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Art and Mark on Doping, Endurance and Health

A few months back I exchanged a series of interesting letters with Art De Vany on fitness, doping, cardiovascular health and other issues related to health and to endurance athletes in particular. Here’s the complete set:

I have followed with great interest your discussion and analysis of purported steroid use and home-run distributions. In a recent post, you asked about the incidence of false positives in sports drug-testing and you wondered how that might factor into the equation. I’ve given great deal of thought to that and related issues over the past 15 years and now feel compelled to add my two cents to your discussion – but on a much grander scale. At the risk of sounding a bit brazen, I would suggest to you and your audience that sport would be better off allowing athletes to make their own personal decisions regarding the use of so-called “banned substances” and leaving the federations and the IOC out of it entirely. (Even the term “banned substance” has a negative connotation, since most of these substances are actually drugs that were developed to enhance health in the general population). Bottom line: the whole notion of drug-testing in sports is far more complex than even the media make it out to be.

First, I should tell you that I was the Anti-doping Commissioner of the International Triathlon Union (ITU) – a relatively new sport within the Olympic Family – for nearly 13 years. I had to act as “prosecutor” on many doping cases (doping = drugs in sport). Prior to that, I helped write the first set of “anti-doping” rules for triathlon in 1988. Before that, I was an elite marathoner (2:18) and triathlete (4th Place Ironman Hawaii) in the ‘70s and ‘80s, so I have accumulated a fair amount of “inside information” regarding drugs in sport at the Olympic level. I also own a supplement company and have done extensive research on performance enhancement in pursuit of natural, legal alternatives.

There are three main points I want to make here: first, that it is impossible to fairly police and adjudicate drugs in sport; second, that the notion of a “level playing field” is a farce and, finally, that the performance requirements set by the federations at the elite level of sport almost demand access to certain “banned substances” in order to assure the health and vitality of the athlete throughout his or her career and – more importantly – into his or her life after competition.

Impossible to fairly police and adjudicate. Most people think that a positive test is conclusive proof of guilt, but the reality is that almost all these tests are nothing more than GC/MS (http://www.scientific.org/tutorials/articles/gcms.html for a good description) quantitative analyses that look for parts per billion of certain metabolites in the urine. They are not black and white indicators of guilt. They are wavy lines on a graph subject to interpretation by scientists with varying degrees of expertise. In many cases a “threshold level” is established below which you are “clean” but above which you are “guilty.” Test results will vary significantly from one “accredited” lab to another. You can test positive in one lab and, conceivably, have another lab exonerate you using a portion of the very same sample. I have presided over cases where an athlete tested positive for metabolites of nandrolone (a once-popular steroid) at levels of 4 or 5 parts per billion when the cut-off was 2.5 or 3. Even at such disputably low levels, athletes are presumed guilty. Some labs have proven that these metabolites can occur in the body from having consumed certain types of meat or from other foods or are even endogenously produced. In my opinion, the threshold levels have always been too low, so a handful of innocent athletes get severely penalized, while others who are dirty but are not tested get cleared to compete and keep whatever money or medal they win.

In the old days if you ate a poppyseed muffin before a race, your urine could easily show above-threshold levels of metabolites of opium and you could be disqualified. It actually happened to a triathlete who was later cleared. There are other similar “false positives” we had to be on the lookout for.

A T/E (testosterone to epitestosterone) higher than 6:1 was considered evidence of a doping violation, yet we had cases of women who scored a T/E of 20, not because testosterone was present in high amounts, but because the epitestosterone was extremely low as a result of birth control pills. In other cases, elite athletes’ normal testosterone levels were high enough to exceed the limit, but they were allowed to compete when they showed proof of genetic abnormality. The limit is now 4:1 and produces thousands of “false positives” each year!

In other cases, athletes who have been diagnosed with asthma (now nearing 25% of the elite athlete population – don’t get me started) and who have properly notified the IOC and have a “therapeutic use exemption” on file can use salbutamol, salmeterol and similar “anabolic-property” drugs which are otherwise banned. But god forbid you are an athlete from a developing nation with asthma whose team physician failed to properly file your papers. Same condition, but now you can be severely penalized for the ignorance of your coaches or doctors.

There are known cases of sabotage where ex-wives have tainted supplements (or even toothpaste) to cause a positive test, and where athletes in races have consumed tainted drinks offered by unscrupulous coaches or fans of rival competitors.

Even when you do get a fairly reliable test result from the lab, a good lawyer can throw doubt on the integrity of the collection process, the chain of custody or a number of other factors, enough to get a truly guilty athlete off on a technicality. All these factors combined lead me to the conclusion that it is impossible to fairly police or adjudicate doping in sport.

The notion of a level playing field is a farce. The IOC and many professional leagues suggest that banning doping in sports will create a “level playing field”, meaning that all athletes should have access – or not – to the same advantages and disadvantages. Art’s exceptional analysis of home-run distribution notwithstanding, there are clearly advantages to be had from the use of certain substances specifically within certain sports. Take the use of EPO in cycling and running. EPO (Erythropoetin) is a natural hormone produced by the body. EPO stimulates the production of red blood cells, whose level in the blood is measured by hematocrit. Red blood cells contain the hemoglobin that carries oxygen to muscles where fuel can be burned. The more oxygen you deliver to the muscles, the more energy output you derive from those muscles. So having more red blood cells is a good thing and is a primary goal of many endurance athletes. Hard training raises EPO and hematocrit, but drug companies also make artificial EPO which does the same thing without training (intended medical use is for recovery from chemotherapy which destroys RBCs). Artificial EPO is banned. Now here’s the irony: research confirms that if you train at sea level and sleep at 14,000 feet, your body makes red blood cells at an impressive rate and amount. Several companies have developed expensive “altitude chambers” for home use where you can now train at sea level and then retire to your room for the night, simulating an altitude of 14,000 feet or higher. The end result is that you have, within the letter of the law, manipulated your own EPO to artificially raise hematocrit, yet using artificial EPO to do the same thing is punishable by a 2-year suspension. Talk to an endurance athlete from a developing nation with $2 to his name about THAT level playing field.

In the early days of EPO testing, the cycling federation would measure the hematocrit of every cyclist before a race. If your hematocrit was above 52%, you were not allowed to race and were presumed to have doped. However, there were instances of cyclists from high-mountain regions in South America who had normally high hematocrits (from training AND living at 14,000 feet or higher). Some were not allowed to race because they had achieved a high hematocrit naturally. Meanwhile, others who used artifical EPO to get from, say, 44% to 51% raced without penalty. Talk to those South Americans about a level playing field.

There are many other idiosyncrasies. Within the IOC, 2 cups of coffee is OK, but 8 cups is illegal. Marijuana will get you suspended by some federations, but not by others. Creatine, one of the best natural performance enhancing substances is legal in track and field, while beta-blockers, which have no effect on performance, were not. My point is that the concept of a level playing field is a nice idea, but one that has not been realized in Olympic sport.

The performance requirements set by the federations at the elite level of sport almost demand access to certain “banned substances” in order to assure the health and vitality of the athlete throughout his or her career and – more importantly – into his or her life after competition. As I write this, Mike Quarry has just died at 55 from “pugilistic dementia”, the same fate that took his brother Jerry at age 52. World class athletes tend to die significantly younger than you would predict from heart disease, cancer, diabetes and early-onset dementia. They also typically suffer premature joint deterioration from the years of pounding, and most endurance athletes look like hell from the years of oxidative damage that has overwhelmed their feeble antioxidant systems. Most people don’t realize it, but training at the elite level is actually the antithesis of a healthy lifestyle. The definition of peak fitness means that you are constantly at or near a state of physical breakdown. As a peak performer on a world stage, you have done more work than anyone else, but you have paid a price. It is again ironic that the professional leagues and the IOC, the ones who dangle that carrot of millions of dollars in salary or gold-medalist endorsements are the same ones who actually create this overtrained, injured and beat-up army of young people. They don’t care. These organizations then deny the athletes the very same drugs and even some natural “health-enhancing” substances that the rest of society can easily receive whenever they feel the least bit uncomfortable.

I had to disqualify and suspend a kid from competition for 90 days because he had a head cold the night before his national championships. His dad had gone to the drugstore and gotten him some Sudafed so he could breathe while he slept. His urine test was positive when he won the race the next day. He forfeited his winnings and he had to sit out the World Championships as a result. I felt terrible, but the rules required that we do it.

I had to suspend a talented and promising young Mexican triathlete because his vitamins contained a tiny amount of a little-known stimulant legal over-the-counter in Mexico. His doctor had prescribed vitamins for him because he had been chronically overtraining and yet had little or no access to decent training foods.

These days many athletes avoid taking high-potency multi-vitamins out of fear that contaminants in their supplements could destroy their careers. Yet these same athletes have nutrient requirements that exceed the RDAs by a factor of 10 or 20 in some cases. It has been said many times that world class athletes will do anything to win – even if it means risking their lives. If that’s the case, then don’t let them train so hard that they destroy their health and then deny them the very tools they need to recover!

I could go one, but you get my drift. I believe that with proper supervision, athletes could be healthier and have longer careers (not to mention longer and more productive post-competition lives) using many of these “banned substances.” And perhaps the biggest assumption I will make here is that the public just doesn’t care. Professional sport has become theater. All the public wants is a good show and an occasional world record.

Part 2:
In a prior post, I introduced a notion that training for sports competition at the elite level was the antithesis of a healthy activity. Since many people seem to think that athletes are almost by definition healthy, I thought I might develop that idea a bit further in this post and open it up for discussion.

Please don’t misconstrue what I say here as advocating any sort abstinence from sports or from training. On the contrary, I believe sports of all types can play a huge role in personal development, self-awareness and self-image, and may even help mold long-lost community life-skills like sharing, mutual cooperation and loss acceptance. I will make a case that sports and other non-group recreational exercise activities can contribute greatly to health, longevity and the quality of life. But, as with all things in life, moderation seems to be the key.

I first became aware of the distinction between “fitness” and “health” when I was competing as a marathoner in the 1970s and later as a triathlete for a while in the 80s. From 1975 until 1980 I averaged between 75 and 110 running miles a week in my training. Much of that mileage was done at over 75% of my VO2 Max and a substantial portion at over 90%. During that period, I became extremely “race fit”, as defined solely by the ability to enter a race and run fast. On the other hand, in retrospect, I consider myself to have been very unfit in a true Darwinian (or EF) sense during that time. I would routinely get upper respiratory tract infections, irritable bowel conditions (probably cortisol and ischemia-related), chronic tendonitis in my joints, and I eventually developed osteoarthritis. I spent an average of 5-6 weeks a year sick or injured (running was a year-around sport in those days) yet I was considered extremely fit! My injuries got so bad in 1980 that I could no longer train at the level required to be a top marathoner, so I switched to triathlons for a few years, and raced quite well in that nascent sport. Unfortunately, the same illnesses and injuries continued to plague me and the set-backs piled up.

When I retired beat-up at the ripe old age of 29 in 1982, I decided to write a book on triathlon training and to focus on the idea of “quality” over “quantity” in terms of mileage and training time. I wasn’t the first to really delve into this, and much discussion about maximizing training has gone on since. But I came up with a theory that the human athlete is much like a helicopter. The old saying about helicopters (and it may have since changed) was that according to the laws of physics, they are not supposed to be able to fly. The fact that they can fly is great, but the wear and tear of overcoming this “natural order of things” requires that they spend an inordinate amount of time being maintained – up to an hour and a half of maintenance for each hour flown. Well, the same holds true for humans. We were not designed to run (or cycle, swim or skate) for hours each day at 90% VO2 Max, or to spend hours each day in the gym lifting heavy weights. The fact that we can and that we are able to derive some short-term performance gain or adaptation to these exercises is great – if your desire is to measure your performance against another human. But we must recognize that in so doing – in going beyond the “natural order of things human” – we need to spend an inordinate amount of time on maintenance, or we will break down just like a poorly maintained helicopter. Our bearings will wear out, our parts will oxidize and corrode and our engine will fail. Literally. Athletic performance may be impressive, but it comes at a huge cost.

Here are some real cases to review – and many of these are people I know personally: Greg Welch, one of the most versatile all-around triathletes ever (he won Ironman Hawaii, the ITU World Championships and the world Duathlon Championship) was forced to retire at age 37 due to severe heart problems. He has had over 10 open heart surgeries and wears a pace-maker. Mark Montgomery, who was a top pro triathlete for many years, had his pace-maker installed at age 46 as a result of V-tach issues. Johnny G, the developer of the popular “Spin” classes and a RAAM racer, has had severe cardiomyopathy and recently had a pacer-maker installed. Maddy Tormoen, 3-time world Duathlete-of-the-Year and 35-year old Emma Carney, twice ITU World Triathlon champion each now have defibrillators implanted in their chests to correct life-threatening arrhythmias. Chris Legh and Julianne White, both Ironman winners, have each had entire sections of their colon removed immediately after a race due to “ischemic conditions” where the blood supply to the GI tract was rerouted for so long (as the body diverted the blood to its periphery to cool itself) that whole sections of the colon literally died from lack of oxygen and nutrients. Alberto Salazar, arguably the greatest marathoner the USA has produced suffered a heart attack at age 48. John Walker, one of the greatest milers of all-time was diagnosed with Parkinsons at age 46. Marty Liquori, another world-best miler was diagnosed with leukemia at age 43. Bruce Balch, Steve Scott and Lance Armstrong (all endurance athletes) all got testicular cancer after a few years of competing. Most of the top runners from the 80’s don’t run anymore; many can barely walk due to arthritic conditions. And we think endurance training is healthy?

One of the most alarming trends in sports these days is the increase in EIA or Exercise Induced Asthma. In some countries, over 25 % of elite endurance athletes eventually develop EIA as a direct result of their superhuman training schedules. In many cases, the diagnosis requires treatment with otherwise “banned substances” such as salbutamol, salmeterol and corticosteroids under a special IOC “therapeutic use exemption.” Another phenomenon that has concerned me for a while is the prevalence of amenorrhea in younger female athletes who train at elite levels, particularly runners and gymnasts. This condition, along with cortisol output, can result in loss of bone density during competitive years and dramatically increase risk for osteoporosis later in life. The list goes on.

Clearly, training and competing at the elite level has huge costs. We weren’t designed to train that hard for that long. We were built to migrate – at low level aerobic pace – across the plains foraging for food, scavenging leftover meat some carnivore had already killed and finished, maybe having to sprint for a few seconds to the safety of a tree. Even later when we became hunter-gatherers, we probably relied more on methodical tracking skills than on trying to outrun our prey. Nothing in my research indicates that earlier humans spent regular long periods of time at a high VO2max output other than in periodic games.

The intense and voluminous training regimens used by elite athletes today and over the past few decades – in an effort to perform ever higher, faster, and farther – have resulted in the accumulation of stresses far greater than the human body was designed to withstand. As a result, the adrenals – the body’s primary stress organs – pump out cortisol and other corticosteroids at a very high rate in an effort to “survive” what the HPA axis perceives as life-threatening events, even though we might think they are healthy stresses. We know that while some cortisol is necessary for life, chronic excess cortisol causes muscle wasting, increases deposition of fat, decreases the uptake of calcium by bone, dramatically suppresses the immune system, shuts down digestion and reproduction and has a deleterious effect on other neuroendocrine functions in general. All of these cortisol effects are exactly what a healthy person tries desperately to avoid, and yet an athlete often lives in a veritable cortisol bath – until the adrenals finally fatigue and a whole host of new problems arise. Moreover, revving up the metabolic rate by a factor of 10-20 times normal for hours at a time results in oxidative fallout (free-radical output) sometimes 100 or more times the normal output and gets to the point where an athlete’s feeble antioxidant systems are simply overwhelmed. Oxidative-based inflammatory processes start occurring not just in joint and muscle tissue, but in the circulatory system and in and around nerve cells. (NB: most models of heart disease now look at inflammation as a critical component). And we could have yet another whole side discussion on the typical athlete diet too high in simple carbohydrates and its effects on insulin, advanced glycated end-products and epinephrine/norepinephine.

I think we are starting to see the first signs of damage in a generation of athletes who trained too hard for too long without proper maintenance (to go back to my helicopter analogy). And it’s not just among the elites anymore, but also among the millions who tried to emulate their heroes’ training regimens – all because they thought more was better or more was healthier. I made a point in a prior article that I thought it was ironic that the Federations and Leagues that established the high level of performance and outrageous pay scales in the first place are the same ones now suggesting that athletes should not use performance-enhancing substances. After researching the physical destruction that elite training can produce at many different levels (see all above), I am left believing we should give elite athletes (and those who train like them) every possible means of avoiding injury, illness or future life-threatening conditions. If that means that we have sports medicine doctors administering high-potency multi-vitamins, antioxidant cocktails, the occasional shot of testosterone, EPO or local cortisone injections, so be it. If an athlete has a cold and needs Sudafed to sleep the night before a big race, s/he should be allowed to do so. I’m not suggesting that drugs are the only answer – good diet, better attention to rest and periodicity in training, biofeedback and other forms of “maintenance” can help. But if athletes were simply given access to the same tools that OSHA and the EDD demand we give any worker who was stressed out, exhausted or injured on the job, in the end we could eliminate the current untenable hypocrisy and at the same time allow for a healthier generation of athletes to wow us with their latest feats.

As for the recreational athlete who is not competing at any level, my advice is to limit your hard training to less than an hour a day, with complete days off. Vary your exercise and other forms of play as much as possible. My own epiphany came at 40 when I decided I would train to “look fit” rather than “be fit.” Of course, the irony is that I look fitter now than when I was one of the fittest guys on the planet – because I am the healthiest I have ever been. And in the end, health and your total enjoyment of life are all that matter.

I welcome your feedback.

Originally posted at Art De Vany’s [1] excellent Evolutionary Fitness (and other topics) blog.

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[tags] doping, sport, triathlon, marathon, running, endurance, evolutionary fitness, cardiovascular, training [/tags]