Tablets, injections and … poppy seed cake. How do athletes “coke”?

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If it is written about an athlete that he was doping, it is associated with very unpleasantness. First, he will be at least temporarily disqualified. Second, it is a big stain on honor. The problem is that even a player who has been treated with a legal cough medicine can be accused of using doping.

1. It’s not that anti-doping rule violators are always intentionally scammers. Some of the mishaps come from ignorance, ignorance – translates for MedTvoiLokona, Dr. Urszula Zdanowicz, who for many years sat on Polish medical boards, dealing with doping
2. Banned substances can be found, for example, in sports nutrition – the study found that they are up to 80 percent. such products
3. The presence of a given substance in the body may also be related to physiology – some people, for example, have a higher testosterone level than the norm provides. It does not always mean that they were taking pills or giving themselves injections
4. More information can be found on the Onet homepage.

Agnieszka Mazur-Puchała, Medonet: Let’s start by clarifying what actually doping in sport is. What substances are placed on the anti-doping list and why are they?

Dr Urszula Zdanowicz, sports orthopedist and traumatologist: The World Anti-Doping Agency (WADA) defines doping as anything that violates anti-doping rules. These can be substances, but also certain methods (e.g. blood transfusions) that are prohibited in sports.

The regulations governing the anti-doping list change from year to year. They are valid from January 1 to the end of the calendar year, and in the fall there are changes that will appear in the following year. Why the changes? First, the knowledge of how different substances affect humans is changing. There have been times when things that were once on the anti-doping list are no longer on the anti-doping list (for example, caffeine was banned until 2004). Secondly, it’s such a game of policemen and thieves. Those who break the rules invent new ways, and those who pursue them find out that it is possible and legally forbid it.

So what can’t be the substance that athletes take? Are, for example, nutrients on the list of prohibited substances?

The purpose of anti-doping rules is to ensure that competition in sport is fair and safe. So that no one artificially improves their abilities. And here we enter quite a muddy ground, because where does the artificial support begin? Is taking high-tech supplements an “artificial support” or not yet?

The answer is simpler than it seems and is not subject to subjective assessment, as it is regulated precisely by anti-doping regulations. If something is on the WADA Prohibited List, it is not allowed. You can more or less agree with these provisions. Some doctors, scientists and athletes express their opinions loudly, saying that they think something works or not, something should be on the list or be removed from it. It is such discussions that are changing the rules. However, as long as they are in force in a given year, they should be adhered to.

It’s just like the rules of a particular sport. If we play with one ball in football, we won’t suddenly start playing with two just because we think it will be more fun. There are rules and you must follow them as long as they are in place. Regardless of what our view is on this subject, and whether it will help us or not.

Do the same anti-doping laws apply to all athletes? Regardless of the discipline they practice?

The rules apply to all athletes, but there are also substances that are only prohibited in certain sports. For example, the so-called beta-blockers (drugs used in cardiology) are prohibited, inter alia, in shooting, skiing or car rallies. Why? It turns out that these drugs also have a calming effect, so they cannot be used in sports that require, among others, concentration. And this is what it looks like, depending on what feature (endurance, strength, concentration) is required in a given sport, their players are “caught” on such substances. In addition, the list includes substances that are always banned and those that are only banned in competition.

1. Also read: Which winter sport has the most injuries? Orthopaedist: definitely not in ski jumping

Why are some people cheating? Well, to win. Get fame and money. And if you can get fame and money somewhere, unfortunately there will be those who will try to help themselves artificially.

Players caught doping often explain that they simply did not know. They had no idea that they were taking something that would improve their performance and that it was illegal. It is possible not to know?

It is indeed not all that simple. It happened many times that someone was doping, and then explained that they did not know that there were prohibited substances in the sports supplement. Is it possible? Unfortunately yes. The production of sports nutrition is not as carefully regulated as the production of drugs. Very often, nutrients contain substances that are not listed at all on the labels or these substances are in much higher concentrations than declared. And we are not talking about higher levels of vitamin C – these additional ingredients are often steroids and hormones.

According to prof. Navarro from Einstein Medical Center in Philadelphia, nearly 80 percent. sports nutrients contains additional substances that are not listed on the labels and are even dangerous to health and life. First of all, anabolic steroids or hormones. There is a saying about supplements: “If it’s too good to be true, it most likely is forbidden.” I’m afraid there are no non-doping drugs that work miraculously.

Unfortunately, even unknowingly ingesting banned substances is severely punished. The competitor is responsible for what he takes into his body. So if, for example, someone in the Olympic Village wants to give him something, a reasonable competitor will not take it. Unless he completely trusts that person.

Ignorance of the regulations is not an explanation either. The competitor has to know them and know what he is taking into his body. And when in doubt, the best solution is simply not to take it. In practice, this is indeed a minefield, because it is easy to dope unknowingly. The list of prohibited substances includes not only the names of the prohibited substances, but also any substances with a similar chemical structure or effect. Therefore, for a player, checking if something is on the list does not have to be easy.

Moreover, the list includes the names of the active substances, not drugs. These are often the names of quite complex chemical compounds. In simple terms: if we go to the pharmacy and buy APAP, we are actually getting paracetamol. With Aspirin, it’s acetylsalicylic acid. These are the active substances. So in order to find out if a given drug is on the list, you need to analyze its full composition and check whether all its elements are legal.

I am reminded of the case of Justyna Kowalczyk before the Olympics in Turin …

Yes, in 2005 she was disqualified for two years for taking a banned substance. Justyna Kowalczyk explained that she had taken the drug because of pain in the Achilles tendon, and that the drug itself was prescribed by a local doctor. Unfortunately, such a translation is not enough. Due to this case, Justyna would not have gone to Turin to the Olympics. Anyway, I was involved in writing the appeal at that time. I tracked that our player took a drug belonging to the group of the so-called specific substances. They are so common in various medical devices that the penalty for doping is lower. It is assumed that in this case it is usually not intentional, but an accidental breach of the rules. The penalty was reduced and Justyna was able to go to Turin and win medals there.

I was intrigued by these specific substances. Are there substances on the list of forbidden things that we use every day and it does not even occur to us that they can be doping?

Well, it actually is. There are studies showing that even eating… poppy seed cake may be problematic. There are certain amounts of narcotic substances in the poppy seeds. After eating too much, the doping test may be positive.

Another example is pseudoephedrine, a popular ingredient in cough syrups. Legal, over-the-counter at any pharmacy. From a certain concentration it is banned. And here, in fact, the player can experience a shock when it turns out that he had a cough, bought a legal drug in a pharmacy, and thus broke the regulations, and his career is broken.

It’s not that anti-doping rule violators are always intentionally scammers. Some of the mishaps come from ignorance, ignorance, neglect, or just a certain nonchalance.

Really do athletes have to analyze each cold medicine on their own? There is no one to do it for them?

It depends a bit on the sports association and organization. For many years I was responsible for the fight against doping in the PZPN Medical Committee. At that time, we conducted trainings for doctors working in clubs and for players. I was also responsible for anti-doping matters in the Polish Swimming Association just around 2004, i.e. the period of Otylia Jędrzejczak’s greatest successes. In addition to training players and coaches, we had such an agreement that whenever they want to take something, they first contact me. Later, we checked whether the composition of such a drug or supplement was okay.

Drugs for asthma and diabetes are doping. Meanwhile, some athletes do have these diseases. How is this resolved legally?

Although athletes have anti-doping laws, that does not mean they cannot be treated. WADA provides for the so-called TUE (therapeutic use exemption), i.e. therapeutic exclusion. The competitor may ask for permission to take medications containing substances on the list when in need of treatment. To obtain such consent, you must provide evidence that you are actually sick. A simple statement from the doctor is not enough. For the most common diseases, there are specific WADA criteria that must be met in order to apply for such an exemption.

In everyday life, when a patient has four out of five symptoms of some disease, this is usually enough to make a diagnosis and start treatment. After all, not everyone is sick in the same way, not always presents all the symptoms of a given disease. In competitive sports, it is a bit more complicated. In the case of Therapeutic Exclusion, if five symptoms are listed, the athlete must have five. End, period.

Another problem is people with, for example, higher than average testosterone levels, high enough to indicate doping. Such a player must prove that he is not taking anything. For this purpose, he must regularly test himself in accredited laboratories to demonstrate that these levels are increased each time. He then receives the so-called biological passport.

In the case of, among others Testosterone can be checked whether it comes from the outside or the inside. If it turns out that the hormone was taken in pills or injections, even with its low blood levels, we are talking about breaking the anti-doping regulations.

As you can see, there are many pitfalls, and when a player costs many millions of euros, his suspension for two years can be, to put it mildly, problematic.

For example, footballers have contracts worth millions. What kind of doping is involved in their case?

Football is not a sport in which anti-doping rules are frequently violated. From the 2018 WADA report, we can learn that the largest number of competitors caught doping was bodybuilding (21%), cycling (17%) or athletics (15%). Footballers accounted for only 4 percent. in this group. I think it is because football is a sport in which you cannot “help” yourself very much. It’s a technical discipline that requires team play.

Statistically, footballers are most often caught using drugs, marijuana. FIFA data from 2011 shows that out of 28 thousand. 587 samples, only 19 were positive (0,07%), indicating the use of adjuvants. Another 40 samples tested positive for marijuana.

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3. Cardboard beds and plexiglass lunches. A doctor of the Polish team about the Olympics in a pandemic