Performance Enhancing Substances 1 R. Robert Franks, D.O., FAOASM Director of Concussion Program Sports Medicine Rothman Institute 2015 AROC Conference April 16, 2015 Atlantic City, New Jersey Performance Enhancing Substances History History
Performance Enhancing Substances
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R. Robert Franks, D.O., FAOASM
Director of Concussion Program
Sports Medicine
Rothman Institute
2015 AROC Conference
April 16, 2015
Atlantic City, New Jersey
Performance Enhancing
Substances
History
History
Performance Enhancing Substances
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History
History
The Dietary Supplement Health and Education Act of 1994 (DSHEA)
Allowed regulation of ergogenic supplements to be governed by FDA
Included herbal and botanical products and constituents or metabolites of other dietary supplements
No consistency in components of chemical compounds or labeling between manufacturers
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University of Michigan’s Institute for Social Research “Monitoring the Future” Survey
Steroid use increased by high school students throughout the 1990s
More than 300,000 students between eight and twelveth grades used steroids
One third of users were females
Many males were using not only for athletic performance but also because of muscle dysmorphia or the “Adonis Complex”
Reasons for Use Performance
enhancement
Desire to keep up with abilities of peers
Emulation of professional athletes
Body image issues
Peer pressure
Baseball 2004
Jason Giambi used expansive regimen of illegal performance enhancing drugs
Barry Bonds admitted he took performance enhancing drugs but was unaware of what he was taking
Major League Baseball changes drug testing policy
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January 2005 Andro, androstenedione, a precursor of
testosterone and drug of choice for Mark McGwire, was made Schedule III drug this January 21.
It can no longer be obtained without prescription
DHEA, also precursor of testosterone, was not included in rescheduling. DHEA is converted to Andro in the body
Both in larger doses result in the same side effects as anabolic steroids
Supplements With Proven Benefit
Creatine
Supplements With Proven Benefit
Creatine
Amino acid found naturally in skeletal muscle, heart, brain, retina, testes and uterus
On average, 1-2 g/day made in the body with another 1 g/day ingested in diet
Excreted via the kidney
Works by having phosphocreatine replenish ATP during short bursts of high intensity exercise
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Supplements With Proven Benefit
Creatine
Usually loaded at 20 mg/day for 5 days
Maintenance dose 2-3 g/day
Supplements With Proven BenefitCreatine
Literature was favorable; however, studies used small sample sizes
Showed increased mass with repetitive bouts of weight supported activity
Felt due to water retention but protein/muscle synthesis has not been ruled out
Side effects include muscle cramping/strain, increased compartment pressures, rhabdomyolysis, renal dysfunction
Has not been studied extensively in children and adolescents
Legal by all regulating commissions
Supplements With Proven Benefit
Caffeine
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Supplements With Proven Benefit
Caffeine
In CNS, a methylxanthine stimulant
Adenosine receptor antagonist
Dosed at 3-9 mg/kg
Athletes need on average 210-630 mg for 70 kg athlete (1 cup of coffee has approximately 110 mg) for ergogenic effects
Supplements With Proven BenefitEnergy Drinks
Caffeine and sugar often largest component of energy drinks
One Red Bull has 80 mg of caffeine
Many adolescents are using more than one with practice/competition
American Academy of Pediatrics recommends adolescents get no more than 100 mg of caffeine per day
Supplements With Proven BenefitEnergy Drinks
Issue with adolescents is side effects:
Nervousness
Irritability
Insomnia
Tachycardia
Hypertension
Mixing with alcohol often blunts feelings of intoxication leading to further intoxication effects
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Supplements With Proven BenefitCaffeine
In studies, given to male cyclists at low, moderate and high doses (150, 230, 325 mg)
Performance improvement even at lowest dose
Performance best with endurance athletes as opposed to athletes engaged in anerobic activities
Supplements With Proven BenefitCaffeine
Allowed by NCAA and IOC
IOC limit is 12 micrograms/ml in urine
NCAA limit is 15 micrograms/ml in urine (8 cups of 100 mg cup of coffee to reach 12 micrograms)
Supplements With Proven Benefit
Caffeine
Relatively low side effect profile
Side effects can include increased blood pressure, heart rate, and tremors
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Substances With Mixed Support
Substances With Mixed Support
• Nitric Oxide
– Actual supplement is usually L-Arginine
– Oxidized by NO Synthase to NO
– Breaks down to NO to increase vasodilation
– Increased NO can enhance oxygen and nutrient delivery to active muscles increasing tolerance to exercise and recovery
Substances With Mixed Support
• Nitric Oxide
– Ergogenic benefits mixed
• Works best with those less highly trained and rarely in those highly trained
• Most ergogenic in older males
• Not banned by IOC or NCAA but often combined with banned substances
• Side Effects
– Nausea and diarrhea
– Issue with blood pressure
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Substances With Mixed Support
Glutamine
Substances With Mixed SupportGlutamine
Amino acid
Theory is that it may decrease immune deficiency secondary to intense training
Real benefit is only for those athletes with true glutamine deficiency
Legal by all regulating commissions
Substances With Mixed SupportBranched Chain Amino Acids
In CNS, decrease fatigue secondary to increased serotonin in the brain
No proof scientifically of efficacy
Side effect is toxicity at higher doses secondary to increased ammonia production
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Substances With Mixed Support
HMB (Hydroxy-methyl-butyrate)
Substances With Mixed SupportHMB (Hydroxy-methyl-butyrate)
Formed by breakdown of Leucine, an amino acid
Has been promoted as a inhibitor of catabolism during exercise
No proven effect on body mass, fat-free mass, or repetitive maximal strength
Legal by all regulating commissions
Substances With Mixed Support
Chromium Picolinate
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Substances With Mixed SupportChromium Picolinate
Aids insulin in binding to receptors enhancing its actions including glucose uptake and amino acid metabolism
By enhancing insulin action, glucose and amino acids are transported into muscle tissue more rapidly leading to muscle catabolism being decreased and muscle mass increased
Picolinate allows for better ingestion from gastrointestinal tract
Substances With Mixed SupportChromium Picolinate
Daily dosage between 50 and 200 micrograms
Clancy et all gave 36 college football players chromium picolinate at 200 micrograms a day for 9 weeks.
Showed no difference in strength between those on supplement and control subjects
There was also no difference in percent of body fat
Legal by all regulating commissions
Substances With Mixed Support
Chromium Picolinate
Doses of 600 micrograms for 6 weeks have been associated with renal failure
May also lead to anemia by impairing iron transport via its binding to transferrin
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Substances With Mixed SupportChromium Picolinate
Chromium picolinate does not increase muscle strength or lean body mass or decrease fat mass
Legal by all regulating commissions
Substances With Mixed Support
Antioxidants
Substances With Mixed SupportAntioxidants
Include Vitamins C, E, Beta Carotine, and Coenzyme Q
Promoted to decrease free radical production, and thus, reduce fatigue via the electron transport system
None have shown to have ergogenic activity in athletics
Coenzyme Q has shown to possibly be pro-oxidant
Legal by all regulating commissions
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Substances With Mixed Support
Ginseng
Substances With Mixed SupportGinseng
Promoted as decreasing fatigue by glycogen sparing
No good scientific evidence of any benefit
Legal by all regulating commissions
Steroid Precursors
Anabolic Steroid Pathway
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Steroid Precursors
DHEA
Steroid PrecursorsDHEA
Dehydroepiandrosterone
Testosterone precursor
Steroid produced by adrenal cortex
Promoted for weight loss, increased libido, and muscle mass
Steroid PrecursorsDHEA
Dehydroepiandrosterone
Study by Brown
19 males age 23 ingested 150 mg/day of DHEA for 8 weeks
Study conclusion was no change in body habitus or strength
Early studies show no true ergogenic effects resulting in change in body habitus or strength
Questionable safety profile
Banned by IOC and NCAA
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Steroid Precursors
Androstenedione
Steroid PrecursorsAndrostenedione
Testosterone precursor
Steroid produced by adrenal cortex
Promoted for weight loss, increased libido, and muscle mass
Steroid PrecursorsAndrostenedione
Studies by King in 1999
30 healthy men ages 19-29 ingested 100 mg/day for 8 weeks
Showed no increase in serum testosterone, lean body mass, or muscle fiber size
The Andro Project
50 men ages 35-65 ingested 200 mg/day for 12 weeks while performing resistance training
Showed small increase in serum testosterone and estrogen, but no increase in muscle fiber size or strength
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Steroid PrecursorsAndrostenedione
Early studies show no true ergogenic effects resulting in change in body habitus or strength
Questionable safety profile
Banned by IOC and NCAA
Includes Ma Huang, Ephedra, and Herbal fen-phen
Herbal supplement
Promoted for weight loss and energy maintenance
Active ingredient in Metabolifeand Ripped Fuel
Ephedra Alkaloids
Ephedra Alkaloids
Weak support for ergogenic effects
Small Study by Bell
16 male untrained subjects
Ingested 1 mg/kg of ephedrine
Improved Wingate Cycling Test
Athletes reported feeling “pumped up”
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Ephedra AlkaloidsSide Effects
Annals of Internal Medicine March 2003 demonstrated that these products make up less than 1 % of sales but account for 64% of all adverse effects of ergogenic supplements
Effects attributed include heart attack, hemorrhagic stroke, seizure, and death
Banned by IOC and NCAA
Pseudoephedrine
Pseudoephedrine Active ingredient in Sudafed (OTC
Decongestant)
Two small studies in cycling performed after ingestion of 120 mg of pseudoephedrine
Showed no effect on performance, fatigue, or strength
Side effects include increased blood pressure and heart rate
Banned by IOC but allowed by NCAA
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Human Growth Hormone
Found naturally in body
Decreases as age
Results in the following
Decrease in lean body mass
Increase in adipose tissue
Skin thinning
Can only be used via injection
Expensive
“Newest” Ergogenic Aids
“Newest” Ergogenic AidsHuman Growth Hormone
Side effects can be serious
Side effects include the following:
Edema
Myalgias
Arthralgias
Disease transmission
Death
Banned by both the IOC and NCAA
“Newest” Ergogenic Aids
Erythropoetin (EPO)
Darbypoetin (Synthetic EPO)
Enhances oxygen carrying ability of blood
Must be injected leading to needle sharing
Banned by both the IOC and NCAA
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Thyroid Hormone
Human Chorionic Gonadotrophin (HCG)
Gene Therapy
Future Ergogenic Aids
Anabolic Steroids
Anabolic Steroids Compounds that mimic effect of testosterone, male
hormone produced by the testes Enter muscle cell and turn on genes that
manufacture muscle proteins actin and myosin. These form new filaments swelling the size of the muscle cells
Weight lifting amplifies effects by stressing and making the muscle hypertrophic
Reverse glucocorticoid action and metabolize protein in the diet
Induce the “steroid rush” that allows for euphoria and decreased fatigue that allows for longer workouts
Anabolic steroids are labeled as controlled substances
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Anabolic Steroids Side Effects
Testicular atrophy as increased testosterone injected stops production of own testosterone via pituitary feedback loop
Increased testosterone can also be converted to estrogen leading to male feminization – i.e. breast development, etc
Reduced sperm count
Enlarged prostate
Impotence
Increased testosterone may lead to masculinization in females including increased body hair, enlargement of the clitoris, deepened voice, reduced breast size, and menstrual problems
Anabolic Steroids Side Effects
Acne
Male Pattern Baldness
Headache
Stroke and blood clots
Nausea
High blood pressure and heart disease
Bloating
Urinary and bowel problems
Anabolic Steroids Side Effects
Stunt growth by fusion of bony growth plates
Increased injury as tendon tissue cannot maintain force from hypertrophied muscles
Decrease in HDL
Increase in LDL
Liver toxicity
Mood swings
Aggressive and volatile behavior – the “roid rage”
Paranoia
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Anabolic Steroids Discontinuation
When stopped, testosterone levels in body decrease to almost zero in the body
Testes then eventually resume testosterone production
This usually produces a devastating depression
Those who attempt to stop steroids often relapse ending up back on the drugs
Thank You