Doping in Sports Delaware Academy of Family Physicians PowerPoint Presentation

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Doping in Sports Michael J. Ross, MD Sports Medicine Physician, Rothman Institute Medical Director, The Performance Lab

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August 24, 2012

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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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Discuss some of the common doping agents abused by athletes Anabolic steroids Other anabolics Stimulants Blood doping Discuss strategies for obtaining desired effects without doping Doping at a glance

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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 Blames red meat 1996 Dieter Baumann 1500m and 5000m 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 Had sex four times the previous night and a lot of beer Testosterone

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Increases Lean muscle mass Increases red blood cell volume Decreases Body Fat Testosterone effects

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Acne Testicular suppression Coronary Artery Disease Testosterone side effects

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Victor Conte Bassist, Nutritional Consultant, Convict Produced designer androgens custom-developed for elite professional athletes to evade doping detection Bay Area Lab Cooperative

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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 Detecting Testosterone

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Testosterone increases in response to: Intervals Strength training Testosterone decreases in response to Low Intensity Endurance training (L.I.E.) Increasing Testosterone

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One of the major hormones for controlling blood sugar Non functional in diabetics Synthetic insulin used to have a “C-peptide,” not in recombinant insulin Insulin

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Insulin as a drug of abuse in body building Br. J. Sports Med., Aug 2003; 37: 356 - 357.

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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 What it does

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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 Adiposity Side Effects

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Bodybuilders find it easy to obtain insulin to help them in training BMJ 1997;314:1280 (26 April)

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Glycogen depletion Replace calories as high glycemic carbohydrate Incorporate protein into recovery mix 1g/kg carbohydrate + 0.3g/kg protein What else to do

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Anabolic hormone Secreted in pulses, the largest pulse happens in the first 1 hour of sleep Growth Hormone

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Increases recovery (acute) Increased amino acid uptake into muscle Increased glycogen through glucose uptake Increases Energy (chronic) Stimulates fatty acid release from adipose tissue Increases sensitivity to fatty acid release GH Effects

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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

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Braces and a six pack

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GH deficiency Pituitary disorder GH a potential treatment for: frailty osteoporosis morbid obesity cardiac failure Growth hormone (GH) replacement

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Increases recovery (acute) Increased amino acid uptake into muscle Increased glycogen through glucose uptake Increases Energy (chronic) Stimulates fatty acid release from adipose tissue Increases sensitivity to fatty acid release Increases lean muscle mass What it does

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Cancer Bony Changes Jaw and Forehead Long bones if still growing Coronary artery disease Cardiomyopathy Side Effects

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1992 2005

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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” What else to do

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Catabolic hormone Release glucose and fat Stress steroids Glucocorticoids

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Increased energy from release of sugar and fat What it does

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Muscle breakdown Central obesity Moon facies Osteopenia Adrenal suppression Side Effects

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Caffeine for fatty acid release Maximize glycogen “supercompensation” What else to do

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Increase alertness and (perceived) energy Mimics effects of adrenaline Cocaine Amphetamine Phenylpropanolamine Ephedrine Stimulants

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VO2max= HR x SV x (A-V)02

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2005 Mariano Puerta, French Open finalist 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 2001-2002 58.3% of collegiate hockey players admit to stimulant (ephedrine, pseudoephedrine, amphetamin) use 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

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Increases time to exhaustion Increases cardiac output Increases liver and muscle glycogen release Bronchial dilatation Appetite suppressant Ephedra: What it does

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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 Side Effects

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Caffeine 4-5mg/kg + pseudoephedrine 1mg/kg Minimizes side effects, maximizes ergogenic effect What else to do

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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 Blood

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VO2= HR x SV x (A-V)02

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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 Spanish soccer Tennis Cycling Operation Puerto

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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?

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Alexi Grewal First gold medal in road cycling since 1912 Alexi had just finished a 2 week suspension for ephedrine

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Erythropoetin 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

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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) EPO Dosing

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Altitude training Altitude tents Hypoxic training What else to do

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Beware the athletes Know what is being used Know what training/dietary alternatives to offer