Performance-Enhancing Drugs

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Performance-Enhancing Drugs Methods

• Chapter 16

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Definition of Performance-Enhancing Substance

• Performance-enhancing substance means a
  manufactured product for oral ingestion,
  intranasal application or inhalation containing
  compounds that
• Contain a stimulant, amino acid, hormone
  precursor herb or other botanical or any other
  substance other than an essential vitamin or
  mineral
• Are intended to increase athletic performance,
  promote muscle growth, induce weight loss or
  increase an individuals endurance or capacity
  for exercise.

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Variations of Steroids and Performance-Enhancing
Substances
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Why do athletes take anabolic steroids or
performance-enhancing substances?

• To
• Boost athletic performance
• Build muscle
• Increase body mass
• Lose body fat

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What influences an athlete to take anabolic
steroids or performance-enhancing substances?
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Desire to Emulate Role Models
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Peer Pressure to Succeed
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Media Influences
Images that portray steroids in a positive light
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Cover Stories About Steroids
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Desired Body Image Based on Gender
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Dangers of Anabolic Steroids and
Performance-Enhancing Substances

• Steroids are dangerous for two reasons
• They are ILLEGAL.
• They can damage a persons mental and physical
  health.
• If used by adolescents, can have permanent
  negative consequences

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Some Health Risks for Both Males and Females

• Acne, really bad acne, especially on face and
  back
• Stunted growth in teens (by causing bones to
  mature too fast and stop growing at an early age)
• High blood pressure, unhealthy cholesterol
  changes, and heart disease
• Blood clots and stroke
• Liver damage, jaundice, or liver cancer

• Headaches, aching joints, and muscle cramps
• Increased risk of ligament and tendon injuries,
  which can end an athletes career for good
• Needle sharing results in higher risk for serious
  infections like Hepatitis B and C or HIV, which
  causes AIDS
• Baldness

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Gender Differences and Risks of Drug Use

• Young Females
• Self-esteem
• Depression/mood
• Body image
• Media

• Young Males
• Risky behavior
• Impulsivity
• Body image
• Media

Specific, based on gender
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Health Risks for Males

• Shrinking of the testicles
• Low sperm count
• Impotence (inability to get an erection)
• Increased breast growth in males, especially
  teens
• Possible lactating
• Enlarged prostate

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Health Risks for Females

• Breast shrinkage
• Male-type facial and body hair growth
• Deepening of the voice
• Problems with menstrual periods
• Enlarged clitoris
• Insatiable sex drive

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Health Risks for Both Genders

• Internal organ disease liver, kidneys,
  arteriosclerosis
• Various cancers

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Psychological Health Risks

• Roid rage- severe, aggressive behavior that may
  result in violence, such as fighting or
  destroying property
• Severe mood swings
• Paranoia- extreme feelings of mistrust and fear
• Anxiety and panic attacks
• Depression and thoughts of suicide

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Definition of Cycling

• Anabolic steroids are taken orally or injected,
  typically in cycles of weeks or months, rather
  than continuously.
• Cycling involves taking multiple doses of
  steroids over a specific period of time, stopping
  for a period, and starting again.

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Definition of Stacking

• Users often combine several different types of
  steroids to maximize their effectiveness while
  trying to minimize negative effects.

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Slang for anabolic steroids or performance-enhanci
ng substances

• You may have heard steroids called
• Roids
• Juice
• Hype
• Pumpers
• Gym Candy
• Arnolds
• Gear
• Weight Trainers
• Stackers
• 420 (pronounced four-twenty)

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What should you look for if you are concerned
that an athlete may be taking anabolic steroids
or performance-enhancing substances?

• Unfortunately, many of the symptoms of steroid
  abuse look very similar to typical appearances
  and attitudes that occur during adolescence.
  Here are some signs to look for
• Increased aggression
• Rapid weight gain (10 lb/month or 40lb/year)
• Pustular acne
• An obsession with and bragging about increased
  performance (i.e. increased bench press)
• Virilization in females (lowering of voice
  facial hair, male pattern of hair growth on body)

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Common Myths

• Steroids are safe
• Taking any kind of steroid will result in death
• Injectable steroids are safer than oral steroids
• Steroids wont really stunt your growth
• All steroids are pretty much the same
• Steroid abuse isnt really a big problem in the
  U.S.
• All steroids are pills
• Only a certain kind of person uses steroids
• Steroids arent addictive
• Steroids arent as illegal as other drugs
• Steroids build muscle without working out
• Women dont use steroids
• Roid rage isnt real

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Stimulants

• Drugs that can reduce fatigue, suppress appetite,
  and increase alertness aggressiveness
• Stimulate the CNS, increase your heart rate,
  blood pressure, body temperature metabolism

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Stimulants cont.

• Most common include caffeine and amphetamines
• Cold remedies often contain the stimulants
  ephedrine pseudoephedrine (Sudafed)
• Street drugs such as cocaine methamphetamine
  belong to this group

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Stimulants cont.

• Can boost physical performance promote
  aggressiveness on the field
• Have side effects that can impair athletic
  performance
• Nervousness irritability, insomnia
• Can become psychologically addicted or develop a
  tolerance so that they need greater amounts to
  achieve the desired effect

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Stimulants cont.

• Other side effects may include
• Heart palpitations
• Heart rhythm abnormalities
• Weight loss
• Mild hypertension
• Hallucinations
• Convulsions
• Brain hemorrhage
• Heart attack other circulatory problems

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Ephedra

• Erythropoetin (EPO) increases endurance
• Ephedra delays fatigue
• On April 12, 2004, the Food and Drug
  Administration prohibited the sale of dietary
  supplements containing ephedrine alkaloids
  (ephedra).
• Ephedra, also called Ma huang, is a naturally
  occurring substance derived from plants. Its
  principal active ingredient is ephedrine, which
  when chemically synthesized is regulated as a
  drug.

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Ephedra cont.

• Ephedra products have been extensively promoted
  to aid weight loss, enhance sports performance,
  and increase energy.
• Linked to significant adverse health effects,
  including heart attacks and strokes
• Increased risk of side effects, possibly may be
  fatal
• No evidence that ephedra products enhance
  athletic performance
• Short-term weight loss may be the only benefit

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Creatine

• Formal name is creatine monohydrate
• Compound produced by your body that helps release
  energy in your muscles
• Naturally occurring compound
• Can also ingest creatine from protein-rich foods
  such as meat or fish
• Take a nutritional supplement

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Creatine cont.

• May be able to produce small gains in short-term
  bursts of power
• Improving maximum-weight bench press or
  increasing speeds of very short duration
• Some studies show an increase in lean muscle mass

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Creatine cont.

• Helps muscles make circulate adenosine
  triphosphate (ATP)
• Nucleotide that helps give you energy
• ATP is used for quick, explosive bursts of
  activity (weightlifting sprinting)
• Also reduces energy waste products, such as
  lactic acid
• Can cause muscle fatigue

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Creatine cont.

• Said to enhance performance decrease fatigue
• No evidence that creatine enhances performance in
  aerobic or endurance sports

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Creatine cont.

• Liver produces about 2 grams of creatine each day
• Stored in muscles, and levels are easily
  maintained
• Kidneys will remove excess creatine, the value of
  supplements to someone who already has a high
  muscle creatine content is questionable

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Creatine cont.

• Possible side effects of creatine that can
  decrease athletic performance
• Stomach cramps
• Muscle cramps
• Nausea
• Vomiting
• Diarrhea

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Creatine cont.

• Weight gain is a known side effect
• After prolonged use, weight gain is more likely
  the result of water retention than an increase in
  muscle tissue
• High doses can potentially damage
• Kidneys
• Liver
• Heart

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Creatine cont.

• Unknown the effects from long-term usage
• Dosage levels vary widely depending on product
  how much creatine you take
• Not regulated by FDA
• Not sure of purity on market

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Creatine cont.

• Improves energy and performance in brief,
  high-intensity activities
• Short-term advantages increased energy in short
  bursts can aid in improving athletic anaerobic
  performance (weight lifting sprinting rowing)
  delays muscle fatigue
• Known disadvantages requires serious strength
  training program dehydrates blood stream, so
  requires excessive consumption of water with the
  consumption of excessive amounts it has the
  potential to cause renal disease

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Blood Doping

• Increasing the number of red blood cells in the
  body to increase the oxygen carried to muscle
• Administration of blood, red blood cells, or
  related blood products
• Erythropoietin
• Stimulates bone marrow to produce red blood cells

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Blood Doping proven effects

• 7 increase in Hgb
• 5 increase in VO2 max
• 34 increase in time to exhaustion at 95 VO2 max
• 44 second improvement in 5 mile treadmill run
  time

(Williams and Branch summarized study findings)
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Blood Doping - Side Effects

• Transfusion reactions
• Infections
• Increased viscosity of blood
• Stroke, MI, PE

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Blood Doping - regulation

• Erythropoietin only by prescription
• Doping banned by USADA, NCAA
• Blood tested for antigens
• Ceiling on allowable Hct level at 50

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Beta-2-Agonists

• Physiology
• Bronchodilation, increased ventilation
• Examples albuterol, terbutaline, salmeterol

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Beta-2-Agonists proven effects

• Clear benefit in asthma and EIB
• Increased ventilation
• No increase in performance in NON-asthmatic
  athletes
• Side effects tremor, tachycardia
• Regulation
• USADA prohibited
• NCAA inhalation permitted

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Nitric Oxide-releasing agents

• Physiology
• Arginine is a precursor of NO
• NO regulates BP and blood flow to organs
• Most supplements Arginine a-ketoglutarate
• Claims
• Improves pump and blood flow to muscles
• Increases strength and size
• Speeds recovery

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Nitric Oxide-releasing agents

• Endurance exercise studies
• No benefit in endurance athletes
• Limited evidence of benefit in debilitated pts
• Strength exercise mixed results, no proven
  benefit
• More studies needed

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Sodium Bicarbonate

• Mechanism buffers metabolic acidosis after
  strenuous exercise
• Proven ergogenic efx in high-intensity exercise
• 100m 200m swim
• Repeated sprints
• Repeated judo throws

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Bicarbonate

• Limited conflicting evidence of benefit in
  aerobic exercise
• High-intensity running 17 better
  time-to-exhaustion (30 vs 26 min)
• 60-min max-effort cycle ergometry 14 higher
  power vs Placebo
• 60-min high-intensity cycling no difference vs
  Placebo

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Bicarbonate

• Dose 0.2 - 0.3 mg/kg
• GI side effects common

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Carbs

• Sports drink consumption
• Carbohydrate loading

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Sports Drink Consumption

• Evidence supports enhanced endurance performance
  vs water in events gt60 min
• No benefit from added protein

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Carbohydrate Loading

• Known to increase muscle glycogen levels 13 -
  100
• Prolongs time to exhaustion 2-3 in endurance
  events gt90 minutes
• Higher effect in Untrained persons
• 25-km treadmill

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Methods of Carbo Loading

• Classic 6-day regimen
• 3 days intense glycogen-depleting exercise
• 3 days high-CH diet, no exercise
• Modified 6-day regimen
• 3-day exercise taper, normal diet
• High-CH (70) light exercise 3d prior
• Single-day regimen
• 10 gm/kg/day CH 1-day prior
• Normal exercise regimen

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Carbohydrate Loading s

• Little standardization of methods
• Athletes need to try methods prior to competition
  to see what works
• Exact roles of glycogen-depleting exercise, type
  of CH, and timing are unclear

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Miscellaneous Losers

• Vitamin E and other vitamins
• Minerals Cr, Mg, Zn, Se
• L-Carnitine
• Antioxidants
• Pyruvate
• Arginine
• Hydroxy-methyl-butyrate (HMB)

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Diuretics

• Drugs that change your bodys natural balance of
  fluids salts
• Can lead to dehydration
• Water loss may allow an athlete to compete in a
  lighter weight class

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Diuretics

• Commonly used to treat high blood pressure
  conditions that cause fluid retention (edema)
• Such as congestive heart failure
• May cause
• Muscle cramps, exhaustion, decreased ability to
  regulate body temperature, potassium deficiency,
  heart arrhythmias

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Diuretics cont.

• Used to increase the amount of urine produced and
  to increase kidney function, thereby speeding up
  the elimination of fluid from the body
• In turn this will cause rapid weight loss in
  sports where performers are required to compete
  within strict weight boundaries

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What healthcare professionals can do

• Be clear about your expectations
• Talk to student athletes that unless the
  long-term effects of performance-enhancing drugs
  on young athletes are known to be safe, you
  expect him or her to avoid them
• Discuss alternatives to performance enhancers,
  include sports nutrition and strength training
  techniques
• Set rules. For example, if a student uses
  performance-enhancing drugs, he or she will be
  removed from the team
• Teach students that short-term gains can lead to
  long-term problems.

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What to docontinued

• Discuss ethics and proper training. Athletes
  should compete fairly
• Remind them that using a performance-enhancing
  drug is similar to cheating, but even more
  importantly, could lead to serious health
  problems or even death. Another key message is
  that a balanced diet and rigorous training are
  the true keys to athletic performance
• Encourage the student athlete to feel good about
  his or her sports performance
• Monitor for signs of drug use. Signs the student
  may be taking anabolic steroids include increased
  acne and male-pattern baldness. If a female takes
  anabolic steroids, she may develop male
  characteristics, such as a deep voice or dark
  facial hair. Teens who take anabolic steroids may
  seem unusually moody and have angry outbursts
  known as roid rage
• Discuss the school districts policy concerning
  anabolic steroids and other performance enhancing
  drugs with all student athletes

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Anabolic Steroids and Performance-Enhancing
Substances Prevention

• Least Effective Method
• Simply teaching students about steroids harmful
  effects does not convince adolescents that they
  personally will be adversely affected.
• More Effective Method
• Presenting both the risks and benefits of steroid
  use is more effective in convincing adolescents
  about steroids negative effects, because they
  find a balanced approach more credible and less
  biased.

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Anabolic Steroids and Performance-Enhancing
Substances Prevention

• MOST EFFECTIVE Method
• Science-based, research-based curriculum with
  predictable outcomes, combined with credible,
  unbiased facts.