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High-altitude acclimatization is understood to evoke increases in red blood cell count, hemoglobin and capillary density. Moreover, when high altitude-acclimatized individuals exercise at lower altitudes, mitochondrial density increases in response to the additional availability of oxygen, resulting in increased strength, stamina, and numerous other benefits. (Living High/Training Low).

In a normal healthy body, red blood cells deliver oxygen to the tissues, including all the muscles. This oxygen is used by the mitochondria in the muscle cells to convert carbohydrates and fats into energy. At high altitude, less oxygen is available for use by the body. The body compensates by increasing the number of blood vessels and red blood cells. The increased red blood cells and capillaries allow more oxygen to be delivered to the body’s cells.
Extensive research into the high-altitude adaptation response reveals that it results in the kidneys producing erythropoietin (EPO), a hormone that up-regulates red blood cell (RBC) production. This increase provides more oxygen available to the target cells. Additionally, high-altitude conditioning has been proven to increase the number of capillaries, providing more surface area for oxygen exchange.
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