Chapter 11 - Performance Enhancing Substances and Methods

Question 1

Ergogenic Aids

Answer 1

Any substance, mechanical aid, or training method that improves sport performances; for purposes of this review, the term refers specifically to pharmacological aids.

Question 2

Products that can be sold as dietary supplements

Answer 2

Vitamin
Mineral
Herb/Other Botanical
Amino Acid
Dietary Substance for use by humans to supplement the diet by increasing total dietary intake.
A concentrate, metabolite, constituent, or extract (or combo of any ingredient identified above.

The product must be intended for ingestion and cannot be advertised for use as a conventional food or as the sole item within a meal/diet.

Question 3

Hormones

Answer 3

Anabolic Steroids.
Testosterone Precursors (Prohormones).
Human Chorionic Gonadotropin (HCG).
Insulin.
Human Growth Hormone (HGH).
Erythropoietin.
B-Adrenergic Agonists.
B-Blockers.

Question 4

Anabolic Steroids

Answer 4

Synthetic (man-made) derivatives of testosterone.

Question 5

Anabolic Steroids Dosing

Answer 5

Athletes typically use steroids in a “stacking” regimen, in which they administer several different drugs at the same time.
Potency of one anabolic agent may be enhanced when consumed simultaneously with another anabolic agent.
Taken in cyclic pattern (use drugs for several weeks/months and alternate these cycles with periods of discontinued use).
Often administered in a pyramid (step-up) pattern (dosages are steadily increased over several weeks. Toward end of cycle, athletes step-down to reduce chance of negative side effects).

Question 6

Who uses anabolic steroids?

Answer 6

Olympic athletes
Pro athletes
College athletes
High school athletes.

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

Question 7

Anabolic Steroid Efficacy

Answer 7

Muscle Mass and Strength.
Increases in muscle protein synthesis with steroid use likely responsible for increases in lean body mass.
Changes occur in both recreationally trained and competitive athletes.
Changes in performance depend on training status.

Question 8

Anabolic Steroid Psychological Effects

Answer 8

Associated with changes in aggression, arousal, and irritability.

Question 9

Anabolic Steroid Adverse Effects – Cardiovascular

Answer 9

Lipid Profile Changes.
Elevated BP.
Decreased myocardial function.

Question 10

Anabolic Steroid Adverse Effects – Endocrine

Answer 10

Gynecomastia (enlargement of breasts).
Decreased sperm count.
Testicular Atrophy.
Impotence and transient infertiility.

Question 11

Anabolic Steroid Adverse Effects –Genitourinary (genital/urinary organs)

Answer 11

Males --
Decreased sperm count.
Decreased testicular size.
Females--
Menstrual cycle irregularities.
Clitoromegaly (enlarged clitoris).
Deepening of voice.
Both--
Gynecomastia.
Libido changes.

Question 12

Anabolic Steroid Adverse Effects – Dermatological

Answer 12

Acne.

Male pattern baldness.

Question 13

Anabolic Steroid Adverse Effects – Hepatic

Answer 13

Increased risk of liver tumors and liver damage.

Question 14

Anabolic Steroid Adverse Effects – Musculoskeletal

Answer 14

Premature epiphyseal plate closure.
Increased risk of tendon tears.
Intramuscular abscess.

Question 15

Anabolic Steroid Adverse Effects – Psychological

Answer 15

Mania.
Depression.
Aggression.
Hostility.
Mood Swings.

Question 16

Testosterone Precursors (Prohormones)

Answer 16

Androstenedione.
Androstenediol.
Dehydroepiandrosterone (DHEA).

Taken under the impression it will have similar effects as anabolic steroids.
No significant increases strength, body comp., lean tissue, testosterone concentrations, and muscle size.
Increased estradiol and estrone (associated with lower HDL)
Athletic performance changes may not occurs; may be at higher risk of adverse effects of anabolic steroids.
Deemed a controlled substance.

Question 17

Human Chronic Gonadotropin (HCG)

Answer 17

Hormone obtained from placenta of pregnant women and is very closely related in structure and function to luteinizinig hormone (a hormone that stimulates Leydig cells in testicles to produce testosterone.

Question 18

Insulin - Efficacy and Adverse Effects

Answer 18

Increases protein synthesis.
Used to potentiate effects of growth hormone and insulin-like growth factors via injections.
May cause a previously healthy athlete immediate death, coma, or development of insulin-dependent diabetes.

Question 19

Human Growth Hormone (HGH)

Answer 19

Protein secreted from the anterior pituitary gland.
It’s anabolic due to its stimulation of bone and skeletal , muscle growth.
Also important for metabolic functions like: maintain blood glucose levels, increasing uptake of glucose and amino acids in muscle cells, and stimulating release of fatty acids from fat cells.
Injection is necessary in order to avoid its complete metabolism (oral ingestion does nothing).

Question 20

HGH – Efficacy

Answer 20

No studies on efficacy of HGH in athletic populations (ethical reasons).
Anecdotal reports suggest impressive musculoskeletal performance changes in athletes using HGH.
Regularly used for its anabolic potential and its ability to reduce body fat among athletes.
Mediated through IGF-1.

Question 21

HGH – Adverse Effects

Answer 21

Although HGH used as replacement therapy for people with GH or IGF-I deficiency can be effective and can have minimal adverse consequences, the dosages that are likely used by athletes may pose a significant risk for acromegaly.

Side effects for prone individuals may include: cardiovascular dysfunction, muscle/joint/bone pain, hypertension, abnormal growth of organs, and accelerated osteoarthritis.

Question 22

Erythropoietin (EPO)

Answer 22

Produced in kidneys and stimulates production of new RBC.

It’s also a protein hormone that can be produced by recombinant DNA techniques.

Question 23

Blood Doping

Answer 23

Increases RBC mass and is typically conducted using blood transfusions or taking the hormone erythropoietin.

Autologous BD: transfusion of one’s own blood, which has been stored until needed.
Homologous BD: transfusion of blood that has been taken from another person with same blood type.

Question 24

EPO – Efficacy

Answer 24

Injections of EPO are associated with elevations in both hematocrit and hemoglobin.
Overall, it enhances oxygen-carrying capacity of blood ; making it an effective ergonomic aid for aerobic endurance athletes.

Question 25

EPO – Adverse effects

Answer 25

Once EPO is injected, the stimulus for producing RBC is no longer under control.
Increased risk of blood clotting.
Elevations in Systolic BP.
Compromised thermoregulatory system.
Dehydration during aerobic endurance events.

Question 26

B-Adrenergic Agonists – Efficacy and Adverse Effects

Answer 26

AKA B-agonists.
Substances chemically related to epinephrine that regulates lipolysis and thermogenesis.
Originally developed to treat asthma (i.e. clenbuterol; a bronchial dilator).
Taken cyclically (3 weeks on (2 days on, 2 days off during “on” week) 3 weeks off).
Can increase lean mass and decrease stored fat (there’s scarce data available).
Potential side effects are: transient (short time) tachycardia, hyperthermia, tremors, dizziness, palpitations, and insomnia.

There is a lack of data for both the efficacy and the adverse effects of B-agonists.

Question 27

B-Blockers – Efficacy and Adverse Effects

Answer 27

Class of drugs that block the B-adrenergic receptors, preventing catecholamines from binding.
Reduce anxiety and tremors during performance (used by athletes who rely on steady, controlled movements: archers or marksmen).
Shown to impair cardiovascular response to exercise by reducing maximal HR, O2 consumption, and 10 km race time performance. Associated with increased RPE.

Question 28

Dietary Supplements

Answer 28

Essential Amino Acids.
Arginine.
B-Hydroxy-B-Methylbutyrate (HMB).
Nutritional Muscle Buffers.
L-Carnitine.
Creatine.

Question 29

Essential Amino Acids

Answer 29

Can augment muscle protein synthesis in healthy human subjects.
Types of EAAs: isoleucine, leucine, valine, lysine, methionine, phenylalanine, threonine, and tryptophan.
BCAA leucine is a key regulator in stimulating muscle protein synthesis.
Leucine directly activates the Act/mTOR pathway in skeletal muscle, which is a key pathway in skeletal muscle protein synthesis.
No info available on adverse effects.

Question 30

Arginine

Answer 30

Conditional amino acid required for protein and creatine synthesis, and its metabolism results in the production of nitric oxide (causes vasodilation naturally during exercise);
Does NOT have the ability to to elevate nitric oxide levels, increase muscle blood flow, and improve exercise performance, as previously believed.
Very little scientific evidence supporting these claims.
Oral arginine supplementation is not recommended as it does not any better than naturally elevated nitric oxide levels as a result of exercise.

Question 31

B-Hydroxy-B-Methylbutyrate (HMB)

Answer 31

Evidence shows that HMB stimulates protein synthesis and decreases protein breakdown by inhibiting the ubiquitin-proteasome pathway.
Due to HMB’s role in the regulation of protein breakdown, it may be an effective supplement for minimizing losses of lean muscle mass in situation that promote a catabolic state.
Most effective for untrained/beginners (suppresses soreness).
Trained individuals: improve total strength and lean body mass when following a periodized training resistance training program.
No known adverse effects for doses of 3-6g/day

Question 32

Nutritional Muscle Buffers

Answer 32

B-Alanine.
Sodium Bicarbonate.
Sodium Citrate.

Question 33

B-Alanine

Answer 33

Nonessential amino acid.
It’s the rate limiting substate for carnosine synthesis (found in Type II skeletal muscle and contributes ~40% of MBC of H+ during anaerobic exercise, thus causing a drop in pH).
Skeletal muscle carnosine levels have a positive correlation with anaerobic performance because of the relationship between carnosine and MBC.
Does not improve maximal strength or aerobic power.
Improved anaerobic threshold (meaning endurance activities can be performed at higher intensities for longer periods.
Adverse effect: paresthesia (tingling. prickling, or numbness of a person’s skin).

Question 34

Sodium Bicarbonate

Answer 34

Antacid (counteracts or neutralizes acid).
Naturally formed in body and baking soda.
Helps regulate pH levels.
Shown to improve MBC and in turn high-intensity exercise performance.
Minimum 0.3g/kg body mass ingested ~60-90 min before activity improves short-duration (60s-6min.), high-intensity exercise performance.
Try supplementing during practice before using in competition.

Question 35

Muscle Buffering Capacity (MBC)

Answer 35

Ability to regulate H+ concentration in skeletal muscle during high-intensity exercise.
Improving MBC by training or nutritional means I’m proves performance in sports and activities that my be limited by H+ buildup.

Question 36

Sodium Citrate

Answer 36

Can increase pH without the gastrointestinal distress that’s commonly seen with Sodium Bicarbonate.
Citrate breaks down into bicarbonate, thus increasing extracellular pH.

Question 37

L-Carnitine

Answer 37

Synthesized from amino acid lysine and methionine and is responsible for transport of fatty acids from the cytosol into the mitochondria to be oxidized for energy.
No adverse effects of concern.

Question 38

Creatine – Importance of

Answer 38

Ability to rapidly rephosphygorylate ADP is dependent upon the enzyme creatine kinase and the availability of creatine phosphate (CP) within the muscle.
Creatine, in the form of CPr (phosphocreatine), has an essential role in energy metabolism as a substrate for the formation of ATP by rephosphorylating ADP, especially during short-term, high-intensity exercise.

Question 39

Creatine Supplementation

Answer 39

Creatine supplementation increases creatine content of muscles by approx. 20%, but there is a saturation limit (150-160 mmol/kg dry weight).
Typical regimen: Loading dose of 20-25 g/day for 5 days (0.3g/kg if a person wants to dose relative to BW). Followed by maintenance dosing of 2g/day (0.03 g/kg relative to BW).
No loading: can reach levels similar with loading, but will take longer than if loaded (~30 days v. 5 days).
Once maintenance stopped: muscle creatine levels will return to baseline in ~4 weeks.

Creatine is better as a training supplement rather than a performance enhancer.

Question 40

Creatine – Body Mass Changes

Answer 40

Prolonged creatine supplementation generally associated with increases in BW, especially increases in fat-free mass.
Increases in body mass is believed to be partly related to an increase in total body water.
Increasing creatine content of muscle appears to be coupled with an increased rate of muscle contractile protein synthesis.

Question 41

Creatine – Adverse Effects

Answer 41

Despite certain media and reports linking creatine to dehydration and cramping, there is NO reason to believe that creatine enhances the risk for these side effects.

Question 42

Stimulants

Answer 42

Caffeine.
Preworkout Energy Drinks.
Ephedrine.
Citrus Aurantium.

Question 43

Caffeine – Efficacy

Answer 43

Pure caffeine form is best (i.e. tablet)
Increases time to exhaustion.
Anaerobic improvements in trained athletes by 3-9%.
In doses of 3-9 mg/kg BW consumed ~60 minutes before exercise or during prolonged exercise, caffeine is ergogenic.
There is no further benefit when it is consumed at higher dosages (>/=9 mg/kg).
It can decrease feelings of perceived exertion, improve work capacity, and increase mental alertness.

Question 44

Caffeine – Adverse Effects

Answer 44

Anxiety, gastrointestinal disturbances, restlessness, insomnia, tremors, heart arrhythmias, and increased risk of heat illness.
Physically addicting.
Scientific literature doesn’t support caffeine-induced diuresis during exercise or any harmful change in fluid balance that would negatively affect performance.

Question 45

Preworkout Energy Drinks – Efficacy

Answer 45

Increase RT volume performance, other anaerobic activities (wind gate, speed/agility performance) not as responsive.
Ingredients: caffeine, CHO, Vitamin B, tyrosine, and gingko biloba.
Approx. 2 mg caffeine/kg BW (less than the recommenced caffeine consumption of 3-9 mg/kg), consumed within 60 minutes before exercise, is recommended for enhancing exercise performance. This contributes to the hypothesis that the combined effects of all energy drink ingredients may be responsible for the enhancements.

Same potential adverse effects of caffeine.

Question 46

Ephedrine

Answer 46

B-agonist used to treat bronchial asthma, bronchitis, allergies, etc.
Popular for it’s thermogenic qualities.
Works by elevating basal metabolic rate, thereby increasing energy expenditure and ultimately resulting in fat loss.
Often used as a stacking agent with caffeine for enhancement.

Question 47

Ephedrine – Efficacy

Answer 47

Effective only when combined with caffeine.

Improve aerobic endurance performance.

Question 48

Ephedrine – Adverse Effects

Answer 48

Nausea, vomiting, anxiety, change in mood, autonomic hyperactivity, palpitations, and few cases of death.

Banned by most sport governing bodies.

Question 49

Citrus Aurantium – Efficacy

Answer 49

From bitter orange (contains synephrine – stimulates specific beta adrenergic receptor B-3 that stimulate fat metabolism).
When combined with caffeine and other herbal products, significant improvements in time to fatigue have been reported.
Thought to contribute to appetite suppression, increased metabolic rate, and lipolysis (breakdown of fat).

Question 50

Citrus Aurantium – Adverse Effects

Answer 50

Vasoconstriction and increased BP from synephrine stimulation when combined with other stimulants.
On the NCAA banned substance list.

Question 51

L-Carnitine Efficacy

Answer 51

Decreases pain and muscle damage.
Decreases markers of metabolic stress.
Enhances recovery.

Include enhanced blood flow regulation through enhanced vasodilator effect that reduces thee magnitude of exercise-induced hypoxia.