Use of Performance Enhancing Substances Good Chemistry Gone Bad. Evan M. Klass, M.D., F.A.C.P.

Transcription

1 Use of Performance Enhancing Substances 2017 Good Chemistry Gone Bad Evan M. Klass, M.D., F.A.C.P.

2 Doping the use of banned athletic performance-enhancing drugs by competitors Performance enhancing substances (drugs) are substances used to improve any form of activity performance in humans Ergogenic aids OVER 3 MILLION USERS IN THE US!

3 Motivation To enhance athletic performance Body image disorders many users are not participating in organized athletic activities Performance and image enhancing drugs Correlates include: Athletics Body dissatisfaction Higher BMI Training at a commercial gym Appearance focused media

4 The History of Doping Might have started with the ancient Greeks the synthesis of testosterone led to the idea that it could improve performance Germans may have used testo at the Berlin Olympics 1930 s-40 s- German use of testosterone to improve performance of troops 1952 and 56 Olympics- Soviet testo use documented Ben Johnson used stanazolol at the Seoul Olympics the reveal of systematic doping by East Germany

5 The History of Doping Then: Lyle Alzado, Mark Maguire, Barry Bonds, Marion Jones Floyd Landis, Lance Armstrong, etc. Before 1990, doping agents were mostly known pharmacologic agents. Since then multiple agents have been identified including androgen precursors. Often marketed as nutritional supplements and available at the gym or on-line!

6 From: Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement Endocr Rev. 2014;35(3): doi: /er Endocr Rev Copyright 2014 by the Endocrine Society

7 How serious was Maria Sharapova s doping?

8 How serious was Maria Sharapova s doping? Meldonium The drug was specifically used to enhance the sexual performance and sperm motility of boars. Its license was later expanded for use in humans. 2 "Demonstrates an increase in endurance performance of athletes, improved rehabilitation after exercise, protection against stress, and enhanced activations of central nervous system (CNS) functions." 8

9 Categories of agents Anabolic androgenic steroids Human growth hormone Thyroid hormone Erythropoietin Diuretics Creatine L-carnitine Stimulants

10 Anabolic Androgenic Steroids Testosterone or a variety of derivatives including prohormones Injected, oral, buccal, or transdermal Enhance protein synthesis Increase muscle mass and strength BUT: in children may cause premature epiphyseal closure Acne Gynecomastia Suppression of testicular function Lipid changes Behavior changes Cardiac enlargement/ myocardial infarction/cardiomyopathy

11 Human growth hormone or IGF-1 Injectable Increase lean body mass but no proven performance improvement Anti-aging? BUT: Insulin resistance/diabetes/hypertension/cardiac enlargement Myalgia/arthralgia Acral enlargement Edema

12 Thyroid hormones Not banned but the criteria for diagnosis are being challenged May increase cardiac performance and alertness BUT: May cause arrhythmia Muscle loss Weight loss

13 This Doesn t Sound Legal : Inside Nike s Oregon Project NY Times May 19,2017

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15 Erythropoietin/ Auto-transfusion (Blood doping) Increases oxygen delivery to tissue BUT: Increase in red blood cells can increase blood viscosity Increased risk of blood clots and stroke

16 Creatine Delays onset of muscle fatigue during high intensity training Minimal measured performance improvement BUT: No evidence of harm in adults but not studied in children

17 Protein supplements Many forms including powders/bars/shakes No evidence of performance improvement BUT: Usually come with increased calories Not regulated so lack of standardization/risk of contamination

18 Energy drinks Caffeine content not regulated by FDA AAP position is that energy drinks containing stimulants as never allowable

19 Polypharmacy is common No substantial racial differences in use Different patterns of use between boys and girls- boys focused on muscle accumulation and girls on thinness PES use is correlated with increased use of recreational drugs and alcohol! Ironic?

20 Strategies to avoid detection Use of an unknown substance- designer steroids Use of enzyme inhibitors to block metabolism- aromatase inhibitors Masking agents- diuretics, probenecid, finasteride Use naturally occurring agents- T +E to maintain a normal ratio Use hcg

21 Muscle dysmorphia Listed in DSM-5 official diagnosis- dissatisfied with body size and shape and are pre-occupied wit the idea that their body is insufficiently muscular 2.2% of US men affected with body dysmorphic syndrome of whom 9-25% have muscle dysmorphia Associated with elevated rates of anxiety and depression, obsessive and compulsive behaviors, substance abuse and impaired social and occupational function In two studies over 40% reported lifetime use of anabolic/androgenic steroids

22 What does work? Children and adolescents have enormous opportunities to increase strength/performance and appearance 30% improvement in strength with resistance training in 8-20 wks. Avoidance of overweight and obesity There are no shortcuts! The use of legal strength aids may be a gateway The shift in change in the focus of the importance of sports from fun, doing one s best, friendship, skills acquisition, and good health to winning at all cost

23 Monitoring and assessment Home testing-??reliability, negative impact on parental-child relationships. AAP does not endorse Office testing- screening at the time of routine visits using open ended questions advised. The effects of PES may not be evident on exam Pre-participation physical has specific advised questions High schools- Random testing has been deemed legal but the efficacy is doubtful College/elite athletes- formalized protocols have been developed but a moving target

24 Contact Evan Klass, M.D. Pennington Medical Education Building University of Nevada, Reno/0332 Reno, NV (775)