May 22nd 2006

SUPPLEMENT USE BY YOUNG ATHLETES QUESTIONED

ORLANDO, Fla – Dietary supplements and performance-enhancing drugs are unreliable and may, in some instances, be unsafe and ineffective, said sports medicine physician William O. Roberts, M.D., FACSM. "Coaches, trainers and others who recommend them risk passing the wrong message to athletes who do not have the genetic gift of speed, endurance, motor skill, or motor planning that doing your best is not enough," he said. Roberts spoke Tuesday at a special pre-conference on dietary supplements at the American College of Sports Medicine (ACSM) 10th-annual Health & Fitness Summit & Exposition in Orlando. The conference included a scientific review of popular supplements and an update on ethical, legal and regulatory considerations regarding their use.

Studies have revealed significant use of anabolic steroids in high school and middle school, and experts believe that supplement use is even more widespread. Roberts noted that young athletes, in particular, are vulnerable to suggestions from coaches. "Does the mere suggestion of use by a coach become a de facto requirement?" he asked. "For example, a coach might tell an aspiring athlete 'You need to get bigger and stronger to play.'"

Young athletes frequently turn to coaches, athletic trainers, personal trainers, parents and peers for information.. "We're all role models," said Roberts. "Every day, we need to choose whether we're going to be positive or negative role models. Like it or not, kids look up to what we do." Athletes, he noted, are particularly influential in our culture.

Medical experts' credibility may have been hurt, said Roberts, when some previously denied the strength-enhancing effects of anabolic steroids. "Part of the credibility gap is a carryover from the days when we said 'Steroids don't work.' There's some mistrust." While experts acknowledge steroids are associated with changes in body composition, size and strength, there is consensus in sports medicine that the health risks and consequences far outweigh the temporary benefits.

While dietary supplements do have legitimate uses—for example, for people with vitamin deficiencies or with diseases that prevent them from getting enough calories—Roberts cited numerous issues involved in recommending or supplying them for youngsters.

Safety questioned
Safety is a big concern, he said. "Are the supplements themselves pure? What else is in them?" One study found that 14.8 percent of strength and body-building supplements in Germany (and even more in some other countries) contain anabolic steroids not declared on the label. Governmental oversight is lax, as supplements are not subject to regulation by the U.S. Food and Drug Administration (FDA). "Claims of benefits should be documented and reproducible," Roberts maintained. Supplements should be treated as drugs, not food." This would subject them to rigorous testing for safety and efficacy. Even these measures cannot guarantee the safety of pharmaceuticals, he noted, but the FDA maintains a system to track adverse reactions to drugs. Use of anabolic steroids has been linked to numerous problems including depression and suicide.

Are they effective?
The effectiveness of many supplements also is questionable and insufficiently documented. Roberts noted again that, if supplements were regulated as drugs, they could not be marketed unless their safety and efficacy were proven. Absent demonstrated proof of their effectiveness, he said, "You may simply be creating expensive urine."

Ethical considerations
Ethical considerations also rank high among Roberts' reservations about the use of performance-enhancing supplements by young athletes. "Is it ethical to pursue performance enhancement, beyond hard work, skilled coaching, genetic gift, proper training, proper rest and recovery, and adequate nutrition?" he asked.

National and international sport governing bodies conduct testing to discourage the use of banned substances. Athletes who use them are at risk of discovery and are subject to various sanctions.

Legal liabilities a concern
Those who work with young athletes face legal liabilities when recommending dietary supplements, Roberts pointed out. For example, informed consent discussions should involve parents as well as high-school-age competitors. Coaches and other professionals should consider what happens when informed consent is omitted and something goes wrong. "Is the school, sport association or health club liable," he asked, "or does the liability fall on the shoulders of the personal trainer or the coaching staff?"

Checklist for nutrition and substance recommendations
Roberts proposed the following questions be answered before any substance is recommended or introduced into the training regimen:
- How does it work?
- Is it safe?
-Is it effective?
-Is it tested?
- Is it legal?
- Is it ethical?
- Does it interact with other medications?
- Does it truly make a difference?
- Who profits?

"In short," Roberts counseled health and fitness professionals, "Never recommend a substance to a minor without consulting the parents. Never recommend using a substance above the package or industry dosage. As in the practice of medicine, your credo should be 'first do no harm.'"

ACSM's Health & Fitness Summit & Exposition is going on now at The Buena Vista Palace at Walt Disney World. For more information on the event, or to speak with staff in the on-site media office, please call 407-938-6156 (through Friday, April 14, 2006).

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 International, National and Regional members are dedicated to promoting and integrating scientific research, education and practical applications of sports medicine and exercise science to maintain and enhance physical performance, fitness, health and quality of life.

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