Over-the-Counter Creatine Supplements and Underage Teens: Easy Access and Misinformation Provided By Health Food Stores
The American Academy of Pediatrics (AAP) and American College of Sports Medicine (ACSM) recommend against Creatine supplement use by pediatric populations because of concerning adverse effects (including renal and liver damage) -- with increased risk of these at higher doses. Despite this, a Mayo Clinic study found that 8.2% of high school athletes used Creatine supplements and that health food and vitamin supplement stores (HFS) were a primary information source for these users. In that study, 86% of Creatine users purchased their Creatine at a HFS. The purpose of our study was to determine how commonly HFS spontaneously suggest or endorse Creatine supplementation to a 15-year-old customer and to assess the availability of Creatine supplements for purchase by a 15-year-old.
The telephone survey included 200 national chain retailers (4 in each state) and 44 other HFS (smaller chain or individually owned) nationwide. A HFS was defined as a store that primarily sells dietary supplements. At the beginning of each phone call with a sales attendant (SA), the researcher identified himself as a 15-year-old male high school football player interested in strength training. The researcher then asked an open ended question of the SA: what supplements, if any, would he/she recommend. If the SA did not recommend Creatine initially, the researcher then asked specifically whether the SA would recommend Creatine. The SA was also asked if a 15-year-old could purchase Creatine there without an adult.
67.2% (164/244) of SAs recommended Creatine for a 15-year-old male athlete. 38.5% recommended Creatine without prompting; an additional 28.7% recommended Creatine when specifically asked. Male SAs were more likely than female SAs to recommend Creatine without prompting (p=.005). 30.3% of SAs did not recommend Creatine, while 2.5% refused to make phone recommendations. 74.2% of SAs said a 15-year-old could purchase Creatine on his own, while 22.5% stated that one must be 18 to purchase Creatine. 2.5% of SAs were unsure if a minor could purchase Creatine, and 0.8% refused to answer. National chain HFS tended to recommend Creatine less frequently (p=.088). There was no difference in Creatine recommendations based on geographic region.
Despite recommendations against pediatric Creatine use by the AAP and ACSM, employees at HFS frequently recommend Creatine for teens. Although national HFS describe their employees as “knowledgeable,” “extensively trained,” and “experts in health and wellness products”, HFS jeopardize the health of teens when recommending Creatine supplementation. Pediatricians should counsel teens about safe supplement usage and recommend against products containing Creatine.