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 rules for cheating

Monday, January 21, 2013

Lance cheated. Deep in our hearts we knew it, but until the words came out of his mouth, there was a glimmer of hope that he still could be our hero. Now he has fallen, admitting that he blood doped, used steroids and EPO and exhibited disdain to those around him, friend and foe both. The problem, however, is that sports is always filled with cheating, with some acts that the public accepts as part of the game. The distinction between what is ethically acceptable and what is not, continues to be a blurred line.

Muscle cells are a factory that take raw materials, oxygen and glucose, and turn them into energy. Training increases the ability of the body to deliver oxygen to the cells and increases their size. More efficiency and more power yield better athletic performance. Increasing the number of red blood cells in the body increases the oxygen carrying capability and that’s where blood doping and erythropoietin (EPO) come in.

EPO is a naturally occurring hormone in the body that stimulates the bone marrow to produce more red cells. Used medically, it can help patients with anemia of chronic disease whose bone marrow is suppressed to have more energy and increase daily function. But, inject it into an elite athlete and the extra oxygen increases their aerobic capacity. If the cell factory runs out of oxygen, it turns to anaerobic metabolism whose waste products shut down the ability to perform. The risk? Too many red cells can cause blood to sludge and clot in arteries and veins, causing bad things like stroke and heart attack.

Blood doping has the same end result as EPO. In effect, the athlete donates a unit (about a pint) or two of blood to himself. The blood can be stored for a month or two while the body replenishes it and just before competition, the save blood is transfused back into the athlete, increasing the red blood cell count and the oxygen delivery capacity. The risk? The same as EPO, blood clots and potential death.

Blood doping and EPO are illegal acts…cheating. But if money is no object, the same end result can be achieved quite legally. Runners who train at altitude, about 6000 feet above sea level can see an increase in their erythropoietin level. This is the body adapting to low oxygen concentrations. But intense training is difficult at altitude and performance increased but not to a great extent. However, if an athlete could sleep at altitude and train at sea level, the effect on performance could be much more dramatic. This the development of hypoxic tents (hypo=low  + oxic= oxygen), where an athlete could sleep and lounge for hours on end and then step outside and train at sea level. Erythropoietin increases in the body as do red blood cell counts and oxygen carrying capacity. It’s a perfectly legal strategy and accepted by WADA, the World Anti-Doping Agency because of its safety record.

As research improves the capabilities of training to safely enhance performance, the line between cheating and legal will continue to blur. Imagine being able to see a baseball or a tennis ball with vision better than 20/20. Will that extra split second help turn a ground out into a hit or a backhand in the net into a winner? Lasik surgery is an accepted procedure and unlikely to be considered an unethical performance enhancing operation. Oscar Pistorius, a double amputee, used Cheetah carbon fiber blades to run in the Olympics. His accomplishments were amazing as he overcame too many obstacles to count, not the least was making certain that the blades did not provide him a mechanical advantage over his non-amputee competitors. How long though before technology does create the advantage and then what?

An Olympic gold, a Super Bowl championship or a World Series ring demands years of sacrifice and training. The seduction of fame and riches often causes those with those aspirations to make unethical decisions. As much as the public adores a champion, it loathes somebody who cheats, but one person’s cheater is another’s crafty veteran. Throwing a spitball and not getting caught might get you into the baseball hall of fame, but as seen in the latest writers’ vote, drugs are a nonstarter.

Repeated studies have asked athletes whether they would choose use steroids and die early or win an Olympic medal, and the temptation of gold wins every time. Lance cheated and then lied about cheating. Perhaps the world would have forgiven the drugs but it won’t forgive the lie.

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