Supplements: Modern Miracles?
THE PHYSICIAN AND SPORTSMEDICINE - VOL 27 - NO. 5 - MAY 99
Our news editor, Lisa Schnirring, joked not long ago that The Physician and Sportsmedicine should run a "supplement of the month" column. If we did, filling the column wouldn't be a problem—narrowing the choices would be. You might have read this year about SAMe (S-adenosylmethionine), whey protein, glutamine, olive leaf extract, and glyconutrients, to name a few. But the story would tend to follow a standard pattern: Claims of "Great Benefit X" would usually give way to "Inconsistent Evidence of Y" or "Side Effect Z," and the various views would be supported by enthusiastic, cautious, or cautionary statements by proponents and skeptics.
Despite this predictability, nutritional supplements arrive regularly on the athletic scene, each touted as enthusiastically as the last. Part of this steady stream is propelled by the fact that occasionally a supplement or technique really does enhance performance. But the flow of supplements (and money) is driven even more by the athletes' craving for prowess, perfection—and magic. In consumer magazines like Muscle and Fitness and Triathlete, the ad copy reflects the desire: "Get the body you want," "Bring out the animal in you," "Achieve peak physical performance," "Go faster...go harder...go longer."
Some have attributed the modern obsession with ergogenic aids to our wish for instant gratification. (Don't make me work for those muscles—I'm gonna buy 'em!) Certainly an element of gullibility is involved as well. But the use of potions and special foods to enhance strength and endurance is hardly a modern invention. Greek Olympians, for example, downed mushrooms, Aztecs used a cactus-based stimulant, and Peruvian Indians chewed coca. Use of these substances was often included in ritual as well, raising or reflecting their importance to the society. At least for a subset of the population, the culture around modern athletics and its traditions is strongly related, in emotional terms, to these ancient devotions. For all these reasons, though particular supplements may come and go, purported ergogenics in general aren't disappearing any time soon.
A few supplements remain popular and widely used for years. Creatine is one of these. In this issue, author Mark S. Juhn, DO, in his article "Creatine Supplementation: Separating Fact From Hype," page 47, succinctly analyzes the literature on creatine's ergogenic efficacy and conveys what is known and unknown about the supplement's safety. When patients come to you with the questions, "Does creatine work? Can it hurt me?" the information in this article can help you provide answers that balance the nature of the supplement—its effects, side effects, and chemical purity—with the patient's unique history and needs and your own and society's ethical principles.
Keeping up with the supplements du jour requires a lot of effort. We'll do our best to help, keeping you updated on significant new and commonly used ergogenics (though we won't be adding a supplement-of-the-month department). Some of the resources we draw on may also help you and your patients: On the Web, try the database of the National Institutes of Health (https://dietary-supplements.info.nih.gov) and the nonprofit Quackwatch, Inc. (https://www.quackwatch.com). One of many print resources is The Ergogenics Edge: Pushing the Limits of Sports Performance, by Melvin H. Williams, PhD (National Council Against Health Fraud Books, Allentown, Pennsylvania).
As always, we invite your comments and questions; please let us know what we can do to help you more.