Should We Allow Drugs in Sports?

Sports DopingDear Mark,

I know you used to be involved in triathlon sports administration. I see so much written about “banned substances” and “cheating” going on in the world of professional sports these days, especially with the Olympics looming. What do you make of all this?


Ray, my position hasn’t changed on this issue in a long while. Here is a piece I wrote for another website two years ago – before Floyd Landis tested positive for testosterone in the Tour de France.

A “Slightly-Less-Than-Modest” Proposal

At the risk of sounding a bit brazen, I would suggest that elite and professional sports would be better off allowing athletes to make their own personal decisions regarding the use of so-called “banned substances” and leaving the federations and the IOC out of it entirely. Even the term “banned substance” has a negative connotation, since most of these substances are actually drugs that were developed to enhance health in the general population. The irony here, of course, is that I have always been vehemently against the use of medications when natural remedies are usually better choices. But with sport we have athletes often doing “inhuman” or “unnatural” tasks that might require unnatural remedies. The bottom line is that drug-testing in sports is an extremely complex issue, about which most sports administrators have very little knowledge or understanding.

First, I should tell you that I was the Anti-doping Commissioner of the International Triathlon Union (ITU) – a relatively new sport within the Olympic Family – for nearly 13 years. I had to act as “prosecutor” on many doping cases (doping = drugs in sport). Prior to that, I helped write the first set of “anti-doping” rules for triathlon in 1988. Before that, I was an elite marathoner (2:18) and triathlete (4th Place Ironman Hawaii) in the ‘70s and ‘80s, so I have accumulated a fair amount of “inside information” regarding drugs in sport at the Olympic level. I also own a supplement company and have done extensive research on performance enhancement in pursuit of natural, legal alternatives.

There are three main points I want to make here: first, that it is impossible to fairly police and adjudicate drugs in sport; second, that the notion of a “level playing field” is a farce and, finally, that the performance requirements set by the federations at the elite level of sport almost demand access to certain “banned substances” in order to assure the health and vitality of the athlete throughout his or her career and – more importantly – into his or her life after competition.

Impossible to fairly police and adjudicate. Most people think that a positive test is conclusive proof of guilt, but the reality is that almost all these tests are nothing more than GC/MS (visit this link for a good description) quantitative analyses that look for parts per billion of certain metabolites in the urine. They are not black and white indicators of guilt. They are wavy lines on a graph subject to interpretation by scientists with varying degrees of expertise. In many cases a “threshold level” is established below which you are “clean” but above which you are “guilty.” Test results will vary significantly from one “accredited” lab to another. You can test positive in one lab and, conceivably, have another lab exonerate you using a portion of the very same sample. I have presided over cases where an athlete tested positive for metabolites of nandrolone (a once-popular steroid) at levels of 4 or 5 parts per billion when the cut-off was 2.5 or 3. Even at such disputably low levels, athletes are presumed guilty. Some labs have proven that these metabolites can occur in the body from having consumed certain types of meat or from other foods or are even endogenously produced. In my opinion, the threshold levels have always been too low, so a handful of innocent athletes get severely penalized, while others who are dirty but are not tested get cleared to compete and keep whatever money or medal they win.

In the old days if you ate a poppyseed muffin before a race, your urine could easily show above-threshold levels of metabolites of opium and you could be disqualified. It actually happened to a triathlete who was later cleared. There are other similar “false positives” we had to be on the lookout for.

A T/E (testosterone to epitestosterone) higher than 6:1 was considered evidence of a doping violation, yet we had cases of women who scored a T/E of 20, not because testosterone was present in high amounts, but because the epitestosterone was extremely low as a result of birth control pills. In other cases, elite athletes’ normal testosterone levels were high enough to exceed the limit, but they were allowed to compete when they showed proof of genetic abnormality. The limit is now 4:1 and produces thousands of “false positives” each year!

In other cases, athletes who have been diagnosed with asthma (now nearing 25% of the elite athlete population – don’t get me started) and who have properly notified the IOC and have a “therapeutic use exemption” on file can use salbutamol, salmeterol and similar “anabolic-property” drugs which are otherwise banned. But god forbid you are an athlete from a developing nation with asthma whose team physician failed to properly file your papers. Same condition, but now you can be severely penalized for the ignorance of your coaches or doctors.

There are known cases of sabotage where ex-wives have tainted supplements (or even toothpaste) to cause a positive test, and where athletes in races have consumed tainted drinks offered by unscrupulous coaches or fans of rival competitors.

Even when you do get a fairly reliable test result from the lab, a good lawyer can throw doubt on the integrity of the collection process, the chain of custody or a number of other factors, enough to get a truly guilty athlete off on a technicality. All these factors combined lead me to the conclusion that it is impossible to fairly police or adjudicate doping in sport.

The notion of a level playing field is a farce. The IOC and many professional leagues suggest that banning doping in sports will create a “level playing field”, meaning that all athletes should have access – or not – to the same advantages and disadvantages. Art DeVany’s exceptional analysis of home-run distribution notwithstanding, there are clearly advantages to be had from the use of certain substances specifically within certain sports. Take the use of EPO in cycling and running. EPO (Erythropoetin) is a natural hormone produced by the body. EPO stimulates the production of red blood cells, whose level in the blood is measured by hematocrit. Red blood cells contain the hemoglobin that carries oxygen to muscles where fuel can be burned. The more oxygen you deliver to the muscles, the more energy output you derive from those muscles. So having more red blood cells is a good thing and is a primary goal of many endurance athletes. Hard training raises EPO and hematocrit, but drug companies also make artificial EPO which does the same thing without training (intended medical use is for recovery from chemotherapy which destroys RBCs). Artificial EPO is banned. Now here’s the irony: research confirms that if you train at sea level and sleep at 14,000 feet, your body makes red blood cells at an impressive rate and amount. Several companies have developed expensive “altitude chambers” for home use where you can now train at sea level and then retire to your room for the night, simulating an altitude of 14,000 feet or higher. The end result is that you have, within the letter of the law, manipulated your own EPO to artificially raise hematocrit, yet using artificial EPO to do the same thing is punishable by a 2-year suspension. Talk to an endurance athlete from a developing nation with $2 to his name about THAT level playing field.

In the early days of EPO testing, the cycling federation would measure the hematocrit of every cyclist before a race. If your hematocrit was above 52%, you were not allowed to race and were presumed to have doped. However, there were instances of cyclists from high-mountain regions in South America who had normally high hematocrits (from training AND living at 14,000 feet or higher). Some were not allowed to race because they had achieved a high hematocrit naturally. Meanwhile, others who used artifical EPO to get from, say, 44% to 51% raced without penalty. Talk to those South Americans about a level playing field.

There are many other idiosyncrasies. Within the IOC, 2 cups of coffee is OK, but 8 cups is illegal. Marijuana will get you suspended by some federations, but not by others. Creatine, one of the best natural performance enhancing substances is legal in track and field, while beta-blockers, which have no effect on performance, were not. My point is that the concept of a level playing field is a nice idea, but one that has not been realized in Olympic sport.

The performance requirements set by the federations at the elite level of sport almost demand access to certain “banned substances” in order to assure the health and vitality of the athlete throughout his or her career and – more importantly – into his or her life after competition.
World class athletes tend to die significantly younger than you would predict from heart disease, cancer, diabetes and early-onset dementia. They also typically suffer premature joint deterioration from the years of pounding, and most endurance athletes look like hell from the years of oxidative damage that has overwhelmed their feeble antioxidant systems. Most people don’t realize it, but training at the elite level is actually the antithesis of a healthy lifestyle. The definition of peak fitness means that you are constantly at or near a state of physical breakdown. As a peak performer on a world stage, you have done more work than anyone else, but you have paid a price. It is again ironic that the professional leagues and the IOC, the ones who dangle that carrot of millions of dollars in salary or gold-medalist endorsements are the same ones who actually create this overtrained, injured and beat-up army of young people. They don’t care. These organizations then deny the athletes the very same drugs and even some natural “health-enhancing” substances that the rest of society can easily receive whenever they feel the least bit uncomfortable.

I had to disqualify and suspend a kid from competition for 90 days because he had a head cold the night before his national championships. His dad had gone to the drugstore and gotten him some Sudafed so he could breathe while he slept. His urine test was positive when he won the race the next day. He forfeited his winnings and he had to sit out the World Championships as a result. I felt terrible, but the rules required that we do it.

I had to suspend a talented and promising young Mexican triathlete because his vitamins contained a tiny amount of a little-known stimulant legal over-the-counter in Mexico. His doctor had prescribed vitamins for him because he had been chronically overtraining and yet had little or no access to decent training foods.

These days many athletes avoid taking high-potency multi-vitamins out of fear that contaminants in their supplements could destroy their careers. Yet these same athletes have nutrient requirements that exceed the RDAs by a factor of 10 or 20 in some cases. It has been said many times that world class athletes will do anything to win – even if it means risking their lives. If that’s the case, then don’t let them train so hard that they destroy their health and then deny them the very tools they need to recover!

I could go on, but you get my drift. I believe that with proper supervision, athletes could be healthier and have longer careers (not to mention longer and more productive post-competition lives) using many of these “banned substances.” And perhaps the biggest assumption I will make here is that the public just doesn’t care. Professional sport has become theater. All the public wants is a good show and an occasional world record.

I welcome your feedback.


Part II

In a prior post, I introduced a notion that training for sports competition at the elite level was the antithesis of a healthy activity. Since many people seem to think that athletes are almost by definition healthy, I thought I might develop that idea a bit further in this post and open it up for discussion.

Please don’t misconstrue what I say here as advocating any sort abstinence from sports or from training. On the contrary, I believe sports of all types can play a huge role in personal development, self-awareness and self-image, and may even help mold long-lost community life-skills like sharing, mutual cooperation and loss acceptance. I will make a case that sports and other non-group recreational exercise activities can contribute greatly to health, longevity and the quality of life. But, as with all things in life, moderation seems to be the key.

I first became aware of the distinction between “fitness” and “health” when I was competing as a marathoner in the 1970s and later as a triathlete for a while in the 80s. From 1975 until 1980 I averaged between 75 and 110 running miles a week in my training. Much of that mileage was done at over 75% of my VO2 Max and a substantial portion at over 90%. During that period, I became extremely “race fit”, as defined solely by the ability to enter a race and run fast. On the other hand, in retrospect, I consider myself to have been very unfit in a true Primal Blueprint sense during that time. I would routinely get upper respiratory tract infections, irritable bowel conditions (probably cortisol and ischemia-related), chronic tendonitis in my joints, and I eventually developed osteoarthritis. I spent an average of 5-6 weeks a year sick or injured (running was a year-around sport in those days) yet I was considered extremely fit! My injuries got so bad in 1980 that I could no longer train at the level required to be a top marathoner, so I switched to triathlons for a few years, and raced quite well in that nascent sport. Unfortunately, the same illnesses and injuries continued to plague me and the set-backs piled up.

When I retired beat-up at the ripe old age of 29 in 1982, I decided to write a book on triathlon training and to focus on the idea of “quality” over “quantity” in terms of mileage and training time. I wasn’t the first to really delve into this, and much discussion about maximizing training has gone on since. But I came up with a theory that the human athlete is much like a helicopter. The old saying about helicopters (and it may have since changed) was that according to the laws of physics, they are not supposed to be able to fly. The fact that they can fly is great, but the wear and tear of overcoming this “natural order of things” requires that they spend an inordinate amount of time being maintained – up to an hour and a half of maintenance for each hour flown. Well, the same holds true for humans. We were not designed to run (or cycle, swim or skate) for hours each day at 90% VO2 Max, or to spend hours each day in the gym lifting heavy weights. The fact that we can and that we are able to derive some short-term performance gain or adaptation to these exercises is great – if your desire is to measure your performance against another human. But we must recognize that in so doing – in going beyond the “natural order of things human” – we need to spend an inordinate amount of time on maintenance, or we will break down just like a poorly maintained helicopter. Our bearings will wear out, our parts will oxidize and corrode and our engine will fail. Literally. Athletic performance may be impressive, but it comes at a huge cost.

Here are some real cases to review – and many of these are people I know or knew personally: Marathoner Brian Maxwell, ranked #3 in the world at one time and founder of PowerBar died of a heart attack at age 51. Alberto Salazar, probably the greatest American distance runner ever had a heart attack at age 48 that left him clinically dead for 8 minutes (his heart stopped several more times on the way to the hospital). Greg Welch, one of the most versatile all-around triathletes ever (he won Ironman Hawaii, the ITU World Championships and the world Duathlon Championships) was forced to retire at age 37 due to severe heart problems. He has had over 10 open heart surgeries and wears a pace-maker. Mark Montgomery, who was a top pro triathlete for many years, had his pace-maker installed at age 46 as a result of V-tach issues. Johnny G, the developer of the popular “Spin” classes and a RAAM racer, has had severe cardiomyopathy and recently had a pacer-maker installed. Maddy Tormoen, 3-time world Duathlete-of-the-Year and 35-year old Emma Carney, twice ITU World Triathlon champion each now have defibrillators implanted in their chests to correct life-threatening arrhythmias. Chris Legh and Julianne White, both Ironman winners, have each had entire sections of their colon removed immediately after a race due to “ischemic conditions” where the blood supply to the GI tract was rerouted for so long (as the body diverted the blood to its periphery to cool itself) that whole sections of the colon literally died from lack of oxygen and nutrients. John Walker, one of the greatest milers of all-time was diagnosed with Parkinsons at age 46. Marty Liquori, another world-best miler was diagnosed with leukemia at age 43. Bruce Balch, Steve Scott and Lance Armstrong (all endurance athletes) all got testicular cancer after a few years of competing. Most of the top runners from the 80’s don’t run anymore; many can barely walk due to arthritic conditions. And we think endurance training is healthy?

One of the most alarming trends in sports these days is the increase in EIA or Exercise Induced Asthma. In some countries, over 25 % of elite endurance athletes eventually develop EIA as a direct result of their superhuman training schedules. In many cases, the diagnosis requires treatment with otherwise “banned substances” such as salbutamol, salmeterol and corticosteroids under a special IOC “therapeutic use exemption.” Another phenomenon that has concerned me for a while is the prevalence of amenorrhea in younger female athletes who train at elite levels, particularly runners and gymnasts. This condition, along with cortisol output, can result in loss of bone density during competitive years and dramatically increase risk for osteoporosis later in life. The list goes on.

Clearly, training and competing at the elite level has huge costs. We weren’t designed to train that hard for that long. We were built to migrate – at low level aerobic pace – across the plains foraging for food, scavenging leftover meat some carnivore had already killed and finished, maybe having to sprint for a few seconds to the safety of a tree. Even later when we became hunter-gatherers, we probably relied more on methodical tracking skills than on trying to outrun our prey. Nothing in my research indicates that earlier humans spent regular long periods of time at a high VO2max output other than in periodic games.

The intense and voluminous training regimens used by elite athletes today and over the past few decades – in an effort to perform ever higher, faster, and farther – have resulted in the accumulation of stresses far greater than the human body was designed to withstand. As a result, the adrenals – the body’s primary stress organs – pump out cortisol and other corticosteroids at a very high rate in an effort to “survive” what the HPA axis perceives as life-threatening events, even though we might think they are healthy stresses. We know that while some cortisol is necessary for life, chronic excess cortisol causes muscle wasting, increases deposition of fat, decreases the uptake of calcium by bone, dramatically suppresses the immune system, shuts down digestion and reproduction and has a deleterious effect on other neuroendocrine functions in general. All of these cortisol effects are exactly what a healthy person tries desperately to avoid, and yet an athlete often lives in a veritable cortisol bath – until the adrenals finally fatigue and a whole host of new problems arise. Moreover, revving up the metabolic rate by a factor of 10-20 times normal for hours at a time results in oxidative fallout (free-radical output) sometimes 100 or more times the normal output and gets to the point where an athlete’s feeble antioxidant systems are simply overwhelmed. Oxidative-based inflammatory processes start occurring not just in joint and muscle tissue, but in the circulatory system and in and around nerve cells. (NB: most models of heart disease now look at inflammation as a critical component). And we could have yet another whole side discussion on the typical athlete diet too high in simple carbohydrates and its effects on insulin, advanced glycated end-products and epinephrine/norepinephine.

I think we are starting to see the first signs of damage in a generation of athletes who trained too hard for too long without proper maintenance (to go back to my helicopter analogy). And it’s not just among the elites anymore, but also among the millions who tried to emulate their heroes’ training regimens – all because they thought more was better or more was healthier. I made a point in a prior article that I thought it was ironic that the Federations and Leagues that established the high level of performance and outrageous pay scales in the first place are the same ones now suggesting that athletes should not use performance-enhancing substances. After researching the physical destruction that elite training can produce at many different levels (see all above), I am left believing we should give elite athletes (and those who train like them) every possible means of avoiding injury, illness or future life-threatening conditions. If that means that we have sports medicine doctors administering high-potency multi-vitamins, antioxidant cocktails, the occasional shot of testosterone, EPO or local cortisone injections, so be it. If an athlete has a cold and needs Sudafed to sleep the night before a big race, s/he should be allowed to do so. I’m not suggesting that drugs are the only answer – good diet, better attention to rest and periodicity in training, biofeedback and other forms of “maintenance” can help. But if athletes were simply given access to the same tools that OSHA and the EDD demand we give any worker who was stressed out, exhausted or injured on the job, in the end we could eliminate the current untenable hypocrisy and at the same time allow for a healthier generation of athletes to wow us with their latest feats.

As for the recreational athlete who is not competing at any level, my advice is to limit your hard training to less than an hour a day, with complete days off. Vary your exercise and other forms of play as much as possible. My own epiphany came at 40 when I decided I would train to “look fit” rather than “be fit.” Of course, the irony is that I look fitter now than when I was one of the fittest guys on the planet – because I am the healthiest I have ever been. And in the end, health and your total enjoyment of life are all that matter.

I welcome your feedback.

Further Reading:

A Case Against Cardio

Doping/Dopey Scientists

Do you have MDD (Motivational Deficiency Disorder)?

TAGS:  Big Pharma, Hype

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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31 thoughts on “Should We Allow Drugs in Sports?”

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  1. Mark, as someone who has been involved with sports at the elite level for a few decades, I think this is one of the best discussions I have ever read about the issues involved.

    I say that even though I disagree with your conclusions that drugs should be allowed. But while I disagree with that conclusion, I absolutely believe that the real cost to the athletes should be more widely understood.

    As it is now, the whole approach is fantasy-land. Like you, I have seen the effects of the training that’s necessary to compete at the highest levels. But by design, all of that is hidden from the public.

    If that veil of secrecy and b.s. were pulled back, and we could have an honest discussion about what goes on behind the scenes in sports and in the bodies of the athletes, then maybe we could talk intelligently about the issue of drugs.

    The problem I see with your level-playing-field argument is the one that I have heard for years. If we allow drugs in sports, then athletics becomes a competition between chemists rather than athletes. And how well do you think an athlete from a poor country will be able to compete with athletes at the top making millions of dollars who can afford the best chemists?

    The counter-argument to that, of course, is that this is exactly what’s going on now, as you point out. And while even some of the top athletes, with the best chemists (e.g., Marion Jones) sometimes get caught, we all know for a fact that many more don’t get caught.

    It’s a conundrum, for sure. But I am in strong agreement with you that we need to talk about this honestly, and realistically, and open our eyes. Maybe with honest and open discussion we can figure this out.

    I’m certain that without more honest discussion, this issue will continue to be the tangled mess that it is now.

  2. Charles,

    Thanks for your comment. I didn’t say this in the piece above, but I think if the public knew all the issues and carefully examined them, they just wouldn’t care about them. Elite (and mostly professional) sport is no longer about morals, ethics, or settting examples for young people. It’s theater pure and simple. It’s about the money. Asses in seats and eyeballs on sets. These are modern day gladiators. Why else would a network run cage-fighting in prime time on a weekend? The public wants to see records, drama and they want to see the occasional bloodshed. As despised as Barry Bonds is these days, do you think MLB would sell one less ticket if he were playing this year? They just don’t care (but I think they just don’t KNOW they don’t care yet – because the media makes such headlines of doping). Anyway, appreciate your take on this, too.

  3. Well-presented arguments, Mark. I largely agree with you, yet I still have reservations about legalizing drug use. My reservation is the message sent to young people. I really fear that more and more young athletes, high school or even younger, will feel the need to use drugs to “level the playing field”. I fully agree that an open and frank discussion is needed and that current testing standards and protocols are a farce and that the vast majority of drug-users will avoid being caught.

  4. Scott,

    That’s always an issue, isn’t it? What about the message we are sending young people? Of course, one response might be that you don’t let anyone mess with this until they have been accepted into the pro-leagues, or Olympic development, etc, etc. Kind of like not allowing NCAA athletes to be paid while competing in college. To the extent you can control that, it might be as effective (or not).

    On the other hand, what message do we send kids already today when we say: we are going to enhance your immune system with an HPV (or other) vaccine. We are going to enhance your thought process and focus with Adderal or Ritalin. If you are a few inches shorter than your peer group, we might try some HGH, and rather than re-educate you and your parents on eating habits, we are going to inject you with insulin every day because your body is not processing sugars correctly. Meanwhile, lawyer dad takes meds to stay focused during his trial and journalist mom takes a little “speed” to help her meet her deadline.

    Point being: where exactly do we draw the line? Why is all this enhancement OK in “real life” but not in sports?

  5. I agree with you, Mark. We should legalize drugs, which may help as much as they hurt as long as athletes are determined to kill themselves in search of silly records. The stupid training is not illegal; the drugs should not be either.

    That said, I too can appreciate the problem brought up by Scott. What are young people to do? My advice is that they ignore professional sports and just do whatever they like as long (and as hard) as they want to. Turn off the idiot box–better yet, just burn it–and send the kids out to play: they can enjoy pick-up games, join a local league, or go solo training martial arts or whatever suits them. Without adults yelling at them to be “bigger, stronger, faster” all the time, they will find a healthy equilibrium that suits them in their chosen field of athletic endeavor. Without the TV, they will gravitate toward real-life role models who possess skills they learn to value. These role models are busy at work right now in communities all over the place–at the gym, at Highland games, at the dojo down the street. We just don’t get out enough to see them because most of us have our heads buried in the TV screen where another would-be hero is making a touchdown, crossing the finish line, knocking out his nemesis, and digging himself an early grave.

  6. Mark,

    I can’t tell you how lucky I feel to have stumbled upon your site (through Rusty). You guys have really enlightened me on the depth of nutrition and health beyond any teacher or “guru” has ever been able to.

    I have two questions. My first regards training and rest days. Simply, how many days of complete rest should I take for an entire week? I someone who’s been overweight for most of his pre-teen and teenage life, and who was able to lose that excess weight at 17 (I’m 20 now). My current goal is to “look fit” (and be healthy), which primarily entails eliminating the stubborn fat on my body that have refused to go away. If I’m doing three days of high-intensity interval training, for around 15-20 minutes per day, and three days of 1 hour lifting, for a total of 6 days per week with one day of rest, is that doing too much?

    Secondly, where do I get most of my fiber on a primal blueprint diet if most high-fiber vegetables can only be attained sparingly (I’m a poor college student)? I’ve been looking around your site for the answer, and the only thing I’ve read mentioned in passing was flaxseed. If that is your suggestion, where can I buy it? I couldn’t find it in the cereal aisle of my local grocer.

    Sorry if that’s a lot of questions.


    your loyal reader,
    – Josh.

  7. Hands down the best piece I have (ever) read relating to these issues. You should farm this article one out — it needs to be read and digested by the masses in the sporting media. A voice of reason with balls. Thank you. roy

  8. .well i havent read the post but the original Greek Olympiads used all manner of potions right ?
    So long as all know potential worst case risks why not glug-away ?
    We have bigger fish to fry as a species i reckon

  9. There was a documentary-style film on drug use among athletes (Bigger, Faster, Stronger: I am nowhere near being a professional on this subject, and I’m glad to have seen that movie (cleared a lot of false things I heard about) and to have read this post.

    One interesting point from the film was that there were four ways of increasing red blood cell count (an athlete’s medal was taken away after authorities found that he had been raising his blood count through “artificial” means). Of those four, two were legal (training at the official facility, and through normal exercise, while two were not (the athlete’s sleep chamber method, and through switching the old blood with new blood for better performance). These methods led to the exact same result, but two were considered legal, while the other two were not.

    The argument seemed clear at the time I saw the movie, but I’m questioning it now. Just because several methods lead to the same result does not make all the methods acceptable. For example, you can get money by legitimately working at a job, or by robbing a bank.

    Each time I read an article on drug use, I feel like I know even less of what is really going on.

  10. Thanks for your questions, Josh. We’ll try to address them in a future MDA post. Thanks for being a loyal reader and keep up the great work!

    Editor, MDA

  11. I’ve “heard” that if a woman takes “too much” steroids it could make her very “manly.” But she’d have to “over do it.” I wander how true is this?

  12. Donna,

    Very true. Witness the infamous case of the East German women’s swimmers three decades ago. They developed significant muscle mass (the goal), as well as deep voices and fascial hair. These women/girls were definitely subjected to “too much” testosterone. I’m sure that the changes are a continuum and that smaller doses would effect similar, but less noticeable changes.

    Conversely, aging has the effect of suppressing a woman’s estrogen, effectively increasing her testosterone, often with some of the same effects.

  13. Dear Mark,

    Many thanks for your most thought-provoking articles. From someone such as yourself, with an uniquely well-informed position, it made for a most interesting read and caused me to rexamine some of my own beliefs.
    However I do remain concerned about your final position. Are you really advocating a total hands off approach to drugs in sport ? Surely you can’t have been happy to see results of the Eastern Bloc drugs policies in athletics in the 70’s and 80’s ? I shudder to think what the post career lives of those athletes must look like.
    I would also take issue with you on another point. You say that sport has become a spectacle or entertainment, all we want to see is world records and we don’t care how they are achieved. I profoundly disagree. I think the general public was deeply disgusted to learn of the behaviour of drugs cheats such as Marion Jones, Ben Johnson and Dwain Chambers, and rightly considers any titles or records they won to have been falsely achieved.
    Speaking personally I find it inspiring to admire the achievements of modern athletes as they produce amazing performances, and demonstrate the remarkable capability of the human race to develop itself and push back the frontiers of what we regard as possible. If that were to be achieved purely through chemical means I for one would never watch again.
    I share your eloquently expressed concern for the afterlives of top athletes. I can only hope that with increased understanding of modern training methods those sacrifices can be minimised.

  14. The take home message I received from Mark’s post isn’t about using drugs to enhance performance, but to help counteract the damage that extensive training does to the body. Having said that, minimizing damage to the body means faster recovery, and better performance, but I think that the general message is that, especially with endurance athletes, they are more susceptible to stuff like osteoporosis, heart disease, etc. and that they need medicine on their side, not against it.

  15. I agree to a point.

    EPO, as I recall, is known to result in lava-like blood and thereby cause heart attacks (cf. The Death of Marco Pantani by Matt Rendell). If EPO is suddenly declared legal for sport, we’re going to see some ignorant endurance athletes dying in their sleep because their blood gelled up on them in the middle of the night. Granted, if athletes become anemic from training, EPO might come in handy, but perfectly healthy athletes shouldn’t be taking the stuff.

    Then there’s the ethics issue of the East German coaches who gave their swimmers steroids disguised as “vitamins.”

    On the flip side, I recall reading that treatment for Floyd Landis’ hip should’ve included the testosterone he was supposedly busted for using. That’s a case where a not-so-healthy athlete probably should’ve had some leniency.

  16. How about three Olympic catagories?



    Do whatever you want and let er rip!

  17. Great article.

    1. The phrase “What about the kids?” is an appeal to the emotions and usually adds little to any conversation. If parents were truly concerned about their children´s health, they would burn the TV 100% and teach their children to eat properly, play with other children and not video games, and allow them to dream more instead of shoving them around to every sport event and play date.

    2. The given examples of athletes with various heart problems who have died or now have pacemakers is a tad misleading. Most cardiovascular problems which arise during intense sport are usually the result of genetic or unrecognized anomalies. Almost all athletes who die suddenly or have severe cardiovascular problems after sport, had underlying defects which were either undetected or brought to the fore only after some life-threatening event and not caused by endurance training. The young runner who dropped dead before this years NY marathon knew he had an enlarged heart which was not the result of athletics. His doctors told him when he was younger of his chances of dropping dead. A heart which has been thoroughly checked and cleared of any genetic or other organic defects, will respond to increased training by becoming bigger and more efficient. (Athlete´heart)

    Did those athletes you mention have genetic or undetected heart problems?

  18. to Caloi Rider-Pantani died of a cocaine overdose and not an EPO overdose.

  19. Great comments, everyone. I want to remind you that I entitled this “a slightly-less-than-modest-proposal” in reference to Jonathan Swift’s famous treatise. I am suggesting that we need to have a discussion that covers all aspects of sports and looks at the current unhealthy aspects as well as the good stuff. We should NOT blindly assume that all athletes should be prevented from using all or most medications. We should reconsider the definition of a “level playing field” and the hypocrisy that comes when a lawyer using Xanax to control anxiety in trial accuses an athlete of cheating because his supplements were slightly tainted with pseudoephedrine.

    I did not suggest we open the door to everyone using as much of anything as they want. I am suggesting that athletes ought to be allowed to work with sports medicine docs to make sure they are getting the most benefit from their training. Everything in the open. The East German women swimmers had no idea what was happening to them. I don’t condone that. Maybe you choose certain medications that athletes can use and then set high levels where, if they test over those levels, they are disqualifed from that one event or sit out four weeks. I’m not sure what the answer is, but I can guarantee you that what we have now is a total mess and does not work.

  20. Pierre, you said “A heart which has been thoroughly checked and cleared of any genetic or other organic defects, will respond to increased training by becoming bigger and more efficient.”

    You are implying that this will always be the case. I disagree. This is all about gene expression. Some people may have a slight predisposition to “organic defects” but many athletes who have no prior genetic warning still manifest bizarre blood chemistries, arrhythmias, etc based on chronic overtraining and an insulinogenic diet. If you train smartly and eat wisely for a lifetime, you will likely avoid heart problems even if you do have genetic predispositons. OTOH, if you overtrain and eat poorly, it’s likely you could manifest some health-threatening conditions. That’s pretty much my point with this article.

  21. Yes, I should have made it clear that it is not always the case. But, as I mentioned, the vast majority of athletes who die suddenly or have chronic heart problems have underlying cardiac problems which have little of nothing to do with endurance training. This is not hearsay, but is supported by the literature. Most people who undertake endurance training are NOT obese and usually eat what appears to be a healthy diet. An overly obese person is not going to run a marathon or train for one-their joints would give out before their heart in most cases. OTOH, many, many more people who do no exercise at all, die of the same types of cardiac problems as those experienced by elite athletes. The types of cardiac problems which arise in normal healthy elite athletes develop over years of training and in some cases, over-training. Most athletes at this level, eat rather well, maybe not primal, but healthy non-the-less.

    Small changes in gene expression are usually not the culprit here. Structural changes and alterations in electrical signals of the heart musculature are the main problems. For example, the electrical signals driving the contraction of the heart can be so strong in the athletic heart, that the signal will jump out and spread over areas of the heart causing extra beats.

    Pre-dispositions are usually found with a thorough cardiac checkup- the heart is an amazing organ, but relatively simple.

  22. Pierre-

    I was merely citing my source for that information. The Death of Marco Pantani is the title of a book by Matt Rendell, and the two little letters before the book title come from a Latin term meaning “cross reference.”

    Matt Rendell merely outlines the health risks of using EPO in the book. He also, interestingly enough, pointed out that Bjarne Riis was a client of Francesco Conconi’s before Bjarne confessed. It’s a pretty interesting read, so I’d recommend it if you have the interest.



  23. Hi Again,

    Back to Mark’s suggestion that athletes should be allowed to use medication to ensure they get the maximum benefit from training or minimise the damage, let me give you a very pertinent example – the Tour de France. Under TdF rules, asthmatics certified by their doctors are permitted to take certain substances which for non-asthmatics could be considered as performance-enhancing. Guess what – over 25% of all TdF cyclists are certified asthmatics !!

  24. Josh, the amount of rest you need is dependant upon the work load. One day a week of rest sounds fine for what you’ve described, but two day soff wouldn’t set you back in your training either.

    As for fiber in the diet, it is over-hyped by the media. We don’t actually need that much fiber, beyond what we get from consuming a few fruits and vegetables each day and provided we don’t consume processed foods. The notion that we need “whole grains” for the fiber effect is total BS.

  25. Mark, great article. What is your opinion with regard to time off at the end of a racing/training season. Timothy Noakes believes that 2 months a year, with no athletic training is the correct way. Just to heal all the nicks, strains, niggles. etc. I have been taking 4 weeks off, but then an injury or illness gives me the other 4 weeks anyway. Thank you. Greg

  26. Re: competition between chemists not athletes

    I couldn’t disagree more with this! Over the past 15 years while working out at various commercial gyms, I’ve come in contact with dozens if not hundreds of people who were using more PEDs than any Olympic-caliber athlete.

    It takes infinitely more than anabolic steroids and performance enhancing drugs to make an elite athlete. A chemist has never created a drug that could remotely accomplish such a feat and most likely never will.

  27. Re: allow drugs in sports will disadvantage poor athletes.

    I strongly disagree with this statement. PEDs are relatively inexpensive – certainly significantly less expensive than optimum nutrition.

    It is drug testing that has potentially disadvantaged poor athletes because the readily available inexpensive PEDs are banned creating the market for designer steroids (afforded by affluent athletes).

    In addition, “rich” athletes can afford extensive monitoring to bypass detection of their use of PEDs in a drug-tested system. This potentially disadvantages poor athletes.

    So,ultimately permitting PEDs in sports will help poor athletes.

  28. Mark,

    This is a great observation.

    “…the performance requirements set by the federations at the elite level of sport almost demand access to certain “banned substances” in order to assure the health and vitality of the athlete throughout his or her career and – more importantly – into his or her life after competition.”

    This is especially true in “extreme sports” like endurance events where the extreme demands of the sport itself often compromises the health of the athlete.

  29. Greg, I agree with Noakes that you should take at least 2 months off. Noakes is a god among exercise physiologists, by the way.

  30. Mark, Thanks for your reply. Sometimes it is hard to stop training at the end of the season, but I think the payoff in terms of a longer, healthier career, is well worth it. I learned alot from Noakes’s book, “Lore of Running” not surprised he is well respected. It was the low intensity aerobic exercise you recommend that catapulted Mark Allen to a record 6 Ironman victories including one at age 37. I tried it for a season and it really did work. My aerobic running pace went from 10 minutes per mile to 8 minutes in about 14 weeks. Mark Allen’s aerobic running pace dropped to around 5:30 per mile, all on easy, but voluminous, training during the base period. Greg

  31. Hey
    First of all, i was so sad to read that sportsmen addicted to drugs. sports keep a person fit, but these people do not know why they addicted.