Use of Nutritional Supplements Among Young Athletes Getting Harder to Swallow

Although currently legal, the use of nutritional supplements among young athletes is getting harder for some sports administrators to swallow.

The E-mail appeared unsolicited, sporting only a tempting subject line ("Gain muscle fast") and a link to an E-commerce site selling anabolic bodybuilding supplements. From there, interested Web surfers were invited to explore the brave new world of so-called performance-enhancing-and legal-substances with difficult-to-pronounce names and enticing claims.

"Today you can get anything from the Internet," says Jim Clover, a member of the California Interscholastic Federation's Health and Safety Committee and director of the S.P.O.R.T. Clinic in Riverside, Calif., which specializes in sports medicine for high school and college student-athletes. "I don't know what these kids are getting into because I don't know what they have access to."

Long gone, apparently, are the primitive days when high school football players boosted their on-the-field effectiveness by downing salt tablets and then hastened post-game recuperation Sucking honey from plastic packets.

The Internet is fast becoming a friendly marketing tool-although certainly not the only one-for companies supplying athletes with some of today's most popular nutritional (or dietary) supplements, including creatine, androstenedione (better known as andro), dehydroepiandrosterone (DHEA) and beta-hydroxy betamethylbutyrate (HMB). With a recent study by research firm Grunwald Associates indicating there are 25 million Web surfers in the United States who have yet to reach age 18, young athletes are easy targets.

Eric Small is a New York pediatrician who has studied young people's use of creatine-a manufactured version of a nitrogen-containing compound produced naturally by the body to supply muscle energy. He recently found that children as young as 11 are taking large amounts of creatine to supplement the small amount their bodies produce daily. Furthermore, in a study of 1,300 male and female student-athletes in grades 6 through 12, Small found that 44 percent of the high school seniors surveyed took some form of creatine.

Without regulation from the Food and Drug Administration, supplement makers are free to pitch products through Web sites, magazine and TV ads, and store displays. Their colorful packaging often features information written in foreign languages and announces fantastic claims of newfound strength and hidden energy-even if they haven't been scientifically proven to be effective or safe. What's more, the ingredients in these supplements may not be accurately represented on the packaging.

Nandrolone, for example, the banned steroid that American shot putter C.J. Hunter tested positive for in July, is contained in many over-the-counter musclebuilding supplements that don't list it as an ingredient, experts say. During the 1998-99 school year, 38 college studentathletes tested positive for nandrolone-more than twice the number who tested positive for the substance in any of the previous three years, the National Collegiate Athletic Association reports. Many of them were football players or track athletes who were consuming musclebuilding supplements permissible under NCAA rules. (Hunter, by the way, has denied using nandrolone as a steroid.) It's all enough to make Stella Volpe, an associate professor of nutrition at the University of Massachusetts-Amherst, throw up her arms. "When did we lose sight of the fact that we actually need to work hard to get better and stronger?" she asks. "Supplement use among young people is definitely increasing, and it's pretty scary."

Wit's unclear just how prevalent supplement use has become among high school and college student-athletes, there is enough cause for alarm to prompt sports organizations-from the pros to amateur groups-to develop policies concerning supplements. Yet reports still abound in the high school ranks of coaches, parents and peers offering supplements of all sorts to student-athletes. (Creatine gum, anyone?)

Consider this: A football coach at Hays High School in Buda, Texas, used to hand out fliers about creatine to players and offer the supplement to them at cost - that is, until the state made it a crime for public school coaches and administrators to supply performance-enhancing products to student-athletes. Some manufacturers have even offered rebates to schools that pitch their products. Meanwhile, a member of the Olathe (Kan.) East High School football team collapsed last fall after popping four capsules of Ripped Fuel-an over-thecounter supplement containing the controversial stimulant ephedrine-in two-and-a-half hours. The player and 14 teammates were suspended for one game by the school's principal, who said at the time he hoped to send a clear message that administrators would not tolerate supplement use.

No tolerance at schools, however, packs little punch when parents-many of them living vicariously through their children's athletic endeavors-spend hundreds of dollars a month on an array of supplements in an attempt to give their kids an advantage over the competition. "It's all about whoever has the money," Clover says.

The issue here, supplement opponents say, is that just because these products are legal doesn't mean caution shouldn't be exercised when taking them. Many supplements may have yetunproven consequences and-murkier still-present ethical dilemmas about whether taking such substances is akin to cheating.

"Does creatine work? Absolutely, without question," Clover says about one of the few supplements scientifically proven to be safe and effective when taken in moderation. "But that doesn't mean I'm going to recommend it all the time." "There's no doubt that there are some advantages to creatine," says Jerry Diehl, an assistant director of the National Federation of State High School Associations and a liaison to the federation's Sports Medicine Advisory Committee. "But do the advantages outweigh the amount of money you're spending on it and the risk you're taking with your body? There's nothing that guarantees the quality of what you're purchasing."

Creatine is perhaps the most popular supplement taken by young athletes today. More than 2,000 tons of creatine - most of it in white-powder form-were consumed in 1999, according to Ronald Terjung, professor of biomedical sciences at the University of Missouri, Columbia. Terjung was involved in an American College of Sports Medicine (ACSM) study of the physiological and health effects of oral creatine supplementation last year. The study determined that creatine ingestion enhances short periods of "extremely powerful anaerobic activity" and fosters great strength gains during strength training. But the study also revealed that creatine does not increase performance of aerobic exercise or maximal isometric strength-meaning that there is probably little benefit to be gained from it by most athletes.

While some users claim that creatine causes muscle cramping, water retention and increased blood pressure, scientific studies have not confirmed those side effects. And some high school coaches say that young athletes using creatine may experience emotional changes, such as shortened tempers and loss of patience.

Meanwhile, a trio of NCAA studies has examined the non-performance physiological effects of creatine use. Together, the NCAA and ACSM studies contend that just because creatine is a naturally occurring compound does not make taking extra doses of it safe, even if those doses appear to have few adverse effects. And virtually nothing is yet known about creatine's long-term effects - especially when taken by adolescents. Indeed, most supplements have not been the subjects of studies evaluating the effects of long-term use. In the case of andro, a supplement much more controversial than creatine because of its similarity to a steroid, few such studies exist. The risks associated with placing athletes on controlled use of a substance that raises the body's level of testosterone and estrogen is just too great, researchers say.

Already banned by several athletic organizations, andro is converted to testosterone and estrogen. Testosterone may produce larger muscles through an anabolic effect for up to 24 hours. It also reportedly quickens muscle recovery from exercise. But whether this shortterm increase in testosterone levels is enough to make any significant difference in muscle size or strength is debatable.

In a 1999 Iowa State University study, researchers evaluated 30 men with normal testosterone levels between the ages of 19 and 29. Twenty of the participants performed eight weeks of resistance training, with 10 receiving daily doses of 300 milligrams of andro. The others were given a placebo. Study results revealed muscle mass did not differ between the men who took andro and the men who took the placebo. The subjects also showed no change in their testosterone levels. The ones taking andro, however, did show signs of increased estrogen levels, which is associated in males with large breasts and a heightened risk of heart disease and pancreatic cancer. Other potential, albeit lesser side effects include acne and oily skin. Manufacturers recommend dosages of less than 200 milligrams a day.

Another muscle-building supplement, which a small number of studies have deemed free of side effects, is HMB. Produced in the body from the essential amino acid leucine, HMB may improve the growth of lean muscle tissue-but only in untrained athletes just beginning a strength-training program, according to Sports Medicine, a journal renowned for objective reviews of various medical studies. The publication recently reviewed the work of two Australian researchers who revealed that HMB doesn't appear to work well-if at all-in trained athletes or experienced bodybuilders. But another study, published this year in the Journal of Nutrition, found that HMB proved to be helpful to both trained and untrained athletes. (A word of warning: That study was funded by Metabolic Technologies, a maker of HMB supplements.)

Officials at the nonprofit Center for Science in the Public Interest, based in Washington, D.C., also question the efficacy of nutritional supplements for athletes, including DHEA, which manufacturers claim boosts physical and psychological well-being; ginseng, which allegedly increases stamina; and garcinia cambogia, an herbal compound that purportedly facilitates weight loss.

Manufacturers of these types of supplements operate under the assumption that at least a small percentage of all users' faith in a particular product is psychological, according to Clover, who uses an athlete's pregame meal choice as an example. "That steak and potatoes you eat before the game has nothing to do with how you're going to perform," he says. "But it has everything to do with your psyche. The same goes for supplements." To their credit, many reputable manufacturers place warning labels on their products recommending users be older than 18. But that still doesn't stop the local health-store clerk from selling supplements to minors-although the GNC chain took andro off its shelves two years ago.

WHAT, then, can be done to at least curb the use of supplements until more research has been conducted? "We can't lie to our kids, because we lied to them a number of years ago about anabolic steroids," Diehl says. "We told them they wouldn't do any good. But then the kids found out steroids really do help build muscles."

Instead, the NFHS has taken a written stance on the use of creatine and andro, which appears on the organization's Web site at www.nfhs.org: "In order to minimize health and safety risks to studentathletes, maintain ethical standards and reduce liability risks, school personnel and coaches should never supply, recommend or permit the use of any drug, medication or food supplement solely for performance-enhancing purposes."

While that might help keep employees in line, student-athletes may decide the long-term risks are well worth the shortterm gains. And win-at-all-costs peer pressure prevalent at some schools may just be too great. "A lot of kids take supplements for social interaction or to be cool and get attention," Clover says, adding that athletic directors have more control over supplement use than they probably realize.

Consider the words of wisdom, compiled by NFHS officials and posted at www.nfhs.org, that coaches and athletic directors have used to counteract the potent messages sent to student-athletes by nutritional supplement manufacturers. Among them:

• "If it's too good to be true, it probably is."
• "If a marketer can gain from your decisions, check out the product thoroughly before making a decision."
• "If you win naturally, you'll know it was you who won."
• "I'm your coach (or athletic director), and I don't think use of these substances is a good choice for you, or for the team."

"Right now, I don't hear a lot of complaints about supplement use from coaches and parents," says Ron Swann, athletic director for Hoover City Schools, which this fall became the first district in Alabama to enact mandatory tobacco testing for student-athletes in grades 7 through 12. "The community sets the norms for this type of thing. Our studentathletes are on the front lines. People pay to watch them play, and I think the residents of Hoover expect a little more out of them."

Even though Hoover schools don't ban supplement use, kids are encouraged Swann, their coaches and the district's "Safe and Drug Free" school coordinator to seek a doctor's advice before ingesting substances. "We know we've got kids using them who don't go to the doctor, but we can at least try to help them," Swann says, adding that many student-athletes voluntarily attend optional Wednesday morning resource sessions at the school during which administrators discuss a variety of pertinent issues, including doping and supplement use.

The key, Volpe says, is to let studentathletes make the decision on their own not to use-or misuse-supplements. Explain the side effects of various supplements, support that information with study results and then ask kids to stop taking the supplement for a week or two while increasing the amount of protein in their diets. "Kids will probably realize they don't know as much about supplements as they thought," says Volpe, who follows those steps in two UMass-Amherst programs aimed at high school and middle school student-athletes in western Massachusetts. "I hope we help these kids decide that they don't really need supplements."

One program, funded by a federal Family Nutrition Program grant and targeted to low-income students, involves two university graduate students teaching basic nutrition (including supplement information) for five weeks. The other program, supported by the university's Center for Nutrition in Sports and Human Performance, teaches high school student-athletes (chosen by their coaches and teachers) how to educate middle school students about sports nutrition.

By leveling with athletes at an early age about what they're putting in their bodies, Volpe says, they might make wiser decisions regarding supplement use later in life. "I know adults whose personal trainers ask them to take several different supplements, and the users don't even know what they are," she says. "Some trainers don't have a background in nutrition. People have died taking things from personal trainers because the users and trainers don't know what's in them."

OLD habits can be tough to break, and it's not surprising when high school student-athletes taking supplements continue to do so after they move on to the college ranks. Recognizing this as a problem, the NCAA (which has already banned andro) began restricting the use of muscle-building supplements in August because of their unproven safety record. The new rule states that NCAA member schools may only provide student-athletes with non-muscle-building nutritional supplements-such as those found in energy bars and sports drinks-and then only to boost calories and electrolytes.

The NCAA also helps fund The Dietary Supplement Resource Exchange Center (REC), part of the National Center for Drug Free Sport, in Kansas City, Mo. The REC was developed in conjunction with the NCAA specifically to help high schools, colleges, universities and other amateur athletic organizations begin drug-education or drug-testing programs, or evaluate their existing drugprevention programs.

Lawmakers in states like Texas and Michigan have taken the National Federation's stance on supplements a step further and made it a misdemeanor for any public school coaches, teachers, administrators and volunteers to promote or distribute performance-enhancing products to student-athletes. "If there's something that jeopardizes true high school competition in sports, we should do something about it," says Michigan Sen. Leon Stille, a Republican from Spring Lake, a 40-year veteran of refereeing high school athletics and author of the legislation that became Michigan law late last year. "We won't wait for a tragedy to compel us to act on this issue."

With several positive steps being taken to increase awareness of potential supplement dangers, it's somewhat surprising that California Gov. Gray Davis in September shot down a bill requiring supplements containing ephedrine to bear warning labels. Proposed by Rep. Susan Davis (D-San Diego), the bill received strong bipartisan support and would have mandated that manufacturers of more than 200 dietary supplements list possible dangers and a toll-free telephone number on their labels. Almost 30 other states have taken steps to restrict the availability of ephedrine and its close cousins, pseudoephedrine and phenlyptopanolamine.

California's bill was modeled after a similar measure that passed in Texas. Gov. Davis, in a statement issued to the Assembly after his veto, contended that regulation and labeling of dietary supplements is a "matter of interstate commerce and clearly the responsibility of Congress to regulate, which they have thus far neglected to do."

"That's the irony here," says Robert Herrell, chief consultant to the State Assembly Consumer Protection Committee, formerly chaired by Rep. Davis. "Because the Feds have been unwilling or unable to act-and I think it's a little bit of both-states have stepped in to fill the void. This is a high-profile issue that is not over in California." Herrell says chances are "fair to high" that a similar bill will be proposed by state lawmakers soon.

Meanwhile, two marketers of andro supplements were ordered by the Federal Trade Commission in late 1999 to disclose andro's potential risks in all advertising, labeling and promotional materials. In separate complaints, the FTC alleged that MET-Rx USA Inc. and AST Nutritional Concepts advertise that their andro supplements increase strength and muscle mass "safely and with minimal or no negative side effects."

The complaints challenged the manufacturers' lack of substantiation for those claims, which were primarily made on Internet sites promoting the products. Still, hundreds-maybe even thousands - of nutritional supplement products aimed at athletes of all ages continue to proliferate in a market free from federal regulation, making the task of sports administrators everywhere even more daunting.

"There are so many out there that we know little about," Diehl says. "I don't know how we control it, but we need to do more about what these kids are putting in their bodies. What we don't want to see is some youngster fall over dead on the basketball court and find out that the cause was an overdose of creatine."