American swimmer Jessica Hardy set two world records in 2008 and was poised to take home medals from the Olympics, but she never made it to Beijing. Instead, she was booted from the Olympic team after testing positive for clenbuterol—an asthma medication that can increase muscle growth—at the Olympic trials. Like almost every athlete who’s ever tested positive for performance-enhancing drugs, Hardy insisted that she hadn’t doped. For once, this doesn’t appear to have been an outright fib.
What Hardy had taken was something called Arginine Extreme, a nutritional supplement made by AdvoCare, a multi-level marketing outfit that describes itself as a health and wellness company and was one of her sponsors. Though clenbuterol is not listed on the ingredients list, tests presented by Hardy's defense team showed that the Arginine Extreme supplements did, in fact, contain the drug. AdvoCare disputes the evidence and denies wrongdoing. The company was not a party to the arbitration proceeding and so did not question witnesses or present evidence. AdvoCare asserts that tests conducted on its behalf by two independent laboratories found no evidence of contamination in the supplements and that the ingredients listed on the products were the only ingredients found in them. During her arbitration hearing, Hardy convinced the World Anti-Doping Agency that she’d inadvertently ingested clenbuterol via a contaminated supplement, and she received only a one-year suspension instead of the usual two-year ban. Even so, she missed both the Olympics and the World Championships and lost an opportunity not just for medals and records, but also for sponsorship opportunities and income. (She’ll get another chance this month when she competes in London.)
Hardy is among a growing number of athletes who have traced a positive doping test back to a tainted supplement. Swimmer Kicker Vencill and cyclists Flavia Oliveira and Scott Moninger (an acquaintance of mine), also tested positive after taking supplements, and 400-meter gold medalist LaShawn Merritt linked his positive dope test to a product called Extenz that he picked up at 7-Eleven. The problem is so prevalent that the U.S. Anti-Doping Agency (USADA) has developed an educational campaign for athletes, called Supplements 411.
Supplements are risky thanks in part to a piece of legislation passed in 1994 called the Dietary Supplements and Health Education Act. The DSHEA essentially deregulated dietary supplements, including vitamins, herbs, protein shake mixes, nutritional supplements, and other powders and pills that millions of people of all levels of athletic ability might take to improve their health. Most people assume that if a product is available on store shelves, it must be OK. But supplements are not required to be evaluated or proven safe or effective before they’re sold. New rules finalized in 2007 gave the FDA power to regulate the manufacturing and packaging of supplements, but the agency’s ability to police supplement companies remains limited by DSHEA. Its chief author and most powerful advocate is Sen. Orrin Hatch, whose home state of Utah is home to much of the U.S. supplement industry. Hatch, who attributes his good health to the supplements he takes each day, fought a recent amendment to increase the FDA's ability to regulate the industry.
FDA investigations have repeatedly found safety problems with supplements, including dangerous ingredients—everything from diet pills containing a drug previously pulled from the market due to safety concerns to body-building supplements packed with anabolic steroids. These are hardly isolated cases. A 2004 study found that 18 percent of nutritional supplements purchased in the United States contained undeclared anabolic androgenic steroids. The FDA has also warned consumers about supplements laced with dangerous levels of selenium and chromium. In 2009, college baseball player Jareem Gunter told a Senate hearing that he'd ended up in the hospital with liver failure after taking a body-building supplement, and late last year, the Army set up a probe to investigate whether body-building supplements containing dimethylamylamine, or DMAA, a stimulant that can narrow blood vessels and arteries, were involved in the deaths of two soldiers and liver and kidney damage in others.
In April, the FDA sent warning letters to 10 supplement makers and distributors marketing "natural" stimulants such as Hemo Rage Black, Jack3D, and Biorhythm SSIN Juice that contained DMAA, warning that DMAA did not qualify as a dietary ingredient. (Manufacturers told the New York Times they disagreed.) A recent Chicago Tribune investigation reported that the FDA has discovered manufacturing violations in nearly half of the 450 dietary supplement producers it has inspected since new rules gave the agency more oversight five years ago.
Given these dangers, why on earth would athletes take supplements? Hardy popped the pills expecting them to help her recover after races and practices. AdvoCare’s website makes at least nine claims about Arginine Extreme—it can “support nutrient delivery to muscles,” “promote short-term increases in nitric oxide levels,” nourish “the precursors necessary for muscle growth and recovery,” “enhance strength and stamina, (“especially when used with AdvoCare Muscle Fuel”), and help “maintain a healthy cardiovascular system” and an “efficient immune system.”
These are big promises, especially from a product whose declared ingredients consist of nothing more than some amino acids and vitamins. Like most supplements purporting to enhance athletic performance, AdvoCare’s products are not backed by peer-reviewed clinical trials, just testimonials, the endorsements of professional athletes, and some scientific advisory board members with MDs or Ph.D.s behind their names. AdvoCare says that its products are subject to testing and quality assurance standards, and that in the company’s history, there has been only one claim (from Hardy) that its products were contaminated.
When studies do appear to support supplement companies’ claims, they are usually small and at best can offer only hints of efficacy, not definitive proof. As I learned first-hand during my earnest attempt to study the effects of beer on running, even seemingly robust study designs can lead you to a dodgy conclusion. My study could have easily been interpreted to show that beer made women better runners, but as a participant of the study, I discovered problems in the standard protocols that might not have been apparent otherwise. A series of reports published July 19 in BMJ found “a striking lack of evidence to support claims about improved performance and recovery” made by products aimed at athletes like sports drinks and supplements and concluded that it is “virtually impossible for the public to make informed choices about the benefits and harms of advertised sports products.”
Despite the scarcity of evidence, athletes continue to take supplements at high rates. A 2009 study estimated that 85 percent of elite track and field athletes took supplements, and 87 percent of Canadian athletes who participated in a survey published this year reported taking dietary supplements in the previous six months.
According to FDA rules, supplements are supposed to contain substances that could be obtained through food. That means vitamins, minerals, and nutrients like carbohydrates, amino acids, or protein. But there’s no reason to think athletes benefit from supplementing their diets with these things. Elite athletes spend hours each day training and must consume thousands of calories. It’s hard to become nutrient-deficient when you’re eating that much. The American College of Sports Medicine’s position statement says, “vitamin and mineral supplements are not needed if adequate energy to maintain body weight is consumed from a variety of foods.”
The one exception is iron, which often becomes depleted in menstruating women, especially if they don’t eat much meat. (Low iron stores can lead to fatigue and poor performance.) But you rarely see sport supplements touting iron. Instead, advertisements target athletes with dubious claims that supplements can boost red blood cells or build muscle “naturally.” And these pitches are often shrouded in pseudo-scientific language. When a supplement is promising results that you wouldn’t expect from simple good nutrition, chances are the claim is bogus or the supplement contains an illicit, undeclared drug.
The difference between winning and losing is often measured in fractions of a second, and athletes trying to bridge that gap are easy targets for quackery. After Hardy’s positive test, you’d expect her teammates on the U.S. swim team to eschew supplements, but Hardy estimates that, despite her warnings, about 90 percent of the swimmers still take them.
Coaches and trainers, too, are often fooled. Most have little scientific training, and the supplement industry bombards them with literature about nutrition. And there’s plenty of incentive to believe the hype. Endorsement deals from supplement companies provide a major source of income for many teams, coaches, and athletes, and trainers or coaches sometimes get paid to peddle supplements to their athletes.
Under the best-case scenario, a supplement provides an expensive source of a nutrient that the athlete could be getting from food. Worst-case scenario, it's providing dangerous levels of heavy metals, pesticide residues, undeclared drugs, or illicit performance-enhancers that may show up on a drug test. USADA provides detailed advice for athletes contemplating the use of supplements, including a list of red flags that should make them think twice about using a product, such as promises that they'll enhance muscle-building or energy or claims about "proprietary blends" that are "clinically proven."
Given the slew of high-profile doping cases traced back to supplements, and USADA’s concerted efforts to educate athletes, it’s hard not to suspect that some of these runners, swimmers, and cyclists know exactly what they’re doing. I have no reason to think that Hardy had any intention of doping, but cases like hers may give cover to genuine cheaters. After all, the designer steroid that took down Marion Jones and Barry Bonds was created and distributed through a supplement company—the Bay Area Laboratory Co-operative (BALCO) that gave the scandal its name.
If I were a doper, I'd be sure to have a medicine cabinet full of supplements—ones that claim to produce the same results as my drugs. Then, if I ever tested positive for doping, I'd have a plausible excuse.