An athlete’s dilemma

Taking any medication is a double-edged sword. While medicines are lifesaving drugs, they also have the ability to enhance performance of an athlete.

Cutting out the risk: While choosing the medication, one has to make sure he takes exactly the one prescribed by the doctor.

Weightlifter Sathish Kumar Sivalingam gave India a brilliant start, winning the gold medal in the men’s 77 kg category at the 2018 Commonwealth Games in Gold Coast. But what many don’t know is that he was sick nearly three weeks before the Games with high fever, cold and body ache. The first thing Sathish asked me was what he could take to bring down the fever.

Taking any medication is a double-edged sword. While medicines are lifesaving drugs, they also have the ability to enhance performance of an athlete. Today doping or consuming a banned substance, as defined by the World Anti-Doping Agency (WADA), is tantamount to cheating.

Over the years, athletes have tried to win by illegal methods using drugs. But today, with stringent testing, athletes can be caught even at a later date as samples are stored for future testing.

1. What can one do to avoid a positive test from a medication?

There are two ways of obtaining medication: by prescription from your doctor, or off the shelves of a drug store or pharmacy. Anytime you need a prescription, you must remind your doctor that you are an athlete and are subject to anti-doping regulations. Your doctor should ensure that the medication prescribed does not contain any banned substances. If your doctor is unable to determine this, then the decision should be taken in consultation with your National Anti-Doping Organisation (NADO) or with a competent pharmacist/sports nutritionist.

If you need to take a medication that does not require a prescription (commonly referred to as ‘over-the-counter’), it is highly recommended that you consult NADA (National Anti-Doping Agency) or you show the Prohibited List to the doctor/sports nutritionist and ask for help before you decide on buying the medicine.

While choosing the medication, make sure that you take exactly the one that was recommended. Some brands offer multiple variants of the same product (e.g., non-drowsy, fast relief, extra strength, long lasting), and with the formula being different for each, there is a real risk that one of them could contain a prohibited substance.

2. What if the only medication to treat your medical condition contains a prohibited substance?

The World Anti-Doping Code (Code) recognises the right of athletes to the best possible treatment for any medical condition. If you are in need of medication, please contact NADA to find out more about the criteria and procedures to apply for a Therapeutic Use Exemption (TUE). Before applying for a TUE, it is recommended that you consult your doctor to consider possible alternative treatments that do not involve the use of a prohibited substance or method. If such an alternative treatment exists, your TUE request will likely be denied and the whole process can only delay your recovery.

3. If you fall sick, and your next competition is scheduled in two weeks, how long will it take for medications to be eliminated from your body?

The time someone’s body takes to get rid of all traces of a substance depends on the nature of the substance and quantity taken, the individual’s metabolism, the administration method, and on a number of other factors such as quantity of liquids consumed, interaction with other ingredients in the same medication, or other substances ingested. In essence, there is no general rule, and the delay can vary from a few hours to several months.

More importantly, since you are also subject to out-of-competition testing, the fact that you will not compete in the next two weeks does not preclude the possibility of being tested by then.

4. What should you do if you fall sick while travelling in a foreign country?

Medications are usually commercialised under different names in different countries, and even if they have the same brand names, they may have a different composition in order to respect each country’s laws on the availability of certain substances. In one country, a product may be safe to take from an anti-doping perspective, while in another country the product sold under the same name may contain a prohibited substance.

Before using medications purchased in a foreign country, it is best to consult your team doctor for advice on what to do. One way to prevent such a situation is to bring with you, as part of your travel kit, small doses of medications from home that you know are safe to use and that you anticipate may be required during your stay abroad (e.g., for pain and fever, allergy, common cold, stomach aches, skin infections etc.). Before bringing any medication into a foreign country or bringing one back home from abroad, it is wise to check whether customs regulations would allow you to do so. Ensure that you do not carry any substance that is illegal at your destination.

5. Should you worry about creams, eye drops and other medications that you do not need to swallow?

You certainly should. Prohibited substances come in different forms and shapes and they may enter your body in different ways: through contact with your skin (creams and ointments), by inhalation (if you breathe in the vapour or mist), by contact with a mucus membrane (eye or ear drops, suppository, etc.).

Any medication applied to your body will likely enter your system to act in the way that is intended (reduce inflammation, relieve pain, kill bacteria, etc.), and will be present in your blood before eventually being eliminated by the kidneys and will turn up in your urine.

6. What about homoeopathic products and alternative medicine?

As is the case for nutritional supplements, in some countries homoeopathic products, herbal remedies and other alternative medicine are not subjected to the same quality control requirements as pharmaceutical products. Therefore improper labelling, poor manufacturing and contamination can cause prohibited substances to be present without the consumer knowing it.

Homoeopathic products are usually very low in concentration of active substances. However, since the label usually does not specify ingredients by chemical substances but rather by origin (name of plant or animal it is extracted from), it is difficult for anyone to determine whether a prohibited substance may be present. In addition, athletes have to be careful about any home remedies that have found a place in the family tradition or cultural lifestyle. Many such concoctions are derived from herbal products and some prohibited substances do originate from plants. Remember, under the strict liability principle, it does not matter how or why a prohibited substance entered an athlete’s body. Athletes are responsible for everything that goes into their body.

7. What happens if your test result is positive because you used medication without knowing that it contained a prohibited substance?

Under the overarching principle of strict liability in effect under anti-doping regulations, as an athlete you are ultimately responsible for everything that goes into your body, whether it was recommended, prescribed, or even provided by someone else. If an athlete tests positive, the result is a disqualification, and possible sanction or suspension.

8. Is there a list of medications that do not contain prohibited substances?

To maintain current information with respect to prohibited substances on all products manufactured by the pharmaceutical industry is very difficult. Several tools and publications exist for this purpose.

At Qua Nutrition Clinics we have access to an index of pharmaceutical products clearly stating which medications are allowed and which are not in sports. It is updated every year. This is how we help any athlete in-season or off-season when he falls sick.

However it’s a very strange world with even food supplements sometimes having banned substances in them. They are created for the Bodybuilders which is a non-tested sport. These products leak into competitive tested sports domains.

Any athlete can get the banned substances list at https://www.wada-ama.org/en/content/what-is-prohibited

To get year round advice for your diet, supplements and medication enrolling on a sports nutrition program will significantly help in not falling sick, recovering quickly using food supplements that are legal and getting advice in conjunction with your sports doctor on best practices for your intakes.

Email ryan@quanutrition.com to get a list of medications when you fall sick.