Let's imagine you begin your first day at a new health club, and you're the personal trainer hired to do the "intake" interviews with all new members. "Hello," you appropriately begin with your first appointment. "I'm a fitness professional, and I'm here to help you achieve your goals. I'd like to ask you some questions." The client's response: "I don't need a personal trainer! Don't try to sell me on anything. I know what I have to do. I'm stacking cocaine and Lexapro along with some diuretics and laxatives. I need to lose 50 pounds."
    It's an absurd scenario…or is it?
    We all recognize that cocaine is addictive, is a brain cell cannibal and can have destructive or lethal ramifications, if abused. We also know its illegal — oh, and I don't think anyone would dispute it can be a very powerful weight loss aid. Few, if any, sane people would opt to use cocaine as a preferred weight loss compound, if they understood the potential outcomes.
    What much of our society fails to recognize is that the quest to find a legal product that mimics cocaine consumes the researchers for both the pharmaceutical companies and some of the nutritional supplement sellers.
    Suppose we could go back in time and modify the above example so the user opts not for cocaine but for ephedrine, Prozac, "pee-more" and Ex-Lax. Most people would likely acknowledge that it's starting to sound a bit more acceptable. Sure, you as a personal trainer see the flaw, but you're not "most people." Most people have limited access to reality when it comes to the cut-throat competition among those seeking to drive the fitness and weight loss-wanting consumers to part with their money.

    A Glance Backwards
    The Phen-Fen drugs were a whopping success, not for weight loss but for the drug companies during the time Phen-Fen was being prescribed. The combination of phentermine and fenfluramine combined a stimulating, appetite-suppressing compound with a serotonin boost. Phentermine, in its molecular structure, is an isomer of methamphetamine, perhaps the most addictive substance on the planet, and it acts upon the neurotransmitters epinephrine and norepinephrine to stimulate the CNS, stimulate the fight-or-flight response and, in that, suppresses or switches off appetite. By combining the stimulant with a feel-good serotonin reuptake inhibitor, the sense of anxiety typically present with CNS stimulants is minimized. It's very much analogous to cocaine and Laxapro or ephedrine and Prozac.
    There was a problem. After millions of Phen-Fen prescriptions were written by medical professionals, it became evident that there was an alarming correlation between the emergence of the drug combination and both valvular disease and a life-threatening incurable condition known as primary pulmonary hypertension, so the FDA pulled the drug combination from the market.
    The reaction was shocking, at least to personal trainers. People wanted their Phen-Fen! And the drug companies and supplement companies recognized the financial power of the stimulant: feel-good combinations and all sorts of hybrids emerged, and they haven't gone away!

    Is the Public Gullible?
    Before the Mayo Clinic released reports of Phen-Fen-induced disease, the public bought into the drug with little reservation. Why? Because doctors said it was okay, and the users lost weight. That oddly placed trust in the pharmaceutical-medical combination, and it threw the doors wide open for the weight loss drugs to follow.
    So why are we discussing drugs in an article about fitness, wellness and personal training? Because it's a reality we deal with more often than we may even know. I couldn't begin to address the complexity of the issue in a single article, but I can give you enough insight so you begin to recognize the responsibility fitness professionals have, which is to, at the very least, understand the effects of the non-food substances that clients are ingesting. Your clients may not be gullible, but they can easily be victimized by partial truths designed to make pills in bottles appealing.
    Several supplement companies have tip-toed on the lines of legalities and have lobbied effectively to question laws. In recognizing the appeal of CNS stimulation, both in the performance arena and the weight loss marketplace, they've have found stimulant compounds that are readily embraced by the public, and they reinforce their appeal by using words such as "herbal" and "natural." The resulting perception is that these are somehow safer than drugs.

    Crank 'Em Up "Naturally"
    Caffeine is a readily-accepted CNS stimulant, and, thanks to the product marketers, caffeine has a variety of herbal sources. Supplements that simply say "caffeine" are not likely to corner the market, but there are many opportunities to attract consumers wanting fat loss in a bottle.
    By buying a "natural, herbal" product containing guarana, kola nut, green tea and cha de bugre or featuring trimethylxanthine, caffeine, theine, mateine, guaranine, methyltheobromine and 1,3,7-trimethylxanthine on the ingredient label, you're simply buying caffeine. Add in yohimbe bark, L-tyrosine, barberry extract, yellow thistle juice, sandalwood and gotu kola, and you're stacking one stimulant upon another. By designing formulas aimed at marketability and relying on unrecognizable ingredients, caffeine is in greater demand than ever. Is a reliance on an herbal stimulant combination much different than a stimulant drug addiction? If you were in the business of selling supplements and didn't care much about people's welfare, wouldn't it be in your best interests to sell addictive compounds?
    They can then add in diuretic herbs, such as dandelion root, stinging nettle or yarrow, to amplify rapid water loss, creating the instant illusion that the compound is "working." Finally, add in a compound or two that might increase serotonin production, and you might very well have a weight loss formula with much of the appeal of Phen-Fen.
    My intention is not to turn you against supplements, as many have great virtues (including caffeine compounds, with the right applications). My intention is not to turn you against prescription drugs, as many medications serve as important and efficacious treatments and cures, but when the goal is fitness, and we are asked to serve as guides, it's important that we recognize the biochemical alterations our clients' actions might bring about. The lines between prescription drugs, OTC medicines and nutritional supplements are becoming significantly blurred, and in this jungle of overwhelming information targeting the fitness and weight loss-wanting consumers, confusion abounds — and confusion is the greatest enemy of achieving desired fitness results.

    Are Our Clients at Risk?
    We must remain within our scope of practice, but we also have to recognize risk. While we should never prescribe a drug or supplement regimen, it is purely within our scope of practice to acquire a list of all supplements and medications that each of our clients incorporate in their regular regimens. We as fitness professionals should ask the hard questions, driving our clients to find some answers. Our clients should, at the very least, understand why they're taking the things they're taking, and when you begin to interview them, I promise you this: You'll be blown away by how readily they swallow tablets and capsules without understanding them.
    It's no wonder: The marketing is powerful and becoming even more powerful. Never before has an OTC weight loss product hit the marketplace with the anticipation of alli (play with the pronunciation, and you might find some irony in the name). Alli is touted as a tool, a part of a weight loss program, and since the advertisers have intentionally stayed away from presenting it as the great weight loss cure, it comes across as being marketed sensibly and responsibly.
    There's more to the story than the handsome drug store displays might reveal. In 1999, the FDA approved Roche's weight loss drug, orlistat, marketed under the brand name Xenical. Xenical limits the absorption of fat in the digestive tract, and if fatty foods are consumed, a percentage of the ingested fat will find its way from the beginning of the digestive tract straight through to the exit on the other end. The research was less than thrilling, the dropout rates in the studies were high and, with time, the side effects seemed to gain greater exposure than the alleged winning outcomes. In other words, the "exit" was more pronounced than any revelation of fat loss in the mirror or on the scale. Even the research touted as evidence to its success showed only a three-pound additional weight loss among those who used the drug along with diet and exercise — over a two-year period. Not thrilling for people now exposed to television ads for liposuction; far less thrilling when the side effects of anal leakage and loose and oily stools become real. The sales of Xenical dropped, so rather than abandoning the product, Roche sold it to GlaxoSmithKline for $100 million. The intention was to lower the dosage and release the disappointing weight loss drug as a much-hyped OTC product, as so they did, heading toward sales of three billion dollars in its first year. Consumers bought both the hype and the product.
    I'll share one more example of how the confusion crosses the lines from the health food store to the drug store. You've no doubt come in contact with information related to ephedrine. Are ephedrine and its herbal sources, ephedra and ma huang, illegal? Ask supplement sellers — they'll say it is, and then they'll try to sell you a product with synephrine, telling you it's safer and more effective. Five minutes later, walk into a pharmacy, and head toward the cough and cold products. Find Primatene tablets, and read the ingredient label. You will see ephedrine hydrochloride, right there for purchase. While you're there, pick up some Neo-Synephrine nasal spray (note the word following the prefix Neo), and read the warning label. You might even hold it side-by-side with the ephedrine product. Here's what you'll find: The public is confused, the marketplace is competitive and, whether they call themselves drug sellers or supplement marketers, there are huge entities with deep pockets willing to market aggressively, often in violation of the FTC regulations — and the victims are those people who need your help but might be looking for solutions in all the wrong places.

    A Glance Forward
    I've had callers call my radio show, asking about the safety of proprietary amino-acid injections they receive in Mexico. I've met thousands of people who buy their gray market drugs on the Internet, prescription-free. A new procedure is being promoted in spas claiming to be better than liposuction; it involves the injection of phosphatidylcholine into "trouble areas" to dissolve fat cells. There hasn't been enough study on this procedure to determine whether the dissolving of cell membranes may be indiscriminate, nor has anyone answered the question of where the fat goes and how its purported release might impact biochemistry in the long term. The questions of safety and efficacy have not been answered in any peer-reviewed research. Growth hormone and HCG injections are being touted as anti-aging solutions, and again, the questions far outweigh the answers — we fitness professionals have an opportunity to steer people along better, safer, healthier paths.

    My Suggestion
    Whenever you record health histories, don't ask whether the client takes any medications. Ask the question assumptively: "What medications are you taking?" Don't mistake the word "none" for an honest response. Ask the question at least three times. Once the list begins, it grows and grows.
    Do the same for supplements. After the list is complete, go back and ask the client what each compound is intended to do and what they know about it. Befriend a PDR (I have found it to be a worthwhile purchase), and gain an open line to a pharmacist. If you're ever uncertain of the risk or contraindications of a prescribed medication, speak to the client's physician, and get clearance before designing a program.

    The special herbal formulation containing 1,3,7-trimethylxanthine, L-tyrosine, 5-HTP, valerian root, dandelion root and an herbal laxative may not be all that much different than the absurd scenario I provided at the opening. Some might suggest I'm being overly concerned, but I've seen my share of deaths and injuries related to prescribed drugs and improper use or abuse of stimulant compounds. I also feel a responsibility to help my clients gain clarity, and I feel a complete understanding of their habits and choices provides me greater power to facilitate the results they seek. I sincerely hope you feel the same.
    Phil Kaplan is the author of Personal Training Profits and a Secure Fitness Future and the e-program, Change Your Mind, Change the World. Respond to Phil's arguments by emailing him at phil@philkaplan.com, or visit philkaplan.com for more information.