Performance Enhancing Substances - njosteo.com · Felt due to water retention but protein/muscle synthesis has ... Promoted for weight loss, increased libido, ... stops production

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


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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


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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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


Caffeine


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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)


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


• 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


• 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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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


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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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



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


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



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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Chromium picolinate does not increase muscle strength or lean body mass or decrease fat mass



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



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Ginseng

Substances With Mixed SupportGinseng

Promoted as decreasing fatigue by glycogen sparing

No good scientific evidence of any benefit


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


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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Early studies show no true ergogenic effects resulting in change in body habitus or strength

Questionable safety profile


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


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


Acne

Male Pattern Baldness

Headache

Stroke and blood clots

Nausea

High blood pressure and heart disease

Bloating

Urinary and bowel problems


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

Documents

Performance Enhancing Substances - njosteo.com · Felt due to water retention but protein/muscle synthesis has ... Promoted for weight loss, increased libido, ... stops production