Ergogenic means "work enhancing." In competitive sports, an ergogenic aid is any sub stance or method that has the capacity to enhance athletic ability. It does so by increasing performance during an event, aiding recovery between workouts, or aiding during a workout to increase later performance. Performance enhancers may be legal or illegal-anything from supplementing glycogen during a ride to blood doping.
This Section addresses the ethical and legal considerations for the use of ergogenic aids in Cycling and examines the efficacy of a few of the most common ones.
------------ Ergogenic aids, such as these in tablet form, are often employed
in an attempt to increase performance.
ETHICS AND LEGALITY
Cyclists are continually striving to improve their performance, looking for that one thing that will make them just a little faster. If someone offered you a magic pill that would increase your performance, would you take it? If I told you it was a legal magic pill with no negative side effects, it would probably make your decision easier. But what if it were illegal and had serious side effects, including possible death? That too seems like an easy decision, but a surprising number of people say yes. Balancing the risks of legal actions and serious health complications against improved prospects of winning is a decision that many athletes make every day.
Throughout history, athletes have competed to determine who is best. There is an assumption that victory is gained on the bases of genetics, discipline, training, and skill and not through the application of some advantage that is unavailable to other competitors. It's an appalling period in our sport when we have to wait for the results of drug tests to determine the true winner of the race. As I write this, the 2006 winner of the Tour de France is still up in the air due to a positive drug test of overall winner Floyd Landis, and in the 2007 Tour de France, two teams were disqualified for the same reason. Le Tour-by far the most visible bicycle race in the world-has become virtually synonymous with cheating, and the sponsor of the most successful team in Tour history withdrew be cause of the bad publicity. If we want to see our sport flourish, we must not tolerate unethical or illegal behavior. It's not just the responsibility of the sport's governing bodies; it behooves every athlete, coach, trainer, and team sponsor to keep the sport clean.
The World Anti-Doping Agency (WADA) was created by the International Olympic Training Committee to develop a list of banned substances, draft rules governing their use, test for the banned substances, and enforce the rules. Testing and enforcement in the United States is handled by the United States Anti-Doping Agency (USADA). Sub stances are usually banned for one or more of the following reasons:
__The substance is illegal to buy or sell.
__The substance has side effects that endanger the cyclist's health.
__The substance gives an unfair advantage to the cyclist.
The list of banned substances is modified from time to time (see web site), and competitors need to check it periodically to stay current. Ignorance is not a valid argument if you are found using a banned substance. Be careful when taking over-the-counter medications because many contain banned substances. If you need to use a medication that contains a banned substance to treat an illness, you can file for a therapeutic-use exemption. Be cautious of nutritional supplements because some contain banned substances that may not be listed on the label.
Athletes are held accountable regardless of how the substance entered their body.
Not all ergogenic aids are illegal. There may be a gray area in which certain legal aids could be unethical, such as a hypothetical new drug that would artificially increase your hemoglobin count but is not yet banned. In those instances you need to consult your conscience. As an athlete, your goal should be to perform to the best of your ability within the rules of the game. As an exercise physiologist, I spend a lot of time researching ways to improve performance, and although I despise any form of cheating, I fully support the use of ergogenic aids that fall within the sport's legal guidelines, are ethically sound, and don’t endanger the athlete's health.
SUPPLEMENTS
I have a hard time coming to terms with the way in which nutritional supplements are allowed to be manufactured and sold in the United States. Because supplements are not considered drugs, they are not required to undergo safety testing. Except for the one limitation that supplement companies can’t make claims regarding curing or affecting a disease state, the companies are allowed to make any claims they wish, regardless of the truthfulness of the statements. They are not required to show independent scientific evidence supporting their claims, and the listed ingredients and their amounts need not be accurate or truthful.
The drug ephedrine is an excellent example of the negative effect of this lack of regulation. Ephedrine is a stimulant that was used in supplements that promoted weight loss and increased athletic performance. Over many years, adverse side effects were reported that included arrhythmias, cardiovascular disease, stroke, heat-related illness, seizures, and death. These effects were well documented, but it took until 2004 and more than eighty deaths before the Federal Drug Administration (FDA) finally banned the use of ephedrine in supplements.
Many supplements are asserted to be healthful because they are "natural" herbs. Although many natural herbs have valuable properties, the fact that a substance is natural is in no way related to its healthfulness. Ma huang is a natural herb used as a stimulant in many supplements. It contains ephedrine and has been shown to cause heart arrhythmias, psychotic events, and death.
Some supplements can be beneficial, some can be detrimental, and some will only cost you money. Before taking any supplement, research it. First let's look at where you should not obtain information:
__Celebrity endorsements. These are always strongly suspect because the celebrity is being paid to promote the product, may have no personal experience with it, and didn't write the advertisement (and may not care what it says).
__Athlete's unsolicited testimonials. Even if the athlete is not trying to mislead, these testimonials are questionable because the number of variables surrounding athletic success makes it difficult to accurately assign credit to any one factor. Though an athlete may truly believe that the supplement is the secret to his or her success, few athletes have the expertise of nutritionists or physiologists to make these judgments accurately. The "success" could also be due to a placebo effect, whereby the athlete trains harder because he or she believes that the supplement is effective.
__Magazine articles. Consumer health and "enthusiast" magazines are a poor source of information on supplements, especially if the supplement companies advertise in the magazine. Magazines often run well intentioned articles on supplements, but many magazine writers lack the expertise to properly interpret the results of scientific research. Articles may be based on a single study in a peer-reviewed journal. This is problematic because even careful research results often contradict one another. Even worse are articles based on news releases from a single researcher that fail to mention the conflicting results of other tests, or from supplement manufacturers themselves that may be based on no sound research whatsoever.
__Magazine advertisements. As noted above, supplement companies can make virtually any claims they wish, regardless of truth or accuracy. Beware especially of advertisements designed to look and read like objective magazine articles or product reviews.
Most magazines require that these pseudo articles carry a disclaimer stating "paid advertisement," but these words are usually run so small as to go unnoticed. The intention of these ads is to mislead the reader, and I think they damage the credibility and integrity of any magazine that runs them.
Now pardon me while I contradict myself. I stated that athletes and magazines are not ac curate sources of information on the effects of supplements. Nevertheless, these sources can be a good place to start your research. Although many important discoveries occur in a lab, often it is athletes and coaches who first discover what works, after which we science geeks conduct the research necessary to validate or disprove those claims. Few cyclists read peer-reviewed scientific journals, often getting their tips instead from other athletes or magazines. If many professional cyclists are using a specific supplement, it's possible that there is some benefit to its use. The key is to investigate the scientific literature.
Sound scientific research is conducted in an independent lab in a manner designed to obtain unbiased results. (Many supplement companies claim that their products have been scientifically proven, but the majority of these claims are un founded: the labs may not be independent, and the research, if it was conducted at all, is not intended to be unbiased but, rather, to generate a desired result.) The best database for exercise science and sports medicine literature is Pub Med; see the Appendix for the website.
Scientific literature does have drawbacks, however. Because the articles are written for scientists, they may be difficult for the average individual to understand. Although the Pub Med database is available to everyone, full articles may be hard to obtain outside of a university library.
(You might try interlibrary loan.) When perusing the literature, read beyond whether the substance seems to "work" and look for known and possible side effects. Most importantly, read all of the studies relevant to the substance of interest. One positive result doth not scientific consensus make.
If the scientific literature is too cumbersome and the popular magazines are unreliable, where do you go for sound information? Exercise physiologists, nutritionists, qualified coaches, and sports physicians are knowledgeable sources for information on supplements.
If you decide that an ergogenic aid is worth trying, be cautious with it and learn how your body reacts before you make it part of your training regimen. Different individuals may respond differently, which is why the scientific literature can be equivocal at times.
Ginseng
Touted as an energy booster, ginseng root is probably one of the most widely used supplements in the world. It is sold as a supplement and added to a vast number of other products. Ginseng theoretically enhances athletic performance by reducing fatigue and providing more energy.
Current scientific research shows no benefit to taking ginseng as an ergogenic aid. Anecdotal evidence of increased performance may be due to stimulants present in some ginseng products.
Phosphate Loading
In theory, ingesting sodium phosphate increases available phosphate for ATP production, which in turn leads to increased performance. It is also thought that increased phosphate stores lead to increased synthesis of 2,3-diphosphoglycerate.
This compound stimulates the release of oxygen from hemoglobin so it can be more readily trans ported to the muscle.
Although little research has been conducted, the current evidence is equivocal and does not support an increase in performance from ingesting sodium phosphate as an ergogenic aid. There appear to be no adverse reactions to ingesting phosphate, but at high doses gastrointestinal distress is common.
Creatine
Creatine has been one of the most talked-about and disputed supplements in recent history. In the ATP-PCr system of short-burst (3 to 15 seconds) energy production, creatine binds a phosphate with ADP to create ATP. In theory, if creatine stores are increased, more energy is produced through the ATP-PCr system.
Research as to whether creatine actually works during short-term anaerobic exercise is equivocal (roughly twenty-five articles for and eighteen against). This could be due to differences among individual test subjects. There is no strong scientific evidence that creatine enhances endurance performance. However, there may be some benefit to using creatine during off-season weight training or interval training.
The most common short-term side effects linked to supplementing with creatine are muscle cramping, dehydration, and gastrointestinal distress. Long-term effects are not known. Due to the known side effects and the absence of conclusive benefits, I don’t recommend creatine use for cyclists.
Ribose
Ribose is a naturally occurring sugar that affects performance in three ways:
__assists in glucose production
__can be converted to pyruvate for energy production through the oxidative pathway
__is a key compound in adenosine, an important component of ATP
In theory, increased stores of ribose lead to increased ATP production and increased performance. The first studies conducted on ribose were in clinical settings, where ribose infusions increased ATP stores in cardiac patients suffering from ischemic heart disease (heart disease marked by a reduction in blood flow to the myocardium). In studies using animals with induced ischemia, ATP levels also increased after ribose infusions.
Research on ribose as an ergogenic aid, how ever, has been less promising, and current studies don’t support its use. In the clinical studies, ATP levels were initially low due to an ischemic condition, whereas in the ergogenic studies, ATP levels began at normal levels. In the clinical trials, large doses were administered intravenously, whereas in the ergogenic trials, smaller doses were administered orally. (Ribose may have been degraded in the stomach during oral dosing.) The only known side effect is the possibility of gastrointestinal distress at high oral doses.
Caffeine
Caffeine is a natural stimulant commonly found in coffee, tea, chocolate, and most sodas. Research has demonstrated conclusively that caffeine can boost athletic performance.
Caffeine can depress feelings of fatigue and discomfort during exercise, enabling the athlete to perform at a higher intensity level and/or for a longer period. Caffeine also increases the mobilization of free fatty acids, making them more available for energy production and thus conserving glycogen stores. In addition, caffeine increases activity at the junctions between nerves and muscles, and increases the recruitment of motor units, both of which increase the muscles' ability to contract.
Caffeine's side effects are also well known.
It can cause muscle tremors, gastrointestinal distress, headache, nervousness, elevated heart rate, arrhythmia, and high blood pressure. In hot conditions it can lead to thermoregulatory complications. These symptoms are more likely to occur at high doses and in individuals who don’t usually consume caffeine.
If you normally take in caffeine and it does not negatively affect you, consuming responsible quantities before a race should not lead to adverse conditions. If you don’t normally consume caffeine, do not consume any prior to an important race because you do not know how it will affect you in those circumstances. You really do not want to spend the race in the port-a-john. Experiment during training and low-priority events.
----------- Drinking coffee, in the correct amount and situation, can increase
performance.
I can’t make the following statement strong enough: Stay away from caffeine pills! The amount of caffeine in pills is not regulated, and most contain Caffeine is the most widely used stimulant in the world, larger amounts than you would obtain from drinking even a lot of coffee.
In the past, cycling limited the amount of caffeine that could be in your system during competition. But most individuals would experience negative effects below the legal limit of six to eight cups of coffee. The ideal amount for performance enhancement is usually considered to be about three or four cups of coffee.
WADA recently removed caffeine from the prohibited-substance list and placed it on their "watch" list, meaning that there is no legal limit, but they are monitoring its use for possible later regulation. The National Collegiate Athletic Association (NCAA) still has an upper limit of allowable caffeine, but collegiate Cycling in the United States is governed by the National Collegiate Cycling Association (NCCA), which has no caffeine limit.
ILLEGAL AIDS
Two illegal and unethical ergogenic aids are so prevalent in cycling that I must address them here. Because their use constitutes cheating, you should be aware that discovery inevitably results in disciplinary action. (And your conscience should inform you that any "win" due to their undiscovered use is no win at all.) More importantly, these ergogenic aids pose serious health risks.
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CAFFEINE CASE STUDIES
Here are two examples of individuals who took caffeine pills to increase their athletic performance.
I used to teach a jogging class in which students were required to run 5 kilometers in 28 minutes in order to pass. The students knew this from day one and had all semester to prepare. One female student chose to walk and talk with friends during class instead of training.
When it came time for the 5k, she was worried about passing and took caffeine pills to help her performance.
By the second lap she was shaking and having heart palpitations. We quickly took her off the track and brought her in for medical treatment, which was successful. Fortunately there were no lasting complications.
The second example involved a male exercise physiology student who was a moderately to highly trained triathlete. During exercise physiology class, I discussed the benefits and side effects of caffeine as an ergogenic aid and told the story of the lady from my jogging class. This student asked questions about exactly what form of caffeine pills she had taken. A few weeks later, I conducted a 1.5-mile run/walk test in the class. Being an overachiever, the male student wanted to outperform everyone in the class and took caffeine pills. Not only did he end up visiting the doctor with heart palpitations, he had to wear a portable electrocardiogram (ECG) for two weeks and could not consume any caffeine for a much longer time. He later said that because he was fit and regularly drank coffee, he thought the caffeine pills would not affect him in that manner.
The point I want to drive home is that just because caffeine is sold over the counter does not mean it's harmless. If you plan to use caffeine as an ergogenic aid, do it responsibly. Everyone responds differently, and what may be safe for one individual may cause distress in another.
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Anabolic Steroids
Anabolic steroids are synthetic testosterone. Re search has demonstrated unequivocally that steroids increase muscle mass and performance. It is theorized that they speed recovery by repairing damaged tissue, and they reduce the catabolic effects of exercise. These benefits enable the athlete to make larger gains faster. There is also evidence that steroids stimulate increased levels of red blood cells. Steroids can be administered through injection, oral doses, patches, and creams.
Although cyclists usually do not want to gain large quantities of muscle mass, steroids can still improve their performance by aiding in the recovery process.
Steroids are banned by WADA, USADA, UCI, and the International Olympic Committee (IOC). A cyclist caught using steroids will be suspended or banned from the sport. In the United States, steroids are illegal to buy, sell, or possess, any of which can lead to a prison term. Being illegal, steroids are sold on the black market, making them extremely expensive and precluding any guarantee of purity.
Serious side effects accompany steroid use, some reversible, others not. Reversible side effects include acne, depression, "roid rage" (uncontrollable fits of anger), infections at injection sites, and an unhealthy cholesterol profile. After cessation of steroid use, these effects tend to disappear.
The list of irreversible side effects is longer and more serious. Side effects affecting males and females include cancer, liver disease, cardio vascular disease (all of which can cause death), and baldness. Male users run risks of testicular atrophy, impotence, developing mammary glands (breasts), and a permanent decrease in natural testosterone production. Women users may develop male traits (facial hair and deep voice). Steroid use in women has also been linked to serious birth defects. Steroid use in adolescence can lead to stunted growth due to early closure of the epiphyseal plates (growth plates in the bones). Let's do the math. On the negative side: steroids have a negative impact on health; they are extremely costly; and users could be banned from Cycling, sent to prison, or die. On the positive side: users might cross the finish line first (but they'll know it doesn't count). Time to choose, math wiz! Blood Doping Blood doping is more prevalent in Cycling than in any other sport, and its rampant use has left the sport with a black eye. Blood doping is the act of artificially increasing hemoglobin (red blood cells) in the body to increase the oxygen-carrying capacity of the blood. This increases the amount of oxygen delivered to the working muscles, which in turn increases the amount of work the muscles can perform. Current research demonstrates unequivocally that blood doping improves endurance performance.
Blood doping takes three forms:
__Autologous blood doping. The athlete's own blood is drawn; the plasma and hemoglobin are separated; the plasma is re-infused; and the hemoglobin is frozen for later use. Over the course of a month or two, the athlete naturally rebuilds his normal level of hemoglobin. The stored hemoglobin is re-infused just before competition to further increase the body's hemoglobin. During the time that hemoglobin levels are returning to normal, however, the athlete feels slightly weak, which affects his training.
__Homologous blood doping. Hemoglobin from a donor is infused into the athlete just prior to competition. This carries the risks of transmitting disease, infection, and an allergic reaction to, or outright rejection of, the hemoglobin (even if the donor and recipient have the same blood type).
__Erythropoietin injection. Erythropoietin (EPO), which is produced in the kidneys and liver, is responsible for stimulating red blood cell production within the bone marrow. In this treatment, synthesized EPO is injected to spur the creation of more red blood cells.
This increases the body's demand for iron, which is administered as supplements.
Blood doping has strong negative health con sequences; there have been at least eighteen documented deaths linked to blood doping in Cycling. By increasing hemoglobin without increasing plasma, doping raises hematocrit to dangerous levels, making the blood too viscous to flow smoothly. The heart has to work harder to push the thickened blood through the body, increasing blood pressure and wreaking havoc on the heart and circulatory system. The thick blood is also prone to clotting in the arteries, which can lead to a heart attack or stroke.
As a cyclist sweats during a long, hard race, the plasma volume drops naturally and hematocrit levels rise. A non-doping cyclist can handle this in crease in hematocrit, particularly if he or she pays attention to hydration levels. But when you add blood doping to the mix, hematocrit levels will be much higher than normal, greatly increasing the chances of a cardiovascular incident.
Unfortunately, testing for blood doping is problematic. A higher than normal hematocrit (more than 50 percent for males; more than 47 percent for females) is considered a positive test for blood doping. Although this test catches almost every cyclist who dopes, it also results in occasional false positives. Due to genetics, some individuals naturally have a hematocrit level that is over the limit; if an individual is borderline high, he or she might test positive after a long hot day in the saddle.
Training at altitude can also raise hematocrit levels by stimulating increased production of EPO and hemoglobin. WADA and UCI recognize this problem and have developed a procedure to accommodate individuals with naturally high hematocrit levels. Through blood testing, these cyclists can have a blood profile recorded. Paperwork is then submitted to establish the higher-than-nor mal hematocrit levels and exempt the individual from the normal limits.
It is nearly impossible to directly detect autologous blood doping because the introduced red blood cells are the individual's own. On the other hand, homologous blood doping is easy to detect through genetic differences in the cells, and such tests are reliable and valid. Testing for EPO is more complicated, and the results are still questionable due to difficulties distinguishing between natural and synthesized EPO. If a governing body decides to end a cyclist's career, it should be positive about the results.
Given the difficulties in directly detecting two of the three doping methods, I propose that a complete blood profile be maintained of every rider, and scheduled and random testing be conducted throughout the year (not just during race season). In theory, this should eliminate false positives due to naturally high hematocrit levels, and it would also catch cyclists with naturally low hematocrit levels who dope up to "normal" levels (for example, a cyclist with a normal level of 43 percent who artificially raises it to 49 percent). This pro gram would involve high costs and difficult logistics, but if it can keep the sport clean, it may be worth it.
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