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Sports Supplements Andrew Gregory, MD Assistant Professor, Orthopedics/ Pediatrics Team Physician, Vanderbilt University Jan. 10, 2002.

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Presentation on theme: "Sports Supplements Andrew Gregory, MD Assistant Professor, Orthopedics/ Pediatrics Team Physician, Vanderbilt University Jan. 10, 2002."— Presentation transcript:



3 Sports Supplements Andrew Gregory, MD Assistant Professor, Orthopedics/ Pediatrics Team Physician, Vanderbilt University Jan. 10, 2002

4 Definition: Ergogenic Aids n Ergo = work n Gennan = to produce n Any substance or method used to enhance performance through increased energy utilization: –production –control –efficiency

5 Classification n Drugs: –Hormones –Stimulants –Narcotics –Diuretics –B-Blockers n Supplements: –Prohormones? –Amino Acids –Metals –Antioxidants –Herbs

6 Prevalence: n Estimated 11% of HS athletes, college, and professional. n Majority of Olympic swimmers, cyclists, sprinters, & weight lifters n 2/3 of the 1998 Tour de France teams n Billion Dollar Industry

7 Reasons: n Have to use them to be competitive n Need the edge n Not genetically gifted n Dissatisfaction with size/ weight n Peer/ Team Pressure

8 Hormones n HGH n EPO n BHCG n Steroids


10 Human Growth Hormone n Normally secreted by the pituitary n Normal function of GH is growth and development of every body system, including bone and muscle n Can be stimulated by propanolol, vasopressin, clonidine, and levodopa n Synthetic growth hormone

11 Side Effects: n Acromegaly (may be irreversible) n Peripheral Neuropathy n Coronary Artery Disease n Cardiomyopathy n Diabetes, Hypothyroidism, arthritis n No available urine test available, but banned by NCAA and IOC

12 Erythropoietin n Hormone released by the kidneys in response to low Hct n Stimulates RBC production from bone marrow n Has recently been manufactured by recombinant DNA technique n Can increase Hct in renal patients by up to 35%, lasting up to 7 months n Used most by cyclists

13 Blood Doping n Induced Erythrocythemia: An increase in Hb following reinfusion of an athletes blood n Goal: to increase the oxygen-carrying capacity of Hb n Has been used as far back as 1947 n 1984: seven US Olympic cyclists guilty n Banned by IOC in 1985

14 Pathophysiology n Muscles depend on ATP for energy n Aerobic metabolism = breakdown of glycogen in presence of O2 >>>ATP n Aerobic metabolism-higher yield of ATP n More O2 carrying capacity>>more ATP production, more energy to muscle n 1 U PRBC>>500 ml / min increase in O2 carrying capacity

15 Methods: n Autologous reinfusion method: 2 units blood removed 4-8 weeks prior to competition & frozen c glycerol n Hb / Hct returns to pre-transfusion levels n Reinfusion 1-7 days prior to event n Can produce up to 25% improvement in endurance, with poorer conditioned athletes showing greatest benefits

16 Side Effects: n Heterologous blood: transfusion rxn (3- 10%), Hepatitis (10%), HIV (?%) n Autologous blood: bacterial infections n Polycythemia: increased viscosity >>CHF, HTN, CVA n Most young healthy athletes show no side effects

17 Detection: n Blood doping and Erythropoietin: banned by IOC n No known urine test to detect n Testing: Measured Hct >50 n Measurement of serum Fe and Bilirubin to detect hemolysis after frozen PRBC transfusion


19 Anabolic Steroids n The ultimate ergogenic aid aka Juice n Creates the Superhuman Athlete n Testosterone derivatives (cholesterol) n Produced in the adrenal/ testes

20 Anabolic/Androgenic Steroids n Anabolism - Constructive n Catabolism - Destructive n Anabolic effects : inc. skeletal mm mass n anticatabolism n Androgenic effects: secondary sexual characteristics - pubic hair, genital size n No Pure Anabolic Steroids

21 History of Steroids n First Available - 50s (Dianabol) n Drug Banned - 60s n Testing Initiated- 76 n Athletes Banned - 83 Pan Am Games n Schedule III Controlled Substance - 90 Anabolic Steroid Control Act n US Dietary Supplement Act - 94 no FDA approval if no drug intent

22 Administration: n Athletes may take up to 40-100x therapeutic dose (200-2000 mg/ wk) n IM adm bypasses the liver/ PO does not n Stacking: using various aids in combination n Cycling : gradual inc. then taper over 6-10 weeks, 1-3 cycles /year, bridging between n Illicit - Nandrolone, Stanozolol (Winstrol), Methelone, Tibolone, Oxandrolone n Medical - Testosterone, Enanthate, Undelanoate, Dehydrotestosterone (patch)

23 Desired Effects: n Increase in strength n Increase in weight n Increase in aggressiveness n Increased capability of sustaining repetitive, high intensity workouts n Enhanced performance


25 Side Effects: n CV: MI - hypertension, inc. LDL, dec. HDL, cardiac hypertrophy, thrombosis n Endocrine: virilization, testis atrophy, azospermia, priapism, prostatic hypertrophy/ CA, gynecomastia, erectile dysfct, libido n Liver : peliosis hepatitis, hyperplasia, adenoma, no carcinoma, elevated LFTs n MS: epiphyseal closure, inc. bone density, dec. tendon strength

26 Side Effects (contd): n Skin: acne, hirsuitism, striae, androgenic alopecia, inc. sebaceous glands n Metabolic: hypernatremia, kalemia, phosphatemia, calcemia, prediabetic n Psychiatric : aggressiveness, extreme mood swings - depression/ mania, dependence, other drug use, Reverse Anorexia n Long Term - dec. life span

27 Specific Side Effects n Women (Virilzation): –Clitoril enlargement, Deepening of voice, Male pattern baldness, dec. breast size, libido n Children: –premature closure of growth plate in long bones & thus short stature


29 Prohormones n Androstenedione n DHEA n Androstenediol n Norandrostenedione n Norandrostendiol

30 Androstenedione n 1/2 of the Mark McGuire Special n A natural steroid hormone found in all animals and some plants n Metabolite of DHEA n Precursor of testosterone n Synthesized in Adrenals/ Gonads n Metabolized in the liver to testosterone

31 Effects: n Benefits: Same as Testosterone –Increased energy –Enhanced recovery and growth from exercise –heightened sexual arousal and function –greater sense of well-being n Plasma levels of testosterone increased from 140% to 330% of normal levels after 50mg and 100mg doses n SEs : Same as Testosterone n Banned by IOC, NCAA, NFL

32 DHEA (Dehydroepiandrosterone) n What it is: A hormone produced by adrenal gland n Claims: Anabolic effect n What is does: Increases testosterone levels n Banned by the NCAA, NFL

33 Stimulants n Caffeine n Amphetamines n Cocaine n Ephedrine

34 Amphetamines n Have been used as far back as WWII when soldiers used them to delay fatigue n First study in 1959 showed significant improvement in performance n Available data suggest Amphetamines can improve performance in sports where speed, power and endurance are required

35 Side Effects: n Related to drugs effect on CNS: insomnia, instability, agitation and restlessness n Confusion, paranoia, hallucinations n Dyskinesias, especially in facial muscles n Cardiac complications: HTN, arrhythmias n GI disturbances n Severe rebound of fatigue and depression after discontinuance

36 Caffeine n A Methylxanthine: same class as theophylline and theobromine n 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

37 Caffeine (contd) n Is banned by IOC and NCAA in large doses n Legal limit = 15 micrograms / ml n Equal to 6-8 cups of coffee at one sitting, with testing within 2-3 hours n Beneficial most in endurance events, such as cycling n Doses up to 5 mg / kg were required to see benefits. Doses of 17 mg/kg produce the maximum legal limit.

38 Side Effects: n Similar to s/e of other stimulants: –insomnia, irritability, nervousness –Tachcardia, arrthymias, and possibly death!

39 Ephedrine n What it is: Is a drug found in herbal products containing Ma haung, anti-asthmatic medications, and many cold and cough products. n Claims: Increases body fat loss n 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 n Max dose : 24 milligams per day!!!!!!

40 Amino Acids n Creatine n L-Carnitine n Choline n Inosine n HMB (B-OH-B- Methylbutyrate)

41 Amino Acids n Essential amino acids: found in a balanced diet n Recommended protein intake: 0.8 g /kg/day n Athletes may benefit from up to 1.4 -2.4 g/kg/day n Most beneficial for athletes on a poor diet, or vegetarians n In endurance athletes, up to 10% of energy expenditure is from protein breakdown


43 Creatine n The Other 1/2 of the Mark Mcguire Special - The Creatine Craze - Sales expected to reach $200 million in 1998 n Use has spread: –13% of HS athletes –80% of University of Nebraska football team –50% of NFL players –Vast majority of Olympic sprinters, cyclists, and sprinters

44 Creatine n Methylguanidine-acetic acid - made from glycine, arginine & methionine n Estimated Daily requirement: 2gms n Available in meats and fish (1/2 EDR) n Sold as Creatine Monohydrate n Stored in Skeletal MM n 2000 NCAA banned distribution in training rooms

45 Pathophysiology: n Energy Substrate for muscle contraction n Creatine binds Phosphorus as substrate for formation of ATP (main source of energy of contraction) n PCr also buffers Lactic Acid n After PCr is depleted must resort to glycolysis for ATP production n Net result: sustained muscular contraction, delayed fatigue

46 Benefits: n Improved performance in repeated bouts of high intensity strength work and sprints n Single sprint activity results are equivocal n Does not enhance endurance exercise n More work with less lactic acid production n No studies on competetion benefits n 1998 ACSM meeting: 19/19 studies showed significant ergogenic benefit

47 Dosing: n Loading Phase: 20-30 gm/d, x 5 -7 days n Maintenance phase: 2-5 gm/day n Loading increases PCr stores by 10-40% n Normal resting levels of creatine: 100-150 mM/kg n Most striking benefits occur in subjects with lower resting Cr level n After saturation of tissues, excessive supplementation is renally excreted

48 Side Effects: n Muscle Cramping n Diarrhea n Dizziness n Dehydration n Biggest danger: getting impure creatine n Significant WEIGHT GAIN common 2nd to water retention

49 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 nThe secret is to find something that is effective in improving performance, but not against the rules, and with no side effects n …no clear evidence of harmful side effects of creatine use has emerged…--The Physician and Sportsmedicine, June 1998 n Long term effects of Creatine not yet studied: Concerns focus on effects to kidney, pancreas, and liver.

50 Counseling your patients n Creatine may or may not improve performance n Weight gain will occur n Side effects (especially long-term) not well known n Need to have renal and liver fct. Monitored –should not be used in patients with chronic kidney/ liver disease n Do not exceed the recommended dose

51 n Synthesized in Liver/ Kidney from Lysine & Methionine n found in meats & dairy products n Assists in Fat transportation into muscle mitochondria for oxidation, sparing Glycogen & may prevent lactic acid accumulation n Improved endurance performance not shown in studies L-Carnitine

52 HMB n Metabolite of KIC (ketoisocaproate) which is a metabolite of leucine n Leucine & KIC found to have anticatabolic effects n decreased mm proteolysis, inc. lean mm mass, inc. strength n no known side effects

53 Choline n Precursor for the neurotransmittor Acetyl Choline & the lipoprotein Lecithin (Phosphattidylcholine) n choline depletion in marathoners n no studies supporting

54 Inosine n Increases myocardial contractility n no performance enhancement in runners/ cyclists

55 Metals/ Minerals n Chromium n Magnesium n Boron n Vanadium

56 Chromium n Insulin Cofactor n inc. AA uptake into mm cells n increase mm mass, dec. body fat n found in meats, grains, raisins, apples, & mushrooms n SEs: anemia, chromosomal damage, cognitive impairment & interstitial nephritis in excessive doses

57 Magnesium n Involved in ptn synthesis & mm contraction n + effects on oxygen consumption & lactate production n no change in performance

58 Boron n Originally thought to inc. testosterone levels n not born out in studies

59 Vanadium n What it is: Non-essential trace mineral n Claims: Anabolic effect, enhances insulin action n What it does: No studies to show anabolic effect. Doses>10gms/day causes abd. Pain, cramps, green tongue,diarrhea, wt. loss

60 Antioxidants n Vitamins E & C n potential damage from free oxygen radicals produced by lipid peroxidation in exercise n exercise performance is not improved

61 Herbs n Ginseng n Yohimbe n Tribulus Terresteris n Ma haung

62 Ginseng n What it is: A root from an Asian plant (panax ginseng). n Claims: Enhanced performance. Improved recovery rate. n 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. n Dose: 100-200mg per day used occ.2-3 weeks on 1-2 weeks off

63 n What it is: Supplement derived from tree bark. n Claims: Anabolic effect, Increased virility n What it does: Stimulant effect, no anabolic effect. Can cause nervousness, HA, nausea, Vomiting, increased B/P Yohimbe

64 n What is it: A plant hormone n Claims: Anabolic effect n What it does: Increases testosterone levels n Banned by NFL Tribulus Terresteris

65 Miscellaneous: n Bicarbinate Loading n Coenzyme Q n Linoleic Acid

66 Bicarbonate Loading n Used prior to competition to neutralize lactic acid produced by anaerobic activities n Lactic acid>>lower pH>>fatigue n May improve runnerstimes if taken 30 min prior to competition : best in intermediate distances 800-1500 meter events n 300mg/kg required n Terrible GI s/e in 50% of users--cramps, diarrhea, ^ BP

67 Coenzyme Q10 Conjugated (coQ10,Ubloquinone) Linoleic Acid n Produced by the body in mitochondria n claims: Enhances performance, delays fatigue, prevents injury n What really does:Functions as an antioxidant n Safe levels:60-200mg/day but also$$$$$ n Naturally occurring fatty acid found in beef,lamb and dairy n claims: decreases body fat,increases muscle gain,antioxidant n What really does: No effect on performance

68 References n Blue J, Lombardo J, Nutritional Aspects of Excercise: Steroids & Steroid-like compounds, Clinics in Sports Medicine, Vol 18, Num 3, July 1999, pp 667-689 n Stricker P, Other Ergogenic Agents, Sports Pharmacology, Vol 17, Num 2, April 1998, pp283-297 n Agee R, Ergogenic Aids, ASMI Lecture, Nov. 99

69 Useful Resources n Organizations: n A) Gatorade sports science Institute 800-616-4774 n B) Herb Research Foundation 303-449-2625 n C) USOC Drug Information Hotline 800-233-0393 n Web Sites: n FDA:http// n U.S. n Dietary Supplements Reference: n USOlympicCommittee: n IOC: n NCAA:

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