Question: I was interested to read about a grandmother’s concern over her adolescent grandson’s protein powder use. This week, I discovered many of my Year 12 and Year 13 students who are weight training also take dietary supplements, including creatine, caffeine (tablets/capsules), fish oil, multivitamins, protein drinks/protein bars, and magnesium. The boys seem to think these supplements are good because they bought them from a health shop. Please advise about any risks with these supplements.
Answer: Popping dietary supplements has become a nutritional insurance policy for many people, hoping they will make up for any dietary shortfalls and boost their health and wellbeing. But not all dietary supplements are without risk, particularly for adolescents. A recent US study found specific categories of supplements were linked to a greater risk of severe medical events in adolescents and young adults.
The 2019 study, published in the Journal of Adolescent Health, was by Harvard TH Chan School of Public Health researchers. It reviewed reports in the US Food and Drug Administration’s adverse events database between 2004 and 2015. It found 977 reports of adverse events during those 11 years among individuals aged from 0 to 25 years. However, the reporting process is voluntary and many consumers and physicians do not report incidents, so this is likely to be a fraction of the events that really occur.
Supplements sold for muscle building, energy and weight loss were associated with almost three times the risk of a severe medical event, including death and hospitalisation, compared with vitamins. Depending on the specific products your students use, they may fall into these higher-risk categories; supplements containing creatine, caffeine and protein are often targeted at muscle building and boosting energy.
The issue with these types of supplements is two-fold for adolescents. First, their safety and efficacy have not been tested explicitly in this age group, so we cannot definitively state whether they are safe or useful during this development phase of life.
A 2021 study published in the journal Nutrients noted that although creatine supplements are popular among adolescents, there is still a lack of high-quality clinical trial data to verify what impact and any adverse side effects they have in this age group from a performance perspective.
Second, the Harvard study noted many supplements sold for weight loss, muscle building and energy are adulterated with everything from prescription medications to heavy metals, pesticides, banned substances (such as steroids) and a range of other dangerous chemicals. So just because these supplements are sold in a health shop does not make them healthy.
New Zealand has very loose regulations around the safety of dietary supplements. There is no pre-approval safety process for dietary supplements. Instead, the onus is on the company selling the product to ensure it is of acceptable quality and safe to use.
This lackadaisical approach does not work and puts consumers at risk, judging by a 2022 Consumer New Zealand investigation. It found six sports supplements that contained seven illegal drugs – including amphetamine-like stimulants and prescription medications used to treat ADHD and Parkinson’s disease. These sports supplements were, unsurprisingly, targeted at muscle building, weight loss and increasing energy.
As noted in a previous Nutrition column (July 29), the use of protein supplements in this age group is associated with eating-disorder risk factors among boys (but not girls). The use of creatine supplements is also associated with eating-disorder risk factors among adolescent boys, noted a 2021 study in Frontiers in Sports and Active Living.
Rather than spending money on dietary supplements of unknown origin, with potentially dubious usefulness and side effects, a better investment would be booking a consultation with an experienced sports dietitian who can guide adolescents to create a healthful programme to meet their sports goals while maintaining their health as they grow.
