Should Children/Adolescent Athletes take Dietary Supplements?

1. Should Children/Adolescent Athletes take Dietary Supplements? Mike Perko, Ph.D., CHES University of Alabama

2. Objectives • Examine the changing landscape: Sports participation by young athletes in US; • Provide overview of sports dietary supplement use among young athletes; • Provide evidence to support non-use of sport dietary supplements by young athletes in following areas; • Federal/ Environmental • Medical/Scientific • Ethical/Legal • Conclusions.

3. Sports participation by young athletes in US

4. Nat’l Fed. of State High School Association (NFSHSA)

5. NFSHSA Annual Survey of High School Sports Participation –Fastest Growing Sports, 2003-04 • Girls soccer gained the most in popularity • Tennis (Boys and girls) • Boys lacrosse • Track and Field (Outdoor) • Wrestling (boys and girls)

6. According toNational Council of Youth Sports, between 1997-2001 • Total participation among all athletes in youth sports was 53 million athletes (some overlap occurred) • Approx. makeup of athletes was: • Boys (63%) • Girls (37%) National Council of Youth Sports Report on Trends and Participation in Organized Youth Sports, 2001 Edition

7. National Council of Youth Sports, between 1997-2001 • Girls participation in youth sports increased in every age group other than the 16-18 age group. • Boys participation decreased in every age group other than the 16-18 age group. National Council of Youth Sports Report on Trends and Participation in Organized Youth Sports, 2001 Edition

8. X-treme participation Heavily marketed recreational/leisure sports: • Surfing • Snow boarding • Skate boarding • BMX • Inline skating

9. Provide overview of sports dietary supplement products and use among young athletes

10. RecentHeadlines: • “BALCO…” • “Steroids/performance enhancers world-wide issue …” • The “Cream” and THG tip of the iceberg.” • “Creatine works, but long term effects are unknown…” • 1998 GNC, Inc. tops $2 Billion in revenue, opens new store every 12 hours. Sold for $2.5 billion to Rexall Drugs. • 2003 – Rexall sells GNC for $750 million.

11. Target Market

12. Creatine HMB N02 Glutamine Ephedra-free products 1-AD Myoplex Cell Tech EAS MetRx Weider Nutrition Twin Labs Current “HOT” supplements and Companies

13. By the Numbers • In 2003 the dietary supplement industry saw profits of $18 billion dollars.1 • Sports supplements in particular saw $6 billion. • Men are targeted for muscle, women for weight loss. • Currently over 3000 different products on market; what % is sports supplements hard to estimate.2 • Among special interest groups politically, it’s been said the dietary supplement lobby is second only to the NRA in terms of influence and power.

14. Currently there exists no nationwide study to show a prevalence rate of dietary supplement use among athletes. However in 1994, Sobal and Marquart published a review of the literature citing all studies regarding athletes and dietary supplements. Findings showed: • 51 studies on 10, 274 athletes, • Overall prevalence rate of 56%, • Adolescent athletes had a prevalence rate of 46%, almost twice the rate for adolescents nationwide. *International Journal of Sports Nutrition, 4, 320-334

15. Among published reasons for use among young athletes: • Improves performance, • Muscle development, • Treats illness, • Helps with growth, and • Combats tiredness.

16. Influences on use were: • Parents, • Peers, • Coaches, • Physicians, • Athletic trainers, • Media • Professional athletes, • Health food stores, and, • Health clubs/gyms.

17. Who needs em? According to the American Dietetic Association (ADA) Position Paper on Dietary Supplement’s, (1994, unchanged 1998, re-released 2005), medical evidence suggests only certain subgroups of people need dietary supplements. For example: • Increased iron needed for pregnant women, • Special formulas for infants and small children, • Folate for women of child bearing years, • Strict vegans, and • Calcium for adolescent girls and young women.

18. “Say No to Drugs”This product was made by the reputable Conan ResearchCompany

19. Marketers dream “Developed specially for aspiring athletes 8-19 years of age. While there is no evidence that Creatine can harm young athletes, they should be aware that taking excess amounts is not a wise decision. One 5ml dose of Teen Advantage combines a safe and effective amount of Creatine with other nutrients and supplements beneficial to growing bodies.”

20. Not just for boys “Designed specifically to meet the needs of physically active women, and eliminates the side effects associated with powdered Creatine, such as bloating, water retention, and bulking up. It’s natural ingredients are safe for women of all ages.“

21. Provide evidence to support non-use of sport dietary supplements by young athletes • Federal/Institutional • Medical/Scientific • Ethical/Legal

22. From the Top… • “The use of performance-enhancing drugs like steroids in baseball, football and other sports is dangerous and it sends the wrong message: that there are shortcuts to accomplishment and that performance is more important than character.” George Bush, State of the Union, Jan. 20, 2004

23. 1994 Dietary Supplements Health and Education Act (DSHEA) DSHEA provides that: • Claims may not be made about the use of a dietary supplement to diagnose, prevent, mitigate, treat, or cure a specific disease • Dietary supplement products must bear ingredient labeling.

24. However… Key caveat of DSHEA: Manufactures and distributors do not need to register with the FDA or get FDA approval before producing or selling dietary supplements.

25. Dietary Supplements, Defined 1950’s: “A product in capsule, tablet, or liquid form that provides an essential nutrient - such as a vitamin, a mineral, or a protein.”

26. “A product (other than tobacco) that is intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, a mineral, an herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract, or combinations of these ingredients, is intended for ingestion in pill, capsule, tablet, or liquid form, and is not represented for use as a conventional food or as the sole item of a meal or diet.” Current Formal Definition of a Dietary Supplement:

27. Institutional • American College of Sports Medicine • American Academy of Pediatrics • National Education Association • National Center for DrugFree Sport • National Strength and Conditioning Association • United States Anti-Doping Agency • World Anti-Doping Agency

28. Institutional • Nat’l Federation of State High School Associations • BC/BS Healthy Competition Foundation • International Olympic Committee • NCAA • Canadian Centre for Ethics in Sports

29. Medical/Scientific “Why would you even agree to debate this? Charles Yesalis, Author, Anabolic Steroids in Sport and Exercise and Performance Enhancing Substances in Sport and Exercise, Consultant, NSCA. Personal communication, April 2, 2005

30. Medical/Scientific Caveats – • “First, do no harm…” • Creatine may work - - but is it HARM-LESS in young children who are healthy?

31. FDA Clinical Drug Trials

32. FDA-required Clinical Drug Trials for Dietary Supplements

33. Medical/Scientific “If little is known about the safety and efficacy of dietary supplements in adults, then even less is known about their use in the pediatric populations. Very few studies have looked at the actions of dietary supplements in children. It must be remembered that children cannot be treated as “little adults.” Drug Information Journal, 2001

34. Ethical/Legal

35. Legal issues: In “Clinical and Legal Aspects of Nonphysician Prescription of Vitamins, Amino Acids, and Other Nutritional Supplements,” Clark, Sees, & Nathan (1988) state that: • Nutritional supplements occupy a nonthreatening position in the mind of the avg. person. • However, the ready availability and apparent harmlessness of nutritional supplements may be deceptive and can … create potential medical and legal ramifications for nonphysician prescription.

36. In Essence: • If mere nutrition is not the intent of your “advice”, although rare, it can invite civil and criminal charges for practicing medicine without a license. • Even if nutrition is the intent, liability can still result for failure to know the manufacturer of the supplement, the content, side effects, contraindications, adverse reactions, adverse reactions in combinations with other substances, dosage levels, time period of usage, and even knowledge about the filler and binding agents to guard against allergic reactions.

37. Ethical considerations: In Williams (1994) “The Use of Nutritional Ergogenic Aids in Sports: Is it an Ethical Issue?” Dr. Williams reminds us of the following : The Olympic ideal is the belief that athletes should succeed through their own unaided effort.

38. Sage Advice "For those who aspire to an athletic career, youth is the time to experiment with various sports and to concentrate on skill and fitness development, the two major keys to sports success attained through proper training. Taking dietary supplements with the notion that they may function as a magic bullet to enhance sports performance may lead to an attitude that training is less important, the result being suboptimal development of sport-specific skills and fitness." Melvin H. Williams, PhD, FACSM Eminent Scholar Emeritus Old Dominion University Personal communication, April 20, 2005

39. The distribution list for this publication is: • A.D. • Coaches • P.E. • A.T. • S.I.D.

40. The back cover of Sports Supplement -What message are we sending?

41. Is this in your “Library?”

42. The entire back cover of a recent bodybuilding magazine consisted of this ad.

43. CONCLUSIONS: • Currently DSHEA does not have the consumers best interests in mind to support any measures at all to introduce dietary supplements for sports performance to children/adolescents. • There is no medical/scientific evidence to support, safe or otherwise, dietary supplement use among a healthy youth sports population.

44. CONCLUSIONS: • Most policies surrounding youth sports focus on proper nutrition, rest, and sport specific practice to become better. • Sport professionals should adhere to ethical and legal guidelines established for the safety of the athlete, rather than the performance.

45. Final: As with any other public health issue, this is not about performance but about health.

46. Final: The current laws do not protect the consumer – therefore, advocacy on the part of the allied health professionals to press for more stringent regulations will only make your rigorous scientific efforts that much more meaningful.