In Depth Feature: Tom Sietas and His Anti-Doping Challenge

Photos by Tim Calver

Tom Sietas is not a happy freediver. I called him at his flat in Hamburg, Germany last week and asked him how the whole situation has affected his life and his relationships with friends, freedivers and fans.

“It is very difficult” Tom says. “Thanks to god, my family and my friends who stand by me. These are the only persons with whom I don’t feel the urge to explain myself over and over again. I mean even if I talk with people who know me for a bit and who believe me I don’t feel safe. What do they really think? Do they trust me one hundred percent? It’s very hard not being sure whether the person in front of you believes you or not.”

 “All I want to do is relax and be myself. I am tired of dealing with everyone’s questions, that’s very hard to do.”

Here’s what happened: On September 4, 2004, Tom Sietas received a letter from the WADA anti-doping laboratory saying that his urine sample from his June 11th static apnea World Record attempt (8’47") had tested positive for 1.1 nanograms per milliliter in urine (0.0000000011 g/ml) of metoprolol, a common beta-blocker also known as “Lopressor.” The letter informed him that he could choose to have his sample "B" tested at the laboratory of his choosing. Tom and some friends came up with the 500€ to have the sample tested at a local lab in Germany where Tom will be able to observe the test. The procedure began on September 16 and results should be available by October 1. Tom opted to have the sample "B" tested just in case there was a mistake or contamination of the sample, but he is not optimistic about the chances for a negative result, since it was taken at the same time as sample “A.”

In Depth Feature: Tom Sietas and His Anti Doping Challenge freediving competition records  static apnea record AIDA

Tom has considered the few possible reasons for the positive test. He has ruled out medication he might have taken, citing only two aspirin in the six months preceding the record. He wonders about a possible human error with the test in the laboratory. Then there’s a flatmate of his who has had a prescription for metoprolol, which Tom recognizes as an unfortunate coincidence. Nonetheless, Tom believes that the chance of accidental contamination is unlikely. Tom has considered the idea that someone might have spiked his water bottle. But since it is impossible to prove and discouraging to think about, he won’t pursue it any further.

Tom is checking into one other possibility.  In Germany, there have been studies to show that the ground water in certain cities and towns are contaminated with metoprolol and several other drugs with similar trace concentrations as was found in his urine sample. Tom drank three litres of water to help produce a sample for the anti-doping test. He wonders if perhaps the water ran right through him and whether contamination could account for the positive result.  Unfortunately, it is expensive to have the water tested at the pool where he set his record. At the time of writing this article, Tom Sietas is still considering his options.

So where does that leave the still pending static apnea world record holder? For now, he is waiting for the B sample result. Since WADA operates on a zero-tolerance policy and AIDA has opted to follow the WADA code without any specific policy of its own for freediving, it is almost certain that he will lose his static apnea record should the B sample test positive.

AIDA’s Very Short History of Anti-Doping

AIDA does not have a freediving-specific doping policy (AIDA defers to the WADA standards) The WADA anti-doping code is designed to protect athletes from harmful substances, and to promote fairness in sport. The WADA banned substances list includes the beta-blocker metoprolol but specifies the events in which it is a banned substance (freediving is not on this list).

Before Tom Sietas and Sam Still of the UK (prednisone), Jean-Michel Pradon of France had failed a drug test for pseudoephedrine, a stimulant found in some cold medications, at the 2000 AIDA World Cup in Montreux, Switzerland. Pradon was disqualified from the Montreux competition and was banned from competition for several months. Because it took so long for AIDA to decide what to do about his case, he actually competed in Nice on the winning French team two months after Montreux.

Tom expects that he will lose his static record and it will return to the mark of 8’06 set by Czech freediver Martin Stepanek. Tom is unsure about further penalties and how it will affect his participation at the AIDA World Championships in Vancouver (he passed his doping tests there) and future competitions in 2005. He is hopeful that the details of his case will yield a lenient result given the particularities of his case.

Metoprolol: Culprit or Accidental Tourist?

Aside from the AIDA ruling, probably the most important issue is the question of guilt and Tom Sietas’ contention that he has achieved all of his astounding results in static apnea without the use of banned or performance-enhancing substances.

Well, let’s look at that. Would metoprolol increase his performance significantly enough to explain his success in static apnea?

I asked the competition doctor for the AIDA Freediving World Championships in Vancouver to comment on the effects of the beta-blocker in question. Dr. John Fitz-Clarke is an emergency and hyperbaric physician who also has a PhD in biophysics, and often prescribes beta-blockers to patients.  He has also developed a computer model to study the effects of freediving on the cardiovascular and respiratory systems.

Dr. Fitz-Clarke explained in detail to me how beta-blockers such as metoprolol work. The heart muscle has alpha and beta receptors, which are linked to the sympathetic nervous system by synapses that secrete adrenaline. Stimulation of beta receptors with adrenaline increases heart rate and blood pressure (part of the "fight or flight response" that heightens our readiness). Blocking these receptors with metoprolol slows heart rate and lowers blood pressure.

According to the Compendium of Pharmaceuticals and Specialties, a reference for medical professionals, metoprolol is completely absorbed by most people in about 1 to 2 hours after ingestion. The half-life is about 3 to 4 hours. Dr. Fitz-Clarke says that it would take 6 half lives or about 24 hours for it to be 99.9% out of the human body with considerable variability from person to person. Trace amounts might take much longer to leave the body.

What would the effect of trace amounts such as the 1.1 nanograms per milliliter found in Tom’s urine only a few hours after his static world record of 8’47”?

Dr. Fitz-Clarke says: “Trace amounts like this would have no physiological effect. The only significant residual effect is the rebound hypertension and increased heart rate that sometimes occurs when you stop taking a beta-blocker. This happens because, while the drug blocks the receptors, the body tries to make more adrenaline because it thinks the receptors are not working. Then you stop the drug, the receptors unblock, and are exposed to higher levels of adrenaline. This lasts for one to two days, depending how long the beta-blocker has been used. We see this in patients who run out of their beta-blocker pills, and come in for a prescription refill after a day or two. They sometimes have a high heart rate and high blood pressure due to overshoot during the withdrawal period. For this reason, it could be somewhat counter-productive for a breath-holder to take a beta-blocker for a few days and then stop it just before competition to avoid detection.”

Another way of looking at it is if you stopped taking beta-blockers say two days before your static attempt to evade drug testing, your heart rate and blood pressure would increase and could compromise your attempt. And if you waited even longer, say five or six days, the trace amounts of beta-bloker would have no effect on increasing performance anyway.

Now, how about the actual increase in performance by a regular dose of metoprolol, say 25-50 mg? Dr. John Fitz-Clarke says that beta-blockers affect only the beta receptors on the heart muscle (myocardial tissue) and not the rest of the body, and that the heart generally accounts for only 10% of oxygen consumption. A few studies show that beta blockers might also reduce the body’s resting metabolic rate by a few percent, but these studies are not consistent. The gain in performance would likely be between 2 to 4% of the total breath hold time, or 8-20 seconds. Not 1-2 minutes as has been implied by certain people on the internet. 

“Based on my calculations, I would expect performance to improve while on a beta-blocker by maybe 8 to 20 seconds,” says Dr. Fitz-Clarke, “then be impaired by a bit less than that amount after stopping the drug (due to withdrawal rebound), then return to baseline after one to two days when the drug effects have completely worn off.”

When a world record can be broken by two seconds, taking a substance that can provide a gain of 2 to 4% is significant and ample reason for a beta-blocker to be considered as performance enhancing.  But as an explanation for a 2 minute gain in a static performance, it is not nearly as convincing. Dr. Fitz-Clarke doesn’t believe that metoprolol, even in a full dose (easily detectable by doping tests) would result in such a significant gain in static time.

Beta-blockers in general should probably be banned because of the possible side effects of taking the drug. Since they lower the heart rate and decrease blood pressure, any additional bradycardia could result in hypoxic blackout at depth or in the pool during apnea. In addition, there are a number of side-effects that could compromise a freediver’s safety, including dizziness, low blood pressure, conduction block of the heart, and worsening of any existing asthma. If AIDA had its own freediving anti-doping list, it should be on it. An alternative would be to have WADA add special clauses to the regulations that would pertain specifically to anti-doping in freediving.

Dr. Fitz-Clarke believes that work should be done to adapt current international anti-doping policy to the sport of freediving because these cases will likely happen again in the future.

“I certainly have some issues with the appropriateness of the WADA anti-doping regulations as applied to free diving (they are really meant for exertional sports that involve high activity, essentially the opposite of free diving),” he says, “but a beta-blocker is one drug that definitely should not be used by freedivers, since it could certainly give an unfair advantage, even if it is small.”

“The best advice is to take nothing in the way of medication (unless medically approved), and guard your food and drink carefully around competitions.”

From Seven Minute Man to Nine Minute Man in Only One Year?

Have you ever thought that the way in which you practice for static apnea is not the best way? Have you ever considered that someone might find a training method that blows you out of the water?

Currently, the general wisdom endorsed in many freediving courses and by world famous freedivers is that we should use warm ups to gradually build up to a maximum breathhold through repeated cycles of “breathe-up” (in most cases this is hyperventilation). From what I’ve seen at the recent Worlds in Vancouver and at many other competitions is that most freedivers use several warm-up statics of increasing length before going for their maximum.

In Depth Feature: Tom Sietas and His Anti Doping Challenge freediving competition records  static apnea record AIDA

Now if a freediver who happens to have a radically different method of training and preparation for static apnea comes along, one that doesn’t use any warm-ups in his preparation, then there is bound to be doubt and skepticism. This skepticism is understandable, given that not many people can achieve a maximum performance on their first try. But then again, not many people make this the goal of their training.

Now combine that original skepticism with the news of a positive test for metoprolol, and you might think that’s enough circumstantial evidence for cheating.  But consider the following:

Tom Sietas used to train like most people do: static apnea once or twice a week, maybe dynamic once in a while for fun, and also general fitness training. He told me that he changed his training approach starting with the 2003 German Championships in Austria.

At the start of training, Tom had a personal best of 7’20”. For ten days in a row, he did static apnea in the pool. His progression was as follows: 7’20”, a few 7’30”s, then 7’45” twice, 7’55” and then 8’06” the day before the competition. He was excited to have the chance to break Hubert Maier’s 7’02” German record but succumbed to nerves and pulled up at 6’52”. During this training period he would start off with a seven minute breath hold (or 80% of his max) and then go for maximum as many as three times after the first static.

After Austria, he went to Egypt for three months and did no training. The 2004 German Indoor Championships in Berlin was in February and so Tom started his training three weeks before. He started off again at 7’00” for the first 3 to 4 days and then did 7’56” and 8’26”, a new personal best. For the next four to five days he had several statics in the 8’12” to 8’15” range before he was mentally exhausted. After a day off, he made 8’58. “I was damn surprised by that,” Tom says. He was surprised because he achieved the time on his first breath hold of the day. “I felt good and looked at my watch and saw 7’30” already and decided to keep going,” he says.

 “This is when I started to think that going for maximum on the first dive was good since my breathing reflex was always around 3’00-3’30”.” He achieved 7’48” in the competition, again succumbing to nerves, but broke the German static record handily.

Tom’s training style then evolved into a unique method: performing maximum breath holds on the first try during an intensive training period. The 2004 French Championships in Nice was when he applied this new strategy from the start. With only one week off between Berlin and Nice, and after four days of static training, Tom reached 9’00”. Two days later, he achieved 9’14” on the first static of the day.

In Nice, Tom suffered from lung squeeze on the constant ballast day and only managed a 7’30” static in competition. But after doing so well in training, he decided to announce a World Record attempt in static for June 11, 2004.

His training continued to go well, starting with two weeks of light training (twice a week) and then everyday for two weeks straight. He did no static less than 8’45” except for a “bad day” where he did 8’35”. There were many breath holds over 9’00” including a personal best of 9’24”.

During the World Record attempt, Tom Sietas tried over three days to break Martin Stepanek’s 8’06” mark. On day one, he made 8’12”. He decided to try again right after and had LMC at 8’15”. Next day, 8’27”. On the final day, he made 8’47” for the new World Record. After a demonstration static for the audience and friends, and drinking over 3 litres of water, Tom was tested for anti-doping that evening.

Since the World Record, Tom says he has surpassed nine minutes more than twenty times. When discussing these amazing progressions, Tom’s frustration with this whole anti-doping thing is apparent. “What do people think –that I take a pill for every day of training since 2003?  What would that do to my body?”

The Anti-Doping Challenge for Freediving

In the end, it may be that the history of AIDA freediving shows a disqualification for metoprolol by Tom Sietas. While we assume that the test does not lie, the question of whether Tom Sietas actually took a beta-blocker to become the static apnea king is far from being answered by an anti-doping test.

Science seems to indicate that there would be little incentive for Tom to take a beta-blocker, that it would be difficult to gain benefit from it without it being detected in much greater amounts, that its side effects would likely interfere with his performances and jeopardize his safety while freediving and that it would take a well-planned and implemented drug plan to use the drug over such a long period of time and still pass anti-doping in Vancouver, which he did.

Tom is eager to show that his ability to break nine minutes is the result of his training and physiological adaptations. He hopes that detailed analysis of his physiology would reveal that he has optimized his training and that ten minutes is achievable because he found a way to get there through training.

"I did not take any beta-blockers," says Tom Sietas. "I have never even thought of taking any. In Germany, there are these talk shows where they use polygraphs (lie-detectors) on the guests. I should take one of those tests. They could ask me anything and I would pass."