Sport, by its nature, always has a competitive structure. Such as two teammates competing with each other to be in the A team or to represent their team in competitions in a professional branch, the struggle between two different teams competing with each other to reach the trophy in which the most successful team/individual will be crowned, or a recreational athlete who is going to run on the weekend for the podium in a 10-kilometer running race etc. Many more examples can be given on this subject. However, the competition, which can help individuals improve their health and sports performance one step further, can unfortunately harm in some cases. In order to achieve success in the field of sports, as in every field, people may resort to some shortcuts against the nature of equal competition. This is where the issue of doping comes into play and can cause individuals to gain unfair advantages against other competitors, and may cause short and/or long-term damage to the health of individuals who apply these methods. Doping is an issue that needs to be dealt with meticulously, which is very broad and includes many details. In this article, we will talk about an often neglected aspect of doping, the concept of “unintentional doping”.
Unintentional doping is the accidental/unintentional intake of prohibited substances into the body by various means. You may think that the athlete would not be banned from competition if the investigations revealed that the doping was unintentional. However, in line with the strict liability policy of the World Anti-Doping Organization (WADA), the athlete may face a 2-year ban from professional competitions, even if it is considered as unintentional doping. As it can be understood from this situation, WADA always leaves the responsibility of this situation to the athlete, whether the prohibited substance is taken into the body intentionally or unintentionally, and for this reason, it imposes the punishment on the athlete regardless. For this very reason, the concept of unintentional doping is of extra importance for athletes competing at a professional level.
So, for what reasons can unintentional doping happen to athletes the most?
- Nutritional supplement products contaminated with prohibited substance.
- The use of drugs containing prohibited substances for therapeutic purposes (not knowing the content of the drug or not being able to adjust the amount of the drug).
- Consumption of foods containing or contaminated with prohibited substances.
- 4) Sabotage.
In this article, we will focus on the first of these possible reasons, the consumption of nutritional supplements contaminated with prohibited substances by athletes.
The control mechanism that the nutritional supplements are subject to and the control mechanism that the drugs are subject to are different from each other, and considering the degree of severity of the control mechanism, the control network of nutritional supplements is more similar to the control network of foods. A comparison of some features of the control chains that drugs and nutritional supplements are subject to is given in the table below, and considering this table, you may have noticed that nutritional supplements do not have as strict control mechanism as you thought before.
|Drugs||Nutritional supplement products|
|Clinical Trials on Safety and Efficacy||+||x|
|Independent-Scientific Due Diligence||+||x|
|Withdrawal of Suspicious Products from the Market for Security Reasons||+ +||+ *|
|Suspension of Production of Suspicious Products for Security Reasons||+ +||+ *|
*The body controlling/regulating this situation is required to provide sufficient/strong evidence of the alleged charges.
Another reason why it is necessary to focus on the contamination of nutritional supplements with prohibited substances is the prevalence of the use of these products in the athlete population and the lack of knowledge of the athlete population about choosing these products (1).
To strengthen this claim, let’s examine the scientific studies on the athlete population and the prevalence of nutritional supplement use. In the article published by Huang and his colleagues in 2006, which is one of the strongest studies in this field, the rate of use of any nutritional supplement product by Canadian Olympic athletes in the 1996 Atlanta and 2000 Sydney Olympics was expressed as 69% and 74%, respectively (2). In another study, the nutritional supplement usage rates of the athletes competing in the 2002 and 2006 FIFA World Cups were found to be 0.7 and 1.3 per game for each player, respectively (3). As can be seen in the results of both studies, the use of nutritional supplements has increased over the years in the athlete population. In addition to these two studies, another study that revealed a higher rate of nutritional supplement use includes 310 athletes participating in the World Championships organized by the International Association of Athletics Federations, published by Maughan et al. in 2007(4). The rate of use of any nutritional supplement product by these athletes was found to be 86% (4).
You may think that “We know that nutritional supplement use is common among athletes, but what does this have to do with unintentional doping?” In order to demonstrate this relationship, let’s take a look at studies that examine nutritional supplements and their contamination with banned substances. In the article published in 2004 by Geyer et al., the first of these studies, 634 nutritional supplement products from 215 different brands from 13 countries were examined between 2000 and 2001, and it was stated that 14.8% of them contained anabolic androgenic steroids, although they were not specified on their labels (5). In another comprehensive study, 114 products of 24 nutritional supplement brands in Europe were examined in this context and it was revealed that 10% of them were contaminated with steroids and/or stimulants, which are classified as banned substances (HFL Sports Science 2013 European Supplement Contamination Survey). Finally, in the study published by Outram and Stewart in 2015, which summarizes well the nutritional supplement and doping issue, between the years of 2006 and 2013 in Australia, the United Kingdom and the USA, 6.4% to 8.8% of the athletes’ doping test was positive. The reason for the positive result was stated as the use of contaminated nutritional supplements (6).
Explaining the issue with examples from more concrete and real athletes will perhaps help everyone to better understand the seriousness of the issue. Our first example is Jamaican sprinter Asafa Powell, who was banned from professional competitions for 18 months due to the fact that the nutritional supplement called “Epiphany D1” contains “oxylophrine”, which is on the list of prohibited substances, although it is not included in the ingredient list of the supplement. However, his objection was later accepted under the title of unintentional doping and his sentence was reduced from 18 months to 12 months. Another athlete who has been victimized in this regard is the cross-country skier and biathlete, Evi Sachenbacher-Stehle. She was banned from professional competitions for 2 years after she was positive for “methylhexanamine”, which is on the banned substance list in the Sochi Winter Olympics held in 2014, but the athlete appealed under the title of unintentional doping, as in the previous case, and the penalty of the athlete whose objection was accepted was reduced from 2 years to 6 months. An interesting point in this example is that the nutritional supplement product that causes a positive result is a concentrated tea powder used to support the immune system. This case shows us that, from the most insignificant nutritional supplement to the most complicated, all of them may be contaminated with prohibited substances and must be carefully examined before starting their use. In our last example, 30-year-old Claire Squires, a recreational athlete, was unfortunately not as lucky as our first two athletes and died of a heart attack about 1.5 kilometers before the finish line in the London marathon due to the use of nutritional supplements that she did not know that they contained prohibited substances. The athlete, who does not know that the nutritional support product “Jack3d”, which she uses, contains “methylhexanamine”, which is one of the prohibited substances, perhaps symbolizes many people around us who use more than one nutritional supplement without knowing its content and do sports recreationally, and teaches us a very painful and important lesson. Following this event, as a result of detailed investigations carried out in England, many products containing “methylhexanamine”, including this nutritional supplement, were removed from the market.
So, as a professional or recreational athlete, what should we pay attention to when choosing a nutritional supplement in order not to encounter such a life-threatening situation that would disrupt such a sports career?
- First of all, you need to answer questions about the nutritional supplement product you intend to use, such as “Will it really provide you with the benefit you expect, are there side effects that it may cause while providing this benefit?” In other words, making a benefit-harm assessment and, if possible, carrying out this assessment with a healthcare professional who are experts in the field will be the most valuable measure to prevent such situations.
- If the potential benefits claimed by the product sound “too good to be true” while choosing a nutritional supplement, it would be beneficial to stay away from such products. In addition, when choosing “herbal concentrated products”, which have a higher risk of contamination than other nutritional supplement product groups, it would be appropriate to pay extra attention to the content and source of the product.
- When choosing a nutritional supplement, if you have the opportunity (this is especially important for professional athletes who are subject to doping control mechanism), the products that have been tested and labelled by internationally reliable independent laboratories (such as Informed Sport, HASTA, Cologne List) should be preferred.
- Before starting to use any nutritional supplement product, the ingredient list on the product should be examined in detail and detailed information should be obtained about the substances that cannot be understood in the content by consulting a healthcare professional specialized in anti-doping.
- Especially for professional athletes, as a precaution against a possible negative situation in the future, before starting to use any nutritional supplement, the “batch number” on the product and the date of use of the product should be recorded (professional athletes, given as an example above and whose penalties were reduced, proved in this way that the products they used contained prohibited substances and thus had the right to object within the scope of unintentional doping).
In this article, I tried to explain the relationship between unintentional doping and contaminated nutritional supplements based on the scientific papers and case studies. I wish you all healthy and doping-free days.
- Garthe I, Maughan RJ. Athletes and Supplements: Prevalence and Perspectives. Int J Sport Nutr Exerc Metab. 2018;28(2):126-138.
- Huang SH, Johnson K, Pipe AL. The use of dietary supplements and medications by Canadian athletes at the Atlanta and Sydney Olympic Games. Clin J Sport Med. 2006;16(1):27-33.
- Tscholl P, Junge A, Dvorak J. The use of medication and nutritional supplements during FIFA World Cups 2002 and 2006. Br J Sports Med. 2008;42(9):725-730.
- Maughan RJ, Depiesse F, Geyer H; International Association of Athletics Federations. The use of dietary supplements by athletes [published correction appears in J Sports Sci. 2009 Apr;27(6):667]. J Sports Sci. 2007;25 Suppl 1:S103-S113.
- Geyer H, Parr MK, Mareck U, Reinhart U, Schrader Y, Schänzer W. Analysis of non-hormonal nutritional supplements for anabolic-androgenic steroids – results of an international study. Int J Sports Med. 2004;25(2):124-129.
- Outram S, Stewart B. Doping through supplement use: a review of the available empirical data. Int J Sport Nutr Exerc Metab. 2015;25(1):54-59.