Mountaineering and Doping

The term doping is widely used by organizations that regulate sporting competitions to explain the use of drugs or methods to enhance performance and/or is harmful to the athlete’s health and is considered unethical, and therefore prohibited, by most international sports organizations. PED’s (performance-enhancing drugs) are substances that are used to improve any form of activity performance in humans. The line of what is or not a PED is stablished by WADA, the World Antidoping Agency, when publish every year its list with the substances and methods considered doping, but it isn’t a permanent line, because it evolves including new substances or because some other substances not listed there can have similar effects in performance, like the use of painkillers to perform under pain.

WADA’s code, establish “Anti-doping programs seek to preserve what is intrinsically valuable about sport. This intrinsic value is often referred to as “the spirit of sport.” it is the essence of Olympism, the pursuit of human excellence through the dedicated perfection of each person’s natural talents. it is how we play true. The spirit of sport is the celebration of the human spirit, body and mind”. Therefore is widely considered the use of PED’s unethical and against fair play in sports.

Doping has sadly existed in sports since sports existed, and mountain activities aren’t an exception. I remember the surprise of all of us when we discover the positif with EPO of Blanc in 2006 Patrouille des Glaciers. Or in 2012 when Osa took the same substance in a trailrunning race, after being already banished for doping in cycling. Or 2016’s Calisto, caught with EPO at UTMB. Those are only some of the cases of doping in mountain competitions, but I (want to) believe that it is a very small part of the elite athletes who took or think about taking PED’s to increase their performance. Fortunately skimo and climbing athletes are under ADAMS program and it’s biological passport, same of many trail runners in ADAMS or the national antidoping comitees or the Quartz program, and almost all international competitions carry antidoping controls.

But among amateur’s, doping is also existing, mostly (I hope) by ignorance, but it isn’t uncommon to see athletes doing infiltrations, taking corticosteroids, painkiller pills or other medications to be able to practice, not to “win” but to “finish”, putting their health in risk. This “soft” auto-medication can be also very dangerous for the health, and it’s very common in long distance running.

PED’s in mountaineering

A study carried in the normal route of Mont Blanc showed that 35% of mountaineers took a diuretic or hypnotic to climb the summit. Out of 430 samples analyzed from the huts by the AFLD ( French antidoping association) 35.8% contained at least one drug. Diuretics (22.7%) and hypnotics (12.9%) were the most frequently detected drugs, while glucocorticoids (3.5%) and stimulants (3.1%). Some of those drugs, as acetazolamide, glucocorticoids and stimulants are indeed banned in sports, being included in the list of prohibited substances of the World Anti-Doping Agency (WADA).

Mountaineering is not a regulated sport (fortunately!) and among all the freedom that that enables to be more about creativity than performance, it leaves talso he use or not of PED’s and doping to the climber choice.

Taking medication to climb mountains has never been seen as doping, but as a natural way of surviving on difficult environments. At the beginning of the 8000’s climbing history, the conquest of the summit was the maing goal (get there, not matter how) and because the environment and difficulties up there were so extreme it was considered impossible without all the possible external help. When Maurice Herzog and Louis Lachenal climb Annapurna in 1950 they used bottles with oxygen and also took morphine to overcome the effort.

Hermann Buhl is one of the most visionary climbers that have ever lived. His ascents in the Alps and after in Himalayas were futuristic by the dificulty, speed and style. His ascent of Nanga Parbat in 1953, without suplementary oxygen, porters or fixed ropes make a big precedent of the after called Alpine Style. In his book “Nanga Parbat Pilgrimage“, he explains how he took methamphetamine pills, Pervitin: “It was the only chance; its brief renewal of my strength might last long enough for me to get down to the tent.” Pervitin, was well used among German and Austrian climbers then for extra energy and focus. It was used before, during WWII to Nazi infantry.” Buhl took two. After he took some Padutin, a blood-flow agent to prevent frostbite, and then three more Pervitin pills.

Stephen Venables’s, one of the Alpine Style most prolific climbers took strength caffeine pills during his 1988 ascent of the Kangshung Face of Everest. Loretan and Troillet took adalat during their stunning ascent of Hornbein in a single push of 43h. Those are some examples of the cutting-edge alpinism, carried in a purist style, without assistance (porters) nor supplemental oxygen, so in commercial alpinism, the use of drug’s is widely used.

High altitude biggest challenge is the low quantity of oxygen in the air. At 8000m, that will be only the 35% compared to sea level, so the climber will perform a 65% less, that said, if he or she is well acclimatizzed. The best way to mitigate the risk of high altitude climbing is to increase the amount of oxygen in a climber’s blood. Climbers can do this in a number of ways. One is to spend extensive time acclimatizing to high elevation. They can also use drugs like acetazolamide or dexamethasone, which reduce a variety of altitudinal conditions, steroids, amphetamines, erythropoietin (or EPO), epinephrine and nifedipine, morphine and codeine, Viagra, adalat and Cialis, which increase blood flow to the lungs (all of them on WADA’s list) or carry and use supplemental O2.

Many of those drugs are in climbers pharmacy, as they can be the only solution in case of severe problems as HACE, HAPE, altitude sickness or oder deseases that can appear up there, but many climbers today took them not to get down when a problem have occur, but to get a extra help to climb.

What it does to climb with suplemental O2 ?

When during the 50’s and 60’s the first 8000 m summits were climbed, climbers and scientists thought that it wasn’t imposible to survive at this altitude without supplemental oxygen, and like astronauts going to the space, they took bootles with oxygen (among many other drugs to be able to climb and perform) to survive at that altitude. But we shoudn’t forgot that much before that, Norton reached already 8570m without suplemental oxygen in the Everest North face in 1924! It took 30 years to get higher without supplemental oxygen, when in 1978 Messner and Habeler reach Everest summit, since then it is proved that supplemental oxygen isn’t need to survive at this altitude. Despite it has been more than 40 years since that, from the 5000 persons who have climbed Everest, only 200 have done it without supplemental O2.

Dr. Hackett of the Institute for Alpine Medicine says: “Supplemental oxygen is the only drug that has been shown to be absolutely performance-enhancing at high altitude”.

In the book “Endure” by Alex Hutchinson it quotes some of the early sport science experiments, “ The importance of oxygen was confirmed the next year by Leonard Hill, a physiologist at the London Hospital Medical College, in the British Medical Journal. He administered pure oxygen to runners, swimmers, laborers, and horses, with seemingly astounding results. A marathon runner improved his best time over a trial distance of three-quarters of a mile by 38 seconds. A tram horse was able to climb a steep hill in two minutes and eight seconds instead of three and a half minutes, and it wasn’t breathing hard at the top”

In this article, Jim Gille, altitude skier, did a good research on what are the differences between climbing with or withour suplemental oxygen, showing how the altitude that the climber feels decreases more than 2000 or 3000 meters when using bottled O2. That means that when climbing in the higher slopes of Everest or K2 the ones using bottled oxygen are feeling like in Island or Mera Peak, summits just above 6000m.

Graphic by 8kPeak

Normally climbers use O2 botlles in a flow rate of 2 to 4/L/min, that means that a climber will feel like climbing at 6000 or 7000m when “outside” is at 8000 or 8800m. That’s for sure a big performance enhancing method, since the dificulty of the mountain is hugely downgraded.

The safety net

When Amundsen reached the south pole in 1911 his goal was achieved, but the journey didn’t stop there since to come back to civilization they had to return in their footsteeps for another 1300km. During the almost 100 days of expedition they rely completely at themselves, the gear they carried, their capacities and decisions. In parallel, Scott’s expedition at the same time show what the consequences of when something goes wrong. Polar expeditions is one of the sports or activities (with open sea sailing, diving…) that share this exposure with mountaineering.

One of the particularities of mountaineering is that unlike many other sports and activities is the exposure. That diference (with creativity) is what makes ascents something more than the addition of the technical dificulties. Most part of climbers (and I incliude myself) are not suicidal and in case of problems will call for help, this can be for example carrying a pharmacy with some medication in case something goes wrong. With today technologies it is possible to (almost) eliminate this component. The use of satelit telephones, weathers forecast, heli – plane transport or fixed gear can take away part of the exposure, but also the access to PED’s. It’s a big difference to perform with the use of drugs or without, but in terms of exposure is a big difference between carring drug’s or not regardless of it’s untaken. If we take climbing as an example, it is a big difference between free climbing without falling and freesoloing. The technical dificulty will be the same (even harder free climbing with a rope because the weight of the gear and placing the gear) but the exposure and consequences of a fall isn’t comparable. Something similar we can say about high altitude climbing where the exposure is linked to the effects of lack of oxygen in our body, carrying PED’s or supplemental oxygen will supose the same physiological performance but a very different exposure in terms of climbing. It is also a big difference on carrying those PED’s and bottles just as in case of a medical emergency, like starting and edema and take Dyamox to go down or take oxygen to start decending, or using them to continue up when our body says no.

At the end it is the climber’s decision to take or not PED’s, since motivations to carry up activities in the mountains are as many as persons doing it and nobody (and the least me) should put rules in one of the last freedom landscapes, but therefore we should be honest explaining what is inside our body. #NoOmission