It's just water.
“I only took drugs when absolutely necessary, which is nearly always.” Fausti Coppi.

Even casual readers of this blog will know that drug use in cycling is a serious issue. We only need to invoke one name here to trash the notion that cycling is a clean sport - Lance. Lance is a sociopath, a reprehensible human who cheated to achieve his aims without remorse. Thankfully the story of drugs and cycling is bigger and more interesting than Lance.

First up we’re going to do a whistle-stop tour of drugs in cycling just in case you don’t know much about it. From there we’ll segue into the reasons normal people take therapeutic drugs and then look at cycling and mood and how exercise is meant to help, and make some bold assertions about cycling and health.

Lets start with the basics - why do the pros take performance enhancing drugs? The logic is elementary:

Axiom A: I want to win.
Axiom B: If I go faster I will win more.
Axiom C: Drugs are good for making me faster.
Moral get out clause 1: Everyone else is doing it.
Conclusion: I’d be stupid not to take drugs.

This line of reasoning (which avoids questions of moral and physical risk) has applied since the first races were held in the late 1890s. Cycling is a ‘winner takes all’ sport, there has always been more to gain by cheating than by being caught [1].

And so it became a dirty sport. Many sports are - note 40 medal podium winners currently losing their medals from the 2008 and 2012 Olympics - but Cycling’s cross to bear is that it is a highly visible dirty sport. Cycling and drugs have gone together like rhubarb and custard since the day the pedals started turning. What the drug of choice is has changed over the years, but there is no doubt that use has been endemic. That’s because cycling has always been about money. From early races where riders were treated like dogs and horses, to current big-value sponsorships that sell ‘The Dream’ of self-perfection through exercise right through to the Lottery-funded Olympic squads selling Brand Britain, it’s always been one of the most ‘incentivised’ popular sports.


What, you're still believing me?

As a consequence riders have always taken drugs. Before WWII cyclists took ‘normal’ drugs; Opium, cocaine, brandy, that kind of thing. Early Tour De France riders would have ether-soaked handkerchiefs under their chins. Riders in six-day track events took everything they could, including small does of strychnine. ‘Managers’ were prone to doping their charges as if they were racehorses. No great surprise then that the first death by doping happened on the track at the end of the 19th century.

After WWII the chemicals kicked in. Invented way back in 1887, amphetamines gained use in war as a way to keep soldiers going for long periods of time. Post war it quickly found a happy home in cycling. Champion Jaques Anquetil admitted doping in the 50s with a brazen attitude - of course we take drugs, shrugged it off. Tommy Simpson died from too many amphetamines and heat on Mt Ventoux. Plenty of books detail endemic doping in professional cycling. One of the original and best of these A Dog in a Hat: An American Bike Racer’s Story of Mud, Drugs, Blood, Betrayal, and Beauty in Belgium</a> about racing in Belgium, includes quite a bit of race-fixing as well [2]. Rumours of Mafia involvement in the outcome of the Tour of Italy abound.

As tests for drugs got better in the 60s the game started to change. It’s one thing to get a ‘lift’ from a drug, it’s quite another to indulge in systematic blood doping. From transfusions of your own ‘rested’ blood to artificially boosted blood carefully made in a lab by the team ‘doctor’ things started to get serious. They developed a test for that (detecting plastic particles from the transfusion bags in the blood) and the game changed again in the 80s and early 90s - complex brews of growth hormone, cortisones, steroids, more sophisticated amphetamines and artificial opioids.

Then the 90s - EPO. Originally meant for kidney failure patients, EPO artificially boosts your bloods oxygen levels. This means better performance and a massive boost to recovery as oxygen is a key agent in the transfer of energy around the body.


The Festina Affair, 1998 - Finally, after years of the sport 'self policing' the gendarmerie get involved

The lid was blown off this in the 1998 Tour - the whole Festina team was chucked out when a masseur was caught with a boot load of EPO. The EPO era lasted through Lance Armstrong’s seven ‘straight’ wins and right into the extraordinary 2006 tour where six favourites weren’t even allowed to start and the winner was retrospectively tested positive for testosterone and booted off. During this period the use of EPO was tacitly tolerated by the world cycling authority, the UCI, under the directorship of Dennis McQuaid, the Seth Blatter of cycling, who only left the sport a couple of years ago. It was all very dodgy - Armstrong failed a test in the ‘99 tour, blamed it on saddle-cream and donated money for an EPO detection machine to the UCI in the same year. Breath-taking hypocrisy.

So EPO was the big one, but in the last twenty years cyclists have used a whole range of drugs from human growth hormone, cortisone, catabolic steroids to artificial opioids and increasingly sophisticated steroids. Apparently there are plenty of riders currently abusing Tramadol - a synthetic opioid that is not banned:

“It was originally designed to be a bit of a low grade non-mind altering opioid for chronic pain, a bit like methadone in that you don’t get a big high like shooting heroin but it’s definitely an opioid and for an athlete in a sport that’s painful everyday, it takes the edge off it and makes it less unpleasant. It’s addictive too.”

And lately cyclists have been busted for taking pills called GW1516, an EPO-like medication that was discontinued at trial stage because they caused high levels of cancer in animal trials.

So, despite Lance, cyclists still cheat. Like teenagers looking for legal highs they ignore the obvious risks and only care if it’s allowed or not.

How much do you need to want to win to risk that? A lot. While there is apparently a good trade in performance enhancers in amateur cyclists (particularly in the older age brackets!) it should come as no surprise then that the biggest race in the world has also had the biggest range of cheats.

Here’s a quick chart I made using data from wikipedia:


The number of cyclists in Tours de France since 1998 who are know to dope or admitted it, in an infographic. Only the blue are clean riders.

And it’s not going away either - here’s one ‘coach’ who was banned this year for injecting his 17 year old son intravenously with Nandrolone (an anabolic steroid) without his son’s knowledge [3]. Classy.

Before we move on to more interesting aspects of doping, here’s a timeline of drug abuse in cycling I have put together on another page - entertaining and instructive but probably just for the devoted.

So there’s a whole range of drugs there, everything from weight loss drugs to stimulants like amphetamines to steroids for muscular strength and the cortisones [4]. Also with that are the pain killers, morphine, opioids and synthetic equivalents, even heroin. Then there are odd things like insulin and Oxyglobin (administered intravenously - used for treating anaemia in dogs).

Bad pro cyclists!


Riis 'winning' the Tour in '96 - looks healthy right?

None of this is new - if you follow the sport there will be zero surprises in what I’ve written above. But there is an aspect that needs looking at. Above I talked about drugs that give pain relief, that boost strength and give you better blood for performance and recovery - but what about drugs for the mind?


I mentioned the 1996 Tour De France ‘champion’ Barne Riis ‘won’ on EPO. But it turns out he was also on Human Growth Hormone, steroids and Prozac at the same time.

Prozac?

"The pills made me feel much more positive, which allowed me to see possibilities rather than limitations. This really seemed to help at stage races, which can be very stressful mentally, and where maintaining a positive frame of mind could really help."

Here’s another description of Prozac use from a pro rider of the 90s:

“The drugs lead you to other addictions. The anti-depressants almost automatically accompany other doping treatments. I took up to eight pills of prozac a day when I was racing... Prozac cuts the appetite, keeps you in another world, a world where you're not afraid of what you're doing. You're no longer afraid to inject yourself with all the crap. It takes you to a world where you don't ask any more questions, especially you don't ask your doctor questions either or your sporting director."

Prozac again.

But the thing about Prozac (an SSRI - serotonin re-uptake inhibitors) is that it doesn’t work unless you have depression. There is no benefit to people with normal mood, though there are side effects which are ‘useful’, like suppression of appetite. So the riders were using Prozac to medicate away the depressive effects of the drugs they were using, the stresses of their career, and any innate tendencies towards depression. Or they were using it control appetite - one persons side effect is another persons performance enhancement.

While there is good evidence that at least one family of drugs regularly abused by cyclists, the corticosteroids, cause major depressive episodes [5] you would think that putting that amount of shit in your body and then pushing it to the limit would have mental health consequences, even if you weren’t prone to to mental illness.


Of course we shouldn’t be surprised to think about pro cyclists having depressives in their number. Depression is a broad church. One publications sums up the predilection towards depression as coming from ‘gender, genetics, family factors, adverse childhood experiences, personality factors and social circumstances’. I think we can safely say that taking bucket loads of drugs in order to perform in a physically demanding and dangerous sport counts at the bodily, personality and social levels.

Self-medicating anti-depressives isn’t just going to help you feel better about cheating, it means you can hide from any underlying depression for a very long time. And trust me, the ‘underlying issues’ will make themselves known to you sooner or later.

There are many stories of cyclists loosing the plot once their career ends:

"Then one day all of the sudden it stops and you become dramatically depressed. Look at Pantani, Vandenbroucke and all the others we don't even talk about. They are numerous other cyclists and former cyclists that are addicted to cocaine, heroin and other medications.”

Pantani busted for drug use on the 1999 Tour of Italy, was undoubtedly an EPO user. Dead 5 years later.

Pantani, a very high-performing depressive, died a few years after the end of his career from a crack overdose. A friend describes visiting him prior to his death.

"The door was locked. The room was very hot. The room was in chaos. There were empty cans and a candle in a bottle. There was white powder everywhere. [...] He was smoking [cocaine], sniffing it, burning it, reducing it to resin or oil and putting the drops in his nostrils. He was eating it. Another physique would have collapsed."

VDB confesses. A real talent who, unfortunately, left children behind when he died, aged 34.

Vandenbrooke battled psychosis and depression and made multiple attempts on his own life, finally succeeding aged 34 [6].

If you want an example of how doping destroys people then google Jesus Manzano whose confessions and photos (unbelievable, below) show you how close cheating with EPO makes you look like a junkie - you can see how the medicalised use of injections could make the transition to ‘proper’ drug addict pretty easy.

There are plenty more names to add to the list, and plenty of cyclists who have had dark periods, with and without drug assistance, and made it through. A few recent notable cyclists are David Millar (EPO, confessed, ‘dark periods’, reformed), Tyler Hamilton (EPO, depressed), Graham Obree (just depressed ). The very driven, the very best.

A brilliant career outcome then - you torture yourself for fifteen years on the bike, take acres of drugs to make it through. If you are lucky you don’t get caught. Then, at the end of it, you are dumped by the sport and - deprived of the drugs and/or excitement and with nothing much in the way of an education or alternate profession - you have to either have to grow up very quickly or start self-medicating with ‘recreational’ drugs. Perhaps you end up getting arrested trying to steal mobile phones - surely one of the most pathetic ends to a career yet [7].


Aitor Gonzales, arrested here for doping in 2002, before his slide into petty crime.

But what does all of this mean for us, the weekend warriors, MAMILs and MAWILs, the commuters and casual cyclists? Where do we stand with drugs and cycling and mood? Is there any communality between an Armstrong or a Pantani and ourselves?

There is a common point, and I am going to make it early and then work to justify it:

Cycling can be really bad for you.

 

 


Eddy Merckx now has a heart defect from cycling so much. Here, totally wrecked after being punched by a speon Le Tour.

Lets just get right back to basics here.

Material things, like bikes and bridges, fatigue under stress and eventually break. Materials do not get stronger once they are created - it’s a one-way path from being a beautiful frame in a bike shop to a rusty pile of tubes, or a shattered mess of carbon shards.

Only biological entities respond to stress by overcompensating and getting stronger. Good stress enlivens us, makes us stronger. We recover, we bounce back, better than before. Writing an essay, lifting small numbers of heavy weights, yoga - these all impose stress and are tiring but the body bounces back, overcompensates and gets stronger. This is the way that training for strength and endurance in any sport works.

For humans there is good stress and bad stress. Of course my good stress and yours might be quite different. You might like jumping from planes, I like singing in public. However there seems to be universal agreement that low level chronic stresses are not great. I am thinking here of sitting at desks, the commute, tedious ‘time saving’ office work, arsey bosses and the like.

The body also gives us small rewards for overcoming our lethargy. Exercise creates elevated mood, a little jolt of endorphin - naturally occurring opioids and cannaboids. You feel good after exercise.


And breathe...

As this relates to depression the common thinking - well researched - is that cycling can be good for your mental health. Mild exercise in small to medium doses is a proven benefit to those suffering from mental health issues.

This doesn’t mean that it will make chronic mental conditions magically better. The opposite of depression is not feeling good, it’s feeling normal. That sounds counter-intuitive, but the chemical pathways are different. Serotonin is the one that monitors mood and endorphins relate to feeling good. This means it is perfectly possible to be in an overall wretched state and yet get a rush from cycling. Again, this sounds counter intuitive, but depressives will recognise that as being true.


It's complicated in there... [credit]

You can be enjoying your ride but can be floored by the effort of fixing a puncture. Sometimes the mental effort of hunting around the house for all the gear needed to go out on a ride can make you ill with worry and anger. This makes getting on the bike a complicated thing - you know it can do you good, but at the same time there are plenty of triggers for bad stress and panic attacks: fatigue, mechanicals, rain, over-reaching yourself, traffic.

There’s no way the euphoria from a good ride or race can compete with chronic depression. What’s awful is that you feel like it should. People tell you to exercise more. To ride it off. But that creates more pressure. If you just ride more you’ll get better? Nope. The worst thing is someone telling you to go for a ride to ‘clear your head’. When you are seriously depressed this is about as patronising as it gets.

There is a benefit to exercising on the bike, the endorphins give you a moment of relief, they give you a chance to glimpse something else. However research on the benefits of cycling tend to indicate that the effects tail off quite quickly. The benefit is measurable with 15 minutes of mild exercise, peaks at 30 and remains beneficial up to 90 minutes, but after that there is no further benefit to mental health. So that four-hour ride on the weekend is about as good for mental health as a commute to work.

There is also good evidence that exercise can have very good long-term effects on your brain:

“Although physical exercise is an acute stressor, chronic [regular] exercise can have neuroprotective effects instead. These effects are illustrated by the finding that subjects who had undergone physical training had lower levels of cortisol both at rest and in response to a stressor than sedentary subjects.”

The same study ends:

“We conclude that regular physical training can reduce the severity of several symptoms that are related to various mental disorders such as depression, AD (Althzeihers) and PD (Parkinsons). There are many neurobiological hypotheses that may explain the wide variety of observed responses to exercise. Acute exercise appears to improve mood by activating specific cortical areas and by inducing the release of neurotransmitters and trophic factors that contribute to adherence to a program of regular physical activity. Chronic physical exercise appears to induce both neurogenesis and angiogenesis, which are important for improving behavioural and cognitive function and for improving the health of patients with mental disorders. Moreover, as the studies of athletes that were discussed in this article have shown, physical exercise can modulate mental health in both constructive and destructive ways.”

But reread that last sentence - physical exercise can modulate mental health in both constructive and destructive ways. That is to say it’s not a given that it’s an outright benefit all the time. Exercise is ‘obviously’ a benefit, but things get less clear when the person you are talking about is already taking exercise to the extreme.


Pushing well beyond normal - riders on the 1200km Paris Brest Paris. Most will get 3-4 hours sleep in 90 hours.

Serious endurance athletes do not have a normal relationship to exercise. I’ll come back to this in later posts, but lets just say for now that when ordinary people say ‘some exercise will help’ they don’t have a six hour MTB winter epic, a double-century road ride or a Paris-Brest-Paris in mind, they are more likely thinking of an amble up the towpath - the kind of riding normal people do.

When you are mentally ground down over-exercising is not a great way to recover. By exercising too much you make things worse. The good stressor becomes the chronic bad stress. Riding a bike for hours a day makes it ‘a day at the office’.

“Although regular exercise has the potential to promote mental health, an excessive level of exercise can have adverse effects, such as overtraining. In addition to exercise, other factors associated with a high level of pressure to perform well and other stressors, contribute to the high prevalence of mental disorders among elite athletes.“

Overtraining is now recognised as a serious issue in endurance athletes. Many cyclists live in a state of chronic depletion. They ride too much, don’t recover properly and exercise for performance not fitness or health. They may be very ‘bike fit’ but they are literally out of shape - waddling along with their bums out, their pelvis tilted to hell (guilty!). Really talented amateurs have it the worst - they have the stress of fitting the training in around sitting at a desk for 8 hours a day and don’t have professional chefs and saunas and regulated downtime to cope.


Overtraining syndrome. It must be a real thing, there are thousands of bad slides online about it.

Overtraining doesn’t mean just being a bit tired:

“It is also worth discussing the acute effects that exercise has on mood and adherence to an exercise program… diagnoses of various mental disorders are surprisingly common among athletes who have been subjected to overtraining, fatigue, competition-related stress, injuries, failure and retirement.” [1]

So if that’s the case, then we have to ask - might it be particular personailty types who get into this kind of thing in the first place? If you have a propensity towards depression or obsession then perhaps cycling was a good way to cope with some of the symptoms of a fledgling mental illness? Perhaps you were running away from something, perhaps you were seduced by the romance of it, perhaps you had found something you could pour all that mental energy that you had into, somewhere all that energy and anger could be transmuted into something that looked like winning, that was societally approved?

“Most people who are driven to be the absolute best in anything… when you think about it, it’s quite abnormal behaviour and there must be a driving force behind that other than the absolute want of glory."" [Obree]

Sounds healthy right?


Olympic Champ Hindes enjoying some good training effect.

Cycling (and exercise in general) can become a form of self-harm. And it can be hard to tell the difference between healthy and unhealthy exercise.

As a case in point see the photo to the left of Olympian Hindes after a turbo session at Chris Hoy’s place. Hinde is pushing himself for training effect. Being an Olympian means it probably pays off and is relatively normal given the territory. But it’s easy to see that if you are depressed then throwing up while telling yourself you are shit is not going to be doing much good for you. The extra layers of psychological complication put you in danger; Maybe you want to tire yourself out so you don’t feel anything anymore. Perhaps unconsciously you want to break yourself apart, to trigger a crisis.

In my case cycling had always been something that had given me a way to deal with life - a tool to escape my teenage plight, a way to ground my spinny brain, a compensation for a lack of faith, a tool to use to induce exhaustion or escape all the pesky, irritating people. A lot of that was about putting distance between myself and trouble, but trouble is faster and fitter - eventually it will catch you.

I am most definitely not saying that my depression was caused by cycling, far from it, but after fifteen years of hard riding it was doing nothing for me. More often than not it became an acute stressor. Cycling had become part of the problem, part of the lived experience of depression and misery.

I am certainly not alone in thinking this way - here is an extract from a blog by a serious amateur cyclist:

“I have become more aware of the tightrope I walk in relation to cycling: it does make me feel good more often than not, but I have also had experiences before, during and after rides where I have had quite extreme negative episodes which do not seem to be coincidental. Sometimes the stress of getting ready to go out on a ride seems to be a trigger (not being able to find my pump or glasses; realising that the bike I want to use is unroadworthy or unsuitable for the weather); sometimes I have had to stop by the side of the road, completely numb; and sometimes after a ride I have felt like I never want to ride again.” [Col de Spandelles]

Sometimes I imagine what I would have done at this point had cycling really been my life rather than just a serious hobby. What if I had been a pro, someone like a Pantani or an Millar, someone who loved to ride fast but had a huge amount of talent and opportunity but now looked at the bike and wondered if I had what it takes to really excel. What would I have done at that moment had someone offered me a chemical solution?

I answered this question as soon as I had started taking anti-depressants - if you’re desperate enough you’ll take anything. I would have taken the EPO. I would have added the human growth hormone, the cortisone. Then I would have needed the SSRIs to feel ok and then, when my career ended, I would be have an utter and total mess.


David Millar - one of the few to have doped and reformed properly. Also the only living bike rider as classy as Coppi.

Many cyclists and admins have been working steadily over the years to make this kind of decision null and void - to make sure that young men and women are not systematically abused by doping (what else to call it but abuse?). David Millar, a reformed doper, says cycling is cleaner than it’s ever been. “Now one of the cleanest sports in the world”. That’s about as much as we can hope for at the moment.

Just as well I wasn’t a successful pro then (as if I could ever have been!) Better to be mortal, better not to be a suffering saint of the bicycle, better not be be dead five years later in a hotel room, or morally bankrupt, or become another kind of criminal.


So what’s the cure for all this? If cycling is meant to be part of the cure but it’s really part of your problem, what do you do?

You have to stop. Not ‘rest’, stop.

You have to do the exact opposite of what pro riders have to do, year in, year out. They keep going, no matter what. If you haven’t given yourself the option of giving up then the drugs will seem like a good idea, even for an amateur [8].

As I was not a professional cyclist it was easy, I just gave up riding.

Not consciously. If someone told me that as part of my cure I had to give up cycling for a while I would have found that incomprehensible. It just happened as a natural consequence of other things I was doing. I couldn’t afford another bike after the Scott died, I was saving for something else. I went to the UK for six months and went on precisely one bike ride in all that time.

It wasn’t just the cycling I stopped. I didn’t really worry much about a career or the future. I sat in cafes in Manchester and drank lots of strong dark tea, walked in the Peak district, did quite a lot of writing and didn’t so much as look in a bike shop window. I stayed with a lovely, very normal, English family and learned about drinking warm bitter. I went to ‘house parties’ and House Parties, I discovered deep bass and blipy-skwarky music and went to The Hacienda. I stayed a long long way from any drugs but the ones that the doctor gave me, and generally chilled the fuck out.

Total mind and body rest, away from anything I knew or that would stress me out. A complete luxury in one way but also a necessity. Somewhere in that winter in The North I got some sanity and motivation back, and when my six months visitors Visa ran out I got on the plane and made my way to Manchester’s doppelganger, Melbourne, where I began another life.

I’m going to finish this episode with a quote from a rider (not me) on one of the cycling forums I hang around on, on a private thread where riders in trouble with depression post:

"Woke up this morning.  Wished I hadn't.
I decided to go for the bike ride, thinking it would do me good.  Made myself go.  Wished I was dead, the whole time.  The smiling face, the making conversation, all the time feeling like I was in a glass bubble with everything around me muted and distant.  None of the beauty of the day could touch me.
Got home just wanting to curl up in a corner and cry, and cry.
But now I'm feeling the benefit, and quite glad I'm not dead really.  Might as well continue with today and see what happens.
Crack on."

So there is hope for depressives who also happen to ride. There is hope in the day - as above - and I tell you there is hope over the years, and that a bike can be part of the cure.

And if you’re a depressive and a Professional cyclist? Then you are in very deep - good luck and I hope you can afford good treatment once you retire.

Next: A bike is a bike is a bike

 

 

 


References

[1] the prisoner’s dilemma for dope cheats</a>

[2] A Dog in a Hat: An American Bike Racer’s Story of Mud, Drugs, Blood, Betrayal, and Beauty in Belgium

[3] Ex pro injects son with banned drug.

[4] David Millar describes what cortisones do to you. “In one sense, it would be like hitting a self-destruct button: The moment the drug entered my body, I would become catabolic. The cortisone would start to strip me down, and I began to use my own body as fuel.”

[5] Pubmed

[6] VDB The Times obituary

[7] Spanish Grnd Tour winner tries to steal mobile phones.

[8] Confession on an amateur doper

Some further reading

Not just cycling - I could go on and on here, but one recent article will make the point: 75 athletes (40 medal winners) stripped of medals from 2008 and 2012 olympics: “Nearly all of the violations, across nationalities, were for the anabolic steroids Stanozolol or Turinabol, the very substances that notoriously fueled East Germany to global dominance in the 1970s and 80s.” ref

This article about Graham Obree works to more or less the same conclusion as I have, though I only read it after I had finished. Highly recommended.

Neuroscience of Exercise:From Neurobiology Mechanisms to Mental Health - 2013

[EPO risks](http://link.springer.com/article/10.1007%2Fs12012-009-9054-2] and more

Guardian article of doping, cycling and depression

2010 on - EPO substitutes: FG-4592 GW1516, AICAR

Tramadol used in Team Sky And in general.

Detailed but readable list of prohibited drugs for all athletes.

The drugs Lance used - a guide

A brief history of Strychnine

Epo and gene doping

The effect of EPO on performance

An amateur doping story

And finally, someone who understands rest and how to use it - read if you are an active cyclist!