Rising star who says her career collapsed after England football team doctor advised her to take high doses of thyroid drugs
Aformer elite athlete believes her thyroid medication was mishandled by current England football team doctor Rob Chakraverty and caused eating disorders, overtraining and stress fractures which ended her career at the top level. Emma Jackson, fourth over 800m at the 2010 Commonwealth Games, has chosen to speak out after watching Monday night’s BBC Panorama, which featured a section on how banned coach Alberto Salazar encouraged athletes to use thyroid drug thyroxine seemingly as a legal performanceenhancing drug.
The documentary also featured Dr Chakraverty, who was doctor at UK Athletics from 2009-2016 before joining the FA, focusing on how he infused quadruple Olympic champion Mo Farah with controversial supplement L-carnitine but failed to record the levels.
Jackson, 31, has raised fresh concerns. She was given levels of thyroxine which she says were described as ‘through the roof’ when she sought a second opinion from another doctor.
Much of the Salazar controversy has been over inappropriate use of thyroxine with athletes who have only marginal need of the drug. Jackson is different in that she was born without a thyroid gland, which produces the natural thyroxine to regulate the physiological processes in the body, which allows people to exercise effectively. Jackson therefore needed thyroxine replacement medicine to bring this level to normal, so there is no suggestion that Chakraverty gave her the drug without good reason. The questions are over the levels at which he told Jackson to take thyroxine over a sustained period.
Chakraverty took over Jackson’s supervision of thyroxine use in 2011 at a time where her levels were variable, which had led her GP to prescribe 250mcg of thyroxine per day, which was intended to be for a short period. When Chakraverty took over, he lowered the levels to 225mcg per day and later to 200mcg per day — but for two years. Jackson then continued the dosage for an additional year because no one told her to stop.
Dr Nicky Keay, a sports endocrinologist at Durham University, said: ‘A high dose for a slim young person with accompanying report of significant symptoms is potentially suggestive of over replacement.’
Over the next two years, Jackson’s health, mental state and training deteriorated to such an extent that Barry Fudge, now UKA Head of Endurance but then a sports scientist with the English Institute of Sport, asked her father if she had an eating disorder. Her body fat was 9.5 per cent and nd skin folds were 35mm in March 2013, 013, causing one nutritionist to comment she was ‘the lean- est female 800m runner he has ever encountered.’ She ran her personal best in early 2012 but failed to make the London Olympic team that year, after suffering a rib stress fracture and d losing form.
During that period, Jackson son says she was experiencing g personality changes, becoming obsessive about food and t raining, constantly eating but always hungry. ‘I was just training all the time and I was always hungry. You know when you have to eat because you’re so hungry? It was like that all the time. It wasn’t a nice feeling. I was obsessed with what I was eating. I was looking at people around me thinking, why am I eating so much? You feel like your heart rate is always going and you can never switch off.
‘Everyone thought the obsessiveness and personality change was down to missing out at the Olympics. Because I was so disappointed, people thought I had become obsessive. But it was actually because of the high dose. And as soon as the dose was brought back down my personality was visibly different.’
Keay said: ‘High levels of thyroxine can lead to the situation of metabolism speeding up, causing adverse physical and psychological effects such as fast pulse rate, excessive hunger and compulsion to over exercise due to anxiety.’
Despite the warning signs and seeing her fat test results, Chakraverty continued to email her to say that she should ‘stay on same dose of thyroxine.’
After she ceased to be funded by UKA because of her injuries and poor performance in 2013, Jackson maintained the levels of thyroxine until October 2014, when they were independently assessed by another sports doctor. ‘He told me that my thyroxine levels were through the roof and told me to halve the dosage immediately, which tells you how serious it was,’ she said.
Jackson initially spoke out in 2015 about what she felt had been inappropriate care and at that stage UKA organised a meeting with her and Chakraverty to reassure her, at which she accepted that she had not been used as a guinea pig to test how effective thyroxine was.
But Jackson feels that she wasn’t taken seriously by the endocrinologist at the meeting, Dr Kristien Boelaert, when suggesting that her stress fractures could have been caused by high doses of thyroxine
Jackson said: ‘ I am concerned how quickly I was dismissed in the meeting. They didn’t seem to care about the fact that I was not able to eat enough to fuel my training. I explained why I felt let down but she [Boelaert] kept saying: “No, no, that’s not the case. That wouldn’t have caused stress fractures.” Before the meeting I could tell Rob [Chakraverty] was worried. After it had finished, he seemed relieved. I felt like I was coerced into getting the reaction they wanted about the causes of my injuries.’
After meeting with UKA, Jackson agreed to make a statement that she had accepted their reassurances ‘that there was no attempt to boost my performance.’ Also, Chakraverty denied that the high levels of t hyroxine prescribed were to enhance performance. However, contemporaneous notes taken at the meeting, seen by The Mail on Sunday, record that he did say he should have handled the case differently and that he apologised to Jackson.
Despite feeling undermined by Boelaert at the meeting, Jackson took up an offer to be assessed by her, after which the athlete said the doctor’s attitude changed and she was ‘really nice’ and helped her regulate her dose. But her elite running career never recovered and Jackson believes the high levels of thyroxine contributed to the stress fractures that ended her career.
Keay said: ‘ We know that there is an impact on bone health from patients with an overactive t hyroid gland with high levels of thyroxine in the body in the long term. In the shorter term, stress fractures are often a result of relative energy deficiency in sport. Potentially a secondary consequence of high levels of thyroxine speeding up the metabolism, combined with a high energy demand training load, could unintentionally lead to low energy availability. The situation of low energy availability is well documented to be a risk factor for stress fractures in athletes. Running is repetitive so foot stress fractures are not unusual. Stress fractures in unusual areas would be clinically significant and further investigations warranted to identify the cause.’
Jackson had a stress fracture of the rib in June 2012, a fracture of the foot in July 2012 and two femur
stress fractures in 2014. Boelaert declined to comment, citing patient confidentiality.
Last month Jackson was contacted by UKA, for the first time in five years, in the run up to the Panorama documentary, to remind her of the statement she had made in 2015. ‘That was the first contact I’ve had in years and though it appeared friendly it felt like a threat not to speak out,’ she said.
Keay said: ‘In keeping with official guidelines from The National Institute for Health and Care Excellence (NICE), over treatment with thyroxine is indicated in the clinical context of significant symptoms and by suppressed levels of TSH (thyroid-stimulating hormone). The only situation where the aim is to suppress TSH with thyroxine treatment, is in someone has had a particular type of thyroid cancer. Moving forward, discussions are leading to better management of endocrine issues in athletes.’
Jackson, who is now pursuing her banking career in Edinburgh, wants athletes taking thyroxine to be aware of dosage and potential da gers. ‘If they are still prescribing this to athletes, which it sounds like they are, do athletes understand what they’re doing? It’s not meant to be used as weight-loss tool. It’s a hormone that speeds up your whole system and can be quite dangerous.
‘I was weeing five times a night because my kidneys were working so much faster! And you wonder: “What’s that doing?” I’m not sure the effects are fully understood. It can end up making you feel more fatigued. I would say be careful with it, though I know they have Dr Boelaert to advise now.’ After Jackson’s case, Chakraverty continued to suggest screening elite athletes for thyroid issues. The Daily Mail has documented how he raised the issue with Premier League doctors, discussing if it would be possible to screen England players for thyroid conditions, though they never did so due to the negative response he received.
He attended a summit with the English Institute of Sport in 2014 which discussed treatment of athl etes for ‘ subclinical hypothyroidism’ — essentially athletes on the borderline. Minutes from that meeting do, however, stress that it would not be administered as a performance-enhancing strategy.
Chakraverty said: ‘I have had the privilege of working with many world- class athletes and I take pride in the care I provide, which is always in their best interests. I refute any suggestion that I have been encouraging medical screening or the use of medication for any reason other than protecting athletes’ health.
‘All elite athletes undergo screening tests for a range of medical conditions — including thyroid issues. This medical screening is standard process and helps us to manage their health and medical care proactively and is not aimed at performance enhancement. Athletes with abnormal results are managed in accordance with usual medical practice and where appropriate NICE guidelines. It would be inappropriate for me to comment on the treatment of any part i cular athlete, however it is standard process to monitor bone density in athletes who have stress fractures and if these tests are normal, then this would not highlight a specific risk factor that needed addressing. I am also unable to comment on injuries or management that occurred when an athlete was not under my or UKA’s care.’
UK Athletics said: ‘At all times medical practitioners have acted in good faith and prioritised the health of athletes. We refute any suggestion that a UKA medical practitioner sought to gain a performance advantage by over-medicating an athlete on thyroxine.’
UKA said they asked the World Anti-Doping Agency to change the rules so thyroxine is only available under a therapeutic use exemption and added: ‘This would help protect athlete health, ensure usage is for health requirements only and is correctly recorded by national antidoping agencies. Screening tests for a number of medical conditions, including thyroid disease, are performed on world-class performance athletes as is best practice for the health care of elite athletes.’