February 2000 • Volume 6 • Number 2
Protect young athletes:
Discuss supplements during sports exams
BY SHARON DENT
Blue Nitro. Remforce. Firewater. Thunder Nectar. As young athletes feel pressure to win at any cost, they may experiment with these or similar supplements in hopes of improving performance or "bulking up." Family physicians can educate these patients and help prevent serious health problems by discussing the issue of performance-enhancing drugs during preparticipation physical exams, according to AAFP's Commission on Public Health.
"The commission recently reviewed information from the FDA, and we feel that family physicians are in an ideal position to warn their patients about these dangerous supplements," says commission chair Lily Ning, M.D., of Honolulu, Hawaii.
The FDA is specifically urging physicians to be on the lookout for patients taking supplements that contain gamma butyrolactone (GBL), gamma hydroxybutyric acid (GHB), and 1,4 butanediol (BD). Although labeled dietary supplements, these products are illegally marketed, unapproved new drugs and are associated with reports of at least 122 serious illnesses and three deaths, the FDA warns. Items containing these drugs include Longevity, Revivarant, G.H. Revitalizer, Gamma G, Blue Nitro, Insom-X, Remforce, Firewater, Invigorate, Revitalize Plus, Serenity, Enliven, GHRE, SomatoPro, NRG3, Thunder Nectar and Weight Belt Cleaner.
In 1990, the FDA banned the use of GHB. Some companies switched to GBL -- and after warnings about GBL, switched to BD. These are all similar chemicals that the body converts to GHB with the same dangerous effects, the FDA reports.
Patrick Harr, M.D., of Maryville, Mo., AAFP past president and team physician for local high school and university athletic teams, says raising the issue of supplement use is essential during a preparticipation physical. "Almost all kids have taken some sort of supplement," he says. "Some are taking multivitamins, and that's probably OK. But some are feeling peer pressure to try these performance drugs."
During the exam, Harr says, the FP can tackle three important areas: sending the message that he or she is concerned about dangerous supplements, counseling the patient on the health risks of using them, and making a note to monitor the patient or even talk to the coach or trainer.
However, Harr says physicians should be honest about the supplements' claims. "If you try to tell a kid that none of the supplements are helpful, then you lose credibility because the kids see that the drugs help them bulk up," he says. "Be up front about the fact that the drugs do work, but that there's a heavy price to pay."
Rebecca Jaffe, M.D., has a private family practice including sports medicine in Wilmington, Del. She says she asks about supplement use at every well-patient visit, regardless of the patient's age or athletic prowess.
"With the kids, I always ask, 'What medications are you taking? What vitamins are you taking? What other supplements are you taking, legal or illegal?'" she says. "Whenever someone asks me to comment on a supplement they're taking, I ask them to bring it in. The only way to know what's in these products is to go through them piece by piece."
Jaffe has seen patients who admitted taking Longevity, one of the supplements included in the FDA warning. "Having something from the government is helpful," she says. "Patients can read the details to see how the drugs could affect them."
Jaffe also recommends that FPs pay attention when young patients report hanging out with a new circle of friends or experiencing sudden changes in school perfor- mance or weight. "These should lead you to a heightened awareness, making you keep an eye out for problems or things you can intervene with," she says.
In this day and age, Jaffe says, physicians must stay informed about supplements because so many patients are looking for shortcuts to good health.
"Everyone's looking for that thing that's going to help them win a little faster than the next person," she says.
FDA's warning about GHB, GBL and BD is available at http://www.fda.gov under "What's New" and then "Dietery Supplements." Or request it from AAFP Express; see "Quick Fax" in this issue.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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