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Chapter 16

Performance-Enhancing Drugs

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Reasons for concern include:

Athletes are role models for young people

Drugs may provide an unfair advantage during competition

Athletes at all levels of ability may risk their health or lives by taking drugs

Concerns about Drug Use by Athletes

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Early products

May not have provided any true physical performance enhancement

Probably had only a placebo value

Ancient Greek Olympians and Aztec athletes used plant-based stimulants

Athletic competitions probably developed in tribal societies as a means of training for war or hunting

Drugs were also often used for these activities

History: Ancient Times

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Strychnine

At low doses = a CNS stimulant

Higher doses may lead to convulsions and death

1904 Olympic marathon winner used brandy and strychnine

Despite associated dangers, some use of strychnine may have continued into the 1960s

Cocaine

Available beginning in the 1800s

Mariani’s Coca Wine was used by the French cycling team

Athletes later used pure cocaine

Caffeine

Many athletes used coffee and/or pure caffeine

Early Use of Stimulants

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Potential benefits over other stimulants:

More potent than caffeine

Safer than strychnine

Seemed to be the ideal ergogenic drug

Probably in use by athletes soon after they were introduced in the 1930s

Many early reports of the use by boxers, cyclists, and soccer players

Examples of adverse events:

1950s Olympics: Many reports of amphetamine use, a few deaths

1960 Olympics: One cyclist died, several others hospitalized due to amphetamine use

History: Amphetamines

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1968:

International Olympic Committee established rules to disqualify any athlete who used banned drugs or refused to be tested

Scope of testing at the Olympics has continued to expand over time

More than 5000 urine tests at London 2012 games, but fewer drug disqualifications than the three previous games

International Drug Testing

  • 1960s:
  • Some sports began testing athletes, but problems continued
  • Example: cyclist died during 1967 Tour de France
  • Amphetamines found in his system

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1960s:

Many football players used amphetamines during games

Attitudes toward amphetamines changed

American Football

1971: NFL banned the distribution of amphetamines by team officials

Initially no testing of players, who could still obtain the drug on their own

Current NFL policy restricts all use of amphetamines and many other drugs

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1960s: Many U.S. athletes used steroids

Weight lifters and bodybuilders

Track and field athletes

1970s: Testing in athletic events began

History: Steroids

Testosterone was used for weight gain in malnourished people

Soviets began to use testosterone to build up athletes in the 1950s

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Rumors of steroid use by certain professional baseball players

June 2003: Evidence surfaced that athletes were using tetrahydrogestrinone

Previously unknown steroid that did not show up in tests developed by the U.S. Anti-Doping Agency

BALCO Laboratories founder Victor Conte was implicated

Along with a number of professional athletes from several different sports

The BALCO Scandal

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1980s: Reports of drug use among athletes grew

Most sports organizations adopted stricter testing guidelines

Longer lists of banned substances

Despite extensive and expensive tests, use of performance-enhancing substances continues

There is ongoing development of new drugs and strategies to help athletes avoid detection

The Battle Over Testing

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Types of drugs used as performance enhancers include:

Stimulants

Steroids

Human growth hormone

Beta-2 agonists

Creatine

Performance Enhancers

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Are stimulants effective?

Amphetamines:

Studies indicate that most athletes perform better

But the improvement is small

At high levels of competition, small improvements can make a big difference

Underlying mechanism of improvement is unclear

Increased physical ability (increased strength, masking of fatigue)

Effects on the brain (increased confidence, winning attitude)

Stimulants as Performance Enhancers

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Caffeine:

Improves endurance under laboratory conditions

May not be effective under certain conditions

May need large amounts of caffeine

Ephedrine:

On Olympic and NCAA lists of banned substances

Professional sports organizations were slower to ban it

Example: Major League Baseball

2003: Death of pitcher Steve Bechler in 2003 was attributed to ephedrine-related heat stroke

Stimulants as Performance Enhancers

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The male sex hormone testosterone has two type of effects

Androgenic effects (masculinizing)

Growth of the penis and other male sex glands

Deepening of the voice

Increased facial hair

Anabolic effects (tissue building)

Increased muscle mass

Control of the distribution of body fat

Increased protein synthesis

Increased calcium in the bones

  • Synthetic anabolic steroids have fewer androgenic effects

Steroids

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Synthetic anabolic steroids enhance the natural process of muscle building

Vigorous workouts cause microtrauma to muscles

Muscle repair leads to larger and stronger muscles

Steroids speed up the recovery and repair process

  • Synthetic anabolic steroids allow the athlete to return to heavy training more quickly

Steroids

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Are steroids effective?

Research findings

Animal studies: Synthetic anabolic steroids build muscle in castrated animals

Laboratory research on healthy men

Steroids can produce small increases in lean muscle mass and muscular strength

No evidence for increase in aerobic capacity or endurance

Unclear if giving anabolic steroids to males who have normal testosterone levels will have a significant effect

Steroids

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Difficult to extrapolate laboratory findings to athletes

Athletes may use much higher doses

Athletes may use combinations of steroids (“stacking”)

Psychological effects of steroids may affect results

Users report that they feel stronger and can thus work harder

Possible active placebo effect

Steroids: Research Issues

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Anecdotally, steroids produce a stimulant-like high and increased aggressiveness

May allow for more work done during training and increased intensity of effort during competition

Concerns about high dose use

Psychological dependence, resulting in mood swings and depression when users don’t take the drugs

Interference with social relationships and other areas of life

“Roid rage”:

Stories may be exaggerated

But there are many reports of violent feelings and actions among steroid users that raise concern

Steroids: Psychological Effects

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Risks for young users

Premature closure of the growth plates of the long bones

Risks for men

Atrophy of the testes, breast enlargement

Risks for women

Decreased breast size, enlargement of the clitoris, increased facial hair, deepening of the voice

Risks for all users

Peliosis hepatitis (Bloody liver cysts)

Changes in blood lipid levels that may contribute to atherosclerosis, high blood pressure, and heart disease

Steroids: Adverse Effects

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Issues leading to regulation

Large black market for the drugs

Concerns about use among adolescent boys, even non-athletes

Anabolic steroids are listed on Schedule III

Limited prescription refills

More record keeping

Steroids: Regulation

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HGH: pituitary hormone

can potentially increase height and weight to gigantic proportions

Administration of doses of HGH may produce a more controlled increase in body size

Experiments have shown HGH may increase lean body mass but may not improve strength

It is illegal to distribute HGH for nonmedical purposes

Human Growth Hormone

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Example: clenbuterol

Mechanism of action and effects

Selective stimulation of the beta-2 subtype of adrenergic receptors

Sympathomimetic effects on the bronchi of the lungs

Used in treating asthma

Animal studies showed a possible effect on muscle mass

No evidence for improved athletic performance

Banned for use in competition

Beta-2 Agonists

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A natural substance found in meat and fish

Sold legally as a dietary supplement

Mechanism of actions and effects

Helps regenerate ATP, which provides the energy for muscle contractions

Users tend to gain weight, some of which is water weight

May improve strength and short-term speed in sprinting

No evidence for improvement in longer-distance events

Performance may decrease possibly due to weight gain

Creatine

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Increasingly, bodybuilders are seeking a strong and lean look

“Cut” refers to a lean, strong body, a “sculpted” body

Body fat percentage may be as low as 6 to 9 percent

14-20% is ideal for a healthy male

Getting “Cut”

Many bodybuilders take “fat burners”

Dietary supplements of questionable safety and effectiveness

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