Are sports supplements “gateway” drugs to doping?

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In 2013, Susan Backhouse of Leeds Metropolitan University in Britain published an interesting anonymised study looking into attitudes toward doping among university and international athletes, and how they related to the use of legal sports supplements.

The key finding was that the athletes who reported using nutritional supplements were also more than three-and-a-half times more likely to report doping (22.9 percent compared to 6.0 percent). They were also more likely to report positive attitudes toward doping, and greater belief in the effectiveness of doping. The results were seen as support for the “gateway hypothesis”: you start out looking for an edge with legal performance-boosting pills, and eventually graduate to the “hard” (i.e. banned) stuff.

At the American College of Sports Medicine annual meeting earlier this month, a pair of posters presented by 3:41 1500-metre runner Phil Hurst, of Canterbury Christ Church University, took an interesting approach to exploring this concept.

The study involved a group of more than 300 team-sport athletes, who did a set of five 20-metre sprints. The athletes were then given a supplement which they were told would either improve their sprint performance (the placebo condition), or improve their endurance but hurt their sprint performance (the nocebo condition, which is basically a negative placebo). In both cases, the supplement was just a placebo. Then, 20 minutes later, they repeated the five 20-meter sprints.

The results, presented in the first poster, were more or less what you’d expect: those who received the placebo were better able to maintain their speed compared to those who received the nocebo. It would have been interesting to also have a control group, to find out whether the placebo improved performance more than the nocebo decreased performance, but it’s still a nice simple demonstration of placebo power.

The next stage of the experiment, presented in the second poster, was to explain the placebo results to the subjects, along with some background research on the power of placebo effects in sport.

The athletes then re-completed a questionnaire (which they had also completed before the experiment started) that assessed their attitudes toward sports supplements and doping, along with their intention to use. Not surprisingly, after this “experiential” placebo education, the athletes reported weaker beliefs in the effectiveness of sports supplements, and also less favorable attitudes to doping in general.

One thing that’s important to clarify: the study isn’t suggesting that performance-enhancing drugs are mostly placebos (which is a canard advanced by some people in favor of drug legalisation). Many banned substances really do boost performance.

Legal sports supplements, on the other hand, are predominantly placebos (with a few notable exceptions like caffeine). So the thinking is: educate athletes about the illusory benefits of sports supplements, and they’ll be less likely to take them. This, in turn, will reduce the number of people progressing on to banned drugs through the “gateway” effect.

Would it work? It’s an interesting idea, but I also wonder whether it could have the opposite effect -because after all, the placebo supplement improved performance. If I were an athlete who didn’t take any sports supplements, and this intervention demonstrated to me that I could go faster with a simple (and inert) pill, I might think, “Hmm, I should start taking some supplements, and just make sure not to read anything that casts doubt on their effectiveness.”

I’m being a little tongue-in-cheek here, but this is an issue that I don’t quite know how to think about. Whether we’re talking about recovery aids (like ice baths) or supposed performance-boosters, placebos really do work. So as an athlete, how do you handle that? Hire someone to lie to you?

I like to think that the most powerful boost comes from strongly believing in something that’s really true. That’s why I do think it’s worth examining the supplements (and other training practices) used by athletes, to separate fact from fiction. But it’s a tricky topic!