With racing stars like Lance Armstrong, Tyler Hamilton and Jan Ullrich, the sport became increasingly popular in the 1990s and early 2000s – many followed the Tour de France spellbound on their television screens. Over ten years ago, Tyler Hamilton described systematic doping in cycling in his book. He paints a picture of the sport in which athletes would either have to enter the doping machine or leave professional cycling. Jan Ullrich describes it very similarly in an interview with stern: doping as normality in cycling.

In endurance sports like cycling, only a few seconds often decide between victory and defeat. Anyone who can pedal a little harder and with more endurance will be ahead in the race. A popular doping approach to improve one’s performance is blood doping. It starts with the red blood cells. They transport oxygen throughout the body and thus also to the muscles. The more oxygen that reaches there, the more efficient the athlete is. The number of red blood cells can be increased through blood doping (autologous and foreign blood doping) and the intake of genetically produced erythropoietin (EPO). We will give you an overview of how blood doping works, what dangers it poses and how EPO is used for doping.

The goal of athletes when doing blood doping is to increase the number of red blood cells so that their body can transport more oxygen. This allows larger amounts of oxygen to be transported to the muscles and supply them with energy. This can improve the endurance and performance of athletes. More precisely, the hemoglobin concentration in the blood should be increased. Because: The protein compound hemoglobin is a component of red blood cells (erythrocytes) and contains a lot of iron, which oxygen can bind to. Hemoglobin is responsible for transporting oxygen in the body. It also gives our blood its typical color and is therefore also referred to as blood pigment.

We are usually familiar with blood transfusions from hospitals – there, people who have lost a lot of blood in an accident or during an operation are provided with appropriate blood donations to compensate for the loss of blood. With autologous blood doping, the athlete’s own blood is administered. To do this, blood is taken from the athlete a few weeks before the competition. This ideally happens after altitude training. By exercising in the thin air, the body produces more red blood cells. Blood with an increased concentration of erythrocytes is drawn. The red blood cells are isolated from the blood and the canned food is stored frozen. In the period leading up to the competition, the body compensates for blood loss and also produces new red blood cells. Shortly before the competition, the stored erythrocyte concentrate is administered again to the athlete – and the number of red blood cells and thus also the hemoglobin concentration are increased.

Doping with your own blood can place increased strain on the cardiovascular system. It also poses a risk of high blood pressure, informs the Austrian Anti-Doping Agency (NADA). Thrombosis can also occur because the more red blood cells the blood contains, the thicker it is. The blood must be stored and checked professionally, otherwise there is a risk that the canned food will no longer be usable and may pose an enormous health risk, said Professor Mario Thevis from the Center for Preventive Doping Research at the Cologne Sports University to “Deutsche Welle”.

It works on the same principle as autologous blood doping. The difference: the erythrocyte concentrate from a donor is used. As with a blood transfusion in the hospital, the donor blood must meet certain criteria, such as the same blood group, so that it can be given to the athlete at all. However, this method has been detectable using a DNA test since 2004. Foreign blood doping poses significant health risks such as kidney damage, fever, allergic reactions, jaundice or infections such as hepatitis, informs the German Sport University Cologne and NADA Austria.

Since it is the athletes’ own blood, it is very difficult to prove this. Unlike with foreign blood doping, there is no foreign material in the body, said expert Mario Thevis to “Deutsche Welle”. There is indirect proof of the “Athelete Biological Passport”, an athlete’s passport. It was largely developed by the World Anti-Doping Agency. Blood is taken from the athletes here over a period of months. The blood parameters are determined and if fluctuations in the values ​​occur that cannot be explained by something like a blood donation, autologous blood doping is assumed, Mario Thevis explained to “Deutsche Welle”.

Erythropoietin also occurs naturally in the body. It is a hormone that increases the production of red blood cells. Erythropoietin is mainly produced in the kidneys.

The genetically engineered EPO is known from numerous doping scandals in sport – just like autologous blood doping, it is used to increase the number of red blood cells in the blood and thus improve performance. Athletes inject it into their veins or under their skin. Genetically engineered EPO has only been detectable in urine since 2000.

It is very useful for people who have too few red blood cells due to an illness. However, if EPO is used improperly, such as to improve performance in sports, it can have serious health consequences, reports the United States Anti-Doping Agency (USADA). The thickened blood increases the risk of several fatal diseases such as heart disease, stroke and brain or pulmonary embolism.

Since the Olympic victories of the Finnish long-distance runner Lasse Virén in 1972, it has been suspected that some athletes use their own blood doping to improve performance. Blood doping has been a banned method since the late 1980s and is on the prohibited lists of the International Olympic Committee (IOC) and WADA. This method fell into the background when genetically engineered EPO was used to improve performance in the 1980s. With the detectability of EPO in urine, autologous blood doping, which is more difficult to detect, experienced a rebirth in competitive sports.

Sources:  Sport University Cologne EPO, Sport University Cologne Blood Doping, German Sport University Cologne Doping Control, Swiss Sport Integrity, Deutsche Welle, NADA, USADA, WADA Athlete Biological Passport, Wolfgang Jelkmann: Blood Doping – Myth and Reality. In: Christine Knust, Dominik Groß (ed.) 2010: Blood. The power of the very special juice in medicine, literature, history and culture. On Google Books, National Library of Medicine Erythropoietin