New York Yankees pitcher Roger Clemens, who was recently outed by a New York tabloid for using Viagra to increase his performance on the field, is among many professional athletes who make unorthodox use of pharmaceutical drugs.
Experts believe athletes and performers use a strange and alarming array of methods to keep themselves competitive in two of the most competitive careers in America, often at their own peril.
Although it may seem counterintuitive, Viagra -- which Major League Baseball does not prohibit -- works by relaxing muscles and increasing blood flow through the body.
Dr. Robert Dimeff, president of the American Medical Society for Sports Medicine, says that doctors first became aware of athletes' "off-label" use of drugs like Viagra a few years back, when cyclists, who "love to experiment with weird performance-enhancing stuff anyway," reported that it helped improve performance.
Dimeff says he presumes that their improvement at high altitudes is due to improved oxygenation of mild or "subclinical" pulmonary edema and inefficiency.
Dimeff also says that while large-scale, double-blind studies are necessary to confirm these reports, when they do not exist, doctors must rely on small studies and anecdotal evidence. And, of course, their pharmacological training.
A study presented in 2006 at an American College of Sports Medicine conference indicated that the potent ingredients in Viagra and Cialis, which treat erectile dysfunction, did seem to improve lung function by increasing oxygenation of the blood to the lungs.
Human Growth Hormone (hGH)
Sylvester Stallone, on the other hand, says he prefers to use human growth hormone to keep his 61-year-old self looking tight.
The muscly actor told "Today's" Matt Lauer five months ago that he does indeed take the substance and has no qualms about saying so.
Stallone, who pleaded guilty to possession after Australian airport officials last year found 48 vials of human growth hormone in his luggage, emphasized that his physique is buff because of years and years of training.
The hormones serve only as enhancement to an already strong body, he said.
Human growth hormone, he said "really takes off the wear and tear that your body takes."
Some bodybuilders and other athletes also sing its praises, claiming that it improves vision and makes for faster muscle recovery after workouts.
Dimeff says that if there were a shred of evidence that the hormone could improve eyesight, he'd be taking it himself. There is not.
But it is generally accepted in the medical community that the growth hormone can increase metabolism and protein synthesis, which means that with exercise, one can potentially grow leaner. He qualifies his comments, however, by emphasizing the significance of the placebo effect.
Because the word "placebo" has come to mean, at least in layman's terms, that whatever forces at work are not "real," Dimeff dislikes using the term.
But in most every study the placebo effect is so significant that it accounts for a 30 percent improvement in any given condition. "Just thinking you are taking something can make you feel better, but it is very real, very profound," he says.
That said, Dimeff says human growth hormone does accelerate the body's recovery from strenuous exercise as well as increase protein growth.
And although there have been reports of joint pain and increased risk of diabetes associated with its use, Dimeff says that unlike steroids, which linger in body, the growth hormone stays for no longer than nine hours. Therefore, he says, the risk of side effects is minimal.
But the hormone is very expensive. Bodybuilders who want an extra boost may find that Preparation H, the hemorrhoid-fighter with the distinctive metallic odor, fits better into their budgets.
For competitors who want to target problem areas before a big contest, the anti-inflammatory shrinks tissue temporarily. Trouble can come when old faithful is used regularly for extended periods of time, doctors say.
Darrell S. Rigel, clinical professor of dermatology at New York University Medical Center, warns that because it works by constricting blood vessels, Preparation H may raise one's blood pressure.
'Soda-Doping' With Baking Soda
Baking soda is another athlete's underground secret. Runners have ingested baking soda before races for decades -- it's called "soda-doping."
Enthusiasts compare it to carbohydrate loading before a race.
But Ronald W. Deitrick, fellow of the American College of Sports Medicine, recently told members at their annual conference that although his studies show that giving runners baking soda in capsule form did seem to improve the performance of middle distance runners -- and with few side effects (diarrhea being the worst case scenario) -- he believes its use should be banned.
"I think it violates the spirit of fair play," he told the group.
Eating Disorders and Weight Management
Gymnasts, wrestlers and dancers have to maintain a low weight in order to stay competitive, but according to experts, jockeys have it particularly hard.
In other sports, being a little above ideal weight simply puts one at a disadvantage, says Ron Johnson, co-author of Helping Athletes with Eating Disorders. But if a jockey doesn't "make weight," he won't be allowed to ride. Making weight means making rent.
The average jockey is a little taller than five feet and weighs 110 to 112 pounds. In order to maintain that weight, he says, jockeys often restrict their calorie intake to 500-800 a day, and just before the weekend when they race, sweating in rubber suits, purging with laxatives and vomiting ("flipping" in jockey parlance) is more than common.
So common, in fact, that the bathrooms for jockeys at many tracks feature oversized, square toilets and saunas -- aka "the hotbox" -- to facilitate quick weight loss.
Not surprisingly, this all takes a toll on a jockey's body.
But Johnson says that in large part kidney failure, heart problems and tooth and gum decay are all seen as occupational hazards by the athletes, who exist in a subculture where purging and starvation is the norm.
Athletes who practice severe forms of experimental enhancements are certainly taking a risk, even if the risks are -- as of yet -- unknown or unproved. For example, athletes who practice severe calorie restriction may not believe they have a psychological problem, but experts believe that starving and purging is likely to create one.
Risking It All for a Competitive Edge
Dirk Miller, executive director of the Minnesota-based Emily Program for the treatment of eating disorders, points to what is still considered the seminal study on food deprivation -- "The Biology of Human Starvation." The 1951 study took a group of war protestors and asked them to go on a hunger strike. The volunteers -- men with no history of pathology -- went on a medically supervised, highly restrictive diet.
The men developed an unhealthy obsession with food even after the study was completed and they were able to eat whatever they wanted. Moreover, they developed an obsession with weight -- they wanted to stay very, very thin, Miller said.
Well into old age many of the volunteers continued to suffer from food and body-image thoughts that nearly parallel those of people with bona-fide eating disorders.
While the detrimental effects of anabolic steroids is now well known, the dangers were not always common knowledge, and most doctors would emphasize using extreme caution before tinkering with a healthy body.
One could say there's a terrible irony in the fact that in an effort to better their physical selves, a significant number of athletes are achieving just the opposite.