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Zapata-Linares J, Gervasini G. Contaminants in Dietary Supplements: Toxicity, Doping Risk, and Current Regulation. Int J Sport Nutr Exerc Metab 2024; 34:232-241. [PMID: 38653450 DOI: 10.1123/ijsnem.2023-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 04/25/2024]
Abstract
Athletes, both amateur and professional, often resort to the consumption of nutritional supplements without professional supervision and without being aware of the risks they may entail. We conducted an exhaustive literature search to determine the most common substances found as contaminants in dietary supplements. For each substance, we analyzed its mechanism of action, clinical indication, health risk, and putative use as doping agent. In addition, we evaluated the current regulation of these supplements. Contamination of nutritional supplements (accidental or intentional), especially with steroids and stimulants, is a hazardous situation. The prolonged consumption of these products without being aware of their composition can cause serious health risks and, in the case of professional athletes, a possible sanction for doping.
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Affiliation(s)
- Jesús Zapata-Linares
- Faculty of Medicine and Health Sciences, Division of Pharmacology, Department of Medical and Surgical Therapeutics, School of Medicine and Health Sciences, University of Extremadura, Badajoz, Spain
| | - Guillermo Gervasini
- Faculty of Medicine and Health Sciences, Division of Pharmacology, Department of Medical and Surgical Therapeutics, School of Medicine and Health Sciences, University of Extremadura, Badajoz, Spain
- Instituto Universitario de Biomarcadores de Patologías Moleculares, University of Extremadura, Badajoz, Spain
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2
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Matusak M, Aljabban J, Wirtz M, Agni R, Spengler E. Cholestasis Linked to Bodybuilding Supplements: Exploring the Risks of Contamination. Case Reports Hepatol 2024; 2024:5112461. [PMID: 38826497 PMCID: PMC11142851 DOI: 10.1155/2024/5112461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 10/26/2023] [Accepted: 04/22/2024] [Indexed: 06/04/2024] Open
Abstract
Drug-induced liver injury resulting from herbal and dietary supplement use is increasingly common and underrecognized. We report a case of a 34-year-old male recreational bodybuilder who presented with muscle cramping, fatigue, and diffuse itching in the setting of bodybuilding supplement use. Labs showed cholestatic liver injury, and liver biopsy revealed bland cholestasis and sinusoidal dilation. He was diagnosed with anabolic-androgenic steroid-induced liver injury. He was symptomatically managed with plasmapheresis for debilitating pruritus. This case highlights drug-induced liver injury as a complication of bodybuilding supplement use containing unlabeled anabolic-androgenic steroids. Sports medicine providers should inquire on herbal and dietary supplement use and be aware of potential contaminants.
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Affiliation(s)
- Mark Matusak
- Department of Family Medicine, University of Wisconsin Hospital and Clinics, Madison, USA
| | - Jihad Aljabban
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, USA
| | - Mark Wirtz
- Department of Family Medicine, University of Wisconsin Hospital and Clinics, Madison, USA
| | - Rashmi Agni
- Department of Pathology, University of Wisconsin Hospital and Clinics, Madison, USA
| | - Erin Spengler
- Department of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinics, Madison, USA
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3
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Backhouse SH. A Behaviourally Informed Approach to Reducing the Risk of Inadvertent Anti-doping Rule Violations from Supplement Use. Sports Med 2023; 53:67-84. [PMID: 37801267 PMCID: PMC10721667 DOI: 10.1007/s40279-023-01933-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/07/2023]
Abstract
For many reasons, athletes' use of supplements is highly prevalent across sports and competitive levels, despite the risk of these products containing a substance on the World Anti-Doping Agency Prohibited List. Contravening anti-doping rules through supplement use could have serious consequences for competitive athletes (e.g., ineligibility from major competitions, loss of medals and funding) due to the principle of strict liability. Indiscriminate supplement use also poses a risk to athlete health. To reduce the possibility of ingesting a supplement containing prohibited substances, independent quality assurance and certification programs have been established (e.g., Informed Sport). However, these programs do not completely eliminate risk, leading to some anti-doping organisations promoting a 'just say no' to supplements stance. Yet, this approach can be problematic as a small number of supplements may be necessary for athletes to consume, in certain situations. Recognising that athletes will continue to use these heavily marketed products, this narrative review describes a theoretically underpinned and systematic approach to preventing inadvertent doping by considering the barriers to and enablers of athlete adherence to risk minimisation supplement use guidelines (RMSUG). By outlining a conceptual shift towards a behaviourally informed approach, this review serves to stimulate the development of multifaceted interventions to prevent inadvertent doping through supplement use. Recognising that risk-minimised supplement use involves a myriad of behaviours, the problem of inadvertent doping through supplement use is framed, and research appraised, through the lens of the Behaviour Change Wheel.
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Dembitsky VM. Steroids Bearing Heteroatom as Potential Drugs for Medicine. Biomedicines 2023; 11:2698. [PMID: 37893072 PMCID: PMC10604304 DOI: 10.3390/biomedicines11102698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Heteroatom steroids, a diverse class of organic compounds, have attracted significant attention in the field of medicinal chemistry and drug discovery. The biological profiles of heteroatom steroids are of considerable interest to chemists, biologists, pharmacologists, and the pharmaceutical industry. These compounds have shown promise as potential therapeutic agents in the treatment of various diseases, such as cancer, infectious diseases, cardiovascular disorders, and neurodegenerative conditions. Moreover, the incorporation of heteroatoms has led to the development of targeted drug delivery systems, prodrugs, and other innovative pharmaceutical approaches. Heteroatom steroids represent a fascinating area of research, bridging the fields of organic chemistry, medicinal chemistry, and pharmacology. The exploration of their chemical diversity and biological activities holds promise for the discovery of novel drug candidates and the development of more effective and targeted treatments.
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Affiliation(s)
- Valery M Dembitsky
- Centre for Applied Research, Innovation and Entrepreneurship, Lethbridge College, 3000 College Drive South, Lethbridge, AB T1K 1L6, Canada
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5
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Smoliga JM, Wilber ZT, Robinson BT. Premature Death in Bodybuilders: What Do We Know? Sports Med 2023; 53:933-948. [PMID: 36715876 PMCID: PMC9885939 DOI: 10.1007/s40279-022-01801-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/31/2023]
Abstract
Premature deaths in bodybuilders regularly make headlines and are cited as evidence that bodybuilding is a dangerous activity. A wealth of research has revealed elite athletes typically enjoy lower mortality rates than non-athletes, but research on bodybuilder lifespan is surprisingly limited. Anabolic androgenic steroid (AAS) use is commonly cited as a key contributor to morbidity and premature mortality in bodybuilders, but this area of research is highly nuanced and influenced by numerous confounders unique to bodybuilding. It is quite possible that bodybuilders are at elevated risk and that AAS use is the primary reason for this, but there remains much unknown in this realm. As global participation in bodybuilding increases, and healthcare providers play a more active role in monitoring bodybuilder health, there is a need to identify how numerous factors associated with bodybuilding ultimately influence short- and long-term health and mortality rate. In this Current Opinion, we discuss what is currently known about the bodybuilder lifespan, identify the nuances of the literature regarding bodybuilder health and AAS use, and provide recommendations for future research on this topic.
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Affiliation(s)
- James M. Smoliga
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC 27268 USA
| | - Z. Taggart Wilber
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC 27268 USA ,Helix Performance Recovery, Wellington, FL USA
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Lee JH, Jung EJ, Ham HJ, Yang YJ, Kim NS, Kim HI, Baek SY. Application of LC-MS/MS and UHPLC-Q-Orbitrap methods for determining 54 steroids in illegal dietary supplements and other sample types. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2022; 36:e9334. [PMID: 35705484 DOI: 10.1002/rcm.9334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
RATIONALE With the development of the Internet and social network services, the public access to or use of illegal products has been increased via on/offline black markets. Steroids refer to the compounds yielding strong treatment effects on some diseases or muscle building, and are classified as the pharmaceutical compounds that are prohibited for personal use without a prescription. The prohibition is made for their potential risk to cause serious adverse effects along with their efficacies. METHODS To monitor the distribution of illicit products containing steroids, a simple and reliable analytical method was established and validated, allowing rapid and simultaneous determination of 54 steroids in them. During the screening, LC-Q-Orbitrap/MS was performed first followed by quantitative analysis using LC-MS/MS. For the accurate and reliable analysis, the samples were extracted using QuEChERS to reduce the matrix effect. RESULTS After the screening of 617 illegal samples advertised as being effective in alleviating various diseases or improving athletic performance with the established LC-Q-Orbitrap/MS method, the validated LC-MS/MS method was used to perform the quantitative analysis of the detected steroids. Of these, 142 samples were adulterated with steroids, and several samples with two or more steroids were detected. Due to the lack of previous studies on the toxicity of these illicit products, the side effects of consuming them are unpredictable and could be harmful. CONCLUSIONS The development of LC-Q-Orbitrap/MS method accompanied by LC-MS/MS could be successfully applied to the inspection of illegal steroid products for public health, enabling the rapid and accurate detection of analytes and incorporation of non-analyte components.
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Affiliation(s)
- Ji Hyun Lee
- National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Center for Advanced Analysis, Cheongju, Republic of Korea
| | - Eun Ju Jung
- National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Center for Advanced Analysis, Cheongju, Republic of Korea
| | - Hyeon Joo Ham
- National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Center for Advanced Analysis, Cheongju, Republic of Korea
| | - Yoon Ji Yang
- National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Center for Advanced Analysis, Cheongju, Republic of Korea
| | - Nam Sook Kim
- National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Center for Advanced Analysis, Cheongju, Republic of Korea
| | - Hyung Il Kim
- National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Center for Advanced Analysis, Cheongju, Republic of Korea
| | - Sun Young Baek
- National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Center for Advanced Analysis, Cheongju, Republic of Korea
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7
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Dietary Supplements as Source of Unintentional Doping. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8387271. [PMID: 35496041 PMCID: PMC9054437 DOI: 10.1155/2022/8387271] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/24/2022] [Indexed: 01/26/2023]
Abstract
Background The substances used in sport could be divided into two major groups: those banned by the World Anti-Doping Agency and those which are not. The prohibited list is extremely detailed and includes a wide variety of both medicinal and nonmedicinal substances. Professional athletes are exposed to intense physical overload every day. They follow a relevant food regime and take specific dietary supplements, which is essential for the better recovery between trainings and competitions. However, the use of “nonprohibited” dietary supplements (DS) is not always completely safe. One of the risks associated with the use of dietary supplements is the risk of unintended doping—originating from contaminated products. The presence of undeclared compounds in the composition of DS is a serious concern. The aim of this study is to evaluate the risk of unintentional doping. Materials and Methods Literature search was done through PubMed, Science Direct, Google Scholar, and Web of Science. Studies investigating the presence of undeclared compounds, in dietary supplements, banned by WADA met the inclusion criteria. The last search was conducted in June 2021. The present review is based on a total of 50 studies, which investigated the presence of undeclared compounds in DS. Results The total number of analyzed DS is 3132, 875 of which were found to contain undeclared substances. Most frequently found undeclared substances are sibutramine and anabolic-androgenic steroids. Conclusion More than 28% of the analyzed dietary supplements pose a potential risk of unintentional doping. Athletes and their teams need to be aware of the issues associated with the use of DS. They should take great care before inclusion of DS in the supplementation regime.
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Aamer M, Siddiqui M, Jabeen A, Irshad R, Khan FA, Atia-Tul-Wahab, Choudhary MI, Wang Y. Structural transformation of methasterone with Cunninghamella blakesleeana and Macrophomina phaseolina. RSC Adv 2022; 12:9494-9500. [PMID: 35424863 PMCID: PMC8985176 DOI: 10.1039/d2ra01396g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
An anabolic-androgenic synthetic steroidal drug, methasterone (1) was transformed by two fungi, Cunninghamella blakesleeana and Macrophimina phaseclina. A total of six transformed products, 6β,7β,17β-trihydroxy-2α,17α-dimethyl-5α-androstane-3-one (2), 6β,7α,17β-trihydroxy-2α,17α-dimethyl-5α-androstane-3-one (3), 6α,17β-dihydroxy-2α,17α-dimethyl-5α-androstane-3,7-dione (4), 3β,6β,17β-trihydroxy-2α,17α-dimethyl-5α-androstane-7-one (5), 7α,17β-dihydroxy-2α,17α-dimethyl-5α-androstane-3-one (6), and 6β,9α,17β-trihydroxy-2α,17α-dimethyl-5α-androstane-3-one (7) were synthesized. Among those, compounds 2–5, and 7 were identified as new transformed products. MS, NMR, and other spectroscopic techniques were performed for the characterization of all compounds. Substrate 1 (IC50 = 23.9 ± 0.2 μg mL−1) showed a remarkable anti-inflammatory activity against nitric oxide (NO) production, in comparison to standard LNMMA (IC50 = 24.2 ± 0.8 μg mL−1). Whereas, its metabolites 2, and 7 showed moderate inhibition with IC50 values of 38.1 ± 0.5 μg mL−1, and 40.2 ± 3.3 μg mL−1, respectively. Moreover, substrate 1 was found to be cytotoxic for the human normal cell line (BJ) with an IC50 of 8.01 ± 0.52 μg mL−1, while metabolites 2–7 were identified as non-cytotoxic. Compounds 1–7 showed no cytotoxicity against MCF-7 (breast cancer), NCI-H460 (lung cancer), and HeLa (cervical cancer) cell lines. Fungal transformation of methasterone resulted in six products (2–7). 2–5, and 7 were identified as new. Substrate 1 showed remarkable anti-inflammatory activity but was cytotoxic. Products 2 and 7 showed moderate activity but were non-cytotoxic.![]()
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Affiliation(s)
- Muhammad Aamer
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan
| | - Mahwish Siddiqui
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan
| | - Almas Jabeen
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi Karachi 75270 Pakistan
| | - Rimsha Irshad
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan
| | - Farooq-Ahmad Khan
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan .,Third World Center (TWC) for Chemical Sciences, International Center for Chemical & Biological Sciences, University of Karachi 75270 Pakistan
| | - Atia-Tul-Wahab
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi Karachi 75270 Pakistan
| | - M Iqbal Choudhary
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan .,Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi Karachi 75270 Pakistan.,Department of Biochemistry, Faculty of Science, King Abdulaziz University Jeddah-21589 Saudi Arabia
| | - Yan Wang
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan
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Abstract
Androgens are potent drugs requiring prescription for valid medical indications but are misused for invalid, unproven, or off-label reasons as well as being abused without prescription for illicit nonmedical application for performance or image enhancement. Following discovery and first clinical application of testosterone in the 1930s, commercialization of testosterone and synthetic androgens proliferated in the decades after World War II. It remains among the oldest marketed drugs in therapeutic use, yet after 8 decades of clinical use, the sole unequivocal indication for testosterone remains in replacement therapy for pathological hypogonadism, organic disorders of the male reproductive system. Nevertheless, wider claims assert unproven, unsafe, or implausible benefits for testosterone, mostly representing wishful thinking about rejuvenation. Over recent decades, this created an epidemic of testosterone misuse involving prescription as a revitalizing tonic for anti-aging, sexual dysfunction and/or obesity, where efficacy and safety remains unproven and doubtful. Androgen abuse originated during the Cold War as an epidemic of androgen doping among elite athletes for performance enhancement before the 1980s when it crossed over into the general community to become an endemic variant of drug abuse in sufficiently affluent communities that support an illicit drug industry geared to bodybuilding and aiming to create a hypermasculine body physique and image. This review focuses on the misuse of testosterone, defined as prescribing without valid clinical indications, and abuse of testosterone or synthetic androgens (androgen abuse), defined as the illicit use of androgens without prescription or valid indications, typically by athletes, bodybuilders and others for image-oriented, cosmetic, or occupational reasons.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, Australia.,Andrology Department, Concord Hospital, Sydney, Australia
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Lund RA, Cooper ER, Wang H, Ashley Z, Cawley AT, Heather AK. Nontargeted detection of designer androgens: Underestimated role of in vitro bioassays. Drug Test Anal 2021; 13:894-902. [PMID: 33864649 DOI: 10.1002/dta.3049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/03/2021] [Accepted: 04/14/2021] [Indexed: 01/23/2023]
Abstract
Androgens, both steroidal and nonsteroidal in nature, are among the most commonly misused substances in competitive sports. Their recognized anabolic and performance enhancing effects through short- and long-term physiological adaptations make them popular. Androgens exist as natural steroids, or are chemically synthesized as anabolic androgenic steroids (AAS) or selective androgen receptor modulators (SARMs). In order to effectively detect misuse of androgens, targeted strategies are used. These targeted strategies rely heavily on mass spectrometry, and detection requires prior knowledge of the targeted structure and its metabolites. Although exquisitely sensitive, such approaches may fail to detect novel structures that are developed and marketed. A nontargeted approach to androgen detection involves the use of cell-based in vitro bioassays. Both yeast and mammalian cell androgen bioassays demonstrate a clear ability to detect AAS and SARMS, and if paired with high resolution mass spectrometry can putatively identify novel structures. In vitro cell bioassays are successfully used to characterize designer molecules and to detect exogenous androgens in biological samples. It is important to continue to develop new and effective detection approaches to prevent misuse of designer androgens, and in vitro bioassays represent a potential solution to nontargeted detection strategies.
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Affiliation(s)
- Rachel A Lund
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Elliot R Cooper
- National Measurement Institute, Lindfield, New South Wales, Australia
| | - Hui Wang
- The Fourth Hospital of Jinan, Jinan, China
| | - Zoe Ashley
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Adam T Cawley
- Australian Racing Forensic Laboratory, Racing NSW, Randwick, New South Wales, Australia
| | - Alison K Heather
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.,Insitugen Ltd, Dunedin, Otago, New Zealand
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Mazzilli M, Macaluso F, Zambelli S, Picerno P, Iuliano E. The Use of Dietary Supplements in Fitness Practitioners: A Cross-Sectional Observation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095005. [PMID: 34065071 PMCID: PMC8125933 DOI: 10.3390/ijerph18095005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/22/2022]
Abstract
This study was aimed at evaluating the prevalence of use of dietary supplements (DSs) among gym users and gym instructors involved in body shaping-oriented fitness training. Furthermore, this study aimed to verify whether differences existed in the prevalence and in the types of DSs used in both gym users and gym instructors involved in body shaping-oriented fitness competitions vs. those not involved in fitness competitions. A survey was distributed to 316 participants, composed of 89 gym instructors and 227 gym users of both genders aged 27.3 ± 7.7. Among these participants, 52 were involved in competitions and 248 were not, while 16 participants did not specify either way. The results showed a high prevalence in the use of DSs in the population considered, with 85.4% of the participants declaring they used DSs, with high heterogeneity in the numbers and in the combinations used. No differences were found between gym instructors and gym users, or between participants involved and those not involved in competitions. The results indicate that DSs are widely used by persons involved in body shaping-oriented fitness training. The results also suggest that the majority of the participants decided individually which DSs to use.
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12
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Pounina TA, Gloriozova TA, Savidov N, Dembitsky VM. Sulfated and Sulfur-Containing Steroids and Their Pharmacological Profile. Mar Drugs 2021; 19:240. [PMID: 33923288 PMCID: PMC8145587 DOI: 10.3390/md19050240] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
The review focuses on sulfated steroids that have been isolated from seaweeds, marine sponges, soft corals, ascidians, starfish, and other marine invertebrates. Sulfur-containing steroids and triterpenoids are sourced from sedentary marine coelenterates, plants, marine sediments, crude oil, and other geological deposits. The review presents the pharmacological profile of sulfated steroids, sulfur-containing steroids, and triterpenoids, which is based on data obtained using the PASS program. In addition, several semi-synthetic and synthetic epithio steroids, which represent a rare group of bioactive lipids that have not yet been found in nature, but possess a high level of antitumor activity, were included in this review for the comparative pharmacological characterization of this class of compounds. About 140 steroids and triterpenoids are presented in this review, which demonstrate a wide range of biological activities. Therefore, out of 71 sulfated steroids, thirteen show strong antitumor activity with a confidence level of more than 90%, out of 50 sulfur-containing steroids, only four show strong antitumor activity with a confidence level of more than 93%, and out of eighteen epithio steroids, thirteen steroids show strong antitumor activity with a confidence level of 91% to 97.4%.
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Affiliation(s)
- Tatyana A. Pounina
- Far Eastern Geological Institute, Russian Academy of Sciences, 159 Prospect 100-letiya Vladivostoka, 690022 Vladivostok, Russia;
| | - Tatyana A. Gloriozova
- Institute of Biomedical Chemistry, 10 Building 8, Pogodinskaya Street, 119121 Moscow, Russia;
| | - Nick Savidov
- Centre for Applied Research, Innovation and Entrepreneurship, Lethbridge College, 3000 College Drive South, Lethbridge, AB T1K 1L6, Canada;
| | - Valery M. Dembitsky
- Centre for Applied Research, Innovation and Entrepreneurship, Lethbridge College, 3000 College Drive South, Lethbridge, AB T1K 1L6, Canada;
- A.V. Zhirmunsky National Scientific Center of Marine Biology, 17 Palchevsky Str., 690041 Vladivostok, Russia
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13
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Fabresse N, Gheddar L, Kintz P, Knapp A, Larabi IA, Alvarez JC. Analysis of pharmaceutical products and dietary supplements seized from the black market among bodybuilders. Forensic Sci Int 2021; 322:110771. [PMID: 33838562 DOI: 10.1016/j.forsciint.2021.110771] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 02/02/2023]
Abstract
Substandard/counterfeit drugs are a growing global problem. According to the World Health Organisation, counterfeit medicines are medicines that are mislabelled deliberately and fraudulently regarding their identity and/or source. In high income countries, drugs seized are mainly represented by performance and image enhancing drugs (PIEDs). The aim of this study was to present the qualitative and quantitative results of toxicological analyses of pharmaceutical and dietary supplements seized from the black market among bodybuilders in France. All dietary supplements and pharmaceuticals seized from the black market and addressed to the laboratory for a qualitative and quantitative analysis between January 2016 and December 2019 were included in the study. A screening was carried out by gas chromatography-mass spectrometry and liquid chromatography-high resolution mass spectrometry. Identified compounds were quantified by liquid chromatography-tandem mass spectrometry. One hundred and ten products were seized and submitted to the laboratory for identification of active compounds and quantification: 75 pharmaceuticals and 35 dietary supplements. This included 39 oily and 3 aqueous solutions for intramuscular injection, 34 tablets, 13 capsules, 14 powders, 4 liquids and 3 lyophilizates. Among the pharmaceuticals, 25/75 (33%) were substandard (dosage not on the acceptable range defined for original products), 24/75 (32%) were counterfeit (qualitative formulation does not match the label) and 14/75 (19%) were original (qualitative formulation and levels of active ingredients fully matches the declared formulation. The analysis of the 12 remaining products revealed a correct qualitative content for 11/75 (15%), but quantitation could not be carried out because of the lack of reference standards at the time of the analysis. Fifty-four pharmaceuticals contained anabolic-androgenic steroids (AAS). Four out of 54 (7.4%) AAS were found as original, 8/54 (15%) could not be quantified (one with wrong active ingredient), corresponding to 43/54 (80%) AAS being non-original. In contrast, only 1/35 dietary supplement (3%) was adulterated, with a doping substance (1,3-dimethylbutylamine, DMBA). This work allows to show that France is not spared by the trafficking of PIEDs. The use of counterfeit drugs in mainstream population is an underestimated public health issue.
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Affiliation(s)
- Nicolas Fabresse
- Laboratoire de Pharmacologie - Toxicologie, Centre Hospitalier Universitaire Raymond Poincaré, FHU Sepsis, AP-HP, 104 boulevard Raymond Poincaré, 92380 Garches, France; Plateforme de Spectrométrie de Masse MassSpecLab, INSERM UMR 1173, UFR des Sciences de la Santé Simone Veil, Université Paris-Saclay (Versailles Saint-Quentin-en-Yvelines), 2 avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France
| | | | - Pascal Kintz
- Institut de médecine légale, Strasbourg, France; X-Pertise Consulting, Mittelhausbergen, France
| | - Adeline Knapp
- Laboratoire de Pharmacologie - Toxicologie, Centre Hospitalier Universitaire Raymond Poincaré, FHU Sepsis, AP-HP, 104 boulevard Raymond Poincaré, 92380 Garches, France
| | - Islam Amine Larabi
- Laboratoire de Pharmacologie - Toxicologie, Centre Hospitalier Universitaire Raymond Poincaré, FHU Sepsis, AP-HP, 104 boulevard Raymond Poincaré, 92380 Garches, France
| | - Jean-Claude Alvarez
- Laboratoire de Pharmacologie - Toxicologie, Centre Hospitalier Universitaire Raymond Poincaré, FHU Sepsis, AP-HP, 104 boulevard Raymond Poincaré, 92380 Garches, France; Plateforme de Spectrométrie de Masse MassSpecLab, INSERM UMR 1173, UFR des Sciences de la Santé Simone Veil, Université Paris-Saclay (Versailles Saint-Quentin-en-Yvelines), 2 avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France.
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14
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Harvey O, Parrish M, van Teijlingen E, Trenoweth S. Support for non-prescribed anabolic androgenic steroids users: a qualitative exploration of their needs. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2019.1705763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Orlanda Harvey
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Margarete Parrish
- Department of Sociology and Social Work, Bournemouth University, Bournemouth, UK
| | | | - Steve Trenoweth
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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15
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Osterman S, Gray VB, Loy M, Coffey AB, Smallwood K, Barrack MT. Prioritized Dietary Supplement Information Needs of 307 NCAA Division I Student Athletes. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:867-873. [PMID: 32059834 PMCID: PMC7735714 DOI: 10.1016/j.jneb.2020.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate dietary supplement information needs among collegiate athletes. METHODS Three hundred seven (n = 154 male; n = 153 female) student athletes participating in a National Collegiate Athletic Association Division I team completed a dietary supplement survey. Qualitative coding addressed open-ended responses, and chi-square test of independence explored differences among athlete subgroups. RESULTS Five themes representing athletes' information needs included quality/composition (53.5%; n = 77), general information (31.9%; n = 46), nutrition information (30.6%; n = 44), performance (18.8%; n = 27), and body composition (13.2%; n = 19). Athletes with "no" or "minimal" (n = 63), vs "moderate" or "strong" (n = 195), perceived knowledge of supplement safety were more likely to list a question about supplement quality or composition (34.9% [n = 22/63] vs 21.5% [n= 42/195]; P = .03; chi-square = 4.6). CONCLUSIONS AND IMPLICATIONS Further research is needed to corroborate findings to inform educational efforts and promote safe and effective use of dietary supplements by student athletes.
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Affiliation(s)
- Sarah Osterman
- Department of Family and Consumer Sciences, California State University, Long Beach, CA
| | - Virginia B Gray
- Department of Family and Consumer Sciences, California State University, Long Beach, CA
| | - Michelle Loy
- Division of Natural Sciences, Fullerton College, Fullerton, CA
| | - Alaina B Coffey
- Department of Family and Consumer Sciences, California State University, Long Beach, CA
| | - Kelly Smallwood
- Department of Family and Consumer Sciences, California State University, Long Beach, CA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, CA.
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16
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Severe Acquired Hypokalemic Paralysis in a Bodybuilder After Self-Medication With Triamterene/Hydrochlorothiazide. Clin J Sport Med 2020; 30:e172-e174. [PMID: 31770156 DOI: 10.1097/jsm.0000000000000763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Severe hypokalemia with severe neurological impairment and electrocardiogram (ECG) abnormalities due to the misuse of triamterene/hydrochlorothiazide (HCTZ) in a bodybuilder has not yet been reported. CASE REPORT A 22-year-old bodybuilder developed acute generalized muscle cramps, sensory disturbance of the distal lower and upper limbs, quadriparesis, and urinary retention. These abnormalities were attributed to severe hypokalemia of 1.8 mmol/L (normal range 3.4-4.5 mmol/L) due to misuse of triamterene/HCTZ together with fluid restriction. He was cardiologically asymptomatic, but ECG revealed a corrected QT (QTc) interval of 625 ms. On intravenous application of fluids along with intravenous and oral substitution of potassium, his condition rapidly improved, such that the sensory disturbances, quadriparesis, and bladder dysfunction completely resolved within 2 days after admission. CONCLUSIONS Self-medication with diuretics along with fluid restriction may result in severe hypokalemia, paralysis, and ECG abnormalities. Those responsible for the management of bodybuilding studios and competitions must be aware of the potential severe health threats caused by self-medication with diuretics and anabolic steroids. Although triamterene is potassium-sparing, it may enhance the potassium-lowering effect of HCTZ.
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17
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Melhem AJ, Araújo AC, Figueiredo FNS, Figueiredo DLA. Acute Myocardial Infarction in a Young Bodybuilder: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924796. [PMID: 32848124 PMCID: PMC7476749 DOI: 10.12659/ajcr.924796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Patient: Male, 26-year-old Final Diagnosis: Myocardial infarction Symptoms: Chest pain Medication: — Clinical Procedure: — Specialty: Cardiology • Endocrinology and Metabolic
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Affiliation(s)
- Abrão José Melhem
- Department of Medicine, Midwest State University of Paraná-UNICENTRO, Guarapuava, PR, Brazil
| | - Amélia Cristina Araújo
- Department of Medicine, Midwest State University of Paraná-UNICENTRO, Guarapuava, PR, Brazil.,Department of Cardiology, São Vicente Hospital, Guarapuava, PR, Brazil
| | - Felipe Nathan S Figueiredo
- Department of Medicine, Midwest State University of Paraná-UNICENTRO, Guarapuava, PR, Brazil.,Department of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - David Livingstone A Figueiredo
- Department of Medicine, Midwest State University of Paraná-UNICENTRO, Guarapuava, PR, Brazil.,Institute for Cancer Research, IPEC, Guarapuava, PR, Brazil
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18
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Mullen C, Whalley BJ, Schifano F, Baker JS. Anabolic androgenic steroid abuse in the United Kingdom: An update. Br J Pharmacol 2020; 177:2180-2198. [PMID: 31989581 PMCID: PMC7174889 DOI: 10.1111/bph.14995] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/03/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Abstract
Anabolic androgenic steroids (AASs) are prescribed for medical conditions related to low testosterone. Abuse of AASs has surged as they become recognised as potent image enhancement drugs. The primary goal of most abusers is to obtain a more attractive outward appearance. Abuse is complex. There are a vast range of AAS substances illegally available, the nature of their true composition is difficult to evaluate. Users follow dosing patterns which incorporate a number of different AASs, in addition to other pharmaceutical substances believed to complement the desired physical effects or manage unwanted effects. Animal work and medical case reports suggest potential to cause serious hepatotoxicity, plus possible neurotoxicity, nephrotoxicity and damage to the cardiovascular and reproductive systems. As the long-term AASs users reach maturity, further controlled experimentation, with larger sample sizes, is required. Data gathering should be directed towards the most vulnerable group of AAS users, females and adolescent boys.
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Affiliation(s)
- Carrie Mullen
- School of Computing, Engineering and Physical SciencesUniversity of the West of ScotlandPaisleyUK
| | - Benjamin J. Whalley
- School of Chemistry, Food and Nutritional Sciences, and PharmacyThe University of ReadingReadingUK
| | - Fabrizio Schifano
- School of Life and Medical SciencesUniversity of HertfordshireHatfieldUK
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and HealthHong Kong Baptist UniversityKowloon TongHong Kong
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19
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Ketheeswaran S, Haahr T, Povlsen B, Laursen R, Alsbjerg B, Elbaek H, Esteves SC, Humaidan P. Protein supplementation intake for bodybuilding and resistance training may impact sperm quality of subfertile men undergoing fertility treatment: a pilot study. Asian J Androl 2020; 21:208-211. [PMID: 30226218 PMCID: PMC6413551 DOI: 10.4103/aja.aja_49_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Shathmigha Ketheeswaran
- The Fertility Clinic Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark.,Faculty of Health, Aarhus University, Aarhus C 8000, Denmark
| | - Thor Haahr
- The Fertility Clinic Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark.,Faculty of Health, Aarhus University, Aarhus C 8000, Denmark
| | - Betina Povlsen
- The Fertility Clinic Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark
| | - Rita Laursen
- The Fertility Clinic Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark
| | - Birgit Alsbjerg
- The Fertility Clinic Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark
| | - Helle Elbaek
- The Fertility Clinic Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark
| | - Sandro C Esteves
- Faculty of Health, Aarhus University, Aarhus C 8000, Denmark.,ANDROFERT, Center for Male Reproduction, Campinas 13075-460, Brazil.,Department of Surgery, Division of Urology, University of Campinas (UNICAMP), Campinas 13083-887, Brazil
| | - Peter Humaidan
- The Fertility Clinic Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark.,Faculty of Health, Aarhus University, Aarhus C 8000, Denmark
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20
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Waller CC, Weththasinghe SA, McClure L, Cawley AT, Suann C, Suann E, Sutherland E, Cooper E, Heather A, McLeod MD. In vivo
metabolism of the designer anabolic steroid hemapolin in the thoroughbred horse. Drug Test Anal 2020; 12:752-762. [DOI: 10.1002/dta.2769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Lauren McClure
- Australian Racing Forensic Laboratory Racing NSW Sydney Australia
| | - Adam T. Cawley
- Australian Racing Forensic Laboratory Racing NSW Sydney Australia
| | - Craig Suann
- Australian Racing Forensic Laboratory Racing NSW Sydney Australia
| | - Emily Suann
- Australian Racing Forensic Laboratory Racing NSW Sydney Australia
| | - Emma Sutherland
- Department of Physiology, School of Biomedical Sciences University of Otago Dunedin New Zealand
| | - Elliot Cooper
- Department of Physiology, School of Biomedical Sciences University of Otago Dunedin New Zealand
| | - Alison Heather
- Department of Physiology, School of Biomedical Sciences University of Otago Dunedin New Zealand
| | - Malcolm D. McLeod
- Research School of Chemistry Australian National University Canberra Australia
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21
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Barrack MT, Muster M, Nguyen J, Rafferty A, Lisagor T. An Investigation of Habitual Dietary Supplement Use Among 557 NCAA Division I Athletes. J Am Coll Nutr 2020; 39:619-627. [PMID: 31935156 DOI: 10.1080/07315724.2020.1713247] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Supplements may expose athletes to dangerous ingredients, banned substances, toxins or contaminants; however, few investigations assess use among collegiate athletes in the U.S.Objective: This cross-sectional study evaluated habitual dietary supplement intake, defined use ≥2 days/week over the past year, in NCAA Division I athletes.Methods: Male and female members of a NCAA Division I team, at two universities in southern California completed a 13-item survey. Among 705 eligible participants, 596 submitted surveys (84.5% response rate), 557 surveys included complete data. Chi-square (χ2) analyses evaluated differences among athletes based on sex, weight status, year in college, and sport-type. Independent t-test or ANOVA evaluated mean differences for continuous variables.Results: A total of 45.2% athletes (n = 252) reported taking supplements (≥2 days/week over the past year). Vitamin/minerals (25.5%, n = 142), protein/amino acids (24.6%, n = 137) were used most frequently. Male, vs female athletes, took more supplements overall (1.2 ± 0.1 vs 0.8 ± 0.1, p = 0.004) and indicated higher use of protein/amino acid products (34.2% vs 13.5%, p < 0.005), whereas, females reported higher use of vitamin/minerals (30.5% vs 21.1%, p < 0.05). Higher supplement use was also reported by athletes with BMI ≥ 30.0 kg/m2 (vs <30 kg/m2, 1.9 ± 0.3 vs 1.0 ± 0.1, p = 0.02), and athletes in ≥ third college year (vs first or second year, 1.2 ± 0.1 vs 0.9 ± 0.1, p = 0.03).Conclusions: Nearly half of NCAA athletes reported habitual supplements use, with significant variation in patterns based on sex, sport-type, year in college, and weight status.
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Affiliation(s)
- Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California, USA
| | - Mark Muster
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California, USA
| | - Jennifer Nguyen
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California, USA
| | - Aaron Rafferty
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California, USA
| | - Terri Lisagor
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California, USA
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22
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Sassone J, Muster M, Barrack MT. Prevalence and Predictors of Higher-Risk Supplement Use Among Collegiate Athletes. J Strength Cond Res 2019; 33:443-450. [PMID: 30531412 DOI: 10.1519/jsc.0000000000002979] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Sassone, J, Muster, M, and Barrack, MT. Prevalence and predictors of higher-risk supplement use among National Collegiate Athletic Association Division I athletes. J Strength Cond Res 33(2): 443-450, 2019-This study aimed to identify the prevalence and predictors associated with the use of higher-risk dietary supplements, defined as supplements containing herbal ingredients, caffeine, or those classified for weight loss, muscle-building, or as a preworkout supplement, among 557 National Collegiate Athletic Association Division I male and female collegiate athletes. Although 252 (45.2%) athletes reported the use of a dietary supplement on ≥2 days per week over the past year, 46 (8.3%) athletes met criteria for higher-risk supplement use. Twenty (3.6%) athletes reported the use of herbal, 1 (0.2%) caffeinated, 5 (0.9%) weight loss, 28 (5.0%) preworkout, and 1 (0.2%) muscle-building supplements. Body mass index status (BMI ≥30 kg·m), sport-type (sports using the phosphocreatine energy system), and college year (≥4th year) were associated with the use of preworkout, muscle-building, or herbal supplements. A multiple regression analysis identified predictors of higher-risk supplement use including the number of dietary supplements used in the past year (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.7-2.7, p < 0.001), the reported motivation of taking dietary supplements to gain muscle and lose body fat (OR = 3.5, 95% CI = 1.1-11.7, p = 0.04), and the motivation to increase athletic endurance (OR = 3.5, 95% CI = 4.0, 95% CI = 1.6-9.9, p < 0.005). These factors may be considered as a part of a screening process to evaluate athletes with an increased risk of higher-risk supplement use and potential consequences to health or eligibility status.
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Affiliation(s)
- John Sassone
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California
| | - Mark Muster
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California
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23
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Lorenz LM, Toomey VM, Lanzarotta AC, Flurer RA, Falconer TM. Identification of the designer steroid Androsta-3,5-diene-7,17-dione in a dietary supplement. Drug Test Anal 2019; 11:1109-1115. [PMID: 30892803 DOI: 10.1002/dta.2589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/09/2022]
Abstract
A liquid chromatography-mass spectrometry (LC-MS) screen for known anabolic-androgenic steroids in a dietary supplement product marketed for "performance enhancement" detected an unknown compound having steroid-like spectral characteristics. The compound was isolated using high performance liquid chromatography with ultraviolet detection (HPLC-UV) coupled with an analytical scale fraction collector. After the compound was isolated, it was then characterized using gas chromatography with simultaneous Fourier Transform infrared detection and mass spectrometry (GC-FT-IR-MS), liquid chromatography-high resolution accurate mass-mass spectrometry (LC-HRAM-MS) and nuclear magnetic resonance (NMR). The steroid had an accurate mass of m/z 285.1847 (error-0.57 ppm) for the protonated species [M + H]+ , corresponding to a molecular formula of C19 H24 O2 . Based on the GC-FT-IR-MS data, NMR data, and accurate mass, the compound was identified as androsta-3,5-diene-7,17-dione. Although this is not the first reported identification of this designer steroid in a dietary supplement, the data provided adds information for identification of this compound not previously reported. This compound was subsequently detected in another dietary supplement product, which contained three additional active ingredients.
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Affiliation(s)
- Lisa M Lorenz
- U.S. Food and Drug Administration, Forensic Chemistry Center, Cincinnati, OH, United States
| | - Valerie M Toomey
- U.S. Food and Drug Administration, Forensic Chemistry Center, Cincinnati, OH, United States
| | - Adam C Lanzarotta
- U.S. Food and Drug Administration, Forensic Chemistry Center, Cincinnati, OH, United States
| | - Rick A Flurer
- U.S. Food and Drug Administration, Forensic Chemistry Center, Cincinnati, OH, United States
| | - Travis M Falconer
- U.S. Food and Drug Administration, Forensic Chemistry Center, Cincinnati, OH, United States
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24
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Stolz A, Navarro V, Hayashi PH, Fontana RJ, Barnhart HX, Gu J, Chalasani NP, Vega MM, Bonkovsky HL, Seeff LB, Serrano J, Avula B, Khan I, Cirulli ET, Kleiner DE, Hoofnagle JH. Severe and protracted cholestasis in 44 young men taking bodybuilding supplements: assessment of genetic, clinical and chemical risk factors. Aliment Pharmacol Ther 2019; 49:1195-1204. [PMID: 30934130 PMCID: PMC6682544 DOI: 10.1111/apt.15211] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/02/2019] [Accepted: 02/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bodybuilding supplements can cause a profound cholestatic syndrome. AIM To describe the drug-Induced liver injury network's experience with liver injury due to bodybuilding supplements. METHODS Liver injury pattern, severity and outcomes, potential genetic associations, and exposure to anabolic steroids by product analysis were analysed in prospectively enrolled subjects with bodybuilding supplement-induced liver injury with causality scores of probable or higher. RESULTS Forty-four males (mean age 33 years) developed liver injury with a median latency of 73 days. Forty-one per cent presented with hepatocellular pattern of liver injury as defined by the R > 5 ([Fold elevation of ALT] ÷ [Fold elevation of Alk Phos] (mean, range = 6.4, 0.5-31.4, n = 42) despite all presenting with clinical features of cholestatic liver injury (100% with jaundice and 84% with pruritus). Liver biopsy (59% of subjects) demonstrated a mild hepatitis and profound cholestasis in most without bile duct injury, loss or fibrosis. Seventy-one per cent were hospitalised, and none died or required liver transplantation. In some, chemical analysis revealed anabolic steroid controlled substances not listed on the label. No enrichment of genetic variants associated with cholestatic syndromes was found, although mutations in ABCB11 (present in up to 20%) were significantly different than in ethnically matched controls. CONCLUSIONS Patients with bodybuilding supplements liver injury uniformly presented with cholestatic injury, which slowly resolved. The ingested products often contained anabolic steroids not identified on the label, and no enrichment in genetic variants was found, indicating a need for additional studies.
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Affiliation(s)
- Andrew Stolz
- University of Southern California, Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | - Jose Serrano
- Liver Diseases Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Bharathi Avula
- National Center for Natural Product Research, School of Pharmacy, University of Mississippi, University, MS
| | - Ikhlas Khan
- National Center for Natural Product Research, School of Pharmacy, University of Mississippi, University, MS
| | | | - David E. Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Jay H. Hoofnagle
- Liver Diseases Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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25
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Garcia-Argibay M. The Relationship Between the Big Five Personality Traits, Impulsivity, and Anabolic Steroid Use. Subst Use Misuse 2019; 54:236-246. [PMID: 30375916 DOI: 10.1080/10826084.2018.1512630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The increase in the prevalence of anabolic-androgenic steroids (AAS) use has been the subject of study in the last decades. Several studies indicated a strong association between the use of AAS and the performance of risky behaviors mediated by factors such as aggression, impulsivity, depression, and anxiety. OBJECTIVE This study aimed to identify differences in personality trait, impulsivity, and the ability to delay gratification between AAS users and non-users that predispose or serve as a buffering mechanism against its usage and whether it is related to an increased likelihood of engaging in infidelity. METHODS Two hundred and twelve male volunteers (88 AAS users), aged between 21 and 36 years (M = 28.22), completed self-report measures of personality, impulsivity, delayed gratification, and attitudes toward infidelity. Multivariate analysis of variance and logistic regression were conducted to establish differences between AAS users and non-users. RESULTS The results showed that AAS users displayed an inability to delay gratification, a greater impulsivity, and a more benevolent attitude toward infidelity. AAS users obtained higher scores on openness and neuroticism, which was larger "off-cycle," although they presented lower scores on extraversion compared to the non-users group. Regression analysis revealed that neuroticism, impulsivity, and delaying gratification scores were significant predictors of AAS usage. In addition, impulsivity functioned as a partial mediator in the relationship between neuroticism and AAS use. CONCLUSION The results of this research highlight a pivotal implication of impulsivity in AAS use in conjunction with neuroticism, openness, and extraversion traits.
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Affiliation(s)
- Miguel Garcia-Argibay
- a Department of Behavioral Science, Faculty of Psychology , National University of Distance Education (UNED) , Madrid , Spain
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26
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Magnetic dispersive solid phase microextraction technique coupled with LC–MS/MS for evaluating content versus label claims in ephedrine-free food supplements. J Verbrauch Lebensm 2018. [DOI: 10.1007/s00003-018-1203-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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27
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Heidet M, Abdel Wahab A, Ebadi V, Cogne Y, Chollet-Xemard C, Khellaf M. Severe Hypoglycemia Due to Cryptic Insulin Use in a Bodybuilder. J Emerg Med 2018; 56:279-281. [PMID: 30527564 DOI: 10.1016/j.jemermed.2018.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bodybuilding is a demanding sport, which requires high-volume, high-resistance weight training and augmented nutritional intake, toward an increase of overall body muscle mass accompanied by an overall decrease of body fat percentage and mass. Among bodybuilders, the use of various legal and illegal supplements is common. These supplements may be naturally occurring or man-made. CASE REPORT We discuss the case of a 30-year-old male bodybuilder presenting with coma due to severe hypoglycemia from unknown cause, necessitating iterative glucose infusions, which was subsequently found to be related to cryptic insulin injections. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In strength athletes, especially amateurs, the recourse to performance-enhancement drugs (e.g., insulin) is frequent. Beyond the specificity of care required for surreptitious insulin intoxication, emergency physicians should be alert to the possibility that exogenous insulin has been injected for use as an ergogenic aid by bodybuilders and others seeking to increase their body muscle mass when they encounter a patient with a decreased level of consciousness and treatment-refractory hypoglycemia. Moreover, in case of suspicion of such intoxication, the use of other illegal supplements should be screened, due to potentially associated risks of complication.
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Affiliation(s)
- Matthieu Heidet
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France; Université Paris-Est Créteil, Créteil, France
| | - Abdel Abdel Wahab
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Vahid Ebadi
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service d'Accueil des Urgences, Créteil, France
| | - Yann Cogne
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service d'Accueil des Urgences, Créteil, France
| | | | - Mehdi Khellaf
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service d'Accueil des Urgences, Créteil, France; Université Paris-Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Créteil, France
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28
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Holubová B, Mikšátková P, Kuchař M, Karamonová L, Lapčík O, Fukal L. Immunochemical techniques for anabolic androgenic steroid: matrix effects study for food supplements. Eur Food Res Technol 2018. [DOI: 10.1007/s00217-018-3204-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Tircova B, Bosakova Z, Kozlik P. Development of an ultra-high performance liquid chromatography-tandem mass spectrometry method for the determination of anabolic steroids currently available on the black market in the Czech Republic and Slovakia. Drug Test Anal 2018; 11:355-360. [DOI: 10.1002/dta.2541] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Barbora Tircova
- Department of Chemistry, Faculty of Natural Science; Matej Bel University in Banska Bystrica; Banska Bystrica Slovakia
| | - Zuzana Bosakova
- Department of Analytical Chemistry, Faculty of Science; Charles University; Prague Czech Republic
| | - Petr Kozlik
- Department of Analytical Chemistry, Faculty of Science; Charles University; Prague Czech Republic
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Voelker SE, Lorenz LM, Litzau JJ. Semi‐quantitative determination of designer steroids by high‐performance liquid chromatography with ultraviolet detection in the absence of reference material. Drug Test Anal 2018; 11:428-434. [DOI: 10.1002/dta.2511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Sarah E. Voelker
- U.S. Food and Drug AdministrationForensic Chemistry Center 6751 Steger Drive Cincinnati OH 45237 USA
| | - Lisa M. Lorenz
- U.S. Food and Drug AdministrationForensic Chemistry Center 6751 Steger Drive Cincinnati OH 45237 USA
| | - Jonathan J. Litzau
- U.S. Food and Drug AdministrationForensic Chemistry Center 6751 Steger Drive Cincinnati OH 45237 USA
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Tsarouhas K, Kioukia-Fougia N, Papalexis P, Tsatsakis A, Kouretas D, Bacopoulou F, Tsitsimpikou C. Use of nutritional supplements contaminated with banned doping substances by recreational adolescent athletes in Athens, Greece. Food Chem Toxicol 2018; 115:447-450. [PMID: 29621580 DOI: 10.1016/j.fct.2018.03.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 01/03/2023]
Abstract
Although the use of nutritional supplements by adult athletes has been extensively studied, information on supplements consumption by adolescent athletes is still limited. The present study reports on the use of nutritional supplements contaminated with banned doping substances among 170 recreational adolescent athletes from eleven, randomly selected, gym centres, in Athens, Greece. Nutritional supplements consumption was reported by almost 60% of the study population, with proteins/amino acids and vitamins being the most popular. Nine per cent of the users were found to consume nutritional supplements contaminated with anabolic steroids, prohormones, selective androgen receptor modulators (SARMs) and aromatase inhibitors, all pharmacological substances with endocrine modulating properties not stated on the label. None of these individuals had previously consulted a physician or a nutritionist. A representative sample (ca 15%) of the protein/aminoacids and creatine preparations used by the study population were also tested and found free from doping substances. The majority (63%) of adolescents purchased products from the internet. In conclusion, exercising adolescents can have easy access to contaminated nutritional supplements and "black market" products, which could constitute a risk for public health. Low level of awareness and low involvement of medical care professionals among recreational adolescent athletes is also observed.
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Affiliation(s)
- Konstantinos Tsarouhas
- Department of Cardiology, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece
| | - Nassia Kioukia-Fougia
- Doping Control Laboratory of Athens, OAKA "Sp.Louis", Kiffisias 37, Maroussi 15223, Greece
| | - Petros Papalexis
- Spiliopoulio General Hospital "Agia Eleni", 21st Dim. Soutsou Str., Ampelokipi, Athens 11521, Greece
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion 71003, Greece
| | - Dimitrios Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
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Sýkorová S, Fojtíková L, Kuchař M, Mikšátková P, Karamonová L, Fukal L, Lapčík O, Holubová B. Sensitive enzyme immunoassay for screening methandienone in dietary supplements. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2018; 35:1653-1661. [PMID: 29601260 DOI: 10.1080/19440049.2018.1459876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Methandienone is a synthetic exogenous steroid which, like other anabolic steroids, is strictly regulated in many countries. In recent years, increasing numbers have been detected of illegal additions into dietary supplements of methandienone and other anabolic androgenic steroids (AAS). In this work, a competitive indirect enzyme-linked immunosorbent assay (ELISA) has been constructed for the detection of methandienone using an antiserum against methandienone. Under optimal experimental conditions, the ELISA achieved a limit of detection of 0.04 ± 0.01 µg.g-1. The obtained intra- and inter-day coefficients of variation were less than 8%. The developed ELISA was applied in the analysis of real dietary supplement samples. To minimise the effect of the sample matrix, the sample extracts were simply diluted before addition into the immunoassay. The achieved recovery values were around 100%. Results obtained from the ELISA correlated well, both in terms of accuracy and precision, with those obtained by UHPLC-MS/MS (reference method). The presented ELISA could be successfully applied for the simple screening of dietary supplements.
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Affiliation(s)
- Sandra Sýkorová
- a Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology , University of Chemistry and Technology Prague , Prague , Czech Republic
| | - Lucie Fojtíková
- a Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology , University of Chemistry and Technology Prague , Prague , Czech Republic
| | - Martin Kuchař
- b Department of Chemistry of Natural Compounds, Faculty of Food and Biochemical Technology , University of Chemistry and Technology Prague , Prague , Czech Republic
| | - Petra Mikšátková
- b Department of Chemistry of Natural Compounds, Faculty of Food and Biochemical Technology , University of Chemistry and Technology Prague , Prague , Czech Republic
| | - Ludmila Karamonová
- a Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology , University of Chemistry and Technology Prague , Prague , Czech Republic
| | - Ladislav Fukal
- a Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology , University of Chemistry and Technology Prague , Prague , Czech Republic
| | - Oldřich Lapčík
- b Department of Chemistry of Natural Compounds, Faculty of Food and Biochemical Technology , University of Chemistry and Technology Prague , Prague , Czech Republic
| | - Barbora Holubová
- a Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology , University of Chemistry and Technology Prague , Prague , Czech Republic
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Hildebrandt T, Heywood A, Wesley D, Schulz K. Defining the Construct of Synthetic Androgen Intoxication: An Application of General Brain Arousal. Front Psychol 2018; 9:390. [PMID: 29651261 PMCID: PMC5885244 DOI: 10.3389/fpsyg.2018.00390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/08/2018] [Indexed: 01/01/2023] Open
Abstract
Synthetic androgens (i. e., anabolic-androgenic steroids) are the primary component to the majority of problematic appearance and performance enhancing drug (APED) use. Despite evidence that these substances are associated with increased risk for aggression, violence, body image disturbances, and polypharmacy and can develop a pattern of chronic use consistent with drug dependence, there are no formal definitions of androgen intoxication. Consequently, the purpose of this paper is to establish a testable theory of androgen intoxication. We present evidence and theorize that synthetic androgen intoxication can be defined by a pattern of poor self-regulation characterized by increased propensity for a range of behaviors (e.g., aggression, sex, drug seeking, exercise, etc.) via androgen mediated effects on general brain arousal. This theory posits that androgens reduce threshold for emotional reactivity, motor response, and alertness to sensory stimuli and disrupt inhibitory control over the behaviors associated with synthetic androgen use. These changes result from alteration to basic neurocircuitry that amplifies limbic activation and reduces top-down cortical control. The implications for this definition are to inform APED specific hypotheses about the behavioral and psychological effects of APED use and provide a basis for establishing clinical, legal, and public health guidelines to address the use and misuse of these substances.
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Affiliation(s)
- Tom Hildebrandt
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashley Heywood
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daniel Wesley
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kurt Schulz
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Monitoring of essential and toxic elements in multi-ingredient food supplements produced in European Union. J Verbrauch Lebensm 2018. [DOI: 10.1007/s00003-018-1148-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Evans-Brown M, Sedefov R. Responding to New Psychoactive Substances in the European Union: Early Warning, Risk Assessment, and Control Measures. Handb Exp Pharmacol 2018; 252:3-49. [PMID: 30194542 DOI: 10.1007/164_2018_160] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
New psychoactive substances (NPS) are drugs that are not controlled by the United Nations international drug control conventions of 1961 and 1971 but that may pose similar threats to public health. Many of them are traded as "legal" replacements to controlled drugs such as cannabis, heroin, benzodiazepines, cocaine, amphetamines, and 3,4-methylenedioxymethamphetamine (MDMA). Driven by globalization, there has been a large increase in the availability and, subsequently, harms caused by these substances over the last decade in Europe. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is monitoring more than 670 NPS that have appeared on Europe's drug market in the last 20 years, of which almost 90% have appeared in the last decade. While some recent policy responses have been successful in reducing availability and sales of these substances in some settings - such as "legal highs" and "research chemicals" sold openly in the high street and online - and there are signs that growth in the market is slowing, new challenges have emerged. This includes monitoring a growing number of highly potent substances - including 179 synthetic cannabinoid receptor agonists and 28 fentanils - that can pose a high risk of life-threatening poisoning to users and can cause explosive outbreaks. This chapter briefly traces the origins of NPS, provides an overview of the situation in Europe, and discusses the work of the EMCDDA as part of a legal framework of early warning, risk assessment, and control measures that allows the European Union to rapidly detect, assess, and respond to public health and social threats caused by these substances.
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Affiliation(s)
| | - Roumen Sedefov
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
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Mamoojee Y, Ganguri M, Taylor N, Quinton R. Clinical Case Seminar: Postmenopausal androgen excess-challenges in diagnostic work-up and management of ovarian thecosis. Clin Endocrinol (Oxf) 2018; 88:13-20. [PMID: 28980338 DOI: 10.1111/cen.13492] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/19/2017] [Accepted: 09/29/2017] [Indexed: 02/06/2023]
Abstract
Postmenopausal hyperandrogenism can be tumour- or non-tumour-related, with pathology residing either in the ovary or adrenal gland(s). The tempo of investigation is determined by the clinical severity of hyperandrogenism (presence/absence of actual virilisation) and degree of serum testosterone elevation. When clinical or biochemical hyperandrogenism is severe, rapidly developing, or associated with hypercortisolism, screening for adrenocortical or ovarian carcinoma with cross-sectional imaging should be prioritised over detailed biochemical evaluation. Adrenal hyperandrogenism is readily characterised, both biochemically and radiologically. By contrast, even a combination of high-resolution imaging with laboratory evaluation, including dynamic endocrine testing, often cannot distinguish between ovarian hyperthecosis (OH) and virilising ovarian tumour (VOT); a definitive diagnosis usually emerging only after histological examination of excised ovaries. VOTs are typically below the resolution-limit of current imaging modalities and exhibit suppression of gonadotropin-dependent androgen secretion with GnRH-analogue therapy. Thus, for well-characterised ovarian hyperandrogenism, laparoscopic bilateral salpingo-oophorectomy may serve both as a diagnostic and therapeutic procedure. Nevertheless, women unable or unwilling to undergo ovarian surgery can be reassured that malignant VOTs are exceedingly rare and that long-term medical therapy with oral antiandrogens or GnRH-analogues is safe and well-tolerated. OH is strongly associated with insulin-resistance, with hyperinsulinaemia acting synergistically with raised gonadotropin levels to stimulate thecal cell hyperplasia and androgen secretion by the postmenopausal ovary, which lacks granulosa cell aromatase activity and thus cannot convert testosterone to 17 beta estradiol. Thus, features of metabolic syndrome may indicate OH, and significant reductions in androgens can thereby potentially be achieved with lifestyle measures and/or insulin-sensitising drugs.
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Affiliation(s)
- Yaasir Mamoojee
- Department of Endocrinology, Newcastle-upon-Tyne Hospitals, Newcastle Upon Tyne, UK
| | - Murali Ganguri
- Department of Endocrinology, Newcastle-upon-Tyne Hospitals, Newcastle Upon Tyne, UK
| | - Norman Taylor
- Steroid Laboratory, Kings College Hospital, London, UK
| | - Richard Quinton
- Department of Endocrinology, Newcastle-upon-Tyne Hospitals, Newcastle Upon Tyne, UK
- Institute of Genetic Medicine, University of Newcastle-upon-Tyne, Newcastle Upon Tyne, UK
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Van Wagoner RM, Eichner A, Bhasin S, Deuster PA, Eichner D. Chemical Composition and Labeling of Substances Marketed as Selective Androgen Receptor Modulators and Sold via the Internet. JAMA 2017; 318:2004-2010. [PMID: 29183075 PMCID: PMC5820696 DOI: 10.1001/jama.2017.17069] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Recent reports have described the increasing use of nonsteroidal selective androgen receptor modulators, which have not been approved by the US Food and Drug Administration (FDA), to enhance appearance and performance. The composition and purity of such products is not known. OBJECTIVE To determine the chemical identity and the amounts of ingredients in dietary supplements and products marketed and sold through the internet as selective androgen receptor modulators and compare the analyzed contents with product labels. DESIGN AND SETTING Web-based searches were performed from February 18, 2016, to March 25, 2016, using the Google search engine on the Chrome and Internet Explorer web browsers to identify suppliers selling selective androgen receptor modulators. The products were purchased and the identities of the compounds and their amounts were determined from April to August 2016 using chain-of-custody and World Anti-Doping Association-approved analytical procedures. Analytical findings were compared against the label information. EXPOSURES Products marketed and sold as selective androgen receptor modulators. MAIN OUTCOMES AND MEASURES Chemical identities and the amount of ingredients in each product marketed and sold as selective androgen receptor modulators. RESULTS Among 44 products marketed and sold as selective androgen receptor modulators, only 23 (52%) contained 1 or more selective androgen receptor modulators (Ostarine, LGD-4033, or Andarine). An additional 17 products (39%) contained another unapproved drug, including the growth hormone secretagogue ibutamoren, the peroxisome proliferator-activated receptor-δ agonist GW501516, and the Rev-ErbA agonist SR9009. Of the 44 tested products, no active compound was detected in 4 (9%) and substances not listed on the label were contained in 11 (25%). In only 18 of the 44 products (41%), the amount of active compound in the product matched that listed on the label. The amount of the compounds listed on the label differed substantially from that found by analysis in 26 of 44 products (59%). CONCLUSIONS AND RELEVANCE In this limited investigation involving chemical analyses of 44 products marketed as selective androgen receptor modulators and sold via the internet, most products contained unapproved drugs and substances. Only 52% contained selective androgen receptor modulators and many were inaccurately labeled.
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Affiliation(s)
| | - Amy Eichner
- US Anti-Doping Agency, Colorado Springs, Colorado
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Uniformed Services University, Bethesda, Maryland
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, Salt Lake City, Utah
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Intended or Unintended Doping? A Review of the Presence of Doping Substances in Dietary Supplements Used in Sports. Nutrients 2017; 9:nu9101093. [PMID: 28976928 PMCID: PMC5691710 DOI: 10.3390/nu9101093] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 01/29/2023] Open
Abstract
Introduction: The use of dietary supplements is increasing among athletes, year after year. Related to the high rates of use, unintentional doping occurs. Unintentional doping refers to positive anti-doping tests due to the use of any supplement containing unlisted substances banned by anti-doping regulations and organizations, such as the World Anti-Doping Agency (WADA). The objective of this review is to summarize the presence of unlabeled doping substances in dietary supplements that are used in sports. Methodology: A review of substances/metabolites/markers banned by WADA in ergonutritional supplements was completed using PubMed. The inclusion criteria were studies published up until September 2017, which analyzed the content of substances, metabolites and markers banned by WADA. Results: 446 studies were identified, 23 of which fulfilled all the inclusion criteria. In most of the studies, the purpose was to identify doping substances in dietary supplements. Discussion: Substances prohibited by WADA were found in most of the supplements analyzed in this review. Some of them were prohormones and/or stimulants. With rates of contamination between 12 and 58%, non-intentional doping is a point to take into account before establishing a supplementation program. Athletes and coaches must be aware of the problems related to the use of any contaminated supplement and should pay special attention before choosing a supplement, informing themselves fully and confirming the guarantees offered by the supplement.
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Abstract
CONTEXT With the increasing use of unregulated dietary supplements, athletes are at continued risk from adverse medical events and inadvertent doping. EVIDENCE ACQUISITION A review of Clinical Key, MEDLINE, and PubMed databases from 2012 to 2017 was performed using search terms, including dietary supplement, contamination, doping in athletes, inadvertent doping, and prohibited substances. The references of pertinent articles were reviewed for other relevant sources. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS Poor manufacturing processes and intentional contamination with many banned substances continue to occur in dietary supplements sold in the United States. Certain sectors, such as weight loss and muscle-building supplements, pose a greater threat because they are more likely to be contaminated. CONCLUSION Athletes will continue to be at risk for adverse events and failed doping tests due to contaminated dietary supplements until legislation changes how they are regulated. In the interim, there are several steps that can be taken to mitigate this risk, including improved education of medical staff and athletes and use of third party-certified products.
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Neves DBDJ, Caldas ED. GC–MS quantitative analysis of black market pharmaceutical products containing anabolic androgenic steroids seized by the Brazilian Federal Police. Forensic Sci Int 2017; 275:272-281. [DOI: 10.1016/j.forsciint.2017.03.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/10/2017] [Accepted: 03/22/2017] [Indexed: 11/25/2022]
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Kim EH, Seo HS, Ki NY, Park NH, Lee W, Do JA, Park S, Baek SY, Moon B, Oh HB, Hong J. Reliable screening and confirmation of 156 multi-class illegal adulterants in dietary supplements based on extracted common ion chromatograms by ultra-high-performance liquid chromatography-quadrupole/time of flight-mass spectrometry. J Chromatogr A 2017; 1491:43-56. [DOI: 10.1016/j.chroma.2017.02.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 01/08/2023]
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42
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Waller CC, McLeod MD. A review of designer anabolic steroids in equine sports. Drug Test Anal 2016; 9:1304-1319. [DOI: 10.1002/dta.2112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/05/2016] [Accepted: 10/07/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher C. Waller
- Research School of Chemistry; Australian National University; Canberra ACT Australia
| | - Malcolm D. McLeod
- Research School of Chemistry; Australian National University; Canberra ACT Australia
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43
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McVeigh J, Begley E. Anabolic steroids in the UK: an increasing issue for public health. DRUGS-EDUCATION PREVENTION AND POLICY 2016. [DOI: 10.1080/09687637.2016.1245713] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jim McVeigh
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Emma Begley
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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Henning A. Challenges to promoting health for amateur athletes through anti-doping policy. DRUGS-EDUCATION PREVENTION AND POLICY 2016; 24:306-313. [PMID: 28736489 DOI: 10.1080/09687637.2016.1208732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Anti-doping regulations are intended, at least in part, to promote the health of athletes. While most anti-doping efforts target elite and professional competitors, there have been recent moves by sport governing bodies to expand anti-doping testing to include amateur athletes. Drawing on previous critiques of anti-doping policies and illustrating cases, this article outlines five of the challenges to health promotion of applying the current detect and ban model to the amateur level of sport. I argue that the current approach is not effective and, in some ways, may undermine the goal of health promotion at the amateur level. In order to address these challenges, I propose alternative, health-centred strategies that focus on athlete empowerment and choice through critical awareness of a variety of substances, associated risks and rewards, and the role of expertise in decision-making.
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Affiliation(s)
- April Henning
- Behavioral Sciences Training, National Development and Research Institutes, New York, NY, USA
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Jurášek M, Göselová S, Mikšátková P, Holubová B, Vyšatová E, Kuchař M, Fukal L, Lapčík O, Drašar P. Highly sensitive avidin-biotin ELISA for detection of nandrolone and testosterone in dietary supplements. Drug Test Anal 2016; 9:553-560. [DOI: 10.1002/dta.2005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Michal Jurášek
- University of Chemistry and Technology Prague; Prague Czech Republic
| | - Sandra Göselová
- University of Chemistry and Technology Prague; Prague Czech Republic
| | - Petra Mikšátková
- University of Chemistry and Technology Prague; Prague Czech Republic
| | - Barbora Holubová
- University of Chemistry and Technology Prague; Prague Czech Republic
| | - Eva Vyšatová
- Czech Agriculture and Food Inspection Authority; Prague Czech Republic
| | - Martin Kuchař
- University of Chemistry and Technology Prague; Prague Czech Republic
| | - Ladislav Fukal
- University of Chemistry and Technology Prague; Prague Czech Republic
| | - Oldřich Lapčík
- University of Chemistry and Technology Prague; Prague Czech Republic
| | - Pavel Drašar
- University of Chemistry and Technology Prague; Prague Czech Republic
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46
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Development of Enzyme-Linked Immunosorbent Assay for Determination of Boldenone in Dietary Supplements. FOOD ANAL METHOD 2016. [DOI: 10.1007/s12161-016-0511-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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47
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Willick SE, Miller GD, Eichner D. The Anti‐Doping Movement. PM R 2016; 8:S125-32. [DOI: 10.1016/j.pmrj.2015.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Stuart E. Willick
- Physical Medicine and Rehabilitation, University of Utah Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108
| | | | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT
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48
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Avigan MI, Mozersky RP, Seeff LB. Scientific and Regulatory Perspectives in Herbal and Dietary Supplement Associated Hepatotoxicity in the United States. Int J Mol Sci 2016; 17:331. [PMID: 26950122 PMCID: PMC4813193 DOI: 10.3390/ijms17030331] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 01/06/2023] Open
Abstract
In the United States (US), the risk of hepatotoxicity linked to the widespread use of certain herbal products has gained increased attention among regulatory scientists. Based on current US law, all dietary supplements sold domestically, including botanical supplements, are regulated by the Food and Drug Administration (FDA) as a special category of foods. Under this designation, regulatory scientists do not routinely evaluate the efficacy of these products prior to their marketing, despite the content variability and phytochemical complexity that often characterizes them. Nonetheless, there has been notable progress in the development of advanced scientific methods to qualitatively and quantitatively measure ingredients and screen for contaminants and adulterants in botanical products when hepatotoxicity is recognized.
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Affiliation(s)
- Mark I Avigan
- Office of Pharmacovigilance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
| | - Robert P Mozersky
- Office of Dietary Supplement Products, Center for Food Safety and Applied Nutrition, 5100 Paint Branch Parkway, College Park, MD 20740, USA.
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49
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Thevis M, Kuuranne T, Walpurgis K, Geyer H, Schänzer W. Annual banned-substance review: analytical approaches in human sports drug testing. Drug Test Anal 2016; 8:7-29. [PMID: 26767774 DOI: 10.1002/dta.1928] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 12/30/2022]
Abstract
The aim of improving anti-doping efforts is predicated on several different pillars, including, amongst others, optimized analytical methods. These commonly result from exploiting most recent developments in analytical instrumentation as well as research data on elite athletes' physiology in general, and pharmacology, metabolism, elimination, and downstream effects of prohibited substances and methods of doping, in particular. The need for frequent and adequate adaptations of sports drug testing procedures has been incessant, largely due to the uninterrupted emergence of new chemical entities but also due to the apparent use of established or even obsolete drugs for reasons other than therapeutic means, such as assumed beneficial effects on endurance, strength, and regeneration capacities. Continuing the series of annual banned-substance reviews, literature concerning human sports drug testing published between October 2014 and September 2015 is summarized and reviewed in reference to the content of the 2015 Prohibited List as issued by the World Anti-Doping Agency (WADA), with particular emphasis on analytical approaches and their contribution to enhanced doping controls.
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Affiliation(s)
- Mario Thevis
- Center for Preventive Doping Research, Institute of Biochemistry, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.,European Monitoring Center for Emerging Doping Agents, Cologne/Bonn, Germany
| | - Tiia Kuuranne
- Doping Control Laboratory, United Medix Laboratories, Höyläämötie 14, 00380, Helsinki, Finland
| | - Katja Walpurgis
- Center for Preventive Doping Research, Institute of Biochemistry, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Hans Geyer
- Center for Preventive Doping Research, Institute of Biochemistry, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Wilhelm Schänzer
- Center for Preventive Doping Research, Institute of Biochemistry, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
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