Sports Medicine Corner
By Dr. Don Kirkendall
I’m kind of an infographics junkie, always interested in seeing how creative people present data (especially BIG DATA) in a meaningful design. My favorite book is The Visual Miscellaneum by David McCandless. Great visuals. Worth a look.
One of his most widely circulated designs is entitled Snake Oil where he presents “scientific evidence for popular dietary supplements showing tangible health benefits when taken orally by an adult with a healthy diet” (pg 18). You can see an interactive version on his website at
I thought of that graphic when I saw that researchers at Johns Hopkins published an article in the December 2013 issue of the highly respected Annals of Internal Medicine titled “Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer.”
The bottom line? They found “limited evidence to support any benefit from vitamin and mineral supplementation for the prevention of cancer or cardiovascular disease.” They did mention that two studies showed “small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on cardiovascular disease.”
Those results were supported by an editorial that was simply titled, “Stop Wasting Money on Vitamin and Mineral Supplements.[show_disconnected][show_to accesslevel=’Subscriber’]”
It was estimated in 2012 that nearly $32 billion was used to buy supplements, and that’s just in the United States. About half of all Americans take a supplement and many take multiples. Part of the problem is that if a little doesn’t do much, then more is needed.
This is in spite of clear evidence that beta-carotene, vitamin E, maybe even vitamin A actually increase mortality. Antioxidants (wildly popular in sports), folic acid, B vitamins, and multivitamins provide no clear benefit (remember the focus from the study: prevention of cancer and cardiovascular disease.
Folic acid is routinely prescribed, for good reason, for pregnant women. Iron is another item that is beneficial, but only in those who actually need it. Both are prescribed for the short term). The jury is still out on the current wonder child: vitamin D. There is particular interest in (mostly older) people with a documented deficiency.
On the grand scheme of global population, athletes are but a small piece of the population pie, but surveys show that athletes as a group are very heavy users of supplements. There are surveys from international competitions showing that 100%, that’s every participant, takes something. Multivitamins are the most common.
FIFA has an initiative underway to discourage the routine use of non-steroidal anti-inflammatory drugs (aspirin, Advil, Alleve, etc.). Players will use these to deal with pain of training and competition (they think), but excess use of NSAIDs can disrupt transit of molecules across the small intestine (the phrase is ‘a loss of gut barrier integrity’).
One of the issues with supplements has to do with purity. Consider a supplement manufacturer in, say Asia or Africa (or anywhere. The supplement industry is largely unregulated). The machinery is used to make a multivitamin. Then it has to be reconfigured to make, say, antibiotics for inclusion in animal feed. Then something else is next.
What’s the weak link (and the most expensive step) in this process? Cleaning the machinery. So guess where a company is most likely to look to save some money? The cleaning process. That’s why the IOC found that nearly 40% of a random sample of over the counter supplements was so tainted that their use would result in a positive doping test.
And no one can be sure that all ingredients are listed on the label. Some ‘muscle/strength building’ supplements actually contain some unlabeled anabolic steroids. The user does indeed get stronger and bigger, so the supplement worked and continues to get purchased.
If the user is in a sport that conducts doping controls, they are toast. No governing body buys the ignorance argument – you took it, you’re guilty. Next case.
Worse, about the same time that I saw that Annals article, I saw a New York Times report of liver damage from use of a ‘fat burning’ supplement. A 17-year old boy in Texas went to the ER with ‘highlighter yellow’ eyes, chest, and face. That boy is now on the liver transplant list. The article went on to say that dietary supplements are responsible for 20% of drug-related liver damage and that this is 2-3 times higher than what was seen just 10 years ago.
And this one is not seen in just kids. It’s turning up in middle age women who turn to these ‘fat burner’ supplements for weight loss. Used to be that liver damage in athletes was related to anabolic steroid use. Not any more.
Most of the offending ‘fat burner’ products are highly concentrated doses of catechins, a favorable component of green tea that in huge doses is toxic to the liver.
One problem is no one knows who is or isn’t susceptible to high doses of anything, much less a component of green tea ( cited two products connected to acute hepatitis: OxyElite Pro, and OcyElite Pro Super Thermo Powder, both are in the process of being pulled from the shelves).
I like the editorial’s title: Stop Wasting Money! A varied, colorful diet according to accepted nutritional standards works perfectly well. The only real difference between an athlete’s diet and that of a spectator is simply the volume.
Spend the money on food, not a pill or a powder, and do the one thing absolutely known to improve sports performance: work hard.


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