Transcript Doping in Sports

Doping in Sports
Michael J. Ross, MD
Sports Medicine Physician, Rothman Institute
Medical Director, The Performance Lab
August 24,
2012
August
25,2012
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9/20/06
Floyd Landis
becomes the first
Tour de France
winner to have his
title revoked for
doping
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Doping at a glance
Discuss some of the common doping
agents abused by athletes
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Anabolic steroids
Other anabolics
Stimulants
Blood doping
Discuss strategies for obtaining desired
effects without doping
Testosterone
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2007 Christian Moreni arrested at Tour
de France
2007 Mattias Kessler
2007 Brazilian defender Marcao,
suspended four months after testing
positive for finasteride. (Masking agent)
Testosterone
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1996 Dean Capobianco, Australian 100m
champion, tests positive for anabolic
steroid stanozol
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Blames red meat
1996 Dieter Baumann 1500m and 5000m
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Blames positive testosterone test on
spiked toothpaste
Testosterone
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April 2006 Justin
Gatlin Olympic gold
sprinter-facing 8
year ban
August 2007
Chicago Bears
fullback Obafemi
Ayanbadejo-4 game
suspension
Testosterone
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1998 Dennis Mitchell 400m relay gold
medalist and 4 time US champion
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Had sex four times the previous night
and a lot of beer
Testosterone effects
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Increases Lean muscle mass
Increases red blood cell volume
Decreases Body Fat
Testosterone side
effects
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Acne
Testicular
suppression
Coronary Artery
Disease
Bay Area Lab
Cooperative
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Victor Conte
Bassist, Nutritional Consultant, Convict
Produced designer androgens
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custom-developed for elite professional
athletes to evade doping detection
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Detecting
Testosterone
Testosterone and EpiTestosterone are
produced in equal amounts from a
precursor
If the Ratio of
Testosterone:EpiTestosterone is greater
than 1:1, doping is suspected
Cutoff is 4:1
RadioImmunoAssay
Increasing
Testosterone
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Testosterone increases in response to:
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Intervals
Strength training
Testosterone decreases in response to
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Low Intensity Endurance training
(L.I.E.)
Insulin
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One of the major hormones for controlling
blood sugar
Non functional in diabetics
Synthetic insulin used to have a “Cpeptide,” not in recombinant insulin
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Insulin as a drug of abuse in body
building
Br. J. Sports Med., Aug 2003; 37: 356 357.
What it does
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Insulin is anabolic at large doses.
Imports amino acids into cells to speed
recovery and muscle building
Imports glucose into muscle cells to be
stored as glycogen
Side Effects
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Too much can cause low blood sugar,
change in mental status and coma
Fat deposition at injection site
Can only be used in cases of glycogen
depletion
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Adiposity
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Bodybuilders find it easy to obtain
insulin to help them in training
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BMJ 1997;314:1280 (26 April)
What else to do
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Glycogen depletion
Replace calories as high glycemic
carbohydrate
Incorporate protein into recovery mix
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1g/kg carbohydrate + 0.3g/kg protein
Growth Hormone
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Anabolic hormone
Secreted in pulses, the largest pulse
happens in the first 1 hour of sleep
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GH Effects
Increases recovery (acute)
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Increased amino acid uptake into
muscle
Increased glycogen through glucose
uptake
Increases Energy (chronic)
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Stimulates fatty acid release from
adipose tissue
Increases sensitivity to fatty acid
release
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6/06: Diamondback pitcher Jason
Grimsley possessed a season's worth of
hGH, federal indictment
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9/07: Washington Redskins tackle Jon
Jensen:"very naive and foolish" to think
that NFL players aren't using human
growth hormone.
"maybe 15, 20%" of the league's players
use illegal performance-enhancing
substances.
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Wade Wilson, Dallas Cowboys QB
Braces and a six pack
Growth hormone (GH)
replacement
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GH deficiency
Pituitary disorder
GH a potential treatment for:
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frailty
osteoporosis
morbid obesity
cardiac failure
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Increased amino acid uptake into
muscle
Increased glycogen through glucose
uptake
Increases Energy (chronic)
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What it does
Increases recovery (acute)
Stimulates fatty acid release from
adipose tissue
Increases sensitivity to fatty acid
release
Increases lean muscle mass
Side Effects
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Cancer
Bony Changes
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Jaw and Forehead
Long bones if still growing
Coronary artery disease
Cardiomyopathy
1992
2005
What else to do
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Restful sleep
Avoid pre-bedtime snacks containing fat
or carbohydrate
Encourage training intensity, while
discouraging training volume without
intensity
Arginine as “secretogogue”
Glucocorticoids
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Catabolic hormone
Release glucose and fat
Stress steroids
What it does
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Increased energy from release of sugar
and fat
Side Effects
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Muscle breakdown
Central obesity
Moon facies
Osteopenia
Adrenal suppression
What else to do
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Caffeine for fatty acid release
Maximize glycogen “supercompensation”
Stimulants
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Increase alertness and (perceived)
energy
Mimics effects of adrenaline
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Cocaine
Amphetamine
Phenylpropanolamine
Ephedrine
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VO2max=
HR x SV x (A-V)02
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2005 Mariano Puerta, French Open
finalist
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Traces of cardiac stimulant in blood
Claimed it was from his wife’s
menstrual pain medication when he
drank her water
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1999 Javier Sotomayor, Olympic high
jump gold medalist and world record
holder, tests positive for cocaine at Pan
Am Games
Fidel Castro blames it on a CIA
conspiracy
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NCAA reports an increase in positive
stimulant (and cocaine) tests since 20012002
58.3% of collegiate hockey players admit
to stimulant (ephedrine,
pseudoephedrine, amphetamin) use
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Current Sports Medicine Reports, September,2004
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April 2004: Track sprinter Torri Edwards
tests positive for Nikethamide-2 year ban.
“Accidentally” taken in an over the
counter medication
2003 100m and 200m sprinter Kelli White
tests positive for Modafinil
1998 Dennis Mitchell 400m relay gold
medlaist tests positive for testosterone
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Cory Stringer All-pro offensive
linemandied from combination of ephedra
and heat illness
2003 Steve Belcher dies of heat stroke
while using ephedrine
2007 800m freestyle world champion
Oussama Mellouli banned for 18 months
Ephedra: What it does
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Increases time to exhaustion
Increases cardiac output
Increases liver and muscle glycogen
release
Bronchial dilatation
Appetite suppressant
Side Effects
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Pre-disposition for heat illness
Appetite suppressant
Insomnia (affects GH)
Tachycardia, arrhythmias and heart
disease
Mental status changes
Fatigue depression and lethargy
What else to do
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Caffeine 4-5mg/kg + pseudoephedrine
1mg/kg
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Minimizes side effects, maximizes
ergogenic effect
Blood
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Muscles perform best when they can use
oxygen and glucose to make energy.
Red blood cells transport oxygen from
the lungs to the muscles
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VO2= HR x SV x (
A-V)02
Operation Puerto
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Spanish police raid a lab/office of Madrid
based hematologist, Eufamanio Fuentes
Multiple high-end athletes implicated in
his blood doping ring
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Spanish soccer
Tennis
Cycling
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Extra blood increases aerobic/endurance
potential
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1984 Ed Burke, PhD and US Cycling
Federation coaches admit to providing
homologous and autologous blood
transfusions to US Olympic Cycling Team
US wins gold in the Road Race and
medals for the first time since 1912
Who wins, where were the 1984
Olympics held?
Alexi Grewal
First gold
medal in road
cycling since
1912
Alexi had
just finished
a 2 week
suspension
for
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Erythropoetin
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12-15% increase in power
Decreased lactate accumulationEur J Appl
Physiol. 2002 Mar;86(5):442-9
7% increase in VO2max MSSE 2000 Jul;32(7)
rEPO v Aranesp
CERA
Take it out, train, put it back
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EPO changed everything...All of a
sudden whole teams were ragingly fast;
all of a sudden i was struggling to make
the time limits...I’d be on climbs, working
as hard as I’d ever worked, and right
alongside me would be these big-assed
guys, and they’d be chatting like we were
on the flats!
Andy Hampsten, winner Tour of Italy
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Fleche Wallone, 1994: three riders from
Gewiss team rode away from the pack
After the race, team doctor Michele
Ferrari was asked about EPO use
“I don’t prescribe the stuff, but you can
buy EPO in Switzerland without a
prescription”
“EPO is not dangerous; it’s the abuse that
is. It’s also dangerous to drink 10 liters of
orange juice”
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Late 1980’s and early 1990’s Dutch
cyclists keep dying in their sleep
Blood is too thick and clots develop with
the slow heart rate
Risk of blood borne diseases
Ricco: septic after transfusion
EPO Dosing
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WADA spent millions of dollars over
years
Ferrari took 5 minutes
Microdosing not detected by Blood
Passport Eur J Appl Physiol 2011 Sep;111(9)
What else to do
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Altitude training
Altitude tents
Hypoxic training
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Beware the athletes
Know what is being used
Know what training/dietary alternatives to
offer