1 / 64

ERGOGENIC AIDS Andy McGown, MD

ERGOGENIC AIDS Andy McGown, MD. Definition:. Ergo = work Gennan = to produce Any substance or method used to enhance performance through increased energy utilization: production control efficiency. History.

dimaia
Download Presentation

ERGOGENIC AIDS Andy McGown, MD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. ERGOGENIC AIDS Andy McGown, MD

  2. Definition: • Ergo = work • Gennan = to produce • Any substance or method used to enhance performance through increased energy utilization: • production • control • efficiency

  3. History • 3000 Years ago the Greeks ate “substances” to improve athletic performance including Strychnine. Used recently in 1904 and 1992 Olympics • 776 BC (1st Olympiad) • Hallucinogenic mushrooms and sesame seeds • 1889 1st Self-administered Steroids • Brown-Sequard “Testicular extracts” • 1935 Testosterone Synthesized

  4. Goldman’s Poll • Two questions posed to 198 aspiring olympians during the 1990’s • Take banned substance if guaranteed to win a medal and not be caught • Take banned substances and not be caught and win every competition for the next 5 years but die an early death from side effects

  5. Drugs: Hormones Stimulants Narcotics Diuretics B-Blockers “Supplements”: Prohormones? Amino Acids Metals Antioxidants Herbs Classification

  6. Prevalence: • Estimated Use • Adolescents • 11% male (most start < 16yo) • 2.5% female • Adult ~ 15% • Usually recreational athletes • Swimming, Cycling, Weight lifting, Track and Field • Billion Dollar Industry

  7. “There is no room for second place. There is only one place in my game, and that’s first place.” -Vince Lombardi

  8. Reasons: • Have to use them to be competitive • Need the edge • Not genetically gifted • Dissatisfaction with size/ weight • Peer/ Team Pressure

  9. Human Growth Hormone • Naturally secreted by the pituitary • Normal function of GH is growth and development of every body system, including bone and muscle • Can be stimulated by propanolol, vasopressin, clonidine, and levodopa • Synthetic growth hormone

  10. Side Effects: • Acromegaly (may be irreversible) • Peripheral Neuropathy • Coronary Artery Disease • Cardiomyopathy • Diabetes, Hypothyroidism, arthritis • No available urine test available, but banned by NCAA and IOC

  11. Erythropoietin • Hormone released by the kidneys in response to low Hct • Stimulates RBC production from bone marrow • Has recently been manufactured by recombinant DNA technique • Can increase Hct in renal patients by up to 35%, lasting up to 7 months • Used most by cyclists

  12. Doping • Attributed to the Dutch word “dop” which was a narcotic mixture of opium used to stimulate racing horses

  13. Blood Doping • Autologous Reinfusion • 2 units blood removed 4-8 wks prior to competition • Frozen w/ glycerol • Reinfusion 1-7 days prior to event • 1 U PRBC>>500 ml / min increase in O2 carrying capacity • Can produce 25% improvement in endurance • The poorer the athletes conditioning the greater the benefit

  14. Side Effects • Blood Transfusions • Heterologous • transfusion rxn (3-10%), Hepatitis (10%), HIV (?%) • Autologous • bacterial infections • r-EPO • Polycythemia • increased viscosity >>CHF, HTN, CVA

  15. Detection • Blood Doping and r-EPO • Banned by IOC • No Direct Test • Hct >50 • Serum Fe and Bili • Detecting post-transfusion hemolysis • Legal issues

  16. Anabolic Steroids • The ultimate ergogenic aid aka “Juice” • Creates the Superhuman Athlete • Testosterone derivatives (cholesterol) • Produced in the adrenal/ testes

  17. Anabolic/Androgenic Steroids • Anabolism - Constructive • Catabolism - Destructive • Anabolic effects : inc. skeletal mm mass • anticatabolism • Androgenic effects: secondary sexual characteristics - pubic hair, genital size • No Pure Anabolic Steroids

  18. History of Steroids • First Available - 50’s (Dianabol) • Drug Banned - 60’s • Testing Initiated- ‘76 • Athletes Banned - ‘83 Pan Am Games • Schedule III Controlled Substance - ‘90 Anabolic Steroid Control Act • US Dietary Supplement Act - ‘94 no FDA approval if no “drug intent”

  19. Administration: • Athletes may take up to 40-100x therapeutic dose (200-2000 mg/ wk) • IM adm bypasses the liver/ PO does not • “Stacking”: using various aids in combination • “Cycling” : gradual inc. then taper over 6-10 weeks, 1-3 cycles /year, “bridging” between • Illicit - Nandrolone, Stanozolol (Winstrol), Methelone, Tibolone, Oxandrolone • Medical - Testosterone, Enanthate, Undelanoate, Dehydrotestosterone (patch)

  20. Desired Effects: • Increase in strength • Increase in weight • Increase in aggressiveness • Increased capability of sustaining repetitive, high intensity workouts • Enhanced performance

  21. Side Effects: • CV: MI - hypertension, inc. LDL, dec. HDL, cardiac hypertrophy, thrombosis • Endocrine: virilization, testis atrophy, azospermia, priapism, prostatic hypertrophy/ CA, gynecomastia, erectile dysfct, libido • Liver : peliosis hepatitis, hyperplasia, adenoma, no carcinoma, elevated LFTs • MS: epiphyseal closure, inc. bone density, dec. tendon strength

  22. Side Effects (cont’d): • Skin: acne, hirsuitism, striae, androgenic alopecia, inc. sebaceous glands • Metabolic: hypernatremia, kalemia, phosphatemia, calcemia, “prediabetic” • Psychiatric : aggressiveness, extreme mood swings - depression/ mania, dependence, other drug use, “Reverse Anorexia” • Long Term - dec. life span

  23. Specific Side Effects • Women: Virilzation: • Clitoril enlargement, Deepening of voice, Male pattern baldness, dec. breast size, libido • Children: premature closure of growth plate in long bones & short stature

  24. “Prohormones” • Androstenedione • DHEA • Androstenediol • Norandrostenedione • Norandrostendiol

  25. Androstenedione • 1/2 of the “ Mark McGuire Special” • A natural steroid hormone found in all animals and some plants • Metabolite of DHEA • Precursor of testosterone • Synthesized in Adrenals/ Gonads • Metabolized in the liver to testosterone

  26. Effects: • Benefits: Same as Testosterone • Increased energy • Enhanced recovery and growth from exercise • heightened sexual arousal and function • greater sense of well-being • Plasma levels of testosterone increased from 140% to 330% of normal levels after 50mg and 100mg doses • SE’s : Same as Testosterone • Banned by IOC, NCAA, NFL

  27. DHEA (Dehydroepiandrosterone) • What it is: A hormone produced by adrenal gland • Claims: Anabolic effect • What is does: Increases testosterone levels • Banned by the NCAA, NFL

  28. Stimulants • Caffeine • Amphetamines • Cocaine • Ephedrine

  29. Amphetamines • WWII • Soldiers used them to counteract fatigue • 1959 Study shows Performance Enhancing Potential • Used in Sports where Speed, Power and Endurance are Required

  30. Side Effects: • Predominantly CNS • Insomnia, agitation and restlessness • Confusion, paranoia, hallucinations • Dyskinesias • especially in facial muscles • Cardiac • HTN, arrhythmias • GI • Diarrhea • Rebound Fatigue and Depression

  31. Caffeine • A Methylxanthine: same class as theophylline and theobromine • Exerts its’ effects by: • Translocation of Calcium for more muscular availability • Increase in cAMP by inhibition of phosphodiesterase • Blockage of adenosine receptors, blocking the sedative properties of adenosine

  32. Caffeine (cont’d) • Is banned by IOC and NCAA in large doses • Legal limit = 15 micrograms / ml • Equal to 6-8 cups of coffee at one sitting, with testing within 2-3 hours • Beneficial most in endurance events, such as cycling • Doses up to 5 mg / kg were required to see benefits. Doses of 17 mg/kg produce the maximum legal limit.

  33. Side Effects: • Similar to s/e of other stimulants: • insomnia, irritability, nervousness • Tachcardia, arrthymias, and possibly death!

  34. Ephedrine • What it is: Is a drug found in herbal products containing Ma haung, anti-asthmatic medications, and many cold and cough products. • Claims: Increases body fat loss • What really does: Acts as a CNS stimulant, delays fatigue by sparing body glycogen reserves. Increase in B/p respiratory, heart rate, insomnia, and nervousness • Max dose : 24 milligams per day!!!!!!

  35. Amino Acids • Creatine • L-Carnitine • Choline • Inosine • HMB (B-OH-B-Methylbutyrate)

  36. Amino Acids • Essential amino acids: found in a balanced diet • Recommended protein intake: 0.8 g /kg/day • Athletes may benefit from up to 1.4 -2.4 g/kg/day • Most beneficial for athletes on a poor diet, or vegetarians • In endurance athletes, up to 10% of energy expenditure is from protein breakdown

  37. Creatine • The Other 1/2 of the Mark McGuire “Cocktail” • Sales topped $200 million in 1998 • 13% of HS athletes • 50% of NFL players • Vast majority of Olympic sprinters and cyclists

  38. Creatine • Methylguanidine-acetic acid - made from glycine, arginine & methionine • Estimated Daily requirement: 2gms • Available in meats and fish (1/2 EDR) • Sold as Creatine Monohydrate • Stored in Skeletal MM

  39. Mechanism of Action : • Methylguanidine-acetic acid - made from glycine, arginine & methionine • Estimated Daily requirement: 2gms • Available in meats and fish (1/2 EDR) • Sold as Creatine Monohydrate • Stored in Skeletal MM

  40. Benefits: • Improved performance in repeated bouts of high intensity strength work and sprints • Single sprint activity results are equivocal • Does not enhance endurance exercise • More work with less lactic acid production • No studies on competetion benefits • 1998 ACSM meeting: 19/19 studies showed significant ergogenic benefit

  41. Dosing: • Phase: 20-30 gm/d, x 5 -7 days • Maintenance phase: 2-5 gm/day • Loading increases PCr stores by 10-40% • Normal resting levels of creatine: 100-150 mM/kg • Most striking benefits occur in subjects with lower resting Cr level • After saturation of tissues, excessive supplementation is renally excreted

  42. Side Effects: • Muscle Cramping • Diarrhea • Dizziness • Dehydration • Biggest danger: getting “impure” creatine • Significant WEIGHT GAIN common 2nd to water retention

  43. The Perfect Supplement? • “The secret is to find something that is effective in improving performance, but not against the rules, and with no side effects” • “…no clear evidence of harmful side effects of creatine use has emerged…”--The Physician and Sportsmedicine, June 1998 • Long term effects of Creatine not yet studied: Concerns focus on effects to kidney, pancreas, and liver.

  44. Counseling your patients • Creatine may or may not improve performance • Weight gain will occur • Side effects (especially long-term) not well known • Take a thorough medical history • Monitor renal and liver fct. • Make sure they’re taking reccomended dose

  45. L-Carnitine • Synthesized in Liver/ Kidney from Lysine & Methionine • found in meats & dairy products • Assists in Fat transportation into muscle mitochondria for oxidation, sparing Glycogen & may prevent lactic acid accumulation • Improved endurance performance not shown in studies

More Related