1. Performance-Enhancing Substances
chapter 9
Performance- Enhancing Substances
Jay R. Hoffman, PhD; CSCS,*D; FACSM; FNSCA Jeffrey R. Stout, PhD, CSCS, FACSM, FISSN, FNSCA

2. Chapter Objectives
Provide reliable information to athletes on the risks and benefits of performance-enhancing substances.
Evaluate advertising claims for over-the-counter supplements marketed for performance benefits.
Describe the current status of research on performance-enhancing supplements.

3. Key Term
ergogenic aid: Any substance, mechanical aid, or training method that improves sport performance; for the purposes of this chapter, the term refers specifically to pharmacological aids.

4. Section Outline
Types of Performance-Enhancing Substances

5. Key Point
The distinction between a drug and a dietary supplement is linked to FDA approval for safety and effectiveness.
If a product is not classified as a drug, FDA regulations are relatively relaxed
Dietary supplement
FDA will not investigate its safety or effectiveness unless a health risk is brought to the agency’s attention

6. Types of Performance- Enhancing Substances
Definition of Products That Can Be Sold as Dietary Supplements
A product (other than tobacco) intended to supplement the diet that contains one or more of the following dietary ingredients:
A vitamin
A mineral
An herb or other botanical
An amino acid
(continued)

7. Types of Performance- Enhancing Substances
Definition of Products That Can Be Sold as Dietary Supplements (continued)
A product (other than tobacco) intended to supplement the diet that contains one or more of the following dietary ingredients:
A dietary substance for use by humans to supplement the diet by increasing the total dietary intake
A concentrate, metabolite, constituent, or extract (or combination of any ingredient identified above)
(continued)

8. Types of Performance- Enhancing Substances
Definition of Products That Can Be Sold as Dietary Supplements (continued)
The product must also be intended for ingestion and cannot be advertised for use as a conventional food or as the sole item within a meal or diet.

9. Types of Performance- Enhancing Substances
Dietary Supplements can be sold if they do not present:
“a significant or unreasonable risk of illness or injury when used as directed on the label or under normal conditions of use.”

10. Types of Performance- Enhancing Substances
Ergogenic substances are usually banned from athletic competition when a consensus is reached that they may provide an unfair competitive edge or pose a significant health risk.

11. Section Outline Hormones Anabolic Steroids Dosing
Who Uses Anabolic Steroids?
Ergogenic Benefits
Muscle Mass and Strength
Athletic Performance
Psychological Effects
Adverse Effects
(continued)

12. Section Outline (continued)
Hormones
Testosterone Precursors (Prohormones)
Human Chorionic Gonadotropin
Insulin
Human Growth Hormone
Efficacy
Adverse Effects
Erythropoietin
β-Adrenergic Agonists
β-Blockers

13. Hormones
A variety of endogenously produced hormones are used to enhance performance:
Testosterone
Along with synthetic derivatives
Growth Hormone
Erythropoietin
Catecholamines

14. Hormones Anabolic Steroids
The synthetic (man-made) derivatives of the male sex hormone, testosterone
Stimulate protein synthesis
Resulting in:
Improvements in muscle size
Improvements in body mass
Increased muscle strength
Development and maturation of male secondary sex characteristics

15. Table 9.1

16. 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.
(continued)

17. Hormones Anabolic Steroids Dosing (continued)
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.

18. Dose-Response Curve Figure 9.2 (next slide)
Dose–response curve of anabolic steroids and changes in lean body mass

19. Figure 9.2
Reprinted, by permission, from Hoffman, 2002.

20. 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.

21. Fat-Free Mass Figure 9.3 (next slide)
Changes in fat-free mass with anabolic steroid administration (200 mg/week nandrolone decanoate for eight weeks) and following drug cessation
*p < .05

22. Figure 9.3
Adapted, by permission, from Van Marken Lichtenbelt et al., 2004.

23. 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.

24. Hormones Anabolic Steroids Psychological Effects Adverse 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.

25. Table 9.2

26. Hormones Testosterone Precursors (Prohormones)
Although performance changes may not occur with prohormone use, athletes may be at higher risk for experiencing adverse side effects similar to those associated with anabolic steroid use.
Androstenedione or dehydroepiandrosterone
Have only relatively weak androgenic properties
Even if large dose is ingested, most of these substances are rapidly eliminated from circulation.

27. Hormones Human Chorionic Gonadotropin Insulin
When injected into men, HCG can increase testicular testosterone production.
Insulin
Insulin increases protein synthesis, but the side effect of hypoglycemia can be fatal.

28. Hormones Human Growth Hormone Efficacy
There are no studies on the efficacy of HGH in athletic populations.
Anecdotal reports suggest impressive musculoskeletal performance changes in athletes using HGH.

29. Key Point
The anabolic potential of human growth hormone (HGH) and its ability to reduce body fat have contributed to the rise in HGH use among athletes.

30. Hormones Human Growth Hormone Adverse Effects
Although growth hormone used as replacement therapy for people with growth hormone 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.

31. Hormones Erythropoietin β-Adrenergic Agonists β-Blockers
Injections of EPO are associated with elevations in both hematocrit and hemoglobin.
Health risks include increased risk of blood clotting, elevations in systolic blood pressure, a compromised thermoregulatory system, and dehydration during aerobic endurance events.
β-Adrenergic Agonists
β-adrenergic agonists can increase lean mass and decrease stored fat.
β-Blockers
β-blockers reduce anxiety and tremors during performance.

32. Key Point
More research is needed to examine the effect of many ergogenic aids in athletic populations. Athletes should not miscon-strue a lack of scientific information as an indication of safety.

33. Section Outline Dietary Supplements Essential Amino Acids
β-Hydroxy-β-Methylbutyrate
Nutritional Muscle Buffers
β-Alanine
Sodium Bicarbonate
Sodium Citrate
L-Carnitine
Creatine
Importance of Creatine to Exercise
Creatine Supplementation
(continued)

34. Section Outline (continued)
Dietary Supplements
Creatine (continued)
Ergogenic Benefits
Body Mass Changes
Adverse Effects
Stimulants
Caffeine
Efficacy
Ephedrine
Citrus Aurantium

35. Dietary Supplements
The sport supplement industry throughout the world has exploded, with more than 600 sport nutrition companies marketing over 4,000 products that produce annual sales of more than $4 billion in the United States alone.

36. Dietary Supplements Essential Amino Acids
EAA can augment muscle protein synthesis in healthy human subjects.
β-Hydroxy-β-Methylbutyrate (HMB)
It is believed that HMB has both anabolic and lipolytic effects, but research is limited. Recent studies do not support HMB supplementation in resistance-trained athletes.

37. Dietary Supplements Nutritional Muscle Buffers L-Carnitine β-Alanine
Sodium Bicarbonate
Sodium Citrate
L-Carnitine
Studies examining L-carnitine’s role as an ergogenic aid for increasing lipid oxidation have not shown clear efficacy.
L-carnitine may enhance recovery from exercise.

38. Dietary Supplements Creatine Importance of Creatine to Exercise
The ability to rapidly rephosphorylate ADP is dependent upon the enzyme creatine kinase and the availability of creatine phosphate (CP) within the muscle.
Creatine Supplementation
Creatine supplementation increases the creatine content of muscles by approximately 20%, but there is a saturation limit.
Ergogenic Benefits
Studies consistently show significant ergogenic benefits.

39. Key Point
Creatine, in the form of creatine phosphate (CP; also called phosphocreatine [PCr]), has an essential role in energy metabolism as a substrate for the formation of adenosine triphosphate by rephosphorylating adeno-sine diphosphate (ADP), especially during short-duration, high-intensity exercise.

40. 1RM Squat Strength Figure 9.4 (next slide)
Changes in 1RM squat strength in experienced collegiate American football players ingesting creatine, creatine plus β-alanine, or a placebo
* = significantly different (p < .05) compared to placebo

41. Figure 9.4
Adapted, by permission, from Hoffman et al., 2006.

42. Key Point
Creatine supplementation has been shown to increase strength and improve training by reducing fatigue and enhancing postworkout recovery.

43. Dietary Supplements Creatine Body Mass Changes Adverse Effects
Prolonged creatine supplementation has been generally associated with increases in body weight, especially increases in fat-free mass.
Adverse Effects
Controlled studies have been unable to document any significant side effects from creatine supplementation.
Concerns include gastrointestinal disturbances and strain on the kidneys.

44. Dietary Supplements Stimulants Caffeine Efficacy Adverse Effects
Increases time to exhaustion
Effects on sprint or power performance unclear
Adverse Effects
Many adverse effects, including anxiety, gastrointestinal disturbances, restlessness, insomnia, tremors, heart arrhythmias, and increased risk for heat illness
Is physically addicting

45. Key Point
A central nervous system stimulant, caffeine is an ergogenic aid that may enhance perfor-mance in aerobic and anaerobic athletes alike.

46. Dietary Supplements Stimulants Ephedrine Efficacy Adverse Effects
Effective only when it is taken in combination with caffeine
Improves aerobic endurance performance
Adverse Effects
Many adverse effects, including death
Banned by most sport governing bodies, including the International Olympic Committee

47. Dietary Supplements Stimulants Citrus Aurantium
Is thought to contribute to appetite suppression, increased metabolic rate, and lipolysis
When combined with caffeine and other herbal products, significant improvements in time to fatigue have been reported
On NCAA list of banned performance-enhancing drugs