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 an article in the August edition of the journal Neurosurgery.

It 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,” says 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 found that amphetamine derivatives and the ergonomic aid creatine may contribute to dehydration and heatstroke in selected individuals.”
In the 10 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 says.

All the deaths, including the widely-reported collapse and death of Korey Stringer of the Minnesota Vikings in August 2001, happened during summer practices.

Ephedrine, Ma-huang, Creatine Targeted
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 use.

“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 says.

It’s been estimated that athletes require 1 or 2 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 says.

Despite the warning signs, the pressure for young athletes to gain an edge has never been greater.

“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 says.

Heatstroke Awareness Critical
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 per 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 per year).

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 per year) due 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.

While the exact science and pathophysiology of dehydration and heatstroke in athletes is not completely 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 says. “These data suggest that another mechanism besides heatstroke may be involved.”