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Training for Altitude: Introduction to Altitude
8.4k Plays8 months ago
The Uphill Athlete podcast returns with a new educational series dedicated to altitude and endurance athletes. In this multi-episode season, they begin with an introduction to altitude with guests Chantelle Robitaille and Martin Zhor who have extensive background in altitude education and application. Alyssa, Chantelle and Martin define the different altitude zones as well as give a general overview of the body’s reactions at these zones. They discuss AMS (Acute Mountain Sickness), HAPE (High Altitude Pulmonary Edema) and HACE (High Altitude Cerebral Edema) with specific recommendations on how to monitor and assess an athlete’s well being at altitude. Lastly, they define differences between male and female reactions at altitude as well as common myths many athletes believe about altitude. Learn from experts in the field of altitude study to keep you safe and healthy in your high mountain pursuits.
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Transcript
Introduction to Altitude Education
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. We've been brewing a fantastic new season for you. And I'm thrilled to introduce the first episode in our new educational series on all things altitude.
Meet the Altitude Specialists
00:00:31
Speaker
For our first episode, I have two of our altitude specialists on the uphill athlete team who are joining me to provide an introduction to altitude. Chantel Robitai and Martin Zor have extensive knowledge and education in altitude training, effects, considerations, and more. Thanks for being on, you two. Thanks, Alyssa. Great to be here. Thank you. Me too.
Chantel's Journey to High Altitude Physiology
00:00:55
Speaker
So before we get into our kind of introduction to altitude episode, I'd love to hear from both of you of what drew you to study altitude and its effects on athletes and what your background is in these studies and actually like kind of what is your specialty within altitude because it's a big topic.
00:01:15
Speaker
I would agree it definitely is a big topic and yeah we could probably, well we will be talking about this for days. I got into studying altitude since I was living in Switzerland once upon a time and doing a lot of running and skiing and things like that and I was also coaching ultramarathon runners and as much as I
00:01:40
Speaker
understood a lot of physiology, what I really didn't feel I understood enough was the physiology, the impact of altitude on physiology and also on athletes at exercise, especially when they're working really hard in races.
00:02:00
Speaker
And so I actually changed careers completely. I was sort of a part-time coach and full-time corporate woman, whoa, wearing heels and business suits. And I went back to school and I got a master's degree in high altitude physiology so that I could understand that better. And although I, you know, dedicated time to doing that, it's still an ongoing process of learning because science isn't fixed.
00:02:27
Speaker
coaching as a practice, so still always learning. So I'm excited to be working with Martin, who is actively studying in school now, and so it's cool to continue learning through his experience as well.
Martin's Passion for Mountaineering
00:02:43
Speaker
Yes, thanks, Chantal. I think it's been quite a journey now. Today we're here. I'm an uphill athlete team, coaching people to climb mountains and Everest and all the others. So it's really a dream. Maybe even multiple dreams come true.
00:03:04
Speaker
Well i come from small country republic there's no really mountains we will talk about those categories of what is it like what are you so it doesn't even fit into that one. But i get dreaming about mountains mountaineering and reading books about legendary and eventually also became one also of the nest climber made it to chamony where i live here right now.
00:03:31
Speaker
Working at a let's say high altitude three thousand eight hundred meters for twelve years on a guilty lady left which is pretty legendary around here.
00:03:41
Speaker
And then also performing as an athlete, as a runner and climber and actually connecting all those dots then to do some faster sense in even extreme altitude. And also wondering what actually lies behind it and the physiology of it. So when I studied sports science back in 2015,
00:04:06
Speaker
I was supposed to write the final thesis so it had to be about altitude physiology so i talked to my professor and he agreed so that's that's where. I really dug into the theory and i chose a topic of faster acclimatization.
00:04:26
Speaker
And that's actually what I'm doing now, continuing this project as a master's student in Ostersund University in Sweden. And it's ongoing. It will take a while to make the experiment, to find the right group of participants in the study. But yeah, I'm super excited and learning in the process and bringing it all together to this job. So yeah, exciting.
00:04:56
Speaker
love it.
Defining Altitude Zones
00:04:57
Speaker
And both of you have already I think touched on this is that we use the general term altitude, but it's really a lot more complex than that. Martin, you've already said high and extreme. So how do we
00:05:13
Speaker
define different altitude zones, because it's certainly a different effect to be at, say, 8,000 feet, or that's about 2,500 meters, as opposed to being up in, you know, 24-25,000 feet, which is above
00:05:32
Speaker
6,000 meters? I'm trying to do the conversions right. Thanks for Melissa. Oh, thank you. Yeah, on the fly, working with a lot of European athletes. So Martin, can you kick us off of how do we define altitude zones? Yeah, so I had to actually look up some papers before this podcast to maybe review this, but actually, I think
00:05:58
Speaker
Let's just keep it simple and so I would say until maybe 1800 meters, 1800 meters, there's just not enough hypoxic stimulus or just the hypoxia doesn't really affect the body as much so I would really call it low altitude and maybe the next category of moderate altitude until 3000 meters which might be 10,000 feet.
00:06:23
Speaker
I would call it a significant threshold where if you go above that level, some people might already struggle. If they don't really respect the process of acclimatization, they might even get sick.
00:06:39
Speaker
or just have some severe symptoms. So I think that moderate altitude is quite important because athletes like endurance athletes wanting to perform at a sea level or low level of altitude, they seek this altitude to train and to get those adaptations to actually then boost their oxygen carrying capacity. And so we will talk about these adaptations later.
00:07:06
Speaker
what that would be this category and so the next one would be high altitude three thousand meters until five thousand meters i would say i'm really anything about five thousand i would call it extreme because then it really is a really.
00:07:26
Speaker
do we find the highest peaks in the world so that's really that's really around that you need to take your time for the other patients to occur to to adapt and to respect that process and maybe in these extreme altitude category i would say about seven thousand meters nobody lives permanently i think it's actually even lower like six thousand two hundred four hundred i'm not sure exactly now but
00:07:53
Speaker
It's physiologically almost impossible above 7,000 meters. I think you're really going down slowly but surely. And then so-called depth zone, about 8,000. The hypoxia is so severe that you don't really want to be up there for too long without supplemental oxygen now. We're talking not many people go there without.
00:08:14
Speaker
without supplemental oxygen anyway and so I think it's also good to know that what does it actually relate to with altitude we're looking into the reduced oxygen availability and this is actually a function of the barometric pressure which is lower and lower the higher we go so I think I like to think of it also that way just to have an idea what is actually happening in altitude.
00:08:44
Speaker
I was just going to say, I think that's an important distinction that I feel some people don't quite understand well about. They think that here's different ways people describe about there's less oxygen in the air, things like that. We always have about 21% of oxygen that's around us in the air. But when we are going up to higher altitudes and the barometric pressure is lower, that means the concentration of the oxygen molecules that we breathe is going to be less.
00:09:13
Speaker
So I think that's an important distinction for people to understand about altitude. And I think that's a good definition. And as Martin said, he had to look it up. I think there's lots of different definitions of these different categories of you'll see some different tables that will have three distinct altitude zones. Some will have four, some will have five. I think the important difference is we think about the
00:09:41
Speaker
Altitudes where we do have a lot of people who are tend to be living in training. We have places that people will Altitudes that people will visit in a transient way for a particular mountain objective We have you know different places where people will go very seldom So those are important distinctions for us to be able to make
00:10:05
Speaker
to learn some of the differences in terms of how our bodies will adapt, how we will be able to perform, and places where we absolutely shouldn't be spending too much time or should be spending time carefully. So I think that's what we'll try to focus on today is talk about that a little bit more to help understand a little bit more of what's happening to our bodies when we are going to higher altitudes or
00:10:29
Speaker
than we're used to and what's actually, what we will experience and actually what's happening in our bodies. Amazing. Yeah. So that, I mean, Chantel, you teed it up perfectly of in a general sense, because again, this is a massive question. I mean, gears of study, but generally how is the body responding in different zones? What are some key
00:10:55
Speaker
I guess, I don't know, reactions or indicators of the effect of altitude, what's happening within your body and what are those kind of reactions that we're seeing.
Body's Reaction to Altitude Zones
00:11:07
Speaker
Yeah, I think we sort of have two levels of this, right? Like what are we experiencing? What are we noticing about our bodies? And then what is actually happening in our bodies? So typically when we are going to a higher elevation, so let's take a typical example. If someone lives in Austin, Texas and they decide to visit, well, I live near Jackson, Wyoming.
00:11:31
Speaker
So pretty typical. They're going to a different elevation. Some of the things you're going to notice, probably big ones, maybe they're going to notice that it's a little bit harder to breathe. So their breathing is a little bit faster. Breathing rate is a little bit faster. And that's lungs trying to keep up with the change in the barometric pressure and the amount of available oxygen.
00:11:58
Speaker
their heart is heart rate is a little bit faster so they'll notice that their resting heart rate is a little bit faster. That's also normal response to altitude. That's the blood pumping or the heart rather beating faster to increase the amount of oxygenated blood in the body. They may also notice that they are peeing more often and increased urination rate that's also a common symptom. That's one of the early symptoms as the body is trying to
00:12:27
Speaker
It kind of comes from a hypoxic stimulus that we're getting to our kidneys and the body is initially getting rid of plasma essentially from the blood to concentrate the red blood cells.
00:12:42
Speaker
So your blood is becoming thicker. The red blood cells carry more, the oxygen in your blood. So that's a good way to help your body get through that. If you're going a little bit higher in altitude, you may also notice some difficulty sleeping. So some people may find that they are experiencing a lot of frequent wake-ups. Typically this is happening above 2,500 meters, so above 8,000 feet.
00:13:11
Speaker
but it could be, some people might be a little more sensitive to that. So they could be experiencing that. We'll get into this a little bit more later on specifically, but tends to be that men will experience this sort of sleep apnea more often than women at the higher elevations. And these are all normal responses to altitude. It means that your body is starting to,
00:13:37
Speaker
make some really cool changes under the hood, so to speak, to help you cope with altitude. And so in the early days, you know, these are the types of things that you're going to start to notice, you know, breathing, heart rate, things like that.
00:13:53
Speaker
But what's happening over the days and weeks is that we are getting an increase in hemoglobin. We are getting an increase in red blood cell mass. Eventually, the plasma volume that we are initially dumping, it's going to start to increase again over time as our heart rate and cardiac output starts to level out. That will happen within a few weeks.
00:14:22
Speaker
And we won't continue to have this sort of hyperventilation that we experienced initially. Again, over a couple of weeks that starts to decrease as we're able to counteract the hypoxic stimulus that we're having. So all these things are really normal and they're all necessary for the different physiological changes that we need to experience for our bodies to be able to stay healthy and stay alive at higher altitudes.
00:14:50
Speaker
And then as we go even higher, this is a little bit different and maybe Martin, that's something you want to expand on a little bit. Sure. I think that's a great overview.
00:15:03
Speaker
or stay a bit more with the timeline of those adaptations. The body, when we go to that altitude, as I mentioned, the first kind of threshold, maybe 1800 meters, what happens is that the body senses the hypoxia, so reduced amount of oxygen molecules in the air we breathe.
00:15:26
Speaker
body works in a very smart way so there are actually these receptors in different parts of the body but the main important ones maybe are
00:15:35
Speaker
the one in our town, the ones in the brain. So very sensitive obviously because we are highly dependent on oxygen to function our brain specifically. Obviously when it comes to performance because it's for us, for athletes, it is a lot about performance. So you can imagine that we need the oxygen. So if there's a lack of it, the body will start to, to the response basically. And so as Chantal,
00:16:02
Speaker
Now describe some of those adaptations happen very quickly within minutes, let's say, so the increased breathing, rate of breathing, the depth of breathing, increased heart rate. And then if we stay at that altitude or at hypoxia, so the other adaptations will start to happen later on because some of those actually take a while and it's all interconnected.
00:16:28
Speaker
This is the study of how to do this is an ongoing thing we still don't know a big part of it. We know that about maybe fifty sixty percent very large part of the our genome actually that's something that expresses something under hypoxia stress so you can imagine that it's not only about these points but i guess we can we can.
00:16:55
Speaker
What do we understand it and we can agree on these are really very important ones it's really about trying to bring that oxygen into the body. More efficiently because there's a lack of it and then also utilize it within the tissues within the muscles and becoming more efficient so all these applications are actually the way.
00:17:16
Speaker
for the body to just bring that, to keep the function and possibly even to improve them. So when it comes to high or extreme altitude, it's really about being careful to respect that process because if you really cross maybe that 3,500 meter threshold, maybe it's not a threshold as such, but just the level,
00:17:39
Speaker
Then we are really risking some of those i'll do you sicknesses or illnesses to occur because we're just which is going too fast and i just cannot deal with the hypoxia this is very individual.
00:17:56
Speaker
Some people have a tendency to get these illnesses more often or just randomly. We just don't exactly know why there are mechanisms behind this. But just what I want to say is the timeline of those different adaptations. So when we go to high and extreme altitude, it really needs to be
00:18:21
Speaker
there needs to be certain times of the week or two to really try to stay in the lower levels and then for those first adaptations to kick in to return so that the first ones actually can relax so the heart rate starts to go down the saturation is actually improving saturation of oxygen and blood the breathing as well and so because the other patients that take more longer time they already happens and so
00:18:49
Speaker
sort of like replaces one another and so then for the high and extreme altitude is really needs to be weeks weeks spent at those levels and actually try to even progressively increase that level. That's amazing and that also
00:19:09
Speaker
brings us to kind of a next question you alluded to, altitude sicknesses.
Understanding Altitude Sickness
00:19:15
Speaker
What are the common ones? I think we hear the terms, hape and haste used quite frequently. And where do we draw the line? And Martin, again, you kind of touched on this between feeling these, you know, changes and these reactions and really beginning to worry about this is going in the direction of an altitude sickness.
00:19:37
Speaker
Let's say the first stage of some kind of illness, because we can already talk about some kind of discomfort when we go to altitude.
00:19:49
Speaker
simulated altitude. So it's definitely worth to observe those symptoms. So the way we feel, the way we breathe, the heart rate, the saturation, all those outputs of the body can give us some kind of insight into if we are acclimatizing or our body is just struggling too much. But then obviously that comes the symptoms like headache, nausea, dizziness, lack of cognitive function. So you obviously
00:20:17
Speaker
might not even realize, but people around you can see that you're confused, that you're losing balance or other more severe symptoms. So they are different ones. So the first stage is the AMS acute, acute mountain sickness. So the acute is very important. It really usually, usually happens in this acute stage of acclimatization or when we just are at altitude.
00:20:46
Speaker
exposed to hypoxia, so if we really don't respect that acclimatization process and we just go a bit too fast, too high, this can happen. So acute mountain sickness.
00:21:01
Speaker
Visualize the headache some kind of nausea or vomiting and so the best way to is to go down to go to lower altitudes and to recover and just to give the body time to for further adaptation some.
00:21:18
Speaker
If we don't recover or we just have a tendency to just ignore or just to push even higher, definitely not recommended. So then there are the other two more severe conditions and they are very life threatening. So pace and height, so high altitude, cerebral edema and pulmonary edema. So those two are obviously very serious conditions and come with
00:21:44
Speaker
very severe symptoms and this is really minutes and hours. It's really usually the only, not the only, but the main important solution is to bring the person down or just use the hyperbaric chamber or something else. But it's really important to say that this is very serious. Maybe Chantal, if you would like to talk about those symptoms.
00:22:10
Speaker
Yeah, I think that's something, those are really good distinctions, Martin. I think one important thing for people to recognize when they are spending time in higher altitudes is to really pay attention
00:22:23
Speaker
to the small things, making sure that they are really getting a proper amount of rest, that they are staying well hydrated, that they are fueling well, and that they're truly paying attention to how they feel. Like don't ignore your symptoms, don't not tell your tent mates that you're having a headache for the last three days, something like that. And acute mountain sickness
00:22:45
Speaker
is really defined by headache plus some other type of symptom, right? So headache plus GI symptoms, fatigue, dizziness, impact on your activities.
00:22:57
Speaker
And so if you have, you know, just a headache, you know, be aware of it, share about that, pay attention to how you're doing, try to get a little extra rest and see how that goes. If you're getting a headache and you're feeling a little bit dizzy and you're having some stomach problems, then that's a little bit more serious. And then as Martin said, you definitely want to consider
00:23:18
Speaker
going to a lower elevation and waiting until you're feeling a little bit better before you attempt going higher. Because if you are ignoring the small warning bells, then big warning bells are really serious, like high altitude cerebral edema.
00:23:34
Speaker
and pulmonary edema, both are life-threatening. And for cerebral edema, that's fluid accumulation in the brain, and that causes potentially fatal neurological dysfunction, and that's extremely serious. So the symptoms for that would be headache, loss of coordination, confusion, hallucination. You could have someone that's a little bit combative. You're trying to help someone, and they're just really angry, really aggressive. Those are really signs to look out for.
00:24:04
Speaker
in yourself, but also in your mountain partners to be really aware and really talk about what you're experiencing on a daily basis and throughout the day. For pulmonary edema, that's when we have fluid accumulating in the lungs. So that means that the oxygen exchange with outside and in your lungs is going to be impaired. So this leads to some
00:24:30
Speaker
respiratory distress, so really difficulty breathing, short breaths, maybe pain in the chest, coughing, pay attention to someone's skin. You might see that they're looking a little bit blue. That's extremely serious and extremely life threatening.
00:24:46
Speaker
So you really want to pay attention to how you're doing, how your partners are doing, and thinking about monitoring your symptoms on a daily basis. So how are you sleeping? How well are you able to eat and stay hydrated? Are you having any GI symptoms? Monitoring your
00:25:04
Speaker
uh the oxygen concentration in your blood so having a having a monitor and sharing that information with your partners and noticing how you are changing day to day and if you are noticing that you are you know getting worse instead of better you need to speak up and you need to really take care of yourself.
00:25:22
Speaker
So it's normal that you're going to feel a decrease in your performance or a decrease in your strength and endurance, particularly in those first few weeks. Totally normal. But honor that. Slow the heck down. Take some rest. But if you're noticing at the higher elevations, definitely you're going to also notice maybe slower reaction times, impaired decision making,
00:25:49
Speaker
And again, notice those things in your partners. Talk about these things before your expedition or your trip as well to talk about these things. Make sure that everyone in the group is on the same page about these symptoms, about the dangers, and how you can potentially help each other. Because you really depend on each other when you're in these types of environments. And so you really need to speak up
00:26:17
Speaker
never think about, I think the biggest mistake that I see people making is like they're afraid to slow others down in the group. But you're going to slow someone down a lot if you need to spend some time in a hyperbaric bag or you worst case scenario need a rescue.
00:26:34
Speaker
this, that's excellent. And I think it really, it just emphasizes the fact that this mountain climbing, you know, honestly, all these sports that we do are so team dependent, and this awareness of yourself of others, and that we have to work together, you know, it is not an individual
00:26:55
Speaker
Endeavor by any means and so just looking out for each other and being really conscientious and I think that's actually another reason why. We emphasize training so much is because you should have a baseline of how your body feels when.
00:27:11
Speaker
you are in your home turf, whether you live in Colorado, whether you live, you know, by the seas that you understand how your body's functioning, you understand some of your basic vitals. And so hopefully you have some awareness, some feelings of like, this is uncomfortable, and then this is like, not good.
00:27:31
Speaker
Yeah, this is dangerous. Yeah, this is dangerous. Yeah, it's gonna say not good. It's a very simple way of putting it but yeah, so just you know, so much of training is really just understanding how your body feels in measurable circumstances and kind of safe circumstances so that you can feel hey, this is really drawing the line between okay and over the top.
00:27:57
Speaker
If I may just add here, I agree 100% with what you just said. I think it really comes with also experience, try to maybe take it as a process if you're aiming to climb high mountain. So reach out, reach out to our team, our lead or the guiding companies that usually have some kind of
00:28:21
Speaker
climbing one for example right to take it from the from some easier mountains and then higher and higher so that you actually are getting that experience in my technical side of things but also yes knowing your body the way it reacts to altitude because this is quite individual as we mentioned already and so
00:28:41
Speaker
people still every year there are reports about accidents about people getting sick and people actually also dying and it's totally avoidable it's really important to.
00:28:57
Speaker
to come humble to these places and to really take this learning and knowing that, you know, uh, it might have worked five times, but the sixth time you might still struggle or, or just, uh, randomly, uh, full six. So you have to go down. So yeah, I think just adding that, uh, um, the humility, the, the, this approach is, is usually better also for, for you in general, for your health. Uh, very, uh, very important.
00:29:24
Speaker
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00:29:48
Speaker
To tee off that, as you said, it's individual and also Chantel, you pointed out a difference with sleeping between men and women at high altitude that can often come up.
Gender Differences in Altitude Effects
00:30:03
Speaker
Altitude
00:30:04
Speaker
has a different effect on a man versus a woman. And so I'd love to hear what you see some of these differences are, why these differences may occur and how a man and a woman should approach going into altitude.
00:30:25
Speaker
Yeah, there are a couple of things that women might experience a little differently than men. On the good side, women tend to not experience the level or degree of sleep apnea that men do. Not to say that women are never going to experience it, but generally speaking, that's an observation.
00:30:43
Speaker
but something that I think both men and women need to be aware of. For women who are premenopausal, they will experience typically a higher hypoxic ventilatory response when they are in the early to mid part of their luteal phase of their menstrual cycle. So we're talking about like post ovulation.
00:31:07
Speaker
And this might sound like a positive thing, but since women already have an elevated breathing rate during this phase of their cycle anyway, it means that this could lead to them having some higher instance of respiratory distress at higher altitudes. So throughout the menstrual cycle, women experience changes in their ventilatory rate, heart rate,
00:31:35
Speaker
and even their body temperature. So these are things to really consider that these things, for women that do experience that normally during their menstrual cycle, know that some of those symptoms may be exacerbated when they are at higher altitudes. So something to be a little bit aware of. They may have to move a little bit more slowly when they're at that phase of their cycle if they are experiencing that.
00:31:57
Speaker
If they've never experienced any breathing issues, they may definitely experience some asthmatic type issues, even if they've never had problems before at their home elevation. When they are postmenopausal, they will have a similar hypoxic ventilatory response, but their cardiac response is going to be a little bit different. So their cardiovascular system's ability to increase
00:32:27
Speaker
output and increased stroke volume may be decreased because of the difference in their hormonal profile at that point in time. So again, that's why I say for everyone, and I think Martin, you've stated that as well. It's always really important to know how does your body really perform normally and being able to recognize when it is performing or behaving abnormally when you're in a new environment.
00:32:55
Speaker
Altitude is obviously one environmental stressor, but you could also at altitude sometimes have compounding environmental stressors as well, right? You could also have altitude and heat. You could have altitude and cold. So it's really important to really always be monitoring how you're feeling, how your body is responding, regardless of whether you're male or female, and regardless of what a hormonal profile your body is experiencing at that time.
00:33:24
Speaker
A secondary effect that we typically see with women is that women carry more body fat. And so women tend to be able to spare carbohydrates when they're at higher altitudes compared to men. So men's bodies will rely more on carbohydrates for fuel.
00:33:41
Speaker
And since women have more body fat, we're better able to burn fat at altitude for energy. But that also means that when we are trying to do work at a higher intensity at altitude, it's harder for women, particularly for premenopausal women who still have estrogen in their bodies, because estrogen triggers the body to spare carbohydrates. And we actually need our bodies to burn carbohydrates for harder efforts.
00:34:09
Speaker
And so that can be kind of hard to perform at a higher intensity task for women. And also for premenopausal women, progesterone naturally increases breathing rates.
00:34:24
Speaker
So depending on where a woman is at in her cycle, if she is in a phase of her menstrual cycle where progesterone levels are on the higher side, so that's post-obulation into that luteal phase, the breathing rates are going to be naturally higher because of the hormones, and then if we
00:34:40
Speaker
compound that with being at higher altitudes and breathing rate being higher from that, we have kind of a double effect. So again, just something to be aware of, of knowing how your body normally responds, how you're feeling, what your effort level is like. It may mean that you need to slow down a little bit and be really careful about pushing your body into a higher intensity and really being mindful of your breathing and your heart rate.
00:35:10
Speaker
So those are some of the main ones, but I think in general, for any person at any phase of their life, male hormones fluctuate throughout life as well. No matter who you are, it's always important to be monitoring your body, monitoring your effort level, monitoring your unique experience. I think that's really critical.
00:35:32
Speaker
Yeah, I would like to add maybe just a couple of points, but great overview from Chantal here. But women have a tendency or a female body has a tendency to hypoventilate in hypoxia, which also relates to exercise in general, not only altitude. And so this definitely becomes an issue in altitude related hypoxia. So your
00:36:00
Speaker
the body has a tendency to basically react slower with that increased rate of breathing. So that's the high book segment, the lottery response. But it's kind of natural, it's related to slightly different physiology in women. Also in general, obviously in very general sense, lung size.
00:36:27
Speaker
is smaller, the absolute volume in women is slightly smaller in general again. So that definitely affects the gas exchange surface and so reduces the capacity. So that might be also one important point in altitude.
00:36:49
Speaker
And maybe just another last point here is for people with heavy menstrual bleeding, there is this risk of iron deficiency, so it's definitely important to
00:37:04
Speaker
Monitor that to do testing in the time before you go to the expedition or to altitude to make sure that you get some supplementation if needed because iron and ferritin are very important in those adaptations specifically.
00:37:23
Speaker
uh the product producing the hemoglobin that's that's uh the particle in your blood that will carry the oxygen around so uh if you're deficient in iron that definitely can affect negatively the the production of their neural blood cells. Martin I think that's a that's a really great uh point and I think something important for all athletes male and female uh when they're preparing to go to altitude or they're doing some type of um
00:37:53
Speaker
pre-acclamation protocol with a tent or some other method for all athletes to in advance have their iron tested, have their ferritin tested to know what are your iron stores so that if there is a deficiency you have time to correct it before you go to altitude and that you get some good medical advice about supplementation potentially when you are out on your expedition or out on your hike or trek or whatever you're doing.
00:38:19
Speaker
Because without your iron stores being in a good place, you will absolutely struggle to acclimate. So that's really low-hanging fruit. So for women, it's particularly important for people who are on vegan and vegetarian diets. They also tend to be lower in iron, so that they may need some supplementation and there are some
00:38:44
Speaker
you know, non-animal sources of iron supplementation that you can take as well. But even for some people it's just maybe something that is normal for them or genetic about their genetic makeup that they
00:39:00
Speaker
tend to store iron a little less. And for some people, they could be on the other end of the spectrum. You could have some people that are just taking iron supplementation because they hear that it's good for altitude. And actually, their bodies now have too much iron. So please don't supplement iron without being tested and without doctor supervision so that you make sure that you are taking the right amount and you are only taking it if you need it.
00:39:30
Speaker
Definitely agree on that. I mean, I'm a huge fan of getting blood panels. Particularly if you're going into hard training cycles or, you know, quite a bit before you're going to do your hard effort to make sure that everything's in a good spot.
00:39:49
Speaker
I did want to touch on one thing Martin you said just to get a definition of the difference between hyperventilation, which I think most people have heard that term before in hypoventilation and you said hypoventilation. So can you tell us the difference between the two?
00:40:06
Speaker
Yeah, so hyperventilation or actually whatever follows that hyper is something increased or a higher rate and then hypo is the lower. So specifically what I mentioned about the hypo ventilation is that in women
00:40:24
Speaker
female physiology for different reasons works in such a way that compared to man that the reaction to actually increase the rate of reading to actually catch up with the lack of oxygen is a bit slower and so related to altitude this can have an effect but just want to say that
00:40:48
Speaker
Reading about this specific topic that the sex differences between men and women in high altitude or in altitude is still non conclusive it's a.
00:40:59
Speaker
First, the studies, the big studies about altitude physiology were just big groups of people. And so now they're trying to actually say, okay, are there these differences? And so I think it's a really good discussion of what we're doing here and trying to really
00:41:18
Speaker
talk about these topics that we already know that can help you out there to actually make your decisions. But back to your question, hyperventilation is definitely one of those first adaptations when you come to hypoxia, when you come to altitude.
00:41:44
Speaker
It's actually then related to the sleep apnea so that i mentioned before so that's actually related in a way that you read and more. Air and oxygen so that's what you want that's what the body wants that's why it's gonna automatically automatically happening in voluntarily not automatically so but what it also causes that we breathe out more.
00:42:07
Speaker
What we breathe out is the carbon dioxide and that actually offsets the balance in our bodies and the brain also has the sensors for the carbon dioxide not only just oxygen and so the brain sees that or senses there's a.
00:42:24
Speaker
like lower levels of carbon dioxide and so basically stops breathing for seconds or you know it's until the point where it's actually apnea so basically breathe stops for 10 seconds even even longer sometimes and then you start to suffocate so then there's this huge loud inhale and usually people experience this during the sleep time so that's why it's called sleep apnea and
00:42:53
Speaker
And it's not very nice, it's not a very nice feeling. I experienced it myself, just one factor on a Mada Blanc last November. And it's just so annoying. It's just so annoying. The whole night I was just basically falling asleep and woke up myself because I was not breathing. And you cannot do anything about it. It's all out of your control. And yeah, so basically spent the whole night doing this.
00:43:24
Speaker
It's just the first stage of acclimatization. That's a good thing, usually. But I think for most people, you acclimatize better and so within days this disappears, this very annoying symptom. That does sound incredibly frustrating.
00:43:43
Speaker
I actually, and please jump in on this, would assume that just based off of historical numbers of men and women that are going into high to extreme altitude, that probably a lot of the studies are just naturally geared towards men because there just weren't women who were doing it and so able to participate in the studies. Is that a correct assumption?
00:44:11
Speaker
Yes, and also the propensity for a lot of scientific studies to think like, well, women have menstrual cycles and so they're, quote unquote, more complicated to study. So we'll just study it in men, you know, and then we'll just extrapolate for women. So that I think that sense in science is now changing to realize that there are more, you know, and we have we have a lot more female athletes that are challenging themselves in different ways and we have more
00:44:39
Speaker
female researchers and even male researchers who recognize the importance of studying both sexes to understand this better, to give better recommendations. So thankfully that's changing, but we still have, if you think about general population of people who are going to these more extreme environments, we're still an odd little funny group of people, right? It's still a small group.
00:45:05
Speaker
Yeah. So let's jump to, it's our first episode. Let's just get this out of the way. But what are a few common myths that you see around altitude experiences and you just want to be like, let's get that right out of the way.
Misconceptions and Risks in Acclimatization
00:45:21
Speaker
Martin, if you want to lead off. Yeah, I can start here. So I was, yeah, what I what I see are
00:45:29
Speaker
repetitively like one with my coaching work but also with my direct experience in the mountains is that really people still don't respect the acclimatization process enough and as I mentioned before, even these years, these seasons, there are accidents that are easily avoidable if people really follow
00:45:54
Speaker
Follow that process if they inform themselves or just reach out. Again, the acclimatization takes time. Adapting to altitude takes time. We can adapt. It's individual, so everybody reacts slightly differently.
00:46:14
Speaker
It's definitely important. I think what I've seen a lot is that the fit people, maybe young people in that category, think that they'll be fine. They'll be better off. But it's actually not really correlated. It's the fitness level. And then being able to tolerate altitude is not actually that correlated. Definitely helps.
00:46:44
Speaker
I've seen people collapse or just faint at high altitude here, being working on a guilty medic. You could really clearly see that they were young, they were ready to climb, so they were geared up once. But at the same time, there were people around that were just clearly not very sporty, and they were totally fine. So there is something about it. So also knowing that from Nepal and other big ranges that
00:47:12
Speaker
people just go and just go directly to the base camp and actually die the next day. They just completely ignore the process to really stage it, to go step by step and go directly to 5,000 meters and higher and it goes terribly wrong. I would say just related to this, I would encourage people to do the research when they plan the trips to these mountains to
00:47:39
Speaker
uh really um if specifically if you haven't have had some experiences in those mountains uh because there is a tendency for some companies to organize these trips uh in a very short time so people already are asked to or just basically the plan is to climb the mountain within like one week one week time which is which is
00:48:04
Speaker
Totally short for people before mountains that are about five thousand meters or six thousand meters so for some of them it works out pretty well but i just like to tell my clients specifically that if you climb the mountain without preparation in seven eight days you leaving and yours your body is actually still acclimatized and you already climbed it you go lucky but that,
00:48:29
Speaker
It might have gone wrong, you might have gone sick and also you probably didn't enjoy it as much because you just kind of suffered through it. So I encourage them to take their time and actually respect the timeline of those adaptations and actually enjoy it. I would say that would be something I experienced quite often.
00:48:52
Speaker
Yeah, I think that that is, that really goes to the idea that just because you get away with something doesn't mean you should have done it. And I think unfortunately that happens a lot in the mountains where it's like, Oh, I got away with it this time or like, well, I did it. And it's like, well, you might've gotten just really lucky that one time. And that's probably not going to, uh, be a, um,
00:49:19
Speaker
something you should hang your hat on all the time or the basis of your your future endeavors. Chantel, what are what are some of your favorite altitude myth debunks? Yeah, I think the Martin you touched on one of my favorites is people thinking that their fitness is going to protect them. I think sometimes you have these like really fit people are often working pretty hard in their training. And they're maybe not giving themselves enough time to
00:49:50
Speaker
rest and recover before they travel. So they're training really hard and then they get on a plane or they try to do something without being very well rested. And so they are going to struggle to acclimate maybe their body is depleted in some way. It could be iron stores, for example. It could be that they're just fatigued and so the body cannot adapt well. So it's important to
00:50:19
Speaker
You know, really manage your health, take care of your health, make sure that you're healthy before you go. And there's no magic pill. So your fitness, certainly being fit and being well prepared is definitely an advantage. But you still need to respect your body and respect the mountain and listen to your body as you're going through the process.
00:50:44
Speaker
Some people also tend to think that they've been to altitude plenty of times before or they've climbed a mountain with a specific aggressive ascent rate and gotten away with it before. And so they think that it's always going to happen. Definitely not. There's no guarantee. I had an athlete who had a super scary experience who had been to altitude multiple times, been to quite high altitude multiple times.
00:51:11
Speaker
never experienced any issues. And then one summer he was planning to race in Leadville. So that's, you know, spending a significant amount of time around 10,000 feet. But he'd been to that level of elevation before multiple times and even higher, never had any problems. And he ended up being helicopter off the mountain because he had haste, never had any kind of problem before. So
00:51:36
Speaker
Again, just can't say this enough to really listen to your body, pay attention to how you're feeling, take care of yourself well, and speak up if something that before it's too late. And maybe another one, this is a little silly one, that you cannot have caffeine at higher elevations. That's, I think, a common one that people say. It's not that you have to avoid caffeine, but don't
00:52:04
Speaker
you know, don't overdo it. If you're someone that's used to drinking caffeine quite regularly, you might actually get a headache from removing caffeine. So if you're planning to, you know, avoid caffeine on your trip or your expedition, then do the caffeine detox before you go to the mountain. Don't do it on the mountain. Then, you know, that wouldn't be good for you.
00:52:31
Speaker
And another one is sometimes people looking for the magic pill. And so for some people, they may think that taking dimox is kind of a cure-all, and it's gonna help them avoid altitude sickness, or it's gonna help them ascend more rapidly, and it's gonna avoid any kind of problem, right? It's kind of a magic bullet. And the truth is, there's no magic bullet. Dimox is certainly helpful for certain people under very specific circumstances,
00:53:00
Speaker
but it's not something that everyone needs to take or that someone should just blanket take. Learn about it. Learn what it does to your body. Learn how it helps. Learn how it may hinder and make the right decision for yourself. We are not doctors, but there are really wonderful doctors out there that can give you really good information. The truth is there's no
00:53:21
Speaker
There's no magic bullet. There's no guarantee. The mountain always decides. And we have to do the best job we can of taking care of ourselves, monitoring our own symptoms, and doing the best job that we can to follow
00:53:38
Speaker
a good ascent protocol that's going to keep us safe and keep us healthy so that we can continue. The goal is always to get back down the mountain, right? Whether you summit or not or whether you finish the race or not, the goal is always to make it back down the mountain safely, healthy, back to your loved ones. So always keep that in mind. Absolutely. I like to say the summit is the parking lot when you're back down.
00:54:08
Speaker
I would like to add maybe one more, because obviously we are talking about different levels of altitude again, but maybe related to the high and extreme altitudes. So for those who don't know or are not aware of, there are ways to acclimatize also at home, once you're at home.
00:54:32
Speaker
Just for you to know that it's all this that we just talked about, about the sicknesses, illnesses and how it's risky. Definitely it needed to be mentioned, but then for some people it's just impossible to leave.
00:54:48
Speaker
to leave for a long period of time, let's say for several weeks for when it comes to these high-mounted. So nowadays there are systems available that you can actually use at home, so hypoxic tents or hypoxic chambers. Those are actually becoming more available in the cities, like in the commercial gyms, but mainly it is about the
00:55:10
Speaker
hypoxic then so you can actually pre acclimatize before you go to the mountains so you can still stay at home with your families, living at sea level, keep working, having your business and then pre acclimatize to the really good level before you leave and actually do even reduced time on those expeditions because I mean Everest takes usually eight weeks until eight weeks.
00:55:37
Speaker
to actually completely acclimatize to the base camp and then do the climb. So it's really, it's a long time for most people to leave the job and the family. So by using these systems, you can definitely make it possible. And so just another myth that I think we can confirm it works. We at Appellate we've been using these methods and so reach out if you want to know more.
00:56:07
Speaker
That's great. So this is just, I mean, gosh, what a great start. I feel like we really covered a lot of amazing information and I'm super stoked to see where we go from here. Is there anything else you two would like to add before we wrap up our intro to Altitude?
00:56:28
Speaker
Um, I think we covered a lot of good stuff. And Martin, you touched on an important, uh, piece as well, that there are ways that people can, uh, pre acclimate before their trip or before their acclimate before, and we'll, we'll have some, uh, great future episodes on the specifics of, of what that looks like, what some of those methods
Next Episode Preview: Nutritional Preparation
00:56:48
Speaker
are. Uh, I think, you know, those, uh, the ability to purchase or rent, uh, one of these hypoxic tent systems is becoming, uh, much more affordable or
00:56:58
Speaker
even some gyms, gyms and other facilities where there are actually rooms, climate controlled rooms where people can train, which is also pretty cool. There's also the ability to do, there's sometimes people do like a poor man's pre-acclamation where they will do like a heat train protocol, which helps them to improve or increase red blood muscle mass.
00:57:25
Speaker
But I think aside from those things, other things like basic stuff people should pay attention to is your general health really matters. Your iron fair and iron stores and other important blood values to make sure that you're healthy before you are putting your body in a really stressful situation physiologically. We also touched on the importance of getting proper rest.
00:57:50
Speaker
staying hydrated, eating more carbohydrates. So for those people out there that are following high protein, high fat diets, and avoiding carbohydrates, don't do that and then go to your expedition and then find that in the base camp everything they're providing is high carbohydrate foods. That's not going to be good for your
00:58:12
Speaker
your body, so make sure that you are also following a well-balanced diet because carbohydrate consumption is really important at higher altitudes. Other things you can do is, you know, avoiding alcohol. Obviously, that's going to be an additional stress when you're at higher altitudes. Respect the mountain. Respect the the the ascension rate that works for your body.
00:58:38
Speaker
and listen to your body most importantly. Listen to your body. Listen to what's happening and pay attention to those things already now in training. Know what's normal for you. Know what feels normal for you. Know what is a normal, what does your breath sound like when you are working really comfortably and sustainably and know what your breath sounds like when you're working really hard and unsustainably.
00:59:03
Speaker
Because when you're going even if you're training now with your your watch and your heart rate strap and all that stuff your Quote-unquote normal heart rates where you live are not going to be the same as they are going to be at 14,000 feet or above 4,000 meters, right? That's obviously it's gonna be different but you're still gonna know like what it feels like what it sounds like and
00:59:26
Speaker
that's going to be something that's consistent. So start paying attention to those things. And really, you know, we, as athletes, I think we work really hard for a good chunk of our lives to ignore those signals. Um, and so I think a lot of what we do as coaches is helping our bodies, our, our athletes to learn to actually listen and actually pay attention and learn what, what your body's trying to tell you before it shuts you down.
00:59:54
Speaker
I agree. I think it's as Chantal said, it's just learn, just listen to the mountain, listen to yourself, your body. And I think for most people, they can realize they go up there for some kind of physical challenge, but it's definitely a big mental challenge and sort of some kind of spiritual as well, a lot of self discovery there. But I think it's not only about the summit, maybe a bit of a different
01:00:23
Speaker
Different topic here, but it's not only about that. It's really what you put into it, how much effort, but in a way that is not putting you and your life and your health at risk. Definitely, if you listen to this, you probably have a better idea now what to look out for.
01:00:47
Speaker
I think a great point you can tell about the heart rate. I like to tell my clients that
01:00:54
Speaker
to work with RBE already during those weeks and months before the expedition, because when you come to the high altitudes, the hardware doesn't make much sense, and so the zones will not make sense, as you know, so if you're only relying on that, you will run into trouble. You will probably either push yourself too hard or too little, but I think it's mostly pushing too hard.
01:01:18
Speaker
so knowing yourself already working with the rb so rate of perceived exertion so really knowing yourself you just obviously you can keep using the watch but i really use it for knowing the time how long i've been going and the elevation the altitude diameter the elevation speed but the heart rate is really i am not really watching that at all so this is really important point and to learn throughout the process of training
01:01:50
Speaker
But otherwise, I think, how did you decide to go back? I mean, we could just keep going for an hour or two, but let's see something. We will be, Martin. We will be. We will be, yeah. No, it's been amazing.
01:02:07
Speaker
I love having both of you on and actually, uh, again, you, you both just teed up everything so perfectly because Chantel, our next episode is, um, bringing our dietician, Alisa Lieb on to talk about nutrition at, um, altitude and considerations, um, in the carbohydrate element and also just saying like, Hey, get used to the food that you're going to eat on the mountain, um, and in base camp.
01:02:35
Speaker
because that will be a huge shock to the system is a great primer for that. So yeah, thank you both for being on. As you can see, we have a wealth of knowledge at uphill athletes. So if you want to talk to Chantel or Martin and learn more from them, you can visit uphillathlete.com to chat with them through phone consults.
01:02:59
Speaker
etc. Also, there are presentations about altitude in our level three memberships. I've had the privilege of seeing these presentations and they are
01:03:11
Speaker
top-notch really helpful to learn more about this. So thank you both very much and thank you for listening to the uphill athlete podcast. If you could rate, review, and subscribe on your favorite podcast platform, that really helps us to help more people do their best and be safe in altitude situations. It's not just one, but a community. We are uphill athlete.