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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.

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ERGOGENIC AIDS Andy McGown, MD

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  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

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