Whatever it takes

More and more young men aim for the perfect body through pills, powders, and dietary supplements

Twenty-two-year-old Steve Teixeira begins his day by scooping powder into three glasses of water. He fills the first with a multivitamin mix, the next with a protein powder, the third with creatine powder, which promises to boost his energy level and build his muscles. Then he gulps down all three.

But that's only the beginning. By the end of a typical day, Mr. Teixeira, a trashman in Somerville, Mass., who's also an avid weightlifter, will have consumed two more glasses of creatine, two additional portions of protein mix, and a few nutrition bars.

Teixeira's regimen is part of his broadening quest for a "better body," one that's bigger, stronger, and more muscled.

He's not an isolated example. Walk into any gym or weight room in the country, and you will probably find them: men in their teens and 20s, who are turning to dietary supplements to add bulk, build muscle, or burn fat from their bodies.

Not all of them are athletes or body-builders. Yet many will use whatever legal products are available to help them dramatically change their physiques – including consuming dietary supplements that promise to do just that.

Americans spent $16.7 billion on supplements in 2000, according to the Nutrition Business Journal – most of it on products they bought in efforts to boost energy, ease depression, or overcome fatigue. But a growing segment of this market is dedicated to "body image" supplements, which claim to help users add or subtract significant weight.

Americans' interest in body-image supplements is growing rapidly: Sales have nearly doubled in four years, according to the Nutrition Business Journal. Supplements are promoted through the Internet, magazines, and television. Some are now starting to appear on supermarket shelves.

Many experts – and parents – are distressed by what they describe as the supplements' dubious claims and the lack of oversight on the part of the federal government.

Others point to the social causes fueling the supplements' popularity: American men, experts say, are growing more conscious – and critical – of their bodies than ever before. For many, dietary supplements are a quick-fix solution.

"Certainly the use of supplements is more common among younger men coming into the gym," says Harrison Pope, a professor at Harvard University's School of Medicine. "There are lots and lots of teenagers who use these substances looking for something that immediately makes them look bigger."

Supplement use gained momentum in the early 1990s as Americans started drinking shakes to make up for a supposed lack of protein in their regular diets.

Other supplements were aimed at people who began spending significant time exercising and bodybuilding. Creatine, a protein-based product that is sold to boost energy and build muscles, and ephedra, a "fat-burner," have become as common in American fitness circles as step aerobics.

Synthetic supplements, derived from human hormones, drew national attention when St. Louis Cardinals first baseman Mark McGwire broke Major League Baseball's single-season home-run record while using "andro" (androstenedione). (See box for more information on these supplements.)

The supplements' growing publicity has fueled a lengthy sales boom. Since 1997, sales of protein shakes have increased 30 percent, according to the Nutrition Business Journal. Sales of powdered protein and creatine formulas have jumped 50 percent, and sales of pill-form supplements – the majority of which are ephedra-based – have risen 44 percent.

The substances are now a common part of exercise culture, particularly among young men. "The young generation is typically overdoing everything they can get their hands on," says Acea Theroux, personal training director at the Beacon Hill Athletic Club in Boston and a former USA All-Natural Junior Body Building Champion.

In a 2001 survey of more than 500 people at Boston-area health clubs, Harvard's Dr.Pope found a high rate of supplement use by participating males. Sixty-one percent testified to having used protein supplements in the past three years; 47 percent said they had used creatine.

Twenty-six percent said they had used ephedra, and 18 percent had used andro. The median age: 27.

Most young men learn about supplements from teammates or friends at their gym, according to Patrick, the manager of a Boston-area nutrition store who asked that his last name be withheld. "They are usually involved in high school sports, football, or [running]," he says. "I've had many kids come in saying: 'Coach recommended supplementing.' "

High school student Carl Palko started lifting weights and taking supplements a year ago to bulk up for street hockey.

Like so many dedicated lifters, the Hazelton, Pa., resident does not drink alcohol, smoke, or use drugs. He closely watches his diet. Carl says he needs to take supplements, mostly creatine and protein, to meet his personal goal: putting 15 more pounds on his 175-pound frame.

"With hockey, you can't be the skinny guy. You get pushed around a lot," he says. "I want to get bigger, I want to get stronger."

The words "get big" are paired with great frequency by men in their teens and 20s to explain why they use supplements.

In the past, the phrase "getting big" likely meant putting on fat. The words now communicate the aspiration of millions of young men who are seeking distinction and strength by refining their physiques.

Zachary Falconer believes that bigness has become the new status symbol of manhood. He works in violence-prevention programs with student athletes at the Center for the Study of Sport in Society at Northeastern University in Boston. "It's become very apparent to me that young men are being socialized to believe that in all facets of life, in order to be a real man, bigger is better."

Statistics of steroid use point up the trend. The demographic group with the highest percentage of users: 14- to 17-year-old males, according to Mr. Falconer.

Young men today often have a preoccupation with being muscular, according to Roberto Olivardia, a professor at Harvard's School of Medicine.

"Ways men used to define themselves are now being shared by women," he says. "It's led some men into seeking new ways of expressing masculinity."

The pressure does not seem to come from women alone. When asked whether appearance is important to them, most men say "not much," according to Dr. Olivardia. They answer "very important," however, when asked if appearance is important to their peers.

Such sensitivity about appearance has resulted in a surge in gym memberships, liposuction, plastic surgery, and even makeup use among American men, experts say.

Supplements are seen as less invasive and offer the advantage of discretion – the powders are easily disguised in a jar of Ovaltine. In many cases, they carry a natural-product cachet, giving consumers the feeling that they must be harmless.

More and more supplements are going mainstream. Protein and creatine powders are available on the shelves of supermarkets such as Whole Foods.

Body-image supplements are advertised on television, on roadside billboards, and in fitness magazines.

The products' wider distribution and visibility have strengthened their credibility in consumers' eyes, experts say. Many consumers are not aware that, unlike food and prescription drugs, the FDA does not test the effects of dietary supplements or verify their ingredients.

"Patients come to me all the time and say, 'It's got to be OK, because the government would never let that stuff go to the shelves otherwise,' " says Gary Wad-ler, a professor at the New York University School of Medicine.

Dietary supplements are essentially exempt from premarket approval and testing because, unlike many drugs, they do not claim to be effective, pure, and safe. And since the supplements are all-natural, they cannot be patented, leaving little incentive for the manufacturers to spend the money required to determine their precise composition.

The lack of testing has created a culture of misinformation in the supplement industry, according to Todd Cooperman, who heads consumerlab.com, an independent group that tests supplements' composition.

"We have found a quarter of the products on the market have some sort of problem to make them a poor-quality product," says Mr. Cooperman. "They often contain too little of what they are labeled to contain."

The Council for Responsible Nutrition, a supplement-industry group in Washington, says that its recent study shows that dietary supplements are regulated as rigorously as conventional food, and often more so.

The council is quick to point out that federal law requires supplement labels to include a statement indicating that the FDA has not evaluated any performance claims made by the product. It has also lobbied for an FDA-mandated warning label on all ephedra-based products, because of perceived health risks.

However, many experts, particularly in international sports, believe that current labels often contain inaccurate information regarding the products' contents. Testing done by the International Olympic Committee in 2000-2001, for example, found that nearly 15 percent of supplements purchased randomly around the world would produce a trace of a substance not listed on the products' labels, which would disqualify an athlete who used it.

It took Cambridge, Mass., resident Bill Borenheim five months to conduct research before he let his 16-year-old son, Judd, a football player, take creatine. "Some of the doctors I spoke to didn't know what it really was," says Mr. Borenheim. "Why the government isn't answering these questions conclusively for people is a great concern to me."

Emran Chowdhury of Cambridge, Mass., who spends three hours in his high school's weight room five nights a week, admits that he knows very little about Hydroxycut, the "fat burner" of which he takes two pills each day. Emran has not told his parents that he uses Hydroxycut.

His friend Tenzin Sange continues to use protein supplements despite his family's concerns.

"My father thinks it's bad," he says. "I don't listen to him. I just want to get big."

Supplements explained

Androstenedione (andro) is marketed as a natural alternative to muscle-building (anabolic) steroids. It is a naturally occurring human hormone that the body uses to make testosterone.

Advocates of the supplement say it raises testosterone levels, thereby increasing muscle size and strength. Some studies have measured no change in testosterone levels after subject took andro. The Olympics, as well as various professional sport leagues, have banned andro, citing health risks and similarities to anabolic steroids.

Creatine is a protein compound produced by the body. It is said to provide an energy boost during a workout and pull fluid to the muscles, thereby increasing their size, but some studies show negligible results.

Ephedra, or "Ma Huang," is a plant extract that, when combined with caffeine and aspirin, is said to improve the body's ability to burn calories. Scientists as well as industry officials recognize serious health risks with its use.

Protein supplements usually come in the form of soy and whey in pre-made energy drinks or powders that users mix with juice, milk, or water. Some experts have recom-mended that athletes daily consume one gram of protein per pound of body weight.

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