Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Saturday, October 22, 2005

Boom and bust: Supplements tough for pro leagues

Posted on Fri, Oct. 14, 2005

Boom and bust: Supplements tough for pro leagues

The Seattle Times

(KRT) - During a lunch break at the Seattle Seahawks training camp in Cheney, Wash., quarterback Matt Hasselbeck points excitedly across the campus at Eastern Washington University.

"You see that smoothie place over there," he's saying. "They'll sometimes throw in a boost, protein or whatever, like you get at Jamba Juice. And here's the thing: I'm afraid to get a boost at Jamba Juice."

Hasselbeck laughs when he says this, because he knows he sounds a little paranoid. But make no mistake: Supplements in sports are not a joking matter.

His fear comes from an incident last season. Hasselbeck and his linemen are sitting around the locker room, laughing about the contents of a drink he bought at Whole Foods Market.

"What's bitter orange?" he asks, reading off the label.

"I don't know," responds guard Chris Gray, the Seahawks' player rep. "But I think it's a banned substance."

Hasselbeck panics. He calls the league and confirms that bitter orange is indeed on the banned-substance list. A drink he purchased at one of the healthiest markets on the planet might cost him four games in suspensions and, just as important, four paychecks.

Turns out there's bitter orange in orange juice. Turns out Hasselbeck would have needed to drink 20 glasses on the day of his test to yield a positive.

What his paranoia shows is that sports are having a hard time wrapping their arms around the issue of over-the-counter supplements, even everyday purchases of protein drinks and multi-vitamins.

Since all sports operate under strict liability, athletes are responsible for everything they put into their bodies. The problem with most over-the-counter supplements is that nobody really knows what's in them.

The industry is only loosely regulated. Which is why Jennifer Devine, an Olympic rower beginning a medical residency at Harvard, compares the process to "watching somebody make sausage. Once you find out what goes into it, you may not want to eat it ever again."

"The supplement industry is the wild, wild West of pharmaceuticals," says Maxwell Mehlman, law and bioethics professor at Case Western Reserve. "It's the cowboy stuff all over again. And that's not to denigrate cowboys."

Cleveland Browns center Jeff Faine is the future of supplements and sports. Before starting his NFL career three years ago, a strength coach set Faine up with a chemist in San Diego.

It was love at first vitamin. Twice a year, the chemist analyzes Faine's blood and urine, looking for deficiencies. Then he makes a mixture of supplements, some sort of vitamin nirvana, specific to Faine's tests. Each pill contains equal parts of the same ingredients, and Faine swallows 22 in the morning, 22 in the afternoon and 21 in the evening, good for 65 a day and more than 23,000 a year.

Since Faine isn't big on eating vegetables, the chemists adds more iron. Since linemen are hard on joints, the chemist adds shark cartilage to increase blood flow. To keep Faine's core temperature up, the chemist adds cinnamon extract. Then fish oils and salmon oils, and on and on, all for a specific purpose.

Faine says the hardest part is grasping the fact he's swallowing 65 pills a day, although three years into the experiment he can ingest 17 of them in a single swallow.

Fraught with frequent illness as a child, Faine says he gets sick maybe once a year now.

"I feel better throughout the day," he says. "I have a lot more energy. I might get some teasing from my teammates, but I stand by it. A lot of NFL linemen die early. A big part of that is the way they live their lives, the way they take care of their bodies. I'm trying not to be a statistic."

The difference, Faine says, between his approach and the over-the-counter variety is that he knows exactly what he's putting in his body. And still, some experts aren't convinced.

"He's depleting his wallet," says Dr. Gary Wadler, noted performance-enhancing drug expert, "and he's running the risk of developing a condition from taking too many vitamins called hyper-vitaminosis."

Supplements aren't new to sports. They're just more popular and easier to obtain.

Baseball players have popped amphetamines - or greenies - for decades, while athletes in all sports have tried everything from coffee to cocaine to supplement their training. Before anabolic steroids were banned in sports, they were even considered a supplement.

Dr. Mark Webber, a chiropractor for the Seattle Thunderbirds who has run drug testing for several international bodybuilding federations, remembers the original slogan for the anabolic steroid dianabol, before Wheaties patented it and made it famous.

"They called it the breakfast of champions," Webber says.

There are athletes and trainers who swear that supplements are necessary, that athletes aren't like normal people and can't reach maximum performance with simply the right amounts of sleep and water.

Devine trained for the Athens Olympics while studying to become a doctor. She even went so far as to sleep in an altitude tent.

"There's just not enough time," she says. "You need drinks that have electrolytes in them. You need to take a vitamin supplement. There's not enough time to eat the right stuff in the right concentrations and recover with sleep and water."

Dr. Marian Neuhouser is a nutritional epidemiologist at the Fred Hutchinson Cancer Research Center here in Seattle. Her studies have nothing to do with sports, but they find the same kind of motivation.

People take supplements for the same reasons they buy insurance - they're afraid that their diet isn't good enough, that they might be missing something.

"They want to take a supplement," Neuhouser says, "but they do that without regard to whether or not the supplement works. Some of these people are sold on the idea that these are imaginary magical bullets. There really isn't enough research yet. Are they beneficial? Or are you just flushing money down the toilet?"

Some experts, like Wadler, can hear the flush.

"There's not enough there to enhance performance," he says. "There is enough to give you a positive test, since we use the principle of strict liability. My advice to athletes is there's probably no value whatsoever in the first place. If you want protein, eat fish, eat chicken, eat beef.

"But don't eat powders."

Mariners pitcher Ryan Franklin represents the present of supplements and sports. He's been caught by baseball's testing policy and condemned in the court of public opinion. He says his positive test stems from taking over-the-counter supplements, from the protein shakes he drank or the multi-vitamins he took.

And here's where supplements and sports get tricky. Experts say it's possible Franklin is telling the truth.

The problem is they need to know exactly what he took and what he tested positive for. Franklin handed over his supplements to the commissioner's office and even asked to be tested weekly. But until he hears back from the arbitrators, he says he can't release that information.

"We still haven't received the statement on why Ryan was suspended," says Jay Franklin, his brother and agent. "This is one of the biggest jokes I've ever seen in how it was handled. There are rules we have to follow in what we can and cannot talk about. I can't comment on the testing procedure until we get a written statement."

Jay Franklin can, however, speak from personal experience. He admits to taking steroids to prolong his baseball career in the mid-'90s. Up until 1995, when he failed a physical that prevented him from playing in Taiwan. The red flag? Liver problems Jay Franklin says stemmed from steroid abuse.

At that point, the family sat down for a discussion. The brothers' dad and a sister both work in the medical field, and they talked about the damage performance-enhancing drugs can inflict on a career.

"Ryan was very aware of it," Jay Franklin says. "He knows my liver was messed up because of the abuse of steroids. So why would he go down that same road?"

Devine says doctors like to "pat themselves" on the back for "daring" to ask patients about recreational drug use. She also asks her patients what supplements they take.

"There are a much higher percentage of people taking vitamins or ginger root or whatever than there are people taking crack," she says. "But it's the same principle - you don't really know what's in it. Look, this stuff is not regulated by the FDA. We have no idea what's actually in it."

Adds Faine, "Buying over-the-counter supplements is like playing Russian roulette."

Congress passed the Dietary Supplement Health and Education Act in 1994 in an attempt to allow the Food and Drug Administration to establish standards for dietary supplements. The problem is that the FDA never determined what so-called "good manufacturing processes" consist of. So far only ephedra, linked to the death of Baltimore Orioles pitcher Steve Bechler, has been banned.

Since supplements are defined as dietary, they aren't subject to the same standards as drugs like aspirin are by the FDA. Devine says there are several levels of regulation. Determining whether the drug is safe. Determining whether it's effective. Determining how effective. Then stages and clinical trials.

"There's no question that there are consistently contaminated dietary supplements," Wadler says. "Because so-called good-manufacturing processes have not been implemented in the supplement industry."

Like what? Neuhouser says colleagues have found supplements contaminated with hormones, lead, minerals, pesticides and glass.

Take calcium, for example, which is involved in bone strength. If a supplement contains calcium, even trace amounts, Neuhouser says companies are allowed to put "maintains bone strength" on the bottle.

She points to two other studies. Like the time she and other colleagues looked at the link between lung cancer and beta-carotene. It was thought that beta-carotene reduced the risk of lung cancer. It actually increased it. She also examined the link between vitamin e helping cure cardiovascular disease, which showed little to no effect.

"There are certain regulations the FDA has about what you can and cannot put on a supplement bottle," Neuhouser says. "But the FDA doesn't have unlimited resources. They can't police tens of thousands of products."

Only if the industry is forced to. If not, Devine says, "It's too expensive. It's prohibitively expensive. Supplement companies have a fair complaint there."

Some supplements don't list all of their ingredients. Some call them by different names. Some don't have the strength - or have more strength - than what's listed on the bottle. Some even contain performance-enhancing substances companies include on purpose, experts say, to make them more attractive to consumers. Like, well, athletes.

Just last week Wadler chaired a symposium in Germany on the issue of supplements and sports. Two years ago, he chaired a similar symposium in Montreal. Sports is trying. But other than the NFL, nothing has been put into practice.

"The FDA has no handle on it," Mehlman says. "God knows what's being sold and what people are using and what it's doing to them and not doing to them. There is the potential for serious side effects and a lot of quackery. There's no good data and no prospect of getting any.

"Let's really end the hypocrisy and stop treating athletes who are really just responding to the pressure of high-level competition as if they are pariahs. If sports is really trying to protect them, there are ways of protecting them that we're not using now."

The bottom line is athletes need to exercise caution. When Hasselbeck's allergies kicked up in Cheney, trainers told him not to take Claritin D because the Sudafed in it could lead to a positive test.

Tennis pro Greg Rusedski probably wishes he had obtained the same advice. He tested positive for the steroid nandrolone, but was exonerated in March 2004 because a panel ruled his positive result came from contaminated supplements given to him by trainers on the ATP tour.

The difference between the NFL and the rest of the sports world is its testing program. Companies must pay for testing of their supplements, and if they are shown to be free of banned substances, the NFL puts its sticker of approval on them. So far, only five - all by EAS - have the sticker. And even that, says Mariners general manager Bill Bavasi, is not a guarantee.

"As a club, we are not in a position to endorse any supplement," he wrote in an e-mail he sent through a staff member. "The only way to know for sure that something is safe is to send it out to a lab and have it tested, and even then, you only know about one container you tested. We're not in a position to do that."

"Obviously, football has better control on this situation than baseball does," Jay Franklin says. "It's your job to educate your employees. They should be like, 'Here's a list of substances you guys can take. Here's what you can use.' It seems to make sense to me."

And to Hasselbeck, paranoia aside.

"You can know, without a shadow of a doubt, that the product you're taking is legal," says Hasselbeck, now a spokesman for EAS. "Besides our program, you can't be sure, and you can't be safe.

"I feel like I need more, but it's just not worth it."


© 2005, The Seattle Times.

Visit The Seattle Times Extra on the World Wide Web at

Distributed by Knight Ridder/Tribune Information Services.

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