High Risk Supplement Use in High School Athletes

The dietary and sports supplement industry is an ever-evolving and growing industry that currently offers numerous different supplements for consumers in which to choose. The sports supplement market is expected to generate more than $90 billion this year. New companies and products pop up, seemingly overnight, and it can be challenging for healthcare practitioners who work with athletes to know what’s safe vs. high risk as well as those that may pose a risk for their health or eligibility.

Protein and sports drinks continue to see significant growth in the sports nutrition sector. The use of pre-workout supplements and energy drinks are prevalent in locker rooms at all levels, especially in high school athletics. It is estimated that 60 percent of athletes use some form of dietary supplement.

A 2012 study of middle school and high school students revealed 34.7 percent of boys reported using protein supplements, 5.9 percent used steroids, and 10.5 percent used some other muscle- enhancing substance. Furthermore, a study of 37 public high schools in Wisconsin found 30.1 percent of high school football players reported using creatine.

High school athletic programs, especially football, are bigger than ever and athletes are looking to gain any potential edge to accomplish the challenging task of winning a state championship or earning a college scholarship. With minimal focus on nutrition education in the high school sector, many young athletes do not meet the calorie demands of their respective sport.

A combination of too much activity (i.e., calorie output) with an insufficient calorie intake (i.e., calorie input) is a recipe for constant fatigue, muscle loss, poor recovery and poor performance. High school athletes often do not know where to turn to improve their eating habits. Instead of working with a Licensed Sports Dietitian, most are being educated by someone who is not trained and credentialed to provide such education. This often leads to the individual student-athlete looking to solve a problem with a dietary supplement.

Energy drinks have been labeled a dietary supplement within the marketplace and considered to be the highest in increasing consumer penetration. Between 30-50 percent of adolescents and young adults consume energy drinks. The primary reasons for use are study, pleasure, sports and leisure. It is recommended that teenagers between the ages of 13-18 should have no more than 100 mg of caffeine per day. The United States Anti-Doping Agency (USADA) suggests we should call them “stimulant drinks.” Energy drink consumption has been associated with many health problems, including conditions associated with the heart, nerves and stomach. Some believe cardiovascular side effects from energy drinks might be related to the drinks’ effects on endothelial, or blood vessel, function.

Dr. John Higgins recently studied 44 non-smoking, healthy medical students in their 20s by testing their endothelial function before each of the students drank a 24-ounce energy drink. Oneand- a-half hours after consuming the energy drink, researchers checked their artery flow mediated dilation (an ultrasound measurement that indicates blood vessel health). It was found that vessel dilation was 5.1 percent before the energy drink and dropped to 2.8 percent after, indicating an acute impairment in vascular function.

The most alarming outcome was researchers were not sure what the exact mechanism of action is but hypothesize it may be due to the combination of ingredients. The standard energy drink with 100-200 mg of caffeine is not as much of a concern as those that contain high levels of caffeine with multiple stimulants. Many energy drinks are combining caffeine with stimulants such as guarana seed, yohimbe and yerba mate. Some drinks also contain synephrine, along with guarana seed which is on the banned substance list for many professional sporting agencies and the NCAA.

Combining high levels of caffeine and stimulants may cause an electrical disturbance causing a life-threating arrhythmia (i.e., heart palpitations). As we’ve seen in several cases in teens and adults, it could potentially lead to cardiac arrest and eventually death.

Pre-workout supplements are currently sweeping the locker rooms of many high schools. The purpose of a pre-workout supplement is to be consumed prior to a workout to provide more energy and focus. Supplement companies use marketing strategies to entice athletes to use their products claiming they can experience everything from “more energy, a greater muscle pump, enhanced strength, increased testosterone, explosive workouts, faster absorption, and increased muscle size.”

The most intimidating component of a pre-workout supplement is the supplement facts panel. The most common method of keeping the formula of a pre-workout supplement a secret is by creating a “Proprietary Blend.” This is when a company combines a variety of ingredients together into one big formula. When companies use a proprietary blend, the objective is to hide the ingredient profile because the ingredients being used are in very low dosages and they prefer to not be transparent.

The biggest concern with pre-workouts supplements is similar to energy drinks in that most have caffeine as the primary stimulant combined with additional stimulants and prohibited substances that would cause a positive doping test for those participating in collegiate or professional sports.

In pre-work powder there are a few ingredients that pose concern. One of those is the stimulant Synephrine HCL, also known as Bitter Orange (Citrus Aurantium). It is an ingredient commonly found in weight loss supplements due to its potential to increase metabolic rate. This ingredient is also on the NCAA banned substance list indicating athletes using this product who are drug tested, could lose their eligibility to participate in sport. Adverse events such as chest pain, increased heart rate, stroke and fainting have been reported in those who consumed synephrine in dietary supplement form.

Dendrobium 4:1 is another ingredient in pre-work. It is found in orchids used in Chinese medicine to treat a variety of conditions. In pre-workout supplements, extracts are typically used that contain phenethylamines (PEAs), a type of stimulant that can have effects similar to amphetamines. When consumed in high amounts, it could slow breathing and heart rate and may cause an unsafe drop in blood pressure.

High school athletes who are consuming adequate calories and getting proper rest (8-9 hours of sleep) should not require an energy drink or pre-workout supplement to fuel through a workout. While caffeine is a very effective and well-researched performing enhancing agent, a standard cup of coffee will suffice by providing the same or as much caffeine. More focus should be directed toward implementing a year-round sports nutrition program for young athletes, parents and coaches in order to improve eating habits and performance-enhancing outcomes.

For more information about the nutritional needs for young athletes along with questions on dietary supplements, email the author at tavis.piattoly@taylorhooton.org.