Prohibited supplements: how not to get a positive test

Every year anti-doping organisations consider cases of athletes who insist they took nothing but «ordinary supplements». Some of them are telling the truth: a protein, a pre-workout complex or a «testosterone booster» really can contain prohibited substances not listed on the label. The editorial team explains where this risk comes from, which ingredients are most dangerous and how to minimise the likelihood of a positive test by legal means.

Strict liability: why «I didn't know» does not help

The foundation of anti-doping law is the principle of strict liability, enshrined in Article 2.1 of the World Anti-Doping Code. Every athlete is personally responsible for any prohibited substance found in their sample. To establish a violation, there is no need to prove intent, fault or negligence.

In practice this means: if a supplement contained a prohibited substance not stated on the label, the athlete has violated the rules all the same. The question of fault arises only at the stage of determining the sanction. It is here that the athlete can prove that the substance entered the body through a contaminated product and count on a reduction of the disqualification term.

The 2021 Code separately regulates the situation with contaminated products (Article 10.6.1.2). If the athlete proves no significant fault and that the substance came from a contaminated product, the sanction may range from a reprimand to two years' disqualification. But the burden of proof lies with the athlete, and this requires concrete evidence.

The key word is «concrete». What is needed is product residues, preferably from the same batch, a laboratory analysis confirming the presence of the substance, and consistency with the concentration in the sample. Without this, the argument «it was a supplement» has no chance.

How widespread supplement contamination is

The most famous study of the problem was carried out by the Cologne anti-doping laboratory on behalf of the IOC. Geyer and co-authors (2004) analysed 634 dietary supplements from 215 suppliers in 13 countries. In 94 products (14.8%) they found undeclared prohormones — precursors of anabolic steroids capable of causing a positive test.

Further work by the same group (Geyer et al., 2008) described not only accidental cross-contamination in production but also deliberate adulteration: the addition to products of metandienone, stanozolol, stimulants and other active substances in pharmacologically significant quantities. Such products «work» precisely because they contain undeclared preparations.

The problem is not limited to sports nutrition. Cohen and co-authors (2014), in a study in JAMA, showed that a significant proportion of supplements that the FDA had recalled because of the content of prohibited pharmaceutical substances continued to contain these substances on sale half a year and more after the recall.

It is important to understand the scale: for a positive test, microgram quantities of some substances are enough, while the manufacturer may not even know about the contamination. Modern laboratories have very high sensitivity, so «trace» quantities that were previously undetectable now become grounds for a case.

Red-list ingredients

Some substances systematically appear in anti-doping cases linked to supplements. Some of them are listed on the label, but under little-known or botanical names that the athlete does not recognise as prohibited.

Special attention should be paid to «plant extracts». Plant origin does not mean permissibility: ephedra contains ephedrine, some plants contain higenamine. A label with Latin plant names should put you on guard.

Caffeine, creatine, beta-alanine, sodium bicarbonate, protein and most vitamins are not prohibited. Caffeine is only in WADA's monitoring programme. However, a product with these components may be contaminated with other substances, so not only the composition but also the manufacturer matters.

Finally, one should remember threshold substances. For ephedrine and methylephedrine the limit in urine is 10 mcg/ml, for pseudoephedrine — 150 mcg/ml. Exceeding it is possible even when taking ordinary cold medicines shortly before a start.

Certification and product choice

No system gives a hundred-percent guarantee, but independent certification substantially reduces the risk. The IOC consensus statement on dietary supplements (Maughan et al., 2018) recommends that athletes subject to testing choose products that have undergone batch testing for prohibited substances.

• Informed Sport— testing of each product batch before it goes to market; the batch number can be checked on the programme's website.
• NSF Certified for Sport— checking for the content of prohibited substances, correspondence of the composition to the label, and a production audit.
• The Cologne List (Kölner Liste)— a list of products whose batches have been tested in a specialised laboratory.

It is the batch number, not just the brand, that should be checked. Certification applies to specific tested batches, and the presence of a logo on the seller's website does not yet guarantee that your particular tin passed the check.

A practical tip: for athletes who undergo doping control, it is sensible to minimise the number of supplements. Before buying a product, it is worth asking yourself whether there is an evidence base for its effectiveness. If the benefit is doubtful and the risk of contamination is real, the rational decision is obvious.

We warn against products with aggressive marketing: promises of «an effect like steroids», «legal anabolics», rapid fat burning. It is precisely in this category that undeclared preparations are most often found.

The athlete's checklist and what to do in case of a problem

The risk can be minimised with simple habits. The editorial team has gathered the main rules used by sports doctors and nutritionists who work with athletes subject to testing.

1. Use only those supplements that are really needed, and discuss them with a doctor or nutritionist.
2. Choose products with independent batch certification.
3. Check every ingredient, especially plant extracts, against the Prohibited List or in the databases of national agencies.
4. Avoid «proprietary blends» without an indication of the amount of the components.
5. Do not buy supplements privately, on marketplaces without a guarantee of origin, and do not take «something without a label» from other athletes.
6. Keep receipts, packaging and, ideally, a small quantity of the product from each batch.
7. Record the supplements taken on the doping control form.

If you have received notification of an adverse analytical result, you must act quickly and systematically. Do not throw away supplement residues and do not change anything in the packaging. Contact a sports law lawyer and consider the possibility of an independent laboratory analysis of the products.

It is also important to be consistent in your explanations from the very first contact with the anti-doping organisation. Contradictory versions at different stages substantially reduce trust in the contamination argument.

Finally, remember that medicines too can contain prohibited substances. If treatment is necessary, check the preparation and, if needed, obtain a therapeutic use exemption in advance.

Editorial conclusions

The principle of strict liability makes the athlete responsible for everything that enters their body, even if the prohibited substance was not stated on the supplement's label.

Supplement contamination is a documented problem: in the IOC study almost one product in seven contained undeclared prohormones. The greatest risk is pre-workout complexes, fat burners and «testosterone boosters».

Independent batch certification, minimising the number of supplements and keeping evidence are the most effective means of protection.

We also recommend reading our articles on the therapeutic use exemption, on appeals in doping cases and on doping in crossfit.

References

1. Geyer H, Parr MK, Mareck U, Reinhart U, Schrader Y, Schänzer W. Analysis of non-hormonal nutritional supplements for anabolic-androgenic steroids — results of an international study. Int J Sports Med. 2004;25(2):124–129.
2. Geyer H, Parr MK, Koehler K, Mareck U, Schänzer W, Thevis M. Nutritional supplements cross-contaminated and faked with doping substances. J Mass Spectrom. 2008;43(7):892–902.
3. Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018;52(7):439–455.
4. Cohen PA, Maller G, DeSouza R, Neal-Kababick J. Presence of banned drugs in dietary supplements following FDA recalls. JAMA. 2014;312(16):1691–1693.
5. World Anti-Doping Agency. World Anti-Doping Code 2021 (Articles 2.1 and 10.6). Montreal: WADA; 2021.
6. World Anti-Doping Agency. The Prohibited List. Montreal: WADA; чинна редакція.