The Wrong Stuff

Your athletes can be penalized for taking banned substances, even when they’re trying to avoid them. Here’s a look at the prevalence of contaminated nutritional supplements and how to avoid them.

By R.J. Anderson

R.J. Anderson is an Assistant Editor at Training & Conditioning.

Training & Conditioning, 14.4, May/June 2004, http://www.momentummedia.com/articles/tc/tc1404/wrongstuff.htm

Freestyle swimmer Kicker Vencill was supposed to be training this spring for the Athens Olympics. Instead, he is working at Home Depot.

In January 2003, the 25-year-old Vencill was in Irvine, Calif., preparing for the Pan-Am Games, when he tested positive for a steroid precursor banned by the USOC—19-norandrosterone, a byproduct of nandrolone—and was given a four-year suspension by the U.S. Anti-Doping Agency (USADA). Vencill was shocked by the test results. He maintains he never knowingly took a banned substance, but ingested it in his multivitamins, which had apparently been tainted with the steroid precursor.

His claims were buttressed by the low amounts of norandrosterone—four nanograms per milliliter—found in his blood. The suspension was reduced to two years, and a USADA official told the LA Times that the positive test result likely stemmed from contamination.

Last summer, running back Mike Cloud was suspended from the National Football League for four games after testing positive for metabolites of the steroid nandrolone. Cloud also claimed he had never knowingly taken steroids and submitted the dietary supplements he was taking to the league for testing. One of the supplements, a chocolate-flavored protein powder Cloud purchased at a nutrition store, was shown to have nandrolone among its ingredients although it was not mentioned on the product’s label. Despite the NFL’s admission that Cloud was likely duped by the manufacturer, the suspension was upheld due to the league’s zero-tolerance policy.

The results were announced while Cloud, then a free agent, was seeking a new contract. Despite a productive 2002 season, the best offer he received was to play for the league minimum. Cloud has since filed a lawsuit against the manufacturers of the protein powder.

Professional sports teams, Olympic committees, and the NCAA are working hard to rid athletics of steroids. Caught in the wake of these efforts are a handful of athletes who are being suspended for taking what they believed to be legal products. With careers at stake, is consuming any nutritional supplement a game of Russian roulette? Or are there steps you can take to help your athletes avoid unknowingly taking banned substances?

No Regulation
"It’s definitely a buyer beware market," says Cindy Thomas, ATC, Marketing and Account Director for the National Center For Drug Free Sport, Inc., a Kansas City-based organization that oversees drug testing for the NCAA and the NFL. "Because there is basically no regulation of the dietary supplement industry, consumers have no guarantee that a label accurately reveals what is or isn’t in a bottle."

According to the Dietary Supplement Health and Education Act (DSHEA) of 1994, dietary supplements are not classified as drugs, so they are not subject to FDA regulation. The act defines supplements as equivalent to foods and assumes them to be safe unless the FDA has evidence to the contrary. Many experts point to the lack of regulation as the driving force behind the supplement industry’s boom over the last 10 years. Manufacturers are not required to register their companies or their products with the FDA, and there are no FDA regulations to establish minimum manufacturing standards for dietary supplements.

"There is a risk when taking any dietary supplement," says Thomas. "It can relate to the quantity of ingredients listed or the presence of substances in the bottle that aren’t listed on the label."

As proof, a 2001 International Olympic Committee study found that 15 percent of tested supplements from around the world contained steroid precursors that weren’t listed on the label. Among products sold in the U.S. or over the Internet, 19 percent were found by the study to be tainted.

"There is a distinct possibility that some companies may knowingly omit from their labels ingredients that are in the bottle," Thomas says, "but there also may be companies that include banned substances in a supplement’s ingredients and don’t know it. Many manufacturers use the same equipment to make different kinds of supplements. For a company that makes some supplements that contain steroid precursors, trace ingredients from a product containing banned substances may be left over on a mixing machine. If that machine isn’t cleaned thoroughly, it can later contaminate another supplement that isn’t meant to contain the banned substance."

When contamination occurs, trace amounts of a banned substance may be carried in an otherwise legal supplement. These miniscule levels are probably not enough to enhance an athlete’s performance, but they can be enough to produce a positive test result.

Outside Testing
In an article this spring in the Newark Star-Ledger, Scott Strickland, a relief pitcher for the New York Mets, said he submitted requests to have his dietary supplements tested for banned substances by his team as well as Major League Baseball. Strickland, whose urine will be randomly tested by MLB at some point during the 2004 season, ingests 23 pills three times a day, which are prepared by a laboratory in Colorado called RX-1 and were suggested by his personal trainer. Still, as the cloud surrounding the Bay Area Laboratory Cooperative (BALCO) continues to hover over a number of MLB stars, Strickland wants to make sure his urine sample doesn’t turn out dirty.

"There’s vitamins and minerals, and creatine," Strickland told the Star-Ledger, "but they could put Viagra in there for all I know."

The Mets informed Strickland that the club was not equipped to test the pills, and MLB was not eager to respond to Strickland’s request either. Though he received a list of the ingredients contained in the pills, as well as a document from the lab assuring him there is nothing illegal in the supplements, Strickland does not want to take any chances. "I’m totally confident there is nothing in there that’s illegal," he said. "But I just want to be absolutely positive. This is my career."

Even with the clout that comes with being a big league baseball player, Strickland has been unable to find a way to verify what’s in his supplements. So imagine the difficulties that a typical high school or college athlete would face if he or she wanted to do the same thing. The good news is that a growing list of third-party testing companies are stepping up to the plate to help out.

One of those companies is NSF International, a non-profit organization best known for its environmental testing. This winter, the NFL and the NFL Players Association (NFLPA) asked NSF to test and certify dietary supplements for its players, which NSF has begun to do. Manufacturers foot the bill for the testing, which entails NSF screening products twice a year for purity of ingredients, banned substances, bioavailability (how the product breaks down so that it may be used by the body), and correct labeling, as well as auditing the manufacturers’ production facilities and laboratories for proper manufacturing practices.

In addition, manufacturers that want to be considered for the NSF/NFL/NFLPA program cannot be involved with production of supplements containing banned substances. This is intended to eliminate the possibility of inadvertent contamination.

If a product passes, the manufacturer earns the right to display the NSF/NFL/NFLPA seal of approval on the label, and the product is added to a list of approved supplements circulated among NFL players. Kathy Pompliano, General Manager for NSF International’s Dietary Supplement Certification division and overseer of the program, says products bearing the NSF/NFL/NFLPA seal will be available to the general public sometime in May. She adds that, "Neither NSF nor the NFL or its players association endorse any products, nor are they receiving any money directly to benefit them."

Along with the NFL/NFLPA program, NSF also offers an established certification program co-sponsored by the National Nutritional Foods Association (NNFA), the largest dietary supplement trade association in the United States. The NSF/NNFA Good Manufacturing Practices (GMP) certification is similar to the NSF/NFL/NFLPA program, except it does not test for banned substances. If a product satisfies NSF/NFFA’s GMP criteria, a "GMP Certified" seal is put on the bottle.

Julie Burns, MS, RD, CCN, a sports nutritionist whose clients include the Chicago Bears and the Chicago Blackhawks, says she trusts the GMP seal of approval, but warns that some companies put misleading claims on their labels. "Their labels might say, ‘GMP Compliant’ or ‘Exceeds GMP Standards,’ but that doesn’t mean it has the GMP seal of approval—which says ‘GMP Certified,’" she explains. "These companies try to make it look like they’ve opened up their production facilities to get audited—and many times they haven’t."

Another company providing a seal of approval for dietary supplements is U.S. Pharmacopeia (USP), a non-profit organization that has tested supplements for purity and performed production facility audits since 2002. In addition to a base-testing fee, USP charges manufacturers a fee for each bottle its seal appears on.

Because this testing is so expensive, from $12,000 to $25,000 for some products, many manufacturers don’t apply for any type of certification. But that doesn’t mean their products will escape scrutiny.

Since 1999, ConsumerLab.com has been pulling dietary supplements from store shelves, testing products for ingredient purity, bioavailability, and label accuracy. And for the most part, they’ve been doing it on their own dime.

After testing a dozen or so products from each category, and screening multiple bottles of each brand tested, the company posts the results on its Web site. The company gains the majority of its revenue through subscriptions to its Web site, which lists the products that passed the testing and those that failed to meet their standards. Non-subscribers are privy only to information on companies that pass, and pay for, voluntary testing.

Tod Cooperman, MD, President of ConsumerLab.com, says that 15 percent of his Web site’s subscribers are health care professionals and that over 1.7 million people visit the site each year. The company does not test for banned substances or perform audits of manufacturing facilities for products that appear on the Web site, but it does screen a large volume of dietary supplements for ingredient purity and label accuracy.

"We try to get a good sampling of what is out there and test the biggest-selling products," says Cooperman. "We also try to sample one or two smaller brands in a category." To date, they have tested over 1,000 dietary supplements from over 250 manufacturers, and Cooperman estimates that one out of every four supplements tested fails to meet ConsumerLab.com standards. If a product does fail, it is submitted to an independent laboratory to have the findings verified.

"We’ve found that how hard a company tries to meet standards depends on how lucrative each particular market is," says Cooperman. "Like with echinacea, the market has gone down in the last three years, and so has the quality. With chondroitin the opposite has happened—the market has grown significantly, and so has the manufacturers’ focus."

Reading Labels
While the emergence of drug-testing companies is a big step forward in monitoring the supplement industry, it is only one step. The GMP, USP, and ConsumerLab.com programs do not test for banned substances, which is what athletes most often need to know about a supplement. In response, many sports nutritionists recommend educating athletes about how to read labels and decipher ingredient names.

With more than 3,000 dietary supplement products on the shelves, coaches and athletic trainers cannot be expected to recognize and evaluate every single ingredient, but they can familiarize themselves with problematic ingredients. The first step is knowing what is banned by relevant governing bodies (see "Resources" sidebar below). Next, decide what is and is not considered acceptable in your athletic program. From there, you can key in on uncovering substances your athletes should not be ingesting.

Chris Rosenbloom, PhD, RD, nutrition consultant for the Georgia Tech athletic department and an Associate Professor at Georgia State University, suggests looking out for any supplements that are labeled as prohormones. "Anything that’s supposed to mimic the effects of anabolic steroids can get you into trouble," she says. Examples of prohormones include 4-androstenediol (andro), which converts to testosterone, and 19-norandrostenedione, which converts to nandrolone.

Rosenbloom also suggests staying away from potential fat burners. "Products like Xenadrine, EFX, and Hydroxycut are fat burners that may contain ephedrine or synephrine," she explains.

Thomas advises looking for discrepancies in names for a particular ingredient. "Take ephedrine for example," she says, "It can be listed as ephedra, epitonin, ma huang, sida cordifolia, or sinica, among other things." Thomas adds that caffeine—a substance banned above a certain level by the NCAA and IOC—can be listed as guarana, kola nut, maté, paullinia cupana, or tea extracts.

Mike Perko, PhD, CHES, Associate Professor and Health Coordinator at the University of North Carolina-Wilmington, and author of Taking One For the Team—Young Athletes and Dietary Supplements, suggests you red flag anything that says, "You may experience heart palpitations, nervousness, or anxiety." It may contain ephedra under another name, or a product similar to ephedra. "Either way," says Perko, "those are not normal central nervous reactions I would want when taking any kind of drug or supplement."

Cooperman says to look out for new ingredients. "Typically, newer and more expensive ingredients have more problems. Especially when there is a lot of hype around a new supplement and the demand has outstripped the supply," he says. "That’s when bad materials enter the market—especially when it’s a higher-priced ingredient." Cooperman says his laboratory sees problems with herbals more often than non-herbals because they are much more complex and subject to more problems at different stages of production—from growing, harvesting, and processing to shipping and storage.

Cooperman also advises consumers to take a harder look at multivitamins. "It’s funny, because with multivitamins, most of the ingredients are pretty straightforward," he says. "But because of the complexity of mixture, there is more opportunity for problems."

If you allow your athletes to take creatine, Cooperman says to avoid liquid creatine. While not harmful, it is not as effective. "They typically don’t contain what they claim because creatine is unstable to begin with. When it is mixed with water it starts falling apart," says Cooperman, who adds that creatine powders generally passed ConsumerLab.com tests.

Supplemental Education
The last piece of the puzzle in avoiding contaminated supplements involves setting up policies and educational procedures that warn your athletes of the risks. It also means communicating with them openly on the issue.

Rosenbloom says that education needs to begin with policy. "Get everyone on the same page with an institution-wide policy regarding supplement use—what is allowed and what isn’t," she says. "Athletes should be made aware of the policy the minute they walk in the door. That way, if they run into the contamination problem, they only have themselves to blame."

Rosenbloom initiates policy awareness when a student-athlete takes a preseason physical. "At Georgia Tech, we ask athletes what they are taking and follow up with a question asking whether they know what substances are illegal," she says. "Then we ask for some examples of banned substances—a lot of them can’t give any." After the physical, each Georgia Tech athlete meets with the school’s nutritionist to discuss the supplements they are taking.

Purdue University also provides its athletes with one-on-one discussions. "I try to make sure that every freshman has a sit-down with our dietician," says Dennis Miller, ATC, PT, Head Athletic Trainer at Purdue. "They go over their goals, and we cover supplements and issues like contamination."

Miller and his staff also talk to teams as a group. "At the beginning of each year we explain that the NCAA is advertising that ignorance is no excuse," says Miller. "So we appeal to them, ‘Please, don’t get caught up in what you read, and don’t fall for advertising that talks you into taking a supplement. If you’re taking something that is not endorsed by our department, please bring it to us so we can sit down together and evaluate what the claims are, what the ingredients are, and what the potential hazards are.’ We make sure our athletes don’t feel that we’re going to ostracize them or penalize them for getting into supplements on their own, and that increases the level of honesty."

Even though they may not face the same testing as college athletes, high school student-athletes can benefit from these same measures. To promote consistency, Rosenbloom says that when putting together a supplement policy, high school athletic programs should follow the lead of their collegiate counterparts and ban the same substances as the NCAA. Rosenbloom says this helps to ensure proper health and safety, while at the same time better prepare student-athletes for what they will face if they compete at the collegiate level.

Alan Beste, Wellness Coordinator for the Iowa High School Athletic Association, agrees that communication and positive reinforcement are the keys to getting your message to athletes—which, he notes, is especially important when they don’t face regular testing. "It all starts with what you say, and silence is not an option," he says. "Kids interpret silence as a message that taking supplements is okay with you.

"I wouldn’t say, ‘If I find out that anyone is using ephedra, they’ll be off the team,’" Beste adds. "That’s the way to ensure no one will tell you anything. Your message needs to be, ‘This is very dangerous, and I’m concerned about this issue because I care about you.’ Whether you leave the door open from the start will determine how honest your players will be with you about the issue all year."

Your message needn’t come packaged as a formal presentation either. "Take advantage of teachable moments," Beste advises. "Pay attention to current events, and when you see a newspaper story about the results of an athlete using supplements, discuss it with your players. Print copies and post them in the locker room or pass them around. Your words have a lot more impact when players can link them to something real."

Educating parents is equally important. "Parents see these supplements at the supermarket and think, ‘If these weren’t safe, how could stores sell them?’" Beste says. "So we need to provide parents with the same information we’re giving players. If I’m a player taking ephedra, I’m probably not going to take a pamphlet about the dangers home to my parents. So you need to get parents together and spend a few minutes telling them what your concerns are about supplement use."

With the uncertainty that exists in the supplement industry, athletic trainers must be the first line in an athlete’s defense against contamination. Making sure your athletes are well informed will go a long way toward ensuring they have long and healthy careers.



Sidebar: Resources

www.ncaa.org
For a printable PDF that includes a complete listing of substances banned by the NCAA, click "Rules and Eligibility" then click "Drug Screening."

www.usantidoping.org
This site contains printable PDFs listing substances banned by the International Olympic Committee (IOC) and World Anti-Doping Agency (WADA). There are two sizes of PDF available: enlarged and wallet-sized.

www.nsf.org
NSF International is partnering with the National Football League and the NFL Player’s Association to provide a seal that certifies a dietary supplement safe to be ingested by NFL players. The NSF/NFL/NFLPA seal is the only certification that verifies a product has been tested for banned substances. The Web site also details NSF’s agreement with the National Nutritional Foods Association (NNFA) to provide a testing program that screens dietary supplements for ingredient purity, bioavailability, label accuracy, and good manufacturing practices (GMP).

www.ConsumerLab.com
The site lists manufacturers that meet ConsumerLab.com’s standards for ingredient purity, label accuracy, and bioavailability. Unlike other drug-testing companies, ConsumerLab.com lists those manufacturers that don’t meet its testing requirements.

www.usp.org
U.S. Pharmacopeia audits production facilities to ensure good manufacturing practices and screens for ingredient purity, bioavailability, and label accuracy.

www.drugfreesport.com
Click "Dietary Supplement Information" for background material on sports nutrition and dietary supplements. Click "Resource Exchange Center" for information on Drug Free Sport’s Dietary Supplement Resource Exchange Center, a subscription service for institutions wishing to provide athletics staff and athletes with accurate and confidential information about dietary supplements and dangerous and/or banned substances.

www.fda.gov
For information on the dietary supplement industry and the FDA’s role in industry regulation, enter "dietary supplements" into the search window.