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Thursday, February 05, 2009

Cyclist dies in sleep

Belgian cyclist dies in sleep during Tour of Qatar

Sad news from the world of professional sports today is that a young Belgian cyclist, Frederiek Nolf, has died during his sleep between the fourth and fifth stages of the Tour of Qatar, currently underway.

Nolf, aged only 21 (and five days from his 22nd birthday), was a member of the Topsport Vlaanderen-Mercator team, which has now pulled out of the event, with the day's stage being shortened and neutralised to an uncontested 40km ride.

Cause of death speculation

Sadly, for cycling, the speculation has already begun that this is drug-related death, partly because of the reputation of the sport and the historical precedent for this type of event among cyclists. At this early stage, the ASO (the Tour's organizers) couldn't even confirm the death, and so discussing a cause is very, very premature.

However, a few people emailed me the story this morning with the very obvious implication that this was yet another in a long series of sudden deaths in fit and healthy athletes. In the 1990s, there was a spate of sudden deaths, at least a dozen, where fit amateur and professional cyclists died in their sleep. That negative publicity was at least part of the reason for the clamping down on EPO use, which was rampant at the time.

It brings to mind one of the most fascinating quotes I've ever come across in a cycling book - it was in the book "The death of Marco Pantani" by Matt Rendell, in which a story is recounted of how in the 1990's, with EPO use rampant, the cyclists would set their heart rate monitors to sound an alarm if their heart rate dropped below a certain level. On hearing the alarm, the cyclists would have to wake up, get the bike out and spend 10 minutes on the rollers, in their hotel rooms, just to jump start the circulation.

In the words of one cyclist: "During the day we live to ride, and at night, we ride to stay alive". Quite chilling, and I must confess that these were the first thoughts that went through my head upon reading of the death of Nolf.

However, and this is very important, such speculation doesn't provide answers, only more questions. There are some other reasons why cyclists might be predisposed to sudden death - riding at high intensities when carrying viral infections (as pro athletes tend to do) is one of them. And, as Ryan Shay, and a number of other high profile cases have shown recently, sudden death is a tragic, but not completely uncommon event. There are reports that Nolf's cardiogram was normal, but even that is not a guarantee of health, because those tests can often miss the quite rare conditions that cause sudden death in athletes.

So let's see what unfolds, and whether any answers emerge. In the meantime, a sad day for cycling and those who knew Nolf.



Anonymous said...

Hi !

Hm, its strange that the drug allegations are only dug out by the press when cyclists are involved..
The most likely cause of death for this poor young man is the "sudden cardiac death" that claims victims among athletes every few months. A German 800m runner just died some weeks ago, some soccer players passed away last year...

And to the "cycling at night to keep the circulation going under EPO": Look at it scientifically: There are many old people with a disease called polycythaemia vera that have an increased red cell mass showing often (untreated) Hct values of around 70%. And they do remarkably well. Those people are old a dont have the trained cardiovascular system of athletes...

Another point in this context: The highest Hct values observed in "healthy" humans are from mine workers in the Andes at 5000m+ that show values up to 90% (!). (See
Jefferson JA et al. Excessive erythrocytosis, chronic
mountain sickness, and serum
cobalt levels. Lancet 2002; 359: 407–408). And they live..

And lastly: The deaths in the 1990`among the swedish orienteeres you are probably referring to was later clearly attribuable to an infection (see Pedersen BK. Sudden cardiac death in Swedish orienteers – a mystery solved? Scand J Med Sci Sports 2001: 11: 259)

Although many of the stories and their explanations you wrote about today are appealing, few stand proper scientific evaluation.

Keep up the good work !

Ross Tucker and Jonathan Dugas said...

HI Anonymous

Thanks for the comments and information. I wasn't referring to the Swedish Orienteerers, actually, but to a host of Belgian cyclists (predominantly, there were a couple of nationalities involved).

As for the quote, that's a direct quote from within the scientific community, not my opinion. I would suggest that excessive erythrocytosis as a result of EPO abuse may have a very different clinical outlook than that of people living at altitude or with a disease. Perhaps I'm incorrect, but I'm not convinced the comparison is quite valid.

Also, I suspect that the use of EPO would not have been isolated (and here I'm referring to the deaths in the 90s, not the latest one), and may have been accompanied by other drugs, including amphetamines, with known cardiac effects.

And then as to the first point you raise about how drug allegations are dug out only when cyclists are involved - you're being blinkered there, because Ryan Shay was a runner in whom drugs were very definitely discussed in the media, and that was the case with the soccer players as well. I dare say that your Swedish Orienteer athletes faced the same allegations? I don't know the story, but I would be right guessing that they too were suspected to have been using.

Cycling has a reputation of being tainted by drugs. That doesn't mean other sports do not, of course, but cycling deserves all the skepticism it gets - it gets to lie in the bed it has made for itself. So it's not "strange", but obvious. If, for whatever reason, someone from another sport has the same problem, I'll approach it the same way.


Michelle Simmons said...

I have a question that is unrelated to this post...

Have you seen any research or have experience with female athletes competing at a higher level when they are post-partum than they did pre-pregnancy? I've seen a little bit of info regarding VO2 max and blood volume pre and post partum, but it didn't seem conclusive. I haven't had a lot of luck searching on the internet and was wondering if you might comment.

I am a 35 year old amateur triathlete and 3 months post-partum. I swear I feel stronger while training now than at any other time in my long athletic life. Just wondering if there is actually a physiological reason for my current success or if it's just because I'm training smarter?

Rohit said...

...the cyclists would set their heart rate monitors to sound an alarm if their heart rate dropped below a certain level. On hearing the alarm, the cyclists would have to wake up, get the bike out and spend 10 minutes on the rollers, in their hotel rooms, just to jump start the circulation.

I have little medical background, why would their heart rate drop (to fatal levels) when they are sleeping?

Anonymous said...

A very, very good friend of mine died from sudden cardiac arrest -not really arrest, specualted to be ventricular fibrilation etc because there were no causes found at post mortem.
I knew one other person fairly well who also suffered similar fate.
Neither of these, to my knowledge, were on-or had any need/desire to be on- drugs of any sort. In fact their lifestyles and diet etc were extremely healthy.
I have heard of many other instances of such deaths where I don't know the peopple involved.

After my good friend's death I did a lot of internet (and soul I suppose) searching to find out what could have happenned and how could one know about this beforehand. I am none the wiser, except for speculation about things like LQTS (long Q-T syndrome) etc.
I also found out that it is speculated that in the USA at least between 0.01% and 0.1% of people die like this every year. As a % of actual deaths that would be much higher.

So my question to you is: Why is it that when a sports person suffers this sudden fate, especially cyclists, whether in their sleep or during training, competing etc, is the finger immediately pointed at drugs.

As Sports Scientists who started off their blog with a lot of facts and debunking mytths by bringing a lot of the research out there to the masses, you lately seem to be doing a lot of speculating, jumping to conclusions or offering social commentary.

Why not dig up some info for us (which is your strength), so that people can understand why this happens to the general population and we can put it into context.
And in that way it may highlight this as an accepted form of death, so that research is accelerated towards finding reasons and finding preventative measures.


Ross Tucker and Jonathan Dugas said...

Dear Anonymous number 2

If you don't enjoy the approach we take to sport, and the so-called "social commentary", then feel free not to read it. You clearly don't understand the purpose of the site, which means it's not for you. Perhaps you should stick to scientific journals.

Read my response to the first Anonymous poster, and then maybe read the post, and you'll see that it's a very clear opinion post. If you want a scientific journal, then go find one. And then to finish, read the "Mission and Values" section of this site and try to understand what it is we are trying to achieve.

Also, go to this site:


And then scroll down to the series named "Sudden Death during Exercise", and give that a read. It covers everything you've suggested. So it's been done. Read that.

Finally, the reason the accusatory finger is pointed is because this is cycling. It has a history of drug use, a history of cyclists dying in their sleep, and a current problem with doping.


Anonymous said...

To the second anonymous poster:

I agree with Ross' response - you should find yourself a nice, scientific journal and read it to your heart's content.

This site never was, and never should be, about translating science for the sake of it. If you read the Mission and Vision (and if you have been with the site since the beginning), you'll know that the main focus is to apply science to sports news, and to give some level of insight into the sports happenings that would miss otherwise.

I think Ross' latest posts have done a fantastic job of doing this. You think they're social commentaries. Fine, that's your opinion, but don't come here pointing an accusatory finger because you don't enjoy the angle taken.

And like he says, they've covered this sudden death thing in enormous detail before. Read those posts. What we have here is a news story, and their opinion or first thought in response. And let's be fair, Ross made a point at the start of saying that speculation doesn't help, and he emphasized that the EPO thing was the first thing that went through his head. I think what you're missing is that this is a personal site, not a distant, impersonal journal.

So Ross, keep going, I love the "social commentary", even if they're not good enough for some people. Maybe those people should start their own site, and then think about pointing fingers.


P.S. What is it with all you anonymous posters? It's the internet - there are millions of people, you can reveal your name...no one will come knocking on your door

Anonymous said...

Dear Ross and Jonathan,
absolutely love your site. I am a cardiologist, runner and am doing a PhD on athletes' heart and the risk of arrhythmias /sudden death. I am extremely frustrated by the lay press reporting of sudden death in athletes. I am even more frustrated by the knee jerk drug allegations. There are a number of other growing theories that deserve attention but are often lost in the main stream. People need a reason, they do not like dealing with uncertainty. Therefore, the common person deals with this news by saying "must have been on drugs". The medical fraternity are just as guilty. It seems scientifically unacceptable to even consider that a toxic threshold of exercise may exist. People believe that it is irresponsible to speculate because of the need to promote exercise as a public health measure. I am an extremely keen endurance runner and am very happy to deal with the fact that the exercise benefit may not be black and white.
For example, why was the finding of myocardial fibrosis on Ryan Shay's autopsy dismissed as "natural causes". We do NOT expect to find fibrosis in the heart of a young person. It is abnormal yet it seems that it is somewhat taboo to ask why it was there at all.
EPO and cardiac death? There is no known cardiac risk (excepting that the ridiculous doses of decades past are gone). I am of course not condoning it but it is a very unlikely cause of sudden death. In fact, I am unaware of any current drug of abuse with known cardiac toxicity. Therefore, why is it always considered the most likely cause. Professionally, I would consider it a most unlikely cause.

I am keen to send you some of my publications which address this topic.
I do not know how to contact you but if you are interested then please let me know how I can send you some journal articles.

Unknown said...

High hematocrit increases the "viscosity" of the blood, making it harder to pump. It is a bit difficult to define viscosity in this case... blood is a non-newtonian fluid. Try to learn what that means if you don't already know.

About super-high hematocrit: yes, but also consider errors if measuring "old school" with centrifuge. 90% is a hoax or fuck-up. It would make blood no longer be a fluid, therefore impossible to pump.

About cyclists waking up at midnight to work-out: they were mostly afraid of blood cloths.

Yes, Ross, it is believed that blood that is enhanced by means of large doses of epo is more viscous than the blood of high-altitude dwellers. [Speculation]Speed of increase is to blame for that. You can't grow hematocrit as fast at altitude because of mountain-sickness: you will have to climb slowly from sea level to Everest because there are other things to adapt as well, you know... which allows your plasma to rearange somewhat. With epo, impossible is nothing.

To Mama Simmons
If I recall pregnancy was used in the past as a means of "doping". Not sure about today. It is kinda like the other trick female athletes do when they get their period right on the day of the olympic finals. Don't know about post-partum, but note that in the later months of pregnancy the heart has to make a considerable effort even at rest, it would have to pump up to 40% more blood per minute in the 9th month if I am not mistaken. Maybe you feel better now that the burden has been lifted off your... hips? Data please no feelgood subjectivity!

Indeed, Andre, epo is as healthy as orange juice, as Ferrari said it. Amphetamines are potential cause for sudden cardiac death, and can be used by athletes, especially in technical disciplines. But yea, it is hard to accept that one can die just like that for no reason, so one is always tempted to blame something such as drugs. As so many are incredulous of their loved ones commiting suicide.