Sports Medicine: Just the Facts

by Food and Drug Administration (FDA) in near

future. Ephedra/caffeine combinations are already

banned by FDA. Subsequently sold in combination

with guaraná (the herbal and more potent form of

caffeine).

5.Conclusion: Ephedra products, especially ephedra/

guaraná combinations are banned substances, are

not safe, and have been demonstrated to cause

considerable harm. As negative publicity builds,

Ephedra-free versions of products appear, but

there is no evidence that these will be any safer

than the original formulations.

• Chromium picolinate (Fox and Sabovic, 1998;
  McLeod, Gaynes, and Golden, 1999; Speetjens et al,
  1999; Beutler and Jonas, 2004).
  
  
  1. Primary use: Increase lean body mass, improve
     glycemic control in diabetes.
     2.Evidence: While earlier, design-flawed studies sug-
     gested some beneficial effects, newer studies show
     no ergogenic or fat-burning effects. Some studies
     suggest slight, dose-dependant improvements in
     diabetes control and lipid profiles.
  
  
  2. Toxicity: Tremor, along with cognative, sleep, and
     mood changes have been reported as side effects.
     Concern exists for potential deoxyribonucleic acid
     (DNA) mutations with long-term exposure to
     chromium supplementation.
  
  
  3. Regulated/Banned: No
  
  
  4. Conclusion: Though inexpensive and minimally
     toxic with short-term use, real concern exists for
     DNA mutations with long-term use or high
     chromium levels. Since the reported benefits are
     very small and the risk of long-term toxicity
     potentially great, patients should avoid this sup-
     plement.
  
  
  
  


• Pulsed electromagnetic field therapy(PEMF) (Bassett,
  Payluk, and Pilla, 1974; Aaron, Ciombor, and Jolly,
  1989; Hulme et al, 2002)
  1 Primary use: Decrease pain and stiffness in
  osteoarthritis
  2. Evidence: The beneficial effect of PEMF therapy
  in delayed union fractures is well established.
  Similar magnetic fields have been found to stimu-
  late proteoglycan production in vitrochondrocytes;
  however, despite abundant anecdotal Internet
  reports, a recent Cochrane review found only three
  quality articles in the scientific literature. The
  review found that PEMF produced statistically sig-
  nificant, but clinically insignificant changes in
  knee osteoarthritis(OA) pain and disability. The
  optimum dosage and frequency of PEMF—as well
  as acceptable technical standards for the PEMF
  equipment—remain unknown. The cost of PEMF
  can exceed $200 per day.
  3. Toxicity: Unknown. The effects of pulsed electro-
  magnetic fields on human tissues have not been
  well-studied.
  4. Regulated/Banned: No
  5.Conclusion: Patients should be advised that
  PEMF’s small benefits in OA pain and stiffness are
  outweighed by uncertain side effects, incomplete
  technical data, and tremendously high cost. Other
  proven-effective, lower cost treatments for OA
  exist; and are favored over PEMF therapy.

Permit

• Ginko leaf (Pittler and Ernst, 2000; van Dongen et al,
  2000; Oken et al, 1998)
  
  
  1. Primary use: Combat memory loss and slow pro-
     gressive dementia. Also used to relieve vascular
     claudication symptoms.
  
  
  2. Evidence: Most studies suggest that ginko leaf can
     slow dementia progression and increase cognitive
     function in middle-aged adults without subjective
     memory loss. In some countries, ginko is the stan-
     dard of care (in place of cholinesterase inhibitors)
     for Alzheimer’s dementia. More limited evidence
     also suggests that ginko may improve walking dis-
     tance in vascular claudication.
  
  
  3. Toxicity: Mild gastrointestinal(GI) upset and con-
     stipation are the most common side effects
     reported; however, ginko has anticoagulant proper-
     ties and lowers the seizure threshold. Ginko has
     been linked to spontaneous bleeding. It should not
     be used in patients taking other anticoagulants or
     in those with a seizure disorder or in combination
     with other drugs that lower seizure threshold.
  
  
  4. Regulated/Banned: No
  
  
  5. Conclusion: In the appropriately selected patients,
     ginko is a permissible alternative to conventional
     drug treatments, especially if the patient prefers
     ginko supplementation.
  
  
  
  


• St. John’s Wort (SJW) (Gaster, 2000; Woelk, 2000;
  Brenner et al, 2000; Schrader, 2000; Beutler and
  Jonas, 2004).
  1.Primary use: Antidepressant, anxiolytic, anti-
  insomnia, and adjunct to weight-loss uses are com-
  monly described.
  2. Evidence: Most evidence suggests SJW to be
  effective for mild to moderate depression. SJW
  may also be effective in obsessive-compulsive dis-
  orders. Severe depression is not reliably treated by
  SJW and higher dosages of SJW increase the risk
  for severe skin reactions.
  3. Toxicity: Insomnia, restlessness, and GI distress
  are common. Hypericin doses over 5 mg/day
  increase risk for severe photodermatitis. SJW has
  fewer side effects than TCA or SSRI antidepressants;

456 SECTION 5 • PRINCIPLES OF REHABILITATION