A few months ago many cyclists cared little about what the USADA or WADA acronyms meant, but the Lance Armstrong debacle has set the record straight on that. The United States Anti-Doping Agency and the World Anti-Doping Agency are the non-profit organizations setting and enforcing anti-doping rules. Both receive partial funding from their respective home governments and from various Olympic-related committees. This column will define doping, discuss WADA banned substances and methods, and help you to stay “clean” while working to optimize your performance.
By Harvey Shapiro, MD, John Howard, and Gina Poertner, CHES
Illegal performance enhancement techniques and substances have long been a part of sport. One of us (John Howard) will never forget the conversation with a European soigneur who inadvertently convinced him to turn down a ride with a top pro team following the 1976 Olympic Games. His words are as chilling now as they were then. “You Americans have it all wrong,” he said. “You use drugs for pleasure, we use them for business.”
Human nature pushes competitive athletes to their extreme limits. That translates into employing the best training techniques and strategies, which are the PEZ Toolbox’s bread and butter. This column will define doping, discuss WADA banned substances and methods, and help you to stay “clean” while working to optimize your performance. It is not a “Chicken Soup for Cheaters” guidebook.
WADA, based in Canada, is the overarching international watchdog, and in many countries beyond the US agencies similar to USADA exist. These organizations have long arms extending from professional sports down to amateur levels.
Long before the term doping was introduced endurance cyclists used substances mainly aimed at reducing their perception of pain and fatigue. Those pain-dulling substances included alcohol, ether inhalation, narcotics and cocaine, along with stimulants such as strychnine and amphetamines, popular in the 1950’s and 1960’s. William Fotheringham, in his excellent Tom Simpson biography, “Put Me Back on My bike,” goes into considerable detail about the saga of doping throughout the history of cycling.
The term “blood doping” initially described only the transfusion of red blood cells into athletes’ veins to gain an endurance edge. In the late 1980s a hormone erythropoietin (EPO), given by injection, to boost an anemic patient’s blood count invaded the sport of cycling. Today’s anti-doping tests detect EPO, body-building steroids and related drugs, stimulants, human growth hormone (HGH), narcotics, and others.
Historically the anti-doping effort began as an effort to protect cyclists. It now includes defending the integrity of the sport. With today’s multitude of non-red blood cell related performance enhancement drugs and methods the term “doping” may be overly restrictive, but it will likely prevail as the buzzword that encompasses all illegal performance enhancement techniques. Beyond drugs, the banned methods can also include any equipment or methods that give its user an unfair advantage.
WADA 2013 List of Prohibited Substances and Methods
This compilation can be found on the WADA website with downloads available for mobile devices. While avoiding specifics, we outline the list’s intent and content. If you consider yourself a competitive cyclist looking for every possible advantage, please understand that you are responsible for what goes into your body, so checking the list is your obligation. The WADA document is only nine big-print pages long and not hard to read. There is an excellent Q&A section detailing changes from the 2012 list involving blood doping, beta blockers, stimulants, methylhexaneamine (MHA), and clenbuterol.
Some substances and methods, while outlawed in competition, are permissible at other times. For those who might try their hand at medicinal manufacture, keep in mind that any pharmacological agent not addressed on the list and which is not approved by a governmental agency for therapeutic use is prohibited at all times.
Prohibited at All Times
• Substances: Anabolic substances, like body-building steroids, growth hormones and factors, beta-2 agonists such as anti-asthma bronchodilators with muscle building side-effects, e.g. Clenbuterol. Therapeutic use of these anti-asthma medicines requires a formal exemption request, meaning that they are allowed under medical supervision and within certain urine threshold levels. In the nineties the incidence of asthmatics applying for this exemption far exceeded the prevalence of asthma in the general population. Also included are hormone and metabolic modulators, diuretics and other masking agents.
• Methods: Manipulation of blood and blood components, tampering with integrity of samples, intravenous infusions, and gene doping. There is not yet an accepted test for DNA doping.
• Stimulants: Amphetamine, ephedrine and other adrenaline-like drugs. Interestingly, perhaps because their use is prevalent, caffeine, nicotine, and phenylephrine and some of its related drugs are not considered prohibited. But buyer-beware admonition applies here as route of administration counts and cross-contamination with prohibited agents can occur.
• Narcotics and Marijuana-related compounds.
• Glucosteroids. These have anti-inflammatory properties.
Alcohol is specifically prohibited in certain sports, particularly sports involving driving, as well as beta-blockers to control nervousness or shaking in a sport like archery.
Maximizing Performance: Staying on the Right Side of the Line
Winning, performing better, or fending off the ravages of aging are part of being human. If everyone is driving 80 in a 65 mph zone, many will opt for a little over 70 but know they may still get a ticket. We may even get incensed over getting stopped. Given the high profile Armstrong case, you can bet the anti-doping authorities will increase their “speed-traps” and bust more athletes for cycling while doping. This is a bad time to stray too close to the line dividing cheaters from those who play fair.
The performance enhancement suggestions made below are conservative and made based on legal and scientific suggestions. Some of these come from biochemist Chris Cooper’s excellent book, “Run, Swim, Throw, Cheat: The Science Behind Drugs in Sport.”
Make Sure You Understand What’s Going Into Your Body
The excuse, “My doctor gave me this” might not work especially if it is a free sample given to you in the office or handed to you by a friend. You must have a written prescription, and if it’s for a banned substance, you’ll need to apply for a therapeutic exemption.
How many times have you heard the excuse, “My nutritional supplement was contaminated?” While that can happen because of assembly line cross-contamination, it can also occur as unscrupulous manufacturers spike their products with steroids, in the hope that word will spread in the gym that “this stuff really works.”
Legal Performance Enhancers
These substances fall into the “it might help and won’t hurt category.” Among them Cooper lists the Big Three: Creatine, carnitine, and caffeine. The first two require pills or powder, as you can’t get enough with normal diet sources. At high body concentrations they are known metabolic modulators, have demonstrated muscle building potential, and usually having the greatest effects in untrained individuals.
Cooper states, “Research indicates that only three currently well-validated methods for increasing muscle strength that do not arouse the wrath of the doping agency: Resistance (weight) training coupled with a balanced increase in caloric intake; creatine supplementation.”
Caffeine, an endurance booster, is an effective brain stimulant helping to ease the perception of pain, as well as a direct muscle stimulant when exercise lasts over five minutes. If its use were not so socially acceptable, it would be a likely candidate for the prohibited list with the addition of caffeine suppositories in use since the 1960’s.
Other legal nutrition-based approaches like beetroot juice or powder for nitrites, carbo-loading, and post exercise protein-carbohydrate programs have been discussed in previous PEZ Toolbox columns. For you organic foodie advocates the nitrites in beetroot, spinach, or lettuce is not present as it’s sourced from agricultural fertilizers.
Still legal in the blood manipulation category is the “live high, train low” technique for boosting your red cell count and thereby increasing your blood’s oxygen delivering capacity. To reach peak effectiveness you must live over 6,500 feet for at least three weeks. Once your return to lower altitudes your hematocrit falls to normal levels in about the same time frame. These changes mimic those associated with the infamous EPO so often cited in USADA’s case against Armstrong and other cyclists.
A Post Doping Era?
USADA’s case against Armstrong elevates the anti-doping agencies into their golden age. They will be emboldened in their policing activities to cut cheating to a minimum. Upon this fairer playing field athletes now have a great opportunity to change the doping culture from within. The fall of an icon brings home the argument that doping isn’t cool. That should transfer into enhanced drug testing and educational efforts directed toward teenage athletes, a group in whom the gruesome side effects of doping can have long-lasting consequences to health.
The excuse that one must dope just to keep up with the peloton has been stripped of much of its validity. Sports with sporadic enforcement policies should heed cycling’s example. The innocence of blind abuse is now punishable.