IRON SUPPLEMENTATION & NUTRITION RECOMMENDATIONS FOR
ALTITUDE TRAINING Trent Stellingwerff, PhD; Susan Boegman, RD; and Padraig McCluskey, MD
ptimal training adaptation is a balance between stress and recovery and altitude training causes an increase in both training and systemic stressors to the athlete. Altitude can provide an alternative stimulus for adaptation; however, as with training, the stress of altitude needs to be strategic and mitigated by optimal nutrition interventions to ensure peak adaptation. It is now well established that altitude training not only provides a stimulus to potentially increase red blood cells (RBC), (measured in studies as hemoglobin mass (HBmass)) [1, 2], but it can also positively impact nonhematological factors, such as muscle buffering and mitochondrial biogenesis . Currently, the vast majority of our knowledge on the physiological effects of altitude training relate primarily to aspects of HBmass/RBC production with a series of studies having established that the optimal hypoxic dose is approximately 3 to 4 weeks at altitudes of ~2000 to 2500m [4, 5]. If these hypoxic doses are satisfied, athletes can expect, on average, an approximate 1% increase in HBmass for every 100hrs at altitude . However, altitude RBC responses are highly individual , with some athletes showing 10% increases in HBmass and others showing no increases over the same altitude training camp. These individual variations in HBmass responses to altitude likely reflect the many positive and negative impactors to RBC production (see Figure 1 below). Interestingly, several of the ‘controllable’ factors to RBC production are nutritionally based, and coupled with some very new publications in this area, provide the impetus of the current nutrition and iron recommendations for altitude.
HP SIRCuit Summer 2016
Iron Status and Supplementation Before and During Altitude One of the impactors on RBC production is iron status and availability. The International Olympic Committee consensus group suggests athletes should have iron status assessment ~6 to 10 weeks prior to altitude, and ideally, serum ferritin concentration should be >30 μg•L-1 for females and >40 μg•L-1 for males with normal hemoglobin values (e.g. not anemic; ). It has been suggested that athletes with ferritin below these values may have increased potential for mal-adaptation and lower red blood cell production. However, the newest data suggests that iron supplementation before and during altitude is possibly more important for RBC production than incoming iron stores (ferritin), as long as hemoglobin is within normal ranges [14, 15]. This contemporary research shows a near dose-response relationship with increasing iron intake (up to 200mg of elemental iron/day) and subsequent increases in HBmass (RBC’s) while training at altitude (NOT SEA LEVEL!). In this series of studies, Govus et al.  and GarvicanLewis et al.  examined 178 athletes who participated in altitude camps and found that those athletes who did not supplement with iron had minimal HBmass increases of only +1.2% (within HBmass measurement error), Français
Trent Stellingwerff Trent is an applied sport physiologist with a specialization in the area of performance nutrition. He earned a Bachelor of Science in Human Nutrition and Exercise Physiology at Cornell University and he earned his Ph.D. from the University of Guelph in Exercise and Skeletal Muscle Physiology. At the Canadian Sport Institute Pacific he focuses on providing his physiology and nutrition expertise to Canada’s national rowing, track and field and triathlon teams, as well as leading Canadian Sport Institute’s Innovation and Research division.