Performance-Enhancing Drugs & Methods

1. Performance-Enhancing Drugs & Methods Chapter 16

2. 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 individual’s endurance or capacity for exercise.

3. Variations of Steroids and Performance-Enhancing Substances

4. Why do athletes take anabolic steroids or performance-enhancing substances? To: • Boost athletic performance • Build muscle • Increase body mass • Lose body fat

5. What influences an athlete to take anabolic steroids or performance-enhancing substances?

6. Desire to Emulate Role Models

7. Peer Pressure to Succeed

8. Media Influences Images that portray steroids in a positive light

9. Cover Stories About Steroids

10. Desired Body Image Based on Gender

11. Dangers of Anabolic Steroids and Performance-Enhancing Substances Steroids are dangerous for two reasons: • They are ILLEGAL. • They can damage a person’s mental and physical health. • If used by adolescents, can have permanent negative consequences

12. 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 athlete’s career for good Needle sharing results in higher risk for serious infections like Hepatitis B and C or HIV, which causes AIDS Baldness Some Health Risks for Both Males and Females:

13. Young Females Self-esteem Depression/mood Body image* Media* Young Males Risky behavior Impulsivity Body image* Media* Gender Differences and Risks of Drug Use *Specific, based on gender

14. 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

15. 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

16. Health Risks for Both Genders • Internal organ disease: liver, kidneys, arteriosclerosis • Various cancers

17. 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

18. 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.

19. Definition of “Stacking” • Users often combine several different types of steroids to maximize their effectiveness while trying to minimize negative effects.

20. Slang for anabolic steroids or performance-enhancing substances • You may have heard steroids called: • Roids • Juice • Hype • Pumpers • Gym Candy • Arnolds • Gear • Weight Trainers • Stackers • 420 (pronounced “four-twenty”)

21. 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)

22. Common Myths • Steroids are safe • Taking any kind of steroid will result in death • Injectable steroids are safer than oral steroids • Steroids won’t really stunt your growth • All steroids are pretty much the same • Steroid abuse isn’t really a big problem in the U.S. • All steroids are pills • Only a certain kind of person uses steroids • Steroids aren’t addictive • Steroids aren’t as illegal as other drugs • Steroids build muscle without working out • Women don’t use steroids • Roid rage isn’t real

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

24. 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

25. 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

26. 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

27. 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.

28. 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

29. 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

30. 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

31. 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

32. Creatine cont. • Said to enhance performance & decrease fatigue • No evidence that creatine enhances performance in aerobic or endurance sports

33. 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

34. Creatine cont. • Possible side effects of creatine that can decrease athletic performance: • Stomach cramps • Muscle cramps • Nausea • Vomiting • Diarrhea

35. 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

36. 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

37. 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

38. 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

39. 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)

40. Blood Doping - Side Effects • Transfusion reactions • Infections • Increased viscosity of blood • Stroke, MI, PE

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

42. Beta-2-Agonists • Physiology • Bronchodilation, increased ventilation • Examples: albuterol, terbutaline, salmeterol

43. 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

44. Nitric Oxide-releasing agents • Physiology • Arginine is a precursor of NO • NO regulates BP and blood flow to organs • Most supplements: Arginine α-ketoglutarate • Claims • Improves “pump” and blood flow to muscles • Increases strength and size • Speeds recovery

45. 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

46. Sodium Bicarbonate • Mechanism: buffers metabolic acidosis after strenuous exercise • Proven ergogenic efx in high-intensity exercise • 100m & 200m swim • Repeated sprints • Repeated judo throws

47. 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

48. Bicarbonate • Dose: 0.2 - 0.3 mg/kg • GI side effects common

49. Carbs • Sports drink consumption • Carbohydrate loading

50. Sports Drink Consumption • Evidence supports enhanced endurance performance vs water in events >60 min • No benefit from added protein