Athletes have been trying to fulfill the Olympic motto of “faster, higher, stronger” by adding food and other substances into their daily routine since 776BC when the Greeks used dried figs, mushrooms, and strychnine to boost their athletic performance.
There are several reasons that athletes choose to take dietary supplements, such as:
- improving recovery,
- maintaining physical health,
- manipulating body composition,
- and/or optimizing performance.
It’s one thing to knowingly attempt to cheat the system with banned substances and hope they don’t show up on the doping test. But, did you know the cleanest of athletes can inadvertently take a banned substance due to a contaminated dietary supplement?
Perhaps you’ve heard of the recent Nate Diaz scandal in which he was accused (and cleared) of doping after taking an organic, vegan, plant-based daily multivitamin?
Or perhaps you’ve heard of a recently-settled and vindicating lawsuit in which another UFC fighter (by the name of Yoel Romero) was awarded $27 million dollars after a tainted supplement caused him to fail a drug test and subsequently be suspended.
So, what substances do you need to watch out for if you’re competing? Let’s find out!
Who Regulates Dietary Supplements?
Firstly, it’s not exactly the wild wild west out there, certain controls are in place.
A key piece of legislation relating to nutritional supplements is the 1994 Dietary Supplement Health and Education Act (DSHEA), which gave authority to the FDA to regulate dietary supplements as food rather than as pharmaceuticals (2).
This means that supplement manufacturers are responsible for ensuring the safety of ingredients and accurate product labeling but do not need to gain FDA approval to produce or sell them.
The DSHEA also gave the FDA authority to establish good manufacturing practices (GMPs). This includes testing products for quality, confirming the absence of contaminants, verifying the accuracy of labeling, maintaining minimal standards for marketing and packaging, monitoring and reporting adverse events, and making all records available for FDA inspection (3).
See here on how the FDA is further strengthening supplement regulations.
Athlete Knowledge (Or Lack Thereof)
You’d think that professional athletes had a higher knowledge of the stuff they’re taking, right?
Despite the widespread use of dietary supplements in athletes, knowledge of them is relatively poor.
One study found that:
- 62% of athletes did not know the active ingredient,
- 57% did not know the side effects,
- 54% did not know the mechanism of action,
- and 52% did know the recommended dose of the supplement they were taking. (4).
Together, these factors make it more likely that an athlete could fail a doping test. This can occur from the inadvertent ingestion of a banned substance, passive exposure, food or abnormally high physiological levels (5).
Failing a doping test can also occur because of poor manufacturing practices or unscrupulous manufacturers (6).
Contamination in Dietary Supplements
But it’s impossible to know 100% for sure whether a product is free of contaminants or not, without doing actual testing. No athlete can be faulted for drinking their workout shake as fast as possible and getting on about their day, trusting the brand’s reputation and the protocols in place.
Dietary supplements, such as multivitamins and multiminerals, tend to be safe and free from contamination. However, there was once a case of cross-contamination of vitamin tablets with steroids using the same production line (7).
Supplements taken to boost sports performance or change body composition are most likely to be contaminated. The amount of contamination does not have to be high to cause an abnormal doping test. One capsule of a tainted dietary supplement once resulted in urinary levels of steroid metabolites above the WADA threshold (8).
The FDA has a list of tainted supplements, which has been maintained since 2007 and includes products in the following categories: sexual enhancement, weight loss, muscle building, and others.
Between 2004 and 2012, there were 465 Class 1 FDA drug recalls:
- 51% of which were classified as dietary supplements,
- 40% of these were for sexual enhancement,
- 41% for muscle building
- and 27% for weight loss.
Unapproved drug ingredients were found to be the reason for all the recalls above (9).
The highest risk supplements for contamination are AAS (steroids) and stimulants (10). This is because consumers want quick and noticeable results, so pharmaceutical ingredients are sometimes added by manufacturers.
Muscle Building Goals
A 2015 WADA Antidoping Rules Violation Report found that the most common sports implicated for infractions were: athletics, bodybuilding, cycling, weightlifting, and powerlifting (11).
The most frequent class of contaminants in doping testing is Anabolic-Androgenic Steroids (AAS), which accounts for 50% of the 4500 adverse analytical findings at WADA laboratories. This is likely due to the growing problem with unapproved and/or designer substances (12).
The first solid evidence for steroid contamination of dietary supplements in 2000 demonstrated that of 634 non-hormonal dietary supplements from 13 countries and 215 suppliers, 14.8% were contaminated with hormones or prohormones (13). The majority of these are steroids (89%), with the remainder 11% being aromatase inhibitors (14).
Weight Loss Goals
Weight-loss dietary supplements account for 39% of the FDA’s tainted dietary supplements list and have been contaminated with many substances, such as appetite suppressants, stimulants, antidepressants, diuretics, and laxatives.
Specific contaminants found in them include:
- sibutramine (Meridia) and its analogs,
- lorcaserin (Belviq),
- fluoxetine (Prozac),
- dimetylamylamine (DMAA),
- orlistat (Alli),
- furosemide (Lasix),
- and fenproporex (Perphoxene) (15).
The most common adulterant in this class of dietary supplement is sibutramine (Meridia), which was approved in 1997 by Abbott but was voluntarily withdrawn in November 2010 due to its role in increasing the risk of cardiovascular events, including myocardial infarction and stroke. Sibutramine is a serotonin-norepinephrine reuptake inhibitor, which is structurally related to amphetamine (16).
Caffeine is found naturally in food and drink, such as chocolate, coffee, tea, and energy drinks. Along with other stimulants, caffeine increases alertness, improves focus, decreases reaction time, and delays fatigue.
It is not banned by the WADA/USADA but is on the monitored list. The NCAA limits caffeine levels to <15 μg/mL in urine samples, which can be achieved with intakes of 500 mg or 6 to 8 cups of brewed coffee 2 to 3 hours before a competition (17).
Other Dietary Supplements
Only 2% of the FDA CDER list for tainted supplements were in the category of ‘other’, with the majority being nonsteroidal anti-inflammatory drugs. However, they also included benzodiazepines and corticosteroids, which are banned.
Narcotics are not often found in dietary supplements but mitragynine (Kratom), a herbal preparation with stimulating and opioid effects, is increasing in use (18). This is on the WADA monitored list as a narcotic in competition and has been found in some brands to be adulterated with tramadol (Ultram) (19).
FDA Guidelines for Third-Party Testing
The FDA does not have quality standards for dietary supplements but several third-party companies will assess dietary supplements for quality, purity, potency, and composition.
The USADA provides guidance on choosing a third-party testing company, including that the companies should be free from conflict of interest, have external accreditation, conduct audits for GMPs, evaluate the dietary supplements for overall safety and quality, and have validated and accredited methods to test for prohibited substances (19).
In summary: Being cognizant of the above-mentioned and most common performance-enhancing drugs in sports will better equip you for your upcoming doping test and the competition you’ve been training so hard for!
Stock Photos via View Apart & SeventyFour / Shutterstock