EPO Blood Doping - Endurance & Performance Drug plus Side-Effects

EPO Blood Doping

Never Rely on Drugs to Achieve Great Results

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It's an unfortunate fact of life that drug use is pervasive in sports. While strength sports, such as powerlifting, Olympic lifting and bodybuilding, are most associated with the use of drugs that affect muscular size and strength, a plethora of other drugs are also used by athletes in sports ranging from track and field to gymnastics.

The increased pressure for dominance has led athletes to rely increasingly on drugs with more toxic potential than those favored in the past. For example, drugs that weren't even imaginable in Arnold's day, such as Cortisol blockers and insulinlike growth factor-l, are nearly de rigueur among some current professional bodybuilders. The use of other drugs, including diuretics, has likewise increased among bodybuilders looking for the coveted ripped appearance that often spells victory.

Bodybuilders who take such drugs may tread a fine line between benefits and toxicity, but from a purely objective perspective, their addition to a bodybuilder's drug stack can be rationalized. That is, some scientific foundation exists to support their use by bodybuilders. In other cases, however, the rationale for including certain drugs in a stack rests on tenuous ground at best.

An example of the latter is the drug erythropoietin (EPO). EPO is a naturally occurring hormone in the human body. Ninety percent of it is synthesized in the kidneys; the remaining 10% is made in other tissues, mainly the liver. The synthesis of EPO is stimulated by low levels of oxygen delivery to the kidneys. EPO acts to remedy this deficiency by promoting bone-marrow red-blood-cell production. The hemoglobin in red blood cells is the primary oxygen-carrier of the body.

EPO was first isolated in 1977, but synthetic EPO didn't become available in Europe until a decade later. It was finally approved by the Food and Drug Administration in 1989. Similar to synthetic growth hormone, the drug version of EPO is made by a process involving recombinant DNA, and it is virtually identical to that made in the body. It's sold under such trade names as Epogen, Procrit and Eprex.


Before EPO was available, some endurance athletes achieved a similar effect by using a technique called blood doping. This involved drawing a certain amount of blood from an athlete and then reinfusing it about two weeks later. The result was an increased hematocrit, or concentration of red blood cells. By delivering more oxygen, the increased red blood cells served to increase oxygen delivery to muscle (V02 Max), resulting in a dramatic increase in endurance.

With the introduction of EPO, blood doping more or less went the way of high-button shoes. Of course, the primary purpose of the drug version of EPO wasn't to serve as an ergogenic aid; rather, it was intended to treat the severe anemia associated with chronic kidney failure. Regardless, athletes around couldn't wait to get their hands on EPO after an early study identified 10% endurance increase in athletes taking EPO over a six-week period.

How long EPO lasts in the body depends on its route of administration. Given as an intravenous injection, the half-life (ie. The time it takes to break down 50% of the initial dose) is four to five hours. Taken subcutaneously, however, the half-life extends to 20 hours. The effects on increasing red-blood-cell production persist for at least another two weeks.

While EPO does increase the blood hematocrit, or red-blood-cell proportion, it presents potential problems. In some cases, EPO works too well, increasing the blood viscosity to the point of near sludging. This, in turn, decreases both blood circulation and oxygen delivery, thereby defeating the whole purpose of taking EPO for athletic purposes.


Dehydration, a loss of water and blood volume, makes the side effects of EPO potentially life threatening. As the blood hematocrit rises above 55%, blood takes on the consistency of molasses on a cold day, which raises the risks of high blood pressure, congestive heart failure and clot formation. The symptoms associated with sludged blood include headaches, dizziness, altered vision and seizures.

In 1987, when EPO first became available in Europe, several cases were reported of competitive cyclists dying, often at rest or while sleeping. The suspected cause of death was a combination of thickened blood, promoted by EPO; dehydration; and subsequent coronary artery occlusion, or heart attack. This fatal scenario can easily unfold for a bodybuilder combining improper EPO use with diuretics.

Why do cyclists and other endurance athletes continue to risk their lives by taking EPO? If you can increase oxygen delivery through augmented red-blood-cell production without going over the line into excessive blood viscosity, you could wind up with better athletic performance. That's fine for endurance athletes, but why would bodybuilders even con-template using this stuff?

Bodybuilding, as practiced today, hardly qualifies as an endurance sport. If anything, weight training is primarily anaerobic and thus less dependent than aerobic activity on oxygen delivery for energy. In addition, normal workouts increase blood volume by an average of 10-15% without the use of drugs.

Bodybuilders who take anabolic steroids have a built-in red-blood-cell builder, since steroids promote synthesis of EPO in the kidneys. In fact, an original medical indication of steroids such as Anadrol 50 was to treat anemias associated with kidney failure. If you consume the nutrients involved in red-blood-cell production, such as folic acid, vitamins B6 and B12, iron and others, your production of red blood cells will be optimal. So why would a bodybuilder consider taking recombinant EPO?


Apparently, some bodybuilders think that taking EPO will increase oxygen delivery. (It will, but it's a tricky proposition and, in most cases, unnecessary, unless you suffer from frank anemia.) Others mention "increased vascularity" as a reason for EPO use, but the only mechanism here would be increased blood pressure, since increased hematocrit itself wouldn't contribute to more prominent vascularity.

One bodybuilder actually told me something about EPO making his muscles appear "fuller." This statement reflects the misperception that thicker blood equals thicker muscles. In reality, muscle fullness is based on water content (muscle is 72% water), muscle glycogen (each gram of stored glycogen holds 2.7 grams of water in muscle) and intramuscular fat content. None of these factors is even remotely related to EPO usage.

In short, using EPO for bodybuilding purposes can best be summed up in three words: dumb, dumber and dumbest.

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