Rethinking Your Energy Supply

On May 27th 2017, Adrian Ballinger summited Mount Everest without supplemental oxygen. This is an accomplishment that less than 200 people have achieved and followed a failure to summit the previous May of 2016. The 41 year old seasoned climber attributed his failures to the cold, which could have been aided by more muscle and fat content, better insulated jacket and gloves, but he wondered why his climbing partner, Cory Richards so easily made it to the top. Ballinger came to realize it that wasn’t his gear or body composition, but it was that Richards had a different approach to training and nutrition that gave him the edge to summit. Richards trained with a organization called Uphill Athlete that trains its athletes to become a fat burners. After hearing of Richard’s training regimen Ballinger was determined to pursue the same for a another summit attempt in 2017. Ballinger was a carb burner, which means he was relying on burning carbohydrates for energy. When he attempted to summit Everest being a carb-burner, he simply ran out of energy to fuel his body through the last grueling stretch. This was due to depleted glycogen levels that a carb-burner relies on. The average human can only contain enough carbohydrates to supply glycogen stores for about 45 minutes. Once your glycogen stores are depleted, you need to refuel, which in Ballinger’s case, would mean pulling a hand out of a mit in the frigid Everest air to replenish his energy every 45 minutes. This is also known as “bunking,” which means completely exhausting your energy supply, which is what happened to Ballinger. Richards on the other hand, was a fat burner. With alterations in Ballinger’s nutrition and training regimen, he was successful in 2017.

But what is a fat burner?

A fat burner is an athlete that primarily uses fat for energy, and this metabolic process is called fat oxidation. When an athlete is exercising on a typical high carb and low fat diet, they are burning about a 50/50 mix of carbs and fats during steady exercise. If that athlete decides to sprint at full speed being a carb burner or a fat burner, they are primarily burning carbohydrates, known as glycogen. This is the body’s evolutionary design to have instant energy to run away from the tiger when it storms your cave. In Ballinger’s scenario, the high intensity of Everest climbing was like a sprint, depleting all of his glycogen stores causing him to “bunk”.

Why is a fat-burning diet better for climbing?

Being a fat burner for a long distance endurance athlete is beneficial because it eliminates the need to refuel every 45 minutes, which is bothersome. Ever wonder why there is a plethora of fancy sugary “sports” drinks, gummies, and energy bars at sporting stores? They are called “energy” foods, because they are loaded with simple carbohydrates and sugar. On the other hand, a fat burner does not need refueling foods or drinks during exercise, but relies on the extensive supply of fat throughout the body. Even the most elite athletes with very low body fat will have enough to supply the body energy for a event. Picture this, there is a giant fuel tanker truck cruising on I-70. The truck has its own fuel tank which sits below the cab of the truck, which will be depleted in a couple hours. What if the truck could access the large tank that it’s hauling? That would give the trucker a enough fuel to drive for days! In the context of nutrition and your body, the small tank is the your glycogen storage and the large tank is fat storage. This is why some people can fast for days without skipping a beat; they have tapped into their fat supply.

What does it take to become a fat burner?

To become a fat burner, it’s quite simple: cut the carbohydrates. Well, I guess some may think it’s not so easy. You have to cut out pizza, bread, candy, tortillas, and all that good tasty stuff. When a person limits their carbohydrate intake to less than 10% of caloric intake, and increase fat consumption to 70% of their intake, their body shifts into a different mode of creating energy, by burning fat instead of carbs. The by-products of fat oxidation are called ketones. When a person converts to being a fat burner, it is called being in ketosis. This process may take a few days to weeks, which varies from person to person.

Is there any research behind this crazy idea of eating all the bacon and butter you can handle? ….Yes, yes there is!  

In the research article by Volek et al. (2015), the authors wanted compare a low carbohydrate ketogenic diet and a typical high carbohydrate diet in 20 elite endurance athletes. The authors tested the athletes with a 180 minute, moderate intensity (64% VO2 max), treadmill run.

VO2 max is known as the capacity of your cardiovascular system and its ability to distribute oxygen throughout the body. Higher means a stronger cardiovascular system, so 64% of your maximum effort would be considered moderate exercise.

A 64% VO2 max to you or I would be a brisk walk or a slow hike up the that beautiful 14’er, but for these Ironman athletes it was a easy run on a treadmill. The authors compared the rate of fat oxidation and carb oxidation between the two diets, as well as their ability to recover and replenish their glycogen stores. The authors found that the fat adapted athletes had 2.7 times the rate of fat oxidation than the high carb diet athletes. The low carb group also had fat oxidation at higher VO2 max, meaning they could go faster without tapping into their precious glycogen stores. The study also found that after the exercise, the athletes in both groups had similar glycogen level in their muscle. This is significant because the classic rule of thumb with exercising is that you need t a post-work shake with protein and carbs to replenish your muscles, or your exercising efforts are gone to waste…WRONG! It turns out your body has its own way of replenishing its glycogen stores without the post workout carb load. That means after you climb that 14’er, you don’t necessarily have to stop at the local brewery for carb-tastic IPA, but I don’t judge you if you do.

In another research article by Hetlelid et al., they wanted to compare the levels of fat and carb oxidation levels between nine well-trained (WT) runners and nine recreationally-trained (RT) runners during a high-intensity interval training session (HIIT). There was no difference in diets amongst the participants is the study. The study found that the WT runners had a three times higher rate of fat oxidation than RT runners and increased performance with higher VO2 max. The author attributed the increased performance due to the higher rates of fat oxidation. These athletes were consuming a normal carb-ful diet, which makes me wonder what the difference would have been if they were fat adapted.  

So, let’s get down to why all this mumbo jumbo is important to your next trip to the high country. Many outdoor activities that we enjoy in the summer like hiking, biking, climbing, etc. all require significant energy to supply for all day fun. Take climbing a 14’er for example. You will most likely be climbing for several hours, depleting your energy stores as you climb being on a high carb diet. You have to stop, refuel, start up climbing, stop and repeat. As a fat adapted climber, you could sail past your carb-comrades with ease, not depleting your glycogen stores all day, all while burning some of that winter Christmas cookie belly in the process. As we examined the two research articles, we also found that higher fat oxidation could mean higher VO2 max levels. What does this mean for your next trip to high altitude? That’s right, better usage of the less available oxygen level in the high country and improving oxygen delivery throughout the body. If you want to be the best Balliger you can be on the mountains this summer, rethink your energy supply and consider life in the fat lane! 

So, here are some personal tips to becoming fat adapted…

-Give you body at least 3 weeks to become adapted before any highly strenuous activity, climbing a 14’er

-Hydrate, hydrate, hydrate with water and balanced with electrolytes

-Consult with your physician before drastically changing your diet

-Choose foods high in natural fats (eggs, nuts, olive oils, avocados, meat, fish, dairy) stay away from unhealthy trans fats

-Intermittent fasting can help you transition into ketosis faster (12-16 hrs)

 

Hetlelid, K. J., Plews, D. J., Herold, E., Laursen, P. B., & Seiler, S. (2015). Rethinking the role of fat oxidation: Substrate utilisation during high-intensity interval training in well-trained and recreationally trained runners. BMJ Open Sport & Exercise Medicine, 1(1). doi:10.1136/bmjsem-2015-000047

Volek, J. S., Freidenreich, D. J., Saenz, C., Kunces, L. J., Creighton, B. C., Bartley, J. M., . . . Phinney, S. D. (2016). Metabolic characteristics of keto-adapted ultra-endurance runners. Metabolism, 65(3), 100-110. doi:10.1016/j.metabol.2015.10.028

http://www.adrianballinger.com/about/

A Query on Mt Quandary

A personal story of acute mountain sickness (AMS)

Disturbing the “Locals”

“Race ya down”, my friend Liz took off from the summit of Mt. Quandary. Ahead of us stood a 2 mile scrabble through a boulder field with a 1 mile decent down a winding trail through the forest where we would descend from 14,265’ to 10,850’. In my experience, a 6 mile hike with 3,400 vertical feet was no feat. However, something was different as we approached the cars at the end of the hike. I noticed the start of a headache and I held onto the car to keep myself from swaying while taking off my boots. Thinking this was merely dehydration I finished my 3 liters of water – but that did not help. Once in the car my head continued to throb as we drove over Hoosier pass. Incoherently I mentioned that we should stop for Gatorade but the 64 oz of Gatorade did not abate my symptoms. In fact they worsened, my symptoms included severe dizziness, nausea, and a pounding headache. While my memory was hazy I knew this was not dehydration, maybe this was acute mountain sickness? But how could it be? I was in shape, lived at 5,400’, and this was my 5th 14er that summer. Was it possible to have AMS on the same peak I had climbed just weeks prior?

Standing on the summit of Mt. Quandary

My name is Chris Whitcomb and I am a 3rd year PA student at the University of Colorado. This story is all too familiar for anyone who spends time at elevation. Thankfully by the time we hit Idaho Springs, 7,526’, my symptoms dramatically improved. After reviewing my case and talking it over with my peers I believe that I developed AMS with some elements of HACE mixed in. A quick calculation of the Lake Louise Score came in at 6, which would classify this episode as “severe AMS”.

Who is most susceptible to AMS?

A prospective study analyzed a total of 11,182 workers on the Quighai-Tibet railroad in Tibet. This study identified 6 independent risk factors for AMS such as: rapid ascent to elevations above 3500 m (11482’), sea-level or lowland newcomers, young people of age, heavy physical exertion, obesity, or SaO2 below 801 Another study in 2013 looked into various other predictive indexes for AMS and found that the level of activity (higher activity) and sex (male>female) lead to increased odds of AMS 2. A quick review of the above criteria showed that I was the perfect demographic for AMS. I am a young male who was exerting myself physically at altitude.

Will this stop me from hiking at elevation?

Not one chance! Last summer alone my wife and I backpacked and hiked over 250 miles in Colorado. Since the incident I now make sure that I have the ability to seek lower elevation if needed during all our outdoor adventures. I also pay close attention to how I am feeling as we ascend.

Should I take acetazolamine/Diamox before backpacking trips because of my past AMS episode?

A meta-analysis in 2015 looked at 7021 individuals to see if a past episode of AMS warranted medication to prevent future AMS episodes. Interestingly enough they found that the literature did not support it. This was in part due to the sporadic nature of AMS 3I personally do not take a prophylactic medication before hiking at elevation, but this would be a great conversation to have with your medical provider if you are at all concerned.

Chris Whitcomb, PA-S3
University of Colorado
Class of 2018

References

  1. Wu TY, Ding SQ, Liu JL, Jia JH, Chai ZC, Dai RC. Who are more at risk for acute mountain sickness: a prospective study in Qinghai-Tibet railroad construction workers on Mt. Tanggula. Chin Med J. 2012;125(8):1393-400.
  2. Beidleman BA, Tighiouart H, Schmid CH, Fulco CS, Muza SR. Predictive models of acute mountain sickness after rapid ascent to various altitudes. Med Sci Sports Exerc. 2013;45(4):792-800.
  3. Macinnis MJ, Lohse KR, Strong JK, Koehle MS. Is previous history a reliable predictor for acute mountain sickness susceptibility? A meta-analysis of diagnostic accuracy. Br J Sports Med. 2015;49(2):69-75.

Does Hypoxia Prevent Cancer?

Summit Daily News recently published an article based on research in the Journal of the American Medical Association showing Summit County                                                                                                       with the lowest cancer rate in the nation FOR 30 YEARS. Are people moving away when they get cancer? No, they are treated in Vail, Denver                                                                                                      and now the St. Anthony Summit Medical Center.  Do we have fewer older people? No, there is a large percentage of retired residents.

The report shows stark differences in regional cancer death rates : detailed estimates for deaths from nearly 30 types of cancer in all 3,100 U.S. counties for over 35 years.From 1980 to 2014, the U.S. death rate per 100,000 people for all cancers combined dropped from about 240 to 192 — a 20 percent decline. More than 19 million Americans died from cancer during that time, the study found. Healthy lifestyle with low rates of obesity and smoking and increased physical activity contribute to low cancer rates in the mountains.

The picture was rosiest the Colorado ski country, where cancer deaths per 100,000 residents dropped by almost half, from 130 in 1980 to just 70 in 2014;

The air is thinner up here!

More and more people of all ages travel to  and reside in the mountains. Scientists and health care providers are just beginning to discover the effect of high altitude on health.

I have practiced medicine in Frisco, Colorado at 9,100 feet since 2000. Before that I worked on Saipan at sea level for 20 years. The difference has made me aware of special considerations when caring for people from newborns to retirees at high altitude. Simple measures can be taken to save a vacation or preserve an active life style in the mountains.  All visitors who are not pregnant should consider taking Diamox (acetazolamide) starting two days before travel. Tourists and residents should buy an inexpensive home pulse oximeter to monitor oxygen levels.  Anyone staying for more than a week should pursue testing for night time hypoxia and pulmonary hypertension when experiencing difficulty sleeping, fatigue or trouble breathing

Read articles on the Ebert Family Clinic Website for more information. I will add new information, discuss symptoms and diagnoses, and respond to questions. We have a power point available to interested groups. Personal evaluations and consults can be scheduled at Ebert Family Clinic with myself for children and Laura Amedro FNP for adults or children

Hi altitude Conference- peoples final.