Joseph W. McNutt, M.D. Frisco Orthopedics and Sports Medicine.

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Joseph W. McNutt, M.D. Joseph W. McNutt, M.D. Frisco Orthopedics Frisco Orthopedics and and Sports Medicine Sports Medicine

Transcript of Joseph W. McNutt, M.D. Frisco Orthopedics and Sports Medicine.

Joseph W. McNutt, M.D.Joseph W. McNutt, M.D.Frisco OrthopedicsFrisco Orthopedics

and and Sports MedicineSports Medicine

Performance Enhancing Performance Enhancing DrugsDrugs

Performance EnhancingPerformance EnhancingDrugsDrugs

• Anabolic Steroids • Androstenedione• Human Growth Hormone• Beta–2 Agonists• Stimulants• Beta Blockers• Erythropoitin• Creatine• HMB

Anabolic SteroidsAnabolic Steroids

• 1995 poll – 198 Olympic level power athletes

• Given following scenario: you offered a banned substance with two guarantees

1. You will not be caught

2. By taking the substance you will win your event

• Only 3 said no

Anabolic SteroidsAnabolic Steroids

• Same poll, new scenario:

1. The substance will allow you to win every competition you enter over the next 5 years

2. However the substance will then kill you

• More than 50 % would still use the substance!

This is why performance This is why performance enhancing drugs remain in the enhancing drugs remain in the

spotlight of sportsspotlight of sports

Anabolic SteroidsAnabolic Steroids

• Class of steroid hormones related to the male hormone – testosterone

• Increase protein synthesis within cells which results in growth of muscle

• Also have androgenic properties which include the development and maintenance of males characteristics

• Have both medical and sport performance uses

Anabolic SteroidsAnabolic Steroids

• AS have been modified many times to maximize the anabolic effects and minimize the androgenic affects

• Alkylation of the 17-alpha position (oral)

• Esterfication of the 17-beta hydroxyl group (IM)

Anabolic SteroidsAnabolic Steroids

• All AS possess both anabolic and androgenic properties

• None are absolutely selective

• Testosterone anabolic:androgenic ratio: 1

• Nandrolone: 10

• Stanozolol: 30

• Anabolic effect dose dependent (300 mg per week required)

Anabolic SteroidsAnabolic SteroidsHistoryHistory

• 1931 – male hormone androstenone isolated

• 1934 – androstenone synthesized

• 1935 – testosterone identified and synthesized

• 1937 – clinical trials on humans with testosterone began

Anabolic SteroidsAnabolic SteroidsHistoryHistory

• WWII – German scientist synthesized other anabolic steroids and experimented on concentration camp inmates to treat chronic wasting

• Also given to German soldiers hoping to increase their aggression

• Adolf Hitler rumored to take anabolic steroids

Anabolic SteroidsAnabolic SteroidsHistoryHistory

• 1940s - Soviet Union and Eastern Bloc Countries (East Germany) established steroid programs in Olympic and amateur weight lifters

• 1958 – Dianabol (methandrostenolone) approved in U.S. by the FDA

Anabolic SteroidsAnabolic SteroidsHistoryHistory

• 1972 – study showed no difference in performance enhancement in participants compared to ones given placebo

• Remained unchallenged for 18 years• Poor study with inconsistent controls and

insignificant doses• 2001 – study showed clear increase in muscle

mass and decrease in fat associated with high doses of anabolic steroids

Anabolic SteroidsAnabolic SteroidsAnabolic EffectsAnabolic Effects

• Two different, but overlapping effects

• Anabolic – promote cell growth. Increased protein synthesis, appetite, bone remodeling and growth, and production of red blood cells

• Increase the size of muscle fibers (hypertrophy) leading to increase in muscle mass and strength

• Decrease the amount of fat in muscle

Anabolic SteroidsAnabolic SteroidsAndrogenic EffectsAndrogenic Effects

• Androgenic (virilizing) - development and maintenance of male characteristics:

• Increased growth of pubic, beard, chest and limb hair

• Enlargement of vocal cords

• Increased libido

• Enlargement of clitoris

• Suppression of natural sex hormones

Anabolic SteroidsAnabolic SteroidsAdverse EffectsAdverse Effects

• Most side effects are dose dependent

• Elevated blood pressure (most common)

• Increase LDL cholesterol and decrease HDL

• Increase risk of CV disease and coronary artery disease, arrhythmias, and heart attacks (chronic use)

Anabolic SteroidsAnabolic SteroidsAdverse EffectsAdverse Effects

• Accelerate the rate of premature baldness (male and female)

• Acne – stimulates the sebaceous glands

• Liver damage (cancer) – increased demand on liver as oral steroids are changed (increase bioavailability and stability)

Anabolic SteroidsAnabolic SteroidsAdverse EffectsAdverse Effects

• Tendon rupture has been linked to AS

• Stiffer and less elastic tendon

• No consistent AS –induced ultrastructural or biochemical alterations

• Probably tendon does not adapt as fast (weak link

Anabolic SteroidsAnabolic SteroidsGender Specific EffectsGender Specific Effects

• Gynecomastia – development of breast tissue in males

• Conversion of testosterone to estrogen by an aromatase enzyme

Anabolic SteroidsAnabolic SteroidsGender Specific EffectsGender Specific Effects

• Temporary infertility (decreased production of sperm)

• Testicular atrophy (caused by decrease levels in natural testosterone)

Anabolic SteroidsAnabolic SteroidsFemale-Specific EffectsFemale-Specific Effects

• Increase in body hair• Male-pattern baldness• Deepening of voice

(permanent)• Enlarged clitoris

(permanent)• Temporary decrease in in

menstrual cycle• Affect fetal development

during pregnancy

Anabolic SteroidsAnabolic SteroidsAdolescent EffectsAdolescent Effects

• Stunted growth – Premature growth plate shut down as a result of increased levels of estrogen

• Premature sexual development

• Anabolic steroid use in adolescence has been correlated with poorer attitudes related to health

Anabolic SteroidsAnabolic SteroidsAdverse EffectsAdverse Effects

• Risk of mortality among chronic AS users repoted to be 4.6 times higher than non-AS users

• Weekly doses of 600 mg ot testosterone or its equivalent for cycles lasting less than 12 weeks appear to cause few side effects during scientific studies

• Rule: bigger the dose, the bigger the muscle, the bigger the problem

Anabolic SteroidsAnabolic SteroidsBehavioral EffectsBehavioral Effects

• Controversial• Mood swings• Aggression (roid rage)• Mania• Depression• Withdrawal• Dependence

Anabolic SteroidsAnabolic SteroidsBiochemical MechanismsBiochemical Mechanisms

• Effect of AS on muscle mass is caused in at least two ways:

1. Increase the production of proteins

2. Reduce recovery time by blocking the effects of cortisol (promote the breakdown of muscles)

• AS affect the number of cells that develop into fat storage cells by favoring cellular differentiation into muscle cells

Anabolic SteroidsAnabolic SteroidsBiochemical MechanismsBiochemical Mechanisms

• Steroid hormones mainly interact with cells by binding to proteins called steroid receptors

• After binding, proteins move into the cell nucleus and can alter the expression of genes or activate processes in other parts of the cell

Anabolic SteroidsAnabolic SteroidsBiochemical MechanismsBiochemical Mechanisms

• Receptors involved with AS are called Androgen receptors

• Different types of AS bind with different affinities depending on their chemical structure

• This determines the characteristic effects of the AS (anabolic vs androgenic)

The human receptor bound to testosterone

Anabolic SteroidsAnabolic SteroidsMedical UsesMedical Uses

• Bone marrow stimulation – aplastic anemia

• Growth stimulation – use GH now

• Appetite stimulate – AIDS, cancer

• Induction of male puberty – extreme delay

• Reversible male contraceptive - future

• Hormone replacement therapy (men)

• Gender dysmorphia - psyciatric

Anabolic SteroidsAnabolic SteroidsNon-medical use and abuseNon-medical use and abuse

• Extremely difficult to determine what percentage of use in the population

• Usually middle class, heterosexual men with a median age of 25

• 2006 study – 78% noncompetitive bodybuilders and non-athletes (cosmetic)

• 13% reported unsafe injection practices (needle sharing)

Anabolic SteroidsAnabolic SteroidsNon-medical use and abuseNon-medical use and abuse

• Users often stereo-typed as uneducated or “muscle heads”

• 1998 study showed steroid users to be the most educated drug users out of all users of controlled substances

• Research their product more than any other group

Anabolic SteroidsAnabolic SteroidsAdministrationAdministration

• 3 common forms of AS administration:

• Oral – most convenient (dangerous - liver)

• Injectable – intramusclar not intravenous (HIV and Hepatitis)

• Transdermal – self adhesive skin patches

Anabolic SteroidsAnabolic SteroidsMethods of AdministrationMethods of Administration

• Athletes who take AS do so typically during the active Athletes who take AS do so typically during the active years of the careersyears of the careers

• They combine multiple steroid forms (oral and They combine multiple steroid forms (oral and injectable), a practice called injectable), a practice called “stacking”“stacking”

• The drug dosage is progressively increased The drug dosage is progressively increased (“pyramiding”) during a 4 to 18 week cycle, including a (“pyramiding”) during a 4 to 18 week cycle, including a drug-free period between drug regimens (4-6 weeks). drug-free period between drug regimens (4-6 weeks).

• The drug quantity far exceeds the recommended The drug quantity far exceeds the recommended medical dose (200X)medical dose (200X)

• The athlete then progressively reduces the drug dosage The athlete then progressively reduces the drug dosage in the months prior to competition (to avoid detection) in the months prior to competition (to avoid detection)

Anabolic SteroidsAnabolic SteroidsMethods of AdministrationMethods of Administration

• The cycling of steroids coincides with competitionThe cycling of steroids coincides with competition• Many athletes use the training model – “Periodization”Many athletes use the training model – “Periodization”• An athlete with a yearly training program (macrocycle) An athlete with a yearly training program (macrocycle)

subdivides the year into phases called mesocycles (3 subdivides the year into phases called mesocycles (3 months)months)

• As competition nears, training volume gradually As competition nears, training volume gradually decreases while training intensity increasesdecreases while training intensity increases

• Steroid use coincides with the mesocycles, with the goal Steroid use coincides with the mesocycles, with the goal of achieving maximum strength and size at competitionof achieving maximum strength and size at competition

Oral Anabolic SteroidsOral Anabolic Steroids

• 17-alpha methyl testosterone 17-alpha methyl testosterone (Android)(Android)

• 17-alpha ethyl testosterone 17-alpha ethyl testosterone (Maxibolin)(Maxibolin)

• 1-methyl testosterone 1-methyl testosterone (Primobolan)(Primobolan)

• Androstenediol (“Andro” food Androstenediol (“Andro” food supplements)supplements)

• AndrostenedioneAndrostenedione• Dihydroepiandrosterone Dihydroepiandrosterone

(DHEA)(DHEA)

Anabolic SteroidsAnabolic SteroidsPost Cycle TherapyPost Cycle Therapy

• “PCT” – takes place after each cycle to combat the natural testosterone suppression and restore proper function of numerous glands

• Typically consists of a combination of the following drugs:

1. Clomiphene or tamoxifen (Primary PCT drug)

2. Anastrozole – aromatase inhibitor

3. HCG – restore hormonal balance

Anabolic SteroidsAnabolic SteroidsPost Cycle TherapyPost Cycle Therapy

• Finasteride (Propecia) – reduces the conversion of testosterone to DHT (high rate of alopecia)

• The drug is useless in cases in which the steroid is not converted into a more androgenic derivative

Anabolic SteroidsAnabolic SteroidsLegal StatusLegal Status

• Varies from country to country• U.S. - Schedule III controlled substance

(requires prescription, possession without Rx. federal crime punishable up to 7 yrs)

• Canada – Schedule IV (obtaining or selling punishable for up to 18 mo., possession not punishable

• Also illegal without Rx. in Australia, Argentina, Brazil and Portugal

• Legal in Mexico and Thailand

Anabolic SteroidsAnabolic SteroidsU. S. Legislation on ASU. S. Legislation on AS

• Interest and debate after 1988 Summer Olympics in Seoul following controversy of Ben Johnson

• AS added to Schedule III of the Controlled Substances Act in the Anabolic Control Act of 1990

• Prohormones or “Designer Steroids” not included (Androstenedione)

Anabolic SteroidsAnabolic SteroidsProhormonesProhormones

• In 1994 , the Dietary Supplement Health and Education In 1994 , the Dietary Supplement Health and Education Act was signed into law.Act was signed into law.

• This act classified substances derived from natural This act classified substances derived from natural sources as food supplements and made many drugs sources as food supplements and made many drugs such as prohormones available over the counter.such as prohormones available over the counter.

• Thus these substances are not regulated under the Thus these substances are not regulated under the same rules and regulations by the FDA. (Loop hole)same rules and regulations by the FDA. (Loop hole)

• This can result in the dosages and actual quality of these This can result in the dosages and actual quality of these substances to be in question as they are sold to the substances to be in question as they are sold to the consumer consumer

• Amended in 2004 (Androstenedione)Amended in 2004 (Androstenedione)

Anabolic SteroidsAnabolic SteroidsStatus in SportsStatus in Sports

• AS are banned by all major sporting bodies:

1. IOC

2. NBA

3. NHL

4. NFL

5. MLB

6. NCAA

Anabolic SteroidsAnabolic SteroidsStatus in SportsStatus in Sports

• Testing in Texas high schools to start this year (UIL)

• Expensive

• Jurisprudence

• Normal T:ET ratio 1.3:1

• 1 in 1000 men ratio of 4:1

• Positive test result 6:1

Anabolic SteroidsAnabolic SteroidsStatus in SportsStatus in Sports

* For testosterone the definition of positive depends on an adverse analytical finding (positive result) based on any reliable analytical method (e.g., IRMS,GCMS, CIR) which shows that the testosterone is of exogenous origin, or if the ratio of the total concentration of testosterone to that of epitestosterone in the urine is greater than 6:1, unless there is evidence that this ratio is due to a physiological or pathological condition.

Anabolic SteroidsAnabolic SteroidsIllegal TradeIllegal Trade

• The majority of AS are obtained illegally through black market trade

• Usually manufactured in other countries and smuggled across borders

• Smuggling usually done in conjunction with other illegal drugs

• Organized crime is involved

Anabolic SteroidsAnabolic SteroidsCounterfeit DrugsCounterfeit Drugs

• Significant health hazard

• Computer and scanning technology as made it to copy labels

• Product could contain anything (vegetable oil to toxic substances)

• Users have died of injecting unknown substances in their body

• Products also diluted to maximize profits

Anabolic SteroidsAnabolic SteroidsProduction and DistributionProduction and Distribution

• AS are either manufactured by legitimate pharmaceutical companies or under ground laboratories

• In the 1990’s most U.S. producers stopped making and marketing AS

• Eastern Europe still produce AS in quantity (most medical grade AS sold illegally in North America)

• Many illegal AS are veterinary grade (produced and handled in cruder and less sterile fashion)

Anabolic SteroidsAnabolic SteroidsProduction and Distribution)Production and Distribution)

• AS can be obtained from several sources

• Sold at gyms and competitions

• Illegal drug dealers• Mail order

(magazines)• Internet (websites

posing as oversea pharmacies)

AndrostenedioneAndrostenedione

• Made famous by Mark McGuire during historic 1998 chase for single season record of home runs

• Immediate precursor to testosterone (prohormone)

• Marketed to raise testosterone levels

AndrostenedioneAndrostenedioneBasic ScienceBasic Science

• Concept of how “Andro” works is based on knowledge of the effectiveness of testosterone as an ergogenic aid

• Postulated that the higher the concentration of “andro” than the more that is converted to testosterone (debated)

• Majority of studies have shown no increase in testosterone levels

• Significant increase in estrogen levels (not marketed)

AndrostenedioneAndrostenedionePerformance StudiesPerformance Studies

• No studies have shown any significant increase in lean body mass or strength increase

• No significant improvement in athletic performance has been shown

AndrostenedioneAndrostenedioneSide EffectsSide Effects

• Similar to AS• Decrease HDL• Increase estrogen

levels (gynecomastia)

AndrostenedioneAndrostenedioneTesting and PolicyTesting and Policy

• Was availble over-the-counter until Anabolic Steroid Act amended in 2004

• Banned by IOC, NCAA, NBA, NFL, and MLB

• Currently listed as a Schedule III controled substance

Human Growth HormoneHuman Growth Hormone

• Produced in the anterior Produced in the anterior lobe of the pituitary glandlobe of the pituitary gland

• Can be made Can be made synthetically via synthetically via recombinant DNA recombinant DNA technologytechnology

• Accelerates linear growth Accelerates linear growth in the skeletally immature in the skeletally immature

• Increases body weight Increases body weight and muscle mass in both and muscle mass in both the mature and the the mature and the skeletally immature skeletally immature

Human Growth HormoneHuman Growth HormoneBasic ScienceBasic Science

• 191-residue, 22kDa peptide hormone

• Release regulated by GHRH, sleep, exercise, L-dopa, and arginie

• Studies show administration of hGH leads to muscle hypertrophy but not increased strength

Human Growth HormoneHuman Growth HormonePerformance StudiesPerformance Studies

• Little research has been done with hGH supplementation

• Most studies deal with endocrine dysfunction

• Increase in lean body mass but no increase in strength or performance

Human Growth HormoneHuman Growth HormoneSide EffectsSide Effects

• Insulin resistance (diabetes)Insulin resistance (diabetes)• Increased serum cholesterol Increased serum cholesterol

and triglyceridesand triglycerides• Cardiac enlargementCardiac enlargement• Hypogonadism (testicular Hypogonadism (testicular

shrinkage)shrinkage)• Acromegaly (abnormal Acromegaly (abnormal

enlargement of appendages)enlargement of appendages)• Muscles may be myopathic Muscles may be myopathic

with long term usewith long term use

Human Growth HormoneHuman Growth HormoneTesting and PolicyTesting and Policy

• Available legally only through physician Rx

• Banned by IOC but not officially tested

• Testing not available in professional sports in the US

Beta-2 AgonistsBeta-2 Agonists• Clenbuterol is another drug Clenbuterol is another drug

with Anabolic effects, but not in with Anabolic effects, but not in the steroid familythe steroid family

• It is a beta-2 adrenergic It is a beta-2 adrenergic agonist approved for the agonist approved for the treatment of asthmatreatment of asthma

• Brand names include Brand names include Clenasma, Monores, Novegan, Clenasma, Monores, Novegan, Prontovent, and SpiroventProntovent, and Spirovent

• It promotes protein synthesis It promotes protein synthesis and increases lean body mass and increases lean body mass as well as its medicinal effect as well as its medicinal effect of opening constricted airwaysof opening constricted airways

• Bodybuilders switch to the Bodybuilders switch to the drug prior to competition to drug prior to competition to avoid detection and to achieve avoid detection and to achieve “cut” look“cut” look

Beta-2-AgonistsBeta-2-Agonists

• Clenbuterol is not approved for human use in the United Clenbuterol is not approved for human use in the United StatesStates

• Side effects can include muscle tremor, agitation, Side effects can include muscle tremor, agitation, palpitations, muscle cramps, rapid heart rate, and palpitations, muscle cramps, rapid heart rate, and headacheheadache

• No data exist of its effectiveness or safety in long term No data exist of its effectiveness or safety in long term use.use.

• Not justified or recommended for use as an ergogenic Not justified or recommended for use as an ergogenic aid.aid.

StimulantsStimulants

• CaffeineCaffeine• NicotineNicotine• EphedrineEphedrine• AmphetaminesAmphetamines

CaffeineCaffeine

• Most widely available Most widely available ergogenic substancesergogenic substances

• Found in coffee, tea, Found in coffee, tea, chocolate, soft chocolate, soft drinks,prescription drugs, and drinks,prescription drugs, and over the counter drugs (No over the counter drugs (No Doz, Vivarin, Excedrin, Midol)Doz, Vivarin, Excedrin, Midol)

• Central Nervous System Central Nervous System stimulusstimulus

• Delayed onset of fatigueDelayed onset of fatigue• Increased metabolism of free Increased metabolism of free

fatty acids for energy (spares fatty acids for energy (spares glycogen stores)glycogen stores)

CaffeineCaffeineAdverse EffectsAdverse Effects

• Diuretic – can result in Diuretic – can result in dehydrationdehydration

• Diminished muscular strengthDiminished muscular strength• Diminished enduranceDiminished endurance• Increased risk of heat-related Increased risk of heat-related

injury or sicknessinjury or sickness

EphedrineEphedrine• Chemical found in the plant genus Chemical found in the plant genus EphedraEphedra• Contained in many nonprescription drugs, foods, and Contained in many nonprescription drugs, foods, and

nutritional supplements (greenies)nutritional supplements (greenies)• Used specifically to attempt to reduce fatigue and to Used specifically to attempt to reduce fatigue and to

enhance mental alertnessenhance mental alertness• Herb teas, Ginseng, gingko, and non prescription cold Herb teas, Ginseng, gingko, and non prescription cold

medicinesmedicines

EphedrineEphedrineSide EffectsSide Effects

• With recent death of NFL lineman, this class of drugs has come under scrutiny

• Anxiety, ventricular dysrythmias (death) and hypertension

• Possible relationship with heat stroke

AmphetaminesAmphetamines

• Most potent ergogenic drugs in Most potent ergogenic drugs in the stimulant categorythe stimulant category

• Increase cardiac output and Increase cardiac output and metabolism of free fatty acidsmetabolism of free fatty acids

• CNS stimulation: increased CNS stimulation: increased aggression, increased mental aggression, increased mental alertness, decreased alertness, decreased perception of fatigueperception of fatigue

Amphetamines Amphetamines Side EffectsSide Effects

• Illegal (methamphetamines – home labs)Illegal (methamphetamines – home labs)• Heat-related injuries: increased metabolic activity and Heat-related injuries: increased metabolic activity and

altered cardiovascular coolingaltered cardiovascular cooling• Addiction, withdraw syndrome, depression, marked Addiction, withdraw syndrome, depression, marked

reduction of athletic performancereduction of athletic performance

StimulantsStimulantsTesting and PolicyTesting and Policy

• Several amphetamines and stimulants available over the counter

• Most classes banned by the IOC

• Several forms banned in American professional sports

• NFL recently banned ephedrine

Beta BlockersBeta Blockers

• PropanololPropanolol• Compounds that slow the Compounds that slow the

heart rate and lower blood heart rate and lower blood pressurepressure

• Little ergonomic potential Little ergonomic potential except in sports such as except in sports such as shooting, archery, and shooting, archery, and biathalon where fine motor biathalon where fine motor control and relief of “jitters” are control and relief of “jitters” are critical (steady hand)critical (steady hand)

• These are prohibited in these These are prohibited in these sports (IOC)sports (IOC)

Erythropoitin and Blood DopingErythropoitin and Blood Doping

• Use of exogenous Use of exogenous erythropoietin (EPO) and/or erythropoietin (EPO) and/or blood transfusions to increase blood transfusions to increase blood count blood count (hemoglobin/hematocrit)(hemoglobin/hematocrit)

• This improves the availability This improves the availability of oxygen to the exercising of oxygen to the exercising muscle.muscle.

• Improves aerobic capacity and Improves aerobic capacity and muscle endurancemuscle endurance

• Detection is difficult and Detection is difficult and expensiveexpensive

• Popular in the cyclists and Popular in the cyclists and other aerobic athletesother aerobic athletes

Erythropoitin and Blood DopingErythropoitin and Blood DopingBasic ScienceBasic Science

• EPO – hormone naturally produced in the kidney

• Can be created synthetically via recombinant DNA technology

• Once released it stimulates an increase in hemoglobin

• Increases oxygen carrying ability of blood

Erythropoitin and Blood DopingErythropoitin and Blood DopingAdverse EffectsAdverse Effects

• Increases risk of hyperviscosity syndrome (thick blood) Increases risk of hyperviscosity syndrome (thick blood) • Increased risk of stroke, heart failure, and even deathIncreased risk of stroke, heart failure, and even death• Increased risk of dehydration with exerciseIncreased risk of dehydration with exercise• HIV or HBV infection from blood transfusionsHIV or HBV infection from blood transfusions• 5 Dutch cyclists died in 1987 in first year release of EPO5 Dutch cyclists died in 1987 in first year release of EPO• Between 1997 and 2000, 18 cyclists have died of stroke, Between 1997 and 2000, 18 cyclists have died of stroke,

MI, or Pulmonary embolismMI, or Pulmonary embolism

Erythropoitin and Blood DopingErythropoitin and Blood DopingTesting and PolicyTesting and Policy

• Only available with physician’s Rx

• Not legal in any sport

• Gas and liquid chromatography used for screening

• Remains difficult to detect

• Some governing bodies use an upper limit of hemoglobin as their guide

CreatineCreatine

• Since its introduction in 1992, it has become the most popular nutritional supplement on the market

• Discovered by Chevreul in 1832

• First reported use by elite athletes occurred during the 1992 Barcelona Olympics (British track and field athletes)

CreatineCreatine

• Several studies show up to 50 % usage rate in male college athletes

• Recent survey of NFL trainers and team physicians:

1. All teams had players actively taking creatine

2. Average use 33% and reports as high as 90%

CreatineCreatineBasic ScienceBasic Science

• Naturally occuring compound made from amino acids: glycine, arginie, and methionie

• Primarily synthesized in the liver, pancreas, and kidney

• 95% stored in skeletal muscle

• Exogenous sources: fresh fish and meat

• 2 g daily turnover

Creatine Creatine Basic ScienceBasic Science

• Provides energy during short-duration maximal bouts of anaerobic exercises

• Phosphorylated form provides a phosphorous atom to re-synthesize ATP

CreatineCreatinePerformance StudiesPerformance Studies

• Weight lifters – single rep max up 20 -30%• Cyclists – help maintain muscular force and

power outputs• Swimming – mixed results (complex

mechanics?)• Track and field – 1–2 % decrease in times• Body composition – increase weight and lean

body mass (1-2 kg per short term cycle)• Summary – effective for simple, short-duration,

maxi-effort anaerobic events

CreatineCreatineSide EffectsSide Effects

• 30% no response rate

• May lead to increase in muscle cramping (dehydration?)

• As in all supplements – lack of quality control

• Otherwise short term use safe , long term use unknown (further studies needed)

CreatineCreatineTesting and PolicyTesting and Policy

• Available over the counter in several nutritional supplements

• Not tested for or banned by any major athletic organization

• NCAA does not allow its member teams to provide creatine to their players

• Many teams discourage use in season (cramps)

HMBHMB

• Beta-hydroxy-beta-methylbutyrate

• Leucine metabolite that has gained popularity as an “anticatabolic”

• Marketed to suppress protein breakdown in recovery phase after workout

HMBHMBBasic ScienceBasic Science

• Mechanism not truly known but several theories:

1. Increase testosterone levels (similar to AAS)

2. Delay anaerobic metabolism

3. Prevent exercise-induced muscle damage

HMBHMBSide EffectsSide Effects

• No effect on blood, liver, or kidney function

• No changes seen in urinalysis

• Lowered LDL, total cholesterol, and systolic blood pressure

• Thus HMB appears to be safe and may be cardioprotective

What can we do?What can we do?

• Education - wealth of information out there (internet, books, magazines)

• Your young athlete knows more about it than you (and they don’t know enough)

Proper TrainingProper Training

• Sleep

• Hydration

• Stretching

• Nutrition (timing, whey protein, creatine)

• Proper form and technique (especially in skeletally immature athletes)

• Goals

Thank You!Thank You!