitrogen intake but still individuals can still consume a bit more than the RDA’s

recommendation and benefit a positive nitrogen balance to help increase their lean body mass

(Wolfe, 2000).

In this study, a cross-sectional quantitative study design is going to be used in order to have an

estimation of the use of protein supplements by gym-goers with various body shapes and sizes of

lean muscle mass to report on the use of any protein supplements and whether they undergone

any valuable changes during their exercise along with the presence of knowledge about the

background and effects of the supplement consumed. To get this estimation, a questionnaire is

going to be handed to a group of 30 people attending two different gymnasiums; one in Zahle

“Life Gym” and the second one in Ashrafiyeh “Beirut Gym”.

7

Literature Review

A literature review was conducted using the keywords: Nutrition, protein supplements,

athletes, adolescent athletes, gym-goers, side effects of protein supplements, sports,

effectiveness, protein supplements and exercise, ergogenic supplements, risk factors and use of

dietary supplements in several databases and online journals. These include PubMed, Academic

Search Complete, Proquest Central, American Journal of Clinical Nutrition, Journal of Sports

Science & Medicine, The Journal of Clinical Endocrinology & Metabolism, International Journal

of Sport Nutrition and Exercise Metabolism, Journal of Strength & Conditioning Research, and

Journal of applied physiology.

Several studies were conducted on many populations such as in Canada, USA and

Sydney. In a cross sectional study that was done on 115 males and 88 females athletes attending

the USA Division I university, the results showed that 89% of the participants were using

supplements or used supplements previously (Froiland et al., 2004). This correlates with a case-

control study done in a Canadian university by distributing questionnaires on 247 varsity(cases)

and 204 non-varsity(controls) athletes; the questionnaires included the use of supplements, the

reasons for use, and if there were any detected side effects. The results showed that 98.6% of

cases and 94.3% of controls were using supplements among which protein powder, creatinine

and carbohydrate gels (Kristiansen et al., 2005).

Different studies focused on grade levels; for example the O’Dea study done year 2003

focused on 78 students from a co-educational program high school, from grade 7-11 ranging

between 11 and 16 years old. It was revealed that 56.4% used sports drinks, 42.3% energy

drinks, 5.2% creatinine, and 3.9% high protein milk supplements. On the other hand, a study

done in Singapore year 2003 by Slater et al on 160 athletes focused on the rationale behind the

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usage and the influence that demographic parameters and sources of information about the

supplements have on the overall consumption. The results revealed a prevalence rate of 77% of

usage of sports drinks, creatinine and multivitamin supplements (Slater et al., 2003).

Oliver et al. (2011) have examined the prevalence of protein supplementation in gyms of

415 males and females in Madrid from Seville fitness centers based on three variables: age, sex

and time of practiced sport. More than 25% of the gym-goers used protein supplements which far

exceeded the RDA recommended for protein intake for athletes of which 42.7% where males and

3.2% were females. This study also revealed a 28% (42.75 men and 3.2% women) intake of

protein supplements out of the total participants, which is higher than two other studies done by

Hirschbruch et al and Lavalli Goston and Correia that obtained a total of 10% and 13.98% of

protein intake by gym goers. Moreover, resistant athletes far exceeds the recommended daily

allowance ranging between 1.2 to 1.4g/kg, and reached up to 2.2 to 2.8g/kg/day which is 190%

of the recommended value. Thus, this would increase the risk of dehydration if the right amounts

of water were not consumed; every 50ml of water are needed to excrete 1gram of urea (Erdman

et al, 2006). In the study done by Oliver et al (2011), the time of intake of protein supplements

varied: 21.7%, 20.9%, 19.1%, before training, after training and before and after training

successively. Not to forget that 77.4% (89 individuals) of those using supplements in the sample

reported positive results, whereas 19.1% (22 individuals) stated negative results and 3.7% were

indecisive.

In another study that examined the misconception about the effectiveness of protein

supplements among athletes in a small Midwestern town found that athletes can obtain their

protein needs from dietary sources of protein without the need to consume any type of

supplements since no studies till today have found any significant benefits from it (Duellman et

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al. 2008). In this study, a questionnaire handed to sixty one school football players (39

supplementers and 22 non-supplementers), revealed a significant difference between the two

groups about misconception and the sources of information with a p-value = 0.001. Over half of

the protein-supplementers thought that no harm is caused by the use of supplements while only 4

of the non-supplementers thought so. Nevertheless, it correlated with the findings of Jacobson et

al (2001) and Rosenbloom et al (2002); sources of information to get the supplements reported

as being the coach, friends or family, is considered a less scientific source of nutritional

information since they don’t have accurate knowledge about the subject in matter.

The relationship between the media and body shape concerns with the use of supplements

was highlighted by a study done by Field et al (2005) done on 6212 girls and 4237 boys between

the ages of 12 and 18 who agreed to participate in the GUTS(Growing Up Today Study) using a

survey. In this study, they found that 91% of the girls were reading magazines like teens,

women’s fashion, and women’s health/fitness magazines and 83% of the boys were reading

magazine like sports magazines and to a lesser extent, men’s and teen and health/fitness

magazines. Besides, about 4% of the boys declared their desire to look like the males in

magazines, on television or in movies. Moreover, the prevalence of use of protein supplements

was 3 times more than their peers who did not track the media to get the perfect body shape with

a significant correlation for the boys (OR: 2.3; 95% CI: 1.1– 4.9) (Field et al. 2005). Not to

forget a study that was mentioned before done by Duellman et al (2008), that revealed that 7 out

of the 39 protein-supplementers got information about the use of supplementation from the

media. Field et al study also established a parallel association between the participation in team

sports like football and the weekly use of supplementation to gain muscles and have a good

appearance in both genders.

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Rationale

A major gap in the literature that was encountered was by the lack of studies that consider

the Lebanese population and its gym goers that consume protein supplements. In addition, there

was a lack in the studies reviewing the effects that are caused by the over intake of supplements

such as gout, kidney failure, dehydration and many others. Therefore, it is crucial to conduct this

study to evaluate the use of supplements by the Lebanese gym-goers and if there were any side

effects that need to be considered especially that these effects is dangerous and life-threatening.

Not to forget that most of the users are consuming without the supervision of any nutritional

intervention or the help of a physician (Duellman et al. 2008).

Thus, in this study, we might try and get a prevalence of the usage of these supplements

and the biological status of supplementers in order to come up with the perfect intervention to

help and educate gym-goers in the near future.

To get an idea about the prevalence of protein supplements intake, a cross-sectional study

is going to be piloted. With the use of a survey including specific questions concerning protein

supplements intake and some information about attending gym, data is going to be collected and

evaluated at a one point in time.

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Research Aims and Objectives

Aim

The aim of this study is to assess the degree of protein supplementation among 50 Lebanese

athletes and gym-goers and whether they have any adverse side effects on their health in two

gyms; one in Ashrafiyeh (Beirut Gym) and the other is in Zahle (Life) so that we would be able

to compare between two different regions and cultural views.

Data would be collected using a detailed questionnaire including various questions about protein

supplements’ use.

Objectives

To measure an estimate of the supplements intake among the participants

To assess the efficacy and contribution of protein supplements to the total protein intake

per day as compared to the RDAs.

To evaluate the health status of supplements’ consumers and assess for any adverse side

effects or benefits behind the intake of additional non-dietary proteins.

To determine the reasons behind the use of supplements by gym-goers.

To provide a comprehensive education intervention based on the results obtained in the

study

Research Question

What is the prevalence of protein supplements’ use by athletes in Lebanon and to what degree

does it contribute to the total protein intake per day?

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Methodology

Study Design

The study design is a descriptive cross-sectional design. The data was collected from two gyms;

“Life Gym” in Zahle and “Beirut Gym” in Ashrafiyeh. Using this study design, a snapshot will

be obtained at a one point in time providing us with valuable information about the prevalence of

protein supplements intake in Lebanon in a short period of time. Cross-sectional study design is a

cost effective method that will allow us to get a great number of data from a significant number

of participants.

Sampling and Recruitment

Target population

Lebanese gym-goers in Ashrafiyeh and Zahle who consumes protein supplements (shakes,

powder ...)

Attainable population

The attainable population will be the gym goers attending the Life Gym in Zahle and Beirut Gym

in Ashrafiyeh.

Sample size N=50

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Data Collection

Data will be collected with the use of a questionnaire with closed ended questions. These surveys

are going to be distributed to several gym goers attending the gyms already mentioned and

anything not understood will be explained thoroughly taking into consideration that some of the

participants are French educated in order to get the most accurate response.

The questionnaire will be distributed at different times during the day and at different days of the

week; for example we will choose Wednesday and Saturday, so that we obtain a wide source of

information from all possible gym goers and different ages to limit possible biases in data

collection. Not to forget that most of athletes have jobs or attend schools and universities.

Concerning weight and height, weight will stated orally by the participants

The questionnaire is aimed at investigating athletes’ intake of proteins during the day and any

kind of knowledge related to the subject in matter and their perception about the efficacy of

supplementations on the long run.

Data Entry and Data Management

Responses will be analyzed using Excel program. Data will be entered manuallyand will be

revised twice to check for any typing errors or missing responses.

Data Analysis

Data will include the results of weight and height measurements in addition to the proportions

resulting from our study design regarding the knowledge and intake of protein supplements.

Data will be described, organized and summarized using tables and graphs.

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Results

Participants Characteristics

Sex Proportion (N=50)

Females N=15 30%

Males N=35 70%

Age Group Proportion

15-24 N=32 64%

25-34 N=12 24%

35-44 N=6 12%

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A. Protein supplements intake

The majority of the participants did not consume protein supplements, but a significant number

of 20 out of 50 are consuming protein supplements. The last 3 used to consume and stopped.

Total

0

5

10

15

20

25

30

NoYes

Yes, used to

27

20

3

Intake of Protein Supplements

Total

16

B. Gym-Goers Based on Gender Differences

Most of the gym goers were males and constituted 70% of the sample size and the rest were

females.

0

5

10

15

20

25

30

35

F M

15

35

Gym-Goers

Total

17

C. Protein intake according to Gender:

Consumption of protein supplements was higher among males (18 out of 20) than in females

(2 out of 20).

2

18

0

2

4

6

8

10

12

14

16

18

20

Females Males

Protein Intake

18

D. Reason For Not Consuming Protein Supplements

The non-protein supplementers had different opinions for choosing not to consume protein

supplements:

14 out of 30 participants heard that these supplements are unhealthy;

10 didn’t believe in their efficacy on their muscle mass, strength and performance;

5 thought that it’s expensive;

and 1 of them didn’t know what supplements are

1

5

10

14

Don't Know What Supplements are

Thinks It's Expensive

Don’t Believe in It's Efficacy on Muscles & Performance

Heard It's Unhealthy

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E. Protein intake according to age groups

Results showed that protein intake dominated by the smallest age group from 15-24 years old

attending gym and equal consumption for both ranging from 25 till 34 and 35 till 44 years

old.

12

4 4

60%20% 20%

0

2

4

6

8

10

12

14

15-24 yrs 25-34 yrs 35-44 yrs

Protein intake Percentage

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F. Level of Protein Intake

The level of protein supplements intake varied from 25 to 90grams.

Mainly participants consumed 45grams (8 out of 20) followed by 5 participants who consumed

90 grams along with another 5 who consumed 30grams. Only 1 participant consumed 25 grams

and one consumed 75 grams.

2 out of the 3 participants who used to consume protein supplements, had a usual intake of 30

grams/day. Another gym-goer who used to consume protein supplements had a usual intake of

50grams.

0

2

0

1

0

0

0 1 2 3 4 5 6 7 8 9

25

30

45

50

75

90

Amount of Protein Intake

Currently Used to

21

G. Type of Protein Supplements Consumed

Participants consumed protein shakes/powder, whey and casein and scored 12, 6 and 2

respectively out of 20 supplementers.

6

12

2

WHEY PROTEIN SHAKES/POWDER CASEIN

Type of Protein Supplements

22

H. Reasons for attending gym

60% of the sample (50) attended gym in order to be in good shape and get the perfect body

construction they wish to have, while only 24% attended to profit from the health benefits

exercising offers and the last 16% showed up only to exercise.

60%24%

16%

Reason for Attending Gym

Good Shape Health Benefits To Exercise

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I. Source of advices

The greatest influence on gym-goers to consume protein supplements dominated by gym

instructors scoring 40%, followed by media with a 30% and personal choice with 20%. The

minor influence was provided by friends with a 10% score.

10%

40%

30%

20%

Motivation

Friends Gym Instructor Media Personal Choice

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J. Sources of Supplements

As for the sources of protein supplements that gym goers consume, it varied significantly,

whether from the Gym, the Nutrition Supplements Stores, the Online Stores and Sports Stores.

Most of the gym goers got their supplements from the Gym (14 out of 20).

4 gym goers got their supplements from the Nutrition supplement Stores and the rest from the

Online Stores.

None of the participants recorded buying their supplements from the Sports Stores.

4

14

2

0

20%

70%

10%

0%

0 2 4 6 8 10 12 14 16

Nutrition Supplement Stores

Gym

Online Stores

Sport Stores

Sources of Supplements

Percentage N

25

K. Side Effects

13 out of the 20 protein supplementers noticed positive side effects after they consumed protein

supplements and 7 participants didn’t undergo any physical or performance changes.

7

13

0

S I D E E F F E C TS

SUPPLEMENTS SIDE EFFECTS

No Positive Positive Negative

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Discussion

In Lebanon, there was a scarce in studies taking protein supplements topic into

consideration. This study was done to assess the prevalence of protein supplements’ intake by

gym-goers in Lebanon.

One study was found considering Beirut population in Lebanon done by Khoury and

Antoine-Jonville (2012) and followed approximately the same rout of questions and methods.

Our study, where the prevalence of supplementation was found to be 40%, is almost the same as

the one described by Khoury and Antoine-Jonville (2012) which resulted in 36.3% of gym-goers

consuming supplements. But the prevalence in our study was significantly lower than the one

found in the Oliver et al (2011) study, where they got a prevalence of 28% out of 415

participants from both genders as well. Our study also scored higher prevalence than in both

Hirschbruch et al (2008) and Lavalli Goston and Correia (2010) studies were they respectively

obtained 10 and 13.98% of protein intake by gym-goers.

In addition, there was another sign of constancy between our study and the one done in Beirut,

revealed by the type of protein supplements consumed; protein powder consumption had a

prevalence of 40% and 39.8% in both our study and this study respectively. However, whey

consumption differed with a prevalence of 20% and 32.3% respectively.

Our findings revealed a very high intake of protein supplements which have reached 90

grams per day and 75 grams per day; it is significantly high compared to the RDA

(Recommended Daily Intake) of 0.8-1.0 g/kg per day. This also correlates with the results of

Oliver et al (2011) were 25% of the gym-goers had far exceeded their RDA with the use of

protein supplements.

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Sources of information about protein supplements intake are very controversial,

considering the limited scientific background from where it originates, such as media, trainers,

friends or either personal choice. In the current study, gym instructors were the primary source of

information. This finding is compliant with Khoury and Antoine-Jonville (2012) discovery

where coaches provided an ultimate source of information for exercisers. Therefore, critical

considerations about the accuracy, feasibility and effectiveness of such information and

knowledge are taking place; taking into account that most of what concerns coaches and gym

instructors would be the financial benefits they receive by giving such advices and motivations

(Khoury and Antoine-Jonville, 2012).

Another influential factor greatly affecting people’s choice to consume protein supplements

would be “Media”. Media in all of its shapes, television, internet, books and magazines subjected

30% of our study participants to protein supplements consumption. Our conclusion correlates

with Jacobson et al (2001) and Rosenbloom et al (2002) who considered media, coaches and

peers as a poor source of nutritional scientific information. Duellman et al (2008) also showed

that 7 out of 39 protein supplementers got information on supplementation from the media.

Furthermore, getting feedback about sports topics from medical professionals and scientific

professors is very low as evidenced by a prevalence of 73.1% of gym-goers not asking for

guidance or advices from nutritionists (Khoury and Antoine-Jonville, 2012).

Now considering the effects provoked by this consumption, 65% of the participants using

supplements in our study reported positive results, whereas 35% (7 individuals) stated the

absence of any positive results and no one reported the occurrence of any negative side effects.

Compared to the study done by Oliver et al (2011), a higher percentage of exercisers (77.4%)

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testified experiencing positive results, while 19.1% reported experiencing negative results and

3.7% were indecisive.

Reasons for which exercisers attend gym vary considerably. 24% reported attending the

gym for health benefits and to prevent disease manifestation and 60% to be in good shape.

Closely, 15.6% of gym-goers who consume supplements in Beirut stated exercising for the

prevention of disease occurrence in the future but with a greater frequency of 47.3% was for

muscles and weight gain (Khoury and Antoine-Jonville, 2012).

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Limitations

Several limitations might affect the strength of the study. The study population may not

be as representative to the entire Lebanese gym-goers population.

First, the study sample was small which may lead to sampling error and is limited to only two

gyms in two cities in Lebanon; Zahle and Beirut. Also, the time at which data were collected

may not be representative to all the gym-goers were some might be at work, or have afternoon

sessions at the universities. Therefore, a greater sample must be targeted with a broader set of

cities and settings in Lebanon to get as much as possible data that would be reliable.

In addition, weight and height were self-reported and not measured by the investigator and

inaccuracy may result. Thus, the use of a digital scale and a stadiometer would be helpful for

getting more accurate information.

Second, some of the participant would have reporting bias and may not express freely the

possible occurrence of any side effects due to supplements’ use. Maybe a prospective cohort

study would be beneficial to follow the participants and see the possible manifestation of any

positive or negative side effects.

30

Ethics

Participation in this study was voluntary and confidentiality was conserved; the identity

of the participants was not collected and privacy was preserved.

The purpose of the study and its importance were explained and participants were

informed that no intervention would take place. The health and physical beneficence of the study

also have been explained. In addition, the participants were acknowledged that the investigator is

a student at the University of Balamand and that the study is for research purposes and not to

intrude their privacy and personal information. This study offers no harm whether physical,

social, legal or psychological of any kind. Only those who wish to participate will give us 10

minutes of their time to fill the questionnaire and whoever wished not to participate had the

freedom to return the questionnaire and not be part of the study.

Questionnaires were kept in a sealed safe place and only the investigator will have access

to it. And after about 5 years of the analysis and publication of the findings, data will be

destroyed.

31

Conclusion

Our study findings revealed a high prevalence of protein supplementation among gym-

goers which highlights the need to develop and implement programs and strategies to spread

scientific knowledge and awareness, especially among young adults, for the prevention of any

possible disorders resulting from the over consumption of these additives.

Control over the media should be applied to prevent any further negative impact on the

knowledge and perceptions of gym-goers and all the exercisers who wish to build the perfect

body shape. In addition, investigation should be done to govern non- medical professionals who

are promoting the use of supplements for financial profits.

Further studies should be done to investigate the possible occurrence of any side effects or

negative implications of over consumption of protein intake on gym-goers.

32

Survey

1. Sex:

Male ( ) Female ( )

2. Age:

------

3. Weight Height BMI

------ ------- ------

4. What is the main reason for attending gym?

a. Good shape

b. To exercise

c. For health benefits

5. How often do you attend the gym?

a. Daily (60min/day)

b. 3 days a week

c. Few hours a week (less than 3 hours)

d. Other

6. Do you consume any protein supplements to increase your muscle mass?

a. Yes

b. No

7. If no, what is the reason that you don’t consume supplements?

a. You’ve heard it’s unhealthy

b. You think they are expensive

33

c. You don’t believe in their efficacy on muscle mass and performance

d. You don’t know what supplements are

8. If yes, where do you get your supplements from?

a. Gym

b. Sports stores

c. Nutrition supplements stores

d. Online Stores

9. Who motivated you to consume supplements?

a. Friends

b. Gym instructor

c. Trainers

d. Personal choice

e. Media

10. What is your daily intake of protein supplements?

---------

11. Have you noticed any side effects after consuming protein supplements?

a. Yes

b. No

12. Have you noticed any positive changes after consuming these supplements?

a. Yes

b. No

13. What type of supplements do you use?

a. Protein shakes/powder

34

b. Whey

c. Casein

35

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