Pushing Pills: The Skinny on Supplements

With natural-sounding names like yohimbe and willow bark, many supplements seem harmless additions to a workout routine. Until it's too late.

By Kimberly Olson

Like many women, 37-year-old Anne Marie Capati was still battling a few extra pounds several months after her second pregnancy. Committed to dropping the extra weight, the New York fashion designer joined Crunch, a popular gym.

She spared no expense, investing in a special membership that included workouts with a personal trainer. In addition to coaching her workouts, Capati's trainer developed a customized nutritional regimen for her which included 11 dietary supplements such as ephedra (ma huang), yohimbe, phenylalanine and willow bark.

A diagnosed hypertensive, Capati was also taking blood pressure medication, but her trainer assured her that her workouts would help lower her blood pressure.

Over the next several months, Capati began experiencing unexplained headaches. One winter morning, she had an unusually severe headache and told her trainer she wasn't feeling well. He encouraged her to continue her workout.

As Capati struggled her way through a series of leg presses, she began vomiting and then collapsed. She was rushed to a nearby hospital and died a few hours later.

Doctors say the supplements Capati was taking elevated her already high blood pressure to dangerous levels, eventually causing a stroke.

Over-the-counter killers

All across the country, well-meaning personal trainers are touting the benefits of performance-enhancing neutroceuticals, sometimes also referred to as nutraceuticals. But are they qualified to make such recommendations?

Capati's headaches, a warning sign of her worsening condition, were disregarded by her trainer. Capati's husband, Douglas Hanson, has filed a wrongful death suit against the gym, his wife's trainer, the supplement manufacturers and the supplier.

"Anne Marie's trainer was a Level II trainer," says Terrence McCartney, an attorney representing Hanson. "He was supposed to have nutritional training, but in fact he had none. The ephedra and yohimbe she was taking contained phenylpropanolamine, which had the effect of increasing her already high blood pressure. She came into the gym complaining of a headache, and he put her on a piece of equipment that uses one of the largest muscle groups, jacking up her blood pressure even more. She just couldn't have been given poorer advice."

Because the Food and Drug Administration does not regulate dietary supplements, neutroceuticals, or so-called phytochemicals and phytonutrients, there is no guarantee of the safety, effectiveness or quality of these products.

Supplements in the spotlight

At fitness facilities, supplements are big business. IDEA, the Health and Fitness Source, an association for personal trainers, commissioned a study in 1995 which revealed that the average trainer earns $1,500 a year in supplement sales.

One of the most popular boosts being promoted today, creatine, is used to increase stamina. While creatine is naturally found in the body, taking unnatural amounts of the substance can lead to problems.

Mark Pinsky, D.O., a board certified physician in sports medicine, advises proceeding with caution. "Creatine has some good science behind it, but there have been some reports of sudden renal failure in those who use it," he says. "We also see effects like cramps, nausea and vomiting."

Another neutroceutical, androstenedione, is also being used by fitness and sports enthusiasts who want to improve their performance. Androstenedione elevates blood levels of testosterone, increasing strength and endurance.

Creatine and androstenedione both enjoyed a huge boost in popularity last year when St. Louis slugger Mark McGwire admitted using them to help him hit 70 home runs.

"Supplements like these don't have a lot of data to support them," Dr. Pinsky says. "When you have athletes and others who have influence touting these supplements, people can really be influenced. There are questions as to androstenedione's effect on the liver and potential cancer-causing properties."

While long-term studies haven't been conducted, people are taking a serious gamble on something that hasn't even been proven to enhance performance. The Olympics, the National Football League and the NCAA have all banned the use of the androstenedione.

Protein powder pitfall

So what about less controversial supplements, like protein powders?

While some of the old stand-bys may not present side effect risks, they may fall short on their claims to enhance performance.

"I think protein powder is a waste of time and money," says Stan Reents, a pharmacologist and editor-in-chief of Clinical Pharmacology. "There's a big misconception that you need a lot more protein if you're working out."

While personal trainers can provide expert fitness advice, they are not necessarily trained in nutrition. For this reason, the American Council on Exercise, the largest nonprofit certifier of personal trainers in the country, discourages trainers from recommending dietary supplements to clients.

"When you make up your mind that you're going to modify your lifestyle or become a top-notch athlete, you really need to take a comprehensive approach," advises Dr. Pinsky. "You need to really talk to someone who knows about nutrition."

Experts recommend that all athletes — whether professional, amateur or weekend warriors — seek the advice of a qualified nutritionist, preferably someone knowledgeable about sports nutrition, before taking supplements.