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Jolt of Reality Following the lead of elite athletes, teenagers are increasingly juicing their workouts with pills and powders-sometimes with tragic results

April 07, 2003
April 07, 2003

Table of Contents
April 7, 2003

Inside Tennis
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Jolt of Reality Following the lead of elite athletes, teenagers are increasingly juicing their workouts with pills and powders-sometimes with tragic results

By L. Jon Wertheim Special Reporting by Luis Fernando Llosa and Lester Munson

Sean Riggins and some of his friends at Lincoln (Ill.) Community
High had a name for it: jacketing. Before wrestling meets or
football practices or even on Saturday nights when they wanted a
surge of quick energy, they would pop a yellow-and-black-striped
capsule called a Yellow Jacket. The pill, perfectly legal,
contained ephedra and caffeine, a combination that speeds up the
metabolism. According to the package, it was an EXTREME
ENERGIZER! The ritual of jacketing also entailed chasing the pill
with a swig of Mountain Dew or Red Bull, both heavily caffeinated
beverages. In retrospect, it was nuts. But wisdom can be hard-won
when you're 16 and trying to make the varsity football team. ¶
Growing up in a sleepy town of 15,000, Sean was a jock for all
seasons. He was a varsity wrestler as a freshman in 2001, had a
black belt in taekwondo and, at a squat 5'6" and 170 pounds,
delivered a mean hit as a linebacker. By all accounts Sean hardly
cut a wild figure. His hair was closely cropped. He didn't smoke
or drink.

This is an article from the April 7, 2003 issue Original Layout

He worked out religiously, deadlifting 425 pounds when he was a
sophomore. The year before that, he started jacketing. "I'm sure
he thought it was going to help him play better," says Will
Gilmer, one of Sean's best friends and a member of the football
and wrestling teams. "Knowing Sean, I'm sure he thought it was
O.K."

Who could blame him? The product, labeled a dietary supplement,
was available right at the counter of the Apollo, the local
minimart. Sean had seen countless similar products advertised in
the muscle magazines he read and on the pro wrestling telecasts
he watched. Marshall Faulk, star running back of the St. Louis
Rams, had endorsed a supplement containing ephedra before it was
banned by the NFL. The Yellow Jacket label warned SALE TO MINORS
IS PROHIBITED, but all the kids knew that there was no legal age
restriction on buying supplements. And at $1.19 for a package of
three, the price was right.

At some point last Labor Day, friends and teammates say, Sean
took part in the jacketing ritual. He had a jayvee football game
that night, but told the Railsplitters coaches he was feeling out
of sorts. He dressed but spent the game looking glassy-eyed on
the sideline, an ice pack on his head. Once he lay down near the
team's bench. "He wasn't himself at all," recalls sophomore
teammate Tim Reddix. Sean drove home with his parents and went to
sleep that night, and when he woke up on Tuesday, saw a doctor.
After interviewing Sean and being told that he had not taken any
drugs, the doctor assumed that he was dealing with a case of the
flu that was going around; he prescribed a decongestant and sent
Sean home. A few hours later Sean went into cardiac arrest, and
by that afternoon he was dead.

The local coroner, Chuck Fricke, performed an autopsy and
determined that the cause of death was acute myocardial
infarction. "Basically his heart was pumping so fast, it gave out
on him," says Fricke. This explanation didn't satisfy Sean's
parents, Kevin and Debbie, who questioned why a healthy, athletic
16-year-old would have a heart attack. Fricke, too, was puzzled,
and ordered tests on the water of Clinton Lake, where Sean and
several friends had been swimming that weekend and which is near
a power plant. It was only when the school nurse starting asking
around that public health officials got wind that jacketing was a
common practice among Lincoln High's football players and
wrestlers. Though by then it was too late to test Sean's body for
ephedra--the autopsy, as was common practice at the time, included
no toxicology test for ephedra--his symptoms were typical of
someone who had taken a substance that stimulates the
cardiovascular system. "After we heard he had taken ephedra, it
all made sense," says Kevin. "As much sense as you can make of
having an active, athletic 16-year-old one day and then having
him drop dead the next."

They are the 900-pound gorillas of sports. While illicit steroids
hijacked headlines and preoccupied governing bodies, wholly
legal, over-the-counter dietary supplements pumped up and
burgeoned to become a $17.7 billion business (including $1.7
billion in so-called sports-nutrition supplements). Largely
outside the FDA's purview, supplements are not federally
approved. They haven't been subjected to clinical trials, and
often little is known about their chemical composition, side
effects or efficacy. "Basically, anyone who uses these products
is a human lab rat," says Dr. Arthur Grollman, a professor of
pharmacological sciences and medicine at the State University of
New York at Stony Brook.

But millions of athletes are taking supplements containing
everything from ephedra to creatine to andro in any of several
forms--pills, powders, even gums--in hopes of gaining an edge in
the weight room, on the field, in the pool. "It used to be that
if you wanted performance enhancement, you'd have to go to the
musclebound guy at the gym who was selling steroids," says Mike
Perko, an associate professor of Health and Applied Human
Sciences at UNC Wilmington and author of Taking One for the Team:
The New Thinking on Dietary Supplements and Young Athletes. "Now
you can go to the grocery or to GNC [General Nutrition Centers]
or even Smoothie King and get your supplements."

The recent deaths of Minnesota Vikings tackle Korey Stringer,
Northwestern safety Rashidi Wheeler and Baltimore Orioles
pitcher Steve Bechler have underscored the prevalence of
supplement use among elite athletes. But these elixirs are
hardly used by high-level athletes only. Promising something
for everyone--Michelangelo muscles, instant energy, washboard
abs, overnight weight loss--sports supplements are in vogue
with jocks at every level. Evidence suggests that the most
eager consumers are young athletes not unlike Sean Riggins. A
2001 survey conducted by Blue Cross Blue Shield's Healthy
Competition Foundation indicated that approximately one million
kids had used supplements. Other experts wonder if the real
number isn't double that. "Everyone, and I mean everyone, takes
supplements now," says Southern Methodist University strength
coach Chuck Faucette. "When a recruit comes in, the first
question I get is, 'What kind of supplements can I take?'"

To be sure, the lure of a college scholarship is part of the
appeal. When one tenth of a second in the 40 or a few pounds on
your bench-press can make the difference between a full ride and
walking on, it's easy to see why athletes would swallow anything
with the potential to accord a competitive advantage. The appeal
of supplements crosses gender lines as it taps into teens'
insecurities about their bodies. For boys, they're tailored to
the ideal of adding muscle and having cinder blocks for biceps.
For girls, they're often aimed at aerobic improvement and weight
loss. A 2001 NCAA study revealed that ephedra, though banned in
college sports, was most popular among female gymnasts (8.3%) and
male lacrosse players (5.5%). "It was obvious that the women were
using it to drop weight and the guys were using it for something
entirely different," says Frank Uryasz, president of the National
Center for Drug Free Sport and former head of drug testing for
the NCAA. "Most said they started using in high school."

If young athletes are a growth sector, it's not lost on the
manufacturers. The marketplace is flooded with kid-friendly
supplements available in in fruity flavors and products such as
Cookies 'n Creatine and Teen Advantage Creatine Serum, the latter
advertised as "developed especially for young aspiring athletes
8-19." Supplement companies advertise products in magazines, on
websites and on television shows--including the Little League
World Series--that have a demographic that skews young. Both the
ads and the packaging are awash in teen vernacular; terms such as
ripped, cut, mega, Xtreme and turbo are used repeatedly.

In some cases manufacturers christen a product with a name shared
by a street drug. The legal Yellow Jackets that Riggins ingested
acted much like an amphetamine. But "yellow jackets" is also the
nickname of a popular prescription barbiturate. Perhaps because
of the confusion, NVE Pharmaceuticals, the supplement maker,
decided to discontinue selling Yellow Jackets but now sells
another ephedra product called Yellow Swarm, which, according to
a company sales rep, "is basically the same thing with a
different name." (NVE did not respond to calls seeking comment on
product safety, nor to questions faxed to its New Jersey
headquarters.)

Even the term dietary supplement can be confusing. It sounds
innocuous, even beneficial. "What kids--especially those
health-conscious and interested in sports--don't want to
supplement their diet?" says Uryasz. "But the [notion] is a joke.
No one is going to suffer because of an ephedra or creatine
deficiency. We need to call these things what they are: drugs."

In the wake of Bechler's death on Feb. 17, there has been support
for curtailing the sale of products containing ephedra. Senator
Richard Durbin (D., Ill.) introduced legislation last week that
would require all dietary supplements containing stimulants to
prove their safety before sale. So far only one locale, New
York's Suffolk County, has banned the sale of ephedra, while a
handful of states, and Sean's hometown, have instituted
prohibitions on ephedra sales to minors. Some stores in areas
without bans have voluntarily demanded to see proof that
consumers are over 18. Critics, however, wonder whether these
acts could have the same effect as the Joe Camel campaign,
creating a taboo that makes supplement products more desirable to
teens. "GNC locks the stuff up behind the counter, but it's in a
glass container, so everyone can see what's inside," says Perko.
"What kid isn't going to be curious about that?" Although GNC
spokesperson Stephanie Mangini described ephedra--"when used as
directed"--as "a safe and effective part of a comprehensive
weight-management program," she said that some GNC stores began
locking up ephedra products last fall. GNC also cards potential
purchasers, she says. "If these products had warning labels
advising people under 18 not to take them, we thought we
shouldn't sell them to [minors]," says Mangini.

Vitamin shops offer a dizzying array of products, but often young
athletes don't have to venture that far for their "supps":
Manufacturers have taken to enlisting coaches as distributors and
pitchmen. With supplement deals springing up like shoe contracts,
many big-time college athletic departments have endorsement
arrangements with supplement companies. For instance, MET-Rx, a
leading supplement manufacturer, has deals with more than a dozen
schools, including Arizona, Florida State, Stanford, Syracuse and
UCLA. (MET-Rx also sponsored ABC's college football preview show.)

AdvoCare, a Dallas-based firm, has been particularly adept at
forging alliances with coaches. In fact, AdvoCare employs several
current or former college coaches. For instance, Joe Hadachek was
a sales rep for the company in 1999, while he was coaching
football at Division III Buena Vista University in Iowa.
(Hadachek, who declined to comment, resigned from Buena Vista in
1999 to work full time for AdvoCare.) Other coaches, including
Oklahoma State basketball coach Eddie Sutton and SMU's Faucette,
endorse the company's products on its website. AdvoCare even
sells a line of products that Faucette says conforms with NCAA
guidelines (which forbid not only ephedra but also steroids and
amphetamines) and is overseen by Bert Hill, former strength coach
for the Detroit Lions. Rachel Olander, a spokesperson for the
National Center for Drug Free Sport, which has a toll-free number
that pro and college athletes can call anonymously to receive
information on supplements, says that many of those calls pertain
to AdvoCare. "It's usually, 'My coach is telling me, Take this,
but is it safe?'" says Olander. (AdvoCare did not return calls
seeking comment.)

Why would a coach agree to sell or endorse a sports supplement?
"When I was at the University of Texas, we had a $200,000 budget
for supplements," says Faucette, who left the Longhorns for SMU
in 2001. "If I can get free supplements for my kids [in exchange]
for making a few appearances a year, that's really helping my
budget." Says Dave Van Halanger, football strength and
conditioning coach at Georgia, and also an AdvoCare endorser, "We
made sure it was tested and so forth. Look at Julius Peppers [of
the Carolina Panthers, the NFL's Defensive Rookie of the Year,
who tested positive for ephedra and was suspended for four games
last season]. He was taking a product he knew nothing about."

To others, the concept of coaches endorsing supplements, even if
they are not paid by the companies, is a classic conflict of
interest. "Who has more credibility with athletes than coaches?"
say Uryasz. "When we speak on campuses, we're always telling
administrators to be sure that their staff members aren't the
pushers."

Dietary and sports supplements fall under the 1994 Dietary
Supplement Health and Education Act (DSHEA), which mandates that
products derived from herbs and natural sources be classified as
food and not drugs. This has been a boon to supplement
manufacturers, which can skip the long and often prohibitively
expensive process of seeking FDA approval. (In the last two
election cycles, dietary supplement manufacturers have
contributed more than $3.3 million to federal candidates and
political parties, according to the Center for Responsive
Politics. Senator Orrin Hatch (R., Utah), who drafted DSHEA and
disputes the widely held view that it shields the supplement
industry from government scrutiny, was the biggest congressional
recipient of industry largesse during the 2000 election cycle,
with $41,750 in contributions, according to the center.

Industry critics say the current landscape is like something out
of the Wild West. "If you want to start selling supplements
today, you don't have to register, you don't have to show your
product to be effective," says Dr. Sidney Wolfe, director of
Public Citizen's Health Research Group, a consumer advocacy
organization. "Just call it natural and it's a free pass--even
though there's no reason to think it's less worrisome than a
chemical synthesized in a lab."

Bechler's death and the subsequent backlash have forced some
supplement manufacturers to reformulate. On Feb. 27 the AMA urged
the FDA to take dietary supplements containing ephedra off the
market. Manufacturers, many of whom were already producing
ephedra-free products, moved to market those alternatives more
heavily. Supplements laced with such stimulant alkaloids as
bitter orange (also known as synephrine) promise results similar
to those of ephedra, though there exists little conclusive
evidence that these substitutes are any more or less harmful.

For some supplement manufacturers and researchers, this
remarkable lack of data can make for an effective defense. "When
you have random reports and no clinical tests, you don't know
what the normal occurrence would be if people hadn't been taking
supplements," says Richard Kreider, a professor and director of
the Exercise and Sport Nutrition Lab at Baylor. "It's been
reported that Americans take three billion doses of ephedra a
year. If there was a huge problem, we should have seen more
reports."

Kevin Riggins struggles to wrap his brain around this line of
reasoning. "[The manufacturers] should have to prove that
supplements are safe and effective," he says. "Consumers
shouldn't have to prove they're ineffective and can kill you." A
muscular 38-year-old with a goatee and tattoos, Kevin knew
virtually nothing about supplements before Labor Day of last
year. Today he is an expert--"not by choice," he is quick to add.
He works 40 hours a week at the Bridgestone/Firestone tire plant
up the road in Bloomington, Ill., and spends the balance of his
time running the Sean Riggins Foundation for Substance Free
Schools. Sean's small bedroom, still festooned with martial-arts
trophies and posters of muscle cars, serves as the foundation's
headquarters.

Wearing Sean's green number 51 home jersey, Kevin speaks to
numerous high school kids around Illinois. He is in frequent
contact with Durbin regarding his legislation to ban ephedra.
"The foundation was the best way I could think of to honor Sean,"
says Kevin. "The basic message is that these supplements can be
dangerous and that chemicals don't enhance sports performance."

Kevin has no delusions about the scope of the challenge. He knows
how deeply supplements are embedded in today's sports culture.
And he knows that thriving, multibillion-dollar businesses are
not in the habit of rolling over. But his jaw tightens when he
hears manufacturers defend their products on the grounds that
reports of any injuries and deaths merely constitute anecdotal
evidence. "We're talking about kids here, not anecdotes," he
says. "I refuse to let people dismiss Sean as 'anecdotal
evidence.' He was a great kid, and he should be finishing
wrestling season right now."

COLOR PHOTO ILLUSTRATION: ILLUSTRATION BY KEVIN IRBY/COURTESY THE RIGGINS FAMILY ENDGAME Sean's body wasn't tested for ephedra, but friends say the 16-year-old took a supplement containing that substance the day before he died.COLOR PHOTO: DARREN CARROLL WEIGHTY ISSUE SMU's Faucette says endorsement deals such as the one he has with AdvoCare help a school's bottom line.FIVE COLOR PHOTOS: PETER GREGOIRE (5)COLOR PHOTO: MEL LEVINE (HGH)COLOR PHOTO: JONATHAN DANIEL A DAD'S MISSION Kevin uses Sean's room as the home base of his fight for substance-free schools.

THE INSIDE STORY

What's in that pill you're about to pop or that drink you're
ready to chug? A guide to some common ingredients in sports
supplements and their potential dangers

EPHEDRA

An extract of the Chinese plant ma huang that stimulates
cardiovascular and central nervous systems

FOUND IN Weight-loss, energy-boosting and bodybuilding products,
including Stacker 2 and Metabolife 356

POTENTIAL RISKS Can cause elevated blood pressure. When taken in
excessive doses or by people with certain medical conditions, can
result in cardiac arrhythmia, heart attack, seizure or stroke

WHO BANS IT NFL, NCAA, World Anti-Doping Agency (WADA, which
oversees Olympic drug testing)

SYNEPHRINE

An extract taken from orange peel and used as a substitute for
ephedra; sometimes called bitter orange

FOUND IN Weight-loss, energy-boosting and bodybuilding products
marketed as "ephedra free," including Stacker 2 Ephedra Free,
Xenadrine EFX Ephedra Free and Metabolife Ephedra Free

POTENTIAL RISKS Pharmacological and toxic properties similar to
ephedra; could cause an athlete to test positive for ephedra,
depending on test methodology

WHO BANS IT NCAA

ANDROSTENEDIONE, ANDROSTENEDIOL

Steroid precursors that stimulate the body's production of
testosterone

FOUND IN Supplements such as Andro 100 Poppers; the body converts
andro into testosterone, which is believed to increase lean
muscle mass

POTENTIAL RISKS Have the potential to produce adverse effects
linked to anabolic steroids: breast enlargement and testicular
atrophy in men; breast shrinkage and deepened voice in women;
growth retardation in teens

WHO BANS IT NBA, NFL, NCAA, WADA

CREATINE

Natural compound created from three amino acids; produced by the
liver and kidneys and used by muscles and organs as an energy
source

FOUND IN Supplements designed to increase muscle mass and build
strength and endurance, such as Simply Creatine and Creatine
Candy; also in red meat and some fish

POTENTIAL RISKS Can cause dehydration, diarrhea, stomach cramps,
and muscle and ligament tears

WHO BANS IT No governing body

HUMAN GROWTH HORMONE BOOSTER

Chemically produced enhancer of hGH (a substance made by the
pituitary gland for growth and cell repair) used by those seeking
to build strength

FOUND IN Products like Ultimate HGH and Secretagogue-One contain
substances such as amino acids said to help the body release hGH

POTENTIAL RISKS Elevated hGH levels can damage heart and liver,
and promote growth of jaw, forehead, hands and feet. May also
cause diabetes

WHO BANS IT NFL, NCAA, WADA

CAFFEINE

Stimulant and mild diuretic causes a feeling of heightened
alertness

FOUND IN Coffee, tea, chocolate, colas, energy drinks such as Red
Bull and headache tablets; some supplements and drinks such as
SoBe Sports System contain extract from guarana, a caffeine-rich
plant

POTENTIAL RISKS Has mildly addictive effect; in large
quantities, can cause cardiac arrhythmia

WHO BANS IT NCAA, WADA (in amounts roughly equivalent to
consuming eight cups of coffee in a two-hour time frame)

"Everyone takes supplements now," Faucette says. "When a recruit
comes in, the first question is, 'What kind of supplements can I
take?'"
"The basic message," says Kevin, "is that these supplements can
be dangerous and that chemicals don't enhance sports performance."