DR. WORNIK: Prescription drugs and illegal steroids aren’t the only appearance and performance enhancing substances our children have to worry about. Even legal, over-the-counter supplements can be surprisingly dangerous for teens. Two of the most common are protein powders and creatine, a muscle-growth enhancer.
Over and over, anti-doping watchdog groups have found commercial supplements are laced with illegal steroids. In 2014, Informed-Choice.org found that 15 of 58 protein powders tested screened positive for steroids. And in 2010, the U.S. Anti-Doping Agency found that 60% of creatines they tested were laced with the steroid nandrolone.
There could be more exotic substances in workout supplements, too: a 2013 analysis by the journal Drug Testing and Analysis found that a supplement was laced with a designer drug similar to methamphetamine. In 2010, Consumer Reports found that every protein drink they tested had at least one sample contaminated with arsenic, cadmium, lead, or mercury. Twenty percent exceeded USP recommendations.
Workout supplements bill themselves as “health foods,” but they aren’t regulated by the FDA. No government oversight guarantees that their ingredients are effective or safe… or that what’s on the label is what’s actually in the container. Yet a huge number of teens and their families fall prey to the claims these products make.
Nearly 35% of all middle school and high school students, including 18% of non-athletes, use protein powder to boost performance or achieve a more muscular physique. And up to 17% of boys and 9% of girls are also using creatine, which is a likely gateway drug for steroid abuse.
Yet few families know the risks these substances pose. The AAP’s stance is clear: supplements are untested, often contaminated, and are not beneficial for children and adolescents. Instead of looking for quick fixes, teens should work with their doctors to find diet, sleep, and exercise habits that maximize their athletic performance and health.
Let’s consider a case study. Tom is 14 and on the junior varsity football team. His dad has brought him in for his physical. His pre-participation evaluation form shows some APES risk factors: he says he’s taking supplements and he wants to gain weight. These red flags should be a prompt to ask further questions.
One technique that can save time when you need to share information is to ask a question first to engage the family and establish what they already know. Then, you can add any new information, then follow up with a question to engage their response. You might have heard this technique called Ask-Tell-Ask.
Now let’s look at an example interaction where Dr. Denke, a pediatrician, talks with Tom and his dad, Curtis, about supplement use.
First, let’s look at an interaction that goes poorly. Dr. Wornik will appear from time to time with observations and advice.
DR. DENKE: I see here that you’re taking supplements and you want to gain some weight. Tell me a bit about what you’re taking.
TOM: Well, you know, like protein powder before and after workouts. And I started using creatine a few months ago. It really made a difference.
CURTIS: (proud) Did it ever! He’s done two four-week cycles so far, and I can already see his muscles are getting bigger. Used to be I had to push him to finish workouts. Now he’s the one pushing me.
DR. DENKE: So you’re using protein powder and creatine. Are you on any special diet where you would need that extra protein?
TOM: Nah, it’s just for workouts.
CURTIS: (proud) He’s put on about seven pounds, and got his bench press from 135 to 185, ten reps.
DR. WORNIK: This is a good way to begin the conversation. Dr. Denke has noticed some warning signs on Tom’s pre-participation evaluation form and is following up on them in the visit. But now Dr. Denke is about to lecture Tom and Curtis, which will make him come across as judgmental and out-of-touch.
DR. DENKE: You know, a lot of dietary supplements can be bad for your health, even dangerous.
TOM: (skeptical) Really?
DR. DENKE: All that work you put in, wouldn’t you rather do it the old-fashioned way, instead of using a chemical like creatine, which can cause diarrhea, vomiting, heart palpitations, even kidney failure?
CURTIS: Oh, come on. Are they still telling kids that? I’ve been using creatine for years, never had trouble with my kidneys.
CURTIS THOUGHT: (thinking to himself) You’ve never tried creatine in your life. You don’t know.
DR. DENKE: You shouldn’t be using protein powder or creatine, Tom. I’d like you to stop.
DR. DENKE: Dietary supplements aren’t regulated. And no one’s studied their effects in kids. Medically, we recommend you avoid them completely.
TOM: That’s crazy. Every kid on my team uses this stuff.
CURTIS THOUGHT: (thinking to himself) You don’t know what you’re talking about.
DR. DENKE: It may seem harmless to use supplements, but they can be quite dangerous. More than 20,000 emergency room visits a year are associated with misuse of dietary supplements.
CURTIS: People “misuse” protein powder? What, do they get it in their eyes?
DR. DENKE: A quarter of protein powders and up to 60% of creatine brands have been found to be contaminated with steroids. It’s possible that any muscle gain you’ve been experiencing is because you’ve taken a spiked product.
TOM: What?! I’m not on steroids!
CURTIS: (holds up a hand to calm Tom down) It’s okay, doc. We get the picture. Use responsibly.
CURTIS THOUGHT: (thinking to himself) You must think I’m an idiot. I’m not giving my kid anything dangerous.
DR. WORNIK: Dr. Denke is taking an authoritarian tone, and it’s provoking a negative response from the family. People who use workout supplements have often done a lot of research. This can make them skeptical when healthcare providers try to lecture them about a topic they already consider themselves to be experts in. Now Dr. Denke will change his approach and look for better ways to improve his athletic performance.
DR. DENKE: How much sleep do you get most days?
TOM: Well, I’m usually at the gym until nine, then I eat and do homework ‘til about midnight. So maybe six hours? Sometimes five.
DR. DENKE: Did you know that growth hormone is only secreted when you sleep? (Tom shakes his head) That means without enough sleep, it doesn’t matter how many protein shakes you drink, your muscles don’t have time to recover and grow. Are there changes you can make to get more rest? (Tom looks at Curtis)
CURTIS: (grudging) I didn’t know homework was taking so much time. Maybe we can cut back a little, be home by seven on school days.
TOM THOUGHT: (thinking to himself) Guess I was “growing” a lot in math class this morning…
DR. WORNIK: Most teen athletes have a packed schedule of school, practice, games and homework. Often this prevents them from getting sufficient sleep. Improving his sleep habits will help Tom’s performance more than any powder or pill. That exchange went well; but now Dr. Wornik is about to make another misstep.
DR. DENKE: You know better than to try steroids, right, Tom?
TOM: Uh, yeah, sure.
DR. DENKE: They can do real harm to your body. Boys who use steroids can grow breasts, and their testicles shrink. They even make your bones stop growing. You’re 5’7” now. Use anabolic steroids and you may never be as tall as your dad.
CURTIS: Worse than that, they’re cheating. Tom would never cheat. Right, bud?
TOM: (uncomfortable) Right.
DR. DENKE: Okay, Tom. That’s about all we’ve got for today. You’re in fine shape to join the team.
TOM: Awesome.
DR. WORNIK: Tom has several risk factors for future steroid use (using creatine, working out at a gym, wanting to gain weight), so it was a good idea to talk to him about steroids. However, by condemning steroids instead of asking questions, Dr. Denke discouraged Tom from being completely honest.