Nutritional supplements used to improve sports performance may pose risks to the heart

Nutritional supplements taken to improve athletic performance may pose risks to the heart, according to a statement from the European Society of Cardiology (ESC) published today in the European Journal of Preventive Cardiology, a review of the ETUC.

“Nutritional supplements are generally considered safe substances that can enhance performance,” the document states. “Certain nutritional supplements, including various herbal and ‘natural’ extracts, may pose a serious health risk and athletes may even be at risk of anti-doping rule violations.”

“Athletes who use supplements often have no knowledge of their effects on athletic performance and overall health,” the paper continues. “Most athletes are reported to receive nutritional counseling from coaches, other athletes, family members and friends, suggesting that broader educational interventions at an early age are necessary.”

Key points for athletes using dietary supplements:

  • A natural supplement is not necessarily a safe supplement.
  • Use products from established manufacturers with recognized quality standards.
  • Athletes are personally responsible for the substances they use.
  • Ignorance is not accepted as an excuse for a positive doping test.

The position paper describes the cardiovascular effects during sports of doping substances, prescription and over-the-counter drugs, legal performance-enhancing supplements and experimental drugs.

Doping refers to the use of a substance or method that is potentially harmful to the health of athletes or likely to improve their performance. To take one example, deaths in athletes doped with anabolic androgenic steroids are estimated to be 6 to 20 times higher than in clean athletes, and approximately 30% of these deaths can be attributed to cardiovascular causes.

The World Anti-Doping Agency (WADA) maintains a list of prohibited drugs, but nutritional substances are not on it, as many are not regulated or permitted. The use of legal supplements by athletes varies between 40% and 100% depending on the sport and the level of competition. Intended to enhance performance and provide a competitive edge, legal supplements include caffeine, creatine, energy drinks/gels/bars, beet juice, and protein.

Caffeine is a great example of a natural substance considered safe. Although caffeine improves performance, especially aerobic capacity in endurance athletes, its abuse can lead to rapid heartbeat (tachycardia), heart rhythm disturbances (arrhythmias), high blood pressure, and in some cases , sudden cardiac death..”

Dr Paolo Emilio Adami, Study First Author, World Athletics

“The ‘more is better’ philosophy, when applied to caffeine consumption in sport, may result in side effects that outweigh the performance benefits,” the paper states.

Many elite athletes consume a combination of supplements daily and the document states, “Unfortunately, it is common for athletes to ignore dosage recommendations and use multiple medications simultaneously.” Athletes should be aware that the use of supplements puts them at risk of ingesting prohibited substances as they are regulated as food ingredients and not subject to the rigorous safety standards of pharmaceutical products.

The document warns that the desire and consent of athletes to use experimental drugs that have not been proven safe in humans is potentially even riskier than the use of steroids or other banned drugs. Continued use of selective androgen receptor modulators or peptides “carries a substantial risk of adverse long-term health consequences, which are generally underestimated by their promoters,” the document states. He also points out that gene doping to improve strength, reduce pain and repair tissue should “occur behind the scenes with limited protective actions and therefore increased health risks” and “poses a great threat and major concern for the future of human performance manipulation”. .

Dr Adami said: “In many cases, athletes use a mixture or cocktail of substances to enhance their performance and the interaction between them can also be extremely dangerous. All doping substances are at risk and their use as medicine should only be authorized when prescribed by a physician to treat a medical condition, when no therapeutic alternative is available, and following the requirements of the Therapeutic Use Exemption (TUE) Depending on the dose, duration of use and interaction with other substances, the health consequences may vary and in some cases From a cardiovascular point of view, they can cause sudden cardiac death and arrhythmias, atherosclerosis and heart attack, high blood pressure, heart failure and blood clots.

He continued: “Athletes should be aware that natural supplements and substances are not necessarily safe and should only be used if recommended by professional nutritionists. It is fundamental to use products from well-established manufacturers with internationally recognized and approved quality standards.”

Dr. Adami concluded: “Athletes are always personally responsible for the substances they use. Ignorance is not accepted as an excuse for a positive doping test. In people with established cardiovascular disease, a doctor or a sports cardiologist should always be consulted before using any performance aid or supplement.”


European Society of Cardiology

Journal reference:

Adami, PE, et al. (2022) Cardiovascular effects of doping substances, commonly prescribed drugs and ergogenic aids in relation to sport: a position statement from the sports and exercise cardiology core of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology.

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