Vitality Unleashed: The Functional Medicine Podcast

The Truth About Wellness Clinics for Athletes

• Dr. Kumar from LifeWellMD.com • Season 1 • Episode 81

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The wellness and anti-aging clinic boom promises optimization for active individuals—but could their treatments secretly derail your athletic career? This eye-opening exploration reveals the surprising anti-doping implications of common performance therapies.

When it comes to navigating the world of wellness clinics as an athlete or physically active person, what you don't know can hurt you. We meticulously examine hormone replacement therapies, revealing why substances like testosterone and DHEA are prohibited at all times—regardless of whether they're "bioidentical" or prescribed by a doctor. The misconception that restoring "natural" hormone levels is somehow exempt from anti-doping rules has ended countless athletic careers, and we clarify exactly what you need to know to avoid this fate.

Weight loss treatments offer another minefield of potential violations. While phentermine is only prohibited during competition, HCG is banned for men at all times and lacks FDA approval for weight loss in women. Perhaps most surprising is the strict regulation against IV infusions exceeding 100mL within 12 hours—meaning those trendy vitamin drips and recovery IVs at wellness bars could trigger violations even when their ingredients are perfectly legal. We also untangle the complex rules surrounding newer therapies like ozone treatments (where the method matters more than the substance) and stem cells (permitted for healing but not enhancement).

Your performance goals deserve informed decisions. Before your next wellness clinic appointment, arm yourself with this critical knowledge about supplements (seek NSF Certified for Sport products), compounded medications (beware contamination risks), and homeopathic remedies (none FDA-approved). Remember—the ultimate responsibility for anti-doping compliance rests with you, not your healthcare provider. Check GlobalDRO.com or contact USADA's drug reference line whenever you're unsure about a treatment's status. Your competitive future may depend on it!

Disclaimer:
The information provided in this podcast is for educational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making changes to your supplement regimen or health routine. Individual needs and reactions vary, so it’s important to make informed decisions with the guidance of your physician.

Connect with Us:
If you enjoyed today’s episode, be sure to subscribe, leave us a review, and share it with someone who might benefit. For more insights and updates, visit our website at Lifewellmd.com.

Stay Informed, Stay Healthy:
Remember, informed choices lead to better health. Until next time, be well and take care of yourself.

Speaker 1:

Hey, welcome back to the Deep Dive. If you're someone who pushes your limits whether you're aiming for that new personal best love, the weekend competition, or maybe just believe in living a really active life you're probably always looking for smart ways to improve. The big question is how do you make sure those methods you're exploring are not only going to get you results but also keep you safe and, importantly, within the rules of whatever game you're playing?

Speaker 2:

That's exactly the right starting point, and what's kind of fascinating right now is this huge increase in interest around wellness and anti-aging clinics.

Speaker 1:

You see them everywhere.

Speaker 2:

You do, and they promise a lot when it comes to optimizing our health or physical capabilities, and it's easy to see the appeal if you're really focused on maximizing performance.

Speaker 1:

Absolutely so. In this deep dive, we're going to kind of pull back the curtain on some of the really common therapies you might run into in these clinics. Our goal here is to give you, hopefully, a clear understanding, especially if you're an athlete or just physically active, about what's actually safe and legal for performance enhancement and what could potentially put you in violation of anti-doping regulation. Right, and we're drawing directly from information provided by the US anti-doping agency, usada, to help navigate this sometimes confusing terrain.

Speaker 2:

And it is a landscape where careful navigation is really key. What stands out is that, while your personal goals in seeking these therapies might be all about health and well-being, the rules that govern competitive sports are incredibly specific. They don't always align perfectly.

Speaker 1:

Okay, let's dive right into a topic then that comes up a lot Hormone replacement therapies, or HRT, and also bioidentical hormone replacement therapies, BHRT. Can you kind of break down what these are all about for us?

Speaker 2:

Sure. So these therapies are often suggested to address the natural hormonal shifts we all experience as we age, things like menopause in women or that natural decline in testosterone levels in men. Right, you might also hear about hormones, including steroid hormones, being used to maybe combat feelings of fatigue or improve bone density or even enhance stamina general wellness stuff often.

Speaker 1:

Right, okay, that makes sense as a general approach.

Speaker 2:

Yeah.

Speaker 1:

But here's where it gets really interesting when we look at it from USADA's perspective. What are the like critical things athletes need to be aware of regarding HRT and BHRT?

Speaker 2:

Okay, the most crucial point to understand really is that many of the hormones used in these therapies, specifically things like testosterone and DHEA, are included on the World Anti-Doping Agency's prohibited list. And this isn't just during competition. This prohibition is in effect at all times, whether you're actively competing or in your off-season, and it's important to emphasize this applies across the board national level athletes, non-national, junior, recreational masters, everyone.

Speaker 1:

So it's definitely not just the elite pros who need to worry about this.

Speaker 2:

Exactly. The anti-goping rules have a really wide reach and what's absolutely vital to get is that, whether the testosterone or DHEA is naturally produced by our body, chemically identical to what the body produces that's the bioidentical part or synthetically manufactured, it doesn't change its prohibited status. Wow, it's prohibited, regardless of its origin or how you take it.

Speaker 1:

That's a really key distinction, because I can easily see someone thinking well, I'm just trying to get my natural hormone levels back to where they used to be. That shouldn't be a problem, right.

Speaker 2:

That's such a common misconception. Your healthcare provider might even suggest that restoring what they consider normal levels isn't performance enhancing. However, under the anti-doping regulations, any use of these prohibited steroid hormones without an approved therapeutic use exemption a TUE is a direct violation, full stop.

Speaker 1:

Me too right.

Speaker 2:

The amount you use, the method of administration tablets, creams, injections it just doesn't matter. No TUE, it's a violation.

Speaker 1:

And how are these HRT and BHRT substances typically given? You mentioned a few.

Speaker 2:

Yeah, they can be administered in a whole variety of ways. You've got tablets you take orally, creams or patches you apply right onto the skin injections, of course or even these tiny pellets that are surgically implanted under the skin for a kind of gradual release of the hormone.

Speaker 1:

Okay, so for someone who's considering HRT or BHRT, what's the absolute must-know takeaway here? Like the bottom line.

Speaker 2:

The single most important step bar none is to know with absolute certainty what is in the medication you are being prescribed. You have a responsibility as the athlete to verify its status under anti-doping rules.

Speaker 1:

Okay.

Speaker 2:

The best way. Check the globaldrocom website, that's G-L-O-B-A-L-D-R-Ocom, or you can directly contact USADA's drug reference line by sending an email to drugreferenceatusadaorg. That's your primary safeguard. Don't just rely on the clinic.

Speaker 1:

Gotcha Check globaldro or email USADA Okay, Let. Or Yungel, Usada Okay. Let's pivot now to another area where people often seek guidance from wellness clinics medical weight loss. What are some specific things athletes and active folks need to keep in mind here?

Speaker 2:

Yeah, weight loss comes up a lot. One substance to be particularly aware of is phentermine. It's a stimulant sometimes prescribed to help with weight loss. It's specifically prohibited in competition, so athletes need to be really careful about the timing if it's prescribed.

Speaker 1:

In competition only for that one.

Speaker 2:

OK, ok, but let's focus maybe more specifically on something called human chorionic gonadotropin, usually just called HCG.

Speaker 1:

HCG? Yes, I've definitely heard that mentioned in weight loss circles. What's the deal with that for athletes?

Speaker 2:

OK For male athletes, HCG is prohibited at all times. Simple as that.

Speaker 1:

Okay, ban for men.

Speaker 2:

Now, while it's not actually on the prohibited list for women, female athletes still need to exercise Pretty significant caution. Here's why the Food and Drug Administration, the FDA, has approved HCG as a prescription med for specific uses, mainly treating female infertility Right, but it has not been approved by theG as a prescription med for specific uses mainly treating female infertility Right, but it has not been approved by the FDA as a safe or effective treatment for weight loss.

Speaker 1:

Ah. So even if it's not technically banned for women in sports, there are still pretty big concerns.

Speaker 2:

Precisely. The FDA itself has stated very clearly there's basically no solid scientific evidence to support the claim that HCG actually leads to weight loss beyond what you'd get from just cutting calories. They also point out it doesn't cause like a better distribution of fat or reduce the hunger that comes with dieting. Furthermore and this is critical the FDA emphasizes it is illegal to sell HCG over the counter as a dietary supplement or as a homeopathic medication for any purpose, including weight loss.

Speaker 1:

Wow, okay, that's a really significant point. So even if a female athlete is being prescribed HCG for weight loss at, say, a wellness clinic, there are major red flags way beyond just potential anti-doping issues.

Speaker 2:

Exactly that lack of FDA approval for weight loss is a crucial consideration regarding its safety and whether it even works for that purpose, even if it doesn't trigger a positive test for female athletes. It's a health and efficacy question too.

Speaker 1:

Okay, super important distinction. Let's move on to another increasingly popular trend Intravenous or fine infusions, vitamins, saline you see these advertised everywhere. Now, right, dedicated clinics, even mobile services that come to your house.

Speaker 2:

Yep, the IV bars hangover cures.

Speaker 1:

Yeah, what's the important info for athletes here? It seems harmless enough, maybe.

Speaker 2:

Well, this is an area where the anti-doping rules are actually quite clear and pretty strict. Any and all IV infusions of more than 100 milliliters total within any 12-hour period are prohibited at all times under anti-doping regulation.

Speaker 1:

Wait. More than 100 milliliters, that's not very much, is it Like less than half a cup?

Speaker 2:

It's not a large volume, no, and the rule applies regardless of what's actually in the IV bag. So those popular Myers cocktails or those so-called hangover cures delivered via IV drip, they almost certainly fall under this prohibition because they usually involve much more than 100 milliliters of fluid.

Speaker 1:

So, even if it's just like a mix of vitamins and saline solution, nothing actually banned in the bag.

Speaker 2:

Yes, the critical factors here are the volume of fluid being infused and the method, the IV administration itself. The only specific exceptions to this rule are if the IV infusion is legitimately received during necessary hospital treatment, as part of a surgical procedure or maybe during clinical diagnostic investigations.

Speaker 1:

And I'm guessing wellness or anti-aging clinics wouldn't typically count as hospital settings for these specific anti-doping rule exceptions.

Speaker 2:

That's correct. They generally don't meet that definition. Therefore, receiving an IV infusion at a wellness clinic, even if it seems completely harmless, could still constitute a violation of anti-doping rules simply based on the volume and method.

Speaker 1:

Wow, okay, that's a big one. A lot of people might not realize that. Okay, another type of therapy that's been getting some buzz is ozone therapy. What do athletes need to understand about this one?

Speaker 2:

Ozone therapy basically involves introducing ozone gas into the bloodstream through various methods, now one particular method known as auto-hemotherapy. That's where a quantity of your blood is drawn out, infused with ozone gas and then re-injected back into your body. That method is prohibited at all times under anti-doping rules. Okay, while ozone itself isn't specifically on the prohibited list as a substance, any procedure that involves the manipulation of blood, like removing it and then reintroducing it into the circulatory system, is considered a prohibited method.

Speaker 1:

Ah, so the procedure itself, the blood manipulation, that's the issue in that specific case, not the ozone.

Speaker 2:

Precisely. However, it's worth noting there is another method of ozone therapy called rectal insufflation, where ozone gas is introduced into the colon via a catheter. This particular method, as things stand, is currently permitted under anti-doping rules.

Speaker 1:

That's a very specific distinction, but important to know. Okay now, many of these wellness clinics seem to frequently offer compounded medications. What are the potential risks or pitfalls for athletes who might be prescribed these types of custom-made drugs?

Speaker 2:

Yeah, compounded meds are common in this space. They're essentially custom-made drugs prepared by specialized compounding pharmacies, often based on a specific prescription from a wellness clinic doctor. The primary concern for athletes here is the significantly increased risk of unintentional contamination with substances that are prohibited.

Speaker 1:

Contamination, how so?

Speaker 2:

Well, because these products are often mixed manually in a pharmacy setting where prohibited substances might also be handled maybe they're making a testosterone cream one minute and your medication the next the potential for cross-contamination is inherently higher compared to, say, pre-packaged medications made by big pharma companies under super strict quality control.

Speaker 1:

Okay.

Speaker 2:

Plus, compounding pharmacies typically operate under less stringent regulatory oversight compared to those large manufacturers.

Speaker 1:

So hang on. Even if the active ingredient in the compounded medication itself isn't prohibited, there's a real risk of inadvertently getting something else in there that is banned.

Speaker 2:

Exactly right. Athletes who have prescriptions for compounded medications, or even compounded supplements, for that matter, need to be extremely aware of this elevated risk. It's another area where you really need to exercise extra caution and do your homework.

Speaker 1:

That's a bit scary, actually. Ok, we've also heard discussions around the concept of adrenal fatigue, which seems to be diagnosed at some of these wellness clinics. What should athletes know about? Treatments may be offered for this.

Speaker 2:

Right Adrenal fatigue. It's important to note that this isn't really a universally accepted medical diagnosis within the mainstream medical community, but it is something some wellness clinics address. The treatments can vary, but one particular treatment to be very aware of is the prescription of oral cortisone.

Speaker 1:

Cortisone, like corticosteroids, aware of is the prescription of oral cortisone.

Speaker 2:

Cortisone like corticosteroids yes, exactly. Oral cortisone is prohibited in competition under anti-doping rules. So if you happen to receive a diagnosis of adrenal fatigue and are prescribed any medication for it, it is critically important to verify its anti-doping status, especially checking if it's okay during competition periods.

Speaker 1:

Got it. Check anything prescribed for adrenal fatigue, especially cortisone. Okay, let's move on to a topic that affects almost everyone involved in sports and fitness, dietary supplements. Wellness clinics often recommend a whole slew of these products. What is USADA's sort of fundamental stance on supplements for athletes?

Speaker 2:

The most fundamental thing, the absolute baseline you need to remember about dietary supplements is that they are not subject to pre-market approval by regulatory agencies like the FDA.

Speaker 1:

Meaning.

Speaker 2:

Meaning there's no independent body that verifies the accuracy of the product label or the safety of the ingredients before these supplements hit the shelves and are available for purchase. As a direct consequence of this lack of oversight, no dietary supplement can ever be guaranteed to be completely free of substances that are prohibited in sport. There's always a risk.

Speaker 1:

So it really is a bit of a buyer beware situation when it comes to supplements, then To a significant extent.

Speaker 2:

yes, if athletes choose to use dietary supplements despite these inherent risks and many do USADA strongly advises using only the supplements that have undergone third-party certification by a program that specifically tests for substances prohibited in sport.

Speaker 1:

Third-party certification. Yeah, like who.

Speaker 2:

Currently, NSF Certified for Sport is widely recognized as the sort of gold standard in this area. They test batch by batch for a wide range of banned substances. Athletes can find much more detailed information and lists of certified products on USADA's NSF Athlete Advisory page on their website.

Speaker 1:

Okay, so look for that NSF Certified for Sport logo if you're going to use supplements. That's really practical, actionable advice. What about some of the more, let's say, advanced or cutting-edge therapies sometimes offered, like stem cell therapies and orthobiologics, particularly, maybe, for sports injuries?

Speaker 2:

Yeah, these types of treatments are definitely becoming more prevalent, more talked about. According to the World Anti-Doping Agency, wada, stem cell injections are generally permitted provided that no prohibited substances are added to the stem cell material and if the application is localized, meaning injected right at the site of the injury with the primary intention of just facilitating healing, not with the aim of enhancing athletic performance.

Speaker 1:

So there are conditions.

Speaker 2:

Yes, the crucial aspects here are the nature of the material being injected. Are the stem cells themselves manipulated? And the intended use. If the stem cells are modified or manipulated in any way that could give a performance-enhancing benefit, then they would be prohibited.

Speaker 1:

So it really comes down to the specific application and whether any prohibited substances are being introduced either with the cells or through manipulating the cells themselves.

Speaker 2:

Exactly. The overarching principle is is this to support recovery and healing from an injury, or is it trying to gain an unfair athletic advantage? That's the line.

Speaker 1:

Okay, that makes sense. And finally, let's just quickly touch on homeopathic remedies. These are also quite commonly found and recommended in wellness circles. What's the perspective for athletes considering these?

Speaker 2:

Right homeopathy. It's important to understand that there are currently no homeopathic remedies that have received approval from the FDA None None. These products can be marketed and sold without undergoing any FDA evaluation for either their safety or their effectiveness. In fact, the FDA has actually identified certain homeopathic products in the past that were found to contain active pharmaceutical ingredients. Things that shouldn't have been in there were found to contain active pharmaceutical ingredients, things that shouldn't have been in there and there have also been instances of products that were unsterile or otherwise unsafe.

Speaker 1:

So similar to the supplements. Then there's a significant lack of robust regulatory oversight. It's kind of the Wild West.

Speaker 2:

Precisely Due to this absence of rigorous pre-market review, USADA simply cannot provide any guarantee regarding the accuracy of the ingredient labels on homeopathic medications. They just don't know what's really in them for sure.

Speaker 1:

Okay.

Speaker 2:

And therefore they cannot provide an official anti-doping status for these products. Consequently, just like with dietary supplements, athletes who choose to use homeopathic remedies do so entirely at their own risk.

Speaker 1:

At your own risk, got it. So, as we kind of bring all of this information together, what is the most important overarching message for our listeners, the athletes, the weekend warriors, the active individuals who might be contemplating some of these various wellness clinic therapies?

Speaker 2:

anti-aging clinics might present themselves as offering really attractive options for boosting your overall health and physical performance, you absolutely must proceed with a significant degree of caution and you need to ensure you are extremely well informed about the relevant anti-doping regulations before you start anything. The mere fact that a particular treatment or substance is being offered, or even prescribed to you, maybe by a doctor, at one of these clinics does not automatically mean that it is either safe from a health perspective or permissible under those anti-doping rules. The two aren't always the same.

Speaker 1:

So the ultimate responsibility for that due diligence it really lies squarely with the athlete themselves, doesn't it?

Speaker 2:

Absolutely 100%. You must be proactive in verifying the status of any procedure or medication you are considering, even if it comes highly recommended by a health care professional you trust. Always take the necessary steps to determine if a therapeutic use exemption, that TUE, is required for your situation Right. And when you have any doubts or questions whatsoever and it's okay to have doubts the best course of action is to reach out directly to USADA's drug reference line. Email them drugreference at USADAorg or call them 785-2000 and pick option two. They are there specifically to provide guidance and help you navigate these often complex issues safely.

Speaker 1:

That's truly invaluable advice. Use those resources. So, as we conclude this deep dive, the central message seems crystal clear Stay informed, exercise caution always double check the facts and use the resources available. A huge thank you for providing such clarity on this really vital topic.

Speaker 2:

My pleasure. It's really all about safeguarding fair play and, just as importantly, protecting the health and integrity of athletes at every single level.

Speaker 1:

Absolutely, and that brings us to the end of another insightful deep dive. We really hope this information has armed you with some clarity and maybe some actionable steps you can take. Now here's something to mull over how can a deeper understanding of your own body and the specific regulations that govern athletic performance truly empower you to achieve your goals in a way that is both safe and ethically sound? Definitely something worth thinking about Until our next deep dive. Take care everyone.