Nutrition Considerations for Altitude

00:00.96
Alyssa C
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 are continuing on our educational series around altitude. Our second episode focused on nutrition I am joined today by our RD Alyssa Leib who will help us learn about nutrition considerations at altitude. Thanks for being here.

00:29.90
Alyssa L
Thanks Alyssa 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.

00:40.23
Alyssa C
Ah no I feel like least and I’ve talked about this on the side but it has just been the winter of cold and sickness after another. Oh I’m sorry when.

00:51.35
Alyssa L
Yeah, it’s never ending very excited for spring.

00:57.35
Alyssa C
Yeah, we can get outside and well I mean we’re already here outside. That’s not fair. We do brave the colder weather. Ah well yeah, a couple weeks ago I barely had a voice. So yeah I feel your feel your pain.

01:12.89
Alyssa L
I Know you’ve done a few podcast lost episodes where your voice has been a little off so it shouldn’t be anything new for our listeners.

01:21.65
Alyssa C
Yeah, just ah, changing it up on you all you think you know who we are by our voices but you never know so as we dive into this. Let’s start off with just maybe not a fun story but ah do you have any specific experience at altitude.

01:39.70
Alyssa C
With nutrition that was particularly memorable or unexpected.

01:45.20
Alyssa L
I actually do it was both unexpected and very memorable. I just as some background I’ve been lucky enough to not really have many altitude issues up to about fourteen Thousand feet or around four thousand meters but I had the very unfortunate experience of getting food poisoning at the high camp on Mount Kilimanjaro in 18 the night before our summit push, 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 Killi is not at all technical. And we had a very small amount of snow but it was basically just hiking and it took about 6 hours to hike the five kilometers and about 4000 vertical feet to the smit 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. So number one food safety is really important, especially when you’re at altitude climbing a mountain on an expedition.

02:59.28
Alyssa L
And then the second piece is just the role that adequate fueling and hydration can play in performance, and this is especially true at altitude.

03:09.71
Alyssa C
Ah, well I’m sorry that happened to you. Ah, that’s not fun, 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 like ah you know it’s part of a bigger group or like I’ll just you know have this and, 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. Any specifics and I am probably pretty similar that I handle an altitude decently well which very much irks. My husband who has a little bit more trouble with it, but.

03:56.97
Alyssa L
Quick with it.

04:02.68
Alyssa C
Yeah, I would just say I think the best the best thing I’ve ever eaten is like a freeze dried blueberry cobbler meal at Muir Camp ah 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 and we’re going to again get into this is I’m just always surprised by 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 years ago and I was like oh my gosh. That’s amazing, that makes so much sense. But it’s always surprising.

04:49.61
Alyssa L
Yeah, you are 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.

05:00.83
Alyssa C
Definitely and unfortunately sometimes what we think will absolutely work doesn’t always work when you start getting into higher situations. But let’s ah, let’s get into it so there’s quiet. Different levels of altitude as we talked about in our first episode kind of ranging from moderate to our extreme altitudes of Eight thousand meters or so what are some considerations athletes should take as we increase altitude and how do our needs change with. Those increases.

05:35.10
Alyssa L
Absolutely so. There are a lot of physiological changes going on as we move up in altitude that can both affect nutrition or that you know we need to modify our nutrition in order to take into consideration. So, the first one a list 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 four thousand meters is going to have a different metabolic increase than someone who maybe lives at five Thousand feet and then climbs up to six thousand meters but in general the higher you go the more calories you will need to eat to maintain your body mass, and here, 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, 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.

06:57.54
Alyssa L
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 with those increasing. We also see higher carbohydrate Metabolism, and of course anyone who has ever talked to me knows that I really prioritize carbs for all of my athletes, but this is even more important at altitude the next kind of main physiological change relates to hydration. So. 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. Also find out 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. 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 important another piece that I want to mention is Iron Status. So, this becomes especially important at altitude because of Iron’s role in Oxygen transport.

08:24.12
Alyssa L
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 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. 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 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 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.

09:56.11
Alyssa L
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, so when we go to high altitude. That level of oxidative stress increases which means we need more antioxidants in order to combat that 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.

10:32.72
Alyssa L
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. 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.

11:19.90
Alyssa C
Oh, that’s an amazing run-through and I think it helps to 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 kind of is normal. Expectations of like yes this is more challenging on the body, and what’s going into the like this is problematic territory, so that’s really helpful of like yeah things are going to happen. It’s I mean in many ways kind of similar to what happens in an ultramarathon is like your stomach is. Receiving less blood flow and attention than normal. So not that you can’t, 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?? 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 the nutrition is working with a coach is like that’s what we’re doing is coming up with these plans and strategies to help.

12:41.34
Alyssa L
Absolutely yeah and I think, you know similar to your analogy about running an ultramarathon. 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. And so that that is where something yeah 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.

13:17.37
Alyssa C
Yeah, it’s why I am man my 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 ah 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 4 hours like X y and z happens then I can combat that versus when I go for the 8-hour summit push and I’m standing at the top of a mountain going. Uh-oh I feel terrible x y and z happened and I have no way to combat that. That’s why I’m always like no we do these long runs not just because I love to torture you know anything like that’s like it’s because we have to know how our body reacts and we have to practice with tool. Yeah, with like actually being able to see how our body reacts.

14:22.62
Alyssa L
Absolutely good. Good solid freak keeping advice from Alyssa there don’t skip a long run., no and I and I know we’re going to get into it a little bit more just around kind of pieces of advice and things to be doing.

14:24.30
Alyssa C
Yes, don’t skip. Don’t skip your long run. Ah.

14:40.85
Alyssa L
You know that’s why I always encourage, especially if you’ve never been to. You know super high altitudes before if you have a trip planned get up as high as you can in some sort of shakedown. You know, 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 you know, fumbling with it on summit day and everything is going wrong.

15:09.39
Alyssa C
Totally. So 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.

15:34.41
Alyssa L
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 you know, 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., you know it’s hard to 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. 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 3 to six months, 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.

17:05.50
Alyssa L
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 a 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. Oh, that’s kind of my piece of advice there.

17:35.30
Alyssa C
Yes, that’s what I was giving you all can’t see this I was giving a first app because yes blindly supplementing especially iron. There are stories out there actually of women.

17:52.66
Alyssa C
Runners who had too much iron and it caused massive issues, so you really had, 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 way though doesn’t it that like if you have too much Iron. You can actually feel almost similar. Symptoms to too low of iron.

18:12.78
Alyssa L
I can think the bigger issue is that symptoms of an iron deficiency are pretty general right? It’s a lot of fatigue I’m just feeling really run down and.

18:23.38
Alyssa C
That’s a good point. Yeah.

18:27.86
Alyssa L
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, you know, 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.

18:55.89
Alyssa C
No, that’s really helpful and I think another piece of this is remembering that we are not the general population. Like your point of saying that yes it may be within a normal range, but you might be.

19:13.58
Alyssa C
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 person. Jane or Joe or whatever. No offense to the janes 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 the specifics and demands of what you do.

20:03.79
Alyssa L
And 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? yeah.

20:25.88
Alyssa C
Definitely so yeah, any further tips that you have.

20:31.56
Alyssa L
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. 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. You know, 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, kind of related to this I know a lot of uphill athletes do hypoxic training or sleep with altitude masks, and if you if this is you excuse me.

21:36.51
Alyssa C
Weird.

21:37.84
Alyssa L
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 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 on your trip at Altitude underweight.

22:12.72
Alyssa L
That you know certainly is not a good starting point and then go ahead.

22:17.18
Alyssa C
No, I was going to say I have I don’t know how I feel about this but have there been situations where it can actually be positive to go in plus a bit of weight or do you find that that kind of like the benefits don’t outweigh. The potential risks or detriments.

22:41.24
Alyssa L
Yeah, that’s a great question I think it’s going to be very individualized, so 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 see the differences or see the effects of substantial weight loss? You know if you’re.

22:47.86
Alyssa C
Totally.

22:58.69
Alyssa L
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 into is just sort of the practicality of actually putting on additional weight prior. So, for some people you know, especially people who have a crazy high vole of training eating enough to build muscle mass that can be a challenge on its own, you know 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 place where that athlete is around food and around changes in body weight. for some people it. It would not be appropriate to try to have them. You know, intentionally trying to alter their body size. So, it really would be totally individualized. I definitely think that there are situations where, 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.

24:06.31
Alyssa C
Nice yeah, that makes total sense. The first thought was oh 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 adding that element in.

24:24.70
Alyssa L
Absolutely.

24:24.49
Alyssa C
Could be tough. I think your last bit is something we were kind of harping on but ah, practicing How does that come into play.

24:38.00
Alyssa L
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 just practicing your fueling and hydration strategy. However, you can So you know there are a lot of things that we don’t really know about me. 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 and 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.

25:15.15
Alyssa L
To just really have your systems dialed and I think you know 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.

25:33.38
Alyssa C
Absolutely. 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 training practices.

25:45.40
Alyssa L
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 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 I get above a certain altitude. You know this certain type of food doesn’t work for me and you know, and I have to kind of go with that right? because everybody knows their body. Best, you know where they are 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 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 not wanting to eat the foods. You’ve packed to sort of add on to that right? We already are facing so many challenges both physiologically and then just from a mental psychological perspective when we’re traveling at high altitudes.

27:13.47
Alyssa L
We want to make it as easy as we possibly can for ourselves, so that means training and practicing 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 if I’m at seven thousand meters and it freezes, how do I make that work so really practicing that strategy of okay I’m going to keep it in an inside pocket close to my body and have 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 long way, and then I think that that.

27:52.84
Alyssa C
Oh.

28:07.20
Alyssa L
Other kind of pieces are just really focused on that sort of general nutrition making sure that you’re meeting your needs in training like we talked about so that you’re not showing up in Nepal and your carbohydrate stores are depleted. You know you’re already underweight because you weren’t able to keep up with your training so just really make 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 you. 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, 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 important.

29:09.73
Alyssa C
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, make sure you bring your water bottle and maybe 3 if you can 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 kind of the unknowns’ of these expeditions? From nutrition lines.

29:49.23
Alyssa L
Yeah, I think the first piece is do everything you can to reduce the number of unknowns, 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 bring? What are you going to provide? What are some examples of the meals that you’re going to provide? 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., you 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 about things like weight loss if you’re going out for like a 3-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 are a lot more important to make sure you have dialed on longer trips.

31:15.81
Alyssa L
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. So just really make sure you’re on top of these kinds of general nutritional aspects. Thinking about the foreign country’s perspective of things given my experience on Killy food safety is 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 pure water purification devices are going to be better or less. Good in different locations, 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 make sure that the water that you’re drinking is safe and isn’t going to make you sick, of course there are.

32:35.16
Alyssa L
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 and Katmandu 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 a really smart guideline 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.

33:13.38
Alyssa L
On kind of another note with that if you are planning to bring food into the country on your own and this is this is a lot of you know logistical 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. Its factory sealed. Ah so what? That means your mountain house is probably going to be allowed. 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. 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 20 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, they had a supermarket but you know 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 1 store in town that sold peanut butter, it was.

34:39.79
Alyssa L
Organic vegan store which was fun and that jar of peanut butter cost me $14 and it was in a glass jar so doing that kind of research and just making sure that whatever you’re planning on buying is something that you can actually find.

34:53.35
Alyssa C
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 play it on this and then you get there and you’re like oh 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 that I I’m so glad you touched on the water piece because something I learned we lived over. Ah, in Italy for a couple of years and 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 every month just a quick Google of like can you drink. Out of the tap in country and obviously 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 real 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, you know the same level of water drinkability, publicly available is really key and I think honestly an easy one to miss. Especially if your kind of like ah well everywhere in Europe is probably fine to drink like probably but just do a quick check just make sure, so yeah, I think that’s an excellent point. Yeah.

36:38.70
Alyssa L
I think that’s yeah, that’s a really good addition there and I think I’ll even add to that that 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 I’m doing that.

36:46.29
Alyssa C
That too yes.

36:53.50
Alyssa L
Extra research is really smart.

36:54.25
Alyssa C
Yeah, I mean that was really interesting. We lived over in Naples and I love Naples. But 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.
37:32.52
Alyssa C
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 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.

38:00.88
Alyssa L
Yeah, it’s always so Interesting, because yeah, you’re 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.

38:21.24
Alyssa C
Yeah, no, it really isn’t and also Aqua frizzante in Italy is just 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 aqua con gas, but all right. So, say you have an athlete that’s going on a guided trip, and they are getting food provided for them. How do you help athletes to kind of manage that aspect of the trip?
38:55.48
Alyssa L
Yeah, so like I kind of briefly mentioned, just doing everything you can to reduce uncertainty, so like you mentioned you know 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 are 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? 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 you know they’ll be able to provide oh well, the guide says you know we’ll probably be walking for. 6 hours on this day. But if you can really get that dial down figure out your miles your elevation gains 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.

40:11.93
Alyssa L
Really being sure about okay I know that we’re going to be out for 8 hours today we’re probably going to cover fifteen miles it’s got four thousand vertical feet of gain that means that I need to eat about x amount of food and they’re going to provide 2 meals for us. So, while we’re on the trip I need to bring however many snacks. I also just related to this usually recommend bringing more food than you expect to need as a Justin 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 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. 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 while fantastic I love carbs, I love rice and potatoes. But 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.

41:43.57
Alyssa L
Or even in this case just having a protein supplement would be beneficial 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.

41:53.24
Alyssa C
Oh yeah, that’s tough and also, I’m curious like how because food like it is in it is like ah it’s such an interesting thing because it’s like it is a necessary thing for survival. But also, that to me says like. I would be so unsatisfied if that was my dirt like I would be I would be sad if I sat down to a meal and I had rice and potatoes and everyone else had like a nice meal at the end of a really hard long day. So, like how you do how factor in like the satisfaction and like happiness element of food. When you’re thinking about this too.

42:35.24
Alyssa L
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 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, which doesn’t necessarily make it. Okay, but you know I would say in that case, bring 1 thing a little treat, you know whether it’s brought a bar of chocolate and so you can have a couple of.

42:53.78
Alyssa C
Yeah.

43:07.30
Alyssa L
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 have something there that that is that does provide that satisfaction Factor and hopefully just through. Again, communicating with your guide company ahead of time you can kind of minimize that or at least you now have a better understanding of how often things like that are going to happen so that you can bring an alternative.

43:38.67
Alyssa C
Yeah, definitely and actually I’ve looked into some guiding companies before actually was, I think a couple of very near ones and was honestly really impressed by how specific they were listing out what they had and kind of their meal plans where it was like three nature valley bars, 2 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, I really need to be and I think.

44:18.57
Alyssa C
That that just yeah, so hopeful in planning and also from a coaching perspective. It’s really helpful to know what your days are going to look like, so I was like yes, I am right behind that of like I also want that information.

44:31.43
Alyssa L
And yes, it is. It’s so important to find and I’m always shocked by a lot of these guided treks. How little how hard it is to find that information, you know I know like 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. And you know and I’ve got 8 tabs open trying to figure out okay 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.

45:04.63
Alyssa C
Yeah, no, well hopefully we can continue to champion the transparency of food options for the expeditions. So, one of the last things that Alyssa has written out.

45:23.20
Alyssa C
Beautiful notes and I am super curious to hear more about supplements, as you have quite a bit of really interesting information about that. So, what about supplements?

45:38.60
Alyssa L
Yeah, so I thought that this was important to bring up because this is a question that I get asked a lot, and there are a lot of you know if you Google altitude supplements. There’s like a million things that come up. and a lot of them if you read the labels there. Very, let’s go with interesting but yeah, I did want to talk about 2 supplements in particular that I think are probably better researched than most of the other kind of random things out there.

45:59.40
Alyssa C
That’s a nice way of putting it.

46:12.83
Alyssa L
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. Basically nitrate is produced by our bodies. But it’s also something we can consume through diet. The main food source that we hear about is beets or beet root, beet Root juice. 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, but it makes sense that if your blood is moving faster and it’s moving more effortlessly because you’re. Your veins have literally just gotten bigger but you have that same blood vole 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.

47:34.69
Alyssa L
In the research we find there maybe is a little bit of support here. So 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 you know people who live at higher altitudes in Nepal or Tibet tend to have higher levels of nitric oxide in their blood. Then 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 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 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 Gingko Balboa.

48:50.99
Alyssa C
I Just love the name so much.

48:51.85
Alyssa L
Which is an herbal supplement. 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 gingko. It’s like gink.

49:08.32
Alyssa C
So I would assess, and I could be wrong. So I grew up with a ginkgo tree in my yard and I would assess that it comes from that tree of some kind of yeah element of it. They have the coolest leaves.

49:10.15
Alyssa L
Well.

49:22.39
Alyssa L
I don’t actually know I don’t actually know the answer to that but I would asse it’s got to be related somehow. But yeah, so the herb is pretty commonly used for its antioxidant properties.

49:24.67
Alyssa C
They really do. Yeah, that that would be my guess. Yeah.

49:40.14
Alyssa L
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, 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. You know the research was much more observational. It was you know we had a group of people who were climbing 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 of Gingo Balbo 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.

51:06.63
Alyssa L
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 is that they found that there was no significant difference in Acute Mountain sickness. Sickness risk or severity, between people who took the supplement and people who didn’t 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.
51:39.18
Alyssa L
But don’t expect that’s going to make you acclimatized like a pro and not run into any potential downsides.

51:50.84
Alyssa C
Ah, yeah, 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 Alyssa any last things you’d like to touch on as we wrap on nutrition and altitude obviously not a wrap but for this episode.

52:23.10
Alyssa L
Yeah, you know I think I’ll just sort of leave everyone with 2 sort of 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 ah 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 just dial in your strategy and make sure that you’re fueling consistently throughout training is going to make things a lot easier when smit day come 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 you know your first time going up to a high altitude. Whether it’s talking with a mentor or working with a coach or a dietician, just to make sure that you are confident and have a plan going into your trip, you know you don’t have to. Figure everything out on your own so seek help.

53:36.27
Alyssa C
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 seventy or eighty of an ultra or you know hour 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 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 going to do and this is worth it, 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 the bigger. Not bigger but like 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.

55:07.31
Alyssa C
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 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 3 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. Someone like for the mental ah piece like a psychologist or a sports psych. 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.

55:52.71
Alyssa L
And yeah, that that was really beautiful. Couldn’t have said that better myself.

55:58.33
Alyssa C
Oh 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 going to do nutrition kind of as our main season. So I’m very excited about that. It’ll be great so you can or Alyssa actually can you tell people how they can work with you at uphill athlete.
56:29.74
Alyssa L
Yeah, absolutely so there are 2 options. The first is through nutrition consultations, so this would be basically we would a set 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, typically we don’t use them to go to do a super deep dive into your background I’m not going to you know, 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. 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 2 weeks so we’d meet twice each month. 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 really just set specific action items for each session and then you go off into the world and you practice them and you.

57:57.25
Alyssa L
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 and you don’t want to wait another week and a half for next session we can make sure that you get that answered sooner rather than later.

58:17.53
Alyssa C
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. It’s not just one but a community we are uphill athlete.