Supplements and drugs used to enhance athletic performance

Knowledge, practice and attitude toward anabolic hormones and nutritional supplements among people practicing sports in the MENA region before and during COVID-19 lockdown

Introduction

During the COVID-19 lockdown, people's lifestyles have changed including their habits and physical activities. There has been an increase in anabolic hormones and nutritional supplement use among people who regularly do exercise in the MENA region. This study aims to assess knowledge, practice, and attitude toward the use of anabolic hormones and nutritional supplements among people who regularly exercise in the Middle East and North Africa (MENA) region and to compare their exercise habits and hormones and supplements usage between before and during COVID-19 lockdown.

Methods

A self-administrated online Google form survey was carried out between February 2021 and April 2021. Five thousand eight hundred forty-five participants who regularly exercise and aged ≥18 years responded to the questionnaire. The questionnaire was distributed through social media platforms and included five sections: demographic, training characters, knowledge, practice, and attitude.

Results

The participants mean age was 27.4 ± 8.6 years. Males represented 58.2 % of participants. 75.3% of the study participants had not used either hormones or supplements, and about 19% used supplements only. The mean percent score for knowledge, practice, and attitude were 39.3 ± 30.5, 1.1 ± 9.5, and 21.3 ± 23.8, respectively. Level of knowledge was higher among participants who worked in the medical field or as sports coaches. The practice was higher among male participants. The most commonly used anabolic hormones and nutritional supplements were steroids and proteins with bodybuilding being the most common purpose. Internet was the main source of information and pharmacy was the main source for procuring these substances. There was a significant decrease in proteins, carbohydrates, and sports drinks used during the COVID-19 lockdown compared to before the COVID-19 lockdown, while a statistically significant increase in vitamins used during the COVID-19 lockdown compared to before COVID-19 lockdown.

Discussion

In the MENA region, there has been an increase in the use of anabolic hormones and nutritional supplements. Most of the population has low knowledge of the harmful effect of uncontrolled, uninformed and unmonitored use of these substances Therefore, increasing the awareness level of participants and sports coaches should be a priority to limit the unsupervised use of hormones and supplements.

A Comprehensive Assessment of Knowledge, Attitudes, and Practicalities Related to Doping Agents use among Jordanians

Background

People perform sports for better health and wellbeing. However, the use of doping agents is emerging among young adults. This study investigated aspects related to doping agents.

Methods

A reliable self-administered questionnaire (Cronbach's alpha =0.72, Pearson's r = 0.89) was used to assess knowledge, attitudes, and practicalities related to the use of doping agents. Results for pharmacists as health care providers (HCP, n=550) were compared with non-healthcare providers (Non-HCP, n=319).

Results

Among pharmacists, 82.9% knew the definition of doping agents vs. 72.4% of non-HCP (P<0.001). However, 36.7% of pharmacists vs. 39.6% of non-HCP incorrectly classified doping agents (P=0.02). The majority of responders (89.8%) supported having an anti-doping authority, yet, only 15% were aware of the anti-doping organizations. The majority of responders (83%) did not receive an official education related to doping agents. Enhancing physical performance was perceived as a leading driver (82.1%) to use doping agents. More than 90% of responders supported awareness in the community. The perceived best tool for awareness was social media and TV sites, as suggested by pharmacists (95.0%) and non-HCP (92.1%, P=0.312). A total of 6.1% had ever used doping agents (3.6% pharmacist vs. 9.8% non-HCP, P<0.001). Almost half of the users utilized a diet or medication to counteract the side effects of doping agents. Within pharmacists, males received more requests to provide doping agents (41.9%) compared with females (23.8%, P<0.001).

Conclusion

It is crucial to enhance professional and legal knowledge and public awareness about doping agents, not only for non-HCP but also for HCPs. Applying more restrictions on doping agents is strongly recommended.

Use, Misuse and Abuse of Testosterone and Other Androgens

INTRODUCTION

For several decades, testosterone and its synthetic derivatives have been used for anabolic and androgenic purposes. Initially restricted to professional bodybuilders, these substances gradually became more popular with recreational weightlifters. Considering its increasing prevalence, the consumption of anabolic androgenic steroids (AAS) has become a matter of great concern. Although most side effects are mild and reversible, some of them can cause permanent damage or can be potentially life threatening.

OBJECTIVES

To review and summarize medical literature regarding misuse and abuse of testosterone and other androgens, in order to provide evidence-based information on the main topics related to this subject, such as how to identify and how to deal with these patients, and to elucidate the multiple possible adverse effects secondary to this practice.

METHODS

Key studies were retrieved from PubMed (1989-2021) with reference searches from relevant articles. Search terms included "hypogonadism", "anabolic androgenic steroids", "androgens", "misuse AND testosterone", "abuse AND testosterone", and "side effects AND testosterone".

RESULTS

There is a significant lack of information in the peer-reviewed literature describing demographic data, implications for different organ systems and the management of current or former AAS users; however, androgen abuse has been already linked to a wide variety of cardiovascular diseases, metabolic, endocrine, neurological, psychiatric and liver disorders. Despite all this, most physicians still feel uncomfortable and hesitate to discuss the issue with patients.

CONCLUSIONS

The chronic use of high doses of AAS is associated with adverse effects in several organ systems; however, there are still many gaps in our knowledge about the long-term consequences of this practice and how to deal with these patients. Healthcare professionals have a crucial role in combating this public health problem, recognizing and preventing the spread of androgen abuse. Linhares BL, Miranda EP, Cintra AR, et al. Use, Misuse and Abuse of Testosterone and Other Androgens. Sex Med Rev 2021;XX:XXX-XXX.

Sports Nutrition for Young Athletes

Nutritional needs for peak athletic performance include sufficient calorie intake, adequate hydration, and attention to timing of meals. Student athletes and their advisors often are misinformed or have misconceptions about sports nutrition. This paper identifies nutritional needs of young athletes, reviews common misconceptions, and examines the nutrition knowledge of athletes and their sources of nutrition information. Topics covered include energy, carbohydrate, protein, fat and micronutrient needs, hydration requirements, timing of meals, and issues related to age, gender, and specific sports. Other issues addressed include “making weight” and ergogenic aids. Proper nutrition for young athletes is critical not only to their athletic success, but more importantly to their growth, development, and overall health. Nutritional recommendations should be based on the most current scientific data; we provide information about appropriate resources for the school nurse when advising student athletes and their coaches and parents.

Potential harmful effects of dietary supplements in sports medicine

PURPOSE OF REVIEW

The purpose of this article is to collect the most recent data regarding the safety of well-known or emerging dietary supplements used by athletes.

RECENT FINDINGS

From January 2014 to April 2016, about 30 articles have been published in the field. New data show that 90% of sports supplements contain trace of estrogenic endocrine disruptors, with 25% of them having a higher estrogenic activity than acceptable. About 50% of the supplements are contaminated by melamine, a source of nonprotein nitrogen. Additional data accumulate toward the safety of nitrate ingestion. In the last 2 years, the safety of emerging supplements such as higenamine, potentially interesting to lose weight, creatine nitrate and guanidinoacetic acid has been evaluated but still needs further investigation.

SUMMARY

The consumption of over-the-counter supplements is very popular in athletes. Although most supplements may be considered as safe when taking at the recommended doses, athletes should be aware of the potential risks linked to the consumption of supplements. In addition to the risks linked to overdosage and cross-effects when combining different supplements at the same time, inadvertent or deliberate contamination with stimulants, estrogenic compounds, diuretics or anabolic agents may occur.

Illicit drugs and cardiac arrhythmias in athletes

The current management of athletes with cardiac arrhythmias has become complicated by the widespread use of illicit drugs, which can be arrhythmogenic.

The World Anti-Doping Agency annually updates a list of prohibited substances and methods banned by the International Olympic Committee that includes different classes of substances namely, anabolic androgenic steroids, hormones and related substances, β2-agonists, diuretics, stimulants, narcotics, cannabinoids, glucocorticosteroids, alcohol, β-blockers and others. Almost all illicit drugs may cause, through a direct or indirect arrhythmogenic effect, a wide range of cardiac arrhythmias (focal or reentry type, supraventricular and/or ventricular) that can even be lethal and which are frequently sport activity related.

A large use of illicit drugs has been documented in competitive athletes, but the arrhythmogenic effect of specific substances is not precisely known. Precipitation of cardiac arrhythmias, particularly in the presence of a latent electrophysiologic substrate including some inherited cardiomyopathies, at risk of sudden death or due to long-term consumption of the substances, should raise the suspicion that illicit drugs may be a possible cause and lead cardiologists to investigate carefully this relationship and appropriately prevent the clinical consequences.

Health Risks of Selected Performance-Enhancing Drugs

This article reviews adverse effects of and the difficulty of attributing toxic effects to selected drugs and dietary supplements that purportedly enhance athletic performance. On surveys estimating the extent of performance-enhancing drug use, 5% of high school students indicated anabolic-adrenergic steroid use, and approximately 28% of collegiate athletes and 5.6% of middle and high school athletes admitted creatine use. Many adverse health effects from the abuse of androgenic-anabolic steroids and androstenedione (a prodrug) are exaggerations of excessive testosterone on hepatic, cardiovascular, reproductive, and behavioral functions that can produce permanent changes. With creatine use, nausea, vomiting, diarrhea, elevated serum transaminase concentrations, hypertension, fluid retention, muscle cramping, and muscle strains have been reported. Ephedra stimulates adrenergic receptors, leading to tachycardia and hypertension, with central nervous system effects of anxiety, tremor, and hyperactivity. From 1997 to 1999, 10 people died and 13 suffered permanent disabilities due to ephedra. γ -Hydroxybutyrate and several prodrugs (γ -butyrolactone and 1,4-butanediol) can produce alternating agitation and coma, amnesia, hypotonia, ataxia, nystagmus, tremors, bradycardia, respiratory depression, and apnea. Although γ -hydroxybutyrate abuse began as a bodybuilding aid, most serious adverse effects are from acute overdoses. Adverse effects from performance-enhancing drugs do occur, but their extent and frequency are unknown.

Mad men, women and steroid cocktails: a review of the impact of sex and other factors on anabolic androgenic steroids effects on affective behaviors

RATIONALE

For several decades, elite athletes and a growing number of recreational consumers have used anabolic androgenic steroids (AAS) as performance enhancing drugs. Despite mounting evidence that illicit use of these synthetic steroids has detrimental effects on affective states, information available on sex-specific actions of these drugs is lacking.

OBJECTIVES

The focus of this review is to assess information to date on the importance of sex and its interaction with other environmental factors on affective behaviors, with an emphasis on data derived from non-human studies.

METHODS

The PubMed database was searched for relevant studies in both sexes.

RESULTS

Studies examining AAS use in females are limited, reflecting the lower prevalence of use in this sex. Data, however, indicate significant sex-specific differences in AAS effects on anxiety-like and aggressive behaviors, interactions with other drugs of abuse, and the interplay of AAS with other environmental factors such as diet and exercise.

CONCLUSIONS

Current methods for assessing AAS use have limitations that suggest biases of both under- and over-reporting, which may be amplified for females who are poorly represented in self-report studies of human subjects and are rarely used in animal studies. Data from animal literature suggest that there are significant sex-specific differences in the impact of AAS on aggression, anxiety, and concomitant use of other abused substances. These results have relevance for human females who take these drugs as performance-enhancing substances and for transgender XX individuals who may illicitly self-administer AAS as they transition to a male gender identity.

Nutrition knowledge, attitude and practice of college sportsmen

PURPOSE

Nutrition is an important component of any physical fitness program. The main dietary goal for active individuals is to obtain adequate nutrition to optimize health fitness and to increase sports performance. The present study aims to assess the nutrition knowledge, attitude and practice among the selected athletes.

METHODS

Athletes from five different private colleges situated in Salem District, Tamilnadu, India were selected. A total number of 102 athletes, 32 sportsmen belong to Volleyball discipline, 25 belongs to weightlifter discipline and 45 belong to runners discipline in sports. All the selected athletes were including in the study. The Knowledge, Attitude and Practice (KAP) questionnaire contained ten questions about nutrition knowledge, nine questions about attitudes, and ten questions about dietary practice were collected from the selected athletes. Dietary composition of the sportsmen is also assessed. The collected data was coded and used for evaluation.

RESULTS

Results about KAP revealed that 42 per cent of the volleyball players had good nutritional knowledge (60-69per cent) compared to weight lifters (43per cent) who had satisfactory (50-59per cent) knowledge about nutrition. Twenty nine per cent of the runners had very good (70-79per cent) knowledge about nutrition. Regarding food consumption pattern intake of cereals, other vegetables and milk was found to be less compared to the RDA for the athletes. Among the three disciplines sports persons, the mean nutrient intake of the runners is high compared to volleyball and weight lifters.

CONCLUSION

The sports disciplines strongly affected the nutrition knowledge, attitudes and practices of sportsmen. The overall scores indicate that most sportsmen had good knowledge of nutrition and supplements.

A case study of virilizing adrenal tumor in an adolescent female elite tennis player--insight into the use of anabolic steroids in young athletes

A 14-year-old Caucasian girl was referred to the endocrine clinic for evaluation of voice deepening, facial hirsutism, and acne starting 2 years previously. She had been a competitive tennis player since age 7 years, practicing for 4-6 hours daily. On physical examination she was noticed to have a masculine appearance with mild facial acne and moderate hirsutism. Tanner stage was 1 for breast tissue and 5 for pubic hair. Her androgen levels (testosterone, androstenedione, dehydroepiandrosterone sulfate) were extremely elevated. Adrenal ultrasonography revealed a round left 4.6 × 5.3-cm adrenal mass. Laparoscopic left adrenalectomy was performed. The histologic findings were compatible with a benign adrenocortical tumor. Postoperatively, androgen levels dropped to within the normal range. Breast development proceeded normally, menarche occurred 2 months after tumor resection, and menses has been regular since then. Muscle strength of the dominant and nondominant upper and lower extremities was measured 1 month before surgery and 1 year later, using an isokinetic dynamometer (Biodex Systems II, Biodex, Shirley, NY, USA). There was no significant decrease in overall muscle strength after removal of the virilizing tumor and the marked drop in circulating androgens. In addition, the patient maintained her age category, number 1, national tennis ranking. The results suggest that even extremely high levels of tumor-related circulating androgens had no evident effect on muscle strength and competitive performance in a female adolescent tennis player. The lack of beneficial effect on performance in adolescents, combined with the potentially hazardous side effects of anabolic steroids, suggests that teenage athletes should avoid their use.

Getting Huge, Getting Ripped: A Qualitative Exploration of Recreational Steroid Use

Steroid use is only now being recognized as a national epidemic. Although American athletes have been using anabolic steroids since the 1950s, it was not until the 1980s that athletic governing bodies began to monitor and sanction illegal supplementation. It is easier to understand why paid, professional athletes might partake in steroid use; keeping up with the competition, sustaining or improving abilities, salary incentives and endorsements based on performance are but a few reasons. But it is more difficult to understand why adult nonprofessional athletes would eagerly flout the law and put their health at risk. Academic research into steroid use has largely ignored this populous group, instead focusing on professional, college or high school/adolescent athletes. Through semi-structured interviews with 37 recreational steroid users, this paper seeks to fill that void by exploring their motivations, knowledge, and attitudes toward illegal anabolic steroids. The findings are discussed in terms of their policy implications.

Neuropsychiatric Effects of Prescription Drug Abuse

Prescription drugs have become a major category of abused substances, and there is evidence that the prevalence of prescription drug abuse may soon overtake that of illicit drugs. Study of prescription drugs has been hampered by vague terminology, since prescription drugs are only separated from other drugs of abuse by social and legal constructs. Reviewed herein is published literature on the abuse of four major categories of abused prescription drugs: sedative-hypnotics, stimulants, anabolic steroids, and anticholinergics. The review emphasizes evidence regarding the effects of these drugs on neural systems. Other abused prescription drugs that fall outside of the major categories are also briefly addressed.

Testosterone precursors: use and abuse in pediatric athletes

The dietary supplements androstenedione, dehydroepiandrosterone, and androstenediol are precursors in the endogenous production of testosterone. The efficacy and safety of these prohormones are not well established but are promoted to have the same androgenic effects on building muscle mass and strength as anabolic-androgenic steroids. Studies have demonstrated repeatedly that acute and long-term administration of these oral testosterone precursors does not effectively increase serum testosterone levels and fails to produce any significant changes in lean body mass, muscle strength, or performance improvement compared with placebo. The Anabolic Steroid Control Act of 2004 lists androstenedione as a schedule III controlled substance, and it is regulated by the U.S. Food and Drug Administration. Testosterone precursors are banned by most major sports organizations.

Erythropoietin and other blood-boosting methods

Dating back to the earliest Olympics, athletes have been searching for a performance edge. Recombinant human erythropoietin was made commercially available in 1987 to treat various diseases associated with anemia. Within a few years, elite endurance athletes capitalized on its potential as an undetectable performance-enhancing agent. Although antidoping agencies have developed a test to detect its use, there are pitfalls. More importantly, athletes continue to add more sophisticated doping practices to their armamentarium, challenging regulatory agencies, putting their health at great risk, and tainting the spirit of fair competition.

Popular ergogenic drugs and supplements in young athletes

Ergogenic drugs are substances that are used to enhance athletic performance. These drugs include illicit substances as well as compounds that are marketed as nutritional supplements. Many such drugs have been used widely by professional and elite athletes for several decades. However, in recent years, research indicates that younger athletes are increasingly experimenting with these drugs to improve both appearance and athletic abilities. Ergogenic drugs that are commonly used by youths today include anabolic-androgenic steroids, steroid precursors (androstenedione and dehydroepiandrosterone), growth hormone, creatine, and ephedra alkaloids. Reviewing the literature to date, it is clear that children are exposed to these substances at younger ages than in years past, with use starting as early as middle school. Anabolic steroids and creatine do offer potential gains in body mass and strength but risk adverse effects to multiple organ systems. Steroid precursors, growth hormone, and ephedra alkaloids have not been proven to enhance any athletic measures, whereas they do impart many risks to their users. To combat this drug abuse, there have been recent changes in the legal status of several substances, changes in the rules of youth athletics including drug testing of high school students, and educational initiatives designed for the young athlete. This article summarizes the current literature regarding these ergogenic substances and details their use, effects, risks, and legal standing.

Psychiatric complications of anabolic steroid abuse

The authors review the literature from human and animal studies on the neurochemical and pathological psychiatric effects of supraphysiological doses of anabolic-androgenic steroids (AAS) and discuss the AAS use and abuse patterns, additional drug use patterns, and personality and behavioral characteristics of AAS abusers.

Abuse of Supraphysiologic Doses of Anabolic Steroids

The following article is a literature review of supraphysiologic doses of anabolic-androgenic steroids (AAS). This article contains a brief review of the history of AAS, the chemistry of the varying forms of AAS, and proposed mechanisms of action. The article then focuses on how AAS are used in an illicit manner by the general population. Terms such as "stacking" and "pyramiding" are discussed. The article concludes by looking at the major detrimental side effects, such as liver damage and cardiovascular changes, which physicians may encounter when treating AAS abusers.

The college athlete

Participation in sports is important to many college students. Student athletes come from different levels of previous sport experience as they enter collegiate athletics. The primary source of student medical care is the campus student health center. The health care providers at student health centers attend to many of the sports-related concerns of student athletes. Preparticipation evaluation provides an opportunity to assess the general health of the student athlete and to identify conditions that might increase the risk of further injury. Sudden cardiac death and sports-associated concussions have generated much interest and are reviewed in this article. Other areas reviewed here include use of drugs and supplements, ankle sprains, acute knee ligament injuries, back pain, and shoulder impingement syndrome.

Justified and unjustified use of growth hormone

Growth hormone (GH) replacement therapy for children and adults with proven GH deficiency due to a pituitary disorder has become an accepted therapy with proven efficacy. GH is increasingly suggested, however, as a potential treatment for frailty, osteoporosis, morbid obesity, cardiac failure, and various catabolic conditions. However, the available placebo controlled studies have not reported many significant beneficial effects, and it might even be dangerous to use excessive GH dosages in conditions in which the body has just decided to decrease GH actions. GH can indeed induce changes in body composition that are considered to be advantageous to GH deficient and non-GH deficient subjects. In contrast to GH replacement therapy in GH deficient subjects, however, excessive GH action due to GH misuse seems to be ineffective in improving muscle power. Moreover, there are no available study data to indicate that the use of GH for non-GH deficient subjects should be advocated, especially as animal data suggest that lower GH levels are positively correlated with longevity.

Drug Use in Sports: A Veritable Arena for Pharmacists

OBJECTIVE

To describe opportunities and obligations for pharmacists regarding doping control in sports, and to present information and resources on drugs and dietary supplements that are popular among athletes for performance enhancement.

DATA SOURCES

Sports medicine journals and articles in English obtained from Medline (1966 through June 2003) using the search terms doping in sports, drugs in sports, dietary supplements, sports, amphetamine, stimulants, ephedrine, ephedra, caffeine, anabolic steroids, human growth hormone, erythropoietin, darbepoetin, androstenedione, dehydroepiandrosterone, and creatine. Information was also obtained from sports-governing agencies, such as the National Collegiate Athletic Association and the International Olympic Committee.

STUDY SELECTION

Studies and reports that were credible and scientifically sound that evaluated the ergogenic effects of drugs and dietary supplements.

DATA EXTRACTION

By the author.

DATA SYNTHESIS

Pharmacists can participate in doping control programs in a number of ways. Pharmacists also have an obligation when counseling, advising, and treating athletes to help them avoid banned substances. Athletes use a host of drugs for their performance-enhancing effects, many of which are banned by major sports-governing bodies. Myriad dietary supplements are marketed to athletes, claiming to have ergogenic effects. Some of these popular supplements have proven performance-enhancing effects, while others do not. Adverse effects of these drugs and dietary supplements are discussed.

CONCLUSION

A variety of drugs and dietary supplements have proven performance-enhancing effects in athletes. However, many of these substances have adverse effects and are banned by various sports-governing organizations. Pharmacists can play a key role in participating in doping control programs, and can prevent athletes from inadvertently consuming a banned substance.

Substance abuse in adolescents: a complex conundrum for the clinician

Substance abuse remains a complex and pervasive conundrum for society and for clinicians seeking to improve the lives of their pediatric patients. Substance abuse is linked to the human instinct for pleasure at any cost and is fueled by enticing encouragement of the media teaching society to seek drug-induced pleasure without fear of negative consequences. Other complications are the limited education about psychoactive substances provided to youth and the health care profession pledged to serve them. Primary care clinicians must provide their adolescent patients with adequate screening and counseling about substance abuse. Treatment of the substance-abusing patient is often a combination of behavioral interventions (including family therapy), and, in limited situations, addiction-specific medications. Research suggests that female drug addicts have a better outcome in female-only drug treatment programs. In addition, new drugs are being developed that target specific brain mechanisms involved in drug addiction; these drugs will have less toxicity and less abuse potential than illicit drugs such as cocaine. Vaccines are being developed that will block the effects of such drugs as cocaine and PCP. Medications developed for the treatment of depression and epilepsy will be a source of medications for the treatment of drug addiction. The study of endorphins and the neurobiology of stress and substance abuse promise to develop potent anti-addiction chemicals, greatly aiding in the war on drug abuse.