EPO: questions and answers on a banned drug

LA Times—July 28, 2008

As a medication, EPO helps raise red blood cell levels in anemic patients but it can be deadly when athletes illegally use the drug to improve performance.

This month, three cyclists competing in the Tour de France were expelled after testing positive for the banned drug erythropoietin (EPO). EPO improves athlete performance by excelling the rate at which oxygen reaches muscles by increasing the level of red blood cells present in blood. However, EPO can cause dangerous complications for abusers.

"There's no natural shut-off," said Jordan Metzl, M.D., a sports medicine physician at Hospital for Special Surgery in New York City. "The blood can get thick, like heavy motor oil."

High hematocrit levels can lead to issues involving clotting, heart attack and stroke.

But there are ways to achieve what EPO doping can do for athletes the natural way. According to Metzl, athletes can "train high and compete low," meaning that athletes who train in high altitudes have more naturally occurring EPO in their systems to deal with the decreased amount of oxygen in the air.

So why do athletes use potentially risky banned drugs to enhance performance?

"If you ask, 'Would you like to take this drug that might be harmful to you, and it's illegal, and you might get caught, but it could help you win,' " Metzl says, "most athletes say yes." Athletes also may fear that everyone else is doing it, so they have to too.

"We need to keep fighting the good fight with drug tests," he says. "If we don't, we're just encouraging athletes to do this stuff."

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