Thank you nickc, I think that covers it perfectly.
And mrlebowski wtf are you on!!! 🙂
I don't think I mentioned anything you have said so I'm not entirely sure of your point.
"I don’t think I mentioned anything you have said so I’m not entirely sure of your point."
My bad - reading on an iPhone & dirt obscured some of your post!
Sorry!
Anyway, don't the UCI/WADA look stupid now.......I mean just WOW..
Btw Froome took a standard TUE allowed dose of predisolone oral glucocorticoid in 2014 for an asthma exacerbation due to an infection. Something most asthmatics with moderate/severe asthma will have done. Wiggins received an on-label approved injection of kenscort which is the same glucocorticoid and also requires a TUE as it is not inhaled. The kenacort injection is a slow release intramuscular injection that provides low protective suppression of symptoms of allergy over weeks. The dose is the same as the oral dose for asthma but only given once not for five days. Neither dose has been shown to have performance enhancing properties. You really don’t want to take prednisolone chronically orally if you can help it. Performance studies use supratheapeutic levels and longer dosing periods. And rodents.
Sorry to disappoint, but neither of these two events are anything noteworthy. Kenacort injection is not a common treatment, but it is approved for just this use. As are intranasal steroids. Which may be less effective if you are as snotty as I am when I race! Glucocorticoids are much more effective than antihistamines as anyone with bad hay fever will know. Intranasal sprays have almost zero systemic exposure (unless you are taking certain HIV meds).
I wonder if L'Equipe will be reporting on the findings of WADA and particularly the comments by Fitch. You know, just so the French "fans" intent on heading out dressed as inhalers lobbing bidons of piss about are kept up to date with the latest findings.
I doubt they'll be interested though.
Guys - I have been asked to shut up so I will rather than addressing points put to me as all it does is further entrench positions.
For the record my view on Froome is changing as the evidence comes out as I have said from "guilty" to " dubious"
Point of order - Prednisilone and Kennacort are not the same drugs. 40 mg daily is a very high dose of prednisilone for exacerbation of asthma. Both are performance enhancing at the dosages used.
With that - consider me completely out of this debate please. I have annoyed enough folk and got annoyed enough myself.
OK?
Wiggins received an on-label approved injection of kenscort
Sorry to disappoint, but neither of these two events are anything noteworthy.
Is that the same Wiggins who claimed never to have injected?
Prednisilone and Kennacort are not the same drugs. 40 mg daily is a very high dose of prednisilone for exacerbation of asthma.
Bollocks, frankly. My son is currently on 30mg daily for exacerbation of asthma due to hayfever. He is 15, 5 foot six and weighs 50 kilos. The GP looked up the correct dose for his weight and height. I checked it later on.
Froome is, allegedly, 6ft 1ins and 68 kilos. Go figure.
The maximum recommended dose for an adult for asthma exacerbation is 60mg daily.
You could at least look it up on BNF before making such an assertion.
Interesting, so what about Millar's thoughts on Kenacort - he seems to think it was weapons grade stuff? Maybe at a different dosage?
https://www.nytimes.com/2016/10/16/opinion/sunday/how-to-get-away-with-doping.html?_r=0
5 foot six and weighs 50 kilos
So pretty big for the pro peloton then 😉
Sorry TJ is correct. My mistake. Kenacort is triamcinalone another glucocorticoid steroid. It’s relative potency is 40/32 or about 1.33 times prwdnisolone, so really no much difference. For comparison fluticasone is many many times more potent.
as for the no needles, well it does look like a contravention but perhaps the detail was for non approved indications and vitamin supplants etc. I assume they were not denied a flu vaccination? I do not know.
So pretty big for the pro peloton then
I'm not noticing any major performance gains at the moment. I'm planning to give him some FTP tests when he stops coughing so much.
40 mg daily is a very high dose of prednisilone for exacerbation of asthma. Both are performance enhancing at the dosages used.
Please stop with this sort of hyperbole, 40mg is not a "massive" or "very high" dose, it can be a lot of pills in one go if you're offered 5mg tabs (so you end up taking 8 pills in one go) but it's still a normal dose.
Neither is it particularly performance enhancing; one of the long term effects is weight gain (for example)
A possibility that Sky’s defence rested on the validity of the test?
Sky and WADA have indicated in their press releases that the main plank of the defence was Froome demonstrating that his AAF test result was within the range of "natural variability" for a series of Salbutamol tests taken over the course of the race. Froome's result included the adjustment which was introduced into the test for the specific gravity of urine (which is why the original test value was revised downwards).
Despite the alleged limitations of the test, it only appears to have caught a small number of people, despite the large number of professional athletes that appear to be using Salbutamol.
My thoughts on Millar is that either he did not have it intramuscular, but subcutaneous instead (both injections) and hence would have very much higher concentrations over a shorter period. And repeatedly. Or it was a placebo effect.
TJ the patients in our severe asthma studies are taking those doses all the time for exacerbations. It is really not a large dose. It would be a large dose for maintenance therapy (5 mg is more usual), and in the age of biological therapies, one would like to remove oral use completely. See
https://www.ncbi.nlm.nih.gov/m/pubmed/25199060/
And the fluid retention, lipid changes, fat redistribution, bone weakening, etc... with chronic oral use are not performance enhancing.
40 mg daily is a very high dose of prednisilone for exacerbation of asthma
As stated above it is entirely normal for an asthma flare. In fact (not opinion) the standard guidelines (British Thoracic Society) state that 40-50 mg is the standard dose for an acute flare and emphasise the need for adequate dosing. I wouldn't normally correct but IIRC you are in the health profession TJ (apologies if I got that wrong) and so you would understand that your opinion on drug dosing carries a certain weight. To be absolutely clear it is a dose prescribed every day in GP and Respiratory clinics round the country for asthma flares. I have never ever heard it described in a medical setting as a "massive" or "very high" dose for this purpose. It is simply misleading to state otherwise.
I tend to avoid commenting on doping threads. Not because I'm not interested. I've followed pro cycling since the 80s, so doping has always been a big part of the story. More because sensible rational people whose posts I generally enjoy seem to become quite irrational on these threads and I don't want to fall out with people that I generally like.
Anyway, I just wanted to say well done to everyone for mostly keeping this one pretty civil for 10 pages and for all the interesting points made.
TiRed, this what Millar says:
"
<p class="css-1i0edl6 e2kc3sl0">On one occasion, I received a T.U.E. for a fake tendon issue. A doctor simply wrote a prescription for an ankle injury that required an intra-articular injection, although the injection was then administered intramuscularly (at the time, injecting the drug intramuscularly was banned, hence the need to lie on the T.U.E., because, I can only assume, it is more powerful when administered in that way). The maximum dosage I ever took was 40 milligrams, which is in the range of the manufacturer’s recommended dosages.</p>
<p class="css-1i0edl6 e2kc3sl0">The Kenacort was so powerful that it was ultimately destructive: Apart from being a catabolic agent, it would also suppress your immune system, making you more susceptible to infections. I didn’t like taking it, but I was so deep into what I was doing at the time that I did what I considered had to be done. Still, I took it only twice after 2001: for the 2002 Vuelta a España and the 2003 Tour de France. Both were big targets, as, for the first time, I was aiming for a high placing in the overall classification, and this required me to be lighter and stronger than ever before. Both times, I took an initial 20 to 40 milligram dose, and then topped up with 10 to 20 milligrams about 10 days later, in order to prolong the effects into the final week of the three-week stage race and to avoid too rapid a descent off it."</p>
So, intramuscular & multiple doses.
Shall we take bets on how much money the lawyers appointed by Petacchi and Ulissi will be asking for?
Doesnt seem much point chasing retrospective remediation for an event that occurred over 10 years ago, and to what end? Reinstatement of classification? Loss of earnings (dropped from team and banned for a year)?
I’d hazard a guess that there is some sort of statute of limitations in place at the UCI.
Good point though, if opened up could result in many retrospective claims.
On the question of the placebo effect, in "Breaking the Chain", Willy Voet, the Festina soigneur, who was busted with a boot full of drugs in 1998, describes Richard Virenque pleading for a dose of a new wonder drug that he had learned another team were using. Voet was worried about adding something else to the mix of stuff that Virenque was already taking, and in the end jabbed him with a syringe of saline solution to keep him quiet. Virenque declared that he had never felt so good when he raced the next day!
I used to know an Orthopaedic surgeon who also was involved as a physio for a Scottish football team. He would give saline injections for injuries that he didn't think were injuries, which were very effective
Going off topic here so I apologise now….TiRed, think we may need to agree to disagree on the Wiggins Kenacort use. Kenacort is a strange one, I don’t think we can safely say “Sorry to disappoint, but neither of these two events are anything noteworthy.”
From Jeroen Swart ( https://cyclingtips.com/2016/09/team-sky-tue-controversy-why-one-medical-expert-has-real-concerns/)
But the benefits of corticosteroids are documented. Not only in peer-reviewed scientific manuscripts that have demonstrated statistically-significant performance enhancing effects of corticosteroids in endurance sport. But you have also got the testimony from a large number of riders, ex professionals. David Millar’s testimony in his book. Laurent Fignon when he got diagnosed with cancer. Armstrong admitted to the use of corticosteroids. There are probably dozens of others if you went hunting for them.
The use of corticosteroids as a performance-enhancer in cycling is, from an anecdotal perspective, is very well founded and from a performance perspective in science in competition, definitely evidence is there.
So you are taking a long-acting corticosteroid just before a Grand Tour, and the chances are you can gain a performance benefit out of it.
Michael Rasmussen talked about applying for a TUE to get this injection. He said that Geert Leinders did exactly that for them. He would apply for a TUE for some arbitrary illness, and then inject them with exactly the same substance, Triamcinolone acetonide, just before a Grand Tour.
From the Secret Pro….
"I’ve never taken Kenacort, but from what I have heard, it’s just rocket fuel. All of my injuries have involved me ending up in the hospital. I can only take it from guys I’ve spoken with, how good it is. Supposedly it makes you bionic. It strips down any muscle you’re not using, and any fat you have is used as energy. Your arms waste away, your legs become lean; the muscles you do use become all muscle, no fat."
Pretty similar to what Millar says. https://www.nytimes.com/2016/10/16/opinion/sunday/how-to-get-away-with-doping.html
My thoughts….Isn't the thing about Kenacort that not only does it reduce body fat it also preserves glycogen thus enhancing performance which is what you would want for an endurance sport? Along with the possible PED advantages it also aids with recovery, reducing any inflamations a rider may have? Should pre-emptive use of a Corticosteroid be allowed? Ethically I don’t think its correct.
Looks to me like it’s not really safe to say that Wiggins’ injection of kenacort was nothing noteworthy. Its been used as a PED since the 1960’s. I also accept there are other medical studies showing no performance enhancement. So its quite contradictory and in my opinion based on the history of the usage of the drug, the fact that Team Sky doctors wouldn’t allow Wiggin’s doctor to order a fourth TUE by changing the password on the Adams system, by the lack of medical records kept by Sky, make it in my opinion noteworthy.
I’m familiar with millar’s rocket fuel quote. I’ve also conducted a lot of placebo controlled trials. If it is administered intramuscular then the absorption is very slow and the levels remain low compared with oral dosing.
Wiggins use was on-label for an approved medicine at the approved regimen with a documented medical history. I don’t have a problem with that.
for salbutamol, athletes must undergo a reversibility test to show that the have airway obstruction. Exercise induced asthma is a legitimate indication and salbutamol only restores normal function. It’s pretty hard to bronchodilate healthy volunteers. I spent years trying!
Salb can be a PED if ingested at chronic levels though TiRed or do you think otherwise?
I've seen 4 studies which, if I've understood correctly, indicate that chronic uptake can increase maximal aerobic power:
https://www.ncbi.nlm.nih.gov/pubmed/16195983
https://www.ncbi.nlm.nih.gov/pubmed/16687481
https://www.ncbi.nlm.nih.gov/pubmed/22230921
http://suppversity.blogspot.com/2014/09/albuterol-salbutamol-doping-works.html
The research looks legit to me.....what are your thoughts?
As for it's use for asthma in athletes I've obviously no issue there.
https://www.bbc.co.uk/sport/cycling/44694122
So who has read it all yet?
Team Sky have taken the unprecedented step of releasing a cache of data to BBC Sport detailing Chris Froome's diet, power output and heart-rate from the Briton's victory in May's Giro d'Italia.
Thanks for the link...
But you can keep the sarcasm....there's no need for it.
The other riders who also requested Kenacort for PED reasons behind false TUE’s were also on label for an approved drug. They’ve since confirmed their usage and how they played the TUE system.
I’m sure you’re familiar with Geert Leinders, the Sky doctor in 2011 and 2012, who was banned for life in 2015 for doping violations.
“Rasmussen – who was thrown off the Tour de France in 2007 because of disparities in the information he gave over his whereabouts for out-of-competition testing – claimed that Leinders assisted him with blood transfusions during the 2004 and 2005 Tours de France and the 2007 Giro d’Italia, that Leinders wrote false medical certificates to enable him to use cortisone”
Just seems strange, that a drug used as a PED since the 1960’s, used by a doctor in professional cycling as a PED, one who gave out false TUEs, who worked at Sky during the years in question, a rider who injected it, but then said he never had injections, whose team had a no needle policy. A TUE which was used as preventative, using a drug that is not the best or most appropriate for the condition, was used. By a team who didn’t keep any medical records of who was given the treatment, what amounts they were given or how often.
When I read things like this it makes me think, hmmm, maybe something fishy went on with Wiggins’ TUE as well....
http://www.cyclingnews.com/news/westra-admits-using-tues-for-performance-enhancement/
Anyone follow the Anti Cycle Cycle Club on Insta or FB, if not you are missing out on some very witty/sarcastic posts.
But you can keep the sarcasm….there’s no need for it.
Sarcasm? Who's post was that in?
To paraphrase Paracelsus, the dose makes the poison. Those studies look well controlled. But oral doses of 12000 micrograms per day will give you a lot more adrenergic drive than 1600 much/day, which is the maximum allowed daily dose of salbutamol
Yea it can be performance enhancing. But there is a reason why we go to all the trouble of developing inhaled drugs. Patients would really much rather take tablets, but topical inhaled drugs like salbutamol and inhaled steroids keep lung pharmacology high and systemic pharmacology low.
Cheers TiRed - nice to have someone around who can be objective.
Not sure who Paracelsus is, was that the Jiffybag courier? (Ah, well I thought it was amusing!)
Reading the BBC Link from MikeWSmith makes great reading. The numbers, in terms of watts and duration are awesome. Planned timing and power 45 mins at 350 watts, 45 mins at 250 watts, recovering for an hour at 200 watts, followed by just over an hour at 400 watts, Froome managed 407 watts for the climb. Just seeing how organised the team is in terms of energy expenditure versus energy consumed is really interesting.
16 mins averaging 603 watts - wow. Makes my 1 min effort look incredibly feeble!! (Note to self, must try harder!)
Not read the full document yet, but will do this evening. Just shows he is a machine, and as the article says, a perfect match between intelligence and athletic ambition.
Back to Froome and the Salbutamol, some really interesting quotes from Dr Jeroen Swart yesterday, which I fully agree with....
"So my take on the Froome issue. This has been brewing for some time. 1) There is limited evidence for Salbutamol being on the list in the first place. Other more pressing substances aren’t on it. 2) The thresholds were based on very limited research. This is WADA’s mess."
"It just took someone who had the finances and means to challenge the regulations on Salbutamol and they’ve been found wanting."
"My opinion: Take Salbutamol off the list. You get more bang for your buck out of a cup of coffee. Then put Tramadol on it. And prohibit Corticosteroids at all times. Hopefully some changes soon."
That's a good read but I've yet to listen to the podcast or read any other analysis. You have to me impressed by Sky's planning.
The only thing I'd call out at this stage is the "Beta Fuel" & it's claims of being ground-breaking. It seems somewhat hyperbolic. The Glucose/Fructose science has been out for over a decade to start with.
Anyway, thoughts are:
SIS at 500ml has 80g of carbs.
Torq for example has 30g of carbs at 500ml.
They are both isotonic, though I can't find out anything on SIS & how you mix it.....so I'm stumped by that a bit.
Exercising at the kind of intensity on Finestre would require about 60-90g per hour. So, either you have 1 bottle of SIS or 2 bottles of Torq - with the bottle being 750ml. It would appear that the SIS would be really quite syrupy so you might need another source for hydration.
So the only difference I can see is it's more concentrated & then secondly how have they managed it & kept the drink isotonic?Or is it balanced out by having a second source for hydration?
Any new research out there?
Just to say that this thread has been most illuminating, thanks to those who have been able to explain the science around the testing, the drugs and protocols. Its much appreciated. Having an acquaintance who was subject to a ban brought about poor testing/contamination I have been aware that those who we rely on to police the sport can and do make mistakes.
Teadious point scoring from me. Perhaps there would be a little less suspicions about from if he was not on a Murdoch sponsored team.
16 mins averaging 603 watts – wow
It's 16 seconds. If he was reporting that power output for 16 minutes, you would definitely be stripping his bike down to look for a motor.
14 Go gels? That's an effective weight loss plan... Wouldn't want to ride behind anyone consuming that amount
Any new research out there?
Cycling Weekly from last week (28th June edition) has a whole article about nutrition science and how new research in "the understanding of carbohydrate uptake" has lead to new products, higher carbs per hour uptake etc.
It's actually quite an interesting piece, seems well researched.
Context is everything with the data. As Michael Hutchinson points out, without being able to compare this to other riders, it's difficult to draw overall conclusions. Probably in an ideal world we should be logging everyone in the race and continuously analysing the results to spot odd patterns. That doesn't sound completely unfeasible, based on current technology, and it might be more effective than retrospectively trying to catch cheats by looking for drugs.
Haha, I was thinking 16 minutes at that power was ridiculous!! But then 400 watts for over hour just seems crazy to me as well. Thanks for highlighting my schoolboy mistake. I even had a quick look on my sufferfest passport to see my 5 second power to compare it. Going to go on the wattbike tonight and see what I can maintain for 16 seconds - yep I won't be 18 days into a Grand Tour or already climbed some tough mountains, but apart from that surely its a close scientific comparison?!? We do weigh the same afterall.....Even if I'm 5 foot 8 and he's 6 foot 1.
Yeah the 14 gels, not nice. I struggle with 2 gels on a long ride. But then again I prefer real food (by real food I mean cake).
Wonder if my cappuccino with one brown sugar in it is classed as isotonic?
Cycling Weekly from last week (28th June edition) has a whole article about nutrition science and how new research in “the understanding of carbohydrate uptake” has lead to new products, higher carbs per hour uptake etc.
That's interesting, because the conventional wisdom for carb drinks used to be that mixing them at too high a concentration wasn't good for your performance, and you should aim for around 7% carbohydrate solution. I once rode a marathon event where my wife was doing support, and I thought one of the bottles she handed me towards the end tasted a bit different. I later discovered that instead of carefully measuring a couple of small scoops of powder as recommended, she had just tipped about half the packet into the bottle. I did get a good result, so perhaps she was just ahead of the sports science research curve!
"
Cycling Weekly from last week (28th June edition) has a whole article about nutrition science and how new research in “the understanding of carbohydrate uptake” has lead to new products, higher carbs per hour uptake etc.
It’s actually quite an interesting piece, seems well researched."
Is there a link? I'd like to read that.
I just compared the Froome power and heart rate data against my commute to work today, trying to match a sector as closely as i could while allowing that he's a bit younger so his ave HR against mine as a % of max would mean his would be a bit higher.
Froome - 40mins at ave power 408W, ave HR 142, ave cadence 94
TOJV - 43 mins at ave power (est) 254W, ave HR 137, ave cadence 92
Apart from the fact he's 20kg lighter, and his 40mins saw him climb 1538VAM's (mine was 114) - do you think I could go pro 😉 ?
(disclosure, I had to sit down for a bit after getting here)
400W average for 75mins up Finestre on stage19 is mind boggling ~5.8W/Kg and shows how crap I am in comparison, ~3.2Kg.
The good news is, there is room for improvement, if my middle aged body is willing before it starts disintegrating! 😆
