PROS AND CONS OF PERFORMANCE ENHANCING DRUGS (PEDs) – The basics

PROS AND CONS OF PERFORMANCE ENHANCING DRUGS (PEDs) – The basics

Written by Dr. Michael Wald

Director of Nutritional Services at Integrated Medicine of Mount Kisco, P. C.

495 E. Main Street, Mount Kisco, New York

Ph: 914-242-8844 (Ext. 1)

Website: www.intmedny.com and www.BloodDetective.com

Email: drwald@intmedny.com

Twitter: DrMichaelWald@BloodDetective

 Following my upcoming interview on CBS Radio on the topic of the pros and cons of sports enhancing drugs on January 12^th, 2013, I will post several White Papers examining the controversies surrounding performance enhancing drugs or PEDs.

PEDs represent a large number of drugs within 10 basic categories including:

1. Anabolic agents
2. Hormones and hormone-related substances
3. Beta-2-agonists
4. Hormone antagonists and hormone modulators
5. Diuretics and additional masking agents
6. Cannabinoids
7. Glucocorticosteroids
8. Alcohol
9. Beta-blockers
10. 10. Banned methods

Scientific, philosophical, health, political and other reasons are consistently sited among the polarized groups concerned with PEDs’ use in professional athletics.  Suffice it to say that this topic will not go away, and will continue to mount controversy, on both sides of the spectrum (and those in between) for years to come.

This primer White Paper will concisely address some of the concerns surrounding the use or prohibition of PEDs in professional sports. Namely, whether or not they are they harmful or helpful? I would like to point out that the relative potential for help or harm when it comes to both natural and man-made (synthetic) compounds is not only based upon the drug(s) in question (i.e, growth hormone, testosterone, epitestosterone (aka Epi), etc., but also upon the individual’s metabolic ability to handle various PEP compounds.  In other words, what may help one athlete may kill another or cause permanent damage to overall health.

It is certainly true that not all of the data is in regarding use of PEDs by athletes, nor will it ever likely be, considering that this topic is an ever-evolving one in terms of use and scientific development.   However, sports physiologists, scientific researchers, physicians, trainers and athletes alike should concern themselves with their positive and negative potential. The various “powers that be” including, but certainly not limited to, the International Olympic Committee, the United States Olympic Committee and WADA (World Anti-Doping Agency) have taken the stance that PEDs should not be used in professional sports. There are a long list of reasons that I will examine in upcoming White Papers regarding this point, but for now, it is important to simply accept that WADA has set fourth criteria that have been more or less adapted by the US and International Olympic Committees and other sports organizations that regulate “clean” sports participation.

WADA has composed a list of specific medications and drug categories that are, generally speaking, reviewed and potentially modified (i.e., drugs added or removed) annually.  Drugs may be added or removed based upon WADAs determinations.  I should also point out that just because a specific drug is not named on WADA’s list does not mean that athletes are permitted to use the drug for enhancing athletic performance.  If the drug is used by an athlete, but is not found on WADA list, but falls within one of the WADA banned drug categories, the athlete will be sanctions or dismissed from professional sports if discovered.

It is certainly accepted by those that are pro and con on the topic of PEDs in professional sports that many athletes have chosen to take them of their own free will.  These substances in some cases are purchased over the Internet, directly through health care providers; from other athletes, coaches and on the black market Virtually anyone can by any one of the hundreds of banned items with little difficulty given a bit of research and diligence.

What about the question of whether or not PEDs are healthy or unhealthy for the professional athlete?  Are PEDs safe or are they not safe?  First, let me point out that this question is moot if one takes the moral stance that PEDs are banned substances within most professional sports arenas. If certain substances are banned then a detailed discussion by athletes, coaches, scientists or others who are in favor of their use is merely philosophical.  In other words, PED use is simply illegal.  I am not taking a personal stance for or against PEDs use in professional sports, but merely pointing out some pros and cons of their use from a scientific-health and athletic performance perspective.

The number and type of PEDs used in professional sports is simply staggering, and many new types of PEDs continue to find their way into the hands, and bodies, of professional athletes.  As I stated in the opening of this article, it is unlikely that PEDs will ever go away.  I will venture to say that some athletes in virtually every professional sport will continue to use, or start using, PEDs in an attempt to simple “keep pace” with their fellow athletes.  Some athletes, coaches, physicians and scientists alike have developed some ingenious methods of cheating PED detection.  A basic understanding of the extent that those involved with PED use will go to use these substances, and escape detection, may shed some light upon the enormous the gravity of PED use in professional sports.

Some of these methods used by athletes to hide PEDs detection include

1. Urine replacement/substitution of tainted urine with clean urine from another person or from the athlete at a time when no drug(s) were take
2. Use of epitestosterone to maintain  a seemingly normal ratio of testosterone to epitestosterone that is acceptable to WADA (World Anti-Doping Agency)
3.  Use of soap to sabotaging the EPO (erythropoietin) urine test
4.  Gene Doping that involves tinkering with human DNA to boost athletic performance utilizing altered viruses that have been inserted into cells permanently altering their function; even enhancing the effects of EPO
5. Blood transfusions to improve the bloods oxygen carrying capacity improving stamina, strength and endurance
6.  Micro-dosing of growth hormone so that levels appear “normal”

Considering the strong probability of continued PED use I do believe that greater scientific study of the health and athletic benefits and detriments should continue to be explored.

All health care providers utilize a drug encyclopedia known as the PDR or Physicians Desk Reference. Versions exist on the World Wide Web, CD-ROM or as a printed book.  The PDR is considered the “bible” of drug effects, both positive and negative (also known as side-effects).  In fact, more than half of PDR describes the voluminous side effects of prescription medications.  When one examines PEDs drugs, and many of them are found in the PDR, one finds that they also have side effects, but also have athletic and health promoting effects as well.  It is curious why at least some PEDs are not part of mainstream medicine’s arsenal for health enhancement and disease treatment.

Here is my quick pros and cons list of PEDs drug categories.  I have provided only the category of the drug or have provided only one or two examples of each drug under each respective category.  Keep in mind that there may be dozens of variations under each drug category.

ANABOLIC AGENTS

Exogenous Anabolic Androgenic Steroids (AAS)

Examples: 1-androstendiole, 1-testosterone 

PROS:  Increases endurance, fat loss, muscle recovery, increases strength and muscular size.  Helps to treat anemia, asthma, bone pain, muscle loss and helps balance other hormones.

 CONS:  May cause menstrual cycle irregularities, aggressiveness, baldness, brain tissue damage, breast enlargement, fever, hypertension, liver dysfunction, muscle pain, nausea, sexual appetite increase and vomiting.

HORMONES AND CHEMICALLY RELATED SUBSTANCES

Examples: Erythropoietin (EPO), Growth Hormone (hGH)

PROS:  endurance enhancement during exercise efforts, faster muscle recovery, used to treat anemia of kidney failure, HIV and certain cancers.

CONS:  Death, clots known as deep vein thrombosis in the lower legs, heart attack, hyperviscosity (thickening) of blood, heart attack (myocardial infarction), stroke, thrombosis and pulmonary embolism.

BETA-2 AGONISTS

Examples: All beta-2-agonists excluding formoterol, salbutamol, salmeterol, etc.

PROS:  Improves aerobic exercise performance, enhances muscle growth and fat reduction, used medically for asthma and COPD (chronic obstructive pulmonary diseases).

CONS:  Anxiety, heart arrhythmias, dizziness, headache, insomnia, mood disorders, muscle cramps, nausea, palpitations, tachycardia, sweating and tremors (usually of the hands).

HORMONE ANTAGONISTS AND HORMONE MODULATORS 

Examples: Aromatase inhibitors including aminoglutethimide, tamoxifen, clomiphene

PROS:  Enhancing muscle buildup and dramatically slows muscle breakdown (anabolic), increases muscle strength, used medically for breast cancer and infertility in females.

CONS:  Abdominal pain or discomfort, can cause certain cancers, hot flushes, slurring of speech, reduction of libido

DIURETICS AND OTHER MASKING DRUG AGENTS

Examples: Acetazolamide, amiloride

PROS:  Helps to hide banned substances, dramatically improves urine excretion reducing the concentration and therefore the detection of banned substances, promotes weight loss.  Used to treat heart failure and hypertension (high blood pressure).

CONS:  Can cause dramatic drops in blood pressure, death, cramps, dizziness, dehydration, headaches, heart failure, muscle cramps, nausea, potassium depletion, overall fluid volume depletion in the body.

STIMULANTS

Examples: adrafinil, adrenaline

PROS:  Increases generalized aggressiveness, stimulates overall mental alertness, increases competitiveness and competitive response (reaction time), reduces fatigue and promotes weight loss. Used medically to treat allergies, asthma, ADHD (attention deficit disorder), headache, nasal congestion and the common cold. 

CONS:  Addictive, aggressiveness, anxiety and hyperalertness, heart arrhythmias, brain hemorrhage (bleeding), confusion, dehydration, death, hand tremors, heart attack, heat stroke, insomnia, stroke, sweating, weight loss and tremor.

NARCOTICS 

Examples: buprenorphine, dextromoramide

PROS:  May promote a generalized feeling of invincibility, acts as a pain killer, increases overall pain threshold, creates a sensation of euphoria.  Used medically to treat pain from a variety of sources.

 CONS:  Addictive, can cause coordination and balance difficulties, death, reduced ability to concentrate, increases injury risk, nausea, respiratory depression, vomiting and sleepiness.

CANNABINOIDS 

Examples: Cannabinoids (i.e., marijuana, hashish)

PROS:  Creates a sensation of euphoria and is a sedative. Used medically for pain in cancer patients.

CONS:  Addictive, can cause anxiety, apathy, stimulate appetite, bronchitis, cancer of the mouth, throat, lung and tongue, loss of concentration, drowsiness, heart rate increases, hallucinations, dry mouth, reflex loss and weight gain, panic and paranoid attacks/thinking, loss of motivation, mood swings and learning impairment.

GLUCOCORTICOSTEROIDS

Examples: glucocorticosteroids

PROS:  Act as anti-inflammatory agents and used medially for asthma, arthritis, inflamed tissues such as nerves, tendons, cartilage and muscles and used for allergies. 

CONS:  Can cause fluid retention, hyperglycemia (raise blood sugar levels), mood alteration, musculoskeletal dysfunction and disease, immune alterations and increase risk of systemic infections.

ALCOHOL 

Example: ethanol

PROS:  Anti-anxiety effect, enhances/maximizing the effects of other medications taken simultaneously.

CONS:  Addictive, can cause B-vitamin losses and permanent central and peripheral nervous system problems including dementia and neuropathy (nerve problems). May also cause liver failure, cirrhosis, death, depression, incontinence, double vision and heart disease.

BETA-BLOCKERS 

Examples: acebutolol and alprenolol

PROS:  Reduces muscle tremors that would otherwise negatively impact precision sport skills, sedative effects

CONS:  Lowers blood pressure, reduces heart rate, reduces performance capacity (particularly in endurance sporting events), causes sleep disturbances and fatigue.

BANNED APPROACHES

Examples: blood doping methods, tampering physically or chemically with samples

and gene doping

PROS:  Enhances general sports performance and enhances the ability to perform at higher altitudes. 

CONS:  Can cause autoimmune allergic reactions is incorrect blood type is used, death, blood poisoning, reduces cardiac output, may promote infectious disease transfer, hypertension, promotes clot formation and stroke, iron overload (hemosiderosis), kidney damage, reduces platelet count, can cause sexual dysfunction and transient fevers.

In conclusion (for now), although far from an exhaustive examination of the topic of PEDs (performance enhancing drugs) in professional sports, it does seem that they possess both positive and negative health and athletic potential.  PEDs are being aggressively studied and many of these substances are in fact currently in use within mainstream medicine for legitimate health purposes, and among professional and non-professional athletes, illegally

The use of PEDs by some professional athletes is undeniable. The absence of utilization of certain PEDs in medical circles for various conditions and diseases is odd considering their huge potential for improving general sense of wellbeing including physical and mental functionality.  In the area of professional sports, such improvements in wellbeing including physical and mental improvements are, and will remain to be, an area of intense debate.