Well, no sooner did I pen my article last week, lamenting the shadow performance enhancing drugs have cast on the Olympic Games, then Michael Phelps began making Olympic history, moving ahead of both Mark Spitz and Carl Lewis as history’s most decorated Olympic athlete. Day, after day, after day, Phelps broke world records in both short and intermediate length swimming events.

Shortly after he was awarded his third gold medal of the 2008 Games, I began to hear commentators on radio programs questioning how this was being done. One expert summed it up by saying, “When I see someone performing superhuman feats over an extended period of time, I become suspicious. I hope I’m wrong, but I don’t believe it is possible for someone to perform at that level for more than a few days in a row.”

In Phelps’ case, the suspected medication is not a steroid or a human growth hormone, but a drug known in athletic circles as “EPO.” Keep in mind, there is no evidence that Phelps’ medals are the result of anything more than incredible genetics, an unbelievable work ethic, complete mental focus, and the mind-boggling ability to digest nearly 10,000 calories a day to maintain his training regimen. I am certainly not accusing him of any wrongdoing, whatsoever. Unfortunately, due to the recent misdeeds of several athletes, the subject will inevitably come up. Further, since this is a health column, I thought it was an excellent opportunity to blend information on medication with the latest headlines.

“EPO” is short for erythropoietin, a glycoprotein growth factor, synthetically available as epoetin alfa, or Procrit. Erythropoietin is found in blood plasma, and produces erythrocytes that encourage the reproduction of red blood cells, the cells that carry oxygen throughout the body.

Procrit is a recombinant glycoprotein from erythropoietin that has been cloned from Chinese hamster ovary cells. (I suppose the use of ovaries from a Chinese hamster is quite appropriate as we focus on this week’s Olympic games.) Procrit increases the number of red blood cells that have the ability to differentiate into mature erythroblasts, encourages hemoglobin synthesis, enhances the release of red blood cell precursors, known as reticulocytes, from bone marrow, and improves the viability of existing red blood cells. In other words, Procrit increases the body’s ability to transport oxygen to muscle groups, and would improve endurance during physical activity.

Typically, Procrit, or longer lasting derivatives, such as Aranesp (darbepoetin), are given to renal patients to help increase their red blood cells. Erythropoietin is a glycoprotein, and certain diseases may decrease the amount of protein available for red blood cell production, such as kidney failure.

Procrit would be a treatment option for people suffering from anemia, as well. Anemia is a term that describes a low-level of red blood cells in the body, sometimes termed “iron poor blood.” In addition, cancer patients undergoing chemotherapy may have a significant decrease in their red blood cells, and Procrit is used to help these patients recover their normal cell level, hopefully without blood transfusions.

While the above are accepted uses for Procrit, the temptation to abuse this product, should be obvious. Anyone wishing to increase their aerobic endurance, or decrease muscle fatigue and muscle recovery time, would find Procrit a useful tool. Lets see, that would be long-distance runners, long-distance swimmers, cyclists, weight-lifters - well, you get the idea.

As medications become more specialized, mimicking naturally occurring processes in the body, testing for the substances become more difficult. For example, human growth hormone is naturally occurring in everyone, but at steadily decreasing levels as we age. “HGH” is, of course, a banned substance for Olympic athletes, although some medical exemptions exist, where some amount may be prescribed by an athlete’s physician. I can only imagine the paperwork required by the International Olympic Committee for both physician and athlete to complete, should “HGH,” “EPO,” or any other banned substance, be deemed necessary for the athlete’s health. Unfortunately, the day may come where athletes who have naturally high levels of certain hormones, yet abused nothing, may be ruled out of Olympic competition.

Dara Torres, the ageless 41-year-old Olympic swimmer, has insisted she be subjected to regular drug testing, in an effort to silence critics that believe only wine improves with age. Dara is currently swimming faster than at any point in her impressive career, a feat many believe is not possible without a “little help from her friends.” In this case, the “friend” in question is “EPO,” or Procrit.

Personally, I think the only substance Michael Phelps may be abusing is some form of kelp or plankton at his training table. He is shaped, swims, and resembles a fish in many ways, and it would not surprise me if he was eating like one. Hopefully, the IOC will not ban kelp or plankton during the next eight year testing window!