Definition: "An ergogenic aid is any substance or phenomenon that enhances performance "

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Smilax, the deadly testosterone booster

It's sixteen years old this amazing horror story in The American Journal of Emergency Medicine. The details are so horrific and at the same time so typical that we don't want you to miss them. So here's a treat from the past: from us to you. Just for the heck of it. Because it's January and the sun's shining.
Are you sitting comfortably?

An eighteen-year-old marine arrives in a state of panic at the emergency department of a hospital. He's in a wheelchair and is dribbling. He can hardly swallow and can only talk in a whisper.

Smilax, the deadly testosterone booster
The marine thinks he's dying and, hell, the doctor on duty thinks this may well be the case. The guy can hardly breathe. All he can do is try to remain calm. That's about it.

Everything in his mouth is swollen. The guy's tongue has lost all sensation, it's rock hard and has reached gigantic proportions. It's so big it hardly fits in the guy's mouth. When the doctors try to examine the man's mouth they manage to create a space of just four millimetres through which they can peer.

In the man's throat there are lumps five to six centimetres big. Swollen lymph glands. The man's liver is ok, and a blood test shows that the concentration of the liver enzyme SGGT and the white blood cell count are both high.

The marine is given antibiotics and anti-inflammatory corticosteroids. He starts to recover gradually. After three days he's able to drink a little. And after ten days his blood has returned to normal.

While he's in the hospital, a military doctor visits the marine. He tells the hospital doctors later why the marine fell ill. He had been using a legal testosterone booster supplement Smilax. Which supplement it was, he didn't dare tell, but it he had to put the drops under his tongue. An example of the kind of product the doctor was referring to is shown above. When the doctors came to assess the marine's case, they concluded that it was a combination of several factors.

Smilax, the deadly testosterone booster
On the one hand, the marine seemed to have had an extremely allergic reaction. But that can't be the whole story. Anaphylactic shock is accompanied by constricted airways and low blood pressure. The raised level of the liver enzyme SGGT indicated poisoning however.

At that point, the author of the article, Janice Pearl, takes an unexpected turn. She goes to supplements stores, in search of products containing smilax. She can only find protein powders, like Anabolic Activator Hot Stuff, that have had Smilax added.

Anabolic Activator was popular at the time, and is still available. [] It contains protein powder and a huge amount of 'anabolic components'. The current Anabolic Activator contains creatine and Tribulus for example. The 1993 version contained germanium aspartate and smilax, as well as lots of other substances.

The supplements industry cooks up all sorts of mixes, Pearl complains in her article. Anabolic Activator probably contains allergenic and toxic components, which together helped bring the marine to the brink of death. They should be outlawed!

"Like illegal drugs, the use of 'ergogenic aids' and 'natural hormone boosters' may be denied", Pearl writes. "Since these products have the potential for severe acute and chronic toxicity, further investigation of their chemical composition and purity is needed." It's just a shame Anabolic Activator isn't a fluid that you have to place under your tongue. Apart from that it sounds convincing.

Oh yes.

There's an interesting sentence in the article that caught our attention. "Forty-eight hours prior to this illness the marine had received plague and typhoid immunizations. However, none of the 500 other marines who received these immunizations had experienced symptoms."

We're not saying the supplements industry is perfect. Scientists certainly have a point when they point to the dubious practices of some companies. But sometimes you just wonder how expert the critical scientists themselves really are.

Am J Emerg Med. 1993 Mar;11(2):188-9.