performance. Besides being a complex ethical as well
as a philosophical issue, the long term effects on
health have not been investigated to date.Interactions
Athletes who train hard frequently complain
about energy drain and fatigue. Because they are reg-
ularly reminded to consume adequate fluids and fuel
to minimize early fatigue and to maximize perform-
ance and recovery, many have turned to ‘‘energy’’
drinks’’. These are liquid food products that contain
both fluid and energy together in one bottle. Recent
research sponsored by the Food and Nutrition Infor-
mation Center of the United States Department of
Agriculture (USDA) has shown however, that some
energy drinks were found to contain herbs, amino
acids,protein, and other substances in such small
amounts that they were unlikely to have any notice-
able effect on performance. Other energy drinks were
found to have contents that may result in inefficient
absorption of fluid and nutrients from the intestine,
with the possibility of gastrointestinal distress. The
absorption of nutrients involves a delicate balance of
interactions among various nutrients and the body
and boosting intake of one may upset that balance.
Athletes are always looking for sound, effective
aids to boost performance and many believe that herbs
can improve athletic performance. Herbs are non-
woody plants or parts of plants that have a long his-
tory of medicinal or therapeutic use. In fact, many
common medications, such as aspirin and quinine,
were first developed from herb extracts. However, if
herbs can act as drugs, they are also associated with
potential adverse effects or interactions with foods,
other herbs, or medications.Aftercare
Treatment for excessive use of ergogenic supple-
ments starts with complete avoidance. Depending on
the supplement used and the medical complications,
aftercare is tailored to individual cases and depend on
the nature of the resulting medical condition.Complications
Harmful effects have been reported for several
ergogenic products. Anabolic steroids have many
adverse effects, most related to the unwanted andro-
genic effects, such as shrinking testicles, enlargedpros-
tate gland, and lower sperm levels. Some of the
adverse effects are potentially serious and irreversible
and they include heart, liver, and immune system
problems. Behavior changes may include aggression,paranoia, mood swings, low sex drive, and depression.
Blood doping has been linked to strokes, allergic reac-
tions, and infections. HGH adverse effects include
heart and nerve diseases, glucose intolerance, and
higher levels of bloodfats. Other effects also come
from the extra HGH levels in the body along with
what is already produced by the pituitary glands.
Ergogenic doses ofcaffeinemay cause restlessness,
nervousness, insomnia, and tremors. At least 17
deaths have been linked to products that combine
caffeine and ephedrine. Additional risky supplements
in the ephedrine class include androstenedione and
other ‘‘prohormone’’ precursors to testosterone,
yohimbine, and products that contain kava. Adverse
effects have also been reported with carbohydrate
supplementation. Increased insulin levels after carbo-
hydrate consumption were shown to significantly
decrease blood glucose levels in some athletes, and
fructose-containing solutions have been associated
with adverse gastrointestinal effects in some studies.Parental concernsParents should educate their teenagers concerning
the use of ergogenic aids, and strive to increase their
awareness of illegal ones. Most teens however, seem
very smart in that they stay away from steroids. As
part of a 2002 study funded by the National Institute
for Drug Abuse, teens were asked if they had ever tried
steroids, even if only once. Results were that only
2.5% of 8th graders had ever tried steroids, only
3.5% of 10th graders, and 4% of 12th graders. For
teenagers, hormone balance is especially important
since they are at the age of puberty. Hormones are
involved in the development of feminine traits in girls
and masculine traits in boys. When teenagers use ste-
roids, there is a risk of gender mix-ups. Boys can
experience shrunken testicles and can also end up
with breasts (gynecomastia). Using steroids, girls can
develop deeper voices and grow excessive body hair
with a decrease of breast size.
Steroid users may be very pleased when they flex
muscle in a mirror, but they may develop health prob-
lems that may hurt them for the rest of their lives, and
even shorten their lives. Ergogenic supplements,
unlike medicines and other drugs, do not undergo
rigorous testing and screening for efficacy and safety,
but information is still available, for instance from
health care providers and sport medicine practitioners
or at Supplement Watch (www.supplementwatch.
com) and Consumer Lab (www.consumerlab.com),
which provide independent test results and informa-
tion to help people evaluate and select supplements.Ergogenic aids