October 18, 2021

Supplements & The Tactical Athlete: Brief Update

Brian L. Springer, MD, FACEP

 

Supplement use is common among competitive and recreational athletes. This is also true when working with the tactical athlete. In order to ensure mission safety and success, as well as peak health and fitness of their personnel, tactical medical providers (TMPs) must have a working knowledge of sports medicine and be aware of what officers are putting in their bodies to enhance performance and speed recovery.

As a general rule, the TMP should remember that supplements are not regulated as medications, but instead like a food product. Under the 1994 Dietary Supplements Health and Education Act, the burden lies on the FDA to prove that a supplement is harmful, rather than on the manufacturer to demonstrate product safety and efficacy. While the article is over 15 years old, any physician who treats athletes (to include tactical athletes) at any level should read “Sports Supplements: A Modern Case of Caveat Emptor” by Pearce in Current Sports Medicine Reports, June 2005;4(3):171-178. A terrific article to refer to your officers is “Supplements 101 For Law Enforcement” by Henkel on the Law Officer website: https://www.lawofficer.com/supplements-101-for-law-enforcement/. Remember, just because a supplement makes a claim on the label, there may not be any scientific validity to that claim, and safety of the product is not guaranteed.

Optimal exercise performance and recovery in training and operations requires a properly balanced intake of fluids, calories, carbohydrates, fats and protein. Supplements can help, although there is still a paucity of solid data relative to the number of supplements that are sold and touted, particularly on the internet. There are some standouts, with caffeine and creatine both being well researched and effective. Caffeine, taken 60 minutes pre-work-out at doses of 3-6 milligrams/kilogram, is effective in increasing performance for all durations of exercise. At that dose and lower, it can enhance alertness and can improve workout quality. Be aware that when discussing the proven ergogenic dose, we are talking at least 2 cups of coffee or two Red Bull energy drinks for a 70 kg athlete, and this may have adverse effects such as sleep disturbances, tachycardia, nausea, and anxiety (Casazza G, et al. Energy Availability, Macronutrient Intake, and Nutritional Supplementation for Improving Exercise Performance in Endurance Athletes, Current Sports Medicine Reports June 2018 17(6):215-223.)

Creatine, dosed with a loading phase followed by a maintenance phase, increases performance in repeated bouts of brief (10-20 seconds) high intensity exercise. It continues to show an impressive safety profile, with no serious adverse effects reported with up to 5 years of daily doses of 30 grams. Performance benefits are most consistently demonstrated in weightlifting and bodybuilding athletes, who rely on short high intensity bursts and the development of lean body mass. The effects of creatine supplementation on specific sports performance (wrestling, tennis, soccer, squash) are variable, with some studies showing improvement in the highest intensity components of a given sport, and others showing no benefit. Increased total body weight due to intracellular water retention, a side effect of creatine’s osmotic effects, could potentially affect athlete performance, especially in endurance sports (Hall M, et al. Creatine Supplementation: An Update, Current Sports Medicine Reports July 2021;20(7):338-344.)

Not surprisingly, placebo effect plays a major role in how supplements and other interventions affect sports performance, even in supplements where there is evidence of physiologic ergogenic effects. In the fascinating article “Nonplacebo Controls to Determine the Magnitude of Ergogenic Interventions: A Systematic Review and Meta-Analysis” (Marticorena F, et al. Med Sci Sports Exerc August 2021;53(8):1766-1777) the authors note that studies of ergogenic aids without a non-placebo control arm may underestimate the overall effect of the supplement plus placebo effect. The authors found that the difference between an active intervention (ergogenic supplement) and a non-placebo was greater than the difference between a supplement and placebo. In other words, placebo effect is strong, and accounts for up to 60% of the overall effects of supplements in the articles the authors incorporated into their metanalysis. They emphasize that coaches and practitioners should be aware that the effects of supplements and placebo are additive, and a positive belief in the supplement’s efficacy may actually further increase performance.