For
thousands of years people have been using substances to improve
their physical performance and appearance. Descriptions of
athletes ingesting special foods to enhance their performance
date back to ancient Greece.1 Recently,
use of creatine and androstenedione in professional sports
has been heavily publicized. Substances that are used to
improve physical performance are collectively referred to
as "ergogenics," a
term derived from a Greek phrase meaning "work production." In
relation to athletic performance, the term refers to any
means used to enhance energy production, control, or efficiency.2
An
alarmingly large number of children and adolescents use ergogenic
aids,3 and their use may pose significant
health risks 4 (Table
21). The principal substances misused by children and adolescents
are anabolic steroids, amphetamines, sympathomimetic amines,
caffeine, and protein and vitamin supplements.5 Children
and adolescents also use narcotics, human growth hormone, and
beta-2 agonists for performance enhancement, but the extent
to which they do so is not well documented.
Fifty
percent of the estimated 1 million anabolic steroid users in
the United States are 19 years old or younger.6–8 Five
to 11 percent of male high school students and 0.5 to 2.5 percent
of female high school students have used steroids. More than
half of these students began using steroids before their 16th
birthday.9 According to one study,
3.8 percent of the 800 seventh-grade students surveyed were
using anabolic steroids.10 (It should
be noted that epidemiological studies of ergogenic aid use,
which derive their data from self-reported questionnaires,
may underestimate or overestimate the prevalence of use.7,8)
These are disturbing statistics, given the possible detrimental
effects of anabolic steroids on physical and psychological
health. For children and adolescents these effects include
the potential for premature closure of growth plates, which
limits overall physical development.11
Anabolic
steroid use among children and adolescents is not confined
to athletes. Approximately one-third of high school students
using steroids are not active in school sports.9 Adolescents
state that they use steroids not only to improve strength and
athletic performance but also to improve sexual performance,
increase sexual organ size, and improve appearance.12
Public awareness of the detrimental effects of anabolic steroids has
increased, and a growing number of educational programs are targeting
potential users. Nevertheless, recent reports suggest that, since
1991, steroid use among adolescent males has remained stable. These
same reports show an increase in steroid use among adolescent females.
It has been suggested that, as females' participation in sports
gains acceptance and support, adolescent females face increased
temptation to use ergogenic aids.7
Human Growth
Hormone and Stimulants
Most
of the research on ergogenic aid use in children and adolescents
has focused on anabolic steroids. Much less is known about
the use of other anabolic agents, such as human growth hormone
and stimulants. Human growth hormones have become more widely
available to children and adolescents. While they may cause
accelerated linear growth in growing children, significant
side effects include increased serum cholesterol and triglycerides,
cardiac enlargement, hypogonadism, and changes of acromegaly
in facial bones. There appears to be an increasing use of
stimulants such as amphetamines, caffeine, and ephedrine
by high school students.13 The
use of these stimulants can result in dehydration or cardiac
arrhythmia.
Protein, Vitamin,
and Mineral Supplements
Children
and adolescents are barraged by information that promotes
the ergogenic effect of protein, vitamins, and minerals.
One of the few studies addressing ergogenic aids other than
anabolic steroids found that, among high school athletes,
35 percent had used protein supplements and 33 percent had
used vitamin supplements to improve performance.4 Excessive
protein intake increases the risk of dehydration as well
as renal toxicity. Growing children and adolescents need
to be cautious of excessive intake of vitamins and minerals.
Many vitamins and minerals compete for the same absorption
site, and an excess of one may limit absorption of others.
Children and adolescents need to eat a variety of foods that
provide adequate calories for growth and activity. (See
the Nutrition chapter.)
