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Training for Altitude: Nutrition Considerations at Altitude
7.1k Plays7 months ago
In the second episode of the Uphill Athlete podcast altitude series, Alyssa welcomes Registered Dietician, Alyssa Leib, to discuss nutrition considerations at altitude. The two run through nutritional needs at different altitudes and recommended practices for training. They also discuss how to navigate eating on expeditions in foreign countries and the challenges athletes may face with travel and on mountain nutrition. Lastly, they dissect the use of certain supplements and their effectiveness in altitude adaptations. Alyssa Leib brings a wealth of knowledge and advice to help support your high-altitude adventures.
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Transcript
Introduction to Uphill Athlete Podcast
00:00:00
Speaker
Hi, everyone. Welcome to the uphill athlete podcast. Our mission is to elevate and inspire all mountain athletes through education and celebration. My name is Alyssa Clark and I will be your host today.
Featuring Guest Alisa Lieb on Altitude Nutrition
00:00:13
Speaker
We are continuing on our educational series around altitude with our second episode focused on nutrition.
00:00:27
Speaker
I'm joined today by our RD, Alisa Lieb, who will help us learn about nutrition considerations at altitude. Thanks for being here. Thanks, Alisa. I'm always happy to be here. And I just apologize in advance. I'm pretty congested today and I think my voice sounds a little off. So that is why.
00:00:45
Speaker
Oh, you're fine. Ah, no. At least I've talked about this on the side, but it has just been the winter of cold and sickness after another. Yeah, it's never ending. Very excited for spring. Yeah, we can get outside and well, I mean, we're already here outside. That's not fair. We do bring the colder weather.
00:01:11
Speaker
Well, yeah, a couple weeks ago, I barely had a voice, so yeah, I feel your pain. I know you've done a few podcast episodes where your voice has been a little off, so it shouldn't be anything new for our listeners. Yeah, just changing it up on you all. You think you know who we are by our voices, but you never know.
Personal Experience: Food Safety at Mount Kilimanjaro
00:01:32
Speaker
So as we dive into this, let's start off with just maybe not a fun story, but do you have any specific experience at Altitude with nutrition that was particularly memorable or unexpected?
00:01:47
Speaker
I actually do. It was both unexpected and very memorable. I just have some background. I've been lucky enough to not really have many altitude issues up to about 14,000 feet or around 4,000 meters. But I had the very unfortunate experience of getting food poisoning at the high camp on Mount Kilimanjaro in 2018, the night before our summit push.
00:02:12
Speaker
So I will spare you all the details, but let's just say by the time we started climbing the mountain the next morning, I was thoroughly dehydrated and nutritionally depleted, which I think then contributed to getting some altitude sickness. It was overall a very miserable experience. For anyone who doesn't know, Kili is not at all technical. And we had a very, very small amount of snow, but it was
00:02:36
Speaker
basically just hiking. And it took about six hours to hike the five kilometers and about 4,000 vertical feet to the summit. I felt so terrible. Really couldn't stomach any food or water the entire climb, which was very bad. So I think there are a few kind of takeaways here.
Critical Aspects of Nutrition and Hydration at Altitude
00:02:54
Speaker
So number one, food safety is really important, especially when you're
00:02:58
Speaker
at altitude, climbing a mountain on an expedition. And then the second piece is just the role that adequate fueling and hydration can make in performance. And this is especially true at altitude. Oh, well, I'm sorry that happened to you. That's not fun.
00:03:17
Speaker
but you're totally right about and we're going to get into more detail about what we do on these trips where honestly things are in our control but can easily kind of slip into the the like oh well you know it's part of a bigger group or like i'll just you know have this and um unfortunately becomes really tricky when you're in foreign environments so i appreciate you sharing that i was trying to think actually if i had
00:03:46
Speaker
any specifics. And I am probably pretty similar that I handle altitude decently well, which very much irks my husband who has a little bit more trouble with it. But yeah, I would just say I think the best
00:04:07
Speaker
The best thing I've ever eaten is like a freeze-dried blueberry cobbler meal at Muir camp a couple hours before we went for our summit push and I just thought it was the best thing ever because it was hot and tasted delicious. But yeah, you know, I think actually we're gonna again get into this is I'm just always surprised by
00:04:32
Speaker
how much altitude can affect your caloric needs and how we don't know that right off the bat. I had someone remind me of that or tell me that a couple of years ago and I was like, Oh my gosh, that's amazing. Like that makes so much sense, but always surprising. Yeah, you're spot on with that. And I think it's always nice to find that kind of cozy meal that just really soothes you at altitude.
00:05:02
Speaker
definitely. And unfortunately, sometimes what we think will absolutely work doesn't always work when you start getting into higher situations. But
00:05:13
Speaker
Let's get into it. So there's quite different levels of altitude as we talked about in our first episode, kind of ranging from moderate to our extreme altitudes of 8,000 meters or so.
Physiological Changes and Energy Needs at Altitude
00:05:28
Speaker
So what are some considerations athletes should take as we increase altitude and how do our needs change with those increases?
00:05:38
Speaker
Absolutely. So there are a lot of physiological changes going on as we move up in altitude that can both affect nutrition or that we need to modify our nutrition in order to take into consideration.
00:05:52
Speaker
So the first one, Alice, as you mentioned, is that your metabolism increases. So your energy needs increase. It's kind of hard to quantify these changes just since they depend on individual metabolic factors as well as changes in altitude. So somebody living at sea level who goes up to 4,000 meters is going to have a different metabolic increase than someone who maybe lives at 5,000 feet and then climbs up to 6,000 meters.
00:06:17
Speaker
But in general, the higher you go, the more calories you will need to eat to maintain your body mass. And here I'm actually not just talking about fat. We actually see quite a bit of muscle atrophy occurring at high altitude as a result of not eating enough. So that's really important to keep in mind. Of course, this increase in metabolism combined with other factors like high energy expenditure of exercise,
00:06:43
Speaker
decreased appetite at altitude and then challenges associated with just carrying enough calories in the first place. These things can all kind of compound and as a result you could dig yourself into a pretty deep hole as far as calories and energy go.
00:06:58
Speaker
Another change that your body will make at altitude is that your body will actually metabolize more carbohydrates for energy relative to fats. And this basically just results from the changes in hormones that happen at altitude, so namely cortisol and adrenaline increase and then
00:07:15
Speaker
With those increasing, we also see a higher carbohydrate metabolism.
Hydration Challenges in Thinner Air
00:07:20
Speaker
And of course, anyone who has ever talked to me knows that I really prioritize carbs for all of my athletes. But this is just even more important at altitude. The next kind of main physiological change relates to hydration.
00:07:35
Speaker
The air is thinner, often drier. And so as a result, you're losing more fluids through both your breath and your urine. And as a result, you need to drink more in order to stay hydrated. We also find at altitude, your thirst cues are going to be even less reliable than usual. So if you find that you're waiting until you're thirsty to drink, it's probably too late.
00:07:56
Speaker
And this is all especially true if you're taking something like Diamox for the altitude. So acetazolamide used to treat altitude sickness is a diuretic. So what that means is that it's causing you to lose even more fluid through urine. So hydration just becomes extra, extra important. Another piece that I want to mention is iron status.
The Role of Iron in High Altitude Performance
00:08:18
Speaker
So this becomes especially important at altitude because of iron's role in oxygen transport.
00:08:25
Speaker
So our red blood cells are responsible for transporting oxygen throughout our bodies. And one key component of red blood cells is hemoglobin, which is this sort of complex molecular structure, but it includes an iron molecule in the middle. So if you have an iron deficiency, that means basically that your body is just not very efficient at getting oxygen into your muscles.
00:08:48
Speaker
which of course is necessary for aerobic exercise, which is generally what we're doing at altitude. And especially when the air is really thin and there's just less oxygen in the air, this just becomes even more problematic.
00:09:02
Speaker
So because of that, and we'll get in a little bit more later into just specific recommendations, but just making sure that your iron status is optimized before you travel to altitude is super, super important. Another kind of piece where it's not a direct change in nutritional status, but where nutrition can play a role involves something called oxidative stress. So oxidative stress basically is a situation where
00:09:29
Speaker
you have an imbalance between something called free radicals and then antioxidants. Free radicals are basically just damaging to your body and they result from stressful situations. So our bodies will produce free radicals throughout our daily lives, but certain activities can increase their production. So these would include things like smoking or exposure to radiation, but they also include things like exercise or being at high altitude.
00:09:57
Speaker
And antioxidants, this is kind of like a buzzword in the nutrition world anymore, but antioxidants are basically compounds that we find in food that can help to neutralize these free radicals and basically prevent that damage from occurring in our bodies.
Digestive Issues: Nausea and Bloating at Altitude
00:10:13
Speaker
So when we go to high altitude, that level of oxidative stress increases, which means we need more antioxidants in order to combat that.
00:10:23
Speaker
And then the final thing that I just want to mention here is that it is not at all uncommon to run into gastrointestinal issues at altitude, even if you're not getting food poisoning. Without getting into too much detail around the physiology, nausea, vomiting, diarrhea, bloating, these are all very common. Another piece related to some of that is that digestion can be slowed, basically as energy is prioritized for other more essential bodily functions.
00:10:52
Speaker
your heart beating, your lungs expanding, those sorts of things. The body will basically prioritize those processes over digestion. And as a result, this can cause sort of a slow digestive process that can result in feeling kind of bloated and gross and low appetite. So of course, all of these factors can then influence your ability to meet all of your nutritional needs. So there are a lot of changes that happen in the body as we move up in altitude.
00:11:23
Speaker
Oh, that's an amazing run through and I think helps too. I think sometimes we think something's wrong with us. And I think that's one of the main kind of questions that we want to keep addressing with altitude is like, what is kind of normal expectations of like, yes, this is more challenging.
00:11:44
Speaker
on the body. And what's going into the like, this is problematic territory. So that's really
Managing Normal vs Problematic Altitude Effects
00:11:51
Speaker
helpful of like, yeah, things are going to happen. It's I mean, in many ways, kind of similar to what happens in an ultra marathon is like your stomach is receiving less blood flow and attention than normal. So not that you can't
00:12:08
Speaker
make it better in many ways and do a lot to combat that. But also like there is just a natural element of like your body's adapting to a stress that's being put on it. And so things do happen and kind of knowing what's a red flag, like a big red flag and what's like, okay, we just need to work on this and work out a plan, which I think is what's so amazing about working with a nutritionist, working with a coach is like,
00:12:37
Speaker
That's what we're doing is coming up with these plans and strategies to help. Absolutely. And I think, you know, similar to your analogy about running an ultra marathon, it's the kind of situation where if you've never been in this situation, and you don't really know what to expect, you haven't really felt it, that makes it all the more challenging to plan for.
00:12:59
Speaker
And so that is where something like working with a coach, working with a dietician can be so helpful, even just finding a mentor so that you can best prepare yourself for what could happen. And so that you're not suddenly surprised when you're super bloated at altitude and you're like, what is going on here?
00:13:18
Speaker
Yeah, it's why I am, obviously there are reasons why we need to move workouts around, etc. But I'm always like, don't skip your long run. And that's not because, or don't skip your long effort, because you have to practice, you have to understand how your body navigates.
00:13:40
Speaker
harder efforts, longer duration efforts before it becomes a consequential action to go and do it where it's like, okay, if I understand at four hours, like X, Y, and Z happens, then I can combat that versus when I go for the eight hour summit push and I'm standing at the top of a mountain going, Oh, I feel terrible. X, Y, and Z happen. And I have no way to combat that. So that's what I'm always like, no, we do these long runs, not just because
00:14:10
Speaker
I love to torture you, you know, anything like that. It's like, it's because we have to know how our body reacts and we have to practice.
00:14:18
Speaker
with tool, yeah, with like actually being able to see how our body reacts. So yes, don't skip, don't skip your long run. Good, good solid freekeeping advice from Alyssa there. Don't skip your long run. No, and I know we're gonna get into it a little bit more just around kind of pieces of advice and things things to be doing. But you know, that's why I always encourage especially if you've never been to
00:14:45
Speaker
super high altitudes before if you have a trip planned, get up as high as you can in some sort of shakedown and just make sure you have your systems dialed and try to get as close to that situation as possible so that it doesn't come as a total surprise. So that you can practice your nutrition strategy so that you're not fumbling with it on summit day and everything is going wrong.
Iron Levels and Supplementation Risks
00:15:11
Speaker
Totally.
00:15:14
Speaker
Yeah, that directly leads us to our next question of what are recommendations that you have for athletes if they don't live at altitude? Because a lot of us, I mean, so many of our athletes are not able to live where they can pretty frequently access altitude. Absolutely. Yeah. So going off of that conversation, get out and practice however you can. You know, if you have a big trip in the Himalaya planned and you live in the US,
00:15:44
Speaker
Can you take a trip out to Colorado, climb a 14, or just have some experience getting exposed to somewhat higher altitudes than where you live? I recognize that's not always possible for everybody, but if that is, I definitely think that is a great strategy. It's hard to
00:16:03
Speaker
practice your fueling and your hydration strategies if you don't know how you're going to feel in terms of appetite, GI issues, that sort of thing. So if you can practice in any way, please do that. Beyond that, and this is just sort of a little more practical for everybody. And this is actually good advice for any athlete, no matter what elevation you live at or what elevation you're traveling to.
00:16:28
Speaker
Get your iron levels checked. Do this regularly. I recommend that all athletes get a full iron panel done every single year. If you are a menstruating female, if you have a history of iron deficiency, if you eat a plant-based diet, get this done every three to six months.
00:16:47
Speaker
just because iron plays such an important role in transporting oxygen. So it's really important to make sure that your levels are optimal, which I think is sort of an important segue that wherever you get your lab work done, it'll come back with a normal range.
00:17:02
Speaker
that isn't necessarily optimal. So if your level is on the low end of normal, you probably have some work to do there. So get your iron levels checked at least a couple of months prior to going to higher altitude, just so that you have time to correct it if you need to. And then just something else I will throw out there, do not blindly supplement iron. If you don't get your levels checked, do not take a supplement because getting too much can also be really dangerous.
00:17:31
Speaker
So that's kind of my piece of advice there.
00:17:36
Speaker
No, I am, yes. I was giving, you all can't see this, I was giving a fist pump because, yes, blindly supplementing, especially iron. There are stories out there actually of women runners who had too much iron and it caused massive issues. So you really have, and it wasn't, it was not like a blind supplementation, just naturally the way the athlete was. It does show up in a very similar
00:18:03
Speaker
way, though, doesn't it? That if you have too much iron, you can actually feel almost similar symptoms to too low of iron? It can. I think the bigger issue is that symptoms of an iron deficiency are pretty general, right? It's a lot of fatigue, just feeling really run down.
00:18:24
Speaker
And those can be caused by a lot of different things, right? Maybe it's another vitamin deficiency. Vitamin D is another one that kind of looks that way, B12. Maybe you have a thyroid problem. Maybe you have sleep apnea. Maybe it's just general life stressors causing you to feel that way. So yeah, it can be really easy to just sort of say, oh, well, I read that iron deficiencies can cause fatigue, and I'm tired all the time. So that must mean I'm iron deficient. And a lot of the time, that isn't the case.
00:18:52
Speaker
No, that's really helpful. And I think another piece of this is remembering that we are not the general population.
Athletes' Unique Nutritional Needs
00:19:02
Speaker
Like your point of saying that, yes, it may be within a normal range, but you might be
00:19:10
Speaker
like that might be the start of a really deep dive. And also we are putting higher strain than the normal population on our bodies. And so what's quote unquote normal that wouldn't be flagging anything for say just kind of a regular
00:19:29
Speaker
person, Jane or Joe or whatever, no offense to the Jains or Joes who are out there. You know, it might not work. And it could be manifesting in ways that are really problematic. And so that's why I'm always a fan of getting someone on your medical team that really understands endurance athletes. Because otherwise, you could just have someone who's like, Yeah, well, you're fine for, again, general public, but not for
00:19:58
Speaker
the specifics and demands of what you do. Yeah, absolutely. I agree wholeheartedly with all of that, and especially just that piece where it is important to make sure that your healthcare providers understand not only that you are an endurance athlete, but also that they understand how to treat endurance athletes because there are some differences there.
00:20:20
Speaker
So yeah, any further tips that you have? Yeah, you know, I would say make sure that you're dialing in your overall nutrition strategy when you're at home and just making sure that you're meeting all of your nutritional needs throughout training.
00:20:34
Speaker
So one of the things I mentioned earlier was the oxidative stress piece and just the importance of eating plenty of antioxidants. So the best way to do this really is just eat a variety of fresh fruits and vegetables. And this can just help your body to fight off or neutralize these free radicals during training because that's kind of the last thing that you want is to
00:20:56
Speaker
go from a situation where you've been training really hard putting this stress on your body and then you go to your expedition or your climb and you are suddenly at high altitude which is just putting additional stress on your body and now your body may not have the tools that it needs to stay healthy. So just really making sure that you're going into the trip as healthy as possible.
00:21:19
Speaker
Kind of related to this, I know a lot of uphill athletes do hypoxic training or sleep with altitude masks.
Extra Weight: A Strategy for Altitude Trips?
00:21:27
Speaker
And if this is you and you start doing this, you might start to notice that you're feeling hungrier after starting this kind of training. And again, this is just your metabolism increasing in a situation where it's not getting as much oxygen. So just really making sure that you are eating enough.
00:21:44
Speaker
just really in general making sure that you're eating enough to support your training and also just considering the fact that a lot of people, especially on longer expeditions, are losing weight when they go on their expedition. So you don't want to go into your trip at altitude underweight. That certainly is not a good starting point. I have
00:22:08
Speaker
I don't know how I feel about this, but are there situations where it can actually be positive to go in plus a bit of weight, or do you find that the benefits don't outweigh the potential risks or detriments? Yeah, that's a great question. I think it's going to be very individualized. Here I'm looking at, first of all, what is their trip that they're going on? Is it long enough that they're actually going to
00:22:38
Speaker
see the differences or see the effects of substantial weight loss. If you're on like a three month long expedition, that of course is very different than if you're spending two weeks on a mountain. The other piece that I'm going to look at into is just sort of the practicality of actually putting on additional weight prior.
00:22:58
Speaker
So for some people, especially people who have a crazy high volume of training, eating enough to build muscle mass, that can be a challenge on its own. I think for most athletes I'm working with, it's a challenge just to get them eating enough, let alone eating extra. And then the other component that I'm looking at here really is sort of the psychological
00:23:22
Speaker
place where that athlete is around food and around changes in body weight for some people it would not be appropriate to try to have them intentionally trying to alter their body size so it really would be totally individualized I definitely think that there are situations where
00:23:41
Speaker
putting on additional weight prior is warranted, but I think for the majority of us, just making sure that you're going in adequately fueled should be enough. Are you ready to achieve your next trail running goal and perform at higher altitude races and adventures? At Uphill Athlete, you can train your way with our fuel-tested, science-backed training programs. Choose from training plans, personal coaching, or the new Uphill Athlete Training Membership.
00:24:09
Speaker
Check out the link in the show notes to achieve your trail running objectives and push your best foot upward. Yeah, that makes total sense. The first thought was psychologically that could be really troubling if you didn't have a great relationship with that to start with and then going into something that's going to be really stressful.
00:24:30
Speaker
adding that element in could be tough. Absolutely. I think your last, the last bit is something we were kind of harping on. But practicing, how does that come into play? Yeah, so you know, we talked about practicing being at altitude if that's possible. But if that isn't, or even if it is,
00:24:50
Speaker
just practicing your fueling and hydration strategy however you can. So there are a lot of things that we don't really know about if you haven't spent much time at altitude. But in general, just making sure that you're trying a variety of different fuel and hydration products.
00:25:07
Speaker
just really working on eating and drinking regularly during training, just to mimic your strategy while you're on your expedition, while you're on your climb, to just really have your systems dialed. And I think this goes for if you're spending time at altitude, this goes for if you are running long distances, this goes for pretty much anybody who is doing any sort of training in the outdoors. Practice, practice, practice. Absolutely.
00:25:36
Speaker
So then how do you prep your athletes? And we've touched on a few of these, but how do you prep them for tackling higher altitudes through their their training practices? Yeah, so a lot of this is going to depend on individual factors. So what is the expedition that they're going on? Is it something like a shorter push, or are they going to be out there for a couple of months?
00:25:58
Speaker
What is their experience at altitude? What lessons have they learned from past experience? I know I've definitely met with certain people who they're like, oh, I know that once they get above a certain altitude, you know, this certain type of food doesn't work for me. And, you know, and I, I have to kind of go with that, right? Because everybody knows their body best.
00:26:17
Speaker
you know, where are they currently from a health and fitness perspective? It's really just a very individualized approach. But I can talk through some sort of common strategies that I will recommend to most athletes. The first one should come as no surprise, test out different fuel and hydration products and make sure that you have a variety of foods that you're excited to eat.
Fueling Strategies and Logistical Planning
00:26:43
Speaker
you know, because altitude impacts our appetite, it can cause potential GI issues. Never mind that if it's cold and stopping to eat isn't always what you want to do. Sometimes it can be dangerous to stop. You basically don't want
00:26:58
Speaker
Not wanting to eat the foods you've packed to sort of add on to that right we we already are facing so many challenges both Physiologically and then just from in a mental psychological perspective When we're traveling at high altitudes that we want to make it as easy as we possibly can for ourselves So that means training and practicing
00:27:21
Speaker
not only with the foods that you're planning on taking with you, but also with the gear and the clothes that you're planning on taking. So figuring out your strategy of, okay, well, I know that I can pretty much suck down a gel at any time, but
00:27:35
Speaker
If I'm at 7,000 meters and it freezes, how do I make that work? So really practicing that strategy of, OK, I'm going to keep it in an inside pocket close to my body and have a almost like a train of fuel where now I take this out of my inside pocket, I eat it, I replace it with another one so that in 20 minutes when I need fuel again, I have that there and I don't have to worry about it being frozen. I'm just really like those logistical things can go a really, really long way.
00:28:05
Speaker
And then I think the other kind of pieces are just really focused on that sort of general nutrition, making sure that you're meeting your needs and training like we talked about so that you're not
00:28:16
Speaker
showing up in Nepal and your carbohydrate stores are depleted. You're already underweight because you weren't able to keep up with your training. So just really making sure that you're keeping up with your fueling on a day-to-day basis and meeting all of your needs. Potentially, in some cases, I might recommend doing something like a carb load, just so that you make sure that you're starting out with your
00:28:40
Speaker
carb stores totally topped off so that you aren't starting out in a deficit there. And then I think just the other piece, since I know a lot of our athletes are flying to get somewhere, just make sure you double down on your hydration, since flying in an airplane is one of the most dehydrating situations we're ever in.
00:29:03
Speaker
especially if you have a really long flight or you know, you're traveling for 24 hours plus, this is all going to be really, really important. Oh, those are fantastic. And yeah, the level of dehydration is just wild. And I think for most of us, these are longer flights. So yeah, making sure you're bringing your water bottle and maybe three
00:29:26
Speaker
if you can do it. But this kind of leads into another piece for a lot of our athletes. They're taking on pretty big expeditions in foreign countries. So how do you help athletes prepare for the unknowns of these expeditions from a nutrition lens? Yeah, I think the first piece is do everything you can to reduce the number of unknowns.
00:29:56
Speaker
So whether it's, you know, if you're going with a guiding company, make sure that you're very clear with them. You understand what are the expectations around what foods I need to be bringing? What are you going to provide? What are some examples of the meals that you're going to provide? You know, again, talking with a mentor or a coach who has been there and who understands what that situation is going to be like and can give you some advice around that so that you don't come in totally blindsided.
00:30:26
Speaker
know, I think thinking about some of these just issues that come up around longer expeditions in general, you know, we sort of touched on this a little bit, but all of the nutritional concerns that I mentioned earlier, these are going to play more of a role if you're out for a month, two months, three months versus if you're out for like a week or two. So here I'm talking things like weight loss. If you're
00:30:51
Speaker
going out for like a three day push at altitude and you end up a little bit behind in your calorie intake. Ultimately, it's not going to have as big of an effect as if you spend three months under eating and now your pants aren't fitting and you've lost substantial muscle mass. So these sorts of things just really
00:31:11
Speaker
are a lot more important to make sure you have dialed on longer trips. Iron status is another really big one. Even if you start a trip with optimal iron stores, if you're out there for three months, that's enough time where you could potentially then dip into a deficiency.
Navigating Local Food Safety on Expeditions
00:31:27
Speaker
So just really making sure you're on top of these kind of general nutritional aspects. Thinking about the foreign country's perspective of things,
00:31:37
Speaker
given my experience on Kili, food safety, very important. Do whatever you can do to make sure that you are using clean water. So if you're filtering or boiling your own water, make sure you do research on the needs in the country you're traveling to and in the region you're traveling to. Different water purification devices are going to be better or less good in different locations.
00:32:06
Speaker
you know, for example, a lot of the filters that we use here in Colorado, they don't filter out viruses. And so if you're in a country, you know, perhaps like Nepal, where viruses being in the water is a really big deal, you may want to look into some different water purification strategies, maybe like multiple strategies as well, just to make sure that the water that you're drinking is safe and isn't going to make you sick. Of course, there are
00:32:34
Speaker
always situations where what you're eating isn't entirely under your control. But I think there are ways that you can be a little bit smarter about it, you know, as tempting as the street food in Kathmandu looks. Maybe if you're heading out to start your expedition tomorrow, maybe you skip it, you know, choosing things that are cooked or that can be peeled when it comes to fruits and veggies. That's always just really, really smart guideline.
00:33:03
Speaker
opting for the banana or the orange rather than the apple, just so that you know that you're not eating anything that is contaminated. On kind of another note with that, if you are planning to bring food into the country on your own, and this is a lot of logistical
00:33:23
Speaker
things going on here. But I do think that that's a lot of nutrition. But make sure you do research on what kinds of foods you're allowed to bring into that country. For example, a lot of countries do require that if you bring in food, it's factory sealed. So what that means is your mountain house is probably going to be allowed.
00:33:43
Speaker
But if you're trying to dehydrate food at home and just put it in Ziploc baggies to save money, that might not be allowed. That might get flagged at customs. And then now you are in country and you have a whole, you know, month of food that you now need to obtain.
00:34:00
Speaker
Similarly, if you're trying to buy food after you arrive in the country, just do some research on what kinds of foods you might be able to find. I will let you all learn from my mistakes again. I was in Chile for a trek in 2020 and my plan was to buy peanut butter there to take with me. Didn't realize that because we were in a really small town,
00:34:23
Speaker
They had a supermarket, but peanut butter isn't a staple of their diets in South America like it is here. So I couldn't find it at the regular supermarket. It turned out that there was only one store in town that sold peanut butter. It was the organic vegan store, which was fun. And that jar of peanut butter cost me $14 and it was in a glass jar. So
00:34:47
Speaker
doing that kind of research and just making sure that whatever you're planning on buying is something that you can actually find. Oh, those are amazing. Yeah, examples. I've definitely been in situations where I think like, Oh, yeah, it'll be easy to get this food or I'll plan on this and you get there and you're like, Oh,
00:35:05
Speaker
Okay, and peanut butter is one of the ones that I have definitely run into. Shockingly, Europe is, they'll occasionally carry it, but it's like not really their thing. Which is totally valid. Nutella is great. But yeah, you know, I think the I I'm so glad you touched on the water piece because something I learned we lived over in Italy for a couple years and
00:35:33
Speaker
It is not universal as it is I think in the US of clean water that you can just drink out of the tap and so we got really used to checking where everyone went just a quick Google of like can you drink out of the tap in X country and obviously
00:35:52
Speaker
you need to be really careful more than just the quick google but it's an awareness i think that when you're coming from the states you don't have really well of course i can drink out of this or of course i can have that and so i think just bringing in a situational awareness of not every place has the same um
00:36:12
Speaker
you know, the same level of water drinkability, um, publicly available is, is really key. And I think honestly, an easy one to miss, especially if you're kind of like, Oh, well, everywhere in Europe is probably fine to drink, like probably, but just do a quick check, just make sure. Um, so yeah, I think that's an excellent point. Yeah, that's a really good addition there. And I think I'll, I'll even add to that, that
00:36:42
Speaker
just because locals are drinking tap water doesn't mean that it's going to be okay for you to drink either. So I do think doing that extra research is really smart. Yeah, I mean, that was really interesting. We lived over in Naples, and I love Naples.
00:37:00
Speaker
there were requirements actually that the US government had for US citizens of what the level of drinking water, I don't know if it was like minerals, kind of like what the factors were, but we were not supposed to drink out of the tap in Naples according to these standards. So we were given water by landlords or like our water was treated in a different way if you lived on base.
00:37:29
Speaker
And to be honest, I don't, I think for the most part, a lot of people really don't drink tap water in Naples. But that like, who would think that in a city in Italy, that that would be kind of a standard operating procedure, like wouldn't have thought of that. So just kind of like, just because it might be okay for the locals, or like, you might think it's fine just being extra cautious.
00:37:56
Speaker
Yeah, it's always so interesting. Because yeah, you're absolutely right. In most of the world, people drink bottled water. And as an American, when I go to a restaurant and order a glass of water, I've gotten a lot of very weird looks, even in places where the tap water is safe to drink. It just isn't part of culture in a lot of places. Yeah, no, it really isn't. And also, Aqua Frisante in Italy is just
00:38:23
Speaker
It's the best though when it comes out of a spout. They have those all over. It's awesome. I'm a huge fan. It's one of the things I miss is aqua con gas. All right. So say you have an athlete that's going on a guided trip and they are getting food provided for them.
Understanding Provided Meals and Dietary Supplements
00:38:44
Speaker
How do you help athletes to kind of manage that aspect of the trip?
00:38:49
Speaker
Yeah, so like I kind of briefly mentioned, just doing everything you can to reduce uncertainty.
00:38:56
Speaker
So like you mentioned, often on these guided trips, you don't have a whole lot of control over what foods you're eating or when, but there's a lot of variability, right? Some guided trips might provide all of your food for the whole trip. Some of them might only provide certain meals like breakfast and dinner, and then you're expected to bring along snacks or lunch. So just really communicating with that guide company so that you can be really clear about not only what food will be provided, so as far as what meals, what snacks,
00:39:26
Speaker
Asking for specific examples of what these meals can look like just so that you know going into it And then also just being really clear about how long you'll be walking each day So, you know, this is another thing that I've seen a lot with my athletes is
00:39:41
Speaker
they'll be able to provide, oh, while the guide says, we'll probably be walking for six hours on this day. But if you can really get that dialed down, figure out your miles, your elevation gain, those average number of hours. And that's just really helpful so that you can estimate your own energy requirements and then just match them up with additional food brought from home. So just really being sure about, okay, I know that we're going to be out for
00:40:10
Speaker
Eight hours today, we're probably going to cover 15 miles. It's got 4,000 vertical feet of gain. That means that I need to eat about X amount of food and they're going to provide two meals for us. So while we're on the trip, I need to bring however much in snacks.
00:40:25
Speaker
I also just related to this usually recommend bringing more food than you expect to need as a just in case because oftentimes what we find is you know the guide company may say oh yeah we'll have plenty of snacks for you and then those plenty of snacks end up being like
00:40:40
Speaker
a bar for the whole day, which is certainly not enough. Especially if you have any kind of dietary restriction, this is all so true to just plan on bringing things that you can supplement meals and snacks with. So for example, if you're a vegetarian, and I bring this up because this did actually happen recently with an athlete that I worked with.
00:41:04
Speaker
who they claimed, the guide company said, yeah, we can provide vegetarian meals, no problem. But those meals actually ended up just being rice and potatoes, which is not a super balanced meal, especially when you're out there for weeks on end, your muscles, like your bodies are working really hard. You need recovery and you need protein and rice and potatoes. Well, fantastic. I love carbs. I love rice and potatoes.
00:41:29
Speaker
you need some protein in there. So in those situations, maybe it is bringing a couple of dehydrated meals so that you have something in a pinch. Or even in this case, just having a protein supplement would be beneficial to just kind of drink on the side. So you've got your carbs, you've got your protein, and you know that you're able to meet your nutritional needs. Oh, yeah, that's tough. And also, I'm curious like how
00:41:53
Speaker
Because food, it is such an interesting thing because it's a necessary thing for human survival. But also, that to me says, oh, I would be so unsatisfied if that was my dirt. I would be sad if I sat down to a meal and I had rice and potatoes and everyone else had a nice meal at the end of a really hard, long day. So how do you factor in the satisfaction
00:42:23
Speaker
happiness element of food when you're thinking about this too? Yeah, that's a really good question and a really good point. You know, and I think a lot of it, unfortunately, sometimes we have to just kind of sit with that and, and it sucks, right? But I will say I think that anybody who has any kind of dietary restriction is unfortunately probably pretty used to this happening.
00:42:48
Speaker
which doesn't necessarily make it okay. Um, but you know, I would say in that case, bring, bring one thing, a little treat, um, you know, whether it's bring a bar of chocolate and so you can have a couple of squares at the end of the day so that you still have something there that's satisfying you and you're not just having to sit with that rice and potatoes and protein shake meal, which is pretty sad. Um, have something there that, that is, that does provide that satisfaction factor. Um, and hopefully just through,
00:43:17
Speaker
Again, communicating with your guide company ahead of time, you can kind of minimize that or at least, you know, have a better understanding of.
00:43:26
Speaker
how often things like that are going to happen so that you can bring an alternative. Yeah, definitely. And actually, I've looked into some guiding companies before, actually, I think a couple of Rainier ones, and was honestly really impressed by how specific they were in listing out what they had in kind of their meal packs, where it was like,
00:43:51
Speaker
three Nature Valley bars, two Snickers bars. So hopefully like other companies kind of can follow suit or like have an idea. But yeah, I was actually really impressed by how specific and then hearing more about this. It's like, yeah, really need to be. And I think
00:44:09
Speaker
that that just, yeah, so helpful in planning. And also from a coaching perspective, it's really helpful to know what your days are gonna look like. So I was like, yes, I am right behind that of like, I also want that information. Yes, it is. It's so important to find and I'm always shocked by a lot of these guided tracks, how little how hard it is to find that information. You know, I know, like I I've worked with athletes in trying to come up with their fueling plan and figure out what they need to supplement what the guide is providing.
00:44:39
Speaker
And I've got eight tabs open trying to figure out, OK, well, on day one, they're going from this place to this place. So see if I can find a map that shows the distance between those. And it's a lot of sleuthing work when I feel like it doesn't necessarily have to be.
00:44:55
Speaker
Yeah, no, well, hopefully we can continue to champion the transparency of food options. So one of the last things that Alyssa has written out beautiful notes, and I am super curious to hear more about supplements, as you have quite a bit of really interesting information about that.
Exploring Nitrate Supplements for Altitude
00:45:23
Speaker
So what about supplements?
00:45:26
Speaker
Yeah. So I, I thought that this was important to bring up because this is a question that I get asked a lot. Um, and there are a lot of, you know, if you Google altitude supplements, there's like a million things that come up. Um, and a lot of them, if you read the labels, they're very, um, let's go with interesting. I didn't want to talk about two supplements in particular that I think are
00:45:55
Speaker
probably better researched than most of the other kind of random things out there. And these are also the supplements where I get the most questions about. So the first one I'll talk about is nitrate, which I feel like is really sort of having its heyday. So nitrate, just to go into very brief physiology so that I don't confuse you when I start calling it different things.
00:46:19
Speaker
Basically, nitrate is produced by our bodies, but it's also something we can consume through the diet. The main food source that we hear about is beets or beetroot juice.
00:46:31
Speaker
And basically, nitrate goes through this pathway in our bodies that results in the production of nitric oxide. And nitric oxide is a vasodilator. So it causes your blood vessels to expand. And what this does is it basically helps your blood move faster through your veins. And that means that it can transport nutrients more quickly throughout your body, including oxygen to your muscles. We've talked about oxygen a lot in the context of iron.
00:46:58
Speaker
But it makes sense that if your blood is moving faster and it's moving more effortlessly because your veins have literally just gotten bigger, but you have that same blood volume moving through, then it means that you can engage in the same level of exercise with less oxygen because it's just getting transported that much faster. So you can see how at altitude this might be beneficial. In the research, we find there maybe is a little bit of support here.
00:47:28
Speaker
There have been some cool studies looking at people who live at high altitude versus people who live at lower altitudes. And so they found that people who live at higher altitudes in Nepal or Tibet tend to have higher levels of nitric oxide in their blood than do residents at lower altitudes, which is pretty cool. So the theory there is that by increasing nitric oxide levels, this could potentially help with acclimatization and
00:47:54
Speaker
reduce altitude sickness and all of those negative effects that come with it. But when we actually look at the research on this, it's pretty mixed. We see that supplementing nitrate can result in some physiological changes in terms of like blood markers,
00:48:12
Speaker
and that sort of thing. But this may not actually translate into exercise efficiency at altitude. So of note, there is actually quite a bit of research showing improved performance at lower altitudes if you're taking a nitrate supplement, but we haven't really seen this translate at higher altitudes. So that's kind of what's what on nitrate. The other supplement I want to bring up is Ginkgo Balboa.
00:48:40
Speaker
which is in herbal supplement. I just love the name so much. It is, yeah, I'm not actually sure where that comes from. And I also didn't realize until I was typing out my notes for this that the K comes before the G in ginkgo.
00:48:57
Speaker
So I would assume, and I could be wrong, so I grew up with a ginkgo tree in my yard, and I would assume that it comes from that tree of some kind of element of it. They have the coolest leaves. I don't actually know the answer to that, but I would assume it's got to be related somehow. That would be my guess.
00:49:22
Speaker
But yeah, so the herb, it's pretty commonly used for its antioxidant properties. So of course, we've spent quite a bit of time today talking about antioxidants and their role in neutralizing free radicals and just reducing damage to the body. So in the context of altitude, specifically, the thinking is kind of that it could reduce the hypoxic damage in body tissue.
00:49:46
Speaker
and then could potentially have an effect on acute mountain sickness, which would be really cool. And so there was some sort of initial research conducted on this that was just very, without getting into all the weeds on different sort of levels and types of research, the research was much more observational. It was, we had a group of people who were climbing
00:50:11
Speaker
in Nepal and we gave them ginkgo-balboa supplements and this was what we observed. And in a lot of that early research, we actually found that there seemed to be some sort of association where people who were taking the supplement were not getting as bad altitude sickness. And then I think this is really cool. There was actually a randomized double-blind placebo-controlled trial
00:50:34
Speaker
of ginkgo balboa supplementation among trekkers to Everest Base Camp, which is really cool because a lot of the time, the randomized control trial is the gold standard of research. And a lot of the time when we talk about nutrition research, and especially like in the world of outdoor mountain sports, a lot of the time it just isn't practical to do a trial like that. So I think it is so cool that they were actually able to do that kind of study. The downside, however,
00:51:03
Speaker
is that they found that there was no significant difference in acute mountain sickness risk or severity between people who took the supplement and people who didn't. So with both of these things, you know, what I would say is if you are really stoked on the idea and you want to give it a try, go for it.
00:51:25
Speaker
But don't expect it to be the end all be all that's going to make you acclimatize like a pro and not run into any potential downsides.
00:51:37
Speaker
Uh, yeah. The, the, the maybe, they're like the depends, like possibly this would be super cool. But yeah, no, that's really helpful. And I would be interested to see more, hopefully more research done on both of these to see kind of what the outcomes are. But at least any last things you'd like to touch on,
00:52:00
Speaker
as we wrap on nutrition and altitude. Obviously not a wrap, but for this episode. Yeah, I think I'll just sort of leave everyone with two sort of
00:52:14
Speaker
brief pieces of advice that hopefully don't feel like they're totally out of the blue. First one being just get comfortable with being uncomfortable. You know I think we see this in a lot of endurance sports in general but it's just sort of magnified at altitude that a lot of the time eating when we're doing hard work is not what we want to be doing. But know that if you don't eat things will only be worse. So doing everything you can to
00:52:43
Speaker
just dial in your strategy and make sure that you're fueling consistently throughout training is going to make things a lot easier when Summit Day comes. My second piece of advice, and we've kind of touched on this a little bit too, but I just want to reiterate here, seek help if needed. You don't have to be alone in this, even if it is your first time going up to a high altitude, whether it's talking with a mentor or working with a coach or a dietitian,
00:53:13
Speaker
just to make sure that you are confident and have a plan going into your trip. You don't have to figure everything out on your own, so seek help.
00:53:22
Speaker
I love those. And just to kind of add to them, eating is great. I love eating. I don't love eating, you know, at mile 70 or 80 of an ultra or, you know, our whatever of a hard effort. But it is the difference between success and feeling really bad and potential failure. And so I think it's like, I don't ever want people to think that
00:53:48
Speaker
they can't have joy in eating but also at points it's like no this is necessary to achieve what I want to do and I might not enjoy it and that's okay and find the things that's like the least offensive in many ways at that point like no one's having a great time eating at certain points and you just have to decide like this is what I'm gonna do and this is worth it
00:54:10
Speaker
And the other piece is that I think when we see athletes being really successful, it's because they figured out how to build their team. Like that is one of the pieces that I've found in my own career that I'm helping, trying to help my own athletes. It's like,
00:54:30
Speaker
the the bigger not bigger but like the the stronger and more collaborative your team is around you the more successful you'll be so when you run into those roadblocks when you're struggling you have people you can turn to that can fix it like i remember very early on in my career where i would just hit these roadblocks and i'd be like oh my gosh i don't know where to go from here and it would like take me out for
00:54:56
Speaker
You know, a week or so of just like, I don't know how to fix this. And now it's like, Oh, I have three people that I can immediately say like, Hey, having this issue. And they're like, Oh, cool. We'll fix it this way. And like the better you build your team and a coach nutritionist.
00:55:13
Speaker
Um, someone like for the mental piece, like a psychologist or a sports psych, um, a PT, you know, all of those pieces are what make an athlete successful, not just that singular. Like I have to do this all on my own. So I'm really glad that you brought up the ask for help. Like we want to help. That's what we're here for. Yeah, that, that was really beautiful. Couldn't have said that better myself.
00:55:40
Speaker
Well, thank you. I mean you brought it up. So I'm very glad you did This was amazing as always I can't wait. I'm I think down the line we're gonna do Nutrition kind of as our main season. So I'm very excited about that. You're like, oh gosh, she's bringing up on the no, you'll be It'll be great. So you can or at least it can actually can you
00:56:07
Speaker
tell people how they can work with you at uphill athlete. Yeah, absolutely. So there are two options. The first is through nutrition consultations. So this would be basically we would set a an amount of time to talk to each other and get your questions answered. I like to think of the consultations as kind of pick my brain sessions.
00:56:29
Speaker
Typically, we don't use them to go to do a super deep dive into your background. I'm not going to complete a full assessment. But if you're just like, hey, I've been reading all these things and I don't know what to believe and I just really want a professional who knows what they're talking about to set me straight.
00:56:46
Speaker
That's the perfect use case for the consultations. The other way to work with me is through nutrition coaching. So it works kind of similarly to regular coaching where it's on a monthly basis and each month we would have a Zoom meeting about every two weeks. So we'd meet twice each month.
00:57:04
Speaker
And this would all start with a really thorough assessment so that I can get a full understanding of your not only your diet, but your lifestyle, your preferences, your training and just really understand how all of that fits together and what we can do to help you meet your goals that way. And then it's a very collaborative process. We work together to prioritize goals and
00:57:29
Speaker
really just set specific action items for each session. And then you go off into the world and you practice them and you see what challenges you run into. And then we come back and we talk about how to overcome them. You as part of coaching, you also get access to me over email or text in between those sessions as well. So that if something comes up,
00:57:53
Speaker
And you don't want to wait another week and a half for our next session. We can make sure that you get that answered sooner rather than later. Awesome. Well, please sign up if you're interested in nutrition coaching and we'll take care of you. So thank you for listening to the uphill athlete podcast. If you could rate, review, subscribe on your favorite podcast platform, that helps us to educate and hopefully inspire more athletes to get out there and do their best.
00:58:23
Speaker
It's not just one, but a community. We are a pill athlete.