Despite recommendations against the use of creatine by anyone under age 18, more than two-thirds of sales clerks at health food stores told a researcher posing as a 15-year-old male football player to give it a try.

Creatine is a naturally occurring compound involved in the production of energy in the body used by athletes, bodybuilders, wrestlers, sprinters, and others who to gain muscle mass.  

Both the American Academy of Pediatrics and the American College of Sports Medicine recommend against its use by anyone under the age 18.  

As part of a clinical research program in summer 2014 at Cohen Children's Medical Center in New York, undergraduate researchers contacted 244 national chain and independent health food stores by phone and read from a script that began: "Hi, my name is Mark and I'm a 15 year-old going into my sophomore year of high school. I'm a football player trying to do strength training before the season. Do you have any supplements you would recommend?"

If the sales attendant did not recommend creatine, the researcher said that other players on the team told him creatine worked well for them, and asked if they would recommend that supplement.  They also asked whether they could buy creatine on their own, or if they would need to bring an adult with them.

Troubling findings

• 67.2 percent of sales attendants recommended creatine for a 15-year-old male athlete. 
• 38.5 percent recommended creatine without prompting.
• An additional 28.7 percent recommended creatine when specifically asked.
• Male sales attendants were more likely than female sales attendants to recommend creatine without prompting.
• 74 percent of sales attendants said a 15-year-old could purchase creatine on his own.
• There was no difference in creatine recommendations based on geographic region.

Education about dangers needed 

Senior investigator Ruth Milaniak, DO, said the study's findings have implications that swell beyond male teenagers looking to gain muscle mass. "Body image issues are becoming more prevalent for all ages and genders. Employees in stores that sell supplements must be educated regarding which specific products are safe for use by minors," she said. In addition, she said, customers of all ages need to be informed of the dangers of weight loss and body shaping supplements.

"If teenagers are being recommended supplements that not only have adverse effects for their growing bodies but are clearly marked on the package as not for use under the age of 18, they are being put at risk by the very stores that they are going to for advice on health," Dr. Milaniak said.

Unregulated, potentially contaminated

Principal investigator Maguire Herriman said parents and pediatricians should make sure to speak with teenagers about safe supplement usage. "There needs to be stricter guidelines for the sale of supplements to minors," he said. "Since supplements are not regulated by the FDA and do not need a prescription, the extent of this problem is not fully known.

Herriman's comments were echoed by Don Hooton, President of the Taylor Hooton Foundation, a non-profit group dedicated to educating about the dangers of anabolic steroids and other appearance- and performance-enhancing drugs (APEDs).

"In addition to the health risks that accompany supplements like creatine, the truth is that these supplements are unregulated and no agency is verifying that what is in the container is what is what is described on the label. Numerous studies have shown that as many as 20-25% of body building dietary supplements like creatine are contaminated/spiked with banned substances like anabolic steroids and others and these young people have no way of knowing whether the ones they are using are safe.

Hooton, whose son Taylor committed suicide after abusing steroids, recommends that young people consult a physician before taking any supplement, and that, in event they decide to use supplements, they only use supplements that have been certified to be free from banned substances by qualified independent testing agencies such as NSF (NSFSport.com) or AegisShield (aegisshield.com). 

Sources:

American Academy of Pediatrics 

Abstract. "Over-the-Counter Creatine Supplements and Underage Teens: Easy Access and Misinformation Provided by Health Food Stores" Milanaik RL, Herriman M, Fletcher LA,  Adesman AR. Presented at American Academy of Pediatrics National Conference and Exhibition, Washington, D.C. October 24-27, 2015.

Posted October 23, 2015