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Sports Doping: What Should Parents Know?

By: Donald E. Greydanus, MD

Using chemicals in the hopes of improving athletic performance is nothing new. If you were an athlete in the Greek Olympic days, your coach might have suggested you try various mushrooms to gain a competitive advantage. In the present, the pressure to excel and to win is stronger than ever. From playgrounds to professional arenas, athletes today are tempted by a wide variety of substances that promise to boost performance, appearance, and overall health. We call this phenomenon sports doping. It is important that the parents of young athletes understand how prevalent and potentially dangerous this situation is.

There is much yet to be learned about the effects and side effects of performance enhancing chemicals, especially on children.

Because these drugs are so widely available, and because many famous athletes are known users, some parents assume that drugs are OK for their children to use, especially since many famous athletes are known to be users and abusers of various chemicals.

Parents often ask me why we know so little about these drugs. In truth, well-conceived, scientific studies are often done only on adult males who are involved with competitive athletics.

It is not easy to clearly relate a side effect to a specific chemical taken, since there are many factors that may be involved for each individual. Further, many of these chemicals are called nutrients and are readily available in nutrition stores. Since some of these substances are not classified as drugs, they are not under the control of the Federal Drug Administration. The manufacturers and sellers of these nutrients are free to make extravagant and unproven claims about their products. Unfortunately, it is our children who may suffer the negative effects of these products while the makers and sellers reap the profit. ‘Buyer Beware!’ is certainly the right message for anyone who wants to become, or remain, a sports doper. I will now provide an overview of some of the most common performance enhancing substances used by children.

Creatine

Creatine has become a very popular product with teen athletes. Annual sales total over 200 million dollars. It is advertised as a natural product that will provide larger, more powerful muscles. Creatine is actually an essential amino acid, meaning that it is a necessary nutrient for human beings. It can be produced by the body from other amino acids, such as arginine and glycine. It may also be provided in the diet—creatine occurs naturally in fish, milk, meat, and other foods.

Studies performed on adult athletes indicate that creatine may increase muscle mass, probably due to the retention of fluid. More importantly, the athlete who is undergoing intense exercise training and taking creatine may increase his or her power for short-term sports action, such as sprinting and playing football. Thus, it is very popular with high school football players and track athletes. Some coaches, trainers, and even parents have pushed this product on their athletes in the hope of producing winners.

So what is wrong with taking creatine? Well, creatine has received very little scientific study. We do not know anything about its long-term effects. We do not know what doses are best and what is excessive. The doses kids take are varied and often mixed with other drugs or chemicals that have their own unknown effects. The stores that sell creatine have no idea how pure the product is, how much to use, or when to stop.

We do know that creatine produces no improvement in long-term endurance activities. A number of side effects are possible, including abdominal pain, nausea, loose stools, increase in weight due to the retention of water, muscle cramps, and muscle strains. Case reports indicate that dehydration and even death may occur when athletes take creatine and exercise in hot weather. Reduction in kidney function and enlargement of the heart muscle have been observed in kids. Additionally, creatine supplementation suppresses the body’s own production of creatine. We do not know what effects this may have on a growing child. There are simply too many unknowns about creatine at this time. It would be wise to stop the current hype.

Anabolic Steroids

Anabolic steroids are synthetic testosterone derivatives. They have become very popular with athletes who seek improved muscle size and strength, whether to gain an advantage in competition or simply to look better in a culture that reveres large, muscular bodies. Athletes at high abuse risk for these products include those involved with football, weight lifting, wrestling, shot putting, discus throwing, sprinting, and many other sports.

A number of anabolic steroid products have been available over the past several decades, including stanozolol (Winstrol7), nandrolone decanoate (Deca-Duraboline7), oxymetholone (Anadrol-507), and others. One form, methandrostenolone (Dianabol7), was available in the 1970s and 1980s as an injection and was abused by many teens. After various needle-related consequences were reported (e.g., hepatitis, HIV infection), methandrostenolone was discontinued. Today, however, a pill form is making a comeback.

Anabolic steroids are very popular around the world. Up to 11% of American high school males and up to 2.5% of high school females use anabolic steroids—a staggering number! We know that half of these abusers start with steroids while under the age of 16. About one-third of steroid users do not consider themselves athletes. We also know that the desire to excel in sports and/or personal appearance drives young people to use high doses of anabolic steroids, often in combination with other drugs. Can these kids gain muscle mass and strength? Yes, but only if they also engage in specific, strenuous exercise training at the same time. Using steroids without this training does not increase weight and power.

Anabolic steroids: a time bomb
Kids who use anabolic steroids are fooling around with a time bomb. Many dangerous side effects await the unwary user of these dangerous chemicals. Females can become masculinized, with excessive hair growth (called hirsutism), enlargement of the clitoris, and loss of hair (seen in males also). Growing athletes may increase the maturing of growth plates in bones, resulting in a shorter height than they would otherwise attain. Acne may become very severe and resistant to therapies. Some steroid users become aggressive and irritable; some become depressed. Testosterone levels may drop with reduction in the size of testicles. There are many other potential problems, such as stomach ulcers, increased blood sugar, fluid retention, and increase in injuries to tendons. Some scientific articles report a link between liver cancer and the use of anabolic steroids.

Athletes may take additional drugs in an attempt to augment the effects of anabolic steroids and/or reduce some of the side effects. Many athletes become involved with a dangerous practice known as stacking, taking many drugs at high doses for weeks or months. Some stop only before a sports event, and only if they will be tested for drugs. Some female athletes try to take just enough to become more powerful but not enough to become masculinized. Officials at the Olympic games have banned anabolic steroids from competition and have been testing for them since the 1970s.

Looking for safe alternatives
The athletic world constantly seeks safe alternatives to anabolic steroids. For example, athletes have tried a chemical called, androstenedione. It is related to testosterone and is taken an hour or so before a sports event to improve power and strength. Well-known professional athletes have even used it. However, it is not really effective and it has become less popular today.

DHEA beware
DHEA (dehydroepiandrosterone) is another chemical that is related to testosterone (and also estrogen) and promoted in nutrition stores. It is widely advertised as a wonder drug that will improve muscle size and strength, lessen depression, prevent heart disease, and increase sex drive among other unproven claims. A reputed fountain of youth, it has special appeal to adult athletes. Though hyped as a safe alternative to anabolic steroids, it is not safe and is linked to many anabolic steroid-like side effects. Excessive hair growth and endometrial cancer are reported in women, while prostate cancer and permanent breast development are reported in men. Yes, this natural product is found in human adrenal glands and even in wild yams. It is, however, a dangerous chemical. Young people and adults alike should be discouraged from using it.

Protein and Amino Acid Supplements

The use of protein and amino acid supplements to improve sports performance has been promoted for the past several decades. Do athletic children need more protein than their non-exercising peers? Yes. Does protein supplementation help their sports activity? No. Most athletes get more than enough protein from their normal intake of food. There are some athletes who try to stay very thin and/or lose weight, such as gymnasts, dancers, and wrestlers. Providing extra protein may help this select group. I do not recommend expensive protein supplements for them. I suggest they get their additional protein from evaporated milk or relatively inexpensive protein powder (egg or soy).

The use of branched-chain amino acids to increase growth hormone production has not been proven to help the athlete perform better. I point out to athletes that protein or amino acid supplements can be ineffective and needlessly expensive. Overuse may even lead to loose stools. I worry that an overabundance of some amino acids may lead to an imbalance of others and that unknown side effects may result from such supplementation.

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Common Questions

Here are some questions I often receive from parents and teens regarding sports doping:

What about the use of Antioxidants?
Antioxidants are chemicals that are thought to reduce the amount of body damage done by free radicals. Some athletes are concerned that harm may be caused by the production of exercise-induced free radicals. Some antioxidants include vitamin C (ascorbic acid), vitamin E (alpha tocopherol), beta carotene (a vitamin A precursor), iron, zinc, selenium, manganese, and copper. At this point, we do not really know if these antioxidants improve sports performance. More research is needed in this area. Everyone should get a recommended amount of these substances in their diets. For example, the recommended daily allowance is 10 mg a day for vitamin E and 60 mg a day for vitamin C. Extra doses of some chemicals (such as vitamin C or beta carotene) may cause illness.

Is there a role for iron supplementation?
It has not been shown that iron will improve sports performance or that most athletes need or would benefit from iron supplementation. Runners and other endurance athletes do lose iron in their intestinal tracts, urine, and sweat, and may need more dietary iron than non-athletes. Normally, they will consume what iron they need in their diet. Athletes with a low iron level will benefit from taking a daily multivitamin with iron. This includes vegetarian teens as well as females with excessive menstrual blood loss and limited dietary iron.

Is calcium necessary?
Calcium itself is not ergogenic, i.e., does not produce sports performance improvement. It is recommended, however, that individuals between 11 and 24 years of age receive a daily intake of 1200 to 1500 mg of calcium. If intake of calcium is below this level, then supplementation is warranted. Female athletes who are required to be thin, such as gymnasts or dancers, may be on a low calorie diet and have low estrogen levels. They are at increased risk for fractures, absence of menstrual periods, and, later in life, osteoporosis. They are often afraid of calcium-rich dairy products, which may contain too much fat for them. I suggest they take yogurt or skim milk in this case.

Are there other amino acids and chemicals taken as muscle drugs?
Yes. A popular muscle drug is HMB (beta-hydroxy beta-methylbutyrate), a leucine metabolite found in citrus fruits, breast milk, and even cat food. Some studies show it increases muscle size and may allow the muscle to repair itself faster. Its effectiveness as a sports doping agent and its potential long-term side effects are unknown at this time.

Other unproven amino acids on the market include L-carnitine (found in dairy products and meats), Arginine, Glutamine (found in almonds, soybeans and peanuts), and Conjugated Linoleic Acid or CLA (found in yogurt, milk, treated cheese, venison, and beef). We do not know enough about these agents. Their use should be discouraged. The exact dose found in each bottle is unclear. They may contain impurities as well. In the 1980s, another amino acid, L-tryptophan, was linked to deaths due to impurities. Side effects observed include diarrhea with L-carnitine and drowsiness with L-tryptophan. We also do not know the effects of adding these chemicals to other sports doping agents. I advise athletes to play it safe and avoid these drugs.

A published study suggests that chromium (an essential trace element) can lead to muscle gain and a reduction in body fat. Other studies, however, have not confirmed chromium’s ergogenic properties. Side effects include gastrointestinal upset, anemia, and kidney disease. I only recommend chromium as part of a multivitamin tablet, one that does not exceed 200 mg/day of this element.

Another trace mineral, vanadium, has been marketed as a muscle builder. I tell my patients that there is no proof of this and that side effects may include diarrhea, abdominal cramps, and even a green tongue.

What about Boron?
Boron is a substance essential for plants but not humans. It is present in foods of plant origin, non-citrus fruits, leafy vegetables, nuts, and legumes. Although boron is sold to increase muscle mass, there are no studies to support claims of increased lean body mass, total testosterone, or strength.

Do some athletes give themselves their own blood to improve sports performance?
Yes. This is called blood doping (also blood packing or blood boosting). The individual saves his or her own blood and takes it intravenously before a sports event. This increases hemoglobin (protein in the blood which carries oxygen) to a high level and may allow increased endurance. Laboratory tests are not able to catch athletes who use this method. Some athletes take a product called erythropoetin, or EPO, which also increases oxygen-carrying capacity. In both cases, the blood becomes thicker, increasing the risk of strokes, heart attacks, and seizures. I tell my patients that blood doping is not allowed by sports authorities. The risks are not worth any benefit it might produce.

I have asthma. Can I take my medications? I have heard that asthma medications are not allowed for sports participation.
It is perfectly fine and indeed important for athletes with asthma to take asthma medications. These medicines include terbutaline, albuterol, and others. The confusion developed because of a medication called ephedrine. This is a stimulant drug that can also help asthma. Stimulant drugs (like ephedrine, amphetamine, and caffeine) give the athlete an unfair advantage and are not allowed in Olympic and other competition. They have a number of side effects, including increased aggressiveness, higher blood pressure, increased heart rate, loss of fluids, shakiness, and anxiety. Some athletes find that too much coffee may lead to increased urination and too many trips to the bathroom. Olympic officials have limited the amount of caffeine they will allow their athletes to take.

Are pain pills okay?
In general, it is fine to take pain pills to relieve pain from sports-related injuries. It is important to take them under a knowledgeable clinician’s direction. Some athletes have taken too many of these pills in the face of injury so they can continue with the game. This may lead to even more severe injury. I tell parents to be sure to seek careful evaluation and treatment for children who are hurt in sports. Don’t come back to the game too soon. Come back when you are healed and ready.

Why are diuretics banned in sports?
Diuretics are medications that increase urine output. They are used inappropriately by athletes who need to lose weight in a hurry (wrestlers, for example). These medicines are also used to mask the presence of other performance enhancing drugs. Athletes should be advised that using diuretics for such purposes is wrong and that a number of side effects may result, including dehydration, weakness, and heart irregularities. In addition, weakness caused by diuretic use can make an athlete more susceptible to injury.

Is it okay to use medications to calm the athlete’s nerves?
An athlete who is diagnosed with an anxiety disorder may benefit from certain medications known to improve anxiety. These are fine to take. Some athletes take pills called, beta-blockers (such as propranolol). These are used to reduce performance anxiety by controlling hand tremor, lowering heart rate, and reducing blood pressure. They are banned in some Olympic sports.

Summary

The best sports performance method is to combine a vigorous exercise plan (under the supervision of a qualified person) with a well-balanced diet. The use of chemicals and drugs is fraught with many unnecessary dangers, as outlined in this article. Parents should be guardians of their children and be sensitive to the societal pressures on their children to win at all costs. These drugs do not usually work and are not worth the price our children may pay. I advise you to tell your children, coaches, and schools to discourage the practice of sports doping. The safety of your children is at stake.