The Strange Realities of Inadvertent Doping

Raul (Adalberto) Mondesi inadvertently violated the JDA by taking over-the-counter cold medicine. (via Minda Haas Kuhlman)

Occasionally, when a suspension for violating the MLB Joint Drug Agreement is announced, the accused party will allege that he didn’t knowingly used a prohibited substance, chalking up his test result to a “careless” mistake. Whispers ensue in the comments section of your favorite baseball websites, contending that unintentional doping must be the result of eating meat treated with the detected substance. However, the use of growth promoting chemicals in animals raised for human consumption has been banned in many countries around the world. In theory, their presence in the meat of in food-producing animals (and subsequently in an athlete’s urine) should be a rarity. But is it? Is it possible that players consuming meat when they’re abroad during the offseason can lead to a case of unintentional doping?

This isn’t all that farfetched, and the analytical chemistry and food science communities have been aware of the possibility of a transfer of drugs from food-producing animals to humans for decades. The possibility of nandrolone-contaminated meat leading to a positive drug test presented itself as an issue at the 2000 Olympics. By 2008, researchers advised Olympians to refrain from eating “indefinable meat dishes (such as pasta filled with meat), which could be made from low-quality meat,” boar meat, and pork offal. The World Anti-Doping Agency (WADA) issued a statement in 2011 urging athletes to use caution when consuming meat. The U.S. Anti-Doping Association (USADA) issued its own guidance on clenbuterol, suggesting that players avoid eating liver, liver products, and “unusual or exotic meat products” when not in the States.

But it’s not just non-U.S. meat products that have been scrutinized; trenbolone and zeranol are on the prohibited substances list, but they are also on the list of synthetic hormones approved by the FDA for use in food-producing animals. In a rare case, it was determined to be unlikely than an athlete had intentionally consumed zeranol, and her positive test was attributed to consuming zeranol-tainted meat.

To date, no official warning or guidance regarding meat has been issued by the MLBPA, although players are generally told that they must take responsibility for everything that goes into their bodies. But there are disparities in food safety regulations from country to country, and as baseball continues to enlist players from around the globe, educating future prospects on the possibility of unintended doping will continue to be a challenge. To this end, MLB is undertaking an educational effort directed towards younger prospects in Latin American countries.

The MLB Commissioner’s Office initiated the Trainer Partnership Program in 2018, wherein partnered trainers in Latin American countries can guide young, prospective players toward careers in professional baseball. Among other things, these young players are being educated on avoiding PED use; presumably, that means they’re also being educated on the potential for accidental ingestion of banned substances through the use of supplements.

Avoiding this scenario is a little easier in the U.S., as NSF Certified for Sport supplements are more widely available in clubhouses. But neither the NSF Certified for Sport website nor the smartphone app have a “where to buy” section — it’s a reference to check whether a supplement is on the list, but it doesn’t provide much guidance when it comes to actually sourcing these materials.

The NSF Certified for Sport program pertains only to supplements, however, and can’t be of help when it comes to your normal diet and whole foods. While we like to think of whole foods as being pure and unadulterated, that’s an idealization; unless we know the exact circumstances under which our food arrived at our plate, we don’t always know what’s in our food. It’s a leap of faith — fueled by convenience — that we just assume that the governmental agencies are watching over our comestibles and making food safety a priority, with close oversight and random testing.

The use of approved growth promoting agents varies from country to country. But there are many that are banned widely, including anabolic steroids, so food safety regulators in many countries are actively monitoring the illegal use of these compounds in animals. Indeed, many analytical chemistry methods for detecting prohibited substances have been developed for testing both livestock and humans.

Boldenone is an anabolic steroid that is also a prohibited substance, and it is widely illegal for use as a growth promoter in food-producing animals. Clostebol is another anabolic steroid that may be found in meat. But could an animal that was treated with clostebol reasonably convey clostebol in a detectable amount to humans?

In a study of the steroid in meat, participants consumed raw minced beef, and their urine was monitored for 18 hours afterwards. Of the 10 participants, only one had detectable levels of a clostebol metabolite. One in 10 is hardly a convincing argument that eating clostebol-tainted meat will lead to a positive drug test, but the researchers noted that the presence of the prohibited substances clostebol acetate, nandrolone and its esters, and stanozolol were easily detected at the site of injection. The presence of stanozolol in particular organs and at the site of the injection was confirmed by other scientists as well. Depending on how the drug is administered, a particular cut of meat might contain more of the drug than another cut based on the site of administration, and where the drug is accumulating in the animal. If a human eats meat from the site where an animal received an injection of a prohibited substance, it’s entirely possible that they will have a positive test for a prohibited substance — hence the advisory against consuming low-quality meat, ground meat, and certain organs and animals.

Although many studies focus on the consumption of beef, pork has come under particular scrutiny as well. A study of boar meat consumption in three volunteers bluntly concluded that it was very likely that consuming boar meat could result in an analytical positive test of nandrolone. All three volunteers had postprandial nandrolone levels significantly higher than the acceptable limit set forth by anti-doping agencies for several hours, and nandrolone was detectable for at least 15 hours post ingestion. A more conservative review noted that it’s highly unlikely that consumption of nandrolone-treated pigs would result in a positive test; despite acknowledging that this is a highly improbable result, the researchers stated, “athletes should prudently avoid meals composed of pig offal in the hours preceding the test since the consumption of edible parts of a non-castrated pig, containing 19-nortestosterone, has been shown to results in the excretion of 19-norandrosterone in the following hours.”

The use of growth-promoting agents in livestock goes beyond steroids, as there are other WADA and MLB prohibited substances that are used in animal husbandry. One such prohibited substance is clenbuterol. Clenbuterol is a beta 2 agonist bronchodilator classified as a prohibited substance by the MLB Joint Drug Agreement; it is often abused as a weight loss drug. Clenbuterol is prohibited by the FDA as both a therapeutic agent and for use in any animal that may be consumed by humans. But despite many other countries having prohibited its use, it is still available in some countries. A boxer alleged that his positive test for clenbuterol was the result of contaminated meat from Mexico. After an NFL player tested positive for clenbuterol following a trip to Mexico, the NFL and the NFL Player’s Association went so far as to warn players not to eat meat in Mexico or China.

While contaminated meat has become a go-to excuse for a positive drug test, there’s another source of unintentional doping: medications purchased abroad, of both the prescription and over-the-counter variety. Although players are aware of the pitfalls of over-the-counter dietary supplements as it pertains to unintentional doping, it’s not clear if players are made similarly aware of the potential hazards of over-the-counter medications. Players traveling abroad and taking over-the-counter medications could be unknowingly taking prohibited substances.

We have an MLB-specific precedent: Adalberto Mondesi, formerly known as Raul Mondesi, disclosed that his 2016 positive test for clenbuterol was the result of taking an over-the-counter cold medication in the Dominican Republic.

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Goodbye for now.

The JDA has provisions for mitigating circumstances: “If a Player proves by clear and convincing evidence that he bears no significant fault or negligence for the presence of the Performance Enhancing Substance in his test result, the Arbitration Panel may reduce the mandated suspension…. A Player cannot satisfy his burden under this Section by merely denying that he intentionally used a Performance Enhancing Substances; the Player must provide objective evidence in support of his denial.” In Mondesi’s case, the normal 80-game suspension was reduced to 50 games, and Mondesi reminded everyone that they are responsible for reading labels and consulting with the team and trainers.

Even if a player avoids the use of prohibited substances himself, he needs to be aware of the risk of cross contamination as he comes into contact with other humans. It’s improbable, but still possible, particularly when we come into intimate contact with another. Again, there is precedent for this in other sports; in 2009, a tennis player inadvertently took cocaine after kissing a woman in a nightclub. Given the amount of cocaine that was detected, arbitrators agreed that this was not an intentional use. In 2016, a pole vaulter also tested positive for cocaine after “a tryst with a woman he met on Craigslist.”

The most recent example of this is American Olympic sprinter Gil Roberts “passionate kissing” defense to explain the detection of a prohibited substance in his urine. Although Roberts himself did not take a medication, he contends that his positive test was the result of repeated, intimate contact with his girlfriend while she was taking a prohibited substance. While traveling abroad, Roberts’ girlfriend received an antibiotic to treat a sinus infection. This is completely within reason — the typical treatment for a sinus infection is the use of an antibiotic. But Roberts’ girlfriend was given Moxylong, a capsule sold in India that contains the antibiotic amoxicillin, as well as the diuretic probenecid. While there are therapeutic reasons to administer probenecid in combination with an antibiotic, probenecid is classified as a masking agent on the prohibited substances list. Rather than swallow the capsules, Roberts’ girlfriend sprinkled the capsule’s contents onto her tongue. Roberts was unaware that his girlfriend was taking medication, and did not realize that kissing his girlfriend could lead to a positive test. Roberts’ “passionate kissing” defense was effective for the Court of Arbitration for Sport to overturn his suspension.

Incidental exposure through intimate contact isn’t just limited to kissing. An International Olympic Committee (IOC) testing facility found traces of clostebol metabolites in an athlete’s urine; he claimed that “he was contaminated as a result of sexual intercourse with a woman taking a medication containing clostebol.” This isn’t impossible; in Brazil, clostebol acetate can be found in dermatologic and gynecologic creams. Trofodermin is clostebol acetate formulated for intravaginal administration; it contains 200 mg of clostebol acetate and 200 mg of neomycin sulfate in a 40 g package, and the recommended dose is 5 g once or twice a day.

An IOC-certified laboratory investigated the possibility of inadvertent exposure to clostebol during sexual activity, conducting a study examining exposure to clostebol during sexual intercourse versus direct topical application. In group one, comprising two heterosexual couples, both women received 5 g of the clostebol formulation. These two couples had sexual intercourse for 20 minutes (we should note that it is not clear if vaginal to oral transmission was studied). A second group, comprising two men, applied 200 mg of clostebol acetate topically to their penis for 20 minutes. Urine was collected for the following two days from both groups.

Although both men in the second group had higher amounts of a single, long-term clostebol metabolite, all four men’s urine contained trace amounts of the same clostebol metabolite for up to 15 hours after administration; this trace amount was near the limit of detection, which would have resulted in a positive test, confirming the possibility of inadvertent doping with clostebol via sexual contact.

In nearly all of these cases of inadvertent doping, such as in Mondesi’s case, it is noted that a positive test for a trace amount of a prohibited substance would not have had a performance-enhancing effect, and it’s highly unlikely that any amount resulting from accidental, incidental exposure to a prohibited substance would enhance performance. However, regardless of whether or not one would actually enjoy any kind of performance enhancement from a trace amount of clostebol, rules are rules. Athletes should be advised to be aware of not only what they themselves are ingesting, but what their intimate partners may be using.

Ultimately, should a player have a positive test for a prohibited substance, the burden falls to the player to present evidence that the exposure was unintentional. We assume that MLB’s appeals process is similar to the USADA review, which examines an athlete’s whereabouts, dietary habits, and test results. The review may also include empty packaging and an investigation of the lot number of the suspect material — although if the material didn’t have the NSF Certified for Sport labeling, the MLB arbitrators and appeals process will not be sympathetic. In Gil Roberts’ case, the investigation of his whereabouts included his girlfriend’s airline tickets, and a sample of her medication (she didn’t complete her round of antibiotics, which is not good practice but isn’t within the scope of this story). Perhaps Raul Mondesi provided receipts or an empty package showing the purchase and use of the clenbuterol-tainted cold medication.

As always, athletes need to be cautious regarding what they put in their bodies, as they are held responsible for what they’re consuming. Their caution needs to be heightened while they’re traveling abroad, whether they’re home for the offseason, playing in a winter league, or on vacation. And that caution should include not only meat and supplements, but medications as well. All that said, while we can find anecdotes of positive test results following inadvertent ingestion, individual anecdotes are poor evidence for the claim that this is a widespread issue. It’s possible, but it’s highly improbable.

References and Resources

Stephanie Springer is an organic chemist turned patent examiner. Follow her on Twitter @stephaniekays.
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Jetsy Extrano
4 years ago

I have learned some things today. Also, industrial farming is still gross.

For the boars, do people steroid-dose them, or is this endogenous? The specific call-out to offal of non-castrated boars makes me wonder if we’re talking boar testicles here, but then what happens with Rocky Mountain oysters more generally?

4 years ago

The most famous case of clenbuterol was probably cyclist Alberto Contador, who claimed it contaminated meat he ate in his home country of Spain. He was eventually sanctioned, losing a Tour de France and Giro d’Italia title, though the Court of Arbitration in Sport (CAS) that ultimately made the decision ruled it was a contaminated supplement (which almost certainly was not the case).

Cyclist Daryl Impey beat a probenecid positive by claiming that the drug resulted from contamination of capsules he bought for a legal substance at a pharmacy.

Athletes of course frequently claim that the amount of drug detected would not be performance enhancing, when in fact small amounts may simply mean that they took the drug several weeks or more before testing. Since clenbuterol is abused for rapid weight loss, it’s quite possible an athlete would not have taken it close to the time of an in-competition test.