Erythropoietin doping, also known as EPO

Posted on: 12/27/2024

Mainly produced by your kidneys, EPO is used to treat anemia caused by various conditions such as kidney disease, cancer or AIDS.

However, EPO has also made headlines for its use by endurance athletes. No one has forgotten the Festina in 1998, when a soigneur from the French cycling team Richard Virenque was caught with over 400 vials of EPO, growth hormones, testosterone and corticosteroids, resulting in the team's exclusion and several convictions. Or even Lance Armstrong, the cycling icon who was stripped of his titles and disbarred for life in 2012, having been found guilty of doping and tested positive for EPO.

In this article, we take a closer look at EPO, its usefulness in medicine and why it's so prized by endurance athletes for enhancing sporting performance.

What is EPO ?

Erythropoietin is a complicated name, but its translation could not be clearer. "Erythro" means red blood cells and "poietin" means "to make". With this clarification, it's much easier to understand the role played by the hormone lerythropoietin in our body; it simply helps to produce red blood cells. Red blood cells carry oxygen from the lungs to all parts of the body. And if there's a shortage of red blood cells, he can't get enough of them, which can lead to anemia, fatigue and other health problems.

The main source of EPO production in the body is the kidneys, although it can also be produced in the liver and other tissues. When the kidneys detect that oxygen levels in the body are low, they release EPO into the bloodstream, stimulating the production of more red blood cells.

EPO is mainly used to treat chronic kidney disease, anemia linked to cancer or HIV, blood loss or premature babies. But that's not all it does. It plays a role in neuroprotection, helping to protect nerve cells from damage and degeneration, boosting cellular recovery and energy levels, and aiding wound healing. It also improves cognitive function in people suffering from mood disorders. As you can see, EPO isn't just a hormone that "boosts" athletes.

EPO and sports performance

As you know, you can't survive for more than a few minutes without oxygen. Every cell in the body needs it for energy, and it's the lungs that transport oxygen to the cells using red blood cells. The more red blood cells you have, the more easily oxygen is delivered. Since erythropoietin increases the number of red blood cells, the result of more EPO is a noticeable improvement in sporting performance.

Many athletes use EPO to combat muscle fatigue. The substance increases the number of red blood cells in the body, which dramatically improves endurance and performance in sports such as cycling and long-distance running. This type of doping is known as blood doping, and includes not only EPO, but also other substances which increase aerobic capacity and sporting performance. Numerous studies (1) show that blood doping can boost performance in endurance sports by up to 10%, which is far from negligible.

The use of EPO as a doping agent is obviously illegal in sport and can have serious health consequences, such as increasing the risk of blood clots, stroke and heart attack. There are, however, ways of improving your performance naturally, which we'll discuss later in this article.

How is EPO used ?

There are different ways of administering EPO. Intravenously, the drug is administered directly into the vein via a syringe. This is a fast, effective method. By subcutaneous injection, it is injected into the fatty tissue just beneath the skin. A method often used by type I diabetics when taking insulin. Finally, by intramuscular injection, which, as the name suggests, means that the drug is injected directly into a muscle.

There are also ESA drugs (erythropoietin-stimulating agents) which mimic the effects of EPO in the body. They work by stimulating the bone marrow to produce more red blood cells, just as EPO does. ESAs bind to the same receptors on the surface of bone marrow cells as EPO, and this leads to an increase in red blood cell production.

However, even when used in a medical setting to help people with anemia, ESAs are not without risk and are not generally administered lightly.

What are the side effects of EPO ?

Although it's really interesting for athletes, the use of EPO is illegal in competitive sports for obvious reasons. Blood doping is not allowed because it gives users an unfair advantage over their opponents. However, risking a competition ban is not the only problem with these products. The body can produce too many red blood cells as a result of EPO, leading to a thickening of the blood that can increase the risk of blood clots, strokes and heart attacks.

These side effects are quite serious, and EPO is often prescribed when there is no other solution. As if these risks weren't enough, there are a number of side effects you may experience with EPO, including high blood pressure, headaches, nausea and vomiting, allergic reactions, joint pain and flu-like symptoms such as fever, chills and body aches.

Are there EPO-boosting supplements ?

Some supplements claim to increase red blood cell production and improve sporting performance. Formulated with natural ingredients, including vitamins (B12, folate), minerals (iron) and plant extracts (Ashwagandha, Rhodiola Rosea), they are claimed to stimulate EPO production in the body.

There's no risk of testing positive for banned substances with this type of supplement, as it's not blood doping. They're supposed to simply stimulate your body to naturally increase its EPO levels. But unfortunately, there isn't much scientific evidence to support the efficacy of these products.

How to improve EPO levels naturally ?

Fortunately, there are many ways to improve your sporting performance without resorting to blood doping.

1 - High altitude training

Training at altitude - or in hypoxia - is an excellent way to increase your EPO production, lower your heart rate and blood pressure, and improve your body's production of growth hormones. At high altitude, there's less oxygen, and when you train in these conditions, you induce a state of hypoxia that forces the body to adapt. It becomes more efficient in using the available oxygen and produces many more red blood cells than usual. Once you've returned to a normal altitude after training, your body will continue to benefit from these adaptations and your performance will improve.

2 - Using a respiratory training system

This type of science-based device (2) - like Airofit - is designed to strengthen respiratory muscles and improve breathing capacity. It offers resistance to respiratory muscles such as the diaphragm during inhalation and exhalation. Regular use can improve respiratory muscle strength and endurance, boosting lung function and respiratory capacity.

3 - Adopt a healthy diet

Diet plays a huge role in your sporting performance. To boost the production of red blood cells, an iron-rich diet will be of great help. Here are some iron-rich foods to eat regularly: red meat, fish, leafy vegetables, fortified cereals, beans, lentils, tofu, hazelnuts and seeds.

If you take supplements, use vitamin B12 and folate to boost your red blood cell production. Herbal supplements such as Ashwagandha and Rhodiola Rosea can also help improve your performance. Studies (3) show that ashwagandha increases both red blood cells and haemoglobin, improving aerobic capacity. Rhodiola Rosea (4) also promotes the production of red blood cells in the bone marrow.

4 - Adopt a healthy lifestyle

Good nutrition and good lifestyle habits are essential for performance. For example, sleep is the key to health and sporting performance. So it's crucial to get enough sleep if you want to feel good and perform at your best. Drinking and smoking are not compatible with a sporting lifestyle. Smoking has been shown to be detrimental to aerobic capacity and sporting performance. If you want to improve not only your performance, but also your general health, give up cigarettes and opt for healthier lifestyle habits.

Finally on EPO

So now you know the basics about EPO and its effects on the body. Remember that unless it's medically necessary, you should always opt for natural ways of improving your performance, as anything else is not only illegal but also risky for your health.

Sources :

1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372716/

2 - https://www.atsjournals.org/doi/full/10.1164/ajrccm.162.5.9912026

3 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687242/

4 - https://www.tandfonline.com/doi/full/10.1080/13880209.2022.2083187