Athletes face heart health risks if they take some nutritional supplements to boost performance, cardiologists warned today.
A paper published by the European Society of Cardiology (ESC) in the *European Journal of Preventive Cardiology* says although nutritional supplements are commonly viewed as risk-free substances that may improve performance, some, including plant and ‘natural’ extracts, may pose a serious health risk and athletes could also risk contravening anti-doping rules.
“Athletes who use supplements often have no knowledge regarding their effects on sports performance and overall health,” write the authors.
“It is reported that most athletes get nutritional advice from coaches, fellow athletes, family members and friends, suggesting that more wide-reaching educational interventions, at an early age, are necessary.”
The position paper outlines the cardiovascular effects during sports of doping substances, prescribed and over-the-counter medicines, legal performance-enhancing supplements, and experimental drugs.
Although the World Anti-Doping Agency (WADA) publishes a list of prohibited drugs, nutritional substances are not included because many are unregulated and unlicensed.
Depending on the sport and level of competition, athletes’ use of legal supplements, which includes caffeine, creatine, energy drinks/gels/bars, beetroot juice, and proteins, varies between 40% and 100%.
First author Dr Paolo Emilio Adami, of World Athletics, said: “Caffeine is a prime example of a natural substance that is considered safe.
“While caffeine improves performance, particularly aerobic capacity in endurance athletes, its abuse may lead to fast heart rate (tachycardia), heart rhythm disorders (arrhythmias), high blood pressure, and in some cases sudden cardiac death.”
The research paper warns that the “more is better” philosophy for caffeine use in sports could result in side effects that outweigh the performance benefits.
It also says that many elite athletes take a combination of supplements every day and may ignore dosing recommendations, which exposes them to the risk of ingesting prohibited substances because they are not subject to the rigorous safety standards of pharmaceutical products.
The authors also warn that the ongoing use of selective androgen receptor modulators or peptides “carry a substantial risk for long-term detrimental health consequences, which are usually understated by their promoters”.
Dr Adami said: “In many cases sportspeople use a mix or cocktail of substances to improve their performance and the interaction between them can also be extremely dangerous.
“All doping substances are risky and their use as medications should only be allowed when prescribed by a physician to treat a medical condition, when no therapeutic alternatives are available, and following the Therapeutic Use Exemption (TUE) requirements.
“Based on the dose, the duration of use, and the interaction with other substances the health consequences can vary and in some cases be lethal. From a cardiovascular perspective they can cause sudden cardiac death and arrhythmias, atherosclerosis and heart attack, high blood pressure, heart failure, and blood clots.”
He added that athletes should remember they are always personally responsible for any substances they consume.
“Ignorance is not accepted as an excuse in relation to a positive doping test. In those with established cardiovascular disease, a sports physician or sports cardiologist should always be consulted prior to using any performance aid or supplement,” he concluded.
Adami PE, Koutlianos N, Baggish A, et al. Cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids in relation to sports: a position statement of the sport cardiology and exercise nucleus of the European Association of Preventive Cardiology. *Eur J Prev Cardiol.* 27 January 2022. doi:10.1093/eurjpc/zwab198.
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