Chapter 9: Performance-Enhancing Substances: Effects ... · Other performance benefits have not been well tested or demonstrated. Suspected psychological effects are difficult to

C.S.C.S. Exam Preparation

Rafael Escamilla, Ph.D., C.S.C.S. 1

Chapter 9:Performance-Enhancing

Substances:Effects, Risks, and

Appropriate Alternatives

Chapter Outline

Types of performance-enhancing substances

Anabolic steroids

Other hormones

Drug testing

Dietary supplements

Prevalence of use of performing enhancing substances

“I have never taken steroids.Period.” Rafael Palmeiro

March 2005

Suspended 10 days positive drug testAnabolic Steroids.

July 2005



The 400+ Page Mitchell Report Implicated Nearly 100 Major League Baseball Players Regarding Steroid or HGH Use.

Dec 2007

Includes Big Name Players, Such as: Barry Bonds, Roger Clemens, Rafael Palmeiro, Jason Giambi, Gary Sheffield, Andy Petite, Mo Vaughn, Miguel Tehama, etc…

Anabolic Steroid use Baseball

Always presumed or suspected

Hitting records falling at increased rates.

Sports Illustrated article in May 2002 contained admission by Ken Caminiti and later followed by admission of use by Jose Conseco

First hint of wrong-doing by Mark McGwire and his use of androstenedione during home run record season.

Types of Performance-Enhancing Substances

Naturally occurring hormones and the drugs that mimic their effects

Dietary supplements



Definition of Products That Can Be Sold as Dietary Supplements

A product (other than tobacco) intended to supplement the diet. The product contains one or more of the following: vitamin; mineral; herb or other botanical; amino acid; dietary substance for use by humans; or a concentrate, metabolite, constituent, extract, or combination of these ingredients.

The product must also be intended for ingestion and cannot be advertised for use as a food.

Because of their widespread use by athletes, the synthetic derivatives of anabolic steroids are the most important ergogenic substances about which the strength and conditioning professional should be knowledgeable.

�

Table 11.2 Principal Anabolic Steroids Used by Athletes: Injectable Steroids (Excreted 14-50 days).

Generic name or category Example trade names

Testosterone esters Delatestryl, Sustanon

Nandrolone esters Deca-Durabolin

Stanozolol Strombaject

Methenolone enanthate Primobolan-Depot

Boldenone undecylenate Parenabol

Trenbolone acetate Parabolan



Risks of Injectable Anabolic SteroidsHIV

Hepatitis B, CEndocarditis

Systemic infectionsImpurities

Table 11.2 Principal Anabolic Steroids Used by Athletes: Orally Active Steroids (Renal excretion in 4-10 days).Generic name or category Example trade names

Methandrostenolone Dianabol (developed 1956)

Oxandrolone Anavar

Stanozolol Winstrol

Oxymetholone Anadrol

Fluoxymesterone Halotestin

Methyltestosterone Oreton-M

Mesterolone ProvironNote: After Ben Johnson (Canada) ran the fastest 100 m time ever (9.79 s) at

the 1988 Olympics, he tested positive for Winstrol, was striped of his gold medal, and was effectively given a lifetime ban from competing in Track & Field. Interestingly, in 2005 baseball player Rafael Palmeiro also tested positive for Winstrol, and under the MLB newly established “get tough on steroid use” policy, he was suspended for 10 games (roughly 6% of the season)

MLB Steroid Policy- 2006 to current

• All players tested at spring training physicals and once during season

• Additional random testing during season

• Penalties:

1st Positive – 50 game suspension

2nd Positive – 100 game suspension

3rd Positive – Lifetime ban

Note: As a comparison, a 1st positive in track and field is a 2 year ban



EVENT WOMEN’S WORLD RECORDS

100 m Florence Griffith Joyner10.49 s, US, 7/16/88

200 m Florence Griffith Joyner21.34 S, US, 9/29/88

400 m Marita Koch47.60 s, East Germany, 10/6/85

800 m Jarmila Kratochvilova1:53.28, Czechoslovakia, 7/26/83

100 m Hurdles Yordanka Donkova12.21 s, Bulgaria, 8/20/88

400 m hurdles Yuliya Pechenkina52.34 s, Russia, 8/8/03

400 m Relay Msller, Rieger, Auerswald, Gshr41.37 s, East Germany, 10/6/85

(finally broke by USA women in 2012 Olympics)

1600 m Relay 3:15.17, Soviet Union, 10/1/88

EVENT WOMEN’S WORLD RECORDS

High Jump Stefka Kostadinova6-10¼ , Bulgaria, 8/30/87

Long Jump Galina Chistyakova24-8¼ , Soviet Union, 6/11/88

Triple Jump Inessa Kravets50-10¼, Ukraine, 8/10/95

Pole Vault Yelena Isinbayeva16-5¼, Russia, 8/12/05

Shot Put Natalya Lisovskaya74-3, Soviet Union, 6/7/87

Discus Gabriele Reinsch251-11, East Germany, 7/9/88

Hammer Throw Tatyana Lysenko253-11 , Russia, 6/24/06

Javelin Osleidys Menendez235-3 , Cuba, 8/14/05

More recently, new designer synthetic anabolic steroids are being used by strength and power athletes to enhance athletic performance. The use of THG (known as “The Clear”), or Tetrahydrogestrinone, lead to a major scandal in October of 2003 when it was detected among track and field athletes.

The use of THG (which resembles the synthetic steroids trenbolone and gestrinone) among track and field athletes was reported anonymously to the US anti doping agency (USADA) by track coach Trevor Graham, who turned over to them a syringe containing THG. The coach told the USADA that THG was distributed by Bay Area Laboratory Co-Operative (BALCO), a nutrition company utilized by numerous professional athletes. Prior to that time THG was undetectable by current methods used in athletes to detect anabolic steroids, so it is unknown how long THG has been used by athletes.

THG was banned by the FDA on 10/28/2003.

�



In 2007 Major League Baseball’s All Time Home Run Leader Barry Bonds was indicted for perjury and obstruction of justice based on his 2005 grand jury testimony that he never knowingly took anabolic steroids (he claims he “unknowingly” took THG - he thought it was a flaxseed oil supplement).

In 2007 world champion sprinter Marion Jones admitted to taking THG prior to the 2000 Summer Olympic Games, in which she won 5 medals (4 gold). She was stripped of all 5 metals and banned from track and field competition for a least 2 years.

In 2013 5 time Tour De France Winner Lance Armstrong admitted to taking anabolic steroids, Human Growth Hormone, Erythopoietin (EPO), and numerous other performance enhancing drugs

Anabolic Steroid Studies 1960’sNo Increase in Strength

?

Body Composition Changes With Anabolic SteroidsBody Composition Changes With Anabolic Steroids



An interesting comparison…1972 1976

Helena Fibingerova

Women's Shot Put Final. Olympic Games 19721. Nadezhda CHIZHOVA (SOV) 21.03m.2. Margitta GUMMEL (GDR) 20.22m.3. Ivanka HRISTOVA (BUL) 19.35m.4. Esfir DOLZHENKO (SOV) 19.24m.5. Marianne ADAM (GDR) 18.94m.6. Marita LANGE (GDR) 18.85m.7. Helena FIBINGEROVA (CZE) 18.81m.8. Yelena STOYANOVA (BUL) 18.34m.

Women's Shot Put Final. Olympic Games 19761. Ivanka HRISTOVA (BUL) 21.16m.2. Nadezhda CHIZHOVA (SOV) 20.96m.3. Helena FIBINGEROVA (CZE) 20.67m.4. Marianne ADAM (GDR) 20.55m.5. Ilona SCHOKNECHT (GDR) 20.54m.6. Margitta DROESE (GDR) 19.79m.7. Eva WILMS (GER) 19.29m.8. Yelena STOYANOVA (BUL) 18.89m.

Another interesting “size” & stats comparison...

In 1992, at age 27, Barry Bonds won his 2nd NL MVP with the Pittsburgh Pirates, hitting .311 with 34 home runs & 103 RBIs, & a .6237 slugging percentage (total bases/total at bats), leading the Pirates to a NL division title. In 2001, at age 36, Bonds won his 4th NL MVP with the San Francisco Giants, hitting .328 with 137 RBI’s, & set several major league records, including & an incredible .8634 slugging percentage & 73 home runs. His full season 5-year home run average both before & after 2001 was approx. 40, & the most home runs he hit in his 22 year major league career (excluding 2001) was 49!!



Risks of Anabolic Steroid UsePrimary risk for women is masculinization, which

includes decreased body fat, increased fat free mass, deepening of the voice, cessation of menstrual cycles, and increased facial hair.

Primary risks for young boys are accelerated puberty; early closure of the ends of the long bones.

Psychological changes that include increased aggressiveness, depression, and addiction.

Cardiovascular disease (lowered HDL, atherosclerosis, hypertension)

Tendon ruptures (e.g., biceps brachii & pec major)

Gastrointestinal- liver disease (peliosis hepatis), liver cancer, liver abnormalities

Potential Risks to Performance

Uncontrolled emotional responses directed at a teammate

Unanticipated decline in performance when steroid use is stopped

Undesirable increase in body weight, especially for aerobic endurance athletes

Anabolic Steroids: Bottom Lines

Anabolic steroid use will likely increase body weight, in part due to increased muscle mass.

Other performance benefits have not been well tested or demonstrated.

Suspected psychological effects are difficult to test.

Health risks in men are comparable to known risks to women from use of oral steroidal contraceptives.

More serious health risks accompany the use of very high doses of anabolic steroids.



Other Hormones Used by Athletes As Ergogenic Aids

Growth hormone stimulates physical growth of the body by increasing protein synthesis. Growth hormone treatment is very expensive - $13,000/yr.

Although growth hormone used as replacement therapy for people with growth hormone or IGF-I deficiency can be effective, no evidence suggests that supplemental growth hormone produces effects of the same magnitude or enhances performance in normal men and women.

Human Growth Hormone (HGH) History in Sport

•Reports of use of cadaveric pituitary extract in 1980’s•1988 Ben Johnson admits to combining AS and HGH•1998 Discovery of HGH in Tour de France support vehicle•2000 HGH found in Chinese swim team luggage in Sydney•2005- Study of AS users reveals 25% also use HGH and insulin*•HGH use increases due to improved testing for AS, since HGH cannot be detected by current urine tests

* Parkinson AB, MSSE 2005;37(5):S37-8

Human Growth HormoneMechanisms

•HGH considered a “partitioning” agent rather than anabolic•Protein synthesis favored over fat synthesis•Insulin required otherwise HGH becomes catabolic•Estimate 5% of AS users also use insulin*•HGH stimulates IGF-1

*Perry P, et al. Clinical Journal of sports medicine 2005;15:326-30



Human Growth Hormone Testing

•Banned by IOC, NCAA•Cannot detect cadaveric pituitary HGH•Best blood tests can only detect use in past 24-36 hrs•Urine tests cannot detect presence of HGH•Testing at 2004 Summer Olympic

No positive tests reported

Reasons-No one using HGH?-Test ineffective?-Test may not be ready for prime time

Other Hormones� Erythropoietin (EPO)

– Six weeks of Injections of EPO have resulted in elevations in both hematocrit (50% increase) and hemoglobin (10% increase), and aerobic capacity increased 6-8%.

– Health risks include increased risk of blood clotting (due to decreased plasma volume and increased blood viscosity), elevations in systolic blood pressure, a compromised thermoregulatory system, and dehydration during aerobic endurance events.

� β-Adrenergic Agonists– β-adrenergic agonists can increase lean mass and

decrease stored fat.� β-Blockers

– β-blockers reduce anxiety & tremors during performance.

Problems in Drug TestingSome ergogenic substances, such as caffeine,

occur naturally in the body.

Some substances, such as recombinant human growth hormone, are difficult to test for because they are indistinguishable from naturally occurring hormones.

Masking agents (e.g., diuretics) may dilute the urine specimen and make it difficult to obtain a positive test.

Testosterone injections can be difficult to detect because the body produces it. Tests focus on the ratio of testosterone and epitestosterone (a breakdown product). According to the US Anti Doping Agency, when this ratio jumps above 6:1 the test is considered positive (but cheaters take epitestosterone along with testosterone to maintain a consistent ratio)



The 1994 legislation on dietary supplements

means that few safeguards are in place to

ensure these products are safe or that they

provide claimed benefits. Dietary supplement

use represents an uncontrolled experiment, with

athletes serving as human guinea pigs.

�Dietary Supplements

Supplement Definition

� A product intended to supplement the diet by increasing total dietary intake of one of the following: vitamin, mineral, herb or botanical, amino acid, another dietary substance

� Is not represented as a conventional food

� Is labeled as a dietary supplement

Advertising Claims� May Not Be False or Misleading� May Not Claim a Relationship to a Disease or Health-related Condition

* The FTC Took 8 Legal Actions Against Ad Claims In 1998.



Analysis of Over-The-Counter supplements

Green G, Catlin D, Starcevic B.

Clinical Journal of Sports Medicine

11:254-259, 2001.

Conclusion: 11/12 supplements did not contain what was on the label!

Supplement Points

� Questionable quality control and purity� Relatively high cost� Lack of scientifically controlled studies� Theoretical benefits have not been

clinically demonstrated� Most are probably innocuous at best� Most are probably innocuous at worst

Steve Bechler 1979-2003



FDA bans Ephedra supplements!!

•FDA determines ephedra violates DSHEA in December 2003•150 deaths cited, multiple adverse reactions•62 manufacturers receive letter to desist

Dietary Supplements

Vitamins: Chronic B vitamin deficiency, which are important in energy metabolism, have been shown to decrease physical performance. However, there are no data that have demonstrated excessive quantities of vitamins enhance performance. In fact, excess vitamins can cause health problems, especially excess fat soluble and B6 vitamins. Antioxidant vitamins, such as C and E, may reduce tissue damage caused by oxidative stress, but further research is needed to substantiate this.

Dietary SupplementsSteroid replacers: No steroid supplement sold as

“steroid replacement” or “steroid releasers” are know to be effective performance enhancers.

L-carnitine: L-carnitine is synthesized in the body and stored primarily in skeletal and cardiac muscle. It is theorized that increases in L-carnithine will produce a greater utilization of fat and a sparing of muscle glycogen during exercise, but this has never been demonstrated.



Dietary Supplements

Growth hormone releasers: Intravenous infusion of the amino acids arginine and ornithine have been demonstrated to produce a relatively consistent increase in human growth hormone in normal subjects. However, there are no data which have demonstrated that oral administration of these amino acids produce a similar rise in growth hormone or enhance performance. The best growth hormone releaser is high intensity resistance training with short rest intervals, which have shown as large a rise in growth hormone as intravenous infusions of arginine.

Caffeine and creatine are two of the few

dietary supplements known to be effective in

enhancing certain types of athletic performance

for some individuals.

�

Dietary Supplements

Caffeine: Caffeine is a direct CNS stimulate that has several performance enhancement traits, such as reduced fatigue, arousal, increased confidence, euphoria, increased strength (increased intramuscular Ca++), and glycogen sparing through increased fatty acid mobilization and utilization (desirable by endurance athletes). Ergogenic dose believed to be at a concentration of 250-350 mg (2-3 cups of fresh brewed coffee). The principal drawback with caffeine relative to performance is its diuretic effect and concomitant dehydration.



Dietary SupplementsCreatine Monohydrate:

• One of today’s most popular ergogenic aid

• Used by high school, college, professional & Olympic athletes

• Creatine first introduced as an ergogenic aid in 1992 and used by strength and power athletes at a relatively high rate

• Throughout the 90’s sports teams distributed Creatine to NCAA athletes for free and unlimited usage, but as of August 2000 the NCAA Division I Bylaw 16.5.2.g has placed creatine supplements on the “nonpermissible” list of nutritional supplements, meaning that universities are prohibited from providing creatine to student-athletes (BUT student-athletes are still allowed to use it on their own)

• Recent NCAA Study reported 13.3% of college athletes use creatine• 2015 Study reports higher use (30-45%) among strength & power

athletes (football, track and field) – Judge et al, JSCR, 2015)

Dietary Supplements

Creatine Monohydrate:

• Creatine is synthesized in the liver and also obtained through consumption of meat and fish products (approx. 1 g per ½ pound of raw meat)

• About 1g/day made in body; another 1g/day consumed in diet

• 2 forms in muscle: free creatine (1/3) & creatine phosphate (2/3)

Dietary Supplements

Creatine Monohydrate: • During brief explosive-type exercises, energy supplied to

resynthesize ATP (the basic form of energy used by cells) is determined by amount of phosphocreatine stored in muscles

• As phosphocreatine stores become depleted, performance is likely to deteriorate, due to inability to resynthesize ATP at rate required

• Creatine supplementation has been reported to increase total muscle creatine and phosphocreatine content by 10% to 40%

• Increasing availability of phosphocreatine helps ATP levels during intense exercise and accelerates rate of ATP resynthesis following short term high intensity exercise



Dietary SupplementsCreatine Monohydrate:

• Creatine is purported to:

– Increase muscle strength

– Produce greater and faster lean-tissue muscle gains

– Increase energy during high intensity training

– Improve sprint performance

– Delay fatigue

– Aid in fat loss

• Creatine loading may improve high intensity exercise performance in a variety of sports: (e.g., football, sprint and field events in track & field, weight lifting, sprints in cycling & swimming)

Dietary Supplements

Creatine Monohydrate Usage:

• Initial loading phase: 5 g four times per day (20 g/day total) for 5 consecutive days

• Maintenance phase: approximately 5 g/day– Most athletes ingest 2-10 g/day

• Research shows it may most effective (and safe) to cycle creatine (e.g., 3 months on creatine, 1 month off creatine)

Dietary Supplements

Creatine Concerns – Suppression of Creatine Synthesis:

• Natural creatine synthesis has been reported to decline during periods of increased dietary creatine intake

• However, creatine synthesis appears to return to normal at cessation of supplementation

• There is no evidence from animal or human trials to indicate long-term suppression of creatine synthesis



Dietary Supplements

Other Creatine Concerns:

• Promotes rapid weight gain (from muscle proteins or water retention)?– 2-5 pounds in 1 week often reported

• Increases thermal stress?

• Promotes dehydration?

• Causes muscle strains and pulls?

• Causes muscle cramping and spasms?

• Causes liver damage?

Documents

Chapter 9: Performance-Enhancing Substances: Effects ... · Other performance benefits have not been well tested or demonstrated. Suspected psychological effects are difficult to