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Medical and Anti-Doping

1. Anti-Doping On-line Education

Link to IFSC AD Rules

The Anti-doping e-learning platform (ADeL)offers access to all topics related to clean sport and anti-doping. It offers courses for athletes, couches, doctors, Administrators, and anyone interested in learning more about anti-doping and protecting the values f clean sport.

Please click here to access the courses.

Please enter the real identity information while creating an account, as the completion, the course will be recorded. You will be given access to the relevant courses based on your role in the sport (athletes, coach, parents or, physician).

The platform gives access to the following courses:

  • Anti-Doping Education Course for Athletes: ALPHA;
  • Anti-Doping Education Course for Coach: CoachTrue;
  • Parents' Guide;
  • Sport Physician's Tool Kit.

Anti-Doping Education Course for Athletes: ALPHA

The Athlete Learning Program about Health and Anti-Doping (ALPHA) gives athletes information about the dangers of doping and the importance of anti-doping controls and promotes positive attitudes toward avoiding doping.

It consists of eight sessions and takes two hours to complete. Athletes are encouraged to take the course in several stages. Progress is then saved from one visit to another. A pre-and post-course anti-doping knowledge test and attitude survey are included to evaluate the effectiveness of the program.

A score of 80% or higher is required for ALPHA certification, though athletes with insufficient scores are able to repeat the program. Those who have completed the program in previous years do not need to redo it.

Please enter the real identity information while creating an account, as the completion of the course will be recorded.

ALPHA is currently available in: English, French, Spanish, Hungarian, Croatian and Japanese. More languages will be added in the future.

This online education course is highly recommended (it will become mandatory from 2019) for the participants of the following competition:

World Championships and Youth Championships

 

Anti-Doping Education Course for Coach: CoachTrue

CoachTrue provides anti-doping education for coaches of elite and recreational-level athletes. It has different modules covering all anti-doping processes as well as tutorials, scenario-based activities, and quizzes. CoachTrue is available in English, French, Spanish, Indonesian, Polish, and Vietnamese. More languages will be added in the future. This online education course is highly recommended for elite coaches.

 

Parents' Guide

An anti-doping reference guide/booklet for parents seeking more information to ensure healthy athletic development and prevent the use of prohibited substances. This resource is relevant to parents of all levels of athletes from beginner to elite.

Parents' Guide is available in English, French, and Spanish. More languages will be added in the future.

 

Sport Physician's Tool Kit

Sport Physician’s Tool Kit is a course covering anti-doping modules tailored for physicians and other medical personnel. There are also three modules covering major games topics, done in collaboration with the IOC.

Sport Physician’s Tool Kit is available in English. More languages will be added in the future.

 

2. Resources for Athletes

Anti-doping Leaflets

These leaflets produced by WADA give the athletes an overview of the Anti-doping regulations and processes:

WADA Athlete Guide

The athlete reference guide, produced by WADA, is a short document (around 20 pages) that helps the athletes to understand the Anti-Doping Code. This guide gives an overview of the Code in a comprehensive way, and is available in 13 different languages:

Athlete Reference Guide: available in English, French, Danish, Dari, Estonian, Finnish, Kazakh, Kyrgyz, Mongolian, Spanish, Tajik, Turkmen, Uzbek.

 

Checking Your Medication

The guidance below will help an athlete or personal support when checking the status of a substance or medication against the World Anti-Doping Agency’s Prohibited List*.

INGREDIENTS: Ask your doctor or a pharmacist to check that all the ingredients of your medication are permitted for use in sport. Checking only the brand name of the product can lead to error: in different countries, or even at different times in your own country, a product known under one same brand-name can contain different substances, one or several of which may be prohibited.

CORRECT SPELLING: Do not guess the spelling of the name of a product or its ingredients, as one substance might not be prohibited, while another, with a name that is similar, but not exactly the same, might.

ROUTE OF ADMINISTRATION: The status of a substance may vary depending on how it is used (e.g., orally, by injection etc).

SUBSTANCES PROHIBITED IN PARTICULAR SPORTS: Certain substances are prohibited only in particular sports. Ensure that you consult the Prohibited List to see if your sport prohibits substances that are specific to your sport.

UP TO DATE INFORMATION: Check the status of each ingredient of any medication that you buy, even if you have bought that medication before, as previously acceptable ingredients may have changed in status or new, prohibited ingredients may have been added.

CHANGES TO THE PROHIBITED LIST: Check any existing medication against the current Prohibited List and plan ahead to take any changes into account (an updated List comes into effect on January 1st each year but is first published three months earlier).

PERMITTED ALTERNATIVES: When checking your medication and you find it includes a prohibited substance, you are encouraged to try and find a suitable permitted alternative. Most common ailments can be treated with products that do not contain a prohibited substance!

THERAPEUTIC USE EXEMPTIONS: If a permitted alternative is not available, you may need to apply for a Therapeutic Use Exemption (TUE) by submitting a TUE application to your NADO or your IF.

IF ALL ELSE FAILS: Remember, if you can’t find information about a substance or medication, DO NOT assume it is safe to use.

*The Prohibited List outlines which substances and methods are prohibited in sport. A new version of the Prohibited List comes into effect every year on January 1st, however, it may be changed from time to time so it is important that you check for changes on a regular basis. The new List is always published three months before it becomes effective.

Medication and Q&A

This leaflet produced by WADA highlights issues relating to taking prescription and over-the-counter medications as they relate to the fight against doping in sport. Available in English, French, Spanish and Portuguese Download.

 

3. Nutrition Advice

Protein Update
Late in 2003, the IOC brought together a group of sports nutrition experts and researchers from around the world to discuss and revise its consensus statement on sports nutrition. Part of this consensus statement says:
"A varied diet that meets energy needs will generally provide protein in excess of requirements. Muscle mass is maintained or increased at these protein intakes, and the timing of eating carbohydrate and protein may affect the training adaptation." - IOC consensus statement on sports nutrition 2003, Journal of Sports Science, 2004: 22.

 

What is protein?

Protein is part of our diet and is the “group” term for the delivery of a range of amino acids. Our diet provides us with 28 amino acids, of which 8 are essential as they cannot be manufactured within our bodies. These amino acids are ingested as whole protein and are then broken down to their individual components and either used or are stored and an amino acid depot ready for our bodies to make new proteins (for example, muscle, hair, nails, skin, enzymes, hormones, antibodies, etc).
Different protein foods contain different amino acids, and in varying quantities – so it is important to consume a range of protein-containing foods. The main use of protein is in growth and repair, although it is also a source of fuel to our body, especially if carbohydrate stores (glycogen) are low.
Foods rich in protein include meat products (including poultry, fish, and seafood), eggs, dairy products, legumes, nuts and seeds, and tofu. Bread and cereals, rice and pasta also contribute useful amounts of protein to our diets.

 

Do Athletes need more Protein?

It is well recognised that athletes require more protein than sedentary people. What is interesting is that protein requirements of both strength and endurance athletes are very similar – around 1.2-1.7g/kg body mass (compared to 0.8g/kg body mass for sedentary people). Strength athletes require more protein for maintenance and growth of muscles, whereas endurance athletes require more protein to repair tissue damage (such as blood cells, etc) and also as a source of fuel. The good news is that most athletes achieve this higher protein need quite naturally, simply by the fact that our traditional diets aren’t low in protein, and because athletes tend to have higher energy intakes. This level of protein intake does not constitute a HIGH PROTEIN DIET, however.

 

What is the best type of Protein?

In the past, egg protein was considered the most complete, and many “protein” supplements were based on either egg or skim milk protein (which is a combination of whey and casein proteins). More recently, the supplement industry has pushed isolated whey protein as the optimal source for athletes – unfortunately with very little scientific backing. What we understand now is that different proteins are absorbed at different rates (much like the glycaemic index for carbohydrates) and have different functions. Whey protein is absorbed rapidly from the gut, and elevates blood amino acids levels but only for a relatively brief period of time. Whey protein may also boost immune function. Casein, on the other hand, is absorbed more slowly but maintains an elevation in blood amino acid levels for a longer period of time than whey. Casein also has an anti-catabolic action, which means it reduces muscle protein breakdown, which whey protein doesn’t do. Soy protein is also promoted heavily in some sports, and has an advantage of containing some antioxidants. The bottom line is that it’s probably best to include a variety of protein types in our diet, particularly after exercise, and that timing is more important than type, or probably even the amount.

 

Is better to take Amino Acids, rather than Protein?

Amino acids have also been made popular by some supplements companies, which is partly because many of the studies on protein metabolism use amino acid concentrates. However, the reason scientists use amino acids is because they can more easily quantify exactly how much amino acids they are providing to subjects and they can label and trace their movement in and out of muscles, not because they are a better source. It is important to remember that we receive more than just amino acids from food – most protein sources are also excellent sources of other important nutrients for athletes, such as iron, zinc, and calcium. Also, excessive amounts of one single amino acid can disrupt overall protein balance since all of our body proteins require different proportions of the various amino acids. Remember that 5g of amino acids (as capsules) is effectively 5g protein, which you can achieve much more cheaply by eating an egg!
Some amino acids have been studied to learn more about their specific functions in the sport. For example, branched-chain amino acids are a group of 3 amino acids which have been researched in the area of “central” fatigue (i.e. the brain and nervous system) in prolonged endurance exercise. Although taking BCAA’s can delay this fatigue, consuming carbohydrate works equally well, if not better. Another example is glutamine and immune function. Researchers found that glutamine levels fall at the same time as some immune parameters during prolonged exercise. Whilst supplementing athletes with glutamine stops the fall in blood levels, it does not alter immune function.

 

Is timing important?

We all know that taking in carbohydrate soon after exercise promotes greater glycogen replenishment in the muscle. Recent protein studies have shown a similar effect with protein. If you don’t eat after resistance training, you will actually create a breakdown of muscle. If you eat protein, the muscle will actually start to take up protein, rather than break it down. Even more interesting are a couple of studies which have looked at the effect of eating protein PRIOR to resistance training – and the effect on protein uptake after training seems to be even better than just eating protein after the session. So, timing is very important. The optimal amount of protein after exercise is around 10-15g.

 

What about other nutrients?

Studies have shown that consuming either protein OR carbohydrate after resistance exercise will reduce muscle breakdown and promote muscle generation. More importantly, the outcomes from a number of studies show that combining the two has an even greater effect - ie carbohydrate AND protein work together produces a more positive protein uptake by muscle. There is even some evidence to suggest that the protein also supports greater carbohydrate uptake when there has been some muscle damage.

 

Don't I need more Protein if I’m trying to bulk up?

While resistance training does increase protein requirements, as indicated above this is no greater than that needed for any other type of training. The key ingredients to bulking up include the right training program (and a willingness to train hard!), and a high energy intake. Many athletes struggle to achieve the energy needs for gaining muscle mass, especially if they have a busy schedule of training, work/study and home commitments. Get yourself organised to eat regularly throughout the day (5-6 meals/snacks at least), make use of your fluids by drinking milk, juice, cordial and sports drinks, and eat more energy-dense snacks such as dried fruit and nuts and cereal bars.

 

Won't eating more Protein help me lose body fat?

To lose body fat, you need to eat a little less energy than you burn. High protein weight loss diets can work in the short term for non-exercising people because they reduce total energy intake. Protein tends to satisfy your appetite the best, and if you take out carbohydrate, then you remove out a lot of food sources.
Whilst a non-exercising person might get away with dropping out carbs and increasing protein, someone who’s training hard won’t. Dropping carbs will result in increased fatigue, an inability to train effectively, and may reduce your immune function, making you more prone to getting sick. If you eat a high protein diet AND maintain your carbohydrate intake as well, then you may very well gain body fat!

 

What happens if I eat too much Protein?

There is no strong evidence that a high protein intake is dangerous to our health nor results in body fat gain, although we do know that high protein intakes can reduce calcium uptake into bones. More importantly for athletes, eating too much protein leaves little room for achieving carbohydrate needs – which is most likely to compromise training. Also, high protein diets are generally more expensive.

 

Our Recommendation

  • Protein is important, but you don’t need to eat massive amounts. Make sure you base each meal and snack on carbohydrate but with a source of protein included and don’t forget the importance of a balanced diet as well.
  • Eat soon after training, using a combination of both protein and carbohydrate. Note: although most of the protein research has been with resistance training, there is no reason to believe the same effects would not be seen after a moderate-high intensity paddling session or a prolonged endurance session.
  • Go for real food wherever possible, but supplements such as protein plus can be useful if you’re short of time or don’t feel like eating.
  • For weights sessions, have a protein-based snack within 30-60 mins prior to the training session as well as afterward.

 

Good examples of Protein and Carbohydrate snacks for recovery include

  • Cereal with low-fat milk
  • Fruit with yogurt
  • Sandwiches or rolls with lean meat/chicken / low-fat cheese/tuna fillings
  • Dried fruit and nuts mixtures
  • Eggs or baked beans on toast
  • English muffins with peanut butter
  • Low-fat milkshake / smoothie / flavoured milk / protein plus/ sustagen
  • Jelly and custard

 

Think Carefully Before You Take - Supplements

In my experience, most athletes don’t use supplements very much, however now is a good time to remind you of some of the potential issues you could face.

 

What is a supplement?

The definition of a Supplement can be a little grey, which is where much of the confusion can lie. In most instances, it can be defined as something which provides a nutrient, or range of nutrients, in larger amounts than those found commonly in food. However, it also can include powders and capsules which are promoted in addition to, or in replacement of, food. Supplements don’t necessarily have to be promoted specifically to athletes in order to be a problem.

 

Why is there a problem?

Between 2000-2002, the IOC had an accredited laboratory test 634 sports supplements products from 13 different countries. Of these supplements, 15% tested positive to steroids and prohormones which were on the banned substance list of the WADA code. These substances were not declared on the label of the supplement, and if consumed would have resulted in a positive doping test. Furthermore, 15% also didn’t contain the “active ingredient” which was MEANT to be in there (in other words, if it was a Ginseng supplement there were no traces of Ginseng found in the product).
If you thought that this would have made manufacturers reassess their quality control procedures and reduce the risk of cross-contamination, think again! Just this year a laboratory in the UK tested a range of over-the-counter supplements purchased in the USA. These included products promoted for weight loss, muscle gain, hormone regulators, testosterone boosters, protein supplements, post-workout recovery and energy drinks. Of the 54 products analysed, 25% tested positive for a banned substance which was NOT stated on the label. These banned substances included nandrolone, DHEA, androstenedione, androstenediol, and ephedrine (amongst others). The most predominant products to test positive were testosterone boosters (67% tested positive) and weight loss supplements (29% tested positive).
The same laboratory who undertook these tests also systematically tests products for banned supplements for companies in the UK, Europe, and the USA who are wanting to sponsor athletes and provide evidence that their products are safe. It has been reported that of these tests, 2.8% of products have tested positive, and they have also found that even the capsules in which some products are packed have tested positive for banned substances.
Why is this? Some of it is due to inadvertent cross-contamination by using large-scale packing equipment to pack a range of products. Unlike the pharmaceutical industry, where all equipment has to be thoroughly cleaned between batches and raw ingredients held securely, the quality control procedures in the supplements industry are not strictly regulated. Therefore, if a batch of product y is packed immediately after product x, which happened to contain a banned substance, there is a risk that there are some remnants of product x still around in the packing equipment which will be mingled with product y. It only takes a minute amount of nandrolone (2.5-5 micrograms) to test positive. There are also potential issues with the storage of the raw ingredients in the same large area. Then, some of it is due to the deliberate inclusion of a banned substance in a product without declaring it. In some instances, the source of the raw ingredients is also of concern.

 

So, what can I do to check?

That’s the tricky thing. Since the majority of these contaminants aren’t listed on the label, there is no way of checking whether it’s likely to be a problem. You can have a product tested by a laboratory, but that still provides no guarantee for EVERY batch of the product. Calling your National Anti-Doping Organisation (NADO) is unlikely to resolve this question either as, if they test, they are unable to test every batch of every supplement available in your country, let alone throughout the world. So, generally, it is recommended that you avoid taking supplements. Alternatively, ask the manufacturer for a written guarantee that the product you’re taking doesn’t contain any banned substances, and make sure you write down EVERYTHING you’re taking if you’re asked to undergo a drug test.
Regardless, if you test positive for a banned substance, no matter how inadvertent it may be, YOU are responsible for this and it will still be considered a positive test.
Don’t be fooled either by-products which claim their ingredients are “pharmaceutical grade”. This may very well be the case, however, they are not packed in a pharmaceutical plant and are therefore still open to the same risks as any other ingredient. Similarly, while there maybe be organisations in some countries which control the safety of ingredients brought into their country and approve supplements for sale, the internet provides a multitude of options which these organisations cannot control. For example, in Australia, you cannot legally purchase DHEA whereas in the USA it’s available even in supermarkets, with no control over purchase.

 

Are there any exceptions?

Generally, products manufactured within the food industry or within the pharmaceutical industry are generally safer as the standards within these industries are tighter. Hence, multivitamins or individual vitamins/minerals from a pharmaceutical company tend to be safe, as are sports drinks and some liquid meal supplements (e.g. Ensure, Sustagen).

 

Final Tips

  • Think very carefully about the need for a supplement BEFORE taking any.
  • Find out exactly what the supplement is meant to do and who manufactures it.
  • Ask the manufacturer for a written declaration that the product contains ONLY what is stated on the label and check carefully where they source their ingredients and how / where the product is packed.
  • Try and get what you are needing from food.

 

4. ADAMS

Under the World Anti-Doping Code (Code) — the document harmonizing anti-doping policies in all sports and all countries — WADA has an obligation to coordinate anti-doping activities and to provide a mechanism to assist stakeholders with their implementation of the Code.
The Anti-Doping Administration & Management System (ADAMS) was developed for this purpose. It is a Web-based database management system that simplifies the daily activities of all stakeholders and athletes involved in the anti-doping system.

 

What is a therapeutic use exemption?

Athletes, like all other, may have illnesses or injuries which require them to take particular medications. If the medication which you need to treat an illness or medical condition is included in the Prohibited List, you must apply for a Therapeutic Use Exemption (TUE) if you wish to take the medication. After the IFSC Therapeutic Use Exemption Committee has reviewed the application, you may be given authorization to take the needed medicine.
Which Athletes should apply to the IFSC for a TUE?
If you are participating in any International Competition, you must apply for a TUE directly from the IFSC either through ADAMS or by email.
If the Athlete already has a TUE granted for national-level competition by his/her National Anti-Doping Organisation, that TUE is not automatically valid for international-level competition and it is necessary to apply to the IFSC for recognition. If the TUE meets the criteria set out in the International Standard for Therapeutic Use Exemptions, then the IFSC will recognise it for purposes of international-level Competition.

 

If you need to take any prohibited medications

If you wish to apply for the therapeutic use of prohibited substance or method which is included in the Prohibited List, you must:

  • complete a full TUE application form
  • attach a complete medical file
  • send it to the IFSC HQ via adams, email or post

Important note: the process can take up to one month, so please make sure to submit the required documents in time in order to have the response from the Medical Committee before your competition.

 

If you need to use glucocorticosteroids

The type of documentation you must submit for the use of glucocorticosteroids depends on the “route of administration” (how you administer or take the medication)
Authorised Routes of Administration
You do not need to submit any TUE if you take Glucocorticosteroids by the following routes:

  • Dermatological – on the skin;
  • Auricular - in or on the ear;
  • Buccal – inside the mouth (without swallowing);
  • Gingival - on the gums;
  • Nasal - inside the nose, either by topical application or nasal spray;
  • Ophthalmic – on or in the eye;
  • Perianal – on or around the anus;
  • Inhalation – through the mouth via an inhaler or “puffer”;
  • Intradermal injection – into the skin;
  • Epidural injection – into the spine;
  • Intra-articular injection – into a joint capsule;
  • Periarticular injection – around a joint;
  • Peritendinous injection – around a tendon.

Systemic Administration

You must complete a full TUE application if you take glucocorticosteroids by any of the following systemic routes:

  • Orally – through the mouth, usually in the form of pills or tablets;
  • Intravenous injection – injected into a vein;
  • Intramuscular injection – injected straight into a muscle;
  • Rectally – into the rectum usually in the form of a suppository or rectal application of a cream.

IF YOU NEED TO USE BETA-2 AGONISTS FOR ASTHMA
Submitting a TUE for the use of beta-2 agonists for asthma depends on the “drug” which is used to treat your asthma. Please pay attention to the substance which is included in your inhaler!
Beta-2 agonists for asthma (Salmeterol /Salbutamol/Formoterol)
You do not need to submit any TUE if you take inhaled Salmeterol, Salbutamol (up to a daily dose of 1600 μg) and/or Formoterol (up to a daily dose of 54 μg).
Terbutaline or other beta-2 agonist
If you take Terbutaline or any other beta-2 agonist for the treatment of asthma, you must submit a TUE for asthma and a full medical file to confirm the diagnosis of asthma and/or its clinical variants. The medical file should include:

  • A detailed medical history and clinical review;
  • Lung function test with spirometry;
  • Bronchodilator response;
  • Bronchial provocation tests.

 

Submission Requirements

All TUE applications must be submitted in legible English. Written medical reports must also be submitted in legible English, although results of tests may be in the original language.
All TUE applications must be received by the IFSC at least 21 days before medication is commenced.

Applications may be received by the IFSC by the following address: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

4. Retirement

Retirement from sport

Based on IFSC anti-doping Rules art 5.7 and 7.12 an Athlete in IFSC’s Registered Testing Pool shall continue to be subject to the obligation to comply with the whereabouts requirements of Annex I to the International Standard for Testing and Investigations unless and until (a) the Athlete gives written notice to IFSC that he/she has retired or (b) IFSC has informed him or her that he/she no longer satisfies the criteria for inclusion in IFSC's Registered Testing Pool.

 

Retirement from competition

5.7.1 An Athlete who has been identified by the IFSC for inclusion in the IFSC’s Registered Testing Pool shall comply with the whereabouts requirements of the International Standard for Testing until he or she receives written notice from the IFSC that he or she is no longer included in the IFSC Registered Testing Pool for reasons of retirement (the Athlete has to give written notice to the IFSC that he or she has retired) or nonfulfilment of the criteria for inclusion in the IFSC Registered Testing Pool.
5.7.3 If an Athlete retires from sport while subject to a period of Ineligibility, the Athlete shall not resume competing in International Events or National Events until the Athlete has given six months prior written notice (or notice equivalent to the period of Ineligibility remaining as of the date the Athlete retired, if that period was longer than six months) to IFSC and to his/her National Anti-Doping Organisation of his/her intent to resume competing and has made him/herself available for Testing for that notice period, including (if requested) complying with the whereabouts requirements of Annex I to the International Standard for Testing and Investigations.

 

5. Anti-Doping Committee

The Anti-doping Commission is established in the IFSC Statutes, Article 34.

The function of the Anti-Doping Commission is to ensure that the IFSC complies with the World Anti-Doping Code. Its rules will comply with the World Anti-Doping Code.

IFSC Anti-doping Commission
President
Renato NICOLAI ITA
This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 

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