Nutritional Supplements in Sport: Improving, Enhancing or Endangering Performance?

I appeared last Friday before the National Anti-Doping Panel at Sport Resolutions in London, on behalf of a professional boxer. This was an Appeal regarding the 24-month period of ineligibility against the athlete, as a result of a positive anti-doping test. The adverse analytical finding was the result of the use of a 'contaminated' nutritional supplement, which, unbeknown to the athlete, contained in it, the prohibited substance methylhexaneamine (MHA), which is a stimulant and it is classified by WADA as a specified substance. My involvement in this case made me realise that we are a long way away from educating and protecting athletes from the dangers of the use of dietary and other nutritional supplements. I hope, with the present post, to raise some concerns and disseminate further findings with a constructive discussion.

The outcome of the Appeal will be announced in the next few days and I will produce a separate post regarding the legal issues that affect this controversial area of sports law. The present post, however, has as an aim to raise several concerns, regarding the use of dietary and nutritional supplements by professional athletes. Although several cases have been made known to the public, regarding the dangers of supplements in sport, it is alarming to discover that many athletes do not appreciate such dangers. More alarming is the fact that several governing bodies remain in apathy and ignore their duty to educate the athletes, or at least, communicate to them the seriousness of the situation.

Supplements

A careful and closer examination of this topic would identify several important considerations. Athletes need to understand that some of these supplements pose not only dangers to one's health, but also dangers in terms of producing adverse analytical findings in anti-doping tests. Some athletes tend to ignore the latter situation, as they usually take into consideration the misplaced notion of the 'legality' of such supplements. It is true that some of the supplements could be used by athletes without restrictions. But such use poses many dangers as to the actual content of the supplement and its chemical composition. 

The several cases before national anti-doping panels, as well as before the Court of Arbitration for Sport, serve as a reminder that supplements are not safe. In the majority of these cases,  the athletes in question had no knowledge that the supplements they were using contained prohibited substances. Although the regulatory framework allows for a reduction [or even elimination] of the period of ineligibility, when exceptional circumstances could be established, the anxiety and stress caused by the subsequent disciplinary procedures into the positive tests, should not be dismissed at face value.

Several of these supplements omit to state, on their label, the correct chemical composition or specifically state the list of the substances contained in the supplement. As is the case with MHA, it is possible that one substance may appear on the label of one supplement under a completely different name, as opposed to another product that contains the same substance but has on its label a different name for the same substance. For example, any product [supplement] that contains the following ingredients, will, most certainly, produce a positive result for MHA: Methylhexaneamine; Methylhexanamine; DMAA (dimethylamylamine); Geranamine; Forthane; Forthan; Floradrene; 2-hexanamine, 4-methyl-; 2-hexanamine, 4-methyl- (9CI); 4-methyl-2-hexanamine; 1,3-dimethylamylamine; 4-Methylhexan-2-amine; 1,3-dimethylpentylamine; 2-amino-4-methylhexane; Pentylamine, 1, 3-dimethyl-.

Athletes, therefore, cannot ignore the dangers from the use of supplements. The current regulatory framework promotes the application of strict liability, which, in turn, does not allow for too much flexibility and latitude. Once an adverse analytical finding is established, during the anti-doping test, the athlete would have to start compromising with the idea of the provisional suspension, the subsequent period of ineligibility, the loss of earnings and, of course, the possibility of a substantial damage to reputation.

Further, one must not dismiss the enormous responsibility that governing bodies owe to their members. The analysis of several of these cases before disciplinary panels, indicates that some governing bodies fail in their duty to educate their athletes as to the dangers from the use of supplements. Although athletes are responsible to observe their primary fundamental duty as to what they put in their system, governing bodies also need to ensure that athletes fully understand such duty. 

Governing bodies must establish certain criteria and design a specific list of steps that athletes need to follow prior to the use of supplements. Athletes should not place reliance on their friends for advice. They must research the internet to ensure that the product they are using, does not contain any prohibited substances. They must purchase their supplement from licensed sources and not in the 'grey' market. They must consult a medical doctor and/or a physiotherapist. If they can, they must test the product to ensure its safe chemical composition. But the best solution of all, would be not to take such supplements. 

The use of dietary and other nutritional supplements has created a multi-billion pound industry. There are a lot of different interests in progress. Any proposal to have all supplements used by professional athletes banned, will be met, I am convinced, with fierce opposition from those who have a stake in this industry. 

It follows, therefore, that the only effective solution to this problem will be the proper education of athletes. This could only be achieved if there is appropriate and effective communication between sporting bodies and athletes. The dangers from the use of supplements in sport must not be underestimated. It is possible that when such dangers are fully described and explained to athletes, athletes may be able to make an informed decision as to the use of supplements. 

In conclusion, there is only one drastic, but safe solution:

Do not use supplements.

Do not take the risk....

Dr. Gregory Ioannidis

24 March 2013