The Oxygen Advantage: How EPO can Improve Endurance and Athletic Performance

Have you ever heard of erythropoietin (EPO)? It’s a hormone that helps your body make more red blood cells, which carry oxygen to your organs and tissues. It’s mainly produced by your kidneys and is used to treat anaemia caused by various conditions like kidney disease, cancer, and HIV/AIDS. 

However, EPO has also been in the news for its potential use as a performance-enhancing drug in sports, which has caused some controversy. In this article, we’ll take a closer look at EPO, its uses in medicine, and why it’s been making headlines in the sports world.

What is erythropoietin?

First off, let’s take a look at what erythropoietin is. “Erythro” means red blood cells and “poietin” means “to make”, so the name literally explains that this hormone aids in the production of red blood cells.

Sometimes, this hormone is also called “haemopoietin” – “haemo” means blood in Latin. 

So, now that we know where the name comes from, it’s a lot easier to understand the role erythropoietin plays in our bodies. 

Red blood cells are responsible for carrying oxygen from the lungs to all parts of the body. Without enough red blood cells, the body cannot get enough oxygen, which can lead to anaemia, fatigue, and other health problems.

Speaking of anaemia, EPO is used medically to treat this condition, which can be caused by a variety of different factors. For example, people with chronic kidney disease may not produce enough EPO to stimulate red blood cell production, leading to anaemia. 

EPO therapy can help increase the number of red blood cells and improve symptoms such as fatigue and shortness of breath. EPO has also been used to treat anaemia caused by cancer and HIV/AIDS.

Naturally, the primary 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 sense that the oxygen levels in the body are low, they release EPO into the bloodstream, which travels to the bone marrow and stimulates the production of more red blood cells.

How does erythropoietin work?

Every cell in the body uses oxygen for energy, which is why we can’t survive more than a few minutes without a fresh supply of O2. Oxygen is carried from the lungs to the cells using red blood cells. 

The more red blood cells you have, the more oxygen will get delivered to the cells and vital tissues.  

This is not only linked to better recovery, but it also leads to improved athletic performance and endurance. 

Since Erythropoietin increases the number of RBCs, the result of more EPO is a substantial improvement in athletic performance. 

But let’s take a closer look at this:

EPO and Athletic performance

EPO has also been a topic of controversy in the sports world. 

Some athletes have used EPO as a performance-enhancing drug, since, as we already mentioned, it can increase the number of red blood cells in the body, which can improve endurance and performance in endurance sports like cycling and long-distance running. 

This is due to the fact that the red blood cells have a higher capacity of delivering O2, which in turn slows down the progression of muscle fatigue. 

Although enticing, the use of EPO as a doping agent is illegal in sports and can have serious health consequences, such as increasing the risk of blood clots, stroke, and heart attack.

This type of doping is referred to as blood doping, and under that category is not only EPO but also other substances that increase aerobic capacity and athletic performance. 

But if doping increases your risk of things such as strokes and heart attacks, why would anyone choose to do it?

Unfortunately, studies show that blood doping can increase performance by up to 10% in endurance sports, so some athletes feel that their careers would be boosted if they used this doping method to enhance their results. 

The good news? There are ways to naturally enhance your performance, which we will talk about a bit later in this article. 

First, let’s take a look at Erythropoietin Stimulating Agents: 

Erythropoietin Stimulating Agents

Erythropoietin Stimulating Agents (ESAs) are drugs that are designed to mimic the effects of erythropoietin (EPO) in the body. 

ESAs work by stimulating the bone marrow to produce more red blood cells, just like EPO does. 

They do this by binding to the same receptors on the surface of the cells in the bone marrow that EPO does. This leads to an increase in the production of red blood cells, which can help to relieve anaemia symptoms such as fatigue and shortness of breath.

ESAs are used to treat anaemia in people with chronic kidney disease, cancer, and HIV/AIDS, among other conditions.

The most commonly used ESAs are epoetin, darbepoetin, and methoxy polyethylene glycol-epoeitin beta.

However, even when used in a medical setting to help people with anaemia, ESAs are not without risk and are usually not administered light-heartedly. 

If you’re wondering whether there is another way to boost your EPO, you’re onto something:

Erythropoietin Supplementation

There are certain supplements that claim to increase RBC production and improve athletic performance. 

EPO Boost is one of these safe and competition-approved supplements. It contains a blend of natural ingredients, including vitamins, minerals, and herbal extracts, that apparently stimulate the production of EPO in the body. 

The nice thing about this supplement is that it contains antioxidants and key nutrients for healthy blood cells. 

But that’s not all: it also contains vitamin B12, folate, iron, Ashwagandha, and Rhodiola Rosea, so you are getting a bunch of different vitamins you would otherwise have to get separately. 

And the best part? It is guaranteed to pass a qualification test and screening for banned substances, as it is not “blood doping”, it simply helps your body to naturally increase its amount of EPO. 

Unfortunately, there is not a lot of scientific evidence that supports the efficacy of EPO Boost or similar supplements, and as with any supplementation, it would be best to talk to a healthcare professional before starting to use it. 

What is EPO used for?

EPO increases the number of circulating red blood cells in the body, thereby improving oxygen delivery to the muscles and other cells of the body. 

It’s primarily used for addressing medical conditions such as:

  • Chronic kidney disease
  • Cancer-related anaemia
  • HIV-related anaemia
  • Blood loss
  • Premature infants

EPO is also used for enhancing athletic performance, particularly when it comes to endurance, like long-distance running or cycling. 

How can you take EPO?

There are a number of different ways in which EPOs (or ESAs) are administered: 

Intravenous (IV)

Intravenous administration means that the drug is administered directly to the vein via a syringe. This method ensures fast delivery to the bloodstream. 

Subcutaneous injection

Subcutaneous injection means that the drug is injected into fat tissues just below the skin. This type of injection is often used by Diabetes Type I patients when they take insulin. 


As the name suggests, intramuscular injection means the drug goes directly into a muscle.

It’s vital to note that EPO is a prescription medication and should only be taken under healthcare professionals’ guidance.

EPO supplementations such as EPO Boost can be taken as capsules after meals. 

Other Benefits

Enhanced athletic performance is the biggest, but not the only benefit of EPOs. 

Similarly important, EPO plays a role in neuroprotection, which essentially just means it helps protect nerve cells from damage and degeneration. 

On top of that, this hormone aids in better cell recovery, increased energy levels, and enhanced wound healing. 

One of the most interesting benefits of the hormone EPO, however, is that it improves cognitive function in people with mood disorders

Risks and Side Effects

Although it has tons of benefits, using EPO is illegal in competitive sports for obvious reasons. 

Blood doping is not allowed as it gives users an unfair advantage over their opponents. 

However, risking a ban from the competition is not the only side effect of EPOs you should be worried about. 

Whether you are enhancing EPOs for athletic performance or for legit medical reasons, the body can produce too many red blood cells because of EPO, which results in blood thickening, which, in turn, may increase:

  • Risk for blood clots
  • Risk for stroke
  • Risk for heart attacks
  • Risk for cancer progression

Those side effects don’t sound appealing, which is why EPOs should generally only be taken if there is absolutely no other way and it is medically necessary. 

As if those risks are not bad enough, there are a number of side effects you might experience from enhancing your EPOs. 

Side effects include:

  • Hypertension
  • Headaches
  • Nausea and vomiting
  • Allergic reaction
  • Joint pain
  • Flu-like symptoms such as fever, chills, and body aches

There is some good news about all of this, though! You can naturally improve your EPO and RBC levels and forego all of these unwanted side effects! 

Natural ways to improve EPO and RBC levels

Fortunately, there are a few different ways in which you can enhance your athletic performance without needing to resort to blood doping. 

High altitude training

High altitude training is a great way to boost your production of EPO, decrease your heart rate and blood pressure, and improve the production of growth hormones in your body. 

Why does this work? High altitudes have thinner air which means there’s lesser oxygen around. When you train under those conditions, you induce a state of low oxygen levels (hypoxia). 

This hypoxia forces the body to adapt and become more efficient in utilizing available oxygen. Essentially, your body will produce a lot more red blood cells than usual in order to function properly under these difficult conditions. 

Once you come back to a normal altitude after this training, your body will still have these adaptations and therefore take up a lot more oxygen and your performance will skyrocket. 

​​However, the exact duration of the effects of high altitude training can vary depending on the individual and the specific training regimen. 

Some studies have found that the benefits of high-altitude training can begin to diminish within a few weeks of returning to sea level, while others have shown that the effects can last for several months.

It’s also worth noting that high-altitude training can have adverse effects on an athlete’s health since it can lead to altitude sickness. 

If you want to take advantage of this method, you should do so with a coach who is experienced in high-altitude training. 


It is no secret that exercise improves your overall health and therefore also your athletic performance. 

High intensity exercises can increase blood parameters, including EPO, which is why incorporating HIT into your routine is a great way of enhancing your performance. 

High-Intensity Training (HIT) is a type of exercise that involves short bursts of very intense activity, followed by periods of rest or low-intensity activity. 

This could be anything from running, sprinting, lifting heavy weights, etc. 

Using Lung Trainer

A lung trainer, also known as a respiratory muscle trainer, is a device designed to strengthen the respiratory muscles and improve breathing capacity. 

This tool works by providing resistance to the breathing muscles such as the diaphragm during inhalation and exhalation. This resistance can be adjusted to match the individual’s current level of fitness and breathing capacity.

Using a lung trainer regularly can help to improve respiratory muscle strength and endurance, which can lead to improved lung function and breathing capacity. 

All this is based on science – studies show that respiratory training significantly improves gas exchange in the lungs.

Eating-iron Rich Diet

It comes as no surprise that your diet plays a huge role in your athletic performance, so of course you can use it to enhance your performance even further. 

In order to boost the production of red blood cells, a diet rich in iron will help you out a lot. 

Why is that the case? 

Iron is a key component of haemoglobin, a protein found in red blood cells that carries oxygen from the lungs to the body’s tissues.

When we consume iron-rich foods, the iron is absorbed by the body and transported to the bone marrow, where red blood cells are produced. 

Inside the bone marrow, iron is incorporated into haemoglobin, along with other components like protein and heme. Haemoglobin then enables red blood cells to bind and transport oxygen throughout the body.

Some foods rich in iron are:

  • Red meat
  • Fish
  • Leafy vegetables
  • Fortified cereals
  • Beans
  • Lentils
  • Tofu
  • Nuts
  • Seeds

Vitamin B12 and folate supplementation 

If you are a fan of supplementation, then you can boost your red blood cell production by taking Vitamin B12 and Folate. 

Vitamin B12 and folate are essential nutrients for the production of red blood cells because they are involved in the synthesis of DNA, which is necessary for the production of new cells, including red blood cells.


Sleep is the key component of health and athletic performance, so getting enough sleep is crucial if you want to feel and perform your best. 

An adequate amount of sleep varies from person to person, but on average, getting 7-9 hours of good-quality sleep a night should be your goal if you want to recover fully and progress. 

Cold plunge

Cold plunges are amazing for your health, as much as it sucks to admit that (who deliberately wants to emerge themselves in ice cold water on purpose?). 

​​During a cold plunge, the body is exposed to cold water, which causes blood vessels to constrict and the heart rate to slow down. This can increase the release of EPO, which in turn may stimulate the production of red blood cells.

So not only will you get numerous health benefits, you will also get a natural boost of EPO. 

Herbal Supplements

If you are a fan of herbal supplements, Ashwagandha and Rhodiola Rosea can help you enhance your performance, as well. 

Studies show that ashwagandha increases both the RBC and haemoglobin,  which enhances aerobic capacity.

Not only that but Ashwagandha has also been found to be an adaptogen, which means that it helps the body regulate its stress levels and lowers cortisol.  

Rhodiola Rosea also promotes RBC production in the bone marrow. 

Avoid Smoking

This one should be a no-brainer, but smoke isn’t great for increasing aerobic capacity and athletic performance. 

If you want to take not only your performance but your general health up a notch, ditch the cigarettes and instead opt for healthier habits. 


There you have it – you now know everything you need about EPO and its effects on the body. 

Hopefully, by now you have a good understanding of what this hormone does and why some people choose to use ESAs as a performance-enhancing drug. 

However, remember that unless medically necessary, you should always opt for natural ways to enhance your performance, since everything else is not only illegal but also extremely detrimental to your health. 

Anna Scheucher
Editor at The Fitness Tribe | + posts

Anna is our massage, recovery, nutrition, and training specialist. She holds a degree in Medical Massage Therapy from the Bergler Massage Institut and a Personal Trainer and Nutritionist degree from the OTL Academy. She is originally from Austria but lives in the U.S and when she is not writing science backed articles for you can find her globe trotting around the world.

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