Now let’s look at an interaction that goes well. Dr. Wornik will appear from time to time with observations and advice.
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. DENKE: It sounds like you’re working hard. Being in good shape is really important to you.
TOM: Yeah, I want to, you know, try for varsity next year. I know I’ll only be a sophomore, but... well, my dad’s hoping I’ll impress them and maybe end up landing a scholarship…
CURTIS: I played three years of varsity football, then blew it all off without even trying for a ticket to college. I’m not gonna let Tom make that mistake.
DR. DENKE: So, your goals are to stay healthy, build your strength, and try out for the team in the fall.
TOM: (nods) Yeah.
DR. WORNIK: Here, Dr. Denke affirmed Tom’s hard work and aspirations. That helped build trust and put him at ease. When Dr. Denke brings up the dangers of supplements, Tom and Curtis are more likely to believe he’s on their side.
DR. DENKE: Do you mind if I share some information about Tom’s growth rate?
CURTIS: Sure.
DR. DENKE: Every time kids grow an inch, they put on about six pounds of muscle, bone... everything that inch comes from. And Tom’s put on almost two inches in the last six months. What do you make of that?
TOM: So, everything I gained is just ‘cause I’m getting taller?
DR. DENKE: (nods) And that’s what your body is working on now. It’s not going to put a lot into growing bigger muscles until you’re at your full adult height. No supplement is going to change that.
DR. WORNIK: Notice how Dr. Denke used Ask-Tell-Ask. He started by asking, “Do you mind if I share some information?” Then he told the family about growth rates. He followed up by asking, “What do you make of that?” That question re-engaged the family.
Another thing you can point out is that most weight gain on creatine comes from water retention, not muscle growth.
Let’s observe Dr. Denke use Ask-Tell-Ask again, this time to bring up the dangers of supplements.
DR. DENKE: How much do you know about how dietary supplements are regulated?
TOM: Uh… (looks at Curtis)
CURTIS: (shrugs) I dunno. Doesn’t the government certify them or something?
DR. DENKE: You’d think so. But the FDA doesn’t test supplements’ claims. Actually no regulatory agency oversees them. Which means you can get a lot of contamination, including poisons like lead or mercury. And watchdog groups have found that around a quarter of all protein powders and about 60% of creatine on the market contain illegal steroids. Sometimes enough to make athletes test positive on a drug test. What do you think of that?
CURTIS: (shocked) That’s nuts. We buy this stuff in the mall.
DR. WORNIK: Using Ask-Tell-Ask to find out what the family already knows lets you focus on what they don’t. The Council for Responsible Nutrition found that sixty-eight percent of American adults take dietary supplements, and 84% are confident in the safety, quality, and effectiveness of the supplement industry. Simply letting your patients know the lack of quality controls can go a long way toward breaking that misplaced trust.
Now let’s observe as Dr. Denke switches to finding ways to improve Tom’s athletic performance without relying on workout supplements.
DR. DENKE: Can I make you a deal, Tom?
TOM: (wary) What kind of deal?
DR. DENKE: Your body can only actually absorb a set amount of protein per day, so if you’re eating a proper diet, there isn’t anything more that a protein supplement can do for you. (pause as Tom considers) You eat breakfast?
TOM: (shakes head, sheepish) I barely make it to school before the bell as it is.
DR. DENKE: Can we give this a try, then? For two weeks, I want you to really work on eating right -- no supplements, just breakfasts, lunches, dinners and post-workout snacks with natural protein, lots of fruits and veggies, and healthy carbs -- then come back and tell me if you’re feeling better or worse than you are right now. Okay?
TOM: (skeptical) I guess...
DR. DENKE: You really want to keep spending fifty bucks on protein powder when you could just be eating peanut butter?
TOM: (looks thoughtful)
DR. WORNIK: And now, as part of preventative care, Dr. Denke brings up steroids. But rather than directly asking Tom about intentions to use steroids, Dr. Denke uses an indirect question about his friends. This is a less threatening way to approach this delicate topic. Also, pay attention for another use of Ask-Tell-Ask to collaboratively share information.
DR. DENKE: You have a lot of friends at the gym and at school? (Tom nods) And have any of them talked about trying anything harder than protein or creatine?
TOM: (wary) Like what?
DR. DENKE: We do see high school athletes who experiment with anabolic steroids. You ever hear anyone talk about that?
TOM: (glances at Curtis) I don’t know. I guess. I mean, just talking.
CURTIS: (shocked) What?
DR. DENKE: What do they say?
TOM: Uh, just that they make you stronger. Bigger.
DR. DENKE: Anabolic steroids do make your muscles bigger, that’s true. Do you know what else they do to your body?
TOM: Uh, they make you like, Hulk out, get all rage-y and stuff, right?
DR. DENKE: They can. They can also do some serious damage to your body. Steroids are artificial versions of the male hormones you already make, but when you take them, they stop your body from making any of its own. So, when kids take them before they’re done growing, it can stop them from getting any taller, make boys grow breasts. They can even make your testicles shrink. What do you think of that?
TOM: (shrugs, uncomfortable) ...Gross.
CURTIS: And they’re cheating. If I ever catch you cheating like that, say goodbye to that car you want senior year.
TOM: (mutters) I thought you want us to win…
CURTIS (shocked): Hey, look, protein and creatine’s one thing, but steroids?
TOM: It’s not that different...
CURTIS: No way. Steroids are illegal. And they can get you thrown off the team. I would never want you to do something like that…
DR. WORNIK: It was important for Dr. Denke to get Tom and his father talking about supplements and steroid risk. Very few families have any idea how unregulated the supplement market is or have talked to their children about the dangers of steroids. By talking about APES whenever you notice risk factors, you allow parents and teens to ask questions and share their experiences in a safe environment where everyone understands that the most important thing isn’t winning, but the child’s health.