Protocol to reduce the risk of unintentional doping caused by dietary supplements ingestion
Revisão - Número e225468 - publicado 19 de setembro de 2023
DOI:
https://doi.org/10.33233/rbfex.v22i1.5468Keywords:
dietary supplements, doping in sports, athletic performance, security measuresAbstract
Introduction: Dietary supplements have been considered the main cause of unintentional doping among athletes; however, the prevalence of supplement use by elite athletes is almost 100%, and awareness of the risk of unintentional doping does not seem to be effective. The literature has pointed out some possible factors related to the poor quality of products available on the market; however, it does not propose any protocol that objectively guides health professionals and athletes in terms of reducing the risk of doping and damage to health caused by supplements contaminated with prohibited substances not listed on the label. Objective: To propose a protocol to reduce the risk of unintentional doping, based on a narrative review of studies that have discussed regulatory factors related to dietary supplements, prevalence of contamination of supplements, their main contaminants, possible adverse effects on human health, awareness of athletes about the indications for supplement use and the risks of unintentional doping. Methods: Narrative review and document analysis on the websites of international agencies related to anti-doping policy, such as the World Anti-Doping Agency (WADA) and the Brazilian Authority for Doping Control (ABCD). Results: A six-step protocol was developed, which proposes methods potentially capable of reducing the risk of unintentional doping. Conclusion: This instrument could be highly relevant in sports, especially among elite athletes; however, without excluding the importance for any consumer of this type of product, since high prevalence of contamination of food supplements and consumption of this product were identified, as well as insufficient awareness on the part of its consumers.
References
Maughan RJ, Shirreffs SM, Vernec A. Making decisions about supplement use. Int J Sport Nutr Exerc Metab. 2018;28(2):212-9. doi: 10.1123/ijsnem.2018-0009
Guest NS, Van Dusseldorp TA, Nelson MT, Grgic J, Schoenfeld BJ, Jenkins NDM, et al. International society of sports nutrition position stand: caffeine and exercise performance. J Int Soc Sports Nutr. 2021;18(1):1. doi: 10.1186/s12970-020-00383-4
Kerksick CM, Wilborn CD, Roberts MD, Smith-Ryan A, Kleiner SM, Jäger R, et al. ISSN exercise & sports nutrition review update: research & recommendations. J Int Soc Sports Nutr. 2018;15(1):38. doi: 10.1186/s12970-018-0242-y
Stellingwerff T, Heikura IA, Meeusen R, Bermon S, Seiler S, Mountjoy ML, et al. Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): shared pathways, symptoms and complexities. Sports Med. 2021;51(11):2251-80. doi: 10.1007/s40279-021-01491-0
Maughan RJ, Burke LM, Dvorak J, Larson-Meyer DE, Peeling P, Phillips SM, et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018;52(7):439-55. doi: 10.1136/bjsports-2018-099027
Daher J, Mallick M, El Khoury D. Prevalence of dietary supplement use among athletes worldwide: a scoping review. Nutrients. 2022;14(19). doi: 10.3390/nu14194109
Lauritzen F, Gjelstad A. Trends in dietary supplement use among athletes selected for doping controls. Front Nutr. 2023;10:1143187. doi: 10.3389/fnut.2023.1143187
Thomas M, Kalicinski M. The effects of slackline balance training on postural control in older adults. J Aging Phys Act.2016;393-8. doi: 10.1123/japa.2015-0099
Hurst P. Are dietary supplements a gateway to doping? A retrospective survey of athletes’ substance use. Subst Use Misuse. 2023;58(3):365-70. doi: 10.1080/10826084.2022.2161320
Outram S, Stewart B. Doping through supplement use: a review of the available empirical data. Int J Sport Nutr Exerc Metab. 2015;25(1):54-9. doi: 10.1123/ijsnem.2013-0174
Kozhuharov VR, Ivanov K, Ivanova S. Dietary supplements as source of unintentional doping. Biomed Res Int. 2022;2022:8387271. doi: 10.1155/2022/8387271
WADA - World Anti-Doping Agency. Anti-doping code. [Internet] 2021 [citado 2023 jul 24]. Disponível from: https://www.wada-ama.org/en/resources/world-anti-doping-program/world-anti-doping-code.
Wierzejska RE. Dietary supplements-for whom? The current state of knowledge about the health effects of selected supplement use. Int J Environ Res Public Health. 2021;18(17). doi: 10.3390/ijerph18178897
Richardson E, Akkas F, Cadwallader AB. What should dietary supplement oversight look like in the US? AMA J Ethics. 2022;24(5):E402-9. doi: 10.1001/amajethics.2022.402
Cadwallader AB. Which features of dietary supplement industry, product trends, and regulation deserve physicians’ attention? AMA J Ethics. 2022;24(5):E410-18. doi: 10.1001/amajethics.2022.410
Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária (ANVISA). Resolução da Diretoria Colegiada – RDC n°243, de 26 de julho de 2018. Dispõe sobre os requisitos sanitários dos suplementos alimentares. Diário Oficial da União. Brasília: Diário Oficial da União; 2018.
Molin TRD, Leal GC, Muratt DT, Marcon GZ, Carvalho LM, Viana C. Regulatory framework for dietary supplements and the public health challenge. Rev Saúde Pública. 2019;53:90. doi: 10.11606/s1518-8787.2019053001263
Brasil. Instrução Normativa - IN No 76, de 5 de novembro de 2020. Dispõe sobre a atualização das listas de constituintes, de limites de uso, de alegações e de rotulagem complementar dos suplementos alimentares. Brasília: Diário Oficial da União; 2020.
WADA - World Anti-Doping Agency. The prohibited list. [Internet]. 2023. [citado 2023 jul 24]. Disponível em: https://www.wada-ama.org/en/prohibited-list.
Walpurgis K, Thomas A, Geyer H, Mareck U, Thevis M. Dietary supplement and food contaminations and their implications for doping controls. Foods. 2020;9(8). doi: 10.3390/foods9081012
ABCD - Autoridade Brasileira de Controle de Dopagem. Apostila Antidopagem. {Internet]. 2022. [citado 2023 jul 24]. Disponível em: https://www.gov.br/abcd/pt-br/composicao/educacao-e-prevencao/material-educativo-antidopagem-1. 2022
Anderson JM. Evaluating the athlete’s claim of an unintentional positive urine drug test. Curr Sports Med Rep.2011;10(4):191-6. doi: 10.1249/JSR.0b013e318224575f
Silva LFM, Ferreira KS. Segurança alimentar de suplementos comercializados no Brasil. Rev Bras Med Esporte. 2014;20(5). doi: 10.1590/1517-86922014200501810
Henao MMM. Desenvolvimento e aplicação de método analítico para detecção de estimulantes em suplementos nutricionais adulterados. São Paulo: Universidade de São Paulo; 2018.
Florentin M, Liberopoulos EN, Elisaf MS. Sibutramine-associated adverse effects: a practical guide for its safe use. Obes Rev. 2008;9(4):378-87. doi: 10.1111/j.1467-789X.2007.00425.x
James WPT, Caterson ID, Coutinho W, Finer N, Van Gaal LF, Maggioni AP, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010;363(10):905-17. doi: 10.1056/NEJMoa1003114
Scheen AJ. Cardiovascular risk-benefit profile of sibutramine. Am J Cardiovasc Drugs. 2010;10(5):321-34. doi: 10.2165/11584800-000000000-00000
Torrisi M, Pennisi G, Russo I, Amico F, Esposito M, Liberto A, et al. Sudden cardiac death in anabolic-androgenic steroid users: a literature review. Medicina (Kaunas). 2020;56(11). doi: 10.3390/medicina56110587
Karila T, Hovatta O, Seppälä T. Concomitant abuse of anabolic androgenic steroids and human chorionic gonadotrophin impairs spermatogenesis in power athletes. Int J Sports Med. 2004;25(4):257-63. doi: 10.1055/s-2004-819936.
Ivanova S, Ivanov K, Pankova S, Peikova L. Consequences of anabolic steroids abuse. Farmatsiia [Internet]. 2014 [citado 2022 set 12];61(4):44-50. Disponível em: https://www.researchgate.net/publication/287323821_Consequences_of_anabolic_steroids_abuse
Duiven E, van Loon LJC, Spruijt L, Koert W, de Hon OM. Undeclared doping substances are highly prevalent in commercial sports nutrition supplements. J Sports Sci Med. 2021;20(2):328-38. doi: 10.52082/jssm.2021.328
Leaney AE, Heath J, Midforth E, Beck P, Brown P, Mawson DH. Presence of higenamine in beetroot containing “foodstuffs” and the implication for WADA-relevant anti-doping testing. Drug Test Anal. 2023;15(2):173-80. doi: 10.1002/dta.3383
Zhang Y, Wu X, Wang W, Huo J, Luo J, Xu Y, et al. Simultaneous detection of 93 anabolic androgenic steroids in dietary supplements using gas chromatography tandem mass spectrometry. J Pharm Biomed Anal. 2022;211:114619. doi: 10.1016/j.jpba.2022.114619
Rodriguez-Lopez P, Rueda-Robles A, Sánchez-Rodríguez L, Blanca-Herrera RM, Quirantes-Piné RM, Borrás-Linares I, et al. Analysis and screening of commercialized protein supplements for sports practice. Foods. 2022;11(21). doi: 10.3390/foods11213500
Mallick M, Camacho CB, Daher J, El Khoury D. Dietary supplements: a gateway to doping? Nutrients. 2023;15(4):881. doi: 10.1080/10826084.2022.2161320
Froiland K, Koszewski W, Hingst J, Kopecky L. Nutritional supplement use among college athletes and their sources of information. Int J Sport Nutr Exerc Metab. 2004;14(1):104-20. doi: 10.1123/ijsnem.14.1.104
Tian HH, Ong WS, Tan CL. Nutritional supplement use among university athletes in Singapore. Singapore Med J. 2009;50(2):165-72. https://pubmed.ncbi.nlm.nih.gov/19296032/
Dodge T. Consumers’ perceptions of the dietary supplement health and education act: implications and recommendations. Drug Test Anal. 2016;8(3-4):407-9. doi: 10.1002/dta.1857
Braun H, Koehler K, Geyer H, Kleiner J, Mester J, Schanzer W. Dietary supplement use among elite young German athletes. Int J Sport Nutr Exerc Metab. 2009;19(1):97-109. doi: 10.1123/ijsnem.19.1.97
Torres-McGehee TM, Pritchett KL, Zippel D, Minton DM, Cellamare A, Sibilia M. Sports nutrition knowledge among collegiate athletes, coaches, athletic trainers, and strength and conditioning specialists. J Athl Train. 2012;47(2):205-11. doi: 10.4085/1062-6050-47.2.205
Baylis A, Cameron-Smith D, Burke LM. Inadvertent doping through supplement use by athletes: assessment and management of the risk in Australia. Int J Sport Nutr Exerc Metab. 2001;11(3):365-83. doi: 10.1123/ijsnem.11.3.365
Chan DKC, Donovan RJ, Lentillon-Kaestner V, Hardcastle SJ, Dimmock JA, Keatley DA, et al. Young athletes’ awareness and monitoring of anti-doping in daily life: Does motivation matter? Scand J Med Sci Sports. 2015;25(6):e655-63. doi: 10.1111/sms.12362
Hon O, Coumans B. The continuing story of nutritional supplements and doping infractions. Br J Sports Med. 2007;41(11):800-5; discussion 805. doi: 10.1136/bjsm.2007.037226
Wardenaar FC, Hoogervorst D, Vento KA, de Hon PhD O. Dutch olympic and non-olympic athletes differ in knowledge of and attitudes toward third-party supplement testing. J Diet Suppl. 2021;18(6):646-54. doi: 10.1080/19390211.2020.1829248
Erdman J, Oria M, Pillsbury L. Nutrition and traumatic brain injury: improving acute and subacute health outcomes in military personnel. In: Erdman J, Oria M, Pillsbury L, eds. Washington, DC: National Academies Press; 2011.doi: doi: 10.17226/13121
Lewis M, Ghassemi P, Hibbeln J. Therapeutic use of omega-3 fatty acids in severe head trauma. Am J Emerg Med. 2013;31(1):273e5-8. doi: 10.1016/j.ajem.2012.05.014
Thomas DT, Erdman KA, Burke LM. American College of Sports Medicine joint position statement. Nutrition and athletic performance. Med Sci Sports Exerc. 2016;48(3):543-68. doi: 10.1249/MSS.0000000000000852
Pereira C, Veiga N. Educação para a saúde baseada em evidências. Millenium. Journal of Education Technologies and Health [Internet]. 2014 [citado 2022 jun 12];46(46):107-36. Disponível em: https://revistas.rcaap.pt/millenium/article/view/8144
Porrini M, Del Boʼ C. Ergogenic aids and supplements. Front Horm Res. 2016;47:128-52. doi: 10.1159/000445176
Judkins CMG, Teale P, Hall DJ. The role of banned substance residue analysis in the control of dietary supplement contamination. Drug Test Anal. 2010;2(9):417-20. doi: 10.1002/dta.149
Kamber M, Baume N, Saugy M, Rivier L. Nutritional supplements as a source for positive doping cases? Int J Sport Nutr Exerc Metab. 2001;11(2):258-63. doi: 10.1123/ijsnem.11.2.258
Khazan M, Hedayati M, Kobarfard F, Askari S, Azizi F. Identification and determination of synthetic pharmaceuticals as adulterants in eight common herbal weight loss supplements. Iran Red Crescent Med J. 2014;16(3):e15344. doi: 10.5812/ircmj.15344
Mathews NM. Prohibited contaminants in dietary supplements. Sports Health. 2018;10(1):19-30. doi: 10.1177/1941738117727736
Gueorguieva EP, Ivanov K, Gueorguiev S, Mihaylova A, Madzharov V, Ivanova S. Detection of sibutramine in herbal food supplements by UHPLC/HRMS and UHPLC/MS-MS. Biomedical Research. 2018;29(14). doi: 10.4066/biomedicalresearch.29-18-879
Cohen PA, Travis JC, Keizers PHJ, Boyer FE, Venhuis BJ. The stimulant higenamine in weight loss and sports supplements. Clin Toxicol (Phila). 2019;57(2):125-30. doi: 10.1080/15563650.2018.1497171
Leaney AE, Beck P, Biddle S, Brown P, Grace PB, Hudson SC, et al. Analysis of supplements available to UK consumers purporting to contain selective androgen receptor modulators. Drug Test Anal. 2021;13(1):122-7. doi: 10.1002/dta.2908
Kintz P. The forensic response after an adverse analytical finding (doping) involving a selective androgen receptor modulator (SARM) in human athlete. J Pharm Biomed Anal. 2022;207:114433. doi: 10.1016/j.jpba.2021.114433
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Renata Rebello Mendes, João Rafael Santos Prado
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms: Authors retain the copyright and grant the journal the right of first publication, with the work simultaneously licensed under the Creative Commons Attribution License which allows the sharing of work with acknowledgment of authorship and initial publication in this magazine; Authors are authorized to assume additional contracts separately, for non-exclusive distribution of the version of the work published in this journal (eg, publish in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal; Authors are allowed and encouraged to publish and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this can generate productive changes as well as increase impact and citation of published work (See The Effect of Open Access).
