Performance-Enhancing Performance-Enhancing DrugsDrugs & Methods & Methods

Chapter 16Chapter 16

Definition of Performance-Definition of Performance-Enhancing SubstanceEnhancing Substance

““Performance-enhancing substance” Performance-enhancing substance” means a manufactured product for oral means a manufactured product for oral ingestion, intranasal application or ingestion, intranasal application or inhalation containing compounds that:inhalation containing compounds that:– Contain a stimulant, amino acid, hormone Contain a stimulant, amino acid, hormone

precursor herb or other botanical or any other precursor herb or other botanical or any other substance other than an essential vitamin or substance other than an essential vitamin or mineralmineral

– Are intended to increase athletic performance, Are intended to increase athletic performance, promote muscle growth, induce weight loss or promote muscle growth, induce weight loss or increase an individual’s endurance or capacity increase an individual’s endurance or capacity for exercise.for exercise.

Variations of Steroids and Variations of Steroids and Performance-Enhancing Performance-Enhancing

SubstancesSubstances

Why do athletes take anabolic Why do athletes take anabolic steroids or performance-steroids or performance-enhancing substances?enhancing substances?

To:To: Boost athletic performanceBoost athletic performance Build muscleBuild muscle Increase body massIncrease body mass Lose body fatLose body fat

What influences an athlete to What influences an athlete to take anabolic steroids or take anabolic steroids or performance-enhancing performance-enhancing

substances?substances?

Desire to Emulate Role Desire to Emulate Role ModelsModels

Peer Pressure to SucceedPeer Pressure to Succeed

Media InfluencesMedia Influences

Images that portray steroids in a positive lightImages that portray steroids in a positive light

Cover Stories About Cover Stories About SteroidsSteroids

Desired Body ImageDesired Body ImageBased on GenderBased on Gender

Dangers of Anabolic Steroids Dangers of Anabolic Steroids and Performance-Enhancing and Performance-Enhancing

SubstancesSubstances

Steroids are dangerous for two reasons:Steroids are dangerous for two reasons:– They are ILLEGAL.They are ILLEGAL.– They can damage a person’s mental and They can damage a person’s mental and

physical health.physical health. If used by adolescents, can have permanent If used by adolescents, can have permanent

negative consequences negative consequences

Some Health Risks for Both Some Health Risks for Both Males and Females:Males and Females:

– Acne, really bad acne, Acne, really bad acne, especially on face and especially on face and backback

– Stunted growth in Stunted growth in teens (by causing teens (by causing bones to mature too bones to mature too fast and stop growing fast and stop growing at an early age)at an early age)

– High blood pressure, High blood pressure, unhealthy cholesterol unhealthy cholesterol changes, and heart changes, and heart diseasedisease

– Blood clots and strokeBlood clots and stroke– Liver damage, Liver damage,

jaundice, or liver jaundice, or liver cancercancer

– Headaches, aching Headaches, aching joints, and muscle joints, and muscle crampscramps

– Increased risk of Increased risk of ligament and tendon ligament and tendon injuries, which can injuries, which can end an athlete’s end an athlete’s career for goodcareer for good

– Needle sharing results Needle sharing results in higher risk for in higher risk for serious infections like serious infections like Hepatitis B and C or Hepatitis B and C or HIV, which causes HIV, which causes AIDS AIDS

– BaldnessBaldness

Gender Differences and Risks Gender Differences and Risks of Drug Useof Drug Use

Young FemalesYoung Females

Self-esteemSelf-esteem Depression/moodDepression/mood Body image*Body image* Media*Media*

Young MalesYoung Males

Risky behaviorRisky behavior ImpulsivityImpulsivity Body image*Body image* Media* Media*

*Specific, based on gender

Health Risks for Males:Health Risks for Males:

Shrinking of the testiclesShrinking of the testicles Low sperm countLow sperm count Impotence (inability to get an erection)Impotence (inability to get an erection) Increased breast growth in males, Increased breast growth in males,

especially teensespecially teens Possible lactatingPossible lactating Enlarged prostateEnlarged prostate

Health Risks for Females:Health Risks for Females:

Breast shrinkageBreast shrinkage Male-type facial and body hair growthMale-type facial and body hair growth Deepening of the voiceDeepening of the voice Problems with menstrual periodsProblems with menstrual periods Enlarged clitorisEnlarged clitoris Insatiable sex drive Insatiable sex drive

Health Risks for Both Health Risks for Both GendersGenders

Internal organ disease: liver, kidneys, Internal organ disease: liver, kidneys, arteriosclerosisarteriosclerosis

Various cancers Various cancers

Psychological Health Risks:Psychological Health Risks:

““Roid rage”- severe, aggressive behavior Roid rage”- severe, aggressive behavior that may result in violence, such as that may result in violence, such as fighting or destroying propertyfighting or destroying property

Severe mood swingsSevere mood swings Paranoia- extreme feelings of mistrust and Paranoia- extreme feelings of mistrust and

fearfear Anxiety and panic attacksAnxiety and panic attacks Depression and thoughts of suicideDepression and thoughts of suicide

Definition of “Cycling”Definition of “Cycling”

Anabolic steroids are taken orally or Anabolic steroids are taken orally or injected, typically in cycles of weeks injected, typically in cycles of weeks or months, rather than continuously.or months, rather than continuously.

Cycling involves taking multiple Cycling involves taking multiple doses of steroids over a specific doses of steroids over a specific period of time, stopping for a period, period of time, stopping for a period, and starting again.and starting again.

Definition of “Stacking”Definition of “Stacking”

Users often combine several different Users often combine several different types of steroids to maximize their types of steroids to maximize their effectiveness while trying to effectiveness while trying to minimize negative effects.minimize negative effects.

Slang for anabolic steroids or Slang for anabolic steroids or performance-enhancing performance-enhancing

substancessubstances You may have heard steroids You may have heard steroids

called:called:– RoidsRoids– Juice Juice – HypeHype– PumpersPumpers– Gym CandyGym Candy– ArnoldsArnolds– GearGear– Weight TrainersWeight Trainers– StackersStackers– 420 (pronounced “four-twenty”)420 (pronounced “four-twenty”)

What should you look for if you are What should you look for if you are concerned that an athlete may be concerned that an athlete may be

taking anabolic steroids or taking anabolic steroids or performance-enhancing substances?performance-enhancing substances?

Unfortunately, many of the symptoms of steroid Unfortunately, many of the symptoms of steroid abuse look very similar to typical appearances abuse look very similar to typical appearances and attitudes that occur during adolescence. and attitudes that occur during adolescence. Here are some signs to look for:Here are some signs to look for:– Increased aggressionIncreased aggression– Rapid weight gain (10 lb/month or 40lb/year)Rapid weight gain (10 lb/month or 40lb/year)– Pustular acne Pustular acne – An obsession with and bragging about increased An obsession with and bragging about increased

performance (i.e. increased bench press)performance (i.e. increased bench press)– Virilization in females (lowering of voice; facial hair, male Virilization in females (lowering of voice; facial hair, male

pattern of hair growth on body)pattern of hair growth on body)

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

Common MythsCommon Myths

StimulantsStimulants

Drugs that can reduce fatigue, Drugs that can reduce fatigue, suppress appetite, and increase suppress appetite, and increase alertness & aggressivenessalertness & aggressiveness

Stimulate the CNS, increase your Stimulate the CNS, increase your heart rate, blood pressure, body heart rate, blood pressure, body temperature & metabolismtemperature & metabolism

Stimulants cont.Stimulants cont.

Most common include caffeine and Most common include caffeine and amphetaminesamphetamines

Cold remedies often contain the Cold remedies often contain the stimulants ephedrine & stimulants ephedrine & pseudoephedrine (Sudafed)pseudoephedrine (Sudafed)

Street drugs such as cocaine & Street drugs such as cocaine & methamphetamine belong to this methamphetamine belong to this groupgroup

Stimulants cont.Stimulants cont.

Can boost physical performance & Can boost physical performance & promote aggressiveness on the fieldpromote aggressiveness on the field

Have side effects that can impair Have side effects that can impair athletic performanceathletic performance– Nervousness & irritability, insomniaNervousness & irritability, insomnia– Can become psychologically addicted or Can become psychologically addicted or

develop a tolerance so that they need develop a tolerance so that they need greater amounts to achieve the desired greater amounts to achieve the desired effecteffect

Stimulants cont.Stimulants cont.

Other side effects may include:Other side effects may include:– Heart palpitationsHeart palpitations– Heart rhythm abnormalitiesHeart rhythm abnormalities– Weight lossWeight loss– Mild hypertension Mild hypertension – HallucinationsHallucinations– ConvulsionsConvulsions– Brain hemorrhageBrain hemorrhage– Heart attack & other circulatory problemsHeart attack & other circulatory problems

EphedraEphedra Erythropoetin (EPO) increases enduranceErythropoetin (EPO) increases endurance Ephedra delays fatigueEphedra delays fatigue

– On April 12, 2004, the Food and Drug On April 12, 2004, the Food and Drug Administration prohibited the sale of dietary Administration prohibited the sale of dietary supplements containing ephedrine alkaloids supplements containing ephedrine alkaloids (ephedra). (ephedra).

– Ephedra, also called Ma huang, is a naturally Ephedra, also called Ma huang, is a naturally occurring substance derived from plants. Its occurring substance derived from plants. Its principal active ingredient is ephedrine, principal active ingredient is ephedrine, which when chemically synthesized is which when chemically synthesized is regulated as a drug.regulated as a drug.

Ephedra cont.Ephedra cont. Ephedra products have been Ephedra products have been

extensively promoted to aid weight extensively promoted to aid weight loss, enhance sports performance, loss, enhance sports performance, and increase energy. and increase energy.

Linked to significant adverse health Linked to significant adverse health effects, including heart attacks and effects, including heart attacks and strokes strokes

Increased risk of side effects, Increased risk of side effects, possibly may be fatalpossibly may be fatal

No evidence that ephedra products No evidence that ephedra products enhance athletic performanceenhance athletic performance

Short-term weight loss may be the Short-term weight loss may be the only benefitonly benefit

CreatineCreatine

Formal name is creatine Formal name is creatine monohydratemonohydrate

Compound produced by your body Compound produced by your body that helps release energy in your that helps release energy in your musclesmuscles

Naturally occurring compoundNaturally occurring compound– Can also ingest creatine from protein-Can also ingest creatine from protein-

rich foods such as meat or fish rich foods such as meat or fish – Take a nutritional supplementTake a nutritional supplement

Creatine cont.Creatine cont.

May be able to produce small gains May be able to produce small gains in short-term bursts of powerin short-term bursts of power– Improving maximum-weight bench Improving maximum-weight bench

press or increasing speeds of very short press or increasing speeds of very short durationduration

Some studies show an increase in Some studies show an increase in lean muscle masslean muscle mass

Creatine cont.Creatine cont.

Helps muscles make & circulate Helps muscles make & circulate adenosine triphosphate (ATP)adenosine triphosphate (ATP)– Nucleotide that helps give you energyNucleotide that helps give you energy– ATP is used for quick, explosive bursts of ATP is used for quick, explosive bursts of

activity (weightlifting & sprinting)activity (weightlifting & sprinting) Also reduces energy waste products, Also reduces energy waste products,

such as lactic acidsuch as lactic acid– Can cause muscle fatigueCan cause muscle fatigue

Creatine cont.Creatine cont.

Said to enhance performance & Said to enhance performance & decrease fatiguedecrease fatigue

No evidence that creatine enhances No evidence that creatine enhances performance in aerobic or endurance performance in aerobic or endurance sportssports

Creatine cont.Creatine cont.

Liver produces about 2 grams of Liver produces about 2 grams of creatine each daycreatine each day

Stored in muscles, and levels are Stored in muscles, and levels are easily maintainedeasily maintained

Kidneys will remove excess creatine, Kidneys will remove excess creatine, the value of supplements to the value of supplements to someone who already has a high someone who already has a high muscle creatine content is muscle creatine content is questionablequestionable

Creatine cont.Creatine cont.

Possible side effects of creatine that Possible side effects of creatine that can decrease athletic performance:can decrease athletic performance:– Stomach crampsStomach cramps– Muscle crampsMuscle cramps– NauseaNausea– VomitingVomiting– DiarrheaDiarrhea

Creatine cont.Creatine cont.

Weight gain is a known side effectWeight gain is a known side effect– After prolonged use, weight gain is more After prolonged use, weight gain is more

likely the result of water retention than likely the result of water retention than an increase in muscle tissuean increase in muscle tissue

High doses can potentially damage:High doses can potentially damage:– KidneysKidneys– LiverLiver– HeartHeart

Creatine cont.Creatine cont.

Unknown the effects from long-term Unknown the effects from long-term usageusage– Dosage levels vary widely depending on Dosage levels vary widely depending on

product & how much creatine you takeproduct & how much creatine you take Not regulated by FDANot regulated by FDA

– Not sure of purity on marketNot sure of purity on market

Creatine cont.Creatine cont. Improves energy and performance in brief, Improves energy and performance in brief,

high-intensity activitieshigh-intensity activities Short-term advantages — increased energy Short-term advantages — increased energy

in short bursts; can aid in improving athletic in short bursts; can aid in improving athletic anaerobic performance (weight lifting; anaerobic performance (weight lifting; sprinting; rowing); delays muscle fatiguesprinting; rowing); delays muscle fatigue

Known disadvantages — requires serious Known disadvantages — requires serious strength training program; dehydrates blood strength training program; dehydrates blood stream, so requires excessive consumption stream, so requires excessive consumption of water; with the consumption of excessive of water; with the consumption of excessive amounts it has the potential to cause renal amounts it has the potential to cause renal disease disease

Blood DopingBlood Doping

Increasing the number of red Increasing the number of red blood cells in the body to blood cells in the body to increase the oxygen carried to increase the oxygen carried to musclemuscle– Administration of blood, red blood cells, Administration of blood, red blood cells,

or related blood productsor related blood products– ErythropoietinErythropoietin

Stimulates bone marrow to produce red Stimulates bone marrow to produce red blood cellsblood cells

Blood Doping – proven Blood Doping – proven effectseffects

7% increase in Hgb7% increase in Hgb 5% increase in VO2 max5% increase in VO2 max 34% increase in time to 34% increase in time to

exhaustion at 95% VO2 exhaustion at 95% VO2 maxmax

44 second improvement in 44 second improvement in 5 mile treadmill run time5 mile treadmill run time

(Williams and Branch summarized study findings)(Williams and Branch summarized study findings)

Blood Doping - Side EffectsBlood Doping - Side Effects

Transfusion reactionsTransfusion reactions InfectionsInfections Increased viscosity of bloodIncreased viscosity of blood

– Stroke, MI, PEStroke, MI, PE

Blood Doping - regulation Blood Doping - regulation

Erythropoietin only by prescriptionErythropoietin only by prescription Doping banned by USADA, NCAADoping banned by USADA, NCAA Blood tested for antigensBlood tested for antigens Ceiling on allowable Hct level at 50Ceiling on allowable Hct level at 50

Beta-2-AgonistsBeta-2-Agonists

PhysiologyPhysiology– Bronchodilation, increased ventilationBronchodilation, increased ventilation– Examples: albuterol, terbutaline, Examples: albuterol, terbutaline,

salmeterolsalmeterol

Beta-2-Agonists – proven Beta-2-Agonists – proven effectseffects

Clear benefit in asthma and EIBClear benefit in asthma and EIB– Increased ventilationIncreased ventilation

No increase in performance in NON-No increase in performance in NON-asthmatic athletesasthmatic athletes

Side effects: tremor, tachycardiaSide effects: tremor, tachycardia RegulationRegulation

– USADA: prohibitedUSADA: prohibited– NCAA: inhalation permittedNCAA: inhalation permitted

Nitric Oxide-releasing Nitric Oxide-releasing agentsagents

PhysiologyPhysiology– Arginine is a precursor of NOArginine is a precursor of NO– NO regulates BP and blood flow NO regulates BP and blood flow

to organsto organs– Most supplements: Arginine Most supplements: Arginine αα--

ketoglutarateketoglutarate ClaimsClaims

– Improves “pump” and blood flow Improves “pump” and blood flow to musclesto muscles

– Increases strength and sizeIncreases strength and size– Speeds recoverySpeeds recovery

Nitric Oxide-releasing agentsNitric Oxide-releasing agents

Endurance exercise studiesEndurance exercise studies No benefit in endurance athletesNo benefit in endurance athletes Limited evidence of benefit in Limited evidence of benefit in

debilitated ptsdebilitated pts Strength exercise: mixed Strength exercise: mixed

results, no proven benefitresults, no proven benefit More studies neededMore studies needed

Sodium BicarbonateSodium Bicarbonate

Mechanism: buffers metabolic Mechanism: buffers metabolic acidosis after strenuous exerciseacidosis after strenuous exercise

Proven ergogenic efx in high-intensity Proven ergogenic efx in high-intensity exerciseexercise– 100m & 200m swim100m & 200m swim– Repeated sprintsRepeated sprints– Repeated judo throwsRepeated judo throws

BicarbonateBicarbonate

Limited & conflicting evidence of Limited & conflicting evidence of benefit in aerobic exercisebenefit in aerobic exercise– High-intensity running: 17% better time-High-intensity running: 17% better time-

to-exhaustion (30 vs 26 min)to-exhaustion (30 vs 26 min)– 60-min max-effort cycle ergometry: 14% 60-min max-effort cycle ergometry: 14%

higher power vs Placebohigher power vs Placebo– 60-min high-intensity cycling: no 60-min high-intensity cycling: no

difference vs Placebodifference vs Placebo

BicarbonateBicarbonate

Dose: 0.2 - 0.3 mg/kgDose: 0.2 - 0.3 mg/kg GI side effects commonGI side effects common

CarbsCarbs

Sports drink consumptionSports drink consumption Carbohydrate loadingCarbohydrate loading

Sports Drink ConsumptionSports Drink Consumption

Evidence supports enhanced Evidence supports enhanced endurance performance vs water in endurance performance vs water in events >60 minevents >60 min

No benefit from added proteinNo benefit from added protein

CarbohydrateCarbohydrate Loading Loading

Known to increase muscle glycogen Known to increase muscle glycogen levels 13% - 100%levels 13% - 100%

Prolongs time to exhaustion 2-3% in Prolongs time to exhaustion 2-3% in endurance events >90 minutesendurance events >90 minutes

Higher effect in Untrained personsHigher effect in Untrained persons– 25-km treadmill25-km treadmill

Methods of Carbo LoadingMethods of Carbo Loading

Classic 6-day regimenClassic 6-day regimen– 3 days intense glycogen-depleting exercise3 days intense glycogen-depleting exercise– 3 days high-CH diet, no exercise3 days high-CH diet, no exercise

Modified 6-day regimenModified 6-day regimen– 3-day exercise taper, normal diet3-day exercise taper, normal diet– High-CH (70%) & light exercise 3d priorHigh-CH (70%) & light exercise 3d prior

Single-day regimenSingle-day regimen– 10 gm/kg/day CH 1-day prior10 gm/kg/day CH 1-day prior– Normal exercise regimenNormal exercise regimen

Carbohydrate Loading ‘s Carbohydrate Loading ‘s

Little standardization of methodsLittle standardization of methods– Athletes need to try methods prior to Athletes need to try methods prior to

competition to see what workscompetition to see what works Exact roles of glycogen-depleting Exact roles of glycogen-depleting

exercise, type of CH, and timing are exercise, type of CH, and timing are unclearunclear

Miscellaneous LosersMiscellaneous Losers

Vitamin E and other vitaminsVitamin E and other vitamins Minerals: Cr, Mg, Zn, SeMinerals: Cr, Mg, Zn, Se L-CarnitineL-Carnitine AntioxidantsAntioxidants PyruvatePyruvate ArginineArginine Hydroxy-methyl-butyrate (HMB)Hydroxy-methyl-butyrate (HMB)

DiureticsDiuretics

Drugs that change your body’s Drugs that change your body’s natural balance of fluids & saltsnatural balance of fluids & salts

Can lead to dehydrationCan lead to dehydration– Water loss may allow an athlete to Water loss may allow an athlete to

compete in a lighter weight classcompete in a lighter weight class

DiureticsDiuretics

Commonly used to treat high blood Commonly used to treat high blood pressure & conditions that cause pressure & conditions that cause fluid retention (edema)fluid retention (edema)– Such as congestive heart failureSuch as congestive heart failure

May cause:May cause:– Muscle cramps, exhaustion, decreased Muscle cramps, exhaustion, decreased

ability to regulate body temperature, ability to regulate body temperature, potassium deficiency, & heart potassium deficiency, & heart arrhythmiasarrhythmias

Diuretics cont.Diuretics cont.

Used to increase the amount of urine Used to increase the amount of urine produced and to increase kidney produced and to increase kidney function, thereby speeding up the function, thereby speeding up the elimination of fluid from the bodyelimination of fluid from the body

In turn this will cause rapid weight In turn this will cause rapid weight loss in sports where performers are loss in sports where performers are required to compete within strict required to compete within strict weight boundariesweight boundaries

What healthcare What healthcare professionals can do…professionals can do…

Be clear about your expectations

Talk to student athletes that unless the long-term effects of performance-enhancing drugs on young athletes are known to be safe, you expect him or her to avoid them

Discuss alternatives to performance enhancers, include sports nutrition and strength training techniques

Set rules. For example, if a student uses performance-enhancing drugs, he or she will be removed from the team

Teach students that short-term gains can lead to long-term problems.

What to do…continuedWhat to do…continued

Discuss ethics and proper training. Athletes should compete fairlyRemind them that using a performance-enhancing drug is similar to cheating, but even more importantly, could lead to serious health problems or even death. Another key message is that a balanced diet and rigorous training are the true keys to athletic performanceEncourage the student athlete to feel good about his or her sports performanceMonitor for signs of drug use. Signs the student may be taking anabolic steroids include increased acne and male-pattern baldness. If a female takes anabolic steroids, she may develop male characteristics, such as a deep voice or dark facial hair. Teens who take anabolic steroids may seem unusually moody and have angry outbursts known as ‘roid rage’Discuss the school district’s policy concerning anabolic steroids and other performance enhancing drugs with all student athletes

Anabolic Steroids and Anabolic Steroids and Performance-Enhancing Performance-Enhancing Substances PreventionSubstances Prevention

Least Effective MethodLeast Effective Method::– Simply teaching students about steroids’ Simply teaching students about steroids’

harmful effects does not convince harmful effects does not convince adolescents that they personally will be adolescents that they personally will be adversely affected. adversely affected.

More Effective Method:More Effective Method:– Presenting both the risks and benefits of Presenting both the risks and benefits of

steroid use is more effective in convincing steroid use is more effective in convincing adolescents about steroids’ negative adolescents about steroids’ negative effects, because they find a balanced effects, because they find a balanced approach more credible and less biased. approach more credible and less biased.

Anabolic Steroids and Anabolic Steroids and Performance-Enhancing Performance-Enhancing Substances PreventionSubstances Prevention

MOST EFFECTIVE Method:MOST EFFECTIVE Method:– Science-based, research-based Science-based, research-based

curriculum with predictable outcomes, curriculum with predictable outcomes, combined with credible, unbiased facts.combined with credible, unbiased facts.