Reaching for that “Edge”Westchester teens’ use of supplements dangerously high

Remember when it was not if you won or lost, but how you played the game? It’s a whole new ball game these days, and one with a whole new language: anabolic steroids, androstenedione, creatine, diuretics, ergogenic substances, and nutritional supplements — all used to improve young athletes’ performances. And while there are differences in their health benefits and risks as well as their legal status, their use frequently echoes the same mantra: “Win at all costs.” “If you could take the same undetectable substance, win every competition for five years and then die, would you?” This was the question put to athletes on the 1998 U.S. Winter Olympics team for a study on performance-enhancing drugs, and more than half answered yes. Unfortunately, the quest to win with enhanced ability is not limited to the Olympics, but is associated with athletes at all levels.

Westchester students studied In 1998, the same year the Olympics athletes were studied, more than six million American high school athletes were reported to be using nutritional supplements, including ergogenic aids, which chemically improve sports performance. In 2001, the medical journal Pediatrics published results of a Westchester-based study on creatine use revealing 5.6 percent of student athlete participants, ages 11 to 17, admitting confidentially to using creatine, and 44 percent of Westchester seniors in the study saying they had used the supplement. Dr. Ann Engelland, a specialist in adolescent medicine based in Mamaroneck, concurs with those findings, saying, “We see kids as young as sixth grade using supplements.” Among the Westchester student athletes who were studied, creatine usage was more prevalent among boys than girls, but it was used by athletes in every sport, especially football, wrestling, hockey, gymnastics, and lacrosse. Student athletes are not using just creatine. Brett Martell, who plays soccer, baseball, and basketball at Valhalla High School, says, “I know people who use dietary supplements, but it’s not a school-wide thing.” Ann Connors, also of Valhalla, plays volleyball, and says she heard a rumor that someone in her school was using steroids, but the athletic department immediately addressed the issue and urged students to report anyone they knew who was using this kind of supplement. White Plains athlete Brian Koizim says that in his school, “Usually it’s the weightlifters who are really using stuff like creatine.” According to the 2001 study, the most common reason given by Westchester student athletes for their usage was the improvement of their sports performance. Creatine is used to make muscles stronger. Anabolic steroids, such as nandrolone and Dianabol, which are taken orally or injected, are also used to strengthen muscles. Androstenedione is another product used to increase strength. Diuretics are used to lose weight quickly, often preferred by athletes involved in wrestling and swimming.

What is a “dietary supplement”? In the Dietary Supplement Health and Education Act (DSHEA) of 1994, Congress classified the term “dietary supplement” as “a product taken by mouth that contains a ‘dietary ingredient’ intended to supplement the diet.” Vitamins, minerals, herbs or other botanicals, amino acids, enzymes, organ tissues, glandulars and metabolites all fall under the category of “dietary ingredient”. Currently, according to the Food and Drug Administration (FDA), “There are no regulations that are specific to dietary supplements that establish a minimum standard of practice for manufacturing dietary supplements.” But in early March, the FDA proposed labeling and manufacturing standards for all dietary supplements. Meanwhile, as the proposal to regulate such supplements develops into legislation, Tommy Thompson, U.S. Secretary of Health and Human Services, has issued a strong caution regarding certain dietary supplement products that have Ephedra (ephedrine), an herbal supplement used for bodybuilding and weight loss, as an ingredient. As we went to press, Westchester County legislators unanimously passed a bill to ban sales of Ephedra in the county by September and County Executive Andrew Spano promised to sign it.

Long-term effects unknown The pending legislation addresses many doctors’ concerns about nutritional supplements. One is that the long-term effects on young, growing bodies are largely unknown. Dr. Jordan Metzl, medical director of the Sports Medicine Institute for Young Athletes at the Hospital for Special Surgery in Manhattan, warns that nutritional supplements “have never been tested in kids and we do not know about their safety.” Side effects in kids, however, are better known. By using anabolic steroids and androstenedione, boys can experience early puberty, girls can develop facial hair, and both sexes risk liver cancer. Creatine can cause young bodies to retain water and increases the risk of kidney failure. Diuretics can effect electrolyte abnormalities, which then can lead to cardiac arrhythmia. Finally, Ephedra, the most recent supplement to come under public scrutiny, has been known to cause high blood pressure, heart palpitations, rapid heart rate, seizures, and stroke. A RAND Corporation study, commissioned by the National Institutes of Health, found Ephedra use in the cases of two deaths. Westchester County has already banned the sale of Ephedra to minors and the Board of Legislators is considering extending the ban to adults as well. Further, according to Dr. Cheryl Appel, a specialist in adolescent medicine in Tarrytown, dietary stimulants used to keep weight down often have a “rebound effect”, which reverses the weight loss. “The problem,” she says, “is that kids need to keep taking appetite suppressants; if they stop, they start to rebound, and they binge eat as a response to starvation.” Dr. Katherine Halmi, who directs the eating disorder program at the Westchester division of New York Presbyterian Hospital, says many girls who have eating disorders come in abusing diet pills and herbs, in particular Ephedra, which comes from the Chinese herb Ma Huang. She claims that it is rare to see this form of abuse under the age of 13, but “between the ages of 13 and 30, use of these supplements increases dramatically.” Like Drs. Engelland and Halmi, Dr. Appel says she also sees nutritional supplement use in patients, and claims: “Kids don’t know how to use these enhancers and dietary aids, and they don’t care about the long-term effects. They are more concerned with the short-term.” She says a teenager may read the directions on the bottle, but may overuse the product by rationalizing: “If a little can work, a lot can do more!”

Easy to acquire Another concern among doctors is the ready availability of nutritional supplements and sports enhancers. A brief search on the Internet turns up scores of websites selling them. Even more misleading is their easy availability at chain drug and vitamin stores. Dr. Appel points out that diet aids and stimulants are found in over-the-counter products such as TrimSpa, Stackers, Metabolift, and Dexatrim, among others. Since they are sold over-the-counter and often claim to be “natural,” a misconception is fostered, leading kids to believe that the chemicals within them are harmless. Another difficulty Dr. Engelland notes is that even though doctors “know nutritional supplement use is out there, it’s hard to get kids to admit it.” While each says they do not use supplements themselves, both Ann Connors and Steve Rinaldo, who plays football at Valhalla High School, speak to what they see as the silence around the use of nutritional supplements and other sports enhancers. Connors claims there is a lot of “hush-hush” about the issue, and Rinaldo admits that as far as fellow students’ use goes: “I try not to know.” Connors perceives supplement use in the context of a larger problem. She says that “a lot of kids are forced to play a sport. When someone doesn’t want to play, they can feel like ‘I’m not good enough,’ and use supplements to help.” Dr. Engelland sees the issue as a cultural phenomenon: “There’s a belief in our culture that we should take a pill to make our health better, so it’s not illogical for teenagers to think if they take a pill, it will enhance their body.” She points out that the American Academy of Pediatrics has never endorsed even the use of vitamins. Dr. Engelland believes that supplement use is a manifestation of what she calls “a kind of cultural body-image disorder,” explaining: “A lot of kids feel inadequate. Boys’ use of supplements is equivalent to girls’ eating disorders. They feel as if their performance defines them, in the same way a girl feels that her body size and shape define her.”

Advice for parents For parents who suspect that their son or daughter may be taking dietary supplements, Dr. Appel says it is important to ask the child, but emphasizes: “Don’t accuse him and don’t be too confrontational.” Dr. Metzl suggests that part of the solution to supplement use is to emphasize ways to improve sports performance without compromising integrity. In his book, The Young Athlete, he asserts: “There is no personal satisfaction or growth from winning by cheating — by having a chemical do the work instead of your own effort.” Instead of simply telling teenagers not to rely on supplements, he explains, “It’s important to give them an alternative, constructive route to their goals.” Dr. Metzl’s lessons are not lost on many Westchester athletes. When asked if he would consider taking a performance enhancer, Brian Koizim shrugged, saying, “Some guys are trying to get that ‘edge’. But I think it’s better for me to eat 10 steaks than to try experimenting with stuff like creatine.” Perhaps Koizim’s awareness comes from the efforts of coaches like Bob Drysdale, who coaches football and track at Valhalla High School, and who takes precautions against nutritional supplements and sports enhancers. Drysdale says: “We talk about prevention and the negative effects of steroids with our athletes every year.” His recommendation for improvement starts with a holistic workout plan, which includes good diet and exercise, because, he says, “You wouldn’t believe how many teenagers eat a couple bags of chips and a candy bar for lunch.” Dr. Metzl says that good habits must start early: “Strength training — not power training — can begin as early as eight years old, as long as it is supervised and healthy goals are well supported.” Melinda Swope, the fitness director of the YWCA of White Plains, emphasizes the necessity of finding a sport a teenager enjoys: “Make exercise fun. Then kids will look forward to it.”

Pointers for Parents Before you give your child a dietary supplement, be aware of the following: — Many dietary supplements, especially herbal products, have not been tested in kids to determine their safety or effectiveness. — Dietary supplements in this country are not held to any set of federal standards for quality or purity. — Your best advisor is your child’s pediatrician or another health care provider. Be sure to check with them before starting your child on a supplement. And keep them informed of your child’s continuing use of the product. — Supplements advertised as “natural” are not necessarily safe. In fact, herbs, like other so-called natural products, can have powerful drug-like effects. Some of these effects can be especially risky for people who take other medicines or have certain medical conditions. — Fraudulent promoters often fall back on the same claims to trick consumers into buying their products. Tip-offs that they’re trying to fool you are: o Claims that the product is a “scientific breakthrough”, “miraculous cure”, “exclusive product”, “secret ingredient”, or “ancient remedy”. Says Howard Beales, director of the FTC’s Bureau of Consumer Protection: “Ask yourself, ‘If a product is so amazing, why would I be reading about it for the first time in an ad?’” o Claims that the product is a quick and effective cure for a wide range of ailments. o Claims that use medical terms that sound impressive. This ploy is an attempt to cover up a lack of good science. o Claims that the government, medical profession and health care industry are in a conspiracy to suppress the advertised product. o Undocumented case histories of people who’ve had supposedly amazing results. o Claims that the product is available from only one source, and payment is required in advance. o Claims of a “money-back guarantee”. Source: Federal Trade Commission website: