WHY IS THIS IMPORTANT?


Today, 88% of athletes reportedly use supplements, and the problem is an old one.14 Most cultures have admired and rewarded athletic prowess and bestowed athletes with extraordinary status. Ancient Olympians consumed animal organs in the hope of acquiring the performance capabilities of the animal.3,15,16 They also experimented with herbs, alcohol, and hallucinogens to enhance their strength and courage for competitions. Ancient Incan couriers chewed coca leaves as a performance aid that was believed helpful for running at high altitudes.17 


WHO USES PERFORMANCE-ENHANCING SUBSTANCES?


Performance-enhancing substances are used by teenagers and preteens as early as middle school; in high school, approximately 3% of girls and 6% of boys were found to use anabolic steroids.3,18-20 Generally, use of performance enhancers varies with the sport.1,10 When illicit substance use is common, athletes may feel compelled to use performance enhancers in order to "level the playing field." In addition, many athletes unwittingly consume performance-enhancing substances because approximately 15% of retail ergogenic supplements contain banned substances that are not identified on the product label.14 According to the Mitchell Report, an investigation into the use of performance-enhancing drugs in professional baseball, 5% to 50% of Major League Baseball players used performance-enhancing substances during the early part of the 21st century.21


Unfortunately, patients may not report use of these substances or supplements, either for privacy concerns or because they do not consider such use to be a medical issue. Thus, PAs who suspect use or misuse of performance-enhancing substances or supplements should ask specific questions about their use:22


  • Have you gained or lost weight in the past 6 months?

  • Are you trying to gain or lose weight?

  • What are your sport or activity goals for this year?

  • Are you taking any medications, including vitamins or supplements?22


CONCLUSION


Powerful cultural incentives accompany elite athletic achievement. Products that enhance performance or physique are continually being developed, and their use can have a significant impact on our patients' health. Gene modifiers and insertion of modified DNA into a patient's genome (transfection techniques) may be the next generation of performance-enhancing practices.12,13 PAs need knowledge about performance-enhancing practices in order to help patients navigate this troubling environment. JAAPA


This article was written by Thomas Moreau, PA-C, MS. Contributors included the other members and staff of CSAC 2009-2010: Daniel L. O'Donoghue, PhD, PA-C, Chair; Gilbert A. Boissonneault, PhD, PA-C; Anthony E. Brenneman, MPAS, PA-C; Alison C. Essary, MHPE, PA-C; Michelle Lynn Heinan, EdD, PA-C; and Marie-Michèle Léger, MPH, PA-C. The manuscript was edited by Sarah Zarbock, PA-C. 

REFERENCES


1. Gomez J, American Academy of Pediatrics Committee on Sports Medicine and Fitness. Use of performance-enhancing substances. Pediatrics. 2005;115(4):1103-1106.


2. Petroczi A, Naughton DP, Pearce G, et al. Nutritional supplement use by elite young UK athletes: fallacies of advice regarding efficacy. J Int Soc Sports Nutr. 2008;5:22.


3. Calfee R, Fadale P. Popular ergogenic drugs and sup­plements in young athletes. Pediatrics. 2006;117(3):
e577-e589.


4. Smits P, Thien T, Van't Laar A. The cardiovascular effects of regular and decaffeinated coffee. Br J Clin Pharmacol. 1985;19(6):852-854.


5. Lopez-Garcia E, van Dam RM, Qi L, Hu FB. Coffee consumption and markers of inflammation and endothelial dys­-
function in healthy and diabetic women. Am J Clin Nutr. 2006;84(4):888-893.


6. Haller CA, Duan M, Jacob P 3rd, Benowitz N. Human pharmacology of a performance-enhancing dietary supplement under resting and exercise conditions. Br J Clin Pharmacol. 2008;65(6):833-840.


7. Namdar M, Schepis T, Koepfli P, et al. Caffeine impairs myocardial blood flow response to physical exercise in patients with coronary artery disease as well as in age-matched controls. PLoS One. 2009;4(5):e5665. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682574/pdf/pone.0005665.pdf. Accessed April 8, 2010.


8. Roberts MD, Taylor LW, Wismann JA, et al. Effects of ingesting JavaFit Energy Extreme functional coffee on aerobic and anaerobic fitness markers in recreationally-active coffee consumers. J Int Soc Sports Nutr. 2007;4:25. 


9. Walter AA, Herda TJ, Ryan ED, et al. Acute effects of a thermogenic nutritional supplement on cycling time to exhaustion and muscular strength in college-aged men. 
J Int Soc Sports Nutr. 2009;6:15.


10. World Anti-Doping Agency International Standards Prohibited List. http://www.wada-ama.org/en/World-Anti-Doping-Program/
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Standards/Prohibited-List/. Accessed April 8, 2010.


11. Healy ML, Gibney J, Pentecost C, et al. Effects of high-dose growth hormone on glucose and glycerol metabolism at rest and during exercise in endurance-trained athletes. 
J Clin Endocrinol Metab. 2006;91(3):320-327.


12. Saugy M, Robinson N, Saudan C, et al. Human growth hormone doping in sport. Br J Sports Med. 2006;
40(suppl 1):i35-i39.


13. Azzazy HM, Mansour MM, Christenson RH. Doping in the recombinant era: strategies and counter strategies. Clin Biochem. 2005;38(11):959-965.


14. Molinero O, Márquez S. Use of nutritional supplements in sports: risks, knowledge, and behavioural-related factors. Nutr Hosp. 2009;24(2):128-134.


15. Applegate EA, Grivetti LE. Search for the competitive edge: a history of dietary fads and supplements. J Nutr. 1997;
127(5 suppl):869S-873S.


16. Jenkins S. Winning, cheating have ancient roots. Washington Post. August 3, 2007. http://www.washingtonpost.com/wp-dyn/content/article/2007/08/02/AR2007080202497_pf.html. Accessed April 8, 2010.


17. Lewis BR. The Chasqui—athlete of the Andes. The Inca speed messenger. Suite 101.com Web site. Published December 7, 2009. http://inca-history.suite101.com/article.cfm/the_chasqui_
athlete_of_the_andes#ixzz0cETfqZA2. Accessed April 8, 2010.


18. Irving LM, Wall M, Neumark-Sztainer D, Story M. Steroid use among adolescents: findings from Project EAT. J Adolesc Health. 2002;30(4):243-252.


19. Hampton T. Researchers address use of performance-
enhancing drugs in nonelite athletes. JAMA. 2006;295(6):
607-608.


20. Kuehn BM. Teen steroid, supplement use targeted: officials look to prevention and better oversight. JAMA. 2009;302(21):2301-2303.


21. Mitchell GJ. Report to the Commissioner of Baseball of an Independent Investigation into the Illegal Use of Steroids and Other Performance Enhancing Substances by Players in Major League Baseball. New York, NY: Office of the Commissioner of Baseball; 2007.


22. Jarvi JF. Stay alert for performance-enhancing substance use. JAAPA. 2004:17(12):36-39.


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