Use of protein, creatine supplements could be linked to body issues, new study shows

The use of legal performance-enhancing drugs and substances is having adverse mental and sometimes physical health effects on young people in Canada, a new study shows.

Some concerning side effects on young people include mental health issues like eating disorders and physical side effects like hospitalization, the study published in the National Library of Medicine in December 2022 reads.

In some instances, the legal appearance- and performance-enhancing drugs (APEDs) have been contaminated with stimulants or are mislabelled, the study reads, which can cause further adverse effects.

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The study is one of the first of its kind in Canada to document how prevalent the use of muscle-building or weight-loss supplements and substances are among youth. Using previous research from the United States, this study was able to draw connections between the increased use of legal supplements and the impacts younger Canadians could experience.

Knowing the risks associated with APEDs and the lack of awareness, one expert is advocating to Health Canada for stricter regulations.

APEDs are defined as any drug or substance used to "improve not only athletic appearance and performance but also cognitive and sexual performance."

In a 12-month period, a majority of young Canadians reported using substances such as caffeine, protein bars, whey protein powder and creatine monohydrate.

While these legally sold "over-the-counter" products are verified by Health Canada, the impacts these substances can have on the health of young people, particularly men and boys, are increasingly concerning, the study says.

WHAT ARE APEDS?

In interviews conducted in November and December 2021, researchers asked participants if they had used any of the following APEDs in the past 12 months:

• amino acids or branched-chain amino acids (BCAAs);
• caffeine;
• creatine monohydrate;
• diuretics or water pills (such as furosemide [Lasix] hydrochlorothiazide, spironolactone);
• energy drinks (e.g., Monster, NOS);
• pre-workout drinks or powders (such as Bang!, Jack3D, Cellucor C4, JYM);
• probiotics;
• protein bars;
• "weight gainers"; and
• whey protein powders or protein shakes.

These substances are used to alter or maintain a person's body weight and shape, and improve overall athletic performance, the study says.

A number of APEDs are considered legal in Canada but should not be confused with illegal anabolic-androgenic steroids, which use the male hormone testosterone to increase muscle capacity.

Health Canada considers APEDs as "natural health products."

"Whey protein actually aids the ingestion of sufficient protein for muscle growth," Kyle Ganson, lead researcher of the study, said in a presentation on March 6. "You're using powders and different protein drinks, in order to just increase the amount of grams of protein one can consume in a day, which obviously increases the help with muscle growth."

Ganson says because of the concentrated nature of the product, people can consume more protein than if they ate protein-rich foods like chicken.

"Creatine is a naturally occurring substance actually in our bodies," Ganson said. "It improves exercise performance and muscle growth."

Amino acids come in pills or powders and are used to repair muscles and reduce fatigue, Ganson explained.

Other APEDs include weight-loss products like diet pills and diuretics.

"Diet pills are reported to sort of help reduce appetite or increase fat-burning capabilities," Ganson said. "With diuretics or water pills, this helps rid the body of salt and water to reduce the appearance of weight that one might have."

Products like pre-workout and BCAAs, which come commonly in powder form, have a combination of amino acids that assist the body to recover from physical activity. Pre-workout has caffeine in it and BCAA products are taken typically post-exercise.

APEDS COMMON AMONG YOUNG CANADIANS

The 10 different APEDs were common among the respondents of the study.

Using data from the Canadian Study of Adolescent Health Behaviours, 2,731 young people were analyzed on the prevalence and frequency of use of some APEDs. People between the ages of 16 and 30, from all 13 provinces and territories, completed the survey.

Some effects of muscle-building and weight-loss supplements include "problematic alcohol behaviours, such as binge-drinking, future use of anabolic-androgenic steroids, criminal offending, intimate partner violence, sexual risk behaviours, muscle dysmorphia and eating disorder symptoms, disability, and death," the study reads.

The most common APED used was caffeine, with 71.3 per cent of respondents saying they consumed it in the last 12 months, followed by protein bars (63.4 per cent) and whey protein powders or shakes (63.1 per cent).

"Most people start with whey protein and then they move on to creatine," Ganson said. "Whey protein is seen as the first step for many young people who are trying to build muscle mass whereas creatine is oftentimes the next step."

Over a third (34.6 per cent) used energy drinks, 25.5 per cent consumed creatine and just under a quarter (24.5 per cent) used pre-workout drinks or BCAAs (21.3 per cent).

The least common was "weight gainers" (4.5 per cent), which are high-caloric products, and water pills (2.3 per cent).

About half of the respondents indicated they wanted to gain weight or muscle (52.8 per cent), showcasing the increased usage of muscle-building APEDs. A majority of the sample (62.2 per cent) also said they had done weight training in the past 12 months.

"There were gender differences in the prevalence of use of APEDs," the study reads.

Over three-quarters (80 per cent) of Canadian young men who responded are using whey protein powder or protein shakes. About 75 per cent of men and boys reported using caffeine and about 50.3 per cent reported using creatine monohydrate.

The usage of all APEDs is "significantly higher" for men and boys compared to women or transgender/non-conforming gender participants, with the exception of water pills and probiotics, which women and girls used more.

Despite the increased usage of APEDs in men and boys, the study also notes a "significant proportion" of girls and women (50 per cent) are using whey protein. Nearly 10 per cent reported creatine and 15 per cent are using BCAAs.

"Taken together, these findings likely underscore the new pressures for girls and women to adhere to the fit and toned body ideal," the study explains.

The study places blame on the body ideals of different sexes for why the two use APEDs differently.

"Regarding sociodemographic predictors of APEDs use, overall, compared to girls and women, boys and men had a higher likelihood of APEDs that are marketed to increase performance, weight, and muscle mass," the study reads.

HOW TO PROTECT YOUNG PEOPLE

Due to the common use of APEDs and the lesser known impacts of continued usage, Ganson says Health Canada could implement a number of pre-market and post-market regulations.

Prior to a product being accessible to the public, Ganson suggests APEDs should have an age restriction in place to decrease the number of young Canadians using the substances.

Similar to tobacco and alcohol, Ganson suggests these products should also be subjected to additional taxes to deter younger Canadians from taking the products.

"If we increase funds through taxation, we actually can then fund the research prevention intervention efforts to understand what happens long term and to educate young people," he said.

Along with deterring use, Ganson believes these products should not be as easily accessible and could be behind a pharmacist's counter, allowing consumers to interact with someone who understands the effects.

Ganson hopes Health Canada will engage in more pre-market testing, better regulation of ads encouraging the use of APEDs and better product notices of impacts.

"Creating more transparency (and) being clearer about some of these products and their concerns around them is very important," Ganson said.

Once the product is out for public consumption, Ganson wants Health Canada to engage in more testing to ensure no contamination of products, further education and improved monitoring of adverse side effects.

CTVNews.ca reached out to Health Canada to understand its stance on Ganson's recommendations.

A spokesperson told CTVNews.ca in an email, "There is some degree of risk associated with the use of any health product. To minimize risks, Health Canada regulates natural health products to be sold to Canadian consumers through a rigorous licensing process, which includes an extensive pre-market review and the ongoing post-market assessment of the health product's safety, effectiveness, and quality."

The federal health agency continued by saying it assesses the benefits and risks of all products it approves and monitors adverse reactions.

"Through the Health Products and Food Branch Inspectorate, Health Canada is responsible for health product compliance, monitoring, and enforcement activities such as industry inspection and product investigation," the spokesperson said.  

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The following is a list of resources and hotlines dedicated to supporting people:

The National Eating Disorder Information Centre provides resources and referrals supporting people directly or indirectly affected by disordered eating.

Toll-free: 1-866-633-4220

Kids Help Phone offers free, anonymous and confidential professional phone counselling and online counselling, available 24/7 for kids and youth 20 years of age and younger.

1-800-668-6868

http://www.kidshelpphone.ca

The Canada Suicide Prevention Helpline is available for those who are in, or know someone who is in, immediate crisis or has suicide-related concerns.

1-833-456-4566 (24/7)

1-866-277-3553 in Quebec (24/7)

Text to 45645 (4 p.m. – Midnight ET). Text messaging rates apply. French text support is currently unavailable.