Doping

Sports Doping
T.S.MUTHUKUMAR.,M.P.T(Cardio-Resp)
Introduction
In 1997, Sports Illustrated asked 198 aspiring
US Olympians,
“Would you take a banned performance

enhancing substance if you were guaranteed
to win and not get caught?”
98% said “YES”

Introduction
Then, when asked,
“Would you take the same undetectable

substance if it would contribute to winning
every competition for 5 years, then result in
death?”
Over 50% still said “YES!!!”

Prevalence
 Over 1,000,000 Americans have used anabolic
steroids – 250,000 of them adolescents
 5-14% of NCAA atheletes
 35% of 11-18 yr olds believe caffeine will
enhance athletic performance; 25% have used
(1993 Canadian national school survey)
 Significant increases in creatine and
androstenedione sales after 1998 MLB home run
race between McGwire and Sosa
IOC prohibited substances
1. Anabolic agents
2. Peptide hormones, mimetics, and
analogues
3. Stimulants
4. Diuretics
5. Narcotics
Anabolic Agents
 Enhance muscle mass gained from strength
training
- Anabolic steriods
- Testosterone precursors
Anabolic Steroids
 Testosterone derivatives – modified to
increase anabolic effects while decreasing
androgenic effects
 Doses may reach 100X medical
replacement dose
 Efficacy in numerous studies since the
1970’s
Anabolic steroid side effects
 Acne  Adverse lipid profile
 Alopecia  Hypertension
 Testicular atrophy  Glucose intolerance
 Masculinization  Premature epiphyseal
 Gynecomastia closure
 Infertility
 Mood alterations
Testosterone precursors
Cholesterol
Pregnenolone
17-hydroxypregnenolone
DHEA
Androstenedione
Testosterone
Androstenedione / DHEA
Dehydroepiandrosterone
 Excess quantities theoretically are
metabolized to testosterone, thereby
increasing serum levels.
 Early studies showed promise, but a recent
randomized, double-blinded study of 30
men by King (1999) demonstrated no gains
over placebo in testosterone levels or
strength.
Androstenedione / DHEA
 Potential side effects similar to anabolic
steroids
 Excessive precursors shown to be
aromatized to form estrogen
Human Growth Hormone
 Manufactured by recombinant technology
for replacement in deficient patients
 Promotes protein anabolism
 Intramuscular delivery
 No virilizing effects – attractive to women
Human Growth Hormone
 Studies suggest increases in muscle size,
but not strength
(increased collagen in muscles
without an increase in contractile tissue)
 Excess may lead to SxS of acromegaly
Insulin-like Growth Factor
 Newer; poor in vivo data
 Potential anabolic and growth promoting
effects similar to human growth hormone
without the lipid side effects
 More prone to cause hypoglycemia
Creatine
 Intrinsic fuel for anaerobic activity
 After ingestion, creatine readily binds to
phosphorus
 Phosphocreatine mediates the regeneration
of ATP from ADP
P-Cr + ADP + H+  Cr + ATP

Creatine
 Supplementation aimed at maximizing
stores of phosphocreatine in muscle tissue
 Potentially decreases fatigue and increases
recovery time
 Enhances training, but no direct anabolic
effect
 Still legal for most competitions
Creatine
 Some equivocal studies
 Others demonstrate positive effect on short,
high-intensity activity
- Dawson (1995), repeated short sprints
- Earnest (1995) & Hamilton-Ward (1997),
bench press weight
Creatine side effects
 Muscle cramps at recommended doses
 Potential for renal insult at high doses, with
a few anecdoctal reports of interstitial
nephritis
Stimulants
 Promote CNS and muscular excitation
 Caffeine
 Amphetamines
 Ephedrine (and pseudoephedrine)
Caffeine
 The most used and abused drug in the world
 Variety of effects from adenosine receptor
antagonism
- increased catecholamines
- increased lipolysis
- CNS activation
- improved respiratory function
Caffeine
 Many studies of varying quality
 Review by Sinclair and Geiger; studies
1994-1998 selecting only those using highly
trained athletes (for reproducibility of
performance) with caffeine washout period
- 11 studies, 115 participants
- cycling/running
- significant increases in time to exhaustion
and decreased perception of effort
Caffeine
 Tolerance develops to repeated dosing
 Excess may cause increased anxiety,
insomnia, and cardiovascular strain
Amphetamines
 Abused since 1920’s
 Increase alertness and produce euphoria by
central modulation of dopamine and
noradrenaline
 Side effects: psychosis, hyperthermia,
cardiovascular strain
 Several deaths from heat stroke
Ephedrine
 Ma Haung, ephedra
 Increases myocardial contraction and blood
pressure, decreases perception of fatigue,
decreases appetite
 Similar side effects of hyperthermia and
cardiovascular strain
Caffeine and Ephedrine
 Randomized, blinded, placebo study by Bell
(2001) with 24 healthy, untrained men
cycling to exhaustion
 Significant increase in power by ephedrine
 Significant increase in endurance by
caffeine
 Synergistic effect
Other Agents
 Erythropoietin
- increases hematocrit to increase oxygen-
carrying capacity, and thus stamina
- increases blood vicosity posing risk for
vascular occlusion, especially when
concurrent with dehydration during
exercise
Other Agents
 Beta Blocker
- reduce anxiety and tremor, but also
reduces energy
 Diuretics
- transient weight loss (e.g. wrestlers and
boxers seeking a lower weight class)
- risk for dehydration
Conclusions
Conclusions
 Sports doping is widespread
 Lack strong data on safety and efficacy
 Potential benefits in amateur athletes (our
patients) probably negligible
 Unclear risks, especially on long-term use
and mega dosing
 First, do no harm.

Doping

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Sports Doping

“Would you take a banned performance

98% said “YES”

“Would you take the same undetectable

Over 50% still said “YES!!!”

P-Cr + ADP + H+  Cr + ATP

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