DRUGS IN SPORTS

Steroids
● There are 63% samples that were analyzed during the
OUTLINE last 2013. It gives us adverse or typical finds. There is
I. Prevalence of Sport Related Drug Use really a high use of anabolic agents in sports such as
II. Total ADRVS – top 10 Sports steroids.
1. The athlete’s nationalities with the highest ● 10% are the stimulants followed by diuretic agents
number of ADRVS
a. Charles Brown Sequard
next is the glucocorticosteroids, your hormones,
III. Steroids in Sports cannabinoids and then other substances that are
1. Sex Steroids prohibited in the list.
2. Corticosteroids ● DO NOTE THAT THERE IS A HIGH USE OF
IV. Steroids
1. Anabolic ANABOLIC AGENTS
2. Androgenic
3. Ergogenic TOTAL ADRVS - TOP 10 SPORTS
V. Steroid Precursors
1. How do they advertise them?
VI. Testosterone
1. Anabolic-Androgenic Steroids
a. Why are they popular among athletes?
VII. EVIDENCE: AAS (Anabolic Androgenic Steroids)
VIII. Adverse Effect and Reversibility
1. Cardiovascular
2. Reproductive – MALE
3. Reproductive – FEMALE
4. Hepatic
5. Endocrine
6. Musculoskeletal
7. CNS
IX. Direct Measures
1. Gas chromatography-mass spectrometry
2. Liquid chromatography-mass spectrometry
3. Athlete’s Biological Passport
a. Steroidal Module
X. Concepts that athlete’s do to so that they will not be
detected
1. Cycling ● Highest groups came from the body builders, 22%.
2. Stacking Next is the athletics group, cycling group, weightlifters,
3. Pyramiding powerlifting, wrestling, rugby, boxing, and lastly the
4. Plateauing aquatics group.
XI. Plants and Animal Steroids
XII. Muscle Dysmorphia ● This will show us the violations that have occurred
XIII. Dependency and Withdrawal when we look at individually in sporting events.
XIV. Corticosteroids
1. Glucocorticoids
XV. Possible Red Flags THE ATHLETE NATIONALITIES WITH THE HIGHEST
XVI. Post Lecture Discussion NUMBER OF ADRVS
● The highest is Italy, followed by France, United States,
PREVALENCE OF SPORT RELATED DRUG USE Brazil, Russia, China, India, Belgium, Spain, and lastly
is South Africa.

● This is all reported by WADA, they have a committee

that looks into this. Were expecting this Olympics that
they could come up again with more recent findings.

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 DRUGS IN SPORTS (Second Shifting Period) | Steroids

o Released in the ovaries

CHARLES BROWN SEQUARD (1817-1894)
● A known physiologist and neurologist. For Males:
● In neurology, he was responsible for defining a ● During puberty, a sudden change of voice from a soft
neurologic condition called brown sequard voice will change to a deeper voice, development of
syndrome, where you will see a transection of the adam's apple, start to be taller, more muscle mass.
spinal cord and if it is a hemitransection o For reproductive functions, sperm cells/ sperm
(hemitransected). He was able to define the signs and counts would already be matured so there would
symptoms. be an increase in the number of the sperm cells
● Where is the sensory, is it on the right or left? Where and quality of sperm. So that is reproductive
is the motor? He was able to define all of this. functions that are present in males during puberty
● He was also an endocrinologist, he was able to find and onwards the adult life.
and describe a lot of substances, mechanism of how o Released in the testicles
hormones can work. This included his studies on
steroids. CORTICOSTEROIDS
● He did a research on the use of looking at test testiller ● These steroids are for/by the adrenal glands and there
extract, where he got testosterone extract from are two types: Mineralocorticoids and
testicles. He said that he tested it himself. Glucocorticoids.
● Results say that testicular hormone/testosterone can ● What makes them different from sex steroids is that
indeed provide just a hormonal level of individuals these corticosteroids are for the control and balance of
changes in muscle mass and strength. This was many our fluids and electrolytes; they are able to maintain
years ago, as we move forward in the field of medicine. normal fluid volume, normal sodium potassium -
Newer drugs came out but the basis of them are from mineralocorticoids are responsible for this.
Mr. Charles Brown Sequard. ● The glucocorticoids are responsible for metabolism
and immune function - these are inflammatory
STEROIDS IN SPORT responses
● In doping courses, when we hear the word “steroids” ● When we talk about … we said that steroids have a
the word comes to our mind is body, the physique. role in the immune function in swelling, edema and
inflammation
TWO TYPES OF STEROIDS
1. Sex Steroids
2. Corticosteroids
Sex Estrogen Sexual
Steroids Progesterone Characterist
SEX STEROIDS Androgen(Testoster ics
● When we talk about SS there will be an estrogen, one) Reproductiv
progesterone, and androgen (highest percent of the e Functions
androgen is the Testosterone)
● It defined our sexual characteristics. So if you are Corticostero Mineralocorticoids Fluids and
female mostly you have estrogen & progesterone ids Glucocorticoids electrolytes
while if you are male, mostly you will have Metabolism
testosterone. Immune
o NOTE: I said MOSTLY because sometimes male Function
have Estrogen & Progesterone levels. The same
goes with testosterone with the female.
● So they will define your sexual characteristics. STEROIDS
● We need to look at these 3 terminologies when we talk
Example about steroids
For Female:
● During the puberty that is the time when there is a ANDROGENIC
surge already of our sex steroids you will see already ● Increase in the sexual characteristics
how females would start to look like adult female. ● Enhance male characteristics
There is an enlargement of the breast, hips will also be
forming, waist become smaller, and face become for ANABOLIC
feminine. These are all female characteristics. ● There is an increase in muscle mass
o The reproductive functions will also be the age ● Increase in strength
where you will get menstruation, start ovulating.

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 DRUGS IN SPORTS (Second Shifting Period) | Steroids
ERGOGENIC
● Increase in power and function
● Increase in performance
● Chemically speaking, testosterone is derived from
cholesterol, and it goes through several processes
before it becomes testosterone
● DHEA, 5-Androstenediol, Androstenedione and 4-
Androstenediol these are steroid precursors of your
testosterone
● Some athletes also use the steroid precursors hoping
that they will be tested positive for testosterone
● This study looked at the anabolic and androgenic
steroids and testosterone precursors as ergogenic
aids in sports
● Although data that support the theory of conversion of
prohormones, such as androstenediol, to testosterone
in the body is available, support for testosterone
precursors alone as ergogenic aids is lacking
● It’s clear these steroid precursors will not provide
ergogenic advantage
STEROID PRECURSORS
● Androgenic (are they able to develop male and female
characteristics) - not enough data
● Anabolic (increase in muscle mass( - no
● ergogenic(improve athlete performance) - no
● Positive test ( if wada test you) - yes positive result
● Adverse health effects - yes
However, unfortunately, in the black market - you will see
these products. They all contain steroid precursors.
HOW DO THEY ADVERTISE THEM?
● “These are not steroids, these are not testosterone but
these are the substances that testosterone were
derived from so you will get the benefits of
testosterone.”
● But we have shown that this is not true and If you get
tested, you will be positive
● The lesson is - please look carefully into the
ingredients of these substances. Find the names that
are prohibited from the wada list.
● Sometimes, these products are contaminated
meaning, intentionally or not intentionally, they added
a steroid in it and it is not written in the ingredients.
WADA’s stand on steroid precursors? It is prohibited at all
times.
TESTOSTERONE
ANABOLIC ANDROGENIC STEROIDS
● Endogenous - naturally occurring. The males have
their own testosterone and the females have their own
amount of testosterone
● Exogenous - synthetic derivatives of testosterone so
that is from the outside. Manufactured from the lab and
they are being injected, inhaled, taken in, drank to the
body
WHY ARE THEY POPULAR AMONG ATHLETES?
● They are meant for muscle building and increase male
characteristics.
● Going back, androgenic is the development of male
characteristics and anabolic is increasing muscle
mass.
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 DRUGS IN SPORTS (Second Shifting Period) | Steroids

▪ If you are adding this to your program, it will

help them increase their strength
o No increase in endurance performance
▪ There is a difference between power and
endurance.
▪ Don’t expect steroids to improve your
endurance.
o Adverse effects are well documented

EVIDENCE: AAS (ANABOLIC ANDROGENIC STEROIDS)

o This is an old journal because this is the one that
defined the role of steroids and how it affects the
performance of athletes.
o They did a study using testosterone 600 mg a
week for 10 weeks in weightlifters
o What did they find after 10 weeks?
▪ There was a 6 kg weight gain and a 22 kg
improvement in 1RM bench press in
experienced weightlifters.
▪ As you can see, there was an increase in
weights and ergogenic properties of this
substance.
● Increase in muscle mass: hypertrophy (enlargement of
muscle cells) and hyperplasia (increase in number of
muscle cells)
● Increase in strength: enhanced calcium release from
SR (sarcoplasmic reticulum) and/or increased calcium
sensitivity of the contractile proteins
o When calcium is released, contractile protein
starts to do their work
o Steroids make contractile proteins respond better
● Anti-catabolic effects
● Reduction in breakdown of muscle mass to maintain a
good muscle mass
● Endpoints (size and strength) are enhanced by training
o You cannot gain muscle mass with steroids
without training

ANABOLIC ANDROGENIC STEROID TESTOSTERONE

Androgenic YES

Anabolic YES

Ergogenic YES

Positive Test YES

Adverse health YES

effects

o Another study titled the effects on androgenic-

anabolic in athletes.
o There are individual differences for dose and
response.
▪ Even if the dose - low dose vs high dose, there
are different responses.
▪ The frequency, every six hours, every day,
every week, there is also a difference in
response.
▪ Even if you give the same dose and frequency,
there will still be individual differences. One
person may respond differently than the other
person.
o In strength athletes, megadoses increase lean
body mass and strength
▪ Strength athletes which mean they are
powerlifters or etc

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 DRUGS IN SPORTS (Second Shifting Period) | Steroids

MOST COMMONLY USED ANABOLIC-ANDROGENIC o Football players, weightlifters

STEROIDS
ADVERSE EFFECTS & REVERSIBILITIES
ADVERSE EFFECTS & REVERSIBILITIES OF
ORAL INJECTABLE CARDIOVASCULAR
1. Increased LDL
Anadrol Deca-Durabolin 2. Decreased HDL
(oxymetholone) (nandrolone decanoate) 3. Hypertension
4. Elevated Triglycerides
Anavar (oxandrolone) Durabolin (nandrolone 5. Atherosclerotic Heart Disease
phenpropionate)
LDL & HDL
Dianabol Depo-Testosterone ● Low Density Lipoprotein aka bad cholesterol increases
(methandienone) (testosterone cypionate) ● High density lipoprotein aka good cholesterol
decreases
Winstrol (Stanozolo) Agovirin (testosterone ● Reversibility: Yes
propionate)
HYPERTENSION
Restandol Retandrol (testosterone ● Chronic use of steroids can increase your blood
(Testosterone phenylpropionate) pressure
undecanoate) ● Reversibility: Yes

Equipoise (boldenone ELEVATED TRIGLYCERIDES

undecylenate) ● Chronic use of steroids can increase triglycerides
● Reversibility: Yes
WADA
● Anabolic Androgenic Steroids (both exogenous and ATHEROSCLEROTIC HEART DISEASE
endogenous when administered exogenously) are ● When coronary blood vessels decreases in diameter
prohibited which decrease blood supply to the heart and can lead
o Exogenous - comes from outside the body to myocardial infarction or heart attack
o Endogenous - from the body like getting your ● Reversibility: No
testosterone and injecting it
SYSTEM ADVERSE REVERSIBILITY
● Other anabolic agents (clenbuterol, selective
EFFECT
androgen receptor modulators, tibolone, zeranol,
zilpaterol) are prohibited Reproductive Testicular Yes
- MALE Atrophy
WHICH ATHLETES WOULD MOST LIKELY BE
ENTICED TO USE STEROID TESTOSTERONE? Gynecomastia Possible
SYSTEM ADVERSE REVERSIBILITY
EFFECT Impaired Yes
spermatogenesis
Cardiovascula Increased LDL Yes
r Altered libido Yes
Decreased HDL Yes

Hypertension Yes Male pattern No

baldness
Elevated Yes
Triglycerides

Atherosclerotic No
Heart Disease ADVERSE EFFECTS & REVERSIBILITIES OF
● Those who want to increase muscle mass and REPRODUCTIVE - MALE
strength 1. Testicular Atrophy
2. Gynecomastia

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 DRUGS IN SPORTS (Second Shifting Period) | Steroids

3. Impaired Spermatogenesis
SYSTEM ADVERSE REVERSIBILITY
4. Altered Libido
EFFECT
5. Male Pattern Baldness
Reproductiv Menstrual Yes
TESTICULAR ATROPHY
e - FEMALE dysfunction
● Testicles will dry up due to being atrophied. Their
functions will also decrease. Altered libido Yes
o Due to a lot of testosterone, the testicles will
atrophy because they are not needed anymore.
o The hormones will do a check in balance through Clitoral No
positive and negative feedback, hence, if there is enlargement
too much testosterone already, the testicles will
say “My function is no longer needed, I can already Deepening of the No
atrophy.” voice
● Reversibility: Yes
o If you stop taking the steroid, it can be reversible Male pattern No
baldness
GYNECOMASTIA
● Enlargement of the breasts in males ADVERSE EFFECTS & REVERSIBILITIES IN
● Reversibility: Possible REPRODUCTIVE - FEMALE
1. Menstrual Dysfunction
IMPAIRED SPERMATOGENESIS 2. Altered Libido
● The sperms will decrease in number 3. Clitoral Enlargement
● There will also be abnormal types of sperms 4. Deepening of the Voice
o In physiology, you might have been introduced to 5. Male Pattern Baldness
what a sperm cell would look like. It has a head
and a tail MENSTRUAL DYSFUNCTION
o In impaired spermatogenesis, for example, the ● You will start having irregular menses.
sperm cells can also look abnormal like two heads, ● You may even have the absence of menses.
short tail, or two long tails ● You may have a smaller amount of menstrual blood
● Reversibility: Yes than normal.
● Reversibility: Yes
ALTERED LIBIDO ● In females, there is menstrual dysfunction. This means
● In males taking steroids, initially there will be an that the menses can totally stop because that is a
increase in libido. But later on, they are no longer male hormone.
interested in this sexual function. ● The menses may also be irregular or scant (konti yung
● The alternation is biphasic menstrual flow)
o Initially, they are very very interested due to an
increase in libido. But later on, they are no longer ALTERED LIBIDO
interested because there is a decrease in libido. ● Initially there will be an increase in libido. But later on,
● Reversibility: Yes they are no longer interested in this sexual function
● Reversibility: Yes
MALE PATTERN BALDNESS
● They will start losing hair CLITORAL ENLARGEMENT
● There are some males who have a genetic ● The clitoris is the female counterpart of the male penis.
predisposition to male pattern baldness. If it runs in Since you are taking in high amounts of testosterone,
the family, have a high hairline, and you lose your hair your clitoris will enlarge.
as you mature. It means you have a high level of ● Reversibility: No
testosterone in your body.
● In persons taking testosterone, you will also develop DEEPENING OF THE VOICE
this male pattern baldness. It means there is a high ● Since this is a male characteristic, taking testosterone
level of testosterone. will make your voice deepen.
● Reversibility: No ● Reversibility: No

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 DRUGS IN SPORTS (Second Shifting Period) | Steroids

● If you are injecting testosterone, it is a male hormone, SYSTEM ADVERSE REVERSIBILITY

your voice will lean towards the male voice because of EFFECT
the changes in your larynx, pharynx, and vocal cords. Endocrine Altered glucose Yes
intolerance
MALE PATTERN BALDNESS Decreased Yes
● Male pattern baldness is also seen in females taking FSH, LH
testosterone. Acne Yes
● Reversibility: No Altered glucose Yes
intolerance

ADVERSE EFFECTS & REVERSIBILITIES IN

ENDOCRINE
1. Altered Glucose Intolerance
2. Decreased FSH, LH
3. Acne

ALTERED GLUCOSE INTOLERANCE

● You can have high blood sugar levels
● Reversibility: Yes

DECREASED FSH, LH
● Follicle-stimulating Hormones (FH) and Luteinizing
Hormones (LH) direct ovulation
● Reversibility: Yes
SYSTEM ADVERSE REVERSIBILITY
EFFECT ACNE
Hepatic Elevated liver Yes ● It can be seen on both males and females
enzymes ● You can observe this in your athletes if they suddenly
Jaundice Yes have a lot of pimples not just on the face, but also on
Hepatic Tumors No the back.
Peliosis hepatis No ● Reversibility: Yes

ADVERSE EFFECTS & REVERSIBILITIES IN HEPATIC SYSTEM ADVERSE REVERSIBILITY

1. Elevated Liver Enzymes EFFECT
2. Jaundice Musculoskeletal Premature No
3. Hepatic Tumors epiphyseal
4. Peliosis Hepatis closure
Tendon ??
ELEVATED LIVER ENZYMES
degeneration
● High risk for testosterone levels can damage your liver
● Reversibility: Yes

JAUNDICE ADVERSE EFFECTS & REVERSIBILITIES IN

● Yellowish discoloration of the skin, chances are there MUSCULOSKELETAL
is a liver problem 1. Premature Epiphyseal Closure
● Reversibility: Yes 2. Tendon Degeneration

HEPATIC TUMORS PREMATURE EPIPHYSEAL CLOSURE

● Abnormalities in the mass of the liver ● The epiphysis of the long bone determines the height
● Reversibility: No of individuals. This will enlarge as we grow taller
● If the younger ones, especially during pre-puberty, if
PELIOSIS HEPATIS they are being given steroids, you can see that will
shield their maximum height. They do not reach their
● Like pockets of blood found all of the liver maximum height.
● Reversibility: No ● Reversibility: No

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 DRUGS IN SPORTS (Second Shifting Period) | Steroids

TENDON DEGENERATION ● Injectable forms have earlier onset than the oral forms
● They damage their tendons because of chronic steroid ● Injectable are shorter in duration than oral
use ● Urine analysis is a single condition, in the presence or
● Reversibility: ?? the absence of steroids which metabolize or other
o Some say they can regenerate, but others say related substances of steroids.
they cannot ● Right here, right now

SYSTEM ADVERSE REVERSIBILITY 3. Athlete’s Biological Passport

EFFECT ● Steroidal Module
CNS Mood swing Yes o Operational on January 1, 2014
Violent Yes o Monitors selected urinary steroid concentrations
over time
behavior
o Meant to constantly monitor and see if there is a
Depression Yes pattern of your steroid concentration over a period
Psychosis Yes of time

ADVERSE EFFECTS & REVERSIBILITIES IN CNS CONCEPTS THAT THE ATHLETE’S DO SO THAT THEY WILL NOT
1. Mood Swings BE DETECTED IN A SINGLE URINE SAMPLE
2. Violent Behavior 1. Cycling
3. Depression 2. Stacking
4. Psychosis 3. Pyramiding
4. Plateuing
MOOD SWINGS
● One minute, you are very happy, the next minute, you CYCLING
are sad o They take steroid A for one week straight, and then
they stop taking it for another week
VIOLENT BEHAVIOR o They will start taking it again in the third week, and
then stop taking it again in the fourth week
● You might have heard of drug rage/steroid rage
o They cycle the use of steroids
● There was an MMA fighter who killed his wife and
● The aim is to be able to maintain just enough level of
children and also shot himself because of his violent
steroids in their body to achieve the effects they want
behavior. He was found out to be a chronic steroid
and just enough for the urine test to be tested negative
user.
● They do not want to have a high levels of steroids at
any given time
DEPRESSION ● They will take this week, the following they will not -- a
cycle
PSYCHOSIS
● There is an alteration on the behavior on how they STACKING
think, what is normal, and what is not o They would use different types of steroids
● They can have delusions and hallucinations o Week 1: Steroid A; Week 2: Steroid B; Week 3:
Steroid C etc.
o Remember that there are many many types of
WHY STEROIDS ARE IN PROHIBITED LIST
steroids, and if they go below that level, by just
1. Increase Performance (Cheating) taking them for a week, they would test negative
2. Damage the health of the athletes o If they take a different one next week, steroid level
will go down again that will make them test
DIRECT MEASURES negative
1. Gas chromatography-mass spectrometry
2. Liquid chromatography-mass PYRAMIDING
spectrometry o Inverse pyramid
● Done in the laboratory o They will start by taking low dosage and gradually
● How long do we expect the levels to be present in the going up, increasing slowly until they achieve their
urine desired objective
● Metabolites may be present up to 30 days depending o Then they go back to taking low dosage, gradually
on agent, dose, route increase again hoping that they would not test
● Route: how you took it positive for the urine steroids

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 DRUGS IN SPORTS (Second Shifting Period) | Steroids
PLATEAUING
o Similar to pyramiding, but they are able to test
themselves and once they have certain steroid
level in their body that is already in plateau, they
will stop it
o If they already achieved a certain steroid level in
their blood, they stop, once it goes down, they will
start again
o They will target a plateau stage, only up to that
part, because in this part their urine will already
test negative
● This is how athletes behave just to get away from
being tested positive in the urine test
● This is also the reason why we have steroidal module
for the ABP
PLANT AND ANIMAL STEROIDS
● Some manufacturers will even advertise
● “These are not human steroids, but if you take them,
they’re safe because they are from plants and animals
and you will not be tested positive”
SCIENTIFIC EXPLANATIONS
● We are not plants nor animals, so the steroids from
them will not be behaving as the testosterone that we
want
● Unfortunately, it will not work, and there is a possibility
that you may test positive
MUSCLE DYSMORPHIA
● This is a mental or psychological condition wherein the
individual is not forever happy with how he/she looks
● He/she wants to look better or bigger muscles
● They would most likely be taking steroids because
they want to improve on how they look
● These people would need professional help because
they will not stop
● It is rooted on low self-esteem and insecurities
● Address the low self-esteem and insecurities to be
able to stop taking steroids
DEPENDENCY AND WITHDRAWAL
● Chronic use of steroids can cause dependency and
withdrawal
● These two are different from each other
● Dependency is described as being dependent on a
substance
o You are craving for it
o You have drugs seeking behaviors
o Psychologically dependent on it
● Being on a drug for a long period of time, and you
suddenly stopped it, you develop withdrawal
symptoms
● These withdrawal symptoms are physiological like
palpitations, dryness of the mouth, blood pressure
changes etc.
● Psychiatric symptoms
CORTICOSTEROIDS
1. Glucocorticoids
o These are the ones that are responsible for the
immune function
WADA
● All glucocorticosteroids are prohibited in-competition
when administered orally, rectally, intravenously, and
intramuscularly
o In competition: just before midnight of the day of
your competition and ends when you have been
tested already
o Oral: capsule, tablet, syrup
o Rectally: inserting in rectum or anus
o Intravenously: you get an iv line through in vein or
inject in your vein
o Intramuscularly: inject in the muscle
o All are prohibited
● Glucocorticosteroids are under the monitoring
program during out-of-competition
o Out of competition: athletes are also being tested
outside of competitions
o If they test positive in glucocorticosteroids, they
won’t be sanctioned because it’s still not prohibited
yet
o Who know, maybe in the following year it will be
added in the prohibited list since they’re thinking of
adding it in the WADA 2022
o For now, it’s only prohibited in in-competition only
ALLOWED DURING IN-COMPETITION
● Glucocorticosteroid Joint Injection
o In chronic pain conditions especially if there’s pain
● Inhaled Glucocorticosteroid in Asthma
o Anti-inflammatory
o If you have asthma and you’re not responding to
the usual medications, doctors may prescribe
steroids that are inhaled
● Topical Glucocorticosteroid
o If during competition, you get sore eyes or insect
bites, doctors can prescribe you topical steroids
● If you need to take it orally, rectally, intravenously, and
intramuscularly, you can get a TUE
o If you need to take it orally or rectally because of
an emergency
o If it’s for life threatening allergic reactions and you
need to be given and IV or IM to save your life
o Sometimes, it can be a Retroactive TUE after
being given the drug
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 DRUGS IN SPORTS (Second Shifting Period) | Steroids
POSSIBLE RED FLAGS THAT YOUR TEEN IS USING A
PERFORMANCE-ENHANCING DRUG INCLUDE (FROM MAYO
CLINIC)
● Behavioral, emotional, or psychological changes --
particularly increased aggressiveness (“roid rage”)
o If you have an athlete who was very calm, nice,
and pleasant before then suddenly he's more
aggressive, always angry and irritated, that can be
a possible red flag for steroid use
● Changes in body build, including muscle growth, rapid
weight gain and development of the upper body
● Increased acne
o Not just in the face but also at the back
● Needle marks in the buttocks or thighs
● Enlarged breasts, male-pattern baldness and
shrinking of the testicles in boys
● Smaller breasts, voice deepening and excessive
growth of body hair in girls
POST LECTURE DISCUSSION
KEY TERMS:
● Anabolic: improve strength or muscle mass
● Androgenic: improve male characteristics
● Ergogenic: improve athlete’s performance
TWO TYPES OF STEROIDS MAY BE USED IN SPORTS
1. Anabolic- Androgenic Steroids (AAS)
o Anabolic - improve strength or muscle mass
o Androgenic - male characteristics
o Common example: Testosterone (all 3 key terms)
2. Glucocorticosteroid
o They really have a role especially for athletes with
injury or chronic pain, steroids can decrease
inflammation which is usually injected
When we train athletes, two most common things we want
to happen in relation to steroids is to enhance strength
and endurance
When an athlete is taking steroids, to enhance its effects,
by evidence, you can get the maximum benefit if you
do strength conditioning and workouts.
o The concept is that taking steroids is not enough
since you have to combine it with exercises like
weight training.
Weightlifters, Body Builders, Football and Rugby Players
usually use steroids to increase strength, muscle
mass, and performance.
HOW DO WE TEST FOR STEROIDS?
● Urine: but it’s only ‘here and now’
● Athlete Biological Passport: if it’s chronic and we saw
difference behaviors of the athlete; to track repeated
chronic use of steroids
Cycling
● If you take this week, urine levels will increase since
it’s in your body so you stop after a week so the urine
level won’t increase and be detected
● Blood levels won’t be detected if you’re urine gets
tested because you didn’t take it continuously
Stacking
● Take different types of steroids weekly
● It won’t test positive because it’s only low doses but it
still has effects because of continuous use
Pyramiding
● Start with very low doses and gradually increase it
● Stay within low levels of drugs
Plateauing
● One or several steroids but you want to achieve a
plateau stage
● Aim is to achieve a certain level that they will plateau
because they’ll test positive above it
● Stay below the radar and when achieved, stop or
change
ARE THERE SPECIFIC INJECTION SITES?
● Ideally, for IM, it’s in deltoids or buttocks because of
their large muscle mass
ARE THERE STEROIDS FOR THE HEART MUSCLES?
● Target of steroids is skeletal muscles only and not the
cardiac or smooth muscles because of different
characteristics.
TRANSGENDERS HAVE HORMONE THERAPY, LIKE
TRANSWOMEN WHO TAKE ESTROGEN TO CONTROL
TESTOSTERONE. WON’T THEY BE TAGGED BY WADA?
● If you’re being injected with an exogenous steroid,
that’s already a violation whether trans or not
● If there are abnormal levels, it's still a violation from
WADA
● But there's an ongoing discussion for transgenders
joining different competitions like the olympic level
● There’s a debate in the ethical considerations since
individuals who want to shift from male to female or
vice versa might need hormones while doing this
● As for now, we all follow the rules so if you’re tested
positive, you will still be sanctioned
● One of the considerations they’re looking at is if they’re
a legit transgender and they’re transitioning using
hormones, they’re looking at whether you’ll be allowed
a TUE
3SPS | Batch 2023 10
 DRUGS IN SPORTS
Human Growth Hormone (HGH)
OUTLINE HOW ARE GROWTH HORMONES RELEASED?
I. Human Growth Hormone (HGH) 1. Hypothalamus (generates growth hormone
1. How are Growth Hormones released? releasing hormone aka GHRH)
2. The Major Goal of Growth Hormone
II. 2 Major Mechanisms
2. GHRH enters the hypothalamic hypophyseal
III. Skeletal Muscle portal system (network of blood vessels that
1. Bones carries GHRH to ant. Pituitary Gland)
IV. Effect of HGH on Athletic Performance 3. GHRH stimulates Anterior Pituitary Gland to
V. Side Effects of HGH Abuse
VI. Test for HGH
generate HGH or Human Growth Hormone
1. The Isoforms Approach (somatotropin)
2. The Markers Approach 4. From the Anterior Pituitary Gland, Growth
VII. Analytical Doping Cases involving HGH Hormone is released into the blood
VIII. Matrix Used for Detecting HGH
1. Is the test Reliable?
2. Are the isoform differential immunoassays and • Growth hormone is released into the blood into the
the HGH biomarkers tests complementary? general circulation, where it travels to target tissues
IX. GH Releasing Factors
X. Best Time to Test Athletes for HGH • Now we're going to see that it's going to have effects
1. Is A Urine Test for HGH Likely to Be Developed? on tissues like adipose tissue, skeletal muscle, bone,
2. Can Blood Samples be Stored? and the liver
HUMAN GROWTH HORMONE (HGH)
• But before we get into all these specific functions, I
want to go over the major goal of growth hormone
• Hormone that is naturally produced by the body because this major goal is really going to dictate all the
• It is synthesized and secreted by cells in the anterior specific functions.
pituitary gland located at the base of the brain.
• Its secretion into the circulation follows a pulsatile
pattern resulting in widely fluctuating blood levels
that are influenced by multiple factors such
Age
Gender
Sleep
physical activity
diet
stress
fever
steroids
environment.
• In serum, hGH exists as a complex combination of
different molecular forms (isoforms), including the
major 22-kDa form and minor isoforms such as the 20-
kDa form.
• hGH also exists as aggregates of these isoforms
(dimers and oligomers, forming both homo- and
heterodimers). Following secretion into the blood THE MAJOR GOAL OF GROWTH HORMONE
circulation, the 22-kDa hGH has a short half-life of 10- • To provide adequate nutrients for ATP synthesis
20 minutes. and protein synthesis
• stimulates many metabolic processes in cells. • So, if we think about all sorts of peripheral cells, like,
• affects protein, fat, carbohydrate and mineral let's say skeletal muscles, skeletal muscles are
metabolism. composed of cells that are going to be metabolically
• Major Role of hGH: to stimulate the liver to secrete active
Insulin-like Growth Factor-I (IGF-I). • To conduct metabolism, you have to have nutrients
IGF-I stimulates production of cartilage cells, like glucose fatty acids
resulting in bone growth and plays a key role in • And why do you have to have those nutrients to make
muscle protein synthesis and organ growth. ATP?
• prohibited both in- and out-of-competition under Because ATP is what's going to allow that cell to
section S2 of WADA’s List of Prohibited Substances do work
and Methods. • To have ATP you must have nutrients.
And to get that nutrient, you need something that's
going to stimulate the body to allow for the
availability of those nutrients

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 DRUGS IN SPORTS (Second Shifting Period) | Human Growth Hormone (hGH)
• If you want to do work, you must have ATP. And if you
want ATP, you must have nutrients
• The growth hormone is going to make some changes
around the body to increase the availability of those
nutrients
liver and adipose tissue
§ now adipose tissue is just your body fat, and
the body fat of course is going to contain lipids
in the form of triglycerides so the first effect
that growth hormones going to have is on
adipose tissue where it stimulates lipolysis
now in general lipolysis is a process that
breaks down those triglycerides into
individual fatty acids
§ And then the fatty acids are released into the
blood well that makes sense given the school
because those fatty acids could be taken up
by skeletal muscle or other cells that are
metabolically active and use to make ATP
• Lipolysis and adipose tissues are the first function
• Liver is going to play a major role in increasing blood
glucose
glucose can go to cells that are metabolically
active for ATP synthesis and the way the liver is
going to do that:
ACTIVATING GLUCONEOGENESIS
• the synthesis of glucose from non-carbohydrate
precursors. So, if the liver is making glucose by this
method, it’s then taking that glucose and dumping it in
the blood and therefore that glucose is going to be
available to all sorts of peripheral tissues
GLYCOGENOLYSIS
• breaking that glycogen down into glucose. The
glucose that’s created through glycogenolysis is going
to be released into the blood where it can then go and
travel to peripheral tissues and those tissues can take
it up and make ATP.
2 MAJOR MECHANISMS
The liver is increasing blood glucose through two major
mechanisms
1. Through gluconeogenesis
2. Through glycogenolysis
• Now growth hormones going to stimulate the liver to
do one more thing and that is going to be to release
another type of hormone called igf -1 (Insulin-like
growth factor 1)
• The effects that growth hormone has on adipose tissue
and the liver is to increase the availability of
nutrients in the blood specifically glucose from
adipose tissue and all those nutrients are going to
travel in the blood to tissues like skeletal muscles and
bone where they are going to take up utilized in
metabolic pathways to make ATP and that allows the
cells to do work.
One of example of a process that is going to take
a lot of ATP:
§ Protein synthesis - take a lot of molecules of
ATP just to make one protein
SKELETAL MUSCLES
• As we learned in A&P one is composed of lots and lots
of proteins, but it turns out that growth hormone is also
going to have some other specific effects on cells of
skeletal muscles and bone.
Growth hormones also going to have some other specific
effects on cells of skeletal muscle and bone
• In skeletal muscle, growth hormone is going to
stimulate glucose uptake
by increasing the number of transporters in the
membrane of the skeletal muscle cells
§ these are called glucose transporters
• If the muscle cells put more glucose transporters in
their membrane, they can uptake more glucose
stimulated by growth hormone
• Amino acid uptake is increased by a similar
mechanism
in conjunction with the increased amount of ATP
from all the glucose uptake the amino acids can be
strung together into proteins
• Overall growth hormone is going to increase protein
synthesis all over the body but especially in skeletal
muscles
BONES
• growth hormone also is going to have similar effects
on bones
• Growth hormones going to stimulate increased
glucose uptake into the bone cells
• Stimulate increased amino acid uptake into the
bone cells
With that increased uptake of amino acids in
conjunction with increased ATP synthesis you're
going to be able to synthesize more proteins
• so, protein synthesis increases
• an increase in bone mineral density
the more growth hormone a person has the more
dense their bones are okay and this is important in
preventing osteoporosis
One of the reasons why as we age, we have an
increased susceptibility to osteoporosis is
because growth hormone levels naturally decline
with age
§ if you have less growth hormones circulating
in your blood at any given time over time your
bone mineral density may actually drop
3SPS | Batch 2023 2
 DRUGS IN SPORTS (Second Shifting Period) | Human Growth Hormone (hGH)
• During puberty whenever your bones grow in length
remember that involves cartilage and the synthesis of
cartilage is termed Chondrogenesis
Growth hormone also stimulates chondrogenesis
which helps bones grow in length
• Overall, what the growth hormone is doing through the
adipose tissue in liver it's increasing the amount of
circulating nutrients and then those nutrients are taken
up by cells like skeletal muscle and a bone
• Also, growth hormone augments the uptake of those
nutrients like glucose and amino acids but then
through metabolic pathways we get more ATP and
then we can build more proteins
GROWTH HORMONE CAN ALSO DO TWO OTHER
THINGS
1. Growth hormone can actually stimulate the
liver to generate another hormone that's
released into the blood and those are IGFs or
insulin like growth factors
One of the most common insulin growth factors is
igf-1 which would be termed somatic in one so
IGFs are also called somatomedin
Those IGFs travel in the blood to all sorts of
peripheral tissues and they exert functions there
by binding to the insulin receptor and overall
What the IGFs do is they increase glucose uptake
by those cells they also increase amino acid
uptake and they increase protein synthesis as
Same as in the case of skeletal muscle and bone
except it's not directly growth hormone that's doing
that for a bunch of other cells it's the IGF
2. They can actually exert negative feedback on
the release of growth hormone releasing hormone
What they do is if there's too much IGF in the blood
those IGS can then circulate back and inhibit the
release of growth hormone releasing hormone
because if we have plenty of IGFs in the blood,
that signals that not only do we have plenty of
IGFs, but we also have plenty of growth hormones
and we don't need to get any more growth
hormones released. So IGFs can inhibit the
release of GH RH.
It’s also worth noting that there's another inhibitory
hormone called growth hormone inhibiting
hormone or GHIH.
§ This can also exert a similar effect to IGFs.
§ inhibit the release of growth hormone.
COMPREHENSIVE LOOK AT WHAT GROWTH
HORMONE IS DOING
• It’s really just making sure that the blood has plenty
of circulating nutrients
• Then it will also increase the ability of a lot of these
cells to uptake those nutrients
• Which then allows them to make more ATP and have
more protein synthesis
• Growth hormone also stimulates the liver to release
insulin like growth factors which have similar effects
on all sorts of other cell types
• Comparing the Growth Hormones to the function of
thyroid hormones, we’ll see that they are very similar
in function. Although, there's a couple differences
between the functions.
EFFECT OF HGH ON ATHLETIC PERFORMANCE
• Some of the effects attributed to hGH, which may
explain the attraction for its use as a doping agent,
especially in power and endurance sports
1. The reduction of body fat (lipolysis)
2. The increase in muscle mass and strength
(anabolic effect)
3. Its tissue-repairing effects (recovery) on the
musculo-skeletal system.
• The anabolic actions of GH are mostly mediated
through IGF-I and include increases in total body
protein turnover and muscle synthesis. hGH also
appears to be used synergistically with other
performance-enhancing drugs, thus having an effect,
albeit indirect, on muscle anabolism and athletic
performance.
SIDE EFFECTS OF HGH ABUSE
Commonly reported side effects for hGH abuse are:
1. Diabetes in prone individuals
2. Worsening of cardiovascular diseases
3. Muscle, joint and bone pain
4. Hypertension and cardiac deficiency
5. Abnormal growth of organs
6. Accelerated osteoarthritis.
In untreated acromegalic individuals (known for
pathological over-production of hGH), many of the
symptoms described above are observed and life
expectancy is known to be significantly reduced.
7. Metabolic Dysfunction
Because of the role that hGH plays in stimulating
IGF-1 secretion, excessive use of hGH may also
lead to metabolic dysfunction, including glucose
intolerance and other side effects associated with
excess levels of IGF-1.
TEST FOR HGH
• The menace that doping with hGH presents to fair play
and the health and well-being of athletes has driven
the sport and anti-doping authorities to support the
development of analytical methods for its detection.
• Such tests have been elaborated following two distinct,
but complementary scientific approaches:
the Isoforms Approach
the Markers Approach
3SPS | Batch 2023 3
 DRUGS IN SPORTS (Second Shifting Period) | Human Growth Hormone (hGH)
ISOFORM DIFFERENTIAL IMMUNOASSAYS
• Isoforms Test
• was first introduced as a research-scale test at the
2004 Summer Olympic Games in Athens, Greece
• later applied at the 2006 Winter Olympic Games in
Torino, Italy.
• Following a process of assay development and
validation into a new technical platform (tube-based
chemiluminescence technique), which is suitable for
the production of commercial kits, the currently applied
test kits were firstly used during the 2008 European
Football Championship in Austria and Switzerland,
as well as during the 2008 Summer Olympic Games
in Beijing, China. Currently, all WADA accredited
laboratories test for hGH using the Isoforms Test.
• Since the total levels of hGH secreted into circulation
vary naturally, are widely fluctuating over time and may
be influenced by several factors not associated with
doping.
• it is practically impossible to develop an anti-doping
test based simply on the measurement of increased
total hGH concentrations.
• However, doping with recombinant hGH (recGH)
alters the naturally constant proportions between the
different isoforms of hGH present in blood of an
individual.
• The hGH Isoform Differential Immunoassays were
developed to detect changes in the proportions of
different hGH isoforms after recombinant recGH
injection.
HGH BIOMARKERS TEST
• the Markers Approach
• was briefly introduced for testing during the 2012
London Olympic and Paralympic Games.
• However, following the temporary withdrawal from
the market of one of its constituent assays, a
process of validation of new assays for IGF-1 and P-
III-NP has been completed in collaboration with
USADA and several research groups, including the
method-developer GH-2000 team from the UK and
various WADA accredited laboratories.
• Following the completion of the study on the
determination of the Decision Limits (DLs) for the hGH
Biomarkers Test, the application of the method will be
resumed in a number of WADA accredited laboratories
in the near future.
• hGH affects the expression of many different
proteins which may serve as biological markers of
hGH activity.
• These include markers of hGH action in the liver such
as IGF-I, as well as markers of hGH action on soft
tissue collagen turnover, such as the N-terminal
peptide of procollagen type III (P-III-NP).
The measurement of these two hGH markers in
serum may serve to uncover the manipulation of
the hGH/IGF-I axis independently of the doping
substance used
be it recGH or other agents used to increase
circulating hGH [for example analogs of GH-
releasing hormone (GHRH)
§ hGH secretagogues such as GH-releasing
peptides (GHRP) or even hGH gene doping].
• The detection and quantification of such biomarkers of
hGH activity constitute the rationale of the indirect
method for detection of doping with hGH, referred
to as the ‘markers approach’.
ANALYTICAL DOPING CASES INVOLVING HGH
• Since 2010, there have been approximately 15
adverse analytical findings reported following the
application of the hGH Isoforms Test.
• In addition, two athletes were sanctioned following
detection of doping with hGH through the application
of the hGH Biomarkers Test during the 2012 London
Paralympic Games.
MATRIX USED FOR DETECTION OF HGH
• Tests for detection of hGH doping are applied in blood
serum
which is obtained following the centrifugation in
the laboratories of blood collected in specified
tubes containing an inert polymeric serum
separator gel and a clotting activation factor.
ARE THE HGH TESTS RELIABLE?
• The concepts and development of both hGH tests
have been systematically reviewed by international
independent experts in such fields as hGH and IGF-I,
endocrinology, immunoassay, analytical chemistry,
pharmacology, laboratory work, anti-doping, etc., and
published in international scientific journals.
• The 2013 Court of Arbitration for Sport (CAS)
decision on the FIS vs. Veerpalu case confirmed that
the current Isoforms Test is robust and
scientifically reliable.
• As a result of criticism expressed by the CAS Panel on
the statistical procedure originally applied to the
determination of the test’s DLs, new statistical
analyses were performed on an increased number of
hGH doping control data
samples from athletes treated under real doping
control conditions of sample collection,
transportation, storage and analysis, including
standardized analytical protocols and
instrumentation) by two independent teams of
statisticians.
• The results of the study have been published in an
independent peer-reviewed scientific journal
specialized in GH and IGF-I research.
• The revised DLs have been incorporated into a new
version of the Guidelines on hGH Isoform Differential
Immunoassays for anti-doping analyses, available on
WADA’s website.
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 DRUGS IN SPORTS (Second Shifting Period) | Human Growth Hormone (hGH)
These Guidelines continue to provide direction on
the sample pre-analytical preparation procedure,
the performance of the test and the interpretation
and reporting of the test results.
“hGH isoforms differential immunoassays applied to blood
samples from athletes: decision limits for anti-doping
testing”. Growth Hormone & IGF Research, 2014.
• The scientific validity and efficacy of the hGH
biomarkers approach has been documented in
multiple scientific publications for over a decade.
• A series of placebo-controlled recombinant recGH
administration studies performed in Europe and
Australia has shown that both IGF-I and P-III-NP rise
substantially following recGH administration in a dose-
dependent manner.
• These markers have been evaluated for several
confounding factors that might influence the scores of
the discriminant functions, including
Age
Gender
Ethnicity
Exercise
diurnal
day-to-day variation
intra-individual variation
bony and soft tissue injury
sporting discipline
body habitus (physique).
• Nevertheless, before resuming its implementation in
WADA-accredited laboratories, the study on the
determination of the DLs for the new assays will be
also subjected to independent peer review and
publication in an international scientific journal.
ARE THE ISOFORM DIFFERENTIAL IMMUNOASSAYS
AND THE HGH BIOMARKERS TESTS
COMPLEMENTARY?
• These two tests are complementary in nature and in
time window of hGH detection.
• The hGH Isoforms Test detects the alteration of
proportions (ratios) between hGH isoforms up to 24-
48 hours after recGH administration.
• The Biomarkers Test is based on measuring the
increased synthesis of two biological markers of
hGH bioactivity, namely IGF-I and P-III-NP
It may not detect the initial phase of recGH use,
but does so at later times and for a longer period
than the Isoforms Test.
GH-RELEASING FACTORS
GH-releasing factors includes
1. GH Releasing Hormone (GHRH) and its analogues,
GH secretagogues (GHS)
2. GH-releasing peptides (GHRPs).
• These compounds induce the secretion of
endogenous hGH by the pituitary gland.
• They are used in place of recGH to attain the effects
of hGH doping, and possibly to mask detection of
recGH use with the Isoforms Test.
• However, anti-doping laboratories have developed
mass spectrometry-based methods for their
detection, and adverse analytical findings have been
reported following their detection in doping control
samples.
• In addition, their use may be detected with the indirect
hGH Biomarkers Test.
BEST TIME TO TEST ATHLETES FOR HGH
• As for any other doping controls, test distribution plans
for hGH testing should be based on the
implementation of ‘Intelligent Testing’ strategies
aimed at making an effective and efficient use of
available testing resources.
• Athletes use hGH as a doping agent for extended
periods of time in order to benefit from its purported
performance-enhancing effects (in contrast, for
example, to other doping agents such as stimulants,
which may have an immediate effect).
• Therefore, testing for hGH should be prioritized to
out-of-competition periods, and be based on
intelligent, non-notice and unpredictable testing.
Because Doping Athletes suspect that they may
be tested for hGH during competition periods.
• Target testing of suspected athletes based on
intelligence information
e.g. information about doping routines
prior suspicious test results or dubious and
unexpected sporting achievements is also
recommended.
• Due to their complementary nature in detecting hGH
doping, it is advised that samples are tested with
both the Isoforms and the Biomarkers Tests.
IS A URINE TEST FOR HGH LIKELY TO BE
DEVELOPED?
• According to the majority of international experts, the
blood matrix is the most suitable matrix for the
detection of hGH.
• hGH in urine is found in extremely small quantities
(less than 1% than that found in blood), and not much
information is available regarding the excretion of
different hGH isoforms in urine .
• Research efforts undertaken to develop urine-based
detection methods for hGH have been unsuccessful so
far. However, WADA continues collaborating with
research teams to explore this possibility using novel
scientific ideas and technical strategies.
3SPS | Batch 2023 5
 DRUGS IN SPORTS (Second Shifting Period) | Human Growth Hormone (hGH)

CAN BLOOD SAMPLES BE STORED?

• Freezing blood serum is a scientifically acceptable
procedure that allows for the preservation of
substances in samples for future testing and detection.
• Research has shown that hGH is stable in serum if
frozen under the right conditions (please refer to
the hGH Guidelines for Assay Pre-analytical
Procedure, section 6.2).
• WADA encourages Anti-Doping Organizations under
the World Anti-Doping Code to store blood samples
when relevant
e.g. in cases of unexpected results, intelligence
available to the anti-doping organization, etc.
Storing serum for future testing has a significant
deterrent effect.
• The 2015 World Anti-Doping Code makes it possible
to open a disciplinary proceeding within ten years from
the date an anti-doping rule violation occurred.

3SPS | Batch 2023 6

 DRUGS IN SPORTS
Growth Hormones, Beta Blockers, Diuretics
OUTLINE The effects of rhGH in the improvement of sport
I. Growth Hormone performance is still under debate among users.
II. Gigantism The positive effects described in rhGH deficient
III. Acromegaly
IV. Adverse Effects of Growth Hormone
adults are not that clear among athletes.
V. Other Anabolic Agents
1. Clenbuterol WHY DO WE HAVE RECGH RIGHT NOW?
VI. Players who tested positive
1. Erick Morales • In the medical field there are times when patients
2. Alberto Contador would be requiring human growth hormones as
VII. Insulin treatments for some medical conditions. Because we
VIII. Beta-agonist & Beta-antagonist
1. Beta-Agonist give this to the patients, we see the positive effects.
2. Beta-Antagonist However, when they tested it on athletes it's not very
a. Asthma clear that their effects are the same as the patients with
b. Nebulizer growth hormone deficiency.
IX. Betablockers
1. Decrease Blood Pressure and Heart Rate • Although many of these underground reports indicate
2. Angina Pectoris some positive effects on muscle mass, it is difficult to
3. Cardiac Arrhythmias differentiate benefits obtained when rhGH is taken in
4. Ergogenic Effects combination with anabolic steroids or even if the rhGH
5. Ergolytic Effects
6. Impairs Cardiovascular Response used was a less effective product.
X. Prohibited • Athletes would often combine GH and steroids. We
XI. Diuretics don't know which one is increasing muscle mass,
1. Misuse in Sports
XII. Post Lecture Discussion
whether it's the steroid or GH. This is illegal, that's why
it's done underground.
GROWTH HORMONE • There are few controlled studies on the
• Also called somatotropin. effectiveness of GH on the performance of top level
• Normally secreted by the body in the anterior pituitary athletes.
gland. We talk about the ethical considerations on this
• Stimulates liver to produce insulin like growth factor matter. Do we test GH on top level athletes? It
(IGF-1) which: might be unethical because there’s only a few
Increase in height during childhood.Reason why controlled studies.
grow taller and there's a peak in adolescents. To test effectiveness, what would be the best
▪ Age related. scientific research methodology to test the
▪ Highest during sleep and lower in waking effectiveness of a drug of a substance. The best
hours. way is to do a randomized control trial
▪ By age 21 it slowly declines. ▪ You need two groups: one group will be given
• Stimulates bone and skeletal muscle growth and the drug the other group will not be given. Best
regeneration. ways to see the effects of the drug but often
that cannot be done because of ethical
• Increase in protein synthesis.
considerations
• Increase in lipolysis.
• In general, these studies have been performed with
Breakdown of fat.
supraphysiological dosages but not with the large
• Promotes gluconeogenesis.
amounts claimed to be effective, for instance, by body
New sources of glucose.
builders
• Stimulates the immune system. Supraphysiological - the highest normal
What is the normal highest level of growth
WHY ATHLETES ILLEGALLY USE GROWTH hormone secreted by our pituitary gland
HORMONES? They only tested those athletes on those levels of
• increasing protein synthesis dosages but the athletes that are using it test them
• stimulating the immune system with more than that
• bone and muscle growth and regeneration It is hard to compare the studies only test on
physiologic doses of course for fear of side effects
1986 Athletes who use it illegally go with very large
amounts so it cannot be really compared
• Until 1986 the only source of growth hormones were
human cadavers. After that, because of advanced • The results of these most controlled studies are
science, they were able to create recombinant generally less impressive than the claims of those
technology and produce new sources of growth who misuse the substance
hormone. No need to extract from humans or animals. What they are claiming is not really that convincing
• Urine tests not reliable - Wada does not use them for
growth hormone
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 DRUGS IN SPORTS (Second Shifting Period) | Growth Hormones, Betablockers and Diuretics

• Blood tests • In adults who are beyond adolescence and high levels
• Isoforms of growth hormone. Sometimes the pituitary gland
• Markers suddenly has a tumor and starts secreting large
• Wada: prohibited at all times (in and out of amounts of growth hormone, this is called
competition) acromegaly.
• The bones will no longer grow taller because the
GIGANTISM epiphysis has been closed. The bones become
flatter and wider.

• Young adults who had elevated growth hormone

during adolescence. We call it gigantism, excessive
growth hormone release during adolescence can
cause gigantism.
• Enlargement of the fingers secondary to excessive
growth hormone release

ADVERSE EFFECTS OF GROWTH HORMONE

• Look how unstable the person is when you have
gigantism
• You may look huge and tall but actually their bones
and joints are unstable
• The further you go away from the source of center of
gravity, your balance becomes unstable
ACROMEGALY
• Gigantism
• Acromegaly
• Impaired insulin function - hyperglycemia (decrease
in insulin - blood sugar level increases)
• Advancement of cancerous tumors
These growth hormones stimulate a lot, basically
all our metabolic cells in the body
If you happen to have cancer, and high levels of
growth hormone. Chances are the cancer cells
can proliferate, the tumor can increase in size
• Cardiomyopathy
cardiac muscles malfunctions, they are not normal
you can have heart failure secondary to excessive
growth hormone release
Your heart will not be able to pump very well
• Gynecomastia
increase muscles in males
pectoralis
• Muscle and joint pains
due to the excessive increase in size of the
muscles and joints

OTHER ANABOLIC AGENTS

• Very popular

CLENBUTEROL
• Sympathomimetic amine
It mimics the effects of the sympathetic nervous
system
• When do we use in medicine?
Anti-asthma
▪ causes bronchodilation

3SPS | Batch 2023 2

 DRUGS IN SPORTS (Second Shifting Period) | Growth Hormones, Betablockers and Diuretics

Anabolic • Beta I receptors is present in the heart and Beta II

increases muscle mass receptors is present in the lungs
Reports of ergogenic potential • When you stimulate Beta I receptors in the heart, they
Food contamination increase heart rate and blood pressure.
▪ one of the Olympic events tested positive in • We have Beta II receptors in the lungs and when
clenbuterol stimulated, there is bronchodilation.
▪ Canteen was serving steak contaminated with
clenbuterol BETA-AGONISTS
▪ In that country they Inject clenbuterol to the
• There is sympathetic response
cows so that the muscles will become more
• Chemically related to epinephrine
bigger, firmer, stronger and more delicious as
Sympathetic
a steak
• Bronchodilators (for asthma)
▪ This particular food is no longer allowed to be
serve in the athlete village • Regulated thermogenesis
Because of the vasodilation, there can be an
• WADA: Prohibited at all times
increase in temperature
• Decrease fat mass by enhanced lipolysis and lowered
ERICK MORALES (2013) lipogenesis
• Positive for Clenbuterol use Because of sympathetic activity
• Suspended for 2 years • Increase lean mass by increasing protein synthesis
• Boxer {anabolic}
Athletes might use it for anabolic properties
ALBERTO CONTADOR
• winner of the 2010 tour de France POTENTIAL SIDE EFFECTS
• Positive for Clenbuterol
• Transient tachycardia
• He raised it to the Court of Arbitration of Sports If stimulated can increase heart rate
• He claims that it was food contaminant • Hyperthermia
• Upon further investigation CAS upheld the positive Increase in body temperature
result sent by WADA and all the sporting communities • Tremors
• CAS: Stripped Tour de France medal, suspended until Sympathetic stimulation
2012, team contract annulled • Dizziness
Increase of sympathetic stimulation to the central
INSULIN nervous system
• A popular drug in the medical field and use for • Palpitations
diabetes. Manifestations to the increase of heart rate
Irregularity on your heartbeat
WHAT IS THE ROLE OF INSULIN IN DIABETES? • Malaise
• When we take in food, it is absorbed by glucose in the Body feeling very tired
blood but once in the blood - we need to transport that • Headache
glucose into the cells. But sometimes because of Because of the vasodilation.
deficiency of insulin, there is nothing to facilitate the Vascular dilation when the blood vessels in the
entry of glucose into the cell to use glucose. Hence, brain dilate.
we need to inject these patients with insulin.
• Facilitates entry of glucose into the cell BETA-ANTAGONIST
For utilization • They will do the reverse
• Stimulates liver to store glucose to glycogen • Decrease heart rate and blood pressure
• Stimulates uptake of amino acids {anabolic} • If you inhibit the Beta II receptors in the lungs, there is
This is the reason why wada prohibited this bronchoconstriction
because of anabolic properties.
• For asthmatic patients, we give beta-agonists to
Athlete who has diabetes needs TUE
promote bronchodilation
• WADA: prohibited at all times - get a TUE • For hypertensive patients and patients with irregular
heartbeat (arrhythmia), we give beta-antagonists.
BETA-AGONISTS AND BETA-ANTAGONISTS
ASTHMA
PHYSIOLOGY • Common condition that some athletes may have but
• There are beta-receptors in our body. can still participate in sports provided that they have
anti-asthma medications.

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 DRUGS IN SPORTS (Second Shifting Period) | Growth Hormones, Betablockers and Diuretics

COMMON ANTI-ASTHMA MEDICATIONS NEBULIZER

• Allowed but with exceptions within specified limits
• Salbutamol
Contains 100mcg
All of these are allowed in sports provided there is
maximum of 1600mcg over 24 hours in divide
doses not to exceed 800 mcg over 12 hrs starting
from any dose: 16 puffs/24 hrs or 8 puffs/12hrs
• Salmeterol
Contains 25mcg
Max. 200mcg over 24 hrs: 8 puffs • This is a nebulizer. It’s different from the inhaled,
• Symbicort pressurized canister.
Contains 80mcg of bronchodilator
Max. 54mcg over 24 hrs: 12 puffs
• If you are within those limits, you will not test positive
for these beta agonists
• For those who are not aware of these medications:

• This is where we put the liquid Ventolin

1. Shake it since the drug is in the high pressure

canister
2. Inhale the drug which is a bronchodilator as a
treatment for asthma
There is another bronchodilator which is the same
ventolin (salbutamol) but instead of an inhaler,
there is an inhalation nebulizer
If you are nebulizing with ventolin, maximum of
1600mcg (1.6mg) over 24 hrs in divided doses not
to exceed 800mcg over 12 hrs starting from any
dose (since this is high, a TUE is needed)
THE QUESTION IS, IF THE ATHLETE IS TAKING
SALBUTAMOL (VENTOLIN INHALER), DOES HE NEED
TO GET IT (TUE)?
• No it’s exempted.
• Because if you are within this (ventolin) dose (16
puffs/24hrs or 8 puffs/12 hrs) it is allowed
• BUT if you are using ventolin as a nebulizer, you need
to get a TUE
• There’s a machine that converts the liquid Ventolin into
very tiny droplets of the drug, carried by the air, and it
is sent to the lungs, and the patient is asked to inhale
the drug.
BETA-BLOCKERS
1. Decrease Blood Pressure and Heart Rate
2. Angina Pectoris
3. Cardiac Arrhythmias
DECREASE BLOOD PRESSURE AND HEART RATE
• We give beta-blockers to patients who are
hypertensive, those who have very fast heart rates,
and those who have arrhythmias (irregularities in heart
rates)
• That is the medical indication — to decrease BP and
decrease heart rate
ANGINA PECTORIS
• We also give beta-blockers to patients with angina
pectoris (chest pain secondary to a myocardial
infarction/heart attack)
• Why do we need to give this to patients with angina?
It decreases BP and decreases heart rate
When you have a high heart rate, there is a high
oxygen demand for the heart
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 DRUGS IN SPORTS (Second Shifting Period) | Growth Hormones, Betablockers and Diuretics
▪ And a patient who has suffered from a heart
attack has a limited cardiac reserve. So, you
need to slow down the heart, so that the heart
will not be demanding a lot of oxygen. We
need to decrease the heart rate of these
patients.
CARDIAC ARRHYTHMIAS
• Severe tachycardia, severe arrhythmias, premature
ventricular contractions, atrial fibrillations. All of these
may warrant the use of a beta-blocker to control the
heart rate. That is the medical indication.
ERGOGENIC EFFECTS OF BETA-BLOCKERS
• They can improve performance.
HOW CAN THEY IMPROVE PERFORMANCE?
• Reduce Anxiety and Tremors
You are calm. Your heart rate is down. You are
able to perform better.
And you remove the tremors in your hands. There
are sporting events wherein tremors in the hands
may not be beneficial. So, they want to reduce
those tremors.
In fact, beta-blockers are often used by stage
performers before they go up the stage to reduce
anxiety, to reduce stage fright. So, some of these
stage performers take beta-blockers.
There is really an ergogenic role in beta-blockers.
ERGOLYTIC EFFECTS OF BETA-BLOCKERS
• There is also an ergolytic (impair functions) effect
secondary to beta-blockers.
IMPAIRS CARDIOVASCULAR RESPONSE
• Impairs cardiovascular response to exercise by
reducing oxygen delivery to exercising muscles
• Because you have limited cardiac output. Therefore,
you limit the amount of blood that is pumping to your
exercising muscles, you are reducing the oxygen
delivery to those exercising muscles.
Beta-blockers have a DUAL ROLE. They can be
ergogenic, and it can be ergolytic at times.
SIDE EFFECTS OF BETA BLOCKERS
1. Bronchospasm
Since we have beta-2 in the heart, if that is
blocked, we will have this side effect
In patients, clients, and/or athletes who have
asthma, giving beta-blockers can insight an
asmathic attack because beta-2 is blocked in the
lungs
2. Lightheadedness
3. Increased Fatigue
4. Hypoglycemia
PROHIBITED
• Beta-blockers are prohibited in-competition only in the
following sports:
Archery (WA)
▪ A precision sport, you are not able to precisely
and accurately hit your target if you are
trembling or anxious
▪ You might need something to calm you down,
lower heart rate
▪ There is a role of beta-blockers
Automobile (FIA)
Billiards (all disciplines - WCBS)
Darts (WDF)
Golf (IGF)
Shooting (ISSF, IPC)
Skiing/Snowboarding (FIS) in ski jumping,
freestyle aerials/halfpipe and snowboard
halfpipe/big air
Underwater sports (CMAS) in constant-weight
apnoea with or without fins, dynamic apnoea with
and without fins, free immersion apnoea, jump
blue apnoea, spearfishing, static apnoea, target
shooting and variable weight apnoea
• Prohibited out-of-competition
Archery (WA)
Shooting (ISSF, IPC)
• All of the federations mentioned above went to WADA
and they saw that there is a role that Beta-Blockers,
using this is unfair
DIURETICS
• Drugs that can decrease fluid volume in the body
WHEN DO WE USE DIURETICS IN THE MEDICAL
FIELD?
1. To decrease the fluid volume in patients
Congestive heart failure
Too much fluid in the heart and the heart cannot
pump very well
Blood goes back to the lungs because the heart
cannot pump it out. Therefore, lungs are drowning
in fluid
2. Patients who are not able to pump out or
circulate their blood volume very well
They are very edematous in the lower extremities
Indication that patients have to be diuresed
MISUSE IN SPORTS
• Weight reduction
Especially for sports who have weight
classifications
Ex. Boxing (heavyweight, welterweight, flyweight)
You might need to be able to get into that exact
weight category, so when they weigh in and they
see or feel that they are beyond the weight
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 DRUGS IN SPORTS (Second Shifting Period) | Growth Hormones, Betablockers and Diuretics

category, they misused diuretics to decrease body They include caffeine when they test athletes
weight If you test positive, you won’t be sanctioned and
They use this as weight reduction to fit in the it’s not an adverse analytical finding
events that require weight categories But, WADA is looking at the behavior of the
• Reduce drug urine concentration athletes
Athletes take diuretics, after that you will urinate a ▪ How come majority sobra magkape?
lot removing all your fluids ▪ They’re taking 20 cups of coffee, is there
There is a chance that the drug urine something to it?
concentration that will be left has been urinated So it’s in the monitored list but not in the prohibited
already list
Although, it’s now being tested and researched by
EXAMPLE OF DIURETICS WADA so who knows, maybe next year it
becomes prohibited
• Medically indicated usually for cardiac patients
• WADA changes its list every year as athletes
• Same drigs which athletes may use to try to decrease
sometimes come up with new substances they find
fluid volume in the body
effective
• Hydrochlorothiazide (Combinar, Hyzaar, Micardis WADA tries to catch up and be at par or one step
Plus), Furosemide (Lasix) higher than athletes
• Testing are being improved and making it more
WADA sensitive
• At all times, diuretics and other masking agents are You’ll see this year if it’s .005, it’s positive
prohibited as are other substances with similar Next year it’s .004 and it’s already positive
chemical structure or similar biologic effect/s
• A masking agent is something that will cover
something up or cover your positive result
How? By diluting your urine
Urinated all the drugs because of diuretics
• You cannot get away with WADA, even if FDA days it’s
not a diuretic, but WADA says it has a similar structure
and biologic effects, it is still prohibited
• The detection in an athlete’s sample at all times or in-
competition, as applicable, of any quantity of the
following substances subject to threshold limits;
formoterol, salbutamol, cathine, ephedrine, methyl
ephedrine, and pseudoephedrine, in conjunction
with a diuretic or a masking agent, will be
considered an ADVERSE ANALYTICAL FINDING
• You used the diuretic to cover up a high dose of anti-
asthma drug → anabolic property
WADA says, you can use it, but if you tested
p[positive with a diuretic together with anti-asthma
drug it is considered as an adverse analytical
finding UNLESS the athlete has an approved TUE
for that substance in addition to the one granted
for the diuretic or masking agent
• You cannot get away with WADA you have to have
TUE for both if you must use both

POST LECTURE DISCUSSION

TEA AND COFFEE HAVE DIURETIC EFFECTS SO

WHAT ABOUT ATHLETES WHO USE IT?
• Coffee and Tea have diuretic properties and they
contain caffeine
• Under WADA, caffeine is in the monitored substances
They’re monitoring these substances for possible
misuse among athletes
• What does WADA do?
3SPS | Batch 2023 6
 DRUGS IN SPORTS
Dietary Supplements
OUTLINE
I. Dietary Supplements
II. Prevalence of Supplements Among Athletes
III. Top 3 Most Commonly Used Dietary Supplements
1. Vitamins
2. Creatine
3. Protein
IV. SENSE
1. S- search for evidence
2. E- ethical considerations
3. N- nutritional assessment
4. S- side effects
5. E- examine the needs
V. Example of Supplements
1. Blackstone Dust Extreme
2. Cellucor C4
VI. Post Lecture Discussion
DIETARY SUPPLEMENTS
• a product used in conjunction with a healthy diet and
contains any of the following:
A vitamin
A mineral
An herb or other botanical
An amino acid
A dietary substance for use by man to supplement
the diet by increasing the total dietary intake
A concentrate, metabolite, constituent, extract, or
combination of any ingredient
• That definition comes from the USA dietary
supplement health and education act of 1994, adapted
by the US FDA, adapted by the Philippine FDA
• Dietary supplements can come in any of those
following products or constituents.
• Define them and separate them from food, food is
something that when taken alone can sustain life,
but for dietary supplements it cannot sustain life
alone. They are meant to supplement only your diet,
whatever is lacking in your diet they can be
supplemented by these products.
• International Olympic committee (IOC) consensus
statement: dietary supplements and the high-
performance athlete, 2018 stated
• Dietary supplements: It can be a food, food
component, nutrient or non-food compound that is
purposefully ingested in addition to the habitually
consumed diet with the aim of achieving a specific
health and/or performance benefit.
• We have no problems with the health benefits but
perhaps the reason why we are discussing this is
because it might affect performance. We know with
WADA if it is performance enhancing then you have an
unfair advantage towards the other athletes then the
problem comes in.
• FDA in the Philippines, all food supplements need to
be registered with the FDA - term is registration.
Unlike with drugs, they need to be registered and
approved by the FDA. Drugs have a different process
when applying in FDA. For drugs to come out in the
market they undergo several steps, several stages of
testing so there is a phase 1,2,3,4 for testing drugs. All
of these are very rigid; they take several years to test
one single drug before it finally comes out in the
market. Even the vaccines we used during the
pandemic they are on phase 3 when they released
them to the population. FDA had to issue a special
permit for an emergency use for vaccines because
they were up to phase 3 only but it is acceptable
because it is a pandemic. Actually, all drugs and
vaccines have to undergo up to phase 4 testing. Now
for food supplements they do not go undergo those 4
steps that we are discussing because of this FDA just
wants them to register and they will look into
manufacturing conditions how you manufacture it. You
have to submit the components of what it is made up
of, what is the major component of the food
supplement and also you will have to also consider the
manufacturing practices of that laboratory - good
laboratory practices, manufacturing practices of that
laboratory and FDA will approve and act on it as a
registered substance. Since food supplements did not
undergo the rigid training/testing which drugs
underwent, FDA will require that you put a tagline
which states that there are no approved therapeutic
claims - requirement for FDA for food supplements.
• Thousands of food supplements are out in the market
and everyday there are new supplements that the FDA
cannot monitor all the time.
FDA just requires that the manufacturer company
to just register it and submit all the necessary
requirements.
For food supplements: it must be FDA registered
If there is an adverse finding/effect secondary to
these food supplements, then a person can file a
complaint and the FDA will conduct an
investigation that can eventually pull that product
out of the market.
PREVALENCE OF SUPPLEMENTS AMONG
ATHLETES
STUDY: PREVALENCE OF DIETARY SUPPLEMENT
USE BY ATHLETES: SYSTEMATIC REVIEW AND
META-ANALYSIS
• Lack of homogeneity among studies
The studies are not all similar in the methods
▪ Some conducted interviews, focus group
discussions, questionnaires, conducting them
by sports, conducting them by elite and non-
elites
• By sport - high variability
No sport, it was well distributed.
• Supplement type - high variability
Vitamins, minerals, proteins
Athletes were all into them
• Elite > non-elite
Elite athletes were more into supplements than
non-elite athletes
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 DRUGS IN SPORTS (Second Shifting Period) | Dietary Supplements

• Men vs women - similar except for: Time frames for reporting prevalence were not the
Women - iron supplements same, this can pose as a problem when we report
▪ Because of the heavy menstrual period prevalence
▪ They do not want to drop their hemoglobin • Varied research methodologies
levels and RBC count because it is necessary Some were interviewed, some answered
for oxygen transport questionnaires
▪ Hence, that is why they are more into iron Limitation of studies in prevalence
supplements We have to be careful when interpreting
▪ They also use it to prevent and treat anemia prevalence
secondary to blood loss during menstruation The longer the monitoring period the better
o Men - Protein, Creatine, Vitamin E The more participants the better
The more defined the objectives the better
STUDY: ATHLETES AND SUPPLEMENTS: The more direct identifying which exact
PREVALENCE AND PERSPECTIVES supplements you are looking into the better
• Prevalence
40% of US adult population in USA (1988-1994) TOP 3 MOST COMMONLY USED DIETARY
68% of US adult population (CRN, 2015) SUPPLEMENTS
71% of US adult population (CRN, 2016) 1. Vitamins
Therefore, it was getting more prevalent as the 2. Creatine
years go by 3. Protein
• They looked into 10,274 athletes
46% among college athletes were into VITAMINS
supplements • Vitamin B1 (Thiamine)
59% among elite athletes were into supplements Breakdown carbohydrates and protein for energy
▪ Prevalence and sex • Vitamin B2 (Riboflavin)
They looked into 32 track and field athletes Energy production, RBC formation
▪ 62% used supplements
▪ 75% of women were into it while 65% of men
• Niacin
Supports aerobic and anaerobic performance
were into it
They looked into bodybuilders • Vitamin B6
▪ There are 250 males and 250 females Energy production, increasing hemoglobin
▪ 87% of males were into it while 11% of females • Vitamin B12
were into it RBC formation
According to Wiens (2004), there is no difference • Vitamin C
in terms of prevalence and sex Antioxidant, protection from infection and damage
Males are into protein and ergogenic supplements to cells, helps produce collagen, keeps capillaries
Females are into vitamins and minerals firm
• Prevalence and Age It enhances cellular performance
Prevalence, type of supplement, number of
• Vitamin D
supplements increased with increasing age and
Calcium absorption, promote bone health
training hours
▪ The older the population, the more reliance on • Vit. E (Tocopherol)
supplements An antioxidant
• Vit. A
CHALLENGES WHEN REPORTING PREVALENCE Protects epithelial cells and good for the eyes
• Different definitions of dietary supplements (vision)
Some athletes would not consider it as • Co-enzyme Q10
supplements Also an antioxidant
Some athletes would consider it as part of their
regular meal and not as a supplement STUDIES
• Diverse characteristics of respondents
Males vs females • 2 very strong studies found out that a reduction in
Elite vs non-elites physical performance is observed in chronic vitamin
Age deficiencies
Number of training hours Bates,C.J. Powers, and D.I. Thurnham. Vitamins,
• No uniform time frames Iron and Physical Work. Lancet 2:313-314.1989
For example: when did the study happen, did you
only measure it for one month, two month or years
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 DRUGS IN SPORTS (Second Shifting Period) | Dietary Supplements
Brouns,F., and W. Sars. How Vitamins Affect
Performance. J Sports Med. Phys. Fitness
29:400-403.1989
• It is true that if you have a chronic vitamin deficiency,
your physical performance will be affected
WHAT ARE THE COMMON FORMS OF CHRONIC
VITAMIN DEFICIENCIES?
• Malnutrition is the most common one. For example, if
you are not much into fruits and vegetables, then you
might have chronic vitamin deficiencies. In children,
who are really malnourished, they have chronic
vitamin deficiencies.
• Diseases can also cause chronic vitamin deficiencies
and can reduce your physical performance. If you have
a vitamin deficiency, your physical performance will be
affected negatively.
• There are other sets of studies that say greater than
normal intake of vitamins does not enhance
performance.
Walter, P. Supraphysiological dosages of vitamins
and their implications in man. Experientia 47:178-
181.1991
Williams, M.H. Vitamin supplementation and
athletic performance. Beihft Int. Z. Vitamin Ern
Arhungsforshung 30:163-191.1989
• Some of us have the tendency to overdo it
[drinking vitamins].
For example, they know that these vitamins help a
particular performance. For instance, if it
enhances your strength or endurance, they will
take more than the recommended [amount].
• But these studies have shown that greater than normal
intake of vitamins will not enhance your performance.
Too much is also not good because it will not
enhance your performance.
WHY IS IT NOT GOOD?
• Because if you take them over 300% of your RDA, we
will get the following:
RDA 300% RDA
Vit A 0.8-1 Fatigue, Irritability,
mg Gastrointestinal upset (diarrhea),
Liver Toxicity, Joint Pain
Vit C 60 Gastrointestinal upset (acidity),
mg Kidney stones
Vit E 8-10 Gastrointestinal upset (nausea,
mg vomiting, and diarrhea),
Fatigue, Weakness, Lipid
Abnormalities, Bleeding
Coenzyme - 100 mg/day can already cause
Q0 Epigastric pain, Nausea, Diarrhea
Vit D 400 10 x RDA: Excessive calcium
iu deposits in the kidney (it can
lead to kidney stones), Weight
Loss
all of these are secondary to too
much vitamin D
Vit B6 2 mg More than 600 mg/day can cause
loss of sensation in peripheral
nerves
Vit B6 enhances neural
performance, they are prescribed
for patients who have neural
abnormalities. But too much of it
can cause a loss of sensation in
your peripheral nerves
• The National Research Council, Subcommittee on the
Tenth Edition of RDAs concluded that vitamins are
important in disease prevention… but there is no basis
for their use as performance enhances in an athlete is
not vitamin deficient
We recognize the role of vitamins in prevention of
disease. BUT if you want to improve your
performance and you are not vitamin deficient, you
are just wasting your money on these vitamins
• VITAMINS
Essential for normal cellular function
BUT readily available in the diet
▪ Just encourage your athletes, instead of
spending a lot of money on these vitamins,
they could just have a well-balanced diet.
▪ If their diet is not sufficient and lacks certain
types of vitamins, then there is an indication
High doses of vitamins can have harmful side
effects
PROTEINS
• Dietary protein for athletes: From requirements to
optimum adaptation
Stuart M. Phillips & Luc. J.C. Van Loon (2011),
Journal of Sports Sciences, 29sup1, S29-S38,
DOI
Protein consumption can enhance rates of MPS
and possibly lower rates of MPB, thus improving
muscle NPB. The improvement in NPB appears to
accumulate to promote greater protein retention in
the case of resistance exercise and may enhance
training-induced adaptations with endurance
training, although the latter has yet to be tested
The improvement in NPB when using protein is
more for resistance exercises
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 DRUGS IN SPORTS (Second Shifting Period) | Dietary Supplements
With endurance training, studies are still being
done
▪ MPS = muscle protein synthesis
▪ MPB = muscle protein breakdown
▪ NPB = net protein balance
A dose of protein that appears to maximally
stimulate MPS appears to be in the range of 20-
25g, although this estimate may be lower for
lighter athletes (i.e. <85gkg)
Ex. For athletes lower than 85kg, you might have
to go lower than 20-25g
To optimize the ratio of fat-to-lean tissue mass loss
during hypoenergetic periods, athletes are
advised to ensure that they lower their
carbohydrate intake to 40% of their energy intake
(with an emphasis on the consumption of lower GI
carbohydrates), which usually means no more that
3-4 g/kg/day and increase their protein intake to
20-30% of their energy intake or 1.8-2.7g/kg
▪ This just means you will need to decrease your
carbohydrate intake and increase your protein
intake as a compensation
The optimum timing for protein ingestion to
promote the most favorable recovery and
adaptation is after exercise. While data do not yet
exist to define exactly how long a theoretical
“window of anabolic opportunity” exists, it is safest
to state that athletes who are interested in
performance need to consume protein as soon as
possible after exercise
An economical, practical, and efficacious
beverage for athletes to consume after exercise is
milk, particularly flavored milk that contains added
simple sugar
▪ Milk will still be the most complete food as they
say and is the one that’s recommended
because a lot of protein products on the
market are not pure, so often times they
contain something else that may be
detrimental to the health of the athlete that
may cause a positive result when doping tests
come in
CREATINE
• Nitrogenous organic compound
• Synthesized naturally in the body
• Found in meat and fish
• Stored in skeletal muscle, brain heart and testes
• Energy source during exercise
DOES ORAL CREATINE SUPPLEMENTATION
IMPROVE STRENGTH? A META-ANALYSIS
• Dempsey RL, Mazzone MF, Meurer LN. J Fam Pract.
2002 Nov;51(11):945-51
• Gathered 16 articles on oral creatine supplementation
• Oral creatine supplementation with resistance training
increases maximal weight lifted in young men
• There is no evidence for improved for improved
performance in older individuals or women or for other
types of strength and power exercises
• The safety of creatine remains unproven. Therefore,
until these issues are addressed, its use cannot be
universally recommended
CREATINE SUPPLEMENTATION WITH SPECIFIC VIEW
TO EXERCISE/SPORTS PERFORMANCE: AN UPDATE
• Cooper R, Naciero F, Allgrove J, Jimenez A. J Int Soc
Sports Nutr. 2012;9(1):33. Published 2012 Jul 20. Doi:
10.1186/1550-2873-9-33
• Regardless of the form, supplementation with creatine
has regularly shown to increase strength, fat free
mass, and muscle morphology with concurrent heavy
resistance training more than resistance training
alone.
Heavy resistance training + Creatine = increase fat
free mass, strength, and muscle morphology
• Creatine may be of benefit in other modes of exercise
such as high-intensity sprints or endurance training.
However, it appears that the effects of creatine
diminish as the length of time spent exercising
increases.
There is a limit on how much you can use creatine
when you are comparing it with the length of time
of exercising
Does not mean that the longer you go in terms of
exercising, the better
• More recent research suggests that creatine
supplementation in amounts of 0.1g/kg of body weight
combined with resistance training improves training
adaptations at a cellular level and subcellular level
Improvement in the resistance training
• Finally, although presently ingesting creatine as an
oral supplement is considered safe and ethical, the
perception of safety cannot be guaranteed, especially
when administered for long period of time to different
populations (athletes, sedentary, patient, active,
young or elderly)
Look at the studies
If the study focuses more on marathoners or
swimmers, just focus on those athletes, you
cannot apply these to other athletes because they
may respond differently
SENSE
S- search for evidence
E- ethical considerations
N- nutritional assessment
S- side effects
E- examine the needs
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 DRUGS IN SPORTS (Second Shifting Period) | Dietary Supplements
S - SEARCH FOR EVIDENCE
• Meta Analyses
Highest level of evidence
Gather several studies and would try combine the
results and if they are homogenous, they can do
meta-analysis or statistical analysis
If it is not possible, systematic review is used
Combination of knowledge from several articles
• Randomized Controlled Trials
Test actual substance or drugs into two groups
Control group and experimental group
• Cohort Studies
• Case-Control Studies
• Case-Series or Case-Reports
• Editorials and Expert Opinion
Lowest level of evidence
E - ETHICAL CONSIDERATIONS
• Professional Qualifications
Of those people who may be encouraging,
advertising, & recommending
Look into licensed nutritionists, sports scientists,
before you believe in everything they are saying
• Conflicts of Interests
Sometimes, if an individual is being paid by a
pharmaceutical company or a company that is
manufacturing a certain substance, then there is a
potential conflict of interest & that person may lean
towards promoting the product even if it is of
substandard quality or if it promotes danger to the
individual
• Ethics in Sports
Remember, we said that any substance that can
promote unfair advantage over the others is
unethical
So, if it promotes ergogenic properties, meaning,
it enhances an athlete’s performance over and
above his baseline, then that is unethical
We treat athletes with vitamins only to bring them
to their normal baseline performance, not to make
them achieve more than what they can really be
capable of doing
So, the ethics in sports is an important
consideration
N - NUTRITIONAL ASSESSMENT
• Individualize Needs
There are individual needs for each individual
athlete
Not all athletes are the same, some would be into
a very good diet, wherein they have a balanced
diet, and they would be loving eating fruits and
vegetables and meat
But others would not really be into fruits and
vegetables
Hence, you should individualize the needs of your
athletes
Do not make a standard, one program for your
athletes
There is an individual need when assessing your
athletes in terms of nutritional assessment
• Medical Concerns
Be very careful in athletes with medical conditions
and are into some treatments, medicines, for their
medical conditions
Drug interaction can be fatal, so you always have
to ask athletes whether they have a medical
condition or if they have medication that they have
been taking
And of course, ask or coordinate with their doctor
whenever you need to perform a nutritional
assessment
• Re-Assessment
You need to re-assess regularly, not because you
provided the program then that’s it for the rest of
their life. You really have to re-assess on a regular
basis
S - SIDE EFFECTS
• Dosing
Not all supplements that are out in the market
contain exact amount of that particular food
supplement or drug for that matter
Look very carefully into it
• Duration
How long do you intend to give your athletes those
dietary supplements? Will it be forever or a short
period of time while recuperating from a disease?
You should have specific plans for that
• Polypharmacy
Make sure you know what your athlete is into as
well
What are the other drugs he has been prescribed
with by his doctor or is he into other food
supplements?
Polypharmacy & drug-drug interaction can be
dangerous
You don’t want to get into that trouble of these side
effects of polypharmacy
3SPS | Batch 2023 5
 DRUGS IN SPORTS (Second Shifting Period) | Dietary Supplements
E - EXAMINE THE NEED
• Age/Maturation/Experience Sufficient to Warrant
Use?
What is the age of your athlete?
Is he mature enough to be into supplements?
Is the experience sufficient to warrant use?
Be careful because you don't want to get into
trouble with minors & with athletes who have drug
dependency or those who are not mature enough
to be into supplements
• Relevant Training Variables Included?
Will it be subjecting the athlete to endurance
training?
If you are into a supplement, what will be the role
of resistance training, endurance, training, etc?
• What are the Athlete’s Performance Goals?
What does your athlete want from all these
supplements?
You have this discuss that well with your athletes
WADA provided us with this decision-making figure on how
to decide whether we will give our athletes supplement or
not
• Has the rationale for use been evaluated?
Performance level and goals, age, medical
indications.
We look into the evidence of that supplement as to
performance and how it will affect the athlete
You also look into the performance level, what
does the athlete want to do, is he a collegiate or
professional athlete, age group, medical
indications
If the answer is NO → Don’t use it
If the answer is YES → Proceed to next question
• Does it work? Is it evidence-based and supported
by science? Are there protocols for specific events
with timing amount and frequency?
Example of a protocol: For elite athletes, this is the
dose, timing, how often you give it, amount you
take
If the answer is NO → Don’t use it
If the answer is YES → Proceed to next question
• Is it safe? Has there been an evaluation of acute
and long-term use and potential side effects?
Possible interference with other supplements,
medicines, or foods?
We must look into it like simple gastrointestinal
problems, you will get epigastric pain, diarrhea,
nausea, and vomiting
Will it also affect me if I have a medical condition?
What are the potential side effects knowing that
the athletic is asthmatic diabetic?
Possible effects with other supplements,
medicines, or foods
If the answer is NO → Don’t use it
If the answer is YES → Proceed to next question
• Is it permitted? Is it classified as a low-risk
supplement? Is it laboratory-tested for banned
substances according to the WADA list?
If the answer is NO → Don’t use it
If the answer is YES → You may use it
EXAMPLES OF SUPPLEMENTS
1. Blackstone Dust Extreme
2. Cellucor C4
BLACKSTONE DUST EXTREME
• It is marketed locally and is available in the black
market
• It has a stimulants (Dimethylaminoethanol and 1, 3
DMAA (Dimethylamylamine)) and Beta 2 Agonist
(Higenamine) which are prohibited by WADA
• The one Kiefer Ravena had in which he tested positive
for a bad substance leading to his suspension by FIBA
CELLUCOR C4
• Does not contain any prohibited substances
• Not a promotion but still we need to look closely as
sometimes they reformulate it or add something there
that wasn't there before
• The classification of the ingredients has to be looked
into very well
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 DRUGS IN SPORTS (Second Shifting Period) | Dietary Supplements
• Today, this is how it looks but always check very well
once you get hold of this for out athletes
POST LECTURE DISCUSSION
Yung sinabi kanina na wala masyadong studies about
sa doses pero meron na bang kahit 1 study na sinabi
na eto yung dose na masasabing overdose na and if
ever po meron na bang side effects if ever na
maraming creatine?
• Doc Lea: Right now, I have yet to see one but there
may be single studies, but again, we want to look at
the highest level of evidence.
• Usually, I do not believe 1 single study alone unless it
is a randomized controlled study
RANDOMIZED CONTROLLED STUDY
• This study would tell us that we have 2 groups - 1 was
given creatine and the other was not given
• And then they will look into the effects
• For the effectiveness study you look into randomized
controlled trials
DOSE FINDING STUDY
• For dose finding, it is another study altogether so you
go into a study that would compare groups
For example: Group A has 10 mg, Group B has 5
mg, Group C has 2 mg
• Side effects will also go in this study
For example: With 10 mg, they find out that there
was was nausea and vomiting while in 5 mg,
there's none but maybe a little heartburn or
epigastric pain
• Those are the types of studies you want to look at
JOURNAL ARTICLES IN THE INTERNET
• Randomly, you can go to the net and find some but be
careful in interpreting ang believing journal articles that
say they are effective
• If you find a journal, look into the methodology
• What are the objectives and did the methods
addressed the objectives of the study
• If they just interviewed 10 athletes, I wouldn't believe
that journal when what I'm looking for is its
effectiveness
• 10 athletes do not answer the question on
effectiveness or efficacy
• For dose finding, if they tested on 10 - 20 athletes I still
don't want to believe that journal as those are low
levels of evidences
• We don’t have to discredit these articles as they can
be jumpstart for future studies
• Maybe the method is perfect already but they just need
to invite more research participants so the population
gets bigger which will strengthen the results and make
it more valid and accurate
• Remember that not everything that's published is real
or can be believable
If you published a case series and you have 3
athletes in UST taking creatine and found out it’s
effective at a certain dose, 3 athletes is not
generalizable to the rest of the population
Hence, it can’t be applied to all athletes
• Emphasize on the level of evidence
• Doc is always on the lookout for systematic reviews
and meta analysis
• For meta analysis, it takes a while for it to come out
because if within the year, there’s no published article
or study about creatine, then they can’t do the meta
analysis
FOOD AND DRUGS ADMINISTRATION (FDA)
• Everything goes through FDA
Food, drugs, supplements, makeup, facial & body
products
• With FDA, it’s different when they deal with drugs vs
supplements
• For drugs, we want them to be FDA Approved
• For supplements, no need to be approved but should
be FDA Registered as the minimum requirement
• The other requirement for supplements is to inform
FDA about the components and ingredients as well as
studies that can support their claims
For example: If you were able to come up with a
new substance that can enhance performance
and it’s a food supplement, first is to register under
FDA to make it more legitimate and then FDA will
ask the contents
They will also ask where you manufacture it, they
will check on your laboratory (so have good
laboratory practices), look into your credentials
and then they will allow you to register it
• After registering it, you always have to put the tagline
“No approved therapeutic claims”
it means it’s not approved by FDA or whatever
they're claiming because it didn’t undergo the
clinical trials (Phase I-IV)
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 DRUGS IN SPORTS (Second Shifting Period) | Dietary Supplements
• In Tagalog “Mahalaganag Paalala: Ang (Name of
Product) ay hindi gamot at hindi dapat gamiting
panggamot sa anumang uri ng sakit.”
• Sometimes it flashes quickly in TV but it is required by
FDA for all food supplements
• If there’s a food supplement in the market and a group
of people complain suddenly that there's death,
hospitalization, and adverse effects because of that
then they can go to FDA and file a complaint
• FDA will then do an investigation and they can shut
down that lab and even file criminal charges to that
company and they will pull it out from the market
• Lambanog Issue few months before the pandemic
There were sudden hospitalization and even death
among people who were drinking it
It came out in the news so FDA stepped up and
pulled out all the lambanog products that those
people partook of
True enough, there was a high level of alcohol in
them and not the ethyl but the rubbing alcohol they
are using to disinfect
• Bangkok Pills were very popular back then as
slimming or diet pills
For the obese community, they were very into it
Became an issue in the medical community as
there were a lot of deaths mostly due to liver failure
Tru enough, they found very dangerous levels of a
particular substance in the pills - mostly it was
stimulants
Stimulants are ergogenic which mimic adrenaline
so you get hyper throughout the day so you’ll be
very slim
However, it can also affect the heart and liver so it
was pulled out from the market
• If you have complaints, you can always go to FDA
• Be careful with your supplements so always check if
it’s at least FDA Registered as well as with the
presence of the taglines
• Always explain to your athletes as there can be a lot of
evidence for use like protein
• Those products out in the market, there's no truth in
advertising as they say because sometimes, it
contains ingredient that they didn’t include in the list
and then when they did lab tests, they found other
things
• They can also be contaminated with something that’s
not listed so be careful if it’s bought in the black market
and not registered in FDA
VITAMINS
• Athletes love to take these
• Usually, we recommend these if they have flu or
trangkaso or they have no energy to eat so that may
be an implication for vitamin supplementation
• Since he doesn’t have craving for food, he might lack
the necessary vitamins so that can be an indication
• Doctors can prescribe vitamins especially when we
were kids, we have a lot of vitamins because we never
like to eat a well balanced diet so vitamins
supplementation was very important
• But now we're adults, we should be wiser enough to
know that there are natural sources of all of this
vitamins
• So we use it if there's a need to it like during or after a
disease to gain back the lost nutrients during the
disease process or maybe to supplement because the
patient doesn feel like eating yet then
• But for you to say that they should drink 2 bottles of Vit
C to improve strength is a no no
We know it doesn't work that way and there are
side effects when we overdose or go beyond the
recommended doses
If there's something interesting that comes out in the
market that’s a trend among athletes, inform us and we can
maybe discuss it and look for evidence. If there’s
something that's interesting, it will be well appreciated if we
share it in class.
PROTEIN SHAKES
• Use them wisely
• You always need to have a goal as to why you need
them
• Look for evidence that will tell you the timing and dose
• Do exercise with proteins and drink them immediately
after exercise, the window of opportunity to get the
maximum effects of your protein
• This was a trend in the past years and maybe even up
to now
• Be careful of this shakes like Kiefer’s in which he took
it after a training and unfortunately it had stimulants
• Even if you’re an athlete because we’re not just after
being tested positive and being reprimanded by
WADA, the next thing is its adverse effects if you take
too much of it
• After drinking protein, you need to drink water because
protein can damage your kidneys and liver
• Sometimes, athletes drink the shake and not drink
water the whole day
3SPS | Batch 2023 8