New Paper Finds Natural Supplements Can Pose Heart Risks for Athletes

The paper also outlines the cardiovascular effects during sports of doping substances, prescribed and OTC medicines, legal performance-enhancing supplements, and experimental drugs.

A statement from the European Association of Preventive Cardiology warns that nutritional supplements taken to boost athletic performance may pose risks to the heart.

“Nutritional supplements are commonly viewed as risk-free substances that may improve performance,” the paper states. “Some nutritional supplements, including various plant and ‘natural’ extracts, may pose a serious health risk and athletes may even risk contravening anti-doping rules.”

The document notes that athletes who use supplements frequently lack knowledge regarding t effects on sports performance and overall health.

“It is reported that most athletes get nutritional advice from coaches, fellow athletes, family members and friends, suggesting that more wide-reaching educational interventions, at an early age, are necessary,” the paper authors wrote.

Some key points for athletes using nutritional supplements include:

  • Knowing that a natural supplement is not necessarily a safe supplement.
  • Looking for products by established manufacturers with known good quality standards.
  • Being an athlete means you are personally responsible for any substances you consume.
  • Being ignorant is not accepted as an excuse in relation to a positive doping test.

The paper also outlines the cardiovascular effects during sports of doping substances, prescribed and OTC medicines, legal performance-enhancing supplements, and experimental drugs.

Although the World Anti-Doping Agency maintains a list of prohibited drugs, nutritional substances are not included because many are unregulated and unlicensed. Legal supplements vary between 40% and 100% depending on the sport and level of competition, which include caffeine, creatine, energy drinks/gels/bars, beetroot juice, and proteins.

“Caffeine is a prime example of a natural substance that is considered safe,” said first study author Paolo Emilio Adami of World Athletics, MD, the global governing body for track and field, in the press release. “While caffeine improves performance, particularly aerobic capacity in endurance athletes, its abuse may lead to fast heart rate (tachycardia), heart rhythm disorders (arrhythmias), high blood pressure, and in some cases sudden cardiac death.”

The researchers noted that athletes commonly ignore dosing recommendations and use multiple drugs simultaneously.

Athletes should continue to be aware that supplement use exposes them to the risk of ingesting prohibited substances because they are regulated as food ingredients and not subject to the rigorous safety standards of pharmaceutical products, according to the paper.

The document also warns that athletes’ desire and consent to use experimental drugs that have not been proven safe in humans is potentially even riskier than using steroids or other prohibited drugs.

The document further states that ongoing use of selective androgen receptor modulators or peptides have a substantial risk for long-term negative health consequences that are frequently understated by their promoters.

The paper emphasizes that doping to improve strength, reduce pain, and repair tissues is anticipatedand lacks protective actions that may subsequently increase health risks. The researchers said this represents a significant threat regarding the future of human performance manipulation.

“In many cases sportspeople use a mix or cocktail of substances to improve their performance and the interaction between them can also be extremely dangerous. All doping substances are risky and their use as medications should only be allowed when prescribed by a physician to treat a medical condition, when no therapeutic alternatives are available, and following the Therapeutic Use Exemption requirements,” Adami said in the press release. “Based on the dose, the duration of use, and the interaction with other substances the health consequences can vary and in some cases be lethal. From a cardiovascular perspective they can cause sudden cardiac death and arrhythmias, atherosclerosis and heart attack, high blood pressure, heart failure, and blood clots.”

Adami added that athletes should be aware that natural supplements and substances are not necessarily safe and should only be used if recommended by professional nutritionists.

“It is fundamental to use products from well-established manufacturers with known and internationally approved good quality standards,” Adami said in the press release. “Athletes are always personally responsible for any substances they consume. Ignorance 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.”


Athletes warned against potential dangers of natural supplements. European Society of Cardiology. January 27, 2022. Accessed January 28, 2022.

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