User login
STUDY DESIGN: We performed a cross-sectional survey.
POPULATION: Individuals entering military service for enlisted training were included.
OUTCOMES MEASURED: We recorded previous use of any nutritional ergogenic supplements and self-reported health risk behaviors.
RESULTS: Of 550 eligible participants, 499 completed the survey (91% response rate). Individuals who used ergogenic supplements were more likely to drink alcohol (adjusted odds ratio [AOR]=1.8; 95% confidence interval [CI], 1.1-3.1), more likely to drink heavily (AOR=2.4; 95% CI, 1.5-3.9), more likely to ride in a vehicle with someone who had been drinking (AOR=2.2; 95% CI, 1.3-3.6), more likely to drive after drinking (AOR=2.4; 95% CI, 1.3-4.4), and more likely to have been in a physical fight (AOR=1.9; 95% CI, 1.0-3.5), compared with those who had not used supplements. Men were more likely to use supplements than women (P <.001). There were no differences in patterns of supplement use according to age or body mass index.
CONCLUSIONS: Our study indicates an association between individuals who use ergogenic nutritional supplements and specific health risk behaviors. This represents an important opportunity for preventive counseling.
Since ancient times, athletes have ingested substances to gain a competitive edge.1 The use of such supplements, however, is not restricted to athletes. In 1996, Americans spent $6.5 billion on dietary supplements.2 Individuals cite many reasons for using such supplements, including to ensure good nutrition, prevent illness, improve performance, ward off fatigue, and enhance personal appearance.3
Since 1998, interest in the ergogenic effects of products currently marketed as nutritional supplements, in particular creatine and androstenedione, has increased. Creatine is currently the most popular dietary ergogenic supplement.4 The reported benefits of creatine include increased energy during short-term intense exercise, increased muscle mass, increased strength, increased lean body mass, and decreased lactate accumulation during intense exercise. Although it is clear that supplementation raises intramuscular creatine stores,5 it remains unclear how effective creatine is as an ergogenic aid. Generally, it is felt that creatine supplementation may be useful for repeated bouts of high-intensity short-duration exercise.6 Claims of increased strength and muscle mass have not, however, been unequivocally proven.
Androstenedione is a steroid hormone. Many sporting communities, including the International Olympic Committee, have banned its use. By itself, androstenedione is weakly androgenic. To date, the largest controlled trial examining the effectiveness of androstenedione as an ergogenic aid showed no significant gains in muscular strength compared with a standard program of resistance training.7 Methodologic concerns have been raised about this particular study,8 because supplement manufacturers are not subject to United States Food and Drug Administration approval if no unsupported claims of efficacy are made. Therefore, sales of ergogenic supplements remain brisk.
Within this context, our study was designed to examine the prevalence of ergogenic supplement use in a young population. We also sought to determine the extent to which supplement use was associated with personal health risk behaviors and to determine how effective ergogenic supplements were perceived to be.
Methods
Sample Recruitment
Our study was conducted at Lackland Air Force Base, Texas, and Parris Island, South Carolina, from June through September, 1999. All men and women entering military basic training at these sites were eligible to participate. Individuals were randomly selected to receive the survey. There were no specific exclusion criteria.
Survey Administration
The Youth Risk Behavior Survey (YRBS)9 was modified for use in our study. Specifically, questions about nutritional ergogenic supplement use were added to the standard instrument that is used to examine health risk and preventive behaviors, such as tobacco use, alcohol use, seat belt use, helmet use, and suicide. The subjects were specifically asked to report use of creatine and androstenedione. They were also given an open-ended opportunity to report any other ergogenic supplement use.
Data Analysis
We used basic descriptive statistics for categorical variables. Proportions were compared using the chi-square test of contingency. The Fisher exact test was used for rare responses. Continuous variables were compared using the Student t test for independent samples. We calculated adjusted odds ratios with a multivariate logistic regression analysis controlling for sex, age, and body mass index.
Results
Of 550 individuals recruited for participation, 499 (91%) completed the survey. The respondents ranged in age from 17 to 35 years (mean age = 21 years). The study sample was 88% men (n=439) and 12% women (n=60). The lifetime prevalence of ergogenic supplement use in our study population was 41%. Creatine was the most commonly used ergogenic supplement (n=117; 23% of the study sample), followed by androstenedione (n=38; 8%).
Ergogenic supplement use was significantly associated with several health risk behaviors. Individuals who used ergogenic supplements were more likely to drink alcohol, more likely to drink heavily, more likely to ride in a vehicle with someone who had been drinking, more likely to drive after drinking, and more likely to have been in a physical fight compared with those who had not used supplements Table 1.
Men were more likely to use ergogenic nutritional supplements than women (P <.001). No difference in the pattern of supplement use was noted relative to age or body mass index. An equal number of respondents (70%) felt that creatine, androstenedione, and anabolic steroids were all effective at building muscle strength. Men, respondents younger than 20 years, and individuals who reported using ergogenic supplements were all more likely to believe in the effectiveness of creatine, androstenedione, and steroids compared with others (P <.05).
Discussion
Our study has 3 important findings: (1) a significant number of young people have used ergogenic supplements; (2) a similar majority of respondents believe creatine, androstenedione, and anabolic steroids are effective with respect to gains in muscle strength and mass; and (3) use of nutritional ergogenic supplements is associated with certain high-risk health behaviors.
Although it has been reported that 38% of high school athletes use vitamin supplements,10 the prevalence rates of creatine or androstenedione use in adolescents are not known. Our study suggests that a significant number of young persons use ergogenic supplements, creatine in particular. The self-reported prevalence rate of 41% of individuals who have used ergogenic supplements represents a baseline that needs to be verified by further studies.
A majority of respondents (70%) believed that creatine and androstenedione are effective in increasing muscle strength. There is limited evidence to support this in the medical literature. This is important given the credibility gap the medical community created when discussing anabolic steroids with athletes and adolescents in the past. Physicians routinely counseled that steroids were ineffective in building muscle strength and mass. Athletes’ experiences in the gym and on the playing field proved otherwise,11 however, and a pervading sense of mistrust developed among athletes toward the medical community.12 Our study shows that many young individuals believe that ergogenic supplements are effective. Some of this belief may stem from word of mouth,13 some from savvy marketing, and some from perceived experience. Whatever the case, physicians must be careful to provide accurate clinical information, while not alienating patients, when discussing ergogenic supplements. Our results also suggest that individuals who have used ergogenics are more likely to believe in their effectiveness. This agrees with the model suggesting that users of “natural” products are more likely to believe in their safety and efficacy than nonusers.14
Finally, and perhaps most important, our study indicates that supplement use is associated with certain health risk behaviors. Specifically, ergogenic supplement users are more likely to drink alcohol heavily, ride as a passenger with a driver who has been drinking, drive after drinking, and get involved in a physical fight. A similar pattern of behavior has been described among adolescents who use anabolic steroids.15 Although the prevalence of anabolic steroid use in the general adolescent population has been estimated at 3% to 10%,16,17 our study shows a much higher rate of ergogenic supplement use. This establishes an important link in behavioral data between nutritional supplement users and anabolic steroid users. While steroids are illegal, ergogenic supplements are readily available. If, as our results suggest, ergogenic use is associated with a risk-behavior syndrome similar to that seen with steroid use, this is a valuable marker for physicians to use to provide targeted preventive counseling.
Limitations
Our study, however, has several important limitations. The respondents were all military recruits. Caution must therefore be used before generalizing the results to an unselected population. The prevalence of risk behaviors reported by the respondents relative to data from the 1999 YRBS18 also show several important differences Table 1. Our respondents appear more likely to drink, less likely to ride with someone who had been drinking, more likely to smoke, more likely to wear a seatbelt, less likely to fight, and less likely to report symptoms of depression compared with general data from the YRBS. The prevalence of other risk behaviors appears to be similar. It is uncertain whether these behavioral differences are particular to a military population. Another limitation of our study is the use of self-reported data, which potentially introduces a significant recall bias.
Conclusions
Our study suggests that in a young healthy military population there is widespread belief that creatine and androstenedione are effective ergogenic agents. The prevalence of supplement use in this population is significant, and such use is associated with certain health risk behaviors. This pattern of behaviors appears similar to a risk-behavior syndrome previously noted with anabolic steroid use. Clinicians should routinely ask adolescents and athletes about their use of dietary supplements. They should ask which supplements their patients are using, why they are using supplements, and what doses they are taking. Clinicians should be alert so they can provide targeted preventive counseling for individuals who are identified as users of ergogenic supplements.
Acknowledgments
Our study was supported by Uniformed Services Academy of Family Physicians grant G-1879.
Related resources
- FDA Dietary Supplement Consumer Information Homepage: http://www.cfsan.fda.gov/~dms/supplmnt.html
- USDA Food and Nutrition Information Center http://www.nalusda.gov/fnic/etext/000015.html
- Australian Academy of Sciences—Drugs in Sport http://www.science.org.au/nova/055/055sit.htm
1. Applegate E, Lee G. Search for the competitive edge: a history of dietary fads and supplements. J Nutr 1997;127:869S-73S.
2. Kurtzweil P. An FDA guide to dietary supplements. Washington, DC: US Food and Drug Administration; 1999.
3. Ervin RB, Wright JD, Kennedy-Stephenson J. Use of dietary supplements in the United States, 1988-94. Vital Health Stat 11 1999;i-iii:1-14.
4. Feldman EB. Creatine: a dietary supplement and ergogenic aid. Nutr Rev 1999;57:45-50.
5. Harris RC, Soderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clin Sci 1992;83:367-74.
6. Terjung RL, Clarkson P, Eichner ER, et al. American College of Sports Medicine roundtable: the physiological and health effects of oral creatine supplementation. Med Sci Sports Exerc 2000;32:706-17.
7. King DS, Sharp RL, Vukovich MD, et al. Effect of oral androstenedione on serum testosterone and adaptations to resistance training in young men: a randomized controlled trial. JAMA 1999;281:2020-28.
8. Yesalis C. Medical, legal and societal implications of androstenedione use. JAMA 1999;281:2043-44.
9. Kolbe L, Kann L, Collins J. Overview of the Youth Risk Behavior Surveillance System. Public Health Reports 1993;108:2-67.
10. Sobal J, Marquart LF. Vitamin/mineral supplement use among high school athletes. Adolescence 1994;29:835-43.
11. Sturmi JE, Diorio DJ. Anabolic agents. Clin Sports Med 1999;17:261-83.
12. Blue JG, Lombardo JA. Steroids and steroid-like compounds. Clin Sports Med 1999;18:667-89:ix.
13. Metzl JD. Strength training and nutritional supplement use in adolescents. Curr Opin Pediatr 1999;11:292-96.
14. Klepser TB, Doucette WR, Horton MR, et al. Assessment of patients’ perceptions and beliefs regarding herbal therapies. Pharmacotherapy 2000;20:83-87.
15. Middleman A, DuRant R. Anabolic steroid use and associated health risk behaviours. Sports Med 1996;21:251-55.
16. Terney R, McLain L. The use of anabolic steroids in high school students. Am J Dis Child 1990;144:99-103.
17. Elliot D, Goldberg L. Intervention and prevention of steroid use in adolescents. Am J Sports Med 1996;24:S46-47.
18. Kann L, Kinchen SA, Williams BI, et al. Youth Risk Behavior Surveillance—United States, 1999: state and local YRBSS coordinators. J Sch Health 2000;70:271-85.
STUDY DESIGN: We performed a cross-sectional survey.
POPULATION: Individuals entering military service for enlisted training were included.
OUTCOMES MEASURED: We recorded previous use of any nutritional ergogenic supplements and self-reported health risk behaviors.
RESULTS: Of 550 eligible participants, 499 completed the survey (91% response rate). Individuals who used ergogenic supplements were more likely to drink alcohol (adjusted odds ratio [AOR]=1.8; 95% confidence interval [CI], 1.1-3.1), more likely to drink heavily (AOR=2.4; 95% CI, 1.5-3.9), more likely to ride in a vehicle with someone who had been drinking (AOR=2.2; 95% CI, 1.3-3.6), more likely to drive after drinking (AOR=2.4; 95% CI, 1.3-4.4), and more likely to have been in a physical fight (AOR=1.9; 95% CI, 1.0-3.5), compared with those who had not used supplements. Men were more likely to use supplements than women (P <.001). There were no differences in patterns of supplement use according to age or body mass index.
CONCLUSIONS: Our study indicates an association between individuals who use ergogenic nutritional supplements and specific health risk behaviors. This represents an important opportunity for preventive counseling.
Since ancient times, athletes have ingested substances to gain a competitive edge.1 The use of such supplements, however, is not restricted to athletes. In 1996, Americans spent $6.5 billion on dietary supplements.2 Individuals cite many reasons for using such supplements, including to ensure good nutrition, prevent illness, improve performance, ward off fatigue, and enhance personal appearance.3
Since 1998, interest in the ergogenic effects of products currently marketed as nutritional supplements, in particular creatine and androstenedione, has increased. Creatine is currently the most popular dietary ergogenic supplement.4 The reported benefits of creatine include increased energy during short-term intense exercise, increased muscle mass, increased strength, increased lean body mass, and decreased lactate accumulation during intense exercise. Although it is clear that supplementation raises intramuscular creatine stores,5 it remains unclear how effective creatine is as an ergogenic aid. Generally, it is felt that creatine supplementation may be useful for repeated bouts of high-intensity short-duration exercise.6 Claims of increased strength and muscle mass have not, however, been unequivocally proven.
Androstenedione is a steroid hormone. Many sporting communities, including the International Olympic Committee, have banned its use. By itself, androstenedione is weakly androgenic. To date, the largest controlled trial examining the effectiveness of androstenedione as an ergogenic aid showed no significant gains in muscular strength compared with a standard program of resistance training.7 Methodologic concerns have been raised about this particular study,8 because supplement manufacturers are not subject to United States Food and Drug Administration approval if no unsupported claims of efficacy are made. Therefore, sales of ergogenic supplements remain brisk.
Within this context, our study was designed to examine the prevalence of ergogenic supplement use in a young population. We also sought to determine the extent to which supplement use was associated with personal health risk behaviors and to determine how effective ergogenic supplements were perceived to be.
Methods
Sample Recruitment
Our study was conducted at Lackland Air Force Base, Texas, and Parris Island, South Carolina, from June through September, 1999. All men and women entering military basic training at these sites were eligible to participate. Individuals were randomly selected to receive the survey. There were no specific exclusion criteria.
Survey Administration
The Youth Risk Behavior Survey (YRBS)9 was modified for use in our study. Specifically, questions about nutritional ergogenic supplement use were added to the standard instrument that is used to examine health risk and preventive behaviors, such as tobacco use, alcohol use, seat belt use, helmet use, and suicide. The subjects were specifically asked to report use of creatine and androstenedione. They were also given an open-ended opportunity to report any other ergogenic supplement use.
Data Analysis
We used basic descriptive statistics for categorical variables. Proportions were compared using the chi-square test of contingency. The Fisher exact test was used for rare responses. Continuous variables were compared using the Student t test for independent samples. We calculated adjusted odds ratios with a multivariate logistic regression analysis controlling for sex, age, and body mass index.
Results
Of 550 individuals recruited for participation, 499 (91%) completed the survey. The respondents ranged in age from 17 to 35 years (mean age = 21 years). The study sample was 88% men (n=439) and 12% women (n=60). The lifetime prevalence of ergogenic supplement use in our study population was 41%. Creatine was the most commonly used ergogenic supplement (n=117; 23% of the study sample), followed by androstenedione (n=38; 8%).
Ergogenic supplement use was significantly associated with several health risk behaviors. Individuals who used ergogenic supplements were more likely to drink alcohol, more likely to drink heavily, more likely to ride in a vehicle with someone who had been drinking, more likely to drive after drinking, and more likely to have been in a physical fight compared with those who had not used supplements Table 1.
Men were more likely to use ergogenic nutritional supplements than women (P <.001). No difference in the pattern of supplement use was noted relative to age or body mass index. An equal number of respondents (70%) felt that creatine, androstenedione, and anabolic steroids were all effective at building muscle strength. Men, respondents younger than 20 years, and individuals who reported using ergogenic supplements were all more likely to believe in the effectiveness of creatine, androstenedione, and steroids compared with others (P <.05).
Discussion
Our study has 3 important findings: (1) a significant number of young people have used ergogenic supplements; (2) a similar majority of respondents believe creatine, androstenedione, and anabolic steroids are effective with respect to gains in muscle strength and mass; and (3) use of nutritional ergogenic supplements is associated with certain high-risk health behaviors.
Although it has been reported that 38% of high school athletes use vitamin supplements,10 the prevalence rates of creatine or androstenedione use in adolescents are not known. Our study suggests that a significant number of young persons use ergogenic supplements, creatine in particular. The self-reported prevalence rate of 41% of individuals who have used ergogenic supplements represents a baseline that needs to be verified by further studies.
A majority of respondents (70%) believed that creatine and androstenedione are effective in increasing muscle strength. There is limited evidence to support this in the medical literature. This is important given the credibility gap the medical community created when discussing anabolic steroids with athletes and adolescents in the past. Physicians routinely counseled that steroids were ineffective in building muscle strength and mass. Athletes’ experiences in the gym and on the playing field proved otherwise,11 however, and a pervading sense of mistrust developed among athletes toward the medical community.12 Our study shows that many young individuals believe that ergogenic supplements are effective. Some of this belief may stem from word of mouth,13 some from savvy marketing, and some from perceived experience. Whatever the case, physicians must be careful to provide accurate clinical information, while not alienating patients, when discussing ergogenic supplements. Our results also suggest that individuals who have used ergogenics are more likely to believe in their effectiveness. This agrees with the model suggesting that users of “natural” products are more likely to believe in their safety and efficacy than nonusers.14
Finally, and perhaps most important, our study indicates that supplement use is associated with certain health risk behaviors. Specifically, ergogenic supplement users are more likely to drink alcohol heavily, ride as a passenger with a driver who has been drinking, drive after drinking, and get involved in a physical fight. A similar pattern of behavior has been described among adolescents who use anabolic steroids.15 Although the prevalence of anabolic steroid use in the general adolescent population has been estimated at 3% to 10%,16,17 our study shows a much higher rate of ergogenic supplement use. This establishes an important link in behavioral data between nutritional supplement users and anabolic steroid users. While steroids are illegal, ergogenic supplements are readily available. If, as our results suggest, ergogenic use is associated with a risk-behavior syndrome similar to that seen with steroid use, this is a valuable marker for physicians to use to provide targeted preventive counseling.
Limitations
Our study, however, has several important limitations. The respondents were all military recruits. Caution must therefore be used before generalizing the results to an unselected population. The prevalence of risk behaviors reported by the respondents relative to data from the 1999 YRBS18 also show several important differences Table 1. Our respondents appear more likely to drink, less likely to ride with someone who had been drinking, more likely to smoke, more likely to wear a seatbelt, less likely to fight, and less likely to report symptoms of depression compared with general data from the YRBS. The prevalence of other risk behaviors appears to be similar. It is uncertain whether these behavioral differences are particular to a military population. Another limitation of our study is the use of self-reported data, which potentially introduces a significant recall bias.
Conclusions
Our study suggests that in a young healthy military population there is widespread belief that creatine and androstenedione are effective ergogenic agents. The prevalence of supplement use in this population is significant, and such use is associated with certain health risk behaviors. This pattern of behaviors appears similar to a risk-behavior syndrome previously noted with anabolic steroid use. Clinicians should routinely ask adolescents and athletes about their use of dietary supplements. They should ask which supplements their patients are using, why they are using supplements, and what doses they are taking. Clinicians should be alert so they can provide targeted preventive counseling for individuals who are identified as users of ergogenic supplements.
Acknowledgments
Our study was supported by Uniformed Services Academy of Family Physicians grant G-1879.
Related resources
- FDA Dietary Supplement Consumer Information Homepage: http://www.cfsan.fda.gov/~dms/supplmnt.html
- USDA Food and Nutrition Information Center http://www.nalusda.gov/fnic/etext/000015.html
- Australian Academy of Sciences—Drugs in Sport http://www.science.org.au/nova/055/055sit.htm
STUDY DESIGN: We performed a cross-sectional survey.
POPULATION: Individuals entering military service for enlisted training were included.
OUTCOMES MEASURED: We recorded previous use of any nutritional ergogenic supplements and self-reported health risk behaviors.
RESULTS: Of 550 eligible participants, 499 completed the survey (91% response rate). Individuals who used ergogenic supplements were more likely to drink alcohol (adjusted odds ratio [AOR]=1.8; 95% confidence interval [CI], 1.1-3.1), more likely to drink heavily (AOR=2.4; 95% CI, 1.5-3.9), more likely to ride in a vehicle with someone who had been drinking (AOR=2.2; 95% CI, 1.3-3.6), more likely to drive after drinking (AOR=2.4; 95% CI, 1.3-4.4), and more likely to have been in a physical fight (AOR=1.9; 95% CI, 1.0-3.5), compared with those who had not used supplements. Men were more likely to use supplements than women (P <.001). There were no differences in patterns of supplement use according to age or body mass index.
CONCLUSIONS: Our study indicates an association between individuals who use ergogenic nutritional supplements and specific health risk behaviors. This represents an important opportunity for preventive counseling.
Since ancient times, athletes have ingested substances to gain a competitive edge.1 The use of such supplements, however, is not restricted to athletes. In 1996, Americans spent $6.5 billion on dietary supplements.2 Individuals cite many reasons for using such supplements, including to ensure good nutrition, prevent illness, improve performance, ward off fatigue, and enhance personal appearance.3
Since 1998, interest in the ergogenic effects of products currently marketed as nutritional supplements, in particular creatine and androstenedione, has increased. Creatine is currently the most popular dietary ergogenic supplement.4 The reported benefits of creatine include increased energy during short-term intense exercise, increased muscle mass, increased strength, increased lean body mass, and decreased lactate accumulation during intense exercise. Although it is clear that supplementation raises intramuscular creatine stores,5 it remains unclear how effective creatine is as an ergogenic aid. Generally, it is felt that creatine supplementation may be useful for repeated bouts of high-intensity short-duration exercise.6 Claims of increased strength and muscle mass have not, however, been unequivocally proven.
Androstenedione is a steroid hormone. Many sporting communities, including the International Olympic Committee, have banned its use. By itself, androstenedione is weakly androgenic. To date, the largest controlled trial examining the effectiveness of androstenedione as an ergogenic aid showed no significant gains in muscular strength compared with a standard program of resistance training.7 Methodologic concerns have been raised about this particular study,8 because supplement manufacturers are not subject to United States Food and Drug Administration approval if no unsupported claims of efficacy are made. Therefore, sales of ergogenic supplements remain brisk.
Within this context, our study was designed to examine the prevalence of ergogenic supplement use in a young population. We also sought to determine the extent to which supplement use was associated with personal health risk behaviors and to determine how effective ergogenic supplements were perceived to be.
Methods
Sample Recruitment
Our study was conducted at Lackland Air Force Base, Texas, and Parris Island, South Carolina, from June through September, 1999. All men and women entering military basic training at these sites were eligible to participate. Individuals were randomly selected to receive the survey. There were no specific exclusion criteria.
Survey Administration
The Youth Risk Behavior Survey (YRBS)9 was modified for use in our study. Specifically, questions about nutritional ergogenic supplement use were added to the standard instrument that is used to examine health risk and preventive behaviors, such as tobacco use, alcohol use, seat belt use, helmet use, and suicide. The subjects were specifically asked to report use of creatine and androstenedione. They were also given an open-ended opportunity to report any other ergogenic supplement use.
Data Analysis
We used basic descriptive statistics for categorical variables. Proportions were compared using the chi-square test of contingency. The Fisher exact test was used for rare responses. Continuous variables were compared using the Student t test for independent samples. We calculated adjusted odds ratios with a multivariate logistic regression analysis controlling for sex, age, and body mass index.
Results
Of 550 individuals recruited for participation, 499 (91%) completed the survey. The respondents ranged in age from 17 to 35 years (mean age = 21 years). The study sample was 88% men (n=439) and 12% women (n=60). The lifetime prevalence of ergogenic supplement use in our study population was 41%. Creatine was the most commonly used ergogenic supplement (n=117; 23% of the study sample), followed by androstenedione (n=38; 8%).
Ergogenic supplement use was significantly associated with several health risk behaviors. Individuals who used ergogenic supplements were more likely to drink alcohol, more likely to drink heavily, more likely to ride in a vehicle with someone who had been drinking, more likely to drive after drinking, and more likely to have been in a physical fight compared with those who had not used supplements Table 1.
Men were more likely to use ergogenic nutritional supplements than women (P <.001). No difference in the pattern of supplement use was noted relative to age or body mass index. An equal number of respondents (70%) felt that creatine, androstenedione, and anabolic steroids were all effective at building muscle strength. Men, respondents younger than 20 years, and individuals who reported using ergogenic supplements were all more likely to believe in the effectiveness of creatine, androstenedione, and steroids compared with others (P <.05).
Discussion
Our study has 3 important findings: (1) a significant number of young people have used ergogenic supplements; (2) a similar majority of respondents believe creatine, androstenedione, and anabolic steroids are effective with respect to gains in muscle strength and mass; and (3) use of nutritional ergogenic supplements is associated with certain high-risk health behaviors.
Although it has been reported that 38% of high school athletes use vitamin supplements,10 the prevalence rates of creatine or androstenedione use in adolescents are not known. Our study suggests that a significant number of young persons use ergogenic supplements, creatine in particular. The self-reported prevalence rate of 41% of individuals who have used ergogenic supplements represents a baseline that needs to be verified by further studies.
A majority of respondents (70%) believed that creatine and androstenedione are effective in increasing muscle strength. There is limited evidence to support this in the medical literature. This is important given the credibility gap the medical community created when discussing anabolic steroids with athletes and adolescents in the past. Physicians routinely counseled that steroids were ineffective in building muscle strength and mass. Athletes’ experiences in the gym and on the playing field proved otherwise,11 however, and a pervading sense of mistrust developed among athletes toward the medical community.12 Our study shows that many young individuals believe that ergogenic supplements are effective. Some of this belief may stem from word of mouth,13 some from savvy marketing, and some from perceived experience. Whatever the case, physicians must be careful to provide accurate clinical information, while not alienating patients, when discussing ergogenic supplements. Our results also suggest that individuals who have used ergogenics are more likely to believe in their effectiveness. This agrees with the model suggesting that users of “natural” products are more likely to believe in their safety and efficacy than nonusers.14
Finally, and perhaps most important, our study indicates that supplement use is associated with certain health risk behaviors. Specifically, ergogenic supplement users are more likely to drink alcohol heavily, ride as a passenger with a driver who has been drinking, drive after drinking, and get involved in a physical fight. A similar pattern of behavior has been described among adolescents who use anabolic steroids.15 Although the prevalence of anabolic steroid use in the general adolescent population has been estimated at 3% to 10%,16,17 our study shows a much higher rate of ergogenic supplement use. This establishes an important link in behavioral data between nutritional supplement users and anabolic steroid users. While steroids are illegal, ergogenic supplements are readily available. If, as our results suggest, ergogenic use is associated with a risk-behavior syndrome similar to that seen with steroid use, this is a valuable marker for physicians to use to provide targeted preventive counseling.
Limitations
Our study, however, has several important limitations. The respondents were all military recruits. Caution must therefore be used before generalizing the results to an unselected population. The prevalence of risk behaviors reported by the respondents relative to data from the 1999 YRBS18 also show several important differences Table 1. Our respondents appear more likely to drink, less likely to ride with someone who had been drinking, more likely to smoke, more likely to wear a seatbelt, less likely to fight, and less likely to report symptoms of depression compared with general data from the YRBS. The prevalence of other risk behaviors appears to be similar. It is uncertain whether these behavioral differences are particular to a military population. Another limitation of our study is the use of self-reported data, which potentially introduces a significant recall bias.
Conclusions
Our study suggests that in a young healthy military population there is widespread belief that creatine and androstenedione are effective ergogenic agents. The prevalence of supplement use in this population is significant, and such use is associated with certain health risk behaviors. This pattern of behaviors appears similar to a risk-behavior syndrome previously noted with anabolic steroid use. Clinicians should routinely ask adolescents and athletes about their use of dietary supplements. They should ask which supplements their patients are using, why they are using supplements, and what doses they are taking. Clinicians should be alert so they can provide targeted preventive counseling for individuals who are identified as users of ergogenic supplements.
Acknowledgments
Our study was supported by Uniformed Services Academy of Family Physicians grant G-1879.
Related resources
- FDA Dietary Supplement Consumer Information Homepage: http://www.cfsan.fda.gov/~dms/supplmnt.html
- USDA Food and Nutrition Information Center http://www.nalusda.gov/fnic/etext/000015.html
- Australian Academy of Sciences—Drugs in Sport http://www.science.org.au/nova/055/055sit.htm
1. Applegate E, Lee G. Search for the competitive edge: a history of dietary fads and supplements. J Nutr 1997;127:869S-73S.
2. Kurtzweil P. An FDA guide to dietary supplements. Washington, DC: US Food and Drug Administration; 1999.
3. Ervin RB, Wright JD, Kennedy-Stephenson J. Use of dietary supplements in the United States, 1988-94. Vital Health Stat 11 1999;i-iii:1-14.
4. Feldman EB. Creatine: a dietary supplement and ergogenic aid. Nutr Rev 1999;57:45-50.
5. Harris RC, Soderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clin Sci 1992;83:367-74.
6. Terjung RL, Clarkson P, Eichner ER, et al. American College of Sports Medicine roundtable: the physiological and health effects of oral creatine supplementation. Med Sci Sports Exerc 2000;32:706-17.
7. King DS, Sharp RL, Vukovich MD, et al. Effect of oral androstenedione on serum testosterone and adaptations to resistance training in young men: a randomized controlled trial. JAMA 1999;281:2020-28.
8. Yesalis C. Medical, legal and societal implications of androstenedione use. JAMA 1999;281:2043-44.
9. Kolbe L, Kann L, Collins J. Overview of the Youth Risk Behavior Surveillance System. Public Health Reports 1993;108:2-67.
10. Sobal J, Marquart LF. Vitamin/mineral supplement use among high school athletes. Adolescence 1994;29:835-43.
11. Sturmi JE, Diorio DJ. Anabolic agents. Clin Sports Med 1999;17:261-83.
12. Blue JG, Lombardo JA. Steroids and steroid-like compounds. Clin Sports Med 1999;18:667-89:ix.
13. Metzl JD. Strength training and nutritional supplement use in adolescents. Curr Opin Pediatr 1999;11:292-96.
14. Klepser TB, Doucette WR, Horton MR, et al. Assessment of patients’ perceptions and beliefs regarding herbal therapies. Pharmacotherapy 2000;20:83-87.
15. Middleman A, DuRant R. Anabolic steroid use and associated health risk behaviours. Sports Med 1996;21:251-55.
16. Terney R, McLain L. The use of anabolic steroids in high school students. Am J Dis Child 1990;144:99-103.
17. Elliot D, Goldberg L. Intervention and prevention of steroid use in adolescents. Am J Sports Med 1996;24:S46-47.
18. Kann L, Kinchen SA, Williams BI, et al. Youth Risk Behavior Surveillance—United States, 1999: state and local YRBSS coordinators. J Sch Health 2000;70:271-85.
1. Applegate E, Lee G. Search for the competitive edge: a history of dietary fads and supplements. J Nutr 1997;127:869S-73S.
2. Kurtzweil P. An FDA guide to dietary supplements. Washington, DC: US Food and Drug Administration; 1999.
3. Ervin RB, Wright JD, Kennedy-Stephenson J. Use of dietary supplements in the United States, 1988-94. Vital Health Stat 11 1999;i-iii:1-14.
4. Feldman EB. Creatine: a dietary supplement and ergogenic aid. Nutr Rev 1999;57:45-50.
5. Harris RC, Soderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clin Sci 1992;83:367-74.
6. Terjung RL, Clarkson P, Eichner ER, et al. American College of Sports Medicine roundtable: the physiological and health effects of oral creatine supplementation. Med Sci Sports Exerc 2000;32:706-17.
7. King DS, Sharp RL, Vukovich MD, et al. Effect of oral androstenedione on serum testosterone and adaptations to resistance training in young men: a randomized controlled trial. JAMA 1999;281:2020-28.
8. Yesalis C. Medical, legal and societal implications of androstenedione use. JAMA 1999;281:2043-44.
9. Kolbe L, Kann L, Collins J. Overview of the Youth Risk Behavior Surveillance System. Public Health Reports 1993;108:2-67.
10. Sobal J, Marquart LF. Vitamin/mineral supplement use among high school athletes. Adolescence 1994;29:835-43.
11. Sturmi JE, Diorio DJ. Anabolic agents. Clin Sports Med 1999;17:261-83.
12. Blue JG, Lombardo JA. Steroids and steroid-like compounds. Clin Sports Med 1999;18:667-89:ix.
13. Metzl JD. Strength training and nutritional supplement use in adolescents. Curr Opin Pediatr 1999;11:292-96.
14. Klepser TB, Doucette WR, Horton MR, et al. Assessment of patients’ perceptions and beliefs regarding herbal therapies. Pharmacotherapy 2000;20:83-87.
15. Middleman A, DuRant R. Anabolic steroid use and associated health risk behaviours. Sports Med 1996;21:251-55.
16. Terney R, McLain L. The use of anabolic steroids in high school students. Am J Dis Child 1990;144:99-103.
17. Elliot D, Goldberg L. Intervention and prevention of steroid use in adolescents. Am J Sports Med 1996;24:S46-47.
18. Kann L, Kinchen SA, Williams BI, et al. Youth Risk Behavior Surveillance—United States, 1999: state and local YRBSS coordinators. J Sch Health 2000;70:271-85.