What percentage gain does blood doping/epo actually give?

[python]

If micro doping is not worth it why are they doing it. <snip>

don't know.

with the example, i merely tried to illustrate the direct quantitative answer jv gave to the original poster.

there could be little doubt that some will decide to manipulate their blood regardless of the consequences. but there is a point were investing in increasingly sophisticated routine becomes too risky and questionable in terms of benefit vs return

when i said a 'no brainer' i only spoke for myself. i was an elite xc skier in my day, saw a lot.

 

[Escarabajo]

If micro doping is not worth it why are they doing it. I reckon they are doping and a it more than micro doping and ahead of the anti doping testing as usual.

The cost to athletes is a big chunk of their earnings so again why do they?

Are they conned into by DSs and team Docs making money of their riders backs or is it just indoctrinated and ingrained into the mentality.

I thought micro dosing was done to help to cover up the Bio Passport when a rider infuses blood and therefore the retics go down. At that point you need the EPO in order to increase the retics count. No?

Landis and some posters have said it here. I maybe read it from one of the so many sources posted in this forum.

 

[Merckx index]

I thought micro dosing was done to help to cover up the Bio Passport when a rider infuses blood and therefore the retics go down. At that point you need the EPO in order to increase the retics count. No?

Landis and some posters have said it here. I maybe read it from one of the so many sources posted in this forum.

That's correct. As noted here many times, transfusions can be done in a way that makes them virtually indetectable by the passport. Withdrawals are much more difficult to hide, but again as discussed, if they are done in conjunction with a transfusion, very little risk.

By the way, the assertions JV made about Hb/oxygen relationships, to the extent they have any experimental support at all, are based on animal, not human studies. Those of you who think animal studies should not be used to draw conclusions about humans might want to consider this before accepting his argument uncritically. E.g., when JV says that when Hb levels increase from 15 to 16 g/dl (a HT change from mid 40s to near 50), oxygen delivery efficiency decreases (take that, Cunego!) this is based on animal work. Not to say this isn't likely the case also in humans, I believe it is, but keep in mind you can't easily do the things to humans that are needed to obtain this kind of data.

Also, JV himself notes that when riders transfuse, they generally dilute their blood, so that the HT remains approximately the same as before despite the increase in red blood cell numbers. This means that the problem of decreasing oxygen delivery efficiency is avoided. You not only get the advantage of more oxygen carrying capacity, but you get it under conditions where delivery is not compromised. And just because conditions are largely unchanged, it is easy to hide the transfusion.

I do think JV is right that there is a limit to how much is transfused, but this limit may be determined not by, or only by, fear of the passport, but by the HT limit. You can only increase the volume of your blood by so much, so given that you want to keep your HT more or less constant, you have to limit the amount of red cells transfused. The 7% increase JV suggests sounds about right; I can imagine a 10% increase, which would correspond to about 500-700 ml of whole blood (or corresponding amount of packed cells with saline), but not much more. But unless he can produce evidence that oxygen delivery does not go up in tandem with this increase, he is underestimating the performance-enhancing effect of this increase.

In any case, the argument that the increase is small enough that it could be accomplished by better training, aerodynamics, etc., seems to me to miss the point. Those factors may indeed result in an equal amount of enhancement, but if the rider then transfuses on top of that, he will get still further enhancement. There will always be an edge available, and if riders believe they can avoid a positive--and the feeling of invulnerability that highly competitive athletes have carries over to doping--they will definitely want to get this edge.

 

[Tyler'sTwin]

Do you really think it's likely that FTP increases as much as total Hb mass? That would mean riders would get a 20% boost in FTP when going from 14.0 g/dl to 16.8 g/dl. Riders in the 90's would have increased their FTP's by 50% from blood boosting alone! I believe Papp said he was a very good responder to EPO and gained 10-12% in power. He certainly beefed up his Hb mass by more than that. There was another american rider who talked about his EPO-doping last year. Maybe cat-1, I don't remember, but there's a thread here somewhere. Anyway, he raised his Hct by ~16% and got a 9% increase in power.

It all has to do with the improvement from the baseline. If a rider keeps levels consistently high with more frequent transfusions, as is alleged is the practice these days, they still get a large improvement from their natural levels.

How on earth are you going to keep your levels consistently high year round with transfusions when all that blood needs to be withdrawn from your own body?

 

[Merckx index]

Do you really think it's likely that FTP increases as much as total Hb mass? That would mean riders would get a 20% boost in FTP when going from 14.0 g/dl to 16.8 g/dl. Riders in the 90's would have increased their FTP's by 50% from blood boosting alone! I believe Papp said he was a very good responder to EPO and gained 10-12% in power. He certainly beefed up his Hb mass by more than that. There was another american rider who talked about his EPO-doping last year. Maybe cat-1, I don't remember, but there's a thread here somewhere. Anyway, he raised his Hct by ~16% and got a 9% increase in power.

First, there is that decrease in oxygen delivery efficiency at HTs above 50 or so. I noted that if the rider diluted his blood that wouldn't occur, but in the 90s, before the 50% rule was instituted, there would have been no need to do this, and riders probably weren't aware that dilution might actually improve oxygen delivery. I also pointed out that there is a limit to how much blood can be diluted. If a rider transfuses with enough cells to raise his HT 20%, he can not take in enough fluid to lower his HT to it's original value. The system can't handle that much. So Mr. 60%, for example, could not dilute his blood down to 50%. He might dilute his blood to some extent, but it would still be in the range where decreased efficiency in oxygen delivery was occurring.

Second, I question whether there is necessarily a linear relationship between oxygen carrying capacity or oxygen delivery and power. In a certain range, maybe, but not at all levels. Delivering oxygen to the tissues is only the first step; the tissues have to utilize it. It may well be that when large increases in oxygen carrying capacity occur, metabolism in the tissue can't keep up. I think when JV claimed that oxygen capacity rose only half as fast as HT, he was basing this conclusion on the belief that power rises in this relationship to HT, and then assuming that power and oxygen rise together. But this is a shaky assumption.

The bottom line is that Hb binds oxygen. If you raise Hb by a certain % without changing any other conditions, you should raise bound oxygen by the same proportion. As I said before, the only studies I have seen that examined this relationship were in animals, and they found this correlation in most tissues. To determine the relationship accurately, one has to look at a large spectrum of HT values, including ones much lower than normal. Obviously you can't do studies like these in humans. In animals, data points may include HT values of 10% or lower.

Of course, power is the key point in JV's argument. If it doesn't rise as fast as Hb, then his point about there being a limited performance enhancement of blood doping makes more sense. My point about oxygen rising as fast as Hb becomes irrelevant. But I would like to see systematic studies demonstrating this claimed relationship between Hb and power. Anecdotal evidence such as you provide may be suggestive but it does not convince me. What is needed is a study in which individuals are transfused with different amounts of red cells, to raise their Hb to different levels, then the effect of this on power increase determined. I doubt very much that such a study has been done, but if it has, you can be sure the subjects were not elite racers.

 

[athletepassport]

But I would like to see systematic studies demonstrating this claimed relationship between Hb and power. Anecdotal evidence such as you provide may be suggestive but it does not convince me. What is needed is a study in which individuals are transfused with different amounts of red cells, to raise their Hb to different levels, then the effect of this on power increase determined. I doubt very much that such a study has been done, but if it has, you can be sure the subjects were not elite racers.

There are plenty, eg Sawka et al 1987. See also the reviews by the same author.

 

[Mrs John Murphy]

The other point to consider is the psychological factor - if riders have always doped and are in the mindset that they have to dope to win or even to just hold on then riders will dope.

Ricco, Dertie, DDL, Vino, Frodo, Zabel, Uniballer, LL, Horner don't know anything other than what comes at the point of a needle. Take that away from them and the pyschological comfort blanket that it provides and I am sure you would see a very significant drop in their performances.

As a response to the OP - I can't comment on EPO but I did read an article written a few years back by some Swedish researchers looking at the performance of people once they had come off steroids, what the report noted was that long after they had stopped taking them (ie years later) they were still getting benefits from them. As a footnote, the reason why the researcher was able to get such good info and such a good group was because he himself was part of the sport (it was powerlifting I think) and knew a lot of top competitors involved.

 

[Merckx index]

There are plenty, eg Sawka et al 1987. See also the reviews by the same author.

Thanks for this information. They did not study the hemoglobin/oxygen relationship systematically, but looked at the effects of transfusion of a single dose of red cells. Still, even this was more than I thought had been done. I couldn’t access the full article, but in the abstract they report that there was no correlation between the increase in Hb and the increase in VO2 max. The increase in VO2 max varied greatly, and was greatest in individuals with medium (natural) VO2 max levels, greater than individuals with both higher and lower VO2 max levels.

So there was no fixed relationship between Hb increase and oxygen increase. That does not support what I was claiming, but neither does it support what JV was claiming. It’s not really inconsistent with the animal studies I referred to, though, since in those a different measure of oxygen delivery was used; obviously in animal studies one can’t use VO2 max. This suggests to me, again, that in studies involving maximal efforts other factors will come in that complicate the relationship between Hb, oxygen and power. For example, individuals with very high natural levels of VO2 may not be able to use the increased oxygen available from transfusion as well as individuals with somewhat lower levels.

However, I note that the mean increase in VO2 did correlate fairly well with the mean increase in Hb. The mean Hb increase resulting from the transfusion was 1.36 g/dl, which corresponds to about 10%, and the mean increase in VO2 max was 357 ml/min, which per kg would be about 10% of the mean natural VO2 max. So oxygen delivery can increase proportionately to Hb in some subjects. I would have to see the actual data for individuals to say any more.

Also, there is this article: http://bjsm.bmj.com/content/37/3/190.full

They show a figure in which total Hb and O2 max values are plotted over a very wide range, as obtained from a large number of men and women. No transfusions here, just natural values. The points fall along a straight line, and the slope of the line indicates that O2 max does increase at the same rate as Hb. Individuals with say, twice the total Hb of other individuals have about twice the max O2 values.

I found this a little strange at first, because that would indicate two individuals of the same size (so about the same blood volume) and with the same HT would have the same O2 max, yet I know this is not necessarily the case. HT alone does not predict O2 max (my HT is about the same as LA's, and we are roughly the same size). Yet that seems to be what this figure is claiming. I think such discrepancies are explained by the fact that elite athletes will have, e.g., much larger hearts and/or lung capacity, so that their O2 values do not fall on this line, but are outliers. Since elite athletes make up a very small proportion of the population, these outlying points would not have much effect on the average, so that HT would in most cases be a good predictor of O2 max.

Anyway, I think the best conclusion at this point is that as Hb is raised, bound oxygen is raised at the same rate, and is delivered to the tissues. However, what happens next, which is usually referred to as "extraction", may depend on several other factors, and these will ultimately determine power. The bottom line is that different individuals will exhibit different increases in O2 max in response to a given increase in Hb. That being the case, I think JV's argument is weakened a little. I don't think we can conclude that the 3% increase in power he threw out will be the case for everyone, even assuming that a 6-7% increase in HT is the most that could slip past passport controls.

 

[Winterfold]

Brilliant informative thread - thanks all.

 

[Zinoviev Letter]

I doubt very much that such a study has been done, but if it has, you can be sure the subjects were not elite racers.

It would hardly be possible to do such a study on elite racers for fairly obvious reasons.

 

[lean mean &green]

a 7% change in mass is a sizeable difference. assuming an athlete's normal blood volume is about 6 liters for easy math, hypothetically moving from 15g/dl (Ht 45 or 900g tHbmass) to 16g/dl (Ht 48 or 954g tHbmass) is a change in mass equal to a transfusion of 1 full unit of whole blood (approx 60g of hemoglobin).

a 3.5% increase at FTP is an underestimation but not by too much and individual results will vary. for obvious reasons the improvement is not linear or even uniform across an entire power profile.

as much as i hate to be kind to vaughters, i think his post was an explanation of his own rule of thumb and i didn't interpret it as an explanation meant to stand up to scientific scrutiny. it's his own mental shortcut with a pinch of spin. the more interesting question is why did he answer the question so awkwardly? why not just say he estimates one unit of whole blood gives you 3 or 4 percent for sustained efforts? ...ok, maybe it was more than a pinch.

also, even an additional 4% more power on top of a seasonal peak is quite large and not easily overcome by rice cakes, special skinsuits, or saunas

EDIT: a few notes for anyone a little confused. Hb is hemoglobin concentration. it is just a slightly less error proned version of hematocrit - it's still susceptible to dilution and is approx 1/3 of hematocrit. FTP is functional threshold power. IOW the power a rider can maintain for extended periods of time, by definition about an hour but it's a critical value for longer climbs and ITT's necessary for stage racing success.

 

[Merckx index]

Here’s a study in which “highly trained” runners were given a transfusion and effect on VO2 measured: http://jap.physiology.org/content/48/4/636.short

Hb was increased by 6.4%, very close to what JV was arguing was the maximum increase likely possible in the biopassport era, while VO2 went up nearly as much, 5.1%. I believe these are averages, though, and I could not access individual data to get an idea of how much variability might occur. No standard errors or deviations were provided in the abstract.

Here is another, similar study http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.1991.tb00276.x/abstract in which Hb increased by 11.2%, while VO2 increased by 8.0%. In this study, both transfusion and EPO were used to raise HT/Hb, and the authors comment that the Hb/VO2 relationship was the same for either method. The average HT value of subjects prior to infusion was 44.5, and post infusion was 49.7, so the range is obviously relevant to cycling.

So in these two studies, the VO2 increase was 70-80% of the Hb increase.


Finally, here is a review article, published in 1989: http://bjsm.bmj.com/content/23/2/84.full.pdf

Though that is quite a while ago, most of the original studies of transfusion and athletic performance were carried out in the 1970s and 1980s. This article contains a table that summarizes the results of about two dozen studies, including % increase of Hb and VO2. The values are all over the map, though, with VO2 increase sometimes greater than Hb increase, sometimes less. In fact, of the twelve studies where both parameters were determined, VO2 increase was actually reported as larger than Hb increase in eight of them. The authors also note that “The improvement in performance is often much less than would be predicted from the increased hemoglobin and there is considerable doubt as to the exact mechanism by which the increased endurance capacity is achieved,” and conclude that “The lack of a predictable response to improvements in hematocrit and total red cell mass suggest that there maybe limitations at the muscle level which are of considerable importance.”

 

[lean mean &green]

Here’s a study in which “highly trained” runners were given a transfusion and effect on VO2 measured: http://jap.physiology.org/content/48/4/636.short

Hb was increased by 6.4%, very close to what JV was arguing was the maximum increase likely possible in the biopassport era, while VO2 went up nearly as much, 5.1%. I believe these are averages, though, and I could not access individual data to get an idea of how much variability might occur. No standard errors or deviations were provided in the abstract.

Here is another, similar study http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.1991.tb00276.x/abstract in which Hb increased by 11.2%, while VO2 increased by 8.0%. In this study, both transfusion and EPO were used to raise HT/Hb, and the authors comment that the Hb/VO2 relationship was the same for either method. The average HT value of subjects prior to infusion was 44.5, and post infusion was 49.7, so the range is obviously relevant to cycling.

So in these two studies, the VO2 increase was 70-80% of the Hb increase.


Finally, here is a review article, published in 1989: http://bjsm.bmj.com/content/23/2/84.full.pdf

Though that is quite a while ago, most of the original studies of transfusion and athletic performance were carried out in the 1970s and 1980s. This article contains a table that summarizes the results of about two dozen studies, including % increase of Hb and VO2. The values are all over the map, though, with VO2 increase sometimes greater than Hb increase, sometimes less. In fact, of the twelve studies where both parameters were determined, VO2 increase was actually reported as larger than Hb increase in eight of them. The authors also note that “The improvement in performance is often much less than would be predicted from the increased hemoglobin and there is considerable doubt as to the exact mechanism by which the increased endurance capacity is achieved,” and conclude that “The lack of a predictable response to improvements in hematocrit and total red cell mass suggest that there maybe limitations at the muscle level which are of considerable importance.”

another suggestion... studies involving well trained athletes and heavy use of EPO/transfusions create an ethical dilemma but there are plenty more involving both tHb mass measurements and altitude training. it would give you a feel for the relationship between changes in red blood and performance. it's an imperfect comparison as the body may adapt to altitude changes in other ways yet to be identified but i know of numerous and more recent studies drawing on the same comparison outlined by vaughters except manipulation was accomplished with LHTL.

 

[VeloCity]

The other point to consider is the psychological factor

Reminds me of an anecdote about Virenque from Voet's book (tho the quote is taken from a blogger's review of the book):

"In the time trial at St. Etienne, Virenque apparently wanted something special, a mystery drug, Voet said, recommended by a client of Ferrari’s and a Spanish soigneur. Voet relented, and Virenque placed second in the time trial, despite being caught by Ullrich. “That stuff’s amazing,” Virenque apparently said. “We must get hold of it.” But unknown to Virenque, Voet had refused to give him the mysterious drug, concerned about its effects. Voet had just given him a glucose injection."

http://le-grimpeur.net/blog/archives/34

 

[lean mean &green]

another suggestion... studies involving well trained athletes and heavy use of EPO/transfusions create an ethical dilemma but there are plenty more involving both tHb mass measurements and altitude training. it would give you a feel for the relationship between changes in red blood and performance. it's an imperfect comparison as the body may adapt to altitude changes in other ways yet to be identified but i know of numerous and more recent studies drawing on the same comparison outlined by Vaughters except manipulation was accomplished with LHTL.

 

[hrotha]

Reminds me of an anecdote about Virenque from Voet's book (tho the quote is taken from a blogger's review of the book):

"In the time trial at St. Etienne, Virenque apparently wanted something special, a mystery drug, Voet said, recommended by a client of Ferrari’s and a Spanish soigneur. Voet relented, and Virenque placed second in the time trial, despite being caught by Ullrich. “That stuff’s amazing,” Virenque apparently said. “We must get hold of it.” But unknown to Virenque, Voet had refused to give him the mysterious drug, concerned about its effects. Voet had just given him a glucose injection."

http://le-grimpeur.net/blog/archives/34

He crossed the finish line a few seconds ahead of Ullrich, giving a finger salute usually reserved to his victories, as if saying "damn I'm so good!". Just how corrupt could Virenque be. It's incredible.