However, caffeine from other diuretics like coffee or tea is safe for moderate use in conjunction with balanced nutrition. For more information on banned and dangerous performance-enhancing substances, check out the National Collegiate Athletic Association NCAA list of banned substances.

Many performance-enhancing supplements offer safe options for improving athletic performance. Branched-chain amino acids , or BCAAs, include leucine, isoleucine, and valine.

These three essential amino acids have a unique, branched chemical structure that allows the mitochondria in skeletal muscle tissue to metabolize them.

BCAAs can provide energy during exercise when metabolized, possibly providing greater strength and muscle mass gains from training. With no reported adverse effects for doses of up to 20 grams per day for up to six weeks, BCAAs fall under the category of safe and legal performance-enhancing supplements.

In addition, Ingredient Optimized options such as ioBCAA offer increased bioavailability of each of the three essential amino acids to ensure you receive the best possible benefits. Protein is one of the most common performance-enhancing supplements among athletes and non-athletes alike.

Protein assists with building, maintaining, and repairing muscle tissue, and it has been proven effective in numerous clinical trials.

A quality protein supplement can optimize muscle training response during and after exercise. There are no adverse effects or safety concerns reported at daily recommended intakes for athletes of up to 2 grams of protein per kilogram of body weight one kilogram equals 2.

These products have been scientifically proven to offer better bioavailability than non-optimized protein supplements, ensuring you see results and are not wasting your money.

Creatine is a widely-used, thoroughly studied dietary supplement for sports performance. It can help supply energy to your muscles for short-term, anaerobic activities, such as HIIT, weight training, and circuit training.

Aside from supplementation, creatine is obtained in small amounts from food and produced by your body. Creatine supplementation may help you increase power and strength from full effort muscle contractions. It can also help your body adapt to athlete training regimens over time.

It should be noted, however, that creatine does significantly enhance performance in endurance activities. Typical doses of up to 20 grams per day for up to seven days or grams for up to 12 weeks show minimal safety concerns.

Adverse effects are most likely to include weight gain caused by water retention, not fat accumulation , muscle cramps, muscle stiffness, and nausea. Creatine monohydrate is the most widely used and well-researched form of creatine, but it also comes in creatine anhydrous, which contains more creatine by weight.

Both options offer the benefits of creatine supplementation. Caffeine is one of the most widely used substances in the world. Caffeine works by blocking the activity of adenosine, a neuromodulator that can make you feel sleepy or tired. In doing so, it reduces perceived exertion and even pain.

Caffeine may enhance athletic performance for endurance activities and long-duration activities like playing sports. Adverse effects may include irritability, blood pressure spikes , increased heart rate, restlessness, insomnia, arrhythmia, nausea, and vomiting.

When taken in very high doses of grams 10,, mg , caffeine is also associated with a risk of death. Caffeine from pre-workout supplements, energy drinks, and coffee can add up fast. Beetroot and beet juice is a safe and potentially effective performance-enhancing supplement.

Beetroot and beet juice may improve energy production , reduce muscle oxygen use, and dilate blood vessels in the muscles you are exercising. Main article: Actoprotector. Main article: Nootropic.

Main article: Analgesic. Main articles: Sedative and Anxiolytic. Main article: Blood doping. Main article: Erythropoietin. Main article: Gene doping. Main article: Prohormone. Main article: Doping in sport. May doi : PMC PMID Primary Care.

Amphetamines and caffeine are stimulants that increase alertness, improve focus, decrease reaction time, and delay fatigue, allowing for an increased intensity and duration of training Current Neuropharmacology.

The first aim of this paper was to review current trends in the misuse of smart drugs also known as Nootropics presently available on the market focusing in detail on methylphenidate, trying to evaluate the potential risk in healthy individuals, especially teenagers and young adults.

Better Fighting Through Chemistry? The Role of FDA Regulation in Crafting the Warrior of the Future. Food and Drug Law: Final Paper. Retrieved 4 March British Journal of Pharmacology. ISSN Retrieved 12 April Substance Abuse and Rehabilitation. Regulatory Toxicology and Pharmacology.

Clinics in Sports Medicine. In , Chandler and Blair 47 showed significant increases in knee extension strength, acceleration, anaerobic capacity, time to exhaustion during exercise, pre-exercise and maximum heart rates, and time to exhaustion during maximal oxygen consumption VO2 max testing after administration of 15 mg of dextroamphetamine versus placebo.

Most of the information to answer this question has been obtained in the past decade through studies of fatigue rather than an attempt to systematically investigate the effect of ADHD drugs on exercise. In , Roelands and colleagues 53 studied the effect of reboxetine, a pure NE reuptake inhibitor, similar to atomoxetine, in 9 healthy, well-trained cyclists.

They too exercised in both temperate and warm environments. They showed decreased power output and exercise performance at both 18 and 30 degrees centigrade. Their conclusion was that DA reuptake inhibition was the cause of the increased exercise performance seen with drugs that affect both DA and NE MPH, amphetamine, and bupropion.

Frontiers in Integrative Neuroscience. Manipulations of dopaminergic signaling profoundly influence interval timing, leading to the hypothesis that dopamine influences internal pacemaker, or "clock," activity. For instance, amphetamine, which increases concentrations of dopamine at the synaptic cleft advances the start of responding during interval timing, whereas antagonists of D2 type dopamine receptors typically slow timing; Depletion of dopamine in healthy volunteers impairs timing, while amphetamine releases synaptic dopamine and speeds up timing.

Sports Medicine. S2CID Frontiers in Physiology. Aside from accounting for the reduced performance of mentally fatigued participants, this model rationalizes the reduced RPE and hence improved cycling time trial performance of athletes using a glucose mouthwash Chambers et al.

Dopamine stimulating drugs are known to enhance aspects of exercise performance Roelands et al. Sports Medicine Auckland, N. ISSN X. World Anti-Doping Agency. In recent decennia however, it became clear that the central nervous system plays an important role in the onset of fatigue during prolonged exercise Klass et al.

This indicates that subjects did not feel they were producing more power and consequently more heat. The authors concluded that the "safety switch" or the mechanisms existing in the body to prevent harmful effects are overridden by the drug administration Roelands et al.

Taken together, these data indicate strong ergogenic effects of an increased DA concentration in the brain, without any change in the perception of effort.

The combined effects of DA and NA on performance in the heat were studied by our research group on a number of occasions.

Coinciding with this ergogenic effect, the authors observed core temperatures that were much higher compared with the placebo situation. Interestingly, this occurred without any change in the subjective feelings of thermal sensation or perceived exertion.

Similar to the methylphenidate study Roelands et al. Sports Health. February Molecular and Cellular Biochemistry. December International Journal of Sports Physiology and Performance. British Journal of Sports Medicine. Molecular Pathology. October April Endocrine Reviews. Current Drug Targets.

European Medicines Agency Committee on Herbal Medicinal Products. Journal of Cognitive Neuroscience. The present meta-analysis was conducted to estimate the magnitude of the effects of methylphenidate and amphetamine on cognitive functions central to academic and occupational functioning, including inhibitory control, working memory, short-term episodic memory, and delayed episodic memory.

In addition, we examined the evidence for publication bias. Forty-eight studies total of 1, participants were included in the analyses.

We found evidence for small but significant stimulant enhancement effects on inhibitory control and short-term episodic memory. Small effects on working memory reached significance, based on one of our two analytical approaches.

Effects on delayed episodic memory were medium in size. However, because the effects on long-term and working memory were qualified by evidence for publication bias, we conclude that the effect of amphetamine and methylphenidate on the examined facets of healthy cognition is probably modest overall.

In some situations, a small advantage may be valuable, although it is also possible that healthy users resort to stimulants to enhance their energy and motivation more than their cognition.

Earlier research has failed to distinguish whether stimulants' effects are small or whether they are nonexistent Ilieva et al. The present findings supported generally small effects of amphetamine and methylphenidate on executive function and memory.

Specifically, in a set of experiments limited to high-quality designs, we found significant enhancement of several cognitive abilities. The results of this meta-analysis cannot address the important issues of individual differences in stimulant effects or the role of motivational enhancement in helping perform academic or occupational tasks.

However, they do confirm the reality of cognitive enhancing effects for normal healthy adults in general, while also indicating that these effects are modest in size.

Retrieved 13 October Molecular and Cellular Endocrinology. Drug Testing and Analysis.

Most young athletes who eat a healthy, well-balanced diet do not need and would not benefit from protein supplements. However, vegetarians may be at risk of not eating enough protein and may benefit from meal planning with a registered dietitian. See Effects of Puberty on Sports Performance: What Parents Need to Know for more information.

Caffeine is found in a variety of foods and drinks. About 3 out of 4 children consume caffeine on any given day. The FDA regulates the amount of caffeine in items sold as foods and drinks; however, it does not have control over items sold as supplements, such as energy drinks.

It is very difficult to know how much caffeine is in many of these products. Consuming too much caffeine, such as that found in powders, pills, and multiple energy drinks, can be dangerous. Although caffeine appears to improve some parts of sports performance in adults, the effects vary a lot.

The effects of caffeine are not as well studied in children. They also need to keep track of their fluid intake and how they respond to severe heat and humid conditions when exercising or competing.

Athletes do not need vitamins and mineral supplements if they are eating healthy, well-balanced meals. Low iron levels are associated with decreases in athletic performance, but high doses of iron, or of any other vitamin or mineral, have not been shown to improve sports performance in otherwise healthy athletes.

Anabolic steroids are drugs that are illegal without a doctor's prescription. Athletes sometimes use anabolic steroids to enhance muscle strength and size. Nonathletes may use anabolic steroids because they want to look more muscular. However, there are side effects. Anabolic steroids stop growth in children and teens who are still gaining height.

They may also cause long-term problems with the heart, skin, and other organs that can be severe and may be irreversible. Note: Anti-inflammatory steroids, such as prednisone, that are used for asthma and other conditions are safe and often needed for young athletes when prescribed by a doctor.

Eat carbohydrates. Athletes should consume carbohydrate-rich foods every several hours on the day of competition.

Carbohydrates are an important source of fuel during exercise. Stay hydrated. Sports performance can be enhanced when athletes get the right amount of fluid and electrolytes.

Proper hydration is especially important during practices or games that last more than 60 minutes. Here are a few guidelines to keep the body hydrated and performing at its best level. During practice and competition: Drink 4 to 8 ounces of water or sports drinks every 15 minutes throughout the practice or competition.

Athletes should reload their bodies with fluids and food as soon as possible after a practice or game. Reloading is especially important when athletes are playing in multiple games in a short time frame, such as during a basketball or soccer tournament.

Eat well. A well-balanced meal with the right kinds of proteins and carbohydrates will help the muscles recover between practices and games.

Well-balanced meals are especially important if athletes are recovering from an injury and want to return to practice and competition. You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Turn on more accessible mode. Turn off more accessible mode.

Skip Ribbon Commands. Skip to main content. Turn off Animations. Upon arrival, you find a muscular year-old male with severe facial acne complaining of severe flank pain.

When you inquire about some abrasions and contusions, he tells you they are from a fight several days ago. His girlfriend confides that he has had an uncharacteristically volatile temper lately. Based on the five clues in this scenario, did you suspect that the patient might be abusing some type of performance-enhancing drug?

Many EMS providers would likely miss the clues of anabolic steroid abuse. The use of steroids and other performance-enhancing drugs or supplements is not restricted to professional athletes, but is now commonplace among amateur body-builders, student athletes and health club members.

Most EMS providers have either used some type of supplement, or know someone who has. Do you know which supplements are dangerous? Would you recognize a friend, coworker or patient whose health was at risk because of these supplements?

This article introduces readers to the most frequently used performance-enhancing drugs and supplements and what the research says about their safety and effectiveness.

There are many different types of dietary supplements that are claimed to provide improved athletic performance, increased muscle mass and faster recovery time between workouts. By definition, a supplement is taken orally and contains at least one dietary ingredient, such as vitamins, minerals, herbs, botanicals or amino acids.

Unlike prescription and over-the-counter drugs, dietary supplements are not required to meet FDA standards for efficacy, potency or safety before going to market. A communication gap exists between authority figures and those likely to use a performance-enhancing drug or supplement.

Part of that gap is due to a lack of knowledge by authority figures, such as coaches, parents and healthcare providers. That gap is widened when those authority figures are unable, or unwilling, to provide honest answers about supplement use.

The fact that anabolic steroids will increase muscle mass is not in question; the problem is the considerable risks associated with their use. Anabolic steroids are not to be confused with corticosteroids, another family of steroids that have no body-building effects.

Anabolic steroids were developed in the s to combat the loss of muscle mass due to disease. The controversy surrounding anabolic steroids began in the s, when athletes from Eastern Bloc countries, which dominated the Olympic Games, were caught using them.

Some female athletes developed so many male characteristics that chromosome tests were needed to confirm their gender. Anabolic steroids are only legal in the U.

with a prescription and are used to treat conditions such as delayed puberty and impotence. According to the National Institute on Drug Abuse, it is not uncommon for steroid abusers to take times what would be prescribed by a physician. Not surprisingly, the potency, strength and purity of these steroids are extremely unreliable.

Lower doses are taken early in the cycle and gradually increased. During the back half of the cycle, the dose is gradually reduced.

Users argue that this is a safer approach with fewer side effects, since they are taking lower quantities of any one drug. Since steroids allow for an unusually rapid increase in muscle mass, the risk of stress injuries to muscles and tendons is high. As a result, users will sometimes add pain killers to the regimen so they can continue to work out while injured.

No hormones, including anabolic steroids, should ever be taken unless directed by a physician. There are significant risks associated with inappropriate use of anabolic steroids and other hormones.

Although hormones do have legitimate medical uses, a reputable physician would never prescribe them to a young, healthy person who wanted them simply to increase muscle mass. HGH is a pituitary hormone that tricks the body into an artificial or prolonged state of puberty, leading to increased testosterone production.

HGH increases muscle mass, accelerates loss of body fat and stimulates bone growth. Using HGH without a prescription is illegal and dangerous. Adverse effects of HGH include liver and joint problems, heart failure, hypertension, pituitary disorders and abnormal growth of the hands and feet.

Since recovery time is reduced, it is used to allow more training in less time. Erythropoietin is produced by the kidneys. Also known as EPO, it is taken to boost the production of red blood cells. Amazingly, insulin is being abused by some who believe it will provide a competitive advantage by speeding glucose delivery throughout the body.

This procedure is extremely dangerous and can lead to insulin shock, seizures, permanent brain injury, coma and death. There is absolutely no evidence that insulin will help increase muscle mass or provide a competitive advantage.

Andro is the dietary supplement made famous by baseball player Mark McGwire, who took it before it was banned. It is a steroid precursor used to make testosterone18 and presents the same health risks as anabolic steroids.

A University of California Los Angeles UCLA study found that most brands of andro failed to meet the claims on their own labels for dose and ingredients. DHEA, sometimes referred to as a prohormone, is another steroid precursor.

The body converts DHEA several times, eventually leading to usable hormones, including testosterone. The FDA banned the sale of DHEA as a drug in ; however, it is still available as a dietary supplement. Some publications state side effects of DHEA may include liver problems, increased cancer risk and steroid- related complications.

Phosphocreatine, better known as creatine, is a naturally occurring compound that functions as a building block of protein. Research indicates that creatine appears to be an effective and relatively safe supplement to help increase lean body mass. Creatine may also increase glycogen stores in muscle tissue, making energy more readily available.

Those with low inherent creatine levels are the most likely to see results from taking a creatine supplement. Once the muscles are fully saturated, taking more creatine is of no additional benefit.

Herbal supplements have become a popular alternative to anabolic steroids, because many of them can be purchased legally without a prescription. Some herbal supplements have anabolic properties, but the human body cannot convert plant sources into anabolic steroids.

The fact that anabolic herbal supplements are not controlled is a clear indication of their lack of effect. Ephedra is similar to amphetamine, causing the user to feel energized. Ephedra causes sympathetic nervous system stimulation, elevated blood pressure and increased heart rate.

Until recently, ephedra was a very popular and legal supplement used as a stimulant and appetite suppressant. Also known as ma huang, ephedra has clearly been the most controversial of all herbal supplements. For years before ephedra was banned in the U.

After eight years, the FDA banned all supplements containing ephedra in April , marking the U. With a drug, the manufacturer must prove it is safe.

With a dietary supplement, the burden of proof rests more on the FDA. To ban a dietary supplement, the FDA must demonstrate a significant or unreasonable risk to the consumer. This constraint can make it challenging for the FDA to protect the public in a timely manner.

Adding to the difficulty, if manufacturers of supplements become aware of side effects, they are not required to report them to the FDA. While it was still legal in the U. Bitter orange, or synephrine, is becoming a popular legal substitute for ephedra. Bitter orange comes from the fruit of the Citrus aurantium plant and is chemically similar to ephedrine.

There is very little research on the effectiveness or safety of bitter orange, but its stimulant properties make it likely that its side effects will be similar to those of ephedra. Some claim that wild yams Dioscorea villosa can enhance performance due to its anabolic properties.

Wild yams contain a substance called diosgenin, which can be converted to DHEA in a laboratory setting. The human body is not capable of converting diosgenin to DHEA. Yams offer no performance-enhancing benefits, but there appears to be little risk of side effects.

Gamma-oryzanol, also known as rice bran oil, is derived from sterol and ferulic acid. It has been marketed as a way to raise serum levels of testosterone, but has no proven anabolic effect. Some claim that tribulus terrestris puncture vine can increase testosterone levels by stimulating the pituitary gland.

Smilax comes from desert plants containing sarsaparilla and contains the building blocks for artificial production of anabolic steroids. Saponins are building blocks for the laboratory production of steroids; however, the body is unable to convert smilax into testosterone or any other steroid.

Yohimbine is extracted from either yohimbe bark or the South American herb quebracho. Some claim it increases blood flow through the testes, leading to higher testosterone levels. There is no proof that yohimbine has any anabolic effects, but it can be extremely dangerous.

Combining yohimbine and tyramine found in many foods and wines can cause an acute spike in blood pressure. In addition to hypertension, side effects of yohimbine include seizures, paralysis and death. The club drug GHB is a CNS depressant made by combining degreaser or floor solvent with drain cleaner.

For some reason, a number of uninformed bodybuilders became convinced that they could build muscle mass while they slept by taking GHB. Some extremely uninformed bodybuilders took GHB around the clock, risking an overdose.

A GHB overdose, as well as unsupervised withdrawal, can be fatal. Not surprisingly, there is absolutely no research to support the idea that GHB enhances muscle mass in anyone, awake or not. Diuretics are sometimes used to hide traces of illegal or banned substances.

Competitive bodybuilders sometimes take diuretics before competition to shed excess weight and increase muscle definition. Taking diuretics, especially during increased physical activity, can lead to dehydration, syncope and heat-related emergencies.

The use of most performance-enhancing drugs and supplements appears to be at best a waste of money, and at worst fatal. For those considering a supplement, here are some tips for selecting wisely Some are ineffective and dangerous only to your pocketbook.

Some, such as anabolic steroids, will work, but pose outrageous risks. Creatine is one of the few supplements that appears to have considerable research to support the claims made of it.

Thorough research, consultation with a physician and a healthy skepticism continue to be the best approach toward any drug or supplement. EMS professionals familiar with the facts are better equipped to discourage use of dangerous supplements and recognize patients who are potentially at risk.

For additional information on exercise supplements, visit the following websites:. National Institutes of Health. Dietary Supplements: Background Information. Coleman E, Nelson-Steen S, Maughan R, Skinner R.

Gatorade Sports Science Institute Sports Science Exchange Roundtable Rawson E, Clarkson P.