Dietary Supplements in Sports

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Texas — site of upcoming AMSSM annual meeting [Dallas, 4/15 – 4/20]

One of the studies in our March 2016 CJSM which has generated substantial interest is original research from the Department of Military and Emergency Medicine, Uniformed Services University of the USA: “Dietary Supplements: Knowledge and Adverse Event Reporting among American Medical Society for Sports Medicine (AMSSM) Physicians.

The AMSSM, one of our affiliated societies, is having its annual meeting coming up in Dallas April 15 – 20, and we’re looking forward to joining in those proceedings [the official hashtag of the meeting is #AMSSM16 — keep that in mind you Twitter folks].  The physician membership is not infrequently surveyed about a variety of matters of interest to practicing sports medicine clinicians; the results of these surveys often provide invaluable data to researchers who have published in the CJSM pages.

Examples of this include “Concussion Practice Management Patterns among Sports Medicine Physicians” and “Cardiovascular Preparticipation Screening Practices of College Team Physicians.” 

Regarding the study on dietary supplements (DS), the authors looked at a variety of issues.  Of note, they found that majority of survey respondents (71%) reported that athletes under their care had experienced an adverse event associated DS use.

Not all of us who read this blog or subscribe to the journal are AMSSM members, of course, and so I thought it might be time for a poll, asking this very question: have you ever taken care of an athlete who has experienced an adverse DS event?  Please, take the poll, and if you can, send us a comment on this blog identifying the DS, the adverse outcome, and possibly the sport in which your athlete was participating.

We hope to see you in Dallas!

To Tackle or Not: That is the Question

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Rugby Sports Med panel (L to R): Drs. Kerr, Gerber, Viljoen, Cantu, Akhavan, Mjaanes, Landry

There is an ever-increasing debate on both sides of the Atlantic regarding contact and collision sports for youth.  In particular, the issue of tackling (whether in rugby or American football) is in the cross-hairs of many.  I’ve written about this recently after Dr. Bennet Omalu, the subject of the movie ‘Concussion’ and the pathologist who first described CTE in an American professional football player, wrote an op-ed piece in the New York Times arguing that contact football should be banned in those under age 18 [‘Don’t Let Kids Play Football’].

My impetus for this blog post is two-fold: 1) I am currently attending a rugby sports medicine conference, where the issue of tackling and brain injury is a ‘hot topic’ for discussion; 2) the issue of tackling in youth rugby has exploded after recent events in the UK.

USA Rugby sports medicine hosts a conference each year around this time, and this year there was a panel of experts who entertained the question: when should youth athletes take up contact/collision sports?  There was a variance of opinion and a recognition that more research needs to be done to give an informed answer to this question.

In the background, occurring in the ‘real world,’ this same question was being debated in the media and social media after a group approached the UK government asking for a ban on tackling in youth rugby. The Sport Collision Injury Collective (@sportcic on Twitter) circulated a petition signed by 70 academics asking that touch rugby only be taught to schoolboys in the UK [“Our message is simple: Prevent injury, remove contact.  Replace contact with touch in school rugby.”]

The media response has been vigorous:  check out these stories from the BBC and the Guardian.  Opinions have come from players, parents and coaches as well as physicians  [the Royal College of Paediatrics and Child Health wrote a response to this proposal ] and sports scientists.

This is an important and healthy debate, one where I find most if not all stakeholders have the health and welfare of our youth foremost in mind as we try to gather more information and make decisions now, the ramifications of which may not be seen for years to come.

And so, I thought I would use this blog as one more platform where concerned folks could weigh in on their opinion of this question. Take the poll below,* ** follow the links above, and engage in the discussion which is taking place in the media.

*There have been many ages proposed for initiation of contact in youth sports, ranging from age 10 to 18.  For the purposes of the poll, I have tried to give a variety of options, though I recognize the choices are not exhaustive.

**I have intentionally given poll takers the option for a limited number of answers, recognizing that there is room for many more (e.g. ‘we need more information’, ‘yes, allow contact, but we need to reduce the amount kids get’, ‘football and rugby are different, and my answers would be different for each sport’ etc.)

The Cardiovascular PPE

One of the more popular articles in our November 2015 CJSM has been “Limitations of Current AHA Guidelines and Proposal of New Guidelines for the Preparticipation Examination of Athletes,” from a group of authors who are in the Division of Cardiovascular Medicine at Stanford University.  This is also one of the studies that have been picked by the Editor-in-chief to be freely available, and so if you click on that link you can read not just the abstract, but the study itself.

The authors set out “To examine the prevalence of athletes who screen positive with the preparticipation examination guidelines from the American Heart Association, the AHA 12-elements, in combination with 3 screening electrocardiogram (ECG) criteria.”  

The topic of screening to prevent sudden cardiac death (SCD) in athletes, in particular young athletes, is a perennial ‘hot button’ issue in our field — we’ve written about the issue here in the blog, and we have published several studies on the subject in the journal.  As most readers of the blog will know, in the USA (in contradistinction to Europe, Japan, Israel and elsewhere), there  is no recommendation for inclusion of an ECG in PPE screening.

There are many interesting aspects to the Stanford study.  The main outcome measures in the screen of 1596 high school and college athletes were i) the 8 personal and family history questions from the AHA 12-elements; and ii) ECGs using three separate criteria for interpretation: Seattle criteria, Stanford criteria, and European Society of Cardiology (ESC) criteria.  The different criteria had different rates of abnormal ECGs, but what was most concerning was the nearly 25% of athletes who screened ‘positive’ using AHA questions.

The authors conclude, “In a patient population without any adverse cardiovascular events, the currently recommended AHA 12-elements have an unacceptably high rate of false positives. Newer screening guidelines are needed, with fewer false positives and evidence-based updates.”

What do you think?  Take the poll, and let us know!

CAS vs. IAAF — the Dutee Chand decision

The Court of Arbitration in Sport (CAS) made a major ruling yesterday with broad implications. Dutee Chand, an Indian sprinter, had been fighting the International Association of Athletics Federation (IAAF) policy which would have required her to undergo surgery, take medicine, and agree to other interventions if she were to compete as a female. Ms. Chand has naturally higher levels of testeosterone than most women; she had never identified in her life as anything but female.  She and her legal team fought the IAAF policy in the CAS, and won.

The CAS questioned the advantage of naturally high levels of testosterone in women’s sport, and ruled that Ms. Chand must be allowed by the IAAF to compete as a woman, essentially overturning the current IAAF policy. A New York Times article makes for fascinating reading.

This is a victory for Ms. Chand, and many would argue that it is a victory for women’s sport, and for sport in general. Nevertheless, many athletes, including marathoner Paula Radcliffe, supported the IAAF policy and worry that women’s sport may now be conducted on a less level playing field, if you will.

Issues of gender in society are front page news this summer in the USA. Sports, as a mirror of society at large, offer up a narrative within this larger story — the Dutee Chand story has been ongoing for well over a year, and we’ve discussed her story and the overall story of ‘Too Much T’ at different times here in the blog.

We thought we’d repost (below) a very popular commentary which includes discussion of this issue of testosterone in women’s sport: ‘The Sports Gene: How Olympians are made (or born).’ And we thought we’d include a poll on what you, the reader, think of this most recent CAS decision on IAAF policy. Vote, and let us know what you think!

Take Our Poll (function(d,c,j){if(!d.getElementById(j)){var pd=d.createElement(c),s;pd.id=j;pd.src='https://s2.wp.com/wp-content/mu-plugins/shortcodes/js/polldaddy-shortcode.js';s=d.getElementsByTagName(c)[0];s.parentNode.insertBefore(pd,s);} else if(typeof jQuery !=='undefined')jQuery(d.body).trigger('pd-script-load');}(document,'script','pd-polldaddy-loader'));

Clinical Journal of Sport Medicine Blog

The venues at Sochi are still, it seems, a work in progress.  Nevertheless, before the week’s end, we will (should?) see the Winter Olympic games start up.  Soon, we’ll get to watch some of the finest athletes in the world compete at their sport.

There has been a lot of talk about the on-going construction at the most expensive games in Olympic history, as well as the issue of gay rights and cultural sensibilities in Russia;  and there have been worries about the potential for terrorism.  But soon, when the competitions begin, I hope the focus will justifiably be on the athletes on the snow and ice.

Or in Tweet speak: #LetGamesBegin

I’ve not been consciously preparing for this elite sporting event, but rather coincidentally recently picked up a book that highlights elite athletes and has received a great deal of positive ‘buzz’:  The Sports…

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