You Don’t Forget: Doping and the Brain

Stay the CourseAfter a four-year investigation behind closed doors, the United States Anti-Doping Agency (USADA) announced last week that storied U.S. track coach Alberto Salazar as well as the physician he worked with Dr. Jeffrey Brown have been banned from the sport for four years for doping offenses. The USADA stated that Salazar trafficked testosterone, administered prohibited amounts of the supplement L-carnitine to his athletes, and tried to tamper with doping controls. For more information, read the official USADA press release and official arbitration ruling document.

This is a big story in every corner of running. All runners, coaches, race directors, and medical professionals should pause and consider the impact of performance-enhancing substances and methods on the sport. While historically referring to the use of heavy-duty, old-school anabolic steroids or blood doping, modern-day doping can also involve naturally occurring substances­–such as vitamins, minerals, amino acids, and hormonal precursors–that, when artificially manipulated, are performance-enhancing and illegal doping.

This strategy is central to the Salazar case, wherein he manipulated the supplement L-carnitine­–a naturally occurring amino-acid precursor found in highest concentrations in beef–and administered it intravenously in very high concentration–which is illegal–to his athletes. Salazar and Brown reportedly did this because they believed it led to multiple forms of performance enhancement.

Among the doping questions often debated are:

  • What substances and strategies should be considered doping?
  • What is the place for Therapeutic Use Exemptions, or the use of prohibited substances to treat athletes’ legitimate medical conditions?
  • What are appropriate doping sanctions? Namely, is there a case for lifetime banishments from competition?

The World Anti-Doping Agency (WADA) has answered most of these questions. Established in 1999 as an independent international agency, WADA governs the global process for what substances and methods are and aren’t allowed in sports competitions and training, as well as determines violations sanctions. Its Anti-Doping Code and Prohibited List, created by the foundation’s board and endorsed by over 1,500 delegates across the sporting world, have made great strides to level the playing field of international sporting competition by regulating the use of substances and methods which may unfairly enhance performance and/or compromise athletes’ health.

Despite these advances, there may be another important question that could have powerful ramifications about how we confront doping in sports, namely endurance and ultramarathon running. What is the potential effect of doping on the brain? That is, how does even a short-term bout of doping impact long-term motor learning, performance, and health?

A deeper look into this question as well as the current theories of motor learning in the brain and nervous system might help us understand why doping is so inherently unfair and dangerous, why it should not be allowed, and potentially make the case for long-term–if not lifetime–bans from competition.

The Tip of the Iceberg: Doping’s Physiological Effects

The consensus of the effects of doping are that performance-enhancing substances and techniques create physical changes to the body–artificially, often rapidly, and significantly beyond what can be naturally attained–in such a way that results in improved performance.

As an example, steroids make football players bigger and stronger, which helps them run faster, throw farther, or hit harder. These physical changes are inherently unfair. Moreover, they come with often dire health effects like soft-tissue damage and cardiac risks. Thus, this substance is banned from sport.

The Base of the Iceberg: The Brain and Doping

When considering the effects of doping, we need to look beyond the physical and into the mental. Indeed, no one knows better than ultrarunners how important the mental component of performance is. Over the long trials of mountains and miles in ultrarunning, athletes with superior mental capabilities can outperform more physically gifted athletes. How does this happen? I think baseball player and coach Yogi Berra had the answer, “Ninety percent of the game is half mental.”

If you consider the mental aspect of sport, the brain is what determines what we can and cannot do. This is the foundation of the Central Governor Theory, which states that “it is the brain that dictates exercise intensity and duration in order to ensure its own survival.”

It’s my belief that the true purpose of training is to teach the brain that what we are doing or want to do is safe. Since the brain’s primary function is to ensure our safety, hard experiences that don’t result in real harm teach the brain that it can, with subsequent efforts, return to that level of intensity and even slightly increase it.

This is the entire point of training: we run for X time with Y effort and cover Z distance with the hope that, the next time we do it, we will put in the same time and effort but cover more distance. What allows us to do this isn’t just physiological adaptation. Yes, muscles get bigger and mitochondria and red blood cells become more numerous, but that’s only part of the story. The brain, the Central Governor, theoretically learns, becomes more confident in our exertional capacity, and increases it. Most notably, it retains that memory for a very long time.

And that’s the key: memory. The brain retains memory of previous stressful events, and creates adaptations to better handle that stress should it repeat in the future. This enhances survival. (Indeed, this, too, is the neuroscience behind post-traumatic stress disorder, which in effect represents a hyper-activity of that stress-induced adaptive response.)

So, how does memory work? There are two types of memory, declarative and procedural. Declarative memory includes two sub-types:

  • Episodic ­memory – recollections of past events and experiences we experience first-hand; and
  • Semantic memory – factual knowledge such as names, places, and other trivia.

Performance, or how we do things, is procedural memory. Besides the obvious difference of knowing something versus knowing how to do something, procedural memory is stored in a different area of the brain and, as research has discovered, is extremely strong and resistant to decay.

The strength and resiliency of procedural memory is highlighted by extreme stories of brain injury wherein people, robbed of basic cognitive function and memory due to trauma or disease, can still perform previously learned skills, and even at virtuoso levels. Such observations help explain skill retention among us all, including how to ride a bike, regardless of practice.

What are the implications of procedural memory? It could mean that performance learning through doping can persist far beyond the actual use of banned substances, even if the physical growth and development responsible for such performances has long since receded. Biologically, it behooves our nervous system to remember how to do that thing should we need to replicate it in order to survive another similar challenge.

Procedural Memory and Running: Long-Term Performance and Health Impacts

Veteran runners frequently experience the effects of procedural memory. It’s far easier to continue to run five-minute miles if, as a youngster, you routinely ran them. On the other extreme, subsequent 100 milers are usually a lot easier after that first one.

The procedural learning from intense experience persists. As a result, performance can often be replicated with less preparation, effort, and pain. Because pain “is a system output based on sensory input the brain perceives as a threat,” previous experience decreases the threat and makes the same effort hurt less. Less pain often leads to pushing harder and running faster. And to reiterate, this might all occur in the absence of any current doping.

This is also an argument for the increased possibility of grave physical harm as a result of doping. If the Central Governor is able to push to great extremes through artificial and illicit means, then the brain theoretically learns to push closer to true physiological harm. Beyond simple orthopedic injury and long-term burnout, the implications of doping-induced performance learning is that, someday, a doping athlete could potentially run themselves to death.

An Anecdote on the Central Governor in Ultrarunning

The strength of procedural memory might play a central role in championship ultrarunning, and harkens back to a memorable conversation among some legends of the sport. In early 2013, Jacob Rydman and I were training for the upcoming Western States 100. I’d run well in 2012 and was looking to improve upon my ninth-place finish, while Jake, an up-and-coming ultrarunner in his late-20s, had just run a screaming-fast time at the Waldo 100k to gain an automatic entry. We’d traveled to Ashland, Oregon to learn from a couple champion ultrarunners.

On a snowy Saturday in February, Jake and I got in an epic training run with then-WS-100-defending-champion Timothy Olson, and later grabbed dinner with Tim and another local WS 100 cougar trophy owner, Hal Koerner. Over beers and pizza, we prognosticated what it takes to win the WS 100 and who had the best shot at winning the 2013 edition. Two-time champion Hal said succinctly, “I think Tim’s going to win again. He’s already won it. And once you know how to win WS 100, it’s easy to keep winning.”

That’s exactly what happened that year. And over the 40-plus year history of the WS 100, the number of repeat winners is staggering. You could argue, as Hal did, that those with repeat success learned how to tip toe that red line through the high country, fly up and down the canyons, crush Cal Street, and close hard to the high school. Those executions–the neurological ability, mental toughness, and courage–become skill sets. And once you know, you know.

Final Thoughts

To conclude, our theory is that:

  • When the brain learns how to do something while someone is doping, it may know how to do it forever.
  • While someone is doping, their brain can learn to push closer to true physiological harm.

If this is true, then it fundamentally changes the debate on doping and its impact. It should change how we look at performance following the doping experience, what sanctions should be considered–including lifetime suspensions–and on the potentially grave danger placed upon a doping athlete.

Call for Comments (from Meghan)

This is obviously a sensitive topic. We welcome you to constructively talk with each other in the comments section of this article, but we also implore you to do so according to iRunFar’s comment policy. Comments not adhering to this policy are subject to redaction or removal. Thank you.

  • Do you agree that it’s easier to repeat the same hard thing as you have in the past because you have that previous experience? Alternately, have you ever had surprising success at doing something hard in part because you were a ‘newbie’ and didn’t know what it would be like?
  • What do you make of this theory that what the brain learns while using banned substances and methods might affect how your brain works later?
Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There are 19 comments

  1. Mike Miller

    Im curious then, what role you think the brain plays in over-training syndrome? Is it possible that at some point the brain simply rejects the notion that we can safely go any harder and prevents from trykng? is it all mental?

    And whaf does the central governor theory say about why we have seen so many runners, Tim Olson included, burst on the scene, put out a few insane performances and then never seem to be able to get back to the same level again?

    1. Joe Uhan

      Thanks for the comment, Mike.

      In short: Absolutely. This is the basis for PTSD and, in effect, post-overtraining training and racing “intolerance” may very well operate in this same fashion: an over-amplication of “protection” for non-threatening stimuli.

      As for individual runner and their paths, it’s tough to say. Each has training and racing (and life balance) experiences that effect that subsequent performance progression/decline. Some is neurological, some is not.

  2. AT

    Finally, a spin on this topic that isn’t SJW esque, but actually a deep dive conversation around why athletes may turn to doping and the psychology that plays into it all. I really appreciate this article, very timely.

    I am absolutely against doping more from the health implications. As a HS/College football player witnessing the side effects of external testosterone and other highly questionable supplements was very eye opening. Hormone imbalances, heightened liver enzymes, severe acne, mood disorders, irregular heartbeats, and freak lower limb fractures all within the year taking PEDs.

    A good college friend of mine fell into the PED trap, working out with some older teammates who were taking D-Bol and Winni-V during the off season, they were working out 3x a day, and just looking absolutely ripped and their recovery time on top of being 19-21 years old was almost immediate. He told me about 2 years later that the 2 cycles he took was one of the worst decisions of his life. The “come down” experienced from these drugs is hardly ever talked about because the ill symptoms can widely vary. He had to see an endocrinologist because his everyday day mood and energy just flat lined and his acne was actually painful. Other teammates would feel racing heart rates at random times of the day. Just bad news all around.

    It may be tempting to a young athlete, but if there’s any value to young long term health, avoid the nonsense by all costs, just not worth it.

  3. David Hedges

    It seems that the purity of the competition will dictate that runners who dope have to convince themselves that they are clean. The ‘marginal gains’ techniques and asthma prescription sort of abuses, even rubbing testosterone cream in, must seem to dopers as being essentially innocent, especially if they subsequently pass a test. Ross Tucker cites a study in his podcast on the subject that indicated that cheaters are more likely to cheat in increment steps and rarely go all in. But when someone is training 30hrs/week say, and are in the middle of a hundred mile race, if they weren’t convinced that they were clean, the psychological weight, the guilt, must be extreme and performance detracting. Unless one is a psychopath like Lance, I guess. Maybe not. But the stress, shame, and dishonesty that accompanies cheating must be lifelong, so athletes stick with amino acid injections and sketchy creams to rationalize it all to themselves. Thanks for the interesting take.

  4. John Vanderpot

    It would seem, based on emerging science, that long-term/lifetime bans for this kind of thing are a reasonable solution to what I’m inclined to believe is a growing problem…

    This is serious stuff, the stakes are high (people are attempting to make a living at it) and that someone with Salazar’s reputation/credentials is involved, well, that pretty much tells me about everything I care to know…

  5. Fred

    How about marijuana? It seems like that would provide mental benefits during use and training. However, there are runners using during training but not leading up to/during races. Or using before races that don’t drug test.
    Thanks for the great article.

    1. Joe Uhan

      Possibly, but I believe that would be a more secondary gain: cannibas decreases pain(?) during/after activity, which might allow for better performance. This seems to be to be slightly less potent than doping that directly creates the infrastructure (muscle, blood/Hg, etc) to perform at a higher level.

      1. SageCanaday

        “slightly less potent”?! More like “a lot less potent” (granted I would never take cannabis during a race as that is against the rules and have not used it in training)…And the legal limit (for “in use racing”) is also quite high…even to trip a PED test.

        I’m not too worried about top competitors taking cannabis anyway when they are taking much more powerful PEDs… I’d believe EPO/HGH/testosterone are going to provide way, way more “superhuman” advantages (in both training and racing…actually mainly training/recovery). A 3-8% gain for an elite sponsored runner is everything.

        #cleansport

        1. Billy Madison

          “Chlorophyll? Sounds more like ‘Borophyll!’” …. You got Chlorophyll Man talking about God knows what …. I’m here to learn, everybody … Go on with the Chlorophyll!”

  6. Brian

    David Epstein has a fascinating book and Ted Talk breaking down the record setting athletic performances through history and accounting for equipment variables. Basically boils down to show marginal improvement in athletic records over 100+ years of competition. I bring this up to pose the question “what does it matter?” Swimming records have an apteryx during the speed suit era, Cycling has the Lance era and even worse to an extent the aero bike that has more impact on performance advancement, Baseball as it’s steroid era. What is the impact or who is the poster fraud that will define Running’s tainted era and have we even entered a tainted era compared to the other sports?

    Competitive integrity seems like a moving finish line – we applaud Nike 4% and encourage the next performance enhancing piece of equipment but we condemn substances (designer or natural) based on personal morality and then issue a pass and encourage advancement in other substances (i.e. CBD/cannabis).

    I like the conversation and thoughts in the article – lastly in less than a week we’ll watch Eluid attempt to break 2 hours with the No Human Is Limited slogan, all while competing in an event that is funded/sponsored by IEOS who has an environmental background rich with controversy, this highly orchestrated event is a PR propaganda stunt with no budget and no resource off limits all with the corporate goal to shift the global public association/name recognition of INEOS under the guise of competitive exhibition.

    1. SageCanaday

      Distance running (on the track at least) already had an EPO era in the ’90s I believe. “Natural” blood doping with blood bags as well. Of course people are still using EPO and probably microdosing more though. Also testosterone, HGH, IGF-1, etc.
      Maybe infusing over 50ml of L-carnitine even etc.

      As for as INEOS goes…well yeah that is big marketing and for a lot of exposure obviously. If Kipchoge runs 1:59 or 2:00 it’s not going to count as an official World Record anyway because it’s not a real race. But the masses don’t seem to care or know that. Personally I would have been much more inspired if he instead would’ve raced Bekele head to head in Berlin a few weeks ago for that sub 2:01:30 in an actual race. It could have been the greatest marathon race in history.

      As far as was what is “morally correct” or where we draw the line it is quite simple: You either break WADA rules or you don’t. It is very black and white…with the only gray area being TUEs. Now if we could just get a governing body in MUT Running to enforce more WADA/IAAF doping protocol and rules we’d probably see a lot more positives from sponsored pros and elites. Surprise PED testing is where its at. In my experience we very, very rarely actually get real PED testing done (And it is not a surprise).

      Heck I’d chip in $500 of my own money each year ( if the top 50 ranked MUT Runners all took part in this) to formulate our own random PED tests between races and done under WADA code. Private races can enforce strict PED rules for top ranked runners as well. The sponsored athletes benefit a lot from this sport and I think more testing is in order.

      #cleansport

      1. Brian

        Thanks Sage, appreciate your perspective and love your YT content, I subscribe and consume it daily. I suppose I’m more conflicted with the question: What is the purpose or appropriate place/priority of athletic competition in a professional market place? Does capitalism’s marketplace ruin sport purity and redefine the rules/purpose. The athlete and athletic competition become a consumable good and any consumable good/service will be produced with profitability and innovation at the forefront. What we’re seeing with Nike’s involvement here @NOP and the exploitation of the East African running community is the tangible byproduct of innovation and profitability. As we look forward, do we think WADA is the solution or holds responsibility or capability to change the outlook? Thoughts?

        1. SageCanaday

          Thanks for your comment. I see where you are coming from. Obviously I’m very biased…

          I think there is always competition and there will always be cheaters. This goes on in any aspect of life. Daniel Pink wrote a book that essentially says why we are “all in sales” and “to sell is human.” As a sponsored pro athlete I am for sure a marketing arm for my sponsors. But in business and life many people (in some role) will always seek to be competitive and gain “advantages” The question is do these break laws/rules/social code?

          I think there are mid packers who dope purely out of ego….or for a Strava segment….or an age group award. Its not all about the money and sponsorship….or innovation. Maybe insecurity?

          So I view this more as an issue (not breaking the rules in terms of doping but also cutting switchbacks or cutting courses) that can be solved by the community applying social pressure. Sure, any sort of testing and enforcement of code by WADA/IAAF in MUT Running would be a huge leap forward (i don’t think one has to run very elaborate doping schemes right now as we hardly ever get tested!).

          But ultimately it requires people speaking out more, showing more transparency, and holding each other responsible. I’d like to think honestly, integrity and natural hardwork (as well as mutual respect for all runners) are still the foundations of mountain-ultra-trail running. I see dopers the same way that I see runners that cut courses (don’t run the full race distance). Ultimately they are cheating themselves. I don’t know how they sleep at night.

  7. Jacob Rydman

    That ‘13 weekend with Timmy & Hal will never be forgotten. Never again will a San Francisco Running Co hat be the pinnacle of greatness as it was at the Vinyl Club between Hal & I.

  8. Brady

    I agree that memory of artificial success may have lasting benefits for some, but that it could cut both ways. A great example that comes to mind is Alex Hutchinsons’s 5k PR barrier, surpassed long-term due to an incorrect split timer at one race. But conversely I can see self-doubt imposing new barriers if one attributed their initial success to a drug no longer taken.

    Personally I find the lasting physical benefits of those drugs as better rationale for longer suspensions. The powerlifters who achieved decade-long improvements to their muscle fibers and performance after taking a short-term course of steroids, for example. (unless that research from 2008 has been debunked) Or the benefit from longer stretches of high quality training achieved by steroid-assisted injury recovery. http://www.sciencedaily.com/releases/2008/09/080925072430.htm

    Either way the lasting erosion of trust and legitimacy that results from doping does not seem to match the relatively short punishments handed out. And thinking about the punishment as a deterrent, Is a 4 year suspension qualitatively different from a win or blow-up strategy already employed by many athletes?

  9. Gsnch

    One question to consider is WADA’s changing status of existing “performance enhancing” banned substances. For example, when I competed professionally, the substance caffeine could find me anywhere from a Warning to a 6-month ban. I avoided coffee and Coke at all costs. Never used caffeine pills, and now a few years later, we’re allowed to basically over-dose on Caffeine. I’m afraid there are quite a few more of these substances that by 2030 will be legal, i.e., EPO, testosterone, micro-dosing once the science proves it out like it did Caffeine.

    1. SageCanaday

      Gsnch, unless you were taking like 8-10 cups of coffee or a ton of caffeine pills you probably wouldn’t have to worry about tripping that old limit.

      There are of course lasting physical (long term effects) from PEDs though (or the fact that banned athletes continue to dope during their suspensions) that continue to boost athletic performance for years…

      I’d imagine Testosterone and HGH are big culprits in ultra-trail running currently (although we already know EPO cases at UTMB and shorter distance mountain running events). Just being able to recover from hard long runs and high mileage high intensity would be a huge advantage at the top end.

      I’d also imagine some dopers justify it just like Lance Armstrong and other cyclists in that era did: “everyone else is doing it, so it is just leveling the playing field”. That being said, I don’t think there are that many dopers in MUT Running…they are in the minority….but we certainly know it is not 100% clean. I think a lot of this choice has to do with mental attitude and perception…sure trail-ultra runners are driven by career changing sponsorship deals, international travel perks and some prize money/bonuses. Not to mention “social media fame.” But ultimately I think cheaters have to be driven by ego. It feels good to smash course records and podiums and feel “superhuman” etc.

      As a sponsored pro in MUT Running the past 8 years I’ve only had one legitimate PED test (under WADA code by an actual governing body) ever. We almost never get tested.

      #cleansport

  10. RP

    Past PED use would have a super negative effect on future clean performance from a cognitive perspective. I mean imagine showing up to a start line knowing that you were able to put in a huge amount of volume with some hard efforts, with the ability to recover like a 20 year old, just oozing fitness: the confidence! Then imagine showing up to the same start line a couple of years later but now you’re clean. Sure you got your training in, but always lurking in the back of your mind you know that you’re slower than you used to be and it’s going to hurt a lot worse this time! This really speaks to the hard-to-quantify increase in confidence that doping facilitates. But those physical gains; those stay around forever. You’re body is always going to remember those extra large blocks of volume, those extra races, the crazy hard intervals, that doping enabled. I think that when people talk about being addicted to doping, it’s the confidence of knowing that they are taking a PED that they are addicted to, rather than (which is guaranteed to improve one’s performance) the drug’s actual effects. Unfortunately there’s always going to be athletes that are going to seek out some ‘extra help’. I think the nature of MUT running helps insulate itself from individuals that dope; it’s a sport, no, a life style, that fosters a compassionate and collaborative approach to competition. I mean, sometimes just finishing a race, irregardless of placing or time, is a victory in itself. Our activity is more than a contrived ball and stick game, or a riding a bike up a mountain before a time cut. As illustrated in the comments above, a pro’s place is to reinforce this positive and clean perspective (thank’s Sage!). Running until the sun rises in some of the most beautiful places on earth is all the PED that we need.

  11. Ib Erik Söderblom

    It would be interesting to some statistics about athletes results, when they return from a longtime ban for doping.
    Do they fall down to mediocre levels or do they stay as they where before or do they actually get better?
    What do the numbers tell us happens to the convicted cheaters?

    Of course, like Sage points out, if they continue doping when banned, statistics will be wrong…

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