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Jokipalo I, Khudayarov A. A Netnography and a Survey on Doping Use among Competitive Doping-untested Strength-sport Athletes. Int J Sports Med 2021; 42:645-650. [PMID: 33506442 DOI: 10.1055/a-1342-7312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Doping-untested strength-sport athletes (powerlifters, strongmen, armlifters, etc.,) are infamous for their doping use, but their exact doping regimens are not known. The purpose of this study was to provide a reasonable portrait of doping history in this specific athlete group for medical practitioners. Seventy-five athletes were selected by netnography of the social media community around the Finnish doping-untested strength-sport federations on the basis of their activity in doping-related discussions, and the athletes were invited to answer a detailed doping-related anonymous survey. Fifty respondents completed the survey. 100% of the respondents reported use of anabolic androgenic steroids, 66% reported use of stimulants, and 80% use of non-steroidal anabolic substances. The doses of both testosterone products and human growth hormone were notably larger than reported in previous studies of gym users (mostly non-competitive athletes). The subjects reported simultaneous use of an average 5.66 illegal substances, and lifetime use of 16.78 illegal substances. The doses of illicit drugs, as well as polypharmacy, among competitive doping-untested strength-sport athletes are higher than previously reported among recreational gym users, and side effects are likely in this specific population.
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Affiliation(s)
- Iiro Jokipalo
- Department of Nursing Science, Mikkeli University of Applied Sciences, Mikkeli, Finland
| | - Anna Khudayarov
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland
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2
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Zheng E, Sandhu N, Navarro V. Drug-induced Liver Injury Secondary to Herbal and Dietary Supplements. Clin Liver Dis 2020; 24:141-155. [PMID: 31753247 DOI: 10.1016/j.cld.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The use of herbal and dietary supplements (HDS) is increasing in the United States and worldwide. Its significant association with liver injury has become a concern, particularly because rates of hepatotoxicity caused by HDS are increasing. There are variety of HDS available, ranging from multi-ingredient substances, to anabolic steroids for bodybuilding purposes, to individual ingredients for purposes of supplementing a diet. This article reviews the impact of liver injury cause by HDS and explores the hepatotoxic potential of such products and their individual ingredients.
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Affiliation(s)
- Elizabeth Zheng
- Columbia University Medical Center, 622 West 168th Street, PH-14-406, New York, NY 10032, USA
| | - Naemat Sandhu
- Einstein Medical Center, 5401 Old York Road, Klein Building Suite 505, Philadelphia, PA 19141, USA
| | - Victor Navarro
- Einstein Medical Center, 5401 Old York Road, Klein Building Suite 505, Philadelphia, PA 19141, USA.
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García-Cortés M, Robles-Díaz M, Ortega-Alonso A, Medina-Caliz I, Andrade RJ. Hepatotoxicity by Dietary Supplements: A Tabular Listing and Clinical Characteristics. Int J Mol Sci 2016; 17:537. [PMID: 27070596 PMCID: PMC4848993 DOI: 10.3390/ijms17040537] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/17/2016] [Accepted: 03/25/2016] [Indexed: 02/07/2023] Open
Abstract
Dietary supplements (DS) are extensively consumed worldwide despite unproven efficacy. The true incidence of DS-induced liver injury (DSILI) is unknown but is probably under-diagnosed due to the general belief of safety of these products. Reported cases of herbals and DS-induced liver injury are increasing worldwide. The aim of this manuscript is to report a tabular listing with a description of DS associated with hepatotoxicity as well as review the phenotype and severity of DSILI. Natural remedies related to hepatotoxicity can be divided into herbal product-induced liver injury and DS-induced liver injury. In this article, we describe different DS associated with liver injury, some of them manufactured DS containing several ingredients (Herbalife™ products, Hydroxycut™, LipoKinetix™, UCP-1 and OxyELITE™) while others have a single ingredient (green tea extract, linoleic acid, usnic acid, 1,3-Dimethylamylamine, vitamin A, Garcinia cambogia and ma huang). Additional DS containing some of the aforementioned ingredients implicated in liver injury are also covered. We have also included illicit androgenic anabolic steroids for bodybuilding in this work, as they are frequently sold under the denomination of DS despite being conventional drugs.
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Affiliation(s)
- Miren García-Cortés
- Servicio de Farmacología Clíınica and Unidad de Gestión Clínica (UGC) de Gastroenterología y Hepatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
| | - Mercedes Robles-Díaz
- Servicio de Farmacología Clíınica and Unidad de Gestión Clínica (UGC) de Gastroenterología y Hepatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
| | - Aida Ortega-Alonso
- Servicio de Farmacología Clíınica and Unidad de Gestión Clínica (UGC) de Gastroenterología y Hepatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Inmaculada Medina-Caliz
- Servicio de Farmacología Clíınica and Unidad de Gestión Clínica (UGC) de Gastroenterología y Hepatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Raul J Andrade
- Servicio de Farmacología Clíınica and Unidad de Gestión Clínica (UGC) de Gastroenterología y Hepatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
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Robles-Diaz M, Gonzalez-Jimenez A, Medina-Caliz I, Stephens C, García-Cortes M, García-Muñoz B, Ortega-Alonso A, Blanco-Reina E, Gonzalez-Grande R, Jimenez-Perez M, Rendón P, Navarro JM, Gines P, Prieto M, Garcia-Eliz M, Bessone F, Brahm JR, Paraná R, Lucena MI, Andrade RJ. Distinct phenotype of hepatotoxicity associated with illicit use of anabolic androgenic steroids. Aliment Pharmacol Ther 2015; 41:116-25. [PMID: 25394890 DOI: 10.1111/apt.13023] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/15/2014] [Accepted: 10/21/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND We have observed an increase in hepatotoxicity (DILI) reporting related to the use of anabolic androgenic steroids (AAS) for bodybuilding. AIM To characterise phenotype presentation, outcome and severity of AAS DILI. METHODS Data on 25 cases of AAS DILI reported to the Spanish (20) and Latin-American (5) DILI Registries were collated and compared with previously published cases. RESULTS AAS DILI increased from representing less than 1% of the total cases in the Spanish DILI Registry in the period 2001-2009 to 8% in 2010-2013. Young men (mean age 32 years), requiring hospitalisation, hepatocellular injury and jaundice were predominating features among the AAS cases. AAS DILI caused significantly higher bilirubin values independent of type of damage when compared to other drug classes (P = 0.001). Furthermore, the cholestatic AAS cases presented significantly higher mean peak bilirubin (P = 0.029) and serum creatinine values (P = 0.0002), compared to the hepatocellular cases. In a logistic regression model, the interaction between peak bilirubin values and cholestatic damage was associated with the development of AAS-induced acute kidney impairment (AKI) [OR 1.26 (95% CI: 1.035-1.526); P = 0.021], with 21.5 ×ULN being the best bilirubin cut-off point for predicting AKI risk (AUCROC 0.92). No fatalities occurred. CONCLUSIONS Illicit recreational AAS use is a growing cause of reported DILI that can lead to severe hepatic and renal injury. AAS DILI is associated with a distinct phenotype, characterised by considerable bilirubin elevations independent of type of damage. Although hepatocellular injury predominates, acute kidney injury develops in cholestatic cases with pronounced jaundice.
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Affiliation(s)
- M Robles-Diaz
- Servicio de Farmacología Clínica and Unidad de Gestión Clínica (UGC) de Gastroenterología y Hepatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Málaga, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Sakkas GK, Mulligan K, DaSilva M, Doyle JW, Khatami H, Schleich T, Kent-Braun JA, Schambelan M. Creatine fails to augment the benefits from resistance training in patients with HIV infection: a randomized, double-blind, placebo-controlled study. PLoS One 2009; 4:e4605. [PMID: 19242554 PMCID: PMC2646129 DOI: 10.1371/journal.pone.0004605] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 01/02/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Progressive resistance exercise training (PRT) improves physical functioning in patients with HIV infection. Creatine supplementation can augment the benefits derived from training in athletes and improve muscle function in patients with muscle wasting. The objective of this study was to determine whether creatine supplementation augments the effects of PRT on muscle strength, energetics, and body composition in HIV-infected patients. METHODOLOGY/PRINCIPAL FINDINGS This is a randomized, double blind, placebo-controlled, clinical research center-based, outpatient study in San Francisco. 40 HIV-positive men (20 creatine, 20 placebo) enrolled in a 14-week study. Subjects were randomly assigned to receive creatine monohydrate or placebo for 14 weeks. Treatment began with a loading dose of 20 g/day or an equivalent number of placebo capsules for 5 days, followed by maintenance dosing of 4.8 g/day or placebo. Beginning at week 2 and continuing to week 14, all subjects underwent thrice-weekly supervised resistance exercise while continuing on the assigned study medication (with repeated 6-week cycles of loading and maintenance). The main outcome measurements included muscle strength (one repetition maximum), energetics ((31)P magnetic resonance spectroscopy), composition and size (magnetic resonance imaging), as well as total body composition (dual-energy X-ray absorptiometry). Thirty-three subjects completed the study (17 creatine, 16 placebo). Strength increased in all 8 muscle groups studied following PRT, but this increase was not augmented by creatine supplementation (average increase 44 vs. 42%, difference 2%, 95% CI -9.5% to 13.9%) in creatine and placebo, respectively). There were no differences between groups in changes in muscle energetics. Thigh muscle cross-sectional area increased following resistance exercise, with no additive effect of creatine. Lean body mass (LBM) increased to a significantly greater extent with creatine. CONCLUSIONS / SIGNIFICANCE: Resistance exercise improved muscle size, strength and function in HIV-infected men. While creatine supplementation produced a greater increase in LBM, it did not augment the robust increase in strength derived from PRT. TRIAL REGISTRATION ClinicalTrials.gov NCT00484627.
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Affiliation(s)
- Giorgos K. Sakkas
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Division of Endocrinology, San Francisco General Hospital, San Francisco, California, United States of America
- Department of Medicine, University of Thessaly, Thessaly, Greece
| | - Kathleen Mulligan
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Division of Endocrinology, San Francisco General Hospital, San Francisco, California, United States of America
| | - Makani DaSilva
- Division of Endocrinology, San Francisco General Hospital, San Francisco, California, United States of America
| | - Julie W. Doyle
- Northern California Institute for Research and Education, San Francisco, California, United States of America
| | - Hootan Khatami
- Division of Endocrinology, San Francisco General Hospital, San Francisco, California, United States of America
| | - Thomas Schleich
- Department of Chemistry & Biochemistry, University of California Santa Cruz, Santa Cruz, California, United States of America
| | - Jane A. Kent-Braun
- Department of Exercise Science, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Morris Schambelan
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Division of Endocrinology, San Francisco General Hospital, San Francisco, California, United States of America
- * E-mail:
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Augé WK, Augé SM. Naturalistic observation of athletic drug-use patterns and behavior in professional-caliber bodybuilders. Subst Use Misuse 1999; 34:217-49. [PMID: 10069751 DOI: 10.3109/10826089909035644] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Athletic performance-enhancing drug use is widespread. Awareness in the medical community lags because various athletic subcultures have not been penetrated by conventional medical literature. This report presents a current and comprehensive assessment of drugs used by professional-caliber bodybuilders to enhance athletic performance. The scale of drug use documented significantly exceeds all previous reports from athletic populations and indicates that this group is at significant risk for use. Drug-use patterns and behavior encompass multiple domestic, foreign, and veterinary agents to create "successful" training programs. The presence of interathlete and intersport communication at amateur and professional levels creates a wide application for this information in athletic settings. Since use may not be limited to the competitive athlete, a heightened awareness will aid practitioners in correlating clinical observations with accurate athletic drug-use information.
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Affiliation(s)
- W K Augé
- Center for Orthopaedic and Sports Performance Research, Española-Presbyterian Medical Center, Public Health Service, United States Department of Health and Human Services, Santa Fe, New Mexico, USA.
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Abstract
Drug abuse by athletes is a problem not restricted to the elite athlete. Regardless of one's specialty, physicians caring for any athlete or anyone engaged in sport activities must consider drug abuse as an integral part of their patient assessment. To diagnose drug abuse, one must think about drug abuse. The issues are complex. Admittedly it is a sad societal commentary that the physician must entertain the possibility of EPO abuse when evaluating an endurance athlete with a higher than average hematocrit, or think about clenbuterol abuse when a body-builder presents with palpitations, or think of anabolic androgenic steroid abuse when a teenager exhibits an unusual degree of acne. Drug abuse in sports, however, has been and continues to be a reality. The goal of this article was to raise the level of consciousness about the possibility of drug abuse when evaluating and treating athletes regardless of their skill level or record of achievement. History has made it abundantly clear that although drug abuse is not new to sports, the specific drugs of abuse are continuously changing. The physician must be ever mindful.
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Affiliation(s)
- G I Wadler
- Cornell University Medical College, Manhasset, New York
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