Use of performance-enhancing substances (PESs)

Performance enhancement: not just for athletes anymoreMichele LaBotz, M.D., FAAP

Use of performance-enhancing substances (PESs) traditionally has been considered an issue in athletes, and prevention and screening efforts have primarily focused on that population. However, patterns of pediatric use of PESs have changed significantly over the past few years, with reports of increased rates of use by non-athletes, primarily for appearance-related concerns. This includes use of “diet pills” for weight loss, as well as protein, creatine and anabolic agents to enhance muscularity.

An updated clinical report from the AAP Council on Sports Medicine and Fitness discusses trends in PES use and offers tips for pediatricians, parents and athletes. Use of Performance-Enhancing Substances,, will be published in the July issue of Pediatrics.
The greatest medical risk with attempts to enhance performance/appearance occurs with diversion of controlled substances, according to the report. Several classes of drugs frequently are diverted for these purposes. The following rates of non-medical use have been reported in recent national surveys of high school students: amphetamines, 12%, anabolic steroids, 7% and synthetic human growth hormone, 11%.
Protein, creatine most common
Although generally not considered as dangerous as drugs, the PESs most commonly used by adolescents typically are sold as dietary supplements. Protein and creatine are at the top of the list. Recent surveys of high school students report protein supplement use by 30% of boys and 18% of girls.
Pediatricians may find the following information helpful when counseling patients on protein supplementation:
Protein supplements typically are in the form of powders, shakes or bars. They commonly contain 20-30 grams (g) of protein per serving, which is similar to the amount contained in a 3-4 ounce (oz) chicken breast.

Young athletes may require up to 2 g protein/kilogram (kg) body weight/day (almost 70 g in a 150-pound athlete). This often is readily met with a typical American omnivorous diet.

Vegetarians and others who are restricting their diet may benefit from nutritional consultation, but several easy changes can greatly increase dietary protein intake, as follows:

Traditional yogurt has 7 g protein/6 oz serving, while Greek yogurt provides 17 g and cottage cheese has 21 g.

Nonfat dry milk contains 12 g protein per half cup. This can be added to soups, sauces or beverages as a “hidden” source of added protein.

Peanuts, almonds and cashews all contain over 20 g protein per 100 g serving.

Creatine use has been reported by 18% of 12th-grade males and almost 2% of 12th-grade females.

Creatine is stored in skeletal muscle and helps replenish adenosine triphosphate during maximal effort activities of short duration.

The body requires about 1 g ingested creatine/day, which can be found in 2-3 servings of meat or fish.

There is no added benefit to extra creatine.

Contamination concerns
Pediatricians should remind families that Food and Drug Administration regulation of supplements is much looser than for items sold as foods or drugs. However, it can be very difficult for consumers to distinguish these categories, as supplements often are intermingled on shelves with food and/or over-the-counter drugs at point of sale.
Analysis of supplements sold as PESs revealed that 25% were contaminated with anabolic steroids, 20% with heavy metals and 11% with stimulants.
Concerns regarding contamination and lack of FDA regulation of dietary supplements prompted attendees of the 2016 AAP Annual Leadership Forum to adopt a resolution calling for enhanced education and advocacy.
Risk factors, different motivation
Risk factors for PES use include: male, higher body mass index, body dissatisfaction, training in commercial gym and exposure to appearance-oriented fitness media. While use of PESs correlates with substance abuse and other high-risk behaviors, PES use typically is “goal oriented,” whereas most other substance use in adolescents is recreational. This calls for a different approach when counseling on PES use.
Adolescents base their decisions regarding PES use largely on their hope for benefit, and this significantly outweighs any potential concern about adverse consequences. Therefore, prevention efforts are best focused on the lack of benefit of PES use, and pediatricians can provide information on alternative methods for achieving their goals.
Emphasize the following when counseling patients:
The overwhelming majority of initial claims by supplement manufacturers regarding muscle-building, weight loss or performance enhancement are debunked after further investigation.

Even the most favorable studies on the effects of PESs on athletic performance cannot rival the 30% strength gains that are reported in youth strength-training studies of several months’ duration.

Adherence to fundamental principles of training, rest and nutrition remains the best way for patients to achieve healthy fitness and appearance-related goals.

Dr. LaBotz, a lead author of the clinical report, is a former member of the AAP Council on Sports Medicine and Fitness Executive Committee

Humility is a Great Virtue

Explosive Spring by Salvador Dali

Explosive Spring by Salvador Dali

I don’t think there’s anything wrong with showing a little vulnerability now and again, but what people want to see is true confidence and sincerity in your abilities whatever status you are. It’s about how authentic you are at the end of the day. If you’re super successful, but always telling people how incompetent you are, they’ll quickly get turned off because you’re coming across as insincere. Conversely, if you’re over-confident with little or no basis or track record, people are going to be equally turned off, as you can’t back up your overbearing demeanor with any substantial achievements. Finding the right balance between confidence and the understanding you don’t know everything and are constantly learning can be honed over time, but it’s important for your personal brand.

Mel Carson
Founder and principal strategist, Delightful Communications; Author, Pioneers of Digital

Work – Passion – Less Than Perfect

Sunset on the river. Gulls Arkady Rylov Russian Painter 1887-1947

Sunset on the river. Gulls
Arkady Rylov
Russian Painter

Be motivated by passion rather than fear. Fear of failure can be powerful in the short term, but it also leads to stress, burnout and failure. Focus instead on passion

I no longer work 16 hr days. I stopped those kind of hours about four years ago. Prior to then I would leave home at zero dark thirty come home late and often leave again to go to the hospital to attend to newborns or patients. My wife was and is amazingly patient with me and my job. Her famous quote “you chose to be a pediatrician” She is only partly right. I feel that pediatrics chose me.

This time of year, I am seeing my older patients begin senior year or go to college for the first time.

Many are amazingly confident others are still finding their way.
Some are stressing about class status, honors classes, zero hour, or looking for an acceptance from a prestigious school. all worried that they may not make the grade. Too many times my kids do not appreciate the journey I know I did not. My confidence level did not always hit a ten but the passion was always there and will always be there.

Love your classes. Love your school work. Love your activities. Love your Music. Be Passionate about today and be passionate about your future.

Don’t Let Perfect Get In The Way

Pink – Perfect Lyrics
Pretty, pretty please Don’t you ever, ever feel Like you’re less than ###### perfect

Exercise – The Daily Dozen

Cox and rowers The Popular Magazine, 1910,  J. C. Leyendecker (1874-1951)

Cox and rowers
The Popular Magazine, 1910,
J. C. Leyendecker (1874-1951)

My Grandmother used to watch my brothers and I if my parents went out of town, which was infrequent.

She would exercise. her routine was the daily dozen. I am sure it was only calisthenics but it those days that was good exercise. It must have been good for her she passed at 98.
It still is good exercise today.

What is a Calisthenics Workout?

It is very important to have a balanced exercise routine that targets all muscle groups, both upper and lower body.

I would recommend lighter weights with more frequent reps. I discourage the maxing out that some coaches and teens do when there is not adequate supervision in the wt room.

A recent study showed better results with shorter workouts.

All too often we see people who try to bulk up.

In most cases it does not look healthy and in some cases appears to be uncomfortable if not grotesque.

We all enjoy seeing people who are fit.
Not emaciated but healthy.

The best approach is a routine that addresses body health and over all well being.

That means a routine that again targets cardio, core, and extremities with stretching and allows rest and provides for adequate nutrition.

Supplements for Fitness?

If you want to build muscle, lose fat or run, swim or cycle faster, you’re better off with a solid training program and healthy diet than with supplements. In any case, the small effect some of these supplements may have would be meaningless for recreational athletes or exercisers, though the risks are just as great. In particular, if you are counseling children or teenagers who want to excel in sports, persuade them to do it through training, not pills.

Too often my athletes have been told by their “trainer” to bulk up using protein supplements powders and drinks.

In many cases this may add bulk but not strength. and in the cases with creatine may be harmful.

The Bottom Line:
“Increased muscle mass results from small amounts of protein synthesis (positive net protein balance) in response to nutrient intake (carb and protein) combined with resistance exercise (Tipton & Ferrando, 2008). Most of us already get the amount of protein we need to maximize our efforts in the gym.

Eating a high-quality diet with good sources of protein is the best thing to do if you’re looking to gain strength and muscle mass. Lean protein, like lentils, beans, grains, chicken, pork, fish, and lean red meat, are great protein sources. Peanut butter, and other nuts/seeds are also good. Eating a snack post-workout is smart for athletes who are undergoing more than an hour of resistance exercise. However, a protein supplement at this time is not necessarily the best bet; instead, try to eat a mixed meal of carb and protein and, additionally, factor this snack into your day’s diet.”

There is nothing that will hurry puberty and the accompanying increase in muscle mass

I do not want kids to gain weight just to fill a slot for some coach.

I want my athletes to participate in the sports that they enjoy and have coaches and mentors who enjoy sharing their knowledge of the sport or game

It all comes back to facilitating the development of a healthy mind body and soul.

Above all athletics is a means by which we can exercise but also socialize or network with our peers.

The most important thing that some athletes lose site of is that education comes first and sports are secondary.

We do not like to think that our ability to participate in a sport may cease but what we learn from the sport in self determination and perseverance and just the joy of participation cannot be taken away.

The Best Core ExercisesCore workouts that target more than just the ab muscles