Saturday, May 21, 2011

Doping - What Would My Blood Profile Look Like?

What would my blood profile look like?

It's a question I hadn't thought of until recently. The blood passport thing that the UCI maintains for each professional rider is a bit out of my regular world. I'm not a pro, I don't do well in races that require any substantial fitness, and I've never been asked to pee in a cup after a race. Or had someone wake me up to take blood some random morning.

To me the passport thing was something a bit arcane, not really real, just some concept that pros have to deal with so they can race.

A little while back someone leaked a UCI list of riders (specifically those in the 2010 Tour de France). The UCI ranked the riders by just how suspicious their blood profiles appeared based on the changes in various parameters. The UCI noted a few of the things that changed a rider's ranking, but they didn't explain it in any detail.

Basically any weird changes to the blood profile, especially those that seem like targeted changes (boosts in races for performance, declines in training when extracting blood, declines over the year because they eased on the doping), make your profile jump up and shout, "Me! Me! Me!"

It's like deducting $10,000,000 in losses when you have $1,000 in income on your taxes. The IRS gets really interested in you real fast.

With even a hint of what the UCI is looking for, the passport thing became more real to me - I could relate to it a bit now.

And that got me thinking - "What would my blood profile look like?"

Let's take a hypothetical doper named Iam Doper.

Doper will follow what I think would be a sensible doping program. There'd be three phases to the whole thing.

First, in the off season, Doper would be extracting blood pretty regularly. This blood would be stored for much of the season, re-injected into Doper's bloodstream at "critical" points of the season - big climbing stages, time trials, or, if Doper was a sprinter, maybe for critical sprint stages.

Doper would try and keep the immature red blood cell count a bit consistent by waiting some amount of time between extractions. I don't know the science with cell life cycles but let's say that it takes 7-10 days for the ratio of immature:mature red blood cells to stabilize to some acceptable number. Doper would extract blood based on that schedule so the blood profile of the blood extracted would look right.

It's possible that extracting a small amount of blood daily would do the same trick. Whatever the scenario, this would be phase one.

Second, Doper would be microdosing EPO and maybe some drugs for recovery like testosterone and HGH. By microdosing, i.e. taking very small quantities regularly, the drugs will raise Doper's blood parameters to a slightly higher level, but since it's regular, the blood parameters appear consistent, i.e. "natural". The biological profile would appear to be that Doper is one of those higher hematocrit/testosterone racers, not of someone taking drugs.

By setting a higher bar to start with, Doper gives himself leeway for blood manipulation. Any drops could be explained by fatigue and the like. With a higher-than-normal baseline, though, Doper can consistently boost blood parameters and hopefully performance.

Third, Doper would carefully plan re-injection schedules. Doper should have an idea on how his blood would respond to various training and racing stresses, and therefore can figure out a way to stabilize the expected declines. A really careful approach would include allowing the numbers to drop off just a bit over the course of a hard block of riding - like a Grand Tour for example.

Fourth (I know I just said there'd be three phases, but bear with me), there'd be the stuff I don't know about. I don't know if riders who re-inject blood also inject saline solution to thin out the blood. I don't know if there are other ways of "normalizing" blood parameters. There may be other drugs available to aid recovery, mask EPO/testosterone use, boost this number or that value or whatever. I don't know what I don't know so I can't include this in Doper's phases. I am guessing that there'd be a fourth or fifth phase to a doping calender, I just don't know what it would be.

Let's contrast Doper's schedule to his erstwhile counterpart, Iam Clean.

Mr. Clean, contrary to Doper's very detailed annual plan, races a bit more by the seat of his pants. His season breaks out into three phases too, although they differ a bit in emphasis.

First, he does a lot of off-season preparation. This includes some long rides, rest, and getting any changes to the bike squared away. Powermeter, heartrate, yada yada yada. Compared to the medical level treatment of Doper, Clean simply monitors training and its effect on his body. He cannot manipulate his body directly, not in a fitness sense.

Second, he starts his "race to train" phase, starting racing for the season and doing speedwork otherwise. He'll return to this phase whenever not peaking for a race.

Third, he'll hit a few peaks, maybe three or four for an amateur, perhaps three for a pro. They'll target important (to Clean) races, which may or may not coincide with races the world considers important. Each peak gets preceded and followed by a slight break or easing in intensity, the former to build reserves, the latter to recover a bit.

During those phases diet may change a bit. Clean may emphasize more proteins and carbs during the harder training phases. I know that red meat really helps boost various blood parameters relating to iron levels. Clean may also take some vitamins (say a multi) and mineral supplements (iron, calcium, stuff like that), depending on either a set schedule, or, if taken less regularly, based perhaps on how Clean has been feeling for the past few days, or maybe with an eye towards a particularly hard block of training.

Although Clean may have a physical at some point during the season, that's the only expected blood work planned for the season.

In other words, Mr. Clean is flying blind as far as his blood profile goes.

I thought of something relating to this idea.

I wondered out loud what my profile would be, what would the UCI think of my blood parameters.

I've gotten perhaps 4 or 5 physicals in the past 6 or 7 years. I also got blood drawn for various purposes a few times over the course of just a few weeks.

Each time I had blood drawn I asked to get a copy of my blood profile. I don't know what everything means, but I looked at the stuff that the doping articles mention - hematocrit (HCT, % of blood which is red blood cells) mainly, with a glance at the iron levels. I also look for anything that's out of normal range, since pretty much everything on my blood profile is within normal limits.

I know that I've hit as high as 49.3% HCT. In the blood tests done over the course of a few weeks (I had different people give me physicals), my HCT level varied by a good few points.

I'm not a dietician but I think I may have affected the blood profiles simply through my diet. When I hit my record 49.3% HCT, I had just finished a huge pack (Costco huge) of really high quality ground steak beef patties. My sister-in-law asked if I wanted a pack, and since I hadn't been eating a lot of red meat just before, I figured, what the heck, it'll be good to have. I don't know how big it was but I'm guessing it was about 10 pounds of ground beef.

I ate it in about five days.

Then went to get my blood drawn.

I happened to spike my cholesterol up too, so I'm thinking that the beef affected my blood parameters. When I had another physical done (my primary physician changed or something), my blood parameters for HCT and cholesterol both dropped. Prior to that physical I hadn't done a week of my "ground beef diet".

But say it was the UCI who tested the blood. What would they think of my Costco Ground Beef HCT Boost? Would that result in an uptick in my rating?

I don't know what my blood profile looks like during the season - I try and avoid physicals (more specifically the needles and normal bruising and pain that occurs during needle use) when I'm riding regularly.

A rider who doesn't dope and is in pretty good shape (i.e. not always overly fatigued and whatnot) probably doesn't get blood drawn all that often.

However a well supported Doper would get blood drawn all the time - he'd want to make sure things looked okay. That's where the interesting dilemma pops up.

What if Doper carefully manipulated his blood parameters to fit the expected average, and therefore had a perfect plain-Jane profile?

And what if Clean inadvertently screwed his up by eating, say, hamburgers three times a day for 5 days? These spikes in HCT could indicate illicit doping, unsophisticated EPO use for example.

Or it could mean that someone gave my Two Pounds Of Ground Beef A Day Diet a try.

I'm sure you've been in a situation where you're driving normally on the highway, 5-10 mph over the limit. (5-10 over is good - at a town meeting a DOT person told us that speed limits are set a bit low for normal conditions and that they expect people to drive faster than the posted limit most of the time.)

Let's say you're passing a slightly slower car. You speed up just a bit, maybe close to that +10 mph threshold. You look in your mirror and see someone approaching at a rapid pace.

A really rapid pace.

They're going well over 100 mph, slowing as they approach your 75 mph bumper.

You goose the gas pedal, get around the car, and move over to the right lane.

The other car doesn't go by. Instead, it sits about where it was, 50 yards behind you.

Unbeknown to you, that driver has a sophisticated and expensive radar/laser detector and jamming system. And just when you goosed the go pedal in your car, his detector started blaring at him.

He braked firmly, slowing within seconds to under 75 mph, his detector hitting the "Jam Now!" switch automatically and sending a bit of fuzz through the airwaves.

And then you pass a State Trooper on the shoulder.

You're out there trying to get out of his way going 82 mph, a beautiful reflective car for the trooper's radar/laser gun.

That would totally suck, right?

You were following the principle of the law, that of driving about the same speed as traffic (no more than 15% difference in speed - that's the safest range of speed, and in a 65 mph zone, that's about 10 over for the high mark), going just over the speed limit, just like the DOT thinks is appropriate.

The other driver is driving, by definition, recklessly, exceeding the speed limit substantially. Because they know they'll be breaking the principle of the law, they also prepared a bit of possibly illegal defense. Perhaps they spent some money on a radar/laser detector. A more serious effort would involve an illegal radar/laser jammer.

The most sophisticated speeding setup I've read about is the setup a guy used to try to drive across the US in record time. Just to give you an idea of the goal, when he set off for the cross-country drive, the record stood at 32 hours and 7 minutes.

Using public roads.

The car's setup included all sorts of stuff, some of it stuff I'd thought of too, some of it just crazy.

I'll leave you to read the article since I found it fascinating.

But you'll see my point.

In such a (hypothetical for the doping bit) scenario, it's possible the clean riders look dirty and the dirty riders look clean.

Fine, if an M5 goes blasting by you at 160 mph, yeah, that doesn't look right. But if he's equipped to the nines to avoid getting a ticket, then he's beat the system.

A naive and innocent rider could pedal into disaster by inadvertently changing his blood profile, while the hardened doper could skate by the controls by carefully manipulating his numbers.

So, the question remains.

What would my blood profile look like?


Apparently I didn't understand a lot of what happens with blood. Here are a bunch of corrections. The take-away? The blood passport, if used extensively, can and should discourage all common of blood manipulation techniques.Link


Kokorozashi said...

...Catching up again on your excellent blog.

A similar question has wandered through my mind from time to time. I take albuterol for asthma. Like clenbuterol, it increases fat metabolism and also acts as a stimulant and bronchodilator.

During the non-winter months (also known as 'racing season), when my asthma is at its worse due to its allergic origins, I take albuterol as a precaution before I undertake any serious athletic event -- including hard rides, including races. I do so because it seems smarter just to take it and head potential asthma attacks off at the pass -- used that way, it's much more effective than when it's used in reaction to an attack that's already in progress.

The thing is, I sometimes wonder if it's entirely fair. There's always a possibility that I could have an attack during a ride, but I've also forgotten my pre-exercise dose on occasion and ridden hard with no obvious symptoms. Likewise, I generally skip it once it starts to get cold (around here, that can be anywhere between November and January -- so during early in 'cross season, I'm usually still hitting the inhaler prior to riding).

Here's where it gets sticky, ethically: if I'm riding a race wherein (unbeknownst to me) I wouldn't have had an attack anyway, am I -- in essence -- giving myself an unfair advantage? Does the fact that, under other circumstances, my asthma can be a crippling handicap outweigh that advantage?

To complicate things even more, because of the chronic nature of the condition, my body has had to adapt to getting by on less oxygen -- which is kind of what one hopes to achieve through high-altitude training. Essentially, means that when my asthma is really, really under control, I possess something of an advantage even before I take the albuterol.

I seem to recall that this issue has troubled the Olympics folks from time to time, and I'm sure it's been an issue in other sports.

Fortunately, so far, I've ridden exactly one race -- a cyclocross race last fall -- and all I can say for that one is that I finished, which was all I wanted :)

However, as I prepare for this year's 'cross season, and for road-racing next year, part of me does worry about it. One of the things I respect most about my fellow cyclists is our wide-spread respect for good sportsmanship and fair play. I don't like knowing that I might not, in fact, really be playing fair -- but I also don't want to only race between December and March!

I guess, ethically, it wouldn't be great either to not take my medicine, have an attack, and die in the middle of a race -- but that doesn't really make the question any easier for me ... especially since I know that I can sometimes ride hard without albuterol without any trouble.

Where do we draw the line, these days, between medical necessity and unfair advantage?

Sorry this is so long, by the way. As you can probably tell, this has been on my mind a fair bit of late, and your post sort of made it all 'gel.'

Aki said...

K - I appreciate your thoughts and thinking things out in font. I think, though, that what you're dealing with is not doping in the sense of cheating. I think allowing your body to perform in a normal sense is not doping.

An anemic person should take EPO or iron or something so that they get their blood values back in line. Yes, someone could take a bit extra. My mom's HCT dropped to something extremely low during chemo, like 30-something. The docs gave her EPO and it jumped up into the mid-40s. Then they stopped, and that's key. If they'd kept going, to get her HCT up to, say, 55, that would be doping.

It's a tough question - for example, Petacchi tested positive for an inhaler because he exceeded the err "regular dose", i.e. it appeared he took a lot of it. Bugno tested positive for caffeine - he took enough that it was the equivalent of drinking 20 cups of coffee or something. And in the 80s everyone (ok, not Lemond) seemed to have tested positive for pseudoephedrine.

But I think that in principle, because you're thinking about your medicine, conscious as to its effects, and not intentionally overdoing it, you're okay.

Of course I'm not an anti-doping official but that'd be my stance. For example it makes sense to have let Vaughters take cortisone for his bee sting without forcing him to drop out of the Tour.

Aki said...

I forgot to add, I have corrections to make to my post in general.

Kokorozashi said...

That's good to hear -- I try to think of it that way, and to keep reminding myself that an occasional advantage (even with which I'll probably still be only mediocre) is probably better than literally dying in the middle of a race :)

Also: "Bugno tested positive for caffeine - he took enough that it was the equivalent of drinking 20 cups of coffee or something."

I think it's interesting that they do test for caffeine on that level. I was talking with a guy at a BBQ about that very topic on memorial day.

As for Bugno -- he must have intestines of steel (or maybe titanium, steel intestines might be a bit heavy)! If I had that much caffeine, I would only be able to race for one thing -- the men's room! :D

Kokorozashi said...

PS - I look forward to your updates, and I'm glad to know they won't make you drop out of a race if you need to use something like cortisone for an allergic reaction. I am allergic to, like, everything :D