By Dev K. Mishra, M.D.

A "supplement" by definition is something you would take in addition to whatever you would eat or drink in the course of your normal diet.

Examples of supplements can range from commonly used and safe substances such as multivitamins, to generally safe performance improving substances such as creatine, and then to unsafe items such as ephedrine and pseudoephedrine.

There is another class of substances beyond these called Performance Enhancing Drugs, which include anabolic steroids and human growth hormone. And yet another type of abused drug would include medications that are prescribed for proper medical reasons but are then abused and used in inappropriate ways.

Ritalin, commonly used for attention deficit hyperactivity disorder, is reported to improve focus or cope with jet lag in athletes.

For the purposes of this post I would like to focus on substances that typically would not require a prescription. Unfortunately, that does not mean they are all safe, and in fact the most dangerous substances are surprisingly easy to obtain in your local community or on the Internet. One of the biggest problems is that the supplement industry is unregulated so it is very difficult for the person using the supplement to be sure of the quality. Some supplements can contain a number of very unsafe ingredients.

Many young athletes are using and experimenting with substances supposedly useful to increase strength and muscle mass, improve endurance, and give them an edge on the competition. The pressures to use measures to improve sports performance are significant, and I expect these pressures only to increase as the years go by.

So let’s take a practical approach to supplements and let me provide a very simple “stoplight” guide to common supplements.

Generally Safe Supplements Used For Dietary and Nutritional Support
Most of these items would be safe for young athletes to use but there may be some instances where it would be wise to check first with your physician before use. For example, it’s possible to take too many multivitamins, too much protein powder, or eat a protein bar containing nuts when you have a peanut allergy. There’s evidence that taking a daily children’s multivitamin is a good idea for most kids.

* Daily multivitamin.
* Calcium.
* Sports drinks containing protein and multivitamins.
* Protein powders (obtain from a nationally reputable supplier).
* Fruit smoothies with protein boost or vitamin supplement

Probably Safe Supplements For Muscle Recovery and Increased Energy
In this category I would include creatine, used for muscle recovery and muscle mass gains; and naturally occurring stimulants such as caffeine, guarana, some B-vitamins, and kola nut.

Let me first be clear on one thing: there is no published credible research on the safety of creatine in adolescents or teens. Having said that, most trainers and physicians who take care of young athletes generally report that there are no “serious” side effects from creatine use, but stomach upset, dehydration, and muscle cramping are fairly common. Creatine use is probably fine, but check with your child’s physician before starting use.

Caffeine is another substance that falls into this intermediate category. Caffeine is found naturally in more than 60 plants and of course it’s found in coffee and sodas. For adults there is an upper limit on the amount of caffeine legally allowed in competitions such as the Olympics but again, we have no established limits for caffeine use in adolescents or teenagers.

Caffeine is a tough substance to avoid because it’s found in so many things so the best you can do is to read labels and use as little as possible.

Unsafe Supplements - Definitely Avoid
This category includes substances for which we have solid medical evidence of potential harm from use. I would also place prescription medications being used for reasons other than they were prescribed here.

For example, using Ritalin to improve focus or concentration in an adolescent without ADHD, or using an asthma inhaler to improve airway opening in a teen without asthma could lead to very serious health consequences.

What follows is just a tiny list of the most commonly abused substances. Literally hundreds of “performance enhancing drugs” and other substances are on banned substance list of most organized competitions. Most professional sports league, the Olympics, and the NCAA have strict screening and penalties for illegal substance use, and some state High School associations are also starting random drug screening. If you have any question at all check with your physician but you should avoid all of these:

* Anabolic steroids.
* Human Growth Hormone.
* Androstenedione (Andro).
* Ephedrine, pseudoephedrine (Sudafed), ephedra (Ma Huang).
* 19-norandrostenedione (19-Nor).
* DHEA (dihydroepiandrostenedione).
* Ritalin for use in individuals without Attention Deficit Hyperactivity Disorder.
* Asthma inhalers in non-asthmatics.


(Dev K. Mishra is the creator of the SidelineSportsDoc.com injury management program for coaches. He is an orthopedic surgeon in private practice in Burlingame, Calif. He is a member of the team physician pool with the U.S. Soccer Federation and has served as team physician at the University of California, Berkeley. This article first appeared on SidelineSportsDoc.com.)