Ergogenic Agents Offer Few Benefits and Plenty of Risks

VANCOUVER, B.C. — When it comes to improving performance in young athletes, the tried and true approaches—such as a balanced diet and adequate training—trump the energy drinks, supplements, and drugs.

Although anabolic androgenic steroids increase muscle strength, they have inconsistent effects on aerobic performance. These steroids are known to increase the risk of atherosclerosis, but new research has implicated them in the development of hypertrophic cardiomyopathy, Dr. Bernard A. Griesemer said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics.

It is unknown whether young athletes who begin using steroids in seventh or eighth grade are at a higher risk for hypertrophic cardiomyopathy than are mature athletes using the same chemicals, said Dr. Griesemer.

Anabolic steroids also have prothrombotic effects, and “consequently, the risk for coronary thrombosis has been reported,” said Dr. Griesemer of Missouri State University, Springfield.

The use of anabolic steroids for purely aesthetic and cosmetic purposes is on the rise, according to Dr. Griesemer. Several years ago, roughly 50% of users were noncompetitive body builders, but that value is now 78% (Med. Sci. Sports Exer. 2006;38:644–51). This means that increasing numbers of nonathlete middle school, high school, and college-age students are using these chemicals just to look good, he said, adding that “it's no longer just a sports medicine issue.”

Drugs such as androstene and androstenediol, which were previously available as supplements under the Dietary and Supplement Health and Education Act of 1994, have since been reclassified as controlled substances, whereas others with similar physiological effects, such as dehydroepiandrosterone (DHEA), have not. “The classification of these chemicals as a dietary supplement—you can get them at your local nutrition store—versus a class III controlled substance has probably more to do with politics and money than it has to do with biochemistry,” he said.

Stimulants have many positive ergogenic effects, but they also adversely affect athletic performance, mainly by causing diuresis, which puts athletes at increased risk for dehydration. In addition, stimulants can impair thermoregulatory mechanisms, and that may lead to heat stroke, he said.

Two potent stimulants—taurine and glucuronolactone—are found in energy drinks such as Red Bull, Vault, and Monster, which are available in the United States but have been withdrawn from the European Union market because of the risk of sudden death in young athletes, according to Dr. Griesemer. The risk may be especially high for children taking medications for attention-deficit/hyperactivity disorder, he said.

The ergogenic effects of creatine vary among individuals, according to Dr. Griesemer. It enhances performance in about a third of athletes, mainly those who play sports that require brief bursts of power, but even so, the gain is only 5%–7% at best. In another third of athletes, primarily those who play endurance sports, it negatively affects performance.

A related, newer phenomenon that physicians may encounter is “crystal vases,” the term given to highly muscled young athletes who consume energy drinks and protein or creatine supplements, engage in intense activity on hot days, and become dehydrated, leading to rhabdomyolysis.

“[These kids] look gorgeous, but those muscles don't sprain or strain; they tend to shatter,” Dr. Griesemer explained, noting that some affected young football players have creatine phosphokinase levels of 23,000 U/L or higher. Athletes taking selective serotonin reuptake inhibitors may be especially susceptible, said Dr. Griesemer, who reported that he had no disclosures in association with his presentation.

VANCOUVER, B.C. — When it comes to improving performance in young athletes, the tried and true approaches—such as a balanced diet and adequate training—trump the energy drinks, supplements, and drugs.

Although anabolic androgenic steroids increase muscle strength, they have inconsistent effects on aerobic performance. These steroids are known to increase the risk of atherosclerosis, but new research has implicated them in the development of hypertrophic cardiomyopathy, Dr. Bernard A. Griesemer said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics.

It is unknown whether young athletes who begin using steroids in seventh or eighth grade are at a higher risk for hypertrophic cardiomyopathy than are mature athletes using the same chemicals, said Dr. Griesemer.

Anabolic steroids also have prothrombotic effects, and “consequently, the risk for coronary thrombosis has been reported,” said Dr. Griesemer of Missouri State University, Springfield.

The use of anabolic steroids for purely aesthetic and cosmetic purposes is on the rise, according to Dr. Griesemer. Several years ago, roughly 50% of users were noncompetitive body builders, but that value is now 78% (Med. Sci. Sports Exer. 2006;38:644–51). This means that increasing numbers of nonathlete middle school, high school, and college-age students are using these chemicals just to look good, he said, adding that “it's no longer just a sports medicine issue.”

Drugs such as androstene and androstenediol, which were previously available as supplements under the Dietary and Supplement Health and Education Act of 1994, have since been reclassified as controlled substances, whereas others with similar physiological effects, such as dehydroepiandrosterone (DHEA), have not. “The classification of these chemicals as a dietary supplement—you can get them at your local nutrition store—versus a class III controlled substance has probably more to do with politics and money than it has to do with biochemistry,” he said.

Stimulants have many positive ergogenic effects, but they also adversely affect athletic performance, mainly by causing diuresis, which puts athletes at increased risk for dehydration. In addition, stimulants can impair thermoregulatory mechanisms, and that may lead to heat stroke, he said.

Two potent stimulants—taurine and glucuronolactone—are found in energy drinks such as Red Bull, Vault, and Monster, which are available in the United States but have been withdrawn from the European Union market because of the risk of sudden death in young athletes, according to Dr. Griesemer. The risk may be especially high for children taking medications for attention-deficit/hyperactivity disorder, he said.

The ergogenic effects of creatine vary among individuals, according to Dr. Griesemer. It enhances performance in about a third of athletes, mainly those who play sports that require brief bursts of power, but even so, the gain is only 5%–7% at best. In another third of athletes, primarily those who play endurance sports, it negatively affects performance.

A related, newer phenomenon that physicians may encounter is “crystal vases,” the term given to highly muscled young athletes who consume energy drinks and protein or creatine supplements, engage in intense activity on hot days, and become dehydrated, leading to rhabdomyolysis.

“[These kids] look gorgeous, but those muscles don't sprain or strain; they tend to shatter,” Dr. Griesemer explained, noting that some affected young football players have creatine phosphokinase levels of 23,000 U/L or higher. Athletes taking selective serotonin reuptake inhibitors may be especially susceptible, said Dr. Griesemer, who reported that he had no disclosures in association with his presentation.

VANCOUVER, B.C. — When it comes to improving performance in young athletes, the tried and true approaches—such as a balanced diet and adequate training—trump the energy drinks, supplements, and drugs.

Although anabolic androgenic steroids increase muscle strength, they have inconsistent effects on aerobic performance. These steroids are known to increase the risk of atherosclerosis, but new research has implicated them in the development of hypertrophic cardiomyopathy, Dr. Bernard A. Griesemer said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics.

It is unknown whether young athletes who begin using steroids in seventh or eighth grade are at a higher risk for hypertrophic cardiomyopathy than are mature athletes using the same chemicals, said Dr. Griesemer.

Anabolic steroids also have prothrombotic effects, and “consequently, the risk for coronary thrombosis has been reported,” said Dr. Griesemer of Missouri State University, Springfield.

The use of anabolic steroids for purely aesthetic and cosmetic purposes is on the rise, according to Dr. Griesemer. Several years ago, roughly 50% of users were noncompetitive body builders, but that value is now 78% (Med. Sci. Sports Exer. 2006;38:644–51). This means that increasing numbers of nonathlete middle school, high school, and college-age students are using these chemicals just to look good, he said, adding that “it's no longer just a sports medicine issue.”

Drugs such as androstene and androstenediol, which were previously available as supplements under the Dietary and Supplement Health and Education Act of 1994, have since been reclassified as controlled substances, whereas others with similar physiological effects, such as dehydroepiandrosterone (DHEA), have not. “The classification of these chemicals as a dietary supplement—you can get them at your local nutrition store—versus a class III controlled substance has probably more to do with politics and money than it has to do with biochemistry,” he said.

Stimulants have many positive ergogenic effects, but they also adversely affect athletic performance, mainly by causing diuresis, which puts athletes at increased risk for dehydration. In addition, stimulants can impair thermoregulatory mechanisms, and that may lead to heat stroke, he said.

Two potent stimulants—taurine and glucuronolactone—are found in energy drinks such as Red Bull, Vault, and Monster, which are available in the United States but have been withdrawn from the European Union market because of the risk of sudden death in young athletes, according to Dr. Griesemer. The risk may be especially high for children taking medications for attention-deficit/hyperactivity disorder, he said.

The ergogenic effects of creatine vary among individuals, according to Dr. Griesemer. It enhances performance in about a third of athletes, mainly those who play sports that require brief bursts of power, but even so, the gain is only 5%–7% at best. In another third of athletes, primarily those who play endurance sports, it negatively affects performance.

A related, newer phenomenon that physicians may encounter is “crystal vases,” the term given to highly muscled young athletes who consume energy drinks and protein or creatine supplements, engage in intense activity on hot days, and become dehydrated, leading to rhabdomyolysis.

“[These kids] look gorgeous, but those muscles don't sprain or strain; they tend to shatter,” Dr. Griesemer explained, noting that some affected young football players have creatine phosphokinase levels of 23,000 U/L or higher. Athletes taking selective serotonin reuptake inhibitors may be especially susceptible, said Dr. Griesemer, who reported that he had no disclosures in association with his presentation.