by Douglas Page © 2002
Sports medicine experts contend that dietary supplement use among football players may be a factor in the recent surge
of heat stroke deaths among football players, according to a special editorial in the August, 2002, edition of the journal
The editorial argues that popular diet supplements may have a significant impact on the body's ability to remain properly
hydrated, especially during stressful exercise in hot weather.
"Recent trends in football heatstroke fatalities may, in part, be attributable to or aggravated by the use of dietary supplements,"
said Julian Bailes, M.D., chair of neurosurgery at West Virginia University, and a consultant to the National Football League
Players Association on health issues. "Credible scientific evidence has been found that amphetamine derivatives and the ergonomic
aid creatine may contribute to subclinical dehydration and heatstroke in selected individuals."
In the ten years from 1985 through 1994, only six deaths secondary to dehydration and heatstroke were recorded among football
players - a rate of 0.6 per year, but there were four deaths each in 1995, 1998, 2000, and 2001, Bailes said.
All the deaths, including the widely-reported collapse and death of Korey Stringer of the Minnesota Vikings in August 2001,
happened during summer practices.
The editorial therefore urges athletes, coaches, trainers, and team physicians to be vigilant for signs of heat stress,
and to put more effort into letting players know that there are well-recognized risks in using unregulated diet supplements.
"Improvements in the education of athletes about the dangers of over-the-counter supplements and the misuse and potential
adverse effects of such substances are necessary, because the use of these substances may predispose certain individuals to
experience life-threatening dehydration and heatstroke."
Ephedrine and related compounds, sold as "herbal energy" products, are promoted as weight-loss and energy-booster compounds.
The herbal product, also sold as Ma-huang, has an amphetamine-like effect. It can have serious potential side effects on the
heart and central nervous system, as well as raising core body temperature and decreasing the body's ability to cool.
Creatine monohydrate is marketed as a muscle builder. It has been shown to shift body water from the bloodstream into muscle
cells, which makes heatstroke more likely.
Use of both products is common in athletes, although the NFL and the NCAA have both taken steps recently to ban ephedrine
"Protocols that limit strenuous exercise during hot weather should be encouraged, and the early recognition of warning
signs may prevent the serious consequences of heat-related illness from occurring," Bailes said.
It has been estimated that athletes require one to two weeks to become acclimated to exercising in hot conditions, and
fluid delivery remains the top priority for athletes while exercising in hot environments. Programmed drinking with cold liquid
(especially water) seems to increase the rate of body core cooling and gastric emptying, he said.
"High school, college, and professional athletes are under a great deal of pressure to produce peak performances, and the
use of nutritional supplements seems to be the rule rather than the exception," Bailes said. "The use of these unregulated
dietary and nutritional supplements may be a significant risk factor for intravascular volume depletion and has the potential
to cause central nervous system side effects in selected or vulnerable athletes."
Three distinct periods of heatstroke fatality trends in American football are evident over the past 30 years, according
to data collected by the National Center for Catastrophic Sports Injury Research.
Forty-four deaths (4.4/year) occurred during the initial period (1965-1974), before awareness of the dangers of dehydration
in sports became prevalent. After the publication of scientific evidence and reports of the advantages of proper hydration
before and during practices and games, the next 10-year period (1975-1984) witnessed a total of 17 fatalities (1.7/year).
Then, from 1985 to 1994, further developments led to greater understanding of the role of free access to water for hydration
and rehydration, as well as the promotion of policies and publicity that advocated active fluid replenishment, on a regular
basis, with both free water and electrolytes. During this period, only six deaths (0.6/year) secondary to dehydration and
heatstroke were recorded.
The events of the most recent period (1995-2001), however, indicate a reversal of this downward trend, despite widespread
dissemination of information to and education of athletic trainers, coaches, and players.
"This recent increased incidence, highlighted by lay press reports, raises the question whether athletes' current behavior
and training regimens pose new and dangerous risks for heatstroke," Bailes said.
While the exact science and pathophysiology of dehydration and heatstroke in athletes is incompletely understood, advances
in the management of hydration, electrolytes, and practice session strategies have occurred in sports over the past three
decades, leading to progressively diminishing fatality rates due to heatstroke in athletes.
"The recent and dangerous upward trend is disturbing." Bailes said. "These data suggest that another mechanism besides
heatstroke may be involved."
Article appeared in the Oct/Nov 2002 issue of GridIron
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