How to Increase Erythropoietin (EPO) Naturally

Erythropoietin (EPO) is a hormone produced mainly by the kidneys in response to low oxygen levels. It stimulates the bone marrow to produce and mature red blood cells, increasing the blood's oxygen-carrying capacity.

The good news: you can increase EPO naturally by up to 36% using breath holding exercises, with no drugs, no injections, and no risk of disqualification.

What Is Erythropoietin (EPO) and What Does It Do?

Erythropoietin (EPO) is a naturally occurring hormone
About 90% of EPO is secreted by the kidneys
EPO stimulates production and maturation of red blood cells in the bone marrow
This increases the oxygen-carrying capacity of the blood

Erythropoietin, or EPO, is produced when oxygen levels in the body are low. This occurs naturally at high altitude. Like any hormone, imbalance can also be caused by sickness or overtraining.

High EPO hormone levels are seen in sleep apnea patients. These people stop breathing periodically during sleep. Their blood oxygen saturation can drop to as low as 50%.

Low blood oxygen stimulates the production of erythropoietin. EPO can increase by up to 20%. It is one of the body's protective mechanisms. The cells are starved of oxygen, so the body releases and matures new red blood cells to compensate.

EPO: Natural Benefits, Blood Doping Risks and Safe Alternatives

EPO is essential for the production of red blood cells. A healthy red blood cell count boosts aerobic power and oxygen-carrying capacity. For the athlete, this means greater strength and stamina, and reduced breathlessness.

Synthetic EPO is available as a pharmaceutical. It regulates the concentration of red blood cells and hemoglobin in the blood. It is used to treat anemia.

It is also used in blood doping, when athletes inject EPO to boost their aerobic capacity.

Blood doping is banned. It results in permanent disqualification from competition. It has tainted events like the Tour de France. Since the Sydney Olympics in 2000, EPO testing has been commonplace.

Even worse, blood doping can be fatal. When EPO concentration is too high, the bone marrow produces too many red blood cells. This causes the blood to thicken. Thick blood is difficult for the heart to pump, slowing blood flow and affecting blood pressure.

The full long-term effects of unregulated synthetic EPO use are not known. But young athletes have suffered clotting and strokes. Some have died from heart attacks. It is possible to boost EPO ethically and without these risks.

How to Increase EPO Naturally

If you want to increase your red blood cell count, you first need to look at your diet. Certain foods support your body's natural EPO production. This is especially important when your body is subject to endurance exercise stress.

Choose foods high in iron and supplements including:

B vitamins (B3, B6, B12, B complex and folic acid, B9)
Vitamins A and E
Vitamin C
Minerals including zinc, selenium and copper
Kelp and garlic
Probiotics and digestive enzymes

Special diets for cancer patients can be useful for over-trained endurance athletes, especially if your red blood cell count is low.

You can also boost EPO in the sauna, according to research cited by Men's Health.

Does Exercise Increase EPO?

EPO production occurs when the cells are low in oxygen. For erythropoietin production to increase naturally, arterial oxygen levels need to drop below 91%.

To achieve this during exercise, you would have to work at an intensity beyond your VO2 max. This could risk injury or overtraining. Breath holding is a safer and more controlled method.

How Breath Holding Increases EPO Naturally and Safely

Breath holding to simulate training at high altitude increases EPO production. When the body taps into its own supply of EPO, it is safe and legal.

When synthetic EPO is injected, over-saturation lasts for 72 hours. This represents a serious risk for the heart.

When you use breath holding to boost EPO naturally, you can achieve a 24% increase in EPO, but levels only stay high for around 5 hours. This means the effect is powerful but short-lived, making timing important.

Benefits of Higher EPO for Athletic Performance

Increasing your EPO naturally through breath holding exercises has two distinct benefits for athletes.

Breath holding to create hypoxia triggers an acute rise of EPO in the blood. This happens immediately. But it takes 3 to 4 days before your bone marrow floods your blood with new red blood cells. If you are using breath holding to prepare for competition, you will need to time it right.
If you practice breath holding regularly, the effects will last. You will see long-term improvements in your oxygen-carrying capacity and your aerobic fitness. This is why breath hold divers typically have 5% more red blood cells than the average person.

Breath holding has many benefits beyond EPO production. It strengthens the diaphragm, improves aerobic capacity, and helps simulate the effects of altitude training without leaving sea level.

Whether you are an elite athlete or an amateur fitness fan, breath holding should be a no-brainer. It improves your body's ability to get oxygen to your muscles and enhances performance, without the risks to your career, your health or your life.

If you want to learn your current breathing efficiency, start by measuring your BOLT score. A higher BOLT score reflects better CO2 tolerance and greater capacity to benefit from breath holding exercises.

Research: How Much Can You Increase EPO Naturally?

Study 1: Breath Holds Increase EPO by 24%

Results showed that EPO concentration increased by 24%, peaking at three hours after the final breath hold and returning to baseline two hours later.

Exercise protocol: Three sets of five maximum duration breath holds, with each set separated by ten minutes of rest.

de Bruijn R, Richardson M, Schagatay E. "Increased erythropoietin concentration after repeated apneas in humans." Eur J Appl Physiol 2008; 102:609-13.

Study 2: Lowering Blood Oxygen Saturation Increases EPO by 24 to 36%

Researchers from the Human Performance Laboratory, University of Calgary, Canada, investigated the relationship between decreased oxygen concentration during exercise and erythropoietin production.

Five athletes cycled for three minutes at supramaximal intensity at two different elevations: 1,000m and 2,100m. Oxygen saturation of hemoglobin dropped below 91% for approximately 24 seconds at 1,000m and for 136 seconds at 2,100m. EPO levels increased by 24% and 36% respectively following the exercise.

Roberts D, Smith DJ, Donnelly S, Simard S. Plasma-volume contraction and exercise-induced hypoxaemia modulate erythropoietin production in healthy humans. Clinical Science. 2000.

Study 3: Repeated Breath Holds and Hematocrit Levels

Korean researchers Choi et al. carried out a study on 263 subjects to determine the relationship between hematocrit levels and obstructive sleep apnea.

Patients with severe sleep apnea had significantly higher hematocrit levels than those with mild and moderate OSA. Hematocrit levels were significantly correlated with the percentage of time spent at oxygen saturation below 90%, confirming that reduced blood oxygen directly stimulates red blood cell production.

Jong Bae Choi, et al. Does obstructive sleep apnea increase haematocrit? Sleep and Breathing. 2006.

If you are interested in trying the OA method for yourself, why not try our online course, become a certfied breathwork instructor, or find an Oxygen Advantage® instructor near you.