Primary care, family medicine, and mental health clinicians should ask every adolescent and young adult they care for if they take muscle-building supplements such as protein or creatine, according to a new commentary in the Journal of Adolescent Health.
Muscle-building supplements are not tested before going to market like pharmaceutical drugs, and are associated with greater rates of death and disability in adolescents than vitamin supplements such as A, C, and folate. Even if protein shakes or creatine gummies do not seem to negatively affect a teen, in many cases the needed nutrients are obtained from food intake, and supplements are not necessary.
"For many young people, particularly boys, use of these supplements is pretty ubiquitous ," said Kyle Ganson, PhD, MSW, an assistant professor of social work at the University of Toronto in Ontario, Canada, and author of the commentary.
Other research has shown that males are more likely to have eating disorders linked to muscle-building, in addition to being the largest number of consumers of muscle-building supplements.
Ganson's research has shown that > 80% of adolescent boys and young men take a protein supplement, and ≤ 50% take a creatine boost. But health clinicians may not know about use because they do not ask, Ganson added.
After a clinician asks about use and learns that a teenager or young adult is taking a dietary supplement, they should use a harm reduction approach that encourages curtailing or modifying supplement use rather than insisting on total abstinence, Ganson and coauthors wrote.
For example, a clinician can assess the patient's dietary intake of carbohydrates, proteins, fats, calories, vitamins, and minerals, and if appropriate, advise the teen that they are get all the nutrients they need at mealtime. Michele LaBotz, MD, medical director of the Master of Science in Athletic Training program at the University of New England in Biddeford, Maine, said most teen boys and young adults will not listen to a clinician telling them about the potential harms from supplements.
However, counseling these patients that the supplements are probably a waste of money — muscles will develop just fine with a healthy diet and regular exercise — is more effective at reducing use, according to LaBotz, who was a sports medicine physician for nearly 20 years.
Keeping open lines of communication about supplements may open the door for a teen to share that they are also using muscle-building steroids. Ganson said the step to a more dangerous product sometimes occurs after teens no longer perceive they are benefiting from supplements.
"It's not one conversation and you're done: It's about providing support and medical monitoring," Ganson said.
Ganson said his colleagues hope professional societies develop formal clinical practice guidelines about muscle building supplements in teens and young adults.
Contaminated and Dangerous Supplements
Although any teenage boy may want to build muscles, athletes are of particular concern. LaBotz authored an American Academy of Pediatrics recommendation that young athletes adhere to appropriate nutrition and training programs rather than turning to supplements.
Adverse outcomes from muscle-building supplements can occur when the products are labeled deceptively. For example, what is sold as creatine sometimes contains other ingredients that may be harmful, such as deterenol or oxilofrine, which are not approved for use in the United States.
Words like "proprietary," "blend," or "complex," on a supplement label should raise red flags, according to Pieter Cohen, MD, associate professor at Harvard Medical School, Boston, and an internist at the Cambridge Health Alliance who advises clinicians and patients about the safe use of dietary supplements.
Unlike for pharmaceuticals, the US Food and Drug Administration is not authorized to assess the safety of dietary supplements before they are sold to consumers. Supplement manufacturers are also not required to disclose the quantity of each ingredient in a proprietary blend on product labels. By one estimate, 23,000 emergency room visits annually in the United States are due to adverse effects from dietary supplements, ranging from cardiac trouble to swallowing difficulties.
In general, Cohen said, supplements with less than six ingredients and have been certified by a third party are more likely than others to be safe. The Department of Defense provides a scorecard for consumers to help decipher which supplements are safer to use.
"American consumers are the lab rats for these products," said Bryn Austin, ScD, SM, professor of social sciences at the Harvard TH Chan School of Public Health, Boston, and director of a program that trains health professionals how to intervene to prevent eating disorders. "This industry invests a lot of money to invent a health halo for themselves. Muscle-building supplements can be downright dangerous and will not turn anyone into the elite athlete of their dreams."
Commentary authors reported no financial disclosures.
Marcus A. Banks, MA, is a journalist based in New York City who covers health news with a focus on new cancer research. His work appears in Medscape Medical News, Cancer Today, The Scientist, and Spectrum.