By John M. MacKnight, MD
Supplement use by high school student-athletes has exploded in recent years. Some estimate as many as 40% of high school students participating in organized athletics use dietary supplements of some variety. Without question, this is a concerning trend. Legitimate health-related benefits may come from multivitamins, omega-3 fatty acids, probiotics and vitamin D, particularly for documented deficiencies. However, supplements targeted for athletic performance enhancement generally lack any high quality, unbiased data to support their use, value or safety. Understanding that these products are pervasive in sport, we as sports medicine practitioners must stand firmly against their escalating use and abuse. Superior athletic ability does not come out of a bottle, and this must be our consistent message.
Dietary supplements have been allowed to flourish under permissive Food and Drug Administration (FDA) regulation, which has classified them as food rather than pharmaceuticals. (1) As such, manufacturers have seized on this favorable environment and are aggressively marketing products to the high school athlete. Vitamin and nutritional supplement stores are cropping up everywhere, while the availability of online products is essentially limitless. In addition, increasing numbers of readily available “energy” drinks, popularized by the feel-good kick from excessive stimulant content, have become the supplement of choice for high school athletes. (2)
So why the increasing interest in supplement use? Is it to enhance health? Perhaps. Studies have found the major reasons for supplementation in adolescent athletes are growth, illness prevention, illness treatment, enhanced performance, tiredness and muscle development. (2) Is it to augment the value of an ideally constructed training regimen? Not likely. In my opinion, the real interest lies in trying to get more from less. To run faster or longer with less training. Lift more with fewer repetitions or sets. These are the claims that these products make. Young athletes are losing touch with the “old school” reality that great nutrition, adequate hydration and flat out hard work are the keys to athletic success. Dietary supplements have never made up for the lack of these key foundation elements of athletic ability and they never will.
Supplements for sport may carry with them a clear risk for misuse, tainting and deception. Anyone consuming them has to be concerned about the quality of the ingredients, the accurate representation of what is in each supplement and the possibility of harmful, even lethal, side effects. Even supplements that are reasonably studied and accepted to have efficacy for sports, like creatine, can be harmful or tainted. There simply is no means of knowing that a given product is risk-free. Remember the hospitalization of 24 McMinnville, OR, high school football players (three of whom required surgery) for severe swelling and cramping likely resulting from widespread creatine use. (3) Or the 25 Menomonie, WI, high school football players suspended for consuming a creatine supplement energy drink marketed as “the most explosive pre-workout intensifier.” (4) Who could resist? Unfortunately, the product was tainted with Synephrine HCl, a potent sympathomimetic, which violates Wisconsin High School athletic rules. Such product mislabeling is a major problem, as flashy packaging and claims of enhanced athletic prowess are too much for many young athletes, and their parents, to resist. In 2009, the FDA recalled 65 dietary supplements available on a popular bodybuilding website because they contained anabolic steroids. (5) The list of such instances is lengthy and it must stop.
Further challenges arise from elite and professional athletes who glamorize supplement use and encourage young athletes to mimic their actions. For those who dream of participating on these bigger sport stages, the notion that dietary supplements play a vital role in getting there is unfortunate and unnecessary. In high school kids who can’t resist the lure of anything that might improve their athleticism, the slippery slope from supplements to stimulants, anabolic steroids and growth hormone is steep and precarious. The moment that supplement use becomes a more important factor in athletic preparation than hard work and dedication is the moment that the true spirit of sport and competition is lost.
It is time for the sports medicine community to lobby strongly against the uncontrolled manufacture and distribution of dietary supplement products to high school students. Show us solid clinical research supporting their efficacy as well as their short and long-term safety. Until these criteria are met, sports supplements should not be taken and we must be the voice of reason to dissuade high school athletes from using these products. Our message should be loud, clear and consistent. Beware of the validity of what the label says. Don’t believe the product is safe just because you have confidence in a store or website or the advice of a teammate or coach. Never ingest any supplement without the advice and supervision of a qualified sports medicine provider. Optimize all aspects of your training and leave the supplements behind.
References can be found at http://www.amssm.org/Content/pdf%20files/Mar13_SR_Ref.pdf