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Natural EPO

by Dr. OK

How hopoxic blood triggers natural EPO

Hemoglobin is a wonderful protein that carries oxygen to the muscles and allows one to climb like the proverbial mountain goat. As with many biological systems its production is a cycle or to borrow a Disney phrase a “circle of life”. As with life, there needs to be balance in the whole system. Too much of a good thing can kill, literally.

Hypoxia: A condition in which insufficient oxygen reaches body tissue
Now, for some rudimentary Physiology and Biochemistry. The production of erythropoietin (EPO) is primarily performed by the kidney. This production is stimulated by any condition producing a hypoxic state. This hypoxic state may be brought about by many conditions such as living at high altitude, anemia, bleeding or any condition that diminishes the ability to oxygenate hemoglobin. You don’t have to have a pillow shoved on your face to stimulate the production of erythropoietin.

Contrary to popular belief, the concentration of oxygen does not decline appreciably with elevations in altitude. It is the barometric pressure that goes down with altitude and thus the partial pressure of oxygen that declines. The atmospheric pressure on Everest is about 1/3 of that at Sea Level. Now none of us are racing bikes at 29000 ft +. Now at about 18000 ft., it’s about ½ of Sea Level. It’s like having 210 pounds of pressure pushing a mixture through a filter. Now suppose the mixture remains the same but you’ve changed the pressure to 70 pounds. Same composition, less material getting through. Now substitute Air and Atmospheric pressure, the result being decreased oxygen and resultant hypoxia. That’s why people get hypoxic climbing Everest. When this hypoxic blood reaches the kidneys, (with more detail than I remember from med school) magically the kidneys release erythropoietin.

Erythropoietin (EPO from now on) is carried by the blood to the bone marrow, the primary site of erythropoiesis (red blood cell production). Under the influence of the EPO, the marrow starts the assembly line production and release of new red blood cells (RBC). This production continues until the hypoxic signal is stabilized by the increased RBC volume. Red blood cells have an average life span of about 120 days.

Once again, it’s clear that cheating does work.
Now, the good stuff. As with most systems, this cycle can be tricked. Specifically, in regards to endurance sports (cycling, soccer, cross country skiing, distance running, etc.), a high hematocrit can be of great benefit. That high oxygen carrying capacity allows one to exercise longer and at a higher intensity. No doubt you’ve heard of EPO and its various cousins, the newest family member being CERA. All of these agents act like EPO, stimulating the bone marrow to produce more red blood cells. The latest version, CERA, gaining “fame” with the likes of Ricco, Kohl, Schumacher, and a few others. The cheaters or the competitively challenged thought that they were staying ahead of the doping police. Once again, it’s clear that cheating does work. EPO takes pack fodder and turns them into stars, albeit falling stars when they get caught. Kinda’ makes you wonder how many riders are getting away with it. I’ve heard many say that as long as the riders are making “that kinda’ money”, there will always be financial motivation to cheat. I don’t believe this, as there is cheating going on at the local weekend warrior level. As long as we have cheaters, we’re gonna’ have cheating. What I mean is, we’re gonna’ have cheating.

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