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While the world of professional and elite sports comes to terms with illegal steroid usage, many everyday athletes wrestle with whether legal supplements can build their muscles.
Creatine, protein powders, other amino acids and androstenedione top the list, but some athletes add whey, little liver pills and anything else that seems to work for the person next to them in the gym.
Their widespread usage raises questions: Do they work, and is it OK for teenage athletes to take them? They're also pricey --- a jar of creatine that lasts a month can cost $30.
"I get bombarded with questions daily," said Jacob McLendon, 23, a trainer and bodybuilder studying nutrition at Georgia State University. "Parents ask me. The athletes ask me: 'Is there anything I can do to help me out?' "
There's reason for confusion. The nutritional supplements field has doubled to a $16 billion industry since 1994, when a landmark federal law gave wide berth to supplements. That law, called the Dietary Supplement Health and Education Act, placed the onus on the government to prove a supplement is unsafe, rather than requiring its manufacturer to prove that it is safe. Fans of creatine
Supplements sprouted like alfalfa. Shark cartilage, yam cream and protein powders line health food stores in metro Atlanta and across the country.
For athletes, the supplements that reportedly build muscle are the most appealing, with creatine being the leader of the pack. Creatine sales have skyrocketed in the past eight years, with sales soaring from $50 million in 1996 to nearly a billion dollars in 2002.
The amino acid became wildly popular after sluggers Mark McGwire and Sammy Sosa acknowledged using it in the late 1990s. The Los Angeles Lakers were reported to have kept tubs of it in their locker room.
Closer to home, Reggie Greene, a trainer and bodybuilder, uses 5 grams of creatine as a part of his regular routine. He works out twice daily and carefully watches what and even when he eats.
He keeps cans of tuna, salmon and peanut butter in his car in case he gets stuck in traffic and risks missing a meal, something he doesn't want to do because he believes it would break down muscle fiber. He also takes 6 tablespoons of flaxseed oil, amino acids glutamine, leucine and valine and a range of B vitamins. He pops liver pills as if they were chocolate drops.
But looking at him --- 5 feet 9 inches tall, 198 well-muscled pounds --- who could argue? At 37, a few years past prime for bodybuilders, he's won a Georgia open middleweight championship and is training for another in July. Greene said the supplements give him at least a mental edge, if not physical.
"Even if they might not work, they work mentally because they make you work harder," Greene said. "They give me a renewed sense of purpose. And, if I'm spending all that money on them, I'm going to make them work."
McLendon, who works at the Planet Fitness on Buford Highway with Greene, said he began using creatine about seven years ago when he played cornerback at Heritage High School in Conyers. It is impossible to see a dot of fat anywhere on his 5-foot-8-inch frame ---- even though he weighs 177 pounds. Concerns about effects
Researchers, however, are not convinced that supplements work for the rank-and-file athletes.
"We have been unable to identify anything that's legal and effective [in building muscle]," said Wilkie Wilson, professor of pharmacology at Duke University and co-author of the book "Pumped" with Cynthia Kuhn, also a professor of pharmacology at Duke. "Creatine might pass that test, but it's the only one that falls into that category."
An article in the Journal of the American Pharmaceutical Association in 1999 said that creatine, an amino acid that occurs naturally in the body and is important in muscle restoration, "may possibly" aid performance in high-intensity, short-duration spurts, or those less than 60 seconds, such as sprinting and powerlifting.
It went on to say, however, that clinical trials have not proved creatine to be effective, and it also raised questions about whether in large doses it could cause kidney damage, as the Houston Astros' Derek Bell and others have claimed in newspaper articles.
"We just don't know the long-term effects," said Dr. Ed Laskowski, co-director of the Mayo Clinic's Sports Medicine Clinic in Rochester, Minn. "We know it can cause muscle-cramping, because it diverts water from the body to muscles, and it can be related to dehydration, but we haven't studied the long-term results. And that's what we're most concerned with." What's in the bottle?
Long-term effects are not the only concerns of physicians and researchers. They worry about dosaging of creatine and other supplements and the purity of the products. The 1994 law does not require uniform dosaging standards or oversight of the ingredients of a supplement.
"The doses are all over the place," Laskowski said. "You can have 10 different products of creatine, and they'll all have different levels of it. Sometimes, they'll have inert products in them that someone can be allergic to."
If creatine is the best of the bottled supplements, and its benefits minimal and long-term effects unknown, what does that mean for the other alleged muscle-building supplements like other amino acids, protein and andro?
"You can accomplish the same thing by eating eggs," Wilson said of amino acid supplements.
"Most of the protein powders are excreted [through urine]," said Laskowski.
They also are not fans of androstenedione, a substance secreted by the adrenal glands that can break down into testosterone. It has no benefits, they said, but could be risky because it affects hormonal balance. Teens in particular should avoid it.
While doctors, trainers and athletes know that testosterone does build muscle fiber, they also know that it takes huge doses, sometimes as much as 1,000 times the amount of the hormone naturally produced in the body, to do so. Even if andro boosts testosterone levels in the body, the increase would be short, minimal and useless for competition.
"I can't say it strongly enough: Humans in the developmental stages should not be taking any of this stuff," said Wilson.
Many doctors view the legal supplements with some jaundice, seeing them as gateway substances that could lead to steroid usage, which could have far more dangerous side effects. That's why some draw the line even on supplements.
"It's a matter of are you going to rely on an external agent or on conditioning and training," said the Mayo Clinic's Laskowski. "We want to empower them so that they don't need an additional agent. We want them to know that any time you take something that's not been proven safe, you're going into a black box."
Copyright 2004 The Atlanta Journal-Constitution