Nutrition and Altitude: Strategies to Enhance Adaptation, Improve Performance and Maintain Health: A Narrative Review

Abstract

Training at low to moderate altitudes (~ 1600-2400 m) is a common approach used by endurance athletes to provide a distinctive environmental stressor to augment training stimulus in the anticipation of increasing subsequent altitude-and sealevel-based performance. Despite some scientific progress being made on the impact of various nutrition-related changes in physiology and associated interventions at mountaineering altitudes (> 3000 m), the impact of nutrition and/or supplements on further optimization of these hypoxic adaptations at low-moderate altitudes is only an emerging topic. Within this narrative review we have highlighted six major themes involving nutrition: altered energy availability, iron, carbohydrate, hydration, antioxidant requirements and various performance supplements. Of these issues, emerging data suggest that particular attention be given to the potential risk for poor energy availability and increased iron requirements at the altitudes typical of elite athlete training (~ 1600-2400 m) to interfere with optimal adaptations. Furthermore, the safest way to address the possible increase in oxidative stress associated with altitude exposure is via the consumption of antioxidant-rich foods rather than high-dose antioxidant supplements. Meanwhile, many other important questions regarding nutrition and altitude training remain to be answered. At the elite level of sport where the differences between winning and losing are incredibly small, the strategic use of nutritional interventions to enhance the adaptations to altitude training provides an important consideration in the search for optimal performance.

Dietary Adjustments to Altitude Training in Elite Endurance Athletes; Impact of a Randomized Clinical Trial With Antioxidant-Rich Foods

“…Training in hypoxia elevates oxidative stress in blood (Dosek et al, 2007 ; Pialoux et al, 2009 ) and potentially also alters substrate utilization during exercise (Griffiths et al, 2019 ; Young et al, 2019 ). Accordingly, this environmental stress will also modify the dietary needs of the athletes which seem to require certain dietary adjustments for optimal hypoxic adaptations (Stellingwerff et al, 2019 ).…”

“…Current dietary recommendations for athletes at altitude cover several nutritional aspects (Maughan and Burke, 2012 ; Stellingwerff et al, 2014 , 2019 ; Michalczyk et al, 2016 ). Emerging evidence shows that adequate energy availability prior to training at altitude is a perquisite for optimal hbmass increase (Heikura et al, 2018 ).…”

“…Sudden increase in training load and/or training intensity together with altitude exposure increases oxidative stress and circulating inflammatory biomarkers (Lewis et al, 2015 ; Debevec et al, 2017 ; Koivisto et al, 2019 ). Accordingly, larger intake of antioxidants has been recommended (Michalczyk et al, 2016 ; Koivisto et al, 2019 ; Stellingwerff et al, 2019 ). However, because high-dose antioxidant supplementation has shown to have negative effects on training adaptation (Merry and Ristow, 2016 ), possibly due to interruption of normal ROS signaling (Merry and Ristow, 2016 ), plant-based foods is the recommended antioxidant source (Maughan and Burke, 2012 ).…”

Influence of Dietary Nitrate Supplementation on High-Intensity Intermittent Running Performance at Different Doses of Normobaric Hypoxia in Endurance-Trained Males

“…Heretofore, laboratory studies reporting improved performance following NO 3 − supplementation in normobaric hypoxia have administered gas mixtures with a fraction of inspired oxygen (FIO 2 ) equivalent to moderate-to-high altitude (≥2,500 m). However, it is well known that most athletes complete training sessions while at terrestrial altitude training camps at a low-to-moderate altitude (<2,500 m) and that further research is required to assess the ergogenic potential of different dietary interventions at such altitudes (Stellingwerff et al, 2019). Therefore, the potential translation of findings from laboratory studies assessing the effect of NO 3 − supplementation on performance in hypoxia to performance at altitude training camps is unclear, particularly for highintensity intermittent exercise performance which has received comparatively little attention.…”

Sports Nutrition for Optimal Athletic Performance and Health: Old, New and Future Perspectives

“…The paper on nutrition and health at altitude [6] has been written by several scientists renowned for their work examining strategies to enhance adaptation, improve performance and maintain health in athletes living and training at low-to-moderate altitudes (1600–2400 m). Much of the existing altitude research was conducted at high to extreme altitudes (> 3000 m) and not the lower altitudes that athletes typically train at.…”