performance enhancing substances aka ergogenic substances l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Performance Enhancing Substances aka Ergogenic Substances PowerPoint Presentation
Download Presentation
Performance Enhancing Substances aka Ergogenic Substances

Loading in 2 Seconds...

play fullscreen
1 / 90

Performance Enhancing Substances aka Ergogenic Substances - PowerPoint PPT Presentation


  • 556 Views
  • Uploaded on

Performance Enhancing Substances aka Ergogenic Substances. Kevin deWeber, MD, FAAFP Director, Primary Care Sports Medicine Fellowship USUHS. Adapted from: Scott A. Playford MD, Garry Ho MD. Objectives. Discuss what an ergogenic aid is Discuss why this is important

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Performance Enhancing Substances aka Ergogenic Substances' - paul2


Download Now 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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
performance enhancing substances aka ergogenic substances

Performance EnhancingSubstancesaka Ergogenic Substances

Kevin deWeber, MD, FAAFP

Director, Primary Care Sports Medicine Fellowship

USUHS

Adapted from: Scott A. Playford MD, Garry Ho MD

objectives
Objectives
  • Discuss what an ergogenic aid is
  • Discuss why this is important
  • Discuss specific examples
  • Stay awake…
ergogenic aid defined
Ergogenic Aid - Defined
  • Substance or device that enhances energy production, use, or recovery and provides an athlete with a competitive advantage.
ergogenic aid examples
Ergogenic Aid - Examples
  • Mechanical(shoes)
  • Psychological(hypnosis)
  • Physiologic(blood doping)
  • Nutritional(creatine)
  • Pharmacologic(anabolic steroids)
why do athletes use supplements
Why do athletes use supplements?
  • Provide more convenient form of nutrient
  • Prevent a perceived deficiency
  • Provide direct ergogenic effect
  • Belief that every top athlete is taking it; they can’t afford to lag behind
many athletes will do whatever it takes to win
Many athletes will do whatever it takes to win…
  • In 1995, 198 Olympic-level power athletes were given this scenario:
    • You are offered a banned substance with 2 guarantees:
      • You will not be caught
      • By taking the substance you will win

Only 3 declined!

at any cost
…at any cost
  • The same 198 athletes were offered a banned substance with 2 additional guarantees:
    • You will win every event for the next 5 years
    • You will die at the end of those 5 years

50% still said they would use it!

prevalence
Prevalence

1996-1999 10,449 boys and girls age

12-18 surveyed:

  • 4.7% of boys and 1.6% of girls used protein powder or shake, creatine, amino acids/HMB, DHEA, growth hormone, or anabolic steroids at least weekly to improve appearance or strength
placebo effect in athletes
Placebo effect in athletes
  • Athletes are HIGHLY suggestible
    • 97% believe placebo effect works
    • 73% said they had experienced it
    • Beedie CJ. J Sports Sci Med 2007
  • “Expectancy Effect” is significant
    • Belief in efficacy  performance improvement
  • Pill Colors red/orange/yellow  stimulant
  • Injection > pill
  • Expensive > cheap
nocebo effect in athletes
Nocebo effect in athletes
  • Belief that a substance negatively affects performance
  • 1.57% slower 3x30sec sprints from nocebo
    • Beedie et al.
anabolic steroids
Anabolic Steroids
  • Analogs of testosterone
  • More than 100 types
  • Forms:
    • Oral
    • Injection
    • Topical (gels, creams)
  • Prevalence 2009
    • Jr high: 2%
    • 12th grade: 5% (males 7%, >females 2%)
anabolic steroids proven effects
Anabolic Steroids – Proven Effects
  • Increase in fat-free mass
  • Increase in body weight
  • Increase in arm girth
  • Increase in leg girth
  • Increase in bench press and squat scores
  • Increase in libido
anabolic steroids disproven effects
Anabolic Steroids—Disproven Effects
  • No effect on endurance exercise
    • Males on treadmill
      • Eur J Appl Physiol 2006
    • VO2max in rats
      • Med Sci Sports Exer 2004
anabolic steroids side effects
Anabolic Steroids - Side Effects
  • Hepatocellular damage
  • Cardiovascular disease (stroke, MI)
  • Psychological disturbance

Effects can sometimes be permanent!

side effects of anabolic androgenic steroids abuse followed body builders for 2 years
“Side effects of anabolic androgenic steroids abuse”Followed body builders for 2 years
  • Decr LH, FSH, SHBG
  • Decr sperm count and fertility index
  • Decr HDL (57  42)
  • No change liver/prostate US, hematological indices
more side effects
More side effects…
  • Men
    • Acne
    • Premature baldness
    • Prostatic hypertrophy
    • Prostatitis
    • *Injection complications
    • Testicular atrophy
    • *Impotence
    • *Gynecomastia
more side effects18
More side effects…
  • Adolescents
    • Premature closure of physes
    • Decreased libido
    • Depression
more side effects19
More side effects…
  • Women
    • Clitoral enlargement
    • Menstrual dysfunction
    • Male-pattern baldness
    • *Masculinization
    • Deepening of voice
    • *Hirsutism
side effects that can be permanent
Side effects that can be PERMANENT
  • Premature growth plate closure
  • Testicular atrophy
  • Gynecomastia
  • Male pattern baldness
  • Female masculinization
  • Excessive hair growth
  • Deepening voice
  • Clitoral enlargement
anabolic steroid regulation
Anabolic Steroid regulation
  • Illegal except by prescription
  • Banned by the USADA, NCAA, NFL, NBA, and MLB
prohormones
Prohormones
  • Precursors of testosterone
    • Androstenedione
    • Dehydroepiandrosterone
    • Androstenediol
prohormones the evidence
Prohormones – the evidence
  • No improvement in strength or lean body mass
  • *Causes positive urine test for steroids
prohormones side effects
Prohormones - Side Effects
  • May be similar to anabolic steroids, but probably less frequent.
prohormone regulation
Prohormone regulation
  • Anabolic Steroid Control Act of 2004
    • prohormones classified as controlled substances
  • Banned
    • USADA, NCAA, NFL, NHL, NBA, MLS
stimulants28
Stimulants
  • Caffeine
  • Amphetamines
  • Cocaine
  • Sympathomimetics
    • Ephedrine
    • Pseudoephedrine
    • Phenylephrine
    • Phenylpropanolamine (PPA)
  • Modafinil (Provigil)
stimulant use prevalence
Stimulant Use Prevalence
  • Ephedrine:
    • 3.5% in NCAA athletes
      • Clin J Sports Med 2001
    • 12% of HS boys/26% of girls have tried
      • Med Sci Sports Exer 2002
  • Caffeine
    • 33% of British club track/field athletes
    • 60% of British club cyclists
      • Chester N, Int J Sports Med 2008
caffeine s proven effects
Caffeine’s Proven Effects
  • Increased time to fatigue (”capacity”) in wide range of lab protocols
    • Prolonged submaximal (> 90 min)
    • Sustained high-intensity (20-60 min)
    • Short-duration supra-max (1-5 min)
  • Likely beneficial in endurance and “stop-n-go” sports
  • No clear benefit in strength/power events
caffeine in endurance running
Caffeine in Endurance Running
  • 4.2-sec faster 1.5-km
  • 1-3% faster 5-km
  • 24-sec faster 8-km
  • 50-sec faster 10-km military pack march
  • No change in 21-km race
  • Improved treadmill time-to-exhaustion in marathoners
caffeine in other sports
Caffeine in Other Sports
  • Rowing: 1-3% faster 2000m race
  • Swimming: 24-sec faster 1500m race
    • About 21 min
  • Cycling: 3.5% higher mean power in 40km race
caffeine dosing
Caffeine Dosing
  • Doses 2-9 mg/kg in studies
      • 2-5 mg/kg usually effective
      • 250-500 mg
    • Cola: 40 mg
    • Coffee: 100 mg
    • Tea: 20-100 mg
    • Red Bull: 115 mg
    • Vivarin: 200 mg
  • No difference in fx between “users” and “non-users”
caffeinated sports drinks
Caffeinated Sports Drinks
  • No proven performance benefit
    • 18-km run times
    • Pl vs carb drink vs carb+150mg caffeine
    • consumed 4x in race
    • Int J Sports Med 2005
ephedrine
Ephedrine
  • 78-sec faster 10-km run (with backpack & helmet) vs placebo
    • 30-sec faster than caffeine
      • -0.8 mg/kg
    • No benefit when added to caffeine
modafinil
Modafinil
  • Cycling at 85% VO2max
    • 22% longer time to exhaustion vs Placebo
      • 18.3 min vs 15.6
    • Central mechanism: decreased RPE
    • Dose 4 mg/kg
    • No side-efx seen
stimulant mechanisms of action
Stimulant Mechanisms of Action
  • Not conclusively known
  • Likely: CNS-regulated decreased perceived exertion
stimulants side effects
Stimulants - Side Effects
  • Anxiety*
  • Dysrhythmias*
  • Hypertension*
  • Hallucinations
  • Addiction
  • Death
stimulant regulation
Stimulant regulation
  • Many prohibited by WADA & NCAA
    • Most ADHD meds
  • Some still allowed (cold meds)
    • Pseudephedrine, PPA
  • Caffeine
    • WADA: no longer monitored
    • NCAA < 15 mcg/ml
    • 1 cup coffee = 100mg = 1.5 mcg/ml in urine
blood doping
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
blood doping proven effects
Blood Doping – proven effects
  • Increased Endurance
    • 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)

blood doping side effects
Blood Doping - Side Effects
  • Infections with transfusions
  • Increased viscosity of blood
    • Stroke, MI, PE
blood doping regulation
Blood Doping - regulation
  • Erythropoietin only by prescription
  • Doping prohibited by WADA, NCAA
  • Blood tested for antigens
  • Ceiling on allowable Hct level at 50
beta 2 agonists
Beta-2-Agonists
  • Physiology
    • Bronchodilation, tachycardia
    • Examples: albuterol, terbutaline, salmeterol
beta 2 agonists proven effects
Beta-2-Agonists – proven effects
  • Clear benefit in asthma and EIB
    • No increase in ventilation of performance in studies of NON-asthmatic athletes
  • Clenbuterol: anabolic (25% as effective as anabolic steroids)
  • Side effects: tremor, tachycardia
  • Regulation
    • WADA: most prohibited
    • NCAA: inhalation permitted
beta blockers
Beta blockers
  • Physiology
    • Decreased heart rate, reduced tremor, lower BP
  • Examples
    • Atenolol
    • Metoprolol
    • Propranolol
  • Efficacy in sports
    • Proven improved scores in shooting sports
beta blockers47
Beta blockers
  • Side effects
    • Hypotension, bronchospasm, bradycardia
  • Regulation
    • NCAA: banned in Rifle sports
    • WADA: banned in…
      • Aeronautic, archery, autos, billiards, bobsled, boules, bridge, curling, golf, gymnastics, motorcycling, modern pentathlon, powerboating, bowling, sailing, shooting, skiing, snowboarding, wrestling
    • Alcohol banned for same reason
creatine
Creatine
  • Most popular nutritional supplement
  • In 2000, >$300 million in sales in the US
creatine49
Creatine
  • Replenishes ATP in anaerobic exercise
    • Made in liver, kidneys, and pancreas
    • Dietary sources: meat, fish
    • Stored in skeletal muscle
    • Excreted as creatinine in urine
creatine disproven effects
Creatine – disproven effects
  • Meta-analysis 2002:
    • NO overall benefit on anaerobic performance (weight lifting, sprint cycling, spring running, sprint swimming, kayaking, arm cranking, or jumping/kicking)
    • 29 quality studies
      • 35% were statistically significant between Cr and Placebo
      • 65% NON statistically significant
creatine disproven effects51
Creatine – disproven effects
  • Meta-analysis 2003:
    • No significant difference in field-based athletic performance (e.g. running, swimming)

X

X

X

X

X

X

X

X

Branch JD. Int J Sports Nutr Exerc Metab June 2003

creatine proven effects
Creatine – proven effects
  • 2003 meta-analysis of strength efx:
    • 8% increase in 1RM strength vs placebo (20% vs 12%)
    • 14% increase in # of reps
    • Highly variable response
  • Body Composition
    • Increase in weight and lean body mass by 1-2 kg over short term

Rawson, Volek. J Strength Cond Res 2003.

creatine mechanisms of action
Creatine Mechanisms of Action
  • Increases PCr energy availability
    • ->Increased effort in resistance training
slide55

Increased gene expression for contractile proteins

    • ? Due to more available energy
  • Increased contractile protein synthesis
creatine side effects
Creatine - Side Effects
  • Studies of 2-10 weeks: no side efx
  • Long term:
creatine regulation
Creatine - regulation
  • Not banned anywhere
  • Surveys suggest ~ 50% of male college athletes and 1/3 of all NFL players are on creatine
hydroxy methylbutyrate hmb
β-Hydroxy-Methylbutyrate (HMB)
  • Physiology
    • A metabolite of the essential amino acid leucine
    • Produced in small amounts endogenously
    • Regulates protein metabolism
      • Less catabolism, more anabolism
      •  ? Increased muscle mass
hmb proven effects
HMB – proven effects
  • Meta-analysis 2003:
    • Small increase in lean mass and 25% greater strength vs placebo
  • Greater effect in untrained persons
    • Less muscle breakdown
    • Some utility in muscle wasting
  • Side-efx: none reported in 3 studies
  • Non-regulated

Nissen, Sharp. J Appl Physiol 2003

buffering agents proven
Buffering Agents: proven
  • Mitigate metabolic acidosis after strenuous exercise
    • Bicarbonate, citrate
  • NaHCO3: Proven ergogenicefx in high-intensity exercise
    • 100m & 200m swim
    • 400 & 800 m run
    • Repeated sprints
    • Repeated judo throws
    • 30 min high-intensity running
    • 60 min max-effort cycle ergometry
  • Citrate less effective in studies
bicarbonate
Bicarbonate
  • Dose: 0.2 - 0.3 mg/kg
  • GI side effects common
alanine
β-Alanine
  • Supplementation results in higher skeletal muscle CARNOSINE, an intracellular buffer
  • Proven effective in high-intensity anaerobic performance
    • >1 to <5 min duratio n
      • Acidosis most prominent
    • Delays onset of neuromusc fatigue
    • Increased time to exhaustion
    • (no change in VO2max or max strength)
alanine64
β-Alanine
  • Dose
    • 3.2 – 6.4 gm/day
    • Effective after 4 week supplementation
    • 800 mg qid or 1600 mg slow-release qid
  • Side-efx: paresthesias at doses higher than above
    • No others reported
  • Not regulated or prohibited
nitric oxide releasing agents
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
nitric oxide releasing agents the evidence
Nitric Oxide-releasing agents: the evidence
  • Several studies in performance
    • Endurance exercise:
      • No benefit in endurance athletes
      • Limited evidence of benefit in debilitated pts
    • Strength exercise: mixed results, no benefit proven, more studies needed
nitric oxide releasing agents67
Nitric Oxide-releasing agents
  • Side effects
    • Diarrhea, nausea, migraines
  • Regulation: none
peptide hormones analogues
Peptide Hormones & Analogues
  • Adreno-corticotripon (ACTH)
  • Growth hormone (hGH)
  • Chorionic gonadotropin (hCG)
  • Insulin-like growth factor (ILGF-1)
  • Leutenizing hormine (LH)
  • Erythropoietin (EPO) etc.
diuretics urine manipulators
Diuretics & Urine Manipulators
  • Can be used to mask urine tests
  • Examples
    • Acetazolamide (altitude sickness)
    • Furosemide (Lasix)
    • Spironolactone (acne, HF)
    • Hctz (Htn)
anti estrogens
Anti-Estrogens
  • Often used to counteract side-efx of anabolic steroids
    • Tamoxifen (breast cancer)
    • clomiphene (infertility)
other substances
Other Substances
  • NO proven ergogenic effects from:
    • Citrulline, Carnitine,
    • Coenzyme Q, Colostrum
    • Asparagine, Arginine, Pyruvate, Ribose
    • Choline, Chromium picolinate
    • Antioxidants, Bee pollen, Boron
    • Folate, Gamma-hydroxy-butyrate
    • Inosine, leucine
    • Yohimbine
    • Vitamins and Minerals
    • Branched chain amino acids
      • Inconsistent effects in Overtraining Syndrome
supplements herbals energy drinks
Supplements, Herbals, Energy Drinks
  • ‘TAKE AT YOUR OWN RISK’
    • Be VERY cautious to recommend any
  • Not tested by the FDA
    • Often contain traces of banned substances
    • May not contain what label says
  • No such thing as “side-effect free!”
  • Some supplement ingredients are discussed on USADA at http://www.usantidoping.org.dro/
contamination facts
Contamination facts
  • 2001 IOC international study;
    • 634 non-hormonal supplements,
    • 15% contained undeclared steroids
  • 2007 study of 58 USA supplements
    • 25% contaminated w/ prohib steroids
    • 11% contaminated w/ prohib stimulants
  • 2008 UK study of 152 supplements
    • 10% contaminated w/ steroids/stim
2010 11 ncaa banned drugs
2010-11 NCAA Banned Drugs
  • The NCAA bans the following classes of drugs:
  • Stimulants
    • Phenylephrine and pseudoephedrine OK
  • b. Anabolic Agents
  • c. Alcohol and Beta Blockers (banned for rifle only)
  • d. Diuretics and Other Masking Agents
  • e. Street Drugs
  • f. Peptide Hormones and Analogues
  • g. Anti-estrogens
  • h. Beta-2 Agonists
anti doping in elite amateur competition
Anti Doping in Elite Amateur Competition
  • WADA rules apply
    • Testing will be done in accordance with WADA/USADA
  • Permitted/Prohibited?

http://www.usantidoping.org.dro

1-800-233-0393

2010 wada prohibited substances
2010 WADA Prohibited Substances
  • Anabolic androgenic steroids
  • Other anabolic agents
    • Clenbuterol, selective androgen receptor modulators (SERM)
  • Erythropoiesis-stimulating agents
  • Growth hormone and growth factors
  • Chorionic gonadotropins, LH
  • Insulins
  • Platelet-rich plasma (IM injection)
    • Other locations require Declaration
2010 wada prohibited substances79
2010 WADA Prohibited Substances
  • Hormone antagonists and modulators
    • DHT blockers (finasteride, dutasteride)
    • They mask anabolic steroid use
  • Diuretics and masking agents
    • Acetazolamide, hctz, spironolactone
    • Plasma expanders; glycerol, IV albumin, etc.
2010 wada prohibited methods
2010 WADA Prohibited METHODS
  • Enhancement of Oxygen Transfer
    • Blood doping (transfusions, etc.)
  • Gene doping
    • Gene transfers
    • Substances than alter gene expression
  • Chemical or mechanical manipulation
    • IV infusions, except if hospitalized
    • Sample tampering
2010 wada prohibited in competition
2010 WADA Prohibited in COMPETITION
  • Stimulants, e.g. ADHD meds
    • Exceptions:
      • Caffeine OK
      • Phenylephrine and PPA OK
      • Ephedrine < 10 mcg/ml
      • Pseudoephedrine < 150 mcg/ml
  • Narcotics
  • Cannabinoids
2010 wada prohibited in competition82
2010 WADA Prohibited in COMPETITION
  • Glucocorticoids by oral, IV, IM, rectal
    • Declaration required for inhalation and other injection sides
    • Topicals OK
2010 wada prohibited in particular sports
2010 WADA Prohibited in PARTICULAR SPORTS
  • Alcohol
    • Aeronautic, archery, auto, karate, shooting, motorcycle, bowling, powerboating
  • Beta-blockers
    • Aeronautic, archery, autos, billiards, bobsled, boules, bridge, curling, golf, gymnastics, motorcycling, modern pentathlon, powerboating, bowling, sailing, shooting, skiing, snowboarding, wrestling
declarations and therapeutic use exemptions
Declarations and Therapeutic Use Exemptions
  • Declaration required for:
    • Non-systemic corticosteroid injections
    • Inhaled albuterol, salmeterol, glucocorticoids
  • TUE required for
    • All other prohibited substances
    • Doc fills out, send to USADA, along with supporting documents
    • Process takes 1-2 months to approve
    • Variable duration
testing during competition
Testing During Competition
  • Commonly tested substances:

• Stimulants • Narcotics

• Cannabinoids

• Glucocorticosteroids

• Anabolic Agents

• Hormones and Related Substances

• Diuretics and other Masking Agents

• Beta-2 Agonists

• Anti-Estrogenics

• Prohibited methods, such as blood doping

If a prohibited substance

or method is detected

in your sample – even

if it was unintentional –

it will result in a

doping violation.

athletes rights during testing
Athletes’ Rights During Testing
  • Having an Athlete Representative and/or Language Specialist present
  • Doping Control Officer (DCO) explain any part of the testing process that you do not understand.
  • A copy of all forms used to document the

processing of your sample.

  • Providing feedback to improve testing policies or

procedures.

Note: If any portion of the test does not seem right to you, document that on the doping control paperwork.

athlete s responsibilities during testing
Athlete’s Responsibilities During Testing
  • Comply with the doping control procedures.
  • Bringing a photo ID to the Doping Control Station.
  • Report to the Doping Control Station within 60

minutes of being notified for testing.

  • Stay within view of the DCO (or Chaperone) from the

time you are notified until the sample collection procedures

are complete.

  • Ensure that all paperwork is completely accurate