Dec. 2--Mikey Santini was in junior high when he started taking creatine and protein supplements to build muscle and enhance his athletic abilities. By his junior year at Stevenson High School, he had moved on to nitric oxide "energy igniters" such as N.O.-Xplode and so-called "legal anabolic" products such as Mass FX, which claims to boost strength, aggression and testosterone levels.
"You can get fabulous results," said Santini, 19, of Buffalo Grove, who played soccer and ran cross country. But he acknowledges the products have a potentially dangerous downside. "It involves taking a lot of other stuff for your liver and prostate and rebalancing your testosterone levels so you don't get side effects."
Some surveys show anabolic steroid use has decreased among adolescents over the last decade, but a popular alternative for many athletes -- over-the-counter supplements -- is raising concerns among parents, coaches, the U.S. Food and Drug Administration and even lawmakers.
Proponents say the legal products can provide a competitive edge and fill in nutritional gaps for athletes with hectic schedules and poor diets. But supplements, which are as easy to buy as aspirin, can pose risks to young athletes, whose developing bodies often are undergoing rapid physical changes. The long-term health effects of commonly used products such as creatine aren't known, but children often mix products or take more than the recommended amounts, and most of the safety research has been done on adults.
The FDA, which has limited ability to regulate dietary supplements before they hit the market, recently prompted several major recalls of bodybuilding supplements and warned consumers to avoid products marketed as alternatives to anabolic steroids.
Moreover, some see supplements as a bad habit, one that can lead to more dangerous drugs and discourage teens from what they really need: nutritious whole foods. But supplement use is generally overlooked because parents and coaches often have no clue what -- or how much -- children are actually taking. Though Illinois is one of three states testing athletes for illegal steroids, there are no state rules -- and very little advice -- governing dietary supplements.
"(Supplements) are actually more of a potential problem in our society than steroids," said C. Roger Rees, a professor of human performance sciences at Adelphi University who specializes in social issues and high school sports. "Kids see supplements as safe and they're sold over the counter. I'd be concerned about large use if I was a parent."
For athletes, the benefits of taking supplements rarely outweigh the risks. With the exception of creatine, there's little evidence that sports supplements, a $2.7 billion industry in the U.S., actually enhance performance. Yet even seemingly benign ingredients have potential dangers.
Protein, for example, is relatively safe. But some products may contain multiple sources of protein, said personal trainer Erin Palinski, a registered dietitian who specializes in adolescent athletes. In general, athletes need 2 grams of protein per kilogram of body weight. "Teen athletes who get too much can excrete calcium, which could decrease bone mass," Palinski said. "Since that's prime time for bone building, it could lead to future problems."
Creatine, which the American College of Sports Medicine says shouldn't be used by those younger than 18, has been shown to be ineffective for some people. It can cause stomach upset and muscle cramps and overwork the kidneys. There are no data evaluating the long-term consequences of use or its effect on the heart and brain.
Supplements marketed as prohormones or testosterone-boosters such as DHEA (dehydroepiandrosterone), meanwhile, have been linked to prostate cancer; side effects include male breast development, heart problems and hormonal changes in both men and women. And if a supplement appears to work, it likely has other "stuff" in it, said Nancy Clark, a Boston-based sports nutritionist. The FDA said those mystery ingredients could include undeclared steroids, which can cause a host of serious health effects, including acute liver damage and kidney failure, male infertility, shorter stature in children and increased risk of heart attack and stroke.
Comprehensive research on supplement use among high school athletes is scarce. One 2006 study of 139 Nebraska high school athletes found 22 percent took dietary supplements. Other research shows use ranging from 8 percent to 58 percent among high school athletes. And though many high school coaches encourage exercising and eating well and don't promote any products beyond generic protein shakes, some acknowledge that teens aren't open about what they do off the field.
"It really picks up in the offseason," said Santini. "I know people who have no idea what's going into their body but they've put on 20 pounds in two or three weeks." The FDA, concerned about the escalating use among minors, has started taking a closer look at products on store shelves. Last month, the federal agency triggered recalls of more than 70 dietary supplements that may contain ingredients -- such as "Superdrol," "Madol," "Tren," "Androstenedione" and "Turinabol" -- that are classified as steroids. In June the FDA issued a public health alert warning consumers about bodybuilding supplements that claim to boost or diminish the effects of hormones because they could contain undeclared steroids, in part to protect unwitting high school athletes, said attorney Mike Levy, the director of the FDA's office of compliance in the division of drug evaluation and research.
Congress, meanwhile, is investigating whether regulations for bodybuilding dietary supplements need to be strengthened. Unlike food and drug products, the 10,000 supplements on the market are not approved by the FDA for safety and efficacy before they hit the market. Instead, under the Dietary Health and Supplement Education Act of 1994, it's up to the manufacturer to make sure the product is safe. The FDA can take action only after the products are on store shelves.
But sports supplement attorney Michael DiMaggio, of New York, said the majority of manufacturers produce safe products. Moreover, most are labeled for those older than 18 and often 21. "The sports nutrition companies don't market or advertise to teenagers -- or athletes either -- so we're always amazed at the outrage by Congress. Most major governing bodies have told athletes not to take sports supplements so the companies don't want to bother advertising to them." He said that most of the people who use supplements are looking for cosmetic enhancement.
Others say supplements such as protein and creatine, which can both be found naturally in whole foods, can be beneficial for teen athletes whose busy schedules and notoriously poor diets make it hard to get proper nutrition. Ingesting small amounts of protein and carbohydrates before and after exercise has been shown to have positive effects.
Jess Banda, an athletic performance specialist in Connecticut, recommends supplements like branched-chain amino acids, beta-alanine, creatine, vitamin D3 and fish oil.
"I'm often ridiculed by my colleges for my unwavering belief in supplementation and its ability to positively affect athletic performance," Banda wrote in his e-book, "Nutritional Supplements for Sports and Wellness." "But in an increasingly competitive world, optimal supplementation can mean the difference between coming in first place or bringing up the rear."
Brian Grasso, who specializes in youth athletic development, has no problem with certain supplements such as protein or fish oil -- as long as athletes have sound nutritional habits. He worries, however, that creatine can be a gateway drug. "Once you start dabbling in ergonomic (performance enhancing) aids, my concern is they become addictive and are not enough," said Grasso, founder and CEO of the International Youth and Conditioning Association. "It opens the door to steroids."
Athletes say the pressure to succeed and the desire to keep up with peers often drives supplement use. Though whey or soy-based protein supplements are among the most popular products, creatine is frequently used by boys participating in team power sports such as football, wresting and hockey. "In this time, this era, being big is what you want to be," said Tom Kelly, 17, a senior wide receiver at Chicago's St. Rita High School who drinks a protein shake after working out. "You want to get bigger and faster, and this helps."
But even athletes who might not be looking can be steered toward supplements. Gianna Abruzzo, 17, a senior on the Fremd High School basketball team, said she doesn't take any such products. But when she goes to GNC to purchase a multivitamin, employees pressure her to get them.
Schools often lack answers. When kids ask the coaches at Glenbrook South High School in Glenview about a supplement, they're told, "You don't need it, we don't recommend it, and if you eat right and work hard, you'll get the same benefit," said head athletic trainer Brian Robinson. But like many schools, Glenbrook South doesn't have a formal policy supporting or condoning the use of legal performance enhancement supplements. At Glenbard West High School in Glen Ellyn, football players get an information sheet, but head coach Chad Hetlet said supplement use is more of a "kid-parent" issue than one that should be monitored by coaches.
Perhaps the biggest problem is that the supplement world is shrouded in mystery, said Pieter Cohen, an internist at Cambridge Health Alliance in Massachusetts and an instructor at Harvard Medical School. The FDA doesn't know about potential side effects because premarket testing isn't required, there aren't any studies on whether they have positive or negative impacts on teenagers and adolescents are unlikely to tell doctors what they're taking, Cohen said.
Santini, who now is studying criminal justice at the College of Lake County, gleaned his information on supplements from the Internet and friends. He works out two to three hours a day and boosts his effort by taking Mass FX, Mass Caps, naNO Vapor, protein powder, creatine, milk thistle and 60 to 80 fluid ounces of water. Some of the products he was using have been recalled by the FDA, but he said he can still get them on the Internet and plans to stock up.
"I like the feeling of being in shape, maximizing my athletic abilities and making the most out of my strength and potential," he said.
jdeardorff@tribune.com
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