What You Need to Know

Buzz Walton, MD

In this day and age sports participation is very important with the rise of childhood obesity in America. According to the National Council on Youth Sports, High School sports participation is at an all-time high. Sporting activity is considered a positive and healthy behavior. However, when it comes to the young athlete’s health, factors such as safety, physical growth and development and nutrition are vital issues.

Consumers of all ages use a variety of products before and after exercise and even during competition, such as energy drinks containing caffeine, carbohydrate energy drinks and supplement powders. A recent study showed that most students 11-18 years of age who took supplements did not recognize the risks of adverse events associated with their use: nausea, vomiting, dehydration, high blood pressure, arrhythmias, seizures, structural changes of the heart, liver problems, and death.

In the competitive world of youth sports, the pressures placed upon our young athletes to attain higher levels in sport, the influences of professional athletes, and the financial cost of college, many young athletes are looking for that competitive edge to achieve their goal. Some of those student athletes are turning to dietary supplements even if risk causes premature death. The more supplements are consumed by adolescents, the more likely it opens up the flood gates to use other banned substances like anabolic steroids.

What is a dietary supplement? “A product that is intended to supplement the diet; it contains one or more dietary ingredients that include vitamins, minerals, amino acids (proteins), and herbs”. According to the American Academy of Pediatrics (AAP), dietary supplements are “any substance taken in non-pharmacologic doses specifically for the purposes of improving sports performance. In addition, a substance should be considered performance enhancing if it benefits sports performance by increasing strength, power, speed, or endurance (ergogenic) or by altering body weight or body composition. Furthermore, substances that improve performance by causing changes in behavior, arousal level, and/or perception of pain should be considered performance enhancing”.

In the United States the sales of dietary supplements is a multi-million dollar industry. In 2009, the sales of supplements were totaled to estimate $26.9 million. They are the third most common category of medications in the United States. They can be found in all shapes and sizes from bars, gels, drinks, pills, and even jelly beans.

One misconception about dietary supplements is that they have the same rules and regulations as prescription drugs. This is not the case. The Dietary Supplement Health and Education Act of 1994 gave the Food and Drug Administration (FDA) expanded authority for the regulation of dietary supplement manufacturing, labeling, and marketing. However, responsibility for determining the safety and efficacy of supplement ingredients and the accuracy of the product labels remains under the control of the manufacturer. Most preworkout products contain a mixture of ingredients, “a proprietary blend”, intended to increase energy and mood, extend endurance, and boost muscle gains. A problem with these blends is that the FDA does not monitor dietary supplement labels to ensure that specific amounts of all ingredients are listed on the labels.

Common ingredients in popular preworkout products: arginine, beta-alanine, caffeine, carnosine, creatine, dietary supplements, dimethylamylamine (and its abbreviation DMAA), energy drinks, human growth hormone, nitric oxide, performance enhancement, phosphates, phosphorus, and taurine.

Like most foods and over-the-counter drugs, many dietary supplements have not been studied in children because of the difficulties in recruiting study subjects and because of ethical reasons. Most of the manufacturers of these products do not even list the exact amounts of ingredients. So to gain that competitive edge, the athlete may consume more than is recommended per his/her body weight. Evidence suggests that supplements may improve sports performance among adults, but the potential long-term benefits and consequences have not been scientifically studied in a healthy child or adolescent population. This can be very risky and detrimental to the athlete as it can cause unwanted side effects (anxiety, dehydration, heat illness, and palpitations) and hinder performance.

A considerable number of children in the United States are using a wide variety of dietary supplements including nonvitamin minerals such as creatine, specifically to improve sport performance. A large proportion use multi-vitamins and/or mineral combinations. However, pediatric and other health groups have warned of the dangers of this population taking supplements for sport performance, and this should not be taken lightly.

We need to educate our children on the healthy way to achieve their sport goals. They need to be informed of the risks and benefits of nutritional supplements and anabolic steroid use. Adolescence is a period of rapid growth. The nutrients needed not only for bone growth and development but for peek athletic performance can come from a healthy well-balanced diet and adequate sleep. Remember that the health benefits from fruits and vegetables cannot be replicated in pill form!

Supplement Side Effects

 SupplementsUseSide Effects
CreatineNatural substance in the body to provide energy to working muscles. Improves performance only in brief (< 30 sec) high intensity exercise. No benefit if lasting >90 sec.Muscle cramps, weight gain, dehydration, heat illness
ProteinHelps repair and build muscleDiarrhea, dehydration, arrhythmias, impaired kidney function
ChromiumTo increase muscle mass, decrease fat, improve performance, and increase energyDizziness, depression, blood disorders, liver and kidney damage
Anabolic Steroids(DHEA, Androstenedione)Increase muscle mass, strength and energy. Banned by most national federations and professional leagues.Stops bone growth in kids, behavioral changes, depression, heart problems
CaffeineIncrease physical endurance. No benefit with short-term activity Chest pain, palpitations, dehydration, anxiety
QuercetinIncrease endurance and athletic performanceHeadache, numbness and tingling in arms and legs
 Nitric OxideIncrease performanceLow blood pressure( dizziness, confusion, loss of balance), seizures, arrhythmias
 Multi-vitamins For general bone health and preventionNot severe, but can be used as a stepping stone to the use of more dangerous supplements ( growth hormones and steroids)

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