Despite ongoing improvements to regulatory and manufacturing guidelines, the potential for contaminated nutritional supplements to cause a failed doping test for an athlete remains a concern. Several surveys of supplements available through the internet and at retail have confirmed that many are contaminated with steroids and stimulants that are prohibited for use in elite sport. Suggested responses to this issue include the complete avoidance of all supplements. However, this approach seems to be unrealistic as many athletes use nutritional supplements for very different reasons. In addition, the number of publications describing trials that demonstrate the benefit of certain nutritional products has also increased over the last decade or so. This ensures that for many sports the use of supplements will remain a common practice. In response to the issue of contamination in nutritional supplements, many reputable manufacturers have their products rigorously tested by sports anti-doping laboratories to help ensure as far as possible that the risks to an athlete remain minimal. In this chapter we review the issue of supplements and contamination, and look at how this might be addressed through effective quality control procedures at the manufacturing facility and through the highly sensitive testing of finished products using appropriately accredited tests.

The potential for contaminated dietary supplements to result in a failed doping test remains a concern for athletes, trainers, and sporting authorities despite improvements to regulatory guidelines. Previous surveys of readily available supplements confirm that many are contaminated with steroids and stimulants prohibited for use in elite sport. Suggested responses to this issue include the complete avoidance of all supplements. Many athletes, however, use nutritional supplements to achieve effective training and also to ensure that daily nutritional requirements are met (e.g. recommended levels of vitamins and minerals). This ensures that the use of supplements is and will remain the norm for a range of sports. As a result, an alternative approach of rigorous testing of materials destined for use by elite athletes has been introduced in several countries. While the testing of final product for banned substances may help mitigate the problem, it will not help to remove the underlying issue of contamination. In this article we describe an alternative approach that uses appropriate quality assurance procedures backed up by testing to remove sources of contamination. The decrease in the incidence of contamination amongst supplement companies adopting such a system is explained, and contrasted with the relatively high incidences of contamination found in products that are not part of a quality system. These findings are of key importance to both supplement manufacturers and those involved in advising athletes about supplement use.

Ingestion of trace amounts of 19-norandrostenedione can result in transient elevations of urinary 19-NA and 19-NE concentrations. The addition of as little as 2.5 microg of 19-norandrostenedione to a supplement (0.00005% contamination) appears sufficient to result in a doping violation in some individuals.

Peak 19-NA concentrations were higher, and occurred later, when the 19-norandrostenedione was added to a solid supplement. This may be due to a slower rate of absorption and/or a reduced diuresis, resulting in a longer period for the metabolites to accumulate in the urine.

Trace quantities of anabolic and androgenic steroids have been found in dietary supplements without their presence being disclosed on the label (1) . It has previously been demonstrated that ingestion of 10 mg 19-norandrostendione added to a creatine supplement results in urinary 19-norandrosterone (19-NA) levels > 2 ng/ml in all subjects (2) . This result constitutes a positive doping result under current World Anti Doping Agency (WADA) guidelines. The aim of the present investigation was to monitor the appearance of nandrolone metabolites in the urine following the ingestion of smaller doses of 19-norandrostendione.Eleven male and nine female volunteers (age 25 (SD 4) years, height 1.68 (SD 0.06) m, body mass 68.6 (SD 13.1) kg, BMI 24.2 (SD 3.2) kg/m 2 ) were recruited to participate in the study. On three occasions subjects entered the lab in the morning following an overnight fast. An initial urine sample was collected and body mass was measured. Subjects then ingested 500 ml water containing 5 g creatine monohydrate and 1.0, 2.5 or 5.0 mg 19-norandrostendione. All urine passed throughout the remainder of the day was collected, the volume measured and an aliquot taken. All samples were analysed for the metabolites 19-NA and 19-noretiocholanolone (19-NE) by GC-MS.The mean total urine volume passed during each trial was 1.79 (SD 0.73) litres: this volume was not different between trials (P = 0.731). Baseline urinary 19-NA concentrations were 0.19 (SD 0.14) ng/ml. Ingestion of the supplement resulted in peak urinary 19-NA concentrations (ng/ml) of 0.68 (SD 0.36), 1.56 (SD 0.86) and 3.89 (SD 3.11) in the 1.0, 2.5 or 5.0 mg dose trials respectively. Under current WADA regulations the 1.0 mg dose produced no positive doping tests, whereas five (20%) subjects would have tested positive in the 2.5 mg dose trial and fifteen (75%) exceeded urinary 19-NA concentrations of 2 ng/ml after ingesting the 5.0 mg dose (Figure). There was an inverse relationship between the dose ingested and percentage total recovery of 19-NA + 19-NE (1.0 mg, 55 (SD 19); 2.5 mg, 46 (SD 14); 5.0 mg, 40 (SD 19); P < 0.001). No significant association was found between body mass and the peak 19-NA concentration measured in the urine following the 5 mg dose (r 0.377; P = 0.102).The present study demonstrates that the ingestion of trace amounts of 19-norandrostendione can result in a marked elevation in urinary 19-NA and 19-NE concentrations. These data show that the addition of 2.5 mg 19-norandrostendione to a fluid-based supplement (0.0005% (w/v) contamination) was sufficient to result in a doping violation in some individuals.