Performance-enhancing drugs

A multi-million-dollar industry is working constantly to improve the human body. With the help of science, some elite athletes are flouting the rules of their various sports to stretch the limits of human performance. Should you too be reaping the rewards, or are the costs too high?

BY MIKE PATTENDEN AND DANIEL WILLIAMS

PHOTOGRAPHY BY LUKE KIRWAN

Citius, Altius, Fortius. The Olympic motto is meant to inspire athletes, but a cynical reinterpretation could view the call-to-arms “faster, higher, stronger” as a brief for those covertly working to re-engineer their bodies.

Doping has become endemic in some sports as athletes strive for an edge, aware that their bodies can be retuned and souped-up. Recent history is littered with infamous cases, from Ben Johnson’s 1988 steroid-assisted 100 metres in Seoul, to Floyd Landis being stripped of his 2006 Tour de France victory.

Even the once-pristine Tiger Woods has been linked with prescription drug misuse and with controversial “blood-spinning” doctor Tony Galea, who was recently charged in the US with administering unlawful drugs, including human growth hormone, to at least one NFL player. And there’s no sense pretending Australian athletes are immune to all this: among those to have succumbed to the temptation of performance-enhancing drugs (PEDs) are cyclist Martin Vinnicombe, sprinter Dean Capobianco and rugby league international Rodney Howe.

These, though, were elite sportsmen at or near the top of their respective games. A description that doesn’t fit most of us.

So how, apart from the occasional pub debate, do PEDs affect you? With all the funding and expertise pouring into the underground science of performance enhancement, is there something in it for us mere mortals? Well, the simple fact is that PEDs alter the body’s physiology. Any body. If erythropoietin (EPO) helps Tour de France cyclists to pedal for longer, and steroids give Olympic sprinters more explosive power, they could do the same for you.

What’s more, not all substances that enhance performance are banned, and very few involve criminality. So if a tablet promises to improve your triathlon time, or give you the legs to kick a goal on the siren, should you be interested?

Even away from the more extreme tabloid hyperbole, the ethical verdict seems clear-cut. Using PEDs makes you a cheat. Worse than that, a drug cheat, a subset of the unsporting we hold in particular contempt. It’s seen as somehow worse than rubbing dirt into a cricket ball or going all Bambi-on-ice in the penalty area.

But is it? Really? Is something that helps you train harder and improve your body really “cheating”? And what if you’re only looking to break your own personal best, or you’re competing with no-one but the mirror and your self-esteem?

Beyond the ethics, your choices should be informed by the health implications and legality. The fact is you can train longer, harder and faster. You can add more muscle, stamina and power. You can go higher, stronger, further.

But at what price? Over these eight pages, the very latest science will answer the central question: should you become a “drug cheat”?

PART I Cheating dirty

Desperately trying to control the spiralling dope issue, the World Anti-Doping Agency (WADA) recently introduced new regulations forcing selected elite athletes to make themselves available to testers at some point during every day.

In the recreational sporting arena, the legal sports nutrition market continues to grow, with Australian sales hitting between $85 and $100 million a year and growing, according to Vitaco Health Australia, which owns the Balance and Aussie Bodies brands.

People are looking for an edge, but where are the lines drawn? Under the WADA code, a drug is banned if it falls foul of at least two of these three criteria: it has the potential to improve sporting performance; it represents an actual or potential health risk; its use is contrary to the “spirit of sport”.

WADA’s prohibited list covers more than 100 substances, from alcohol (banned in archery because of its nerve-steadying effects) to zeranol (an anabolic agent derived from mushrooms). As well as the expected anabolic steroids and blood-boosting agents, the list includes some basic shopping-centre products, making it clear the bans are about more than just health risks or breaking the law.

Most substances on WADA’s list are legal to possess and use. So a banned substance could boost performance and be neither harmful nor illegal. Which, depending on how dear you hold “the spirit of sport”, could make cheating rather tempting.

IT’S IN THE BLOOD

The Goal Endurance

The Drugs Blood-boosters

All athletes are looking for the same gains: to be stronger and to last longer. The PEDs that can help them fall into three loose categories: blood-boosters, muscle-builders and stimulants.

For long-distance sportsmen – runners, triathletes, cyclists – the holy grail is endurance. If this is your game, being able to train harder for longer and call on those gains come competition time is crucial.

In the Nineties, the blood-booster EPO became the endurance drug of choice. Developed for treating anaemia, EPO replicates a hormone that controls red blood cell production and is an extremely effective performance-enhancer.

It’s a simple equation: more red blood cells equal increased endurance and aerobic capacity. EPO was rife in professional cycling. Bjarne Riis, winner of the 1996 Tour de France, recently confessed, “It was a part of everyday life as a rider.”

EPO has fallen away in professional sporting circles since it became detectable in 2000, replaced by the derivative CERA (continuous erythropoietin receptor activator), and by blood transfusion. In case you’re thinking transfusion sounds just the ticket for an easy stroll to glory, the technique involves draining blood from your body, spinning it rapidly in a machine, then freezing it before finally pumping it back into your veins. All in the name of boosting your count of those oxygen-schlepping red blood cells. Which might make a more ambitious 10-kilometre time sound rather less appealing.

The traditional EPO route is still very much available to amateurs seeking an edge, though. Type the initials “E-P-O” into Google and take your pick.

But do you really want to go this way? Dr Mike Ashenden, director of the SIAB (Science and Industry Against Blood doping) research consortium on the Gold Coast, says provided you’re screened for risk factors before starting treatment, and have ongoing monitoring of blood levels, it is possible to use EPO safely.

“But without both of those in place, it would be foolhardy to blindly inject yourself with such a potent prescription drug,” he says.

Ashenden reckons there are about 100 laboratories around the world producing “copy” EPO. The strength and purity of these copies varies, he says, and it’s impossible to know what you’re getting when you buy on the black market.

“Quite honestly, I would no sooner inject a copy EPO obtained via the internet than use a second-hand syringe found on the floor of a public toilet.”

If taking EPO doesn’t already seem a bit over the top for the Sydney half-marathon, consider the drug’s most calamitous potential side effect.

“EPO thickens the blood, greatly increasing the risk of stroke,” says Dr John Brewer, professor of sport at the University of Bedfordshire in the UK. EPO’s rise in the Nineties saw an alarming spike in deaths of pro cyclists, and here’s the image to take away: athletes having to pedal through the night to force the sludge through their arteries and avoid heart attacks. You can label it E-P-NO.

POWER PLAYS

The Goals Muscle, strength, speed

The Drugs Steroids

For anyone looking to build muscle, strength and speed, anabolic steroids have long been the preferred option. Anabolics have dogged sport since testosterone was first synthesised in Germany in the Thirties, and hundreds of athletes have failed tests since, including Capobianco’s positive result for stanozolol in 1996.

Far from being an elite-only option, steroids are popular right the way down the chain.

An Australian Institute of Health and Welfare survey published last year found up to one per cent of Australian males aged 14 years and older had used steroids for non-medical purposes at some time in their lives. That equates to more than 50,000 dabblers as well as dedicated users and abusers. They’re not just the preserve of gym rats, either.

“There are a large number of blokes who say they want to use them during the winter period so they’ll look good on the beach in summer,” says Sydney sports doctor Tony Millar, founder of Australia’s first sports medicine clinic and Australian team doctor at three Commonwealth Games.

While banned in sport, steroids are not illegal. Pharmacists can sell them with a doctor’s prescription, though doctors risk their career by prescribing them for non-medical purposes. Nevertheless, some are prepared to do this, figuring that by supervising a patient’s steroids program they reduce the likelihood of excessive doses that could, among other side effects, shrink your testes to the size of walnuts – not such a great look on the beach.

The lack of criminality is a factor, but the main reason steroids are so pervasive is because they’re effective.

“Oh, they work all right,” says Millar. Assuming someone trains like a beast and eats well, “my experience is that a six-week course of Sustanon, one ampoule a week, can put on somewhere between two and five kilograms, and most of that will be muscle”.

Millar contends that health authorities have tended to exaggerate the dangers of using steroids.

“I know from experience that up to two or three ampoules of Sustanon taken weekly for 6-8 weeks and then stopped doesn’t do any harm. Now is that the maximum dose or not? I don’t know. I just know that it’s safe.”

There is, it has to be admitted, a notable lack of rock-solid clinical data to say otherwise. “Because these are illicit substances, evidence from controlled studies is lacking,” explains Dr Andrew McLachlan, professor of pharmacy at the University of Sydney.

Still, from what he’s seen and read – including reports in the Medical Journal of Australia suggesting steroid use is linked with sudden cardiac death in young men – McLachlan is convinced that steroid users risk liver and cardiovascular problems. “And I’m a pharmacist, someone who’s supportive of medicines.”

Men’s Health fitness expert Paul Haslam, a sports scientist and two-time Mr Australia, has seen it all over more than three decades in gyms. “Problems come when guys figure that if a little bit is good, a whole lot more must be better.” Even at low doses there’s a trade-off between positive and negative effects, he warns. Injection-site pain and acne are common.

“If your voice deepens, that’s an indication the dose is too high,” says Haslam, who adds a guy would be a mug even to consider trying steroids unless he had several years of solid training behind him, as well as a top-notch diet and supplements program.

Dr Matthew Dunn, a researcher at the National Drug and Alcohol Research Centre at the University of NSW, takes a similar line. Anyone considering steroids should “look at what the effects are, and not just the positive ones”, he says.

“If you’ve hit a plateau in your training – and that’s often the trigger – before considering steroids look at changes in your diet or workout regimes. Or maybe you just need a rest.”

The anabolics story is typical of PEDs. Scientists spend years researching a drug’s therapeutic properties – in steroids’ case, for treatment of body-wasting conditions – then it’s co-opted by sportsmen.

“Products often begin life in the medical sphere, but that doesn’t mean they can be safely applied to a sporting environment,” says Brewer. “Most, like steroids, are used medically for a short time during rehabilitation. In sport, you get continual usage, with often vastly increased dosages.”

And vastly increased risks – risks that, however seriously you take your sport or how you look at the beach, hardly seem worth taking.

THE FINAL PUSH

The Goals Alertness, performance, stamina

The Drugs Stimulants

Stimulants are the original PEDs. Amphetamines were discovered in Germany in the late 1800s but no use was found until World War II, when millions of tablets were given to soldiers on both sides. By the Fifties, they’d infiltrated sport, most notably cycling. Tom Simpson’s Mont Ventoux death during the 1967 Tour de France was the result of amphetamine abuse.

Amphetamines are illegal, except when prescribed for specific medical conditions, but not all stimulants are classified the same way.

Ephedrine is one of the most widely used. There’s a good chance you’ve already taken it. Found in over-the-counter cold medications, it was un-banned by WADA in 2003 but re-banned this January.

Sudafed’s Australian manufacturer Johnson & Johnson has added a new product containing phenylephrine rather than ephedrine, though you can still obtain the ephedrine variety by showing ID at the pharmacy.

Still, there’s no need to mess about with cold cures when, via the internet, you can buy a month’s supply of tablets combining caffeine and ephedrine. You’re not breaking the law and there’s evidence it works, too. Research on 1500m runners in the journal Medicine and Science in Sports and Exercise found the two stimulants “work better in conjunction”. So what’s stopping you?

While it’s true any stimulant is going to raise your alertness and energy, it’s also going to increase your heart rate and blood pressure, says Dunn.

“If you’re playing sport, your body is under stress anyway,” he says. “Your systems are going at full pelt and you’re asking them for more.”

Adds Brewer: “Stimulants have the potential to damage the heart, even bring on a heart attack. You don’t need to go further than that, surely.

PART II Cheating clean

Fortunately, there are substances that can give you an edge without crossing the line.

“There have been massive advances in clean sports nutrition in the past decade,” says Brewer.

Better still, the “nutraceuticals” that work for top sportsmen can prove equally effective for weekend warriors.

“Key for athletes at all levels are ‘The Three Cs’,” says Brewer. “Carbohydrate, creatine and caffeine. Carb-loading is proven to enhance performance in endurance and sprint-based events, creatine aids training and recovery, and caffeine improves mental alertness and physical performance.”

Creatine, the poster boy for clean sports supplementation, promises faster recovery and more muscle. With no evidence of serious side effects and proven performance-enhancing qualities, it’s your acceptable “cheat”.

Australia’s most widely used sports supplement is a naturally occurring compound found in red meat and made from amino acids, the building blocks of protein. And if you’re looking for a helping hand getting stacked, well, it really seems to stack up.

“Over 30 studies show it satisfies the safety aspect,” says Dr Liam Kilduff, lecturer in applied sports sciences at Swansea University in the UK. “And research indicates that, although it doesn’t directly impact muscle mass, it does enable you to train harder.”

Better still, creatine could be even more beneficial for the everyman than the superman.

“There are potentially real benefits for everyone,” adds Kilduff. “It seems the more highly trained you are, the less you absorb creatine, so it could benefit your weekend warrior more.”

But there are sceptics. Millar says when he suggests to patients asking about steroids that they try creatine first, the response is nearly always the same. “You know what they tell me? ‘I tried that – it was no good’.” Or, as one long-time bodybuilder told MH: “It’s like a weak latte up against speed.”

Speaking of hot beverages, you probably didn’t realise that too many morning coffees could once have made you a “drug cheat”, but caffeine was on WADA’s banned list until 2004.

Numerous studies have confirmed caffeine not only enhances alertness, it also mobilises fat stores, sparing your muscles’ glycogen supply and so boosting endurance. When WADA gave caffeine the green light, it allowed elite athletes to start using it to enhance their performance.

Research shows six milligrams per kg of bodyweight (for an 80kg man, that’s the equivalent of roughly five strong coffees) one hour before exercising, then 70-200mg during exercise, delivers optimum results.

Caffeine isn’t the only performance-enhancer lurking in your kitchen. Baking powder – aka bicarbonate of soda – can boost endurance by preventing lactic acid build-up in muscles. Athletes have been “soda-loading” for decades, and if you’re after an endurance boost, a dose of 300mg per kg of bodyweight an hour before exercise delivers. “Results are most apparent in activities where the athlete exercises at maximum intensity for less than 10 minutes,” says Ashenden.

Soda-loading does have its side effects, though – wind and potentially explosive diarrhoea.

The next big things?

One new, clean supplement has the highly seductive double promise of boosting muscle and endurance. Sports-legal and freely available online, the naturally occurring amino acid beta-alanine may boost muscular strength, plus anaerobic and aerobic endurance, but, so far, we’re lacking long-term studies to prove it.

“The jury’s out,” says Brewer. “We need more research on its benefits. But where you get mixed reports, athletes tend to take the positives.”

Early indications are tantalising, though. One of the few studies – on college athletes at Adams State College in Colorado last year – found that beta-alanine supplementation improved their levels of performance and stimulated lean muscle mass.

Brewer is a recreational marathon runner. Is he tempted?

“No. I wouldn’t use it because it has yet to be proven to work and it may have long-term side-effects. I don’t want to play with my health.”

Another potential breakthrough is beta-hydroxy beta-methylbutyrate (HMB). It is sports-legal and promises to limit protein breakdown, enhancing muscle size and strength, promoting fat loss and easing muscle damage. Found in grapefruit, alfalfa and some fish, HMB is already available in supplements such as Optimum Nutrition’s HMB-1000. But it has only been around since the mid-Nineties and there simply aren’t enough independent studies to rubber-stamp it.

A recent Australian Institute of Sport report noted: “Current evidence suggests HMB has a minor effect on strength, body composition, muscle damage and exercise performance.”

At about $90 for a month’s supply, HMB will make a hole in your pocket for what may be only minor benefits.

To cheat or not to cheat?

The idea that doping instantly transforms donkeys into thoroughbreds is a myth. The experts are united in emphasising that no supplementation will be effective without careful attention to nutrition and training as a whole. And that applies to weekend joggers as much as it does to the elite.

“Elite athletes work to training plans,” says Kilduff. “Nutritionists ensure supplementation is planned around their training phases, so the correct macro- and micronutrients are used to enhance adaptation.

“Recreational sportsmen tend to use these things over long periods without really considering what they’re trying to achieve. You need to understand how to optimise effects through diet and training.

Very few of these things work in isolation. Even creatine should be paired with carbohydrate to increase uptake.”

Surely, though, given all the options, if you take enough powders and tablets it could make the difference.

“Can you beat someone with more talent who doesn’t supplement?” says Brewer. “It’s possible, but how do you evaluate that at the grass roots? I prefer to qualify, not quantify, so let’s put it another way: if you have two people with the same talent and one trains properly and has a good diet, he will perform better than the other who consumes fish and chips and a few supplements. Even proven ones.”

Cheating, it seems, can only take you so far.

Agents of Change

Understand the competition status and potential risks of today’s performance-enhancing agents

Stimulants: Amphetamines, ephedrine
Status: V Various
Benefits: Improved alertness, reactions

Possible Side Effects: Cardiovascular stress, anxiety, insomnia, rapid heart rate

Stimulants: Caffeine
Status: WL Spike, ASN Xtreme-Energy 75
Benefits: Mobilisation of fat stores; improved endurance, alertness and concentration

Possible Side Effects: Insomnia, rapid heart rate, gastrointestinal complaints, increased blood pressure (high doses); withdrawal symptoms include headache and fatigue

Anabolic agents: Steroids
Status: BW Sustanon 250, Dianabol, Nandrolone
Benefits: Increased muscle mass, improved recovery time

Possible Side Effects: Drop in sex hormones, acne, temporary infertility, liver damage, testicular shrinkage, breast development, increased prostate cancer risk

Non-steroids: Selective Androgen Receptor Modulators
Status: BW Andro, Andarine
Benefits: Increased muscle mass

Possible Side Effects: Appear fewer than anabolic steroids, but unknown. Possible shrinkage of testes, growth of breast tissue

Growth hormones: Peptide hormones
Status: BW Human growth hormone (HGH)
Benefits: Strengthened joints, muscle building, faster tissue repair

Possible Side Effects: Acromegaly (enlarged bones in head, hands and feet), organ growth, heart damage

Blood enhancers: EPO, CERA
Status: BW Erythropoietin
Benefits: Increased red blood cell production, boosting endurance and aerobic capacity

Possible Side Effects: Blood thickening, increasing risk of stroke or heart attack

Bulking agents: Creatine monohydrate
Status: WL Musashi Growling Dog, MAXS Crea8 Carnage
Benefits: Improved capacity for anaerobic exercise, reduced lactic acid, increased muscle gain, faster recovery

Possible Side Effects: Loss of appetite, stomach discomfort

Bulking agents: Beta-alanine
Status: WL Beta-Nox
Benefits: Increased muscle mass, anaerobic and aerobic endurance

Possible Side Effects: Flushing, tingling, long-term effects unknown

Buffers: Sodium Bicarbonate
Status: WL Baking powder
Benefits: Increased endurance

Possible Side Effects: Gastrointestinal problems, diarrhoea

*V – varies depending on individual product , WL – WADA-legal, BW – banned by WADA

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