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EPO-Boost, the probable placebo

EPO-Boost, a supplement containing various vitamins, minerals and herbal extracts, promises much through it’s name alone, but we decided to ask the questions: does it really boost endogenous EPO levels in human subjects? If so, by how much? Does it represent good value for money?

Without any double-blind randomized placebo-controlled clinical trial results to directly back their claims, we can only analyze the presence of individual ingredients as follows:

Vitamin C – low plasma levels linked to erythropoietin resistance(1), intake increases absorption of oral non-heme iron(2), improves utilization of high ferritin stores(7)(8)

Vitamin B-3 – Deficiency a.k.a. Pellagra may lead to anemia, though a direct effect is unclear(10)

EPO-BoostVitamin B-6 (Pyridoxine HCl) – red cell B6 known to be depleted by increased RBC count as a result of erythropoietin treatment(3)

Folic Acid – red cell folic acid levels known to be depleted in the same way as B6(3), plus supplementation can significantly enhance the response to erythropoietin treatment in anemic patients with chronic renal disease(4). Anemia due to folate deficiency possible.

Vitamin B12 – deficiency can lead to pernicious anemia or increase resistance to EPO(5)(6)

Iron – apart from anemia brought about by a serious deficiency, supplementation of iron is required to achieve optimal response to erythropietin treatment(8)

BodyEndurance(TM) Complex and Alpha-Lipoic Acid – the primary ingredient here, echinacea purpurea extract, was shown to increase serum EPO levels by up to 63% during a 4wk study of oral supplementation at 8g/day.(9) Out of the remaining ingredients, we are unaware of any that directly stimulate EPO levels, but the addition of these may increase the total iron content and absorption as well as oxidative stress that may limit the effectiveness of any EPO increase.

It is immediately clear that there is only one ingredient that has been clinically proven to increase serum EPO levels and that is echinacea purpurea extract. Based on a generous assumption of 2g per capsule (we are kept in the dark regarding the exact dosage, but it is the main ingredient of the BodyEndurance(TM) Complex which totals 2.1g per capsule), we can see that the total echinacea purpurea dose is in line with that of the study referenced above.

Unfortunately this study did not result in ANY change in Hemoglobin, Hematocrit or RBC count!! Although erythropoietin has other benefits which we will address in later articles, it is safe to conclude that the purpose of injecting recombinant human erythropoietin or boosting EPO levels by other means (e.g. hypoxic exposure) is normally a resultant increase in the oxygen carrying capacity of the blood via enhanced hemoglobin content.

As for the remaining ingredients, these very well might increase the effectiveness of this echinacea purpurea stimulated EPO production, but to an extent capable of significantly increasing hemoglobin content seems unlikely, unless the user is already anemic due to iron/B6/B12/folate deficiency.

When one considers the relatively cheap cost of echinacea purpurea extract bought separately and the incredibly low content of iron in EPO-Boost, we struggle to reach any conclusion other than this product is very poor value for what can only be described as a mild effects.

(1) Intravenous vitamin C can improve anemia in erythropoietin-hyporesponsive hemodialysis patients
(2) Enhancers of iron absorption: ascorbic acid and other organic acids
(3) Vitamin levels in the serum and erythrocytes during erythropoietin therapy in hemodialyzed patients
(4) Folic acid supplementation improves erythropoietin response
(5) Erythropoietin resistance due to vitamin B12 deficiency. Case report and retrospective analysis of B12 levels after erythropoietin treatment.
(6) Hydroxocobalamin supplementation and erythropoisis stimulating agent hyporesponsiveness in haemodialysis patients.
(7) Efficacy and Safety of Oral Versus Intravenous Vitamin C in Hemodialysis Patients with Functional Iron Deficiency
(8) Erythropoietin hyporesponsiveness: from iron deficiency to iron overload.
(9) The effect of 4 wk of oral echinacea supplementation on serum erythropoietin and indices of erythropoietic status.
(10) Spivak JL, Jackson DL: Pellagra: An analysis of 18 patients and a review of the literature. Johns Hopkins Med J 140:295, 1977.

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Darbepoetin: Maybe not so “Novel”

Since first appearing on the market, Recombinant Erythropoietin preparations have called for 2-3x weekly dosing schedules. And at first glance this appears to be a logical approach, particularly considering the half life of intravenous preparations being limited to ~8.5 hours(1).

With the arrival of NESP (Novel Erythropoiesis Stimulating Protein, a.k.a. Darbepoetin alfa) and an IV half-life 3x longer, an obvious opportunity to market an alternative to Epoetin, one that didn’t need to be injected more than once a week.Darbepoetin Alfa

The fact remains however that subcutaneous Epoetin administration results in a large half-life range(2) of 16-67h. In other words a median half-life of 41.5h. Barely differing to the 48.8h half life of subcutaneous NESP(3)!

And yet subcutaneous NESP is recommended for 1x weekly dosing. Why not take Epoetin 1x weekly instead?
Well that question has since been answered by a 2000 Swedish study who found NO difference between 1x versus 2-3x weekly Epoetin (same total weekly dose).(4)

In fact, as far back as 1992 a study conducted by the Chinese University of Hong Kong uncovered “similar responses” between 1x and 2x weekly subcutaneous administration.(5)

Furthermore it was since revealed that as little as once MONTHLY Darbepoetin alfa was effective at maintaining Hemoglobin levels in stable dialysis patients.(6)

One might conclude that any patient considering 1x weekly subcutaenous Darbepoetin alfa in the interests of convenience may very well reduce their costs considerably by opting for 1x weekly rhEPO instead.

(1) Pharmacokinetics of novel erythropoiesis stimulating protein compared with epoetin alfa in dialysis patients
(2) profile of Epoetin Alfa
(3) An overview of the efficacy and safety of novel erythropoiesis stimulating protein (NESP)
(4) The efficacy of once weekly compared with two or three times weekly subcutaneous epoetin beta: results from a randomized controlled multicentre trial. Swedish Study Group.
(5) Once weekly versus twice weekly subcutaneous administration of recombinant human erythropoietin in haemodialysis patients
(6) Darbepoetin alfa administered once monthly maintains haemoglobin levels in stable dialysis patients