Physiology Questions
Physiology Questions
Q:  What are the physiological benefits of altitude training?

A:  There are several beneficial changes affect the heart, lungs, circulatory system, and muscles:

  • Increase in blood flow to the lungs, promoting oxygen exchange
  • Increase of the permeability of the lungs to oxygen
  • Increase in the number of red blood cells able to carry oxygen
  • Increase in enzymes that facilitate release of oxygen from red blood cells into muscles
  • Increase in capillary density in muscles
  • Increase in the number of mitochondria (the energy-producing structures inside every living cell)

Together, these changes represent a powerful combination of positive effects that can significantly
improve your athletic performance.
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Q:  What is EPO?  Isn't it banned?

A:  EPO (erythropoietin), a hormone naturally produced in the body, signals the bone marrow to begin
the production of new red blood cells.  Everyone has natural EPO in their body.  One of the main effects
of altitude training is to stimulate the production of natural EPO.

Synthetic EPO is a drug developed for treatment of severe anemia, which may develop from cancer
treatments or HIV infection.  As an athletic performance booster, it is dangerous and illegal in all sports.  
Doses of drug EPO are many times higher than natural amounts, and EPO doping has injured and
even killed otherwise healthy athletes due to stroke and heart attack resulting from overly-thick blood.  
Altitude training stimulates your body's natural production of EPO, rather than overwhelming your natural
systems like "drug" EPO.
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Q:  Will altitude training help my VO2 max go up?

A:   Quite probably, yes.  Your key to going faster is increasing the rate at which your body delivers
oxygen to your muscles.  VO2 max, which measures your maximum oxygen delivery rate, has been
observed to increase 3-8%.  Scientists have also observed decreases of about 3% in the body's
demand for oxygen at a fixed running velocity (running efficiency).  This means you work less hard to go
the same speed.  Even where VO2 max increases have not been observed, other important
performance measures such as time until exhaustion have increased substantially.   
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Q:  Will my hematocrit rise?

A:   Quite probably, yes.  Hematocrit is a measure of the proportion of blood volume that is occupied by
red blood cells.  The higher your hematocrit, the more oxygen can be delivered per volume of blood.  As
you generate new red blood cells, your hematocrit will rise.  In some cases, this can be partially masked
by a simultaneous increase in blood plasma volume.   A rise of 4-5 points is not unusual, but personal
results cannot be predicted.  

Some sports place limits on hematocrit, e.g. 50%.  While doping with synthetic EPO can push you to
50% and beyond, it is unlikely that altitude training could do so unless your pre-altitude baseline is
exceptionally high.
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Q:  Should I take any dietary supplements to help the process?

A:   Taking a B-Complex vitamin that includes Folate or Folic Acid is a good supplement to help your
body build new red blood cells.  Iron is also necessary, but supplemental iron should be added only
with caution.  Your body probably has enough iron already, and excess iron cannot be excreted, and can
build up.  Men in particular should be very cautious about taking iron supplements, because it is easy
for men to get iron overload.  A normal diet with red meat and/or green leafy vegetables almost always
provides enough iron for men.   Women, who are more prone to iron-deficiency anemia, might consider
additional iron, but only on the advice of a physician.
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Q:  Should I have blood tests to monitor what is happening?

A:  You can, but probably isn’t necessary.  Simulated altitude training is very similar to going to high
altitude.  People who go hiking or skiing in Colorado don’t usually think about getting blood tests.  If you
do, you will want to arrange both "before" and "after" tests, and look at hematocrit (red cell density) and
reticulocyte (new red blood cell) counts.
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Q:  Can this help runner's anemia?

A:  For reasons that are not fully understood, long distance runners and other endurance athletes are
prone to borderline anemia.  Various reasons have been postulated, including destruction of blood
cells from intense foot strike, reduced absorption of iron, and internal blood loss.  Whatever the cause,
an athlete with borderline anemia will not perform as well as an athlete with normal red blood cell
density.  Normal hematocrit ranges from 40-50, and borderline anemia may be considered to be the
range 35-40.  

While we cannot say this is typical, a marathon runner with borderline anemia (36)  raised his
hematocrit to 42, returning his red blood cell count to the normal range.  At the end of this period, he
bested his personal marathon record by 14 minutes and qualified for the Boston Marathon after 7
unsuccessful attempts.
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