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Ergogenic aids: Powders, pills and potions to enhance performance

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Americans spend several billion dollars annually on nutritional supplements. Roughly one half of the U.S. population has used some form of nutritional supplement, often on an ongoing basis.1 Supplement use extends from infancy into old age and crosses lines of gender and ethnicity. Nutritional supplements are used in attempts to balance the diet, prevent disease, ward off fatigue, enhance looks and improve performance. Supplements are also being used to augment physical appearance, enhance sexuality, delay aging and increase vitality.

In this issue of American Family Physician, Ahrendt2 raises the particularly important issue of ergogenic supplements used to enhance athletic performance. The mnemonic SOLE (safety, outcomes, legal, ethical), derived from the model proposed by Williams,3 can help physicians effectively counsel patients about the safe and appropriate use of ergogenic supplements.

Is it safe? In 1994, Congress passed the Dietary Supplement Health and Education Act (DSHEA). This act was passed partly in response to public pressure calling for an increase in the availability of natural products designed to promote health and prevent disease. These dietary supplements are not subject to the arduous drug approval process of the U.S. Food and Drug Administration (FDA) and, therefore, do not have rigorous controls on claims of safety and efficacy.

While the risks of androgenic steroid use have been known for some time,4 safety data regarding most of the currently popular ergogenic supplements are purely anecdotal. Creatine was implicated in the deaths of several collegiate wrestlers, but the cause was difficult to prove. Gamma-hydroxybutyrate has been associated with seizures and mortality and has been placed under federal restriction as a controlled substance. Most accounts of adverse events associated with ergogenic supplement use have been reported as individual cases or small case series. Relatively little prospective data are available regarding the safety of most emerging ergogenic supplements....