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. CBD oil can help. 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.