How are blood loading and EPO handled by the athletic federations and organizations that monitor drug use in their sports?

It is very difficult to test for EPO and blood loading, even with a blood test. Most sports related testing consists of urine testing. Testing urine is an almost impossible way to reliably detect blood loading or EPO use. The approach taken by some of the cycling federations has been to check hematocrits before the race, and forbid anyone from starting who has a hematocrit over 50%. The rationale is that someone with a higher hematocrit, even if for genetic reasons, would be at some greater risk of sudden death. The underlying thought might be that this number is so uncommonly high that it would only catch blood loaders and EPO users. Some of the competitors contend that they do, in fact, naturally run hematocrits that high and that they are unjustly punished for one component of their talent. Such issues that are, in truth, completely valid make this a difficult area to regulate.

My Favorite Quote!

My favorite quote about this entire subject comes from Jonathon Vaughters, an American who raced in Europe for three seasons.

“With the levels set at 50, that means that some riders can still use it and get a little benefit, but it isn’t like it was before when there were guys up in the 59’s. When you use it like that, it’s like turning a four-cylinder engine into an eight-cylinder engine.” VeloNews 6/30/97.


My Favorite Rumor!

This is the drug that is primarily responsible for the incredible success of the Chinese women distance runners (Though their swimmers are known to use Human Growth Hormone).

Public Knowledge!

Some of the Scandinavian distance running champions have admitted to blood loading during the heyday of their distance running success. Some members of the 1984 US Olympic Cycling Team have admitted to blood loading.
The Festina Team was thrown out of the Tour de France this year for the planned use of multiple performance enhancing drugs including EPO.

What is the bottom line on EPO and blood loading from the perspective of a Sportsmedicine and Emergency Medicine Physician?

This is a very effective performance enhancing method that may have effectiveness over a wide range of distances and durations-in running from a quarter mile to an ultramarathon. It is also effective in many other sports.

With close monitoring and conservative usage it is fairly safe, but a mistake can kill you. Or even if you don’t make a mistake, you might be an individual that responds more easily to the drug. Or you might be one of those people who clot more easily by an accident of metabolism.

As a practicing physician in this country you would be crazy to prescribe EPO to an athlete to improve performance. If your patient had sudden death or any other major problem you would stand a good chance of being sued for malpractice. However, the situation is different in some other countries. In these countries the incidence of malpractice suits is much less than ours; also, the individual athlete may be allowed to make his or her own personal decision and then is expected to face any adverse consequences without resulting to litigation.

What are the training lessons from this information for the competitive athlete who does not blood load or take EPO?

The first is living at altitude and perhaps training at altitude. The lower amount of oxygen available at altitude stimulates your body to make additional red blood cells. This will not raise your hematocrit and blood volume like EPO and Blood Loading but it can be helpful. The mainstream sports medicine consensus seems to be sleep high and train low. The rationale is that sleeping at altitude will give you your higher blood count, but that you will only be able to do the necessary quality in your training at altitudes closer to sea level. In other words you can’t run your repeat halves at the pace you need for a time goal in a race. My feeling is that this is not true for the vast majority of competitive endurance athletes and that most would benefit from altitude training. You have to work your heart and lungs and willpower harder at altitude than at sea level to run the same pace. And despite the intensity of the effort you’re putting less biomechanical stress on the muscles and decreasing the potential for injury.

Heat training is another technique that allows the athlete to reap some of the benefits of blood loading or EPO use. When an athlete heat trains by purposefully overdressing or by seeking a hot training environment, he or she will tend to alternately dehydrate and then rehydrate. There is a normal tendency for athletes to fail to rehydrate rapidly after their training. And most athletes will fall behind on their fluid intake during warm weather training. The body reads this dehydration as a shortage of circulating blood volume in the body and as a water shortage in the blood. Its response to this is to make more plasma proteins and these plasma proteins draw water into the blood vessels. You get more plasma increase than red blood cell mass intake with heat training, but this will still help your performance.

The third lesson to learn from this information is that there may be a training advantage to be gained by donating blood without blood loading later. Why is this? Since blood supply is one determinant of athletic performance, exercising while anemic puts additional stress on the body. Compensatory adaptations in other systems (lungs, muscle cellular level, and capillary formation) persist after the body has made new blood to replace the donated blood. A ball park figure for this would be 3-4 weeks. Then for a week or two the body would “believe” it was blood loaded. To my knowledge this has not been proven, but there are anecdotal reports from participants in blood loading studies. I would recommend donating blood at the local blood bank 4 weeks before the event you were pointing for, and make sure that you eat properly and take the appropriate blood building supplements during this recovery period. You would not modify your training except to anticipate slower times for your timed runs and intervals. The main caution is for women runners to ensure that they are not already borderline anemic or iron deficient. The best way to check for iron deficiency is to measure serum ferritin-the best measure of your body’s iron stores.

Dr. James (Mac) Larson, M.D. is a San Diego-based physician.