Warning Your Teen Athlete Not to Heed Supplement Sellers’ “Advice”

Health food stores provide ready access to dietary supplements for teen athletes, despite American Academy of Pediatrics recommendations against them, a new study finds.

Specifically, the AAP recommends against pediatric use of creatine and testosterone boosters, yet research suggests that many young teenagers take these dietary supplements. Many male athletes are interested in improving muscle mass and strength and may use nutritional supplements and muscle-enhancing products to achieve this goal. The study’s objective was to determine to what extent health food stores would recommend and/or sell creatine and testosterone boosters to a 15-year-old male customer.

A research assistant posing as a 15-year-old high school football player called a national sample of 244 health food stores and told the sales attendant he was involved in strength training and wanted recommendations about supplements. If the sales attendant did not initially recommend creatine or a testosterone booster, the research assistant then asked specifically about these products.

It turns out that two-thirds of sales attendants at health food stores recommended creatine and 10% recommended testosterone boosters for an adolescent male athlete, despite current recommendations against these supplements.

Prevalence and dangers of youth creatine use
Young boy athletes often perceive themselves as less muscular than their ideal body image, and therefore may take supplements to try to increase their muscle mass. In 2005, one study reported that 12% of boys reported using supplements to improve appearance, muscle mass or strength. More recently, in a 2012 study of 2,793 adolescents at 20 urban middle and high schools in Minnesota, 34.7% of boys reported using protein supplements, 5.9% used steroids and 10.5% used some other muscle-enhancing substance.

Even setting aside the well-known dangers of steroid use, creatine is one of the most popular weight gain supplements among this age group; several studies report between 8.8% and 21% of high school boy athletes admit creatine use. In a study of 37 public high schools in Wisconsin, 30.1% of high school football players reported creatine use.

Clearly, there is widespread use of creatine among adolescents despite the recommendations of the AAP, as well as the American College of Sports Medicine, against creatine use by those under age 18. The physiologic effects claimed by dietary supplement companies in advertising and marketing are often not supported by research. Moreover, use of creatine and/or testosterone boosters may pose significant health risks to adolescents.

Creatine use has also been associated with an increased risk of compartment syndrome, a condition where pressure builds in a muscle compartment and prevents blood flow. Furthermore, because dietary supplements are subject to little oversight by the FDA, the safety and efficacy of supplements available on the market are not rigorously established. In fact, research shows that dietary workout supplements are often adulterated with pharmaceutical drugs and can lead to adverse effects, such as hypertension, stroke and liver injury.

Often high school creatine users either do not know how much creatine they are taking or are intentionally taking more than the dose recommended on packaging provided by manufacturers.

Details of the health food store study
Overall, 67% of the 244 sales attendants recommended creatine (94 without prompting and 70 after prompting); just 30% recommended against its use. More encouragingly, almost 90% of sales attendants recommended against a testosterone booster; of the 24 who did recommend it, only 2 did so without prompting. Still, overall, 74% of sales attendants told the caller he could purchase creatine on his own; 41% said the same for a testosterone booster.

This study documents that health food stores nationally often recommend age-restricted supplements to young male teenagers. It highlights the need to review how supplements are promoted and the important role pediatricians play in counseling youth about the risks of supplement use.

Parents and pediatricians should inform teenagers, especially athletes, about safe, healthy methods to improve athletic performance and discourage them from using creatine or testosterone boosters. Retailers and state legislatures should also consider banning the sale of these products to minors.

Pediatrics, Jan. 2, 2017, e-pub, http://pediatrics.aappublications.org/content/early/2016/12/29/peds.2016-1257

(return to front page)