Counseling on Caffeine, Energy Drinks, and Other Natural Supplements

Every athlete works to be the best they can be on the playing field. Some athletes (not the majority) consume nutritional supplements that are used to improve athletic performance. But is consumption of these products in the best health of the athlete? The answer is probably no.

A recent position paper published by the European Association of Preventative Cardiology states, “The use of substances and medication with potential cardiovascular effects among those practicing sports and physical activity has progressively increased in recent years.”¹

The policy addresses 3 categories of users:

• professional and amateur athletes using substances to enhance performance;
• people with chronic conditions, who include physical activity and sport in their therapeutic plan, in association with prescribed medications; and
• athletes and young individuals using supplements or ergogenic aids to integrate their diet or obtain a cognitive enhancement effect.

The list of substances used by these 3 groups is substantial.  They include anabolic agents (ie, erythropoietin) which activate the androgen receptor signaling.² This signal increases testosterone levels which, when combined with regular training, increases muscle mass strength and reduces body fat.  These substances are associated with 6x-20x increased mortality, 30% of which is due to cardiovascular events, compared to athletes not taking substances.³

Other substances include human growth hormone, selective androgen receptor modulators, many narcotic analgesics, β-2 agonists, glucocorticoids, and stimulants. These agents lead to cancer, hyperlipidemia, arrhythmias, and cardiac arrest.¹

Commonly prescribed medications are also used. Β-adrenergic blockers (ie, nebivolol, atenolol, propranolol) and anthiarrhythmics (ie, flecainide) have been used.¹ Even anticoagulants and antiplatelet agents have been tried.¹  

Caffeine and nicotine are very common supplements for athletes. Caffeine acts as a stimulant during exercise and attenuates autonomic recovery postexercise.³ Nicotine is one of the most widely used psychostimulants and is used in many forms prior to or during an event (ie, nicotine gum) to improve time to exhaustion.⁴

Counseling on the use of these agents is very important. Beginning use of these substances may, and often does, lead to a pathway of prohibited substances. If combined in a “cocktail” of multiple substances, excessive cardiovascular danger may ensue.

Athletes and persons with underlying cardiovascular disease must be warned about not using these supplements. The results can be fatal.

References:

1. 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 Preventative Cardiology. Eur J Prev Cardiol. 2022;zwab198. doi:10.1093/eurjpc/zwab198
2. Pope Jr HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: An Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341-75. doi:10.1210/er.2013-1058
3. Sarshin A, Naderi A, da Cruz DJG, et al. The effects of varying doses of caffeine on cardiac parasympathetic reactivation following an acute bout of anaerobic exercise in recreational athletes. J Int Soc Sports Nutr. 2020;17(44). doi:10.1186/s12970-020-00373-6
4. Johnston R, Crowe M, Doma K. Effect of nicotine on repeated bouts of anaerobic exercise in nicotine naïve individuals. Eur J Appl Physiol. 2018;118(4):681-689. doi:10.1007/s00421-018-3819-x