By Marina Renton
You've seen them at the gym: extremely body conscious men, driven to achieve a level of physical perfection through grueling workouts.
Well, new research suggests that overusing popular supplements like whey protein and creatine to improve workout performance may signal an emerging eating disorder.
Researchers presented their findings at the American Psychological Association’s annual convention in Toronto earlier this month.
Almost 200 18- to 65-year-old men who consumed legal appearance- and performance-enhancing drugs (APEDs) and worked out at least twice a week participated in the study, led by co-authors Richard Achiro and Peter Theodore, both from the California School of Professional Psychology at Alliant International University, Los Angeles. In addition to asking about their supplement use and eating habits, researchers surveyed the participants about their psychological well-being, asking about their body image, self-esteem and gender role conflicts.
Almost 30 percent of the people surveyed said they were worried about their supplement use. Over 40 percent had increased their supplement intake over time. Twenty-two percent said they consumed the supplements instead of a meal, even when that wasn’t their intended use. Eight percent had been advised by their doctor to curb their use of supplements, and 3 percent had been hospitalized for kidney or liver problems stemming from their supplement intake.
Risky behaviors were influenced by how much participants had internalized what the study authors called “cultural standards of attractiveness,” their self-esteem, gender role conflict and body dissatisfaction. (For more details, see NPR's coverage here.)
"Our findings suggest that misuses [over the counter] workout supplements is a type of eating disorder among gym-active men," Achiro wrote in an email. "This is a critical finding because we have been overlooking this form of eating disorder based on our conventional understanding of eating disorders being directed toward a drive for thinness (which predominates among women) rather than considering that men are more likely to strive for a body that is both lean and muscular — exactly the type of physique many of these supplements purport to foster."
I spoke with Dr. Jacques Carter, an attending physician at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School, about the research and the use of legal APEDs. He said a surprisingly high number of his patients use the workout supplements.
Below is our conversation, lightly edited:
MR: What was your reaction to the research?
JC: I had never looked at legal supplement use as being an issue related to an eating disorder in men. I have lots of male patients who take supplements — more than you would imagine, actually. And they often come in with their supplement in hand to inquire as to whether I think they’re OK to take.
In most of those cases, these are guys who I think are eating well, not skimping on meals, and not using these supplements as some kind of snack. I think they use them to help build muscle tone and muscle mass, and not so much for any other reasons.
But, maybe now I’ll ask some of these guys, 'Do you have any problems with eating, do you skip meals when you take this stuff?' I’d like to know that because it’s not something that immediately comes to mind. These guys who seem healthy and work on their overall health and bodies, you don’t tend to think about them having eating issues. They don’t fit the typical profile.
So, your patients often come to you with questions about the appropriate use of supplements?
Absolutely. The main reason that they come in with the supplements, actually, is to make sure that they’re OK to take, that there’s nothing harmful in them. I’ll look at the label and I’ll go through the ingredients on the label and say, 'This will raise your blood pressure, this will do this, this will do that.' Most of these products are quite safe if used in moderation, as long as they don’t have a lot of stimulants in them. But some of them have stimulants in them, and that can cause some problems.
What are some of the most common products you see?
Creatine is a big one, and a lot of my patients come in with products with amino acids in them. A lot of claims are made for these products that don’t have to be backed up scientifically. And they get marketed that way, and consumers have no idea, they just read the label and say this is going to help me build more muscle, or have more energy, or blow off more fat. So that’s why they use these products, but there is absolutely no way to know for sure. And you can’t put stock in those advertisements because they don’t have to be backed up scientifically at all.
Would you advise people consult their doctors if they’re considering taking supplements?
If it’s more than just a simple multivitamin, I would suggest a telephone call about the product’s safety. Especially if you have some underlying health issues, such as hypertension, diabetes, high cholesterol or kidney disease. You have to be careful of your renal function, especially with some of these products like creatine and other protein products.
How can they damage your kidneys or liver?
When you take these products, you have to eliminate them somehow. And they have to be broken down, and they go through the liver. Some of them are excreted through the bowels and some are excreted through the urine, through the kidneys. If you’re prone to some renal problems, sometimes it doesn’t take very much of an overload to make that worse.
You have to be very careful with some of these products, especially if you’re taking them in some mega doses. A lot of these folks take these things in multiple pills. You have to know your health history and how well you are, how well your kidneys and heart are functioning.
A lot of my patients who use these supplements are in their 50s and 60s. They’re health-conscious, that’s why they take some of these products, but they especially have to be careful if they have tenuous renal function.