Forget Popeye and his muscle-building can of spinach. The world of sport has a whole new menu of performance enhancements wooing athletes from 10 to 25 years of age and older with dreams of record-setting feats.

The average layperson might think age 10 a bit of a stretch. But according to several drug-use experts at UM, ergogenics aren’t just for college and professional athletes. Their use starts as early as middle school and is common among high school athletes as well as nonathletes wanting enhanced performance or a muscular body.

Ergogenics include testosterone and the derivative anabolic steroids that have been around since the mid-1930s. Although banned by the National Collegiate Athletic Association and International Olympic Committee, these substances are available by doctor’s prescription, on the black market and through the Internet, which lists pages of sellers to tempt the would-be buyer. And college and even high school athletes in Missoula are using drugs of this sort, says UM pharmacy Adjunct Assistant Professor Vince Colucci, a clinical pharmacist and pharmacotherapy specialist at Western Montana Clinic.

But ergogenics also include certain unregulated dietary or nutritional substances that are readily available at the neighborhood pharmacy. The fact that they’re “nutritional” doesn’t necessarily mean they’re safe. Nor does the fact that they’re the drugs of choice for some athletes mean they’re effective. And be forewarned, says pharmacy Associate Professor Cathy Bartels, who directs UM’s Drug Information Service:

“A lot of these products are banned by the NCAA and IOC, so just because they are dietary supplements does not mean that they are OK for an athlete to take.” Here are three common ones at the top of her long list: creatine, dehydroepiandrosterone (DHEA) and ephedra.

• Creatine. This substance — which, incidentally, can be found in spinach — is the most popular for younger athletes, according to Bartels, Colucci and Scott Richter, a professor in the health and human performance department.

Creatine is popular, they say, because it’s easy to get and safe, allegedly.

But is it safe? Richter says yes, so far. Short-term studies done on creatine have found muscle cramps to be the only serious side effect. Colucci says maybe not, that some case reports have linked creatine with liver and kidney damage if a user doesn’t drink plenty of water. Bartels calls it “one of the safer” ergogenics, which isn’t the same as saying it’s safe.

Does it work? Yes and no. No for runners and swimmers, Colucci says, because it may cause weight gain, which negates the extra strength creatine may have helped build. Bartels says maybe yes, but only for weight-lifters by increasing the weight they can lift, the repetitions they can do and the frequency of their workout sessions. But she says not to rule out a placebo effect.

“What happens when you’re a weight lifter and you’re continuing to work out?” she asks. “You’re going to be doing better, and so how do you differentiate between whether creatine really is improving your ability or whether your physical ability is improving because you’re continuing to work out?”

• DHEA. This product also is popular, Bartels says. Magazines that cater to athletes are rife with ads claiming this dietary supplement burns fat and builds muscle. So far no studies confirm that. On the other hand, Bartels says, as a hormonal product DHEA is potentially dangerous, particularly for people at risk of developing certain hormonal cancers such as breast, uterine, cervical and testicular cancer. Furthermore, Colucci says, hormonal products are metabolized mostly by the liver, so they can cause liver damage.

DHEA is converted in the body to estrogen or androgen, which is testosterone. So DHEA use can produce bad side effects, especially for girls and women who take large doses. Deepening of the voice, acne, menstrual irregularities, hair loss and hirsutism — growth of hair on the face and chest — have all been reported to the Food and Drug Administration. These are lifelong side effects, Bartels says, even if the user stops taking DHEA. In men the most common side effects are aggressive behavior, angry outbursts and headaches.

• Ephedra. A synthetic ephedra is a common ingredient in cold and allergy over-the- counter medication, and it’s effective as a decongestant. But ephedra in its natural state is a species of plant, and a plant-derived ephedra is sold in dietary supplements over the counter, Bartels says. It comes in single-ingredient form or as a component of a multi-ingredient preparation. Ephedra is a powerful stimulant that athletes take to delay fatigue and increase alertness and heart rate. But, Bartels says, too large a dose increases blood pressure to the point of hypertension. Tremors, coma, seizures, permanent disability and death have all been associated with ephedra products, she says.

Anabolic steroids, however, are probably the most dangerous of the performance-enhancing drugs. Bartels says that if, heaven forbid, she had to choose between taking dietary supplements or anabolic steroids, she would pick supplements. But they really don’t work, she says.

“I think that across the board you can probably say that nutritional ergogenics don’t work, with the one exception being creatine,” she says. “It may work for weight lifters.”

Steroids, on the other hand, do work, says Gene Burns, health and human performance professor and department chair.

“I think one thing has to be made clear up front in any discussion about steroids,” Burns says. “They work. There’s no question about it. ... In a three months’ period you’ll see a young man go from 150 pounds to 185, rock solid, hard muscle.” On the other hand, you also will likely see a personality change from nonaggressive to very aggressive, Richter says. Coaches, counselors and health professionals call this phenomenon “roid rage.”

In the early 1990s, when Richter and Burns were making presentations about steroid use in area high schools, the response was alarming, Burns says.

“If you could take one side, the negative side effects associated with steroid use — and they are many, and they are damaging, and they are long-lasting, and they are threatening in many cases to life — and you present those to athletes, as young as most of them are, the choice is clear for many of them,” he says. “Steroids.”

Liver damage, tumors in the kidneys, worsening of the lipids profile — higher LDL, lower HDL — salt and water retention, and high blood pressure are all possible side effects. In women, steroids have the same irreversible masculinizing effects as does DHEA. But scare tactics seldom work, Colucci says, because lots of users will say they’ve never had any side effects and don’t know anyone who has.

“Using really comes down to a personal choice,” he says. “It comes down to a question of morals and values. Everyone has to answer that question for himself.” Colucci doesn’t mention the word “cheating,” but Bartels does.

“Using a substance that isn’t natural to help improve athletic performance,” Bartels says, “is considered a form of cheating.” But explaining this to kids who are convinced that creatine or some other ergogenic gives them the edge they want in sports is nothing but a turnoff, she says.

“Kids want to be gods, want to be heroes,” Burns says. Unfortunately, the percentage of them who will be are minuscule. Something like .001 percent of them even have a shot at professional athletics, he says. About 10 percent will go on to play college sports.

“Is it really worth it for the 90 percent that are trying to do it, trying to make it, and all of a sudden their careers are over, and the damage has been done?” he asks.

What’s the alternative? Colucci says that to become a successful athlete three things matter most: a strong training ethic; appropriate nutrition — a balanced diet and knowing when to eat and adhering strictly to that; and an intense determination to achieve and the fortitude to put up with sacrifices.

While staying off ergogenics clearly is healthier, it also has another bonus — never having to worry about failing a drug test. While it’s true that athletes have become experts at getting around the tests, Richter says, scientists are constantly developing better testing methods. And as more information comes out about side effects of drugs, more will be banned by the NCAA and the IOC, Bartels says.

“So if kids want to go into NCAA or IOC types of events, they better be careful, because otherwise they’re going to jeopardize their careers,” she says.
Parents need not sit helplessly by when they suspect — or know — their child is using a performance-enhancing drug, Colucci says. They should find out why their athlete is interested in using drugs and where the pressure is coming from. Is he or she getting wrong information from peers or from somebody at the gym? Does he or she have an image problem or lack self-confidence? Are ergogenics simply a shortcut to either becoming attractive or becoming a star athlete or both?

“Parents need to instill the attitude that people get what they earn,” he says. “But life in the fast lane, instant gratification, is very addicting. Parents have to be honest with themselves — are they taking shortcuts themselves?” The worst thing they can do is acknowledge that using performance-enhancing drugs is safe and OK because everyone does it, he says.

— Terry Brenner