* Amino acids (arginine, ornitine, lysine, aspartate, glutamine, leucine, tryptophan, carnitine) -- are used for performance and appearance enhancing benefits.
* Androstenedione -- is a precursor to testosterone. Dihydroepi-androsterone (DHEA) is a precursor to androstenedione and are available as supplements taken orally to increase levels of testosterone. The US Department of Health have warmed that long term use could produce adverse effects similar to anabolic steroids. FDA warned manufacturers to stop the distribution of such products.
* Creatine -- is used to assist in the production of energy source. Having more creatine enables the body to increase supply of energy to the muscles. Creatine cannot work without training.
Creatine does not increase strength; rather it increases the athlete's ability to train. It is shown to be of great benefit in repetitive short-burst sports such as power lifting and wrestling rather than swimming and long distance running.
Studies are not available on the safety of creatine in children. Creatine is used not only by athletes desiring strength enhancement but also by children in non-strength activities to improve appearance or excel in academic performance.
This permissive attitude in using one performance-enhancing substance may end up using other substances like anabolic steroids.
Prescription drugs
Prescription drugs that may have added performance-enhancing effects include:
* Betablockers -- are drugs used to treat heart problems and high blood pressure. As a PES (performance-enhancing substance) athletes use betablockers to control anxiety in sports that demand precision such as long range rifle shooting, archery, and golf.
* Beta agonists -- are used primarily to treat asthma. In the competitive world of sports beta agonist is considered a stimulant and as an anabolic agent.
In 1984 Olympics, 15 percent of participating athletes had a diagnosis of exercise-induced asthma. This had increased to 60% in 1996 Olympics to justify its use if the athlete is found positive on prohibited drug test.
* Diuretics -- are used to increase urination both in volume and frequency. In sports, athletes use diuretics to lose weight in order to qualify on the weight division he intends to compete. At the same time it will help the athlete pass the drug test since diuretics can alter urine composition.
* Local anesthetics -- to decrease pain and increase performance
Banned or illicit substances
Performance-enhancing substance classified under banned or illicit substances include:
* Cocaine -- sense of euphoria increases performance. It is habit forming
* Narcotics -- decreases pain and increase performance. It is habit forming
* Amphetamines -- are stimulants alleviating fatigue and produce feeling of mental alertness and well being. It is habit forming
* Erythopoietin -- is a substance that increases the number of red blood cells and hemoglobin, increasing the capacity of blood to carry oxygen to the issues. This increases the athlete's ability to perform in endurance competition. Side effects are high blood pressure, stroke and heart attacks.
* Human growth hormone -- can decrease body fat, increase amino acid uptake and increase protein synthesis. Athletes believe that human growth hormone can increase strength and muscle mass. Side effects include behavioral changes, diabetes, hypertension and cardiovascular disease. Cost is 3,000-5,000 dollars a month of treatment.
* Anabolic steroids -- use has increased among adolescent athletes who are engaged in weight lifting and gymnastics.
In one survey, 8-11% of high school students admitted using anabolic steroids. Steroid increases protein synthesis with resulting increase in strength, body weight and muscle mass.
To attain its desired effects, athletes often take the steroid at a dose 10-100 times higher than recommended for medical treatments. Side effects include aggressive behaviors, enlargement of the breasts, acne, altered liver function, and delayed healing and virilization in females. Testicular atrophy in males and stunting of growth are irreversible side effects.
* Ephedra -- is marketed as herbal supplement. The active ingredient is ephedrine a central nervous system stimulant for the treatment of asthma and nasal congestion. Athletes use ephedra as an aid in weight control program and in endurance performance. Side effects include increase in blood pressure, hyperactivity and palpitations.
The FDA has banned the sale of supplements containing ephedra because of the significant increase in stroke cases, a documented report of heart attack in a healthy 19-year body builder and deaths of a football player and a major league baseball player. (J. Koch, Pediatrics in Review. Sept 2002)
