Issue:
96
Page: 54-63
Dietary Supplements and Botanicals in Sports: Evidence, Regulation, and Doping Controversies
by Lindsay Stafford Mader
HerbalGram.
2012; American Botanical Council
Introduction
As US swimmer Michael Phelps
fiercely splashed his way to a record 19 Olympic medals at the London Games
last summer,1 most spectators sat on their couches and watched in
awe at his near-superhuman abilities. Few people doubt the physical differences
among athletes and non-athletes. While many people struggle to run a mile in 10
minutes, world record-holder Hicham El Guerrouj of Morocco ran the fastest mile
in 3 minutes and 43 seconds;2 most sports viewers would jump ship at
the mere thought of doing a cartwheel, while US Olympic gold medalist Gabrielle
Douglas spun, leaped, and kicked her way to becoming a modern legend known as
the “Flying Squirrel.”3
One experience that does unite most modern humans is the
desire to be a better version of oneself. Athletes yearn to run faster, jump
higher, train longer. Non-athletes long to be thinner, healthier, or more
energized. Millions of Americans turn to herbal and dietary supplements with
these objectives every year,4 and that athletes also consider these
products as a natural way to improve their wellbeing and performance should be
easily understood. As sports nutrition consultant Susan Kundrat, RD, wrote for
the Gatorade Sports Science Institute, “Athletes, coaches, and health
professionals who work closely with athletes are consistently looking for
sound, effective ways to enhance health and performance with foods, fluids, and
dietary supplements.”5
Still, dietary and herbal
supplements almost always have a negative reputation when discussed in the
context of sports. During the recent 2012 Summer Olympic Games, mainstream
media outlets and several sporting and anti-doping organizations vilified
supplements, calling them ineffective and risky, and warned athletes to steer
clear.6 These reporters and officials make both the problem and
solution seem clear and simple: supplements are unequivocally ineffective and
dangerous, and athletes should stop taking them. Upon closer inspection,
however, the facts reveal a different story.
The Blame Game: Illegal, Misbranded
Products Posing as Dietary Supplements
From a Czech kayaker and Welsh boxer
to an American NASCAR driver and a Greek high-jumper, many athletes who test
positive for banned substances attribute it to a dietary supplement. In one of
the best-known cases, a Jamaican-born sprinter for Great Britain named Linford
Christie tested positive for ephedrine at the 1988 Seoul Olympics.7
He blamed the outcome of the test on his consumption of a ginseng (Panax spp., Araliaceae) tea that
allegedly contained undisclosed, prohibited ingredients. Christie was let off
the hook and took home a silver medal.
Steven Dentali, PhD, chief science
officer of the American Herbal Products Association (AHPA), expressed doubts
over Christie’s excuse. “Was the tea ever identified or just claimed to be the
source?” asked Dr. Dentali. “Attributions of herbal effects, good or bad, must
begin with proper determination of what was actually ingested. With the
available evidence, the Christie case does not rise to the level of a banned
substance found in an herbal product” (oral communication, July 26, 2012).
(About 10 years later, Christie tested positive for 100 times the limit of a
prohibited anabolic steroid and was banned from the Olympics for 2 years. Many
sources report that he spuriously attributed this to eating avocados.)
The Christie situation embodies the
most complex — and likely the most significant — issue of the
supplements-doping controversy: Are the supplements blamed for failed drug
tests really at fault or are these athletes bluffing in order to maintain a
false innocence? In other words, who is telling the truth? In most cases,
unfortunately, the answer is unclear.
“Misbranded supplements and athletes
blaming supplements is an issue that cuts both ways,” said Edward Wyszumiala,
head of the dietary supplements, functional foods, and athletic banned
substances programs at NSF International, a nonprofit organization that
monitors and sets standards for consumer goods. “For example, we’ve seen
cases recently where a NASCAR driver was blaming his positive doping test on a
dietary supplement, but when the story was investigated further, it was proven
he was actually not taking a contaminated supplement, but actually a
pharmaceutical product. On the other side, there have been cases that have
been traced back directly to a contaminated supplement” (email, July 20 and
August 23, 2012).
The World Anti-Doping Agency (WADA)
is an independent organization responsible for sports-related anti-doping
activities like standards-setting and drug testing.8 It works with
governments of numerous countries, sporting organizations, and analytical
laboratories to address doping in sports. When an athlete fails a doping test,
WADA’s World Anti-Doping Code states that a tribunal of officials will consider
the athlete’s arguments if he or she wishes to appeal.9 This
tribunal can be one of a variety of sports arbitration boards, such as the
American Arbitration Association (AAA), the Court of Arbitration for Sport, or
other international bodies.
According to Gabriel Dollé, director
of the Medical and Anti-Doping Department of the International Association of
Athletics Federations (IAAF) — the world-governing body of international
athletics — the burden of proving a supplement was at fault falls on the
athlete. The arbitration boards, he said, do not test supplements, although the
IAAF can order a counter-analysis if it has doubts over the test or submitted
evidence.
“The IAAF orders very rarely
counter-analysis of supplements,” said Dr. Dollé (email, September 11, 2012).
Sometimes, the US Anti-Doping Agency
(USADA) — an independent Olympics-related anti-doping organization — will take
part in the testing of supplements on behalf of American athletes, said Amy
Eichner, PhD, USADA’s special advisor on drugs and supplements. “If the results
indicate that a prohibited substance plausibly could have come from a
supplement, it is up to the arbitration panel of independent judges to
determine whether the evidence bears this out. The arbitration panel makes that
decision,” she said. If testing results do not indicate a supplement, any
potential appeal will likely be dropped and the initial penalties enforced
(e-mail, July 25 and September 11, 2012).
Reduced penalties are possible if
the athlete “can establish to the satisfaction of the tribunal how the
substance entered his or her system, demonstrate that he or she was not at
fault or significant fault, or in certain circumstances did not intend to
enhance his or her sport performance.”10 Most importantly, said Dr.
Dollé, the athlete must show that he or she took steps to ensure the
supplements taken did not contain prohibited ingredients. Ignorance about what
is present in a dietary supplement, or any other nutritional product chosen by
an athlete, is considered an unacceptable defense.
If the athlete can convince the
panel that a supplement was at fault, the panel may decrease the athlete’s
penalty, as was the case with US swimmer Jessica Hardy. At the 2008 US Olympic
trials in Omaha, Nebraska, Hardy qualified for several Beijing Olympics
swimming events. She also tested positive for the banned substance clenbuterol
and was no longer eligible to compete in Beijing.11 Hardy took the
case before AAA, which found that she satisfactorily demonstrated that the
AdvoCare® Arginine Extreme dietary supplements she was taking
contained clenbuterol based on analysis done by the “father of drug testing in
sports,” Don Catlin, MD, of Anti-Doping Research Inc., in Los Angeles.13
AAA ruled that she had taken various measures in an attempt to ensure that her
supplement was safe, including the following: she had a promotional endorsement
contract with the Plano, Texas-based AdvoCare; she spoke with AdvoCare
representatives about the supplements’ purity prior to taking them; the
company’s website stated that its products were “formulated with quality
ingredients” and were considered “natural bodybuilding;” she obtained the
supplements directly from AdvoCare; and several additional examples. Hardy’s
penalty was decreased from a 2-year ban to a 1-year ban — the maximum possible
reduction — and she was permitted to compete in the 2012 Olympic Games in
London, where she won a gold and a bronze medal.12
Dr. Dollé noted, however, that a
very small percentage of investigations conclusively find that a sports
supplement was contaminated.
“Most of the time,” said Dr. Dollé,
“athletes do not even attempt to test the supplement. Cases of spiked
supplements are difficult to investigate because the content changes from one
batch to another and that the athlete, most of the time, no longer has the
batch he used at the time of the doping control.”
Even when an arbitration panel
agrees with athlete-produced evidence, supplement companies often contest the
lab findings and an absolutely conclusive answer remains somewhat at large.14
Regarding the AdvoCare and Hardy case, the company argued that it
specifically tested the lots of products provided to the swimmer, as well as
every lot of every ingredient (M. Miller, email, October 2, 2012). It appears
that the analysis groups employed by the company, NSF International and
Informed-Choice, did not find clenbuterol while Anti-Doping Research, which
Hardy hired to test the products, did find it. This might be explained by
various analysis/certification companies’ usage of different testing and
validation processes. AdvoCare also asserted that it was absent from some of
the meetings and thus unable to present its findings to the officiating
organizations. Ultimately, the ruling favored Hardy.13
Anthony L. Almada — a
co-investigator on a number of university-based clinical trials on sports
nutrition products and CEO of the sports nutrition brand GENr8 — voiced concern
for the difficulty in establishing an appropriate threshold of detection for
substances in varying dosage frequencies and sizes.
“Testing for banned substances is a
step forward, but the sensitivity of the testing methods, the testing ‘limbo’
of how low can a lab’s analytical methods go in detecting a banned substance,
is rarely if ever considered by a dietary supplement manufacturer,” said Almada
(email, September 20, 2012).
Government and Industry Response
The dietary supplements industry
often stresses the fact that if a product labeled as a dietary supplement does
contain prohibited or designer pharmaceutical ingredients, it is no longer a
dietary supplement and is instead a drug being sold illegally as a supplement.
It also often claims that companies participating in such activities, referred
to as economically motivated adulteration, represent a small, rogue portion of
the industry and that most manufacturers and retailers are reputable
businesses.
“I think that’s a bit of
miscalculation on the industry’s behalf,” said Daniel Fabricant, PhD, director
of the US Food and Drug Administration’s (FDA) Division of Dietary Supplement
Programs. “It is their reputation, after all. It’s really incumbent on the
industry to remain vigilant. The problem isn’t going to auto-correct. Saying
it’s not your problem doesn’t make it go away” (oral communication, September
6, 2012).
According to Dr. Fabricant, FDA has
no official data on the number of companies marketing tainted products as
sports supplements. He did note, however, that sports supplements represent one
of the top 3 areas of concern for FDA, along with supplements marketed for
weight loss and sexual enhancement.
“If there’s a drug in a supplement,
generally it’s not there by accident,” he said. “And [drug substances are] not
at levels that would indicate a cross-contamination problem. They’re at large
levels intended to have a profound biological effect. I don’t think there’s one
archetype that participates in these activities. We’ve seen tainted products in
a variety of different environments of distribution. You know, retail,
internet. You name it, we’ve seen it — a variety of large and small. There’s
not one type, per say, that fits the bill.”
Sometimes dietary supplement trade
publications reinforce the image of an industry whose problems have been
unfairly exaggerated. NutraIngredients USA, for example, reported after the
London Olympics that the synthetic substance DMAA — a banned stimulant also
called methylhexaneamine, or MHA — was implicated in only one
Olympics doping ban.16 (Some companies say DMAA can be found in
extremely small quantities in the oil of the geranium plant [Pelargonium graveolens, Geraniaceae],
and therefore, according to the companies, is actually a natural product,
although at least 3 peer-reviewed analytical studies have determined that it is
synthetic.*15 This lone DMAA doping case represented 12.5% of the 8
total 2012 Summer Olympics doping cases. According to the Anti-Doping Database,
172 professional athletes have tested positive for DMAA since 200917
— a number that includes failed drug tests in all sports, not just the 2012
Olympics, and thus provides a more comprehensive assessment. (The most
suspensions occurred in 2011 when 95 athletes tested positive for DMAA.)
Although many mainstream media
stories (and some sports governing bodies) claim that dietary supplements are
not regulated and thus athletes have no protection against adulterated sports
supplements, in fact, FDA can provide some degree of enforcement through market
surveillance, inspections of facilities’ Good Manufacturing Practices (GMPs),
and more.
“We’re really looking to use
whatever tools we have at our disposal to take action on manufacturers who are
really marketing drugs as dietary supplements,” said Dr. Fabricant.
In August of 2012, for example, the
largest online retailer of bodybuilding supplements — Bodybuilding.com — was
ordered to pay $8.1 million for selling steroid products labeled as dietary
supplements, which FDA uncovered at a GMP inspection in 2008.18
“The inspections revealed some of
the challenges the firm had, let’s just say,” said Dr. Fabricant. “We get a lot
of information on just visiting a firm. It’s part of our authority, you know,
getting eyes into the firm and seeing what’s going on.”
Still, FDA has experienced a high
rate of non-compliance with GMP inspections, according to Dr. Fabricant.
Furthermore, inspections do not prevent tainted products from entering the
marketplace, nor do they offer total protection against the few banned
substances that are legal for normal consumers not involved in professional
sports.
“It seems the FDA has greatly
increased the number of GMP inspections,” said USADA’s Dr. Eichner, “which is
great, but the fact that so many companies — roughly half* — have
failed such inspections speaks to poor quality-control across the industry.
Hopefully improved compliance with GMP regulations will help, but GMP
regulations don’t require companies to test for contamination by substances
prohibited in sport, and companies could be compliant with GMP but still
produce a supplement that contains a prohibited substance (such as [the
hormone] DHEA).” (*Editor’s
Note: FDA spokesperson Sebastian Cianci confirmed this figure, noting that more
than half of the firms inspected by FDA
for GMPs thus far during 2012 had problems needing correction [email, September
21, 2012]. GMP non-compliance can be
due to a variety of reasons and is not necessarily indicative of manufacturers
spiking supplements with banned substances or illegal drugs.)
“If someone has spec sheets around
that indicate that something that shouldn’t be there was added to the product,
of course that would obviously get uncovered in an inspection,” said Dr.
Fabricant. “If it’s something that is completely criminal and has been hidden
all the way, then that’s a different scenario. I think the issues are, ‘Does
the FDA regulate dietary supplements?’ Yes. We have different tools to do that
with. But the bottom line is that manufacturers and distributors are ultimately
responsible for insuring their products are safe and in compliance with all
applicable laws and regulations.”
Most anti-doping and sports
organizations’ solution is to strongly caution athletes against using all
dietary supplements. It seems entirely unavoidable, however, that all athletes
will abstain. Some researchers have estimated that anywhere from 65 to 99% of
elite athletes use dietary supplements,19 a figure likely impacted
by the intense pressure they experience to maintain certain body weights and
extreme physical abilities. If an athlete chooses to take a dietary supplement
or an herbal product, various measures and certification programs can enable
him or her to be more confident that it does not contain a prohibited
substance.
“We encourage [athletes] to be fully
informed and educated about the risks, and to weigh the risks and the benefits
carefully as they make their own decision,” said Dr. Eichner. “While there may
be high-quality herbal products on the market, to an athlete it is difficult to
distinguish between legitimate herbal products and those that are adulterated
or spiked with prohibited substances.”
USADA advises athletes to choose
single-ingredient or few-ingredient herbal and dietary supplement products.
“Dietary supplements that contain fewer ingredients require fewer manufacturing
steps (on average) than products containing dozens (or many dozens) of
ingredients,” said Dr. Eichner. “The more ingredients there are, the more
opportunities for error in manufacturing and identification, and the greater
chance for ingredient interactions with other supplements or drugs.
“They should also do enough of their
own research on the company that they feel comfortable in using their
products,” she continued. “This research would include visiting
Supplement411.org, the FDA website, the [Federal Trade Commission] website, the
Better Business Bureau, and also the companies’ own websites. Athletes who want
health benefits from a particular plant should generally be aware of
adulteration issues globally and query herbal companies about how they avoid
purchasing adulterated raw materials.”
While certified laboratories and
anti-doping organizations test athletes’ urine and blood samples for prohibited
substances, neither WADA nor anti-doping agencies test dietary supplements for
ingredient purity or approve labs to conduct such testing. A few independent
companies and organizations do provide these services. The Banned Substances
Control Group’s BSCG Certified Drug Free™ program certifies that products
contain no banned substances.20 BSCG — run by Dr. Catlin as chief
science officer and his son Oliver Catlin as president — was one of the first
to start certifying dietary supplements, almost 8 years ago, and currently
certifies products for more than 30 dietary supplement manufacturers. Dr.
Catlin also serves as CEO of the nonprofit Anti-Doping Research.
“At the beginning, we stated we
could test for all the substances on the WADA list as we could in urine,” said
Oliver Catlin (email, September 26, 2012). “As we gained more experience, we
realized the difficulty that dietary supplements present through their
variability, making testing them particularly demanding. While urine samples
present a fairly standard matrix and are relatively easy to analyze, dietary
supplement matrices can present much greater challenges. To ensure that we can
detect everything in our menu in every product, we conduct a unique step called
product validation. During validation we
actually spike all the compounds we test for into a representative sample of a
product and run it through our tests to demonstrate that we can detect the
substances if they were to be present and to establish the detection levels for
that unique matrix.”
“The process begins with initial
ingredient review [of the product’s stated ingredients] to ensure that nothing
listed is banned or could lead to a positive drug test if used as directed.
Once accepted to the program,” continued Catlin, “BSCG tests all finished
batches of a product in order for a product to be certified. In so doing, we
are auditing not only the raw materials that went into the product but also the
manufacturing process, the 2 areas where accidental or purposeful contamination
can be introduced.”
SPORT SAFE Testing Service provides
testing and education for student athletes.21 NSF also has a sports
supplements testing program, which is currently supported by several
professional US sports organizations, including Major League Baseball, the
National Football League, the Professional Golfers’ Association, the Ladies
Professional Golf Association, and the National Hockey League.22
“Each supplement we test, we screen
for over 170 of the listed WADA-banned substances,” said Wyszumiala. “For
companies looking to certify selective batches, the costs can be a few thousand
dollars a year if their manufacturer is already GMP-certified by NSF. For
larger programs that certify all lots of their products, the costs can go into
the tens of thousands of dollars for a product line.”
Currently, NSF’s Certified for Sport®
program has certified products from about 44 manufacturers.23 In
order to have products certified, manufacturers must submit their products to a
strict testing and review process, which includes analysis of the product’s
formulation, labeling, ingredient suppliers, and toxicology, as well as
inspections of the manufacturing facilities to ensure that “that no banned
substances are stored or manufactured at the facility.”22 Inspectors
also conduct a variety of tests and analyses each year to assess the product
for any heavy metals, pesticides/herbicides, disintegration, or banned
substances, and to ensure that the label accurately lists what the product
contains. If a manufacturer’s product satisfies all components of the process,
it can feature the NSF label and be listed on NSF’s website as a Certified for
Sport company. In addition, Wyszumiala suggests that companies conduct tests on
random batches and/or raw ingredients.
Dr. Dentali, of the trade group
AHPA, noted the website KeepSupplementsClean.org,24 a resource AHPA
created in order to help educate industry and consumers on supplement issues,
including international enforcement efforts.
In addition to efforts from within
the industry, US legislators are seeking to eradicate products containing
banned substances that pose as dietary supplements. On July 25, 2012, US
Senators Orrin Hatch (R-Utah) and Sheldon Whitehouse (D-RI) proposed the
Designer Anabolic Steroid Control Act of 2012.25 If passed through
Congress and signed by the President, this bill — which does not apply to
botanicals or their derivatives — would amend the Controlled Substances Act so
that the Drug Enforcement Administration has more authority to regulate
anabolic steroids and products containing these substances that are illegally
being marketed and misbranded as dietary supplements.
“The bill corrects the terrible
design and drafting of previous anti-steroid legislation from 1990 and 2004,”
said Rick Collins, a New York lawyer whose firm represents numerous sports
nutrition and dietary supplement companies (email, September 22, 2012).
But Collins noted that the
designer-steroids problem is partly attributable to the original law itself,
which he said enumerates only specific steroid compounds and thus inadvertently
fostered creative efforts to bypass the Controlled Substances Act through
marketing a plethora of unlisted, synthetically designed steroids.
“The new bill, if passed, is
structured to accomplish what Congress likely intended in its prior botched
efforts: to criminalize a long list of specific compounds as well as unlisted
steroidal substances that are similar
to them,” said Collins.
The Illegal and Legal Uses of
Botanicals in Sports
Although the term doping carries a negative connotation,
it does not always indicate that a substance is harmful. According to WADA,
which publishes an annual document listing the substances banned in sports
competitions worldwide, a substance will be prohibited if it meets at least 2
of the following criteria: “1) It has the potential to enhance or enhances
sport performance, 2) It represents an actual or potential health risk to the
athlete, or 3) It violates the spirit of sport.”26
Of the approximately 200 substances
and methods on WADA’s 2012 Prohibited List, only one whole botanical is
prohibited: cannabis (Cannabis spp.,
Cannabaceae). WADA additionally prohibits the use of several botanical
derivatives and their synthetic counterparts, including the stimulants
ephedrine, methylephedrine, and pseudoephedrine, all of which come from ephedra
(Ephedra spp., Ephedraceae); the
stimulant cocaine, which comes from coca (Erythroxylum
coca, Erythroxylaceae); the stimulant cathine, which comes from the African
medicinal plant khat (Catha edulis,
Celastraceae); and morphine and diamorphine (heroin), which are derived from
the opium poppy (Papaver somniferum,
Papaveraceae) and considered by WADA to be narcotics. (All of the above are
illegal in dietary supplements in the United States).
Instances in which botanicals are
implicated in doping sometimes make headlines. Most recently, on August 6,
2012, an American judo fighter was sent home from the 2012 London Olympics
after testing positive for cannabis, which he claimed was due to eating a
cannabis brownie.27 Although it seems rather surprising that an
athlete would consume the widely illegal substance, the Anti-Doping Database
reveals that cannabis has been implicated in about 38 failed doping tests since
1997,28 likely due to its recreational popularity. Several cases
document South American soccer players testing positive for cocaine and
morphine and attributing it to drinking traditional Bolivian coca leaf tea and
eating poppy seed bread, respectively.29 Again in 2011 — even after
poppy seeds’ effects were made famous by an episode of the television comedy Seinfeld in which the sitcom’s character
Elaine fails a drug test after eating poppy seed muffins — a New Zealand
triathlete tested positive for morphine and argued that he had consumed poppy
seed bread.30 Studies have confirmed that consuming the parent plant
or parts of the parent plant can yield traces of these isolated substances, and
sometimes officials sympathize with the athletes’ claims by reducing penalties
or completely exonerating them.29,30 Still, these cases are seldom.
“Adequate information does not exist
to support the view that sports doping with botanical materials is an issue,”
said AHPA’s Dr. Dentali. “Ephedrine-containing products are not allowed in
foods, including dietary supplements in the United States. Most everyone is
aware that poppy seeds may trigger a positive drug test, and generally speaking
athletes are smart enough to know that drinking coca leaf tea might produce the
same result” (e-mail, July 30, 2012). (A peer reviewer of this article noted
that in Canada, low-dose ephedrine hydrochloride [8 mg] as well as the herb
ephedra are widely available for purchase as licensed natural health products
[NHPs]. NHPs, which include vitamins, minerals, herbs, homeopathic
preparations, and more, are regulated as a special class of drugs in Canada,
not as the United States regulates dietary supplements, which are considered
foods.)
Coca, ephedra, and khat are the only
traditionally used herbs whose derivatives are explicitly prohibited in sports,
and the testing of additional herbs or other medicinally active plants for
performance-enhancing properties is not common nor easy due to their complex
chemistry and pharmacology.31 Because different countries have a
more accurate and detailed knowledge of culturally used herbs and substances,
each can issue warnings for any botanical products suspected of affecting
doping test results.
“There are many specialized, local
botanical products used traditionally around the world, and monitoring them and
their use is something left up to the local regulatory body,” said NSF’s
Wyszumiala (email, July 20, 2012).
During the 2008 Beijing Olympics,
for example, the Chinese Olympic Committee decided to forgo the use of
traditional Chinese medicine (TCM) to treat athletes in order to avoid
potential doping problems, and also banned products containing the herb Chinese
angelica, or dong quai (Angelica sinensis, Apiaceae) for the
same reasons.31
WADA previously prohibited the
botanical stimulant caffeine,32 which is found in many common food
plants including coffee (Coffea arabica,
Rubiaceae), chocolate (Theobroma cacao,
Sterculiaceae), and tea (Camellia
sinensis, Theaceae), as well as the popular Argentinian herbal beverage
yerba maté (Ilex paraguariensis,
Aquifoliaceae), among others. During this ban, athletes could not have 12 mg or
more of caffeine per liter of urine. This would be caused by drinking at least
5 cups of coffee, at least 6 cups of tea, or eating 2-3 chocolate bars shortly
preceding the collection of urine samples.29 In 2004, WADA lifted
its ban on caffeine, stating that it is “ubiquitous in beverages and food” and
“metabolized at very different rates in individuals.”32 Caffeine
remains on the organization’s monitoring list, and some WADA officials continue
to express concerns for the stimulant, especially when formulated in
high-dosage pills.33
“Herbal or plant-derived stimulants
can be a very interesting dilemma,” said Oliver Catlin. “Some things like
ephedrine are clearly banned, while other plant-derived stimulants like
theobromine, which is in chocolate, are not considered banned. For an athlete,
the pathway of determining what is or is not legal is challenging especially
when the language in the stimulant section of the WADA Prohibited List
includes, ‘and other substances with a similar chemical structure or similar
biological effect(s).’ Determining what does or doesn’t qualify under this
clause can be a difficult job, and a moving target.”
Even in regards to dietary and
herbal supplements that are legal for use in sports, such as caffeine, many
critics claim that athletes can receive all their nutritional and performance
needs from diet and that there is no evidence these products actually work. In
September 2012, for example, the Chief Medical Officer of Fédération
Internationale de Football Association (FIFA) told the media that soccer
players’ widespread usage of dietary supplements was “alarming” because it is
“definitely not based upon the scientific evidence or literature.”34
He continued, “Scientists and nutritional specialists agree that a
well-balanced diet will supply the body with the appropriate amount of
nutrients it needs for top performance.”
WADA and IAAF take similar
positions.
“Athletes do not necessarily need
supplements,” said Dr. Dollé of IAAF . “As a question of principle, we never
engaged in recommending or advising supplements. Firstly, because it would not
be consistent with our consensus statement, secondly, because we do not have
the resources to test the supplements.”
Some criticize anti-doping
organizations for their one-way, hard-line stance against supplements.
“That mentality is certainly
understandable as they don’t want athletes to get caught up with inadvertent
positive tests,” said Catlin, “but is not in line with the reality that we face
today, namely that athletes do take and will continue to take dietary
supplements. The reality is that many supplements are indeed fine to take,
while others can lead to positive drug tests and health complications. I really
do appreciate [anti-doping organizations’] position and of course worked with
them myself for many years. I just wish they could take a broader look at the
supplement issue and accept the realities that athletes use them. I believe
that if they did accept supplements and could help athletes find natural and
safe alternatives to drugs that it would create trust and could help the
anti-doping cause.”
It is also important to assess the
accuracy of anti-doping groups’ claims of supplement inefficacy. A review of
the evidence suggests some botanical supplements can produce performance-enhancing effects. According to a 2012
article, “Herbs in Exercise and Sports,” published in the Journal of Physiological Anthropology, caffeine is documented as
improving athletic performance in swimmers, endurance runners, and cyclists, as
well as improving mental alertness.35 The International Society of
Sports Nutrition’s (ISSN) 2010 recommendations for athletic supplements list
caffeine as being “apparently effective,” which the authors define as,
“supplements that help people meet general caloric needs and/or the majority of
research studies in relevant populations show is effective and safe.”36
The authors continued, “Suggestions that there is no ergogenic value to
caffeine supplementation [are] not supported by the preponderance of available
scientific studies.”
ISSN recommended green tea extract
as “possibly effective” (defined as “supplements with initial studies
supporting the theoretical rationale but requiring more research to determine
how the supplement may affect training and/or performance”) for its ability to
increase energy expenditure in humans and possible use for weight loss.36
Ginseng, one of the most commonly
marketed herbs for athletes, also has been referred to as the most studied herb
for performance enhancement. Research has shown various species of ginseng,
particularly Asian ginseng (P. ginseng),
to increase exercise endurance, lower blood pressure, support oxygen
consumption, abbreviate post-exercise recovery, enhance chest and leg strength,
and reduce stress responses through its adaptogenic properties.35,37
Other studies, however, have found no significant effects on physical
performance.38 (One review article suggested that many of the
ginseng trials used a relatively low dosage level, i.e., usually those equivalent to about 8 mg total ginsenosides per
day, compared to higher dosage levels used in traditional Chinese medicine.39)
The Australian Institute of Sport
(AIS) lists beet (Beta vulgaris,
Chenopodiaceae) root juice as a Class B supplement (“Considered for provision
to AIS athletes under a research protocol”) presumably due to its nitrate
contents and several studies showing that consuming beetroot juice prior to
exercise can enhance performance.40 Furthermore, a 2010
double-blind, controlled clinical trial, published in the Journal of the International Society of Sports Nutrition, found
that male weightlifters taking a fenugreek extract (Trigonella foenum-graecum,
Fabaceae; Torabolic™, Indus Biotech) experienced significantly increased
“upper- and lower-body strength and body composition in comparison to placebo”
and had no side effects.41 Another study on TestoSurge®, a fenugreek
extract, found that it increased testosterone levels and the bioavailability of
testosterone when compared to placebo.42
According to 2 studies, ginger (Zingiber officinale, Zingiberaceae) root
extract has been shown to improve pain and joint stiffness in osteoarthritic
individuals after standing and walking.5 A study on rhodioloa (Rhodiola rosea, Crassulaceae) root
extract, which is marketed for athletic-enhancing functions in the United
States, reported that an acute dosage (200 mg) significantly increased
endurance and somewhat increased oxygen intake in participants completing 17
minutes of cycling,5 although this effect was no different than
placebo after 4 weeks of taking the supplement.43 A small study
examining the use of an extract made from the traditional Chinese herb
astragalus (Astragalus membranaceus, Fabaceae) determined that
it improved athletic endurance, though the study was criticized for its lack of
standardization.5 A 1997 study on cayenne pepper (Capsicum spp., Solanaceae) taken by male
long-distance runners found it increased “respiratory exchange ratio and blood
lactate concentration both at rest and during exercise,” but that it had “no
effect on oxygen consumption or energy expenditure.”38
Several additional herbs exhibit the
ability to decrease pain, inflammation, and other conditions that can
negatively affect athletic performance, but have not been studied specifically
in athletic situations.5 Additional research has found no effect in
athletic performance for some herbs, including cordyceps (Cordyceps sinensis and C. spp., Clavicipitaceae), yohimbe (Pausinystalia johimbe, Rubiaceae),
puncture vine (Tribulus spp.,
Zygophyllaceae), and Eurycoma longifolia
(Simaroubaceae) root, possibly due to short supplementation period and/or low
concentration of E. longifolia.5,35,37
More studies are warranted to support the initial investigations into
botanicals’ effects on sports and athletic performance.
According to Almada, most clinical
trials performed on botanicals and other dietary supplements for sports
performance “lack a key investigative, due diligence step” — testing the
study’s products for banned substances.
“Is it not sufficiently inspiring to
the crafty, unscrupulous marketer to have a ‘special batch’ made just for a
study, adulterated with a ‘special ingredient’ since the university research
lab invariably does not have the capability, nor intent, to analyze what is
being studied for banned substances? Testing study products for banned
substances, by an expert independent lab, should be standard protocol before
undertaking the study.”
Conclusion
The relationship between
professional athletes and dietary and herbal supplements is nothing less than
complex. Despite the oft-negative representation and reputation of dietary
supplements in and among mainstream media outlets as well as major sporting and
anti-doping organizations, little hard evidence proves that herbal dietary
supplements pose a risk in this context. Some evidence even suggests that various botanicals can have safe, beneficial effects on athletic performance.
Still, evidence fails to exonerate all cases of potentially intentional
adulteration by dietary supplement manufacturers. In order to progress toward
resolving these issues, responsible parts of the dietary supplements industry,
analysis labs, sports and anti-doping organizations, and the media must
collaborate to support athletes through education, vigilance, and
open-mindedness toward the reality of the situation.
*See feature article “New Research Supports Synthetic Origin of DMAA in Supplements” in HerbalGram 95 for more details on this topic.
References
-
Phelps sets record for Olympic medals. New York Daily News. July 31, 2012. Available at: http://articles.nydailynews.com/2012-07-31/news/32966485_1_michael-phelps-yannick-agnel-ricky-berens. Accessed
September 14, 2012.
- Tymn M. Mile
trivia. Running Times Magazine. May
2004. Available at: http://runningtimes.com/Article.aspx?ArticleID=6385&PageNum=&CategoryID=. Accessed
September 14, 2012.
- Ross S. Douglas
wins gold in gymnastics individual all-around. NBC News. August 2, 2012.
Available at: www.nbcchicago.com/news/sports/Gabrielle-Douglas-and-Aly-Raisman-164740506.html. Accessed
September 14, 2012.
- Rise in
supplement use by US adults. Natural
Products Insider. April 13, 2011. Available at: www.naturalproductsinsider.com/articles/2011/04/rise-in-supplement-use-by-us-adults.aspx. Accessed
September 14, 2012.
5. Kundrat S. Herbs
and athletes. Gatorade Sports Science Institute. Sports Science Exchange 96. 2005;18(1). Available at: www.gssiweb.com/Article_Detail.aspx?articleid=704. Accessed
September 14, 2012.
6. Aschwanden C.
Athletes, stop taking supplements. Slate
magazine. July 26, 2012. Available at:
www.slate.com/articles/health_and_science/medical_examiner/2012/07/dietary_supplements_at_the_olympics_why_athletes_risk_false_drug_charges_.html. Accessed
September 14, 2012.
7. Linford
Christie. United Kingdom Athletics website. Available at: www.uka.org.uk/e-inspire/hall-of-fame-athletes/linford-christie/. Accessed
August 22, 2012.
8. About WADA.
World Anti-Doping Agency website. Available at: www.wada-ama.org/en/About-WADA/. Accessed June
25, 2012.
9. World
Anti-Doping Code. World Anti-Doping Agency. 2009. Available at: www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-The-Code/WADA_Anti-Doping_CODE_2009_EN.pdf. Accessed
September 14, 2012.
10. Questions & answers on strict liability in anti-doping.
World Anti-Doping Agency website. Available at: www.wada-ama.org/en/Resources/Q-and-A/Strict-Liability-in-Anti-Doping/. Accessed July
26, 2012.
11. World Anti-Doping Agency (WADA) v. Jessica Hardy
& United States Anti-Doping Agency (USADA). CAS 2009/A/1870. Arbitral Award
delivered by the Court Of Arbitration For Sport.
12. Jessica Hardy events and results. London 2012 Olympic
and Paralympic Games website. Available at: www.london2012.com/athlete/hardy-jessica-1134700/events/. Accessed
September 14, 2012.
13. Abrahamson A. Jessica Hardy, AdvoCare file suit
against each other. Swimming World
Magazine. January 30, 2009. Available at: www.swimmingworldmagazine.com/lane9/news/20137.asp. Accessed
September 14, 2012.
14. Burke L. Positive drug tests from supplements. SportsScience. 2000;4(3). Available at: http://www.sportsci.org/jour/0003/lmb.html. Accessed
September 14, 2012.
15. Smith T. New research suggests synthetic origin of
DMAA in supplements. HerbalGram.
2012; (95):46-49. Available at: http://cms.herbalgram.org/herbalgram/issue95/hg95-feat-dmaa.html.
16. Starling S. London Olympics 2012: DMAA responsible for
1 of 8 doping busts. NutraIngredients. August 14, 2012. Available at: www.nutraingredients.com/Regulation/London-Olympics-2012-DMAA-responsible-for-1-of-8-doping-violations. Accessed
September 14, 2012.
17. Advanced search: methylhexaneamine. Anti-Doping
Database website. Available at: www.dopinglist.com. Accessed
August 17, 2012.
18. Bodybuilding.com execs fined for selling steroids. Natural Products Insider. August 2,
2012. Available at: www.naturalproductsinsider.com/news/2012/08/bodybuilding-com-execs-fined-for-selling-steroids.aspx. Accessed
September 14, 2012.
19. Kim J, Chun Y-S, Kang S-K, Cho H-C. The use of
herbal/traditional products supplementation and doping tests in elite athletes.
Int J Appl Sports Sci. 2010;22(2):137-149.
20. Banned Substances Control Group website. Available
at: www.bscg.org. Accessed
September 14, 2012.
21. SPORT SAFE Testing Service website. Available at: www.sportsafe.com. Accessed
September 14, 2012.
22. How to get certified. NSF Certified for Sport
website. Available at: www.nsfsport.com/how_certified.asp. Accessed July 25, 2012.
23. Certified for Sport companies. NSF International
website. Available at:
www.nsf.org/Certified/consumer/listings_results.asp?KeyWords=&ProgramCode=BANNEDSUB&CompanyName=&ProductName=&SearchType=QUICK&prog_add=N&ShowCompany=N&p_special=ABS&p_abs=Y
. Accessed July 25, 2012.
24. KeepSupplementsClean website. Available at www.keepsupplementsclean.org. Accessed September 14, 2012.
25. Sens. Hatch and Whitehouse introduce Anabolic
Steroids Control Act; AHPA endorses legislation [press release]. Silver Spring,
MD: American Herbal Products Association. July 25, 2012. Available at: www.ahpa.org/Default.aspx?tabid=69&aId=803.
26. The 2012 Prohibited List International Standard. The
World Anti-Doping Code, World Anti-Doping Agency. August 24, 2011. Available
at: www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/2012/WADA_Prohibited_List_2012_EN.pdf. Accessed
October 3, 2012.
27. U.S. judoka expelled for marijuana. Reuters. August
6, 2012. Available at: http://www.nbcolympics.com/news-blogs/judo/u-s-judoka-expelled-for-marijuana.html. Accessed
September 14, 2012.
28. Advanced search: cannabis and marijuana. Anti-Doping
Database website. Available at: www.dopinglist.com. Accessed
August 17, 2012.
29. Yonamine M, Garcia PR, de Moraes Moreau RL.
Non-Intentional Doping in Sports. Sports
Med. 2004;34(11):697-704.
30. Graham O’Grady blames poppy seeds for doping glitch.
Triathlete.com. March 24, 2011. Available at: http://triathlon.competitor.com/2011/03/news/graham-ogrady-blames-poppy-seeds-for-doping-glitch_24598. Accessed July
26, 2012.
31. Stafford L. Concerns over use of African herbs during
the 2010 World Cup. HerbalGram.
2010;(86):24-25. Available at: http://cms.herbalgram.org/herbalgram/issue86/article3520.html.
32. What is the status of caffeine? Questions and answers
on 2012 Prohibited List. World Anti-Doping Agency website. Available at: www.wada-ama.org/en/Resources/Q-and-A/2012-Prohibited-List/. Accessed July
25, 2012.
33. Habashy A. AOC warns of caffeine use amid Stilnox
ban. Yahoo!7 Sport. July 3, 2012. Available at: http://au.sports.yahoo.com/news/aoc-warns-caffeine-amid-stilnox-070548712.html. Accessed
October 3, 2012.
34. Nieburg O. FIFA chief medical officer attacks food
supplements. NutraIngredients. September 6, 2012. Available at: www.nutraingredients.com/Regulation/FIFA-chief-medical-officer-attacks-food-supplements. Accessed
September 14, 2012.
35. Chen CK, Muhamad AS, Ooi FK. Herbs in exercise and
sports. J Physio Anthropol. 2012;31(1):4.
Available at: www.jphysiolanthropol.com/content/31/1/4. Accessed
October 3, 2012.
36. Kreider R, Wilborn D, Taylor L, et al. ISSN exercise & sport nutrition review: research &
recommendations. J Int Soc Sports Nutr.
2010;7(7). Available at: www.jissn.com/content/7/1/7. Accessed
October 3, 2012.
37. Bucci L. Selected herbals and human exercise
performance. Am J Clin Nutr. 2000;72(suppl):624S–36S.
38. Williams M. Dietary supplements and sports
performance: herbals. J Int Soc Sports
Nutr. 2006; 3(1):1-6.
39. Dharmananda S. The nature of ginseng: traditional
use, modern research, and the question of dosage. HerbalGram. 2002;(54):34-51.
40. Beetroot juice/nitrate website fact sheet. Australian
Institute of Sport. Australian Sports Commission. Available at: www.ausport.gov.au/__data/assets/pdf_file/0009/466029/Beetroot_juice_Nitrate_11-_website_fact_sheet.pdf. Accessed
September 14, 2012.
41. Poole C, Bushey B, Foster C, et al. The effects of a commercially available botanical supplement
on strength, body composition, power output, and hormonal profiles in
resistance-trained males. J Int Soc
Sports Nutr. 2010;7(34).
42. Wilborn C, Taylor L, Poole C, et al. Effects of a
purported aromatase and 5 x-reductase inhibitor on hormone profiles in
college-age men. Int J Sport Nutr Exerc Metab. 2010;20(6):457-465.
43. De Bock K, Eijnde BO, Ramaekers M, Hespel P. Acute Rhodiola rosea intake can improve
endurance exercise performance. Int J
Sport Nutr Exerc Metab. 2004 Jun;14(3):298-307.
HISTORY OF HERBS IN SPORTS
Public disapproval
of doping increases with each news report of an athlete’s failed drug test. The
stance of official organizations reflects this, as WADA vowed to collect 5,000
samples in order to make the London Games the most tested and allegedly
“cleanest” Olympics ever.1 Still, doping scandals continue and some
might find themselves reminiscing about a time when all athletes performed
their sports wholesomely and without any outside aid.
What many
spectators do not realize, however, is that the practice of ingesting
substances — often botanicals — with the hopes of enhancing sports performance
has existed to some extent for thousands of years.2 In fact,
athletes were never tested for performance-enhancing substances and illegal
drugs until the 1960s, when the death of a Danish cyclist, who passed out while
riding and had a severe crash, was attributed to an amphetamine overdose.2,3
The Ancient
Greeks are reported to have ingested herbs and fungi for performance
enhancement, as well as to have used honey to boost energy and carbohydrate
levels.2 Physicians gave Olympic athletes bread prepared with spices
and juices extracted from the poppy, and Roman gladiators allegedly ingested
caffeine and the bitter alkaloid strychnine from the nux-vomica tree (Strychnos nux-vomica, Loganiaceae). The
Roman naturalist Pliny the Younger (61 – 12 CE) recorded that runners would
attempt to increase their muscle mass and strength by consuming a plant called
mare’s tail (Hippuris vulgaris,
Hippuridaceae).
According to
John Riddle, PhD, a history and botany professor at North Carolina State University and an expert on the use of botanicals during ancient times through
Classical Antiquity, the 1st century Greek physician Galen, who attended to Roman emperor Marcus Aurelius, got his start as a doctor for gladiators (email, July 18, 2012). Dr. Riddle’s 1997 book, Eve’s Herbs: A History of Contraception and Abortion in the West, reports that Galen wrote of “an athletic trainer [who] required his men to
sleep on a botanical bed of chaste tree [Vitex agnus-castus, Lamiaceae],”4 which was a reputed male
contraceptive and erectile function preventative, in order to preserve their energy.*
Centuries
later, in the late 1800s, an American long-distance walking athlete reportedly
chewed coca leaves during a trek of approximately 110 miles completed within 24
hours.5 Additional performance-enhancing substances during this
period typically consisted of “sugar cubes dipped in ether, mixtures of brandy
and cocaine, caffeine, cordials containing alcohol, and even nitroglycerine and
strychnine.”6
During the
1950s, the Union of Soviet Socialist Republics (USSR) began to study
adaptogenic substances, including many herbs, with the goal of enhancing
performance and work output of athletes, soldiers, and government workers.7
According to the book Adaptogens: Herbs for Strength, Stamina, and Stress Relief (Healing Arts Press, 2007) by
David Winston and Steven Maimes, “The Soviets’ pursuit of superior military strength, performance in the Olympic Games, political power, and the excellence
of the well known Bolshoi Ballet mattered so much to them that whatever they
could do to accomplish the goal of dominance was pursued.” Of the approximately
4,000 plants investigated, 12 herbs were considered adaptogens, including Siberian
ginseng (now sold in the United States as “eleuthero”; Eleutherococcus senticosus, Araliaceae), rhodiola, and schisandra (Schisandra spp., Schisandraceae).
Government scientists studied these herbs in Olympic athletes, miners, truck
drivers, factory workers, and more, with results indicating improved physical
performance and lower rates of sickness and fatigue, although the results
published in Russian-language journals are difficult to access. One of the lead
researchers of the Soviet adaptogens project, Israel I. Brekhman, created a
multi-herb adaptogen product (sometimes marketed in the United States as “Prime
One®”), which was reportedly used by more than 100 American athletes
at the 1996 Atlanta Olympic Games.
References
1. Wilson S. 9 athletes
suspended for doping in lead-up, 2 new procedures at ‘most tested’ Olympics
ever. The Washington Post. July 25,
2012. Available at: www.washingtonpost.com/sports/9-athletes-suspended-for-doping-in-lead-up-2-new-procedures-at-most-tested-olympics-ever/2012/07/25/gJQAnMwW9W_story.html.
2. Papagelopoulos PJ, Mavrogenis AF, Soucacos PN. Doping in Ancient and
Modern Olympic Games. Orthopedics.
2004;27(12). Available at: www.healio.com/orthopedics/journals/ORTHO/%7B938E8E86-5151-451A-BD36-CAB0E26D9746%7D/Doping-in-Ancient-and-Modern-Olympic-Games. Accessed July
25, 2012.
3. Aschwanden C. The top athletes looking for an edge and the scientists
trying to stop them. Smithsonian
magazine. July-August 2012. Available at: www.smithsonianmag.com/science-nature/The-Top-Athletes-Looking-for-an-Edge-and-the-Scientists-Trying-to-Stop-Them-160284335. html. Accessed July 26, 2012.
4. Riddle J. Eve’s Herbs: A
History of Contraception and Abortion in the West. Cambridge,
Massachusetts: Harvard University Press. 1997.
5. Heggie V. Sports doping, Victorian style. The Guardian. June 19, 2012. Available at: www.guardian.co.uk/science/blog/2012/jun/19/sports-doping-victorian-style. Accessed July
26, 2012.
6. Ravilious K. Barry Bonds steroid debate highlights history of drugs
in sports. National Geographic News. June 22, 2007. Available at: http://news.nationalgeographic.com/news/2007/06/070622-barry-bonds.html. Accessed July
25, 2012.
7. Winston D, Maimes S. Adaptogens: Herbs for Strength, Stamina, and Stress Relief.
Rochester, Vermont : Healing Arts Press. 2007.
|