EPO Doping in Today's Endurance Sports

[Perry]

This winter I went down a rabbit hole of research, and it seems very likely that EPO use has been widespread in recent years and may continue although detection has improved.

https://www.sciencedirect.com/science/a ... via%3Dihub

https://pubmed.ncbi.nlm.nih.gov/35847455/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205923/

[Zé]

Stop doping to steal Strava CR's Perry.

[Ellen]

Howdy Ze (Joe)

Stop doping to steal Strava CR's Perry.

Perry don't need no stinkin' EPO to beat Strava's current records

Miles of smiles,
Ellen

[Perry]

I wish I was fast enough to be accused of doping. Alas, I am only talented at downhill running and mid-distance climbs. I would love to have a 7% increase in VO2 max.

What's interesting about Strava is that at the highest levels, the most prestigious crowns, athletes could in theory use ITPP which is otherwise easy to detect in drug tests.

[Perry]

Some more research here. Here's a graph of detection ability of the newer EPO test. In sports that can only afford race-day testing, like trail and ultra running, an athlete can stop injecting a week before the race and pass the test. Also it's unclear in the WADA documents whether some nations can still use the older LC-MS method. There also may be a loophole for mid-distance runners if only 30% of the EPO testing is required. It's unclear to me what that means.

[Perry]

I think a fair and honest solution is to limit hematocrit to 50% while testing for plasma expanders. However athletes get to 49.9% would be their business, and somebody at 51% could either draw blood to lower it or sit out that 1 race. The obstacle to this kind of policy is that everyone would have to admit that EPO use is happening instead of continuing the lie. It's not perfect because someone could train at dangerously high levels, then lower before race day, but at least it reduces the effects of cheating. 1 big factor is when athletes are notified in advance of the tests, and we don't know how "random" they are or what corruption might happen inside the labs.

[Perry]

Another one is AICAR which stimulates production of mitochondria. No athlete has ever tested positive for it. However, it's only possible to detect within about 5 hours of a dose, and it was found in the trash at the Tour de France I think in 2009. It is very expensive, but maybe a black market operation has reduced the cost. Also, this experiment with a horse showed an enormous increase in urine concentration which raises the question of whether a lower dose combined with exercise would be effective and reduce the cost.

[Perry]

It looks like the ABP is deliberately weakened by not using proposed biomarkers that could detect more doping.
https://pubmed.ncbi.nlm.nih.gov/34626008/
https://pubmed.ncbi.nlm.nih.gov/27758046/
https://pubmed.ncbi.nlm.nih.gov/27260108/

[Perry]

Not sure why the view count went up so much. I've mostly stopped researching this, but here are some more things I discovered over the last year, in case there's still interest in this topic.

Still no update on the biological passport. I think that's been delayed until after the 2024 Paris Olympics because it would be a PR nightmare if numerous athletes got busted or if times got much slower.

In the attached images from the Cox 2021 paper, Day 56 is 2 weeks after the last EPO injection, and Day 70 is 4 weeks after. RET and IRF are currently used in the passport. After 2 weeks they start to climb back towards baseline values. CD71/B3 is the ratio of 2 proteins: one found in the newest of new red blood cells and one found in all red blood cells. This biomarker remains well below baseline even at 4 weeks after last injection which means it's better at catching dopers. Interestingly, the placebo values are a little above the baseline. Maybe this is from all the blood draws or iron supplements. Just guessing

For a clean endurance athlete to compete at the highest levels, it appears that they might have to spend 10 to 16 hours a day at simulated 3,000 to 4,000 meters depending on residence altitude and how much the individual responds with more red blood cells and how well they recover from workouts.
https://pubmed.ncbi.nlm.nih.gov/23118056/
(Large variability of individual response, but moderate residence altitude may reduce hours needed at high altitude.) This gives an advantage to athletes with time and money. Living at high altitude and training with oxygen has the same issue.

5,000 meters may be too high because of a potential reduction in training adaptation, even if workouts are performed with normal oxygen:
https://pubmed.ncbi.nlm.nih.gov/34142871/

But 5,000 meters does produce a consistent substantial response:
https://pubmed.ncbi.nlm.nih.gov/25271637/

At extreme residence altitudes it may take months for various hormones to stabilize:
https://pubmed.ncbi.nlm.nih.gov/9354184/

Alternatively, a person can inhale carbon monoxide 5 times a day to increase red blood cells. This is dangerous unless done in a controlled lab setting. But it's legal because they would have to ban smoking. Another reason to carefully-legalize EPO I think.
https://pubmed.ncbi.nlm.nih.gov/32118696/

What muddies the ethical waters even further is that there are 2 genetic mutations around Norway and Finland that increase hemoglobin to around 20 to 22 g/dL. Despite some risks, these people are allowed to compete because it's natural.
https://norwegianscitechnews.com/2018/0 ... ry-solved/

Various research also shows natives to the Andeas having higher hematocrit levels than other people living at similar altitudes (Tibetans, Ethiopians, and research subjects moving to high altitude in other papers I think).
https://academic.oup.com/icb/article/46 ... ogin=false

AICAR may be in current or recent use by pro cyclists:
https://www.cyclingweekly.com/news/raci ... ton-431194

WADA's web site has more advanced research on detecting AICAR. However, it's missing from the technical documents that describe lab procedures and threshold limits, so it's unclear to me if the testing is being done and whether there are any consequences to positive results.
https://www.wada-ama.org/en/resources/s ... ation-mass

https://www.wada-ama.org/en/resources/s ... erm-marker

https://www.wada-ama.org/en/resources/l ... ents-index
(terms "AICAR" and "AICAR ribonucleotide" missing from these documents)

Looking at scientific literature, there's some research questioning whether EPO is performance-enhancing. I believe "science" is being polluted by politics and greed. For example, here's a paper that is total garbage, shows electrical grounding speeding up wound healing. It should be retracted, yet it's still listed in PubMed about 9 years later:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378297/

That's all for now. It's a complicated world, and I wish there was more honesty and fairness.