Supplements for athletes: Experts call for caution

• A position paper authored by the European Society of Cardiology outlines the adverse cardiovascular effects of doping substances, some common medications, and other performance-enhancing supplements.
• The authors outline how these substances, both legal and illegal, can have significant effects on the cardiovascular health of athletes.
• The paper advises athletes to seek medical advice before taking anything that could impact their performance.

Sports activities are increasingly popular and, as people strive to achieve, some may wish to take substances that can enhance performance.

A position paper authored by the European Society of Cardiology, which appears in the European Journal of Preventive Cardiology, provides updated information on how certain medications and supplements can be dangerous for athletes’ cardiovascular health.

The authors outline the intent of their updated statement as follows:

“The objective is to inform physicians, athletes, coaches, and those participating in sport for a health enhancement purpose about the adverse cardiovascular effects of doping substances, commonly prescribed medications, and ergogenic aids when associated with sport and exercise.”

The authors describe doping as “the use of a substance or method [that] is potentially dangerous to athletes’ health or capable of enhancing their performance,” as defined by the International Olympic Committee’s Lausanne Declaration on Doping in Sport.

The use of substances in sports

The World Anti-Doping Agency (WADA) lays out specific substances and medications that athletes cannot use. However, there can be a significant amount of time between athletes experimenting with novel drugs or supplements and WADA being alerted to their use.

Prof. Bernard Cheung, an expert in cardiovascular disease who was not involved in the recent paper, explained to Medical News Today that “the lists of banned substances cannot keep up with new designer drugs designed to circumvent existing regulations.”

The new position paper identifies several doping substances and how they can impact cardiovascular health. It also outlines why athletes use these substances.

Doping substances and cardiovascular health

The paper lists several doping substances and the cardiovascular problems that can arise for some people who use them.

For example, athletes might use anabolic agents to help improve muscle mass. However, these can increase athletes’ risk of heart attacks, thrombosis, heart failure, and coronary atherosclerosis, which is the buildup of plaque in the coronary artery, among other cardiovascular problems.

Similarly, some athletes use stimulants to improve endurance and enhance cognitive function. The authors explain that using stimulants can increase the risk of heart failure, heart attacks, and abnormal heart rhythms.

MNT also spoke with Dr. Edo Paz, a cardiology specialist and vice president of medical at K Health, who was not involved in the paper. He noted the following about the substances discussed in the paper:

“These substances lead to a laundry list of dangerous heart-related issues: high blood pressure, blockages in the arteries of the heart, heart attacks, abnormal heart rhythms, sudden cardiac death, diseases of the heart muscle, and heart failure.”

This paper also discusses the use of more commonly prescribed medications, such as beta-blockers, antiplatelet medications, and psychoactive drugs such as benzodiazepines.

Some of these medications can negatively affect heart health if athletes do not take them correctly.

While doctors regularly prescribe them to help treat medical conditions, individuals need to consult with their doctors about how they might impact them when engaged in sports.

Legal substances and cardiovascular health

WADA allows athletes to take some nutritional supplements. Still, the paper’s authors warn that even legal substances can increase athletes’ risk of cardiovascular problems in some cases.

Many athletes take vitamins, minerals, and other supplements allowed under WADA. However, adverse events can occur when athletes take several supplements at once or ignore dosing recommendations.

Among the listed legal nutritional supplements and products, the authors note that caffeine, nicotine, and some plant supplements can cause heart problems among athletes.

Also, some manufacturers contaminate supplements with prohibited substances. Other supplements still need more testing before we understand their full cardiac effects. The authors make it clear that even if something is labeled “natural,” that does not mean it is safe. They write:

“Some nutritional supplements, including various plant and “natural” extracts, may pose a serious health risk and athletes [who take them] may even risk contravening anti-doping rules.”

Athletes must take a cautious approach and be careful not to overuse these substances. For example, excessive amounts of caffeine can increase heart rates and blood pressure and raise the risk of abnormal heart rhythms.

The key is to use caution and not to take supplements in excess. Dr. Cheung noted to MNT:

“Most athletes do not wish to abuse performance-enhancing drugs, but they are often young and might receive bad advice from the more experienced, including peers and coaches. Many substances, such as supplements, are legal and allowed, but these can also be abused if taken in excess.”

Encouraging healthy practices

The authors note that scientists need to study the heart health impacts of some newer practices. For example, there are many unknowns about the effects of taking synthetic peptides on heart health.

They note that athletes need to educate themselves and take responsibility for any supplements they take. They should consult with their doctors and nutritionists as needed.

Dr. Paolo Emilio Adami, one of the paper’s authors, told MNT the most critical takeaway from this position paper is that every athlete needs to take personal responsibility. He explained:

“The most important takeaway is that athletes are always personally responsible for any substances they consume. This also applies to natural supplements and substances, which are not necessarily safe, therefore should only be used if recommended by professional nutritionists.”

“Ignorance,” the paper states, “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.”

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