Are use of dietary supplements and performance enhancing drugs also disordered eating behaviors?

by Jerel P. Calzo, PhD, MPH

You might have looked at the title of this blog post and asked yourself why there would be a post about dietary supplements (e.g., protein powders, creatine) and performance enhancing drugs (e.g., anabolic steroids) on a website about eating disorders. Shouldn’t this be on a website about sports or substance use instead?

The first reason for this post is that the topic is timely. Dietary supplements and discussions about performance enhancing drugs have received considerable media attention over the past two months. Media coverage ramped up during the Olympics, as public concerns increased regarding corporate sponsorships and athlete endorsements of dietary supplements during the games. With high school and college football season starting up this fall, parents, coaches, and health professional raised concerns about athletes turning to dietary supplements to build muscle and increase athletic performance. Supplements, doping, and athletic performance are back in the news again with coverage of the cyber attacks on the medical records of Olympic athletes. Stories like these, while often noting the potential dangers of performance enhancing supplements and drugs, still reinforce the harmful message that exceptional feats of athleticism can’t be achieved without the aid of supplements and drugs.

The second reason for this post is that as clinicians, researchers, and supporters of males affected by eating disorders, we need to recognize that performance concerns may be a neglected area of eating disorders work. Thus far, much of the research on eating disorders has tended to focus on the appearance components of body image. For boys and men, body dissatisfaction may not be limited just to how their bodies look, but may also include what their bodies can and cannot do. Turning to dietary supplements with the goal of lifting more and running faster may seem like a quick solution to resolve these performance concerns. The fact that dietary supplements are easily purchased at many grocery and health food stores may lead consumers to think that these products are safe.

Unfortunately, dietary supplements are under-regulated, and run the risk of containing contaminants, dangerous amounts of pharmaceutical ingredients, banned substances, or analogues of banned substances1. In fact, due to the Dietary Supplement Health and Education Act of 1994, which prohibits safety and efficacy prescreening of dietary supplements, the Food and Drug Administration can’t remove unsafe supplements from the market until a healthcare professional files a report with the government that someone has been harmed by a supplement. As a result, serious adverse events occur, including death.

Although there is general agreement on the dangers of performance enhancing drugs, such as steroids, dietary supplements are far from innocuous. As research and clinical work on male eating disorders grows, more attention is warranted on the appearance and performance concerns underlying supplement use, which may also be detrimental to mental health and wellbeing.


1. Cohen PA, Maller G, DeSouza R, Neal-Kababick J. Presence of banned drugs in dietary supplements following FDA recalls. JAMA. 2014;312(16):1691–3.