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Posted: December 21, 2004

Multisport: Performance Enhancement Drugs…Should You Be Taking Them?

By Lance Tarr

Defining Ergogenic (Performance Enhancement) Aids:

Technically speaking, an assortment of definitions exists for ergogenic aids. Wilmore and Costill offered, "An ergogenic aid is any substance or phenomenon that enhances performance." Fox, Bowers, and Foss state, "An ergogenic aid, simply defined, is any substance, process, or procedure which may, or is perceived to, enhance performance through improved strength, speed, response time, or endurance of an athlete." Williams writes, "Scientific literature refers to substances that athletes use to help enhance performance as ergogenic aids, or sports ergogenics." And finally, no talk of ergogenics would be complete without reference to the "placebo effect." Wilmore and Costill defined it as "The phenomenon by which your expectations of a substance determines your body's response to it."

The history of ergogenic use dates to the ancient Olympics where stories of warriors eating a lion's heart for courage, or deer liver for speed have been reported. More recent history illustrates the health risks associated with the use of ergogenic aids as in the cases of Knut Jensen (cyclist in the 1960 Olympics) and Tommy Simpson (cyclist in the 1967 Tour de France) who both died secondary to amphetamine use during their respective competitions.

Some of the most popularly used ergogenics are anabolic steroids, growth hormone, creatine, erythropoietin (EPO), glycerol, and blood-boosting; the three former being primarily utilized by the strength / power athlete, while the three latter have been applied in enhancing performance of the endurance athlete. Needless to say, the list of things we inject, inhale, ingest and absorb as well as wear, use and apply in the hope of gaining some competitive edge, slowing the aging process, or feeding the vanities that sometimes plague us all, athlete or not, is long and varied.

In addition to the aforementioned, some specifically used aids are amphetamines, beta 2 agonists, CoQ10, caffeine, ephedrine, DHEA, bicarbonate, antioxidants, vitamins, diet manipulation, ginseng, oxygen, androstenedione, glucosamine, chondrotin sulfate, nicotine, diuretics, hormones, and amino acids, altitude training, hyperbaric chambers, CO2 re-breathers, and carbon-fiber / titanium equipment (golf clubs, fishing rods, bicycles, etc. Granted, these are more ergonomic than ergogenic, but they do aid in performance enhancement, which fits the definition of ergogenic aids.) The list is exhaustive.

The International Olympic Committee (IOC), the U.S. Olympic Committee (USOC), and the National Collegiate Athletic Association (NCAA) all name specific ergogenic aids, which are banned for use by competing athletes. The IOC developed their list in 1967 - just prior to the 1968 Olympics - due, in part, to the widespread use of anabolic steroids in the 1964 Olympics. The USOC has a program much like the IOC's. The NCAA began testing in 1986. As the use and testing for ergogenic aids evolved, some substances were deleted while those in vogue were added. (To view a list of banned substances by any of those sports governing bodies, please go to their respective websites).

Each of the following categories of ergogenic aids with their respective banned substances are examples of "help" that's not acceptable by the IOC, USOC, and the NCAA. This list represents only some of the more common aids.

Stimulants: Amphetamines, Ephedrine, and Caffeine (dose limited)
Beta 2 Agonists: Clenbuterol, Salbutamol, Albuterol, Salmeterol (the last three may be used as an inhaler for asthma).
Anabolic / Androgenic: Testosterone, Nandrolone, Adrostenedione, DHEA
Hormones: Growth hormone, Erythropoietin, Insulin
Processes: Blood doping (AKA blood-boosting)
Narcotics: Morphine (banned by the NCAA, but not the IOC)
Corticosteroids: oral / systemic are banned, while topical, local injection, or intraarticular are not banned.

It's worth noting that many of the banned substances are also found in over-the-counter (OTC) and legally prescribed medicines. This has undoubtedly caused unwitting competitors duress when learning that they've tested positive for a banned ergogenic aid, but know they didn't consciously partake of an illegal performance enhancer. Indeed, there's a specific instance of one Olympic gold medal winner being disqualified secondary to just such a situation.

Components Of Competition

There are primary components of athletic endeavors that relate to fitness and performance. Fitness-related components are cardiovascular-respiratory, muscular strength, muscular endurance, and body composition. Performance-related components are speed, agility, balance, power, coordination, and reaction time. In addition, an athlete's psychological state and ability to recover from training or injury figure hugely into how competitive he or she will be on any given day.

By common thread, the higher the level of competition, the more likely some ergogenic aid is being used to enhance these parameters. Likewise, the more success athletes have at their chosen sport(s), the more likely they are to supplement with ergogenics. Opinions from roundtable literature on ergogenics also suggest that elite athletes participating in individual sports (vs. those in team sports) may be more likely to supplement based on lack of teammate support and influence.

Suffice it is to say that athletes at a national to world class level are far more likely to use ergogenic aids as a way of gaining an edge. However, it's doubtful that even the most challenged but dedicated local athlete hasn't tried a supplement, technique, or process at one time or another in order to enhance his / her performance in the competitive arena.

Efficacy, Safety & Legality

Following are examples of a few ergogenic aids that are applicable to endurance sport.

1. Blood Doping

Also referred to as "blood boosting," it's a technique used to increase the number of red blood cells (RBCs) which also increases the amount of hemoglobin (the oxygen carrying protein found on RBCs). This, in turn, increases both aerobic capacity and aerobic power. There are several ways to increase the number of RBCs, such as blood transfusion (autologous or homologous), use of recombinant human hormone erythropoietin (EPO), or altitude training (endurance training at elevations over 5,000 feet above sea level.)
Does It Work? Yes!!! In addition to improving one's ability to run, bike, swim, etc. at faster speeds and for longer durations at those speeds, it also seems to enhance performance in the heat, especially in athletes who are already acclimatized.
Is It Safe? Let's just say it's risky. Transfusion Risks involve reactions from either autologous (one's own blood) or homologous (someone else's blood), which can occur due to mishandling of blood or clerical errors. Thickening of the blood (hyperviscosity) can occur with EPO use as well as with transfusions. This can lead to thrombosis (blood clotting) with inherent risk of stroke, vascular sludging, and myocardial arterial occlusion. A significant increase in blood pressure can also occur. In addition, decreases in lymphocyte count have occurred suggesting that EPO may have an effect on regulation of cells affecting the immune system function.
Is It Legal? No!! Blood doping is currently banned by most sports governing bodies. Autologous infusion is a bit harder to detect than homologous, and EPO use can be detected only for a few days post administration.

2.Sodium Bicarbonate

This compound is found naturally in the body and acts as a buffering agent for lactic acid when lactate levels rise due to high-intensity exercise.
Does It Work? Probably. It's been the topic of research on many occasions and appears to be effective in improving performance in 400m, 800m, and 1500m runs.
Is It Safe?Only in moderation. Excessive doses can lead to alkalosis. It appears safe at the doses necessary to produce ergogenic effect, with the primary side effects being GI distress and diarrhea. These symptoms may well offset the ergogenic effect as well.
Is It Legal?Yes. Sodium bicarbonate is currently not a banned substance.

3. Caffeine

Caffeine is a xanthine which acts as a central nervous system stimulant. It's been described as a strong stimulant (though not as strong as amphetamine) and a weak to moderate diuretic. It's found in food products such as coffee, tea, chocolate, and soda. It can also be found in over-the-counter drugs such as Vivarin and No-Doze. It's been used by both power and endurance athletes for its ergogenic properties.
Does It Work? Depends on who you ask. Studies are conflicting at present; however, caffeine does seem to provide performance enhancement for both prolonged activity and shorter intense efforts. The effect may be minimized in those who are habituated or training / racing in hot humid environments.
Is It Safe?Depends on dosage. In doses of 5-8 mg / kg of body weight, caffeine is deemed safe while producing little side effects. Higher doses (>10mg/kg) may induce seizures, cardiac tachycardia or arrhythmia, and even death.
Is It Legal?Yes & No. At normal doses it's not banned. Ingestion of approximately 7mg/kg produces urinary levels very close to the limit for the IOC (12 um/ml). The NCAA levels are a bit more lenient at 15 um/ml. Seven ml/kg is roughly 2 cups of coffee. {For more info on caffeine, refer to Suzanne Eberle's article in the July/August 2003 issue.}


Glycerol is a compound that occurs naturally in the body (i.e., triglycerides, etc.). When it's ingested with water, it allows the body to store even more water than it would normally. Consequently, a state of 'hyperhydration' is attained which translates into a delay of dehydration during prolonged efforts.
Does It Work? Maybe. Some studies have shown as much as a 20% increase in performance, while others have shown no difference in hyperhydration with water vs. hyperhydration with glycerol.
Is It Safe?Glycerol is used by the medical community to decrease swelling in the brain and eyes due to fluid buildup. Therefore, glycerol use may present a risk for dehydration in those areas in healthy individuals. In addition, those with any renal disease or limitations should avoid its use.
Is It Legal? Yes. Glycerol isn't banned by the NCAA or the IOC.


What is fair? What isn't? Is it fair that one endurance athlete grew up at altitude, lives and trains there, while others need to uproot and move to that environment? Is it fair for a professional golfer to use a golf cart secondary to a physical condition that prevents him from walking the course? No easy answers here. Personally, I wonder where sportsmanship has gone. We've all seen rare glimpses of it at the world class level when Lance Armstrong waited for Jan Ulrich after he crashed during the 2002 Tour de France. And we saw it again in this year's competition when Ulrich waited for Armstrong when Armstrong went down.

A few years ago I had the good fortune of running the final few miles of the Ogden 20K Classic (then the Big Boy Classic) with running legend Bill Rodgers (I'm not that good; Bill was just coming off an Achilles injury.) As we approached the finish line, I slowed and asked Bill to please go ahead. Personally, I couldn't have imagined trying to sprint ahead of a man who exemplifies such sportsmanship and good will.

It's my opinion that hard work, good nutrition, consistent discipline, sound training programs and recovery phases are all the ergogenics needed. The basis for competitive sport should be taught to our children not as "win at any and all cost" but instead: "work hard, train smart, recover well, eat right, and above all, enjoy what you're doing." That doesn't mean "don't be focused or dedicated;" it only means that competitive sport is a gift that shouldn't be abused or distorted.

Far too many scientists and athletes express the view that if it's safe and legal, why not use it? I hesitate to agree, only because I've competed at individual sports all my life and I've found that the simplicity of just you and the sport is where the beauty lies. Particularly in running, nothing could be simpler - you could run naked if necessary! You can run in place, on a treadmill, on a track, or down the road - the simplicity and naturalness is beautiful. Why would anyone ever want to complicate the sport by ingesting, inhaling, applying, and / or absorbing something to go faster unnaturally?

LANCE TARR is a licensed physical therapist, an exercise physiologist, and a NSCA Certified Strength and Conditioning Specialist. He has experience in sports medicine, orthopedic and cardiac rehabilitation, industrial medicine/work hardening, and diabetes education/exercise issues. A runner for more than 30 years, he enjoys cycling and swimming as well. He has coached competitively, and stays fit with an emphasis on balance of mind, body and spirit.

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