The young man likes to push ahead. Tadej Pogacar is rarely at a loss for quick answers - not in the race, not in press conferences. But sometimes his possibly ill-considered, at least sometimes overconfident reactions are not good for him. His opponents know that. And so the Jumbo-Visma team took him by storm at the 2022 Tour de France when Jonas Vingegaard and Primoz Roglic challenged their rivals with alternating attacks.
Pogacar fell for the trick, squandered his strength on the Galibier, had nothing to counter Vingegaard's final attack on the steep Col du Granon and lost a lot of time when he was exhausted. But while the Tour victory was lost back then, he initially survived the attacks at the last Tour of France largely unscathed. This time, however, his toughest opponents were not on the race course, but in the press centre.
Carbon monoxide in cycling: doping from the exhaust?
At a press conference after the stage, the man in the yellow jersey reacted rather unhappily to journalists' questions about the use of carbon monoxide (CO) in his team. The Australian website "Escape Collective" had previously reported on the use of CO inhalers by the UAE Team Emirates and Visma | Lease a Bike teamsthe employers of Pogacar and Vingegaard.
"I only know it as what comes out of the exhaust pipe," the now 26-year-old Slovenian initially replied when the journalists wanted to know more about the possible connection between carbon monoxide and Pogacar's exceptionally strong performances this season. A little later, he had to admit that he was also familiar with it in another context and had indeed inhaled the potentially poisonous gas from a kind of balloon - but allegedly only to measure the change in his blood volume around an altitude training camp.
Carbon monoxide not expressly prohibited in cycling
But the questions remain - and not only because the Slovenian's great superiority raises them and "Pogi" changed virtually overnight from being completely clueless to a detailed expert on the proceedings, thus making himself suspect. Basically, it has to be said that the Tour winner did not actually do anything that is expressly forbidden. According to the World Anti-Doping Agency (WADA), inhaling carbon monoxide is not considered doping. But you have to know: Carbon monoxide is a highly toxic gas that can be fatal if inhaled in large quantities. And in the history of sport, bans and dangers have never stopped cheats from diverting a drug or medical method from its actual purpose.
And many experts agree that inhaling the gas has the potential to improve performance in sport. "It's a potentially dangerous method, but it could replace all altitude training," says Professor Walter Schmidt. The sports physician at the University of Bayreuth has published one of the few studies on the subject of performance enhancement using carbon monoxide. This is a poisonous gas that can also be fatal (see below).
It is a potentially dangerous method that could replace all altitude training. - Professor Walter Schmidt
Five per cent more power?
In September 2020, Schmidt and his research group published the test procedure and the results: Trained athletes were made to inhale low doses of carbon monoxide (CO) five times a day for three weeks, so that around five per cent of the haemoglobin in their blood was blocked by the gas for oxygen transport. The finding: the haemoglobin mass of the test subjects increased by an average of 4.8 percent - the maximum oxygen uptake capacity VO2max, the most important parameter for endurance performance, tended to increase by a similar amount. An increase in performance of around five per cent is equivalent to a quantum leap in modern elite sport - a water carrier can become a winner.
The negative effects of the gas predominate for around 24 hours if a person only inhales low doses of carbon monoxide. Once they have gradually exhaled it, they experience an increase in performance that can last for weeks. This is because the human body reacts to the temporary lack of oxygen by releasing more of the body's own hormone erythropoietin and thus producing additional red blood cells; these then replace the haemoglobin components that are unusable for oxygen transport due to CO binding, but which are freed from the occupants again after a while and are also available.
Carbon monoxide in cycling: dangerous but effective
In short: the procedure is potentially dangerous, but apparently very effective. "It belongs one hundred per cent on the doping list," is Professor Schmidt's verdict on regular CO inhalation to boost performance. The problem is that the World Anti-Doping Agency does not seem to be up to date when it comes to the effects of carbon monoxide. It argues as if Schmidt's study does not exist. "There is no consensus on whether CO can have a performance-enhancing effect, and there is currently no sufficiently reliable data to support this claim," WADA said via its press spokesperson two months after the end of the Tour de France when asked by TOUR.
However, the organisation adds that it is currently investigating whether the repeated and regular use of the CO inhalation method violates passage M1.2, which prohibits the manipulation of oxygen uptake. Three points play a role if a method or substance is to be placed on the doping list: There must be potential for performance enhancement, it must be harmful to health, and it must violate ethics in sport - three points that carbon monoxide basically fulfils if you ask scientists.
48,000 euros for a "rebreather"
"It's not forbidden," emphasises Carsten Lundby, "but for me it's unethical to boost performance with toxic gas. Carbon monoxide should be banned." With his company Detalo, the medical professor from Denmark earns money with machines that measure blood volume and changes in blood volume by inhaling carbon monoxide, taking a blood sample and analysing it using special software. He therefore adds that these measurements should be excluded from a possible ban. Finally, he wants to continue selling his inhalation devices called "Detalo Carbon Monoxide Rebreather" for 48,000 euros each - in the version for use in competitive sports.
The Visma | Lease a Bike teams led by two-time Tour de France winner Jonas Vingegaard and Israel-Premier Tech use Lundby's equipment. The Danish medical professor claims that this is done exclusively for performance diagnostics. He rules out misuse to improve performance. This is because all usage data from the devices, including the frequency of use, is automatically sent to his company - he has not yet observed any misuse beyond blood volume measurement based on the data. It is not possible to seriously verify this claim.
It is not forbidden, but it is unethical to boost performance with toxic gas. - Prof Carsten Lundby, sports physician and developer of CO inhalation devices
Carbon monoxide in cycling: Which device does Pogacar use?
Lundby emphasises that Pogacar and UAE Team Emirates do not use Detalo equipment. The Emirates team's press office had not responded to an enquiry from TOUR by the editorial deadline. Pogacar had stated during the Tour that he had inhaled CO from a kind of balloon. This description fits a device manufactured and sold by the company Blood tec with CEO Walter Schmidt. In principle, the inhalation devices can be misused. "It is certainly a doping-relevant method," says a renowned anti-doping researcher who does not wish to be named.
Many experts cannot understand WADA's position. However, it also took a while for the gases xenon and argon, which have a similar effect on the body, to be added to the list of banned substances and methods - after rumours about their use to enhance performance around the Winter Olympics in Sochi, Russia, in 2014 had intensified. The crux of the matter: detecting doping could be difficult with carbon monoxide - after all, CO can also enter the body through cigarette smoke or exhaust fumes. "If you do it right, it's difficult to detect. You'd have to catch someone in the act," says Freiburg toxicologist Professor Volker Auwärter, who also works with the doping prosecutor's office.
So far, however, WADA has lacked any visible ambition to at least clearly brand the procedure - for whatever reason. "With (artificial, editor's note) EPO, higher gains could be achieved more safely in comparison," says Professor Walter Schmidt. After all, if the carbon monoxide application is sloppy, the quantity is calculated incorrectly or a valve is set incorrectly, there is a risk of poisoning with consequences including death, warns toxicologist Auwärter. The disadvantage of EPO doping, which is also not harmless, is that it can now be detected relatively easily and reliably using doping test procedures.
Carbon monoxide in cycling: concealment as targeted doping?
But perhaps the use of carbon monoxide in sport is more of a cover-up than targeted doping. After all, the Spanish doping doctor Eufemiano Fuentes was heard to say last summer that, according to his information, doping with EPO and autologous blood was still taking place - but with microdoses that could not be measured with the current test methods used by the doping hunters.
It is quite possible that the devices only help to control illegal methods through regular measurements so precisely that they are not noticed during tests and the so-called biological start passport should not show any abnormalities in the decisive values. Another danger: cheaters in sport have often been fooled by how well doping investigations sometimes work - increasingly with the help of police and public prosecutors, for example in France, Italy, Austria and Germany.
And in the case of Tadej Pogacar, one can hope that Andrea Agostini from the management of his team keeps an eye on what the athletes in his racing team are doing - or perhaps better not doing. The former amateur racer from Cesenatico was a childhood friend of one of the outstanding racers of his generation, who won the Giro and Tour in the space of a year in 1998. Five years after this double, Agostini had to carry his friend Marco Pantani to his grave. Quite a few people believe that his death had a lot to do with doping.
The most important information about carbon monoxide: An odourless killer
Carbon monoxide (CO) is a toxic (poisonous) gas that is usually produced by the incomplete combustion of carbon-containing materials. It is treacherous because people cannot smell or taste the gas. Poisoning is therefore often recognised too late. In fires, most people do not die from heat or burns, but from so-called flue gas poisoning - usually due to suffocation caused by carbon monoxide. If CO is inhaled, it can be fatal. Carbon monoxide molecules bind to haemoglobin and form a particularly strong bond.
The blood pigment haemoglobin is responsible for transporting oxygen in the human body - oxygen loses the battle for transport places in the blood against the "stronger" CO. Experience has shown that up to a level of 10 per cent of haemoglobin containing carbon monoxide, no symptoms are noticed. From 20 to 30 per cent, symptoms of poisoning occur, and from 40 per cent it can become life-threatening. From a concentration of 60 per cent "occupied" red blood cells, the poisoning leads to death within an hour. The person virtually suffocates internally because the body is no longer supplied with sufficient oxygen. The body also absorbs the potentially toxic gas when smoking a cigarette or inhaling exhaust fumes - but usually in a harmless dose that is broken down or exhaled again.
Andreas Kublik
Editor
