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While the world runs away with lightening fast progress in the fields of sports medicine, sports science and sports performance and recovery nutrition, this is the kind of lousy, unscientific advice (see picture below) that our cricketers dish out to their juniors. And, to think that the Indian cricket board is the richest board and some cricketers feature amongst the richest of athletes in the world.

cricketers_sports_nutritionists_dhoni.jpg

Imagine for a moment, that I came out with a book on how to win the world cup (of cricket)! I’d be a laughing stock in cricketing circles, wouldn’t I? However, the other way around is – most often than not – allowed. People in the fitness – sports world (athletes, fitness models and bodybuilders-strength athletes) are allowed to dispense unscientific and sometimes, even downright wrong advice on nutrition.

Keith Baar, PhD, a researcher of muscle physiology at the University of California, says, ‘everyone thinks that they are an expert in fitness if they are fit.’ Well, ain’t that the truth?! Interesting to note here that if you happen to don a visible set of six-pack abdominals, you are on your way to becoming a ‘guru’. Whatever you say, will be taken as gospel…

In effect, Dhoni says here that you can eat anything – provided it is during the first half of the day! According to him, ‘burning it off’ is all that matters! Whatever happened to the nutrients you need (as a sports person) to perform and to recover?! I feel sorry for gullible fans of his, who also happen to be budding cricketers and therefore, likely to slurp up every piece of (such!) advice that he dishes out…

If you were to argue that he is just talking about what he does, well, this quote of his is included in the THE OFFICIAL BCCI CRICKETER’S HANDBOOK, © 2017 GoSports Foundation. So, it is likely to be followed to the letter by his followers.

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wadaOn 29th of September this year, the World Anti-doping Agency (WADA) made pubic the list of prohibited substances and methods for the year 2018. The List, which was approved by WADA’s Executive Committee on 24 September 2017, comes into force on 1 January 2018.

Feel free to download the list in PDF format (in English) HERE. To download in other languages, head over to this LINK.

The World Anti-doping Code can be downloaded HERE.

WADA_2018.jpg

We at Conditioning Clinic, fully support WADA and its efforts in ‘cleaning up’ sports. However, we believe that WADA’s Code is inherently flawed. Here’s a BLOG POST (written in 2013, mind you… so much of the information may be outdated!) where I go into much details, and makes me want to stick my neck out and say that WADA’s ‘war on drugs’ (we are not talking about the traditional War on Drugs here) has been a failure.

PS: We do not recommend, advice or condone the use of banned substances and methods for performance enhancement in sports. Also, see our DISCLAIMER.

 

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DENNIS LILLEY (Australia) 08/1975 CricketerDennis Keith Lillee: arguably, one of the best fast bowlers of all time! Quick, aggressive and dead accurate, he could intimidate batsmen not just by sheer pace but by his guile with the ball too! Along with Jeff Thomson, Dennis formed, perhaps, the most feared fast-bowling pair of all time!

But Dennis wasn’t just a great fast bowler; he was a ‘thinking cricketer’ as well. When he broke down in the West Indies in 1973 and was subsequently diagnosed with lumbar stress fracture, most cricket pundits around the world thought his fast bowling days were numbered. Lillee – the fighter that he was – wasn’t, however, ready to give up just yet!

Seeking help from exercise and sports medicine researchers from the University of Western Australia (chiefly Dr. Frank Pyke), Dennis went on a strength and conditioning program to get his back sorted.

WHY NOW?

Why – after almost 5 decades – are we talking about Dennis and his magical comeback from a career-threatening injury?! Pretty sure, there must have been other miraculous cases of comebacks. While that is true, you’ve got to remember that what Dennis and his researcher friends did almost 50 years ago was pioneering work. What’s more, given the fast pace of modern cricket and the short recovery time at the disposal of modern cricketers, the number of injuries that young fast bowlers are diagnosed with is staggering. And, lumbar stress fractures are the most debilitating of these injuries, typically resulting in 6–12 months of missed playing time (Mitchell R. L. Forrest et al., 2017).

This makes discussing Dennis’ case even more relevant today, than back in the day!

STRENGTH AND CONDITIONING PROTOCOL

Here’s a little look at Dr Frank Pyke’s protocol for Dennis Lillee – it makes for fascinating reading – notice how the program doesn’t differ much in principle – from what you’d prescribe today. Having said, there are better fitness parameters and better conditioning tools at our disposal today. I’d definitely put in more Olympic lifts and plyometric moves than bench press and arm curls!

INITIAL TESTING

Baseline tests for monitoring progress were ordered; these were

  • Body weight
  • Body fat% using Skinfold method (Yuhasz, 1962)
  • Submaximal and maximal treadmill performance (Pyke, Elliott, Morton, & Roberts, 1974)
  • Arm, shoulder and wrist strength (Clarke, 1953)
  • Arm and shoulder power (Glencross, 1966)
  • Lower back and hamstring flexibility (Wells & Dillon, 1952)

STRENGTH AND CONDITIONING PROGRAM

Cardiovascular training

  • Initially 20 min. treadmill runs at 80% of maximal velocity
  • Interval training (treadmill) – 5 sec sprints and 15 seconds of walking

Strength Training

  • General strength improvement to start off with – bench press, dumbbell flys, incline sit ups were prescribed
  • Intensity gradually increased to 3 sets of 8 reps; less than a minute rest between sets
  • At the end of 9 weeks – explosive weight training initiated along with movement based exercises and patterns that mimicked bowling – by using a pulley system, bowling with a 10 Kg resistance and using a 2 Kg med ball

Flexibility training

  • Flexibility work for lower back and hamstrings (mainly) as prescribe by Holt, was undertaken (Holt, 1974)

lillee_case_study1Results of the Conditioning Program

In addition to the impressive changes in the fitness parameters shown above, Dennis’s performance in the comeback series against England was a great success.

In 1975, when he was clocked against some of the other fast bowlers in the world; Dennis was the second fastest of the group – only Jeff Thomson was quicker!

TAKE HOME MESSAGE

Fast bowlers and their ‘handlers’ need to realise that previous injuries are an important predictor for future injury. It makes even sense to design and implement a tailor-made strength and conditioning program for and improved biomechanics to prevent injuries in the first place.

An effective and tailor-made strength and conditioning program will:

  1. Help the athlete perform better,
  2. Prevent injuries, and
  3. Help the athlete recover better and in a shorter time

REFERENCES

Clarke, H. H. (1953). Cable Tension Strength Tests. Springfield, Massachusetts: Brown-Murphy Co.

Forrest R L Mitchell et al (2017). Risk Factors for Non-Contact Injury in Adolescent Cricket Pace Bowlers: A Systematic Review. Sports Med., 2017

Glencross, D. J. (1966). The Power Lever: An Instrument for Measuring Power. Research Quarterly, 37, 202-210.

Holt, L. E. (1974). Scientific Stretching for Sport. Halifax: Holt.

Pyke, F. S., Elliott, B. C., Morton, A. R., & Roberts, A. D. (1974). Physiological adjustments to intensive interval treadmill training. British Journal of Sports Medicine, 8, 163-170.

Wells, K. F. & Dillon, E. G. (1952). The Sit and Reach – A Test of Leg and Back Flexibility. Research Quarterly, 23, 115-118.

Yuhasz, M. S. (1962). The Effects of Sports Training on Body Fat in Man with Predictions of Optimal Body Weight; Unpublished Doctoral Dissertation. University of Illinois.

 

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RE-BLOGGED FROM 2013

Abraham Lincoln once famously said that prohibition “makes a crime out of things that are not crimes.” WADA has done exactly that’

– Sally Jenkins, Columnist, Washington Post

quotes_david_epstein‘Do we want to see the highest possible achievements by men and women who do not use performance-enhancing drugs? If so, what counts as performance-enhancing? If sports fans really want to see achievement that they can relate to, perhaps athletes should be restricted to diets of pizza and beer, and be required to have 40-hour-a-week desk jobs’ 

–  David Epstein, author, Sports Illustrated

At the London Olympics 2012, more samples were collected and analysed for ‘doping’ than any other previous games. With more than 150 scientists and 1000 lab technicians working around the clock, the (World Anti-Doping Agency) WADA-approved lab at Essex did everything to ‘uphold the fairness and integrity of the games’. Well, really?!

122121HOW RAMPANT IS THE USE OF PEDs?

Athletes, coaches, team doctors, physical therapists and sports federations. all know that everyone’s ‘doing it’. Research too supports the general notion that use of performance-enhancing substances and methods is quite rampant in competitive sports.

Back in 1992, a lady named Vicky Rabinowicz went around conducting interviews of Olympic athletes; most candidly agreed that almost all medal winning athletes were ‘on drugs’ 1.

  • In 2004, Bents et al. reported in their study that almost half of college hockey players were using/ or have previously used stimulants like ephedrine, pseudoephedrine and amphetamines 2
  • Sottas and his fellow researchers reported 48% prevalence rate for ‘blood doping’ in endurance athletes 3
  • Scarpino et al. reported that of the Italian athletes they studies, 10% reported having used anabolics or amphetamines at the national or international stage; other drugs commonly used were bronchodilators and doping methods like blood doping 4
  • Thevis and co-workers found that 10% of young athletes aspiring to reach elite levels used tetrahydrocannabinol (cannabis) and other stimulants  5
  • Mottram, David and George, somewhat surprisingly, report a low level of positive samples for anabolics in athletes. However, the authors argue that athletes – more often than not – tend to use anabolics in training. Furthermore, to conducts surprise ‘out of competition’ tests is not only costly but isn’t always easy either, especially in some countries. Consequently, therefore, a study of the prevalence of anabolic usage will rarely, if ever, return a true picture 6

From these observations, it should become clear that despite the existent ban – imposed by WADA – on the use performance-enhancing drugs (PEDs), the tests conducted, and the much-publicized, ‘alleged’ detrimental health effects of PEDs, their widespread abuse by athletes still remains very much rampant!

122121333

Also, here’s an interesting aspect of drug testing. According to the International Amateur Athletic Federation’s own admittance, in any major competition only 10-15% of athletes are tested for doping. In such a scenario, the actual samples that turn out positive could be higher if all athletes were to be tested.

UPHOLDING THE SPIRIT OF THE GAME

According to WADA’s anti-doping code, the ‘spirit of the game’ is defined as under:

‘Celebration of human spirit, body and mind’ characterized by the following values:

  • Ethics, fair play and honesty
  • Health
  • Excellence in performance
  • Character and education
  • Fun and joy
  • Teamwork
  • Dedication and commitment
  • Respect for rules and laws
  • Respect for self and other participants
  • Courage
  • Community and solidarity

The code further states that ‘doping is contrary to the spirit of the game’.

SO, WHAT’S WRONG WITH THE ANTI-DOPING CODE?

There are vast differences of opinion between everyone concerned with elite sports (let alone, sports medicine researchers) about the validity of the anti-doping measures in place. There are those who advocate ‘ban them all and hand out lifetime bans, even for first time offenders’. Others, however, (get braced for this) recommend ‘legalizing them all so that some sort of sanity could return to the use of PEDs’ and it is a more ‘level playing field’.

Legalising will ensure that research is conducted to study the drugs in detail with institution of proper dosage regimen. This will ensure that side effects are kept to the minimum and athletes can be effectively stopped from ‘abusing’ them. Legalising PEDs will, more importantly, ‘even out the playing field’.

DISCUSSION

An increasing number of people are beginning to think that banning PEDs does not solve the problem; it in fact, compounds the problem. As opposed to WADA’s aim of making the games ‘fair’, anti-doping measures make it unfair in the sense that the athletes that have used PEDs but aren’t caught (due to vested interests or otherwise!) get a massive unfair advantage.

Also, if you ever thought banning PEDs will make the contest even, think again. Genetics and some other factors like access to better training and support facilities may have, in my opinion, a bigger impact on the results of the contest.

QUESTIONS TO PONDER OVER

  • Natural levels of erythropoietin (EPO, increases red cell count, improves delivery of oxygen to muscles, helps endurance sports) and growth hormone (builds muscle, strength and power) vary widely in different individuals. There are those unlucky one in whom the levels are very low. On the other hand, natives of high altitude areas have much higher physiological levels of EPO. Isn’t that unfair?!
  • Athletes of Jamaican descent have more % of fast twitch muscle making them awesome sprinters. Isn’t that unfair on the ones that don’t have that genetic gift?!
  • Athletes born at higher altitudes are blessed with huge chest cavities, more EPO production, more packed cell volume (PCV) and thus better delivery of oxygen to exercising muscles. All these physiological adaptations are in place to deal with the rarefied atmosphere at higher altitudes. This gives athletes born at higher altitudes an edge in endurance sports over other athletes. Isn’t’ that unfair?
  • Athletes from cash rich federations and with more endorsements can afford to have access to better training facilities, coaches, physios and other support staff. Isn’t that unfair?
  • Athletes with access to more money can travel to higher altitudes to train and acquire an edge over the ones that can’t. Isn’t that unfair?

Add to the list personal attributes of athletes like 7 feet tall basketball players and the massive feet of Ian Thorpe and you will realise that with genetics favouring some, it will never a level playing field out there. So, the argument that use of PEDs makes the games unfair doesn’t hold much water. The games are already stacked in favour of the genetically gifted!

And, what happens when gene doping becomes a full-fledged reality? There will no stopping the unfair advantage that the genetically engineered ‘super-athletes’ will receive! There are some indications that these super-athletes are already roaming freely amongst us! Click here to read more.

It all very well to say that WADA is making an effort to make sports a fair contest for all participants. But to say that we have been successful in preventing use of PEDs by conducting tests and banning ‘cheats’ is far from the truth. The use of PEDs continues to be widespread amongst athletes. If you’ve ever handled an elite athlete, you will know that most times clocked on the sprints, distances achieved on the javelin throws, or the poundage lifted on snatches can never be a product of just genetics, brilliant training regimens and diet alone.

CONCLUSION

There is a school of thought which suggests that legalizing PEDs will ensure a level playing field. With some vested interest not testing athletes from cash rich federations, you can bet your bottom dollar that not everything that’s going on is in ‘the spirit of the game’.

An acquaintance of mine says the other day, ‘there shouldn’t be any drug tests and everyone should be allowed to do whatever it takes to enhance their performance… Maybe, the Olympics would then be really worth watching….I’d pay a million quid to go watch the 100 metres dash then’.

And I say, ‘well, you’ve already been watching drug-loaded 100 metres sprints for quite some time now…, just that they never told you’!

Guess my friend’s remark sums up the way everyone is sceptical of the alleged success of WADA’s ‘anti-doping policy’!

PS: We do not recommend, advice or condone the use of banned substances and methods for performance enhancement in sports. Also, please see our DISCLAIMER

REFERENCES

(1) Raboniwicz V. Athletes and Drugs: A separate pace? Pyschol Today 1992; 25:52-53. Link

(2) Bents RT, Tokish JM, Goldberg L. Ephedrine, pseudoephedrine, and amphetamine prevalence in college hockey players: most report performance-enhancing use. Phys Sportsmed 2004; 32(9):30-34.

(3) Sottas PE, Robinson N, Fischetto G, Dolle G, Alonso JM, Saugy M. Prevalence of blood doping in samples collected from elite track and field athletes. Clin Chem 2011; 57(5):762-769.

(4) Scarpino V, Arrigo A, Benzi G, Garattini S, La VC, Bernardi LR et al. Evaluation of prevalence of “doping” among Italian athletes. Lancet 1990; 336(8722):1048-1050.

(5) Thevis M, Sauer M, Geyer H, Sigmund G, Mareck U, Schanzer W. Determination of the prevalence of anabolic steroids, stimulants, and selected drugs subject to doping controls among elite sport students using analytical chemistry. J Sports Sci 2008; 26(10):1059-1065.

(6) Mottram DR, George AJ. Anabolic steroids. Bailliere’s Best Practice & Research Clinical Endocrinology & Metabolism 2000; 14(1):55-69.

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cafe_neroGet off the Tube – straight into the nearest Cafe Nero  – pick up your favorite coffee and then off to work – isn’t that what most of us do?! Don’t we all love having our coffees, especially first thing in the morning? Yes, we do! – The reason being?! Well, for sure one of the reasons has got to be that coffee really ‘gets you going’ first thing in the morning. But, have you ever wondered how your innocuous looking cup of coffee manages to do that? Read on to find out more.

CAFFEINE

Let’s face it, we have to drink coffee every single morning coz somewhere along the line, we’ve got addicted to caffeine present in our coffee. It is this caffeine that is responsible for the ‘gets me going’ phenomenon!

It shouldn’t come as a surprise then that caffeine is the most ingested psychoactive drug (stimulant) in the world. It is a of major contents of almost all ‘stimulant’ beverages like tea, coffee, cola and energy drinks (not to mention thermogenic fat loss supplements).

According to Starbucks information on beverages, a tall latte’ contains 150mg of caffeine (filter coffee ‘venti’ – meaning twenty in Italian – is low in calories but contain a whopping 400mg per serving). Taking in that amount of the drug can have profound effects on your physiology.

What exactly are these effects and how does caffeine in your tall, skinny latte’ help you to get ‘switched on’, you might want to ask? Well, read on to find out more.

CHEMICAL STRUCTURE AND PHARMACOKINETICS OF CAFFEINE

But before we get into the intricacies of what makes caffeine tick, let us have a closer look at what caffeine really is. Chemically, caffeine is 1,3,7-trimethylxanthine.

Derived from the purine xanthine, methylxanthines have numerous medicinal applications, especially in lung disease. Apart from caffeine, other methylxanthines of note are theophylline, aminophylline (both of which are used as bronchodilators – in asthma), paraxanthine and theobromine. As you may have guessed, methylxanthines are  cardiac and CNS stimulants and bronchodilators (with individual variations, of course).

On ingestion, caffeine is expeditiously absorbed through the lining of the gastrointestinal tract. Within 15 minutes of consumption of coffee, trace levels of caffeine appear in blood; peak concentrations are reached within an hour 1.

Caffeine is highly lipid soluble (dissolves rapidly and completely in fat). Thus, it can cross cell membranes (of muscle and nerve cells), especially, the blood-brain barrier (a partition which allows only certain chemicals to enter the brain matter).

Caffeine exerts its action (as given below) on various systems through a number of proposed mechanisms.

After exerting its action, caffeine is broken down by the liver and kidneys – metabolites (break down products) that are formed are paraxanthine, theobromin and theophylline1. Incidentally, these metabolites have actions similar to caffeine as well – theophylline is considered even more potent!

ACTIONS OF CAFFEINE 

As mentioned previously, caffeine is the most often used stimulant in the world with prominent actions on the central nervous system as well as metabolism. As opposed to caffeine present in drinks, anhydrous form of caffeine (in the form of capsule/tablet/powder) is more potent.

Pharmacologically, caffeine is a competitive adenosine-receptor agonist, i.e. it serves as a competition for adenosine at its receptor. This receptor is responsible for suppressing neurotransmitters like adrenaline, nor-adrenaline, acetylcholine, dopamine and serotonin. Thus, ingestion of caffeine increases the production of these neurotransmitters.

However, since these neurotransmitters have complex and sometimes conflicting actions, effects of caffeine in endurance, strength and explosive sports (enhancement of performance, recovery and hydration) can be conflicting as well.

However, the main actions of caffeine can be described as under:

  • COGNITIVE EFFECTS

Caffeine improves wakefulness and vigilance. It may be also responsible for improved skill levels, especially those acquired through repeated training 2.

Foskett et. al. demonstrated in their study, improved cognitive parameters in athletes due to caffeine ingestion with enhanced sprint abilities as well as ball passing, ball control and accuracy associated with acute ingestion of caffeine3.

Because caffeine in low to moderate doses (3-6 mg/kg of body weight) has been shown to cause improved concentration during sleep-deprived spells, it may find application in services like the Special Forces 2.

  • THERMOGENIC EFFECTS

Consumption of caffeine causes stimulation of metabolism and a significant increase in the production of energy 4 – thermogenic action of caffeine has been shown to last for almost 3 hours after ingestion 4. Caffeine causes mobilization of free fatty acids and fat oxidation to produce energy during exercise 5-7. Additionally, it causes extra-muscular fat oxidation as well. Thus, caffeine seems to be definitely associated with causing fat loss 7.

These metabolic-stimulatory and fat-burning effects make caffeine a crucial ingredient of most fat-loss supplements (thermogenics).

  • ENHANCED EXERCISE ABILITY 

It is believed that caffeine enhances exercise performance. This is owing to its ‘glycogen-sparing effect’ – decreased utilization of muscle glycogen for energy during exercise – fats are used instead. Thus, owing to muscles glycogen lasting longer, the setting in of fatigue is prolonged.

Also, caffeine supports formation of new glycogen (glycogenesis) and thus aids in recovery after an intense exercise session.

Enhanced secretion of endorphins induced by caffeine is also a presumed mechanism in enhancing exercise performance 8 – the resultant decrease in pain perception leading to ‘feel good factor’ of beta-endorphins is well-documented 9.

In addition to the above findings, research also suggests that caffeine can improve neuromuscular transmission and muscle contraction 10;11 – both isometric and muscle endurance components are improved 10.

 To conclude, research overwhelmingly supports the view that caffeine enhances performance in endurance events 5;12, sports involving muscle power-strength components 13;14 as well as high intensity team sports 14;15.

TAKE HOME MESSAGE

So, the next time you are sipping that favourite coffee of yours, you know exactly what it is doing to you!

To sum up, caffeine has the following effects:

  • is more potent when ingested in the anhydrous state (as a tab/capsule/powder supplement rather than as coffee)
  • aids in sports performance
  • improves skills acquisition in sports – like ball control and passing
  • supports new glycogen formation (glycogenesis) and thus helps quicker recovery from an exercise session
  • prolongs exercise induced fatigue – by their ‘glycogen-sparing’ effect so you can keep going for a longer
  • improves neuromuscular transmission and muscle contraction
  • has thermogenic effects – stimulates metabolism causing burning of calories
  • induces fat loss – mobilizes fatty acids from fat stores and uses these as substrate (instead of glycogen) for producing energy
  • improves concentration – especially during sleep-deprived states
  • secretes beta-endorphins – makes you feel good

 References

  1.  Harland BF. Caffeine and nutrition. Nutrition 2000; 16(7-8):522-526.
  2. Lieberman HR, Tharion WJ, Shukitt-Hale B, Speckman KL, Tulley R. Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training. Sea-Air-Land. Psychopharmacology (Berl) 2002; 164(3):250-261.
  3. Foskett A, Ali A, Gant N. Caffeine enhances cognitive function and skill performance during simulated soccer activity. Int J Sport Nutr Exerc Metab 2009; 19(4):410-423.
  4. Astrup A, Toubro S, Cannon S, Hein P, Breum L, Madsen J. Caffeine: a double-blind, placebo-controlled study of its thermogenic, metabolic, and cardiovascular effects in healthy volunteers. Am J Clin Nutr 1990; 51(5):759-767.
  5. Ivy JL, Costill DL, Fink WJ, Lower RW. Influence of caffeine and carbohydrate feedings on endurance performance. Med Sci Sports 1979; 11(1):6-11.
  6. Erickson MA, Schwarzkopf RJ, McKenzie RD. Effects of caffeine, fructose, and glucose ingestion on muscle glycogen utilization during exercise. Med Sci Sports Exerc 1987; 19(6):579-583.
  7. Spriet LL, MacLean DA, Dyck DJ, Hultman E, Cederblad G, Graham TE. Caffeine ingestion and muscle metabolism during prolonged exercise in humans. Am J Physiol 1992; 262(6 Pt 1):E891-E898.
  8. Laurent D, Schneider KE, Prusaczyk WK, Franklin C, Vogel SM, Krssak M et al. Effects of caffeine on muscle glycogen utilization and the neuroendocrine axis during exercise. J Clin Endocrinol Metab 2000; 85(6):2170-2175.
  9. Grossman A, Sutton JR. Endorphins: what are they? How are they measured? What is their role in exercise? Med Sci Sports Exerc 1985; 17(1):74-81.
  10. Kalmar JM, Cafarelli E. Effects of caffeine on neuromuscular function. J Appl Physiol 1999; 87(2):801-808.
  11. Lopes JM, Aubier M, Jardim J, Aranda JV, Macklem PT. Effect of caffeine on skeletal muscle function before and after fatigue. J Appl Physiol 1983; 54(5):1303-1305.
  12. Hogervorst E, Bandelow S, Schmitt J, Jentjens R, Oliveira M, Allgrove J et al. Caffeine improves physical and cognitive performance during exhaustive exercise. Med Sci Sports Exerc 2008; 40(10):1841-1851.
  13. Woolf K, Bidwell WK, Carlson AG. The effect of caffeine as an ergogenic aid in anaerobic exercise. Int J Sport Nutr Exerc Metab 2008; 18(4):412-429.
  14. Beck TW, Housh TJ, Schmidt RJ, Johnson GO, Housh DJ, Coburn JW et al. The acute effects of a caffeine-containing supplement on strength, muscular endurance, and anaerobic capabilities. J Strength Cond Res 2006; 20(3):506-510.
  15. Schneiker KT, Bishop D, Dawson B, Hackett LP. Effects of caffeine on prolonged intermittent-sprint ability in team-sport athletes. Med Sci Sports Exerc 2006; 38(3):578-585.

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00000SusThe worldwide prevalence of obesity has reached epic proportions. So much so, that calling obesity a pandemic wouldn’t amount to exaggeration! In addition to putting individual lives on the line, obesity has the ability to severely increase health care costs, negatively impacting on most economies of the world 1;2.

So, what is it that causes obesity – you might want to ask!


What causes obesity?

Well. traditionally, we have been told that ‘excess intake of calories coupled with decreased expenditure’ is the immediate cause of obesity. Excess calories are treated as reserve food material (read: fats) and deposited as triglycerides (TGs) inside adipose tissue (fat stores). However, having said that,it does not seem to be as simple as that.

Recently, it is increasingly being suggested (and, I am one of those who believes in this) that obesity may be a metabolic disorder where your nutrient metabolism goes for a toss. Also, rather than how many calories you consume, what kind of food you eat (and where the calories are coming from) will define if you stay lean or pack on weight; ingestion of nutrient-dense food is likely to make you leaner and healthier than foods that are only rich in calorie and poor in nutrients.

Also, a number of (as yet poorly understood) factors play a causative role: hormones, metabolic enzymes, metabolic rate, nutrient partitioning and calorie partitioning abilities of the individual. It must be emphasized here that the kind of food you eat will have a massive influence all of the aforementioned factors.

Anthropometric tell-tale signs of obesity are:

  • Increased waist circumference
  • Increased waist-hip ratio
  • Increased body mass index (BMI)

Adverse-effects of being Obese?

In addition to the much publicized ill-effects of obesity (given below), not many people are aware that obesity causes testosterone deficiency (TD) as well. Testosterone has a prominent effect on metabolism; deficiency can add to the problems. In addition, low levels of T can have a detrimental effect on a person’s psyche, making it hard to stick to a prescribed regimen of healthy food and exercise to counter obesity. Thus a ‘vicious cycle’ connection exists between obesity and low testosterone levels.

Well-known adverse-effects of obesity are:

  • Metabolic syndrome
  • Cardiovascular disease (CVD)
  • Diabetes Mellitus (Type 2 DM)
  • Hypertension (rise in blood pressure)

Testosterone deficiency and Obesity in Men

Testosterone (as the major male sexual hormone) is responsible for the male sexual and reproductive functions. However, not many people are aware that it plays a significant role in calorie utilization and metabolism as well. The exact mechanisms by which testosterone levels are affected in / contribute to obesity remain a mystery 3.

However, here are some interesting facts connecting testosterone to obesity are: testosterone:

  • causes nitrogen retention (read: increasing muscle mass, as part of the anabolic process) 3;4, low levels in obesity therefore cause loss of lean muscle
  • affects body composition in a positive way by reducing fat mass and increasing lean muscle mass 5, low levels therefore, reverse these effects
  • stimulates hormone sensitive lipase (enzyme responsible for fat breakdown), inhibits triglyceride uptake and mobilises fat from fat stores 6, low levels in obesity therefore, lead to increased fat deposition
  • an inverse relationship exists between parameters of obesity (WC, WHR and BMI) and plasma testosterone levels in an individual 3
  • an inverse relationship also exists between the ill-effects of obesity like metabolic syndrome, hypertension, type 2 diabetes and plasma levels of testosterone 7
  • number of studies report the irrefutable proof that low testosterone levels are connected with diabetes and cardiovascular disease 8;9
  • low levels of testosterone definitely connected with all-cause mortality 10

Thus, it can safely be said that testosterone is responsible for maintaining and increasing muscle while burning fat; low levels are responsible for fat deposition resulting in obesity, diabetes, cardiovascular disease, metabolic syndrome and increased mortality 3-5;7-10.


How can obesity be treated?

A number of strategies have been proposed by researchers, physicians and fitness professional to fight obesity. Some of these are:

  1. Calorie Deficit: This involves ‘dieting’, using liquid diets, etc. However, this causes loss of lean mass in addition to fat loss
  2. Calorie Deficit combined with Exercise: This maintains lean mass whilst causing weight loss, however a number of people have found this pretty hard to stick to
  3. Surgery (gastric binding or bariatric): effective but reserved only for the morbidly obese

A novel, effective method proposed for treating obesity is combining exercise and healthy diet with testosterone replacement therapy (TRT) – especially if accompanying signs and symptoms suggestive of hypogonadism are present. Additionally, as opposed to other modes of treatment, testosterone has the potential to elevate mood and energy and reduce fatigue 11.


Future research

Although TRT sounds like an exciting treatment option for tackling obesity, the plasma levels of testosterone at which therapy should be initiated remain undefined. Currently, it is recommended only in individuals diagnosed with testosterone deficiency (hypogonadism / erectile dysfunction).

A sad fact is that most doctors treating obese patients with diabetes or cardiovascular disease are not aware of the connection of testosterone with obesity and the potential benefits of testosterone therapy. Furthermore, the misconception that testosterone increases cardiovascular risk 12 and chances of pancreatic cancer prevents clinicians from prescribing testosterone 13.

There is a definite and realistic need to further explore this option for treating obesity in men. Also, an effort should be initiated to educate both doctors as well as members of the general population (who are struggling with obesity and its ill-effects) regarding the benefits of testosterone replacement therapy.


References

(1) Kypreos KE. Mechanisms of obesity and related pathologies. FEBS J 2009; 276(20):5719.

(2) Freedman DH. How to fix the obesity crisis. Sci Am 2011; 304(2):40-47.

(3) Traish AM, Feeley RJ, Guay A. Mechanisms of obesity and related pathologies: androgen deficiency and endothelial dysfunction may be the link between obesity and erectile dysfunction. FEBS J 2009; 276(20):5755-5767.

(4) Singh R, Artaza JN, Taylor WE, Braga M, Yuan X, Gonzalez-Cadavid NF et al. Testosterone inhibits adipogenic differentiation in 3T3-L1 cells: nuclear translocation of androgen receptor complex with beta-catenin and T-cell factor 4 may bypass canonical Wnt signaling to down-regulate adipogenic transcription factors. Endocrinology 2006; 147(1):141-154.

(5) Emmelot-Vonk MH, Verhaar HJ, Nakhai Pour HR, Aleman A, Lock TM, Bosch JL et al. Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. JAMA 2008; 299(1):39-52.

(6) Traish AM, Abdou R, Kypreos KE. Androgen deficiency and atherosclerosis: The lipid link. Vascul Pharmacol 2009; 51(5-6):303-313.

(7) Dhindsa S, Miller MG, McWhirter CL, Mager DE, Ghanim H, Chaudhuri A et al. Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care 2010; 33(6):1186-1192.

(8) Aversa A. Drugs targeted to improve endothelial function: clinical correlates between sexual and internal medicine. Curr Pharm Des 2008; 14(35):3698-3699.

(9) Cattabiani C, Basaria S, Ceda GP, Luci M, Vignali A, Lauretani F et al. Relationship between testosterone deficiency and cardiovascular risk and mortality in adult men. J Endocrinol Invest 2012; 35(1):104-120.

(10) Araujo AB, Dixon JM, Suarez EA, Murad MH, Guey LT, Wittert GA. Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011; 96(10):3007-3019.

(11) Saad F, Aversa A, Isidori AM, Gooren LJ. Testosterone as potential effective therapy in treatment of obesity in men with testosterone deficiency: a review. Curr Diabetes Rev 2012; 8(2):131-143.

(12) Traish AM, Kypreos KE. Testosterone and cardiovascular disease: an old idea with modern clinical implications. Atherosclerosis 2011; 214(2):244-248.

(13) Morgentaler A. Testosterone replacement therapy and prostate cancer. Urol Clin North Am 2007; 34(4):555-63, vii.

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“Cocaine is a hell of a drug”- Rick James on the Chapelle Show

Cocaine, also known as coke, crack, rock and by numerous other names, is a drug used for ‘recreational purposes’. Allegedly, it causes an ‘euphoriant high’. No wonder then, that its regular use is fraught with the risks of developing a dependence. This propensity to cause cravings and the severe adverse effects associated with its regular use has resulted in a ban imposed on its use – either for medical or recreational purposes.

Recently, however, it is being increasingly suggested that cocaine has a profound effect on human metabolism and the way our bodies store fats. Thus, it is being touted as a potential drug in the fight against obesity.

Also, in sporting circles, there is a school of thought that cocaine – on account of  its stimulant effects – may help enhance performance. Athletes have tended to use cocaine both during competition and in training (to improve intensity). However, owing to severe adverse effects – even sudden death – associated with its use (in a sport setting) and the fact that cocaine use is banned by both the IOC and WADA Anti-doping code, athletes need to be wary of its use under any pretext whatsoever!

Here’s a bit more about cocaine and why you should avoid it – in competition and outside of it!

What is cocaine?

That question is probably as dumb as it can get! Most definitely, almost everyone knows a bit about cocaine. However, here’s some more info – especially relevant if you are an athlete.

Cocaine is the most powerful natural stimulant of the human central nervous system (Avois et al., 2006; Kloner & Rezkalla, 2003; Welder & Melchert, 1993) (in case, you are wondering – amphetamines aren’t natural; they are man-made). And, not to mention, cocaine also happens to be the most addictive of all drugs known to mankind (Avois et al., 2006).

Historically, humans have used cocaine as a psychoactive drug for thousands of years – dating as far back as the times of the Incas (aptly enough, one of the many street names for cocaine is Inca Message! – bet you didn’t know that…)

Pharmacologically speaking, cocaine is a triple-re-uptake-inhibitor; it inhibits the re-uptake of three chemicals (with potent neuroendocrinal actions): adrenaline, serotonin and dopamine. So, what does that mean in plain English?

Well, it means that cocaine inhibits the normal, rapid re-uptake of these neurologically active chemicals back from where they were secreted (vesicle present in the neurons or nerve endings of the central nervous system) – effectively prolonging the time duration of action of these potent neuroactive chemicals significantly. This leads to prolonged and potent physiological actions on the target cells, either in the human brain or peripheral organs like the heart – see below.

A point to be noted – the pharmacological actions of cocaine can be quite complex and may vary depending on the amount of dosage used.

What does cocaine do to your brain and body?

Normally, cocaine is administered using one of the following ways – snorting, smoking or injecting. Of these, snorting is the most popular. Owing to rapid absorption through the linings of the nasal cavities and almost immediate entry into the blood stream, this route of administration produces peak effects within 5 minutes.

Cocaine causes an ‘initial rush’ or a ‘feeling of well-being’ which is characterized by:

    • euphoria,
    • alertness,
    • clarity of thought process,
    • a decreased feeling of fatigue,
    • talkativeness, and
    • increased social interaction

This initial rush is, however, followed by depression! This is what makes cocaine a top candidate for repeated use and subsequent development of dependence (cocaine is more addictive than amphetamines).

Adverse effects that cocaine can cause are:

    • depression,
    • anxiety,
    • paranoid events,
    • arrhythmia,
    • respiratory disturbances,
    • epileptic seizures, and
    • strokes

Why are athletes tempted to use cocaine?

Contrary to popular belief, cocaine does precious little to help enhance sports, study, sexual or work-place performance! However, athlete still continue to use cocaine; believing that it may help them run that much quicker or lift that much more weight.

Cocaine may improve cognitive processes and therefore, the level of motivation (during competition) and skill-learning (during training sessions) may be affected favorably – some believe that this may be a prominent reason for athletes to get attracted to cocaine, especially since very little evidence suggests that cocaine enhances other aspects of metabolism sufficiently to affect sport performance.

Anecdotal evidence suggests that cocaine does precious little to enhance performance in ‘endurance sports’. However, an animal study conducted by Braiden et al., suggests that the opposite may be true and cocaine by accelerating glycogen degradation and accumulation of lactate during exercise, may, in fact, help endurance events (Braiden, Fellingham, & Conlee, 1994). In ‘power sports’ like weightlifting, there is evidence that some amount of benefit may be achieved through the use of cocaine (Bohn, Khodaee, & Schwenk, 2003).

Having said that, enough conflicting evidence exists for the effectiveness of cocaine use in either power or endurance sports. Additionally, some believe that cocaine may not affect sporting performance at all – favorably or otherwise. And that the sense of euphoria and clarity of thought process associated with cocaine use, creates a false sense of improved performance rather than actually improving it!

Why should athletes be discouraged from using cocaine?

Cocaine use is fraught with risks – some fatal! Cocaine (similar to amphetamines) increases risk of sudden death due to cardiac arrest during intense exercise sessions – such as an on-field sport performance, especially those involving short bursts of sprints!

Researchers believe that pathophysiological processes induced by cocaine that may be responsible (Avois et al., 2006), either singly or in combination for such fatal incidences as sudden cardiovascular death are:

    • enhanced heat production
    • increased lactic acid synthesis
    • intense constriction of blood vessels

Also, cocaine is an adrenergic drug. Regular use with resultant chronic stimulation of cardiac β1 receptors may cause death of heart cells. This may lead to fatal cardiac arrhythmia and cardiac arrest (Davis, Loiacono, & Summers, 2008).

If, however, you are not worried about the adverse effects and driven by the ‘win-at-all-costs’ attitude, another reason why you should refrain from using cocaine is because cocaine is not used in any over-the-counter drugs. Slightest traces of either cocaine or its metabolites (benzoylecgonine and methylecgonine) in urine, therefore,  constitutes a serious doping offence and ground enough for immediate suspension under the WADA (World Anti-Doping Agency) Code. Contrast that with ephedrine alkaloids which are present in some over-the-counter cough/cold medications; there can therefore be enough grounds for defending your case – whether you’ve unknowingly (or ‘otherwise’) used ephedrine/ephedra alkaloids.

Just to let you know, the World Anti-Doping Code’s Doping List classifies cocaine as an ‘indirectly acting sympathomimetic agent and a noradrenaline reuptake inhibitor and hence a performance enhancing drug (Davis et al., 2008). It is mentioned in the S6-a (stimulants) class of prohibited substances (on page 8 of the 2015 list).

TAKE HOME MESSAGE

cocaine_PEDTo conclude, notwithstanding the anecdotal evidence, cocaine seems to do precious little to improve sports performance. It may, on the other hand, be detrimental and may also increase the risk of fatal adverse effects. In short, using cocaine – for sports persons – is a ‘lose-lose situation’.

Therefore, if you’re an athlete and looking for an ergogenic aid, cocaine is the last thing on earth that you should look to get in your system!

 References

Avois, L., Robinson, N., Saudan, C., Baume, N., Mangin, P., & Saugy, M. (2006). Central nervous system stimulants and sport practice. Br.J Sports Med, 40 Suppl 1, i16-i20.

Bohn, A. M., Khodaee, M., & Schwenk, T. L. (2003). Ephedrine and other stimulants as ergogenic aids. Curr.Sports Med Rep., 2, 220-225.

Braiden, R. W., Fellingham, G. W., & Conlee, R. K. (1994). Effects of cocaine on glycogen metabolism and endurance during high intensity exercise. Med Sci.Sports Exerc., 26, 695-700.

Davis, E., Loiacono, R., & Summers, R. J. (2008). The rush to adrenaline: drugs in sport acting on the beta-adrenergic system. Br.J Pharmacol., 154, 584-597.

Kloner, R. A. & Rezkalla, S. H. (2003). Cocaine and the heart. N Engl J Med, 348, 487-488.

Welder, A. A. & Melchert, R. B. (1993). Cardiotoxic effects of cocaine and anabolic-androgenic steroids in the athlete. J Pharmacol. Toxicol. Methods, 29, 61-68.

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