Erythropoietin is one of the most “talked-about” doping substances in sports.
Much thanks to it, the legendary cyclist Lance Armstrong became who he is, and because of it, he lost his titles after the fact of his doping use was revealed.
In this article, we will discuss what erythropoietin is, how it works, and of course, what the side effects of its use in sports are.
Main thoughts:
In sports, erythropoietin is used to increase endurance
The use of erythropoietin increases the risk of death and autoimmune diseases
What is erythropoietin? Mechanism of action
Erythropoietin is a peptide hormone that is naturally produced in the human body (in the kidneys and liver) and regulates the formation of red blood cells by acting on the bone marrow.
Red blood cells or erythrocytes (which give blood its characteristic red color) perform a transport function in the body: they transport oxygen to all cells, including muscle cells.
In addition, the hormone erythropoietin plays an important role in wound healing and the creation of new blood vessels.
The initial purpose of erythropoietin was its use in medicine for the treatment of anemia (a condition in which the number of red blood cells (hemoglobin) decreases and the body’s tissues receive insufficient oxygen for normal functioning), which is caused by chronic kidney disease, cancer, and the effects of chemotherapy.
However, later some doctors recognized the potential for its use in sports in its mechanism of action.
The initial purpose of erythropoietin was its use in medicine for the treatment of anemia in certain diseases
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What is recombinant erythropoietin?
Recombinant erythropoietin is an artificially synthesized hormone that is almost identical to the natural one.
It is obtained in the laboratory using a special technology that allows for the reading of DNA codes and recreating a molecule of the substance that is almost identical to the natural one 3.
What does a high level of erythropoietin in the blood indicate?
This may be a sign of anemia: a low concentration of oxygen in the blood is a trigger for increased production of the hormone erythropoietin, which is responsible for enhancing the production of red blood cells 3.
What is erythropoietin used for in sports?
Erythropoietin in sports falls under the category of doping substances commonly referred to as “blood doping.”
When erythropoietin is introduced into an athlete’s body, the concentration of red blood cells in the blood increases; the higher their concentration, the more oxygen is delivered to the muscle cells; in sports, this means improved athletic performance and results.
The use of erythropoietin in sports is particularly common in those disciplines that require endurance, such as long-distance running, cycling, cross-country skiing, biathlon, triathlon, and others.
Better oxygen supply to the muscles delays the onset of fatigue and allows for longer and faster running/cycling.
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History of erythropoietin use in sports
The use of erythropoietin in cycling began around 1990 and became widespread by 1998.
In 1998, the entire Festina and TVM cycling teams were disqualified from the Tour de France due to suspicions of erythropoietin use 5.
The prestigious competition was later dubbed by journalists as ‘Tour du Dopage’ (doping tour), as many cyclists admitted to using doping.
A number of elite cyclists in the Tour de France, including Floyd Landis and Lance Armstrong, admitted to using doping, including erythropoietin and anabolic steroids.
Data from anti-doping activists confirm the widespread use of erythropoietin in professional cycling.
The World Anti-Doping Agency (WADA) placed erythropoietin on the list of prohibited substances for use in sports in 1990 1.
In 2005, a seven-time Tour de France winner, one of the most decorated cyclists in history, was stripped of his titles as the Anti-Doping Agency confirmed his use of erythropoietin and other doping substances 5.
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How effective is erythropoietin in sports?
Information from the BBC news agency: “Trials in Australia showed that erythropoietin provides such an immediate increase in athletic performance that one might expect after several years of training 2“.
Erythropoietin provides such an immediate increase in athletic performance that one might expect after several years of training
Scientific research on this matter is contradictory.
Scientific studies on the effectiveness of erythropoietin in sports
Heuberger and colleagues analyzed all available scientific studies on the effectiveness of erythropoietin in sports and concluded that “despite the fact that the use of recombinant erythropoietin in sports is common practice, there is no scientific basis to claim that it is effective in increasing athletic performance, endurance, and speed 5“…
One of the main arguments in this statement is that three parameters determine an athlete’s physical endurance – maximum oxygen consumption VO2max, blood lactate levels, and efficiency (the ratio of speed or power to oxygen consumption) – while erythropoietin only affects one of them, VO2max 5.
At a certain level of training, efficiency becomes more significant for endurance than oxygen consumption 5.
The scientists’ statement was criticized by their colleagues, pointing out that the facts of erythropoietin’s effectiveness in sports are evident and that improving oxygen delivery is a sufficient factor for increasing endurance 6.
Here 8 the largest scientific experiment on the effectiveness of erythropoietin in sports (cycling) is mentioned.
The experiment involved 48 trained amateur athletes, some of whom took erythropoietin, while others received a placebo for 8 weeks. They were tested for endurance in 7 tests of different types and complexities.
The scientists’ conclusion, surprisingly, is similar to the previous one: athletes on erythropoietin were not faster than those who did not take it.
This conclusion was shocking to the entire scientific community, as other experiments and success stories of athletes suggest otherwise.
In the study of the effect of erythropoietin on the structure of muscle fibers and the vascular network in muscles, which are indicators of adaptive changes in the body, the scientists also found no effect 7.
Their conclusion: “Although erythropoietin improves oxygen supply to the muscles, it does not produce adaptive changes in the athlete’s body that are important for endurance. Such changes occur during endurance training.“
Scientific research on the effectiveness of erythropoietin in sports is contradictory. Its use does not lead to adaptive changes important for endurance and, if it does improve athletic performance, it is not the case for all athletes.
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Side effects of erythropoietin use in sports
While erythropoietin has a tremendous therapeutic effect in certain diseases, its off-label use in sports can lead to serious side effects.
It is well known that the use of erythropoietin in sports increases the risk of death from heart attack, stroke, or pulmonary embolism (rupture of an artery in the lungs), as it causes blood thickening and makes thrombus formation easier 1,2.
The use of recombinant erythropoietin can lead to autoimmune diseases with serious health consequences 1.
Some researchers claim that side effects from the use of erythropoietin in sports are a rare occurrence 6.
The use of erythropoietin increases the risk of death and autoimmune diseases
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How is the doping test for erythropoietin conducted in sports?
The testing method was developed and implemented in 2000 for the Summer Olympics in Sydney (Australia).
The test was based on blood and urine analysis: first, a blood sample was taken, followed by a urine test to confirm the result.
At the Olympic Games in Australia, no athlete was caught using erythropoietin with this test.
Later, it was shown that to establish the fact of erythropoietin use by an athlete, a urine test is sufficient, yet many sports federations still analyze both. This is not a meaningless precaution, as some new agents that stimulate erythropoiesis (the production of red blood cells) can only be detected in the blood 1.
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How should an athlete take erythropoietin to avoid a positive doping test?
To pass a doping test, athletes need to stop erythropoietin injections 5-7 days before competitions. On the other hand, to achieve the effects of this doping agent, it must be taken 5-7 days before competitions.
Contradiction. What to do?
In the feature film about Lance Armstrong, the legendary cyclist who became such thanks to erythropoietin, the intimate moments of doping in cycling, which are not commonly discussed, are well revealed. I recommend this film to anyone interested in understanding what professional sports are like, specifically its dark doping side.
In particular, it shows how athletes dealt with the aforementioned dilemma in the 90s of the last century: right after the competition, they would lie under a drip and inject themselves with pure blood, which allowed them to quickly reduce the concentration of erythropoietin to acceptable levels by the time the testers invited them for a doping test.
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