Experience From - Dana Roueche , Fred Vance , Brick Robbins , Al Zeller , Norm Yarger , Robert Thomas #1 , Kevin the Mathineer , Karl King #1 , Karl King #2 , Rich Schick #1 , Robert Thomas #2 , Ray Zirblis , Robert Thomas #3, Heidi Schutt , Rich Schick #2 , Hartmut , Michael Farris ,

Dana Roueche

Subject: Traveling to Altitude

For those traveling from lower elevations to the higher mountain runs this summer, I'd like to offer a suggestion based on what I've learned that has worked successfully for me.

Even though I live at 5,000 feet, there is still a significant difference between that elevation and the elevation of 12,000 to 14,000 I will be faced with during my runs this summer. Those traveling from lower elevations have even a greater gap to overcome. We recognize that most of those traveling from low altitude will not be able to do so a month before the race to acclimate and have time to build a lot of extra red blood cells to compensate for the reduced oxygen levels at higher altitudes. That does not preclude other actions that can be done to help improve performance on race day.

The first biggest aspect to handling altitude which we all focus on and may even take for granted, is to be in the best physical condition we can be in. There is no better way to prepare for altitude than that, even if you live at high altitude. Given you are in very good shape, you can teach yourself in the very short term to adapt to high altitude. Your mind and body has been accustomed to work with an expectation of a certain level of oxygen. That expectation will still be there when you are trying to climb a high pass and you will suffer because of it. You will be working at a certain rate and your mind and body will be wondering what the heck is going on? Your rate of breathing, heart rate, oxygen exchange will be out of whack because you are not accustomed to the lean air. (heart monitors will be singing)

You will not be there long enough to grow more red blood cells but you can learn to use the ones you have most efficiently in short order. You do need to arrive 5 or 6 days before the race. After arriving, find the highest possible point that you can drive to. You need to be very careful not to over do it in your final taper week. Ideally, you want to drive to a point that is as high as the highest point on the course. After you drive as high as possible, go for a 2 or 3 mile hike/jog. The point is to give yourself an idea of what it is like to work at that altitude. You should find it very difficult compared to what you are used to. It is best to do this at least twice, the 2nd time should feel a lot easier because you are becoming accustomed and changing your oxygen expectations physically and mentally.

On race day, this will be your 3rd time working at altitude and you will be even further accustomed. It is critical to start very very slow when racing at altitude. This will allow your body and mind to adapt while you are in the run itself. If allowed, the body will become as efficient as it can with the resources it has. If you start out too fast or work too hard going over a pass, the altitude can do an incredible amount of damage in terms of fatigue. Later, when the course becomes easier, you will not be able to run as well as you could have if you where more conservative.

Fred Vance

Your Pikes Peak time indicates that you had a problem with the altitude (I'm assuming that you were in shape to run Pikes Peak). It is possible that you will not have an altitude problem with Leadville since it only broaches 12,000 feet for two relatively short time periods.

I've run Pikes Peak (x3), Mt. Evans(x3), Handies Peak(x2), and Mt. Whitney all at elevations over 14,000. I know this is an individual characteristic, but I find that I begin to experience hypoxia at elevations of about 11,500 (a little above tree line).

I find it difficult to separate the feeling of hypoxia from other problems like dehydration, hypoglycemia, and hypothermia. My solution to hypoxia is to make a conscientious decision to breathe frequently. I've heard it referred to as "pumping your lungs".

One caution here, do not hyperventilate. How do you tell whether you are hyperventilating or not? I'm not sure.

Hypoxia doesn't affect me as I would expect. Instead of wanting to breathe more, I have a tendency to breathe less and become drowsy. At that point I slow down too much (I don't use a pacer and have to rely on myself to keep going at the appropriate rate.)

Another symptom of hypoxia is what the jet jocks refer to as "tunnel vision". I've experienced this when running hard at Mt. Evans to set a PR. Your vision reduces to the point that you feel like you are looking through a couple of cardboard tubes. At that point you must stop running and pump your lungs because the next step is a loss of consciousness. (By the way, you tend to temporarily loose your color vision also.)

I believe that my difficulty in finishing Hardrock was mostly due to a combination of fatigue, hypothermia, and hypoxia making me profoundly sleepy. By the time I would reach the Fish Hatchery on the return trip, I would be so close to the cutoff times, that the adrenaline of running on the bubble would carry me through to a twenty or thirty minute margin at the finish.

Unlike a lot of runners, I don't spend the required two weeks of altitude training before a high altitude ultra. I can't afford the time or money. So I go and run and pump my lungs and fight off the sleepiness, and generally have a good time.

By the way, I lived at 6,000 feet when I first had trouble with Pikes Peak, but I have lived at 270 feet for the last five years and haven't had any problems with Handies Peak or Pikes Peak.

Brick Robbins

Subject: Tunnel Vision, Night Blindness and Gammow Chambers

Fred Vance wrote:

"Another symptom of hypoxia is what the jet jocks refer to as "tunnel = vision"."
Actually "tunnel vision" is caused by high "g" forces from high speed turns or acceleration. It is caused by blood pooling in the lower extremities instead of going to the brain. Fighter pilots wear special suits that compress their lower bodies to force blood back where it is needed most: the brain.

If adjust back pressure on the control stick (and thus the "g" forces), you can control the size of the "tunnel" you look through. Scary the first few times, but you get used to it after a while.

"By the way, you tend to temporarily loose your color vision also."

The very first symptom of high altitude is loss of NIGHT VISION and begins around 6,000 ft for us flatlanders. It is very pronounced at 10,000 ft. I had this displayed to me by taking a couple of hits of oxygen while flying an unpresurized aircraft at night. I thought I could see OK, but when I took the O2, it looked like someone flipped on a light switch. Over the next few minutes after taking of the mask, I didn't notice the world getting darker, but when I put it back on, the world lit up again.....

Color vision is lost a slightly higher altitude. While trekking in Nepal I noticed the world getting much more colorful as we descended through 14,000ft. I mentioned this to an MD whom I met, and he told me that the plants weren't greener at the lower altitude, it was just that I could see it.

There is a fair body of literature that indicates that high altitude acclimatization occurs only during sleep. I have seen arguments that it is better to train at lower altitude, where you're muscles are not oxygen limited, and to sleep higher where your body will produce more red blood cells.

To facilitate this, there is a device called a Gammow Chamber that is basically a bed inside an air tight bottle, and a vacuum pump attached. You can dial it up to as high as 18,000ft while you sleep. It looks like a big propane tank with a glass end. They were advertising in UR for a while (though the picture was of a different device, called a Gammow Bag, that has the exact opposite use: to reduce altitude sickness by compressing air into an airtight "bag" ).

Al Zeller

Subject: Tunnel Vision, Night Blindness and Gammow Chambers

Brick Robbins wrote:

"There is a fair body of literature that indicates that high altitude acclimatization occurs only during sleep. I have seen arguments that it is better to train at lower altitude, where you're muscles are not oxygen limited, and to sleep higher where your body will produce more red blood cells."

This seem to fly in the face of skiing and mountaineering acclimatization lore. The old saying is "Train high, sleep low." In mountaineering, particularly in the Himalayas, the routine is to climb high during the day then to descend to a lower camp to sleep. It's well known that sleeping is more difficult the higher you go, until you become well acclimatized.

I'm not a biologist, but I thought the more demands you place on the blood system by training resulted in the production of more red blood cells. Thus if you want more red blood cells you should train at altitude. Guess I would agree with you that if you want to run faster at low elevation you should train at lower elevation, but don't know how this translates to running across Hope Pass.

Norm Yarger

My understanding of the train high, sleep low regimen is that it allows one to perform at altitude. Becoming acclimated to altitude requires spending time at altitude. But since you can get more performance out of muscles at low altitude, you get more muscle improvement by training low. That means that train low, sleep high would be good before the event while perform high, sleep low would be better during the event.

I have wondered if the technology of scuba re-breathers could be applied to eliminate the carbon dioxide from the exhaled breath and then use the reduced oxygen level of that air along with makeup air to maintain the desired oxygen level for simulated altitude training.

Robert Thomas #1

Subject: Training

Training for altitude is an inexact science. Much like my writing skills. But there are some truths I think that can be used as a general guide. First you need to agree what is high altitude? The 10000 to 12600 feet of Leadville is different that the 15000 plus altitude of the Himalayas and there are different considerations to be made depending on where you are going. But just speaking on the normal conditions of a normal healthy person going to Leadville here are some tips. It takes about three days to adjust ones breathing rate to 10000 feet coming from sea level. It can take many weeks to several months to fully adjust blood hemoglobin levels up to what would be your individual hemoglobin level that you would maintain if you lived at 10000 feet. The train high rest low, train low rest high or train high rest high (if your talking about 10000 to 13000 foot levels for the high part.) theories all have some merit depending on all sorts of variables and how you execute your over all training plan. But the general guide is coming from low altitude to say 10000 feet, the more time at 10000 feet the faster your hemoglobin and breathing will adjust and the faster you will acclimatize. But higher than that is not necessarily better.

Leadville is hard to finish because of the altitude and extra strain involved, acclimatizing helps tremendously but does not fully mitigate the extra efforts involved because of the altitude. Leadville is also hard because of the very fast start the course has. The first major climb does not begin until 14 or so miles from the start and many people go out to fast. I know because I have done that a few times, like the year Ann Trason did not pass me till about 4 miles into the run, BIG mistake!

Gammow chambers are interesting gadgets and would be fun to play with, but they are very expensive. I personally think they have virtually no merit at all in practical use. The reason I think this are sleeping as high as the chamber goes to, I believe 18000 feet puts an undo and unnecessary strain on a person. Even lesser altitudes are hard on a person. You don't want to induce altitude sickness with the chamber. If you are coming from sea level and want to get use to altitude you don't want to start off sleeping at 18000 feet or even 13000 for that matter. Also the enclosed tight space of the chamber, I have read can disturb a persons sleep. No one lives at 18000 feet all the time because of the erosion of health that occurs. Of course people go that high and much higher for limited times, but it is not good or healthy for you. I don't think it does you much good to live or train over 10000 feet to get ready for the sorts of events we do in the U.S. Except for the quick trip to the top of a mountain back down again runs which are so much fun.

But the main reason the chamber is unnecessary is the little known but highly effective nutritional practice that can raise hemoglobin levels to maximum normal levels very quickly and safely. I call it nutritional blood doping and it is when viewed with safety, legal to do and compete, ease of doing, convenience, cost and effectiveness far superior to Gammow chambers, hormone doping, blood bank blood doping, or any kind of altitude training for increasing hemoglobin levels up to maximum normal range.

Basically it is a simple nutritional regime, that in a few weeks boosts hemoglobin levels up to maximum normal range, increases red blood cell count to but usually not much over about 50 percent, (which is optimal I think) reduces blood viscosity and enables a higher percentage of red blood cells to carry oxygen in the usable state, reducing as much as possible free radicals generated by the oxygen being carried in the blood. Other than hemoglobin levels none of these other positive effects are induced by the other regimes. I am writing a chapter covering all aspects on the subject for a how to book on adventure racing.

The Gammow bag is a great idea and a must have for safety at really high Everest type climbs.

A rebreather type system, constructed to wear while running, has been made in the past for simulating high altitude (about 8000 to 10000 feet I think) while working out at lower sea level altitude. It was a marketing bust and in practical use ineffective.

There is more to acclimatization the just hemoglobin levels and much more to top fitness and performance than just being acclimatized. As I said at the start it is an inexact science. Eating very well (this absolutely includes taking nutritional supplements.), being healthy and rested is even more important than normal when training and racing at altitude.

Kevin the Mathineer

Matt talks about "altitude houses" which supposedly simulate living at altitude by reducing the percentage of O2 in the air.

This may help increase red blood cell count, but it won't simulate altitude. At altitude the percentage of 02 is unchanged, but the air pressure is greatly reduced. This is a different situation.

One technique that is recommended to climbers (it helps me) is called pressure breathing. Upon exhalation, you purse your lips and breathe out forcefully. This increases the pressure differential across the alveoli (sp?) and aids in O2 uptake.

When I'm climbing, I sound a lot like a steam locomotive heading up a steep hill!

Karl King #1

I've tried running Mosquito Marathon on one day's acclimation. Bad result. Then I tried Collegiate Peaks on 2 day's acclimation (one spent in Denver due to weather). I made the cutoff at 25 miles, but was too trashed to do the second loop.

For Leadville '97 I spent a week at altitude (Vail, Aspen, Leadville) and felt much, much better. However, I was still too slow compared to the pace I thought I'd be able to run.

Following some study on what are the biochemical drivers for altitude acclimation, I've decided that for Leadville '98 I'll spend a week in Colorado but spend more of it at higher altitude.

The driver for increasing red blood cells is low oxygen in the blood delivered to the kidneys. 3-4 hours at 14,000 feet will dramatically increase the driver for red blood cell synthesis, so I plan on spending some of the morning hours on Mt. Evans near Idaho Springs, and on Mosquito Mountain east of Leadville. These have roads that make it easy to get high in short order.

The chemical 2,3 DPG works with hemoglobin in the blood to help unload the oxygen it carries. The driver for synthesis of 2,3 DPG is local hypoxia in exercising muscle.

So, my plan is to do some hiking at altitude and some running on the Leadville course, primarily Tabor boat ramp to May Queen. It doesn't take much exercise in the first few days to get breathless at Leadville. Since the mountains are usually clear in the morning and get showers in the afternoon, I'll spend the mornings up high, and run in the afternoon.

Given my lack of speed, Leadville is at the limit of my capability as a runner; I'll need all the acclimation I can pack into one week. After the run, I'll post how the strategy worked.

Karl King #2

Charles Steele asks:

"Given this, would the technique of hypoxic breathing work to increase one's ability to handle altitude? It seems as though it would do both. of the above, if done while running.

[Hypoxic breathing is a mostly a swimmer's exercise, in which you breathe less often than normal, e.g. instead of every 3rd stroke, every 7th or 9th stroke. I used to train with it a lot (swimming) and it seemed to help both my running and swimming. It's a pretty hard exercise.]"

Good question. Hypoxic breathing or "anaerobic" intervals at the track should work to increase 2,3 DPG, which would be useful at altitude or running a 10K. What it would not do is simulate the other conditions of altitude, namely reduced partial pressure of oxygen and carbon dioxide which would cause blood chemistry changes (shift in pH, and altered plasma volume).

There are a number of physiological changes with altitude adaptation, but most of them take place in the first few days at altitude with no special action needed, so I didn't mention them. Growth of red blood cells, and increase in DPG take longer, and can be influenced by what a runner does in the first week at altitude. There are other changes, such a reduced muscle fiber diameter for better oxygen transport, that will only come with prolonged stay at altitude ( for example: Kirk Apt, Tom Sobal ). The runner who comes to Leadville for a week or two will not see much of those changes.

Rich Schick #1

There Are no shortcuts! Lots of research is available on the subject. This monkey rides the back of the mountain climbers big time, and as this pastime attracts a lot of folks with big bucks not to mention world class rivalries between nations, funds have been available for research. The US military and that of many other nations have also expended a lot of resources exploring the subject. The verdict - no quick fixes. The drug Diamox affords some protective affect against the various forms of mountain sickness, but offers no performance advantage to the athlete. More bad news, the fitter you are the more likely you are to suffer mountain sickness.

The recommendation to either arrive at the race sight the night before or at least three days before has to do with the appearance of mountain sickness, not acclimatization - that takes about two weeks. Discussion of tactics to raise the hematocrit, train with oxygen deprivation, or use drugs to facilitate oxygen utilization demonstrate a basic misconception about what the problem is. The problem is not simply one of decreased oxygen content in the air at high altitude, it is a problem of decreased pressure, that is why a person suffering from high altitude pulmonary edema(HAPE) or high altitude cerebral edema(HACE) will still die even if given 100% oxygen - oxygen ain't the major problem - its that nasty old Boyle's law that deals with the behavior of gases at various pressures.

It takes the body a while to figure out how to deal with the different way gases behave at lower pressures. Unfortunately some folks have bodies that are metabolically too "dumb" to master this and they end up seriously ill or dead with HAPE or HACE . For most folk it just means the body doesn't work so hot for a while, but things do gradually adapt to a degree. Another interesting tidbit is that there does seem to be a ceiling for human habitation. Above a given altitude although humans will seemingly adapt quite well, they will waste away over a period of months even with adequate nutrition and rest. Seems they can't quite beat old Boyle's law.

Robert Thomas #2

I had some personal communication back in the mid eighties with Peter Hackett M.D. author of Mountain Sickness, he's a researcher also. The bottom line was I had a number of ideas related to acclimatization and mitigating altitude sickness, in the course of our discussion not one of my ideas had been research as far as he knew at the time. But that he was going to be researching in the future a few of my ideas, that in parallel had been thought up by himself and some other researchers. Today I can think up a number of studies that I don't think have been conducted yet that might have some positive prophylactic effects as regarding mitigating altitude sickness. There is always room for new ideas.

Just a few quick thoughts, there has been some research conducted with gingko biloba that shows it helps minimize some altitude induced problem. There are drugs of the Nootropic/antihypoidotic family that help maintain normal brain function at the highest altitudes possible to climb. I just read a research paper about Hydergine and altitude I include it at the bottom of my post. They only use 5 mg of the drug, 20-30 mg is a more effective dose. It's a 1990 piece of work. I thought about Hydergine back in the late seventies and the possible usefulness of it, it was one of the things I discussed with Peter Hackett back in the eighties. Here we are in the 90's and I wonder how many climbers have used it or the many other similar drugs when climbing? I know some climber have.

Of course there is nutritional blood doping that can be helpful in a few ways for making the transition to altitude easier and may have some important helpful effect on micro circulation depending on just what you do.

I am continuing working on my own theoretical program of drugs and nutrition that may has some real value for extreme high altitude climbing.

What altitude you go to and stay at makes a lot of different. Running Leadville for instance is nothing like hiking over 16 thousand feet and that is nothing like climbing over 25000 feet.

I don't think anyone live year round at over 16000 feet.

Paper: On brain protection of co-dergocrine mesylate (Hydergine) against hypoxic hypoxidosis of different severity: double-blind placebo-controlled quantitative EEG and psychometric studies.

Authors: Saletu B, Grunberger J, Anderer R

Sponsors: Division of Pharmacopsychiatry, Psychiatric University Clinic of Vienna, Austria.

Utilizing quantitative EEG and psychometric methods we investigated in two subsequent double-blind, placebo-controlled trials The following questions:

  1. Does co-dergocrine mesylate (CDM) protect against cerebral hypoxic hypoxidosis as objectivated by neurophysiological and behavioral measures in man?
  2. Does CDM offer protection equally both against moderate and marked hypoxia induced experimentally by inhalation of a gas mixture of 9.8% and 8.6% O2 (equivalent to 6000 m and 7000 meter altitude, respectively)?
  3. Are brain-protective effects of CDM improving by drug administration over a longer period of time 2 weeks)?
In the first study, hypoxic hypoxidosis was induced by a fixed gas combination of 9.8% oxygen and 90.2% N2 (equivalent to 6000 m altitude), which was inhaled for 23 min under norm baric conditions by 15 healthy volunteers. They received randomized after an adaptation session placebo and 5 mg CDM. Blood gases, quantitative EEG, and psychometric measures were obtained under normoxic (21% O2) and hypoxic (9.8% O2) conditions before as well as 2, 4, 6 and 8 h after oral drug administration. Blood gas analysis demonstrated under hypoxia a drop in PO2 from 91 to 37 mmHg and in PCO2 from 38 to 33 mmHg, while pH increased from 7.41 to 7.47. Computer-assisted spectral analysis of the EEG showed an increase of delta/theta, decrease of alpha, and an increase of superimposed fast beta activity indicative of deterioration in vigilance.

The latter was documented at the behavioral level by deterioration of intellectual and mnestic functions, psychomotor activity, performance in a reaction time task, mood, and wakefulness. CDM attenuated significantly this brain dysfunction, as it attenuated delta/theta and increased alpha-adjacent beta activity.

Psychometric performance based on all 11 variables deteriorated under hypoxia by 49% after placebo, while after 5 mg CDM only by 26%. However, in a subsequent double-blind placebo-controlled trial in 12 healthy young volunteers, further augmentation of hypoxia induced by inhalation of a gas combination of 8.6% O2 and 91.4% N2 (equivalent to 7000 m altitude) leading to a drop of PO2 and PCO2 to 32 and 32 mmHg, respectively and an increase of pH to 7.46 resulted in a loss of brain protection, even when CDM was given over 2 weeks daily.

Our findings suggest that treatment of organic brain syndromes with nootropic/antihypoxidotics should be initiated in an early rather than a late stage.

Ray Zirblis

To chime in on the altitude discussion, Dr. Charles Houston's book, which I think is titled MAN AND ALTITUDE, supports the advice long held through anecdotal evidence in mountaineering, of "climb high, sleep low," so what ever one does during the day as regards running and hiking at higher elevations, dropping down a couple of thousand feet to sleep seems beneficial. Increasing altitude, say 1500 to 2000 feet per day in one's training, and dropping down at night, was long the climbing model. No surprise that proper hydration is also essential to acclimatization.

The rest step and generally moving slowly,( one may not have a choice), will also help. As in all endurance endeavors, training at altitude also builds the essential mental toughness that can get keep one moving through mental lazitude and times when ones legs seem to weight tons.

Robert Thomas #3

The process of acclimatization can be amplified many fold by taking specific nutrients.

Having personally conducted medical testing on my self, I have seen the advantages of supplementing versus non-supplemented. Some years ago there was testing being conducted at Leadville that coincided with my own testing to determine a few different physiological parameters, among them blood hemoglobin and hematocrit. Having not unpacked my medical files I am going from memory. As I recall my hematocrit was 50 and my hemoglobin was very near 18 g/dl. This level of hematocrit is very near ideal as a higher number can be more problematic with dehydration induce thickening of the blood and a lesser number decrease's the oxygen carrying capacity of the blood. 18 g/dl hemoglobin is at the maximum normal limits and I think that's the best we should expect out of acclimatization. I was careful to be well hydrated during my testing to get as accurate a measurement as possible.

I achieved these levels living and training at one thousand feet for one month before going to Leadville and had only been at Leadville for a day and a half before my blood test there. There were about 28 people participating in the test at Leadville and only one person had a higher hematocrit of 53, but with lower hemoglobin. I don't remember anyone having higher hemoglobin and only one other that was near mine. What's interesting about the results are that many of the other participants in the study lived and trained in Colorado, at much higher altitudes than myself.

Approximately six weeks before the testing at Leadville I had myself tested for hemoglobin and hematocrit. They were approximately 14.5 g/dl and low forties for hematocrit. The change I had at Leadville was a direct result of specific nutrient supplementation.

I feel that taking hematopoietic nutrients is such an important and valuable aid for acclimatization and maximizing athletics in general. Realizing what can be done by these nutrients it's a shame it's not discussed by sports nutritionists more often. I am devoting a whole chapter in the sports nutrients section of my book on adventure racing to this subject alone. It will be possible to go into much more detail later than is possible in my post right now. But I will let you know what I was basically doing and what I was basically taking to help acclimatize.

First there is a proviso; the levels of some of the vitamins I took are much much higher than the RDA. There are safety issues that need to be addressed and I don't recommend that you do exactly what I did. Also there are some proprietary elements that I am saving for my book. Nothing is completely safe; too much water can kill you.

Basically I was taking 10 mg (not micrograms) of folic acid a day for three weeks before Leadville. This is well over 10 times the RDA. There are some reported problems with doses of just about any vitamins by some people at some times. With folic acid some people have reported problems at intakes of 1 mg. But folic acid is generally regarded as a safe non-toxic vitamin. Two to three mg a day for a few weeks would be more prudent and still effective. Along with folic acid I took 2 mg of vitamin B12 (not 2 micrograms, I took 2 mg or 2000 micrograms). A more prudent level would be 200 micrograms B12. B12 is generally regarded as being safe. If you're a meat eater, in general I would not recommend taking any iron as a supplement. But if you are marginal in iron intake, extra iron will be helpful, first I would recommend eating extra iron containing foods, if that does not work you could take 50 mg a day iron supplement. A good multi vitamin, mineral supplement should be taken to fill in any gaps of your micronutrients.

Anti oxidant vitamins like C, E and lipoic acid have various uses in maintaining blood in its healthiest state. You could take 500 mg of C, 1500 IU of E and several hundred mg of lipoic acid; these are modest amounts and generally regarded as safe levels of these nutrients.

The oxygen disassociation curve that controls how strongly oxygen binds into the red blood cells is controlled by 2,3-bisphosphoglycerate (BPG) or 2,3-diphosphoglycerate (DPG) depending on what you read. There are some nutrients that help change the enzyme level of BPG that helps loosen the binding of oxygen to hemoglobin and there by improving tissue oxygenation by blood

Other issues that have nutrient control are maintaining the proper shape of the blood cells, minimizing viscosity, minimizing oxidative damage of blood cells, enabling the maximum useful configuration of oxygen that's carried by the red blood cells and maintaining high ATP levels in red blood cell. All very interesting concepts that need to be considered and have relevance in a modern sports diet.

I find these ideas exciting and I hope to include the newest information and careful examination of this interesting area in sports nutrition in my book (publish date TBD) and by news group posts.

As you can see the core supplement program for acclimatizing is very simple, takes only a few weeks to be effective, works at see level, everyone can afford it. It works even better if you can spend some days at altitude before an event. There are other changes your body undergoes that these nutrients or any nutrients for that matter can't induce before going to altitude. So three or four days at altitude helps greatly in adjusting to altitude, when used with these nutrients.

Optimum Sports Nutrition has a good section on "Good Red Blood" that is useful in helping fully understand the idea of nutritional improving blood or as I like to think of it legal nutritional blood doping.

One last thought, when I have run at altitude I feel great, my breathing is not unduly labored and I feel the supplements really help compared to not taking them. But I still have not had a good run at Leadville. You have got to do everything else right, being acclimatized the best you can be is only the thin icing on the cake.

Heidi Schutt

With regard to Altitude Adjustment, I live in Denver Metro area, but still have an altitude problem. I travel a lot, so I am in and out of altitude quite often - and it is not a fun time. I have been experimenting with what works and what doesn't and have also found that driving into altitude seems to adjust my body quicker than flying in. As I do both, flying and driving, I have been paying close attention as to how I feel when I return. I must say that just as soon as I acclimate to altitude I am on my way out to a lower altitude again, and then in a few days I am back, and just as quickly as I adjusted, I unadjusted.

I have run Pike's Peak Ascent and Marathon numerous times trying different ways to adjust - no matter what I did, I could not adjust to even higher altitudes. The only time I was able to beat 5 hrs in the Ascent was when I did not do any altitude training and just did lots of miles. But as soon as I hit 10,000' in altitude, it's like hitting a brick wall.

I did train one year at higher altitudes - driving to top of Pikes Peak and running up and down to A Frame and back for 3-4 hours. On event day - I was excited - seemed to be doing well - but then I got to 10,000' and there was that brick wall again! So I have finally accepted the fact that I have an altitude problem and that is that.

I have been searching for years for something to help me and finally I have discovered "Altitude Adjustment" from Mountain Lift. It contains Vit C 250 mg, Calcium ascorbate 250 mg, Siberian Ginseng extract (25:1) 100 g, Schizandra extract (4:1) 100 mg, L-Tyrosine 100mg, Ginkgo Biloba extract 50 mg, ginger root 50 mg, Reishi Mushroom extract (4:1) 25 mg. My husband tells me that the Schizandra is the main ingredient in this product that helps to get the oxygen into my blood. Is anyone familiar with Schizandra?

I have not had an opportunity to try this on Pikes Peak Event, but have used it in training there. It doesn't make me any faster, but does make it easier on my breathing. My business, Running Delights at does have this product available if anyone is interested.

Also I was born and raised in Iowa, my children were born in Denver - which seems to have given them a "gift" - they are not bothered by altitude. My youngest son runs 14ers for training!

Rich Schick #2

Here's a altitude web site. It's a good overview in plain English, I've included a quote from the second.

High Altitude and its Effects on Exercise Performance

"At the muscle tissue level, oxygen is released from the blood and enters the cells of the working muscles to sustain aerobic metabolism. The preferred fuel for exercise at altitude appears to be fat due to a dramatic decrease in carbohydrate metabolism. This complex shift in substrate utilization is not well understood but may be due to the fact that a reduced oxygen supply already causes a higher lactic acid level in the muscles and bloodstream and carbohydrate consumption must be curtailed.

Lactate is only produced during carbohydrate (not fat) breakdown. The end result of these occurrences is reduced maximal aerobic power, diminished endurance capacity, and earlier muscular fatigue during your high altitude ski vacation."


As a trainer, I would keep my secrets for myself. But, being a physician, I have an interest that ALL OF YOU OUT THERE have the best chance to reach Auburn in the best shape possible. Most of this is rather theoretical information. Most of you will have much more practical experience than I have, and will know very well, what to do to arrive in good shape.

However, information never hurts, you just have to pick what's most interesting for you. I tried to summarize the practical points, to get some message across.

Around the fireplace of Foresthill Hotel a few of us brought up the topic of high altitude acclimatization. It is of interest for 100 Milers like Hardrock. Definitely less for Western States, since it is more reasonable to do the high altitude part slowly anyway. One point really kept my mind busy. Why sleeping low and climbing high is so far better than exercising and sleeping at the same altitude?

I recommend Chip Tuthills advice page on high altitude acclimatization on Stan's Website

Well, I went through the best books, and here are some additional points concerning high altitude physiology and pathophysiology, namely on AMS, HAPE and HACE. Finally I come up with an answer to the previous question.

The common pathogenesis (=chain of causes leading to disorder, sickness and possibly death) in AMS (Acute mountain sickness), pulmonary and cerebral oedema (HAPE and HACE) consists of hypoxemia (lack of oxygen) in all cells of your body, most evident in the tissues which need oxygen the most urgently, like the brain. Therefore neurological symptoms like in the AMS are the first to show up. When Hypoxemia is more pronounced, there occurs damage of endothelial cells (vascular cells which your blood vessels consist of). This damage includes leakage of fluid into the space between the surrounding cells, called oedema (swelling).

Swelling of the space between pulmonary alveoli and blood vessels impedes diffusion by the mere function of increased distance the oxygen molecules have to travel to get into the blood system. This happens at the early and all latter stages of HAPE. The mechanism of transport of oxygen is further compromised in shock, which is present in late stages of HAPE and HACE. The chain of causes leading to shock starts with trauma, which in this case consists of lack of oxygen. Trauma leads to cell death, release of inflammatory transmitters, leakage of membranes and subsequently to oedema (increase in fluid content between cells). So, fluid is lost into a space where it cannot readily be recovered. This is not dehydration, because the fluid is still there, but has the same consequences for the blood pressure. The effects of an already present dehydration are pontentiated. Blood pressure and blood flow goes down, the vicious circle is started, because this further compromises the transport and utilization of oxygen. As well the metabolites resulting from trauma and cell death cannot readily be removed, more inflammatory transmitters are released, more vessels leak, more fluid is lost into the intercellular space and so on and on?.

The consequences for you to avoid this vicious circle are:

  1. Avoid trauma, therefore either acclimatize your body to the high altitude or go very slow. You will need both at altitudes over 14.000 ft.

  2. Drink enough EARLY. At high altitudes a substantial part of fluid is lost breathing. This plays almost no role at sea level and in humid air. But it makes up to 40% of the total fluid loss in altitudes over 18.000 ft. Therefore

  3. At the start of Western States, you will need a bit less sodium compared to the hot canyons, where the fluid loss is almost only due to sweating. I doubt, however, that this will be of any importance, since we spend just 6-8 hours at higher altitude.

    Dehydration and mild stages of shock potentiate the cell toxic effect of the lack of oxygen and can lead from AMS to HAPE and HACE. There is one caveat. Fluid management in a patient, who already has signs of HAPE and HACE has to be taken with great care. Too much fluid with present oedema will enhance oedema and therefore even more threaten life.

    The only choice in any of these cases is DESCEND as early as possible.

    Another point, what you can do to improve your performance at high altitude is applying the "lip brake", when you exhale. This acts as PEEP (positive endexpiratory pressure) and keeps more alveoli (the smallest air compartments in your lungs) open and ready for gas exchange. It is meant to give more time for the diffusion of oxygen into the blood. It helps as well CO2 transport. Due to the lip brake, a small amount of CO2-rich air stays trapped in our lungs. Since the tidal breating volume is increased automatically, this is not negative. The CO2 partial pressure in our alveoli, which is similar to our blood pCO2 and stands in balance with the HCO3- concentration in the blood, plays an important role in blood buffering capacity, since bicarbonate is the bloods major chemical buffer system. Such a buffer is important to cope with peaks in lactactic acid (!).

    Hyperventilation is excess ventilation, or breathing, leading to decrease of pCO2, HCO3- concentration, to shift in pH and shift in binding of free Ca2+ in the blood. This leads to hyper excitability of nervous membranes. The symptoms are dizziness, feeling your hands go numb etc. The best to avoid this, is BREATH SLOWLY while applying the lip brake. This gives a kick on the vagus and helps keeping nervous control. As well, the physical characteristics of our chest make slow breathing cycles more efficient. Asthmatic persons will know this very well. So, 4th point is

  4. Use the lip brake, you may increase your breathing volume to maximum, but BREATH SLOWLY.

  5. To prevent trauma to your lungs, especially in dusty dry air, try to inhale through your nose. Try to take at least the first part of your every breath through your nose. It will be the part which gets down the deepest in your lungs. Some people wear a face mask for the dusty parts.

    The time frame you spend at a certain altitude before you climb higher is 5-7 days for 14.000 ft. In this time frame just 30-40% of the full acclimatization effect occurs. After 5-7 days, it is certainly safe to perform climbing activities and to proceed to a higher sleeping elevation. However, full acclimatization requires increase in your red blood cell count to increase oxygen transport capacity, which takes 3-12 weeks. The fact that heart rate and breathing frequency go down in these 5-7 days is due to change in the sensitivity of the chemoreceptors in the brain stem. The breathing center gets its input from oxygen, pH- and CO2-sensors, situated on the surface of the brain stem. Oxygen and CO2 partial pressures go down, according to air pressure. pH, which is in close relationship to CO2 and bicarbonate, goes up. In the first 2-3 days, the breathing center in the brain stem still applies the old ranges of its chemosensor sensitivity. As the CO2 concentration in the cerebrospinal fluid needs this time frame to go down to the same levels as in the blood, the balance of the breathing center is regained within 3-5 days. This is due to the slower process of production and reabsorption of this cerebrospinal fluid, which envelops the brain and spine. Blood, in contrast, adjusts instantly due to its direct communication with the lungs. This is, how most people think, it works.

    Now comes an interesting novel point: I always asked myself why the strategy "climb high and sleep low" is so successful. Sleeping at high altitude is constant stress for the body due to the low partial oxygen pressure and the whole chain of symptoms caused by it. However, if you very slowly increase your climbing and sleeping elevation and climb and sleep at the same elevation, it should be possible to find the right steps to have the degree of stress, which your body can cope with permanently. But that's not the most efficient way. Why is climbing high and sleeping low so much more efficient? The need of less stress during sleep than during our active times of day sounds somewhat logic, but never fully satisfied me as explanation.

    Only recently anaerobic or lactatic threshold training has been discovered as being import even for supposedly true aerobic workouts like a marathon run. (Well, you don't tell me that a 2:11 marathoner is working purely aerobic) In response to training at the anaerobic threshold, capillary blood vessels in lungs and muscles increase. This process is called "capillarization". As well, the enzymatic capacity of the liver metabolizing lactic acid and making it reusable as fuel to the muscle is greatly enhanced. Well then, there is no easier way to work at the anaerobic limit than to climb in high elevation. So this explains very well, why activity, as opposed to rest, is such a benefit to be done in higher elevation than the sleeping elevation. It does make good sense. So, a great deal of our medium fast acclimatization (in the 5-10 day range) is, apart from different chemosensor regulation in our breathing center, just increasing our anaerobic threshold.

    So, for Hardrock, the formula will be:

  6. Climb high, sleep low

    For Western States, unless you want to fly ahead of Tim, only to be caught by him after the canyons, this will NOT be your major training issue. However, reasonably applied, some of these tips will save your energy to be in much better shape when you reach the canyons (!)

Michael Farris

Here is a summary of the basic laws of acclimatization and suggestions for the flatlander who has limited time to acclimatize before a race. Climbers and medical researchers worked these issues out long ago, but listers seem to want to occasionally reinvent the wheel. Clip and save!


Acclimatization- reversible physiological and biochemical changes in response to lowered atmospheric oxygen concentration.

High elevation/altitude- There are three functional categories (roughly speaking):

Most medical research has likely been done on responses to 15-24k ft (e.g. cabin pressure failures in planes). Runners are most interested in range A.

Here are some absolute truths (as of 1999):

  1. Different people have different abilities to acclimatize. CONSEQUENCE- Set your own acclimatization schedule when possible; and some people may need less acclimatization to perform well at the lower ranges of high altitude (like Leadville). Disregard any and all advice from others when appropriate. Learn your own responses to altitude.

  2. You may acclimatize differently every time you go to high elevation. CONSEQUENCE- Nobody is immune to altitude sickness; be flexible with your acclimatization plan.

  3. Physical fitness has no effect on acclimatization speed or ability. CONSEQUENCE- nothing substitutes for 'time on the hill'. Performance-wise, the fit/acclimatized person will be fastest, the unfit/unacclimatized will be slowest. This seems to be the hardest 'truth' for runners to accept.

  4. There are no drugs that are proven to speed up acclimatization. CONSEQUENCE- Diamox RELIEVES SYMPTOMS of acute mountain sickness (headaches, nausea, dizziness), it does not help you acclimatize. Don't use it as a crutch.

  5. True acclimatization takes about 3 weeks. CONSEQUENCE- Feeling better after 4 days does not mean that you have acclimatized, it means that some initial symptoms of mountain sickness have disappeared. Your performance will still be below your potential.

Suggestions for the person who has fewer than 7 days to acclimatize.

These are based on nearly 25 years of short trips from the flatlands to the mountains, and on the medical literature.

  1. (*) See #1 above.

  2. Be well rested and well hydrated prior to arriving at elevation.

  3. Engage in moderate physical activity for the first couple of days.

  4. There is no advantage to going as high as possible as soon as possible.

    In other words, flying to Denver, driving up Mt. Evans (14,000+) and doing repeats is counterproductive. Or, trying to run up Hope Pass at Leadville the Monday before the race if you arrived at elevation on Saturday. Aerobic hiking at 8-10,000 feet is much better for you.

  5. Maximize your fitness. While it won't help with acclimatization, you will perform better than if you are less fit.

  6. You are going to be breathing real hard. Train your respiratory/chest muscles for the load by doing fast repeats or hard hills.

  7. Have Diamox (acetazolamide) available. It can help you rest, but I wouldn't take it less than 48 hours before a race (diuretic). It is medically accepted for this use, even if it is a banned substance (so elite runners shouldn't use it).

  8. Avoid caffeine and alcohol; eat a high carbohydrate diet.

  9. Learn the symptoms of AMS, HAPE, and HACE (three altitude illnesses). It is very unlikely that runners will contract these in the U.S., but better safe than sorry.

  10. Reduce your expectations.

I hope this helps. I'm off to acclimatize for Hardrock (17 days before the race).