A Peptide Debate is Rocking Ultra-Running. Is Triathlon Next?

Last week, the ultra-running world found itself at the center of the anti-doping universe with the revelation that a record-breaking runner admitted to the use of a banned substance while on a podcast. It has ignited a fierce debate online as to what substances should actually appear on the WADA Prohibited List as well as who that list should actually apply to. Naturally, there’s also plenty of overlap with triathlon and other endurance sports.

Peptide BPC-157 and the WADA Prohibited List

At the center of the ultra-running controversy is a peptide known as BPC-157. BPC-157 is a synthetic pentadecapeptide originally isolated from gastric juice — as in, the stuff from inside your stomach lining. And that’s the most concrete thing we know with certainty about BPC-157; there is extremely little known about the peptide, its benefits, and side effects. As in, as of a 2025 systemic review of the compound had identified that there has been precisely one human study, consisting of all of 12 people, on it. The 35 other studies that had been performed on BPC-157 had all been performed on animals.

The extremely limited information that can be gleaned from those studies is that BPC-157 results in “improved outcomes in muscle, tendon, ligament, and bone injury models in animals.” According to Dr. Christopher Raffo of Maryland Orthopedic Specialists, it appears that there are multiple pathways in which BPC-157 works in these situations:

• Promoting new blood vessel growth;
• Boosting collagen production;
• Reducing inflammation; and
• Supporting muscle and nerve function.

Raffo writes that, “These combined effects are particularly intriguing for orthopedics because many musculoskeletal injuries (Achilles tendon ruptures, rotator cuff tears, chronic tendinopathies) occur in precisely those areas where blood flow is limited and healing is frustratingly slow.”

However, to be clear, BPC-157 is not FDA approved. It can be bought online “for research purposes only” (and no, I am not giving you a link to it). That puts it squarely in a regulatory gray area whereby it can be procured legally, but there is no standardization, potential for contamination, and unknown long-term effects.

As such, the WADA Code prohibits BPC-157 as a non-approved substance under class S-0. That means that its usage is prohibited at all times. The Prohibited List states:

“Any pharmacological substance which is not addressed by any of the subsequent sections of the List and with no current approval by any governmental regulatory health authority for human therapeutic use (e.g. drugs under pre-clinical or clinical development or discontinued, designer drugs, substances approved only for veterinary use) is prohibited at all times.”

So, to summarize: BPC-157 may be beneficial in healing orthopedic injuries, but it is not approved for FDA usage and therefore banned under the WADA Code.

The Ultra-Runners at the Center of the Debate

BPC-157 usage in ultra-running stormed into the spotlight last week with the public revelation by Mike McKnight on Cam Hanes podcast that he had used the peptide to avoid back surgery over the winter. McKnight recently set a new course record at the Arizona Monster 300 this spring, and finished 13th at Cocodona 250 in May. He’d previously won and finished second at Cocodona 250 in 2022 and 2023. His most successful season of racing was back in 2019, where he won 3 of 4 ultras he entered into.

McKnight said in a post on Instagram that he had suffered a herniated disc in his back while slipping on laundry detergent just after Cocodona 250 last year. He had scheduled surgery on the disc when, he says, friends recommended the peptide to him. McKnight says, “A nurse came to my house, taught me about the benefits of it, and recommended how much to take each day. I followed her advice, and saw major improvements by the end of the first week. By the time my surgery date had arrived, I felt almost 100% better. I called the surgeon and canceled my surgery.”

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McKnight said in the same post that he was unaware that BPC-157 was prohibited by the WADA Code. However, he also said that “I’m also not going to sit here and say I regret my decision. This decision kept me from having to have back surgery. This decision made it so I could walk and start doing something that has been a part of my life for almost 15 years. If being honest about this decision brings me hate, I’ll move on with my life. If this makes it so I’m banned from every race under the sun, I’ll wake up tomorrow and every day after that and go for a fun run.”

Hanes, for his part, had previously publicly admitted to his usage of the peptide after Cocodona 250. He said that he was taking BPC-157 in an attempt to avoid surgery on a broken foot — the type of injury that Dr. Raffo described as the peptide potentially providing benefit for. Unlike McKnight, Hanes is not a contender for overall victory at races. The 58-year old ran a 13 minute personal best at the Eugene Marathon in April, running 2:39:11 and finishing in 70th place. He did, however, win his age group.

The ultra-running world seemed to split itself into three separate camps. The first, which includes Sage Canaday, was to hold strict scrutiny to the WADA Code; they took the substance, admitted to it, and therefore should be banned. Canaday also took issue with athletes not having knowledge of the Code, posting a video to Instagram on how to find out anti-doping rules.

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The second camp centered on the benefits of the peptide, and that both McKnight and Hanes had used BPC-157 in a medical manner as opposed to one for performance enhancement. And then the third camp differentiated on the athletic status of McKnight and Hanes; McKnight, as a professional racer and coach, should be held to a different status than Hanes, who is “just” an age-grouper (one with 1.8 million Instagram followers, but an age-group athlete nonetheless). That was, in part, the take of Kilian Korth.

Further complicating matters is that anti-doping efforts in ultra-running are a patchwork of efforts. Since 2023 USADA has performed a total of 175 tests to Mountain, Ultra and Trail athletes. Triathlon has had five times the number of tests performed by USADA alone during the same time period. To describe it as messy is doing a disservice to the word.

Triathlon, the WADA Code, and Applicability

The debate in ultra-running has raised a critical point: where should we draw the line on who falls under the full WADA Code?

To be unequivocally clear, today, everyone who participates in a sanctioned event falls under the WADA Code, just like how everyone falls under the drafting rules, or the prohibition on earbuds, or the limits on wetsuits. By that extent, both McKnight and Hanes should earn bans for their behavior, health outcomes be damned.

Outside of the walls of Slowtwitch, though, and you will find shock and awe from triathletes everywhere that there are any medical treatments, including standard over-the-counter medications, banned in sport. You don’t have to go far to find people who are amazed that hormone replacement therapy is regulated because, “I get it from my doctor.” There was, for instance, Andrew Starykowicz’s ban for medication received during the course of an infection in 2020.

It would not be surprising, then, to find age group triathletes today who are using BPC-157. It would, however, be extremely surprising to find a professional in that same bucket, just given the number of organizations now testing athletes.

In my opinion, there are three distinct buckets of athletes who participate in endurance sports. You have your professional / elite license holders. These are folks who absolutely, positively should be held to the absolute strictest sense of the WADA Code. It’s the exact kind of athlete for whom the Code, and by extension, all of the anti-doping organizations were created for, coming out of the Festina Affair at the 1998 Tour de France. WADA was born directly from that case — to snuff out doping at the highest levels of sport.

Then there are your competitive age-group athletes. These are people who might be winning their local road races, or earning IRONMAN World Championship slots. They, too, are competing on an international or national level. Some may be on the pathway to professional or elite status. This is where we have argued in the past that more efforts need to be spent by race organizers on anti-doping. We’ve been pining for the return of having to opt-in to World Championship qualification pre-race, a function that was turned off in the registration process at least 15 years ago. And by checking that box, you’re agreeing to be held to the full WADA Code and more stringent enforcement across the entirety of the rulebook.

And then we have your participatory athletes — your 13 or 14 hour plus IRONMAN finishers in the deepest age groups. These are athletes who, frankly, fund a lot of our sport’s existence. And given their finishing position in races, they are also the ones most likely to take a similarly unapologetic position to that of McKnight — it helped heal me, it was medical treatment, sport consequences be damned. And there’s a real question as to whether there’s value in holding these people to the same strict standards that we do in the first two buckets.

I am somewhat sympathetic to that viewpoint. As I’ve written on these pages for the last seven years, I think we can probably recognize the difference of an athlete who is trying to compete for a Kona slot and one who is simply trying to check off their bucket list, and the level of enforcement of rules for each party; for example, I think rules on running with your family, or on drafting, can be loosened for your purely recreational athlete without ruining the integrity of the sport. But I also think that there are places, such as with experimental treatments like with BPC-157, we probably need to press pause on — at least until there’s some actual human trials that trend towards FDA approval — and keep things where they are today.

Ultimately, in this case, I err on the side of some type of ban for both athletes. McKnight, as a professional, can’t hide behind not knowing better. He has to know that he is subject to the WADA Code, and that’s the extent of it For Hanes, it’s slightly more complicated, in my opinion; he’s a bit of a victim of having such a good run in Eugene. That puts him more in that second bucket of “elite” amateur, and probably needs to be held to a higher standard.

But, in my opinion, our rulebooks need to better reflect the realities of medical care and athletic status. Professionals and elite amateurs should be held to the highest standards and restrictions on what treatments they seek out. I just don’t think that’s the right course of action for your recreational athlete. Where that line ultimately gets drawn is yet to be determined — but unapproved treatments should remain banned.

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