Written by: Nancy White M.D., Henry Ford Center for Athletic Medicine

To run faster, jump higher, and be stronger are traits desired among our student athletes. Our athletes weight-train, run, cross-train, and mentally train to improve their performance. They push their bodies to be faster, stronger, and more agile. Some are happy with their improvements, others want more. They seek out other ways to be faster and stronger. Unfortunately, some of those other ways can be very detrimental to their overall health. Furthermore, some of the people telling them that it's okay to use these other ways are their coaches, teammates, family members, their role models, and big companies with slick advertising.

One of these "other ways" is the use of ergogenic aids and supplements. As a sports medicine physician, I am often asked about the use of such agents. When it comes to children and adolescents, the answer is quite simple: DON'T. The basic answer is simple. However, getting the athlete to understand DON'T, can be tough. In the following paragraphs, I will highlight some of the more common types of agents that your student athletes may be exposed to, as well as some of the detrimental health issues that arise with the use of these agents.

The first group of agents, and certainly most described in the media are the anabolic steroids (androstenedione, stanazol, depo-testerone, dianabol, etc.). The anabolic steroids can be used orally, through injections, and topically. They are reported to be helpful in increasing muscle strength, increasing weight, decrease the muscle fatigue experienced with intense training.  However, there numerous side effects of steroid use. These side effects include:

  • Testicular atrophy
  • Gynecomastia (increased breast tissue in males)
  • Diabetes
  • Liver cancer
  • High blood pressure
  • Decreased HDL (good cholesterol)
  • Acne
  • Premature balding
  • Tendon weakness
  • Depression
  • Aggression
  • Addiction
  • Psychosis

DHEA (dihydroepiandrosterone) is also a popular supplement. It is a weaker form of the anabolic steroids. It is also advertised in the anti-aging and obesity markets. Its effects are not proven, and it's detrimental effects to a child's or adolescent's body is unknown.

Creatine is probably the most asked about supplement in my adolescent patients. Natural creatine is made in our liver, pancreas and kidney, and most of it is found in our skeletal musculature.  Normal intake comes from lean meat and fish. The purported benefits of creatine are increased power during anaerobic, short-duration, high-intensity activity. It has no benefit in aerobic activities.  The athlete using creatine my have decreased need for recovery time, increased energy for repeated activity, and less effect of lactic acid build-up.

The great concern that I have with creatine are three-fold. Common adverse effects include muscle cramping and dehydration. There are unknown effects to the growing body (including brain development and testicular development). I think that most concerning is the fact that these supplements are not regulated by the Food and Drug Administration. Therefore, we left to trust that what is on the label is actually in the bottle. More on that later.

The last supplement that I will highlight is ephedra (ma huang). Ephedra is a supplement that was taken off the market as a diet aid because of increased risk of side effects, possibly even fatal ones, but incredibly it is now in many stimulant drinks. There is presumed improvement in athletic performance, physical appearance, weight control, and increased energy. It's like a powerful cousin to caffiene. There are no good studies to support its use. There are a number of studies that state ephedra will increase blood pressure, heart rate. Case reports reveal incidence of irregular heart beats, heart attacks, strokes, irritability and anxiety with the use of ephedra.

Common to all of these supplements is the fact that they are not regulated. Again, when we take these supplements, we are trusting that what is on the label is actually in the bottle. The U.S. Olympic Organization asked athletes to bring in such supplements from the US and around the world. Upon analysis, several of these products included anabolic steroids as an ingredient when their labels did not indicate it, ephedra when the label read "ephedra-free," and a whole host of toxic fillers contained within the tablets.

Several millions of dollars were spent on such supplements in 2000. We probably know more about the marketing of these products that we know about what's in them and what they do. With this large uncertainty about the quality and contents of supplements, what their true benefits are, and the known negative side-effects, it's easy to say DON'T.

If you have an athlete that is considering these agents, it's a great opportunity to look at their current diet and training program. Making sure that they're getting adequate protein, good carbohydrates, good fats, and proper hydration is the key.  Appropriate, supervised strength-training will get them to the next level. The easy fix of supplements is not the answer.

For further information on this article or for priority appointments for sports injuries please contact Henry Ford Center for Athletic Medicine at 313-972-4216.