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Vitamins and Supplements for Athletes? Only in Special Cases

Bert R. Mandelbaum, MD, DHL (Hon)


October 21, 2015

Supplements Send Thousands to the ED

Sports medicine physicians get questions all the time about nutritional supplements and performance-enhancing drugs. We hear from professional athletes looking for an edge that could transform their careers and from amateurs who don't have to submit to drug tests. And with the news reported this month that supplements send 23,000 Americans to emergency departments every year, those questions are taking on a new urgency.[1]

The supplement business is lucrative; it took in about $32 billion in 2013.[2] Too often the companies behind these pills are selling hype and false hope. People hear marketing fluff on TV and can't sort it out.

So how can we help athletes make the right choices?

Risks of Vitamins and Supplements

It would be dishonest to start by saying that no drug is going to help your performance. Anabolic steroids can make you bigger and stronger.[3] Caffeine and creatine can provide some temporary zip and zest.[3] A handful of other substances have shown a handful of other benefits.[3]

But all of these substances come with real risks. Steroids can raise the risk for cardiovascular disease and male infertility.[3] I have seen several deaths that I can attribute to some combinations. Caffeine at high levels can impair concentration and cause gastrointestinal upset.[3] Creatine can cause muscle cramps and weight gain.[3]

And dangers lurk in unexpected places. One of the problem substances I see the most is cannabis. Athletes are around marijuana a lot. Some don't realize it is banned by the US Anti-Doping Agency, and not just at the lowest levels.[4]

Even some everyday foods can cause athletes to run into trouble. In some countries, like Mexico, even beef may be tainted by by clenbuterol, a powerful beta-adrenergic agonist popular among anabolic steroid users.[5]

The National Collegiate Athletic Association (NCAA) sanctions athletes for a serum caffeine level above 15 mcg/mL.[6] It would take about 15 cups of coffee to get there, but it happens.[6]

Otherwise innocuous vitamins are often bottled with dangerous contaminants or banned drugs. If you are taking care of athletes, it is your role to help educate them to understand that almost 25% of all supplements may be tainted with some banned substance.[7]


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