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Commentary: Disputing Ferrari’s altitude training claims, part 2

For the sake of thoroughness and closure for the fans of the sport, one final way to address the question at hand is to look as directly as possible at the effect of doping on Armstrong’s blood data. Because only biological passport data from 2008-2009 onward is available, an assumption has to be made that Armstrong’s level of doping in 2009 would have been less than from 1999-2005, though Armstrong maintains he did not cheat during his 2009-2010 comeback.

Similarly, because the bio passport does not contain direct measurements of Hgb mass, increases in Hgb mass have to be inferred from suppressions of the reticulocyte count. With these assumptions made, the data points from June 16, 2009 through the end of the Tour de France stand out.

It is clearly visible here that the reticulocyte count during this period is consistently suppressed, indicating a sustained increase in Hgb mass. In USADA’s reasoned decision, it concluded that “the approximate likelihood of Armstrong’s seven suppressed reticulocyte values during the 2009 and 2010 Tours de France occurring naturally was less than one in a million.” If we rephrased this statement in terms of altitude and doping, it would read: “The approximate likelihood that the effect of Armstrong’s 2009 doping could have been equaled by altitude training is less than one in a million.” So, Armstrong’s own blood data suggests that there was no way that altitude could produce the same magnitude of effect seen with even his 2009 doping, let alone his 1999-2005 doping.

To summarize, a realistic look at the scientific data allows a reasonable estimation that Hgb mass would be increased by 10-18 percent from the combination of EPO and blood transfusions used by Lance Armstrong. Even well-timed altitude training is unlikely to produce a sustained effect greater than five percent. Based on the literature reviewed, Dr. Michele Ferrari’s claim that Armstrong could have won all seven of his Tour de France titles clean is not credible.

Michael Puchowicz is a former lab rat turned sports medicine physician. After the last two years of laying waste to grammar, farce, and pretense in the shadowy world of anonymous cycling blogs and Twitter rants, he’s finally caved and gone legit. Please don’t mistake his views for those of his employer, his friends, or anyone else linked by real or perceived affiliations through the medical and science communities. To do so, would surely end his uncompromising pursuit of all things true and glorious in cycling.

Author’s note: To calculate the effect of blood doping, we can use Dr. Ferrari’s estimated nine-too-10 liters of blood volume and Armstrong’s average Hgb gm/dL of 14.5. 145 gm/L x 9.5 L = 1377 gm of Hgb. One 0.5L blood bag withdrawn at 14.5 gm/dL would contain 72.5 gm of Hgb. Transfusing a fresh, stored bag with a yield of 72 percent (Ashenden 2011) would increase Hgb mass by 52.2 gm or 3.8 percent per bag.

Works cited
#### 1990 [Title, author withheld]

a Ashenden M, Gough CE, Garnham A, Gore CJ, Sharpe K. Current markers of the Athlete Blood Passport do not flag microdose EPO doping. European Journal of Applied Physiology. 2011 Sep;111(9):2307-14.

Ashenden M, Mørkeberg J. Net haemoglobin increase from reinfusion of refrigerated vs. frozen red blood cells after autologous blood transfusions. Vox Sang. 2011 Nov;101(4):320-6.

Berglund B. High-altitude training. Aspects of haematological adaptation. Sports Medicine. 1992 Nov;14(5):289-303. Review.

Chapman RF, Stray-Gundersen J, Levine BD. Individual variation in response to altitude training. Journal of Applied Physiology. 1998 Oct;85(4):1448-56.

Clark SA, Quod MJ, Clark MA, Martin DT, Saunders PU, Gore CJ. Time course of haemoglobin mass during 21 days live high:train low simulated altitude. European Journal of Applied Physiology. 2009 Jun;106(3):399-406.

Friedmann B, Frese F, Menold E, Kauper F, Jost J, Bärtsch P. Individual variation in the erythropoietic response to altitude training in elite junior swimmers. British Journal of Sports Medicine. 2005 Mar;39(3):148-53.

Garvican L, Martin D, Quod M, Stephens B, Sassi A, Gore C. Time course of the hemoglobin mass response to natural altitude training in elite endurance cyclists. Scandinavian Journal of Medicine and Science in Sports. 2012 Feb;22(1):95-103.

Gore CJ, Hahn A, Rice A, Bourdon P, Lawrence S, Walsh C, Stanef T, Barnes P, Parisotto R, Martin D, Pyne D. Altitude training at 2690m does not increase total haemoglobin mass or sea level VO2max in world champion track cyclists. Journal of Science and Medicine in Sport. 1998 Sep;1(3):156-70.

Gough CE, Saunders PU, Fowlie J, Savage B, Pyne DB, Anson JM, Wachsmuth N, Prommer N, Gore CJ. Influence of altitude training modality on performance and total haemoglobin mass in elite swimmers. European Journal of Applied Physiology. 2012 Sep;112(9):3275-85.

Heinicke K, Heinicke I, Schmidt W, Wolfarth B. A three-week traditional altitude training increases hemoglobin mass and red cell volume in elite biathlon athletes. International Journal of Sports Medicine. 2005 Jun;26(5):350-5.

Klausen T, Ghisler U, Mohr T, Fogh-Andersen N, Erythropoietin, 2,3 diphosphoglycerate and plasma volume during moderate-altitude training. Scandinavian Journal of Medicine and Science in Sports. 1992; 2:16-20.

Pottgiesser T, Garvican LA, Martin DT, Featonby JM, Gore CJ, Schumacher YO. Short-term hematological effects upon completion of a four-week simulated altitude camp. International Journal of Sports Physiology and Performance. 2012 Mar;7(1):79-83

Rice L, Ruiz W, Driscoll T, Whitley CE, Tapia R, Hachey DL, Gonzales GF, Alfrey CP. Neocytolysis on descent from altitude: a newly recognized mechanism for the control of red cell mass. Annals of Internal Medicine. 2001 Apr 17;134(8):652-6.

a Robertson EY, Saunders PU, Pyne DB, Aughey RJ, Anson JM, Gore CJ. Reproducibility of performance changes to simulated live high/train low altitude. Medical Science of Sports and Exercise. 2010 Feb;42(2):394-401.

b Robertson EY, Saunders PU, Pyne DB, Gore CJ, Anson JM. Effectiveness of intermittent training in hypoxia combined with live high/train low. European Journal of Applied Physiology. 2010 Sep;110(2):379-87.

c Robertson EY, Aughey RJ, Anson JM, Hopkins WG, Pyne DB. Effects of simulated and real altitude exposure in elite swimmers. Journal of Strength and Conditioning Research. 2010 Feb;24(2):487-93.

Saunders PU, Ahlgrim C, Vallance B, Green DJ, Robertson EY, Clark SA, Schumacher YO, Gore CJ. An attempt to quantify the placebo effect from a three-week simulated altitude training camp in elite race walkers. International Journal of Sports Physiology and Performance. 2010 Dec;5(4):521-34.

Wachsmuth NB, Völzke C, Prommer N, Schmidt-Trucksäss A, Frese F, Spahl O, Eastwood A, Stray-Gundersen J, Schmidt W. The effects of classic altitude training on hemoglobin mass in swimmers. European Journal of Applied Physiology. 2012 Nov 9

Wehrlin JP, Zuest P, Hallén J, Marti B. Live high-train low for 24 days increases hemoglobin mass and red cell volume in elite endurance athletes. Journal of Applied Physiology. 2006 Jun;100(6):1938-45.

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