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Cortisone Use and Abuse in Cycling

Cortisone Use and Abuse in Cycling
4
Jul

We spoke with Cycling Ireland Doctor, Dr Conor McGrane to get his thoughts on cortisone and it’s relation to cycle sport.

Lars Boom is the latest of many cyclists who have shown a low level of cortisone in their blood before a major race. While this is allowed by WADA it is seen as a sign of poor health by the MPCC who have requested that riders be withdrawn until their cortisone levels return to normal.

Testing for cortisone is a complex and indeed confusing process. It is a naturally occurring hormone which is present in all our bodies. Levels vary from day to day and even from morning to evening. They can be affected by illness, inflammation but also by the use of inhalers, tablet and injections of artificial cortisone. These artificial forms can be detected but only sometimes. It can also be difficult to tell if the levels are simply normal for that person, the result of illness or the result of doping. WADA is constantly trying to refine testing to more accurately tell which is which.

Cortisone or corticosteroid in its various forms are one of the most commonly used medicines. It is a drug which is easily available, cheap and its effects in illness are well documented. Usually it is used to reduce inflammation in its many forms. It is an important treatment in illnesses such as asthma, inflammatory arthritis and joint problems, severe allergy, bowel inflammation (chrohns and ulcerative colitis) and some skin rashes. Many cyclists have commented that is used almost routinely in some teams although this has not been proven.

It’s available as cream, tablets, inhalers and also injections. Used without good cause it is a banned drug under the WADA code. While creams and inhalers are permitted with prescription the use of tablets or injections is supposed to be more strictly controlled. Generally it requires a TUE (therapeutic use exemption), in advance if possible, and often a period out of competition. This is both to protect the health of the athlete and to prevent overuse or abuse of the drug.

There are a huge amount of known side effects. Fluid retention, low potassium, weight gain, muscle weakness, mood swings and even psychosis, diabetes, high blood pressure, ulcers, thin skin and easy bruising, stretch marks and osteoporosis/fractures are just a few.

The effects of cortisone as a performance enhancing drug (PED) are not well listed. This is for a number of reasons. Being a banned drug without permission its use tends not to be publicised and effects not reported. For the same reasons research on its effects isn’t usually published in medical journals which is the way most doctors and scientists usually tell others about their findings.

So the information we have on it tends to come from the likes of WADA, athletes who have retired or been caught doping and case reports.

From what we know or suspect it seems to have effects on increasing airflow in the lung by opening the airways, it also has an effect on reducing pain at high intensity exercise. There seems to be an effect on the body’s metabolism below about 75% threshold which although not fully understood may help aid weigh loss while being able to continue training.

In short it possibly makes you a bit euphoric (elated or high) so you can train harder but also at lower intensity train longer while eating less and so lose weight.
At this point in time there is a feeling that while creams and inhaled cortisone probably has little effect on performance other than to treat underlying skin problems (like saddle sores) or asthma the use of tablets and injections has potential to give an unfair benefit (ie doping/cheating).

Using a short course of high dose steroids can possibly improve performance. That said if there is a severe allergy, flare of asthma or bout of colitis it may be a necessary and even life saving treatment. The difficulty for those who give TUE’s is to try to tell the difference.

Controversial TUE’s have given in the middle of races. While these may have allowed the athlete to continue when they would otherwise not have been able to, there is a strong argument that if sick enough to need cortisone for that reason they are too sick to safely continue and should have pulled out. This is an area where many doctors have different opinions and there is not a clear consensus.

Overall it’s a difficult area for the anti doping authorities. A low cortisone can be simply normal, it can be due to illness, can be a sign of the use of medicines or can be a sign of doping.

WADA have levels which have been accepted by most sports and federations and apply these. The MPCC have tried to apply a stricter set of levels, the problem with these is that they can exclude cyclists who have low levels even though they have done nothing wrong.

Unfortunately cases such as Lars Boom will probably occur again and at this time there is not full agreement between experts on what exactly suggests doping, illness, side effects of permitted medication or simply natural variation.

Dr Conor McGrane, Cycling Ireland doctor.
Twitter: @conortmcgrane