blood doping, another PED

Wednesday, December 14, 2016

Erythropoietin (EPO) is a great drug for people who have chronic anemia (low red blood cell count) because of chronic disease. It stimulates the bone marrow to produce red blood cells and is useful for those with chronic kidney disease including those on dialysis, cancer, chemotherapy and inflammatory bowel disease. For the most part, these are the only people who should be taking this medication. But  don’t tell that to endurance athletes who want the benefit of extra oxygen carrying capacity in their bloodstream. Blood doping is not legal, it acts like a performance enhancing drug and has life threatening complications.

Erythropoietin is manufactured within the kidney and is very sensitive to the body’s environment.  Receptors can judge the amount of red blood cells within the bloodstream and if there aren’t enough, the level of EPO rises and causes the bone marrow to manufacture more red cells. Red cells contain hemoglobin, the molecule that attaches to oxygen in the lung and delivers it all the organs and tissues in the body, including muscles. Muscles need oxygen and glucose to function aerobically and get maximum performance. The more oxygen that can be delivered, potentially the longer the muscle can contract and the further and faster an athlete can run.

EPO is very sensitive to the body’s hypoxic (hypo=less +oxic=oxygen) stress, meaning that if oxygen concentrations in the bloodstream decrease, even over a short period of time, EPO concentrations increase, more red blood cells are manufactured and the concentration in the bloodstream increases. More hemoglobin presumably means more oxygen deliver and the hypoxic stress is relieved.

Patients with kidney disease, or those who become anemic from cancer or chemotherapy, cannot generate enough natural EPO to stimulate the bone marrow. Fortunately, over the past generation, pharmaceutically created EPO can be injected to help treat anemia and allow a better quality of life. More red cells allow the patient to be able to not feel constantly short of breath or weak.

Now imagine an endurance athlete who would like the benefit of 5 or 10% more red blood cells and oxygen carrying capacity in the blood. Not only would the length of activity be increased for training but so would the speed. The Olympic motto “faster, higher, stronger” “citius, altius, fortius” was meant to be achieved by perseverance and training, not necessarily living better by chemistry. Injecting erythropoietin or its cousin, the long acting darbypoietin would be a short cut to the hours spent training. It comes with a cost and that is the increased risk of stroke and heart attack. Too many red blood cells can cause blood to sludge and not flow easily through the narrow blood vessels in the body…arterioles, venules and capillaries.

EPO was a chemical way to enhance the body. Old school blood doping used more crude methods. An athlete would donate a unit of blood (about 500cc or a pint) a month or more before a competition and store it. Red blood cells have a shelf life of about 90 days if cared for properly and during that time, the body would gradually replace the lost blood. Just before the event, the blood would be transfused back into the athlete and voila…more oxygen carrying hemoglobin magically available to help performance. Same risks as EPO for heart attack and stroke.

The body’s naturally occurring EPO has a different chemical signature than artificial EPO, so testing has caught up can tell the difference proving who has been less than nice should they inject the drug.

There are legal ways to blood dope, if you have enough money. At altitude, the air contains less oxygen than it does at sea level. The body’s receptors recognize this oxygen deficiency causing EPO levels to rise and force the bone marrow to create more red blood cells to compensate for fewer oxygen molecules available with each breath. Unfortunately, training at altitude is less efficient than training at sea level, so the athlete needs to sleep at higher altitudes and train lower down. This is expensive and more than a little inconvenient. Nike developed a high-tech solution called Project Oregon. The company built a tightly sealed house in Portland where filters could decrease oxygen in the air inside to a level found at 12,000 feet. Athletes sleep at altitude and walk out the door to train at sea level. Nice if you can afford it.

There are opportunities to bend the rules. Blood doping is not legal and is potentially life threatening, however your body can be tricked into doing it legally by the letter of the rule, not necessarily by the intent. It has been a long time since the concept of a level playing field for all actually mattered.


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the why of performance enhancing drugs

Monday, December 12, 2016

Every week seems to bring another player suspension by the NFL for the use of performance enhancing drugs. The frequency numbs us to the issue and unfairly, we may even suspect players who are clean and free of abuse. For that reason, the depth and breadth of the Russian doping allegations, should make us stand up and wonder what’s wrong with the state of sport. The report from the World Anti-Doping Agency provided evidence of more than a thousand international athletes who benefitted from illegal drugs or tainted testing processes as part of a governmentally run and approved program to have athletes cheat to reach the podium.

Depending upon the sport and the goal, there are a couple basic goals for doping. Anabolic steroids and human growth hormone (HGH) may allow the athlete to train harder recover more quickly, leading to muscle cell hypertrophy and increased strength. Blood doping, either by using erythropoietin (EPO) or by blood transfusion, allows increased oxygen deliver to the body prolonging the ability for muscles to work aerobically.

There is a cat and mouse chemistry battle between the athlete who dopes and the regulatory agencies that try to keep sports clean. The BALCO controversy revealed that anabolic steroid use can be successfully masked from testing but the 2002 Salt Lake Olympic testers were able to uncover the use of darbypoietin, a long acting EPO that had just been released on the market. Presumably, the athlete’s chemist may have a little time advantage initially, but the monitoring agencies catch up quickly. The question though, is why would an individual athlete want to cheat? It’s all about work ethic and philosophy.

Consider this one way of grouping athletes:

  • Group one has innate talent and work hard to maximize their potential
  • Group two does not have elite talent but does work hard to maximize potential
  • Group three has innate talent but lacks the motivation to work
  • Group four has neither talent nor motivation.

Group one athletes will generally succeed but should injury occur, fear of not returning to pre-injury levels might allow a pharmaceutical option to be a tempting proposition. Group three athletes might consider using drugs to substitute for work in the weight room to improve their performance the field.

The use of performance enhancing drugs might allow an athlete to leapfrog from one group to another. The rewards can be impressive and may mean the difference between playing varsity in high school as a showcase for getting a college scholarship. It may allow the college athlete to make a pro roster or an athlete to move from the B team to the Olympic squad. For a country to develop a system wide approach to performance enhancing drug abuse, it seems to make competition on the playing field a proxy for conflict on the battlefield. Based on the WADA report, the Russians were determined to assault the Olympic podium.

Interestingly, there are ways to artificially enhance performance that are quite legal. What is acceptable and what is cheating usually has to do with safety. Imagine a baseball player who can improve his vision by LASIK surgery to 20/15 and can then see the ball that much better than with glasses. Fans would cheer his dedication to his sport to undergo surgery to improve performance.

It gets complicated though. That same thinking to get LASIK surgery would be acceptable for an archer or a trap shooter.  If those two athletes would use a beta blocker, a common medication that blocks the effects of adrenaline in the body, slowing the heart rate and perhaps steadying a shaky hand, it would be considered doping. However, if that athlete had high blood pressure (hypertension) and was prescribed the beta blocker, a medical waiver might be issued.

It’s all about trust. Each competitor trains hard and hopes that their best is better than their opponent and as long as the playing field is level, may the better player win. It’s nice in theory but only works when everybody plays fair. One might argue that we should allow athletes to compete better by chemistry. The “only” downside are the complications of that chemistry, including but not limited to issues like cancer, stroke and death.

The next column talks about blood doping. Stay tuned.



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