Triathlon and Meldonium

Is it that athletes suddenly became stupid and were caught using Meldonium? We have always say that we do not need doping if we follow an orderly life considering nutrition, recovery and training.  But most of our athletes are not educated well to follow a life for success.

We have posted an article related to genes and training.  The use of meldonium reminds me of patients addicted to heroin whom I used to detoxify, they continue to have bone pain for several months after stopping heroin, even when they were getting substitutes.  The up-and-down-regulation after inducing genes takes months to come back to normal, reason why athletes using meldonium could not go “cold turkey” after January first of 2016.

Up-regulation and down-regulation[edit]

Up-regulation is a process that occurs within a cell triggered by a signal (originating internal or external to the cell), which results in increased expression of one or more genes and as a result the protein(s) encoded by those genes. On the converse, down-regulation is a process resulting in decreased gene and corresponding protein expression.

·         Up-regulation occurs, for example, when a cell is deficient in some kind of receptor. In this case, more receptor protein is synthesized and transported to the membrane of the cell and, thus, the sensitivity of the cell is brought back to normal, reestablishing homeostasis.

·         Down-regulation occurs, for example, when a cell is overstimulated by a neurotransmitter, hormone, or drug for a prolonged period of time, and the expression of the receptor protein is decreased in order to protect the cell (see also tachyphylaxis).

https://en.wikipedia.org/wiki/Regulation_of_gene_expression

5 août 2012

Triathlon and Genetics

Inducing Genes versus Maximizing Gene Expression

Wiggins wins the time trial at the London Olympics.  At the age of 20 he was winning in the track, where the only way to increase velocity is by increasing cadence.  Wiggins transformed himself genetically by inducing genes that could help pedaling at high cadence; he just needed time on the bike to win the Tour the France.  At the same time, he was learning more about the peloton.  The next step was to maximize the gene induction that he had produced while practicing cadence on the track; and this is done with long hours on the road keeping what was induced manifested through technique and cadence. Inducing genes is the job to accomplish before the age of 20 if you want to be like Wiggins.

Gene induction is the job done with Armstrong as pointed out by Edward Coyle and it is translated as PEDALING EFFICIENCY.

http://www.edb.utexas.edu/coyle/content/armstrong%20article%20JAP.pdf

Although during all laboratory measures of mechanical efficiency, cycling cadence was held constant at 85 rpm, this individual’s freely chosen cycling cadence during time trial racing of 30- to 60-min duration increased progressively during this 7-yr period from 85–95 rpm to 105–110 rpm. This increase in freely chosen revolutions per minute when cycling at high intensity is indeed consistent with increases in type I muscle fibers because cyclists with a higher percentage of type I fibers choose a higher pedaling cadence when exercising at high power outputs (22). Although this may initially seem paradoxical, higher cycling cadence serves to both bring muscle fiber contraction velocity closer to that of maximum power and reduce the muscle and pedaling force required for each cycling stroke. Keep in mind that when exercising at a given rate of oxidative metabolism, an 8% increase in mechanical efficiency will result in 8% more muscle power and force development on the pedals when cycling cadence is held constant. As cycling efficiency increases due to increased percentage of type I muscle fibers, it is possible that increased power is manifested by increasing cycling cadence (i.e., velocity) rather than increasing the muscle forces directed to the pedals. This approach appears to produce less sensation of effort relative to muscular strength (27). Therefore, it is likely that the increases in freely chosen cycling cadence displayed over the years by this Tour de France champion reflect his increased mechanical efficiency, agreeing with the pattern expected to result from muscle fiber conversion from type II to type I.

Nowadays is not enough maximizing genes; we need to induce genes in order to maximize performance. Translated differently what I said, do not expect to have an athlete with the full speed and just add mileage after DISCOVERING HIM or HER.  You have to INDUCE THE GOING FAST GENES by increasing cadence and improving technique.  Guennadi Tourestki puts it more elegantly: “10,000 hours in the water are needed to discover talent.” And for that same reason, PLEASE EDUCATED THE KID first to be able to induce genes. Wiggins could improve from what we see from his interview; fortunately, he got the genes induced on time or after a break from his self.

Triathlon and Malnutrition

I watched the documentary Armstrong Lie.  I had some time to see it as a psychiatrist, teacher, coach, doctor, and researcher.  It is an eye-opening experience, no wonder we have the “global warming.”  Armstrong is right:

Lance Armstrong: "I grew up ... like a wild animal" http://www.businessinsider.com/lance-armstrong-biggest-mistakes-2015-12 …

I had a seven-year-old child who came with his parents because “he cries when the bad guy dies in the movie.” Many kids grew up like that and they become athletes. They have problems following rules and never acquire a helpful education to take care of themselves or their business (professional athletes).  Malnutrition is a consequence of this lack of education (unable to follow rules) and doping is a consequence to take a shortcut for something that is doable with education (to eat properly at the right time).  We have children who refuse to eat as indicated to keep the caloric intake as well as the vitamins and minerals to recover from training in order to continue training.  Parents complain about it but they do not do what is needed.  How to overcome this problem?  This is a unique problem for the athlete and his family.

In a matter of a month, hemoglobin can drop one point if the caloric-protein intake is not enough to keep up with growing up and training.  This is what we encounter with some of our athletes, close to 50% of our children are at the border of “normal” values for a CBC (complete blood count).  The erythrocytes are small and neutrophils count is low, even though the ferritin is above 35. This scenario happens when the calories do not reach 4,000 a day. 

Eufemiano Fuentes said that he was treating athletes and not doping them when he was charged of doping patients:

30 janv. 2013

Operación Puerto and Triathlon

I will paraphrase what Eufemiano Fuentes mentioned during his interrogatory in court for the English speaking readers.  I copy from the newspaper Marca.  There are videos related to the interrogatory in the same newspaper. 

Fuentes is questioning the way doping is considered because he believes that he was treating anemia.  It is interesting because the dilution of blood when training is well known and could mimic anemia.  He mentioned that he was giving the amount of blood needed to get to the normal level, always using the same subject’s blood.  This does not sound incorrect from the point of view of a medical doctor except for the fact that the problem can be solved differently by administering the right amount of nutrients at the right time; instead of the blood itself. Fuentes says that time was the limiting factor; he needed to have ready the competitor in a few days or perhaps weeks.  But he knew also that the administration of blood was doping for the UCI rules.  Fuentes questions that there is a hematocrit value of 50 as an upper limit; but there is no low value accepted by the UCI to be treated.  He took care of his athletes because there is a danger in practicing cycling at a professional level with a low hematocrit.

Triathlon´s Vital Signs

We tend to forget what vital signs mean.  In Medicine, vital signs are the most important aspect of the patient to consider.  I follow a 95-year-old patient daily and the vital signs are our guidelines for treatment.  Historically we have four vital signs: blood pressure, temperature, heart rate and respiratory rate.  The vital signs should change as much as they could change in teenager for a 95-year old lady.  When she runs out of oxygen in the middle of the night because she removes it while sleeping, her pulse can be 10 beats higher in the morning as if she had a hard work out during the night.  Her saturation can drop to low 80’s if she does not have oxygen at night.  I do not need to know what happened during the night when checking the heart rate in the morning; during the day her saturation stays above 92 without oxygen.

Temperature should not change or being above 37 degrees Celsius.  If it is higher than that we should stop practice for the day at least and a differential diagnosis for fever should take place.  DO NOT LET THE DIAGNOSIS OF HAVING AN INFECTION FOOL YOU.  Above 37 degrees Celsius of core temperature can help you to understand athlete´s life; is the athlete resting well? Is the athlete eating well? Check the Complete Blood Count and find out about the erythrocyte production.  Even if the athlete does not have anemia, nutrition could be a problem for repetitive infections (we all have bugs but other factors play a role in athlete’s illness).  Even if athletes eat well, resting is another variable; and by the same token, lesions in athletes (ask the footballers).  We found out that our triathletes were out in the middle of night after we checked lactate levels at rest in the morning and they were 2 or above.

High blood pressure should not be present in athletes unless something very important is happening somatically.  Is the athlete withdrawing from drugs? Is the athletes falling into kidney failure (you should have many other signs by then)?  No athlete should faint unless something is really bad (Laurent Vidal fainted years before he died).

Respiratory rate and heart rate are intertwined.  The second to second regulation is done by the amount of CO2 in arterial blood.  They both go up when CO2 increases but there are adaptations to this phenomenon of CO2 increment.  The respiratory rate adapts first, so the heart rate stayed up and helps to monitor fitness or CO2 retention without the need of getting Arterial Blood Gasses in somebody who is monitored several times during the day.  This is our observation in a 95-year–old lady who has been monitored for more than a year.

Weight is not a vital sign but helps to monitor patients.  Weight increment of 1.5 kilograms is the norm comparing the morning weight and evening weight in the same athlete.

How can we apply this to triathlon? Let’s take the heart rate and weight.  We have had the cardiac monitor for several decades already.  It is part of an educated triathlete, but how much we want to ignore about weight?

There is a study (many studies have been published) which gives information about weight in horses the way we can understand running in humans:

Table 2 shows the velocity versus oxygen consumption for a TB horse.  Column one is the horse speed (feet per second, ft/sec) on the treadmill, column two through five are the oxygen consumption values (ml/kg/min) on the treadmill, column three for running on sand (simulate the race track), column four is for a jockey weight of 130 pounds and the last column for a jockey of 110 pounds.  The table shows that at a constant speed the oxygen required increases as the load condition increases running in sand or carrying weight.

Table 2:

Velocity                Oxygen                 Running          Jockey           Jockey

                         Consumption in Sand           Weight           Weight

Vel, ft/sec	O2, ml/kg/min	1.2	130	110
5	15.5	18.6	20.84	20.49
10	26	31.2	34.96	34.38
15	36.5	43.8	49.07	48.26
20	47	56.4	63.19	62.14
25	57.5	69	77.31	76.03
30	68	81.6	91.42	89.91
35	78.5	94.2	105.54	103.79
40	89	106.8	119.66	117.68
45	99.5	119.4	133.77	131.56
50	110	132	147.89	145.44
55	120.5	144.6	162.01	159.33
60	131	157.2	176.12	173.21
65	141.5	169.8	190.24	187.09
70	152	182.4	204.36	200.98
75	162.5	195	218.47	214.86
80	173	207.6	232.59	228.74
85	183.5	220.2	246.71	242.63

The same thing is happening to humans running but the effort can be greater when relating them to the center of gravity and weight.

The effect of weight at other locations other than the center of gravity can have a significant impact on oxygen consumption levels.  Myers (1985) found that the cost of adding a given mass to the limbs is significantly greater than adding it to the center of mass and that this effect becomes more pronounced as the limb loads are moved distally (towards the foot).  Miller (1987) showed a 0.8% increase in oxygen consumption for ankle weights of 100 grams on human runners.  A 600-gram weight at the center of gravity would result in the same increase of oxygen consumption.  Relative to horse racing, any increase in extra weight carried along the leg and at the hoof could impact on a horse’s performance.  For example on a muddy or sloppy day a large horse (large hoof) could end up carrying extra dirt in its hoof relative to a smaller horse (smaller hoof).  Also the come from behind type of runner could have additional weight along the legs from mud being thrown back from horse’s in front.  This extra weight could be enough to cost a win.

We are not kicking a dead horse!  Flying while running has implications for performance if we consider weight into the equation.  If we have a cadence of 200 rpm running a mile in 4 minutes and we cannot compete in triathlon running the last 10k, it is because we cannot fly in triathlon after the effort on the bike or due to the way we pedal during the race.  In addition to what we know scientifically we have many examples of low cadence running and inability to run in an Olympic distance triathlon. I have seen Lukas Verzbicas running the last 10k in Puerto Progreso this last weekend and he was running above 33 minutes the 10k.  I have seen videos of Alan Webb running after swimming and biking and he was not able to “fly.” They keep the same cadence without flying.  What have we learned from horses?  Keeping the weight (if extra-weight) at the center of gravity does not affect performance so much.  Increasing cadence is another one, it keeps the center of gravity in front of us most of the time; horses increase cadence to go faster because they cannot increase flying time as humans do.  Flying after the bike is very difficult to do and sometimes impossible because the way we develop our muscle doing our bicycling training.

How we can keep weight at the center of gravity? We need technique for running.  Yes, there is a technique for running and we have pointed out in this blog.

28 juin 2013

Triathlon and Running Technique

Triathlon and “Concussion”

It is refreshing listening to Bennet Omalu, MD.  Omalu is the real hero of the story; he makes me wear my MD hat with proudness.  The interview given by Eric Topol is very enlightening and helps to understand what life is about.  Topol was fired at the Cleveland Clinic when he went on against Merck and the Cleveland Clinic for using drugs that created more harm than the opposite:

Topol's advocacy on the subject led to what the New York Times described as an "unusually public dispute" with the Cleveland Clinic's leadership over ties between the academic institution and the pharmaceutical industry, ultimately leading to Topol's departure from the Clinic after his administrative position as head of the Clinic's academic program was abolished.

https://en.wikipedia.org/wiki/Eric_Topol

What does it have to do with triathlon?  Triathlon is not a contact sport but competing in places without organization and contaminated as it would be the case of Rio endangers competitors.  Organizers do not care about the problems the athletes will have.  Triathletes do not speak clearly about this danger because they already competed in Beijing, and they are afraid of mentioning the dangers to authorities.  Fighting against our corrupted Federations is a parallel to what happened to Bennet and Topol.  We have written an article regarding Topol:

21 déc. 2012

Triathlon and the legacy of Eric Topol

Bennet makes me rethink what we do as human beings: “Do what you need to do if you are seeing things.”  He was misjudged because he is an African. He suffered the “white privilege,” and was able to survive it.  Thanks man!  Your actions help us to stay human.

http://www.medscape.com/viewarticle/856308

  

The address is for Topol´s interview with Omalu in medscape. Below is Will Smith with Omalu

Triathlon and Lance Armstrong

We have learned many things from Armstrong.  “The only rational way of teaching is with the example, even when we are not a good example,” quoting Albert Einstein. We learned about how pervasive doping is in cycling and it was even worse; we learned how people lied even when they can lose everything.  Are they stupid? Nope, lack of the right education to live according to the new circumstances is the problem.  It is Peter´s principle: “The capacity to perform well disappears when we do not have the tools to deal with the new scenario.”  It is the case of Debi Thomas.

Lance Armstrong: "I grew up ... like a wild animal."

This week, Lance Armstrong said he made two really big mistakes in his life, and one of them has proved to be much more costly than the other.

One was doping, the other mistreating people.

The disgraced global sports icon was speaking on "Movember Radio" with CEO Adam Garone in a podcast published on Tuesday.

Armstrong, 44, talked about how attacking people during his cycling career proved to be a much more significant mistake than his actual doping…

He replied: "Understand that you may face some decisions in this sport, but, man, don't ever isolate, attack, ostracize, incite another human being."

Armstrong, who was raised by a single mother, added, "My mom and I had more of a brother-sister relationship ... I never had that person that in my life — and I'm not making excuses — but nobody ever tapped me on the shoulder and said, Dude.

"I sort of raised myself. But nobody ever said, Dude, what I just saw. Never do that again. And so it is what it is. And I got to live with that and spend the rest of my life trying to make it right."

Our posts are an effort to teach our kids to think about what is coming for them in order to acquire the tools to face a much more complex reality.  We have said: Dude, what I just saw. Never do that again.  Sometimes parents are unable to say it for the very same reason Armstrong mentions, and teachers do not speak clearly because they are afraid of losing their jobs.  We have to say it knowing all possible consequences.  Most of the time we are counterattacked by pointing out our mistakes instead of looking at how to improve as a whole.  This counterattacking is an ingredient of poverty and perhaps the strongest that keep us poor. We are unable to reflect as Armstrong is doing.  I am not sure that Armstrong will do what is needed because he has a habit/addiction that is very difficult to irradicate but reflecting is the first step. 

There is a well written article that looks into this matter from a psycho-social point of view:

Born to Be Conned

By MARIA KONNIKOVADEC. 5, 2015

New York Times

And the stories the grifter tells aren’t real-world narratives — reality-as-is is dispiriting and boring. They are tales that seem true, but are actually a manipulation of reality. The best confidence artist makes us feel not as if we’re being taken for a ride but as if we are genuinely wonderful human beings who are acting the way wonderful human beings act and getting what we deserve. We like to feel that we are exceptional, and exceptional individuals are not chumps…In a sense, all victims of cons are the same: people swept up in a narrative that, to them, couldn’t be more compelling. Love comes at the exact moment you crave it most, money when you most need it. It’s too simplistic to dismiss those who fall for such wishful-seeming thinking as saps — just as it’s overly neat to dismiss the types of people who would take advantage of them as unfeeling psychopaths…Nobody thinks they are joining a cult, David Sullivan explains. “They join a group that’s going to promote peace and freedom throughout the world or that’s going to save animals, or they’re going to help orphans or something. But nobody joins a cult.” We don’t knowingly embraces false beliefs. We embrace something we think is as true as it gets. We don’t set out to be conned. We set out to become, in some way, better than we were before.

The great Jacques Lacan would say:  “L’amour, l’amour…c’est pour ça qu’on a inventé l’ inconscient (Jacques Lacan, Le Seminaire, Livre XX; 11).” Armstrong is working hard trying to understand why he blew his life up, perhaps for the sake of his children.

20 août 2013

TRIATHLON AND PETER PRINCIPLE

24 juil. 2013

Tour de France, the Best of the Dopers