Can cold and flu remedies actually harm an athlete's performance?
'I firmly believe that if the whole of materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind - and all the worse for the fishes.'
Oliver Wendell Holmes
The cold and flu season is upon us, and many athletes will be considering taking a variety of over-the-counter and prescribed elixirs and potions with the intent of easing aches, pains, sniffles, sore throats, coughs, blocked air passageways, and general 'blah' feelings. Sports Injury Bulletin feels it would be useful to review some of the reasons for using such 'materia medica', and we'll also describe the effects of popular medications on performance and point out which medicines are banned from competition.
First, though, we should mention the situations in which athletes should put their workouts on hold. Whenever you have a fever greater than 100 degrees, extreme fatigue, shortness of breath or wheezing, or a rapid/irregular heartbeat, it's best to abstain from training. The risk of making things worse, combined with the likelihood of completing a poor workout which won't really help you attain your training goals, make it wise to rest until such symptoms resolve themselves.
The over-the-counter drugs used for the relief of symptoms of colds and the flu can be divided into five categories. These include antihistamines, decongestants, fever reducers (anti-pyretics) and pain relievers (analgesics), cough preparations, and combinations of the above ('shotguns') (see numbered points below). A thoughtful approach which takes into account your specific symptoms should be used to make a selection from one of the above categories. Read product labels carefully and ask your doctor and chemist questions concerning the specific relief you might get from each product.
Don't expect a quicker recovery. Bear in mind, however, that dosing yourself with medication will not ensure a quicker recovery from your illness. In research carried out at Johns Hopkins University, a group of about 100 children suffering from 'colds' was subdivided into three sub-groups.
The first sub-group was given an antihistamine / decongestant combi-nation, the second a placebo, and the third nothing at all. All three groups recovered in about the same time, with more than half of the kids in all three sub-groups feeling better in two days ('Effectiveness of an Antihistamine-Decongestant Combination for Young Children with the Common Cold: A Randomised, Controlled Clinical Trial,' Journal of Pediatrics, Vol. 118, pp. 125-130, 1991). This study was carried out with children, not adult athletes, but the results should still give you something to think about the next time you're standing in front of a pharmacy wall stocked with scores of expensive cold elixirs.
Instead of relying on medications to ease symptoms and enhance recovery, an increasing number of athletes with colds or the flu are doing well simply by drinking large volumes of fluids and getting extra amounts of rest. As we'll discuss later, these simple steps can go a long way towards relieving much of your discomfort and can in certain cases remove the need to ingest a medication which might have some negative side effects.
Here's a rundown
Let's consider each category of medication and describe how it might influence your athletic performances. We'll also mention which medicines are banned from use during competitions. If you are concerned about a particular medication, consult the official web page of the International Olympic Committee (IOC).
(1) Antihistamines are designed to relieve the sneezing, itching, watery eyes, and runny noses associated with colds and allergic reactions. Depending on the antihistamine, drowsiness can be a major side effect. That can be a problem, of course when judgement and alertness are mandatory, as when you get up early to drive to a race or when you must cycle through a difficult course during a bike race or triathlon. Fortunately, some of the newer prescription-strength antihistamines are less likely to cause sedation. These newer drugs are not without problems, however; they tend to be expensive, and they can take a long time to 'clear' themselves from your system.
Other problems with antihistamines include excessive drying of the mucous membranes in your mouth, eyes, and nose, which can actually make you more uncomfortable than you were before you took the medication. Blurring of vision may also be a problem for a few athletes. Although antihistamines are sometimes associated with sluggishness, they generally do not directly affect aerobic performance or muscle strength and endurance.
Pure antihistamines are usually not banned by athletic bodies, but they are frequently combined in medications with decongestants which are tightly restricted (see below).
(2) Decongestants are supposed to relieve nasal and sinus congestion. Since decongestants generally have a mild stimulant effect, tremor, insomnia, and a feeling of being 'hyper' are relatively common problems associated with their use. As they increase alertness, decongestants can also elevate heart rate and blood pressure, a potential problem for those athletes with underlying blood-pressure difficulties.
The decongestant nose sprays can also produce what is called a 'rebound effect,' in which the nasal passages actually become more congested than usual as the medication wears off. As a result, larger and more frequent doses of the medication are subsequently needed, producing an even greater 'rebound' and a potentially 'vicious circle' in which more decongestant actually leads to greater congestion. In general, decongestant usage should be limited to no more than a few days at a time.
Many decongestants are listed as banned substances by the IOC. Specifically, decongestants containing sympathomimetic amines (which are classified as stimulants by the IOC), including pseudoephedrine, norpseu-doephedrine, and phenylpro-panolamine, are prohibited by the IOC. The reasoning behind this ban is that the amphetamine-like effects of these decongestants can increase heart rates and enhance explosive muscular contractions, leading to potentially heightened performances in cycling, swimming, running, or ice-skating events lasting less than 10 minutes or so. At the other extreme, it is doubtful that decongestant ingestion would help athletes in events lasting several hours (for example, a triathlon or marathon). In fact, the upswing in heart rate associated with the use of decongestants might make exercise seem more intense than usual at typical race speeds.
(3) Fever reducers (anti-pyretics) and pain relievers (analgesics), including aspirin, acetaminophen (Tylenol), and ibuprofen (Advil, Nuprin, Motrin, Medipren) help with fever, achiness, and headache, and they have no known effects on performance, although the pain relief provided by the analgesics would certainly seem to make sustained or high-intensity exercise more possible to carry out. Unfortunately, this pain-relieving feature represents one reason why these medications are sometimes abused by athletes. If you are taking too much analgesic, you might actually continue to exercise when you have a stress fracture, for example, whereas the pain associated with such bone damage would force you to stop exercising if you were medication-free. It's important to note that if you must take ibuprofen regularly in order to control pain enough to allow you to continue your present training, that means that you are training too much. You should cut back on your workouts until you reach a safer training level, instead of risking injury or the possibly dangerous side effects of prolonged drug use.
A potentially troublesome feature of ibuprofen is that it can block your body's production of natural chemicals called prostaglandins. When prosta-glandin production is reduced, blood vessels leading into your kidneys can become constricted, causing blood flow to the kidneys to diminish. While this might seem like a good thing (less urine would be produced during exercise), it's possible that the lowered blood flow could create a dangerous kidney condition called acute tubular necrosis.
The potential reduction in kidney blood flow associated with ibuprofen use probably won't produce problems for athletes involved in competitions lasting 45 minutes or less; during such relatively short time frames, blood is diverted for too brief a time to create lasting damage.
On the other hand, ultra-marathon and ultra-triathlon participants - the very individuals who tend to use large quantities
of ibuprofen - are at greater risk. The many hours of exercise required for such events can lead to prolonged periods in which the kidneys are low on blood and oxygen, inducing potential damage (Renal Failure, Vol. 11, pp. 209-212, 1990). Older athletes or athletes who have had kidney problems in the past are probably particularly susceptible. As a result, it seems unwise to ingest ibuprofen during an ultra-event. In fact, it makes sense to stop using ibuprofen entirely about 48 hours before an ultra-competition, giving the drug enough time to clear out of your blood.
(4) Cough preparations can be divided into two categories - expectorants and cough suppressants. Expectorants are actually designed to increase the flow of bronchial mucus so that it is easier to 'cough it up'. The primary ingredient in expectorants is usually a chemical called guaifenesin. Suppressants can act to decrease the amount of coughing, and a typical key ingredient is dextromethorpan.
Interestingly enough, it is difficult to find either guaifenesin or dextromethorpan in their isolated forms; most often they are combined with various other ingredients. This means that looking at your chemist's display shelves for these cough medications can get a little complicated, as any one brand of cough preparation usually exists in a number of different varieties (see below under 'shotguns').
Expectorants such as guaifenesin, when used alone, do not impair performance. However, note that drinking plenty of water and other fluids - which you should be doing anyway - will often loosen mucus and phlegm in your airways as well, if not better, than expectorant medications.
Cough suppressants can act as sedatives and possibly hinder performance. Additionally, suppressing a cough is not always the best strategy to follow. After all, coughing serves an important purpose: it helps to clear mucus and infectious micro-organisms from bronchial tubes and lungs, helping to limit infections.
Neither guaifenesin nor dextromethorpan are banned, but they are often combined in 'shotguns' with decongestants which may be prohibited, so check a product carefully before using.
When the shotgun may misfire
(5) There are literally hundreds of combinations of the above remedies, called 'shotguns', which work on the various symptoms mentioned previously. Some shotguns contain two of the above nostrums, while others may have all four. Just as a sledgehammer is not preferable to a fly-swatter for carrying out the assassination of a fly, a shotgun is not necessarily better than a simpler medication for controlling the problems associated with colds or flu. That being true, it's wise to carefully review the ingredients on any product you are thinking of buying (ask your chemist or doctor for help, if necessary).
For example, if congestion and thickened mucus are plaguing you, a pure decongestant combined with plenty of clear liquids (not alcoholic ones, however) will probably give you the most relief; a shotgun is simply not needed. If you do take a shotgun which combines an antihistamine with the decongestant, you may get a hefty dose of sedation along with the drying and thickening of your mucus, all of which can actually make you feel worse rather than better.
Remember that a shotgun's specific ingredients will determine if the medicine is on the restricted list or not. If a decongestant is involved, the shotgun is probably banned.
To conclude, many of the symptoms of colds and flu are self-limited. By drinking plenty of fluids, getting extra rest, and judiciously using a pain and fever reducer, you will often obtain adequate relief from your symptoms. Whenever particular symptoms are preventing you from getting a good night's rest, one of the cold/flu remedies might be helpful. If you are confused about the multitude of medications which are available, an excellent source of information is The Complete Drug Reference. Although priced rather steeply, this volume tells you what to expect from various drugs and advises you about which drugs to avoid if you have underlying medical conditions. If you are ever unsure about what to take, talk to your doctor for helpful hints.