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What constitutes a performance-enhancing drug? That question continues to spark vigorous debate. The off-label use of beta blockers in recent years is one example. These drugs have made their way into many arenas where people must perform or compete:
- Athletes use beta blockers to reduce anxiety and steady their hands in sports like golf, darts, and archery, which demand fine motor skills.
- Musicians and performers take these drugs before performances to manage their nerves and the physical effects of stage fright.
- In the work world, someone might pop a beta blocker before a presentation to prevent their voice from wavering or their hands from trembling.
This trend of using beta blockers for performance enhancement raises still other questions about the safety and efficacy of their off-label use. For answers, we turned to Dr. Alex Elkabbany, PharmD, RPh, CPh. Dr. Elkabbany oversees all in-house pharmacy operations as the director of FHE Health’s on-site pharmacy. His wide-ranging expertise in the field of pharmacology, as evidenced by a doctoral degree in pharmacy and more than 10 years of work in the field, gives him a unique point of view on beta blockers and their performance-enhancing use. In a recent interview, he helped shed more light on the subject….
Beta Blockers: Medical Use and Conditions They Treat
We began the conversation with a brief overview of beta blockers and how they work, their intended medical use, and what conditions they are typically prescribed for.
Beta blockers like Carvedilol, Metoprolol, Atenolol, and Propranolol have been around since the 1960s and 1970s. They are “a class of medications that block the effects of the stress hormone adrenaline on the body’s beta receptors,” Dr. Elkabbany said. Beta receptors, which are responsible for signaling in the sympathetic nervous system, play a key role in mediating the body’s fight-or-flight response.
What conditions are beta blockers prescribed for? “They are mainly used to treat conditions such as hypertension (high blood pressure), angina (chest pain), heart failure, and certain arrhythmias (irregular heartbeats),” Dr. Elkabbany said.
Beta Blockers When Used for Performance Enhancement
In what ways are beta blockers used off-label for performance enhancement, and how do they help to enhance performance?
These drugs are “used off-label to manage symptoms of anxiety, tremors, migraine headaches, and stage fright,” Dr. Elkabbany said. “They are also used off-label to enhance performance in activities that require steady hands and a calm demeanor, such as public speaking, performing arts, and competitive shooting. By blocking the physical symptoms of anxiety (such as tremors and rapid heartbeat), beta blockers can help individuals maintain composure under pressure.”
Beta Blockers’ Effects on Body and Performance
How do beta blockers affect the body, and what are their mechanisms of action? Dr. Elkabbany re-emphasized that they block the action of adrenaline on beta receptors in the body:
This results in a decrease in heart rate, blood pressure, and the force of heart contractions. By reducing these physiological responses, beta blockers help to alleviate symptoms of anxiety and reduce the workload on the heart.
Considerations Re: Beta Blockers for Improving Performance
What are some things to consider and some precautions regarding the use of beta blockers for performance enhancement? Dr. Elkabbany listed the following risks and side effects:
- Physical symptoms like “dizziness, fatigue, and the masking of symptoms of underlying medical conditions”
- Mental health risks such as depression or the exacerbating of existing depressive symptoms
- Dependence and withdrawal symptoms from misuse; while “abuse and addiction are less common with beta blockers compared to other performance-enhancing drugs,” the body can still become used to taking a beta blocker and experience symptoms like palpitations or a rise in blood pressure upon discontinuation.
What are the benefits of using beta blockers to improve performance? “Reduced physical symptoms of anxiety, improved focus, and steadier hands,” Dr. Elkabbany said. “These effects can be particularly advantageous in situations where precision and concentration are required.”
Opinion on Beta Blockers for Performance
When we asked Dr. Elkabbany for his opinion about the use of beta blockers to improve performance, he was quick to say they “should only be used under the guidance of a healthcare professional.” He added that “while they can be effective in certain situations, they also come with potential risks,” and “that’s why It’s important to weigh the risks against risks of potential side effects.”
Natural or Holistic Alternatives to Beta Blockers
When we asked if there were natural or holistic alternatives to beta blockers that might achieve similar effects, Dr. Elkabbany listed some “natural alternatives for managing conditions like hypertension and anxiety.” They included:
- Hawthorn, a plant known for its cardiovascular benefits and for potentially reducing blood pressure and improving heart function
- Magnesium, which can help relax blood vessels and lower blood pressure
- Garlic, known to reduce blood pressure, and which may help reduce the risk of heart disease
- Coenzyme Q10, an antioxidant that supports heart health and may help lower blood pressure
- L-theanine, an amino acid found in green tea that can promote relaxation and reduce anxiety without causing drowsiness
Dr. Elkabbany also mentioned yoga and meditation as holistic practices that “can help reduce stress and promote overall well-being, potentially lowering blood pressure and heart rate over time.”
