Triathlon and Self-Awareness

We work with athletes and patients.  The key to have results is self-awareness; we cannot lie to ourselves if we want results.  An example of what we should not want from athletes is lack of self-awareness as in the case of the highest rank official of the FMTRI which comment highlights lack of self-awareness:

“It is not stupidity to say that Crisanto Grajales could be in the top six in Tokyo.” His premise is based on the fact that 65 competitors started the Tokyo race last year and just finished 46, and Grajales run a second faster than Mislowchuk and Stornes (the first two), a minute behind on the bike; not counting that Mola, Gómez, Luis and others were not there.  And the fact the event’s page said: price money TBA for competing in that race.  Some competitors were there to test the bike course.  That comment gives information about the lack of self-awareness or perhaps he is just “Trumping.” 

http://www.hidrocalidodigital.com/deportes/articulo.php?idnota=169051

Researchers are working on how to measure self-awareness in athletes.  The constructs are not easy to develop but as any science, it does not proof anything, it just probes.  We have known the facts empirically for centuries.

Introduction

Mental toughness (MT) is widely recognised as a fundamental attribute for attaining success in sport.¹ Mentally tougher athletes maintain performance levels during adversity; perceive pressure as a challenge and a catalyst for prospering; and maintain emotional, cognitive and behavioural control despite situational stressors.² Considering the appeal that these cognitive and behavioural signatures have to athletes, MT has become a prominent research area in the sport performance literature.³

Scholars' primary interest in MT is based on the capacity to acquire MT attributes through sport and non-sport developmental influences and experiences⁴, as well as through psychological interventions⁵. However, determining the MT dimensions that may be taught and the most effective approaches to develop them requires resolutions to the current conceptual and operational disparities that exist. Some researchers contend that MT is a narrow personality trait that is situationally stable^5,6, whereas others suggest MT is state-specific and may fluctuate depending on the situation^7,8. In addition to MT manifestation distinctions, these conceptualisations differ in the extent to which MT may be developed. However, in support of the mutual inclusivity of these perspectives, Gucciardi et al.³ reported that a combination of intraindividual (i.e. within person) and interindividual (i.e. between person) differences may be attributed to the variability of MT. Accordingly, an athlete may display enduring patterns of MT across similar situations, but varied levels of MT across dissimilar situations.

Although the multidimensionality of MT has generally been supported⁹, the type and quantity of constituents comprising MT remains unclear¹⁰. In addition to dimensional discrepancies between sport types,¹¹ within-sport MT differences have been found. For instance, Coulter et al.¹² reported that risk-taking is an integral MT component in soccer, whereas Thelwell et al.¹³ indicated that MT in a soccer player involved affecting one's opponents. The characterisation of MT variations are reflected in the range of instruments that often diverge in the types of MT that are measured. To illustrate, affective intelligence is included as a subfactor on the Cricket Mental Toughness Inventory¹⁴, but is not contained within the Australian Football Mental Toughness Inventory¹⁵.

Although unequivocally determining the components that constitute MT is necessary, there are several components that are repeatedly referred to in the literature.¹⁶ These components include confidence or self-belief; emotional and cognitive control; accepting, persevering and thriving through challenges; and commitment and determination.^2,17 Accordingly, MT refers to a collection of personal resources (inherent and developed) associated with athletes' pursuit of optimal athletic performance levels, irrespective of positive and negative situational demands.^18,19

In the extant literature, considerable attention has been devoted towards examining the characteristics associated with MT. Commonly identified correlates of MT include effective coping, the use of self-talk, relaxation strategies and mental imagery.^20-22 Mentally tougher athletes have greater flow experiences (concentration, autotelism)²³, perceive stressors as less intense²⁴, and utilise performance- and mastery-approach achievement goals²⁵. Collectively, MT is related to a number of positive psychological characteristics. However, self-awareness, also referred to as psychological self-mindedness, is one concept that has received limited quantitative MT research attention. Self-awareness represents the capacity to attend to, recognise and examine one's thoughts, physiological sensations, emotions and behavioural reactions, either as they occur or retrospectively.^26,27

Although the self-awareness process is multifaceted and associated with an array of corollaries and self-directed attention areas²⁶, common conceptualisations encompass two primary components: engagement in self-reflection and the attainment of self-insight^28-30. Self-reflection involves emotional, cognitive and behavioural self-introspection, whereas self-insight refers to clarifying and obtaining a deeper understanding of such experiences.²⁹

Even though self-reflective activities may not automatically result in self-insight³¹, self-awareness represents an important process for identifying and replacing maladaptive responses as well as establishing progress towards achieving positive psychobehavioural changes^28,32.

In sport, awareness of one's emotions has been linked to superior performance.³³ In particular, maintaining peak performance levels is at least partly dependent on the ability to recognise negative emotions and cognitions and effectively control or avoid the detrimental effects of such experiences.³⁴ With research supporting the emotional and cognitive control of mentally tough athletes³⁵, along with the understanding that MT is associated with positive performance outcomes³, self-awareness attributes may be relevant to athletes' MT.

Recent qualitative research has posited the relevance of several forms of self-awareness (e.g. emotional and cognitive) in relation to MT. Bull et al.²⁵, for instance, qualitatively established thinking clearly (awareness, focus and control of thoughts) as an essential component of MT in elite cricket. Slack et al.³⁶ extended this finding to denote cognitive awareness of own emotions as indicative of mentally tough English Premier League football referees. There is also evidence to suggest that self-awareness promotes or facilitates heightened levels of MT³⁷ - a finding that supports early heuristic MT perspectives³⁸.

Taken together, these findings provide preliminary support for the applicability of self-awareness characteristics to the MT of athletes. However, prior MT studies have not specified what embodies self-awareness, and, despite recent qualitative findings, there is a dearth of knowledge about the role of emotional, cognitive and behavioural self-awareness in relation to MT. Therefore, the purpose of the current study was to explore the relationships between MT and self-awareness components (i.e. self-reflection and self-insight) in competitive tennis players. It was hypothesised that MT and each of its subcomponents would be significantly predicted by both (1) self-reflection and (2) self-insight.

http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23532017000100012

…The finding that self-insight was the single significant predictor of global MT suggests the phase is particularly important to athletes' MT. However, given that attaining insight requires introspection and evaluation of the self,³¹ self-reflection is a necessary part of the self-awareness process. Considering the markedly larger effect size between MT and self-insight, as compared to self-reflection, mentally tougher athletes appear to be better at progressing from self-reflective activities to achieve higher levels of self-insight. With prior studies reporting that self-awareness promotes the development of MT,³⁷ attaining maximal MT benefits might require athletes to engage in and proceed beyond mere self-introspection toward generating a profounder level of psychobehavioural clarity and understanding.

Conclusion

The findings in this study support the positive association between MT and self-awareness in competitive tennis players. Most notably, the strongest predictor of MT and its subcomponents was self-insight. Notwithstanding the necessity of self-reflection in the process toward obtaining insight, the latter appears to be particularly important when considering MT and its development among athletes. Research identifying the contextual demands and situation-based use of self-awareness among mentally tough athletes is warranted, along with whether self-reflection and insight may be used to develop MT through interventions.

We work on education with the purpose of increasing self-awareness to have better triathletes.

Triathlon Doping: “An open letter to Michele Ferrari and Eufemiano Fuentes.”

I looked at the biological passports of different athletes, including the one on Lance Armstrong.  It is incredible how malnourished these athletes were according to the passports.  Eufemiano Fuentes mentioned when doping these athletes that he was treating them when he was caught at the Operación Puerto.  Looking at the Biological Passport of these athletes we should agree with him; but the remedy is not the appropriate one.  

https://veloclinic.com/athlete-biological-passport-outlier-vs-level-change-detection/

We have mentioned that if somebody needs steroids for asthma, he or she is not in any condition to remain competing for at least a few months, by then it is too late to come back for the year: of course, athletes are not that ill to require steroids.  Steroids are used for other reasons. Eufemiano’s intention is not to treat them but to help them in the “rat race.” Please read our posts related to doping. 

19 oct. 2019

Triathlon and TUEs

8 oct. 2019

Triathlon and Asthma

I remembered when the Swiss fixed addicts in mobile units located at parks to avoid spreading infections, criminal behavior or overdoses.  The “fix” was not for “treatment” but to decrease the trouble behavior.  Eufemiano’s declarations remind me of these remedies:

https://www.marca.com/2013/04/04/ciclismo/1365029848.htm

P. Siempre se ha dicho eso, que de un burro no se hace un caballo de carreras. Pero, ¿eso sirve también después de la aparición de hormonas como la EPO? ¿No convirtió la EPO a algunos burros, con perdón, en caballos de carreras?
R. Creo que no. Evidentemente hay tratamientos que mejoran el rendimiento, pero habría que valorar más cosas, como por ejemplo si ese rendimiento fue mejorado sólo por uno o por dos o por todos. Es decir, habría que saber quién recurrió a la EPO y quién no.

P. La justicia está estudiando si, con sus prácticas, cometió o no un delito contra la salud pública. Pero a estas alturas no negará que había dopaje, ¿no?
R. ¿Dopaje? Estamos hablando de hechos que ocurrieron antes de que saliera la ley antidopaje. Dopaje deportivo es posible que hubiera, pero yo le llamaría dopaje terapéutico, que sería el uso de sustancias dopantes con finalidad terapéutica, para evitar males mayores.

También se podría emplear una sustancia dopante, haciendo un mal uso, y tener consecuencias no deseables. Pero, al igual que ocurre en algunos deportes, no de este continente pero sí del americano, como la NBA o el fútbol americano, donde las sustancias dopantes son utilizadas con fines terapéuticos. Y están permitidas.

P. ¿Usted realizaba entonces dopaje terapéutico?
R. Así lo entendía yo. Parece ser que no todos lo entendían así, pero yo buscaba siempre proteger la salud de mis deportistas. Buscaba protegerles del daño, inmenso daño, que les hacía el entrenamiento a los niveles que lo hacían y del calendario competitivo tan exigente que tenían.

Eufemiano touches areas related to poor nutrition and recovery.  He decided to treat them with “whole blood” instead of teaching them how to eat right.  Eufemiano was right that “whole blood” was the way to go because it was very difficult to educate to change habits; EPO, steroid or other drug does not work with a poor nutrition.  The objective was to keep them in “the rat race.”  He claims that they did not have time to do the teaching and recovery for cyclists because of the racing schedule: “Professional cycling is not good for your health; I help cyclists to avoid more trouble with their health so they can continue racing.”

Based on the above, we say to our athletes that triathlon has to do with the administration of our time.  The winner is who administers his/her time the best way where nutrition, recovery and education are priority.  There is not talent, just repetition with intention to improve and administration of our time.  The need for doping is not there if we have educated athletes.  Eufemiano was acquitted from doping athletes after Operación Puerto trial.  Ferrari was suspended after his second trial for trafficking performance enhancing drugs (Al Capone ended up in jail for not paying taxes).

https://www.youtube.com/watch?v=3N_2rRQQpbc

Triathlon and Training Process

Listen to counsel and accept discipline, in order to become wise in your future. Proverbs 19:20 

In much wisdom is much grief: and he that increased knowledge increased sorrow.  Ecclesiastes, 1:18, King James Version

It is difficult to follow Salomon but we agree with the two quotes above.  We try to teach kids to become wise in the future but we struggle with how being listened by them, and the acceptance on their part of what is required to grow as a wise person.  We have failed after they become adults most of the time.  The hypothesis is that the “adverse score” (low SES) hits when they become adults and competition becomes extreme.  They do not leave with sorrow because they do not acquired knowledge.  Most of the time, they were able to understand the situations, but the knowledge did not belong to them.  We have failed introjecting knowledge, because as Albert Einstein said: “knowledge is experience, the rest is information.” To learn from experience “certain knowledge” needs to be present.

“Certain knowledge” is in the environment the athlete lives in, such a knowledge will depend on the Socio-Economics-Status (SES).

http://www.kjcls.org/journal/view.html?doi=10.15324/kjcls.2017.49.3.227

“SES has a significant effect on sports performance: High SES displayed higher performance in all three speeds than low SES group.” 

This study done in Morocco took into consideration “personality traits” in addition to SES; such personality traits belong more to a high SES than to a low SES; but it shows that certain personality traits are related to better performance in sports.  High performance is related to high SES scholarly also:

An analysis was conducted on the Academic Performance Index (API) for charter and noncharter schools in California. API scores for the years 1999, 2000, and 2001 were analyzed along with various charter school characteristics. Since socioeconomic status (SES) has a strong correlation with student performance on standardized tests, comparisons were made focusing on schools serving free or reduced lunch eligible students (low-SES students). Raw comparisons of test scores (unadjusted for SES) tend to be misleading since charter schools often choose to work with the most challenging populations, and have done so with lower funding levels per student, as California has not provided facilities funds to charter schools.

https://files.eric.ed.gov/fulltext/ED469276.pdf

We work with low SES children; the process we follow last at least ten years to equalize the effect of low SES.  It is not a matter of injecting money into it, but improving education.  We work daily on how to produce experiences that could have an impact in the learning process so “the experience can become knowledge.”  We emphasized that our political class amassed millions, but they still belong to a very low SES because of their low education; even though they went to college (most of them went to College).  Our children belong to the lowest SES in Mexico, but we have the top triathletes for children and adolescents in Mexico. We have the only world champion in triathlon from Mexico.  As David Salo wrote when publishing his book about swimming and receiving criticism: "lack of having produced a recognizible 'elite' athlete." We do have the “elite sample": 

To be sure, these concepts have been challenged, not for the lack of experimental and theoretical evidence, but more for the lack of having produced a recognizable “elite” athlete. In order to provide some practical support for the training model, I extensively describe the details of the training program that I utilize.”

http://www.nadafacil.co/documentos/SprintSalo.pd

I leave you these two videos, part of our teaching experience:

https://www.youtube.com/watch?v=kqtqWPi8DN4

https://www.youtube.com/watch?v=6vuetQSwFW8

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.

Triathlon and Off-Score II

We have a previous post regarding this subject, but looking at comments in www.slowtwitch.com  related to anemia and how low hemoglobin is in some triathletes prompt us to write again about this subject.  The slowtwitch forum mentions a nonprofessional athlete who suffered an incident that made him bleed 8/29/18:

taking iron supps for 6 weeks now as I thought my H&H values, and iron were low when tested 6 weeks back. I have sent latest info to doc(online blood test order yesterday) asking for how to proceed/what to check. Doc wasn't really concerned 6 weeks ago, but I was as I didn't enjoy be tired/weak/fatigued/short of breath all the time. This is now 1 year(8/29/18) post heart slicing and dicing. Any thoughts from ST docs and "docs"?

Off-Score is calculated taking into consideration the average hemoglobin in a cycling population:

The UCI pilot project Following a meeting which took place in Paris in October 2007, between WADA, the French sporting authorities and the cycling family, UCI launched in 2008 a pilot project for the implementation of the hematological module of the Athlete’s Passport (Zorzoli & Rossi, 2010).

Since then, more than 800 athletes per year were enrolled in the program. UCI signed contracts with several sample collection providers in order to face the high demand of in- and out-of-competition tests. At the beginning samples were only analyzed in the group of laboratories that have been involved with the nostart tests for many years, because they were already participating to the same external quality control program that WADA has chosen (Swiss Center for Quality Control) and were all using the same technology. Progressively, as other WADA accredited laboratories were fulfilling the requirements to conduct hematological passport tests, UCI only relied on these laboratories for three major reasons: - The samples could be directly analyzed for the detection of forbidden substances or methods; - Decreased costs with sample transport when collection included both urine and blood; - Ease of the laboratory with technical and legal aspects related to anti-doping procedures (documentation package; chain of custody; testifying in court).

The experts were chosen by the UCI and WADA. All qualified in the field of hematology (either clinical or laboratory), sports medicine, exercise physiology or blood doping. Each week, 10 to 15 updated profiles were sent by the APMU to the experts for review. In these profiles the Bayesian adaptive model has identified the Hb or Off-hr score abnormal with a 99% probability (either for the single measurement as a function of previous results or for the complete sequence) or with normal or lower levels of probability.

The main problem in any research looking for answers related to a particular population is the sample.  In this case the professional cyclists.

Extrapolating the data to triathletes is not a big problem, hours of training are long, endurance sports for sure.  But let’s take a look at what Vincent Luis has for breakfast.

http://www.planetatriatlon.com/vincent-luis-desayuno/

This kind of breakfast make you anemic in a few weeks.  No wonder why Vincent and his teammates had a bad performance in Lausanne; perhaps with the exception of Mario Mola (small frame).  The average hemoglobin is very low because of the nutrition or bad illness.  Well-nourished individuals will have suspicions Off-Scores if we compare them to athletes eating the way Vincent Luis does.  We have information from a newspaper on Javier Gómez’s hematocrit values:

37% hematocrit the lowest, 42% average.  This talks about deficiencies in nutrients. 

https://www.lavozdegalicia.es/noticia/deportes/2011/04/12/gomez-noya-hematocrito/0003_201104G12P49991.htm

The average hemoglobin and hematocrit from African nations are lower compared to the Europeans.  This is not related to ethnic differences because athletes like Bekele have values similar to the Europeans in the 90^th percentile.

In summary, malnourishment exist in triathlon.  300 protein's calories per day could make the difference between being anemic or having a homoglobin above 14 for females.  

The Off-Score is based on malnourished athletes which represent the control group.  Is there a booth that takes complaints based on evidence?

Triathlon and Off-score

Reticulocytes measurements are not accurate most of the time, perhaps the interpretation is easier.  Reticulocytes are one of the two elements in the quick formula to flag a doping violation:

OFF-Score = (Hemoglobina (g/dL) x 10) – (60 X √% reticulocitos)

The aim was to prevent athletes from competing when their (HCT) or hemoglobin (HGB) values were higher than the established limit, which was the same limit for all athletes (population limit). For some sporting bodies it was considered as a medical rule, while for others it was a competition rule. The UCI introduced it in March 1997, and athletes were subjected to tests at or during competitions but not out-of-competition. Tests were conducted on the field, and the samples were analyzed on site. During unannounced bloods tests, several haematological parameters were measured, which included HCT, HGB, % reticulocytes (RET%) and the calculation of the stimulation index or OFF-hr score (Hb [g/L] – 60*√Ret[%]) (OFF-score).

https://pdfs.semanticscholar.org/e21e/c772138a49ebdb7a145f48fbca9b9a88c92c.pdf

It is not easy to obtain the software which takes into account the majority of the parameters because it is limited to the certified labs.  As ordinary mortals, our only option is to have an Off-score which has the disadvantage of measuring the reticulocytes:  Let’s see what Medscape says about it:

The automated hematology analyzer can also report a measurement of reticulocyte-specific hemoglobin content as mean reticulocyte hemoglobin content (CHr) or reticulocyte hemoglobin equivalent (Ret-He), depending on the type of instrument used. CHr and Ret-He, two comparable but not identical parameters, give a snapshot of the functional iron available for incorporation into hemoglobin within RBCs over the previous 3-4 days. ^[9] A decreased value generally reflects reduced cellular hemoglobin content and is reliable in identifying functional iron deficiency…

Note that the reference ranges for automated reticulocyte count (absolute reticulocyte count), immature reticulocyte fraction (IRF), and reticulocyte specific hemoglobin content (mean reticulocyte hemoglobin content [CHr] and reticulocyte hemoglobin equivalent [Ret-He]) vary owing to the different methods and different instruments used. Each laboratory should determine reference values according to their own methods and instruments. A comparison of different reference ranges as reported by different authors can be found in a review published article by Piva et al. ^[3]

As far as we know, Paula Radcliffe was scrutinized based on her Off-score:

https://www.facebook.com/213103522034028/posts/on-off-scores-and-doping-since-youve-probably-seen-that-paula-radcliffe-has-rele/1061634447180927/

On off-scores and doping, since you've probably seen that Paula Radcliffe has released the three off-scores in question to the media. Here's a quick summary of what it means (and doesn't):

Off-score is calculated using Hemoglobin & reticulocytes (immature red cells). Specifically, the equation is:

Off-score = Hb (g/L) - (60 x sqrt(Retic %))

If Hb is high & Ret% is low, then off-score is high, and vice-versa.

At some point, the off-score gets so high, it is strongly indicative of doping (the 1 in 100, 1 in 1000 thing). For example, Shobhukova had an off-score of 153 (yikes). The off-score can also be so low that it suggests doping, and these "cut-offs" or limits are known.

Radcliffe's values (115, 110 & 109) lie either just below (2) or just above (1) the off-score upper limit WHEN TAKING ALTITUDE INTO ACCOUNT.

That is, there is a different 'cut-off' to deal with altitude cases, because altitude is known to affect the blood. So a normal cut-off of 103 is increased to accommodate this recognized possibility/explanation.

Anyway, the point is that Radcliffe is NOT a Shobhukova type example, though her numbers are still high.

Where it gets tricky, however, is that off-score values are ONLY PART of the picture, which is why releasing 3 off-scores is not conclusive of anything, even if they are close to those cut-off limits.

That's because the whole premise of the passport is to measure CHANGE over time, and so a value can be "normal" and thus not flagged by itself, but when that value is looked at relative to others, it may be marked anyway.

Because of this, a 'spot' off-score of 100 might be more suspicious than a value of 110, if the preceding values were 70 vs 105, respectively. The biological passport software does have an adaptive component that works out a sequence score, but we're dealing here with "spot" off-scores.

The formula gives a lot of value to reticulocytes and a variation of .5% is a huge difference.  Measuring reticulocytes is not accurate, even the definition of reticulocyte is not accurate, and variations are bigger than 0.5% from lab to lab. We should spend our time and money educating athletes, instead of paying for research that is not accurate.