Download ASMI

ERGOGENIC AIDS
Andy McGown, MD
Definition:
• Ergo = work
• Gennan = to produce
• Any substance or method used to enhance
performance through increased energy
utilization:
» production
» control
» efficiency
History
• 3000 Years ago the Greeks ate “substances” to
improve athletic performance including
Strychnine. Used recently in 1904 and 1992
Olympics
• 776 BC (1st Olympiad)
» Hallucinogenic mushrooms and sesame seeds
• 1889 1st Self-administered Steroids
» Brown-Sequard “Testicular extracts”
• 1935 Testosterone Synthesized
Goldman’s Poll
• Two questions posed to 198 aspiring
olympians during the 1990’s
» Take banned substance if guaranteed to win a
medal and not be caught
» Take banned substances and not be caught and
win every competition for the next 5 years but
die an early death from side effects
Classification
• Drugs:
»
»
»
»
»
Hormones
Stimulants
Narcotics
Diuretics
B-Blockers
• “Supplements”:
»
»
»
»
»
Prohormones?
Amino Acids
Metals
Antioxidants
Herbs
Prevalence:
• Estimated Use
» Adolescents
• 11% male (most start < 16yo)
• 2.5% female
» Adult ~ 15%
• Usually recreational athletes
• Swimming, Cycling, Weight lifting, Track and
Field
• Billion Dollar Industry
“There is no room for second place. There is
only one place in my game, and that’s first
place.”
-Vince Lombardi
Reasons:
•
•
•
•
•
Have to use them to be competitive
Need the edge
Not genetically gifted
Dissatisfaction with size/ weight
Peer/ Team Pressure
Human Growth Hormone
• Naturally secreted by the pituitary
• Normal function of GH is growth and
development of every body system, including
bone and muscle
• Can be stimulated by propanolol, vasopressin,
clonidine, and levodopa
• Synthetic growth hormone
Side Effects:
•
•
•
•
•
•
Acromegaly (may be irreversible)
Peripheral Neuropathy
Coronary Artery Disease
Cardiomyopathy
Diabetes, Hypothyroidism, arthritis
No available urine test available, but banned by
NCAA and IOC
Erythropoietin
• Hormone released by the kidneys in response to
low Hct
• Stimulates RBC production from bone marrow
• Has recently been manufactured by recombinant
DNA technique
• Can increase Hct in renal patients by up to 35%,
lasting up to 7 months
• Used most by cyclists
Doping
• Attributed to the Dutch word “dop” which
was a narcotic mixture of opium used to
stimulate racing horses
Blood Doping
• Autologous Reinfusion
» 2 units blood removed 4-8 wks prior to competition
» Frozen w/ glycerol
» Reinfusion 1-7 days prior to event
• 1 U PRBC>>500 ml / min increase in O2 carrying
capacity
• Can produce 25% improvement in endurance
» The poorer the athletes conditioning the greater the
benefit
Side Effects
• Blood Transfusions
» Heterologous
• transfusion rxn (3-10%), Hepatitis (10%), HIV (?%)
» Autologous
• bacterial infections
• r-EPO
» Polycythemia
• increased viscosity >>CHF, HTN, CVA
Detection
• Blood Doping and r-EPO
» Banned by IOC
• No Direct Test
» Hct >50
» Serum Fe and Bili
• Detecting post-transfusion hemolysis
» Legal issues
Anabolic Steroids
•
•
•
•
The ultimate ergogenic aid aka “Juice”
Creates the Superhuman Athlete
Testosterone derivatives (cholesterol)
Produced in the adrenal/ testes
Anabolic/Androgenic Steroids
•
•
•
•
•
Anabolism - Constructive
Catabolism - Destructive
Anabolic effects : inc. skeletal mm mass
anticatabolism
Androgenic effects: secondary sexual
characteristics - pubic hair, genital size
• No Pure Anabolic Steroids
History of Steroids
•
•
•
•
•
First Available - 50’s (Dianabol)
Drug Banned - 60’s
Testing Initiated- ‘76
Athletes Banned - ‘83 Pan Am Games
Schedule III Controlled Substance - ‘90
Anabolic Steroid Control Act
• US Dietary Supplement Act - ‘94
no
FDA approval if no “drug intent”
Administration:
• Athletes may take up to 40-100x therapeutic dose
(200-2000 mg/ wk)
• IM adm bypasses the liver/ PO does not
• “Stacking”: using various aids in combination
• “Cycling” : gradual inc. then taper over 6-10
weeks, 1-3 cycles /year, “bridging” between
• Illicit - Nandrolone, Stanozolol (Winstrol),
Methelone, Tibolone, Oxandrolone
• Medical - Testosterone, Enanthate, Undelanoate,
Dehydrotestosterone (patch)
Desired Effects:
•
•
•
•
Increase in strength
Increase in weight
Increase in aggressiveness
Increased capability of sustaining repetitive,
high intensity workouts
• Enhanced performance
Side Effects:
• CV: MI - hypertension, inc. LDL, dec. HDL,
cardiac hypertrophy, thrombosis
• Endocrine: virilization, testis atrophy, azospermia,
priapism, prostatic hypertrophy/ CA,
gynecomastia, erectile dysfct, libido
• Liver : peliosis hepatitis, hyperplasia, adenoma, no
carcinoma, elevated LFTs
• MS: epiphyseal closure, inc. bone density, dec.
tendon strength
Side Effects (cont’d):
• Skin: acne, hirsuitism, striae, androgenic
alopecia, inc. sebaceous glands
• Metabolic: hypernatremia, kalemia,
phosphatemia, calcemia, “prediabetic”
• Psychiatric : aggressiveness, extreme mood
swings - depression/ mania, dependence,
other drug use, “Reverse Anorexia”
• Long Term - dec. life span
Specific Side Effects
• Women: Virilzation:
» Clitoril enlargement,
Deepening of voice,
Male pattern baldness,
dec. breast size, libido
• Children: premature
closure of growth
plate in long bones &
short stature
“Prohormones”
•
•
•
•
•
Androstenedione
DHEA
Androstenediol
Norandrostenedione
Norandrostendiol
Androstenedione
• 1/2 of the “ Mark McGuire Special”
• A natural steroid hormone found in all animals
and some plants
• Metabolite of DHEA
• Precursor of testosterone
• Synthesized in Adrenals/ Gonads
• Metabolized in the liver to testosterone
Effects:
• Benefits: Same as Testosterone
»
»
»
»
Increased energy
Enhanced recovery and growth from exercise
heightened sexual arousal and function
greater sense of well-being
• Plasma levels of testosterone increased from 140%
to 330% of normal levels after 50mg and 100mg
doses
• SE’s : Same as Testosterone
• Banned by IOC, NCAA, NFL
DHEA (Dehydroepiandrosterone)
• What it is: A hormone produced by adrenal
gland
• Claims: Anabolic effect
• What is does: Increases testosterone levels
• Banned by the NCAA, NFL
Stimulants
•
•
•
•
Caffeine
Amphetamines
Cocaine
Ephedrine
Amphetamines
• WWII
» Soldiers used them to counteract fatigue
• 1959 Study shows Performance Enhancing
Potential
• Used in Sports where Speed, Power and
Endurance are Required
Side Effects:
• Predominantly CNS
» Insomnia, agitation and restlessness
» Confusion, paranoia, hallucinations
» Dyskinesias
• especially in facial muscles
• Cardiac
» HTN, arrhythmias
• GI
» Diarrhea
• Rebound Fatigue and Depression
Caffeine
• A Methylxanthine: same class as theophylline and
theobromine
• Exerts its’ effects by:
» Translocation of Calcium for more muscular
availability
» Increase in cAMP by inhibition of
phosphodiesterase
» Blockage of adenosine receptors, blocking the
sedative properties of adenosine
Caffeine (cont’d)
• Is banned by IOC and NCAA in large doses
• Legal limit = 15 micrograms / ml
• Equal to 6-8 cups of coffee at one sitting, with
testing within 2-3 hours
• Beneficial most in endurance events, such as
cycling
• Doses up to 5 mg / kg were required to see
benefits. Doses of 17 mg/kg produce the
maximum legal limit.
Side Effects:
• Similar to s/e of other stimulants:
» insomnia, irritability, nervousness
» Tachcardia, arrthymias, and possibly death!
Ephedrine
• What it is: Is a drug found in herbal products
containing Ma haung, anti-asthmatic medications,
and many cold and cough products.
• Claims: Increases body fat loss
• What really does: Acts as a CNS stimulant, delays
fatigue by sparing body glycogen reserves.
Increase in B/p respiratory, heart rate, insomnia,
and nervousness
• Max dose : 24 milligams per day!!!!!!
Amino Acids
•
•
•
•
•
Creatine
L-Carnitine
Choline
Inosine
HMB (B-OH-BMethylbutyrate)
Amino Acids
•
•
•
•
Essential amino acids: found in a balanced diet
Recommended protein intake: 0.8 g /kg/day
Athletes may benefit from up to 1.4 -2.4 g/kg/day
Most beneficial for athletes on a poor diet, or
vegetarians
• In endurance athletes, up to 10% of energy
expenditure is from protein breakdown
Creatine
• The Other 1/2 of the Mark McGuire
“Cocktail”
• Sales topped $200 million in 1998
» 13% of HS athletes
» 50% of NFL players
» Vast majority of Olympic sprinters and
cyclists
Creatine
• Methylguanidine-acetic acid - made from glycine,
arginine & methionine
• Estimated Daily requirement: 2gms
• Available in meats and fish (1/2 EDR)
• Sold as Creatine Monohydrate
• Stored in Skeletal MM
Mechanism of Action :
• Methylguanidine-acetic acid - made from glycine,
arginine & methionine
• Estimated Daily requirement: 2gms
• Available in meats and fish (1/2 EDR)
• Sold as Creatine Monohydrate
• Stored in Skeletal MM
Benefits:
• Improved performance in repeated bouts of
high intensity strength work and sprints
• Single sprint activity results are equivocal
• Does not enhance endurance exercise
• More work with less lactic acid production
• No studies on competetion benefits
• 1998 ACSM meeting: 19/19 studies
showed significant ergogenic benefit
Dosing:
•
•
•
•
Phase: 20-30 gm/d, x 5 -7 days
Maintenance phase: 2-5 gm/day
Loading increases PCr stores by 10-40%
Normal resting levels of creatine: 100-150
mM/kg
• Most striking benefits occur in subjects with lower
resting Cr level
• After saturation of tissues, excessive
supplementation is renally excreted
Side Effects:
•
•
•
•
•
•
Muscle Cramping
Diarrhea
Dizziness
Dehydration
Biggest danger: getting “impure” creatine
Significant WEIGHT GAIN common 2nd to water
retention
The Perfect Supplement?
• “The secret is to find something that is effective in
improving performance, but not against the rules,
and with no side effects”
• “…no clear evidence of harmful side effects of
creatine use has emerged…”--The Physician and
Sportsmedicine, June 1998
• Long term effects of Creatine not yet studied:
Concerns focus on effects to kidney, pancreas, and
liver.
Counseling your patients
• Creatine may or may not improve
performance
• Weight gain will occur
• Side effects (especially long-term) not well
known
• Take a thorough medical history
• Monitor renal and liver fct.
• Make sure they’re taking reccomended dose
L-Carnitine
• Synthesized in Liver/ Kidney from Lysine &
Methionine
• found in meats & dairy products
• Assists in Fat transportation into muscle
mitochondria for oxidation, sparing Glycogen &
may prevent lactic acid accumulation
• Improved endurance performance not shown in
studies
HMB
• Metabolite of KIC (ketoisocaproate) which
is a metabolite of leucine
• Leucine & KIC found to have anticatabolic
effects
• decreased mm proteolysis, inc. lean mm
mass, inc. strength
• no known side effects
Choline
• Precursor for the neurotransmittor Acetyl
Choline & the lipoprotein Lecithin
(Phosphattidylcholine)
• choline depletion in marathoners
• no studies supporting
Inosine
• Increases myocardial contractility
• no performance enhancement in runners/
cyclists
Metals/ Minerals
•
•
•
•
Chromium
Magnesium
Boron
Vanadium
Chromium
•
•
•
•
Insulin Cofactor
inc. AA uptake into mm cells
increase mm mass, dec. body fat
found in meats, grains, raisins, apples, &
mushrooms
• SE’s: anemia, chromosomal damage,
cognitive impairment & interstitial nephritis
in excessive doses
Magnesium
• Involved in ptn synthesis & mm contraction
• + effects on oxygen consumption & lactate
production
• no change in performance
Boron
• Originally thought to inc. testosterone levels
• not born out in studies
Vanadium
• What it is: Non-essential trace mineral
• Claims: Anabolic effect, enhances insulin
action
• What it does: No studies to show anabolic
effect. Doses>10gms/day causes abd. Pain,
cramps, green tongue,diarrhea, wt. loss
Antioxidants
• Vitamins E & C
• potential damage from free oxygen radicals
produced by lipid peroxidation in exercise
• exercise performance is not improved
Herbs
•
•
•
•
Ginseng
Yohimbe
Tribulus Terresteris
Ma haung
Ginseng
• What it is: A root from an Asian plant (panax
ginseng).
• Claims: Enhanced performance. Improved
recovery rate.
• What it really does: Acts as an adaptogen- may
boost immune system and protect cells. May cause
insomnia, and should not be used if B/p is
elevated.
• Dose: 100-200mg per day used occ.2-3 weeks on
1-2 weeks off
Yohimbe
• What it is: Supplement derived from tree
bark.
• Claims: Anabolic effect, Increased virility
• What it does: Stimulant effect, no anabolic
effect. Can cause nervousness, HA, nausea,
Vomiting, increased B/P
Tribulus Terresteris
•
•
•
•
What is it: A plant hormone
Claims: Anabolic effect
What it does: Increases testosterone levels
Banned by NFL
Thank You Very
Much