Friday, 22 February 2013

Oscar Pistorius would never have failed a drug test

Thanks to Millard Baker for coming up with the best answer to what “testosterone” was found in Oscar Pistorius’s house [1]. He is a better Internet detective than me and came up with the idea of a homeopathic remedy called “testis composutim”. This costs $107 for 10 vials on Amazon (other suppliers are available). It should be used for “Lack of stamina; Nocturnal emissions; Male hormone imbalance” [2, 3, 4]. It can be taken orally as a pill or solution or injected into the Large Intestine 11 (LI.11) acupuncture point; hence the needles allegedly found by the detectives.

Here are the ingredients: Each 300 mg contains: Aralia quinquefolia 4X 3 mg, Testis suis 4X 3 mg, Agnus castus 6X 3 mg, Ascorbicum acidum 6X 3 mg, Caladium seguinum 6X 3 mg, Picricum acidum 6X 3 mg, Strychninum sulphuricum 6X 3 mg, Cantharis 8X 3 mg, Cor suis 8X 3 mg, Curare 8X 3 mg, Damiana 8X 3 mg, Embryo suis 8X 3 mg, Manganum phosphoricum 8X 3 mg, Phosphorus 8X 3 mg, Diencephalon suis 10X 3 mg, Ferrum phosphoricum 10X 3 mg, Magnesia phosphorica 10X 3 mg, Selenium metallicum 10X 3 mg, Zincum metallicum 10X 3 mg, Cortisone aceticum 13X 3 mg, Glandula suprarenalis suis 13X 3 mg, Conium maculatum 28X 3 mg, Lycopodium clavatum 28X 3 mg.

I don’t want to bore you with translating all of these, but “Ascorbicum acidum” is vitamin C and Testis Suis is presumably some form of animal testicle extract. To counteract this there is “Agnus Castus” which comes from the “chasteberry tree”. The clue as to its proposed function is in the name (it is also known as Monk’s pepper); this is a treatment to reduce sexual desire. So a confusing addition to the list of ingredients.

As Millard eloquently says on his blog [1], “If athletes are still injecting animal testicle extracts, it represents a major step backwards for science. While this may have been popular among athletes over a century ago most athletes have upgraded their choice of performance-enhancing products to reflect advances in science.” But he doesn’t need to worry. This is a homeopathic formulation. Each X is a factor of 10 serial dilution. So the most concentrated ingredient here (the 4X) dilution is only 1 in 10,000 of what was in the original material. “Conium maculatum” is an extract of the plant poison hemlock. Does this make testis composutim poisonous? Don’t worry - Oscar was in no danger. A 26X dilution is the equivalent of adding 1/3 of a drop of this plant extract into all the water in all the oceans on earth. At the 28X dilution here there is virtually no chance of there being any molecules present at all. Certainly nothing to effect its stated aim of treating “sexual nervousness with feeble erection” [3].

So if Oscar Pistorius really was injecting testis composutim he was essentially injecting a solution of dilute salt. If he was taking a pill he was taking magnesium stearate and lactose (inactive filler material).

The bad news is that, whether taken in pill or injection, this composition will have absolutely no effect on performance on the track or in the bedroom. The good news – there is no way you can fail a doping test by taking a homeopathic remedy!

[4] Note to any elite athletes reading this: Viagra is not on the doping banned list and it actually works. 

Thursday, 21 February 2013

Oscar Pistorius, herbal remedies and doping tests

I won’t be commenting on the murder case, other than to note my sympathy for the victim and her family. But I do have a comment about the alleged “performance enhancing drugs” found in the house. In a statement from the International Paralympic Committee, Oscar Pistorius was revealed to have been drug tested twice in London last year by the IPC, on Aug. 25 and Sept. 8. Both test results were negative of course or we would have heard about it.

Why only two tests? Pistorius won three medals at the Paralympics. Silver on Sept. 2nd in the 200m T44, gold on Sept. 5th the 4 x 100m T42/T46 relay and gold again on Sept 8th the 400m T44. He also came fourth in the T44 100m race on Sept. 6th.

All top five finishers in an Olympic final are tested immediately afterwards, the assumption being that no more than two will be caught so all the medals can still be awarded [1]. This is not the case in the Paralympics. As can be seen from the above Pistorius was only tested on arrival at the Games and after his 400m win. This is not to cast any aspersions at all, but merely to note that it is easier to avoid testing in the Paralympics than the Olympics. Admittedly there are more medallists at the Paralympics  (at London the discrepancy was 1,522 for the Paralympics against 962 for the Olympics). But the main issue is cost: there is less money in Paralympic sport so less money for testing. I don’t have the details, but I suspect this disparity will be mirrored in a far less effective out-of-competition testing program.

As to what was found in the Pistorius house. The current view seems to be a legal herbal supplement called “Testocompasutium co-enzyme”. I have no idea what this is; perhaps someone can enlighten me? 

Sunday, 10 February 2013

Australians doping with designer peptides: do they work as sports drugs?

The news that doping with custom peptides (such as CJC-1295, Sermorelin and Tesamorelin) is widespread in Australian sport has been all over the web recently. So I thought I should add my opinion to a somewhat confused story (at least in terms of how the biochemistry and sports performance is being reported). The first confusion is the use of the word “peptide” as if it is some evil drug. Peptides are just a string of amino acids that make up a protein. If the number of amino acids is small the resultant molecule is called a peptide. If there are lots of amino acids strung together it is called a protein. The distinction between a peptide and a protein is therefore essentially arbitrary. So insulin, human growth hormone and erythropoietin are all peptide hormones. But they could just as easily be called protein hormones. This biochemical distinction is being lost in the current discussions about doping in Australian sport, where peptides are just bad molecules you get from criminal gangs.

So what are these artificial designer peptides? They are drugs that are being used to enhance the release of the body’s own peptide hormones. The synthetic peptides work by mimicking other peptides in the body such as GHRH (growth hormone releasing hormone). So Sermorelin (a synthetic peptide) mimics GHRH (a peptide produced in the body) in activating the release of human growth hormone (also a peptide) from the pituitary gland. This is then supposed to increase muscle mass and power. Confused? Well read my book and there will be a test later (only kidding!).

Worryingly many of the drugs are still in clinical trials, or have been used in such trials and found wanting, and so are not licensed for use in humans. So they have to be obtained by links with organised crime. I can’t help feeling that the most interesting aspects of this story are exactly that: doping is widespread in many sports and very closely linked to criminal elements. As we all knew pro-cycling is not an isolated case

Although we have not got all the details yet, what I am not overly concerned that the drugs themselves will have biased the results of sporting events (though I AM concerned about the health of athletes concerned). Why am I not concerned about the cheating? Well many of the peptides are touted to be an undetectable way of raising your human growth hormone (HGH) levels. This is supposed to increase muscle mass and strength. Yet the experimental evidence for a power increase with HGH administration itself is very weak (M.J. Rennie (2003) Claims for the anabolic effects of growth hormone: a case of the emperor's new clothes?, Br. J. Sports Med. 37 100-105). It is therefore unclear that doping with peptides designed to indirectly increase HGH levels will be any more effective.

Of course these statements must be couched with the usual caveats that most studies are not done on elite athletes and, for ethical reasons, err on the low side in dosage. But even a quick trawl through the bodybuilder web sites reveals some dopers who think the claimed benefits of “peptides” are all just a placebo effect. If even bodybuilders are sceptical your product works, you really should doubt its efficacy.

It should also be noted that these drugs were designed for specific clinical problems such as to increase growth in growth hormone deficient patients or to increase fat breakdown in HIV-AIDS patients, in particular to treat a symptom called HIV-associated lipodystrophy (excess abdominal fat). Although they aim to increase lean body mass, this is by reducing fat. They have not been designed to increase muscle mass and power per se. So the clinical data do not directly support their use in athletes. Like HGH the use of these synthetic peptide hormone are touted by what I term “lifestyle clinicians” in the USA to solve all sorts of issues relating to ageing and/or weight problems. This is “off label” prescription i.e. the drugs are not officially approved for this use (which usually means, of course, that there is no supporting data).

So what is the problem if the drugs probably aren’t affecting performance too much? Well some of the drugs are not licensed for use as they have undesirable side effects. Or they may be licensed in sick patients where there have benefits that outweigh the side effects. For example in 2010, the US Food and Drug Administration approved Tesamorelin for treating Lipodystrophy in HIV patients ( But they noted that: “the long-term cardiovascular benefit and safety of tesamorelin have not been studied”, “Tesamorelin increases serum levels of insulin-like growth factor 1 (IGF-1), which has an unknown effect on the development or progression of malignancies” (i.e. cancerous tumors), and “Tesamorelin therapy may also result in glucose intolerance and an increased risk for diabetes mellitus”. It seems from the reports that some of the Australian athletes may have not been told what drugs they were being given. In this case it is not only the supplying gangs that are criminals, but the people who administered the drug as well …..