Substances and their potential effects on performance


As the first woman to land a quadruple jump at the Olympics, 15-year-old Kamila Valieva shot to instant fame. She also helped Russia win a gold medal in the team figure skating event.

Then it was revealed that his drug screening sample from December 2021 found trimetazidine, a banned substance according to the World Anti-Doping Agency (WADA). The same sample also found L-carnitine and hypoxene, two non-prohibited substances. L-carnitine is recognized as a natural health product, but none of the substances are drugs approved by Health Canada.

The circus of the suspension, the hearing and Valieva’s decision to let her compete clouded the Olympics. Ultimately, she placed fourth in the individual figure skating event — a disappointing result for the gold medal favorite.


As a lifelong figure skater and doctor who often prescribes heart medication for medical reasons, I was intrigued by medication. How do they work? Are there any side effects? Who would be legally allowed to take the banned substance?

Trimetazidine is classified as a second-line cardiovascular agent, which means it is used when first-choice treatment alone has not worked. The European Society of Cardiology recommends its use by people with known coronary artery disease (the leading cause of heart attacks) to relieve symptoms of chest pain (also called angina pectoris).

Kamila Valieva competing in the women’s short program in Beijing.
(AP Photo/Bernat Armangue)

Trimetazidine is unique among antianginal drugs. Most antianginal drugs work by balancing the heart muscle’s oxygen supply with its oxygen demand. Instead, trimetazidine increases tolerance to low oxygen states at the cellular level by inhibiting fat-derived energy production (fatty acid metabolism) and stimulating glucose metabolism (a more efficient process).

A potential side effect of the drug that has been investigated by the European Medicines Agency is the development of Parkinson’s disease-like movement disorders.


The other two drugs are not WADA Prohibited Substances. L-carnitine may sound familiar as it is a readily available supplement for athletes in North America, although its benefits are debated. L-carnitine is classified as an antioxidant by Health Canada. It is an amino acid derivative that also occurs naturally in the body.

The theory is that L-carnitine aids in the conversion of fatty acids into energy, particularly in the heart and skeletal muscles where it is found in higher concentrations. It may also help reduce post-exercise muscle damage by playing a regulatory role in muscle/protein balance and acting as an anti-inflammatory. Too many high-dose supplements can cause gastrointestinal symptoms like nausea, vomiting, cramping or diarrhea, or “fishy” body odor.

Carnitine supplements may be medically indicated for people with low blood carnitine levels due to genetic conditions or chronic kidney disease, but they have also been studied in many different diseases, including cardiovascular disease and type 2 diabetes.


Hypoxen is probably the most mysterious drug of the three. It is an antihypoxant, which is used to treat hypoxia (lack of oxygen in the blood or tissues). Published research on this drug in humans is minimal. There is no medical indication for its use. A quick internet search reveals that it is sold online as an exercise supplement.

A female skater on the ice, leaning forward with her hands on her knees
Muscles need more oxygen during exercise. For Olympic-level athletes with extreme training programs, there is not enough oxygen available, leading to occasional oxygen starvation (hypoxia) in the muscles.
(AP Photo/David J. Phillip)

When we exercise, our muscles need more oxygen. For Olympic-level athletes with extreme training programs, there may not be enough oxygen available, which sometimes leads to oxygen starvation (hypoxia) in the muscles. Oxygen return (post-exercise reoxygenation) leads to muscle cell damage (via inflammation and oxidative stress). According to one study, this is why hypoxene, with antioxidant properties (which reduce oxidative stress), is believed to reduce inflammation and contribute to greater endurance and recovery capacity after exercise.

figure skating performance

Figure skating is not a sport that benefits from the stereotypical image of steroid doping and muscle bulking. The drugs could instead be used to improve endurance training, aid recovery after intense exercise, and allow more time on the ice to build muscle memory.

Information about the nature and potential effects of the substances identified in Valieva’s drug test, along with some understanding of what might enhance a figure skater’s performance, can help observers make sense of the doping scandal unfolding in Beijing.

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