Creatine and other supplements

A review of the evolving landscape between the consumer Internet and men's health

Internet adoption continues to increase as broadband access and mobile connectivity penetrate developing global markets. Alongside increasing adoption, the Internet continues to evolve and usher in new modes of user interaction. Social media and search engines have facilitated the emergence of the participatory web, in which users are able to contribute content, form online communities, and disseminate information. This participatory web is reshaping the patient-physician relationship as patients are able to search for medical information, directly engage with healthcare practitioners through social media, and make therapeutic decisions via online marketplaces. The ability for patients to self-diagnose and self-treat is highly relevant to andrology, given that men have a baseline reluctance to visit healthcare providers. Furthermore, men’s health issues such as erectile dysfunction and male infertility are stigmatized, with men turning to the Internet for guidance. The focus of this review is to survey the academic literature that evaluates the quality of online content for four common men’s health conditions: hypogonadism, male infertility, erectile dysfunction, and Peyronie’s disease.

Dietary Supplements and Young Teens: Misinformation and Access Provided by Retailers

BACKGROUND AND OBJECTIVE

Despite the American Academy of Pediatrics' recommendations against pediatric use of creatine and testosterone boosters, research suggests that many young teenagers take these dietary supplements. Our objective was to determine to what extent health food stores would recommend and/or sell creatine and testosterone boosters to a 15-year-old boy customer.

METHODS

Research personnel posing as 15-year-old high school athletes seeking to increase muscle strength contacted 244 health food stores in the United States via telephone. Researchers asked the sales attendant what supplements he/she would recommend. If a sales attendant did not mention creatine or testosterone boosters initially, each of these supplements was then specifically asked about. Supplement recommendations were recorded. Sales attendants were also asked if a 15-year-old could purchase these products on his own in the store.

RESULTS

A total of 67.2% (164/244) of sales attendants recommended creatine: 38.5% (94/244) recommended creatine without prompting, and an additional 28.7% (70/244) recommended creatine after being asked specifically about it. A total of 9.8% (24/244) of sales attendants recommended a testosterone booster. Regarding availability for sale, 74.2% (181/244) of sales attendants stated a 15-year-old was allowed to purchase creatine, whereas 41.4% (101/244) stated one could purchase a testosterone booster.

CONCLUSIONS

Health food store employees frequently recommend creatine and testosterone boosters for boy high school athletes. In response to these findings, pediatricians should inform their teenage patients, especially athletes, about safe, healthy methods to improve athletic performance and discourage them from using creatine or testosterone boosters. Retailers and state legislatures should also consider banning the sale of these products to minors.

Energy drinks: what is all the hype? The dangers of energy drink consumption

PURPOSE

To describe the adverse effects associated with energy drink consumption among adolescents and young adults.

DATA SOURCES

Review of literature utilizing Medscape, the Internet, MD Consult, and CINAHL. The following search terms were used: Energy drinks, caffeine, guarana, taurine, ginseng, sugar, and caffeine toxicity. Search was limited to English language sources from 2005 to 2010.

CONCLUSIONS

The popularity of energy drinks and the rapid growth of their excessive consumption among adolescents and young adults have brought about great concern in regards to overall health and well-being. Caffeine, which is readily available to minors, is the most commonly used psychoactive substance in the world and imposes a potentially harmful influence on health, academic performance, and personal adjustments. Teens and young adults account for nearly $2.3 billion of energy drink sales. Adolescents and young adults are often unaware that various products, such as energy drinks, herbal medications, and various other medications that promote alertness, contain caffeine. When these products are taken together, caffeine toxicity and severe adverse effects can occur.

IMPLICATIONS FOR PRACTICE

Practitioners need to be aware of the consequences of energy drink consumption and be prepared to provide appropriate patient education.

Nutritional supplement use among Slovenian adolescents

OBJECTIVE

Little is known about the prevalence of nutritional supplement use in European adolescents. We conducted the present study to analyse the prevalence of nutritional supplement use and factors associated with this use among Slovenian adolescents.

DESIGN

The nutritional supplementation practices of 818 adolescents were studied using an anonymous questionnaire. Information was sought on the type of supplements used, frequency of use and sources of information.

SETTING

The region of north-west Slovenia.

SUBJECTS

Schoolchildren from twenty primary schools and twelve secondary schools.

RESULTS

Some 19·3% of all adolescents reported using at least one nutritional supplement and the prevalence of use was significantly higher in adolescents who were members of sports clubs. Multivitamins were the most common nutritional supplement. Older adolescents were significantly more likely to be supplementing with iron, protein and minerals. Less than 16% of supplement users in our study sought information from health-care professionals. Nearly 62% obtained information from parents and coaches, and many adolescents appear to decide on nutritional supplementation themselves, without advice. Older adolescents were significantly more likely to combine supplements than younger adolescents.

CONCLUSIONS

One-fifth of Slovenian adolescents use nutritional supplements. There are clear differences in supplement use between younger (age 12 years) and older (age 17 years) adolescents. Multiple use of supplements, coupled with self-managed supplementation in older adolescents, is concerning. Hence, there is an urgent need to provide accurate information regarding nutritional supplements, which will help adolescents, their parents and coaches to make informed choices about their use.

Dietary supplements and team-sport performance

A well designed diet is the foundation upon which optimal training and performance can be developed. However, as long as competitive sports have existed, athletes have attempted to improve their performance by ingesting a variety of substances. This practice has given rise to a multi-billion-dollar industry that aggressively markets its products as performance enhancing, often without objective, scientific evidence to support such claims. While a number of excellent reviews have evaluated the performance-enhancing effects of most dietary supplements, less attention has been paid to the performance-enhancing claims of dietary supplements in the context of team-sport performance. Dietary supplements that enhance some types of athletic performance may not necessarily enhance team-sport performance (and vice versa). Thus, the first aim of this review is to critically evaluate the ergogenic value of the most common dietary supplements used by team-sport athletes. The term dietary supplements will be used in this review and is defined as any product taken by the mouth, in addition to common foods, that has been proposed to have a performance-enhancing effect; this review will only discuss substances that are not currently banned by the World Anti-Doping Agency. Evidence is emerging to support the performance-enhancing claims of some, but not all, dietary supplements that have been proposed to improve team-sport-related performance. For example, there is good evidence that caffeine can improve single-sprint performance, while caffeine, creatine and sodium bicarbonate ingestion have all been demonstrated to improve multiple-sprint performance. The evidence is not so strong for the performance-enhancing benefits of β-alanine or colostrum. Current evidence does not support the ingestion of ribose, branched-chain amino acids or β-hydroxy-β-methylbutyrate, especially in well trained athletes. More research on the performance-enhancing effects of the dietary supplements highlighted in this review needs to be conducted using team-sport athletes and using team-sport-relevant testing (e.g. single- and multiple-sprint performance). It should also be considered that there is no guarantee that dietary supplements that improve isolated performance (i.e. single-sprint or jump performance) will remain effective in the context of a team-sport match. Thus, more research is also required to investigate the effects of dietary supplements on simulated or actual team-sport performance. A second aim of this review was to investigate any health issues associated with the ingestion of the more commonly promoted dietary supplements. While most of the supplements described in the review appear safe when using the recommended dose, the effects of higher doses (as often taken by athletes) on indices of health remain unknown, and further research is warranted. Finally, anecdotal reports suggest that team-sport athletes often ingest more than one dietary supplement and very little is known about the potential adverse effects of ingesting multiple supplements. Supplements that have been demonstrated to be safe and efficacious when ingested on their own may have adverse effects when combined with other supplements. More research is required to investigate the effects of ingesting multiple supplements (both on performance and health).

Sports doping in the adolescent: the Faustian conundrum of Hors de Combat

The drive toward success in sports and the need for a cosmetically acceptable appearance have driven many adolescents to take a wide variety of so-called doping substances. The consumption of these chemicals in the hope and hype of improved sports performance, fueled by the easing of government restrictions on their proof of safety and efficacy, has resulted in an explosion of so-called ergogenic products available to our youth. Agents that have been used include anabolic steroids, anabolic-like agents, designer steroids, creatine, protein and amino acid supplements, minerals, antioxidants, stimulants, blood doping, erythropoietin, beta-blockers, and others. The use of these agents has considerable potential to cause physical and psychological damage. Use and misuse of drugs in this sports doping process should be discouraged. This discussion reviews some of the agents that are currently being used. Clinicians providing sports medicine care to youth, whether through anticipatory guidance or direct sports medicine management, should educate their young patients about the hype and hyperbole of these products that may keep them out instead of in the game at considerable financial cost to the unwary consumer.