(To gain an often unproven competitive edge, many teenage athletes are buying unregulated dietary supplements, not only spending top dollar, but risking serious side effects and unknown long-term health consequences.)
BYLINE: Scott Halasz and Jim DeBrosse, Dayton Daily News
Dayton Daily News
October 13, 2002 Sunday CITY EDITION
DAYTON - Teenagers in the Miami Valley as young as age 14 are using unregulated dietary supplements in the hope of pumping up their bodies and enhancing their athletic performance. But to gain an often unproven competitive edge, they're not only spending top dollar but risking serious side effects and unknown long-term health consequences. And, too often, coaches and trainers who promote a "win-at-all-cost" mentality aren't doing enough to warn kids of the dangers.
"It's most definitely scary," said Lloyd L. Lauerbach, head of the department of health and sport science at the University of Dayton. "None of these products is federally regulated. (Teenagers) don't have a clue what they're getting."
And some are dying as a result.
Last month, a 16-year-old football player in Lincoln, Ill., who was taking Yellow Jackets - a combination of caffeine and the plant-based stimulant ephedra - went into convulsions, stopped breathing and died of a heart attack.
FDA reports have linked ephedra to 81 deaths and 1,400 incidents of heart attacks, high blood pressure and stroke since the 1990s. The supplement industry agrees the product should not be sold to those under 18.
A 2001 survey by the Blue Cross and Blue Shield Association's Healthy Competition Foundation revealed that more than half of youths ages 10 to 17 have taken dietary supplements. The nonprofit foundation was developed to educate youth and their families about the potential hazards of performance-enhancing drugs and to eliminate their use from all levels of sports.
That's a tall order. U.S. consumption of dietary supplements has been growing each year since 1997 and will reach more than $20 billion this year, according to the Nutrition Business Journal. Supplements are sold over the counter at malls, health food stores and even convenience markets and gas stations. On the Internet, Yahoo! Shopping lists more than 6,000 sports nutrition sites. The youth who died in Illinois purchased his Yellow Jackets from a Dutch company on the Internet. To the dismay of many health experts, the U.S. government defines "dietary supplement" so broadly that many products that previously might have been considered prescription drugs no longer are regulated by the U.S. Food and Drug Administration. Congress passed a law in 1994 that defines a supplement as any product that contains a nutrient, herb, botanical extract or metabolite, or any combination thereof, even if a pharmaceutical agent is part of its natural ingredients.
And unlike the pharmaceutical industry, manufacturers of dietary supplements are not required by the FDA to prove the effectiveness of their products or even the accuracy of their labeling.
One study of sports supplements in Los Angeles, published last year in the Clinical Journal of Sports Medicine, found that 11 of 12 brands had failed to list the proper identity and strength of the product's ingredients. Swiss researchers reported similar findings in 75 products purchased over the Internet. And another study of ephedra products found that fewer than half (44 percent) labeled their ingredients correctly.
Certainly, not all sports supplements are hazardous. Hydration drinks such as Gatorade, energy bars, protein powders and multivitamins are used safely by millions of people. Other sports supplements, however, have raised concerns, particularly those containing androstenedione (or andro), ephedra (also known as MaHuang or ephedrine) and creatine.
Andro, a hormone marketed as a "natural alternative" to steroids, became a household word in 1998 when Mark McGwire openly admitted to using it while breaking the single-season Major League Baseball home-run record. Andro is legal but may have the same long-term effects as the banned anabolic steroids, including breast development in men and a greater risk of heart disease and certain kinds of cancer.
The label on at least one andro product, P6 Extreme, warns that urine testing "could produce a positive result if you are subject to steroid testing."
Lauerbach points out that 30 years ago, when anabolic steroids became popular, they, too, were touted as a safe, easy way to build muscle. It was only later, after decades of use, that pumped-up athletes began dying of heart disease, stroke and cancer.
The new potential killer appears to be ephedra, a plant-derived stimulant advertised as an aid to weight loss and the development of lean muscle. It was banned by the NFL following the 2001 heat-stroke death of Minnesota Vikings offensive lineman and former Ohio State University star Korey Stringer. Ephedra products were found in Stringer's locker.
After the death of the 16-year-old football player in Lincoln, Ill., Sen. Richard J. Durban, D-Ill., chided the FDA for not protecting consumers, particularly youths who are most vulnerable to industry claims for supplements.
"We have mountains of evidence that this drug is not safe and these manufacturers are being irresponsible about their marketing practices," he said Tuesday during a Senate subcommittee hearing on sports supplements. "Ephedra is not safe and should be taken off the market."
That same day, U.S. Department of Health and Human Services Secretary Tommy G. Thompson announced that he has asked the FDA to evaluate the evidence against ephedra and recommend the strongest possible mandatory warning label for ephedra products.
But labels, no matter how strong, have a hard time standing up to the influences of coaches and trainers. To many athletes, a coach's suggestion to "hit the weight room" or "beef up" has a secondary meaning: "Do what's necessary to get stronger."
Lauerbach said coaches don't know enough about sports nutrition to educate and warn athletes who turn to dietary supplements as a training aid. Ohio used to require that coaches be certified as teachers, but "now they're looking for anybody willing to do the job," he said. "That's not to say they're not good coaches, but they may not know anything about anatomy, physiology and the nutrition concerns of these kids."
A coach's lack of sports training knowledge can be especially dangerous in football, where the dictum has become "bigger is better."
In 1972, the average size of the All-Area offensive lineman in the Miami Valley was 6 feet-2 inches, 215 pounds. Last season, the average big-school lineman was still 6 feet-2 inches tall, but weighed in at 256 pounds. In the National Football League, the average offensive lineman has bulked up from 248.2 pounds in 1972 to 303.3 pounds last season.
In other words, high school linemen are bigger now than the pros were in 1972, the year the Miami Dolphins won the Super Bowl with a 17-0 record. Food and weight-lifting alone doesn't explain the increased bulk.
"It would be naive to think that supplements weren't a component" in the weight gain, said Barbara Bushman, an associate professor of health and physical education at Southwest Missouri State University in Springfield, Mo.
By far the most popular supplement used by athletes in college, high school and even junior high school is creatine, especially in football, wrestling, powerlifting and certain track and field events. Creatine, an amino acid and one of the building blocks in protein, is found in meat and produced in the body.
Carroll High School senior Justin Mosher, a running back and defensive end, has been using the serum form of the supplement for more than a year and a half. He takes a few squirts under the tongue prior to a weight-lifting session. He uses it in a three-months-on, two-months-off cycle but never during football season.
"You hear different people talking about it in the gym, like Mark McGwire, talking about it," Mosher said. "If he's that big, I figure I might as well give it a try."
Mosher said he has increased his bench press ability from 205 pounds to 300. His squat-lifting maximum has ballooned from 340 pounds to 480. He is the leading rusher in the Mid-Miami League and has been able to bulldoze himself away from would-be tacklers.
He believes creatine helped give him an edge.
He's by no means alone. "A significant number, if not the majority, of high school kids who play football take creatine," said Dr. James Tytko, a sports medicine specialist at Kettering Medical Center and Wright State University School of Medicine. Tytko is the football team physician for Oakwood High School and Wright State University.
Tytko says he doesn't endorse the use of creatine and notes that it has potential dangers, particularly dehydration and cramping if used without taking enough water.
"But overall, it's fairly safe," he said.
Creatine may speed up the breakdown of energy sources inside muscle cells. Studies show it can improve performance in sports that require brief, intense surges of energy, such as powerlifting, football and even wrestling. It has no benefit for basketball, track and other sports of endurance.
Creatine occurs naturally in meat and fish. "In the old days, instead you used to eat steak and eggs," Tytko said. "If you take creatine in the recommended dosages, you're not getting a whole lot more than you're taking in from a well-balanced diet."
But Lauerbach notes that, because dietary supplements aren't regulated by the FDA, their purity and strength "is anybody's guess."
The long-term effects of creatine have been under study for only the past 5 to 7 years, primarily in professional and collegiate athletes, Lauerbach said. Yet more and more high school kids, and even junior high school, are turning to creatine in hopes of pumping up their young careers.
"Very, very few junior high school kids are going to admit to using creatine as a supplement, but I have no doubt many are doing just that," Lauerbach said. Graduates of Lauerbach's sport science program at UD, now working as trainers and coaches at area high schools and junior high schools, "are telling me it's not just the males, but the females" who are using supplements, "especially some of the kids involved in cheerleading stuff."
Lauerbach fears that creatine use will lead young athletes to experiment with more potentially dangerous supplements. "The reasoning could be, if creatine makes me big, then DHEA and Human Growth Hormone will make me even bigger," he said.
Miamisburg coach Tim Lewis knows some of his players use creatine. He has seen the empty containers spread about the Vikings' weight room. It doesn't exactly thrill the veteran coach.
"None of us (coaches) endorse it," Lewis said. "There are no shortcuts (to getting big)." But because creatine is legal and easy to obtain, coaches can't easily discipline students who are found using it.
That doesn't mean it's cheap. A 13- to 18-day supply of one creatine product, Trans-X, can cost as much as $45. A month's supply of the ephedra product Ripped Fuel costs $39 in some nutrition stores. And just 30 capsules of P6 Extreme goes for $60.
"Magic is never cheap," said Brent Aldridge, manager of MaxMuscle, a sports nutrition shop in Centerville.
Aldridge said his store is popular with high school kids in the area, but he recommends that they try protein supplements first before turning to creatine for muscle building. "Kids, especially young kids, don't realize that protein is the most important thing," he said. "You can push (weight) all you want, but unless you get the protein into you, it's not going to do you any good."
Several managers of local nutrition stores also said they discourage creatine use among youth athletes and won't sell ephedra products to those under 18.
Those youths, who want something even stronger, including andro and illegal anabolic steroids, can often turn to local fitness and weight-training facilities, Lauerbach said.
In addition to selling memberships, "they get into selling supplements - that's where a lot of money is being made," Lauerbach said. And, worse, "a lot of times the people who work in these facilities are not trained in the interaction of these drugs."
Renowned strength trainer and fitness center owner Larry Pacifico, a former world champion power lifter, would like to see all of his clients at Champions Gym and Club Champions take creatine.
"It will give you 3 to 5 percent more strength, more speed, more size, as long as you're training," he said. "Some European studies are now saying that it can hurt you. Too much milk can hurt you. Out of 5 or 7 million kids who take creatine, a couple of them are going to get dehydrated or cramp up and would have a problem."
Pacifico suffered two heart attacks because of his prolonged steroid use during his weightlifting career. In 1987, he pleaded guilty to two federal charges of misbranding, dispensing and smuggling steroids into the Dayton area.
Pacifico has his 14-year-old son, Jimmy, an eighth-grader in Vandalia, taking creatine regularly.
"We've seen about a 2 percent increase" in weightlifting strength in the first month of use, his father said.
Jimmy, a national record holder for weight lifting, says he increased his bench press from 260 pounds to 275 and his squat lifts from 450 pounds to 475. At the U.S. Track and Field National Junior Olympic Championships recently, Pacifico won the shotput and was second in the discus in the 13-14 age group. Pacifico thinks his son was at the right age to begin using the supplement and is not worried about side effects.
The University of Tennessee is worried, however. It prohibited the use of the supplement after several football players experienced cramps during the first two games of the Volunteers' 1998 national championship season.
The NCAA prohibits schools from supplying athletes with supplements. Trainers can advise players on how to take it but can't provide the product.
"We have anecdotal evidence of increased muscle strains, muscle tears," said Keith Clements, head athletic trainer at the University of Tennessee.
Fear of injury caused Butler High School senior Mike Ervin to quit using the supplement even though his doctor told him it was safe. "The coaches have been telling us it makes your muscles lean and it takes all the fat out . . . and they're easy to tear when they're highly stressed," Ervin said.
Bellbrook High School senior running back Chris Iacovone may be the among the most versed local athletes on creatine. He has done two research papers on it, focusing on possible side effects, and used to take the supplement himself. "The short-term effects weren't a big deal to me," Iacovone said. "It helps me gain weight quick. I was small."
Iacovone estimates that he was about 150 pounds as a sophomore. He quit taking the supplement, according to his father, because it was causing him to become dehydrated.
Many players appear ready to accept the risks in order to excel.
"The faster and stronger you are the better you're going to be," Mosher said.
Some coaches are against creatine and other supplements because they see it as a shortcut and a way to avoid necessary hard work. "I don't think you need it," said Fairborn football coach Roy Thobe. "I don't encourage it. I'm an old meat and potatoes guy."
Lauerbach said that coaches, trainers and even physicians can no longer turn their heads when they see young athletes using sports supplements. The risks, he said, are too high. "The bottom line is, they need to educate themselves on supplemental use, and then present the pros and cons" to young athletes, he said.
"The junior high school and high school kids are very, very heavily influenced by their coaches and trainers," he said. "The bottom line is, we all have to do a better job of education."
Contact Scott Halasz at 225-7389 or by e-mail at shalasz@coxohio.com
Contact Jim DeBrosse at 225-2437 or by e-mail at jdebrosse@coxohio.com
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