Drug-food interactions in mountaineering

University of the Basque Country researchers have studied the
nutritional and health situations existing at high altitudes as well as the
routinely used nutritional ergogenic and pharmacological aids. According to
their study, the possible interactions between drugs and food and nutrients
taken may endanger the mountaineer’s health if all this is not conducted
under strict control.

According to a recent paper published by the researchers Aritz
Urdampilleta-Otegui, PhD in Physical Education and Sports and lecturer in
the Department of Physical and Sports Education of the UPV/EHU-University of
the Basque Country and at the Government of the Basque Autonomous Community
(region), and Saioa Gómez-Zorita, PhD in Pharmacy and Food Sciences and
researcher at the UPV/EHU’s Department of Pharmacy and Food Sciences, it is
necessary to control the administering of drugs that interact with the foods
consumed and which may be detrimental for the health of the mountaineer.

Among the main performance-limiting factors in mountaineering are muscle
glycogen depletion and increased protein catabolism, hydroelectrolyte
imbalance, and Acute Mountain Sickness (AMS). An optimum diet is essential
for withstanding this situation of great stress experienced at high
altitudes and stays in excess of three weeks. Even so, AMS in mountaineers
is sometimes inevitable and in these cases drugs are used to tackle this
situation, which if this is not done under strict control, the supplementing
could endanger the health of the mountaineer owing to the potential
interactions that could arise with the food or nutritional ergogenic aids

More and more tourists head to high mountains or participate in
high-altitude trekking. Many of them have not had previous experience in
high mountains. These stays lead to great changes in physiological terms
like increased heart rate, increased systemic and pulmonary blood pressure,
hyperventilation, fluid retention, decreased haemoglobin saturation (SaO2),
among others. Owing to the difficulties involved in hypoxia, intense cold
and doing exercise in conditions of little food, climbing up to high
altitudes leads to routinely resorting to nutritional ergogenic aids or
drugs. So updated information on the scientific evidence relating to
pharmacological and nutritional ergogenic aids and potential interactions
between them is of crucial importance.

Acute Mountain Sickness

At high altitudes, in particular above 4,000 metres and depending on
individual susceptibility to hypoxy, it is normal for the appetite to
diminish and for significant weight loss to occur. In particular, when one
sleeps above 4,000 metres it is common to suffer from AMS, which is
characterised by the onset of symptoms like headache, dizziness, nausea,
insomnia, general fatigue and lack of appetite, among others. This appears
in healthy mountaineers who climb high mountains. These symptoms typically
develop during the first 6-10 hours of the ascent and register a peak on the
second or third day of the stay. The incidence of AMS is variable but
relatively high. At altitudes of between 4,000-5,800 metres 67% of the
subjects are affected. Failure to properly control AMS can lead to cerebral
oedema and risk of death. In this situation the mountaineer is no longer
aware, is disoriented and does not coordinate properly, and this may lead to
mistakes that could cause a serious accident.

The latest research suggests that preconditioning prior to ascent in
intermittent hypoxy with a minimum of 12 sessions (2-4 sessions/week)
undertaking aerobic-anerobic physical activity at above 4,000 metres helps
to prevent AMS. Likewise, it has been shown that it is effective training
for improving resilience in a range of sports.

The piece of work by the UPV/EHU researchers has studied the nutritional and
health situations existing at high altitudes as well as the routinely used
nutritional ergogenic and pharmacological aids. After that, an assessment
was made of the drug-food interactions that may arise, as well as the risks
of these interactions for the health of mountaineers, and the following
conclusions were reached:

- At high altitudes the seriousness of AMS affects the appetite and food
intake of mountaineers.

- Particular attention needs to be paid to the use of drugs for AMS, as they
could conceal the usual symptoms of AMS and, as a result, it is possible to
go on climbing up until the moment when the body cannot become acclimatised
to the altitude.

- Food supplements containing vitamin E before the stay and the taking of
iron and vitamin C during the mountain-climbing activity is crucial.

- Isotonic beverages, glycerol, caffeine, aaR, omega 3 Fatty Acids and
Ginkgo Biloba can be effective as nutritional ergogenic supplements.

- To tackle AMS, supplements (Ginkgo Biloba), diuretics, analgesics and, as
a last resort, corticosteroids as well as immunomodulators are used.
Acetazolamide has turned out to be the most effective drug for preventing

- In states of malnourishment, the interactions between nutrients and
nutritional ergogenic aids and drugs can be greater, the most dangerous ones
being the ones that take place between vasodilator supplements (omega 3,
ginkgo biloba, garlic pearls, precursors of nitric oxide and acetyl
salicylic acid).

- The mixing of diuretics (acetazolamide) with corticosteroids (prednisone
or dexamethasone) is not recommended.

Full bibliographic information

Bibliographical reference

Urdampilleta, A. and Gómez-Zorita, S. (2014) Aspectos ergonutricionales e
interacciones fármaco-alimentarias en el alpinismo/Nutritional ergogenics
aspects and drug-food interactions in mountaineering. Revista Internacional
de Medicina y Ciencias de la Actividad Física y el Deporte. Pendiente de
publicación / In press.


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