Maybe illegal anabolic steroids aren’t the biggest worry after all.

A recent study has shown that men looking to build a better physique have relied so heavily on over-the-counter bodybuilding supplements that it has resulted in an emerging eating disorder.

The research, presented at the American Psychological Association’s 123rd annual convention in Toronto, recruited 195 men between the ages of 18 and 65 who had consumed legal appearance-enhancing or performance-enhancing supplements during the previous month.

These supplements included whey protein, creatine, and L-carnitine.

The research subjects also stated that they work out for fitness or appearance-related reasons a minimum of two days a week.

Participants completed an online survey that asked questions about a variety of subjects, including supplement use, self-esteem, body image, eating habits, and gender role conflicts.

Healthline contacted the National Strength and Conditioning Association to weigh in on the study, but they declined to comment.  

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Supplements Are a Growing Trend

Dr. Richard Achiro, Ph.D., of the California School of Professional Psychology at Alliant International University in Los Angeles, presented the research at the association convention.

He said that while there is no knowledge of whether illegal steroids are less prevalent in the bodybuilding world, there is no doubt that over-the-counter supplements are growing.

“I'm not sure whether illegal steroid use is down among men, but I do know that sales of over-the-counter/legal supplements are higher than ever before and now constitute a multi-billion dollar industry,” he told Healthline. “It does seem likely to me that many body-conscious men who would have begun using illicit supplements in the late ‘80s and throughout the ‘90s would now be more likely to use legal supplements excessively instead.”

Achiro added that the “ideal masculine” physique presented by the media has changed from hyper-muscularity — such as Arnold Schwarzenneger — to a mesomorphic ideal, which is muscular and lean, highlighting the importance of muscular definition.

The latter, Achiro said, “is exactly what legal supplements purport to foster.”

Legal supplements are more likely to be used, and even excessively consumed, by a much broader range of men.

“This is likely because physicians and psychologists alike have failed to consider that aspirations to attain a seemingly balanced, healthful physique does not mean that the means by which that body type is pursued is necessarily balanced and healthful,” Achiro said. “Our study demonstrates that, for men who go to the gym as little as two times a week, a large proportion are using legal supplements in a way that has adverse implications for mental and physical health.”

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Use of Supplements Increase Over Time

The study revealed that more than 40 percent of the participants indicated that their use of supplements had increased over time. Twenty-two percent indicated that they replaced regular meals with dietary supplements not intended to be meal replacements.

Achiro highlighted that 29 percent said they were concerned about their own use of supplements.

“These men, who clearly know that their supplement use is becoming a problem but who have not stopped using the supplements, would benefit from counseling or therapy aimed at developing insight around what the body represents to them,” he said, “so that they might begin to relinquish risky body change behaviors rather than cling to them for psychological reasons that are outside of their awareness.”

Another 8 percent of the participants said their physician told them to cut back on or stop using supplements due to adverse health side effects. Three percent had been hospitalized for kidney or liver problems related to the supplement use.

The scale was developed by Achiro and study co-author Dr. Peter Theodore, Ph.D., also at the California School of Professional Psychology.

“I can't say with certainty whether supplements have changed in recent years. However, it is clear that legal supplements have become more widespread,” Achiro said. “Also, there seems to be more of a marketing push to promote supplements that help add muscularity in addition to supplements that help individuals to stay lean and/or work out more rigorously.”

Although the study focused primarily on pre- and post-workout supplements, when asked about other health-related supplements such as fish oil and multivitamins, Achiro said he believes it could have the same effect as proteins and creatines.

“Even these health-promoting supplements can be used excessively if, in the mind of the user, they are considered means for achieving a more ‘perfectly masculine’ physique,” he said.

Focusing on Bodybuilders' Minds

The underlying cause, according to Achiro, wasn’t physical. It was all in the mind of the participant, in which an individual perceives that he is not living up to the strict limitations of masculinity dictated by modern culture.

“Interestingly, our findings demonstrate that, taken together, masculine insecurities and low self-esteem contribute more to a man's propensity to misuse legal supplements than does body dissatisfaction alone,” he said.

He added that it is important to look at the deep-seated emotional issues that are driving the destructive behaviors rather than focusing on the superficial.

 “I would add that the psychological drive to overuse legal supplements is complex and nuanced and cannot be wholly captured by any one study,” Achiro said.

The study found, in its final model, what might drive a gym-active man to overuse legal supplements — body dissatisfaction exacerbated by internalizing cultural standards of low self-esteem.

“In short, body dissatisfaction is a major contributor to legal supplement misuse and other eating disorder behaviors in men,” Achiro summed up. “Also, low self-esteem and gender role conflict were both found to directly contribute to workout supplement misuse and other eating disorder behaviors as defined by the Eating Disorder Examination-Questionnaire.”

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