Sunday, 7 June 2015

Catch me if you can – the science

I haven’t been able to blog for a while, in part due to work constraints, but also due to working on my next book (Blood: A Very Short Introduction). Still the book will be finished by the end of this month and I should have more time to write soon.

Still I couldn’t resist commenting on the latest BBC documentary about doping - Mark Daly’s Catch Me If You Can. I was actually invited to talk about it last week on BBC2s Newsnight; I couldn’t make it as I was busy talking about my artificial blood research at a blood transfusion conference in Scotland (for the latest info see www.haemO2.com).

What I would like to do here is explore some of the science behind the allegations. First up, the least interesting part of the piece – the reporter taking EPO himself to see if he could fool the anti doping biological passport. I am growing to hate this aspect of science TV documentaries [1].  They all do it now (I blame Michael Mosley!) and, although I understand it is used to engage the viewer, it rarely adds anything to the science. In this case we know that microdosing is an issue with the biological passport. We also know that EPO can theoretically improve VO2 max and performance. Actually what we don’t know is whether in this particular case the EPO enhanced the performance. The reporter clearly expected the drug to work He also admitted feeling very different as soon as he took the EPO. One would expect a large placebo effect under these conditions and, as a non-elite athlete, there was a large room for improvement. Did the drug really work or was the effect all in the mind? What the documentary should really have done of course was a double blind crossover study with a placebo. In fact as a watching scientist I wanted the Swiss expert Carsten Lundby’s view, not on the passport data, but on whether he thought the EPO-induced haematocrit change was enough to trigger the measured VO2 max increase. Lundby is a world authority on the performance link between blood oxygen content and performance and it would have been really interesting to hear his opinion about this.

That said the journalistic scoops were really interesting. For me personally the most concerning were the allegations about Alan Wells, one of my childhood heroes. High dose anabolic steroids can clearly increase muscle mass and I would be genuinely saddened if his victories were in part due to steroid use.

But, of course, the most concerns have been raised about the Galen Rupp and Alberto Salazar allegations (hotly denied). Leaving aside the truth or otherwise of the stories what about the science? Well, unlike sprinting, anabolic steroids such as testosterone are not game changers in long distance running (especially in men). They have turned up occasionally, the “steroid in my toothpaste” excuse from Dieter Baumann being perhaps the most famous occasion. The most likely benefit is in training where they might aid recovery and allow for longer, more intense, sessions (although even that is not based on mostly anecdotal data). Likewise asthma therapies like oral corticosteroids. They can stimulate activity, but in some cases could actually be detrimental to performance. Similarly pre race IV drips should not be required for a healthy athlete.

My conclusion, albeit on a one off viewing of a one-hour TV program, is that what was exposed, even if true, was not what led to Galen Rupp’s strong performances. If he got his medals by cheating there was most likely something else going on. What the documentary did expose was a culture that might not have been averse to using a scientific approach to doping methods (and detection prevention) that really could make a significant difference in long distance running events. These include EPO and blood transfusions. That’s what Mo Farah needs to find out when he returns to America to meet with Salazar.


[1] Hypocrite alert – I have just taken part in a Channel 4 documentary where this is done. However, at least this means I can talk with authority about its limitations!

Monday, 9 March 2015

Changes to blog

Dear readers,

I have chosen to make some changes to this blog:

1           I have instigated a rolling program of deleting older blogs. The blog is not meant as a formal reference site and this is to ensure that the information in the blog remains up to date


2       I have unfortunately had to prevent user comments by external users. Whilst some were really interesting they are outnumbered over 20:1 by comments solely sent with the purpose of redirecting readers to the commenter’s web pages. The vast majority of these are commercial pages selling products (such as peptides). These were taking too much of my time to filter out.

Wednesday, 30 July 2014

GW501516: Update on endurobol and doping: some thoughts about dosing

In a previous blog [1], I noted that there was no evidence in animals that endurobol improved performance in animals. I must apologise as I missed a rather important paper from Ron Evans group in 2008 that showed just that. The performance effect was only seen if the mice were also doing exercise training [2].

What is interesting is the doses that were used in this study. The four-week program of exercise training was paired with 5 mg/kg/day of the drug. This is at the low range of the long-term (2 year) toxicity study done by Glaxo [3], which varied from 0 – 80 mg/kg/day. But some adverse effects were still seen at the 5mg/kg/day level.

Interestingly one anonymous commentator on my previous blog said that he/she knew people who have been using it at a dosage of 10 mg per day for fat loss purposes and 20 mg per day for a performance enhancing benefit. Indeed some companies are selling pills of 5 mg size [4]. However, these doses are far lower than are shown to work in the Evans paper (for an average 85 kg human, the “Evans” dose should be 425 mg/day  - or three full bottles every day of the pills that some manufacturers are selling.

The usual caveats apply. There are long-term toxicity effects of this compound and it is generally easier to show performance effects in laboratory rats and mice than highly fit trained athletes.

  1.  http://runswimthrowcheat.blogspot.co.uk/2014/02/gw501516-endurobol-and-doping-whats-all.htm
  2.  Narkar VA, Downes M, Yu RT et al (2008) AMPK and PPARdelta agonists are exercise mimetics. Cell 134:405-415.
  3.   Toxicological Sciences Volume 108, Number 1, March 2009 Abstracts # 895 and 896    
  4. http://www.sarms-supply.com/gw501516-c-95.html



Sunday, 13 July 2014

Doping at the football world cup?

With today’s final imminent it is worth asking what, if any, role doping played in the World Cup? It is true that football teams today are required to be much fitter than before; it is unlikely that even some of the great teams of the past would have performed optimally in the last 30 minutes of a modern match. However, the endurance levels required for the footballers of today still require little more than a sensible diet and a lot of hard work in the gym or training field (although it has to be said even this does seem beyond some players).

Unlike athletics or cycling, In terms of performance enhancement it is difficult to make dramatic changes in skills-based team sports performance by chemical enhancement. It is theoretically possible that “cognitive enhancers” might make a player more alert, even when tired, such that they find that critical defence splitting pass. But I suspect any change would be small, and there is no evidence that teams are attempting to use this route.

Where there is more concern in drugs that are “performance enabling” i.e. that make a player play in a match that they would otherwise not be able to. Painkillers fall into a ‘doping grey-zone’ [1] because there is an obvious need to treat an athlete if they’re injured but they can also be used to shorten the recovery time needed if given in high enough doses. Non-steroidal anti-inflammatories (NSAIDs) in particular have been shown to effectively decrease pain and improve early muscle recovery [2]. Footballers in particular might tend towards painkillers before and during games as it may allow them to both get back on the pitch sooner after an injury and reduce the severity of any injury that may occur [3].

Whilst their use post match to treat an injury is an accepted exercise, what happens when an athlete takes them before playing? Here we do have evidence from the football world cup. FIFA’s chief medical officer, Dr Jiri Dorvak, published a paper looking into the use of medication during the 2010 World Cup [3,4]. He asked team physicians to provide them with details of all of the medications each player took ahead of the games. His study showed that 39% of players took a painkiller in the 72 hours before every game they played in [4] and that overall painkiller use was increasing year on year. This study accounted for the number of players taking prescribed medication; due to the easy availability of painkillers it is likely that the true number is much higher.

Dr Dorvak believes that one of the factors that has resulted in this rise is the increasing pressure put on team doctors by managers and sponsors to get players fit and healthy again [3]; with the incredibly high potential earnings of top international players it is also unsurprising that the players themselves want to make sure they keep hold of the job or shine in a match that could get them their next big transfer. And who would want to miss a World Cup Final if at all possible?

Another issue that arose from the study was the likelihood of further increase in painkiller use in youth teams, with 16-19% of under-17 football players abusing them [3]. Due to the sometimes severe effects that painkillers (NSAIDs in particular) can have on the kidneys and liver, it is a worrying sign that consumption at this level is seen at a young age.

As I say in my book [5], we have been here before, and not just in football. Peter Elliott won a silver medal for Britain in the 1988 Olympic 800m; but only after receiving five cortisone injections in seven days. Hailed by many at the time (including me) as an example of bravery, some were critical of the methods employed.

It is no doubt that injecting an athlete with a range of drugs can aid recovery and enable them to compete at an enhanced level than they would have been able to without the drug. In many cases this is at the cost of possible future injury or disability. So, as far as the individual themselves is concerned, this is not much different from risking long-term health damage by using a banned performance enhancing drug. And we know this is not a deterrent for many dopers. The difference, if there is one, is that the level reached is not “superhuman” i.e. it could be reached without doping if someone could avoid injury.

I think in this area the medical care of an athlete is paramount. It is surely the responsibility of the athlete’s doctor to advice on the health benefits or damage of any treatment. This is yet another reason why advocates of “clean sport” needs to focus as much on coaches and support team (including medical staff) as the athletes themselves.

[I would like to thank Jess Pritchard, a student at the University of Leicester in the UK, for doing some of the original research on this story and writing a preliminary draft. However, as always all the comments expressed in this blog are my own and not those of Jess, my publisher or my university].

References





Friday, 20 June 2014

Sergio Henao, Team SKY and the biological passport

On Sunday June 29, I will be attending at Oxygen Transport meeting at UCL in London where some of the top experts on altitude physiology will be presenting – including Monty Mythen, Carsten Lundby, Peter Wagner and Ron Astin. And Harriet Tuckey will talk about the use of oxygen on the 1953 Everest Expedition. There is still time to register:


but if you can’t make it you can read the abstracts here (a search for altitude in the text is particularly illuminating).


I was going to write a blog prior to this meeting on the science of the Sergio Henao affair, but then one of those ironman / cycling web pages  - decaironman.com - got there first. Honestly, sometimes I think cyclists spend as much time reading research papers as scientists – they are definitely better informed that the average sportsperson.

http://decaironman-training.com/2014/03/19/the-challenge-of-monitoring-altitude-natives-in-professional-cycling/

Anyway the particular Henao story seems to have been resolved now I guess. See:


I was slightly confused by Dave Brailsford’s initial comments that there was something mysterious about red blood cells, Andeans and altitude and they need to carry put further research. They – and their contrast with Tibetans – are the two most studied research populations in altitude science. Basically Andeans have high hematocrits (number of red blood cells) to cope with the altitude. Leaves them with lots of clinical problems. The Tibetans (e.g. the Sherpas) can manage with fewer red cells, but have other adaptations.

The really interesting new finding from Peter Wagner seems to be that those Tibetans with naturally fewer red blood cells are able to reach a higher oxygen consumption peak that those with more red blood cells. Sometimes science does indeed throw you a curve ball.

Now what could be really scary would be to take a Sherpa cyclist who was adapted to altitude performance and then give them EPO to increase their red cell count. My feeling is that Sherpas - like Lance Armstrong? – would be the genetic type that could disproportionality benefit from blood doping


**note the paragraph above is only a scientific thought experiment of course ! *****