Lance Armstrong and Blood Doping Explained

This week, Edmonton was in a cloud of yellow, and not just the from the smoke blown in from the wildfires in British Columbia. Lance Armstrong was in town to raise money for his LiveStrong Foundation and was able to take a trip to Jasper to ride through the Rockies with a group of riders (one of which was Lindsay’s physiotherapist and a member of our Medical Advisory Board!!). As any conversation about Lance, we’re gonna talk about performance enhancing substances, but not in the way you probably think. While not saying whether he did or whether he didn’t, this post will look at what blood doping actually is, how it works, and how it gets detected.

Method One: Blood Doping

The main way that muscles work is by using oxygen to create energy, and oxygen requires the red blood cells to transfer in the blood to the working muscles. The amount of red blood cells is the limiting factor in most cases to how much oxygen can be transported, and will limit the amount of work the person can do. A hormone in the body called erythropoetin (or EPO for short) causes your body to produce more red blood cells to carry more oxygen. This can be either made internally or taken through an injection in the case of dopers or those with anemia (lack of blood cells from medical treatments or disease). Another method of doping is to remove blood from the person, give it a few days to let their blood cells get replaced, and then re-inject the blood back into the person, effectively increasing the amount of blood they have and how much oxygen they can transport. Some studies on doping (here and here) showed that EPO administration can increase hemoglobin (the oxygen carrying component of red blood cells) by 12%, increase oxygen usage (VO2 max) by 12%, and decrease working heart rate at the same intensity by 10%. What this means is the difference between 1st and 15th in world competitions like cross country skiing, cycling, running, and others.

The downfall to doping is that since EPO increases red blood cells, it can make the blood thicker and more viscous. Think molasses versus chocolate milk. If the blood is thicker, it’s harder to pump through the body and can dramatically increase blood pressure as well as the risk of heart problems, strokes and blood clots.

When Lance was battling cancer, he was required to take EPO under therapeutic administration to combat the anemia caused after the chemo he was given began killing his red blood cells. Has he taken any since? Who knows…..

2. Anabolic agents

Commonly called steroids, anabolics cause the body to increase muscle synthesis, which will allow the body to produce more muscular force, faster contractions, and a lower exertion rate under the same load. Some research has shown that the muscle not only increases in size, but can actually create new muscle fibers (hyperplasia), a concept previously thought impossible with normal physiology. By having more muscle fibers and bigger muscle fibers, you can generate a hell of a lot more force. Floyd Landis was in the news recently for admitting to taking androgynous testosterone after hitting the wall on a mountain stage of the Tour de France in 2006 in order to come back and win the stage and to combat hip pain.

The downside is that these are typically going to interfere with normal function of the heart, liver, kidneys, lungs and blood vessels, as well as produce some psychological disturbances (“roid rage”). These can range from chronic abuse issues to sudden cardiac death.

The big debate with performance enhancement substances is whether they should be banned if the person is allowed to use technology to gain an advantage. No one will deny that a $15,000 bike will probably be faster than a $500 bike, much the same way a new type of clothing could make the body cooler on a hot day and help the person wearing it complete a marathon with less discomfort. Where is the line between performance enhancing banned substance and performance enhancement technological innovation? Maybe we should put all cyclists on big-wheel bikes like in the turn of the 19th century, make them all go naked, and let them all get as jacked up as they want to. That way the only thing that could be helping them win or lose would be the engine pushing the machine of the bike.

I think we should have the “Steroid Olympics” once every 5 or ten years, where everyone who has been busted using some form of performance enhancing substance can compete again and shatter a few world records. We could have some Bulgarian weight lifters clean and jerk 957 pounds in the 200 pounds weight category after taking a mixture of testosterone, growth hormone, Tylenol, Prozac, and 8-ball of coke and a couple cups of coffee.