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Is Your Child at Risk What You Need to Know About Performance-Enhancing Supplements&Your Student Athlete

Online Health Chat with Tara Harwood, MS, RD, CSP, LD, Pediatric Dietitian at Cleveland Clinic Children’s Hospital

January 23, 2012


Introduction

Cleveland_Clinic_Host: If you’re the parent of a student athlete, your life is probably as hectic as your child’s. But in the daily chaos of carpools, practices and games, it’s important to talk to your teen about the dangers of performance-enhancing supplements. Pros and Olympic athletes aren't the only ones lured by the promise of a shortcut to increased strength and stamina. Kids in high school, junior high and even middle school are using these products, too. And your child could be among them.

Performance-enhancing supplements, such as energy drinks and protein shakes, and more serious drugs, such as nitric oxide and creatine, are used to boost athletic performance, cut weight and increase personal appearance. They are also taken to increase muscle mass and energy; but they can cause serious harm. Side effects can include nausea, muscle cramps, halted bone growth, and kidney, heart and liver damage.

Tara Harwood, MS, RD, CSP, LD, is a pediatric dietitian at Cleveland Clinic Children’s Hospital. Ms. Harwood completed her Bachelor of Science in Dietetics and her Master of Science in Sports Nutrition at Ohio University. She completed an internship at James A. Haley Veterans’ Hospital in Tampa, Florida. Ms. Harwood is a member of the American Dietetic Association and Sports, Cardiovascular, and Wellness Nutrition (SCAN), and participates in education/counseling at Cleveland Clinic. Her specialty interests include pediatrics and sports nutrition.

To make an appointment with pediatric dietitian Tara Harwood, MS, RD, CSP, LD, or any of the pediatricians or pediatric specialists at Cleveland Clinic Children's Hospital, please call 216.444.KIDS (5437) or call toll-free 800.223.2273, ext. 5437. You can also visit us online at www.clevelandclinicchildrens.org.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic pediatric dietitian Tara Harwood, MS, RD, CSP, LD. We are thrilled to have her here today for this chat. Let’s begin with some of your questions.


Energy Drinks

kjf0721: How do I talk to my kids about the dangers of energy drinks?

Tara_Harwood_MS_RD: My recommendation is to be honest and let your child know the following: The American Academy of Pediatrics recently published a position statement to discourage energy drinks in youth. The reasoning behind their stance is most energy drinks include the addition of caffeine in combination with other stimulants, additives, and herbal ingredients. The effect of the combined ingredients on a youth’s developing neurological and cardiovascular system is not always known, does not necessarily improve performance, and can be a health hazard.

When most youth pick up an energy drink, they do know it contains caffeine. However, most are not aware that some of these energy drinks include another ingredient called guarana, which is very similar to caffeine. Guarana is about 2.5 [times] stronger than caffeine and is also released into the body more slowly than caffeine, which means it delivers more of a slow and steady boost of energy. Guarana combined with caffeine or other stimulant ingredients may produce a synergistic effect - meaning it makes the effects more powerful. This isn’t necessarily a good thing, as many people suffer from side effects both small and large. For example, guarana combined with ephedra and aspirin can cause stroke or death. More common side effects include heart palpitations, increased heart rate, and elevated blood pressure. These side effects become dangerous when consumed on hot summer days when the body has a difficult time cooling itself off.

If your child does not seem deterred by the health risks, let him or her know the drinks oftentimes contain lots of sugars and calories, which cause weight gain over time.

If your child tells you he or she needs a boost of energy or wants to enhance performance, remind him or her that a good night's sleep followed by proper diet and exercise can help more than anything. And it's safe! Go ahead and be a good example and help your child get more involved in the health routines of the family.

Lastly, if your child is not listening to you, take him or her to a dietitian. Sometimes hearing it from multiple sources is the best strategy.

yoga_mom: Can a teen OD on energy drinks?

Tara_Harwood_MS_RD: In general, energy drinks not in combination with other drugs and used in moderation most likely will not be fatal. However, that being said, some of the combinations of ingredients (due to a synergistic effect) in energy drinks paired with other supplements/drugs your child may be taking (such as aspirin) can cause death. The risks of adverse events are increased when exercising or being outside in the heat, as the body has a difficult time cooling itself off and then heat stroke can occur (which can even be fatal if not treated quickly).

Pfit_Z: What is the danger of combining alcohol and energy drinks?

Tara_Harwood_MS_RD: I'm assuming this question is for young adults of at least 21 years. Many young adults are following the popular trend of consuming alcohol mixed with stimulant-containing energy drinks as a means for getting a buzz without getting sleepy. However, this in turn can produce health hazards. Energy drinks contain not only caffeine but additional stimulants such as ginseng, taurine, and guarana. These combinations of stimulants promote stronger effects on the body from the caffeine then if consuming it alone. By combining these powerful stimulants with a depressant (the alcohol), the nervous system becomes confused, which can cause cardiac problems such as heart palpitations and heart rhythm problems. This may be worsened in young adults that have undiagnosed medical conditions dealing with the nervous or cardiovascular systems.

The best way to stay up all night long while engaging in social drinking is to stay adequately hydrated and to not drink alcohol in excess. Try rotating your alcoholic beverage with water throughout the night to control volume and rehydrate. If you really feel a stimulant boost is needed, make sure to exhibit moderation by only drinking one. Remember to always try the energy drink out first during the day without combining it with alcohol to see how your body responds.


Supplements

mollylucas: With all the health supplement and vitamin stores in the malls with people working in them that know very little about what they are selling, what is or where is the best information about all the supplements that are on the market and comparing one product to another?

Tara_Harwood_MS_RD: I fully agree with your concern. I have many patients who get misinformation from someone working at a supplement store. In general, it is very hard to sort out all the misinformation for supplements because supplements do not have to be regulated by the FDA, according to the Dietary Supplement and Health Education Act. This means that the supplement companies do not have to prove the safety or potency of the product in order for it to be on the shelf. Case in point: ephedra, which was in diet pills and exercise supplements, was linked to possibly 80 deaths before being banned in the market. My recommendation is to first talk to your child's doctor or dietitian regarding supplements of interest.

Most general multivitamins from major companies are safe at doses set on the label. The problem is when you are trying to select diet pills, weight gainer supplements, combinations of single vitamins or minerals at high doses, or other supplements claiming to improve performance. Usually an adequate diet paired with proper exercise is your best bet for obtaining everything you need without risking any side effects. Also, be aware of the catchy testimonials claiming the product is the best out there. Be aware that everything that is discussed in an ad or on a label may just be quackery. Some major brands that may not be what they say they are can be found and reviewed on quackwatch.com.

mattpainter: Are there supplements that you can buy at stores like GNC® that are considered banned by college or professional sports organizations?

Tara_Harwood_MS_RD: Yes, because supplements are not regulated by the FDA. Always be aware of what you are taking. Some products may contain substances banned by the NCAA, IOC, etc. In one IOC study: of 200 products, 20 percent contained non-labeled substances that would lead to a positive doping test. What is printed on the label provides no guarantee of what is in the bottle. Always be cautious of unscrupulous advertising making outrageous claims of their supplement enhancing your desired results more so than any other product on the market. As always, I recommend proper diet paired with a proper training routine for the best and safest results/outcomes (although it may take longer and is obviously more work).

B_ballman: Are all supplements considered to be bad?

Tara_Harwood_MS_RD: Not all supplements are considered bad. Some have been proven safe and effective in populations over 18 (not any are recommended under 18 years of age because of the developing eyes, nervous system, or sex organs). For example, creatine supplementation has been found effective for increasing muscular endurance, but has no effect on body composition or aerobic endurance. However, the activity must be Maximal, Brief, Repetitive, and allows Recovery.

But again, creatine can naturally be found in foods and usually an adequate diet will do the job (as it has been shown there are people who do not respond to creatine, which may mean their diet is already adequate in it). Creatine is only recommended for individuals needing to "top off their tanks." Doses on the package are usually excessive and not what research has used.

That being said, most "enhancing" supplements have not been proven effective in legitimate research. Examples include nitric oxide powders, creatine, or amino acid mixtures.

paris: Is creatine okay for my teenager to use?

Tara_Harwood_MS_RD:Creatine is not recommended for anyone under the age of 18 years because creatine is stored in the eyes, brain, and testicles, and there are no known effects of what this will do while these organs are still developing. Creatine should be reserved only for athletes over the age of 18 years.


Protein

swimmom: My daughter has told me girls on her swim team are drinking protein shakes, should I let her?

Tara_Harwood_MS_RD: Protein shakes are not necessarily helpful in improving performance. The myth in the sports arena is that a lot of protein is good for building muscles and keeping the body lean. I tell my patients that yes, the muscle is made of protein, but carbohydrates are what provide the energy to actually use the protein to build the muscles. It's like having a bunch of bricks to build a house but no one to actually lay them. Also, most protein shakes are overly excessive in protein (manufactured for large males), which may be counter-productive in a small female. Excessive protein can have the body lose additional water, which can cause dehydration. Protein is dosed by body weight. One protein shake can have up 20 to 50 grams of protein, which may be all the protein your young female athlete may need for the whole day. (Generally your athletic child will need 1.4 to 1.6 grams/protein/kg; to get weight in kg divide pounds by 2.2.) For example, a 110 pound girl (divide by 2.2 to get 50kg) will only require at the most 80 grams/protein/day. The best way to get protein is drinking flavored milks (ex. chocolate milk). The flavored milks are a natural source of whey protein, and the flavoring provides carbohydrates to help rebuild and refuel the exercising muscle. This is cheap, safe, and has been scientifically proven to improve performance. Your growing teenager also needs around 1300 mg of calcium daily anyway (or 4 servings of dairy), so why not get everything you need by pushing the milk?!

Sylvestercat: How much protein should my son consume if he is strength training?

Tara_Harwood_MS_RD: Protein recommendations go by body weight. For teenage males 1.7 to 2.0 grams/protein/kg of body weight is recommended. (To get weight into kg divide pounds by 2.2.) For example a 150 pound male/2.2 = 68 kg x 2 grams of protein = 136 grams of protein. One ounce of meat = 7 grams of protein, 1 egg = 7 grams of protein and 1 cup of milk = 8 grams of protein. Instead of adding protein shakes to your child’s diet try this: 2 eggs for breakfast, 4 ounces of meat for lunch, 6 ounces of meat for dinner, 4 cups of milk per day. This provides 116 grams of protein. The rest of protein can be obtained from snacks. Going above 2 grams of protein per kg of body weight is not recommended so more isn’t necessarily better as going above this amount can cause dehydration and increase overall saturated fat and cholesterol in the diet.

jessie: What are your thoughts on Whey protein? When should it be taken?

Tara_Harwood_MS_RD: Whey protein is full of branched chain amino acids, which are considered to be essential amino acids (i.e., you need to obtain from diet). Branched chain amino acids have benefits for improving performance. However, do not feel the need to buy overly expensive whey protein shakes. Instead indulge in natural sources of whey in the form of low-fat dairy and yogurt.

lacerta 227: I'm confused about the statement that the BEST way to get protein is drinking flavored milks. This seems like a nutritionally misleading statement. How is a drink made with added chocolate and sugar (empty calories, providing no nutrition) the best form of protein, given the number of other foods that can provide both protein and other nutrients, without it?

Tara_Harwood_MS_RD: The sugar calories are the perfect form of energy for the exercising muscle. For athletes, there is no such real thing as an empty calorie because the muscle soaks up energy in the form of simple carbohydrates to create glycogen stores and to help rebuild the muscle. Active children and athletes have different needs then the general population. There are multiple research articles that have shown the benefits of this simple carbohydrate in the form of chocolate syrup and how it can benefit an athlete. Also, just because there is chocolate syrup in the milk does not mean it isn’t full of nutrients. Milk still contains an excellent source of vitamin D, vitamin A, and calcium. The chocolate syrup just adds bonus energy to the milk for the muscles.


Vegetarian Diet

samba: What are the pros and cons to my teenage daughter following a vegetarian diet?

Tara_Harwood_MS_RD: The pros include: The diet is usually high in carbohydrates, which is the main source of energy for an athlete. The diet is also lower in calories for weight management. In addition, these diets are generally low in saturated fat and cholesterol, which are heart healthy.

Cons: The diet may be inadequate in complete sources of protein. This means essential proteins your body cannot make. Make sure to add complete sources of protein to your vegetarian child’s diet, such as soy protein. These diets can also be low in vitamin B12, zinc, iron, calcium, and vitamin D, more so if your child is a vegan and not including dairy products. I recommend a complete multivitamin with iron taken with 100 percent fruit juice. The fruit juice provides vitamin C, which maximizes iron absorption. Also, high vitamin C foods such as strawberries, tomatoes, oranges, and kiwi are recommended with meals for better iron absorption.


Exercise and Competition

MN7:What is the best thing to eat or drink right after exercising?

Tara_Harwood_MS_RD: Flavored milk. As discussed previously, flavored milk provide the best ration of carbohydrates to protein for glycogen repletion and muscle repair/building.

Wynchester: What should my child eat during a full competition day?

Tara_Harwood_MS_RD: The best idea is to have your child properly fueled prior to competition. This means proper intake on a day-to-day basis and depending on training demands. That way, day of competition it isn’t as stressful to make sure your body is obtaining the right energy because everything should be fully stocked. The day before, have your biggest meal around 4 pm so it can fully digest for the next day. That day, eat easy to digest foods with protein and carbohydrates; for example: turkey bagel, chocolate milk, yogurt with fruit on the bottom, peanut butter and crackers, cottage cheese and a breadstick, or milk and vanilla wafers.


Hydration

sab1077: My son is not very physically active but prefers to drink Gatorade® over anything else. Is this a problem? He probably has 3 or 4 a day.

Tara_Harwood_MS_RD: I do not typically recommend a sports beverage in non-athletes. The general population does not need the extra sodium and calories in these drinks. I hear all the time from my patients that they drink a sports drink for the electrolytes, but then they cannot tell me what an electrolyte is or what it does for us. Electrolytes are the sodium and potassium added to the sports drinks. Generally, during excessive exercise, you lose the sodium through your sweat so it needs to be replaced. But non-athletes do not need to replace the electrolytes; and in addition, we get enough sodium in foods we eat throughout the day. Athletes exercising also need to give the muscle additional energy in the form of carbohydrates, and that's why generally sports drinks contain calories in the form of carbohydrates. Extra calories over time can be stored as fat. Sports drinks are also very acidic and can cause abdominal pain and erode tooth enamel if consumed on a regular basis. Sports drinks should be saved for intense start-stop exercise where there is a lot of sweating or for long duration exercise (exercise greater than 1 hour). If you are not participating in either, just go ahead and grab the water.


General Questions

jen_jen: How do I get my kids to not eat so much junk food?

Tara_Harwood_MS_RD: First set a good example. Try not to engage in junk food eating yourself. Also, parents control what is coming into the house. Make sure not to buy junk food that your children can get into whenever they want. Children most likely will still get junk food outside the home, but you can at least do your part by keeping it out of their daily reach/view. Teach your children about eating healthy and the benefits for the body. When doing this, get your children involved at every step -- from picking out foods to make/snack on during the week to going to the grocery store, and then helping to prepare healthy meals and snacks. Children are in contained settings most of their day so that means it's up to you to provide the example when in the home.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with pediatric dietitian Tara Harwood, MS, RD, CSP, LD, is now over. Thank you again, Ms. Harwood, for taking the time to answer our questions today about Performance-Enhancing Supplements and Your Student Athlete.

Tara_Harwood_MS_RD: Thank you for your questions.


More Information

To make an appointment with pediatric dietitian Tara Harwood, MS, RD, CSP, LD, or any of the pediatricians or pediatric specialists at Cleveland Clinic Children's Hospital, please call 216.444.KIDS (5437) or call toll-free 800.223.2273, ext. 5437. You can also visit us online at www.clevelandclinicchildrens.org.

A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit www.eclevelandclinic.org/myConsult.

If you need more information, contact us or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!

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This chat occurred on 1/23/2012

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. ©Copyright 1995-2012 The Cleveland Clinic Foundation. All rights reserved.