1. Performance-Enhancing Drugs & Methods Chapter 16

2. Definition of Performance- Enhancing Substance “Performance-enhancing substance” means a manufactured product for oral ingestion, intranasal application or inhalation containing compounds that: –Contain a stimulant, amino acid, hormone precursor herb or other botanical or any other substance other than an essential vitamin or mineral –Are intended to increase athletic performance, promote muscle growth, induce weight loss or increase an individual’s endurance or capacity for exercise.

3. Variations of Steroids and Performance-Enhancing Substances

4. Why do athletes take anabolic steroids or performance-enhancing substances? To: Boost athletic performance Boost athletic performance Build muscle Build muscle Increase body mass Increase body mass Lose body fat Lose body fat

5. What influences an athlete to take anabolic steroids or performance- enhancing substances?

6. Desire to Emulate Role Models

7. Peer Pressure to Succeed

8. Media Influences Images that portray steroids in a positive light

9. Cover Stories About Steroids

10. Desired Body Image Based on Gender

11. Dangers of Anabolic Steroids and Performance-Enhancing Substances Steroids are dangerous for two reasons: –They are ILLEGAL. –They can damage a person’s mental and physical health.  If used by adolescents, can have permanent negative consequences

12. Some Health Risks for Both Males and Females: –Acne, really bad acne, especially on face and back –Stunted growth in teens (by causing bones to mature too fast and stop growing at an early age) –High blood pressure, unhealthy cholesterol changes, and heart disease –Blood clots and stroke –Liver damage, jaundice, or liver cancer –Headaches, aching joints, and muscle cramps –Increased risk of ligament and tendon injuries, which can end an athlete’s career for good –Needle sharing results in higher risk for serious infections like Hepatitis B and C or HIV, which causes AIDS –Baldness

13. Gender Differences and Risks of Drug Use Young Females Self-esteem Self-esteem Depression/mood Depression/mood Body image* Body image* Media* Media* Young Males Risky behavior Risky behavior Impulsivity Impulsivity Body image* Body image* Media* Media* *Specific, based on gender

14. Health Risks for Males: Shrinking of the testicles Shrinking of the testicles Low sperm count Low sperm count Impotence (inability to get an erection) Impotence (inability to get an erection) Increased breast growth in males, especially teens Increased breast growth in males, especially teens Possible lactating Possible lactating Enlarged prostate Enlarged prostate

15. Health Risks for Females: Breast shrinkage Breast shrinkage Male-type facial and body hair growth Male-type facial and body hair growth Deepening of the voice Deepening of the voice Problems with menstrual periods Problems with menstrual periods Enlarged clitoris Enlarged clitoris Insatiable sex drive Insatiable sex drive

16. Health Risks for Both Genders Internal organ disease: liver, kidneys, arteriosclerosis Internal organ disease: liver, kidneys, arteriosclerosis Various cancers Various cancers

17. Psychological Health Risks: “Roid rage”- severe, aggressive behavior that may result in violence, such as fighting or destroying property “Roid rage”- severe, aggressive behavior that may result in violence, such as fighting or destroying property Severe mood swings Severe mood swings Paranoia- extreme feelings of mistrust and fear Paranoia- extreme feelings of mistrust and fear Anxiety and panic attacks Anxiety and panic attacks Depression and thoughts of suicide Depression and thoughts of suicide

18. Definition of “Cycling” Anabolic steroids are taken orally or injected, typically in cycles of weeks or months, rather than continuously. Anabolic steroids are taken orally or injected, typically in cycles of weeks or months, rather than continuously. Cycling involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again. Cycling involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again.

19. Definition of “Stacking” Users often combine several different types of steroids to maximize their effectiveness while trying to minimize negative effects. Users often combine several different types of steroids to maximize their effectiveness while trying to minimize negative effects.

20. Slang for anabolic steroids or performance-enhancing substances You may have heard steroids called: You may have heard steroids called: –Roids –Juice –Hype –Pumpers –Gym Candy –Arnolds –Gear –Weight Trainers –Stackers –420 (pronounced “four-twenty”)

21. What should you look for if you are concerned that an athlete may be taking anabolic steroids or performance-enhancing substances? Unfortunately, many of the symptoms of steroid abuse look very similar to typical appearances and attitudes that occur during adolescence. Here are some signs to look for: –Increased aggression –Rapid weight gain (10 lb/month or 40lb/year) –Pustular acne –An obsession with and bragging about increased performance (i.e. increased bench press) –Virilization in females (lowering of voice; facial hair, male pattern of hair growth on body)

22. Steroids are safe Taking any kind of steroid will result in death Injectable steroids are safer than oral steroids Steroids won’t really stunt your growth All steroids are pretty much the same Steroid abuse isn’t really a big problem in the U.S. All steroids are pills Only a certain kind of person uses steroids Steroids aren’t addictive Steroids aren’t as illegal as other drugs Steroids build muscle without working out Women don’t use steroids Roid rage isn’t real Common Myths

23. Stimulants Drugs that can reduce fatigue, suppress appetite, and increase alertness & aggressiveness Drugs that can reduce fatigue, suppress appetite, and increase alertness & aggressiveness Stimulate the CNS, increase your heart rate, blood pressure, body temperature & metabolism Stimulate the CNS, increase your heart rate, blood pressure, body temperature & metabolism

24. Stimulants cont. Most common include caffeine and amphetamines Most common include caffeine and amphetamines Cold remedies often contain the stimulants ephedrine & pseudoephedrine (Sudafed) Cold remedies often contain the stimulants ephedrine & pseudoephedrine (Sudafed) Street drugs such as cocaine & methamphetamine belong to this group Street drugs such as cocaine & methamphetamine belong to this group

25. Stimulants cont. Can boost physical performance & promote aggressiveness on the field Can boost physical performance & promote aggressiveness on the field Have side effects that can impair athletic performance Have side effects that can impair athletic performance –Nervousness & irritability, insomnia –Can become psychologically addicted or develop a tolerance so that they need greater amounts to achieve the desired effect

26. Stimulants cont. Other side effects may include: Other side effects may include: –Heart palpitations –Heart rhythm abnormalities –Weight loss –Mild hypertension –Hallucinations –Convulsions –Brain hemorrhage –Heart attack & other circulatory problems

27. Ephedra Erythropoetin (EPO) increases endurance Erythropoetin (EPO) increases endurance Ephedra delays fatigue Ephedra delays fatigue –On April 12, 2004, the Food and Drug Administration prohibited the sale of dietary supplements containing ephedrine alkaloids (ephedra). –Ephedra, also called Ma huang, is a naturally occurring substance derived from plants. Its principal active ingredient is ephedrine, which when chemically synthesized is regulated as a drug.

28. Ephedra cont. Ephedra products have been extensively promoted to aid weight loss, enhance sports performance, and increase energy. Ephedra products have been extensively promoted to aid weight loss, enhance sports performance, and increase energy. Linked to significant adverse health effects, including heart attacks and strokes Linked to significant adverse health effects, including heart attacks and strokes Increased risk of side effects, possibly may be fatal Increased risk of side effects, possibly may be fatal No evidence that ephedra products enhance athletic performance No evidence that ephedra products enhance athletic performance Short-term weight loss may be the only benefit Short-term weight loss may be the only benefit

29. Creatine Formal name is creatine monohydrate Formal name is creatine monohydrate Compound produced by your body that helps release energy in your muscles Compound produced by your body that helps release energy in your muscles Naturally occurring compound Naturally occurring compound –Can also ingest creatine from protein-rich foods such as meat or fish –Take a nutritional supplement

30. Creatine cont. May be able to produce small gains in short-term bursts of power May be able to produce small gains in short-term bursts of power –Improving maximum-weight bench press or increasing speeds of very short duration Some studies show an increase in lean muscle mass Some studies show an increase in lean muscle mass

31. Creatine cont. Helps muscles make & circulate adenosine triphosphate (ATP) Helps muscles make & circulate adenosine triphosphate (ATP) –Nucleotide that helps give you energy –ATP is used for quick, explosive bursts of activity (weightlifting & sprinting) Also reduces energy waste products, such as lactic acid Also reduces energy waste products, such as lactic acid –Can cause muscle fatigue

32. Creatine cont. Said to enhance performance & decrease fatigue Said to enhance performance & decrease fatigue No evidence that creatine enhances performance in aerobic or endurance sports No evidence that creatine enhances performance in aerobic or endurance sports

33. Creatine cont. Liver produces about 2 grams of creatine each day Liver produces about 2 grams of creatine each day Stored in muscles, and levels are easily maintained Stored in muscles, and levels are easily maintained Kidneys will remove excess creatine, the value of supplements to someone who already has a high muscle creatine content is questionable Kidneys will remove excess creatine, the value of supplements to someone who already has a high muscle creatine content is questionable

34. Creatine cont. Possible side effects of creatine that can decrease athletic performance: Possible side effects of creatine that can decrease athletic performance: –Stomach cramps –Muscle cramps –Nausea –Vomiting –Diarrhea

35. Creatine cont. Weight gain is a known side effect Weight gain is a known side effect –After prolonged use, weight gain is more likely the result of water retention than an increase in muscle tissue High doses can potentially damage: High doses can potentially damage: –Kidneys –Liver –Heart

36. Creatine cont. Unknown the effects from long-term usage Unknown the effects from long-term usage –Dosage levels vary widely depending on product & how much creatine you take Not regulated by FDA Not regulated by FDA –Not sure of purity on market

37. Creatine cont. Improves energy and performance in brief, high- intensity activities Improves energy and performance in brief, high- intensity activities Short-term advantages — increased energy in short bursts; can aid in improving athletic anaerobic performance (weight lifting; sprinting; rowing); delays muscle fatigue Short-term advantages — increased energy in short bursts; can aid in improving athletic anaerobic performance (weight lifting; sprinting; rowing); delays muscle fatigue Known disadvantages — requires serious strength training program; dehydrates blood stream, so requires excessive consumption of water; with the consumption of excessive amounts it has the potential to cause renal disease Known disadvantages — requires serious strength training program; dehydrates blood stream, so requires excessive consumption of water; with the consumption of excessive amounts it has the potential to cause renal disease

38. Blood Doping Increasing the number of red blood cells in the body to increase the oxygen carried to muscle Increasing the number of red blood cells in the body to increase the oxygen carried to muscle –Administration of blood, red blood cells, or related blood products –Erythropoietin  Stimulates bone marrow to produce red blood cells

39. Blood Doping – proven effects 7% increase in Hgb 5% increase in VO2 max 34% increase in time to exhaustion at 95% VO2 max 44 second improvement in 5 mile treadmill run time (Williams and Branch summarized study findings)

40. Blood Doping - Side Effects Transfusion reactions Transfusion reactions Infections Infections Increased viscosity of blood Increased viscosity of blood –Stroke, MI, PE

41. Blood Doping - regulation Erythropoietin only by prescription Erythropoietin only by prescription Doping banned by USADA, NCAA Doping banned by USADA, NCAA Blood tested for antigens Blood tested for antigens Ceiling on allowable Hct level at 50 Ceiling on allowable Hct level at 50

42. Beta-2-Agonists Physiology Physiology –Bronchodilation, increased ventilation –Examples: albuterol, terbutaline, salmeterol

43. Beta-2-Agonists – proven effects Clear benefit in asthma and EIB Clear benefit in asthma and EIB –Increased ventilation No increase in performance in NON-asthmatic athletes No increase in performance in NON-asthmatic athletes Side effects: tremor, tachycardia Side effects: tremor, tachycardia Regulation Regulation –USADA: prohibited –NCAA: inhalation permitted

44. Nitric Oxide-releasing agents Physiology Physiology –Arginine is a precursor of NO –NO regulates BP and blood flow to organs –Most supplements: Arginine α- ketoglutarate Claims Claims –Improves “pump” and blood flow to muscles –Increases strength and size –Speeds recovery

45. Nitric Oxide-releasing agents Endurance exercise studies Endurance exercise studies  No benefit in endurance athletes  Limited evidence of benefit in debilitated pts Strength exercise: mixed results, no proven benefit Strength exercise: mixed results, no proven benefit More studies needed More studies needed

46. Sodium Bicarbonate Mechanism: buffers metabolic acidosis after strenuous exercise Proven ergogenic efx in high-intensity exercise –1–1–1–100m & 200m swim –R–R–R–Repeated sprints –R–R–R–Repeated judo throws

47. Bicarbonate Limited & conflicting evidence of benefit in aerobic exercise Limited & conflicting evidence of benefit in aerobic exercise –High-intensity running: 17% better time-to- exhaustion (30 vs 26 min) –60-min max-effort cycle ergometry: 14% higher power vs Placebo –60-min high-intensity cycling: no difference vs Placebo

48. Bicarbonate Dose: 0.2 - 0.3 mg/kg Dose: 0.2 - 0.3 mg/kg GI side effects common GI side effects common

49. Carbs Sports drink consumption Sports drink consumption Carbohydrate loading Carbohydrate loading

50. Sports Drink Consumption Evidence supports enhanced endurance performance vs water in events >60 min Evidence supports enhanced endurance performance vs water in events >60 min No benefit from added protein No benefit from added protein

51. Carbohydrate Loading Known to increase muscle glycogen levels 13% - 100% Known to increase muscle glycogen levels 13% - 100% Prolongs time to exhaustion 2-3% in endurance events >90 minutes Prolongs time to exhaustion 2-3% in endurance events >90 minutes Higher effect in Untrained persons Higher effect in Untrained persons –25-km treadmill

52. Methods of Carbo Loading Classic 6-day regimen Classic 6-day regimen –3 days intense glycogen-depleting exercise –3 days high-CH diet, no exercise Modified 6-day regimen Modified 6-day regimen –3-day exercise taper, normal diet –High-CH (70%) & light exercise 3d prior Single-day regimen Single-day regimen –10 gm/kg/day CH 1-day prior –Normal exercise regimen

53. Carbohydrate Loading ‘s Little standardization of methods Little standardization of methods –Athletes need to try methods prior to competition to see what works Exact roles of glycogen-depleting exercise, type of CH, and timing are unclear Exact roles of glycogen-depleting exercise, type of CH, and timing are unclear

54. Miscellaneous Losers Vitamin E and other vitamins Vitamin E and other vitamins Minerals: Cr, Mg, Zn, Se Minerals: Cr, Mg, Zn, Se L-Carnitine L-Carnitine Antioxidants Antioxidants Pyruvate Pyruvate Arginine Arginine Hydroxy-methyl-butyrate (HMB) Hydroxy-methyl-butyrate (HMB)

55. Diuretics Drugs that change your body’s natural balance of fluids & salts Drugs that change your body’s natural balance of fluids & salts Can lead to dehydration Can lead to dehydration –Water loss may allow an athlete to compete in a lighter weight class

56. Diuretics Commonly used to treat high blood pressure & conditions that cause fluid retention (edema) Commonly used to treat high blood pressure & conditions that cause fluid retention (edema) –Such as congestive heart failure May cause: May cause: –Muscle cramps, exhaustion, decreased ability to regulate body temperature, potassium deficiency, & heart arrhythmias

57. Diuretics cont. Used to increase the amount of urine produced and to increase kidney function, thereby speeding up the elimination of fluid from the body Used to increase the amount of urine produced and to increase kidney function, thereby speeding up the elimination of fluid from the body In turn this will cause rapid weight loss in sports where performers are required to compete within strict weight boundaries In turn this will cause rapid weight loss in sports where performers are required to compete within strict weight boundaries

58. What healthcare professionals can do… Be clear about your expectations Talk to student athletes that unless the long-term effects of performance-enhancing drugs on young athletes are known to be safe, you expect him or her to avoid them Discuss alternatives to performance enhancers, include sports nutrition and strength training techniques Set rules. For example, if a student uses performance-enhancing drugs, he or she will be removed from the team Teach students that short-term gains can lead to long-term problems.

59. What to do…continued Discuss ethics and proper training. Athletes should compete fairly Remind them that using a performance-enhancing drug is similar to cheating, but even more importantly, could lead to serious health problems or even death. Another key message is that a balanced diet and rigorous training are the true keys to athletic performance Encourage the student athlete to feel good about his or her sports performance Monitor for signs of drug use. Signs the student may be taking anabolic steroids include increased acne and male-pattern baldness. If a female takes anabolic steroids, she may develop male characteristics, such as a deep voice or dark facial hair. Teens who take anabolic steroids may seem unusually moody and have angry outbursts known as ‘roid rage’ Discuss the school district’s policy concerning anabolic steroids and other performance enhancing drugs with all student athletes

60. Anabolic Steroids and Performance- Enhancing Substances Prevention Least Effective Method : Least Effective Method : –Simply teaching students about steroids’ harmful effects does not convince adolescents that they personally will be adversely affected. More Effective Method: More Effective Method: –Presenting both the risks and benefits of steroid use is more effective in convincing adolescents about steroids’ negative effects, because they find a balanced approach more credible and less biased.

61. Anabolic Steroids and Performance- Enhancing Substances Prevention MOST EFFECTIVE Method: MOST EFFECTIVE Method: –Science-based, research-based curriculum with predictable outcomes, combined with credible, unbiased facts.