Doping in Sport - Part 3

At Trimarni, we are against cortisone injections until it is a very last resort after months of seeking other (less invasive) treatments. A steroid shot is usually not a treatment for an underlying issue. It's usually a masking agent for pain. Even when it helps with inflammation, it's not treating the underlying issue. More so, research tells us that there are many severe side effects from cortisone injections, such as nerve damage, joint infection, thinking of skin and soft tissue near the injection sight, bone weakening (contributing to osteoporosis), bone death, and tendon weakening or rupture. Corticosteroids also suppress the immune system. So with hearing those side effects, please avoid steroid injections.

While you may be familiar with cortisone injections, there are other glucocorticoids that can be prescribed via mouth, inhaler, intranasal spray, eye drops, topically and by injection: 

• Prednisone
• Prednisolone 
• Dexamethasone 

These are commonly used to treat injuries, manage chronic inflammation, IBS, asthma and rashes. Corticosteroids that are taken by mouth also have side effects, like swelling in the lower legs, high blood pressure, mood swings, upset stomach, thinning bones and problems with the eyes, such as cataracts.

Doctors routinely prescribe corticosteroids for common conditions like injuries, asthma and allergies but you may be surprised to learn that many forms of these drugs are banned under anti-doping rules and require a therapeutic-use exemption.

1. A triamcinolone acetonide injection may be prescribed for knee pain/osteoarthritis. According to WADA, a TUE is needed if receiving a triamcinolone acetonide injection within 10 days of competition. However, because some joint/tendon injection procedures may accidentally result in some intramuscular injection/absorption, a TUE for Triamcinolone acetonid is needed within 60 days of competition. 
2. The prescription of oral glucocorticoids (pills) is used for inflammation, arthritis, asthma and allergies. According to WADA, a TUE is needed if consuming oral glucocorticoids within 3 days of competition.

While athletes may understand anti-doping rules when it comes to the widely discussed drugs like EPO, testosterone and growth hormone, it can't be stressed enough that it is your responsibility to understand all anti-doping policies, rules and regulations and to think before you act/buy when it comes to medications, injections, pills and creams.

Resources such as USADA can and the World Anti Doping Agency can help you identify products that are safe and effective or that violate a doping code. Check your sport doping code every year to recognize what substances are prohibited in and out of competition.

2023 Prohibited List
Recognize the Red Flags
High Risk Supplement List
TUE process

And lastly, even if you aren't a front pack athlete, you are not trying to qualify for the World Championship or you are just participating in sport for fun, you do not get an exemption from WADA. When you register for an event, you must comply with anti-doping rules - no matter your fitness level. These rules are not just for performance but for your health and wellbeing.

Doping in Sport - part 2

Therapeutic Use

Some athletes require the use of drugs for the treatment of a medical condition. Athletes, just like the normal population, are not immune to illnesses or conditions where drugs are often needed for treatment purposes. For example, lets look at some reasons why athletes may need a drug that is banned by WADA.

1. The drug Raloxifene is used to help treat the thinning of bones (osteoporosis) in postmenopausal women. Raloxifene is a selective estrogen receptor modulator (SERM) and is on the prohibited list. 
2. Calusterone is an orally active androgenic steroid used in the treatment of breast cancer. Calusterone is on the prohibited list. 
3. Pseudoephedrine is a common ingredient in Mucinex and Sudafed, which is used to provide relief to sinus issues, breathing issues or the cold or flu.  According to WADA, Pseudoephedrine is a specified stimulant prohibited In-Competition at a urinary threshold of 150 µg/mL. The threshold level of 150 µg/mL has been established based on the intake of therapeutic doses of pseudoephedrine, defined as a maximum daily dose of 240 mg pseudoephedrine taken either as four daily oral administrations (one every 4-6 hours) of a 60 mg (or 2 x 30 mg) immediate release preparation (i.e. tablet, capsule or liquid), or two daily administrations (one every 12 hours) of a 120 mg extended release preparation or one daily administration of a 240 mg extended release preparation. 
4.  IV nutrient therapies, like B vitamins, are common in the holistic wellness industry. All IV (intravenous) infusions and/or injections of more than 100mL (~6.8 tablespoons) per 12 hour period are prohibited.
5. When a male athlete presents with symptoms consistent with low testosterone, a doctor may be willing to provide a prescription. However, USADA (United States Anti-Doping Agency) will not process a TUE for the use of testosterone unless specific criteria are met by providing all required documents.

When an athlete seeks medication that is on the prohibited list, a Therapeutic Use Exemption (TUE) may give that athlete the authorization to take the needed medicine. Because some drugs can be purchased over-the-counter or online, it's important to ensure that the consumed drug does not contain other banned substances.

Drugs taken by athletes that may require a TUE include (not limited to):

• Insulin
• Diuretics
• Beta-blockers
• Beta-2-agonists
• Glucocorticosteroids
• Decongestant stimulants
• Narcotics

The broad criteria for granting a TUE are:

1. The athlete would experience a significant impairment to health if the prohibited substance or prohibited method were to be withheld in the course of treating an acute or chronic medical condition.
2. The therapeutic use of the prohibited substance or prohibited method would produce no additional enhancement of performance other than that which might be anticipated by a return to a state of normal health following the treatment of a legitimate medical condition.
3. There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or prohibited method.
4. The necessity for the use of the otherwise prohibited substance or prohibited method cannot be a consequence, wholly or in part, of the prior use, without a TUE, of a substance or method which was prohibited at the time of use.

For more information on TUE - click HERE.

Social and recreational use

Did you know that up until 2004, caffeine was on the banned substance list? Whether for social purposes or for other reasons, athletes may follow their peers (or trends) and use social or recreational drugs. Although not every athlete using a recreational drug does so with the intent to enhance performance, some drugs have performance-enhancing properties. Additionally, being under the influence of these substances can pose a threat or danger to other competitors or yourself. 

Drugs on this list include (but are not limited to):

• Alcohol
• Cocaine
• Cannabinoids
• Stimulants

Performance Enhancers

Why do athletes take performance enhancing drugs? There are many factors which influence why an athlete will intentionally resort to using performance-enhancing drugs;

• To level the playing field,
• To win at any cost
• To improve
• Pressure from training partners/coach/organization/federation/country
• To please sponsors
• To change body composition
• To change physiology
• To manage depression self-worth
• To boost self-esteem
• To earn money
• For recognition
• To qualify for an event
• To set a personal best. 

However, no reason is a good enough reason to use a banned substance. Substances on the WADA list used to enhance performance is cheating. It threatens the integrity of sport and may compromise health. Performance enhancing drugs are shortcuts (cheating) to success and are not worth it. 

SUPPLEMENTS

Although most athletes are well aware that anabolic androgenic steroids or EPO (erythropoietin) are banned by WADA, you may not be aware that there are 835 dietary supplements considered high risk due to containing a banned substance. Supplements are not well-regulated and many supplements contain undeclared substances that are prohibited under anti-doping regulations. Be mindful that any supplement used to improve performance, improve recovery, change body composition, prevent or treat nutritional deficiencies or to enhance energy, may contain banned substances.

For example, on the Supplement High Risk List

Brand Name: MetaSalt
Manufacturer: CarboPro
Could Contain: Anabolic agents
Notes: Testing of an open container of an illegible lot number revealed the presence of ostarine. A sealed container of the same lot or formulation was not available for testing. For more information about SARMs see the USADA webpage on SARMS.
What the label says: The Supplement Facts panel lists "a variety of vitamins, minerals and extracts."

Another example is Vital Nutrients DHEA. DHEA may be recommended to you from your doctor or a friend as it's believed to improve sex drive, fight the effects of aging, build muscle, seek relief from menopausal symptoms, help with depression and adrenal insufficiency and treat osteoporosis. While DHEA is allowed in medications and supplements, it's considered a prohibited anabolic agent in sport.

As an athlete, it's your responsibility to stay updated with the current rules, guidelines and prohibited substances set forth by WADA. Even if your doctor makes a medical or supplment recommendation, most doctors are not aware of the anti-doping rules in your sport. A lack of knowledge by you and your doctor about performance enhancing drugs may lead you to fail an anti-doping test, even when it's not your intention to cheat. Whether you take a supplement to improve your performance or take a medication to improve your health, it's your responsibility to know what you are about to put into your body and to comply with all rules set forth by the World Anti-Doping Code. 

Bottom line: Do your research and make sure your supplements are NSF safe.

Resources such as USADA can and the World Anti Doping Agency can help you identify products that are safe and effective or that violate a doping code. Check your sport doping code every year to recognize what substances are prohibited in and out of competition.

2023 Prohibited List
Recognize the Red Flags
High Risk Supplement List
TUE process

And lastly, even if you aren't a front pack athlete, you are not trying to qualify for the World Championship or you are just participating in sport for fun, you do not get an exemption from WADA. When you register for an event, you must comply with anti-doping rules - no matter your fitness level. These rules are not just for performance but for your health and wellbeing.

In Part 3 I'll discuss one of the most commonly used banned substance by athletes.....you may be surprised that you took a banned substance and never realized it. 

Doping in Sport - Part 1

On April 24th, American pro triathlete Collin Chartier admits EPO use after a positive drug test. "Erythropoietin, known as EPO, is prohibited under World Anti-Doping Agency regulations because it stimulates erythropoiesis (red blood cell production) and can modify the body’s capacity to transport oxygen, increasing stamina, and performance."

Although doping is prevalant in all competitive sports, triathlon has had a reputation of being a clean sport (in other words, athletes train and race without the use of performance enhancing drugs). However, the recent news of Chartier reminds us that triathlon is not immune to doping and there isn't enough testing and education. And while some athletes will intentionally cheat, many athletes are unaware of what is considered "banned" by WADA or believe that if they won't be tested, it doesn't matter what they do outside (or during) sport. 

Doping describes the act of using a banned substance to drastically alter the physiology of the human body - often used to improve performance. Justifying the use of a banned substance for financial reasons, mental health, to break a record or to level the playing field not only threatens the integrity of sports but athletes risk health problems or death. As a reminder, anti-doping rules are not just for fair and clean sport but also to protect the health of every athlete who is participating. 

Unfortunately, in every sport, there’s great temptation to use performance enhancing drugs (PEDs). Anabolic-androgenic steroids are used to improve physical appearance by building muscle. Clenbuterol and ostarine are widely popular to burn fat and build lean muscle mass. Human growth hormone and testosterone, commonly prescribed to older adults to combat the age-related decline of these hormones, which may improve muscle protein synthesis. All of these drugs are banned by WADA (World Anti Doping Agency).

Most sports require an athlete to comply with the World Anti-Doping Code, which is "designed to set forth a standard set of parameters within which athletes can participate in triathlons and compete in a positive atmosphere of equal opportunity." As an athlete, when you train for a race, you are agreeing that you 100% comply with the WADA code. These Rules are intended:

a. to promote and maintain sportsmanship, equal opportunity and fair play;
b. to encourage and reward individual performance and initiative;
c. to protect the health, safety, and well-being of participants;
d. to promote the integrity of sport and triathlon as a positive cultural force in modern day society; and
e. to foster the foregoing ideals through the establishment and enforcement of punitive rules.

With this being said, why do athletes take performance enhancing drugs?

The primary reasons include;
Therapeutic use for health.
Social and recreational use.
Performance enhancement.

In Part 2, I'll discuss each of these reasons in more detail. 

For more info: 
2023 Prohibited List
Recognize the Red Flags
High Risk Supplement List
TUE process