An insight into blood doping in sport: ongoing issues in cycling

The term ‘blood doping’ is once more making headlines after the Cycling Independent Reform Commission (CIRC) released their latest report highlighting how cycling is still struggling with ‘doping’. Sports fans worldwide have heard the term repeatedly in recent years, infamously kick-started by Lance Armstrong facing allegations of blood doping ever since his seventh cycling Tour De France win in 2005 (going on to be found guilty). However, blood doping pre-dates this, with it believed to have been first used in around the 1950s. Indeed an early recollection comes before it became illegal in 1986: long distance runner Kaarlo Maaninka was transfused 2 pints of blood before winning medals in the 5,000 and 10,000 metre track races at the 1980 Moscow Olympics.

What is blood doping?

Blood Doping

The simple explanation of the method is that red blood cells are the units of transport in the body for oxygen. The oxygen is transported in the bloodstream, from the lungs to the muscles. Therefore, blood doping results in increased numbers of red blood cells and thus, more circulating oxygen at any given time, leading to increased aerobic capacity (VO2 max) and endurance – easy to see why professionals and amateurs alike could be tempted.

The methods seen in practice are transfusion and the use of erythropoietin (EPO, cycling fans will have probably heard of this). With regard to transfusion, it can be broken down into two further methods: autologous and homologous.

Autologous transfusion involves the subject’s blood, which has been removed from their own body several weeks in advance of the race, or event. The red blood cells are then separated from the fluid (plasma) component of the blood and refrigerated. They are then transfused back into the subject prior to their event. As a matter of course, removing your own red blood cells reduces you aerobic capacity and therefore decreases your capacity to train prior to an event. This is negating by homologous transfusion, in which you use another subject’s blood. However, this carries with it a risk of blood born disease transmission.

This risk led to the preferred method of blood doping becoming EPO doping. EPO is a hormone produced by the kidneys that signal red blood cell production in bone marrow. The increased activity of red blood cell stem cells allows the blood to have a greater carrying capacity for oxygen – which is great for athletes. EPO was first developed to counteract the effects of chemotherapy and radiation therapy for cancer patients. In addition to this, it plays an important role in wound healing and in the brain’s response to nerve injury, whilst also being used by doctors in treating anaemia in chronic kidney disease.

Cycling’s ongoing issue with blood doping

Lance Armstrong is the most famous athlete of all time to have been found guilty of blood doping. Infamously stripped of all seven of his Tour de France wins, he was also given a lifetime ban by the governing body of professional cycling. Despite constant denial during his career, Armstrong eventually admitted to using banned substances, including blood doping (transfusions and EPO) to Oprah Winfrey in January 2013. Perhaps as alarming is Armstrong’s explanation behind his motives to blood dope – so many professional cyclists were doping he felt he had to in order to compete. Armstrong’s use of doping was described by USADA (US Anti-Doping Agency) as “the most sophisticated, professionalised and successful doping program that sport has ever seen”.

Lance Armstrong

Prior to Armstrong’s sensational demise, it was revealed that one-third of the US cycling team at the 1984 Summer Olympics had received blood transfusions before the games – they won 9 medals, their first medal success since the 1912 Olympics. It is clear that cycling, in particular, is one sport where blood doping seriously improves performance, which is perhaps why such controversies still exist in the modern era.

The recent CIRC’s landmark report highlights some serious problems with cycling, both at an amateur and professional level. The main points were highlighted by the BBC:

  • One “respected cycling professional” believes that 90% of the peloton is still doping, another put it at 20%
  • Riders are micro-dosing, taking small but regular amounts of a banned substance, to fool the latest detection methods
  • The abuse of Therapeutic Use Exemptions, sick notes, is commonplace, with one rider saying 90% of these are used to boost performance
  • The use of weight-loss drugs, experimental medicine and powerful painkillers is widespread, leading to eating disorders, depression and even crashes
  • With doping done now on a more conservative basis, other forms of cheating are on the rise, particularly related to bikes and equipment
  • Doping in amateur cycling is endemic

Detection of blood doping

In 2004, a test for detecting homologous blood transfusion doping was implemented, known as flow cytometry. By examining markers on the surface of blood cells, the method can determine whether blood from more than one person is present in an athlete’s circulation. Flow cytometry enables scientists to distinguish the blood of subjects who had earlier received at least one unit of homologous blood.

This technique is able to detect small (<5%) populations of cells that are distinct from an individual’s own RBCs. Autologous blood doping detection is done indirectly via a carbon monoxide rebreathing technique, to measure the non-physiological increases in haemoglobin mass. This detection method is problematic for an athlete as it is not desirable to breathe in carbon monoxide shortly before a competition, which may potentially affect their performances.

In 1997, the Union Cycliste Internationale (UCI) instituted a new rule that riders testing above 50% haematocrit (volume percentage of red blood cells in the blood) were not allowed to race. Robert Millar, former racer, later wrote for Cycling News that the 50% limit was “an open invitation to dope to that level”, pointing out that normally haematocrit levels would start “around 40-42%” and drop during the course of a “grand tour”, but after EPO, they were staying at 50% for “weeks at a time”. In the 1998 Tour de France, Stuart O’Grady won one stage, held the Tour de France yellow jersey for three days, and came second in the points classification with the assistance of EPO.

In 2010, Floyd Landis admitted to using performance-enhancing drugs, including EPO, throughout his career as a professional cyclist. In 2012, the USADA released a report on its investigation into the US Postal Service cycling team and blood doping. The report contained legal statements from numerous riders on the team, including Frankie Andreu, Tyler Hamilton, George Hincapie, Floyd Landis, Levi Leipheimer and others, outlining that they, and Lance Armstrong, used a cocktail of performance-enhancing substances for the Tour de France, most notably EPO, during the 1999 tour.

Tour de Doping

The severe penalties imposed on Lance Armstrong are a direct result of the findings outlined in USADAs “Reasoned Decision” which goes beyond Armstrong’s personal cheating to outline how he and team manager, Johan Bruyneel, forced other cyclists to dope as well. The document goes to the root of their doping network, also targeting the shadowy doctors and back room enablers who helped cyclists procure and administer drugs, and highly placed executives who helped to avoid doping controls and hide positive test results.

Risks of blood doping

Blood doping certainly isn’t a risk free process (aside from the obvious possibility of being caught). The following are side-effects which can occur in any form of blood doping:

  • Increased blood viscosity (thickness)
  • Heart attack risks
  • A blockage, which can be fat, air, or a blood clot
  • Cerebrovascular accident (a stroke)
  • Infections

Tell us your thoughts on blood? Should blood doping be scorned in the same way as performance-enhancing drugs? Or do you think that physiological manipulation is a means to reach an individual’s personal best? Was Lance Armstrong’s punishment deserved or was he harshly treated? Have your say.

Following new recommendations to try and eliminate blood doping in cycling, this is what professional British cyclist Chris Froome thinks:

‘I for one welcome 24hr testing. It may be an inconvenience but if it can help clean up the sport that I love let’s do it’

Chris Smith
Founder of Vivi Nation, sports enthusiast, occasional triathlete, keen cyclist and optimistic Liverpool FC fan.

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