Physiology OAC ISP:
Drugs in Sport
From ancient times, athletes have sought to improve their performance, to better themselves and their peers, and to set new records in their sports of choice. The Olympic games have always been the ultimate place for athletes to show off their skills and compete with the highest elite athletes from countries around the world. Each and every athlete trains to be in the peak of their physical condition, or as close as they can be to that, in the time of the competition. This 'peak' is an athlete's most effective work zone, where they get the most use from every calorie; the most force from every muscle contraction, and their cardiovascular system is functioning at its maximum efficiency. Yet at this elite level, where fractions of seconds choose winners and losers, and records may seem impossible to beat, some athletes refuse to rely on training alone.
One aspect of the ancient Olympics that carries on today is the tradition of doping. From the first games, competitors ate 'magic' concoctions composed of mushrooms, wild berries and other potentially dangerous herbs in the belief that it would make them stronger, faster, and better. Today, supplements and practices that improve performance are much better designed, administered, and provide better results. Biochemical laboratories serve as sources for the drugs needed to push a willing athlete to the finish line ahead of anyone else. From the herbal 'therapies' of old to the modern designer chemicals that are used to boost specific functions of the brain or muscles to superhuman levels, the idea remains the same.
The variety of drugs available for athletes to take is as varied as the sports themselves. Some drugs, such as EPO, are synthetic copies of a natural body hormone, while others, like anabolic steroids, affect muscle growth and the body directly and much more broadly. Stimulants can decrease reaction time, heighten senses, increase overall speed as well as delay exhaustion. These are the general classes of drugs used in sport, not including other drugs which can be used or abused and are tested for, although they appear to have no positive benefit, but which are still banned by the associations of many sports.
Blood Doping
Blood is an obviously essential for the body. However, making the blood work more efficiently and to make it carry both more red blood (oxygen-carrying) cells and have more volume (plasma) can increase an athlete's ability to work harder. When the body increases its stores of blood cells naturally, the blood marrow in the bones is stimulated by a hormone called erythropoietin (EPO) that is released by the kidneys. The stimulus for the body to do this is when the brain detects that the tissues are receiving too little oxygen. Conversely, if cells are getting too much oxygen, EPO levels are reduced and the bones slow production of erythrocytes (red blood cells). The easiest and legal way for athletes to increase the volume of red blood cells in their body is to train at altitude1.
When the body is exposed to the lower oxygen of the high altitude the kidneys produce EPO and the cell counts increase. Because the athlete is continuously subjected to this lower oxygen concentration in the air, the cells develop as quickly as they can, over several weeks. The gains in cells per litre of blood can be great over several weeks, depending on how high above sea level one is. This effect can be seen easily when comparing blood samples from people who live in two different areas. For example, if one were to take a blood sample from people who happened to live in a coastal area, they would have a much lower red blood cell count than someone who lived high in a mountainous region. As would seem logical, mountains are slightly more dangerous areas than flat, temperate valleys or normal training areas like gyms. Because of environmental concerns like fallen rocks or difficult terrain, steep slopes or even the thin air that is helping to train the athlete, training in a high-altitude setting can be dangerous. Because of the low oxygen content of the air, all the tissues of the body will be oxygen-starved until the body can produce enough blood cells to make up the deficit and then to improve until the body reaches normal levels. When the athlete begins to train, the max VO2 that they can reach is a huge drop from what it was at sea level. It requires that they breathe harder and their heart beat much faster in order to get the same level of oxygen from the air, due to their low relative efficiency of their blood and body at this altitude. Should the athlete force himself or herself to try and train at the same intensity immediately, all kinds of injuries and conditions can result, from hypoxia (low oxygen levels), altitude sickness (similar to hypoxia but more chronic, causing weakness, nausea, blue fingers, toes and lips, and other symptoms), edema and pulmonary edema2 (edema- fluid build-up in tissues, pulmonary edema- fluid begins to build up in lungs, drowning can occur miles from water in this situation) and other adverse side effects. All in all, this method of training is difficult to maintain and to begin, and the blood cells are slowly lost once the athlete returns to lower altitudes where the competition will likely be held. Another method that some athletes have taken up in order to improve oxygen circulation is commonly referred to as blood doping.
The process of blood doping involves withdrawing a sample of blood from an athlete several months before an event, and processing it to remove some of the plasma and leave behind the blood cells. New blood cells grown in the bones quickly replace those cells that are taken out. One or two days before the event, these blood cells are reintroduced to the athlete via an intravenous line. This infusion of millions of cells into the athlete can greatly influence the oxygen-carrying capacity of the athlete, providing a similar effect as having trained at higher altitudes for months, ...
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The process of blood doping involves withdrawing a sample of blood from an athlete several months before an event, and processing it to remove some of the plasma and leave behind the blood cells. New blood cells grown in the bones quickly replace those cells that are taken out. One or two days before the event, these blood cells are reintroduced to the athlete via an intravenous line. This infusion of millions of cells into the athlete can greatly influence the oxygen-carrying capacity of the athlete, providing a similar effect as having trained at higher altitudes for months, but with more definite results and none of the dangerous drawbacks of high altitude training. Of course, the main drawback of blood doping is that it has been deemed a form of cheating by the IOC and almost every other major athletics association. Because the cells are taken from the athlete's own body, it can be very difficult to determine if an athlete's blood has been doped, and another bonus of having used one's own cells is that there is no chance of side effects.
There are also several chemical ways of improving the efficiency of the blood. Artificial erythropoietin can be created in labs, and it is absolutely identical to the protein produced by the body. This is yet another method of doping the blood. When the artificial EPO is injected into the blood, it travels to the bone marrow just as the EPO from the kidneys would.
The bone marrow cells interpret the chemical messenger the same way as the natural version and begin to produce red blood cells. These cells obviously need to grow and be released quickly, because the marrow is reacting the way that it would to serious oxygen deprivation. The number of cells available increases dramatically, just like it would in the case of normal blood doping, and this EPO treatment is usually continued for several weeks. Just like every other cell, the red blood cells need time to mature after dividing, and they mature while floating in the blood. This is the easiest way to detect if an athlete has been using EPO to enhance performance. A blood sample is drawn for all of the routine tests, and a comparison of the size of the blood cells is done. If there are a disproportional number of small, immature red blood cells, the athlete may have been using EPO, and they can also check the levels of the hormone in the blood. The main problems with this test are twofold. Some athletes simply may have a high level of EPO in the blood, as it is a natural substance and the synthetic version is identical to the human-made one, and as of yet cannot be distinguished by labs easily. The second issue is that many athletes have been training hard in the last few weeks before the competition, and the body may have sent out signals to produce more blood cells, and thus they could receive a false positive test. At this time, the World Anti-Doping Association (http://www.wada-ama.org) is sponsoring a contest to find an easier EPO test and a way to detect if extra EPO has been administered. As with 'natural' blood doping, there are no side effects other than needing additional iron in the diet to create these new cells, and the possibilities of overdose (polycythemia vera, too many red blood cells causes thickening of the blood3) or stopping suddenly and having a deficit of EPO in the blood. One final method of blood doping is the use of plasma expanders or artificial oxygen carriers.
These chemicals are added to the blood and instead of causing the body to produce more blood cells; they themselves give the benefit to the athlete. Plasma expanders are drugs or fluids which, when intravenously administered to the blood, function almost as plasma. These types of drugs cause the blood volume to increase without increasing the number of cells. They can be used as an easy way' make the blood easier for the body to circulate. The reason for this is that when there is a higher blood pressure (more plasma equals more pressure) then the heart doesn't have to Work as hard to get the same amount of blood around the body as it would if there were less blood. Artificial oxygen carriers such as Oxyglobin@ or perfluorocarbon~ Work slightly differently. These chemicals have the ability to bond to oxygen, just like the hemoglobin in the blood. If an oxygen carrier is used, it is also intravenously 3dministered, and it transforms the plasma itself into an oxygen carrier, making the system that much more efficient at getting oxygen to muscles and organs. The side effects of both of these procedures are minimal, as both break down and/or are excreted from the body soon.
Every blood doping procedure provides a benefit for aerobic sports, such as marathon running, cycling, swimming, and any of the long-duration events. No form of blood doping would help someone in a sport such as weightlifting or the 50-metre sprint, because one's oxygen capacity is irrelevant in CP/Lactic energy sports such as these.
Steroids
The full name for steroids, at least of the form used to build strength, is Anabolic Androgenic Steroids, or AASs, 'Roids, or any number of other variations. There are also several other forms, like corticosteroids, but these are not useful in strength training for sport. Steroids are a class of drugs whose primary function is to promote building of muscle and the body. They are similar in structure to the male sex hormone, testosterone and are similar in function. Because using steroids creates a hormonal imbalance in the body, there are serious and major side effects. In the human body, testosterone promotes muscle building and growth, as well as causing increases in bulk with exercise. When athletes take steroids, these drugs act as a mimic to testosterone, helping the body to build muscle and strength quickly. Obviously, this is an important thing for people involved in sports such as weightlifting, shot put, hammer throw and other places where strength and power are necessary.
The main problem with taking steroids, aside from the litany of serious side effects, is that they are incredibly easy to detect. Steroids must be injected intramuscularly on a regular basis, and they can build up in the body if overused or overdosed. Another problem for athletes wanting to take steroids is the fact that they are prescription only, intended for infirm or people who have need to rebuild wasted muscle (bedridden people, cancer patients) in order to become healthier. If an athlete, already close to peak fitness went to a doctor to seek a prescription for steroids, they would be either laughed out the door or be reported to the coach or their sporting authority. Therefore, many athletes who want to take steroids to improve their gains in strength must turn to black-market or stolen drugs, which may contain impurities or cheaper substitutes of chemicals, leading to even more dangerous side effects4.
There is a massive list of potential side effects from the use of steroids, due to the fact that they are hormones, and the addition of unnecessary hormones to the body disturbs the balance of many other hormones as well. Potential side effects of steroids include:
(Chart from USADA http://www.usantidoping.org/files/USADA_Guide.pdf)
* Acne (M, W)
* Liver dysfunction (M, W) *
* Premature closure of growth centres in adolescents, resulting in stunted growth (M, W) *
* Increased aggressiveness and sexual appetite, sometimes resulting in aberrant sexual and criminal behaviour (M)
* Impotence after chronic or repeated use (M)
* Testicular Shrinkage (M) *
* Breast enlargement (gynarcomastia) (M) *
* Enlargement of prostate gland (M)
* Reduction of sperm production (M)
* Premature baldness (M)
* Masculinization (W) *
* Excessive hair growth on face and body (W) *
* Deepening of the voice (W) *
* Enlargement of the clitoris (W) *
* Abnormal menstrual cycles (suppression of ovarian function and menstruation) (W)
(M - effect on men, W- effect on women, * - may be a permanent change)
Obviously, the cost from taking steroids is huge, but some athletes still choose to use them and suffer these problems in exchange for enhanced performance. Although there are many different varieties of steroids, they all have similar effects and side effects, and are not worth noting here.
Stimulants
A stimulant is any substance that excites or causes a stimulatory reaction in the body or the nervous system. There are a huge number of substances that do this, from the every day things like caffeine, to street drugs like methamphetamine. All of these class of drugs have similar benefits, and similar side effects.
Amphetamines:
Amphetamines are stimulants to the central nervous system. Medically they are used to treat depression, obesity, and other conditions, such as ADD or ADHD. Amphetamines include drugs such as Ritalin and Adderall (both prescription drugs) as well as street drugs like crystal meth (methamphetamine), speed (amphetamine), Benzedrine (inhaled stimulant), many diet pills, and many more. Because stimulants effect the nervous system primarily, these effects pass on to the body as well, especially the muscles. In addition to the physical effects of amphetamines, users report feeling restless, anxious and moody5. Increased doses intensify the effects, and users may become exited or talkative and experience a false sense of self-confidence or superiority. They may behave in a bizarre manner; some become aggressive, hostile or paranoid. Here is a list of the effects the amphetamine class of drugs have on the body:
Mental Effects can include
* Increased alertness
* Positive mood shift, sense of well-being
* Increased talkativeness
* Increased aggressiveness
* Reduced appetite (don't feel hunger)
* Paranoia
* Physical Effects can include
* Dry mouth
* Headache
* Increased heart rate (tachycardia)
* Increased breathing rate
* Increased blood pressure
* Rise in body temperature
* Dilated pupils
* Additional Effects can include
* Fever and sweating
* Flushing
* Diarrhoea or constipation
* Blurred vision
* Impaired speech
* Convulsions
* Dizziness
* Loss of coordination
* Uncontrollable movements (twitching, jerking, tremors, etc...)
* Insomnia
* Dry, itchy skin
* Acne, sores
* Numbness
* Pallor
* Irregular heartbeat (palpitations, arrhythmia)
* Psychotic episodes (rare except in over doses)
* Restlessness
Prolonged use of amphetamines can lead to malnutrition and vitamin deficiencies, skin disorders, ulcers, lack of sleep, weight loss and depression. Frequent use of large amounts of amphetamines can cause brain damage that results in speech and thought disturbances. There is a massive list of reasons not to take stimulants, another of which is their addictive quality. Users of large amount of amphetamines over a long period of time can develop an amphetamine psychosis, which is a mental disorder similar to paranoid schizophrenia. The psychosis is manifested by hallucinations, delusions, and paranoia. Those with amphetamine psychosis exhibit bizarre, sometime violent, behaviour.6
Symptoms usually disappear within a few weeks after drug use stops. Amphetamines have the potential to produce tolerance, which means that increased amounts of the drug are needed to achieve the desired effects. Withdrawal symptoms can occur when use of amphetamines is stopped abruptly. Users may experience fatigue; long, disturbed periods of sleep; irritability; intense hunger, and moderate to severe depression. The length and severity of the depression is related to how much and how often amphetamines were used. 7
* Craving
* Exhaustion
* Depression
* Mental confusion
* Restlessness and insomnia
* Deep or disturbed sleep lasting up to 48 hours
* Extreme hunger
* Psychotic reaction
* Anxiety reactions
Basically, the user is receiving in spades what they were able to avoid while on the drug (tiredness, appetite, etc). Stimulants can be used in a variety of sports, especially those where exhaustion might take place (long-distance or duration events), or those where speed and power are needed. One place where stimulants would be a detriment to the athlete instead of a benefit is in sports of skill, such as shooting or archery, because the small muscles in the hands are seriously and negatively effected by every stimulant drug, causing twitchy and sporadic motions. Basically, where steroids and anabolic agents actually build the muscle mass and power, stimulants push the normal muscles to perform at a level they normally could not.8
Caffeine:
Another stimulant drug that is widely overlooked is caffeine. It is present in coffee, tea and many carbonated drinks. Canadian laws prohibit caffeine from being added to non-cola beverages because of its addictive qualities, but in the US it is present in everything from Mountain Dew to some kinds of bottled water.
The physiological effects of caffeine can begin as early as 15-45 minutes after ingestion. Its maximum central nervous system effects are reached in about 30-60 minutes. Caffeine increases heartbeat, respiration, basal metabolic rate, and the production of stomach acid and urine; and it relaxes smooth muscles, notably the bronchial muscle. All of these changes vary considerably among people and may depend upon the individual's sensitivity to this drug, his/her metabolism, or upon whether the consumer habitually uses or rarely uses caffeine. How long caffeine's effects last are influenced by the person's hormonal status, whether he/she smokes or takes medications, or has a disease that impairs liver functioning.
Subjectively, people report that caffeine gives them a "lift." They feel less drowsy, less fatigued, more capable of rapid and sustained intellectual effort. They also report improved performance of some manual tasks such as driving or, for an athlete, prolonged activities, excluding those requiring precision in the hands. However, caffeine may restore only those abilities or feelings the person had before fatigue or boredom set in. Studies have also shown that caffeine decreases reaction time to both visual and auditory stimuli; it does not significantly alter numerical reasoning (arithmetic skills) or short-term memory; and it can diminish performance of manual tasks that involve delicate muscular coordination and accurate timing. Caffeine has many side effects, and it can cause or aggravate many things such as heartburn, ulcers, breast cancer, heart problems, and nervousness. This class of drug has benefits for many sports. Caffeine metabolites (leftovers after breakdown by the liver) are excreted in the urine and it can be secreted in other fluids like saliva, semen, and breast milk. Although nearly everyone in north America drinks coffee, students are the most prone to overdose, as this is not one of the most commonly used drugs by athletes.9
Student Dies after Swallowing Dozens of Caffeine Pills
Columbia Missouri Tribune
October 27, 1998
MOREHEAD CITY, N.C. (AP) - A 20-year-old man died after taking a dare from a fellow student and swallowing dozens of caffeine pills.
Jason Allen had swallowed most of a 90-pill bottle, which would be the equivalent to drinking as many as 250 cups of coffee, authorities said.
'It's a terrible, terrible story,' said Morehead City police Maj. Wrenn Johnson. 'No one suspects caffeine to be deadly.'
Allen was taking general education development classes at Carteret Community College. He collapsed outside the college during a break from class Oct. 20. It wasn't known when he took the pills.
A security guard found him and called the rescue squad, which took him to Carteret General Hospital, where he died last Wednesday.
Authorities said it appeared that Allen died of heart rhythm irregularities associated with the high dose of caffeine, which is a central nervous system stimulant.
This article shows just how dangerous caffeine can be, much like any other drugs, when misused.
Conclusion:
Although there are many more drugs available to enhance performance in sport like diuretics, painkillers, beta agonists and more, there is just too much information for one sitting. Sports associations recognize the problems of drugs being used by athletes and have put in harsh penalties against their use, from mere loss of their medal or title to being banned from the sport for two years or more, even to life banishment. Olympic drugs tests become more and more strict and technically advanced by the year, and athletes must be careful of what they eat or drink, because trace amounts of drugs may be present for whatever reason. Regardless of how the athlete gets the drug into their system (i.e. Silken Laumann and her cold medication) it is their responsibility to stop it from happening. Drugs in sport will continue to advance in their effects and specialization, but tests will keep developing to fight cheaters.
Athletes must weigh the consequences and choose, to dope or not to dope.
ISP Abstract:
Microsoft Encarta "Track and Field", section on altitude training: http://encarta.msn.com/find/concise.asp?z=1&pg=2&ti=761562123&cid=96#p96
2 WebMD: Edema http://my.webmd.com/content/dmk/dmk_article_1457441
3 WebMD: Polycythemia Vera http://my.webmd.com/content/asset/adam_disease_polycythemia_vera
4 The Steroids Game - By Charles E. Yesalis and Virginia S. Cowart
5 Speed And Amphetamines - Julian Chomet
6 Substance Abuse In Sport - By William Carroll, Frances Niccolai, Robert Banks
7 Amphetamines and Other Stimulants - Lawrence Clayton
8 Facts On Drugs And Sports - Harry Shapiro
9 Caffiene, The Most Popular Stimulant - Richard J. Gilbert
