Prohormones : Warning! - contaminated dietary supplements can seriously damage your career
In previous issues of Peak Performance (176, 188), we saw how seemingly harmless dietary supplements can be contaminated with anabolic steroids, with nandrolone being a particular problem, and how athletes can take steps to protect themselves, or at least to reduce the risk of falling foul of the doping rules because of contaminated supplements. But as Ron Maughan explains, the International Olympic Committee (IOC), World Anti-Doping Agency (WADA), UK Sport and national anti-doping agencies around the world are continuing to struggle with this problem, and there have been some significant developments in the last few months.
The initial concerns focused on the recognition that some prohormones were being sold as dietary supplements: these included especially androstenedione, a prohormone of testosterone, and 19-norandrostenedione and 19-norandrostenediol, both of which are prohormones of testosterone.
Prohormones are compounds that can be converted in the body into an active hormone, so androstenedione (often called ‘andro’ in the circles where it is used) is converted into testosterone, and the 19-nor compounds are converted into nandrolone, which is also known as 19-nortestosterone. The diagnostic test for nandrolone abuse is the presence in the urine of 19-norandrosterone, but there is no way of telling whether this came from nandrolone or from one of the prohormones. So far, it’s pretty simple, but if you’re getting lost, it will help to follow the pathways in figure 1 (below).
Figure 1 Nandrolone pathways
Prohormones were not specifically prohibited by the anti-doping regulations, although the anti- doping agencies believed that they were covered because they are clearly related to testosterone and nandrolone, which were and are banned, and the rules prohibit ‘related compounds’.
Surprisingly, these compounds were classified as dietary supplements and could be sold openly, whereas testosterone and nandrolone themselves are covered by the regulations relating to drugs and a medical prescription is required to obtain them. This has now changed; andro and the 19-nor compounds are specifically banned by WADA, and they are covered by the misuse of drugs regulations, so owning or selling these without proper authority is a criminal offence.
These steps show very clearly where the problem lies – the drug testing authorities are often one step (and maybe more than one step) behind the drug cheats. They react to new developments, and they try very hard to predict new directions in doping, but it is often impossible to predict what the future holds.
The US Anti-Doping Agency recently organised a meeting to which they invited specialists from the world of medical research who described the new treatments, including genetic manipulation, that are being developed to treat muscle-wasting disease. This research is vital to treat these problems, but the outcomes will undoubtedly find their way into sport – some of the researchers said that they are aware that these new drugs are already being used by athletes, even though they have not yet been approved for use in patients because their safety is not yet established.
The problem seemed initially to be confined to nandrolone. Andro, and even testosterone itself, were present in supplements, but the amounts were small and were not enough to trigger a positive urine test. However, even very small amounts of nandrolone or the 19-nor compounds will cause a positive test, and many high profile athletes in different sports were caught.
Although the amounts were often too small to have any effect on performance, they did trigger a positive test. Most of the athletes who tested positive protested their innocence, but even when it seemed clear that the athlete had not knowingly taken a prohibited substance, the strict liability rule meant that they were technically guilty, and were liable to suspension (except in tennis, where a number of players escaped punishment). Because the athletes could not prove that their positive urine sample was the result of innocent use of a contaminated supplement, they were punished and had no legal case against the supplement sellers.
Two court cases have changed that, though. In Germany, a football player who tested positive for nandrolone was suspended from competition – bad news for the player, whose reputation is tarnished, and bad news for the club that pays his wages.
The club investigated and found that samples of the supplements that he used did indeed contain prohibited substances. It seemed clear that his positive result was likely to have been the result of the use of a supplement that the club had given him.
The club took the company to court, claiming for loss of earnings. The court came to the decision that the soccer player’s positive test result was indeed due to the ingestion of nutritional supplements containing an anabolic steroid that had not been listed as one of the ingredients of the supplement.
This outcome from a European court clearly sets a precedent for other athletes who have tested positive due to contaminated nutritional supplements to seek redress. It is important to note, though, that there was no question of the suspension of the player being set aside.
In 2005, there was another successful prosecution of a supplement company, this time in the United States. Kicker Vencill was a successful American swimmer whose hopes of competing in the Athens Olympics ended when he tested positive for nandrolone and was suspended.
He was adamant that his positive result was not due to cheating on his part but to the presence of nandrolone prohormones in a dietary supplement that he had been taking at the time. He was able to show that the supplements he was using did indeed contain traces of nandrolone prohormones and that the American-based company that produced these supplements (Ultimate Nutrition) – had been identified on the Austrian government website as one of the companies that produced contaminated supplements sold in Austria. A court in California concluded that the supplement was indeed the cause of the positive test and awarded damages in excess of half a million dollars.
These two cases demonstrate that there is now widespread acceptance that supplements are contaminated with steroids and that at least some of the athletes who have been punished by suspension may have been technically guilty but were not deliberate drug cheats.
Until very recently, the focus was on contamination of supplements with steroids, mostly products related to testosterone or nandrolone. In 2002, however, another steroid, methandienone (commonly known as Dianabol), was found to be present in a product bought in the UK.
Even though it was not listed on the label as one of the ingredients, it was present in amounts that were sufficient to be effective in building muscle but also in amounts that would have caused serious health problems (including coronary problems and cancer) if used for prolonged periods. Furthermore, it was clear that this was not accidental contamination due to poor manufacturing or handling.
Dianabol was the steroid that was found in a sample provide by the pole-vaulter Janine Whitlock, who served a two-year suspension before returning to competition in July 2004. Whitlock reached the qualifying standard for the Athens Olympics but was not selected as the British Olympic Association’s regulations do not allow the selection of an athlete who has tested positive for drugs. Likewise, she was prevented from taking up her place in the Melbourne Commonwealth Games by a Commonwealth Games Council for England byelaw.
Whitlock appealed in both cases against these decisions, but her appeals were rejected. This demonstrates how severe the penalties for a positive test can be, and also how different the sanctions are in different sports and in different countries. Many other athletes who had served suspensions were able to compete in Athens, and there will be many more in Melbourne later this year.
More recently, the WADA-accredited doping analysis laboratory based in Cologne, Germany found caffeine and ephedrine-related compounds in more than 10% of the supplements they analysed, even though these were not listed on the label. As with methanedienone, this seems not be accidental contamination but rather the deliberate addition of active ingredients to enhance the efficacy of the product.
The Cologne laboratory has continued to pursue this, and some new findings were reported at a WADA meeting held in Leipzig in September 2005. Although there was much discussion, there were no easy solutions. Many of the national anti- doping agencies, however, presented information on schemes they are developing to help protect their athletes, because while a global solution is the ultimate goal, it won’t be easy to implement.
In the meantime, there is at least some good news. The doping authorities have moved away from the position where they tell athletes that the solution is not to take any supplements at all. They now recognise that some supplements can help some athletes and that a more constructive solution has to be found.
At the Leipzig meeting, Dr Hans Geyer, from the Cologne lab, presented some good news and some bad news. The bad news was that they had found significant amounts of the anabolic steroid oxandrolone present in a supplement that was sold as glutamine. Not only that, but the label on the bottle said ‘We declare that GM (glutamine) is controlled and produced to a chemical and technical high standard, so that no contamination with banned substances occurs’. This product was produced in Spain, and the guarantee printed on the label was reported to come from an official Spanish sports medicine centre. What is the athlete to make of this?
Dr Geyer also reported the case of a product that said on the label that it contained prohormones, but in addition to these prohormones, it contained the anabolic steroids stanozolol, boldenone, and dihydrotestosterone.
Perhaps even more incredibly, Dr Geyer was able to buy, via the internet, high quality pharmaceutical products that were being sold as dietary supplements, yet without any warning as to the likely harm to health or to the certainty of a positive doping outcome if these products were used.
The picture may seem bleak, especially for the athlete who wants to take a simple vitamin or mineral preparation, but who cannot afford to take a risk. Although many of the supplements used by athletes may be a waste of money, some have real value. For the athlete with low iron stores, for example, an iron supplement may be a necessary part of the short-term treatment until a dietary solution can take effect. However, there may be risks even with simple iron supplements. But there is some good news (see box below).
The message remains very clear. Athletes using dietary supplements remain at risk of an inadvertent positive doping outcome, and must look very closely at the supplements they use. The risk can be reduced to a very low level by using the products of reputable pharmaceutical companies, but the risk can never be entirely eliminated. The question is how much the benefit of using a particular product outweighs the risk – however small that risk. For an athlete such as Dougie Walker, the penalty was a price that few would choose to pay.
Ron Maughan is professor of sport and exercise sciences at Loughborough University
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