1. Doping in Sports Michael J. Ross, MD Sports Medicine Physician, Rothman Institute Medical Director, The Performance Lab

2. August 24, 2012

3. August 25,2012

5. 9/20/06 9/20/06 Floyd Landis becomes the first Tour de France winner to have his title revoked for doping Floyd Landis becomes the first Tour de France winner to have his title revoked for doping

6. Discuss some of the common doping agents abused by athletes Discuss some of the common doping agents abused by athletes Anabolic steroids Anabolic steroids Other anabolics Other anabolics Stimulants Stimulants Blood doping Blood doping Discuss strategies for obtaining desired effects without doping Discuss strategies for obtaining desired effects without doping Doping at a glance

7. 2007 Christian Moreni arrested at Tour de France 2007 Christian Moreni arrested at Tour de France 2007 Mattias Kessler 2007 Mattias Kessler 2007 Brazilian defender Marcao, suspended four months after testing positive for finasteride. (Masking agent) 2007 Brazilian defender Marcao, suspended four months after testing positive for finasteride. (Masking agent) Testosterone

8. 1996 Dean Capobianco, Australian 100m champion, tests positive for anabolic steroid stanozol 1996 Dean Capobianco, Australian 100m champion, tests positive for anabolic steroid stanozol Blames red meat Blames red meat 1996 Dieter Baumann 1500m and 5000m 1996 Dieter Baumann 1500m and 5000m Blames positive testosterone test on spiked toothpaste Blames positive testosterone test on spiked toothpaste Testosterone

9. April 2006 Justin Gatlin Olympic gold sprinter-facing 8 year ban April 2006 Justin Gatlin Olympic gold sprinter-facing 8 year ban August 2007 Chicago Bears fullback Obafemi Ayanbadejo-4 game suspension August 2007 Chicago Bears fullback Obafemi Ayanbadejo-4 game suspension Testosterone

10. 1998 Dennis Mitchell 400m relay gold medalist and 4 time US champion 1998 Dennis Mitchell 400m relay gold medalist and 4 time US champion Had sex four times the previous night and a lot of beer Had sex four times the previous night and a lot of beer Testosterone

11. Increases Lean muscle mass Increases Lean muscle mass Increases red blood cell volume Increases red blood cell volume Decreases Body Fat Decreases Body Fat Testosterone effects

12. Acne Acne Testicular suppression Testicular suppression Coronary Artery Disease Coronary Artery Disease Testosterone side effects

14. Victor Conte Bassist, Nutritional Consultant, Convict Produced designer androgens custom-developed for elite professional athletes to evade doping detection Bay Area Lab Cooperative

15. Testosterone and EpiTestosterone are produced in equal amounts from a precursor If the Ratio of Testosterone:EpiTestosterone is greater than 1:1, doping is suspected Cutoff is 4:1 RadioImmunoAssay Detecting Testosterone

16. Testosterone increases in response to: Testosterone increases in response to: Intervals Intervals Strength training Strength training Testosterone decreases in response to Testosterone decreases in response to Low Intensity Endurance training (L.I.E.) Low Intensity Endurance training (L.I.E.) Increasing Testosterone

17. One of the major hormones for controlling blood sugar One of the major hormones for controlling blood sugar Non functional in diabetics Non functional in diabetics Synthetic insulin used to have a “C- peptide,” not in recombinant insulin Synthetic insulin used to have a “C- peptide,” not in recombinant insulin Insulin

18. Insulin as a drug of abuse in body building Br. J. Sports Med., Aug 2003; 37: 356 - 357. Insulin as a drug of abuse in body building Br. J. Sports Med., Aug 2003; 37: 356 - 357.

19. Insulin is anabolic at large doses. Insulin is anabolic at large doses. Imports amino acids into cells to speed recovery and muscle building Imports amino acids into cells to speed recovery and muscle building Imports glucose into muscle cells to be stored as glycogen Imports glucose into muscle cells to be stored as glycogen What it does

20. Too much can cause low blood sugar, change in mental status and coma Too much can cause low blood sugar, change in mental status and coma Fat deposition at injection site Fat deposition at injection site Can only be used in cases of glycogen depletion Can only be used in cases of glycogen depletion Adiposity Adiposity Side Effects

21. Bodybuilders find it easy to obtain insulin to help them in training Bodybuilders find it easy to obtain insulin to help them in training BMJ 1997;314:1280 (26 April) BMJ 1997;314:1280 (26 April)

22. Glycogen depletion Glycogen depletion Replace calories as high glycemic carbohydrate Replace calories as high glycemic carbohydrate Incorporate protein into recovery mix Incorporate protein into recovery mix 1g/kg carbohydrate + 0.3g/kg protein 1g/kg carbohydrate + 0.3g/kg protein What else to do

23. Anabolic hormone Anabolic hormone Secreted in pulses, the largest pulse happens in the first 1 hour of sleep Secreted in pulses, the largest pulse happens in the first 1 hour of sleep Growth Hormone

24. Increases recovery (acute) Increased amino acid uptake into muscle Increased glycogen through glucose uptake Increases Energy (chronic) Stimulates fatty acid release from adipose tissue Increases sensitivity to fatty acid release GH Effects

25. 6/06: Diamondback pitcher Jason Grimsley possessed a season's worth of hGH, federal indictment 6/06: Diamondback pitcher Jason Grimsley possessed a season's worth of hGH, federal indictment

26. 9/07: Washington Redskins tackle Jon Jensen:"very naive and foolish" to think that NFL players aren't using human growth hormone. 9/07: Washington Redskins tackle Jon Jensen:"very naive and foolish" to think that NFL players aren't using human growth hormone. "maybe 15, 20%" of the league's players use illegal performance-enhancing substances. "maybe 15, 20%" of the league's players use illegal performance-enhancing substances.

27. Wade Wilson, Dallas Cowboys QB Wade Wilson, Dallas Cowboys QB

28. Braces and a six pack

29. GH deficiency GH deficiency Pituitary disorder Pituitary disorder GH a potential treatment for: GH a potential treatment for: frailty frailty osteoporosis osteoporosis morbid obesity morbid obesity cardiac failure cardiac failure Growth hormone (GH) replacement

30. Increases recovery (acute) Increases recovery (acute) Increased amino acid uptake into muscle Increased amino acid uptake into muscle Increased glycogen through glucose uptake Increased glycogen through glucose uptake Increases Energy (chronic) Increases Energy (chronic) Stimulates fatty acid release from adipose tissue Stimulates fatty acid release from adipose tissue Increases sensitivity to fatty acid release Increases sensitivity to fatty acid release Increases lean muscle mass Increases lean muscle mass What it does

31. Cancer Cancer Bony Changes Bony Changes Jaw and Forehead Jaw and Forehead Long bones if still growing Long bones if still growing Coronary artery disease Coronary artery disease Cardiomyopathy Cardiomyopathy Side Effects

32. 1992 2005

33. Restful sleep Restful sleep Avoid pre-bedtime snacks containing fat or carbohydrate Avoid pre-bedtime snacks containing fat or carbohydrate Encourage training intensity, while discouraging training volume without intensity Encourage training intensity, while discouraging training volume without intensity Arginine as “secretogogue” Arginine as “secretogogue” What else to do

34. Catabolic hormone Catabolic hormone Release glucose and fat Release glucose and fat Stress steroids Stress steroids Glucocorticoids

35. Increased energy from release of sugar and fat Increased energy from release of sugar and fat What it does

36. Muscle breakdown Muscle breakdown Central obesity Central obesity Moon facies Moon facies Osteopenia Osteopenia Adrenal suppression Adrenal suppression Side Effects

37. Caffeine for fatty acid release Caffeine for fatty acid release Maximize glycogen “supercompensation” Maximize glycogen “supercompensation” What else to do

38. Increase alertness and (perceived) energy Increase alertness and (perceived) energy Mimics effects of adrenaline Mimics effects of adrenaline Cocaine Cocaine Amphetamine Amphetamine Phenylpropanolamine Phenylpropanolamine Ephedrine Ephedrine Stimulants

39. VO2max= HR x SV x ( A -V)02

40. 2005 Mariano Puerta, French Open finalist 2005 Mariano Puerta, French Open finalist Traces of cardiac stimulant in blood Traces of cardiac stimulant in blood Claimed it was from his wife’s menstrual pain medication when he drank her water Claimed it was from his wife’s menstrual pain medication when he drank her water

41. 1999 Javier Sotomayor, Olympic high jump gold medalist and world record holder, tests positive for cocaine at Pan Am Games 1999 Javier Sotomayor, Olympic high jump gold medalist and world record holder, tests positive for cocaine at Pan Am Games Fidel Castro blames it on a CIA conspiracy Fidel Castro blames it on a CIA conspiracy

42. NCAA reports an increase in positive stimulant (and cocaine) tests since 2001- 2002 NCAA reports an increase in positive stimulant (and cocaine) tests since 2001- 2002 58.3% of collegiate hockey players admit to stimulant (ephedrine, pseudoephedrine, amphetamin) use 58.3% of collegiate hockey players admit to stimulant (ephedrine, pseudoephedrine, amphetamin) use Current Sports Medicine Reports, September,2004 Current Sports Medicine Reports, September,2004

43. April 2004: Track sprinter Torri Edwards tests positive for Nikethamide-2 year ban. “Accidentally” taken in an over the counter medication April 2004: Track sprinter Torri Edwards tests positive for Nikethamide-2 year ban. “Accidentally” taken in an over the counter medication 2003 100m and 200m sprinter Kelli White tests positive for Modafinil 2003 100m and 200m sprinter Kelli White tests positive for Modafinil 1998 Dennis Mitchell 400m relay gold medlaist tests positive for testosterone 1998 Dennis Mitchell 400m relay gold medlaist tests positive for testosterone

44. Cory Stringer All-pro offensive linemandied from combination of ephedra and heat illness Cory Stringer All-pro offensive linemandied from combination of ephedra and heat illness 2003 Steve Belcher dies of heat stroke while using ephedrine 2003 Steve Belcher dies of heat stroke while using ephedrine 2007 800m freestyle world champion Oussama Mellouli banned for 18 months 2007 800m freestyle world champion Oussama Mellouli banned for 18 months

45. Increases time to exhaustion Increases time to exhaustion Increases cardiac output Increases cardiac output Increases liver and muscle glycogen release Increases liver and muscle glycogen release Bronchial dilatation Bronchial dilatation Appetite suppressant Appetite suppressant Ephedra: What it does

46. Pre-disposition for heat illness Pre-disposition for heat illness Appetite suppressant Appetite suppressant Insomnia (affects GH) Insomnia (affects GH) Tachycardia, arrhythmias and heart disease Tachycardia, arrhythmias and heart disease Mental status changes Mental status changes Fatigue depression and lethargy Fatigue depression and lethargy Side Effects

47. Caffeine 4-5mg/kg + pseudoephedrine 1mg/kg Caffeine 4-5mg/kg + pseudoephedrine 1mg/kg Minimizes side effects, maximizes ergogenic effect Minimizes side effects, maximizes ergogenic effect What else to do

49. Muscles perform best when they can use oxygen and glucose to make energy. Muscles perform best when they can use oxygen and glucose to make energy. Red blood cells transport oxygen from the lungs to the muscles Red blood cells transport oxygen from the lungs to the muscles Blood

50. VO2= HR x SV x ( A -V)02

51. Spanish police raid a lab/office of Madrid based hematologist, Eufamanio Fuentes Spanish police raid a lab/office of Madrid based hematologist, Eufamanio Fuentes Multiple high-end athletes implicated in his blood doping ring Multiple high-end athletes implicated in his blood doping ring Spanish soccer Tennis Cycling Operation Puerto

52. Extra blood increases aerobic/endurance potential Extra blood increases aerobic/endurance potential

53. 1984 Ed Burke, PhD and US Cycling Federation coaches admit to providing homologous and autologous blood transfusions to US Olympic Cycling Team 1984 Ed Burke, PhD and US Cycling Federation coaches admit to providing homologous and autologous blood transfusions to US Olympic Cycling Team US wins gold in the Road Race and medals for the first time since 1912 US wins gold in the Road Race and medals for the first time since 1912 Who wins, where were the 1984 Olympics held? Who wins, where were the 1984 Olympics held?

54. Alexi Grewal First gold medal in road cycling since 1912 Alexi had just finished a 2 week suspension for ephedrine

55. Erythropoetin Erythropoetin 12-15% increase in power 12-15% increase in power Decreased lactate accumulation Decreased lactate accumulation Eur J Appl Physiol. 2002 Mar;86(5):442-9 7% increase in VO2max MSSE 2000 Jul;32(7) 7% increase in VO2max MSSE 2000 Jul;32(7) rEPO v Aranesp rEPO v Aranesp CERA CERA Take it out, train, put it back Take it out, train, put it back

56. EPO changed everything...All of a sudden whole teams were ragingly fast; all of a sudden i was struggling to make the time limits...I’d be on climbs, working as hard as I’d ever worked, and right alongside me would be these big-assed guys, and they’d be chatting like we were on the flats! Andy Hampsten, winner Tour of Italy

57. Fleche Wallone, 1994: three riders from Gewiss team rode away from the pack After the race, team doctor Michele Ferrari was asked about EPO use “I don’t prescribe the stuff, but you can buy EPO in Switzerland without a prescription” “EPO is not dangerous; it’s the abuse that is. It’s also dangerous to drink 10 liters of orange juice”

58. Late 1980’s and early 1990’s Dutch cyclists keep dying in their sleep Late 1980’s and early 1990’s Dutch cyclists keep dying in their sleep Blood is too thick and clots develop with the slow heart rate Blood is too thick and clots develop with the slow heart rate Risk of blood borne diseases Risk of blood borne diseases Ricco: septic after transfusion Ricco: septic after transfusion

59. WADA spent millions of dollars over years Ferrari took 5 minutes Microdosing not detected by Blood Passport Eur J Appl Physiol 2011 Sep;111(9) EPO Dosing

60. Altitude training Altitude training Altitude tents Altitude tents Hypoxic training Hypoxic training What else to do

61. Beware the athletes Beware the athletes Know what is being used Know what is being used Know what training/dietary alternatives to offer Know what training/dietary alternatives to offer