Intro to Performance- Enhancing Agents

Lecture 9

History of ergogenic aids• The use of ergogenic aids is not a new phenomenon• Rooted in antiquity and based upon

– the superstitious and ritualistic behaviors of athletes with regards to the perception that past performances were predicated upon unique dietary constituents and manipulation

• As early as BC 776, Greek Olympians were reported to have used herbs, hallucinogenic mushrooms, dried figs and strychnine in attempts to improve performance (Wadler & Hainline, 1989; Applegate & Grivetti, 1997)

History of ergogenic aids• Accounts from ancient times advocated the consumption of specific animal parts to

confer the varying dynamics of performance associated with that animal or a particular organ.– Dromeus of Stymphalus adopted the consumption of muscle meat in hopes of

improving muscular strength– Aztec athletes ate the hearts of particularly brave adversaries in attempt to confer

their traits of bravery. (Bucci, 1993)

– In the 19th century, the French concocted vin mariani, a drink mixture of coca leaves and wine, which reportedly reduced fatigue and hunger sensation during prolonged activity (Wagner, 1991)

– In the late 1800’s, marathon runners frequently drank alcohol during races to increase relaxation and reduce the perception of stress

(American College of Sports Medicine, 1982).

History of ergogenic aids• In 1889, 72-year old Dr. Brown-Sequard announced at a scientific meeting in Paris

that he had reversed his body’s ailments through injecting himself with…. – an extract of dog and guinea pig testicles (Hoberman & Yesalis, 1995).

• The assumption was that these organs had internal secretions that acted as physiological regulators– This statement led to the discovery of hormones in 1905 and the

isolation of testosterone in 1935

History of ergogenic aids• Recent focus on the use of ergogenic aids stems from the use

of stimulants in the 1952 Olympic winter games• This was followed by the suspicion of anabolic steroid use in

1954 by Soviet athletes.• In the 1950’s, Russian weightlifters began to surpass American

weightlifters through performance enhancing injections. – In response to this, the US Olympic physician teamed with American

chemists to produce a substance that generated similar results.– This led to the creation of the anabolic steroid Dianabol. (McDevitt, 2003).

• The 1960’s saw substantial increases in drug abuse with amphetamines being implicated in the deaths of several cyclists (Voy, 1991)

History of ergogenic aids• In 1961, The International Olympic Committee Medical

Commission was established. – Main responsibilities

• responsibility of doping control at the Olympic games• the classification of pharmacological substances and the methods

with which they are introduced to the body– Introduction of drug testing at the 1968 winter Olympic games

(Murray, 1987)

– bans on anabolic steroids in 1975– testing for anabolic steroids at the 1976 Montreal Games

(Wesson, Wiggins, Thompson, & Hartigan, 2000).

Sports Illustrated Poll• 198 Olympic–level sprinters, swimmers

and power lifters – asked if they would take a banned substance with

the guarantee that they would not be caught and that by taking the substance they would win

– Of the 198 surveyed athletes, only three said that they would not take the banned substance

• The same poll then proceeded to stipulate– the same banned substance would enable the

winning of every event for the next five years, but would then result in death

– More than fifty percent of the 198 surveyed athletes still reported that they would take the substance

Another Poll• 26 USA power lifting team members that competed in

international competition after 1988– given questionnaires soliciting yes or no answers regarding their current of

previous use of anabolic steroids– Fifteen athletes returned questionnaires

• ten admitted to the use of drugs • five admitted to beating the IOC doping control procedures

(Curry & Wagman, 1999)

Why do people use PEAs?• What is the difference between silver and gold

in Olympic sprint times?

• What if you could improve your performance without changing your training routine?

• How much easier would weight loss be if you could speed up your metabolism?

What are PEAs?• What is the definition of a Performance

Enhancing Agent?

• Performance Enhancing Agents– Steroids– Blood Doping– Athletic Equipment???

Athletic Equipment• Cleats

– Cleats improve performance in most field sports 1

• Receivers/Goalie Gloves– Designed to increase friction between the athletes’ hands

and the ball4

• Swim suits– Swim suits are able to reduce drag vs normal suits 2

– Swim suits can also increase buoyancy, improving performance3

1. Benz et al, US Patent Application, US2011/0167676A1.2. Benjanuvatra, N., et al. Comparison of Buoyancy, Passive and Net Drag Forces between FastskinTM and Standard Swimsuits Journal of Science and Medicine in Sport 5(2) 115-123, 2002.3.Parsons, et al. Do Wet Suits Affect Swimming Speed? British Journal of Sports Medicine 20(3), 129-131, 1986.4.Montero, US Patent Application, US1992/5136725.

Athletic Equipment

Doping defined• the administration of or use by a competing athlete of any

substance foreign to the body or of any physiological substance taken in abnormal quantity or taken by an abnormal route of entry into the body, with the sole intention of increasing in an artificial manner his/her performance in competition is regarded as doping..”

• “The use of physiological substances in abnormal amounts and with abnormal methods, with the exclusive aim of attaining an artificial and unfair increase of performance in competition”

- International Olympic Committee

Inadvertent Doping• Ingestion of substances that “unknown” to the

athlete can cause a positive test for doping.

• Causes:– Ignorance of what substances are banned. – Names in ingredients list are not recognized.– Manufacturer may not list all ingredients.– Product could be contaminated in production.

Ergogenic defined• Any substance, mechanical aid, or training method that improves

sport performance • “Ergo” = work• “Genic” = to generate

– These agents either • directly improve the physiological variables associated with exercise performance• remove subjective restraints that may limit physiological capacity

• The broad term of ergogenic aids can be broken down into– physiological– nutritional – mechanical– pharmacological/hormonal – psychological

Physiological Ergogenic Aids• Aim to augment the physiological processes that

occur naturally within the body and improve the body’s physiological response during exercise– achieved through physical methods, which assist in the

• recovery of damaged tissue• training techniques that work to increase physiological efficiency

and capacity.

– Athletes typically add to substances that are already naturally present within the body

• with the premise that if natural levels of a substance are beneficial to performance, then higher levels should be even better

Physiological Ergogenic Aids• Blood doping • Oxygen supplementation• Polycythemia inducing agents • Altitude training • Bicarbonate loading• Phosphate loading• Physiotherapy and acupuncture

Increasing O2 carrying capacity• Endurance athletes are particularly sensitive to the oxygen-carrying capacity in

their blood • Any substance that induces an increase in this capacity provides a significant

competitive edge

Blood Doping• Gained public prominence as a possible ergogenic technique during the 1972

Munich Olympics• Two types of blood doping, both involving the infusion of red blood cells.

– Autologous transfusion • involves withdrawing one to four units of an athlete’s blood, immediately re-

infusing the plasma and placing the packed red cells in frozen storage• The premise behind this method is that the body will naturally re-establish normal

red blood cell levels• Stored red blood cells are then re-infused one to seven days before an endurance

event– increasing red blood cell count– Increased hemoglobin levels by approximately eight to twenty percent

• cannot be detected unless multiple blood samples are obtained before and after infusion

Blood Doping• Gained public prominence as a possible ergogenic technique during the 1972

Munich Olympics• Two types of blood doping, both involving the infusion of red blood cells.

– Autologous transfusion • involves withdrawing one to four units of an athlete’s blood, immediately re-

infusing the plasma and placing the packed red cells in frozen storage• The premise behind this method is that the body will naturally re-establish normal

red blood cell levels• Stored red blood cells are then re-infused one to seven days before an endurance

event– increasing red blood cell count– Increased hemoglobin levels by approximately eight to twenty percent

• cannot be detected unless multiple blood samples are obtained before and after infusion

Blood Doping• Allogeneic transfusion

– Similar to Autologous– involves the infusion of a donors blood that is type-matched without the initial

withdrawal of blood– This method increases the risk of detection due to variances in a specific

spectrum of blood group antigens that are under genetic control and unique for every individual

– In both cases• The added blood volume theoretically leads to a larger cardiac output,

while the increase in hemoglobin levels raises the bloods oxygen-carrying capacity

Blood Doping• Benefits

– Can increase hemoglobin and hematocrit levels by up to 20%

• Risks– Allogeneic blood transfusion increases the risk of acquired immune deficiency

syndrome and hepatitis • Blood that has not been properly screened • The use of needles that are not sterile

– Increasing the volume of blood without a concurrent increase in capillarization can overload the cardiovascular system and increase blood viscosity

• In 1976, the Medical Commission of the International Olympic Committee formally condemned the practice of blood transfusion for athletes in good health

– Increasing blood volume too much can decrease performance (decrease Q)

Oxygen SupplementationProposed Ergogenic Benefit•Take in more oxygen to increase the oxygen content of the blood.

– Blood Doping – increase oxygen-carrying capacity of the blood– Oxygen Supplementation – Directly provide more O2 to the blood and tissues

• By increasing the available oxygen, athletes hope to– Compete at higher intensities– Fend off fatigue for longer periods– Recover faster between exercise bouts

•Can be administered– Before exercise– During exercise– During recovery

Cont.• 1932 Olympic Games

– Japanese swimmers won impressive victories – Attributed success to breathing pure oxygen before competing.

Proven Effects• Before Exercise

– Limited effect on performance of that exercise bout– Total amount of work and rate of work can be increased by breathing oxygen,

provided• The bout is of short duration• The bout occurs immediately after breathing oxygen

– Bouts exceeding 2 minutes – O2 supplementation is greatly diminished– Limited O2 storage potential in the body

Cont.Proven Effects•During Exercise

– Definite performance improvements– Total amount of work and rate of work increase substantially– Submaximal work performed more efficiently– Lower physiological cost– Peak blood lactate levels are depressed following exhaustive exercise– * The nature of most sports doesn’t allow the athlete to go immediately from O2

breathing into competition*

•During recovery– Recovery does not seem to be facilitated– Subsequent performance does not improve

•Risks– No known risks

Why doesn’t O2 Administration Work?

• Oxyhemoglobin Dissociation Curve

– We are already carrying close to 100% saturation

Erythropoietin (EPO)• Hormone naturally produced in the kidneys• Circulates in the blood to the red bone marrow, where it

stimulates erythropoiesis.• Premise

– Increase production of RBCs

• Erythropoietin levels in the blood can be increased through– Exposure to hypoxia (training in a lower partial pressure of oxygen stimulates its

release)– Subcutaneous or intravenous injection of Recombinant Erythropoietin (rEPO)

• Nearly identical derivative of natural EPO both biologically and immunologically • Short half-life

Erythropoietin (EPO)Proven effects•10% Increase in both hemoglobin concentration and hematocrit•6-8% increase in VO2max•13-17% increase in time to exhaustionRisks•The outcome of erythropoietin use is very unpredictable•An absolute relationship between the amount of recombinant erythropoietin administered and the resultant increase in cell production does not exist.•Biological effects last for the life of the red blood cell •Administering too much recombinant erythropoietin can result in an increase in the hematocrit of up to 60%

– hyper-viscosity and hypertension

Athletes are particularly at risk!• Dehydration can increase viscosity of the blood• Hyper-viscosity may also cause "sludging of the blood," which

may result in the occlusion of capillaries.– Severity of these occlusions is dependent upon the location of occurrence

• Occlusion in the brain may cause a stroke • Occlusion in the heart may cause a myocardial infarction

• Erythropoietin has been implicated with the death of numerous athletes, particularly those in the sport of cycling.

Detection• Urine testing is not a suitable testing means for control purposes

– The clinical manifestations of its effects are delayed– Low renal elimination

• Detection– No approved detection technique– Red blood cell age - Athletes using recombinant erythropoietin should

demonstrate a younger red blood cell population – Recent use of the “Biological Passport”

• Must maintain Hct and Hb levels• Any spikes or dips are considered a failed test• How is this effected by altitude?

Altitude Training• Altitude training is considered “natural” and

therefore considered a LEAGAL form of training

• Theory originally introduced in the 1930s• Benefits associated with altitude training

– Increased erythropoiesis– Increased base secretion– Increased mitochondria

Altitude Training• Training at altitude

– Must be at a sufficient altitude for any ergogenic benefit (2200m for at least four weeks)

• Increase in EPO are 77-92% at 2200m• Below this point, EPO levels increase only 24-30%

– Just training at altitude provides only short lived benefits upon return to sea level

• RBC mass decreases 15% within a few days• EPO levels also decrease dramatically

Altitude Training• “Live High, Train Low”

– Most effective way of improving sea level performance– Can double EPO levels– Large inter-individual variability, which leads to the idea of

“responders” and “non-responders”

• Sleeping in hyperbaric chambers– Leads to large increases in serum EPO and RBC mass

• Is this an ethical means of improving performance?

Pharmacological Ergogenic Aids• Amphetamines• B-Blockers• Caffeine• Diuretics• Recreationally used drugs

Anabolic Steroids• Dosing• Who Uses Anabolic Steroids?• Ergogenic Benefits

– Muscle Mass and Strength– Athletic Performance

• Psychological Effects• Adverse Effects

Hormones • Anabolic Steroids

– The synthetic (man-made) derivatives of the male sex hormone, testosterone

Dosing of Anabolic Steroids• Synthetic (man-made) derivatives of the male sex hormone,

testosterone.

• Elevations in testosterone concentrations stimulate protein synthesis, resulting in improvements in muscle size, body mass, and strength.

• Rapid degradation occurs when testosterone is given orally or through injectable administration, thus chemical modification was necessary to retard the degradation process.

(Forbes, 1985)

Hormone Men Women

Testosterone 300-1200 ng/dL

30-95 ng/dL

Estrogen 10-50 30-400

Hormones• Anabolic Steroids

– Dosing• Athletes typically use anabolic steroids in a “stacking” regimen, in which

they administer several different drugs simultaneously. • The potency of one anabolic agent may be enhanced when it is consumed

simultaneously with another anabolic agent.• Most users take anabolic steroids in a cyclic pattern, meaning that they use

the drugs for several weeks or months and alternate these cycles with periods of discontinued use.

• Often athletes administer the drugs in a pyramid (step-up) pattern in which dosages are steadily increased over several weeks. Toward the end of the cycle, the athlete “steps down” to reduce the likelihood of negative side effects.

Dose-Response Curve

Hormones• Anabolic Steroids

– Who Uses Anabolic Steroids?• Olympic athletes, professional athletes, collegiate

athletes, and high school athletes have been reported to use steroids.

• Many users are not involved in sports; they use steroids to improve appearance.

– Ergogenic Benefits• Muscle Mass and Strength

– Increases in muscle protein synthesis with steroid use are likely responsible for increases in lean body mass.

– Changes occur in both recreationally trained and competitive athletes.

Use in Hollywood

Hormones• Anabolic Steroids

– Ergogenic Benefits• Muscle Mass and Strength

– Increases in muscle protein synthesis with steroid use are likely responsible for increases in lean body mass.

– Changes occur in both recreationally trained and competitive athletes.

Changes in Fat-Free Mass

Hormones• Anabolic Steroids

– Ergogenic Benefits• Athletic Performance

– The purported ergogenic benefits commonly attributed to anabolic steroid use are increased muscle mass, strength, and athletic performance, but these changes depend on the training status of the individual.

Hormones• Anabolic Steroids

– Psychological Effects• Anabolic steroid use is associated with changes in

aggression, arousal, and irritability. – Adverse Effects

• The medical problems related to anabolic steroids may be somewhat overstated.

• Many of the side effects linked to abuse are reversible upon cessation.

• Side effects differ between anabolic steroid use under medical supervision and consuming many drugs at high doses.

Table 9.2

Testosterone Precursors• Androstenedione, androstenediol, and

dehydroepiandrosterone [DHEA]• Goal: Increase testosterone concentrations and achieve

performance changes similar to those of anabolic steroids• However, these precursors have only weak androgenetic

properties in themselves.– Androstenedione: 1/5th the biological activity of testosterone– DHEA: 1/10th the biological activity of testosterone

• Limited research for support (1 study on females)• Listed as controlled substances

Questions?