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19.6: 19.6 Drugs, Athletic Performance, and the Brain

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    177691
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    Learning Objectives

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    Thermogenic products

    A thermogenic is a broad term for any supplement that the manufacturer claims will cause thermogenesis, resulting in increased body temperature, increased metabolic rate, and consequently an increased rate in the burning of body fat and weight loss. Until 2004 almost every product found in this supplement category comprised the "ECA stack": ephedrine, caffeine, and aspirin. However, on February 6, 2004, the Food and Drug Administration (FDA) banned the sale of ephedra and its alkaloid, ephedrine, for use in weight loss formulas. Several manufacturers replaced the ephedra component of the "ECA" stack with bitter orange or citrus aurantium (containing synephrine) instead of the ephedrine.

    Caffeine

    Caffeine is a chemical called xanthine found in the seeds, leaves, and fruit of many plants, where it acts as a natural pesticide. It is the most widely consumed psychoactive substance and is such an important part of many people’s lives that they might not even think of it as a drug. Up to 90 percent of adults around the world use it on a daily basis. According to both the FDA and the American Medical Association, the moderate use of caffeine is “generally recognized as safe.” It is considered a legal psychoactive drug and, for the most part, is completely unregulated.

    Typical Doses and Dietary Sources

    What is a “moderate intake” of caffeine? Caffeine intakes are described in the following manner:

    • Low–moderate intake. 130–300 milligrams per day
    • Moderate intake. 200–300 milligrams per day
    • High intake. 400 or more milligrams per day

    The average caffeine consumption for American adults is considered moderate at 280 milligrams per day, although it is not uncommon for people to consume up to 600 milligrams per day. This works out to almost 4 ½ cups of coffee per day. The bitter taste of caffeine is palatable for many and coffee is the most readily available source of it, accounting for 70 percent of daily caffeine consumption. The second readily available source of caffeine is soft drinks, delivering 16 percent of daily caffeine. (In this case, the bitter caffeine taste is usually masked by a large amount of added sugar.) Tea is the third common source of caffeine, at 12 percent.

    Just how much caffeine is there in a cup of coffee? It varies. The caffeine content of an average cup of coffee can range from 102 to 200 milligrams, and the range of tea is 40 to 120 milligrams. Table 15.6.2 provides useful information on the levels of caffeine found in common beverages. When estimating your total caffeine consumption remember its not only in beverages but also some foods and medicine.

    Table 15.6.1: Caffeine Content in Various Beverages and Foods
    Beverage/Food Milligrams
    Starbuck’s Grande Coffee (16 oz.) 380
    Plain brewed coffee (8 oz.) 102–200
    Espresso (1 oz.) 30–90
    Plain, decaffeinated coffee (8 oz.) 3–12
    Tea, brewed (8 oz.) 40–120
    Green tea (8 oz.) 25–40
    Coca-Cola Classic (12 oz.) 35
    Dr. Pepper (12 oz.) 44
    Jolt Cola (12 oz.) 72
    Mountain Dew (12 oz.) 54
    Mountain Dew, MDX (12 oz.) 71
    Pepsi-Cola (12 oz.) 38
    Red Bull (8.5 oz.) 80
    Full Throttle (16 oz.) 144
    Monster Energy (16 oz.) 160
    Spike Shooter (8.4 oz.) 300

    Source: MedicineNet.com. “Caffeine.” Accessed October 2, 2011. http://www.medicinenet.com/caffeine/article.htm.

    Health Benefits of Caffeine

    The most renowned effects of caffeine on the body are increased alertness and delay of fatigue and sleep. How does caffeine stimulate the brain? Watch "Video 15.6.1" to see a graphic account of a brain on caffeine. Caffeine is chemically similar to a chemical in our brains (adenosine). Caffeine interacts with adenosine’s specific protein receptor. It blocks the actions of the adenosine, and affects the levels of signaling molecules in the brain, leading to an increase in energy metabolism. At the molecular level, caffeine stimulates the brain, increasing alertness and causing a delay of fatigue and sleep. At high doses caffeine stimulates the motor cortex of the brain and interferes with the sleep-wake cycle, causing side effects such as shakiness, anxiety, and insomnia. People’s sensitivity to the adverse effects of caffeine varies and some people develop side effects at much lower doses. The many effects caffeine has on the brain do not diminish with habitual drinking of caffeinated beverages.

    Video 15.6.1: A Brain on Caffeine. Watch this graphic account of the brain on caffeine.

    Scientific studies suggest caffeine can improve endurance capacity by increasing energy available during exercise. The effect may only work in non-caffeine drinkers and it only takes 1-3 days for the body to become "caffeine-naive."

    Bicarbonate

    The term bicarbonate refers to sodium bicarbonate a salt that disassociates in water to form sodium and bicarbonate ions. Remember, the small intestine produces and uses bicarbonate to neutralize the acid in your stomach. Baking soda is sodium bicarbonate. There is limited scientific evidence that bicarbonate can improve athletic performance. The mechanism of action is through increased buffering of the blood which may be beneficial for high-intensity exercise.

    Growth Hormone

    Growth hormone (GH) is a hormone our body produces. In sports, athletes use this the abbreviations GH or HGH (human growth hormone) to refer to growth hormone. GH is a prescription medication so possession and use of it without a prescription is illegal. There is limited scientific evidence that it will increase muscle mass and improve athletic performance. Adverse effects of inappropriately using GH include weakened heart wall and premature death.

    Thermogenic products

    A thermogenic is a broad term for any supplement that the manufacturer claims will cause thermogenesis, resulting in increased body temperature, increased metabolic rate, and consequently an increased rate in the burning of body fat and weight loss. Until 2004 almost every product found in this supplement category comprised the "ECA stack": ephedrine, caffeine and aspirin. However, on February 6, 2004 the Food and Drug Administration (FDA) banned the sale of ephedra and its alkaloid, ephedrine, for use in weight loss formulas. Several manufacturers replaced the ephedra component of the "ECA" stack with bitter orange or citrus aurantium (containing synephrine) instead of the ephedrine.

    Controversies of Fitness Supplements

    Mislabeling: According to University of Helsinki food safety professor Marina Heinonen, more than 90% of dietary supplement health claims are incorrect. While many of the claims are based on scientifically based physiological or biochemical processes, their use in bodybuilding parlance is often heavily colored by bodybuilding lore and industry marketing and as such may deviate considerably from traditional scientific usages of the terms. In addition, ingredients listed have been found at times to be different from the contents. In 2015, Consumer Reports reported unsafe levels of arsenic, cadmium, lead and mercury in several of the protein powders that were tested. Other studies in 2013 showed that one-third of the supplements tested contained unlisted steroids. In 2015 a CBC investigative report found that protein spiking (the addition of amino acid filler to manipulate analysis) was not uncommon, however many of the companies involved challenged these claims.

    Health problems: The US FDA reports 50,000 health problems a year due to dietary supplements and these often involve bodybuilding supplements. For example, the "natural" best-seller Craze, 2012's "New Supplement of the Year" by bodybuilding.com, sold in Walmart, Amazon etc., was found to contain undisclosed amphetamine-like compounds. Also other products by Matt Cahill have contained dangerous substances causing blindness or liver damages, and experts say that Cahill is emblematic for the whole industry.

    Liver damage: The incidence of liver damage from dietary supplements has tripled in a decade, the majority of these involved bodybuilding supplements. This resulted in liver transplants and, in some cases, death to the patient. Some have argued that the liver damage is more often caused by prescription drugs rather than supplements.

    Lack of effectiveness: In addition to being potentially harmful, some have argued that there is little evidence to indicate any benefit to using bodybuilding supplements. For example, according to the IOC, no consensus had been reached in determining whether an individual in exercise training benefits from protein and amino acid supplements. "In view of the lack of compelling evidence to the contrary, no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise".

    Anabolic Steroids

    Anabolic steroids are synthetic, or human-made, variations of the male sex hormone testosterone. The proper term for these compounds is anabolic-androgenic steroids. "Anabolic" refers to muscle building, and "androgenic" refers to increased male sex characteristics. Some common names for anabolic steroids are Gear, Juice, Roids, and Stackers. Health care providers can prescribe steroids to treat hormonal issues, such as delayed puberty. Steroids can also treat diseases that cause muscle loss, such as cancer and AIDS. But some athletes and bodybuilders misuse these drugs in an attempt to boost performance or improve their physical appearance.

    The majority of people who misuse steroids are male weightlifters in their 20s or 30s. Anabolic steroid misuse is much less common in women. It is difficult to measure steroid misuse in the United States because many national surveys do not measure it. However, use among teens is generally minimal. The 2016 NIDA-funded Monitoring the Future study has shown that past-year misuse of steroids has declined among 8th and 10th graders in recent years, while holding steady for 12th graders.

    People who misuse anabolic steroids usually take them orally, inject them into muscles, or apply them to the skin as a gel or cream. These doses may be 10 to 100 times higher than doses prescribed to treat medical conditions.

    Commons patterns for misusing steroids include:

    • cycling—taking multiple doses for a period of time, stopping for a time, and then restarting
    • stacking—combining two or more different steroids and mixing oral and/or injectable types
    • pyramiding—slowly increasing the dose or frequency of steroid misuse, reaching a peak amount, and then gradually tapering off to zero
    • plateauing—alternating, overlapping, or substituting with another steroid to avoid developing a tolerance

    There is no scientific evidence that any of these practices reduce the harmful medical consequences of these drugs.

    How Anabolic Steroids Work

    Anabolic steroids work differently from other drugs of abuse; they do not have the same short-term effects on the brain. The most important difference is that steroids do not directly activate the reward system to cause a “high”; they also do not trigger rapid increases in the brain chemical dopamine, which reinforces most other types of drug taking behavior. Misuse of anabolic steroids might lead to negative mental effects, such as: paranoid (extreme, unreasonable) jealousy, extreme irritability and aggression (“roid rage”), delusions—false beliefs or ideas, impaired judgment, and mania. Aside from mental effects, steroid use commonly causes severe acne. It also causes the body to swell, especially in the hands and feet.

    Anabolic steroid misuse might lead to serious, even permanent, health problems such as kidney problems or failure, liver damage and tumors, enlarged heart, high blood pressure, and changes in blood cholesterol, all of which increase the risk of stroke and heart attack, even in young people, and increased risk of blood clots. Several other effects are gender- and age-specific:

    • In men: shrinking testicles, decreased sperm count, baldness, development of breasts, increased risk for prostate cancer
    • In women: growth of facial hair or excess body hair, decreased breast size, male-pattern baldness, changes in or stop in the menstrual cycle, enlarged clitoris, deepened voice
    • In teens: stunted growth (when high hormone levels from steroids signal to the body to stop bone growth too early) and stunted height (if teens use steroids before their growth spurt)

    Some of these physical changes, such as shrinking sex organs in men, can add to mental side effects such as mood disorders.

    Anabolic Steroids Addiction

    Even though anabolic steroids do not cause the same high as other drugs, they can lead to a substance use disorder. A substance use disorder occurs when a person continues to misuse steroids, even though there are serious consequences for doing so. The most severe form of a substance use disorder is addiction. People might continue to misuse steroids despite physical problems, high costs to buy the drugs, and negative effects on their relationships. These behaviors reflect steroids' addictive potential.

    Research has further found that some steroid users turn to other drugs, such as opioids, to reduce sleep problems and irritability caused by steroids. People who misuse steroids might experience withdrawal symptoms when they stop use, including:fatigue, restlessness, loss of appetite, sleep problems, decreased sex drive and steroid cravings.

    One of the more serious withdrawal symptoms is depression, which can sometimes lead to suicide attempts. Some people seeking treatment for anabolic steroid addiction have found a combination of behavioral therapy and medications to be helpful. In certain cases of addiction, patients have taken medicines to help treat symptoms of withdrawal. For example, health care providers have prescribed antidepressants to treat depression and pain medicines for headaches and muscle and joint pain. Other medicines have been used to help restore the patient's hormonal system.

    Summary

    • Anabolic steroids are synthetic variations of the male sex hormone testosterone. Health care providers can prescribe steroids to treat various medical conditions. But some athletes and bodybuilders misuse these drugs to boost performance or improve their physical appearance.
    • People who abuse anabolic steroids usually take them orally, inject them into the muscles, or apply them to the skin with a cream or gel.
    • People misuse steroids in a variety of doses and schedules. Misuse of anabolic steroids might lead to short-term effects, including paranoid jealousy, extreme irritability and aggression, delusions, impaired judgment, and mania. Continued steroid misuse can act on some of the same brain pathways and chemicals that are affected by other drugs, including dopamine, serotonin, and opioid systems.
    • Anabolic steroid misuse might lead to serious long-term, even permanent, health problems. Several other effects are gender- and age-specific.
    • Even though anabolic steroids do not cause the same high as other drugs, they can lead to addiction. Some people seeking treatment for anabolic steroid addiction have found behavioral therapy and medications to be helpful. Medicines can help treat symptoms of withdrawal in some cases.

    Contributors

    • Wikipedia
    • National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

    Prohormone

    Prohormones are precursors to hormones and are most typically sold to bodybuilders as a precursor to the natural hormone testosterone. This conversion requires naturally occurring enzymes in the body. Side effects are not uncommon, as prohormones can also convert further into DHT and estrogen. To deal with this, many supplements also have aromatase inhibitors and DHT blockers such as chrysin and 4-androstene-3,6,17-trione. To date, most prohormone products have not been thoroughly studied, and the health effects of prolonged use are unknown. Although initially available over the counter, their purchase was made illegal without a prescription in the US in 2004, and they hold similar status in many other countries. They remain legal, however, in the United Kingdom and the wider European Union. Their use is prohibited by most sporting bodies.

     

    Drugs, Athletic Performance, and Drug Screening

    The use of performance-enhancing tactics or more formally known as PEDs, and more broadly, the use of any external device to nefariously influence the outcome of a sporting event has been a part of the Olympics since its inception in Ancient Greece. One speculation as to why men were required to compete naked was to prevent the use of extra accoutrements and to keep women from competing in events specifically designed for men.[1] Athletes were also known to drink "magic" potions and eat exotic meats in the hopes of giving them an athletic edge on their competition.[2] If they were caught cheating, their likenesses were often engraved into stone and placed in a pathway that led to the Olympic stadium.[1] In the modern Olympic era, chemically enhancing one's performance has evolved into a sophisticated science, but in the early years of the Modern Olympic movement the use of performance-enhancing drugs was almost as crude as its ancient predecessors. For example, the winner of the marathon at the 1904 GamesThomas Hicks, was given strychnine and brandy by his coach, even during the race.[3]

    During the early 20th century, many Olympic athletes discovered ways to improve their athletic abilities by boosting testosterone. As their methods became more extreme, it became increasingly evident that the use of performance-enhancing drugs was not only a threat to the integrity of sport but could also have potentially fatal side effects on the athlete. The only Olympic death linked to athletic drug use occurred at the Rome Games of 1960. During the cycling road race, Danish cyclist Knud Enemark Jensen fell from his bicycle and later died. A coroner's inquiry found that he was under the influence of amphetamine, which had caused him to lose consciousness during the race.[4] Jensen's death exposed to the world how endemic drug use was among elite athletes.[5] By the mid–1960s, sports federations were starting to ban the use of performance-enhancing drugs, and the IOC followed suit in 1967.  In 1967 the IOC banned the use of performance-enhancing drugs, instituted a Medical Commission, and created a list of banned substances.  Mandatory testing began at the 1968 Summer Olympic Games.  In a few cases the IOC has reversed earlier rulings that stripped athletes of medals.

    The first Olympic athlete to test positive for the use of performance-enhancing drugs was Hans-Gunnar Liljenwall, a Swedish pentathlete at the 1968 Summer Olympics, who lost his bronze medal for alcohol use, 'two beers to steady his nerves'. Liljenwall was the only athlete to test positive for a banned substance at the 1968 Olympics, as the technology and testing techniques improved, the number of athletes discovered to be chemically enhancing their performance increased as well.

     

    Exercise and  the Brain

    The neurobiological effects of physical exercise are numerous and involve a wide range of interrelated effects on brain structure, brain function, and cognition.[1][2][3][4]A large body of research in humans has demonstrated that consistent aerobic exercise (e.g., 30 minutes every day) induces persistent improvements in certain cognitive functions, healthy alterations in gene expression in the brain, and beneficial forms of neuroplasticity and behavioral plasticity; some of these long-term effects include: increased neuron growth, increased neurological activity (e.g., c-Fos and BDNF signaling), improved stress coping, enhanced cognitive control of behavior, improved declarativespatial, and working memory, and structural and functional improvements in brain structures and pathways associated with cognitive control and memory.[1][2][3][4][5][6][7][8][9][10] The effects of exercise on cognition have important implications for improving academic performance in children and college students, improving adult productivity, preserving cognitive function in old age, preventing or treating certain neurological disorders, and improving overall quality of life.[1][11][12]

    In healthy adults, aerobic exercise has been shown to induce transient effects on cognition after a single exercise session and persistent effects on cognition following regular exercise over the course of several months.[1][10][13] People who regularly perform aerobic exercise (e.g., running, jogging, brisk walking, swimming, and cycling) have greater scores on neuropsychological function and performance tests that measure certain cognitive functions, such as attentional controlinhibitory controlcognitive flexibilityworking memory updating and capacity, declarative memoryspatial memory, and information processing speed.[1][5][7][9][10][13] The transient effects of exercise on cognition include improvements in most executive functions (e.g., attention, working memory, cognitive flexibility, inhibitory control, problem solving, and decision making) and information processing speed for a period of up to 2 hours after exercising.[13]

    Aerobic exercise induces short- and long-term effects on mood and emotional states by promoting positive affect, inhibiting negative affect, and decreasing the biological response to acute psychological stress.[13] Over the short-term, aerobic exercise functions as both an antidepressant and euphoriant,[14][15][16][17] whereas consistent exercise produces general improvements in mood and self-esteem.

    Regular aerobic exercise improves symptoms associated with a variety of central nervous system disorders and may be used as an adjunct therapy for these disorders. There is clear evidence of exercise treatment efficacy for major depressive disorder and attention deficit hyperactivity disorder.[11][16][20][21][22][23] The American Academy of Neurology's clinical practice guideline for mild cognitive impairment indicates that clinicians should recommend regular exercise (two times per week) to individuals who have been diagnosed with this condition.[24] Reviews of clinical evidence also support the use of exercise as an adjunct therapy for certain neurodegenerative disorders, particularly Alzheimer’s disease and Parkinson's disease. Regular exercise is also associated with a lower risk of developing neurodegenerative disorders.[28][31] A large body of preclinical evidence and emerging clinical evidence supports the use of exercise as an adjunct therapy for the treatment and prevention of drug addictions.  Regular exercise has also been proposed as an adjunct therapy for brain cancers.[37]

     

    Summary

    Resources

    Wikipedia