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Performance Enhancing Substances

What you need to know

Performance-enhancing substances are also known as ergogenic aids. Ergogenic aids are defined as any substance taken into the body by an abnormal route and/or in excessive amounts, with the intention of increasing performance. These substances can be normal prescription medications at supra-physiologic doses, illegal drugs, over-the-counter medications or dietary supplements.

Under the Dietary Supplement Health and Education Act of 1994 (DSHEA) substances sold as supplements or "natural substances" do not require FDA approval prior to being introduced into the U.S. market. They also do not require proof of their claims with validated research and are generally considered safe until proven to be harmful (ephedrine is a recent example). These products frequently are "contaminated" with substances or quantities not listed on the label, which can be problematic for individuals that undergo drug testing.

In the 1990s the supplement industry brought in approximately $1.2 to $3 billion; currently the industry is estimated to bring in $18 billion a year. This is thought to coincide with the rise of supplement use in high school and middle school students.

Substances & Side Effects

  • Amino acid naturally produced by the liver, kidneys and pancreas and stored in muscle tissue
  • Also found in food, such as fish and red meat
  • Creatine use significantly increased after the 1992 Olympics in Barcelona when it was discovered that many Olympians had used it to help improve their performance
  • Often used by people involved in sports that require power, such as football
  • Used by the body to help make Adenosine Triphospate (ATP), a form of energy utilized in sprinting or anaerobic activities
Desired Effects on the Body
  • Increase work capacity with short, repetitive exercise or anaerobic activity
  • Prolong onset of fatigue after exercise
  • Increase in weight and muscle strength, as well as improve performance
Research Evidence
  • Studies in the laboratory setting have found some ergogenic benefit (including increase in power, strength and sprint performance) in activities of high energy and short duration (<30 sec). Application of this to enhanced performance in sporting activities is less well demonstrated.
  • Increase in weight gain
Potential Side Effects
  • Water retention resulting in weight gain at initiation of supplement
  • Anecdotal muscle and stomach cramping
  • Dehydration
  • Possibility of developing reversible kidney issues
  • Potential increased risk of compartment syndrome
  • Very few studies have evaluated the short- and long-term effects of creatine usage in people younger than 18 years old
  • American Academy of Sports Medicine suggests that people younger than 18 years old should not be using creatine
  • "Creatine can be viewed as a 'gateway substance' that may prompt a young athlete to consider other ergogenic aids, such as anabolic steroids." (Laos & Metzl)
Organizations Banning this Substance
  • No bans in place
  • Cannot be given to athletes directly through NCAA-associated facilities

  • Formally known as dehydroepiandrosterone
  • Naturally produced and secreted by the adrenal glands and gonads
  • Very similar to androstenedione and anabolic steroids
  • DHEA production decreases with age
  • Used by the body to help increase the amount of testosterone in the body
Desired Effects on the Body
  • Increase muscle mass and strength when high doses are used
  • Improve performance
  • Decrease body fat
  • Decrease risk of cardiovascular disease, cancer, Alzheimer's and osteoporosis
  • Decreases or reverses aging process; known as "fountain of youth"
Research Evidence
  • Increases in testosterone are not found with moderate doses
  • Studies have shown no increase in muscle mass, strength or performance, as well as no other ergogenic effects on the body
Risk Factors
  • Testicular shrinkage
  • Male pattern baldness
  • Weight loss
  • Stretch marks
  • Irreversible development of breasts in men
  • Acne
  • Irreversible acquisition of male characteristics in women
  • Decrease in strength of tendons
  • Possibility of addiction
  • Increased estrogen effect, which can increase the risk of developing CVD, breast cancer and pancreatic cancer
  • Possibility of increasing hormone-sensitive malignancies
  • May lead to adverse ratio of total cholesterol to high-density lipoprotein
  • May result in stunted growth in athletes who have not completed growing
  • May cause positive results with drug testing
Organizations banning this substance
  • Banned by major sports organizations such as the International Olympic Committee, National Collegiate Athletic Association and the National Football League

  • A stimulant found in the herbal forms of ephedra and Ma Huang
  • Used in the production of methamphetamine in illegal drug labs
  • Usually combined with caffeine in weight loss products<
  • Hundreds of unfavorable reactions, including death, have been reported to the FDA after using products containing ephedrine
  • Increase in heat production and resting metabolic rate, which helps with caloric expenditure and results in weight loss
  • Delays fatigue
  • Believed to cause an increase in stimulation of the central nervous system
Research Evidence
  • Some studies have shown that the use of ephedrine did not lead to improvements in performance
Potential Side Effects
  • Jittery
  • Sweating
  • Weight loss
  • Increased heart rate
  • Increased blood pressure
  • Heart Attack
  • Stroke
  • Seizure
  • Arrhythmias
  • Psychiatric problems
Organizations banning this substance
  • Banned by major sports organizations
  • Banned by FDA in 2004

Protein Supplements
  • One of the more commonly used supplements in athletes
  • Most US Citizens take in more than the required daily amount of protein
  • RDA protein general population is 0.8 mg/kg/day
  • RDA for an athlete is 1.2-1.4 mg/kg/day (endurance) and 1.2-1.7 mg/kg/day (resistance training)
  • Typically available in powder and liquid forms
  • Best source of protein supplementation is food-based protein

Desired Effects on the Body

  • Weight gain
  • Increases in strength, power & lean muscle
Research Evidence
  • BCAA have not been proven to increase lean muscle or help improve performance, especially with resistance training
  • Some studies have demonstrated no change in strength or lean muscle with the use of glutamine
Potential Side Effects
  • Water retention resulting in weight gain at initiation of supplement
  • Anecdotal muscle and stomach cramping
  • Dehydration
  • Possibility of developing reversible kidney issues
  • Potential increased risk of compartment syndrome
Risk Factors
  • Kidney problems when taken in high amounts
  • Not proven to increase strength or lean muscle
Organizations Banning this Substance
  • No bans in place


1. Are over-the-counter supplements safe?

Over-the-counter supplements might be safe for most people, but can be dangerous if impure, taken improperly, or if used in athletes with underlying medical problems. Since supplements are not regulated by the Food and Drug Administration, they may be contaminated and put elite athletes that undergo random drug testing at risk for a testing positive on a drug test. This depends on the ingredients and the amount of that ingredient inside specific products. Every product is different, and we can not generalize them into one category.

2. What forms do performance enhancing supplement come in?

They are sold as powders and pills that are taking orally.

3. Where are they found and are they purchased as individual items or are they found in other products?

They can be found by themselves or as ingredients in other products, which is why it is important to always read the food label for the ingredient content. Performance-enhancing supplements are often purchased from the Internet, drug stores, health and vitamin stores, and grocery stores.

4. How can you tell if someone is using a performance-enhancing substance?

It is sometimes harder to tell if someone is using a performance-enhancing substance than it is with anabolic steroids, as the effects are less dramatic. However, a striking increase in performance in a short period of time might be an indication.

5. Are supplements banned by the NCAA?

Refer to the NCAA Banned-Drug Classes document for the complete list of substances banned by the NCAA.

6. What are the short term and long term effects of using supplements?

This truly depends on the specific supplement and dosage of that supplement. There is limited research on the long-term effects of performance enhancing substances, particularly in children and adolescents. Furthermore, research is even more limited on the consumption of multiple performance enhancing substances at once and at high dosages.

7. What are the healthy alternatives to using performance-enhancing substances?

A nutritious and well-balanced diet, adequate rest, and a high quality-conditioning program are healthy alternatives to using performance-enhancing substances.

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