Altitude Training in a Bottle

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Your Brain on Altitude

Your Aptitude Not Your Attitude Determines Your Altitude! 

Its a brilliant headline, I know.  But it didn’t take me more than 5 seconds to think of because my brain is currently operating on a large 6 gram dose of piracetam–the Motzart of smart drugs.  The origin of my interest in nootropics, however, goes deeper than writing a cleaner, smarter blog post.  Believe it or not many of these interesting compounds have been studied specifically for their ability to enhance our well-being in high altitude.  Piracetam, for example was shown to improve the motor skills and reaction time of athletes exposed to a simulated altitude of 17,400 ft.  Good news if you have problems running into trees when you are skiing, or if you are the guy who likes to dodge through the ski school crowd in the slow zone.

But seriously,

Why else have I been experimenting with nootropics for high altitude applications?

  1. Central Nervous System (CNS) fatigue, which occurs as your SP02 drops, has been shown to be performance limiter at altitude (and in heat)
  2. A commonly used, but unpromising nootropic called Ginkgo Biloba has been studied for is ability to reduce altitude sickness and marketed as the “side-effect free Diamox.”
  3. Mental performance, specifically measured by the ability to learn a task, has been shown to decline even at moderate altitudes.
  4. In addition to impairing cognitive function, prolonged extreme altitude exposure can also result in damage to your brain that may be permanent–the brain scans of Everest Summiteers reveal what seem to be a series of miniature strokes!
  5. Many “neurotransmitter optimizing” nootropics such as choline are garnering significant clinical attention for their ability to enhance athletic performance.

What if you were stranded near the Death Zone of Mt. Everest and suddenly a storm hit.  Wouldn’t it be nice to pop a pill that could hone your focus and enable you to navigate your way back to Camp 4?  How about a supplement that could decrease your chance of colliding with a tree during a backcountry trip through some dense glades?  What if you simply live above 9,000 ft and want to make sure your mental faculties are all there so you can do your job?  You will definitely find this post interesting and useful.

Smart Drugs: Many Options 3 Major Mechanisms

The market for nootropics is insanely huge!  How huge?  Revenue from the top selling Piracetam product Nootropil was over 1 BILLION dollars in 1990.  Many of you are probably wondering how these top sellers work.  After scratching the surface of the massive body of nootropic research it seems that the majority of these drugs work in three types of ways.

  1. By increasing levels of a neurotransmitter or acting upon its receptor
  2. By enhancing cerebral bloodflow
  3. By reducing free radical damage to brain tissue

Each of these three mechanisms has interesting application for coping with high altitude.  Below I am going to describe these applications for each major class of nootropics and identify the major players in each category that I have experimented with.  Then we can dive into some of the interesting research findings and my personal experience and theories about each.  Lets go!

Neurotransmitter Manipulators

Drugs in this category are generally either precursors to a neurotransmitter or compounds that interact with a neurotransmitter’s receptor. The most common neurotransmitter targeted by these brain boosta’s is acetylcholine.  Acetylcholine excites neuronal activity in the brain, and high levels in the body are associated with improved mental performance and memory retention.  It also slows the activity of cardiac tissue while stimulating motor unit recruitment in skeletal muscle.  For this reason different acetylcholine effector nootropics have been used by both endurance athletes as well as Olympic sprinters.

Piracetam: Like Caffeine With Mild Euphoria Instead of the Jitters

Piracetam is the most widely used nootropic.  When you ingest it, you feel its subtle effects quickly.  I would describe them as having a mild stimulatory effect combined with a sense of clarity and mild feeling of euphoria.  Scientists have not completely mapped out how it works in our brains, but is a strong effector of cholinergic (acetylcholine regulating) receptors.  Many studies have demonstrated it has a positive impact on improving our body’s ability to withstand hypoxia.  Most of these studies were performed on elderly populations with conditions such as anemia or cardiac conditions that induce “internal hypoxic states.”  However, in the study I mentioned at the beginning of this post piracetam was shown to blunt the hypoxic ventilatory response.  This may be due to its effect on dopamine, which has an inhibiting impact on ventilation.  For that reason I don’t and wouldn’t take piracetam during treks at extreme altitudes.

The best application for piracetam may be for short duration anaerobic events, such as sprinting, especially at high altitude.  Here’s why: Many world records in short-burst racing events have been set in arenas situated in very high altitudes.  For example, the world record for the velodrome 1 km time trial was set by Arnaud Tournant in La Paz, Bolivia at an altitude of 11,942 ft.  Arnaud and many others have leveraged the decrease aerodynamic drag of thin air in order to reach “supra-sea-level” speeds.  However, when athletes compete at these altitudes they may experience a phenomenon known as “reflex inhibition.”  This occurs as lower blood oxygen levels slow down the nervous system and decrease neuromuscular output.  I have heard many rumors of professional sprinters experimenting with acetylcholine optimization to heighten neuromuscular capabilities in normoxic competitions.  I believe this benefit would be even more pronounced in short-durations in “record setting” hypoxic environments.

**Athletes have been steering away from more basic stimulants such as caffeine, which do not provide the stimulatory benefit to skeletal muscle and also constrict blood vessels.

**Apparently phenylpiracetam is a newer form of the compound that has a much stronger stimulatory effect.

Choline: Ze Acetylcholine Precursor

Choline has become a popular ingredient in “marathon supplements”.  These products are being formulated based on recent research that showed how choline supplementation can improve high volume endurance exercise performance by preventing the depletion of acetylcholine.  It has also been used as a successful treatment for ADD.

Choline is a precursor to the production of acetylcholine.  Choline supplementation by itself only produces a subtle improvement in cognition and only improves performance in long marathons when acetylcholine becomes depleted.  This is because acetylcholine deficiencies are rare.  However, many athletes and CEO’s take it in conjunction with piracetam to ensure acetylcholine levels remain high.

Unfortunately, no studies have been conducted on its ability to improve high altitude performance.  I decided to touch on it though because if you take piracetam you should probably take choline with it.

Less Oxygen in the Blood, More Blood Flow

Unlike your pulmonary blood vessels, cerebral blood vessels respond to hypoxia by dilating to enhance blood flow.  This is mainly thought of as a blessing because it increases the amount of oxygen delivered to this vital organ.  However this response is dramatically reduced during sleep, which is one of the reasons why altitude sickness is often the worst in the morning.  I began experimenting with large doses of Ginkgo Biloba, a nootropic touted for its circulation enhancing properties, before bed to attenuate this effect.  Honestly, I felt zero improvement, which did not come as a surprise.  Ginko biloba is an overhyped altitude remedy with very little research supporting its benefits for reducing altitude sickness as well as enhancing cognition.

There is, however, a herbal supplement called Vinpocetine, with far more compelling empirical support that is purported to work similarly by enhancing cerebral blood flow.  In regards to high altitude, vinpocetine has been shown in a few studies to enhance both cognitive and athletic performance in hypoxia.  I typically take 10 mg of vinpocetine before bed during high altitude treks and notice less drowsiness and headaches in the mornings.  It also helps greatly if you are prone to headaches during work or stress.

This Is Your Brain on Altitude 

When you venture into the thin air of the Himalayas pronounced fluctuations in oxygen delivery to your brain result in an large increase in the production of cerebral reactive oxygen species (ROS).  This reactive molecules cause physical damage to the tissue and blood vessels in the brain.  When combined with the increases in cerebral blood pressure these molecules contribute to the cerebrovascular leakage and swelling that characterize AMS and HACE.  The even scarier part is that when your brain is subject to this state to a high degree and for a long enough period of time permanent brain damage can occur.  Paradoxically, intermittent hypoxic exposure which involves brief periods of extreme altitude exposure can actually improve neural development.

Scientists have long been interested in hypoxia related brain damage for its role in degenerative brain diseases such as Dementia and Alzheimers.  As part of this research, scientists examined several natural compounds and nootropics.  I am far from an expert or even a “learned researcher” in this particular field, but I am aware of two interesting candidates through various personal and athletic quests.

Melatonin: Improves Sleep Without Inhibiting Ventilation and Protects Brain

I am an insomniac.  And not in the way most people began flippantly describing themselves after Fight Club came out.  I can’t sleep, like ever.  But so do many other people when living at high altitudes (this is due to a combination of elevated catecholamines, disruptions in natural circadian rhythm, and breathing pattern disturbances).  The problem with sleeping pills is that they all inhibit ventilation, which increases the risk and severity of altitude sickness.  And this is why melatonin is perfect for sleeping at high altitude.

Melatonin has not only helps reduce insomnia without slowing your breathing, but it also reduces the formation of cerebral ROS.  As I mentioned earlier those free radicals contribute significantly to high altitude sickness and, in extreme cases, permanent brain damage.

Beta-Alanine: Does this stuff work for everything?

Beta-alanine is one of the most potent, legal performance-enhancing substances.  It works by supersaturating your tissues with a natural buffering agent called carnosine (don’t buy carnosine by itself in supplement stores because your body does not absorb it).  If you are a cyclist try take 4-8 grams of bet-alanine daily for 4 weeks and watch your power output meter reach record highs.  In addition to buffering the acidic byproducts of exercise, carnosine also neutralizes reactive oxygen species.  Michigan State researchers described it as being “robustly neuroprotective.”

What is particularly interesting about beta-alanine is that scientists haven’t found a timeframe in which it stops continually improving performance.  Creatine, for example, will maximally saturate your creatine phosphate stores within a week.  After that point you are simply maintaining that elevated level.  Fascinatingly, multi-month beta-alanine studies show that performance and muscle carnosine concentrations keep increasingly and increasing with no tapering effect.

**Beta-alanine commonly causes a side effect called paresthesia, which is a tingling, itching sensation in the skin.  Though beta-alanine has no immediate ergonomic impact, it is widely included in pre-workout supplements.  I think this is because athletes perceive this itchy feeling and then think “Oh man this stuff must work I feel it kicking in!” Or it makes unmotivated people feel uncomfortable sitting still thus causing them to workout.  Would you consider that a benefit?

Ketones: The Secondary Source of Brain Fuel?

For a long time scientists thought that our brains rely exclusively on glucose for fuel.  However, relatively recent research shows that in times of distress our brains also metabolize substrates called ketones.  Our liver converts fat into ketones, when our blood sugar levels are low.  Scientists have shown that elevated ketone blood ketone levels significantly increased the survival time of rats subject to increasingly extreme levels of hypoxia.  The study authors concluded that ketone supplementation may be an effective tool for mediating cognitive deficits that occur at altitude.  As of now, ketones are a new topic in sports nutrition, and I believe several company’s are developing ketone supplement products (not the raspberry ketone variety).  These will likely become another interesting ingredient to add to the high lander nutritional regiment.


  • azscuba

    Very well written article and I like the play on aptitude vs. attitude. Seems you have a great product here and I cannot wait to try it!

  • Jane M Schwartz

    Fascinating article. Can I take vinpocetine, ketones, and melatonin along with your product Mountain Might all at the same time? We are climbing Kili in a few weeks and am looking for every advantage for acclimatization and performance.