Workout supplements: An emerging eating disorder in men?

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When developing a fictional character, you may not think about the character using large amounts of over-the-counter dietary supplements.  Especially a man who uses large amounts of workout supplements.

While there has been widespread publicity on the dangers of the non-prescribed use of anabolic steroids, not much is said about legal, over-the-counter supplements.  Are there risks?  And if so, what are they? 

There are several things the writer should consider.
  1. Supplement use is becoming an eating disorder with many men who use them to prepare for and recover from a workout.
  2. There is growing evidence of a link between muscle-building supplements and testicular cancer.
  3. There is evidence that over-the counter medications and supplements are the most common causes of drug-induced liver failure (a rare event, but still a risk.)  There is even evidence that, “certain popular herbal and dietary supplements can also cause liver damage," says Steven Scaglione, MD, a hepatologist (liver specialist) at the Loyola University Health System.
Could this evidence impact your story arc?  Or a character in your story?  That’s for you to decide and develop as you work through your project.  This does raise the issue of how doing something that most people consider healthy behavior may have serious impacts on a person’s well being later in life.

Here are excerpts of several research reports for your consideration, as always with links to the actual research in the story attributions.



Excessive workout supplement use: 
An emerging eating disorder in men?
In an effort to build better bodies, more men are turning not to illegal anabolic steroids, but to legal over-the-counter bodybuilding supplements to the point where it may qualify as an emerging eating disorder, according to research presented at the American Psychological Association's 123rd Annual Convention.

"These products have become an almost ubiquitous fixture in the pantries of young men across the country and can seemingly be purchased anywhere and everywhere -- from grocery stores to college book stores," said Richard Achiro, PhD, California School of Professional Psychology at Alliant International University, Los Angeles, who presented the research. "The marketing efforts, which are tailored to addressing underlying insecurities associated with masculinity, position these products perfectly as a 'solution' by which to fill a void felt by so many men in our culture."

For the study, the researchers recruited 195 men age 18-65 who had consumed legal appearance- or performance-enhancing supplements (e.g., whey protein, creatine, L-carnitine) in the past 30 days and had stated that they work out for fitness or appearance-related reasons a minimum of two times a week. Participants completed an online survey asking questions about a variety of subjects, including supplement use, self-esteem, body image, eating habits and gender role conflicts.

Achiro and co-author Peter Theodore, PhD, also at the California School of Professional Psychology, found that ~

  • more than 40 percent of participants indicated that their use of supplements had increased over time and 
  • 22 percent indicated that they replaced regular meals with dietary supplements not intended to be meal replacements. Most alarming, said Achiro, was that 
  • 29 percent said they were concerned about their own use of supplements. On the more extreme end, 
  • 8 percent of participants indicated that their physician had told them to cut back on or stop using supplements due to actual or potential adverse health side effects, and 
  • 3 percent had been hospitalized for kidney or liver problems that were related to the use of supplements. 
What's driving this risky misuse of legal workout supplements, said Achiro, appears to be a combination of factors, including body dissatisfaction, low self-esteem and gender role conflict, in which an individual perceives that he is not living up to the strict limitations of masculinity dictated by modern culture.
*  *  *  *  *

Testicular cancer link found 
for muscle-building supplements
Men who reported taking muscle-building supplements, such as pills and powders with creatine or androstenedione, reported a significantly higher likelihood of having developed testicular cancer than men who did not use such supplements, according to a new study in the British Journal of Cancer.

Moreover, said study senior author Tongzhang Zheng, the associated testicular germ cell cancer risk was especially high among men who started using supplements before age 25, those who used multiple supplements and those who used them for years.

"The observed relationship was strong," said Zheng. "If you used at earlier age, you had a higher risk. If you used them longer, you had a higher risk. If you used multiple types, you had a higher risk.  Testicular cancer incidence rose to 5.9 cases per 100,000 men in 2011, from 3.7 cases in 100,000 in 1975, Zheng continued.  "Testicular cancer is a very mysterious cancer. None of the factors we've suspected can explain the increase."

The odds ratios increased to 2.77 (a 177 percent greater risk) among men who used more than one kind of supplement, and to 2.56 among men who used supplements three years or longer. Men who started using supplements at age 25 or younger also had an elevated associated odds ratio of 2.21, the researchers calculated.

"Considering the magnitude of the association and the observed dose-response trends, muscle-building supplements use may be an important and modifiable exposure that could have important scientific and clinical importance for preventing testicular germ cell cancer development if this association is confirmed by future studies," the authors conclude in the study.
*  *  *  *  *

OTC medications, supplements are most
common causes of drug-induced liver failure
Drug-induced acute liver failure is uncommon, and over-the-counter medications and dietary and herbal supplements -- not prescription drugs -- are its most common causes, according to new research from the Perelman School of Medicine at the University of Pennsylvania. 

One of the most feared complications of drugs and medications is acute liver failure, traditionally associated with a greater than 50 percent chance of dying without a liver transplant. Drug-induced liver injury, known as hepatotoxicity, is the second most common reason drugs are withdrawn from the market, behind cardiac toxicity, according to the U.S. Food and Drug Administration (FDA). The real risk of acute liver failure that the researchers calculated was 1.61 per million people per year.

Among the 5,484,224 patients evaluated, 62 were identified with acute liver failure, nearly half of which were drug-induced.

  • Acetaminophen was implicated in 56 percent of cases, 
  • dietary/herbal supplements in 19 percent, 
  • antibiotics in 6 percent and 
  • miscellaneous medications in 18 percent.
"We discovered that 75 percent of acute liver failure cases resulting from prescribed medication use were derived from over-the-counter products such as acetaminophen or herbal supplements," says Goldberg. "Prescription medications are an exceedingly rare cause of acute liver failure."
*  *  *  *  *


Dietary supplements can cause
liver injury, says hepatologist

"Kava, comfrey, valerian, vitamin A, niacin
and even green tea, when consumed in 
high doses, have been linked to liver disease."

Niacin, comfrey, Kava and even green tea in high doses can cause liver injury. A Loyola liver specialist explains acetaminophen is just one of many drugs taken that negatively impacts liver health.

Dose-dependent (acetaminophen) and idiosyncratic drug-induced liver injury (DILI) is the leading cause of acute liver failure in the United States, responsible for approximately 50 percent of all reported cases. "Awareness of the dangers of acetaminophen has risen but many consumers and even many health care professionals are not aware that certain popular herbal and dietary supplements can also cause liver damage," says Steven Scaglione, MD, hepatology, Loyola University Health System. "Kava, comfrey, valerian, vitamin A, niacin and even green tea, when consumed in high doses, have been linked to liver disease."

Acetaminophen is one of the most widely used over-the-counter pain relievers and more than 25 billion doses are sold yearly. "Therapeutic doses of acetaminophen have been associated with liver toxicity," says Scaglione, who cares for liver patients at Loyola. Acetaminophen is also a basic component in many over-the-counter cold and flu remedies for adults and children.

"Liver injury caused by medications is often difficult to identify and diagnose as well as treat," said Scaglione, who also specializes in live transplantation and research. "The new LiverTox online reference is ideal for medical professionals as an educational tool and a guide in the evaluation of patients with suspected drug induced liver injury. The use of case examples is particularly helpful."
Scaglione is board certified in internal medicine and gastroenterology. He is part of the Loyola liver-referral system for transplantation with offices throughout Illinois.
*  *  *  *  *

 The benefits and dangers of supplements

Understanding
Dietary Supplements


by Jenna Hollenstein
(Registered-certified dietitian-nutritionist)

Order new or used from
Powell's Books
From multivitamins to supplements that pledge to help with everything from depression to treating athlete's foot, whole stores are filled with these alternative medications. With so many options out there it can be difficult for patients to know what is beneficial or even where to start.

"Today more than ever it's important for patients to work with their physician or nutritionist when considering supplements. Some are beneficial but others can be dangerous, especially when it comes to interacting with other supplements or medications," said Aaron Michelfelder, MD, of Loyola University Health System. "In general there is no benefit from taking a supplement just for the sake of supplementing. So, talk to your doctor about what would be beneficial for you."

For instance, Michelfelder says that many people don't know that calcium supplements can interfere with thyroid absorption. If a patient is on a thyroid medicine, taking a calcium supplement at the same time could cause side effects.

Vitamin C is another common supplement that people may take for the wrong reasons. According Michelfelder there is no evidence that it helps ward off colds, but it does help with iron absorption and can be helpful for people who are anemic.

"There is such a thing as too much of a good thing. People shouldn't take more than 2,000 mg of vitamin C a day as it can lead to kidney problems. It's also extremely acid, making it a bad choice for someone with stomach issues," Michelfelder said. "It's hard to navigate all the products out there on your own. That is why it's important to work with a medical professional as a team."

He says if a person has mildly high blood pressure he might recommend trying a supplement and lifestyle change for 6 months and then evaluate if a medication is necessary.

There also are instances, such as sleep problems, when Michelfelder prefers to prescribe supplements rather than prescription medication.

"Sleep medications can be habit-forming and leave people impaired the next day. I would much prefer my patients to try melatonin or just better sleep hygiene, such as limiting screen time and increasing exercise," Michelfelder said.

Because there is little research on the effects of supplements on a fetus Michelfelder suggests pregnant women stay away from all supplements with the exception of a prenatal vitamin.

"There are not as many regulations or as much research done on supplements as there is for medications, so the most important thing is to make sure you talk to your doctor," Michelfelder said. "There are so many interactions that many patients aren't aware of, but if you work with your physician, you can find the best and safest combination for you based on your health history and needs." 

Story Source:  
  1. "Excessive workout supplement use: An emerging eating disorder in men?" ScienceDaily, 6 August 2015.
  2. N Li, R Hauser, T Holford, Y Zhu, Y Zhang, B A Bassig, S Honig, C Chen, P Boyle, M Dai, S M Schwartz, P Morey, H Sayward, Z Hu, H Shen, P Gomery, T Zheng. Muscle-building supplement use and increased risk of testicular germ cell cancer in men from Connecticut and Massachusetts. British Journal of Cancer, 2015
  3. David S. Goldberg, Kimberly A. Forde, Dena M. Carbonari, James D. Lewis, Kimberly B.F. Leidl, K. Rajender Reddy, Kevin Haynes, Jason Roy, Daohang Sha, Amy R. Marks, Jennifer L. Schneider, Brian L. Strom, Douglas A. Corley, Vincent Lo Re. Population-representative Incidence of Drug-induced Acute Liver Failure Based on an Analysis of an Integrated Healthcare System. Gastroenterology, 2015
  4. "Dietary supplements can cause liver injury, says hepatologist." ScienceDaily, 26 October 2012.
  5. "The benefits and dangers of supplements." ScienceDaily, 16 September 2014.

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