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Andjelkovic M, Paal P, Kriemler S, Mateikaite-Pipiriene K, Rosier A, Beidleman BA, Derstine M, Pichler Hefti J, Hillebrandt D, Horakova L, Jean D, Keyes LE. Nutrition in Women at High Altitude: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2024; 25:9-15. [PMID: 37971430 DOI: 10.1089/ham.2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Andjelkovic, Marija, Peter Paal, Susi Kriemler, Kaste Mateikaite-Pipiriene, Alison Rosier, Beth Beidleman, Mia Derstine, Jacqueline Pichler Hefti, David Hillebrandt, Lenka Horakova, Dominique Jean, and Linda E. Keyes. Nutrition in women at high altitude: a scoping review-UIAA Medical Commission recommendations. High Alt Med Biol. 25:9-15, 2024. Background: Nutritional concerns such as food composition, energy intake, and nutrient absorption are essential for performance at high altitude and may differ between men and women. We performed a scoping review to summarize what is currently known on nutrition for women during short-term, high-altitude, physically active sojourns. Methods: The UIAA Medical Commission convened an international team to review women's health issues at high altitude and to publish updated recommendations. Pertinent literature from PubMed and Cochrane was identified by keyword search combinations (including nutrition, metabolism, energy composition, micronutrients) with additional publications found by hand search. Results: We found 7,165 articles, of which 13 original articles assessed nutritional aspects in physically active women on short-term high-altitude sojourns, with other articles found by hand search. We summarize the main findings. Conclusions: Data on women's nutrition at altitude are very limited. Reduction in energy intake plus increased energy expenditure at high altitude can lead to unbalanced nutrition, negatively influencing high-altitude adaptation and physical performance. Therefore, adequate dietary and fluid intake is essential to maintaining energy balance and hydration at high altitude in women as in men. Iron supplementation should be considered for women with iron depletion before travel.
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Affiliation(s)
- Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Institute of Pharmacy, Singidunum University, Belgrade, Serbia
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Kaste Mateikaite-Pipiriene
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Dialysis Clinic, Elektrėnai, Lithuania
| | - Alison Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Beth A Beidleman
- U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massachusetts, USA
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jacqueline Pichler Hefti
- Swiss Sportclinic, Bern, Switzerland
- Department of Internal Medicine, Hospital Biel/Bienne, Biel, Switzerland
| | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsworthy, Devon
| | - Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology, Perioperative and Intensive Care, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Paediatrics, Infectious Diseases and Altitude Medicine, Grenoble, France
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
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Viscor G, Corominas J, Carceller A. Nutrition and Hydration for High-Altitude Alpinism: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3186. [PMID: 36833880 PMCID: PMC9965509 DOI: 10.3390/ijerph20043186] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
This report aims to summarise the scientific knowledge around hydration, nutrition, and metabolism at high altitudes and to transfer it into the practical context of extreme altitude alpinism, which, as far as we know, has never been considered before in the literature. Maintaining energy balance during alpine expeditions is difficult for several reasons and requires a deep understanding of human physiology and the biological basis for altitude acclimation. However, in these harsh conditions it is difficult to reconcile our current scientific knowledge in sports nutrition or even for mountaineering to high-altitude alpinism: extreme hypoxia, cold, and the logistical difficulties intrinsic to these kinds of expeditions are not considered in the current literature. Requirements for the different stages of an expedition vary dramatically with increasing altitude, so recommendations must differentiate whether the alpinist is at base camp, at high-altitude camps, or attempting the summit. This paper highlights nutritional recommendations regarding prioritising carbohydrates as a source of energy and trying to maintain a protein balance with a practical contextualisation in the extreme altitude environment in the different stages of an alpine expedition. More research is needed regarding specific macro and micronutrient requirements as well as the adequacy of nutritional supplementations at high altitudes.
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Affiliation(s)
- Ginés Viscor
- Secció de Fisiologia, Departament de Biologia Cel·Lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, 08028 Barcelona, Spain
| | - Jordi Corominas
- International Federation of Mountain Guide Associations (UIAGM/IFMGA), CH-1920 Bern, Switzerland
| | - Anna Carceller
- Secció de Fisiologia, Departament de Biologia Cel·Lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, 08028 Barcelona, Spain
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Paris HL, Sinai EC, Shei RJ, Keller AM, Mickleborough TD. The influence of carbohydrate ingestion on peripheral and central fatigue during exercise in hypoxia: A narrative review. Eur J Sport Sci 2021; 21:1423-1435. [PMID: 33106121 PMCID: PMC8140067 DOI: 10.1080/17461391.2020.1842512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hypoxia impairs aerobic performance by accelerating fatiguing processes. These processes may originate from sites either distal (peripheral) or proximal (central) to the neuromuscular junction, though these are not mutually exclusive. Peripheral mechanisms include decrements in muscle glycogen or fluctuations in intramuscular metabolites, whereas central responses commonly refer to reductions in central motor drive elicited by alterations in blood glucose and neurotransmitter concentrations as well as arterial hypoxemia. Hypoxia may accelerate both peripheral and central pathways of fatigue, with the level of hypoxia strongly dictating the degree and primary locus of impairment. As more people journey to hypoxic settings for work and recreation, developing strategies to improve work capacity in these environments becomes increasingly relevant. Given that sea level performance improves with nutritional interventions such as carbohydrate (CHO) ingestion, a similar strategy may prove effective in delaying fatigue in hypoxia, particularly considering how the metabolic pathways enhanced with CHO supplementation overlap the fatiguing pathways upregulated in hypoxia. Many questions regarding the relationship between CHO, hypoxia, and fatigue remain unanswered, including specifics on when to ingest, what to ingest, and how varying altitudes influence supplementation effectiveness. Therefore, the purpose of this narrative review is to examine the peripheral and central mechanisms contributing to fatigue during aerobic exercise at varying degrees of hypoxia and to assess the role of CHO ingestion in attenuating fatigue onset.
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Affiliation(s)
- Hunter L Paris
- Department of Sports Medicine, Pepperdine University, Malibu, CA, USA
| | - Erin C Sinai
- Department of Sports Medicine, Pepperdine University, Malibu, CA, USA
| | - Ren-Jay Shei
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Timothy D Mickleborough
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
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Effect of Carbohydrate-Electrolyte Solution Including Bicarbonate Ion Ad Libitum Ingestion on Urine Bicarbonate Retention during Mountain Trekking: A Randomized, Controlled Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041441. [PMID: 33557035 PMCID: PMC7913653 DOI: 10.3390/ijerph18041441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
We investigated whether bicarbonate ion (HCO3−) in a carbohydrate-electrolyte solution (CE+HCO3) ingested during climbing to 3000 m on Mount Fuji could increase urine HCO3− retention. This study was a randomized, controlled pilot study. Sixteen healthy lowlander adults were divided into two groups (six males and two females for each): a tap water (TW) group (0 kcal with no energy) and a CE+HCO3 group. The allocation to TW or CE+HCO3 was double blind. The CE solution contains 10 kcal energy, including Na+ (115 mg), K+ (78 mg), HCO3− (51 mg) per 100 mL. After collecting baseline urine and measuring body weight, participants started climbing while energy expenditure (EE) and heart rate (HR) were recorded every min with a portable calorimeter. After reaching a hut at approximately 3000 m, we collected urine and measured body weight again. The HCO3− balance during climbing, measured by subtracting the amount of urine excreted from the amount of fluid ingested, was −0.37 ± 0.77 mmol in the CE+HCO3, which was significantly higher than in the TW (−2.23 ± 0.96 mmol, p < 0.001). These results indicate that CE containing HCO3− supplementation may increase the bicarbonate buffering system during mountain trekking up to ~3000 m, suggesting a useful solution, at least, in the population of the present study on Mount Fuji.
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The Possible Importance of Glutamine Supplementation to Mood and Cognition in Hypoxia from High Altitude. Nutrients 2020; 12:nu12123627. [PMID: 33255790 PMCID: PMC7760805 DOI: 10.3390/nu12123627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022] Open
Abstract
Hypoxia induced by low O2 pressure is responsible for several physiological and behavioral alterations. Changes in physiological systems are frequent, including inflammation and psychobiological declines such as mood and cognition worsening, resulting in increased reaction time, difficulty solving problems, reduced memory and concentration. The paper discusses the possible relationship between glutamine supplementation and worsening cognition mediated by inflammation induced by high altitude hypoxia. The paper is a narrative literature review conducted to verify the effects of glutamine supplementation on psychobiological aspects. We searched MEDLINE/PubMed and Web of Science databases and gray literature by Google Scholar for English articles. Mechanistic pathways mediated by glutamine suggest potential positive effects of its supplementation on mood and cognition, mainly its potential effect on inflammation. However, clinical studies are scarce, making any conclusions impossible. Although glutamine plays an important role and seems to mitigate inflammation, clinical studies should test this hypothesis, which will contribute to a better mood and cognition state for several people who suffer from problems mediated by hypoxia.
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Burtscher M, Niedermeier M, Burtscher J, Pesta D, Suchy J, Strasser B. Preparation for Endurance Competitions at Altitude: Physiological, Psychological, Dietary and Coaching Aspects. A Narrative Review. Front Physiol 2018; 9:1504. [PMID: 30425646 PMCID: PMC6218926 DOI: 10.3389/fphys.2018.01504] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/05/2018] [Indexed: 01/14/2023] Open
Abstract
It was the Summer Olympic Games 1968 held in Mexico City (2,300 m) that required scientists and coaches to cope with the expected decline of performance in endurance athletes and to establish optimal preparation programs for competing at altitude. From that period until now many different recommendations for altitude acclimatization in advance of an altitude competition were proposed, ranging from several hours to several weeks. Those recommendations are mostly based on the separate consideration of the physiology of acclimatization, psychological issues, performance changes, logistical or individual aspects, but there is no review considering all these aspects in their entirety. Therefore, the present work primarily focusses on the period of altitude sojourn prior to the competition at altitude based on physiological and psychological aspects complemented by nutritional and sports practical considerations.
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Affiliation(s)
- Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria.,Austrian Society for Alpine and Mountain Medicine, Innsbruck, Austria
| | - Martin Niedermeier
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Johannes Burtscher
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Dominik Pesta
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Jiri Suchy
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Barbara Strasser
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Medical School, Sigmund Freud University, Vienna, Austria
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Williamson E. Nutritional implications for ultra-endurance walking and running events. EXTREME PHYSIOLOGY & MEDICINE 2016; 5:13. [PMID: 27895900 PMCID: PMC5117571 DOI: 10.1186/s13728-016-0054-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 11/01/2016] [Indexed: 01/15/2023]
Abstract
This paper examines the various nutritional challenges which athletes encounter in preparing for and participating in ultra-endurance walking and running events. Special attention is paid to energy level, performance, and recovery within the context of athletes' intake of carbohydrate, protein, fat, and various vitamins and minerals. It outlines, by way of a review of literature, those factors which promote optimal performance for the ultra-endurance athlete and provides recommendations from multiple researchers concerned with the nutrition and performance of ultra-endurance athletes. Despite the availability of some research about the subject, there is a paucity of longitudinal material which examines athletes by nature and type of ultra-endurance event, gender, age, race, and unique physiological characteristics. Optimal nutrition results in a decreased risk of energy depletion, better performance, and quicker full-recovery.
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Affiliation(s)
- Eric Williamson
- Department of Exercise Science, University of Toronto, 55 Harbord Street, Toronto, ON M5S 2W6 Canada
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Anthropometry and Dietary Intake before and during a Competition in Mountain Runners. J Nutr Metab 2014; 2014:893090. [PMID: 25177498 PMCID: PMC4142283 DOI: 10.1155/2014/893090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/27/2014] [Indexed: 11/23/2022] Open
Abstract
Mountain running is a non-Olympic sport consisting of uphill or up- and downhill races at moderate-to-high altitude. Special nutritional requirements are anticipated, but no nutritional data of mountain runners are available. In three studies, physique of elite and recreational athletes (N = 62), maximum oxygen uptake (N = 3), and prerace and race day dietary intake (N = 6) were measured (mean ± SD). Mean oxygen uptake was 68.7 ± 5.2 mL/kg/min. Energy and carbohydrate intake before a race (29 ± 15 km, 1596 ± 556 m HD) was 3199 ± 701 kcal/d (13.4 ± 2.9 MJ/d) and 497 ± 128 g/d (8.3 ± 1.8 g/kg/d) in German national team members. Fluid intake was calculated as 2783 ± 1543 mL/d. During the race, athletes consumed 336 ± 364 kcal and 927 ± 705 mL of fluids. Substrate intake per hour was calculated as 23 ± 22 g of carbohydrates and 4.0 ± 3.2 g of proteins. In conclusion, anthropometric and oxygen uptake characteristics of mountain runners were similar to those reported for elite distance runners. Carbohydrate intake before and during the race was below recommendations for endurance athletes. This is of concern when considering the increased reliance on carbohydrates at altitude.
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Abstract
Many sports incorporate training at altitude as a key component of their athlete training plan. Furthermore, many sports are required to compete at high altitude venues. Exercise at high altitude provides unique challenges to the athlete and to the sport medicine clinician working with these athletes. These challenges include altitude illness, alterations in training intensity and performance, nutritional and hydration difficulties, and challenges related to the austerity of the environment. Furthermore, many of the strategies that are typically utilized by visitors to altitude may have implications from an anti-doping point of view.This position statement was commissioned and approved by the Canadian Academy of Sport and Exercise Medicine. The purpose of this statement was to provide an evidence-based, best practices summary to assist clinicians with the preparation and management of athletes and individuals travelling to altitude for both competition and training.
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Effects of a high-carbohydrate versus high-protein meal on acute responses to hypoxia at rest and exercise. Eur J Appl Physiol 2012; 113:691-702. [DOI: 10.1007/s00421-012-2472-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 07/28/2012] [Indexed: 12/21/2022]
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