Commentary in journal lays out guidelines for “mitigating risks” of muscle supplements

A recent commentary in a scientific journal laid out recommendations for how clinicians can shield young consumers from “dangerous” muscle-building supplements. An authority on the products maintains it’s a rush to judgement that circumvents scientific protocols. 

The commentary was published earlier this month in the Journal of Adolescent Health, a publication of the Society for Adolescent Health and Medicine. It was written by Kyle T. Ganson, Ph.D., of the University of Toronto and Jason M. Nagata, M.D., of the University of California San Francisco. 

The authors noted that most consumers – even minors – who use these products do so without any difficulties. However, in a minority of cases, use of muscle-building supplements can pose risks, they said, adding there is little for practitioners to go on to assess those risks. 

“We provide guidance to health-care professionals who are assessing muscle-building supplement use among adolescent and young adult clients, including whether use is potentially problematic, and how to intervene to mitigate risks from use,” the authors wrote. 

Their assertion that muscle-building supplements are potentially risky is based on the work of Harvard researcher S. Bryn Austin, a professor at Harvard T.H. Chan School of Public Health and founding director of the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED).  

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Austin’s group has put forward the idea that the use of certain weight loss and muscle-building supplements can exacerbate eating disorders among vulnerable young people. The assertion has little support in the sports nutrition research community, but it has found a friendly ear among state lawmakers who have been advancing bills aimed at restricting the sales of these products to minors, including the one that recently became law in New York State.  

Included in the commentary is a table providing a framework for “assessment and harm reduction interventions to mitigate risks associated with muscle-building supplement use.”   

The table includes some noncontroversial statements, such as advising practitioners to “provide education on potential harms of body change behaviors.” 

However, the guidance is characterized by an overarching view that these supplements are inherently risky, even though the authors admitted earlier that most consumers use them without experiencing any problems. 

For example, the table is laced with observations like this: “Some clients will experience various acute and chronic physical health problems related to their use of muscle-building supplements.” 

Reaction to commentary 

Susan Hewlings, Ph.D., vice president of research affairs with the contract research firm Radicle Science, has long railed against the connection between supplements and eating disorders, which in her view is based on faulty assumptions. She is a registered dietitian, former eating disorder practitioner and sports nutrition scientist. 

When asked for her reaction to the recent commentary, she said guidelines for practitioners are usually based on a careful assessment of the underlying evidence.  That usually is arranged in tiers from recommendations based on gold standard science to recommendations that might be helpful but are less well supported. She said the table in the commentary contains no such evidentiary review. 

“I am shocked to see a ‘commentary’ translated to practice guidelines for practitioners,” Hewlings noted. “Typically, such guidance is created based on a pre-defined grading system so that the evidence can be weighted in order to provide evidenced-based treatment guidance.” 

Eating disorders and the behaviors surrounding them occur on a continuum, Hewlings added. Sexual orientation, teasing, body cultural ideals, and whether the client was previously overweight all play a role. 

The authors of the commentary acknowledge that complexity, Hewlings reflected. The extreme use of supplements can be placed on that continuum, in which some users will “take it to extremes and harm themselves,” she acknowledged. 

But Hewlings said the authors eventually veer off the path of matching recommendations to the best scientific results and enter the realm of advocacy. 

“Then, the commentary takes a non-scientific turn in that it focuses only on muscle-building supplements for its guidance to practitioners. In doing so, it smells like an opinion piece hiding behind an agenda, not a peer-reviewed guidance,” she said. “The goal of the authors appears to be to use a well-recognized approach to care when assessing anyone with a mental health issue and narrow it down to one thing that they are focusing on to fuel their agenda. Their agenda is to limit sales of supplements to teens.”