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go2altitude Newsletter: BLOOD TESTING AT ALTITUDE


Many climbers undergo bloods to measure certain altitude-related parameters within the body to assess how well the body is adapting. The most commonly assessed parametres includes:

FBC ...
(or Full Blood Count) which is a measure that includes just about everything. However in particular the most significant indicators tend to be red blood cell counts, hematocrit and hemoglobin.

Red blood cells (RBC) - It is these cells that carry oxygen and make up between 35-50% of the total blood volume. To some extent the more red blood cells you have, the greater the body's ability to deliver oxygen to working muscles. Altitude exposure increases red blood cell, which in turn leads to a greater availability of oxygen to working muscles allowing the athlete to work harder (i.e. Go faster for longer).

Hematocrit (or [Hct]) - Is an expression of red cell volume as a percentage of the total blood volume. In a normal adult it tends to be between 40 to 45%. An optimum hematocrit is a balance between maximising oxygen carrying capacity and how thick (or viscose) the blood becomes - making it harder and harder for the heart to pump. When Hct increases above 50% there is an exponential rise in this viscosity. With endurance training, however, there is a decrease in viscosity (because the plasma volume expands - which is the solution in which the RBC float), as well as increase in the pliability of the RBC, making the blood more fluid. Hct do become dangerous 55% or above. It should be noted if you can elevate your Hct by 25% (from say 40 to 50%) you'll be making any additional 25% more oxygen available to your working muscles. Short of cheating by injecting an illicit substance, altitude simulation can help you to achieve this.

Hemoglobin (or Hb) - Is the protein that binds and carries oxygen on the RBC. At high oxygen concentrations (in the lungs) Hb binds oxygen. It then travels (to areas of low oxygen concentrations (e.g. Working muscle cells) where the Hb releases the oxygen. As a consequence of altitude, the resultant greater circulating Hb increases the oxygen-carrying capacity of the blood.

EPO...is a hormone that regulates the growth and development of RBC and Hb from stem cells of long bones. Measuring EPO concentrations in the blood can be used to determine the potential of the body to increase RBC production and hence improve oxygen delivery to the tissues.

Within hours of altitude exposure, EPO concentrations increase significantly by as much as 40% hitting maximum levels within 72 hours.  The higher the altitude the greater the EPO response. If the athlete stays at altitude this response levels out within a week, but stays elevated relative to sea-level conditions.

FERRITIN ... (or Serum Ferritin) is a common indicator of iron stores, which in turn are an indicator of Hb production. A low ferritin can be indicative of iron deficiency - not an uncommon occurrence for athletes traveling to altitude for the first time and not being aware of the increases in RBC production and hence the potential for iron depletion which eventually results in over-training syndromes, a lowering of athletic performance and illness.

There are various papers that indicated iron supplementation may be beneficial to athletes training at altitude. However iron supplementation should not be undertaken without first consulting with a knowledgeable physician in the area and discussing your intentions. If the doctor agrees that you have a greater need for iron it is suggested you start taking 200-300mg of iron/day 3-12 weeks before undertaking  altitude exposure. Remember, excess iron intake is toxic and in extreme cases lethal - so take care.


To perform at your best you have to be optimally fueled. At altitude this becomes even more important because of the additional physiological stress the body is placed under compared to sea-level dwelling. When exposed to altitude, many athletes actually have a lowered appetite as their basal metabolic rate increases. This lowered inclination to eat coupled with a higher energy output can cause all sorts of micro-nutrient deficiencies as well as significant weight loss. The greater the different between energy intake and energy output the more likely these problems become.

Dehydration is another problem associated with actual and simulated altitude. Since the relative humidity at altitude is lower than at sea-level, the air that you ventilate draws moisture out of the body (via the respiratory tract). Given that you are initially breathing harder, deeper and regularly at altitude the body loses vital fluids even more rapidly. It is therefore important that athletes consume considerably more fluid (ideally water) than they otherwise would at sea level.

In relation to specific dietary changes, there is no specific diet that athletes should be prescribed when training at altitude. There are however some useful guidelines to consider.

Eat a wide variety of foods early and often. Monitor your body weight and try to maintain energy balance. Increase your carbohydrate (and possibly protein) intakes. Diets need to be tailored to individual athletes, however an increase in carbohydrate and protein is pretty much standard and for those athletes struggling to maintain energy balance fat can be added back into the diet if a stable body weight cannot be maintained. Drink early and often. At altitude your fluid requirements may exceed 5 liters per day. Using sports drinks can help provide fluid as well as extra carbohydrate. Even though there is some dispute over the necessity of vitamin/mineral intake at altitude, there is certainly no harm in adding a daily multi-vitamin/mineral supplement to the diet to ensure adequate intakes of these micro-nutrients. For example, a drop of as little as 10% in Hb concentrations (due to inadequate iron intake) can lower performance by a staggering 20-25%. So stay on top of your dietary practices when traveling to altitude or using any altitude simulation equipment - remember altitude is a physiological stressor and your body is going to need all the appropriate nutrition to deal with that.


1. Ruud J, Lickteig JA. The Height of Good Nutrition. Today's Dietician. 2002, 28-31.
2. Berglund, Bo. High-altitude training-aspects of haemotological adaptation. Sports Medicine. 1992; 14(5):189-303.
3. Puranen AS, Rusko HK. On- and Off-response of EPO, reticulocytes, 2,3-DPG, and plasma volume to living high, training low. Medicine and Science in Sports and Exercise. 1996;28:s159.

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