Supplements and anti-doping

With a few high profile doping cases recently gone through appeals hearings, now is a good time to revisit the area of anti-doping, particularly in relation to adverse findings as the result of contaminated supplements.

Strict Liability

The first point to reiterate is the notion of strict liability.  This means that the athlete alone if responsible for what is found in their bodies.  There have been a number of cases where athletes have failed drug tests without knowingly taking a banned performance enhancing substance.  The consequences in these cases, if a non-specified substance (generally substances which have limited performance enhancing benefits), is, by default, a two year ban, which in some cases gets reduced to 6 months.

Why do Supplements Carry a Risk?

Food supplements are not subject to the very strict monitoring that medical drugs are.  Because of this, they can contain just about anything!

• They can contain substances that are not listed on the label.
• Substances can be named under a very different name to that which appears on the WADA code
• They can be manufactured in the same factories as products which contain banned substances, and become contaminated.
• Products say that they are 'approved' and athletes believe that that makes them ok to take.
• The 'sports nutrition' industry is a lucrative business. They give products to high performance athletes in return for endorsement.  Athletes like getting free stuff, and all of a sudden the perception is that you can't perform without taking a range of products.

Current Position

Until recently, the advice from UKAD was not to take any supplements.  That made life a lot easier from the perspective of the Anti-doping advisor perspective. You could just tell an athlete that the advice was not to take anything, and then they could choose to heed that advice or not.  Things have changed in recent years, and while UKAD cannot endorse any products, they now give advice based on the likelihood that athletes are going to take supplements anyway, and the current approach is based on risk reduction rather than elimination.  This is fine, and their advice is sound, but in the absence of any information relating to products (or types of products) which carry a high risk, have been linked with positive tests in the past, or which contain banned substances, it's very difficult to hammer home to athletes just how seriously they should be taking the whole matter.  In the ten or so years that I have been involved in advising athletes, the only product I have really seen named is JACK3D, a product which is now banned for sale in the UK and Ireland ...

Positive Moves

... Or at least that was until I saw this recent announcement from the Australian anti-doping body.  In it they name three products which have been shown to contain banned substances, and advise against certain groups of supplements.  They recommend taking special care with weight-loss supplements and with supplements claiming to improve mental performance.  This level of information is very useful when educating athletes.

I have also since noticed that the body responsible for anti-doping in the US (USADA) has a list of high risk supplements - details of supplements which either list banned supplements or have been found to contain banned substances.  Of course this list is by no means complete, but can give some indication to athletes the level of precaution they need to take.  The list includes Ephany D1, the vitamin/mineral/herbal supplement which was blamed for Asafa Powell's failed drug test.

Removing some of the Grey Areas

I find it bizarre why athletes would need to take weight-loss supplements, or to 'get them up' for training or competition.  A wise man - the man who thought me everything I know about athletics - once (or 100 times) told us that if it doesn't work, it's a waste of money and if it does work, it's probably illegal. While this may not be completely true, it's been a good motto to live by.  For me, anti-doping has nothing to do with being caught.  I would hate to look back in a few years and not be able to say that what I achieved in sport, no matter how pitiful, was 100% me.  For me, too many grey areas are created by our fixation on rules and what you can get away with.  Performing clean should be about much more than that.

What Athletes Should Do

Consider the need - Despite the claims, few food supplements actually legally help improve performance, and none make up for poor nutrition.  Consider what changes you can make to your diet, before you resort to any nutritional supplement.  Only take supplements that you actually need.

Consider the risks and the consequences - Some of the risks associated with nutritional supplements are listed above.  From January 2015, first-time doping offences, where there was an intention to cheat, will result in a 4 year ban. The onus will shift to the athlete to prove that there was no intention to cheat.  It is highly likely that more inadvertent doping offences for non-specified substances than before will result in 2 year bans. But think beyond the bans and tangible consequences of inadvertently using a supplement that's found to contain a banned substance.  Consider how you would feel if someone told you that that harmless looking 'endurance enhancer' that you have been using for the last 2 years contains EPO, and that your performances have been artificially enhanced, or that the 'herbal' supplement that you have been using to help shift a few pounds actually contains amphetamines, and has been damaging your health.

Do what you can to reduce the risk - While no anti-doping body can 100% guarantee that a produce does not contain a banned substance, some products sign up to undergo rigorous testing, and those which have not been found to contain substances are listed on sites such as Informed-Sport.  

• Check that any products that you plan on using have undergone this testing.  
• Check what other products are made by the same company/in the same factory - there is an increased risk of contamination if made in the same factory as products which contain banned substances.  
• Do some online research to see if the product has been linked with any doping cases in the past.  
• Check any active ingredients against drug databases (Global Dro in UK; Eirpharm in Ireland).
• Keep all packets and samples of the product, so it can be tested if you have a case to answer.
• If you are chosen for a test, ensure that you list all products that you are taking on the doping declaration form.  It's very difficult to claim that the adverse finding was for a supplement that you hadn't declared you were using.

Training and competing in the Heat - what can you do to help?

As Britain enjoys one of the warmest summers I remember, I was asked the question, 'how does heat effect your training and what can you do to help your training and racing in the heat?'

One of the main effects of heat is an increase in perceived effort and the decreased motivation to go out and perform. Training or competing seem much harder and therefore times can suffer either in training or competition.

But what are the physiological effects of the heat?

The main ones are:

• Dehydration
• Increased Heart Rate
• Reduced Blood Flow (and subsequently oxygen) to the working muscles.

Dehydration - I have already covered dehydration and why and what we should drink in a previous posts. But why does the risk of dehydration increase as the environmental temperature increases? 

Thermoregulation is the body's way of maintaining a consistent internal temperature, vital for bodily functions which keep us alive.  One of the ways that the body looses heat is via sweating, with the rate of evaporation linked to how well the body is cooled and the atmospheric humidity. When humidity is low evaporation increases, when humidity is high the rate of evaporation decreases and less cooling occurs.

Sweating leads to fluid loss, and dehydration occurs from the inadequate replacement of fluids. It is thought that every 2% loss of body weight through sweat can lead to about a 4-6% decrease in performance.  If this fluid is not replaced an athletes blood volume decreases, less blood returns to the heart and less oxygen rich blood reaches the muscles. You produce less energy aerobically and you run slower for a given effort level.  As it gets hotter, this effect is increased. The more heat that needs to be dissipated, the greater the proportion of blood diverted to the skin.

What can you do?

Training in itself provides some adaptation to the heat. It increases the total plasma volume which is why the fittest athletes (and likely those with the highest plasma volume) typically adapt more easily to the heat and perform better.

Regular training in the heat can result in it becoming easier to maintain a faster pace and reduce perceived exertion by increasing blood plasma volume, increasing sweat rate, reducing heart rate at a given pace and speeding up the onset of sweating. These adaptations make it easier to perform in the heat and can be noticed after only a week or two of heat exposure.  Training in the same temperatures as you would be competing at can have a massive positive affect.

Heat also effects intensity. Some athletes may benefit from moving training focus away from a certain time goals to running at an equivalent efforts. Sessions could be moved away from a track, to make it easier to pay attention to feel and perceived exertion rather than split times

What can you do for racing in the heat?

• Adjust preparation - increase the layers in training to replicate warmer temperatures when you race. I have known triathletes preparing for Kona do bike sets next to a radiator with additional layers to prepare themselves for the heat they could expect when they race
• Increase fluid and electrolyte intake in the days prior to racing to make sure you are hydrated
• Stay as cool as possible before the race (sponges)
• Perhaps have a shorter warm up
• Pay more attention to perceived effort rather than race splits 

The other bit to recognise is the signs and symptoms of heat stroke:

• Headache
• Dizziness and light headedness
• Lack of sweating despite exercising in the heat
• Dry Skin
• Muscle weakness or cramps
• Nausea and Vomiting

If you do train in the heat and experience any of the above, try to get in a cool environment and drink plenty of water.

Mental Health and Sport

This week, Maudsley Learning, in association with the Register of Personal Development Practitioners in Sport (RPDPS) will be running a conference on mental health in sport.  The event, entitled Game Changing in Mental Health: Tackling Stigma and Building Resilience in Elite Sport*, tackles a very important issue in high performance sport, and promises to be an excellent conference.  Unfortunately,due to other commitments, I won't be able to attend, but I did take part in a webinar (Mental Health in Sport: Kicking Stigma Into Touch) that they ran in preparation for the event a few weeks ago.  That prompted me to revisit the whole area of depression and mental illness in sport, something which we first blogged about in November 2012.

Our original blog post looked at the causes and symptoms of depression, but there is so much that we don’t know, and so much more that can be done to help prevent and manage mental illness in competitive sport. One of the biggest take-home messages from the webinar for me was the comparison between psychology and psychotherapy and the need for both in sport.  The second speaker (Nick Peters, Clinical Psychotherapist and former Professional Cricketer) spoke of how through sports psychology, athletes are trained to avoid and dispel all negative thoughts and to remain in a positive state of mind at all times on the playing field, in order to maximise performance.  The area of mental health, however, requires us to embrace negative thoughts, confront our anxieties, and learn to manage strong emotions.  An athlete who suffers from mental illness, isn’t physically or even psychologically weak.  They just haven’t sufficiently developed the coping mechanisms to deal with everyday emotions, fears and anxieties. Many elite athletes may take the pressures that come with performing on the world’s greatest stage in their stride, but putting simple plans in place to ease the retirement transition, or even thinking about life after sport, may be a step too far.  In an environment where maintaining positive composure is so important, is it any wonder that athletes are so inept with dealing with everyday emotions, fears and anxieties?

Currently, there is a lot of focus is on ensuring that athletes have support structures in place when things go wrong, and that is a very positive move.  However, there is an argument that all athletes, even with no symptoms of mental illness, could benefit from training to manage their mental health.  Afterall, if prevention is better than cure in relation to the physical body, it definitely true for the mind.

In recognition of the role of prevention, some organisations have implemented prevention programmes, and some spend time delivering workshops to clubs.  This is in addition to a range of organisations that deal with the symptoms.  Below is a summary of just some of the groups and organisations which run prevention programm, help those suffering from distress, depression, eating disorder, addiction or other mental or psychological illness, raise awareness, or provide information or training for those in contact with vulnerable individuals.  Some, but not all, are specific to sport:

ANYONE IN DISTRESS 

The Samaritans - UK & Ireland - www.samaritans.org - 08457 909090 (UK) / 116123 (free from ROI)

The Samaritans is charity which works across 201 branches in the UK and Ireland helping anyone in distress.  Though suicide prevention is one of their main aims, individuals don't have to be suicidal to contact them.  In fact, their website states the the majority of their callers are not suicidal.  Individuals in distress can contact by phone, email or in person.  Their website includes links to other sources of help for addiction, bereavement etc.

DEPRESSION AND MENTAL ILLNESS

Maudley Learning - UK - www.maudsleylearning.com - @MaudsleyLearn
Maudley Learning is a UK-based organisation which aims to 'support and provide world class and accessible learning in mental health and wellbeing. 

State of Mind  - UK - Rugby League - www.stateofmindrugby.com - @SoMRugbyLeague;

State of Mind is an organising which works to improve the mental health, wellbeing and working like of rugby league players and communities.  After realising that the incidence of suicide was higher not only in rugby league players, but also in fans and communities (compared with the general UK population), the organisation began to work to use the sport to reach out to larger communities and increase awareness and help reduce the incidence of suicide in fans and communities.  Check out their 10 practical ways to look after your mental health. 

Opening Up Cricket - UK (NorthWest) - Cricket - www.thecalmzone.net/get-involved/opening-up/ - @OpeningupCC
Opening Up cricket is a projected launched as the result of the tragic passing of Sefton Park's Alex Miller. This dedicated and cricket focused group publices the work of CALM within cricket, and delivers short mental health support sessions to cricket clubs in the North West of England. 

The Campaign Against Living Miserably (CALM) - UK - www.thecalmzone.net - @theCALMzone
CALM specifically targets suicide prevention in young males by offering support helpline support to men of all ages who are down or in a crisis, challenging the culture which prevents men for seeking help, and working with other organisations to push for changes in practice and policy. 

Aware - Ireland - www.aware.ie - 1890 303302
Aware is a large Irish-based charity which provides depression-related support, information and training. Individuals who are feeling depressed and those who are concerned for a friend or loved one can seek helpline support.

ADDICTION 

Sporting Chance Clinic - UK - www.sportingchanceclinic.com

Inspired by his own recovery from alcoholism, Sporting Chance Clinic is the brainchild of former Arsenal footaballer Tony Adams.  Tony saw the need for a safe, dedicated environment, where sportsmen and women could receive support and counselling for the kinds of destructive behaviour patterns that exist in competitive sport, but which are often denied. 

Gamcare - UK - www.gamcare.org.uk - 0808 8020133
GamCare provides support, information and advice to anyone suffering with a gambling problem though online support, phone support and counselling services.

EATING DISORDERS 

Beat - UK - www.b-eat.co.uk - 0845 6341414

Beat provides helpline support, live chat, support groups, and online support to individuals suffering from eating disorders and their friends and families.  They also provide training and run conferences. 

Bodywhys - Ireland - www.bodywhys.ie - @bodywhys - 1890 303302
Bodywhys, The Eating Disorder Association of Ireland, offers a range of supports services for individuals suffering form eating disorders and those close to them, in the form of helpline support, support groups, online support and email support.  They do not offer counselling. 

Adapt Eating Distress Association - Northern Ireland - www.adapteatingdistress.com - 028 38323895
Adapt is a Northern Ireland body image and eating disorder orgnaisation which provides support to individuals in eating distress, and to their friends and family.

RETIREMENT AND GENERAL ATHLETE WELFARE 

British Athletes Commission (BAC) - UK - www.britishathletes.org @TheBAC

The BAC is the association which offers acvice and support for elite Olympic, Paralympic and world Class athletes in more than 40 sports. The support in a range of areas which may cause distress, anxiety or depression in athletes.  Read an article by Ian Briad from the BAC here on some of the causes of distress in sport that they can help with. 

Professional Players Federation (PPF) - UK - www.ppf.org.uk
The PPF is the national organisation for professional player associations in the UK.  They are currently developing tutor training on identifying, treating and preventing problem gambling for professional athletes, which they will deliver in partnership with Gamcare. They have carried out research into the difficulties players face following retirement, and work with members to promote mental wellbeing initiatives and the importance of dual career preparation. 

Professional players associations, including BPA, RPA, PGA and PJA in UK and GPA in Ireland.
A number of professional sports have players associations which act as a voice for the players.  Some of these run specific initiatives to support the welfare of the player or athlete, or work with other organisations to provide this support for their members.  The Gaelic Players Association (GPA) provides a 24/7 confidential councelling support line for all its members. 

The Sport In Mind - www.thesportinmind,com - @TheSportInMind
A website covering a broad range psychology in sport topics, including a number of interesting pieces on mental health issues.

If you know of any organisations or resources that we've missed out on, please feel free to mention them as a comment below.

*Further details on the conference can be found here

The conference twitter hashtag is #GCMH

What should you drink?

Continuing the blog on hydration, I thought I would look at the different types of drinks and when they may be useful in different situations.

When training or exercising, athletes need to consider the intensity of their session, the duration of the activity and the environmental conditions, and how these may affect their sweat rates. For example, if their session is a light aerobic session in a cool environment, their sweat rates and energy needs are going to be lower than if they were training at a high intensity on a hot summer's day.

Some sports have very little change in environmental conditions such as swimming or indoor sports, whereas some sports involve varying conditions and therefore athletes need to understand how their body responds to different conditions and be prepared in order to ensure they maximise their training and recovery.

There are three different types of drinks, based on the solute concentration and their osmotic pressure. 

Hypotonic - generally contains less than 4g of carbohydrates per 100ml. It provides little energy, but will be taken up by the body quickly, and therefore ideal for recreational sports or shorter or less strenuous exertion.  Examples include:

• Water
• WeakCordial 

Hypertonic - this type of drink generally has more than 8g of carbohydrates per 100ml and greater osmotic pressure than bodily fluids. Its main aim is to supply energy and the fluid is taken up more slowly than water. Ideal use is 30-60 mins before exercise and immediately after sports.  They are also useful for athletes who find they need a bit more energy.

• Milkshakes
• Smoothies
• Concentrated Fruit Juices 

Isotonic - this type of drink contains between 4-8g of carbohydrate per 100ml and has about the same osmotic pressure as bodily fluids. An Isotonic drink is taken up by the body about as quickly as water and they are intended to help hydration and provide energy.

• Sports Drinks
• Squash

Also considering the different times athletes may need to choose different drinks. 

Before Exercise - The main aims are to ensure the athlete is hydrated before exercise, as athletes will be able to meet energy needs through solid foods, therefore a hypotonic drink such as squash or water will be adequate. If it is prior to competition, and athletes struggle to eat, then isotonic drinks can help meet energy requirements while making sure athletes are hydrated. 

During - This will be dependent on the training programme. Many athletes will be fine with a hypotonic sports drink replacing fluid loss and athletes should choose drinks which are palatable to encourage consumption. However, if the training session or competition is high intensity and longer than 90 min, some athletes may need to include some energy, therefore an isotonic drink will meet an athletes needs. Other ways to meet this need if athletes prefer to drink water is to take a high carbohydrate snack to have alongside training which can be consumed at an appropriate interval. 

After - The session type and environment conditions will influence the athlete's choice of drink. After a  high intensity session, it is going to be important to replace energy and fluid needs. If an athlete is able to eat immediately after a session, a high carbohydrate snack alongside squash or water should be sufficient to meet their needs. However, if an athlete struggles to consume any food following a training session, a hypertonic drink which is high in carbohydrate will be able to support this. This is why many athletes now choose to drink milk or milkshakes after a training session. Athletes should be aware of when their sweat rates are high and make sure they adequately replace their fluid intake in the hour after a training session.

Athletes can monitor their hydration by comparing to a pee chart, a simple indication of their hydration status, with the idea to be on the paler side of the chart.  One of the main things is to to be happy and comfortable with what you drink. It could be the best drink which will help performance, but if the athlete doesn't like the taste they probably won't consume as much as is needed. 

Identity in sport

Recently, something happened which surprised me a lot.  I reached a point where I just couldn't talk about athletics anymore!  The watershed moment came on a recent altitude training trip to Ethiopia when I was staying at a training camp, surrounded by athletes, talking about athletics, all day long.

Don't get me wrong.  Sport is my life!  I run twice a day most days of the year, am in a bad mood when I haven't trained, have competed in the sport for more than 21 years and have no immediate plans of quitting, plan my social life around the race calendar, spend my holidays altitude training, studied sports science for 7 years, and have spent my entire working life supporting athletes and writing about sport.  I could not imagine my life without sport.  But at that moment in time, I just wanted to talk about something else!

I guess that even after all these years of being involved in sport, I've still managed to develop a personality independent of it.  True, sport has done a lot to make me the person I am, but I am not defined by it.  And that moment brought home to me just how important it is for athletes of all levels to have interests away from their sport, and to be able to switch off from repetition times, competitors' results, and target paces. Not only will it help with your performances as an athlete, but having interest outside of sport, and having an identity that is not completely built around sport, greatly eases the retirement transition.

I have often heard people say that you shouldn't study sport if you're an athlete; it'll be too much.  I can see where they're coming from, but there are a couple of flaws in their advice.   Who is going to make the best sports academics and practitioners, apart from the people who are genuinely interested in sport?  When advising athletes about career choices, I always encourage them to do something that they are interested in. Why study aeronautical engineering when you have no interest in either airplanes or engineering?  Yes, don't study sports science just because it has sport in the title - when you have no interest in science - but don't just avoid it because you already do sport.  There are many other ways to develop an identity that is not completely dependent on your sport and your performance as an athlete.

Let one thing lead to another

You may start out studying sport science, but this may lead to an interest in a particular area which takes you away from sport (e.g. biomechanics in ageing populations), and back again (e.g. how exercise can delay the ageing population).  Your interests are inspiring your career choices, but you have not pigeon-holed yourself because of what you see your identity to be.

Taking my own career as an example, I can explain this a little better.  I studied sports science because I was interested in sport and science.  This got me interested in research, and I did a PhD which looked at menstrual health in female athletes, something which I had a personal interest in.  Along the way I realised that I wanted to help athletes, and got a job supporting high performance athletes.  During this time I was surrounded, not only by high performance athletes, but by colleagues with a range of interests and hobbies.  I learned who to develop websites - when I set up a club website - and developed an interest in writing when writing athletics reports for a local newspaper.  I learned a range of skills on the job, that could be applied to a number of situations outside of sport.  Training at altitude in Kenya developed an interest in travel, and in African sociology and history.  I also got interested in photography, and started taking photos at races.  And I've always loved reading.  So the transition to writing a book which involved travel, taking lots of photos and running was an obvious one.  When doing that I learned about publishing, promotion, blogging and other social media, not to mention developing my stress management, self motivation and personal management skills.

The sport that I love has always been my guiding light, but I feel I have managed to develop a well rounded personality, with a range of interest (even if all these interests are related to sport).  I don't think I am defined by my results in athletics (probably just as well), or by anything else I have achieved along the way.  I am defined by how I behave, interact with others, and approach life.  All of these have been molded by my participation in sport, but would not change dramatically if I stopped running, and got a job away from sport tomorrow.

Surround yourself with the right people

There is no doubt but that being surrounded by the right people affects who we are, and how successful we become.  For some athletes that's being surrounded by other athletes that will motivate and push them. For others, being in a competitive environment 24/7 is just too much, and some successful athletes don't hang around with athletes at all.  Yes, you need people to understand you, but that doesn't always have to be other athletes.  Find the right mix of people for you.  Don't become stuck in a rut just because you and all your fiends have the some interests, drive and goals.  It's good if your friends have the similar values to you, but you don't have to have the same hobbies or interests as somebody else to get on with them.  In fact having a friend group with different interests, backgrounds and roles will not only help you in your sporting life, but will also help you moving forward from sport.

Don't let your results define your own self-worth

It's good to have stretching goals, to work hard towards those goals, and to celebrate in achieving those goals.  In fact there are few things more rewarding than finally realising a dream.  However, your self worth should't be defined by how fast you've ran, or what you achieved in sport.  I see myself as Elizabeth Egan, the person who takes on massive task, learns what she needed to along the way, overcomes a few setbacks along the way, and achieves what she sets out to do, rather than Elizabeth Egan who wrote a book.  The first is about character, is long-lasting and is independent of talent.  More importantly it consists of skills that can be transferred to any aspect of life.  The times we run, or medals we win are dependent on luck, other external factors, and talent, and will soon be forgotten about.  We can dine out for a lifetime on our personality and character, but even the Olympic golds will be forgotten about.

In summary
To have a long a successful sporting career, and a successful and rewarding life after sport, learn to have interests outside of sport. Surround yourself with a variety of well-rounded individuals, who may or may not participate in sport at a high level.  Other interests don't always have to have a negative impact on your focus or energy.  In fact, time away from thinking about training and performances usually have a positive impact.