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Echinacea Alters Erythropoietin Levels?


Echinacea Alters Erythropoietin Levels?

Echinacea and Erythropoietin?

This is the second post in my series of articles on dietary supplements that may improve athletic performance. Though Echinacea is commonly used in the hopes of preventing the common cold, this article discusses its role as an ergogenic aid for endurance athletes.

Blood doping, the process of artificially increasing the number of red blood cells in the body, has been used by athletes in an attempt to improve athletic performance.

Performance improvement in endurance sports is enabled because of the extra oxygen-carrying capacity provided by the increase in red cell mass. In the past, athletes accomplished this by blood transfusion. The practice of blood doping has been outlawed not only because it confers an unfair advantage, but also because of the dangers involved.

What is Erythropoietin / EPO?

Erythropoietin (EPO), a glycoprotein hormone that is produced by the liver and kidneys, has put a whole new spin on blood doping. It plays a role in the regulation of red blood cell production. When exogenous EPO is used, it is a performance-enhancing drug that can now be detected.

How Dangerous is Erythropoietin Used by Athletes?

To the many athletes who have tried EPO as a performance-enhancing drug, the results have often been deadly. Numerous athletes including many cyclists have died from heart attacks which have been speculated to be related to EPO use. In short, EPO use as a performance-enhancing drug is extremely dangerous as its use thickens user’s blood which increases their risk of developing a heart attack or stroke. In the past, the only way to test for EPO use was to detect elevated hematocrit levels, i.e. above 50%.

Normal hematocrit ranges are:

  • Adult males: 42-50%
  • Adult women: 36-44%

Fortunately, newer tests are now available that can distinguish between the recombinant human EPO and the natural form.

Do Echinacea Increase Erythropoietin Levels?

The results of a recent study, published in the International Journal of Sports Nutrition and Exercise Metabolism, suggest that Echinacea may actually elevate levels of EPO. In fact, statistically significant increases of EPO were found at days 7, 14, and 21 reflecting 44%, 63%, and 36% increases, respectively (Whitehead et al, 2007).

However, despite these statistically significant increases in EPO levels, Echinacea use did not significantly alter hemoglobin or hematocrit levels. The dose of Echinacea that was used in this particular study was 8000 mg/day which was divided into four separate doses. Given that the Echinacea users did not experience an increase in hemoglobin or hematocrit, it is unlikely that Echinacea will be used as a blood doping alternative in these Olympics.

Echinacea / EPO – Conclusion:

Echinacea is commonly used by people in the hopes of preventing the common cold. Given that much of the latest research finds the data for Echinacea’s efficacy at preventing the common cold to be inconclusive (Woelkart et al, 2008), further studies are necessary to support this use.

Additionally, further studies are also necessary to determine if Echinacea use confers any benefit for endurance athletes.


  1. Whitehead MT, Martin TD, Scheett TP, Webster MJ. The effect of 4 wk of oral echinacea supplementation on serum erythropoietin and indices of erythropoietic status. Int J Sport Nutr Exerc Metab. 2007 Aug;17(4):378-90.
  2. Woelkart K, Linde K, Bauer R. Echinacea for preventing and treating the common cold. Planta Med. 2008 May;74(6):633-7. Epub 2008 Jan 10.


  • Jarret Morrow

    Maria Moreno, a cyclist from Spain, is the first athlete to test positive for a banned drug at the 2008 Beijing Olympics. She tested positive for EPO.

  • mark

    Is there any research that has been done to test if there is any performance improvement from supplimenting with ecinachea? If EPO levels are elevated, thus increase red blood cell levels...wouldn't it help with increase oxygen utilization? Thanks for your thoughts.

  • Jarret Morrow

    Mark, Thank you for commenting on this post. In this particular study, despite elevations in EPO levels, there were no consequent increase in red blood cell levels. As such, this particular study does not suggest that Echinacea would confer any possible performance improvement. As far as I am aware, this is the only study of its nature. I did a quick search of medline and did not find any other studies on the effects of Echinacea having an ergogenic or performance enhancing benefit. Cheers.

  • Alex knight

    I was thinking how can it be posible to have such increase in epo levels without performance improvement, and the the only thing that occurs to me is not to train does the study say what the subject trainning rutting was or if they had any at all. I guess even exogenous epo would not alter performance or hematocrite level if not given the stimulous of trainning right? That´s my question.

    • Jarret Morrow, M.D.

      Alex, thanks for stopping by this blog and asking an intelligent question. First, this particular study did not include an outcome measure for performance improvement. The study authors did find that supplementation with echinacea did stimulate increases in both IL-3 and erythropoeitin stimulate . However, the authors did not find that this altered RBCs, hemoglobin, or hematocrit. Keep in mind that this is just a single study on this effect. It's possible that limitation in the study design resulted in this negative result. Previous research in animal models has demonstrated that echinacea supplementation did result in increases in these parameters (RBC, hemoglobin, hematocrit) (O'Neil et al, 2002). As for your question, yes, exogenous epo would stimulate increases in hematocrit levels without the stimulus of training. It is drug which is used to treat anemia. References: O’Neill, W., S. McKee, and A.F. Clarke. Immunological and haematinic consequences of feeding a standardised echinacea (Echinacea angustifolia) extract to healthy horses. Equine Vet. J. 34:222-227, 2002.

  • Rick

    How is it possible for the erythropoeitin levels to have such a dramatic increase without an increase in hematocrit levels? The only reason I could see would be if there was no training stimulus therefore no reason for the body to make more red blood cells. I am also wondering why the epo levels go from a 63% increase on day 14 to a 36% increase on day 21 unless it is an increase upon the previous week in which case the total increase from day 1 to day 21 would be a massive 319% increase.

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