View from a Doctor’s Desk – Dr Lisa Surman

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

Many people will be spending some time watching the Winter Olympics and may wonder what they could do to improve their own fitness, endurance and muscle power? An ideal time to get accurate information on supplements.

Many people use sports supplements (available over the counter and online) for varied and complex reasons - to gain muscle mass, lose weight, improve health or performance. Almost 3% of Australian adults reported using a special dietary product in an Australian survey from 2012, with 70% of the supplements being sports and protein beverages or powder. The rate of use in young men aged 19-30 years was 7.8%. The claims are very tempting - better recovery, improved endurance, increased strength. loss of body fat and enhanced immune systems.

Most people believe that government laws prevent companies from making false claims, particularly in writing, and would prevent unsafe products from being available. In Australia, supplements fall under the control of the Therapeutic Goods Administration, the most lightly regulated category of the TGA. There is no requirement that a product must have proof of its benefits to be accepted at this level and supplements can be heavily marketed in Sports Magazines, brochures and other communications with very little control over the claims made. The testimonials of successful athletes are part of sponsorship or paid advertising by the manufacturers or simply by word of mouth, which are persuasive arguments to others. Performance is the result of many factors such as talent, training, equipment, diet and mental attitude. In real life an athlete finds in difficult to pinpoint how much each factor contributes to a success.

Just prior to the last Olympics, ASADA released results that found one in five of 67 common Australian supplements analysed contained banned substances such as anabolic drugs or stimulants and, importantly, none of these substances were listed on the ingredient list on the labels.

According to the Australian Anti-Doping Authority as many as one in five products contain banned substances including stimulants and anabolic drugs and warned that any supplement may not be safe to use as a result of these findings. Some contain large amounts of protein or creatine, which may alter blood results in an otherwise healthy person, and long term effects are not known. Taurine is promoted for its ability to improve exercise capacity and performance, but most products do not contain enough for therapeutic benefit and little is known about the long term effects of regular, nor heavy use. Androgenic steroids are often not listed on the ingredient label and can cause androgen deficiency with symptoms such as fatigue, lethargy, low mood, irritability, poor concentration, hair loss, acne, liver damage, breast development in males and reduced sexual desire or performance.

Designer anabolic hormones, also referred to as pro-hormones, natural steroids, testosterone boosters have been available in the legal marketplace for the past ten years. The pro-hormones have also been identified in tests of supplements and not declared on the labels. Despite attempts to improve regulatory efforts, many remain easily available. These products have potential significant side-effects, now seen increasingly in General Practice. Liver damage, hypertension, renal failure, hypogonadism, gynaecomastia and infertility are increasingly being reported, most are reversible on ceasing the supplement, more permanent damage is possible from chronic use, including heart attack and stroke Some products contain "liver protectors" such as milk thistle extract or herbs, none have been demonstrated to have any protective value against oral androgen liver damage.

The Australian pharmacy business is controlled by a number of regulatory and licensing requirements. A prescription is required for some products and importations of controlled substances is prohibited. Online pharmacies generally supply products without prescriptions and may or may not employ pharmacists. All studies and warnings from regulatory agencies emphasise the caution " buyer beware" many websites operate outside legal requirements and there is no way to check the authenticity of the product and how it will affect you. The TGA does not conduct any regulatory review of internet sites. The TGA's position assists consumers in having greater confidence in Australian online pharmacy sires rather than those overseas.

The advice given by the Australian Sports Anti-Doping Authority to competitive athletes in relation to the various supplements available is to assess whether the specific supplement is safe, effective or necessary and the same advice is relevant to the general public. The advice to athletes is to completely avoid the combined products and "enhancers". Improvements to health and performance are possible with changes to nutrition, sleep or training and there are professional sports dieticians, exercise scientists and even medical practitioners who can provide useful guides about benefit and harms of various products and chemicals. There remains significant concern about the unlisted and potentially dangerous substances in the supplements that are not listed on the labels.

For the current Supplement In Sport Fact Sheet from the AIS see ausport.gov.au for a list of products and the current evidence for benefit or not for individual products such as creatine and simple dietary guides re nutrition and protein intake when training.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software?s Clinical Leadership Advisory Committee