How to “Win” the Olympics: Doping with Trimetazidine


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Kamila Valieva performs her short program to “In Memoriam” by Kirill Richter at the 2022 Beijing Olympics figure skating team event, prior to her doping allegations.

In 2021, Russian skating star, Kamila Valieva, burst onto the senior ranks with two impeccable quadruple jumps and a levitating triple axel. Prior to the 2022 Olympics, Valieva had been crowned champion at every major international competition she attended, quickly making her one of the most decorated athletes in figure skating history.

A clear favorite in Beijing, Valieva maintained her position as a dominant force within the field. In the team event, she scored a near-world record in the short program and performed two clean quadruple jumps in the free skate, helping Team Russian Olympic Committee secure their second-ever gold medal in the team figure skating event. Well, maybe not quite.

A positive trimetazidine (TMZ) test from the 15-year-old superstar halted the medal ceremony, putting Russia’s gold, and the certainty of the other countries’ medals, into question. 

Doping is not, by any means, a first for Russia. For the past three Olympic Games, Russian athletes have been barred from competing under their country’s flag, a decree that follows several fatal reports from Russian whistleblowers regarding an alleged state-run doping program. 

With Russia’s infamous history with performance enhancing drugs, Valieva’s positive test only fuels the skepticism surrounding the legitimacy of Russian sport.

To understand the severity of this situation, we need to understand what TMZ is used for and whether it actually has performance enhancing benefits.

Traditionally, TMZ is used to treat heart-related conditions such as angina—a condition where a lack of blood supply to the heart can cause severe chest and upper body pains. TMZ allows the body to better metabolize fatty acids and, subsequently, better utilize oxygen. For patients with heart conditions, it helps to regulate blood pressure swings and increase blood supply to the heart during exercise.

In the context of sports, however, the use and effects of TMZ are disputed. 

Since 2014, the World Anti Doping Agency (WADA) has classed TMZ as a prohibited substance. The drug is currently listed as a “metabolic modulator” and athletes are prohibited from using the drug in or out of competition.

“If you’re in a highly exertional sport, where you’re using a lot of energy and you’re putting your heart under significant stress, it certainly could help your heart function better theoretically,” explains Dr. Johnson-Arbor, a medical toxicology physician at MedStar Georgetown University Hospital. 

“While it does not have the muscle building or stimulant-like effects of many commonly recognized performance-enhancing or doping drugs, trimetazidine may enhance athletes’ physical efficiency and endurance.”

In skating programs, the long program especially, skaters must endure a grueling four-minute performance that includes twelve elements spread out throughout. With little energy remaining for the second half of the program, skaters often find themselves making the most mistakes after the two-minute mark. 

If there was a drug that would allow athletes to bypass one of those qualities, in this case, aerobic endurance, it sounds like a tempting shortcut.

Other experts, however, question the efficacy of TMZ as a performance enhancer.

Dr. Benjamin J. Levine, a heart expert and professor of exercise science at the University of Texas Southwestern Medical School, told the New York Times that TMZ was unlikely to have any performance enhancing qualities in Valieva’s case.

“The chance that trimetazidine would improve her performance, in my opinion, is zero. The only chance would be for it to hurt her,” explained Dr. Levine. “The heart has plenty of blood, and the heart is so good at using different fuels.”

As the effects of TMZ are debated, perhaps we should not be so quick to assume its effectiveness in doping. But, in any case, the drug is still on WADA’s banned list.

“I’ve been involved in roundtables with the [International Olympic Committee], and I think their policy is: When in doubt, ban the drug,” says Scott Powers, a physiologist at the University of Florida who studies the effects of exercise on the heart. “I guess they’re just trying to err on the possibility that this drug may be an ergogenic aid.”


‘None of this is the fault of the athlete,’ CAS panel writes in Valieva report. -By Tariq Panja

Star Russian Figure Skater Tested Positive for Banned Drug -By Juliet Macur and Andrew Keh

What We Know and Don’t Know About the Kamila Valieva Case -By The New York Times

Will Russia Be Thrown Out of the Olympics on Monday? A Primer -By Andrew Keh and Tariq Panja

What Is Trimetazidine and Why Is It Banned at the Olympics? -By Alyssa Hui

Kamila Valieva’s ‘doping’ drug probably doesn’t give athletes an edge -By Philip Kiefer