Portrait of a High-Altitude Athlete: The Ultra Mountain Athlete

Yuki Ikeda has been a professional cyclist for the past 10 years. He’s won titles in both Japan and the US. Interestingly enough, however, he come to Colorado to study at Metro State in Denver in order to play pro basketball. He is now known as an Ultra Mountain Athlete, not only biking, but running races up to 100 miles at altitudes over 10,000 ft. Over some decaf coffee on a warm Sunday afternoon at Gonzo’s in Frisco, he tells me he tried out every semester for the college team and failed. He had never really explored outdoor recreation growing up in Japan, because he had been so focused on a career in basketball.

He started taking some classes on outdoor sports while he was in Colorado, at Metro and then at Red Rocks Community College: rock climbing, cycling, backpacking, kayaking … He ended up staying in Colorado after graduating from Metro. “At that time, I was so into mountain biking,” he says. “I decided to pursue my career in mountain biking.”

He started racing in 2002. It took him five years to accumulate sponsors and become a full-on pro. “After every season, I sent my resume — racing results and what I do — to so many teams [to see if] they [would] accept me or not.”

Ultra Mountain Athlete Yuki Ikeda

But he started to get burned out. While he was still improving his stats, he was noticing that he couldn’t maintain the lead against some up-and-coming younger racers. “I was mentally very tired the last couple of years. I was kind of frustrated. Last year, after the season, I was so bummed out, I didn’t want to ride my bike, and I didn’t feel like starting training for the next year, so I stayed away from biking. I didn’t even touch my bike for a month.”

“But I still wanted to do some exercise. I just followed my wife, running, then I kind of joined the local trail running community. They showed me where to go and where to run, and I just loved it. I was so into mountain biking only, I thought doing other sports might cause injuries and effect my career. But it was the opposite.”

His new love for running turned his career around. “Physically, I don’t know [if it has improved my biking] yet, but mentally it helped. Now, my training is still 60 – 70% cycling, but not all the time. When I get on the bike, my brain is still fresh. Before, I rode my bike every day, pushing hard every day. It burned me out.”

Last month, he ran his first ultra running race, 50K. “Last October, I got sore from just running only 5K. Now I an run 50K, so that’s awesome.” He won.

Ultra Training at Altitude

I ask him how he trains for these races. Every summer, he comes to Colorado, staying in Frisco or Breckenridge to train in preparation for a series of races at altitude. It usually takes him 10 days to almost 3 weeks before he can do the same workouts he does at sea level in Tokyo.

Threshold power key. Threshold power is the maximum power you can sustain for about 60 minutes. He has a power meter on his bike that measures the power he exerts in watts. Recently, he has also been wearing a similar device on his shoe for when he runs.

“In Tokyo, my number is 310 watts, but here, it’s almost 270 to 280. I just did a threshold test last week. So that’s almost 10 to 12% lower. But still, if it’s within 10 to 15%, that’s very good for this altitude. But I usually take the test after a week or 10 days after I get here. I cannot push myself hard enough [before that]. Even [if] you’ve adjusted to this altitude, your power number is still lower than at sea level. I feel like I’m weak, but you have to accept it. That’s just how it is.”

His next race is part of the Leadman series, consisting of 5 mountain biking and trail running races in Leadville, Colorado. This next one is 42 km. Originally, the trail takes the runners over Mosquito Pass, which is at over 13,000 ft. But this year, there is still so much snow that the trail has been re-routed, so the runners aren’t sure what to expect. But the race starts at over 10,000 ft.

To train for this, he’s been running and biking six days a week. Every morning, he measures his blood oxygen saturation using a pulse oximeter. The first morning he arrived in Frisco, it was at 92. After a couple weeks of acclimation and training, it’s pretty reliably at 96 every morning.

Pacing

Yuki claims the most difficult part about running these long races is pacing. His coach encouraged him to run “negative splits”, increasing his speed toward the end of the race. “At my first 50 km race, even though I won it, I could have paced myself better. I just went too hard at the beginning [to] take the lead and paid for it later in the race. I was so trashed after the race, I couldn’t even stand and walk.”

“My coach is saying to be careful about [hitting the wall] at altitude. It’s so hard to recover. It takes almost five times longer than at sea level. I need to pace myself, especially for running 100 miles,” Yuki says, referencing the Leadville Trail Run in August he is also preparing for: 100 miles at altitude. “I’m so excited, but at the same time, I’m so nervous. Even finishing is questionable at this point.”

Acclimation

His secret to acclimating comfortably and quickly is actually movement. He says he feels the affects of the elevation more when he’s sedentary. In order to get more oxygen to his body, he has to get his circulation going. “The first week, I feel better when I exercise than when I just sit [around]. “

Also, beets. And red bell pepper. And arugula.

He eats a limited portion of these every day he’s at altitude. These vegetables provide a lot of nitrates, which your body processes into nitric oxide, facilitating blood circulation. At altitudes over 8000 ft., where you have access to about a third of the oxygen available in the air at sea level, the key to supplementing the oxygen your body requires is increased blood flow. After a certain amount of time, your body starts creating more oxygen-carrying red blood cells to counter the deficit, so getting the blood moving is literally vital.

According to high-altitude growth and development expert Dr. Christine Ebert-Santos, nitric oxide is often the way newborn babies with complications at altitude are treated. Hypoxia (the state of receiving less oxygen than is normal at sea level) causes pulmonary vessels (in the lungs) to constrict. Putting these infants on nitric oxide gas dilates the pulmonary arteries and improves some types of respiratory distress.

There are powders marketed to aid the food version of this nutrition, including BeetElite, Yuki’s product of choice, which he’ll add to his sports drinks in addition to consuming about an ounce of roasted beets. But portion control is also important, as too much nitrate can also have a negative effect on the body.

Running Recovery

Yuki is learning that he has to deal with an interesting phenomenon when it comes to his ultra running races: it’s tough on his guts. When it comes to his diet, he doesn’t typically change anything for recovery after a long event. “But I think my guts are more tired, because your body is bouncing so much from running.”

When running these incredible distances, he fuels his body with an energy gel every 20 to 30 minutes while running. “It usually has about 100 to 120 calories. It’s a dense energy. Then you take them for five hours, continuously, so it also tires out your guts. During the race. You have to maintain your blood sugar and keep your muscles moving. My muscles are tired, but also, my intestine and stomach are tired.”

“Even water is hard on my stomach [after running a race]. I’m kinda worried about running 50 and 100 miles. I’m not only worried about my legs, but even my stomach. I’m not used to [consuming] energy for 20 hours, eating and running at the same time.”

In Japan, hot springs and bathing are also a huge, sacred part of the recovery and health ritual. He takes a hot bath almost every day, “especially in winter,” he says. “It helps me to sleep at night.”

Sleep

The first week he spends at altitude in Colorado, he finds it harder to fall asleep. “I used to take one or two melatonin capsules every night, but it’s hard to tell if it helped. I just go to bed early, like 8 or 9, even if I cannot fall asleep. I just take the time to lay down and recover. [I try to sleep] at least 7 to 8 hours a night, but sometimes it’s hard. If I can’t get that amount of sleep, I usually take a nap after training.”

This may sound obvious, but sleep is when your body does most of its recovery, both mentally and physically. Sleep experts and studies have proven that the body and brain visibly deteriorate after so much sleep deprivation. And at altitude, with less oxygen available to supply a body in constant motion, sleep may be more important than ever.

Plant-based Nutrition

Yuki isn’t the first high-altitude athlete I’ve spoken to who advocates for a plant-based lifestyle. In a recent blog, skier and duathlete Cierra Sullivan also tells us about how a plant-based diet seems to make a big difference.

“When I used to like and eat animal products a lot, my recovery time was slower than now. It was hard to digest animal fats. I believed that they had a lot of good protein, but it was so hard on your body and digestive system,” Yuki says. “It took time to change my diet, but I now feel more comfortable with my plant-based diet, physically and mentally.”

Live High Train Low

Another recurring theme among high-altitude athletes.

“One of my sponsors has an altitude tent. They leased it to me before the competition, so I used it about a month. I slept in the tent, set at about 3000 m, then I train at sea level. I think it helped a bit, but it might be too short to tell. It tired me [out], though. I think I needed to do it longer before the competition, like, two or three months. I couldn’t train well, because I felt tired all the time. But I think for altitude training, I think this elevation is almost too high. Because you cannot push to your maximum potential. For example, for cycling, I can push up to 1000 – 1200 watts at sea level, but I cannot hit that number here, so I cannot train in that range here. I can lose that high power if I stay longer here. But it depends on your [goal]. My [goal] is winning the Leadman series, that’s why I’ve come here to train.”

This is partly why Yuki will lift weights once a week when training at altitude, “to maintain my high power.” With such limited access to oxygen, athletes up here can’t reach the same “punching power” that they can at lower elevations, so lifting may help maintain that power. “Very short, maybe 45 minutes, once a week, just to maintain. Weightlifting is still supplemental for your specific sport, so I don’t want it to affect my training on my bike or running. For race week, I don’t lift weights, because lifting weights takes time to recover.”

Keeping It Fun

“My trick to keep going — the best way to improve yourself,” Yuki adds, in a final reflection, “is to keep it fun. If you’re not having fun, I think that’s not good. Last year, I almost lost my motivation as an athlete. I almost thought about quitting racing, but I still love the sport. Trail running helped me mentally and physically, and my motivation came back, even for cycling. Having fun is the key to keep going.”

Ultra mountain athlete Yuki Ikeda with high-altitude researcher and writer Roberto Santos at Gonzo’s Coffee in Frisco after an insightful afternoon interview.

Thank you, Yuki. I completely agree. And best of luck with that 100-mile trail run at 13,000 ft.! Keep track of Yuki’s race schedule, social media and stats at http://yukiikeda.net/

robert-ebert-santos
Roberto Santos on an epic powder day at the opening of The Beavers lift at Arapahoe Basin ski area.

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

Nocturnal Pulse Oximeter Study

    “I’ve never had a patient with a normal overnight pulse oximetry study,” said Tara Taylor, Family Nurse Practitioner at Ebert Family Clinic. She has been a provider there for a year, after 14 years working as a nurse in the intensive care unit at Swedish Hospital. Of course, the study that tracks oxygen and heart rate during sleep is usually performed on patients with symptoms such as snoring, fatigue, poor-quality sleep, attention deficit, depression, or high blood pressure.

    What is normal for healthy adults at altitude? When would sleeping on oxygen help cure or prevent some of these symptoms? Do we even notice when we’re being deprived of oxygen while we sleep?

These are the questions addressed in a new investigator-initiated research trial at Ebert Family Clinic. The catalyst for the study was a conversation between Dr. Christine Ebert-Santos and Annette Blakeslee FNP at the 7th World congress of Chronic Hypoxia in La Paz, Bolivia in February. Annette is the provider for the US Embassy staff at 12,000 ft elevation. State department officials spend months or years on assignment there, and Annette wanted to know when she should be concerned. Local residents living at altitude for generations are adapted, while people living in La Paz and Summit County for months or years are acclimatized but still at risk for conditions caused by the low-oxygen environment.

    The study, called “Overnight Pulse Oximeter Study at Three Altitude Sites”, will recruit healthy adults ages 20 to 65 years. Participants will fill out a health questionnaire, take home a simple monitor worn on the finger and wrist to wear during sleep, and return the monitor the next day. Ebert Family Clinic staff will download the data for further analysis. Participants will be notified by a provider regarding the results of their study. De-identified data will be transferred to Excel spreadsheets from which graphs and charts can be generated.

    Besides dividing participants into three different altitude ranges between 7,000 and 12,000 feet, data will be analyzed by age groups and symptoms. “Everyone responds to altitude differently,” states Dr. Ebert-Santos. “There are hundreds of chromosomes that affect our ability to adapt. Many studies show the benefits of living in a low-oxygen environment, but a small percent of us will do better sleeping on oxygen. We are hoping this study will establish normal values and suggest who should be evaluated further.” — Dr. Christine Ebert-Santos

For more information, or to become a participant in this sleep study, residents of altitudes 7,000 ft. or above in Colorado for at least 6 months and between the ages of 20 and 65 years old should call Ebert Family Clinic at (970) 668-1616.

Metabolism at Altitude : Preventing Acute Mountain Illness through Strategic Nutrition

Last September, my friend and I decided to go camping. We chose an area close to Silverthorne, Colorado (9,035 ft.) and decided to camp above tree line at around 11,000 feet. Both of us were endurance athletes and had done camping trips at altitude many times without complications. We considered ourselves in great shape and ready for any adventure. 

We departed from our home in Fort Collins (5,003 ft.) in the morning and arrived at the trailhead before noon. We were well prepared and had plenty of nutrition in our 40+ lb.-backpacks. The start of the trailhead was at 9,035 ft and we had to hike 7 miles to our destination at 11,000 ft. We were well hydrated, built our camp and went to bed. Both of us had mild edema to our extremities, but nothing that we were worried about as we had experienced these symptoms on multiple hikes to higher elevations in the past. 

We spent the next day hiking above tree line, staying hydrated and fueling with high-quality calories. We have learned from personal experience to eat even when we do not feel like it. We both have experienced weight loss of about 5-10 lbs. per week when camping and hiking above 10,000 ft. 

We did a 7-mile exploratory hike along the ridge line at 11,000 ft. the next day, again, staying hydrated and consuming plenty of calories. We returned to camp when my partner first mentioned a mild pounding headache. He drank more fluids, had dinner and went to bed. 

Rewarding views, in a tent at altitude!

I woke up at around midnight due to my partner running out of the tent. He vomited once and returned to the tent. Something else seemed off. He did not zip the tent door shut when he returned. He mumbled that his head was hurting and kept his head elevated as it relieved the pain to some degree. A few hours later, he vomited again. 

The next morning I proposed that we should pack up camp and hike down the mountain, as he continued to complain of a pounding headache. He refused and wanted to go hike some more. I left the tent site first, walked a few steps and turned around: he was sitting down, staring at the ground. Now I started to really get worried as he was an amazing endurance athlete with a never-ending hunger for adventure. This was not like him. 

I decided to pack up the tent, whether he liked it or not. We needed to get off the mountain before his condition worsened. 

After many attempts, I was finally able to convince him to come with me, and we started our descent. Between 11,000 ft. and 9,000 ft. we walked slow, as his coordination was slightly limited. As soon as we reached 9,000 ft., he started to improve: he started to walk faster, was more coordinated, and communicated more. By the time we got back to our car, he was back to his normal self, however he still had a lingering headache. 

The effects of altitude on his body were very surprising. He demonstrated some classic symptoms of what the high altitude medical community refer to as “HACE”, High Altitude Cerebral Edema: headache, vomiting, confusion, and ataxia (a loss of control of body movement). The experience was unexpected and scary. Cell phone reception is very limited in the backcountry and if his condition would have worsened, this trip could have ended in a very bad situation. 

Summit County, Colorado is a beautiful place to explore the outdoors, hiking and camping. I recently had a conversation with an avid outdoorsman who calls Fort Collins (4,982 ft.) his home and enjoys hiking and camping in Summit County at elevations ranging from 9,000 ft – 12,000 ft. He stated that he consistently experiences unwanted weight reduction of around 5-10 lbs. in body weight per week when living in the backcountry at elevations above 9,000 ft.

Is this weight loss related to increased activity without adjusting calorie intake? Could this weight loss be related to exposure to higher elevation and possible changes in metabolism? How can one keep track of calorie-cost and anticipate the inevitable stress on the body at altitude?

Compare your activity level

A GPS or even a pedometer can help measure and compare activity. An increase in miles or steps compared to baseline may require caloric adjustment in order to prevent weight loss. Calorie input should equal calorie expenditure in order to prevent weight loss. It is important to take into consideration that hiking in the mountains usually requires a high level of physical performance due to elevation gain and loss as well as walking on uneven surfaces which result in increased muscle recruitment.

Increased basal metabolic rate (BMR)

According to Dünnwald et al. (2019), exposure to higher altitude increases BMR initially as the body is adapting to the hypoxic environment. The study concluded that increased sympathetic activity and hypoxia may be responsible for the increase in BMR. Due to more extreme exposure to elements such as cold, wind, rain and snow, involuntary shivering may also contribute to an increase in calorie expenditure and should be considered when preparing for the backcountry.

Decrease in appetite

Another factor contributing to possible weight loss may be related to a lack in appetite. Research on the cause of high altitude anorexia is ongoing, however some researchers believe there may be a correlation between a change in appetite-stimulating hormones at altitude. A study by Shukla et al. (2005) found a decrease in total levels of the appetite-stimulating hormone ghrelin, peptide YY, glucagon-like peptide-1, and leptin at initial exposure to altitude. Pre-packaging and scheduling meals while hiking at altitude may aide in the prevention of weight loss during backcountry activities.

Muscle atrophy

Chaudhary et al. (2012) propose that changes in protein turnover in hypoxic environments may be related to muscle wasting, including a decrease in protein synthesis and an increase in protein degradation. To minimize muscle atrophy, it is important to consume high protein foods frequently. Amino acids may also aide in protein synthesis. Packing snacks with high nutritional value can prevent weight loss. Nutrition labels on food items are a great way to identify optimal snacks.  

Hiking in the backcountry on a multi-day trip requires preparation. I choose high-calorie foods that taste good, are light to pack, and have minimal waste. I make breakfast and dehydrated meals at home and put them into individual bags that only require me to add water. Making your own dehydrated meals allows you to avoid unnecessary additives. I supplement throughout the day with high calorie snacks. If I have room in my pack, I also add what I call “novelty” backcountry foods, such as cheese and wine – it is important to splurge every once in a while, even if you live in a tent. 

Great foods for the back country:

  • Butter or Coconut Oil coffee: many companies make pre-packaged individual coffee. One cup of butter coffee is around 200 calories.
  • Perfect Bars: 1 Bar has around 300 calories and 17 grams of protein. 
  • Pro Bars: 1 Bar has 390 calories, they are light to pack and taste great.
  • Nuts and seeds: easy to pack, great source of healthy fats, calories and protein
  • Jerky: we make our own elk jerky. It is a great snack throughout the day with healthy protein and added salt. 
  • Apples: It is difficult to get fresh fruit in the back country. Apples are easy to pack, last for a long time and allow you to get vitamins and fiber. 
  • Dehydrated fruits and vegetables: great addition to oatmeal in the morning and your dinner at night. Dehydrated fruits and vegetables are easy to make at home, very light to pack, and you can rehydrate them in the backcountry. 
  • Oatmeal with protein powder: we pre-package oatmeal with dehydrated fruit and a scoop of our favorite protein powder in individual bags. Just add water and you have a fantastic-tasting and calorie-rich breakfast. 

Every backcountry excursion should be well planned and it is always better to be over-prepared. It is crucial to be knowledgeable about what foods need to be consumed and when, in order to prevent negative outcomes. Know the distance and elevation changes on your trip, prepare for changes in weather, plan your calories out for every meal on every day, and make a schedule to prevent complications related to nutrition. 

Most importantly: enjoy the beauty of the high-elevation backcountry!

Angi Axmann Grabinger is Nurse Practitioner student at the University of Northern Colorado. Angi’s passion in healthcare involves disease prevention and integrative medicine. If Angi is not studying, working or gardening, you can find her exploring the mountains running or hiking. 

References

Chaudhary, P., Suryakumar, G., Prasad, R., Singh, S.N., Ali, S., Ilavazhagan, G. (2012). 

Chronic hypobaric hypoxia mediated skeletal muscle atrophy: role of ubiquitin–proteasome pathway and calpains. Retrieved from: https://link.springer.com/article/10.1007%2Fs11010-011-1210-x

Dünnwald, T., Gatterer, H., Faulhaber, M., Arvandi, M., Schobersberger, W. (2019). Body 

Composition and Body Weight Changes at Different Altitude Levels: A Systematic Review and Meta-Analysis. Retrieved from:https://www.frontiersin.org/articles/10.3389/fphys.2019.00430/full

Shukla, V., Singh, S.N., Vats P., Singh, V.K. , Singh, S.B., Banerjee, P.K. (2005).  Ghrelin and 

leptin levels of sojourners and acclimatized lowlanders at high altitude. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/16117183

Portrait of a High-Altitude Athlete: a Medical Student’s Philosophy of Training and Preparedness

When I first met Cierra Sullivan, I had been preparing for a year abroad in Japan to continue my Japanese language studies, and she was working on her Bachelor’s in Molecular, Cellular and Developmental Biology at the University of Colorado in Boulder. We didn’t have much of a chance to connect before I left the country, but through social media, we were able to follow each other’s passion for extreme sports and the remote outdoors. I ended up in Japan for several years while Cierra graduated from CU, finished a Master’s in Nutrition and Metabolism at Boston University School of Medicine, grew a career as a competitive athlete and high country adventurer, and found a deeper path into Naturopathic and Chinese medicines, in which she is completing a Doctorate and Master’s respectively.

Her resume is an impressive timeline of contributions to every aspect of her academic experience, and studies and volunteering have taken her from both US coasts, South America, Africa and back, working with underprivileged communities in several languages, providing aid, health care, and opportunities for children of underrepresented demographics, just to name a few of the projects on the long list.

itu-world-championships
Cierra Sullivan (center) at the Duathlon ITU World Championships, July 2018 in Odense, Denmark, with teammates Emily Allred (left) and Alex Veenker (right).

Now that we’re both back in the continental US, we’ve had more opportunities to share about our mutual passions, and I was finally able to get some time with her over the phone to really talk about her philosophy of health care and how she represents that in her active outdoor life. In addition to her experience playing basketball, rugby and golf, she continues to compete nationally for Team USA as a duathlete, and is currently seeing her fourth consecutive year of having skied every single month.

Why Naturopathic and Chinese Medicine?

Her background in Western medicine made her aware of the lack of focus on nutrition in the United States, which she believes is essential not only to healing, but more importantly to disease prevention. Naturopathic medicine “is a focus on healing from the inside out,” she tells me. “I really value the patient-physician relationship,” she continues. The ever-looming presence and power of insurance companies means the interaction between physicians and their patients is constantly restricted by time and money.

She says her experience in Naturopathy and Chinese medicine has put more emphasis on the mind-body experience, first doing no harm, and the importance of doctor-as-teacher philosophy. When it comes to health, there are some fundamental similarities; Western and Eastern medical practitioners both recommend exercise and drinking plenty of water. The main difference, she speculates, may be in the definition: “What is it to ‘eat healthy’ and ‘stay hydrated’?”

The essence of her philosophy of nutrition is simple. Even in preparation for the many physically strenuous expeditions she trains for, she tries to maintain a minimally-processed, plant-based lifestyle. Even the companies that sponsor her as an athlete create products that adhere to her strategy of nutrition. Being so particular about the products, both what she puts on her body and in it, she looks for products that value the same things that she does, products that are more beneficial to the body, with no extra colors, preservatives or fillers. Ultimately, she wants to be able to reduce recovery time and enhance performance.

The Mental Game

trail-running-with-doggo
Trail running in Forrest Park out in PDX.

Cierra tells me she wasn’t always so passionate about the outdoors, having been more immersed in playing basketball when she was younger. But she had always been competitive, and playing sports her whole life, gradually shifted from traditional indoor sports to the wild outdoors. She started climbing and cycling when she was in Boulder, then did a duathlon (running and cycling). “You do a few races, then you get hooked. You see results on the board and it motivates you.”

Her growing experience being an athlete in the outdoor arena fostered the idea of being present in any moment, whether it’s inside, or out with nature. “Ultimately, you learn to set boundaries and cut out all the noises and distractions of social media.” Now, after a brief hiatus from all of that, she has a renewed relationship with her online presence, motivated by the opportunity to share her lifestyle and philosophy and stay in touch with friends and family, which she says is better portrayed in photos than in words.

But her mental strategy remains a strong part of her training, preparation, and execution when it comes to the outdoors and altitude.

“For high altitude excursions, decision-making and mind set are always going to be the challenge. Knowing when to turn around when conditions aren’t right, constantly watching the weather, [being aware] if someone’s not keeping up.” She tells me this is the most difficult aspect of her career right now. And I completely appreciate it. For all the trekking our research team does at altitude, I agree every time she says “you’re only as strong as your weakest team member,” an old proverb we’ve both learned to live by. Although when it comes to the high altitude excursions we’re talking about, I don’t think either of us would use “weak” to describe any member of our team.

She tells me she’s bailed on plans to ascend Mt. Hood for not having fallen asleep by the time their alarms went off before 3 am. “[You] can’t let your ego supersede the safety of everybody in the group. You have to push yourself outside your comfort zones, but you have to do it smart. Even expert backcountry rescuers get stuck.” And it’s not because they’re inexperienced. It’s because conditions outdoors can easily overwhelm even the most experienced bodies.

The Physical Game

Staying active, consistently challenging her body, and consistency are large parts of her strategy when it comes to optimizing her condition at altitude. She says she pays more attention to self-care and exercise than some of her more stressed colleagues in her Naturopathic and Chinese medicine programs, which, for her, looks like a lot of time outside over weekends and breaks.

“Live high and train low might be best for the access to oxygen,” she recommends. I’ve heard the phrase before, but honestly, I’d never really put much thought into it. I’d just always assumed it was most efficient to live and train at altitude. But the way she puts it, having more access to oxygen at lower elevations allows you to train longer and harder, so you’re more physically prepared for long treks at higher elevations. Combine that with the oxygen deficit during recovery and you have a recipe for hard training and increased red blood cell production to maximize performance. And I do admit, training at 9,000 ft. in Summit County is grueling, even for a resident, and I can definitely go longer and harder when I’m at a lower altitude, especially sea level.

She ski tours for hours to train for cycling and running events, saying, “if you can sustain a low Zone 2 workout for 5 or 6 hours [at altitude], you’re set at sea level,” referring to the heart rate zones. (I’ve found a great description of the five zones on Pivotal Fitness’s website.)

The hardest part of acclimation for Cierra, she says, is “being patient for your body to catch up.” She’s really conscious about continuous snacking and water. “I sweat easily, so I switched to Merino wools, adjust layers, and avoid being soaked and getting cold.”

high-altitude-family
Cierra with the family, Olli and Jackie Shea, out for daily exercise at Mary Jane in June 2018

When she prepares for the monthly ski trips, she carb loads, increases fats, does lots of endurance training, stays hydrated and nourished, and makes sure she gets enough quality sleep.

The Gear Game

I ask her what tools or resources she most consistently relies on. I’m expecting some top trade secrets, but, luckily for us, they’re pretty standard and more or less obvious:

“When it comes to winter-time skiing, definitely get to know your [local] avalanche forecasters; avalanche reports are key. Apps like Gaia and Caltopo are great for route planning, but having a GPS spot and being competent with a compass and a map are way undervalued in our tech-loaded society. Of course a good dose of common sense goes a long way, even if the avy report is green, make sure you have your avalanche gear, headlamps, and enough water. Extra high-fat bars that can get you through a 24-hour emergency, confidence in who you’re going to be out with. Layer appropriately. Don’t go above the skill of your weakest member. Food is my comfort thing. Snacks.”

We’re hoping to get some of her time and expertise in the Ebert Family Clinic and on the high altitude research team next summer, but in the meantime, you can follow Cierra’s minimally-processed, plant-based, outdoor adventures on Instagram.

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.