Sports Doping
Ed Chung
May 7, 2002
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”
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!!!”
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
IOC prohibited substances
1. Anabolic agents
2. Peptide hormones, mimetics, and
analogues
3. Stimulants
4. Diuretics
5. Narcotics
Anabolic Agents
Enhance muscle mass gained from strength
training
- Anabolic steriods
- Testosterone precursors
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
1970’s
Anabolic steroid side effects
Acne Adverse lipid profile
Alopecia Hypertension
Testicular atrophy Glucose intolerance
Masculinization Premature epiphyseal
Gynecomastia closure
Infertility
Mood alterations
Testosterone precursors
Cholesterol
Pregnenolone
17-hydroxypregnenolone
DHEA
Androstenedione
Testosterone
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.
Androstenedione / DHEA
Potential side effects similar to anabolic
steroids
Excessive precursors shown to be
aromatized to form estrogen
Human Growth Hormone
Manufactured by recombinant technology
for replacement in deficient patients
Promotes protein anabolism
Intramuscular delivery
No virilizing effects – attractive to women
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
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
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
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
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
Creatine side effects
Muscle cramps at recommended doses
Potential for renal insult at high doses, with
a few anecdoctal reports of interstitial
nephritis
Stimulants
Promote CNS and muscular excitation
Caffeine
Amphetamines
Ephedrine (and pseudoephedrine)
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
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
Caffeine
Tolerance develops to repeated dosing
Excess may cause increased anxiety,
insomnia, and cardiovascular strain
Amphetamines
Abused since 1920’s
Increase alertness and produce euphoria by
central modulation of dopamine and
noradrenaline
Side effects: psychosis, hyperthermia,
cardiovascular strain
Several deaths from heat stroke
Ephedrine
Ma Haung, ephedra
Increases myocardial contraction and blood
pressure, decreases perception of fatigue,
decreases appetite
Similar side effects of hyperthermia and
cardiovascular strain
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
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
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
Conclusions
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.