Abstract des Autors

Performance-enhancing substances are banned in sports, a major reason being to protect athletes from the acute and chronic harm that can result from their use. The sad death of Tom (Tommy) Simpson in the Tour de France in 1967, related to the use of methamphetamine together with alcohol and in the context of dehydration, still resonates today, in part because this was the first recorded ‘doping death’ in front of television cameras.1 By contrast to the amphetamines, which are controlled substances throughout the world, the sale of many other sympathomimetic amines in supplements are not subject to such control. These substances are generally included in the World Anti-Doping Agency (WADA) prohibited list.2 However, outside the circle of elite sports competitors, users of such supplements will not be subject to the jurisdiction of sports governing bodies which undertake enforced drug control tests of elite athletes to act as a deterrent. Perhaps the best example of those individuals who do not fall under such jurisdiction is the majority of participants in the World Marathon Majors (WMM), which includes the London marathon. It is reasonable to assume that such participants will not have the knowledge that such supplements contain stimulants that present a potential risk to their health when combined with strenuous exercise. Indeed, there is the likelihood that these supplements will be perceived as safe to use, as they can be purchased legally.

1,3-dimethylamylamine (DMAA), also referred to as methylhexaneamine , is an aliphatic sympathomimetic amine.3, 4 It was investigated in the 1940s as a potential nasal decongestant and patented in 1944 by Eli Lilly as Forthane™.5 In 2005/2006 there were reports of dietary supplements containing DMAA being marketed in the USA as a slimming agent (Geranamine™); while some felt that it was introduced in the guise of a legal supplement ingredient, others regarded that this was permissible as DMAA was considered a ‘natural product’, thus fulfilling a criterion of the US Dietary Supplement Health and Education Act of 1994.6 This consideration was based on a single study by Ping et al., who described the presence of DMAA in geranium oil (Geranamine™).7 However, this report has been criticized for its lack of scientific rigour by Zhang et al., who determined that it is unlikely that DMAA in supplements originates from natural sources, but is a synthetic additive.8 Two further recent studies funded by USPLabs, a major supplier of DMAA supplements, reported trace amounts of DMAA in geranium samples,9, 10 but even if present, the quantity provided in supplements is orders of magnitude greater.11, 12 By contrast, recent independent investigations reported that DMAA is not present at all in Pelargonium (Geraniaceae) species/cultivars.13-15

In 2008/2009, DMAA started to be sold as a recreational drug on Internet sites trading in new psychoactive substances (NPS); it was also sold in high street head shops in New Zealand and a number of European countries.16-18 At that time, DMAA was also being marketed as a supplement that ‘provides energy, focus and acts a thermogenic fat-burner’, properties which were attractive to bodybuilders and also athletes. DMAA was always considered to be prohibited by WADA, as a substance with a similar chemical structure or similar biological effect to listed stimulants. Even so, WADA decided to formally add DMAA to its named list of prohibited substances in 2010,19 using its alternative name of methylhexaneamine, because of its availability in dietary supplements and also because of the number of positive urinalysis findings for athletes being reported by WADA-accredited laboratories. In the WADA Adverse Atypical Findings for 2009, methylhexaneamine (DMAA) was ranked joint third in the stimulant class. However, in 2010 to 2012, it consistently ranked at number one, accounting for 45.9% (320 of 697) of occurrences within the stimulant class for 2012.20 The use of DMAA by the general public has also been demonstrated in a recent study that analyzed anonymized pooled urine samples collected from portable street urinals in central London, UK. In this study, over a six-month period, DMAA was identified in 25% to 100% of the monthly pooled urine samples which was comparable in frequency to the novel psychoactive drugs and classical recreational drugs detected.21 Nevertheless, the study could not differentiate its presence as being part of an energy supplement or taken as an NPS.

There have been previous reports of serious adverse health effects related to the use of supplements containing DMAA.22 Furthermore, in the USA there have been two deaths of military service members thought to be potentially related to DMAA and reported in the scientific literature.23 We describe here a fatality in a marathon runner related to, analytically confirmed, DMAA.