Triathlon and TUEs

Our previous post deals specifically with asthma.  Please read previous post.  Let’s see what hypothyroidism treatment can do for us.  Remember, Galen Rupp has been treated for asthma and hypothyroidism:

Last week, the Wall Street Journal profiled Jeffrey Brown, an endocrinologist to star athletes and a medical consultant for Nike. His roster of patients includes nine-time Olympic gold medalist Carl Lewis, and athletes treated by Brown have won 15 Olympic gold medals combined, according to the doctor.

https://www.ibtimes.com/hypothyroidism-star-athletes-undiagnosed-epidemic-hormonal-gray-area-or-cloaked-doping-1196751

We can believe that confined variables exist to the fact that gold medalists taking thyroid hormone won gold; they are more focus, they take care of details, etc.  but we still have other problems.

Thyroid hormone is known to affect sex hormone-binding hormonal globulin (SHBG) concentrations. Men with hyperthyroidism have elevated concentrations of testosterone and SHBG. Thyroid hormone therapy in normal men may also duplicate this elevation. 

https://www.ncbi.nlm.nih.gov/pubmed/15142373

This knowledge about thyroid hormone elevating the concentration of testosterone is well known by endocrinologists, even Floyd Landis knew about it:

In 2006, bicycle racer Floyd Landis blamed his hypothyroid medication for the illegally high testosterone levels detected in urine samples taken during his Tour de France ride, according to the New York Times. An overactive thyroid gland does seem to coincide with higher levels of testosterone, so it seems feasible that an increase in thyroid hormones from medication could cause a similar reaction. Race officials, however, were not swayed, and Landis was stripped of the yellow jersey that summer.

We have a history of using performance enhancing methods for years, at one point valid methods; Lasse Viren injecting his own blood for example. Emma Snowsill running with a Ventolin puffer.  If we want a clean sport, TUEs should be transparent.  Who has one and how he/she is monitored by WADA should be available to the public. 

https://www.flotrack.org/video/5106138-lasse-artturi-virn

Below, a few things related to Salbutamol.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658979/
Our results add to the growing body of evidence that salbutamol mediates anabolic effects, and we report a mechanism by which salbutamol might promote such effects. Salbutamol has a short plasma half‐life (3–6 h).4 Following a recommended dose of inhaled salbutamol, the compound is only transiently detectable in the plasma,4 and salbutamol reaches levels up to 2.5 ng/ml or 1.04×10−8 M.27 These levels are considerably lower than effective concentrations in our in vitro experiments, which were above 10−6 M with an (IC50 value of 8.93×10−6 M). Whereas anabolic properties have been demonstrated in several species after systemic use of some beta‐2 agonists,11,20,21 salbutamol possess anabolic activity only after intravenous administration,22 and no potent anabolic effects have been reported after oral administration in animals.11,21 In addition, in humans, oral administration of therapeutic levels of salbutamol increases maximal anaerobic power,24,25,26 irrespective of the subjects' training status, without changing the body composition.25,26 Similar improvements in performance have been shown in two other studies, using a comparable daily salbutamol dose.9,23 Of note, there is no evidence that inhaled beta‐2 agonists have ergogenic effects at therapeutic doses.28 Although it is too early to draw final conclusions, based on these studies we hypothesise that the agonistic activity we observed at the androgen receptor might play also a role after intravenous administration of salbutamol.

Triathlon and Asthma

This post is a follow up of the two previous posts.  The job done by WADA is sloppy regarding doping; many fault positives and nonsense regarding persecutions.  Is it possible to go after the real problem, TUEs?

During the 2008 Beijing Olympics, 17 percent of cyclists and 19 percent of swimmers were diagnosed with asthma. These asthmatic athletes went on to win 29 and 33 percent of the medals in those sports, respectively. At the 2012 Olympic Games in London, 700 of approximately 10,000 competing athletes had confirmed asthma diagnoses and, surprisingly, they were almost twice as likely to win a medal as their non-asthmatic peers. If trends from past Olympic Games continue, there may be similar statistics in Rio.

https://fbresearch.org/rio-olympics-special-guest-asthma/

Some webpages considered asthma a bless: “It may seem like elite athletes don’t ever have asthma. After all, athletes need a robust supply of oxygen during their competitions. And symptoms like wheezing and coughing might seem to hinder someone from training and performing at their peak.”

Chris Froome had twice the salbutamol level in urine authorized by the WADA.  The urine sample was taken after one of the last stages of La Vuelta a España, 2017.  He mentioned the report done to a Swiss athlete where the value was extremely high after taking three puffs of salbutamol.

The first reported instance in an athlete and the most publicized involved a young Swiss male who appeared to have consistently unique pharmacokinetics for salbutamol. 14 This was discussed in detail in a recent paper. 15 Briefly, his post-race urinary salbutamol concen- tration was ~8000 ng/mL and subsequently, when he received the same inhaled dose, 900 μg in five hours on two occasions, the concen- trations were 3000-4000 ng/mL. ...

To treat asthma does not need more than 400 μg in a three-hour period, something that could be done in the ER; otherwise the salbutamol level will be high as above and more importantly, the athlete needs a more aggressive treatment and he or she is not able to compete.

The permissible level of inhaled Salbutamol is 1600 μg (16 puffs of the reliever inhaler) over 24 hours and no more than 800 μg every 12 hours [1]. If the presence of Salbutamol in urine exceeds 1000 ng/mL, it is presumed not to be an intended therapeutic use and considered as an adverse analytical finding by WADA.

https://blogs.bmj.com/bjsm/2018/01/09/froome-case-despite-adherence-wada-regulations-physiologically-possible-urine-sample-can-contain-permissible-level-salbutamol/

The above brings us to the problem that asthmatic patients are winning one third of the podium in the Olympics.  If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.