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The inside line: The Lars Boom dilemma

Lars Boom has withdrawn from the Tour de France due to health concerns. (Source: Wiki Commons)
Roar Guru
14th July, 2015
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When it was announced that 29-year-old Dutch rider Lars Boom wouldn’t miss the 2015 Tour de France despite a doping test returning a low cortisol reading, the controversy surrounding the embattled Astana team escalated to new heights.

As a signatory to the MPCC’s regulations the Kazakhstan team were ethically obligated to rest Lars Boom until follow-up blood tests indicated the Dutchman’s cortisol levels had returned to normal.

However, despite initially intending to comply by flying in 34-year-old Italian rider Alessandro Vanotti as a replacement, the decision would later be controversially reversed.

Just what had happened during the hours in between the two announcements?

Current Union Cycliste Internationale (UCI) regulations forbid teams from replacing riders after the team manager meetings have occurred, usually held the day before a race’s first stage. So according to Astana’s account of events the team received word of Lars Boom’s low cortisol levels after the deadline.

Unable to receive a special dispensation from the UCI the Kazakhstan team were left with two options. Faced with either sidelining Lar Boom and beginning the race with just eight riders, or leaving the association and taking yet another hit to their credibility, the decision was made to suffer the latter.

Are the Astana team playing a game of Russian roulette with Lars Boom’s health in the hopes of successfully defending Vincenzo Nibali’s 2014 Tour de France victory? Without being privy to Lars Boom’s medical records all that exists is speculation, however the MPCC have good reason for concern due to the health risks associated with the causes for low cortisol levels.

Helping perform a key role in both metabolism and the body’s response to stress, a low cortisol level can alert medical professionals of potentially dangerous issues with the adrenal glands, responsible for cortisol production. However, due to the marvels of modern medicine low cortisol levels can paradoxically be an indicator of high cortisol levels.

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It didn’t take modern medicine long to try and harness the powerful anti-inflammatory effects of cortisol. Usually known as cortisone, this synthetically produced drug is used in everything from the treatment of asthma to relieving inflammation and pain in joints, connective tissues and muscles. Cortisone use reduces the production and levels of the cortisol present in the body, similar to the effect anabolic steroids has on natural testosterone levels.

High levels of cortisol or cortisone use can lead to the development or worsening of diabetes, Cushing’s Syndrome, suppression of the immune system, catabolism of muscle (Myopathy) and, critically, a failure to produce cortisol once cortisone use stops. While scientific studies have worryingly also found links between the use of cortisone and major depression in the general population.

It is the abuse of cortisone which has the MPCC, FIFA’s medical committee and other associations worried about the long-term well-being of professional and amateur athletes. Unfortunately, the sporting world has a worrying history of disregarding the long-term well-being of athletes, concussions just one of many issues that continue to dog the NFL, AFL and others.

It has been acknowledged that medical staff are under immense pressure to ensure players are ‘fit’ to compete. One of the most common uses of cortisone is to ensure injured athletes can compete in their next game, race or event via localised injections. It can also be abused to help improve athletic performance as illustrated by Bjarne Riis’ autobiography “Riis – Stages of Light and Dark’.

“Before anything else though, I decided to try a stronger form of cortisone. It appeared to have a more desirable effect on me. Kenacort, as it was called, became my cortisone of choice. I lost a lot of weight and got better power in my legs,” Riis wrote.

The MPCC have been lobbying the UCI and the World Anti-Doping Agency (WADA) to implement regulations around the use of cortisone under a growing weight of supporting scientific evidence and expert consensus. In the interests of protecting the long-term well-being of current and future athletes it is time WADA and the UCI admit that there might be a problem.

As suspected, reportedly suffering from a fever and body aches since the Stage 9 team time trial, Lars Boom has since had to withdraw from the 2015 Tour de France due to ill health. Astana have gambled with the well-being of Lars Boom and now it has come back to haunt them.

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With the welfare of the athletes at stake, the decision needs to be freed from the teams and their conflicting interests before someone tries pushing their luck one step too far.

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