As more and more young athletes compete to stand out in their sport, they may have questions regarding the use, efficacy and safety of nutritional and performance-enhancing supplements. Below are helpful guidelines from the Children's Healthcare of Atlanta Sports Medicine Program, to help keep young athletes safe and healthy.
What is a supplement?
The Dietary Supplement Health and Education Act of 1994 helped define what a supplement is.
A dietary supplement is a product (not including tobacco) that:
- “Supplements” or “adds to” the diet those nutrients already found in foods (that’s why they are not called “replacements)--this means you cannot take a vitamin to make up for the fact that you may not like to drink milk
- Contains one or more ingredients, including vitamins, minerals, herbs or other botanicals, amino acids and other substances or their constituents.
- Is intended to be taken by mouth as a pill, capsule, tablet or liquid--a B-12 shot is not a supplement but a B-12 vitamin in a pill form is considered a supplement.
- Has a label on the front panel that identifies itself as a dietary supplement.
Do I need to take a supplement to improve my performance?
Athletes, both young and adult, are often looking for an “edge” when it comes to sports performance. And while there is no magic pill that someone can take to help win that gold medal or make that leaping catch, athletes, parents and coaches may overlook the obvious nutritional deficiencies and hope that taking a vitamin or some other type of supplement will make up the difference. Unfortunately, supplement companies don’t have to actually prove that their products work. In fact, they don’t even have to prove they are safe before they are sold to the public.
So how do you know what helps and what hurts and if there are age-specific recommendations to help kids meet their nutritional needs?
Popular Supplements for Young Athletes
- Build muscle
- Add strength
- Increase power
- Improve performance
- Reduce recovery time
Research shows anabolic steroids, with the proper training program and nutrition plan, can increase muscle, power and strength.
Significant health risks such as stroke, heart disease, cancer, liver damage, increased cholesterol and increased blood pressure may occur. Prolonged use can cause physical changes, such as acne on the face and back, hair loss (baldness), hair growth (on the back) and reduced testicle size and breast growth in men. Psychological changes such as aggression or “roid rage,” depression and psychosis can occur, perhaps due to the hormone changes being manipulated. In teenagers, the body may shut off its own production of hormones, which can lead to stunted growth. Steroids are illegal and dangerous and should be avoided.
- Build muscle
- Increase testosterone naturally and safely
- Add strength
- Be a safe alternative to steroids
Like steroids, most people who take this will see a difference in muscle mass and strength. However, short-term and long-term studies are lacking to determine its safety over time. Therefore, most manufacturers market this product as if it were completely safe. However, the health and safety concerns are similar to those regarding steroids. This product, while not illegal, is banned by most sports associations and should be avoided for use in young athletes.
Because androstenedione is converted in part to estrogens, persons taking this supplement may have estrogenic side effects. A visible problem could be gynecomastia (formation of breast tissue) in males. The FDA believes that the use of dietary supplements containing androstenedione may increase the risk of serious health problems because of their conversion in the body to active hormones with androgenic and estrogenic properties.
Beta -Hydroxy-Beta-Methylbutyrate (HMB)
- Reduce the amount of muscle damage incurred during and after a weightlifting workout
- Reduce post-workout soreness
- Shorten recovery times
- Improve strength and muscular gains
HMB is short for beta-hydroxy beta-methylbutyric acid. It is a substance that occurs naturally in the body. It is formed from the breakdown of the amino acid leucine, which is found in high concentrations in muscles. During weight training and prolonged exercise, there is damage to muscles that causes the breakdown of leucine and a resulting increase in HMB. HMB supplements may work by signaling the body to slow down the destruction of muscle tissue. HMB has been used for weight training because it may help with muscle building by reducing the amount of muscle that breaks down during exercise. It is also used to help prevent muscle damage during prolonged exercise.HMB is not essential in our diets. There are small amounts in citrus fruit and catfish. An HMB supplement is needed in order to reach the therapeutic dosage.
A typical dosage of HMB is three grams per day. HMB should not be confused with the supplement gamma hydroxybutyrate (GHB), which can have strong sedation effects. HMB appears to be safe; however, more long-term studies are needed. HMB should not be used by children, pregnant or nursing women or people with severe liver or kidney disease.
- Be beneficial for short bursts of high-intensity exercise of the repetitive type (i.e. basketball, soccer)
- Increase muscle and bone mass during weight training
Creatine is widely used for improving sports performance. It is a naturally occurring substance in the body. Your body makes it from the amino acids L-arginine, glycine and L-methionine that are found in protein; so as long as dietary protein intake is sufficient, supplementation should not be necessary. However, people on a vegetarian diet may have difficulty with creatine production because meat is an important source.
A typical dosage is two to five grams per day. Absorption into muscles is enhanced when creatine is taken with a simple carbohydrate. Caffeine may block the effects of creatine. Creatine appears to be safe, at least in healthy athletes. Creatine is metabolized in the kidneys, however, and there is some concern about causing kidney injury with excessive doses of creatine.Another concern is that creatine is metabolized in the body to formaldehyde, which is a toxic substance. It is not known whether the amount of formaldehyde produced during creatine supplementation will cause harm. Creatine is not recommended for athletes less than 16 years of age. Older adolescent athletes may need to be monitored by their physician when using the product.
- Increase muscle
- Build body mass
- Increase strength
Amino acids are the individual constituent parts of proteins. Consumption of foods containing intact proteins ordinarily provides sufficient amounts of the nine amino acids needed for growth and development in children and for maintenance of health in adults. The safety of amino acids in this form is generally not a concern. When marketed as dietary supplements, amino acids are sold as single compounds, in combinations of two or more amino acids, as components of protein powders, as chelated (a compound usually containing a metal ion) single compounds, or in chelated mixtures. Amino acids are promoted for a variety of uses, including body-building. Some are promoted for claimed pharmacologic effects.
The Federation of American Societies for Experimental Biology (FASEB) recently conducted an exhaustive search of available data on amino acids and concluded that there was insufficient information to establish a safe intake level for any amino acids in dietary supplements, and that their safety should not be assumed. FASEB warned that consuming amino acids in dietary supplement form posed potential risks for several subgroups of the general population, including women of childbearing age (especially if pregnant or nursing), infants, children, adolescents, the elderly, individuals with inherited disorders of amino acid metabolism and individuals with certain diseases. At least two of the amino acids consumed in dietary supplements have also been associated with serious injuries in healthy adults: L-tryptophan and phenylalanine.
Other Protein Supplements
The average diet, unless the athlete is vegetarian, provides more than enough protein to build muscle. It is the balance of protein and total calories (mostly coming from carbohydrate) combined with training that will build lean tissue. A diet too high in protein can lead to excess fat stores if the total calorie intake is too high. Or, an excessive protein intake with low carbohydrate intake can lead to dehydration and softening of the bones.
Safe amount of protein are 0.8 to two grams per kilogram of body weight and may depend on age, gender and activity type in which the child is involved.
Ephedra (Ma Huang,)
- Increase energy
- Enhance performance
- Help control body weight, specifically fat weight
Ephedra is a stimulant. It was originally used in smaller doses as a bronchodilator and to help treat asthmatic conditions. The possibility of performance improvement has not been well documented.
The recommended doses for ephedra can vary between sources. The FDA recommends that ephedra products not be used for longer than seven days, and doses should not be more than eight milligrams of ephedrine every six hours, or 24 milligrams/day. Other sources state that the adult dose is 15 to 30 milligrams/dose, while some list the maximum dose as 300 milligrams/day. Ephedra can also raise blood glucose levels, causing poor control in diabetic patients.
There are additional disease states and conditions where the use of ephedra should also be avoided. Most of these disease state-ephedra interactions can be predicted by knowing the actions of ephedrine. For example, any cardiovascular disease should be considered a potential contraindication to ephedra. Also, anorexia and bulimia are contraindicated due to the appetite suppressing effects of ephedra. Even conditions such as narrow-angle glaucoma can be exacerbated due to sympathetic nervous system activation and resultant mydriasis.
Caffeine (Gotu Kola, Guarana)
- Increase energy and endurance
- Reduce mental fatigue
- Increase fat usage as an energy substrate
Some studies indicate increased fat storage use, particularly in endurance and ultra-endurance athletes. Other studies show no positive effect. Caffeine can create increased dehydration problems. Young athletes can be more susceptible to heat illness in general and should avoid caffeine.
Risks include anxiety, upset stomach, insomnia, dehydration and irritability. Young athletes will not have improved performance because of the use of caffeine.
- Increase energy
- Improve endurance
- Improve mental status (more alert, less fatigue)
- Aid in recovery, improve sleep, enhance performance
These drinks can vary widely with their ingredients. Most notably, they contain sugar and caffeine or other stronger stimulants.
“Energy drinks” are stimulants containing caffeine which increases the heart rate and may cause irregular or abnormal heartbeats. Stimulants also contribute to a loss of coordination and balance, and affect the body’s ability to maintain a regular temperature. This, combined with the dehydrating effect of the caffeine, may place an individual at a greater risk of suffering from heat illness, particularly when exercising in warmer weather. Adverse effects include dehydration, insomnia, headaches, nervousness, nosebleeds and vomiting. Reports claim that energy drinks have caused even more severe reactions, such as seizure, heart arrhythmia and death. Energy drinks can become dangerous when taken after exercise or mixed with alcohol. The stimulating effect of energy drinks is deceiving, causing people to feel less intoxicated than they actually are.