Expert Advice about Performance-Enhancing Drugs
Dr. Amanda Weiss Kelly from University Hospitals, Rainbow Babies & Children’s Hospital and Dr. Susan Joy from the Cleveland Clinic on performance-enhancing drugs.
What are performance-enhancing drugs?
Weiss Kelly: All substances taken to improve athletic sports performance.
Joy: Dietary supplements and anabolic steroids.
What are the most common performance-enhancing drugs used by teens and what do they do?
Weiss Kelly: Creatine is a naturally occurring substance in the body that is also sold as an over-the-counter supplement. Studies show that a Creatine supplement along with weight training may increase muscle mass in some people. Creatine is popular with athletes who participate in sports that require short bursts of power. It is legal and has been proven safe for adults; however, safety for teen usage has not been tested. Protein supplements, such as whey, can help athletes who are strength training to build muscle. Caffeine is used by many teens because it gives them energy and is readily available.
Joy: Teens commonly use caffeine and energy drinks for a “boost.” Creatine may help athletes involved with strength training and quick burst activities (e.g. sprints) to enhance muscle mass and improve recovery after workouts. Caffeine, energy drinks, creatine, fish oil and omega-3 fatty acids are natural anti-inflammatory agents that athletes may use to help them recover from workouts or injury.
Why do teens take performing-enhancing drugs?
Weiss Kelly: High school athletes competing for college scholarships feel considerable pressure to succeed. Wanting to improve their performance, they may feel that supplements will help them become stronger and faster. Teens participating in track, football and wrestling are often at a higher risk for using supplements. Bodybuilders interested in enhancing their physiques may find anabolic steroids easily obtainable in community gyms. Girls may take anabolic steroids to decrease fat mass and build muscle mass. Teens who are teased for being “skinny” may also be at increased risk for using performance-enhancing drugs or supplements.
Joy: Many athletes at all levels use performance-enhancing agents to improve speed, strength, attention, recovery or endurance. They may take them to help their training and see results such as improved quickness or power. Because of the potential to increase muscle mass, some teens may also use them to improve their physical appearance.
Can you define anabolic steroids?
Weiss Kelly: Anabolic steroids are supplements but not all supplements are anabolic steroids. Anabolic steroids increase muscle mass, speed and strength when used in conjunction with strength training.
Joy: Steroids are compounds that the body naturally produces, such as testosterone. Anabolic steroids are precursors of the human hormone testosterone.
What are the psychological risks of using anabolic steroids?
Weiss Kelly: Anabolic steroids create many problems. The mortality rate of the people who use them is four times higher than average. (Anna Petersson, Drug and Alchohol Dependence 2006.) Anabolic steroid use can cause violent behavior, also known as “roid rage.” Moreover, individuals who stop using without the care of a doctor can experience serious withdrawal symptoms, such as mood swings, fatigue, loss of appetite, insomnia and depression. Some depressive symptoms associated with anabolic steroid withdrawal have been known to persist for a year or more after the abuser stops taking the drugs. Halting usage of steroids should only occur under the care of a doctor.
What are the health risks of performance-enhancing drugs?
Weiss Kelly: Anabolic steroids can cause:
*Liver enzymes to rise, which can change the processing of other medications.
*Severe acne.
*Gynecomastia (breast development in boys).
*Bones to stop growing, so they’re particularly dangerous for teens who are still growing.
*An increased risk of liver cancer or other diseases.
*The use of anabolic steroids can cause an increase in bad cholesterol, a decrease in good cholesterol and heart disease. Girls can experience facial hair growth and a deepening of their voice that will persist after usage has stopped.
*Creatine can cause weight gain, nausea and muscle cramps. High doses of Creatine can harm the kidneys.
Joy: Supplements may cause a variety of side effects such as rash, fatigue, kidney or liver damage, to name a few. True allergic reactions (hives or anaphylaxis) may occur, particularly to supplements that contain a variety of compounds. Also, if a supplement happens to be manufactured in a facility that processes nuts, it can pose a danger to someone with a nut allergy. The government regulates dietary supplements differently than pharmaceutcial agents so the consumer needs to be knowledgeable and exercise an appropriate amount of caution. One example of the potential for problems with dietary supplements is illustrated by Ephedra. It was once available over the counter but was determined to be associated with a significant amount of risk related to heart problems, strokes and sudden death. Because of this, it was taken off the market.
Which performance-enhancing drugs can be purchased over-the-counter?
Weiss Kelly: Creatine, Vitamin D, whey proteins and DHEA. DHEA can be purchased over-the-counter, but it is prohibited in competitive sports because its side effects are similar to those of anabolic steroids.
Joy: Some performance-enhancing drugs can be bought over the counter. Anabolic steroids are only available with a prescription but are often sold illegally.
Are some supplements more dangerous than others?
Weiss Kelly: Ephedra and anabolic steroids are considered the most dangerous supplements for teens to use.
Joy: Anything used for the wrong reasons can be dangerous. It is important to know the intended effect and the dose of the supplement being used. Tell your doctor when taking a supplement because it may interfere with other medications. Also, just because a supplement is natural does not mean it is safe.
How can parents identify if their teen is using anabolic steroids or supplements?
Weiss Kelly: Parents may notice a change in behavior, like increased irritability or an onset of acne. Also, because supplements are expensive, teens may ask for additional money, or money may inexplicably disappear.
Joy: Look for significant behavioral and physical changes. If you see muscle gain, ask your teen about their training. Also, be aware of subtle mood changes that cannot be explained. Try to have an open conversation with teens about why they are using anabolic steroids or other supplements, and educate them on ways to take a more healthful approach.
What warning would you give to parents regarding supplement use?
Weiss Kelly: Steer away from supplements that are not FDA regulated. If a supplement is not FDA regulated, all ingredients may not be disclosed on the label, so a supplement may contain ephedra or steroids without the consumer’s knowledge. The burden is on the consumer to know what ingredients they are ingesting. College athletes have lost scholarships because they tested positive for steroids that were added to other supplements.
Joy: Parents can get up-to-date information regarding supplements by going to http://www.fda.gov/food/dietarysupplements/default.htm.
Are there any supplements that you would recommend for teens?
Weiss Kelly: Encouraging appropriate calorie intake and following a nutritious diet is the healthiest way for teens to achieve their optimum level of performance. Calories are necessary in order for a teen to build bone mass. Restricting calories can increase the risk of stress fractures or osteoporosis. Athletes looking to improve their performance may want to meet with a sports nutritionist or dietician to help them create a healthy performance diet. Also, it is important for teens to have enough calcium, a multi-vitamin and a vitamin D supplement. Vitamin D is important for bone density and bone health. Iron supplements can be helpful for distance runners. Teens using iron supplements should have their iron and blood counts tested regularly.
Joy: A daily multivitamin is often helpful for teens to round out their daily dietary intake. Young athletes who are vitamin D or iron deficient may benefit from supplementation; your doctor can discuss the blood tests that help to assess that.
How can teens deal with athletic pressures and competition in a healthy way?
Weiss Kelly: Participating in organized sports is important for teens because it teaches them how to compete and encourages a healthy attitude. Teen athletes are more likely to graduate high school and go to college, and they are less likely to become pregnant or do illegal drugs. That being said, the expectation for teen athletes should be to enjoy physical activity, improve concentration, be healthy, meet people, learn time management and become well rounded. The goal should not be to get a college scholarship. Parents should encourage their kids to have fun and enjoy playing sports.
Joy: Parents should openly discuss their teens’ training and address their teens’ concerns about trying to “keep up.” There are many ways young athletes can improve performance – for example, making improvements to training, nutrition and sleep – without risking unexpected health effects from taking performance-enhancing agents.
What can parents do if they suspect use?
Both doctors suggest that parents enlist the help of a professional – pediatrician, sports medicine specialist, psychologist or psychiatrist.
Dr. Amanda Weiss Kelly is a pediatrician at University Hospitals, Rainbow Babies & Children’s Hospital. She is the director of Pediatric Sports Medicine. She is also Associate Professor at Case Western Reserve University.
Dr. Susan Joy is a primary care sports medicine physician with Cleveland Clinic Sports Health and is the director of Women’s Sports Health. She also serves as the Head Team Physician for Cleveland State University and Independence High School and was a recent member of the Board of Directors of the American Medical Society for Sports Medicine.
Interview by Lisa Golovan
Thanks for making this available to teenagers. With so much information available it is important for teens to have access to straightfoward info to help them make good decisions about their health.