Apart from birds, humans are the only species to have developed activities at high altitude in regions where physiology is clearly challenged. Mountain sport covers a wide range of disciplines. The Spanish Mountaineering and Climbing Federation, FEDME, includes ski mountaineering, climbing, mountain running, hiking, canyoning, Nordic walking, mountaineering and specialties such as ice climbing. Nutrition requirements and physical demands therefore vary by discipline, but two factors are unique to the mountain environment:
cold and altitude-related hypoxia. These are two key elements, sometimes called “invisible enemies,” that clearly affect sports performance.
Nutrition in these disciplines has become specialized, just as equipment and the sports themselves have, requiring several specific considerations.
Many authors define high mountain activity as taking place above 2600 m. Under these conditions, we encounter:
Low oxygen availability, causing tissue hypoxia and reducing the working capacity of the cardiopulmonary system.
For every 300 m gained above 1500 m, exercise capacity decreases by 3%.
Poorer sleep quality, which impairs sports performance and cognitive and mental capacity.
Hypoxia and altitude also alter the expression and metabolism of numerous substances, including iron metabolism, myostatin function and certain interleukins. Research has also shown reduced mitochondrial capacity and increased reactive oxygen species, or ROS. This environment downregulates protein synthesis, increasing protein requirements and changing energy and hydration needs.
Energy requirements increase above 2000 m, especially above 3000 m. Intake in kcal/kg FFM/day must be adjusted to provide at least 45 kcal/kg FFM/day at baseline, plus estimated activity expenditure. This is important because chronic altitude exposure combined with exercise can lead to RED-S—Relative Energy Deficiency in Sport—with serious health implications for high-level athletes.
For hydration, the combination of hypoxia and the low air humidity associated with altitude increases water loss both at rest and during activity. Thirst may also be reduced, while environmental conditions can limit fluid availability, creating a substantial dehydration risk. If hypothermia occurs, cold-induced vascular redistribution further contributes to dehydration. Fluid intake should therefore be adjusted upward; many authors propose a baseline of around 3 liters plus estimated losses.
Based on current evidence, sports activity above 3000 meters involves:
Higher energy requirements.
Greater oxidative stress, without clear evidence supporting higher antioxidant intake.
Higher iron requirements.
Greater glycogen use and increased carbohydrate requirements.
Between 2000 and 3000 meters, these increases have not been observed except for the need for iron supplementation and a modest rise in energy requirements.
Cold at 2200 m above sea level combined with maximal effort: the perfect equation for high demand. Photo courtesy of Gorka Martínez –
@gkmph
In conclusion, where the discipline permits, a useful strategy is to complete the highest-quality, most consistent training between 2000 and 3000 m. This can optimize carbohydrate and fluid use while accounting for energy needs, adequate protein and greater intake of iron or heme-containing foods and products.
Mountain athletes should train carbohydrate use and oxidation rates close to 120 g/h and monitor hydration by estimating losses through sweat testing and urine or plasma analysis to support optimal performance.
For expeditions and high-altitude mountaineering, nutrition must be individualized to cover resting and activity requirements while remaining compatible with the equipment carried, because weight can be a limiting factor for climbers.
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BIBLIOGRAPHY:
Śliwicka E, Cisoń T, Kasprzak Z, Nowak A, Pilaczyńska-Szcześniak è (2017) Serum irisin and myostatin levels after 2 weeks of high-altitude climbing. PLoS ONE 12(7): e0181259. https://doi.org/10.1371/journal.pone.0181259
Optimizing Nutrition for Performance at Altitude: A Literature Review. Journal of Special Operations Medicine Volume 11, Edition 1 / Winter 11.Nutrition and Altitude.
Performance and Maintain Health: A Narrative Review. Trent Stellingwerff· Peter Peeling · Laura A. Garvican Lewis · Rebecca Hall· Anu E. Koivisto·Ida A. Heikura· Louise M. Burke. Sports Medicine (2019) 49 (Suppl 2):S169–S184 doi: 10.1007/s40279-019-01159-w
Author:
César Canales Hortelano.
Consultant physician in the Emergency Department at Hospital Virgen de la Luz and member of the Pain Unit in the Department of Anesthesia and Resuscitation.
Master's degree in Mountain and Wilderness Emergency Medicine.
FEDME competition medical officer.
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