Fourth in a Four Part Series on Getting High: Nutrition Considerations at Altitude

Got iron? I am continually challenged by low iron storage (aka pre-anemic state). My first experience with low iron was during my high school running career when I decided that I didn’t like meat, not for any other reason than I preferred bread and pasta. Being the avid, OCD, calorie counter I was back then, I swapped protein calories for carbohydrate calories.

This of course was not smart but at sixteen,  it made  perfect sense. The most absorb-able source of iron of course is red meat. As my meat consumption decreased so did my iron status. This is important because iron is the critical mineral in transporting oxygen to muscles, and when muscles are running they use more of it. This little dietary stunt sent my long-distance running, low-iron-storing, menstruating  female body into declining athletic performance that cost me my entire senior year of competition and athletic scholarship.

The lesson was clear. Study nutrition and begin enjoying steak at least once in a while. Even now, as a meat eater and someone who knows that iron absorption from green leafy vegetables can increase when consumed with orange juice, I really have to work during training to keep iron levels out of the pre-anemic state.

The pre-anemic state is no big thing when the muscles aren’t demanding tons and tons of oxygen. A runner however, can feel the effect of low iron storage even before meeting clinical criteria for anemia. I have had to convince my doctor to test my ferritin levels (iron storage) despite not showing signs of anemia.

Any low iron state will be exaggerated at altitude because iron has the job of carrying the limited oxygen available around the body to the muscles. Getting a baseline blood test as training for a mountain objectives begins can allow time to adjust the diet and take a supplement if needed. It can take six to ten weeks of iron supplementation and increasing iron-rich foods to get stores back up.  There can be however, side effects of too much iron. Diets consisting of iron rich foods won’t likely put someone over the top but, before hitting the supplement bottle based on an assumption, get that test.

Running on low-iron felt to me like moving in slow motion beginning at about mile three of any run. It can feel a lot like over training, and it can be very discouraging to then increase training only to worsen performance. I found it very satisfying after running my first fifty kilometer trail race to discover my iron status was in the dumps. Why? Because I knew how to fix it. Get the test.

Mother’s Days. Adventures Are On!

Mother’s Day doesn’t seem right unless I am on the Northern California Coastline unplugged and with my dudes soaking up all the outdoor adventures we can squeeze into a long weekend of car camping. Some moms long for breakfast in bed, pampering of the nails, or brunching fine-dining style.  Those things are great but, me? Nah, I ask for a family adventure. Even car camping is an adventure when you add kids and a new puppy to the mix!

I wouldn’t have Mother’s Day any other way right now. Last year we opted for a Mother’s Day of regularly scheduled little league and a nice home cooked dinner. It was great but, we all longed to be under the oak tree near the stream hiking, biking, trail running and roasting s’mores. So this year we went back to the tent.

This time of year Mama is usually training for some kind of mountain running/scramble race. My sights are on running the  Broken Arrow 26km which, covers some of Squaw Valley’s  famous terrain ascending to elevation of 8750 feet covering nearly 5,400 feet of vertical or, vert as the cool kids call it. Take a look at this fun!

Broken Arrow Sky Race Short from Jon Rockwood on Vimeo.

Needless to say my Mother’s Day gift this year was a long training run on the trails. Or as I like to call it “the gift of bliss”!

What does an adventure mama  dietitian do to prepare the night before a training run on an epic family camping trip? Well here is the run down:

  • The night before:  Cold-leftover-fried-chicken, salad, followed by S’mores and an unmeasured, seemingly bottomless tin cup, of wine  while reading in front of the campfire. Before snuggling up in the family-size sleeping bag I fill up my hydration pack and stock it with the necessary energy chews and gels. Then I put on my running clothes to sleep in so I don’t have to think about changing in the chilly morning. Just up and at em’, shoes on, and out! Not quite.
  • The morning of:  I woke, crawled out of the tent to find my main man dressed for his mountain bike ride while our boys slept.  Me being a slow starter and preferring to poop, pee, and enjoy a cup of coffee (not necessarily in that order) before running, I let him go first.
  • Before my long run: Being the good sports dietitian I determine  I also had time to top of glycogen (AKA stored energy) in my muscles with the recommend breakfast of running champions – oatmeal mixed with a spoonful of delicious sunflower seed butter  and mashed banana –  with ample time to digest before he returned.

Now, if I had my sights on winning races the wine the night before would probably not be something I would recommend to myself, or cold store-bought fried chicken (gross), but we are camping on Mother’s Day after all.  Given my goals are set around middle of the pack kind of running, a relaxing night by the campfire is just what this dietitian adventure mama ordered (no cooking, cleaning, or giving a care).


Dietitian Confessions

I don’t survive on broccoli, beans, and blueberries alone.

I eat ice cream OR chocolate almost every day. It IS Dreyer’s Slow-churn and only fair trade  dark.

I love good bread and have zero interest in pre-sliced, manufactured variety.

I eat candy corn out of childhood nostalgia. ONLY in the fall

I eat candy pumpkins out of college-days nostalgia  and sometimes mail them to my friends  even though it costs more to mail and they can get them where the live (probably)

I feed my kids cinnamon-sugar-butter toast (whole wheat) for breakfast and have been known to eat their leftovers… the floor

I am not behind the removal of donuts from company breakfast meetings. I love donuts, but most of all, love getting donuts at Bob’s in San Francisco

I struggle to get one son to eat vegetables and the other to eat fruit BUT I NEVER GIVE UP!

Stand tuned, there will be many more confessions.

Dealing with Halloween Candy as a Parent and Dietitian

Halloween candy is gross. It is full of NOTHING good. Unless we happened to Trick-or-Treat in a Utopian food bubble, it is pretty much guaranteed that my kids are not getting candy made with simple and real ingredients like cane sugar, coco, and nuts to name a few. Oh, and forget the peanuts since my oldest is allergic to them.

Yet, just like I am not going to be the rigid mom who makes their kids go to bed on a school night before game five of the World Series is over (Red Sox!!); I am not going to be the rigid dietitian-mom who denies her children the joy of collecting as much candy as they possibly can on Halloween.

Our neighborhood is the best neighborhood ever for Halloween. It is a parade of kids from all over the area. Everyone decorates and most decorations are over-the-top with theatrics like strobe lights, haunted mansions, and candy casinos.

Check out this traveling haunt we came across in the parking lot at the pool:

Yes, our house has the reputation of being the “nutrition house”. We own it! Occassionally  I do have candy with no artificial colors, sweeteners, or flavors in reserve. Thankfully, there are more on the market this year.

What becomes difficult to navigate is helping my boys manage their candy loot. Obviously they get way more candy than I feel comfortable with them even eating in an entire year. Thinking about all that crap going through their little systems is nauseating.

Oh yeah, AND I don’t want my oldest son with the peanut allergy to feel like he is losing out when he hands over all the candy suspect of peanuts.

What to do?

  1. The “witch switch?” This seems so deceptive to me so I have never done it. Plus my younger son values candy/sugar way more than toys/things and would really hate that witch!
  2. Put it away in hopes that the forget about it? This always works with Eric, my now twelve year-old but, has never worked for Noah (8 years old). Again, the sweet tooth thing is real. I do put it out of site so they have to ask for it though.

Rather than be the “candy police” I opted for a win-win third option.

3. I let them exchange candy for money OR extra screen-time on the weekends.

Each piece of candy is worth one dollar or one minute of screen-time. This exchange rate is much higher than what the dentist’s office is offering and gets their attention. Plus, the dentist sends this candy to our troops. I don’t know about you but, I don’t think our troops need this candy any more than our children. I compost it or my husband eats it after we are all in bed.

Eric eagerly hands over all peanut-containing candy for screen-time and an additional ten pieces. This exchange sends him off happily enjoying only half the bag over the next few weeks with extra minutes of screen-time in his “pocket”.

Noah is a bit more reluctant and thoughtful in his exchange. He too opts for screen time but, recently confirmed by both skin and blood test to NOT have a peanut allergy, he keeps some peanut candy.  He does however exchange about half of his candy for additional minutes of screen time on the weekend. He also has less total candy than Eric because he is more uncertain and skips some intimidatingly haunted-looking houses. I don’t blame him!

No, I don’t love them even eating any of this candy but, making it forbidden would only make it more tantalizing and later, provoke guilt for my boys. I also know that like years past, they will bore of the candy before  finishing  what they have left. Come the weekend they will also begin exchanging for more screen-time and eventually forget about it, even my sweet-tooth eight-year old.



I have had to compromise on my own food values for this occasion but, I also know that they will poop most of this right out, burn off the sugar, and they are watching me. Why is watching me around candy important? Because I don’t like it for myself so I don’t eat it, and because leading by example is one of my most powerful tools in influencing my children I am going to bank on them some day losing interest in eating candy just of the sake of eating candy.











A Time for Comfort Food & Running

The smell of fresh baked, oatmeal, chocolate chip cookies wafted through the neonatal intensive care unit (NICU) every afternoon at  three o’clock. I sat there in the mother’s room expressing milk for my preemie son for the fifth time that day when I first discovered this daily bit of tasty comfort. After completing my milk maid duties, I took great comfort in enjoying two, whole, soft, chewy delicious cookies, and washing it down with a small carton of whole milk that accompanied every cookie delivery.

Over our three month stay in the NICU watching our son grow and develop into a full fledged baby, I took comfort in the daily  cookies-milk ritual with no regard for nutrition. It wasn’t about nutrition. Well, maybe it was a little about nutrition. I did revel in the fact that generating and expressing as much milk as possible for my little guy was the only thing I could focus on and my body needed hearty, whole, and real nutrients to do that. My afternoon ritual was literally feeding my journey through this uncertain and changing time. Cookies and milk were a small delight to my day and there was no shame in needing them.

Eventually, I cut back to one cookie then, no cookie, and went back to two-percent milk. My natural instinct is to stay at some sort of equilibrium. I was born a dietitian you see, and these things come naturally when I pay attention to what I need and what I am working towards.

Eric came home from the hospital in December of 2006. After two months at home and no cookies, running was calling me back. In fact it was running that brought ME back to me. I am so well-trained in the science and art of nutritious behavior that it is my normal. I am also so well-trained to the ritual and habit of being active that my body began asking me back to that natural equilibrium as well.

I remember so clearly stepping out the door of our San Francisco flat in the Richmond district wear running clothes. At this point I hadn’t been out of the house much let alone on a run. I surprised my neighbor who said to me with a sigh of relief, “Oooh, sooo good to see things getting back to normal.” It was normal for him to see me run-ready. Off I went, ten whole blocks before I was huffing and puffing. It had been at least seven months since I had much physical activity other than walking to and from the hospital and expressing milk. Running had not felt like this since I began running for the first time at age twelve! I was starting over and I was grateful. In fact, I was so full of gratitude for legs that moved, lungs that could breath in air, and blood to transport oxygen to my muscles that running was now more than I function of getting in shape. It was a practice of gratitude for being right where I was. I began running up the big hill into the Presidio once a day, probably no more than one mile out and back. At the top, I would breathe, give thanks, then stretch maybe add some push-ups to the mix and charge back down the hill. Sometimes on the way back I would be so flooded with gratitude tears would stream down my face literally while I was running.

Cookies and milk rebuilt my strength. Running brought me back to me, overflowing with gratitude for the strength to face the big mountain climbs.



Should I eat before a workout?

There was a disturbing time  for me when running was more about burning calories than it was about feeling energized and free. It wasn’t entirely my fault.  My Mom and Dad’s eating and activity behaviors showed me that calories were something to restrict and burn and, to limit them at all costs. So when a dietitian told me that  calories could help improve my running performance I was confused. I actually was so distrusting if this skinny woman with glasses that I had to become a  dietitian to study this for myself.

Yes, it is true you don’t want to eat more calories than you burn unless you want to put on weight (SOME people DO benefit from putting on weight).  More importantly for an active person already at a healthy weight is eating enough calories to energize the body’s potential to run far and sometimes fast(er).  Timing those calories has proven beneficial to me as well. That brings me to the topic at hand. I recently did an interview where they asked me this question:

Should you eat before a workout?

The simple answer is yes. The complicated answer addresses when, how much, what, and why you should eat before a workout. Here are some general rules of thumb that I employ. Also, I have come to believe that calories are my friend, not my enemy and after several years of struggling we have learned how to play well together.

Real Premium Calories  Eaten by Scott Jurek on his Appalachian Trail journey to FKT . He grubbed this down minutes, maybe even seconds, before heading to blaze.

Why eat before a workout? If you are eating on an empty stomach because you heard you would burn more fat you most certainly are cheating your workout and your body.   Working out on an empty stomach may  lead you down the path of a shorter workout time at lower intensity  than you liked simply because you don’t have the energy on board to do what your training plan is asking of you.

Eating a light snack before exercise maximizes your workout by providing quality energy to your body so you can complete all sets and reps in the gym or run your entire 5K loop in the appropriate heart rate zone.  Depending on how your body digests food, it is recommended to consume a high-carbohydrate snack 1-2 hours before exercise that is lower in total fat and protein.

Here are some rules of thumb to try and see if they work for you:

  • How much protein a pre-workout snack should have is dependent on how soon before your workout you plan to eat and whether or not you are doing a strength training work out or a more cardio workout:
    • If snacking three hours before your workout 7-15 grams of protein is about right. The shorter the amount of time between eating and your workout, the less protein you should consume and if you are eating a snack 30 minutes before a cardio workout you should be eating little to no protein. Save it for after your workout.
  • How many carbs? Carbs get your energy engine (muscles) up and running. If you are doing a one hour work out eat about 15-30 grams of carbohydrate 1-2 hours before. Organic Energy Food Oatmeal is a great choice here. If you are 30 minutes I out I would recommend Organic Energy Food Banana Mango Coconut
  • Should you avoid fat and fiber?  If your workout is lower intensity some folks can tolerate some fat, but if you are going hard you definitely what to limit the amount of fat you eat to as little as possible in the 1-3 hours before your workout. It will take longer for you to digest fat and having fat in your stomach during a high intensity workout could give some GI distress. Same thing goes for fiber: Keeping fiber under 3 -5 grams in a pre-workout foods eaten around the three hour mark is a good place to start. Everyone responds differently when it comes to digesting so you may be able to tolerate more or less than that amount.
  • Are there any micronutrients (e.g. calcium, potassium, sodium, etc.) that are important to get before a workout? In general micro nutrients should be coming from the foods you eat all day long to prevent inadequate consumption of any one nutrient to prevent deficiencies that in the long run will hurt both your health and your workouts. However, sodium which is the primary mineral lost in your sweat can give you a leg up on hydration. Sodium will not give you energy but it will help you with fluid absorption and retention, especially if you are a heavy sweater. CLIF SHOT electrolyte drink before your workout will give you three nutrients in one to support your efforts: carbohydrate, fluid, and sodium


Some people can eat a burger and hop on their bike while others need food to be totally digested before the can even think about exercise. Eating 1-2 hours of prior to your activity seems to work for most but, try out different timing and different foods to see what your stomach says are best.  Some pre-workout foods: half a whole wheat bagel with 1 tablespoon organic  peanut butter; CLIF Bar; 1 cup of nonfat yogurt with a banana; or 16-ounces of CLIF Electrolyte Drink.

Bottom line is to eat and/or drink something before you workout to improve the quality of your exercise!