Workout Supplements: Does Overuse Signal An Eating Disorder Among Men?



By Marina Renton
CommonHealth Intern

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.

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Calcium, Vitamin D For Osteoporosis: Are Recommendations Skewed By Conflicts Of Interest?

A photo illustration shows over-the-counter calcium supplements. (Bebeto Matthews/AP)

A photo illustration shows over-the-counter calcium supplements. (Bebeto Matthews/AP)

By Marina Renton
CommonHealth Intern

Might commercial influences be driving the widespread recommendation of calcium and vitamin D supplementation for the prevention and treatment of osteoporosis?

That’s the conclusion of an analysis published in the journal BMJ, written by Andrew Grey and Mark Bolland, endocrinologists and associate professors at the University of Auckland.

The analysis — strongly refuted by organizations that advocate for osteoporosis research — further complicates the already contentious issue of whether it’s a good idea to take the supplements and if so, at what dosage.

The Supplement Conundrum

Women over 50 are most likely to develop osteoporosis, a bone disease affecting millions of Americans that results in bone weakness and increased risk of fracture. Calcium and vitamin D supplements are widely recommended to prevent and treat the condition.

“But as we point out, the considerable body of randomized trial evidence doesn’t support that practice,” Grey, the study’s co-author, wrote in an email.  “We wondered why practice hasn’t changed to reflect the evidence.”

To promote bone health, over half of older Americans take calcium and vitamin D supplements, which can be prescribed by a doctor or purchased over the counter, the authors write.

The Institute of Medicine (IOM) recommends adults take in 1,000 mg of calcium per day (1,200 for adults 70+ and women 51-70) and 600 IU (international units) of vitamin D — 800 IU for the 70+ set.

As of 2013, the U.S. Preventive Services Task Force does not recommend daily calcium and vitamin D supplementation for non-institutionalized postmenopausal women to prevent fractures. This, they note, is not necessarily inconsistent with the IOM’s recommendations, which do not specifically discuss fracture prevention.

The supplements have been standard clinical practice in preventing or treating osteoporosis in older adults since the early 2000s. Since then, however, studies have emerged to contest their effectiveness, according to the paper. Continue reading

Shops Remove Possibly Dangerous Diet Supplements After Study Faults FDA

Following a report this week that the U.S. Food and Drug Administration kept silent about synthetic stimulant contamination in some popular diet supplements, a major vitamin seller announced it will pull products that may be tainted with the chemical BMPEA.

Here’s The Vitamin Shoppe announcement via PR Newswire:

Mike Mozart/flickr

Mike Mozart/flickr

Because the health and safety of our customers is our number one priority, and out of an abundance of caution, we are immediately removing all acacia rigidula containing products, due to the concern that some of them may contain BMPEA, from our stores and website. BMPEA is a synthetic drug-like substance that should not be used in dietary supplements.

We are concerned by the findings outlined in the study published yesterday in Drug Testing and Analysis, which state that some acacia rigidula containing products may also contain BMPEA. If these findings are confirmed by the FDA, these products should not be sold as dietary supplements.

The Vitamin Shoppe requires that all manufacturers of the products we carry comply with all applicable laws. The Vitamin Shoppe decided to remove these products because the safety of these products is now in question and may not be in compliance with FDA regulations. In addition, the Vitamin Shoppe continues to encourage the FDA to use its authority to remove any dietary supplements from the market which it deems unsafe.

On Wednesday, The New York Times offered a detailed account of the tainted supplement study, which was published in the journal Drug Testing and Analysis:

Popular weight-loss and workout supplements on sale in hundreds of vitamin shops across the nation contain a chemical nearly identical to amphetamine, the powerful stimulant, and pose dangers to the health of those who take them, according to a new study. The Canadian health authorities in December called the chemical, BMPEA, “a serious health risk,” and pulled supplements that contain it from store shelves.

The Food and Drug Administration documented two years ago that nine such supplements contained the same chemical, but never made public the names of the products or the companies that made them. Neither has it recalled the products nor issued a health alert to consumers as it has done with other tainted supplements. The F.D.A. said in a statement that its review of supplements containing the stimulant “does not identify a specific safety concern at this time.”

But public health experts contend that the F.D.A.’s reluctance to act in this case is symptomatic of a broader problem. The agency is not effectively policing the $33 billion-a-year supplements industry in part because top agency regulators themselves come from the industry and have conflicts of interest, they say.

Dr. Pieter Cohen, an assistant professor at Harvard Medical School, and the lead author of the study, said in an email that he has some short-and long-term hopes for what happens next in the tainted supplement saga. Cohen, also a primary care doctor at Cambridge Health Alliance wrote:

I would hope the FDA stops hiding their head in the sand and immediately warns consumers that they have found a synthetic stimulant in many supplements. The FDA should use it’s full enforcement capabilities to remove BMPEA from all supplements. The FDA should also clarify that the plant being used as cover for this stimulant, a shrub called Acacia rigidula, has no legitimate place in supplements and all supplements labeled as containing Acacia rigidula should be immediately withdrawn from the market. Continue reading

Meth-Like Stimulant Found In ‘Craze’ Workout Powder; Production Stops

A rock of crystal meth (not found in Craze.) Photo: Psychonaut/Wikimedia Commons

A rock of actual crystal meth (not the analog found in Craze.) Photo: Psychonaut/Wikimedia Commons

In medical research, “impact” usually refers to the number of times that an article or a journal is cited by others going forward. If your findings only ever find their way into, say, three sets of footnotes in other people’s papers, you can be pretty sure your impact is minimal.

In journalism, however, when you’re, say, applying for a Pulitzer prize, you need to show “impact” in the sense that your stories have led to significant change: The corrupt sheriff was ousted, or the systemic injustice corrected.

Dr. Pieter Cohen (Courtesy)

Dr. Pieter Cohen (Courtesy  Cambridge Health Alliance)

Dr. Pieter Cohen, a general internist at Cambridge Health Alliance who researches dietary supplements, has just crossed the line from the academic sort of impact to the journalistic: On Monday, he and colleagues published a paper warning that they had analyzed the popular pre-workout supplement Craze and found that it contained a little-studied methamphetamine-like substance. Now, USA Today reports: “Driven Sports, maker of the pre-workout supplement Craze, announced Tuesday that it has suspended all production and sales of the product in the wake of tests finding amphetamine-like ingredients.”

In fact, Driven Sports writes on its Website that it stopped production “several months ago while it investigated the reports in the media regarding the safety of Craze” — though it also maintains that Craze is safe and its own testing has found no amphetamine or other controlled substances.

But would we have known that Craze production had been suspended if Dr. Cohen’s study in the journal Drug Testing And Analysis had not appeared? We asked him for his main messages from the Craze tale, and he replied:

• Supplements are all assumed safe until proven otherwise by the FDA.  But the FDA has no effective system to detect hazardous supplements.

• In this setting it’s concerning to find that more and more supplements, like Craze, that contain new, untested compounds.  This can lead to serious health effects: The FDA is currently investigating whether a new ingredient in a weight loss supplement, aegeline, was responsible for one death and dozens of cases of severe hepatitis in Hawaii. Continue reading

More Than Mojo: ‘Natural’ Sex Pills May Contain Viagra Or Worse

(Source: FDA)

(Source: FDA)

The patient was not complaining, by any means. He’d just started a new “natural” sex enhancement supplement, and he reported that it was working terrifically.

But Dr. Pieter Cohen’s astute resident at the Somerville Hospital primary care clinic, Dr. Rachael Bedard, had her suspicions, and she brought the patient to his attention. Dr. Cohen, a general internist at Cambridge Health Alliance and a frequent medical mythbuster, sent the pill out to be tested.

“The lab not only found Viagra in it,” he recalled. “They also found Cialis, another erectile dysfunction drug, as well as a brand new designer drug, as well as caffeine.” So in all, “You’ve got two prescription drugs that we would never prescribe together, a brand new drug, and caffeine, all in one pill. And that’s what our patient was consuming when he thought he was taking a natural sex enhancer.” In fact, the supplement, Sex Plus, was “chock full of pharmaceuticals that had nothing to do with nature.”

Dr. Bedard sent the findings to the FDA, which did its own testing and ended up issuing this alert late last month. And Dr. Cohen has just co-authored a paper in the Journal of the American Medical Association Internal Medicine — “Adulterated Sexual Enhancement Supplements,” subtitled “More Than Mojo” — spreading the word that sex-enhancement supplements advertised as natural may in fact be nothing of the kind. And they may contain brand new designer erectile-dysfunction drugs whose potential dangers are anyone’s guess.

His bottom line: “If you want a natural sex enhancer, talk to your doctor about prescription ‘yohimbe,’ but it may have side effects and it’s not very effective. Still, if you want to avoid Viagra, that’s the way to go. When it comes to any supplement sold for sexual enhancement, it should be avoided because it’s either going to be useless or potentially harmful.”

What might be the danger of, say, the drug that Somerville patient was taking? Continue reading

Study: Multivitamins Slightly Reduce Cancer Risk In Older Men

(US Navy via Wikimedia Commons)

Please don’t groan. Yes, this is one more of those confusing studies that seem to flip-flop the previous confusing studies. But let’s just file it away as a valuable data point in an evolving picture, and rejoice that at least, as these studies get bigger and better, the findings should become stronger.

Last we heard — last fall, actually — a study of more than 38,000 older women in Iowa brought disturbing news to the millions who take daily vitamins. It found, as NPR reported: “Use of many common supplements — iron, in particular — appeared to increase the risk of dying, and only calcium supplements appeared to reduce mortality risk. The increased risk amounted to a few percentage points in most instances.”

Now comes a somewhat countervailing study: The Journal of the American Medical Association reports that in 15,000 older men, multivitamins do confer apparent benefit, reducing the total risk of cancer by 8 percent. I spoke with the study’s co-author, Dr. Howard Sesso, an associate professor of medicine at Brigham and Women’s Hospital. He acknowledged my flip-flip complaint, but noted that this latest study does take the research up a notch:

Previous multivitamin studies have been “observational studies,” he said. “These are free-living populations, and they take multivitamins or they don’t,” and the researchers would try to control for the pre-existing differences between vitamin takers and non-takers.

This new research, he said, is different in that among the 15,000 men in the Physicians’ Health Study, it randomly assigned men to take vitamins or a placebo, for an average of 11 years. So it’s longer-term than previous studies, and it is “the first long-term randomized trial that tested whether daily multivitamin use prevents cancer.”

In a few weeks, he noted, the researchers will also present data on vitamins’ effects on heart and blood-vessel health. And in a months, on eye disease and cognitive function. Continue reading