CHAPTER 70 • MEDICATIONS AND ERGOGENICS 421- Users attempt to avoid detection by tapering in
advance of announced tests, staying within the 6:1
testosterone to epitestosterone level, or using mask-
ing agents like diuretics. Recent development of a
hair test may change the way testing is done in the
future. - Androstenedione, although banned, currently is not fre-
quently specifically tested (Blue and Lombardo, 1999).
BICARBONATE
EFFICACY
- Thought to act ergogenically by helping to buffer
lactic acid during high intensity exercise or through
some action of the sodium ion on intravascular
volume (Williams, 1995). - Appears to be effective in reducing acidosis of the
muscle cell and blood, decreasing the perception of
fatigue, and improving performance and delaying
time to exhaustion in high intensity events, and
improve performance in highly trained runners in 400,
800, and 1500 m (Williams, 1995).
SAFETY
- Appears safe at doses needed to produce ergogenic
effects (Williams, 1995). Excessive doses could lead
to alkalosis.
•Major side effect at ergogenic doses is GI distress and
diarrhea, which may cause runners to not show the
ergogenic effect.
LEGAL
- Bicarbonate is currently not a banned substance.
BLOOD DOPING AND RECOMBINANT
ERYTHROPOIETIN
EFFICACY
- Blood doping refers to the process of artificially
increasing red blood cell (RBC) mass to improve
exercise performance. Increasing RBC mass can be
accomplished through infusion of RBCs or through
the use of the recombinant erythropoietin(rEPO) of
human hormone stimulating RBC production (Sawka
et al, 1996). - By increasing the RBC mass, oxygen carrying capac-
ity is increased with resultant increase in both maximal
aerobic power and aerobic capacity. The increased
VO2maxand time to exhaustion cause improvements in
race performance especially in distance runners
(Sawka et al, 1996; Ekblom, 1996).- Blood doping also seems to help performance in the
heat, especially in acclimatized individuals (Sawka
et al, 1996).
SAFETY- Although rare, the major risk from blood transfusions
is transfusion reactions. Other complications include
infection from the blood or procedure. - Hyperviscosity can occur with hemoglobin levels
over 55%, which may increase the risk of thrombosis
causing strokes or myocardial infarction in athletes
using rEPO or blood transfusions. It has been postu-
lated that numerous deaths among cyclists have been
as a result of rEPO induced hyperviscosity causing
vascular sludging and myocardial artery occlusion
(Sawka et al, 1996; Eichner, 1992). - Blood pressure may also be increased by rEPO and is
contraindicated in uncontrolled hypertension (Ekblom,
1996).
LEGAL- Banned by the IOC and NCAA (American College of
Sports Medicine, 1987; U.S. Antidoping Agency, 2003). - Blood transfusions can be detected if homologous
blood is used, but autologous blood and rEPO are
harder to detect (Sawka et al, 1996). Improved testing
including direct measuring of erythropoietin iso-
forms can be done, but since rEPO currently can only
be detected for a few days after administration but
has effects that last for weeks, reliable testing is dif-
ficult.
CAFFEINEEFFICACY- Caffeine enhances performance during both pro-
longed activity and shorter intense activity, and has
been hypothesized to work for runners by increasing
free fatty acid production (which would spare muscle
glycogen), elevating adenosine 3’,5’-monophosphate
(cAMP) levels in cells, altering the movement of cal-
cium by the sarcoplasmic reticulum, increasing levels
of catecholamines, increasing neuromuscular trans-
missions, and decreasing perceived effort and fatigue
(Applegate, 1999).