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Doping in Sports

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

August 24,
2012

August
25,2012

9/20/06
Floyd Landis

becomes the first


Tour de France
winner to have
his title revoked
for doping

Doping at a glance

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

Testosterone
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
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
April 2006 Justin

Gatlin Olympic
gold sprinterfacing 8 year ban

August 2007

Chicago Bears
fullback Obafemi
Ayanbadejo-4
game suspension

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

Testosterone side
effects
Acne
Testicular

suppression

Coronary Artery
Disease

Bay Area Lab


Cooperative
Victor Conte
Bassist, Nutritional Consultant,
Convict

Produced designer androgens


custom-developed for elite

professional athletes to evade


doping detection

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

Insulin
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 as a drug of abuse in body

building
Br. J. Sports Med., Aug 2003; 37: 356
- 357.

What it does
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
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

Bodybuilders find it easy to obtain


insulin to help them in training

BMJ 1997;314:1280 (26April)

What else to do
Glycogen depletion
Replace calories as high glycemic
carbohydrate

Incorporate protein into recovery


mix

1g/kg carbohydrate + 0.3g/kg


protein

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

GH Effects
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

6/06: Diamondback pitcher Jason


Grimsley possessed a season's
worth of hGH, federal indictment

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 performanceenhancing substances.

Wade Wilson, Dallas Cowboys QB

Braces and a six pack

Growth hormone (GH)


replacement

GH deficiency
Pituitary disorder
GH a potential treatment for:
frailty
osteoporosis
morbid obesity
cardiac failure

What it does

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

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

1992

2005

What else to do
Restful sleep
Avoid pre-bedtime snacks containing
fat or carbohydrate

Encourage training intensity, while


discouraging training volume
without intensity

Arginine as secretogogue

Glucocorticoids
Catabolic hormone
Release glucose and fat
Stress steroids

What it does

Increased energy from release of


sugar and fat

Side Effects
Muscle breakdown
Central obesity
Moon facies
Osteopenia
Adrenal suppression

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

Stimulants
Increase alertness and (perceived)
energy

Mimics effects of adrenaline


Cocaine
Amphetamine
Phenylpropanolamine
Ephedrine

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

2005 Mariano Puerta, French Open


finalist

Traces of cardiac stimulant in


blood

Claimed it was from his wifes

menstrual pain medication when


he drank her water

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

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

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

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
Increases time to exhaustion
Increases cardiac output
Increases liver and muscle glycogen
release

Bronchial dilatation
Appetite suppressant

Side Effects
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
Caffeine 4-5mg/kg +

pseudoephedrine 1mg/kg

Minimizes side effects, maximizes


ergogenic effect

Blood
Muscles perform best when they can
use oxygen and glucose to make
energy.

Red blood cells transport oxygen


from the lungs to the muscles

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

Operation Puerto
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

Extra blood increases

aerobic/endurance potential

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

Erythropoetin
12-15% increase in power
Decreased lactate accumulation

Eur J Appl Physiol.

2002 Mar;86(5):442-9

7% increase in VO2max
rEPO v Aranesp
CERA
Take it out, train, put it back

MSSE 2000 Jul;32(7)

EPO changed everything...All of a

sudden whole teams were ragingly


fast; all of a sudden i was struggling
to make the time limits...Id be on
climbs, working as hard as Id ever
worked, and right alongside me
would be these big-assed guys, and
theyd be chatting like we were on
the flats!

Andy Hampsten, winner Tour of Italy

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 dont prescribe the stuff, but you can


buy EPO in Switzerland without a
prescription

EPO is not dangerous; its the abuse

that is. Its also dangerous to drink 10


liters of orange juice

Late 1980s and early 1990s 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
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
Altitude training
Altitude tents
Hypoxic training

Beware the athletes


Know what is being used
Know what training/dietary
alternatives to offer