Science / How to Increase Erythropoietin (EPO) Naturally

How to Increase Erythropoietin (EPO) Naturally

by Patrick McKeown

Use the Power of Your Breath for an Oxygen Boost

  • 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

Let’s find out how to increase erythropoietin naturally, and safely.

How to Increase Erythropoietin Naturally

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.

For instance, 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’s 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: The Good, The Bad and The Ugly

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’s used to treat anemia.

It’s 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. It slows blood flow, affecting blood pressure. The full long-term effects of unregulated synthetic EPO use aren’t 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.

And according to Men’s Health, you can boost EPO in the sauna too.

Does Exercise Increase EPO?

EPO production occurs when the cells are low in oxygen. In order for erythropoietin production to increase naturally, arterial oxygen levels need to drop below 91%. To achieve this during exercise, you’d have to work at an intensity beyond your VO2 max. This could risk injury or overtraining.

Using Breath Holding to Stimulate EPO

Breath holding to simulate training at high altitude increases EPO production. When the body taps into its own supply of EPO, it’s 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.

What Does EPO Do for Athletes?

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

Breath holding has many benefits. One of them is that you can learn how to increase erythropoietin naturally.

If you’re 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 it enhances performance. Without the risks to your career, your health or your life. 

What the Scientists Say about EPO


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

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

See: de Bruijn R, Richardson M, Schagatay E. “Increased erythropoietin concentration after repeated apneas in humans.” Eur J Appl Physiol 2008; 102:609–13. Epub 2007 Dec 19.


Researchers from the Human Performance Laboratory, University of Calgary, Canada, conducted a study to investigate the relationship between a decrease of oxygen concentration during exercise and erythropoietin (EPO) production. Five athletes cycled for three minutes at an intensity greater than maximal (supramaximal) at two different elevations: 1,000m and 2,100m.

Oxygen saturation of hemoglobin was lower than 91 percent for approximately 24 seconds during exercise at 1,000 meters and for 136 seconds during exercise at 2,100 meters, with EPO levels increasing by 24 percent and 36 percent, respectively following the exercise.

See: Roberts D, Smith DJ, Donnelly S, Simard S. Plasma-volume contraction and exercise-induced hypoxaemia modulate erythropoietin production in healthy humans. Clinical Science.2000 ;(Jan;98(1)):39-45


Korean researchers Choi et al. carried out a study on 263 subjects to determine the relationship between hematocrit levels and obstructive sleep apnea (involuntary holding of the breath during sleep). Patients with severe sleep apnea had significantly higher levels of hematocrit than mild and moderate OSA.

Study findings showed that hematocrit levels were significantly correlated with per cent of time spent at oxygen saturation of below 90 percent, as well as average oxygen saturation.

See: Jong Bae Choi, José S. Loredo, Daniel Norman, Paul J. Mills, Sonia Ancoli-Israel, Michael G. Ziegler and Joel E. Dimsdale. Does obstructive sleep apnea increase haematocrit? Sleep and Breathing.2006 ;(Sep;10(3)):155-60

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