Sports Doping

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Sports Doping

• Ed Chung
• May 7, 2002

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Introduction

• In 1997, Sports Illustrated asked 198 aspiring US
  Olympians,
• Would you take a banned performance
  enhancing substance if you were guaranteed to win
  and not get caught?
• 98 said YES

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Introduction

• Then, when asked,
• Would you take the same undetectable
  substance if it would contribute to winning every
  competition for 5 years, then result in death?
• Over 50 still said YES!!!

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Prevalence

• Over 1,000,000 Americans have used anabolic
  steroids 250,000 of them adolescents
• 5-14 of NCAA atheletes
• 35 of 11-18 yr olds believe caffeine will
  enhance athletic performance 25 have used
  (1993 Canadian national school survey)
• Significant increases in creatine and
  androstenedione sales after 1998 MLB home run
  race between McGwire and Sosa

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IOC prohibited substances

• Anabolic agents
• Peptide hormones, mimetics, and analogues
• Stimulants
• Diuretics
• Narcotics

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Anabolic Agents

• Enhance muscle mass gained from strength training
• - Anabolic steriods
• - Testosterone precursors

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Anabolic Steroids

• Testosterone derivatives modified to increase
  anabolic effects while decreasing androgenic
  effects
• Doses may reach 100X medical replacement dose
• Efficacy in numerous studies since the 1970s

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Anabolic steroid side effects

• Acne
• Alopecia
• Testicular atrophy
• Masculinization
• Gynecomastia
• Infertility
• Mood alterations

• Adverse lipid profile
• Hypertension
• Glucose intolerance
• Premature epiphyseal closure

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Testosterone precursors

• Cholesterol
• Pregnenolone
• 17-hydroxypregnenolone
• DHEA
• Androstenedione
• Testosterone

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Androstenedione / DHEA

• Excess quantities theoretically are metabolized
  to testosterone, thereby increasing serum levels.
• Early studies showed promise, but a recent
  randomized, double-blinded study of 30 men by
  King (1999) demonstrated no gains over placebo in
  testosterone levels or strength.

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Androstenedione / DHEA

• Potential side effects similar to anabolic
  steroids
• Excessive precursors shown to be aromatized to
  form estrogen

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Human Growth Hormone

• Manufactured by recombinant technology for
  replacement in deficient patients
• Promotes protein anabolism
• Intramuscular delivery
• No virilizing effects attractive to women

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Human Growth Hormone

• Studies suggest increases in muscle size, but not
  strength (increased collagen in muscles
  without an increase in contractile tissue)
• Excess may lead to SxS of acromegaly

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Insulin-like Growth Factor

• Newer poor in vivo data
• Potential anabolic and growth promoting effects
  similar to human growth hormone without the lipid
  side effects
• More prone to cause hypoglycemia

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Creatine

• Intrinsic fuel for anaerobic activity
• After ingestion, creatine readily binds to
  phosphorus
• Phosphocreatine mediates the regeneration of ATP
  from ADP
• P-Cr ADP H ? Cr ATP

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Creatine

• Supplementation aimed at maximizing stores of
  phosphocreatine in muscle tissue
• Potentially decreases fatigue and increases
  recovery time
• Enhances training, but no direct anabolic effect
• Still legal for most competitions

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Creatine

• Some equivocal studies
• Others demonstrate positive effect on short,
  high-intensity activity
• - Dawson (1995), repeated short sprints
• - Earnest (1995) Hamilton-Ward (1997), bench
  press weight

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Creatine side effects

• Muscle cramps at recommended doses
• Potential for renal insult at high doses, with a
  few anecdoctal reports of interstitial nephritis

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Stimulants

• Promote CNS and muscular excitation
• Caffeine
• Amphetamines
• Ephedrine (and pseudoephedrine)

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Caffeine

• The most used and abused drug in the world
• Variety of effects from adenosine receptor
  antagonism
• - increased catecholamines
• - increased lipolysis
• - CNS activation
• - improved respiratory function

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Caffeine

• Many studies of varying quality
• Review by Sinclair and Geiger studies 1994-1998
  selecting only those using highly trained
  athletes (for reproducibility of performance)
  with caffeine washout period
• - 11 studies, 115 participants
• - cycling/running
• - significant increases in time to exhaustion
  and decreased perception of effort

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Caffeine

• Tolerance develops to repeated dosing
• Excess may cause increased anxiety, insomnia, and
  cardiovascular strain

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Amphetamines

• Abused since 1920s
• Increase alertness and produce euphoria by
  central modulation of dopamine and noradrenaline
• Side effects psychosis, hyperthermia,
  cardiovascular strain
• Several deaths from heat stroke

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Ephedrine

• Ma Haung, ephedra
• Increases myocardial contraction and blood
  pressure, decreases perception of fatigue,
  decreases appetite
• Similar side effects of hyperthermia and
  cardiovascular strain

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Caffeine and Ephedrine

• Randomized, blinded, placebo study by Bell (2001)
  with 24 healthy, untrained men cycling to
  exhaustion
• Significant increase in power by ephedrine
• Significant increase in endurance by caffeine
• Synergistic effect

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Other Agents

• Erythropoietin
• - increases hematocrit to increase
  oxygen- carrying capacity, and thus stamina
• - increases blood vicosity posing risk for
  vascular occlusion, especially when concurrent
  with dehydration during exercise

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Other Agents

• Beta Blocker
• - reduce anxiety and tremor, but also reduces
  energy
• Diuretics
• - transient weight loss (e.g. wrestlers and
  boxers seeking a lower weight class)
• - risk for dehydration

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Conclusions
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Conclusions

• Sports doping is widespread
• Lack strong data on safety and efficacy
• Potential benefits in amateur athletes (our
  patients) probably negligible
• Unclear risks, especially on long-term use and
  mega dosing
• First, do no harm.

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