The 2009 NATA conference for me was a big success and well worth the trip. Unfortunately because of family commitments I needed to miss all of Saturday, but my goals for Thursday and Friday were met and exceeded on all fronts.

By way of a background over the past several years I make the conference about every two or three years to stay current, scout technology and ensure CEUs for the BOC. I’m a Professor of Neurology and no longer work directly with athletes, but rather do research related to head injury, traumatic brain injury and related neurologic diseases. As it turns out technologies that are applied in the sports medicine setting have many applications to the primary, secondary and tertiary care arenas. So much of what I get from the conference is newer methods and technologies that might have applications to other clinical settings. Therefore, I attend presentations, poster sessions and the exhibits to get a feel for what is being done for and to athletes.

In my main work we are trying to develop ways to diagnose and treat patients with concussion, traumatic brain injury and stroke. These patients are similar to athletes in that they are seeking care, treatment and rehabilitation to return to their lives, much like athletes are seeking care and rehab to return to play. A difference is that the stroke patient’s goal is often to be able to do the simple things in life; like walking and getting dressed in the morning. Whereas the athletes are more willing and able to try new things in an effort to gain a competitive edge, the stroke patient will need to depend upon their care givers to apply FDA approved modalities to improve their situation. So in a way, the trainers and athletes are giving me an opportunity to see what we can put to the FDA for helping TBI, stroke and head injured patients.

Over the past few years there have been hot new things at the convention which have eventually faded and disappeared and some things move into mainstream. I like to think that I am part of that process of mainstreaming technologies. A concern that I have about the relatively rapid nature with which new technologies can come and go in the sports medicine arena is that sometimes the background research and safety may be lacking. Of particular concern I have and have had is untested, unfounded and misleading nutritional supplements marketed to the athletes. For example, a few years ago I was emailed a supplement’s info that someone wanted me to look at and according to the ingredients it had toxic heavy metals in it as well as one radioactive nuclide. Yes, a compound whose most common isotope was radioactive. Needless to say that supplement was not long lived.

Recent FDA activity has also called into question the safety of dietary supplements targeted to athletes. http://www.cnn.com/2009/HEALTH/07/28/body.building.steroids/index.html

I therefore have a bit of a habit of looking at the ingredients of the nutritional supplements and quizzing the vendors on their claims. Most are inflated and with the vaguest of background research support but rarely do you see toxic and radioactive compounds in them. That is until this year. I was looking at the ingredients list for an ergogenic aid and dietary supplement mixture from a company I have chosen to keep nameless. In the ingredients list was guanidinopropionic acid also known as GPA. The most common form of GPA is the beta form, where the guanidine group is attached to the third carbon of the propionate. This molecule, GPA is an analogue of creatine. It can be phosphorylated by creatine kinase in muscle to produce GPA-phosphate. However it is not as good a buffer of ATP, compared to phosphocreatine and GPA is an inhibitor of creatine transport. A proprietary form of creatine was also on the ingredients list. So, GPA’s presence will inhibit the putative benefits from creatine in the formulation.

The above information about GPA is a cause for concern in and of itself, because GPA might be decreasing the beneficial effects of creatine and impeding the creatine kinase and creatine transporter systems. What makes this supplement of particular concern is that GPA has been known since the 1980s and 1990s to cause heart failure. It is actually given to animals to cause experimental heart failure. It is highly toxic especially if given the chance to accumulate in the body, which is what the company suggests for its supplemention regimen. GPA accumulates as GPA-phosphate to much larger concentrations than phosphocreatine and will deprive the muscle of ATP. Heart failure is thought to occur because of damage to the mitochondria and contractile proteins of the muscle.

This is obviously a case of caveat emptor, let the buyer beware. But the informed athletic trainer also needs to beware of what, if any, science is behind the technologies being peddled by the exhibitors. As stated in the beginning of this piece, there are a lot of cutting edge technologies available to the sports medicine community and I’m proud to play a part in getting technologies to other patient populations, which means your athletes are the guinea pigs for my stroke and head injury patients. However, I would hate for you the ATC and your teams to have to learn lessons of toxicity in some supplements, when the information is already out there. The counter to Caveat emptor is Lux Et Veritas, Light and Knowledge.

This is a re-post of a letter to the editor of the NATA News which appeared in the July 2009 Issue. Reprinted with permission.