Wednesday, 7 November 2012

Altitude Training versus EPO use

Something’s been annoying me recently, and when something annoys me I do what I do best, I moan about it.  Below is my slightly tongue-in-cheek take on the differences between EPO use and altitude training.  In the interest of keeping things simple (and lets face it, when I argue, things need to be kept as simple as possible), when I refer to a drug’s secretion naturally in the body I give it it’s full name (e.g. erythropoietin), and when I’m referring to the drug in it’s synthetic, exogenous or administered form, I refer to it in abbreviations (e.g. EPO).

And, so, for those who I haven’t lost already, let’s cut to the chase….

‘Legalise EPO’ they say, ‘because you can’t ban altitude training, and they’re essentially the same thing’.  ‘The only difference between EPO use and altitude training is that one is banned in sport and that the other isn’t’, I’ve recently heard people argue.  ‘They both increase red blood cells, so they must be the same thing’; a simplistic, and ignorant, statement which not only misinterprets how EPO and altitude training work, but completely ignores the ethos behind drug-free sport.

People’s arguments suggest that if there were different legislators in sport, altitude training might find itself on WADA’s prohibited list, or that one day we might see EPO legalised in sport.  As somebody who has strong anti-doping convictions, but has benefited from altitude training, for me, EPO use, and altitude training are worlds apart. 

To argue that EPO use and altitude training are the same thing because they have similar effects would be the same as saying that steroid use and weight training are similar (they both increase muscle size), and that taking an afternoon nap following training would be just as unethical as injecting HGH, as to do so would cause an increase in human growth hormone secretion and expose the body to it’s benefits.  In fact, hill training, endurance training, recovery runs, fartlek training, plyometrics, good nutrition, heat acclimatisation… and pretty much every other form of training, increases the body’s ability to perform through increased hormone secretion, increased tissue growth and/or increased neural adaptation, and it would be ridiculous to suggest that any of these are on the same moral footing as using banned performance-enhancing drugs.  Training is very much allowed!

The drug EPO is not only banned in sport, but it is a prescription-only drug, designed to help keep individuals with an inability to produce it naturally healthy.  It is not (or at least should not be) available for healthy individuals to purchase and use without medical reason.  Conversely, individuals around the world have the right to be born or live at any altitude at which human life is possible.

The use of EPO is extremely dangerous.  Prolonged or excessive use can have at least two fatal consequences in humans.  EPO increases red blood cell production, and the more red blood cells you have, the thicker your blood becomes.  Blood can in fact become so thick that your heart is no longer able to pump blood around the body.  If that happens, you die.  Additionally, EPO use can affect your body’s natural ability to produce erythropoietin.  Without erythropoietin you can’t produce red blood cells, and without red blood cells you can’t transport oxygen around the body.  Oxygen, I hear, is fundamental for human life (and not just in life involving sport), so that’s pretty crap.  Of course you don’t have to die, but you do become dependant on EPO.  Altitude exposure at or below 3,000m, even over a prolonged period of time, though not without it’s side effects (crazy dreams for example), is unlikely to kill you!

And now to the scientific bit, and the crux of my argument. Just because two things have the same end product, doesn’t mean that they are the same thing, physically, morally or legally.  We’ve already agreed (unless you’re the real argumentative type), that training in sport is allowed, and indeed encouraged if you want to be any good at sport, and call me an idealist, but I feel that injecting ourselves with any substance (when not medically required) to take a short-cut to enhanced performance is not in line with drug-free sport, irrespective of whether that substance is banned or not.

Now, I will agree that a large portion of the response to EPO use, and to altitude training, is the same, but there are some fundamental differences.  As we mentioned before, EPO use increases red blood cell production; increased red blood cells carry more oxygen around the body; and a greater oxygen carrying capacity increases endurance performance.  The main way in which altitude training is proposed to work is that the reduced atmospheric oxygen stimulates the body to increase erythropoietin synthesis, which in turn increases red blood cell production, increased red blood cells carry more oxygen around the body; and a greater oxygen carrying capacity increases endurance performance.  Taking EPO makes training easier.  It allows the body to recover quicker (because the body is not the one synthesising the EPO, which believe you me is stressful business for the body), and allows you to train hard day after day.  Altitude training on the other hand is a nightmare!  It’s impossible to breathe, you sleep 14 hours a day, simple tasks like walking to the shops can tire you out, you can’t run as hard or as long as you can at sea level, and think again if you think you’re going to do session after session after session.  Like lots of other beneficial training methods (e.g. weight training, hill reps), you need to recover.  Increased EPO increases red blood cell production.  More EPO creates more red blood cell production.  Altitude exposure increases erythropoietin, and subsequently red blood cell production, to respond to the reduced oxygen in the air, but once it’s adapted, it doesn’t keep on producing erythropoietin.  More altitude exposure doesn’t mean more erythropoietin.  And the real catch is that some people’s bodies are so against the whole erythropoietin synthesis lark that they don’t bother.  Yes, not everyone responds to altitude.  The good news though is that these people are usually the freaks that find altitude training easy.

For me altitude training and EPO use are as different from each other as helping old ladies cross the road and sticking needles in little babies’ eyes.  Other methods of increasing endurance such as altitude tents, altitude masks, iron injections, blood transfusions and blood doping may fall various degrees closer to the proverbial fine line, but training your ass off in difficult environments is not the same as injecting yourself with a drug, which you’ve acquired illegally, to make the route to the top easier for yourself.

Now, I don’t’ know if all of you, or in fact any of you, have managed to read through my waffle, but I have sure as hell enjoyed putting up my side of the argument.  If you’d like to agree or disagree, then please leave your comments below.

I’ve been Elizabeth Egan, and, I’m for drug-free sport (and afternoon naps).  Thanks for reading!


  1. Hi, my name is Jason Keck. I am a high altitude researcher for Alpine Performance Laboratories and I just discovered you blog. I thoroughly agree with every point you just made. I would also add that high altitude training requires that you make very strategic training decisions to eliminate both anaerobic detraining and overtraining, which adds to the challenge.

    The one point that may show high altitude training in an unfair light is that access to it is restricted based on geographic and financial limitations. Only people who are lucky enough to live in a region of sufficient altitude or buy expensive simulation equipment have the privilege of high altitude training.

  2. Hello. I totally agree. But I have to comment one important factor in altitude training (for sea level performance). It is more common that the effect are negative than positive. Have you read the book exercise physiology by McArdle, Katch and Katch? A danish study concluded that the effect was based on the placebo effect. I think that is an interesting answer.

  3. I always think that it's interesting that so many people use altitude training as preparation for racing at sea level. I think that the real benefit is in using it as base-building in the off-season. I use altitude training to get really fit, and the bigger a base I can build, the better I can train/race for the rest of the year. People talk about the benefits of altitude being lost after 2-3 weeks, but if used as a base builder I think they can indirectly last longer. Racing after being at altitude can be a lot more complicated and getting the timeing right is difficult - I'm pretty sure that my 'best' day after returning from altitude was different after each altitude trip I've done. I must admit thought that I use altitude training as an excuse to get away to somewhere nice and put in a good stint of training. That may well be a placebo effect, but I usually enjoy myself :-)

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