Myoplex Deluxe 36 packets

Myoplex Ready to Drink Shakes

Amino 2222 Liquid Protein

Vitamin B Complex

Liquid Calcium

Viactiv Calcium Chews

Zinc

Paragon Supplements

Americans spent an estimated $1.4 billion on sports supplements in 1999, hoping that the pills, drinks, and powders would help them bulk up, slim down, or compete more effectively. But people who take these products are actually conducting what amounts to a vast, uncontrolled clinical experiment on themselves with untested, largely unregulated medications.

The few good scientific studies available on these "dietary" supplements suggest that they either are ineffective or, at best, produce only slight changes in performance. More disturbing, they can contain powerful and potentially harmful substances, such as:

Androstenedione, which can upset the body's hormonal balance when it metabolizes into testosterone and estrogen, and may cause premature puberty and stunted growth in adolescents.

Creatine, a substance produced by the body that can help generate brief surges of muscle energy during certain types of athletic performance. It may also cause kidney problems in susceptible individuals.

Ephedra, an herbal stimulant that acts like an amphetamine ("speed") and that some investigators hold responsible for dozens of deaths and permanent injuries.

"All you have to do to get these products is walk into a food-supplement store," says Gary Wadler, M.D., a New York sports-medicine specialist and adviser to the White House Office of National Drug Control Policy. That's because a federal law, the 1994 Dietary Supplement Health and Education Act, allows supplements to be sold to consumers of any age without rigorous safety testing and without meaningful oversight of product quality.

Little is known about the long-term safety of these products in adults, and even less about their effect on youngsters. But if the supplement industry has its way, at least some of these products will be consumed by ever-increasing numbers of weekend athletes and even nonathletes.

"Sports nutrition isn't just for hard-core athletes any more," Anthony Almada, president of a California supplement company, told an industry journal recently. It's for anyone seeking energy improvement, he said, or "a woman who wants to tone her body and lose a few pounds, or a person who rides a bike and wants to perform like an athlete."


Into the mouths of babes

Nutrition Business Journal, a trade publication that tracks the industry, estimates that 4 percent of American adults have taken a sports supplement at least once, including 1.2 million who use the products regularly.

Adolescents are using sports supplements at least as enthusiastically as adults, according to a national survey conducted in 1999 for the Blue Cross and Blue Shield Association. The survey found that 6 percent of youths ages 15 to 16 and 8 percent of 17- and 18-year-olds, had taken a sports supplement; the vast majority of users were male. About one in four respondents said they knew someone who took the products.

Teenagers and adults seem to be taking the supplements for the same reasons. The first is to develop bigger muscles. Bodybuilding magazines such as Muscle & Fitness bulge with ads from supplement makers pushing these products.

To Benjy, 15, creatine "seems like a magical way to gain muscle effortlessly, to look good, impress girls and guys, etc." (Kids quoted here responded to a questionnaire and are identified by first name and age only, to protect their privacy.) Benjy said he was tempted to try creatine because a friend, who "seemed unnaturally muscular for his age," said it was from taking the supplement.

But sometimes it's adults who push youngsters to take the pills. "My football coaches suggested I take creatine to bulk up for this year's season," said Cyrus, 17.

The second motivation for using such supplements is to have energy to burn, either to improve athletic performance or as an aid to losing weight.

Heather, 16, said friends who use an ephedra supplement "are always telling everyone how much weight they have lost, and bragging and bragging."


Easy access

You don't need to live near a nutrition specialty store to purchase these products. According to industry estimates, 28 percent of sports supplements are sold in mass-merchandise stores and another 17 percent by trainers and through direct marketing and the Internet.

Of the teenage Blue Cross and Blue Shield survey respondents who knew someone using such supplements, half said they were "very easy" or "pretty easy" to get.

Here's a sample of the products we easily found online and in retail stores:

3-Andro Xtreme, whose recommended dose contains large amounts of androstenedione and ephedra plus the caffeine equivalent of two cups of coffee.

Teen Advantage Creatine Serum . The manufacturer of this product claims that it's "specially formulated for teens from ages 11-19" and delivers "the benefits of creatine supplementation safely." When we asked for research to back those claims, the manufacturer sent us sales brochures with no references to any study.

LifeSmart's Creatine Chews, advertised as tasting "like candy." "We feel it's totally safe for kids in high school, but we're not actively marketing it to them," says Darren Lopez, vice president of LifeSmart Nutrition, the product's manufacturer.

Yellow Jacket, a blister pack of three capsules we picked up at a gas station. The label failed to specify the quantities of ephedra and caffeine contained in its "proprietary blend," but it did promise that users would "feel the sting of extreme energy!"


Untested, unrestricted

Any dietary supplement can be marketed without advance testing under current federal law. The only restriction: The label can't claim the product will treat, prevent, or cure a disease. But the label can traffic in vague claims like "enhances energy" or "supports testosterone production." If serious problems are reported, it's up to the Food and Drug Administration (FDA) to prove they're real before it can order a supplement off the market or impose other restrictions. So far, that has not happened. (However, a few manufacturers have voluntarily recalled their supplements after the FDA warned them of possible dangers.)

Sports-medicine researchers have tested androstenedione, creatine, and ephedra in adults. There has been no systematic testing in minors and, for ethical reasons, there probably won't be.

Here, then, is what's known about these supplements and their effects:


Androstenedione

Androstenedione--"andro" to its enthusiasts--is a pro-hormone, one of several compounds formed in the body during production of testosterone, the male hormone, a potent muscle-building steroid. To sports aficionados, it's the Mark McGwire drug, the supplement that the brawny Cardinals slugger took on the way to hitting 70 home runs in 1998.

"The first time I ever heard of these supplements was on TV, when Mark McGwire broke the home-run record," wrote Kevin, 14, responding to our questionnaire. "Soon after, I heard kids in school talking about it, wondering whether they should take them."

But andro flunked the two most rigorous studies of its efficacy. In both studies, volunteers took daily doses of andro while on a strength-training program; control groups followed the same training, but without taking andro.

One of the studies, published in 1999 in the Journal of the American Medical Association, involved young men ages 19 to 29; the other, published last November in the Archives of Internal Medicine, involved men 35 to 65. In both studies, those who didn't take andro gained just as much muscle and strength as those who took the supplement.

For the younger group, taking andro didn't even increase the average testosterone level. The older men experienced a temporary rise in testosterone, which subsided to normal levels by the end of the 12-week study. That's because taking the supplement for more than a few weeks disrupts the normal feedback that signals the body to produce its own sex hormones, says Craig Broeder, Ph.D., director of the human performance laboratory at East Tennessee State University and leader of the study involving the older men. "The body says 'I've got too much testosterone' and starts shutting off its own production of the hormone."

In both age groups, the androstenedione also produced unwelcome changes in blood-cholesterol levels, with an increase in the harmful kind and a decrease in the protective kind.

But perhaps the most disconcerting result of both studies was a marked increase in levels of the female hormone estrogen. In theory, that could lead to feminization, including the development of breast tissue, in long-term male users--a common side effect of prolonged steroid use.

Andro use in boys before or during puberty hasn't been studied formally. "We're just hypothesizing," Broeder says, "but based on everything we know, the minute a child took andro, his normal hormonal development would go awry." Among the possible results, depending on whether the andro ends up mainly as estrogen or testosterone: feminization, premature puberty, male-pattern baldness, and premature growth cessation.


Creatine

Of the sports supplements, creatine is the only one that careful, published research has shown to improve performance of certain athletic tasks.

Creatine is an amino acid made by the liver, kidneys, and pancreas; it also occurs naturally in meat and fish. It's stored in muscle and elsewhere in the body and plays a key role in producing immediate bursts of energy.

Taking supplemental creatine causes a rapid weight gain of perhaps one to four pounds. Scientists believe the extra weight is mainly water retained in muscles.

A few well-designed studies have found that creatine enhances performance requiring brief, intense bursts of strength, as in high jumping and weight lifting. But it doesn't improve the endurance needed for sports like distance running or soccer.

There has been no systematic study of creatine's side effects, but there have been case reports in the medical literature of muscle cramping and the exacerbation of existing kidney problems. Most studies of creatine involved short-term use, so "long-term effects are completely unknown," says Bernard Griesemer, M.D., director of a pediatric sports-medicine practice in Springfield, Mo.


Ephedra

The herbal supplement ephedra (also known as ma huang) may be the most hazardous of the major sports supplements.

It contains several stimulants, including ephedrine and pseudoephedrine, active ingredients in over-the-counter cold and sinus drugs. But while the drugs contain just one active ingredient, almost all the supplements combine multi-ingredient ephedra with at least one other stimulant, usually caffeine or guarana (an herb containing caffeine).

"Ephedrine and caffeine work synergistically," says Bill Gurley, Ph.D., associate professor of pharmaceutical sciences at the University of Arkansas. "The effect is similar to taking amphetamines." The FDA found the combination so dangerous that it banned it from over-the-counter drugs in 1983.

In March, the International Journal of Obesity published the first well-controlled clinical trial of the herbal combination ephedra and guarana. By the eighth week, the supplements had produced moderate weight loss. (Two very small studies have found that ephedra plus caffeine slightly increases endurance as well.) But side effects, notably heart palpitations, forced 8 of the 35 users to drop out of the study. And in the real world, where no one is overseeing the dosages, the risks may be more serious.

Last December, scientists from the University of California, San Francisco, published a study, partly funded by the FDA, of 140 "adverse event" reports the agency had received on ephedra products. The agency concluded that 87 of the events were "definitely," "probably," or "possibly" caused by the ephedra.

Nearly half of those cases involved cardiovascular symptoms such as sudden high blood pressure or a racing heartbeat. There were 17 strokes and seizures, 13 cases of permanent impairment, and 10 deaths, including a 15-year-old girl.

Another group of physicians recently wrote The New England Journal of Medicine about a 19-year-old male bodybuilder with no apparent cardiovascular risk factors who suffered a heart attack 15 minutes after taking an ephedra-caffeine energy supplement.

For the past four years, the FDA has been trying to exert its limited authority under the 1994 law to limit the maximum doses in ephedra supplements to 24 milligrams a day.

The industry has vigorously disputed the idea that ephedra is unsafe and has proposed an alternative maximum of 100 milligrams a day, with a label saying "not for use by anyone under the age of 18."


Recommendations

Weekend warriors, young athletes, and people who want to lose weight or gain energy should not take sports supplements. Evidence for the products' effectiveness is sketchy at best, and concerns about their safety are too numerous.

Adults and youngsters alike should focus instead on the basics of fitness and nutrition. "You can accomplish your goals with a well-balanced diet, a disciplined workout program, and sports-specific training," says Wadler, the sports-medicine specialist.

Parents who are concerned that their children may be taking any of these supplements should familiarize themselves with some of the most common brand names and ingredients .

It is imperative that the FDA continue pursuing stringent nationwide restrictions on the use of ephedra. At least ten states and several local governments have imposed various limitations, such as requiring a prescription, outlawing sales to minors, or limiting the maximum dose. We've testified in favor of several state and local laws restricting ephedra sales. States and municipalities that have not moved to control ephedra should consider doing so.