Ketosis

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Ketosis

Potential health implications of ketosis at higher altitudes include tissue protection, weight loss, an increase of AMPK, improved performance, and enhanced survival responses. While there was plenty of information about the effects of ketosis on human health in general, research could not ascertain if these effects were as a direct result of ketosis at sea level.

Protection of Tissues

  • According to the National Center for Biotechnology Information (NCBI) paper, ketone bodies produced as a result of ketosis offer protection for key tissue organs such as the brain from the adverse effects of deprived oxygen availability (hypoxia) experienced at high altitudes.
  • Dr. Dominic D'Agostino agrees as he notes in this article that ketones can provide up to two-thirds of the energy required by brains.
  • Additionally, NCBI asserts that ketones collaborate with amino acids produced in high altitudes to protect cells from the adverse effects of hypoxia.

Weight Loss

  • NCBI notes that higher altitudes lead to decreased appetite and the malabsorption of nutrients. This leads to the body turning to fat as an alternative source of energy, leading to "marked involuntary" weight loss.
  • Diet Doctor also notes that decreased appetite and insulin levels, as well as fat-burning induced by ketosis leads to weight loss.

Increase of AMPK

  • Hypoxia induced at high altitudes is noted to not only increase ketosis but also increase the levels of AMPK. The Natural Medicine Journal defines AMPK as a nutrient-sensing enzyme that regulates metabolism and the generation of energy.
  • AMPK is noted as the key inhibitor of mTOR, an enzyme that coordinates cell production and growth. Too much of mTOR has been linked to type 2 diabetes, cancer, obesity, and aging.

Performance Boost

  • In his book Tools for Titans, Timothy Ferris notes that ketosis promotes the better use of oxygen, which may be responsible for better performance at high altitudes. Ferris posits that this may be a reason that elite cyclists have been experimenting with keto diets.
  • He also notes that more energy per oxygen molecule can be derived from ketones. While he is not an expert on ketosis, his book features the research and quotes from Dr. Dominic "Dom" D'Agostino, a regarded expert on nutrition and environmental medicine.

Enhanced Survival Response

  • Hypoxia induced in high altitudes facilitates ketosis and triggers the human response NCBI identifies as wasting. Wasting leads to weight loss and altered cellular metabolism; factors that contribute to higher survival rates in high altitudes.

Research Strategy

To identify insights on the potential health implications of ketosis at sea level versus higher altitudes, research began by cross-referencing available data on ketosis and its effects/impact on the two different environments. This led to the discovery of NCBI's paper on the same, which detailed the effects of ketosis induced in high altitudes on the human body. While it was published in 2014, research deemed it relevant to this brief as it was the only information that offered scientifically backed data on ketosis at high altitudes. Cross Fit's article by renowned nutritional and environmental medicine expert, Dr. Dominic D'Agostino, also features in this brief. Timothy Ferris, an American entrepreneur and author, also features Dr. D'Agostino and his research on ketosis in his book, an excerpt of which is featured in this brief.

Unfortunately, research could not identify the health implications of ketosis at sea level. While research did identify multiple resources on the effects of ketosis on the human body, none of them explicitly noted that these effects were induced by ketosis at sea level. Additionally, sea levels are said to be different geographically, thus it was difficult to pinpoint which environment at sea level contributed to the various effects of ketosis generally identified.


The recommended diet as per expert consensus for optimal performance at higher altitudes include a fat-based diet, increased fluid intake, anti-oxidant and anti-inflammatory foods, quality carbohydrates, and
foods rich in iron.

Fat-based Diet

  • Uphill Athlete, a training company dealing with alpinism, notes that reducing dependency on carbohydrates for fuel, and shifting to a fat-based diet, is key in maintaining energy levels required for optimum performance at high altitudes.
  • According to Uphill Athlete, fat reserves in athletes are virtually limitless, compared to sugar derived from glycogen. The article asserts that this enables high energy outputs.
  • Men's Journal painstakingly details Adrian Ballinger's journey from carb-burning to fat-burning through with the help of Uphill Athlete's Master Coaches Scott Johnson and Steve House. They changed Ballinger's diet to 10% carbs, 60% healthy fats, and 30% protein. This keto diet, combined with targeted training, helped Ballinger reach Mount Everest's peak without the aid of supplemental oxygen.

Increased Fluid Intake

  • Peak Performance notes that athletes run a risk of dehydration at higher altitudes due to drier air. To counter this, it recommends a "net increase" in fluids for better performance.
  • Peak Performance also advocates for the avoidance of diuretics such as tea, caffeine, and alcohol that increase loss of fluids. Dr. Jason Baker at Natural Athlete Clinic particularly warns about alcohol, further adding that high altitudes exacerbate the effects of alcohol. Alcohol affects the hemoglobin's ability to circulate oxygen, which is detrimental to performance.

Anti-oxidant and Anti-inflammatory Foods

  • Natural Athlete Clinic asserts that foods with anti-oxidant and anti-inflammatory properties are key to protecting the body's immune system from the additional stress brought on by high altitudes.
  • Dr. Baker recommends colorful vegetables and fruits such as strawberries, carrots, yellow bell peppers, purple eggplants, and blueberries. He further points out that dried fruits are an easy and portable way for athletes in high altitudes to get their anti-oxidants, vitamins, and minerals.

Quality Carbohydrates

  • Dr. Baker affirms that training at high altitudes increases the use of carbohydrates as a potential source of fuel, compared to training at sea level.
  • He, however, cautions that quality carbohydrates such as oats, bananas, sweet potatoes, and dates, are better than carbs derived from sugary foods and refined grains like candy bars and gels.

Foods Rich in Iron

  • High altitudes are said to boost the production of red blood cells that aid in increasing the circulation of oxygen throughout the body. Iron is a critical component of this process, and Dr. Baker advocates for the consumption of foods such as chicken, pork, salmon, lean beef, and eggs to increase levels of iron.
  • The article notes that calcium-rich foods should not be consumed together with the foods listed above as they are said to inhibit the absorption of iron. Dr. Baker lists milk, tea, and coffee as examples of calcium-rich foods.

Research Strategy

To provide insights on the recommended diet as per expert consensus for optimal performance at higher altitudes, research began by identifying companies or individuals focused on high altitude performance. Uphill Athlete, Peak Performance, and the Natural Athlete Clinic were identified by research as providing relevant information to this brief. Expert consensus was determined by experience and qualification-merits that were apparent in all 3 companies. Uphill Athlete trains in alpinism, the art of climbing the most complex mountains, and helps train world-class mountaineers such as Adrian Ballinger. Peak Performance has 28 years of experience in developing maximum athlete performance, and Dr. Jason Baker, the founder of Natural Athlete Clinic, is noted as an expert in preventive medicine and natural health care.
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