From the mayo clinic

Banned substances enhance athletic performance, but at a price

Efforts to enhance performance are nothing new in competitive sports. Hundreds of years ago athletes ate special meals of meat and honey in preparation for important events. For some athletes today, vitamins, supplements and even illegal drugs - such as anabolic steroids - are as much a part of their diet as fruits and grains.

Some products do little to improve performance, while others help athletes achieve remarkable results. Some carry the risk of major side effects such as heart and liver damage, endocrine-system imbalance, elevated cholesterol levels, strokes, heightened aggression and genitalia dysfunction.

In light of baseball star Ken Caminiti's recent admission that he used steroids when he won the National League Most Valuable Player Award in 1996 and his belief that at least half of today's professional baseball players use some sort of performance-enhancing drug, questions abound as to whether these drugs work, how they affect your body and what dangers they pose to your health.

Exercise physiology 101

In most Olympic and non-Olympic professional sports, the athletes who win are those with the greatest strength, speed or endurance. Each sport requires specific skills, such as the ability to kick a ball a certain way or hit a home run. Doing so with not just excellent but instead extraordinary strength, speed or endurance marks the difference between a good player and an elite player.

Sheer strength is determined by two factors: amount of muscle and the ability of nerves to stimulate muscle contraction. Some elite athletes perform special exercises specific to their sports to improve the neural stimulation of their muscles, and many do weight training to build more muscle. Some, especially professional athletes, also take hormones and synthetic (man-made) drugs to induce their body to build even more muscle.

The amount of muscle and the ability of your nerves to stimulate muscle contractions also play a big role in determining a person's speed. A larger muscle mass allows you to generate more power, which helps you perform short bursts of activity - a track sprint or short swim race - faster.

Your muscles contain two basic types of fibers, and the percentage of each type of muscle fiber you're born with affects how fast your muscles react and therefore how fast you can move. Drugs that help athletes build muscle will help them run, swim, ski, row, cycle or perform other activities faster.

An athlete's endurance is determined mainly by how efficiently his or her body delivers oxygen to muscles. That's because muscles burn fat and a sugar derived from glycogen when they contract during endurance exercise, and they can't burn those fuels without oxygen. One muscle fiber type is better suited to this aerobic (oxygen-burning) activity, and the amount of this fiber in your body affects how well your body performs in endurance events, such as a marathon or triathlon. Therefore, drugs and practices that help your body deliver more oxygen to muscle increase your endurance.

Drugs and supplements - what's allowed?

The terms banned drug and banned substance refer to chemicals that are prohibited for use during athletic training and competition. Your body naturally produces some of these compounds, such as testosterone and growth hormone, in small amounts. Other compounds, including some anabolic steroids, are created only in the lab.

To make things more complicated, different sport organizations ban different substances - if they ban anything at all. Athletes who compete in Olympic sports must avoid taking compounds listed on the International Olympic Committee (IOC) list of banned substances. If they test positive for any such drugs, they may not compete for a short time - a few months - or as long as the rest of their lives.

On the other hand, Major League Baseball has not banned such performance-enhancing drugs as androstenedione or steroids. When Mark McGwire used the supplement androstenedione when he set a home run record in 1998, he received no penalty, even though the human body rapidly converts this compound to testosterone, which builds muscle mass. The IOC, National Football League, National Basketball Association and National Collegiate Athletic Association all prohibit use of androstenedione. The NFL, NBA and IOC prohibit steroids and test for them. The NHL and Major League Baseball have no policy regarding steroid use.

Even if a substance is not classified as a drug, it can still be banned. Some substances that are banned by the IOC are sold in the United States as nutritional supplements rather 4han as drugs. They can be bought at some health food stores and pharmacies. This category includes compounds such as dehydroepiandrosterone (DHEA), androstenedione and creatine.

The IOC also bans certain practices that achieve the same result as banned drugs. Blood doping is one such practice. It involves removing and storing a small quantity of blood, then administering it immediately before a competition. The additional red blood cells increase the amount of oxygen that the blood carries to the muscles, and thereby increase the amount of work the athlete can do before performance starts to wane.

Banned drugs

The IOC list is the most comprehensive list of banned substances used by an agency governing sports. The types of drugs included on the list have many common medical uses, so it's important for athletes to check the list before entering a sanctioned competition.

Anabolic steroids are probably the best known of the IOC's banned substances, made famous when athletes such as sprinter Ben Johnson tested positive for their use and now Ken Caminiti's admission that he used them playing baseball. This group of drugs includes synthetic derivatives of testosterone, a male sex hormone. Some of the most common steroids include dehydrochlormethyl-testosterone (Turnibol), metandienone (Dianabol), methyltestosterone (Android), nandrolone phenpropionate (Durabolin), oxandrolone (Oxandrin), oxymetholone (Anadrol) and stanozolol (Winstrol).

Anabolic steroids have several medical uses. They improve the symptoms of arthritis, and they may help people infected with the human immunodeficiency virus (HIV) gain and maintain muscle mass and reduce the wasting that occurs with AIDS. Men who are deficient in testosterone take steroids to replace their lost testosterone.

Some athletes take anabolic steroids to increase their muscle mass and strength. The drugs may help athletes recover from a hard workout more quickly by reducing the amount of muscle damage that occurs during the session. Some like the aggressive feelings that occur when the drugs are taken over several weeks or months. Most athletes take anabolic steroids at doses that are much higher than those prescribed for either AIDS wasting or testosterone replacement therapy. The effects of taking steroids at very high doses have not been well studied.

Their benefits come with potentially life-threatening side effects. Men may develop prominent breasts, baldness and shrunken testicles. Women may experience a deeper voice, enlargement of the clitoris and increased body hair. Severe acne, liver abnormalities and tumors, increased low-density lipoprotein (LDL) and lower high-density lipoprotein (HDL) cholesterol, psychiatric disorders, and dependence may occur in both sexes. If an injected form is used, there is higher risk of infections and diseases that are transmitted in blood, including HIV and hepatitis. And in teens, steroids can halt their normal pattern of growth and development and put them at risk of future health problems.

Drugs in another class, the beta-2 agonists, also are considered anabolic agents. This group includes drugs such as salmeterol (Serevent) and metaproterenol (Alupent). Athletes may be prescribed these drugs if they have asthma and administer them with an inhaler.

Stimulants may reduce fatigue, suppress appetite, and increase alertness and aggressiveness. They stimulate the central nervous system, increasing your heart rate, blood pressure, body temperature and metabolism. Some research suggests that caffeine promotes the burning of fat stores during endurance events.

The most common stimulants include caffeine and amphetamines (Dexedrine, Benzedrine). Cold remedies often contain the stimulants ephedrine, pseudoephedrine hydrochloride (Sudafed) and phenylpropanolamine (Acutrim). Street drugs such as cocaine and methamphetamine also belong to this group.

Although stimulants can boost physical performance and promote aggressiveness on the field, they have side effects that can impair athletic performance. Nervousness and irritability make it hard to concentrate on the game, and insomnia can prevent an athlete from getting needed rest. Heart palpitations, weight loss, mild hypertension, hallucinations, convulsions, brain hemorrhage, heart attack and other circulatory problems may result. Athletes may become psychologically addicted or develop a tolerance such that they need greater amounts to achieve the desired effect.

Narcotics are synthetic compounds and drugs derived from the poppy, such as morphine, codeine and heroin. In conventional medicine they're used to ease pain, and injured athletes use them for that purpose. Narcotics act as a sedative and decrease bowel activity. Some people experience elation or euphoria when taking narcotics.

Dependence and addiction are common among those who abuse narcotics. Other adverse effects include nausea and vomiting, mental clouding, dizziness, delirium, constipation, respiratory depression, muscle rigidity and low blood pressure.

Diuretics change your body's natural balance of fluids and salts (electrolytes) and can lead to dehydration. This loss of water may allow an athlete to compete in a lighter weight class, which many athletes prefer. Diuretics also help athletes pass drug tests by diluting their urine.

Diuretics are commonly used to treat high blood pressure and conditions that cause fluid retention (edema), such as congestive heart failure. When taken in small amounts, they have relatively few side effects, although electrolyte disturbances can occur.

When taken at the higher doses preferred by some athletes, however, the adverse effects may be significant. Using diuretics to achieve weight loss may cause muscle cramps, exhaustion, decreased ability to regulate body temperature, potassium deficiency and heart arrhythmias.

Some of the most common diuretics include acetazolamide (Diamox, Storzolamide), benzthiazide (Marazide, Aquastat), spironolactone (Aldactone), dichlorfenamide (Daranide), chlorothiazide (Diuril) and furosemide (Lasix, Fumide).

Peptide hormones, mimetics and analogues. This class of drugs includes several hormones naturally produced by the body that can enhance performance. The IOC banned substance list includes:

Human chorionic gonadotropin (HCG). A hormone of early pregnancy that stimulates secretion of testosterone by the fetus (prohibited only in men).
Pituitary and synthetic gonadotropins: Luteinizing hormone (LH). A hormone that stimulates the secretion of sex hormones by the ovaries and testes (prohibited only in men).
Corticotropins: Adrenocorticotropic hormone (ACTH). A hormone that stimulates secretion of other hormones by the adrenal cortex.
Tetracosactide (corticotropin). A hormone that stimulates growth of the adrenal cortex or secretion of its hormones.
Human growth hormone (HGH). A hormone that indirectly stimulates the transport of amino acids (protein) into cells, thereby helping athletes increase body size.
Insulin-like growth factor (IGF-1). A peptide that mimics many of the functions of insulin on tissues, such as stimulation of amino acid uptake, and all the substances associated with it.
Erythropoietin (EPO). A hormone that stimulates the formation of red blood cells.
Insulin. A hormone that stimulates the absorption of sugars, fats and proteins into cells (permitted in athletes with documented type 1 diabetes- formerly called juvenile or insulin-dependent diabetes).
Many sport authorities believe that growth hormone and erythropoietin are the most commonly abused compounds in this category. Each substance has serious negative effects for users.

HGH stimulates growth directly and through the effect of IGF-1 of all internal organs and bones, not just the muscles. Over time, changes such as enlargement of facial features (acromegaly) and overdeveloped fingers and toes occur. The layer of fat that protects the organs is reduced, which may leave athletes more vulnerable to internal injury. Diabetes, heart muscle damage, sexual dysfunction and menstrual disorders also occur with inappropriate use of HGH.

The IOC also permits individual sport governing agencies to ban some classes of drugs if they want to. These classes include alcohol, cannabinoids, local anesthetics, glucocorticosteroids and beta blockers.

Alcohol may be banned because it may impair judgment and cause a loss of coordination.

Cannabinoids - the active compounds in plants such as marijuana - may decrease awareness of your surroundings, impair judgment and reduce reaction time.

Local anesthetics. The regular use of local anesthetics is prohibited because they may mask the pain of injury and permit an athlete to injure himself or herself more seriously or put others at risk. They may be used when medically necessary, such as when treating an injury.

Glucocorticosteroids. Systemic use of glucocorticosteroids is prohibited because they alter metabolism, circulation, muscle tone, arterial blood pressure and other body functions. They may be used when medically necessary, such as after an injury.

Beta blockers slow the heart rate and are used to treat high blood pressure and some heart disease. In sports that require precision rather than speed, strength or endurance, a lower heart rate can be an advantage. Shooters, biathletes and modern pentathletes may take these drugs so that they can shoot between heartbeats to improve accuracy. Beta blockers also help steady the hands of shooters and archers. Some of the more common banned beta blockers include acebutolol (Sectral), atenolol (Tenormin), metoprolol tartrate (Lopressor) and propranolol (Inderal).

Training methods that are always illegal include blood doping, administering artificial oxygen carriers or substances that expand blood volume (increase the number of red blood cells). These practices can increase an athlete's endurance and speed by increasing the amount of oxygen available to muscles.


Determining which athletes use banned substances is not easy. There are no accurate tests for some banned drugs, such as HGH. And many athletes have learned how to avoid testing positive for some drugs.

The IOC began testing athletes' urine for banned drugs during the 1968 Winter Olympics in Grenoble, France. Until the 2000 Summer Olympics in Sydney, Australia, urine testing was the only procedure sport organizations used to detect which athletes used drugs. In Sydney, the IOC used both blood and urine testing to detect EPO. In each event the three medalists and another athlete chosen randomly were tested for banned substances.

Other sport governing bodies are adopting the blood test for EPO. Fifteen percent to 20 percent of the drug tests done at the World Track and Field Championships in August 2001 were tests for EPO.

The United States Anti-Doping Agency (USADA) is responsible for coordinating drug testing of U.S. athletes. It conducts both in-competition tests - tests at events such as the U.S. National Swimming Championships - and out-of-competition (OOC) tests. OOC tests are also called No Advance Notice tests.

OOC tests may be given to any athlete who is a member of a national sport governing body. Athletes must give this agency their current address and update the information if they move or go somewhere else to train. When a representative of the USADA goes to an athlete's residence, the athlete must provide a sample for testing. If an athlete is not available for testing, the absence is reported and he or she is asked to provide an explanation. An athlete who misses three OOC tests in 18 months may be ruled ineligible to compete for 2 years.

The sample is split into parts A and B, and the samples are sent to an accredited lab. If the A sample is positive for any banned drug, USADA notifies the athlete so that he or she may attend the testing of the B sample. If both samples are positive, the USADA Review Board will decide what action to take.

The Olympic Movement Anti-Doping Code outlines several key points a these rules too.
A urine test for EPO and a test bout drug testing:

Each athlete must ensure that banned drugs do not enter his or her body. Not knowing that a substance is banned or that a product contained a banned substance is not an excuse.
It doesn't matter whether or not the use of a banned substance or prohibited training method enhances performance. If it's banned, athletes may not take it.
The presence of a banned drug in an athlete's urine is an offense, no matter how the drug got there.
An athlete cannot appeal the inclusion of a drug on the list of banned substances.
Each athlete is responsible for checking on updates to the list of banned substances.
International sport governing bodies may ban other drugs or training methods. Athletes must followfor HGH are in development.