Enzo Maccarinelli and another boxing positive test

Enzo Maccarinelli takes a "fat burner" and got banned from boxing for six months.  Yet the supplement claimed to be athlete safe. I am sure this was an accident as Enzo says -  he is even seeking to sue the magazine that advertised the product. But it raises some questions about the whole supplement industry.


The banned stimulant found in the supplement in question was methylhexaneamine; as I show in my book this is rapidly becoming the new "nandrolone", at least in so much as many athletes are getting caught by taking nutritional supplements laced with this compound and hence suffering a positive doping test. 

So what was this boxer thinking about? Very few drugs can burn fat. If a supplement works as a fat burner, it is almost certainly going to contain a banned substance. Or it will be very dangerous. More likely the fat buying moniker is just industry hype aiming to sell a product.

So to summarise: the pill probably doesn't work; if it does work it will be dangerous and/or get you banned. Not a clever idea for an experienced boxer to get involved here, especially one who also trains 40 young boxers.

For the purposes of being balanced to the supplement industry I should take 5 minutes to give their side of the argument. "Fat burners" are popular with body builders. They claim to contain compounds that activate uncoupling proteins.  Uncoupling proteins can indeed burn fat with no gain in energy to the body. But we should be cautious. The slimming industry is a much larger market than the body building world. Not surprisingly a high amount of pharmaceutical and medical research money has gone into trying to produce a safe compound that activates uncoupling proteins. No one has succeeded.

What about Maccarinelli? Dexaprine is the compound he claimed to have taken. It contains “iiodo-thyronines”. This is a word meant to sound like "iodothyronines", which are thyroid hormones. Thyroid hormones do indeed increase the body's metabolic rate, possibly by activating uncoupling proteins. So the manufacturers use a plausible argument. But there is one fatal flaw. Thyronines are proteins. They readily get digested in the gut. Taking iodothyroanine in a pill form is like taking EPO or human growth hormone in a pill, rather than injecting it. It just won't work.

There is only one way to "burn fat" in a pill form. It is called dinitrophenol, a compound that is used effectively by bodybuilders. As I explain in the book this was a very successful slimming drug given by doctors in the easy part of the 20th century. But some patients had an unfortunate side-effect: DEATH. Dinitrophenol became the very first drug ever to be banned by the US Food and Drug administration. Do not try this at home!

When I read all this hype in the supplement industry, it almost makes me feel sympathy with those who dope. At least they are using stuff that actually has a chance of working .........

Frank Schleck’s Tour de France drug test – what is xipamide anyway?

In one sense there is not much to say about Frank Schleck’s positive drug test (of his A sample only at the time of writing). Xipamide is not likely to enhance performance in its own right; it is banned as it could “mask” the use of other substances that are effective. Xipamide is a diuretic; it makes you urinate more. It therefore has the potential to affect the metabolism of another banned substance. You pee more and so all the drugs in your body are expelled faster.

Xipemide is a drug in current clinical use and so there could be medical reasons for taking it. Hence it does NOT lead to an immediate outright ban with no questions asked. But an athlete does need to explain why it is in his/her body in order to get away with just a slap on the wrists. If Schlek’s B sample does turns out positive it would be nice to know what really happened here. Though I doubt anyone will tell.

I am always somewhat surprised about why these sort of compounds are used. Drug metabolism rates are so individual that it is possible you are just adding to your chances of being caught by taking two banned substances. Were I to be a doper-in-chief I would want to measure the metabolism of both the performance enhancing drug and the masking agent, before deciding whether to risk this. Fortunately this sort of precision is only possible with the connivance of a testing lab. This used to happen in the bad old days of the East German state-sponsored doping; then the while team was pre-tested to ensure that the anabolic steroids they had taken were undetectable prior to competing at the Olympics. But I think it is an unlikely occurrence now.

As for xipamide? It will now return into obscurity. Apart from one footnote: every patient who searches the internet in order to find out about the drug used to treat their fluid retention will now have to wade through a mass of cycling stories at the same time…..

Drug cheating at the Olympics: who, what, and why?

I've written a "state of the union" article about where I feel drugs in sport are at these Olympics.

It is in the premier medical journal "The Lancet" and can be downloaded here

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61114-3/fulltext

Doping at the Tour de France

In time for the Tour, the US political magazine covered my essay on the ethics on drugs in sport. They were pushing for a much stronger pro enhancement line. I tried to write a balanced essay with a twist at the end. You can find the edited piece at

http://www.tnr.com/blog/plank/104528/should-we-allow-doping-in-the-tour-de-france-or-all-sports

I will post my original version later.

Jack3d – not worth the risk in all sorts of ways

Dimitar Kutrovsky, the Bulgarian tennis player, has just been found guilty of doping and banned for two years for using a banned stimulant ^{1, 2}. The drug in question is 4-methylhexan-2-amine, (otherwise known as methylhexanamine, 1,3 dimethylamylamine, DMAA, DMP, Forthane or Geranamine amongst other sobriquets). In 2010 it earned the moniker “drug of the year” on Ross Tucker’s science of sport web page ³. As noted in my book, at the time it was in danger of becoming the new nandrolone, in that it was a drug that was triggering a spate of positive doping tests at least in part due to its presence, labeled or otherwise, in supplements taken by athletes.

So what is methylhexanamine? Originally trademarked in 1944 as a nasal decongestant, it was repackaged in 2006 as part of a sports supplement by one Patrick Arnold, the same chemist who synthesized the “undetectable” steroid THG that Dwayne Chambers took. Like most decongestants that are taken to relieve cold or flu symptoms methylhexanamine also has stimulant properties. In some parts of the world, such as New Zealand, it has been used recreationally as a party pill.

Methylhexanamine is an ingredient in many products that claim to improve performance. For example Jack3d – the product Kutrovsky took – is aimed at bodybuilders. It is worth noting that no one has shown any performance benefit for methylhexanamine – in fact I am unaware of any scientific performance study at all on this drug. It was originally “marketed” in part due to its supposed similarity to ephedrine, a stimulant that is now available only on prescription due to concerns about its safety. It is worth noting that, unlike methylhexanamine, the performance effects of ephedrine have been studied but are less than impressive.

The wheels seem to be coming off the methylhexanamine train. Like ephedrine the authorities are concerned about its safety. It seems to be able to restrict blood flow centrally, not just peripherally, with a consequent increase in blood pressure ⁴. It has recently been banned as an ingredient in supplements in New Zealand. In the USA the influential Food and Drug Administration have not banned it outright, but they have called on the manufacturers to prove it is safe ⁵; this is likely to amount to the same thing, as supplement manufacturers don’t have the resources or expertise to undertake the relevant clinical trials.

So this drug is on the banned list, it has no proven performance benefits, it is potentially harmful to health and is readily detectable by the anti doping agencies. If I was of a humourous bent I would tell all athletes thinking of using it to Jack it in…….

1 Thanks to University of Essex student, Tom Green, for bringing this story to my attention

2 http://m.atpworldtour.com/News/Tennis/2012/05/Features/Kutrovsky-Decision.aspx

3  http://www.sportsscientists.com/2010/12/drug-of-year-methylhexanamine-and.html

4 http://www.ncbi.nlm.nih.gov/pubmed/22030947

5 http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm302133.htm

Boxing’s latest doping scandal

I am writing from the country that is bringing you the David Haye/Dereck Chisora fight at Upton Park¹, courtesy of the world renowned Luxembourg Boxing Federation. It is hard to know what to think about professional² boxing as a sport. Perhaps its best just to admire its chutzpah in driving through whatever scandal might get in the way of – or in fact enhance – the pot of money at the end of its blood coloured rainbow.

When it comes to drug testing, professional boxing is essentially unregulated. There are usually tests at each fight and sometimes before; the details can form part of the negotiating process. But there is no out of competition testing. Given the length of time between many fights (sometimes as long as six months) it is hard to believe that the sport is drug free. 

The most recent scandal involves US boxer Lamont Petersen. Peterson controversially beat the British boxer Amir Khan to win the WBA and IBF light welterweight titles in December 2011. As part of the rematch scheduled this month the Peterson camp suggested the two fighters agree to voluntary drug testing. Peterson has just failed his test and the fight has been cancelled. The Shakespearean phrase “hoist with his own petard” springs to mind.

The nature of this failed drug testing is intriguing. Let’s leave aside the fact that you have to work quite hard to fail a drug test that you initiated and which you know could only be taken in a short time window. Or the irony that one of the chief supporters of the drug-testing agency used – VADA³ – is Victor Conte, the BALCO chief who supplied the drugs that UK sprinter Dwain Chambers was caught using. What about the science?

Peterson tested positive for “synthetic” testosterone, an anabolic steroid.  This is the same compound that Floyd Landis  - the disgraced Tour de France winner – was banned for.

Why testosterone? Well testosterone is the human anabolic steroid. Although it is not the optimum steroid to take for performance, athletes use it in the hope that it can’t be distinguished from natural testosterone in a doping test.

Why synthetic? Purifying natural testosterone from human or other animals would be extortionately expensive (in the book I note the heroic attempts in the 1930s to isolate testosterone; the starting materials varied from 20 kg of bulls’ testicles to 15,000 litres of German policemen’s urine). Nowadays a steroid from soya beans called Diosgenin can be purified cheaply in large quantities – this can then readily be turned into testosterone in a chemistry laboratory.

The problem for Peterson is that – even though its molecular structure and muscle building activity is identical to the testosterone we produce in our own bodies – the synthetic version contains a clue as to its specific plant origin. This clue is the carbon isotope ratio (CIR). Carbon is the atom that is the backbone for all the molecules in our bodies. Mostly it has a mass of 12 (C12). But a small percentage of carbon atoms are heavier, with a mass of 13. (C13). We get all our carbon from the food we eat. So the ratio in our body is the average of all the plants we have eaten (either directly or via the plants that the animals we eat have themselves eaten). The normal human ratio is 98.9% C12 and 1.1% C13. But soya beans have a slightly different ratio of 99.0% C12 to 1.0% C13.

A machine called an isotope ratio mass spectrometer can measure this ratio in the testosterone from an athlete’s urine sample. Hence the presence of the banned synthetic testosterone can be detected over and above the body’s normal testosterone. A CIR test is expensive and is only done by WADA for confirmation when testers are already suspicious of a sample (as was the case for Floyd Landis⁴). But VADA pride themselves on doing this test on all samples. This is the test that tripped Peterson up.

Could Peterson have avoided being caught by the test? Yes, if he paid someone to make testosterone from a human or animal starting material.  But this would be extortionately expensive. There is one other possibility. As it is the presence of two different carbon ratios that is the clue to the doping, changing your diet might fool the test. First the good news I’ve passed the test; now the bad news, I had to eat only soya beans for the three months before……..

1.   Upton Park is the current home of West Ham football club who won the original bid to take over the Olympic Stadium. In my fantasy alternative universe with a two-year time lapse the fight could have been the first post Olympic event in this stadium.

2.   In contrast Olympic boxing (the 3 round version) has to obey all the WADA drug testing rules.

3.  VADA uses WADA approved laboratories so the test result itself is robust

4.  Click here for a nice link to the Landis case.

Presbyterian minister and blood doping

Another minister and doping story (see my April 23 blog), but this time the minister is of the religious persuasion.

Anti-doping agencies have a “strict liability” rule. If a drug is in your body you are guilty. The authorities don’t have to prove how it got there. Therefore “false positive” tests are a huge problem in developing a new test. The example I give in my book is of a test for gene doping that is accurate 999 out of 1,000 times. This is much better than the usual statistical tests that scientists use. If the 1 in 1,000 chance is of missing a cheat (false negative) this might be acceptable. However, it is unacceptable if the 1 in 1,000 chance is of catching an innocent (false positive). This is because doping tests are not used to confirm whether someone is cheating; in this case a 1 in 1,000 error would probably be considered “beyond reasonable doubt” by a jury. Instead they are the primary way of catching someone in the absence of any other evidence. A statistical calculation shows that for a 1 in a 1,000 chance of a false positive result, it would only take on average 693 tests to convict an innocent person. To put this in context, London 2012 will conduct over 6,000 drug tests.

We can relate this idea to our own lives by thinking of what might happen when we see a doctor. Say she gives us a test for a fatal disease that affects 1% of the population. The test is 99 percent reliable; so 99% of people who have the disease test positive and 99 percent of those are healthy test negative. The doctor gives you a test and it comes back positive. How worried should you be? How likely are you to die? The immediate thought is that you are 99% likely to die. Start writing your will and putting your affairs in order now. In fact the answer is that your doom is only 50% likely. You still have a chance.

The statistical tests that are used to make these calculations are based on Bayes's theorem. Thomas Bayes was an 18^th century English mathematician and Presbyterian Minister based in Tunbridge Wells in Kent. In an essay published posthumously he devised a theory that used prior knowledge of a distribution to determine the likelihood of a subsequent event being correct.

What has this got to do with doping? Well Bayesian probability underpins the test for blood doping used in the athlete’s blood passport¹. Upon being enrolled in the passport program, the athlete gives blood regularly. At first it is assumed that his blood parameters are the same as the general population. As more tests are taken a statistic is calculated that is biased towards the individual parameters of the specific athlete. The athlete becomes his own control. If his blood deviates from his own normal readings, such as might happen following EPO doping or a blood transfusion, he can fail a doping test even if no specific doping product is found in the blood.

This is not an academic question. Last week saw the very first successful prosecution of a runner for blood doping via the use of a biological passport. A four-year ban² was given to the Portuguese marathon runner, Helder Ornelas, solely for anomalous readings in his blood passport during the 2010 season.

We may be entering a new era in anti-doping (although see my April 3 blog for a different view).

¹ you want to find out more about the biological passport and Bayesian theorem in layman's terms, check out these links:  Biological Passports; Bayesian probability.

²  At 38 years old any ban effectively ends Ornelas’s career. The unusually long ban for a first offence in this case suggests that the authorities may be trying for a deterrent effect; they want the dopers running scared of the passport system.