Cyclist
Does cycling have a problem with over-the-counter medication? Part 3: The truth
In the final part of the series – read part one and part two if you missed those – investigating the use of over-the-counter medication for enhancing performance, Cyclist finds out what’s being taken and whether we can ever find out the truth.
In part two we spoke about gateway theory, and in practice it seems to be more supplements than over-the-counter medication. It’s an area that Jacek Kapela, who we met in part one, is familiar with.
‘I’m always looking for something that’s going to help me with my riding,’ he says. ‘In front of me now, I have a range of supplements including high-absorption magnesium, L-arginine, coenzyme Q10 and L-carnitine.
‘At the moment, my friends and I are discussing ways to improve performance by way of better oxygen flow. We follow a nutritionist called Asker Jeukendrup who works for Visma-Lease a Bike. He’s shown that supplementation of L-citrulline with L-arginine will improve your blood flow and your oxygen intake. Like beetroot, though I don’t use the shots but I do eat a lot of beetroot. I also use DHEA. That has helped hugely.’
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DHEA is an endogenous steroid hormone precursor that produces testosterone. It’s often used by males who, like Kapela, are over 50. ‘My testosterone level dropped to 190 ng/dl [nanograms per decilitre] from around 380 ng/dl,’ he says. You’re considered to have low testosterone levels if you dip below 190 ng/dl. ‘It’s illegal in cycling [you would need a TUE] but it’s helped my recovery, my riding and my general health. I take a 100 milligramme capsule once a day.’
As Kapela says, it’s on WADA’s prohibited list. He also stresses it’s for general health as much as cycling, albeit a 2012 paper entitled, ‘Psychosocial predictors of doping intentions and use in sport and exercise: a systematic review and meta-analysis’, found that ‘there is probably higher susceptibility to doping among sub-elite or older athletes’. That’s not applicable to Kapela, but it is to several riders he knows.
‘We have a big group ride here in Warsaw; there are up to 200 of us,’ he says. ‘There are ex-professionals and good amateur riders. When I first started to ride with them, I heard that some of them were doping. I couldn’t believe it. There are no prizes to be won, no money made, we are just having a group ride. But they were right, with synthetic testosterone the most popular because it’s cheap and effective. They’re not using it for health but solely for cycling performance. You realise that in amateur cycling, there are a lot of ambitious people who want to show up and simply ride strong to look good.’
If that number’s under ten of the 200, that would roughly tally with Ask Vest Christiansen’s 2023 study into recreational athletes that kicked off part one, which showed the prevalence of bonafide doping was really low: zero in females and 3.1% in males.
Can we ever know the truth?
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We couldn’t corroborate Kapela’s revelations, leaving uncertainty about the figures, which is the final area we’ll delve into: how do the likes of Christiansen overcome ‘social desirability bias’, i.e. when respondents give answers that they believe will make them look good to others and so concealing their true opinions of experience?
Christiansen used the randomised response technique, which asks respondents to use a randomisation device, such as a coin flip, with the outcome unobserved by the interviewer. By introducing random noise, the method conceals individual responses and protects respondent privacy.
‘For us, we asked in which month your mother was born,’ he says. ‘If it was February, March or April, please reply “yes” to the next question. If she was born in any other month, reply honestly to the next question. We then ask, “Do you often use over-the-counter medication for performance purposes?” For the respondents whose mothers aren’t born in those months, they can see that at least 25% will answer “yes”, meaning they won’t stick out if they answer “yes”. It’s an incentive to answer more honestly.’
Another truth-finder is flagged up by USADA’s Laura Lewis. A team of French researchers investigated the prevalence of drug use in ultra running. Intent on gaining more accurate results than a randomised-response questionnaire, they collected urine samples from experimental urinals positioned near the start line of UTMB races that were used by male participants within three hours of the start. These urinals were connected to a custom-made tubing system positioned on the urinal drainpipe. The participant’s presence in the urinal cubicle was detected by a presence sensor, which triggered an antenna that read the runner’s radio frequency identification (RFID) tag attached to his bib. Resulting signals were computed to generate a presence-detection file associated with an encrypted tag code, thus preserving the participant’s anonymity.
They discovered that among the 412 individual urine samples, 205 (49.8%) contained at least one substance and 16.3% of the samples contained one or more prohibited substances. Substances detected in urine included non-steroid anti-inflammatory drugs (NSAIDs) (22.1%), acetaminophen (15.5%), opioids (6.6%), diuretics (4.9%), hypnotics (4.4%), glucocorticoids (2.7%), beta‑2 agonists (2.2%), cannabinoids (1.9%) and stimulants (1.2%). As a snapshot, 12.9% of respondents to a separate questionnaire reported using NSAIDs, nearly 10% lower than physiologically proven.
What does all of this mean? Well, it’s safe to say that over-the-counter medication is being used, but it’s impossible to find out and be sure of whether it’s for ‘enabling’ or ‘enhancing’ performance. And there’s clearly never going to be doping controls on club rides.
So arguably the main takeaway is to reflect on what we would do to improve cycling performance and whether that marries with our principles, our values and our attitude to life. Do painkillers and co. enable or enhance performance? And where do you draw the line?
If you missed the previous parts, make sure to read part one and part two.
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