Natural supplements and potential risk factors on athletes’ cardiovascular health


In a recently published report, the European Society of Cardiology (ESC) warned athletes of the adverse cardiovascular effects associated with natural substances and their potential to coincide with doping.

Published in the European Journal of Preventative Cariology, the paper is a comprehensive look on the adverse effects that many medications, substances, and supplements have on cardiovascular health as they relate to athletes and doping. In the paper, lead author, Paolo Emilio Adami, MD, PhD, and his colleagues explained that between 40 and 100 percent of competitive athletes take supplements, often all-natural, plant-based, and legal, to enhance their performance. According to the paper, research suggests the most common supplements taken by these athletes included multivitamins/multiminerals, vitamin C, vitamin D, and iron.

The paper said that while the World Anti-Doping Agency (WADA) does not consider consumption of legal nutritional supplements to be doping, they do pose potential risk factors. The authors explain that most ingredients in these supplements like caffeine, creatine, β-Alanine, sodium bicarbonate, and nitrates are naturally occurring and generally considered safe but in high doses, they can be harmful to cardiovascular health. For instance, Adami and his colleagues described creatine as “the most popular non-stimulant legal ergogenic supplement in sports since the early 1990s” and he paper recounts case reports suggesting a link between creatine health problems such as deep vein thromboses, atrial fibrillation, and cardiac arrhythmia.

According to the paper, supplements are not subject to the same regulations of pharmaceutical products and in turn, they could include substances or prohormones that are prohibited under WADA rules. In addition, the paper said athletes who ingest supplement “cocktails” risk mixing substances that have harmful health effects when taken together. The authors also said athletes commonly ignore dosing recommendations, which can lead to cardiovascular disorders.

To conclude, the authors urge athletes to be hyperaware of the nutritional supplements they choose to ingest, how these supplements interact with other substances, and dosing information. This paper is relevant to the integrative healthcare community as it reminds physicians treating athletes to make sure recommended supplements do not violate doping regulations and are safe when paired with rigorous exercise.