Ken Chlouber, Creator of the the Leadville Trail 100
EPO. Ever used it? Think it will make you faster? Increase your hemoglobin/hematocrit, oxygen carrying capacity, that sort of thing? As you might imagine, I get a lot of letters with medical questions. One recent questioner's note deserves discussion as, when discussing his own blood level, he stated, "I have a hematocrit of 51. I think it's normal, I looked it up." I politely disagreed.
I was told recently that I would be amazed at the number of age groupers who'd experimented with some kind of performance enhancing agent be it EPO (erythropoitin alpha), Adderall (the combination of dextroamphetamine and amphetamine used in attention deficit hyperactivity disorder), or any of the steroid or growth hormone products that we see pro athletes accused of on a routine basis. I couldn't believe it and still have a hard time comprehending it now. How could winning a fifty cent medal, competing for the most part against a group of people you don't know, be so important that you don't give it the same thoughtful consideration you do for your kid's school issues or the interest rate on your home mortgage?
Just to be clear, EPO (Epogen) is normally produced by the body in the kidneys and it stimulates the bone marrow to produce more of the oxygen carrying red blood cells. It's one of the agents that pro cyclists are accused of injecting to increase their gross number of red cells, their hematocrit. There are a number of problems with this:
- EPO increases the rate of DVT, blood clots in the legs, which can break off, travel up the venous system to the heart/lungs leading to an increased risk of death . The primary docs liken it to sludging when the blood actually thickens.*
- Patients given EPO as part of their treatment are at "Greater risk for death and serious cardiovascular events...to target higher versus lower hemoglobin levels....in two studies." In other words, we as athletes would be at a higher level of risk than patients with a lower blood count.*
- EPO "...shortened overall survival...in some clinical studies..."*
Short History Lesson 30 years ago there was very little regulation of transfusions. For example, if you'd recently undergone a CABG (coronary artery bypass) your surgeon could give you blood anytime he/she felt like it. Then along came AIDS and the playing field changed. Limitations were placed on transfusions where, unless you had a documented hematocrit below 33, you were not permitted to transfuse the patient, even if the patient had pre-donated their own blood. Sometime later the level was dropped to 31, then 29, etc., all with the intent to only give patients what they absolutely needed.
This takes us to laboratory values. At our hospital, the normal range of hematocrits is 35 - 47. But, everyone of you who've donated blood, or had a significant bleeding episode of one cause or another, and then gone out on Sunday with the usual bike group, knows that you are sucking wind big time when it comes to climbing! It's said that losing one unit of blood, approximately 10% of your blood volume, only drops the hematocrit by 3-4 points. But it makes a difference for sure. You can still be in the normal range but have very abnormal performance.
But, is this true of all lab values? Should we as athletes have different normals simply because we're athletes? A piece in one of the tri mags presented that opinion recently. That as endurance athletes we have different normals than the gal next door. But I was unable to find support for that position after interviewing the head of Pathology of our hospital (in charge of all the blood tests, urine specimens, path reports, etc.) nor from Pathology of the University Teaching Hospital. I looked in my copy of the running bible The Lore of Running by Tim Noakes and was not able to find mention of a difference. For example, if the standards for serum sodium are 135 - 145, would an endurance athlete be higher or lower and how do you define endurance athlete? One who does sprints but trains a great deal? The Iron jock who may work out less but chooses a greater racing target?
The answer I was given by the Pathologist, a terrific biker who does the local hilly century ride in under 5 hours? Normal is normal.
* Physicians Desk Reference