Be aware of substance use in the athlete who is attempting to enhance performance

Author: Nailah Coleman, MD

What to Do - Gather Appropriate Data

Athletes have been using performance-enhancing substances for as long as there has been athletic competition. In fact, the prevalence of the use of performance-enhancing substances has increased over time. Classified as supplements, prescriptions medications and banned/illicit substances, performance-enhancing substances have found their uses in the world of sports, for both theoretical and proven reasons.

Supplements can be packaged as such when sold as a beneficial supplement and not defined as a drug or proclaimed to treat a medical condition. Adolescent athletes most commonly utilize supplement performance-enhancing substances. Currently used supplements include creatine, androstenedione, antioxidants, and amino acids. Creatine, naturally found in the body and utilized for energy production via its conversion to phosphocreatine, has been used in the sporting world since 1992. The use of creatine in the adolescent population is increasing due to several potential reasons, including its claim as a "natural" supplement, its easy access on the Internet, and its routine use by collegiate and professional athletes. The premise behind its use is that the added creatine allows for more readily available aerobic energy and decreased use of anaerobic metabolism, as increased levels of phosphocreatine lead to increased conversion of adenosine diphosphate (ADP) to adenosine triphosphate ATP. Creatine, however, does notworkwithoutstrengthtraining,anditsside-effectprofileisstillunknown at this time. Recent reports suggest a reversible renal dysfunction related to decreased glomerular filtration rate. Androstenedione, also available for use for some time, is believed to work as a precursor to testosterone; however, it remains on the supplement list due to lack of efficacy in clinical trials. Androstenedione use in a prepubertal athlete could, in theory, cause premature puberty or premature closure of the growth plates. Amino acid supplements are often used to achieve a positive nitrogen balance; antioxidants are used for their immunity-promoting properties.

Prescription medications are obtained by a physician for a specific medical purpose but may also have beneficial effects with regards to sports participation when used at supratherapeutic doses or in healthy athletes. Beta-agonists, such as albuterol, have both anabolic and stimulating effects, and because of this, they have been banned from use by the International Olympic Committee, if used without a medical indication (e.g., bronchospasm). Other prescription medications that may have additional benefits in healthy athletes include narcotics, which, by decreasing pain, can increase an athlete's stamina and ability; beta-blockers, which, when used in sports that require accuracy (e.g., archery), can decrease anxiety; and diuretics, which can be used to alter one's form (e.g., in body-building) and to dilute one's urine (e.g., for drug testing).

Banned/illicit substances are those that are either banned by athletic competition governing boards or declared illegal by law. Some banned/illicit substances may also be supplements and/or prescription medications. Most of the banned/illicit substances are anabolic steroids and their derivatives or other hormones and hormone analogs. Steroids, increasingly used by adolescentathletes,areusedfortheiranabolicand/oranticataboliceffects.Anabolic steroids are purported to increase muscle mass and strength and to decrease recovery time. Unlike many supplements, steroids have a well-defined side- effect profile, including acne, hirsutism, hypertension, psychosis, premature closure of the growth plates, and decreased sexual function. In addition, anabolic steroid use in adolescents had been linked to other illicit substance abuse in adolescents. Commonly used androgenic compounds include anti- estrogens, which inhibit the conversion of androgens to estrogen, and dehydroepiandrosterone (DHEA), a precursor to androgens and utilized for their androgenic effect. Additional banned/illicit substances include stimulants, such as caffeine and ephedra, which are used to increase one's endurance and to increase fatty acid breakdown, and "blood doping," such as nontherapeutic transfusions or erythropoietin, which is also used to improve one's endurance. The ideal time to screen for the use of performance enhancing substances is at the preparticipation exam. A detailed history with pointed, but nonjudgmental, questions should be used to elicit an athlete's use of performance enhancing substances. Questions should focus on the use of any substance, including vitamins, herbs, and minerals, to help with sports competitions, workouts, or one's general appearance. Appropriate screening and diagnosis could then help to keep our young athletes safe and competing well into the future.

Suggested Readings

American Academy of Pediatrics. Committee on Sports Medicine and Fitness. Adolescents and anabolic steroids: a subject review. Pediatrics. 1997;99:904–908. Koch JJ. Performance-enhancing: substances and their use among adolescent athletes. Pediatr Rev. 2002;23(9):310–317. Metzl JD, Small E, Levine SR, et al. Creatinine use among young athletes. Pediatrics. 2001;108: 421–425.

Book Source Details

• Book Title: Avoiding Common Pediatric Errors
• Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
• Year of Publication: 2008
• Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.

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More About This Book: Title: Avoiding Common Pediatric Errors Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7489-6

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