#98 Podium Pills: Fame or Folly?

Newscaster [0:00] Over 1000 Russian athletes competing in summer, winter and Paralympic sport can be identified as being involved in or benefiting from manipulation to conceal positive doping tests.

Braeden Page [0:18] The sheer scale of the doping scandal in Russia shook the Olympic and Paralympic sporting world, but it certainly wasn't the first time in sport that doping has caused a stir. The pursuit of "higher, faster, stronger" has led some athletes to risk shame, bans and even death to get an extra competitive edge for a long time. And doping has come a long ways since the days of strychnine and raw eggs many years ago. Today, there are several ways athletes can enhance their performance using banned substances.

Swapna Mylabathula [0:46] Steroids, like stanozolol were used in the 70s and 80s, with a particularly high profile moment, occurring at the '88 Olympics when, Canadian, Ben Johnson set a world record in the 100 meter final. His positive test and subsequent fall from grace were a real eye opener to the fact that doping was more widespread than thought. Athletes were doping across nations and across sports. But while steroids taken over the course of training can indeed improve performance, they can also lead to a plethora of health issues including infertility and cardiovascular implications.

Braeden Page [1:22] Ephedrine was the reason that the celebrated Diego Maradona, of Argentinian soccer glory was disqualified from the '94 World Cup. He had taken multiple types of ephedrine and tested positive with huge impact on his comeback from another doping scandal. Ephedrine is a stimulant used to help athletes increase their exercise tolerance, but can also impact cardiac health.

Swapna Mylabathula [1:43] In 2012, the notorious controversy of EPO, or blood doping took center stage when Lance Armstrong admitted to using it and other banned substances in the Tour de France. EPO or erythropoietin is used to dope to increase the capacity to carry oxygen to the muscles with a myriad of health risks if misused.

Braeden Page [2:03] These examples are all cases where the substances used were clearly substances used to enhance performance. But there are more convoluted cases where the banned substance is ingested in ways that aren't necessarily deliberate or for performance enhancement. Athletes have to be on the lookout for foods and medications that may include banned substances. A recent case was that a Nicholas Backstrom at the Sochi Olympics, after Sweden defeated Slovenia in the ice hockey quarterfinals. Backstrom tested positive for the stimulant pseudoephedrine. his explanation was that it was in a medication he had taken for allergies and was later cleared of intention to cheat by the International Olympic Committee.

Swapna Mylabathula [2:40] So how are all of these cases found? We dive in with perspectives from an anti-doping official, and athletes themselves to find out how and why performance enhancement happens in sport. Before we continue, we'd like to acknowledge that here in Toronto, we are on the traditional territory of many Indigenous nations, including the Mississauga is of the Credit River, the Anishinaabe, the Chippewa, the Haudenosaunee, and the Huron-Wendat. This meeting place is still home to many First Nations, Inuit, and Metis peoples, and we are grateful for the opportunity to live and work on this land. As some of you may know tomorrow, September 30 2021, is the first ever national day for Truth and Reconciliation here in Canada, we ask you, our listeners, to take this opportunity to set aside time to learn about and reflect upon the history of Indigenous peoples in Canada. In particular, we hope you will consider reading the final report of the Truth and Reconciliation Commission and its 94 calls to action.

Braeden Page [3:49] We know that many different types of performance enhancing drugs exist, but who is responsible for enforcing anti-doping regulations and professional sports? And how do they do it? We sat down with James Fitzgerald, the senior manager in Media and Communications at the World Anti-Doping Agency or WADA for short. He explains what WADA is, what they do, and what they hope to continuously achieve in the world of anti-doping.

James Fitzgerald [4:13] WADA is the global regulator for anti-doping in sport around the world. It was started just over 20 years ago, and it came out of a time when there was very little consistency in the world of of anti-doping. So you could have a situation where some sports had rules, other sports had different rules or no rules at all. Some countries had had strong anti-doping legislation, others did not and there was no consistency and no harmonization. So you can have a situation where an athlete could be suspended from competing in one sport on one country due to doping offenses, but at that time, they were free to compete in other sports or other countries. So clearly it wasn't an optimal situation. And so WADA was born out of that, and very quickly, sort of put rules on everything. And so it's quite a remarkable achievement, I suppose to get to a stage where we're now we have nearly 200 governments and all the main sports, including the Olympic movement, all fully behind the anti doping system when we've got one set of rules that are applicable around the world. So that so that athletes know that they're protected in their their own country, but also they're protected when they go and compete overseas, and crucially that their competitors from other countries are subject to the same rules as they are.

Swapna Mylabathula [5:43] As James mentions, one of WADA's goals is to protect athletes and promote clean, fair sport. But the reality is that some professional athletes often use drugs or supplements as part of their training. How does WADA decide what is safe and permitted? James discusses what his role in continuously managing and updating which substances are deemed to be prohibited, as well as the rigorous process behind how exactly prohibited substances are determined and published each year.

James Fitzgerald [6:11] See, the document that governs this area is called the prohibited list for substances and methods. And this particular document, it's a it's an international standard. It's constantly evolving. So, there's a new prohibited list that is published every year and comes into effect on the first of January of each year. In order to get to that stage, there's a whole process of making sure that the latest scientific research is reviewed and discussed, and we have what we call the prohibited list expert group. And they meet during the year to discuss any new developments that may be coming through in science any any compelling evidence that may require a rethink in terms of certain substances, whether that is to, to bring a substance onto the list and make it prohibited, or in some cases, to take a substance off the list. So that it's no longer prohibited. Or maybe it will be only prohibited, maybe in competition, as opposed to in and out of competition. So there's a whole process that goes through. And we have three criteria that we generally talk about when it comes to whether a substance or method should be put onto the onto the prohibited list, there's whether the substance or method has the potential to enhance performance. I think that's, that's fairly self explanatory, whether the, the substance or method has the potential to negatively affect the health of the athlete. Or the third one is, is whether it would be in breach of the spirit of sport. And so what we say is that if if the substance meets two out of those three criteria, then it'll definitely be considered for addition to the prohibited list. And so the over the years have been substances that have come off new ones I've gone on, and it's important that we're constantly up-to-date on the latest scientific information and evidence in relation to those substances. And then this expert group will also it will go out to, to our stakeholders to to all the the the international federations for sport and, and you know, the laboratories and all the different stakeholders that we have and they'll they'll get information back from them also from governments as to maybe advice that they have in relation to the prohibited list. And then at the September executive committee meeting, which we've just had, incidentally, the the new list for the following year, gets approved by that committee, and then it's published on on or before the first of October, and then it comes into effect on the first of January, so that the next list is coming. It'll be published in the next few days. And then it'll come into effect on the first of January 2022.

Braeden Page [9:04] With new technological and scientific advances also comes to opportunity for advances and new performance enhancing substances entering the market. How does testing keep up with these advances and new substances?

James Fitzgerald [9:17] As I said earlier, that the system and all the processes within it are constantly evolving. So when it comes to testing, various improvements have been made over the years in analysis, sample analysis, the quality of the laboratories and the forms of analysis that they're doing and how detailed and how sensitive they are these days is much improved on on previous years. We have we have a memorandum of understanding with the pharmaceutical industry and various pharmaceutical companies and under that MOU, these companies will tip us off when they develop the new compound that they feel has the potential to provide a performance enhancement. So before that substance even comes on the market, in some cases, we know about the compound and we can develop a test for it. So somebody who thinks they're using this brand new compound that that nobody knows about. Actually, we do know about it, we just haven't told anyone else about it yet. And we are testing for it. And so that's happened in the past where we have managed to catch or, or the laboratories and other anti-doping organizations have managed to catch people using new compounds, when they thought it was a secret.

Swapna Mylabathula [10:36] In addition to pharmaceutical testing for new substances, there have been advances in the methods of detection for these substances, such as dried blood spot analysis, James dives into these advances in more detail.

James Fitzgerald [10:48] But we've just developed in conjunction with a number of national anti-doping organizations and the International Olympic Committee, the the International Testing Agency, we developed this new process called dried bloodspot analysis, whereby, literally a single drop of blood on a piece of paper can then be taken away and analyzed and tested for various substances. And so where we see the advantages in this particular system is it's it's a lot less intrusive for the athlete than more conventional testing of urine or blood, it's a lot easier to store, it's a lot easier to transport, it's just a, it's basically a small little thing compared to a bottle or a vial in the more traditional testing. So storage costs are down, transport costs go down, which means anti-doping organizations can do more of that. And so it's it's potentially cheaper. So yeah, it's it's a, it's a, it's a really exciting development. And it's it's going to, there was some elements of it used in the Tokyo Olympics just gone by and Paralympics. And it's going to be rolled out for routine use in Beijing for the Winter Olympics next year. Now, it won't, it won't necessarily replace conventional testing. And they'll still be a need for urine and blood testing. But hopefully, what it'll do is it will compliment it really well. And so it'll just be another string to our bow when it comes to, to the testing side of it. And you know, we've talked a bit about testing, but that's not the only thing we do. So within the anti-doping system, it's not all about testing there's important other elements that are increasingly coming to the fore in this area, I think of intelligence, and investigations, we now have a pretty large intelligence and investigations team at WADA. They've had remarkable success in investigating conspiracies, and doping rings, and various other aspects of doping that are not necessarily associated with presence cases, as we call them. So it's not necessarily that they're there. They're catching athletes with a prohibited substance in their system. But they're looking into big doping conspiracies and other aspects of maybe corruption within the anti-doping system or various other elements that need to be routed out in order to have a properly clean system. So intelligence investigations is really important. And part of that is is our whistleblower platform. Because as we know, the vast majority of investigations when it comes to anti-doping start because of a whistleblower, somebody who decided to come come forward with information that can then lead to the beginning of an investigation, and hopefully down the line some some good results for sport at the end of it. So that's a really important aspect of of our job, and increasingly so in the last years.

Braeden Page [14:04] As James mentioned, whistleblowers can be very helpful in raising red flags that will prompt further investigation. However, WADA needs to be able to identify and flag athletes based on their test results. And monitoring 1000s of athletes produces a lot of data that can be difficult to process and efficient and accurate way. James discusses the challenges this poses and some solutions that are on the horizon.

James Fitzgerald [14:27] We also have some research that we're doing into artificial intelligence. In particular in Montreal is Montreal seems to be a real hub for for artificial intelligence research globally. So we've been working with some partners there to investigate how artificial intelligence might be used for particularly in the area of big data. So we collect all this data from from athletes we have their whereabouts information in our what we call our Adams system. So we have their whereabouts we have all the tests that they've done, or the results or the blood, passport information together in one place. And it's a huge amount of data like it's, it's more than, than any human could, could possibly look through and analyze in a lifetime or a collection of lifetime. So where AI can help us is by potentially pointing us and raising flags, you know, if there's something that doesn't look right, and all this data can come and speak to each other, basically. And so that it's that's a really exciting area for anti-doping, but isn't connected specifically with with testing,

Swapna Mylabathula [15:48] As James mentioned, WADA doesn't only focus on testing, he talked to us about a new initiative they've been working on to provide proper education through anti-doping programs for athletes.

James Fitzgerald [15:59] And then, you know, we have, we've spoken a lot about what happens after an athlete has chosen to cheat, the testing, the the intelligence investigations, and all that sort of stuff, the big data that comes out of that, but we have to remember that, you know, the vast majority of of athletes don't want to cheat, and will never cheat and, you know, most of them are passionate about clean sport, and the level playing field for everyone, or making sure that whatever they do, it's on them, instead of their hard work and their talent alone, it's not, they haven't been given this artificial boost. And so part of that, and making sure that we harness that reality is through our education programs. And we have a an Anti-Doping Education and Learning Program, which is really exciting. It works on the assumption that we want to get to athletes, before they're tempted to do something that they later regret, and educate them on the importance of clean sport. That's a really exciting part of the anti-doping system at the moment as well. And it's, it's something we know, we know bears fruit over time. And it helps to prevent the doping from taking place in the in the first place. You know,

Braeden Page [17:19] WADA isn't the only one keeping their eyes out for athletes who are doping. Athletes themselves can monitor their competitors', usages of substances, and have a vital role to play in clean sport.

Evan Dunfee [17:29] So basically, what happened was, I came across a bunch of pictures of Russian athletes competing at an indoor race, and knew that a bunch of those athletes were banned that they shouldn't be allowed to be competing. So I wrote a little blog post about it, basically being like, well, this is against anti-doping rules. They're not allowed to be competing while they're on they're ban. They should they're ban should restart. And you know, that got a little bit of attention. And the Russians came out and said, "oh, no, no, no, these are photos from from last year." And I was like, "well, no, they aren't like these shoes weren't available last year", like these, it's pretty clear that this is this is a recent photo. And then in their process of trying to cover things up. And they were trying to like move photos of different albums on their website, and you could see all the metadata that none of it added up. And in the process of like changing their results, they actually took out people's names that we didn't know were publicly banned yet. So they'd had athletes serving secret bans, that they kind of exposed through their own incompetence. So it is wild to me to think that they then went on to orchestrate this massively successful doping program, when, from what I could see was happening it was you know, incompetence at the highest level.

Swapna Mylabathula [18:47] We just heard from Canadian Olympic athlete Evan Dunfee, about his investigative work of finding evidence that a Russian race walker competed in an event despite receiving a two year ban for using prohibited hormones and modulators of metabolism. We sat down with Evan and Maddie Kelly, another track athlete who competed in the Tokyo Olympics, to learn about their experiences being tested for performance enhancing drugs as current athletes competing in regulated sports.

Madeleine Kelly [19:15] I am Maddie Kelly. I run primarily the 800 meter on the track occasionally a 1500. And I got started running I guess, you know, high- or sorry, elementary school track in grade eight, and it just kind of progressed from there.

Evan Dunfee [19:35] So I'm Evan Dunfee. Canadian Olympic race Walker. So I compete in the 20k and the 50k. And last Olympics in Tokyo was my second Olympics. I competed just in the 50k and came away with a bronze medal to build on my fourth place finish from the 2016 games. To begin, both athletes detail what the process is like for an athlete when being tested for performance enhancing drugs.

Madeleine Kelly [19:57] So in competition you're approached immediately after your race like you haven't even left the track yet. You've basically like they let you catch your breath and then they come up to you and they let you know that you've been selected for testing and then you're basically assigned like a babysitter until you can produce a full sample so if you have to, like go to an award ceremony or go to a medical tent, or I don't know like hug your mom you can do all of those things your babysitter just has to come with you and you are to drink only like close sealed substances that they give you. So because usually you're pretty dehydrated, so sometimes it can take a while to produce that sample. So that process has taken me as short as 25 minutes or as long as like four hours like I was super dehydrated after one competition.

Evan Dunfee [20:59] And when you're ready, you sort of go into a room fill out some paperwork, grab a cup and go and deliver your sample they have to watch you pass urine from with an unobstructed view from nipple, the knees, so you pants come down, shirt goes up. And you know, it's something that the first time is certainly a little bit alarming, but when you've done it a few times, you just kind of get used to it and and yeah, that from that they just sort of watch the process of pouring out pouring your sample into your bottles and making sure they're they're sealed up and going through all the paperwork that makes sure that that it gets to the right place, and it's all labeled properly and all that stuff. So the first time it's certainly like a bit overwhelming. But after that, like it's no matter where you are in the world, the process is pretty much the exact same which is, you know, which is good, because you kind of know what to expect to know how things should be.

Swapna Mylabathula [21:50] Both athletes at different stages of their athletic careers provided insights into the frequency of being tested depending on their registration status in the testing pool. They also highlighted how the testing experience has evolved as they've progressed through their various competitive levels.

Evan Dunfee [22:06] World Athletics which is our governing body has their own testing pool and so we have our own testing authority, the Athletics Integrity Unit who are kind of supposed to be semi-independent of World Athletics and they're kind of in charge of of our testing. So I've been on and off their testing pool basically it's it's how you know, it's your results at the end of the season, either if you're good enough yet put in the pool, if you're not good enough, you get taken out of the pool. So I've been on and off in that and I've consistently been in the Canadian testing pool for nearly 10 years now. So I get tested about once a month out of competition, kind of like clockwork, you know, which maybe isn't the best isn't the best thing you can don't want to be like clockwork, but I've kind of cottoned on to it's about once a month and you've maybe every second time will be blood as well as as urine. So as an endurance athlete, the blood the bio passport is obviously very important for tracking those changes over time. And yeah, I've never had any issues with it, I'm pretty diligent with filling out my whereabouts, that's probably the most time consuming aspect of being in the testing pool and scary aspect of it is you have to fill out, you know, where you're, where you're sleeping every night, and an hour every day that you guarantee your location. And that's basically where testers can show up, and they can try to test you outside that window. So I've had time where my testing window is usually at 6am just because I know I'll be at home in bed. Whereas I've had testers show up probably just because, you know, they're testing other athletes in the area and they said, okay, we'll just go and see if we have test Ecan and you know, at dinner time and I haven't been home and you still feel bad that they've come to your house to test you and you're out there but there it's not you're not required to be there in those circumstances. So it's really just that one hour every day do you have to guarantee where you're gonna be with that can still be tough. You know, this year, I found myself in a in a relationship. And, you know, on a whim would be like, "Oh, I'll stay let's stay over at your place tonight" and it's like okay, I gotta change my whereabouts. And you got to kind of remember all that stuff. But that's probably the most like, cumbersome of the entire process. But it's crucial. I mean, it's it's impossible to do out of competition testing without that. And the out testing competition is so much more important than in competition testing, because, you know, anyone who's intentionally doping, if they're getting caught in competition, they're really bad at it. So at my level, there's certain things that you have to have if you're taking them for therapeutic use, you need an exemption, you need to what's called a TUE. And that process has to be done in advance. So you know, for athletes who are taking like high doses of asthma medication, they'll need to have all that filled out and approved beforehand. At the university level, where, you know, testing is sort of less frequent, and they'll set the expectations of the athlete is less, those sorts of things can be done retrospectively. So if you're an athlete with severe asthma, and you're taking the medication for that, that would otherwise be banned, and you get tested and obviously it's going to come up postive for that, if you have all that documentation from a doctor, if you're getting it through a proper means anyways, you can do all that stuff retroactively, which just is it just makes more sense at that level. So I personally think the system's really, really good in terms of educating and moving people through. And so, yeah, I think it's perfectly appropriate and works really well in Canada.

Madeleine Kelly [25:23] I have been tested once in the last two years, I went and raced in the States, and I'm just I'm never gonna be pulled by USADA or not, I shouldn't say never, but I just wasn't finishing high enough in the races, and I'm Canadian. So I think they're just they're looking to get American athletes and American athletes who are finishing well, which makes sense to me. And then, but I knew as soon as I came home for a series of Canadian races in June that I'd be tested, and I was the first one they pulled me. And I just like, knew it, because I haven't been tested and so long due to the pandemic and the fact that I haven't been home. So that's just kind of an easy place for them to make sure everything's aboveboard. And in order for an event to receive a certain level of accreditation, or to be like world record, ratifiable, for example, there has to be drug testing happening on-site in competition. So if you like we had an event, just like a really small meet in Victoria in March, and one of the para athletes ran a world record. And people didn't know he was gonna run a world record. So for it to get ratified, they just had to test one person from the whole event. So my teammate got tested. Like they had to call doping control, get them there, test her, we were at the track, it was dark out there were deer in like walking around the track, because it's like, U, UVic campus, it's, it's beautiful, but it is certainly not downtown Toronto. But yeah, there is, I would say frequent testing, sort of at the senior-national level and beyond, but at the Usports level, it's hit and miss, but it is there.

Braeden Page [27:05] So how are the results of the test communicated by athletes? Do they know what happens when there is a positive test result or of any blips that may have occurred in the system?

Evan Dunfee [27:13] Essentially, no news is good news. We have so the Adams system, which is sort of the data management system, that's where we update our whereabouts through and all that stuff. And it, the results of your tests will be published there. So when you're doing blood tests, it's really nice cuz you actually get your hematological profile. So it's like getting a free blood test, which is nice. But you can go in and see like your off score, which is the number that they use to determine your ranges and sort of a big number that's using all their algorithms to decide whether or not you have suspicious values. But you can see all that information, which is really neat. And then next to your urine sample just have like negative or, you know, I don't know what it looks like if it's positive, because I have never had one. But I have had a scary moment where I've had, like no result, or I can't say exactly how it was worded. But it was very ambiguous. And I like freaked out and an email became center read ethics board me like, what does this mean? And they were very diligent getting back and being like, oh, no, that just basically meant that the sample had caught up somewhere along the lines and didn't get the lab and time so they couldn't use it, because it was stale at that point, which wasn't noted on the form. So it was terrifying for me being like, I don't know what this means, but it's not it doesn't mean negative. So if you're if your A sample comes up positive, basically, from that point, you are like notified. And you can either kind of sort of accept a suspension at that point. And you know, you kind of become provisionally suspended while they go through the process and, but that all counts towards whatever time period you end up serving. Or if you if you want to fight it, because either you think your win or you or you genuinely didn't take anything and and don't know what's going on, you can request having your B sample tested. If you are dirty, and you know, you're dirty, you know, your B sample is going to go into pop as well, then a lot of times we'll just say yeah, okay, if you caught me like, don't bother testing the B sample, because I know what it's going to say.

Madeleine Kelly [29:09] The Athletics Integrity Unit has a running list at all times of people serving bands from all across the world. So that's, that's where you can where you can find that and every time someone is served a ban, it is published there and there is a press release sent out. You can find them on Twitter, it's all public record. However, when you get that initial email, if you've tested positive, that's not when the press release goes out. The press release goes out after it is all settled. And like in some cases, the press release doesn't come out until months later, just depending on the case. And you know, what's going on behind the scenes.

Swapna Mylabathula [29:50] What are some of the educational resources available for athletes to use if they're unsure about the legality of a certain substance?

Braeden Page [29:57] There's a great website that we have called Global DRO. So it's a joint effort between I think, Australia, Canada, the UK and the US. And you basically put in your country and you put in your sport, and then you can search up whatever the either the brand name or the the medical ingredient and find it from there. And then it will show you whether or not as per its, you know, that product is permitted to use in competition or out of competition. So if I'm ever having to, like, get something new, that's the first thing I'll do is read the ingredients, search it up on Global DRO and make sure that it's something that I can take.

Madeleine Kelly [30:32] It never hurts to check, like, just check, don't take your coach's word for it. And even if you've heard from your team doctor, double check, because ultimately your team doctor is not getting suspended, you're getting suspended. So yeah, that isn't that is an invaluable resource and one that I use frequently.

Evan Dunfee [31:05] It's still always the athletes responsibility to to know what's what's on the banned list. And you'll get cases of similar with when Maria Sharapova tested positive for meldonium, you know, claimed that they had no idea it was on the banned list. And you know, that's that's a pretty that's not a that's not the that's not the excuse you think it is, that's actually an indictment on, you're not taking this seriously. You make you make millions and millions of dollars. This is your career, you should if you don't know yourself, you should have people who know this list inside and out.

Braeden Page [31:40] The enhancement of performance by even half a percent could be the difference between landing on the podium and missing out. Has there ever been any pressure from any angle to improve performance using methods beyond the traditional training methods?

Evan Dunfee [31:52] Sure, I mean, certainly for me, through altitude training, I use an altitude I use an altitude tent, I have one. And you know, that's something that's somewhat controversial, because you know, places like Italy, that's banned. It's an anti-doping offence in Italy to use an altitude tent, that I think the only place where it's banned, but certainly so there are some things like that, that I do take advantage of, but in terms of supplements and pressure, like outside pressure to take those things to performance, I've never felt any of that.

Madeleine Kelly [32:20] Yeah, like altitude training, the jury's kind of out on altitude training for the 800 meter 1500. And up there is solid research that it helps however, you know, 800 meters, kind of a funny bubble event. That's a hybrid of two systems. So it's been suggested to me, but I have never gone not that, you know, people, you can go to altitude, that's totally, that's totally legal and fine, but I've just never done it. And there are there's a few supplements, you know, beta alanine being one of them. That's, you know, creatine is another, both of those things are legal, and there are things you can take to give you like small, incremental improvements, those are just considered nutritional supplements, but no, no pressure to even engage in that if you're not interested.

Swapna Mylabathula [33:10] One of the most interesting stories about current events and doping to come out of our conversation with Maddy and Evan, is the recent revelation of some us athletes who are testing positive for performance enhancing drugs after eating tainted meat.

Madeleine Kelly [33:25] I mean, I guess the big, the big thing that's changing in the specifically track and field world right now is people are testing positive and claiming tainted meat. And this isn't just one case. This is several cases now. And I, you know, there are people on both sides of the argument. You know, some people think that it was intentional doping. Other people think it wasn't. So like, there needs to be some resolution, there as to like some testing done about like, what's, you know, in beef, for example, like, what are the levels of different, you know, like nandrolone, testosterone, like these different performance enhancing drugs that you can't test positive for? And how common is it? And is this something that can actually happen to someone you didn't mean to? Or is this a cover-up story? And I would say that, that that certainly needs to be looked at because you never want to be catching the wrong people. And then you also don't want it to become you know, an accepted scapegoat either.

Braeden Page [34:34] That was interesting. You know, Shelby Houlihan, I was really interesting case because it was obviously something that her and her team knew about, you know, got ahead of the narrative and really tried to own the narrative to cast her in a positive light. So it was really interesting to see how that like, you know, using the court of public opinion to to win people over when the actual evidence, you know, from from what I've seen in the gas report is pretty clear cut that like, that argument doesn't hold hold any water. Despite the tight regulations and education athletes receive the use of performance enhancing drugs still remains rampant in sport. This leads to the ultimate question for athletes: is it worth it? I've also been lucky in the fact that you know my event is not really a glory event. Racewalking isn't isn't an event that that attracts those the the win-at-all-costs mentality, I don't think because really, there's not that much that comes with winning race walking, or you know, you're not making millions of dollars being a world champion race walker. So I do think it tends to attract more people who are just want to see what their personal potential is, which obviously is in congruent with taking performance enhancing drugs, you know, I find it so funny, I see a lot of stuff on social media from fans of track and field who say, oh, any, any medalist is doping. And then I hang around our athletes at training camps, or at, in the Olympic Village, you think these people don't, a lot of people don't care enough to dope, like, it's just not worth it, especially in Canada, when you as an Olympic medalist, you might be able to make a couple $100,000 off of off of that, and, and you could probably have a pretty good career as a speaker, you know, doing staying relevant, at least as an olympic metalist. But one, you know, one doping case, again, you know, take that failing a drug test, you're all of us, that's gone. And so I think the cost-benefit from it just doesn't weigh out the way the general fan base thinks it does. So I, I have a tough time. But I do think that it's rampant within our sport, and that's a huge problem. And that there's probably people that I would consider friends that are doing stuff that that isn't legal, that I just don't know about, you know, statistically that's likely, but I also don't buy this idea that you need to take drugs to be to be a medalist or, or that it's, you know, the vast majority of athletes at the Olympic level that are that are doping because you know, those a lot of the people are my friends. I see them at training camps all the time. And it's they wouldn't know how to even start and yeah, same personally, like I wouldn't know where to go to get EPO for sure.

Swapna Mylabathula [37:20] For most athletes, it sounds like the risks of doping just aren't worth it. And as we heard from James Fitzgerald earlier, not only is doping against the spirit of the sport, but many performance enhancing drugs can have real health risks. And yet, every year hundreds of athletes continue to test positive for these drugs. So how bad really are the health risks? And what about sports that aren't regulated? Like some bodybuilding competitions or even recreational athletes who want to test their personal limits? Can performance enhancing drugs be used safely in certain circumstances? To help us answer these questions? We spoke with Dr. Dean St. Mart, a well known voice in the bodybuilding community.

Dr. Dean St Mart [38:01] To introduce myself I'm Dr. Dean St. Mart I'm a scientist you could say from Ireland, and I have a first class honours degree in chemistry and pharmaceutical chemistry where I came top of my university and I hold a PhD in synthetic organic chemistry. So I've, I became quite well known in bodybuilding circuits as a very straight talking pharmacologist, of applying what I learned through university and my own critical thinking of how people use performance enhancing drugs, but may not be using them in the most appropriate manner.

Braeden Page [38:42] We asked Dr. Dean as he is affectionately known, how he became interested in performance enhancing drugs.

Dr. Dean St Mart [38:48] I was I was a kickboxer and an international kickboxer, but I had quite a bad injury that then led me to go down the path of bodybuilding, just as a consequence of the rehab and my dad also being involved with bodybuilding. So obviously, most people are aware that bodybuilding is a sport that has both natural connotations and also performance enhancing elements. And as as I got further into bodybuilding, I began to see some of the protocols and science that has been discussed on forums surrounding pharmacology of performance enhancing drugs in bodybuilding, and I began to realize that when you have like a formal education and pharmacology, a lot of is being said as a little bit nonsense and starts to become almost like whispers of someone said this and then the next person takes a little bit of that and creates their own hypothesis on it and eventually end up in a scenario where the advice that's being given out online is is quite dangerous in certain aspects. There's there's a clear deficit and knowledge of how these substances ultimately will affect your health. And obviously, you'll see that raise quite a large stigma to performance enhancing drugs. And more, particularly when we're speaking about performance enhancing drugs, we're keying in specifically on anabolic or androgenic, steroids. And we we see that people have a, a basic knowledge of, for example, steroids cause heart disease, steroids cause heart attacks, etc, that we we sort of end up with this stigma that steroids are evil basically. And what I began to sort of sit back and, and critically assess my background and pharmacology. And as I became a slightly older, I started to study more into functional medicine, which is trying to figure out the root cause to disease. So if something's gone wrong, ultimately, what is the disease process that has caused that effect? So if we say steroids cause heart disease, well, how do they cause heart disease? Let's get down to the bare molecular science of how they interact in the body and ultimately cause a heart attack. Same for kidney disease. And the same goes for liver cancers or liver disease also. And what you start to understand is the molecular mechanisms by which these drugs work in the body prime or amplify your nutritional intake and your environment, which more than likely contributes to the disease manifesting as opposed to those molecules themselves, causing disease. And so what I began to do was educate people online, surrounding the root cause of how steroids affect your health ultimately, and how we may potentially put risk mitigation strategies in place with a core understanding of those root cause disease mechanisms, to hopefully increase longevity, and increase someone's quality of life if they decide to use these substances.

Swapna Mylabathula [42:13] So where do all these performance enhancing drugs come from? Dr. Dean shares that a lot of them actually come from the therapeutic context, then they're applied beyond that, in the pursuit of performance enhancement.

Dr. Dean St Mart [42:26] A lot of these substances that are used for performance enhancement, were actually developed as medicines. And then the abuse cam through the misuse of these compounds and undertaken dosages that are far outside the therapeutic window. Because when we get to the core root of how these molecules work, they have brilliant therapeutic benefits. But with it, they do have the risk to amplify disease as well, and I mean, we have to, we have to be very critical and understanding that a lot of drugs that we ingest for different diseases have the same reward to risk ratio, and that that personal needs analysis of whether you need to take that compound or not. So by viewing that these compounds were originally medicines, we immediately then start to remove this mentality of almost danger that steroids will, will kill you or steroids will cause serious health issues. And we start to understand that really, the ultimate end of how someone gets hurt from these compounds is misuse and abuse. By not understanding, first and foremost, that therapeutic window and the therapeutic window of these drugs is no different to performance enhancement. But again, human mentality more equals better, faster, is better, bigger, stronger. So you then end up in a scenario where people start to think well, if I take x dosage of this steroid, it will increase my ability to accrue and retain nitrogen in my body to make more protein, which is ultimately muscle mass. And it gives me a certain degree of strength increase. So if this dosage causes this effect, well, if I double that dose, I'm going to get double the effect.

Braeden Page [44:21] As Dr. Dean mentioned earlier, this mentality has helped lead to widespread adoption of potentially dangerous protocols for taking performance enhancing drugs, and specifically anabolic steroids.

Dr. Dean St Mart [44:32] Within bodybuilding, we have a term known as blasting and cruising. So this term originated in the late 90s, early 2000s on internet forums, and the concept of blasting and cruising was you blasted with a really high dose, and then you cruised at a moderate dosage level. And the idea behind that was that you're returning to a dosage that may provide a physiological level of hormones without ceasing the use of the hormones themselves. So I like I said, as you can see to blast and cruise mentality then sets us up for a huge abusive mentality in that someone could take maybe 1000 milligrams as their blast dose, and then move to a lower dose of maybe 300 or 350 milligrams of an androgen when they're cruising. That 350 milligrams, more likely will still yield a super physiological level of androgens, so in other words their way outside their natural level of testosterone, because obviously, the reverse of that is you do a cycle of steroids to take a cycle 12 to 16 weeks cycle of increased dose or a super physiological level of androgens. And then you come off and you stop taking anything and you go through a clearance phase, which we termed a post-cycle phase. And from that post-cycle phase, we might derive a post-cycle therapy. If we feel that the male HPTA that hypothalamic pituitary testicular axis doesn't recover by itself naturally. The other side to it then is you do what I tend to educate people on and that is a TRT phase. When you use a physiological level of androgens like testosterone. And you use a cycle of anabolic steroids, what that will ultimately yield is a a scenario where your body is able to gain back a baseline of physiological health. That would be akin to if you had come off steroids, and let your own body produce its own natural testosterone. But it provides a scenario where you don't run through a zero hormone period where you're allowing drugs to clear in that post-cycle therapy phase. So it sort of helps to protect that person's health in terms of providing a physiological level of testosterone to allow liver enzymes, kidneys, GI tract, the brain, everything to sort of try and get back to where it was at a physiological of testosterone if they hadn't taken anything. So that the term of using TRT at that point allows that person to continue to feel physiologically healthy without going through that, what can be a depressive phase when we're allowing drugs to clear and restore the HPTA function.

Swapna Mylabathula [47:41] We asked Dr. Dean whether one of the risks of that depressive phase was actually losing some of the gains from the cycle.

Dr. Dean St Mart [47:49] So what happens here is when you let the compounds clear from your body, and what you're trying to elicit there is the hypothalamus is trying to sense that there's no testosterone present in the body, and it makes us secrete a hormone that stimulates a male's brain to produce our two fertility hormones, luteinizing hormone and follicle stimulating hormone. So when we allow the drugs to clear we do hit a point where we could have a two or three week period where we're waiting for that HPTA axis to respond effectively, in order for your body to start making testosterone again in the testicle following that pituitary stimulation. During that clearance period, what can happen is you get an increase in aromatization to estrogen. So now you have a higher ratio of female hormone in your body, which can have depressive effects in male mood and male mentality. You may not be as motivated to train during that period, because there's nothing to suggest that you can't maintain close to what you have gained with an anabolic steroid cycle. But how these drugs ultimately work is by binding to the androgen receptor on the surface of our cells. And that binding of that testosterone molecule or I guess, any androgenic molecule, to that receptor, yields a complex that can move into the nucleus of your cell the centre of your cell where all your DNA is kept and elicit changes in how our genes are turned on or off. So specific genetic instructions are then given based on that androgen receptor complex. So that gene could be for increasing protein production. It could be to retain a higher amount of nitrogen or amino acids in our blood. And so with that, the muscle mass that's gained by a super physiological level of androgens would be maintained to a sufficient degree through nutrition and true training. So we know that a certain level of muscle mass will be attributed Due to increases in strength and tensile strength of that muscle and according to that development. And so if you're able to maintain close to that peak strength you had on cycle versus when you are allowing these compounds to clear when you're off, then that muscle mass has no reason to dissipate or be lost because it's receiving sufficient stimulation.

Braeden Page [50:23] So given some of these androgenic drugs are actually just enhancing existing pathways to grow muscle. And for example, the testosterone supplement is often biologically identical to testosterone reproduce naturally. Where did the health risks come from? Yeah, yeah,

Dr. Dean St Mart [50:39] I mean, let for example, cardiovascular disease, activate the androgen receptor in our body: how does that yield cardiovascular disease? So in other words, we see that potentially, androgen receptor activation in our liver can cause our liver to produce more hepatic lipase, which is the enzyme that breaks down HDL, high density lipoprotein, when that recycles back to the liver to excrete lipids and triglycerides its transported from the body back to the liver. So by having a lower level of HDL circulating, potentially, you're going to have higher levels of circulating triglycerides, which in other words can can yield a certain degree of cardiovascular disease. But then we have to view that low HDL and response to anabolic steroids is probably only a fraction of how they contribute to cardiovascular disease. And what I mean by that is, it's not just a matter of viewing cardiovascular disease as low LDL, so having low low density, low protein, and having good high levels of high density, low protein, there's nuances in the middle, towards total body inflammation, foam cell production, free radicals and causing oxidation of those LDL particles, that you then start to realize that blaming anabolic steroids for cardiovascular disease, is not the correct way to view these compounds. In other words, that the underlying nutritional practices that come alongside taking these compounds, probably augments this effect. And you then start to appreciate that just because they cause a decrease in HDL production and an increase in LDL doesn't necessarily mean that you correlate these compounds to cause cardiovascular disease.

Swapna Mylabathula [52:32] Dr. Dean described similar complexity and the ways androgenic drugs can contribute to liver disease. With understanding the pathways involved, we asked if anything could be done to help mitigate the health risks of using performance enhancing drugs.

Dr. Dean St Mart [52:46] Yeah, so so what what another sort of area where I became quite well known was taking this functional medicine approach of understanding the root cause of how these compounds might injure. And I became the formulator for a supplement company in the UK called Supplement Needs. And what I started to develop was a liver stack, a heart stake, a kidney and blood pressure stack. These, I guess, natural supplements that have clinical research to offset mechanisms of disease, that when combined together would have a synergism to offsetting potential damage when you use anabolic steroids. So for example, the heart CV stack has a fully comprehensive panel of vitamin E, which is bolted to tocopherols and tocotrienols. And then we have ingredients that provide a rich source of polyphenols which again are antioxidants for our arteries, as well as certain plant extracts to help facilitate the increased production of HDL in the liver. So what I'm trying to do there is offset that decrease in HDL from hepatic lipase. I'm trying to provide the body with high levels of antioxidants that offset LDL oxidation. So if the body up regulates making more LDL in response to steroid exposure, that increase in LDL doesn't directly translate over to cardiovascular disease. So these stacks were ultimately developed to try and offset some of the root causes of disease where steroids might contribute to heart disease. But again, it comes back to your nutritional status and your antioxidant intake, which ultimately results in LDL oxidation and the LDL oxidation forming plaque.

Braeden Page [54:45] Dr. Dean also told us about the potential neurological effects of androgenic steroids.

Dr. Dean St Mart [54:50] From a harm reduction perspective. It then does fall back to again, given the younger generation and my opinion that's coming up now, a clear understanding of how these drugs ultimately upset your health long term. And quite recently, like I've been doing a lot of extended seminars. And when it gets to the section where I start speaking about the neurotoxicity, that's when all the young guys then start to pay attention. And they start to see that what can ultimately happen is, estrogen helps to facilitate serotonin and transport to the brain. Androgens facilitate dopamine transport and production. So that's why when someone takes anabolic steroids, they feel very motivated, very alpha male, very driven, again, more testosterone in their body producing dopamine and dopamine transport. So what we find is then when we have really high levels of androgens in our system from using a cycle of steroids, that stimulation of dopamine, the potential on the neuron increases, so that the gating voltage on the neuron goes up. And that can yield higher sex drive, higher libido, higher vitality, so you feel great, you have all this dopamine in your system, and those neurons are loving that higher potential going across. But then we start to see problems when people cease use. So the treshold of those neurons has become so used to having high levels of dopamine, that when that person fully recovers post use of steroids, and they verify through blood work that that HPTA axis is now making testosterone naturally at a baseline level. A lot of individuals then find that they have no motivation. They have no sex drive, they have loss of libido. But meanwhile, their physiological parameters through their serum bloodwork shows everything to be perfectly fine. And this again, then becomes a deficit when in the medical community whereby someone is used anabolic steroids for an extended period of time, resulting in neurological changes, that takes a lot of time to reset back to that normal voltage where it was pre exposure to steroids. So in other words, there is no explanation from the bloods to suggest why that person is having low libido, low sex drive. And what tends to happen there then is people start to view well, when I took steroids, I had really high sex drive libido. So I'm just gonna go back on again to fix this problem. And that's where we started potentially see a model for psychological addiction, in that these compounds don't cause physical withdrawal when we cease their use. But if they do manifest themselves in terms of neurological changes that require that exposure, in order to be sexually stimulated, again, that is addiction, if you do require that substance in order to feel the same as prior to the exposure, and that is you start to tell people, that neurological change due to high dopamine, the only way you can resolve that efficiently is by removing dopamine stimulation. I mean, every minute we look at our phone, with social media, and that's a dopamine hit, of looking at how many likes we got, or, you know, who looked at our posts, we have, you know, pornography, you're effectively telling someone to live a very boring life in order for their brain chemistry to to resolve. And it's an extremely difficult, I guess, scenario to maintain. We're now starting to appreciate this at a much higher level, though, you know, in 10 years time, these psychological disorders are going to be be rampant amongst their 17 to 22 year olds who are chronically using these drugs and and stopping after, you know, seven or eight years of use, that it's very difficult to resolve and gain back normal function without putting some level of testosterone back in.

Swapna Mylabathula [59:08] So are there health risks when taking performance enhancing drugs? Definitely. And maybe not just the ones we've been talking about. And steroids certainly aren't a shortcut to reaching peak performance. After all, countless elite athletes set personal bests and world records on nothing but oatmeal and orange juice. Dr. Dean reminds us that you can't skip the basics.

Dr. Dean St Mart [59:31] I mean, I'm bodybuilding since I was 19. And now I'm 33. So that's 14 years of being in the gym, rarely missing a week of training, being very meticulous with my nutrition. And whenever I'm training in certain gyms, you'll be in the changing room getting dressed and you'll have a 16 or 17 year old look at you and the first question is Mr., what do you take? There's there's no thought process behind oh Mr. what's your diet to eat? How many meals do you eat? What's your training like? The first question is what do you take? So, before I even answer, I always laugh and you know, turn back and go try 14 years of training, and then we can have that conversation. So when you tell someone of that age, this is very achievable, but it takes time and patience. It's almost like you're, you're lying to them. And that they really want to believe that there's a magic supplement that makes them magically bigger, stronger without any sacrifice.

Braeden Page [1:00:38] We've learned a lot about performance enhancement in the context of sport today and how we got here. Looking ahead, we asked our guests what the future may hold, and how the governing bodies can improve the experience and education for athletes.

James Fitzgerald [1:00:51] Well, I think the challenge of the next few years, will also be the challenge of of our first 21 years of existence, which is holding that harmonization of the system together, you know, providing that consistency, providing that protection that athletes deserve. And making sure that that those who would want to take down the system, for whatever reason, who would want to fragment it, again, are not successful. And that is why we have a very collaborative approach to everything that we do, it's very important that we keep all stakeholders inside and we rely on on governments, we rely on the sports movement, we rely on national anti-doping organizations, we rely on the athletes to do their part, and to tell us where the system needs to be changed to tell us where there's things that can be done better or differently, or the whole system depends on everybody collaborating.

Madeleine Kelly [1:01:59] I'm hesitant now when I'm in the states competing about you know, where I get my meat. And if I'm out at a restaurant, what I order, and do I eat vegetarian tonight, just because, you know, I don't, I don't want something to go wrong. And I know I'm not the only person who feels this way. So that is certainly something that needs to be looked at, because a system that catches the wrong people is is still a broken system.

Evan Dunfee [1:02:23] You know, it's it's hard to say how much more the Federation's could do or the anti-doping agencies could do. I think a lot of it comes down to just the athletes willingness to understand that this part of this part of the job, filling out your whereabouts, taking these courses, understanding the WADA code. It's it's not the most glorious parts of being an athlete, but it's it's part of being an athlete, it's part of your job. And I don't know what more those those agencies could do to instill that kind of mentality with the athletes. You know, I think that comes more from the individual coaches or the training environment that you're in kind of promoting that as as sort of the holistic part of being an athlete, which, yes, certainly could could see more at that kind of more granular level, university coaches, teammates, training partners, all those sorts of things are probably like the best place to improve overall.

Swapna Mylabathula [1:03:21] Athletes have always tried to push the limits of what is physically possible through years of training, meticulous nutrition, and sometimes just sheer willpower. Pushing those limits can have negative health consequences, especially if using certain performance enhancing drugs. So are those drugs evil? Maybe, maybe not. But in the spirit of fairness, for those who don't want to take the risks, most performance enhancing drugs continued to be banned in most sports. Enforcing those bands, as we've learned today is not a simple task. It relies on a mutual commitment to fair competition amongst athletes, organizers, and even governments.

Braeden Page [1:04:00] As always, a very special thanks to our guests today, James Fitzgerald from the World Anti-Doping Agency. Maddie Kelly, University of Toronto alumnus and 800 meter Olympian of inductee Olympic race walker and medalists and Dr. Dean St. Mart bodybuilder and product formulator for Supplement Needs. And of course, thank you for listening.

Swapna Mylabathula [1:04:21] This episode was hosted by myself, Swapna and Braden. Jenna helped conduct the interviews and Claire and Elizabeth helped develop content. Alex was an audio engineer and Jesse was an executive producer. Tune in again in two weeks for our 99th episode on refugee health. Until next time!

Braeden Page [1:04:42] Raw Talk podcast is a student presentation at the Institute of Medical Science, the Faculty of Medicine at the University of Toronto. The opinions expressed on the show are not necessarily those of the IMS, the faculty of medicine or the university. To learn more about the show, visit our website rockoff podcast calm and stay up to date by following us on Twitter and Instagram and Facebook at Raw Talk podcast. support the show by using the affiliate link on our website when you shop on Amazon. Also, don't forget to subscribe on iTunes and Spotify or wherever else you listen to podcasts and be sure to rate us five stars.