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In Blood Stepped: The History Of Blood Doping In Sport

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Re: Re:

08 Jan 2018 23:33

fmk_RoI wrote:I'd forgotten about this, and I'd even contacted the author to see what - if anything - new he had. Had hoped he'd have something new, given how the abstract claimed "the author had a medical role at each of the Olympics that is discussed."

Because that peer-reviewed paper was unsurprising doesn't mean that he couldn't have any more detailed insight on the matter, he apparently has his interest in the blood doping subject stemming from somewhere and he seems to have commented even earlier on the PED topic and the prestigious jounal The Physician and Sportsmedicine (1983: 11:8, 131-145) has the take of four specialists on how the hormone subject should be dealt with and K.D. Fitch is one of them (the other three being Daniel F. Hanley, E.C. Percy and Herman Adlercreutz)

I should add that he was very cordial in his reply when I wrote an e-mail to him a week or two ago pointing out a few minor errors and omissions in his paper.
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Re: Re:

20 Apr 2018 09:11

Here is one item relating to the intellectual history of blood doping.

Even when there does exist some gossip about athletes using transfusions already in the 1960's, the consensus view is that these claims are unreliable because blood doping was "invented" only in the early 1970 and there was no blood doping research published before that decade. But there was some vaguely blood doping related research preceding the 1972 study as CN readers know from the FMK's transfusion-article:
The first scientific studies to highlight the possible sporting benefits of transfusions appeared after the end of the Second World War. These studies were not aimed actually at sportsmen but came out of the military and were aimed at ways of combating hypoxia...

The next major study on the beneficial effects of transfusions came in 1960 when Gullbring et al published their paper The Effect of Blood Volume Variations on the Pulse Ratio in Supine and Upright Positions and During Exercise. This was based on the transfusion of 610ml blood one week after extraction. In 1966 Robinson et al published another paper, Circulatory Effects of Acute Expansion of Blood Volume based on a study transfusing 1,000ml of blood two weeks after extraction. Both Gullbring and Robinson's studies showed only marginal post-transfusion gains – two to three per cent – in endurance or VO2 max.

Of the two 1960's studies the 1960 study (Gullbring et al) is even somewhat interesting, because it originated from Sweden and one of its authors (B. Gullbring) coauthored blood doping research later with Björn Ekblom, who is usually mentioned as the "inventor" of blood doping. Still it is practically forgotten study by now and most people know about its existence only from secondary sources, such as from the reviews of the blood doping literature by exercise physiologists such as Norman H. Gledhill and James Stray-Gundersen. One can also confidently claim that the modern view (vouched for by FMK) that there was practically no performance benefit found in the 1960 study is almost always based on Gledhill's paper from 1982 who claims that the performance increase was only 3 % and not significant when he listed the available blood doping research papers.

https://pdfs.semanticscholar.org/b64d/f1d95e7a2f99a3df43e6bc677403579b8304.pdf

According to Gledhill, if one did read the study in the 1960's, he shouldn't have been impressed about its findings. But there are still two problems with the Gledhill's assessment even when he is mainly correct in dismissing the significance of the study:

1) The elevation in performance was more than his figure of 3 %, a figure that doesn't originate anywhere from the study. In fact, if one measures the power output of the subjects at constant submaximal heart rate of 170 BPM, the increase in performance from pre-blood withdrawal to the post-infusion is 9.4 %, from 194 to 212 Watts. It is still true that there is no statistical analysis performed and it must've been very underpowered study due to large variation in response and only six subjects. (see the figure below)

2) When the efficacy of blood doping was under debate in the 1970's and it was customary to make crude lists of the earlier handful of transfusion studies where benefit was seen where it wasn't seen, the study was almost always under the former category even when the researhers usually concluded that there were some other factors than blood volume/hemoglobin variations explaining the results (training effects, small cohort etc).

The study itself is strange not because of the protocol but because of the findings. The researchers took out 10 % of the blood volume of only six subjects and reinfused it back only a week later and conducted several exercise tests at 1 h, 2-3 days after the blood removal and right before and after the reinfusion. As should be expected, the performance of the subjects fell significantly after roughly 10 % of the blood was removed, but it returned to the original level in only 2-3 days and had risen 5 % above the pre-withdrawal level in 6-7 days when the hemoglobin level hadn't recovered at all. When the blood was reinfused at this point only after a week, the performance was elevated some 4 % more. That is to say, a huge 9 percent increase in watt output even when the hemoglobin level hadn't increased at all and had only been recovered to the starting point as the time gap between blood removal and reinfusion was only 7 days.

Image
Effect of blood removal and reinfusion on work capacity during the Gullbring study. Left is PWC170 (power output at heart rate of 170, pre-blood removal = 100), below is time, arrow down means the blood removal and arrow up is the reinfusion. Black line represesents the mean of the six subjects whereas the coloured lines are each individual subject. The chart looks nothing like the schematic blood doping charts where benefit is seen after reinfusion (e.g. Gledhill, 1982, p. 185).

The training effect is the most obvious explanation for the strange results and even when one doesn't fully know what to make of the findings, the existence of this research paper might've been known even widely, because - unlike the transfusion reserach of the 1940's at the Bethesda military hospital - this was a research on the exercise physiology and many of its authors were exercise physiologists and the paper was published in a prestigious journal where P.O-Åstrand and his colleagues published regularly.

In addition, the key findings of the study were discussed at the 1958 meeting of the Swedish Medical Association under the extremely blood doping sounding title "Fysisk arbetsförmåga efter blodavtappning och retransfusion" (Physical capacity after blood removal and re-transfusion). As an interesting anecdote, when Björn Ekblom, Bengt Gullbring [sic.] and Alberto Goldbarg published the "first" blood doping study some fourteen years later, it was titled "Response to exercise after blood loss and reinfusion" using almost exactly the same title.

As another anecdote, I can recall a few years ago discussing the subject of blood doping with one prestigious Finnish sports journalist and biographer well-connected with the circles specifically in the 1960's and 1970's and showing him a paper copy of the Gullbring-paper. He instantly recalled the study having being discussed on some level even even when he had never seen a copy of it. Too bad he didn't specify whether it was discussed already in the 1960's or only later, when there was other blood doping research originating from Sweden.

If one can't conclude too much about the 1960 paper, the least one can conclude is that the method of transfusion found its way into the exercise physiology-related research and into the journals of the field.
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05 Dec 2018 18:47

A Q came up recently elsewhere about the current prevalance of blood doping, in light of on going research projects into new detection methods. A new Danish study from the Department of Sport and Nutrition at the University of Copenhagen suggests that micro-transfusions could be offering noticeable performance gains:
Half a bag of blood.

Directly from the fridge and into the veins.

It may feel a bit cold in the arm as the blood runs into the body, but after half an hour the blood bag is empty and you can be a five percent better athlete.
Not sure how 'robust' the study was:
The research project involved a group of nine well-trained men with an average age of 29 years and blooded them with 135 milliliters of red blood cells corresponding to half a bag of blood.

One minute better

The result was not to be mistaken. Their performance in a time drive by bicycle was improved by 4.7 percent.
Danish link

(Excuse the poor Google pidgin.)
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Re:

06 Dec 2018 10:01

The material was published two years ago in one master's degree:

http://curis.ku.dk/ws/files/163093434/Speciale_jvx919.pdf

I went quickly through the PDF-version and the "Discussion"-section makes it clear that there are shortcomings in the study:
Conversely, it should be stressed that the findings of improved endurance performance in the present study and the discrepancy between the present and earlier findings about the performance enhancing effect of ABT of 400 mL, are due to unsuccessful blinding in the present study. Knowledge about the treatment allocation can affect the subjects’ psychological and physiological responses to the intervention. Subjects knowing that they are in the ABT group might harbour favourable expectations. Likewise, subjects in the PLA group can potentially be positively influenced by the “placebo effect”.

I don't personally even get it why people conduct these kind of non-blinded experiments at all other than to finish their degrees and to get the "feeling" on how research and statistical analysis is conducted etc., because they are always prone to criticism.

To think it this way, in the 1980's there were two double-blind placebo controlled studies in which both running speed and Vo2Max were measured before and after blood infusion (760-900 ml). In both of these studies, Vo2Max of the subjects was elevated some 8-12 %, but due to physical and physiological processes, only a quarter of this was "realized" into actual speed increase (c:a 2.5 %). In the present study, there is barely noticeable Vo2Max increase, but the speed increase is amazingly high.
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Re: Re:

06 Dec 2018 11:28

Aragon wrote:The material was published two years ago in one master's degree:
Cheers for taking a look at it. It came up on Twitter yesterday and I wasn't near a computer, just a tablet.

It's funny, the EPO-doesn't-work study got torn apart in moments, this one gets a hall pass elsewhere.

This was interesting in it:
Out of the six participants, four subjects (n = 4) underwent a placebo (PLA) intervention and five subjects (n = 5) an autologous blood transfusion (ABT), of which three subjects (n = 3) completed the crossover (ABT -> PLA; n = 2, PLA -> ABT; n = 1) within the master project’s data collection period. One subject became ill just before the last set of performance tests (W6 Post) and was therefore not able to complete these tests. Likewise, no baseline measurement for Hb(mass) was conducted for Subject 3 in the second round due to sickness. Additionally, as the recordings stopped halfway during the 650-kcal TT following microtransfusion for Subject 6, the results from this subject were excluded from the time trial database. Likewise, due to technical problems with the specific heart rate monitor, heart rate data for Subject 1 was not included in the study.
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Re: Re:

06 Dec 2018 13:09

Fast news cycle can lead people to accept a lot of material at face value whereas confirmation bias can cause overly critical approach towards "unfavourable" opinions and findings.

It reminds me of the study involving rHuEPO and Kenyans published a few months ago where there was a huge improvement in speed even four weeks after the treatment had ended when there was still a small surplus of RBCs.

https://mobile.twitter.com/Scienceofsport/status/1038043037480435712

If one reads the study, Vo2Max of the subjects was elevated only statistically insignificantly 3.1 % at that time whereas speed was 3.4 % faster, which is an enormous and statistically significant speed improvement, largests of all blood doping studies. So simultaneously there was so miniscule elevation in the amount of RBCs to barely elevate Vo2Max, but still enough to increase actual speed to render it to be a "high end study" in this regard.

Needles to say, no control group, and even the authors speculate about placebo effect and notice that the subjects themselves self-reported that they had put more effort into the test runs they did under rHuEPO (ie. higher RPE).
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Re:

06 Dec 2018 14:01

[quote="fmk_RoI"]A Q came up recently elsewhere about the current prevalance of blood doping, in light of on going research projects into new detection methods. A new Danish study from the Department of Sport and Nutrition at the University of Copenhagen suggests that micro-transfusions could be offering noticeable performance gains:[quote]
A new Danish study shows that micro blood doping (only 135 ml) can increase the performance by up to nearly five percent. First time studying such small doses. Very worrying reading as it will be almost impossible to detect.
Article (in Danish)
http://sport.tv2.dk/2018-12-05-chokerende-dansk-forskning-lille-maengde-bloddoping-kan-give-stor-forbedring
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Re: Re:

06 Dec 2018 14:35

Tim Booth wrote:
fmk_RoI wrote:A Q came up recently elsewhere about the current prevalance of blood doping, in light of on going research projects into new detection methods. A new Danish study from the Department of Sport and Nutrition at the University of Copenhagen suggests that micro-transfusions could be offering noticeable performance gains:
A new Danish study shows that micro blood doping (only 135 ml) can increase the performance by up to nearly five percent. First time studying such small doses. Very worrying reading as it will be almost impossible to detect.
Article (in Danish)
http://sport.tv2.dk/2018-12-05-chokerende-dansk-forskning-lille-maengde-bloddoping-kan-give-stor-forbedring
Thank you, I really wish I'd posted that. Oh, hang on a moment, I did. Thank me!
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Re: Re:

06 Dec 2018 17:19

fmk_RoI wrote:
Tim Booth wrote:
fmk_RoI wrote:A Q came up recently elsewhere about the current prevalance of blood doping, in light of on going research projects into new detection methods. A new Danish study from the Department of Sport and Nutrition at the University of Copenhagen suggests that micro-transfusions could be offering noticeable performance gains:
A new Danish study shows that micro blood doping (only 135 ml) can increase the performance by up to nearly five percent. First time studying such small doses. Very worrying reading as it will be almost impossible to detect.
Article (in Danish)
http://sport.tv2.dk/2018-12-05-chokerende-dansk-forskning-lille-maengde-bloddoping-kan-give-stor-forbedring
Thank you, I really wish I'd posted that. Oh, hang on a moment, I did. Thank me!

sorry - didn't notice that 'Twitter' was a link :o
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Re: Re:

06 Dec 2018 17:55

Tim Booth wrote:
fmk_RoI wrote:
Tim Booth wrote:
fmk_RoI wrote:A Q came up recently elsewhere about the current prevalance of blood doping, in light of on going research projects into new detection methods. A new Danish study from the Department of Sport and Nutrition at the University of Copenhagen suggests that micro-transfusions could be offering noticeable performance gains:
A new Danish study shows that micro blood doping (only 135 ml) can increase the performance by up to nearly five percent. First time studying such small doses. Very worrying reading as it will be almost impossible to detect.
Article (in Danish)
http://sport.tv2.dk/2018-12-05-chokerende-dansk-forskning-lille-maengde-bloddoping-kan-give-stor-forbedring
Thank you, I really wish I'd posted that. Oh, hang on a moment, I did. Thank me!

sorry - didn't notice that 'Twitter' was a link :o
It wasn't. The Danish link was. The Twitter link was in an entirely different post. Still, can't expect people to read a whole post. Or an article, for that matter.
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Re: Re:

06 Dec 2018 18:40

Tim Booth wrote:
fmk_RoI wrote:A Q came up recently elsewhere about the current prevalance of blood doping, in light of on going research projects into new detection methods. A new Danish study from the Department of Sport and Nutrition at the University of Copenhagen suggests that micro-transfusions could be offering noticeable performance gains:
A new Danish study shows that micro blood doping (only 135 ml) can increase the performance by up to nearly five percent. First time studying such small doses. Very worrying reading as it will be almost impossible to detect.
Article (in Danish)
http://sport.tv2.dk/2018-12-05-chokerende-dansk-forskning-lille-maengde-bloddoping-kan-give-stor-forbedring


Cool! Thanks for sharing
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08 Dec 2018 14:51

Rasmussen on the new brouhaha over the two-year-old thesis:
It costs about 20 euros to acquire five blood bags by mail order, and it takes about 15 minutes to blood dope yourself. It is neither expensive nor complicated. Blood doping just requires a refrigerator, a courier that can ship the blood bag from A to B, and maybe another room in the rider's hotel on a different floor than the rest of the team, so that you can do it.
Danish link

The short version is the usual I did it ergo anyone can do it (but maybe not that donkey Riccò) and everyone is doing it. He notes that the performance gain is likely overstated for pros (likely? ya don't say!). He seems to think the paper tested whether the ABP could detect the transfusions when it did no such thing.

Oh yeah, and blod doping was invented in 1972.
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Re:

08 Dec 2018 15:31

This is a mea culpa-moment from my part for not doublechecking the information about the 2016 thesis before bringing it up and claiming that it is the same study as the 2018 paper.

It might be exactly the same experiment or the 2018 paper with some extra material added, and the two are clearly related, because some researchers such as Solheim and Bejder had some input in both of the papers and the protocol is almost exactly the same one. But from the small tidbits published about the 2018 study here and there, the data is slightly different even when the key findings remain the same.

I think that the key problem with the 135 ml experiments is the fact that the participants most likely were still heavily anemic during the infusion, because nobody can recover in 3-4 weeks fully from anemia caused by donation of 900 millilitres of blood. In the 2016 thesis, total hemoglobin mass was still on average 4 percent lower than the baseline level just before reinfusion (804.1 g vs 837.4 g) and hematocrit was still lower compared to baseline 24 hours after transfusion (41.8 % vs 43.8 %) even when THb wasn't measured at this point.

So the 135 ml infusion experiment most likely isn't an inquiry about a small secondary polycythemia per se but only about how well relative anemic body reacts if it becomes slightly less anemic via small blood infusion.
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Re: Re:

08 Dec 2018 17:52

I should try to obtain the actual paper and quote from it, but one quite reliable poster of the Letsrun.com-forum claims that he has read the paper and my gut feeling was pretty right, because the hemoglobin concentrations of the transfusions groups were following according to him:

15.0 g/dl [before blood donation]
14.1 g/dl [before first reinfusion]
14.6 g/dl [after microinfusion]
15.5 g/dl [after larger infusion]

Summa summarum: there could've been improvement in performance from 14.1 to 14.6, but this increase wasn't elevation of hemoglobin level above normal levels but only recovery from anemia. Correspondingly it doesn't mean that body could've used as effectively the extra 135 ml of RBCs if a "normal" 15.0 g/dl body would've obtained them via transfusion.
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