Chris Froome & Bilharzia

In the past I have written about Chris Froome and his development throughout his career. What is integral is the glaring gap between his arrival at Sky in 2010 and his startling ascension at the 2011 Vuelta. Between those two points in time, Froome went through a grey patch of results as he struggled to compete in the World Tour. His performances were so dismal that Sky were considering releasing him at the end of the year and indeed the managing director of Garmin – Jonathan Vaughters – has said that he was in the process of recruiting Froome prior to the Vuelta.

Froome has in the past attributed those performances as due to the parasitical disease of Bilharzia. He claims it weakened him and left him incapable of performing to his true potential until it was diagnosed at the end of 2010. Yet it would not be controversial to say that these claims have been contrived to justify his meteoric rise and are merely a contrived excuse for doping. Furthermore it does come across as very ideal that Froome was stricken with a disease which would have affected his blood values and therefore irregular blood values as a result of doping could have been explained away by Froome’s Bilharzia.

Bilharzia Timeline & Explanation

Distribution of Bilharzia victims in the world:

I will present a basic timeline of Chris Froome’s bilharzia but it is also imperative to just have a bit of background on bilharzia. Bilharzia is an extremely common disease in Africa where it affects many millions of people. In global terms, bilharzia is the second most common disease caused by parasites after malaria. Indeed an estimated 200 million people are infected worldwide, with 85% of the cases occurring in sub-Saharan Africa, furthermore forty percent of the Kenyan population is infected by it. It is especially common in popular tourist destinations with the NHS citing Lake Malawi, a lake Froome regularly swam in, as having high levels of the parasites. Therefore to consider that Froome developed the disease in Kenya is not all together that difficult. Likewise the likelihood he developed the disease is higher than people generally think.

Infection

The original cause of the bilharzia and when Froome originally contracted it is unclear. The problem stems as bilharzia can lie dormant for an extended amount of time so it really is impossible to ascertain when it was initially contracted. Froome estimates, 

“I must have touched some contaminated water somewhere in Africa. I probably had it for year before I found it.” 

Indeed it can go undetected for quite some time and therefore the exact date when he contracted it will likely remain unclear, but it is fair to say the date was likely around a year from December 2010 which puts it at about December 2009, just before he arrived at Sky. 

That also would coincide with the time frame in which Froome visited Africa for a holiday and then to partake in a training camp. As the bilharzia’s primary impact would be to considerably weaken the immune system, this quote from Dave Brailsford before the 2010 Giro d’Italia does indicate that it is very likely that Froome had it in his bloodstream at least prior to the start of the 2010 racing season, likely when he visited Kenya in the off season. 

"Chris has been ill and is also coming back from a crash so I think we want to nurse him back and make sure he's ready to go.”

 And the Sky website saying, 

“The 25-year-old did well to even make Team Sky's starting line-up for the Giro after overcoming a chest infection”.

 Such chest infections will become a regular occurrence for Froome until he finally managed to rid himself of the bilharzia in 2012.

By the end of the season Froome posted on twitter, 

“That's the last time I get sick this year!! Back with a vengeance now.” 

Illness was obviously a recurring problem for Froome due to his bilharzia.

Diagnosis

Froome has stated in many places that the bilharzia was diagnosed on a trip to Kenya in December 2010 which Froome had made for his brother’s wedding. What is more unclear is just how Froome become aware of the disease.

He states, 

“It was late 2010 at the wedding of my brother in Kenya, when the International Cycling Union (UCI) checked me for the blood passport. I immediately asked to examine all parameters. Then she discovered that I suffer from the disease.''

It would not be surprising for the blood samples to have stood out as the parasites feed on the victim’s red blood cells, therefore when Froome would have received his results it would have been very conspicuous that there was something wrong.

Yet another interview Froome gives a slightly different insight:

“I'd gone to Kenya to see family and did the normal UCI blood passport tests. At the same time I said to the doctor, 'Can't you scan for anything that's not right in my blood?' He came back straight away and said you're riddled with bilharzia."

The problem with this is that Kenya is isolated in terms of WADA accredited labs and therefore it is highly unlikely that Froome was in direct contact with the doctor. Indeed the nearest lab is in Tunis or possibly Bloemfontein, South Africa. At the same time I don’t see this interview as much of a problem as it is standard UCI procedure to make the information from blood tests immediately available to the athlete in accordance with the International Standard for the Protection of Privacy and Personal Information. The person Froome would have been in contact with is called DCO and Froome could have very well been in telephone contact with this person and discussed examining the blood due to the obvious blips which would have occurred due to the bilharzia. That he calls the person a doctor is surprising but it is possible he was in contact with a doctor at the lab or either he or the interviewer made a mistake.

Edit: I recently saw a very accurate source which confirms that Froome was diagnosed in a lab in Kenya and then treated by a specialist in Medical Parasitology.

2011

Froome’s 2011 was a very turbulent year, he got better as the year progressed and then took a giant leap straight onto the podium of the Vuelta as the cycling season drew to a close.

Froome started off the season soundly, though not spectacularly and was building up to lead Sky at the Tour of California. Unfortunately he was then hit by a chest infection as this article on Team Sky’s website details:

“Froome proved there are few stronger after an impressive run to 15th overall at the Tour de Romandie at the end of April, yet the Kenyan-born rider has seen his preparations take a knock following a chest infection."

He added: 

“When I got back from Romandie I had to take about a week off the bike because I got a bit of a chest infection and cough. That held me back a little bit but I can feel since coming over here that I’m feeling better and better each day so hopefully by the time the race starts on Sunday it will be pretty much clear.”

As detailed above bilharzia causes the immune system to be considerably weakened and therefore it comes as no surprise that Froome was hit with this chest infection. Unfortunately this scuppered his plans in California, where Sky had been touting him for an impressive performance.

In a later interview with Velonews, Bobby Julich who was Froome’s coach at Sky stated that:

“'In the 2011 Tour of California, he was amazing one day and really bad the next. So we tested for bilharzia again and sure enough he had it. And once he got treatment, he started progressing again.'
The bilharzia has returned on occasion, but Julich and Froome can now immediately identify the symptoms.”

Even check out this video here at 1:05:

He was going pretty well on that climb but due to his bilharzia he could not maintain that consistency and struggled on the subsequent mountain finish to Mount Baldy.

Froome indeed says in a subsequent interview that:

“I had to re-do the treatment after the Tour de Suisse this year. Since then, I have been a lot more consistent and good in my training.”

Once again in Switzerland Froome’s trajectory was very much one of starting off well and then not being able to maintain his consistency as the race progressed, obviously due to the bilharzia.

Logically I would map out Froome’s schedule as him racing through the bilharzia to complete the Tour de Suisse and only then taking the medication, which would fit in as he was out for a over a month after Suisse, something which can be put down to the heavy medication which would have left him unable to ride.

Vuelta

After Suisse and his break from racing to take the medication, Froome returned and based his second half of his season around the Vuelta. He started off quietly at the Tour of Poland but that was only to be expected seeing as he had been off the bike so long.

Before the Vuelta meanwhile he said this particularly interesting comment:

“I’ve had one or two problems with illness but we’ve treated them and the team have been really supportive. They are sorted and, touch wood; everything seems to be going in the right direction right now.”

Interestingly enough he does not address the problem of bilharzia directly instead referring to his illnesses, but nevertheless it is evident that after his treatment he believed that he was back on track now that he had been treated for the bilharzia. With a sufficient amount of training after his layoff and finally being rid of the bilharzias, Froome was finally capable of performing as he should have always done.

Froome was out of contract at the end of the season and Garmin’s Jonathan Vaughters has said that he contacted Froome about signing with Garmin just prior to the Vuelta. I asked Vaughters whether he was aware of the disease and he replied that, 

“I knew he had parasite issues. I didn't know the exact name.” 

Therefore it seems highly unlikely that this was all fabricated as Vaughters himself was aware of the issues facing Froome.

2012

Froome’s 2012 performances whilst not being all out ridiculous still caused more than a few raised eyebrows. His early season results brought back memories of his pre breakthrough days after abandoning the Volta ao Algarve due to a chest infection which forced him to then miss Paris Nice. The article on the Sky website seems uncannily familiar to those of early 2011:

Team Sky doctor Richard Freeman said: 

“Chris has not yet recovered from the chest infection he picked up at the Volta ao Algarve. He’s improving and it’s nothing serious but by skipping Paris-Nice this gives him ample time to recover."

Therefore in hindsight it came as no surprise that Froome was diagnosed with bilharzia once again in March after a fairly ambiguous Criterium International and he immediately took the required medication. The medication took Froome off the bike for a week and set his Tour de France preparations back significantly. Certainly looking at Froome’s Romandie results in late April he was not even close to where he would have wanted to be at that stage of his Tour preparation. Michelle Cound has said that his Tour place was in serious doubt at that point but Froome was building his form and made the Dauphine squad where he was one of three Sky riders to place in the top four overall.

 

The rest of the 2012 season is history, obviously the Praziquantel had done its job of clearing Froome’s system of the parasites and that allowed Froome to tap his true potential and show the world what he could truly do.

2013

But for Froome not everything is plain sailing. The bilharzia worms lay eggs deep within Froome’s system and therefore though the Praziquantel does kill the majority of the parasites, there is a still risk of the disease returning. Therefore Froome currently undergoes treatment at regular intervals of around every 6 months and then goes for a subsequent scan.

Another problem which Froome faces is that due to the fact that bilharzia is primarily only contracted in Africa the infrastructure for testing for bilharzia is in fact very limited in Europe. That explains why Froome has sometimes gone unaware of his disease and indeed even this year Froome did not manage to do the follow up test for the treatment he carried out in January as it was simply not viable to fit in with his schedule. 

Unfortunately the bilharzia still continues to be a persistent problem for Froome and though he finally has put into place the resources to manage it, nevertheless it continues to haunt him and whilst doctors say that it is highly unlikely for Bilharzia to continue to be a problem, 7 years after the initial infection Froome’s disease seems to be deeply embedded.

How Bilharzia would have affected Froome?

As detailed above Froome was stricken by many infections and illnesses as a result of the disease, typically Bilharzia is described as causing “chronic ill health”. For a professional cyclist this is particularly debilitating as to properly challenge with the best in the mountains you need to be at 100% and therefore little colds and coughs though not particularly health threatening would have ensured Froome could not demonstrate his true potential. I would also suggest that as the bilharzia feeds on red blood cells, Froome would have been further affected as he would have been less capable of storing oxygen within his red blood cells.

Additionally bilharzia commonly will lie dormant for a significant period of time before someone starts to develop symptoms and feel the proper effects of the disease. Indeed the NHS website details that Bilharzia symptoms develop months or possibly years after infection with the parasites. This is known as chronic schistosomiasis and it is the most common type of infection.

Effects of Medication

People have claimed that Froome has used the bilharzia as an excuse to take TUE’s or other medication which would aid him and would otherwise be prohibited. Froome has explicitly denied this, something he could only do if it was true otherwise the UCI would have called him out. Similarly there is no record of TUE’s being used to treat Froome’s specific type of bilharzia and therefore there would be no reason for him to apply for any.

The common treatment for bilharzia is biltricide which is effectively praziquantel. It is listed as having a number of side effects (headache, dizziness, stomach pain, nausea, tiredness) which are not significant but would be enough to prevent Froome from training whilst on the medication.

Blood Cell and EPO relationship

The bilharzia worms feed on red blood cells and therefore typically someone suffering from the disease will have a lower blood cell count than average. Many people have claimed it can be used as a mask for EPO, but it in fact does the opposite as it decreases the red blood cells rather than increasing them.