FIGHT DOCTOR The Risks of Dietary Supplements –
drugs. A 2022 paper published by the Journal of the American Medical Association reported that beginning in 2015, the Federal Drug Administration (FDA) sent 31 warning letters to weight- loss product manufacturers. Only one product was recalled, and nine could still be bought online years after the FDA issued the warning. Another study published by the California Department of Public Health in 2018 looked at supplements from 2007-2016 and found unapproved pharmaceutical ingredients in 776 products marketed for sexual enhancement, weight loss or muscle building. Some contained sibutramine, a dangerous stimulant that was removed from the U.S. market and many countries in 2010 due to the risk of heart disease. Several prohibited diuretics were also found, and some products even contained antidepressants. Antidepressants themselves are a valuable treatment, and many fighters take them. Although antidepressants are not banned, they could still have serious side effects in the wrong athlete, including gastrointestinal upset, sleep disorders, heart disease, weight gain, low sex drive, erectile dysfunction and mental health issues. The right dose and correct drug requires strict physician supervision. So, adding an extra antidepressant as a contaminant can seriously interfere with someone’s current prescription medication. BOTTOM LINE: Fighters need to investigate everything they take. They could be consuming something that not only might cause a positive drug test, implode their reputation or cause a lengthy suspension, but could also endanger their health. For example, there has been significant discussion recently about SARMs (selective androgen receptor modulators), which can trigger an increase in muscle mass. A prime example is ostarine – also known as enobosarm. Many athletes have been caught with SARMs in their supplements. Some may purposely take supplements containing SARMs believing they’re the magic bullet for improving
muscle growth without lifting weights. Although one can easily purchase them on the internet, SARMs remain under investigation by the FDA, so their safety profile and long-term side effects are unknown. It is illegal for companies to market them as “dietary supplements,” but manufacturers get around this by using the following language on the label: “For research purposes only” or “Not for human consumption.” This lack of regulation means the SARM amount could be very low or very high. As of 2023, the FDA has warned that SARMs could increase the risk of a heart attack, stroke, psychosis, hallucinations, liver disease/ failure, testicular shrinkage, infertility or miscarriage. “Research chemicals are also becoming a huge issue for athletes,” notes Catlin. “Many are investigational drugs or experimental substances sold online as research chemicals to get around dietary supplement laws and regulations. In fact, they often contain dangerous or banned substances.” How can you determine what’s in your supplements? Reading the label is a nightmare, as substances frequently have multiple names. That is certainly true of stimulants. So if you are looking for a specific prohibited substance, you might think you’re in the clear when actually you’re not. Plus, who has the time to go through everything on a label? Catlin describes a four-step plan that every boxer should follow before taking any dietary supplements: “One, look for a third-party seal on the product label. Two, even if the seal is there, look for the lot number on the product label – usually on the bottom. Three, pull up the product online and search their database for the lot number of your bottle to ensure your lot was certified. And four, purchase two bottles with the same lot number and keep one sealed.” In this way, should the boxer test positive, they would have a guarantee to prove that either the supplement was contaminated or that the label contained an unlisted prohibited substance. There has been the rare success story of an athlete litigating against a
supplement company for a prohibited substance not listed on the label, but sadly, the positive outcomes happen long after the athlete has been labeled a drug user. Former UFC, Bellator and now Global Fight League fighter Yoel Romero faced a possible two-year suspension in 2016 for ibutamoren, a prohibited substance that stimulates growth hormone secretion. When it was found that a supplement he’d taken – “Shred Rx” from Gold Star Performance Products – contained ibutamoren but didn’t mention it on the label, Romero was awarded $27.45 million (reduced to $12.45 million) and was given a reduced six-month suspension. That still took time and attorney fees. Possible reputational damages are being decided at another trial. It’s also unclear if he has received any funds. Some blame the increased sensitivity of anti-doping testing. Many commissions in the U.S. and internationally use World Anti-Doping Association (WADA) accredited laboratories. They test for everything on the banned list. Since the 1980s, WADA laboratories’ ability to pick up prohibited substances has improved or increased over 1,000-fold. This amplifies the risk that a fighter using contaminated or “spiked” dietary supplements will “pop” positive and be labled as a “doper” by a social media universe with little conscience. There are positive changes. Clenbuterol, a substance banned in the U.S. since 1991 and the European Union since 1996, is still used by many countries to result in leaner meat or a higher muscle-to-fat ratio in livestock. In humans, it has been abused due to its anabolic (muscle building) properties and can produce an increased heart rate, muscular tremors, headaches and nausea. In May 2019, WADA finally conceded that testing needed to distinguish between deliberate versus accidental consumption that was not performance- enhancing, if less than 5 nanograms/ml was found in a urine test. Also in 2019, the California State Athletic Commission, under the direction of Andy Foster, went even
further and modified their disciplinary guidelines for a handful of banned substances that they believed could appear from contamination, or adjusted the levels considered to be performance- enhancing. Hopefully other commissions will follow suit. VADA works with a service called Axis (axis.drugfreesport.com), which is free to all fighters, their representatives and trainers. It has considerable up- to-date lists of supplements that have ever contained banned substances and is a resource for diet and exercise as well. After establishing an account, the fighter or his or her team can email copies of labels and names to determine if a supplement company or product has ever been found to contain prohibited substances, whether listed on the label or not. Axis won’t ultimately confirm a supplement is safe, but they will advise the level of risk. An even better way for fighters to see if their supplements are free of banned substances is to see if they’re certified. There are several companies in the U.S. and abroad – including BSCG, Eurofins, Intertek, Informed Sport and NSF – that conduct product certification. Certification starts with an in-depth audit of the label along with the company’s claims and quality control. Every batch is tested for over 500 drugs that include substances banned in sports, over 200 prescription medications and over-the-counter or illicit drugs, with annual verification of label claims and contaminant testing. If the supplement isn’t listed as certified on a database, fighters or their representatives can mail sealed supplements to one of the testing companies to undergo testing. Yes, it’s costly, but when you compare the repercussions in testing positive, it’s a sound investment for many. Dr. Margaret Goodman is a former Nevada State Athletic Commission chief physician, co-hosts the Fighter Health and Safety Podcast and is president of the Voluntary Anti- Doping Association.
Are Fighters Flying Blind? By Dr. Margaret Goodman
A fighter subject to any anti- doping program is ultimately responsible for anything found in his or her system. The various dietary supplements commonly used for health benefits are a tricky part of the equation. Yes, supplements are the go-to excuse for many caught in the crosshairs of an adverse drug test – the same way a driver who runs a stop sign says it was blocked by a tree – but unfortunately, too few really understand the risks in using supplements and are often playing Russian roulette with their health, career and reputation. As head of an anti-doping testing program since 2011, I’ve seen how supplements are a minefield for every boxer. Fighters sometimes list more than 20 supplements on their Voluntary Anti-
Doping Association (VADA) enrollment forms, but rarely have they had any of their supplements tested. According to Oliver Catlin, president and co-founder of Banned Substance Control Group (BSCG), “Banned substances are everywhere. They appear in dietary supplements, contaminated meat, drugs in our water, through plants absorbing drugs through irrigation, certain plants synthesizing anabolic steroids, contaminated medications and compounding pharmacies. Banned substances can also be transmitted through kissing someone after they’ve used a drug, sexual contact with a drug user or sharing sports equipment like a knee brace or neoprene sleeve.” Supplements marketed for weight loss often contain hidden pharmaceutical
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