Most parents are unaware of what their children are using to supplement and enhance their sports performance. TV and magazine commercials tout the benefits of using these supplements to become the best in their sport. Athletes today believe these commercials and are using supplements in record numbers. The high school and college statistic for supplement use is 40-50%. Even steroid use is common in the high school and college arenas. Approximately 13% of high school football players are now using steroids. In high school women's sports, basketball is the highest steroid sport at 8.8%.

Parents should ask their athlete what they are using, be aware of what is out there and know the risks and benefits of these drugs.

So, how important is it to your athlete that they succeed in their sport? A study in Sports Illustrated posed the question to athletes that if they could take a drug and be at the top of their sport for 5 years and then die, would they take it. Over 80% of the athletes said they would!

You can begin to analyze whether your athlete is at increased risk of supplement or steroid use by asking the following questions. The more "yes" answers, the more likely they are to be using some kind of supplement or steroid.

These questions may seem to encompass a large percentage of high school athletes, but again the statistics show performance enhancement drug use to be high as well.

Steroid use is obviously the most dangerous of the performance-enhancing drugs, and there are many signs that might tip you off to their use. Increased muscle mass, out of proportion to what they normally would gain with a good workout routine, is a common sign. Increased acne on the face, chest and back is also common. In the female, steroids will lower the voice and cause facial hair growth, because the steroid is a testosterone derivative. Men with chronic steroid use will have small testicles, which may be noted by their doctor.

Creatine is probably the most asked-about supplement in my practice. It is touted as safe and effective. Creatine is a naturally occurring substance in our bodies produced by the liver, pancreas and kidneys. Human skeletal muscle uses 95% of it. It is said to increase muscle mass and power during short-duration activities. Studies have shown that it does what it claims but that you must continue to use it to sustain the benefits. Muscle mass and power return to pre-creatine levels when the athlete stops using it. Risks to the athlete include dehydration, cramps, muscle strains, electrolyte imbalances and stomach upset. There are no long-term studies to show if it is safe for multiple years of use.

Ephedra has been recently banned by the sporting world because of multiple deaths. Unfortunately, the ban does not cover ephedra derivatives and substances which become ephedra after ingestion. A large percentage of the ephedra-free substances have these other substances in them. Benefits are increased concentration and focus, as with any stimulant.

Protein or amino acid supplementation is also very common. Although safe, it is not proven to enhance performance. No evidence supports protein supplementation over 2 g/kg lean body mass a day. Very few Americans are protein deficient. Improved conditioning that naturally occurs as training continues decreases protein breakdown, making protein supplementation a waste of money.

Dr. Golemon is board-certified by the American Academy of Family Physicians, with a Certificate of Added Qualifications in Sports Medicine. She sees patients at Methodist Family Medical Center.