Coaching and supplement use
By Dr. William O. Roberts

Creatine and other chemical or dietary supplements are used by athletes with the intention of improving performance and gaining a competitive edge.

However, use of performance-enhancing substances, whether proven or perceived, raises many questions for young athletes, parents, coaches and administrators:

• Who is responsible for the use of ergogenic substances at the high school level and should these substances be used by adolescents?
• Should a youth coach endorse or require their use?
• Does the mere suggestion of use by a coach become a de facto requirement?

The principle concern of supplement use is safety, but many athletes and coaches are more concerned with the potential for "bigger, stronger, and faster." Is it safe to take creatine, androstenedione, ephedrine or other sympathomimetic amines during or in preparation for competition?

Underlying the entire issue is the use of anabolic steroids. Systematic denials of steroid efficacy for performance enhancement by the medical community decreased the credibility of medical providers with regard to improving sports performance with ergogenic substances. As a result, athletes have turned to other providers and sources for answers which are not always based on science and safety.

The questions that should be answered before any drug or substance is recommended for adolescent athletes include:

• How does it work?
• Is it safe?
• Is it effective?
• Is it tested?
• Is it legal?
• Is it ethical?
• Does it interact with other medications?
• Does it truly make a difference?
• If there is a health risk, is the increased health risk worth the potential for increased performance?

Most of the drugs used in medicine are cleared by the Federal Drug Administration (FDA) for safety and efficacy. Substances like creatine are not under the jurisdiction of the FDA and are not subject to the rigorous pre- or post-release review of everyday medications.

For substances known to enhance performance, but considered unsafe or unethical, the international or national sport governing bodies conduct doping contol testing to discourage the use of "banned" drugs.

Substances like creatine cannot currently be detected by standard testing, but ephedrine and the symapthomimetic amines can be easily detected and are currently on the IOC banned list.

These questions must be posed with regard to the use of ergogenic substances in athletes:

• Is it ethical to pursue performance enhancement outside the traditional mix of hard work, skilled coaching, genetic gift, proper training, proper rest and recovery and adequate nutrition?
• Should a substance like creatine be advocated to gain an edge over an opponent, or have these substances become necessary to maintain a level playing field with the school across the tracks?
• Finally, should potentally unethical behaviors be tolerated, much less endorsed, by coaches in the youth sports setting?
• If a substance like creatine is recommended, can you as a coach give an adequate, informed, consent discussion to allow both the parents and athletes to make a reasonable decision regarding the use of the substance? Since youth coaches deal mainly with minors, informed consent must be presented to both the parents and the athletes.
• How should an informed consent be given to families and players?
• Who should be informed first?
• What are the legal implications if the informed consent is given and accepted by the parents, or if informed consent is omitted, and something goes wrong during the substance use?
• Is the sports program liable or does the liability fall on the shoulders of the coaching staff?

There are no set answers to these questions. They address the very heart of youth athletic competition down to the basic questions of what is winning and at what price.

We teach our young athletes lessons they will carry throughout a life time. The value of hard work, setting and achieving of goals, good nutrition and hydration, teamwork and sportsmanship are the simple lessons of athletic participation.

We can inadvertently pass the wrong message to athletes who do not have the genetic gift of speed, endurance, motor skill or motor planning that doing your best is not enough.

Coaching decisions regarding the use of ergogenic aids like creatine will shape the future of individual programs and the future of young athletes. The issues extend well beyond improved performance and safety into the realm of ethics, informed consent, reliability and responsibility.

In general, a coach should not recommend a substance to a minor without consulting the parents and should never recommend using a substance above the package or industry dosage or amount. As in the practice of medicine, your credo should be "first do no harm."

Here is a checklist for nutrition and substance recommendations to youth athletes:

• Scientific evidence to support the use of the substance or diet modification.
• Safety profile established for the athletes at the youth level.
• Gender specific risks addressed.
• The sport program administration has been informed of the coach's recommendation.
• The sport program policies permit coach's recommendation.
• Assistant coaches are using the same guidelines.
• Parents are informed before the minor athlete is presented the material.
• Informed consent is documented and signed by parents and athlete.

Dr. William O. Roberts is a clinical associate professor at the University of Minnesota and a charter member of the American Medical Society for Sports Medicine. He is a member of the Sports Medicine Advisory Board for Minnesota High Schools and the USA Soccer Cup. Roberts is also a senior editor of the Sports Medicine Journal and has worked with various other publications. He currently resides in Bear Lake, Minn., where he is the director of the Twin Cities Marathon.

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